All Articles

Colleen Longacre¹, Hala Jassim AlMossawi¹, Yogan Pillay², Neeraj Kak¹*

¹University Research Co., LLC (URC); Chevy Chase, MD, USA

²National Department of Health; Pretoria, Gauteng, South Africa

Sheetal Mungul, Shivesh Maharaj*

Johannesburg Academic Hospital, School of Neurosciences, Department of Otolaryngology, University of the Witwatersrand, Johannesburg, South Africa

Pediatric deep neck space infection is an important entity that often requires hospitalisation for antimicrobial therapy. There is a higher pattern of drug resistance in lower income countries such as South Africa. Resource limitations, poor access to healthcare, nutritional deficiencies and immune deficiency necessitate appropriate antimicrobial use as resistance may have a greater socioeconomic impact relative to higher income countries.

AR Somashekar¹*, KG Ramakrishnan¹, Vanitha Gowda²

¹Department of Pediatrics, M.S. Ramaiah Medical College and hospitals, Bangalore, India

²Department of Biochemistry, M.S. Ramaiah Medical College and hospitals, Bangalore, India

Aim: To assess the serum levels of a complement factors C3 in Indian asthmatic children and compare them with those of healthy controls in order to establish a relationship between the levels of these factors and asthma disease process.

Method: Serum c3 levels of 44 children with acute asthma and 44 controls of the age group of 6-16 years was determined and statistically compared. Lung function tests (FEV1%) was done and correlated with serum c3 levels using Pearson’s comparison coefficient.

Results: The mean serum c3 value of cases (138±32.99) is higher than the controls (112.82±14.6), with 32% cases showing higher than normal level of serum C3. Pearson’s correlation coefficient reveals negative correlation between FEV1% with serum C3 levels.

Conclusion: This study reveals that serum levels of complement c3 are statistically higher in subjects with asthma as compared to healthy subjects. Further, serum levels of c3 reflect the severity of the disease, with its levels being higher when disease is more severe.

Charlotte Hill¹, Mark G. Jones^2,3, Donna E. Davies^2,3,4 and Yihua Wang^1,4*

¹Biological Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton SO17 1BJ, UK.

²Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK.

³NIHR Respiratory Biomedical Research Centre, University Hospital Southampton, Southampton SO16 6YD, UK.

⁴Institute for Life Sciences, University of Southampton, Southampton SO17 1BJ, UK.

Idiopathic pulmonary fibrosis (IPF) is the prototypic progressive fibrotic interstitial lung disease. Median survival is only 3 years, and treatment options are limited. IPF is thought to be a result of a combination of genetic and environmental factors with repetitive micro-injuries to alveolar epithelial cells playing a central role. IPF is characterised by aberrant extra cellular matrix (ECM) deposition by activated myofibroblasts. Epithelial-mesenchymal transition (EMT) is a process where polarised epithelial cells undergo molecular changes allowing them to gain a mesenchymal phenotype, with a subsequent enhanced ability to produce ECM components and increased migration and/or invasion. The source of myofibroblasts in IPF has been debated for many years, and EMT has been proposed as a source of these cells. However, lineage tracing in transgenic mice suggests the contribution of epithelial cells, which have undergone EMT, to the fibroblast population may be negligible. Instead, recent findings suggest that alveolar epithelial type II (ATII) cells undergoing EMT promote a pro-fibrotic microenvironment through paracrine signalling activating local fibroblasts. This review paper explores the contribution of ATII cells, which have undergone EMT, in the context of pulmonary fibrosis.

Tsering Stobdan¹ and Gabriel G. Haddad^{1, 2, 3}*

¹Division of Respiratory Medicine, Department of Pediatrics, University of California, San Diego, La Jolla, CA 92093, USA

²Department of Neurosciences, University of California, San Diego, La Jolla, CA 92093, USA

³Rady Children's Hospital, San Diego, CA 92123, USA

Madumani Amararathna¹, Kerry Goralski², David W. Hoskin^3,4, H. P. Vasantha Rupasinghe^1,3*

¹Department of Plant, Food, and Environmental Sciences, Faculty of Agriculture, Dalhousie University, Rm 219-C, Cox Institute Building, 50 Pictou Rd. PO Box 550, Truro, NS, B2N 5E3, Canada.

²College of Pharmacy and Department of Pharmacology, Dalhousie University, Halifax, NS B3H 4R2, Canada.

³Department of Pathology, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada.

⁴Department of Microbiology and Immunology, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada.

