Journal of Thoracic Disease and Cardiothoracic Surgery
Latest articles in this journal
Journal of Thoracic Disease and Cardiothoracic Surgery, Volume 3, pp 01-03; https://doi.org/10.31579/2693-2156/037
Congenital lobar emphysema (CLE) is a rare respiratory disorder which allows air to enter the lungs but can’t escape causing over-inflation of the lobes of the lung. This condition (CLE) is commonly detected in the newborn or young infants but some cases are diagnosed in adulthood. Congenital lobar emphysema is a rare congenital malformation with a prevalence of 1 in 20,000 to 1 in 30, 000, and more prevalent in males, with a male to female ratio of about 3:1. This is a 17 day old male neonate that presented with respiratory difficulty and .had a supine chest radiograph that showed an overinflated left lung field more on the upper and middle zones with flattening of the left hemi diaphragm, marked shift of the heart and mediastinum to the right with some degree of loss of volume involving the right lung. We report the radiographic findings of this case due the rare nature of congenital lobar emphysema.
Journal of Thoracic Disease and Cardiothoracic Surgery, Volume 3, pp 01-04; https://doi.org/10.31579/2693-2156/032
Rationale: The term “fragmentation of the QRS complex” denotes the existence of high-frequency potentials (spikes) in the QRS-complex. It is either a marker for cardiac structural diseases inducing biventricular hypertrophy or any condition interfering with the normally homogeneous depolarization status inside the myocardium. An associated right ventricular infarction with inferior infarction maybe carry a risk impact and serious complications. Patient concerns: A 64-year-old married, farmer, heavy smoker, Egyptian male patient presented with acute severe chest pain and inferior with right ventricular ST-segment elevation myocardial infarction and fragmentation of the QRS complex. Diagnosis: QRS-complex fragmentations and right ventricular infarction in the presence of inferior infarction with the triple-vessels disease. Interventions: Electrocardiography, oxygenation, streptokinase intravenous infusion, echocardiography, and percutaneous transluminal coronary angioplasty. Outcomes: Dramatic response of acute inferior with right ventricular ST-segment elevation myocardial infarction and QRS-complex fragmentations to streptokinase. Lessons: Despite the presence of inferior and right ventricular ST-segment elevation myocardial infarction with QRS-complex fragmentations, but there is no correlation with the severity of the disease. Dramatic clinical and electrocardiographic response signifying the role of streptokinase and fibrinolytic. The presence of fragmentation of the QRS-complex may have a bidirectional impact from seriousness to complications.
Journal of Thoracic Disease and Cardiothoracic Surgery, Volume 3, pp 01-13; https://doi.org/10.31579/2693-2156/030
Asthma is a common chronic airway disease affecting about 358 million people worldwide, and an estimated 7 million children globally. Approximately 10% of patients with asthma have severe refractory disease, which is difficult to control on high doses of inhaled corticosteroids and other modifiers. Among these, are patients with severe neutrophilic asthma. Neutrophilic asthma is a severe phenotype of asthma, characterized by frequent exacerbations, persistent airway obstruction, and poor lung function. Immunopathologically, it is characterized by the presence of high levels of neutrophils in the airways and lungs. Interleukin-17 produced by Th17 cells, plays a key role in the pathogenesis of neutrophilic asthma by expressing the secretion of chemoattractant cytokines and chemokines for the recruitment, and activation of neutrophils. Interleukin-8 is a powerful chemoattractant and activator of neutrophils. Activated neutrophils produce an oxidative burst, releasing multiple reactive oxygen species, proteinases, cytokines, which cause airway epithelial cell injury, inflammation, airway hyperresponsiveness, and remodeling. Furthermore, exasperated neutrophils due to viral, bacterial or fungal infections, and chemical irritants can release extracellular nucleic acids (DNA), designated as NETs (neutrophil extracellular traps), which are more toxic to the airway epithelial cells, and orchestrate airway inflammation, and release alarmin cytokines. Dysregulated NETs formation is associated with severe asthma. Most patients with neutrophilic asthma are unresponsive to the standard of care, including high dose inhaled corticosteroids, and to targeted biologics, such as mepolizumab, and dupilumab, which are very effective in treating eosinophilic asthma. There is unmet need to explore for novel biologics for the treatment of neutrophilic asthma, and in refining therapies, such as bronchial thermoplasty.
Journal of Thoracic Disease and Cardiothoracic Surgery, Volume 3, pp 01-05; https://doi.org/10.31579/2693-2156/036
Rationale: A novel COVID-19 is a multi-systemic critical worldwide pandemic infection. Certainly, associated multiple electrolytes imbalance in COVID-19 pneumonia is a remarkable decisive event. Camel-hump T-wave, Tee-Pee sign, and Wavy triple sign (Yasser’s sign)are novel highly significant descriptive electrocardiographic signs that are seen in calcium and potassium disturbance. There is an established and strong relationship between and electrocardiographic abnormalities and electrolytes imbalance. COVID-19 pneumonia and cerebrovascular stroke are commonly seen in a patient with Coronavirus infection. Patient concerns: A 69-year-old married worker Egyptian male patient was presented to the emergency department with COVID-19 pneumonia and cerebrovascular stroke. Diagnosis: COVID-19 pneumonia with lacunar infarction, hypocalcemia, and hyperkalemia. Interventions: Chest CT scan, brain CT scan, electrocardiography, oxygenation, and echocardiography. Outcomes: Initial bad and deterioration outcome but, the dramatic outcome had happened after later management. Lessons: The understanding of electrocardiographic signs regarding metabolic disorders such as electrolytes imbalance and other associated systemic diseases is very important. Elderly male sex, heavy smoker, COVID-19 pneumonia, cerebrovascular stroke, chronic renal impairment, ischemic heart disease, hypokalemia, hypocalcemia, and hypernatremia represent bad prognostic points and is indicating a high-risk condition.
