Special Issue:
Challenges and Opportunities in Pulmonology
Opanasenko Mykola, MD
Professor, chief medical officer, Head of the Department of Thoracic Surgery and Invasive Diagnostic Methods at the State University "National Institute of Phthisiology and Pulmonology FG Yanovsky NAMS of Ukraine », Kyiv, street. Amosova 10.
Tereshkovych Oleksandr, MD.
Deputy chief physician of State University "National Institute of Phthisiology and Pulmonology". FG Yanovsky NAMS of Ukraine », Kyiv, street. Amosova 10
Konik Bohdan, PhD
Head of the department of surgical treatment of tuberculosis and non-specific diseases of the lungs complicated by purulent-septic infections State Enterprise "National Institute of Phthisiology and Pulmonology" FG Yanovsky NAMS of Ukraine », Kyiv, street. Amosova 10
Lysenko Volodymyr, Junior Researcher
Department of Thoracic Surgery and Invasive Diagnostic Methods, State University "National Institute of Phthisiology and Pulmonology". F. G. Yanovsky NAMS of Ukraine », Kyiv, street. Amosova 10
Shalahai Serhii, Senior Researcher
Department of Thoracic Surgery and Invasive Diagnostic Methods, State University & National Institute of Phthisiology and Pulmonology". F. G. Yanovsky NAMS of Ukraine », Kyiv, street. Amosova 10
Levanda Larysa
Head of the Department of Anesthesiology, DU "National Institute of Phthisiology and Pulmonology. FG Yanovsky NAMS of Ukraine », Kyiv, street. Amosova 10
Kalenychenko Maksym, PhD, Researcher
Shamrai Maksym, Anesthetist
Department of anesthesiology, State University & National Institute of Phthisiology and Pulmonology. FG Yanovsky NAMS of Ukraine », Kyiv, street. Amosova 10.
Stepaniuk Alona
Surgeon in the department of surgical treatment of tuberculosis and non-specific diseases of the lungs complicated by purulent-septic infections State Enterprise & National Institute of Phthisiology and Pulmonology & FG Yanovsky NAMS of Ukraine », Kyiv, street. Amosova 10
Bilokon Serhii, Junior Researcher
Department of Thoracic Surgery and Invasive Diagnostic Methods of the State University & National Institute of Phthisiology and Pulmonology & FG Yanovsky NAMS of Ukraine », Kyiv, street. Amosova 10
Shestakova Oleksandra, Anesthetist
Department of anesthesiology, State University "National Institute of Phthisiology and Pulmonology". FG Yanovsky NAMS of Ukraine », Kyiv, street. Amosova 10
Abstract
Introduction. Pulmonary tuberculosis is a serious problem as in Ukraine as throughout the world. The number of patients with pulmonary tuberculosis is increasing year by year, which is due to the difficulties in early detection of this disease.
The aim. To determine the effectiveness of surgical treatment of patients with pulmonary tuberculosis by using video-assisted thoracoscopic interventions.
Methods. In the Department of Thoracic Surgery of the State University “National Institute of Phthisiology and Pulmonology named after F. G. Yanovsky NAMS of Ukraine” from 2008 to 2022 140 video assisted lung resections were performed in a planned manner for phthisis-surgical patients. The distribution according to the type of resection intervention was as follows: atypical segmental resection – in 30 (21.4 %) cases, typical segmentectomy – in 50 (35.7 %), lobectomy – in 52 (37.2 %), bilobectomy – in 3 (2.1 %), pulmonectomy – in 5 (3.6 %).
The results. The average duration of operative VATS resection interventions was (75.1 ± 22.3) min., intraoperative blood loss was (85.4 ± 1.6) ml, duration of narcotic analgesics prescription in patients with video-assisted thoracoscopic lung resections was (2.20 ± 0.04) days. Early mobilization of patients recorded in 112 (80.0 ± 3.4) cases. The average length of stay of the patient in the intensive care unit after video-assisted thoracoscopic lung resection was (2.6 ± 0.8) days, length of stay of the patient in the hospital in the postoperative period was (12.4 ± 0.5) days. Intraoperative complications were diagnosed in 7 (5.0 ± 1.8) % of patients. The rate of postoperative complications was 22 (15.7 ± 3.1) % of observation. There was no postoperative mortality after minimally invasive surgical interventions. The overall efficiency of performing video-assisted thoracoscopic lung resections was 97.1 %.
