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The search for biological markers, which allow a relatively accurate assessment of the individual course of pulmonary sarcoidosis at the time of diagnosis remains one of the research priorities in this field of pulmonary medicine. The aim of our study was to investigate possible prognostic factors for pulmonary sarcoidosis with a special focus on cellular immune inflammation markers. 2 years follow-up of the study population after initial prospective and simultaneous analysis of lymphocyte activation markers expression in the blood, as well as bronchoalveolar lavage fluid (BALF), and lung biopsy tissue of patients with newly diagnosed pulmonary sarcoidosis, was done. We found that some blood and BAL fluid immunological markers and lung computed tomography (CT) patterns have been associated with a different course of sarcoidosis. We revealed five markers that had a significant negative association with the course of sarcoidosis (worsening pulmonary function tests and/or the chest CT changes) – blood CD4+CD31+ and CD4+CD44+ T lymphocytes, BALF CD8+CD31+ and CD8+CD103+ T lymphocytes and a number of lung nodules on chest CT at the time of the diagnosis. Cut-off values, sensitivity, specificity, and odds ratio for predictors of sarcoidosis progression were calculated. These markers may be reasonable predictors of sarcoidosis progression.

BACKGROUND: The mechanisms driving the transition from inflammation to fibrosis in sarcoidosis patients are poorly understood; prognostic features are lacking. Immune cell profiling may provide insights into pathogenesis and prognostic factors of the disease. This study aimed to establish associations in simultaneous of lymphocyte subset profiles in the blood, bronchoalveolar lavage fluid (BALF), and lung biopsy tissue in the patients with newly diagnosed sarcoidosis. METHODS: A total of 71 sarcoid patients (SPs) and 20 healthy controls (HCs) were enrolled into the study. CD31, CD38, CD44, CD103 positive T lymphocytes in blood and BALF were analysed. Additionally, the densities of CD4, CD8, CD38, CD44, CD103 positive cells in lung tissue biopsies were estimated by digital image analysis. RESULTS: Main findings: (I) increase of percentage of CD3(+)CD4(+)CD38(+) in BALF and blood, and increase of percentage of CD3(+)CD4(+)CD44(+) in BALF in Löfgren syndrome patients comparing with patients without Löfgren syndrome, (II) increase of percentage of CD3(+)CD4(+)103(+) in BALF and in blood in patients without Löfgren syndrome (comparing with Löfgren syndrome patients) and increase of percentage of CD3(+)CD4(+)103(+) in BALF and in blood in more advanced sarcoidosis stage. (III) Increasing percentage of BALF CD3(+)CD4(+)CD31(+) in sarcoidosis patients when comparing with controls independently of presence of Löfgren syndrome, smoking status or stage of sarcoidosis. Several significant correlations were found. CONCLUSIONS: Lymphocyte subpopulations in blood, BALF, and lung tissue were substantially different in SPs at the time of diagnosis compared to HCs. CD3(+)CD4(+)CD31(+) in BALF might be a potential supporting marker for the diagnosis of sarcoidosis. CD3(+)CD4(+)CD38(+) in BALF and blood and CD3(+)CD4(+)CD44(+) in BALF may be markers of the acute immune response in sarcoidosis patients. CD4(+)CD103(+) T-cells in BALF and in blood are markers of the persistent immune response in sarcoidosis patients and are potential prognostic features of the chronic course of this disease.

Background/aim The objectives of this study were to evaluate systemic inflammation using different sclerosing agents and to estimate the prediction of systemic inflammation for the efficacy of pleurodesis. Patients and methods Ninety-six patients with recurrent and symptomatic malignant pleural effusion were enrolled in this retrospective study. We used serum C-reactive protein (CRP) levels, serum leukocyte counts and neutrophil-to-lymphocyte ratios (NLRs) as parameters of systemic inflammatory reactions. Evaluations of these parameters were performed before and 24 h after pleurodesis. Results Pleurodesis was successful in 81 (84.4%) patients. The non-graded talc induced the highest changes in serum CRP levels, total white blood cell and neutrophil counts compared to other agents, while mitoxantrone induced the lowest. Graded talc and bleomycin induced the same levels of changes in serum CRP levels and serum leukocyte counts. The change in serum NLR was the same for all agent groups. Logistic regression confirmed that a change in serum CRP levels [odds ratio (OR)=0.92, p=0.002] and previous chemotherapy (OR=3.31, p=0.012) were independent predictors of pleurodesis efficacy. Conclusion Pleurodesis agents induced a systemic inflammatory response at different levels. The change in serum CRP levels could be useful for predicting the success of pleurodesis.

