Congenital Lobar Emphysema in a 17-Day-Old Male Neonate: The Plain Radiographic Features and a Case Report

Congenital lobar emphysema (CLE) is a rare respiratory disorder which allows air to enter the lungs but can’t escape causing over-inflation of the lobes of the lung. This condition (CLE) is commonly detected in the newborn or young infants but some cases are diagnosed in adulthood. Congenital lobar emphysema is a rare congenital malformation with a prevalence of 1 in 20,000 to 1 in 30, 000, and more prevalent in males, with a male to female ratio of about 3:1. This is a 17 day old male neonate that presented with respiratory difficulty and .had a supine chest radiograph that showed an overinflated left lung field more on the upper and middle zones with flattening of the left hemi diaphragm, marked shift of the heart and mediastinum to the right with some degree of loss of volume involving the right lung. We report the radiographic findings of this case due the rare nature of congenital lobar emphysema.

A Review on Pre and Post Systematic Survey of Corona Virus Disease-19

Coronavirus disease2019(COVID-19)has become a serious ill health causing sever acute respiratory disorder in humans. The most purpose of this work to review various symptoms which occur during this disease of corona. It’s claimed that the coronavirus disease 2019 (COVID -19) Pandemic had a negative impact on psychological state. Since, it's important to spot which factors modulate the strain response to the pandemic. This article gives detailed information of corona virus or disease, that's origin of virus, how these virus affects the body? Which symptoms are produced during this disease? It describes detailed information of not only pre-covid phase but also post-covid phase. Because in some cases, after recovering of covid, some symptoms are remaining in patients and that they can appear as very long time this called post COVID. So, this text Describes that what Symptoms are produced and the way was treated that's it describes over you journey of coronavirus to black fungus i.e., Mucormycosis. The study was informed by emerging clinical understandings of long Covid and theories from the social sciences of the narrative nature of human experience, lived experience of illness and its links to identity, stigma, burden of illness, good professional practice, access to health care, peer support among patient communities and experience-based co-design of services. The main aim of this research study is to assess the impact of theCovid-19 Outbreak on psychological state and to research the flexibility of pre-outbreak SOC levels to predict changes in psychopathological symptoms.

Usefulness of a Titratable Mandibular Positioner During Sleep Endoscopy as a Prediction Tool for Treatment Outcome with Mandibular Advancement Devices: DISE-SAM Protocol

Mandibular advancement devices (MAD) are an effective alternative treatment to CPAP. However, different maneuvers have been performed during the performance of drug sleep-induced endoscopy (DISE) to mimic the effect of MAD. Using the Selector Avance Mandibular (SAM) device, we aimed to identify MAD candidates during DISE using a titratable, reproducible, and measurable maneuver. This DISE-SAM protocol may help to find the relationship between the severity of the respiratory disorder and the degree of response, and to determine the advancement required to improve the collapsibility of the upper airway. Explorations were performed in 161 patients (132 males; 29 females) with a mean age of 46.81 (SD = 11.42) years, a BMI of 27.90 (SD = 4.19) kg/m2 and a mean AHI of 26.51 (SD = 21.23). Results showed no relationship between severity and MAD recommendation. Also, there was a weak positive relationship between the advancement required to obtain a response and the disease severity. Using the DISE-SAM protocol, the response and the range of mandibular protrusion were assessed, avoiding the inter-examiner bias of the jaw thrust maneuver. We suggest prescribing MAD as a single, alternative, or multiple treatment approaches following the SAM recommendations in a personalized design.