Conclusion. The use of video-assisted thoracoscopic is a convenient, effective and low-traumatic method in the treatment of patients with pulmonary tuberculosis. The overall effectiveness of video-assisted thoracoscopic methods for pulmonary tuberculosis was 97.1 %. An adequate assessment of the possibility of performing video-assisted thoracoscopic and the use of methods to prevent complications ensures a predictable course of the intra- and postoperative periods and increases the effectiveness of surgical interventions.
Opanasenko Mykola, MD
State University “National Institute of Phthisiology and Pulmonology named after F. G. Yanovsky National Academy of Sciences of Ukraine “, Department of Thoracic Surgery and Invasive Diagnostic Methods.
Tereshkovych Oleksandr, MD
State University “National Institute of Phthisiology and Pulmonology named after F. G. Yanovsky National Academy of Sciences of Ukraine “, Department of Thoracic Surgery and Invasive Diagnostic Methods.
Kalenychenko Maksym, PhD, Researcher
State University “National Institute of Phthisiology and Pulmonology named after F. G. Yanovsky National Academy of Sciences of Ukraine “, Department of Thoracic Surgery and Invasive Diagnostic Methods.
Shalahai Serhii, Senior Researcher
State University “National Institute of Phthisiology and Pulmonology named after F. G. Yanovsky National Academy of Sciences of Ukraine “, Department of Thoracic Surgery and Invasive Diagnostic Methods.
Konik Bohdan, PhD
State University “National Institute of Phthisiology and Pulmonology named after F. G. Yanovsky National Academy of Sciences of Ukraine “, Department of Thoracic Surgery and Invasive Diagnostic Methods.
Levanda Larysa, Anesthetist
State University “National Institute of Phthisiology and Pulmonology named after F. G. Yanovsky National Academy of Sciences of Ukraine “, Department of Thoracic Surgery and Invasive Diagnostic Methods.
Lysenko Volodymyr, Junior Researcher
State University “National Institute of Phthisiology and Pulmonology named after F. G. Yanovsky National Academy of Sciences of Ukraine “, Department of Thoracic Surgery and Invasive Diagnostic Methods.
Stepaniuk Aliona, thoracic surgeon
State University “National Institute of Phthisiology and Pulmonology named after F. G. Yanovsky National Academy of Sciences of Ukraine “, Department of Thoracic Surgery and Invasive Diagnostic Methods.
Shamrai Maksym, Anesthetist
State University “National Institute of Phthisiology and Pulmonology named after F. G. Yanovsky National Academy of Sciences of Ukraine “, Department of Thoracic Surgery and Invasive Diagnostic Methods.
Bilokon Serhii, Junior Researcher
State University “National Institute of Phthisiology and Pulmonology named after F. G. Yanovsky National Academy of Sciences of Ukraine “, Department of Thoracic Surgery and Invasive Diagnostic Methods.
Shestakova Oleksandra, Anesthetist
State University “National Institute of Phthisiology and Pulmonology named after F. G. Yanovsky National Academy of Sciences of Ukraine “, Department of Thoracic Surgery and Invasive Diagnostic Methods.
Abstract
Introduction: Multi/extensive drug-resistant lung tuberculosis (MDR/EDR–TB) is a serious problem as in Ukraine as throughout the world. The number of patients with pulmonary MDR/EDR–TB is increasing year by year, which is due to the difficulties in early detection of this disease.
The aim. To analyze the results of pneumonectomy and pleuropneumonectomy in patients with pulmonary tuberculosis with multiple/extensive drug resistance (MDR/EDR–TB).
