पल्मोनरी एवं श्वसन चिकित्सा

PAVM is a rare but fatal disease in many cases. Patients may be asymptomatic or present dyspnea, cyanosis, and polyglobulia. However, complications such as paradoxical thromboembolism, brain abscess, and massive hemoptysis are causes of higher morbidity and mortality. This article presents 3 patients with PAVM who underwent lobectomy between 2014 and 2018. The clinical and surgical data were obtained from their medical records. In the 3 cases, pulmonary lobectomy was performed, 2 received hybrid treatment: previous embolization and pulmonary surgery. The mean age was 41.3 years. The main symptom was cyanosis. In 1 case the affection was in a single lobe; in 2 cases it was complex. We consider that surgery is the first treatment option, especially when the PAVM is localized and greater than 5cm or when transcatheter embolization cannot be performed.

An adult female who is a wheelchair bound since early childhood was found to have hereditary multiple skeletal deformities consistent with the rare condition of spondyloepiphyseal dysplasia congenital associated with osteoporosis as well. The patient also suffered from episodic attacks of bronchospasm, stridor and cough. They sometimes were severe enough to call for admission to hospital. Interestingly, the CT images of the chest showed extensive calcifications extending from the sub glottis to trachea and bronchial tree compatible with the diagnosis of tracheobronchopathia osteochondroplastica. This case represents a unique concurrence of these two rare conditions.

Background: The 2019 update by the ISHLT of classification for CLAD includes a mixed and undefined phenotype.

Objectives: Assess (a) frequency phenotypes (per ISHLT) with emphasis on double lung transplants (DLTxs), (b) concordance spirometry with imaging and transbronchial biopsy findings, (c) mortality rates amongst phenotypes.

Methods: Single-center retrospective study of adult patients. Time from transplant to CLAD and mortality amongst phenotypes compared by ANOVA adjusted for age, gender and BMI.

Results: Of 360 patients, 96 (27%) met criteria for CLAD (57 DLTx). Seventy-four (77%) experienced combined FEV1 and FVC decline. In DLTxs, onset of FEV1 decline (n=12) occurred 10 months earlier than for FVC (n=4) and 5 months before simultaneous onset of FVC and FEV1 decline (n=41). Amongst DLTxs, largest cohort was mixed group (n=30, 53%); RAS phenotype second largest (n=16, 28%). Median onset of CLAD: 30 months for BOS and mixed categories (combined n=34); 48 months for RAS (n=16). Time to death following DLTx: longest in BOS, shortest in RAS, intermediate in mixed phenotypes.

Conclusion: CLAD occurs in more than one-quarter of patients; three-fourths exhibit concurrent decline in FEV1 and FVC. Imaging detects changes when biopsy findings are mild or not identified and often do not reflect spirometric changes.

Background: The aim of this observational study was to evaluate the quality of life 3 years or younger children with bronchiolitis and communityacquired pneumonia using the validated Armenian version of the QUALIN and PCQ questionnaire.

Methods: The subjects of the research were children 3 years or younger. Children who were hospitalized with a diagnosis of severe bronchiolitis and community-acquired pneumonia in the “Mouratsan” University Complex formed case group. Healthy children receiving care from the Preventative Polyclinic department in same hospital were formed control group. QL were measured by QUALIN and PCQ questionnaires. Depending on the severity of community-acquired pneumonia, we have formed the 2 subgroups in case group.

Results: QUALIN scores of children with bronchiolitis and community-acquired pneumonia were lower compared with control. Were registered a dependency between the severity of community-acquired pneumonia and QL scores. In case of severe pneumonia scores of QUALIN and PCQ were more affected.

Conclusion: A significant decrease in all subscales of the QUALIN and PCQ questionnaires indicated impact of community-acquired pneumonia and bronchiolitis on QL of the early aged children. Most affected subscale in QUALIN was ARA and in PCQ Q1. All scores in case group were significantly lower than it in control group.