Assessments of the associations of thrombus localization with accompanying disorders, risk factors, D-dimer levels, and the red cell distribution width in pulmonary embolism

OBJECTIVE: Pulmonary embolisms occur as a wide spectrum ranging from clinically asymptomatic thrombi to massive thrombi that lead to cardiogenic shock. The purpose of this study was to determine the associations of thrombus localization with risk factors, accompanying disorders, D-dimer levels and the red blood cell distribution width in patients with pulmonary embolism. MATERIAL AND METHODS: In 148 patients diagnosed with pulmonary embolism, the presence and anatomical localization of the thrombus were assessed via computed tomographic pulmonary angiography. The accompanying disorders, risk factors, serum D-dimer levels, and red blood cell distribution width of the patients were retrospectively evaluated. ClinicalTrials.gov: NCT02388841. RESULTS: The mean age of the patients was 54±16.0 years, and 48 patients were ≥65 years of age. The most frequent accompanying disorders were chronic obstructive pulmonary disease (22%) and malignancy (10.1%), and the most frequent risk factors were recent operation (14.1%) and immobilization (18.2%). Thrombi were most frequently observed in the right pulmonary artery (37.8%). In 31% of the patients, the thrombus was localized to the main pulmonary arteries. Immobile patients exhibited a higher proportion of thrombi in the main pulmonary arteries than mobile patients. The mean D-dimer level and the mean red blood cell distribution width in the patients with thrombi in the main pulmonary arteries were higher than those in the patients with thrombi in more distal pulmonary arterial branches. CONCLUSION: Significant associations of proximally localized thrombi with immobilization, the D-dimer levels, and the red blood cell distribution width were observed

A Case of Viral Myocarditis Presenting With Acute Asthma Attack

Acute viral myocarditis is one of the causes of heart failure. Cardiac asthma is commonly observed in elderly patients with left heart failure. If the pulmonary manifestations are prominent it can mask the involvement of heart. We report a young case of viral myocarditis mimicking acute asthma attack. Case Presentation: A 27-year-old young man with a history of asthma presented to the pulmonary department of our hospital with dyspnea, left sided chest pain, cough, wheezing. Asthma was diagnosed and treated, however his respiratory complaints have persisted. Laboratory evaluations revealed that elevated cardiac enzymes, Echocardiogram showed global hypokinesia in the left ventricle and a decrease of ejection fraction. We concluded that viral myocarditis can present itself like an acute asthma attack

Impact of neuraminidase inhibitors on influenza A(H1N1)pdm09‐related pneumonia: an individual participant data meta‐analysis

BACKGROUND: The impact of neuraminidase inhibitors (NAIs) on influenza‐related pneumonia (IRP) is not established. Our objective was to investigate the association between NAI treatment and IRP incidence and outcomes in patients hospitalised with A(H1N1)pdm09 virus infection. METHODS: A worldwide meta‐analysis of individual participant data from 20 634 hospitalised patients with laboratory‐confirmed A(H1N1)pdm09 (n = 20 021) or clinically diagnosed (n = 613) ‘pandemic influenza’. The primary outcome was radiologically confirmed IRP. Odds ratios (OR) were estimated using generalised linear mixed modelling, adjusting for NAI treatment propensity, antibiotics and corticosteroids. RESULTS: Of 20 634 included participants, 5978 (29·0%) had IRP; conversely, 3349 (16·2%) had confirmed the absence of radiographic pneumonia (the comparator). Early NAI treatment (within 2 days of symptom onset) versus no NAI was not significantly associated with IRP [adj. OR 0·83 (95% CI 0·64–1·06; P = 0·136)]. Among the 5978 patients with IRP, early NAI treatment versus none did not impact on mortality [adj. OR = 0·72 (0·44–1·17; P = 0·180)] or likelihood of requiring ventilatory support [adj. OR = 1·17 (0·71–1·92; P = 0·537)], but early treatment versus later significantly reduced mortality [adj. OR = 0·70 (0·55–0·88; P = 0·003)] and likelihood of requiring ventilatory support [adj. OR = 0·68 (0·54–0·85; P = 0·001)]. CONCLUSIONS: Early NAI treatment of patients hospitalised with A(H1N1)pdm09 virus infection versus no treatment did not reduce the likelihood of IRP. However, in patients who developed IRP, early NAI treatment versus later reduced the likelihood of mortality and needing ventilatory support

