Transbronchial biopsy vs. bronchoalveolar lavage in interstitial lung disease.

PURPOSE OF REVIEW: Interstitial lung diseases (ILDs) are heterogeneous disorders characterized by varying degrees of inflammation and fibrosis in the lung parenchyma. The use of bronchoalveolar lavage (BAL) cellular analysis and transbronchial biopsy with forceps (TBLB) in ILD is often a matter of debate. ILDs have been a diagnostic challenge and require multidisciplinary discussion (MDD) to develop a consensus diagnosis based on clinical, radiologic, laboratory, BAL cellular analysis, and histologic information. RECENT FINDINGS: The BAL cellular analysis is a commonly performed tool, and some ILDs have distinctive cellular findings. Its use alone is seldom diagnostic and almost always requires clinical, radiologic findings, and or histologic information interpretation. The minimally invasive procedures, such as TBLB, transbronchial cryo-biopsy (TBCB), and invasive procedures, such as surgical lung biopsy (SLB) help obtain a histologic diagnosis. SUMMARY: This review serves as a resource to assist clinicians to develop effective communication and close collaboration through MDD for accurate selection of diagnostic tools to reach the correct and final diagnosis.

Trends in hospitalisations and inpatient mortality from acute myocardial infarction among patients with psoriatic arthritis: an analysis of nationwide inpatient sample 2004-2014.

OBJECTIVES: Psoriatic arthritis (PsA) is associated with increased cardiovascular morbidity and mortality. Higher disease activity has been associated with increased rates of mortality in PsA. The objectives of the study were to describe the trends for hospitalisations from acute myocardial infarction (AMI) amongst patients with underlying PsA. METHODS: All adult hospitalisations for AMI with and without PsA from 2004-2014 in the nationwide in-patient sample (NIS) database were captured. A propensity score-matching model was also developed for comparative outcome analysis and reduce the potential of selection bias. RESULTS: From 2004 to 2014, 4778 unmatched weighted hospitalisations were estimated for AMI with underlying PsA. Mean age for hospitalisations with AMI and PsA was lower (average age in years: 63.1±11.5 vs. 67.5±14.4; p-value <0.05), with a higher percentage being males (62.7% vs. 60.4%, p-value <0.05). When adjusted for confounding factors, overall mortality was found to be signi cantly lower in hospitalisations with PsA (2.21% vs. 5.8%, p-value <0.05). After propensity matching analyses, in-hospital mortality in PsA cohort continued to be signi cantly lower when compared to the matched cohort without PsA (1.79% vs. 5.71%, Odds ratio=0.3, p-value 0.002). CONCLUSIONS: The study suggests that overall rates of mortality in AMI with underlying PsA are lower compared to those without PsA. A decrease in cardiovascular mortality from AMI in PsA re ects that even though PsA is associated with an increased prevalence of cardiovascular risk factors, the trends in mortality are similar or even better than those for the general population.

Tumid Lupus Erythematosus and Systemic Lupus Erythematosus: A Report on Their Rare Coexistence.

Tumid lupus erythematosus (TLE) is a rare variant of cutaneous lupus erythematosus. Clinically, it lacks typical changes found in discoid lupus and antinuclear antibodies (ANA) levels are elevated in only 10% of the patients. Coexistent systemic lupus erythematosus (SLE) has been reported to be rare, and literature shows only a few case reports. We present a case of coexistent tumid lupus and SLE. We present a case of a 48-year-old Caucasian female who presented with chronic facial rash, photosensitivity, intermittent oral ulcers, joint pain with morning stiffness, and unintentional weight loss. Laboratory studies showed positive ANA at 1:640, elevated erythrocyte sedimentation rate, positive anticardiolipin immunoglobulin (Ig) G, anticardiolipin IgM, and anti-beta-2 glycoprotein IgM. Skin biopsy of the rash showed a superficial and deep dense lymphocytic infiltrate with mucin deposition, histopathology favoring tumid lupus. The patient was diagnosed with TLE with SLE and was started on hydroxychloroquine with improvement in her rash. Ultraviolet light and certain medications have been proven to play a role in the pathogenesis of tumid lupus. It usually responds to photoprotection, topical treatment, or oral antimalarial therapy.

Functional recovery and blood pressure on acute post-stroke setting.

