Summary

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<p>Interstitial lung disease (ILD) is a pulmonary involvement that is commonly manifested in systemic sclerosis (SSc) patients. The immunopathogenesis of SSc-ILD involves several mechanisms, including microvascular injury, alveolar epithelial cell defect, inflammation, genetics, epigenetics, telomeres, telomerase and inflammasome, which result in lung fibrosis. Detection of ILD should be performed in every SSc patient by using high-resolution chest tomography (HRCT) scan of the thorax, in addition to evaluation by pulmonary function tests. When ILD is discovered, the physician might start treatment considering factors such as the extent of the lesion, progressivity of the disease, prognosis and drug toxicity. The current guideline recommends cyclophosphamide, mycophenolate mofetil and nintedanib as the initial choices for SSc-ILD treatment. Other agents such as biologic immunotherapies, haematopoietic stem cell transplantation and lung transplantation could be an option if the disease becomes progressive.</p>
</abstract>

Department of Pulmonology and Respiratory Medicine, Faculty of Medicine

Universitas Indonesia, Persahabatan Hospital

Interstitial lung disease in systemic sclerosis: From immunopathogenesis to treatment

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<p>Introduction: Human immunodeficiency virus (HIV)–tuberculosis (TB) coinfection is a worldwide problem and a subject of concern, being associated with high mortality and risk of complications. Intravenous drug use is a way of getting infected with HIV that continues to rise, especially in the big cities. We aimed to study the peculiarities of persons with HIV–TB who inject drugs.</p>
<p>Methods: We performed a retrospective, observational study, among patients treated for TB in the 4<sup>th</sup> District TB unit, Bucharest, during a 10-year period. A unique registry of patients with TB was used, and data of all patients with HIV–TB were noted ( demographics, medical, treatment outcome). A comparison between drug users (people who inject drugs [PWID]) and nondrug users (non-PWID) was assessed.</p>
<p>Results: We identified 122 patients with HIV–TB: 60 PWID, 58 non-PWID, and 4 former users. The mean age was 36.4 ± 9.8 years, 75% were males, and 73% were using antiretroviral treatment (ART). After comparing PWID with non-PWID patients, the following differences were noted: age (33.0 ± 6.0 years in PWID vs 40.5 ± 11.3 in non-PWID, P &lt; 0.0001), gender (87% vs 66% males, P = 0.0034), presence of chronic hepatitis (97% vs 21%, P &lt; 0.0001), CD4 number (156.1 ± 204.5 cells/mm<sup>3</sup> vs 260.8 ± 248.9 cells/mm<sup>3</sup>, P = 0.0409), ART (65% vs 84%, P = 0.0075), and evaluation at the end of TB treatment (P = 0.0373).</p>
<p>Conclusions: PWID represent a vulnerable population of those with HIV–TB coinfection, whose outcome in TB treatment is significantly poorer and who are at risk of abandonment, death, and comorbidities. They should be included in dedicated programmes that are aimed at increasing adherence to treatment and care, additionally assessing the dependence problem.</p>
</abstract>

Peculiarities of persons who inject drugs among patients with HIV–tuberculosis coinfection registered in 4<sup>th</sup> District TB Unit Bucharest during 2009–2018

