Summary

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Tuberculosis (TB) is an infectious and contagious disease caused by Mycobacterium tuberculosis, and it mainly affects the lungs. As Romania has consistently ranked first in the European Union (EU) in terms of the incidence and prevalence of TB in the past years, this paper aims to bring to the attention of physicians the new therapeutic regimens and ways to approach patients with multidrug resistant TB and extended resistance.
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“Carol Davila” University of Medicine and Pharmacy

The Multidisciplinary Research Department

New therapeutic approach for multidrug resistant pulmonary tuberculosis

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<bold>Introduction:</bold> Spirometry is a widely used pulmonary function test that requires several steps to be performed. In Thailand, there is only limited amount of data on the success rate and associated factors in children.
<bold>Objective:</bold> To determine the success rate and factors affecting spirometry performance.
<bold>Method:</bold> This cross-sectional study involved participants aged 5–18 years who underwent spirometry testing at the Naresuan University Hospital between 1 January 2015 and 31 December 2020. The subjects were divided into success and failure groups using the American Thoracic Society and European Respiratory Society 2005 criteria for acceptability and repeatability. The data collected include general characteristics, spirometry techniques and processes to determine the success rate and its associated factors.
<bold>Results:</bold> A total of 132 subjects underwent spirometry testing, with a success rate of 71.2%. The success group’s mean age, weight and height were significantly greater than the failure group. The most unsuccessful spirometry step in the failure group was a prolonged exhalation. Between the two groups, there was a statistically significant difference in the plateau phase of the volume time curve (85.1% vs. 55.3%, P &lt; 0.001).
<bold>Conclusion:</bold> Children’s age, weight and height are all considered predictor variables of success. The most frequently step failure in spirometry tests is prolonged exhalation phase. However, the plateau on volume time curves is a critical component of success. To achieve optimal success, encourage children to blow vigorously as long as they can be stable throughout the prolonged exhalation phase and assess their ability to follow instructions.
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The success rate of spirometry tests in Thai children

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Cryptogenic organising pneumonia (COP) is an interstitial lung disease, with an unknown aetiology. Treatment is based on oral corticotherapy, starting with attack doses given for 2–6 weeks, followed by gradual tapering over a period of 3–6 months. Relapses are common, especially in the first year. A 51-year-old patient, former smoker, without exposure to noxious substances, presented to the hospital in January 2020 with fever, dry cough and malaise. On chest radiography, lesions suggestive of bronchopneumonia were revealed and antibiotic treatment was started. The patient did not respond to treatment and chest Computed tomography (CT) was performed, which detected pulmonary condensations, predominantly with a subpleural disposition, predominantly in the lower lobes, as well as pleural effusion and minimal pericarditis. Due to the unfavourable disease evolution despite treatment and according to other investigation results, COP diagnosis was raised and oral corticotherapy was prescribed, with a favourable response. The patient complained of reappearance of the initial symptoms at dose weaning and she was reassessed by CT in June 2020. The Coronavirus Disease 2019 (COVID-19) pandemic raised the suspicion of a severe acute respiratory syndrome coronavirus-2 (SARS-COV2) infection, which was infirmed later. Corticotherapy was resumed, and at a check-up after 10 months, broncho-alveolar lavage was performed, with results within normal limits. The evolution of the patient was favourable. In conclusion, in the case of a pneumonia in which there is a discrepancy between the clinic, biologic and imagistic (possibly with a migratory pattern) and the response to treatment, COP must also be considered. Relapses are relatively common, and may occur both during corticotherapy dose reduction and after the end of treatment.
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University of Medicine and Pharmacy “Victor Babeș”

Cryptogenic organising pneumonia – a continuous challenge. Case report

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Cough is a natural defence mechanism of the lungs to prevent aspiration and to keep the airway clean. Cough, wheezing and shortness of breath are common symptoms of asthma. Cough-variant asthma is one of the phenotypes of asthma with the main symptom of cough without shortness of breath and wheezing. Cough-variant asthma is largely observed in patients with bronchial hyperresponsiveness who experience cough due to innocuous stimuli, and it is associated with a family history and seasonal allergy. In the present study, in patients with cough-variant asthma, no abnormalities were found during the lung function test, particularly forced expiratory flow in the first second (FEV1) or peak expiratory flow (PEF), although these values were lower than those in normal individuals. A bronchial provocation test using methacholine is needed to assess airway hyperresponsiveness, and depending on the outcome of the test, an assessment can be made as to the probability of the patient requiring a diagnosis of cough-variant asthma. Administration of inhalation therapy with bronchodilators and corticosteroids is the mainstay of management in patients with cough-variant asthma presenting with the symptom of persistent cough. Until now, there have been no specific guidelines for drug selection, dose and duration of inhaled corticosteroid use in cough-variant asthma. If symptoms do not resolve with inhaled corticosteroid monotherapy, consideration may be given to increase the inhalation dose or to add other drugs such as long-acting B2 agonists, slow-release theophylline or leukotriene receptor antagonist (LTRA).
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Diagnosis and management of cough-variant asthma

