rss_2.0Pneumologia FeedSciendo RSS Feed for Pneumologia Feed ventilation – palliative care for an oncology patient<abstract> <title style='display:none'>Abstract</title> <p>Patients with neoplastic lung disease experience a decreased quality of life due to progressive respiratory dysfunction. The inclusion of non-invasive ventilation (NIV) in the management plan of these patients has been effective in relieving symptoms of acute respiratory failure, reducing respiratory effort and increasing sleep quality. A 48-year-old patient diagnosed with pulmonary adenocarcinoma (radio-chemo-treated) and COPD presented to the ER with the complaints of thoracalgia, dyspnoea and daytime fatigue. Initial tests showed hypoxemic respiratory failure, mild obstructive sleep apnoea syndrome and right medium pleural effusion. CPAP therapy was initiated but not tolerated by the patient and, therefore, we switched to NIV – BPAP (spontaneous mode) with satisfactory results. The literature indicates that NIV therapy has proved superior to oxygen therapy in cancer patients, relieving dyspnoea in patients with hypoxemic respiratory failure (regardless of PaCO<sub>2</sub> level). Moreover, NIV-treated patients required lower doses of opioids and reported an improved quality of life.</p> </abstract>ARTICLEtrue of oxygen desaturation in OSA–COPD overlap syndrome compared to OSA alone: an observational cohort study<abstract> <title style='display:none'>Abstract</title> <p>Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnoea (OSA) syndrome (OSAS) are both common conditions. Their comorbid association – overlap syndrome (OVS) – can result in clinically important nocturnal oxygen desaturation. We sought to compare demographic and anthropometric characteristics, associated comorbidities and oxygen saturation in patients with OVS versus OSA alone.</p> <sec><title style='display:none'>Methods</title> <p>We included consecutive patients diagnosed with OSA in our sleep laboratory. Overnight sleep studies were performed, and data regarding demographic and anthropometric characteristics, prevalence of comorbidities and somnographic parameters were compared for patients with OVS versus OSA alone. A P value of &lt;0.05 was considered significant.</p> </sec> <sec><title style='display:none'>Results</title> <p>A total of 2173 OSA patients were assessed, of whom 381 (17.5%) had OVS. Significant differences were found between the OVS and OSA groups regarding all evaluated demographic and anthropometric characteristics, prevalence of comorbidities and somnographic parameters.</p> </sec> <sec><title style='display:none'>Conclusions</title> <p>OVS patients were older, were predominantly male, had a higher prevalence of common cardiovascular and metabolic comorbidities, and had worse apnoea–hypopnoea index (AHI) and oxygen saturation parameters.</p> </sec> </abstract>ARTICLEtrue arterial hypertension and lung transplantation: when one severe pathology is replaced by another<abstract> <title style='display:none'>Abstract</title> <p>Pulmonary arterial hypertension (PAH) is a rare and severe disease characterised by the progressive narrowing of the small pulmonary arteries resulting in right-sided heart failure. Despite advances in treatment, some PAH patients require lung transplantation, which carries risks of long-term complications. We report the case of a male patient with no significant comorbidities, who developed progressive dyspnoea on exertion at the age of 38 years. After echocardiography and right heart catheterisation, he was confirmed with idiopathic PAH and was started treatment with bosentan, sildenafil and beraprost. After 3 years of stability, the PAH worsened. Treatment with continuous intravenous epoprostenol was introduced in a national premiere, unfortunately with little effect. The patient underwent lung transplantation at the age of 43 years. Afterwards, he developed several complications, including chronic lung allograft dysfunction, post-transplant lymphoproliferative disorder and pulmonary embolism. He died at the age of 52 years of invasive pulmonary aspergillosis. The case is noteworthy due to the above-average post-transplant survival despite multiple complications.