Pulmonary hypoplasia is a rare disease characterized by a defect of lung development more often unilateral. The diagnosis requires several exams to eliminate other causes of pulmonary retraction. We report two cases a...Pulmonary hypoplasia is a rare disease characterized by a defect of lung development more often unilateral. The diagnosis requires several exams to eliminate other causes of pulmonary retraction. We report two cases at the department of pneumophtisiology of the University Teaching Hospital of Point G. The first case is a young adult who was complaining of a chronic cough. Etiological investigation required several exams including spirometry and Computed tomographic scan (CT scan). After elimination of all suspected causes of pulmonary opacity, the diagnosis of pulmonary hypoplasia was retained. The second case is a 2-year-old girl who was born with congenital cardiopathy whose respiratory complications were increasing during her childhood and respiratory explorations discovered pulmonary agenesis. Pulmonary hypoplasia is rare in our medical practice, but attention must be drawn to a retractile pulmonary opacity in young age after elimination of all infectious causes in TB endemic area.展开更多
Common cold sufferers frequently report sleep disruption during the symptomatic period of infections. We examined the effects of treatment with a topical aromatic pharmaceutical ointment (Vicks VapoRub?), on associate...Common cold sufferers frequently report sleep disruption during the symptomatic period of infections. We examined the effects of treatment with a topical aromatic pharmaceutical ointment (Vicks VapoRub?), on associated sleep disturbances. The effects of Vicks VapoRub? versus placebo (petrolatum ointment) on subjective and objective measured sleep parameters were assessed in an exploratory study of 100 common cold patients, in a randomized, single blind, controlled, two-arm, parallel design study. The primary efficacy variable was subjective sleep quality measured with the SQSQ (Subjective Quality of Sleep Questionnaire). Additional measures included, ease of falling asleep and depth of sleep (measured with a post-sleep Visual Analog Scale), total sleep time, sleep onset latency, activity score, percentage of sleep, sleep efficiency (measured with actigraphy and SQSQ) and sleep quality index measured with a modified Karolinska Sleep Diary (KSD). The primary endpoint, “How was the quality of your sleep last night?” showed a statistically significant difference in change from baseline in favour of VapoRub treatment (p = 0.0392) versus placebo. Positive effects of VapoRub versus placebo were also observed for “How refreshed did you feel upon waking up?” (p = 0.0122) (SQSQ), “Did you get enough sleep?” (p = 0.0036) (KSD), “How was it to get up?” (p = 0.0120) (KSD) and “Do you feel well-rested?” (p = 0.0125) (KSD). No statistically significant changes from baseline versus placebo were detected in the Actiwatch endpoints. Vicks VapoRub? when applied before retiring to bed can reduce subjective sleep disturbances during a common cold. The results of this exploratory study support the belief among patients that the use of VapoRub improves subjective sleep quality during common cold which was associated with more refreshing sleep.展开更多
Thoracoscopy is a well established invasive method for the diagnosis and management of pleural nosologies. The role and the impact that this procedure exerts in settings alongside the diagnostic yield in pleural malig...Thoracoscopy is a well established invasive method for the diagnosis and management of pleural nosologies. The role and the impact that this procedure exerts in settings alongside the diagnostic yield in pleural malignancies are unquestionable. New insights and novel techniques promise an even greater future towards the usefulness of this technique in interventional pneumonology. This is a short review highlighting the principles and novel aspects in the evolutionary progress of pleuroscopy.展开更多
Upper respiratory tract infections or common colds are a multi-symptom disease which is usually symptomatically treated with fixed dose multi-active ingredient medicinal products which are commonly used as non-prescri...Upper respiratory tract infections or common colds are a multi-symptom disease which is usually symptomatically treated with fixed dose multi-active ingredient medicinal products which are commonly used as non-prescription and over the counter. However, the active ingredients combined require a particular and clinically sound justification. Analgesics and decongestant can be combined to treat simultaneously the prominent symptoms cold-related pain (e.g. headache, muscle aches and pains), fever, inflammationand nasal/sinus congestion. This overview provides a summary of the evidence supporting the combination of acetylsalicylic acid (aspirin) and pseudoephedrine available in the common cold product Aspirin? Complex.展开更多
<b>Background:</b><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:V...<b>Background:</b><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> Obstructive sleep apnea syndrome (OSAS) may promote</span></span></span></span><span><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;"> hyperglycemia, insulin resistance, and hypertension (HTN). </span><b><span style="font-family:Verdana;">Purpose:</span></b><span style="font-family:Verdana;"> To evaluate if there is a relationship between the severity of OSA and the severity of type 2 diabetes mellitus (T2DM) and HTN in our patients, aiming to understand and optimize the control for comorbidities. </span><b><span style="font-family:Verdana;">Materials and Methods:</span></b><span style="font-family:Verdana;"> Patients referred for polysomnography (PSG) were retrospectively recruited during the period from October 2017 to August 2020. A STOP-BANG questionnaire formed eight questions was used to assess the risk of OSAS. We divided the patients </span></span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">in</span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">to two group</span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">s</span></span></span></span><span><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;">;group 1, who have snoring without T2DM, and group 2, who have snoring with T2DM. PSG was completed for all subjects and data were collected for each patient including apnoea hypopnea index </span><span><span style="font-family:Verdana;">(AHI), mean arterial oxygen saturation (SaO</span><sub><span style="font-family:Verdana;">2</span></sub><span style="font-family:Verdana;">), and Nadir SaO</span><sub><span style="font-family:Verdana;">2</span></sub><span style="font-family:Verdana;"> recorded</span></span><span style="font-family:Verdana;"> during PSG. Anthropometric data, medical history, and medications for T2DM (for group 2) and HTN and HbA1c were collected (for group 2). AHI was used to evaluate the severity of OSA and its relation to T2DM and HTN. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> The study included 300 patients who met the inclusion criteria with</span><span style="color:red;"> </span><span style="font-family:Verdana;">mean age </span></span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">of </span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">49.9 ± 13.6 years. </span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">The </span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">majority of subjects (56.3%) were males and the mean body mass index (BMI) was 38.0 ± 8.4 kg/m</span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><sup><span style="font-family:Verdana;">2</span></sup></span></span></span><span><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;">. Forty-two percent had HTN and 32.7% had T2DM. OSA was diagnosed in 209 patients (69.7%). OSA was more detected among those with increased age, increased BMI, and those with HTN and T2DM. The severity of both HTN and T2DM was significantly higher among patients with OSA. </span><b><span style="font-family:Verdana;">Conclusions:</span></b><span style="font-family:Verdana;"> There is a relation between OSA and T2DM and HTN. </span></span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">The </span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">risk of OSA is higher among patients with uncontrolled T2DM and HTN. OSA should be suspected in subjects with obesity, especially with uncontrolled HTN and T2DM.</span></span></span></span>展开更多
