{"title":"Multimacronodular pulmonary tuberculosis (bacteriologically negative) confirmed histologically.","authors":"Gabriela Jimborean, Roxana Maria Nemeş, Paraschiva Postolache, Doina Milutin, Edith Simona Ianoşi","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary tuberculosis can be confirmed by positive bacteriology of sputum, bronchial aspirate or by biopsies (microscopy and/ or culture) or by histopathological examination highlighting specific tuberculous granulomas. When microscopy is repeatedly negative during noninvasive methods, lung biopsy by thoracoscopy is needed for confirmation and differential diagnosis.</p><p><strong>Case presentation: </strong>A 40-year-old female patient (nonsmoker, diabetic, with previous exposure to chemicals) was admitted to the hospital for weight loss, dry cough, loss of appetite, pallor, and fatigue. Chest-X-ray and thoracic CT revealed multiple irregular macronodules with various shapes, randomly spread across the lungs. Bacteriology for acid fast bacilli (AFB) from six spontaneous sputum was negative. Bronchoscopy showed an acute bronchitis. Bronchial aspirate was negative for tumor cells and AFB. Several biopsies from bronchial wall showed unspecific changes. The molecular biology tests for specific nucleic acids detection (Polymerase Chain Reaction) or positron-emission-tomography (to differentiate benign nodules from malign ones) were not accessible. Multiple biopsies from lung parenchyma and pleura were obtained using thoracoscopy. Histopathology\u0000 revealed multiple specific tuberculous granulomas. The complex antituberculous treatment (9 months) has led to the total cure of the disease and resorption of the nodules. The patient’s last visit (after 2 years) showed no clinical/imagistic or bacteriologic relapse of the disease.</p><p><strong>Conclusion: </strong>Tuberculosis may present in the form of multiple macronodules spread randomly across the lung parenchyma. Thoracoscopy coupled with multiple large lung biopsies are recommended for diagnosis of multinodular lung lesions, especially when common bacteriology/cytology from bronchoscopic aspiration failed to achieve diagnosis. Histological exam from thoracoscopic biopsies allows differential diagnosis between entities that have macronodular features: tuberculosis, primitive lung cancer, lymphomas, metastatic disease or invasive fungal disease.</p>","PeriodicalId":20345,"journal":{"name":"Pneumologia","volume":"65 3","pages":"146-9"},"PeriodicalIF":0.0,"publicationDate":"2016-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35917974","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}
{"title":"Neutral package and tobacco tactics – what we need to know!","authors":"Florin Mihălţan","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>In the last year after the implementation of the plain packaging (PP) in Australia, another type of battle and tactics of another war from part of the tobacco industry started. Their campaigns became increasingly intense after the announcement of Great Britain, Ireland, France, and Hungary. This article is trying to identify these new tactics and how we can fight against them.</p>","PeriodicalId":20345,"journal":{"name":"Pneumologia","volume":"65 3","pages":"164-7"},"PeriodicalIF":0.0,"publicationDate":"2016-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35917399","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}
{"title":"Infectious cause of an interstitial lung disease.","authors":"Ariadna Petronela Fildan, Claudia Lucia Toma, Elena Danteş, Oana Arghir, Aneta Şerbescu, Doina Tofolean","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>We present a case of a previously health middleage male patient, without personal history of other condition, who was admitted in our hospital presenting fever, weight loss, and signs and symptoms of acute respiratory distress. The chest computed tomography showed numerous cystic lesions, diffuse ground-glass opacities, honeycombing, and consolidation areas. An HIV infection was confirmed, and the diagnosis of Pneumocystis jirovecii pneumonia was made on induced sputum smear stain. After the initiation of oral treatment with trimethoprim-sulfamethoxazole, the clinical course was rapidly improved. It is important to consider that opportunistic infections such as Pneumocystis jirovecii pneumonia can occur not only in patients previously diagnosed with HIV-infection, but also in patients without a medical history of immunosuppressing disorders.</p>","PeriodicalId":20345,"journal":{"name":"Pneumologia","volume":"65 3","pages":"152-5"},"PeriodicalIF":0.0,"publicationDate":"2016-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35917976","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}
