Pulmonology

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32 A case of a 13 year old boy with sudden onset dyspnea with cough.
By Arnab Maji · NRS MEDICAL COLLEGE, KOLKATA, INDIA

Eva Rakoczi · University of Debrecen

http://www.cancer.gov/cancertopics/pdq/treatment/lchistio/HealthProfessional/page2

http://www.cancer.gov/cancertopics/pdq/treatment/lchistio/HealthProfessional/page2

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6 tuberculosis
By Sumaira Akram ·

Gyanshankar Mishra · Government Medical College, Nagpur

Pyridoxin has to be given with INH for peripheral neuropathy prophylaxis in all patients.

Pyridoxin has to be given with INH for peripheral neuropathy prophylaxis in all patients.

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1 Regarding fixed air-flow obstruction in ASTHMA, how do you clinically describe this air-flow limitation?
By Arnab Maji · NRS MEDICAL COLLEGE, KOLKATA, INDIA

Harm Tiddens · Erasmus MC

Morphological changes in asthma are primarily localized in the small airways. Look at the peripheral flows (FEF75) In %pred it will be way down the FE... [more]

Morphological changes in asthma are primarily localized in the small airways. Look at the peripheral flows (FEF75) In %pred it will be way down the FEV1 and FVC. Clinically it is silent (except for the typical dry asthma cough en reduced excursive tolerance)

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2 What are the biomarkers to predict mortality in COPD?
By Arnab Maji · NRS MEDICAL COLLEGE, KOLKATA, INDIA

Yanick Simon · Université Quisqueya

COPD is the fourth most common cause of death in the world, it is predicted to rise to the third position by the year 2020 (Kelly et al., 2013). Many ... [more]

COPD is the fourth most common cause of death in the world, it is predicted to rise to the third position by the year 2020 (Kelly et al., 2013). Many biomarkers can predict mortality in COPD particularly serum inflammatory biomarkers because inflammation is thought to play a pivotal role in the genesis of this pathology. C-reactive protein (CRP), IL-6, pulmonary and activation-regulated chemokine (PARC), surfactant protein-D (SP-D), fibronectin have been observed to be independently associated with increased risk of death. Other systemic molecules that have been shown to have a role in predicting cardiovascular mortality have been investigated as potential predictors of mortality in COPD such as Adrenomedullin, troponin T (hs-cTnT), Adiponectin. Please receive this attach which probably can help you with your search.

http://www.medscape.com/viewarticle/778723_2 ×
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10 Role of ultrasound in thoracic medicine.
By Arnab Maji · NRS MEDICAL COLLEGE, KOLKATA, INDIA

Kalpana Radhakrishnan · Madras Medical College

Moving vessels are not a great hinderance as such. Lot of information regarding flow and patency can be made even if vessel is moving. But practically... [more]

Moving vessels are not a great hinderance as such. Lot of information regarding flow and patency can be made even if vessel is moving. But practically , vessels are not that mobile to be a real problem. Of course due to respiratory movement doppler may be a little difficult.

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2 VAP-PIRO - Validation?
By Arnab Maji · NRS MEDICAL COLLEGE, KOLKATA, INDIA

Arnab Maji · NRS MEDICAL COLLEGE, KOLKATA, INDIA

Ventilator-Associated Pneumonia PIRO Score - Philippine Heart Center Results --- Patients were scored using the VAP PIRO Score. Using the following ... [more]

Ventilator-Associated Pneumonia PIRO Score - Philippine Heart Center Results --- Patients were scored using the VAP PIRO Score. Using the following variables for scoring; predisposition (comorbidities: COPD, congestive heart failure, chronic renal failure and immunocompromised, insult (bacterimia), response (hypotension SBP <90 mmHg) and organ dysfunction (hypoxemia PF ratio of <300). Using the simple PIRO scoring, with score ranging from 0-4, the best cut off for predicting ICU mortality would be a score of 3 and above with a sensitivity of 88.9% and specificity of 54.5%.

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Open Semiquantitative culture vs quantitative culture in the diagnosis of VAP?
Validation of quantitative and semiquantitive culture in the microbiological diagnosis of VAP.

Validation of quantitative and semiquantitive culture in the microbiological diagnosis of VAP.

By Arnab Maji · NRS MEDICAL COLLEGE, KOLKATA, INDIA

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Open Outcome predictor in VAP.
What is the best outcome predictor score for VAP at the time of admission?

What is the best outcome predictor score for VAP at the time of admission?

By Arnab Maji · NRS MEDICAL COLLEGE, KOLKATA, INDIA

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Open NTM - diagnosis and management.
As per recent diagnostic criteria for the diagnosis of NTM, there is a chance of overdiagnosis of NTM, thereby enhancing the potential toxicities of t... [more]

As per recent diagnostic criteria for the diagnosis of NTM, there is a chance of overdiagnosis of NTM, thereby enhancing the potential toxicities of the drugs. There is also a chance of undertreatment. How do you defend this column? What do you think?

