<abstract>
<title style='display:none'>Abstract</title>
<sec><title style='display:none'>Background</title>
Exudative pleural effusions are often challenging, and on many occasions remain undiagnosed. Hence, a blind closed needle pleural biopsy (CNPB) is extremely relevant against this background.
</sec>
<sec><title style='display:none'>Methods</title>
We conducted a prospective study, in which a CNPB using a Cope’s needle was done in patients with exudative pleural effusion. Data were analysed using SPSS software.
</sec>
<sec><title style='display:none'>Results</title>
Our study included 250 patients, of which 140 (56%) were males and 110 (44%) female. 218 (87.2%) had tubercular effusion 22 (8.8%) had effusion secondary to malignancy, 8 (3.2%) had synpneumonic effusions, and 1 (0.4%) each had effusion secondary to pancreatitis and rheumatoid arthritis (RA). AFB culture was positive in 50 (22.4%) on pleural fluid, as compared to 209 (87%) on pleural biopsy. CBNAAT detected MTB in 34 (14%) on pleural fluid as compared to 72 (28.8%) on pleural biopsy. Caseous granuloma was found in 184 (73.6%). The sensitivity for AFB culture using CNPB tissue and pleural fluid was 95.8% and 22.5%, respectively (P &lt; 0.05). Drug susceptibility testing (DST) done on pleural tissue divided our patients as drug sensitive 182 (87%), MDR 13 (6.2%), preXDR 12 (5.7%), and XDR TB 2 (0.9%). For malignancy, sensitivity of pleural fluid and pleural biopsy was 9% and 63%, respectively (P &lt; 0.05). Major complications of the procedure were pain in 25 (10%), pneumothorax in 15 (6%), and haematoma in 8 (3%). Of the patients who developed pneumothorax, only one patient required intervention with an intercostal drain, and the rest resolved spontaneously.
</sec>
<sec><title style='display:none'>Conclusion</title>
CNPB is an easy, quick, cost-effective, and reliable method that can be used for diagnosing exudative pleural effusions of indeterminate aetiology in the out-patient setting.
</sec>
</abstract>

Diagnostic utility of closed needle pleural biopsy in exudative pleural effusions

<abstract>
<title style='display:none'>Abstract</title>
<sec>
<title style='display:none'>Objective</title>
To identify essential competencies required for equipping pulmonologists to manage respiratory diseases such as the Covid-19 pandemic.
</sec>
<sec>
<title style='display:none'>Methods</title>
A descriptive and qualitative study was conducted. Focus group, which consisted of five Syrian members who were affiliated with the Syrian Association of Thoracic Medicine and Surgery were invited to formulate a preliminary list of competencies. Delphi technique with three cycles was also employed to evaluate the resulted list. The number of pulmonologists who accepted to take part was 67 out of 110. All competencies suggested by at least 80% of experts were included in the final list. Reliability was tested using Cronbach’s alpha, Descriptive statistics including Mean and standard deviation were performed.
</sec>
<sec>
<title style='display:none'>Findings</title>
Forty-five essential competencies were identified including ten competencies in cognitive domain, 11 skills, and 24 competencies related to attitude domain.
</sec>
<sec>
<title style='display:none'>Conclusion</title>
A list of 45 competencies has been identified. It is hoped that they will guide and enable pulmonologists to provide the best health care to patients with respiratory infections, especially during the COVID-19 pandemic. It will also guide decision makers to design training programs that can address these competencies.
</sec>
</abstract>

A framework for the identification of competencies required from Syrian pulmonologists during COVID-19 pandemic

<abstract><title style='display:none'>Abstract</title>With the advent of computed tomography (CT) in respiratory medicine, a greater delineation of the respiratory structures has been possible in the two-dimensional space. The various CT techniques used by pulmonologists include the high-resolution computed tomography (HRCT) thorax with expiratory scans, contrast-enhanced CT (CECT) thorax, CT thorax, CT pulmonary angiography (CTPA) and rarely a CT aortography/angiography. Each of the imaging techniques presents stronger and weaker points. In this paper, radiological lesions are classified according to their location. Such abnormalities are observed in the airways, in the lung parenchyma, in the interstitium and last but not least in the pleura. The review mainly addresses radiological lesions with higher specificity because they are key elements in establishing a definitive diagnosis. In conclusion, performing a chest CT is vital in the diagnosis and management of respiratory conditions.</abstract>

