Standard operating procedures in work of nursing staff as way to prevent infections associated with provision of medical care

In the conditions of modern realities of domestic healthcare, more and more attention is paid to the quality of medical care provided by both doctors and paramedical personnel. In order to minimize risks when performing routine medical procedures, it is necessary to create standard operating procedures that should help medical staff to provide high-quality and timely medical care in real practice. The article offers an answer to frequently asked questions regarding the development of standard operating procedures and an example of a standard operating procedure for the rehabilitation of the tracheobronchial tree and tracheostomy care.

Therapeutic Role of Shwasa Kuthar Rasa in the Management of Tamaka Shwasa (Bronchial Asthma): A Single Group Randomized Clinical Trial

Background: Bronchial Asthma is a disease of airways that is characterized by hyper-responsiveness of the tracheobronchial tree to a variety of stimuli resulting in widespread spasmodic narrowing of the airway. According to WHO 2016, Asthma affects 235 million people worldwide, out of which 15-20 million people are from India. In India, the prevalence of self-reported asthma is 2% among women aged 15-49 years and 1% among young women aged 15-19 years as well as men aged 15-49 years as per the latest report. Prevalence of asthma is more in urban areas than rural area as due to smoke, pollution and environmental factor. In Ayurveda Bronchial Asthma has a high resemblance with Tamaka Shwasa which comes under Pranavaha Srotas. It is described in Brihatrayee as well as Laghutrayee. Acharya Charak and Sushruta has given detailed description of Tamaka Shwasa. Aim and Objectives: To study the effect of shwasa kuthar rasa in the management of (bronchial asthma) and to find out an effective Ayurvedic medicine for Tamaka Shwasa (Bronchial Asthma). Material and Methods: For this open clinical study, 10 patients of Tamak Shwasa (bronchial asthma) were registered from OPD of Kayachikitsa department and admitted in IPD of Pt. Khushilal Govt (Auto.) Ayurveda Hospital Bhopal. The patient was treated with Shwasa Kuthar Rasa. Duration of study was 30 days and follow up was done after completion of trial every week for 1 month, assessment was done on the basis of symptomatic relief and increase the range of FEV1 and FVC value after treatment. Observation: yielded symptomatic relief after treatment. The overall effect of the treatment in patient suggested that, there is 87.50 % relief in cough (Kasa), 90.01% relief in dyspnoea (Shwasakashta), 93.37% relief in chest tightness (Urashool) and 74.99% relief in wheezing (Ghurghurak) and value of FEV1 and FVC were increased up to 22.29% & 24.43% after treatment. Conclusion: On the basis of result obtained, it can be concluded that Shwasa Kuthar Rasa can be used as an effective medicine in the management of (Bronchial asthma). Key words: Tamaka Shwasa, Bronchial Asthma, Shwasa Kuthar Rasa.

Phase-contrast X-ray tomography resolves the terminal bronchioles in free-breathing mice

Phase-contrast X-ray lung imaging has broken new ground in preclinical respiratory research by improving contrast at air/tissue interfaces. To minimize blur from respiratory motion, intubation and mechanical ventilation is commonly employed for end-inspiration gated imaging at synchrotrons and in the laboratory. Inevitably, the prospect of ventilation induced lung injury (VILI) renders mechanical ventilation a confounding factor in respiratory studies of animal models. Here we demonstrate proof-of-principle 3D imaging of the tracheobronchial tree in free-breathing mice without mechanical ventilation at radiation levels compatible with longitudinal studies. We use a prospective gating approach for end-expiration propagation-based phase-contrast X-ray imaging where the natural breathing of the mouse dictates the acquisition flow. We achieve intrapulmonary spatial resolution in the 30-μm-range, sufficient for resolving terminal bronchioles in the 60-μm-range distinguished from the surrounding lung parenchyma. These results should enable non-invasive longitudinal studies of native state murine airways for translational lung disease research in the laboratory.