Assessments of the associations of thrombus localization with accompanying disorders, risk factors, D-dimer levels, and the red cell distribution width in pulmonary embolism

OBJECTIVE: Pulmonary embolisms occur as a wide spectrum ranging from clinically asymptomatic thrombi to massive thrombi that lead to cardiogenic shock. The purpose of this study was to determine the associations of thrombus localization with risk factors, accompanying disorders, D-dimer levels and the red blood cell distribution width in patients with pulmonary embolism. MATERIAL AND METHODS: In 148 patients diagnosed with pulmonary embolism, the presence and anatomical localization of the thrombus were assessed via computed tomographic pulmonary angiography. The accompanying disorders, risk factors, serum D-dimer levels, and red blood cell distribution width of the patients were retrospectively evaluated. ClinicalTrials.gov: NCT02388841. RESULTS: The mean age of the patients was 54±16.0 years, and 48 patients were ≥65 years of age. The most frequent accompanying disorders were chronic obstructive pulmonary disease (22%) and malignancy (10.1%), and the most frequent risk factors were recent operation (14.1%) and immobilization (18.2%). Thrombi were most frequently observed in the right pulmonary artery (37.8%). In 31% of the patients, the thrombus was localized to the main pulmonary arteries. Immobile patients exhibited a higher proportion of thrombi in the main pulmonary arteries than mobile patients. The mean D-dimer level and the mean red blood cell distribution width in the patients with thrombi in the main pulmonary arteries were higher than those in the patients with thrombi in more distal pulmonary arterial branches. CONCLUSION: Significant associations of proximally localized thrombi with immobilization, the D-dimer levels, and the red blood cell distribution width were observed

Obstructive sleep apnea related to rapid-eye-movement or non-rapid-eye-movement sleep: comparison of demographic, anthropometric, and polysomnographic features

Objective : To determine whether there are significant differences between rapid-eye-movement (REM)-related obstructive sleep apnea (OSA) and non-REM (NREM)-related OSA, in terms of the demographic, anthropometric, and polysomnographic characteristics of the subjects. Methods : This was a retrospective study of 110 patients (75 males) with either REM-related OSA (n = 58) or NREM-related OSA (n = 52). To define REM-related and NREM-related OSA, we used a previously established criterion, based on the apnea-hypopnea index (AHI): AHI-REM/AHI-NREM ratio > 2 and ≤ 2, respectively. Results : The mean age of the patients with REM-related OSA was 49.5 ± 11.9 years, whereas that of the patients with NREM-related OSA was 49.2 ± 12.6 years. The overall mean AHI (all sleep stages combined) was significantly higher in the NREM-related OSA group than in the REM-related OSA group (38.6 ± 28.2 vs. 14.8 ± 9.2; p < 0.05). The mean AHI in the supine position (s-AHI) was also significantly higher in the NREM-related OSA group than in the REM-related OSA group (49.0 ± 34.3 vs. 18.8 ± 14.9; p < 0.0001). In the NREM-related OSA group, the s-AHI was higher among the men. In both groups, oxygen desaturation was more severe among the women. We found that REM-related OSA was more common among the patients with mild-to-moderate OSA, whereas NREM-related OSA was more common among those with severe OSA. Conclusions : We found that the severity of NREM-related OSA was associated mainly with s-AHI. Our findings suggest that the s-AHI has a more significant effect on the severity of OSA than does the AHI-REM. When interpreting OSA severity and choosing among treatment modalities, physicians should take into consideration the sleep stage and the sleep posture

Kronični učinci ambijentalnoga dima iz biomase na histopatologiju pluća u ljudi: opis niza slučajeva

