Pulmonary Medicine http://www.hindawi.com The latest articles from Hindawi Publishing Corporation © 2016 , Hindawi Publishing Corporation . All rights reserved. Long-Term Chronic Intermittent Hypobaric Hypoxia in Rats Causes an Imbalance in the Asymmetric Dimethylarginine/Nitric Oxide Pathway and ROS Activity: A Possible Synergistic Mechanism for Altitude Pulmonary Hypertension? Mon, 30 May 2016 06:39:12 +0000 http://www.hindawi.com/journals/pm/2016/6578578/ Chronic intermittent hypoxia (CIH) and chronic hypoxia (CH) are associated with high-altitude pulmonary hypertension (HAPH). Asymmetric dimethylarginine (ADMA), a NO synthase (NOS) inhibitor, may contribute to HAPH. This study assessed changes in the ADMA/NO pathway and the underlying mechanisms in rat lungs following exposure to CIH or CH simulated in a hypobaric chamber at 428 Torr. Twenty-four adult Wistar rats were randomly assigned to three groups: CIH2x2 (2 days of hypoxia/2 days of normoxia), CH, and NX (permanent normoxia), for 30 days. All analyses were performed in whole lung tissue. L-Arginine and ADMA were analyzed using LC-MS/MS. Under both hypoxic conditions right ventricular hypertrophy was observed () and endothelial NOS mRNA increased (), but the phosphorylated/nonphosphorylated vasodilator-stimulated phosphoprotein (VASP) ratio was unchanged. ADMA increased (), whereas dimethylarginine dimethylaminohydrolase (DDAH) activity decreased only under CH (). Although arginase activity increased () and L-arginine exhibited no changes, the L-arginine/ADMA ratio decreased significantly (). Moreover, NOX4 expression increased only under CH (), but malondialdehyde (MDA) increased (up to 2-fold) equally in CIH2x2 and CH (). Our results suggest that ADMA and oxidative stress likely reduce NO bioavailability under altitude hypoxia, which implies greater pulmonary vascular reactivity and tone, despite the more subdued effects observed under CIH. Nicole Lüneburg, Patricia Siques, Julio Brito, Karem Arriaza, Eduardo Pena, Hans Klose, Fabiola Leon-Velarde, and Rainer H. Böger Copyright © 2016 Nicole Lüneburg et al. All rights reserved. Tolerability of Nasal Delivery of Humidified and Warmed Air at Different Temperatures: A Randomised Double-Blind Pilot Study Sun, 03 Apr 2016 12:49:14 +0000 http://www.hindawi.com/journals/pm/2016/7951272/ Objectives. Delivery of warmed, humidified air via nasal high flow therapy could potentially reduce replication of temperature-sensitive viruses in the upper respiratory tract. This study investigates whether nasal high flow therapy is well tolerated by healthy adults at 37°C and 41°C. Methods. In this randomised, double-blind, controlled crossover pilot trial, nasal high flow therapy was used to deliver humidified air at 35 L/min, at either 37°C or 41°C, for three one-hour sessions of use over one day. The alternative was delivered at least 14 days later. Ten healthy, nonsmoking adults were asked, via questionnaire after each day’s use, whether they would use nasal high flow therapy while being unwell with a cold or flu if it was demonstrated to improve symptoms. Results. All participants completed both interventions. Eighty percent responded “yes” to future use of nasal high flow therapy, for both 37°C and 41°C. There was no significant change from baseline in saccharin times following either intervention or in the following morning. Conclusions. Delivering humidified air via nasal high flow therapy at both 37°C and 41°C is well tolerated by healthy adults. This supports investigation into the potential use of nasal high flow therapy as treatment in viral upper respiratory tract infections. Trial Registration. This trial is registered with ACTRN12614000183684 (tolerability study of nasal delivery of humidified & warmed air). Susan Bibby, Sumeet Reddy, Terrianne Cripps, Steve McKinstry, Mark Weatherall, Richard Beasley, and Janine Pilcher Copyright © 2016 Susan Bibby et al. All rights reserved. Liver Cirrhosis and Diabetes Mellitus Are Risk Factors for Staphylococcus aureus Infection in Patients with Healthcare-Associated or Hospital-Acquired Pneumonia Mon, 22 Feb 2016 14:29:24 +0000 http://www.hindawi.com/journals/pm/2016/4706150/ Background. The risk factors for Staphylococcus aureus (S. aureus) pneumonia are not fully identified. The aim of this work was to find out the clinical characteristics associated with S. aureus infection in patients with healthcare-associated pneumonia (HCAP) and hospital-acquired pneumonia (HAP), which may be applicable for more appropriate selection of empiric antibiotic therapy. Methods. From July 2007 to June 2010, patients who were admitted to the intensive care unit with severe HCAP/HAP and severe sepsis were enrolled in this study. Lower respiratory tract sample was semiquantitatively cultured. Initial broad-spectrum antibiotics were chosen by Taiwan or American guidelines for pneumonia management. Standard bundle therapies were provided to all patients according to the guidelines of the Surviving Sepsis Campaign. Results. The most frequently isolated pathogens were Pseudomonas aeruginosa, S. aureus, Acinetobacter baumannii, Klebsiella pneumoniae, and Escherichia coli. Patients with positive isolation of S. aureus in culture had significantly higher history of liver cirrhosis and diabetes mellitus, with odds ratios of 3.098 and 1.899, respectively. The S. aureus pneumonia was not correlated with history of chronic obstructive pulmonary disease, hypertension, and hemodialysis. Conclusion. Liver cirrhosis and diabetes mellitus may be risk factors for S. aureus infection in patients with severe HCAP or HAP. Huang-Pin Wu, Chien-Ming Chu, Chun-Yao Lin, Chung-Chieh Yu, Chung-Ching Hua, Teng-Jen Yu, and Yu-Chih Liu Copyright © 2016 Huang-Pin Wu et al. All rights reserved. The Protective Effect of Naringin against Bleomycin-Induced Pulmonary Fibrosis in Wistar Rats Wed, 10 Feb 2016 10:29:42 +0000 http://www.hindawi.com/journals/pm/2016/7601393/ The aim of the current study was to investigate the protective effect of naringin on bleomycin-induced pulmonary fibrosis in rats. Twenty-four