Flexible bronchoscopy in foreign body removal in the pediatric population: A Systematic Review

Background: Foreign body aspiration (FBA) in the tracheobronchial tree is a common problem in the pediatric population. Rigid bronchoscopic procedure is currently the gold standard method for treatment in pediatric patients, whereas recent reports present flexible bronchoscopy as an alternative method. The aim of this study was to summarize all available evidence regarding the application and the success rate of flexible bronchoscopy in foreign body (FB) removal. Methods: Systematic review of the use of flexible bronchoscopy as the first-line treatment in FBA cases in PubMed from 2001 to 2021. Results: Out of 243 citations, 23 studies were included on the use of flexible bronchoscopic procedure as a treatment of choice in 2,587 children with FBA. The FBs were successfully removed in 2,254/2,587 (87.1%) patients with a low complication rate. The majority of FBs retrieved were organic materials 1,073/1,370 (78.3%), and they were most commonly lodged in the right bronchial tree 708/1,401 (50.5%). General anesthesia was applied in most studies (14/23) before proceeding to a flexible bronchoscopy and laryngeal mask airways (LMAs) were mostly used (10/23 studies) to secure the airway during the procedure. Ancillary equipment, usually forceps 1,544/1808 (85.4%) assisted in the FB retrieval. Conclusion: The use of flexible bronchoscopy is shown to be a feasible and safe alternative therapeutic procedure in FBA cases. There is a need for development of extraction equipment and techniques to assist the procedure. Finally, future studies focusing on the comparison between clinical outcomes of flexible and rigid bronchoscopies are necessary.

The Clinicopathological Features and Unusual Immunophenotype of Primary Tracheobronchial Granular Cell Tumors

BackgroundPrimary tracheobronchial granular cell tumors (GCTs) are rare. The characteristics of these tumors are unclear, and they are easily misdiagnosed. Thus, the present study aimed to investigate the clinicopathological features and immunophenotype profile of these tumors of the tracheobronchial tree.MethodsFour patients were treated for GCTs of the tracheobronchial tree at our institution during 2009–2020. The clinicopathologic and immunohistochemical (IHC) findings were performed in all cases. In addition, seven typical GCTs involving the subcutaneous tissues (4/7) and esophagus (3/7) were also selected as control groups to evaluate the differences in IHC characteristics in different locations. Fisher’s exact test was adopted in analysis of categorical data.ResultsThere were four patients, two females and two males, aged 15, 22, 45 and 52. Three tracheobronchial tumors were solitary with a range from 2.0 to 3.1 cm (mean, 2.6 cm) in its large axis, while one sample was multiple. Chest computed tomography (CT) often suggested lung infectious lesions. On histopathology, three samples were typical GCTs, and the other sample was atypical with a fusiform or spindled morphology. All tumor cells stained positive for S100 protein, CD68, and Nestin and negative for Inhibin-α and thyroid transcription factor-1（TTF-1）. The Ki-67 index was less than 5%. Tracheobronchial GCTs exhibited occasional focal and weakly positive transcription factor E3 (TFE3) staining and had a lower ratio than those in other sites, while calretinin showed predominant subcutaneous expression. Two patients treated with tumor resection and the others only performed an endoscopic biopsy. Follow-up period ranged from 24 to 68 months with a mean of 42 months.ConclusionsPrimary tracheobronchial GCTs are rare and are often mimics pneumonia, which have a good prognosis even without surgical resections. Tracheobronchial GCTs had an unusual immunophenotype of TFE3 expression compared with other sites. This result may reflect a site-specific phenomenon distinguishing GCTs of the tracheobronchial tree.

Imaging of congenital lung diseases presenting in the adulthood: a pictorial review

Congenital lung diseases in adults are rare diseases that can present with symptoms or be detected incidentally. Familiarity with the imaging features of different types of congenital lung diseases helps both in correct diagnosis and management of these diseases. Congenital lung diseases in adults are classified into three main categories as bronchopulmonary anomalies, vascular anomalies, and combined bronchopulmonary and vascular anomalies. Contrast-enhanced computed tomography, especially 3D reconstructions, CT, or MR angiography, can show vascular anomalies in detail. The tracheobronchial tree, parenchymal changes, and possible complications can also be defined on chest CT, and new applications such as quantitative 3D reconstruction CT images, dual-energy CT (DECT) can be helpful in imaging parenchymal changes. In addition to the morphological assessment of the lungs, novel MRI techniques such as ultra-short echo time (UTE), arterial spin labeling (ASL), and phase-resolved functional lung (PREFUL) can provide functional information. This pictorial review aims to comprehensively define the radiological characteristics of each congenital lung disease in adults and to highlight differential diagnoses and possible complications of these diseases.

