Psychiatric morbidities in respiratory disorders:a cross sectional report providing insight into consultation-liaison psychiatry services in India

Background:Respiratory disorders are among the leading disorders contributing to extensive morbidity and mortality worldwide.Disorder variants,like Chronic Obstructive Pulmonary Diseases(COPD)in developed and developing countries,as well as infectious causes,like Tuberculosis(TB)in developing countries,contribute to significant disease burden.The literature points towards the coexistence of psychiatric disorders with respiratory disorders responsible for poorer outcomes.Despite the extensive burden of respiratory disorders and the presence of concurrent psychiatric disorders,studies focusing on their prevalence are limited in India.Methods:A cross-sectional psychiatric screening was carried out on sequential patients attending the tertiary respiratory unit over eight months.Those screened positive were interviewed in detail for psychiatric diagnosis and challenges in the management were discussed.Psychiatric diagnosis,pulmonary TB and medical comorbidity were assessed for correlation with demographic and clinical variables and analyzed by using the Chi-square test and logistic regression method using SPSS version 20.Results:Psychiatric morbidity was present in 100 out of 350 patients(28.57%).Tuberculosis was the most common diagnosis(46%)in subjects attending the respiratory clinic services while common mental disorders like depression,anxiety,and insomnia were the most common psychiatric concern(88%)in this study.Conclusion:Psychiatric disorders and medical morbidities are common in patients with respiratory disorders.Multiple factors determine the treatment adherence in both respiratory and psychiatric disorders.Screening for psychiatric disorders with the help of a consultation-liaison psychiatrist in respiratory units is recommended.Future studies should focus on developing dedicated psychiatry services to enhance overall outcomes in patients with respiratory disorders.

Is There an Association between the Type of Activities and Respiratory Disorders among e-Waste Workers? Case of Two Major Cities in West Africa

Background: Several studies have demonstrated that e-waste workers had a risk to develop the respiratory disorders but this was not specifically differentiated according to the type of the e-waste activities. The main aim of this study was to evaluate if the risk to develop respiratory disorders was different according to the type of activities carried out by the e-waste workers. Methods: A cross sectional study was conducted in Abidjan and Cotonou, two big cities in West Africa. The participants were randomly selected based on the list of e-waste workers provided by the census of different sites of e-waste. The spirometry was performed on all the study participants to assess whether they had respiratory disorders. A regression logistic model was performed to estimate the risk of developing respiratory disorders according to the type of activities carried out by the e-waste workers. Results: In total 308 e-waste workers including 149 at Abidjan and 159 at Cotonou were interviewed. Participants of this study ranged in age from 14 years to 69 years and the mean age was 33.71 ± 10.96. The main activities carried out by the study participants were respectively repairing (44.8%), buying or selling (40.3%), dismantling (31.8%). The prevalence of respiratory disorders was 20.1%. The multivariate analysis had not found a significant association between the type of activities and the presence of respiratory disorders. Conclusion: The effect of exposure to e-waste on respiratory health of workers was not different according to the type of activities. So, any policy that aims to reduce the risk of exposure on respiratory health must take into account all the e-waste workers regardless of the type of activities they perform in this sector.

Current status of neonatal acute respiratory disorders： a one-year prospective survey from a Chinese neonatal network

Background We conducted a prospective, multicenter investigation of incidence, management and outcome of neonatal acute respiratory disorders （NARD）, and evaluated related perinatal risk factors and efficacy of respiratory therapies in neonatal intensive care units （NICUs） in a Chinese neonatal network.Methods Data were prospectively collected in 2004-2005 from infants with NARD defined as presence of respiratory distress and oxygen requirement during the first 3 days of life.Results A total of 2677 NARD was classified （20.5% of NICU admissions）. There were 711 （5.44%） with respiratory distress syndrome （RDS）, 589 （4.51%） pulmonary infection, 409 （3.13%） meconium aspiration syndrome, 658 （5.03%）aspiration of amniotic fluid and 239 （1.83%） transient tachypnoea. Meconium aspiration syndrome had the highest rate with fetal distress, transient tachypnoea from cesarean section, and RDS with maternal disorders. Assisted mechanical ventilation was applied in 53.4% of NARD, and in above five disorders with 84.7%, 52.3%, 39.8%, 24.5%, and 53.6%,respectively. Corresponding mortality in these disorders was 31.4%, 13.6%, 17.8%, 4.1% and 5.0%, respectively.Surfactant was provided to 33.9% of RDS. In all RDS infants, the survival rate was 78.8% if receiving surfactant, and 63.4% if not （P 〈0.001）.Conclusions This study provided NICU admission-based incidence and mortality of NARD, reflecting efficiency of advanced respiratory therapies, which should be a reference for current development of respiratory support in NICU at provincial and sub-provincial levels, justifying efforts in upgrading standard of care in emerging regions through a collaborative manner.

