Pulmonary Department Research Articles

POSITIVE PULMONARY ARTERY REMODELING AFTER A SERIES OF BALLOON PULMONARY ANGIOPLASTIES IN A PATIENT WITH CHRONIC THROMBOEMBOLIC PULMONARY HYPERTENSION

Objective: To demonstrate positive pulmonary artery remodeling after balloon pulmonary angioplasty (BPA) in patients with chronic thromboembolic pulmonary hypertension (CTEPH). Design and method: A 68-year old female was admitted to pulmonary hypertension department with swelling of the feet and legs, low level of arterial blood saturation (92%). She passed two episodes of pulmonary embolism – 7 and 5 years before the hospitalization. The patient was treated with anticoagulants (warfarin), diuretics (furosemide, spironolactone). Invasive pulmonary angiography confirmed thromboembolic lesions of pulmonary artery. Another types of pulmonary hypertension, except CTEPH, were excluded. Multidisciplinary commission considered her as inoperable due to obesity and anemia of unknown origin. But it was technically possible to perform BPA. The patient underwent 5 sessions of BPA. Before and just after the first BPA and 3 months after the last BPA intravascular ultrasound (IVUS) of pulmonary arteries was performed. Results: According to the results of treatment the functional class improved in the patient (from 4 to 3), the distance in 6-minute walking test slightly increased (from 290 to 303 m), and the mean preassure in pulmonary artery decreased from 40 to 35 mm Hg. When assessing the size of the pulmonary arteries, underwent angioplasty, there were determined signs of positive remodeling (Table 1). According to invasive angiography the diameter of branches of the subsegmental arteries increased up to 14.3%. According to the results of IVUS, comparable results were obtained: 10% increase of the lumen diameter. Conclusions: successful series of BPA in patients with CTEPH can lead to the significant positive remodeling of pulmonary arteries.

Affective and somatoform disorders in children in clinical settings of pulmonary department, their prevalence and impact on patient’s life quality

Chronic respiratory diseases affect the personality and emotional state of the people who experience them. Purpose - to determine the incidence of hyperventilation syndrome (HVS) and depressive disorder in patients with organic and functional pathologies of the lungs at the pulmonary department and to assess their impact on the life quality of patients. Materials and methods. We have examined 131 patients aged 6-17, among them there were 54.9% (n=72) boys and 45.1% (n=59) girls. The patients were divided into three groups: the children with somatoform disorder (SD) from the respiratory system 33.6% (n=44), those with bronchial asthma (BA) - 34.3% (n=45) and those with pneumonia - 32.1% (n=42). For the diagnosis of depression we used a questionnaire for children’s depression by M. Kovacs (1992), for the diagnosis of HVS we used Nijmegen questionnaire. To determine the patient’s quality of life we used Pediatric Quality of Life Enjoyment and Satisfaction Questionnaire (PQ-LES-Q). Results. The main structure of HVS 25 (19.1%) was composed of 17 (68%) children with SD, 5 (20%) children with BA and 3 (12%) children with pneumonia. Mild depression was determined in 56 (81.1%) sick children, an average one was found in 13 (19.9%) sick children. The severity of depression was significantly higher in the patients with SD in comparison to the patients with BA (95% CI: 6.5-15.5; p<0.0001) and in comparison to the patients with pneumonia (95% CI: 3.2-12.0; p<0.0009). The children with SD had the lowest rate of quality of life according to the PQ-LES-Q scale in comparison to the children with BA (95% CI: 5.4-14.6; p<0.0001) and the ones with pneumonia (95% CI: 6.2-12.6; p<0.0001). Conclusions. Hyperventilation syndrome occurs in 25 (19.1%) of the patients with pulmonary pathologies in childhood. In general, 69 (52.6%) of the children had depressive symptoms. Most likely, the basis of low satisfaction with the quality of life in patients with pulmonary pathology might be depressive disorders, as evidenced by the inverse and strong correlation between the data scales for depression and quality of life, whereby r=-0.773 (p<0.0001). The study was conducted in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee for all participants. Informed consent of the child’s parents was obtained for the research. No conflict of interests was declared by the authors. Key words: depression, bronchial asthma, pneumonia, somatoform disorder, quality of life, children.