Treatment complexities and the cytotoxicity of anticancer drugs to normal cells often results in therapeutic failure. Biodegradable nanoparticles have gained attention as drug carriers due to their physicochemical characteristics. Nanoparticles are able to encapsulate anticancer drugs and deliver them to target malignant cells while sparing normal cells. Since lung cancer usually arises in lung epithelium, localized drug delivery could be an alternative strategy to effectively treat this disease. Encapsulation of lung cancer drugs in nanoparticles may facilitate intact drug delivery, avoid first-pass metabolism, and reduce cytotoxicity to normal cells, as well as being attractive to patients. However, nanoparticles should be formulated in such a way as to facilitate entrance, deposition, retention, and permeability on targeted lung tissues and escape mucociliary clearance and phagocytosis. Additionally, the patient’s diversity related to lung cancer type, stage of disease, and physical fitness should be considered when formulating a nanocarrier and a delivery device. The potential of localized drug delivery for lung cancer using nanoparticles is reviewed here.

Abbreviations: PLGA, poly(lactide-co-glycolide); MRP1, multidrug resistance associated protein 1; GST, glutathione-s-transferase; NAT, N-acetyltransferease; SULT, sulfotransferases; TRAIL, tumor necrosis factor-related apoptosis-inducing ligand.

Paul A. Lilburn¹*, Henry Ainge-Allen¹, Paul S. Thomas^1,2

¹Department of Respiratory Medicine, Prince of Wales’ Hospital

²Prince of Wales’ Clinical School and Mechanisms of Disease and Translational Research, University of New South Wales, NSW, Faculty of Medicine, University of New South Wales, NSW, Australia

Asthma affects approximately 240 million people worldwide. It is characterised by an allergic pattern of smooth muscle constriction and airway inflammation, and if chronic, the inflammation can lead to structural changes and fixed airflow obstruction. Bronchodilators relieve the bronchoconstriction, while inhaled corticosteroids reduce the airway inflammation. This paper reviews fluticasone furoate (FF), a novel inhaled corticosteroid with 24-hour duration of action. It is a synthetic fluorinated corticosteroid with agonist activity at the glucocorticoid receptor (GRE). It is reported to have a fast association and slow dissociation from the GRE compared to other ICSs. FF has been found to have a greater lung retention time than all other ICS preparations which may contribute to the extended duration of anti-inflammatory action. FF has extensive first pass hepatic metabolism resulting in a low gastrointestinal bioavailability which is consistent with the findings for other ICS preparations. FF, however, will pass from the lung into the systemic circulation and therefore an adverse profile similar to all ICS is likely, but long term data are needed.

FF has demonstrated treatment efficacy for asthma between 100μg and 200μg alone, but in combination with the long-acting beta agonist, vilanterol (FF/VIL 200μg/50μg OD) there were further improvements in lung function relative to monotherapy. There is an increased risk of pneumonia identified in patients with airways disease in associated with ICS preparations and surveillance will be required to determine if this also applies to FF. Once daily therapy, such as FF, may improve compliance and could hopefully be translated into further improvements in asthma-related outcomes.

AR Somashekar*, KG Ramakrishnan

Department of Pediatrics, MS Ramaiah Medical College and Hospitals, Bengaluru, Karnataka, India

Emanuela Cortesi, Juan-Jose Ventura*

Translational Cell and Tissue Research, Dept. of Imaging and Pathology, KU Leuven, Belgium

Lung cancer is the leading cause of cancer-related deaths worldwide with poor prognosis, mainly due to the delay in the diagnosis. Adenocarcinoma, a subtype of non-small cell lung cancer, has the highest incidence and significant recurrence rates. Experimental and clinical researches suggested that the presence of cancer stem cells could support the development, malignization and resistance of lung cancer. Unfortunately, our knowledge in the field is still limited.

Here we report our findings regarding a cell population expressing LGR6, an epithelial stem cell marker. Under the pressure of a fine regulated p38? MAPK/mir-17-92 axis, LGR6⁺ stem cells produce differentiated bronchioalveolar cells, in the normal lung.

LGR6 is enriched in tumour cells during adenocarcinoma progression. Similar to normal stem cells, LGR6⁺ cancer cells show self-renewal and differentiation capacities, alongside with a higher oncogenic potential. Our studies suggest a disruption in the p38? MAPK/mir-17-92 network, that enhances Wnt pathway activity, could be responsible for the selection of malignant LGR6⁺ tumour cells. These results support the existence of a cell population with stem-like characteristics and strong oncogenic potential. This population could be useful for predictive diagnosis and a novel target for improved and more effective therapies against metastases and recurrences of lung adenocarcinomas.

