Pub Date : 2021-03-12DOI: 10.4236/OJRD.2021.112008
H. Gharsalli, M. Attia, S. Zairi, I. Sahnoun, A. Ayadi, H. Neji, S. Maȃlej, Leila Douik Elgharbi
A 32-year-old patient with no previous history was admitted for chest pain, dyspnea, appetite and weight loss. Chest X-ray revealed an opacity involving the lower two-thirds of the right hemithorax, suggestive of a pleural effusion. Because of the absence of fluid return even after ultrasound-guided thoracentesis, a Chest Computed tomography was required showing a heterogeneous anterior mediastinal mass with soft tissue, fat, fluid and calcifications associated with extensive encysted fluid collection in the right hemithorax. A video-assisted mini-thoracotomy revealed a mediastinal tumor firmly attached to the thymus with a cystic wall lined by squamous epithelium and sebaceous gland composed of respiratory tissue, adipose tissue, cartilage, smooth muscle fibers, and well-differentiated pancreatic tissue. These findings led to the diagnosis of a mature thymic teratoma. The patient was discharged 7 days after surgery, with no recurrence on follow-up.
{"title":"Mature Teratoma Revealed by an Encysted Pleural Effusion","authors":"H. Gharsalli, M. Attia, S. Zairi, I. Sahnoun, A. Ayadi, H. Neji, S. Maȃlej, Leila Douik Elgharbi","doi":"10.4236/OJRD.2021.112008","DOIUrl":"https://doi.org/10.4236/OJRD.2021.112008","url":null,"abstract":"A 32-year-old patient with no previous history was admitted for chest \u0000pain, dyspnea, appetite and weight loss. Chest X-ray revealed an opacity involving the lower two-thirds of the right hemithorax, suggestive \u0000of a pleural effusion. Because of the \u0000absence of fluid return even after ultrasound-guided thoracentesis, a Chest Computed tomography \u0000was required showing a heterogeneous anterior mediastinal mass with soft \u0000tissue, fat, fluid and calcifications associated with extensive encysted fluid collection in the right hemithorax. A video-assisted mini-thoracotomy revealed a mediastinal tumor firmly attached to \u0000the thymus with a cystic wall lined by \u0000squamous epithelium and sebaceous gland composed of respiratory tissue, \u0000adipose tissue, cartilage, smooth muscle fibers, and well-differentiated \u0000pancreatic tissue. These findings led to the diagnosis of a mature thymic \u0000teratoma. The patient was discharged 7 days after surgery, \u0000with no recurrence on follow-up.","PeriodicalId":83134,"journal":{"name":"The Journal of respiratory diseases","volume":"11 1","pages":"84-89"},"PeriodicalIF":0.0,"publicationDate":"2021-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43308134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-03-12DOI: 10.4236/OJRD.2021.112005
A. Alfaiate, D. Noivo, V. Clérigo, V. Durão, F. Durão, M. Castanho, S. Sousa, L. Fernandes, Paula Duarte
Objectives: Early identification of patients with the novel coronavirus induced-disease 2019 (COVID-19) and pneumonia is currently challenging. Few data are available on validated scores predictive of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection. The Portuguese Society of Intensive Care (PSIC) proposed a risk score whose main goals were to predict a higher probability of COVID-19 and optimize hospital resources, adjusting patients’ intervention. This study aimed to validate the PSIC risk score applied to inpatients with pneumonia. Methods: A retrospective analysis of 207 patients with pneumonia admitted to a suspected/confirmed SARS-CoV-2 infection specialized ward (20/03 to 20/05/2020) was performed. Score variables were analyzed to determine the significance of the independent predictive variables on the probability of a positive SARS-CoV-2 rRT-PCR test. The binary logistic regression modeling approach was selected. The best cut-off value was obtained with the Receiver Operating Characteristic (ROC) curve together with the evaluation of the discriminatory power through the Area Under the Curve (AUC). Results: The validation cohort included 145 patients. Typical chest computed-tomography features (OR, 12.16; 95% CI, 3.32 - 44.50) and contact with a positive SARS-CoV-2 patient (OR, 6.56; 95% CI, 1.33 - 32.30) were the most significant independent predictive variables. A score ≥ 10 increased suspicion for SARS-CoV-2 pneumonia. The AUC was 0.82 (95% CI, 0.73 - 0.91) demonstrating the good discriminating power for COVID-19 probability stratification in inpatients with pneumonia. Conclusions: The application of the PSIC score to inpatients with pneumonia may be of value in predicting the risk of COVID-19. Further studies from other centers are needed to validate this score widely.
