Episodes Of Dyspnea Research Articles

Levodopa-induced respiratory dysfunction in Parkinson’s disease managed with subthalamic nucleus deep brain stimulation

A variety of respiratory disorders have been reported in relation to Parkinson’s disease (PD). Long-term levodopa treatment often leads to motor fluctuations and dyskinesia, and some respiratory disorders may also occur as a result of levodopa therapy. Here, we present the case of an 80-year-old man with PD who experienced episodes of dyspnea attributed to levodopa-induced dyskinesia, which was effectively managed with deep brain stimulation.

Traditional Herbal Drug Approach used in the Treatment of Asthma: A Review

Asthma is a persistent inflammatory disease of the lower respiratory airway where the tracheobronchial smooth muscles of the lungs become tremendously narrow due to various causative agents like virus, allergens, exercise and become extremely responsive which leads to increase in secretions, mucosal oedema and mucus plugging. This results in repeating episodes of dyspnoea, wheezing, chest tightness, breathlessness, and coughing which might limit a person’s ability to work and function depending on the time and intensity of the episode. WHO’s assessment suggests that more than 339 million individuals had Asthma internationally and there were 417,918 deaths because of asthma worldwide in 2016. A review affirms that 1 out of every 10 Asthma patients are from India. Asthma can have various etiologies and types. The treatment involves Anticholinergics, corticosteroids, β2 agonists, Xanthine drugs. These oral administration drugs are effective but come with their own respective side effects to some extent. Since ancient times the mankind has always turned to natural substances to cure various diseases and ailments. In a similar manner, Asthma treatment is also seeing new advances with the use of traditional herbal drugs from various plant sources. They work in various complex mechanisms and have very minimal side effects. This review deals with Mangifera indica and Laurus nobilis as treatment options for Asthma and the mechanism with which they work. Keywords: Asthma, Mangifera indica, Mangiferin, Vimang, Laurus nobilis, Magnolialide

Hérnia diafragmática peritônio-pericárdica em gato

Peritoneal-pericardial diaphragmatic hernia (PPHD) is a rare condition in dogs and cats, being more prevalent in felines. Studies show that the Persian breed is particularly predisposed to this condition, suggesting a genetic predisposition. HDPP is generally a congenital anomaly and is not associated with trauma in small animals. The most commonly herniated organs include the liver and loops of intestine, due to their proximity to the diaphragm. Diagnosis of HDPP usually involves a combination of imaging methods such as radiography, echocardiography, and abdominal ultrasound. Surgical correction is recommended in cases of evident clinical manifestations, as well as in herniations of vital organs, such as intestinal loops or stomach. However, in cases where the hernia is an incidental finding and the patient is clinically stable, surgery may be avoided due to the risks associated with the procedure. The objective of this work is to report the case of a five-year-old Persian cat, which had no clinical manifestations and was diagnosed with peritoneal-cardiac diaphragmatic hernia. During the treatment, the animal presented dyspnea, which was an episode that had previously occurred according to the owner. An x-ray, Doppler echocardiogram and abdominal ultrasound were requested. A significant increase in the cardiac silhouette and the presence of liver tissue within the pericardial sac were noted, confirming the diagnosis of HDPP. Due to the animal's age, the herniated organ and the presence of only one sporadic clinical sign, surgical treatment was not initially recommended. The owner chose not to perform the surgery and was prescribed a specific diet to assist in the weight loss process and avoid episodes of dyspnea. The animal lived until it was nine years old, when it died due to chronic kidney disease unrelated to HDPP.

