Τhe Co-Existence of Obstructive Sleep Apnea and Bronchial Asthma: Revelation of a New Asthma Phenotype?

Bronchial asthma (BA) and obstructive sleep apnea (OSA) are common respiratory obstructive diseases that may coexist. It would be interesting to study the possible influence of that coexistence on both diseases. Until now, reviews focused mainly on epidemiology. The aim of this study was to review the literature in relation to epidemiology, pathophysiology, consequences, screening of patients, and treatment of the coexistence of OSA and BA. We pooled studies from the PubMed database from 1986 to 2019. OSA prevalence in asthmatics was found to be high, ranging from19% to 60% in non-severe BA, reaching up to 95% in severe asthma. Prevalence was correlated with the duration and severity of BA, and increased dosage of steroids taken orally or by inhalation. This high prevalence of the coexistence of OSA and BA diseases could not be a result of just chance. It seems that this coexistence is based on the pathophysiology of the diseases. In most studies, OSA seems to deteriorate asthma outcomes, and mainly exacerbates them. CPAP (continuous positive airway pressure) treatment is likely to improve symptoms, the control of the disease, and the quality of life in asthmatics with OSA. However, almost all studies are observational, involving a small number of patients with a short period of follow up. Although treatment guidelines cannot be released, we could recommend periodic screening of asthmatics for OSA for the optimal treatment of both the diseases.

A fatal case of cytomegalovirus disease in an immunocompetent young woman: a case report.

Cytomegalovirus can cause severe disease with adverse outcome in immunocompromised patients. Severe cytomegalovirus infection in previously healthy individuals is rare. Here we present an unusual case of cytomegalovirus infection with neurological and pulmonary involvement in a previously healthy young woman with no history of immuno-suppression. Unfortunately, the disease followed a malignant course and despite the efforts of the medical staff the patient died. CMV infection should be considered in the diagnostic work-up of immunocompetent patients with fever and unexplained neurological or pulmonary manifestations. Although uncertainty exists regarding the optimal treatment of CMV in healthy individuals, early recognition and administration of ganciclovir may prevent a fatal outcome.

Drug resistant pulmonary tuberculosis mimicking a flu-like syndrome in an elderly man: an atypical case report.

Despite remarkable reductions in its incidence and mortality, tuberculosis (TB) continues to be a major health burden globally. Pulmonary TB occasionally challenges physicians, either due to TB's ability to mimic many different conditions or because of the increasing number of drug-resistant Mycobacterium tuberculosis isolates. Here we present a case of pulmonary TB with both characteristics and a brief review of the relevant literature.

Legionella Pneumophilla Infection Masquerading as Acute Cholecystitis.

Legionella pneumophilla represents a relatively common cause of community acquired pneumonia with high mortality related burden if not promptly diagnosed and treated with appropriate antibiotics. Clinical characteristics of Legionella infection are often non-specific making accurate diagnosis challenging. We report a case of a middle aged immunocompetent woman referred to our department via her gene ral practitioner with a history of fever and abdominal pain located in the right upper abdominal quadrant. Initial diagnostic work up disclosed a moderate elevation of inflammation markers and chololithiasis. The paucity of respiratory symptoms led initially to an altered presumed diagnosis of acute cholecystitis. Development of pulmonary symptoms during hospitalization raised the suspicion of Legionella community acquired pneumonia. The diagnosis was later confirmed by serology.

Helicobacter pylori seroprevalence in patients with chronic obstructive pulmonary disease.

An increased seroprevalence of Helicobacter pylori (H. pylori) and especially of the high virulent cytotoxin-associated gene-A (CagA) positive strains has been found in several extragastroduodenal pathologies, characterized by activation of inflammatory mediators. Moreover, it has been reported that the risk of chronic bronchitis may be increased in H. pylori infected patients. The aim of the present study was to assess the seroprevalence of H. pylori and in particular of CagA-positive virulent strains in patients with chronic obstructive pulmonary disease (COPD). We evaluated 126 COPD patients (88 males and 38 females, aged 61.3+/-8.1 years) and 126, age and sex-matched, control subjects. All subjects enrolled underwent an enzyme-linked immunosorbent assay (ELISA) IgG serologic test for H. pylori and CagA protein. The prevalence of H. pylori infection in patients and controls was 77.8% and 54.7%, respectively (P<0.001) and that of CagA-positive H. pylori infection was 53.9% and 29.3%, respectively (P<0.001). Moreover, COPD patients had a significantly increased mean serum concentration of both anti-H. pylori IgG (118.3+/-24.4 vs. 61.9+/-12.9U/ml, P<0.001) and anti-CagA IgG antibodies (33.8+/-3.4 vs. 19.0+/-1.5U/ml, P<0.001). Finally, no statistically significant difference, as regards the spirometric values, was detected between H. pylori infected COPD patients and uninfected ones. In conclusion, H. pylori infection may be associated with COPD. Further studies should be undertaken to clarify the potential underlying pathogenetic mechanisms.

Helicobacter pylori seroprevalence in patients with lung cancer.

AIM: To assess Helicobacter pylori (H pylori) seroprevalence in a cohort of Greek patients with lung cancer. METHODS: Seventy-two lung cancer patients (55 males and 17 females, aged 58.2+/-11.7 years) and 68, age and gender-matched, control subjects were enrolled. All subjects underwent an enzyme-linked immunosorbent assay IgG serologic test for H pylori diagnosis. RESULTS: A correlation between age and H pylori IgG level was detected for both lung cancer patients (r = 0.42, P = 0.004) and controls (r = 0.44, P = 0.004). Seropositivity for H pylori did not differ significantly between patients with lung cancer and controls (61.1% vs 55.9%, P>0.05). Concerning the mean serum concentration of IgG antibodies against H pylori, no significant difference between the two groups was detected (32.6+/-19.1 vs 27.4+/-18.3 U/mL, P>0.05). CONCLUSION: No significant association between H pylori infection and lung cancer was found.