Pulmonary & Respiratory Medicine

It was realized lately that, urbanization took a high cost by increasing the death rate due to pollution and other hazardous toxicity towards human. Air-pollution is the prime cause underlying several pulmonary diseases, which is the fourth leading cause of death in USA and India tops among the countries suffering most from the pulmonary disorders [1]. Pulmonary diseases are a spectrum of disorders affecting the lungs, such as COPD, asthma, pulmonary hypertension, and lung cancer, infections like pneumonia tuberculosis, and influenza, and many other respiratory disorders and allergies. Plethora of research has been documented prophylactic ways for pulmonary disorders and offered adequate medicinal support to eradicate several lung deathly infections from the world like TB, Pneumonia etc. Taking the fact in mind the present Journal of ‘Journal of Pulmonary & Respiratory Medicine’ showcased some interesting case studies like-lung carcinoma metastasizing to the appendix, cardio vocal syndrome manifesting as a symptom of pulmonary hypertension, assessment of the sociodemographic features of Tuberculosis patients, assessment of TB related knowledge among the patients, a follow-up study on multidrug resistant tuberculosis (MDRTB), markers delineating the severity of Progressive lung diseases, and assessment of allergic reactions to Trimethoprim- Sulfamethoxazole (TMP-SMX).

Objectives: To evaluate the respiratory muscle strength among children (<10 years old) and adolescents with asthma.

Methods: This is a cross-sectional, retrospective study, among children and adolescents (7 years to 14 years of age) with asthma. Maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) [in cmH2O] were measured through digital manometer. The variables evaluated were: gender, age, BMI (body mass index), severity of asthma, use of inhaled corticosteroid (IC).

Results: A total of 48 individuals were studied. MIP values were according: a) normal weight=69.5 ± 22.6; overweight=81.6 ± 25.4 (p<0.088); b) use of inhaled corticosteroid=70.5 ± 23.0; no use=25.1 ± 86.3 (p<0.045). MEP values according: a) ages 7-9 years=78.8 ± 19.4; 10-14 years=68.1 ± 22.7 (p<0.097); b) normal weight=66.1 ± 18.9; overweight=80.3 ± 23.3 (p<0.024); c) use of inhaled corticosteroid=68.3 ± 18.3; no use=83.1 ± 27.5 (p<0.036); d) with bronchiectasis=61.8 ± 19.2; without bronchiectasis=83.1 ± 27.5 (p<0.069).

Conclusions: Patients who used inhaled corticosteroid had MIP and MEP lower than the others; patients with normal BMI tended to have lower MEP than the overweight group and lower MIP in the group of normal weight. There was a tendency of adolescents to present lower MEP than children.

Background: We present 4 cases of alveolar hemorrhage in patients receiving rivaroxaban. While bleeding is a common complication of rivaroxaban therapy reported by multiple case reports in the literature, this complication is not frequently reported. There were two cases of alveolar hemorrhage related to rivaroxaban found in our literature search. Alveolar hemorrhage is a potentially fatal complication and must be promptly recognized.

Case Presentation: The electronic medical record was reviewed for patients with alveolar hemorrhage syndromes admitted to our hospital between July 1, 2014 and June 30, 2015. This data was cross referenced for patients received anticoagulant medications.

Our series of patients included one patient with underlying Antiphospholipid Syndrome (APS) and systemic lupus erythematous, another patient with pulmonary malignancy and distant lung resection, a third patient with lymphangioleiomyomatosis, and a fourth patient with myelodysplastic syndrome. Rivaroxaban accounted for 13.6% of all cases of clinically significant pulmonary hemorrhage and drug related pulmonary hemorrhage accounted for half of cases. The rate of alveolar hemorrhage associated with Rivaroxaban in our institution was about 3 cases in 1000.

Conclusions: We identified four cases of rivaroxaban associated alveolar hemorrhage. We encourage cautious use of rivaroxaban in patients with underlying lung conditions or factors that predispose to alveolar hemorrhage. Further research to clarify the risk of diffuse alveolar hemorrhage (DAH) in at-risk patients receiving oral anticoagulants is recommended.

Acute respiratory distress syndrome, also known as diffuse alveolar damage, is an acute injury to the lungs. Patients experience severe shortness of breath and require mechanical ventilation. It is not a specific disease, but an acute lung dysfunction associated with a variety of disorders: pneumonia, shock, sepsis, and trauma. A similar lesion occurs in newborn infants, called hyaline disease of the newborn. It occurs in premature babies and has the same pathophysiological mechanism as acute respiratory distress syndrome. Hyaline membranes are a pathologic feature of acute respiratory distress syndrome, consisting of basophilic structures that coat alveolar surfaces. They prevent oxygen exchange and are the basis of the lethality of this disorder. The syndrome is associated with very high levels of hyaluronan in broncho-alveolar lavage specimens. We postulate that the hyaline membranes of acute respiratory distress syndrome are hyaluronan-rich structures associated with serum hyaluronan-binding proteins such as fibrinogen and fibrin. Potent infectious influenza viruses are recurrent pandemics and potential terrorist threats. Lethality of influenza infection correlates with the presence of hyaline membranes. Installation of hyaluronidase as an aerosol would provide a new treatment for acute respiratory respiratory distress syndrome, for which there has been no new treatment in 45 years. The pig is the only species other than humans that develop hyaline membranes. Employing this treatment in the porcine model would provide a direct test of the hypothesis.

