Symptoms Of Cough Research Articles

Cervical lung herniation of the azygous lobe: a case report and literature review.

To report an adult case of cervical lung herniation involving the azygous lobe and to review the literature. A trauma patient was incidentally found to have a cervical lung herniation involving the azygous lobe. We reviewed the literature on cervical lung herniation, described techniques used to diagnose and evaluate cervical lung herniations and summarized management options. Cervical lung herniation results in a defect in Sibson's fascia allowing the apical lung to protrude above the thoracic inlet. In the adult population, these are commonly seen after trauma or surgical intervention, but congenital forms have also been described in the pediatric population. Apical herniation of the lung can cause symptoms due to mass effect on the esophagus or trachea. We report an adult case of cervical lung herniation involving the azygous lobe. Cervical lung herniation is a relatively rare entity compared to lung herniation through the rib cage. Knowledge of this entity is essential to properly evaluate trauma patients and to diagnose patients who have symptoms of cough, dysphagia or a bulging neck mass.

Rare Presentation of Non-Tuberculous Mycobacteria: A Case of Lung Infection with Pleural Effusion

Background: Non-tuberculous mycobacteria (NTM) are environmental organisms that can cause pulmonary infections, particularly in individuals with predisposing conditions. While NTM lung disease is increasingly recognized, pleural effusion as a complication remains uncommon, posing diagnostic and therapeutic challenges. This case emphasizes the importance of a high index of suspicion, comprehensive microbiological investigations, and bronchoscopy in the diagnosis of NTM lung disease with pleural effusion. Case presentation: We present the case of a 55-year-old male farmer with a history of smoking, who presented with progressive dyspnea, cough, and constitutional symptoms. Initial investigations suggested tuberculosis, but sputum tests were negative. Chest imaging revealed a right pleural effusion and cavitary lung lesions. Pleural fluid analysis showed an exudative pattern with elevated adenosine deaminase (ADA) but negative for acid-fast bacilli. Bronchoscopy with bronchoalveolar lavage culture yielded Mycobacterium other than tuberculosis (MOTT). The patient was diagnosed with NTM lung disease complicated by pleural effusion and initiated on multidrug therapy. Conclusion: This case highlights the diagnostic challenges of NTM lung disease, particularly when presenting with pleural effusion. A high index of suspicion, comprehensive microbiological investigations, and bronchoscopy are crucial for accurate diagnosis. Prompt initiation of appropriate multidrug therapy is essential for optimal outcomes.

Type 2 diabetes mellitus as an independent risk factor of pulmonary tuberculosis: A hospital based cross-sectional study

Background: The growing frequency of infectious and non-communicable illnesses on a global scale is primarily associated with the changing patterns observed in epidemiology. Diabetes mellitus (DM) significantly leads to the development of tuberculosis (TB) and less effective treatment outcomes if not identified early. Objective: This study aims to investigate type 2 DM as a risk factor for TB infection.Methods: Participants in this cross-sectional research study comprised DM patients who reported cough complaints at the TB treatment center and the internal medicine department of Zainoel Abidin Hospital. Random blood glucose and glycated hemoglobin (HbA1c) levels were measured in all respondents. The Chi-Square test assesses the association between DM and Pulmonary TB.Results: There are 48 DM patients with new pulmonary TB, an averageage of 53 years (SD 9.1). Most of them have symptoms of cough for more than 2 weeks (85.4%), loss of body weight (77.1%), chest pain (58.3%), and loss of appetite (72.9%). The high HbA1c levels were associated with TB, as detected by Xpert MTB/RIF assay and typical radiographic signs (p<0.05). DM patients with increased HbA1c were found to have a two times chance of showing results from a chest x-ray typical of TB and probability of TB infection (PR: 2.850, 95% CI (1.152-7.053); 2.745, 95% CI (0.969-7.780)) respectively.Conclusion: DM patients had two times the risk of lung damage based on chest X-rays and having TB. DM may seriously compromise the efficacy of TB control programs and impede a nation's progress toward TB elimination.