Introduction: Mycobacteria pulmonary diseases are chronic illnesses with various impacts on patients’ health status, and wellbeing. These diseases currently represent a global health issue due to increasing burdens a...Introduction: Mycobacteria pulmonary diseases are chronic illnesses with various impacts on patients’ health status, and wellbeing. These diseases currently represent a global health issue due to increasing burdens and the lack of new development on therapeutic options. Policies based on the quality of life may help to improve the management of this chronic respiratory disease;this study was designed to assess the quality of life of patients treated for the pulmonary mycobacterial disease. Materials and Methods: Participants diagnosed with a mycobacterial pulmonary disease were selected from the University Clinical Research Centers’ (UCRC) 2019 mycobacterial cohort database. A telephone interview was conducted using the Medical Outcome Study Short Form (SF-36) which has 36 items evaluating physical and mental wellbeing. Scores range from 0 - 100, with higher scores indicating greater Health-related quality of life (HRQOL). Statistical analysis was performed with SPSS 23.0 and the Fisher test was used to compare percentages. A p-value less than 0.05 was considered significant. Results: A total of 26 participants were reached and interviewed by phone. The mean age was 42 ± 10.6 years, and 76.9% (20/26) were male. The most common cause of the mycobacterial pulmonary disease was Mycobacterium tuberculosis, with 84.6% (22/26). Four cases of Non-Tuberculous Mycobacteria (NTM) were diagnosed including one Mycobacterium avium complex strain (MAC). HIV-positive cases were 46.2% (12/26), and the main respiratory sign was cough for all the participants (100%), followed by dyspnea 46.2% (12/26), chest pain 38.5% (10/26). The mean BMI was 19.7 ± 6.9 kg/m<sup>2</sup>, the mean respiratory rate was 24.7 ± 8.6, and the mean hemoglobin was 11.8 ± 2.2 g/dl. The mean SF-36 score was 75.1 ± 16.6, and impairment was mainly related to mental problems in 59.6%. The mean total score was significantly lower with age more than 42 years than age less than 42 years. But HIV positive and BMI less than 18.5 do not lead to a significant change of mean total score. Conclusion: Patients with mycobacterial pulmonary diseases have more psychological problems than physical ones. Hence the importance of psychological support in their management to improve their quality of life. A large sample size with a deep interview component would be necessary to address limitations in this design.展开更多
Common colds incur significant costs in terms of sick leave and personal discomfort for affected individuals. This study investigated the performance of ColdZyme? Mouth Spray (ColdZyme), a protective barrier against c...Common colds incur significant costs in terms of sick leave and personal discomfort for affected individuals. This study investigated the performance of ColdZyme? Mouth Spray (ColdZyme), a protective barrier against common cold, in rhinovirus-inoculated healthy volunteers. This randomized, doubleblind, placebo-controlled pilot study was conducted on 46 healthy volunteers inoculated with rhinovirus 16 via the nose. Subjects self-administered ColdZyme or placebo 6 times daily for 11 days. Symptoms were recorded daily in a diary. Rhinovirus 16 in nasal and oropharyngeal samples at days 0, 3, 4, 6, 7 and 10 were quantified by RT-qPCR. The primary outcome measure was the reduction in viral load in oropharyngeal samples. Rhinovirus 16 was only detected in 35 out of 46 inoculated subjects. Exploratory analysis measuring the total viral load (i.e., area under the curve (AUC)) for days 3 - 10 in successfully inoculated subjects found that ColdZyme treatment resulted in a lower total viral load in the oropharynx (p = 0.023). In subjects who experienced symptomatic common cold, irrespectively, if virus were detected, treatment with ColdZyme resulted in a reduction in the number of days with common cold symptoms from 6.5 to 3.0 days (p = 0.014) in comparison to placebo. ColdZyme reduced virus infection in the oropharynx and reduced the number of days with common cold symptoms and highlights the possible importance of the oropharynx in common cold infections. Suitable outcome measures for a feasible study on ColdZyme are total viral load in the oropharynx in subjects having detectable virus present in nasal or oropharyngeal samples.展开更多
Background: The breathing intolerance index, BIT, a noninvasive derivation of the tension-time index of respiratory muscles, has been recently used to evaluate patients with respect to their need for noninvasive venti...Background: The breathing intolerance index, BIT, a noninvasive derivation of the tension-time index of respiratory muscles, has been recently used to evaluate patients with respect to their need for noninvasive ventilation. Comparing the BIT index in different disorders with mild to moderate respiratory impairment, such as COPD and obesity, would be useful in determining differences in threshold for respiratory muscle fatigue amongst cohorts. Objectives: The purpose of this study was to compare control of ventilation and BIT in individuals with obesity, chronic obstructive pulmonary disease (COPD), and control subjects free of cardiorespiratory disorders. Because change in posture can alter respiratory load and control of ventilation, variables were assessed in two postures. Methods: We assessed 142 subjects consisting of 81 with obesity, 42 with COPD, and 19 non-smoking healthy adults. All subjects underwent evaluation of pulmonary function, control of ventilation and BIT index [(Ti/Ttot) × (Vt/FVC)] in seated and supine postures. Findings: BIT index was significantly greater in seated posture in all 3 cohorts due primarily to an increase in Vt in this position. BIT index was similar in value amongst cohorts in both postures, but tended to be higher in patients with obesity and COPD. Conclusion: While BIT index is higher in seated posture, and tends to be higher in patients with obesity and COPD as compared to control subjects, discrimination between cohorts is not found in our study because of small inter-group variations of respiratory function amongst cohorts. Thus, in clinically stable patients whose vital capacities are mild to moderately reduced, the BIT index alone cannot be recommended as a predictive guide for initiating assisted ventilation for respiratory failure. Nevertheless, because it is easy to perform, and is comfortably tolerated by patients, its potential usefulness may be in periodic measurements to monitor its increase as respiratory reserve declines.展开更多
