Mild Obstruction Research Articles

Features of combined mucoactive therapy for bronchopulmonary diseases in children in outpatient practice

In 2022, ARVI rates among the paediatric population were 72281.8 per 100,000, which is 6.2% higher than such rates in 2021 (68062.5 per 100,000; p < 0.05). Estimated influenza rates among the paediatric population were 165.8 per 100,000, which is 2.9 times higher than this rate in 2021. Impaired mucociliary clearance makes a significant contribution to the pathogenesis of acute and chronic bronchopulmonary diseases. Slowing of mucociliary clearance that results from chronic mucus hyperproduction leads to airway obstruction and infection, which acts as a cause of aggravation of the disease. There’s no question, the choice of a drug that can affect the secretory function of the mucous membrane or the bronchial mucous itself and its evacuation requires an individual approach to each patient. The article presents a detailed review of modern literature, as well as the authors’ own experience about cough therapy methods, including those used in broncho-obstructive syndrome. At the same time, the use of combination drugs that have a simultaneous effect on various pathogenetic mechanisms of respiratory diseases are justified more than ever before. Due to synergistic interactions of its components, the modern combination therapy, including a fixed-dose combination of salbutamol, bromhexine, guaifenesin (Bromhekomb), contributes to the productive treatment of acute bronchopulmonary diseases and exacerbations of chronic bronchopulmonary diseases accompanied by cough, mucostasis and events of mild bronchial obstruction, as well as ensures high compliance, including due to consideration of the syrup dosage form, which is especially important in outpatient paediatric practice

Artificial neural network identification of exercise expiratory flow-limitation in adults

Identification of ventilatory constraint is a key objective of clinical exercise testing. Expiratory flow-limitation (EFL) is a well-known type of ventilatory constraint. However, EFL is difficult to measure, and commercial metabolic carts do not readily identify or quantify EFL. Deep machine learning might provide a new approach for identifying EFL. The objective of this study was to determine if a convolutional neural network (CNN) could accurately identify EFL during exercise in adults in whom baseline airway function varied from normal to mildly obstructed. 2931 spontaneous exercise flow-volume loops (eFVL) were placed within the baseline maximal expiratory flow-volume curves (MEFV) from 22 adults (15 M, 7 F; age, 32 yrs) in whom lung function varied from normal to mildly obstructed. Each eFVL was coded as EFL or non-EFL, where EFL was defined by eFVLs with expired airflow meeting or exceeding the MEFV curve. A CNN with seven hidden layers and a 2-neuron softmax output layer was used to analyze the eFVLs. Three separate analyses were conducted: (1) all subjects (n = 2931 eFVLs, [GRALL]), (2) subjects with normal spirometry (n = 1921 eFVLs [GRNORM]), (3) subjects with mild airway obstruction (n = 1010 eFVLs, [GRLOW]). The final output of the CNN was the probability of EFL or non-EFL in each eFVL, which is considered EFL if the probability exceeds 0.5 or 50%. Baseline forced expiratory volume in 1 s/forced vital capacity was 0.77 (94% predicted) in GRALL, 0.83 (100% predicted) in GRNORM, and 0.69 (83% predicted) in GRLOW. CNN model accuracy was 90.6, 90.5, and 88.0% in GRALL, GRNORM and GRLOW, respectively. Negative predictive value (NPV) was higher than positive predictive value (PPV) in GRNORM (93.5 vs. 78.2% for NPV vs. PPV). In GRLOW, PPV was slightly higher than NPV (89.5 vs. 84.5% for PPV vs. NPV). A CNN performed very well at identifying eFVLs with EFL during exercise. These findings suggest that deep machine learning could become a viable tool for identifying ventilatory constraint during clinical exercise testing.

