Pulmonary Medicine

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BMC Pulmonary Medicine reviewer acknowledgement 2014

BMC Pulmonary Medicine reviewer acknowledgement 2014

Simone Accordini Italy.. Ritesh Agarwal India.[r]

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BMC Pulmonary Medicine reviewer acknowledgement 2015

BMC Pulmonary Medicine reviewer acknowledgement 2015

Marco Confalonieri Italy. Claudio Pedone Italy[r]

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Approach to Patients with Severe Asthma: a Consensus Statement from the Respiratory Care Experts’ Input Forum (RC-EIF),Iran

Approach to Patients with Severe Asthma: a Consensus Statement from the Respiratory Care Experts’ Input Forum (RC-EIF),Iran

A panel of experts from pulmonary medicine and allied fields discussed the current evidence, limitations and clinical peculiarities in the management of severe and refractory asthma. Each participant was selected based on clinical expertise and academic records in the field of asthma. All experts interacted in contextual question-based round table discussions during this forum. A systematic approach toward key issues was taken including: 1) definition and clinical correlates of severe asthma, 2) assessment of comorbidities and contributory factors, 3) approaches to asthma phenotyping, and 4) treatment options. The available information together with expert opinions were compiled to draw a consensus.
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Indications for Caesarean Section Among the Antenatal Cases Admitted In a Tertiary Care Hospital of Kollam, Kerala

Indications for Caesarean Section Among the Antenatal Cases Admitted In a Tertiary Care Hospital of Kollam, Kerala

The study sample comprised of 95 patients of suspected chronic cor pulmonale presenting to the department of Medicine, regional geriatric centre, department of Pulmonary medicine (TB and chest medicine) of Gauhati Medical College and Hospital, who fulfilled the inclusion and exclusion criteria. The screening process included a thorough history and clinical examination, electrocardiography, chest X-ray-posterior view, laboratory investigations. After the initial screening, patients suspected to have chronic cor pulmonale underwent echocardiography to confirm the diagnosis.
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Thrombolytic treatment (alteplase; rt-PA) in acute massive pulmonary embolism and cardiopulmonary arrest

Thrombolytic treatment (alteplase; rt-PA) in acute massive pulmonary embolism and cardiopulmonary arrest

We retrospectively evaluated patients with PE between January 2010 and December 2013 in the Department of Pulmonary Medicine, Medical Park Samsun Hospital, Samsun, Turkey. The demographic and disease character- istics of patients who received thrombolytic treatment were retrospectively analyzed. The diagnosis of PE and patient selection for thrombolytic treatment were decided on using the following criteria: 1) patients .17 years with onset of symptoms suggestive of acute massive PE; 2) massive PE defined as acute PE with sustained hypotension (systolic blood pressure ,90 mmHg for at least 15 minutes or requir- ing inotropic support, not due to a cause other than PE, such as arrhythmia, hypovolemia, sepsis, or left ventricular [LV] dysfunction), pulselessness, or persistent profound bradycardia (heart rate ,40 bpm with signs or symptoms of shock). In addition, acute RV dilation, hypokinesis, and acute pulmonary arterial hypertension with paradoxal movement of the interventricular septum on echocardiography were added as criteria for thrombolytic treatment in patients with hemodynamic instability and/or cardiopulmonary arrest; and 3) PE is confirmed with contrast-enhanced thorax computed tomography (CT) in appropriate patients.
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Clinical Profile of Patients with Tubercular Lymphadenitis

