Pulmonary Medicine
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Respiratory Disorders Related to e-Waste Exposure among Workers in the Informal Sector in a Sub-Saharan African City: An Exposed Nonexposed Study

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Pulmonary Medicine publishes research related to the prevention, diagnosis and management of pulmonary and associated disorders, as well as related molecular genetics, pathophysiology, and epidemiology.

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Research Article

Correlation between Reduced FEF25-75% and a Positive Methacholine Challenge Test in Adults with Nonobstructive Baseline Spirometry

Rationale. FEF25-75% is routinely reported on spirometry and is thought to be a marker of small airway obstruction. It is reduced in children with asthma, but its significance in adults and especially those without asthma diagnosis remains unclear. Objective. To clarify whether in adults with a nonobstructive spirometry a reduced FEF25-75% is associated with a positive methacholine challenge test (MCT). Methods. Data was collected for all the patients who had a MCT done between April 2014 and January 2020 but had nonobstructive baseline spirometry. Logistic regression was utilized to estimate the log odds of a positive methacholine test as a function of FEF25-75% and also for age, gender, BMI, FEV1, and FEV1/FVC. Results. Out of 496 patients, 187 (38%) had a positive MCT. Baseline characteristics in two groups were similar except that patients with positive MCT were younger ( vs. years, respectively, ). Mean FEF25-75% was lower in MCT positive ( L/s) vs. MCT negative ( L/s) patients, . Logistic regression results suggest that MCT outcome is inversely related to FEF25-75%, age, and gender. Specifically, as FEF25-75% percentage of predicted value increases, the log odds of a positive MCT decrease (, 95% confidence , ). Also, as age increases, the log odds of a positive MCT decrease (, , ). Conclusions. Reduced FEF25-75% in adults with nonobstructive spirometry can predict a positive response to MCT in younger patients. However, this relationship becomes weaker with increasing age.

Research Article

Warfarin Use Is Associated with Increased Mortality at One Year in Patients with Idiopathic Pulmonary Fibrosis

Rationale. Previous data suggest that warfarin may worsen outcomes in IPF in patients with no indication for anticoagulation when compared to placebo. However, warfarin continues to be widely used for cardiac and thromboembolic indications in this patient population due to unavailability of data comparing warfarin with other anticoagulants in patients with IPF. Objectives. We studied the safety and efficacy of warfarin compared to direct acting oral anticoagulant use in patients with IPF. Methods. We conducted a retrospective cohort study of all patients with IPF who were prescribed warfarin or direct acting oral anticoagulants (DOACs) for cardiac or thromboembolic indications and followed at our institute for their care. Univariate tests and multivariable logistic regression analyses were used for assessing association of variables with outcomes. Results. A total of 73 patients were included in the study with 28 and 45 patients in the warfarin and DOAC groups, respectively. Univariable analysis revealed a significant difference in mortality in one year between warfarin and DOAC groups (7/28 vs. 3/45, value 0.027). Significantly more patients in the warfarin group suffered an exacerbation that required hospitalization within one year (9/28 vs. 5/45, value 0.026). Multivariate logistic regression analysis showed that anticoagulation with warfarin was independently associated with mortality at one-year follow-up (OR: 77.4, 95% CI: 5.94–409.3, value: 0.007). Conclusion. In our study of patients with IPF requiring anticoagulants, we noted statistically significant higher mortality with warfarin anticoagulation when compared to DOAC use. Further larger prospective studies are needed to confirm these findings.

Review Article

Periodontal Diseases: Major Exacerbators of Pulmonary Diseases?

Periodontal diseases are a range of polymicrobial infectious disorders, such as gingivitis and periodontitis, which affect tooth-supporting tissues and are linked to playing a role in the exacerbation of several pulmonary diseases. Pulmonary diseases, such as pneumonia, chronic obstructive pulmonary disease (COPD), asthma, tuberculosis, COVID-19, and bronchiectasis, significantly contribute to poor quality of life and mortality. The association between periodontal disease and pulmonary outcomes is an important topic and requires further attention. Numerous resident microorganisms coexist in the oral cavity and lungs. However, changes in the normal microflora due to oral disease, old age, lifestyle habits, or dental intervention may contribute to altered aspiration of oral periodontopathic bacteria into the lungs and changing inflammatory responses. Equally, periodontal diseases are associated with the longitudinal decline in spirometry lung volume. Several studies suggest a possible beneficial effect of periodontal therapy in improving lung function with a decreased frequency of exacerbations and reduced risk of adverse respiratory events and morbidity. Here, we review the current literature outlining the link between the oral cavity and pulmonary outcomes and focus on the microflora of the oral cavity, environmental and genetic factors, and preexisting conditions that can impact oral and pulmonary outcomes.