Common pulmonary computed tomography signs and their clinical relevance: A review

<abstract>
<title style='display:none'>Abstract</title>
Cough is a natural defence mechanism of the lungs to prevent aspiration and to keep the airway clean. Cough, wheezing and shortness of breath are common symptoms of asthma. Cough-variant asthma is one of the phenotypes of asthma with the main symptom of cough without shortness of breath and wheezing. Cough-variant asthma is largely observed in patients with bronchial hyperresponsiveness who experience cough due to innocuous stimuli, and it is associated with a family history and seasonal allergy. In the present study, in patients with cough-variant asthma, no abnormalities were found during the lung function test, particularly forced expiratory flow in the first second (FEV1) or peak expiratory flow (PEF), although these values were lower than those in normal individuals. A bronchial provocation test using methacholine is needed to assess airway hyperresponsiveness, and depending on the outcome of the test, an assessment can be made as to the probability of the patient requiring a diagnosis of cough-variant asthma. Administration of inhalation therapy with bronchodilators and corticosteroids is the mainstay of management in patients with cough-variant asthma presenting with the symptom of persistent cough. Until now, there have been no specific guidelines for drug selection, dose and duration of inhaled corticosteroid use in cough-variant asthma. If symptoms do not resolve with inhaled corticosteroid monotherapy, consideration may be given to increase the inhalation dose or to add other drugs such as long-acting B2 agonists, slow-release theophylline or leukotriene receptor antagonist (LTRA).
</abstract>

Diagnosis and management of cough-variant asthma

<abstract><title style='display:none'>Abstract</title>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.</abstract>

Hypersensitivity pneumonitis in a teenager

<abstract><title style='display:none'>Abstract</title>The main objective of this study was to determine the relationship between the pro- and anti-inflammatory response based on the interleukin 1α and interleukin 10 levels in the serum of patients with acquired bronchiectasis and healthy controls. This study was conducted on 77 subjects, divided into two lots: one lot comprising 57 patients with the aforementioned bronchiectasis and the second one comprising 20 healthy control subjects. The enzyme-linked immunosorbent assay method was used to perform the spectrophotometry test for the serum to detect and measure interleukin 1α and interleukin 10 levels. The results were significant from a statistical point on view but only in terms of the mean value of interleukin 10 that was much higher in the anti-inflammatory cytokine. Therefore, we can assume that there is a systemic anti-inflammatory reaction to the inflammation caused by bronchiectasis. Interleukin 1α is unspecific, and the values were similar in both groups; therefore, this interleukin should not be researched further in this direction. Future research is open in this field for the analysis of interleukin levels in bronchoalveolar lavage compared to serum levels.</abstract>

Inflammatory reaction in patients with acquired bronchiectasis based on the interleukin 1α and interleukin 10 levels measured using the ELISA method

<abstract>
<title style='display:none'>Abstract</title>
As shown in a Spanish study, patients with rheumatoid arthritis (PAR) have a 4-fold increased risk of developing TB (tuberculosis) compared to the general population. Abruptly stopping anti-TNF (tumor necrosis factor α) agents after the development of TB could cause a paradoxical response leading to severe complications and death. We present the case of a 54 years old female patient with seropositive PAR since 2012 in treatment with biological therapy, which was diagnosed 10 years after the start of immunosuppressive treatment with miliary TB. She has had an unfavorable prognosis, dying after one month from the initiation of antituberculosis treatment due to septic shock. Therefore, it is very important to evaluate the bacillary status before initiating any immunosuppressive treatment.
</abstract>