Wistar rats randomly divided into four groups (control, bleomycin alone, bleomycin + naringin 40, and bleomycin + naringin 80) were used. Rats were administered a single dose of bleomycin (5 mg/kg; via the tracheal cannula) alone or followed by either naringin 40 mg/kg (orally) or naringin 80 mg/kg (orally) or water (1 mL, orally) for 14 days. Rats and lung tissue were weighed to determine the lung index. TNF-α and IL-1β levels, hydroxyproline content, and malondialdehyde (MDA) levels were assayed. Glutathione peroxidase (GSH-Px) and superoxide dismutase (SOD) activities were determined. Tissue sections were stained with hematoxylin-eosin, Masson’s trichrome, and 0.1% toluidine blue. TNF-α, IL-1β, and MDA levels and hydroxyproline content significantly increased () and GPx and SOD activities significantly decreased in bleomycin group (). Naringin at a dose of 80 mg/kg body weight significantly decreased TNF-α and IL-1β activity, hydroxyproline content, and MDA level () and increased GPx and SOD activities (). Histological evidence supported the results. These results show that naringin has the potential of reducing the toxic effects of bleomycin and may provide supportive therapy for conventional treatment methods for idiopathic pulmonary fibrosis. Nergiz H. Turgut, Haki Kara, Sahende Elagoz, Koksal Deveci, Huseyin Gungor, and Emre Arslanbas Copyright © 2016 Nergiz H. Turgut et al. All rights reserved. Study of Exhaled Nitric Oxide in Subjects with Suspected Obstructive Sleep Apnea: A Pilot Study in Vietnam Wed, 13 Jan 2016 14:19:27 +0000 http://www.hindawi.com/journals/pm/2016/3050918/ Background and Objective. The concentration of exhaled nitric oxide (eNO), reflecting the activity of inducible NO synthase in airway epithelium, has been found to increase in patients with obstructive sleep apnea (OSA). This study aimed to measure eNO concentration in patients with suspected OSA and to correlate different eNO parameters with clinical and sleep apnea characteristics. Methods. In this cross-sectional study, all patients underwent in-lab overnight polysomnography (PSG) and eNO measurement using a method of multiple flow rates before and after PSG (pre- and post-PSG). Results. According to the result of PSG, 82 persons were divided into two groups: control subjects (; years) and patients with OSA defined as apnea-hypopnea index (AHI) ≥ 5/hour (; years). Body mass index (BMI) and neck and abdomen circumferences of OSA patients were significantly higher than those from control subjects. In OSA group, post-PSG alveolar NO concentration (CANO) ( ppb) was significantly higher than pre-PSG CANO ( ppb; ). Significant correlations have been found between CANO and AHI () and between CANO and nadir SpO2 (). The daytime CANO value of more than 4.1 ppb can be used to screen symptomatic subjects for the presence of OSA with a high specificity of 93.3%. Conclusion. Our findings indicate CANO as a surrogate marker for OSA in persons with suggestive symptoms. Sy Duong-Quy, Thong Hua-Huy, Huyen-Tran Tran-Mai-Thi, Nhat-Nam Le-Dong, Timothy J. Craig, and Anh-Tuan Dinh-Xuan Copyright © 2016 Sy Duong-Quy et al. All rights reserved. The Interpretation of Dyspnea in the Patient with Asthma Thu, 24 Dec 2015 10:03:09 +0000 http://www.hindawi.com/journals/pm/2015/869673/ Physicians have noted dyspnea in severely ill asthmatic patients to be associated with fright or panic; in more stable patients dyspnea may reflect characteristics including lung function, personality and behavioral traits. This study evaluates the symptom of dyspnea in 32 asthmatic patients twice: first when acutely ill and again after an initial response to therapy. Spirometry was performed, dyspnea quantified (Borg scale), and panic assessed with a specialized measure of acute panic (the acute panic inventory (API)) in the 32 patients before and again after treatment. After treatment, questionnaires to evaluate somatization and panic disorder were also administered. When acutely ill, both the API and all spirometric measures (PEFR; FEV1; IC) correlated with dyspnea. Multiple linear regression showed that measures of the API, the peak expiratory flow rate, and female sex taken together accounted for 41% of dyspnea in acute asthma. After treatment, the API again predicted dyspnea while spirometric data did not. Those subjects who described themselves as having chronic panic disorder reported high grades of dyspnea after treatment also. We conclude that interpretations of the self-report of asthma differ between acutely ill and stable asthmatic patients. Marc H. Lavietes Copyright © 2015 Marc H. Lavietes. All rights reserved. Patients with MAC Lung Disease Have a Low Visceral Fat Area and Low Nutrient Intake Sun, 29 Nov 2015 12:04:50 +0000 http://www.hindawi.com/journals/pm/2015/218253/ Objective. This study aimed to examine the nutritional status and nutrient intake of patients with MAC lung disease with a focus on visceral fat area. Patients and Methods. Among 116 patients of our hospital with nontuberculous mycobacteriosis who were registered between May 2010 and August 2011, 103 patients with MAC lung disease were included in this study. In all patients, nutritional status and nutrient intake were prospectively examined. Results. Patients were 23 men and 80 women (mean age, years). BMI (kg/m2) at the time of registration was in men and in women. Visceral fat area (cm2) was significantly lower in women () than in men () (). The comparison with general healthy adults according to age revealed a markedly reduced visceral fat area among patients with MAC lung disease. With respect to nutrient intake, energy adequacy (%), protein adequacy (%), lipid adequacy (%), and carbohydrate adequacy (%) ratios were all low at the time of registration. BMI was significantly correlated with protein adequacy () and lipid adequacy () ratios, while no association was found between visceral fat area and nutrient intake. Conclusion. Patients with MAC lung disease had a low visceral fat area and low nutrient intake. Kentaro Wakamatsu, Nobuhiko Nagata, Sanae Maki, Hisamitsu