Sputum Blood Research Articles

Medieval Recipes for Blood Sputum Treatment by Abulcasis

Medieval Recipes for Blood Sputum Treatment by Abulcasis

Cryptogenic Organizing Pneumonia Mimicking a Mass Lesion: An Unusual Case

Cryptogenic organizing pneumonia (COP) is less common interstitial lung disease with varying clinical picture. It can be misdiagnosed as lung cancer as COP usually presents with malaise, fever, weight loss, and myalgia, which overlap with clinical features of lung cancer. Here, we present a rare case of a 68-year-old male smoker admitted with cough, hemoptysis, arthralgia, fever, and chest pain. On chest X-ray, unilateral homogenous opacity was seen. Blood culture and sputum for Ziehl–Neelsen stain were negative. High-resolution computed tomography chest revealed consolidation in middle and lower zone of the left lung with ground-glass opacity with centrilobular nodules. Bronchoalveolar lavage specimen was negative for bacteria, Mycobacterium tuberculosis, and atypical cells. Transbronchial lung biopsy showed evidence of OP. The patient responded well to steroids.

Anomalous systemic arterial supply to the left basal lung with a calcified abnormal vessel: a case report

BackgroundAnomalous systemic arterial supply to the normal basal segment of the left lower lobe is a congenital abnormality of the lung, frequently and is generally diagnosed at a young age. Surgery is generally recommended if symptoms such as blood sputum or fever are observed. Resection of the abnormal artery is often performed at an early age, with only few reports of surgery being performed at an older age. In addition, to the best of our knowledge, there are no reports on surgical treatment of abnormal calcified vessels to date. Herein, we have presented a case in which a calcified aberrant vessel of lung was resolved surgically.Case presentationA 65-year-old female, previously diagnosed with anomalous systemic arterial supply to the left normal basal segment of the left lung lower lobe of lung was under observation on the basis of being asymptomatic.The patient presented to the emergency room with the chief complaint of blood in the sputum and she was referred to our hospital for a surgery. Computed tomography showed circumferential calcification of the intima of the abnormal vessel, which might have contributed to incomplete resection of the artery if automatic sutures were used. Thus, the abnormal vessel was ligated and dissected using pledgeted 4–0 polypropylene sutures and vessel clips under open thoracotomy followed by left lower lobectomy. The patient was discharged seven days after surgery without any serious surgical complications.ConclusionsVascular congenital anomalies of the lung are often operated at a young age presenting due to the associated symptoms. However, even if the disease is discovered incidentally and does not cause any symptoms or calcification in the aberrant artery, early surgical intervention is important due to the possibility of calcification occuring in the future. This can help minimize the degree of surgical invasion.

O03 ST97 Staphylococcus aureus and oxacillin resistance: an emerging challenge for microbiologists?

BackgroundThe presence of cefoxitin and oxacillin resistance in Staphylococcus aureus isolates is suggestive of methicillin resistance (MRSA) with molecular detection of the mecA or mecC genes providing confirmation. The UK SMI and EUCAST guidelines for MRSA detection describe a subset of strains that exhibit reduced susceptibility to oxacillin and cefoxitin, though negative for mecA and mecC genes—frequently named borderline oxacillin-resistant S. aureus (BORSA). Local data noted a number of S. aureus isolates that matched the above phenotype leading to laboratory, clinical and epidemiological questions.MethodsRoutine samples were collected between August 2020 and April 2021 at West Midlands Health Security Agency Laboratory, Birmingham. If provisional results suggested an MRSA isolate, the following confirmatory tests were undertaken. Locally, clinical samples underwent susceptibility testing with cefoxitin disc diffusion and oxacillin gradient diffusion (MRSA screens) or Vitek 2 (non-MRSA screens). Isolates with discrepant results [susceptible to cefoxitin; resistant to oxacillin (MIC >2 mg/L) or vice versa] were sent to the reference laboratory at Colindale, UK for further testing, which included mecA or mecC gene detection by PCR and serotyping with Illumina sequencing for all isolates.ResultsIn total, 53 isolates were sent to the reference lab of which 22 were confirmed to have an ST97 serotype. All 53 were negative by PCR for mecA and mecC genes. For the 22 isolates of ST97, local oxacillin MIC values ranged from 2 to 6 mg/L. Cefoxitin susceptibility was confirmed locally in all isolates. The 22 isolates were from 15 patients; wound swabs (n = 18); blood culture (n = 1), sputum (n = 1) and MRSA screen (n = 2). Median patient age was 48 years (IQR 38–59) with 5 being female and 10 male. A history of injecting drug use was documented in 53% (8/15).ConclusionsBORSA remains a problem from a laboratory, clinical and infection control perspective. This work raises two important questions: what is the most appropriate local laboratory testing pathway and what is the clinical relevance of these isolates (i.e. can flucloxacillin be relied upon in treatment)? The ST97 serotype appears to be associated with skin and soft tissue infection and may be linked to people who inject drugs.