A polo ball in the right atrium, importance of echocardiographic characteristics of intracardiac myxomas: a case report

BackgroundMyxomas are the most prevalent type of heart tumors, mainly occurring in the left atrium, with approximately 20% of cases found in the right atrium. Timely diagnosis and appropriate management of myxomas are crucial for favorable outcomes and to minimize complications.Case presentationA 77-year-old Asian male with no significant medical history presented with intermittent trepopnea and palpitations. Physical examination revealed regular heart sounds and no other relevant findings. A transthoracic echocardiogram showed a large, round-shaped, smooth-edged mass with diameter of 86 mm, occupying most of the right atrium. Mild tricuspid flow obstruction and mild left ventricular systolic dysfunction were also observed. Cardiac tomography confirmed the size, smooth edges, and showed microcalcifications of the mass, with no invasion of surrounding tissues. Surgical intervention successfully removed the spheroid mass, leading to the alleviation of symptoms. Histopathology confirmed the myxoma nature of the mass. A comprehensive discussion based on relevant medical literature is provided, with emphasis on echocardiographic characteristics of the mass with relation to potential embolic disease.ConclusionThis case shows an atypical presentation of an exceptionally large myxoma in the right atrium, resembling the size of a polo ball, in a patient presenting with supraventricular arrhythmia and trepopnea. Early diagnosis and appropriate management played a vital role in achieving a successful outcome for the patient.

The Role Played by Novel Inflammatory Markers in Assessment of Peripheral Artery Disease.

Background and Objectives: Atherosclerosis is a multifactorial process in which inflammatory markers have both therapeutic and prognostic roles. Recent studies bring into question the importance of assessing new inflammatory markers in relation to the severity of peripheral artery disease (PAD), such as the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and lymphocyte-to-C-reactive protein ratio (LCR). Materials and Methods: We conducted a retrospective and descriptive study including 652 patients with PAD, who were divided into two groups according to the severity of the ankle-brachial index value: mild and moderate obstruction (257 patients) and severe obstruction (395 patients). We evaluated demographics, anthropometric data and clinical and paraclinical parameters in relation to the novel inflammatory biomarkers mentioned above. Results: Weight (p = 0.048), smoking (p = 0.033), the number of cardiovascular risk factors (p = 0.041), NLR (p = 0.037), LCR (p = 0.041) and PLR (p = 0.019), the presence of gangrene (p = 0.001) and the number of lesions detected via peripheral angiography (p < 0.001) were statistically significant parameters in our study. For the group of patients with severe obstruction, all three inflammatory biomarkers were statistically significantly correlated with a serum low-density lipoprotein-cholesterol level, the number of cardiovascular risk factors, rest pain, gangrene and a risk of amputation. In addition, directly proportional relationships were found between NLR, PLR and the number of stenotic lesions (p = 0.018, p = 0.016). Also, NLR (area under the curve <AUC> = 0.682, p = 0.010) and PLR (AUC = 0.692, p = 0.006) were predictors associated with a high risk of amputation in patients with an ABI < 0.5. Conclusions: in our study, we demonstrated the importance of assessing inflammatory markers in relation to the presence of cardiovascular risk factors through the therapeutic and prognostic value demonstrated in PAD.

Epidemiology of Robin sequence in the UK and Ireland: an active surveillance study

BackgroundBirth prevalence of Robin sequence (RS) is commonly reported as 1 case per 8000–14 000 live births. These estimates are based on single-source case ascertainment and may miss infants who...

Pulmonary Function Test Among University Students-A Cross Sectional Survey

Objectives: To identify the lung functioning parameters i.e. FVC, FEV1, FEV1/FVC%, MVV of healthy individuals with normal pulmonary function. Study Design: It was a cross-sectional study. Study Setting: Study was conducted at Institute of Physical and Medical Rehabilitation (IPM&amp;R), Dow University of Health Sciences (DUHS), Karachi, Pakistan from August 2022 to January 2023. Methods: Total 60 students giving the male to female ratio of 1:1 with age ranging of 15-30 years were enrolled and studied for respiratory functions by spirometry. Subjects were divided in two groups depending on their gender. The Measured parameters comprised: Vital capacity (VC), forced vital capacity (FVC), forced expiratory volume first second (FEV1), FEV1/FVC%, and maximum voluntary ventilation (MVV). Result: Our results show that all indices, including FVC, FEV1, FVC/FEV1%, and MVV, were statistically significantly (p0.01) greater in males compared to females. Women have a much lower FEV1/FVC ratio than men do (p&lt; 0.05). Out of a total of 60 students, 57.3% (n=34) were classified as having normal spirometry; 15.3% (n=9) were classified as having mild restrictions; 11.7% (n=7) were classified as having moderate restrictions; 1.7% (n=1) were classified as having moderate severe restrictions; 10% (n=6) were classified as having mild obstruction; and 5.3% (n=3) were classified as having moderate obstruction. Practical Implication: Little data exist on whether and how PFT parameters change depending on a person's gender. As a result, we set out to learn more about the differences between the sexes in PFT variables and the connection between BMI and the tests. Conclusion: Our study revealed that males had greater values of FVC, FEV1, FVC/FEV1, and MVV when compared to females, which was statistically significant (p&lt;0.01). Females have a significantly (p0.05) lower FEV1/FVC ratio than males. Our findings demonstrate that healthy male and female subjects breathe in different ways, which may be related to gender's effect on lung function. Keywords: Gender, Spirometer, FVC, FEV1, FEV1 /FVC%, MVV, Medical Rehabilitation, Pulmonary Function