Small Airway Susceptibility to Chemical and Particle Injury

Small airways (SA) in humans are commonly defined as those conducting airways <2 mm in diameter. They are susceptible to particle- and chemical-induced injury and play a major role in the development of airway disease such as COPD and asthma. Susceptibility to injury can be attributed in part to structural features including airflow dynamics and tissue architecture, but recent evidence may indicate a more prominent role for cellular composition in directing toxicological responses. Animal studies support the hypothesis that inherent cellular differences across the tracheobronchial tree, including metabolic CYP450 expression in the distal conducting airways, can influence SA susceptibility to injury. Currently, there is insufficient information in humans to make similar conclusions, prompting further necessary work in this area. An understanding of why the SA are more susceptible to certain chemical and particle exposures than other airway regions is fundamental to our ability to identify hazardous materials, their properties, and accompanying exposure scenarios that compromise lung function. It is also important for the ability to develop appropriate models for toxicity testing. Moreover, it is central to our understanding of SA disease aetiology and how interventional strategies for treatment may be developed. In this review, we will document the structural and cellular airway regional differences that are likely to influence airway susceptibility to injury, including the role of secretory club cells. We will also describe recent advances in single-cell sequencing of human airways, which have provided unprecedented details of cell phenotype, likely to impact airway chemical and particle injury.

A model for calculating beta exposure doses to tracheobronchial cells during movement of a point source

The article describes a model and method for calculating beta-exposure doses to secretory and basal cells of the tracheobronchial part of the respiratory tract when a point source of 1 Bq activity moves along the inner surface of respiratory formations. The calculations, that used for proposed model, were performed by using a 90Y point source as an example. The dose calculation model takes into account the speed o f movement of the radiation source in each respiratory formation, the size of the respiratory formations, and the depth of the secretory and basal cells. The dose calculation is based on the dose rate attenuation functions published by W. G. Cross et al. (DOI: 10.1097/00004032-199208000-00002). The calculations were performed for a cylindrical model of a respiratory formation. Two kinds of cells were considered for the dose estimation: cells irradiated without beta-particle exit into bronchial lumen (type 1 cells) and cells irradiated due to beta-par­ticle exit into bronchial lumen (type 2 cells). The results of calculations showed, that as far as the generation number increasing, the average irradiation doses of the type 1 cells are 10 or more times greater than those of the type 2 cells. With increasing generation number in the tracheobronchial tree, doses per cells increase by several orders of magnitude. The highest doses are formed in bronchioles of generations 9-15, reaching units and tens of mGy. In spite of the fact that the number of generation increases, the total number of irradiated cells decreases, the collective doses of irradiated cells (sum of doses to all cells of the respiratory formation) in the last generations are 30-50 times higher than the doses of the first generations. Thus, in case of a single point source, there is a significant (by many orders of magnitude) scatter of doses to individual cells in indi­vidual respiratory formation, as well as significant differences in average doses of trachea, individual bronchi and bronchioles.

Role of Amritadi Kwath in Tamaka Shwasa (Bronchial Asthma)

Tamaka Shwasa is one of the chronic disorders of Pranavaha srotos which occurs by Pratiloma gati of Vata due to obstructed Kapha. Tamaka Shwasa is often correlated with Bronchial Asthma in modern medicine. Asthma is a disease of airways that is characterised by increased responsiveness of the tracheobronchial tree to a variety of stimuli. Keeping these points in view, the clinical study entitled as “Role of Amritadi Kwath in Tamaka Shwasa (Bronchial Asthma)” was been selected. For this 27 patients of Tamaka Shwasa were randomly selected on the basis of inclusion and exclusion criteria from Kayachikitsa O.P.D of Rishikul Campus, UAU, Haridwar. The drug chosen was Amritadi Kwath (with Pippali churna as Anupan) from Chakradatta which was given in a dose of 40 ml twice daily for 45 days. Assessment was done at the interval of 7 days during this period, along with a follow up of 15 days after the completion of trial on the basis of subjective and objective parameters. Appropriate statistical tests were used for obtaining the results. The effect of trial was considered on the basis of percentage relief in the above parameters. Maximum improvement were noted in Sleshma vimokshante labhate sukham (92.31%), Kapha nishtivana (88.46%) and Ushnabhinanditi (84.91%). In overall response, marked improvement was found in 56% patients, moderate improvement in 28% patients, mild improvement in 8% patients and no change in 8% patients. As per the data collected, Amritadi Kwath when given in Tamaka Shwasa was effective in relieving the symptoms in the patients.