OBJECTIVES: This study aims to evaluate the effects of blood pressure (BP) on functional recovery and length of stay (LOS) in post-stroke patients in an acute rehabilitation facility (ARF). PATIENTS AND METHODS: A total of 116 ischemic stroke patients (60 males, 56 females; mean age 70.0±12.8 years; range, 37 to 93 years) who were admitted to the ARF between January 2012 and September 2012 were included. Daily BP measurements with mean systolic and diastolic BP values and Functional Independent Measure (FIM) scores at the time of admission and discharge were measured. The LOS and systolic and diastolic BP ranges were also recorded. RESULTS: There was no significant correlation between the BP and FIM scores. The mean diastolic BP was positively correlated with admission (rs=0.316, p=0.01) and discharge (rs=0.287, p=0.002), FIM scores, and FIM effectiveness (rs=0.185, p=0.047) and negatively correlated with age (r=-0.449, p<0.001) and LOS (rs=-0.189, p=0.042). The LOS in hospital was negatively correlated with FIM scores at admission (rs=-0.585, p<0.001) and discharge (rs=-0.352, p<0.001) and positively correlated with FIM score changes (rs=0.414, p<0.001). CONCLUSION: Our study results show that diastolic BP in the subacute phase of stroke does not have a major impact on the functional recovery and LOS in post-stroke patients. However, there is a significant correlation between diastolic BP values and FIM efficiency.

Bronchiolitis obliterans organising pneumonia as an initial manifestation in a patient with systemic lupus erythematosus: a rare presentation.

Bronchiolitis obliterans organising pneumonia as an initial manifestation of systemic lupus erythematosus (SLE) is a rare and uncommon presentation. We describe a case of SLE presenting with shortness of breath, found to have pneumothorax, bilateral nodular infiltrates along with pleural effusions and pericardial effusion. Work-up suggested a diagnosis of active SLE with anaemia, thrombocytopenia, positive antinuclear antibodies (ANAs) and positive anti-double-stranded DNA. On retrospective review of patient records, from 8 years prior to presentation, lung biopsy histology consistent with bronchiolitis obliterans organising pneumonia with positive ANA serology was found, without any further autoimmune work-up. In our opinion, bronchiolitis obliterans organising pneumonia was the index presentation of SLE. Treatment with steroids and subsequent management with immunosuppressive therapy could have prevented subsequent hospitalisations. Prompt work-up for autoimmune diseases should be considered in patients with positive ANA and histological evidence of bronchiolitis obliterans organising pneumonia.

Role of Pulmonary Evaluation in Diagnosis of Neurosarcoidosis.

BACKGROUND: Neurosarcoidosis is a serious extra pulmonary manifestation of sarcoidosis. Its presentation ranges from peripheral or cranial neuropathy to central nervous system dysfunction. It can mimic stroke or multiple sclerosis. Due to the variation in clinical presentation, diagnosis is difficult and often delayed. OBJECTIVE: Determine the proportion of patients with neurosarcoidosis who have positive findings on chest CT, lung biopsy or lymph node biopsy. METHODS: Retrospective study at the Sarcoidosis and Interstitial Lung Disease Center at Wayne State University-Detroit Medical Center in Detroit, MI. Medical records of 424 patients were reviewed and 69 patients with neurosarcoidosis identified. RESULTS: We found that most patients diagnosed with neurosarcoidosis had normal PFT values except for reduction in DLCO. However, we also found that 71% of the patients had abnormal findings on chest CT consistent with sarcoidosis.  Additionally, 57% of the patients had non-caseating granuloma on hilar lymph node biopsy. CONCLUSION: Patients with neurosarcoidosis may not have any pulmonary symptoms. However, they are most likely to have abnormal chest CT, hilar lymphadenopathy and reduction in DLCO.  These data suggest that pulmonary evaluation is warranted in patients who are suspected to have neurosarcoidosis.

Schizophrenia: Impact on quality of life.

AIMS: The purpose of the present study was to assess quality of life (QOL) in patients with schizophrenia and to determine influence of clinical factors and socio-demographic variables on QOL of schizophrenic patients. SETTING AND DESIGN: Cross-sectional study carried out on outdoor patients attending Department of Psychiatry, SMS Medical College, Jaipur, India. MATERIALS AND METHODS: Fifty patients of schizophrenia diagnosed as per ICD - 10 with minimum duration of illness being two years and attending out patient department (OPD) at psychiatric centre or psychiatric clinic at SMS medical college, hospital, Jaipur, India for maintenance treatment fulfilling the criteria given below were registered. They were evaluated using positive and negative syndrome scale (PANSS) and Quality of Life Instrument (WHO QOL - BREF). The data collected on above tools, was analyzed using descriptive and inferential statistics using Pearson correlation coefficient. RESULTS AND CONCLUSIONS: Patients were having lowest QOL scores in social relationships domain of WHO QOL - BREF scale. Social relationship domain of QOL was significantly negatively correlated with occupation with employed patients reporting better QOL in this domain. There were significant positive correlation of total monthly income with social relationship domain and total QOL. There were no statistically significant correlation between QOL parameters and clinical characteristics in schizophrenics. Scores on positive subscale and total PANSS were significantly negatively correlated with physical, Psychological, social relationship domains and total QOL. Negative subscale had significant negative correlation with physical and psychological domains and total QOL. General psychopathology subscale had significant negative correlation with all subscales of QOL. This study confirms poor QOL in schizophrenia despite significant improvement with pharmacological treatment.