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Vedolizumab, an anti-integrin antibody, is effective for moderate to severe ulcerative colitis and Crohn's disease treatment with a good safety profile due to its gut selective mechanism of action. Upper respiratory tract vedolizumab adverse events are common; however, they are mild and do not require treatment withdrawal. Herein, we present a 39-year-old patient under vedolizumab treatment for ulcerative colitis who presented acute severe interstitial lung injury that necessitated vedolizumab withdrawal and systemic steroids administration.

Introduction: Patients recovering from pneumonia and ARDS may develop fibrotic changes. Concerning COVID-19, there is evidence that residual persistent ground glass opacities and/or reticular infiltrates could be related with the development of diffuse parenchymal lung disease. Aim: The detection of interstitial lung disease post COVID-19 pneumonia. Methods: Patients were prospectively assessed 3 months after hospital discharge with high resolution computerized tomography of the chest (HRCT), pulmonary lung function tests (PFTs), SpO2, 6minute walk test (6MWT) and Saint George Respiratory Questionnaire (SGRQ). Patients were classified according to acute phase pneumonia extent as: mild ( 50%). Results: 23 patients (6 women, mean age 55 yrs) were included. 2 patients had a history of mechanical ventilation and 3 of pulmonary embolism. Mild (8), moderate (9) and severe (6) disease patients had no significant differences in age, gender and smoking history. Fifteen (65%) had at least one comorbidity including chronic obstructive respiratory disease. At 3 months patients presented mean values (SD) of FEV1%pred of 98,4±20,3, FVC%pred 104,3±18,3, DLCO%pred 89,2±10,3, Sp02 97,7±0,7%, 6MWT 571,4±87m and SGRQ 4,56(0-8,14). Follow-up HRCT was evaluated as normal or near-normal in all with no significant differences among the three severity groups. 20 patients had normal PFTs, 2 an obstructive pattern (underlying lung disease) and 1 a restrictive pattern with normal DLCO. Conclusion: The results of the present study do not support the hypothesis of the development of diffuse parenchymal lung disease after COVID-19 pneumonia in this study group. The study is ongoing.

Σκοπός: Ο σκοπός της διδακτορικής αυτής διατριβής είναι να εκτιμηθεί η αξία της φυσικοχημικής προσέγγισης, των προσεγγίσεων στηριζόμενων στο έλλειμμα/περίσσεια βάσης (ΒΕ) και τα διττανθρακικά ([HCO3-]) στην αξιολόγηση της οξεοβασικής ισορροπίας σε ασθενείς που προσέρχονται στο Τμήμα Επειγόντων Περιστατικών (ΤΕΠ). Μέθοδος: Οι ασθενείς, στους οποίους κατά την προσέλευση στο ΤΕΠ ελήφθη αρτηριακό αίμα, μελετήθηκαν. Αέρια αίματος, ηλεκτρολύτες και πρωτεΐνες μετρήθηκαν και χρησιμοποιήθηκαν για να υπολογισθούν τα [HCO3-], BE, anion gap (AG), AG adjusted for albumin (AGadj), strong ion difference, strong ion gap (SIG) and SIG διορθωμένο για περίσσεια/έλλειψη νερού (SIGcor). Αποτελέσματα: Ένα σύνολο 365 ασθενών μελετήθηκε. Σε σύγκριση με τη προσέγγιση των BE (n=202) και [HCO3-] (n=151), η φυσικοχημική προσέγγιση (n=279) αναγνώρισε σημαντικά περισσότερους ασθενείς με μεταβολικές διαταραχές (p

Introduction: Alpha1-antitrypsin (A1AT) deficiency is an autosomal co-dominant disease related to SERPINA-1 gene mutations predisposing to pulmonary emphysema and/or liver disease. Aim: to examine the genotype and phenotype of a Greek cohort of A1AT-deficiency patients. Methods: This multicenter study enrolled A1AT-deficiency patients under augmentation treatment from 8 centers in Greece. Results: 23 adult patients, 61% male, 17.4% non-smokers, diagnosed at a median age (IQR) of 47(42-58) years with A1AT levels of 0.24 (0.04-0.4) g/L were identified. Indications for A1AT measurement were severe obstructive pulmonary disease at the age Conclusion: In contrast with the literature, where Z and S are the most common A1AT-deficiency alleles, the present study reveals extremely rare deleterious variants in Greek A1AT-deficiency patients under augmentation treatment. Further examination of phenotype-genotype associations and outcome is expected to unveil their clinical significance in the future.

During the lockdown, IPF patients experienced lower than expected COVID-19, suggesting that simple measures for the winter months, such as face masking, clean hands, physical distancing could be adopted as promising advances in non-pharmacological therapyhttps://bit.ly/2ISi2EV

Highlights • In mechanically ventilated patients on the recovery phase of acute illness, changing the assist level results in changes of inspiratory effort in more patients and to a greater magnitude, than of respiratory rate, though both effort and rate change almost always in the same tendency (either increase or decrease) • Neither the magnitude of change nor the absolute value of respiratory rate can be used to quantitatively estimate the resulting respiratory effort after a change in the level of assist, Aim To describe the response of breathing pattern and inspiratory effort upon changes in assist level and to assesss if changes in respiratory rate may indicate changes in respiratory muscle effort. Methods Prospective study of 82 patients ventilated on proportional assist ventilation (PAV+). At three levels of assist (20%-50%-80%), patients’ inspiratory effort and breathing pattern were evaluated using a validated prototype monitor. Results Independent of the assist level, a wide range of respiratory rates (16-35br/min) was observed when patients’ effort was within the accepted range. Changing the assist level resulted in paired changes in inspiratory effort and rate of the same tendency (increase or decrease) in all but four patients. Increasing the level in assist resulted in a 31% (8-44%) decrease in inspiratory effort and a 10% (0-18%) decrease in respiratory rate. The change in respiratory rate upon the change in assist correlated modestly with the change in the effort (R = 0.5). Conclusion Changing assist level results in changes in both respiratory rate and effort in the same direction, with change in effort being greater than that of respiratory rate. Yet, neither the magnitude of respiratory rate change nor the resulting absolute value may reliably predict the level of effort after a change in assist.

