Evolving epidemiology of lung cancer in India: Reducing non-small cell lung cancer-not otherwise specified and quantifying tobacco smoke exposure are the key.

BACKGROUND: Adenocarcinoma is the most prevalent histological type of lung cancer (LC) in developed countries while squamous cell carcinoma (SqCC) has so far been the most common type at our center. Herein, we report our continued assessment of the epidemiological trend of LC aimed at determining any change in the histological distribution. METHODS: Retrospective analysis involving all consecutive newly diagnosed LC patients over a 4-year period (March 2011-February 2015). Demographic characteristics, histology, and staging data for current data set were compared with our previously published data (2008-2011). As before, smoking index (SI) was used to group patients as never (SI = 0), light (SI = 1-100), moderate (SI = 101-300), and heavy (SI ≥301) smokers. RESULTS: Majority of 1301 patients had advanced disease (Stages IIIB = 30.1%; IV = 53.3%), were males (82.3%) and current/ex-smokers (76.9%). Adenocarcinoma and SqCC (36.4% each) were equally prevalent. As compared to our previous study, adenocarcinoma increased (36.4% vs. 27.5%) and nonsmall cell lung cancer-not otherwise specified (NSCLC-NOS) decreased (5.1% vs. 10.9%) significantly (P < 0.001). The current study had more heavy smokers (68.3% vs. 61.1%; P = 0.013) and median SI was also higher (500 vs. 400; P = 0.001). Among SI-based groups, significant differences were observed for age, gender, body mass index, histology, TNM stage, and metastatic disease distribution. CONCLUSION: Reduction in NSCLC-NOS has led to adenocarcinoma and SqCC being equally prevalent at our center in North India despite an increase in heavy smokers. Accurate histological NSCLC subtyping is necessary for optimal epidemiological assessment.

Meta-analysis of Indian studies evaluating adenosine deaminase for diagnosing tuberculous pleural effusion.

OBJECTIVE: To determine the diagnostic accuracy of pleural fluid adenosine deaminase (ADA) in diagnosing tuberculous pleural effusion (TPE) among Indian patients using systematic review and meta-analysis. DESIGN: The PubMed, Embase, IndMED and Cochrane databases and other relevant publications were searched to identify Indian studies evaluating the sensitivity and specificity of ADA in diagnosing TPE. Pooled diagnostic accuracy measures and 95% confidence intervals (95%CI) were generated using a bivariate random-effects model, and examined using forest plots and hierarchical summary receiver operating characteristic (HSROC) curves. RESULTS: Forty publications with 3524 patients were studied. Pooled sensitivity, specificity and diagnostic odds ratio estimates were high (0.94, 95%CI 0.89-0.96; 0.89, 95%CI 0.83-0.93; and 119.85, 95%CI 48.35-297.08, respectively). The area under the HSROC curve was 0.966. The most common ADA threshold was 40 international units (IU)/l in 18 studies. Pooled positive and negative likelihood ratios for thresholds between 38 and 42 IU/l were respectively 6.80 (95%CI 4.18-11.07) and 0.06 (95%CI 0.03-0.11). There was no clear change in diagnostic performance with increasing ADA thresholds. Multivariate meta-regression did not reveal any factor that significantly influenced the substantial heterogeneity between studies. CONCLUSION: Pleural fluid ADA has good diagnostic accuracy for TPE in Indian patients, and appears more useful at excluding TPE at a threshold value of around 40 IU/l.

Allergic bronchopulmonary aspergillosis complicating Swyer-James-Macleod's syndrome: case report and review of literature.

Allergic bronchopulmonary aspergillosis (ABPA) is a pulmonary disorder that results from immune responses mounted against antigens of Aspergillus fumigatus, resulting in non-specific respiratory symptoms and structural lung damage. Classically defined in individuals suffering from bronchial asthma and cystic fibrosis, ABPA has recently been described in other lung diseases including COPD, pulmonary tuberculosis, idiopathic bronchiectasis and others. Herein, we report the first case of ABPA complicating Swyer-James-Macleod's syndrome that was successfully treated with oral antifungal therapy.