IS IT REALLY A CASE OF TAKOTSUBO? SOMETIMES APPEARENCES CAN BE DECEPTIVE

Abstract We report the case of a 22–year–old female with a history of David procedure and mechanical valve replacement (ATS 22 mm) due to bicuspid aortic valve and severe AR with ascending aorta aneurysm in 2015. Regular annual clinical follow–up (EKG and ultrasound) was always normal. Since 2022 the patient suffered from episodes of dyspnea, chest pain and sadness diagnosed as Panic Disorder. Home–therapy: Warfarin, estroprogestinic pill. At the latest outpatient visit she was asymptomatic and in good overall condition, but her EKG showed novel alterations (T wave inversion in antero–lateral leads and QT prolongation). She was then sent to the ED. LAB: troponin levels were normal (6.8 ng/ml) with an elevated Nt–proBNP (425 ng/ml) and a low INR (1.53). Questioned about recent events she reported a road trauma which occurred two weeks prior. She was then admitted to Cardiology clinic. Ultrasound: apical akinesia with reduced wall thickness, EF 48%, E/E‘ 10, and normal right ventricular function. The aortic valve prosthesis was functional without pathological regurgitation, and other echocardiographic parameters were within normal limits. EKG and ultrasound abnormalities along with a recent history of trauma supported Takotsubo Syndrome diagnosis (InterTAK score = 79.8% – 67pt), even though troponin levels were normal. Throughout hospitalization there were no changes in the EKG or pathological increases in troponin, and the patient remained asymptomatic. The patient was treated with LMWH to achieve adequate INR levels and initiated on B–blocker, ACEi, and SGLT2i for HFmrEF. Cardiac MRI revealed apical segment akinesia with dilation and reduced wall thickness (EDV 97 ml/m²), EF 41%, transmural ischemic LGE in the apical region and a ventricular thrombus (16x4 mm). The patient underwent coronary angiography which showed normal epicardial coronary arteries. Upon careful history–taking, the patient admitted irregular intake of VKA in the previous months. Given this information, the MRI and angiographic findings the diagnosis of unrecognized prior acute coronary syndrome, likely due to coronary thromboembolism in a patient with PHV and suboptimal compliance with VKA, was established. The patient was discharged home upon achieving a persistently therapeutic INR, with instructions to discontinue contraceptive therapy. Conclusion: coronary thromboembolism is a rare complication of PHV with inadequate anticoagulation leading, in this case, to an unrecognized MI.

HCM AT THE CROSSROAD

Abstract Introduction Treatment of oHCM frequently requires difficult choices, especially when it is superimposed on other urgent clinical conditions,such as AMI or mechanical complications. Clinical Case A 52–year–old man with known oHCM, who spontaneously quickly discontinued recommended therapy, presents to theED with a sudden episode of dyspnea and presyncope. A firstECG was essentially normal for pathology. After 1h, the patient experiences a sudden episode of chest pain with rapid hemodynamic deterioration and cardiogenic shock(CS). The ECG shows changes compatible with inferolateral MI. The TTE shows severe LVOTO, SAM, severe MR and a suspicious oval image attached to the anterior mitral leaflet. The patient underwent orotracheal intubation, coronary angiography and TEE. Coronary angiography shows a thrombotic occlusion of the proximal circumflex artery, treated with pPCI. TEE confirms a partial rupture of the papillary muscle head. Treatment:The patient‘s CS can be caused by 2different conditions that require treatments with opposing pathophysiological principles. SevereMR due to papillary muscle rupture, as mechanical complication of MI, requires afterload reduction, hemodynamic stabilization with IABP and emergency transfer to a cardiac surgery center. In contrast, the treatment of the underlying pathology(severe LVOTO and severe rMR due to SAM)requires pharmacological stabilization with depression of cardiac contractility and increase in afterload. In the context of cardiogenic shock a rapid choice was required. To help us make the right choice, an Esmolol test was performed. After iv administration of 2mg Esmolol, heart rate was reduced without reduction in BP. The patient was then treated with esmolol in continuous infusion and norepinephrine. In oHCM the ventriculo–arterial coupling is reduced, less than 1. This treatment favored better V–A coupling, ensuring an increase in afterload and a reduction in myocardial contractility. The patient‘s clinical condition rapidly improved, allowing extubation at48h and early mobilization at96h. Myectomy and mitral repair surgery was scheduled 1 month afterPCI. Conclusions Through the use of a short–lived drug such as Esmolol, it was possible to trace the prevailing mechanism of the patient‘s CS. Differently from other cases of CS, to rebalance the V–Acoupling, it was crucial to reduce myocardial contractility and increase afterload. A pathophysiological pharmacological approach ensured a good outcome.

