Pulmonary & Respiratory Medicine

We report a case of atypical endocarditis for which the transmission mode has long been debated among cardiac surgeons, microbiologists, and infectious disease specialists. This is the first reported case of Streptococcus agalactiae being responsible for the probable sexually transmitted case of endocarditis in a healthy, 49-year-old female.

Keywords

S. agalactiae; Infective endocarditis; Aortic valve

Secondary pneumothorax commonly encountered and it often recurs or becomes a refractory to treatment. Pleurodesis is usually selected for initial treatment in community hospitals. Recently, endobronchial intervention using the endobronchial Watanabe spigot and endobronchial valve for refractory pneumothorax has become available, but these procedures can be performed only at a few institutions with sufficient staff and equipment.

The use of a glucose solution for pleurodesis has been reported as a novel approach to persistent air leakage. Pleurodesis with a 50% glucose solution was occasionally empirically performed in community hospitals. However, only limited literatures have published. Here, I report the experience of five patients (4 men and 1 woman; 71 years to 84 years old), seven times with inoperable secondary pneumothorax who received pleurodesis with a 50% glucose solution. In our cases, two of them had pneumoconiosis, one had chronic obstructive lung disease (COPD), one had interstitial pneumonia (IP) and one had lung cancer. The procedure successfully stopped air leakage and allowed chest tube removal (4 days to 10 days) in three patients without severe complications. Same as previous report, temporary hyperglycemia occurred in three patients. Therefore, pleurodesis with a 50% glucose solution suggested possibility that a feasible and safe. Despite future large-scale studies should aim to examine the efficacy and tolerance of this technique, it would be beneficial to obtain the alternative agent of pleurodesis for patients with inoperable secondary pneumothorax and rural hospitals.

Introduction: Smokers claim that smoking increases their concentration, alertness, and overall mental performance. On the contrary, evidences point at gradual cognitive deterioration in smokers. Montreal cognitive assessment (MoCA) assesses even mild cognitive impairment.

Objective: To determine and compare the cognitive status in smokers and healthy controls.

Method and Materials: A cross-sectional comparative study was done in 46 apparently healthy male healthscience students (23 smokers and 23 nonsmokers) at Pulmonary Function Lab in the Department of Basic and Clinical Physiology, BPKIHS. Pulmonary function tests (PFT) were measured. For cognition assessment MoCA, which is a set of close ended questionnaire was used. To assess smoking status and MoCA score, Mann Whitney U test was employed and data are expressed in median and IQR. Fisher’s Exact Chi-square Test was applied to observe association between smoking and cognition. Level of significance was p<0.05.

Results: All PFT variables, compared between smokers and non-smokers yielded non-significant differences (VC: 3.97 (3.53-4.76) vs. 4.26 (3.83-4.66) p=0.709; FEV1: 3.81 (3.47-4.71) vs. 4.17 (3.58-4.44) p=0.775; FEV1/FVC: 98.09 (95.72-99.09) vs. 95.3 (92.5-98.2) p=0.202). The comparison of MoCA score between the two groups (26(25-27) vs. 27(26-28) p=0.192 as well as the association between smoking and cognition was non-significant.

Conclusion: Young healthy smokers without any pulmonary function abnormalities had cognition state similar to non-smokers. Therefore, there is no association of smoking on cognition in apparently healthy young adults.

Background: Lung cancer most common worldwide cancer, early diagnosis makes effective treatment in lung cancer. Liquid Based Cytology (LBC) for non-gynae specimens has gained popularity over conventional Cytology (CS) during last one decade because of increased sensitivity and specificity.

Aim and objectives: To assess the diagnostic utility of LBC versus CS in fine needle aspirates of lung and mediastinal mass lesions. Compare cyto-morphological parameters in terms of adequacy, interpretation, concordance and diagnostic efficiency.

