Systemic Manifestations of COPD and the Impact of Dual Bronchodilation with Tiotropium/Olodaterol on Cardiac Function and Autonomic Integrity.

Background: Chronic obstructive pulmonary disease (COPD) has significant systemic manifestations, including cardiovascular morbidity. The main aim of our study was to evaluate the effect of short-term COPD treatment with tiotropium/olodaterol (TIO/OLO) 5/5 µg on cardiac function and autonomic integrity. Methods: Twenty-nine patients with newly diagnosed moderate-to-severe COPD were enrolled. We performed pulmonary function tests, cardiac magnetic resonance, cardiac 123I-metaiodobenzylguanidine (123I-MIBG) imaging and analysis of blood biomarkers on our study subjects. The correlations between the tests' results were evaluated at baseline. The changes in pulmonary and cardiac parameters from baseline through 12 weeks were assessed. Results: Significant associations between pulmonary function tests' results and high-sensitivity C-reactive protein (hs-CRP), as well as interleukin-22 (IL-22), were observed at baseline. Treatment with TIO/OLO significantly improved lung function as measured by spirometry and body plethysmography. Moreover, we found that the cardiac index increased from 2.89 (interquartile range (IQR) 1.09) to 3.21 L/min/m2 (IQR 0.78) (p = 0.013; N = 18) and the late heart-to-mediastinum ratio improved from 1.88 (IQR 0.37) to 2 (IQR 0.41) (p = 0.026; N = 16) after 12 weeks of treatment. Conclusions: Treatment with TIO/OLO improves lung function and positively impacts cardiac function and autonomic integrity, suggesting that dual bronchodilation might have a potential in decreasing the risk for cardiac events in COPD. Hs-CRP and IL-22 might be beneficial in determining the intensity of systemic inflammation in COPD. Further research with a larger cohort is needed to enhance the initial results of this study.

Elevated levels of interleukin-33 are associated with allergic and eosinophilic asthma.

IL-33 is a recently discovered cytokine which plays an important role in asthma pathogenesis. AIM: To evaluate serum IL-33 in patients with asthma and healthy controls, and to evaluate the association of IL-33 with different asthma phenotypes. METHODS: Patients with asthma (n = 115) and healthy subjects (n = 85) were included in the study. Subjects with asthma were divided into groups according to their phenotype: allergic/non-allergic, eosinophilic/non-eosinophilic, obese/non-obese and severity according to GINA (mild, moderate and severe). The concentration of IL-33 in serum was measured by standardized enzyme-linked immunosorbent assay. RESULTS: The level of IL-33 was significantly higher in patients with asthma when compared to healthy subjects (672.73 ± 104.47 pg/mL vs 268.52 ± 27.56 pg/mL, P < 0.05). IL-33 was also higher in the allergic asthma group patients when compared to non-allergic asthmatics (844.61 ± 152.08 pg/mL vs 369.56 ± 77.94 pg/mL, P < 0.05). There was a significantly higher serum IL-33 level in the eosinophilic asthma group when compared to the group of non-eosinophilic asthma patients (1001.10 ± 199.11 pg/mL vs 337.49 ± 72.68 pg/mL, P < 0.01). We did not find a significant difference in serum IL-33 level between different asthma severity groups, obese and non-obese asthmatics. CONCLUSION: IL-33 is increased in asthma patients, particularly in some phenotypes: allergic asthma and eosinophilic asthma.

Reactive oxygen species in peripheral blood and sputum neutrophils during bacterial and nonbacterial acute exacerbation of chronic obstructive pulmonary disease.

Chronic airway inflammation can be mediated by an enhanced neutrophil oxidative burst. However, the role of bacteria in the pathogenesis of chronic obstructive pulmonary disease (COPD) exacerbations is highly controversial. The aim of this study was to evaluate the production of reactive oxygen species (ROS) in peripheral blood and sputum neutrophils during bacterial and nonbacterial acute exacerbations of COPD (AECOPD). A total of 40 patients with AECOPD, 10 healthy nonsmokers, and 10 "healthy" smokers were enrolled into the study. Peripheral blood and sputum samples were obtained during exacerbation and after recovery. Neutrophils were isolated by high-density gradient centrifugation and magnetic separation. ROS production by neutrophils was investigated after stimulation with phorbol-myristate-acetate and Staphylococcus aureus bacteria. ROS production by neutrophils was assessed as the mean fluorescent intensity using a flow cytometer. IL-8 levels in serum and induced sputum were determinant by ELISA. Spontaneous ROS production was significantly higher in neutrophils from the patients with bacterial AECOPD as compared with nonbacterial AECOPD and stable COPD (P <0.05). ROS production stimulated with PMA and with Staphylococcus aureus was significantly higher in neutrophils isolated from the patients with bacterial AECOPD as compared with nonbacterial and stable COPD (P <0.05). The serum and induced sputum IL-8 levels were significantly increased in the patients with bacterial AECOPD than nonbacterial AECOPD, stable COPS, and "healthy" smokers and nonsmokers (P <0.05) and higher in the induced sputum as the compared with serum in all studied groups (P <0.05). Enlarge CRP level was documented during AECOPD than in all other groups (P <0.05). A markedly increased ROS production in sputum neutrophils during bacterial AECOPD shows an inflammatory response reflecting enhanced local inflammation, which can be mediated by bacterial colonization.

