Pulmonary Tract Research Articles

Pinus mugo Turra and its Therapeutic Potential: A Narrative Review

Pinus mugo Turra is a coniferous species of shrub or small tree typical of central and south-eastern Europe. It is commonly called mugo pine, mountain pine, or dwarf mountain pine referring to its habit and small size. Indeed, this plant lives at higher altitude above 1400 m above the see level where it deals with harsh conditions typical of high mountain. From an ethnotraditional point of view, P. mugo is mainly used for respiratory disorders and wound healing. In particular, its essential oils have been shown to possess interesting antimicrobial and antioxidant activities, which can substantiate its potential therapeutic effect in pulmonary and urinary tract diseases, as well as antinflammatory and antitumor effects. This review also offers a summary on the chemical constituents of P. mugo that contribute to its therapeutic potential.

Biomarkers reflecting the pathogenesis, clinical manifestations, and guide therapeutic approach in systemic sclerosis: a narrative review.

Systemic sclerosis (SSc) is a progressive autoimmune disorder that mainly affects the skin. There are other clinical manifestations as renal, pulmonary, cardiovascular, and gastrointestinal tract involvements. Based on the skin involvement there are two subtypes of SSc, as limited cutaneous SSc (lSSc) which involves the acral part of the body and diffuse cutaneous SSc (dSSc) resulting in significant skin thickening of the body. Despite of the extensive research the pathomechanism is not fully clarified, how Ssc develops, moreover identifying biomarkers to predict the clinical outcome and prognosis still remains challenging. Circulating biomarkers can be crucial to define the diagnosis, to predict the prognosis and monitor the clinical course. However, only some patients are responsive to the therapy in SSc, and there is a need to reach the ideal therapy for any individual to prevent or slow down the progression in early stages of the disease. In this narrative review, our purpose was to summarize the potential biomarkers in Ssc, describe their role in the diagnosis, pathomechanism, clinical course, organ manifestations, as well as the response to the therapy. Biomarkers assessment aids in the evaluation of disease progression, and disease outcome.

Insights from a unique presentation of small cell neuroendocrine carcinoma of the paranasal sinuses: A case report

Small cell neuroendocrine carcinoma is a rare malignancy that mainly affects the pulmonary tract and only occurs extrapulmonary in very few cases, accounting to about 2.5-5% of all cases [1,2]. Primary sinonasal neuroendocrine carcinoma is extremely rare and typically affects

Evaluation of Bradykinin and Leukotriene B4 and D4 in Serum of Patients with COVID-19: A Case Control Study

Abstract The COVID-19 pandemic has emerged as one of the global threats, infecting millions of people and causing the mortality of several million around the world. Objectives: This study aims to assess levels of bradykinin, leukotriene B4, and leukotriene D4 in patients with COVID-19 and people enjoying good health as a control group, explaining the results scientifically. Materials and Methods: Medical information was collected from 90 participants at Merjin Medical Hospital in Iraq, at the respiratory care unit according to specific criteria. The people were separated into two groups: controls and patients. The study demographic included sex, age, disease severity, oxygen saturation rate (SPO2), and body mass index (BMI), and excluded patients with diabetes, asthma, pulmonary obstructive tract disease, and other chronic diseases. The bradykinin, leukotriene B4, and leukotriene D4 levels were assessed using the enzyme-linked immunosorbent assay technique (ELISA). Results: The results revealed significant variations in bradykinin, leukotriene B4, and D4 levels between the COVID-19 and control groups, with a P value of 0.036, 0.001, and 0.031, respectively. Bradykinin level in the COVID-19 group was 49.36 ± 11.24, whereas the control group showed 34.78 ± 7.15. LTB4 level in the COVID-19 patients was 401.96 ± 89.23, whereas the control group showed 316.40 ± 78.56. LTD4 level in the COVID-19 group was 11.50 ± 1.65, whereas the control group showed 8.33 ± 1.37. Conclusion: Bradykinin, leukotriene D4, and B4 can be considered good indicators to provide knowledge about the severity of COVID-19 and help physicians give appropriate medications.