Identification of nontuberculous mycobacteria isolated from household showerheads of patients with nontuberculous mycobacteria

This study aimed to examine whether nontuberculous mycobacteria (NTM) inside household showerheads are identical to those in patients with NTM-pulmonary disease (PD) since household water is one of the potential NTM sources. Samples were obtained from 32 household showerheads of patients with NTM-PD recruited through the Pulmonary Outpatient Department at the Severance Hospital between October 2018 and October 2019. All isolates from patients with NTM-PD were diagnosed using a reverse-hybridization line probe assay based on the ropB gene. To determine the mycobacterial compositions, the washing fluids were collected and investigated using multiplex polymerase chain reaction assay and NTM culture; suspected microbial isolates in these fluids and culture were identified using sequencing analysis of 16S rRNA gene. NTM species causing the PD in the patients were Mycobacterium avium, M. intracellulare, M. abscessus, M. massiliense, and M. fortuitum complex. The mycobacteria isolated from the showerhead were M. lentiflavum, M. gordonae, M. triplex, M. phocaicum, M. mucogenicum, M. florentinum, M. gilvum, M. llatzerense, and M. peregrinum. However, the species identified in the showerheads did not match those of the patients. Despite NTM species in the showerheads, clinical implications in the main pathogenesis associated with the disease in the patients studied were not elucidated.

ОЦЕНКА РОДИТЕЛЯМИ МЕДИЦИНСКОЙ ПОМОЩИ ИХ ДЕТЯМ С БРОНХИАЛЬНОЙ АСТМОЙ, ИМЕЮЩИМ КОМОРБИДНУЮ ПАТОЛОГИЮ

Currently, there is a steady increase in the number of children suffering from two or more diseases simultaneously occurring. In this regard, the assessment by parents of the medical care received by children with concomitant diseases is highly relevant. Aim. The aim of the study is to study the satisfaction of parents with medical care provided to patients with bronchial asthma and children with comorbid pathology. Material and methods. On the basis of the regional children’s clinical hospital, a selective sociological study was carried out, in which 368 parents of children aged 7 to 14 years old, patients with bronchial asthma with concomitant pathology, took part. Study design: single-center, non-randomized, uncontrolled study. Results and discussion. In the opinion of only 36.4% of the parents surveyed, inpatient medical care provided to their children is always available. The availability of outpatient care was positively assessed by only 29.5% of the respondents. In this case, the main reasons for dissatisfaction were called insufficient provision of the specified specialists and a long wait for the day of admission. The majority (81.8%) of the respondents would like to receive consultations from specialists of other profiles, taking into account concomitant diseases, when the child is in the pulmonary department of the hospital. At the same time, according to almost every second parent, the level of consultation of various specialists is higher in hospitals than in children’s polyclinics. Among the respondents, 69.3% considered themselves sufficiently informed on the issues of bronchial asthma in children. However, the results of the survey showed that only 69% of parents always follow medical recommendations. Conclusion. The presence of concomitant pathology in childhood, including with such a fairly common chronic disease such as bronchial asthma, requires special medical and organizational approaches to treatment. At the same time, it is necessary to take into account the opinion of the legal representatives of children on the availability and quality of medical care provided.

A facial ulcer secondary to a non-invasive ventilation mask in COVID-19 pneumonia