An Unusual Regression of the Symptoms of Kartagener Syndrome

El síndrome de Kartagener es una enfermedad genética poco frecuente que se hereda de forma autosómica recesiva, con una afectación progresiva del sistema respiratorio y situs inversus. Aunque el tratamiento de los pacientes con el síndrome sigue siendo poco claro y las pruebas disponibles son limitadas, es importante su seguimiento con una asistencia adecuada y compartida. En el presente informe se describe un caso clínico del síndrome en una mujer de 25 años de edad. La tomografía computarizada demostró dextrocardia y bronquiectasias. La radiografía simple y la ecografía abdominal confirmaron un situs inversus total. Después de 7 años, se obtuvieron resultados satisfactorios del tratamiento: la función pulmonar mejoró y en la exploración radiológica no se demostraron cambios. En el presente artículo se describe la compleja interrelación entre la variación genética y un tratamiento inespecífico apropiado del síndrome(AU)

Kartagener's syndrome is a rare autosomal-recessive genetic disease with progressive damage of the respiratory system and situs inversus. Although the management of patients with Kartagener's syndrome remains uncertain and evidence is limited, it is important to follow up these patients with an adequate and shared care system. This report presents a clinical case of Kartagener's syndrome in a 25-year-old woman. Computed tomography showed dextrocardia and bronchiectasis. Abdominal X-ray and ultrasound confirmed situs inversus totalis. After 7 years, good treatment results were achieved: lung function improved and radiological findings showed no changes. The present case discusses the complex interrelationship between the genetic variation and a proper nonspecific management of Kartagener's syndrome(AU)

An unusual regression of the symptoms of Kartagener syndrome.

Kartagener's syndrome is a rare autosomal-recessive genetic disease with progressive damage of the respiratory system and situs inversus. Although the management of patients with Kartagener's syndrome remains uncertain and evidence is limited, it is important to follow up these patients with an adequate and shared care system. This report presents a clinical case of Kartagener's syndrome in a 25-year-old woman. Computed tomography showed dextrocardia and bronchiectasis. Abdominal X-ray and ultrasound confirmed situs inversus totalis. After 7 years, good treatment results were achieved: lung function improved and radiological findings showed no changes. The present case discusses the complex interrelationship between the genetic variation and a proper nonspecific management of Kartagener's syndrome.

Carcinoma of two parathyroid glands caused by a novel MEN1 gene mutation - a rare feature of the MEN 1 syndrome.

Multiple endocrine neoplasia type 1 (MEN 1) is a rare syndrome inherited in an autosomal dominant pattern, characterized by combinations of tumors of the parathyroid glands, pituitary gland, and pancreatic islet cells and more rare tumors of endocrine organs and nonendocrine tissues. Germline mutations in the MEN1 gene are responsible for the MEN 1 syndrome, leading to an inactive form of menin protein. Benign lesions of the parathyroid glands are characteristic in patients with the MEN 1 syndrome; however, patients can develop parathyroid carcinomas very rarely. This report presents a clinical case of the MEN 1 syndrome: a 39-year-old woman underwent surgery for carcinoma of two parathyroid glands as well as was treated for pituitary prolactinoma, which caused infertility, and malignant insulinoma; the patient had multiple subcutaneous lipomas as well. Genetic analysis revealed a novel germline mutation in the MEN1 gene - a nucleotide insertion at codon 43 in exon 2 (c.129insA), which caused the occurrence of the MEN1 syndrome. The clinical case of the MEN 1 syndrome presented here is relevant in gathering the data on etiopathogenesis of not only MEN 1 syndrome, but an extremely rare pathology - parathyroid carcinoma - as well.

[Pulmonary hypertension: the issues of diagnosis and treatment]. / Plauciu hipertenzija. Diagnostikos ir gydymo aktualijos.

Pulmonary hypertension is not a rare pathology that is met in a doctor's practice. It has been defined as a mean pulmonary artery pressure >25 mmHg at rest or >30 mmHg at exercise, or by a systolic pulmonary artery pressure >40 mmHg measured by echo-Doppler. The article analyzes pulmonary arterial hypertension, especially primary one, and its classification, diagnosis, and possibilities for medication. The major role in pathogenesis is ascribed for in situ thrombosis, intimal and adventitial proliferation and smooth muscle hypertrophy. Prostacyclin analogues, nitric oxide, calcium channel blockers and endothelin-1 receptor blockers are the most important medicines, which decrease pressure in the pulmonary artery. The clinical case of the 63-year-old woman, who was ill with severe primary pulmonary arterial hypertension, is described in the article.

[Morbidity and attack rate of lung tuberculosis in Kaunas city and Kaunas district during 2000-2002]. / Bendrojo sergamumo bei sergamumo plauciu tuberkulioze kitimas Kauno mieste ir Kauno rajone 2000-2002 metais.

UNLABELLED: The aim of the study was to estimate the changes of lung tuberculosis attack rate and morbidity and its changes in Kaunas city and Kaunas district during 2000-2002. MATERIAL AND METHODS: We analyzed results of National tuberculosis registry entries during 2000-2002 years period concerning new tuberculosis cases and relapses in Kaunas city and Kaunas district. RESULTS: We found significant decrease in lung tuberculosis morbidity from 59.11/100000 to 37.2/100000 (p=0.001) and attack rate from 71.25/100000 to 49.08/100000 (p=0.0026) in Kaunas city during 2000-2002 period respectively. Decrease in Kaunas district in the same time was not significant. The rate of lung tuberculosis relapses during 2000-2002 period in Kaunas city and Kaunas district increased, but not significantly. CONCLUSIONS: The morbidity and attack rate of lung tuberculosis in Kaunas city decreased significantly during 2000-2002. The rate of lung tuberculosis relapses during 2000-2002 in Kaunas city and Kaunas district didn't change significantly.