Current Respiratory Medicine Reviews - Volume 16, Issue 1, 2020

Over the past decade, major breakthroughs in the understanding of lung cancer histology and mutational pathways have radically changed diagnosis and management. More specifically, in non-small cell lung cancer (NSCLC), tumour characterisation has shifted from differentiating based solely on histology to characterisation that includes genetic profiling and mutational status of Epidermal Growth Factor (EGFR), Anaplastic Lymphoma Kinase (ALK), c-ros oncogene 1 (ROS1) and BRAF. These genetic alterations can be targeted by specific drugs that result in improved progression-free survival, as well as higher response rates and are currently standard of care for NSCLC patients harbouring these mutations. In this a narrative, non-systematic review we aim to handpick through the extensive literature and critically present the ground-breaking studies that lead to the institution of tailored treatment options as the standard of care for the main targetable genetic alterations.

Background: Peripheral muscle dysfunction is one of the major comorbidities seen in chronic obstructive pulmonary disease. Focusing more on upper extremity, unsupported elevation of arms results in a change in the recruitment pattern of the respiratory muscles. Over the years, many tests were developed to assess the upper limb capacity and include them in various rehabilitation protocol. Objective: To review the evidence on mechanism, tests, and rehabilitation protocol for the upper limb extremity muscle-dysfunction occurring in chronic obstructive pulmonary disease. Methods: PubMed and Google scholar databases were searched. Based on the inclusion criteria’s:- Chronic Obstructive Pulmonary Diseases patients, any Randomized Controlled or clinical trials, systematic reviews, explaining upper limb extremity muscle dysfunction, various tests to assess upper limb functional capacity and different ways of upper limb extremity training, a total of 15 articles were retrieved. Results: The mechanism of upper extremity muscle dysfunction is now well understood. Various tests were designed in order to assess arm strength, arm endurance and functional capacity. All the studies which included upper limb extremity training as a part of the rehabilitation program, showed beneficial results in terms of reduction of dyspnoea and arm fatigue, as well as improving the activity performing capacity. Conclusion: This review concluded that the alteration in the upper limb extremity muscles is an inevitable consequence of chronic obstructive pulmonary diseases, which can be confirmed by various upper extremity tests, with patients responding positively to the upper limb training incorporated during pulmonary rehabilitation protocols.

Background: Pneumonia is one of the causes of morbidity and mortality in children and adults worldwide. WHO report in 1999 stated that the main cause of death due to infectious disease is pneumonia. The rising mortality rate among severe pneumonia patients is because they do not receive empirical antibiotic treatment according to the infecting pathogens. Objective: The purpose of this study is to identify the bacterial profile and the use of antibiotic treatment on pneumonia patients admitted to the pulmonology ward of Dr. Soetomo General Hospital in Surabaya, Indonesia. Methods: This descriptive observational study used the data from pneumonia patients admitted to the pulmonology ward of Dr. Soetomo General Hospital, Surabaya, from February to April 2018. The data was collected from the patients’ medical records, antibiotic use notes, and culture results of bacterial antibiotic sensitivity test. The total of antibiotic use was calculated using a defined daily dose (DDD) per 100 bed days. The quality of antibiotics was assessed using Gyssens method. The microbial mapping was acquired from a sputum culture test result. Results: The most prevalent bacteria in pneumonia patients were the Gram-negative bacteria and the most common species was Acinetobacter baumannii followed by Klebsiella pneumoniae. In contrast, the most common Gram-positive bacteria species was Streptococcus viridans. The total antibiotic use was 35.53 DDD/100 bed days, and ceftriaxone was the most commonly used antibiotic with 9.23 DDD/100 bed days. Fifty percent of the antibiotic use was in category wise use of antibiotic. Conclusion: The Gram-negative bacteria were the most common cause of pneumonia and ceftriaxone was the most commonly used antibiotic for its cure. Fifty percent of the patients received ceftriaxone appropriately.

Bronchial asthma is one of the most common and severe diseases among children. The phenomenon of creatinuria (CU) in patients with bronchial asthma (BA) has been acknowledged for a relatively long time. Aims: The Aim of the research is to study the level of creatinuria, creatinemia, creatine kinase activity, and the concentration of calcium in biological medium (blood, saliva, urine) in children suffering from an intermittent and persistent form of asthma during the period of exacerbation. Materials and Methods: The research consists of 102 children with asthma who were treated in inpatient department in Simferopol Clinic. The intermittent course of asthma was recorded in 49 children and a persistent course of asthma was recorded in 53 children. The subject of study was blood serum and daily urine of observed patients. The level of calcium in the biological medium was studied using the "Filisit" test kit (Dnipro) and the activity of the creatine kinase by test set "Lahma". The levels of creatine and creatinine were determined using a colorimetric method based on a color reaction with picric acid. Results and Discussion: The analysis testifies that creatinuria in children with persistent BA is caused by the disorder of the phosphorylation process rather than the disorder of creatinin rephosphorylation synthesis, that is testified by the normal creatinine level. In children with persistent BA, there is а decrease of creatinine concentration in the blood serum and urine during the exacerbation period and early post exacerbation period. The low activity of creatinine kinase at the background of creatinine elimination is typical for the children in the phase of exacerbation of persistent form of BA, though its level remains to be sufficient for the synthesis of the necessary amount of creatinine phosphate. Conclusion: The processes of creatinuria and calciuria in children suffering from a persistent form of BA are interdependent, that is testified by the data of correlative analysis. In connection with this, it is possible to consider the change of calcium homeostasis in the pathogenesis of the disease as one of the causes of distributing the creatinine metabolism on the cellular level.