By Arnab Maji · NRS MEDICAL COLLEGE, KOLKATA, INDIA

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2 ARDS and ALI
By Arnab Maji · NRS MEDICAL COLLEGE, KOLKATA, INDIA

Ghazi Aldehayat · King Hussein Medical Center

Good point, I think there will be some time before the term ALI is obsolete because it is present in the literature, books and the mind of many of us... [more]

Good point, I think there will be some time before the term ALI is obsolete because it is present in the literature, books and the mind of many of us, but eventually it will be obsolete, just like the old name ( adult respiratory distress syndrome). I think the current terminology is more logic because you are talking about same disease with same characteristics and you can classify it as mild moderate severe.

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10 Can a bronchoscope be used for medical thoracoscopy?
By Arnab Maji · NRS MEDICAL COLLEGE, KOLKATA, INDIA

Tomas Bohanes · Palacký University of Olomouc

Yes, it will work, but generally you will obtain better results with an appropriate scope including 5mm optics. The only benefit of the flexible one I... [more]

Yes, it will work, but generally you will obtain better results with an appropriate scope including 5mm optics. The only benefit of the flexible one I can see in a situation of multiple pleural adhesions where you can navigate the scope through the pleural cavity in a similar way like in the bronchi to achieve the desired area of the pleura for a biopsy. But usually disadvantages in comparison to the rigid optics should prevail.

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1 Role of NIV in COPD with Cor-Pulmonale.
By Arnab Maji · NRS MEDICAL COLLEGE, KOLKATA, INDIA

Hans Jörg Baumann · Universität Hamburg

To the best of my knowledge, there is no study showing long term effects of chronic NIV use in COPD patients. However, there is one study (open access... [more]

To the best of my knowledge, there is no study showing long term effects of chronic NIV use in COPD patients. However, there is one study (open access) for the whole group of patients with chronic respiratory failure: Thorax. 2001 Jul;56(7):524-8. Long term effects of non-invasive mechanical ventilation on pulmonary haemodynamics in patients with chronic respiratory failure. Schönhofer B, Barchfeld T, Wenzel M, Köhler D. Schönhofer et al. could show that one year of NIV use in patients with restrictive thoracic disorders improved PA pressure and PVR. However, in COPD no changes were observed regarding pulmonary hemodynamics. It has to be mentioned that in this study the restrictive group had a higher PA pressure (32 mm Hg) than the COPD group (25 mm Hg) which may explain the lack in change. The absence of prove does not mean the absence of an effect.

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1 Diffuse parenchymal lung disease (DPLD) with lung volume.
By Arnab Maji · NRS MEDICAL COLLEGE, KOLKATA, INDIA

Claudio Silva · Clinica Alemana

DPLD with increased lung volumes could be: lymphangioleiomyomatosis or pulmonary Langerhans cell histocytosis. Also, idiopathic bronchiolitis oblitera... [more]

DPLD with increased lung volumes could be: lymphangioleiomyomatosis or pulmonary Langerhans cell histocytosis. Also, idiopathic bronchiolitis obliterans, could be a differential. Of course, emphysema could be superimposed to any DPLD.

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13 Sle lung manifestation.
By Arnab Maji · NRS MEDICAL COLLEGE, KOLKATA, INDIA

Parvaiz Koul · Sher-i-Kashmir Institute of Medical Sciences

It is a tough one Arnab. Other manifestations of lupus might help if there is evidence of an active vasculitic involvement but may not be there. Surro... [more]

It is a tough one Arnab. Other manifestations of lupus might help if there is evidence of an active vasculitic involvement but may not be there. Surrogate markers of infection may, as you rightly put it in procalcitonin and hsCRP. Lupus pneumonitis is acute or chronic. In acute setting presence of bilateral disease might point towards lupus. Effusions and concomitant pericardial disease point towards lupus. All these, however, are not absolute and the differentiation can be really tough. If your antibiotic regimen is not working, the only clue to the underlying etiology at times is a therapeutic trial of immunosuppressives and I have found it helpful at times.

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12 Semiautomatic lung volume quantification methods?
By Claudio Silva · Clinica Alemana

Chanukya Krishna Chama · IIT Kharagpur

You may check http://www.mitk.org/Interactive_segmentation http://www.youtube.com/watch?v=hEZsQsTxMlo <--MITK Segmentation tool demo

You may check http://www.mitk.org/Interactive_segmentation http://www.youtube.com/watch?v=hEZsQsTxMlo <--MITK Segmentation tool demo

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1 What are the pulmonary manifestations in Rhupus Syndrome?
By Kaushik Saha · Burdwan Medical College

Arnab Maji · NRS MEDICAL COLLEGE, KOLKATA, INDIA

In rhupus syndrome pulmonary manifestations may be - 1. pleural effusion 2. acute lupus pneumonitis 3. organising pneumonia 4. diffuse alveolar haemor... [more]

