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  • Pneumon 2012, 25(2):164-175
    SUMMARY. Despite progress in the understanding of the mechanisms and aetiology of cough, it remains an alarming and annoying symptom for both patients and physicians. Chronic cough lasting for more than 8 weeks is one of the main reasons for referral in primary or secondary health care and the first symptom of many pulmonary and extra-pulmonary conditions. Its aetiology usually includes environmental causes, including exposure to cigarette smoke and environmental pollution, and several disease entities, both respiratory and non-respiratory. The most common respiratory causes are chronic obstructive pulmonary disease (COPD), bronchiectasis, upper airway cough syndrome (UACS) due to a variety of rhinosinus diseases, asthma and non-asthmatic eosinophilic bronchitis. Non-respiratory causes of cough include the use of angiotensin-converting enzyme (ACE) inhibitor agents and gastro-oesophageal reflux disease. Chronic cough may be multi-factorial and only rarely is its cause not identified, leading to the diagnosis of idiopathic chronic cough. Chronic cough is a disturbing symptom that affects the health-related quality of life of the patients and presents a diagnostic and therapeutic challenge for the clinician. This review summarizes the current evidence on the aetiology and the diagnostic difficulties of chronic cough in adults, and provides an algorithmic approach, along with practical tips, for its management by the busy practicing clinician. Pneumon 2012, 25(2):164-175.
     
  • Pneumon 2012, 25(2):180-183
    SUMMARY. Wind instrument playing requires adequate respiratory function and continuous control of air flow for the production of sound. Professional playing of a wind instrument may be considered to be continuous respiratory muscle training, with resultant improvement in lung function. Playing wind instruments, however, involves increased intra-abdominal and intrathoracic pressures that may predispose to chronic respiratory, or other diseases and cerebrovascular events. This review summarizes the literature concerning the lung function of wind instrument players, the diseases related to wind instrument playing and the use of wind instruments for the prevention and therapy of chronic airway diseases such as obstructive sleep apnoea (OSA) syndrome and asthma. Pneumon 2012, 25(2):180-183.
     
  • Pneumon 2012, 25(2):191-197
    SUMMARY. There has been a major resurgence of tuberculosis (TB) in recent years worldwide. In Cyprus the tuberculin index is below 1%, in spite of an increase in the incidence of TB, particularly among foreign residents. The purpose of this study, the first of its kind in Cyprus, was to calculate the total cost of TB in Cyprus in the year 2009. The calculation was based on complete, detailed data on patients with TB collected from the District of Nicosia, which were then used to extrapolate the cost of TB for the whole of Cyprus. The patients were divided into 5 groups: those with active and those with latent disease diagnosed in 2009, those with active and those with latent disease diagnosed in 2008 who continued treatment in 2009, and contacts in the patients’ close environment who were investigated for TB in 2009. The patient records were studied and cost assessment was made for all tests, hospital days and medication prescribed for each patient for the year 2009. The cost assessment was based on Cyprus Government tariffs used for non-beneficiaries of the system. The total cost for the whole of Cyprus was estimated at €661.937.52, of which €330,768.57 was incurred by the District of Nicosia. The highest costs were generated by those patients with active disease, a mean cost of €6,479.35 per patient from the long-term care programmes within the directly observed treatment short course (DOTS) framework. For the second most costly group, the patients with latent TB, the mean annual cost per patient was €1,171.77. According to the findings of this study the cost of TB in Cyprus closely resembles that in other developed countries. Pneumon 2012, 25(2):191-197.
     
