Najib Rahman - Academia.edu (original) (raw)

Papers by Najib Rahman

Expert Review of Respiratory Medicine, Jul 20, 2020

Malignant pleural effusion (MPE) is a complication of advanced cancer, associated with significan... more Malignant pleural effusion (MPE) is a complication of advanced cancer, associated with significant mortality and morbidity. This entity is commonly treated by respiratory physicians, oncologists and thoracic surgeons. There have been various randomised clinical trials assessing chest drain pleurodesis, indwelling pleural catheters, treatment of septated MPEs, use of thoracoscopy and pleurodesis and pleurodesis through IPCs in the past decade which have addressed some key points for management of MPEs with a significant focus on patient related outcomes. In this review we examine and review the literature for management strategies for MPEs and discuss future directions. Introduction: Malignant pleural effusion (MPE) is seen in around 15 % of all cancers.(1) A retrospective analysis using the Healthcare Cost and Utilization Project National Inpatient Sample database showed that in the United States, MPE accounted for more than 125 000 admissions with an estimated expense of more than 5 billion dollars per year for inpatient stay with an inpatient mortality of around 12% in 2012.(2) Evidence has shown life expectancy to range from 3 to 12 months following a diagnosis of MPE depending on the primary tumour.(3) This in addition to increased mortality and morbidity due to MPEs is also associated with significant financial burden to the health care system. The majority of MPEs are caused by lung cancer in males and breast cancer in females, these two cancers account for 50-60% of all MPEs.(4) Malignant effusions develop in about 30% of patients with lung cancer and in around 7-10% patients with breast cancer.(5, 6) Mesothelioma is the most common primary pleural tumour and is associated with MPE in 90% of cases.(7) It has been shown that in patients with lymphoma, presence of MPE on diagnosis is associated with higher chance of disease recurrence post chemotherapy.(8) Just the presence of pleural effusion in patients with lung cancer, even in the absence of proven malignant nature of the effusion, confers a survival disadvantage when compared with those without the effusion (7.49 vs 12.65 months).(9) With 1 in 8 men and 1 in 10 women developing cancer globally, overall cancer incidence and mortality has increased partly due to aging and growth of population and also due to change in prevalence and distribution of risk factors for cancer. In the UK cancer mortality and incidence is predicted to increase until 2035.(10, 11) Hence it can only be assumed that burden of MPE will also rise in the coming years. Various theories have been hypothesized for pleural fluid formation in MPE including direct tumour invasion from adjacent structures, haematogenous spread to the pleura, tumour emboli and infiltration of lymphatic drainage with upregulation of angiogenic growth factors by tumour cells which leads to further fluid formation.(12, 13) Since the presence of a MPE is associated with advanced and incurable cancer with limited survival, treatment options historically have looked at symptom control and are largely palliative in nature.

Seminars in Respiratory and Critical Care Medicine, Jun 1, 2019

Pleural effusion is a common condition, affecting over 3000 people per million population every y... more Pleural effusion is a common condition, affecting over 3000 people per million population every year. More than 50 causes of pleural effusions are known, including pleural infection and malignant pleural disease. These conditions place a large burden on healthcare systems with one fourth of patients with pleural infection having a length of hospital stay of more than one month. Malignant pleural effusion represents advanced malignant disease with a correspondingly high mortality. Prognostic models using clinical information in combination with blood or pleural fluid biomarkers predicting survival and other outcome measures are therefore a priority in improving clinical care, and potentially outcomes. Identifying patients with poor prognosis may help to avoid discomfort and unnecessary interventions at the end of their lives, while, on the other hand, individuals with scores predicting a particularly good prognosis might be selected for more aggressive early treatment. Such scores must be based on data representing routine practice in a general hospital and variables chosen based on their clinical availability at clinical decision points (i.e. before treatment is instituted), making the findings widely applicable.

