Pulmonary & Respiratory Medicine

Background: Tobacco use is one of the greatest threats for public health. The future prosperity of the tobacco industry depends directly on the youth’s tendency to experiment.

AIMS: The aim of the study was to examine the prevalence of cigarette smoking and the tobacco consumption among school children between age 11 and 15, to examine the knowledge regarding what harmful effects tobacco smoke has on health and to assess the extent of exposure to tobacco smoke in the home environment.

Study design/Methods: The testing is a cross-sectional study conducted on students of upper grade levels in primary school “Miloje Čiplić” in Novi Bečej, Serbia in 2012. A total of 220 school children were tested. Upon verbal instructions they filled in a questionnaire containing 24 questions, designed after the model by a joint survey of the Center for Disease Control and Prevention and the World Health Organization.

Results: Of all respondents, 35% of students have already smoked their first cigarette, and 5.9% of them were everyday smokers. Thirty-two point seven percent of the children came from families where both the mother and the father were non-smokers, 24.1% of the them had both their parents smoking, 16.4% came from homes where the father was the only smoker and 20% where the mother was the only smoker. In 3.6% of cases someone else in the family was the smoker. 56.7% of the children were exposed to smoking in their homes and 74.5% of students were occasionally exposed to tobacco smoke because their guests were allowed to smoke. 25.5% of the students thought smoking was a disease. 44.5% of schoolchildren knew what secondhand smoking was, while 17.7% of students thought that it meant smoking in company of their friends, 6.4% thought it was occasional smoking. Of all children 27.3% stated they did not know what secondhand smoking was.

Conclusion: In this study it has been shown that a large percentage of surveyed schoolchildren between 11 and 15 years old have tried cigarettes, and the number of daily smokers is worryingly high.

Ten patients suffering from COPD were included in the 60 days study. They were administered ipecacuana and songia tosta naturally found. Ipecacuanha contains the pseudo-tannin or cephaëlic acid and the alkaloids emetine (methylcephaeline) and cephaeline. The plant based preparations were used with good efficacy with 100-110 ug of emetine. It expels the phlegm or liquefies and facilitates the mucous to expel out for the relief of congestion in chest/ lungs. The cephaline also facilitates in mucous expulsion. The lung functional efficacy is improved with solution of Spongia tosta because it has been used in several ailments. It contains Avarol that inhibits inflammatory responses like tumor necrosis factor-alpha (TNF-alpha). The combination of both natural drugs give a synergistic effect to cop up the Emphysema (might be major cause of short breath in COPD) and mucolytic effect along with bronco-dilatation for the symptomatic relief of the COPD patient. Still the role of natural drugs is not clear and it needs further investigation on latest diagnostic tools for the better treatment and quality of the life of the COPD patients.

The use of noninvasive ventilation and noninvasive continuous positive airway pressure by mask has increased substantially. The main indications are exacerbation of chronic obstructive pulmonary disease (COPD), cardiogenic pulmonary oedema, trauma, pulmonary infiltrates in immunocompromised patients, and weaning of previously intubated stable patients with COPD. In this mini-review article, we summarize the results of various studies in which noninvasive ventilation was applied and discuss the role and efficacy of noninvasive ventilation.

During pulmonary embolism, the physiology of the ventilation and the perfusion is damaged. A sudden massive increase of the intrapulmonary shunt might result if the clinical setting is not adequately implemented to regulate the inflammatory process. For this reason, the protection of the ventilation and the tracheal gas insufflation are useful tools in modulating the injury, and the hypercoagulability caused by protein C and S and the deficiency of antithrombin lll. All caused by the damage of the endothelial barrier, therefore gives origin to interstitial leakage, tissue damage, inflammation, and apoptosis.

A significant proportion of cases of tracheobronchial foreign body aspiration due to life-threatening condition is observed during childhood and still one of the most common pediatric emergencies. We report the case of a 4 year-old male child who aspirated a shaped metallic foreign body placed in his mouth while playing magic in school, highlighting prevention via parental education and avoidance of objects that produce the greatest risk with children. The clinical presentation was cough, sputum and chest pain which was relieved almost instantly after aspiration. Early diagnosis and treatment with rigid bronchoscopy under general anesthesia should be performed by experienced personnel in patients suspected of foreign body aspiration to avoid life threatening respiratory sequelae. There is a need of exercise caution by parents in the handling of their children.