TO DETERMINE BEST CLINICAL CHARACTERISTICS AND BIOMARKERS THAT GUIDE IN CASE MANAGEMENT AND IMPROVE ANTIBIOTIC STEWARDSHIP FOR CHILDREN ATTENDING PEDIATRIC CLINIC WITH ACUTE RESPIRATORY INFECTIONS

Back ground and objectives : Acute Respiratory Infections (ARI) are one of the most causes for evaluation and management at pediatric outpatient clinics. Most common of these ARIs are self limiting viral illnesses but majority are prescribed with antibiotics which is one of the major contributory factor for development of antibiotic resistance. So the aim of this study was to determine the ideal combination of clinical signs and biomarkers measured in resource limited settings and to facilitate accurate diagnosis and management and inturn antibiotic stewardship. Methods: From June 2021 to Jan 2022, children between one month and 5 years of age presenting with fever and at least one respiratory symptom to the OPD MIMS are included in the study. Patients with pneumonia and severe pneumonia basing on IMNCI guidelines and no exclusion criteria were included in this study. Participants underwent total leukocyte count (WBC), Absolute neutrophil count (ANC), C - reactive protein (CRP), procalcitonin (PCT), chest X-ray. A multiplex polymerase chain reaction (PCR), Sputum blood and urine cultures and sputum microscopy was done to identify the pathogen. Demographic and clinical characteristics of the participants were recorded. We studied the predictive accuracy by combining best clinical signs and biomarkers using statistical analysis. Results: In 15% of cases there was evidence of a mixed viral/bacterial infection, viral infection alone was detected in 52% and bacterial infection alone in 31% of patients. Children aged >2 years had a bacterial pneumonia more often than children aged <2 years. Among clinical markers Respiratory rate and oxygen saturation (92%) could discriminate accurately between bacterial LRTI and other LRTI. The proportion of patients with an increased WBC (>15.0 × 10^9/1) or increased ESR (>40 mm/h) was similar in bacterial and non bacterial RTI (48% v 47% and 66% v 60%, respectively). The differences in the CRP levels were signicant at the selected levels of >40 mg/l (p=0.005), >80 mg/l (p=0.001). PCT > 0.25 μg/L showed the best discriminating ability (AUROC 0.92; 96% CI 0.88–0.98), followed by CRP > 80 (0.80; 0.72–0.88). The combination of tacypnea and procalcitonin had the better predictive value (AUROC 0.98, 97% CI 0.94–1.00). Conclusions: Strict adherence to national guidelines and training physicians in assessment of clinical signs will reduce antibiotic use but still leads to over or under treatment. Although ideally point of care testing for respiratory pathogens like inuenza and RSV would be employed, this is unlikely to be feasible at peripheral health centers and pediatric clinics in India in the near future. Therefore, it remains important to consider use of Procalcitonin that can be quickly and easily adopted even less effective than rapid tests for pathogens.

The role of eosinophil-mediated inflammation in the formation of respiratory remodeling in patients with bronchial asthma of school age children

Objective. To investigate the features of inflammatory changes in the airways, taking into account remodeling markers, determined directly in the sputum of school age children with bronchial asthma, and to optimize the management of this disease.Material and methods. To study the features of the formation of airway remodeling 75 children with persistent bronchial asthma were comprehensively examined on the basis of the Regional Communal Non-Commercial Enterprise "Chernivtsi Regional Children's Clinical Hospital". The children were divided into 2 clinical groups depending on the level of vasoendothelial growth factor (VEGF) and matrix metalloproteinase 9 (MMP-9) in the sputum supernatant. The first (I) group included 37 schoolchildren whose VEGF concentration exceeded 80.0 ng / ml, and MMP-9 was more than 5.2 ng / ml. The second (II) comparison group was formed by 38 children in whom BA was not accompanied by accumulation of airway remodeling markers in the sputum supernatant above the indicated distribution point.Research results. The features of the formation of airway remodeling based on the accumulation of sputum markers such as VEGF> 80.0 ng / ml, MMP-9> 5.2 ng / ml were established. It was shown that bronchial remodeling is associated with a decrease in the group of patients with mild persistent asthma, loss of control over its symptoms, prevalence of family allergic history burdens according to both parental pedigrees and the negative effect of maternity smoking. The most sensitive marker in the verification of bronchial remodeling turned out to be a high marginal content of total IgE (> 750 IU / ml) in blood serum (test sensitivity - 95.8% (95% CI 89.7-98.8), which is advisable to combine in the diagnostic algorithm with more specific tests to optimize airway remodeling verification and develop personalized treatment strategies.Conclusion. The formation of bronchial remodeling in bronchial asthma in school age children is associated with the eosinophilic nature of bronchial inflammation, which is accompanied by an increase in the level of blood eosinophilia (> 10%) and sputum (on average 10.5 ± 1.0%) with an increase in myeloperoxidase activity and signs of degranulation of acidophilic granulocytes in sputum, as well as a high marginal concentration of total IgE (> 750 IU / ml) in blood serum in 95.8% of patients.