Maladaptive Pulmonary Vascular Responses to Chronic Sustained and Chronic Intermittent Hypoxia in Rat

Chronic sustained hypoxia (CSH), as found in individuals living at a high altitude or in patients suffering respiratory disorders, initiates physiological adaptations such as carotid body stimulation to maintain oxygen levels, but has deleterious effects such as pulmonary hypertension (PH). Obstructive sleep apnea (OSA), a respiratory disorder of increasing prevalence, is characterized by a situation of chronic intermittent hypoxia (CIH). OSA is associated with the development of systemic hypertension and cardiovascular pathologies, due to carotid body and sympathetic overactivation. There is growing evidence that CIH can also compromise the pulmonary circulation, causing pulmonary hypertension in OSA patients and animal models. The aim of this work was to compare hemodynamics, vascular contractility, and L-arginine-NO metabolism in two models of PH in rats, associated with CSH and CIH exposure. We demonstrate that whereas CSH and CIH cause several common effects such as an increased hematocrit, weight loss, and an increase in pulmonary artery pressure (PAP), compared to CIH, CSH seems to have more of an effect on the pulmonary circulation, whereas the effects of CIH are apparently more targeted on the systemic circulation. The results suggest that the endothelial dysfunction evident in pulmonary arteries with both hypoxia protocols are not due to an increase in methylated arginines in these arteries, although an increase in plasma SDMA could contribute to the apparent loss of basal NO-dependent vasodilation and, therefore, the increase in PAP that results from CIH.

Automatic detection of respiratory events during sleep from Polysomnography data using Layered Hidden Markov Model

Objective. Sleep apnea is a serious respiratory disorder, which is associated with increased risk factors for cardiovascular disease. Many studies in recent years have been focused on automatic detection of sleep apnea from polysomnography (PSG) recordings, however, detection of subtle respiratory events named Respiratory Event Related Arousals (RERAs) that do not meet the criteria for apnea or hypopnea is still challenging. The objective of this study was to develop automatic detection of sleep apnea based on Hidden Markov Models (HMMs) which are probabilistic models with the ability to learn different dynamics of the real time-series such as clinical recordings. Approach. In this study, a hierarchy of HMMs named Layered HMM was presented to detect respiratory events from PSG recordings. The recordings of 210 PSGs from Massachusetts General Hospital’s database were used for this study. To develop detection algorithms, extracted feature signals from airflow, movements over the chest and abdomen, and oxygen saturation in blood (SaO2) were chosen as observations. The respiratory disturbance index (RDI) was estimated as the number of apneas, hypopneas, and RERAs per hour of sleep. Main results. The best F1 score of the event by event detection algorithm was between 0.22±0.16 and 0.70±0.08 for different groups of sleep apnea severity. There was a strong correlation between the estimated and the PSG-derived RDI (R2=0.91, p<0.0001). The best recall of RERA detection was achieved 0.45±0.27. Significance. The results showed that the layered structure can improve the performance of the detection of respiratory events during sleep.

Estimation of Lung Function Test among Healthy and Blow out Whistle Beginners

Introduction: Pulmonary function test is a non-invasive test. It is measured by the spirometer and it gives an idea about the lung volume, lung capacities, rates of flow and gas exchange. Breathing exercise can increase lung function. The commonly performed breathing exercises are blowing bubbles, blow out whistle, pinwheels, Hoberman spheres etc. The aim of this study is to estimate lung function among healthy and blow out whistle beginners. Materials and methods: 60 Dental students consisting of 2 groups were involved in this study. Group 1: Control individuals (30). Group 2 individuals: blow out whistle beginners (30). Standardised RMS Helios spirometer was used. Age of 18-22, Healthy individuals and non-smokers were included in this study and smokers, alcoholic individuals, respiratory disorder individuals and post- COVID individuals were excluded from the study. Data was collected and analysed using paired ‘t’ tests. Significance is considered at P<0.05 level. Results: In this study FVC, FEV1, FEV3 were found to be significant and FEV1/FVC, FEF 25-75, PEFR were found to be insignificant. The post test values of FVC and FEV1 are comparatively higher than the pre test values. The pre test values of FEF 25-75 and FEV3 are comparatively higher than the post test values. Conclusion: When this blow out exercise is performed there was a significant difference between healthy individuals and blow out whistle beginners. Significant increase in lung function is found. This recreational activity increases lung function which can be a preventive for many pulmonary diseases.

