Journal of Clinical Respiratory Diseases & Care: Acesso Aberto

Background and objectives: COPD is gaining importance in the field of public health because it is expected to become the third leading cause of death worldwide by 2020. Until today, there is no validated score for risk stratification of patients presenting with an exacerbation of COPD to the emergency department. The BAP-65 is a new score, published in 2011 in the «CHEST» journal, which was used to predict the need for mechanical ventilation and predict the risk of mortality in acute exacerbation of COPD. Thus, we decided to conduct this study and apply the BAP-65 score in Lebanon, in order to test its accuracy in correlating the clinical and biological status of the patient presenting with acute exacerbation of COPD with mortality risk and the possible use of MV. Methods: We analysed 980 admissions to two Lebanese hospitals (2005 through 2013) with a discharge diagnosis of acute exacerbation of COPD. The primary endpoints were hospital mortality and need for MV. We used the SPSS program - Version 17 in our analysis. Results:170 patients (17.3%) required mechanical ventilation and 59 patients (6%) passed away during hospitalization. Statistics showed that both end points increased with increasing BAP-65. 1.3% of patients with a score of 0 or 1 needed intubation, while 74% of patients with a score of 3 or 4 were intubated (P-value < 0.001). Moreover, <1% of patients with a score of 0 or 1 passed away, while 51% of patients with a score of 3 or 4 died (P-value < 0.001). Conclusions: The BAP-65 scoring system seems to be a useful and simple tool to classify the patients presenting with AECOPD, and it correlates with both need for mechanical ventilation and mortality. Most importantly, it showed consistent results when applied in different populations.

A 25-year-old lady presented with acute respiratory distress syndrome following dilatation and curettage. Due to non-responding fever she was investigated further. High resolution computed tomography showed ‘random nodules’ with consolidation suggestive of miliary tuberculosis with acute respiratory distress syndrome, which was confirmed later on transbronchial lung biopsy. She responded to antituberculous therapy and was discharged afebrile with normal vital parameters.

Objectives: Body plethysmography is a lung function testing method usually applied for determination of thoracic gas volume and airways resistance, but option to measure work of breathing is available in most models. Although the method has been known over fifty years, assessment of work of breathing with it has not yet systematically studied in obesity. The aim of the study was to evaluate the relevance of work of breathing measured by body plethysmography in obese subjects and to compare the results with those of healthy controls and patients with pulmonary diseases of different pulmonary mechanics. Methods: Altogether sixty-two adults were studied prospectively: healthy non-smoking obese subjects (BMI > 30, N = 15), patients with interstitial lung disease (ILD) (N =15), emphysematic COPD (emphysema) (N = 16) and healthy non-smoking controls (controls) (N = 16). Inspiratory, expiratory and total work of breathing (WOBin, WOBex and WOB) and specific work of breathing (sWOBin, sWOBex and sWOB) were measured. Results: In obese subjects, WOB, WOBin (p < 0.001) and WOBex (p = 0.002) were elevated in comparison to controls. Also in ILD, WOB was significantly higher than in controls (p < 0.006). sWOBin, sWOBex and SWOB were significantly higher in emphysema than in the controls (p < 0.001). Conclusions: In obesity and ILD WOB whereas in emphysematic COPD sWOB differed significantly from controls, which is caused by differences in lung mechanics and lung volumes. The results concerning COPD correspond earlier study, but the present results suggest that body plethysmography is suitable for the assessment of work of breathing also in obesity.

Background: Tuberculosisis an infectious disease responsible for 1.5 million deaths, worldwide, per year. Low levels of knowledge about TB are globally associated with a higher prevalence of latent TB infection and a low rate of treatment success. This study aimed to evaluate the level of TB knowledge of individuals at a recreational center in Goiânia, Goiás, Brazil. Methods: We conducted 573 written structured interviews on recreational center frequentersin February and March, 2013, which included five close-ended questions and one open-ended question concerning TB. Data were analyzed with Epi Info 3.5.2. Results: Percentages of patients who answered questions correctly were: 96.3% knew about TB (Q1); 48.5% knew that TB is caused by a bacterial infection (Q2); 73.8% knew that TB can be transmitted to people in contact with infected people (Q3); 75.4% knew that TB can be transmitted via air or droplets (saliva) (Q4); 85.5% knew that the main symptom of TB is cough (Q5); and 96.1% knew that TB is a curable disease (Q6). Conclusion: Overall, a quarter of the population was not aware of the main symptoms, transmission mode, and transmissibility of TB. In order to control TB infection and prevent its spread, emphasis should be placed on increasing awareness of this disease among individuals.

Nowaday screening of non-small cell lung cancer (NSCLC) patients for epidermal growth factor receptor (EGFR) activating mutations is carried out in routine diagnostics to select patients who could benefit from EGFR inhibitor therapies. We aimed to compare EGFR mutation testing by Ion Torrent PGM technology, using AmpliSeq Colon and Lung Cancer panel, with real-time PCR in order to evaluate the accuracy of next generation sequencing (NGS) in detecting clinically relevant EGFR mutations in NSCLC. In total, 368 NSCLC patient samples were tested for EGFR by PCR and were also sequenced by Ion Torrent PGM by using AmpliSeq Colon and Lung panel. Samples were formalin-fixed, paraffin-embedded tumor specimens of Finnish NSCLC patients. The mutations studied for comparison were G719X, S768I, T790M, L858R, L861Q, deletions in exon 19 and insertions in exon 20. Comparison of EGFR mutations detectable by both PCR kit and NGS panel, showed a high degree of concordance between the two methods. Out of 368 samples, 31 out of 32 positive by PCR were also positive by NGS, and 336 out of 336 negative by PCR for these mutations were also negative by NGS giving a concordance of 99.7%. Two negative samples by PCR showed insertions in exon 20, which were not detectable by PCR. In one sample NGS failed to detect G719X mutation that had a very weak signal in PCR. Our study shows that the Ion Torrent PGM technology gives highly comparable results with the golden standard PCR. Thus, this NGS methodology is sensitive and reliable while testing clinically and diagnostically significant EGFR mutations in FFPE samples.