{"title":"Portuguese Society of Intensive Care Score for Predicting SARS-CoV-2 Infection Applied to Inpatients with Pneumonia: A Reliable Tool?","authors":"A. Alfaiate, D. Noivo, V. Clérigo, V. Durão, F. Durão, M. Castanho, S. Sousa, L. Fernandes, Paula Duarte","doi":"10.4236/OJRD.2021.112005","DOIUrl":"https://doi.org/10.4236/OJRD.2021.112005","url":null,"abstract":"Objectives: Early identification of patients with the novel coronavirus induced-disease 2019 (COVID-19) and pneumonia is \u0000currently challenging. Few data are available on validated scores \u0000predictive of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) \u0000infection. The Portuguese Society of Intensive Care (PSIC) proposed a risk \u0000score whose main goals were to predict a higher probability of COVID-19 and \u0000optimize hospital resources, adjusting patients’ intervention. This study aimed \u0000to validate the PSIC risk score applied to inpatients with pneumonia. Methods: A retrospective analysis of 207 patients with pneumonia admitted to a \u0000suspected/confirmed SARS-CoV-2 infection \u0000specialized ward (20/03 to 20/05/2020) was performed. Score variables \u0000were analyzed to determine the significance of the independent predictive variables on the probability of a \u0000positive SARS-CoV-2 rRT-PCR test. The binary logistic regression \u0000modeling approach was selected. The best cut-off value was obtained with the \u0000Receiver Operating Characteristic (ROC) curve together with the evaluation of \u0000the discriminatory power through the Area Under the Curve (AUC). Results: The \u0000validation cohort included 145 patients. Typical chest \u0000computed-tomography features (OR, 12.16; 95% CI, 3.32 - 44.50) \u0000and contact with a positive SARS-CoV-2 patient (OR, 6.56; 95% CI, 1.33 - 32.30) \u0000were the most significant independent predictive variables. A score ≥ 10 \u0000increased suspicion for SARS-CoV-2 pneumonia. The AUC was 0.82 (95% CI, 0.73 - 0.91) demonstrating the good discriminating power for \u0000COVID-19 probability stratification in inpatients with pneumonia. Conclusions: The application of the PSIC score to inpatients with pneumonia may be of \u0000value in predicting the risk of COVID-19. Further \u0000studies from other centers are needed to validate this score widely.","PeriodicalId":83134,"journal":{"name":"The Journal of respiratory diseases","volume":"11 1","pages":"49-60"},"PeriodicalIF":0.0,"publicationDate":"2021-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46571034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-03-12DOI: 10.4236/OJRD.2021.112004
S. Eldaboosy, Amgad Awad, Hussein Al Qurni, S. Hassan, Mohamed Osama Nour
Background: Obstructive sleep apnea syndrome (OSAS) may promote hyperglycemia, insulin resistance, and hypertension (HTN). Purpose: To evaluate if there is a relationship between the severity of OSA and the severity of type 2 diabetes mellitus (T2DM) and HTN in our patients, aiming to understand and optimize the control for comorbidities. Materials and Methods: Patients referred for polysomnography (PSG) were retrospectively recruited during the period from October 2017 to August 2020. A STOP-BANG questionnaire formed eight questions was used to assess the risk of OSAS. We divided the patients into two groups; group 1, who have snoring without T2DM, and group 2, who have snoring with T2DM. PSG was completed for all subjects and data were collected for each patient including apnoea hypopnea index (AHI), mean arterial oxygen saturation (SaO2), and Nadir SaO2 recorded during PSG. Anthropometric data, medical history, and medications for T2DM (for group 2) and HTN and HbA1c were collected (for group 2). AHI was used to evaluate the severity of OSA and its relation to T2DM and HTN. Results: The study included 300 patients who met the inclusion criteria with mean age of 49.9 ± 13.6 years. The majority of subjects (56.3%) were males and the mean body mass index (BMI) was 38.0 ± 8.4 kg/m2. Forty-two percent had HTN and 32.7% had T2DM. OSA was diagnosed in 209 patients (69.7%). OSA was more detected among those with increased age, increased BMI, and those with HTN and T2DM. The severity of both HTN and T2DM was significantly higher among patients with OSA. Conclusions: There is a relation between OSA and T2DM and HTN. The risk of OSA is higher among patients with uncontrolled T2DM and HTN. OSA should be suspected in subjects with obesity, especially with uncontrolled HTN and T2DM.