{"title":"Correlation between patient perception of the ability to perform morning activities and findings on clinical examination in COPD patients in Romania.","authors":"Florin Mihălţan, Dragos Ungureanu","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Physical activity level is recognized as a predictor of mortality and hospitalization in patients with COPD. RELIEF (CorRELation Between PatIent PErception and Findings on Clinical Examination, NCT01627743) was a non-interventional, multicenter, prospective, 12-week study of patients aged at least 40 years with COPD stage C or D treated for at least 1 month previous enrollment with ICS/LABA combined therapy. The patients' perception on ability to perform morning activities, was evaluated with the CDLM (Capacity of Daily Living during the Morning) questionnaire.. 505 patients were included in the final analysis. The majority of patients were male (85.1%), and the mean age of study subjects was 65 years. The average duration of COPD was 5.31 years and more than half of the patients has COPD stage C (61%). The mean duration of inhaled combined therapy before study was 36 months. Hypertension was the most frequent co-morbidity reported (38.2%), followed by coronary heart disease (20.6%) The mean CDLM score increased during the prospective follow-up from 3.68 to 3.94, as well as the percentage of patients with a general health status of 4/5 from 41.2% to 57.4%. A weak-to-moderate positive correlation was found between the CDLM total score and the general health status (Kendall tau-b-values from 0.2269 to 0.3181). These results indicate a general improvement of subjective perceptions of both patients and health care providers and complete the COPD landscape research in Romania, being the firs study reporting such a correlation between patient reported outcomes and clinical assessments done by specialists.</p>","PeriodicalId":20345,"journal":{"name":"Pneumologia","volume":"65 3","pages":"138-41"},"PeriodicalIF":0.0,"publicationDate":"2016-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35917970","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}
{"title":"Sleep-disordered breathing in male subjects with a history of nose-throat surgery.","authors":"Dan Teculescu, Lahoucine Benamghar","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The question addressed in this study was: could a history of nose-throat surgery represent a risk factor for sleep-disordered breathing? Three hundred and fifty French male employees answered a sleep / respiration questionnaire and had anthropometric measurements. A history of nose and/or throat surgery-mostly tonsillectomy or tonsillectomy plus adenoïdectomy- was given by 69 (19.7%) of the subjects (“at risk” group). The prevalence of snoring, breathing pauses during sleep or grasping was similar in “at risk” and control (no history) subjects, but the prevalence of two symptoms: excessive daytime sleepiness and “waking up with headaches”, was significantly higher in the group at risk. The present results suggest the persistence of minor (residual?) airway obstruction in subjects with a history of nose/throat surgery. This obstruction could be responsible for an alteration of declared sleep quality, although not severe enough for eliciting breathing pauses.</p>","PeriodicalId":20345,"journal":{"name":"Pneumologia","volume":"65 2","pages":"82-4"},"PeriodicalIF":0.0,"publicationDate":"2016-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35914911","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}
{"title":"Elevated red blood cell distribution width predicts mortality in acute exacerbation of COPD.","authors":"Shaghayegh Rahimirad, MohammaReza Ghafari, Khalil Ansarin, Farid Rashidi, Mohammad Hossein Rahimi-Rad","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>Red blood cell distribution width (RDW) has been shown to predict clinical outcomes in many diseases. To our knowledge, the prognostic significance of RDW in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) has not been reported so far. The aim of the present study is to investigate the relation of RDW to in-hospital mortality in patients with AECOPD.</p><p><strong>Methods: </strong>We retrospectively reviewed hospital records of inpatients with AECOPD in two referral teaching hospitals in two provinces of east Azerbaijan and west Azerbaijan, Iran. Associations between RDW and in-hospital death were analyzed with using correlation, logistic regression analysis, and receiver operating characteristic (ROC) curves is SPSS software.</p><p><strong>Results: </strong>We studied 330 patients, of whom 75 (22.7%) did not survive to hospital discharge. In univariate analysis higher RDW-SD values were associated with increased hospital mortality (30.2% vs. 15.8% p=0.002 odds ratio 2.31). Using the first quartile of RDW as reference, odds ratio (OR) mortality among patients in the highest RDW quartile was 5.34 (95%CI, 2.70-12.57;9=0.001). In multivariate analysis RDW-SD remained an independent risk factor for mortality after correction for age, thrombocytopenia, leukocyte count, mean corpuscular volume, anemia. In receiver-operating curve analysis the AUC for RDW was 0.663, which was more than that of hemoglobin, platelets.</p><p><strong>Conclusion: </strong>RDW on admission day proves to be a useful indicator to predict in-hospital death in AECOPD.</p>","PeriodicalId":20345,"journal":{"name":"Pneumologia","volume":"65 2","pages":"85-9"},"PeriodicalIF":0.0,"publicationDate":"2016-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35916900","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}
{"title":"Bronchiectasis in cystic fibrosis and pregnancy.","authors":"Adina Turcanu, Traian Mihăescu, Cristian Cojocaru","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Cystic fibrosis is an autosomal recessive disease with a prognosis determined by the extent of pulmonary lesions. Here we present a rare case of a patient diagnosed with cystic fibrosis in the pediatric service, but who came for the first time to the Pneumology Hospital of Iasi. Respiratory failure, recurrent pulmonary infections and associated metabolic modifications generate a high vital risk during pregnancy.</p>","PeriodicalId":20345,"journal":{"name":"Pneumologia","volume":"65 2","pages":"101-5"},"PeriodicalIF":0.0,"publicationDate":"2016-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35916006","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}
