Pulmonary Complaints Research Articles

The Immersion-Induced Pulmonary Edema in Swimming and Diving

Staying in or underwater can lead to acute pulmonary complaints, which clinically present as an acute immersion-induced pulmonary edema (IPE), particular in strenuous swimming (SIPE) or diving (DIPE). The IPE presents as a cardiac pulmonary edema and is induced by several pathophysiological processes during immersion, including fluid-shift, severe breathing, strenuous exercise, ambient cold, and aggravating cardiac pathologies. This clinical review summarizes current evidence about the incidence of IPE in general, SIPE, and DIPE, the main aspects of its complex underlying pathophysiology, clinical symptoms, outcome and prognosis. It furthers provides recommendations for emergency treatment and indication of hospital admission.

Abstract 16513: Decreased Pulmonary Blood Flow and Airway Volumes in Patients With Long COVID Syndrome Assessed by Functional Respiratory Imaging

Introduction: In contrast to normal chest X-ray, lung computed tomography (CT), and physiological lung and cardiac functions, many patients with long COVID syndrome suffer from shortness of breath. Hypothesis: The aim of this study was to quantify the pulmonary blood and airway volumes of long COVID patients compared with that of healthy controls. Methods: Patients with long COVID syndromes were included if they had PCR-verified previous (≥3 months) SARS-CoV-2 infection, had normal laboratory (e.g. inflammation, coagulation, cardiac or other organ) parameter, normal pulmonary morphology (chest X-ray and CT) and function (spirometry and body plethysmography). The lung CT images were postprocessed by Functional Respiratory imaging analysis by using 3D reconstruction with automated lung vessel segmentation algorithm. Data of the quantitative images were compared with age, gender, and BMI-matched healthy controls. Results: Thirty patients (45±13 years, 37% male, 25.9±4.3 kg/m^2) at a median time of 256 (118-574) days after a confirmed COVID infection and 30 healthy controls (55±7y, 37% male, 26.3±2.7 kg/m^2) were included. All long COVID patients complained of dyspnoea and 14 (48.3%) patients reported thoracic pain. The total pulmonary blood volume was significantly lower in the long COVID patients compared to controls (190±24.3 mL/m^2 vs230.6±26.2 ml/m^2, p<0.001). Similarly, the capillary-small vessel blood flow (vessel cross sectional area <5 mm^2) was reduced in the long COVID population (118±19 mL vs 132±23 mL, p=0.011). (Figure). The specific image-based airway volume of the distal lung regions was lower than that of the healthy population (11.1±6.74 mL vs 17.33±7.7 mL, p<0.05). Conclusions: Both the reduced global and capillary pulmonary blood flow, and distal airway volumes indicate impaired gas exchange and might explain the pulmonary complaints of patient with long COVID syndromes even severe months after Coronavirus infection.

The Effects of a 'New Generation' of Heat and Moisture Exchangers in Laryngectomized Patients with Previous Heat and Moisture Exchanger Experience.

Objectives: To evaluate the effects of a new generation of heat and moisture exchangers (NG-HMEs) on pulmonary rehabilitation, quality of life, patient satisfaction, and usage patterns. Methods: A prospective observational study on 23 laryngectomized patients with prior HME experience from June 1, 2021 to November 30, 2021. Patients were interviewed at inclusion, after 6 weeks and after 12 weeks after the introduction of NG-HMEs. Two validated questionnaires were used to report pulmonary complaints and quality of life: the Cough and Sputum Assessment Questionnaire (CASA-Q), the European Quality of Life 5 Dimensions Index Score (EQ-5D Index Score), and the European Quality of Life 5 Dimensions Visual Analog Scale (EQ-5D-VAS). Usage patterns and patient satisfaction were reported using study-specific questionnaires. Results: The patients had an average age of 65.7 ± 6.8 years, with 87% being male, on average 33.7 ± 35.3 months after total laryngectomy (TLE). NG-HMEs were used for a mean of 21.87 ± 4.63 hours/day (P = .034). After 12 weeks of use, patients reported the following changes in the CASA-Q domains: cough symptoms (+5; P = .663), cough impact (0; P = .958), sputum symptoms (+8; P = .13), and sputum impact (+3; P = .489). The EQ-5D index score increased (+0.024; P = .917) as well as the EQ-5D VAS (+0.8; P = .27). All patients rated their experience with NG-HMEs with ≥3 out of 5. The patients who used NG-HMEs as instructed (n = 13) reported more profound changes in the CASA-Q domains: cough symptom (+11; P = .129), cough impact (+7; P = .209), sputum symptom (+11; P = .123), and sputum impact (+10; P = .102). Conclusions: Our results show that NG-HMEs could have a positive clinical impact on pulmonary rehabilitation after TLE, even in HME-experienced patients. The use of NG-HMEs does not affect the quality of life. The possible effects of NG-HMEs require further evaluation in long-term studies to fully assess their efficacy.