{"title":"Relation between the Severity of Obstructive Sleep Apnea and the Severity of Type 2 Diabetes Mellitus and Hypertension","authors":"S. Eldaboosy, Amgad Awad, Hussein Al Qurni, S. Hassan, Mohamed Osama Nour","doi":"10.4236/OJRD.2021.112004","DOIUrl":"https://doi.org/10.4236/OJRD.2021.112004","url":null,"abstract":"Background: Obstructive sleep apnea \u0000syndrome (OSAS) may promote hyperglycemia, insulin resistance, and hypertension \u0000(HTN). Purpose: To evaluate if there is a relationship between the \u0000severity of OSA and the severity of type 2 diabetes mellitus (T2DM) and HTN in \u0000our patients, aiming to understand and optimize the control for comorbidities. Materials \u0000and Methods: Patients referred for polysomnography (PSG) were \u0000retrospectively recruited during the period from October 2017 to August 2020. A \u0000STOP-BANG questionnaire formed eight questions was used to assess the risk of \u0000OSAS. We divided the patients into two groups; group 1, who have snoring without T2DM, and group \u00002, who have snoring with T2DM. PSG was completed for all subjects and data were \u0000collected for each patient including apnoea hypopnea index (AHI), mean arterial oxygen saturation (SaO2), \u0000and Nadir SaO2 recorded during PSG. Anthropometric data, \u0000medical history, and medications for T2DM (for group 2) and HTN and HbA1c were \u0000collected (for group 2). AHI was used to evaluate the severity of OSA and its \u0000relation to T2DM and HTN. Results: The study included 300 patients who \u0000met the inclusion criteria with mean age of 49.9 ± 13.6 years. The majority of subjects (56.3%) were males and the mean \u0000body mass index (BMI) was 38.0 ± 8.4 kg/m2. Forty-two percent had HTN and 32.7% had T2DM. OSA \u0000was diagnosed in 209 patients (69.7%). OSA was more detected among those with \u0000increased age, increased BMI, and those with HTN and T2DM. The severity of both \u0000HTN and T2DM was significantly higher among patients with OSA. Conclusions: There is a relation between OSA and T2DM and HTN. The risk of OSA is higher among patients with \u0000uncontrolled T2DM and HTN. OSA should be suspected in subjects with obesity, \u0000especially with uncontrolled HTN and T2DM.","PeriodicalId":83134,"journal":{"name":"The Journal of respiratory diseases","volume":"11 1","pages":"37-48"},"PeriodicalIF":0.0,"publicationDate":"2021-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48974570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-03-12DOI: 10.4236/OJRD.2021.112003
S. Senanayake, R. S. P. Fernando, H. F. H. Perera, R. Maddumage, A. G. K. Neranja, K. L. K. T. D. Sandharenu
Idiopathic pulmonary fibrosis (IPF) is a chronic, life-limiting with an average life expectancy of 05 years following the onset of the disease, with no curative treatments. These patients need palliative care and rehabilitation is one of the methods that can be used to improve quality of life (QoL) among these patients. Yet the research conducted to assess benefits of pulmonary rehabilitation (PR) in terms of improving physical activity and QoL in IPF patients remains limited. Hence this study aims to evaluate the effect of a bespoke pulmonary rehabilitation programme, on the physical, physiological and psychological parameters and improvements of QoL among IPF patients. Eleven (11) subjects with IPF received 6 weeks of pulmonary rehabilitation. An interviewer administered quality of life questionnaire, six-minute walking test (6MWT), Incremental bicycle exercise tests were performed, and cardiac and respiratory parameters were assessed pre- and post-rehabilitation. The 6MWT was significantly increased following training (Pre 312.55 ± 89.99; Post, 380.73 ± 59.60). A significant improvement was observed in overall QoL (2.226 ± 0.026), dyspnoea (-0.455 ± 0.004) anxiety (-2.070 ± 0.038), depression (-2.217 ± 0.027) scores. No significant changes were found in the VO2 max and other cardiopulmonary parameters, while non-significant improvement was seen in SpO2 at peak exercise from 85.8 - 86.5. Bespoke pulmonary rehabilitation program is beneficial in short term improvement of the functional exercise capacity, dyspnoea and QoL among IPF patients.
{"title":"Perceived Improvements of Quality of Life (QoL) among Patients with Idiopathic Pulmonary Fibrosis (IPF) in Response to a 6-Week Rehabilitation Program","authors":"S. Senanayake, R. S. P. Fernando, H. F. H. Perera, R. Maddumage, A. G. K. Neranja, K. L. K. T. D. Sandharenu","doi":"10.4236/OJRD.2021.112003","DOIUrl":"https://doi.org/10.4236/OJRD.2021.112003","url":null,"abstract":"Idiopathic \u0000pulmonary fibrosis (IPF) is a chronic, life-limiting with an average life \u0000expectancy of 05 years following the onset of the disease, with no curative \u0000treatments. These patients need palliative care and rehabilitation is one of \u0000the methods that can be used to improve quality of life (QoL) among these \u0000patients. Yet the research conducted to assess benefits of pulmonary \u0000rehabilitation (PR) in terms of improving physical activity and QoL in IPF \u0000patients remains limited. Hence this study aims to evaluate the effect of a \u0000bespoke pulmonary rehabilitation programme, on the physical, physiological and \u0000psychological parameters and improvements of QoL among IPF patients. Eleven \u0000(11) subjects with IPF received 6 weeks of pulmonary rehabilitation. An interviewer \u0000administered quality of life questionnaire, six-minute walking test (6MWT), \u0000Incremental bicycle exercise tests were performed, and cardiac and respiratory parameters were assessed pre- and \u0000post-rehabilitation. The 6MWT was significantly increased following \u0000training (Pre 312.55 ± 89.99; Post, 380.73 ± 59.60). A significant improvement was observed in overall QoL (2.226 ± \u00000.026), dyspnoea (-0.455 ± 0.004) anxiety (-2.070 ± 0.038), depression (-2.217 ± 0.027) scores. No significant changes were found in the VO2 max and other cardiopulmonary parameters, while non-significant improvement was \u0000seen in SpO2 at peak exercise from 85.8 - 86.5. Bespoke pulmonary rehabilitation program is beneficial in short \u0000term improvement of the functional exercise capacity, dyspnoea and QoL among \u0000IPF patients.","PeriodicalId":83134,"journal":{"name":"The Journal of respiratory diseases","volume":"11 1","pages":"27-36"},"PeriodicalIF":0.0,"publicationDate":"2021-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43191864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-03-12DOI: 10.4236/OJRD.2021.112007
S. Eldaboosy, Amgad Awad, A. Ghoneim
The common causes of stridor in adults are abscesses or swelling of the upper airway, tumors, paralysis, or malfunction of vocal cords. Tracheitis due to immunoglobulin deficiency may be a rare explanation for stridor in adults, although occasionally reported in children. We report an adult man having stridor secondary to isolated immunoglobulin A deficiency. We did an in-depth review of the literature to seek out no reported cases of stridor thanks to immunoglobulin deficiency in adults. This case underlines the very fact that a standard symptom like stridor rarely occurs thanks to uncommon causes. This case is exclusive because it reports the presence of stridor associated with isolated immunoglobulin A deficiency in an adult patient. The explanation for the stridor was an intraluminal narrowing of the upper part of the extrathoracic trachea.
