Advances in Respiratory Medicine

151 KiB

Open AccessReview

Obstructive Sleep Apnea Syndrome and Hypothyroidism—Merely Concurrence or Causal Association?

by Wojciech Kuczyński, Agata Gabryelska, Łukasz Mokros and Piotr Białasiewicz

Adv. Respir. Med. 2016, 84(5), 302-306; https://doi.org/10.5603/PiAP.2016.0038 - 27 Sep 2016

Cited by 9 | Viewed by 830

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 [...] Read more.

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. Full article

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Open AccessReview

The Role of the TGF-SMAD Signalling Pathway in the Etiopathogenesis of Severe Asthma

by Marcelina Koćwin, Mateusz Jonakowski, Marcelina Przemęcka, Jan Zioło, Michał Panek and Piotr Kuna

Adv. Respir. Med. 2016, 84(5), 290-301; https://doi.org/10.5603/PiAP.2016.0037 - 27 Sep 2016

Cited by 13 | Viewed by 819

Abstract

Asthma is a chronic inflammatory heterogeneous disease of the lower respiratory tract characterised by the occurrence of bronchial hyper-responsiveness and paroxysmal, changeable bronchial obstruction. Transforming growth factor-beta (TGF-β) is one of the cytokines involved in mediating airway inflammation and remodelling. The [...] Read more.

Asthma is a chronic inflammatory heterogeneous disease of the lower respiratory tract characterised by the occurrence of bronchial hyper-responsiveness and paroxysmal, changeable bronchial obstruction. Transforming growth factor-beta (TGF-β) is one of the cytokines involved in mediating airway inflammation and remodelling. The level of TGF-β1 gene expression correlates with severity of symptoms. Alterations in the main SMAD signal transmission, overexpression of TGF-β genes and changes in the transcriptome cause excessive secretion of TGF-β and its increased expression in target cells, which clinically induces a moderate-severe or severe course of asthma as well as an earlier and faster disease progression. Knowledge of these processes allows clinicians to assess immune responses in patients, which affects adequate disease control and prevention of remodelling. Full article

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Open AccessCase Report

Hemoptysis in a Patient with Multifocal Primary Pulmonary Angiosarcoma

by Aleksandra Piechuta, Tadeusz Przybyłowski, Małgorzata Szołkowska and Rafał Krenke

Adv. Respir. Med. 2016, 84(5), 283-289; https://doi.org/10.5603/PiAP.2016.0036 - 27 Sep 2016

Cited by 4 | Viewed by 550

Abstract

Primary pulmonary angiosarcoma (PPA) is a rare tumour arising from arterial or venous pulmonary vessels of various size. It is characterized by aggressive course and poor prognosis. The early diagnosis is difficult due to diverse clinical and radiological manifestations. We present a case [...] Read more.

Primary pulmonary angiosarcoma (PPA) is a rare tumour arising from arterial or venous pulmonary vessels of various size. It is characterized by aggressive course and poor prognosis. The early diagnosis is difficult due to diverse clinical and radiological manifestations. We present a case report of 70 year-old man, active cigarette-smoker, with a 2-month history of non-massive hemoptysis. The thorax CT revealed several solid pulmonary nodules surrounded by areas of ground glass opacity. As bronchoscopy failed to deliver adequate tissue samples, video assisted thoracic surgery (VATS) with pleura and lung biopsy was necessary. Histopathological findings were consistent with pulmonary angiosarcoma. Since no extrapulmonary lesions were demonstrated, the final diagnosis of primary pulmonary angiosarcoma was made. The patient died three months after the onset of symptoms. Our case report highlights that differential diagnosis in patients with hemoptysis and pulmonary nodules should include primary pulmonary sarcoma. Full article

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Open AccessCase Report

Musculosceletal Tuberculosis with Involvement of Tendon Sheaths and Formation of Synovial Cyst

by Michał Zieliński, Henryka Mazur-Zielińska and Jerzy Kozielski

Adv. Respir. Med. 2016, 84(5), 278-282; https://doi.org/10.5603/PiAP.2016.0035 - 27 Sep 2016

Cited by 1 | Viewed by 397

Abstract

Due to an increasing amount of patients on immunosuppressive treatment, the number of tuberculosis (TB) of atypical course and extrapulmonary tuberculosis cases increase. Locomotor system is a place of every fifth case of extrapulmonary TB. Because of lack of characteristic symptoms, as well [...] Read more.