Materials and methods: The results of 118 own operations performed on patients with various forms of pulmonary tuberculosis with multiple/extensive drug resistance (MDR/EDR-TB) treated in our clinic during 2006-2022 were analyzed. Pneumonectomy (PE) was performed in 82 (69.5%) patients, pleuropneumonectomy (PPE) – in 36 (30.5%) patients. Minimally invasive video-assisted surgical procedures (VATS) were used in 5 (4%) patients whom VATS – pneumonectomy was performed: 3 (2.5%) on the right and 2 (1.5%) on the left.
Research results: Among the patients operated on by us surgery treatment was effective in 102 (86.4±3.2%) patients during the observation period of up to 6 years. Postoperative complications developed in 11 (9.3±2.7%) patients: 5 (4.2±1.9%) patients – pleural empyema with bronchial fistula, 2 (1.7±1.2%) patients – early postoperative empyema without bronchial fistula, 4 (3.4±1.7%) – patients with postoperative intrapleural bleeding. 9 (7.6±2.4%) patients were operated on again due to postoperative complications: thoracostomy application with open sanation – 1 patient (0.8±0.8%), staged thoracoplasties – 2 patients (1.7±1.2%), video thoracoscopic sanation of the pleural cavity – 2 patients (1.7±1.2%), removal of intrapleural hematoma – 4 (3.4±1.7%) patients. 5 (4.2±1.9%) patients died after surgery.
Conclusions: Pneumonectomy (PE) and pleuropneumonectomy (PPE) are effective methods of treatment for patients with pulmonary tuberculosis with multiple/extensive drug resistance (MDR/EDR-TB) against the background of complex antituberculosis therapy. According to the data of our clinic, the use of PE or PPE was effective in 86.4% of cases, progression of TB was observed in 9.3% of patients. Making a decision to perform PE or PPE is possible in conjunction with a phthisiologist only after conducting a spiral computed tomography (SCT), which allows detecting small destructive changes in the remaining lung. Performing PE or PPE is possible in the presence of dense foci or small dense tuberculomes in the contralateral lung without signs of destruction, occupying no more than one segment; in all other cases it is more appropriate to perform collapsosurgical interventions (primary thoracoplasty or resection with thoracoplasty). When conducting PE or PPE in patients with MDR/EDR-TB of the lungs, it is mandatory to use one of the methods of additional strengthening of the bronchial stump and prevention of pleural empyema.
Ana Luisa Fernandes
Pulmonology Department, Hospital Pedro Hispano, Matosinhos, Portugal
Natália Melo
Pulmonology Department, Hospital Pedro Hispano, Matosinhos, Portugal
Inês Neves
Pulmonology Department, Hospital Pedro Hispano, Matosinhos, Portugal
Hélder Novais Bastos
Pulmonology Department, Hospital Pedro Hispano, Matosinhos, Portugal
Patrícia Caetano Mota
Pulmonology Department, Hospital Pedro Hispano, Matosinhos, Portugal
André Carvalho
Pulmonology Department, Hospital Pedro Hispano, Matosinhos, Portugal
José Miguel Pereira
Pulmonology Department, Hospital Pedro Hispano, Matosinhos, Portugal
Susana Guimarães
Pulmonology Department, Hospital Pedro Hispano, Matosinhos, Portugal
Conceição Souto Moura
Pulmonology Department, Hospital Pedro Hispano, Matosinhos, Portugal
António Morais
Pulmonology Department, Hospital Pedro Hispano, Matosinhos, Portugal
Abstract
Non-idiopathic pleuroparenchymal fibroelastosis (PPFE) has been increasingly reported in the literature. Little is known about the clinical relevance of PFFE and hypersensitivity pneumonitis (HP) overlap; therefore, we sought to investigate the clinical, radiological, and pathological features of patients with these two diseases. Five patients were identified, and the detailed characterization of these cases revealed a heterogeneous group in terms of clinical and treatment options. No mortality, acute exacerbations, or a significant decline in lung function were verified. Our cases seem to have a more “benign” disease behavior, contrary to previous idiopathic PPFE studies. More studies are needed to corroborate these findings and to better elucidate the clinical significance of PPFE and HP overlap.
