Advances in Respiratory Medicine

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Open AccessLetter

Amiodarone and Diffuse Alveolar Hemorrhage

by Ilias C. Papanikolaou, Ioanna Makou and Eleftherios Markatis

Adv. Respir. Med. 2020, 88(2), 169-171; https://doi.org/10.5603/ARM.2020.0095 - 30 Apr 2020

Cited by 3 | Viewed by 435

Abstract

Amiodarone, a common anti-arrhythmic drug, is well known for its pulmonary toxicity [...] Full article

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Open AccessCase Report

Curative Lobectomy in a Patient with Pulmonary Arteriovenous Fistula

by Filip Franciszek Karuga, Zuzanna Żychowicz, Magdalena Rogut, Agata Gabryelska and Piotr Białasiewicz

Adv. Respir. Med. 2020, 88(2), 164-165; https://doi.org/10.5603/ARM.2020.0094 - 30 Apr 2020

Viewed by 366

Abstract

A 26-year-old Caucasian male was referred to the Sleep and Respiratory Disorders Centre with a past medical history of polycythemia and hypoxemia with chronic respiratory alkalosis [...] Full article

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Open AccessCase Report

Gynecomastia in Multi-Drug Resistant Tuberculosis—Ethionamide the Villain

by Kunal Deokar, Abdul Latif Shaikh and Gopal Chawla

Adv. Respir. Med. 2020, 88(2), 162-163; https://doi.org/10.5603/ARM.2020.0093 - 30 Apr 2020

Cited by 1 | Viewed by 342

Abstract

A 59-year-old married male, a known case of line probe assay-confirmed multidrug-resistant pulmonary tuberculosis was treated with kanamycin, levofloxacin, ethionamide, ethambutol, pyrazinamide and cycloserine for seven months [...] Full article

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Open AccessCase Report

An Unusual Case of Right Upper Zone Pneumonic Patch

by Suman Kumar Jagaty, Mujeeb Rahman KK, Yera Dhanurdhar and Prasanta Raghab Mohapatra

Adv. Respir. Med. 2020, 88(2), 160-161; https://doi.org/10.5603/ARM.2020.0092 - 30 Apr 2020

Viewed by 313

Abstract

A 32-year-old male heavy smoker presented to outside hospital with history of cough and shortness of breath for 20 days [...] Full article

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Open AccessCase Report

An Unusual Cause of High Density Radiological Opacities

by Ravindra Chary, Leo Sneha, Govindaraj Vishnukanth and Rajaram Manju

Adv. Respir. Med. 2020, 88(2), 157-159; https://doi.org/10.5603/ARM.2020.0091 - 30 Apr 2020

Cited by 1 | Viewed by 439

Abstract

Introduction: Metallic mercury poisoning through intravenous injection is rare, especially as part of a suicide attempt. Diagnosis and treatment of the disease are challenging as clinical features are not specific. Material and metods: A 41-year-old male presented with dyspnea, fatigue, loss of weight, [...] Read more.

Introduction: Metallic mercury poisoning through intravenous injection is rare, especially as part of a suicide attempt. Diagnosis and treatment of the disease are challenging as clinical features are not specific. Material and metods: A 41-year-old male presented with dyspnea, fatigue, loss of weight, and loss of appetite over two months. Routine radiological examination by chest X-ray and CT showed randomly distributed high density opacities with Hounsfield units (HU) around 500 HU all over the body. The diagnosis was then confirmed with a urinary mercury concentration of > 1000 mcg/24 h. Results: The patient’s clinical condition was getting worse in spite of chelation therapy and hemodialysis. The patient eventually died because of respiratory failure. Conclusion: Early diagnosis and appropriate treatment are critical for intravenous mercury poisoning especially because there are no specific signs or symptoms. There should be a high level of suspicion in drug abusers. Treatment should involve the combined use of chelating agents and other treatments such as hemodialysis and plasma exchange in advanced clinical settings. Full article

