Quality of life with tuberculosis Aggarwal, Ashutosh N.
Journal of clinical tuberculosis and other mycobacterial diseases,
12/2019, Letnik:
17
Journal Article
Recenzirano
Odprti dostop
Tuberculosis diagnosis and treatment currently revolves around clinical features and microbiology. The disease however adversely affects patients’ psychological, economic, and social well-being as ...well, and therefore our focus also additionally needs to shift towards quality of life (QOL). The disease influences all QOL domains and substantially adds to patient morbidity, and these complex and multidimensional interactions pose challenges in accurately quantifying impairment in QOL. For this review, PubMed database was queried using keywords like quality of life, health status and tuberculosis, and additional publications identified by a bibliographic review of shortlisted articles. Both generic and specific QOL scales show a wide variety of derangements in scores, and results vary across countries and patient groups. In particular, diminished capacity to work, social stigmatization, and psychological issues worsen QOL in patients with tuberculosis. Although QOL has been consistently shown to improve during standard anti-tubercular therapy, many patients continue to show residual impairment. It is also not clear if specific situations like presence of comorbid illnesses, drug resistance, or co-infection with human immunodeficiency virus additionally worsen QOL in these patients. There is a definite need to incorporate QOL assessment as adjunct outcome measures in tuberculosis control programs. Governments and program managers need to step up socio-cultural reforms and health education, and provide additional incentives to patients, to counter impairment in QOL.
BACKGROUND Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is superior to conventional transbronchial needle aspiration (cTBNA) in the staging of lung cancer. However, ...its efficiency in diagnosis of sarcoidosis when combined with endobronchial biopsy (EBB) and transbronchial lung biopsy (TBLB) has not been studied. This randomized controlled trial compares diagnostic yield of EBUS-TBNA vs cTBNA in combination with EBB and TBLB. METHODS Patients with clinical diagnosis of sarcoidosis were randomized 1:1 to EBUS-TBNA or cTBNA. All patients underwent TBLB and EBB. The primary outcome was detection of granulomas. The secondary end points were the individual and cumulative yields of various procedures, serious adverse events, and procedure time. RESULTS Of the 130 patients, sarcoidosis was diagnosed in 117 (62 cTBNA, 55 EBUS-TBNA). The two groups were similar at baseline. Granulomas were demonstrated in 104 (53 cTBNA, 51 EBUS-TBNA) patients and were similar in two groups (85.5% vs 92.7%, P = .34). Individually, EBUS-TBNA had the highest yield (41 of 55, 74.5%), which was better than cTBNA (30 of 62, 48.4%, P = .004) or EBB (40 of 111, 36.3%, P < .0001) but not TBLB (78 of 112, 69.6%, P = .54). Adding EBB/TBLB to cTBNA led to an increase in granuloma detection, whereas the addition of TBLB (but not EBB) significantly enhanced the yield of EBUS-TBNA. The procedure time was significantly longer with EBUS-TBNA. No major adverse events occurred. CONCLUSIONS Individually, EBUS-TBNA has the highest diagnostic yield in sarcoidosis, but it should be combined with TBLB for the optimal yield. The diagnostic yield of cTBNA (plus EBB and TBLB) is similar to EBUS-TBNA plus TBLB. TRIAL REGISTRY ClinicalTrials.gov ; No.: NCT01908868; URL: www.clinicaltrials.gov
Summary Background and aim Real-time endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive technique for diagnosis of mediastinal lymphadenopathy. ...Although most studies have reported the utility of EBUS-TBNA in malignancy, its use has been extended to benign conditions including sarcoidosis. Herein, we perform a systematic review and meta-analysis of studies reporting the diagnostic yield and safety of EBUS-TBNA in sarcoidosis. Methods We searched the PubMed and EmBase databases for relevant studies published from 2004 to 2011, and included studies that have reported the diagnostic yield of EBUS-TBNA in sarcoidosis. The quality of studies was assessed using the QualSyst tool. We calculated the proportions with 95% confidence interval (CI) to assess the diagnostic yield of EBUS-TBNA in individual studies and then pooled the results using a random effects model. Heterogeneity was assessed using the I2 and Cochran-Q tests while publication bias was assessed using both graphical and statistical methods. Results Our search yielded 15 studies (553 patients of sarcoidosis). The diagnostic yield of EBUS-TBNA ranged from 54 to 93% with the pooled diagnostic accuracy being 79% (95% CI, 71–86%) by the random effects model. The yield was not statistically different in studies employing on-site cytological evaluation (80.1%) vs. those without (81.3%). However, the diagnostic yield was significantly higher in prospective studies (83.9%) vs. the retrospective studies (74.3%). Only five minor complications were reported in 553 patients. There was evidence of heterogeneity and publication bias. Conclusions EBUS-TBNA is a safe and efficacious procedure in the diagnosis of sarcoidosis, and should be routinely employed wherever available.
