Frequency: Quarterly E- ISSN: 2277-8241 P- ISSN: Awaited Abstracted/ Indexed in: Ulrich's International Periodical Directory, Google Scholar, SCIRUS, getCITED, Genamics JournalSeek, EBSCO Information Services
Quarterly published in print and online "Inventi Impact: Pulmonology (Formerly Inventi Impact: Lungs)" publishes high quality unpublished as well as high impact pre-published research and reviews catering to the needs of researchers and professionals. The journal welcomes papers in all the areas of the respiratory system. The focus areas are asthma, COPD, cystic fibrosis, infectious lung diseases, pulmonary circulation, respiratory immunology, sleep-related respiratory problems, lung cancer, lung transplantation, tuberculosis and pulmonary hypertension.
Objective: Exploration for chronic obstructive pulmonary disease with\nbranched air lumen hamartoma by bronchoscoptic treatment. Material and\nMethod: An old man was referred to our hospital with shortness of breath for\nmany years. Clinical evidence emphysema on respiratory examination, lung\nfunction and chest X-ray gave rise to concern. He was diagnosed as COPD\nand treated with ICS + LABA. But the shortness of breath is still existed. Initial\nassessment by CT suggested a left lower lobe collapse. Then bronchoscope\nidentified a solid abnormality in main left bronchus. The pathology showed a\nbenign neoplasm. Because of intolerance of operation, the patient was treated\nby brochoscopic intervention. The endoscopic intervention included resection\nby electrosurgical snare, electrocautery, argon plasma coagulation\n(APC). Result: After intervention, the neoplasm was partly removed and the\npathological result was endobrochial hematoma. After treatment, the patientâ??s\npanting had taken a turn for the better. After one month later, the patientâ??s\nlung function improved a lot. Conclusion: In conclusion, endobronchial\nhamartomas are one of benign neoplasms. It can cause persistent bronchial\nobstruction and recurrent pneumonias. In this case, invasive endoscopic\ntreatment provides an excellent outcome....
Background: Mycobacterium tuberculosis (Mtb) has been found to persist within cavities in patients who have completed their anti-tuberculosis therapy. The clinical implications of Mtb persistence after therapy include recurrence of disease and destructive changes within the lungs. Data on residual changes in patients who completed anti-tuberculosis therapy are scarce. This case highlights the radiological and pathological changes that persist after anti-tuberculosis therapy completion and the importance of achieving sterilization of cavities in order to prevent these changes. Case presentation: This is a case report of a 33 year old female with drug-sensitive pulmonary tuberculosis who despite successfully completing standard 6-month treatment had persistent changes in her lungs on radiological imaging. The patient underwent multiple adjunctive surgeries to resect cavitary lesions, which were culture positive for Mtb. After surgical treatment, the patient’s chest radiographies improved, symptoms subsided, and she was given a definition of cure. Conclusions: Medical therapy alone, in the presence of severe cavitary lung lesions may not be able to achieve sterilizing cure in all cases. Cavities can not only cause reactivation but also drive inflammatory changes and subsequent lung damage leading to airflow obstruction, bronchiectasis, and fibrosis. Surgical removal of these foci of bacilli can be an effective adjunctive treatment necessary for a sterilizing cure and improved long term lung health....
Silicosis caused by the inhalation/deposition of free silica particles is characterized by pulmonary inflammation/fibrosis. Among the clinical disorders associated with silicosis, tuberculosis is by far the most prominent. A 66-year-old male non-smoker, originally from North Africa, reported a dry cough and significant weight loss. He was a foundry worker. He had a medical history of bladder carcinoma associated with schistosomiasis. Computed tomography (CT) and positron emission tomography (PET)/CT showed bilateral multiple hypermetabolic lung nodules, some with cavitation. The patient underwent surgical resection of the largest nodule, which was highly suspicious of lung metastasis. The histological examination revealed multiple nodular formations. Several lesions showed the characteristic features of silicotic nodules. There were also adjacent well-formed granulomas, some with central caseous necrosis. A real-time polymerase chain reaction, performed for the identification and quantification of the DNA of the Mycobacterium tuberculosis complex, was positive. Pulmonary silico-tuberculosis is often encountered in patients with a history of silica exposure in tuberculosis-endemic areas. This case serves as a reminder to never underestimate patient occupational exposure and geographic origin. A careful histological diagnosis and molecular investigation are mandatory when approaching difficult cases, especially patients with a prior cancer history and clinical/radiological features suggestive of tumour recurrence/metastasis....