20S-Ginsenoside Rh2, the major bioactive saponin in Panax notoginseng flowers, ameliorates cough by inhibition of NaV1.7 and TRPV1 channel currents and downregulation of TRPV1 expression

Ethnopharmacological relevancePanax notoginseng flowers, which are the buds of the traditional Chinese medicinal herb Sanqi, are widely used in China for their cough-ameliorating properties, with demonstrated therapeutic effects in the treatment of both acute and chronic coughs. However, both the antitussive mechanism and active compound basis of P. notoginseng flowers remain poorly understood. Aim of the studyWe investigated the antitussive effects of P. notoginseng flowers, identified the bioactive constituents responsible for alleviating cough symptoms, and elucidated the underlying pharmacological mechanisms. Materials and methodsWe analyzed the major chemical constituents of aqueous extracts of P. notoginseng flowers using liquid chromatography–mass spectrometry and quantitatively analyzed the key component, 20S-ginsenoside Rh2, using high-performance liquid chromatography. Using a cough reflex model in healthy mice and an ovalbumin-induced, highly sensitive guinea pig cough model, we verified the suppressive effects of P. notoginseng flowers and their saponin constituents on coughing. Furthermore, we explored the mechanisms of action of the key ion channels, NaV1.7 and TRPV1, using whole-cell patch-clamp techniques and molecular docking. Finally, the therapeutic mechanisms of P. notoginseng flowers on pathological cough were revealed using hematoxylin and eosin staining, immunohistochemistry, and western blotting. ResultsThe active components of P. notoginseng flowers were primarily protopanaxadiol-type saponins, among which 20S-ginsenoside Rh2 had the highest content (51.46 mg/g). In the mouse model, P. notoginseng flowers exhibited antitussive effects comparable to those of pentoxyverine citrate. Although its main saponin component, 20S-ginsenoside Rh2, showed slightly weaker effects, it still demonstrated concentration-dependent inhibition of channel activity. The whole-cell patch-clamp technique and virtual molecular docking showed that Rh2 might exert its effects by directly binding to the NaV1.7 and TRPV1 channels. In the guinea pig model, P. notoginseng flowers and their saponin components not only reduced cough frequency and prolonged the latency period before cough onset, but also significantly inhibited tracheal and pulmonary inflammation and the overexpression of TRPV1. Conclusions20S-Ginsenoside Rh2, the major bioactive saponin in P. notoginseng flowers, exhibits potent antitussive effects. The potential mechanism of action of 20S-Ginsenoside Rh2 in the treatment of cough may involve inhibiting NaV1.7 and TRPV1 channel currents through direct binding to core protein active sites and downregulating TRPV1 expression.

Evaluate the Frequency of EosinophilicEsophagitisin Individuals with Refractory GERD

Background: Theeosinophilic infiltrate of the esophagus mucosal distinguishes the esophageal ailment known as Eosinophilicesophagitis (EoE). This study aims to determine the frequency of EoE in patients with gastroesophageal reflux disease (GERD), a gastro esophageal reflux condition that is persistent. Methods: The 248 children in total hadelectiveupper gastrointestinal endoscopy (UGIE) during the study period were separated in tosix groups: individuals without a history of steroid usage and those with outanesophageal biopsyforthrombocytopenia. As a result, 200 people participated in the study total. Results: After an evaluation of 200 children having elective UGIE, A variety of health problems were found during the investigation, including food bolusimpact (2 %), achalasia cardia (5 %), pepticstricture (6 %), congenitalstricture (3 %), post-esophageal atresia repairanastomoticstricture (4 %), and symptoms of gastro esophageal reflux, including vomiting (10 %), regurgitation (2 %), belchingchest (1,5 %), nocturnal cough (2,5 %), pain/heartburn (12,5 %), and feeding refusal (1 %). There were several unusual illnesses that were observed, including Crohn's disease accounted for 2 %, paediatric intestinal pseudo-obstruction (10 %), abdominal discomfort (17,5 %), celiacdisease (16 %), cow's milk protein allergy (3 %), and un classified IBD (7 %). Conclusion: EoEfrequently affects GERD patients who are recalcitrant to treatment. Dysphagia, food impaction, and heartburn are posible symptoms. EGD and esophageal biopsy should be explored for EoEscreening in elderly individuals with strong GERD who are atopy positive and who have not responded to gastric acid inhibitors.

Assessing lifetime occupational chrysotile inhalation exposure, respiratory symptoms, and lung cancer risk among brake maintenance workers in Malaysia.

