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Original papers

Respiratory tuberculosis in children and adolescents: Assessment of radiological severity pattern and age-related changes within two decades

Introduction: Despite the global decline of tuberculosis (TB), the annual risk of TB infection in children from developing countries remains high. Giving the global and regional epidemiological context in the past 20 years and a recent classification, dividing childhood TB into severe and non‑severe disease, our aim was to find possible differences regarding disease severity in the pediatric population, as assessed by chest radiography (CXR) over 2 decades.
Materials and method: A retrospective analysis of CXRs from newly confirmed respiratory TB patients was performed at the Pediatric Pulmonology Department of a tertiary-care university hospital that acts as a referral TB center in Transylvania. CXRs were reviewed for all patients suffering from respiratory TB in 1994-1999 (Group A) and all respective cases from 2008-2013 (Group B).
Results: In the 110 respiratory TB cases identified in group A and 73 respective cases found in group B, the male:female distribution was similar, 56%-44%. In group A a severe pattern was present in 34% of patients, while in group B there were 43% of respective cases. The median age for severe disease in group A was 10 years, and 15 years in group B (p<0.05). Furthermore, in group B there was less mediastinal lymphadenopathy (55% vs. 68% in group A), more cavities (11% vs. 6% in group A) and a significantly higher number of consolidation, 38% vs. 25% (p=0.04).
Conclusion: CXR findings in the pediatric population have evolved from a mainly nonsevere TB pattern to an increased prevalence of severe disease, found mostly in the adolescents.
Keywords: chest radiography; children; disease severity; tuberculosis

Respiratory rehabilitation in healing depression and anxiety in copd patients

Chronic Obstructive Pulmonary Disease (COPD) is an inflammatory affection of the whole lung, characterized by an accelerated loss of the pulmonary functions, that reduces the patients' independence and stops them from having a normal, active life. The medical rehabilitation is considered "Third class rehabilitation", after preventive medicine and pharmaceutical medicine, and the respiratory rehabilitation recovery represents a complex structure of service addressing to patients with chronic pulmonary illnesses whose aim is to optimize the physical performances, psycho-social and autonomy.
Aim and objectives. The main objective of this study is to show the importance of respiratory rehabilitation that is correctly and timely made, based on the gravity and stage of the illness, the COPD patient's associated illnesses and their importance in improving the patient's mental and physical quality of life. Patients from the study were assigned a complex pulmonary rehabilitation regimen consisting of 10 physical exercise sessions and 10 educational sessions, for two weeks, followed by 3 physical education sessions and medical education per week, for six weeks.
Material and method. The research included 35 COPD patients from the 5th medical Geriatric and Gerontology Clinic during 1.03.2014-30.11.2014. Patients from the study were assigned a complex pulmonary rehabilitation regimen consisting of 10 physical exercise sessions and 10 educational session for two weeks, followed by 3 sessions a week for 6 weeks. The dyspnea evaluation was made by BORG and MRC dyspnea scales, the quality of life was measured by St. George and CAT questionnaires, and anxiety and anxiety and depression were quantified by Hamilton Anxiety Rating Scale (HARS) and Hamilton Depression Rating Scale (HDRS).
Results. The gradation of dyspnea on BORG scale was correlated with the variation of the expiratory capacity that varied at COPD patients, suggesting that hyperinflation has a major role in producing the dyspnea(5). The average score measurement was about 75.25± 5.9. the positive effects of rehab were validated by decreasing the St. George score by 16 % to the initial value. Respiratory rehab was an important way of treatment due to effort tolerance increasing and the patient's independence(6). Depression was significantly more pronounced in women ( Z=-1.876:p=0,039). The little value of maximum respiratory volume per second (VEMS) was correlated to a bigger HARS and HDRS score.
Conclusions. The prevalence and importance of symptoms of anxiety and depression in COPD patients requires a specific questionnaire as routine screening procedure, for detecting early symptoms and preventing their progress.
Keywords: COPD, rehabilitation, physical exercise.

Predictors of daytime sleepiness in patients with obstructive sleep apnea

Background. The main symptomatic criterion to diagnose obstructive sleep apnea (OSA) is the level of daytime sleepiness. The Epworth Sleepiness Scale is a simple, self-administered questionnaire which provides a measurement of the subject's general level of daytime sleepiness.
The aim of this study was to investigate the factors that can predict daytime sleepiness in patients with sleep apnea.
Methods. 50 consecutive patients with obstructive sleep apnea were enrolled into the study. Age, gender, anthropometric and polygraphic data were thoroughly analyzed. In all subjects daily sleepiness was assessed by Epworth Sleepiness Scale.
Results. The mean age of the subjects was 54.7±12.8 years, 82% males. The mean BMI was 31.9±6 kg/m2. Pearson correlation coefficient analysis demonstrates a significant positive correlation between the Epworth Sleepiness Scale and the desaturation index (r=0.31, p<0.01) and arterial hypertension (r=0.32, p<0.01). The forward stepwise regression analysis shows that the apnea hypopnea index and desaturation index are important predictors of daytime sleepiness in patients with obstructive sleep apnea which explains 40% of the Epworth Sleepiness Scale score.
Conclusion. The desaturation index showed the strongest correlation with the Epworth scale. According to the results of the backward stepwise multiple regression and logistic regression, the predictors for the level of daytime sleepiness are oAHI and index of desaturation. According to the analysis of the ROC curve, desaturation index is a predictor of a high specificity.
Keywords: sleep apnea, Epworth Sleepiness Scale, daytime sleepiness

Surgical and Anatomical Particularities and Difficulties in Histopathological Sampling for Superior Vena Cava Syndrome

The superior vena cava syndrome is due to the increased venous pressure in the upper torso, neck and head, caused by the obstruction of the superior vena cava. Both external and internal factors cause obstruction (95% are malign causes), and the most severe manifestation is represented by cerebral edema that can even lead to coma. The diagnostic algorithm for the superior vena cava syndrome is widely known. There are many controversies and discussions about the safety of histopathological sampling. The purpose of this paper is to assess such risks, the complication rate and the diagnostic yield of surgical sampling, by analyzing the 26 interventions performed in our clinic. Although the complication rate was higher than that observed in the absence of the superior vena cava syndrome, surgery remains mandatory for a rapid histopathological diagnosis, therefore demanding a protocol that must include a mandatory extemporaneous exam of the biopsy.
Keywords: superior vena cava syndrome, surgical sampling, complications