Researchers find genes linked to development of active TB.

By Dr Deepu

Researchers in Seattle and South Africa have identified markers in the blood of infected people that may predict those at high risk for developing an active  and potentially fatal form of the disease.

A signature pattern of 16 genes, detected in analysis of samples from more than 6,000 South African adolescents, may one day help create a test to identify and treat people likely to develop active TB  more than a year before they get sick.

FDA approves Injectable drug for uncontrolled Asthma

By Dr Deepu

The Food and Drug Administration approved Teva Pharmaceutical Industries Ltd.’s Cinqair (reslizumab) to adults who have treat severe asthma attacks despite taking other medication.It can be used with other asthma medicines for the maintenance treatment of severe asthma in patients aged 18 years and older.
        The drug is “given by injection every four weeks” and works by “reducing blood levels of eosinophils, a white blood cell that contributes to asthma”.

Cinqair is administered once every four weeks via intravenous infusion by a health care professional in a clinical setting prepared to manage anaphylaxis. Cinqair is a humanized interleukin-5 antagonist monoclonal antibody produced by recombinant DNA technology in murine myeloma non-secreting 0 (NS0) cells. Cinqair reduces severe asthma attacks by reducing the levels of blood eosinophils, a type of white blood cell that contributes to the development of asthma.

The safety and efficacy of Cinqair were established in four double-blind, randomized, placebo‑controlled trials in patients with severe asthma on currently available therapies. Cinqair or a placebo was administered to patients every four weeks as an add-on asthma treatment. Compared with placebo, patients with severe asthma receiving Cinqair had fewer asthma attacks, and a longer time to the first attack. In addition, treatment with Cinqair resulted in a significant improvement in lung function, as measured by the volume of air exhaled by patients in one second.

Cinqair can cause serious side effects including allergic (hypersensitivity) reactions. These reactions can be life-threatening. The most common side effects in clinical trials for Cinqair included anaphylaxis, cancer, and muscle pain.

Researchers develop low-cost, effective chest wall motion assessment system using Xbox Kinect sensors

By Dr Deepu

In a study published online in Medical & Biological Engineering & Computing, investigators “describe the development of a low-cost and effective chest wall motion assessment system, essential for the rapid and accurate diagnosis of respiratory diseases, that uses Microsoft’s Xbox Kinect sensors.” Notably, that new “system allows for 3-D and time varying representations of a patient’s torso, and has shown promise in initial evaluations.”

read the article published in journal medical and biological engineering
Click here

CT Thorax

Chest X Ray

Research shows, Inexpensive Urine Test For Tuberculosis Reduced Risk Of Death Among HIV-Positive Hospital Patients In Africa.

By Dr Deepu

HIV-associated tuberculosis is difficult to diagnose and results in high mortality. Frequent extra-pulmonary presentation, inability to obtain sputum, and paucibacillary samples limits the usefulness of nucleic-acid amplification tests and smear microscopy.Therefore  a urine-based, lateral flow, point-of-care, lipoarabinomannan assay (LAM) and the effect of a LAM-guided anti-tuberculosis treatment initiation strategy on mortality was assessed.
This inexpensive urine test for tuberculosis reduced the risk of death among HIV-positive hospital patients in Africa, where the combined effect of the two diseases is a leading cause of mortality.” Researchers found, “in a randomized controlled trial in four counties,” that “the test was associated with a 17% relative risk reduction in all-cause mortality after 8 weeks, possibly because TB treatment was started more quickly and in more patients.”

The findings were published online in The Lancet.

Exposure to high levels of certain traffic air pollutants may increase risk of preterm birth for pregnant women with asthma.

By Dr Deepu

    Exposure to high levels of certain traffic air pollutants may increase the risk of preterm birth in pregnant women with asthma.

   Researchers analyzed data from over 223,000 single-child births and found this was especially true when women were exposed to pollutants just before conceiving, in early pregnancy and the last six weeks of pregnancy.

The analysis revealed that  preterm births occurred in 11.7% of singleton deliveries across the entire study population and 33.6% of these deliveries were early preterm births. The significant  asthma interactions were  sporadic before 30 weeks gestation, but more common during weeks 34 to 36, with risk highest among women with asthma exposed to NOx, CO and SO2.

 The findings were published online March 1 in the Journal of Allergy and ClinicalImmunology.

Combination therapy may be more effective than monotherapy for slowing disease progression in patients with PAH, suggests Meta-analysis

By Dr Deepu

Combination therapy was significantly more effective than monotherapy for slowing disease progression in patients with pulmonary arterial hypertension.

          Investigators found that “compared with treatment with a single drug, combination therapy was associated with a significantly lower risk for clinical disease worsening and disease-related hospital admissions, and it was associated with a trend toward reduced all-cause mortality and pulmonary arterial hypertension (PAH)-related mortality.” The findings were published in Lancet Respiratory Medicine.

Source: read Full article on LANCET

Sleep Apnea May Impact Brain Function, mood and Skills

By Dr Deepu

HealthDay (2/29, Dallas) reports that a study published in the Journal of Sleep Research suggests that “sleep apnea may have an impact on brain function.” Investigators “examined levels of two brain chemicals: glutamate and gamma-aminobutyric acid, also known as GABA.” The research indicated that individuals “with sleep apnea have lower levels of GABA and abnormally high levels of glutamate.”

