The proper care of cystic fibrosis patients extends over their lifetime. More than half of the children with the disease die before adulthood. An important element in the patient's care is a time of transition from a pae...The proper care of cystic fibrosis patients extends over their lifetime. More than half of the children with the disease die before adulthood. An important element in the patient's care is a time of transition from a paediatric to the care of an internist and the patient's acceptance of this necessity. Transition from paediatric care to an internist should be adequately prepared. It is not only a question of transfer of medical records, but also careful preparation of patients for such transition. The patients expect not only continuity of care but also the introduction to the management with the disease. The creation of a base for specialist hospital treatment for exacerbation of the disease at the adulthood is an important element in the care of these patients. The problem has been solved in the children group, but is still waiting for solution in adults with cystic fibrosis. It has been proven that care in the centres carried out by a specialized team ensures longer life and better quality of life of these patients. The paper is an overview of these two important elements of care of adults with cystic fibrosis.
Gunshot tracheal injuries represent life-threatening events and usually necessitate emergent surgical intervention. We report a case of an exceptional finding of a patient with retained ballistic fragments in the soft ti...Gunshot tracheal injuries represent life-threatening events and usually necessitate emergent surgical intervention. We report a case of an exceptional finding of a patient with retained ballistic fragments in the soft tissues of the thorax, proximal to the right subclavian artery and the trachea, carrying silently his wounds for two decades without any medical or surgical intervention. The bullet pellet on the upper part of the trachea seen accidentally in the chest computed tomography, was also found during bronchoscopy. In short "luck's always to blame".
Tuberculous infection of the tracheobronchial tree, termed as endobronchial tuberculosis (EBTB), is more common in young adults and females. This clinical entity is poorly understood and the diagnosis is frequently delay...Tuberculous infection of the tracheobronchial tree, termed as endobronchial tuberculosis (EBTB), is more common in young adults and females. This clinical entity is poorly understood and the diagnosis is frequently delayed as sputum smears are often negative for acid fast bacilli and the chest radiograph can be normal, resulting in diagnostic confusion. Bronchoscopy continues to play a key role in its diagnosis. Though atelectasis is not uncommon in these patients, EBTB presenting as a middle lobe syndrome (MLS) has rarely been documented. MLS refers to chronic or recurrent collapse of the right middle lobe and has a myriad of causes. The pathogenesis of this entity too is not fully established. We report this exceptional clinical manifestation in a 19-year-old male, who presented for evaluation of respiratory symptoms for 6 months along with constitutional complaints. Imaging suggested the presence of MLS and bronchoscopy established the diagnosis of endobronchial tuberculosis. GeneXpert evaluation of bronchial aspirate detected Mycobacterium tuberculosis. Histopathology confirmed the presence of granulomatous lesions. Subsequently, the cultures of bronchial aspirate and post-bronchoscopy sputum grew M. tuberculosis. Appropriate therapy with anti-tuberculosis drugs resulted in a remarkable symptomatic and radiological improvement. EBTB presenting as a MLS is a distinct rarity.
Klebsiella species infrequently cause acute community acquired pneumonia (CAP). The chronic form of the disease caused by K. pneumoniae (Friedlander's bacillus) was occasionally seen in the pre-antibiotic era. K. oxytoca...Klebsiella species infrequently cause acute community acquired pneumonia (CAP). The chronic form of the disease caused by K. pneumoniae (Friedlander's bacillus) was occasionally seen in the pre-antibiotic era. K. oxytoca is a singularly uncommon cause of CAP. The chronic form of the disease caused by K. oxytoca has been documented only once before. A 50-year-old immunocompetent male smoker presented with haemoptysis for 12 months. Imaging demonstrated a cavitary lesion in the right upper lobe with emphysematous changes. Sputum stains and cultures for Mycobacterium tuberculosis were negative. However, three sputum samples for aerobic culture as well as bronchial aspirate cultured pure growth of K. oxytoca. A diagnosis of chronic pneumonia due to K. oxytoca was established and with appropriate therapy, the patient was largely asymptomatic. The remarkable clinical and radiological similarity to pulmonary tuberculosis can result in patients with chronic Klebsiella pneumonia erroneously receiving anti-tuberculous therapy.
Docetaxel is a semisynthetic cytostatic drug that belongs to the family of taxoids. Docetaxel inhibits normal interphase and mitotic cellular function, causing cell death. Docetaxel is indicated for the treatment of brea...Docetaxel is a semisynthetic cytostatic drug that belongs to the family of taxoids. Docetaxel inhibits normal interphase and mitotic cellular function, causing cell death. Docetaxel is indicated for the treatment of breast, lung and prostate cancers, head and neck cancer and gastric adenocarcinoma. Interstitial pneumonitis is an uncommon side effect of docetaxel. We report a case of docetaxel induced interstitial lung disease (ILD) in a patient with breast cancer.
