Effects of home-based exercise training on functional outcomes and quality of life in patients with pulmonary hypertension: A randomized clinical trial

Objectives The objective of this study was to assess the effects of home-based exercise training (HBET) on function and quality of life (QoL) in patients with pulmonary hypertension (PH). Methods A prospective, nonblinded, randomized clinical trial was carried out on 84 medically stable patients with PH belonging to any functional class or etiology and of either sex. Patients were randomized to either standard care or HBET. Both groups also received education using the Pulmonary Hypertension Manual (PulHMan). Outcomes included functional capacity from 6-min walk distance (6MWD), QoL using the Medical Outcomes Survey Short Form – 36, functional class (FC), and right heart indices (right ventricular systolic pressure [RVSP] and tricuspid annular plane systolic excursion [TAPSE]) and were assessed at entry and after 12 weeks. Results HBET improved 6MWD by 48.5 m and 13 m in the experimental and control groups, respectively (p < 0.001). QoL showed statistical improvements after HBET between the groups for the physical and mental components and for the various subdomains (except body pain). Furthermore, FC improved by one grade with HBET (p < 0.001). Conclusion HBET program improved functional capacity, QoL, and FC in patients with PH.

Right diaphragmatic hernia in an elderly man.

A 71-year-old male presented with progressive exertional breathlessness and cough for the last four years. His breathlessness aggravated after a heavy meal and on lying down. He was a smoker, but had no co-morbidities. He did not remember any major trauma or surgery. Examination of the respiratory system revealed mediastinal shift to the left, diminished breath sounds over the whole of the right hemithorax and gurgling sounds all over, mainly the infrascapular area. Examination of other organ systems revealed no abnormality.

Pleural nocardiosis.

Pleural involvement in nocardiosis is rarely documented in India. We report two cases of pleural nocardiosis. In both the cases, the aetiologic agent was isolated from pleural fluid and was later identified as Nocardia asteroides in one case and as Nocardia brasiliensis in the second case. The former case of pyopneumothorax died before the diagnosis was made and the latter with pleural effusion showed excellent response to six months of therapy with trimethoprim-sulfamethoxazole.

Re-expansion pulmonary oedema: revisited.

A case of re-expansion pulmonary oedema (RPO) following chest tube insertion for left spontaneous pneumothorax is reported. There were no severe symptoms and routine chest radiograph done four hours after tube thoracostomy showed features of pulmonary oedema in the re-expanded left lung. RPO is an uncommon complication of rapid pleural drainage of air or fluid with potentially serious cardiopulmonary manifestations but appears to run a benign course if there is no prior systemic hypoxaemia and if pneumothorax is drained without suction. Chest radiograph should be done routinely within four hours after chest tube insertion for early detection of RPO.