<b><span style="font-family:Verdana;">Background:</span></b></span><span><span><span style="font-family:""><span style="font-family:Verd...<b><span style="font-family:Verdana;">Background:</span></b></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> Idiopathic Pulmonary Fibrosis (IPF) is a chronic, progressive, and life-limiting condition. It has no cure hence it is vital to establish effective methods of improving the quality of remaining life in these patients. One of the key components of improving quality of life is pulmonary rehabilitation. However little research has been conducted to understand the perspectives and lived experience of people with IPF on pulmonary rehabilitation. Hence, we aim to fill this gap in the existing literature. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> We sought to un</span><span style="font-family:Verdana;">derstand how patients coped with pulmonary rehabilitation. A pa</span><span style="font-family:Verdana;">tient-centred approach was used to explore the physical and psychological impact of pulmonary rehabilitation. Semi-structured interviews were conducted by experienced academics. Interviews used a topic guide but mostly led by the participants. An inductive thematic approach was used to analyse data, allowing us to identify common themes in the participants’ experiences. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> Of fifty invited participants, ten took part in the study (aged 53 - 81 years). Inductive analysis of interviews identified seven second-order themes and eleven first-order themes, represented by two General Dimensions: </span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">“</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><i><span style="font-family:Verdana;">motivation</span></i></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">”</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> and </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">“</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><i><span style="font-family:Verdana;">Advantages and disadvantages</span></i></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">”</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">. Overall, participants found the pulmonary rehabilitation programme to be useful and they experienced an increase in their quality of life following rehabilitation.展开更多
Pulmonary mucormycosis is an emergent and life-threatening invasive fungal infection underdiagnosed by clinicians due to unspecific clinical picture and lack of awareness. Although the acknowledgment of risk factors, ...Pulmonary mucormycosis is an emergent and life-threatening invasive fungal infection underdiagnosed by clinicians due to unspecific clinical picture and lack of awareness. Although the acknowledgment of risk factors, clinical and radiological findings may increase early recognition, the definite diagnosis is challenging to establish and the ideal treatment has never been delineated. The authors describe a rare case of pulmonary mucormycosis that was successfully treated with dual antifungal treatment and surgery in a patient with uncontrolled diabetes. When last evaluated, he was asymptomatic with no evidence of relapse. To our knowledge this is a rare report of a successfully treated diabetic patient with pulmonary mucormycosis with L-AmB, triazole posaconazole and surgery with no evidence of recurrence. We highlight the importance of clinicians’ awareness to early diagnosis, combined antifungal treatment and adjuvant surgery as the greatest chance of cure of a rapidly progressive disease with high mortality and morbidity.展开更多
Background: Forced expiratory volume 1 second (FEV1) has traditionally been used as a readily available marker of health in adult cystic fibrosis (CF). However, due to the obstructive nature of this disease, it is pos...Background: Forced expiratory volume 1 second (FEV1) has traditionally been used as a readily available marker of health in adult cystic fibrosis (CF). However, due to the obstructive nature of this disease, it is possible that lung hyperinflation could be more closely related to disease severity than is FEV1. The purpose of this study was to determine if hyperinflation is more closely associated with quality of life, functional status, and pulmonary exacerbations than FEV1 in patients with CF. Methods: Sixty-eight adult patients with CF were evaluated in this retrospective study. We used IC and functional residual capacity (FRC) and their ratios to total lung capacity (TLC) as measures of lung hyperinflation. We used bivariate correlations and backwards regression analysis to assess possible associations between FEV1, lung hyperinflation, and measures of disease severity including questionnaire based quality of life, pulmonary exacerbation frequency, and mortality. The respiratory component of the Cystic Fibrosis Questionnaire–Revised (CRQ-R-Respiratory) was used as a measure of quality of life. Results: Both FEV1 and IC were negatively correlated with pulmonary exacerbations over a 3 year period (p = 0.004, r2 = 0.127;p < 0.001, r2 = 0.307, respectively), while FRC/TLC correlated positively with exacerbations (p = 0.007). Backwards regression analysis showed that among pulmonary function variables, IC had the strongest relationship with exacerbations over 3 years. A lower CFQ-R-Respiratory score was associated with greater mortality (p = 0.005). However, no statistically significant relationships were found between lung function and mortality. Conclusions: FEV1 and lung hyperinflation-as measured by IC and FRC/TLC-are both associated with pulmonary exacerbation frequency. This suggests that chronic dynamic hyperinflation contributes significantly to disease severity in adult cystic fibrosis.展开更多
Aim: To investigate the effects of exposure of a macrolide-resistant [erm (B)-expressing] strain of Streptococcus pneumoniae (strain 2507) to clarithromycin (0.5 and 5 mg/L) added at the outset and 6 hours after initi...Aim: To investigate the effects of exposure of a macrolide-resistant [erm (B)-expressing] strain of Streptococcus pneumoniae (strain 2507) to clarithromycin (0.5 and 5 mg/L) added at the outset and 6 hours after initiation of culture on early gene expression, energy metabolism, and growth. Methods: Bacterial growth was determined by turbidometric and colony counting procedures, energy metabolism by measurement of ATP, while analysis of gene expression was performed using reverse transcription-PCR and sequencing. Results: Addition of clarithromycin, at either concentration, at the outset of culture, caused transient suppression of growth of 10 - 12 hours duration, while delayed addition of antibiotic (during the logarithmic phase) resulted in an abrupt halt in growth followed by recovery. These inhibitory effects of clarithromycin on bacterial growth were associated with up-regulation of expression of erm(B), decreased ATP and protein synthesis, and were unaffected by inclusion of either catalase (500 and 1000 kunits/L), or competence-stimulating peptide (CSP-1, 0.5 mg/L). The inhibitory effects could, however, be overcome by pre-exposure of the bacteria to the antibiotic. Moreover, clarithromycin appeared to potentiate the antimicrobial actions of ceftriaxone, at sub-MIC concentrations, for strain 2507. Conclusions: Unlike several other common bacterial pathogens, the full expression of erm(B)-mediated macrolide resistance by the pneumococcus has a slow onset, which is associated with transient susceptibility to macrolides and inhibition of growth.展开更多
