Progress in clinical application of urgent lung transplantation / 器官移植

Lung transplantation is the only effective treatment of end-stage lung diseases. Nevertheless, shortage of donor lungs has become increasingly prominent worldwide. A large quantity of patients died while waiting for lung transplantation. Urgent lung transplantation is a prioritized allocation strategy for donor lung transplantation according to the urgency of diseases, aiming to shorten the waiting time for donor lungs and reduce the fatality of patients on the waiting list for lung transplantation. However, no consensus has been reached worldwide on the definition, criteria and application of the terminology of urgent lung transplantation. In addition, the survival and net benefits of lung transplant recipients based on this allocation system are still controversial. On the basis of previous clinical research on urgent lung transplantation, the definition criteria, risk factors, survival outcomes, limitations and optimization measures were explicitly elucidated in this article, aiming to provide theoretical reference for comprehensive evaluation of the feasibility of urgent lung transplantation and further optimizing the allocation system of donor lungs.

Classification, diagnosis of reversibility and severity assessment of patients having respiratory distress based on pulmonary function test

Introduction: Pulmonary function testing is the gold standard for physicians to diagnose and manage respiratory problems. An obstructive defect is indicated by low forced expiratory volume in one second/forced vital capacity (FEV1/FVC) ratio, defined as less than 0.7 or below the fifth percentile. If an obstructive defect is present, the physician should determine if the disease is reversible based on the increase in FEV1 or FVC after bronchodilator treatment (i.e., increase of more than 12% and 200 ml in adults). An FVC below the fifth percentile indicates a restrictive pattern based on NHANES III data in adults. If both the FEV1/FVC ratio and the FVC are low, the patient has a mixed defect. Method: A total of 60 patients having respiratory distress, who attended chest OPD underwent a pulmonary function test. Results: In this study out of 60 patients, 32 patients had obstructive airway diseases with low FEV1/FVC (53.33%), 8 of them (13.33%) had restrictive lung diseases, ten patients(16.66%) had mixed features and rest ten patients(16.66%) had normal spirometry. Among those 32 patients of obstructive features, 22 (68.75%) had reversible airway diseases. Severity was measured among the other ten non-reversible obstructive patients according to the GOLD criteria. Conclusion: Pulmonary function test is the fundamental first-line investigation to diagnose obstructive and restrictive lung diseases and also to differentiate between reversible and non-reversible obstruction. It is also a vital tool for determining the severity among non-reversible obstructive airway patients.

Pulmonary Function Test In Patients With Subclinical Hypothyroidism: A Study From Eastern India

Context: Subclinical hypothyroidism (SCH) is defined by an elevated Thyroid stimulating hormone (TSH) level in presence of normal serum free T4 concentration. Thus serum TSH measurement is the necessary test for diagnosis of mild thyroid failure. Aims: Evaluation of the pulmonary function by spirometry in patients of SCH, correlate the pulmonary function with fT3, fT4, TSH level and assess any change in pulmonary function in patients of SCH following treatment. Settings and Design: Prospective case control study from December 2014 to November 2016 in tertiary medical college of eastern India Methods and Material: 70 patients and 35 age sex matched controls were included in the study. The main outcome measures of the study were based on a comparison of spirometric findings of subclinical hypothyroidism with the control group and change in spirometric parameters after 3 months follow up with levothyroxin replacement. Statistical analysis used:The statistical comparisons were done by SPSS software version 20. Pvalue was considered significant if <0.05. Results: The study population 90% were females and 10% males. The mean TSH of the patients with subclinical hypothyroidism was 11.49±8.44 and that of the control group was 3.22±0.79, it was statistically significant. Forced expiratory volume in 1 second of subclinical hypothyroidism patients was significantly lower than control group. The mean FEV1/FVC% was higher in subclinical hypothyroidism as compared with control. After 3 months of thyroid hormone replacement the TSH level was normalised. With improvement of TSH all the respiratory parameters improved significantly. Conclusions: Though mild restrictive pattern of respiratory function abnormality occurs in subclinical hypothyroidism, it cannot be ignored. Hence they should be evaluated and clinical approaches should be taken accordingly at the earliest.