Prevalence of hypothyroidism in newly diagnosed patients with obstructive sleep apnea syndrome: a prospective cross-sectional study

Abstract Introduction: One of the most common presentations of OSAS is daytime sleepiness, which is also seen in patients with hypothyroidism. We hypothesized that hypothyroidism is one of contributing factors in the development of OSAS; thus, adequate management of hypothyroidism can simply help to alleviate OSAS symptoms. Aim of the Study: The aim of this study was to evaluate the prevalence of hypothyroidism in OSAS patients in our locality and to compare respiratory polysomnographic parameters of OSAS patients with hypothyroidism versus those without hypothyroidism. Patients and Methods: In a descriptive prospective cross-sectional study, our patients attending Sleep Disordered Breathing Clinic at Sleep Disordered Breathing Unit, Chest Medicine Department, Mansoura University Hospital. All patients were subjected to full history taking with stress on sleep questionnaires, pulmonary complaints, physical examination, anthropometric measures, diagnostic PSG, laboratory evaluation (serum TSH and free T4 levels), and chest radiology and echocardiography. Results: There were two groups of OSAS participants (hypothyroid and euthyroid). Hypothyroidism was evident in 12% of patients;they were classified according to AHI, 13, 15, and 60 of Euthyroid patients had mild, moderate, and severe OSAS, respectively. hypothyroid patients, 2 mild OSAS, 1 moderate OSAS and 9 severe OSAS. Epworth sleepiness scale scores were significantly higher in the hypothyroid group with a mean score of 18 ± 4.8 vs 12.47 ± 6 in the euthyroid group (P = 0.003). Different PSG parameters showed no difference between the two groups. AHI, serum TSH level, and T4 levels were positively correlated but with insignificant P values. Conclusion: Hypothyroidism is thought to be one of the key players in the development of sleep-breathing disorders. It was evident in 12% of OSAS patients; however, the a proven insignificant difference in PSG parameters in OSAS with hypothyroidism versus euthyroid group, except for affection of daytime sleepiness.

Potentially avoidable emergency department use by patients discharged to skilled nursing facilities.

One-third of patients discharged from hospitals to skilled nursing facilities (SNF) are sent back to the Emergency Department (ED) within 30 days. Little is known about those patients who are discharged from the ED directly back to SNF. We considered these ED visits as potentially avoidable since they did not result in observation or hospitalization stay. Using a retrospective chart review of 1010 patients with ED visits within 14-days of discharge to SNF from University of Pennsylvania health system (UPHS) in 2020-2021, we identified 202 patients with potentially avoidable ED visits among medical and surgical patients. The most common reasons for these ED visits were mechanical falls (17.3%), postoperative problems (16.8%), and cardiac or pulmonary complaints (11.4%). Future interventions to decrease avoidable ED visits from SNFs should aim to provide access for SNF patients to receive timely outpatient lab and imaging services and postoperative follow-ups.

