Acceptance of home support and integrated care among advanced COPD patients who live outside large medical centers.

BACKGROUND: Poor self-management constitutes a risk factor for COPD deterioration. Patients from rural areas located at a considerable distance from large medical centers frequently need home-support in advanced stages of the disease. Integrated care has been proposed as a comprehensive model for appropriate treatment, coordination and holistic support. The aim of the study was to assess whether home visits provided by trained assistants are needed and accepted by advanced COPD patients living in rural areas a to evaluate whether an individual short educational program can actually improve such patients' knowledge of COPD and inhaler use. METHODS: Thirty patients with severe or very severe but stable COPD participated in one-month home-assistance interventions twice a week. RESULTS: The total value ≥70 of SGRQ (St George's Respiratory Questionnaire) was recorded in 18 (60%) patients. At the beginning of the study, the patients' knowledge of COPD and inhalation techniques was highly unsatisfactory. Significant improvement in all items (p=0.00) was obtained after the intervention. The risk for poor self-management was high. All patients had at least one 'factor' that indicated the need for home-support. A total of 240 visits (100%) were completed. Patients expressed high acceptance for home-based support delivered by medical assistants twice a week for one month. No patients opposed this kind of care and most of them expressed interest in receiving it in the future. CONCLUSIONS: The results suggest a compelling need for home care and demonstrate full acceptance of this kind of support on the part of advanced COPD patients.

Musculosceletal tuberculosis with involvement of tendon sheaths and formation of synovial cyst.

Due to an increasing amount of patients on immunosuppressive treatment, the number of tuberculosis (TB) of atypical course and extrapulmonary tuberculosis cases increase. Locomotor system is a place of every fifth case of extrapulmonary TB. Because of lack of characteristic symptoms, as well as rare co-occurrence of active lung lesions in radiological imaging, proper diagnosis is hard to establish. We present a case of patient on immunosuppressive therapy due to myositis, in whom we diagnosed musculoskeletal tuberculosis in form of involvement of tendon sheath and formation of synovial cyst.

Pulmonary lesions in the course of gastric cancer--two cases of Bard's syndrome.

The Bard's syndrome is a medical condition related to miliary dissemination of gastric cancer to the lungs. Difficulties in diagnosis are associated with the need of differentiation between numerous diseases, which may manifest as disseminated lesions in the lung parenchyma on chest X-ray. Despite the advanced proliferative process, primary focus of neoplasm frequently remains subclinical. Metastatic lesions cause many symptoms in the respiratory system, suggesting primary pulmonary pathology. The Bard's syndrome should be always taken into account in differential diagnosis of disseminated lesions, particularly due to prevalence of gastric cancer. The study presents two cases of patients with disseminated pulmonary lesions, corresponding to gastric cancer metastases on radiological imaging.

Circulating concentration of markers of angiogenic activity in patients with sarcoidosis and idiopathic pulmonary fibrosis.

BACKGROUND: Angiogenesis is an important process involved in the pathogenesis of diffuse parenchymal lung diseases. The aim of the study was to compare the angiogenic profile of patients with sarcoidosis and idiopathic pulmonary fibrosis (IPF) based on analysis of circulating factors. METHODS: Serum concentrations of angiopoietin-2 (Ang-2), follistatin, granulocyte-macrophage-colony stimulating factor (GM-CSF), interleukin-8 (IL-8), platelet derived growth factor-BB (PDGF-BB), platelet endothelial cellular adhesion molecule-1 (PECAM-1) and vascular endothelial growth factors (VEGF) were measured in the patients and the healthy subjects. RESULTS: Serum concentrations of G-CSF, follistatin, PECAM-1 and IL-8 were significantly higher in the IPF patients in comparison with the control group and the sarcoid patients. PDGF-BB concentrations were also significantly higher in serum of IPF patients than in sarcoid patients, but not than in the controls. In contrast, Ang-2 and VEGF concentrations did not differ significantly between the three groups. In the sarcoid patients, irrespective of the disease activity or the radiological stage, serum concentrations of these cytokines were similar to the control group. CONCLUSIONS: These results indicate that differences may exist in angiogenic activity between patients with parenchymal lung diseases. In contrast to sarcoidosis, IPF is characterized by a higher serum concentration of different molecules involved in the angiogenic processes .