Omori, Hiroyuki Kumazoe, Kayoko Ueno, Yuko Matsunaga, Makiko Hara, Koji Takakura, Nagisa Fukumoto, Nobuhisa Ando, Mami Morishige, Takashi Akasaki, Ichiro Inoshima, Shinji Ise, Miiru Izumi, and Masayuki Kawasaki Copyright © 2015 Kentaro Wakamatsu et al. All rights reserved. Clinical Investigation of Benign Asbestos Pleural Effusion Tue, 24 Nov 2015 14:03:59 +0000 http://www.hindawi.com/journals/pm/2015/416179/ There is no detailed information about benign asbestos pleural effusion (BAPE). The aim of the study was to clarify the clinical features of BAPE. The criteria of enrolled patients were as follows: (1) history of asbestos exposure; (2) presence of pleural effusion determined by chest X-ray, CT, and thoracentesis; and (3) the absence of other causes of effusion. Clinical information was retrospectively analysed and the radiological images were reviewed. There were 110 BAPE patients between 1991 and 2012. All were males and the median age at diagnosis was 74 years. The median duration of asbestos exposure and period of latency for disease onset of BAPE were 31 and 48 years, respectively. Mean values of hyaluronic acid, adenosine deaminase, and carcinoembryonic antigen in the pleural fluid were 39,840 ng/mL, 23.9 IU/L, and 1.8 ng/mL, respectively. Pleural plaques were detected in 98 cases (89.1%). Asbestosis was present in 6 (5.5%) cases, rounded atelectasis was detected in 41 (37.3%) cases, and diffuse pleural thickening (DPT) was detected in 30 (27.3%) cases. One case developed lung cancer (LC) before and after BAPE. None of the cases developed malignant pleural mesothelioma (MPM) during the follow-up. Nobukazu Fujimoto, Kenichi Gemba, Keisuke Aoe, Katsuya Kato, Takako Yokoyama, Ikuji Usami, Kazuo Onishi, Keiichi Mizuhashi, Toshikazu Yusa, and Takumi Kishimoto Copyright © 2015 Nobukazu Fujimoto et al. All rights reserved. Statins in Asthma: Potential Beneficial Effects and Limitations Thu, 05 Nov 2015 07:43:22 +0000 http://www.hindawi.com/journals/pm/2015/835204/ Asthma’s sustenance as a global pandemic, across centuries, can be attributed to the lack of an understanding of its workings and the inability of the existing treatment modalities to provide a long lasting cure without major adverse effects. The discovery of statins boosted by a better comprehension of the pathophysiology of asthma in the past few decades has opened up a potentially alternative line of treatment that promises to be a big boon for the asthmatics globally. However, the initial excellent results from the preclinical and animal studies have not borne the results in clinical trials that the scientific world was hoping for. In light of this, this review analyzes the ways by which statins could benefit in asthma via their pleiotropic anti-inflammatory properties and explain some of the queries raised in the previous studies and provide recommendations for future studies in this field. Dipanjan Bhattacharjee, Bharti Chogtu, and Rahul Magazine Copyright © 2015 Dipanjan Bhattacharjee et al. All rights reserved. Effects of Symptom Perception Interventions on Trigger Identification and Quality of Life in Children with Asthma Wed, 28 Oct 2015 13:56:47 +0000 http://www.hindawi.com/journals/pm/2015/825137/ Background. Management of individual triggers is suboptimal in practice. In this project, we investigated the impact of symptom perception interventions on asthma trigger identification and self-reported asthma quality of life. Methods. Children with asthma () participated in three asthma education sessions and then were randomized first to one of three home monitoring conditions (symptom monitoring and peak flow training with feedback, peak flow training without feedback, or no peak flow training) and then subsequently to one of three resistive load discrimination training conditions (signal detection training with feedback, signal detection training without feedback, or no training). Triggers were reported at enrollment, following home monitoring, and following discrimination training; quality of life was measured after home monitoring and after resistive load testing. Results. Symptom perception interventions resulted in increases in reported triggers, which increased reliably as a function of home monitoring, and increased further in participants who completed discrimination training with feedback. Increases in the number of reported asthma triggers were associated with decreases in quality of life. Discussion. Patients may benefit from strategies that make trigger-symptom contingencies clear. Complementary strategies are needed to address changes in the perceived burden of asthma which comes from awareness of new asthma triggers. Thomas Janssens and Andrew Harver Copyright © 2015 Thomas Janssens and Andrew Harver. All rights reserved. Differences between Risk Factors Associated with Tuberculosis Treatment Abandonment and Mortality Tue, 27 Oct 2015 07:32:06 +0000 http://www.hindawi.com/journals/pm/2015/546106/ Objectives. To identify the risk factors that were associated with abandonment of treatment and mortality in tuberculosis (TB) patients. Methods. This study was a retrospective longitudinal cohort study involving tuberculosis patients treated between 2002 and 2008 in a TB reference center. Results. A total of 1,257 patients were evaluated, with 69.1% men, 54.4% under 40 years of age, 18.9% with extrapulmonary disease, and 9.3% coinfected with HIV. The risk factors that were associated with abandonment of treatment included male gender (OR = 2.05; 95% CI = 1.15–3.65) and nonadherence to previous treatment (OR = 3.14; 95% CI = 1.96–5.96). In addition, the presence of extrapulmonary TB was a protective factor (OR = 0.33, 95% CI = 0.14–0.76). The following risk factors were associated with mortality: age over 40 years (OR = 2.61, 95% CI = 1.76–3.85), coinfection with HIV (OR = 6.01, 95% CI = 3.78–9.56), illiteracy (OR = 1.88, 95% CI = 1.27–2.75), the presence of severe extrapulmonary TB (OR = 2.33, 95% CI = 1.24–4.38), and retreatment after relapse (OR = 1.95, 95% CI = 1.01–3.75). Conclusions. Male gender and retreatment