Idiopathic pulmonary fibrosis (IPF) is a chronic, life-limiting with an average life expectancy of 05 years following the onset of the disease, with no curative treatments. These patients need palliative care and reha...Idiopathic pulmonary fibrosis (IPF) is a chronic, life-limiting with an average life expectancy of 05 years following the onset of the disease, with no curative treatments. These patients need palliative care and rehabilitation is one of the methods that can be used to improve quality of life (QoL) among these patients. Yet the research conducted to assess benefits of pulmonary rehabilitation (PR) in terms of improving physical activity and QoL in IPF patients remains limited. Hence this study aims to evaluate the effect of a bespoke pulmonary rehabilitation programme, on the physical, physiological and psychological parameters and improvements of QoL among IPF patients. Eleven (11) subjects with IPF received 6 weeks of pulmonary rehabilitation. An interviewer administered quality of life questionnaire, six-minute walking test (6MWT), Incremental bicycle exercise tests were performed, and cardiac and respiratory parameters were assessed pre- and post-rehabilitation. The 6MWT was significantly increased following training (Pre 312.55<span "=""> </span>±<span "=""> </span>89.99;Post, 380.73 ±<span "=""> </span>59.60). A significant improvement was observed in overall QoL (2.226 ± 0.026), dyspnoea (<span style="color:#4F4F4F;">-</span>0.455<span "=""> </span>±<span "=""> </span>0.004) anxiety (<span "=""><span style="color:#4F4F4F;">-</span>2.070</span><span "=""> </span>±<span "=""> </span>0.038), depression (<span "=""><span style="color:#4F4F4F;">-</span>2.217</span><span "=""> </span>±<span "=""> </span><span "="">0.027) scores. No significant changes were found in the VO<sub>2</sub> max and other cardiopulmonary parameters, while non-significant improvement was seen in SpO<sub>2</sub> at peak exercise from 85.8 </span>- 86.5. Bespoke pulmonary rehabilitation program is beneficial in short term improvement of the functional exercise capacity, dyspnoea and QoL among IPF patients.展开更多
We report the case of a patient with pulmonary fibrosis, developed as an adverse reaction to nitrofurantoin therapy received for totally 6 months for the prevention of recurrent urinary tract infections. Chest X-ray a...We report the case of a patient with pulmonary fibrosis, developed as an adverse reaction to nitrofurantoin therapy received for totally 6 months for the prevention of recurrent urinary tract infections. Chest X-ray and CT scan revealed extensive elements of interstitial pulmonary fibrosis. After diagnosis, administration of nitrofurantoin was immediately stopped;and specific prolonged therapy with low-dose corticosteroids per os and inhaled steroids were administered. The patient responded successfully both clinically and biochemically and possible digestive system side effects were prevented through the administration of gastroprotection medication. For the prevention of urinary tract infection, the patient received well tolerated therapy with fosfomycin which was further continued as a prophylactic agent.展开更多
<strong>Objective:</strong> The clinical examination is the basis for the diagnosis and rational choice of complementary tests. The aim of the study was to evaluate the performance of auscultation of the c...<strong>Objective:</strong> The clinical examination is the basis for the diagnosis and rational choice of complementary tests. The aim of the study was to evaluate the performance of auscultation of the chest for screening of disease and for predicting the presence of abnormalities in the other domains of the chest examination. <strong>Methods:</strong> Patients with COPD, atelectasis, pleural effusion, pneumonia and controls were evaluated by two examiners in the absence of any clinical information, initially only with pulmonary auscultation, and then in the other domains of chest examination. <strong>Results:</strong> 192 physical examinations were performed in 104 patients. An abnormal pulmonary auscultation had a sensitivity of 85.2%, positive predictive value (PPV) of 84.1%, positive likelihood reason (LR) of 1.53 (95% CI;1.16 to 2.01) and negative LR of 0.33 (95% CI;0.2 to 0.56) to identify the presence of any disease, and also a positive LR of 2.23 (95% CI;1.02 to 4.9) and a negative LR of 0.3 (95% CI;0.17 to 0.51) to predict additional abnormalities. A normal auscultation showed low accuracy to identify healthy individuals, with sensitivity, specificity, NPV and PPV, respectively, of 44%, 43%, 41% and 46%. The agreement between the examiners considering normal versus abnormal findings showed kappa = 0.76 for any changes in the physical examination present (p < 0.0001). <strong>Conclusions:</strong> Auscultation of the chest alone, may not be a sufficient strategy to track diseases or establish whether continuity of the examination is necessary or not.展开更多
Purpose: To study the factors influencing sputum smear conversion including Serum C-Reactive Protein (CRP) and its correlation with disease severity in tuberculosis patients. Method: Levels of Serum-CRP concentrations...Purpose: To study the factors influencing sputum smear conversion including Serum C-Reactive Protein (CRP) and its correlation with disease severity in tuberculosis patients. Method: Levels of Serum-CRP concentrations were deter-mined in 60 patients with pulmonary tuberculosis, 30 healthy volunteers and patients in follow-up after completion of antitubercular treatment (DOTS therapy). Results: Serum-CRP levels were found to be significantly higher in smear-positive group as compared with the follow-up patients and smear-negative control group. The values were 43.65 ± 23.68, 9.88 ± 5.23 and 4.04 ± 3.85 mg/L respectively (P Conclusion: Serum-CRP levels are significantly correlated with disease severity in patients with active pulmonary tuberculosis. Thus these findings from the present study would certainly add new criteria for early diagnosis of TB, which may lead to development of new strategies to treat TB.展开更多
The most widespread arbovirus in the world, dengue fever has been rampant since the 18th century. Since then, several epidemics have been documented in Asia, the Caribbean, South America and Africa. The authors report...The most widespread arbovirus in the world, dengue fever has been rampant since the 18th century. Since then, several epidemics have been documented in Asia, the Caribbean, South America and Africa. The authors report two cases of dengue fever in children aged six (6) and twelve (12) years respectively. The diagnosis of several dengue pulmonary was retained in these children, clinico-radiological and biological arguments. In addition to the hemorrhagic syndrome, the pulmonary symptomatology associated cough, dyspnea. Chest X-ray revealed bilateral and extensive alveolar interstitial radiological lesions. From a biological point of view, the positivity of dengue-specific IgM has confirmed arboviruses. From the diagnostic peculiarities of the cases observed, the authors suggest the search for factors associated with a primary dengue infection from several onsets to pulmonary manifestation in children. Indeed, this fringe of the population is no longer concerned with acute respiratory infections. In addition, the socio-cultural context of poverty, of pre-hospital therapeutic itinerary favoring traditional medicine, delays hospital care.展开更多