Pulmonary artery thrombosis. Clinical cases

Accumulating evidence supports the need to consider pulmonary artery thrombosis the separate thrombotic complication, which requires its own treatment algorithms.
 The aim of the work is to demonstrate the pulmonary artery thrombosis clinical aspects and the effect of the standard thrombotic prophylactic algorithms with clinical examples.
 Clinical cases of patients with pulmonary artery thrombosis are presented. Pulmonary artery thrombosis is considered to be the thrombotic obstruction of the pulmonary artery branches in the absence of venous and cardiac chambers thrombosis.
 Patient S. with COVID-19 and 75% of lung involvement was treated in the accordance with the actual COVID-19 treatment recommendations. Enoxaparin sodium 6000 IE once a day followed by the increasing dosage of 8000 IE twice a day was used. To prevent exacerbation tocilizumab was infused, and systemic thrombolytic therapy was performed. On the 6th day after systemic thrombolytic therapy patient died. Examination revealed thrombi in the pulmonary artery branches.
 Patient P. with continued growth of cerebral left frontoparietal region glioblastoma was hospitalized. Surgical tumor removal was performed a year ago. Conservative therapy, dexamethasone injections and anticoagulant prophylaxis (enoxaparin sodium 4000 IE once a day) were prescribed. After the patient death thrombi were found in the pulmonary artery segmental branches.
 Outpatient D. had a history of four episodes of dyspnea during the acute respiratory diseases. Computed tomography performed at the time of the third and fourth episodes revealed thrombi in the pulmonary artery segmental branches. The fourth episode occured despite anticoagulant prophylaxis with rivaroxaban (10 mg once a day). Patient was recommended to switch to low molecular weight heparins in case of any disease. There have been no recurrent episodes over the past 8 months.
 Distinctive features of pulmonary artery thrombosis pathogenesis determine the development of the complication despite anticoagulant prophylaxis. Preventive effect of anti-inflammatory drugs on the pulmonary artery thrombosis development has not been demonstrated.

A clinical case of plastic bronchitis on the background of community-accombined pneumonia

Plastic bronchitis (PB) is a rare acute respiratory disease characterized by the formation of fibrin-rich plugs leading to airway obstruction and respiratory failure. This is due to the organization of the exudate, or transudate, which takes the form of the airways. Mortality in BE reaches 28-60% in patients with congenital heart disease (CHD) and 6-7% among other causes. Exact epidemiological data are unknown. In most patients, BE occurs in the context of underlying diseases, which can be conditionally divided into two groups: diseases of the heart and blood vessels and a secondary complication of pulmonary diseases. Clinical manifestations of PB are manifested by episodes of dyspnea, tachycardia, hypoxia, fever, and cough associated with airway obstruction. All existing treatments are symptomatic. The article presents a clinical case of the development and course of PB in a girl aged 1 year and 10 months against the background of acute community-acquired right-sided segmental (S10) pneumonia.

Successful definitive‐intent radiation therapy for recurrent and metastatic feline thymoma with unusual extra‐thoracic metastasis

AbstractA 10‐year‐old, male, neutered, domestic shorthair cat was referred for investigation of cough and dyspnoea episodes. A large cranial mediastinal mass was detected using computed tomography. Upon surgical removal, the mass was diagnosed as a lymphoid‐rich thymoma. Ten months postoperatively, the tumour was reported to recur, followed 2 months later by the development of an axillary mass and enlarged thoracic and superficial cervical lymph nodes. Recurrent and metastatic thymoma was confirmed, which was successfully treated with radiation therapy.

Pulmonary Hypertension in Patients of Chronic Kidney Disease on Maintenance Hemodialysis: Study from a Tertiary Care Center in Central India