Background: The management and control of pulmonary bacteriologically confirmed (PBC) tuberculosis (TB) also\nknown as infectious TB is important not only to monitor for resistance but also to check for severity, treatment\nresponse and limit its spread.\nMethod: A retrospective analysis of diagnosis smear results of PBC TB patients in Kampala district registered\nbetween January 2012 and December 2015 at 65 TB diagnosis and treatment units (DTUs) was done.\nResults: Of the 10,404 records; 6551 (63.0%) belonged to PBC TB patients, 3734 (57.0%) of whom were male.\nSputum smear microscopy was the diagnostic test most commonly used 4905 (74.9%) followed by GeneXpert\ntesting, 1023 (15.6%). Majority, 1951 (39.8%), of the PBC TB patients had a smear positivity grading of 3+ (> 10 acidfast\nbacillus (AFB)/Fields). Public facilities diagnosed more PBC TB patients compared to private facilities, 3983 (60.\n8%) vs 2566 (39.2%). From 2012 through 2015, there was a statistically significant increase in PBC TB patients\nenrolled on anti-TB treatment from 1389 to 2194 (p = 0.000). The percentage of HIV positive co-infected PBC TB\npatients diagnosed decreased from 597(43%) to 890(40.6%) (p = 0.000) within same period. Linkage to HIV care\nimproved from 229\n(34.4%) in 2012 to 464 (52.1%) in 2015 (p = 0.000). The treatment success rate (TSR) for PBC TB patients improved\nfrom 69% in 2012 to 75.5% by end of 2015 (p = 0.001) with an improvement in cure rate from 52.3% to 62% (p = 0.\n000). There was an observed significant decrease in TB related mortality from 8.9 to 6.4% (p = 0.013).\nConclusion: The proportion of diagnosed PBC TB patients increased from 2012 to 2015. PBC TB patients diagnosed\nwith 3+ smear positivity grading results consistently contributed to the highest proportion of diagnosed PBC TB\npatients from 2012 to 2015. This could be due to the delay in diagnosis of TB patients because of late presentation\nof patients to clinics. A prospective study of PBC TB patients diagnosed with 3+ smear positivity grading may\nelucidate the reasons for the delay to diagnosis. Further, we propose a study of wider scope to estimate how many\npeople a single PBC TB patient is likely to infect with TB before being diagnosed and treated....
Background: The most commonly applied treatment for acute exacerbations of chronic obstructive pulmonary\ndisease (AECOPD) is a 5-day course of high-dose systemic corticosteroids. However, this treatment has not been\nshown to reduce mortality and can potentially have serious side effects.\nRecent research has shown that, presumably, only a subgroup of COPD patients identifieable by blood eosinophil count\nbenefit from a rescue course of prednisolone. By applying a biomarker-guided strategy, the aim of this study is to determine\nwhether it is possible to reduce the use of systemic corticosteroids in AECOPD without influencing the outcome.\nMethods: This is an ongoing prospective multicenter randomized controlled open label trial comprising 320 patients with\nAECOPD recruited from four hospitals in Denmark. The patients are randomized 1:1 to either standard care or eosinophilguided\ncorticosteroid-sparing therapy where prednisolone is not administered if the daily blood sampling reveals an eosinophil\nlevel below 0.3 Ã?â?? 109 cells/L. The primary endpoint is length of hospital stay within 14 days after recruitment. The secondary\nendpoints are treatment failure, 30-day mortality rate, COPD related re-admission rate, change in FEV1, and a number of\nadverse effect measures obtained within 3 months after the index hospitalisation date related to corticosteroid usage.\nDiscussion: This will be a very large RCT providing knowledge about the effectiveness of individualized biomarker-guided\ncorticosteroid therapy in hospitalised patients with AECOPD....