This study aimed to estimate workers' occupational lifetime exposure to chrysotile and examine the respiratory symptoms and lung cancer risk. A total of 112 workers were interviewed about their occupational histories. Exposure modeling using information on the determinants of exposure was used to estimate chrysotile emissions. The cumulative lifetime exposure was then assessed for each worker. Respiratory symptoms were obtained using a validated questionnaire. Lung cancer mortality rate was also predicted using a model. Almost all the workers were male and young (mean age = 30 years, SD = 7). The estimated lifetime occupational chrysotile inhalation exposure ranged from 0.0001 to 0.0486 f/mL.years (median = 0.0018 f/mL.years, IQR = 0.486). A high prevalence of cough symptom (11.7%), and low estimated cancer risk (<1%) were reported. In conclusion, the lung cancer risk among our cohort of workers was at a low level because of lower cumulative lifetime occupational chrysotile exposure.

Primary extraskeletal osteosarcomas of the pleura: A clinicopathological, immunohistochemical, and molecular analysis of 4 cases

Four primary extraskeletal osteosarcomas of the pleura are presented. The patients were men between the ages of 63 and 78 years (average: 70.5 years) who presented with symptoms of chest pain, cough, and shortness of breath. Diagnostic imaging showed variably calcified, pleural-based masses and/or diffuse pleural thickening, clinically mimicking mesothelioma. Thoracoscopic surgical material was obtained for histopathological diagnosis. Histological findings showed the presence of a neoplastic spindle cell proliferation composed of fusiform cells with scant cytoplasm, elongated nuclei and inconspicuous nucleoli. Mitotic activity was easily identified. Additionally, all tumors showed extensive osseous differentiation in the form of osteoid matrix production; one tumor demonstrated additional chondrosarcomatous elements and another showed focal myxoid changes. Immunohistochemical analysis revealed that the tumor cells were uniformly negative for a wide variety of antibodies, including keratin AE1/AE3, keratin 5/6, D2-40, EMA, calretinin, WT-1, BerEP4, and HEG1; BAP1 was retained in all cases. In addition, fluorescence in situ hybridization for CDKN2A (p16) was negative for homozygous deletion in all tumors. Clinical follow-up showed that one patient had died 8 months after diagnosis and one had remained alive with short post-diagnostic follow-up. The tumors herein described highlight a challenging issue in the separation of mesothelioma with heterologous elements from true osteosarcomas of pleural origin. We propose that a diagnosis of extraskeletal osteosarcoma of the pleura is rendered for tumors with malignant osseous and/or cartilaginous differentiation in which comprehensive immunohistochemical studies and FISH analysis have failed to provide support for a diagnosis of mesothelioma with heterologous elements.

Pathogenic investigation of human respiratory syncytial virus infection in kindergarten children in Tongzhou District, Beijing City in 2023

The study focused on individuals with influenza-like symptoms (fever, cough, sore throat, runny nose, and other respiratory symptoms) in three kindergartens in Tongzhou District, Beijing City, in April 2023. Nasopharyngeal swab specimens were collected, and real-time fluorescent quantitative PCR was used to detect common respiratory pathogens in the collected specimens. Positive specimens were subjected to sequencing analysis of the highly variable region of human respiratory syncytial virus (HRSV) G protein, homology analysis and phylogenetic tree analysis. A total of 25 fever cases were collected from 3 kindergartens, aged 3-8 years old, with an age M (Q1, Q3) of 4 (3.5, 5) years old. Ten confirmed cases of HRSV positive were screened and detected using the fluorescent quantitative PCR method, with a total detection rate of 40% (10/25). Typing identification and sequencing analysis confirmed that the main epidemic type was HRSV subtype B, which was highly homologous and closely related to previous epidemic strains in the region. Through pathogen investigation and analysis, it was preliminarily determined that this epidemic was dominated by HRSV subtype B.