Prevalence of long COVID complaints in persons with and without COVID-19

We studied the prevalence and patterns of typical long COVID complaints in ~ 2.3 million individuals aged 18–70 years with and without confirmed COVID-19 in a Nation-wide population-based prospective cohort study in Norway. Our main outcome measures were the period prevalence of single-occurring or different combinations of complaints based on medical records: (1) Pulmonary (dyspnea and/or cough), (2) Neurological (concentration problems, memory loss), and/or (3) General complaints (fatigue). In persons testing positive (n = 75 979), 64 (95% confidence interval: 54 to 73) and 122 (111 to 113) more persons per 10 000 persons had pulmonary complaints 5–6 months after the test compared to 10 000 persons testing negative (n = 1 167 582) or untested (n = 1 084 578), respectively. The corresponding difference in prevalence of general complaints (fatigue) was 181 (168 to 195) and 224 (211 to 238) per 10 000, and of neurological complaints 5 (2 to 8) and 9 (6–13) per 10 000. Overlap between complaints was rare. Long COVID complaints were only slightly more prevalent in persons with than without confirmed COVID-19. Still, long COVID may pose a substantial burden to healthcare systems in the future given the lasting high incidence of symptomatic COVID-19 in both vaccinated and unvaccinated individuals.

CHARACTERIZATION OF THE AVERAGE POWER, FREQUENCY AND AMPLITUDE OF ACOUSTIC SIGNAL PEAKS OVER THE LUNGS IN CHILDREN WITH COMMUNITY-ACQUIRED PNEUMONIA USING THE NEW DEVICE "TREMBITA-CORONA"

Background. Community-acquired pneumonia (CАР) is an urgent problem today and a significant cause of morbidity and mortality in children. Diagnosis of pneumonia is complex and requires a comprehensive study. At present, respiratory acoustics is a promising method of diagnosis.
 Aim: to investigate the features of average power values, frequencies and amplitudes of acoustic signal peaks over the lungs in children with community-acquired pneumonia using a new acoustic diagnostic device "Trembita-Corona".
 Materials and methods. 120 children aged from 1 month to 18 years who were treated in pediatric departments were studied. The children were divided into two groups: Group I - 60 patients with CAP, Group II - 60 healthy children. The children from the 1st group underwent complex examinations, which required CAP. All children were also examined using the "Trembita-Corona" acoustic monitoring device for the diagnosis of breathing sounds and localization of lung damage zones.
 The study was conducted in accordance with the international principles of conducting clinical studies GCP, GLP, the protocol was approved at the meeting of the Commission on Bioethical Expertise at the National Medical University named after O.O. Bogomolets (protocol No. 138 of November 10, 2020). Informed consent of parents/guardians was obtained for conducting the study, which was approved at the same meeting of the Commission on Bioethical Expertise at Bogomolets National Medical University (protocol № 138 of November 10, 2020).
 Mathematical processing was carried out on specialized software developed in the Python language in the Google Codelabs environment. Further statistical processing of the obtained results was carried out in specialized programs Medstart, EZR (R-Statistics) and "Matlab".
 Results. In children, the clinical picture of CAP consisted of pulmonary (respiratory) complaints, symptoms of intoxication, RF, and local physical changes. All patients were examined for respiratory lung sounds in the frequency range from 0.1 Hz to 30 kHz using the "Trembita-Corona" device and the corresponding original software. The most promising are the studies of breathing noises in the ranges of 0, 1, 2, 3, 4, 5, 6 octaves. Also, significant differences in average signal power between children with CAP and healthy children in 0,1,2,3,4,5,6 octaves were found. Using the "Trembita-Corona" acoustic monitoring device, reliable differences in peak frequency between children with CAP and healthy children in 0 and 5 octaves and reliable differences in peak amplitude between children with CAP and healthy children in 0, 1, 2, 3 were found. ,4,5,6 octaves. Therefore, the use of the "Trembita-Corona" acoustic monitoring device and the use of the developed specialized software in the Python language in the Google Codelabs environment together make it possible to hear specific acoustic signals over the entire surface of the lungs in children with CAP.
 Conclusion. The "Trembita-Corona" acoustic monitoring device is a new and promising acoustic method for determining the location of the pathological process in the lungs. Significant differences were found: in the average signal strength between children with CAP and healthy children in 0,1,2,3,4,5,6 octaves; on the frequency of peaks between children with CAP and healthy children in 0 and 5 octaves; by the amplitude of peaks between children with CAP and healthy children in 0,1,2,3,4,5,6 octaves.