</p> </abstract>ARTICLEtrue of MAGE-A3 in and histopathological analysis of forceps biopsy specimens of non– small-cell lung carcinoma patients<abstract> <title style='display:none'>Abstract</title> <p>Non–small-cell lung cancer (NSCLC) is a type of epithelial lung cancer and associated with cigarette smoking (passive or active). Melanoma-associated antigen 3 (MAGE-A3) is widely expressed in various types of tumours, including NSCLC. This study aimed to examine the MAGE-A3 expression in forceps biopsy specimens as a tumour biomarker to be used for early diagnosis and screening of lung cancer. This study was an observational, analytical study with a cross-sectional study design. The sample size was determined based on Ronald Fisher’s classic z transformation formula, and samples were selected using consecutive sampling. The study population included 14 lung tumour patients. Samples were obtained by forceps biopsy with bronchoscopy guidance. Histopathological analysis was carried out using Giemsa staining. The expression of MAGE-A3 was determined using RT-PCR. All data were analysed using SPSS statistics software (IBM SPSS Statistics, IBM® SPSS® Statistics is a powerful statistical software platform RRID: SCR_019096). In this study, there were 6 subjects (42.9%) with NSCLC adenocarcinoma and 8 subjects (57.1%) with squamous cell carcinoma. The positive MAGE-A3 expression was found in 5 (35.7%) of the total research subjects, and the expression on RT-PCR analysis was at 569 bp. We found that MAGE 3 gene was mostly expressed in adenocarcinoma of NSCLC, even though there was no statistical correlation with histopathological results (P &gt; 0.05). MAGE-A3 expression in forceps biopsy specimens of NSCLC was mostly found in the adenocarcinoma type at 569 bp. Therefore, it could be used as a tumour biomarker for early diagnosis and screening of lung cancer.</p> </abstract>ARTICLEtrue apnoea syndrome in patients with chronic obstructive pulmonary disease and obesity – hypoxic load, comorbidities<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>Introduction</title> <p>We analyse anthropometric, somnopolygraphic and comorbidities data in patients with OSA syndrome, OSA with COPD, and OSA with COPD and obesity.</p> </sec> <sec><title style='display:none'>Material and method</title> <p>2644 OSA patients, three groups: I – OSA (2112 pts., 79.9%); II – OSA and COPD (116 pts., 4.4%); III – OSA, COPD and obesity (416 pts., 15.7%).</p> </sec> <sec><title style='display:none'>Results</title> <p>significantly older (p &lt; 0.01, p = 001, p &lt; 0.01); more men: 68.4% vs. 80.2% vs. 78.8%; smokers 59.4% vs. 70.7% vs. 74.3%; larger neck circumference: 42.74 ± 5.08 cm vs. 40.57 ± 3.97 cm vs. 45.90 ± 4.92 cm; higher BMI; lower O2 saturation: p &lt; 0.01, p= 123, P &lt; 0.01; higher desaturation index: 30.65 ± 26.96 vs. 18.94 ± 20.28 vs. 42.28 ± 29.02; lowest O2 saturation: (p &lt; 0.01 0, p = 024, p&lt; 0.01); higher AHI: p= 0.001, p &lt; 0.01, p &lt; 0.01; coronary artery disease: p &lt; 0.01, p = 195, p &lt; 0.01; heart failure: p &lt; 0.01, p = 760, p &lt; 0.01; arrhythmias: p &lt; 0.01, p = 796, P &lt; 0.01; stroke: unsignificant; diabetes mellitus: p = 0.252, p = 0.007, p = 0.794; systemic hypertension: p &lt; 0.01, p = 0.786, p &lt; 0.01.</p> </sec> <sec><title style='display:none'>Conclusion</title> <p>COPD in OSA is more severe, with more diabetes and longer hypertension duration, but not significantly different for O2 saturation, CAD, heart failure, arrhythmia, stroke and systemic hypertension. Obesity adds to overlap OSA–COPD significant burden for all recorded data, with the exception of stroke and diabetes.</p> </sec> </abstract>ARTICLEtrue interventional bronchoscopy the first-line solution for mediastinal compression syndrome?