IMMEDIATE AND EARLY OUTCOME OF PULMONARY VALVE CUSP AUGMENTATION FOR REPAIR OF TETRALOGY OF FALLOT (TOF)

Objectives: To determine the immediate and early outcome of pulmonary valve cusp augmentation for repair of tetralogy of Fallot (TOF)&#x0D; Methods: A descriptive study of 36 cases of TOF repair done from July 2020 to December 2022 at Faisalabad Institute of cardiology (FIC). Autologous pericardium used in all cases to augment the pulmonary valve cusp to increase the size of pulmonary valve orifice. Patients were followed in immediate and early post operative period by doing echocardiography to observe the outcome including pulmonary valve regurgitation (PR), stenosis and right ventricular outflow tract obstruction (RVOTO)&#x0D; Results: Median age was 12 years (4–21). Immediate Post repair echocardiography showed no PR in 77.8 % of patients (n=28) while 8 patients had mild PR (22.2%). Majority of patients (61.1%) had mild RVOT obstruction, 13 patients (36.1%) had moderate RVOT obstruction while one patient had severe RVOT obstruction. Mean gradient across RVOT was 36.72 (+/- 11.08). The data on most recent follow up showed no PR in 83.3% (n=30) patients, while 6 patients (16.7%) had mild pulmonary regurgitation. Mild RVOTO was seen in 47.2 % of patients (n=17), 50% (n=18) patients had moderate RVOTO while one patient had severe RVOTO. Mean RVOT gradient was 40.8 +/- 15.20. There was no statistically significant difference between immediate and at last follow up RVOT gradient (p-value = 0.119)&#x0D; Conclusion: Augmentation of the pulmonary valve cusp in selective cases of TOF is a useful technique to avoid the need of transannular patch in significant number of cases&#x0D; Keywords: Tetralogy of Fallot, right ventricular outflow tract, cusp augmentation, transannular.&#x0D;

Improvement in postoperative lung function in patients with moderate to severe airway obstruction after robotic-assisted thoracoscopic tracheobronchoplasty.

The study objective was to examine pulmonary function and quality of life improvement after robotic-assisted thoracoscopic tracheobronchoplasty for patients with different degrees of obstructive airway disease. We performed a retrospective review of a prospective database of patients who underwent robotic-assisted thoracoscopic tracheobronchoplasty between 2013 and 2020. A total of 118 patients underwent robotic-assisted thoracoscopic tracheobronchoplasty. Preoperative and postoperative pulmonary function tests were available for 108 patients. Postoperative pulmonary function tests at a median of 16months demonstrated a significant increase in percent predicted forced expiratory volume in 1second (preoperative median: 76.76% predicted, postoperative: 83% predicted, P=.002). Preoperative and postoperative St George Respiratory Questionnaires were available for 64 patients with a significant decrease in postoperative score at a median of 7months (preoperative median: 61, postoperative: 41.60, P<.001). When stratified by preoperative degree of obstruction, robotic-assisted thoracoscopic tracheobronchoplasty improved forced expiratory volume in 1second in moderate to very severe obstruction with a statistically significant improvement in moderate (preoperative median: 63.91% predicted, postoperative median: 73% predicted, P=.001) and severe (preoperative median: 44% predicted, postoperative median: 57% predicted, P=.007) obstruction. St George Respiratory Questionnaire scores improved for all patients. Improvement for mild (preoperative median: 61.27, postoperative median: 36.71, P<.001) and moderate (preoperative median: 57.15, postoperative median: 47.52, P=.03) obstruction was statistically significant. Robotic-assisted thoracoscopic tracheobronchoplasty improves obstruction and symptoms. With limited follow-up, subgroup analysis showed forced expiratory volume in 1second improved in severe preoperative obstruction and quality of life improved in moderate obstruction. Future follow-up is required to determine robotic-assisted thoracoscopic tracheobronchoplasty effects on the most severe group, but we cannot conclude that increased degree of preoperative obstruction precludes surgery.