Clinical Journal of Oncology Nursing, 2005

Journal of Surgical Oncology, 1978

A pleural effusion is a frequent complication of malignant disease. Essential to the care of onco... more A pleural effusion is a frequent complication of malignant disease. Essential to the care of oncology patients is a fundamental knowledge of the pathophysiology and treatment of such effusions. This article discusses the current thoughts concerning the occurrence of malignant effusions, outlines the current available methods and agents employed for control, and presents a modification of the thoracostomy procedure that appears to be more effective than the standard procedure.

European Respiratory Review, Apr 29, 2020

The Lancet Respiratory Medicine, Jun 1, 2020

Health Technology Assessment, Jun 1, 2020

European Journal of Cardio-Thoracic Surgery, Oct 1, 2010

Objective: Medical thoracoscopy is recommended in the investigation of patients with exudative pl... more Objective: Medical thoracoscopy is recommended in the investigation of patients with exudative pleural effusions, especially when pleural fluid analysis is uninformative. The histological finding of 'nonspecific pleuritis/fibrosis' is common in thoracoscopic biopsies and presents a great uncertainty for clinicians and patients as the long-term outcome of these patients is unclear, and anxieties about undiagnosed malignancy persist. Method: A retrospective case-note study of 142 patients who underwent medical thoracoscopy over a 58-month period in a tertiary referral centre with a high incidence of mesothelioma. Patients with 'nonspecific pleuritis/fibrosis' were followed up until death or for a mean (AESD) period of 21.3 (AE12.0) months. Results: A definitive histological diagnosis was achieved in 98 (69%) patients. A total of 44 (31%) patients had 'nonspecific pleuritis/fibrosis'. Five (12%) were subsequently diagnosed with malignant pleural disease after a mean interval of 9.8 (AE4.6) months. All five patients had histologically confirmed mesothelioma. In 26 patients with 'nonspecific pleuritis/fibrosis', no cause for the pleural effusion was discovered. The false-negative rate of thoracoscopic biopsy for the detection of pleural malignancy was 5%, with a diagnostic sensitivity of 95% and negative predictive value of 90%. Pleural effusion recurrence was more frequently associated with a false-negative pleural biopsy result. However, there was no correlation with other patient characteristics or the thoracoscopist's prediction based on macroscopic appearances. Conclusion: Thoracoscopic pleural biopsy is valuable in the diagnosis of pleural malignancies. Patients with 'nonspecific pleuritis/ fibrosis' require follow-up as a malignant diagnosis (especially mesothelioma) may eventually be established in approximately 12% of cases.

Expert Review of Respiratory Medicine, Mar 6, 2017

Cancers

Pleural effusions are a common respiratory condition with many etiologies. Nonmalignant etiologie... more Pleural effusions are a common respiratory condition with many etiologies. Nonmalignant etiologies explain most pleural effusions and despite being nonmalignant, they can be associated with poor survival; thus, it is important to understand their pathophysiology. Furthermore, diagnosing a benign pleural pathology always harbors the uncertainty of a false-negative diagnosis for physicians and pathologists, especially for the group of non-specific pleuritis. This review aims to present the role of the inflammation in the development of benign pleural effusions, with a special interest in their pathophysiology and their association with malignancy.

Diagnostics, 2020

Pleural disease diagnostics represent a sprawling topic that has enjoyed a renaissance in recent ... more Pleural disease diagnostics represent a sprawling topic that has enjoyed a renaissance in recent years from humble beginnings. Whilst pleural patients are heterogeneous as a population and in the aetiology of the disease with which they present, we provide an overview of the typical diagnostic approach. Pleural fluid analysis is the cornerstone of the diagnostic pathway; however, it has many shortcomings. Strong cases have been made for more invasive upfront investigations, including image-guided biopsies or local anaesthetic thoracoscopy, in selected populations. Imaging can guide the diagnostic process as well as act as a vehicle to facilitate therapies, and this is never truer than with the recent advances in thoracic ultrasound.

