Background: Chronic obstructive pulmonary disease (COPD) is one of the most important reasons for hospitalization worldwide with high 30-day readmission rates. Although the prognostic significance of early readmission is not fully understood, they are often associated with poor outcomes including high mortality rates of 4%–19% at 30 and 365 days, respectively. Similarly, in acute exacerbations of COPD (AECOPD) cases receiving emergency department care, current status on lung function and cardiovascular comorbidities are considered as best predictors for both 30- and 90-day COPD readmission rates. Dual bronchodilator strategy with long-acting muscarinic antagonist (LAMA)/long-acting beta-agonists (LABA) is therefore recommended by GOLD (2019) in the postdischarge phase following an acute exacerbation.

Aim: To further assess the clinical impact of dual bronchodilators including glycopyrronium and arformoterol as home nebulization in the post-discharge phase of AECOPD, the current postapproval, observational study was conducted.

Materials and Methods: An observational, concurrent, and non-inferiority study with glycopyrronium and arformoterol home nebulizing solutions on patients with moderate and severe COPD was conducted at two centers in India. An estimated sample size of 40 patients involving moderate and severe COPD cases was factored for per-protocol analyses with P < 0.05 considered as statistically significant. A concurrent study analysis for the follow-up visit was conducted as per the principles of International Conference of Harmonization for Good clinical practice and Declaration of Helsinki while ensuring confidentiality during access of patient support registration sheets.

1. Chronic Obstructive Pulmonary Disease (COPD) is a chronic inflammatory condition of the airways and alveoli leading to airflow limitation, giving rise to chronic cough, sputum production and breathlessness. Classically, tobacco exposure has been commonly linked to causation of COPD. However, many patients develop COPD without any history of tobacco exposure. Exposure to indoor pollution in the form of biomass fuel smoke or occupational exposure to smoke, may also contribute to development of COPD.

It is also known that pulmonary function reaches its peak (FEV1) at about twenty years of age and thereafter there is a gradual physiological decline in lung function. Due to any reason (like abnormal alveolar development in intrauterine life), if this peak lung function is not achieved in early adulthood, then a declining FEV1, at the same physiological rate, may give rise to early COPD symptoms and this process may further be hastened by smoke, tobacco exposure, infection etc. Infections like tuberculosis and systemic syndromes like Rheumatoid arthritis, HIV may also give rise to COPD symptoms.

If we ask any type of question related to fever by assuming that the Warm sensitive neurons decreases and Cold  neurons increases in fever to protect the  life or organ we will get a clear answer. If avoid or evade from this definition we will never get proper answer to even a single question

If we do any type of treatment  by assuming  that the Warm sensitive neurons decreases and Cold  neurons increases in fever to protect the  life or organ , the body will accept, at the same time body will resist whatever treatment to decrease temperature and blood circulation. No further evidence is required to prove The Warm sensitive neurons decreases and Cold  neurons increases in fever to protect the  life or organ.

To be announced

Pulmonary tuberculosis (PTB) coupled with Acute Respiratory Failure (ARF) usually heralds a dismal patient outcome¹. Admission to the Intensive Care Unit (ICU) along with Invasive mechanical ventilation (IMV) in PTB patients is usually associated with very high mortality². Non-invasive Ventilation (NIV) when applied early in such patients has the potential to prevent intubation and improve prognosis in terms of reduced morbidity and/or mortality ³. We conducted a prospective study in our Institute where NIV was applied to 35 patients with smear-positive PTB who had concurrent ARF. Fourteen patients (40%) improved on NIV and were later discharged on treatment (survivors). The remaining patients (60%) were candidates for IMV but none survived. Statistically significant predictors of mortality in our study were multiple courses of anti-tubercular treatment in the past, advanced disease as assessed radio-graphically, presence of leucocytosis, drug resistance and pH < 7.25. Our study is unique in the fact that it has addressed NIV in active PTB on which very scant literature is available. Our results indicate that a significant proportion of PTB patients with ARF may benefit from NIV based on astute and diligent patient selection and prompt institution of the procedure along with ATT and other supportive therapy. Our study also provides some tentative evidence that patients who fail NIV may not benefit from IMV. How much of this is due to the advanced lung disease and poorer metabolic status of the patient along with co-existent nosocomial infections needs to be elucidated by further studies.  

Lung cancer is the leading cause of cancer death and is often diagnosed at a late stage. Due to that fact  long term survival rates are poor. Detecting the disease and initiating treatment at an early stage are important for improving survival. Low-dose computed tomography (LDCT) is strategy for lung cancer detection that has demonstrated promise in  purpose  to identify the presence of lung cancer in an individual that does not demonstrate any symptoms.

            Based on the results of the National Lung Screening Trial (NLST), NELSON trial, the US Preventive Services Task Force and NCCN guideline recommend annual lung cancer screening with CT. Annual screening for lung cancer with low-dose computed tomography (LDCT) is recommended in adults aged 55 to 80 years who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years.

           There could be risk for harm associated with LDCT screening include: radiation exposure, false negative and false-positive results, incidental findings, overdiagnosis. Patients with several comorbid conditions may be at greater risk.

The prehospital use of noninvasive ventilation (NIV) by emergency medical services is increasing. Applying NIV in the prehospital setting began to gain more attention in the late 1990s when the primary form of noninvasive positive pressure ventilation emerged as a substitute to endotracheal intubation. For the last several years, NIV has become the standard of care for acute cardiogenic pulmonary edema and exacerbation of chronic obstructive pulmonary disease patients in the prehospital setting. A remarkable number of studies demonstrate a reduction in mortality and intubation rates in comparison to standard care when NIV is initiated in the prehospital setting, though there is a lack of evidence to strongly recommend the use of prehospital NIV as a first choice. An in-depth understanding of the science and technological background of NIV machines and interfaces can help attending clinicians in the prehospital setting and thus enhance therapeutic effectiveness by maximizing patient comfort, safety, and stability. Selections of the patients, devices, and interfaces, as well as achieving good patient-ventilator synchrony, are the key aspects of a successful outcome.