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Open AccessCase Report

Pulmonary Oxalosis in Pulmonary Aspergillosis Syndrome

by Oluwasegun S. Osholowu, Vivek Kak and Harpreet Singh

Adv. Respir. Med. 2020, 88(2), 153-156; https://doi.org/10.5603/ARM.2020.0090 - 30 Apr 2020

Cited by 6 | Viewed by 615

Abstract

The presence of pulmonary oxalosis in bronchoalveolar lavage (BAL) or biopsied tissue samples is considered pathognomonic for Aspergillus disease etiology. The finding of calcium oxalate crystals in the tissue samples infected with aspergillosis can serve as a vital diagnostic clue. Detection of calcium [...] Read more.

The presence of pulmonary oxalosis in bronchoalveolar lavage (BAL) or biopsied tissue samples is considered pathognomonic for Aspergillus disease etiology. The finding of calcium oxalate crystals in the tissue samples infected with aspergillosis can serve as a vital diagnostic clue. Detection of calcium oxalate crystals is achievable within 24 hours by most hospital microbiology laboratories. It is much quicker than the time it takes to receive results of other tests like histopathology, sputum cultures, and aspergillus antigen assays. We present this case to emphasize the importance of pulmonary oxalosis as a crucial early diagnostic factor in pulmonary aspergillosis syndromes. Full article

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Open AccessCase Report

Volume-Assured Pressure Support Mode Plus Pirfenidone as Resuscitation Therapy in Patients with Exacerbation of Idiopathic Pulmonary Fibrosis

by Killen Harold Briones Claudett, Mónica H. Briones Claudett, Estupiñan Vargas Domenica, Stalin Rodriguez Garcia, Cesar Andrade Cabrera, Jaime Benites Solis and Michelle Grunauer Andrade

Adv. Respir. Med. 2020, 88(2), 147-152; https://doi.org/10.5603/ARM.2020.0077 - 30 Apr 2020

Cited by 1 | Viewed by 399

Abstract

Introduction: Treatment among advanced stage idiopathic pulmonary fibrosis is quite challenging, especially considering that no major evidence has been released about it. This Case Report demonstrates and discusses the benefit of non-invasive mechanical ventilation in volume-assured pressure support (AVAPS) mode plus pirfenidone based [...] Read more.

Introduction: Treatment among advanced stage idiopathic pulmonary fibrosis is quite challenging, especially considering that no major evidence has been released about it. This Case Report demonstrates and discusses the benefit of non-invasive mechanical ventilation in volume-assured pressure support (AVAPS) mode plus pirfenidone based on the relief of apatient’ssymptoms in combination with high-resolution computed tomography (HRCT) evidence. Material and methods: An 83-year-old female patient with multiple hospital admissions within a six-month period initially presented with cardiac symptoms which were later attributed to apossible exacerbation of her primary diagnosis, idiopathic pulmonary fibrosis. Conclusion: The addition of non-invasive mechanical ventilation in AVAPS mode plus pirfenidone can improve the survival rates even in patients with current exacerbations of acute respiratory failure due to idiopathic pulmonary fibrosis. Full article

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Open AccessReview

Acute Eosinophilic Pneumonia Associated with Non-Cigarette Smoking Products: A Systematic Review

by Toufic Chaaban

Adv. Respir. Med. 2020, 88(2), 142-146; https://doi.org/10.5603/ARM.2020.0088 - 30 Apr 2020

Cited by 19 | Viewed by 867

Abstract

Acute eosinophilic pneumonia (AEP) is characterized by an acute onset respiratory illness with bilateral chest infiltrates and evidence of pulmonary eosinophilia. Cigarette smoking is the main risk factor, but drugs and other inhalational exposures have also been reported. Herein, the association between AEP [...] Read more.

