Current Practices for Severe Alpha-1 Antitrypsin Deficiency Associated COPD and Emphysema
Published on: 26th July, 2024
Alpha-1 antitrypsin deficiency is a genetic disorder that can lead to chronic obstructive pulmonary disease and emphysema. Although it is the most well-studied genetic risk factor for emphysema, data is still scarce. Traditionally, medical therapy is similar to standard chronic obstructive pulmonary disease patients. Over the past several decades, enzyme augmentation therapy has emerged as a highly utilized alpha-1 antitrypsin-specific therapy. It has become the standard of care for severe alpha-1 antitrypsin deficiency despite unclear effects on a multitude of clinical outcomes. Significant data supports interventional therapies, including lung volume reduction surgery and bronchoscopic lung volume reduction, for chronic obstructive pulmonary disease patients without alpha-1 antitrypsin deficiency. These interventions have less robust data in the treatment of alpha-1 antitrypsin-induced chronic obstructive pulmonary disease. This review will explore the data regarding various treatment options for severe alpha-1 antitrypsin deficiency associated with chronic obstructive pulmonary disease and emphysema.
An Uncommon Case Report of Hypothyroidism, Type 1 Diabetes Mellitus, and Systemic Lupus Erythematosus with an Immunosuppressive Consequence: A Case Report
Published on: 27th August, 2024
An autoimmune condition known as Systemic Lupus Erythematosus (SLE) affects several systems and manifests itself in a variety of ways. It is far more common among young women who are fertile.It has been demonstrated that a mix of environmental and genetic variables may trigger immunological responses, triggering T and B cells, and leading the B cells to overproduce pathogenic autoantibodies and dysregulate cytokines, which ultimately result in harm to many organs and tissues. One feature of SLE is the presence of antibodies against cytoplasmic and nuclear antigens. An autoimmune illness is also type 1 diabetes. β-cell antibodies (Ab) and other antibodies that cause the autoimmune death of the pancreatic β-cells, which make insulin, are part of the multifactorial pathophysiology of type 1 diabetes mellitus (T1DM).Immunosuppression is the therapy for systemic lupus erythematosus (SLE), and diabetes itself compromises immunity, making infections more opportunistic. We came across an unusual instance of a patient with SLE, T1DM, hypothyroidism on immunosuppression who subsequently acquired pulmonary TB.Key phrase: Autoimmune diseases such as type 1 diabetes mellitus (T1DM) and Systemic Lupus Erythematosus (SLE).
Effectiveness of Intercostal Stretch Technique on Pulmonary Conditions: A Narrative Review
Published on: 13th September, 2024
Background: The Intercostal Stretch Technique is one of the physiotherapy techniques that is used to solve different respiratory problems. It is used for increasing chest expansion and diaphragm excursion improvement and also intra-thoracic lung volume. Aim: The study aims to evaluate the effectiveness of the intercostal stretch technique.Methodology: A narrative review. In this study, an RCT study was used to review the intervention.Results: Several articles are used to discuss the effectiveness of the intercostal stretch technique. In stable COPD, diaphragmatic breathing and the intercostal stretch technique both work equally well to improve chest expansion and functional capacity while lowering dyspnea. Research has shown that IC stretch outperforms the anterior basal lift technique in lowering heart and respiratory rates while increasing oxygen saturation. According to this study, IC stretching in conjunction with breathing control may improve dynamic lung parameters, particularly FEV1/FVC%, more than breathing control alone. Patients with COPD have an increased functional exercise capacity and reduced dyspnea when aerobic training and respiratory muscle stretching are combined. Conclusion: Different articles demonstrated that IC stretch improved lung function, expired tidal volume, decreased dyspnea, and increased chest expansion.
Obesity in Patients with Chronic Obstructive Pulmonary Disease as a Separate Clinical Phenotype
Published on: 19th September, 2024
Chronic obstructive pulmonary disease (COPD) is a heterogeneous, progressive disease characterized not only by pathological changes in the lungs but also by significant extrapulmonary manifestations and serious concomitant diseases. The current problem for the study is the features of the relationship between COPD and adipose tissue since there are contradictory data in the literature. This review presents studies that claim that obesity aggravates the course of COPD, as well as the results of studies that describe the “obesity paradox” in patients with COPD. Due to the lack of unambiguous data, it is necessary to continue studying this problem to optimize the tactics of managing this group of patients and draw up clear recommendations for patients with COPD.
Influence of COPD on the Diaphragm and Muscles of the Lower Limbs
Published on: 1st October, 2024
Chronic obstructive pulmonary disease (COPD) is associated with numerous comorbidities, including muscle involvement which consists of changes in the structure and function of peripheral and respiratory muscles. Ultrasound can provide a non-invasive assessment of muscle damage. Ultrasound assessment of the quadriceps contractility index (Qci) is feasible, rapid, simple, and reliable. Numerous studies have demonstrated that Qci is linked to the severity of COPD, clinical symptoms, and respiratory muscle activity. Furthermore, ultrasound makes it possible to observe the dynamics of the diaphragm by measuring its amplitude, its contraction speed, and the duration of each contraction phase. Ultrasound examination of muscle damage in COPD could constitute a promising new tool to assess the severity of the disease.
Prolonged Latency in Previable PPROM in Twin Pregnancies: A Case Series
Published on: 18th October, 2024
Previable Preterm Premature Rupture of Membranes (PPROM) before 24 weeks of gestation in dichorionic diamniotic (DCDA) twin pregnancies is a rare and challenging obstetric complication. Three cases are presented in this case series, all involving prolonged latency periods of 74, 98, and 158 days following membrane rupture. The management strategy employed was expectant, utilizing antibiotic prophylaxis and close monitoring to prevent infection. Neonatal outcomes varied, with pulmonary hypoplasia and respiratory distress observed in some cases. One twin from Case 2 died due to sepsis, while the remaining twins in all three instances survived after extended neonatal intensive care. This series highlights the potential for extended latency and favorable outcomes in select cases, though neonatal morbidity remains a significant risk, underscoring the need for individualized counseling and vigilant care.