Cardiovascular safety of two bronchodilators' fixed-dose combination: indacaterol and glycopyrronium.

Combination therapy with anticholinergics and ß2-agonists should be used in COPD patients after failure of previous monotherapy with one of these drugs. Synergistic effect of both mechanisms of bronchodilation can maximize the efficacy of separately administered drugs. The effectiveness of the combination of LABA and LAMA is already confirmed, nevertheless the question about the safety profile of this therapy is still remaining, particularly with regard to the cardiovascular system. The paper discusses the overall safety profile of the combined preparation compare to placebo as well as the active comparators, especially the cardiovascular safety of fixed-dose formulation. Based on the data it has been demonstrated, that the combination of two ultra-long-acting bronchodilators with different complementary mechanisms of action increases the effectiveness of COPD therapy without affecting the safety.

Problems of patients with cystic fibrosis during transition to adulthood.

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.

Occurrence of alert pathogens in patients hospitalised in the department of lung diseases.

INTRODUCTION: Infections caused by multiple drug-resistant pathogens represent an increasingly often encountered challenge in clinical practice. The problem particularly applies to patients with chronic lung diseases resulting in multiple hospitalisations. The aim of this paper was to analyse the incidence of alert pathogens isolated from patients hospitalised in the department of lung diseases, who were divided into three groups: patients qualified for lung transplantation, patients treated for neoplastic diseases and patients with chronic lung diseases. MATERIALS AND METHODS: Analysis involved microbiological test results of 3950 samples obtained from 3521 patients divided into: 200 patients being qualified for lung transplantation, 1292 patients treated for neoplastic diseases and 2029 patients with chronic lung diseases. RESULTS: Infection with alert pathogen was found in 155 of 3521 patients (4.4%). Most often isolated infectious agent was P. aeruginosa, which accounted for 27% of infections. Other pathogens were as follows A. baumanii ESBL(-) (13%), S. pneumoniae (12%), E. cloacae ESBL(+) (10%), K. pneumoniae ESBL(+) (10%), S. aureus MRSA (8%), E. faecalis (7%), E. coli ESBL(+) (6%), S. maltophilia ESBL(+) (5%) and E. kobei ESBL(+) (2%). Alert pathogens were found in 31 (15%) of 200 patients being qualified for lung transplantation, 89 (4.4%) of 2029 patients with chronic lung diseases and 35 (2.7%) of 1292 patients treated for neoplastic diseases. Difference between infection frequency in patients being qualified for lung transplantation and the remaining groups was statistically significant (p < 0.01). P. aeruginosa infection was the most frequent in all groups. It constituted 35% in patients being qualified for lung transplantation, 29% in patients treated for neoplastic diseases and 22% in patients with chronic lung diseases. CONCLUSIONS: Infections caused by alert pathogens were found in more than 4% of patients hospitalised in the department of lung diseases between 2007 and 2011. Their frequency was significantly higher in patients being qualified for lung transplantation than in other analysed groups. In all examined groups the most frequently isolated bacteria was P. aeruginosa (27% of all isolates).

Tuberculosis among the homeless and inmates kept in custody and in penitentiary institutions in the Silesia region.