{"title":"Unusual Cause of Stridor in an Adult Man, Selective Immunoglobulin A Deficiency","authors":"S. Eldaboosy, Amgad Awad, A. Ghoneim","doi":"10.4236/OJRD.2021.112007","DOIUrl":"https://doi.org/10.4236/OJRD.2021.112007","url":null,"abstract":"The common causes of stridor \u0000in adults are abscesses or swelling of the upper airway, tumors, paralysis, or \u0000malfunction of vocal cords. Tracheitis due to immunoglobulin deficiency may be a rare \u0000explanation for stridor in adults, although occasionally reported in children. \u0000We report an adult man having stridor \u0000secondary to isolated immunoglobulin A deficiency. We did an in-depth \u0000review of the literature to seek out no reported cases of stridor thanks to \u0000immunoglobulin deficiency in adults. This case underlines the very fact that a \u0000standard symptom like stridor rarely occurs thanks to uncommon causes. This \u0000case is exclusive because it reports the presence of stridor associated with \u0000isolated immunoglobulin A deficiency in an adult patient. The explanation for the \u0000stridor was an intraluminal narrowing of the upper part of the extrathoracic \u0000trachea.","PeriodicalId":83134,"journal":{"name":"The Journal of respiratory diseases","volume":"11 1","pages":"76-83"},"PeriodicalIF":0.0,"publicationDate":"2021-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44863157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-03-12DOI: 10.4236/OJRD.2021.112006
S. Senanayake, K. Abhayasinghe, R. S. P. Fernando, H. F. H. Perera, R. Maddumage, A. G. K. Neranja, K. L. K. T. D. Sandharenu
Background: Idiopathic Pulmonary Fibrosis (IPF) is a chronic, progressive, and life-limiting condition. It has no cure hence it is vital to establish effective methods of improving the quality of remaining life in these patients. One of the key components of improving quality of life is pulmonary rehabilitation. However little research has been conducted to understand the perspectives and lived experience of people with IPF on pulmonary rehabilitation. Hence, we aim to fill this gap in the existing literature. Methods: We sought to understand how patients coped with pulmonary rehabilitation. A patient-centred approach was used to explore the physical and psychological impact of pulmonary rehabilitation. Semi-structured interviews were conducted by experienced academics. Interviews used a topic guide but mostly led by the participants. An inductive thematic approach was used to analyse data, allowing us to identify common themes in the participants’ experiences. Results: Of fifty invited participants, ten took part in the study (aged 53 - 81 years). Inductive analysis of interviews identified seven second-order themes and eleven first-order themes, represented by two General Dimensions: “motivation” and “Advantages and disadvantages”. Overall, participants found the pulmonary rehabilitation programme to be useful and they experienced an increase in their quality of life following rehabilitation.
