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Laryngopharyngeal reflux (LPR) is a complex of symptoms caused by the backflow of gastric contents into the larynx, pharynx, nasopharynx, sinuses and even to the middle ear space.The symptomatology of LPR includes: chronic cough, hoarseness, throat clearing, laryngitis,"globus pharyngeus", swallowing disturbances, postnasal drip, "fetor ex ore".In the article, the authors present two boys with chronic cough, in one of them the asthma was suspected and antiasthmatic treatment was administrated; in our patients according to the 24-hour pharyngeal pH-metry LPR was diagnosed. The aim of this study was to emphasise that pediatricians should be able to recognise symptoms of LPR. The appropriate diagnosis and treatment leads the symptoms to subside.
Sarcoidosis is an inflammatory disease of unknown etiology. Most commonly it results in the formation of non-caseating granulomas in intrathoracic lymph nodes and lung parenchyma, but the clinical course and picture may be complicated by extrapulmonary involvement and many non-respiratory signs and symptoms which are directly related to the disease. In addition, sarcoidosis patients may suffer from a plethora of symptoms of uncertain or unknown origin. Fatigue is one of these symptoms, and according to some authors it is reported by the majority of patients with active sarcoidosis, but also by a smaller proportion of patients with inactive sarcoidosis, or even with complete clinical and radiological remission. Therefore the term fatigue syndrome is frequently used to name this clinical problem. The definition of fatigue syndrome in sarcoidosis is imprecise and the syndrome is usually recognized by use of validated questionnaires. In this review the uptodate knowledge in this field was presented and different challenges connected with this syndrome were described.
There has been a recent trend of increasing prevalence of asthma in developing countries; prevalence in the Indian population is reported to be 2%. The link between lifestyle factors and asthma has been mostly derived from western literature. The present study intended to study relationship if any, between life style factors and asthma in a representative Indian population. The study is a case-control study performed for a period of one year, between 2014 and 2015. 125 asthma and correspondingly age and sex matched healthy controls were recruited for the purpose of study. A self-reported questionnaire has been prepared based on routine lifestyle habits of Indian population. The hours of TV watching and hours of sleep were significantly higher in asthma patients, and also duration of sports activity showed inverse relation with asthma. Smoking, tobacco, chewing as well as alcohol consumption were higher in asthma patients in comparison to controls, though neither was statistically significant. The mental stress as assessed on scale of 1-10, was significantly higher in asthma patients (p < 0.001). Asthma patients had significantly lower travel duration/week (p < 0.05). The present study concluded increased TV watching, increased mental stress, reduced hours of physical activity and travel may be correlated with asthma in India. With growing evidence of increasing association of asthma and sedentary lifestyle, it is imperative to reduce acquaintance to as well as incidence of these factors through public health policies, which may impact prevalence of asthma in Indian population.
The diagnostic algorithm of non-high risk pulmonary embolism (PE) is based on probability scoring systems and plasma D-dimer (DD) assessment. The aim of the present study was to investigate the efficacy of Revised Geneva Scoring (RGS) and DD testing for the excluding of non-high risk PE, in the patients admitted to the hospital due to acute respiratory diseases. The consecutive patients, above 18 years of age, referred to the department of lung diseases, entered the study. The exclusion criteria were: the pregnancy and the suspicion of high risk PE. Plasma DD was measured with quick ELISA test, VIDAS D-dimer New, bioMerieux, France. Multislice computed tomography angiography was performed in all of the patients. 153 patients, median age 65 (19-88) years entered the study. The probability of PE was: low - in 58 patients (38%), intermediate - in 90 (59%), high - in 5 (3%). DD < 500 ng/ml was found in 12% of patients with low and intermediate probability of PE. PE was recognized in 10 out of 153 patients (7%). None of the patients with DD < 500 ng/ml was diagnosed with PE (NPV 100%). Median DD value was significantly higher in PE patients comparing to non-PE (4500 ng/ml and 1356 ng/ml respectively, p = 0.006). In the group of the patients with acute respiratory symptoms, low or intermediate clinical probability scoring combined with normal DD had a high NPV in excluding PE. Nevertheless, such approach was not very effective, as the increased DD was noted in 88% of the examined population.