Superior Vena Cava Syndrome in Men with Thymic Atypical Carcinoid (Neuroendocrine Tumor Grade 2)

Introduction: Cases of neuroendocrine tumors (NET) can occur in various organs, generally in the form of gastroenteropancreatic (GEP-NET) and pulmonary tract (PNET). The incidence of thymic neuroendocrine tumors (TNET) is rare, accounting for less than 5% of thymic and mediastinal malignancies, and 0.4% of all neuroendocrine tumors. Case presentation: A 57-year-old man came to RSUP Dr. Mohammad Hoesin Palembang with complaints of coughing, bluish and curved blood vessels in the chest, and shortness of breath during activities that have been getting worse for six months. CT scan showed a tumor measuring 18.6 x 11.7 x 11 cm in the anterior mediastinum and pressing on the superior vena cava and abdominal aorta. TTNA and core biopsy with CT guidance showed NET Grade 2, mitoses 6/2 mm2, positive tumor cells with immunohistochemistry for synaptophysin, chromogranin, CD 56, AE1/AE3, and Ki67 9%. The patient received paclitaxel and carboplatin chemotherapy for 6 cycles. Conclusion: The prognosis for atypical carcinoid patients is 20-80% for a 5-year survival rate. Appropriate patient management is needed to improve the outcome of patients with primary thymic atypical carcinoid (NET, grade 2).

Acute Myocardial Infarction during the COVID-19 Pandemic: Long-Term Outcomes and Prognosis-A Systematic Review.

Coronavirus disease 2019 (COVID-19) was a global pandemic with high mortality and morbidity that led to an increased health burden all over the world. Although the virus mostly affects the pulmonary tract, cardiovascular implications are often observed among COVID-19 patients and are predictive of poor outcomes. Increased values of myocardial biomarkers such as troponin I or NT-proBNP were proven to be risk factors for respiratory failure. Although the risk of acute coronary syndromes (ACSs) was greater in the acute phase of COVID-19, there were lower rates of hospitalization for ACSs, due to patients' hesitation in presenting at the hospital. Hospitalized ACSs patients with COVID-19 infection had a prolonged symptom-to-first-medical-contact time, and longer door-to-balloon time. The mechanisms of myocardial injury in COVID-19 patients are still not entirely clear; however, the most frequently implicated factors include the downregulation of ACE2 receptors, endothelial dysfunction, pro-coagulant status, and increased levels of pro-inflammatory cytokines. The aim of this paper is to evaluate the long-term outcomes and prognosis of COVID-19 survivors that presented an acute myocardial infarction, by reviewing existing data. The importance of the association between this infectious disease and myocardial infarction arises from the increased mortality of patients with SARS-CoV-2 infection and AMI (10-76%, compared with 4.6% for NSTEMI patients and 7% for STEMI patients without COVID-19). The literature review showed an increased risk of cardiovascular events in COVID-19 survivors compared with the general population, even after the acute phase of the disease, with poorer long-term outcomes.

Tobacco and menthol flavored nicotine-free electronic cigarettes induced inflammation and dysregulated repair in lung fibroblast and epithelium

BackgroundElectronic cigarette (e-cig) vaping has increased in the past decade in the US, and e-cig use is misleadingly marketed as a safe cessation for quitting smoking. The main constituents in e-liquid are humectants, such as propylene glycol (PG) and vegetable glycerine (VG), but different flavoring chemicals are also used. However, the toxicology profile of flavored e-cigs in the pulmonary tract is lacking. We hypothesized that menthol and tobacco-flavored e-cig (nicotine-free) exposure results in inflammatory responses and dysregulated repair in lung fibroblast and epithelium.MethodWe exposed lung fibroblast (HFL-1) and epithelium (BEAS-2B) to Air, PG/VG, menthol flavored, or tobacco-flavored e-cig, and determined the cytotoxicity, inflammation, and wound healing ability in 2D cells and 3D microtissue chip models.ResultsAfter exposure, HFL-1 showed decreased cell number with increased IL-8 levels in the tobacco flavor group compared to air. BEAS-2B also showed increased IL-8 secretion after PG/VG and tobacco flavor exposure, while menthol flavor exposure showed no change. Both menthol and tobacco-flavored e-cig exposure showed decreased protein abundance of type 1 collagen α 1 (COL1A1), α-smooth-muscle actin (αSMA), and fibronectin as well as decreased gene expression level of αSMA (Acta2) in HFL-1. After tobacco flavor e-cig exposure, HFL-1 mediated wound healing and tissue contractility were inhibited. Furthermore, BEAS-2B exposed to menthol flavor showed significantly decreased tight junction gene expressions, such as CDH1, OCLN, and TJP1.ConclusionOverall, tobacco-flavored e-cig exposure induces inflammation in both epithelium and fibroblasts, and tobacco-flavored e-cig inhibits wound healing ability in fibroblasts.

