'Smoging kills' - Effects of air pollution on human respiratory system

Atmospheric pollution suspended in humid air is popularly known as 'smog'. It is composed of dust particles of different sizes, as well as non-metal oxides, organic compounds, and heavy metals. Exposure to harmful substances suspended in the air - apart from, for example - smoking cigarettes, one of the modifiable factors leading to the development of respiratory diseases. There are six types of substances present in the air that have a negative impact on public health and result in significant consequences: ozone, particulate matter (PM) of different diameters - PM2.5µ, PM2.5‒10 µ, PM10 µ, nitrogen dioxide, sulphur dioxide, carbon monoxide and lead. Particular attention is given to small dust particles (PM10 and PM2.5) because they can penetrate into the lower respiratory tract. Apart from describing the composition of smog and sources of air pollution, the article also discusses the impact of atmospheric pollutants on both development and aggravation of the symptoms of such respiratory tract diseases as asthma, chronic obstructive pulmonary disease, respiratory infections and lung cancer. Some of legal measures applied in different countries aimed at reducing exposure to noxious air pollutants are reviewed. The authors believe that the increased focus on risks arising from inhaling toxic air pollution may be a first step for developing systemic solutions aimed at resolving or, at least, decreasing those risks.

Radon-The Element of Risk. The Impact of Radon Exposure on Human Health

Lung cancer is a heterogeneous group of diseases with multifactorial aetiology. Smoking has been undeniably recognized as the main aetiological factor in lung cancer, but it should be emphasized that it is not the only factor. It is worth noting that a number of nonsmokers also develop this disease. Radon exposure is the second greatest risk factor for lung cancer among smokers-after smoking-and the first one for nonsmokers. The knowledge about this element amongst specialist oncologists and pulmonologists seems to be very superficial. We discuss the impact of radon on human health, with particular emphasis on respiratory diseases, including lung cancer. A better understanding of the problem will increase the chance of reducing the impact of radon exposure on public health and may contribute to more effective prevention of a number of lung diseases.

Pulmonary actinomycosis - the great imitator

Pulmonary localisation represents only 15% of all cases of actinomycosis. The clinical symptoms and radiological changes of this disease are non-specific and sometimes it can be misdiagnosed, usually as tuberculosis, lung cancer or lung abscess. In the reported case, what might look like the lung cancer, finally turned out to be actinomycosis. The interesting case is presented of lung actinomycosis in a 77-year-old farmer, admitted to the Department of Pneumonology, Oncology and Allegology in Lublin due to a massive haemoptysis. CT scan of the chest showed, apart from other changes, the spicular consolidation in the right lung which aroused oncology vigilance. The diagnostic path, which was a real medical challenge, led to the diagnosis of actinomycosis. The process of diagnosis and consequent treatment, which led to the complete regression of clinical and radiological changes, is presented.

Phenolic Composition of the Leaves of Pyrola rotundifolia L. and Their Antioxidant and Cytotoxic Activity

The leaves of Pyrola rotundifolia L. were extracted in the mixed solvent of methanol/acetone/water (2:2:1, v/v/v) and investigated for their phytochemical analysis and biological activity. Total phenolic and flavonoid contents were determined spectrophotometrically. A high content of phenols (208.35 mg GAE/g of dry extract), flavonoids (38.90 mg QE/g of dry extract) and gallotannins (722.91 GAE/g of dry extract) was obtained. Ultra-high performance liquid chromatography diode array detector tandem mass spectrometry (UHPLC-DAD-MS) allowed for the detection of 23 major peaks at 254 nm. The extract was analyzed for its antioxidant capacity using 2,2-diphenyl-1-picryl-hydrazyl (DPPH^•) and 2,2'-azinobis[3-ethylbenzthiazoline]-6-sulfonic acid (ABTS^•+) radical scavenging, metal chelating power and β-carotene-linoleic acid bleaching assays. The examined extract showed moderate radical scavenging and chelating activity, and good inhibiting ability of linoleic acid oxidation (EC₅₀ = 0.05 mg/mL) in comparison to standards. The cytotoxic effect in increasing concentration on five types of leukemic cell lines was also investigated using trypan blue vital staining. It was found that the analyzed extract induced the apoptosis of all the tested cell lines. Our findings suggest that the leaves of P. rotundifolia are a source of valuable compounds providing protection against oxidative damage, hence their use in traditional medicine is justified.