Combination with reserved prognosis: TB- rheumatoid arthritis

<abstract>
<title style='display:none'>Abstract</title>
Respiratory syncytial virus (RSV) is responsible for lower respiratory tract infections across all age groups worldwide. Initial exposure to RSV in infants and young children can lead to severe bronchiolitis, which has the potential to be life-threatening. Among older children and healthy adults, recurrent upper respiratory tract infections caused by RSV are frequent, varying in intensity from asymptomatic infection to symptomatic upper respiratory tract disease. The presence of specific comorbidities (cardiopulmonary conditions, including COPD and CHF, and immunocompromising conditions) increases the likelihood of severe disease in adults (<xref ref-type="bibr" rid="j_pneum-2023-0046_ref_001">1</xref>).
This editorial provides a review of the burden of RSV disease among adults, population groups at increased risk of developing severe RSV disease, the current status of surveillance systems and RSV prevention strategies in adults, including the use of RSV vaccines in adults, recently licensed for use.
</abstract>

RSV Burden of Disease in Adults - a new threat

<abstract>
<title style='display:none'>Abstract</title>
Chronic Obstructive Pulmonary Disease (COPD), the third leading cause of death worldwide and the fifth-ranked cause of chronic disability is usually associated with significant concomitant chronic diseases, Gastroesophageal Reflux Disease (GERD) being the commonest. Exacerbations of COPD (AECOPD) are episodes of worsening of symptoms, the frequency of which increases with the severity of COPD. AECOPD is triggered mainly by respiratory infections, bacterial or viral or both. Human rhinoviruses (HRV) are the top viral pathogen in triggering AECOPD, and experimental infection has provided significant new evidence in establishing a causal relationship between virus infections and AECOPD.
Proton pump inhibitors (PPI), the most potent acid suppressants, are commonly prescribed for isolated GERD or GERD complicating COPD. There has been a breakthrough in Pulmonary Medicine in that PPI, in addition to their well proven role in acid suppression, has emerged as a promising interventional tool in the prophylaxis and symptom control of AECOPD. This efficacy is not limited to patients with COPD complicated by GERD, since PPI also independently and significantly reduced the risk of developing frequent AECOPD in those with COPD alone, delaying disease progression and improving clinical outcomes.
Although the studies conducted so far regarding effectiveness of PPI had promising results, current evidence is insufficient to determine to what extent their long-term use is safe. Large scale multi-center studies are warranted to assess their long-term safety profile and clinical outcomes.
The objective of this study is to identify a possible role of PPI in prophylaxis and symptom control of AECOPD.
</abstract>

Proton Pump Inhibitors: Promising Role in the Prophylaxis and Symptom Control of Acute Exacerbations of Chronic Obstructive Pulmonary Disease

<abstract>
<title style='display:none'>Abstract</title>
<sec>
<title style='display:none'>Background</title>
Dysregulation the immune system is characteristic of the severe stages of COVID-19 disease; therefore, the study aimed to highlight the defective immune regulation patients with COVID-19 pneumonia without chronic diseases.
</sec>
<sec>
<title style='display:none'>Methods</title>
The study included 180 individuals, 60 as a control group, and 120 patients with COVID-19, including 67 males and 53 females, whose ages ranged from 27 to 70 years, at Imam Al-Hussein Teaching Hospital in Thi-Qar Province, South of Iraq. The CXCL 10 and IL-10 were evaluated by enzyme-linked immunosorbent assay (ELISA).
</sec>
<sec>
<title style='display:none'>Results</title>
The current study recorded that CXCL 10 was significantly increased &lt; 0.001 in patients compared to controls, while the IL-10 was decreased significantly in patients, within disease severity the CXCL 10 increased with progress of disease, and IL-10 increased in sever patients, according to BMI the CXCL 10 decrease in obese patients than over and normal weight, while IL-10 increased in normal weight patients.
</sec>
<sec>
<title style='display:none'>Conclusion</title>
This study investigated the CXCL 10 was highly elevated in COVID-19 patients than control group, also noted the CXCL 10 increased with disease progress, therefor consider a good marker for poor outcome, furthermore the obese patients are more likely to have severe outcomes than others, so BMI is considered a risk factor for patients.
</sec>
</abstract>

