Foreign Body Aspiration in Children and Emergency Rigid Bronchoscopy: A Retrospective Observational Study.

Foreign body aspiration is potentially life-threatening in paediatric age group. Early recognition and emergency intervention by Rigid bronchoscopy is life-saving. To highlight various difficulties in emergency paediatric bronchoscopy and discuss our experience in 138 patients. < 12 years children with suspected foreign body aspiration were included. Data of 138 patients < 12 years of age were studied. The most common foreign body found was peanut and organic foreign bodies constituted of total foreign bodies removed. Choking, Cough and sudden onset breathlessness were common symptoms. Tachypnoea, asymmetric breath sound, rhonchi, stridor, reduced chest movements were common signs. Obstructive emphysema was commonest radiological findings. Majority of the patients were discharged within 72 h & only two patients expired. History, clinical and radiological findings are highly indicative of foreign body in the airway. Inspite of being a high risk procedure, Rigid bronchoscopy when performed with necessary expertise,trained anaesthesia team and a paediatric ICU, saves majority of lives of children with tracheobronchial foreign bodies.

Identifying polymorphic cis-regulatory variants as risk markers for lung carcinogenesis and chemotherapy responses in tobacco smokers from eastern India.

Aberrant expression of xenobiotic metabolism and DNA repair genes is critical to lung cancer pathogenesis. This study aims to identify the cis-regulatory variants of the genes modulating lung cancer risk among tobacco smokers and altering their chemotherapy responses. From a list of 2984 SNVs, prioritization and functional annotation revealed 22 cis-eQTLs of 14 genes within the gene expression-correlated DNase I hypersensitive sites using lung tissue-specific ENCODE, GTEx, Roadmap Epigenomics, and TCGA datasets. The 22 cis-regulatory variants predictably alter the binding of 44 transcription factors (TFs) expressed in lung tissue. Interestingly, 6 reported lung cancer-associated variants were found in linkage disequilibrium (LD) with 5 prioritized cis-eQTLs from our study. A case-control study with 3 promoter cis-eQTLs (p < 0.01) on 101 lung cancer patients and 401 healthy controls from eastern India with confirmed smoking history revealed an association of rs3764821 (ALDH3B1) (OR = 2.53, 95% CI = 1.57-4.07, p = 0.00014) and rs3748523 (RAD52) (OR = 1.69, 95% CI = 1.17-2.47, p = 0.006) with lung cancer risk. The effect of different chemotherapy regimens on the overall survival of lung cancer patients to the associated variants showed that the risk alleles of both variants significantly decreased (p < 0.05) patient survival.

No association of the common Asian mitochondrial DNA haplogroups with lung cancer in East Indian population.

OBJECTIVES: Mitochondrial dysfunction has long been associated with the pathogenesis of lung cancer (LC). Mitochondrial DNA (mtDNA) haplogroups have been reported to modify the risk of LC in a few different populations; however, no study has been done among the Indians. Here, we explore the relationship between mtDNA haplogroups and LC in a representative eastern Indian sample set. METHODS: Different combinations of six mtDNA SNPs, which define the major Asian mtDNA haplogroups M and N, and their sub-haplogroups D, G, M7, R, and F were genotyped via polymerase chain reaction (PCR) - restriction fragment length polymorphism (RFLP) - sequencing approach in 94 smoker LC patients and 100 healthy smoker controls from an eastern Indian cohort. RESULTS: The distribution of 7 mtDNA haplogroups did not show any significant differences between patients and controls (p<0.05). We did not find sub-haplogroup M7 in our study population. CONCLUSIONS: Our study is the first to indicate that the major Asian mtDNA haplogroups have no significant (p<0.05) association with LC in East Indian population.

A comprehensive meta-analysis and a case-control study give insights into genetic susceptibility of lung cancer and subgroups.

Reports of genetic association of polymorphisms with lung cancer in the Indian subcontinent are often conflicting. To summarise and replicate published evidence for association with lung cancer and its subgroups. We performed a meta-analysis of candidate associations on lung cancer, its histological subtypes and smoking status in the Indian subcontinent following PRISMA guidelines. Multiple testing corrections were done by the Benjamini-Hochberg method through assessment of significance at a false discovery rate of 10%. We genotyped and investigated rs1048943/CYP1A1 in a case-control sample from eastern India, followed by its global meta-analysis using a similar protocol. Meta-analysis of 18 variants of 11 genes reported in 39 studies (7630 cases and 8169 controls) showed significant association of rs1048943/CYP1A1 [2.07(1.49-2.87)] and rs4646903/CYP1A1 [1.48(1.93-1.95)] with overall lung cancer risk at 10% FDR, while nominal association (p < 0.05) was observed for del1/GSTT1, del2/GSTM1, rs1695/GSTP1 and rs17037102/ DKK2. Subtype analysis showed a significant association of del1/GSTT1 with adenocarcinoma, rs4646903/CYP1A1 with squamous carcinoma, and rs1048943/CYP1A1 with both. Association of rs4646903/CYP1A1 in smokers and effect modification by meta-regression analysis was observed. Genotyping of rs1048943/CYP1A1 that presented significant heterogeneity (p < 0.1) revealed an association with adenocarcinoma among eastern Indian smokers, while a global meta-analysis in 10458 cases and 10871 controls showed association with lung cancer and its subgroups. This study identified the susceptibility loci for lung cancer and its covariate-subgroups.

