Effect on the Prevalence of Various Diffuse Parenchymal Lung Diseases due to Paradigm Change in the Guidelines

Background: Diffuse parenchymal lung diseases (DPLDs) have gone through various changes in nomenclature and classification since they were first described in 1868. Increasing knowledge about their etiopathogenesis has since led to several reclassifications and changes in the nomenclature. This has had a major impact on the prevalence of each interstitial lung disease (ILD) reported by the different registries worldwide. In this study, we attempted to describe the distribution of the different DPLDs in our population and reported changes in prevalence due to changing diagnostic criteria for the disease. Materials and methods: We analyzed retrospective data of 434 patients. For the initial 75 patients, ATS/ERS guidelines published in 2002 were followed in the diagnosis of the ILD (group I). In the later part of the study (359 patients), the diagnosis was based on the computed tomography (CT) patterns defined by ATS/ERS/JPS/ALAT statement on diagnosis of idiopathic pulmonary fibrosis (IPF) and updated 2013 ATS/ERS guidelines (group II). Results: Of the 75 patients in group I, IPF was the most common diagnosis (52%) made at that time, followed by sarcoidosis and connective tissue-related ILD (CTD-ILD) with 12% each. Group II had 359 patients, with IPF again being the most commonly diagnosed ILD with 21.3%. This was followed by CTD-ILD (18.6%), sarcoid (14.7%), and idiopathic nonspecific interstitial pneumonitis (iNSIP; 13.3%). The changing guidelines have an impact on reporting of different DPLD by our multidisciplinary teamover a period of time. Though IPF was the most commonest DPLD reported among both the groups, the diagnosis of IPF had fallen by more than half in the second group. It was paralleled by an increase in the diagnosis of iNSIP and chronic hypersensitivity pneumonitis. These reported changes in the prevalence of DPLDs may reflect the better-defined criteria in the latest guidelines and a better understanding of the fibrotic ILDs other than IPF by the multidisciplinary team. Conclusions: The frequency of diagnosis of the different DPLDs has changed, following the publication of several guidelines in the last decade. It has recognized newer entities with greater clarity, such as idiopathic NSIP and interstitial pneumonia with autoimmune features.

Impact on survival with adjuvant radiotherapy for clear cell, mucinous, and endometriod ovarian cancer: the SEER experience from 2004 to 2011 / 부인종양

OBJECTIVE: Evaluate the impact of radiotherapy on cause specific survival (CSS) and overall survival (OS) for stage (I-III) clear cell, mucinous, and endometriod ovarian cancer. METHODS: We analyzed incidence, survival, and treatments from the Surveillance, Epidemiology, and End Results (SEER) Program from 2004 to 2011 for clear cell, mucinous, and endometriod histologies of the ovary for stages (I-III). We examined CSS and OS for all three histologies combined and each histology with relation to the use of adjuvant radiation therapy (RT). Survival analysis was calculated by Kaplan-Meier and log-rank analysis. RESULTS: CSS was higher in individuals not receiving RT at 5 years (81% vs. 74%) and 10 years (74% vs. 65%, p=0.003). OS was higher in individuals not receiving RT at 5 years (76% vs. 73%) and 10 years (64% vs. 59%, p=0.039). Stage III patients receiving RT had a higher OS at 5 years (54% vs. 44%) and 10 year intervals (36% vs. 30%, p=0.037). Stage III patients with mucinous histology receiving RT had a higher OS at 5 years (50% vs. 36%) and 10 years (45% vs. 26%, p=0.052). CONCLUSION: Those receiving RT had a lower CSS and OS at 5 and 10 years. However, subgroup analysis revealed a benefit of RT in terms of OS for all stage III patients and for stage III patients with mucinous histology.

Sonographic evaluation of intravascular volume status: can internal jugular or femoral vein collapsibility be used in the absence of IVC visualization?

Inferior vena cava collapsibility index [IVC-CI] has been shown to correlate with both clinical and invasive assessment of intravascular volume status, but has important limitations such as the requirement for advanced sonographic skills, the degree of difficulty in obtaining those skills, and often challenging visualization of the IVC in the postoperative patient. The current study aims to explore the potential for using femoral [FV] or internal jugular [IJV] vein collapsibility as alternative sonographic options in the absence of adequate IVC visualization. A prospective, observational study comparing IVC-CI and Fem- and/or IJV-CI was performed in two intensive care units [ICU] between January 2012 and April 2014. Concurrent M-mode measurements of IVC-CI and FV- and/or IJV-CI were collected during each sonographic session. Measurements of IVC were obtained using standard technique. IJV-CI and FV-CI were measured using high-frequency, linear array ultrasound probe placed in the corresponding anatomic areas. Paired data were analyzed using coefficient of correlation/determination and Bland-Altman determination of measurement bias. We performed paired ultrasound examination of IVC-IJV [n = 39] and IVC-FV [n = 22], in 40 patients [mean age 54.1; 40% women]. Both FV-CI and IJV-CI scans took less time to complete than IVC-CI scans [both, P < 0.02]. Correlations between IVC-CI/FV-CI [R[2] = 0.41] and IVC-CI/IJV-CI [R[2] = 0.38] were weak. There was a mean -3.5% measurement bias between IVC-CI and IJV-CI, with trend toward overestimation for IJV-CI with increasing collapsibility. In contrast, FV-CI underestimated collapsibility by approximately 3.8% across the measured collapsibility range. Despite small measurement biases, correlations between IVC-CI and FV-/IJV-CI are weak. These results indicate that IJ-CI and FV-CI should not be used as a primary intravascular volume assessment tool for clinical decision support in the ICU. The authors propose that IJV-CI and FV-CI be reserved for clinical scenarios where sonographic acquisition of both IVC-CI or subclavian collapsibility are not feasible, especially when trended over time. Sonographers should be aware that IJV-CI tends to overestimate collapsibility when compared to IVC-CI, and FV-CI tends to underestimates collapsibility relative to IVC-CI

