romana english

Original papers

Endobronchial Tuberculosis in Anthracotic Bronchitis

Background: Endobronchial tuberculosis (EBTB) is a serious form of pulmonary tuberculosis. In EBTB, mycobacterium tuberculosis involves trachea, large airways and bronchial trees .Combustion of biomass fuels causes anthracotic bronchitis that is characterized by black pigmentation in bronchial tissue. The majority of anthracotic bronchitis are in aged patients, particularly rural women, that use biomass fuel for cooking or traditional bakery .The aim of this study was to evaluate the endobronchial tuberculosis in anthracotic bronchitis.
Material and Methods: In total, 483 EBTB patients who underwent flexible bronchoscopy (FB), for various indications, were included. Tuberculosis was confirmed by microbiological analysis of bronchoalveolar ( smear and culture for Koch's bacillus) and histopathological methods. EBTB patients were divided in two groups: subjects with anthracotic bronchitis (group 1) and without anthracosis (group 2). Demographic data and important clinical , radiological and bronchoscopic findings were recorded. Chi-squre test and Spss 11.5 software were used for statistical analysis.
Results: 483 out of 1824 patients who underwent FB had EBTB. 73.7% patients had EBTB and anthracotic bronchitis (versus 27.3% EBTB without anthracosis).The mean age was significantly higher in EBTB and anthracotic bronchitis (68.45±16.31 versus 49.08±14.7).Female/male ratio was 1.4:4 in EBTB and anthracotic group versus 1:1 in non anthracotic patients. Dyspnea, cough, hemoptysis and wheezing were higher in group 1. History of biomass fuel was more significant in EBTB and anthracotic bronchitis. Mass, diffuse infiltration in lower lobes were revealed higher in radiography of group 1.Bronchoscopy showed the higher frequency of bronchial stenosis in EBTB with anthracosis (P value <0.05).
Conclusion: This study suggested significant association between EBTB and anthracotic bronchitis. Unusual findings in radiological and bronchoscopic features were seen in EBTB with anthracosis.
Keywords: endobronchial tuberculosis, anthracotic bronchitis, biomass

Obesity in association with Sleep Apnea Syndrome as predictor for coronary-vascular comorbidities

Background and aims: Sleep apnea syndrome (SAS) is a common disorder with growing awareness. We sought to evaluate if the presence of obesity in patients with SAS is associated with a high risk for development of coronary-vascular comorbidities.
Methods: We performed a retrospective study that included 1370 patients (30, 3% female and 69, 7% male) diagnosed with SAS from May 2005 to May 2012. The collected data included body mass index (BMI), waist/hip ratio, abdominal, neck, hip circumference and Epworth Sleepiness Scale. The positive diagnostic of SAS was based on apnea-hypopnea index (AHI) provided by polysomnography, and patient comorbidities were obtained from the sleep laboratory records.
Results: From the total of 1370 patients, 989 (72%) had grade I to III obesity, 305 (22%) were overweight and only 76 (6%) had a normal weight. Cardiovascular comorbidities were presented in 60.6% of patients, with coronary disease ranking first (34.2%) followed by heart failure (22.6%) and stroke (3.8%). The predictors for cardiovascular comorbidities were coronary disease (OR 2.1, 95% CI 1.20 - 3.39, p=0.0063), heart failure (OR 3.44, 95% CI 1.60 - 7.74, p<0.001) but not stroke (OR 2.3 95% CI 0.57 - 13.84, p=0.357). Analyzing the polysomnography parameters we found a strong correlation for AHI (p<0.0001), oxygen desaturation index (p<0.0001) and mean average oxyhaemoglobin saturation (p<0.0001).
Conclusions: Overweight and obese patients with SAS have a poor outcome, being at high risk of developing other comorbidities like coronary disease and heart failure.
Keywords: sleep apnea, obesity, cardiovascular risk, coronary disease, heart failure, stroke