Sir, An 83-year-old patient hospitalized in the intensive care unit (ICU) of the pulmonary department for chronic respiratory failure complicated by severe COVID-19 pneumonia with respiratory involvement of 50% of the lungs. The comorbidities included diabetes, uncontrolled hypertension, ischemic heart disease, Parkinson’s disease, and bronchial asthma. The patient was unable to maintain adequate arterial oxygen saturation with a face mask and nasal prongs. The attending physician ordered non-invasive ventilation (NIV) and a continuous positive airway pressure (CPAP) mask was applied. On day ten of the patient’s ICU stay, his attending physician noticed a grade II cheekbone ulcer. The patient was put on a paraffin dressing. The evolution was marked five days later by a worsening in the stage of the pressure ulcer, which had become a stage III ulcer and, therefore, our opinion was requested. An examination of the patient revealed a well-adjusted, full-face mask with pressure against the zygomatic bone aggravated by the application of compresses, which further increased the aggression against the bone. A dermatological examination found two necrotic patches on both cheekbones without a peripheral detachment or inflammatory border (Fig. 1). There were no signs of bacterial infection. Upon investigation, the caregivers revealed that the CPAP mask had been left in place for nearly eighteen hours daily without formal monitoring or the inspection of the pressure areas. Fortunately, the patient’s condition began to improve as did her arterial oxygen saturation. The pulmonologist was gradually attempting to remove the patient from NIV. Strict monitoring of the pressure points was recommended and the patient was put on a hydrogel dressing for five days until the necrosis was eliminated, then on a hydrocolloid dressing after the mechanical removal of the remnants of the necrosis and fibrin with good improvement of the ulcer. The COVID-19 epidemic represents a new challenge for critical care physicians (ICU). In the context of this epidemic, the management of arterial oxygenation during critical care procedures is one of the main challenges for ICU physicians. As an effective means of ensuring satisfactory arterial oxygenation during COVID-19 pneumonia, more than 50% of patients treated in China required non-invasive ventilation (NIV) [1]. During NIV with headgear, ICU nurses should focus on interventions that help to improve the patient’s comfort to maximize the acceptability of the device and minimize mask-induced skin irritability [1]. Skin pressure sores secondary to helmet application may be prevented by applying hydrocolloid dressings associated with close monitoring of the patient’s tolerance to the pressure exerted by the mask [2]. The development of NIV-related pressure sores is due to a combination of pressure effects and shear forces exerted by the presence of a mask, pressure changes during the different phases of ventilation, and the tension of the mask’s strap [3]. The use of oronasal masks and increased time on NIV increases the risk of pressure ulcer formation, as do patient factors such as age, sensory impairment, chronic skin conditions, and hypotension [4]. Oronasal masks remain the most popular interface, with a European survey revealing that they are the first choice in 70% of cases. The reasons given by respondents for their choice were the reduction of air leakage, patient comfort, and cost [5].

Bronchological practice of the pulmonary surgical Department

In our 25-bed pulmonary surgical department, bronchological examinations have been used since March 1965. 236 bronchoscopes have been performed on 204 patients aged 8 to 77 years. All bronchoscopies were performed under anesthesia.

A pilot crossover trial assessing the exercise performance patients with chronic obstructive pulmonary disease

Noninvasive ventilation improves exercise performance in patients with chronic obstructive pulmonary disease (COPD). However, the effect of helmet ventilation (HV) on the short-term self-paced exercise performance of patients with COPD remains unclear. This study investigated the use of HV during a 6 min walk test (6MWT) and analyzed its short-term cardiopulmonary outcomes in patients with stable COPD. A single-site crossover trial was conducted in a pulmonary rehabilitation outpatient department. A total of 20 stable patients with COPD without disability were enrolled. The participants performed 6MWTs with and without HV on two consecutive days. The outcome measures were the distance walked in the 6MWT and the physiological and cardiopulmonary parameters. The mean difference in meters walked between the HV-aided and unaided walk tests was 15.4 ± 37.2 (95% confidence interval: − 2.03 to 32.8 m; p = .145). During the 6MWT, the peak heart rate was significantly higher when walking was aided by HV than when it was unaided (p < .001). The energy expenditure index, walking speed, oxygen saturation nadir, and hemodynamic parameters were comparable. Although carbon dioxide levels inside the helmet increased after the walk test, the participants’ transcutaneous carbon dioxide measurements remained unchanged. HV did not improve the short-term self-paced exercise performance in patients with stable mild-to-moderate COPD. Further research should focus on noninvasive ventilation delivered via helmets in exercise training to determine the setting strategy, breathing circuit configuration, and effects of regular exercise.ClinicalTrial.gov: NCT04156724; IRB number: C108032.

Diagnostic and Staging Value of Serum Angiotensin-Converting Enzyme in Sarcoidosis.

