Introduction: Diabetes mellitus could influence lung function in asthmatic patients, but the data remain conflicting. A better understanding of this interaction is needed to optimize care. The objective of our work is to evaluate the impact of diabetes on the ventilatory function of asthmatic subjects Patients and method: This is a multicenter cross-sectional study with an etiological focus. The collection of information on asthma patients was done prospectively from 01/04/2020 to 31/12/2023. Spirometry was performed according to ATS/ERS recommendations. Statistical analyses used binary linear and logistic regression models. Results: A population of 221 asthmatic patients was collected with a sex ratio of 0.27. The average age of our population is 48.9 ± 15.3 years. Diabetics account for 18.6% of cases. Several conventional and non-conventional spirometric indices are reduced in diabetic asthmatics. FEV1 less than 80% of the predicted value is observed with a significant negative linear correlation between FEV1 levels and glycemic counts. FVC less than 80% of the predicted value is found in 68.3% of diabetics with a significant negative correlation between glycemic figures and FVC values. Multivariate analysis by binary logistic regression showed that hyperglycemia multiplies the risk of deterioration of FVC by 2.2 times. Other spirometric parameters such as maximum expiratory flow rates (DEM25-75, DEM50, DEM75, DEP), VEM3 and VEM6 are reduced to different proportions. The risk of a reduced FEV1/MEV3 ratio is multiplied by 2.4 in diabetics. Conclusion: This research has led to a better understanding of the relationship between diabetes and ventilatory function parameters in adult asthmatic patients. Our results indicate a significant impairment of ventilatory function in the presence of diabetes, which could justify routine screening of lung function in these patients.
COPD is a major public health issue globally, resulting in significant morbidity, loss of productivity, and increased health expenditure. Air pollution is considered the primary factor leading to the development and progression of COPD. While the role of outdoor air pollution was well outlined, studies have looked at how indoor air quality and indoor air pollution can cause or worsen the disease. Even though we know that outdoor air pollution has contributed to COPD, the question remains: how do outdoor air pollution and an increased outdoor air pollution load impact indoor air quality, and how will that impact COPD development and progression, and can indoor air filters tackle that? This narrative review focuses on air pollution, the air quality index, and the impact of environmental pollution on indoor air quality and COPD. We also describe the role of the HEPA filters in tackling indoor air pollution, their mechanism, and their impact on COPD and control of indoor air pollution.
Rationale: Pulmonary arterial hypertension (PAH) is a progressive vascular remodeling disease with elevated pulmonary vascular resistance that is lethal. While therapeutic progress was recently made with endothelin, nitric oxide, and prostacyclin pathway-based therapy for the treatment of PAH, the disease is currently incurable with a high cost of morbidity and mortality. Sotatercept, a new activin receptor IIA-Fc fusion protein, may prove to be a game-changer as a therapeutic agent for the treatment of PAH by regulating the growth factor signaling aberration of PAH. Methods: It is a narrative review of evidence for the drug Sotatercept for Group 1 PAH from a systematic literature search for clinical trials, mechanism studies, and regulatory data up to 2024. Pivotal clinical trials such as PULSAR, SPECTRA, STELLAR, and ZENITH were evaluated for efficacy, safety, and comparative results. Results: Sotatercept is a TGF-β family member ligand trap that rebalances activin/BMP signaling to target vascular remodeling. Clinically, striking effects were shown with exercise (40.8 m improvement in STELLAR 6MWD), pulmonary hemodynamics (PVR reduction of 146-240 dyn•s•cm⁻⁵ in PULSAR), as well as clinical measures (76% reduction of composite morbidity/mortality through ZENITH). On the background with an acceptable drug safety profile of predominantly hematologic effects, as well as injection site reaction, benefits were achieved. Comparison with analyses implies at least similar, if superior in some dimensions, efficacy of current PAH therapies. Conclusion: Sotatercept is a new therapeutic option for PAH as the first drug to act on the activin/BMP pathway. With its strong effect on several clinically relevant end points, it is a "fourth pillar" of PAH therapy. Clinical trials will determine its place in the algorithm, ascertain other combinations, and potentially identify its utility for other types of pulmonary hypertension.
