呼吸器・呼吸器内科

Introduction: Lung cancer is the most commonly diagnosed cancer and leading cause of cancer related death worldwide. Ultimate determinant of patient management lies on histopathological evaluation of the disease process. Immunohistochemistry extends to the determination of cell lineage, determining the primary site of tumour origin and contributing to decisions on prognosis and targeted treatment. The proliferative activity of Ki-67 immuno-staining on biopsy specimens is known to be a valuable prognostic factor.
Aims and objective: To study clinicoradiological correlation with different histological type of bronchogenic carcinoma by different diagnostic modalities to establish diagnosis and to study immunomarker KI-67 in different histological type of lung cancer.
Materials and methods: The study was conducted in the Department of Pulmonary Medicine, SCB Medical College, and Cuttack in collaboration with Department of Pathology during the period May 2016 to December 2017.50 patients of various age groups with strong clinical suspicion and/or chest radiographic diagnosis of lung cancer were included in this study from IPD of Pulmonary Medicine. Patient having known coagulopathy, history of recent myocardial infarction and unwilling to give consent were excluded from the study.
Discussion: The present study constituted 31 males (62%) and 19 females (38%) out of the total 50 with a M: F ratio of 1.63:1. Cough (74%) was the most common symptoms followed by breathlessness (56%) and chest pain (52%). Pallor (44%) and clubbing (28%) most commonly seen followed by lymphadenopathy. The most common radiological presentation was mass lesion (52%) followed by combined presentation (44%) and collapseconsolidation (40%). Various diagnostic modalities used were fibre-optic bronchoscopy with biopsy (42.6%) followed by thoracoscopy and biopsy (23.4%). Evaluated biopsy specimen showed definite malignancy in 80%, inflammatory lesions in 8%, tuberculosis in 2%, fungal in 2% and inconclusive in 8% cases. Adenocarcinoma (45%) followed by Squamous cell Carcinoma (40%) were most commonly evaluated malignant lesions. Squamous cell carcinoma is associated with high Tumor Proliferative Fraction (TPF) with higher mean ki-67% value (46.5%) followed by small cell carcinoma (33.3%) and adenocarcinoma (28.2%).
Conclusion: Clinico-radiological examination along with histopathological evaluation of bronchogenic carcinoma is always necessary for accurate diagnosis, which help in proper sub-classification of tissue type in right clinical context. Immuno-histochemical markers help in subtyping the poorly differentiated carcinomas and predicting clinical evolution and response to treatment. Ki-67 antigen expression is useful to elaborate a therapeutic strategy before surgery or, alternatively, could be relied on to select chemotherapy protocols in non resectable lung carcinomas.

Background: Chronic Obstructive Pulmonary Disease (COPD) is not only a disease of lungs but is also associated with significant extra-pulmonary effects. Metabolic syndrome (MS) and associated cardiovascular morbidity and mortality are more frequent in COPD.
Objective: To study the prevalence of MS in hospitalised COPD patients. To compare their clinical characteristics with presence of MS. To correlate the presence of MS with GOLD spirometric severity and ABCD groups.
Methods: With a cross-sectional design, 100 hospitalised COPD patients were studied. They were asked about history, subjected to clinical examination and investigations to screen for MS and comorbidities. MS was identified using modified NCEP-ATPIII criteria and COPD was diagnosed based on GOLD guidelines 2017. They were classified based on spirometric grading and combined ABCD assessment. Being hospitalised patients, all subjects were either in group B or group D.
Results: MS was found in 40% of COPD patients. Patients with coexisting MS had more number of exacerbations (mean 2.50 vs. 2.03), prior history of hospitalisation (37.5% vs. 30%), longer duration of hospitalisation (7.25 vs. 4.73 days) and higher prevalence of comorbidities like diabetes and hypertension, as compared to those with COPD alone. The prevalence of MS decreased with increasing spirometric severity, with highest prevalence in mild obstruction (66.7%). Prevalence of MS was higher in group D patients as compared to group B (48.4% vs. 25%).
Conclusion: The presence of MS is frequent in hospitalised COPD patients and is associated with adverse clinical parameters. It is more common in earlier spirometric grades and Group D patients. Hence, this population should be considered for screening for MS.

Air pollution has a major impact on respiratory health. We conducted this study with the aim of correlating the levels of pollutants measured by the AQMC with the different respiratory manifestations reported in health facilities in Dakar (Senegal). Descriptive and analytical cross-sectional study conducted in Dakar from 2011 to 2016 to correlate pollution levels with respiratory manifestations. During the six years, 342203 patients were received for respiratory manifestations of which 61.81% had upper airway disease. Cough related or preceded by a cold predominated among the lower respiratory manifestations with 42.49% of cases. Peaks of gaseous pollution were consistently noted in the first and last quarters of each year. The prevalence of respiratory manifestations was strongly correlated with pollutant levels. Air pollution is permanent with peaks during the dry season. It has a negative impact on respiratory health. This justifies the need for multisectoral policies at different scales of decision.