Clinical Profile of Patients with Tubercular Lymphadenitis

BACKGROUND & OBJECTIVES:Tuberculosis is a granulomatous inflammatory process consequent to infection by Mycobacterium Tuberculosis.It is now seen that extra-pulmonary manifestations form a major proportion of new cases, especially since the advent of the Human Immuno-Deficiency Virus (HIV)& Acquired Immuno-Deficiency Syndrome (AIDS) epidemic.Tubercular lymphadenitis is the most common extra pulmonary form of tuberculosis, and cervical lymph nodes are the most commonly affected group of nodes. The objective of this study is to assess the clinical profile of Tubercular Lymphadenitis cases attending OPD and indoor facility of Pulmonary Medicine Department at SMIMER,to assess treatment outcome of Directly Observed Treatment Short Course under Revised National Tuberculosis Control Program (RNTCP), and to observe the clinical outcome of the same on Tubercular lymphadenitis. METHODS & MATERIALS :This study included patients of Tuberculous lymaphadentis attending the OPD as well as indoor facilities of the Pulmonary Medicine Department. The study pattern was Descriptive Longitudinal Study. The observational data was collected using formal proforma, which elicited demographic and clinical information. RESULT : Out of the total 75 patients, 61% of patients were from age group of 18 to 30. Nearly all the patients (100%) presented with neck swelling. Out of the total 75 cases, 62 cases (82.6%) had nodes < 3cm, and 13 cases (17.3%) had nodes > 3 cm.Tubercular lymphadenitis is more common in females. For the 51 cases(68%) on category I anti TB treatment, treatment completion rate was 88.2% with favorable response seen in 82.2% (45) of those cases. Out of 24 cases on category II anti TB treatment, treatment completion rate was 79.16% with favorable response seen in 79% (19) of those cases. FNAC remains the most accurate and diagnostic tool. CONCLUSION : Early diagnosis and treatment of Tubercular lymphadentis helps getting better cure rates. FNAC stays frontline investigation with rest based on it. It is curable with anti-tubercular drugs if administered according to WHO guidelines under RNTCP.
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Which GOLD B patients progress to GOLD D with the new classification?

Which GOLD B patients progress to GOLD D with the new classification?

age $40 years; cough, sputum production, and dyspnea; and a post-bronchodilator FEV 1 /FVC ratio #70% of the normal predicted value. Medical history-taking at baseline includes the frequency and severity of exacerbations in the previous 12 months, the body mass index (BMI), smoking status, patient-reported education level, medications taken (including those already prescribed for COPD), and comor- bidities. The modified Medical Research Council (mMRC) dyspnea score is also recorded, as are the results of the COPD assessment test (CAT) and the COPD-specific version of St George’s Respiratory Questionnaire (SGRQ). The 6-MWD is also performed. All data are recorded on electronic case report forms that are completed by physicians or trained nurses, and all patients are evaluated at 6-month intervals after initial examination. Blood tests are used to measure the levels of inflammatory markers and various chemicals and blood cell counts. The major exclusion criteria are as follows: asthma; other obstructive lung diseases, including bronchiectasis or tuberculous lung destruction; an inability to complete the pulmonary function test; myocardial infarction (MI) or a cerebrovascular event within the previous 3 months; pregnancy; rheumatoid disease; a malignancy; irritable bowel disease; and prescription of steroids for conditions other than COPD exacerbation within 8 weeks of enrollment. Exac- erbations are defined as the worsening of any respiratory symptoms, including increased sputum volume, purulence, or advancing dyspnea, which require treatment with systemic corticosteroids, antibiotics, or both. 5
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Regenerative medicine in the treatment of idiopathic pulmonary fibrosis: current position

Regenerative medicine in the treatment of idiopathic pulmonary fibrosis: current position

Abstract: Idiopathic pulmonary fibrosis (IPF) is a progressive, irreversible disease of the lung that has no lasting option for therapy other than transplantation. It is characterized by replace- ment of the normal lung tissue by fibrotic scarring, honeycombing, and increased levels of myofibroblasts. The underlying causes of IPF are still largely unknown. The focus of the current review is the possible use of stem cell therapy, specifically mesenchymal stem cells (MSCs), a multipotent stromal cell population, which have demonstrated promising data in multiple animal models of pulmonary fibrosis (PF). The most studied source of MSCs is the bone mar- row, although they can be found also in the adipose tissue and umbilical cord, as well as in the placenta. MSCs have immunomodulatory and tissue-protective properties that allow them to manipulate the local environment of the injured tissue, ameliorating the inflammation and promoting repair. Because IPF primarily affects older patients, the issue of aging is intrinsically linked to many aspects of the disease, including the age of the stem cells. Animal models have shown the success of MSC therapy in mitigating the fibrotic effects of bleomycin-induced PF. However, bleomycin, the most commonly used model for PF, is imperfect in mimicking IPF as it presents in humans, as the duration of the illness is not parallel or reversible, and honeycombing is not produced. Furthermore, the time of MSC dosage has proven to be critical in determining whether the cells will ultimately have a positive or negative effect on disease progression, since it has been demonstrated that the maximal beneficial effect of MSCs occurs during the early inflammatory phase of the disease and that there is no or negative effect during the late fibrotic phase. Therefore, all the current clinical trials of MSCs and IPF, though promising, should proceed with caution as we move toward true stem cell therapy for this disease.
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Oxygen Ozone Therapy in the Treatment of Chronic Obstructive Pulmonary Disease: An Integrative Approach