................................................................................................................................... ii DEDICATION ............................................................................................................................... iii ACKNOWLEDGEMENTS ........................................................................................................... iv LIST OF ACRONYMS AND ABBREVIATIONS .................................................................... xiv CHAPTER ONE: INTRODUCTION ......................................................................................... 1 1.0 INTRODUCTION ................................................................................................................. 1 1.1 BACKGROUND ................................................................................................................... 1 1.2 PROBLEM STATEMENT ................................................................................................... 2 1.3 THE AIM OF THE STUDY ................................................................................................. 3 1.4 RESEARCH OBJECTIVES ................................................................................................. 3 1.5 RESEARCH QUESTIONS ................................................................................................... 3 1.6 SIGNIFICANCE OF THE STUDY ...................................................................................... 3 1.7 DEFINITION OF CONCEPTS ............................................................................................. 4 1.8 STRUCTURE OF THE STUDY .......................................................................................... 4 1.9 CONCLUSION ..................................................................................................................... 4 CHAPTER TWO: LITERATURE REVIEW ............................................................................ 5 2.0 INTRODUCTION ................................................................................................................. 5 2.1 THEORETICAL LITERATURE .......................................................................................... 5 2.1.1 VENTILATOR ASSOCIATED PNEUMONIA ............................................................ 5 2.1.2. HAND WASHING ........................................................................................................ 6 2.1.3 ORAL HYGIENE CARE ............................................................................................... 7 2.1.4 POSITION OF THE PATIENT ..................................................................................... 7 2.1.5 ENDOTRACHEAL SUCTIONING PRACTICES ........................................................ 7
Status Asthmaticus, is a medical emergency, an extreme form of asthma exacerbation characterized by hypoxic and hypercapnic respiratory failure with resistance to standard therapy including inhaled selective beta-adrenergic agonists, low dose systemic steroids and usually responds to high dose systemic steroids with continuous nebulization of bronchodilators. Epinephrine, while not significantly advantageous in cases of mild to moderate asthma compared to standard therapy, can be significantly useful in cases of resistant, life-threatening asthma.
Abstract Background- The studies of the clinical and demographic characteristics of COVID-19 patients around the world have made it possible to observe a rich semiology, which implicated obesity as a factor in the severity of COVID-19 pneumonia, and can lead to intensive care or even death. Some biomarkers have been identified as risk factors for mortality. The aim of this study was to verify obesity and the risk factors for mortality of COVID-19 infection. Methods- This was a single-center prospective study carried out at Rouiba University Hospital, between March 19, 2020 to September 30, 2021. The clinical data were collected: age (year), BMI groups (≥ 30 and <30 kg/m²) sex, active smoking, medical history, clinical complaints, peripheral oxygen saturation (SpO2) at admission, and the length of hospital stay. A standard laboratory assessment and a chest CT without a contrast agent were performed. The prognostic was verified, and the healing, death, or transfers to intensive care were noted, and the data was analyzed. Résultats- Our results showed an obesity rate (26.8%) and a mortality rate (5.3%) and found that obesity increases the risk of severity but not mortality in hospitalized patients. The risk factors for death from COVID-19 were the underlying chronic diseases including diabetes, COPD, renal failure and cardiovascular disease, hypoxia on admission, elevated serum LDH, CRP, and D-Dimer levels. Conclusion- The inclusion of obesity and risk factors in therapeutic management strategies and prognostic scores will be essential to improve the prognosis of hospitalized COVID-19 patients.
The prominence of the pulmonary vasculature and/or tortuosity (n = 16) and dilatation of the central PA (n = 39) with RV hypertrophy were frequently observed. The interlobular septal thickening (n = 18, 45%), and centrilobular (perivascular) ground glass opacities (n = 6, 15%) were clearly depicted on gapless HRCT. PA aneurysmal dilatation and irregular dilatation with arterio-venous fistula were observed in 2 (5%) and 3 cases (7.5%), respectively. Bronchial artery dilatation was observed in 5 cases.
The airway inflammation in chronic obstructive pulmonary disease (COPD) does not respond well to the anti-inflammatory effects of corticosteroids. However, Podo-Hwan, a prescription in Korean traditional medicine, has been clinically used since the early 1900s for COPD and has reported sustained efficacy. The purpose of this study was to compare the effects of Podo-Hwan and tulobuterol patch (a transdermal patch formulation designed to provide continuous 24-hour beta 2-agonist effects) treatments on airway inflammation, quality of life (QOL), and lung function in patients with mild to moderate COPD.