<abstract> <title style='display:none'>Abstract</title> <p>The mediastinum is known as the anatomical structure connecting the two pleural sacs. A variety of anatomical structures, from organs to veins and arteries, make mediastinal pathology extremely adventurous. We submit the case of a 67-year-old female patient, a former smoker, who presented to our clinic with dyspnoea on slight exertion, anterior chest pain and ineffective cough. The alarming aspect of the case is the stridor present at regular intervals and the patient’s dependence on oxygen. The CT scan reveals a compression syndrome caused by a tumour located in the upper and middle mediastinum that encompasses mediastinal venous and arterial structures and exerts an extrinsic stress effect on the oesophagus and tracheal. An emergency fibrobronchoscopy is performed and it is placed on a Y-shaped tracheal stent; additionally, two biopsies are also taken from different places. The point of debate of the case was related to the coexistence of two simultaneous histopathological types. The medical team’s swift intervention has given this patient a fighting chance to continue oncological and radiotherapy treatment.</p> </abstract>ARTICLEtrue – a valuable clue in a rare disease diagnosis<abstract> <title style='display:none'>Abstract</title> <p>Pulmonary veno-occlusive disease (PVOD) is a rare microvasculopathy associated with dyspnoea, pulmonary arterial hypertension (PAH) and poor prognosis. A 42-year-old female, with a known history of cured thyroid neoplasm, complained of severe inspiratory progressive dyspnoea, chest pain, dry cough and asthenia. The initial investigations established the diagnosis of idiopathic PAH. Specific associated vasodilator treatment was initiated but with sildenafil intolerance. The clinical condition continued deteriorating, and thus the investigations were extended. DLCO was unnaturally low (24%). Angiography detected a minimal left distal CTEPH (not suitable for balloon angioplasty). Genetic test came positive for biallelic mutations of EIF2AK4, suggestive for PVOD. Finally, the diagnostic was changed to PAH in the PVOD context. A decision was made to refer the patient for lung transplant and to associate treprostinil treatment (with slight clinical improvement). Therefore, severe dyspnoea, hypoxia, decreased DLCO and poor response to vasodilator treatment compel physicians to search for PVOD and refer to lung transplant.</p> </abstract>ARTICLEtrue vaccination in adults: a review of the current recommendations<abstract> <title style='display:none'>Abstract</title> <p>Pneumococcal disease remains a significant cause of morbidity and mortality, particularly in older adults and individuals with underlying medical conditions. To address this public health threat, pneumococcal vaccines have been developed and recommended for use in adult populations. This article provides a comprehensive review of the current recommendations for pneumococcal vaccination in adults and discusses the burden of pneumococcal disease in the adult population, including risk factors for developing the disease. The article concludes with a discussion about future directions for pneumococcal vaccination in adults, including the use of new and improved vaccines, which are developed to ensure wide protection against pneumococcal disease.</p> </abstract>ARTICLEtrue lung tumours – possibilities and limits of diagnosis<abstract> <title style='display:none'>Abstract</title> <p>Considering the wide range of both histological and imaging types found in a small group of tumours as an incidence, they can pose real problems in both diagnosis and therapeutic conduct, being difficult to differentiate clinically, imagistically, or histologically from lung tumours commonly found in the clinic (1). Adenocarcinoma, squamous cell carcinoma, and small cell carcinoma together account for approximately 95% of all lung tumours, but the lung is the site of many other types of tumours that may be of epithelial, mesenchymal, neuroendocrine, or lympho-haematopoietic origin, and these latter together account for approximately 5% of all pulmonary tumours (2,3). With a few exceptions, both the clinical manifestations and the imaging aspect are nonspecific, many of them having features in common with the other tumours with high incidence (3). The present study was performed on a group of 82 patients diagnosed with low-incidence lung tumours, aiming at presenting the main epidemiological, clinical, and paraclinical features as well as the difficulties in diagnosing this heterogeneous group of tumours (4,5). The ratio of patients who presented with benign tumours was close to that of the patients who presented