Pulmonary Research and Respiratory Medicine – Open Journal

Pulmonary Research and Respiratory Medicine – Open Journal

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  • Publisher: Openventio Publishers
  • Country of publisher: india
  • Date added to EuroPub: 2019/Nov/15

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  • Language of fulltext: english

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  • Year open access content began: 2014
  • Does the author retain unrestricted copyright? False
  • Does the author retain publishing rights? False

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This journal has '68' articles

Significance of Combined Emphysema in Idiopathic Pulmonary Fibrosis and Serum Surfactant Protein-D as a Prognostic Factor

Significance of Combined Emphysema in Idiopathic Pulmonary Fibrosis and Serum Surfactant Protein-D as a Prognostic Factor

Authors: Masanori Shiratori
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Abstract

Background and Objectives Idiopathic pulmonary fibrosis (IPF) is a chronic disease of unknown aetiology and is often associated with a syndrome called combined pulmonary fibrosis and emphysema (CPFE). This study aimed to identify practical predictors of prognosis in IPF patients associated with CPFE. Subjects and Methods We retrospectively studied 72 patients with IPF and evaluated the threshold of emphysematous area affecting prognosis on high-resolution computed tomography (HRCT) scans. As predictor candidates, various pulmonary function tests (PFTs) and biomarkers, e.g. surfactant protein (SP)-A and SP-D, were assessed. Results The survival rate of the CPFE group, defined as having an emphysematous area greater than 25% on HRCT, was significantly worse than that of the non-CPFE group, despite no significant difference in fibrosis scores. An annual percent decline of diffusing capacity of the lung for carbon monoxide (% DLCO) of more than 5% was a significant prognostic factor in the CPFE group. High concentration of serum SP-D was a significant prognostic factor in both the CPFE and non-CPFE groups. However, cut-off levels in the CPFE group were lower than those in the non-CPFE group. Conclusions We demonstrated worse prognosis in IPF associated with CPFE syndrome compared to the other subset of IPF, and showed that % DLCO and SP-D are useful predictors of poor prognosis.

Keywords: Emphysema. Idiopathic pulmonary fibrosis. Prognosis. Pulmonary function test. Surfactant protein-D.
Balloon Pulmonary Angioplasty (BPA) and Rehabilitation for Chronic Thromboembolic Pulmonary Hypertension (CTEPH)

Balloon Pulmonary Angioplasty (BPA) and Rehabilitation for Chronic Thromboembolic Pulmonary Hypertension (CTEPH)

Authors: Masahiro Kohzuki
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Abstract

Chronic thromboembolic pulmonary hypertension (CTEPH) has a poor prognosis because of increased pulmonary arterial pressure (PAP) causing pulmonary hypertension and progressive right-sided heart failure.1,2 Typical symptoms are dyspnea on exertion, fatigability, and reduced quality of life.3 Balloon pulmonary angioplasty (BPA) has been reported to improve hemodynamics and functional capacity in patients with CTEPH who are not candidates for pulmonary endarterectomy.4,5 However, the effect of BPA on respiratory function in patients with CTEPH is unclear.

Keywords: Chronic Thromboembolic Pulmonary Hypertension. CTEPH. Balloon Pulmonary Angioplasty. Rehabilitation.
Vitamin C Infusion for Gastric Acid Aspiration-Induced Acute Respiratory Distress Syndrome (ARDS)

Vitamin C Infusion for Gastric Acid Aspiration-Induced Acute Respiratory Distress Syndrome (ARDS)

Authors: Alpha A. Fowler, III
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Abstract

Introduction Gastric acid aspiration into the lung has long been established as a direct cause of acute lung injury that rapidly leads to a clinical diagnosis of acute respiratory distress syndrome (ARDS). Gastric juices contain a low pH liquid and frequently mouth organisms. When aspiration of gastric liquid into the lower airway occurs, a caustic injury to the lower airway and distal airspaces occurs. The acute inflammatory events that occur following gastric acid aspiration induce injury by direct lung tissue toxicity.1 As well, acute adhesion of activated blood neutrophils throughout the pulmonary microcirculation and the subsequent migration of activated cells into the alveolar space rapidly induces acute injury to the alveolar capillary membrane with subsequent rapid loss of lung barrier function. Virtually always acute lung injury of the magnitude described in the case we report here occurs, producing ARDS. Thus far, no therapy has reliably proven effective for gastric acid-induced ARDS. Case Presentation In this report, we describe the onset of acute respiratory failure with rapid onset ARDS in a 34-year-old patient who experienced a generalized tonic-clonic seizure followed by witnessed vomiting and aspiration of gastric contents following a morning meal. The patient rapidly developed acute respiratory failure, necessitating mechanical ventilation. Ventilatory support failed to oxygenate or ventilate the patient. Extracorporeal membrane oxygenation was instituted. Vitamin C was infused intravenously at 50 mg/kg every 6 hours starting on hospital day 2 with subsequent significant improvement in lung function and lung imaging. Conclusion This report adds to the increasing clinical experience employing high dosages of intravenous vitamin C to attenuate the acute inflammatory lung injury. If further adds to the experience of using extracorporeal membrane oxygenation to support lung injured patients.