New SCCM Consensus Definitions for Sepsis and Septic Shock

By Dr Deepu

A critical care task force has proposed a new definition for sepsis and septic shock based on advances in science and the testing of clinical criteria against patient outcomes in EHR data. Find the link to download the full article from JAMA at the end.

The new definition for sepsis includes evidence for infection, plus life-threatening organ dysfunction, which is clinically characterized by an acute change of two points or greater on the Sequential [Sepsis-related] Organ Failure Assessment (SOFA) score.

Septic shock is now defined to include sepsis with fluid-unresponsive hypotension, serum lactate level greater than 2 mmol/L, and the need for vasopressors to maintain mean arterial pressure of 65 mm Hg or greater.

The new definitions do away with the current use of two or more systemic inflammatory response syndrome (SIRS) criteria for sepsis diagnosis. Components of SIRS include tachycardia, tachypnea, hyperthermia or hypothermia, and elevated white blood count.

   Led by Mervyn Singer, MD, of University College London, and Clifford Deutschman, MD, MS, of Hofstra-Northwell School of Medicine in New Hyde Park, N.Y., the international task force that developed the new definitions unanimously considered the requirement for two or more SIRS criteria to be unhelpful in the diagnosis of sepsis.

       They conducted a study to examine the validity of the revised sepsis definitions in a cohort of 148,907 suspected sepsis infections.

Their analysis identified a rapid method for identifying suspected sepsis outside the critical care hospital setting which includes two or more of the following clinical criteria: respiratory rate of 22/min or greater, altered mentation or systolic blood pressure of 100 mm Hg or less.

The bedside clinical scoring system is known as "quick SOFA" or qSOFA.

It is endorsed by SCCM, the American Thoracic Society, the European Respiratory Society, and the European Society of Intensive Care Medicine and related organizations in Africa, Asia, South America, and the Middle East.

The Task Force now recommends that sepsis and septic shock be defined as follows:

• Definitions:

Sepsis: Life-threatening organ dysfunction caused by a dysregulated host response to infection

Septic shock: Sepsis with circulatory and cellular/metabolic abnormalities profound enough to substantially increase mortality

• Clinical Criteria:

Sepsis: Suspected or documented infection and an acute increase of ≥ 2 SOFA points (a proxy for organ dysfunction)

Septic Shock: Sepsis and vasopressor therapy needed to elevate MAP ≥ 65 mmg Hg and lactate > 2 mmol/L (18 mg/dL) after adequate fluid resuscitation


Download the Full article from JAMA

ATS Guidelines on evaluation of suspected PTE in pregnancy

By Dr Deepu

Background: Pulmonary embolism (PE) is a leading cause of maternal mortality in the developed world. Along with appropriate prophylaxis and therapy, prevention of death from PE in pregnancy requires a high index of clinical suspicion followed by a timely and accurate diagnostic approach.

 Methods: To provide guidance on this important health issue, a multidisciplinary panel of major medical stakeholders was convened to develop evidence-based guidelines for evaluation of suspected pulmonary embolism in pregnancy using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) system. In formulation of the recommended diagnostic algorithm, the important outcomes were defined to be diagnostic accuracy and diagnostic yield; the panel placed a high value onminimizingcumulative radiationdose when determining the recommended sequence of tests.

Results: Overall, the quality of the underlying evidence for all recommendations was rated as very low or low, with some of the evidence considered for recommendations extrapolated from studies of the general population. Despite the low-quality evidence, strong recommendations were made for three specific scenarios: performance of chest radiography (CXR) as the first radiation-associated procedure; use of lung scintigraphy as the preferred test in the setting of a normal CXR; and performance of computed-tomographic pulmonary angiography (CTPA) rather than digital subtraction angiography (DSA) in a pregnant woman with a nondiagnostic ventilation– perfusion (V/Q) result.

Discussion: The recommendations presented in this guideline are based upon the currently available evidence; availability of new clinical research data and development and dissemination of new technologies will necessitate a revision and update.

Download the Guideline Here: Pregnancy PE

ATS Guidelines on childhood ILDs

By Dr Deepu

ATS guidelines on childhood ILDs. Interstitial lung disease (ILD) in infants is caused by entities that are distinct from those that cause ILD in older children and adults. Growing recognition and understanding of the various entities that cause ILD in children has led to the need for improved classification and evaluation. A committee was convened by the American Thoracic Society (ATS) to develop guidelines to inform clinicians, patients, and organizations regarding the classi- fication, evaluation, and management of childhood ILD (chILD).

         There is growing recognition and understanding of the entities that cause interstitial lung disease (ILD) in infants. These entities are distinct from those that cause ILD in older children and adults.

    A multidisciplinary panel was convened to develop evidence based guidelines on the classification, diagnosis, and management of ILD in children, focusing on neonates and infants under 2 years of age. Recommendations were formulated using a systematic approach. Outcomes considered important included the accuracy of the diagnostic evaluation, complications of delayed or incorrect diagnosis, psychosocial complications affecting the patient’s or family’s quality of life, and death.  

 After common causes of DLD are excluded, neonates and infants with childhood ILD syndrome should be evaluated by a knowledgeable subspecialist. The evaluation may include echocardiography, controlled ventilation high-resolution computed tomography, infant pulmonary function testing, bronchoscopy with bronchoalveolar lavage, genetic testing, and/or lung biopsy. Preventive care, family education, and support are essential.

Download the full article here – ILD GUIDELINES 

X Ray - Tuberculosis

By Dr Deepu
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