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<sec><h3>Background</h3>
<p>Exudative pleural effusions are often challenging, and on many occasions remain undiagnosed. Hence, a blind closed needle pleural biopsy (CNPB) is extremely relevant against this background.</p>
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<sec><h3>Methods</h3>
<p>We conducted a prospective study, in which a CNPB using a Cope’s needle was done in patients with exudative pleural effusion. Data were analysed using SPSS software.</p>
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<sec><h3>Results</h3>
<p>Our study included 250 patients, of which 140 (56%) were males and 110 (44%) female. 218 (87.2%) had tubercular effusion 22 (8.8%) had effusion secondary to malignancy, 8 (3.2%) had synpneumonic effusions, and 1 (0.4%) each had effusion secondary to pancreatitis and rheumatoid arthritis (RA). AFB culture was positive in 50 (22.4%) on pleural fluid, as compared to 209 (87%) on pleural biopsy. CBNAAT detected MTB in 34 (14%) on pleural fluid as compared to 72 (28.8%) on pleural biopsy. Caseous granuloma was found in 184 (73.6%). The sensitivity for AFB culture using CNPB tissue and pleural fluid was 95.8% and 22.5%, respectively (P &lt; 0.05). Drug susceptibility testing (DST) done on pleural tissue divided our patients as drug sensitive 182 (87%), MDR 13 (6.2%), preXDR 12 (5.7%), and XDR TB 2 (0.9%). For malignancy, sensitivity of pleural fluid and pleural biopsy was 9% and 63%, respectively (P &lt; 0.05). Major complications of the procedure were pain in 25 (10%), pneumothorax in 15 (6%), and haematoma in 8 (3%). Of the patients who developed pneumothorax, only one patient required intervention with an intercostal drain, and the rest resolved spontaneously.</p>
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<sec><h3>Conclusion</h3>
<p>CNPB is an easy, quick, cost-effective, and reliable method that can be used for diagnosing exudative pleural effusions of indeterminate aetiology in the out-patient setting.</p>
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Diagnostic utility of closed needle pleural biopsy in exudative pleural effusions

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<p>Considering the wide range of both histological and imaging types found in a small group of tumours as an incidence, they can pose real problems in both diagnosis and therapeutic conduct, being difficult to differentiate clinically, imagistically, or histologically from lung tumours commonly found in the clinic (1). Adenocarcinoma, squamous cell carcinoma, and small cell carcinoma together account for approximately 95% of all lung tumours, but the lung is the site of many other types of tumours that may be of epithelial, mesenchymal, neuroendocrine, or lympho-haematopoietic origin, and these latter together account for approximately 5% of all pulmonary tumours (2,3). With a few exceptions, both the clinical manifestations and the imaging aspect are nonspecific, many of them having features in common with the other tumours with high incidence (3). The present study was performed on a group of 82 patients diagnosed with low-incidence lung tumours, aiming at presenting the main epidemiological, clinical, and paraclinical features as well as the difficulties in diagnosing this heterogeneous group of tumours (4,5). The ratio of patients who presented with benign tumours was close to that of the patients who presented with malignant tumours. Age, male sex, smoking, and occupational exposure were not included as risk factors for any tumour nature. Significantly more patients in urban areas have developed both benign and malignant tumours. Patients with malignant tumour pulmonary development presented to the hospital with symptoms in a significantly higher number, compared to those diagnosed with benign tumour. The location of benign tumours was mostly peripheral. Peripheral location of benign tumours required surgery to obtain the histopathological type, having a curative visa in some cases. About a third of those with malignant tumours had secondary lung tumours, or distant metastases.</p>
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Regina Maria Medical Clinic, Respiratory Department

Rare lung tumours – possibilities and limits of diagnosis

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<sec><h3>Background</h3>
<p>Obstructive sleep apnoea (OSA) is often underdiagnosed and can cause various complications.</p>
</sec>
<sec><h3>Objective</h3>
<p>This study aimed to find prevalence and correlation between OSA cases in lung cancer patients.</p>
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<sec><h3>Methods</h3>
<p>This was a cross-sectional study of 151 lung cancer patients. We interviewed and assess the risk of OSA in lung cancer patients by using the Berlin questionnaire, Epworth Scale, and STOP-BANG questionnaire.</p>
</sec>
<sec><h3>Results</h3>
<p>Out of 151 patients, 121 (80.13%) patients were identified as having a low risk of OSA and 30 (19.87%) patients as high risk of OSA. Most patients with a high risk of OSA were identified with the Epworth Sleepiness Scale (53 patients). Most patients with a low risk of OSA were identified with the Berlin questionnaire (120 patients). The result shows no significant difference (P > 0.05) between age and risk based on the three questionnaires we used. A significant difference (P &lt; 0.05) was found between body mass index (BMI), body height, and OSA risk based on the Berlin and STOP-BANG questionnaires.</p>
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<sec><h3>Conclusions</h3>
<p>There is a correlation between sleep apnoea and lung cancer as a risk factor and a consequence of poor sleep in the lung cancer population.</p>
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Universitas Indonesia-National Respiratory Center Persahabatan Hospital