Temporary Vocal Fold Augmentation Outcomes for Refractory Chronic Cough with Concurrent Nonparalytic Glottic Insufficiency due to Vocal Fold Atrophy

ObjectiveDetermine the effect of temporary vocal fold augmentation on refractory chronic cough in patients with glottic insufficiency due to vocal fold atrophy. MethodsRetrospective electronic chart review was conducted for patients with a diagnosis of bilateral vocal fold atrophy and refractory chronic cough undergoing vocal fold augmentation with carboxymethylcellulose. Patients with vocal fold immobility were excluded, and cough must have been present for at minimum 8 weeks. VHI-10, CSI, and RSI scores along with subjective overall patient report of chronic cough improvement were collected. ResultsA total of 28 patients underwent 30 vocal fold augmentation procedures with carboxymethylcellulose. All had undergone extensive cough work-up and treatment trials prior to their augmentation procedure. From chart review, 13 overall subjectively reported satisfactory improvement in their cough, 5 reported partial improvement, and 7 reported no improvement in their cough. An uncertain effect on cough was documented in 5 (either patient was uncertain or no mention of cough symptom in the interval chart history note). For those subjects with both pre- and post-augmentation data, mean pre-augmentation CSI: 22.08 + 6.8 (n=13); VHI-10: 13.6 + 8.9 (n=18); RSI: 22.4 + 7.5 (n=17). Mean post-augmentation CSI was 20.7 + 9.2 (n=13); VHI-10: 15.2 + 8.2 (n=18); RSI: 21.1 + 5.8 (n=17). Mean pre-post change in CSI was -1.4 + 5.1 (p=0.175, n=13, range -10 – +6). ConclusionsVocal fold augmentation seems to provide subjective cough improvement in some patients with concurrent glottic insufficiency due to vocal fold atrophy and refractory chronic cough. It can be offered as a diagnostic trial, on which further augmentation may be offered, for patients with persistent cough despite prior work-up and treatment trials. Further controlled prospective studies are needed to identify factors that are predictive of successful cough improvement following vocal fold augmentation, as well as the effect of durable augmentation in those patients who had improvement with a diagnostic trial.

Active Cycle Breathing Technique on Airway Clearance in Pulmonary TB Patients

Abstract Introduction: Gorontalo City has 643 cases of tuberculosis in 2022, with the problem of ineffective airway clearance which causes airway obstruction which is often characterized by symptoms of ineffective cough, excess sputum, wheezing and rhonchi. Objective: To determine the effect of active cycle breathing technique on airway clearance in pulmonary TB patients. Method: The type of research used is quantitative. The research design uses a Quasi Experiment One Group Pre test- Post test design, namely a research design that only uses one group of subjects and takes measurements before and after giving treatment to the subjects being studied. The sampling technique was carried out using the Accidental Sampling technique with a sample size of 10 respondents. Data analysis uses univariate and bivariate analysis and the instrument used is a questionnaire. Results: The results of the study showed that the patient's clinical results from ineffective airway clearance problems, after being given the active cycle breathing technique, resulted in effective airway clearance. The statistical test results obtained p-Value = 0.004, which means less than (α = 0.05), indicating that there is an influence of active cycle breathing technique on airway clearance in pulmonary TB patients. Conclusion: The active cycle breathing technique can be a recommended nursing intervention in overcoming the problem of airway clearance in pulmonary TB patients.

Outcomes of a step-up approach to the treatment of neurogenic cough

IntroductionNeurogenic cough (NC) is thought to be related to sensory neuropathy in the hypopharynx and larynx. Defined as a cough persisting longer than 8 weeks refractory to standard therapy, it is a diagnosis of exclusion when other common etiologies (asthma, gastroesophageal reflux disease (GERD), medication side effects) are ruled out. It affects roughly 11 % of Americans and can negatively impact quality of life. MethodsFollowing institutional review board approval, we evaluated the medical records of adult patients seen at the University of Arizona's tertiary laryngology center from 2018 to 2023. Patients were included if their cough persisted for >8 weeks, and they either did not respond to prior proton pump inhibitor and asthma therapy or had GERD and asthma ruled out. These patients underwent a progressive escalation of therapy, which included neuromodulators with or without cough suppression therapy, superior laryngeal nerve (SLN) block, and laryngeal botulinum toxin injections. The primary outcome was patient-reported improvement in cough symptoms rated on a 1–5 scale: 1 = no response, 2 = mild improvement, 3 = moderate improvement, 4 = significant improvement, 5 = complete resolution. ResultsA total of 56 patients were included. Mean (SD) age was 64.6 (14.8) years, and 66 % were female. Overall, 42 patients (75.0 %) responded to treatment. Among responders, 7 (16.7 %) experienced mild improvement, 14 (33.3 %) experienced moderate improvement, 17 (40.5 %) experienced significant improvement, and 4 (9.5 %) experienced complete resolution of their cough.33 patients (58.9 %) were managed exclusively with neuromodulators ± cough suppression therapy; 27 responded, with an average response rating of 3.0 (SD = 1.2). 11 patients (19.6 %) failed medical therapy and underwent SLN block without subsequent botox treatment; 7 responded, with an average response rating of 2.5 (SD = 1.4). 9 patients (16.1 %) failed all previous therapies and underwent laryngeal botulinum toxin injections; 6 responded with an average response rating of 2.4 (SD = 1.3). The remaining 3 patients underwent cough suppression therapy alone, with 2 responding and an average response rating of 3.3 (SD = 1.7). ConclusionsNeurogenic cough can be effectively treated with a stepwise multimodal approach, including neuromodulators, cough suppression therapy, SLN block, and laryngeal botulinum toxin injections.