Sputum supernatant as a viable alternative for liquid biopsy in advanced non-small cell lung cancer.

3053 Background: Sputum has previously attracted attention as a potential medium for detecting genetic and epigenetic alterations in early-stage lung cancer. Recent progress in advanced non-small cell lung cancer (aNSCLC) has highlighted plasma as an option in scenarios where tissue specimens are unavailable. In this study, we investigated the feasibility of mutation profiling with sputum from aNSCLC patients. Methods: Matched tissue (TIS), whole blood, and either induced or spontaneous sputum were collected from 42 prospectively enrolled, previously untreated patients with stage IIIB-IV NSCLC. Eight and two milliliters of whole blood and sputum were respectively used for preparation of plasma (PLA) and sputum supernatant (SPU). Capture-based targeted sequencing of TIS, PLA and SPU samples was performed with a panel of 520 cancer-related genes. Results: The cohort had a median age of 59 (range 26-79) with a majority of men (31/42). Thirty-five patients were diagnosed with lung adenocarcinoma (LUAD) and the remaining seven with squamous cell carcinoma (LUSC). There were more non-smokers (26/42) than smokers. Most patients (34/42) had metastatic disease. First, we assessed the performance of three sample types in terms of key quality control indices. PLA and SPU showed maximum allelic fraction that were both significantly smaller than that of TIS. Subsequently compared was positive detection rate, TIS, PLA, and SPU achieved respective rates of 92.9%, 71.4%, and 59.5%, revealing comparable levels between PLA and SPU samples (p = 0.36). Rates of detection were highly similar between induced (54.6%) and spontaneous sputum (61.3%), but were higher in LUSC (85.7%) than in LUAD patients (54.3%) although this difference was not statistically significant (p = 0.21). Furthermore, detection rates rose in smokers (81.3% for PLA and SPU, 100% for TIS). Next, using TIS as the gold standard, we compared the sensitivity of detecting eight established driver alterations in NSCLC with the two liquid biopsies. SPU and TIS achieved respective levels of 50.0% and 70.0%, which, similar to detection rate, improved to 88.9% (8/9) and 77.8% (7/9) in the smokers subgroup. Importantly, detection of altered KRAS and ALK was more sensitive with SPU (6/6, 2/3, entire cohort) than with PLA (5/6, 1/3). For EGFR mutation, which occurred mainly in nonsmokers, the sensitivity was considerably lower in SPU (4/14, entire cohort) than in PLA (12/14). Detection of mutant MET, however, appeared difficult for both biopsies (0/4). In addition, there was a high level of correlation between estimates of tumor mutational burden based on PLA and on SPU (Pearson r2 = 0.58). Conclusions: Our study demonstrated that for aNSCLC patients, sputum supernatant demonstrates comparable performance as plasma. Sputum is therefore a viable alternative for profiling for established driver alterations in aNSCLC, especially in smokers.

Pattern of Mosquito Borne Parasitic Infection in the Night Blood Samples of Patients with Elevated TNF-α of> 5.0 pg/ml

