Wendy Jo Svetanoff1*, 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.DOI: 10.29245/2689-999X/2017/1.1114 View / Download Pdf
Emmanuel Andrès1*, Rachel Mourot-Cottet1, Frédéric Maloisel,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%.DOI: 10.29245/2689-999X/2017/1.1101 View / Download Pdf
Ankita S Chakotiya1, Alka Narula3, Rakesh K Sharma2*
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 7th 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.DOI: 10.29245/2689-999X/2017/1.1109 View / Download Pdf
Flavia D’Agostin1*, 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.DOI: 10.29245/2689-999X/2017/1.1110 View / Download Pdf
Chao Pui I1,3*, 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.DOI: 10.29245/2689-999X/2017/1.1105 View / Download Pdf
Yonas Alem1, Solomon Gebre-Selassie2*
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.DOI: 10.29245/2689-999X/2017/1.1106 View / Download Pdf