Oxygen Ozone Therapy in the Treatment of Chronic Obstructive Pulmonary Disease: An Integrative Approach

week for the first 5 weeks, thereafter a single treatment every week for other 10 weeks. Group B ( 25 patients) served as control and not received treatments otherwise the standard therapy with inhaled beta2 long acting bronchodilators and/or corticosteroids .In all patients we measured before and after the end of the study: 1) Pulmonary FunctionTest 2 )Resting Arterial blood gas 3) exercise tolerance by 6 min walking test (6MWT) 4) dyspnea index by Borg dyspnea scale 5) health status, evaluate by the St. George Respiratory questionnaire ( SGRQ). The patient’s characteristics at the start of the study are reported in table 1.
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The impact of primary healthcare reform on equity of utilization of services in the province of Quebec: a 2003–2010 follow-up

The impact of primary healthcare reform on equity of utilization of services in the province of Quebec: a 2003–2010 follow-up

The project also included two surveys of PHC organiza- tions which were conducted in 2005 and 2010 in the two same regions (see Additional file 2). A questionnaire was mailed to key informants in all PHC organizations of both Montréal and Montérégie. Questions related to vision, structure, resources and practices of the various sources of PHC [26]. The types of PHC sources existing in administrative databases as well as these organizational surveys can be divided as follows: family medicine groups (FMG), network clinics (NC), clinics having both FMG and NC status (FMG-NC), local community services centres (LCSC without FMG/NC status), fam- ily medicine teaching units (FMU without FMG/NC status), group clinics (involving more than one phys- ician— not FMG/NC) and solo clinics (involving only one physician).
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The evaluation of &beta;-adrenoceptor blocking agents in patients with COPD and congestive heart failure: a nationwide study

The evaluation of &beta;-adrenoceptor blocking agents in patients with COPD and congestive heart failure: a nationwide study

Carvedilol, bisoprolol, and metoprolol use in patients with coexistent heart failure and chronic obstructive pulmonary disease. Medicine (Baltimore)[r]

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<p>Not All COPD Patients Benefit from Prophylactic Noninvasive Ventilation After Scheduled Extubation: An Exploratory Study</p>

<p>Not All COPD Patients Benefit from Prophylactic Noninvasive Ventilation After Scheduled Extubation: An Exploratory Study</p>

18. Duan J, Tang X, Huang S, et al. Protocol-directed versus physician-directed weaning from noninvasive ventilation: the impact in chronic obstructive pulmonary disease patients. J Trauma Acute Care Surg. 2012;72:1271 – 1275. doi:10.1097/TA.0b013e318249a0d5 19. O ’ Donoghue FJ, Catcheside PG, Jordan AS, et al. Effect of CPAP on intrinsic PEEP, inspiratory effort, and lung volume in severe stable COPD. Thorax. 2002;57:533 – 539. doi:10.1136/thorax.57.6.533 20. Esteban A, Frutos-Vivar F, Muriel A, et al. Evolution of mortality over

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Review Article Meta-analysis of serum gastrin-releasing peptide precursor as a biomarker for prognostic evaluation of small cell lung cancer

Review Article Meta-analysis of serum gastrin-releasing peptide precursor as a biomarker for prognostic evaluation of small cell lung cancer

274 Zhi Jiang Road, Shanghai 200071, China; 2Department of Traditional Chinese and Western Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, No.. Abstract: Bac[r]

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Original Article Effects of the Shenfuyixin granule on hemodynamics and angiogenesis in rats with pulmonary hypertension