No evidence of clinical efficacy of oxomemazine in cough, according to a systematic review.

Cough is a prevalent symptom driving patients to seek medical attention in general practice. Despite its widespread use, the clinical efficacy of oxomemazine, the second most reimbursed molecule in France for symptomatic cough treatment, remains uncertain. This study aims to systematically evaluate the clinical efficacy of oxomemazine in cough. A systematic literature review with meta-analysis of randomized controlled trials (RCTs) was conducted according to the Rebuild the Evidence Base (REB) protocol. Clinical trials comparing the efficacy of oxomemazine versus placebo or active comparator in cough were searched for. Trials with insufficient data were excluded. Searches were conducted across major databases (Medline, Cochrane Central Register of Controlled Trials, and Embase) and trial registries (World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov). RCTs comparing oxomemazine versus placebo or active comparators in cough were sought. Risk of bias was assessed using the Cochrane Collaboration's RoB2 tool. The protocol was preregistered on PROSPERO under the number CRD42022345496 (15). This study received no funding. No RCTs were at low risk of bias. Therefore, no meta-analysis was conducted, in accordance to the pre-specified protocol. This systematic review highlights the lack of evidence regarding the efficacy of oxomemazine in cough treatment and underscores the need for further well-designed clinical trials to inform its clinical utility in primary care settings.

Factors of acute respiratory infection among under-five children across sub-Saharan African countries using machine learning approaches

Symptoms of Acute Respiratory infections (ARIs) among under-five children are a global health challenge. We aimed to train and evaluate ten machine learning (ML) classification approaches in predicting symptoms of ARIs reported by mothers among children younger than 5 years in sub-Saharan African (sSA) countries. We used the most recent (2012–2022) nationally representative Demographic and Health Surveys data of 33 sSA countries. The air pollution covariates such as global annual surface particulate matter (PM 2.5) and the nitrogen dioxide available in the form of raster images were obtained from the National Aeronautics and Space Administration (NASA). The MLA was used for predicting the symptoms of ARIs among under-five children. We randomly split the dataset into two, 80% was used to train the model, and the remaining 20% was used to test the trained model. Model performance was evaluated using sensitivity, specificity, accuracy, and the area under the receiver operating characteristic curve. A total of 327,507 under-five children were included in the study. About 7.10, 4.19, 20.61, and 21.02% of children reported symptoms of ARI, Severe ARI, cough, and fever in the 2 weeks preceding the survey years respectively. The prevalence of ARI was highest in Mozambique (15.3%), Uganda (15.05%), Togo (14.27%), and Namibia (13.65%,), whereas Uganda (40.10%), Burundi (38.18%), Zimbabwe (36.95%), and Namibia (31.2%) had the highest prevalence of cough. The results of the random forest plot revealed that spatial locations (longitude, latitude), particulate matter, land surface temperature, nitrogen dioxide, and the number of cattle in the houses are the most important features in predicting the diagnosis of symptoms of ARIs among under-five children in sSA. The RF algorithm was selected as the best ML model (AUC = 0.77, Accuracy = 0.72) to predict the symptoms of ARIs among children under five. The MLA performed well in predicting the symptoms of ARIs and associated predictors among under-five children across the sSA countries. Random forest MLA was identified as the best classifier to be employed for the prediction of the symptoms of ARI among under-five children.

Combatting Antibiotic Resistance: Identifying Gaps in Knowledge, Attitude, and Practice Among Medical Interns.

