To understand lung damages caused by COVID-19, we deduced two phases lung damage mechanisms. After the lungs are infected with COVID-19, the affected lung tissue swells and surface properties of pulmonary capillaries change, both contributing to an increased flow resistance of the capillaries. The initial damages are mainly fluid leakage in a limited number of involved alveoli. The increased vascular resistance results in retaining more white blood cells (“WBCs”) in pulmonary capillaries. Some of the WBCs may get into interstitial spaces. When more and more WBCs are dynamically retained, the vascular resistance of pulmonary capillaries further rises; and thus the overall vascular resistance of the lungs rises and pulmonary pressure rises. The rise in the pulmonary pressure in turn results in elevated capillary pressures. When pulmonary capillary pressures around the alveoli are sufficiently high, the elevated pressure causes interstitial pressures to change from normally negative values to positive values. The positive pressures cause fluid leakage to the alvoeli and thus degrade lung function. Tissue swelling, and occupation of WBCs in interstitial spaces and occupation of alvoelar spaces by leaked water result in reduced deformable and compressible spaces, and thus causes a further rise of the vascular resistance of the lungs. When the pulmonary pressure has reached a critical point as in the second phase, the blood breaks capillary walls and squeezes through interstitial spaces to reach alveolar spaces, resulting in irreversible lung damages. Among potential influencing factors, the available space in the thorax cage, temperature, and humid are expected to have great impacts. The free space in the thorax cage, lung usable capacity, and other organ usable capacities are the major factors that determine the arrival time of last- phase irreversible damage. The mechanisms imply that the top priority for protecting lungs is maintaining pulmonary micro-circulation and preserving organ functions in the entire disease course while controlling viral reproduction should be stressed in the earliest time possible. The mechanisms also explain how leukecytes are “recruited and migrated” into inflamed tissues by dynamic retention.
Introduction Worldwide, the Chronic Obstructive Pulmonary Disease (COPD) is a major public health concern; On the basis of epidemiologic data, by 2020, COPD will be the third leading cause of death worldwide. Objective To assess the frequency of Microalbuminuria and the presence of Hypoxemia in patients with COPD. Materials and Methods Study Design Cross-sectional observational study. Place of Study Department of Medicine & Respiratory Medicine in Dhaka Medical College Hospital (DMCH). Study Period Six months after approval of the protocol Study Population Patient suffering from COPD and admitted in Department of Medicine & Respiratory medicine, DMCH, Dhaka, Bangladesh. Total 100 samples were included in this study. COPD usually presents with a history of chronic cough with sputum production or exertional breathlessness which may be associated with relevant clinical findings and a post-bronchodilator FEV1/FVC less than 0.7. In most cases it is associated with smoking Results Total 100 patients of COPD were included in the study. Mean age was 58.16±5.4 years ranging from 50 to 74 years. Out of 100 patients, majority (42%) were from age group 55 to 60 years. Among all, 82% patients were male and 18% were female, of 100 patients, majority (30%) were day laborer. Only 2% were unemployed. The percentage of housewives was 18%. Other 34% were businessman and service holders. COPD severity was assessed using GOLD guideline. Out of 100 COPD patients, 38% had severe COPD (GOLD stage III). 16 % patients were in mild (Stage I) and 32% patients were in moderate stage (Stage II). The condition was very severe for 14% patients (Stage IV). Of 100 COPD patients, 30% had microalbuminuria. Among 100 COPD patients, chance of microalbuminuria increases among COPD patients with the increase of age significantly. There is smoking history of 36 pack year for COPD patients with microalbuminuria. Of 100 patients 26% were hypoxemic. The average forced expiratory volume (FEV1%) was 37.40 with standard deviation 14.48 for patients with microalbuminuria. The PaO2 and PaCO2 is 63.06 with standard deviation 7.09 and 46.09 with standard deviation 2.43 for COPD patients with microalbuminuria respectively. All of these characteristics are significant with p-value 0.00. However, the body mass index (BMI), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were not found significant. The patients who had PaO2 less than 70 mmHg were considered hypoxemic. The patients who had microalbuminuria among them 87% were hypoxemic. Only 13% patients were free from hypoxemia who had microalbuminuria. Patients without microalbuminuria had no history of hypoxemia. There is significant relation exists between hypoxemia and the presence of microalbuminuria (p<0.5). Conclusion In this study, about one-fourth of the patients have hypoxemia and more than one fourth of the patients have microalbuminuria. Stage III was more frequent among the study population but there was no association between severity grading and presence of microalbuminuria. However, significant relation is found between co-existence of both microalbuminuria and hypoxemia in COPD patients.