Jaber Saud Alqahtani^{1, 2}*

¹Respiratory Care Department, Prince Sultan Military College of Health Sciences – Dhahran, Saudi Arabia

²Respiratory Medicine, University College London, London, United Kingdom

Hamid Reza Shoraka^1,3, Moslem Taheri Soodejani¹, Omid Abobakri¹, Narges Khanjani²*

¹Dept. of Epidemiology and Biostatistics, Kerman University of Medical Sciences, Kerman, Iran

²Environmental Health Engineering Research Center, Kerman University of Medical Sciences, Kerman, Iran

³Vector-borne Diseases Research Center, North Khorasan University of Medical Sciences, Bojnurd, Iran

Background: Asthma is one of the most common chronic non-communicable diseases which is seen more in the developed than developing countries of the world. Recurrence and exacerbations of the disease are common among patients and often lead to hospitalization and therapeutic interventions. Ambient air temperature might be related to the relapse of asthma. This review was conducted to investigate the relation between ambient temperature and exacerbations of asthma in children.

Methods: Related articles were searched in PubMed, Web of Science, Science Direct, and Scopus databases with appropriate keywords and no specific limitation on October 1, 2018. Initially, the relevance of the articles was examined using the title and abstract. Out of 2633 articles, 23 articles were eligible according to the inclusion and exclusion criteria.

Results: Fourteen studies had reported inverse relations; and showed as the temperature dropped, the number of asthma attacks increased in children. Nine papers observed a relation between hot weather and asthma attacks, 3 studies reported a relation between temperature differences and asthma attacks, and two studies did not show any relation. Some studies suggested the increased incidence of asthma in the 5-14 year old age group was associated with the start of the school year and probably due to the spread of viral diseases, not temperature changes.

Conclusion: Extreme temperatures are likely to cause exacerbation of childhood asthma.

Winnie W. Kung *

Fordham University, Graduate School of Social Service, New York, NY, USA

Giuseppe Tarantini*, Luca Nai Fovino, Alberto Barioli, Alessandro Schiavo, Chiara Fraccaro

Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padova, Italy

The muscle overlying the intramyocardial segment of an epicardial coronary artery is defined as myocardial bridge (MB). The clinical relevance of MBs is extremely heterogeneous, ranging from incidental finding in asymptomatic patients to different clinical manifestations such as stable or unstable angina, arrhythmias, Takotsubo syndrome or other major cardiovascular events. Moreover, patients can evolve from “asymptomatic carriers” to “symptomatic carriers” over time. In this setting, haemodynamic assessment is challenging and optimal therapy still a matter of debate. This review summarizes epidemiology, pathophysiology, diagnostic work-up (including both morphological and functional assessment) and treatment of patients with MB involving the left anterior descending artery, suggesting a pragmatic clinical approach.

Kimberly M. Clark*

MS in Respiratory Care Program, Clinical Associate Professor and Program Director, Department of Kinesiology, University of North Carolina at Charlotte, USA

Interprofessional education (IPE) and collaborative practice have been debated for several decades in the health professions. Over that course of time there have been ebbs and flows of interest in IPE and collaborative practice. Health care reform has brought about a renewed interest. IPE is considered an important component in developing collaborative practice-ready health professionals. IPE readiness, effectiveness, and challenges are considerations for successful IPE implementation. Sufficient evidence exists to suggest that faculty and students are motivated to engage in IPE. Knowledge, skills, and attitudes have been shown to improve with IPE interventions. Questions remain, however, about the linkage of IPE to collaborative practice and health outcomes.

VI Starodubov¹, AN Edeleva¹, TP Sabgayda^1*

¹Federal Research Institute for Health Organization and Informatics of Ministry of Health of Russian Federation, 11 Dobrolyubova Str., Moscow, 127254, Russia

The article compares the prevalence of pathological changes in different organs and systems among city and rural residents of the next ages: elderly (60-74 years for men and 55-74 years for women), senile (75-84 years) and advanced (85 years and older) ages. The results of the continuous survey of all persons of the retirement age of one urban (7809 people) and two rural areas (14749) of the Nizhny Novgorod region were analyzed. The region is comparatively homogeneous in terms of the national composition of the population.

In the city, the number of chronic pathologies of different organs and systems per one person of elderly age are: 2.83 for man and 2.76 for woman of elderly ages, 3.06 and 3.07 respectively for senile ages, 2.71 and 2.75 of advanced ages. In rural areas, the analyzed indicators for men and women are respectively 1.64 and 1.58 for elderly ages, 1.84 and 1.78 for senile ages, 1.86 and 1.84 for advanced ages.