Original Article Effects of the Shenfuyixin granule on hemodynamics and angiogenesis in rats with pulmonary hypertension

PAH is a kind of malignant pulmonary disease caused by many reasons, which is mainly char- acterized by the progressive rising of pulmo- nary arterial pressure and pulmonary vascular resistance. The principle of Chinese traditional treatment is mainly “warming Yang and benefit- ing Qi, promoting blood circulation and inducing diuresis”. Shenfuyixin granule (formerly Xinsh- uaikang granule) is developed by the old fa- mous herbalist doctor with years’ experience in Henan University of Chinese Medicine. In its formulation, there is ginseng to supple- ment Qi, monkshood and cassia twig to warm Yang, salvia miltiorrhiza and motherwort to improve blood circulation for removing blo- od stasis, polyporus, alisma, and pepperweed seed to dispel dampness and promote diuresis, as well as jujube and villous amomum to fortify the spleen and disinhibit dampness. All of
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Role of Ischemia Modified Albumin in Diagnosis of Pulmonary Embolism

Role of Ischemia Modified Albumin in Diagnosis of Pulmonary Embolism

IMA has been suggested as a promising marker for the identification of patients with hypoxemia and ischemia such as pulmonary embolism patients [3]. In our study the mean values of IMA were statistically significantly higher among the PE patient group in comparison with non PE patient group and healthy control subjects. At cut-off value of 0.305 ABSU, IMA had 97.5% sensitivity and 71.42% specificity. The area under the curve was 0.952. The positive predictive value of this cut-off value was 79.59% while the negative predictive value was 96.15%. In comparison with D-dimer, IMA has the same sensitivity but significantly better specificity (71.42% for IMA vs 42.85% for D-dimer). Similar findings have been found by other investigators. A study by Turedi et al., [18] consisting of 30 patients with PE and 30 healthy individuals, demonstrated that serum IMA levels were significantly higher than those in healthy individuals in 97% of patients. In another study by Turedi et al. [16] consisted of 130 patients with suspected PE and 59 healthy controls. Mean IMA levels were 0.362 ± 0.11 ABSU for the PE group (n = 75); 0.265 ± 0.07 ABSU for the non PE group (n = 55); and 0.175 ± 0.05 ABSU for the healthy control group. At a cut-off point of 0.25 ABSU, IMA was 93% sensitive and 75% specific in the diagnosis of PE. PPV was 79.4% and NPV was 78.6%. Zheng et al. [19] found the levels of IMA (75.84 ± 15.70 U/ml) and D-dimer (5.41 ± 5.29 mg/l) in patients with acute pulmonary embolism (APE) were significantly higher than that in healthy controls. According to the ROC curve, the most appropriate IMA cut-off value in APE was 63.30 U/ml with sensitivity 87.2%, specificity 80%. The most appropriate D-dimer cut-off value in APE was 0.57 mg/L with sensitivity 94.9%, specificity 66.7%. The use of IMA in combination with D-dimer has a posi- tive impact on the specificity value. The level of plasma IMA in high risk group of APE was higher significantly than that in medium or low risk groups. In a study carried out by Hogg et al. [20], 452 patients were investigated for DVT, and 354 patients were investigated for PE. 348 patients investigated for PE had IMA testing as did 195 of the first 199 DVT patients. VTE prevalence was 19.7%. The IMA:albumin ratio performed better than
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Thus, the burgeoning growth of such diseases in the country has led to the increasing demand for diagnostic and therapeutic technologies and interventions all over the country. Government hospitals, medical colleges and institutions are striving hard to provide such services; however, there is acute shortage of well-trained medical professionals. There is a need of well-equipped intensive care units with skilled medical professionals in pulmonary and critical care medicine in different parts of the Nepal. There is also a demand for diagnostic and therapeutic interventions in liver diseases including of liver transplant now.
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To analyze the Preoperative respiratory status and Postoperative respiratory complications of Chronic Obstructive Pulmonary Disease patients undergoing abdominal surgery in a tertiary care hospital

To analyze the Preoperative respiratory status and Postoperative respiratory complications of Chronic Obstructive Pulmonary Disease patients undergoing abdominal surgery in a tertiary care hospital

Pulmonary function test was done for all patients who satisfied the inclusion criteria. The test was performed in accordance with the criteria set by the American Thoracic Society using Easyone Spirometer. The instrument was calibrated daily. The procedure was explained to all patients before the test. Any recent history of smoking, illness, medication were enquired and the height and weight were recorded. All participants were kept in the seated position for the procedure.