Background The aim of this study is to evaluate the outcomes of patients submitted to diaphragmatic pacing, and the impact on quality of life of patients who chronically depend on mechanical ventilation, as well as the effectiveness of phrenic stimulation to eliminate the need for mechanical ventilation. Methods From 2010- 2014, 10 patients completely dependent on mechanical ventilation were operated upon, with the implantation of phrenic pacing device. The diagnoses were quadriplegia and congenital central hypoventilation syndrome (CCHS). All patients underwent bilateral approach to the phrenic nerves, by video-assisted thoracic surgery or mini-thoracotomy. Results All patientsstarted pacing 30-40 days post-operatively. The mean age of patients was 12.1 years (2-27 years range) with a median of ten years. Six patients (54.5%) were as old as ten years, and three (27.2%) were older than 20 years. Younger patients had CCHS and older ones were quadriplegic. All patients with CCHS (n = 4) were nine years old or younger while only two quadriplegic patients were in this age group. Conclusions Diaphragmatic pacing can provide improvement in the quality of life of patients who depend on mechanical ventilation, allowing freedom to conduct daily activities, lower respiratory infections, and tracheostomy decannulation.
The question in the title of this article is not a comparison of terms. The answer to this question is fundamental to substantiate the principles of care and further results of treatment of the disease. The choice of the answer to this dilemma determines the strategy for further directions in solving the problem of acute pneumonia (AP). The validity and correctness of this choice will affect not only the effectiveness of further actions and efforts, but also the fate of many patients. To come to a meaningful and reasoned view of the essence of AP, it is enough to analyse the arguments and facts accumulated by medical science and practice.
The prognosis for individuals with cystic fibrosis has improved markedly over the last 50 years, with most countries now reporting that 50% of the population reach at least 35 years of age [1–3]. Despite this improvement, the average age at death is still in the late 20s and varies enormously between cystic fibrosis centres and countries [4]. To further improve the trajectory of lung disease, it is critical to identify patients that would benefit most from early intervention. Adolescent FEV1 decline in cystic fibrosis may be an artefact of the spirometry reference equations used http://ow.ly/J0com
While avoidance measures are a key component of the treatment of allergic rhinitis, pharmacological therapies are often needed to adequately control symptoms. Intranasal corticosteroids are highly effective and are particularly useful in patients with moderate to severe disease.
Vaccines have substantially reduced the incidence of pediatric pneumonias caused by Haemophilus influenzae type b and certain serotypes of Streptococcus pneumoniae. However, other organisms are being identified more frequently, including methicillin-resistant Staphylococcus aureus (MRSA) and serotypes of S pneumoniae that are not covered by the pneumococcal vaccine. Although chest radiographs are still a basic component of the assessment of pneumonia, CT scans are increasingly being used to differentiate effusion from empyema and consolidation and to evaluate for pleural fluid loculations, lung abscesses, and lung necrosis. s-Lactams, particularly extendedspectrum cephalosporins, remain an important cornerstone of the treatment of complicated pneumonia. In areas where community- acquired MRSA is a concern, empirical coverage for this pathogen should be considered in patients with a severe or necrotizing pneumonia. (J Respir Dis. 2008;29(2):85-92)
We present a rare case of Cushing syndrome resulting from thymic carcinoid of the lung. Although Cushing syndrome is not usually associated with respiratory muscle weakness or restriction, our patient had reduced lung volumes and expiratory muscle weakness. His reduced lung volumes could not be completely explained by respiratory muscle weakness, parenchymal lung disease, or obesity. Six months after removal of the carcinoid tumor, the patient's growth hormone level and the lung volumes improved significantly, and he became asymptomatic.
