Colistin is used to treat hospital-acquired pneumonia and ventilator-associated pneumonia. However, direct drug deposition at the site of infection may improve its efficacy and reduce systemic ...exposure. The aim of this study was to assess the safety and tolerability of nebulized colistin among Indian patients diagnosed with pneumonia caused by multidrug-resistant gram-negative bacilli in real-world settings.
We retrospectively reviewed the medical records of patients treated with nebulized colistin for pneumonia. We assessed the adverse events and relevant abnormal laboratory findings of nebulized colistin therapy.
All enrolled patients (N=30, males: 22, females: 8; average age: 71.06 years) were treated for 13.36 days. Almost 80% of patients had a history of shortness of breath, which was a major symptom when they were admitted to the hospital. The patients were administered nebulized colistin for an average of six days (8 hours per day). The most common dosing schedule was 1 million international units (MIU)/8 hours. No serious adverse event was observed, and only one patient died while on the treatment but the death was not related to colistin treatment. The average sequential organ failure assessment score for all patients was 6.5.
Our study demonstrated the efficient clinical utility and well-tolerated safety profile of nebulized colistin in the treatment of patients with pneumonia. Neurotoxicity and nephrotoxicity were not reported. Since a significant percentage of patients were with chronic respiratory diseases, our study further indicates the safety and effectiveness of nebulized colistin in chronic obstructive pulmonary disease (COPD) patients too.
Efficacy and safety of nintedanib in idiopathic pulmonary fibrosis (IPF) has been established by multiple clinical trials. This study aims to assess the efficacy and safety of nintedanib in ...real-world IPF patients in India.
Clinical records of IPF patients (prescribed with nintedanib) visiting tertiary pulmonary care center, between June 2016 and December 2019, were analyzed retrospectively. Data were analyzed for forced vital capacity (FVC), Diffusing capacity of lung for carbon monoxide(DLCO), 6-min walk distance (6-MWD). Acute exacerbations and adverse events were also analyzed.
A total of 76 IPF patients were prescribed with nintedanib. Drug was prescribed at 100 and 150 mg BD dose to 37 and 39 patients. Ten patients (13.1%), of which eight were over the age of 60 years, died during the study period. Only 42 patients visited for follow-up. Mean baseline FVC was 1.67 L and mean annualized absolute change in FVC and FVC % predicted was -0.07 L and -1.80%, respectively. Mean baseline DLCO was 37.21% and mean annualized absolute change in DLCO % predicted was-2.20%. At follow-up, 1 (2.38%), 17 (40.47%), and 24 (57.14%) patients were at Deparatment of Internal Medicine stage I, II, and III, respectively. Acute exacerbations and adverse events were reported by 48 and 6 patients, respectively.
Our results support the findings from previous studies, that nintedanib leads to annual decline in parameters such as FVC and DLCO and increased 6-MWD. It was found to be well tolerated in the Indian patients with IPF.
The present work reports the structural, electrical and magnetic properties of W
6+
and Mo
6+
substituted four-layer Aurivillius compound, Bi
5
FeTi
3
O
15
(BFTO). The oxidation states of the dopants ...and other elements of BFTO are studied from x-ray photo-electron and
57
Fe Mössbauer spectroscopy. The substitution resulted in a net increase of magnetic cation (Fe
3+
) from 25% to about 37.5% in BFTO. However, the magnetization measurements indicate the lack of magnetic ordering even down to 2 K. Further, the high temperature (300-1070 K) dielectric study of these compounds reveal the ferroelectric transition temperature decreases with the increase of magnetic cations in BFTO because of hexavalent W
6+
and Mo
6+
substitution at Ti
4+
site.
Amyloidosis is an uncommon heterogeneous and multi‐systemic disease characterized by extracellular amyloid deposition. The size of proteins varies and forms a part of local disease or systemic ...process. Light chain amyloidosis (AL) is the most prevalent form of systemic amyloidosis which may also be seen in localized disease. Isolated tracheobronchial amyloidosis (TBA) is rather unusual with local amyloid deposition which may pose a diagnostic dilemma with subsequent therapeutic challenge. Awareness of such a presentation is crucial in the diagnosis of this rare disease. We describe three cases who presented with haemoptysis, which on further evaluation were diagnosed as isolated TBA, and a review of literature.
