Treatment for Idiopathic Pulmonary Fibrosis

As everyone working in this field knows, the prognosis of idiopathic pulmonary fibrosis (IPF) is quite dismal (3 years survival of 50%). There have been many treatment regimens that have been suggested, but it is not clear whether any of them are of any use.

The latest issue of the New England Journal of Medicine (NEJM) has 3 articles and one editorial on this subject. The last one on acetyl-cysteine confirms that it does not really work.

However one more phase III trial by Talmadge King’s group on the use of pirfenidone, conducted because the US FDA was not convinced about its efficacy given the conflicting results from previous trials, shows that it does improve decline in lung function and overall survival.

The paper that however does bring a smile and some more hope is the first one by Richeldi Luca et al that shows the usefulness of nintedanib (where do come up with these names) in improving the reduction in FVC in patients with IPF.

There is a lovely short commentary / editorial that puts all these papers in perspective and even addresses the question of whether both nintedanib and pirfenidone should be used together and whether that would help even more or not. This is an interesting thought.

All of these are must reads for all those who have patients with IPF whose care they are responsible for.

 

The role of a radiologist – gatekeeper v/s service-provider

Dr. Saurabh Jha has a very interesting article in a recent issue of The New England Journal of Medicine, discussing the role of a radiologist.

In the UK, where he trained, it was that of a gatekeeper. In the US, it is that of a service provider.

In India, we are predominantly service providers and perhaps less than 5% of the work we do allows us to act as consultant physicians, advising on what next is to be done or on the appropriate modality to be used.

Primary Prevention of Cardiovascular Disease with a Mediterranean Diet — NEJM

As radiologists, while it is important to know our radiology signs and methods of interpretation, a little knowledge of what is happening in the rest of the medical field doesn’t hurt, especially when patients these days often seem better informed.

Today, this study has been published in the current issue of NEJM. There were three groups, two with Mediterranean diets and one control group without. The two groups with the Mediterranean diets along with olive oil and mixed nut (walnuts, almonds and hazelnuts) supplements showed a significant reduction in cardiovascular risk and events over 5 years.

Primary Prevention of Cardiovascular Disease with a Mediterranean Diet — NEJM.

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