Materials and Methods: Eighty -two cases suspected of lung or mediastinal mass lesions underwent imagine guided Transbronchial Needle aspiration (TBNA) or Trans Thoracic Needle aspiration (TTFNA). Fine needle passes were made for both conventional and LBC smears. All smears were examined and diagnosis was correlated in each case with histopathology as gold standard for final diagnosis. Results: Histopathology of 82 cases, 21 were non -neoplastic and 61 were malignant respectively.34 cases of adenocarcinoma, 15 cases of squamous cell carcinoma, 5 cases of adenosquamous cell carcinoma, 4 cases of small cell carcinoma, 1 cases of poorly differentiated 1 case of carcinoid and 1 cases of germ cell tumor. LBC were diagnosed 17 non -neoplastic and 54 were malignant respectively. 25 cases of adenocarcinoma, 11 cases of squamous cell carcinoma, 5 cases of adenosquamous cell carcinoma and 3 cases of small cell carcinoma, CS was diagnosed 4 non -neoplastic and 37 were malignant respectively. 24 cases of adenocarcinoma, 7 cases of squamous cell carcinoma, 4 cases of adenosquamous cell carcinoma and 2 cases of small cell carcinoma.

Conclusion: Concordance of LBC with histopathology was found in higher proportion (72%) as compared to conventional smear (48.8%) (p=0.004), because percentage of adequacy for LBC (85.37%) was higher as compared to CS (56.1%) (P<0.001). The assessment of all the morphological parameters were predominantly equal in both methods except in few cases.

Introduction: The inhalation route is the best choice for respiratory drug delivery, but benefits to patients are strictly related to the proper use of inhalers. The role of patients’ view point (such as: their intuitivity, preference, acceptance, and satisfaction) were extensively investigated, even if other factors, unrelated to their personal beliefs, can further affect inhaler usability.

Aim: to define a specific tool for easily assessing, ranking, and comparing the real usability of whatever inhaler by a single, comprehensive score, also based on objective measurements.

Methods: A specific, anonymous questionnaire was validated. The Questionnaire consists of four main sections (Introductory; Assessing Track; Global Score calculation, Patient’s personal data). Questions are twenty-seven, all scored: twenty-two addressed to the patient, and five to the expert nurse, who has to conduct the independent assessments. The sum of the eight sub-scores of the Assessing Track will represent the final Global Usability Score- GUS, which ranges 0-50 points for each inhaler; higher the GUS value, higher the real usability will be.

Results: the comprehension of all questions at their first reading was >97% in the final version of the GUS Questionnaire, for both patients and nurses participating to the questionnaire development.

Discussion: usability of inhalers is a complex and multifaceted issue. When assessing usability, it should be taken into account that the role of patients’ beliefs differently integrates the role of other objective determinants which are unrelated to the sole patients’ viewpoint. Terms like intuitivity, preference, acceptability, or satisfaction should not be used as synonyms for usability, because too related to the patients’ subjectivity only.

Conclusions: the Global Usability Score represents the first comprehensive score for assessing, ranking, and comparing objectively the contribution of all main components of inhaler usability, and then provide an effective and motivated standard of choice.

Congenital bronchial atresia (CBA) is a rare airway anomaly resulting in termination of a bronchus into a blind pouch with associated mucoid impaction and segmental hyperinflation. The etiology of CBA is related to vascular insufficiency to the bronchial bud during embryologic development. Controversy exists regarding the best approach to treatment for CBA and relating symptoms to the presence of these anomalies can be challenging. This case series describes three patients with varying approaches to diagnosis and treatment of CBA.

Pulmonary hypertension (PH) is a haemodynamic and pathophysiological condition defined as an increase in mean pulmonary arterial pressure (PAP) ≥ 25 mmHg at rest as assessed by right heart catheterization. We report a patient with severe pulmonary hypertension after repair of ventricular septal defect. The patient underwent laparoscopic cholecystectomy. The purpose of this case was to discuss the perioperative management of a patient with severe pulmonary hypertension who underwent laparoscopic cholecystectomy which could provide a reference for the management of these patients in the perioperative period.