Biomass is widely used for fuel in developing countries. Particles and gases of biomass burning may cause changes in the lung. In this prospective study we investigated histopathological changes in the lungs of 42 non-smoking women [mean age (59±10) years] caused by biomass smoke. We valuated exposure to biomass smoke, case histories, and the findings of physical examination, radiology, bronchoscopy, and lung histopathology. Mean exposure to biomass smoke was (28±9) hour-year (1 hour-year equals 365 hours of exposure per year with average exposure of 1 hour a day). The radiological fi ndings were mass (42 %), reticulonodular opacities (31 %), mediastinal lymphadenopathy (26 %), pleuro-parenchymal fibrotic banding (19 %), widening of the pulmonary artery (14 %), ground glass (11 %), mosaic perfusion (9 %), consolidation (9 %), segmental or subsegmental atelectasis (7 %), and bronchiectasis (7 %). The patients were diagnosed with lung cancer (35 %), interstitial lung disease (31 %), sarcoidosis (9 %), tuberculosis (9 %), chronic obstructive pulmonary disease (4 %), chronic bronchitis (9 %), and metastasis (4 %). Bronchoscopy showed pilies, oedema, erythema, bronchus narrowing, endobronchial tumour, mucosal irregularity, increased vascularisation, blue-black anthracotic plaques, mucosal oedema, and purulent secretion. Transbronchial biopsies revealed neutrophil and lymphocyte leucocytes in the perivascular, peribronchiolar, and interalveolar septa, slightly enlarged connective tissue, thickening of the basal membrane, thickening of interalveolar septa, intimal and medial thickening of the vascular wall and vascular lumen narrowing, anthracosis between the cells and in the bronchiole epithelium. These findings confirm that biomass smoke has important toxic effects on the lung parenchyma, interstitium, and pulmonary vessels that may result in malignancies.Biomasa se u mnogim zemljama u razvoju rabi za gorivo. Čestice i plinovi izgorene biomase mogu dovesti do plućnih promjena. Ovdje smo istražili histološke promjene u plućima ljudi uzrokovane biomasom. Ovo je prospektivno ispitivanje obuhvatilo 42 nepušačice izložene dimu iz biomase u kojih je ocijenjena izloženost dimu, uzeta povijest bolesti, napravljen fi zikalni pregled te analizirani radiološki, bronhoskopski i histopatološki nalazi. Srednja dob ispitanica bila je (59±10) godina. Srednja izloženost dimu iz biomase iznosila je (28±9) sati na godinu. Radiološki nalazi upozorili su na tumorsku tvorbu (u njih 42 %), retikulonodularna zasjenjenja (31 %), limfadenopatiju medijastinuma (26 %), fibrozne promjene pleure i plućnog parenhima (19 %), proširenje plućne arterije (14 %), sliku smrvljenog stakla (11 %), sliku mozaične perfuzije (9 %), konsolidacije (9 %), segmentnu i subsegmentnu atelektazu (7 %) te bronhijektazije (7 %). U njih 35 % dijagnosticiran je rak pluća, u 31 % bolesti plućnog intersticija, u 9 % sarkoidoza, u 9 % tuberkuloza, u 4 % KOPB, u 9 % kronični bronhitis te u 4 % metastaze. Bronhoskopija je pokazala pilije, edem, eritem, sužavanje bronhija, endobronhijalni tumor, neurednu sluznicu, izrazitiju vaskularizaciju, plavo-crne antrakotične plakove, otjecanje sluznice te purulentnu sekreciju. Transbronhijalnom biopsijom pronađeni su neutrofili i limfociti u perivaskularnom, peribronhiolarnom tkivu i interalveolarnim septumima, zadebljanje vezivnoga tkiva, zadebljanje bazalne membrane, zadebljanje interalveolarnih septuma, zadebljanja stijenke žila intimalno i medijalno te suženje njihova lumena, crna antrakoza između stanica te u epitelu bronhiola. Sve to upozorava na značajne promjene uzrokovane biomasom, koje obuhvaćaju zloćudne formacije uslijed toksičnoga djelovanja na plućni parenhim, intersticij i žile