Current Issue : October - December Volume : 2019 Issue Number : 4 Articles : 6 Articles
Background: The management and control of pulmonary bacteriologically confirmed (PBC) tuberculosis (TB) also\nknown as infectious TB is important not only to monitor for resistance but also to check for severity, treatment\nresponse and limit its spread.\nMethod: A retrospective analysis of diagnosis smear results of PBC TB patients in Kampala district registered\nbetween January 2012 and December 2015 at 65 TB diagnosis and treatment units (DTUs) was done.\nResults: Of the 10,404 records; 6551 (63.0%) belonged to PBC TB patients, 3734 (57.0%) of whom were male.\nSputum smear microscopy was the diagnostic test most commonly used 4905 (74.9%) followed by GeneXpert\ntesting, 1023 (15.6%). Majority, 1951 (39.8%), of the PBC TB patients had a smear positivity grading of 3+ (> 10 acidfast\nbacillus (AFB)/Fields). Public facilities diagnosed more PBC TB patients compared to private facilities, 3983 (60.\n8%) vs 2566 (39.2%). From 2012 through 2015, there was a statistically significant increase in PBC TB patients\nenrolled on anti-TB treatment from 1389 to 2194 (p = 0.000). The percentage of HIV positive co-infected PBC TB\npatients diagnosed decreased from 597(43%) to 890(40.6%) (p = 0.000) within same period. Linkage to HIV care\nimproved from 229\n(34.4%) in 2012 to 464 (52.1%) in 2015 (p = 0.000). The treatment success rate (TSR) for PBC TB patients improved\nfrom 69% in 2012 to 75.5% by end of 2015 (p = 0.001) with an improvement in cure rate from 52.3% to 62% (p = 0.\n000). There was an observed significant decrease in TB related mortality from 8.9 to 6.4% (p = 0.013).\nConclusion: The proportion of diagnosed PBC TB patients increased from 2012 to 2015. PBC TB patients diagnosed\nwith 3+ smear positivity grading results consistently contributed to the highest proportion of diagnosed PBC TB\npatients from 2012 to 2015. This could be due to the delay in diagnosis of TB patients because of late presentation\nof patients to clinics. A prospective study of PBC TB patients diagnosed with 3+ smear positivity grading may\nelucidate the reasons for the delay to diagnosis. Further, we propose a study of wider scope to estimate how many\npeople a single PBC TB patient is likely to infect with TB before being diagnosed and treated....
Oxygen uptake (VO2) kinetics provide information about the ability to respond to the\nincreased physical load during a constant work rate test (CWRT). Box-Jenkins transfer function (BJTF)\nmodels can extract kinetic features from the phase II VO2 response during a CWRT, without\nbeing affected by unwanted noise contributions (e.g., phase I contribution or measurement noise).\nCWRT data of 18 COPD patients were used to compare model fits and kinetic feature values\nbetween BJ-TF models and three typically applied exponential modelling methods.........................
Background: In patients with chronic obstructive pulmonary disease (COPD), bronchoscopic lung volume\nreduction (BLVR) techniques using unidirectional endobronchial valves improve lung function and increase exercise\ntolerance. BLVR treatment is included in the Global Initiative for Chronic Obstructive Lung Disease (GOLD)\ntreatment guidelines for COPD patients without interlobar collateral ventilation. However, BLVR using an\nendobronchial valve has not been attempted in patients with giant bullae.\nCase presentation: We report successful and safe BLVR using an endobronchial valve in a patient with a huge bullous\nemphysema in the right middle lobe. A 65-year-old male was diagnosed with COPD 5 years prior and had a large\nbullae in the right middle lobe at that time. During regular follow-up, the symptoms of respiratory distress gradually\nworsened, and the size of the bullae gradually increased on computed tomography (CT). Therefore, we decided to\ntreat the patient via BLVR using an unidirectional endobronchial valve. The Chartis system (Pulmonx, Inc., Palo Alto, CA)\nconfirmed the absence of collateral ventilation of the right middle lobe. We successfully inserted an endobronchial\nvalve into the right middle bronchus. After insertion, the bullae decreased dramatically in size, and the patientâ??s\nsymptoms and quality of life improved markedly.\nConclusion: This case supports recent suggestions that BLVR can serve as a good alternative treatment for\nappropriately selected patients....