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The article presents the case of a 66-year-old non-smoking female patient with HIV-negative status. In 2015, she was diagnosed with chronic lymphocytic leukaemia (CLL) at its early stages, with specific complete blood count changes, peripheral lymphadenopathy and hepatomegaly. No specific treatment was recommended at that time. In July 2018, the diagnosis of non-Hodgkin lymphoma (NHL) IV B stage, with the involvement of all groups of peripheral lymph nodes, was confirmed histologically. No episodes of neutropaenia were recorded. Chemotherapy was initiated. Then, 3 months later, radiological examination revealed a bilateral pulmonary nodular dissemination in the upper lobes, and tuberculous aetiology was confirmed using sputum microscopy and cultural methods (a pansensitive strain). At the end of 8 months of antituberculosis treatment, chest X-ray revealed that apical lung consolidation had diminished, while sputum conversed after 4 months of treatment. After 3 months, the patient presented to the pneumology clinic with haemoptysis. CT revealed bilateral pulmonary consolidation, with cavitation in the left upper lobe and nodules in the surrounding region. Relapse of tuberculosis was excluded microbiologically [this was done using microscopy, cultures and molecular genetic examinations of the sputum and bronchoalveolar lavage (BAL) fluid]. A resistant strain of Staphylococcus aureus (MRSA) was identified, with susceptibility to amikacin and tobramycin. Treatment with amikacin had a positive clinical and imaging effect.
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Department of Internal Medicine, Division of Pneumology and Allergology

State University of Medicine and Pharmacy ‘Nicolae Testemitanu’

Diagnostic challenge in an immunocompromised patient

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<bold>Introduction:</bold> Tuberculosis (TB), a common condition worldwide, is still among the main infectious diseases with high mortality rates, both in adults and infants. Drug-resistant tuberculosis (DR-TB) drugs, revised by the World Health Organization (WHO) in 2018, are a prolonged and complex therapy associated with many adverse drug effects (ADEs).
<bold>Aim:</bold> To systematically review the ADEs of second-line anti-TB drugs reported in multicentric studies published after the latest WHO guidelines, compared with those from clinical trials published before 2018.
<bold>Material and methods:</bold> A PubMed search, using keywords (TB OR DR-TB) AND (adverse effects) AND “second-line anti-TB drugs”, resulted in 56 studies. Only two studies, published after the last update of WHO guidelines in 2018, reported ADEs.
<bold>Results:</bold> A total of 223 participants were included in the two selected studies. The use of multidrug regimens has been associated with an increased incidence of ADEs: 42 ADEs were recorded in 30 patients (26.3%) in the first study, while all patients had at least one ADE that occurred or worsened during treatment; and 19 (17%) had severe ADEs in the second study. However, both studies had a good favourable outcome rate (90% and 79.8%, respectively). Gastrointestinal disturbances, hepatotoxicity, headache and dizziness are the most common ADEs induced by a majority of second-line DR-TB treatments. A special attention should be given in the case of association of drugs determining QT interval (QT) prolongation on electrocardiogram, or psychiatric disorders.
<bold>Conclusions:</bold> Proper strategies about ADE management have to be planned for timely detection of the possible ADEs that can be induced by second-line anti-TB therapy.
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“Grigore T. Popa” University of Medicine and Pharmacy Iași

Department of Morpho-Functional Sciences II – Pharmacology and Clinical Pharmacology

at “Grigore T. Popa” University of Medicine and Pharmacy Iași

Adverse effects induced by second-line antituberculosis drugs: an update based on last WHO treatment recommendations for drug-resistant tuberculosis

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Bronchial asthma is defined as a chronic inflammatory process of the airway that causes a simultaneous increase in airway hyperactivity that leads to recurrent attacks of noisy breathing, breathlessness, chest tightness and coughing, particularly at night or in the early morning. The survey aims to study parents’, ideas and perceptions about their children’s asthma. This study was conducted by direct interviewing of 150 parents of asthmatic children with a cross-sectional study on asthmatic children aged 1–14 years who were attending outpatient departments, hospital wards and private clinics from the 1 September 2019 to 1 July 2020 at Basrah city, Iraq. The questionnaire included a review of parents,’ beliefs on the aetiology, naming and trigger factors of their children’s asthma. Another part of the questions was regarding the usage of long-term asthma medications and phobia regarding their side effects. Findings from this study revealed that most parents could not identify asthma by its name because only 39 (26%) of them named the disease as asthma; 94 (62.7%) parents called the disease allergic bronchitis. The aetiology of childhood asthma was considered to be hereditary by most parents, i.e. 108 (72%), and the main trigger factor mentioned by parents for acute exacerbation of asthma was respiratory tract infections [115 (76.7%)]. Only 47% of the patients were using long-term asthma medications, with parents, concern on drug safety was specified by 48 (31.9%) of them as phobia regarding drug addiction [20 (13.3%)], phobia regarding palpitation by 13 (8.6%), and remaining 15 (10%) had phobia regarding growth failure effect from steroids. Most of the parents had misperceptions and inadequate information about the pathogenesis and the aetiology of childhood asthma. There were a significant number of parents who had a concern about childhood asthma drug safety.
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Parental perception and ideas about the childhood asthma

