An early Indian experience with benralizumab - A compendium on severe asthma cases: a case series.

Background: Severe eosinophilic asthma (SEA), one of the phenotypes of asthma that is characterized by elevated blood eosinophil counts, is a common cause of uncontrolled asthma. Patients with SEA often experience severe persistent symptoms and have frequent exacerbations despite optimal inhaler therapy. They also have poor lung function and quality of life (QoL). Benralizumab (Fasenra), a monoclonal antibody, has been approved for managing cases of SEA. This series of six cases, the first of its kind from India, aims to add to the real-world evidence of benralizumab in India. Methods: Benralizumab 30 mg (once in four weeks for the first three doses followed by a dose every eight weeks for two years) was administered in six patients with symptoms of cough, breathlessness on exertion, and wheezing, diagnosed with SEA. The following were the endpoints assessed: (i) overlap between high immunoglobulin E (IgE) and eosinophilic asthma; (ii) reduction of exacerbations; (iii) withdrawal of oral corticosteroids; and (iv) improvement in lung function and QoL. Results: In all cases, management with benralizumab resulted in optimal clinical and functional improvement, a decline in systemic steroid use, and improved QoL. Conclusions: The cases presented here are the first of their kind in the Indian asthmatic population with all SEA patients demonstrating significant improvement in symptoms with the use of benralizumab.

Bronchial thermoplasty for severe asthma: A position statement of the Indian chest society.

Bronchial thermoplasty (BT) is an interventional bronchoscopic treatment for severe asthma. There is a need to define patient selection criteria to guide clinicians in offering the appropriate treatment options to patients with severe asthma. METHODOLOGY: An expert group formed this statement under the aegis of the Indian Chest Society. We performed a systematic search of the MEDLINE and EMBASE databases to extract evidence on patient selection and the technical performance of BT. RESULTS: The experts agreed that the appropriate selection of patients is crucial and proposed identification of the asthma phenotype, a screening algorithm, and inclusion/exclusion criteria for BT. In the presence of atypical clinical or chest radiograph features, there should be a low threshold for obtaining a thoracic computed tomography scan before BT. The patient should not have had an asthma exacerbation in the preceding two weeks from the day of the procedure. A 5-day course of glucocorticoid should be administered, beginning three days before the procedure day, and continued until the day following the procedure. General Anesthesia (total intravenous anesthesia with a neuromuscular blocker) provides ideal conditions for performing BT. A thin bronchoscope with a 2.0 mm working channel is preferable. An attempt should be made to deliver the maximum radiofrequency activations. Middle lobe treatment is not recommended. Following the procedure, overnight observation in the hospital, and a follow-up visit, a week following each treatment session, is desirable. CONCLUSION: This position statement provides practical guidance regarding patient selection and the technical performance of BT for severe asthma.

First-line management of metastatic non-small cell lung cancer: An Indian perspective.

Lung cancer has been the most common cancer in the world for several decades. The non-small cell lung cancer (NSCLC) constitutes approximately about 80% of the total cases of lung cancer. Therapeutic interventions in NSCLC have shifted to the target-based approach from histology-based approach, and this has completely changed the face of the management of NSCLC. Developing countries, such as India, have very limited data compiled about the prevalence and treatment practices of lung cancer, despite a large burden of the disease. However, in recent times, there has been a lot of data generated in this regard. This article is an attempt to collate and shine light on the available data for the first-line treatment of NSCLC in India keeping in mind the current standards of care in this area.

Splenic and lymph nodal involvement in sarcoidosis mimicking lymphoma on fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography.

Sarcoidosis is a multisystemic disease presenting with well-defined, bilateral, symmetric hilar and right paratracheal lymph node enlargement. Recently, fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (F-18 FDG PET/CT) has been used to stage and detect occult site of active inflammation in sarcoidosis. F-18 FDG PET/CT has become a cornerstone imaging modality in the modern lymphoma management, which can present with generalized lymphadenopathy including mediastinal. We present a case series, which shows how sarcoidosis can be a "great mimic of lymphoma" on F-18 FDG PET/CT and how histopathology is essential in diagnosing sarcoidosis and ruling out lymphoma.

Ocular sarcoidosis: does (18)F-FDG PET/CT have any role?