Progressive Right Ventricular Obstruction Caused by a Double-Chambered Right Ventricle Resulting in Shunt-Reversal via a Concomitant Congenital Ventricular Septal Defect and Subsequent Erythrocytosis in a Dog

A 3-year-old Chihuahua was presented because of exercise intolerance, respiratory distress, and syncopal episodes. At the age of 10 weeks, the dog was diagnosed with a congenital small left-to-right shunting ventricular septal defect and a mild right ventricular outflow tract obstruction via echocardiography. At that time, the dog was asymptomatic, but the breeder's veterinarian heard a murmur. Both cardiac defects were judged to be clinically non-relevant at that time. However, at 3 years of age, echocardiography revealed a severe right ventricular obstruction, known as a double-chambered right ventricle, along with right-to-left shunting via the ventricular septal defect. Because of chronic hypoxemia due to the right-to-left shunting, erythrocytosis developed. Flow reversal via the shunt was caused by a progressively worsening right ventricular obstruction leading to a supra-systemic right ventricular systolic pressure. Because of the poor prognosis, the dog was euthanized, and the heart was submitted for post-mortem examination. Gross pathologic findings revealed the close proximity of the right ventricular obstructive lesion to the ventricular septal defect. Histopathology revealed localized muscular hypertrophy and severe endocardial fibrosis. The suspected pathogenesis of the progressive obstruction was infiltrative myocardial fibrosis due to turbulent blood flow from the left-to-right shunting ventricular septal defect, as described in humans.

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Abstract. The aim: to study the prevalence of respiratory symptoms and pulmonary function (PF) in patients with various chronic lymphoproliferative diseases (CLPD) in the Dnipro region of Ukraine. Methods. In all patients who were included in this prospective single-center study, complaints and anamnesis data were collected, anthropometric and general physical examinations, mMRC and CAT questionnaires, analysis of the results of high-resolution computed tomography of the chest organs to determine the presence of intrathoracic lymphadenopathy (ITLAP) were performed. In all patients, parameters of PF were determined using computer spirometry, and when signs of bronchial obstruction were detected, a test with a bronchodilator was performed to determine its reversibility. We analyzed the level of FEV1 , FVC and the ratio of FEV1 /FVC, PEF, MEF25, MEF50 and MEF75. Patients with a confirmed diagnosis of bacterial or viral pneumonia (including patients with COVID-19) were excluded from the study. The methods of descriptive and analytical statistics of the software product STATISTICA v.6.1 (Statsoft Inc., USA) (license number AGAR909E415822FA) were used to process the obtained results. Results. The study found that 37.8 % of patients had complaints from the respiratory system, and 42 % of all patients had significant severity of respiratory symptoms according to the CAT questionnaire. At the same time, only 4.4 % of patients, according to the anamnesis, had established diagnoses of respiratory comorbidity. Among the examined patients with CLPD, 54.4 % had PF disorders, and 81.6 % of them had only obstruction or mixed disorders with a predominance of obstruction (52.5 % mild obstruction, 37.5 % moderate obstruction, and 10 % severe obstruction) and 12.5 % of cases had a positive bronchodilation test. The ratio of FEV1 /FVC was found to be significantly lower in patients with multiple myeloma than in patients with chronic lymph leucosis and lymphomas, which may hypothetically be related to the formation of fibrosis of the bronchial wall; however, the proportions of patients with obstructive PF disorders were equivalent in the groups. ITLAP was detected in 42.2 % of patients. The presence of ITLAP in patients with lymphomas was significantly associated with a lower FEV1 , while in patients with chronic lymph leucosis, who had bronchial obstruction in 43.4 % of cases, the presence of ITLAP had a tendency, but was not statistically significantly associated with the presence obstruction or a lower FEV1 level. Conclusions The obtained results indicate the need for a thorough examination of the respiratory organs, including chest computed tomography and spirometry, in all patients with CLPD, even in the absence of known respiratory comorbidity. According to the obtained results, the presence of PF violations of the obstructive type and the presence of ITLAP are among the main factors that affect the severity of respiratory symptoms in CLPD, therefore, they require careful diagnosis and, in the presence of bronchial obstruction, the appointment of appropriate broncholytic therapy, which can potentially improve the quality life of this category of patients. Key words: multiple myeloma, chronic lymphocytic leukemia, lymphoma, pulmonary function, respiratory symptoms.

