Tobacco consumption is one of the most common preventable cause of premature deaths worldwide. Persisting effects of exposure to tobacco smoke on children and adolescents are apparent during ...pregnancy and in early infancy, passive exposure to environmental tobacco smoke in home and elsewhere, and active smoking during adolescence. While, lung development in these stages of growth is not complete, tobacco smoke puts children and adolescents in danger of severe respiratory diseases and may interfere with the growth of their lungs. Active tobacco consumption by adolescents may have immediate adverse health outcomes such as addiction, impaired lung growth or reduced lung function. Much of the current evidence comes from longitudinal and cross-sectional longitudinal observational studies and propose that the strongest associations with smoke exposure are in the pregnancy and early childhood. The association of nicotine with respiratory system among children and adolescents is less clearly understood and the evidence primarily comes from in vitro and animal studies.
Published data indicate that during the last decades there is a possible change in the pattern of sensitization to different aeroallergens in adult population with atopy. The aim of this ...investigation was based on the hypothesis that during last 15 years there has been a change in the structure of prevalence of sensitization to different aeroallergens in adult population of Zagreb and its surroundings with atopy. Medical records from outpatient allergy clinic were screened for the period 1991-2004. We included 794 patients during years 1991-1994, 814 patients during years 1995-1999, and 969 patients during years 2000-2004. Following data were analyzed: age, gender, education level, residence, referral diagnosis, dominant symptoms, results of skin-prick test (SPT), total and specific serum immunoglobulin E. As risk factors for allergic sensitization we determined the decade of birth (p < 0.0001), male gender (p < 0.008), level of education (p < 0.0001), and place of residence (p < 0.05). Proportion of sensitized individuals to pollen significantly increased from the period 1991-1994 towards 2000-2004 (p < 0.001 for the trend) with a significant increase in the proportion of sensitized individuals to weed pollen (p = 0.002 for the trend) while the proportion of sensitized to other two groups of pollen (grasses and trees) was not significantly different. A significant increase in the proportion of sensitized individuals was determined for sensitization to ragweed pollen (p = 0.004 for the trend), and to mugwort (p = 0.005 for the trend). Despite all its limitations primarily based on the selection bias the results of this study are conclusive about the significant change in the proportion of sensitization to different aeroallergens and different pollen groups and individual pollen species during the investigated 15-year time interval.
During a two-year period (2001-2003), 464 patients were treated for tuberculosis at Jordanovac Department for Lung Diseases in Croatia. Besides pulmonary tuberculosis in 97.7% of patients, patients ...were also treated for tuberculous pleurisy (0.9%), tuberculous laryngitis (0.6%), tuberculous meningitis (0.2%), tuberculous pericarditis (0.2%) and urogenital tuberculosis (0.4%). Out of the total number of patients, 57.3% declared themselves to be active smokers (men were predominant and made up to 80.8%) and 20.9% to be active alcohol consumers. Both risk factors, i.e. smoking and alcohol consumption, were present in 15.1% of all patients. The most common comorbidities were diabetes mellitus (30.4%), cardiac diseases (11.2%) and chronic obstructive pulmonary disease (8.0%). Lung carcinoma was the most common malignant disease (n=51), with
Mycobacterium tuberculosis
isolated in 33% of them. Seventy-two of 464 (15.5%) patients had recurrences of tuberculosis. Of these, 30.5% had one of the risk factors (20.8% were smokers and 9.7% consumed alcohol), while 32.5% of patients had both risk factors. In conclusion, cigarette smoking was proved to be the most significant risk factor for development of pulmonary tuberculosis and its recurrence.
What is known and objectives: Multiple adverse drug reactions (ADRs) are expected, and thus should be prevented in the elderly comorbid patient on polypharmacy. Rosuvastatin is commonly prescribed ...for the treatment and prevention of atherosclerotic diseases, and in rare cases, is associated with rhabdomyolysis. Maprotiline is a tetracyclic antidepressant, infrequently used in the United States, but seemingly more broadly in European countries. Acute colonic pseudo-obstruction (Ogilvie's syndrome) caused by maprotiline has thus far, to our knowledge, not yet been described in the literature.