Multiplex-Heterogeneous Network-Based Capturing Potential SNP “Switches” of Pathways Associating With Diverse Disease Characteristics of Asthma

Asthma is a complex heterogeneous respiratory disorder. In recent years nubbly regions of the role of genetic variants and transcriptome including mRNAs, microRNAs, and long non-coding RNAs in the pathogenesis of asthma have been separately excavated and reported. However, how to systematically integrate and decode this scattered information remains unclear. Further exploration would improve understanding of the internal communication of asthma. To excavate new insights into the pathogenesis of asthma, we ascertained three asthma characteristics according to reviews, airway inflammation, airway hyperresponsiveness, and airway remodeling. We manually created a contemporary catalog of corresponding risk transcriptome, including mRNAs, miRNAs, and lncRNAs. MIMP is a multiplex-heterogeneous networks-based approach, measuring the relevance of disease characteristics to the pathway by examining the similarity between the determined vectors of risk transcriptome and pathways in the same low-dimensional vector space. It was developed to enable a more concentrated and in-depth exploration of potential pathways. We integrated experimentally validated competing endogenous RNA regulatory information and the SNPs with significant pathways into the ceRNA-mediated SNP switching pathway network (CSSPN) to analyze ceRNA regulation of pathways and the role of SNP in these dysfunctions. We discovered 11 crucial ceRNA regulations concerning asthma disease feature pathway and propose a potential mechanism of ceRNA regulatory SNP → gene → pathway → disease feature effecting asthma pathogenesis, especially for MALAT1 (rs765499057/rs764699354/rs189435941) → hsa-miR-155 → IL13 (rs201185816/rs1000978586/rs202101165) → Interleukin-4 and Interleukin-13 signaling → inflammation/airway remodeling and MALAT1 (rs765499057/rs764699354/rs189435941) → hsa-miR-155 → IL17RB (rs948046241) → Interleukin-17 signaling (airway remodeling)/Cytokine-cytokine receptor interaction (inflammation). This study showed a systematic and propagable workflow for capturing the potential SNP “switch” of asthma through text and database mining and provides further information on the pathogenesis of asthma.

Differences in pregnancy and perinatal outcomes among symptomatic versus asymptomatic COVID-19-infected pregnant women: a systematic review and meta-analysis

Background There is dearth of information on COVID-19’s impact on pregnant women. However, literature reported trends of COVID-19 differ, depending on the presence of clinical features upon presentation. Objective This systematic review aimed to assess differences in risk factors, management, complications, and pregnancy and perinatal outcomes in symptomatic vs. asymptomatic pregnant women with confirmed SARS-CoV-2 infection. Methods A search was run on electronic databases to identify studies reporting COVID-19 in pregnancy. Meta-analysis was performed and odds ratios and mean difference with 95% confidence intervals were calculated using Review Manager 5.4. Review Prospero registration number CRD42020204662. Results We included ten articles reporting data from 3158 pregnancies; with 1900 symptomatic and 1258 asymptomatic pregnant women. There was no significant difference in the mean age, gestational age, and body mass index between the two groups. The meta-analysis suggested that pregnant women who were obese (OR:1.37;95%CI:1.15 to 1.62), hypertensive (OR:2.07;95%CI:1.38 to 3.10) or had a respiratory disorder (OR:1.64;95%CI:1.25 to 2.16), were more likely to be symptomatic when infected with SARS-CoV-2. Pregnant women with Black (OR:1.48;95%CI:1.19 to 1.85) or Asian (OR:1.64;95%CI:1.23 to 2.18) ethnicity were more likely to be symptomatic while those with White ethnicity (OR:0.63;95%CI:0.52 to 0.76) were more likely to be asymptomatic. Cesarean-section delivery (OR:1.40;95%CI:1.17 to 1.67) was more likely amongst symptomatic pregnant women. The mean birthweight(g) (MD:240.51;95%CI:188.42 to 293.51), was significantly lower, while the odds of low birthweight (OR:1.85;95%CI:1.06 to 3.24) and preterm birth (< 37 weeks) (OR:2.10;95%CI:1.04 to 4.23) was higher amongst symptomatic pregnant women. Symptomatic pregnant women had a greater requirement for maternal ICU admission (OR:13.25;95%CI:5.60 to 31.34) and mechanical ventilation (OR:15.56;95%CI:2.96 to 81.70) while their neonates had a higher likelihood for Neonatal Intensive Care Unit admission (OR:1.96;95%CI:1.59 to 2.43). The management strategies in the included studies were poorly discussed, hence could not be analyzed. Conclusion The evidence suggests that the presence of risk factors (co-morbidities and ethnicity) increased the likelihood of pregnant women being symptomatic. Higher odds of complications were also observed amongst symptomatic pregnant women. However, more adequately conducted studies with adjusted analysis and parallel comparison groups are required to reach conclusive findings.