Objective To investigate the diagnostic and staging value of serum angiotensin-converting enzyme (sACE) in sarcoidosis. Methods Patients with suspected sarcoidosis treated in the Department of Pulmonary and Critical Care Medicine of the China-Japan Friendship Hospital from 2010 to 2020 were included. The data of sACE, erythrocyte sedimentation rate (ESR), complete blood count (CBC), lung function, bronchoalveolar lavage, and biopsy were collected. The differences between the sarcoidosis group and the nonsarcoidosis group and between different stages of sarcoidosis were compared. The receiver operating characteristic (ROC) curve analysis was used for the diagnostic test of sACE in sarcoidosis. Results A total of 84 cases with suspected sarcoidosis were included, among which 70 cases were confirmed to be sarcoidosis by biopsy. The mean value of sACE in sarcoidosis patients was 56.61 ± 30.80 U/L, which was significantly higher than that in nonsarcoidosis patients (28.07 ± 14.11 U/L, P = 0.001). The level of sACE in sarcoidosis patients with peripheral superficial lymph nodes and multiple system involvement was significantly higher than that in intrathoracic sarcoidosis patients (P = 0.009); the percentage of lymphocytes in bronchoalveolar lavage fluid (BALF) of sarcoidosis patients was 45.39 ± 22.87%, which was significantly higher than that of nonsarcoidosis patients (P < 0.001). There was no correlation between sACE and ESR (correlation coefficient = −0.167). According to ROC curve analysis, when sACE ≥ 44.0 U/L, the sensitivity of sarcoidosis diagnosis was 61.4%, the specificity was 92.9%, and the AUC was 0.819. Conclusion sACE has a good specificity in the diagnosis of sarcoidosis. sACE values in patients with sarcoidosis with systemic involvement were higher than those with simple intrathoracic sarcoidosis.

CLINICAL CHARACTERISTICS AND CHEST X-RAY AND COMPUTED TOMOGRAPHY FINDINGS IN DIFFERENT CLINICAL SEVERITY GRADING OF COVID-19 PATIENTS

Background: Clinical assessment, chest X-ray (CXR) and high-resolution computed tomography (HRCT) are used in the Corona virus disease-19 (COVID-19) management. The aim of the study was to determine the clinical characteristics and CXR and HRCT findings in COVID-19 patients with different clinical severity. Methods: This was a hospital-based cross-sectional study conducted at Chitwan Medical College, Department of Pulmonary and Critical Care Medicine from September to December 2020. Data from sixty adult patients with moderate (non-severe), severe, and critical COVID 19 disease having both CXR and HRCT were collected and were analyzed using SPSS version 16. Results: Median age of patients in our hospital-based study was 59.9 years and 76.7% were male, 30% had diabetes, and 35% had hypertension. Respiratory rate (p=0.001) and shortness of breath (p= 0.011) significantly increased and oxygen saturation (SpO2) (p&lt;0.001) decreased with increase in clinical severity of COVID-19 disease. Among the moderate, severe and critical clinical severity groups, there was significant difference in the HRCT findings like ground-glass opacity (GGO), consolidation, septal thickening, crazy paving pattern, bronchiectasis and fibrosis (p&lt;0.05). GGO was the most common finding. Bilateral consolidation in CXR and multiple lobes in both lungs involvement in HRCT were similar across the moderate, severe and critical clinical severity (p&gt;0.05). Conclusions: There was no difference in CXR and HRCT findings across moderate, severe and critical clinical severities of COVID-19; future study performing CXR whenever HRCT is done for any indication may similarly indicate the situation in mild COVID-19 disease.

Effects of high-flow nasal cannula with oxygen on self-paced exercise performance in COPD: A randomized cross-over trial.

Introduction:Studies have demonstrated that noninvasive ventilation improves exercise intolerance in patients with chronic obstructive pulmonary disease (COPD). The role of heated humidified high-flow nasal cannula (HFNC) therapy in patients with COPD on self-paced exercise performance remains unclear. Therefore, the purpose of the present study was to determine whether HFNC-aided supplemental oxygen during a 6-minute walk test (6MWT) would change self-paced exercise performance and cardiopulmonary outcomes in patients with stable COPD.Methods:A single-site, cross-over trial was conducted in a pulmonary rehabilitation outpatient department. This study enrolled 30 stable COPD patients without disability. The participants with and without HFNC performed 6MWTs on 2 consecutive days. Outcomes were the distance walked in the 6MWT, physiological, and cardiopulmonary parameters.Results:Those performing HFNC-aided walking exhibited a longer walking distance than those performing unaided walking. The mean difference in meters walked between the HFNC-aided and unaided walking scenarios was 27.3 ± 35.6 m (95% CI: 14.4–40.5 m). The energy expenditure index was significantly lower when walking was aided by HHHNFC rather than unaided (median: 1.21 beats/m walked vs median: 1.37 beats/m walked, P < .001). However, there were no differences in transcutaneous carbon dioxide tension between HHHNFC and non-HHHNFC patients.Conclusion:Walking distance and arterial oxygen saturation improved in stable COPD patients receiving HFNC with additional oxygen support. However, HFNC did not affect transcutaneous carbon dioxide tension and the self-reported dyspnea score during the walking test. The present study demonstrated the feasibility and safety of using HFNC in self-paced exercise.Trial registration:NCT03863821