Obstructive Tumor of the Palate in the Old Person: A Case Report

Introduction: Pleomorphic adenoma or mixed salivary gland tumor is a heterogeneous benign tumor of the salivary glands. The most common site is the parotid gland. Its extra-parotid locations, particularly in the accessory salivary glands, are rarer. We report a case of a pleomorphic adenoma of the posterior palate which posed management problems. Observation: This is an 85-year-old patient who consulted for a tumor of the posterior palate that had been evolving for 3 years. The examination revealed a globular tumor of the posterior palate extending beyond the midline by approximately 7 cm in long axis, shooting towards the oropharynx and hindering breathing, speech and eating, indicating a life-saving tracheotomy. A CT scan of the facial area revealed a well-circumscribed tumor at the expense of the soft palate, with multiple sites of bone lysis. The biopsy performed was in favor of a pleomorphic adenoma. The patient underwent total surgical excision of a huge tumor on the palate. The aftermath of the operation was marked by a loosening of the sutures with an oronasal fistula requiring the creation of an obturator plate due to the patient’s refusal to have another operation. Conclusion: Large pleomorphic adenoma of the posterior palate is a rare entity that can cause respiratory problems and surgical difficulties. His prognosis is generally good.

CLINICAL ANALYSIS OF OBSTRUCTIVE SLEEP APNEA SYNDROME WITH ACUTE RESPIRATORY FAILURE

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Chest ultrasound in neonates:What neonatologists should know

For many years,ultrasound was thought to have no indications in pulmonary imaging because lungs are filled with air,creating no acoustic mismatch,as encountered by ultrasound wave beam.Lung ultrasound(LUS)was started in adult critical care settings to detect pleural effusion and acquired more indications over time.In the neonatal intensive care unit(NICU),the use of chest ultrasound has gained more attention during the last two decades.Being a radiation-free,bedside,rapid,and handy tool,LUS started to replace chest X-rays in NICU.Using LUS depends upon understanding the nature of normal lungs and the changes induced by different diseases.With the help of LUS,an experienced neonatologist can detect many of the respiratory problems so fast that interventional therapy can be introduced as early as possible.LUS can diagnose pleural effusion,pneumothorax,pneumonia,transient tachypnoea of the newborn,respiratory distress syndrome,pulmonary atelectasis,meconium aspiration syndrome,bronchopulmonary dysplasia,and some other disorders with very high accuracy.LUS will be helpful in initial diagnosis,follow-up,and predicting the need for further procedures such as mechanical ventilation,diuretic therapy,surfactant therapy,etc.There are some limitations to using LUS in some respiratory disorders such as bullae,interstitial emphysema,and other conditions.This review will highlight the importance of LUS,its uses,and limitations.

Effect of Chinese herbal medicine on lung disease:an updated review

A large number of people worldwide suffer from pulmonary disorders,and their prevalence is on the rise.Although we have gained a greater understanding of the basis of respiratory airway disorders,the treatments and therapies available for those disorders have not progressed historically.Supplements to existing therapies are made from traditional natural derivatives and herbal medicines.Natural compounds such as these are capable of acting as the basis for developing new drugs and related treatments.Plants possess bioactive compounds that have distinct advantages over allopathic medicines because chemotherapy roots severe adverse effects rather than providing limited benefits.As a result of better effects and fewer adverse effects,herbal bioactive is a promising approach for treating respiratory disorders,resulting in a better quality of life and longer life expectancy for patients.Asthma,pulmonary fibrosis,lung cancer,and chronic obstructive pulmonary disease are among the pulmonary disorders addressed in the present article and approaches based on clinical trials.

