Pulmonary & Respiratory Medicine

Introduction: Ventilator-associated pneumonia (VAP) occurs in 9.0% to 27.0% of patients on mechanical ventilation (MV) and has a global mortality rate of 13.0%. VAP is the most frequent infection acquired in the intensive care unit (ICU) among patients submitted to this ventilatory support, resulting in mortality rates’ ranging from 20.0% to 70.0%, with the use of antibiotics is presented in the literature as the most effective prophylactic measure.
Objective: The primary objective of this study was to review national and international scientific literature on preventive measures and pneumonia associated with mechanical ventilation. The secondary objective was to discuss the efficacy of preventive measures for ventilator-associated pneumonia.
Methods: After literary search criteria with the use of Mesh terms: pneumonia, antibiotics, prophylactic antibiotics, mechanical ventilation, patients at risk, major care, contamination and clinical trials and use of the bouleanos “and” between mesh terms and “or” among the historical findings. In the main databases such as Pubmed, Medline, Bireme, EBSCO, Scielo, etc., a total of 56 papers that were submitted to the eligibility analysis were cross-checked and after that 21 studies were selected, following the rules of systematic review-PRISMA.
Results: The results suggest that the use of intravenous and technological support that the surgical patient needs on the day of ICU admission is a risk factor for the development of VAP, as well as the prior use of antibiotics. In addition, the results confirm that VAP significantly increases the mechanical ventilation time and the time of ICU injection. Conclusion: EPI is an important cause of increased morbidity and mortality in severe ICU patients. Enteral nutrition was an important risk factor and previous use of antibiotic protection factor for the development of VAP. Studies to determine incidence and risk factors are useful in guiding the implementation of measures to improve diagnostic accuracy and to implement preventive measures.

Background: Diabetes mellitus (DM) is documented as an important risk factor to tuberculosis (TB). Lao PDR has high TB burden, along with increasing DM prevalence. There are inadequate data on prevalence of DM among TB cases in Lao PDR and lack of data about the effect of DM on treatment outcomes of TB.

Objective: To determine prevalence of DM among TB patients admitted to the Pulmonary Department, Mahosot hospital, Lao PDR, to describe the socio-demographics and others factor associated with TB-DM co-occurrence and to compare the clinical features and treatment outcomes between TB with and without DM patients.

Methods: Using a retrospective design, 199 active TB diagnosed at the Pulmonary-Tuberculoisis Ward, Mahosot Hospital, Lao PDR between February 2015 to August 2016 that met the study criteria were selected. Data regarding socio-demographic characteristics, factors associated with TB-DM co-occurrence, clinical and laboratory parameters, drug susceptibility and treatment outcomes were compared between TB patients with DM and those without DM.

Results: Of the 199 patients, 48 (24.12%) had DM, of which 33 (68.75%) previously diagnosed, 15 (31.25%) new diagnosis at TB diagnosis. On baseline characteristics found that mean age of participating was 52.56 (SD=18.88) years, TB with DM were significantly older than TB  without DM with p=0.007, male patients were more than female (69% vs. 31%), Government staff with TB-DM was higher proportion than those without DM (41.67% vs. 23.84%, p=0.05), patients with family history of DM shown diagnosed DM higher than those without family history of DM (25.00%) vs. 11.26%, p=0.005). While, alcohol consumption and smoking was not significant differed between both groups, weight loss >5% of TB patients with DM was significantly lower than those without DM (25.00% vs 41.06%, p=0.04). TB with DM patients presented cavity on chest radiograph significantly higher than those without DM (91.67% vs 78.15%, p=0.03), sputum AFB conversion at month 2 after treatment shown TB with DM significantly lower than those without DM (43.75% vs. 61.59%, p=0.03). Cured rate of TB with DM patient was significantly lower than TB-non DM (58.33% vs. 74.17%, p=0.036).

Conclusion: Screening for DM in TB patients would help for its early detection and a good control plasma glucose levels to improve the treatment outcomes of TB patients.

Sarcoidosis is an inflammatory granulomatous disease with diverse clinical manifestations. Neurological manifestations occur in minority which can mimic many other pathologies. Sarcoid peripheral neuropathy is a heterogeneous group comprising many different clinical patterns. Acute demyelinating type of polyneuropathy masquerading Guillain-Barre Syndrome (GBS) can rarely occur due to sarcoidosis. We report a 50 year old female with recent onset symptoms of sarcoidosis developing acute demyelinating polyneuropathy mimicking GBS. Distinction between both conditions is important for appropriate management. However, this can be challenging in clinical practice.