FREQUENCY CHARACTERISTICS OF ACOUSTIC FEATURES OF SOUND SIGNALS IN THE LUNGS OF CHILDREN WITH PNEUMONIA USING A NEW ACOUSTIC DIAGNOSTIC DEVICE "TREMBITA-CORONA"

Relevance. Community-acquired pneumonia (CAP) is an urgent problem in practical medicine and the main cause of morbidity and mortality in the world. Diagnosing pneumonia is complex and requires a comprehensive study, taking into account many factors. The development of passive diagnostic methods, such as acoustic ones, is especially promising for children, as this approach reduces significantly the level of radiation exposure to an unformed child's body.The aim. To determine the peculiarities of the frequency characteristics of acoustic signals in the lungs of children with pneumonia using the new acoustic diagnostic device «Trembita-Corona».Materials and methods. We studied 120 children aged 1 month to 18 years, who were treated in the pediatric departments of the Children's Clinical Hospital №. 5 and Children's Clinical Hospital № 7. The children were divided into two groups: Group I – 60 patients with community-acquired pneumonia, Group II – 60 healthy children. Children from І group underwent a comprehensive examination. All children underwent research using the "Trembita-Corona" acoustic monitoring device for the diagnosis of respiratory noise and localization of lung lesions. The computerized analysis of breathing sounds was carried out using mathematical methods without involving human factors.The study was conducted in accordance with the international principles of conducting clinical studies GCP, GLP, the protocol was approved at the meeting of the Commission on Bioethical Expertise at the National Medical University named after O.O. Bogomolets (protocol No. 138 of November 10, 2020). Informed consent of parents/guardians was obtained for conducting the study, which was approved at the same meeting of the Commission on Bioethical Expertise at Bogomolets National Medical University (protocol № 138 of November 10, 2020).Statistical processing of the obtained results was carried out using the licensed programs "MedStat", "Matlab" and with the original calculation programs included in the "Trembita-Corona" system. This work is a part of the complex research work (CRW) of the Department of Pediatrics of Postgraduate Education of Bogomolets National Medical University "Characteristics of the state of health of children who have suffered from COVID-19 and the justification of medical and rehabilitation measures" (2022-2024). State registration number 0122U000486. The authors are performers of the CRW fragment.Results. In children, the clinical picture of CAP consisted of pulmonary (respiratory) complaints, symptoms of intoxication, RF, and local physical changes. Respiratory lung sounds in the frequency range from 0.1 Hz to 30 kHz were studied in all patients using the "Trembita-Corona" device and the corresponding original software. The most promising is the selection of the pathological process of lung damage in pneumonia in the ranges of 0, 1, 2, 3, 4, 5, 6 octaves based on the differences between the average signal power (p<0.05) in children with САP and healthy children.Conclusion. We, in cooperation with leading specialists of the National Aviation University, have developed an experimental sample of the "Trembita-Corona" acoustic monitoring device for the diagnosis of respiratory lung sounds. The "Trembita-Corona" acoustic monitoring device is a new and promising acoustic method for determining the location of a pathological process in the lungs. It was found that the most promising is the selection of the pathological process of lung damage in pneumonia in the ranges of 0, 1, 2, 3, 4, 5, 6 octaves based on the differences between the average signal power (p<0.05) in children with САP and healthy children.

