Advances in Respiratory Medicine

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Open AccessCase Report

A Mediastinal Mass with Abdominal and Pulmonary Presentation

by Pranav Ish, Abanti Das, Nitesh Gupta, Juvva Kishan Srikanth, Sakshi Batra and Shibdas Chakrabarti

Adv. Respir. Med. 2020, 88(4), 362-363; https://doi.org/10.5603/ARM.2020.0135 - 31 Aug 2020

Viewed by 352

Abstract

A 60-year-old male presented with the acute onset of breathlessness and dry cough. He had a documented weight loss of 5 kgs with the lack of appetite [...] Full article

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Open AccessCase Report

Cotrimoxazole-Induced SIADH—A Unique Challenge during Treatment of Pulmonary Nocardiosis

by Nishant Chauhan, Aneesa Shahul S., Shahir Asfahan, Kunal Deokar and Ram Niwas

Adv. Respir. Med. 2020, 88(4), 352-355; https://doi.org/10.5603/ARM.2020.0113 - 31 Aug 2020

Cited by 2 | Viewed by 537

Abstract

A 62 year old male non-smoker diagnosed with pulmonary nocardiosis was initiated on Cotrimoxazole therapy at a dose of 20 mg/kg per day in three divided doses. He developed hyponatremia (serum sodium 105 mEq/L) on day 3 of therapy. The potential causes of [...] Read more.

A 62 year old male non-smoker diagnosed with pulmonary nocardiosis was initiated on Cotrimoxazole therapy at a dose of 20 mg/kg per day in three divided doses. He developed hyponatremia (serum sodium 105 mEq/L) on day 3 of therapy. The potential causes of hyponatremia were evaluated. After ruling out other causes, the cause was suspected to be Cotrimoxazole-induced syndrome of inappropriate anti-diuretic hormone secretion (SIADH). We subsequently re-initiated therapy with Cotrimoxazole and the hyponatremia (serum sodium 110 mEq/L) recurred. Upon discontinuation of therapy, serum sodium levels returned to normal. The patient was started on Amoxycillin-Clavulanic Acid as an alternative therapy for pulmonary nocardiosis which resulted in resolution of the hyponatremia. Cotrimoxazole-induced SIADH is a rare occurrence. This case is representative of a patient with Cotrimoxazole-induced SIADH and the causal relationship was confirmed once resumption of therapy with the offending medi-cation resulted in hyponatremia. Clinicians should be aware of this rare adverse effect of Cotrimoxazole and should monitor serum electrolytes during therapy, especially in the elderly and in those receiving high doses. Full article

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Open AccessReview

Ageing, Sex, Obesity, Smoking and COVID-19—Truths, Myths and Speculations

by Adam J. Białas, Anna Kumor-Kisielewska and Paweł Górski

Adv. Respir. Med. 2020, 88(4), 335-342; https://doi.org/10.5603/ARM.2020.0133 - 31 Aug 2020

Cited by 9 | Viewed by 482

Abstract

In early December 2019, in the city of Wuhan in Hubei Province, China, the first infections by a novel coronavirus were reported. Since then, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has been spreading to other cities and countries becoming the global emerging [...] Read more.

In early December 2019, in the city of Wuhan in Hubei Province, China, the first infections by a novel coronavirus were reported. Since then, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has been spreading to other cities and countries becoming the global emerging epidemiological issue and quickly reaching the status of a pandemic. Multiple risk factors of disease severity and mortality have been identified so far. These include old age, male sex, smoking, and obesity. This concise narrative review highlights the important role of these factors in the pathobiology and clinical landscape of Coronavirus Disease 2019 (COVID-19). We especially focused on their significant role in disease severity and mortality. However, in spite of intensive research, most of the presented pieces of evidence are weak and need further verification. Full article

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Open AccessEditorial

Diagnosis of Sarcoidosis—The Updated ATS 2020 Recommendations through the Prism of Everyday Clinical Practice

by Magdalena M. Martusewicz-Boros and Wojciech J. Piotrowski

Adv. Respir. Med. 2020, 88(4), 293-296; https://doi.org/10.5603/ARM.2020.0134 - 31 Aug 2020

Cited by 3 | Viewed by 409

Abstract

Sarcoidosis is a chronic multiorgan granulomatous disease of unknown etiology, which most often involves the lungs and intrathoracic lymph nodes [...] Full article

