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Original papers

Alpha-1 antitrypsin deficiency and spontaneous pneumothorax: possible causal relationship

Danielius Serapinas 1,2 ; Viltaute Obrikyte 1; Dalius Vaicius 3; Ruta Balciuviene 3; Arvydas Valavicius 4 ; Raimundas Sakalauskas 1
1. Department of Pulmonology and Immunology, Medical Academy, Lithuanian University of Health Sciences; 2. Mykolas Romeris University; 3. Department of Pulmonology and Alergology, Vilnius University Hospital Santariskiu Clinics; 4. Klaipeda University Hospital
Background. An increased incidence of serum alpha-1 antitrypsin deficiency has been reported in patients with chronic obstructive pulmonary disease, but has not been well proven in association with spontaneous pneumothorax. The aim of our study was to evaluate frequency of alpha-1 antitrypsin deficiency in subjects with spontaneous pneumothorax.
Methods. 39 patients with the diagnosis of spontaneous pneumothorax and 100 age- and sex-matched control subjects were included in the study. Alpha-1 antitrypsin concentrations were determined by nephelometry, Serum qualitative Z antitrypsin variant was analyzed using commercial ELISA kits and alpha-1 antitrypsin phenotyping was carried out by means of isoelectric focusing.
Results. AAT deficiency phenotypes were detected in 3 (7.7%) patients with spontaneous pneumothorax, and only in 1 (1%) case in the control group. However, the observed differences did not reach statistical significance due to the considerable size disproportion between groups. The mean serum alpha-1 antitrypsin level was significantly higher in patients with spontaneous pneumothorax (1.53±0.23 g/l) than controls (1.34±0.31 g/l) (p=0.03). Conclusions. Preliminary data confirm the clinical importance of alpha-1 antitrypsin deficiency phenotypes in patients with spontaneous pneumothorax and the need to screen them for alpha1-antitrypsin deficiency.
Keywords: spontaneous pneumothorax, alpha-1 antitrypsin, deficiency

Obstructive sleep apnea syndrome and arterial hypertension – a complicated relationship? The role of controlling blood pressure values in patients with OSAS

Oana-Claudia Deleanu, Andra Elena Mălăuţ, Ana Maria Nebunoiu, Miruna Mihaela Micheu, Florin Dumitru Mihălţan
1. “Carol Davila” University of Medicine and Pharmacy, Bucharest, “Marius Nasta” Institute of Pneumophtisiology, Bucharest, Romania 2. “Marius Nasta” Institute of Pneumophtisiology, Bucharest, Romania 3. Clinical Emergency Hospital of Bucharest, Romania
Background: Arterial hypertension (HT) and obstructive sleep apnea syndrome (OSAS) are associated through cause-effect relationship. We aimed to study the effect of medication controlled hypertension on OSAS patients.
Methods: From 483 followed patients with OSAS, 252 associating HT; 142 patients of them (56.34%) received antihypertensive medication, 59 patients (41.54%) had controlled HT, 83 patients (58.46%) had uncontrolled HT. Demographic and anthropometric data, OSAS symptoms, comorbidities, apnea index (IA), apneahypopnea index (IAH), desaturation index, CPAP titration, CPAP failure rate were studiated regarding differences between patients with controlled and uncontrolled HT.
Results: Fifty nine patients with controlled HT were: 20 women (33.9%), 39 men (66.1%), with mean age of 56.08 years ± 11.33, with an average AHI of 53.61 ± 34.42/hour, an average of CPAP pressure prediction of 10.15 ± 2.43 cm H2O. Eighty three patients with uncontrolled HT were: 18 women (21.7%), 65 men (78.3%), with mean age 55 ± 9.06 years, with an average AHI of 61.91 ± 43.61/hour, an average of CPAP pressure prediction of 10.47 ± 2 cm H2O. Comparing with the controlled HT group, patients with uncontrolled HT reported morning headaches, morning fatigue and impotency in a higher rate (p=0.020, 0.018, 0.011 respectively); Epworth Sleepiness Scale was under 10 (cut-off for daytime sleepiness) in patients with controlled HT (p=0.001) and higher in those with uncontrolled HT. Patients with uncontrolled HT were diagnosed with HT for a longer period (p=0.006), had higher values of systolic and diastolic blood pressure at the time of the presentation. Statistically significant differences were found only for AHI post-CPAP (11.89/h vs. 22.30/h, p=0.013) and nocturnal desaturation index post-CPAP (6.03/h vs. 16.55/h, p=0.017), both higher in patients with uncontrolled HT. The hypothesis regarding existing differences related to the cardiovascular comorbidities was not supported.
Conclusions: Controlled blood pressure deletes sleepiness, a defining symptom for OSAS and reduces remaining symptoms (headaches, impotency and morning fatigue). Presence of OSAS symptoms is less common in the controlled HT group, making the OSAS more difficult to suspect. These patients may have a grater benefit from CPAP therapy – they have AHI post-CPAP and desaturations post-CPAP significantly lower than patients with uncontrolled HT.
Keywords: obstructive sleep apnea syndrome, controlled hypertension, uncontrolled hypertension

Features of severe asthma in young children from Romania

Mihai Craiu, Iustina Violeta Stan
1. Institute for Mother and Child Care, “Alfred Rusescu” Children’s Hospital 2. Second Pediatric Clinic “Alfred Rusescu”, “Carol Davila” Medical University 3. First Pediatric Clinic “Alfred Rusescu”, “Carol Davila” Medical University 4. Medlife Children’s Hospital
Asthma is the most frequent chronic disease of childhood. In spite of significant improvement of treatment options and diagnostic tools, asthma remains in many patients uncontrolled. The term of “severe asthma” seems to be rather a large umbrella for a heterogeneous group of diseases. This paper is presenting our experience in two respiratory disease clinics that evaluate asthmatic children. Current study was designed to test an algorithm for daily practice in a special group of patients: children with previously diagnosed asthma or recurrent-wheezing, evaluated by family physician or pediatrician as severe disease (“Asthma Decalogue in Children”). Out of 313 referrals (during a six months inclusion time) we had 202 children completing study per-protocol. 49 (22.69%) had severe disease, but only 8 had severe asthma (3.7% of total patients and 18.6% of severe patients). They were older, with less male predominance and with more frequent rhino-conjunctivitis and D vitamin deficiency than other asthmatic children with less severe disease. Asthma Decalogue in Children seems to be an efficient tool to differentiate severe asthma from the rest of children with reactive airway diseases.
Keywords: severe asthma, children, algorithm