An Unexpected 12.6 Centimeter Nail in the Thorax Damaging Vital Structures: A Case Report “Nailed It”

We report a patient who was referred to the emergency room with pulmonary complaints and where a computed tomography (CT) scan showed an unexpected 12.6 cm nail in the thorax penetrating part of the left pulmonary upper lobe, the left pulmonary artery, the left main bronchus, and the descending aorta, which had been in situ for at least three days. The quickly deteriorating patient had to be transferred to a tertiary academic hospital where the nail was successfully surgically removed. The comprehensive description of this unique case with a discussion of the critical decision moments could render insights into the management of challenging trauma cases.

LB2303. Single High-dose of Liposomal Amphotericin B in HIV/AIDS-related Disseminated Histoplasmosis: a Randomized Trial

Abstract Background Histoplasmosis is a major AIDS-defining infection in Latin America. Liposomal amphotericin B (L-AmB) is the drug of choice for treatment, but access is limited. Methods Prospective randomized open-label trial of induction therapy with L-AmB for disseminated histoplasmosis in AIDS, followed by oral itraconazole therapy (started on the day after L-AmB was finished). We conducted this trial at 6 centers in Brazil (2019-2022). We randomized subjects to 3 arms of: Single dose 10 mg/kg of L-AmB;10 mg/kg of L-AmB on D1, and 5 mg/kg of L-AmB on D3;3 mg/kg of L-AmB for 2 weeks (control). As a non-inferiority trial, 80% power could detect > 20% non-inferiority margin for a one-sided alpha=0.05 with a sample size of 29 subjects per arm. Clinical response at day 14 was the primary outcome. Results Of 512 screened patients, 118 subjects were randomized (Arm 1, n=40; Arm 2, n=39; Arm 3, n=39). Median CD4 was 25 cells/µL. Subjects presented with weight loss (70%), pulmonary complaints (67%), fever (66%), abdominal findings (59%), skin lesions (38%), lymphadenopathy (38%), and oral lesions (36%). Clinical and lab findings did not differ among arms. Histoplasmosis diagnosis was predominantly via urine antigen (97%). Infusion-related toxicity on D1 was similar in each arm (p=0.56). Kidney toxicity was similar on D3 (p=0.83), D7 (p=0.10), and D14 (p=0.17) as was frequency of anemia, hypokalemia, hypomagnesemia, and liver toxicity (all p >0.05). No subject withdrew due to drug toxicities. D14 clinical response was 82% for Arm 1, 68% Arm 2, and 72% Arm 3 (p=0.69). Absolute risk difference for Arm 1 was 10.3% (95%CI, -8.3% to 28.8%) vs. Arm 3 controls; Arm 2 was -4.2% (95%CI, -24.9% to 16.4%) to controls. Overall survival on D14 was 89.5% (34/38) for Arm 1, 78.4% (29/37) for Arm 2, and 92.1% (35/38) for Arm 3 (p=0.82); 2 subjects were excluded from efficacy analysis due to meningitis and tuberculosis, and 3 were lost to follow up. Conclusion Induction therapy with 10 mg/kg of L-AmB in AIDS-related histoplasmosis was safe. Although efficacy is likely to be non-inferior to standard L-AmB therapy, a confirmatory phase III trial is needed. Such a strategy would markedly reduce drug-acquisition costs (> 4-fold), therefore improving access to L-AmB across the globe. Disclosures Alessandro C. Pasqualotto, FECMM, Gilead: Grant/Research Support|United Medical: Advisor/Consultant|United Medical: Honoraria Diego R. Falci, MD, United Medical: Advisor/Consultant|United Medical: Honoraria Andrej Spec, MD, MSCI, Astellas: Grant/Research Support Dennis Israelski, MD, Gilead Sciences: Empoyee.

Spontaneous Pneumothorax: A Rare Complication of Neurofibromatosis Type 1 Associated Diffuse Lung Disease

The visually striking neurocutaneous findings of neurofibromatosis type 1 (NF1) are well recognized and have been well documented throughout scientific literature. While not uncommon, the pulmonary manifestations of NF1 are unknown to many physicians. Complications of NF1 associated diffuse lung disease (NF-DLD) include pulmonary hypertension, pulmonary artery stenosis, subpleural cysts, and spontaneous pneumothorax. We present a case of a 34-year-old male with NF-DLD found incidentally in adolescence with previous apical bleb repair, presenting nearly twenty years later with spontaneous pneumothorax. In NF1 patients with pulmonary complaints, NF-DLD should be assessed with computed tomography (CT) and physicians should be familiar with associated complications.