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Open AccessCase Report

High-Intensity Exercise Improves Pulmonary Function and Exercise Tolerance in a Patient with TSC-LAM

by Thomas William Lowder

Adv. Respir. Med. 2020, 88(4), 356-359; https://doi.org/10.5603/ARM.a2020.0129 - 27 Jul 2020

Cited by 1 | Viewed by 397

Abstract

Introduction: While exercise has been shown to improve respiratory symptoms, exercise tolerance, and bone mineral density in many populations, no supervised exercise training interventions have been undertaken in patients with lymphangioleiomyo-matosis (LAM). Material and methods: One patient with TSC-LAM (tuberous sclerosis complex lymphangioleiomyomatosis) [...] Read more.

Introduction: While exercise has been shown to improve respiratory symptoms, exercise tolerance, and bone mineral density in many populations, no supervised exercise training interventions have been undertaken in patients with lymphangioleiomyo-matosis (LAM). Material and methods: One patient with TSC-LAM (tuberous sclerosis complex lymphangioleiomyomatosis) participated in two weekly sessions (50–60 min) of supervised aerobic exercise at 80–85% heart rate max for one year. Treadmill ergometry (VO_2peak), spirometry (FEV1, FVC, FEV1/FVC, peak flow), and bone mineral density testing were performed prior to every 3 months. Results: After one year of supervised aerobic exercise training we saw dramatic increases in the patient’s VO_2max (20%), FEV1 (9.5%), FEV1/FVC (9.1%) and peak flow (47%). Conclusions: The results from this study indicate that supervised exercise training can improve exercise tolerance and pulmonary function in a patient with lymphangioleiomyomatosis. Further research is needed, including longitudinal studies with larger sample sizes, to determine long-term effects and consistency of these findings. Aerobic exercise may offer a viable alternative or com-pliment to pharmacological interventions in the treatment of lymphangioleiomyomatosis. We show that high-intensity exercise training can markedly and safely improve pulmonary function in a patient with TSC-LAM. While we did not record quality of life or mood states, our patient did report improved self-confidence as well as enhanced mood. Full article

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Open AccessArticle

The Incidence of mTOR Marker in Tracheal Adenoid Cystic Carcinoma by Immunohistochemical Staining

by Mihan Pourabdollah Toutkaboni, Mehrdad Farahani, Abdolreza Sadegh, Arda Kiani, Makan Sadr, Kimia Taghavi and Atefeh Abedini

Adv. Respir. Med. 2020, 88(4), 305-312; https://doi.org/10.5603/ARM.a2020.0120 - 27 Jul 2020

Cited by 1 | Viewed by 438

Abstract

Introduction: There is an association between the activation of mammalian target of rapamycin (mTOR) signaling and aggressive tumor growth in multiple forms of cancer,including adenoid cystic carcinoma (ACC). ACCs are uncommon yet a malignant form of neoplasms that arises within the secretory glands. [...] Read more.

Introduction: There is an association between the activation of mammalian target of rapamycin (mTOR) signaling and aggressive tumor growth in multiple forms of cancer,including adenoid cystic carcinoma (ACC). ACCs are uncommon yet a malignant form of neoplasms that arises within the secretory glands. Therefore, the aim of this study was to investigate the increase of mTOR in the ACC tumors in order to survey the possibility of treating these tumors with mTOR inhibitors. Material and methods: Samples from known cases of the lung and tracheal ACC were retrievedfrom the archives of the pa-thology department of Masih Daneshvari hospital, and immunohistochemical (IHC) staining for mTOR was performed on them. After preparation of the blocks with specific antibodies, tumor cells with cytoplasmic and/or nuclear expression of mTOR were considered as positive cells by applying a specific scoring method introduced in this study. Results: The paraffin blocks of 26 patients were surveyed and the IHC marker of mTOR was positive in the tumors of 10 patients (38.5%). Out of 10 mTOR positive cases, 5 were females and 5 were males. The primary site of the surveyed tumors was the trachea and bronchus in 12 cases (46%), salivary glands in 7 individuals (27%), and lung tissue in 7 cases (27%), and there was no significant correlation between the primary site of the ACC tumors and the existence of the mTOR markers in them (P = 0.67). From all cases, 13 patients (50%) had cribriform and tubular cells without solid components, 9 cases (34.6%) had cribriform and tubular with less than 30% of solid components, and 4 cases (15.4%) had cribriform and tubular cells with more than 30% of solid com-ponents. There was no significant difference between the morphologies and the existence of mTOR markers in them (P = 0.741). Conclusions: As the incidence of mTOR markers is seen in patients with tracheal ACC, evaluation and scoring of mTOR in these persons can be helpful as further studies can distinguish the use of it in the treatment of the disease.
Full article

