Clinicopathological and immunohistochemistry profile of 100 cases of lung cancer in a tertiary care occupational centre in north India

Background:According to estimates, the global cancer burden increased to 18.1 million new cases and 9.6 million deaths in 2018..Lung cancer is the most common cancer-related cause of death in both men and women. In most Western and Asian countries, adenocarcinoma has now surpassed squamous cell carcinoma. In India, however, the clinical and pathological picture of lung cancer varies greatly.Aim: The goal of this study is to look at the clinicopathological and immunohistochemical profiles of 100 patients of lung cancer in a North Indian tertiary care occupational centre.Material and methods:This is a retrospective study of lung carcinoma patients who were diagnosed with biopsy-proven lung cancer in the previous four years (between May 2016 and May 2020). Patients were diagnosed using the WHO classification of lung malignancies 2015as nonsmall cell lung carcinoma (SCC), adenocarcinoma, nonsmall cell lungcarcinoma not otherwise defined [NSCLCNOS]), small cell lung carcinoma, and others based on morphology in H&E stained sections. In all cases, immunohistochemistry (IHC) was used to help the sub-classification. In some cases, IHC was used to detect EGFR and ALK rearrangements.Result:The average age of the patients in our study was 61.04 years old (12 percent were under 50 years old and 6% were under/equal to 45 years old). Smokers made up 54 percent of all lung cancer patients. COPD was seen in 43.8 percent of lung cancer patients, and it was often linked to smoking. 4.5 percent of the patients had a history of ATT ingestion, while 36.6 percent of the patients had no relevant medical history. Cough (26%) was the most common symptom, followed by chest pain (23%), and shortness of breath (28%) in almost equal percentages and were most frequently occurring together.Squamous cell carcinoma (38 percent), adenocarcinoma (27 percent), non-small cell carcinoma-not otherwise specified(NOS) (5 percent), adenosquamous carcinoma (3 percent), and small cell carcinoma (17 percent) were the subtypes with the highest percentages histologically, with immunohistochemical confirmation.Conclusion:Along with age, radon exposure, environmental pollution, occupational exposures, gender, race, pre-existing lung disease, and genetic factors, cigarette smoking is the leading cause of lung cancer and lung cancer in the occupational category

Assessment of length of hospital stays of patients with acute exacerbations of chronic obstructive pulmonary disease

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is prone to acute exacerbations which may lead to enhanced morbidity and mortality. Information on the time course and recovery from COPD exacerbation is important in standardizing the length of treatment, in planning appropriate follow up and decreasing loss of working days of the patient. Material and Methods: It was a prospective study (observational) which included all patients with Acute Exacerbation of COPD (AECOPD) admitted to the Department of Pulmonary Medicine, People’s College of Medical Sciences & RC, Bhopal, over a period of 1 year 6 months. Results: In this study we observed the mean length of stay (LOS) of patients with AECOPD was 9.53±3.4 days. There was no significant difference in length of stay between patients in different age groups. The LOS varied significantly between different GOLD stages. The patient who had a history of admission for twice or more in the past 1 year had a greater mean LOS as compared to patient with just one or no hospitalisation in the past. Conclusion: The patient who had a history of admission for twice or more in the past 1 year had a greater mean LOS as compared to patient with just one or no hospitalisation in the past

Efficacy and safety of baricitinib for the treatment of hospitalised adults with COVID-19 (COV-BARRIER): a randomised, double-blind, parallel-group, placebo-controlled phase 3 trial

Background: Baricitinib is an oral selective Janus kinase 1/2 inhibitor with known anti-inflammatory properties. This study evaluates the efficacy and safety of baricitinib in combination with standard of care for the treatment of hospitalised adults with COVID-19. Methods: In this phase 3, double-blind, randomised, placebo-controlled trial, participants were enrolled from 101 centres across 12 countries in Asia, Europe, North America, and South America. Hospitalised adults with COVID-19 receiving standard of care were randomly assigned (1:1) to receive once-daily baricitinib (4 mg) or matched placebo for up to 14 days. Standard of care included systemic corticosteroids, such as dexamethasone, and antivirals, including remdesivir. The composite primary endpoint was the proportion who progressed to high-flow oxygen, non-invasive ventilation, invasive mechanical ventilation, or death by day 28, assessed in the intention-to-treat population. All-cause mortality by day 28 was a key secondary endpoint, and all-cause mortality by day 60 was an exploratory endpoint; both were assessed in the intention-to-treat population. Safety analyses were done in the safety population defined as all randomly allocated participants who received at least one dose of study drug and who were not lost to follow-up before the first post-baseline visit. This study is registered with ClinicalTrials.gov, NCT04421027. Findings: Between June 11, 2020, and Jan 15, 2021, 1525 participants were randomly assigned to the baricitinib group (n=764) or the placebo group (n=761). 1204 (79·3%) of 1518 participants with available data were receiving systemic corticosteroids at baseline, of whom 1099 (91·3%) were on dexamethasone; 287 (18·9%) participants were receiving remdesivir. Overall, 27·8% of participants receiving baricitinib and 30·5% receiving placebo progressed to meet the primary endpoint (odds ratio 0·85 [95% CI 0·67 to 1·08], p=0·18), with an absolute risk difference of -2·7 percentage points (95% CI -7·3 to 1·9). The 28-day all-cause mortality was 8% (n=62) for baricitinib and 13% (n=100) for placebo (hazard ratio [HR] 0·57 [95% CI 0·41-0·78]; nominal p=0·0018), a 38·2% relative reduction in mortality; one additional death was prevented per 20 baricitinib-treated participants. The 60-day all-cause mortality was 10% (n=79) for baricitinib and 15% (n=116) for placebo (HR 0·62 [95% CI 0·47-0·83]; p=0·0050). The frequencies of serious adverse events (110 [15%] of 750 in the baricitinib group vs 135 [18%] of 752 in the placebo group), serious infections (64 [9%] vs 74 [10%]), and venous thromboembolic events (20 [3%] vs 19 [3%]) were similar between the two groups. Interpretation: Although there was no significant reduction in the frequency of disease progression overall, treatment with baricitinib in addition to standard of care (including dexamethasone) had a similar safety profile to that of standard of care alone, and was associated with reduced mortality in hospitalised adults with COVID-19