Antibiotic resistance presents a significant global health threat to modern medicine. The awareness and attitude of future doctors undergoing training may play a crucial role in addressing this important issue, influencing the control of resistance and promoting responsible antibiotic stewardship. This study aimed to estimate knowledge, attitudes, and practices regarding antibiotic usage and antimicrobial resistance among tertiary care teaching hospital medical interns. The questionnaire-based cross-sectional study was conducted on 123 MBBS interns from multiple medical institutions. Intern's knowledge, attitudes, and self-reported practices regarding antibiotic use were recorded. Based on survey responses from 123 participants, 116 (94.31%) were aware of the adverse effects of indiscriminate antibiotic use, recognizing the risks of ineffective treatment, increased adverse effects, prolonged illness, bacterial resistance, and higher medical costs. Most (106, 86.18%) acknowledged the challenges of treating antibiotic-resistant infections, and 69 (56.10%) correctly identified that bacteria are not a cause of the common cold and flu. Most (115, 93.5%) recognized antibiotic resistance as a significant global health problem. In attitude, 90 (73%) believed antibiotics should be avoided for colds, but 80 (65%) thought they hastened fever recovery. Only 48 (39%) recognized that antibiotics contribute to resistance, while 102 (83%) agreed skipping doses fosters resistance. Most support hospital policies (118, 96%) and curriculum courses (112, 91%) for rational antibiotic use.Regarding practice, 12 (9.76%) interns admitted to overusing antibiotics, 68 (55.28%) consulted a doctor before starting antibiotics, and 87 (70.73%) checked expiry dates. Additionally, 62 (50.41%) preferred antibiotics for cough and sore throat symptoms. The study highlights that while interns have a good knowledge and awareness of the harms of antibiotic misuse, they are not translating this knowledge into practice. This indicates a disconnect between understanding and application. Therefore, there is a need to add a rational antibiotic prescription and stewardship module to the medical curriculum to ensure that knowledge is effectively translated into changing beliefs and practices.

Impact of Pirfenidone on Patient-Reported Outcomes in Patients With Idiopathic Pulmonary Fibrosis From the Pulmonary Fibrosis Foundation Patient Registry

BACKGROUNDPatients with idiopathic pulmonary fibrosis (IPF) experience debilitating symptoms. While antifibrotics may slow lung function decline, their impact on patients’ health-related quality of life (HRQoL) and disease symptoms in the real world remains unknown. RESEARCH QUESTIONWhat is the impact of pirfenidone vs no treatment on HRQoL and IPF-related symptoms of cough, dyspnea, and fatigue? STUDY DESIGN AND METHODSThis retrospective analysis included patients with IPF aged ≥ 55 years enrolled in the Pulmonary Fibrosis Foundation Patient Registry between March 2016 and December 2021. Change from baseline in patient-reported outcome measures (PROMs) including the Leicester Cough Questionnaire (LCQ), University of California, San Diego Shortness of Breath Questionnaire (UCSD SOBQ), Fatigue Severity Scale, and Short Form-6 Dimension questionnaire were assessed at Months 6, 12, and 18 in patients receiving pirfenidone vs no treatment. A marginal structure model (MSM) accounted for time-varying confounding caused by percent predicted forced vital capacity (%FVC) and percent predicted diffusing capacity of the lung for carbon monoxide. RESULTSIn the LCQ population (n = 237; pirfenidone, n = 155; no treatment, n = 82), treatment groups differed in age, insurance, and %FVC. In the unadjusted analyses, mean changes in PROMs differed numerically between treatment groups; however, based on the MSM, there were no significant differences in adjusted mean changes in PROMs. When analyzed by Gender, Age, and Physiology (GAP) score, a clinically meaningful reduction in worsening of pirfenidone vs no treatment was observed in the adjusted mean change of UCSD SOBQ at Month 12 in patients with GAP stage 2/3. INTERPRETATIONSimilar to previous findings, the difference in UCSD SOBQ scores observed in this real-world analysis suggests that patients with more advanced IPF may experience less dyspnea when receiving pirfenidone vs no treatment; further research is needed to confirm this finding.