Objective: In 2010, a questionnaire-based study on obstructive sleep apnea (OSA) management in Europe identified differences regarding reimbursement, sleep specialist qualification, and titration procedures. Now, 10 years later, a follow-up study was conducted as part of the ESADA (European Sleep Apnea Database) network to explore the development of OSA management over time.Methods: The 2010 questionnaire including questions on sleep diagnostic, reimbursement, treatment, and certification was updated with questions on telemedicine and distributed to European Sleep Centers to reflect European OSA management practice.Results: 26 countries (36 sleep centers) participated, representing 20 ESADA and 6 non-ESADA countries. All 21 countries from the 2010 survey participated. In 2010, OSA diagnostic procedures were performed mainly by specialized physicians (86%), whereas now mainly by certified sleep specialists and specialized physicians (69%). Treatment and titration procedures are currently quite homogenous, with a strong trend towards more Autotitrating Positive Airway Pressure treatment (in hospital 73%, at home 62%). From 2010 to 2020, home sleep apnea testing use increased (76%-89%) and polysomnography as sole diagnostic procedure decreased (24%-12%). Availability of a sleep specialist qualification increased (52%-65%) as well as the number of certified polysomnography scorers (certified physicians: 36%-79%; certified technicians: 20%-62%). Telemedicine, not surveyed in 2010, is now in 2020 used in diagnostics (8%), treatment (50%), and follow-up (73%). Conclusion: In the past decade, formal qualification of sleep center personnel increased, OSA diagnostic and treatment procedures shifted towards a more automatic approach, and telemedicine became more prominent.(c) 2022 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Cryptogenic organising pneumonia (COP) is a rare interstitial lung disease with different onset of symptoms, which responds rapidly to glucocorticoid treatment. We present a case of COP which manifested as progressive 3-year dyspnoea that has led ultimately to acute respiratory failure. Moreover, treatment with prednisone for this patient exhibits slow onset of the effect.

PURPOSE To determine central corneal thickness (CCT) and the corneal parameters in patients with obstructive sleep apnea (OSA), evaluate the relationship between the severity of OSA, minimum peripheral capillary oxygen saturation (min. SpO2), and corneal morphological characteristics. METHODS Patients with OSA diagnosed by full-night polysomnography before treatment were included. Patients with OSA were divided into 3 groups according to the Apnea-Hypopnea Index (AHI). The control group (CG) was examined to exclude the possibility of OSA and ocular diseases. The following data were recorded: age, sex, body mass index, ophthalmologic evaluation, and the results of polysomnography. RESULTS A total of 114 eyes were studied: 74 eyes of patients with OSA and 40 eyes of the CG. The mean age was 57 ± 6 years. The mean values of CCT and endothelial cell density (ECD) varied significantly between the patients and the CG (P < 0.001). The mean values of CCT, ECD, cell variation coefficient (CV), and hexagonal cell percentage (HEX) in the group of patients with OSA were 535.28 ± 21.32 μm, 2632 ± 333, cells/mm. 31.8 ± 3.9, and 55.6 ± 6.9%, respectively. The mean CCT and ECD values for each group were lower than those for the CG. A significant negative correlation was found between CCT and ECD for AHI values (r = -0.390, P = 0.011 and r = -0.109, P = 0.040, respectively), and a weak positive correlation between CCT and ECD was found for min. SpO2 (r = 0.282, P = 0.020 and r = 0.332, P = 0.018, respectively). CV and HEX did not significantly differ between the groups and did not correlate with the results of polysomnography. CONCLUSIONS Hypoxia is associated with significant changes in CCT and ECD. In patients with OSA, these parameters varied significantly when compared with the subjects in the CG. The severity of hypoxemia and the increase in AHI values reduce CCT and ECD in patients.

Cryptogenic organizing pneumonia is a rare interstitial lung disease with different onset of symptoms, which responds rapidly to glucocorticoid treatment. We present a case of cryptogenic organizing pneumonia which manifested as a progressive 3-year dyspnea that ultimately has led to acute respiratory failure. Moreover, treatment with prednisone for this patient exhibited slow onset of the effect.

Introduction: We aimed to investigate community-acquired pneumonia (CAP) requiring hospitalisation, empirically treated with β-lactam monotherapy, with 30-day mortality and risk factors predicting its complicated course. Material and methods: A prospective observational study was conducted at the Pulmonology and Allergology Department in a tertiary care university hospital. 253 consecutive patients diagnosed with CAP requiring hospitalisation were enrolled. Hospital admission was based on PSI or CRB-65 scores, severe comorbidities, signs of intoxication, aspiration risk, social risk consider-ations, ineffective prior antibiotic treatment. Results: Fourty seven percent of the subjects had complications on admission, 13% developed new CAP complications during inpatient treatment. Overall, 53% of individuals had a complicated CAP course. 30-day mortality rate was 5.9%. The factors predicting a complicated CAP course were as follows: neuromuscular disease, multilobar opacities on chest X-ray (or computed tomography), and clinically unstable condition as evaluated using Halm’s criteria. Conclusions: The mortality rate in CAP patients treated with b-lactam monotherapy is low. Neuromuscular disease, multilobar opacities, and clinically unstable condition as evaluated using Halm’s criteria predict a complicated CAP course.

