ABSTRACT
Setting: The study was conducted at Mulago Hospital, Kampala, Uganda. Objective: As chronic respiratory disease (CRD) is a huge, growing burden in Africa, with few available treatments, we aimed to design and evaluate a culturally appropriate pulmonary rehabilitation (PR) program in Uganda for people with post-tuberculosis lung disorder (p-TBLD). Design: In a pre-post intervention study, a 6-week, twice-weekly PR program was designed for people with p-TBLD. Outcome measures included recruitment, retention, the Clinical COPD Questionnaire (CCQ), tests of exercise capacity, and biometrics. Given this was a developmental study, no formal statistical significance testing was undertaken. Results: In all, 34 participants started PR and 29 (85%) completed all data collection. The mean age of the 29 participants was 45 years, and 52% were female. The mean (95% confidence interval) CCQ score at baseline was 1.8 (1.5, 2.0), at the end of PR was 1.0 (0.8, 1.2), and at 6 weeks after the end of PR was 0.8 (0.7, 1.0). The Incremental Shuttle Walking Test (ISWT) was 299 m (268.5, 329.4) at baseline, 377 (339.6, 413.8) at the end of PR, and 374 (334.2, 413.5) at 6 weeks after the end of PR. Improvements were seen in measures of chest pain; 13/29 (45%) participants reported chest pain at baseline but only 7/29 (24%) at the end of PR, and in those with persistent pain, the mean pain scores decreased. Mild hemoptysis was reported in 4/29 (17%) participants at baseline and in 2/29 (7%) at the end of PR. Conclusion: PR for people with p-TBLD in Uganda was feasible and associated with clinically important improvements in quality of life, exercise capacity, and respiratory outcomes. PR uses local resources, requires little investment, and offers a new, sustainable therapy for p-TBLD in resource-limited settings. With the rising global burden of CRD, further studies are needed to assess the value of PR in p-TBLD and other prevalent forms of CRD.
Subject(s)
Exercise Therapy/methods , Lung/physiopathology , Patient Education as Topic , Self Care/methods , Tuberculosis, Pulmonary/rehabilitation , Adolescent , Adult , Aged , Chest Pain/etiology , Chest Pain/physiopathology , Chest Pain/rehabilitation , Exercise Test , Exercise Tolerance , Feasibility Studies , Female , Health Knowledge, Attitudes, Practice , Hemoptysis/etiology , Hemoptysis/physiopathology , Hemoptysis/rehabilitation , Humans , Male , Middle Aged , Quality of Life , Recovery of Function , Surveys and Questionnaires , Time Factors , Treatment Outcome , Tuberculosis, Pulmonary/complications , Tuberculosis, Pulmonary/diagnosis , Tuberculosis, Pulmonary/physiopathology , Uganda/epidemiology , Young AdultABSTRACT
Summary Transbronchial needle aspiration (TBNA) of the hilar and mediastinal lymph nodes and lung masses is a powerful tool in the diagnostic evaluation of mediastinal adenopathies including malignancies. As its use becomes more widespread, few cases have been reported with complications. We present a case of a 57-year-old man who was transferred to our institution for uncontrolled haemoptysis following endobronchial ultrasound-guided TBNA. At our institution, emergent bronchoscopy revealed a large clot distal to the right upper lobe bronchus without a visible fistula tract. A CT pulmonary angiogram and a subsequent pulmonary angiogram showed an aneurysm originating from the right superior pulmonary vein. Management was conservative with strict blood pressure control and lowering the left atrial pressure allowed spontaneous resolution of the bleed.
Subject(s)
Bronchoscopy/adverse effects , Endoscopic Ultrasound-Guided Fine Needle Aspiration/adverse effects , Hemoptysis , Lymph Nodes/pathology , Mediastinal Diseases/pathology , Hemoptysis/etiology , Hemoptysis/rehabilitation , Humans , Iatrogenic Disease , Lymph Nodes/diagnostic imaging , Male , Middle Aged , Treatment OutcomeSubject(s)
Cystic Fibrosis/rehabilitation , Physical Therapy Modalities/methods , Positive-Pressure Respiration/methods , Adolescent , Adult , Breathing Exercises , Drainage, Postural , Evidence-Based Medicine , Exercise Therapy , Female , Hemoptysis/rehabilitation , Humans , Infant, Newborn , Male , Pneumothorax/therapy , Positive-Pressure Respiration/instrumentation , Urinary Incontinence, Stress/therapyABSTRACT
La hemoptisis es un evento raro, pero si es masiva, amenaza la vida del paciente y la causa de murte usualmente es por aspiración de sangre. La identificación del cuadro y la clasificación inicial deben realizarse rápida y simultáneamente con las medidas tendientes a controlar el sangrado y a mantener la vía aérea permeable. Esto dependerá de la cantidad de sangre expectorada, de la patología de fondo, y de la oportunidad con que se inicien las medidas anteriores. Aunque la cirugía permanece como la terapéutica definitiva, las medidas conservadoras usualmente controlan el sangrado agudo y proporcionan tiempo para otras alternativas terapéuticas especialmente en pacientes que no son candidatos para cirugía. Con esta clasificación y plan de manejo, esperamos facilitar la toma de decisión de un Servicio de Urgencias
