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Comorbidities and medical course in a young patient diagnosed with severe obstructive sleep apnea

Abstract

We present the 6-year evolution of a young patient (32 years at diagnosis), smoker (10 pack years), diagnosed in September 2011 by cardiorespiratory polygraphy with severe obstructive sleep apnea syndrome (OSA)-apnea–hypopnea index (AHI) 82/h, mean SaO2 76%, which associate class II obesity (body mass index [BMI] 37.5 kg/m2), dyslipidemia, hypertension, mixed ventilatory dysfunction with hypoxemia and hypercapnia, pulmonary hypertension, and right bundle branch block. It was administered drug treatment, oxygen therapy, and continuous positive airway pressure (CPAP) with favorable evolution. One year later, we notice a significant improvement in the severity of OSA (AHI 13/h) and significant weight loss (about 24 kg). He was diagnosed with thyroid papillary carcinoma and left laterocervical node metastasis. Total thyroidectomy, treatment with radioactive iodine, and Euthirox replacement were done. In 2013, the patient presents moderate OSA (AHI 25/h) and class I obesity (BMI 31.8 kg/m2). Withdrawal of CPAP on its own initiative and weight gain (BMI 43 kg/m2) causes clinical deterioration in 2014, with diurnal drowsiness, dyspnea at rest, peripheral edema, hypoxemia, and hypercapnia, requiring admission. The cardiorespiratory polygraphic evaluation highlights severe OSA with AHI 84/h. Evolution was favorable with medication, oxygen therapy, and CPAP. Over the next 3 years, the patient continues CPAP treatment at home, but variations in body weight help improve or worsen OSA severity.

Open access
Genetics and inflammatory profile in tobacco dependence

Abstract

The state of health of the population is determined by a set of factors belonging to human biology, environment, behaviors, and the health system (preventive, curative, and rehabilitative). Any of these factors can alter both individual and community health.

The primary reason for tobacco dependence is nicotine addiction. Dopamine is released from the neurons located in the mesolimbic system. Nicotine stimulates the release of dopamine from these receptors. The genetic determination of nicotine dependence is determined by the subtypes of nicotine acetylcholine receptors (nAChRs) and conditioned by chromosome mutations at chromosomes 15q25.1, 8p11.21 or 20q13.12-q13.32.

Low-amplitude systemic inflammation is demonstrated in all smokers and is confirmed by elevated levels of C-reactive protein, fibrinogen, Interleukin-6, and increased leukocyte levels. Moreover, coagulation and endothelial function markers such as hematocrit, plasma or blood viscosity, D-dimers, circulating adhesion molecules, tissue plasminogen activator, have also modified values in smokers.

Open access
Hypersensitivity pneumonitis in a teenager

Abstract

Hypersensitivity pneumonitis (HP) is an interstitial lung disease (ILD), consequence of an alveolar allergic reaction against various inhaled allergens occurring in susceptible individuals, manifesting as an acute or chronic granulomatous alveolar allergic process against inflammation of the lung parenchyma. The clinical presentation can mimic acute respiratory infections (in acute form) or an idiopathic ILD (in chronic form); the diagnosis of HP is difficult if the exposure to allergen is not suspected.

We present the case of a male teenager, pigeon breeder, presenting with recurrent episodes of dyspnoea and fever, initially considered and treated as pneumonia. The diagnosis of HP was based on suggestive imaging changes, lymphocytic alveolitis at bronchoalveolar lavage with a low CD4/CD8 ratio and a thorough anamnesis for exposure and positive IgG serum precipitins against pigeon debris. The patient improved over a few months only by avoiding exposure to the incriminated allergen. ILDs in children and adolescents are considered rare diseases, with HP being one of the possible causes in older children and adolescents.

Open access
Inflammatory myofibroblastic tumours of the lung: a case series

Abstract

Inflammatory myofibroblastic tumours represent a rare group of lesions reported in various organs but with an unclear aetiology. Although so far they are considered benign, some cases of recurrence and invasive behaviour have been noted. We report three consecutive cases of tumours of the lung, with heterogeneous clinical presentation. They were all treated by means of surgery, with good long-term results. Diagnosing an inflammatory myofibroblastic tumour relies mainly on an experienced pathologist.

Open access
Prognosing a severe course of asthma in children following the study of endothelial function

Abstract

Background

Asthma is a common disease with increasing prevalence in children and adults. The WHO estimates that annually 15 million disability-adjusted life-years are lost, and 250,000 asthma deaths are reported worldwide. Approximately, 500,000 annual hospitalizations are due to asthma (1).

Aim

In our study, we aimed to evaluate the endothelial function in children with asthma in remission and the prognosis of severe asthma.

Materials and methods

The study involved examination of 91 children, aged 6–17 years, with persistent asthma in the remission period. Indices of endothelial function (soluble vascular molecule of intercellular adhesion-1 [sVCAM-1], concentration of stable metabolites of nitric oxide in blood serum [NO2 +NO3 ], thickness of the intima-media complex [IMC] of the common carotid artery (CCA), and endothelium-dependent dilatation of the brachial artery [FMD%]). Statistical analyses were performed with StatSoft STATISTICA Version 8 (Tulsa, OK). To determine the relation between qualitative characteristics, the criterion χ2 was used, and the procedure of multiple logistic regression analysis was performed.

Results

The endothelium parameter levels (FMD% [H = 46.02], IMC [H = 60.75], NO2 + NO3 [H = 40.82], and sVCAM-1 [H = 76.57, p = 0.0000]) depend on the severity of the disease. The study showed that the factors that should be taken into account in prognosis of the formation of the severe course of asthma include positive family allergic history, serum sVCAM-1 and NO2 + NO3 levels, and the thickness of IMC CCA.

Conclusions

All the children with asthma in the remission period were found to have endothelial dysfunction. The degree of disruption of the function of the endothelium depends on the severity of the course of asthma. An algorithm for predicting the severe course of asthma in children has been developed.

Open access
Sleep apnea syndrome and heart failure—mechanisms and consequences

Abstract

Heart failure (HF) remains a major public health issue despite advances in treatment, being associated with increased morbidity and mortality, multiple hospitalization and, implicitly, very high economic costs. Therefore, it becomes increasingly important to identify and treat factors or comorbidities that contribute to the progression of HF. Breathing disorders during sleep (sleep-disordered breathing), especially sleep apnea syndrome, obstructive or central form, may be one of these factors.

Open access
Open access