Study Background: Plasmodium spp., (Protozoan) and Wuchereria bancrofti (Nematode) are transmitted by mosquitos to cause insect borne diseases known as malaria and Lymphatic filariasis/Elephantiasis. Apart from the social implication of these parasitic infections the infections can also elicit immune responses. Aim and Objective: This work was therefore designed to determine the pattern of mosquito borne parasitic infection in the night blood samples of patients with elevated TNF-α of > 5.0 pg/ml. Materials and Methods: Seventy (70; aged 31 – 76 years; Male- 35; Female-35) volunteers with plasma TNFα of 5.8 ±0.7 pg/including age-matched control participants ( n= 50 ; TNFα of 2.2 ± 0.3 pg/ml). All participants were negative to Acid Fast Bacilli, ant-HCV, HBsAg and HIV tests were recruited for the study. Night blood samples and sputum samples were obtained from the participants. Blood sample was used for determination of TNFα, HIVp24ag-Ab, anti-HCV, HBsAg by ELISA and identification of Plasmodium and Wuchereria by Geimsha thick blood film staining while sputum samples were used for the demonstration of Acid Fast Bacilli by Ziehl Neelsen staining. Results: The results showed a frequency of Plasmodium spp., in individuals with plasma TNF-α of 5.8 ±0.7 pg/ml as 31.4%(22) as against a frequency of 18%(9) in subjects with plasma TNF-α of 2.2 ± 0.3 pg/ml.. The results also showed a frequency of 5.71%(4) and2%(1) Wuchereria bancrofti in subjects with plasma TNF-α of 5.8 ±0.7 pg/ml and TNF-α of 2.2 ± 0.3 pg/ml. respectively. The overall frequency of parasitic infection obtained in both test and control subjects include: 33.3% (40)Plasmodium spp., and 4.2%(5) Wuchereria bancrofti.The overall results from both test and control subjects also showed a gender distribution of 20%(24) and 13.3%(16) Plasmodium spp.,in female and males respectively while a distribution of 1.7%(2) and 2.5%(3) Wuchereria bancrofti in females and males respectively. Conclusion: This work revealed increase in the frequency of Plasmodium spp. and Wuchereria bancrofti infections with increase in plasma TNF-α while the overall frequency of parasitic infection obtained in both test and control subjects was found to be 33.3% (40)Plasmodium spp., and 4.2%(5) Wuchereria bancrofti with possible variations in regional and gender distributions. Mosquito borne parasitic infection of Plasmodium spp., was found to be more prevalent in patients with elevated TNF-α of> 5.0 pg/ml.

Analysis of clinical features of large-cell neuroendocrine carcinoma patients guided by chest CT image under deep learning

This work aimed to explore chest computed tomography (CT) image segmentation of patients with large-cell neuroendocrine carcinoma (LCNEC) based on deep learning, as well as the clinical manifestations and imaging and pathological features of LCNEC patients. Clinical data of 40 patients with LCNEC confirmed by pathological examination in the X Hospital from December 2015 to December 2017 were retrospectively selected. CT image data were segmented by TJ-1 model modified full convolutional neural network (FCNN) model. The accuracy and training time of TJ-1 FCNN model and classic deep learning segmentation network model AlexNet model were compared in terms of image segmentation. According to the image segmentation results by TJ-1 FCNN model, chest CT images of LCNEC patients, were reviewed, and the clinical manifestations, as well as the imaging and pathological features of the patients were reviewed, sorted, and summarized. The results showed that the image segmentation accuracy of TJ-1 network model (99.38%) was higher than that of AlexNet model. The iteration training time of TJ-1 network model for 30 times was 45 min, lower than that of AlexNet model (82 min). LCNEC was more likely to be found in elderly male with a long history of smoking. The clinical symptoms were cough, sputum, sputum blood, and chest pain with no significant specificity. CT imaging showed that peripheral mass was the most common manifestation (67.5%), both lungs were visible, the upper lobe was more likely with lesion (60%), the edge of the lesion was clear or smooth (57.5%), which was lobulated (70%). Under the light microscope, tumor cells were characterized by large volume, low nucleocytoplasmic ratio, high mitosis, and large area necrosis. The positive rates of immunohistochemical neuroendocrine markers were CD56 (62.5%), CgA (50%), and Syn (85%), among which Syn was with the highest positive rate. To sum up, LCNEC lacked clinical and radiological specificity manifestations, while chest CT image segmentation based on TJ-1 FCNN model can quickly mark the location of the lesion, providing technical support for the diagnosis and evaluation of LCNEC clinically.

Bacterial Infection among Cancer Patients: Analysis of Isolates and Antibiotic Sensitivity Pattern.

Introduction Cancer patients being immunosuppressed are vulnerable to develop infections. Knowledge of the changing epidemiology of infections has a pivotal role in its management. Aims and Objectives. The study is undertaken to assess the types of bacterial infections in cancer patients undergoing anticancer treatment, the associated bacterial pathogens, and their antibiotic sensitivity patterns. Materials and Methods A retrospective surveillance study was undertaken in our center. Positive culture reports and other clinical details of cancer patients diagnosed with infection during a stay in the tertiary care center from 1st January 2015 to 31st December 2016 were analysed by descriptive statistical methods chi-square test and odds ratio to study the association. Results Out of 638 cancer patients diagnosed with infections in the 2-year period, 140 patients had positive cultures, representing 272 specimens and 306 isolates. Common specimens sent for culture were blood sputum, urine, and pus. 214 isolates (69.9%) were gram-negative bacilli, and 92 (30.1%) were gram-positive cocci. The most common isolates were Klebsiella spp. (18.30%), Pseudomonas spp. (17.65%), and Escherichia coli (14.71%) followed by Staphylococcus aureus (13.72%). Among the gram-negative organisms, the antibiotic resistance rates reported to fluoroquinolones, aminoglycosides, and third-generation cephalosporins were 45.13%, 39.20%, and 48.58%, respectively. 26.92% of the organisms are resistant to all three antibiotics. 50.4% of Klebsiella spp. and Escherichia coli were ESBL producers. Gram-negative organisms showed 11.63% resistance to β-lactam/β-lactamase inhibitor combination, and 22.22% of gram-negative organisms are resistant to carbapenems. 50% of the Staphylococcus spp. were methicillin resistant, but all were sensitive to vancomycin. Conclusion The surge in the number of gram-negative infections emphasizes the need for broad-spectrum empirical therapy targeting the same. Rate of resistance of the isolated gram-negative organisms to the routinely used empirical therapy is alarming. Prudent use of antibiotics, based on culture reports wherever possible, is of utmost importance to save the lives of infected patients and prevent further development of antibiotic resistance.