Demonstrating the difference in the phenotypic manifestations of the genes of predisposition to chronic diseases in old age between the city and village, the results make it possible to produce the following assumptions. First, better access to medical care does not guarantee the better health status of the elderly, while it contributes to an increase in the life expectancy of men. Second, in spite of better access to health care, urban lifestyle contributes to the accumulation of chronic diseases in population of a region. Third, if chronic pathology of three different classes of diseases presented, then the probability of a long life is fundamentally determined by the access to health care. Fourth, the probability of longevity is significantly reduced in result of illness by neoplasms, cardiovascular, respiratory, endocrine or genitourinary diseases in ages of working or beginning of retirement period.

Samba Niang*

Department of pneumology of the university hospital center, St. Louis, Senegal

Anmol Pitliya¹, Asrar Ahmad², Husnain Shaukat¹, Eiman Ghaffarpasand¹, Sadaf Sharfaei¹, Farima Kahe¹, Syed Hassan A. Kazmi¹, Gerald Chi^1*

¹Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA

²Department of Medicine, Abington Memorial Hospital, Abington, Pennsylvania, USA

Anemia, commonly defined as hemoglobin concentration <12.0 g/dL in women and <13.0 g/dL in men, is a prevalent condition that has been linked to unfavorable prognosis among hospitalized patients. Population-based studies report that low hemoglobin level is associated with various thrombotic disorders including myocardial infarction, stroke, and venous thromboembolism (VTE). A recent study on acutely ill hospitalized patients extends the previous findings and demonstrates that anemic patients were at a greater risk for symptomatic VTE through 77 days of follow-up. Specifically, decreased hemoglobin concentration was associated with a two-fold risk of symptomatic DVT or non-fatal PE, despite the provision of pharmacologic thromboprophylaxis with enoxaparin or betrixaban, an FDA approved direct oral anticoagulant for VTE prevention. Additionally, hemoglobin measurement improved the risk discrimination and reclassification of a well-validated VTE assessment tool (i.e., International Medical Prevention Registry on Venous Thromboembolism [IMPROVE] VTE risk score). Based on these results, future studies should evaluate the use of laboratory biomarkers in conjunction with clinical variables to refine individualized VTE risk assessment.

Anania G1, Fabbri N^1*, Marino S¹, Resta G¹, Giaccari S¹, Tamburini N¹, Fiorica F², Cavallesco G¹

¹Department of Morphology, Experimental Medicine and Surgery, Section of General and Thoracic Surgery, University of Ferrara, Ferrara, Italy

²Department of Radiation Oncology, University Hospital Ferrara, Ferrara, Italy

Aim: The figure of cancer patient has changed. Some reasons are the increase of the average population and higher incidence of diseases related to old age (cardiovascular diseases, diabetes, etc.), but also diseases such as obesity are increasing in industrialized countries. For these reasons is necessary to choose an adequate and personalized treatment, taking into consideration the different risk of mortality and morbidity in therapeutic choices through a greater interaction between medical specialists.

Experiment: we conducted a retrospective study that took into consideration all the patients who underwent surgery of rectosigmoid junction and rectum in our hospital before and after the institution of a multidisciplinary tumour board (MTB) from January 2007 to April 2017. Furthermore, a recent retrospective single-centre analysis was performed in the same hospital by Tamburini et al. on consecutive patients who underwent surgery for non-small cell lung cancer (NSCLC) between January 2008 and December 2015.

Results: the advantage brought by the multidisciplinary evaluation teams are confirmed for the presence of benefits in terms of reduction of morbidity and improvement of the outcome of MTB patient group.

Conclusions: we find that more study depth of neoplastic disease as well as of each individual patient leads to more accurate staging and to a weighted therapy based on the needs of the individual. According to our experience, multidisciplinary tumour board should be present in all hospitals where cancer diseases are treated.

H Rawal^1*, SS Mehta²

¹University of Illinois at Urbana Champaign. 611 west Park Street, Urbana, Illinois 61801, USA

²Carle Foundation Hospital. Senior clinical and Interventional cardiologist. 611 west Park Street, Urbana, Illinois 61801, USA

Anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA) is a very rare congenital heart defect. Most patients are asymptomatic and the anomaly is detected incidentally during evaluation for other problems. Occasionally, ARCAPA may lead to myocardial ischemia and/or sudden cardiac arrest. Here we highlight the presentation, diagnosis and available treatment modalities for the management of this rare anomaly.