Background and Objectives: Chronic hepatitis C virus infection affects about 71 million people worldwide. It is one of the most common chronic liver conditions associated with an increased risk of developing liver cirrhosis and cancer. The aim of this study was to evaluate changes in liver fibrosis and the risk of developing hepatocellular carcinoma after direct-acting antiviral drug therapy, and to assess factors, linked with these outcomes. Materials and Methods: 70 chronic hepatitis C patients were evaluated for factors linked to increased risk of de novo liver cancer and ≥ 20% decrease of ultrasound transient elastography values 12 weeks after the end of treatment. Results: The primary outcome was an improvement of liver stiffness at the end of treatment (p = 0.004), except for patients with diabetes mellitus type 2 (p = 0.49). Logistic regression analysis revealed factors associated with ≥ 20% decrease of liver stiffness values: lower degree of steatosis in liver tissue biopsy (p = 0.053), no history of interferon-based therapy (p = 0.045), elevated liver enzymes (p = 0.023–0.036), higher baseline liver stiffness value (p = 0.045) and absence of splenomegaly (p = 0.035). Hepatocellular carcinoma developed in 4 (5.7%) patients, all with high alpha-fetoprotein values (p = 0.0043) and hypoechoic liver mass (p = 0.0001), three of these patients had diabetes mellitus type 2. Conclusions: Liver stiffness decrease was significant as early as 12 weeks after the end of treatment. Patients with diabetes and advanced liver disease are at higher risk of developing non-regressive fibrosis and hepatocellular carcinoma even after successful treatment.

Background and Objective: Obstructive sleep apnea (OSA) is a heterogeneous chronic sleep associated disorder. A common apnea-hypopnea index (AHI)-focused approach to OSA severity evaluation is not sufficient enough to capture the extent of OSA related risks, it limits our understanding of disease pathogenesis and may contribute to a modest response to conventional treatment. In order to resolve the heterogeneity issue, OSA patients can be divided into more homogenous therapeutically and prognostically significant groups–phenotypes. An improved understanding of OSA phenotype relationship to treatment effectiveness is required. Thus, in this study several clinical OSA phenotypes are identified and compared by their treatment effectiveness. Methods and materials: Retrospective data analysis of 233 adult patients with OSA treated with continuous positive airway pressure (CPAP) was performed. Statistical analysis of data relating to demographic and anthropometric characteristics, symptoms, arterial blood gas test results, polysomnografic and respiratory polygraphic tests and treatment, treatment results was performed. Results: 3 phenotypes have been identified: “Position dependent (supine) OSA” (Positional OSA), “Severe OSA in obese patients” (Severe OSA) and “OSA and periodic limb movements (PLM)” (OSA and PLM). The highest count of responders to treatment with CPAP was in the OSA and PLM phenotype, followed by the Positional OSA phenotype. Treatment with CPAP, despite the highest mean pressure administered was the least effective among Severe OSA phenotype. Conclusions: Different OSA phenotypes vary significantly and lead to differences in response to treatment. Thus, treatment effectiveness depends on OSA phenotypes and treatment techniques other than CPAP may be needed. This emphasizes the importance of a more individualized approach when treating OSA.

Organizuojanti pneumonija (OP) - intersticinė plau­čių liga, kuriai būdingas ribotoje plaučių dalyje arba keliose atskirose vietose mezenchiminių proliferatų susidarymas alveolėse. Sergamumas šia liga nėra aiškus. OP gali būti nežinomos kilmės (kriptoge­ninė) arba susijusi su kita liga ar patologine būkle (sukelta medikamentų, toksinų, uždegiminių autoi­muninių ligų, navikų, radioterapijos ir kt.). Ligos simptomai nespecifiški, gali pasireikšti subfebriliu karščiavimu, sausu neproduktyviu kosuliu, dusuliu. Dažnai klinikinė eiga lengva, retesniais atvejais pro­gresuoja dusulys, kvėpavimo funkcijos nepakanka­mumas. Radiologiniai OP požymiai įvairūs – aiškių ribų plaučių pritemimai (sutankėjimai) skirtinguose segmentuose ar skiltyse. Diagnozė patvirtinama mor­fologiškai ištyrus bronchoskopinės plaučių audinio biopsijos metu gautą medžiagą. Lengvais ligos atve­jais gydymas neskiriamas. Sunkesniais atvejais OP gydoma gliukokortikosteroidais (prednizolonu ar metilprednizolonu), tačiau simptomai išnyksta bei rentgeniniai pokyčiai dažnai visiškai rezorbuojasi tik per kelis mėnesius.