Acute eosinophilic pneumonia (AEP) is characterized by an acute onset respiratory illness with bilateral chest infiltrates and evidence of pulmonary eosinophilia. Cigarette smoking is the main risk factor, but drugs and other inhalational exposures have also been reported. Herein, the association between AEP and smoking devices other than cigarettes is reviewed The PubMed database was searched using terms such as ”smoking”, ”vaping”, ”e-cigarette”, ”waterpipe”, and ”marijuana”, along with other commonly used synonyms for these terms. In addition, eosinophilic lung diseases were also searched for using the same database. All cases of AEP were identified using the modified Philit criteria in association with the use of marijuana, waterpipe, e-cigarettes or heat-not-burn cigarettes. Cases associated with illicit drug use were excluded. Twelve cases were included with amedian age of 20 (15–60). 75% of patients studied were male. Exposures included marijuana smoking (n = 5), waterpipe usage (n = 2), heat-not-burn cigarette use (n = 2), e-cigarette use (n = 2) and synthetic cannabinoid use (n = 1). Arecent change in smoking habits was reported in 50% of patients. Presenting symptoms were dyspnea (91.6%), cough (66.6%), fever (66.6%) and chest pain (25%). 90% of patients had leukocytosis on presentation, but only 16.6% had peri-pheral eosinophilia. The median eosinophil percentage in bronchoalveolar lavage was 67.5% (0 to 78). Two patients had alung biopsy performed. Bilateral involvement on chest imaging was reported in all patients. Five patients (41.6%) required invasive mechanical ventilation and ten patients (83.3%) were treated in an intensive care unit. All patients responded to corticosteroid therapy with no relapses reported. Acute eosinophilic pneumonia is reported with smoking that does not include traditional cigarette smoking such as waterpipes, e-cigarettes, heat-not-burn cigarettes, and marijuana and can have asimilar presentation and clinical course. Full article

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Open AccessReview

Posterior Mediastinal Paravertebral Müllerian Cyst (Cyst of Hattori): Literature Review

by Abdalla Saade Abdalla Al-Zawi, Philip Idaewor, Amira Asaad, Rebeeca Harsten, Vanessa Salih, Jessica English, Ali Salih, Marina Barron, Peter Ozua, Nazar Alsanjari, Kingsley Osayi and Samir Shah

Adv. Respir. Med. 2020, 88(2), 134-141; https://doi.org/10.5603/ARM.2020.0089 - 30 Apr 2020

Cited by 3 | Viewed by 784

Abstract

Mediastinal cysts are typically of bronchogenic, thymic or neurenteric origin, but may also represent oesophageal duplication. Posterior paravertebral mediastinal Müllerian cysts of undetermined pathogenesis are very rare occurrences. The first case of a ciliated cyst arising in the mediastinum, of probable Müllerian origin, [...] Read more.

Mediastinal cysts are typically of bronchogenic, thymic or neurenteric origin, but may also represent oesophageal duplication. Posterior paravertebral mediastinal Müllerian cysts of undetermined pathogenesis are very rare occurrences. The first case of a ciliated cyst arising in the mediastinum, of probable Müllerian origin, was reported by Hattori in 2005, which gave rise to the name cyst of Hatorri (COH) The number of reported cases in literature of a similar nature have since then increased significantly. One of the main concerns about this pathology is the possibility of malignant transformation of the Müllerian tissue. Over the course of this paper we will discuss the pathogenesis, immunohistochemistry and its role in differential diagnosis as well as optimal treatment of such cysts. Full article

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Open AccessArticle

Prevalence of Inducible Laryngeal Obstruction among Patients Diagnosed as Bronchial Asthma

by Heba Wagih Abdelwahab, Amal Aboelnass, Amer Ayman, Amany Ragab Elsaid, Nesrine Saad Farrag and Ahmed M. Hamad

Adv. Respir. Med. 2020, 88(2), 129-133; https://doi.org/10.5603/ARM.2020.0087 - 30 Apr 2020

Cited by 4 | Viewed by 477

Abstract

Introduction: Inducible laryngeal obstruction (ILO) is an important cause of a variety of respiratory symptoms and can mimic bronchial asthma (BA). This study was planned to measure the prevalence of ILO among patients diagnosed with BA and to detect its effect on BA [...] Read more.