{"title":"Patients’ Experiences and Opinions on Pulmonary Rehabilitation and Use of It as a Tool of Palliative Care on Idiopathic Pulmonary Fibrosis (IPF)","authors":"S. Senanayake, K. Abhayasinghe, R. S. P. Fernando, H. F. H. Perera, R. Maddumage, A. G. K. Neranja, K. L. K. T. D. Sandharenu","doi":"10.4236/OJRD.2021.112006","DOIUrl":"https://doi.org/10.4236/OJRD.2021.112006","url":null,"abstract":"Background: Idiopathic Pulmonary Fibrosis (IPF) is a chronic, progressive, and \u0000life-limiting condition. It has no cure hence it is vital to establish \u0000effective methods of improving the quality of remaining life in these patients. \u0000One of the key components of improving quality of life is pulmonary \u0000rehabilitation. However little research has been conducted to understand the \u0000perspectives and lived experience of people with IPF on pulmonary \u0000rehabilitation. Hence, we aim to fill this gap in the existing literature. Methods: We sought to understand how patients coped \u0000with pulmonary rehabilitation. A patient-centred approach was used to \u0000explore the physical and psychological impact of pulmonary rehabilitation. \u0000Semi-structured interviews were conducted by experienced academics. Interviews \u0000used a topic guide but mostly led by the participants. An inductive thematic \u0000approach was used to analyse data, allowing us to identify common themes in the \u0000participants’ experiences. Results: Of fifty invited participants, ten \u0000took part in the study (aged 53 - 81 years). Inductive analysis of interviews \u0000identified seven second-order themes and eleven first-order themes, represented \u0000by two General Dimensions: “motivation” and “Advantages and disadvantages”. \u0000Overall, participants found the pulmonary rehabilitation programme to be useful \u0000and they experienced an increase in their quality of life following \u0000rehabilitation.","PeriodicalId":83134,"journal":{"name":"The Journal of respiratory diseases","volume":"11 1","pages":"61-75"},"PeriodicalIF":0.0,"publicationDate":"2021-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44534938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-02-24DOI: 10.4236/OJRD.2021.111001
U. Onubogu, B. West
Background: Asthma exits with comorbidities which can affect the quality of life of children with asthma. Objective: To identify the common comorbidities with asthma, identify factors associated with the presence of specific comorbidities and evaluate their impact on asthma severity and control among children attending the respiratory clinic in the Rivers State University Teaching Hospital. Materials & Methods: All asthma cases seen in the paediatric respiratory clinic, from 1st November 2014 to 30th October 2019 were consecutively recruited. Results: Of 264 children with asthma, 190 (72.0%) had other comorbidities with a F:M ratio of 1.56:1. Difficulty in breathing, chest pain, and the degree of asthma control were significantly associated with having other comorbidities while SPO2 at 1st consult was significantly lower in children with comorbidities, P value 0.05. Allergic rhinitis 116 (43.9%), adenotonsillar hypertrophy 99 (37.5%), atopic dermatitis 54 (20.5%), allergic conjunctivitis 37 (14%), food allergy 27 (10.2) and Gastroesophageal reflux14 (5.3%) were the commonest comorbidities identified. Majority (24, 88.9%) had allergy to one type of food. Children years and those whose age at diagnosis was years were significantly at lower risk of having atopic dermatitis. Gastroesophageal reflux disease was significantly more likely to be seen in children aged > 11 years, overweight children, and those presenting with chest pain or chest tightness. Presence of various comorbidities increased the odds of having a more severe asthma, and likelihood of which increased with increasing number of coexisting comorbidities. Conclusion: The prevalence of allergic comorbidity is high among asthmatic children with allergic rhinitis being the commonest cause. Most children with asthma have more than one allergic comorbidity. A comprehensive evaluation of these comorbidities is thus essential in the management of asthmatic children for improved outcomes and quality of life.
{"title":"The Pattern of Comorbidities of Childhood Asthma as Seen in the Rivers State University Teaching Hospital, Nigeria","authors":"U. Onubogu, B. West","doi":"10.4236/OJRD.2021.111001","DOIUrl":"https://doi.org/10.4236/OJRD.2021.111001","url":null,"abstract":"Background: \u0000Asthma exits with comorbidities which can affect the quality of life of \u0000children with asthma. Objective: To identify the common comorbidities with \u0000asthma, identify factors associated with the presence of specific comorbidities \u0000and evaluate their impact on asthma severity and control among children \u0000attending the respiratory clinic in the Rivers State University Teaching \u0000Hospital. Materials & Methods: All asthma cases seen in the paediatric \u0000respiratory clinic, from 1st November 2014 to 30th October 2019 were consecutively recruited. Results: Of 264 children with \u0000asthma, 190 (72.0%) had other comorbidities with a F:M ratio of 1.56:1. \u0000Difficulty in breathing, chest pain, and the degree of asthma control were significantly associated with having other \u0000comorbidities while SPO2 at 1st consult was significantly \u0000lower in children with comorbidities, P value 0.05. Allergic rhinitis 116 (43.9%), adenotonsillar hypertrophy 99 (37.5%), \u0000atopic dermatitis 54 (20.5%), allergic conjunctivitis 37 (14%), food allergy 27 \u0000(10.2) and Gastroesophageal reflux14 (5.3%) were the commonest comorbidities \u0000identified. Majority (24, 88.9%) had allergy to one type of food. \u0000Children years and those whose age at diagnosis was years were significantly at lower risk of having atopic dermatitis. \u0000Gastroesophageal reflux disease was significantly more likely to be seen in \u0000children aged > 11 years, overweight children, and those presenting \u0000with chest pain or chest tightness. Presence of various comorbidities increased \u0000the odds of having a more severe asthma, and likelihood of which increased with \u0000increasing number of coexisting comorbidities. Conclusion: The prevalence of \u0000allergic comorbidity is high among asthmatic children with allergic rhinitis \u0000being the commonest cause. Most children with asthma have more than one \u0000allergic comorbidity. A comprehensive evaluation of these comorbidities is thus \u0000essential in the management of asthmatic children for improved outcomes and \u0000quality of life.","PeriodicalId":83134,"journal":{"name":"The Journal of respiratory diseases","volume":"11 1","pages":"1-18"},"PeriodicalIF":0.0,"publicationDate":"2021-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48795663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-02-24DOI: 10.4236/OJRD.2021.111002
Clay Wu, Gloria Wu, L. Fukushima, A. Rao, A. Baydur
Rationale: Survival and longevity in patients with cystic fibrosis (CF) have improved with new treatments, so that pregnancy can be safely undertaken despite physiologic limitations. Dyspnea still develops in the latter stages of pregnancy. To explain this symptom, we evaluated the effect of pregnancy on lung function before and after delivery. Methods: Records of 23 pregnant patients with CF were retrospectively reviewed for data analysis. Spirometry was recorded prior to pregnancy, at first and third trimesters, and every three months following delivery up to one year. Comparisons between time points were adjusted for age and pre-gestational BMI by analysis of variance (ANOVA). Results: Complete clinical and spirometric data were available for eleven of these patients (13 pregnancies total), obtained between 2009 and 2017. FEV1 and FVC declined significantly from baseline to third trimester (by 8.1%, p Conclusions: The changes in FEV1 and FVC occur as a result of increases in intravascular blood volume and lung water during the third trimester. At the same time, FEV1/FVC increases as there is reversal of bronchiolar constriction with elimination of extracellular fluid and lung water. Furthermore, restoration of end-expiratory lung volume post-partum counteracts reversal of air trapping with resolution of peribronchiolar edema, with FVC remaining unchanged. These changes would explain decrease in dyspnea following delivery in CF patients.