Evaluating the technique of using MDI and DPI in patients with respiratory disease

Inhalation therapy plays a major role in treatment of respiratory diseases. Correct inhalation technique is crucial for effective clinical outcomes.The aim of this study was to evaluate and analyse technique of use of Metered Dose Inhaler (MDI) and Dry Powder Inhaler (DPI) in patients with respiratory disease.This observational study was conducted at pulmonary outpatient department of a tertiary care hospital.30 patients were enrolled using convenience sampling. Participants’ demographic and disease specific data was recorded. Participants were asked to use their inhaler just as they would at home. The technique of device use was observed and recorded using inhaler specific checklists. Data collected was analyzed using descriptive statistics.Out of 30 patients 26 were using MDI, 23 of which (92%) performed at least 1 error. Among 4 patients using DPI, 3 (75%) performed at least 1 error. Patients using MDI for more than 1 year performed less errors compared to those who had been using MDI for less than 1 year, however the difference observed was not significant (n=26, p= 0.304). 29 patients (96%) received education about inhaler device use. The most common incorrectly performed steps were “complete exhalation” and “breath hold.”92% of MDI and 75% of DPI users made at least one error during the inhalation maneuver despite majority being educated about inhaler technique. The most frequently performed incorrect steps for MDI and DPI were “Complete exhalation” and “Breath hold”.

Role of spirometry with flow volume loop in the diagnosis of upper airway obstruction: A study from the pulmonary medicine department of a tertiary care center

Role of spirometry with flow volume loop in the diagnosis of upper airway obstruction: A study from the pulmonary medicine department of a tertiary care center

Validity and Reliability of Turkish Version of Reaction Type Scale Against COPD.

The aim of the study is to develop a scale that could assess illness perception and reaction in patients with chronic obstructive pulmonary disease (COPD). The study was conducted in patients who were admitted in the pulmonary disease departments of a public and a private hospital. The study included 271 COPD patients. The COPD Perception and Reaction Scale, consisting of 54 items, was prepared as a Likert-type 5-point rating scale. In the validity phase of the study, expert judgments were obtained for content validity, and explanatory and confirmatory factor analyses (EFA and CFA) were then performed. The reliability of the scale in terms of internal consistency was tested with the Cronbach's alpha coefficient. According to the results of the EFA, the COPD Perception and Reaction Scale consists of 3 subdimensions and 23 items. Factors are termed behavioral reaction, emotional reaction, and spiritual reaction. According to the CFA, the goodness-of-fit indices obtained (χ2/df = (676.47/227) 2.98 and RMSEA = 0.056, NFI = 0.80, CFI = 0.96, NFI = 0.91, and AGFI = 0.85) suggest that the recommended model for the scale is acceptable. The Cronbach's alpha coefficient was 0.74; Cronbach's alpha values for the subdimensions were calculated as 0.87 for "emotional reaction," 0.76 for "behavioral reaction," and 0.79 for "spiritual reaction." The 23-item form of the COPD Illness Perception and Reaction Scale was demonstrated to be a valid and reliable scale for determining the perception and the reaction toward illness in COPD patients in Turkey.