Keywords: Intravenous vitamin C. Acute respiratory distress syndrome. Extracorporeal membrane oxygenation. Acute respiratory failure. Gastric acid aspiration.
The Importance of Rehabilitation before and after Lung Transplantation

The Importance of Rehabilitation before and after Lung Transplantation

Authors: Masahiro Kohzuki
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Abstract

Lung transplantation (LTx) has gained widespread acceptance as a therapeutic option for end-stage pulmonary disease. LTx has been shown to improve quality of life (QoL) and survival in individuals with various end-stage lung diseases.

Keywords: Rehabilitation. Lung Transplantation. quality of life (QoL).
Paraneoplastic Syndrome: What should Pulmonologists know?

Paraneoplastic Syndrome: What should Pulmonologists know?

Authors: Takeshi Saraya
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Abstract

Pulmonologists often encounter patients with oncologic emergencies (Figure 1) such as metabolic syndrome (tumor lysis syndrome),1 hypercalcemia, syndrome of inappropriate secretion of antidiuretic hormone (SIADH), hematologic (febrile neutropenia and hyperviscosity syndrome) and structural disorders (superior vena cava syndrome,2 spinal cord compression syndrome, malignant pericardial effusion,3 and malignant airway obstruction4), along with drug-related adverse events in already-known malignancies including liver5 or pulmonary toxicity6,7 and renal disease.8,9

Keywords: Paraneoplastic Syndrome. Pulmonologists.
Diagnosis of Pulmonary and Extra Pulmonary Tuberculosis: How Best is CBNAAT when Compared to Conventional Methods of TB Detection?

Diagnosis of Pulmonary and Extra Pulmonary Tuberculosis: How Best is CBNAAT when Compared to Conventional Methods of TB Detection?

Authors: Subhakar Kandi
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Abstract

Background Globally, India is a home for more than 25% of global Tuberculosis (TB) burden. The sensitivity of smear microscopy and its inability to detect drug resistance limits its impact on TB control. We compared the cartridge-based nucleic acid amplification test (CBNAAT) results for diagnosis of pulmonary and extrapulmonary tuberculosis with the conventional methods like sputum smear and solid culture examination. Methods A descriptive study was conducted at Government General and Chest Hosptial, Hyderabad, India during 2014 to 2016. The study population included all the pulmonary and extrapulmonary presumptive TB cases who were subjected for further investigations. Results Of the two hundred samples received, 110 (55%) were sputum samples and 90 (45%) were extrapulmonary samples. For pulmonary samples, the sensitivity and specificity for CBNAAT samples were 79.2% and 89.5% respectively; while that for sputum smear were 41.5% and 98.2% respectively. For extrapulmonary samples, the sensitivity and specificity for CBNAAT samples were 85.7% and 93.5% respectively; while that for sputum smear were 60.7% and 100% respectively. Conclusion CBNAAT is one of the rapid diagnostic tests available in the country and it should be routinely used under the public and private health sector effectively to detect a tuberculosis case.