Background: Idiopathic pulmonary fibrosis (IPF) often accompanies lung cancer, and life-threatening acute\nexacerbation (AE) of IPF (AE-IPF) is reported to occur in 20 % of IPF patients who undergo lung cancer surgery.\nPirfenidone is an anti-fibrotic agent known to reduce disease progression in IPF patients. A phase II study was\nconducted to evaluate whether perioperative pirfenidone treatment could reduce the incidence of postoperative\nAE-IPF patients with lung cancer.\nMethods: Pirfenidone was orally administered to IPF patients who were candidates for lung cancer surgery; pirfenidone\nwas dosed at 600 mg/day for the first 2 weeks, followed by 1200 mg/day. Surgery was performed after at least 2 weeks\nof 1200-mg/day administration. The primary endpoint was nonââ?¬â??AE-IPF rate during postoperative days 0ââ?¬â??30, compared\nto the null value of 80 %, and the secondary endpoint was safety. Radiologic and pathologic diagnoses of IPF and AE-IPF\nwere confirmed by an independent review committee.\nResults: From June 2012 to January 2014, 43 cases were enrolled, and 39 were eligible (full analysis set [FAS]). Both\npirfenidone treatment and surgery were performed in 36 patients (per protocol set [PPS]). AE-IPF did not occur in 37/39\npatients (94.9 % [95 % confidential interval: 82.7ââ?¬â??99.4 %, p = 0.01]) in the FAS, and in 38/39 patients (97.2 % [95 %\nconfidential interval: 85.5ââ?¬â??99.9 %, p = 0.004] in the PPS. A grade 5 adverse event (death) occurred in 1 patient,\nafter AE-IPF; no other grade 3ââ?¬â??5 adverse events were observed Conclusions: Perioperative pirfenidone treatment is safe, and is promising for reducing AE-IPF after lung cancer\nsurgery in IPF patients....
Background and objective: The British Thoracic Society (BTS) recommends that sedation for fiber-optic\nbronchoscopy (FOB) should be offered to all patients. This study evaluates the safety of FOB under sedation in\npatients with COPD.\nMethods: Is a prospective observational study, with the approval of institutional review board. Sedation was\nadministered by a board-certified anaesthetist. Patients were premedicated (IV) with metoclopramide 10 mg, fentanyl\ninitial dose: 25 �¼g, midazolam initial dose 2-3 mg. After an initial 50 mg IV propofol, the dose was then carefully\ntitrated according to the ASA physical status classification.\nResults: The duration of the procedure was not different between the two groups (14.7 �± 3.551 vs. 14.9 �± 3.8 min\np=0.695). Serious complications were very infrequent in both groups (2.1 vs. 0.07%, p=0.148). In the group of COPD\npatients there was no correlation between the lowest SaO2 during the procedure (r=0.03, p=0.518) or the SaO2 at the\nend of the procedure (r=-0.006, p=0.909) and the baseline FEV1. Neither the presence of a fall in the SaO2 greater\nthan 4 points (HR 0.895, IC 0.452-1.773, p=0.750) nor a SaO2 lower than 90% during the procedure (HR 0.346, IC\n0.060-1.918, p=0.233) or the general rate of complications (including desaturation) (HR: 0.627, CI: 0.257-1.529,\np=0.305) were predicted by a baseline FEV1 lower than 50%.\nConclusions: We conclude that FOB under conscious sedation by a certified anesthesiologist is a safe procedure\nin patients with COPD with a low incidence of adverse effects....
