Pulmonary rehabilitation following the 2019 novel Coronavirus infection

The treatment of an infectious disease is only one step to a cure and, in many cases, infectious diseases can lead to short-and long-term impairments, including physical, cognitive and psycho-emotional complications. In this paper, we perform a literature review to identify the appropriate rehabilitation interventions for responding to COVID-19 consequences, taking into consideration the current standards for pulmonary rehabilitation and the COVID-19 literature which has been developed during the pandemic’s evolution. Pulmonary, neurological, cardiac, musculoskeletal, nutritional, cognitive and psychological disabilities, as well as dysphasia, have been observed among patients who recovered after needing time in the intensive care unit (ICU), related either directly to COVID-19 or critical care treatments. Some have also been reported in patients who were asymptomatic or recovered from a mild or moderate form of the disease. Patients who still have dyspnea, exercise intolerance and fatigue, are unable to conduct activities of daily living and/or have difficulty in managing or coping with their disease, despite optimised pharmacological therapy, are most likely to benefit from pulmonary rehabilitation. Contraindications should be considered during patient selection. Rehabilitation prescription should be individually tailored, based on patient assessment and outcome measurements. Pulmonary rehabilitation interventions may involve airway clearance therapy, breathing exercises, mobilisation and strength training, flexibility training, balance training, neuromuscular electrical stimulation (NMES), activities of daily living, aerobic training, dysphagia management, nutrition therapy, cognitive training and psychological support. Medical management of comorbidities and patient-family education are key factors for achieving optimal gains from pulmonary rehabilitation.

Comparison of diagnostic values of haematological and inflammatory parameters in predicting COPD exacerbation

Objective: Many patients with chronic obstructive pulmonary disease (COPD) suffer from acute exacerbation. Acute exacerbation of COPD (AECOPD) is currently known as the most important leading cause of death worldwide. Therefore, recognising beneficial biomarkers in order to detect acute exacerbations promptly is crucial. This study aimed to evaluate the role of haematological and inflammatory parameters in the diagnosis of AECOPD. Methods: This cross-sectional study was carried out on 63 patients with AECOPD, during exacerbation and stable period, and on 62 sex- and age-matched healthy controls. Haematological and inflammatory parameters were analysed, and other data were collected. Receiver operating characteristic (ROC) curve and the area under the curve (AUC) were used to evaluate the neutrophil-lymphocyte ratio (NLR), C-reactive protein (CRP) level, and mean platelet volume (MPV) in the diagnosis of patients with AECOPD. Results: The predictive ability of NLR was higher than that of CRP and MPV. The cut-off value of NLR was 2.85, and the sensitivity and specificity for detecting AECOPD were 87% and 70%, respectively (AUC = 0.84, P < 0.001). NLR values positively correlated with the CRP level, erythrocyte sedimentation rate (ESR) and platelet (PLT) count (r = 0.44, P = 0.001; r = 0.31, P = 0.020; and r = 0.32, P = 0.010, respectively) and negatively correlated with the albumin level and MPV in patients with AECOPD (r = −0.31, P = 0.049 and r = −0.27, P = 0.040). Conclusion: NLRs and CRP levels were both increased in patients with AECOPD, and they are both available and beneficial markers in the prompt detection of AECOPD. Further studies should be performed to underpin the diagnostic and prognostic values of haematological and inflammatory biomarkers in patients with COPD.

Beating the virus is not enough

The authors are presenting a case reflecting the evolution of an infected patient representing the source and, at the same time, one of the first severe cases of SARS-COV2 in Romania, burdened by a dragging and difficult evolution both by the nature of a newly identified infection, with real treatment deficiencies, and by deliberate omission of ethical aspects. There was a delay and were considerable difficulties in establishing the diagnosis, the evolution of the disease, along with some other consequences like an increase in the risk of transmitting the infection – a vicious cycle that otherwise could have been interrupted much earlier.

Common pulmonary computed tomography signs and their clinical relevance: A review

With the advent of computed tomography (CT) in respiratory medicine, a greater delineation of the respiratory structures has been possible in the two-dimensional space. The various CT techniques used by pulmonologists include the high-resolution computed tomography (HRCT) thorax with expiratory scans, contrast-enhanced CT (CECT) thorax, CT thorax, CT pulmonary angiography (CTPA) and rarely a CT aortography/angiography. Each of the imaging techniques presents stronger and weaker points. In this paper, radiological lesions are classified according to their location. Such abnormalities are observed in the airways, in the lung parenchyma, in the interstitium and last but not least in the pleura. The review mainly addresses radiological lesions with higher specificity because they are key elements in establishing a definitive diagnosis. In conclusion, performing a chest CT is vital in the diagnosis and management of respiratory conditions.

