Pigeon fanciers lung: A study of the clinical, lung function and immunological responses among pigeon fanciers

Pigeon Fanciers Lung (PFL) is one of the commonest causes of Extrinsic Allergic Alveolitis (EAA) or Hypersensitivity Pneumonitis (HP). It is induced by repeated inhalation of antigens from pigeons in a sensitised individual. Since the majority of fanciers do not develop the disease despite being exposed to similar amount of antigen exposure, the host's susceptibility factors including constitutional and environmental factors and the combination of these factors are prerequisite to the development of disease. Among these predisposing factors, it has been proposed that certain genetic susceptibility such as alleles of the major histocompatibility complex may increase an individual's susceptibility to develop the disease. Other environmental factors such as cigarette smoking and amount of antigen exposure may also play a role. PFL is characterised by inflammation of the lung parenchyma but it also involves small and large airways. Apart from respiratory symptoms, fanciers with PFL also develop systemic symptoms such as fever and myalgia that usually occurs 4-8 hours after antigen exposure and can last until 24 hours. The sequence of immunopathological events that contribute to the development of PFL is unresolved. Evidence supports the role of immune complexes with the exuberant antibody response and the delay in the onset of symptoms. T cell mediated response also plays a vital role with the appearance of granuloma. It is likely that these 2 processes occur simultaneously and complement each other as the immune response progresses. In view of the different clinical presentations and dynamic nature of the disease, the disease can be divided into 3 groups consisting of acute progressive, acute intermittent non progressive and chronic disease. Fanciers with an antibody response but without symptoms should be regarded as having subclinical disease as there is evidence of ongoing immune and inflammatory response and they are at risk of progressing to clinical disease. This thesis examines the immunological response and its correlation with the clinical status and other factors that may influence this response amongst pigeon fanciers. This study emphasises the complexity and the dynamic nature of this disease. The variation in each individual's immune responsiveness towards avian antigen and the various different immunological mechanisms involved in the disease process is highlighted. (Abstract shortened by ProQuest.)

Oxidative stress in metabolic syndrome / Profesor Dr. Hapizah Mohd Nawawi … [et al.]

Background: Metabolic syndrome (MS) is a cluster of abdominal obesity, atherogenic dyslipidaemia, hypertension and insulin resistance with or without hyperglycaemia associated with increased risk of coronary heart diseases. There may be a possible link between MS, central obesity and increased markers of oxidative stress. The oxidative stress in central obesity and MS with different glycaemic status is still unclear. Objective: The aim of our study was to evaluate the oxidative stress in central obesity and MS subjects with different glycaemic status and subjects with central obesity without MS. Design: A total of 260 subjects (Mean±SD : 53±11, 66 Males) were randomly recruited and divided into 5 groups: central obesity without MS (OBXMS), MS with diabetes (MSDM), MS with impaired fasting glucose (MSIFG), MS with normoglycaemia (MSNG) and normal control (NC). In addition, MSDM, MSIFG and MSNG were grouped as all MS group with a total number of 156. The blood levels of oxidized low-density lipoprotein (oxLDL) and 8-Isoprostane were evaluated. Results: OBXMS group was not significantly different compared to NC group. MSDM group compared to NC group had higher 8-Isoprostane (p<0.001).MSIFG group compared to NC group had higher oxLDL (p<0.001) and 8-Isoprostane (p<0.001). MSNG group compared to NC group had higher 8-Isoprostane (p<0.001). All MS group compared to NC group had higher oxLDL (p<0.05) and 8-Isoprostane (p<0.001). All MS group compared to OBXMS group had higher 8-Isoprostane (p<0.001). Conclusions: MS irrespective of glycaemic status has enhanced oxidative stress compared to controls. There is enhanced oxidative stress in central obesity especially in the presence of MS, suggesting high coronary risk of MS subjects

Bronchoscopic Features and Morphology of Endobronchial Tuberculosis: A Malaysian Tertiary Hospital Experience

