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with respect to background factors such as age, gender, history of smoking, DLco and FVC, there were no great differences witnessed between the intervention and the control group. Furthermore, the rate of change in FVC on an annual basis was −610 mL in the intervention group whereas the same is −1320 mL in the control group with P-value less than 0.01. The data further reveals that the combination therapy decreases FVC compared to the control group with rapidly progressive IPF in its advanced stages. However, in the study by Huang et al 84 it is revealed that there was no significant difference in the primary endpoints that was observed between the control and the intervention groups. However, there was a significant decline in the values of FVC in the 24 th week of the research in both the intervention and the control groups. It is also revealed that the combined treatment method led to the prolonged PFS duration in patients with IPF. This is similar to the result of Sakamoto et al 85 which also revealed the prolonged PFS in patients in the intervention group. A further analysis was performed by the researcher wherein it was revealed that in 4 cases (1 in the control group and 3 in the intervention group) there is a substantial decline in the parameters of Pulmonary Function Tests (PFT) such as TLC, FVC, and DLCO since the adverse events which were evident within the 4 weeks of the end-oftreatment timepoint. Further re-evaluation of the data with these 4 cases excluded revealed that the combined treatment had effects on FVC which was observed in both 24 and 48 weeks. However, the research warrants large sample size to verify the results obtained which was further examined by Behr et al 86 . With the need to evaluate the efficacy of the drug combination within a large sample size, Behr et al 87 conducted an RCT for which 121 patients were recruited. The examination of the previous study revealed that this research is the first RCT to investigate the tolerability and safety of the combined treatment method (Oral Acetylcysteine and Pirfenidone) wherein the efficacy of the drug combination was compared with pirfenidone alone as the control in IPF patients. It is revealed that there are no significant alterations in the safety and tolerability of using the combined drug treatment method; however, adverse events such as photosensitivity are evident in the intervention group which the researchers state that further analysis is 84 https://www.ncbi.nlm.nih.gov/pubmed/26496265 85 https://www.ncbi.nlm.nih.gov/pubmed/25639750 86 https://www.ncbi.nlm.nih.gov/pubmed/27161257 87 https://www.ncbi.nlm.nih.gov/pubmed/27161257 © 2017-2018 All Rights Reserved, No part of this document should be modified/used without prior consent Tutors India - Your trusted mentor since 2001 www.tutorindia.com I UK # +44-1143520021, info@tutorsindia.com Page 104 of 172
equired. An exploratory efficacy analyses is performed which revealed that patients which received combination therapy has experienced a decline in the functioning of their lungs than patients in the control. In the PANORAMA study, the exploratory endpoints revealed no evidences of the benefits of using oral acetylcysteine and prifenidone as a combined treatment method for IPF. 5.2 Assessment of the likelihood of combination therapy towards reducing mortality rate For all the studies considered for the systematic review, it is evident that no specific information regarding the likelihood of reducing the mortality rate in IPF patients is present in the researches. However, with respect to the adverse events all studies revealed better outcomes. In the research by Sakamoto et al 88 , it is revealed that patients diagnosed with advanced IPF and with relatively lowered levels of FVS during the 12-month follow-up with the evaluation of the pulmonary function had 8 of the 17 patients in the intervention group to have stated the treatment to be effective; however only 2 out of 10 patients in the control group found the treatment as effective for advanced IPF. Furthermore, there is no specific information pertaining to the death of patients revealed in the study by Sakamoto et al 89 . However, in the study by Huang et al 90 which recruited 78 patients for the research revealed that at the 24 the week, significant outcomes were seen in the intervention group which is treated with pirfenidone and NAC. Though the outcomes were significant in the 24 th week, the same did not persist till the 48 th week. Furthermore, in the intervention group there is high rate of adverse events than the control group. Additionally, four cases died wherein two belonged to the intervention group and two belonged to the control group. However, the prolonged PFS which is evident in the research might reveal that the combined treatment can to some level decrease the rate of mortality in IPF patients. Behr et al 91 discerned the fact that life-threatening events were witnessed in one patient in the intervention group and one patient in the control group wherein death was witnessed in one 88 https://www.ncbi.nlm.nih.gov/pubmed/25639750 89 https://www.ncbi.nlm.nih.gov/pubmed/25639750 90 https://www.ncbi.nlm.nih.gov/pubmed/26496265 91 https://www.ncbi.nlm.nih.gov/pubmed/27161257 © 2017-2018 All Rights Reserved, No part of this document should be modified/used without prior consent Tutors India - Your trusted mentor since 2001 www.tutorindia.com I UK # +44-1143520021, info@tutorsindia.com Page 105 of 172
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Efficacy of pharmacological interve
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2.2.7 Clinical Course of IPF.......