Acute pulmonary embolism is a common diagnostic challenge across the all hospitals in the US. Diagnosis can be delayed due to a number of variables including, but not limited to, the diagnostic time in medical imaging. The presented algorithm offers a solution to such delays by allowing treating physicians an accurate preliminary report. This gained time advantage should translate into a faster treatment response by the ED team. Moreover, the algorithm is designed to accurately depict pulmonary artery and veins and accounts for respiratory artifact during scan acquisition. As second and third pass search is initiated, the algorithm continues to “learn” upon the subsequent pass. Hence, each application is produces greater diagnostic accuracy. We hope this abstract clearly outlines how the latest developments in machine learning algorithms can aid in diagnostic fidelity of acute embolic events.

Amoebiasis is the third leading cause of mortality due to parasitic infection worldwide after malaria and schistosomiasis. The direct pulmonary Entamoeba histolytica is rarer than reactive events called “neighborhood”. We report the role of imaging in the diagnostic orientation in a case of amoebic pleuropulmonary damage (associated with serology and parasitology). Before an excavated pulmonary lesion, imaging can be a great contribution in the working diagnosis of pulmonary parasite Entamoeba histolytica.

Background: FOB is an invasive procedure. It is costly, and is not widely available in the developing countries. In resource poor settings, where transmission of TB is high, sputum induction with hypertonic saline can be useful in adding to the diagnostic yield.

Materials and Methods: A prospective study conducted from 2015 to 2016, comprising of 100 patients fulfilling study criteria. Patients with respiratory symptoms and CXR showing suspicious of pulmonary tuberculosis and in whom two sputum smear samples ( Morning and Spot) were negative for acid fast bacilli were included and at randomly divided into 2 groups of induced sputum and bronchoscopy. Sputum induction was done by using 3 ml of 3% hypertonic saline through nebulizer and bronchoscopy was performed under local anesthesia.

Results: Out of 100 patients, 60 were in induced sputum group and 40 in bronchoscopy group. Induced sputum smear examination detected acid fast bacilli in 27 patients (45%) and acid fast bacilli detected from BAL in 26 patients (65%). Though the diagnostic yield with induced sputum was inferior to FOB, but looking to the cost effectiveness, safety and practical applicability of induced sputum, it can be used in patients of all age groups, new and retreatment suspected cases of initial sputum negative pulmonary tuberculosis for the diagnosis even at peripheral health centers.

Background: Body composition assessment has become increasingly popular in clinical and research areas. But any body composition measurement technique that is used in both clinical and research settings should be reliable and valid. Objectives: Our first aim was to compare predicted thoracic gas volume (Vtgpred) with measured thoracic gas volume (Vtgmeas) using the BOD POD in people living with HIV/AIDS (PLWHA) in Southwest Ethiopia. The second aim was to determine the effect of thoracic gas volume (Vtg) measurement ways on estimation of body fat (BF) using the BOD POD in PLWHA in Southwest Ethiopia. Method: Cross-sectional study was conducted on 68 PLWHA who had follow up at Jimma University Specialized Hospital (JUSH). Subjects were collected using convenience sampling technique. Agreement between the methods was tested using paired t-test, Pearson’s correlation, linear regression, and Bland-Altman plot. Result: Much percent of study subjects were malnourished (60.3%). Vtg and percent body fat (%BF) did not differ significantly (p>0.05) between the two modes of assessment (predicted and measured). Strong correlation was observed between Vtgpred and Vtgmeas (r=0.82, p<0.001). Correlation between predicted %BF (%BFpred) and measured %BF (%BFmeas) was also strong(r=0.92, p<0.001). The regression of Vtgmeas(Y) against Vtgpred (X) (Y=- 0.369+1.140X, R2=0.68, SEE=0.015) did not significantly deviated from the line of identity. Similarly, the regression of %BFmeas (Y) against %BFpred (X=1·70+0.94X, R2=0·96) did not significantly deviated from the line of identity. Bland- Altman plot of the differences against the mean of Vtgpred and Vtgmeas and the differences against the mean of %BFpred and %BFmeas showed no systematic differences. Conclusion: The BOD-POD is a reliable technique to predict Vtg and body composition in PLWHA in Southwest Ethiopia. Therefore, researchers and clinicians can confidently use the predicted Vtg and body fat in place of the measured ones in PLWHA in Southwest Ethiopia.

The current study reports the case report of a 67-year-old gentleman who presented in our institute with complaints of shortness of breath and cough for last 8 months. He was working in a steel industry with continuous exposure for almost 40 years. On evaluation further, he was diagnosed to have occupational lung disease which was mimicking sarcoidosis and lymphoma.

Sequestered lung is a discrete mass of lung tissue, where airways do not connect with the rest of the tracheabronchial tree, and that receives its blood supply from a systemic artery rather than a pulmonary one, while sometimes maintaining normal venous drainage to the heart. Abnormal feeding arteries have been reported from the thoracic and abdominal aorta, celiac trunk, coronaries among others. In this article we describe a patient with left lower lobe sequestration supplied by a peculiar infra-diaphragmatic artery.