The Pores of Kohn, an Overlooked Pulmonary Structure: A Review
Published on: 25th October, 2024
Many studies from the early 20th century on the significance of the pores of Kohn were assessed based on the pathogenesis and pathology of pneumococci pneumonia occurring in man. The pneumococci were carried in the edema fluid directly from alveolus to alveolus through the pores of Kohn and from bronchiole to bronchiole as a result of repeated aspirations, aided by breathing, coughing, and gravity. With the emerging minimally invasive and non-invasive techniques experimentations and the current medications; tackling exacerbations and improving the pulmonary function in various lung diseases remains a dilemma for clinicians and researchers. In this article, we aim to review specifically the pores of Kohn as this is the portal for the spread of infection but also lung recruitment during breathing.
Advances in Physiological Research: Consideration on Arterial Hypercapnia in Acute Cardiogenic Pulmonary Edema (ACPE)
Published on: 24th October, 2024
The causes of hypercapnia in Acute Cardiogenic Pulmonary Edema are still unknown. Our hypothesis recognizes an alteration of the ventilation-perfusion ratio in the apical areas of the lung as the major cause. The redistribution of blood to the apical lung zone in hypertensive pulmonary circulation determines an excess of perfusion compared to ventilation and consequently hypercapnia. Our suggestion might be in favor of Bilevel-PAP over Continuous Positive Airway Pressure (CPAP) as the first line of therapy.
Efficiency of Artificial Intelligence for Interpretation of Chest Radiograms in the Republic of Tajikistan
Published on: 25th November, 2024
The article presents data from recent publications and own data on screening studies with interpretation of chest radiographs using artificial intelligence CAD (Computer-Assisted Diagnosis), which, according to WHO recommendations, provides more accurate clinical thresholds for deciding who needs to take a sputum test. Another aspect of the WHO recommendations is the cost-effectiveness of CAD as a tool for triaging patients with tuberculosis symptoms in low-income countries with a high incidence of tuberculosis. Compared with smear microscopy and GeneXpert, without preliminary sorting, the use of mobile digital X-ray machines equipped with a CAD tool reduces costs, allowing sorting of individuals suspected of having tuberculosis for testing on GeneXpert, while reducing the time to start tuberculosis treatment.Thus, conducting a study using portable X-ray machines using a CAD program is a low-cost and easy-to-implement method, does not require large funds, does not require separate rooms, is highly effective, has good image quality, allows you to quickly clarify individuals suspected of having tuberculosis, differentiating it from other pathological changes in the lungs.Our experience shows that machine analysis of chest computed tomography data, due to the higher resolution capabilities of the method and the absence of fundamental disadvantages of radiography, including the effect of shadow summation, the presence of “blind” zones, etc., is finding increasing application in both diagnostics and screening of respiratory diseases. Our use of this tool allowed us to identify additional new cases of phthisio-onco-pulmonary diseases in field conditions.
Unveiling the Impostor: Pulmonary Embolism Presenting as Pneumonia: A Case Report and Literature Review
Published on: 5th February, 2025
Pulmonary Embolism (PE) can present with symptoms resembling pneumonia, creating a diagnostic challenge, particularly in patients with comorbidities. We report the case of a 67-year-old male who presented with cough, hemoptysis, shortness of breath, fever, and pedal edema. Initially diagnosed with consolidation based on chest X-ray findings, he was treated with antibiotics. However, persistent symptoms prompted further evaluation, leading to the diagnosis of PE with pulmonary infarction and deep vein thrombosis on computed tomography pulmonary angiography and Doppler ultrasound. This case highlights the need to consider PE in the differential diagnosis of consolidation, particularly in high-risk individuals, to avoid delays in appropriate management.
Pneumothorax as Complication of CT Guided Lung Biopsy: Frequency, Severity and Assessment of Risk Factors
Published on: 12th February, 2025
Background: CT-guided lung biopsy is routinely performed minimally invasive procedure. Imaging findings in the lung can have a broad differential diagnosis; therefore, it is indicated for definitive determination of pulmonary nodules or masses. Post-biopsy complications are common with most of them manageable in daycare. As pneumothorax is the most common complication, frequency and severity of pneumothorax with assessment of risk factors and follow-up for resolution is necessary.Methods: A prospective evaluation of 123 biopsies with automated coaxial biopsy of 18 gauge was done. Post-biopsy pneumothorax was evaluated for its incidence and resolution. The studied risk factors were; patient age, sex, lesion location, lesion size, shortest pleural lesion depth, traversed lung parenchymal distance, presence of emphysema, fissure penetration, needle thoracic wall angle, and lesion characteristics.Results: Reported immediate post-procedural pneumothorax was 22% with 19% of mild, 4% of moderate and 2.4% of severe cases. 51.9% of cases showed resolution within 24 hours. The intervention was required in only 4.8% of biopsy cases. A significant p - value of pneumothorax with the nodule depth increased traversed lung parenchymal distance, acute needle angle, fissure puncture, and presence of emphysema was seen. Emphysema was an independent variable in pneumothorax in multivariate analysis.Conclusion: Pneumothorax is an unamenable consequence of CT-guided lung biopsy and a cautious approach should be kept in view of the variables that are associated with it to reduce its incidence and severity in patients.
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