Morbidity pattern and drug utilization study in cancer patients in a tertiary care hospital

Background: Cancer is a set of diseases that include the unchecked proliferation and spread of abnormal body cell types. The primary treatment modalities are surgery, radiation, chemotherapy, immunotherapy, and hormones. As it describes the scope, nature, and causes of drug exposures, drug use research is a key and vital component of pharmacoepidemiology. Aim and Objectives: Utilization study seeks to encourage communities to use medications rationally. Materials and Methods: A prospective, cross-sectional, observational study was conducted in indoor patients of the radiotherapy department of a tertiary care teaching hospital. Six hundred patients of different types of cancers were involved in the study. At the end of data collection, the data were entered and analyzed with Microsoft Excel 2019. Descriptive statistics were used to analyze the results. Results: Buccal mucosa, tongue, and breast cancers had the highest admission rate with 24.17%, 13.33%, and 12.83%, respectively. The average number of drugs per encounter was 13.58 with a range of 5–17. The most frequently used anticancer drugs were cisplatin, carboplatin, paclitaxel, 5-fluorouracil, cyclophosphamide, and Adriamycin. Out of 32 drugs used, 30 drugs were prescribed from the World Health Organization Model List of Essential Medicines, 2021, and National List of Essential Medicines, 2022, and 8 drugs were by brand name. Conclusion: Compared to other systems such as the pulmonary, breast, genitourinary, and gastrointestinal tract, oral malignancies were more common. The most frequently used anticancer drugs were cisplatin, carboplatin, paclitaxel, 5-fluorouracil, cyclophosphamide, and Adriamycin. Prescribing drugs were mainly from Essential Drug List with generic names.

Cumulative Incidence and Characteristics of Infections Requiring Treatment, Delay in Treatment Administration or Hospitalisation in Patients with Relapsed or Refractory Multiple Myeloma Treated with Anti BCMA or Anti GPRC5D Bispecific Antibodies