Fibrobronchoscopy is commonly considered a safe procedure with a low major complication rate not including cerebral arterial gas embolism (CAGE) a severe life threatening iatrogenic complication. Several cases of transbronchial needle aspiration (TBNA) has been related with CAGE when patient happens to have the high airway pressure that exceeds the pressure of the pulmonary veins allowing the air to enter the systemic circulation through the left heart. HBOT is the only effective treatment available for CAGE that provides 100% oxygen at high pressure, which accelerates nitrogen reabsorption and improves oxygenation of ischemic tissue.

We reported a case of successful treatment with full recovery after early Hyperbaric Oxygen therapy of CAGE induced by an uneventful transbronchial biopsy during fibrobronchoscopy.

Meig’s syndrome is a rare syndrome that consists of a benign ovarian tumor accompanied by ascites and pleural effusion. Elevated serum carbohydrate antigen 125 (CA 125) levels in postmenopausal women with solid adnexal masses, ascites and pleural effusion are highly suggestive for malignant ovarian tumors.

Patients with Meig`s syndrome have a benign disease, with good prognosis, but can also have elevated serum CA 125 levels. The authors present a case report of Meig’s syndrome caused by a fibro thecoma with elevated CA 125 levels in a postmenopausal woman. That is a rare cause of pleural effusion, which is interesting because of its diagnosis and clinical course. The authors will also discuss the pathophysiology of this disease.

Although COPD occurs predominantly in smokers, non-smokers also develop COPD. In the past decade and especially the past 5 years, results from a growing number of published studies have suggested that risk factors other than smoking are strongly associated with COPD. The aim of the present study is to explore the different causes of non-smoker COPD patients getting treatment from Pulmonary Medicine department and to compare the demographic incidence of COPD in non-smokers in rural & urban areas.

It’s a study of 126 patients who came to pulmonary medicine department with breathlessness and cough. Every patient underwent spirometry and diagnosis of COPD got confirmed by post bronchodilator FEV1/FVC. Detailed history was taken regarding various risk factors leading to COPD, like biomass exposure, environmental tobacco smoke exposure, occupational exposure, outdoor and indoor air pollution, long standing bronchial asthma, history of pulmonary tuberculosis and associated co-morbidities.

In this study we found out that the exposure to biomass smoke is the most common aetiology of non-smoker COPD, followed by environmental tobacco smoke. Females are affected more than males. Non smoker COPD is more common in rural population than urban population.

Objective: Non parenchyma lung disorders are rare entity with life threatening outcome. Early surgerical intervention is the clue for life saving and avoid life threatening complications.

Methods: From Aug 2008 to dec 2014, 101 cases operated in Zagazig University Hospital for congenital non parenchyma disorder data are collected regarding preoperative, intra operative and post operative results.

Results: The mean age of our patients was 27 month (1 week - 120 month). F\M 61\40. Mean symptom is respiratory distress and frequent chest infection. Tracho-esophygeal fistula 24 cases, Congenital diaphragmatic hernia 17, Diaphragmatic event ration 6, congenital lobar emphysema 37, cystic adenomatoid malformation (n=9), pulmonary sequestration (n=7) and arteriovenous malformation (n=1).

Conclusion: Early surgerical intervention for parenchyma and non parachyanma l disorder is the primary curative to avoid life threatening complications.

Bronchial-associated lymphoid tissue (BALT) lymphoma is a distinct subgroup of low-grade B-cell extranodal non- Hodgkin’s lymphoma, classified as marginal-zone lymphoma. This study was performed in order to assess the natural history of this rare entity. We evaluated retrospectively the clinical, radiological and histological features and to discuss the optimal management and prognostic factors through a literature review, of 4 patients with biopsy-proven BALT lymphoma collected at department of pathology of Erasme from 2010 to 2014. The group of four patients included tree women and one man, with a median age of 69 years (Range: 45-84 years). One of 4 patients presented fever chest pain within bronchopneumonia, other patients were asymptomatic with an incidental finding after preoperative radiological assessment.