Changes in Lung Volumes with Spirometric Disease Progression in COPD.

Abnormal lung volumes representing air trapping identify the subset of smokers with preserved spirometry who develop spirometric chronic obstructive pulmonary disease (COPD) and adverse outcomes. However, how lung volumes evolve in early COPD as airflow obstruction develops remains unclear. To establish how lung volumes change with the development of spirometric COPD, we examined lung volumes from the pulmonary function data (seated posture) available in the U.S. Department of Veterans Affairs electronic health records (n=71,356) and lung volumes measured by computed tomography (supine posture) available from the COPD Genetic Epidemiology (COPDGene®) study (n=7969) and the SubPopulations and InterMediate Outcome Measures In COPD Study (SPIROMICS) (n=2552) cohorts, and studied their cross-sectional distributions and longitudinal changes across the airflow obstruction spectrum. Patients with preserved ratio-impaired spirometry (PRISm) were excluded from this analysis. Lung volumes from all 3 cohorts showed similar patterns of distributions and longitudinal changes with worsening airflow obstruction. The distributions for total lung capacity (TLC), vital capacity (VC), and inspiratory capacity (IC) and their patterns of change were nonlinear and included different phases. When stratified by airflow obstruction using Global initiative for chronic Obstructive Lung Disease (GOLD) stages, patients with GOLD 1 (mild) COPD had larger lung volumes (TLC, VC, IC) compared to patients with GOLD 0 (smokers with preserved spirometry) or GOLD 2 (moderate) disease. In longitudinal follow-up of baseline GOLD 0 patients who progressed to spirometric COPD, those with an initially higher TLC and VC developed mild obstruction (GOLD 1) while those with an initially lower TLC and VC developed moderate obstruction (GOLD 2). In COPD, TLC, and VC have biphasic distributions, change in nonlinear fashions as obstruction worsens, and could differentiate those GOLD 0 patients at risk for more rapid spirometric disease progression.

Asymptomatic obstructive asymmetric hypertrophic cardiomyopathy in late adolescence

An 18-years-old adolescent with asymmetric mid-ventricular hypertrophic cardiomyopathy, undiagnosed because he did not present symptoms. The electrocardiogram indicated an increase in the QT interval, without arrhythmias; the transthoracic echocardiogram revealed asymmetric mid-ventricular hypertrophy, with mild obstruction of the left ventricular outflow tract; the mitral valve was thickened and calcified. Symptoms were not found because the outflow tract obstruction was not noticeable; as hypertrophy increased, the symptoms appeared. The thickening and calcification of the mitral valve, uncommon for the patient's age, could cause mitral regurgitation or heart failure. Key Words: Genetic hypertrophic cardiomyopathy, mild outflow tract obstruction, calcification and thickening of the mitral valve.