Introduction Pulmonary alveolar proteinosis (PAP) is a rare lung disease characterized by the accumulation of a periodic acid-Shiff-positive lipoproteinaceous material (surfactant) in the distal airways. The standard treatment is whole lung lavage (WLL), however, not all patients respond well to WLL. Aim We present an exciting case report on the successful treatment of the rare disease PAP with WLL and subcutaneous granulocyte macrophage colony-stimulating factor (GM-CSF) therapy for 12 weeks. Case study A 20 year-old woman with a 7-month history of progressive shortness of breath was referred to us. Computed tomography of the chest revealed typical geographic ground-glass opacity combined with interlobular septal thickening (crazy paving). Pulmonary function tests showed restriction with severe impairment of diffusion capacity (DLCO 20%). Milky bronchoalveolar lavage fluid (BALF) was detected during bronchoscopy. The cytology of the BALF was consistent with PAP. WLL was performed and subcutaneous GM-CSF was started immediately and continued for 12 weeks. At the end of treatment, the patient's lung function was clearly improved (DLCO 62%). Results and discussion One year after the withdrawal of treatment, the patient remains in good health, with no recurrence of hypoxemia and respiratory symptoms. Different treatment modalities have been applied since PAP was first defined, and WLL has been the preferred first line of treatment. Although our patient‘s condition improved after WLL, her respiratory insufficiency persisted. Consequently, we initiated treatment with subcutaneous GM-CSF. Conclusions WLL significantly improved our patient's condition, and GM-CSF was effective at prolonging pulmonary washout from excess surfactant.

Background: obesity is considered a major risk factor of obstructive sleep apnea (OSA). Studies shows that weight loss reduces apnea-hypopnea index (AHI). However there is still a debate if continuous positive airway pressure (CPAP) therapy helps to lose weight or leads to weight gain in sleep apnea patients. Aims: to evaluate weight (body mass index - BMI) changes after 3 and 9 months after CPAP initiation in OSA patients. Methods: prospective study was performed. Patients diagnosed with OSA to whom CPAP therapy was prescribed were included. BMI changes after 3 and 9 months were analyzed. BMI change by 5% was considered as clinically significant. Epworth sleepiness scale (ESS) changes were also analyzed, > 10 points were considered as increased daytime sleepiness. BMI and ESS changes were calculated using paired samples t-test. Results: a total of 119 patients were included (male 75%), mean age 57±10 yrs. Majority of them were diagnosed with severe (83%) OSA with and average AHI 55. BMI at time of diagnosis was 41 ± 8 kg/m2. Almost 60% of patients had ESS ≥10 points. 55 patients returned after 3 months. The average BMI was 40 ± 7 kg/m2. Clinically significant weight loss was seen in 34% of the patients. Majority of the them (62%) had almost the same weight. For 4% of the patients body weight increased. ESS was After 9 months BMI was 40 ± 7 kg/m2 (n = 32). Significant weight loss was registered in 47% of the patients, for 6% of the patients body weight increased, 47% had the same weight. Most of the patients didn`t have daytime sleepiness (84%). Conclusions: in a short time period almost half of OSA patients lost weight after the initiation of CPAP therapy.

We evaluated the effect of antihyperglycemic therapy on the survival of patients with lung cancer (LC). The analysis included patients with LC and concomitant type 2 diabetes. 15,929 patients were classified into five groups: metformin users, insulin users, metformin and insulin users, sulphonylurea users and non-diabetic group. A multivariate analysis showed that exposure to either metformin or to insulin was associated with a lower risk of LC-specific mortality, and this approached statistical significance (HR 0.82, 95% CI 0.72&ndash, 92 for metformin and HR 0.65, 95% CI 0.44&ndash, 95 for insulin). When deaths from all causes were considered, only metformin exposure was associated with a significantly lower risk of death (HR 0.82, 95% CI 0.73&ndash, 0.92). Users of sulphonylurea were at a higher risk of LC-specific and overall mortality (HRs 1.19, 95% CI 0.99&ndash, 1.43 and 1.22, 95% CI 1.03&ndash, 1.45). Our study shows a positive effect of metformin on the survival of patients with LC. Moreover, our results show that exposure to insulin was associated with a lower risk of LC-specific mortality, but not with deaths from all causes. The study results suggested that users of sulphonylurea may be at a higher risk of LC-specific and overall mortality.

Šiame dokumente pateiktos klinikinės praktikos rekomendacijos, apimančios suaugusiųjų ir vaikų obstrukcinės miego apnėjos diagnostiką ir gydymą.

Background/Aim: The prognostic role of thyroid transcription factor-1 (TTF1) in advanced lung cancer is not clearly established. The present study aimed to evaluate the associations between clinicopathological characteristics, TTF1 expression, and overall survival (OS) of patients with advanced lung adenocarcinoma. Materials and Methods: One hundred and seventy-two patients were enrolled in this retrospective study. OS was assessed according to immunohistochemical TTF1 expression in lung adenocarcinoma tissue, age, gender, performance status (PS), smoking history and status, disease stage, tumor differentiation, epidermal growth factor receptor (EGFR) mutation and EGFR tyrosine kinase inhibitor (TKI) treatment status. Results: The OS time was longer (p