Background. Bispecific antibodies (BsAb) are a new effective treatment for relapsed/refractory multiple myeloma (RRMM). Although these immunotherapies are well tolerated, infectious complications emerged as a predominant issue, mainly with anti-BCMA BsAb. Recent guidelines were presented to prevent and manage these complications based on clinical trials safety signals. In this study, we aimed to report incidence and characteristics of infectious complications in patients treated with anti-BCMA and anti-GPRC5D BsAb. Methods. A retrospective study was conducted in 13 tertiary centers including patients with RRMM treated by BsAb between December 2020 and February 2023. We reported infectious complications events requiring specific treatment, delay in BsAb administration or hospitalisation and occurring up to three months after interruption of treatment. Results. Among the 229 patients included, 200 (87%) received an anti-BCMA BsAb with teclistamab (n=153, 67%) or elranatamab (n=47, 20%) and 29 patients (13%) received an anti-GPRC5D BsAb with talquetamab. 40% (n=90) of patients were treated in monotherapy, 42% (n=94) had dexamethasone in addition to the BsAb after step up doses and 18% (n=41) received a combination with an anti CD38, immunomodulatory treatment, proteasome inhibitor or other. The median age was 67 years (range 38-85), median of prior line of therapy was 4 (range 0-15). 62 (32%) patients had a high cytogenetic risk and 187 (82%) had a triple refractory disease. With a median follow up of 7 months (IQR 4-12 months) 234 infectious events were documented in 142 patients (62%) including 53% grade ≥ 3 and 8.4% (n=19) deaths due to infection. All infections grade ≥ 4 (n= 48; 20.6%) occurred in patients treated with anti-BCMA BsAb. Predominant localisation was pulmonary tract (n= 97, 41%) and disseminated infection (n=52, 22%) . Among the documented infections, 91 (55%) were bacterial, 64 (39%) were viral and 8 (5%) were fungal (Figure 1A). Two (1.2%) infectious events were from a parasite. Most frequent pathogens were Enterobacteriaceae (n=28, 12%), SARS-CoV-2 (n=19, 8%), anaerobic bacteria (n=10, 4%) Pseudomonas aeroginosa (n=6, 2.5%). Invasive pulmonary aspergillosis was found in 6 (2.5%) patients, and 2 (1.2%) event was PML (progressive multifocal leukoencephalopathy) and 1 (0.6%) was disseminated toxoplasmosis. Hospitalization rate was 57% (n=131), including 13% (n=30) requiring intensive care with a median hospitalization time of 10 (range 1-111) days. Overall, n=113 (47%) of the infectious events had an impact on the course of treatment. Illustrated by interruption in n=31 (14%) events, delayed administration in n=70 (32%) events or change in frequency of administration in 2 (0.9%) events. Considering immunosuppression, 125 (68%) of these infections occurred in patients associated with hypogammaglobulinemia (<3 g/L) and 22% (n=50) in patients supplemented with intravenous immunoglobulin. Regarding infectious prophylaxis, n=104 (47%) infectious events occurred despite a bacterial prophylaxis (n=104), 91% (n=125) occurred under viral prophylaxis, 73% (n=166) with trimethoprim-sulfamethoxazole or atovaquone and 11% (n=25) with pentamidine use. Global cumulative incidence of first infection was 70% in all patients, 73% in patients treated with anti-BCMA and 51% with anti-GPR5CD. Treatment with anti-GPRC5D BsAb was independently associated with a lower risk of first infection in a multivariate model adjusted for infectious prophylaxis, and hypogammaglobulinemia, HR 0.43 (IC95% 0.23; 0.77); p=0.005 (Figure 1B). Conclusion. This study highlights the rate of infectious event with BsAb treatment in RRMM setting. We describe higher frequency of infections in patients receiving anti-BCMA agents compare to anti-GPRC5D group. Impact on treatment administration is huge and dosing intervals strategy and prophylaxis appear necessary and effective to improve the morbidity and mortality rate of this hightly effective agents.

A Case of Prune Belly Syndrome: Radiological Aspects of a Rare Disease

Prune Belly Syndrome (PBS) is a rare but morbid entity usually found in male neonates. It is classically defined by a triad of cardinal features that includes deficient abdominal wall musculature, urinary tract malformation and in males, cryptorchidism. Most of the patients have associated pulmonary, cardiac, skeletal and gastrointestinal tract anomalies. Children often require numerous surgical interventions including bilateral orchidopexy as well as individually tailored urinary tract and abdominal wall reconstruction. The prognosis of infants with PBS may be improved by quality antenatal follow-up, to enable the early diagnosis and preparation for prompt surgical intervention. We describe a case of PBS and emphasize the role of imaging, in the process of diagnosis and briefly review the subject.

Influences of long-term care insurance on pulmonary and urinary tract infections among older people with disability.