Sarcoidosis is a multisystemic disease, which may affect almost any organ including the eyes. Recently, F-FDG PET/CT has proved to be a very useful molecular imaging method allowing to obtain a complete morphofunctional cartography of active inflammatory sites and to assess treatment response in patients with sarcoidosis. We report 2 cases of sarcoidosis where F-FDG PET/CT showed intense FDG uptake in the eye globes along with multiple enlarged mediastinal lymph nodes suggestive of active sarcoidosis with ocular involvement.

Low serum PON1 activity: an independent risk factor for coronary artery disease in North-West Indian type 2 diabetics.

The paraoxonase (PON1) gene polymorphisms are known to affect the PON1 activity and coronary artery disease (CAD) risk. Studies done so far have given conflicting results. In the present study, we determined the role of PON1 genetic variants and PON1 activity in the development of CAD in North-West Indian Punjabis, a distinct ethnic group, having high incidence of both CAD and type 2 diabetes. 300 angiographically proven CAD with type 2 diabetics and 250 type 2 diabetics with no clinically evident CAD were enrolled. Serum PON1 activity and genotyping of coding (Q192R, L55M) and promoter (-909G/C, -162A/G, -108C/T) region polymorphisms were carried out and haplotypes were determined using PHASE software. The serum PON1 activity was significantly lower in CAD with type 2 diabetics as compared to diabetics alone (51.0 vs. 114.2nmol/min/ml). In logistic regression model after adjusting for confounding variables, lower PON1 activity was found to be significantly associated with CAD risk in type 2 diabetics with OR being 16.8 (95% CI: 10.2-27.7). The lower serum PON1 activity, irrespective of genotypes and haplotypes is a risk factor for development of CAD in North-West Indian Punjabis with type 2 diabetics.

Role of gastric bypass in patients with unresectable advanced carcinoma of stomach.

CONTEXT: Role of bypass as a palliative surgery for advanced gastric cancer remains controversial. AIMS: To determine the role of bypass in advanced gastric cancer in comparision to resection as gold standard. DESIGN: Hospital-based retrospective outcome as study. METHODS: Patients were divided into three groups: group I (gastric resection), group II (bypass) and group III (exploratory laparotomy alone). The three groups were analysed for palliation of symptoms, operative morbidity and mortality and survival. STATISTICAL ANALYSIS USED: Chi-square, Fischer, One-way Anova, Unpaired-t, Kaplan-Meier analysis. RESULTS: In-hospital morbidity was 19.38% (19 patients) for the entire study group. Bypass group had a lower morbidity rate as compared to the resection group (p=0.029). In-hospital mortality rate was 6.12% (6 patients) for the entire study group. Mortality rates did not differ between the groups. Patient satisfaction with palliation of symptoms was similar between gastric bypass and resection. Gastric resection group had significantly better survival (p=0.002) compared to the nonresective procedures. However, gastric bypass did not confer any survival benefit over exploratory laparotomy (p=0.501). CONCLUSIONS: Gastric bypass can be done when resection is not possible as it palliates symptoms on par with resection and is associated with low operative morbidity though it does not improve the survival outlook of patients.

Role of gastric bypass in patients with unresectable advanced carcinoma of stomach.

CONTEXT: Role of bypass as a palliative surgery for advanced gastric cancer remains controversial. AIMS: To determine the role of bypass in advanced gastric cancer in comparision to resection as gold standard. DESIGN: Hospital based retrospective outcome study METHODS: Patients were divided into three groups: group I (gastric resection), group II (bypass) and group III (exploratory laparotomy alone). The three groups were analysed for palliation of symptoms, operative morbidity & mortality and survival. STATISTICAL ANALYSIS USED: Chi-square, Fischer, One-way Anova, Unpaired-t, Kaplan-Meier analysis RESULTS: In-hospital morbidity was 19.38% (19 patients) for the entire study group. Bypass group had a lower morbidity rate as compared to the resection group (p=0.029). Inhospital mortality rate was 6.12% (6 patients) for the entire study group. Mortality rates did not differ between the groups. Patient satisfaction with palliation of symptoms was similar between gastric bypass and resection. Gastric resection group had significantly better survival (p=0.002) compared to the non resective procedures. However, gastric bypass did not confer any survival benefit over exploratory laparotomy. (p=0.501)kw]Conclusions Gastric bypass can be done when resection is not possible as it palliates symptoms on par with resection and is associated with low operative morbidity though it does not improve the survival outlook of patients.