Maria Arshad
Department of Research & Innovation, Shalamar Medical & Dental College, Lahore, Pakistan
Hadiqa Jaleel
Department of Research & Innovation, Shalamar Medical & Dental College, Lahore, Pakistan
Saleem Perwaiz Iqbal
Department of Community Medicine, Shalamar Medical & Dental College, Lahore, Pakistan
Manahil Asif
Department of Community Medicine, Shalamar Medical & Dental College, Lahore, Pakistan
Madiha Ali
Department of Community Medicine, Shalamar Medical & Dental College, Lahore, Pakistan
Manal Mubarak
Department of Community Medicine, Shalamar Medical & Dental College, Lahore, Pakistan
Samar Asim
Department of Pulmonology, Shalamar Hospital, Lahore, Pakistan
Farkhanda Ghafoor
Department of Research & Innovation, Shalamar Medical & Dental College, Lahore, Pakistan
Abstract
Many studies have identified various risk factors associated with Covid-19, for example, individuals with comorbidities are at an increased risk of contracting the disease and developing severe symptoms than those without comorbidities, however, these findings are inconsistent. This study identifies various risk predictors of Covid-19 patients with and without comorbidities. Data of Covid-19 patients was retrieved from Patient Digital Library of Shalamar Hospital, Lahore and encompassed patients’ gender, age, symptoms and severity besides other vitals. Data of total 1,639 patients who were admitted at Pulmonology Unit of Shalamar Hospital was examined. Out of this, 180 Covid-19 patients were recruited for final analyses as they were fully in accordance with the eligibility criteria framed for this study. Of these, 137 were suffering from comorbidities and the analysis revealed that these comorbidities had significant effect on the end result of the Covid-19 illness (P=0.002) i.e. the mortality rate among the patients with comorbidities was found to be 33.6% (n=46) and that of patients with no comorbidities was 9.3% (n=4). Likewise, the recovery rate of patients without comorbidities was significantly high (90.7%, n=39). However, interestingly, presence or absence of comorbidities had no significant impact on severity of the disease. Moreover, O2 saturation < 90% is predicted as a risk factor of severity whereas age > 59, presence of comorbidities and severe symptoms are found to be the risk predictors for the outcome of the disease being recovered or expired.
Angelo Gianni Casalini, MD
Unit of Pulmonology and Thoracic Endoscopy, University Hospital of Parma, Italy.
Pier Anselmo Mori, MD
Unit of Pulmonology and Thoracic Endoscopy, University Hospital of Parma, Italy.
Roberta Pisi, BSc
Respiratory Disease and Lung Function Unit, Department of Medicine and Surgery, University of Parma, Italy.
Federico Maria Maniscalco, MD
Department of Medicine and Surgery, University of Parma, Italy
Massimo Corradi, MD
Centre for Research in Toxicology (CERT), University of Parma, Italy
Matteo Goldoni, PhD
Department of Medicine and Surgery, University of Parma, Italy
Abstract
A pleural effusion is defined as eosinophilic when eosinophils represent ≥ 10% of the total nucleated cell count, and accounts for approximately 10% of all pleural effusions. The diagnostic significance of eosinophilic pleural effusion has yet to be determined.
Objective and Methods: A retrospective study was conducted on 65 patients with eosinophilic pleural effusion to evaluate the correlation between the percentage of eosinophils present in the pleural fluid and the benign or malignant nature of the effusion. An original aspect of current study was the evaluation of other variables in association with pleural eosinophilia, in particular pleural fluid lymphocytosis (≥ 50%), and the presence or absence of fever.