Background: The mediastinum is composed primarily of fatty tissue that is surrounded by the lungs bilaterally. There is a lack in the published literature in studying changes in mediastinal fat in idiopathic pulmonary...Background: The mediastinum is composed primarily of fatty tissue that is surrounded by the lungs bilaterally. There is a lack in the published literature in studying changes in mediastinal fat in idiopathic pulmonary fibrosis (IPF). The purpose of this study was to determine whether the shape and dimensions of the anterior mediastinal fat in patients with IPF are different from that of a normal control group and to correlate the changes with disease severity. Design and Setting: This prospective case control study was done at the chest department of Assiut University Hospital on IPF patients from May 2010-September 2012. A questionnaire containing questions such as age, sex, clinical findings, high resolution computerized tomography (HRCT) score and pulmonary function tests (PFTs) was filled for patients and normal controls. Results: The IPF retrosternal AP dimension was significantly shorter (p = 0.03) and the transverse dimension was longer (p = 0.001) than that in the normal control group. The convex shape of the anterior mediastinum was predictive of IPF (p = 0.001), whereas concave shape was predictive of normal controls (p = 0.001). The change in anteroposterior diameter (AP) and transverse diameters showed significant correlation with the changes in FVC, DLCO and HRCT score. Conclusions: IPF patients had reduced retrosternal AP and increased transverse dimensions than those of the controls with convex shape of their anterior mediastinal fat. Changes in anterior mediastinal fat dimensions are correlated with lower FVC, DLCO and higher HRCT score. A larger sample size, better multicenteric study is needed to confirm the results of this study.展开更多
The aim of this prospective study was to evaluate the incidence, etiologic agents and mortality rate of ventilator-associated pneumonia (VAP). In a six-month period, cases who were 18 years or older, dependent on mech...The aim of this prospective study was to evaluate the incidence, etiologic agents and mortality rate of ventilator-associated pneumonia (VAP). In a six-month period, cases who were 18 years or older, dependent on mechanical ventilator for more than 3 days and without pulmonary infection on first admission were included in this study. In all cases, body temperature recordings, blood and urine culture, microbiological analyses of endotracheal aspirates, and chest X-rays were obtained and used to identify VAP. Apache II scores on admission, duration of mechanical ventilation, length of intensive care unit (ICU) stay and mortality were recorded. This study included 45 cases and 22 developed VAP (48%). The incidence of VAP was 25.34 per 1000 ventilator days. Univariate analyses showed that duration of mechanical ventilation, length of ICU stay, coma and tracheotomy were associated with the development of VAP. The mortality rate of cases with VAP (72.7%) was significantly higher than cases without VAP (39.1%). The most frequent microorganisms were Acinetobacter spp., Pseudomonas aeruginosa and Klebsiella pneumoniae. In our study, VAP was a very common and important complication of mechanical ventilation and mortality was very high. To reduce mortality, minimize morbidity, shorten the length of stay, and reduce costs, defined risk factors for VAP should be recognized and an effective infection control program for the prevention of VAP should be implemented. Surveillance results should be evaluated regularly and necessary precautions should be taken.展开更多
Human enteroviruses are less well-known causes of acute bronchiolitis. In recent years, Enterovirus D68 [EV D68] has emerged as significant cause of epidemic viral bronchiolitis and pneumonia in the United States and ...Human enteroviruses are less well-known causes of acute bronchiolitis. In recent years, Enterovirus D68 [EV D68] has emerged as significant cause of epidemic viral bronchiolitis and pneumonia in the United States and other countries. Chronic bronchiolitis has not been previously attributed to EV D68. We documented EV D68 in open lung biopsies of a young adult patient who was frequently admitted to the hospital for severe exacerbation of respiratory infections and subsequently developed progressive respiratory insufficiency. The difficulty of diagnosis and potential economic impact of this illness is discussed.展开更多
文摘Pulmonary hypoplasia is a rare disease characterized by a defect of lung development more often unilateral. The diagnosis requires several exams to eliminate other causes of pulmonary retraction. We report two cases at the department of pneumophtisiology of the University Teaching Hospital of Point G. The first case is a young adult who was complaining of a chronic cough. Etiological investigation required several exams including spirometry and Computed tomographic scan (CT scan). After elimination of all suspected causes of pulmonary opacity, the diagnosis of pulmonary hypoplasia was retained. The second case is a 2-year-old girl who was born with congenital cardiopathy whose respiratory complications were increasing during her childhood and respiratory explorations discovered pulmonary agenesis. Pulmonary hypoplasia is rare in our medical practice, but attention must be drawn to a retractile pulmonary opacity in young age after elimination of all infectious causes in TB endemic area.
文摘Common cold sufferers frequently report sleep disruption during the symptomatic period of infections. We examined the effects of treatment with a topical aromatic pharmaceutical ointment (Vicks VapoRub?), on associated sleep disturbances. The effects of Vicks VapoRub? versus placebo (petrolatum ointment) on subjective and objective measured sleep parameters were assessed in an exploratory study of 100 common cold patients, in a randomized, single blind, controlled, two-arm, parallel design study. The primary efficacy variable was subjective sleep quality measured with the SQSQ (Subjective Quality of Sleep Questionnaire). Additional measures included, ease of falling asleep and depth of sleep (measured with a post-sleep Visual Analog Scale), total sleep time, sleep onset latency, activity score, percentage of sleep, sleep efficiency (measured with actigraphy and SQSQ) and sleep quality index measured with a modified Karolinska Sleep Diary (KSD). The primary endpoint, “How was the quality of your sleep last night?” showed a statistically significant difference in change from baseline in favour of VapoRub treatment (p = 0.0392) versus placebo. Positive effects of VapoRub versus placebo were also observed for “How refreshed did you feel upon waking up?” (p = 0.0122) (SQSQ), “Did you get enough sleep?” (p = 0.0036) (KSD), “How was it to get up?” (p = 0.0120) (KSD) and “Do you feel well-rested?” (p = 0.0125) (KSD). No statistically significant changes from baseline versus placebo were detected in the Actiwatch endpoints. Vicks VapoRub? when applied before retiring to bed can reduce subjective sleep disturbances during a common cold. The results of this exploratory study support the belief among patients that the use of VapoRub improves subjective sleep quality during common cold which was associated with more refreshing sleep.
文摘Thoracoscopy is a well established invasive method for the diagnosis and management of pleural nosologies. The role and the impact that this procedure exerts in settings alongside the diagnostic yield in pleural malignancies are unquestionable. New insights and novel techniques promise an even greater future towards the usefulness of this technique in interventional pneumonology. This is a short review highlighting the principles and novel aspects in the evolutionary progress of pleuroscopy.
文摘Upper respiratory tract infections or common colds are a multi-symptom disease which is usually symptomatically treated with fixed dose multi-active ingredient medicinal products which are commonly used as non-prescription and over the counter. However, the active ingredients combined require a particular and clinically sound justification. Analgesics and decongestant can be combined to treat simultaneously the prominent symptoms cold-related pain (e.g. headache, muscle aches and pains), fever, inflammationand nasal/sinus congestion. This overview provides a summary of the evidence supporting the combination of acetylsalicylic acid (aspirin) and pseudoephedrine available in the common cold product Aspirin? Complex.