Thiram - Toxic inhalational lung injury

INTRODUCTION

Thiram, a fungicides, is widely used on seeds and as foliar agent on turf, vegetables and fruit. It is also used in the rubber industry as a vulcanization accelerator. When absorbed through the respiratory system, it is rapidly metabolised to dimethylthiocarbamate and carbon disulphide, causing noxious effects. A brief review is presented of the literature, centering on the interesting case of a 45-year-old woman admitted to the hospital suffering from acute respiratory failure.

RESULTS

Computer tomography in angiographic option (angio-CT) showed an extensive, irregular area of ground glass in both upper lobes and apical segments of the lower lobes of the lungs. A significant enlargement of both atria was also described. There was no improvement after cardiac treatment and patient was transferred to the pulmonary department where she was succesfully treated with systemic glucocortycosteroids. The patient remains under the supervision of the pulmonary out-patient department.

Not only cigarettes - other culprits of lung cancer

Introduction. Before cigarettes became popular, lung cancer was an extremely rare disease, but currently it is the most common cause worldwide of cancer death in both genders. Therefore, it constitutes a huge epidemiological, diagnostic and socio-economic challenge around the world. In Poland, lung cancer is the second most common carcinoma in both men and women, and it is also the most prevailing cause of carcinous death. Undoubtedly, although smoking classical cigarettes is the strongest risk factor of developing the cancer, unfortunately it is not the only one. Objective. The aim of this study was to present smoking-related factors, e.g. cigars, pipes, e-cigarettes or marijuana smoking, etiologically related to lung cancer incidence.

What Remains up to 7 Months after Severe and Moderate Pneumonia in Non-Vaccinated Patients with Long COVID? Results of a CT Study

BACKGROUND

There is a growing evidence of long-lasting lung changes after COVID-19. Our aim was to assess the degree of lung injury and evaluate the recovery process of 4-7-month-non-vaccinated convalescent patients discharged from hospital after moderate and severe COVID-19 pneumonia, who presented with symptoms of long-COVID.

METHODS

On control lung CT after mean 5-month recovery period, we classified and determined the prevalence of residual radiological abnormalities in 39 symptomatic patients. To assess the advancement of the persisting changes we used the total severity score (TSS) and the chest CT score and then correlated the results with clinical data.

RESULTS AND CONCLUSIONS

On follow-up CT images, 94.9% of patients showed persistent radiological abnormalities. The most frequent changes were ground-glass opacities (74.4%), reticular pattern (64.1%), fibrotic changes (53.8%), nodules (33.3%), bronchiectasis (15.4%), vascular enlargement (10.3%), and cavitation (5.1%). The median TSS score was 4.1 points (interquartile range 3), whereas the median of the chest CT score 5.4 points (interquartile range of 4.5). No significant differences were observed between sex subgroups and between the severe and moderate course groups. There were no association between both CT scores and the severity of the initial disease, indicating that, mean 5 months after the disease, pulmonary abnormalities reduced to a similar stage in both subgroups of severity.

Lung cavitation as a consequence of coronavirus-19 pneumonia

OBJECTIVE

There are reports confirming that the development of pulmonary cavities is an atypical CT finding in patients after COVID-19 pneumonia. Before the SARS-Cov-2 pandemic, we knew that the most common causes of pulmonary cavities were mycobacterial, fungal or parasitic infections. Rapidly increasing incidence of pneumonia in the course of COVID-19, and thus, tomographic examinations of the lungs proved that one of the rare complications of this disease may also be cavity development. The aim of the study was to assess the incidence of pulmonary cavities in patients after SARS-CoV-2 pneumonia. We also aimed to analyze the changes accompanying the pulmonary cavities in our patients.