To study the incidence of pulmonary hypertension (PH) in chronic kidney disease (CKD) stage V patients on maintenance hemodialysis (HD) at our center. To compare clinical and metabolic variables among CKD patients with and without PH to search for possible etiologic factors. Comparison of PH in CKD patients at baseline and after 3 months of sildenafil therapy. The study was conducted in the Department of Nephrology, Sri Aurob-indo Institute of Medical Sciences, Indore, for a period of 1 year from December 2021 to November 2022. All CKD patients on maintenance HD at our center were included in the study. A pre-structured proforma was used to record patient data. Detailed clinical examination, 2DECHO, and Biochemical tests were done. All patients with mean pulmonary artery pressure (mPAP) > 25 mmHg on 2D echocardiography were considered to have PH and were started on sildenafil therapy 20 mg three times a day for 3 months. PH was classified as mild PH (mPAP > 25 up to 40 mmHg), moderate PH (mPAP > 40 mmHg to 60 mmHg), and severe PH (mPAP > 60 mmHg). Patients were then followed for 3 months to look for episodes of dyspnea and emergency admissions and reassessed after 3 months by repeat 2D echocardiography to find improvement in PH. A total of 102 patients were analyzed during the study period; among them, 40 patients (39.2%) had PH. Out of them, 18 patients (45%) had mild PH, 14 patients (35%) had moderate PH, and 8 patients (20%) patients had severe PH. Average age of our patients was 48.8 ± 9.4 years, the majority being men. On comparing the clinical features between patients with and without PH, none of the clinical parameters had any statistically significant impact on PH. Also, none of the laboratory parameters had statistical significance among PH and non-PH groups. Among the patients with PH, 25 patients (62.5%) had Arteriovenous (AV) fistula, 10 patients (25%) had temporary dialysis catheters. Eight patients (20%) had jugular catheters, two patients (5%) had femoral catheters, and 5 (12.5%) patients had tunneled jugular catheters. Initially, 102 patients were enrolled in the study. Of these, 40 (39.2%) had PH and 62 (60.7%) did not. Patients who had PH started sildenafil 20 mg three times a day. Of these 40 patients, at 3 months, eight patients were lost to follow-up, and 32 patients with PH remained in the study. Emergency admissions in each group of PH declined after 3 months, and the result was statistically significant. Echocardiographic findings were compared in patients with PH and without PH, but the difference in patients on HD with PH and without PH was not statistically significant. PH is a significant problem in CKD patients on HD. This issue needs to be evaluated in a timely manner to avoid the risk of morbidity and mortality. It is vital to treat them at the earliest to prevent life-threatening complications.

P13 A rare case of Sjögren syndrome in a White woman with Kikuchi–Fujimoto disease

Abstract A 36-year-old White woman was seen in May 2022 for a rash on her upper back, shoulders, cheeks, forehead and extensor surfaces of the upper limbs. It had developed following sun exposure on the beach despite regularly applying SPF50. Over time, the rash became sore but exhibited no signs of vesicles or oozing. Of note, the patient had been recently diagnosed with Kikuchi–Fujimoto disease (KFD) following a lymph node biopsy. She gave history of Raynaud phenomenon since childhood, and arthralgia primarily affecting the small joints of hands. She also experienced episodic dry eyes, dry mouth, peripheral oedema, dyspnoea, abdominal pain and constipation. For the previous month, she had felt fatigued with some undocumented weight loss. Clinical examination revealed an erythematous rash with discrete nonblanching macules and plaques of varying sizes, oval-to-circular in shape, on the involved areas. Lymph nodes were not palpable. Differential diagnosis included cutaneous lupus, other connective tissue disorders, and—less likely—polymorphic light eruption. Skin biopsy showed focal compact hyperkeratosis and parakeratosis with focal subtle spongiosis, intraepidermal neutrophils and lymphocyte exocytosis, with the presence of perivascular and periappendageal chronic inflammation. There was mild basement membrane thickening with focal deposition of fibrinogen at the basement membrane zone on direct immunofluorescence. She was positive for anti-Ro antibodies, with a titre of 84 kU L−1 (normal < 11 kU L−1). A diagnosis of Sjögren syndrome with KFD was made. The patient was advised on photoprotection with a high-potency topical steroid, and referred to rheumatology for review of her joint problems. After 4 weeks, the patient had only some improvement with topical therapy and was started on oral hydroxychloroquine. At the 12-week follow-up, there was significant improvement. Her skin was clear, with improvement in joint pain and fatigue. KFD, also known as necrotizing lymphadenitis, is a benign and self-limited disorder, characterized by regional cervical lymphadenopathy with tenderness, usually accompanied with mild fever and night sweats. Rarely, the skin and joints are involved. There is an established association between KFD and connective tissue disorders, especially Sjögren syndrome (Gates GA, Li Y, Magyar C, Sarantopoulos GP. Kikuchi–Fujimoto disease with unusual cutaneous findings. Am J Dermatopathol 2021; 43:e213–17). This is more prevalent among Asians and rarely reported in White people (Perry AM, Choi SM. Kikuchi-Fujimoto disease: a review. Arch Pathol Lab Med 2018; 142:1341–6), where it may cause diagnostic difficulties. This case highlights the importance of lateral thinking while formulating a differential diagnosis, despite the time pressures of a busy clinic. Although the reported prevalence of KFD among White people has been negligible (Perry et al.), it should not be dismissed solely based on a patient’s ethnicity. Timely and adequate management of rare conditions can reduce patient morbidity and improve their quality of life.

