All Articles

James C. Parker^1*

¹Department of Physiology, College of Medicine, MSB 3074, University of South Alabama, 307 University Blvd. Mobile, AL 36688, USA

Although reduced tidal volumes have improved patient survival during ventilation for acute lung injury, further improvements will require pharmacologic interventions of the cellular pathways for inflammation and injury. We previously reported that pretreatment with mitochondrial targeted mtDNA repair enzymes largely prevented lung injury and inflammation during a protocol for moderately severe ventilation induced lung injury. GSH/GSSG ratios indicated that free radical production had been reduced to baseline levels by treatment. The central role of the alveolar macrophages and cellular mechanisms of injury are discussed. This includes a rapid calcium entry and mitochondrial production of excessive reactive oxygen species. Excessive ROS can then result in activation of the NLRP3 inflammasome and secretion of IL-1 and IL-18 by caspase-1. A simultaneous activation of NFkB to transcribe pro forms of the cytokines is stimulated by damage associated molecular pattern (DAMP) recognition receptors. These are primarily TLR4 responding to various cellular damage products and TLR9 responding to mtDNA fragments that appear to be primarily involved. Intervention in these pathways could result in useful future clinical treatments.

Norma Helena Perlroth^1* and Christina Wyss Castelo Branco²

¹University Hospital Gaffrée Guinle, Department of Pediatrics, Pediatric Emergency Care, Federal University of the State of Rio de Janeiro, RJ, Brazil

²Department of Zoology, Institute of Biosciences, Federal University of the State of Rio de Janeiro, RJ, Brazil

Objective: The present study aims to identify the scientific evidence on the influence of the environment during the critical periods of children’s lung development.

Data source: The search was performed in the Bireme database, using the terms: fetal development, child development, environmental exposure, environmental pollutants, lung diseases, health vulnerability and toxicity pathways in the LILACS, MEDLINE and SciELO systems.

Data synthesis: The vulnerability of children to respiratory diseases due to environmental hazards occurs because very specific physiological characteristics are found in this population. Exposure to toxic agents during the sensitive phases of child development can cause negative impacts to the normal physical lung. The caused effects are reflected in the increased prevalence on children morbidity with temporary or permanent pulmonary damage.

Conclusion: Understanding the effects of environmental exposures on the child lung and how they are established can contribute to the ultimate goal of prevention, i.e. to avoid, minimize or reduce the exposure of children to risk factors for their health.

A.-S. Advenier¹, G. Lorin de la Grandmaison^2*

¹Department of Forensic Medicine, Claude Bernard Lyon 1 University, Hospices Civils de Lyon, France.

²Department of Forensic Medicine and Pathology, Versailles-Saint-Quentin University, AP-HP, Raymond Poincaré Hospital, Garches, France.

Although lesions related to chemical burns concern digestive tract first, pulmonary damage can also be observed, in cases of inhalation or secondary to gastric aspiration. Pulmonary lesions after caustic exposure are non-specific. Multiple factors may influence the pattern of lesions, including the nature of the caustic substance, the duration of contact, the amount of the substance encountering the tissue and the length of postingestion survival. Significant complications of caustic ingestion such as chemical pneumonitis can develop in the first days or later. This article summarizes the most frequent pulmonary lesions according to the corrosive agent (gas, solid and liquid caustic, arsenic).

Ahmet Sinan Copur^1*, D Erik Everhart²

¹Rosalind Franklin University of Medicine and Science, Captain James Lovell Federal Health Care Center, North Chicago, IL.

²DEast Carolina University, Greenville, NC

Sleep disordered breathing (SDB) is a common health problem with significant morbidity and mortality. Positive airway pressure (PAP) therapy is the accepted first-line treatment for SDB. Despite the documented efficacy of PAP therapy in the treatment of SDB, patient adherence is problematic. Proposed reasons for this nonadherence include patient-related, therapy/medication-related, and health professional-related factors. Some research studies have been published regarding the relationship between patient psychological or personality characteristics and adherence with PAP therapy. These studies can be divided into two groups. The first group focuses on psychological/personality characteristics of SDB patients. These studies claim that hypochondriasis, depression, memory and some cognitive function impairment are prevalent among SDB patients. Patients with these psychological and personality characteristics report more symptoms and complaints compared to other SDB patients. The second group examines the PAP adherence and psychological/personality characteristics. They report that PAP adherence may negatively correlate with Type D personality, hypochondriasis, claustrophobia, depression, neuroticism, and BIS while may be positively associated with BAS-FS, and intellect imagination.

