Systemic inflammation, systemic effects and comorbidities in chronic obstructive pulmonary disease

© 2018, Serbian Medical Society. All right reserved. Chronic obstructive pulmonary disease (COPD) is known to be characterized by inflammation both in the stable phase of the disease and during exacerbation. It has been shown that certain inflammatory mediators have a high level in systemic circulation, indicating systemic inflammation in COPD. The first recognized systemic effect of COPD is a disorder of the state of nourishment. Certain diseases, including COPD, can lead to cachexia where patients lose muscle mass despite adequate caloric intake. Inflammation in COPD also has an effect on increased protein catabolism, which leads to a decrease in body weight. Increased activity of enzymes matrix metalloproteinases family (MMP) in patients with COPD can lead to lung tissue destruction and the development of osteoporosis. It is considered that the most important role in the association between COPD and CVD disease is systemic inflammation. Low level of inflammation in small airways in COPD and Atherosclerotic plaques, may be a potential factor in the development of both pathological processes. Systemic manifestations of COPD include numerous endocrine disorders of the pituitary gland, thyroid gland, gonads, adrenal glands and pancreas. The mechanisms by which HOBP affects the endocrine function are not entirely clear, but are likely to include hypoxemia, hypercapnia, systemic inflammation, and the use of systemic glucocorticoids. Explanation for significant depressive disorder in more advanced stages in COPD can be expressive dyspnoea, decreased physical activity, worse exercise tolerance, frequent exacerbations and systemic inflammation which can lead to further physical activity decrease, social isolation, fear, and depression

Risk factors for brain metastases in surgically staged IIIA non-small cell lung cancer patients treated with surgery, radiotherapy and chemotherapy

mortality among patients with carcinomas. The aim of this study was to point out risk factors for brain metastases (BM) appearance in patients with IIIA (N2) stage of nonsmall cell lung cancer (NSCLC) treated with three-modal therapy. Methods. We analyzed data obtained from 107 patients with IIIA (N2) stage of NSCLC treated surgically with neoadjuvant therapy. The frequency of brain metastases was examined regarding age, sex, histological type and the size of tumor, nodal status, the sequence of radiotherapy and chemotherapy application and the type of chemotherapy. Results. Two and 3-year incidence rates of BM were 35% and 46%, respectively. Forty-six percent of the patients recurred in the brain as their first failure in the period of three years. Histologically, the patients with nonsquamous cell lung carcinoma had significantly higher frequency of metastases in the brain compared with the group of squamous cell lung carcinoma (46%: 30%; p = 0.021). Examining treatment-related parameters, treatment with taxane-platinum containing regimens was associated with a lower risk of brain metastases, than platinum-etoposide chemotherapy regimens (31%: 52%; p = 0.011). Preoperative radiotherapy, with or without postoperative treatment, showed lower rate of metastases in the brain compared with postoperative radiotherapy treatment only (33%: 48%; p = 0.035). Conclusion. Brain metastases are often site of recurrence in patients with NSCLC (IIIA-N2). Autonomous risk factors for brain metastases in this group of patients are non-squamous NSCLC, N1-N2 nodal status, postoperative radiotherapy without preoperative radiotherapy

Predicting severity and intrahospital mortality in CovID-19: The place and role of oxidative stress

SARS-CoV-2 virus causes infection which led to a global pandemic in 2020 with the development of severe acute respiratory syndrome. Therefore, this study was aimed at examining its possible role in predicting severity and intrahospital mortality of COVID-19, alongside with other laboratory and biochemical procedures, clinical signs, symptoms, and comorbidity. This study, approved by the Ethical Committee of Clinical Center Kragujevac, was designed as an observational prospective cross-sectional clinical study which was conducted on 127 patients with diagnosed respiratory COVID-19 viral infection from April to August 2020. The primary goals were to determine the predictors of COVID-19 severity and to determine the predictors of the negative outcome of COVID-19 infection. All patients were divided into three categories: patients with a mild form, moderate form, and severe form of COVID-19 infection. All biochemical and laboratory procedures were done on the first day of the hospital admission. Respiratory (p < 0:001) and heart (p = 0:002) rates at admission were significantly higher in patients with a severe form of COVID-19. From all observed hematological and inflammatory markers, only white blood cell count (9:43 ± 4:62, p = 0:001) and LDH (643:13 ± 313:3, p = 0:002) were significantly higher in the severe COVID-19 group. We have observed that in the severe form of SARS-CoV-2, the levels of superoxide anion radicals were substantially higher than those in two other groups (11:3 ± 5:66, p < 0:001) and the nitric oxide level was significantly lower in patients with the severe disease (2:66 ± 0:45, p < 0:001). Using a linear regression model, TA, anosmia, ageusia, O , and the duration at the ICU are estimated as predictors of severity of SARS-CoV-2 disease. The presence of dyspnea and a higher heart rate were confirmed as predictors of a negative, fatal outcome. Results from our study show that presence of hypertension, anosmia, and ageusia, as well as the duration of ICU stay, and serum levels of O are predictors of COVID-19 severity, while the presence of dyspnea and an increased heart rate on admission were predictors of COVID-19 mortality. 2 2 -