Follow up and outcome of transcatheter device closure in pediatric patients in a tertiary cardiac centre of Nepal

BackgroundCongenital heart diseases have significant effect on the growth and development of a child. Timely intervention helps a child to grow and develop to full potential. Cardiac interventionists have not long ago developed methods to cure conditions via transcatheter methods like device closures for shunt lesions. These interventions have been hugely accepted and applied all over the world. ObjectivesThe aim of this study was to determine the outcome of Transcatheter device closure in Atrial Septal Defect (ASD), Ventricular Septal Defect (VSD) and Patent Ductus Arteriosus (PDA) in terms of improvement in echocardiographic parameters and nutritional well-being. It also outlined the immediate and long term complications of Transcatheter device closure of the shunt lesions. MethodologyA prospective study was carried out among 129 pediatric patients who underwent Transcatheter device closure of shunt lesions at Shahid Gangalal National Heart Centre from March 2019 to March 2021. Simple convenient, consecutive non-probability sampling method was used for the study.Independent sample t-test was applied to see the correlation and significance of continuous variables and Linear regression was used to find out relation between weight gain and device closure. ResultsAmong 129 pediatric patients having either ASD, PDA or VSD without other comorbidities who underwent transcatheter device closure at Shahid Gangalal National Heart Centre, there was 1 mortality (0.7 %), 3 device embolization (2.3 %), 11 (8.5 %) tiny residual leaks, 6 (4.6 %) femoral artery thrombosis, 19 (14.7 %) Left ventricular systolic dysfunction, 4 (3.1 %) new onset arrhythmia, 13(10.0 %) new onset trivial AR and 2 (1.5 %) mild obstruction to surrounding structures. There were no long term complications observed during the study period. Pulmonary artery pressures improved in most along with normalization of chamber dilatation. There was significant improvement in weight of children at the end of one year follow up (P < 0.001), however among individual shunt lesion, only patients undergoing PDA device closure demonstrated significant weight gain. ConclusionTranscatheter device closure is a promising, safe and effective means of treatment for ASD, PDA and VSD. It has significant bearing in weight gain as well as general well-being of children. Judicious selection of cases, proficient expertise and availability of suitable infrastructures are paramount for successful outcome.

The Role of Montelukast Sodium in Children with Adenoid Hypertrophy - A Comparative Study.

Background Adenoid Hypertrophy (AH) results in symptoms ranging from mild nasal obstruction to the dangerous obstructive sleep apnoea. Normally for such patients Adenoidectomy with or without Tonsillectomy is carried out. However complications like haemorrhage and recurrence of adenoid tissue are common. Thus, non-surgical therapies have attracted considerable attention as an alternative strategy. The present study is aimed at evaluating the effect of oral Montelukast, a cysteinyl- leukotriene receptor antagonist, in children with AH. Materials and Methods Sixty children aged between 6 and 12 years with adenoid hypertrophy were randomly divided into two groups of thirty each. The study group was prescribed Tablet Montelukast 5mg daily for 12 weeks while the control group received matching placebo. A questionnaire based upon the severity of the symptoms as well as the Adenoid Nasopharynx ratio (A/N), as measured via X-ray Adenoids and the Nasal endoscopic scores done before and after treatment (at 3 months) in the two groups were taken into consideration . Results The Mann Whitney Test which was used found no distinction in snoring, sleep discomfort and mouth breathing between the two groups before the start of treatment. But a significant difference was indeed observed between the two groups after treatment in case of snoring (P < 0.006), sleep discomfort(P < 0.001) and mouth breathing (P < 0.001). Conclusion Oral Montelukast therapy is seen to be effective not only in the reduction of the size of adenoids but also in improvement of the overall symptoms and can thus be considered as a viable alternative .

Pulmonary Functions and Respiratory Symptoms of Wheat Flour Mill Workers in The Duhok District

Exposure to flour dust in flour mill factories may cause diverse lung diseases with different severity of symptoms ranging from simple irritation to allergic rhinitis or occupational asthma; long-term exposure to flour dust can cause chronic lung problems. The aim of this study is to examine the effect of exposure to flour dust on the respiratory system and pulmonary function of wheat flour mill workers in the Duhok district. A cross-sectional study was performed among 63 workers who had direct contact with wheat flour mills. The data were collected using a well-structured questionnaire, anthropometric measurements, and digital spirometry. The workers’ mean age ± (SD) was 29.79 ± 10.60 years. The current study showed the predicted Forced vital capacity (FVC) mean ± (SD) 105.34 L (±) 25.96 L, and the predicted Forced expiratory volume in one second (FEV1) mean ± (SD) 97.90 L (±) 18.65 L, and the predicted FEV1/FVC mean ± (SD) 95.82 L (±) 17.61 L. About 43(68.3%) of workers were normal,10(15.9%) had mild pulmonary obstruction followed by moderate restriction, 5(7.9%), and 3(4.8%) had mild pulmonary restriction. The mild obstructive disorder is more among normal Body Mass Index (BMI) persons, while restrictive disorders are more among overweight workers. This study showed no significant statistical association between PFTs and respiratory symptoms (sneezing, rhinorrhea, change of voice, dyspnea and cough), BMI, and the duration of working in the wheat flour mills.