文摘<b>Background:</b><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> Obstructive sleep apnea syndrome (OSAS) may promote</span></span></span></span><span><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;"> hyperglycemia, insulin resistance, and hypertension (HTN). </span><b><span style="font-family:Verdana;">Purpose:</span></b><span style="font-family:Verdana;"> To evaluate if there is a relationship between the severity of OSA and the severity of type 2 diabetes mellitus (T2DM) and HTN in our patients, aiming to understand and optimize the control for comorbidities. </span><b><span style="font-family:Verdana;">Materials and Methods:</span></b><span style="font-family:Verdana;"> Patients referred for polysomnography (PSG) were retrospectively recruited during the period from October 2017 to August 2020. A STOP-BANG questionnaire formed eight questions was used to assess the risk of OSAS. We divided the patients </span></span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">in</span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">to two group</span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">s</span></span></span></span><span><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;">;group 1, who have snoring without T2DM, and group 2, who have snoring with T2DM. PSG was completed for all subjects and data were collected for each patient including apnoea hypopnea index </span><span><span style="font-family:Verdana;">(AHI), mean arterial oxygen saturation (SaO</span><sub><span style="font-family:Verdana;">2</span></sub><span style="font-family:Verdana;">), and Nadir SaO</span><sub><span style="font-family:Verdana;">2</span></sub><span style="font-family:Verdana;"> recorded</span></span><span style="font-family:Verdana;"> during PSG. Anthropometric data, medical history, and medications for T2DM (for group 2) and HTN and HbA1c were collected (for group 2). AHI was used to evaluate the severity of OSA and its relation to T2DM and HTN. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> The study included 300 patients who met the inclusion criteria with</span><span style="color:red;"> </span><span style="font-family:Verdana;">mean age </span></span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">of </span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">49.9 ± 13.6 years. </span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">The </span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">majority of subjects (56.3%) were males and the mean body mass index (BMI) was 38.0 ± 8.4 kg/m</span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><sup><span style="font-family:Verdana;">2</span></sup></span></span></span><span><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;">. Forty-two percent had HTN and 32.7% had T2DM. OSA was diagnosed in 209 patients (69.7%). OSA was more detected among those with increased age, increased BMI, and those with HTN and T2DM. The severity of both HTN and T2DM was significantly higher among patients with OSA. </span><b><span style="font-family:Verdana;">Conclusions:</span></b><span style="font-family:Verdana;"> There is a relation between OSA and T2DM and HTN. </span></span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">The </span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">risk of OSA is higher among patients with uncontrolled T2DM and HTN. OSA should be suspected in subjects with obesity, especially with uncontrolled HTN and T2DM.</span></span></span></span>
文摘Introduction: Mycobacteria pulmonary diseases are chronic illnesses with various impacts on patients’ health status, and wellbeing. These diseases currently represent a global health issue due to increasing burdens and the lack of new development on therapeutic options. Policies based on the quality of life may help to improve the management of this chronic respiratory disease;this study was designed to assess the quality of life of patients treated for the pulmonary mycobacterial disease. Materials and Methods: Participants diagnosed with a mycobacterial pulmonary disease were selected from the University Clinical Research Centers’ (UCRC) 2019 mycobacterial cohort database. A telephone interview was conducted using the Medical Outcome Study Short Form (SF-36) which has 36 items evaluating physical and mental wellbeing. Scores range from 0 - 100, with higher scores indicating greater Health-related quality of life (HRQOL). Statistical analysis was performed with SPSS 23.0 and the Fisher test was used to compare percentages. A p-value less than 0.05 was considered significant. Results: A total of 26 participants were reached and interviewed by phone. The mean age was 42 ± 10.6 years, and 76.9% (20/26) were male. The most common cause of the mycobacterial pulmonary disease was Mycobacterium tuberculosis, with 84.6% (22/26). Four cases of Non-Tuberculous Mycobacteria (NTM) were diagnosed including one Mycobacterium avium complex strain (MAC). HIV-positive cases were 46.2% (12/26), and the main respiratory sign was cough for all the participants (100%), followed by dyspnea 46.2% (12/26), chest pain 38.5% (10/26). The mean BMI was 19.7 ± 6.9 kg/m<sup>2</sup>, the mean respiratory rate was 24.7 ± 8.6, and the mean hemoglobin was 11.8 ± 2.2 g/dl. The mean SF-36 score was 75.1 ± 16.6, and impairment was mainly related to mental problems in 59.6%. The mean total score was significantly lower with age more than 42 years than age less than 42 years. But HIV positive and BMI less than 18.5 do not lead to a significant change of mean total score. Conclusion: Patients with mycobacterial pulmonary diseases have more psychological problems than physical ones. Hence the importance of psychological support in their management to improve their quality of life. A large sample size with a deep interview component would be necessary to address limitations in this design.
文摘Common colds incur significant costs in terms of sick leave and personal discomfort for affected individuals. This study investigated the performance of ColdZyme? Mouth Spray (ColdZyme), a protective barrier against common cold, in rhinovirus-inoculated healthy volunteers. This randomized, doubleblind, placebo-controlled pilot study was conducted on 46 healthy volunteers inoculated with rhinovirus 16 via the nose. Subjects self-administered ColdZyme or placebo 6 times daily for 11 days. Symptoms were recorded daily in a diary. Rhinovirus 16 in nasal and oropharyngeal samples at days 0, 3, 4, 6, 7 and 10 were quantified by RT-qPCR. The primary outcome measure was the reduction in viral load in oropharyngeal samples. Rhinovirus 16 was only detected in 35 out of 46 inoculated subjects. Exploratory analysis measuring the total viral load (i.e., area under the curve (AUC)) for days 3 - 10 in successfully inoculated subjects found that ColdZyme treatment resulted in a lower total viral load in the oropharynx (p = 0.023). In subjects who experienced symptomatic common cold, irrespectively, if virus were detected, treatment with ColdZyme resulted in a reduction in the number of days with common cold symptoms from 6.5 to 3.0 days (p = 0.014) in comparison to placebo. ColdZyme reduced virus infection in the oropharynx and reduced the number of days with common cold symptoms and highlights the possible importance of the oropharynx in common cold infections. Suitable outcome measures for a feasible study on ColdZyme are total viral load in the oropharynx in subjects having detectable virus present in nasal or oropharyngeal samples.
文摘Background: The breathing intolerance index, BIT, a noninvasive derivation of the tension-time index of respiratory muscles, has been recently used to evaluate patients with respect to their need for noninvasive ventilation. Comparing the BIT index in different disorders with mild to moderate respiratory impairment, such as COPD and obesity, would be useful in determining differences in threshold for respiratory muscle fatigue amongst cohorts. Objectives: The purpose of this study was to compare control of ventilation and BIT in individuals with obesity, chronic obstructive pulmonary disease (COPD), and control subjects free of cardiorespiratory disorders. Because change in posture can alter respiratory load and control of ventilation, variables were assessed in two postures. Methods: We assessed 142 subjects consisting of 81 with obesity, 42 with COPD, and 19 non-smoking healthy adults. All subjects underwent evaluation of pulmonary function, control of ventilation and BIT index [(Ti/Ttot) × (Vt/FVC)] in seated and supine postures. Findings: BIT index was significantly greater in seated posture in all 3 cohorts due primarily to an increase in Vt in this position. BIT index was similar in value amongst cohorts in both postures, but tended to be higher in patients with obesity and COPD. Conclusion: While BIT index is higher in seated posture, and tends to be higher in patients with obesity and COPD as compared to control subjects, discrimination between cohorts is not found in our study because of small inter-group variations of respiratory function amongst cohorts. Thus, in clinically stable patients whose vital capacities are mild to moderately reduced, the BIT index alone cannot be recommended as a predictive guide for initiating assisted ventilation for respiratory failure. Nevertheless, because it is easy to perform, and is comfortably tolerated by patients, its potential usefulness may be in periodic measurements to monitor its increase as respiratory reserve declines.