Discomfort in Use and Physical Disturbance of FFP2 Masks in a Group of Italian Doctors, Nurses and Nursing Aides during the COVID-19 Pandemic

Face masks represent an effective COVID-19 mitigation strategy; this study investigated the quality in use of FFP2 masks in a group of 156 frontline HCWs recruited through a snowball procedure in northwest Italy. Participants filled out an online questionnaire (January 2022) on FFP2 sources of discomfort, physical disturbance at different anatomical points and suggestions for improvement. Most of the participants (69%) reported a feeling of protection and safety, but they also reported episodes of dyspnea (70%). The majority of glasses wearers (62%) reported fogging and displacement of their glasses. Humidity and heat were the main discomfort sources (39%), followed by elastic bands (32%). Physical disturbances were frequent and heavier on the ears, nose and cheekbones. Nursing aides and nurses perceived significantly more discomfort compared to doctors and nursing aides had the highest rate of physical disturbance. To address these issues, following participants’ suggestions, FFP2 masks should be redesigned to be more adjustable, with different sizes and softer fabrics. The investigation pointed out criticalities in the use of FFP2 masks related to different professional roles within the overall group of HCWs and stressed the need for an FFP2 human-centered design that accounts not only for physical needs but also for workload and task variability.

Sublingual fentanyl for refractory episodic acute dyspnea in patients with advanced chronic obstructive pulmonary disease (COPD): A real-world study

BACKGROUND Dyspnea is an extremely prevalent and debilitating symptom in chronic obstructive pulmonary disease (COPD), affecting up to 74% of patients despite optimal medical therapy. Sublingual fentanyl citrate (SLF) has a fast onset of action and a short half-life, both interesting characteristics to treat acute breakthrough dyspnea without inducing metabolite accumulation. The Montreal Chest Institute (MCI) COPD specialty clinic has been using low-dose SLF for patients with advanced COPD experiencing significant episodic dyspnea despite high intensity inhaled therapy. We present here a retrospective chart review, the largest to date, to report on a “real life” experience. METHODS All included patients had a formal diagnosis of COPD and were seen in the MCI COPD specialty clinic between January 1, 2015 and January 1, 2021. All patients prescribed SLF, irrespective of the duration of use, were enrolled in this chart review. Extent of symptom relief, categorized into either major, intermediate or no improvements, and adverse effects were inferred from in-person or telephone follow-up appointment clinical notes. An exacerbation was defined as a self-reported acute increase in symptoms leading to oral corticosteroid use or hospitalization. Rates of exacerbation and hospitalization in the 12 months before SLF initiation and during SLF use were compared. RESULTS In total, 17 COPD patients were given SLF during the study period. The mean FEV1 was 0.51 L (21% predicted). All participants reported MRC5/5 dyspnea and were prescribed regular low-dose oral morphine for daily breathlessness prior to SLF initiation. Most patients used SLF for more than 6 months, and 76.5% of the study group found intermediate or major improvement in breathlessness episodes. There was no significant change in the rates of exacerbation and admission for acute respiratory failure while on SLF. CONCLUSION In this review, we report real-life, long-term data on severe COPD patients using self-controlled as-needed SLF, showing patient acceptability, an improvement in dyspnea, and limited side effects. Hence, this represents an important step toward the first effective alternative rescue medication for the relief of breakthrough dyspnea since short-acting inhalers. Further study using a randomized trial design is required to confirm the efficacy of this therapy.

A cognitive-behavioral model of dyspnea: Qualitative interviews with individuals with advanced lung cancer.

Shortness of breath, or dyspnea, is the subjective experience of breathing discomfort and is a common, distressing, and debilitating symptom of lung cancer. There are no efficacious pharmacological treatments, but there is suggestive evidence that cognitive-behavioral treatments could relieve dyspnea. For this, understanding the psychological, behavioral, and social factors that may affect dyspnea severity is critical. To this end, patients with dyspnea were interviewed with questions framed by the cognitive-behavioral model-emphasizing thoughts, emotions, and behaviors as contributors and outcomes of dyspnea. Two trained individuals conducted semi-structured interviews with lung cancer patients (N = 15) reporting current dyspnea. Interviews assessed patients' cognitive-behavioral experiences with dyspnea. Study personnel used a grounded theory approach for qualitative analysis to code the interviews. Inter-rater reliability of codes was high (κ = 0.90). Thoughts: Most common were patients' catastrophic thoughts about their health and receiving enough oxygen when breathless. Emotions: Anxiety about dyspnea was the most common, followed by anger, sadness, and shame related to dyspnea. Behaviors: Patients rested and took deep breaths to relieve acute episodes of dyspnea. To reduce the likelihood of dyspnea, patients planned their daily activity or reduced their physical activity at the expense of engagement in hobbies and functional activities. Patients identified cognitive-behavioral factors (thoughts, emotions, and behaviors) that coalesce with dyspnea. The data provide meaningful insights into potential cognitive-behavioral interventions that could target contributors to dyspnea.