The risk of Mycobacterium tuberculosis complex (MTBC) infection is correlated with the concentration of infectious particles and exposure time. In closed populations, healthy people staying in very frequent, close and prolonged contact with a smear-positive person, become infected and represent another link in the chain of transmission of the disease. Therefore, in the fight against tuberculosis, an important element is quick identification of the patient and potentially infected people from his environment. In epidemiological investigation of tuberculosis (TB), family members are brought under special control as they are particularly exposed to transmission of infectious diseases. The study included 150 patients with bacteriologically confirmed tuberculosis who were members of 59 families. In the years 2003-2013 this population represented all TB cases detected in Poland in a family environment.Three PCR-based genotyping methods: spoligotyping, IS6110-Mtb1-Mtb2 PCR and MIRU-VNTR typing were used. Of 150 patients, 138 could be assigned to intra-household transmission on the basis of identical DNA fingerprints upon a combined typing approach. For 12 patients in 6 households, the M. tuberculosis isolates were clearly distinct in individual analysis - IS6110-Mtb1-Mtb2 PCR, spoligotyping or MIRU-VNTR typing or in three genotyping methods, suggesting that these patients were infected by the sources in the community. The analysis confirmed the transmission of tuberculosis among members of 53 families. In the remaining 6 families the source of infection were people outside the households. In all families with young children, strains isolated from them have identical DNA patterns as strains obtained from their adult caregivers. To confirm the transmission of TB in the study population of patients, epidemiological analysis required the addition of a genotyping methods characterised by high discriminatory power.
Inhomogeneity of lung attenuation pattern is observed in high resolution chest computed tomography (HRCT) in some IPAH patients despite lack of interstitial lung disease. Such radiological changes are described either as ill-defined centrilobular nodules (CN) or as focal ground glass opacities (FGGO). There is no consensus in the literature, whether they indicate the distinct type of IPAH, or pulmonary venoocclusive disease (PVOD) with subtle radiological changes. Thus the aim of the present pilot study was to assess the frequency and clinical significance of inhomogenic lung attenuation pattern in IPAH. 52 IPAH patients (38 females, 14 males, mean age 41 years ± 15 years), entered the study. All available chest CT scans were reviewed retrospectively by the experienced radiologist, not aware about the clinical data of the patients. CN were found in 10 patients (19%), FGGO - in 12 patients (23%). No lymphadenopathy or interlobular septal thickening suggestive of PVOD were found. The significant differences between CN and the remaining patients included: lower mean age - 31 and 43.5 years, (p = 0.02), lack of persistent foramen ovale (PFO) - 0% and 43% (p = 0.03), and higher mean right atrial pressure (mRAP) - 12.5 mm Hg and 7.94 mm Hg (p = 0.01). No significant survival differences were observed between the groups of CN, FGGO and the remaining patients. Centrilobular nodules in IPAH were combined with lack of PFO, higher mRAP and younger age of patients.
Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) is a rare disease that is classically described as presenting with cough, dyspnea, and wheezing in non-smoker middle aged females. Pulmonary function tests commonly demonstrate an obstructive pattern and CT of chest usually reveals diffuse air trapping with mosaic pattern. We present a case of patient with DIPNECH manifesting with restrictive pattern and as usual interstitial pneumonia on imaging.
The aim of the study is to indicate the relation between the use of alternative medicine and the occurrence of allergic diseases in the Polish population of adults in the age of 20-44 years. Moreover the additional aim of the study is to define the relation between the sex, age and place of living and the use of alternative medicine. The data from the project Epidemiology of Allergic Diseases in Poland (ECAP) has been used for analysis. This project was a continuation of the European Community Respiratory Health Survey II. The questions on alternative medicine were asked to the group of 4671 respondents in the age of 20-44 years. Additionally outpatient tests were performed in order to confirm the diagnosis of allergic diseases. The total of 22.2% of respondents that participated in the study have ever used alternative medicine (n = 4621). A statistically significant relation between the use of alternative medicine and declaration of allergic diseases and asthma symptoms has been demonstrated (p < 0.001). No statistically significant relation between the use of alternative medicine by persons diagnosed by a doctor with any form of asthma or seasonal allergic rhinitis (p > 0.05) has been demonstrated. The occurrence of allergic diseases and asthma influences the frequency of alternative medicine use. However the frequency of alternative medicine use does not depend on allergic disease or asthma being confirmed by a doctor.