An occupational health survey of sewage treatment plant workers of Dakshina Kannada, Karnataka

Background: Sanitation workers are at a risk of exposure to various health hazards which are preventable. The present study aimed at assessing the health status of sewage treatment plant (STP) workers, their respiratory morbidity and onsite assessment of their occupational safety.Methods: A cross sectional study was conducted in a single STP during June-July months of 2017. A total of 32 employees were enrolled in the study. Data collection was done using a questionnaire, clinical examination and onsite assessment for occupational safety. The questionnaire included demographic details, clinical symptoms and use of personal protective equipment (PPE). Clinical examination with special focus on respiratory system and portable spirometry was conducted followed by health education on workplace safety. Descriptive statistics were reported as mean and standard deviation for continuous variables and frequency and proportion for categorical variable.Results: None of the workers underwent pre-placement health check-up and routine health check-ups at regular interval. PPE were available in adequate number. Spirometry revealed 12 workers having forced expiratory volume in one second/forced vital capacity (FEV1/FVC) within normal limits and seven workers with mild restriction. Early small airway obstruction was found in six workers. Regarding the on-site safety, an absence of barricades at two places near anaerobic sludge reactor and clarifier tank was of concern.Conclusions: The workers in STP are at risk of respiratory occupational hazards and should undergo pre-placement and routine health check-up for prevention of occupational hazards. Physical safety in terms of barricades at appropriate sites also needs attention.

Manejo respiratorio en atrofia muscular espinal: cambio de paradigma en la era de las nuevas terapias específicas / Respiratory care in spinal muscular atrophy in the new therapeutic era

Resumen: La atrofia muscular espinal (AME) es la enfermedad genética mortal más frecuente en lactantes, con severidad variable. Se clasifica en cuatro subtipos: tipo 0 de inicio prenatal y recién nacido ya afecta do, con ausencia de esfuerzo respiratorio y ningún desarrollo motor, tipo 1 de inicio en menores de 3 meses que no logran sentarse, tipo 2 que logran sentarse, pero no caminar y tipo 3 que consiguen caminar. La causa más seria de morbimortalidad es la neumonía y la insuficiencia respiratoria. La información a los cuidadores debe contemplarse desde el diagnóstico, para la toma de decisiones anticipadas. Los objetivos del manejo incluyen el estímulo de la tos, evitar la deformación de la caja torácica, la hipoventilación, y tratar oportunamente las infecciones respiratorias, el trastorno de de glución, el reflujo gastroesofágico y la malnutrición. El objetivo de esta actualización es discutir los nuevos desafíos en cuidados respiratorios con un enfoque preventivo, considerando la reciente dis ponibilidad de tratamientos específicos -oligonucleótidos antisentido nusinersen- y otros que están en desarrollo, incluída la terapia génica.

Abstract: Spinal muscular atrophy (SMA) is the first inherited cause of mortality in infants, with four subtypes: SMA0 prenatal onset, SMA1 babies less than 3 months non sitters, SMA2 sitters and SMA3 walkers. Pneumonia and respiratory insufficiency are the most severe complications. Informed parental de cisions are relevant. Respiratory management includes cough assistance, prevention of lung under development due to chest deformity, prompt treatment of respiratory infections, hypoventilation, swallow problems, gastro esophageal reflux and malnutrition. In view of the FDA and EMA approval of the nonsense oligonucleotides nusinersen, the first specific treatment for SMA and the future with gene therapy and others under development, we need to optimize preventive respiratory manage ment with the new standard of care.

Spirometric assessment of pulmonary functions in adult with documented primary hypothyroidism

Introduction: Hypothyroidism is a common endocrine problem, state of deficient thyroid hormones, may be result of many etiologies. Primary hypothyroidism is a subset of Hypothyroidism which accounts for 95% of the cases, only 5% are due to secondary causes. Respiratory manifestations are seldom the major complaints in hypothyroidism. Lung volumes are usually normal, but few studies have shown findings suggestive of restrictive pattern of impairment. This has been attributed to decrease in both expiratory and inspiratory muscle strength, alveolar hypoventilation due to depression of hypoxic and hypercapnic ventilatory drives. Aim of the Study: To study the pulmonary functions of individuals with primary hypothyroidism by performing spirometry, to compare the spirometric findings of primary hypothyroidism patients with euthyroid individuals. Materials and methods: Sample size of the study was around 50 patients. 25 patients were controls who were free from thyroid disease. 25 subjects were diagnosed primary hypothyroidism patients were included in the study. The patients and controls were evaluated as per the predesigned proforma and relevant investigations were done to assess their cardiac status and pulmonary status. Results: The FEV1, FVC, PEFR were found to be decreased and the FEV1/ FVC % was found to be increased in Primary hypothyroidism group when compared to control group. G Ramachandran, N. Chidambaram, S. Periyasamy, R. Santhaprabu. Spirometric assessment of pulmonary functions in adult with documented primary hypothyroidism. IAIM, 2016; 3(12): 115-122. Page 116 Conclusion: Pulmonary functions of individuals with primary hypothyroidism patients was by assessed by spirometry and compared with euthyroid individuals. Spirometry values were consistently lower in primary hypothyroidsm patients .Females are more affected than males. Spirometry values shows restrictive pattern.