We describe three cases who presented with haemoptysis, which on further evaluation were diagnosed as isolated tracheobronchial amyloidosis, and a review of literature.
Gastrointestinal Stromal Tumours (GISTs) are rare but remain the most common mesenchymal tumour of the Gastrointestinal tract (GIT). The asynchronous occurrence of other malignancies in patients with ...GIST during the clinical course is relatively common. However, the synchronous coexistence of GIST and lung cancer has only rarely been reported. We report the case of a 65-year-old male, a former smoker, who was diagnosed with synchronous occurrence of mesenteric GIST and Primary Large Cell Neuroendocrine Cancer (LCNEC) of the lung. There are few case reports on synchronous occurrence of GIST with primary lung cancer but till date no case report exists on GIST with primary LCNEC of lung.
Bronchogenic carcinoma usually presents as a mass lesion associated with variable degrees of lung collapse and associated effusion. Although primaries from other sites such as thyroid, ...choriocarcinoma, and sarcomas may present as miliary mottling, bronchogenic carcinoma presenting this way is uncommon. We present here the case of a 62-year-old housewife, who presented with bilateral miliary shadows on chest radiography and was treated for pulmonary tuberculosis on the basis of history and radiological findings. As the disease advanced, the diagnosis of primary adenocarcinoma of the lung was made.
The most common cause of asymptomatic anterior mediastinal mass in young patient is thymoma. We present an unusual case of asymptomatic anterior mediastinal mass in a young male who was incidentally ...discovered to have aggressive precursor T-cell adult lymphoblastic lymphoma (T-ALL). Routine bronchoscopy and transthoracic needle aspiration were noncontributory, and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) provided the adequate amount of tissue for histopathology and immunohistochemistry, thus establishing the diagnosis of T-ALL. Our case highlights T-cell lymphoma as a cause of silent anterior mediastinal mass and the potential role of EBUS-TBNA as safe and relatively less invasive modality to obtain tissue for pathological diagnosis and saved the patient from potential thoracotomy/mediastinoscopy.
Pulmonary mucormycosis is a life-threatening opportunistic fungal infection. It is considered as a disease of immunocompromised state and is rarely seen in immunocompetent patients. We here report a ...case of refractory bronchovascular pleuropulmonary mucormycosis, who despite early detection, optimal management with liposomal amphotericin B, and posaconazole therapy followed by surgery, progressed further and led to a fatal outcome. Dual antifungal therapy combined with surgery is the only definitive treatment option available in the literature. Many new therapeutic options for mucormycosis treatment have become available but none have shown promising results, and larger studies are required to assess their efficacy.
Literature on concurrent association of sarcoidosis with lymphoproliferative malignancies other than lymphoma e.g. multiple myeloma is meager. The rarity of the situation prompted us to report this ...patient who was a 51-year-old woman with a 2-years history of breathlessness, cough with expectoration, chest pain and backache. Initial evaluation revealed mild anemia, increased alkaline phosphatase with chest skiagram showing both lower zone non homogenous opacities with calcified hilar lymph nodes. CECT chest showed mediastinal with bilateral hilar lymphadenopathy, parenchymal fibrosis, traction bronchiectasis, ground glass opacities, septal and peribronchovascular thickening affecting mid and lower lung zones bilaterally. MRI Dorsolumbar spine was suggestive of marrow infiltrative disorder. EBUS FNA of intrathoracic nodes, EBB and TBLB confirmed sarcoidosis. PET CT revealed hyper metabolic activity in lung, multiple lymph nodes and lytic bone lesions. Serum protein electrophoresis and immunofixation revealed a monoclonal paraprotein, immunoglobulin IgG kappa type. Bone marrow biopsy revealed an increase in plasma cells (15%), but no granulomas. Diagnosis of Indolent or multiple myeloma with sarcoidosis was established. 12 cases of sarcoidosis and multiple myeloma have been reported in literature, and mostly preceding the onset of multiple myeloma by many years, in our case both were diagnosed concurrently.
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