Due to an increasing amount of patients on immunosuppressive treatment, the number of tuberculosis (TB) of atypical course and extrapulmonary tuberculosis cases increase. Locomotor system is a place of every fifth case of extrapulmonary TB. Because of lack of characteristic symptoms, as well as rare co-occurrence of active lung lesions in radiological imaging, proper diagnosis is hard to establish. We present a case of patient on immunosuppressive therapy due to myositis, in whom we diagnosed musculoskeletal tuberculosis in form of involvement of tendon sheath and formation of synovial cyst. Full article

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Open AccessArticle

The Incidence of Tuberculosis Transmission among Family Members and outside Households

by Monika Kozińska and Ewa Augustynowicz-Kopeć

Adv. Respir. Med. 2016, 84(5), 271-277; https://doi.org/10.5603/PiAP.2016.0034 - 27 Sep 2016

Cited by 5 | Viewed by 568

Abstract

Introduction: 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 [...] Read more.

Introduction: 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. Material and methods: 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. Results: 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. Conclusions: 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. Full article

306 KiB

Open AccessArticle

Centrilobular Nodules in High Resolution Computed Tomography of the Lung in IPAH Patients—Preliminary Data Concerning Clinico-Radiological Correlates

by Monika Szturmowicz, Aneta Kacprzak, Barbara Burakowska, Agnieszka Skoczylas, Iwona Bestry, Jan Kuś, Anna Fijałkowska, Adam Torbicki and Marcin Kurzyna

Adv. Respir. Med. 2016, 84(5), 265-270; https://doi.org/10.5603/PiAP.2016.0033 - 27 Sep 2016

Cited by 4 | Viewed by 571

Abstract

Introduction: 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 [...] Read more.

Introduction: 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. Material and methods: 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. Results: 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. Conclusion: Centrilobular nodules in IPAH were combined with lack of PFO, higher mRAP and younger age of patients. Full article

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Open AccessArticle

Effect of Obesity and Metabolic Syndrome on Severity, Quality of Life, Sleep Quality and Inflammatory Markers in Patients of Asthma in India

by Mandeep Singh, Nitesh Gupta and Raj Kumar

Adv. Respir. Med. 2016, 84(5), 258-264; https://doi.org/10.5603/PiAP.2016.0032 - 27 Sep 2016

Cited by 6 | Viewed by 519

Abstract

Introduction: 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. Material and methods: 60 asthma patients [...] Read more.

Introduction: 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. Material and methods: 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. Results: 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. Conclusions: 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. Full article

162 KiB

Open AccessArticle

Persons with Allergy Symptoms Use Alternative Medicine More Often

by Anna Kłak, Filip Raciborski, Edyta Krzych-Fałta, Dagmara Opoczyńska-Świeżewska, Jakub Szymański, Agnieszka Lipiec, Barbara Piekarska, Adam Sybilski, Aneta Tomaszewska and Bolesław Samoliński

Adv. Respir. Med. 2016, 84(5), 251-257; https://doi.org/10.5603/PiAP.2016.0031 - 27 Sep 2016

Cited by 2 | Viewed by 492

Abstract

Introduction: 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 [...] Read more.

Introduction: 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. Material and methods: 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. Results: 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. Conclusions: 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. Full article

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Adv. Respir. Med., Volume 84, Issue 5 (September 2016) – 8 articles , Pages 251-306

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