Keywords: Cartridge-based nucleic acid amplification test (CBNAAT). Tuberculosis. Sputum smear.
Refusal of Venous Thromboembolism Prophylaxis and Incidence of Thrombosis in Patients with Cystic Fibrosis

Refusal of Venous Thromboembolism Prophylaxis and Incidence of Thrombosis in Patients with Cystic Fibrosis

Authors: Nicole L. Metzger
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Abstract

Background Patients with cystic fibrosis (CF) are at risk of venous thromboembolism (VTE) during hospitalization but many refuse VTE prophylaxis. Methods A single-center, retrospective medical record review was conducted to determine the refusal rate of pharmacologic VTE prophylaxis in adult patients with CF and to identify any correlation between patients who refused prophylaxis and the incidence of VTE. Results Of the 426 patient encounters screened, 307 were included, representing 144 unique patients, with a mean age of 28.4±8.9 years. Venous thromboembolism prophylaxis was refused in 77.5% of the patient encounters. Refusal rates were similar for both unfractionated heparin and enoxaparin (78.8% vs. 75.0%). Five patients (1.63%) developed a VTE during hospitalization or within 30 days of discharge; all five patients refused VTE prophylaxis. Conclusions The majority of hospitalized patients with CF refused pharmacologic prophylaxis with no difference in refusal between pharmacologic agents, and the combined incidence of VTE was low.

Keywords: Cystic fibrosis. Prophylaxis. Pulmonary. Anticoagulation. Clinical pharmacy.
Tuberculosis in Pregnancy: Delayed Diagnosis, Lost Lives

Tuberculosis in Pregnancy: Delayed Diagnosis, Lost Lives

Authors: Solwayo Ngwenya
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Abstract

Tuberculosis still remains an important global health disease, killing many people annually. Yet it is a preventable cause of death. Maternal mortality rates due to tuberculosis and HIV/AIDS in Sub-Saharan Africa make up a significant proportion of maternal deaths. It remains a disease of poverty, overcrowding, and underdevelopment. Pregnancy increases maternal and fatal mortality in AIDS-infected women. In pregnancy it can be a challenging diagnosis to make, delaying treatment that could lead to adverse outcomes. Clinicians working in high prevalence areas of tuberculosis and those looking after immunocompromised patients should maintain a high index of suspicion. Developing countries must be helped to develop by the world financial institutions with debt reduction. The Sustainable Development Goal aims to end tuberculosis-related deaths, transmission and catastrophic costs by 2030. Tuberculosis is a preventable death, the world must act together to prevent unnecessary deaths.

Keywords: Tuberculosis. Pregnancy. Complications. Maternal mortality. Outcomes.
Pneumocystis Carinii Pneumonia; Lost Lives in Pregnancy: Chemoprophylaxis Saves Lives

Pneumocystis Carinii Pneumonia; Lost Lives in Pregnancy: Chemoprophylaxis Saves Lives

Authors: Solwayo Ngwenya
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Abstract

The advent of HIV/AIDS brought opportunistic infections such as Pneumocystis jiroveci pneumonia (PJP), formerly known as Pneumocystis carinii pneumonia (PCP) to the fore. This is a fungal opportunistic infection that is an human immunodeficiency virus infection and acquired immune deficiency syndrome (HIV/AIDS) defining illness. It poses significant risks to both the mother and the fetus. Pneumocystis carinii pneumonia can have a sub-clinical insidious onset but can rapidly progress to acute respiratory failure leading to maternal and fetal demise. The best form of management of pneumocystis carinii pneumonia is prevention. Widespread chemoprophylaxis with co-trimoxazole reduces morbidity and mortality. The management calls for a multidisciplinary approach involving the physician, obstetrician and pneumologist. Pneumocystis carinii pneumonia has a more aggressive course during pregnancy with increased morbidity and mortality, maternal and fetal outcomes remaining dismal. Therefore, it is important that widespread HIV testing and use of co-trimoxazole chemoprophylaxis are made readily available to reduce morbidity and mortality. It must be a differential diagnosis of any pregnant HIV seropositive patient presenting with pulmonary symptomatology.

Keywords: Pneumocystis carinii pneumonia. Pregnancy. HIV/AIDS. Maternal mortality. Co-trimoxazole. Outcomes.
An Unbalanced Exon-Expression qPCR-based Assay for Detection of ALK Translocation (Fusion) in Lung Cancer

An Unbalanced Exon-Expression qPCR-based Assay for Detection of ALK Translocation (Fusion) in Lung Cancer

Authors: Rama K. Singh
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Abstract