A RARE CASE OF CHRONIC COUGH

TOPIC: Lung Cancer TYPE: Medical Student/Resident Case Reports INTRODUCTION: Chronic cough is one of the most common symptoms for which outpatient care is sought. The differential diagnosis is broad, and many patients undergo extensive evaluation. We here report a rare case of chronic cough with progressive dyspnea due to Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia( DIPNECH), followed by a brief literature review of DIPNECH. CASE PRESENTATION: 70-year-old female, non smoker, history of Crohn's disease presented to the Pulmonology clinic in 2005 with cough and shortness of breath. PFT's showed restrictive pattern. CT scan showed multiple bilateral pulmonary nodules. Bronchoscopy could not identify cause. On periodic CT, lung nodules remained stable. In the meantime, she continued to have chronic cough and progressively worsening shortness of breath. She received multiple trials of steroids, antibiotics, and inhalers with mild improvement. Repeat PFT's now showed severe obstructive disease. Her coughing spells made it difficult to perform on PFTs. She underwent repeat bronchoscopy with extensive testing, including bacterial, fungal, malignancy, and autoimmune causes of her symptoms, all of which came back negative. The working diagnosis was necrobiotic nodules secondary to her Crohn's disease vs. Asthma. She was put on a prolonged steroid course and developed severe side effects like muscle weakness, mood changes, tremors and worsening kidney function. The patient was hesitant to go back on steroids. She had suffered for 17 years. A trial of steroid-sparing medication CellCept was considered. However, before committing the patient to these, a wedge biopsy of the pulmonary nodule was performed and revealed neuroendocrine cells that stained positive for synaptophysin, chromogranin, and CD56.8 confirming the diagnosis of DIPNECH. The patient was subsequently referred to oncology and started on Octreotide infusions causing significant improvement in symptoms. DISCUSSION: DIPNECH is a rare condition that is becoming increasingly recognized. It is typically characterized by an insidious onset with chronic nonproductive cough, exertional dyspnoea, and wheezing, spuriously attributed to Asthma, chronic obstructive pulmonary disease, or GERD. Indeed, the diagnosis of DIPNECH is usually made several years after the onset of clinical symptoms, often following the incidental discovery of a lung nodule (or nodules) on imaging, usually computed tomography (CT). It is characterized histologically by a diffuse, bronchiolo-centric proliferation of neuroendocrine cells at the periphery of the lung, radiologically by ground-glass opacity, mosaic attenuation with air trapping, bronchial wall thickening, and pulmonary nodules and, Clinically by symptoms of airflow limitation. CONCLUSIONS: We hope this case can increase awareness of DIPNECH among clinicians as patients may otherwise be misdiagnosed and undergo unnecessary treatments or procedures causing permanent harm. REFERENCE #1: Diffuse Idiopathic Pulmonary Neuroendocrine Cell Hyperplasia 1Margaret Wei, MD and 2Mehri Manouchehr-Pour CLINICAL VIGNETTE1UCLA Department of Medicine2UC Riverside Department of Cell, Molecular, and Developmental Biology DISCLOSURES: No relevant relationships by Venkatkiran Kanchustambham, source=Web Response No relevant relationships by Swetha Saladi, source=Web Response No relevant relationships by Khurram Shafique, source=Web Response No relevant relationships by Vinita Vaidya, source=Web Response

Bereaved Family Members' Perceived Care at the End of Life for Patients with Noncancerous Respiratory Diseases.

Background: Data regarding the quality of end-of-life care for patients with noncancerous illnesses are lacking.Objective: This study aimed to evaluate end-of-life care for patients with noncancerous respiratory disease from the perspective of bereaved family members and explore the factors associated with the quality of patient death and care.Design: This cross-sectional study included patients who had died of noncancerous respiratory disease in general wards of pulmonary department in Japan between 2014 and 2016 and conducted an anonymous self-report questionnaire survey for the patients' bereaved family members.Measurements: We evaluated overall satisfaction with care and the quality of death and end-of-life care using the Good Death Inventory (GDI) and Care Evaluation Scale (CES), respectively. A multiple linear regression analysis was performed to explore the factors associated with these outcomes.Results: In total, 130 questionnaires were distributed, and the effective response rate was 38% and 50 patients were included (median age: 82 [range 58–101] years; 37 men [74%]). Primary diagnoses at death included 29 cases of pneumonia (58%), 15 interstitial lung disease (30%), and 3 chronic obstructive pulmonary disease (6%). Of the bereaved family members, 26 (52%) were spouses, and 19 (38%) were children (median age [range]: 68 [33–102] years, 15 men [30%]). The overall CES and GDI scores (mean ± standard deviation) were 77 ± 15 and 79 ± 15, respectively. The presence of dementia was an independent factor associated with high CES and GDI scores in the multiple linear regression analysis.Conclusions: In patients who died of noncancerous respiratory disease, the presence of dementia could be associated with the higher quality of patient death and care. In dementia, an understanding of the terminal nature of this condition may lead to an appropriate end-of-life care.