Cutaneous sarcoidosis: a marker of underlying systemic disease

<p class="abstract">Sarcoidosis/Mortimer’s malady is a multisystem disease defined by presence of epithelioid cell granulomas without caseation in various organs.It involves mainly the lungs, eyes, skin, lymph node etc. We reported a 40 year old female who presented with multiple plaques over different regions of the body with past history of ulcerated lesion of scalp which healed with cicatricial alopecia. On thorough evaluation she was found to have involvement of multiple internal organs. Based on the clinical features and histopathological findings, a diagnosis of cutaneous sarcoidosis (plaque type) was made. Patient treated with systemic and topical corticosteroids resulting in marked improvement in her skin lesions were seen and pulmonary complaints also resolved.</p>

Maternal mortality cases due to COVID-19 pandemic in a tertiary referral hospital

Objective: This study aimed to report the clinical prognoses, laboratory findings, treatment procedures, and neonatal outcomes, from hospitalization to death, of Coronavirus Disease 2019 (COVID-19)-related cases of maternal mortality at our clinic. Methods: Fifteen cases of COVID-19-related maternal mortality, between April 2020 and October 2021, in the Department of Obstetrics & Gynecology of a Training and Research Hospital were retrospectively analyzed for the purpose of the study. Results: During the study period, a total of 501 symptomatic pregnant women received inpatient treatment for COVID-19. In our case group, 93.3% of maternal deaths due to COVID-19 occurred as a result of the worsening of the clinical condition of third-trimester pregnant women. In these patients whose clinical condition deteriorated, delivery was performed after the decision to give birth, and 86.6% of mortalities occurred in the postpartum period and 13.4% before delivery. There was at least one risk factor in 60% of the cases, with obesity being the most prevalent. In all mortality cases, there were pulmonary complaints (shortness of breath and cough) at admission, and bilateral lung involvement was observed during lung imaging; furthermore, there was a corresponding increase in the mean leukocytosis, AST, ALT, LDH, D-dimer, ferritin, procalcitonin, IL-6, and pro-BNP levels with the worsening of the clinical prognosis. The duration of hospitalization and intensive care unit stays were 6.87±3.18 and 5.33±3.27 days, respectively. The mean period of the delivery-to-mortality for mothers was 5.92±3.48 days and the mean period of the intubation-to-mortality for mothers was 3.33±3.15 days. Conclusion: The risks of severe illness and death associated with COVID-19 increased in the third trimester compared to the first and second trimesters. All mortality cases involved unvaccinated pregnant women, of which most had at least one risk factor, obesity being the most prevalent. There was no COVID-19-related mortality in the newborns, and it was found that prematurity rates increased due to maternal disease.

Traditional Uses, Phytochemistry, and Pharmacological Properties of the Genus Blechnum-A Narrative Review.

Blechnum L. is a genus belonging to the Blechnaceae family with 236 accepted species that grow in intertropical, subtropical, and southern temperate regions. Several species of the genus have long been used in folk medicines to treat a broad spectrum of ailments, including typhoid, urinary infections, influenza, wounds, pulmonary complaints, blisters, boils, and antihelmintic-related complications. So far, about 91 chemical compounds have been isolated from different parts of 20 Blechnum species. Among these metabolites, phenolic compounds, sterols, and fatty acids are the main constituents. Modern pharmacological investigations revealed several isolated compounds and extracts to exhibit exceptional biological properties including the antioxidant, antimicrobial, anti-inflammatory, anticancer, insecticidal, antitrematocidal and wound healing. In various tests, both quercetin-7′,3′,4′-trimethoxy and phytol metabolites showed potential antioxidant and antitrematocidal properties, while ponasterone exhibited insecticidal activity. Despite having a broad range of traditional medicinal benefits and biological properties, understanding the scientific connotations based on the available data is still challenging. This article presents a comprehensive review of the traditional uses, phytochemical compounds, and pharmacological aspects of the Blechnum species.