In rhupus syndrome pulmonary manifestations may be - 1. pleural effusion 2. acute lupus pneumonitis 3. organising pneumonia 4. diffuse alveolar haemorrhage 5. pulmonary arterial hypertension 6. pulmonary embolism 7. rarely cavitary pulmonary nodule

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4 Does anyone have any experience in defining the role of Sirtuitins (SIRT3) to induce stem cells to generate different types of cells?
By Omer Iqbal · Loyola University Medical Center

Rajesh Jagirdar · GeneClick.org

Dr Iqbal , you have to use 2 different approaches. 1) Over express SIRT3 and 2) silence SIRT3 by siRNA (transient knockdown) or shRNA(stable knockdown... [more]

Dr Iqbal , you have to use 2 different approaches. 1) Over express SIRT3 and 2) silence SIRT3 by siRNA (transient knockdown) or shRNA(stable knockdown). In both the scenarios try inducing 4 different developmental programs 1) muscle program, 2) lipogenesis, 3) chondrogenesis and 4) Osteogenesis by the use of specific inducers. You can find these inducers published on pubmed. I think this will give you a convincing answer. Choice of your cell line should be MSCs (mesenchymal stem cells) such as embryonic fibroblasts, they could be from any embryonic tissue. I am proposing this approach witht the thought that it will give you a strong understanding of stemness that you can play with for experience sake. Best, RJ

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Open Which journal would be interested in publishing a case report on Askin tumors?
It's a chest wall tumor. Diagnosis was usual for her age, gender and presentation.

It's a chest wall tumor. Diagnosis was usual for her age, gender and presentation.

By Ashok Kumar · College of Physicians and Surgeons Pakistan

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5 Place of oral etoposide in small cell lung cancer treatment
By Arnab Maji · NRS MEDICAL COLLEGE, KOLKATA, INDIA

Jose Gros · Sociedad Española de Oncología Médica

B Lebeau published in Lung Ca 2010, a paper on the role of 2d or 3d line Oral CT with Lomustine-Etoposide-Cyclophosphamide in SCLC, and there is also ... [more]

B Lebeau published in Lung Ca 2010, a paper on the role of 2d or 3d line Oral CT with Lomustine-Etoposide-Cyclophosphamide in SCLC, and there is also the very old results with the MACC protocol of Chahinian, that can the subjected to several modifications; the A Hermes paper of 2008 in JCO gives preference to CarboPlatin plus Irinotecan. Some years ago there where data about Oral Irinotecan, but it's not marketed as of today, The JR Eckardt article in JCO 2006, prefers Oral Topotecan plus CDDP to CDDP-VP-16, and absorption of oral dosed drugs is many times erratic. The work of Hanna NH in AnnOncol 2002 points to a beneficial effect of 3 months of Oral VP-16 maintenance in Non-Progressive pts with Extensive Stage SCLC. How serious are the concerns about off-label use of anticancer drugs?

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3 Does the temperature of expired air equal core body temperature? If not, is there a standard difference?
By Larry Johnson ·

Jyotsana Bharshankar · Government Medical College, Nagpur

I think it is not so because the humidified expired air passes through the dead space and the temperature is also mixed with relatively cool air than ... [more]

I think it is not so because the humidified expired air passes through the dead space and the temperature is also mixed with relatively cool air than the core temperature.

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1 Arsenicosis and dyspnea
By Arnab Maji · NRS MEDICAL COLLEGE, KOLKATA, INDIA

Arnab Maji · NRS MEDICAL COLLEGE, KOLKATA, INDIA

we have had a patient of chronic arsenicosis. she had an unexplained dyspnea and found to have PAH on echocardiographic assessment with mean PASP is 6... [more]

we have had a patient of chronic arsenicosis. she had an unexplained dyspnea and found to have PAH on echocardiographic assessment with mean PASP is 65mmhg. We have excluded the lung, heart, thromboembolic and connective tissue diseases in the causation of PAH. Can it be due to chronic arsenic exposure itself? Any opinion will be of great help to me.

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Open There is a similar parameter to MEF 25-75 in the forced oscillation technique??
In the case of spirometry, we measure flow, but in the case of FOT we measure resistance; This parameter (MEF 25-75) indicates development of small ai... [more]

In the case of spirometry, we measure flow, but in the case of FOT we measure resistance; This parameter (MEF 25-75) indicates development of small airways, i want to know if in FOT we have something similar. Thanks a lot!

By Lety Rafael · Center for Research and Advanced Studies of the National Polytechnic Institute

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Open What types of ventilators are used on neonatals? What mode of ventilaory i.e. cpap, TCPL, PVC, micropressors, What are indications?
Match criteria for each diagnosis - i.e. restrictive disease, obstructive disease, hypoventilation, etc.

Match criteria for each diagnosis - i.e. restrictive disease, obstructive disease, hypoventilation, etc.

By Laura Bosselmann

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