Yousser Mohammad^1*

¹Department of Internal Medicine, Section Pulmonary, Syrian Private University, Syria

C.A Hing¹, A. Alaga^1*, M.K Razul¹

¹Hospital Sultanah Bahiyah, Alor Setar, Malaysia

Pulmonary crytococcosis is a rare infection in immunocompetent patients. It is caused by encapsulated yeast-like fungus Cryptococcus neoformans. A young healthy gentleman presented with 1 day history of dyspnoea and fever, with 2 weeks history of weight loss.

Clinical examination revealed left lung collapse. CT thorax done showed a mediastinal mass with left lung collapse. Tissue obtained from bronchoscopy confirmed presence of Cryptococcus neoformans. The left main bronchial mass was removed during rigid bronchoscopy to expand the left lung. He was given T fluconazole 400 mg OD for 6 months. He improved significantly after the removal of left bronchial mass.

Boushab Mohamed Boushab^1*, Abdoulaye Mamadou Traore², Mamoudou Savadogo³, Sidi Yeslem Ould-Bahiya⁴, Fatima Zahra Fall-Malick⁵

¹Médecine Interne et Maladies Infectieuses, Centre hospitalier de Kiffa, Assaba, Mauritanie

²Service des Maladies Infectieuses, Hôpital du Point G, Bamako, Mali

³Service des Maladies Infectieuses, CHU Yalgado Ouédraogo, Ouagadougou, Burkina Faso

⁴Service d'Imagerie Médicale, Centre National d'Oncologie, Nouakchott, Mauritanie

⁵Institut National d'Hépato-virologie, Faculté de Médecine de Nouakchott, Mauritanie

Background: In recent years, tuberculosis has been experiencing a renewal which appears to be linked to epidemiological, clinical and paraclinical factors. It is a real public health problem.

Summary: There is a prospective study at Kiffa regional hospital from January 1st to December 31st, 2017,

Objective: The goal was establish the real contribution of chest radiography to patient with respiratory infection diseases with a negative microscope smear.

Results: We recruited 53 cases of pulmonary tuberculosis (79% of all TB cases). For Acid-Fast Bacilli (AFB) in sputum on direct examination and optical microscopy was negative in 52% of cases. The eight patients who accepted the HIV test, 6 were HIV positive. The sex ratio M/F was 1.7 and the average age of patients was 45 years old (range 15-80 years)The most common clinical signs were fever, sputum, chronic cough and chest pain. The radiological aspects of the negative tuberculosis were caves (34%), reticular or reticulonodular (26%), lymph nodes pulmonary hilum opacities nodular (23%), pleurisy (14%) and miliary (3%). In the lung lesion, parenchymal lung lesion were majority, it account for 64%, more of the lesions were located in the right upper lobe(49%).

Conclusion: This approach provided a TB diagnostic tool in patients with pulmonary tuberculosis negative bascilloscopie. In hospital practice, the combination of simple clinical, and radiological symptoms as an aid in the diagnosis of TB. Some Similar studies are needed to improve diagnosis in patients from outpatient suspected TB.

Shao Shuai^{1, 2}, Gao Yue^2*

¹National Institute for Radiological Protection, Chinese Center for Disease Control and Prevention, Beijing 100088, China

²Beijing Institute of Radiation Medicine, Beijing 100850, China

Coagulation abnormalities are critical diseases that threaten the survival of patients. Ferulic acid can regulate the blood coagulation function in two aspects. This paper reviews and discusses the reported mechanisms of the antithrombotic activities of ferulic acid. Previous studies suggested that ferulic acid played a role in antithrombosis by inhibiting platelet aggregation and protecting the endotheliocyte. Meanwhile, ferulic acid has fewer side effects on the platelet, leukocytosis and gastrointestinal tract, because it can promote the formation and differentiation of hematopoietic progenitor cells and protect the intestinal cells from injury. Therefore, ferulic acid is a potential protector from thrombotic diseases, such as cardiovascular dysfunction, pulmonary thromboembolism and deep vein thrombosis.

Helmy M. Guirgis^1*

¹The Cancer Free Foundation, 24806 Sea Crest Dr. Dana Point, CA 92629

Liam Rourke^1*, Ron Damant¹, Chris Donoff², Anthony Singhal²

¹Department of Medicine, University of Alberta, Edmonton, Canada

²Department of Psychology, University of Alberta, Edmonton, Canada