Total unilateral pulmonary collapse secondary to allergic bronchopulmonary aspergillosis: a case series of an unusual cause of complete atelectasis

Background Allergic bronchopulmonary aspergillosis (ABPA) is a bronchopulmonary disease caused by a complex hypersensitivity to Aspergillus and is usually associated with underlying respiratory diseases such as asthma or cystic fibrosis. Mucus plugging can lead to segmental or lobar atelectasis, but complete lung atelectasis has been exceptionally reported in the literature, making it difficult to diagnose. The diagnosis of ABPA may however be suggested in patients without known predisposing respiratory disorder, even in the absence of other relevant radiographic findings. Case presentation We report five cases of total unilateral lung collapse secondary to ABPA in 70–81-year-old women. Two of them had a past history of ABPA, while total unilateral lung collapse was the first sign of the disease in the other three patients, contributing to the initial misdiagnosis. Flexible bronchoscopy was initially performed to remove mucus plugs from the obstructed airways but was inefficient in four cases. Corticosteroid and/or antifungal treatment was needed. Conclusion ABPA can cause total unilateral lung collapse even in patients without known underlying chronic respiratory disease, making the diagnosis difficult. Flexible bronchoscopy should be considered when lung collapse is associated with respiratory distress but corticosteroids are the mainstay treatment for ABPA.

Evaluating Technical Knowledge of Using Inhalation Devices Amongst Medical Students and Pediatrics Residents in Iran

Background: Asthma is a common chronic respiratory disorder in children and adults worldwide. Inhalers are vital medications that are prescribed to control the disease and reduce its mortality and morbidity. Objectives: This study aimed to assess the knowledge and skills of Medical Students (MSs) and pediatric residents (PRs) in using different inhaler devices (IDs). Methods: This cross-sectional study included 243 MSs and PRs at Shiraz University of Medical Sciences, Iran, from March 2018 to March 2019. The MSs were divided into the senior medical students (SMSs) and junior medical students (JMSs). Data regarding participants’ knowledge on metered dose inhalers (MDIs), dry powder inhalers (DPIs), and nebulizers (NBs) were gathered using questionnaires and a face-to-face interview. Results: Of the 243 participants in the study, 113 (46.5%) were SMSs, 87 (35.8%) were JMSs, and 43 (17.7%) were PRs. The mean age of the participants was 26/20 ± 4/25 years. There was no significant difference between studied groups regarding recognition of MDI device (P = 0.072). PRs were more familiar with the DPIs than MSs (P < 0.001). They also could recognize the NBs better than the MSs (P < 0.001). In terms of using DPIs correctly, PRs executed all the steps better than MSs (P < 0.001) except for the third step which all the participants had the same knowledge (P = 0.13). Regarding correct use of NBs, PRs had better performance compared to MSs (P < 0.001). Conclusions: According to our results, there was an educational vacancy in training MSs regarding using IDs correctly, which can lead to poor compliance in asthmatic patients and deteriorating their lifestyle. The current research supports the need to redesign the educational curriculum of MSs and PRs in Iran to teach them sufficient knowledge and skills about how to use different types of inhalers properly.