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Open AccessCase Report

Mediastinal Germ Cell Tumour Masquerading as Loculated Pleural Effusion

by Gopal Chawla, Pranav Ish, Avneet Garg and Kunal Deokar

Adv. Respir. Med. 2020, 88(4), 360-361; https://doi.org/10.5603/ARM.a2020.0116 - 15 Jul 2020

Viewed by 314

Abstract

We report a case of a large teratoma arising from the anterior mediastinum that presented as a confusing clinical picture of loculated pleural effusion which was successfully diagnosed and treated by surgical excision [...] Full article

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Open AccessReview

New Horizons from Novel Therapies in Malignant Pleural Mesothelioma

by Mutlay Sayan, Swati Mamidanna, Mehmet Fuat Eren, Vasudev Daliparty, Teuta Zoto Mustafayev, Carl Nelson, Nisha Ohri, Salma K. Jabbour, Aslihan Guven Mert and Banu Atalar

Adv. Respir. Med. 2020, 88(4), 343-351; https://doi.org/10.5603/ARM.a2020.0103 - 15 Jul 2020

Cited by 1 | Viewed by 488

Abstract

Malignant pleural mesothelioma (MPM) is a relatively rare, but highly lethal cancer of the pleural mesothelial cells. Its pathoge-nesis is integrally linked to asbestos exposure. In spite of recent developments providing a more detailed understanding of the pathogenesis, the outcomes continue to be [...] Read more.

Malignant pleural mesothelioma (MPM) is a relatively rare, but highly lethal cancer of the pleural mesothelial cells. Its pathoge-nesis is integrally linked to asbestos exposure. In spite of recent developments providing a more detailed understanding of the pathogenesis, the outcomes continue to be poor. To date, trimodality therapy involving surgery coupled with chemotherapy and/or radiotherapy remains the standard of therapy. The development of resistance of the tumor cells to radiation and several che-motherapeutic agents poses even greater challenges in the management of this cancer. Ionizing radiation damages cancer cell DNA and aids in therapeutic response, but it also activates cell survival signaling pathways that helps the tumor cells to overcome radiation-induced cytotoxicity. A careful evaluation of the biology involved in mesothelioma with an emphasis on the workings of pro-survival signaling pathways might offer some guidance for treatment options. This review focuses on the existing treatment options for MPM, novel treatment approaches based on recent studies combining the use of inhibitors which target different pro-survival pathways, and radiotherapy to optimize treatment. Full article

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Open AccessArticle

An Assessment of Risks Associated with Obstructive Sleep Apnea and Its Relationship with Adverse Health Outcomes among Pregnant Women. A Multi-Hospital Based Study

by Nitin Joseph, Shreeshaina, Shivani Bhat Loliem, Vinod Kumar Gundi, Mrudula Bhargav Herambapura Subramanya and Shreyashree Belthur Shashidhar

Adv. Respir. Med. 2020, 88(4), 327-334; https://doi.org/10.5603/ARM.a2020.0104 - 15 Jul 2020

Cited by 2 | Viewed by 544

Abstract

Introduction: Physiological changes in pregnancy increase the vulnerability of antenatal women to develop obstructive sleep apnoea (OSA). It is a known cause of several adverse health outcomes in pregnancy. Objectives: To assess the risk status of OSA in pregnant women and to study [...] Read more.