Impact of educational instruction on medical student performance in simulation patient.

This study aimed to evaluate the effects, and timing of, a video educational intervention on medical student performance in manikin-based simulation patient encounters. This prospective mixed-methods study was conducted as part of the University of Toledo College of Medicine and Life Sciences undergraduate medical curriculum. One hundred sixty-six students second-year students participated in two simulations on a single day in September 2021. A 7-minute video intervention outlining the clinical diagnostic approach to pulmonary complaints was implemented. Students were randomized into 32 groups which were divided into two cohorts. One received the video prior to simulation-1 (n=83) and the other between simulation-1 and simulation-2 (n=83). Each simulation was recorded and assessed using a 44-point standardized checklist. Comparative analysis to determine differences in performance scores was performed using independent t-tests and paired t-tests. Independent t-tests revealed the video-prior cohort performed better in simulation-1 (t(30)= 2.27, p= .03), however in simulation-2 no significant difference was observed between the cohorts. Paired t-test analysis revealed the video-between cohort had significant improvement from simulation-1 to simulation-2 (t(15)= 3.06, p = .01); no significant difference was found for the video-prior cohort. Less prompting was seen in simulation-2 among both the video-prior (t(15)= -2.83, p= .01) and video-between cohorts (t(15)= -2.18, p= .04). Simulation training, and targeted educational interventions, facilitate medical students to become clinically competent practitioners. Our findings indicate that guided video instruction advances students' clinical performance greater than learning through simulation alone. To confirm these findings, similar investigations in other clinical training exercises should be considered.

Manifestations of Pulmonary Disease in Adults with Congenital Heart Disease

Children with congenital heart disease (CHD) are more frequently living into adulthood as their survival has improved due to availability of better medical and surgical management in recent times. Management of adults with CHD is emerging as new challenge in the field of medical science. Adults surviving with CHD for longer duration have been observed to develop more complications as compared to children. It is important to recognise and treat these complications early to reduce the morbidity. Pulmonary diseases are the most common systemic complications associated with adults having CHD. These individuals are presenting to clinics or emergency for pulmonary complaints, hence, pulmonologist must be aware about the pulmonary manifestations of CHD and their management.

Ethnobotany of Medicinal Seaweeds of Ilocos Norte, Philippines

The Ilocano people of Ilocos Norte in the Philippines have high regard for seaweed use. The traditional seaweed medicines used by them are old and time-tested, albeit little explored. This study examines the selection of seaweeds associated with a defined folk knowledge and their source availability in Ilocos Norte. Thirty-four (34) seaweed species were traditionally perceived as medicinal for eight types of emic indications, almost 80% of which were edible. Three major groups, i.e. rhodophytes (16 spp.), ochrophytes (7 spp.), and chlorophytes (11 spp.), of 12 families and 20 genera constituted the list. Most species were used for digestive, pulmonary, and glandular-related complaints. The Ilocano residing Pagudpud and Burgos were the most familiar in terms of the number of used species. Caulerpa racemosa (ar-arusip) was the most familiar seaweed used as a cough or asthma reliever. Caulerpa racemosa, Hydroclathrus clathratus, and Gracilaria edulis had the highest use value, whereas Codium intricatum, Gelidiella acerosa, and C. racemosa had the highest fidelity level scores. The distribution of taxa in dry and wet seasons markedly varied per site. Gelidiella acerosa was the only species growing on all sites year-round. Correspondence between folk use and phytochemical activity was inferred in nearly all listed species. The information presented here will allow continued validations and tests of folk medicinal seaweeds for new drugs and may bring additional armamentarium to the Philippine pharmacopeia.

WFUMB Technological Review: How to Perform Contrast-Enhanced Ultrasound of the Lung.