PATIENTS AND METHODS

We performed a retrospective analysis of 206 lung CT scans of patients with SARS-CoV-2 infection. In 28 of them, prior radiological examination revealed the presence of pulmonary lesions - these patients were disqualified for the study.

RESULTS

Out of 178 enrolled patients, 6 developed pulmonary cavities (3.37% of all cases). The most frequent changes coexisting with cavitary lesions in our material were: ground glass opacities, reticular pattern, bronchiolectasis and subpleural bands.

CONCLUSIONS

Our study confirms the similar incidence of pulmonary cavities after COVID-19 than previously reported. It also incites the clinicians to pay attention to the possibility of the occurrence of this complication.

A single-institution retrospective analysis of the differences between 7th and 8th edition of the UICC TNM staging system in patients with advanced lung cancer

OBJECTIVE

The TNM (Tumor, Node, Metastasis) classification of Union for International Cancer Control is a system describing the anatomical extent of the solid tumors that leads to staging and decision on the type of treatment. The latter TNM system (2017) as compared to the previous version (2010) has brought numerous changes. Our aim was to examine whether significant changes in the new TNM edition have altered the components of the TNM classification in patients and the stage of the disease to which they are ascribed.

PATIENTS AND METHODS

The study is retrospective and is based on radiological examination reports and case reports of 100 patients of the Department of Pneumonology, Allergology and Oncology of the Medical University in Lublin, Poland. One hundred randomly selected patients, who were hospitalized at the Clinic between 2013 and 2018 with primary lung cancer were enrolled in the study. The chi-square test, Mann-Whitney U test, Kruskal-Wallis test and an appropriate post-hoc test were used in statistical analysis.

RESULTS

It was calculated that the T descriptor evaluated as per TNM in revision 8th in comparison to revision 7th changed in 41% of patients, the M descriptor - in 29% of patients, which resulted in change in staging in 11 patients. In spite of this scale amendments, only three patients could be treated differently because of the change in the stage of the disease.

CONCLUSIONS

Changing the treatment method, including withdrawal from surgery, can help avoid unnecessary treatment, but on the other hand, may potentially reduce the patient's chances of survival by depriving them of the possibility of radical treatment.

'TB or not TB?' Problems of differential diagnosis of cutaneous mycobacteriosis and tuberculosis--A Case Study and interdisciplinary discussion

The diagnosis of cutaneous tuberculosis poses a serious challenge due to many skin diseases of different etiology resembling the lesions caused by the TB (tuberculosis) bacillus, and difficulties in confirming the disease. The presented case concerns skin lesions in a hobby aquarist stung in the finger of the left hand by a fish. The resulting inflammatory infiltration was to be cutaneous tuberculosis or mycobacteriosis caused by MOTT (Mycobacterium other than tuberculosis). Laboratory, pathomorphologic, genetic and microbiologic tests of samples obtained from the patient, fish and water in the aquarium gave ambiguous results. A multidisciplinary discussion is presented on the difficulties in the differential diagnosis, problems with a clear interpretation of the results of various conducted tests, and possible ways of transmission of the infection, relevant to the described example.

Residential Radon Exposure in Patients with Advanced Lung Cancer in Lublin Region, Poland

Exposure to radon is the second most common factor causing lung cancer in smokers and the first among non-smokers. We aimed to measure the impact of the radon exposure on patients with different histological types of advanced lung cancer. The measurement of radon exposure was performed in 102 patients with lung cancer in stage 3B or higher (Poland). There were 78.4% of patients with non-small cell carcinoma and 21.6% of patients with small cell carcinoma. One month radon exposure measurement was performed with trace detectors in order to control whether high radon concentrations (>800 Bq/m3) were found in the homes of patients with cancer diagnosed. Results of the determinations were then compared with the representation of the most common types of lung cancer in the study population. In the analyzed group, the average concentration of radon during the exposure of the detector in the residential premises of the respondents accounted for 69.0 Bq/m3 [37.0−117.0] and had no statistically significant effect on the type of lung cancer developed in patients. The lack of statistical significance may result from the small study group and the accompanying exposure to other harmful components. As the incidence of lung adenocarcinoma is increasing and exposure to tobacco smoke is decreasing, the search for other modifiable causes of lung cancer should be the task in the future.