INTRODUCTION: Inhalation is the preferred route of drug administration for patients with asthma or COPD. It is generally predicted that there is a high error rate in inhaler usage, especially at the therapy start. The pr...INTRODUCTION: Inhalation is the preferred route of drug administration for patients with asthma or COPD. It is generally predicted that there is a high error rate in inhaler usage, especially at the therapy start. The primary objective of this study was the validation of a questionnaire that can be used for assessing a successful inhalation technique, patient satisfaction as well as the compliance in daily practice.The secondary objective was to examine the "real-life" usage of one inhalation device in comparison with other devices at the start of the therapy. MATERIAL AND METHODS: This open, multi centre and non-interventional study was designed to examine usage and usability of dry powder inhaler Easyhaler® (EH) (Orion Pharma, Finland) and other inhalers assessed by the physicians as well as by the patients. Inclusion criteria for patients were a physician-diagnosis of COPD or asthma or children with asthmatic disease, therapy start with an inhalation device and no or only few experiences with inhaler usage (inhaler usage for not more than 3 months). Each physician enrolled an equal number of patients in each group. RESULTS: 263 adult/adolescent patients with asthma and 115 with COPD as well as 164 children with asthmatic disease were enrolled. 49.4% of the adult/adolescent patients with asthma used an EH and 50.6% other inhalers. In the case of COPD, 47.8% were treated with an EH and 52.2% used other inhalation devices. Finally, 50.6% of the children with asthmatic disease used an EH and 49.4% were treated with other inhalers. Inhaler usage, patient satisfaction, compliance and patients assessments of usability were better when the patients used an EH. Inconvenient features were mainly documented for other inhalers. The analysis of Cronbachs alpha clearly showed the consistency of the received data from all patients. In addition, there was a large association between the assessment of the inhaler usage and the general assessment of the used inhaler in all patient groups. CONCLUSION: The results of this study show that investigators found EH easy to teach, the patients found it easy to use and their satisfaction with the device was high in comparison to other inhalation devices. Thus EH can be matched to many patients already at the therapy start. In addition, the high consistency of the received data and large association of the assessment of the inhaler usage and the general assessment of the inhaler indicate that the used questionnaires were appropriate tools to examine usage and usability of inhaler devices in adult patients and children.
INTRODUCTION: Asthma is the most prevalent chronic disease in a young and middle age population worldwide. It is also one of the main reasons for the lost working days and lost days at school. Several epidemiological sur...INTRODUCTION: Asthma is the most prevalent chronic disease in a young and middle age population worldwide. It is also one of the main reasons for the lost working days and lost days at school. Several epidemiological surveys have evidenced an increase in the prevalence of asthma in Poland. This trend is further evident in urban areas such as Tricity (Gdańsk, Sopot, Gdynia). The aim of the study was to assess the prevalence of the disease as well as the risk factors affecting the university student population. MATERIAL AND METHODS: Two surveys were distributed electronically to students of the four major universities in Tricity. The first survey contained nine questions concerning asthma diagnoses and symptoms. The second survey, which evaluated the occurrence of identified risk factors, was sent to students who answered the first survey. Asthmatics also received an Asthma Control Test (ACT). The results were analyzed using the Statistica 10 software. Study group consisted of 1380 students: 1031 (75%) women and 349 (25%) men; the average age was 22.2. RESULTS: Asthma was diagnosed in 138 students (9.6%), additionally 76 students (5.5%) reported asthmatic symptoms; however, these students had no previous diagnoses. Asthma tended to occur more frequently in students living in poorly maintained houses (19%) (p = 0.06), in contrast to those living in a normal environment (10%). According to their ACTs, 81% of diagnosed patients reported that their asthma was well-controlled. CONCLUSIONS: Asthma is becoming an important issue for Tricity students. Educational activities aimed at raising university students' awareness regarding asthma treatment and control should be implemented.
