Pulmonary alveolar proteinosis (PAP) is a rare disease, certainly underdiagnosed, characterised by the intra-alveolar accumulation of a milky fluid rich in phospholipids and lipoproteins derived from alveolar surfactant, positive in periodic acid-Schiff staining. The alveolar macrophage plays a major role in the pathogenesis of PAP, and its role in the turn-over of alveolar surfactant is being altered by various mechanisms.
More than 90% of cases of PAP are primary autoimmune, characterised by the presence in serum of circulating autoantibodies against granulocyte-macrophages colony-stimulating factor. Other causes of PAP are genetic, secondary to other diseases or to exposure to different agents.
The evolution of the disease is unpredictable, from spontaneous remission to progression despite treatment towards pulmonary fibrosis and chronic severe respiratory failure. The gold standard of therapy is the whole lung lavage, other treatments are being still in evaluation.
The article presents a few cases that illustrate different patterns in the evolution of PAP.
Chronic obstructive pulmonary disease (COPD) continues to cause a heavy health and economic burden in the Europe and around the world. Arterial hypertension (AH) is considered as one of the principal COPD-associated comorbidi-ties. However, no data for association between gene polymorphism and AH in patients with COPD in Ukraine have ever been internationally published. We assessed the genotype and allele frequencies of angiotensinogen (AGT) M235T polymorphisms in patients with COPD and comorbid AH.
The study group consisted of 96 patients: Group 1 (25 individuals with COPD), Group 2 (23 individuals with AH) and Group 3 (28 individuals with COPD and AH). The control group consisted of 20 healthy subjects. M/T genotypes of AGT were determined by polymerase chain reaction amplification.
The results of the study have not demonstrated any significant impact of alleles of AGT genes on the occurrence of diseases such as COPD, AH and combinations thereof. However, analysis of odds ratio has demonstrated the presence of a trend towards a protective role of the M allele of the AGT gene concerning occurrence of COPD, AH and their combinations. At the same time, the presence of the T allele of the AGT gene may increase the risk for occurrence of the above-mentioned diseases.
The study that we have conducted suggests that the presence of T allele of the AGT gene at position 235 of the peptide chain both in homozygous and heterozygous states may increase the risk for AH in patients with COPD.
The prevalence of asthma is still high in many countries. However, the asthma mortality rate has been significantly decreased after the epidemic of asthma death in the 1970s. The epidemic was occurred in New Zealand and was associated with the use of high-dose inhaled fenoterol at that time. The increased use of inhaled corticosteroids (ICS) in asthma management is proposed as the key factor in the declining trend of asthma mortality rate. The risk factors of asthma-related deaths included history of near-fatal asthma requiring intubation and mechanical ventilation, hospitalisation or emergency care visit for asthma in the past year, currently using or having recently stopped using oral corticosteroids, not currently using ICS, overuse of short-acting b2-agonists, history of psychiatric disease or psychosocial problems, poor adherence with asthma medications and/or poor adherence with (or lack of) a written asthma action plan, food allergy in a patient with asthma, and air pollution.
Quit-smoking support is provided to Romanian smokers since 2007 through a network of stop-smoking centres. The study aimed to collect up-to-date information about the availability of psychological counselling and medication for smoking cessation at the existing specialised centres.
Materials and methods
All the stop-smoking centres listed on the program’s official website were contacted by phone by a trained evaluator introducing himself as a smoker in need of professional support.
Of the 41 counties listed on the website, only 70.7% provided a contact phone number for the stop-smoking centre. While 56.1% of the centres answered the first or second call, the actual availability of quit support was confirmed by only 41.5% of the centres. The time till the first appointment varied between 1 day and 1 month. Psychological support and free medication for treating nicotine addiction were available in 36.6% and 14.6% of the centres, respectively.
The availability of stop-smoking support at the time of the assessment was significantly limited.
We present the case of a male patient, 34 years old, non-smoker, presenting repeatedly in the past 2 years in emergency and cardiology departments for episodes of palpitation accompanied by faitness. One of the electrocardiograms recorded in emergency department captures bigeminated ventricular premature heartbeats. A cardiac magnetic resonance imaging (MRI) examination in May 2019 showed increased thickness of left ventricle during systole and contrast enhancement in the middle of cardiac wall at the base of the heart, considered initially as hypertrophic non-obstructive cardiomyopathy. The reinterpretation of MRI suggested that the changes were typical for cardiac sarcoidosis. Investigations performed later showed increased angiotensin-converting enzyme (ACE); thoracic computed tomography (CT) scan showed nodules and micronodules bilateral in upper lobes with moderate mediastinal lymph node enlargement and bronchoalveolar lavage (BAL) showed lymphocytic alveolitis with normal CD4/CD8 ratio, normal lung function with normal diffusing capacity. Even without biopsy, but based on CT scan, BAL and ACE, the patient was diagnosed as sarcoidosis with lung and cardiac involvement and was started on oral corticosteroids (methylprednisolone 32 mg/day). The diagnosis of cardiac involvement as initial presentation of sarcoidosis is difficult, due to limited knowledge about the disease among cardiologists and radiologists. Though, a recurrent arrhythmia, potentially severe, in a young patient in the absence of an alternative cause, should raise the suspicion for sarcoidosis with cardiac involvement, with a potential severe outcome in the absence of treatment.
E-cigarette has a long history. From 1965 until now, we accepted the promotional campaigns of the tobacco industry and now a new epidemic disease EVALI is generated with an explosion of deaths and pulmonary lesions. We need now to learn more about the algorithm of diagnosis and treatment. This article is updating for 2019 the guideline of diagnosis and treatment of this new disease.
The European Society of Cardiology and the European Atherosclerotic Society are recommending in the 2019 guideline for dyslipidemia the best management strategies for an individual patient with a given condition.
The guideline recommends the use of new tests to help identify high-risk patients. These include both coronary artery calcium imaging and biomarker tests.
Modifications have also been made to the risk stratification categories, so that patients with atherosclerotic artery disease, diabetes mellitus with target organ damage, familial hypercholesterolaemia and severe chronic kidney disease are all included in very-high risk patients.
The new ESC/EAS guideline for dyslipidemia management compared with the 2016 version include more intensive reduction of LDL-c across CV risk categories. If the goals are not achieved with the maximum tolerated dose of statin, combination with ezetimibe is recommended. An important message of the new guideline is that until this moment there are no known adverse effects of very low LDL-c concentrations.
Current Guidelines for the diagnosis and management of acute pulmonary embolism (PE), as well as all other Guidelines, summarize and evaluate the already available evidence and consensus “with the aim of assisting health professionals in proposing the best management strategies for an individual patient with a given condition”.
In this review we present the most important new recommendations of the latest ESC Guidelines on the diagnosis and management of acute pulmonary embolism.