Are patients undergoing treatment of hyperlipidaemia with statins the best candidates for early cardiac rehabilitation?

The role of statins in the primary and secondary prevention of cardiovascular events is well known. An important adverse event associated with statin treatment is myopathy; intensive physical effort in patients treated with statins increases the risk of muscle injury/myopathy. In this article we discuss the benefits and risks associated with statin treatment in patients undergoing cardiac rehabilitation after acute coronary syndromes and/or coronary revascularization procedures. In our opinion, the benefits of the secondary prevention of coronary heart disease achieved with statins seem to outweigh the hazards associated with statin therapy. The careful selection of patients for both treatment with statins and the gradual intensification of physical training in the course of cardiac rehabilitation appears to constitute an important element of the therapeutic approach.

[The usefulness of natriuretic peptides measurements in the diagnostics of chosen cardiovascular diseases]

Natriuretic peptides compose the group of neurohormones produced by the myocardium in response to its walls stretching caused by the volume or pressure overload. They restrain the sodium kidney reabsorbtion, thus increasing the diuresis and natriuresis. They also participate in blood pressure, initial load as well as the water-mineral balance regulation. The main representatives of this group are ANP (atrial natriuretic peptide) and BNP (brain netriuretic peptide). With regard to slow dynamics of the serum levels changes, the measurements of BNP play an important role in cardiological diagnotics. Its serum concentration raises in these cardiovascular diseases that are connected with the left ventricle overload. So it can be treated as a specific left ventricle dysfunction marker, whereas its high concentrations correlate with the functional class according to NYHA. It also can be used in risk stratification in patients with the acute coronary syndrome and pulmonary embolism, as well as helping to differentiate the pulmonary and cardiac causes of acute dyspnoea. The serum level of NT-proBNP (N-terminal propeptide of brain natriuretic peptide) is also the independent predictive factor of the recurrence of atrial fibrillation after the restoring the sinus rhythm.

[Cardiac manifestation of Morgagni hernia--a case report]

The Morgagni hernia is a rare condition caused by the disturbances in the embryonal development of the diaphragm. The high pressure in the abdominal cavity during the persistent constipations or in pregnant women seems to be important predisposing factor apart from advanced age, obesity, vertebral column deformities and the connective tissue diseases. That is why the Morgagni hernia is very rarely diagnosed in children but usually in women in their fifties. We present the case report of our patent who was admitted to the Department of Internal Diseases for the diagnostics of lasting for 3-4 months weakness, chest pains and the episodes of palpitations. During her stay in our Department the routine chest X-ray examination was performed, that showed the unexpected result. The diagnosis of Morgagni hernia was afterwards confirmed in the computed tomography. Even though the risk of the acute abdominal conditions in the dislocated parts of gastro-intestinal tract our patient did not agree to proposed operation.

[Two cases of serious hepatic injury caused by antithyroid drugs]

We present two cases of severe hepatotoxicity caused by antithyroid drugs in women with Graves disease. The first medication in both cases was methimazole replaced by propylhiouracil due to intolerance. The main symptom was jaundice lasting about 2 months. As a first step in the treatment we terminated the antithyroid drug administration and introduced prednisone and ursodesoksycholic acid therapy. The termination of thyrotoxicosis by means of 131 I administration had also positive influence on the course of disease. In summary we emphasise the significance of prompt discontinuation of antithyroid drug once toxic symptoms appeared and avoid replacement one thyrostatic drug for another in fovour of radioiodine treatment.

[Pneumomediastinum - a case report]

Pneumomediastinum is a rare disorder which often occurs without symptoms. It is sometimes a result of an injury but most often it is spontaneous. Pneumothorax may be iatrogenic; one of the reasons might be tracheotomy. Pneumomediastinum in some cases may be the threat to life and health. In this rare cases surgical intervention is needed, however pneumomediastinum is usually spontaneously absorbed.