A Case on the Use of Korean Medicine Treatment for a Patient with Asthma-Chronic Obstructive Pulmonary Disease Overlap

Background: Asthma and chronic obstructive pulmonary disease (COPD) both require long-term management, and patients with asthma-COPD overlap (ACO) need comprehensive and prolonged care beyond pharmacotherapy. However, due to limited research on ACO, treatment strategies and long-term outcomes remain unclear. This highlights the need for further multidisciplinary research to improve ACO treatment and prognosis.Case Presentation: This case report describes a patient who presented with symptoms of cough, sputum, wheezing, dyspnea, and oral dryness. The patient was diagnosed with ACO and received a combination of Korean medicine treatments alongside standard asthma medication for 15 days. Standardized tools were used to evaluate symptoms and quality of life, respectively. After treatment, Medical Research Council scale, Leicester cough questionnaire Korean-Version and Numerical Rating Score demonstrated clinically meaningful improvement, and Total IgE and Eosinophils were slightly decreased.Conclusion: This case suggests Korean medicine treatments might be effective in managing symptoms in patients with ACO and enhancing quality of life.

Persistência de Sintomas um ano após Infeção por SARS-COV-2 em trabalhadores e seu desempenho em atividades e participação em situações de vida

Introduction Although most individuals recover after acute infection by SARS-CoV-2, others may suffer from persistent symptoms with potential medium and long-term consequences on the performance of activities and participation, with possible implications for their fitness for work. Objective To analyze the persistence of symptoms twelve months after SARS-CoV-2 infection, and the perception of the performance level in activities and participation in life situations, of workers in a company of the industrial sector in the Aveiro Region. Methodology An observational study, developed in an Occupational Health Service of an industrial company in the region of Aveiro, including workers with positive SARS-COV-2 RT-PCR/TRAg test, between October/2020-January/2022. After signaling the infection, the Occupational Health Team applied a questionnaire collecting sociodemographic variables, a list of common symptoms during the acute phase of infection by SARS-COV-2, and the perceived functionality assessed by the Portuguese version of WHODAS 2.0-PT12 (where ’12 points’ means the most functionality). At twelve months, they filled out another list of persistent symptoms after SARS-CoV-2 infection and again WHODAS 2.0-PT12. Data analysis included descriptive statistics and univariate and multivariate linear regression. The analysis was conducted with the software JASP 0.16.3. Results Eighty-five workers were infected with SARS-CoV-2, with a mean age of 36.1±9.8years, 77.7% were male, 36.7% had higher education and 17.7% reported at least one chronic condition. At twelve months, thirty workers (35.3%) reported persistent symptoms, with fatigue (27.7%) and arthralgia (14.4%) being the most mentioned. The mean WHODAS 2.0 in the two evaluation moments was 19.2±8.0 vs 15.7±5.0. Significant associations between WHODAS 2.0 items and persistent symptoms of fatigue, headache, cough, myalgia, arthralgia, and previous chronic disease were found. Conclusions Persistent symptoms twelve months after acute SARS-CoV-2 infection have repercussions on workers’ self-perception of performance in some activities and participation in life situations. The occupational health team can implement continuous surveillance of the infected worker’s health, assess the presence of persistent symptoms of this infection, and implement an individualized rehabilitation program, which minimizes the impact of the persistence of symptoms on their work performance, and in activities and participation in life situations. KEYWORDS: Occupational Health, Occupational Medicine; Occupational Health Nursing, SARS-CoV-2, Symptoms, WHODAS 2.0.

Experience in Treating Prolonged Cough with Deficiency of Lung, Spleen and Qi by Stopping Coughing Powder and Combining with Liujunzi Decoction

This article analyzes the main points of the formulae of Stop Coughing Powder and Six Gentlemen Soup, and cites the case of Stop Coughing Powder combined with Six Gentlemen Soup in the treatment of prolonged cough with deficiency of the lungs, spleen and qi, so as to guide the clinical application. External wind-cold for a long time does not solve and invade the lungs and spleen, resulting in abnormal qi transportation and digestion, so the cough is prolonged and not cured. Therefore, in the treatment of this type of chronic cough, the focus is on the benefit of qi to dispel the evil, in order to restore the normal function of the lungs and spleen. Clinical practice has shown that the combination of Cushioning Powder and Six Gentlemen's Tonic has significant efficacy in the treatment of prolonged cough with deficiency of the lungs, spleen and qi. The combination of the two formulas is safe and can not only effectively relieve cough symptoms, but also improve the overall health and quality of life of the patient.