European Respiratory Journal, 2020

Thoracic ultrasound is increasingly considered to be an essential tool for the pulmonologist. It ... more Thoracic ultrasound is increasingly considered to be an essential tool for the pulmonologist. It is used in diverse clinical scenarios, including as an adjunct to clinical decision making for diagnosis, a real-time guide to procedures and a predictor or measurement of treatment response. The aim of this European Respiratory Society task force was to produce a statement on thoracic ultrasound for pulmonologists using thoracic ultrasound within the field of respiratory medicine. The multidisciplinary panel performed a review of the literature, addressing major areas of thoracic ultrasound practice and application. The selected major areas include equipment and technique, assessment of the chest wall, parietal pleura, pleural effusion, pneumothorax, interstitial syndrome, lung consolidation, diaphragm assessment, intervention guidance, training and the patient perspective. Despite the growing evidence supporting the use of thoracic ultrasound, the published literature still contains a ...

European Respiratory Review, 2019

Focused thoracic ultrasound has become essential in the guidance and direction of pleural interve... more Focused thoracic ultrasound has become essential in the guidance and direction of pleural interventions to reduce unwanted complications and as a result now forms a crucial component of physician training. Current training standards along with assessment methods vary widely, and are often not robust enough to ensure adequate competence.This review assesses the current state of training and assessment of thoracic ultrasound competence in various settings, allowing comparison with alternative competency based programmes. Future directions for training and assessment of thoracic ultrasound competence are discussed.

Annals of the American Thoracic Society, 2019

European Respiratory Journal, 2018

Malignant pleural effusions (MPE) are a common pathology, treated by respiratory physicians and t... more Malignant pleural effusions (MPE) are a common pathology, treated by respiratory physicians and thoracic surgeons alike. In recent years, several well-designed randomised clinical trials have been published that have changed the landscape of MPE management. The European Respiratory Society (ERS) and the European Association for Cardio-Thoracic Surgery (EACTS) established a multidisciplinary collaboration of clinicians with expertise in the management of MPE with the aim of producing a comprehensive review of the scientific literature.Six areas of interest were identified, including the optimum management of symptomatic MPE, management of trapped lung in MPE, management of loculated MPE, prognostic factors in MPE, whether there is a role for oncological therapies prior to intervention for MPE and whether a histological diagnosis is always required in MPE.The literature revealed that talc pleurodesis and indwelling pleural catheters effectively manage the symptoms of MPE. There was li...

Respirology (Carlton, Vic.), 2018

Unexpandable lung is a common complication of malignant pleural effusions and inflammatory pleura... more Unexpandable lung is a common complication of malignant pleural effusions and inflammatory pleural diseases, such as pleural infection (e.g. empyema and complicated parapneumonic effusion) and noninfectious fibrinous pleuritis. Unexpandable lung due to pleural disease may be because of an active pleural process, and is referred to as malignant or inflammatory lung entrapment. An unexpandable lung may also be encountered in the setting of remote pleural inflammation resulting in a mature fibrous membrane overlying the visceral pleura preventing full expansion of the lung. This condition is termed trapped lung and may be understood as a form of defective healing of the pleural space. Trapped lung typically presents as a chronic, stable pleural effusion without evidence of active pleural disease. An unexpandable lung most often manifests itself as an inability of fully expanding the lung with pleural space drainage. Patients will either develop chest pain preventing complete drainage o...

Cancer Management and Research, 2017

Thorax, Sep 14, 2017

The use of thoracic ultrasound outside the radiology department and in everyday clinical practice... more The use of thoracic ultrasound outside the radiology department and in everyday clinical practice is becoming increasingly common, having been incorporated into standards of care for many specialties. For the majority of practitioners, their experience of, and exposure to, thoracic ultrasound will be in its use as an adjunct to pleural and thoracic interventions, owing to the widely recognised benefits for patient safety and risk reduction. However, as clinicians become increasingly familiar with the capabilities of thoracic ultrasound, new directions for its use are being sought which might enhance practice and patient care. This article reviews the ways in which the advent of thoracic ultrasound is changing the approach to the investigation and treatment of respiratory disease from an interventional perspective. This will include the impact of thoracic ultrasound on areas including patient safety, diagnostic and therapeutic procedures, and outcome prediction; and will also conside...