文摘<b><span style="font-family:Verdana;">Background:</span></b></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> Idiopathic Pulmonary Fibrosis (IPF) is a chronic, progressive, and life-limiting condition. It has no cure hence it is vital to establish effective methods of improving the quality of remaining life in these patients. One of the key components of improving quality of life is pulmonary rehabilitation. However little research has been conducted to understand the perspectives and lived experience of people with IPF on pulmonary rehabilitation. Hence, we aim to fill this gap in the existing literature. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> We sought to un</span><span style="font-family:Verdana;">derstand how patients coped with pulmonary rehabilitation. A pa</span><span style="font-family:Verdana;">tient-centred approach was used to explore the physical and psychological impact of pulmonary rehabilitation. Semi-structured interviews were conducted by experienced academics. Interviews used a topic guide but mostly led by the participants. An inductive thematic approach was used to analyse data, allowing us to identify common themes in the participants’ experiences. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> Of fifty invited participants, ten took part in the study (aged 53 - 81 years). Inductive analysis of interviews identified seven second-order themes and eleven first-order themes, represented by two General Dimensions: </span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">“</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><i><span style="font-family:Verdana;">motivation</span></i></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">”</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> and </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">“</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><i><span style="font-family:Verdana;">Advantages and disadvantages</span></i></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">”</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">. Overall, participants found the pulmonary rehabilitation programme to be useful and they experienced an increase in their quality of life following rehabilitation.
文摘Pulmonary mucormycosis is an emergent and life-threatening invasive fungal infection underdiagnosed by clinicians due to unspecific clinical picture and lack of awareness. Although the acknowledgment of risk factors, clinical and radiological findings may increase early recognition, the definite diagnosis is challenging to establish and the ideal treatment has never been delineated. The authors describe a rare case of pulmonary mucormycosis that was successfully treated with dual antifungal treatment and surgery in a patient with uncontrolled diabetes. When last evaluated, he was asymptomatic with no evidence of relapse. To our knowledge this is a rare report of a successfully treated diabetic patient with pulmonary mucormycosis with L-AmB, triazole posaconazole and surgery with no evidence of recurrence. We highlight the importance of clinicians’ awareness to early diagnosis, combined antifungal treatment and adjuvant surgery as the greatest chance of cure of a rapidly progressive disease with high mortality and morbidity.
文摘Background: Forced expiratory volume 1 second (FEV1) has traditionally been used as a readily available marker of health in adult cystic fibrosis (CF). However, due to the obstructive nature of this disease, it is possible that lung hyperinflation could be more closely related to disease severity than is FEV1. The purpose of this study was to determine if hyperinflation is more closely associated with quality of life, functional status, and pulmonary exacerbations than FEV1 in patients with CF. Methods: Sixty-eight adult patients with CF were evaluated in this retrospective study. We used IC and functional residual capacity (FRC) and their ratios to total lung capacity (TLC) as measures of lung hyperinflation. We used bivariate correlations and backwards regression analysis to assess possible associations between FEV1, lung hyperinflation, and measures of disease severity including questionnaire based quality of life, pulmonary exacerbation frequency, and mortality. The respiratory component of the Cystic Fibrosis Questionnaire–Revised (CRQ-R-Respiratory) was used as a measure of quality of life. Results: Both FEV1 and IC were negatively correlated with pulmonary exacerbations over a 3 year period (p = 0.004, r2 = 0.127;p < 0.001, r2 = 0.307, respectively), while FRC/TLC correlated positively with exacerbations (p = 0.007). Backwards regression analysis showed that among pulmonary function variables, IC had the strongest relationship with exacerbations over 3 years. A lower CFQ-R-Respiratory score was associated with greater mortality (p = 0.005). However, no statistically significant relationships were found between lung function and mortality. Conclusions: FEV1 and lung hyperinflation-as measured by IC and FRC/TLC-are both associated with pulmonary exacerbation frequency. This suggests that chronic dynamic hyperinflation contributes significantly to disease severity in adult cystic fibrosis.
文摘Aim: To investigate the effects of exposure of a macrolide-resistant [erm (B)-expressing] strain of Streptococcus pneumoniae (strain 2507) to clarithromycin (0.5 and 5 mg/L) added at the outset and 6 hours after initiation of culture on early gene expression, energy metabolism, and growth. Methods: Bacterial growth was determined by turbidometric and colony counting procedures, energy metabolism by measurement of ATP, while analysis of gene expression was performed using reverse transcription-PCR and sequencing. Results: Addition of clarithromycin, at either concentration, at the outset of culture, caused transient suppression of growth of 10 - 12 hours duration, while delayed addition of antibiotic (during the logarithmic phase) resulted in an abrupt halt in growth followed by recovery. These inhibitory effects of clarithromycin on bacterial growth were associated with up-regulation of expression of erm(B), decreased ATP and protein synthesis, and were unaffected by inclusion of either catalase (500 and 1000 kunits/L), or competence-stimulating peptide (CSP-1, 0.5 mg/L). The inhibitory effects could, however, be overcome by pre-exposure of the bacteria to the antibiotic. Moreover, clarithromycin appeared to potentiate the antimicrobial actions of ceftriaxone, at sub-MIC concentrations, for strain 2507. Conclusions: Unlike several other common bacterial pathogens, the full expression of erm(B)-mediated macrolide resistance by the pneumococcus has a slow onset, which is associated with transient susceptibility to macrolides and inhibition of growth.
文摘Idiopathic pulmonary fibrosis (IPF) is a chronic, life-limiting with an average life expectancy of 05 years following the onset of the disease, with no curative treatments. These patients need palliative care and rehabilitation is one of the methods that can be used to improve quality of life (QoL) among these patients. Yet the research conducted to assess benefits of pulmonary rehabilitation (PR) in terms of improving physical activity and QoL in IPF patients remains limited. Hence this study aims to evaluate the effect of a bespoke pulmonary rehabilitation programme, on the physical, physiological and psychological parameters and improvements of QoL among IPF patients. Eleven (11) subjects with IPF received 6 weeks of pulmonary rehabilitation. An interviewer administered quality of life questionnaire, six-minute walking test (6MWT), Incremental bicycle exercise tests were performed, and cardiac and respiratory parameters were assessed pre- and post-rehabilitation. The 6MWT was significantly increased following training (Pre 312.55<span "=""> </span>±<span "=""> </span>89.99;Post, 380.73 ±<span "=""> </span>59.60). A significant improvement was observed in overall QoL (2.226 ± 0.026), dyspnoea (<span style="color:#4F4F4F;">-</span>0.455<span "=""> </span>±<span "=""> </span>0.004) anxiety (<span "=""><span style="color:#4F4F4F;">-</span>2.070</span><span "=""> </span>±<span "=""> </span>0.038), depression (<span "=""><span style="color:#4F4F4F;">-</span>2.217</span><span "=""> </span>±<span "=""> </span><span "="">0.027) scores. No significant changes were found in the VO<sub>2</sub> max and other cardiopulmonary parameters, while non-significant improvement was seen in SpO<sub>2</sub> at peak exercise from 85.8 </span>- 86.5. Bespoke pulmonary rehabilitation program is beneficial in short term improvement of the functional exercise capacity, dyspnoea and QoL among IPF patients.