with malignant tumours. Age, male sex, smoking, and occupational exposure were not included as risk factors for any tumour nature. Significantly more patients in urban areas have developed both benign and malignant tumours. Patients with malignant tumour pulmonary development presented to the hospital with symptoms in a significantly higher number, compared to those diagnosed with benign tumour. The location of benign tumours was mostly peripheral. Peripheral location of benign tumours required surgery to obtain the histopathological type, having a curative visa in some cases. About a third of those with malignant tumours had secondary lung tumours, or distant metastases.</p> </abstract>ARTICLEtrue and therapeutic features of myositis associated with anti-MDA5 antibodies: three new cases<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>Purpose</title> <p>To assess clinical features, therapy, and outcome of the myositis associated with anti-MDA5 antibodies, and to propose a successful therapeutic protocol for rapidly progressive interstitial lung disease (RP-ILD) in anti-MDA5 dermatomyositis (DM).</p> </sec> <sec><title style='display:none'>Methods</title> <p>A retrospective and descriptive study of three cases of anti-MDA5 associated myositis was conducted in the Department of Internal Medicine in the University Hospital Hedi Chaker, Sfax, Tunisia, between 1996 and 2016.</p> </sec> <sec><title style='display:none'>Results</title> <p>From a series of 115 cases of myositis, three cases of anti-MDA5-positive DM were identified. They were three men with a mean age of 63 years. They manifested specific cutaneous manifestations including ulcers and palmar papules, mild muscular involvement, and RP-ILD. The severity of the disease was correlated to the ILD in all patients. Aggressive therapies were tried including high-dose corticoids, cyclophosphamide (CYC) cures, intravenous immunoglobulins, and rituximab (RTX), with a good outcome in the patient who received combined high steroids, CYC, and RTX pulses. The two other patients died because of a rapid worsening of their respiratory condition.</p> </sec> <sec><title style='display:none'>Conclusion</title> <p>Anti-MDA positive myositis is characterised by a specific cutaneous phenotype, the discretion of muscular signs, and the correlation with RP-ILD. The poor prognosis of this entity is correlated to the high resistance of pulmonary involvement despite aggressive therapeutics. The combination between high-dose steroids, CYC, and RTX has shown good results in many reports, as well as in one of our patients.</p> </sec> </abstract>ARTICLEtrue of persons who inject drugs among patients with HIV–tuberculosis coinfection registered in 4 District TB Unit Bucharest during 2009–2018<abstract> <title style='display:none'>Abstract</title> <p>Introduction: Human immunodeficiency virus (HIV)–tuberculosis (TB) coinfection is a worldwide problem and a subject of concern, being associated with high mortality and risk of complications. Intravenous drug use is a way of getting infected with HIV that continues to rise, especially in the big cities. We aimed to study the peculiarities of persons with HIV–TB who inject drugs.</p> <p>Methods: We performed a retrospective, observational study, among patients treated for TB in the 4<sup>th</sup> District TB unit, Bucharest, during a 10-year period. A unique registry of patients with TB was used, and data of all patients with HIV–TB were noted ( demographics, medical, treatment outcome). A comparison between drug users (people who inject drugs [PWID]) and nondrug users (non-PWID) was assessed.</p> <p>Results: We identified 122 patients with HIV–TB: 60 PWID, 58 non-PWID, and 4 former users. The mean age was 36.4 ± 9.8 years, 75% were males, and 73% were using antiretroviral treatment (ART). After comparing PWID with non-PWID patients, the following differences were noted: age (33.0 ± 6.0 years in PWID vs 40.5 ± 11.3 in non-PWID, P &lt; 0.0001), gender (87% vs 66% males, P = 0.0034), presence of chronic hepatitis (97% vs 21%, P &lt; 0.0001), CD4 number (156.1 ± 204.5 cells/mm<sup>3</sup> vs 260.8 ± 248.9 cells/mm<sup>3</sup>, P = 0.0409), ART (65% vs 84%, P = 0.0075), and evaluation at the end of TB treatment (P = 0.0373).