The clinical characteristics of 89 cases of non-tuberculous mycobacterium pulmonary disease complicated with tracheobronchial lesions

Objective: To explore the clinical characteristics of non-tuberculous mycobacterium(NTM) pulmonary disease complicated with tracheobronchial lesions. Methods: From January 2014 to December 2018, there were 1 006 patients who were admitted to Guangzhou Chest Hospital for the first time and received examination by bronchoscopy. A total of 89 patients with complete data were selected, including 40 males and 49 females, aged 20 to 85 years, with 46 patients (52%) aged 60 years or older. The clinical symptoms and signs of the patients were analyzed with chest imaging, bronchoscopy and pathological examination results. Comparisons between groups were made by Chi-square test and t test. Results: The number of patients with NTM complicated with tracheobronchial lesions accounted for 8.9%(89/1 006) of those hospitalized with NTM and received bronchoscopy during the same period. Clinical symptoms included cough and sputum (89/89), different degrees of hemoptysis or blood sputum (52/89), and shortness of breath (50/89). Chest CT showed that 72 cases (72/89, 81%) had lung lesions involving more than 3 lung fields, and 83 cases (93%) had bronchiectasis and 63 cases (63/89, 71%) with cavities. Pulmonary atelectasis was shown in 45 cases (45/89, 51%). By bronchoscopy, 39 cases (39/89, 44%) were diagnosed as tuberculous lesions involving bilateral upper bronchi, while lesions of the right lower bronchus was found in 27 cases (27/89, 30%).The percentage of patients with multilobar bronchial involvement was 50.6%(45/89). The morphological characteristics of the bronchial lesions included scar stenosis or atresia in 63 cases (63/89, 71%), hyperemia and edema in 46 cases (46/89, 52%), and multiple types of lesions in 48 cases (48/89, 54%). Conclusions: Patients with NTM lung disease complicated with tracheobronchial inflammatory lesions did not have specific manifestations clinically. Lung lesions are extensive, often accompanied by bronchiectasis and cavity formation. Endoscopic changes were mostly manifested as multilobar tracheobronchial involvement characterized by scar stenosis, congestion and edema, mainly involving bilateral upper bronchi and the right lower bronchus.

Gene expression responses to anti-tuberculous drugs in a whole blood model

BackgroundThere is a need for better tools to evaluate new or repurposed TB drugs. The whole blood bactericidal activity (WBA) assay has been advocated for this purpose. We investigated whether transcriptional responses in the WBA assay resemble TB responses in vivo, and whether the approach might additionally reveal mechanisms of action.Results1422 of 1798 (79%) of differentially expressed genes in WBA incubated with the standard combination of rifampicin, isoniazid, pyrazinamide and ethambutol were also expressed in sputum (P < 0.0001) obtained from patients taking the same combination of drugs; these comprised well-established treatment-response genes. Gene expression profiles in WBA incubated with the standard drugs individually, or with moxifloxacin or faropenem (with amoxicillin and clavulanic acid) clustered by individual drug exposure. Distinct pathways were detected for individual drugs, although only with isoniazid did these relate to known mechanisms of drug action.ConclusionsSubstantial agreement between whole blood cultures and sputum and the ability to differentiate individual drugs suggest that transcriptomics may add value to the whole blood assay for evaluating new TB drugs.