Computed tomography (CT), which is more sensitive than standard radiography, has demonstrated that the lesions are unilateral (n=3) and multiple (1 patient), without lymph node enlargement. All of our patients has a thoracoscopy diagnosis and therapeutic. Macroscopy: whitish lesions poorly defined. Microscopy: MALT lymphoma low grade (CD20 +, bcl2+). All of our patients have just a local treatment without chemotherapy and three were alive after a follow extended.

Background: Asthma is frequently misdiagnosed. Peak expiratory flow (PEF) measurement is easy and very useful for asthma diagnosis in primary care.

Objectives: The DIANA project aimed to assess the impact of a course on PEF measurement among primary care physicians in Spain.

Methods: A 7-item questionnaire was sent to selected primary care physicians (Phase A). Respondents were then invited to take a web-based course on PEF in asthma diagnosis. Finally, the questionnaire was again sent to all physicians (Phase B). Questionnaires also asked for demographical data such as age, sex, speciality, route of access to speciality, and geographical area. A comparative statistical analysis was performed on the results of both questionnaires. An extended analysis was performed later. Answers were analysed by percentages and using McNemar’s test. The planned duration of the project was one year.

Results: No statistically significant differences in percentages between the two phases were found for Items 1 (related to asthma diagnosis) and 4 (related to availability and use of PEF meter). However, for Item 2 (related to diagnosis of occupational asthma) differences were significant (p<0.05), with an odds ratio (OR) of 1.50 for those participating in Phase B. Differences were also significant (p<0.05) for those who took the course, with an OR of 1.37. For Item 3 (related to the usefulness of measuring daily variability of PEF), there were also significant differences (p<0.05) between the two phases, with an OR of 1.39. There were also significant differences (p<0.05) for those who took the course, with an OR of 1.53.

Conclusions: The first four results of the survey showed that educational intervention may improve knowledge of the usefulness of PEF in asthma diagnosis among primary care physicians. However, the high percentages of correct answers among those who did not take the course merit further investigation.

Foreign body aspiration generally presents with choking, difficulty breathing and wheezing. We present a case of an 18-year-old male with a normal physical examination after aspirating a metal nail that was confirmed on chest radiograph. Flexible bronchoscopy was unsuccessful and bronchoscopy under general anesthesia was done to retrieve the metal nail. Diagnosis can be accomplished by history, physical exam and radiological evaluation which includes chest radiograph and chest CT. Treatment consists of removal of the object by flexible or rigid bronchoscopy. Complications of foreign body aspiration arise primarily as a result of missed diagnosis or failure to present in a timely manner resulting in delayed removal of the object.

Objective: The decision to withdraw ventilator support for terminal patients is difficult for health professionals and patients’ surrogates. Some intensive care unit physicians attempt to discuss the issue with surrogates. This retrospective study aimed to explore current dilemmas of ventilator withdrawal.

Methods: This is a retrospective review and analysis of medical records of terminal patients receiving ventilator support. The medical records of thirty-eight terminal patients who had received palliative care consultation for ventilator withdrawal at the National Cheng Kung University Hospital from August 2007 to January 2014 were reviewed retrospectively. Patients’ characteristics, including age, gender, diagnosis, withdrawal medications for symptom relief, and period from withdrawal to death, were analyzed.

Results: Thirteen patients were withdrawn from ventilator support and seven were weaned successfully. Eight surrogates signed consents for ventilator withdrawal, but patients died before withdrawal. Patients median age at withdrawal was 75 years (range: 53~80 years), and 46% had terminal cancer. The median period from withdrawal to death was 1.17 hours (range: 0.1~80.92 hours). Withdrawal was performed by palliative care physicians (23%), and 77% of withdrawal was performed in the intensive care unit.

Conclusion: Family conference, good symptom control and psychosocial support are necessary for surrogates’ ventilator withdrawal decisions. Encouraging more health care professionals to establish shared decision-making relationships could reduce the application of futile medical treatment.

Primary pleural thymomas are rare tumors often mistaken for malignant mesothelioma clinically and radiologically. The present study reports the case of a 39-year-old woman presented with a pleural tumor in the right thorax. The tumor was surgically resected and histopathologically diagnosed as ectopic primary pleural thymoma lacking any evidence of a médiastinal tumor. The clinicopathological futures of this unusual thymoma are also discussed.