Correlation of Imprint and Crush cytology with Bronchoscopic biopsy in the diagnosis of Bronchogenic carcinoma

Introduction: Lung carcinoma is the most common cancer with 2.1 million (11.6%) newly diagnosed cases in 2018. Over the years, many cytotechniques have been developed but their combination with histology is still an area of controversy. Imprint and crush cytology are considered simple, rapid and cost effective for a low resource setting in the early diagnosis and management of lung cancer. Here, we aimed to assess the diagnostic accuracy of imprint and crush cytology and compare them with histopathology. Method: A prospective study was conducted from May 2017 to April 2018 at the Pulmonary medicine unit and Department of Pathology at National Academy of Medical Sciences (NAMS), Bir Hospital. A total of 53 patients were enrolled in the study who showed visible mass on bronchoscopy. Three to five bits of tissue were obtained, imprint and crush smear were prepared from them and the tissue were then sent for histopathological examination. The level of significance selected was p &lt; 0.005. Results: The most common age group affected was 60-69 years. 91% cases were smokers, with a male predominance. The most common location of endobronchial growth was left upper lobe. 43 cases were malignant in biopsy. The sensitivity, specificity, accuracy and positive predictive value of imprint cytology was 71.05%, 87.50%, 73.91% and 96.43% respectively while that for crush cytology was 74.36%, 75%, 74.47% and 93.55% respectively. The diagnostic yield of imprint, crush smear and forceps biopsy were 52.8%, 58.4% and 81.1% respectively. Squamous cell carcinoma was the most common carcinoma in this study. Conclusion: Imprint and crush cytology yield additional information that can be complementary to endobronchial biopsy. They are convenient, do not burden the patients and thus can be carried out wherever possible during bronchoscopy.

Мікроаспіраційний синдром у практиці педіатра: сучасні особливості і роль у формуванні бронхообструктивного синдрому

У статті наведені дані щодо дослідження поширеності синдрому мікроаспірації серед дітей раннього віку, які перебували в міському дитячому пульмонологічному відділенні з приводу затяжного перебігу обструктивного бронхіту. Була вивчена структура причин мікроаспірації у дітей раннього віку (2010–2015 рр.). Виділено найбільш значущі причини виникнення мікроаспіраційного синдрому залежно від віку дітей. Для більш ефективного збору анамнезу використовували модифікований опитувальник для батьків. У групі ризику за наявністю мікроаспіраційного синдрому в першу чергу знаходяться діти з перинатальним ураженням центральної нервової системи, народжені раніше терміну, з морфологічними і фізіологічними дефектами носоглотки, з м’язовою дистонією. Проявом мікроаспірації можуть бути часті відрижки, блювота під час кашлю, витікання їжі через ніс, зв’язок нападів кашлю з годуванням, посилення або поява кашлю в положенні лежачи, напади нічного кашлю або задухи, тривале збереження покашлювання після нападу. Педіатрам рекомендується уважно спостерігати за дітьми під час кожного годування, бо дисфагія може бути мінливою. Мікроаспіраційний синдром є складним в діагностиці і вимагає комплексного підходу, найчастіше діагностичні маніпуляції носять інвазивний характер. Своєчасна діагностика і лікування мікроаспіраційного синдрому дозволять знизити рівень респіраторної захворюваності у дітей раннього віку та зменшити тривалість перебігу обструктивних бронхітів.

Прогнозування та діагностика правошлуночкової серцевої недостатності та дисфункції шлуночків серця в період загострення бронхіальної астми у дітей