The most common manifestation of oropharyngeal candidiasis (OPC) is pseudomembranous candidiasis, commonly known as thrush, which appears as a whitish yellow, curdlike discharge on the mucosal surfaces. Other forms of OPC include denture stomatitis, angular cheilitis, and glossitis. Patients with denture stomatitis are usually asymptomatic, but the tissue beneath the denture is typically red and hyperplastic. Patients with angular cheilitis may complain of a burning sensation at the margins of the lips. Candidiasis involving the tongue can be exuberant and is usually associated with complaints of a white tongue, taste alterations, and a burning sensation of the tongue. The diagnosis of OPC can be established by identifying typical fungal elements on potassium hydroxide preparation or Gram stain of scraped material. Treatment options include clotrimazole, fluconazole, itraconazole, and nystatin. (J Respir Dis. 2008;29(3):128-135)
Systemic antibiotics are the mainstay of the management of acute exacerbations of bronchiectasis. Antibiotic selection should include coverage for Streptococcus pneumoniae and Haemophilus influenzae; particular attention also should be paid to the presence of Staphylococcus aureus and Pseudomonas species. The duration of antibiotic therapy is not well-established, but most clinicians recommend a prolonged course, often longer than 3 weeks. There is some evidence that long-term low-dose macrolide therapy can reduce the incidence of acute exacerbations and decrease sputum production. There also may be a role for the use of inhaled antibiotics. Airway clearance strategies, such as chest percussion and postural drainage, are clearly useful in patients with cystic fibrosis and may be useful in other patients with bronchiectasis. Surgical resection can be considered if a patient has localized disease that is refractory to medical management or if he/she is unwilling to undergo long-term medical therapy.
Nocardia asteroides is a rare cause of pulmonary or disseminated infection in immunocompetent persons. Pleural compromise is common, but empyema necessitatis is very rare. The authors describe an apparently immunocompetent patient with N asteroides infection who had chest wall compromise mimicking empyema necessitatis.
Benzocaine-induced methemoglobinemia has been a well-documented illness that is usually simple to cure but can be life-threatening if not recognized. As the use of scope procedures becomes more commonplace, the early recognition of hypoxemia resulting from methemoglobinemia is essential. The authors report a case of benzocaine-related methemoglobinemia following bronchoscopy.
The authors describe a previously healthy patient who required surgical resection of a large mucoid tumor lined with atypical columnar epithelium. The diagnosis was mucinous cystadenocarcinoma, a rare type of pulmonary cancer that is difficult to identify.
Allergic disorders are becoming more common. For example, about 20% of Americans have allergic rhinitis, which accounts for more than 10 million office visits each year. Most of these visits are to primary care clinicians.
A 28-year-old man presented with chest pain, hemoptysis, and wheezing. He had a history of intermittent shortness of breath that occurred at least 3 times a year in the past 3 years; fever; and loss of appetite associated with headache, vomiting, and weakness. His medical history also included asthma, chronic gastritis, and more than 5 episodes of pneumonia since 1996. A test for hepatitis C virus (HCV) had yielded positive results.
Our understanding of the pathobiology of pulmonary arterial hypertension (PAH) has evolved considerably over the past 2 decades, with increasing recognition of the important role that aberrant vasoproliferative responses play in conjunction with disordered vasoconstriction. Classification of the many forms of PAH into categories sharing a similar pathophysiology and clinical presentations help the practicing clinician approach a complex differential diagnosis. Noninvasive tests can be used to narrow this differential but must be applied with an appreciation for their limitations. Transthoracic echocardiography is the screening tool of choice; the workup should also include chest radiography and electrocardiography. However, right heart catheterization is ultimately required to establish the diagnosis. While PAH remains a progressive and generally fatal disease, existing therapies have a significant impact on survival and new therapeutic targets offer great hope for improving the prognosis. (J Respir Dis. 2006;27(11):487-493)
Shortness of breath is a common complaint associated with a number of conditions. Although the results of the history and physical examination, chest radiography, and spirometry frequently identify the diagnosis, dyspnea that remains unexplained after the initial evaluation can be problematic. A stepwise approach that focuses further testing on the most likely diagnoses is most effective in younger patients. Early bronchoprovocation challenge testing is warranted in younger patients because of the high prevalence of asthma in this population. Older patients require more complete evaluation because of their increased risk of multiple cardiopulmonary abnormalities. For patients who have multiple contributing factors or no clear diagnosis, cardiopulmonary exercise testing can help prioritize treatment and focus further evaluation. (J Respir Dis. 2006;27(1):10-24)