Mortality prediction in chronic interstitial lung diseases (ILDs): ILD-GAP (gender age physiology) and (the new modified classification) TNMC-ILD-GAP

Introduction: The interstitial lung disease-gender age physiology (ILD-GAP) model has been proposed on the lines of GAP-idiopathic pulmonary fibrosis (IPF) to predict mortality in chronic ILDs, other than IPF. We replaced diffusion capacity of lung for carbon monoxide (DLCO) with the easy to perform 6-minute walk distance (6 MWD) in the ILD-GAP and proposed the new modified classification (TNMC)-ILD-GAP model. Our aim was to demonstrate the usefulness of the TNMC-ILD-GAP as a predictor of mortality in all chronic ILDs and compare the results with the ILD-GAP. Methods: It was a retrospective observational study conducted at a tertiary care centre. Baseline characteristics of the patients among different ILD groups were analysed. A 3-year follow-up was recorded. The results were compared with the original ILDGAP model. Chi-square and paired t-test was used for comparison of qualitative and quantitative data, respectively. Results: Mean ages were 62.34 (±9.85), 57.9 (±11.6), 46.1 (±14.6) and 55.5 (±14.7) in IPF, non-specific interstitial pneumonitis (NSIP), connective tissue disease (CTD) and unclassifiable groups, respectively. There were 50%, 18%, 26% and 55% males in the four categories respectively. Mean 6 MWD was 227 m, 302 m, 342 m, and 332 m. Mean PaO2 was 64 mmHg, 70 mmHg, 75 mmHg, 69 mmHg. Mean forced vital capacity (FVC) (percentage predicted) was 52, 49, 51 and 54. Most of the patients had comorbidities, among which pulmonary hypertension was the most common. Mortality with ILD-GAP model and TNMC-ILD-GAP showed concordant results as the difference in mortality predicted by ILD-GAP and the TNMC-ILD-GAP models was statistically insignificant (P > 0.050). Conclusion: 6 MWD can serve as a reliable replacement for DLCO in the ILD-GAP model, especially in resource limited settings.

Shifting to the ambulatory patient-centered tuberculosis care model in Romania – preliminary results of the pilot project conducted in Marius Nasta Institute of Pneumology dispensaries, January–December 2020

Reversing the concept of the Romanian medical system in terms of approaching patients with tuberculosis (TB) and removing them from a hospital-centred system into a more friendly outpatient system, closer to their needs, is one of its challenges. Preliminary data of this project show that through minimal and consistent investments the diagnosis, treatment and monitorisation can be made exclusively in the outpatient department for these patients.

Epithelioid haemangioendothelioma – A rare cause of pleural effusion

We present the case of a 44-year-old patient, with a history of lymphatic tuberculosis, diagnosed with a pleural effusion associated with pulmonary consolidations. Pleural effusions are frequent in the general population, presenting an incidence of 3–4 cases/1000 people. The etiological diagnosis can be difficult, as they can be secondary to a variety of diseases. Numerous extrapulmonary disorders can explain fluid accumulations in the pleural space with elevated protein level (exudates). However, more frequently they are the result of pulmonary diseases – inflammatory, infectious or neoplastic. The case entailed a differential diagnosis between pulmonary and pleural tuberculosis and neoplastic diseases. Despite receiving antituberculous treatment, the patient’s initial symptoms worsen, the patient starts presenting new signs and symptoms, and the fluid’s characteristics change – expression of an unfavourable evolution. Establishing the diagnosis proved to be difficult as invasive procedures were necessary. We diagnosed an extremely rare tumour, of vascular origin as the cause of the pleural effusion. Epithelioid haemangioendothelioma (EHE) presents an incidence of 1 in 1 million people. In conclusion, when treating a patient for pleural effusion, the lack of improvement entails reconsidering the initial diagnosis and performing more extensive tests.

Diagnosis particularities of lung cancer in a young patient without external risk factors – A case report

Lung cancer is the most common type of cancer worldwide, smoking being the strongest risk factor. We present the case of a non-smoker, a 23-year-old patient, without environmental exposure or personal pathological history, who was hospitalised for dry cough, a unique episode of haemoptysis and low-graded fever. He was admitted with a left basal diminished vesicular murmur, without detectable rales, and normal oxygen saturation. The chest X-ray highlighted left pleural effusion in a medium amount. A chest ultrasound revealed also an adjacent pulmonary consolidation. The cytological examination of the pleural fluid detected the presence of lymphocytes 36%, eosinophils 25%, polymorphonuclear 39% and frequent red blood cells. Angio-computer tomography confirmed the existence of a left hilar tumour formation with a mass effect on the hilar structures, possibly a few tumoral emboli in the lateral and posterior basal segmentary arteries, a lower left lobe consolidation, a left pleural effusion with hydroaeric level, and a left pneumothorax. The patient required a fibre bronchoscopy that showed us a proliferative infiltrative process, stenosis of the left lower bronchia, and extrinsic compression of the left lower lobe and the 6th segment. Infiltration of mucosa at the left basal pyramid was also detected. The histological examination argued for pulmonary adenocarcinoma. The particularities of the case consist of the lack of exposure to known risk factors for bronchopulmonary neoplasm and the early appearance of lung cancer and its complications in a young patient.