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CHAPTER I: INTRODUCTION Idiopathic
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Progression-Free Survival (PFS) in
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is used (Azuma et al., 2005). The p
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Source: Adopted from Myllärniemi a
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disease is increased; however, no s
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CHAPTER II: LITERATURE REVIEW 2.1 I
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The dangerous disease basically att
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made between the inflammatory and f
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(Giotopoulos et al., 2007). RT of t
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derived cytokines, IL-5 and IL-9, m
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granulomatous lung disease, hence i
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infection and IPF (Wangoo et al., 1
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2.2.6 Pathophysiology Though the pa
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smoking (Rosas et al., 2007; Steele
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histological pattern of UIP in the
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The aim of this procedure is to rec
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procedures involving internal valid
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adiological diagnosis of HRCT (Ragh
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2.2.11.1 Clinical Predictors Age: A
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© 2017-2018 All Rights Reserved, N
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studies and have exhibited that inc
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Numerous physiologic parameters lik
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Dense fibrosis and honeycombing is
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Pharmacological treatment: Glucocor
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i. Oxygen Therapy and ventilation I
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Numerous patients with IPF acquirin
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should be undergone to reveal wheth
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CHAPTER III: RESEARCH METHODOLOGY T
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3.2 Meta-analysis of Randomised Con
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3.4.1 Inclusion criteria The inclus
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3.6.1 Dichotomous Comparisons The v
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CHAPTER IV: RESULTS 4.1 Introductio
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Following are the questions of the
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Study number Table 2- CASP assessme
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Page 131 and 132: American Thoracic Society. Idiopath
Page 133 and 134: and clinical immunology. 115 (1). p
Page 135 and 136: Behr, J., Maier, K., Degenkolb, B.,
Page 137 and 138: Bowling, A. (2009). Research Method
Page 139 and 140: 878-81. Available from: http://www.
Page 141 and 142: http://www.ncbi.nlm.nih.gov/pubmed/
Page 143 and 144: El-Chemaly, S., Ziegler, S.G., Cala
Page 145 and 146: Flaherty, K.R., Andrei, A.-C., Murr
Page 147 and 148: pirfenidone on the generation of re
Page 149 and 150: Hansell, D.M., Bankier, A.A., MacMa
Page 151 and 152: proteoglycan deposition in the airw
Page 153 and 154: Nishimura, J. & Inoue, T. (2009). A
Page 155 and 156: 313-9. Available from: http://www.n
Page 157 and 158: Pereira, C.A., Sahn, S.A., Sussman,
Page 159 and 160: interstitial pneumonia: the prognos
Page 161 and 162: Leslie, K.O., Gruden, J.F., Parish,
Page 163 and 164: America. 25 (4). pp. 709-721. Marti
Page 165 and 166: Meyer, A., Buhl, R. & Magnussen, H.
Page 167 and 168: Moseley, P.L., Hemken, C. & Hunning
Page 169 and 170: topics/topics/idiopathic-pulmonary-
Page 171 and 172: Olson, A.L., Swigris, J.J., Lezotte
Page 173 and 174: Piguet, P.F., Vesin, C., Grau, G.E.
Page 175 and 176:
open-label Phase II study. American
Page 177 and 178:
Rødningen, O.K., Børresen-Dale, A
Page 179 and 180:
Experimental Biology and Medicine.
Page 181 and 182:
Silva, C.I.S., Müller, N.L., Fujim
Page 183 and 184:
Sutton, A.J. (2000). Methods for me
Page 185 and 186:
(11). pp. 1085-1094. Tomioka, H., K
Page 187 and 188:
Wang, Q., Zhu, H., Zhou, W.-G., Guo
Page 189 and 190:
http://www.nature.com/doifinder/10.
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silica-induced lung fibrosis in the
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