Pneumothorax in a patient with pneumonia caused by SARS-CoV-2: A case report

Introduction. The coronavirus disease 2019 (COVID-19) is an acute infectious multisystem disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), man-ifested by acute respiratory symptoms. The novel coronavirus pneumonia (NCP) is the most common serious clinical mani-festation of SARS-CoV-2 infection. In the severe NCP, the sys-temic manifestations of the disease were also demonstrated, and one of the rare complications, first described in Wuhan (China), is pneumothorax. Case report. A 65-year-old female was admitted to the Clinic for Pulmonology with a high fever, shortness of breath, sore throat, and general weakness that started five days before. Laboratory findings revealed lympho-penia, elevated values of inflammatory markers, and liver le-sion. A chest X-ray (CXR) demonstrated diffusely accentuated interstitial pattern and reduced parenchymal transparency, left perihilar. Positive SARS-CoV-2 in a nasopharyngeal swab sam-ple was detected in the real-time reverse transcription-polymerase chain reaction (RT-PCR), confirming the diagnosis of NCP. Immediately, nasal oxygen therapy with a flow rate of 8 L/min, with chloroquine phosphate, antibiotics, and symp-tomatic treatment, was initiated. On the 8th day, her condition suddenly deteriorated, and she developed severe hypoxemia. A repeated CXR showed complete left-sided pneumotho-rax. Thoracic drainage was successfully performed with com-plete reexpansion of the lungs the very next day. The patient was released from the hospital in good general condition with normal arterial blood gases. Conclusion. Pneumothorax may develop as a complication in patients with pneumonia caused by SARS-CoV-2, without previous pulmonary comorbidities, due to alveolar damage. Acute deterioration with rapid oxygen desaturation in these patients should raise the suspicion of pneumothorax. Early diagnosis and prompt treatment are nec-essary to reduce mortality

Small airways in asthma

© 2016, Serbian Medical Society. All rights reserved. Asthma is a chronic inflammatory lung disease characterized by reversible obstruction of airways and bronchial hyperresponsiveness. In recent years there has been a growing interest in the role of the small airways in asthma and there is increasing evidence that they contribute significantly to the clinical expression of asthma. Numerous studies have shown that inflammation is present in the small airways of patients with asthma and that it may be more intense than that found in the large airways, particularly in severe asthma, nocturnal asthma, coexisting asthma and obesity and asthma in smokers. Currently there is no accepted single lung function parameter to detect small airways dysfunction. Recent data show that impulse oscillometry is a promising diagnostic tool to assess the involvement of the small airways. The use of corticosteroids in extrafine formulation, whether alone or in fixed combinations with long-acting b2 agonists, improves drug distribution throughout the bronchial tree, enhancing the therapeutic effect with lower doses of drugs

Churg-strauss vasculitis in patient who received montelukast

© 2018, Inst. Sci. inf., Univ. Defence in Belgrade. All rights reserved. Introduction. Montelukast is a selective leukotriene receptor antagonist. One of side effects of this drug class is the Churg-Strauss syndrome (CSS). There is still no reliable evidence whether the expression of this syndrome could be masked by high doses of corticosteroids and become expressed by termination of corticosteroid use, or whether it could be a consequence of leukotriene receptor antagonists use. Case report. Female patient, aged 49 years, was hospitalized with symptoms of fever, dyspnea, cough and increased sputum production with occasional hemoptysis. She was treated for asthma during the previous year. Leukocyte differential formula registered 44% of eosinophils. IgE value was extremely elevated, with value measured to 580 kU/L and eosinophile cation protein value was 15.1 μg/L. Computed tomography of the chest described changes in the form of ground glass located in all lobes of the right lung and in the upper lobe of the left lung. Computed tomography of paranasal sinuses described changes that could resemble to polyposis, chronic sinusitis, and possible granulomatosis. Mononeuritis of peroneal nerve of the right leg was proven by electromyographic examination. Bone marrow biopsy indicated hypercellularity with domination of eosinophilic granulocytes (30%). Five out of six criteria were noted in patient’s clinical presentation, after which the diagnosis of CSS was set. The patient began treatment with high doses of corticosteroids while montelukast was discontinued which resulted in disease remission. Conclusion. Although there is no evidence that leukotriene modifiers cause the CSS in all patients with asthma, in case of frequent exacerbations with the appearance of pulmonary infiltrates, eosinophilia and paranasal sinus abnormalities make one think of this form of vasculitis