The immune system is known to play a key role in the development of viral-induced wheeze, but the pattern of cytokine response is not clear. The aim of the study was to determine whether plasma cytokine levels during the acute wheezing illness in infants are associated with the subsequent development of persistent recurrent wheezing (PRW). 43 infants admitted to Iashvili Central Children Hospital, Tbilisi, Georgia, were selected. The concentrations of IFN-g, TNF-a and IL-6 were determined by enzyme-linked immunosorbent assay (ELISA). Total serum IgE level was also determined. IgM and IgG antibodies to RSV, Chlamydophila pneumonia and Mycoplasma pneumonia were tested by ELISA. All children were followed-up during 3 years period. There was no significant association with PRW and atopy in the infant or parental atopy, low maternal age, low birth weight, serum level of IL-6, serum level of IFN-g, serum level of total IgE and the particular pathogen. There was a tendency for the association with male sex, bottle feeding and household cigarette smoking, although the relation was not significant. There was just TNF-a which was strongly associated with the risk of PRW after three years of follow up. We have identified TNF-a, as a biomarker, which can be detected in children under 3 years of age and may be useful in the prediction of development of persistence of wheezing later. To further evaluate the usefulness of this and other markers and establish cutoff levels for prediction and use in clinical practice, a larger prospective follow-up study is needed.
Office spirometry has been widely used in recent years by general practitioners in primary care setting, thus the need for stricter monitoring of the quality of spirometry has been recognized. A spirometry counseling network of outpatients clinics was created in Poland using portable spirometer Spirotel. The spirometry data were transferred to counseling centre once a week. The tests sent to the counseling centre were analyzed by doctors experienced in the analysis of spirometric data. In justified cases they sent their remarks concerning performed tests to the centres via e-mail. We received 878 records of spirometry tests in total. Data transmission via the telephone was 100% effective. The quality of spirometry tests performed by outpatients clinics was variable. The use of spirometers with data transfer for training purposes seems to be advisable. There is a need to proper face-to-face training of spirometry operators before an implementation of any telemedicine technology.
A heterogeneous emphysema is one of the most severe forms of chronic obstructive pulmonary disease (COPD). In some cases, besides the standard pharmacotherapy, a new treatment option of emphysema can be used - bronchoscopic lung volume reduction (BLVR) with the use of intrabronchial valves. To examine the health-related quality of life (HRQoL) of patients with severe emphysema after intrabronchial valve (IBV) implantation for the treatment of one lung. From 2011 to 2013 a single centre prospective observational study was performed. The study assessed the effect of the therapeutic BLVR intervention, measured by St. George Respiratory Questionnaire (SGRQ). A statistical analysis by use of Wilcoxon test for dependent variables was performed. Twenty patients were enrolled to the study (mean age 63 ± 10 years), all ex-smokers with tobacco exposure 38 ± 11.3 packyears. After 3 months of IBV treatment the average SGRQ score improved significantly in total (-12.8; p < 0.001) and in domains and the differences were for: "symptoms" (-8.5; p < 0.001), "activity" (-13.9; p < 0.001) and "influence on life"(-13.5; p < 0.002). The presented study revealed a significant improvement of the quality in the life measured by SGRQ after IBV treatment for heterogeneous emphysema. For the first time our study showed the significant improvement of all three domains of SGRQ after IBV treatment.
The Bard's syndrome is a medical condition related to miliary dissemination of gastric cancer to the lungs. Difficulties in diagnosis are associated with the need of differentiation between numerous diseases, which may manifest as disseminated lesions in the lung parenchyma on chest X-ray. Despite the advanced proliferative process, primary focus of neoplasm frequently remains subclinical. Metastatic lesions cause many symptoms in the respiratory system, suggesting primary pulmonary pathology. The Bard's syndrome should be always taken into account in differential diagnosis of disseminated lesions, particularly due to prevalence of gastric cancer. The study presents two cases of patients with disseminated pulmonary lesions, corresponding to gastric cancer metastases on radiological imaging.
Adherence to therapy is one of the basic preconditions of successful treatment of asthma and COPD. Unfortunately, many patients take their medication incorrectly. The aim of this study was to assess doctors' knowledge of this phenomenon, including interventions able to improve patient adherence. It was a questionnaire-based survey conducted among convenience sample of Polish physicians treating asthma and COPD. One hundred and sixty one physicians, mainly specialists in allergology (44.1%) and pulmonology (37.3%) took part in the study. According to participants, asthma patients took on average 65.4 ± 17.1% of doses of prescribed drugs, whereas COPD patients - 61.6 ± 24.2%. Over half of respondents claimed that during the first year of treatment, no more than 20% of asthma and COPD patients discontinue their therapy. Survey participants pointed at patients discourage (41.6%) and lack of knowledge about disease (19.3%) as the main reasons for discontinuation of therapy. Almost 2/3 of participants (65.8%) claimed that they could recognize non-adherence in their patients. Prescribing combination inhaled drugs (72.7%), drugs with infrequent dosing (63.4%), and affordable ones (53.4%) were the most common interventions aimed at improving adherence provided by respondents. Survey participants were aware of the phenomenon of non-adherence in patients with asthma and COPD, but underestimated the real prevalence and seriousness of it. They also overestimated their ability to recognise non-adherence in their patients. Therefore, not necessarily they may obtain better adherence in their asthma and COPD patients. These results point at the issues which should be addressed in pre- and postgraduate education of physicians treating chronic airways conditions.