Pulmonary infection (PI) and urinary tract infection (UTI) have been the most common cause of hospitalization and most frequent infection respectively in older people with disability (OPWD). Long-term care insurance (LTCI) policy, intending to provide services to reduce the disease burden of OPWD, it remains unclear whether LTCI could reduce PI-, and UTI-related hospitalizations. This quasi-experimental study aimed to assess the influences of LTCI on all-cause, especially PI- and UTI-related hospitalizations among OPWD and the variation across sociodemographic characteristics. 32,120 participants in the Chengdu Long-term Care Insurance cohort were considered the intervention group, and 2,704 not covered by the LTCI were in the control group. A total of 3,134,160 hospitalization records were collected between January 2014 and June 2021. A doubly robust difference-in-differences (DID) method was used to estimate the average treatment effect on the treated (ATT), indicating the average effect of LTCI on intervention group. The average monthly all-cause, PI-, and UTI-related hospitalization rates were 16.3%, 4.0% and 0.5% in the intervention group, respectively, and were 19.3%, 3.9% and 0.5% in the control group, respectively. Under LTCI, all-cause (ATT [95% CI]: 7.15% [6.41%, 7.88%]), PI- (3.25% [2.76%, 3.74%]), and UTI-related hospitalizations (0.46% [0.28%, 0.64%]) were decreased. The influences of LTCI became significant after 5 months since the LTCI implementation and remained stable over time. The impact was more pronounced among those with longer coverage. The overall reduction was stronger in those who were not married, lived alone, and resided in institutions. LTCI may reduce the occurrence of all-cause, PI-, and UTI-related hospitalizations in OPWD, with stronger influences observed over an extended period of implementation. The implementation of LTCI can play a role in reducing the burden of infectious diseases in OPWD and the care burden of families and society.

Increasing Antimicrobial Resistance of Gram-Positive Cocci in the Nostrils of Health Care Workers in the Post–COVID-19 Era Compared to Pre–COVID-19 Era in North Khorasan, Iran

Background: In the COVID-19 era, co-infections can lead to an increase in morbidity and mortality. Normal flora bacteria can transfer to the pulmonary tract and create bacterial co-infections. The nasal cavity is one of the main areas housing normal flora in the human body. Objectives: In this study, we evaluated the prevalence and antibiotic resistance of gram-positive cocci in the pre– and post–COVID-19 eras among health care workers. Methods: We assessed 376 nasal swabs from the pre–COVID-19 era and 376 from the post–COVID-19 era. Conventional and molecular methods were used to identify bacterial types and evaluate antimicrobial resistance. Results: The most common gram-positive cocci in the pre–COVID-19 samples were Staphylococcus aureus, S. epidermidis, S. capitis, S. hominis, S. haemolyticus, Streptococcus pneumoniae, and Enterococcus faecalis. In the post–COVID-19 samples, the most common gram-positive cocci were S. aureus, S. epidermidis, S. warneri, S. hominis, and E. faecalis. We observed higher resistance rates in post–COVID-19 samples, as well as resistance to linezolid and vancomycin in S. aureus, S. epidermidis, and S. hominis. Additionally, our isolates showed a high resistance rate to antiseptics. Conclusions: It seems that after the beginning of the COVID-19 pandemic, due to the change in the protective procedures in hospitals, the prevalence and variety of bacteria have decreased, but instead, they have been replaced by more pathogenic bacteria with higher antibiotic resistance.

Electret-based flexible pressure sensor for respiratory diseases auxiliary diagnosis system using machine learning technique

Respiratory diseases have been increasingly affecting people worldwide, posing a major public health challenge due to rising morbidity and mortality rates. Subtle abnormal respiratory sounds s may present early in the pulmonary or respiratory tract diseases, therefore urging an instant intervention in critical clinical conditions. However, the current monitoring and signal analysis technologies pose significant challenges in achieving real-time, convenient, and accurate respiratory disease monitoring. Here, we propose a novel automatic auxiliary diagnosis system that utilizes a flexible electret-based self-powered sensor (FESS), signal processing technology, and machine learning algorithms. The FESS is based on a strain-enhanced laminated electret with an edge-to-edge hollow hemisphere array structure, which enables the system to detect and prevent various respiratory diseases with high accuracy rates of 99.43%, sensitivity of 98.30%, and specificity of 99.02%. Our system holds immense potential in reducing medical burden and improving the overall health of individuals.