Evaluation of CXCL 10 and IL-10 in COVID-19 pneumonia

<abstract>
<title style='display:none'>Abstract</title>
<sec>
<title style='display:none'>Background</title>
Multiple myeloma (MM) is a malignant disorder of plasma cells and includes 1% of all malignancies and 10% to 13% of hematologic cancers. Multiple myeloma, characterized by malignant proliferation of plasma cells, leads to the production of monoclonal immunoglobulins. Pleural involvement by plasma cells in multiple myeloma is rare.
</sec>
<sec>
<title style='display:none'>Case Report</title>
We report a 61-year-old woman with myelomatous pleural effusion in MM.
</sec>
<sec>
<title style='display:none'>Conclusion</title>
A few cases of pleural effusion secondary to MM, in literature, with an incidence of less than 1%, were reported.
</sec>
</abstract>

Myelomatous Malignant Pleural Effusion: A Rare Case Report

<abstract><title style='display:none'>Abstract</title>Tuberculosis (TB) is still a leading cause of morbidity and mortality worldwide. The impact on patient’s life is significant, leading to physical, mental and social deconditioning, not only in active TB but also in post TB sequela. Although with specific antituberculous treatment sputum negativity can be achieved, TB extrapulmonary symptoms such as cachexia, muscle weakness and depression may persist for a long time.The pulmonary rehabilitation (PR) may be a useful tool in this patient’s therapy in active and also in sequela phase. The benefits of PR are: reducing symptomatology, improving the degree of functional independence and quality of life, and increasing the ability to perform daily activities. This article discusses the components of a PR programme in active TB and TB sequela, and the results obtained by studies so far.</abstract>

Pulmonary rehabilitation and tuberculosis: a new approach for an old disease

<abstract><title style='display:none'>Abstract</title><sec><title style='display:none'>Background</title>Cardiovascular diseases (CVDs) are common in people with chronic obstructive pulmonary disease (COPD), and their presence is associated with an increased risk for hospitalization, longer length of stay and all-cause and CVD-related mortality. We assessed the role of angiotensin-converting enzyme (ACE) gene polymorphism in the occurrence of arterial hypertension (AH) in patients with COPD.</sec><sec><title style='display:none'>Methods</title>The study group consisted of 96 patients. Group 1 had 25 individuals with COPD, Group 2 had 23 individuals with AH and Group 3 had 28 individuals with COPD and AH. The control group consisted of 20 healthy subjects. I/D genotypes of ACE were determined by polymerase chain reaction amplification.</sec><sec><title style='display:none'>Results</title>The frequency distribution of polymorphic genotypes of the gene encoding ACE and assessment of compliance with the Hardy-Weinberg population equilibrium were carried out in groups of patients with COPD, AH and COPD + AH combination. The frequencies of the genotype responsible for I/D polymorphism of the ACE gene in the control and experimental groups were not found to deviate significantly from the Hardy–Weinberg equilibrium. The results of the study have not demonstrated any significant impact of alleles of ACE genes or ACE genes on occurrence of diseases such as COPD, AH and combinations thereof. However, analysis of odds ratio has demonstrated that the presence of the D allele of the ACE gene may increase the risk for occurrence of the COPD + AH (OR = 1.26).</sec><sec><title style='display:none'>Conclusion</title>The data obtained in the study allow suggesting that the presence of D allele of the ACE gene may increase the risk for AH in patients with COPD.</sec></abstract>

ACE gene I/D polymorphism and arterial hypertension in patients with COPD

<abstract><title style='display:none'>Abstract</title>The assessment of functional capacity is a significant part of the preoperative evaluation of patients proposed for both thoracic and abdominal surgery. The cardiopulmonary exercise test (CPET) is the most comprehensive exercise test currently used. It provides an objective assessment of the patient's training level and an individualised risk profile for complications and guides the perioperative care. This article provides a brief description of the roles of CPET in thoracic surgery. Guidelines recommend it for perioperative assessments because of its prognostic value, its utility in the postoperative period and in pulmonary rehabilitation programmes.</abstract>

Cardiopulmonary exercise testing in thoracic surgery

Summary

Asthma–COPD–Bronchiectasis combination: an unstudied triplet

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Pneumologia

 Pneumologia is the journal of the Romanian Society of Pneumology, being continuously edited since 1951. Pneumologia is an open-access journal, edited in...

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 Pneumologia is the journal of the Romanian Society of Pneumology, being continuously edited since 1951....