Analysis of clinical characteristics of different types of lung function impaiement in TDL patients

AimThe clinical characteristics associated with pulmonary function decline in patients with Tuberculosis-destroyed lung (TDL) remain uncertain. We categorize them based on the pattern of pulmonary function impairment, distinguishing between restrictive spirometric pattern (RSP) and obstructive spirometric pattern (OSP). We aim to compare the severity of these patterns with the clinical characteristics of TDL patients and analyze their correlation.MethodWe conducted a retrospective analysis on the clinical data of TDL patients who underwent consecutive pulmonary function tests (PFT) from November 2002 to February 2023. We used the lower limit formula for normal values based on the 2012 Global Lung Function Initiative. We compared the clinical characteristics of RSP patients with those of OSP patients. The characteristics of RSP patients were analyzed using the tertiles of forced vital capacity percentage predicted (FVC% pred) decline based on PFT measurements, and the characteristics of OSP patients were analyzed using the tertiles of forced expiratory volume in 1 s percentage predicted (FEV1% pred) decline.ResultAmong the RSP patients, those in the Tertile1 group (with lower FVC% pred) were more likely to have a higher of body mass index (BMI), spinal deformities, and C-reactive protein (CRP) compared to the other two groups (P for trend < 0.001, 0.027, and 0.013, respectively). Among OSP patients, those in the Tertile1 group (with lower FEV1% pred) showed an increasing trend in cough symptoms and contralateral lung infection compared to the Tertile 2–3 group (P for trend 0.036 and 0.009, respectively).ConclusionFor TDL patients, we observed that Patients with high BMI, a higher proportion of spinal scoliosis, and abnormal elevation of CRP levels were more likely to have reduced FVC. Patients with decreased FEV1% pred have more frequent cough symptoms and a higher proportion of lung infections on the affected side.

Comparative analysis of prognostic scoring systems in predicting severity and outcomes of Omicron variant COVID-19 pneumonia.

The global spread of Coronavirus Disease 2019 (COVID-19) underscores the urgent need for reliable methods to forecast the disease's severity and outcome, thereby facilitating timely interventions and reducing mortality rates. This study focuses on evaluating the clinical and laboratory profiles of patients with Omicron variant-induced COVID-19 pneumonia and assessing the efficacy of various scoring systems in prognosticating disease severity and mortality. In this retrospective analysis, we examined the clinical records of 409 individuals diagnosed with Omicron variant COVID-19 pneumonia. We documented the Pneumonia Severity Index, CURB-65, and MuLBSTA scores within the first 24 h and analyzed the sensitivity, specificity, positive predictive value, negative predictive value, and the area under the receiver operating characteristic curve for each scoring system to ascertain their predictive accuracy for disease severity and fatality risk. The cohort's median age was 78 years, predominantly presenting with fever, cough, expectoration, fatigue, and gastrointestinal symptoms. Factors such as expectoration, fatigue, Glasgow Coma Scale score, lactate dehydrogenase levels, procalcitonin, creatinine levels, and co-occurrence of acute respiratory distress syndrome were identified as independent predictors of disease severity. Furthermore, age, oxygenation index, glucose levels, lactate dehydrogenase, and septic shock were independently associated with mortality. For severe disease prediction, the CURB-65, PSI, and MuLBSTA scores demonstrated sensitivities of 65.9%, 63.8%, and 79.7%, respectively, with specificities of 63.8%, 76.8%, and 60.9%, and AUROCs of 0.707, 0.750, and 0.728. To predict mortality risk, these scores at cutoffs of 1.5, 102.5, and 12.5 exhibited sensitivities of 83.3%, 96.3%, and 70.4%, specificities of 59.4%, 60.8%, and 65.4%, and AUROCs of 0.787, 0.850, and 0.736, respectively. The study cohort predominantly comprised elderly individuals with pre-existing health conditions. Elevated lactate dehydrogenase emerged as a significant marker for both disease severity and prognosis, sputum production, gastrointestinal symptoms, GCS score, creatinine, PCT, and ARDS as independent predictors of disease severity, and age, oxygenation index, glucose levels, and septic shock as independent mortality predictors in COVID-19 pneumonia patients. Among the scoring systems evaluated, Pneumonia Severity Index demonstrated superior predictive capability for both disease severity and mortality, suggesting its utility in forecasting the clinical outcomes of Omicron variant COVID-19 pneumonia.