We present a unique case of synchronous rhabdomyolysis and Ogilvie's syndrome in an 80-year-old lung cancer survivor following a recent ischemic stroke for which she was prescribed clopidogrel and rosuvastatin for secondary prevention, and maprotiline for post-stroke, new-onset insomnia and anxiety. The ADRs resolved on removal of the offending agents and initiation of conservative treatment. Retrospective pharmacogenetic testing of the patient's drug-metabolizing enzymes and transporters was performed to guide further management and prevent future potential drug interactions and ADRs. What is novel and conclusions: This is an interesting, albeit unfortunate, complex case that depicts the risk of rare adverse effects to medications and their potential relationship to pharmacogenetics. The impact of anticholinergic side effects of antidepressants on gastrointestinal motility, risk of myopathies with statins, increased susceptibility to ADRs caused by drug-drug interactions, and the utility of pharmacogenomic testing are discussed. The question whether commercially available pharmacogenomic tools are relevant for everyday use to direct patient care and reduce harmful drug-drug interactions is addressed and warrants further research. .
Adie's syndrome (AS) and paraneoplastic sensorimotor neuropathy with cerebellar ataxia (PSN CA) are extremely rare, rapidly progressive, autoimmune diseases associated with the development of ...antibodies against neuronal-specific Hu proteins that are abnormally expressed in small-cell lung cancer (SCLC). We herein present the unique case of a 55-year-old obese woman, previous heavy smoker, who, during treatment with standard cisplatin-etoposide chemotherapy for limited-stage SCLC, developed simultaneous AS and worsening symptoms consistent with PSN CA that led to significant neurological disability and severe axonal electrophysiological pattern on nerve conduction studies. Serology confirmed the presence of low-titre type 1 antineuronal nuclear antibodies (ANNA-1), previously referred to as anti-Hu antibodies. Following plasmapheresis, immunosuppressive therapy and physical rehabilitation, the neurological symptoms progressively improved. The tumour completely regressed, with no recurrence detected on subsequent radiological examinations. The aim of this case was to highlight the importance of a multidisciplinary team approach for early recognition and rapid treatment of paraneoplastic neurological syndromes (PNS) as key to achieving significant recovery and marked improvement of the neurological deficit. This report extends the literature by confirming earlier studies showing that the presence of serum ANNA-1 in SCLC, an aggressive type of pulmonary carcinoma that is challenging to treat, may portend a more favourable prognosis and response to chemotherapy. Thus, patients with SCLC and new-onset neurological symptoms should be tested for ANNA-1. The role of a multimodality approach to treating PNS is also emphasized.
Pneumonije su jedna od najtežih komplikacija KOPB-a i ujedno jedna od najčešćih infekcija u bolesnika s njime, koja znatno pridonosi pogoršanju osnovne bolesti. Upale pluća u bolesnika s KOPB-om ...pokazuju određenu specifičnost u odnosu prema općoj populaciji ne samo u pogledu najčešćih uzročnika, simptoma bolesti i razine upalnog odgovora već i duljine liječenja i terapijskog pristupa. Pneumonije u bolesnika s KOPB-om treba pravodobno dijagnosticirati i liječiti te razlikovati od akutnih egzacerbacija KOPB-a, a unatoč tomu što dovode do težega kliničkog tijeka i duljeg liječenja s češćim hospitalizacijama ne utječu znatno na ukupni mortalitet bolesnika s KOPB-om.
A case is presented of pulmonary botryomycosis in a 61-year-old man with a massive right-side pulmonary infiltrate which looked like a tumor (on X-ray). Microscopic examination of a transbronchial ...biopsy specimen revealed chronic suppurative inflammation, which did not regress despite intensive antibiotic therapy for a period of two months. Histological analysis of specimens taken during surgery for hemoptysis revealed pulmonary botryomycosis. The disease was diagnosed on the basis of characteristic eosinophilic granules in which the bacteria are surrounded by protein material (Splendore-Hoeppli phenomenon). Pulmonary actinomycosis was excluded. The case demonstrates that pulmonary botryomycosis can have the appearance of a mass which resembles pulmonary carcinoma on X-ray, and may also be mistaken for pulmonary actinomycosis. For this reason, pulmonary botryomycosis, although rare, should be excluded during differential diagnosis of hemoptysis or pulmonary infiltrates.