{"title":"Spirometric Changes during Pregnancy in Cystic Fibrosis Patients","authors":"Clay Wu, Gloria Wu, L. Fukushima, A. Rao, A. Baydur","doi":"10.4236/OJRD.2021.111002","DOIUrl":"https://doi.org/10.4236/OJRD.2021.111002","url":null,"abstract":"Rationale: Survival and longevity in patients with cystic fibrosis (CF) have \u0000improved with new treatments, so that pregnancy can be safely undertaken \u0000despite physiologic limitations. Dyspnea still develops in the latter stages of \u0000pregnancy. To explain this symptom, we evaluated the effect of pregnancy on \u0000lung function before and after delivery. Methods: Records of 23 pregnant \u0000patients with CF were retrospectively reviewed for data analysis. Spirometry \u0000was recorded prior to pregnancy, at first and third trimesters, and every three \u0000months following delivery up to one year. Comparisons between time points were \u0000adjusted for age and pre-gestational BMI by analysis of variance (ANOVA). Results: Complete clinical and spirometric data were available for eleven of these \u0000patients (13 pregnancies total), obtained between 2009 and 2017. FEV1 and FVC \u0000declined significantly from baseline to third trimester (by 8.1%, p Conclusions: The changes \u0000in FEV1 and FVC occur as a result of increases in intravascular blood volume \u0000and lung water during the third trimester. At the same time, FEV1/FVC increases as there \u0000is reversal of bronchiolar constriction with elimination of extracellular fluid \u0000and lung water. Furthermore, restoration of end-expiratory lung volume \u0000post-partum counteracts reversal of air trapping with resolution of \u0000peribronchiolar edema, with FVC remaining unchanged. These changes would \u0000explain decrease in dyspnea following delivery in CF patients.","PeriodicalId":83134,"journal":{"name":"The Journal of respiratory diseases","volume":"11 1","pages":"19-25"},"PeriodicalIF":0.0,"publicationDate":"2021-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47192182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-09-22DOI: 10.4236/OJRD.2020.104007
S. Senanayake, K. Harrison, S. Hilldrup, M. Lewis
Idiopathic Pulmonary Fibrosis (IPF) is a chronic, progressive and life-limiting condition of unknown cause with no curative treatment. The impact of IPF on a patient’s quality of life is devastating and palliative treatment such as pulmonary rehabilitation programmes are used to improve quality of life among these individuals, yet relatively little attention has been made to access the effectiveness of rehabilitation programs aimed designed for these patients. There are large gaps in our knowledge on the cardiorespiratory response to exercise and rehabilitation among IPF patients and this study aims to fill this gap in a physiological prospective. We quantified the effects of an eight-week pulmonary rehabilitation program for IPF patients, conducted at Morriston Hospital, Swansea. Fifteen individuals (13 with Idiopathic Pulmonary Fibrosis and two with Pulmonary Fibrosis associated with Rheumatoid Disease) underwent physical and physiological assessments during a three-day testing protocol: 1) On Day 1, physical function (six-minute walk test) and ventilatory function (spirometry) were measured; 2) On Day 2, patients’ cardio-respiratory responses to slowly-increasing, wide-ranging metabolic challenge (using a protocol consisting of periods of rest, incremental bicycle exercise to maximal effort, and post-exercise recovery) were assessed via respiratory gas analysis and ECG recording; 3) On Day 3, patients’ cardio-respiratory responses to rapid-onset, high-workload metabolic challenge were assessed (using a protocol including a rapid-onset, constant workload bicycle exercise) by modelling dynamic respiratory oxygen and heart rate responses. Respiratory gas analysis was used to measure the rate of oxygen uptake ( VO2 ) and oxygen uptake efficiency (OUES). All assessments were performed before and after participants completed the pulmonary rehabilitation programme. A Holter ECG recorder (Pathfinder/Lifecard Digital CF system; Spacelabs Medical Ltd., UK) provided continuous ECG data throughout each exercise test, from which heart rate was derived. Following the rehabilitation programme, heart rate was elevated by 11% - 18% during exercise and recovery states. Post-rehabilitation VO2 was significantly increased (p = 0.01 - 0.03) during the first two