Nausea, Vomiting, and Abdominal Distention After Atrial Fibrillation Therapy

Question: A 71-year-old man with paroxysmal atrial fibrillation and prostate cancer requiring transurethral resection presented with progressively severe diffuse abdominal pain, bloating, abdominal distention, nausea, and intractable vomiting of 2 days’ duration. Four days before presentation, he underwent successful radiofrequency ablation of the right and left pulmonary vein inlet tract; 35 W radiofrequency ablation was delivered around both sides of the pulmonary veins in a wide circumferential fashion by extending the circumferential lesion over the posterior walls bilaterally and carina area of the left-side pulmonary veins per protocol. His medications on admission included 100 mg flecainide twice daily, 40 mg pantoprazole daily, 20 mg rivaroxaban daily, and 20 mg simvastatin daily

Evaluation of serum 25-hydroxyvitamin D, C-reactive protein, and haptoglobin as biomarkers in dogs newly diagnosed with histoplasmosis.

Serum 25-hydroxyvitamin (OH)D, C-reactive protein (CRP), and haptoglobin are useful biomarkers in various infectious diseases and inflammatory disorders in dogs, but their utility in histoplasmosis is unknown. Determine if serum 25(OH)D, CRP, and haptoglobin concentrations are different in dogs with histoplasmosis compared to healthy controls and whether serum globulin, albumin, CRP, or haptoglobin are associated with 25(OH)D concentration. Twenty-two client-owned dogs (histoplasmosis, n=12; controls, n=10). Prospective case-control study. Dogs with histoplasmosis were categorized as pulmonary, disseminated, or gastrointestinal (GI) tract. Serum 25(OH)D was measured using modified high-performance liquid chromatography(HPLC). Serum CRP and haptoglobin were measured with ELISA assays. Dogs with histoplasmosis were grouped as disseminated (n=8) and GI tract (n=4). No dogs had pulmonary tract involvement alone. Dogs with histoplasmosis (median, interquartile range [IQR]; 11.6ng/mL, 16.8) had lower serum 25(OH)D concentrations than controls (35.7ng/mL, 17.6; P < .001). Serum CRP and haptoglobin concentrations were higher in dogs with histoplasmosis (CRP: median, IQR; 63.5mg/L, 37.1 and haptoglobin: 459.7mg/dL, 419.6) than controls (CRP: 1.9mg/L, 2; P < .001 and haptoglobin: 85.5mg/dL, 106.7; P=.003). Serum 25(OH)D concentration was positively associated with fold change in serum albumin concentration (ρ=0.77; P < .001), and negatively associated with fold change in serum globulin (ρ=-0.61; P=.003) and CRP concentrations (ρ=-0.56; P=.01). Assay of serum 25(OH)D, CRP, and haptoglobin could have clinical value in dogs with histoplasmosis.

980. Enterobacter: An Early-Onset Pathogen of Prosthetic Hip and Knee Infections with Poor Prognoses

Abstract Background Enterobacter sp. is a gram-negative, often drug-resistant bacillus that is classically identified from mucosal surfaces, such as pulmonary or urinary tracts. Despite its virulence, Enterobacter represents a less common pathogen in prosthetic joint infections (PJI). This study aims to resolve the current paucity of described clinical characteristics and treatment success of Enterobacter PJI. Methods Thirty-three patients with Enterobacter aerogenes-, cloaecae/asburiae-, or hormachei-positive PJIs were identified at a single institution. Infection clearance was defined as absence of infection or repeat surgery at one year and off all adjunct antibiotic therapy. Patient demographics, PJI characteristics, treatments, and clinical outcomes were compared between patients with and without clearance. Results In this cohort, mean age was 66.8 years (SD: 11.6), mean BMI was 31.0 (SD: 7.1), and mean Elixhauser Comorbidity Score was 9.1 (SD: 4.5). 54.5% had a prior PJI in the same joint, and 87.9% had more than one prior surgery in that joint. Median time of PJI diagnosis after surgery was 22 days [IQR: 18-60]. Patients initially treated with debridement antibiotics and implant retention (n=11) had a 45.5% clearance rate, compared to 23.1% for 2-stage exchange (n=13) and 44.4% for those requiring resection arthroplasty or amputation (n=9). With a median follow-up of 2.9 years, final joint outcomes included resection arthroplasty in 9 (27.3%), above-knee amputation in 7 (21.2%), definitive treatment with an articulating spacer in 6 (18.2%), and arthrodesis in 2 (6.1%) patients. Conclusion Enterobacter PJI often presents acutely and is a difficult pathogen to treat. The outcomes of our cohort reflect the virulence of Enterobacter, with high rates of failure and ultimate joint- or limb-sacrificing procedure. Despite being a less common cause of PJI, prognosis is exceptionally poor with traditional treatment algorithms when compared to historical cohorts of more common pathogens. Disclosures William A. Jiranek, MD, Biomech Holdings LLC: Stocks/Bonds|DePuy, A Johnson &amp; Johnson Company: IP royalties Thorsten M. Seyler, MD, PhD, Heraeus: Paid consultant|Pattern Health: IP royalties|Restor3d: IP royalties|Smith &amp; Nephew: Paid consultant|Total Joint Orthopedics: Paid consultant|Zimmer: research.

