Type and mode of diagnosis of carcinoma lung in a tertiary care centre: one year experience

Background: Lung cancer is one of the commonest cancers and cause of cancer related deaths all over the world. The reported incidence of adenocarcinoma is increasing globally and now reported to be the most common type of lung cancer. A panel of investigations are used for the diagnosis of lung cancer. Hence a study was planned to find out the pattern of malignancy and the most appropriate investigation for diagnosis. Objective of present study was to find out the type of carcinoma lung and to find out the best and easy method for diagnosis of carcinoma lung in a tertiary care centre.Methods: A hospital based cross sectional study was conducted in one unit of the Department of Pulmonary Medicine, Government Medical college, Thiruvananthapuram for a period of one year.148 diagnosed cases of carcinoma lung were enrolled. The type and the methods used for diagnosis were analysed.Results: Adenocarcinoma was the commonest malignancy 57 (38.5%), followed by squamous cell carcinoma 44 (29.7%) and small cell carcinoma 10 (6.75%). Rest of the cases 37 (25%) include non small cell carcinoma, poorly differentiated carcinoma and lymphoma. Diagnosis was established by FNA Lung in 46 (31.1%) patients and bronchoscopy and biopsy in 41 (27.7%). Other methods include TBNA 12 (8.1%), lymph node FNA/biopsy 11 (7.4%), pleural fluid cytology 24 (16.2%), sputum cytology and tru cut biopsy 14 (9.5%).Conclusions: The most common type of lung malignancy in present study was adenocarcinoma. Ultra sound guided FNAC lung and bronchoscopy biopsy were the best methods in present study to confirm the diagnosis

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Effect of Antiplatelet Therapy on Survival and Organ Support–Free Days in Critically Ill Patients With COVID-19

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