Advances in Respiratory Medicine

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Open AccessEditorial

Neprilysin Inhibitors as a New Approach in the Treatment of Right Heart Failure in the Course of Chronic Obstructive Pulmonary Disease. Response to the Letter of Siniorakis et al.

by Maciej Liczek, Iga Panek, Piotr Damiański, Olga Jęczeń, Jędrzej Jaźwiec, Piotr Kuna and Michał Panek

Adv. Respir. Med. 2018, 86(5), 257-259; https://doi.org/10.5603/ARM.2018.0042 - 30 Oct 2018

Cited by 5 | Viewed by 287

Abstract

Neprilysin (NEP) inhibition has become an important issue in cardiology and pulmonology [...] Full article

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Open AccessEditorial

Chronic Obstructive Pulmonary Disease and Sacubitril: Explore the Role of Neprilysin before Its Inhibition

by Eftychios Siniorakis, Spyridon Arvanitakis, Maximilianos Elkouris, Stamatia Kalogirou, Dimitrios Veldekis and Sotiria Limberi

Adv. Respir. Med. 2018, 86(5), 255-256; https://doi.org/10.5603/ARM.2018.0041 - 30 Oct 2018

Cited by 2 | Viewed by 307

Abstract

Based on the findings of the emblematic PARADIGM-HF study [...] Full article

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Open AccessCase Report

Lung Transplantation as a Viable Option of Treatment for Pulmonary Veno-Occlusive Disease

by Marek Ochman, Maciej Urlik, Zofia Tatoj, Marta Wajda-Pokrontka, Fryderyk Zawadzki, Magdalena Latos and Marian Zembala

Adv. Respir. Med. 2018, 86(5), 249-254; https://doi.org/10.5603/ARM.2018.0040 - 30 Oct 2018

Cited by 1 | Viewed by 340

Abstract

Pulmonary veno-occlusive disease (PVOD) is a rare form of pulmonary hypertension caused by alteration of pulmonary veins. Many clinical and hemodynamic similarities to idiopathic pulmonary arterial hypertension (IPAH) may cause diagnostic and therapeutic difficulties. This case report is about a patient with PVOD, [...] Read more.

Pulmonary veno-occlusive disease (PVOD) is a rare form of pulmonary hypertension caused by alteration of pulmonary veins. Many clinical and hemodynamic similarities to idiopathic pulmonary arterial hypertension (IPAH) may cause diagnostic and therapeutic difficulties. This case report is about a patient with PVOD, whose first symptoms of the disease occurred after infectious mononucleosis. The patient was administered prostacycline (PGI2) mimetic (Treprostinil), which made qualification process and lung transplantation possible. Despite more and more knowledge about the causes, ethiopathogenesis and changes in pulmonary veins on molecular level, lung transplantation is the only successful therapeutic option for patients suffering from PVOD. Full article

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Open AccessCase Report

Endobronchial Metastasis from Renal Cell Carcinoma as a Reason for Recurrent Pulmonary Infections

by Serafeim Chrysikos, Theodoros Karampitsakos, Argyrios Tzouvelekis and Katerina Dimakou

Adv. Respir. Med. 2018, 86(5), 245-248; https://doi.org/10.5603/ARM.2018.0039 - 30 Oct 2018

Cited by 8 | Viewed by 365

Abstract

Endobronchial metastases (EBM) secondary to extrathoracic malignancies are very rare. Breast cancer, colorectal cancer and renal cell carcinoma represent the most common types of cancer leading to endobronchial metastases. They usually represent a late manifestation of other types of cancer and their prognosis [...] Read more.