Whether itraconazole monotherapy is effective in the acute stage of allergic bronchopulmonary aspergillosis (ABPA) remains unknown. The goal of this study was to compare the efficacy and safety of ...itraconazole and prednisolone monotherapy in ABPA.
Treatment-naive subjects with ABPA complicating asthma (January 2012 to December 2013) were randomized to receive either oral itraconazole or prednisolone for 4 months. The study was not blinded. The primary outcomes were proportion of subjects exhibiting a composite response after 6 weeks, percent decline in IgE after treatment, and numbers of subjects experiencing exacerbation. The secondary outcomes included the time to first exacerbation, change in lung function, and treatment-related adverse effects.
A total of 131 subjects (prednisolone group, n = 63; itraconazole group, n = 68) were included in the study. The number of subjects exhibiting a composite response was significantly higher in the prednisolone group compared with the itraconazole group (100% vs 88%; P = .007). The percent decline in IgE after 6 weeks and 3 months and the number of subjects with exacerbations after 1 and 2 years of treatment were similar in the two groups. The time to first exacerbation (mean: 437 vs 442 days) and the improvement in lung function after 6 weeks was also similar in the two groups. The occurrence of side effects was significantly higher in the glucocorticoid arm (P < .001).
Prednisolone was more effective in inducing response than itraconazole in acute-stage ABPA. However, itraconazole was also effective in a considerable number and, with fewer side effects compared with prednisolone, remains an attractive alternative in the initial treatment of ABPA.
ClinicalTrials.gov; No.: NCT01321827; URL: www.clinicaltrials.gov).
Introduction: Allergic bronchopulmonary aspergillosis (ABPA) is a complex pulmonary disorder characterized by recurrent episodes of wheezing, fleeting pulmonary opacities and bronchiectasis. It is ...the most prevalent of the Aspergillus disorders with an estimated five million cases worldwide. Despite six decades of research, the pathogenesis, diagnosis and treatment of this condition remains controversial. The International Society for Human and Animal Mycology has formed a working group to resolve the controversies around this entity. In the year 2013, this group had proposed new criteria for diagnosis and staging, and suggested a treatment protocol for the management of this disorder. Since then, several pieces of new evidence have been published in the investigation and therapeutics of this condition.
Areas covered: A non-systematic review of the available literature was performed. We summarize the current evidence in the evaluation and treatment of this enigmatic disorder. We suggest modifications to the existing criteria and propose a new scoring system for the diagnosis of ABPA.
Expert commentary: All patients with asthma and cystic fibrosis should routinely be screened for ABPA using A. fumigatus-specific IgE levels. Glucocorticoids should be used as the first-line of therapy in ABPA, and itraconazole reserved in those with recurrent exacerbations and glucocorticoid-dependent disease.
Summary
Background
The role of recombinant A. fumigatus (rAsp) antigens in the diagnosis of allergic bronchopulmonary aspergillosis (ABPA) has not been systematically evaluated. Herein, we evaluate ...the utility of recombinant A. fumigatus (rAsp) antigens in diagnosing ABPA.