However, limited data, the significant difference of the methods, techniques, number of cases and results of the studies, and contribution of multiple other factors make it difficult to draw a reliable conclusion. More specific studies with larger sample size on proposed psychological/personality variables would give a more clear understanding of this problem.

Shigeki Sawada^1*

¹Department of Thoracic Surgery, Japanese Red Cross Society Himeji Hospital, Japan

Yuusaku Sugihara^{1, 2*}, Keita Harada¹, Hiroko Ogawa², Fumio Otsuka², Hiroyuki Okada¹

¹Department of Gastroenterology and Hepatology, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayaka-shi, Okayama 700-8558, Japan

²Department of General internal medicine, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayaka-shi, Okayama 700-8558, Japan

Pneumatosis cystoides intestinalis (PCI) is the presence of air within the walls of the small intestines or colon. The prevalence of PCI is difficult to determine as patients are mostly asymptomatic. The main cause of PCI is considered to be mechanical, although bacterial and biochemical causes have also been theorized. According to the mechanical theory, PCI results from a loss of integrity of the mucosa, caused by diseases such as necrotizing enterocolitis, intestinal ischemia, inflammatory bowel disease, or obstructive pulmonary disease. On computed tomography, PCI presents as images that are cystic or linear collections of air near the lumen of the bowel. The occurrence of PCI is more common in the colon than in the small intestine, appearing as a polypoid, with the overlying mucosa displaying a blue hue on colonoscopy. PCI can usually be resolved through the discontinuation of medications that increase the formation of intestinal gas. Inhalational and hyperbaric oxygen therapy have also been used for the treatment of PCI. Patients presenting with signs of peritonitis, such as abdominal guarding, rebound tenderness, and metabolic acidosis on abdominal assessment, require emergent treatment, with exploratory laparotomy being recommended.

Wendy Jo Svetanoff^1*, Russell W. Jennings¹

¹Boston Children’s Hospital, Boston, MA

Surgical correction of tracheobronchomalacia (TBM) has continued to evolve over the recent years. A review of the advances in the pre-operative assessment, operative techniques, and post-operative management of patients with TBM was performed. A 3 phase bronchoscopy, as part of the pre-operative evaluation, provides the most information for operative planning for the surgeon. Multiple options for surgical intervention are available, including an open, thoracoscopic, or median sternotomy approach to relieve anterior compression, or an open or thoracoscopic approach for performing a posterior tracheobronchopexy. Excellent outcomes have been seen with both approaches; however, the posterior approach is the preferred method of repair at our institution, as this provides direct support of the posterior membrane and allows for multiple areas of airway collapse to be directly addressed during the same operation; it also makes an anterior approach, if needed, much easier and more effective. Post-operatively, the use of paravertebral catheters has helped tremendously with pain control and respiratory function. The success of TBM repair is due to a multi-disciplinary team approach, as well as experience and analysis of many patients, that can be found at a Center of Excellence due to the high referral rate.

Matthew Randolph Marshall^1*, Marya Ghazipura², Tanzib Hossain³, Terry Gordon¹, Lung-Chi Chen¹

¹New York University School of Medicine, Department of Environmental Health Sciences, New York University Langone Medical Center, New York, NY

²New York University School of Medicine, Department of Population Health, New York, NY

³New York University School of Medicine Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, New York, NY

Purpose: This study aimed to analyze and summarize the effects that waterpipe (WP) smoke has on the cardiopulmonary system through a systematic review and meta-analysis.

Methods: We searched MEDLINE, Embase, Wiley Cochrane Library, Centre for Reviews and Dissemination, CINAHL Plus, and grey literature in March 2017. Our inclusion criteria for the studies were a comparison of WP smokers before and after waterpipe smoking (WPS) or to non-smokers.