Introduction The Khorana score may help physicians to identify patients at high risk of Pulmonary embolism (PE) and decide who is eligible for thromboprophylaxis, however, its role in lung cancer patients remains unclear. Objectives The aim of this study was to evaluate association between the Khorana score and risk of PE development among advanced stage lung cancer inpatients treated with chemotherapy. Materials and methods A retrospective cohort study included 2008-2017 year data of 217 lung cancer inpatients with IIIB and IV clinical stages receiving chemotherapy. The Khorana score was evaluated and patients were divided in two groups: a group of patients with 1 point and a group of patients with 2 or more points of the Khorana score. Results The study population included 46 (21.2%) female and 171 (78.8%) male patients whose median age was 62. During median observation period of 308.5 days 26 (11.9%) patients developed PE. Study included 137 patients with 1 point and 80 patients with 2 or more points of the Khorana score. The frequency of PE was 17 (12.4%) among patients with 1 point and 9 (11.3%) among patients with 2 points of the Khorana score. The relative risk of PE for patients with 2 or more points was 0.895 (95% CI = 0.379-2.114), P = 0.800. Conclusion The Khorana score was not associated with PE development risk among advanced stage lung cancer inpatients treated with chemotherapy.

Background. Treatment of patients with chronic obstructive pulmonary disease with reimbursable medicine in outpatient setting in Lithuania is regulated by the Lithuanian Minister of Health approved Procedure. The aim of study is to evaluate the compliance with this procedure. The number of patients treated with reimbursable medicine in outpatient treatment per year; which part of these patients were treated for the first time; the proportion of subjects with medication prescribed in hospital are assessed. The percentage of pulmonologist consultations of all individuals treated with reimbursable medicine for outpatient treatment and patients treated for the first time are described also. The data were collected from the health insurance system "Sveidra". Results. 34972 patients with chronic obstructive pulmonary disease were prescribed reimbursable medicine for outpatient treatment in 2014, 25.4% of them were treated for the first time. 45.2% of patient reimbursable medicine was prescribed in hospital. The pulmonologist consultated 47.3% of all individuals treated with reimbursable medicine for outpatient treatment and 55.3% of patients treated for the first time in 2014. Conclusion. The compliance of treatment with reimbursable medicine in outpatient setting of patients with chronic obstructive pulmonary disease is insufficient in Lithuania. Patients are rarely consulted by the pulmonologist, even if reimbursable medicine is prescribed for the first time. Large proportion of medication is prescribed in hospital. This is an indirect sign that diagnostics and control of the disease is not well enough in most cases.

Background/Aim: Severe pulmonary influenza A virus (IAV) infection causes lung inflammation and expression of inducible nitric oxide synthase (iNOS), leading to overproduction of nitric oxide (NO). We studied whether zanamivir reduces pulmonary inflammation through inhibition of NO production in mice. Materials and Methods: We treated IAV-infected mice daily with intranasal zanamivir. Controls were infected and either placebo-treated or untreated, or not infected and placebo-treated. Mice were weighed daily. After euthanasia on day 3, lungs were excised and bronchoalveolar lavage was performed and fluid nitrite concentration was determined. Lungs were analyzed microscopically. iNOS and IAV RNA levels in lungs were assessed using quantitative reverse transcription-polymerase chain reaction (RT-qPCR). Results: Mice undergoing zanamivir treatment had less weight loss, viral replication, and lung damage, as well as significant reductions of local NO and iNOS mRNA synthesis (p

Introduction. We report a case of a patient with acute myeloid leukaemia whose treatment with bone marrow transplantation (BMT) was followed by chronic graft versus host disease (GVHD) with lung involvement and bronchiectasis. This report illustrates an unusual course of a fast progression of the bronchiectasis due to BMT. Case description. A 33-year-old female was diagnosed with acute myeloid leukaemia. An allogeneic BMT was performed. One month after the transplantation, acute GVHD with skin involvement occurred. Treatment with prednisolone and mycophenolate mofetil (MMF) has been started. Nine months later, the patient was examined by a pulmonologist due to progressive dyspnoea. A pulmonary computed tomography (CT) scan showed normal parenchyma of the lungs and no changes to the bronchi. A CT scan performed 7 months later revealed bronchiectasis for the first time. No clinical response was associated with the treatment and the patient’s respiratory status progressively deteriorated. During the final hospitalization, a CT scan performed 1 year later revealed huge cystic bronchiectasis in both lungs. Despite the prophylaxis and treatment of GVHD and aggressive antimicrobial therapy, the patient died one year after the diagnosis of bronchiectasis. Conclusions. This case demonstrates that a fast and fatal course of bronchiectasis, that occurs after BMT, should always be considered as a possible manifestation of chronic graft versus host disease (cGVHD) following allogeneic BMT.