AIM

The aim of this study was to present the differential diagnosis of pneumomediastinum based on the case of a 60-year-old woman with tracheostomy, diagnosed eight years ago with generalized irreversible narrowing of the trachea and bronchi (suspicion of tracheobronchopathia osteochondroplastica).

A CASE REPORT

Patient complained of increasing shortness of breath, dry cough and symptoms of upper respiratory tract infections for 2 weeks. In chest CT pneumomediastinum was detected. During bronchoscopy and endoscopic examination of trachea and larynx, no focal lesions of upper respiratory tract and bronchi were detected. By using noninvasive treatment, clinical improvement was achieved. In control chest CT, significant resorption of the air from the mediastinum was detected. Pneumomediastinum occurs often without characteristic symptoms or can be asymptomatic and it is discovered incidentally. If there is no obvious trauma, the cause is usually unknown. In the presented case, after exclusion of the majority of possible causes, we suspected that pneumomediastinum was a complication of tracheotomy but it was not confirmed in endoscopy. It might have been a complication of severe coughing in the course of upper respiratory tract infection or it might have been spontaneous.

CONCLUSIONS

Patient complained of increasing shortness of breath, dry cough and symptoms of upper respiratory tract infections for 2 weeks. In chest CT pneumomediastinum was detected. During bronchoscopy and endoscopic examination of trachea and larynx, no focal lesions of upper respiratory tract and bronchi were detected. By using noninvasive treatment, clinical improvement was achieved. In control chest CT, significant resorption of the air from the mediastinum was detected. Pneumomediastinum occurs often without characteristic symptoms or can be asymptomatic and it is discovered incidentally. If there is no obvious trauma, the cause is usually unknown. In the presented case, after exclusion of the majority of possible causes, we suspected that pneumomediastinum was a complication of tracheotomy but it was not confirmed in endoscopy. It might have been a complication of severe coughing in the course of upper respiratory tract infection or it might have been spontaneous.

IgA vasculitis after COVID-19: a case-based review

IgA-associated vasculitis (IgAV) known as Henoch - Schönlein purpura (HSP) disease is an inflammatory disorder of small blood vessels. It's the most common type of systemic vasculitis in children which can be associated with the inflammatory process following infections. IgA vasculitis is a rare and poorly understood systemic vasculitis in adults. Coronavirus disease 2019 (COVID-19) has been associated with HSP in both adults and children. A 58-year-old woman was diagnosed with HSP, fulfilling the clinical criteria: palpable purpura, arthritis, hematuria. The disclosure of the HSP disease was preceded by a infection of the respiratory tract. COVID-19 infection was confirmed via the presence of IgM and IgG antibodies. This case indicates the possible role of SARS-CoV-2 in the development of HSP. The clinical course of IgAV in adults appears to be different from pediatric IgAV, especially due to higher risk of renal complications. Symptoms of the disease quickly resolved with low-dose of steroids.

[Comorbidity of chronic heart failure and chronic obstructive pulmonary disease]

Cardiovascular diseases most frequently coexist with the chronic obstructive pulmonary disease (COPD). The studies report on over 10 million patients of population suffering both chronic heart failure (CHF) and COPD. Similarity of the clinical symptoms and risk factors found in the medical history of patients with chronic heart failure and chronic obstructive pulmonary disease often causes diagnostic mistakes. At present, medicine has the wide range of diagnostic methods. Among them: well taken medical history, chest radiogram, determination of the serum concentration of natriuretic peptides, spirometry with bronchial reversibility test and many others should be mentioned. The skillfull interpretation of their results guarantee the possibility of more effective treatment. Pulmonary hypertension constitutes the link between the chronic obstructive pulmonary disease and CHF. Although its clinical manifestations are not specific and can be partially masked by the symptoms of COPD, the possibility of its existance should be taken under consideration in every patient with worsening effort toleration or intensification of dysponoea and stable spirometric values with the lack of other causes. It should be emphasized that, apart from the diagnostic leading to diagnosis of those two conditions in one patient, there are also the possible interactions of their concurrent treatment.