Rapid Detection of Respiratory Pathogen 33 in Cases of Acute Respiratory Tract Infection

OBJECTIVES: To determine the efficacy of respiratory pathogen (RP) 33 test for detecting specific RP that cause acute respiratory infection in a short turnaround time. MATERIAL AND METHODS: A retrospective study of RP 33 test was performed from June 2018 to June 2019 of twenty symptomatic participants aged > 18 years old, medical evaluation and laboratory test were carried out at OPD Chest Center in Bangkok Hospital and laboratory test should be conducted during the duration of the study. Subjects were immune-competent and manifested signs and symptoms of acute respiratory infections. Seventeen participants were subjected to additional tests such as blood culture and sputum culture, acid fast bacilli (AFB) test, bronchial washing, Influenza AB viruses, and respiratory syncytial virus (RSV) and Quantiferon test for a definitive diagnosis. RESULT: All 20 participants were included in the study, 10 male and 10 female with a mean age of 64 ± 8.4 years. RP 33 test often takes a shorter turnaround time compared to microbial culture, a mean time of 20 ± 7.767 hours compared to 72 hours from sputum culture or blood culture as demonstrated on our test. Among the twenty participants there were twelve (60%) detected cases, five (25%) of which revealed multiple types of etiologic agent indicating co-infection. For bacterial etiology, nine cases were established: three cases of Staphylococcus Aureus were found, three cases of Klebsiella Pneumonia, one case of Streptococcus Pneumonia. Viral etiology was confirmed in nine cases, the leading pathogen of viral etiology is human Rhinovirus with three cases, two cases of influenza A virus, one case of influenza B virus, one case of Human Corona virus OC43, one case of human Parainfluenza virus 4 and one case of human Metapneumo virus A/B. There were eight (40%) cases of undetected results that needed additional diagnostic tests (sputum culture and sensitivity (Sputum C/S), acid fast bacilli test (AFB test), hemoculture and sensitivity (hemo C/S), bronchial washing, influenza AB&RSV and Quantiferon (TB QFT TB) test) to identify etiologic agent. CONCLUSION: RP 33 test, a multiplex real time polymerase chain reaction (PCR), provided a commendable implication. RP 33 test provided prompt and optimal diagnostic evaluations in ruling out etiologies of respiratory-related infections, particularly acute respiratory infections, thus delivering definitive and precise clinical care to patients leading to minimal usage of broad spectrum antibiotics.

The Relationship Between TLR 2 and 4 with Microbiota of Mouth and Nose in Hypersensitivity Type 1 Iraqi Patients

Hundreds of commensal bacteria are existed in the mouth and nose, and the interactions between these microbiotas and the Toll-like receptors (TLRs) in different parts of the upper respiratory tract, gastrointestinal tract, and immune cells maty assist to maintain the homeostasis of the immune system. Thus, it is importantto study the relationship between type one hypersensitivity and normal flora in the mouth and nose. Blood and saliva or sputum samples of seventy-one allergic patients were collected randomly in Baghdad/ Al- Zahraa center for asthma and allergies. Those patients were suffering from different types of hypersensitivity type1 such as skin and respiratory tract allergy (e.g, asthma and Rhinitis). The results revealed that the allergic females percentage were more than males. Staphylococcus spp., Lactobacillus and Fungi spp. isolated from the mouth and nose were more prevalent than other microorganisms among different age groups. In addition, most age groups were given significant variation in TLR2 level, while TLR4 recorded variation in female more than male patients.

Inflammatory profile in optimally treated patients with adult versus early-onset asthma

ABSTRACTIntroduction: The age of asthma onset is often implicated in clinical manifestation, diagnosis, and management of the disease.Aim: To define demographic, clinical and functional features and inflammatory characteristics in induced sputum in patients with adult-onset asthma.Methods: Optimally treated patients from asthma clinics of two tertiary hospitals were included in the study. Patients underwent assessment of demographic characteristics, severity and treatment regimes, pulmonary function tests, and skin prick tests, as well as measurement of blood eosinophils and sputum induction for the assessment of sputum inflammatory cells, IL-8 and IL-13 levels in the supernatant.Results: Of the 333 patients recruited, 234 (70.2%) had adult-onset asthma. Adult-onset asthmatics were older, had a higher BMI, a shorter disease duration, and were less often atopic, compared to patients with early onset asthma. Higher proportions of patients with severe asthma presented increased levels of FeNO and blood eosinophils, both in the early and the adult-onset patient groups. Finally, obese patients with early onset asthma were characterized by less atopy compared to non-obese patients in the same group.Conclusion: Adult-onset asthma was characterized by less sputum eosinophilia, a nonatopic profile and a higher BMI compared to early-onset asthma. The presence of blood eosinophilia and increased FeNO in patients with severe asthma was comparable in the two groups.