</p> <p>Conclusions: PWID represent a vulnerable population of those with HIV–TB coinfection, whose outcome in TB treatment is significantly poorer and who are at risk of abandonment, death, and comorbidities. They should be included in dedicated programmes that are aimed at increasing adherence to treatment and care, additionally assessing the dependence problem.</p> </abstract>ARTICLEtrue impact of new bronchial drainage device in a complex form of respiratory disease<abstract> <title style='display:none'>Abstract</title> <p>Drainage of secretions in patients with severe lung damage is a challenge. In many cases, due to the significant reduction in muscle mass, difficulties of this nature arise. We present the case of an 82-year-old patient, vaccinated against Severe acute respiratory syndrome coronavirus 2 (SARS COV2), anti-influenza, anti-pneumococcal and anti-haemophilus, former smoker, with no significant exposure to known professional respiratory noxes, with severe comorbidities (cardiac, ophthalmological, rheumatological, neurological, and diabetological) and a congenital pulmonary malformation – right lung hypoplasia (diagnosed in 2008), extensive cystic and varicose bronchiectasis, probably also in a congenital context, with progressive collapse of the right parenchyma and displacement of the mediastinum, complicated with recurrent respiratory infectious episodes with pathogens – Gram-negative germs, anaerobic germs, and repetitive low-amount haemoptysis for 3 years, as well as severe restrictive respiratory dysfunction. Currently, the patient is under bronchodilator treatment, and home oxygen therapy. For about 3 years, regular modern drainage sessions using the studied device have been introduced. Patient adherence was good. The benefits brought by this device on the clinical development of the patient were: efficient drainage of secretions, improvement of the quality of life, and prolongation of survival in a patient with complex pulmonary pathology and multiple comorbidities in development for 13 years. This new therapeutic drainage option has been competing with pre-existing ways (Cough Assist) for several years, demonstrating its multiple benefits in patients with chronic respiratory failure and severe comorbidities.</p> </abstract>ARTICLEtrue utility of closed needle pleural biopsy in exudative pleural effusions<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>Background</title> <p>Exudative pleural effusions are often challenging, and on many occasions remain undiagnosed. Hence, a blind closed needle pleural biopsy (CNPB) is extremely relevant against this background.</p> </sec> <sec><title style='display:none'>Methods</title> <p>We conducted a prospective study, in which a CNPB using a Cope’s needle was done in patients with exudative pleural effusion. Data were analysed using SPSS software.</p> </sec> <sec><title style='display:none'>Results</title> <p>Our study included 250 patients, of which 140 (56%) were males and 110 (44%) female. 218 (87.2%) had tubercular effusion 22 (8.8%) had effusion secondary to malignancy, 8 (3.2%) had synpneumonic effusions, and 1 (0.4%) each had effusion secondary to pancreatitis and rheumatoid arthritis (RA). AFB culture was positive in 50 (22.4%) on pleural fluid, as compared to 209 (87%) on pleural biopsy. CBNAAT detected MTB in 34 (14%) on pleural fluid as compared to 72 (28.8%) on pleural biopsy. Caseous granuloma was found in 184 (73.6%). The sensitivity for AFB culture using CNPB tissue and pleural fluid was 95.8% and 22.5%, respectively (P &lt; 0.05). Drug susceptibility testing (DST) done on pleural tissue divided our patients as drug sensitive 182 (87%), MDR 13 (6.2%), preXDR 12 (5.7%), and XDR TB 2 (0.9%). For malignancy, sensitivity of pleural fluid and pleural biopsy was 9% and 63%, respectively (P &lt; 0.05). Major complications of the procedure were pain in 25 (10%), pneumothorax in 15 (6%), and haematoma in 8 (3%). Of the patients who developed pneumothorax, only one patient required intervention with an intercostal drain, and the rest resolved spontaneously.