The platypnea-orthodeoxia syndrome is a rare condition characterized by postural dyspnea and hypoxemia that disappear or diminish in lying position, so it can be difficult to recognize without close ...assessment of the patient's pattern of dyspnea. The syndrome is commonly associated to an intra-cardiac right-to-left shunt through a patent foramen ovale as the most frequently reported site of the shunt. Platypnea-orthodeoxia syndrome can be the cause of refractory hypoxemia leading to pulmonary hypertension, whereby, if suspected, contrast echocardiography in supine as well as in upright position should be performed. We are presenting a case of an unrecognized platypnea-orthodeoxia syndrome because of a patent foramen ovale and atrial septal aneurysm, with developed chronic complications due to long-standing hypoxemia. This case highlights the need of a high index of suspicion to diagnose the syndrome on time and the necessity of careful echocardiographic evaluation.
Tijekom dvije godine (2001.-2003.) u Klinici za plućne bolesti “Jordanovac”, Zagreb, Hrvatska, od tuberkuloze je liječeno 464 bolesnika. Osim najčešće plućne tuberkuloze u 97,7% bolesnika, oboljeli ...su liječeni i od eksudativnog tuberkuloznog pleuritisa (0,9%), laringealne tuberkuloze (0,6%), tuberkuloznog meningitisa (0,2%), perikardijalne tuberkuloze (0,2%) te tuberkuloze koja je zahvatila urogenitalni sustav (0,4%). Od ukupnog broja bolesnika 57,3% ih se izjasnilo kao aktivni pušači (muškarci 80,8%), dok je 20,9% deklarirano kao aktivni konzumenti alkohola. Ukupno je 15,1% bolesnika imalo oba rizična čimbenika u anamnezi, tj. i aktivno pušenje cigareta i konzumaciju alkohola. Od komorbiditeta najčešća je bila šećerna
bolest u 30,4% bolesnika, od srčanih bolesti bolovalo je 11,2% bolesnika, dok je kronična opstruktivna plućna bolest bila prisutna u 8% bolesnika. Karcinom pluća bio je najčešće zastupljen među malignim bolestima. Od ukupnog broja oboljelih od karcinoma pluća (51 bolesnik), Mycobacterium tuberculosis izolirali smo u 33% bolesnika. Recidivi tuberkuloze su zabilježeni u 72 (15,5%) bolesnika. Jedan rizični čimbenik imalo je 30,5% bolesnika: pušača je bilo 20,8%, dok je alkohol konzumiralo 9,7% bolesnika, a 32,5% bolesnika imali su oba rizična čimbenika. Zaključno, pušenje cigareta pokazalo se kao najznačajniji rizični čimbenik za razvoj plućne tuberkuloze, kao i za pojavu recidiva tuberkuloze.
Published data indicate that during the last decades there is a possible change in the pattern of sensitization to different
aeroallergens in adult population with atopy. The aim of this ...investigation was based on the hypothesis that during
last 15 years there has been a change in the structure of prevalence of sensitization to different aeroallergens in adult population
of Zagreb and its surroundings with atopy. Medical records from outpatient allergy clinic were screened for the
period 1991.–2004.We included 794 patients during years 1991–1994, 814 patients during years 1995–1999, and 969 patients
during years 2000–2004. Following data were analyzed: age, gender, education level, residence, referral diagnosis,
dominant symptoms, results of skin-prick test (SPT), total and specific serum immunoglobulin E. As risk factors for allergic
sensitization we determined the decade of birth (p<0.0001), male gender (p<0.008), level of education (p<0.0001),
and place of residence (p<0.05). Proportion of sensitized individuals to pollen significantly increased from the period
1991–1994 towards 2000–2004 (p<0.001 for the trend) with a significant increase in the proportion of sensitized individuals
to weed pollen (p=0.002 for the trend) while the proportion of sensitized to other two groups of pollen (grasses and
trees) was not significantly different. A significant increase in the proportion of sensitized individuals was determined
for sensitization to ragweed pollen (p=0.004 for the trend), and to mugwort (p=0.005 for the trend). Despite all its limitations
primarily based on the selection bias the results of this study are conclusive about the significant change in the proportion
of sensitization to different aeroallergens and different pollen groups and individual pollen species during the
investigated 15-year time interval.
PDF