Results: Using a random effects meta-analysis, a WPS session was associated with an elevation in systolic blood pressure (SBP) by 6.45 mmHg (95% CI 3.87 to 9.04; p < 0.0001), diastolic blood pressure (DBP) by 3.71 mmHg (95% CI 2.34 to 5.08; p < 0.0001), mean arterial pressure by 5.54 mmHg (95% CI 3.33 to 7.76; p < 0.0001), heart rate by 7.03 bpm (95% CI 4.60 to 9.46; p < 0.0001), carboxyl hemoglobin (COHb) by 4.11% (95% CI 3.38 to 4.84; p < 0.0001), and expired carbon monoxide (CO) by 22.53 ppm (95% CI 15.99 to 29.08; p < 0.0001).

Conclusion: WPS exposure is associated with significant acute increases in cardiopulmonary hemodynamic parameters, along with COHb and expired CO. These findings parallel the acute effects seen with cigarette smoking.

Ana Margarida Matos^1,2 and Paulo Matos^1,2*

¹Department of Human Genetics, National Health Institute ‘Dr. Ricardo Jorge’, Av. Padre Cruz, 1649-016 Lisboa; Portugal

²University of Lisboa; Faculty of Sciences, BioFIG - Centre for Biodiversity, Functional and Integrative Genomics, Campo Grande-C8, 1749-016 Lisboa; Portugal

Ankita S Chakotiya¹, Alka Narula³, Rakesh K Sharma^2*

¹Division of CBRN Defence, Institute of Nuclear Medicine and Allied Sciences, Delhi - 110054, India

²Defence Food Research Laboratory, Mysuru – 570011, India

³Department of Biotechnology, Jamia Hamdard, Delhi - 110062, India

Pseudomonas aeruginosa has become one of the major threats to public health as it causes serious diseases like pneumonia and the condition becomes sever if the disease is caused by drug-resistant strain. Thus, in the present study, the antibacterial activity of Zingiber officinale against P. aeruginosa causing a lung infection in Swiss albino mice was evaluated. Disease analysis includes bacteremia, x-rays based observation of patches formation in lungs, and destruction of lung tissue. Bacterial load showed a significant decline in the herbal treated group up to 1.13 ± 0.2 Log₁₀ CFU/ml at the 7^th day as compared to the untreated group with the bacterial burden 3.0 ± 0.12 Log₁₀ CFU/ml. The histopathology reveals more distorted alveoli in an infected group with an accumulation of immune cells while in the treated group improved lung histology was seen. The findings stated that Z. officinale is effective may provide a suitable lead for future development and possible clinical utility as inhibitors of lung infection caused by P. aeruginosa.

Emmanuel Andrès^1*, Rachel Mourot-Cottet¹, Frédéric Maloise^l,2

¹Departments of Internal Medicine B, University Hospital of Strasbourg, Strasbourg 67000, France

²Department of Hematology, Saint Anne’s Clinic, Strasbourg 67000, France

In this paper, we report and discuss the diagnosis and management of severe neutropenia and agranulocytosis (neutrophil count of <0.5 x 109/L) related to non-chemotherapy drug intake, called “idiosyncratic”. Lung specialists may be faced with these events. In fact, all classes of drugs have been implicated (“causative”) and clinical manifestations may include pneumonia or related disorders. Recently, several prognostic factors have been identified that may be helpful when identifying frailty patients. Old age (>65 years), septicemia or shock, metabolic disorders such as renal failure, and a neutrophil count below 0.1×109/L have been consensually accepted as poor prognostic factors for hematological recovery. In this potentially life-threatening disorder, modern management with broad-spectrum antibiotics and hematopoietic growth factors (particularly G-CSF), is likely to improve the prognosis. Thus, with appropriate management, the mortality rate of idiosyncratic drug-induced severe neutropenia and agranulocytosis is currently around 5%.

Flavia D’Agostin^1*, Paola De Michieli¹, Corrado Negro¹

¹Occupational Medicine Unit, Department of Surgical and Medical Sciences of Health University of Trieste, University of Trieste, Trieste, Italy

Non-occupational exposure to asbestos is a hazard that may contribute to the burden of mesothelioma over the next decades. Such exposure may result from cohabitation with an asbestos worker and the handling of his/her work clothes. This paper reviews the features of mesothelioma from domestic exposure reported by the literature. Household-exposure mesothelioma cases are more likely to be 1)female (primarily wife), 2) diagnosed with pleural mesothelioma 3)exposed and, in some cases, 4)diagnosed at a younger age, and to have a 4)longer latency and 5) similar lung asbestos concentrations compared to occupational cases. Non-occupational subjects are more likely to be under-recognized than those with occupational exposure. This underlines the ongoing importance of exposure history in enhancing early diagnosis and the need of a framework for insurance and welfare protection for mesothelioma cases induced by non-occupational exposure to asbestos.