after abandonment were independent risk factors for nonadherence to TB treatment. Furthermore, age over 40 years, coinfection with HIV, illiteracy, severe extrapulmonary TB, and retreatment after relapse were associated with higher TB mortality. Therefore, we suggest the implementation of direct measures that will control the identified risk factors to reduce the rates of treatment failure and TB-associated mortality. Nathália Mota de Faria Gomes, Meire Cardoso da Mota Bastos, Renata Magliano Marins, Aline Alves Barbosa, Luiz Clóvis Parente Soares, Annelise Maria de Oliveira Wilken de Abreu, and João Tadeu Damian Souto Filho Copyright © 2015 Nathália Mota de Faria Gomes et al. All rights reserved. Knowledge Level of the Primary Healthcare Providers on Chronic Obstructive Pulmonary Disease and Pulmonary Rehabilitation Mon, 26 Oct 2015 11:41:48 +0000 http://www.hindawi.com/journals/pm/2015/538246/ Introduction. Awareness of the healthcare providers on chronic obstructive pulmonary disease (COPD), which is an important cause of mortality and morbidity in our country and all over the world, and on pulmonary rehabilitation (PR) which plays an important role in its nonpharmacological treatment will provide effectiveness in diagnosis and treatment of COPD. The present study aimed at determining knowledge level of the healthcare providers about COPD and PR. Materials and Methods. In this cross-sectional study, family practitioners and staff of home-care in central county of Manisa City were applied a questionnaire in order to determine their knowledge level on COPD and pulmonary rehabilitation during the in-service training on “pulmonary rehabilitation, home-care services for the pulmonary diseases, and respiratory exercises.” Results. 65.5% of the healthcare providers responded to the survey. Rate of those correctly knowing at least one of four items was 97.2%. No responder knew all items correctly. Average value for correct answers was 5.30 ± 2.1 (range: 1–10). The physicians, men, and those working in family health centers had higher level of knowledge on COPD compared to nonphysician healthcare providers , women , and those working in other practices , respectively. Conclusion. Knowledge level of the primary healthcare providers on COPD and PR remains inadequate. Dynamic postgraduate training on this topic will be useful in referring the patients to centers giving service for this condition. Tuğba Göktalay, Ayşe Nur Tuncal, Seçil Sarı, Galip Köroğlu, Yavuz Havlucu, and Arzu Yorgancıoğlu Copyright © 2015 Tuğba Göktalay et al. All rights reserved. Intravenous Dexmedetomidine Provides Superior Patient Comfort and Tolerance Compared to Intravenous Midazolam in Patients Undergoing Flexible Bronchoscopy Mon, 12 Oct 2015 08:21:15 +0000 http://www.hindawi.com/journals/pm/2015/727530/ Dexmedetomidine, an α2 agonist, has demonstrated its effectiveness as a sedative during awake intubation, but its utility in fiberoptic bronchoscopy (FOB) is not clear. We evaluated the effects of midazolam and dexmedetomidine on patient’s response to FOB. The patients received either midazolam, 0.02 mg/kg (group M, ), or dexmedetomidine, 1 µg/kg (group D, ). A composite score of five different parameters and a numerical rating scale (NRS) for pain intensity and distress were used to assess patient response during FOB. Patients rated the quality of sedation and level of discomfort 24 h after the procedure. Ease of bronchoscopy, rescue medication requirement, and haemodynamic variables were noted. Ideal or acceptable composite score was observed in 15 and 26 patients, respectively, in group M (14.48 ± 3.65) and group D (9.41 ± 3.13), . NRS showed that 11 patients in group M had severe pain and discomfort as compared to one patient with severe pain and two with severe discomfort in group D during the procedure, . Rescue midazolam requirement was significantly higher in group M (). We conclude that during FOB, under topical airway anaesthesia, IV dexmedetomidine (1 µg/kg) provides superior patient comfort and tolerance as compared to IV midazolam (0.02 mg/kg). Umesh Goneppanavar, Rahul Magazine, Bhavya Periyadka Janardhana, and Shreepathi Krishna Achar Copyright © 2015 Umesh Goneppanavar et al. All rights reserved. A Rationale for Going Back to the Future: Use of Disposable Spacers for Pressurised Metered Dose Inhalers Sun, 27 Sep 2015 07:14:26 +0000 http://www.hindawi.com/journals/pm/2015/176194/ The introduction of pressurised metered dose inhalers (MDIs) in the mid-1950s completely transformed respiratory treatment. Despite decades of availability and healthcare support and development of teaching aids and devices to promote better use, poor pMDI user technique remains a persistent issue. The main pMDI user aid is the spacer/valved holding chamber (VHC) device. Spacer/chamber features (size, shape, configuration, construction material, and hygiene considerations) can vie with clinical effectiveness (to deliver the same dose as a correctly used pMDI), user convenience, cost, and accessibility. Unsurprisingly, improvised, low-cost alternatives (plastic drink bottles, paper cups, and paper towel rolls) have been pressed into seemingly effective service. A UK law change permitting schools to hold emergency inhalers and spacers has prompted a development project to design a low-cost, user-friendly, disposable, and recyclable spacer. This paper spacer requires neither preuse priming nor washing, and has demonstrated reproducible lung delivery of salbutamol sulphate pMDI, comparable to an industry-standard VHC, an alternative paperboard VHC, and pMDI alone. This new device appears to perform better than these other VHC devices at the low flow rates thought achievable by paediatric patients. The data suggest that this disposable spacer may have a place in the single-use emergency setting. Mark Sanders and Ronald Bruin Copyright © 2015 Mark Sanders and Ronald Bruin. All rights reserved. Evaluation of Anthropometric and Metabolic Parameters in Obstructive Sleep Apnea Tue, 14 Jul 2015 07:16:55 +0000 http://www.hindawi.com/journals/pm/2015/189761/ Aims. Sleep disorders have recently become a significant public health problem worldwide and have deleterious health consequences. Obstructive sleep apnea (OSA) is the most common type of sleep-related breathing disorders. We aimed to evaluate anthropometric measurements, glucose metabolism, and cortisol levels in patients with obstructive sleep apnea (OSA). Materials and Methods. A total of 50 patients with a body mass index ≥30 and major OSA symptoms were included in this study. Anthropometric measurements of the patients were recorded and blood samples were drawn for laboratory analysis. A 24-hour urine sample was also collected from each subject for measurement of 24-hour cortisol excretion. Patients were divided equally into 2 groups according to polysomnography results: control group with an apnea-hypopnea index (AHI) <5 () and OSA group with an AHI ≥5 (). Results. Neck and waist circumference, fasting plasma glucose, HbA1c, late-night serum cortisol, morning serum cortisol after 1 mg dexamethasone suppression test, and 24-hour urinary cortisol levels were significantly higher in OSA patients compared to control subjects. Newly diagnosed DM was more frequent in patients with OSA than control subjects (32% versus 8%, ). There was a significant positive correlation between AHI and neck circumference, glucose, and late-night serum cortisol. Conclusions. Our study indicates that increased waist and neck circumferences constitute a risk for OSA regardless of obesity status. In addition, OSA has adverse effects on endocrine function and glucose metabolism. Yaşar Yildirim, Süreyya Yilmaz, Mehmet Güven, Faruk Kılınç, Ali Veysel Kara, Zülfükar Yilmaz, Gökhan Kırbaş, Alpaslan Kemal Tuzcu, and Fatma Yılmaz Aydın Copyright © 2015 Yaşar Yildirim et al. All rights reserved. Markers of Myocardial Ischemia in Patients with Obstructive Sleep Apnea and Coronary Artery Disease Mon, 18 May 2015 12:45:37 +0000 http://www.hindawi.com/journals/pm/2015/621450/ Obstructive sleep apnea (OSA) is characterized by intermittent hypoxia during sleep. We tested the hypothesis that nocturnal myocardial ischemia is detectable by ST segment depression and elevation of high sensitive troponin T (hsTrop T) and B-type natriuretic peptide (NT-proBNP) in patients with OSA and coexisting coronary artery disease (CAD). Twenty-one patients with OSA and CAD and 20 patients with OSA alone underwent in-hospital polysomnography. Blood samples for hsTrop T and NT-proBNP measurements were drawn before and after sleep. ST segment depression was measured at the time of maximum oxygen desaturation during sleep. The apnea-hypopnea-index (AHI), oxygen saturation nadir, and time in bed with oxygen saturation of ≤80% were similar in both groups. Levels of hsTrop T and NT-proBNP did not differ significantly before and after sleep but NT-proBNP levels were significantly higher in patients suffering from OSA and CAD compared to patients with OSA alone. No significant ST depression was found at the time of oxygen saturation nadir in either group. Despite the fact that patients with untreated OSA and coexisting CAD experienced severe nocturnal hypoxemia, we were unable to detect myocardial ischemia or myocyte necrosis based on significant ST segment depression or elevation of hsTrop T and NT-proBNP, respectively. Misa Valo, Annette Wons, Albert Moeller, and Claudius Teupe Copyright © 2015 Misa Valo et al. All rights reserved. Higher Mobility Scores in Patients with Cystic Fibrosis Are Associated with Better Lung Function Wed, 18 Feb 2015 09:18:40 +0000 http://www.hindawi.com/journals/pm/2015/423219/ Objective. The purpose of this study was to determine whether mobility and physical activity were associated with lung function in adults with cystic fibrosis (CF). Design. This was a prospective cohort observational study in an urban, academic, specialized care center. Participants were ambulatory, nonhospitalized adults with CF. Main Outcome Measures. Mobility was assessed monthly by the Life-Space Assessment (LSA) questionnaire and quarterly by pedometer. Lung function was assessed by spirometry. Results. Twenty-seven subjects participated. Subjects recorded mean pedometer steps of 20,213 ± 11,331 over three days and FEV1% predicted of 77.48% ± 22.60% over one year. The LSA score at enrollment was correlated with initial pedometer steps ( and ), and mean LSA score over one year was correlated with mean number of steps ( and ). LSA mobility and pedometer scores were correlated with FEV1% predicted at enrollment and throughout the study. Conclusions. Mobility and physical activity measured by LSA questionnaire and pedometer are positively associated with lung function in adults with CF. This study confirms the importance of mobility and physical activity and supports the utility of a simple office-based questionnaire as a measure of mobility in adults with CF. Aneesha Thobani, Jessica A. Alvarez, Shaina Blair, Kaila Jackson, Eric R. Gottlieb, Seth Walker, and Vin Tangpricha Copyright © 2015 Aneesha Thobani et al. All rights reserved. Correlation between Clinical Characteristics and Chest Computed Tomography Findings of Pulmonary Cryptococcosis Thu, 12 Feb 2015 14:24:28 +0000 http://www.hindawi.com/journals/pm/2015/703407/ Objective. The aim of this study was to review HIV-negative patients with pulmonary cryptococcosis to analyze the correlations between clinical characteristics and chest computed tomography (CT) findings. Methods. We retrospectively analyzed medical records of 16 HIV-negative patients with pulmonary cryptococcosis diagnosed at our institution, and clinical characteristics of the patients with nodules or masses without ground-glass attenuation (GGA)/consolidation type were compared with those of patients with inclusive GGA or consolidation type. Results. Host status was immunocompromised (81.2%) in most of the patients, and 6 (37.5%) were asymptomatic. The most frequent radiologic abnormalities on chest CT scans were one or more nodules (87.5%), GGA (37.5%), and consolidations (18.8%). Most lesions were located in the lower