पल्मोनरी एवं श्वसन चिकित्सा

Cystic fibrosis is a genetic disorder caused by a defective protein, cystic fibrosis transmembrane conductance regulator. The most common complications of this disease involve the pulmonary, gastrointestinal, and endocrine systems, though there are increasing reports of ocular complications related to cystic fibrosis. Here we report a case of a patient with bilateral retinal artery occlusion of unknown etiology.

Background: Pulse oximetry (SpO2) waveform analysis has recently been compared to intraarterial waveform analysis in assessing intravascular volume in various conditions. Its usefulness during and following ultrafiltration (UF) has not been evaluated. The aim of this pilot study was to assess the relationship of volume removal during UF to SpO2 waveform fluctuations in spontaneously breathing (SB) patients and compare it to patients receiving mechanical ventilation (MV).
Hypothesis: Volume removal during UF increases the amplitude and peak-to-peak variability of the SpO2 waveform (ΔP and ΔS, respectively).
Methods: Pulse oximetry waveform analysis was conducted in thirty-eight critically ill patients (total: 81 encounters) undergoing UF. SpO2 was recorded at the fingertip in 36 of 38 patients.
Results: Fifty-seven encounters were in patients receiving MV, 24 in SB patients. Sepsis was the most common diagnosis in 13 of 38 (29%) patients, with septic shock in 12. Intravascular volume removed during UF ranged between 0.2 L and 4.2 L. Relative to pre-UF, median ΔS increased by 35% by the end of UF (p=0.001). In 57 encounters in MV patients, median ΔS increased by 35%, but did not reach significance (p=0.081), and in 24 encounters in SB patients, it decreased by 5.6% (p=0.001). The mean (± SD) phase angle, φ, between the intraarterial and pulse oximetry waveforms in 12 patients was 79 ± 22 degrees.
Conclusions: This hypothesis-generating study support a potential clinical application of SpO2 waveform variability in evaluating intravascular volume status in patients undergoing ultrafiltration. In general, ultrafiltration results in an increase in ΔS, findings attributable to the reduction in intravascular volume. However, this relationship may depend on respiratory status, which requires further studies to clarify. Prospective studies utilizing methods that accurately estimate baseline intravascular volume and examine how the rate of volume removal over time are related to changes in ΔS and ΔP are needed.

Objective: Earlier studies associated the chronic exposure to the dust of tobacco leaves with increased occurrence of allergies, skin rashes, rhinitis, nausea, dizziness, vomiting, and various respiratory disorders in tobacco farmers and processors. We aimed to investigate if oriental tobacco farm households who store dried tobacco leaves inside their house are more likely to experience and report respiratory and allergic episodes or illnesses than households storing dried tobacco leaves outside the house.
Methods: A cross-sectional study was conducted among tobacco farm households within the Caza of Bint Jbeil in South Lebanon. Demographic, socioeconomic, household characteristics and respiratory symptoms were assessed by separate sets of questions. The questionnaire assessed respiratory symptoms, allergies’ and smoking habits using questions items adopted mainly from The European Community Respiratory Health Survey II.
Results: A borderline association was found between storage status of tobacco leaves and respiratory symptoms (OR= 1.68 (95% CI= 0.93-3.03, p=0.09). Overall, 37.0% among those who stored tobacco leaves inside their house reported respiratory symptoms in comparison to 26.0% among those who stored tobacco leaves outside.
Conclusions: The study findings suggest that indoor storage of dried tobacco leaves can slightly contribute to aggravation of respiratory symptoms. Prospective cohort studies in tobacco farming communities would be useful in determining if indoor storage of dried tobacco leaves can lead to development of asthma and aggravation of symptoms especially among younger age group.