Cardiac metastases from a squamous cell lung carcinoma in the absence of local recurrence - a unique case

OBJECTIVE

Metastatic tumors of the heart are much more frequent than primary tumors. In this paper, we present the uncommon case of heart metastases of a squamous cell lung carcinoma.

CASE REPORT

The study is a description of a unique case of cardiac metastases from lung cancer in the absence of local recurrence. The patient had a squamous cell lung carcinoma and underwent pulmonectomy two years before, followed by four cycles of chemotherapy.

RESULTS

We report this case to raise the awareness of cardiac manifestations of neoplastic diseases that are usually underdiagnosed.

CONCLUSIONS

According to our knowledge, there is no such case described in the literature. Heart metastases are significantly underdiagnosed. Although the survival prognosis is very poor, earlier diagnosis could provide the chance to start the treatment and to prolong patients' life.

[Diagnosis differential of Klinefelter's syndrome in a 24-year old male hospitalized with with sudden dyspnoea--case report]

Klinefelter's syndrome is the most common genetically determined cause of male infertility. It is also connected with higher risk of many diseases such as cardiovascular disorders and malignant tumors as breast cancer and germinal tumors. As a consequence of phenotypic variability, still the majority of cases remains undiagnosed.

CASE REPORT

24 years old male who was admitted to the department because of an episode of sudden resting dyspnoea with the coexisting pain in the retrosternal region and a state of anxiety. Performed examinations did not confirm the diagnosis of heart muscle dysfunction and pulmonary embolism either. However, we noticed the constellation of the specific phenotype features of this patient: high stature, gynecomastia, abdominal obesity, poor hair growth in genital regions. The hormonal tests were performed that allowed to diagnose the hypergonadotropic hypogonadism. Cytogenetic examination revealed the abnormal karyotype of 47,XXY.

CONCLUSIONS

There are no clear references as to diagnosing the Klinefelter's syndrome. Probably, like in this case report, in the majority of cases the diagnosis is accidental.

[Ventilatory disorders in patients with chronic heart failure]

Chronic heart failure (CHF) is a condition in which both structure and functional capacity of cardiac muscle are impaired, resulting in ineffective peripheral tissue perfusion. Affecting numerous organs and systems, it is currently considered to be a systemic illness. Among significant, however until now, hardly recognized consequences of CHF there are ventilatory disorders. Their presence may be explained by proximity of heart and lungs inside rib cage or by close functional cooperation between these two organs. Ventilatory disorders clinically manifest as exacerbations of the underlying disease, i.e. intense dyspnea--primarily exertional in nature, over time, present even at rest. On the basis of functional pulmonary tests, ventilatory disorders may be classified into three categories: restrictive, obstructive and most commonly--mixed. The restrictive model is represented in bodypletysmography as reduction in the total lung capacity to values less than 5th percentile of the predicted values for normals, while Tiffeneau index remains intact. Such condition may probably result from the chronic inflammatory process affecting lung tissue, for which the reaction of macrophage cells to both pulmonary stasis, as well as increased volume of interstitial and alveolar fluid remains the underlying cause. The increased formation of connective tissue fibers engenders thickening of alveolar-capillary membrane, occurrence of disturbed oxygen diffusion and emergence of hypoxemic respiratory failure. Ventilatory disorders of obstructive nature are characterised by reduction of Tiffeneau index--the calculated ratio between forced expiratory volume in 1. second and forced vital capacity--to values below 5th percentile of the predicted range. The research results indicate for the presence of bronchiolar narrowing--dominant in small-diameter bronchi and bronchioles, with larger structures being unaffected--clearly depicted in spirometry as reduced levels of forced expiratory flow after exhaling 50% and 75% of forced vital capacity. Due to a considerable epidemiological problem, as well as significance of the clinical symptoms manifesting ventilatory disorders in course of chronic heart failure, there should be put emphasis on cardiac injury prevention in individuals from risk groups and the proper treatment of patients already suffering from chronic heart failure.