Background: The negative pressure pulmonary edema is rare clinical situation which caused mainly by upper\nairway obstruction. However except upper airway obstruction, there may be other pathophysiological disorders\nmaking patients more vulnerable to pulmonary edema. Based on these disorders, upper airway obstruction is the\ntrigger to induce negative pressure pulmonary edema.\nCase presentation: This case was a 5-year-old girl with tumor on saddle area, her hormones level were abnormal\npreoperatively, such as cortisol, adrenocorticotrophic hormone, free T4 and total T4. During the stage of induction,\nnegative pressure pulmonary edema took place due to mild upper airway obstruction. And the instant chest\nComputer tomography proved diagnosis clue. After intensive care, most lung field of this girl recovered to normal\nwithin 48 h.\nConclusion: The patient with abnormal hormone levels is vulnerable to pulmonary edema, mild upper airway\nobstruction triggered negative pressure pulmonary. Thus pre-operation hormones supplement is as important as\nkeeping upper airway unobstructed....
Introduction. Idiopathic pulmonary fibrosis (IPF) is an independent risk factor for lung cancer development, and small cell lung\ncancer (SCLC) comprises 15-20% of lung cancers with IPF. The objective of this study was to investigate survival outcomes and\ntreatment-related complications according to GAP (gender, age, and physiology) stage in patients having SCLC with IPF (SCLCIPF).\nMaterials and Methods. Retrospectively collected data of SCLC-IPF patients from two tertiary care university hospitals in\nSouth Korea were reviewed. A total of 59 SCLC-IPF patients were identified and categorized according to GAP stage, which was\nproposed by Ley et al. in 2012 to predict the prognosis of IPF. Survival outcomes and treatment-related complications were compared\nbetween the two groups. Results. In a total of 59 patients, the median age was 71 years and 58 (98.3%) were male. In a comparison\nof themedian overall survival (OS) according to GAP stage,median OS of the advanced GAP stage group was significantly shorter\nthan median OS of GAP stage I group (7.1 months vs. 16.1 months; p = 0.002). Treatment-related complications occurred more\nfrequently in the advanced GAP stage group; advanced GAP stage was the only predictor that exhibited a significant association\nwith the incidence of acute exacerbation of IPF. Conclusions. Inferior survival outcome and higher incidence of treatment-related\npulmonary toxicities were noted in the advanced GAP stage group. Furthermore, advanced GAP stage was the only predictor of\ntreatment-related acute exacerbation of IPF. Physicians should thus consider GAP stage, which reflects the severity of IPF, during\ntreatment of SCLC-IPF....
Chronic obstructive pulmonary disease (COPD) is a chronic, progressive respiratory\ndisease and the third leading cause of respiratory disease mortality.\nThe diagnosis of COPD is changed to acute exacerbation of COPD (AECOPD)\nwhen respiratory symptoms become worse, beyond normal day-to-day variations\nand severely enough that changes in medication are required. Both neutrophils\nto lymphocyte ratio (NLR) and peripheral blood eosinophilia (PBE)\nare rapid and relatively inexpensive tests that can be easily applied in the\nclinical practice for the diagnosis and treatment of AECOPD patients. Furthermore,\ncurrent studies found that NLR and PBE had a higher accuracy rate\nthan other traditional markers (Leukocyte count and C-reactive protein) for\nthe diagnosis and management of AECOPD. Besides, recent studies determined\nthat NLR and PBE can be used for prediction of future exacerbations\nin COPD patients. This review aims to explore the current knowledge about\nthe significance of NLR and PBE in AECOPD patients....
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