minutes of heavy-intensity exercise, whilst HR was reduced (p = 0.04) during this period. OUES and standard measures of respiratory performance (minute ventilation, peak VO2) were unchanged following rehabilitation, whilst peak HR and work rates were significantly reduced during incremental exercise only (p -3). Pulmonary rehabilitation improved the rate of oxygen uptake during heavy-intensity exercise, despite substantially lower heart rates. This suggests that the rehabilitation programme increased systemic arterial-tissue oxygen exchange and/or influenced cardiovascular function to improve systemic oxygen delivery. We might therefore expect that individuals with IPF would find it easier to perform the ac
特发性肺纤维化（IPF）是一种原因不明的慢性、进行性和限制生命的疾病，没有治疗方法。IPF对患者生活质量的影响是毁灭性的，姑息治疗（如肺部康复计划）被用来提高这些人的生活质量，但人们相对较少关注为这些患者设计的康复计划的有效性。在IPF患者对运动和康复的心肺反应方面，我们的知识存在很大差距，本研究旨在从生理角度填补这一空白。我们量化了在斯旺西莫里斯顿医院进行的为期八周的IPF患者肺部康复计划的效果。在为期三天的测试方案中，15名患者（13名患有特发性肺纤维化，2名患有与类风湿性疾病相关的肺纤维化）接受了身体和生理评估：1）在第1天，测量了身体功能（6分钟步行测试）和通气功能（肺活量计）；2） 在第2天，通过呼吸气体分析和心电图记录评估患者对缓慢增加的广泛代谢挑战的心肺反应（使用由休息时间、最大努力的递增自行车运动和运动后恢复组成的方案）；3） 第3天，通过模拟动态呼吸氧和心率反应，评估患者对快速发作、高负荷代谢挑战的心肺反应（使用包括快速发作、持续负荷自行车运动在内的方案）。呼吸气体分析用于测量吸氧速率（VO2）和吸氧效率（OUES）。所有评估均在参与者完成肺部康复计划前后进行。Holter心电图记录仪（Pathfinder/Lifecard Digital CF系统；Spacelabs Medical有限公司，英国）在每次运动测试中提供连续的心电图数据，由此得出心率。康复计划后，在运动和恢复状态下，心率提高了11%-18%。在大强度运动的前两分钟，康复后VO2显著增加（p=0.01-0.03），而在此期间HR降低（p=0.04）。康复后，OUES和呼吸性能的标准测量（分钟通气量、峰值VO2）没有变化，而仅在增量运动期间，峰值HR和工作率显著降低（p-3）。尽管心率明显降低，但肺康复在高强度运动中提高了吸氧率。这表明康复计划增加了全身动脉组织的氧交换和/或影响了心血管功能，以改善全身的氧输送。因此，我们可以预期，IPF患者在康复后会发现更容易进行日常生活活动，包括那些需要大量代谢需求的活动。
{"title":"Influence of Rehabilitation on Oxygen Uptake Kinetics during High Intensity Exercise in Patients with Idiopathic Pulmonary Fibrosis","authors":"S. Senanayake, K. Harrison, S. Hilldrup, M. Lewis","doi":"10.4236/OJRD.2020.104007","DOIUrl":"https://doi.org/10.4236/OJRD.2020.104007","url":null,"abstract":"Idiopathic Pulmonary Fibrosis (IPF) is a chronic, progressive and life-limiting condition of unknown cause with no curative treatment. The impact of IPF on a patient’s quality of life is devastating and palliative treatment such as pulmonary rehabilitation programmes are used to improve quality of life among these individuals, yet relatively little attention has been made to access the effectiveness of rehabilitation programs aimed designed for these patients. There are large gaps in our knowledge on the cardiorespiratory response to exercise and rehabilitation among IPF patients and this study aims to fill this gap in a physiological prospective. We quantified the effects of an eight-week pulmonary rehabilitation program for IPF patients, conducted at Morriston Hospital, Swansea. Fifteen individuals (13 with Idiopathic Pulmonary Fibrosis and two with Pulmonary Fibrosis associated with Rheumatoid Disease) underwent physical and physiological assessments during a three-day testing protocol: 1) On Day 1, physical function (six-minute walk test) and ventilatory function (spirometry) were measured; 2) On Day 2, patients’ cardio-respiratory responses to slowly-increasing, wide-ranging metabolic challenge (using a protocol consisting of periods of rest, incremental bicycle exercise to maximal effort, and post-exercise recovery) were assessed via respiratory gas analysis and ECG recording; 3) On Day 3, patients’ cardio-respiratory responses to rapid-onset, high-workload metabolic challenge were assessed (using a protocol including a rapid-onset, constant workload bicycle exercise) by modelling dynamic respiratory oxygen and heart rate responses. Respiratory gas analysis was used to measure the rate of oxygen uptake ( VO2 ) and oxygen uptake efficiency (OUES). All assessments were performed before and after participants completed the pulmonary rehabilitation programme. A Holter ECG recorder (Pathfinder/Lifecard Digital CF system; Spacelabs Medical Ltd., UK) provided continuous ECG data throughout each exercise test, from which heart rate was derived. Following the rehabilitation programme, heart rate was elevated by 11% - 18% during exercise and recovery states. Post-rehabilitation VO2 was significantly increased (p = 0.01 - 0.03) during the first two minutes of heavy-intensity exercise, whilst HR was reduced (p = 0.04) during this period. OUES and standard measures of respiratory performance (minute ventilation, peak VO2) were unchanged following rehabilitation, whilst peak HR and work rates were significantly reduced during