Effect of flutter device on airway mucus clearance, physiological parameters, and arterial blood gas analysis in patients with coronary artery bypass grafting during Phase 1 cardiac rehabilitation - A randomized control trial

Background: cardiac surgery is associated with the occurrence of pulmonary complications, which may be defined as any pulmonary condition that occurring during the post-operative period which may produce dysfunction that is clinically significant and may adversely affects the clinical course. Objective: The objective of the study was to evaluate the effect of flutter device on airway mucus clearance, physiological parameters, and arterial blood gas analysis in patients with coronary artery bypass graft (CABG) in during Phase 1 cardiac rehabilitation. Materials and Methods: A total of 40 patients postoperative CABG surgery were randomly assigned to receive either experimental group along with flutter device and control group received conventional physiotherapy, outcome measure include arterial blood gas analysis, physiological parameters, and sputum amount. Result: This control trial of 5 days gave result that flutter device and conventional exercise have an effect on PCO2 and sputum index both experimental and control group while there was effect on PO2 in the investigational group and pulse rate in control group. Flutter device when analyzed from baseline to 5th post-operative day sputum score and PCO2 analysis. Other measures showed no significant differences. Conclusion: Flutter device should be incorporated as a routine practices along with other chest physiotherapy techniques during Phase 1 of cardiac rehabilitation, which can have positive results in the quality of life and improving overall functional status in subjects following CABG, thereby minimizing the hospital stay.

ON THE OPTIMIZATION OF VERIFICATION OF BRONCHIAL ASTHMA IN CHILDREN WITH MANIFESTATIONS OF BRONCHOOBSTRUCTIVE SYNDROME

Bronchial asthma in children has different causes of development, and examination of markers to verify the disease in case of the first signs of bronchial obstruction is an important issue to find transitory or persisting asthma phenotypes. There were examined 156 children with signs of bronchial obstruction syndrome.They were divided into three clinical groups: the first (І) group included 36 children with acute obstructive bronchitis (average age 6,1 ± 0,6 years, 36 % of girls), the second (ІІ) group – 74 children with relapsing obstructive bronchitis (average age 5,60 ± 0,34 years, 38 % of girls), the third (ІІІ) group included 46 children suffering from bronchial asthma for two years (average age 11,6 ± 0,5 years, 33 % of girls).The family history of one of the parents and of both parents, aggravated by allergic diseases, was most often found in patients with bronchial asthma: in 34,8 % of children on maternal side (Р ˂ 0,05 with І, ІІ : ІІІ), in 17,4 % of cases on paternal side (Р ˃ 0,05) and in 4,3 % – on both sides (Р ˃ 0,05). Patients suffering from bronchial asthma in 78,3 % of cases demonstrated domestic, food or medical allergy, that was reliably higher than that of an appropriate number of children in І (33,3 %) and ІІ groups (37,2 %), Р ˂ 0,05. In case of complicated family anamnesis with allergic diseases and the level of nitrogen monoxide metabolites more than 40 µmol/l the diagnostic value of this test in detection of bronchial asthma is the following: sensitivity 87,5 %, specificity 89,5 %, predicted value of a negative result 97,1 % with realization odds ratio 59,5, relative risk 22,3. Relative blood eosinophilia (Р ˂ 0,05 with ІІІ : І, ІІ) and sputum eosinophilia (Р ˂ 0,05 with ІІІ : І, ІІ) in children suffering from bronchial asthma as compared to the patients with obstructive bronchitis were found. In patients with verified asthma compared with children with acute and recurrent obstructive bronchitis, a significantly higher number of eosinophils, alveolar macrophages and epithelial cells in sputum is observed, which is accompanied by a lower content of neutrophil granulocytes and lymphocytes.Thus, in children with bronchial obstruction, even at its first episode, to identify the risk of bronchial asthma, a family history should be carefully collected on the burden of allergic diseases, the history of the child on allergic manifestations, in the dynamics to determine the number of eosinophils in the peripheral blood and induced sputum, the level serum immunoglobulin E and the content of metabolites of nitric oxide in the condensate of exhaled air.