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Hydatid cyst is a parasitic disease which occurs in multiple locations. The pulmonary localisation is preferential and responsible for an important symptomatology, being the second localisation after the hepatic one, which in most cases evolves asymptomatically. We present the case of a 24-year-old patient, who is a non-smoker and has had exposure to respiratory allergens (cat hair and dog hair), and who was admitted to the Pneumology Hospital with the complaints of cough with mucopurulent sputum and minimal haemoptysis and mild fever (37.1°C). It was reported that 3–5 weeks before hospitalisation, the patient had presented with an episode of vomiting, in moderate amounts with a typical appearance, but in the current context of the Coronavirus Disease-2019 (COVID-19) pandemic, he had delayed his presentation to the hospital. On clinical evaluation, the patient presented with diminished right basal vesicular murmur with overlying crackling rales. Following the investigations, the postero-anterior pulmonary radiography describes, at the level of the right lung, a hydro-aerial image with an uncertain appearance of unspecified aetiology. In this context, a native chest tomography (CT) was performed, which revealed a cystic formation at the level of the middle lobe, with thin walls and a prolific membrane detached inside, which are suggestive aspects for a hydatid cyst. Subsequently, a surgical consultation was performed, which concluded the superinfection of the cyst by a secondary lung abscess and the need for lobectomy. The peculiarity of the case consists in the appearance of persistent symptomatology and complications in a young patient without comorbidities and risk factors, and the fact that an accurate diagnosis was delayed because of the patient’s delayed presentation in the hospital in the context of the COVID-19 pandemic.
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“Iuliu Hatieganu” University of Medicine and Pharmacy Cluj-Napoca

Diagnosis and management challenges of a pulmonary hydatid cyst in the context of the COVID-19 pandemic – case presentation

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<bold>Introduction:</bold> Upper-airway foreign bodies are a common condition in the emergency room, which can lead to death among different-aged populations, and a fast clinical recognition and management have led to improvement in the outcomes.
<bold>Objective:</bold> To present a clinical case of a male patient with an upper-airway foreign body, which only required clinical evaluation before surgical management.
<bold>Clinical case:</bold> We report the case of an 8-year-old Hispanic boy, who presented to the emergency room with upper respiratory symptoms, including dry cough, dysphagia, and chest discomfort; after clinical evaluation, a diagnosis of an upper-airway foreign body was made; the patient was taken to the operating room, and a tracheal foreign body was removed using rigid bronchoscopy. The post-operative course was uneventful, and the patient was discharged.
<bold>Discussion:</bold> The physiopathology, diagnosis, and management based on the presented case are discussed.
<bold>Conclusion:</bold> A good clinical history, along with a thorough physical examination and a high index of suspicion from the clinician, is enough for achieving a diagnosis, facilitating early management and reducing complications.
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Department of Surgery, Facultad de Ciencias de la Salud

Universidad del Sinu Elias Bechara Zainum

Upper-airway foreign bodies: is a clinical approach enough for proceeding with invasive management? Evidence from a case

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Pneumologia

 Pneumologia is the journal of the Romanian Society of Pneumology, being continuously edited since 1951. Pneumologia is an open-access journal, edited in English, 4 issues per year and is included in international databases. It publishes clinical and experimental research articles in the field of respiratory medicine, paediatrics, thoracic surgery, allergology, respiratory intensive care and oncology.  Pneumologia aims to publish scientifically valid papers, related to the respiratory field, offering a good visibility of the published papers. It is also an educational platform for physicians, educators interested in this domain, and aims to promote research and good clinical practice.  Pneumologia publishes original articles in the field of respiratory medicine, paediatrics, thoracic surgery, allergology, respiratory intensive care, and oncology. The following types of submissions are accepted:   Original research papers  Case reports  Reviews  Letters to the editor  Educational materials: practice guidelines, new techniques description and use  News, chronicles   All submitted papers are confidentially peer-reviewed in a timely manner, by at least two independent reviewers selected according to the topic of the article. The peer-review process aims to check the originality, scientific validity, and coherence of the submission.  Pneumologia offers fast publication; the eligible submissions are typically published within 3 months. There is no publication fee, and the online version is available open access on the Journal’s web site. The printed journal is distributed to the members of the Romanian Society of Pneumology and several public libraries.  Romanian and international authors are welcome to submit papers to Pneumologia, which is one of the few journals specifically dedicated to respiratory medicine in the region.  Archiving  Sciendo archives the contents of this journal in Portico - digital long-term preservation service of scholarly books, journals and collections.  Plagiarism Policy  The editorial board is participating in a growing community of Similarity Check System's users in order to ensure that the content published is original and trustworthy. Similarity Check is a medium that allows for comprehensive manuscripts screening, aimed to eliminate plagiarism and provide a high standard and quality peer-review process.  Back issues www.pneumologia.eu/en/all-articles arhiva.pneumologia.eu/ 