lung. Levels of hemoglobin and platelets were significantly lower in patients with inclusive GGA or consolidation type. Although the differences were not significant, patients with inclusive GGA or consolidation type tended to have a C-reactive protein level of ≥1.0 mg/dL. Conclusion. If a patient with anemia and thrombocytopenia shows GGA or consolidation in the lung, pulmonary cryptococcosis should be given careful consideration. Hideaki Yamakawa, Masahiro Yoshida, Masami Yabe, Emiri Baba, Keitaro Okuda, Shota Fujimoto, Hiroaki Katagi, Takeo Ishikawa, Masamichi Takagi, and Kazuyoshi Kuwano Copyright © 2015 Hideaki Yamakawa et al. All rights reserved. Erratum to “Practical Guidelines: Lung Transplantation in Patients with Cystic Fibrosis” Wed, 28 Jan 2015 12:36:14 +0000 http://www.hindawi.com/journals/pm/2015/698460/ T. O. Hirche, C. Knoop, H. Hebestreit, D. Shimmin, A. Solé, J. S. Elborn, H. Ellemunter, P. Aurora, M. Hogardt, T. O. F. Wagner, and ECORN-CF Study Group Copyright © 2015 T. O. Hirche et al. All rights reserved. In Situ Thrombosis of Small Pulmonary Arteries in Pulmonary Hypertension Developing after Chemotherapy for Malignancy Tue, 27 Jan 2015 08:50:57 +0000 http://www.hindawi.com/journals/pm/2015/230846/ A few reports have provided histopathological insight into pulmonary hypertension developing after antitumor chemotherapy. In general, plexogenic pulmonary arteriopathy is a commonly observed finding in patients with severe pulmonary hypertension. We herein report a novel pathological finding that may characterize the histopathological change occurring in patients with pulmonary hypertension after chemotherapy for malignancy. Lung biopsy or autopsy was performed in 7 patients with pulmonary hypertension that developed during or after chemotherapy between 2006 and 2013 to examine the pulmonary vascular changes or to determine the cause of death. Pathological findings included in situ thrombosis in the small pulmonary arteries in 4 of 7 patients. In 2 of 4 patients, pulmonary hypertension was controlled by anticoagulants and antithrombotic agents. One patient who had organized thrombi attained spontaneous remission with oxygen therapy. The other patient died of sudden cardiopulmonary arrest during chemotherapy. Autopsy showed complete occlusion of the peripheral small pulmonary arteries and veins by thrombi. These results demonstrate that in situ thrombosis in the small pulmonary arteries could cause pulmonary hypertension after chemotherapy. Kay Maeda, Yoshikatsu Saiki, and Shigeo Yamaki Copyright © 2015 Kay Maeda et al. All rights reserved. Surgical and Bronchoscopic Lung Volume Reduction in Chronic Obstructive Pulmonary Disease Tue, 30 Dec 2014 00:10:08 +0000 http://www.hindawi.com/journals/pm/2014/757016/ Chronic obstructive pulmonary disease (COPD) is the most extensively studied and researched disease in pulmonology and a cause of significant morbidity, mortality, and financial burden on patient’s family and country’s economy. Its management continues to be a challenge to both the physician and the patient’s family. So far, it is preventable and treatable but not curable. Emphysema, a phenotype of COPD, is the most debilitating condition associated with progressive exercise intolerance and severe dyspnea. Despite decades of research, medical treatments available so far have helped improve quality of life and slowed down the decline in respiratory function but did not significantly improve the survival benefits. Though surgical lung volume reduction (LVR) procedures have shown some promise in context to functional gains and survival but, only in a carefully selected group of patients, bronchoscopic LVR procedures are yet to explore their full potential and limitations. This paper retrospectively studied the developments so far, medical and surgical, with special emphasis on the bronchoscopic procedures of lung volume reduction, and tried to comparatively analyze the risks and benefits of each one of them through various trials and studies done to date. Manoj Meena, Ramakant Dixit, Mrityunjaya Singh, Jai Kumar Samaria, and Surendra Kumar Copyright © 2014 Manoj Meena et al. All rights reserved. Sleep Disordered Breathing in Children with Mitochondrial Disease Tue, 23 Dec 2014 06:10:54 +0000 http://www.hindawi.com/journals/pm/2014/467576/ A retrospective chart review study was performed to determine the presence of sleep disordered breathing (SDB) in children with primary mitochondrial disease (MD). The symptoms, sleep-related breathing, and movement abnormalities are described for 18 subjects (ages 1.5 to 18 years, 61% male) with MD who underwent polysomnography in our pediatric sleep center from 2007 to 2012. Of the 18 subjects with MD, the common indications for polysomnography were excessive somnolence or fatigue (61%, = 11), snoring (44%, = 8), and sleep movement complaints (17%, = 3). Polysomnographic measurements showed SDB in 56% ( = 10) (obstructive sleep apnea in 60% ( = 6), hypoxemia in 40% ( = 4), and sleep hypoventilation in 20% ( = 2)). There was a significant association between decreased muscle tone and SDB (: 0.043) as well as obese and overweight status with SDB (). SDB is common in subjects with MD. Early detection of SDB, utilizing polysomnography, should be considered to assist in identification of MD patients who may benefit from sleep-related interventions. Ricardo A. Mosquera, Mary Kay Koenig, Rahmat B. Adejumo, Justyna Chevallier, S. Shahrukh Hashmi, Sarah E. Mitchell, Susan E. Pacheco, and Cindy Jon Copyright © 2014 Ricardo A. Mosquera et al. All rights reserved. Accuracy of the Hospital Anxiety and Depression Scale for Identifying Depression in Chronic Obstructive Pulmonary Disease Patients Thu, 04 Dec 2014 09:00:59 +0000 http://www.hindawi.com/journals/pm/2014/973858/ Psychological morbidity is common in chronic respiratory diseases. The diagnostic accuracy of the Hospital Anxiety and Depression Scale (HADS) and risk factors for comorbid depression in chronic obstructive pulmonary disease (COPD) are addressed. Consecutive COPD patients (GOLD stage