ON THE OPTIMIZATION OF VERIFICATION OF BRONCHIAL ASTHMA IN CHILDREN WITH MANIFESTATIONS OF BRONCHOOBSTRUCTIVE SYNDROME

Bronchial asthma in children has different causes of development, and examination of markers to verify the disease in case of the first signs of bronchial obstruction is an important issue to find transitory or persisting asthma phenotypes. There were examined 156 children with signs of bronchial obstruction syndrome.They were divided into three clinical groups: the first (І) group included 36 children with acute obstructive bronchitis (average age 6,1 ± 0,6 years, 36 % of girls), the second (ІІ) group – 74 children with relapsing obstructive bronchitis (average age 5,60 ± 0,34 years, 38 % of girls), the third (ІІІ) group included 46 children suffering from bronchial asthma for two years (average age 11,6 ± 0,5 years, 33 % of girls).The family history of one of the parents and of both parents, aggravated by allergic diseases, was most often found in patients with bronchial asthma: in 34,8 % of children on maternal side (Р ˂ 0,05 with І, ІІ : ІІІ), in 17,4 % of cases on paternal side (Р ˃ 0,05) and in 4,3 % – on both sides (Р ˃ 0,05). Patients suffering from bronchial asthma in 78,3 % of cases demonstrated domestic, food or medical allergy, that was reliably higher than that of an appropriate number of children in І (33,3 %) and ІІ groups (37,2 %), Р ˂ 0,05. In case of complicated family anamnesis with allergic diseases and the level of nitrogen monoxide metabolites more than 40 µmol/l the diagnostic value of this test in detection of bronchial asthma is the following: sensitivity 87,5 %, specificity 89,5 %, predicted value of a negative result 97,1 % with realization odds ratio 59,5, relative risk 22,3. Relative blood eosinophilia (Р ˂ 0,05 with ІІІ : І, ІІ) and sputum eosinophilia (Р ˂ 0,05 with ІІІ : І, ІІ) in children suffering from bronchial asthma as compared to the patients with obstructive bronchitis were found. In patients with verified asthma compared with children with acute and recurrent obstructive bronchitis, a significantly higher number of eosinophils, alveolar macrophages and epithelial cells in sputum is observed, which is accompanied by a lower content of neutrophil granulocytes and lymphocytes.Thus, in children with bronchial obstruction, even at its first episode, to identify the risk of bronchial asthma, a family history should be carefully collected on the burden of allergic diseases, the history of the child on allergic manifestations, in the dynamics to determine the number of eosinophils in the peripheral blood and induced sputum, the level serum immunoglobulin E and the content of metabolites of nitric oxide in the condensate of exhaled air.

A comparative study of chemotherapy combined with intermittent microwave ablation and chemotherapy in the treatment of oligometastatic non-small cell lung cancer

// Linjia Zhu 1 , Shaofei Yuan 2 , Meizhen Liang 2 and Youyi Wu 2 1 Department of Respiratory Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Ruian, China 2 Department of Oncology, The Third Affiliated Hospital of Wenzhou Medical University, Ruian, China Correspondence to: Youyi Wu, email: xiaomifa1@outlook.com Keywords: chemotherapy; intermittent; microwave ablation; oligometastatic; non-small cell lung cancer Received: September 16, 2017&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Accepted: December 11, 2017&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Published: January 04, 2018 ABSTRACT Objective: To compare chemotherapy combined with intermittent microwave ablation and chemotherapy alone in the treatment of oligometastatic non-small cell lung cancer. Results: In the experimental group ( n = 34), the total effective rate (CR+PR) was 70.59% vs. 36.36% in the control group ( n = 33) (&chi; 2 =7.890, P &lt; 0.01). The score of KPS in the experimental group was higher than that in the control group, indicating obvious difference ( P &lt; 0.05). The median PFS in the control group and the experimental group was (3.6 &plusmn; 0.2) months and (5.4 &plusmn; 0.1) months (&chi; 2 = 42.731, P &lt; 0.01). There was statistical difference that the incidence of pneumothorax and blood sputum in the experimental group was higher than that in the control group (&chi; 2 = 6.031, P &lt; 0.05). However, no significant differences were found regarding other common complications of microwave ablation and chemotherapy. Conclusions: Chemotherapy combined with intermittent microwave ablation is superior to chemotherapy alone in improving the rate of disease control and the quality of life of patients, as well as prolonging the PFS of patients. Methods: A total of 34 cases of oligometastatic NSCLC who received chemotherapy with intermittent CT guided microwave ablation and 33 cases of oligometastatic NSCLC patients who received chemotherapy only were enrolled. The efficacy and the adverse effects were evaluated.

P1-5 - A Case of Cardiac Sarcoidosis With Difficulty of Steroid Therapy Due to Coexistence of Pulmonary Aspergillosis

A 76-year-old woman was admitted to our hospital with the chief complaint of dyspnea. Chest radiograph showed pulmonary congestion, and echocardiography revealed a decrease in LVEF of 47% with thinning of the basal interventricular septum. She was suspected to have cardiac sarcoidosis, and she was hospitalized to undergo detailed examinations. There were no coronary artery lesions with cardiac catheterization, and no abnormal findings in myocardial biopsy of the right ventricle. Gallium scintigraphy showed no abnormal uptake. Chest CT showed multiple granular shadows in bilateral lungs, and aspergilloma in the upper left lobe. Anti-fungal drug did not improve aspergillosis, and she had blood sputum. Left upper lobectomy was performed for this treatment. As the pathological findings revealed that she had two difficult lesion in the lung, aspergilloma and sarcoidosis. According to these findings, the heart lesion was diagnosed as cardiac sarcoidosis. In this case, because it was considered that introduction of steroid could result in relapse of pulmonary aspergillosis, she has not received steroid therapy. We report a case of cardiac sarcoidosis with difficulty to administer steroid therapy due to coexistence of pulmonary aspergillosis including literature considerations.