  • Pneumon 2012, 25(2):208-218
    SUMMARY. Introduction Tobacco use continues to be the leading global cause of preventable death, contributing to the death of nearly 6 million people each year. Medical students, who are future doctors, have an important role to play in smoking cessation and prevention. The objective of this study was to estimate the prevalence of tobacco use among medical students of the Democritus University of Thrace Medical School, and to evaluate their smoking-related attitudes and the training in tobacco issues they receive during their studies at the University. Methodology This study was conducted from March to May 2011. The students were asked to complete a modified version of the Global Health Professional Students’ Survey (GHPSS) questionnaire. The final study population consisted of 233 randomly selected students in the 1st-6th years of medical studies. Results Of the 233 students invited to participate, 229 submitted adequately completed questionnaires. Of this sample, 24% were smokers, 38.2% of whom had experimented with smoking at the age of 11-15 years. The banning of smoking in all enclosed public places was considered useful by 88.6%, with a statistically significant difference between smokers and non-smokers (65.5% vs. 96%, p<0.001). Of the participants, 31% believed that slim/light and hand-rolled cigarettes are less harmful, and only 8.1% had been taught cessation techniques and 17.8% the reasons why people smoke. Conclusions The study shows that the prevalence of smoking among medical students in northern Greece is high compared with other countries. It is evident that the issue of tobacco use is not covered adequately and systematically by the Medical School curriculum. Pneumon 2012, 25(2):208-218.
     
  • Pneumon 2012, 25(2):228-236

    SUMMARY. Introduction: Severe influenza A infection (H1N1) is associated with acute respiratory failure the management of which challenges intensive care unit (ICU) physicians. The clinical features and outcome of all patients with laboratory-confirmed H1N1 admitted to the Heraklion University Hospital adult ICU during the last two years are reported. Methods: A retrospective observational single centre study was conducted at a tertiary ICU. The medical records of all patients admitted to the ICU with H1N1 infection 10th July 2009 - 1st May 2011 were reviewed. The data collected included demographic characteristics of the patients, the clinical manifestations and illness severity assessed by the Acute Physiology and Chronic Health Evaluation (APACHE) II, and interventions and complications during the ICU stay. The duration of mechanical ventilation, the length of ICU stay and the 60 day mortality were used as outcome indices. Results: During the study period 23 patients with H1N1 were admitted to the ICU. They were relatively young (median age 39 yrs) with a median APACHE II on admission of 12 (range 5-22). In 7 patients (30.4%) there were no comorbidities on admission. In all cases the reason for admission was acute respiratory failure, with a median PaO2/FiO2 128 mmHg (range 83-376). Acute lung injury/ acute respiratory distress syndrome (ALI/ARDS) was the cause of respiratory failure in 21 patients (91.3%), while 2 presented with acute exacerbation of chronic obstructive pulmonary disease (COPD). Twenty patients (87%) required mechanical ventilation; 10 invasive, 5 non invasive and 5 both. Non conventional ventilator management, including oesophageal balloon insertion, high frequency oscillatory ventilation (HFOV), extracorporeal CO2 removal (ECCO2-R) and prone positioning were applied in 8 patients (34.8%). The median duration of mechanical ventilation and median length of ICU stay were 11.6 and 18.6 days, respectively. One patient died (4.3 % mortality). Conclusion: The necessity for non conventional ventilator strategies and the prolonged need for life support characterize the severity of ARDS associated with H1N1 infection. An individualized ventilator approach, based on the principles of lung protective ventilation may have a significant influence on the course of the disease. Pneumon 2012, 25(2):229-236.

     
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  • Pneumon 2012, 25(2):249-252
    pulmonary, teratoma
    SUMMARY. Intrathoracic teratoma is mainly found in the mediastinum. Primary intrapulmonary teratoma is very rare. A 24 year-old female presented with a 2-month history of intermittent episodes of cough and haemoptysis. Contrast enhanced computed tomography (CT) examination of chest revealed a mass in the left lingular lobe with evidence of fat and surrounding peripheral translucency. A presumptive diagnosis of intraparenchymal teratoma was considered. Internal inhomogeneity with irregular margins and bursting fat configuration suggested intrapulmonary rupture.Thoracotomy was performed, which revealed an encapsulated mass in the left lingula with bronchial communication. Lingual segmentectomy was performed, with complete resection of the tumour. Gross and histopathological features of the resected specimen were suggestive of a benign intrapulmonary teratoma. Pneumon 2012, 25(2):243-246.
     
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© 2011 PNEUMON Magazine, Hellenic Bronchologic Society.
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