INTRODUCTION: Sensitization to the Hymenoptera venom is one of the main causes of anaphylaxis in Poland. Venom immunotherapy is the only effective treatment in such cases. Comprehensive patient care includes also educati...INTRODUCTION: Sensitization to the Hymenoptera venom is one of the main causes of anaphylaxis in Poland. Venom immunotherapy is the only effective treatment in such cases. Comprehensive patient care includes also education. The aim of our study was to assess the state of knowledge and to evaluate the quality of life and the anxiety level in patients allergic to the Hymenoptera venom after anaphylactic reaction. MATERIAL AND METHODS: The survey was carried out in the period of the insects flight in 61 adult subjects (35 wasp and 26 bee allergic), using a validated Vespid Allergy Quality of Life Questionnaire (VQLQ), Hospital Anxiety and Depression Scale, and subjective assessment of anxiety level. The majority of respondents received venom immunotherapy. RESULTS: Sensitized to the wasp venom had significantly impaired quality of life (VQLQ score) as compared to the bee venom allergic (p = 0.014). The intensity of anxiety decreased with the duration of immunotherapy (p = 0.01). The majority of subjects knew how to recognize and treat anaphylaxis, but only 8% employed an identification card and about 50% implemented rules of the pre-exposition prophylaxis. CONCLUSIONS: History of a severe anaphylaxis to the Hymenoptera venom affected the quality of life. Venom immunotherapy reduced anxiety. We hope that presented surveys and their results might be useful in qualifying for immunotherapy in clinically uncertain cases.
INTRODUCTION: Thrombocytopenia (TP) is associated with poor outcome in patients who are critically ill with pneumonia, burns, and H1N1 influenza. To our knowledge, no similar study in patients with acute exacerbation of...INTRODUCTION: Thrombocytopenia (TP) is associated with poor outcome in patients who are critically ill with pneumonia, burns, and H1N1 influenza. To our knowledge, no similar study in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) has been conducted to date. The aim of this study was to determine the impact of platelet count on the outcome of patients with AECOPD. MATERIAL AND METHODS: Patients admitted to our teaching hospital for AECOPD were divided into two cohorts, those with and without TP. The outcome of all patients was followed. RESULTS: Of the 200 patients with AECOPD, 55 (27.5%) had TP. Of these, 14 (25.5%) died in the hospital, whereas of the 145 non-TP patents, 11 (7.5%) died (p-value = 0.001). There was a significantly higher transfer rate to the ICU and mechanical ventilation in TP patients. The mean platelet count was significantly lower in patients who died than those who were discharged (161,672 vs. 203,005 cell/μL; p-value = 0.017). There was negative correlation between duration of hospitalization and platelet count. CONCLUSION: TP was associated with poor outcome in AECOPD. TP could be considered as a marker for the assessment of inflammation and prognosis in AECOPD patients based on its cost-effective features.
INTRODUCTION: Despite significant progress in understanding mechanisms and effective treatment there are still therapeutic failures in patients treated for bronchial asthma. Education is vital in the therapeutic process....INTRODUCTION: Despite significant progress in understanding mechanisms and effective treatment there are still therapeutic failures in patients treated for bronchial asthma. Education is vital in the therapeutic process. It improves the control of the disease at the individual level by influencing the adherence and compliance. MATERIAL AND METHODS: The study included 100 patients suffering from bronchial asthma and treated according to GINA 2002 guidelines in Allergy Clinic. Asthma control test (ACT), analysis of patients' medical documentation and a self-constructed questionnaire concerning health promotion and education were used in the study. Aim of this work was to assess differences in the influence of education on results of bronchial asthma control between sexes. RESULTS: Average duration of asthma was similar in women and men (13.0 ± 11.16 vs.12.7 ± 9.74 years). Weaker asthma control was found in women (ACT 17.7 vs. 20.4), as well as lower FEV1 values (80-50% of predicted value in 60.3% of women vs. 43.25 of men). In women an analysis of correlation concerning patients' knowledge and conducted health education with asthma control revealed a statistically significant positive correlation of knowledge acquired from the allergologist with asthma control, information about proceeding in acute attack, whereas negative correlation with asthma control with knowledge passed on by family doctor was found. Among the male respondents positive correlations of knowledge with asthma control within the scope of knowledge from allergologist and information concerning proceeding in asthmatic attack were found, while negative correlation with information coming from family doctor was revealed. CONCLUSIONS: Health education in patients with asthma should be conducted by a specialist in allergic diseases and well-prepared healthcare professionals.