The World Health Organization (WHO) recommends that countries implement pharmacovigilance and collect information on active drug safety monitoring (aDSM) and management of adverse events.The aim of this prospective study was to evaluate the frequency and severity of adverse events to anti-tuberculosis (TB) drugs in a cohort of consecutive TB patients treated with new (i.e. bedaquiline, delamanid) and repurposed (i.e. clofazimine, linezolid) drugs, based on the WHO aDSM project. Adverse events were collected prospectively after attribution to a specific drug together with demographic, bacteriological, radiological and clinical information at diagnosis and during therapy. This interim analysis included patients who completed or were still on treatment at time of data collection.Globally, 45 centres from 26 countries/regions reported 658 patients (68.7% male, 4.4% HIV co-infected) treated as follows: 87.7% with bedaquiline, 18.4% with delamanid (6.1% with both), 81.5% with linezolid and 32.4% with clofazimine. Overall, 504 adverse event episodes were reported: 447 (88.7%) were classified as minor (grade 1–2) and 57 (11.3%) as serious (grade 3–5). The majority of the 57 serious adverse events reported by 55 patients (51 out of 57, 89.5%) ultimately resolved. Among patients reporting serious adverse events, some drugs held responsible were discontinued: bedaquiline in 0.35% (two out of 577), delamanid in 0.8% (one out of 121), linezolid in 1.9% (10 out of 536) and clofazimine in 1.4% (three out of 213) of patients. Serious adverse events were reported in 6.9% (nine out of 131) of patients treated with amikacin, 0.4% (one out of 221) with ethionamide/prothionamide, 2.8% (15 out of 536) with linezolid and 1.8% (eight out of 498) with cycloserine/terizidone.The aDSM study provided valuable information, but implementation needs scaling-up to support patient-centred care.

Background: The aim of the present study was to identify specious radiologic and/or physiologic prognostic marker(s), which lead to optimize of the patient follow-up frequency. Methods: Eighty consecutive patients with newly diagnosed pulmonary sarcoidosis. Patients underwent chest radiography, high-resolution computed tomography (HRCT) examination, pulmonary function tests (PFT), bronchoscopy with bronchoalveolar lavage (BAL) and lung biopsy, and bronchoalveolar lavage fluid (BALF) cell examination. Results: The reduction in PFT values seen in radiological sarcoidosis stage III was greater than that seen in stages I and II. The percentage of neutrophils in the lungs was found to increase in stages II and III. PFT indices were correlated negatively with the consolidation and ground glass opacities CT scores, but not with the micronodule or macronodule scores. The rise in the percentage of BALF lymphocytes was associated with the restriction pattern of PFT. The diagnostic value of BALF for sarcoidosis was higher when the typical radiologic patterns of stage I disease were found and that smoking decreased the diagnostic value of CD4/CD8 ratio. Conclusions: This study supports the opinion that the staging of the pulmonary sarcoidosis with chest X-rays is still valuable from the prognostic point of view, because significant correlations between the radiologic stages of sarcoidosis and PFT parameters were found. Chest HRCT was significantly superior to chest X-ray in detecting mediastinal and pulmonary parenchymal changes. However, the prognostic role of HRCT needs to be better investigated evaluating serial examinations. Only consolidation and ground glass scores (neither of which are frequently found in sarcoidosis) hold prognostic value, since these were negatively correlated with PFT parameters.

Introduction Organizing pneumonia (OP) is a rare disorder which may be associated with various clinical contexts and radiological patterns.

Introduction Drug-resistant tuberculosis (TB) is an important public health problem in Lithuania with MDR rates in new cases reaching 11% in 2012. Currently available diagnostic tools are not fully adequate for an accurate and rapid result for diagnosis of TB and MDR-TB. Objectives To evaluate the performance of Xpert® MTB/RIF assay for an early diagnosis of TB and detection of rifampicin (RIF) resistance in routine settings in Lithuania. Methods A total of 833 individual respiratory samples obtained from patients previously treated for TB and MDR-TB contacts were tested using the Xpert MTB/RIF assay. Performance characteristics of the assay for TB and RIF resistance detection were calculated using culture and phenotypical DST results as a gold standard. Results The overall sensitivity and specificity of the Xpert MTB/RIF assay for TB detection were 93.7% and 91.7%, respectively with the sensitivity for smear-negative specimens reaching 82.5%. Resistance to RIF was detected in 81 (20.7%) primary specimens with no false negative results; there were 4/225 (1.8%) false-positives among strains sensitive to rifampicin. Overall sensitivity and specificity of the molecular assay for detection of RIF resistance calculated against phenotypic DST results were 100% and 98.2%, respectively. Conclusions Our results demonstrate very good performance of the Xpert MTB/RIF assay for the detection of TB and RIF resistance on primary respiratory specimens. It provides strong evidence that implementation of the assay for routine laboratory diagnosis in high drug-resistance settings may improve and facilitate TB diagnosis.

Patients receiving tumor necrosis factor alpha inhibitors for the treatment of rheumatic diseases (rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis) are at high risk of developing tuberculosis during treatment. This article gives the recommendations for the prevention and management of tuberculosis in patients with rheumatic diseases before initiating therapy with tumor necrosis factor alpha inhibitors. They are adapted considering the high prevalence of tuberculosis, high drug resistance of Mycobacterium tuberculosis, and extensive bacille Calmette-Guérin vaccination against tuberculosis in Lithuania. In order to reduce the risk of tuberculosis, the screening should be done before starting antitumor necrosis factor alpha therapy. This includes complete medical history and posterior-anterior, lateral chest radiography. Tuberculin skin test using the Mantoux method with 5 tuberculin units and interferon-gamma release assay should be performed in patients without posttuberculous radiological lesions. If Ghon's complex or untreated posttuberculous lesions are present, or if the results the Mantoux test or interferon-gamma release assay are positive, the patient should be treated for latent tuberculosis. For the treatment of latent tuberculosis, isoniazid and rifampicin are given for 3 months, and the introduction of antitumor necrosis factor alpha therapy is delayed at least for one month. In cases of suspected active Mycobacterium tuberculosis infection, tuberculosis should be confirmed microbiologically or morphologically, and adequate antituberculosis treatment should be initiated.