Prevalence and Risk Factors of Asthma and Allergy-Related Diseases among Adolescents (PERFORMANCE) study: rationale and methods.

Despite a considerable number of international reports on allergic diseases among children, information about the prevalence and risk factors of asthma and allergy-related diseases among Indian adolescents is relatively sparse. The Prevalence and Risk Factors of Asthma and Allergy-Related Diseases among Adolescents (PERFORMANCE) study has been conceived to study the aetiology of asthma and allergic diseases including rhinoconjunctivitis, atopic eczema and food allergies among adolescents in West Bengal, India, using standardised methods and collaborations. The aims of the study are: 1) to estimate the prevalence and risk factors of asthma and allergic diseases among the adolescents residing in rural, suburban and urban areas of West Bengal; 2) to obtain information about the possible role of lifestyle factors (smoking, diet and physical activity) on the disease prevalence; and 3) to create a network for further investigation on social, environmental and genetic factors affecting the diseases. The PERFORMANCE study comprises two phases. The phase I study will investigate the prevalence and possible contributing factors of asthma and allergic diseases in a defined population. The phase II study will be performed as a follow-up of phase I to assess the incidence of asthma and allergic diseases.

Common Presentation with Uncommon Diagnosis: Multifocal Epithelioid Hemangioendothelioma.

A young female patient presenting with recurrent hemoptysis, neck swelling, and mediastinal mass mimicking lymphadenopathy was admitted to the Institute of Post Graduate Medical Education and Research and SSKM hospital, Kolkata, India. Clinical features, radiological studies, fibre optic bronchoscopy, and fine needle aspiration cytology from the neck swelling created a diagnostic dilemma until surgical resection and immunohistochemistry reports confirmed the diagnosis of multifocal epithelioid hemangioendothelioma, a rare vascular tumor with intermediate malignancy potential. Because it is a slow-progressing disease and due to the non-availability of standard chemotherapy, the patient, and her legal guardian, opted for palliative care only. She was asymptomatic for four years but again presented with hemoptysis, reappearance of the neck swelling on the same side, and a mediastinal mass compressing the superior vena cava and right pulmonary artery. This report describes the diagnostic problems and therapeutic challenges in the management of this rare tumor over a four-year follow-up period. The clinical course emphasizes the highly unpredictable nature of this tumor.

A Study of Depression in Adult Patients with Bronchial Asthma Presenting to a Tertiary Care Hospital in Eastern India.

BACKGROUND: Bronchial asthma is a serious global health problem. Depression, the most common mood disorder, is often found to be higher among people with chronic health conditions like bronchial asthma. METHODS: Patients with newly diagnosed to have bronchial asthma (n = 100) who fulfilled the study criteria were evaluated for depression with Beck Depression Inventory (BDI) score. Severity and level of bronchial asthma control were determined as per Global Initiative for Asthma (GINA) guidelines. Subjective asthma severity was assessed by Perceived Control of Asthma Questionnaire. Follow-up evaluation was done after three months of asthma management with the same study tools. RESULTS: In our study population, 65% asthma patients showed depression on first visit (95% Confidence interval [CI] 55.65-74.35). Correlation coefficient between subjective asthma severity and severity of depression was -0.945 (p < 0.001) while correlation coefficient between objective asthma severity and depression severity was 0.066 (p = 0.515). In follow-up visit after asthma management 63% patients still had depression (95% CI 53.54-72.46). Correlation coefficient between objective asthma control and depression severity was 0.1 (p = 0.320). Correlation coefficient between subjective asthma severity and severity of depression was -0.979 (p < 0.001). CONCLUSIONS: Our observational study suggests that depression is highly prevalent in asthma patients. There is a high inverse correlation between depression and patient's perception of asthma control. However, no significant correlation could be observed between objective measures of asthma severity and depression.

Oxcarbazepine induced maculopapular rash - a case report.

Unlike carbamazepine, newer anti epileptic drug like oxcarbazepine, reports fewer side effects. In this report we describe a case of oxcarbazepine induced maculopapular rash probably happened because of a drug interaction with isoniazid, and a brief review of the existing literature is presented herewith. A 40-year-old male patient received oxcarbazepine 300mg twice daily along with other anti-tubercular drugs including isoniazid (300mg) once daily since two days. Extensive cutaneous rash with intense itching developed which subsided on discontinuation of oxcarbazepine. This case highlights the fact that there is a potential possibility of drug-drug interaction between oxcarbazepine and isoniazid and concomitant use of these two drugs should better be avoided during clinical practice.

Spectrum of diffuse parenchymal lung diseases with special reference to idiopathic pulmonary fibrosis and connective tissue disease: An eastern India experience.