INTRODUCTION: There are more than 10 million prisoners in the world. Tuberculosis incidence is 10-100 times higher in prisoners than in the general population. Inmates have close contact with other prisoners and with prison workers and visitors, so tubercle bacilli may be easily spread. Most of the inmates come back to normal life and contact with the general population. The aim of the study was to assess active tuberculosis incidence among prisoners and homeless persons in the Silesia region. MATERIAL AND METHODS: In total 897 people entered the study, of whom 720 were Silesian penitentiary system inmates, and 177 were homeless. BACTEC MGIT fast TB detection system and GenoType Mycobacteria Direct test were used. Drug susceptibility testing was done using SIRE KIT and PZA KIT. RESULTS: Tuberculosis was diagnosed in 13 out of 897 persons (1.45%): in 11 out of 720 inmates (1.53%) and in 2 out of 177 homeless persons (1.13%). Data concerning drug susceptibility were obtained for 11 persons. M. tuberculosis strains isolated from eight persons were susceptible to four first-line antituberculosis drugs (streptomycin, isoniazid, rifampin, ethambutol), while M. tuberculosis strains isolated from three persons were drug-resistant. One out of three isolated strains was resistant to ethambutol, but susceptible to streptomycin, isoniazid, rifampin, and pirazynamide. The second strain was resistant to streptomycin and pyrazinamide but susceptible to isoniazid, rifampin, and ethambutol. The third strain was susceptible to rifampin but resistant to the other four tested drugs. According to the obtained data, culture-positive pulmonary tuberculosis was 100 times more frequent in the examined population than in the general population of the Silesia region in the same period of time. CONCLUSIONS: The health project enabled effective detection of tuberculosis in risk groups and should be continued in the following years. The set of the applied diagnostic methods allowed the detection of in the studied subpopulations people suffering from tuberculosis. Patients were treated with antituberculosis drugs that would stop them from spreading the disease to other people.

Hyponatraemia - evaluation of prevalence in patients hospitalized in the Pulmonary Department and prognostic significance in lung cancer patients.

INTRODUCTION: It is known from clinical practice that data concerning plasma sodium concentration and its influence on patient prognosis are underestimated. The aim of this study was the evaluation of the prevalence and influence of hyponatraemia on prognosis in patients with lung diseases, particularly with lung cancer. MATERIAL AND METHODS: Retrospective analysis of data obtained from a single Pulmonary Department was performed. A total of 449 patients divided in two groups, were analysed. The first group consisted of all lung cancer patients (n = 290) hospitalized in the analysed period. The second group included patients with hyponatraemia but without diagnosed lung cancer (n = 159). The prevalence of hyponatraemia, including severity (mild, moderate or severe), was evaluated. Histological types of lung cancer as well as comorbidities were taken into account. RESULTS: Hyponatraemia was found in 46.9% of patients with lung cancer, including mild (serum sodium 135-130 mEq/L), moderate (129-125 mEq/L) and severe hyponatraemia (< 125 mEq/L) in 66.9%, 25% and 8.1, respectively. In patients without lung cancer and with recognized hyponatraemia, mild, moderate and severe hyponatraemia were found in 81.8%, 13.2% and 5%, respectively (mainly in obstructive and interstitial lung diseases). Hyponatraemia was observed in 52.6% of patients with non-small cell lung cancer (NSCLC) and in 45.2% of patients with small cell lung cancer (SCLC). There was no statistical significance in prevalence of hyponatraemia between histological types of lung cancer. In patients with lung cancer and hyponatraemia compared to patients with lung cancer but without hyponatraemia, a significant increase of in-hospital mortality was found (28.7% vs. 7.8%, respectively) p < 0.001. CONCLUSIONS: Hyponatraemia was a common abnormality found in approximately 50% of lung cancer patients. Hyponatraemia was a significant prognostic factor associated with poor prognosis.

The analysis of ALK gene rearrangement by fluorescence in situ hybridization in non-small cell lung cancer patients.

INTRODUCTION: ALK gene rearrangement is observed in a small subset (3-7%) of non-small cell lung cancer (NSCLC) patients. The efficacy of crizotinib was shown in lung cancer patients harbouring ALK rearrangement. Nowadays, the analysis of ALK gene rearrangement is added to molecular examination of predictive factors. AIM OF THE STUDY: The frequency of ALK gene rearrangement as well as the type of its irregularity was analysed by fluorescence in situ hybridisation (FISH) in tissue samples from NSCLC patients. MATERIAL AND METHODS: The ALK gene rearrangement was analysed in 71 samples including 53 histological and 18 cytological samples. The analysis could be performed in 56 cases (78.87%), significantly more frequently in histological than in cytological materials. The encountered problem with ALK rearrangement diagnosis resulted from the scarcity of tumour cells in cytological samples, high background fluorescence noises and fragmentation of cell nuclei. RESULTS: The normal ALK copy number without gene rearrangement was observed in 26 (36.62%) patients ALK gene polysomy without gene rearrangement was observed in 25 (35.21%) samples while in 3 (4.23%) samples ALK gene amplification was found. ALK gene rearrangement was observed in 2 (2.82%) samples from males, while in the first case the rearrangement coexisted with ALK amplification. In the second case, signet-ring tumour cells were found during histopathological examination and this patient was successfully treated with crizotinib with partial remission lasting 16 months. CONCLUSIONS: FISH is a useful technique for ALK gene rearrangement analysis which allows us to specify the type of gene irregularities. ALK gene examination could be performed in histological as well as cytological (cellblocks) samples, but obtaining a reliable result in cytological samples depends on the cellularity of examined materials.