Research Article

Thyroid Gland Disease as a Comorbid Condition in COPD

Introduction. Chronic obstructive pulmonary disease (COPD) is one of the most common causes of morbidity and mortality worldwide. The disease is characterized by progressive airway inflammation, which not only affects the airways but also has systemic effects that are associated with comorbidities. Although comorbid conditions such as hypertension and coronary artery disease are very well-known in COPD patients, diseases of the thyroid gland have not been sufficiently studied. Therefore, thyroid diseases are not considered among the comorbid conditions of COPD. The purpose of this study was to determine the thyroid gland disease (TGD) prevalence in COPD and associated factors. Materials and Method. The study included 309 (297 (96%) male) patients. The patients were subjected to spirometry and thyroid function tests (TFT) in the stable period. The thyroid gland disease they were diagnosed with was recorded after face-to-face meetings and examining their files. Results. The mean age of the patients who were included in the study was (40-90). Thyroid disease was determined in 68 (22%) individuals. There were hypothyroidism in 7 (2%), euthyroidism in 45 (15%), and hyperthyroidism in 16 (%5) patients. No relationship was found between the severity of airflow limitation and the prevalence of TGD. Conclusion. Thyroid abnormalities are commonly observed in COPD. The most frequently encountered TGDs are euthyroid multinodular goiter, euthyroid sick syndrome (ESS), and toxic multinodular goiter.

Research Article

Chest X-Ray Findings in COVID-19 Patients Presenting to Primary Care during the Peak of the First Wave of the Pandemic in Qatar: Their Association with Clinical and Laboratory Findings

When managing coronavirus disease 2019 (COVID-19) patients, radiological imaging complements clinical evaluation and laboratory parameters. We aimed to assess the sensitivity of chest radiography findings in detecting COVID-19, describe those findings, and assess the association of positive chest radiography findings with clinical and laboratory findings. A multicentre, cross-sectional study was conducted involving all primary health care corporation-registered patients (2485 patients) enrolled over a 1-month period during the peak of the 2020 pandemic wave in Qatar. These patients had reverse transcription-polymerase chain reaction-confirmed COVID-19 and underwent chest radiography within 72 hours of the swab test. A positive result on reverse transcription-polymerase chain reaction was the gold standard for diagnosing COVID-19. The sensitivity of chest radiography was calculated. The airspace opacities were mostly distributed in the peripheral and lower lung zones, and most of the patients had bilateral involvement. Pleural effusion was detected in some cases. The risk of having positive chest X-ray findings increased with age, Southeast Asian nationality, fever, or a history of fever and diarrhoea. Patients with cardiac disease, obesity, hypertension, diabetes, and chronic kidney disease were at a higher risk of having positive chest X-ray findings. There was a statistically significant increase in the mean serum albumin, white blood cell count, neutrophil count, and serum C-reactive protein, hepatic enzymes, and total bilirubin with an increase in the radiographic severity score.

Research Article

Analysis of SARS-CoV-2 PCR and Chest CT Findings at a Single Facility in Tokyo (Machida Municipal Hospital)

Introduction. The SARS-CoV-2 reverse transcription polymerase chain reaction (RT-PCR) test is useful for diagnosing COVID-19, and the RT-PCR positive rate is an important indicator for estimating the incidence rate and number of infections. COVID-19 pneumonia is also associated with characteristic findings on chest CT, which can aid in diagnosis. Methods. We retrospectively evaluated patient background characteristics, the number of cases, the positivity rate, and chest CT findings for positive and negative cases in 672 patients who underwent RT-PCR for suspected COVID-19 at our hospital between April 3 and August 28, 2020. In addition, we compared trends in the positive rates at approximately weekly intervals with trends in the number of new infections in Machida City, Tokyo. Results. The study included 323 men and 349 women, with a median age of 46 years (range: 1 month–100 years). RT-PCR findings were positive in 37 cases, and the positive rate was 5.51%. Trends in the positive rate at our hospital and the number of new COVID-19 cases in the city were similar during the study period. Among patients with positive results, 15 (40.5%) had chest CT findings, and 14 had bilateral homogeneous GGOs. Among patients with negative results, 190 had chest CT findings at the time of examination, and 150 were diagnosed with bacterial pneumonia or bronchitis, with main findings consisting of consolidations and centrilobular opacities. Only 11 of these patients exhibited bilateral homogeneous GGOs. Conclusion. Bilateral homogeneous GGOs are characteristic of COVID-19 pneumonia and may aid in the diagnosis of COVID-19.

Pulmonary Medicine
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CiteScore4.100
Journal Citation Indicator0.730
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Article of the Year Award: Outstanding research contributions of 2021, as selected by our Chief Editors. Read the winning articles.