The study aimed to compare the effect of obesity with and without metabolic syndrome on asthma severity, quality of life, sleep quality, sleep disordered breathing and inflammatory markers as compared to non-obese asthma patients. 60 asthma patients recruited for the study were divided equally into non-obese (NOA), obese without metabolic syndrome (OANMS) and obese with metabolic syndrome (OAMS) groups. Study cohorts were assessed for severity of asthma, quality of life and quality of sleep using questionnaires and inflammatory markers (FENO, hs-CRP, IL-5, IL-6 and leptin). Institutional ethical committee approved the study. The results suggests OAMS patients may be a subtype of asthmatics having significantly severe asthma (p < 0.05), poor quality of life (p < 0.05), high risk of OSA (p< 0.05), decreased lung volumes (FRC) (p< 0.05), higher levels of inflammatory markers (leptin and IL-6) (p < 0.05), and high incidence of sleep disordered breathing (p < 0.05) in comparison to NOA and OANMS patients. The present study has shown that obese asthmatics especially with metabolic syndrome represent a subtype of asthmatic population. Hence, the treatment of metabolic syndrome may be necessary in addition to asthma to achieve optimal control.
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The prevalence of obstructive sleep apnea-hypopnea syndrome (OSAHS) ranges from 4 to 7% in men and from 2 to 5% in women. Its deleterious consequences such as traffic accidents, cardiovascular complications increasing morbidity and mortality, make it a major health problem. Apart from obesity (a major risk factor for OSAHS), hypothyroid patients are prone to reveal this phenotype. Although hypothyroidism seems an acknowledged risk factor for OSAHS, some authors report the lack of clinically relevant association. The argument partly depends on the increased prevalence of hypothyroidism in OSAHS patients, but the epidemiological data is limited and somehow inconsistent; even less is known about sub-clinical hypothyroidism in OSAHS patients. Even if frequency of overt and sub-clinical hypothyroidism in OSAHS patients is comparable to the general population, screening for it seems beneficial, as hormone replacement therapy may improve sleep disordered breathing. Unfortunately, this favorable outcome was found only in a few studies with limited number of patients with hypothyroidism. Yet, despite the lack of international guidelines and no large multicentre studies on the topic available, we think that TSH screening might prove beneficial in vast majority of OSAHS patients.
A 73-year-old male with marked emphysema was admitted to the 2nd Department of Internal Medicine, University Hospital in Krakow because of chronic obstructive pulmonary disease (COPD) exacerbation. His medical history was significant for total laryngectomy due to laryngeal cancer in 2010.
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Bronchial asthma is an increasing problem worldwide. The course of bronchial asthma is dependent on the type of inducing allergens. The differences between the clinical features of asthma in patients with monovalent allergies to molds and with other allergies were explored. Randomly selected 1910 patients (924 women and 986 men) between 18-86 years in age were analyzed according to type of allergy and asthma. The diagnosis of asthma was confirmed on the basis of GINA criteria, physical examination and spirometry. Allergy diagnosis was confirmed on the basis of medical history, a positive skin prick test and the measurement of serum-specific IgE to inhalant allergens, using an extended profile of mold allergens. Patients with monovalent allergies to molds (4% of analyzed group) had significantly more frequent diagnoses of asthma than patients in the other group (53% vs. 27.1-32.4%, p < 0.05). Patients with allergies to Alternaria alternata had an odds ratio of 2.11 (95%CI: 1.86-2.32) for receiving a diagnosis of bronchial asthma. They had less control over their asthma, which was more severe compared to patients with other allergies. Patients with asthma and allergies to mold had significantly more frequent exacerbation of asthma requiring systemic corticosteroids and/or hospitalization. They used a significantly greater mean daily dose of inhaled steroids compared to other patients. Patients with monovalent IgE allergies to molds are at a higher risk for asthma than patients with other allergies. Their asthma is often more intense and less controlled compared to that of patients with other types of allergies.