HRCT findings in various ILDs

By Dr Deepu
Here is an easy pictorial representation of the various ILD.

Anti-malondialdehyde-acetaldehyde adducts antibodies in lung tissues may play important role in pathogenesis of RA-associated interstitial lung disease, study indicates

By Dr Deepu

Anti-malondialdehyde-acetaldehyde adducts (MAA) antibodies and MAA expression in lung tissues of patients with rheumatoid arthritis-associated interstitial lung disease (RA-ILD) likely play an important role in RA-ILD pathogenesis, and anti-MAA antibodies may function well as serum biomarkers in the identification of this disease manifestation.

Patients with RA face premature mortality and RA-ILD is a major determinant of worse long-term outcomes, with a median survival as short as 3 years after diagnosis. In the present study, researchers compared serum anti-MAA antibodies and MAA expression in lung tissues of patients from 13 sites fulfilling the 1987 American College of Rheumatology criteria by selecting participants from the Veterans Affairs Rheumatoid Arthritis Registry.

Multivariable logistic regression models were used to assess the association between anti-MAA antibodies (immunoglobulins A, M, and G [IgA, IgM, IgG]) and RA-ILD status by combining RA alone with RA+chronic obstructive pulmonary disease (COPD) for a comparator group, as unadjusted comparisons found no significant differences in concentrations of anti-MAA antibodies between these groups. Lung tissues from RA-ILD patients, and other patients with ILD, emphysema, and controls were stained for MAA, macrophages (CD68), citrulline, B cells (CD19/CD27), T cells (CD3), and extracellular matrix proteins (fibronectin, vimentin, type-II collagen). Lung tissue expression and MAA co-localization were quantified and compared.

Among the total 1823 participants with RA, 90 had RA-ILD. Higher serum concentrations of IgM and IgA anti-MAA antibodies were seen in RA-ILD vs RA+COPD or RA alone (P =.005). After adjustment for covariates, the highest quartiles of IgM (odds ratio [OR] 2.23; 95% CI, 1.19-4.15) and IgA (OR 2.09; 95% CI, 1.11-3.90) anti-MAA antibody were significantly associated with RA-ILD. MAA expression in lung tissue was greater in RA-ILD than all other groups (P  <.001). The RA-ILD group also showed the greatest degree of MAA co-localized with CD19+ B cells (r =0.78), citrulline (r =0.79), and extracellular matrix proteins (type-II collagen [r =0.72] and vimentin [r =0.77]).

The study authors concluded the study by noting "These findings suggest that MAA immune responses could play an important role in the pathogenesis of RA-ILD and anti-MAA antibodies may be promising serum biomarkers in the identification of this extra-articular disease manifestation"

The finding were published in arthritis and rheumatology

Many children with asthma do not use inhalers properly, study indicates

By Dr Deepu

Research indicates “many children with asthma don’t use their inhalers properly and don’t get a full dose of medicine.” Investigators looked at “inhaler use among 113 children between the ages of 2 and 16 who were hospitalized for asthma.” The researchers found that “at least one crucial step in inhaler technique was missed by 42% of the children,” and approximately “18% did not use a spacer device with their inhaler.” The findings were published in the Journal of Hospital Medicine.

Tuberculosis could be eliminated by 2045, researchers suggest

By Dr Deepu

A new study by researchers  suggests that “increased investment in evidence-based interventions to diagnose, treat, and prevent tuberculosis (TB), especially in high-burden countries, could help end TB” by the year 2045. These interventions should not only “be scaled up, but greater investment and research is needed to develop new methods of diagnosis, treatment, and prevention around the world, [researchers] reported.” Additionally, they suggest that “responsibility for investing in TB programs should be shared between domestic allocation in these countries, as well as external funding through increased developmental assistance.”

The authors mentioned that”to reach these goals, global investment in TB research and development will need to increase to at least $2 billion per year during the next 4 years”.

With the goals of treating 40 million people and preventing 30 million new cases from 2018-2022, the United Nations held its first-ever "high-level meeting" about TB,in September 2018

A TB-free world is possible by 2045 if "increased political will and financial resources" are targeted towards areas where they are needed most, as stated in the report

 In India, the country with the highest burden of TB,  "unavoidable tuberculosis deaths" will cost the country at least $32 billion each year over the next 30 years, even with "optimal implementation of existing tools." The authors also have mentioned that the savings from averting a TB death can be three times the costs in certain countries.

Tuberculosis was declared a global emergency by WHO in 1993. Then, about a third of the world’s population was infected with the bacteria that cause tuberculosis, and the disease was responsible for an estimated 3 million deaths each year. Today, around a quarter of the world’s population has a tuberculosis infection, which causes about 1·6 million annual deaths, making it the leading infectious killer of our time. Although progress has been made in reducing the global burden of tuberculosis in the past 25 years, it has occurred at a frustratingly slow rate. Declines in tuberculosis mortality are not keeping pace with reductions in deaths from other infectious diseases of global importance such as HIV and malaria, and the world is not on track to meet targets set out in the Sustainable Development Goals and the WHO End TB Strategy.

The findings were published in The Lancet.

Statins in Asthma COPD overlap may bring down the risk of CAD and stroke risk

By Dr Deepu

Recently published study in atherosclerosis journal has found that the risk for CAD was lower in all statin-treated patients with ACOS. Whereas the risk for ischemic stroke was lower only in long-term statin users with ACOS. There was no link  between risk for hemorrhagic stroke and  statin use.

A retrospective cohort study was conducted using data from the Longitudinal Health Insurance Database, which included 1 million enrollees in the Taiwan National Health Insurance program from January 1, 2000, through December 31, 2011.

Patients ≥20 years of age with ACOS who were treated with statins (n=916) and those who did not receive statin therapy (n=6338) were enrolled in the study. Investigators examined the cumulative incidence of CAD and stroke (both ischemic and hemorrhagic) with the use of time-dependent Cox proportional regression. Following adjustments for age, sex, inhaled corticosteroid use, oral steroid use, and comorbidities, adjusted hazard ratios (aHRs) and 95% CIs for CAD or stroke in statin users (long-term statin use: >600 days; short-term statin use: ≤600 days) were compared with these values in statin nonusers.

In statin users, the aHRs for CAD and stroke were 0.50 (95% CI, 0.41-0.62) and 0.83 (95% CI, 0.63-1.09), respectively. Furthermore, aHRs for ischemic and hemorrhagic stroke were 0.30 (95% CI, 0.09-0.99) and 0.90 (95% CI, 0.68-1.20), respectively. In addition, in long-term statin users, aHRs for CAD and stroke were 0.23 (95% CI, 0.13-0.41) and 0.42 (95% CI, 0.19-0.89), respectively. In short-term statin users, aHRs for CAD and stroke were 0.58 (95% CI, 0.47-0.71) and 0.93 (95% CI, 0.70-1.23), respectively.

A major limitation of the current study is that lipid levels were not taken into account. Moreover, although a new-user study design was employed, with propensity score matching and a time-dependent model for analysis, results were not as accurate as those derived from randomized controlled trials.

The investigators concluded that regardless of the duration of statin use, the risk for CAD was lower in all statin-treated patients with ACOS. In contrast, the risk for ischemic stroke was lower only in long-term statin users with ACOS, and no link was observed between risk for hemorrhagic stroke and use of statin therapy.

The study was published in atherosclerosis journal