Living in the Wake of Chronic Obstructive Pulmonary Disease and Long-Term Oxygen Therapy

Background: Chronic Obstructive Pulmonary Disease (COPD) is the fourth leading cause of death in the world. COPD is a progressive disease that could lead to chronic hypoxemia, which requires treatment as domiciliary Long-Term Oxygen Therapy (LTOT). There is a need for increased knowledge about self-care strategies used by individuals living with COPD and LTOT. Objective: The aim was to explore experiences and self-care strategies in patients living with both COPD and LTOT. Sample: The sample consisted of five men and five women diagnosed with COPD being prescribed LTOT for more than one year. Method: Ten interviews were undertaken and analyzed for both manifest and latent content. Results: Living with COPD and LTOT was associated with experiences of guilt although there were doubts about what had caused the lung disease. Both the lung disease and the oxygen therapy had a negative impact on their self-image. Anxiety was expressed when thoughts about the remaining time occurred. There was a constant balance between diminishing abilities and increasing restrictions related to the lung disease and the therapy. In order to compensate for arising imbalance, self-care strategies had been initiated aimed at preserving the present state of health, enabling and facilitating physical activity and promoting a positive attitude. Conclusion: The current study suggests that individuals living with COPD and LTOT are encouraged to adopt self-care strategies directed towards maintaining stability with regard to the lung disease, the oxygen therapy, physical capability and emotional reactions.

A 12-month prospective survey of perinatal outcome of liveborn neonates in Julu County, China

Background Population based epidemiologic study on the main diseases and birth status of liveborn neonates remains scarce in China, especially in rural areas where a large number of neonates are born. The aim of this study was to establish an epidemiological basis of live births in Julu County, a representative of the northern and mid-western parts of China in terms of demography, disease pattern and women and children＇s health care infrastructure.Methods The perinatal data of all live births were prospectively collected in three participating county-level hospitals from September 1, 2007 to August 30, 2008.Results There were 5822 live births in these hospitals. Among all live births, 53.7% were male and 4.5% were bornprematurely. Mean （SD） birth weight （BW） was （3348±503） g. The low （〈2500 g） and very low BW （〈1500 g） infants accounted for 3.8% and 0.5% of the total births, with 6.5% as small for gestational age and 2.8% as multi-births.Cesarean section rate was 30.2%, of which 68.6% were elective. There were 745 infants （12.8% of the live births）admitted to local neonatal wards within 7 days of postnatal life, in which 48.3% and 19.3% were due to perinatal asphyxia and prematurity, respectively. The incidences of perinatal aspiration syndrome, transient tachypnea and respiratory distress syndrome were 4.9%, 0.6% and 0.5%, respectively. Neonatal mortality was 7.6%. （44/5822）, with 16 in delivery room and 28 in neonatal ward before discharge.Conclusions This study provided a population-based perinatal data of live births and neonatal mortality in a northern China county with limited resources. Neonatal disorders related to perinatal asphyxia remain a serious clinical problem,which calls for sustained education of advanced neonatal resuscitation and improvement in the quality of perinatal-neonatal care.

Health effects of air pollution:a Southern European perspective

Objective:To summarize the main updated evidence about the health effects of air pollution,with a special focus on Southern Europe.Data sources:Literature was obtained through PubMed Central and the official websites of European Agencies and Scientific Societies.Study selection:Recent shreds of evidence about the health effects of air pollution coming from international reports and original research were collected and described in this review.Results:Air pollution is an avoidable risk factor that causes a huge burden for society,in terms of death,health disorders,and huge socio-economic costs.The southern European countries face a more threatening problem because they experience the effects of both anthropogenic pollutants and natural dusts(particulate matter[PM]).The European Environment Agency reported the number of premature deaths in the 28 countries of the European Union attributable to air pollutant exposure in the year 2016:374,000 for PM2.5,68,000 for nitrogen dioxide,and 14,000 for ozone.In Italy,time series and analytical epidemiological studies showed increased cardiorespiratory hospital admissions and mortality,as well as increased risk of respiratory diseases in people living in urban areas.Conclusions:Based on abundant evidence,the World Health Organization,which hosts the Global Alliance against Chronic Respiratory Diseases(GARD),the scientific respiratory societies,and the patients’associations,as well as others in the health sector,must increase their engagement in advocacy for clean air policies.