The use of ultrasound has revolutionized the evaluation of pulmonary complaints and pathology. Historically, most lung ultrasound uses described are limited to B-mode, M-mode and occasionally color Doppler. However, the use of contrast can significantly expand the diagnostic capabilities of lung ultrasound. Ultrasound contrast enables significant expansion of therapeutic and intervention capabilities. We provide a detailed description of contrast administration, phases and uses in lung ultrasound. Additionally provided are example contrast use cases and illustrative examples of contrast use in a wide range of lung ultrasound applications including pneumonia, atelectasis, pulmonary embolism and neoplasms. Clinical practice examples will help providers incorporate contrast use into their lung ultrasound practice.

ACE2 Protein Expression During Childhood, Adolescence, and Early Adulthood.

Purpose and context. Angiotensin-converting enzyme 2 is the entry receptor for SARS-CoV and SARS-CoV-2. Variations in ACE2 expression might explain age-related symptomatology of COVID-19, that is, more gastro-intestinal symptoms and less pulmonary complaints. This study qualitatively investigated ACE2 protein expression in various organs from the fetal to the young adolescent stage. Method. Autopsy samples from lung, heart, liver, stomach, small intestine, pancreas, kidney, adrenals, and brain (when available) were obtained from twenty subjects aged 24 weeks gestational age through 28 years. Formalin-fixed paraffin-embedded 4-um-thick tissue sections were stained against ACE2. Key results. We showed that the extent of ACE2 expression is age-related. With age, expression increases in lungs and decreases in intestines. In the other examined organs, ACE2 protein expression did not change with age. In brain tissue, ACE2 was expressed in astrocytes and endothelial cells. Conclusions. Age-related ACE2 expression differences could be one substrate of the selective clinical vulnerability of the respiratory and gastro-intestinal system to SARS-CoV-2 infection during infancy.

Pain and falls among top reasons for early return to care following primary elective shoulder arthroplasty in a United States cohort

BackgroundLittle is known regarding reasons for return to the emergency department (ED) or readmission following primary shoulder arthroplasty, especially immediately after discharge and for same-day discharge patients. We sought to identify primary reasons for return to care after this procedure. MethodsWe conducted a descriptive study comprising patients aged ≥18 years who underwent primary elective shoulder arthroplasty from 2009 to 2018 and subsequently had a 90-day ED-only visit or readmission. Patients were identified using our integrated health care system’s shoulder arthroplasty registry, and primary return reasons were determined through manual electronic health record review. Frequencies and proportions were used to describe reasons for 90-day ED and readmission returns, while subcategorizing by surgical and medical reasons. Return reasons were also reported by timing of the postdischarge return and by same-day discharge vs. inpatient stay. ResultsOf 9976 primary elective shoulder arthroplasty patients, 1261 (12.6%) had an ED visit, and 465 (4.7%) had a readmission. Over half (52.9%) of all 90-day ED visits were for reasons related to the procedure, while only a little over a third (35.5%) of all 90-day readmissions were surgically related. The top reasons for 90-day ED visits were postoperative pain, falls, and other nonsurgically treated musculoskeletal complaints. Pain, genitourinary complaints, and pulmonary complaints were the most frequent reasons for ED visit within 2 days of discharge, whereas postoperative pain and falls were the top reasons for ED visit specifically following same-day discharge. The top reasons for 90-day readmissions were all medical related: gastrointestinal, cardiovascular, and pulmonary. Pain related to the procedure, pulmonary complaints, and gastrointestinal complaints were the most frequent reasons for readmission within 2 days of discharge. Almost three-fourths of readmissions following same-day discharge were for medical reasons. ConclusionKnowledge of underlying reasons for returns following shoulder arthroplasty is crucial to improve patient safety, satisfaction, and comfort. While postoperative pain remains an obvious problem, a large proportion of patients also returned to the ED owing to falls. As most ED returns were related to the postoperative surgical care pathway, these returns may potentially be reduced with improved preoperative planning measures.