I–IV, 40–75 years old) were enrolled in a multicentre, cross-sectional cohort study. Diagnosis of depression was ascertained through clinical records. Lung function, HADS score, 6-minute walking test (6-MWT), MRC dyspnoea score, and COPD Assessment Test (CAT) were evaluated. Two hundred fifty-nine COPD patients (mean age 62.5 years; 32% female; mean FEV1 48% predicted) were included. Patients diagnosed with depression (29/259; 11.2%) had significantly higher HADS-D and HADS-Total scores than nondepressed patients (median (quartiles) HADS-D 6 [4; 9] versus 4 [2; 7], median HADS-Total 14 [10; 20] versus 8 [5; 14]). Receiver-operating characteristic plots showed moderate accuracy for HADS-D, AUC 0.662 (95%CI 0.601–0.719), and HADS-Total, AUC 0.681 (95%CI 0.620–0.737), with optimal cut-off scores of >5 and >9, respectively. Sensitivity and specificity were 62.1% and 62.6% for HADS-D compared to 75.9% and 55.2% for HADS-Total. Age, comorbidities, sex, and lower airflow limitation predicted depression. The HADS exhibits low diagnostic accuracy for depression in COPD patients. Younger men with comorbidities are at increased risk for depression. Christoph Nowak, Noriane A. Sievi, Christian F. Clarenbach, Esther Irene Schwarz, Christian Schlatzer, Thomas Brack, Martin Brutsche, Martin Frey, Sarosh Irani, Jörg D. Leuppi, Jochen Rüdiger, Robert Thurnheer, and Malcolm Kohler Copyright © 2014 Christoph Nowak et al. All rights reserved. Sarcoidosis Treatment with Antifungal Medication: A Follow-Up Thu, 04 Dec 2014 08:38:42 +0000 http://www.hindawi.com/journals/pm/2014/739673/ Introduction. The aim of the study was to compare treatment of sarcoidosis with antifungal or corticosteroid medication. Methods. In patients with sarcoidosis antifungal medication (), corticosteroids () or a combination () was given. Nine patients allotted to antifungal medication were later given corticosteroids because of the lack of regression of the disease. X-ray scores for the severity of granuloma infiltration were determined. Chitotriosidase and angiotensin converting enzyme were determined. The time in months till remission was observed as well as the number of recurrences. Marjeta Terčelj, Barbara Salobir, Mirjana Zupancic, and Ragnar Rylander Copyright © 2014 Marjeta Terčelj et al. All rights reserved. Biomarkers to Improve Diagnosis and Monitoring of Obstructive Sleep Apnea Syndrome: Current Status and Future Perspectives Thu, 27 Nov 2014 13:35:06 +0000 http://www.hindawi.com/journals/pm/2014/930535/ Obstructive sleep apnea syndrome (OSAS) is characterized by recurrent episodes of upper airway collapse associated with oxygen desaturation and sleep disruption. It is proposed that these periodic changes lead to molecular variations that can be detected by assessing serum biomarkers. Studies have identified inflammatory, oxidative, and metabolic perturbations attributable to sleep-disordered breathing. Given that OSAS is associated with increased cardiovascular and cerebrovascular morbidity, the ideal biomarker should enable timely recognition with the possibility of intervention. There is accumulating data on the utility of serum biomarkers for the evaluation of disease severity, prognosis, and response to treatment. However, current knowledge is limited by data collection techniques, disease complexity, and potential confounding factors. The current paper reviews the literature on the use of serum biomarkers in OSAS. It is concluded that the ideal serum biomarker still needs to be discovered, while caution is needed in the interpretation of hitherto available results. Konstantinos Archontogeorgis, Evangelia Nena, Nikolaos Papanas, and Paschalis Steiropoulos Copyright © 2014 Konstantinos Archontogeorgis et al. All rights reserved. Association of Serum Magnesium Levels with Frequency of Acute Exacerbations in Chronic Obstructive Pulmonary Disease: A Prospective Study Tue, 18 Nov 2014 08:26:57 +0000 http://www.hindawi.com/journals/pm/2014/329476/ Background. The course of chronic obstructive pulmonary disease (COPD) is accompanied by acute exacerbations. The purpose of this study is to determine the association of serum magnesium level with acute exacerbations in COPD (COPD-AE). Materials and Methods. Eighty-nine patients hospitalized with COPD-AE were included. Hemogram, biochemical tests, and arterial blood gases were analyzed. Pulmonary function tests were performed in the stable period after discharge. Patients were followed up at 3 monthly periods for one year. Results. Mean age of the patients was (range 47–90) years. Mean number of COPD-AE during follow-up was (range 0–15). On Spearman correlation analysis there were significant negative correlations between number of COPD-AE and predicted FEV1% (), total protein (), globulin (), creatinine (), and uric acid levels (). There were also significant positive correlations between number of COPD-AE and serum magnesium level () and platelet count (). According to linear regression analysis predicted FEV1% (), serum magnesium (), and globulin () levels were independent predictors of number of COPD-AE. Conclusions. In this small prospective observational study we found that serum magnesium level during exacerbation period was the most significant predictor of frequency of COPD-AE. Aziz Gumus, Muge Haziroglu, and Yilmaz Gunes Copyright © 2014 Aziz Gumus et al. All rights reserved. Latex Hypersensitivity among Allergic Egyptian Children: Relation to Parental/Self Reports Mon, 17 Nov 2014 11:48:22 +0000 http://www.hindawi.com/journals/pm/2014/629187/ Background. Latex allergy is one of the major health concerns and allergic reactions to latex may be serious and fatal. Purpose. In this study, we sought to determine the frequency of latex hypersensitivity in a group of allergic Egyptian infants and children and its relation to the history provided by the patients or caregivers. Methods. We consecutively enrolled 400 patients with physician diagnosed allergic diseases. The study measurements included clinical evaluation for the site and duration of allergy, history suggestive of latex