Journal of Thoracic Disease and Cardiothoracic Surgery, Volume 3, pp 01-05; https://doi.org/10.31579/2693-2156/035
Asthma is a heterogeneous chronic airway disease comprising of distinct phenotypes characterized by different immunopathophysiologic pathways, clinical features, disease severity, and response to treatment. The phenotypes of asthma include eosinophilic, neutrophilic, mixed cellularity, and paucigranulocytic asthma. Eosinophilic asthma is principally a T helper type 2 (Th2)-mediated airway disease. However, several other immune and structural cells secrete the cytokines implicated in the pathogenesis of eosinophilic asthma. Innate type 2 lymphoid cells, mast cells, basophils, and eosinophils secrete Th2 cytokines, such as interleukin-4 (IL-4), IL-13, and IL-5. Additionally, airway epithelial cells produce alarmin cytokines, including IL-25, IL-33, and thymic stromal lymphopoietin (TSLP). Alarmins are the key initiators of allergic inflammation at the sentinel mucosal surfaces. Innovative biotherapeutic research has led to the discovery of monoclonal antibodies which target and inhibit the immunopathological effects of the cytokines involved in the pathogenesis of eosinophilic asthma. Parenteral biologics targeting the inciting interleukins, include mepolizumab and reslizumab (anti-IL-5), benralizumab (anti-IL-5Rα), dupilumab (anti-4Rα), and tezelizumab (anti-TSLP). They have been shown to significantly reduce annualized exacerbation rates, improve asthma control, lung function, and quality of life. Currently, there are no pulmonary delivered aerosol biologics for topical treatment of asthma. CSJ117 is a potent neutralizing antibody Fab fragment against TSLP, formulated as a PulmoSol TM engineered powder, and is delivered to the lungs by a dry powder inhaler. Phase 2 placebo-controlled clinical trial evaluated the efficacy and safety of CSJ117. CSJ117 delivered as an inhaler attenuated the late asthmatic response (LAR), and the early asthmatic response (EAR) after allergen inhalation challenge (AIC) at day 84 of treatment. The maximum decrease in FVE1 from pre-AIC were significantly lower in the CSJ117 group compared to placebo (P = 029), during LAR. CSJ117 also significantly reduced fractional exhaled nitric oxide before AIC at day 83; and significantly reduced the allergen-induced increase in % sputum eosinophil count. Pulmonary delivery of biologics directly to the airway mucosal surface has several advantages over parenteral routes, particularly in treating airway diseases such as asthma. Inhaler delivered biologics, such as CSJ117 are innovative and attractive methods of future precision treatment of asthma, and other respiratory diseases.
Published: 28 September 2021
Journal of Thoracic Disease and Cardiothoracic Surgery, Volume 2, pp 01-06; https://doi.org/10.31579/2693-2156/026
Background: The COVID-19 can cause serious life-threatening complications. Vitamin D deficiency has been proposed to mediate the disease by some studies, however, there is a lack of sufficient data. Methods: In this descriptive-analytical study, 72 Iranian adult patients with COVID-19 were examined. At the beginning of hospitalization, serum levels of vitamin D were checked and patients were divided into four groups as vitamin D above normal, normal, insufficient, or deficient. The prognosis of patients has been evaluated based on serum levels of vitamin D and other underlying factors. Results: Only 30% of patients had normal vitamin D concentrations. Vitamin D status was associated with COVID-19 complications, but not with underlying diseases. In the multivariable logistic regression, COVID-19 prognosis was associated with being male, length of stay in an intensive care unit (ICU), need for intubation, acute respiratory disease syndrome (ARDS), and myocarditis. The serum vitamin D correlated with COVID-19 complications including ARDS, QT length, the requirement to ICU, and intubation. Conclusion: This study showed a mediating role for vitamin D in COVID-19 complications and identified the frequent complications in these patients and contributing variables exaggerating prognosis for health authorities to properly manage COVID-19 in hospitals. Further relevant examinations are highly encouraged.