Background: Oxygen desaturation during exercise is common in people with chronic obstructive pulmonary\ndisease (COPD). The aim of the study is to determine, in people with COPD who desaturate during exercise,\nwhether supplemental oxygen during an eight-week exercise training program is more effective than medical air\n(sham intervention) in improving exercise capacity and health-related quality of life both at the completion of\ntraining and at six-month follow up.\nMethods/Design: This is a multi-centre randomised controlled trial with concealed allocation, blinding of\nparticipants, exercise trainers and assessors, and intention-to-treat analysis. 110 people with chronic obstructive\npulmonary disease who demonstrate oxygen desaturation lower than 90 % during the six-minute walk test will be\nrecruited from pulmonary rehabilitation programs in seven teaching hospitals in Australia. People with chronic\nobstructive pulmonary disease on long term oxygen therapy will be excluded. After confirmation of eligibility and\nbaseline assessment, participants will be randomised to receive either supplemental oxygen or medical air during\nan eight-week supervised treadmill and cycle exercise training program, three times per week for eight weeks, in\nhospital outpatient settings. Primary outcome measures will be endurance walking capacity assessed by the\nendurance shuttle walk test and health-related quality of life assessed by the Chronic Respiratory Disease\nQuestionnaire. Secondary outcomes will include peak walking capacity measured by the incremental shuttle walk\ntest, dyspnoea via the Dyspnoea-12 questionnaire and physical activity levels measured over seven days using an\nactivity monitor. All outcomes will be measured at baseline, completion of training and at six-month follow up. Discussion: Exercise training is an essential component of pulmonary rehabilitation for people with COPD. This\nstudy will determine whether supplemental oxygen during exercise training is more effective than medical air in\nimproving exercise capacity and health-related quality of life in people with COPD who desaturate during exercise....
Background: Preclinical studies suggest that interleukin-9 may be a central mediator in the development and\r\nmaintenance of airway inflammation in asthma. The aim of this study was therefore to evaluate the effects of MEDI-528,\r\nan anti-interleukin-9 monoclonal antibody, in adults with confirmed uncontrolled moderate-to-severe asthma.\r\nMethods: In this prospective double-blind, multicenter, parallel-group study, 329 subjects were randomized\r\n(1:1:1:1) to subcutaneous placebo or MEDI-528 (30, 100, 300 mg) every 2 weeks for 24 weeks, in addition to their\r\nusual asthma medications. The primary endpoint was change in mean Asthma Control Questionnaire-6 (ACQ-6)\r\nscore at week 13. Secondary endpoints included weighted asthma exacerbation rates and pre-bronchodilator\r\nforced expiratory volume in 1 second (FEV1) at weeks 13 and 25, as well as Asthma Quality of Life Questionnaire\r\nscores at weeks 12 and 25 and the safety of MEDI-528 throughout the study period. The primary endpoint was\r\nanalyzed using analysis of covariance.\r\nResults: The study population (n = 327) was predominantly female (69%) with a mean age of 43 years (range 18ââ?¬â??65).\r\nThe mean (SD) baseline ACQ-6 score for placebo (n = 82) and combined MEDI-528 (n = 245) was 2.8 (0.7) and 2.8 (0.8);\r\nFEV1 % predicted was 70.7% (15.9) and 71.5% (16.7). Mean (SD) change from baseline to week 13 in ACQ-6 scores for\r\nplacebo vs combined MEDI-528 groups was -1.2 (1.0) vs -1.2 (1.1) (p = 0.86). Asthma exacerbation rates (95% CI) at\r\nweek 25 for placebo vs MEDI-528 were 0.58 (0.36ââ?¬â??0.88) vs 0.49 (0.37ââ?¬â??0.64) exacerbations/subject/year (p = 0.52). No\r\nsignificant improvements in FEV1 % predicted were observed between the placebo and MEDI-528 groups. Adverse\r\nevents were comparable for placebo (82.9%) and MEDI-528 groups (30 mg, 76.5%; 100 mg, 81.9%; 300 mg, 85.2%).\r\nThe most frequent were asthma (placebo vs MEDI-528, 30.5% vs 33.5%), upper respiratory tract infection (14.6% vs\r\n17.1%), and headache (9.8% vs 9.8%).\r\nConclusions: The addition of MEDI-528 to existing asthma controller medications was not associated with any\r\nimprovement in ACQ-6 scores, asthma exacerbation rates, or FEV1 values, nor was it associated with any major\r\nsafety concerns....
Abstract: Pulmonary mucormycosis is a relatively rare but often fatal opportunistic fungal infection\nthat occurs mostly in immunocompromised patients. Endobronchial mucormycosis, a distinct\nclinical form of pulmonary mucormycosis, is very rare, and only a few cases have been reported.\nThe most common bronchoscopic findings in patients with endobronchial mucormycosis are stenosis,\nerythematous mucosa and airway obstruction. Here, we present a case of fatal endobronchial\nmucormycosis mimicking actively caseating endobronchial tuberculosis in a young diabetic patient\nliving in a country with an intermediate tuberculosis burden....
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