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Comparative study on medical utilization and costs of chronic obstructive pulmonary disease with good lung function

Comparative study on medical utilization and costs of chronic obstructive pulmonary disease with good lung function

Table 3 shows annual changes in medication use. The proportion of patients is defined as the number of patients who received medications divided by the total number of patients who visited hospitals each year. In 2007, only 5.9% of the patients from KNHANES group received long- acting muscarinic agonist (LAMA), which are long-acting bronchodilators that are routinely prescribed for patients with early COPD. This proportion increased to 20.7% in 2012. For patients from the KOCOSS group, 44.4% of the patients were prescribed LAMA in 2007, and the proportion increased to 78.7% in 2012. A combination of inhaled corti- costeroid and long-acting beta-agonist inhaler (ICS/LABA) was prescribed to 14.1% of KNHANES patients in 2007 and 20.7% in 2012, whereas 34.9% of the KOCOSS group received ICS/LABA in 2007 and 44.4% received it in 2012. Figure 2A and B shows annual change in the proportion of patients who received LAMA, specified according to patient pulmonary function (60% # FEV 1 ,80% and FEV 1 $80%). Figure 2C and D shows the annual change and comparison of use of ICS/LABA.
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Prevalence of Obstructive Sleep Apnoea in Patients with Idiopathic Pulmonary Fibrosis

Prevalence of Obstructive Sleep Apnoea in Patients with Idiopathic Pulmonary Fibrosis

The current focus of IPF research is on the molecular genetics of pathologic events likely to occur at the epi- thelial-mesenchymal interface of the alveolus [4]-[9]. In vitro, studies using lung fibroblast from IPF patients have contributed to the theory that myofibroblasts have a prolonged survival after being activated by an un- known injury, shortened survival of lung epithelial cells, or both [10]. Even though, risk factors have been iden- tified for this disease (e.g. environmental, exposures, genetic determinants, smoking [11], pollutants, gastro- esophageal reflux [12] [13], occupational exposures, [14], viral infections [15] and old age [16]). IPF’s origin and onset are not fully understood. It has been previously suggested that the onset involves alveolar epithelium micro-injuries that lead to dysregulation of cellular homoeostasis in the alveolar epithelial-mesenchymal unit and the reactivation of developmental signaling pathways (e.g. transforming growth factor: TGF- β [17], wing- less-type like (Wnt) [18], sonic hedgehog (SHH) [19], and Notch [20]). The resultant cell dysfunction and death result in progressive scar tissue formation, and eventual distortion of pulmonary anatomical structural relation- ships with disruption of lung homoeostasis [21]. Some authors hypothesize that IPF originates from long term recurring stretch injury to the peripheral and basal lung in individuals with a genetic predisposition. One of the proposed triggers could be ventilatory efforts associated with obstructive sleep apnea (OSA), which may trigger the process of “aberrant healing”. The generated disease is present in more peripheral areas of the lung based on well-known heightened mechanical stretch factors in this anatomical compartment; in essence a mechanical ra- ther than inflammatory damage [10].
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Assessment of Fatigue and Other Extra-Pulmonary Manifestations in Patients Diagnosed with Sarcoidosis: A Prospective Observational study in a South Indian Tertiary Care Centre

Assessment of Fatigue and Other Extra-Pulmonary Manifestations in Patients Diagnosed with Sarcoidosis: A Prospective Observational study in a South Indian Tertiary Care Centre

We included 75 patients in our study to assess for fatigue. All of them had Pulmonary Sarcoidosis. Histo-pathological diagnosis of Sarcoidosis was present in all of them. Patients who were on treatment and those who were treatment naïve were also included, since the literature review done did not show any difference in fatigue experienced between these 2 groups. After obtaining informed consent in patients own language, FAS score was filled and recorded in the pro-forma for analysis.

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