Chao Pui I^1,3*, Cheng Gregory¹, Zhang Lunqing², Lo Iek Long³, Chan Hong Tou³, Cheong Tak Hong³

Objective: The objective of this study was to compare the efficacies of gefitinib and erlotinib in treating EGFR-mutated non-small-cell lung cancer (NSCLC) patients.

Methods: 319 EGFR-mutated NSCLC patients who had been treated with gefitinib or erlotinib at a Macau government hospital between 2005 Jan and 2015 Dec were retrospectively reviewed. Primary endpoint was overall survival (OS); progression-free survival (PFS) and disease control rate (DCR) were also analyzed.

Results: 259 patients were included in OS analysis. Nearly all patients were Asian (>99%). The median age in gefitinib group and erlotinib group were 62.5 and 60 respectively. Female patients predominated in gefitinib group (71.8% vs 46.6%, p<0.0001) and there was significantly more smokers or ever-smokers in erlotinib group (19.2% vs 35.0%, p=0.0046). Most patients were at a late stage of disease (stage III and IV ~85%) and >60% of patients received EGFR-TKI first-line. The median OS and PFS in gefitinib group and erlotinib group were 20.2 versus 26.3 months (p=0.0912) and 11.9 versus 13.4 months (p=0.0162) respectively, DCR was 72.1% versus 81.1 % (p=0.0799). Although erlotinib resulted in the better outcome, the difference was only significant with PFS. In the subgroup of patients receiving TKI first-line, erlotinib also showed a longer OS (19.2 vs. 34.6 months, p=0.0165).

Conclusion: For patients with EGFR mutations, gefitinib and erlotinib resulted in similar overall survival and disease control rate, but a significantly longer progression-free survival was observed with erlotinib. In patients receiving TKI as first-line therapy, erlotinib-treated patients also had a longer overall survival.

Alizaman S. Sadigov¹

Salem A. El-aarag¹, Mahmoud ElHefnawi^2,3*

Yonas Alem¹, Solomon Gebre-Selassie^2*

Background: Tuberculosis is the leading cause of morbidity and mortality killing about 1.8 million people each year. Ethiopia is seventh on the list of high burden countries for tuberculosis. Monitoring outcome of tuberculosis treatment and identifying the specific reasons for unsuccessful treatment outcome are important in evaluating the effectiveness of tuberculosis control program.

Objective: This retrospective study was conducted to analyze the trend of tuberculosis and treatment outcomes at three health centers in Addis Ababa.

Methods: A total of 6178 tuberculosis patients visiting three health centers during 2012 were included in the study. Data of patients on demographic characteristics, year of treatment, disease category, and treatment outcomes were recorded. Data on treatment outcome as cured, treatment completed, failed, died, defaulted, or transferred were collected according to WHO recommendations.

Results: Of the 6178 patients, 3151(51%) were males and 3027(49.0%) were females. The mean age of the study subject was 32.07±14.0. Smear positive pulmonary tuberculosis was 1670(27%), smear negative pulmonary tuberculosis in 2242(36.3%) and extrapulmonary tuberculosis in 2262(36.6%). Treatment outcome was successfully in 4919(79.6%), treatment failure in 42(0.7%), defaulters in 533(8.6%), died in 396(6.4%) and transferred out in 288(4.7%). Treatment success rate was steadily increased across the years from 76.2% in 2006 to 83.6% in 2010 (p<0.001). Female tuberculosis patients had higher treatment success rate of 81.3% while males had 78% success (p=0.001). Patients in the age group of 25-35 years had a significantly low treatment success rate compared to the other age group (p<0.001).

Conclusion: The treatment success rate of pulmonary and extrapulmonary tuberculosis patients treated at the 3 health centers was 79.6% which was lower than the WHO target of 85%. The higher default and death rate in the study area is a serious public health concern. So community mobilization, defaulter tracing, improved supervision, health education and enhanced case detection rate should be implemented in order to increase the treatment success rate in the study area.