TURINYS 1. Įžanga 2. Diagnostika 3. Gydymas 3.1. Antibakterinis gydymas 3.2. Bronchų drenažo gerinimas 3.3. Bronchus plečiantys vaistai 3.4. Vaistai nuo uždegimo 3.5. Skiepijimas 3.6. Mityba 3.7. Gydymas deguonimi 3.8. Komplikacijų gydymas 3.9. Plaučių transplantacija 4. Pagalbos ligoniams organizavimas

To analyze the causes and risk factors of pleural empyema and complicated parapneumonic pleural effusion and to evaluate age, sex, concomitant pathology of the patients studied, time of consulting a doctor, and antibacterial treatment before the diagnosis.A total of 120 patients with pleural empyema (n=67) and complicated parapneumonic pleural effusion (n=53) were studied. When pus in the pleural space was present, pleural empyema was considered. Complicated parapneumonic pleural effusion was diagnosed when multiloculated fluid in the pleural cavity by ultrasound examination, more than 50% neutrophils of all leukocytes in the pleural fluid, and pleural fluid pH7.0 were found.Most patients with pleural empyema and complicated parapneumonic pleural effusion were middle aged (53+/-17 years); men were twice as likely as women to have these conditions. Less than half (46%) of patients had at least one risk factor such as neoplasia (37%), treatment with immunosuppressive medicine (15%), alcohol abuse (15%). Persons consulted a doctor after 12 days, on the average, following the onset of the symptoms of the illness. The risk factors were found more often for the patients with pleural empyema than with complicated parapneumonic pleural effusion (50.75% versus 39.62%). Patients with pleural empyema consulted a doctor later than patients with complicated parapneumonic pleural effusion (21+/-28.6 days versus 9.5+/-9.8 days, P=0.0052). Three-fourths (75%) of the patients were treated with antibiotics, and monotherapy was applied most frequently (86% of cases). Penicillins (28%), cephalosporins (26%), aminoglycosides (20%), and macrolides (10%) were prescribed most commonly. One-quarter (25%) of patients were not treated with antibiotics mostly because of misdiagnosed intercostal neuralgia.Causes of pleural empyema and complicated parapneumonic pleural effusion are multifactorial. Patients consult a doctor too late after the onset of the symptoms, nearly half of the studied patients were found to have conditions that might cause immunosuppression, and a part of patients did not receive antibiotics or antibacterial treatment was administered improperly.

Tyrimo tikslas. Išnagrinėti pleuros empiemos ir komplikuoto parapneumoninio pleurito priežastis ir rizikos veiksnius. Tirtųjų kontingentas ir tyrimo metodai. Ištirta 120 ligonių, sirgusių pleuros empiema (n=67) ir komplikuotu parapneumoniniu pleuritu (n=53). Pleuros empiema diagnozuota radus pūlingo pleuros skysčio. Komplikuotas parapneumoninis pleuritas diagnozuotas ultragarsiniu tyrimu, aptikus inkapsuliuoto skysčio pleuros ertmėje, pleuros skysčio pH&lt, 7,0 bei pleuros skystyje nustačius neutrofilų daugiau kaip 50 proc. visų leukocitų. Tyrimo tikslas – įvertinti tiriamųjų amžių, lytį, gretutinę patologiją, nustatyti laikotarpį, per kurį ligoniai kreipėsi į gydytoją, įvertinti, kokiais antibiotikais ligoniai buvo gydomi iki diagnozės nustatymo. Rezultatai. Pleuros empiema ir komplikuotu parapneumoniniu pleuritu sirgo vidutinio amžiaus tiriamieji (53 metų), vyrai du kartus dažniau nei moterys. 46 proc. ligonių nustatytas bent vienas rizikos veiksnys, dažniausiai neoplazija (37 proc.), imunosupresuojamųjų vaistų (15 proc.) ir nesaikingas alkoholinių gėrimų vartojimas (15 proc.). Atsiradus ligos simptomams, tiriamieji į gydytojus kreipėsi vidutiniškai po 12 dienų. Ligoniams, kuriems buvo diagnozuota pleuros empiema, rizikos veiksniai buvo dažnesni (pleuros empiemos – 50,75 proc., komplikuoto parapneumoninio pleurito – 39,62 proc. atvejų), į gydytojus jie kreipėsi vėliau (21±28,6 dienos) nei sirgusieji komplikuotu parapneumoniniu pleuritu (9,5±9,8 dienos, p=0,0052). 75 proc. tiriamųjų buvo gydyti antibiotikais, daugelis gydyti monoterapija (86 proc. atvejų). Dažniausiai buvo skiriama penicilinų (29 proc.), cefalosporinų (25 proc.), aminoglikozidų (20 proc.), makrolidų (10 proc.). 25 proc. tiriamųjų dažniausiai dėl klaidingai diagnozuotos tarpšonkaulinės neuralgijos antibiotikų neskirta. Išvada. Pleuros empiemos ir komplikuoto parapneumoninio pleurito priežastys yra daugialypės: tiriamieji, atsiradus ligos simptomams, per vėlai kreipiasi į gydytoją, beveik pusei tiriamųjų nustatytos imunosupresinę būklę galinčios sukelti patologijos, daliai ligonių neskirta antibiotikų arba jų buvo skiriama netinkamai.