Background: Obstructive sleep apnea is a common disorder involving, intermittent mechanical obstruction of the upper airway during sleep. Obesity is the most powerful risk factor for obstructive sleep apnea. Objective: This study aimed to investigate the long-term effect of Roux-en-Y gastric bypass bariatric surgery on patients with obstructive sleep apnea. Methods: This study included patients were referred for bariatric surgery (Roux-en-Y gastric bypass) to control symptoms and complications of obesity during a 5-year period. An overnight sleep study was performed for each patient before and after the bariatric surgery, to study its effect on different obstructive sleep apnea-related variables. Results: This study included 179 patients (mean age 35.9 ± 10.7 years). The mean duration from preoperative assessment to postoperative assessment was 2.4 ± 2.2 years. The mean change in body mass index and weight showed a decrease of 16.0 ± 16.0 kg/m2 and48.7 ± 25.9 kg, respectively. The apnea hypopnea index decreased by a mean of 22.6 ± 26.3 events/hour. Conclusion: We concluded that a decrease in the body mass index by 1 kg/m2 could predict a decrease in the apnea hypopnea index by 0.46 events/hour. Moreover, after mean follow-up duration of 2.4 years, 84.3% of mild and 83.3% of moderate obstructive sleep apnea patients became normal postoperatively.

Background: Drug-resistant tuberculosis (DR-TB) is a significant public health problem, especially in the developing and underdeveloped countries; its treatment is relatively expensive, of longer duration, and associated with more adverse effects. Objective: The objective of this study was to report the treatment outcomes in patients with DR-TB and determine if a few selected clinico-demographic parameters and baseline laboratory values, done as part of the pre-treatment evaluation, have any impact on sputum culture conversion and outcomes. The aim was to identify the potential factors associated with unfavourable outcomes prior to starting the treatment. Methods: A retrospective analysis of data of patients diagnosed with DR-TB admitted at our centre from January 2015 to May 2016 was done. Of the 114 patients included, culture reports were available in 85 and 72 patients at the end of the third and sixth month, respectively. The clinicodemographic and laboratory parameters were compared with the sputum culture report at the end of the third and sixth month and final treatment outcomes. Results: Favorable outcome (cured) was seen in 33.3% (38/114) patients. Female gender was associated with delayed sputum culture conversion at three months (P = 0.020). A positive culture at the end of the sixth month was significantly associated with unfavourable outcomes (P = 0.002). A low body mass index (BMI) (15.86 [IQR, 14.10-18.11]) and a higher platelet count (358 x 109/L [IQR, 282-4.85]) at the initiation of treatment were independently and significantly associated with unfavorable outcomes. Conclusion: Patients with a low BMI and high platelet count are more likely to have unfavourable treatment outcomes. Identifying patients with these risk factors during the pre-treatment phase, more intensive follow-up during the treatment course could be advocated.

Introduction: Animal models have been used to understand the pathophysiology of pulmonary hypertension, to describe the mechanisms of action and to evaluate promising active ingredients. The monocrotaline-induced pulmonary hypertension model is the most used animal model. In this model, invasive and non-invasive hemodynamic variables that resemble human measurements have been used. Aim: To define if non-invasive variables can predict hemodynamic measures in the monocrotaline-induced pulmonary hypertension model. Materials and Methods: Twenty 6-week old male Wistar rats weighing between 250-300g from the bioterium of the Universidad del Valle (Cali - Colombia) were used in order to establish that the relationships between invasive and non-invasive variables are sustained in different conditions (healthy, hypertrophy and treated). The animals were organized into three groups, a control group who was given 0.9% saline solution subcutaneously (sc), a group with pulmonary hypertension induced with a single subcutaneous dose of Monocrotaline 30 mg/kg, and a group with pulmonary hypertension with 30 mg/kg of monocrotaline treated with Sildenafil. Right ventricle ejection fraction, heart rate, right ventricle systolic pressure and the extent of hypertrophy were measured. The functional relation between any two variables was evaluated by the Pearson correlation coefficient. Results: It was found that all correlations were statistically significant (p <0.01). The strongest correlation was the inverse one between the RVEF and the Fulton index (r = -0.82). The Fulton index also had a strong correlation with the RVSP (r = 0.79). The Pearson correlation coefficient between the RVEF and the RVSP was -0.81, meaning that the higher the systolic pressure in the right ventricle, the lower the ejection fraction value. Heart rate was significantly correlated to the other three variables studied, although with relatively low correlation. Conclusion: The correlations obtained in this study indicate that the parameters evaluated in the research related to experimental pulmonary hypertension correlate adequately and that the measurements that are currently made are adequate and consistent with each other, that is, they have good predictive capacity.