Non-Small Cell Lung Cancer (NSCLC) constitutes 85-90% of all lung cancer. Accurate diagnosis and selection of targeted therapies in lung cancer depends on robust detection of the molecular events that underlie its pathogenesis. Since patients having a rearrangement in the Anaplastic Lymphoma Kinase (ALK) gene respond well to treatment with crizotinib, identification of such ALK mutations is necessary for the successful treatment of NSCLC. The most common rearrangement of the ALK gene in NSCLC involves fusion with echinoderm microtubule-associated protein-like 4 (EML 4) as the upstream partner. Current testing methods for this rearrangement (IHC and/or FISH) can be very subjective due to high operator variability. They require expert interpretation by a pathologist and have a long turnaround time. The FDAapproved Fluorescence In Situ Hybridization (FISH) test has been shown to lack sensitivity and is generally acknowledged to fail to detect rearrangements in up to 60% of patients. Here, we have adapted an approach described earlier and optimized it for use with degraded RNA obtained from Formalin-Fixed Paraffin-Embedded (FFPE) sections. This method is based on the unbalanced expression of 5’- and 3’-regions (exons) of the ALK gene. It is also applicable to the detection of other cancer-relevant gene rearrangements e.g. ROS 1 or RET that result in increased expression of the 3’-kinase domain. Patients with these rearrangements have been shown to respond to crizotinib and cabozantinib, respectively. Using NSCLC cell lines we demonstrate that our method is cost-effective, reproducible, sensitive, objective, and easy to use. Unlike FISH, it does not require interpretation by several scorers and it can be performed in any clinical laboratory with access to a qPCR instrument. Here we present the protocol for the method and validation with 197 clinical samples.

Keywords: Non-small cell lung cancer. Targeted therapy. Unbalanced exon-expression. EML4-ALK rearrangement.
Modern Technology in Respiratory Medicine: Lung Ultrasonography–Is it Time for the Stethoscope to Give Up its Throne?

Modern Technology in Respiratory Medicine: Lung Ultrasonography–Is it Time for the Stethoscope to Give Up its Throne?

Authors: Taro Minami
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Abstract

The year 2016 marks the 200th anniversary of the invention of the stethoscope by Dr. Réne Théophile Hyacinthe Laennec. He was first inspired in September 1816 when he observed 2 children playing with a long piece of solid wood and a pin. He later made the very first stethoscope when he rolled a paper to listen to the heart sounds of a young woman. He further refined the instrument by constructing it with a hollow tube of wood.1 Three years later, in 1819, he published a textbook, which has been the foundation of respiratory medicine. In his textbook titled “De l’Auscultation Médiate ou Traité du Diagnostic des Maladies des Poumonset du Coeur (On Mediate Auscultation or Treatise on the Diagnosis of the Diseases of the Lungs and Heart)”, he introduced the terms that we still use in respiratory medicine, such as “rale”, “rhonchi,” or “egophony”. Laennec founded the basis of modern respiratory medicine with the invention of this remarkable tool. The stethoscope remains an indispensable tool for physicians, and not a single day passes without it being used to examine a patient. However, in the last decade, notable controversies have emerged regarding the utilization of the stethoscope.

Keywords: Modern Technology. Respiratory Medicine. Lung Ultrasonography. Stethoscope.
Pleural Diseases in Pregnancy: Aetiology and Management

Pleural Diseases in Pregnancy: Aetiology and Management

Authors: Solwayo Ngwenya
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Abstract

Pleural diseases in pregnancy can cause considerable maternal and fetal morbidity and mortality. Some like pleural effusions may be small and pose like danger or massive causing significant respiratory compromise. Others like pneumomediastinum are rare in pregnancy but can be fatal. Emergency interventions may save lives. Such interventions may include periportum caesarean section. The management of such conditions calls for the involvement of a multi-disciplinary team. Clinicians caring for pregnant women must always be well prepared to deal with any respiratory emergencies that may arise and be prepared to take prompt and bold decisions to give life-saving treatment.

Keywords: Pleural diseases. Pleural effusions. Pneumothorax. Haemothorax. Periportum caesarean section.
Diagnosis and Management of Spontaneous Pneumothorax in the Emergency Department: A Review of the
Most Current Clinical Evidence for Diagnosis and Treatment

Diagnosis and Management of Spontaneous Pneumothorax in the Emergency Department: A Review of the Most Current Clinical Evidence for Diagnosis and Treatment

Authors: Ian D. Chong
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Abstract