The main objective of asthma treatment is to control symptoms of the disease; however, despite the availability of guidelines and many groups of medications, the degree of control of this condition is insufficient. In di...The main objective of asthma treatment is to control symptoms of the disease; however, despite the availability of guidelines and many groups of medications, the degree of control of this condition is insufficient. In difficult-to-treat asthma, the optimal control cannot be achieved due to reasons independent of the disease. Factors worsening asthma control include: inadequate treatment plan (low therapy adherence and compliance), inappropriate inhalation technique, insufficient symptom control using the available classes of medications, incomplete response to treatment (non-responders, steroid-resistance), incorrect diagnosis of asthma or comorbidities, and environmental factors. In order to achieve the optimal asthma control, it is recommended to: take therapeutic decisions with the patient, assess the probability of non-compliance, perform detailed diagnostics and initiate treatment of concomitant diseases, carry out differential diagnosis of conditions mimicking asthma, educate the patient as to the inhalation technique and check it, eliminate unfavourable environmental factors, and modify current treatment. New treatment options for patients with asthma include: ultra-long-acting beta2-agonists, long-acting muscarine receptor antagonists (LAMA), monoclonal antibodies, and non-pharmacological interventions. The only LAMA approved for treatment of asthma is tiotropium bromide. The analyses performed demonstrated a high efficacy of tiotropium in terms of improved lung function parameters and prolonged time to the first asthma exacerbation. It is recommended as an add-on therapy at asthma treatment steps 4 and 5 according to GINA (Global Initiative for Asthma) 2014. The optimal asthma control is important from the medical as well as the economical point of view.
Lung diseases are one of the most frequent causes of pulmonary hypertension (PH). The development of PH influences the course of lung disease, worsening the clinical symptoms and prognosis. According to the most recent p...Lung diseases are one of the most frequent causes of pulmonary hypertension (PH). The development of PH influences the course of lung disease, worsening the clinical symptoms and prognosis. According to the most recent publications, PH in the course of lung diseases develops as a result of both "parenchymal" and vascular pathology, in the patients with genetic predisposition. Prolonged infection (especially viral one) may be an additional promoting factor. Right heart catheterization (RHC), which is an invasive procedure, is the only objective method of diagnosing PH. According to the latest recommendations, the management algorithm of PH and coexisting interstitial lung disease is based on RHC and the results of pulmonary function tests. Majority of the patients develop mild PH in the course of advanced lung disease. Best treatment of underlying lung pathology combined with long term oxygen treatment is recommended in this group. In case of severe PH (mean resting pulmonary artery pressure (mPAP) ≥ 35 mm Hg) the alternate cause of PH has to be sought. PAH-specific drugs use should be limited to patients with severe PH participating in clinical trials. In this review, the value of various non-invasive methods (echocardiography, radiological examination, exercise capacity and brain natriuretic peptides assessment) in the process of screening for PH is presented, and the results of recent randomized clinical trials with PAH-specific drugs in patients with diffuse parenchymal lung diseases are discussed.
Self-expandable metallic stents (SEMS) insertion to the oesophagus is the method of choice in palliative treatment of malignant oesophago-respiratory fistulas (ERF). ERF evolve as a result of 0.2-5% of advanced oesopghag...Self-expandable metallic stents (SEMS) insertion to the oesophagus is the method of choice in palliative treatment of malignant oesophago-respiratory fistulas (ERF). ERF evolve as a result of 0.2-5% of advanced oesopghageal or lung cancer. They also appear after radiotherapy. EFR are serious and lethal complications. SEMS insertion is an effective, safe, technically simple and minimally invasive solution. Potential complications of SEMS include thoracic pain, bleeding, perforation, stent migration, tumour overgrowth or ingrowth and food bolus impaction. The article presents three cases of patients with advanced lung cancer with EFR subjected to SEMS insertion procedure in our centre.
Lung cancer and pulmonary tuberculosis (TB) are highly prevalent and representing major public health issues. They share common risk factors and clinical manifestations. It is also suggested that TB predicts raised lung...Lung cancer and pulmonary tuberculosis (TB) are highly prevalent and representing major public health issues. They share common risk factors and clinical manifestations. It is also suggested that TB predicts raised lung cancer risk likely related to chronic inflammation in the lungs. However, it does not seem to influence the clinical course of lung cancer provided that it is properly treated. We present a case report of a 57-year old male with concurrent TB and lung cancer. He was diagnosed with positive sputum smear for acid fast bacilli (AFB) and subsequent culture of Mycobacterium tuberculosis. Besides, his comorbid conditions were chronic hepatitis C virus (HCV) infection and peripheral artery disease (PAD). Later while on anti-tuberculous treatment (ATT) squamous cell lung cancer (SCC) was confirmed with computed tomography (CT) guided biopsy. Due to poor general condition the patient was not fit for either surgery or radical chemo- and radiotherapy. He was transferred to hospice for palliative therapy. We want to emphasize that both TB and lung cancer should be actively sought for in patients with either disorder. In addition, there is no doubt that these patients with lung cancer and with good response to TB treatment should be promptly considered for appropriate anticancer therapy.