allergy, family history of allergy, and skin prick testing (SPT) using a commercial latex extract. Results. The study revealed that 16/400 (4%) patients had positive SPT; 11 of them only had positive history of sensitivity to latex. Positive latex SPT was reported in 3.4% (11/326) of patients with bronchial asthma, 5.9% (7/118) of patients with skin allergy, and 4.5% (2/44) of patients with allergic rhinitis. SPT was positive in 7.4% (4/54) of patients with concomitant respiratory and skin allergy. Latex SPT was more specific than sensitive (97.69% and 77.77%, resp.) with a negative predictive value of 99.47%. Conclusion. Although underrecognized, latex is an important allergen in the pediatric age group with a sensitization frequency of 4% among allergic children. It was observed to be especially associated with multiple allergic diseases coexisting in the same patient. Pediatric allergologists should educate their patients on latex allergy and encourage the use of latex-free products. Zeinab A. El-Sayed, Shereen S. El-Sayed, Rehab M. Zaki, and Mervat A. Salama Copyright © 2014 Zeinab A. El-Sayed et al. All rights reserved. Effect of PAH Specific Therapy on Pulmonary Hemodynamics and Six-Minute Walk Distance in Portopulmonary Hypertension: A Systematic Review and Meta-Analysis Sun, 16 Nov 2014 00:00:00 +0000 http://www.hindawi.com/journals/pm/2014/528783/ Background. Little is known about the effect of pulmonary arterial hypertension (PAH) specific therapy on pulmonary hemodynamics and exercise capacity in patients with portopulmonary hypertension (PoPH) because such patients are usually excluded from randomized clinical trials (RCT) of such therapy. Methods. We searched PUBMED using the terms “(Therapy/Broad (filter)) AND (portopulmonary hypertension).” We included studies that met the following criteria: ≥5 patients, AND PoPH confirmed by right heart catheterization (RHC), AND follow-up RHC data, AND/OR baseline and follow-up 6MWD available. Results. 12 studies met our inclusion criteria. None was a RCT. The baseline mPAP was 48.6 ± 4.4 mmHg, cardiac output (CO) 5.6 ± 0.9 L/min, and pulmonary vascular resistance (PVR) 668.6 ± 219.1 dynes.sec/cm5. The baseline 6MWD was 348.2 ± 35.6 meters. The use of PAH specific therapy improved mPAP by 7.54 mmHg (95% CI 10.2 to 4.9), CO by 1.77 L/min (95% CI 1.1 to 2.4), and PVR by 253 dynes.sec/cm5 (95% CI 291.4 to 214.6) () and 6MWD by 61.8 meters (95% CI 47.5 to 76) (). Conclusions. The use of PAH specific therapy in PoPH results in significant improvement in both pulmonary hemodynamics and 6MWD. Muhammad Faisal, Furqan Siddiqi, Ahmad Alkaddour, Abubakr A. Bajwa, and Adil Shujaat Copyright © 2014 Muhammad Faisal et al. All rights reserved. Hemoglobin Variant (Hemoglobin Aalborg) Mimicking Interstitial Pulmonary Disease Tue, 21 Oct 2014 10:16:33 +0000 http://www.hindawi.com/journals/pm/2014/701839/ Hemoglobin Aalborg is a moderately unstable hemoglobin variant with no affiliation to serious hematological abnormality or major clinical symptoms under normal circumstances. Our index person was a healthy woman of 58, not previously diagnosed with hemoglobinopathy Aalborg, who developed acute respiratory failure after a routine cholecystectomy. Initially she was suspected of idiopathic interstitial lung disease, yet a series of tests uncovered various abnormal physiological parameters and set the diagnosis of hemoglobinopathy Aalborg. This led us to examine a group of the index person’s relatives known with hemoglobinopathy Aalborg in order to study whether the same physiological abnormalities would be reencountered. They were all subjected to spirometry and body plethysmography, six-minute walking test, pulse oximetry, and arterial blood gas samples before and after the walking test. The entire study population presented the same physiological anomalies: reduction in diffusion capacity, and abnormalities in and p50 values; the latter could not be presented by the arterial blood gas analyzer; furthermore there was concordance between pulse oximetry and arterial blood gas samples regarding saturation. These data suggest that, based upon the above mentioned anomalies in physiological parameters, the diagnosis of hemoglobinopathy Aalborg should be considered. Vasiliki Panou, Peter-Diedrich Mathias Jensen, Jan Freddy Pedersen, Lars Pilegaard Thomsen, and Ulla Møller Weinreich Copyright © 2014 Vasiliki Panou et al. All rights reserved. Is Mean Platelet Volume Really a Severity Marker for Obstructive Sleep Apnea Syndrome without Comorbidities? Wed, 17 Sep 2014 00:00:00 +0000 http://www.hindawi.com/journals/pm/2014/754839/ Obstructive sleep apnea syndrome (OSAS) is a common disorder that can lead to significant cardiovascular complications. Several studies have reported increased platelet activation and aggregation in patients with OSAS. In this study we aimed to show a correlation between mean platelet volume (MPV) and severity of OSAS in patients with OSAS without any overt cardiac disease or diabetes. The polysomnography recordings of 556 consecutive patients admitted to the sleep laboratory between January 2012 and July 2012 were retrospectively evaluated. The relationship between polysomnographic parameters and biochemical parameters was assessed. Polysomnographic results of 200 patients (154 males [77%]; mean age, 44.5 ± 11.4 years) were included. No correlation was observed between MPV and the average oxygen saturation index, the minimum desaturation index, or the oxygen desaturation index in the study population as well as in severe OSAS group (AHI > 30). The only correlation was found between MPV and AHI in the severe OSAS group . MPV was not correlated with OSAS severity in patients without any overt cardiac disease or diabetes. These findings raise doubts about the suggestion that MPV might be a marker for OSAS severity, as recommended in earlier studies. Thus, further prospective data are needed. Sinem Nedime Sökücü, Cengiz Özdemir, Levent Dalar, Levent Karasulu, Şenay Aydın, and Sedat Altın Copyright © 2014 Sinem Nedime Sökücü et al. All rights reserved.