Methods
We systematically reviewed the PubMed, EmBase and Scopus databases for studies evaluating rAsp antigens in ABPA. The QUADAS‐2 tool and the GRADE approach were used to assess the risk of bias and the quality of evidence, respectively. The diagnostic performance of IgE or skin test against rAsp f1, f2, f3, f4, f6 and their combination was evaluated separately for ABPA complicating asthma or cystic fibrosis (CF), using an HSROC model. The reference standard for diagnosing ABPA was the composite (clinical, radiological, immunological) criteria.
Results
Our search yielded 26 studies (n = 1694) and 17 studies (n = 1131) for inclusion in the systematic review and meta‐analysis, respectively. In asthmatics, the pooled sensitivity for diagnosing ABPA was best for IgE against a combination of rAsp f1 or f3 (96.7%; 95% confidence interval CI, 87.6‐99.2). The pooled specificity for diagnosing ABPA was highest (99.2%; 95% CI, 88.2‐99.9) for IgE against a combination of f4 or f6. In CF patients, the pooled sensitivity of rAsp f1 or f3 was 93.3% (95% CI, 55.2‐99.9) while the pooled specificity of rAsp f4 or f6 was 93.9% (95% CI, 68.8‐99.9). The quality of evidence was low as per the GRADE approach.
Conclusions
A combination of IgE against rAsp antigens (f1, f2, f3, f4 and f6) is likely to be helpful in the diagnosis of ABPA.
Foreign body aspiration is an uncommon entity in adults. Herein, we describe our experience with flexible bronchoscopy in the removal of tracheobronchial foreign bodies in adults. We also conducted a ...systematic review of the literature on the topic of foreign body inhalation in adults managed with flexible bronchoscopy.
The bronchoscopy database (from 1979 to 2014) was reviewed for subjects > 12 y of age with a history of foreign body aspiration managed with flexible bronchoscopy. Demographic, clinical, and bronchoscopy data were collected and analyzed. PubMed was reviewed for studies describing the use of flexible bronchoscopy for foreign body extraction in adults.
During the study period, a total of 25,998 flexible bronchoscopies were performed. Of these, 65 subjects (mean age of 32.8 y, 49 males) were identified who had undergone bronchoscopy for foreign body aspiration. Nonresolving pneumonia (30.6%), direct foreign body visualization (24.6%), and segmental collapse (18.4%) were the most common radiological abnormalities. Foreign bodies were identified in 49 cases during bronchoscopy and successfully removed in 45 (91.8%) subjects with no major complications. Metallic (41%) and organic (25.6%) foreign bodies were the most common. Shark-tooth (44.9%) and alligator (32.6%) were the most commonly used forceps in retrieving the foreign bodies. The systematic review yielded 18 studies (1,554 subjects with foreign body inhalation). In adults, the proportion of flexible bronchoscopy (6 studies, 354/159,074 procedures) performed for the indication of foreign bodies among the total flexible bronchoscopies was 0.24% (95% CI 0.18-0.31). The overall success of flexible bronchoscopy (18 studies, 1,185 subjects) for foreign body extraction was 89.6% (95% CI 86.1-93.2).
Foreign body aspiration is a rare indication for flexible bronchoscopy in adults. Flexible bronchoscopy has a high success rate in removal of inhaled foreign body and can be considered the preferred initial procedure for management of airway foreign bodies in adults.
Transbronchial lung biopsy with flexible forceps is the most commonly used technique in diagnosis of diseases diffusely involving the lung parenchyma. Recently, transbronchial lung biopsy using the ...flexible cryoprobe (cryo-transbronchial lung biopsy) has also been reported. Herein, we perform a systematic review and meta-analysis describing the efficacy and safety of cryo-transbronchial lung biopsy.
The PubMed and EMBASE databases were searched for studies reporting the outcomes of cryo-transbronchial lung biopsy in subjects with diffuse parenchymal lung involvement. The quality of individual studies was assessed using the QualSyst tool. The pooled diagnostic yield of cryo-transbronchial lung biopsy was calculated using proportion meta-analysis (random effects model). Heterogeneity was evaluated using the I(2) test and Cochran Q test. Publication bias was determined using both statistical and graphical methods.