In mechanically ventilated patients, assisted mechanical ventilation (MV) is employed early, following the acute phase of critical ill -ness, in order to eliminate the detrimental effects of controlled MV, most notably the development of ventilator-induced diaphrag matic dysfunction. Nevertheless, the benefits of assisted MV are often counteracted by the development of patient-ventilator dys synchrony. Patient-ventilator dyssynchrony occurs when either the initiation and/or termination of mechanical breath is not in time agreement with the initiation and termination of neural inspiration, respectively, or if the magnitude of mechanical assist does not respond to the patient’s respiratory demand. As patient-ventilator dyssynchrony has been associated with several adverse effects and can adversely influence patient outcome, every effort should be made to recognize and correct this occurrence at bedside. To detect patient-ventilator dyssynchronies, the physician should assess patient comfort and carefully inspect the pressure- and flow-time waveforms, available on the ventilator screen of all modern ventilators. Modern ventilators offer several modifiable settings to improve patient-ventilator interaction. New proportional modes of ventilation are also very helpful in improving patient-ventilator interaction.

The aim of this study is to evaluate the value of physicochemical, base excess (BE), and plasma bicarbonate concentration ([HCO3(-)]) approaches on the assessment of acid-base status in patients presented to the emergency department (ED).Upon presentation at ED, patients whose arterial blood was deemed in need of analysis were studied. Arterial blood gases, serum electrolytes, and proteins were measured and used to derive [HCO3(-)], BE, anion gap (AG), AG adjusted for albumin (AGadj), strong ion difference, strong ion gap (SIG) and SIG corrected for water excess/deficit (SIGcor). In each patient the acid-base status was evaluated using the BE, [HCO3(-)], and physicochemical approaches.A total of 365 patients were studied. Compared with BE (n = 202) and [HCO3(-)] (n = 151), physicochemical approach (n = 279) identified significantly more patients with metabolic acid-base disturbances (P.0001). Significantly fewer patients with unmeasured anions acidosis were identified with AGadj than with SIGcor (164 vs 230; P.0001). On the basis of BE, 75 patients had normal acid-base balance, and 65 (87%) of them exhibited at least 1 hidden acid-base disturbance, identified by the physicochemical approach. The corresponding values with [HCO3(-)] approach were 108 and 95 (88%) patients. When patients with high AGadj were excluded, 44 patients with BE and 67 with [HCO3(-)] approach had normal acid-base status, and most of them exhibited at least 1 acid-base disturbance with the physicochemical approach, whereas 12 and 21 patients, respectively, had high SIGcor.Compared with the BE and [HCO3(-)] methods, the physicochemical approach has a better diagnostic accuracy to identify metabolic acid-base disturbances.

Bronchoscopic drainage of a pyogenic lung abscess is an established therapeutic approach in selected patients in whom conventional antibiotic therapy fails. This intervention has also been undertaken in patients with abscess owing to underlying lung cancer and prior combined radiochemotherapy. However, this procedure has rarely been performed in cavitary lesions of advanced tumor origin before initiating any chemotherapy/radiotherapy scheme. Herein, we describe a case of a 68-year-old woman with lung adenocarcinoma stage IIIB, who underwent bronchoscopic drainage of necrotizing tumor lesion, thus improving her initial poor clinical condition and rendering other treatment modalities, such as radiotherapy, more effective and beneficial. Bronchoscopic drainage of a symptomatic cancerous lung abscess should be considered as an alternative and palliative treatment approach in patients with advanced inoperable non-small cell lung cancer.

Unilateral primary pulmonary hypoplasia is rare in adulthood. It is usually present in the neonatal period or in early childhood, and is characterized by a decreased number of bronchial segments and decreased/absent alveolar air space. Most patients have recurrent episodes of wheezing or pneumonia and severe respiratory distress leading to chronic respiratory failure, whereas some patients may occasionally be asymptomatic. Herein, we present a case of left lung hypoplasia in an asymptomatic 28-year-old male, who was admitted to the hospital for further investigation of an abnormal result on a chest radiograph that was obtained as part of a health evaluation for military service. A thorough workup, including imaging modalities and bronchoscopy, disclosed a hypoplastic left lung, which had gone undiagnosed for 25 years. Embryological, clinical, and diagnostic aspects are briefly discussed.

Malignant mesothelioma is most commonly found in the pleura, peritoneum and pericardium, whereas mesothelioma of the tunica vaginalis testis is exceedingly rare. The usual sites of metastasis are inguinal nodes, retroperitoneal lymph nodes and lung. Herein, we describe a patient with mesothelioma of testis, who presented with paraneoplastic glomerulopathy and asymptomatic solitary mediastinal lymphadenopathy on serial computed tomography imaging after radical orchiectomy. A diagnosis of metastatic lymph nodal disease was set by using convex-probe endobronchial ultrasound (EBUS) with transbronchial needle aspiration. We also briefly discuss clinical, etiological, pathological and therapeutical aspects of the disease, and highlight the paramount importance of real-time EBUS as the preferred method in the diagnostic approach of mediastinal lesions.