ABSTRACT
Background: Obstructive sleep apnea (OSA) in pediatric population is associated with cardiac, respiratory, metabolic, neurocognitive, and behavioral dysfunctions. Adenotonsillectomy (AT) is the treatment of choice in children who have hypertrophied adenoid and/or palatine tonsils. However, there is paucity of literature on the impact of AT on cardiorespiratory and sleep parameters in these cases. Methods: We did a retrospective study on children who had undergone AT from July 2016 to December 2018 at a tertiary hospital in north India. Only those children, whose polysomnography (PSG) was available both before and after AT were enrolled in this study. � Cardiac parameters: Mean heart rate (MHR) and highest heart rate (HHR), number and duration of arrhythmias, and pulse transit time (PTT) drops. � Respiratory parameters: Apnea-hypopnea index (AHI), respiratory disturbance index (RDI), oxygen desaturation index (ODI), mean oxygen saturation (MOS). � Sleep parameters: Time spent in different stages, sleep efficiency (SE), and arousal index (AI) on PSG were compared before and after AT. Results: A total of 56 children had undergone AT for OSA. Also, PSG, both before and after AT, was available in 37 children. After excluding children having undergone other surgeries for OSA and those with comorbidities, 32 children were enrolled. AT led to significant positive change in AHI (from 7.86 � 7.91 to 2.03 � 3.10, p = 0.01), RDI (from 16.319 � 15.64 to 7.38 � 3.72, p < 0.01), AI (from 22.10 � 14.93 to 15.90 � 8.48, p = 0.012), SE (from 91.47 � 6.31 to 95.866 � 3.03, p < 0.01), ODI (from 6.7959 � 5.03 to 1.865 � 2.09, p < 0.01), MOS (from 95.59 � 2.19 to 97.28 � 1.27), HHR (from 141.68 � 17.93 to 120.93 � 16.98, p < 0.01), MHR (86.68 � 12.95 to 80.29 � 8.81, p = 0.01), and PTT AI (from 36.67 � 27.72 to 26.93 � 24.86, p < 0.01). There was no non-sinus wide or narrow complex tachyarrhythmia in any child before or after AT. There was no statistically significant change in rapid eye movement (REM) sleep duration or number and duration of bradycardia episodes in these children (p > 0.05). Conclusion: Adenotonsillectomy improved SE and oxygenation, and decreased the number of obstructive events, arousals, heart rate, and PTT AI during sleep in children with OSA. Some children had residual disease after surgery. Heart rate and PTT can be excellent non-invasive parameters for detecting obstructive events during sleep in children and monitoring the impact of various therapeutic modalities.
ABSTRACT
Background: Adenocarcinoma (ADC) is the commonest subtype of lung cancer, though a number of studies in India have observed squamous cell carcinoma (SCC) to be the commonest histology. Majority of Indian studies on clinico-pathological profile are retrospective and there is limited data on comparison of demographic, clinical, and radiological features among histological subgroups of lung cancer. Methods: Three-hundred and twelve consecutive confirmed cases of lung cancer diagnosed from December 2014 to January 2017 were enrolled prospectively. Data pertaining to the demographic, clinical, radiological, pathological, and molecular profile were analyzed. Results: Their mean age was 57.2 � 10.8 years. Of all the lung cancer patients studied, 80.5% were males and 73.4% were smokers. Across all histological subtypes, the commonest symptom was cough (76.9%). Chest pain, hoarseness of voice, dysphagia, and neck veins engorgement were significantly higher in small cell lung carcinoma (SCLC) cases, while hemoptysis in SCC cases. The most common radiological finding was a mass lesion predominantly located, peripherally in cases with ADC and SCC lung, while centrally in SCLC. The most common site for distant metastasis was the bone (32.5%), followed by the liver, adrenal, brain, and other organs. ADC, SCC, and SCLC constituted 48.1, 32.1, and 14.4%, respectively. Incidence of epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) mutations in ADC patients were 26.5% and 7.8%, respectively, with a predilection for nonsmokers. The most common EGFR mutation was exon 19 deletions. Conclusions: Adenocarcinoma lung may now be replacing SCC as the commonest type of lung cancer in Northern India. The overall incidence of EGFR mutations in ADC patients was 26.5%, with exon 19 deletion being the most common mutation