Endobronchial metastases (EBM) secondary to extrathoracic malignancies are very rare. Breast cancer, colorectal cancer and renal cell carcinoma represent the most common types of cancer leading to endobronchial metastases. They usually represent a late manifestation of other types of cancer and their prognosis is generally poor averaging a survival of 1–2 years in most case series. Due to their rarity, they remain a challenge for clinicians regarding whether they are primary lung tumors or not. This case report article intends to present a case of a young man with a left nephrectomy due to Clear-Cell Renal Cell Carcinoma, who developed EBM 7 years later and to summarize available data in the field. Furthermore, the utility of diathermic snare as a treatment approach for this entity is highlighted. Full article

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Open AccessArticle

Radiology Findings and Non-Invasive Ventilation Response

by Aysun Isiklar, Sibel Ocak Serin and Antonio M. Esquinas

Adv. Respir. Med. 2018, 86(5), 240-244; https://doi.org/10.5603/ARM.2018.0038 - 30 Oct 2018

Cited by 2 | Viewed by 355

Abstract

Although NIV is a simple and useful method, considerable variation in its use across countries, regions and hospitals may be noted. The patient should be evaluated according to subjective response (respiratory distress, consciousness, problems related to mask and airflow), physiological responses (respiration rate, [...] Read more.

Although NIV is a simple and useful method, considerable variation in its use across countries, regions and hospitals may be noted. The patient should be evaluated according to subjective response (respiratory distress, consciousness, problems related to mask and airflow), physiological responses (respiration rate, respiratory effort, air leakage) and patient-ventilator compliance (gas exchange, pulse oximetry, arterial blood gases). Normalization in respiration rate within 1 or 2 h after initiation of treatment is one of the most important markers for recovery. The goal is to maintain respiration rate between 20 and 30 breaths/ minute. Reduction in intercostal and supraclavicular retractions, paradoxical respiration and sympathetic activity indicate success of treatment. Arterial blood gases are measured within first 2 h in order to assess pH and CO₂; and as needed thereafter. In general, NIV is assessed by arterial blood gases, hemodynamic parameters and several laboratory tests. There is limited number of studies in NIV. Here, we aimed to assess radiological implications of gas distribution within lung tissue during NIV therapy. Full article

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Open AccessArticle

QuantiFERON-TB-GOLD In-Tube in Patients with Sarcoidosis

by Wojciech J. Piotrowski, Adam J. Białas, Łukasz Gwadera, Anna Kumor-Kisielewska, Marek Fijałkowski, Zofia Kurmanowska, Jerzy Marczak, Witold Górski, Wojciech Angowski, Paweł Górski and Sylwia Kwiatkowska

Adv. Respir. Med. 2018, 86(5), 234-239; https://doi.org/10.5603/ARM.2018.0037 - 30 Oct 2018

Cited by 8 | Viewed by 544

Abstract

Introduction: Sarcoidosis and tuberculosis (TB) are the diseases that share many similarities. Mycobacterium tuberculosis (MTB) culture results are the gold standard for the diagnosis of TB, but false positive results are not rare. The aim was to evaluate the utility of QFT [...] Read more.

Introduction: Sarcoidosis and tuberculosis (TB) are the diseases that share many similarities. Mycobacterium tuberculosis (MTB) culture results are the gold standard for the diagnosis of TB, but false positive results are not rare. The aim was to evaluate the utility of QFT in detecting latent TB infection in a group of sarcoidosis patients with negative history of TB and negative culture/BACTEC results, and checking sarcoidosis activity influence on the QFT results. Additionally, we assessed if QFT negative result may strengthen the suspicion that positive culture/BACTEC results are false positive. Material and methods: 37 culture-negative and 6 culture-positive sarcoidosis patients were enrolled. On the basis of clinical and radiological data TB was considered unlikely (false-positive results). A control group consisted of age-matched subjects with excluded TB (n = 37). QuantiFERON-TB GOLD In-Tube (QIAGEN, USA) was used according to the manual. Test validity was checked basing on the results obtained from a low-risk (n = 21) and active TB group (n = 23). Results: The frequency of positive results tended to be higher in MTB(–) sarcoidosis (24.3% vs. 13.5% for the control group, p = 0.37), but was similar to the general population. None of culture-positive sarcoidosis patients was QFT-positive. The positive results were equally distributed among patients with active and inactive sarcoidosis. Conclusions: QFT has been found to be the useful test for the detection of latent TB infection in sarcoidosis patients. In addition, we confirm that sarcoidosis activity does not negatively influence the result of QFT. Moreover, QFT would be proposed as a cost-saving diagnostic test providing additional diagnostic information when false positive MTB culture result in the sarcoidosis patient is highly suspected. However, in each case clinical, radiological and epidemiological data should be considered before taking the therapeutic decision. Full article