Enikő Nemes-Nagy, Zita Fazakas, Zoltán Preg, Mihály László, Erzsébet Fogarasi, Márta Germán-Salló, Dalma Bálint-Szentendrey, Edith Simona Ianosi, Zoltán Ábrám, Péter Balázs, Foley Kristie, István Kikeli Pái
{"title":"Smoking habits of pharmacy students attending the University of Medicine and Pharmacy in Targu Mures.","authors":"Enikő Nemes-Nagy, Zita Fazakas, Zoltán Preg, Mihály László, Erzsébet Fogarasi, Márta Germán-Salló, Dalma Bálint-Szentendrey, Edith Simona Ianosi, Zoltán Ábrám, Péter Balázs, Foley Kristie, István Kikeli Pái","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Smoking is common among health professional students. The aim of this study was to assess the smoking habits of the pharmacy students attending the University of Medicine and Pharmacy in Târgu Mureș (UMPh TM), Romania.</p><p><strong>Material and methods: </strong>Smoking habits and attitudes toward smoking among 414 pharmacy students attending UMPh TM (86% female) were evaluated using a self-completed questionnaire.</p><p><strong>Results: </strong>The rate of smoking increases during the time students attend the university (24.1% to 33.3% from 1st to 5th year) and males are significantly are more likely to smoke than females (41.4% vs. 27.3%, p=0.042). 36.9% of the smoking pharmacy students are tobacco-dependent, and 40.4% of smokers started daily smoking at the age of 16-19. We found significant differences between smoker and non-smoker pharmacy students regarding their attitudes toward smoking and tobacco control policies, with non-smokers being more supportive of smoke-free policies.</p><p><strong>Conclusions: </strong>Prevention programs and education have a very important role in decreasing the percentage of smokers and support for smokefree policies, but it is critical to begin such programs early in their university training.</p>","PeriodicalId":20345,"journal":{"name":"Pneumologia","volume":"65 2","pages":"90-4"},"PeriodicalIF":0.0,"publicationDate":"2016-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35914912","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}
Fariz Nurwidya, Agus Dwi Susanto, Dafsah A Juzar, Isao Kobayashi, Faisal Yunus
{"title":"Continuous positive airway pressure for the treatment of obstructive sleep apnea.","authors":"Fariz Nurwidya, Agus Dwi Susanto, Dafsah A Juzar, Isao Kobayashi, Faisal Yunus","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Obstructive sleep apnea (OSA) is a recurrent episode of partial or complete upper airway obstruction during sleep despite ongoing respiratory efforts and is implicated as the risk factor of cardiovascular disease. The OSA syndrome is typified by recurring partial or total occlusion of the pharynx, sleep fragmentation, episodes of gasping, and, eventually, daytime sleepiness. If it is left untreated, OSA syndrome can cause hypertension, coronary artery disease congestive heart disease, insulin resistance and death. In this review, we describe the pathogenesis and diagnosis of OSA. We also focused on the continuous positive airway pressure (CPAP) as the main therapy for OSA. CPAP has been shown to provide benefit for not only respiratory system, but also for cardiovascular system and metabolic system. Finally, we discussed briefly about the issue of adherence of using CPAP that could contribute to lower compliant in patient with OSA.</p>","PeriodicalId":20345,"journal":{"name":"Pneumologia","volume":"65 2","pages":"72-5"},"PeriodicalIF":0.0,"publicationDate":"2016-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35912422","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}
{"title":"LPA or GeneXpert in the diagnosis of multidrug-resistant tuberculosis.","authors":"Roxana Mindru, Victor Spinu, Oana Popescu","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Facing a constant increase of multidrug-resistant tuberculosis (MDR-TB), there is large need for routine use of new diagnostic tests, based on molecular techniques that allow both a rapid diagnosis for TB complex and rapid identification of resistance mutations. The resistances are due to genetic factors: accumulation of changes within the genome structure, acquisition or loss of genes, spontaneous mutations in chromosomal genes, and changes that induce selection of resistant strains during a suboptimal treatment. The bacteriology laboratory plays a crucial role in the making of the diagnosis, monitoring and preventing TB transmission. World Health Organization offers consistent recommendations in favour of use of Xpert MTB/RIF, GeneXpert platform, as initial diagnostic test in adults and children suspected of TB, because it can simultaneously determine the presence of Mycobacterium tuberculosis and the Rifampicin resistance, which is a surrogate marker of MDR strains. The very high sensibility and specificity, also in the smear negative samples, as well as the short time needed for the results, make Xpert MTB/RIF a valuable tool in the fight against TB. Other recommended tests are: LPA, which identifies M. Tuberculosis complex, the Rifancim and Isoniazid resistance; MTBDR plus or, for second line anti-TB drugs, the MTBDRsl.</p>","PeriodicalId":20345,"journal":{"name":"Pneumologia","volume":"65 2","pages":"76-80"},"PeriodicalIF":0.0,"publicationDate":"2016-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35914910","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}