[May a COPD patient benefit from rehabilitation associated with pharmacological treatment?]. / Czy chory na POChP odnosi korzysci z rehabilitacji skojarzonejz leczeniem farmakologicznym?

Chronic obstructive pulmonary disease (COPD) patients are known to be physically inactive due to exertion dyspnea. Improvement of physical capacity leads to reduction of symptoms severity, increases PFT values, decreases the number of infectious exacerbations and, generally, improves the quality of life and prognosis. Therefore rehabilitation plays a crucial role in the treatment of COPD patients. It has been demonstrated that the use of bronchodilating drugs prior to physical exertion enables rehabilitation by diminishing the shortness of breath.

[Thromboembolic venous disease as a first sign of neoplastic disease--a case report]. / Zylna choroba zakrzepowo-zatorowa jako pierwsza manifestacja choroby nowotworowej--opis przypadku.

Venous thromboembolism is a one of the most common complications of cancer, which contributes to mortality in cancer patients. The prognosis of cancer patients with thrombosis is significantly worse. Venous thromboembolism can be the first manifestation of occult cancer. Incidence of subsequent cancer diagnosis after thrombotic event reaches 25% and is highest within the first 6 months. Risk of cancer diagnosis is significantly higher in patients with idiopathic thrombosis compared with those with secondary thrombosis. We present case of 67-year-old man with recurrent vein thromboembolism and pulmonary embolism, who was subsequently diagnosed with disseminated adenocarcinoma, most likely of the lung.

[Pulmonary rehabilitation in patients with lung cancer]. / Rehabilitacja oddechowa chorych na raka pluca.

The paper presents current news on the possibilities of conducting rehabilitation of patients suffering from lung cancer. It presents the principles of conducting and contraindications for pulmonary rehabilitation for these patients according to current guidelines of American College of Sport Medicine. The methods of measuring exercise capacity for patients with lung cancer have been discussed. The value of ergospirometrial test with maximum oxygen consumption (VO(2peak)) in predicting not only the survival of patients with lung cancer, but also assessing the possibility of pulmonary rehabilitation programs has been highlighted. In the part devoted to physical training for patients before a surgery for lung cancer, current research results have been presented- these show that even a short, high intensity program of pulmonary rehabilitation for patients with lung cancer before surgery is effective and increases the safety of both- the safety of the surgery and extends survival time after operation for lung cancer. The paper describes difficulties in the implementation of rehabilitation programs after surgery conducted on patients with lung cancer resulting from dysfunction of cardiovascular and muscle atrophy - both skeletal and respiratory. The issue of patients with inoperable lung cancer treated with chemotherapy has been discussed so far in only one paper published in 2007. The results shown in it have been discussed as well. The authors demonstrated a significant improvement in the efficiency of respiratory-circulatory system assessed by six-minute walk test, although the rehabilitation program was graduated by small number of patients (44%). It was noted that patients with inoperable lung cancer now account for a large group of patients who use this type of medical intervention and can significantly improve the quality of life and the method shows positive impact on the survival rate.

[The diagnostic value of virus serology in patients with non-ischemic systolic heart failure and parvovirus B19 infection]. / Wartosc diagnostyczna testów serologicznych u chorych ze skurczowa nie-niedokrwienna niewydolnoscia serca i zakazeniem parwowirusem B19.