文摘We report the case of a patient with pulmonary fibrosis, developed as an adverse reaction to nitrofurantoin therapy received for totally 6 months for the prevention of recurrent urinary tract infections. Chest X-ray and CT scan revealed extensive elements of interstitial pulmonary fibrosis. After diagnosis, administration of nitrofurantoin was immediately stopped;and specific prolonged therapy with low-dose corticosteroids per os and inhaled steroids were administered. The patient responded successfully both clinically and biochemically and possible digestive system side effects were prevented through the administration of gastroprotection medication. For the prevention of urinary tract infection, the patient received well tolerated therapy with fosfomycin which was further continued as a prophylactic agent.
文摘<strong>Objective:</strong> The clinical examination is the basis for the diagnosis and rational choice of complementary tests. The aim of the study was to evaluate the performance of auscultation of the chest for screening of disease and for predicting the presence of abnormalities in the other domains of the chest examination. <strong>Methods:</strong> Patients with COPD, atelectasis, pleural effusion, pneumonia and controls were evaluated by two examiners in the absence of any clinical information, initially only with pulmonary auscultation, and then in the other domains of chest examination. <strong>Results:</strong> 192 physical examinations were performed in 104 patients. An abnormal pulmonary auscultation had a sensitivity of 85.2%, positive predictive value (PPV) of 84.1%, positive likelihood reason (LR) of 1.53 (95% CI;1.16 to 2.01) and negative LR of 0.33 (95% CI;0.2 to 0.56) to identify the presence of any disease, and also a positive LR of 2.23 (95% CI;1.02 to 4.9) and a negative LR of 0.3 (95% CI;0.17 to 0.51) to predict additional abnormalities. A normal auscultation showed low accuracy to identify healthy individuals, with sensitivity, specificity, NPV and PPV, respectively, of 44%, 43%, 41% and 46%. The agreement between the examiners considering normal versus abnormal findings showed kappa = 0.76 for any changes in the physical examination present (p < 0.0001). <strong>Conclusions:</strong> Auscultation of the chest alone, may not be a sufficient strategy to track diseases or establish whether continuity of the examination is necessary or not.
文摘Purpose: To study the factors influencing sputum smear conversion including Serum C-Reactive Protein (CRP) and its correlation with disease severity in tuberculosis patients. Method: Levels of Serum-CRP concentrations were deter-mined in 60 patients with pulmonary tuberculosis, 30 healthy volunteers and patients in follow-up after completion of antitubercular treatment (DOTS therapy). Results: Serum-CRP levels were found to be significantly higher in smear-positive group as compared with the follow-up patients and smear-negative control group. The values were 43.65 ± 23.68, 9.88 ± 5.23 and 4.04 ± 3.85 mg/L respectively (P Conclusion: Serum-CRP levels are significantly correlated with disease severity in patients with active pulmonary tuberculosis. Thus these findings from the present study would certainly add new criteria for early diagnosis of TB, which may lead to development of new strategies to treat TB.
文摘The most widespread arbovirus in the world, dengue fever has been rampant since the 18th century. Since then, several epidemics have been documented in Asia, the Caribbean, South America and Africa. The authors report two cases of dengue fever in children aged six (6) and twelve (12) years respectively. The diagnosis of several dengue pulmonary was retained in these children, clinico-radiological and biological arguments. In addition to the hemorrhagic syndrome, the pulmonary symptomatology associated cough, dyspnea. Chest X-ray revealed bilateral and extensive alveolar interstitial radiological lesions. From a biological point of view, the positivity of dengue-specific IgM has confirmed arboviruses. From the diagnostic peculiarities of the cases observed, the authors suggest the search for factors associated with a primary dengue infection from several onsets to pulmonary manifestation in children. Indeed, this fringe of the population is no longer concerned with acute respiratory infections. In addition, the socio-cultural context of poverty, of pre-hospital therapeutic itinerary favoring traditional medicine, delays hospital care.
文摘Background: The mediastinum is composed primarily of fatty tissue that is surrounded by the lungs bilaterally. There is a lack in the published literature in studying changes in mediastinal fat in idiopathic pulmonary fibrosis (IPF). The purpose of this study was to determine whether the shape and dimensions of the anterior mediastinal fat in patients with IPF are different from that of a normal control group and to correlate the changes with disease severity. Design and Setting: This prospective case control study was done at the chest department of Assiut University Hospital on IPF patients from May 2010-September 2012. A questionnaire containing questions such as age, sex, clinical findings, high resolution computerized tomography (HRCT) score and pulmonary function tests (PFTs) was filled for patients and normal controls. Results: The IPF retrosternal AP dimension was significantly shorter (p = 0.03) and the transverse dimension was longer (p = 0.001) than that in the normal control group. The convex shape of the anterior mediastinum was predictive of IPF (p = 0.001), whereas concave shape was predictive of normal controls (p = 0.001). The change in anteroposterior diameter (AP) and transverse diameters showed significant correlation with the changes in FVC, DLCO and HRCT score. Conclusions: IPF patients had reduced retrosternal AP and increased transverse dimensions than those of the controls with convex shape of their anterior mediastinal fat. Changes in anterior mediastinal fat dimensions are correlated with lower FVC, DLCO and higher HRCT score. A larger sample size, better multicenteric study is needed to confirm the results of this study.
文摘The aim of this prospective study was to evaluate the incidence, etiologic agents and mortality rate of ventilator-associated pneumonia (VAP). In a six-month period, cases who were 18 years or older, dependent on mechanical ventilator for more than 3 days and without pulmonary infection on first admission were included in this study. In all cases, body temperature recordings, blood and urine culture, microbiological analyses of endotracheal aspirates, and chest X-rays were obtained and used to identify VAP. Apache II scores on admission, duration of mechanical ventilation, length of intensive care unit (ICU) stay and mortality were recorded. This study included 45 cases and 22 developed VAP (48%). The incidence of VAP was 25.34 per 1000 ventilator days. Univariate analyses showed that duration of mechanical ventilation, length of ICU stay, coma and tracheotomy were associated with the development of VAP. The mortality rate of cases with VAP (72.7%) was significantly higher than cases without VAP (39.1%). The most frequent microorganisms were Acinetobacter spp., Pseudomonas aeruginosa and Klebsiella pneumoniae. In our study, VAP was a very common and important complication of mechanical ventilation and mortality was very high. To reduce mortality, minimize morbidity, shorten the length of stay, and reduce costs, defined risk factors for VAP should be recognized and an effective infection control program for the prevention of VAP should be implemented. Surveillance results should be evaluated regularly and necessary precautions should be taken.
文摘Human enteroviruses are less well-known causes of acute bronchiolitis. In recent years, Enterovirus D68 [EV D68] has emerged as significant cause of epidemic viral bronchiolitis and pneumonia in the United States and other countries. Chronic bronchiolitis has not been previously attributed to EV D68. We documented EV D68 in open lung biopsies of a young adult patient who was frequently admitted to the hospital for severe exacerbation of respiratory infections and subsequently developed progressive respiratory insufficiency. The difficulty of diagnosis and potential economic impact of this illness is discussed.