Background: With patients for whom it is difficult or near impossible to maintain adequate oxygenation by conventional means, it may become necessary to oxygenate the blood outside the body.One method used with moderate success is the procedure of extracorporeal membrane oxygenation (ECMO).The purpose of this study was to determine the effectiveness of ECMO in adult patients suffering from conditions associated with respiratory failure that is refractory to conventional means of treatment.Methods: A systematic review of available studies was utilized to answer the earlier research questions.Reputable research journals were combed for articles pertaining to ECMO use in adult, pediatric, and neonatal populations and their effectiveness.Included in this study were articles that met the eligibility criteria.Relevant information was summarized and applied to the research questions.Results: Ten Studies were identified for analysis (3 neonatal, 3 pediatric, and 4 adult).Each study showed a benefit in survivability from the use of extracorporeal life support (ECLS) in conditions of respiratory failure that was deemed refractory to conventional means of treatment.The Extracorporeal Life Support Organization (ELSO) registry contained the most comprehensive data, with the neonatal population being the most robust, followed by the pediatric and adult populations respectively.Neonatal indications for ECLS administration were less difficult to reverse than are adult conditions. Conclusion:Though not as effective as the pediatric and neonatal populations, adult ECLS was still determined to have some effectiveness.The indication or diagnosis played a significant role in the utilization and effectiveness of ECLS.Complications associated with the use of ELSC were of great concern for all patient populations.The adult population had a higher incidence of infection, cannula site bleeding, and surgical site bleeding than neonatal and pediatric populations.As the technology continues to evolve and the practice of ECLS use in adults continues to progress and increase, there is a potential to realize increasing effectiveness. ReseARch ARticleCheck for updates
Manual hyperinflation is one of the most used respiratory physiotherapy techniques in critically ill patients and consists of administering a higher volume of gaseous fluid than the patient performed using a self-inflating balloon (AMBU). This technique was developed with the objective of removing bronchial secretion and re-expansion of atelectasis lung areas, thus improving pulmonary compliance and oxygenation in mechanically ventilated patients.
Treatment Short Course (DOTs) in Kaduna State.Objective: To identify risk factors of Nosocomial Transmission of Tuberculosis among Healthcare Workers.Design: A cross-sectional cohort study was used to identify risk factors of Nosocomial transmission of tuberculosis among healthcare workers in Kaduna State.Result: Involving in providing tuberculosis care services and medical conditions like HIV and cancer is the risk factors to developing tuberculosis among healthcare workers. Conclusion:Prolong exposure to pulmonary tuberculosis patients, poor provision and effective implementations of tuberculosis infection prevention and control as well medical conditions like cancer and HIV are the risks factors of nosocomial transmission of tuberculosis among healthcare workers.Recommendation: Implementations of tuberculosis infection prevention and control guidelines as well as pre-placement and periodic screening of tuberculosis should be conducted among healthcare workers providing tuberculosis. CLiniCAL ReseARChCheck for updates
A bronchopleural fistula (BPF) is a pathologic communication between a bronchus and the pleural space. BPF has a high morbidity and mortality, therefore a timely diagnosis is of great importance. Methylene Blue has been used for the localization of BPF for decades and although other diagnostic tools are available.
Prone positioning (PP) was advocated more than 40 years ago as a means of improving the oxygenation status in patients exhibiting acute respiratory failure (ARF) and acute respiratory distress syndrome (ARDS).
High flow nasal oxygen (HFNO) has been shown to reduce desaturations during flexible bronchoscopy. We evaluated outcomes of HFNO vs. low flow nasal oxygen (LFNO) on intraprocedural hypoxemia, the demand of sedative and reversal medications, post-procedure complications, procedure conversion to general anaesthesia and patient comfort during outpatient standard and EBUS (Endo Bronchial Ultrasound) guided bronchoscopy under conscious sedation.
The global healthcare has been challenged to provide adequate care during COVID 19 pandemic [1]. There is increased public anxiety and knowledge gaps that have created major dilemmas in health care delivery. In this situation a don't miss diagnosis of Covid-19 is unacceptable and there is a trend to suspect respiratory illness as COVID disease unless proved otherwise.
There have been recently documented reports of pneumothorax and persistent air leaks as complications associated with SARS CoV-2-related ARDS. Alveolar-pleural fistulas and broncho-pleural fistulas can lead to the development of pneumothorax.
Antisynthetase syndrome (AS) is a rare autoimmune condition characterized by fever, Raynaud’s phenomenon, hyperkeratosis, inflammatory polyarthritis
The 2019 novel coronavirus (2019-nCoV) or the severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) as it is now called, is rapidly spreading from its origin in Wuhan City of Hubei Province of China to the rest of the world.
Sarcoidosis is a chronic inflammatory disease involving multiple organ systems for which the inciting stimulus is unknown. It is characterized by elevated markers of inflammation and disseminated granuloma in the affected organs. Factor V Leiden deficiency has been long associated with an elevated risk of thrombosis, however, it has been observed in the patients having sarcoidosis, a secondary inciting stimulus is required to trigger the thromboembolic phenomenon, as to date only a few cases of Primary thrombosis have been reported in Factor V Leiden deficient patients culminating in an increased incidence of thromboembolic disease.