INTRODUCTION: We determined retrospective analysis of the diagnostic value of virus serology in patients with non-ischemic systolic heart failure and parvovirus B19 infection. MATERIAL AND METHODS: Virus serology and endomyocardial biopsy were performed in 31 patients with non-ischemic systolic heart failure hospitalized from 2001 to 2006 in our clinic. RESULTS: The serum specimens from 31 patients were tested for IgM and IgG antibody against parvovirus B19. IgM antibodies were identified in 3 patients and IgG antibodies were identified in 23 patients. All of the patients underwent endomyocardial biopsy which revealed chronic active myocarditis in 10 patients (32.4%), chronic persistent myocarditis in 14 patients (45.1%) and no myocarditis in 7 patients (22.5%). CONCLUSIONS: Virus serology has no relevance for the diagnosis of non-ischemic systolic heart failure caused by parvovirus B19 infection. The result of serological tests are positive more frequently than the biopsy specimens results.

Cytological examination of pleural cavity lavage accompanied by the study of gene promoter hypermethylation of p16 and O6-methylguanine-DNA-methyltransferase genes in diagnostics of non-small cell lung cancer metastatic changes into pleura.

AIM OF THE STUDY: Metastases of non-small cell lung cancer (NSCLC) into pleura disqualify a patient from surgery and present a bad prognostic index. The aim of the study was to find out whether washing out the pleural cavity in such cases and examining obtained washings for presence of cancer cells will help to detect early NSCLC metastases into pleura, and also whether negative results of the cytology determine whether hypermethylation of these genes will increase the sensitivity of this examination. MATERIAL AND METHODS: The study consisted of the examination of 76 patients, including 59 operated on for NSCLC and 17 operated on for other reasons. Pleural washing fluid collected during the surgery was subjected to cytological examination as well as examined to determine the presence of promoter region hypermethylation of p16 and MGMT genes. RESULTS: Positive cytological results of pleural lavage were confirmed in 4 persons (7%) with NSCLC. The presence of promoter region hypermethylation of one or both examined genes was found in 3 patients (18%) in the control group and in 47 (80%) in the study group. Sex, occupational exposure, smoking cigarettes, and NSCLC histological type did not have an influence on the presence of cancer cells or hypermethylation in the pleural lavage fluid. Positive cytology results were more frequent at the T4 stage of NSCLC. Hypermethylation was more frequent in the research group (p < 0.01). Cancer cells and hypermethylation did not occur more frequently in pleural lavage fluid of patients with metastases into pleura. CONCLUSIONS: The cytological examination and promoter region hypermethylation assessment of the p16 gene and MGMT gene in pleural lavage cells do not allow one to detect early metastasis of NSCLC into pleura.

Lung cancer in patients under the age of 40 years.

AIM OF THE STUDY: In the paper clinical cases of individuals diagnosed with lung cancer below the age of 40 years have been analyzed. MATERIAL AND METHODS: THE ANALYSIS INCLUDED: sex, age, clinical symptoms found before and at the moment of diagnosis, character of changes visible in radiological imaging, time that passed from the first symptoms to reporting to a doctor and to establishing a diagnosis, type of diagnostic method used in establishing the final diagnosis, histopathologic type of cancer, degree of cancer progression. RESULTS: The results have been compared with a peer group who had been diagnosed 20 years earlier. Currently 7% of patients were diagnosed at the age of 25 or younger, whereas in the previous cohort patients in this age constituted 2%. The predominant pathological type was adenocarcinoma (currently 33%, previously 4%) in contrast to the earlier group in which 57% of patients had small cell lung cancer (57%). The incidence is equally distributed between both sexes, although there is an evident increase in female lung cancer cases. In the majority of patients the clinical presentation is a peripheral mass on chest X-ray. 20% of patients present pleural effusion on diagnosis. Patients reported the following complaints: breathlessness, chest pain, weight loss and fatigue. The majority of cases were diagnosed in advanced stages on the basis of a bronchoscopy acquired specimen. Time course from symptoms to diagnosis tends to be shorter than 20 years ago.

Preliminary Research on the Effect of Hyperbaric Oxygen Therapy in Patients with Post-COVID-19 Syndrome.