Our search yielded 14 studies (1,183 subjects). The pooled diagnostic yield of cryo-transbronchial lung biopsy was 76.9% (95% CI 67.2-85.3) if only definitive diagnoses were considered and 85.9% (95% CI 78.2-92.2) if both definitive and probable diagnoses were considered. Four studies (321 subjects) the performance of flexible forceps biopsy and cryo-transbronchial lung biopsy. The diagnostic yield of cryo-transbronchial lung biopsy (86.3, 95% CI 80.2-90.8) was significantly higher than that of flexible forceps biopsy (56.5%, 95% CI 27.5-83.2) with an odds ratio of 6.7 (95% CI 3.6-12.4) and a number needed to treat of 4. Lung tissue was obtained in 98% of all samples with cryo-transbronchial lung biopsy and was free of compression artifacts. The size of samples obtained with cryo-transbronchial lung biopsy was significantly bigger compared with flexible forceps biopsy (20.4 vs 4.3 mm(2), P = .005). The complications of cryo-transbronchial lung biopsy included pneumothorax (6.8%), severe bleeding (0.3%), and death (0.1%). Clinical and statistical heterogeneity was present, and there was evidence of publication bias.
Cryo-transbronchial lung biopsy is a relatively safe procedure with good diagnostic yield in diseases diffusely involving the lung parenchyma.
Objective The differential diagnosis of sarcoidosis and tuberculosis is difficult, especially in countries with a high tuberculosis burden. We hypothesized that sonographic features on endobronchial ...ultrasonography (EBUS) would help in differentiating tuberculosis from sarcoidosis. In this study, the endosonographic features of tuberculosis and sarcoidosis are compared. Methods This was a retrospective analysis of prospectively collected data of patients with intrathoracic lymphadenopathy who underwent EBUS-guided transbronchial needle aspiration (TBNA), and were finally diagnosed with sarcoidosis or tuberculosis. Sonographic features such as size, shape (round or oval), margin (distinct or indistinct), echogenicity (heterogeneous or homogeneous), presence or absence of a central hilar structure, and coagulation necrosis sign were recorded and compared in the 2 groups. Results During the study period, 249 EBUS-guided TBNA procedures were performed and a diagnosis of sarcoidosis (n = 118) or tuberculosis (n = 47) was made in 165 patients. A total of 358 lymph node stations were examined. Heterogeneous echotexture (53.4% vs 12.6%, P < .001) and coagulation necrosis (26.1% vs 3.3%; P < .001) were significantly higher in tuberculous lymph nodes. A combination of a positive tuberculin skin test (TST) and either heterogeneous echotexture or coagulation necrosis sign had specificity of 98% and positive predictive value of 91% for a diagnosis of tuberculosis. Conclusions Sonographic features of heterogeneous echotexture or coagulation necrosis in the lymph nodes on EBUS are fairly specific for tuberculosis. Along with a positive TST, these features strongly favor a diagnosis of tuberculosis over sarcoidosis.
The problem of determining the location and orientation of straight lines in images is of great importance in the fields of computer vision and image processing. Traditionally the Hough transform, (a ...special case of the Radon transform) has been widely used to solve this problem for binary images. In this paper, we pose the problem of detecting straight lines in gray-scale images as an inverse problem. Our formulation is based on use of the inverse Radon operator, which relates the parameters determining the location and orientation of the lines in the image to the noisy input image. The advantage of this formulation is that we can then approach the problem of line detection within a regularization framework and enhance the performance of the Hough-based line detector through the incorporation of prior information in the form of regularization. We discuss the type of regularizers that are useful for this problem and derive efficient computational schemes to solve the resulting optimization problems enabling their use in large applications. Finally, we show how our new approach can be alternatively viewed as one of finding an optimal representation of the noisy image in terms of elements chosen from a dictionary of lines. This interpretation relates the problem of Hough-based line finding to the body of work on adaptive signal representation.
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