Infekcyjne zapalenie wsierdzia u chłopca z zespołem Downa po operacji kardiochirurgicznej w okresie niemowlęcym i usunięciu 13 zębów w piątym roku życia

A 14-year-old boy with Down’s syndrome and an atrioventricular septum defect underwent cardiosurgical treatment at 3 months of age. The postoperative course included pericardiocentesis due to fluid accumulation, anemia, lack of body weight increase, and kidney failure. In the years that followed, the boy’s condition was stable, although he often suffered from infections. The reconstructed mitral valve showed good function, the leaflets were not thickened. At 5 years of age, the patient underwent extraction of 13 teeth consecutively, due to extensive inflammatory changes, without antibiotic cover. The child’s health deteriorated after the procedure. Inflammation indicators were positive and symptoms of sepsis appeared. Physical examination revealed splenomegaly, and Streptococcus mitis and Staphylococcus hominis bacteria were cultured in the blood culture. Transthoracic echocardiography and transesophageal echocardiography showed a hyperechogenic structure of 10 × 4 mm on the mitral valve, causing a narrowing of the inflow to the left ventricle and an exacerbation of grade I to III valve regurgitation as well as features of pulmonary hypertension. Vegetation in the course of infectious endocarditis was suspected and intensive antibiotic therapy was initiated in accordance with the antibiogram. After obtaining sterile cultures, the boy underwent diagnostic cardiac catheterization, which showed postcapillary type reversible pulmonary hypertension. The child was qualified for cardiac surgery during which the vegetation was removed and the Medtronic Hancock 23 mm biological valve was implanted in the mitral field. The boy’s condition has systematically improved and he is currently under outpatient control. After several years of follow-up, the mitral valve shows slight regurgitation. Also, a mild obstruction of the left ventricle outflow tract is observed, not requiring any intervention at the moment.

Prevalence of asymptomatic airflow obstruction among patients visiting a tertiary health-care center

Background: Chronic obstructive lung disease is a major health problem worldwide, with a huge impact on health and economics, both at the individual and community levels. In clinical practice, only symptomatic patients seem to undergo spirometry screening, whereas persons with no symptoms or those with early or negligible symptoms are ignored until they present with acute exacerbations and complications. Fair evidence indicates that most individuals with airflow obstruction do not recognize or report symptoms. Aims and Objectives: The present study was conducted to identify the prevalence of undiagnosed airflow obstruction in asymptomatic adults, without known obstructive lung disease or any other pulmonary condition. Materials and Methods: A total of 500 subjects between 18 and 65 years of age, coming to the outpatient department for a routine/preventive health checkup who wereasymptomatic and never diagnosed for airflow obstruction, with no evidence of any physical disease on examination were selected by random sampling method after taking informed written consent. A detailed history, complete general physical and clinical examination, and spirometry (as per the ATS guidelines) for individuals were done. Results: Overall prevalence of AO was 16% of patients (80 patients out of 500). About 4.20% of patients had mild obstruction (GOLD – Stage 1), 4.60% had moderate obstruction (GOLD – Stage 2), 5.40% had severe obstruction (GOLD – Stage 3), and 1.80% had very severe obstruction (GOLD – Stage 4). Subjects with asymptomatic airflow obstruction had a higher prevalence of ever smoking (72.5%, 58 out of 80 patients) than never smokers (27.5%, 22 out of 80 patients) and this difference was highly significant statistically. Conclusion: There is a high prevalence of asymptomatic airflow obstruction, detected by spirometry, in asymptomatic patients of different severities. Smoking is a strong risk factor and AO is directly associated with age, both among smokers and never smokers. The use of spirometry should be implemented in all routine health checkup plans, as an important diagnostic tool.