How far are the platelet indices mirror image of mechanism of thrombocytopenia-mystery still remains.

Evaluation of thrombocytopenia requires thorough clinical history, examination, complete hemogram, including platelet indices and bone marrow study whenever indicated. The etiopathogenetic mechanism decides patient management. The aim was to study relationship between thrombocytopenia and platelet indices with respect to underlying mechanisms. Methods: Totally 100 thrombocytopenic patients with sufficient clinico-hematological workup were included in our study. Results were confirmed by peripheral smear examination and manual platelet count wherever necessary. Similar data during the year 2012 were collected from 100 controls and compared. Results: Patients were grouped based on mechanism-hypoproduction 15 (megaloblastic anemia 8, myelodysplastic syndrome 1, leukemia 6), hyperdestruction 4 (immune thrombocytopenic purpura), hyperspleenism 19 (chronic dengue 10, chronic malaria 6, chronic liver disease 3) and mixed 62 (chronic dengue 29, chronic malaria 24, thalassemia on regular transfusion 3, sepsis 4, disseminated intravascular coagulopathy 2). Conclusion: (1) Platelet indices showed inverse relationship-increase (mean platelet volume [MPV] r = −0.805, platelet distribution width [PDW] r = –0.996) with decreasing platelet count in most increased destruction cases, (2) linear relationship (MPV r = 0.84, PDW r = 0.37) was seen in most hypoproduction cases. p values were also calculated, (3) variable results were obtained in hyperspleenism, mixed and few of above two groups, (4) platelet indices provide important information about platelet kinetics. However, relationship with platelet count is helpful but not always confirmative of mechanism of thrombocytopenias.

Pattern of drug-resistance and treatment outcome in multidrug-resistant pulmonary tuberculosis.

Aims and Objectives. To study the pattern of drug-resistance and treatment outcomes among patients with confirmed multidrug-resistant pulmonary tuberculosis (MDR-PTB). Methods. A prospective study was conducted at Rajiv Gandhi Institute of Chest Diseases, Bengaluru, Karnataka, India. Between January 2005 and December 2008, 224 confirmed MDR-PTB cases were studied for various drug-resistance patterns, and their treatment outcomes were analysed until November 2010. Sputum culture and drug sensitivity tests (DST) were carried out at National Tuberculosis Institute, Bengaluru; DST was done for all first-line drugs except pyrazinamide. Results. Of the 224 MDR-PTB patients, 146 (65.2%) were resistant to all first-line drugs, 39 (17.4%) to isoniazid, rifampicin and streptomycin; 19 (8.5%) to isoniazid, rifampicin and ethambutol; and 20 (8.9%) to isoniazid and rifampicin. Among them, 145 (64.7%) patients were cured, 5 (2.2%) had treatment-failure, 10 (4.4%) died, and 64 (28.5%) defaulted. Among 145 cured cases, 100 (69%) were resistant to all first-line drugs, 23 (16%) to isoniazid, rifampicin and streptomycin, 11(8%) to isoniazid, rifampicin and ethambutol, and 11(8%) to isoniazid and rifampicin. Conclusions. The most common pattern observed in this study was resistance to all four first-line drugs followed by resistance to isoniazid, rifampicin and streptomycin. Patients resistant to all first-line drugs had early sputum culture conversion and better cure rate as compared to other resistance patterns.

Dysmyelinating neuropathy in benign form of megalencephalic leukoencephalopathy with subcortical cysts: A novel observation from south India.

A 37-year-old gentleman presented with macrocephaly since early childhood and progressive impairment of motor and cognitive functions. Magnetic resonance imaging revealed extensive white matter involvement and frontotemporal subcortical cysts. Absent ankle jerk and abnormal nerve conduction study raised a possibility of associated peripheral neuropathy. Sural nerve biopsy was suggestive of dysmyelinating neuropathy. This report serves to expand the clinical spectrum of this rare leukodystrophy.