Transcervical Amnioinfusion in Meconium Stained Amniotic Fluid in the Pregnant Women at Labour and Foetomaternal Outcome Attending Labour Ward of Rajshahi Medical College Hospital

Background: Amniotic fluid is the fluid present in amniotic sac which surrounds the foetus, provides nutrition and maintains temperature of the foetus. Physically it allows the foetus to move and prevents it from injury. Functionally it enables foetal breathing mobility that prevents pulmonary hypoplasia and exercises digestive tract by swallowing amniotic fluid. Objective: The objective of the study was to explore the role of amnioinfusion in intrapartum management of meconium stained amniotic fluid in the pregnant women at labor and foetomaternal outcome of the patients attending labor ward of Rajshahi Medical College Hospital. Methods: This experimental randomized control trial study carried out in the Department of Obstetrics and Gynecology of Rajshahi Medical College Hospital, Rajshahi from July, 2012 to June, 2014. Sample size was 100 and randomly allocated into equally two halves as study group and control group. Purposive sampling technique was followed. Results: In this study the age of the study group up to 30 years was 38(47.5%), control group 42(52.5%) and total 80(80.0%). On the other hand, in &gt;30 year’s study group was 12(60.0%), control group 8(40.0%) and total 20(20.0%) respectively. and that of control group was 26.24 (±4.75) years. The mean age of the study group was 27.44 ± 5.59, control group was 26.24 ± 4.75 and total was 26.84 ±5.18 years. The mean weight of the study group was 66.84 (±3.25) kg and in the control group 62.64(±2.84) kg. In this study, 96.0% of the respondents had normal vaginal delivery and among them, 52.1% were in the study group and 47.9% in the control group. On the other hand, only 4% of the respondents had lower segment caesarean section and all of them were in the control group. The mean gestational age at delivery of the respondents in the study group was 39.88 ± 0.78 weeks and in the control group 39.84 ± 0.75 weeks. Conclusion: In this study Tran’s cervical amnioinfusion gave positive result by providing reducing picture of operative delivery in study group. There was significant difference in respiratory distress in the baby having lower percentage in the study group. A large scale study should be carried out to make the result of this study a reliable one.

The Role of Pediatric Gastroenterologists in the Evaluation of Complex Aerodigestive Disorders.

Children with aerodigestive disorders frequently have concerns regarding difficulty breathing, swallowing, and growing. In this review, we explored the role of pediatric gastroenterologists in the evaluation of complex aerodigestive disorders and the overall approach to these often-challenging patients. Pediatric gastroenterologists evaluate children with aerodigestive concerns ranging from dysphagia and gastroesophageal reflux to complex congenital abnormalities such as esophageal atresia. Diagnostic tools, such as multichannel intraluminal impedance-pH monitoring, are used for diagnosing gastroesophageal reflux and assessing the correlation with symptoms. Endoscopic evaluation, and in some complex cases, with therapeutic dilations may also be performed. Gastrointestinal dysmotility evaluation with manometry studies are also being increasingly utilized. Multidisciplinary aerodigestive programs can provide a coordinated approach to children with complex airway, pulmonary and gastrointestinal tract disorders. A pediatric gastroenterologist's expertise and specialized skills not only offer many diagnostic tools for these complicated medical cases but are also important in long term medical management.