Background: Few studies have focused on risk factors for early readmission in patients with tuberculosis. Objective: Determine what are the risk factors for the early readmission of patients with tuberculosis at General Tijuana Hospital, Mexico. Materials and Methods: All patients aged ≥ 18 years who were admitted with the confirmed diagnosis of pulmonary tuberculosis were prospectively included. Information was obtained on demographic, socioeconomic variables, previous hospitalizations, clinical data, and laboratory and radiographic studies. Results: One hundred and thirty-four patients with tuberculosis were included, and 24 of them (17.9%) corresponded to early hospital readmissions. The interval between initial admission and readmission was 1.45 ± 0.183 months. The readmission group had used illicit drugs for more years (11.3 ± 13.9 years) than the new cases group (8.01 ± 8.25 years; p = 0.03). Forty percent of the patients who were readmitted did not go to their referral health unit after their initial hospital discharge. The reasons argued by the patients included, among others, not having received information regarding their illness during hospitalization, the abuse of illegal substances and the perception of hostility by health personnel. Discussion: One out of every five patients admitted for tuberculosis will be readmitted after only six weeks of initial discharge. Sociocultural factors (addictions, comorbidities, poverty) and of the health system (limited hours of medical care, accessibility) contribute to this phenomenon. Conclusion: Loss of follow-up after hospital discharge is common in most settings and contributes to an increase in morbidity and mortality, and transmission of infection in the community.

Background: Vitamin D has an essential role in enhancing the immune system to fight and destroy bacteria. People with vitamin D deficiency are highly liable to develop active pulmonary and extrapulmonary tuberculosis. Objective: To evaluate the serum level of vitamin D among patients with pulmonary and extrapulmonary tuberculosis. Patients and Methods: A case-control prospective study was conducted among patients with pulmonary and extrapulmonary tuberculosis and asymptomatic persons (controls). The study included 80 participants, 50 were TB patients, while 30 were controls. Vitamin D {1, 25(OH)} assay was done for all. Results: Vitamin D assay of the included subjects revealed that 52 patients were vitamin D deficient, 7 patients had insufficient vitamin D and 21 had normal serum levels. Of the extrapulmonary TB patients, 35 (100%) had vitamin D deficiency, in pulmonary TB patients, 15 (100%) were vitamin D deficient. While 2 study subjects (6.7%) in the control group were deficient of vitamin D, 7 (23.3%) had insufficient vitamin D and 21cases had normal vitamin D levels. There was a statistically significant relationship between pulmonary and extrapulmonary TB cases and vitamin D deficiency (P< 0.001). Conclusion: Vitamin D deficiency was found among pulmonary and extrapulmonary tuberculosis patients especially among female patients and patients in rural residence. The current study needs additional work to evaluate the value of adding vitamin D to the TB treatment regimen.

Background: Asthma and asthma-COPD overlap (ACO) are heterogeneous airway obstruction. This study aims to differentiate ACO and adult-onset asthma based on pulmonary function tests, smoking history, and atopic status. Method: This cross-sectional study of adult-onset asthma evaluated characteristics, such as bronchodilator reversibility test, the skin prick test, total serum IgE, and serum IL-13 levels of asthma patients who were current/former smokers with a smoking history of <10 packs-year and ≥10 packs-year and who also had taken FEV1 / FVC <0.7 post-bronchodilator. Results: The data of 30 subjects were analyzed and divided into two groups (23 asthma and 7 ACO subjects). The ACO patients were older compared to asthma patients (63.4 ± 4.7 vs. 53.7 ± 7.7, p = 0.004). A higher percentage of men was found in ACO than in asthma (85.7% vs. 21.7%, p = 0.004). There was a difference in the cumulative number of cigarettes consumed in patients with ACO and asthma (19.4 ± 6.4 vs. 7.2 ± 2.6, p = 0.014). The ratio of FEV1 / FVC post-bronchodilator in ACO patients was significantly lower than in asthma patients (57.3 ± 6.9 vs. 65.5 ± 8.8, p = 0.033). There was no difference in the duration of the disease between ACO and asthma (7.2 ± 6.1 vs. 6.1 ± 5.5, p = 0.535). Conclusion: Differences were seen in the number of cigarettes consumed and the ratio of FEV1/FVC in ACO and adult-onset asthma patients. The cumulative number of cigarettes consumed could be a distinguishing characteristic between ACO and asthma.