As health implications of frequent and/or inadvertent exposure to poor quality air rises in humans, studies have ranked Nigeria with highest incidences of natural gas flaring across the globe; asserting her to contribute about 46% of overall gas flaring in Africa. With numerous known flaring sites within the country, this study compares markers of cardiovascular and respiratory functions in residents of Oben, Oshi, Ibeno, Ogbia and Agbaro-Otor Communities; common flaring sites within the Niger Delta States of Edo, Rivers, Akwa Ibom, Bayelsa and Delta; south-south Nigeria respectively. A stratified random sampling technique was used to ethically recruit one thousand and eight (1008) participants from across selected communities. Following gender-sorting and obtaining of socio-demographic records (by a questionnaire) of subjects, cardiovascular and respiratory variables (respiratory rates, peak expiratory flow rate, pulse rate, systolic and diastolic blood pressures) were obtained and compared between communities, depending on duration of exposure to gas flaring. With p-value set at .05, one-way analysis of variance (ANOVA) proved that prolonged exposure to gas flaring increased mean blood pressure with a decreased mean peak expiratory flow rate across sampled communities. Gender-dependent variation was also seen to vary across communities, implying that gas flaring impact is gender and duration dependent. Similar, but more sophisticated approach is recommended for other areas in Nigeria with high incidences of gas flaring.

ARDS: Adult Respiratory Distress Syndrome; CXR: Chest X-ray; DF: Dengue Fever; DHF: Dengue Haemorrhagic Fever; DIC: Disseminated Intravascular Coagulation; DSS: Dengue Shock Syndrome; ECG: Electrocardiography; GIT: Gastrointestinal Tract; ICU: Intensive Care Unit; PE: Pulmonary Embolism; Rt: Right; RVH: Right Ventricular Hypertrophy; SOB: Shortness Of Breath; TWBC: Total White Blood Count; WHO: World Health Organization

Introduction: The association of reduced lung functions and diabetes mellitus has been described for many years suggesting that the lung could be a target organ in diabetes mellitus. Chronic obstructive Pulmonary Disease is considered as a disease that goes beyond lung involvement giving it an expression of multisystem inflammatory disease. Diagnosis of Chronic Obstructive Pulmonary Disease in diabetics may have difficulties due to superimposition of restrictive abnormality associated with diabetes mellitus.
Aim: To study pulmonary function test in type 2 Diabetics and in COPD with type 2 Diabetes.
Materials and Methods: The study was conducted in Department of Pulmonary Medicine at Dr. Shankar rao Chavan Govt Medical College, Nanded. After inclusion criteria were met, patients were divided into 3 groups (40 type 2 diabetes with COPD (Group A), 40 type 2 diabetics (Group B), and 40 healthy controls (Group C) who are nonsmoker and having no history of any acute or chronic respiratory illness.) which underwent clinical evaluation and spirometry was performed.
Results: The spirometric parameters shows that among 40 patients of DM with COPD 22 (55%) had restrictive, 12 (30%) had obstructive,06 (15%) had mixed and 0 patients were normal and among 40 patients of DM 26 (65%) had restrictive,06 (15%) had obstructive,06 (15%) had mixed and 02 (05%) patients were normal spirometric findings. We also compared duration of diabetes with spirometric findings (FEV1, FVC, FEV1/FVC) in both the groups so we found no correlation between them (p>0.05).
Conclusion: The finding in our study proved that patients with type 2 DM with COPD showed additional restriction pattern on spirometry with compared usual obstructive pattern, also further we found that in patients with Type 2 DM we also found restrictive pattern. So we can conclude that DM being a systemic disease, also affects lung causing restrictive type of ventilatory changes. The restrictive changes probably because of glycosylation of connective tissues reduced pulmonary elastic recoil and inflammatory changes in lungs.

Chylothorax is the accumulation of lymphatic fluid (chyle) in the pleural space, as a result of obstruction, injury or leakage of the thoracic duct or one of its tributaries. The frequency of causes of chylothorax depends on the type of hospital and the population served but there are few reports of this complication in people with end- stage renal disease and the outcomes with different interventions. We report the case of a 35-years-old man from a low-altitude agricultural community in northwest Nicaragua, diagnosed with end-stage chronic kidney disease (CKD) of nontraditional etiology three months before admission who developed chylothorax after dysfunction of central venous catheter (CVC) at the right internal jugular vein for hemodialysis. After multidisciplinary approach, we found no cause of the chylothorax other than pulmonary Aspergillosis with mediastinal adenopathy and possible external pressure to the thoracic duct as a mechanism similar described in pulmonary tuberculosis, sarcoidosis and histoplasmosis. Chylothorax resolved with the treatment for aspergillosis and performance of lymphangiography with lipiodol after conservative treatment for chylothorax failed and before we continued to embolization of the thoracic duct, which allowed us to performance pleurodesis with iodine without complications. We reviewed the etiologies of chylothorax in patients with end-stage renal disease in hemodialysis reported so far and found no reports of aspergillosis as a cause of chylothorax.