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Open AccessArticle

Influence of Particulate Matter Air Pollution on Exacerbation of Chronic Obstructive Pulmonary Disease Depending on Aerodynamic Diameter and the Time of Exposure in the Selected Population with Coexistent Cardiovascular Diseases

by Michał Zieliński, Mariusz Gąsior, Dariusz Jastrzębski, Aneta Desperak and Dariusz Ziora

Adv. Respir. Med. 2018, 86(5), 227-233; https://doi.org/10.5603/ARM.2018.0036 - 30 Oct 2018

Cited by 17 | Viewed by 518

Abstract

Introduction: Particulate matter air pollution constitutes an important factor affecting the course of various respiratory and cardiovascular diseases. Two main monitored groups of particulate pollution are particulate matter with the aerodynamic diameter below 10 μm (PM10) and 2.5 μm (PM2.5). One of [...] Read more.

Introduction: Particulate matter air pollution constitutes an important factor affecting the course of various respiratory and cardiovascular diseases. Two main monitored groups of particulate pollution are particulate matter with the aerodynamic diameter below 10 μm (PM10) and 2.5 μm (PM2.5). One of the most important respiratory diseases is chronic obstructive pulmonary disease (COPD). Clinical presentation of COPD and cardiovascular diseases is similar and can cause complications during therapy. The study explores connection between particulate matter and COPD exacerbations in population with cardiovascular cause of symptoms excluded. Material and methods: Analysis was based on data from hospitalisations in the years 2006–2016 in the hospitals of Upper Silesian Agglomeration, Poland. The data were correlated with meteorological conditions and particulate matter concentrations up to 90 days before hospital admission. Results: During the whole observation period no connection between PM10 concentration changes and COPD exacerbations were observed. On the other hand PM 2.5 influence started to be significant on 14 day before admission (RR 1.06) and increased up to maximal analysed period of 90 days (RR 1.32). Conclusions: Overall this study highlights the importance of particulate matter pollution emission impact on COPD exacerbations in a long time perspective. Full article

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Open AccessArticle

The Effectiveness of Bronchial Artery Embolisation in Patients with Haemoptysis

by Daria Springer, Szczepan Cofta, Robert Juszkat, Bartosz Żabicki, Joanna Goździk-Spychalska, Agata Nowicka, Hanna Winiarska and Halina Batura-Gabryel

Adv. Respir. Med. 2018, 86(5), 220-226; https://doi.org/10.5603/ARM.2018.0035 - 30 Oct 2018

Cited by 8 | Viewed by 416

Abstract

Introduction: Bronchial artery embolisation (BAE) is one of the methods used in massive and recurring haemoptysis. The aim of the study is to determine the effectiveness and complications of bronchial artery embolisation in recurring haemoptysis. Material and methods: The analysis included [...] Read more.