Formulation and Evaluation of Novel Additive-Free Spray-Dried Triamcinolone Acetonide Microspheres for Pulmonary Delivery: A Pharmacokinetic Study.

This work aimed to establish a simple method to produce additive-free triamcinolone acetonide (TAA) microspheres suitable for pulmonary delivery, and therefore more simple manufacturing steps will be warranted. The spray-drying process involved the optimization of the TAA feed ratio in a concentration range of 1-3% w/v from different ethanol/water compositions with/without adding ammonium bicarbonate as a blowing agent. Characterization of the formulas was performed via scanning electron microscopy, Fourier-transform infrared spectroscopy, differential scanning calorimetry, and powder X-ray diffraction. Our results indicated that the size and morphology of spray-dried TAA particles were dependent on the feed and solvent concentrations in the spray-dried formulations. Furthermore, adding the blowing agent, ammonium bicarbonate, did not produce a significant enhancement in particle characteristics. We prepared additive-free TAA microspheres and found that TAA formulation #1 had optimal physical properties in terms of diameter (2.24 ± 0.27 µm), bulk density (0.95 ± 0.05), tapped density (1.18 ± 0.07), and flowability for deposition during the pulmonary tract, from a centric airway to the alveoli as indicated by Carr's index = 19 ± 0.01. Hence, formulation #1 was selected to be tested for pharmacokinetic characters. Rats received pulmonary doses of TAA formula #1 and then the TTA concentration in plasma, fluid broncho-alveolar lavage, and lung tissues was determined by HPLC. The TAA concentration at 15 min was 0.55 ± 0.02 µg/mL in plasma, 16.74 ± 2 µg/mL in bronchoalveolar lavage, and 8.96 ± 0.65 µg/mL in lung homogenates, while at the 24 h time point, the TAA concentration was 0.03 ± 0.02 µg/mL in plasma, 1.48 ± 0.27 µg/mL in bronchoalveolar lavage, and 3.79 ± 0.33 µg/mL in lung homogenates. We found that TAA remained in curative concentrations in the rat lung tissues for at least 24 h after pulmonary administration. Therefore, we can conclude that additive-free spray-dried TAA microspheres were promising for treating lung diseases. The current novel preparation technology has applications in the design of preparations for TAA or other therapeutic agents designed for pulmonary delivery.

Gut-lung Microbiota Interactions in Chronic Obstructive Pulmonary Disease (COPD): Potential Mechanisms Driving Progression to COPD and Epidemiological Data.

This paper focuses on the gut-lung axis in the context of Inflammatory Bowel Disease (IBD) and Chronic Obstructive Pulmonary Disease (COPD), highlighting the key role played by microbial dysbiosis and the impact of environmental and genetic factors on the innate and acquired immune system and on chronic inflammation in the intestinal and pulmonary tracts. Recent evidence indicates that Antigen-Presenting Cells (APCs) perform regulatory activity influencing the composition of the microbiota. APCs (macrophages, dendritic cells, B cells) possess membrane receptors known as Pattern Recognition Receptors (PRRs), a category of toll-like receptors (TLRs). PRRs recognise distinct microbial structures and microbial metabolites called Signals, which modulate the saprophytic microbial equilibrium of the healthy microbiota by recognising molecular profiles associated with commensal microbes (Microbe-Associated Molecular Patterns, MAMPs). During dysbiosis, pathogenic bacteria can prompt an inflammatory response, producing PAMPs (Pathogen-Associated Molecular Patterns) thereby activating the proliferation of inflammatory response cells, both local and systemic. This series of regulatory and immune-response events is responsible (together with chronic infection, incorrect diet, obesity, etc.) for the systemic chronic inflammation (SCI) known as "low-grade inflammation" typical of COPD and IBD. This review looks at immunological research and explores the role of the microbiota, looking at two recent clinical studies, SPIROMICS and AERIS. There is a need for further clinical studies to characterize the pulmonary microbiota and to obtain new information about the pathogenesis of lung disease to improve our knowledge and treatment strategies and identify new therapeutic targets.