Introduction: Inducible laryngeal obstruction (ILO) is an important cause of a variety of respiratory symptoms and can mimic bronchial asthma (BA). This study was planned to measure the prevalence of ILO among patients diagnosed with BA and to detect its effect on BA control and severity. Material and methods: Patients aged 18 years or older who were previously diagnosed with BA were enrolled. Laryngeal obstruction was induced using the patient’s specific trigger (e.g. exercise). Visualization of vocal folds was accomplished using a 70-degree rigid laryngoscope (Karl Storz). A visual grade score was utilized to determine the severity of laryngeal obstruction. Results: Results showed that 38.3% (n = 46) of the patients had ILO with the majority being classified as grade 2 (80.4%) (n = 37). The most common subtype was glottic ILO (63%). Bronchial asthma duration, level of control, and severity were not associated with ILO (P values: 0.2, 0.3 and 0.8 respectively). Conclusion: Asthma and ILO commonly co-exist. An accurate classification of patients is very important and must be considered in order to determine whether the symptoms are directly related to ILO or whether they are caused by BA. Ceasing inappropriate treatment may be necessary. Objective diagnostic modalities of ILO are essential. Full article

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Open AccessArticle

Transbronchial Lung Cryobiopsy Guided by Radial Mini-Probe Endobronchial Ultrasound in Interstitial Lung Diseases—A Multicenter Prospective Study

by Maciej Gnass, Anna Filarecka, Artur Bartczak, Małgorzata Szołkowska, Agnieszka Knapczyk, Monika Lis, Monika Skrobot, Jerzy Soja, Magadlena Misiaszek, Łukasz Barszczok, Damian Czyżewski and Artur Szlubowski

Adv. Respir. Med. 2020, 88(2), 123-128; https://doi.org/10.5603/ARM.2020.0086 - 30 Apr 2020

Cited by 7 | Viewed by 606

Abstract

Introduction: Transbronchial lung cryobiopsy (TBLC) is commonly used in diagnosing interstitial lung diseases (ILDs). Ageneral anesthesia with endotracheal intubation, balloon blockers and fluoroscopy control is the most common modality. Simplifying the procedure without decreasing it’s safety could result in wider use. Prospective, observational [...] Read more.

Introduction: Transbronchial lung cryobiopsy (TBLC) is commonly used in diagnosing interstitial lung diseases (ILDs). Ageneral anesthesia with endotracheal intubation, balloon blockers and fluoroscopy control is the most common modality. Simplifying the procedure without decreasing it’s safety could result in wider use. Prospective, observational study was conducted in three Polish pulmonology centers to evaluate safety and diagnostic yield of TBLC under conscious sedation, without intubation and bronchial blockers and with radial-EBUS guidance instead of fluoroscopy. Material and methods: In patients suspected of ILD, in accordance with high resolution computer tomography (HRCT) selected lung segments were examined with radial-EBUS mini probe without aguide sheath. If the lung infiltrations were visible this locations were preferred. If not, specimens were taken from two different segments of the same lobe. Two to five biopsies with freezing time 5–8 seconds were performed. Moreover ultrasound examination was used to avoid injury of lung vessels. Results: From March 2017 to September 2019 — 114 patients (M: 59, F: 55) of mean (SD) age 54 (14) years were included to the study on the basis of medical history and HRCT. Histopathology was conclusive in 90 (79%) patients and included 16 different diagnoses (sarcoidosis, EAA, COP predominantly). 24 inconclusive biopsies of unclassifiable pulmonary fibrosis were followed up. Complications included five cases (4.4%) of pneumothorax requiring achest tube drainage and aminor and moderate bleeding in few cases. There was no need for use of balloon bronchial blockers. Conclusions: TBLC under conscious sedation guided by radial EBUS mini-probe is novel, reasonable and safe technique for histological diagnosis of ILDs. Full article