Background Spontaneous non-traumatic pneumothorax is a relatively common clinical presentation in the Emergency Department. The diagnosis of spontaneous non-traumatic pneumothorax has evolved from basic chest radiography to the reference standard of CT imaging. Point-of-care ultrasound is another highly sensitive diagnostic modality that has gained increasing acceptance. Finally, the treatment of this type of pneumothorax has also been rapidly changing. Objective We give an overview of the current literature regarding the definition and classification for pneumothorax. We discuss the current methods of diagnosis and management of spontaneous non-traumatic pneumothorax, which now include the promising treatment alternative of smaller pigtail thoracostomy catheters. We also discuss how a rapidly placed smaller pigtail catheter may be a viable single management option for a spontaneous tension pneumothorax. Discussion The management of spontaneous non-traumatic pneumothorax has been rapidly advancing. Viable treatment options now include observation alone, needle aspiration and placement of a small pigtail thoracostomy catheter, in addition to the use of a traditional thoracostomy tube. Conclusion Although the traditional treatment for a spontaneous non-traumatic pneumothorax was placement of a larger thoracostomy tube, this may no longer be the optimal management approach in these patients. The use of smaller pigtail thoracostomy catheters provides a viable treatment alternative to these larger catheters, and may also be used effectively as the only treatment step in a spontaneous tension pneumothorax. Placement of these smaller catheters sets the stage for potential outpatient management of pneumothorax, with increased comfort for the patient and possible cost savings.

Keywords: Spontaneous pneumothorax. Primary pneumothorax. Tension pneumothorax. Pneumothorax. Pigtail catheter. Mini-catheter. Thoracostomy. Needle aspiration. Observation. Chest tube. Emergency department.
Pulmonary Endometriosis: A Review

Pulmonary Endometriosis: A Review

Authors: Solwayo Ngwenya
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Abstract

Endometriosis is a benign gynaecological condition whereby endometrial tissue exists outside the uterus in women of reproductive age group. It occurs mainly in the pelvis and rarely extrapelvic areas such as the lungs. Pulmonary endometriosis is rare but can be life-threatening. There is active endometrial tissue in the tracheobronchial tree, lung parenchyma and lung pleura.1 Pulmonary endometriosis has four main clinical conditions namely catamenial pneumothorax, catamenial haemothorax, catamenial haemoptysis and endometrial nodules in the lung. Catamenial pneumothorax is the most common manifestation.2 Pulmonary endometriosis is associated with pelvic endometriosis and subfertility. Because of its rare phenomenon, there may be delayed diagnosis leading to serious life-threatening complications. This article aims to raise awareness amongst clinicians particularly gynaecologists about this rare but life-threatening condition. It is a benign, treatable condition and no women should die from it.

Keywords: Pulmonary endometriosis. Benign. Catamenial pneumothorax. Catamenial haemothorax. Catamenial haemoptysis. Life-threatening. Thoracotomy
Periostin Levels do not Distinguish Chronic Obstructive Pulmonary Disease Patients With Frequent and Infrequent Exacerbations

Periostin Levels do not Distinguish Chronic Obstructive Pulmonary Disease Patients With Frequent and Infrequent Exacerbations

Authors: Christian F. Clarenbach
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Abstract

Background Periostin, an extracellular matrix protein, is involved in inflammatory processes of the lung. To date, most studies have focused on periostin in asthma patients, its role in chronic obstructive pulmonary disease (COPD) is less clear and no information has been reported on blood levels of periostin in COPD patients in the context of exacerbation rates. As such, this exploratory study aimed to investigate whether periostin is helpful to distinguish between COPD patients with frequent and infrequent exacerbations. Methods We performed an examination of patients with COPD participating in a COPD cohort study in Switzerland. Periostin levels were determined in serum samples by using a commercially available enzyme-linked immunosorbent assay (ELISA) kit. Patients underwent evaluation of clinical symptoms including exacerbation rate (exacerbation defined by requiring oral corticosteroids and/or antibiotics) and lung function. In a subgroup of patients an annual follow-up was available that was considered in an additional analysis. Results Twenty six patients (global initiative of obstructive lung disease (GOLD) stage 1 none, 31% stage 2, 38% stage 3, 31% stage 4) were included in the analysis. The mean±standard deviation (SD) age of the patients was 63±5.9 years, 16 were males, 24 were smokers or exsmokers. The median (quartiles) post-bronchodilator FEV1% predicted was 36(27/57). There was no significant difference in periostin levels between patients with frequent and infrequent exacerbations. The follow-up data revealed no evidence that periostin is helpful in distinguishing frequent from infrequent exacerbators. Conclusion Our analysis performed in a small group of carefully matched COPD patients demonstrates that there is no significant relationship between exacerbation rate and periostin levels in blood.

Keywords: COPD. Periostin. Eosinophilic inflamation. Exacerbations.

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