Hypogonadism in chronic obstructive pulmonary disease (COPD) - risk factors

© 2019 Inst. Sci. inf., Univ. Defence in Belgrade. All rights reserved. Bacground/Aim. Chronic obstructive pulmonary disease (COPD) is the leading cause of morbidity and mortality in pulmonary pathology. However, apart from its own pulmonary manifestations, this disease is also characterized by systemic effects, including hypogonadism which is described especially in the group of men with COPD. The aim of this study was to evaluate risk factors for hypogonadism in men with COPD. Methods. The study included 96 male patients with COPD in stable phase of the disease. All patients were checked for concentration of free testosterone in serum, markers of systemic inflammation, tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β) and C reactive protein (CRP), pulmonary function test, gas exchange parameters, a 6-minute walk test (6MWT), nutritional status and condition of skeletal muscle (midthigh muscle cross-sectional area - MTCSA using computed tomography). Results. Decreased value of free testosterone was found in 37.5% of the patients. In the group with hypogonadism (free testosterone < 4.5 pg/mL), we found significantly increased serum concentration of TNF-α (5.88 ± 3.21 vs. 3.16 ± 2.53 pg/mL; p < 0.05), significantly lower MTSCA (68.2 ± 18.72 vs. 91.1 ± 21.4 cm2; p < 0.05) and the 6MWT (268.33 ± 32.35 vs. 334.25 ± 43.25 m; p < 0.05). Lung function, gas exchange markers and body mass index (BMI) were similar in both groups. The multivariate regression analysis singled out serum value of TNF-α as an independent predictor of serum concentrations of free testosterone (B = -0.157; 95% confidence interval: -0.262-0.053). Conclusion. In our analysis we found that TNF-α as a marker of systemic inflammation is an independent predictor of the presence of hypogonadism in the patients with COPD. Our results indicate that hypogonadism predisposes to skeletal muscle wasting and exercise intolerance in male COPD patients

Unusual Respiratory Manifestations of Ankylosing Spondylitis – A Case Report

A male patient, 54 years old, was initially admitted to the hospital because of fatigue he felt during the last month and swelling of the lower legs. Upon hospital admittance, gas exchange analysis showed global respiratory failure: pO2=6.1 kPa, pCO2=10.9 kPa, pH=7.35, A-a gradient = 1.0. Due to the existence of hypercapnia and decompensated respiratory acidosis, the patient was connected to a device for non-invasive mechanical ventilation. Reduced chest mobility was noticed, and the respiratory index value was decreased. Radiographs of the chest and thoracic and lumbo-sacral spine showed marked changes on the spine attributable to ankylosing spondylitis (AS). Radiographs of the sacroiliac joints showed reduced sacroiliac joint intraarticular space with signs of subchondral sclerosis. The diagnosis of AS was set on the basis of New York Criteria (bilateral sacroiliitis, grade 3) and clinical criteria (back pain, lumbar spine limitation and chest expansion limitation). HLA typing (HLA B27 +) confirmed the diagnosis of AS. Pulmonary function test proved severe restrictive syndrome. Polysomnography verified the existence of severe obstructive sleep apnoea (AHI =73). This was a patient with newly diagnosed AS, with consequent severe restrictive syndrome and global respiratory failure with severe obstructive sleep apnoea. Thee patient was discharged from the hospital with a NIV (global respiratory failure) device for home use during the night

Unusual respiratory manifestations of ankylosing spondylitis a case report

© 2016, University of Kragujevac, Faculty of Science. All rights reserved. A male patient, 54 years old, was initially admitted to the hospital because of fatigue he felt during the last month and swelling of the lower legs. Upon hospital admittance, gas exchange analysis showed global respiratory failure: pO2=6.1 kPa, pCO2=10.9 kPa, pH=7.35, A-a gradient = 1.0. Due to the existence of hypercapnia and decompensated respiratory acidosis, the patient was connected to a device for non-invasive mechanical ventilation. Reduced chest mobility was noticed, and the respiratory index value was decreased. Radiographs of the chest and thoracic and lumbo-sacral spine showed marked changes on the spine attributable to ankylosing spondylitis (AS). Radiographs of the sacroiliac joints showed reduced sacroiliac joint intraarticular space with signs of subchondral sclerosis. e diagnosis of AS was set on the basis of New York Criteria (bilateral sacroiliitis, grade 3) and clinical criteria (back pain, lumbar spine limitation and chest expansion limitation). HLA typing (HLA B27 +) confirmed the diagnosis of AS. Pulmonary function test proved severe restrictive syndrome. Polysomnography verifi ed the existence of severe obstructive sleep apnoea (AHI =73). is was a patient with newly diagnosed AS, with consequent severe restrictive syndrome and global respiratory failure with severe obstructive sleep apnoea. e patient was discharged from the hospital with a NIV (global respiratory failure) device for home use during the night