Results: Data showed the trend towards a decrease in neoplastic incidence with increasing percentages of eosinophilic counts, although this correlation was not statistically significant. The presence of fever correlated with low incidence of neoplasms (10% of neoplastic effusions in patients with fever) and was the most significant variable (p=0.001), with a Negative Predictive Value of neoplastic disease of 90%, with sensitivity 92.6% and specificity 47.4%.
When evaluated together with fever, eosinophils increased their discriminating sensitivity to the benign or malignant nature of the effusion but lost in specificity.
When evaluated as absence or presence of lymphocytosis (≥50% lymphocytes), associated with eosinophilia, lymphocytes were significantly associated with the neoplastic nature of the effusion.
Conclusions: the study showed that the finding of eosinophilic pleural effusion should not be considered an indicator of benignity of the effusion; the association of other parameters with eosinophilia, lymphocytosis of the pleural fluid and fever can provide more precise prognostic indications; a high percentage of eosinophils, the absence of lymphocytosis and the presence of fever would seem to be associated with a low probability of a neoplastic nature of the effusion.
Wajid Ali Rafai
University of Lahore Teaching Hospital University College of Medicine and Dentistry 1-Km Defence road, off raiwind road, Lahore, Pakistan
Ahmad Ussaid
University of Lahore Teaching Hospital University College of Medicine and Dentistry 1-Km Defence road, off raiwind road, Lahore, Pakistan
Babar Riaz
University of Lahore Teaching Hospital University College of Medicine and Dentistry 1-Km Defence road, off raiwind road, Lahore, Pakistan
Faisal Amin Baig
University of Lahore Teaching Hospital University College of Medicine and Dentistry 1-Km Defence road, off raiwind road, Lahore, Pakistan
Sohail Anwar
University of Lahore Teaching Hospital University College of Medicine and Dentistry 1-Km Defence road, off raiwind road, Lahore, Pakistan
Atif Masood
University of Lahore Teaching Hospital University College of Medicine and Dentistry 1-Km Defence road, off raiwind road, Lahore, Pakistan
Rahma Fiaz
Evercare Hospital, Wapda Town, Lahore, Pakistan
Khurram Saleem
University of Lahore Teaching Hospital University College of Medicine and Dentistry 1-Km Defence road, off raiwind road, Lahore, Pakistan
Farrukh Iqbal
University of Lahore Teaching Hospital University College of Medicine and Dentistry 1-Km Defence road, off raiwind road, Lahore, Pakistan
Abstract
SARS-COV-2 emerged as pneumonia of unknown etiology and transforming into global pandemic leading mass casualties globally. It leads to serious complications with a wide range of symptoms and laboratory and radiological abnormalities.
Methodology: This retrospective study included 191 admitted patients was conducted between 15 April 2020 and 31 August 2020 at university of Lahore teaching hospital, Lahore, Pakistan. Baseline demographics, clinical, laboratory and radiological characteristics were compared amongst disease severity categories with One way ANOVA and comparison amongst recovered and non-recovered was carried out by independent t test, Fisher’s exact and chi-square test respectively. All data were analysed in SPSS 25 and p-value <0.05 was considered significant.
Results: Out of 191 patients enrolled in this study, majority were male and above 50 year age. Fever (68%) was the most common symptom though dyspnea was statistically significant (p-value<0.05) and diabetes (41.4%) being the most common comorbidity. A statistical significant downtrend in eosinophil counts were observed in critical and severe disease from non-severe disease and similar trend was observed in non-recovered (died) patients than recovered. A significant rise in neutrophil to lymphocyte ratio, crp, ferritin and d-dimer were observed amongst critical and severe disease and non-recovered patients (p-value<0.05). Patients with eosinopenia had low survival proportion at day 5 and 10 than those with relatively normal eosinophil counts.
Conclusion: Patients with advanced age, multiple comorbidities, elevated hematological, deranged coagulation markers presented with more severe disease and had poor outcome. In particular, eosinopenia can play key role in early diagnosis, disease severity recognition and disease surveillance as it is an independent risk factor for prognosis.