Obstructive sleep apnoea suspicion in lung cancer patients in Indonesia

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<p>Drainage of secretions in patients with severe lung damage is a challenge. In many cases, due to the significant reduction in muscle mass, difficulties of this nature arise. We present the case of an 82-year-old patient, vaccinated against Severe acute respiratory syndrome coronavirus 2 (SARS COV2), anti-influenza, anti-pneumococcal and anti-haemophilus, former smoker, with no significant exposure to known professional respiratory noxes, with severe comorbidities (cardiac, ophthalmological, rheumatological, neurological, and diabetological) and a congenital pulmonary malformation – right lung hypoplasia (diagnosed in 2008), extensive cystic and varicose bronchiectasis, probably also in a congenital context, with progressive collapse of the right parenchyma and displacement of the mediastinum, complicated with recurrent respiratory infectious episodes with pathogens – Gram-negative germs, anaerobic germs, and repetitive low-amount haemoptysis for 3 years, as well as severe restrictive respiratory dysfunction. Currently, the patient is under bronchodilator treatment, and home oxygen therapy. For about 3 years, regular modern drainage sessions using the studied device have been introduced. Patient adherence was good. The benefits brought by this device on the clinical development of the patient were: efficient drainage of secretions, improvement of the quality of life, and prolongation of survival in a patient with complex pulmonary pathology and multiple comorbidities in development for 13 years. This new therapeutic drainage option has been competing with pre-existing ways (Cough Assist) for several years, demonstrating its multiple benefits in patients with chronic respiratory failure and severe comorbidities.</p>
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Universitatea de Medicină și Farmacie Carol Davila

The impact of new bronchial drainage device in a complex form of respiratory disease

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<sec><h3>Purpose</h3>
<p>To assess clinical features, therapy, and outcome of the myositis associated with anti-MDA5 antibodies, and to propose a successful therapeutic protocol for rapidly progressive interstitial lung disease (RP-ILD) in anti-MDA5 dermatomyositis (DM).</p>
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<sec><h3>Methods</h3>
<p>A retrospective and descriptive study of three cases of anti-MDA5 associated myositis was conducted in the Department of Internal Medicine in the University Hospital Hedi Chaker, Sfax, Tunisia, between 1996 and 2016.</p>
</sec>
<sec><h3>Results</h3>
<p>From a series of 115 cases of myositis, three cases of anti-MDA5-positive DM were identified. They were three men with a mean age of 63 years. They manifested specific cutaneous manifestations including ulcers and palmar papules, mild muscular involvement, and RP-ILD. The severity of the disease was correlated to the ILD in all patients. Aggressive therapies were tried including high-dose corticoids, cyclophosphamide (CYC) cures, intravenous immunoglobulins, and rituximab (RTX), with a good outcome in the patient who received combined high steroids, CYC, and RTX pulses. The two other patients died because of a rapid worsening of their respiratory condition.</p>
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<sec><h3>Conclusion</h3>
<p>Anti-MDA positive myositis is characterised by a specific cutaneous phenotype, the discretion of muscular signs, and the correlation with RP-ILD. The poor prognosis of this entity is correlated to the high resistance of pulmonary involvement despite aggressive therapeutics. The combination between high-dose steroids, CYC, and RTX has shown good results in many reports, as well as in one of our patients.</p>
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</abstract>

Clinical and therapeutic features of myositis associated with anti-MDA5 antibodies: three new cases

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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/ 