Interviews with children and adolescents with epilepsy or asthma about the situation of their healthy siblings.

Chronic conditions can influence the situation of healthy siblings of affected children. We investigated the opinion of the affected child about the situation of their healthy sibling and the sibling relationship. We performed a semi-structured interview with epilepsy or asthma patients aged 6-18 years and asked them to draw a picture: "Epilepsy/Asthma, my siblings and me." Of the 58 children with epilepsy, 67%, and of the 40 children with asthma, 60% thought that their siblings were worried about the condition. Among other aspects, they addressed helplessness during a seizure. Of the children with epilepsy, 83% and of those with asthma, 95% assumed that their siblings were not disadvantaged because of the participant's condition. Of the patients with epilepsy, 91% and of those with asthma, 93% thought that the sibling relationship would not be different without the condition. Of the participants with epilepsy, 86% and of those with asthma, 93% drew a picture; 30% with epilepsy and 14% with asthma visualised an interaction with their siblings in context of a seizure or episode of dyspnoea. According to the affected children, the condition worries their siblings but does not affect the siblings' lives or the sibling relationship.

PS-R04-2: A CASE OF SUCCESSFUL PERCUTANEOUS TRANSLUMINAL RENAL ANGIOPLASTY (PTRA) FOR RENAL ARTERY STENOSIS ASSOCIATED WITH TAKAYASU'S ARTERITIS

Introduction: In Japan, renal vascular hypertension based on renal artery stenosis (RAS) accounts for 1% of all hypertensive patients, and RAS is present in approximately 10% of autopsy cases of coronary artery disease and cerebrovascular disease. As ischemic nephropathy and complications of cardiovascular disease (CVD) due to RAS are common, early diagnosis and treatment for RAS is important. However, results of several large clinical trials have not shown the efficacy of percutaneous transluminal renal angioplasty (PTRA) for atherosclerotic RAS. Case: 51-year-old woman who diagnosed as Takayasu's arteritis (TA) 35 years ago, had been treated with 5 mg daily of prednisone. She presented with hypertension and edema in both legs a year before admission. Her examination at that time revealed increased serum creatinine from 1.0 to 1.7 mg/dL, high proteinuria (7.3 g/gCr), high renin activity (47.0 ng/mL/hr) and right RAS. Eight months before admission, she had an operation for ruptured descending aorta. She had recurrent episodes of dyspnea on exertion, worsening leg edema and severe hypertension and was admitted to the hospital for the treatment. Clinical course: In addition to severe hypertension (190/80 mmHg) and progression of RAS, she had pulmonary congestion, high brain natriuretic peptide (BNP) level (1149.5 pg/mL), increasing creatinine levels (Cr 3.1 mg/dL), and left non-functioning kidney on admission. Despite taking 8 types of antihypertensive drugs and diuretics without renin-angiotensin system inhibitors, blood pressure and fluid retention were poorly controlled, and thus we decided to perform PTRA for the right RAS. After the PTRA, edema, hypertension and pleural effusion had been dramatically improved. In addition, we could observe decrease of serum creatinine (Cr 1.6 mg/dL), proteinuria (0.5 g/gCr) and plasma renin activity (1.9 ng/mL/hr). Therefore, we reduced the antihypertensive drugs from 8 to 2. Discussions: Although the benefit of PTRA for RAS associated with TA remains unclear, the clinical course suggests that the success of PTRA in this case may be related to the fact that the RAS was complicated by TA. It also suggests that we should consider PTRA in cases of hypertension and pulmonary congestion associated with RAS which are difficult to control like this case. Conclusion: We have experienced a case of RAS associated with TA that was successfully treated with PTRA.

Episodic breathlessness in patients with cancer: definition, terminology, clinical features – integrative systematic review

PurposeBreatlessness flares directly impair quality of life of patients with cancer. The aim of this review was to analyse and synthesise the available information related to its terminology, definition and...

