Current Respiratory Medicine Reviews - Volume 14, Issue 4, 2018

Pulmonary hypertension (PH), is a complex and multifactorial entity that affects small pulmonary vessels. It is defined as an increase in the mean pulmonary arterial pressure (PAPm) >25mmHg at rest, assessed by right heart catheterization. A recent classification divides PH into five types: pulmonary arterial hypertension (PAH), PH due to left heart disease, PH due to lung disease and/or hypoxemia, thromboembolic PH and PH with unclear or multifactorial mechanisms. Several molecular and biochemical factors are involved in the pathway of this clinical entity, although the primary origin remains unknown. In recent years, the existence of a genetic predisposition combined with exposure of environmental factors and triggers has been proposed. In PAH, vasoconstriction, endothelial dysfunction, thrombosis in situ, remodeling of the pulmonary vessel, inflammation and cytokines play an important role in the development of this condition. These pathways are the main targets of the therapeutic interventions in PAH. When feasible, a specific course of action, from drug therapy to surgical interventions remains the mainstay of survival for these patients. This article reviews the pathophysiology of this disease as well as available therapeutic options, specifically for PAH in detail.

Asbestos is a naturally occurring mineral that has been mined and used in thousands of products worldwide. Around the turn of the 20th century, lung scarring caused by asbestos [asbestosis] was recognized in many individuals occupationally exposed. As the century proceeded, thousands of cases of asbestosis, lung cancer and mesothelioma were attributed to asbestos exposure in the workplace, in the environment and in homes. Asbestosis develops when asbestos causes injury to cells at the bronchiolar-alveolar levels of the lung. The injury to epithelial cells and macrophages leads to the up-regulation of genes that control expression of peptide growth factors mediating cell proliferation and elaboration of excess connective tissue [i.e., scarring]. Lung cancer and mesothelioma develop when the carcinogenic asbestos fibers cause abnormalities in sets of genes that control cell division. Asbestos causes genetic errors by binding to chromosomal DNA and by generating Oxygen radicals that mediate the development of mutations. All of the six different asbestos minerals can induce all of the changes indicated above and thus cause asbestosis, lung cancer and mesothelioma. The investigators who are able to determine just which sets of genes are required to be damaged for lung cancer or mesothelioma to form will set the course for the development of effective treatments where now there are none for any of the asbestos-related diseases.

Background: Influenza A (H1N1) is a highly contagious virus derived from one of the several types of swine influenza A strains, called H3N2. It can be transmitted from person to person through sneezing or coughing. In 2009, pandemic influenza A (H1N1) emerged in some regions. This study aimed at investigating the mortality incidence associated with the 2009 H1N1 pandemic by a meta-analysis from 21 countries in the WHO Eastern Mediterranean Region. Materials and Methods: Literature search was carried out in international databases. In order to increase the search sensitivity, references were evaluated by hand searching. Finally, 33 eligible articles were identified by quality assessment and implementation of inclusion/exclusion criteria for meta-analysis. The heterogeneity among the results of primary studies was defined by Q and I2 tests. The mortality rate of confirmed cases based on different countries and confidence intervals (95% CI) is shown in the forest plot. Results: This meta-analysis included 33311 articles from 21 countries. The incidence of H1N1 2009 mortality was variable across different countries. Based on subgroup analysis, the rate of death among all countries was 0.10 (95% CI: 0.08, 0.13). Compared with other studies, heterogenicity was found across all studies conducted in Iran (198.40). Conclusion: This meta- analysis showed that the incidence of mortality varied among different areas in the WHO Eastern Mediterranean Region. Mortality rate in all age groups was found to be higher in Iran; probably due to some underlying conditions such as lung disease, neurological disorders, diabetes, pregnancy, changes in immune system, and cardiac and respiratory failure.

Background: Smoking is a major health-related problem in Jordan due to which an effective smoking cessation program is needed. Lung Age which emphasizes the concept of a premature aging of the lungs, is a simple notion that smokers can grasp. Employing reference lung age equations can help health care providers convince smokers to quit. In this study the applicability of reference equations was assessed in estimating lung age for the Jordanian population, to aid smoking cessation. Methods: Adult Jordanians were recruited from Al-Zaytoonah University of Jordan and from several community pharmacies, polyclinics and hospitals located in different areas in Jordan. Overall, 1767 participants of both genders from different age groups were recruited to evaluate the applicability of different reference lung equations for the Estimated Lung Age (ELA). SPSS was used to conduct all statistical analysis. Results: A paired t-test showed a significant difference (p<0.05) between the Chronological Lung Age (CLA) and the ELA among the non-smokers. Similarly, some reference equations including Hansen and Morris and Temple FEF25-75 equations failed to show significant differences in ELACLA between different smoking status groups for women. Conclusions: Our results suggest that the current lung age equations are not reliable in predicting lung age among the Jordanian population, and thus cannot be used in smoking cessation programs.

Background: H1N1 influenza has a broad spectrum of clinical and radiological manifestations. We witnessed a pandemic of H1N1 influenza in the year 2009, an epidemic in 2015 and it continues to cause localised outbreaks to this day causing significant mortality and morbidity. The severity on a chest X-ray and its correlation with the outcome needs evaluation. Objective: To assess the radiological manifestations of H1N1 influenza patients at a presentation in the 2017 outbreak in India in a tertiary care setting and ascertain the most common pattern of radiological involvement. To determine the association between the radiological manifestations of H1N1 pneumonia and the patient outcome. To ascertain if co-morbid conditions contributed to the adverse patient outcome. Methods: A retrospective (December 2016 till July 2017) analysis of the clinico-radiological data of all the inpatient cases positive for H1N1 was done at a tertiary care chest institute in Bangalore, India. The patients' outcome was divided into two groups. A: Recovered and discharged and B: Death. The chest X-rays done at presentation to our hospital were used as the radiological tool. Results: 75 patients were included in this study. Cough, dyspnea and fever were the usual presenting symptoms with an average duration of 7 days, prior to presentation at our hospital. Bilateral midzone and lower zone consolidation was the most common radiological pattern. Patients with a normal chest X-ray had a significantly better outcome. An absence of pleural involvement and lower scores on a severity scale were associated with a better outcome. Diabetes mellitus was the commonly associated co-morbidity. The presence or absence of a co-morbidity did not influence the outcome. Conclusion: In a resource-limited setting, chest X-rays can be used to prognosticate patients with H1N1 influenza. The more the number of zones involved would implicate more complications and greater risk of death.