OBJECTIVE: To evaluate the clinical spectrum of diffuse parenchymal lung diseases (DPLD) encountered in the Indian setting and to compare idiopathic pulmonary fibrosis (IPF) and connective tissue disease associated DPLD (CTD-DPLD), the two commonest aetiologies. MATERIALS AND METHODS: A prospective study of clinical, imaging and laboratory parameters of patients diagnosed as DPLD and followed up in the Pulmonary Medicine Department of a tertiary-care teaching institution in eastern India was conducted over a period of one year. RESULTS: 92 patients of DPLD were diagnosed in the study period with IPF (n = 35, 38.04%), CTD-DPLD (n = 29, 31.5%), hypersensitivity pneumonitis (n = 10, 10.9%), sarcoidosis (n = 5, 5.4%) and silicosis (n = 5, 5.4%) being the common causes. The CTD-DPLD group had a lower mean age (39.5 ± 1.86 vs 56.9 ± 1.12 years), a longer duration of symptoms (3.5 ± 0.27 vs 2.5 ± 0.26 years), more extra pulmonary manifestations, significantly more base line FVC and 6-minute-walk-distance than the IPF patients. 19 patients of IPF (54%) opted for treatment. All the IPF patients had a significant fall in FVC after six months (mean change -0.203 ± 0.01 litres) compared to the CTD-DPLD group (mean change - 0.05 ± 0.04 litres.). CONCLUSION: CTD-DPLD patients belong to a younger age group, with longer duration of symptoms, more extrapulmonary features, better physiological parameters and better response to therapy than IPF patients. Larger prospective epidemiological studies and enrolment in clinical trials are necessary for better understanding of the spectrum of diffuse parenchymal lung disorders and their therapeutic options.

Erasmus Syndrome: A Case Report of Silicosis-induced Scleroderma in a 26-year-old Male.

Several occupational hazards especially exposure to silica have been implicated as causal factors for the development of scleroderma-like disorders. Many case reports have documented the co-existence of silicosis and progressive systemic sclerosis in the same patient, mostly from European countries and also from Japan and the United States. We report a case of a 26-year-old male involved in stone masonry who developed silicosis-induced diffuse parenchymal lung disease and systemic sclerosis after exposure to silica dust. To our knowledge, it is the second case to be reported from India.

Primary Lymphoepithelioma-like Carcinoma of the Lung in a 13 year old Girl.

Lymphoepithelioma-like carcinoma, a large cell carcinoma with pronounced lymphocyte infiltration, is a rare entity mostly seen in the nasopharynx. But primary pulmonary LELC in children & adolescents is extremely rare. Here we present a 13 year old girl with chief complaint of fever, cough, shortness of breath and heaviness in the left side of chest. She underwent left upper lobectomy. Histopathological examination of the biopsy specimen confirmed it to be a case of large cell carcinoma of lung, lymphoepithelioma type, invading pleura (stage pT3N0M0) with high serum titre of anti Epstein-Barr virus IgG antibody.

Squamous cell carcinoma lung with progressive systemic sclerosis.

Association between progressive systemic sclerosis (PSS) and lung malignancy is rare yet well recognised. In order of frequency bronchioloalveolar carcinoma (BAC) is most common followed by squamous cell carcinoma, oat cell carcinoma, anaplastic carcinoma of lung. We present a 55 year old non-smoker male patient with PSS, who presented to us with progressively increasing shortness of breath and dry cough. Initially clinico-radiologically he was provisionally diagnosed as a case of non-resolving pneumonia. Subsequent investigations revealed it is a case of squamous cell carcinoma of lung with PSS.

Effect of magnesium infusion on thoracic epidural analgesia.

INTRODUCTION: Patients of lung volume reduction surgery (LVRS) having an ASA status III or more are likely to be further downgraded by surgery to critical levels of pulmonary function. AIM: To compare the efficacy of thoracic epidural block with (0.125%) bupivacaine, fentanyl combination and (0.125%) bupivacaine, fentanyl combination with adjunctive intravenous magnesium infusion for the relief of postoperative pain in patients undergoing LVRS. METHODS: Patients were operated under general anesthesia. Thirty minutes before the anticipated completion of skin closure in both groups, (Group A and Group B) 7 ml of (0.125%) bupivacaine calculated as 1.5 ml/thoracic segment space for achieving analgesia in dermatomes of T4, T5, T6, T7, and T8 segments, along with fentanyl 50 µg (0.5 ml), was administered through the catheter, activating the epidural block, and the time was noted. Thereafter, in patients of Group A, magnesium sulfate injection 30 mg/kg i.v. bolus was followed by infusion of magnesium sulfate at 10 mg/kg/hr and continued up to 24 hours. Group B was treated as control. RESULTS AND ANALYSIS: A significant increase in the mean and maximum duration of analgesia in Group A in comparison with Group B (P<0.05) was observed. Total epidural dose of fentanyl and bupivacaine required in Group A was significantly lower in comparison with Group B in 24 hours. DISCUSSION: Requirement of total doses of local anesthetics along with opioids could be minimized by magnesium infusion; therefore, the further downgradation of patients of LVRS may be prevented. CONCLUSION: Intravenous magnesium can prolong opioid-induced analgesia while minimizing nausea, pruritus, and somnolence.