ఊపిరితిత్తుల వ్యాధులు & చికిత్స జర్నల్

Invasive fungal rhinosinusitis (IFRS) is a challenging condition and the mortality of IFRS in immuno compromised patients is very high. 75 patients of suspected FRS were included to study the burden and the clinicopathological and mycological profile of invasive fungal rhinosinusitis (FRS) in these patients. The samples collected were exudate from nasal debri, discharge and intraoperative tissue sample and were subjected to direct microscopy to histopathological examination and direct microscopy (KOH and calcofluor white) and culture on Sabouraud dextrose agar. Identification of molds and yeasts were done by conventional methods. 25 cases were suspected to have IFRS were confirmed by microbiological and histo pathological examination, comprising 56% of AIFRS (acute IFRS), 36% CIFRS (chronic IFRS) and 8% CGFRS (chronic granulomatous FRS). Rhizopus arrhizus (64.2%) was the most common isolate followed by Aspergillus flavus (35.7%). Mucor species were solely isolated from AIFRS (14.3%). In CIFRS, Aspergillus flavus (44.4%) seemed to be the major isolate with Aspergillus niger, Alternaria spp., Penicillium spp. and Candida albicans. Necrosis of submucosa, bone, vascular tissue was seen in 96% of cases with aseptate hyphae in 78.5% AIFRS and 77.7% in CIFRS. Radiological features help in presumptive diagnosis of FRS. Direct microscopy along with culture conformation is important for diagnosis and early initiation of treatment.

Effusions can be labeled as inflammatory (exudative) or non-inflammatory (transudative) depending upon the pathophysiological process involved. Various biomarkers (fluid glucose, fluid proteins, fluid albumin, protein ratio, protein gradient, albumin gradient) have been proposed for the same. In this study, we analysed all these biomarkers against the gold standard (cytology) and the practical utility of fluid adenosine deaminase (ADA) for diagnosing Tubercular serositis in a Tuberculosis prevalent area like that of ours. We found that albumin gradient proves its versatility in differentiating the pathophysiological nature of the effusion. We henceforth propose a minimum must step ladder diagnostic algorithm for a case of serositis, thereby cutting the costs of evaluation.

Background: Airway inflammation and inflammatory mediators play an imperative role in the pathogenesis of COPD. Currently, understanding of the anti-inflammatory effect of Chinese herbal medicine (CHM) on COPD is limited, and CHM’s mechanism of actions is unclear. This systematic review (SR) evaluates anti-inflammatory effects of CHM on the concentration of various inflammatory mediators, such as Tumor Necrosis Factor-alpha (TNF-α) and interleukin-8 (IL-8), in the sputum and serum of COPD patients.
Methods: The studies chosen for this SR were obtained from Chinese and English databases. The study selection criteria were based on randomized, controlled trials of stable COPD patients on adjunct oral CHM; and the changes in concentration of inflammatory mediators post-treatment were analyzed via meta-analysis.
Results: 2,268 patients in 29 studies were evaluated. 2 studies were assessed to be of low-risk in all domains. The results showed significant reduction in the serum level of IL-8 (mean: -1.27 and 95% confidence interval (CI) [-1.86, -0.68]) and TNF-α (Mean: -0.72 and 95% CI [-1.01, -0.43]) in patients treated with CHM plus bronchodilators, compared to bronchodilators alone.
Conclusion: This SR explains CHM’s mechanism of action, and demonstrates CHM’s anti-inflammatory effects on patients with stable COPD.

Introduction: Vegetable foreign bodies (FB) are most commonly aspirated in children, these are very dangerous as most of them are hygroscopic, they swell up within a few days causing blockage of the lumen of the bronchus and retention of secretion distal to it.
Method: We report on a 75 yr old patient who aspirated a cherry pit one month prior to clinical presentation. He originally presented with cough and a right lower lobe infiltrate on x-ray. The patient underwent therapeutic videobronchoscopy via the oral route, a cherry pit was detected at the distal end of the bronchus intermedius with signs of local inflammation.
Result: We used saline rising and a flexible cryoprobe and it was activated for 15 s which resulted into a solid contact with the FB and immediate removal without complications.
Conclusion: We have found that by using flexible cryoprobe through video bronchoscopy is possible remove a cherry pit under conscious sedation, which should be considered as a therapeutic option.

Background: To identify certain genes related to anti-tuberculosis drug-induced hepatotoxicity (ATDH) for Japanese patients with pulmonary tuberculosis (TB), we examined an association study of single nucleotide polymorphisms (SNPs) in candidate genes in glutathione synthesis with susceptibility to ATDH.
Method: We studied 100 TB patients treated with anti-TB drugs. The frequencies of alleles and genotypes of 17 tag SNPs in 3 genes between TB patients with and without ATDH were compared by chi-square test or Fisher's exact test in three different inheritance models. A genetic testing was carried out using a single or combination of the associated SNP(s) as a biomarker.
Results: Statistical analyses indicated that a C/C genotype of rs553822 in glutamate cysteine ligase, catalytic subunit (GCLC) and an A/T or T/T genotype of rs12140446 in glutamate cysteine ligase, modifier subunit (GCLM) independently contributed to susceptibility to ATDH. Genetic testing showed that the TB patients without these polymorphisms of GCLC and GCLM could safely be treated with anti-TB drugs on the basis of the higher value for the specificity and negative predictive value.
Conclusion: GCLC and GCLM are ATDH-related genes and may be useful as a new biomarker to predict the high-risk TB patients susceptible to ATDH.