Negative consequences and medical complications of COVID-19 can persist for up to several months after initial recovery. These consequences can include stroke, diabetes, decreased lung diffusing capacity, sleep apnea, pulmonary fibrosis, arrhythmia, myocarditis, fatigue, headaches, muscle aches, heart rate fluctuations, sleep problems, memory problems, nervousness, anxiety, and other neurological disorders. Thirty-one patients who reported symptoms related to previous COVID-19 disease of both sexes were enrolled in the initial program. The patients underwent compression sessions in a multiplace hyperbaric chamber. Each patient underwent a cycle of 15 compressions. Before the first session, each participant completed a venous blood gas test, a Fullerton test, and two spirometry tests (one before the Fullerton test and one after the test). Patients completed psychotechnical tests, a questionnaire on quality of life (Polish version of EQ-5D-5L), and a questionnaire on specific symptoms accompanying the disease and post-infection symptoms. The results showed significant improvements in areas such as quality of life, endurance and strength, some spirometric parameters, the anion gap and lactate levels, working memory, and attention in the group of treated patients. In contrast, there were no changes in pH, pO2, pCO2, glucose, and excess alkaline values. A follow-up interview confirmed that the beneficial effects were maintained over time. Considering the results obtained, including the apparent improvement in the patient's clinical condition, it can be concluded that the use of 15 compression sessions was temporarily associated with a noticeable improvement in health and performance parameters as well as improvement in certain blood gas parameters.

[Management of bacterial exacerbations of obstructive lung diseases]. / Postepowanie w zaostrzeniach bakteryjnych chorób obturacyjnych.

Bacterial infections are a common cause of chronic obstructive pulmonary disease exacerbations. They play a main role in exacerbation of cystic fibrosis, less frequently in COPD and occasionally in asthma. Etiology of exacerbations depends on the severity of these diseases and is known to be facilitated by bacterial colonization of the airways. The clinical presentation of bacterial exacerbations is similar and their course is influenced by prompt and proper antibiotic treatment. The principles of this treatment are discussed in the paper.

[The need of lung cancer screening: new evidence, new expectations]. / Potrzeba badan przesiewowych w kierunku wczesnego wykrywaniaraka pluca ­ nowe dowody, nowe nadzieje.

Lung cancer is the most common cancer in Poland and in the world and the leading cause of cancer-related deaths. In the past 30 years lung cancer survival has not been improved. In the same period of time significant progress has been made in the results of treatment of many other cancers for example: breast, colorectal and prostate cancer. It may be connected with introduction of efficient screening tests. Lung cancer seems to be a disease for which screening could have great impact. In the 1970s trials evaluating chest roentgenograms and sputum cytology as screening modalities were conducted, but did not show reduction in lung cancer mortality. There have been several projects in which low-dose helical computed tomography was used. Many of them were non-randomized cohort studies and showed promising results with respect to sensitivity of computed tomography, but the real benefit, which is mortality reduction, must originate from randomized trials. The major breakthrough is the National Lung Screening Trial (NLST), randomized trial conducted in USA, that demonstrated 20% mortality reduction in low-dose computed tomography group comparing to radiography group. Several randomized trials are ongoing in Europe. Researchers continue to seek new methods of screening such as autofluorescence bronchoscopy, advanced techniques of sputum analysis and techniques of molecular biology.

[Respiratory tract burn injuries]. / Oparzenia dróg oddechowych.

Respiratory tract burns are one of the most serious injuries of human organism. They often accompany severe skin burns, increasing morbidity and mortality. Pathologic events happening in the lungs in the course of inhalation injury consist of: edema and necrosis of bronchial mucosa, increase of bronchial blood flow and vascular permeability, recruitment of inflammatory mediators, and obturation of bronchial tract with the casts composed of mucus, tissue debris, neutrophils and fibrin. The above mentioned processes lead to progressive disturbances of pulmonary gas exchange and tissue hypoxia. Introduction of standardized bronchoscopic procedures resulted in the possibility of early diagnosis and treatment of inhalation injuries. There are many treatment options, some of them combined with early and late complications, the optimal treatment protocol is still lacking. Early hyperbaric oxygen therapy is one of the most promising methods of treatment leading to decrease of mortality due to inhalation injury.