Introduction: Bronchial artery embolisation (BAE) is one of the methods used in massive and recurring haemoptysis. The aim of the study is to determine the effectiveness and complications of bronchial artery embolisation in recurring haemoptysis. Material and methods: The analysis included 47 embolisation procedures performed on 30 patients treated between 2011 and 2017 in the Department of Respiratory Medicine, Allergology and Pulmonary Oncology due to haemoptysis. The patient’s age ranged between 18 and 71 years, while mean age at the time of BAE was 33.5 years. Patients with tuberculosis constituted 73.33% (n = 22) of the sample and underwent 31 embolisation procedures in total. The remaining part of the sample (n = 8) collectively underwent 16 BAEs. The analysis was conducted by verifying the medical documentation, as well as carrying face-to-face and phone conversations. Results: Immediate control due to the inhibition of bleeding was obtained in 95.75% of cases. Recurrence within 3 days of BAE was reported in 5 patients (10.63%), and 4 re-embolisation procedures were conducted. In 10 patients (33.33%), recurrence was observed during the first year post-BAE, while it was reported in 17 cases during the whole observation period (56.66% of patients). The subjects who underwent re-embolisation demonstrated recurrence-free periods lasting from 2 days to 63 months. In patients with recurrence but no re-embolisation, the shortest and longest haemoptysis-free time was 2 and 35 months, respectively. 11 patients (36.66%) required several embolisation procedures during the whole observation period. Conclusions: BAE is a highly successful procedure in treating haemoptysis. The risk of complications is low. Full article

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Open AccessArticle

The Concurrence of Granulomatous Inflammation in Intrathoracic Lymph Nodes with Regional Metastasis from Primary Lung Cancer in Surgically Resected Specimens

by Armin Krvavac, Kurt Munzer, Aaron Miller, Nishant Poddar, Zafar Jamkhana and Setu Patolia

Adv. Respir. Med. 2018, 86(5), 215-219; https://doi.org/10.5603/ARM.2018.0034 - 30 Oct 2018

Cited by 2 | Viewed by 353

Abstract

Introduction: Granulomatous inflammation has been associated with malignancies such as breast, testicular, renal cell, and lymphoma. The coexistence of granulomatous inflammation in mediastinal/hilar lymph node with primary lung malignancy has been described in Case Reports. Our goal was to examine the frequency [...] Read more.

Introduction: Granulomatous inflammation has been associated with malignancies such as breast, testicular, renal cell, and lymphoma. The coexistence of granulomatous inflammation in mediastinal/hilar lymph node with primary lung malignancy has been described in Case Reports. Our goal was to examine the frequency of granulomatous reaction in mediastinal/hilar lymph node in the patients who had undergone surgical resection of lung cancer. Material and methods: We performed a retrospective analysis of 40 patients (1) aged ≥ 18 years and (2) who underwent lobectomy or pneumonectomy from 1 August 2012 to 31 October 2016 at Saint Louis University Hospital and (3) had pathology suggestive of cancer. Results: Of those 40 patients, 3 (7.5%) had granulomatous inflammation in the lymph nodes. None of these 3 individuals had evidence of metastasis in the particular lymph nodes with granulomatous inflammation. Conclusion: Our small cohort revealed that the presence of granulomatous inflammation in a lymph node can be safely taken as an evidence of the absence of metastasis to the lymph node. This finding can obviate the need for further sampling for the particular lymph node with granulomatous inflammation and can decrease the sampling time. Full article

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Open AccessArticle

HIV Status among Presumptive Tuberculosis Cases Attending Tertiary Care Centre in South India

by Manju Rajaram, Adimulam Ganga Ravindra, Dharm Prakash Dwivedi, Jayalakshmi Ramakrishnan, Palanivel Chinnakali and Madhusmita Mohanty Mohapatra

Adv. Respir. Med. 2018, 86(5), 211-214; https://doi.org/10.5603/ARM.2018.0033 - 30 Oct 2018

Cited by 2 | Viewed by 422

Abstract

Introduction: In India, to increase human immunodeficiency virus (HIV) case detection, the National Technical Working Group on TB /HIV had made it mandatory to screen for HIV infection among presumptive tuberculosis (TB) cases. Material and methods: Our study was a cross-sectional [...] Read more.