Juliana Matiello, MD, PhD
Radiation Oncologist Oncology Thoracic Group Santa Casa de Porto Alegre, Brazil Head Radiation Oncology Service Hospital Ana Nery
Maiara Dalenogare
Medical Physicist Radiation Oncology Service Santa Casa de Porto Alegre, Brazil Federal University of Rio Grande do Sul, Porto Alegre, Brazil
Danilo Cortesi Berton, MD, PhD
Pneumonology Professor Division of Pulmonology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
Abstract
Radiotherapy is the most common local treatment for lung cancer. The spectrum of its use ranges from the treatment of early-stage tumors in patients who are not candidates for surgery to the treatment of advanced, unresectable tumors and, very frequently, of metastatic lesions. With great interest, radiotherapy has also been currently cited as a source of neoantigens, stimulating the immune system and enhancing the effect of immunomodulatory drugs. However, the side effects of irradiation on the lung parenchyma and on the immune system can turn it into a hidden foe, impairing patients’ quality of life and survival. Pneumonitis and immunosuppression are two of the side effects of radiotherapy that best exemplify this hidden damage. Studies have shown decreased survival in patients who develop radiation pneumonitis or have a large volume of immune tissue irradiated. Irradiating less lung tissue will reduce damage to lung function and loss of immune cells. However, this alone is not sufficient for dose protection in lymphoid tissue, given the circulation of lymphoid cells in the great vessels and heart and their production in thoracic vertebral bone marrow. Identifying the optimal total dose and the most appropriate daily dose to reduce damage and boost the immune system is the target of our investigations. Although we still do not have an optimal algorithm for dose, fraction, and cost-effectiveness for radiation doses delivered to healthy tissues, we know which path to take.
Daria Lahoda
Doctor of Philosophy in Medicine (PhD), Assistant Professor of the Department of Family Medicine and Polyclinic Therapy, Odesa National Medical University, ave. 2 Valikhovskyi St., Odesa, Ukraine 65000, 0966419743
Abstract
Diseases of the respiratory tract occupy one of the leading places among pathologies in people of working age in the world. According to the data of world studies, it can be considered that these two comorbidities are mutually aggravating, but scientists do not have a unanimous opinion about whether this is a simple coincidence or whether these pathologies are pathogenetically related. There is considerable evidence that asthma patients do not achieve adequate asthma control worldwide. Yes, according to Maria Sandra Magnoni et al. 77.8% of patients with asthma have an uncontrolled course of asthma, although 68.4% of them believe that they have sufficient asthma control, and their treatment does not require correction. Therefore, taking into account all of the above and taking into account the low level of asthma control in patients with comorbid pathology who often suffer from bacterial and viral diseases, we believe that a more detailed study of the immunological status of these individuals is necessary in order to optimize treatment and prevention measures. Aim: to investigate the effectiveness of alternative ways of asthma control in patients with bronchial asthma against the background of overweight or obesity. Materials and methods. At the I stage, 255 patients with BA were examined. According to the study design, patients were selected according to the “inclusion/exclusion” criteria at this stage. The study was randomized. Allocation of patients into groups was carried out by the method of simple randomization with elements of stratification. Groups are statistically significant. Statistical processing of the results was carried out using parametric and non-parametric analysis methods. Resalts. Overweight or obese patients had a more severe course of bronchial asthma than patients with a normal body mass index. Overweight or obese patients were found to have higher levels of systemic inflammation, namely eosinophilic cationic protein levels and erythrocyte sedimentation rate, than patients with a normal body mass index. In addition, a close direct correlation was established between the severity of the course of bronchial asthma and indicators of eosinophil cationic protein (r=0.97; p˂0.001). After pharmacological correction, there was an increase in asthma control in patients with different severity of the course (р˂0.001; p˂0.001; p˂0.001, respectively), a decrease in the frequency of exacerbations (p˂0.05), a reduction in the number of hospitalizations (p˂0, 05) and the number of acute respiratory diseases (p˂0.05) in patients with bronchial asthma against the background of excess body weight or obesity. The use of the developed treatment-prophylactic complex using the drug bacterial lysate and inosine pranobex together with training in the Asthma School and standard treatment contributes to increasing asthma control and compliance with the doctor, reducing the number of exacerbations and hospitalizations per year in patients with bronchial asthma against the background overweight or obesity.