</p> </sec> <sec><title style='display:none'>Conclusion</title> <p>CNPB is an easy, quick, cost-effective, and reliable method that can be used for diagnosing exudative pleural effusions of indeterminate aetiology in the out-patient setting.</p> </sec> </abstract>ARTICLEtrue lung disease in systemic sclerosis: From immunopathogenesis to treatment<abstract> <title style='display:none'>Abstract</title> <p>Interstitial lung disease (ILD) is a pulmonary involvement that is commonly manifested in systemic sclerosis (SSc) patients. The immunopathogenesis of SSc-ILD involves several mechanisms, including microvascular injury, alveolar epithelial cell defect, inflammation, genetics, epigenetics, telomeres, telomerase and inflammasome, which result in lung fibrosis. Detection of ILD should be performed in every SSc patient by using high-resolution chest tomography (HRCT) scan of the thorax, in addition to evaluation by pulmonary function tests. When ILD is discovered, the physician might start treatment considering factors such as the extent of the lesion, progressivity of the disease, prognosis and drug toxicity. The current guideline recommends cyclophosphamide, mycophenolate mofetil and nintedanib as the initial choices for SSc-ILD treatment. Other agents such as biologic immunotherapies, haematopoietic stem cell transplantation and lung transplantation could be an option if the disease becomes progressive.</p> </abstract>ARTICLEtrue sleep apnoea suspicion in lung cancer patients in Indonesia<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>Background</title> <p>Obstructive sleep apnoea (OSA) is often underdiagnosed and can cause various complications.</p> </sec> <sec><title style='display:none'>Objective</title> <p>This study aimed to find prevalence and correlation between OSA cases in lung cancer patients.</p> </sec> <sec><title style='display:none'>Methods</title> <p>This was a cross-sectional study of 151 lung cancer patients. We interviewed and assess the risk of OSA in lung cancer patients by using the Berlin questionnaire, Epworth Scale, and STOP-BANG questionnaire.</p> </sec> <sec><title style='display:none'>Results</title> <p>Out of 151 patients, 121 (80.13%) patients were identified as having a low risk of OSA and 30 (19.87%) patients as high risk of OSA. Most patients with a high risk of OSA were identified with the Epworth Sleepiness Scale (53 patients). Most patients with a low risk of OSA were identified with the Berlin questionnaire (120 patients). The result shows no significant difference (P &gt; 0.05) between age and risk based on the three questionnaires we used. A significant difference (P &lt; 0.05) was found between body mass index (BMI), body height, and OSA risk based on the Berlin and STOP-BANG questionnaires.</p> </sec> <sec><title style='display:none'>Conclusions</title> <p>There is a correlation between sleep apnoea and lung cancer as a risk factor and a consequence of poor sleep in the lung cancer population.</p> </sec> </abstract>ARTICLEtrue organising pneumonia – a continuous challenge. Case report<abstract> <title style='display:none'>Abstract</title> <p>Cryptogenic organising pneumonia (COP) is an interstitial lung disease, with an unknown aetiology. Treatment is based on oral corticotherapy, starting with attack doses given for 2–6 weeks, followed by gradual tapering over a period of 3–6 months. Relapses are common, especially in the first year. A 51-year-old patient, former smoker, without exposure to noxious substances, presented to the hospital in January 2020 with fever, dry cough and malaise. On chest radiography, lesions suggestive of bronchopneumonia were revealed and antibiotic treatment was started. The patient did not respond to treatment and chest Computed tomography (CT) was performed, which detected pulmonary condensations, predominantly with a subpleural disposition, predominantly in the lower lobes, as well as pleural effusion and minimal pericarditis. Due to the unfavourable disease evolution despite treatment and according to other investigation results, COP diagnosis was raised and oral corticotherapy was prescribed, with a favourable response. The patient complained of reappearance of the initial symptoms at dose weaning and she was reassessed by CT in June 2020. The Coronavirus Disease 2019 (COVID-19) pandemic raised the suspicion of a severe acute respiratory syndrome coronavirus-2 (SARS-COV2) infection, which was infirmed later. Corticotherapy was resumed, and at a check-up after 10 months, broncho-alveolar lavage was performed, with results within normal limits. The evolution of the patient was favourable. In conclusion, in the case of a pneumonia in which there is a discrepancy between the clinic, biologic and imagistic (possibly with a migratory pattern) and the response to treatment, COP must also be considered. Relapses are relatively common, and may occur both during corticotherapy dose reduction and after the end of treatment.