Introduction: Physiological changes in pregnancy increase the vulnerability of antenatal women to develop obstructive sleep apnoea (OSA). It is a known cause of several adverse health outcomes in pregnancy. Objectives: To assess the risk status of OSA in pregnant women and to study its association with adverse maternal outcomes, fatigability, and daytime sleepiness. Material and methods: Pregnant women were interviewed to assess for the risk of OSA, fatigability, and daytime sleepiness. STOP BANG, the fatigue severity scale, and the Epworth sleepiness scale were used to assess these parameters. Results: The mean age of the 214 participants was 27.2 ± 4.7 years. 7 (3.3%) participants had a history of snoring louder than the volume of normal talking, or of being loud enough to be heard past closed doors. A moderate risk status of OSA was present among 3 (1.4%) participants. 45 (21.0%) pregnancies were high risk in nature. The risk status of OSA was associated with a high risk status of pregnancies among the participants (p = 0.0088). 41 (19.2%) participants had a history of significant fatigue over the previous week of the study. 7 (3.3%) participants reported mild to severe excessive daytime sleepiness. A history of snoring loudly (p = 0.0179) and a OSA risk status (p = 0.0027) was associated with excessive daytime sleepiness. Conclusions: A risk status for OSA was associated with a high risk pregnancy status and excessive daytime sleepiness among pregnant women in the current setting. Therefore, pregnant women with these conditions need to be evaluated for OSA. They also need to be suitably managed to ensure the healthy well-being of the mother and the baby. Full article

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Open AccessArticle

Are Level of IL-13 and IL-4 Predictive for Formation of Chronic Inflammation in Children with Asthma?

by Nataliia Makieieva, Valeriia Malakhova, Yuliia Vasylchenko and Valentyn Tsymbal

Adv. Respir. Med. 2020, 88(4), 320-326; https://doi.org/10.5603/ARM.a2020.0108 - 15 Jul 2020

Cited by 8 | Viewed by 477

Abstract

Introduction: Asthma diagnosis in young children may represent a clinical challenge. There are no standard prognostic and dia-gnostic methods. The aim of the study was to evaluate the clinical and prognostic assessment of IL-4 and IL-13 concentrations in children with recurrent wheezing. Material [...] Read more.

Introduction: Asthma diagnosis in young children may represent a clinical challenge. There are no standard prognostic and dia-gnostic methods. The aim of the study was to evaluate the clinical and prognostic assessment of IL-4 and IL-13 concentrations in children with recurrent wheezing. Material and methods: The study included 96 children with recurrent wheezing. 81 patients were diagnosed as transient wheezing, 15 patients with asthma, and 25 healthy children were selected as controls. The concentrations of IL-4 and IL-13 were analyzed in exhaled breath condensate (EBC) using an enzyme-linked immunosorbent assay (ELISA). Data analysis was performed using Statsoft Statistica Version 8 (Tulsa, OK) and the statistical program MedCalc version 17.2. Results: Both IL-4 and IL-13 concentrations were significantly higher in DDA (21.13 pg/mL, 26.13 pg/mL, respectively) and TW (13.86 pg/mL, 18.3 pg/mL, respectively) groups as compared to healthy controls (3.37 pg/mL, 16.35 pg/mL, respectively; p < 0.001), and the highest rates were observed in children with diagnosed asthma (p < 0.001, DDW vs. TW, respectively). IL-4 concentration higher than 18.45 pg/mL (with sensitivity 86.7% and specificity 80%) and IL-13 concentration higher than 20.17pg/ /mL (with sensitivity 100% and specificity 76.7%) in EBC in children with wheezing recurrence can be considered as a possible predictor of asthma development. Conclusions: The concentration of the anti-inflammatory cytokines IL-4 and IL-13 were significantly increased in children with recurrent wheezing and the highest rates were found in asthma developing children. The concentrations of IL-4 and IL-13 in chil-dren with wheezing can be considered as a possible predictor of asthma development. Full article

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Open AccessArticle

The Threshold for Detecting a Rise in Airflow Resistance during Tidal Breathing Is Lower in Older Patients with COPD Than in Healthy People of Similar Age

by Stephen Allen, Alex Tanner and Ahmed Khattab

Adv. Respir. Med. 2020, 88(4), 313-319; https://doi.org/10.5603/ARM.a2020.0126 - 15 Jul 2020

Viewed by 392

Abstract

Introduction: To investigate whether or not the threshold for subjectively detecting an increase in the resistance to airflow (LDT) during tidal breathing at rest rises in older age in patients with COPD, as it does in healthy people and asthmatics in remission. Material [...] Read more.