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Open AccessArticle

The -463G/A and -129G/A Myeloperoxidase-Encoding Gene Polymorphism in Chronic Obstructive Pulmonary Disease

by Andrzej Witusik, Łukasz Mokros, Janusz Szemraj, Piotr Kuna and Tadeusz Pietras

Adv. Respir. Med. 2020, 88(2), 116-122; https://doi.org/10.5603/ARM.2020.0085 - 30 Apr 2020

Viewed by 497

Abstract

Introduction: Neutrophils are involved in the pathogenesis of chronic obstructive pulmonary disease (COPD). Myeloperoxidase is an important bactericidal granulocytic enzyme. It is of interest to question whether or not the polymorphic variants of the myeloperoxidase-encoding gene are associated with the risk of developing [...] Read more.

Introduction: Neutrophils are involved in the pathogenesis of chronic obstructive pulmonary disease (COPD). Myeloperoxidase is an important bactericidal granulocytic enzyme. It is of interest to question whether or not the polymorphic variants of the myeloperoxidase-encoding gene are associated with the risk of developing COPD. Material and methods: The study determined the risk of COPD development in 186 COPD patients and 220 healthy subjects in the context of two selected polymorphic sites of the promoter region of the myeloperoxidase-encoding gene. Results: It has been demonstrated that the AA genotype of locus -463 in the myeloperoxidase-encoding gene increases the risk of developing COPD (OR: 2.87; CI: 1.651–4.997). This genotype also correlates with a higher gene expression in patients (0.56 ± 0.12 vs. 0.31 ± 0.18 in patients with AG genotype and 0.29 ± 0.17, p < 0.01 in those with GG genotype). In healthy indivi-duals, the AA genotype was also characterized by increased expression of the myeloperoxidase-encoding gene (0.41 ± 0.16 vs. 0.29 ± 0.15 for AG genotype, p < 0.01 and 0.25 ± 0.16 for GG genotype p < 0.01). Patients with the AA genotype had a significantly higher gene expression than healthy subjects with this genotype. Conclusions: The polymorphic site −129 of the myeloperoxidase-encoding gene was unrelated to the development of COPD. The gene expression did not differ for the individual genotypes. Our studies indicate that the polymorphism of the myeloperoxidase-encoding gene may be related to chronic obstructive pulmonary disease. Full article

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Open AccessArticle

Lung Density in the Trajectory Path—A Strong Indicator of Patients Sustaining a Pneumothorax during CT-Guided Lung Biopsy

by Charbel Saade, Salah Zien-El-Dine, Youssef Ghosn, Nadine Hamieh, Batoul Dekmak, Diamond Ghieh, Gilbert Maroun and Fadi El-Merhi

Adv. Respir. Med. 2020, 88(2), 108-115; https://doi.org/10.5603/ARM.2020.0084 - 30 Apr 2020

Cited by 1 | Viewed by 478

Abstract

Introduction: The purpose is to evaluate the prognostic significance of lung parenchymal density during percutaneous coaxial cutting needle lung biopsy (PNLB). Materials and methods: Retrospective analysis of 179 consecutive patients (106 males, 73 females; mean age 59.16 ± 16.34 years) undergoing PNLB was [...] Read more.

Introduction: The purpose is to evaluate the prognostic significance of lung parenchymal density during percutaneous coaxial cutting needle lung biopsy (PNLB). Materials and methods: Retrospective analysis of 179 consecutive patients (106 males, 73 females; mean age 59.16 ± 16.34 years) undergoing PNLB was included. Mean lobar parenchymal lung density, mean densities anterior to the lesion and posterior to the chest wall in the needle trajectory path were measured in HU. Lesion location and needle trajectory were also measured. Fisher’s exact test and Chi-square test were conducted to analyze the categorical variables. ANOVA test was done to examine continuous and normally distributed variables. Statistical significance was considered when p < 0.05. Results: Mean lobar parenchymal lung density (p < 0.05) and mean parenchymal lung density relative to the needle trajectory path were below -800 HU in patients who sustained a pneumothorax. Increase in the number of pleural passes was significantly associated with the risk of patients having pneumothorax (p < 0.05). The mean distance from the skin to the lesion and needle trajectory angle were not statistically different among patients with and without pneumothorax (p > 0.05). Conclusion: Lobar parenchymal density and lung parenchymal density anterior to the lesion and posterior to the chest wall in the needle trajectory path could be used as predicting parameters in patients undergoing PNLB who sustained a pneumothorax. These findings can help interventional radiologist further assess risk of pneumothorax when preforming such procedure. Full article

