The Nutritional Status of Chronic Obstructive Pulmonary Disease Exacerbators.

Introduction: Malnutrition is underdiagnosed in chronic obstructive pulmonary disease. Objectives: This study aimed to evaluate the nutritional status of COPD patients and the link between dyspnea and nutritional status. Methods: This longitudinal observational study included patients hospitalized with exacerbated COPD. Nutritional status was assessed using Nutrition Risk Screening 2002, anthropometric, and biochemical assessments, in the first 48 hours of hospitalization. Results: Thirty patients were evaluated. According to the Nutrition Risk Screening 2002, half of the patients were at increased risk of malnutrition. 36.7% were classified as malnourished if we only considered the body mass index. From the evaluation of the tricipital skin fold, 69.0% were classified as malnourished, with 48.3% having severe malnutrition. According to the serum albumin level, 29.6% had malnutrition criteria. A significant association between dyspnea and increasing age (p=0.037) was found. There was a strong association between the fold classification and the degrees of severity of dyspnea (Fisher exact test: 13.60, p=0.001, V Cramer = 0.826). Most patients were malnourished and had higher grades of dyspnea. Tricipital skinfold reflects subcutaneous adipose tissue; this anthropometric measurement seems to be a good method to classify the nutritional status of COPD patients. It classified the biggest portion of patients as malnourished. Conclusion: The number of patients classified as malnourished changed with the method under analysis. The tricipital skin fold parameter was strongly associated with the dyspnea score. Most patients had adipose tissue and muscular mass depletion.

Beyond the skin - A rare case of primary pulmonary melanoma and endobronchial aspergilloma.

Melanoma is an aggressive skin tumor, but it may be present in other locations. Primary lung melanoma and endobronchial aspergilloma are rare entities. The authors report a case of a 72-year-old, asthmatic woman, with worsening of her respiratory complaints. Imaging revealed finger in glove sign at the left hemithorax. Bronchoscopy revealed an elongated mass with evidence of Aspergillus. Despite endoscopic mass removal, the patient maintained the nodular imaging at the left hemithorax. She underwent thoracic surgery, and the histological evaluation identified malignant melanoma. After undergoing a thorough evaluation, we excluded other melanocytic lesions, and assumed the diagnosis of primary malignant lung melanoma. This case demonstrates a rare association between endobronchial aspergilloma and primary lung melanoma, raising awareness of considering the co-existence of lung tumor in the presence of endobronchial aspergilloma, and showing endobronchial aspergilloma mimicking malignant lesions.

From the Heart to the Lung: A Case of Drug Toxicity.

BACKGROUND Amiodarone is an anti-arrthymic drug used to treat and prevent several types of dysrhythmias. This drug is known for multiple-organ toxicity. Lung toxicity occurs in about 1% to 5% of cases. A wide variety of lung manifestations have been described, from mild to severe forms. Pulmonary toxicity can be acute, sub-acute, or chronic. Amiodarone-induced lung toxicity is a diagnosis of exclusion. The main treatment is discontinuation of the drug. Lung disease may progress initially due to the prolonged half-life and the accumulation of amiodarone in adipose tissue. Regarding the prognosis, lung toxicity can be reversible, but in some cases, it is irreversible and is sometimes fatal. The risks associated with its use must always be considered. Amiodarone should only be used for short periods. CASE REPORT The authors present a case of a 71-year-old female patient, taking amiodarone 200 mg/day for 18 months. The patient presented with amiodarone-induced lung toxicity. After drug withdrawal, without corticosteroid therapy, we observed clinical, functional, and radiological improvement. CONCLUSIONS This case shows that not all cases of amiodarone-induced lung toxicity require corticosteroid therapy, and highlights that is important to consider this diagnosis in patients on amiodarone therapy with respiratory symptoms.

Salmonella empyema an unusual infection - A case report.

Pleuropulmonary Samonella infections are very rare and are associated with high mortality. We present a case of empyema to Salmonella in an 83-year-old male patient, with uncontrolled hematological disease. The patient presented with a one-week history of fever, productive cough with purulent sputum, dyspnea, and pleuritic pain localized to the right hemithorax. He denied having nausea, vomiting, and diarrhea. No history of smoking or respiratory diseases. Chest imaging showed a right loculated pleural effusion with adjacent parenchymal consolidation. Blood test revealed anemia without leukocytosis with elevated C-reactive protein (36.2 mg/dL). A chest tube was placed, with drainage of purulent fluid and empiric antibiotic therapy with ceftriaxone and clindamycin was started. Pleural fluid and blood cultures were positive for Salmonella serotype Enteritidis. The stool cultures were negative. Due to slow improvement, clindamycin was suspended and ciprofloxacin was initiated. The patient showed clinical and laboratory improvement. After seven weeks of antibiotic therapy, he presented with negative blood cultures and significant imaging improvement. The patient was discharged. This case describes a positive outcome in an unusual infection with a high mortality caused by non-typhoid Salmonella.