</p> </abstract>ARTICLEtrue challenge in an immunocompromised patient<abstract> <title style='display:none'>Abstract</title> <p>The article presents the case of a 66-year-old non-smoking female patient with HIV-negative status. In 2015, she was diagnosed with chronic lymphocytic leukaemia (CLL) at its early stages, with specific complete blood count changes, peripheral lymphadenopathy and hepatomegaly. No specific treatment was recommended at that time. In July 2018, the diagnosis of non-Hodgkin lymphoma (NHL) IV B stage, with the involvement of all groups of peripheral lymph nodes, was confirmed histologically. No episodes of neutropaenia were recorded. Chemotherapy was initiated. Then, 3 months later, radiological examination revealed a bilateral pulmonary nodular dissemination in the upper lobes, and tuberculous aetiology was confirmed using sputum microscopy and cultural methods (a pansensitive strain). At the end of 8 months of antituberculosis treatment, chest X-ray revealed that apical lung consolidation had diminished, while sputum conversed after 4 months of treatment. After 3 months, the patient presented to the pneumology clinic with haemoptysis. CT revealed bilateral pulmonary consolidation, with cavitation in the left upper lobe and nodules in the surrounding region. Relapse of tuberculosis was excluded microbiologically [this was done using microscopy, cultures and molecular genetic examinations of the sputum and bronchoalveolar lavage (BAL) fluid]. A resistant strain of Staphylococcus aureus (MRSA) was identified, with susceptibility to amikacin and tobramycin. Treatment with amikacin had a positive clinical and imaging effect.</p> </abstract>ARTICLEtrue success rate of spirometry tests in Thai children<abstract> <title style='display:none'>Abstract</title> <p><bold>Introduction:</bold> Spirometry is a widely used pulmonary function test that requires several steps to be performed. In Thailand, there is only limited amount of data on the success rate and associated factors in children.</p> <p><bold>Objective:</bold> To determine the success rate and factors affecting spirometry performance.</p> <p><bold>Method:</bold> This cross-sectional study involved participants aged 5–18 years who underwent spirometry testing at the Naresuan University Hospital between 1 January 2015 and 31 December 2020. The subjects were divided into success and failure groups using the American Thoracic Society and European Respiratory Society 2005 criteria for acceptability and repeatability. The data collected include general characteristics, spirometry techniques and processes to determine the success rate and its associated factors.</p> <p><bold>Results:</bold> A total of 132 subjects underwent spirometry testing, with a success rate of 71.2%. The success group’s mean age, weight and height were significantly greater than the failure group. The most unsuccessful spirometry step in the failure group was a prolonged exhalation. Between the two groups, there was a statistically significant difference in the plateau phase of the volume time curve (85.1% vs. 55.3%, P &lt; 0.001).</p> <p><bold>Conclusion:</bold> Children’s age, weight and height are all considered predictor variables of success. The most frequently step failure in spirometry tests is prolonged exhalation phase. However, the plateau on volume time curves is a critical component of success. To achieve optimal success, encourage children to blow vigorously as long as they can be stable throughout the prolonged exhalation phase and assess their ability to follow instructions.</p> </abstract>ARTICLEtrue