Актуальність. Бронхіальна астма (БА) вже в дитячому віці може супроводжуватись серцево-судинними ускладненнями у вигляді синдрому гострого легеневого серця, дисфункції шлуночків серця, метаболічної кардіоміопатії, порушень ритму і провідності, що не тільки обтяжує перебіг захворювання, але й додатково знижує якість життя пацієнтів. Ремоделювання серця при БА передує клінічним проявам серцевої недостатності та може самостійно поглиблювати систолічну і діастолічну дисфункцію шлуночків. Мета. Удосконалення прогнозування розвитку серцево-судинних ускладнень у період загострення БА в дітей шляхом визначення факторів ризику розвитку дисфункції шлуночків і розробки додаткових інформативних клініко-ехокардіографічних діагностичних критеріїв правошлуночкової серцевої недостатності. Матеріали та методи. Під нашим спостереженням перебували 85 дітей, хворих на БА, віком від 5 до 17 років, у яких застосовано методи пульсоксиметрії, спірографії, електрокардіографії, допплер-ехокардіографії. Обстеження проводилось у періоді загострення БА при госпіталізації хворого і в періоді поліпшення стану, на 5–6-ту добу перебування у відділенні пульмоалергології комунального закладу «Обласна дитяча клінічна лікарня» Дніпропетровської обласної ради. Критеріями включення в дослідження були алергічна та змішана персистуюча средньотяжка і тяжка астма в період загострення. В дослідження не ввійшли хворі на БА діти в період ремісії, діти з інтермітуючим перебігом астми та легкою персистуючою БА. Для визначення типу й ступеня вентиляційної недостатності використовували метод спірографії з оцінкою показників життєвої ємності легень (ЖЄЛ), об’єму форсованого видиху за 1 секунду (ОФВ1), ОФВ1/ЖЄЛ. Математичне і статистичне опрацювання матеріалів дослідження проводили з використанням методів біостатистики, реалізованих у пакетах програм Microsoft Excel (Office Home Business 2KB4Y-6H9DB-BM47K-749PV-PG3KT), Statistica 6.1 (StatSoft Inc., серійний № AGAR909E415822FA). Результати. Визначено прогностичні клінічні фактори ризику розвитку систоло-діастолічної дисфункції шлуночків серця у випадку можливого нападу БА, до яких було віднесено: наявність у хворої дитини БА тяжкого перебігу; наявність тахікардії у спокої; порушення реполяризації в міокарді шлуночків на електрокардіограмі; наявність у хворого на астму супутнього хронічного тонзиліту; бактеріоносійство у носоглотці; жіночу стать. Розроблено додаткові інформативні діагностичні критерії розвитку правошлуночкової серцевої недостатності в період загострення БА у дітей. Установлено, що застосування еуфіліну поряд із ­b2-агоністами для бронхолітичної терапії дітей у період загострення БА негативно впливає на діастолічну функцію шлуночків серця і сприяє збереженню підвищеного тиску в легеневій артерії. Висновки. Питання покращення можливостей прогнозування розвитку дисфункції шлуночків серця та своєчасної діагностики серцево-судинних ускладнень у період загострення БА у дітей вирішується шляхом визначення клінічних факторів ризику розвитку дисфункції шлуночків і розробки додаткових інформативних клініко-ехокардіографічних діагностичних критеріїв правошлуночкової серцевої недостатності.

Type 1 Diabetes Mellitus

As has been the case in many areas of child and adolescent health and in medicine in general, the recent Covid19 pandemic has affected children and adolescents with type 1 diabetes (T1D) and their families very much. In addition, health system resources have been allocated to adult care infectious disease and pulmonary medicine departments. Pediatric care and pediatric health care structures have suffered (1-3). Still, a number of important publications have been made available within the last year which shed new light on many aspects of T1D in early life and will allow to improve the care for children and adolescents with T1D.

Tuberculosis at the time of Coronavirus disease (COVID-19) lockdown - Back to the days of yore!!!

Abstract Background: The coronavirus disease (COVID-19) pandemic and the lockdown imposed due to it have served as a major setback to tuberculosis (TB) control. We therefore conducted this study to assess the profile of TB patients presenting to our department immediately after COVID-19 lockdown, which was imposed in India from 24 March 2020 and continued for &gt;3 months, and to compare it with the pre-pandemic pattern. Methods: This was an observational study conducted at the pulmonary medicine department of our tertiary care institute. We evaluated the consecutive cases of TB referred to or diagnosed new by our department as soon as the lockdown was lifted and non-COVID services resumed. The data of 2020 and 2019 during September and October month were gathered and analysed retrospectively. Results: A total of 162 patients were hospitalised from September to October 2019, while 40 non-COVID patients were hospitalised during September to October 2020 in our unit. The mean duration of symptoms was 1 month in both the groups. The incidence of TB cases amongst the patients needing hospitalisation after lockdown was more in 2020 [57.5%; 23 diagnosed TB cases (12 males and 11 females) out of 40 non-COVID hospitalised cases] than in 2019 [13.5%; 22 diagnosed TB cases (13 males 9 females) out of 162 hospitalised cases], and this was statistically significant (chi-squared test: p &lt; 0.00001). There was a statistically significant increase in transfers to the TB hospital where patients requiring further long-term medical care were referred to; in 2020 (12.5%; 5 out of 23 diagnosed TB cases) as compared with those in 2019 (0 out of 22 diagnosed TB cases) (p = 0.049, Fischer’s exact test). There was a statistically significant increase in the duration of hospital stay in 2020 than that in 2019 (p = 0.0076, unpaired t-test). There was no statistical difference in occurrence of pulmonary versus extrapulmonary TB (EPTB) or in occurrence of complications of TB in the two years. Conclusion: The COVID-19 pandemic and its lockdown have skewed the profile and pattern of the clinical manifestations and the complications of TB with a more severe trend.