Published: 28 September 2021
Journal of Thoracic Disease and Cardiothoracic Surgery, Volume 2, pp 01-05; https://doi.org/10.31579/2693-2156/027
Rationale: The arrhythmias associated with myocardial infarction may be serious. Increasing morbidity and mortality in myocardial infarction-induced arrhythmias will be expected. The term “fragmentation of the QRS complex” denotes the existence of high-frequency potentials (spikes) in the QRS-complex. It is either a marker for cardiac structural diseases inducing biventricular hypertrophy or any condition interfering with the normally homogeneous depolarization status inside the myocardium. An associated Passing phenomenon or “Yasser’s phenomenon” may have an apparent hemodynamic impact. Patient concerns: A 68-year-old married, housewife, Egyptian female patient presented to the physician outpatient clinic with acute chest pain and anterior myocardial infarction with QRS-complex fragmentations and Passing phenomenon or “Yasser’s phenomenon”. Diagnosis: Arrhythmogenic acute extensive anterior infarction with QRS-complex fragmentations and Passing phenomenon or Yasser’s phenomenon. Interventions: Electrocardiography, oxygenation, streptokinase intravenous infusion, echocardiography, and percutaneous transluminal coronary angioplasty. Outcomes: Dramatic response of acute arrhythmogenic anterior ST-segment elevation myocardial infarction with QRS-complex fragmentations to streptokinase and percutaneous transluminal coronary angioplasty. Lessons: The presence of runs of ventricular tachycardia, multiform frequent premature ventricular contractions, and QRS-complex fragmentations, elderly, female sex are prognostic factors for the severity of the disease. Dramatic clinical and electrocardiographic response signifying the role of streptokinase, fibrinolytic, and percutaneous transluminal coronary angioplasty. The presence of fragmentation of the QRS-complex may have a bidirectional impact from seriousness to complications. Passing phenomenon or “Yasser’s phenomenon” should be directed at the disease progression.
Journal of Thoracic Disease and Cardiothoracic Surgery, Volume 2, pp 01-06; https://doi.org/10.31579/2693-2156/021
Gallstone ileus is a mechanical intestinal obstruction due to gallstone impaction within the gastrointestinal tract, and responsible for less than 1% of cases of intestinal obstruction. This is a case of a 50-year-old male who was referred for computed tomography of the abdomen on account of abdominal pain, abdominal swelling and discomfort, restlessness, vomiting, constipation, easy fatigability, excess sweating and restlessness. The scout image of the computed tomography (CT) demonstrated linear streaks and foci of radiolucency beneath and around the 10th and 11th anterior ribs on the right most likely pneumobilia. Air distended bowel loops were also demonstrated. Serial axial slides demonstrated an impacted calculus measuring about 30mm in widest transverse diameter in the right iliac region most probably the ileocecal valve region extending in to the cecum with associated dilated bowel loops showing multiple air-fluid levels raising a suspicion of mechanical bowel obstruction. The gall bladder measures about 50mm x 30mm in cranio-caudal and mediolateral diameter, with turbid contents and thickened walls of about 4mm most likely from cholecystitis. A diagnosis of mechanical bowel obstruction following an impacted calculus at the ileocecal valve was entertained; Gallstone ileus in a 50-year-old man. The patient had surgical treatment, this comprised of exploratory laparotomy with entero-lithotomy, fistula repair and cholecystectomy. The patient did well post-operatively and was discharged home subsequently and advised on follow-up visits. We present a case of mechanical bowel obstruction following an impacted gall stone at the ileocecal valve in a 50-year-old male patient.
Journal of Thoracic Disease and Cardiothoracic Surgery, Volume 2, pp 01-03; https://doi.org/10.31579/2693-2156/025
Dextrocardia is a cardiac positional anomaly in which the heart is located in the right hemithorax with its base to apex axis directed to the right and caudad. The malposition is intrinsic to the heart and not caused by extracardiac abnormalities. Dextrocardia is a rare condition and usually found incidentally and in association with other congenital abnormalities. It has an incidence of less than 1%. This is an 18 year old Nigerian female who was referred for computed tomography (CT) of the chest on account of prolonged and recurrent cough with a suspicion of diffuse interstitial lung disease. The chest and upper abdominal CT scan showed dextrocardia with a right placed heart, displaced spleen and stomach to the right hemi-abdomen and liver displaced to the left hemi-abdomen; confirming the diagnosis of dextrocardia with situs inversus. We present this case of dextrocardia with abdominal situs inversus due to its rarity in literature.
Journal of Thoracic Disease and Cardiothoracic Surgery, Volume 2, pp 01-09; https://doi.org/10.31579/2693-2156/023
Phonocardiogram (PCG) signal is a particular approach to explore cardiac activity, to develop technics that may serve medical staff to diagnose several cardiac diseases. We took advantage of PCG signal that shows heart murmurs on its tracing dissimilar to other cardiac signals, to design an algorithm to study and classify heart murmurs. In this paper, the importance is given to the severity of murmurs to highlight its impact, since depending on its stage the patient could be in life-threatening point; therefore, the purpose of this paper is focused on three essential steps: according to the algorithm, extracting murmurs and classifying them to deferent stages then investigate the impact of severity on cardiac frequency through some parameters. The severity stage calculation was based on energy ratio (ER) which is recommended by recent studies as an effective factor, however, we succeed to validate that murmur energy (ME) is also a qualified feature to determine severity. But despite that murmur duration, it's an inefficient way to judge the cardiac severity, which is a very important indicator of the general health of the human body. This study is done on considering many patients and it reveals very interesting results.