Straipsnyje apžvelgiamos dažniausios pleuros ligos, jų priežastys, nagrinėjamos vaizdo tyrimo me-todų, pleuros skysčio, pleuros bioptato tyrimų reikšmė atliekant diferencinę diagnostiką.

Purpose: At present bronchoscopic lung biopsy (BLB) is widely used to diagnose various lung diseases. However placing of BLB in the diagnostic sequence of various clinical situations is not so clear.The purpose of the study was to evaluate the diagnostic value of BLB in a daily clinical practice. Material and methods: The data obtained from the case records of all 304 patients who had undergone BLB since January 1996 to December 2007 at the Centre of Pulmonology and Allergology of Vilnius University Hospital Santariskių klinikos (Vilnius, Lithuania) were examined. Results: Most of indications for BLB were a peripheral lung nodule (40% of all the cases), dissemination in the lung (24% of all BLBs) and non-resolving pulmonary infiltrates (16.3% of all biopsies). Adequate lung tissue for histological examination was obtained in 85% of the cases. Based on the pathological diagnosis and findings of other diagnostic methods the final clinical diagnosis was verified for most of the patients. However, at least in 8% of the cases, the final clinical diagnosis was yet syndromic. Of all the BLBs, serious complications occurred in 8 (2.6%) patients. Clinically significant pneumothorax requiring chest tube treatment occurred in 5 (1.6%) of 304 patients. Severe bleeding occurred in 3 (1%) out of all BLBs. Conclusion: BLB is a relatively effective and safe method for diagnosing lung diseases. In most cases of the lung infiltrate, nodule, dissemination and diffuse changes, BLB is suitable to choose method for lung biopsy.

Straipsnyje apžvelgiamos dažniausios skysčio pleuros ertmėje priežastys, nagrinėjama vaizdinių tyrimo metodų, pleuros skysčio, pleuros bioptato tyrimų reikšmė atliekant diferencinę diagnostiką.

The study included 200 patients with pleural effusion. Pleural effusions were transudative in 48 (24%) and exudative in 152 (76%) of cases. Congestive cardiac failure (14.5%), nephrotic syndrome (5.5%), and liver cirrhosis (2.5%) were the most common etiological diagnoses of transudate cases. Malignant effusion (16.5%), pneumonia (13%), pleural empyema (9%), tuberculosis (6%), and pulmonary embolism (5.5%) were the most common etiological diagnoses of exudative cases. Thirty-two (16%) cases of exudative pleural effusions were of undertermined etiology. Polymorphonuclear leucocytes predominated in 48 patients with exudative pleural effusions. The most common etiological diagnoses were pneumonia (41.67%), pleural empyema (39.59%) and pulmonary embolism (10.42%). Lymphocytes in pleural fluid were predominant in 63 patients, with malignant (6.34%), tuberculous pleurisy (19.02%), pulmonary embolism (6.34%), trauma (6.34%), and (46.11%) cases in patients with pleural exudate undertermined etiology. Eosinophyls were predominant in 16 (8%) patients with exudative pleural effusions. The most common etiology of eosinophilic pleural fluid were pneumonia (37.5%), malignant pleural effusion (25%), pulmonary embolism (12.5%), pyopneumothorax (6.25%) and trauma 6.25%. From 16 patients with eosinophilic pleural exudate, in 31% cases air, in 12.5% blood in pleural fluid were determined and in 12.5% cases previous pleural puncture was performed. Pleural fluid eosinophilia is most commonly associated with the presence of air or blood in the pleural fluid (correalation index 0.82). Malignant pleural effusions were determined in 33 patients. Malignant cells in pleural fluid were identified in 25 cases. The diagnostic sensitivity of pleural fluid cytology for malignant pleural effusions were 76%. Hemoragic pleuritis was determined in 18 and hemothorax in 4 patients. Etiology of hemothorax were trauma (75%) and coaguliopathia (25%). Most common etiological diagnoses of hemoragic pleuritis were neoplasia (33.3%), pulmonary embolism (16.65%), trauma (16.65%), pneumonia (11.11%), and congestive cardiac failure (11.11%). Diagnostic sensitivity and specifity of hemoragic pleuritis is low, 58% and 45% respectively.