ATYPICAL PRESENTATION OF GRANULOMATOUS INFLAMMATION

ATYPICAL PRESENTATION OF GRANULOMATOUS INFLAMMATION

THE FEATURES OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE INFLUENCE ON THE PREGNANCY COMPLICATIONS DEVELOPMENT

&#x0D; &#x0D; &#x0D; &#x0D; In recent years, the prevalence of chronic obstructive pulmonary disease (COPD) has been increasingly observed among women, which is one of the reasons for the higher interest of scientists in the influence of COPD on pregnant woman.&#x0D; The aim of our study was to establish the features of the development pregnancy complications in pregnant women with COPD.&#x0D; Materials and methods. 77 pregnant women with clinically and instrumentally verified signs of COPD were examined and were divided into 2 subgroups depending on the degree of bronchial obstruction: IA - 43 pregnant women with FEV1≥80%, IB - 34 pregnant women with FEV1 50-79%. The control group consisted of 27 healthy pregnant women. The cytokine profile was determined and a correlational interaction with the degree of bronchial obstruction and the frequency of obstetric and perinatal complications was established.&#x0D; The results. Our analysis of cytokine profile indicators in pregnant women with chronic obstructive pulmonary disease at the stage of mild and moderate bronchial obstruction showed a characteristic and reliable increase in the level of pro-inflammatory cytokines (IL-1β, IL-6) and a simultaneous decrease in the level of anti-inflammatory IL-10 (p≤0.05).&#x0D; We established that an increase in the degree of bronchial obstruction is also associated with a higher frequency of detection of such pregnancy and childbirth complications as anemia, respectively, by 3.1 times, the threatened of premature birth by 9 times, preeclampsia by 7 times, placental dysfunction by 3.4 times, intrauterine growth restriction 8 times, premature birth 3.5 times, premature rupture of membranes during labor 4 times, and fetal distress 3 times higher compared to the control group.&#x0D; Conclusions. COPD in pregnant women is characterized by systemic disturbances in the cytokine balance and is accompanied by a significant increase in the frequency of obstetric and perinatal complications, the frequency of which depends on the degree of bronchial obstruction.&#x0D; &#x0D; &#x0D; &#x0D;

Impact of Pulmonary Function on Voice Outcomes After Injection Laryngoplasty for Unilateral Vocal Fold Paralysis

Pulmonary function is closely associated with voice quality especially in patients with voice disorder including unilateral vocal fold paralysis (UVFP). Injection laryngoplasty (IL) is the standard treatment for patients with UVFP. We investigated the subjective and objective voice outcomes according to pulmonary function test (PFT) before IL in patients with UVFP. We retrospectively analyzed the patients who underwent IL for UVFP between 2004 and 2021 (N = 1201), and finally investigated 261 patients with PFT results before IL. The patients were classified into three groups according to results of PFT: normal (n = 189, 72%), mild (n = 40, 15%), and moderate (n = 32, 13%) obstructive pattern. Aspiration symptoms and subjective and objective voice parameters of voice handicap index (VHI), GRBAS score, maximal phonation time (MPT), Jitter, Shimmer, and noise to harmonic ratio (NHR) were compared between normal and abnormal (mild or moderate obstructive pattern) PFT groups. Age (68.0 ± 9.1 and 61.2 ± 12.6, respectively) was significantly higher and males were more common (84.7% and 57.7%, respectively) in abnormal PFT than in normal PFT. Aspiration showed significant improvement in all groups. The subjective and objective voice parameters significantly improved after IL in normal and mild obstruction groups, but MPT, Shimmer, and VHI did not significantly improve in the moderate obstruction group. The improvement in VHI-30 after IL was significantly higher in the normal group (20.0 ± 29.5) than in the mild (10.3 ± 32.8) or moderate (9.9 ± 33.2) obstruction group (P = 0.035). Improved amounts of MPT, Jitter, Shimmer, and NHR were not significantly different among the groups, but improvement of VHI was smallest in the moderate obstructive pattern group. Voice parameters showed significant improvement after IL in both normal and mild obstructive pattern groups, but MPT and VHI did not significantly improve in the moderate obstructive pattern group. In addition, patients with normal pulmonary function had marked improvement of subjective symptoms after IL in comparison with patients with abnormal pulmonary function.