The Hilar Height Ratio in Normal Chest Radiographs of Adults Seen at Selected Tertiary Hospitals in Kampala, Uganda; A Forgotten Parameter in Pulmonary Medicine

Background: The hilar height ratio (HHR) is a numerical expression of the hila position. Displacement of the pulmonary hilum is the most reliable indirect sign, in conditions that result in pulmonary volume changes. Despite the high utility of the chest radiograph, it has a relatively low diagnostic accuracy, high interobserver disagreement and numerous errors following interpretation. Routine use of the HHR with knowledge of the normal ranges would, therefore, help improve the overall chest radiograph sensitivity, reduce on errors and the interobserver disagreement in the interpretation of pulmonary volume changes. This study aims to determine the HHR in our study population, compare it with previous studies, and to relate it with sex, stratified age groups, height and body mass index (BMI).Methods: A consecutive cross-sectional study with purposive sampling were used to filter out a total of 384 normal chest radiographs of adults seen from three tertiary hospitals in Kampala, Uganda. The right and left HHRs were evaluated for each chest radiograph, along with the age, sex weight, height and BMI.Results: The median right HHR for the participants was 1.42 (IQR = 1.31- 1.57), and the median left HHR was 0.92 (IQR = 0.86- 0.98). There was a significant mean difference in the right HHR between the sex groups (p = 0.017) and age groups (p = 0.001). The mean difference in the left HHR was not affected by sex (p = 0.178) or age (p = 0.198). The right and left HHRs showed a very weak correlation to height (r = - 0.10 and r = 0.08, respectively). The right and left HHRs were not significantly different among the BMI groups (p = 0.254 and 0.20 respectively).Conclusion: The median left HHR was not affected by sex, age, weight and height while the right HHR varied with sex and age in our study population. Weight and height do not affect HHRs. The females in our study population had a higher positioned right hilum, whereas the position of the right hilum progressively lowered with increasing age.

Interstitial Lung Disease at High Resolution CT after SARS-CoV-2-Related Acute Respiratory Distress Syndrome according to Pulmonary Segmental Anatomy

Background: The purpose of this study was to evaluate High-Resolution CT (HRCT) findings in SARS-CoV-2-related ARDS survivors treated with prolonged low-dose methylprednisolone after hospital discharge. Methods: A total of 44 consecutive patients (M: 32, F: 12, average age: 64), hospitalised in our department from April to September 2020 for SARS-CoV-2-related ARDS, who had a postdischarge CT scan, were enrolled into this retrospective study. We reviewed the electronic medical charts to collect laboratory, clinical, and demographic data. The CT findings were evaluated and classified according to lung segmental distribution. The imaging findings were correlated with spirometry results and included ground glass opacities (GGOs), consolidations, reticulations, bronchiectasis/bronchiolectasis, linear bands, and loss of pulmonary volume. Results: Alterations in the pulmonary parenchyma were observed in 97.7% of patients at HRCT (median time lapse between ARDS diagnosis and HRCT: 2.8 months, range 0.9 to 6.7). The most common findings were linear bands (84%), followed by GGOs (75%), reticulations (34%), bronchiolectasis (32%), consolidations (30%), bronchiectasis (30%) and volume loss (25%). They had a symmetric distribution, and both lower lobes were the most affected areas. Conclusions: A reticular pattern with a posterior distribution was observed 3 months after discharge from severe COVID-19 pneumonia, and this differs from previously described postCOVID-19 fibrotic-like changes. We hypothesized that the systematic use of prolonged low-dose of corticosteroid could be the main reason of this different CT scan appearance.

Cheyne–Stokes respiration and cardiovascular oscillations ending abruptly when deploying transfemoral aortic valve

A 86-yr-old man was referred for transfemoral aortic valve implantation. Transthoracic echocardiography revealed a severe stenosis (mean gradient: 58 mmHg, aortic valve area: 0.4 cm2), and after multidisciplinary discussion, the risk of surgery was judged too high (logistic Euroscore: 51%), and the patient was proposed for a transfemoral aortic valve implantation (TAVI). On arrival in the operating room, the patient, fully conscious, was noted to have Cheyne–Stokes breathing (CSB), which persisted after 40% oxygen administration. TAVI procedure was successful, and the CSB pattern was interrupted within 8 s. To the best of our knowledge, this report is the first to show an acute disappearance of CSB, occurring only seconds after TAVI and restoration of a normal hemodynamic situation. To explain such rapid changes in breathing pattern, we hypothesize a role played by the acute release of pulmonary hypertension and pulmonary volume overload. NEW & NOTEWORTHY Acute disappearance of Cheyne–Stokes breathing after transfemoral aortic valve implantation suggests a reflex pathway originating from the fall in pulmonary vessels congestion.

Diabetic pneumopathy: A study of induced sputum and pulmonary function in patients with type 2 diabetes mellitus

Objective: To evaluate the cellularity, and albumin and interleukin(IL)-1 levels in induced sputum (IS), and to determinerespiratory function parameters in patients with type 2 diabetesmellitus (DM2). Design: A cross-section study in type 2diabetes mellitus. Participants: Patients with type 2 diabetesmellitus and healthy people. Methods: Patients in both groupshad normal chest x-ray findings. Exclusion criteria for bothgroups were: the presence of current pulmonary disease orsequelae, smoking, respiratory atopy, or respiratory infectionin the past 3 months. The study consisted of two sub-studies.In sub-study 1 (SS1), measurements of pulmonary volume andflow, and diffusion capacity for carbon monoxide (DLCO) wereperformed. In sub-study 2 (SS2), analysis of cellularity, albumin,and IL-1 in IS was performed. Results: In all, 60 patients(45 women, 75%) with DM2 with a mean age of 59.52 years (SD,9.03) were included in SS1. The DM2 group included 8 patientswith airway obstruction (13.33%) without reversibility withbronchodilators, and 9 with restrictive disease (15.00 %) (p =0.026). The DLCO was reduced in 17 patients (28.33%) in theDM2 group. In the control group, all individuals had valueswithin the reference intervals. Lymphocytosis was found inthe IS of patients with DM2 (p = 0.028). The levels of sputumalbumin showed no statistical difference between the twogroups. Conclusion: Our findings indicate the presence ofpulmonary impairment in DM2, characterized by changes inthe respiratory function and a lymphocytosis in IS.Keywords: Diabetes mellitus type 2; Induced sputum;Lymphocytes.

Could routine spirometry suggest sensitisation in the military medicine setting?

IntroductionProviding evidence of sensitisation is the formal requirement for allergy diagnosis. The aim of this study was to evaluate whether spirometry may be able to predict sensitisation in a representative cohort of Italian Navy military personnel.Methods2043 (1875 men, 168 women, mean age 28.35±11.6 years) Italian Navy military personnel were enrolled into this study. Spirometry and skin prick testing were performed to predict sensitisation.ResultsSensitisation, assessed by skin prick test, was documented in 658 (32.2%) subjects. Impaired forced expiratory flow at the 25% and 75% of the pulmonary volume (FEF25–75) as demonstrated on spirometry was detected in 82 subjects, of whom 69 were sensitised (P<0.0001). Impaired FEF25–75 was significantly associated with sensitisation (OR 7.43; 95% CI 4.04 to 14.66; P<0.0001).DiscussionThe findings of this study suggest that impaired FEF25–75 may predict sensitisation in this cohort of Italian Navy personnel. This outcome is relevant in the military medical setting, as it could allow early identification of subjects with subclinical asthma.