MUSCLE TENSION DYSPHONIA MASQUERADING AS ASTHMA

<h3>Introduction</h3> Muscle Tension Dysphonia is a laryngeal disorder characterized as an imbalance of coordination of the laryngeal muscles. Any form of laryngeal dysfunction may masquerade as an asthma exacerbation. <h3>Case Description</h3> A 44-year-old chemistry teacher with a past medical history of well controlled asthma on budesonide/formoterol and seasonal allergic rhinitis presented with shortness of breath and "wheezing." Episodes of her dyspnea were triggered by strong scents such as hand sanitizers and household chemicals or chemical exposures in the chemistry classroom. Spirometry preformed before the episodes of dyspnea as well as during exacerbations were both reproducible and normal with no signs of bronchial obstruction or reversibility. Similarly, exhaled nitric oxide testing before exacerbation and during exacerbation, were also within normal limits on multiple readings. Despite escalating therapy in her asthma regimen, including initiating allergy immunotherapy and different rounds of biologic therapy, her symptoms persisted. Only after an ENT evaluation with a flexible laryngoscopy, was it discovered that the etiology of the patient's symptoms was due to muscle tension dysphonia—not asthma. Patient was subsequently treated with speech therapy and botulinum injections into the vocal cords with improvement of symptoms. <h3>Discussion</h3> When a patient presents with shortness of breath, providers are quick to attribute symptoms to related comorbidities when the etiology may be something else. This case highlights the importance of including muscle tension dysphonia and other laryngeal pathologies in a differential diagnosis for patients with with a history of asthma presenting with symptoms of shortness of breath resistant to escalating asthma therapy.

Nasal eosinophilia as a preliminary discriminative biomarker of non-allergic rhinitis in every day clinical pediatric practice.

Non-allergic rhinitis (NAR) in children, named local allergic rhinitis (LAR) and non-allergic rhinitis with eosinophilia syndrome (NARES), are recently termed entities in childhood characterized by symptoms suggestive of allergic rhinitis in the absence of systemic atopy. Nasal eosinophils (nEo) are the principal cells involved in the allergy inflammation and nasal allergen provocation test is the gold standard method for the diagnosis, albeit with several limitations. The aim of this study was to validate the presence of nEo in combination with the therapeutic response to nasal steroids, as a preliminary discriminator of NAR in real life data. In a prospective cohort study, 128 children (63.3% male, aged 72 ± 42m) with history of NAR were enrolled and followed up for 52 ± 32m. Nasal cytology was performed and nasal steroids trial was recommended initially in all and repeatedly in relapsing cases. Response to therapy was clinically evaluated using 10-VAS. Significant nEo was found in 59.3% of the cases and was related to reported dyspnea episodes. 23.4% had no response to therapy, whereas 51.5% were constantly good responders. Response to therapy was related to nEo and a cutoff point of 20% was defined as the most reliable biological marker with 94% sensitivity and 77% specificity. In children with symptoms of NAR, the presence of nEo > 20% constantly responding to nasal steroid therapy, is a clear indicator of atopy. In an everyday clinical setting, it emerged as an easy, preliminary, cell biomarker suggestive of further investigation such as NAPT, to discriminate LAR from NARES.

Resolution of HCM phenotype and CHF following CMOP protocol in a cat with large cell lymphoma and suspected cardiac involvement

AbstractA 10‐year‐old female desexed domestic shorthair cat was diagnosed by the regular veterinarian with large cell splenic lymphoma in June 2020. A splenectomy was performed; however, complications postoperatively and the owner's willingness to pursue chemotherapy resulted in the patient being referred to the oncology department of a local multidisciplinary specialist hospital. At referral, a hypertrophic cardiomyopathy (HCM) phenotype was diagnosed post an episode of dyspnea. The patient was treated with CMOP (cyclophosphamide, mitoxantrone, vincristine and prednisone) chemotherapy, resulting in remission of the lymphoma and the HCM phenotype. Twenty‐one months out from treatment, the patient was still in remission with no evidence of heart disease.

SUCCESSFUL BIOPSY OF AORTOPULMONARY WINDOW LYMPH NODE WITH ROBOTIC-ASSISTED BRONCHOSCOPY

SUCCESSFUL BIOPSY OF AORTOPULMONARY WINDOW LYMPH NODE WITH ROBOTIC-ASSISTED BRONCHOSCOPY