Introduction: To investigate whether or not the threshold for subjectively detecting an increase in the resistance to airflow (LDT) during tidal breathing at rest rises in older age in patients with COPD, as it does in healthy people and asthmatics in remission. Material and methods: We conducted an open cross-sectional study of 31 older patients (age 55–89) with COPD and 60 healthy volunteers (age 55–86). Inspiratory and expiratory resistive load detection thresholds (ILDT and ELDT respectively) and spirometry were measured. Results: The mean (SD) ILDT was 5.93 (7.02) kPa.s/L in COPD patients, compared to 11.11 (8.47) in healthy people (P < 0.001) in the same age range. There was no significant correlation between ILDT and age in the COPD group (r = −0.182, P = 0.326), though significant correlation with age was found in healthy people (r = 0.591, P < 0.001). ILDT and ELDT in COPD patients correlated significantly with the FEV1/FVC ratio (r = 0.367, P = 0.048 and r = 0.481, P = 0.007 respectively) but not with other spirometry indices, height, weight, BMI, oxygen saturation or smoking pack-years. Conclusion: LDT during tidal breathing appears to be sensitized, and thereby lower, in older COPD patients, possibly due to altered central regulation of the threshold or as a consequence of the effect lung compliance, recoil and volume changes have on afferent input from mechano-receptors in COPD. Older COPD patients with good cognition are therefore likely to be as aware of changing airways resistance as younger patients and take appropriate therapeutic action. Full article

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Open AccessArticle

Analysis of Hospital Management of Chronic Respiratory Diseases in Light of the “Maps of Health Needs” Project in Poland

by Karina Jahnz-Różyk, Małgorzata Czajkowska-Malinowska, Katarzyna Krenke, Dorota Sands, Halina Batura Gabryel, Paweł Kabicz, Emilia Diaków and Barbara Więckowska

Adv. Respir. Med. 2020, 88(4), 297-304; https://doi.org/10.5603/ARM.a2020.0107 - 15 Jul 2020

Cited by 2 | Viewed by 448

Abstract

Introduction: The “Maps of Health Needs” project has been carried out in Poland since 2016 and its purpose is to implement quality-promoting and organisational solutions in the Polish healthcare system. This paper is the analysis of hospitalisations for chronic respiratory diseases recorded in [...] Read more.

Introduction: The “Maps of Health Needs” project has been carried out in Poland since 2016 and its purpose is to implement quality-promoting and organisational solutions in the Polish healthcare system. This paper is the analysis of hospitalisations for chronic respiratory diseases recorded in Polish National Health Fund databases in 2014. Material and methods: The study included 122,000 hospitalisations of adults and 22,000 hospitalisations of children. Epidemio-logical parameters (incidence and prevalence) and major hospitalisation parameters were determined through statistical analysis. Results: The highest registered incidence was observed in asthma patients (548 per 100,000 inhabitants) followed by COPD patients (233 per 100,000 inhabitants). Asthma patients were also characterised by the highest prevalence, with lower values being observed in COPD patients. In the group of adults, patients aged 65 years or older and 80 years or older accounted for 44% and 14% of hospitalised adults respectively. The analysis also revealed that 66% of hospitalisations of adults included patients with asthma, COPD and respiratory failure. The development of respiratory failure prolongs hospitalisation and increases both in-hospital and post-discharge mortality. In children, 90% of the identified hospitalisations were for asthma, chronic inflammatory lung diseases and cystic fibrosis. Conclusions: The results of the study demonstrate that pulmonary obstructive diseases are associated with a considerable burden. Therefore, corrective actions within the Polish healthcare system are required to decrease the number of hospitalisations for these diseases. Full article

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Open AccessLetter

Three-Chamber Chest Drain System in the COVID-19 Era: Is There a Risk of Further Transmission?

by Fabio Davoli, Venerino Poletti and Franco Stella

Adv. Respir. Med. 2020, 88(4), 366-368; https://doi.org/10.5603/ARM.a2020.0100 - 16 Jun 2020

Viewed by 312

Abstract

Once a chest tube is placed, during an emergency or after thoracic surgery, a Chest Drain System (CDS) is attached [...] Full article

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Open AccessLetter

Vitamin D Supplementation to Prevent COVID-19 in Patients with COPD: A Research Perspective

by Malek Chaabouni, Walid Feki, Khansa Chaabouni and Samy Kammoun

Adv. Respir. Med. 2020, 88(4), 364-365; https://doi.org/10.5603/ARM.a2020.0101 - 16 Jun 2020

Cited by 6 | Viewed by 454

Abstract

The Coronavirus disease 2019 (COVID-19) is a global pandemic that has caused now more than 200,000 deaths [...] Full article

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Adv. Respir. Med., Volume 88, Issue 4 (August 2020) – 14 articles , Pages 293-368

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