A. Ajim
Department of Respiratory Diseases 20 August 1953, University Hospital Center IBN Rochd, Casablanca, Morocco
K. Rebbouh
Department of Radiology 20 August 1953, university hospital IBN ROCHD, Casablanca, Morocco
H. Jabri
Department of Respiratory Diseases 20 August 1953, University Hospital Center IBN Rochd, Casablanca, Morocco
M. Chahbounia
Department of Respiratory Diseases 20 August 1953, University Hospital Center IBN Rochd, Casablanca, Morocco
W. Elkhattabi
Department of Respiratory Diseases 20 August 1953, University Hospital Center IBN Rochd, Casablanca, Morocco
N. Bougteb
Department of Respiratory Diseases 20 August 1953, University Hospital Center IBN Rochd, Casablanca, Morocco
H. Arfaoui
Department of Respiratory Diseases 20 August 1953, University Hospital Center IBN Rochd, Casablanca, Morocco
M. H. Afif
Department of Respiratory Diseases 20 August 1953, University Hospital Center IBN Rochd, Casablanca, Morocco
K. Rebbouh
Department of Radiology 20 August 1953, university hospital IBN ROCHD, Casablanca, Morocco
N. Moussali
Department of Radiology 20 August 1953, university hospital IBN ROCHD, Casablanca, Morocco
A. Merzem
Department of Radiology 20 August 1953, university hospital IBN ROCHD, Casablanca, Morocco
H. Belgadir
Department of Radiology 20 August 1953, university hospital IBN ROCHD, Casablanca, Morocco
O. Amriss
Department of Radiology 20 August 1953, university hospital IBN ROCHD, Casablanca, Morocco
N. El Benna
Department of Radiology 20 August 1953, university hospital IBN ROCHD, Casablanca, Morocco
Abstract
Hypersensitivity pneumonitis (HP) classified as an interstitial lung disease is characterized by a complex immunological reaction of the lung parenchyma in response to repetitive inhalation of a sensitized allergen. The estimated worldwide incidence of hypersensitivity pneumonitis is extremely rare and highly dependent on climatic, geographical, occupational and industrial factors. It might be secondary to a domestic or professional exposure, usually occurs in people who work in places where there are high levels of dust, fungus, or molds. Long-term exposure can lead to lung inflammation and acute lung disease. Over time, the acute condition turns into long-lasting (chronic) lung disease. Thus, we distinguish 2 mains aspects fibrotic HP and Nonfibrotic HP. The diagnosis of HP maybe sophisticated especially in fibrotic form. The prognosis of this disease depends on early diagnosis with complete antigen avoidance and most often corticosteroid therapy.
This work aims to study the epidemiological, clinical, paraclinical aspects of hypersensitivity pneumonitis as well as therapeutic management, through a series of eight cases of HP carried out at the Pulmonology Department 20 August 1953, University Hospital Center IBN ROCHD, between January 2020 and January 2022, analyzed using a pre-established exploitation sheet. The average age of the patients studied was 51 years with a female predominance (sex-ratio M/F= 0.34). Domestic and occupational exposures of our patients were equal. The clinical symptomatology is dominated by almost constant dyspnea in all patients. Physical signs increased by crackles, objectified in 75% of patients. Computed tomography (CT) remains a great diagnostic contribution. Thus, allowing to have two categories of patients, depending on the presence or absence of signs of pulmonary fibrosis.
In our study, five patients had fibrotic HP, and three cases had non- fibrotic HP. Precipitins were positive. Plethysmography objectified a restrictive ventilatory disorder in 62.5%. All patients benefited from antigenic eviction with long-term corticosteroid therapy. The evolution was favorable in 87.5% of cases.