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Open AccessArticle

The Effects of Mold Sensitivity on the Clinical Characteristics of Adult Asthmatic Patients

by Dilek Karadoğan, Vehbi Ayhan and Adile Berna Dursun

Adv. Respir. Med. 2020, 88(2), 99-107; https://doi.org/10.5603/ARM.2020.0083 - 30 Apr 2020

Cited by 3 | Viewed by 538

Abstract

Introduction: The effects of mold sensitivity on the development and course of asthma have been researched previously, although study results vary. We sought to evaluate the characteristics of our mold-sensitive patients in comparison with those of other adult asthmatic patients. Materials and methods: [...] Read more.

Introduction: The effects of mold sensitivity on the development and course of asthma have been researched previously, although study results vary. We sought to evaluate the characteristics of our mold-sensitive patients in comparison with those of other adult asthmatic patients. Materials and methods: Data were collected retrospectively from adult asthmatic patients who underwent regular follow-ups at our tertiary care outpatient clinic for immunology and allergic diseases. Patients were grouped and compared according to three categories of aeroallergen sensitivity status determined via a skin prick test. The study variables were demographic data, asth-ma-onset age, comorbid conditions, asthma-related emergency department visits and hospitalizations, systemic corticosteroid burst, asthma control assessment tests, and pulmonary function tests. Results: In total, 242 patients’ data were evaluated. Their mean age was 48.6 ± 15.4 years, with female predominance (81.4%). Mold-sensitive asthmatics composed 34.7%, while the aeroallergen-sensitive group without molds (33.1%) and the non-sensitized group (32.2%) composed the rest. The mold-sensitive group had a higher rate of polysensitization (92.8%) than the sensitized group without molds. In multinomial logistic regression analysis, mold sensitivity was positively associated with shorter asthma duration, absence of sinonasal polyposis, presence of allergic rhinitis, and generally well-controlled asthma compared to the non-sensitized group. Also, mold sensitivity was positively associated with shorter asthma duration, drug allergy, and absence of systemic corticosteroid bursts compared to the sensitized group without molds in logistic regression analysis. Conclusion: Our mold-sensitive asthmatic patients demonstrated better asthma symptom control. It should be considered that mold sensitization in adult asthmatics is not always a poor prognostic factor. Full article

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Open AccessEditorial

New Spirometry? The 2019 Update of the Test Standardization

by Piotr W. Boros and Magdalena M. Martusewicz-Boros

Adv. Respir. Med. 2020, 88(2), 95-98; https://doi.org/10.5603/ARM.2020.0082 - 30 Apr 2020

Viewed by 460

Abstract

Spirometry is a commonly performed assessment of lung function for diagnostic purposes as well as for monitoring of chronic lung diseases [...] Full article

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Open AccessLetter

Coronavirus—Preventing an Occupational Hazard among Doctors

by Nipun Malhotra, Nitesh Gupta and Pranav Ish

Adv. Respir. Med. 2020, 88(2), 166-168; https://doi.org/10.5603/ARM.a2020.0096 - 20 Apr 2020

Cited by 3 | Viewed by 644

Abstract

It all started in the last week of December 2019 when the World Health Organization (WHO) was alerted regarding several respiratory infections localized to a city in China [...] Full article

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Adv. Respir. Med., Volume 88, Issue 2 (April 2020) – 16 articles , Pages 95-171

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