INTRODUCTION: Several studies in developed countries have shown association between indoor air pollution and asthma in children. The present research was undertaken to study this association at Delhi, India. MATERIAL AND...INTRODUCTION: Several studies in developed countries have shown association between indoor air pollution and asthma in children. The present research was undertaken to study this association at Delhi, India. MATERIAL AND METHODS: This study took place at Delhi, capital of India. Eight locations based on the source of pollution such as industrial, residential and villages were included. Recording of the demographic profile and clinical examination of each child was conducted at their residence. Indoor SO₂, NO₂ and SPM (suspended particulate matter) levels were measured by using Handy Air Sampler (Low Volume Sampler). RESULTS: A total of 3104 children were examined of which 60.3% were male and 39.7% were female. 32.4% children were exposed to environmental tobacco smoke. 31.5 % children's families were using biomass fuels for cooking. History of respiratory symptoms included cough (43.9%), phlegm production (21.9%), shortness of breath (19.3%) and wheezing (14.0%). 7.9% children were diagnosed as having asthma, which was highest in industrial areas (11.8%), followed by residential (7.5%) and village areas (3.9%). The mean indoor SO₂, NO₂ and SPM levels were 4.28 ± 4.61 mg/m³, 26.70 ± 17.72 mg/m³ and 722.0 ± 457.6 mg/m³ respectively. Indoor SPM was the highest in industrial area followed by residential area and urban village area. Indoor SPM level was significantly (p < 0.001) higher in the asthmatic children's houses. CONCLUSION: This study suggests that industry plays an important role in increasing the concentration of indoor suspended particulate matter and occurrence of asthma in children in developing countries like India.
INTRODUCTION: Despite the introduction of effective antituberculosis drugs, tuberculosis (TB) is still a serious health problem and one of the most significant causes of death among infectious diseases. Current publicati...INTRODUCTION: Despite the introduction of effective antituberculosis drugs, tuberculosis (TB) is still a serious health problem and one of the most significant causes of death among infectious diseases. Current publications indicate an increase of tuberculosis cases among smokers, diabetics, malnurished subjects and those abusing alcohol and drugs. In the literature, there are only few studies raising the topic of the quality of life (QoL), stress management and health behaviour among patients with tuberculosis. The aim of this study was to evaluate QoL of patients with tuberculosis taking into account gender differences. In the study, the analysis of knowledge, health behaviour and stress management among TB patients depending on sex was carried out. MATERIAL AND METHODS: The study included 80 subjects diagnosed with TB (including 38 females) who were hospitalised at the Regional Hospital Centre of Kotlina Jeleniogórska, Medical Unit Wysoka Łąka, Pulmonology and Phthisiology Department in Kowary between August 2012 and January 2013. The following questionnaires were used in the study: Mini-COPE - evaluating stress management, WHOQoL - assessing the quality of life of patients, IZZ - assessing health behaviour. RESULTS: A difference with regards to sociodemographic profile between females and males was observed. Half of the women surveyed were working (50% vs 19% of men), whereas half of men were entitled to unemployment benefit (50% vs 18.4% of women). More than half of women lived with their family (55.3%), whereas 47.6% of men lived alone. The majority of the subjects consumed alcohol occasionally (60.2% of women vs 45.2% of men), but as many as 31% of male patients vs 7.9% of females admitted that they consumed alcohol frequently. Among the respondents, people who consumed alcohol occasionally dominated (60.2% women vs. 45.2% of men), but as many as 31% of male patients vs. 7.9% of women admitted to consume alcohol frequently. Quality of life (QoL) assessment has shown no statistically significant differences between the sexes in this field. The respondents rated lowest their QoL in the physical domain, 12.4 ± 3.1 (12.9 ± 3.0 women vs. 11.8 ± 3.1 men) and 12.6 ± 2.4 in the environmental domain (13.1 ± 2.3 women vs 12.1± 2.4 men). Women received a higher rating of health behaviour on all subscales of the IZZ questionnaire, with the highest score in the prevention behaviour subscale (3.6 ± 0.7) and the lowest in the subscale of proper eating habits (3.1 ± 0.8). In men the highest score of health behaviour was observed in the subscale of positive mental attitude (3.1 ± 1.0) and the lowest in the subscale of proper eating habits (2.5 ± 0.8). CONCLUSIONS: 1. There are differences between sociodemographic profile of TB patients: women are younger, better educated, economically active and more likely to remain in relationships; 2. There is no difference in QoL of TB patients between the sexes, whereas there are differences in the strategies of stress management and in applied health behavior; 3. Differences between genders indicate the need for matching treatment and preventive action for different patients profiles based on the cooperation of doctors, social workers, therapists, and psychologists.