The diagnosis of endobronchial tuberculosis (EBTB) is difficult as it is not well visualized radiologically, and bronchoscopy is not routinely performed for tuberculosis (TB) patients. Bronchoscopic characterization via endoscopic macroscopic features can speed up the diagnosis of EBTB and prompt immediate treatment. In this study, we identified the clinical and bronchoscopic morphology of 17 patients who were diagnosed with EBTB from 2018 to 2020. Demographics, radiological, microbiological and histopathological data were recorded. Endobronchial lesions were classified according to Chung classification. The diagnosis was made based on a histopathological examination (HPE) of endobronchial biopsy, and/or positive &lsquo;Acid-fast bacilli&rsquo; (AFB) microscopy/Mycobacterium tuberculosis (MTB) culture on microbiological examination of bronchial alveolar lavage (BAL) and/or positive MTB culture on endobronchial biopsy specimens. Furthermore, EBTB was predominant in young women, age 20 to 49 years old, with a male to female ratio of 1 to 2. Underlying comorbidities were found in 53% of the patients. Cough, fever and weight loss were the main symptoms (23.5%). The indications for bronchoscopy are smear-negative TB and persistent consolidation on chest radiographs. Consolidation was the main radiological finding (53%). An active caseating lesion was the main EBTB endobronchial subtype (53%). The leading HPE finding was caseating granulomatous inflammation (47%). All patients showed good clinical response to TB treatment. Repeated bronchoscopy in six patients post TB treatment showed a complete resolution of the endobronchial lesion. EBTB bronchoscopic characterization is paramount to ensure correct diagnosis, immediate treatment and to prevent complication

Serious Asthma Events with Fluticasone plus Salmeterol versus Fluticasone Alone

BACKGROUND: The safe and appropriate use of long-acting beta-agonists (LABAs) for the treatment of asthma has been widely debated. In two large clinical trials, investigators found a potential risk of serious asthma-related events associated with LABAs. This study was designed to evaluate the risk of administering the LABA salmeterol in combination with an inhaled glucocorticoid, fluticasone propionate. METHODS: In this multicenter, randomized, double-blind trial, adolescent and adult patients (age, ≥12 years) with persistent asthma were assigned to receive either fluticasone with salmeterol or fluticasone alone for 26 weeks. All the patients had a history of a severe asthma exacerbation in the year before randomization but not during the previous month. Patients were excluded from the trial if they had a history of life-threatening or unstable asthma. The primary safety end point was the first serious asthma-related event (death, endotracheal intubation, or hospitalization). Noninferiority of fluticasone-salmeterol to fluticasone alone was defined as an upper boundary of the 95% confidence interval for the risk of the primary safety end point of less than 2.0. The efficacy end point was the first severe asthma exacerbation. RESULTS: Of 11,679 patients who were enrolled, 67 had 74 serious asthma-related events, with 36 events in 34 patients in the fluticasone-salmeterol group and 38 events in 33 patients in the fluticasone-only group. The hazard ratio for a serious asthma-related event in the fluticasone-salmeterol group was 1.03 (95% confidence interval [CI], 0.64 to 1.66), and noninferiority was achieved (P=0.003). There were no asthma-related deaths; 2 patients in the fluticasone-only group underwent asthma-related intubation. The risk of a severe asthma exacerbation was 21% lower in the fluticasone-salmeterol group than in the fluticasone-only group (hazard ratio, 0.79; 95% CI, 0.70 to 0.89), with at least one severe asthma exacerbation occurring in 480 of 5834 patients (8%) in the fluticasone-salmeterol group, as compared with 597 of 5845 patients (10%) in the fluticasone-only group (P<0.001). CONCLUSIONS: Patients who received salmeterol in a fixed-dose combination with fluticasone did not have a significantly higher risk of serious asthma-related events than did those who received fluticasone alone. Patients receiving fluticasone-salmeterol had fewer severe asthma exacerbations than did those in the fluticasone-only group