incremental exercise only (p -3). Pulmonary rehabilitation improved the rate of oxygen uptake during heavy-intensity exercise, despite substantially lower heart rates. This suggests that the rehabilitation programme increased systemic arterial-tissue oxygen exchange and/or influenced cardiovascular function to improve systemic oxygen delivery. We might therefore expect that individuals with IPF would find it easier to perform the ac","PeriodicalId":83134,"journal":{"name":"The Journal of respiratory diseases","volume":"10 1","pages":"59-74"},"PeriodicalIF":0.0,"publicationDate":"2020-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42813478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-07-31DOI: 10.4236/OJRD.2020.103006
Waldo Mattos, J. Dallasen, A. Juchem, Fabiana Jaeger Douglas da Silva Pinos
Objective: The clinical examination is the basis for the diagnosis and rational choice of complementary tests. The aim of the study was to evaluate the performance of auscultation of the chest for screening of disease and for predicting the presence of abnormalities in the other domains of the chest examination. Methods: Patients with COPD, atelectasis, pleural effusion, pneumonia and controls were evaluated by two examiners in the absence of any clinical information, initially only with pulmonary auscultation, and then in the other domains of chest examination. Results: 192 physical examinations were performed in 104 patients. An abnormal pulmonary auscultation had a sensitivity of 85.2%, positive predictive value (PPV) of 84.1%, positive likelihood reason (LR) of 1.53 (95% CI; 1.16 to 2.01) and negative LR of 0.33 (95% CI; 0.2 to 0.56) to identify the presence of any disease, and also a positive LR of 2.23 (95% CI; 1.02 to 4.9) and a negative LR of 0.3 (95% CI; 0.17 to 0.51) to predict additional abnormalities. A normal auscultation showed low accuracy to identify healthy individuals, with sensitivity, specificity, NPV and PPV, respectively, of 44%, 43%, 41% and 46%. The agreement between the examiners considering normal versus abnormal findings showed kappa = 0.76 for any changes in the physical examination present (p < 0.0001). Conclusions: Auscultation of the chest alone, may not be a sufficient strategy to track diseases or establish whether continuity of the examination is necessary or not.
{"title":"Is Pulmonary Auscultation Alone Sufficient for Clinical Practice","authors":"Waldo Mattos, J. Dallasen, A. Juchem, Fabiana Jaeger Douglas da Silva Pinos","doi":"10.4236/OJRD.2020.103006","DOIUrl":"https://doi.org/10.4236/OJRD.2020.103006","url":null,"abstract":"Objective: The clinical examination is the basis for the diagnosis and rational choice of complementary tests. The aim of the study was to evaluate the performance of auscultation of the chest for screening of disease and for predicting the presence of abnormalities in the other domains of the chest examination. Methods: Patients with COPD, atelectasis, pleural effusion, pneumonia and controls were evaluated by two examiners in the absence of any clinical information, initially only with pulmonary auscultation, and then in the other domains of chest examination. Results: 192 physical examinations were performed in 104 patients. An abnormal pulmonary auscultation had a sensitivity of 85.2%, positive predictive value (PPV) of 84.1%, positive likelihood reason (LR) of 1.53 (95% CI; 1.16 to 2.01) and negative LR of 0.33 (95% CI; 0.2 to 0.56) to identify the presence of any disease, and also a positive LR of 2.23 (95% CI; 1.02 to 4.9) and a negative LR of 0.3 (95% CI; 0.17 to 0.51) to predict additional abnormalities. A normal auscultation showed low accuracy to identify healthy individuals, with sensitivity, specificity, NPV and PPV, respectively, of 44%, 43%, 41% and 46%. The agreement between the examiners considering normal versus abnormal findings showed kappa = 0.76 for any changes in the physical examination present (p < 0.0001). Conclusions: Auscultation of the chest alone, may not be a sufficient strategy to track diseases or establish whether continuity of the examination is necessary or not.","PeriodicalId":83134,"journal":{"name":"The Journal of respiratory diseases","volume":"10 1","pages":"49-58"},"PeriodicalIF":0.0,"publicationDate":"2020-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46533050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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