Efficacy of plasma vascular endothelial growth factor in monitoring first-line chemotherapy in patients with advanced non-small cell lung cancer

Background: Along with the development of new cancer therapeutics, more effective tools for the estimation of response to therapy and prediction of disease progression are required for the better management of inoperable cancer patients. Methods: We studied 134 newly diagnosed and primarily untreated advanced non-small cell lung cancer patients and 100 controls. Forty two patients received platinum-based chemotherapy. Plasma VEGF levels were quantified in all samples at baseline and also before second and third chemotherapy cycle in 42 patients and correlated with response to therapy as assessed by computed tomography after the third chemotherapy cycle. Results: We observed that, patients who went into remission had significantly lower baseline VEGF levels before second and third cycles of chemotherapy when compared with patients with no change and progression. Plasma VEGF levels showed a greater decrease from cycle 1 to 2 and from cycle 1 to 3 in patients who showed remission in comparison to those with no change or progression. Plasma VEGF levels before the second cycle detected poor response to therapy with a sensitivity and specificity of 76.9% and 75.0%, respectively (area under the ROC curve = 0.724). Early prediction of disease progression was achieved with a sensitivity and specificity of 71.4% for plasma VEGF before cycle 2 (area under the ROC curve = 0.805). The kinetics of VEGF form cycle 1 to 2 and cycle 1 to 3 also gave significant information for predicting disease progression as well as insufficient therapy response. Conclusion: Monitoring of plasma VEGF levels during the course of first-line chemotherapy could identify patients who are likely to have insufficient response to therapy and disease progression at an early stage. This may help in individualizing treatment and could lead to better management of the advanced stage lung cancer

Prevalence of pulmonary tuberculosis in young adult patients with type 1 diabetes mellitus in India

Background: There is limited information on Prevalence of Pulmonary Tuberculosis (PTB) in patients with type-1-diabetes. We assessed the prevalence of PTB in patients with type-1-diabetes attending the outpatient-clinic in a tertiary-care hospital. Methods: 151 patients with type-1-diabetes were screened for PTB by clinical examination and chest-radiography. Sputum Acid-Fast Bacilli Test (AFB) and Mycobacterium tuberculosis (M. tb) culture were performed in patients with clinical and radiological features suggestive of a possibility of PTB and also in those with history of PTB in the past. Their average glycated haemoglobin (HbA1c) during preceding 2 years was assessed. Sputum culture positive patients were managed by a pulmonologist. Results: 5/151 patients had respiratory symptoms and radiographic findings suggestive of PTB. 20/151 patients were asymptomatic but had history of PTB. Four of the five symptomatic patients and 12 with past PTB were positive for sputum M. tb by culture, giving a prevalence of 10.6% sputum culture positive in type-1-diabetes. Average HbA1c was comparable in patients with and without positive sputum culture. ESR and Mantoux test were not discriminatory in these groups. Four clinically symptomatic M. tb culture positive and four asymptomatic patients with sputum culture positive for M. tb on two occasions (6 weeks apart) were put on Antitubercular Treatment (ATT). Patients who were culture positive for M. tb only on one occasion were kept on a close follow up. Conclusions: Patients with type-1-diabetes mellitus in India have high prevalence of PTB. They need to be actively screened for PTB by sputum M. tb culture in order to initiate early treatment and to prevent transmission in the community

Simultaneous presentation of pulmonary tuberculosis and lung cancer: experience from a regional cancer centre

Background: Prevalence of pulmonary tuberculosis is very high in India. Lung cancer is the most common cancer in males in Delhi and because of close similarity in clinical and radiological features of lung cancer and tuberculosis many of lung cancer patients have had received empirical anti tubercular treatment (ATT) before a diagnosis of lung cancer was established. True incidence of pulmonary tuberculosis in lung cancer is not known. Tuberculosis in lung cancer may get reactivated following chemotherapy and/or radiation therapy. Simultaneous presentation of tuberculosis and lung cancer independent of treatment with immunosuppresants, however, is rare. Material and Methods: At our center we evaluated records of 580 lung cancer patients seen over a period of 5 years to see incidence of pulmonary tuberculosis in lung cancer. Patients who had been worked up for pulmonary tuberculosis like sputum or bronchoalveolar lavage (BAL) for AFB smear or culture were identified. Results: Two hundred and ninety eight of these patients were worked up for pulmonary tuberculosis. Twelve patients in the present study had documented evidence of simultaneous existence of pulmonary tuberculosis (acid fast bacilli positive sputum and or culture positivity) and lung cancer. Radiologically, no separate active tubercular lesion was identified except in one patient who had left upper zone fibro parenchymal lesion. Fibrosis and calcification on chest X-rays (CXR) suggestive of old tuberculosis were evident in 7 patients. Eight patients died of progressive lung cancer within 3 months of diagnosis, 4 patients became acid fast bacilli (AFB) negative after 2 months of anti tubercular therapy. Diagnosis of lung cancer was delayed in 4 patients as they were receiving anti tubercular therapy after detection of AFB in sputum. Conclusion: Recognition of tuberculosis is important not only because it is curable but also due to the fact that its presence interferes with radiological assessment to chemotherapy and radiotherapy. Sputum acid fast smear may be done more frequently in patients of lung cancer in countries where tuberculosis has high prevalence. The true incidence may be still higher and newer techniques e.g. PCR based and others may help in knowing true incidence of co existence of lung cancer and pulmonary tuberculosis

Concurrent infections by all four dengue virus serotypes during an outbreak of dengue in 2006 in Delhi, India

<p>Abstract</p> <p>Background</p> <p>Co-circulation of multiple dengue virus serotypes has been reported from many parts of the world including India, however concurrent infection with more than one serotype of dengue viruses in the same individual is rarely documented. An outbreak of dengue hemorrhagic fever/dengue shock syndrome (DHF/DSS) occurred in and around Delhi in 2006. This is the first report from India with high percentage of concurrent infections with different dengue virus serotypes circulating during one outbreak.</p> <p>Results</p> <p>Acute phase sera from patients were tested for the presence of dengue virus RNA by RT-PCR assay. Of the 69 samples tested for dengue virus RNA, 48 (69.5%) were found to be positive. All the four dengue virus serotypes were found to be co-circulating in this outbreak with DENV-3 being the predominant serotype. In addition in 9 of 48 (19%) dengue virus positive samples, concurrent infection with more than one dengue virus serotype were identified.</p> <p>Conclusion</p> <p>This is the first report in which concurrent infections with different dengue virus serotypes is being reported during an outbreak from India. Delhi is now truly hyperendemic for dengue.</p

Acute hypoxemia due to lung collapse in COVID-19: the role of therapeutic bronchoscopy

Bronchoscopy is an aerosol-generating procedure and involves a high risk of transmission of SARS-CoV-2 to health care workers. There are very few indications for performing bronchoscopy in a patient with confirmed COVID-19. These include atelectasis, foreign body aspiration, and suspected superinfection in immunocompromised patients. Proper use of standard personal protective equipment is mandatory to reduce the risk of transmission to health care workers. In this article, we describe a case of acute lung collapse in a 16-year-old boy with cerebral palsy who was infected with COVID-19. This patient responded to therapeutic bronchoscopy and had complete resolution of lung collapse within 24 hours of the procedure

Candidate immunomodulators for COVID-19: Heat-killed Mycobacterium w and BCG vaccine

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