Introduction: In India, to increase human immunodeficiency virus (HIV) case detection, the National Technical Working Group on TB /HIV had made it mandatory to screen for HIV infection among presumptive tuberculosis (TB) cases. Material and methods: Our study was a cross-sectional study, conducted between June 2015 and December 2016 in a tertiary care institute (JIPMER), in South India, to estimate the prevalence of HIV among presumptive TB cases. Results: Among the 964 presumptive TB cases who attended pulmonary medicine OPD, 189 patients were sputum acid-fast bacilli (AFB) positive. Among the 189 sputum positive cases, 9 were HIV positive. Of the 964 presumptive TB cases, 879 gave consent for HIV testing and 33 (3.7%) turned out to be HIV positive. If only sputum positive cases had been screened for HIV, we would have missed 24 new HIV positive cases. The number needed to screen was 27 among presumptive TB cases and 18 among TB patients. Conclusions: The uptake of HIV testing (91%) and the diagnostic yield of 3.7% of HIV positive cases among the presumptive TB patients is quite high compared to that of the Revised National Tuberculosis Control Programme (RNTCP) mechanism of Puducherry. This reinforces the need to screen all the presumptive cases for HIV infection, to increase HIV case detection so that anti-retroviral therapy (ART) can be initiated early. Full article

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Open AccessArticle

Chest X ray Score (Timika Score): An Useful Adjunct to Predict Treatment Outcome in Tuberculosis

by Anushree Chakraborthy, Akshata Jayachamarajapura Shivananjaiah, Swapna Ramaswamy and Nagaraja Chikkavenkatappa

Adv. Respir. Med. 2018, 86(5), 205-210; https://doi.org/10.5603/ARM.2018.0032 - 30 Oct 2018

Cited by 18 | Viewed by 1118

Abstract

Introduction: Chest X-ray (CXR) has been used since long as an aid in the diagnosis of pulmonary tuberculosis (PTB) and also to determine the extent of the disease. The present study was conducted to evaluate the correlation of disease extent on CXR [...] Read more.

Introduction: Chest X-ray (CXR) has been used since long as an aid in the diagnosis of pulmonary tuberculosis (PTB) and also to determine the extent of the disease. The present study was conducted to evaluate the correlation of disease extent on CXR based on the Timika CXR score with clinical and microbiological parameters at baseline, in sputum positive cases of pulmonary tuberculosis. Material and methods: The study was conducted at a tertiary referral centre for chest diseases in Bangalore, Karnataka from January 2017 to January 2018. This is a prospective study of new sputum smear positive pulmonary tuberculosis cases diagnosed in the Department of Pulmonary Medicine. At baseline, patients’ symptoms and signs on chest auscultation were recorded. The clinical scoring was done by the Karnofsky performance score (KPS) and TB score I (Bandim TB score) and II. Baseline CXR postero-anterior (PA) view of each patient was assessed independently by two chest physicians and evaluated by the Timika CXR scoring method. Routine blood investigations and sputum smear for acid fast bacilli were done. The correlation between the CXR score and other disease severity parameters was analysed. Results: Clinical scores such as the KPS and TB score I and II, did not correlate with the presence of cavitary disease on CXR (p > 0.05). 48.6% of patients with cavitary disease had higher baseline AFB density in sputum (i.e. sputum smear microscopy grade 3+) as compared to 40% of patients with non cavitary disease, which was not statistically significant. CXR score > 71 was significantly associated with longer duration of symptoms, higher clinical scores (KPS and TB score I, II) and lower Body Mass Index (BMI) at diagnosis of PTB (p < 0.05). 65.2% of the patients with CXR score > 71 had significantly higher baseline AFB density as compared to only 32.4% with CXR score ≤ 71 (p < 0.04). CXR score > 71 also had significant association with higher ESR. Conclusion: Cavitary disease on CXR is associated with a higher mycobacterial load at baseline. The Timika CXR score is a simple, standard scoring system which can be used by a chest physician in a clinical setting. The CXR score significantly correlates with a broad range of clinical and microbiological measures of disease severity in PTB patients. Thus, it has a role in risk stratification, especially in patients not producing sputum or sputum negative PTB at diagnosis. Full article

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Adv. Respir. Med., Volume 86, Issue 5 (October 2018) – 11 articles , Pages 205-259

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