Day 1 :
Saint Joseph University, Lebanon
Keynote: The effects of respiratory muscle training on improvement of the internal and external thoraco-pulmonary respiratory mechanism in COPD patients
Time : 11:45 -12:30
Rola TOUT has completed his Master in Physical therapy at Saint joseph University of Beirut, she get her University Diploma in cardio Vacular and respirstory Rehabilitation Fron Rene Descarte University (Paris V). She is a PhD candidate in Science at Saint Joeph University of Beirut (Lebanon).
Introduction: Chronic obstructive pulmonary disease (CPOD) is a severe, incapacitating pathology. Inspiratory and/or expiratory muscle training may favorably impact the indicators of both specific and general improvement with regard to this disease. We are hypothesizing that when combined with bronchial decluttering, this training will have a beneficial effect on lung function and quality of life in these patients. Method: Fourty COPD subjects classified Gold I and Gold II and aged 60.38±8.02years were divided into four groups of 10. Three of the groups were trained with the help of Threshold(®) tools used for (1) inspiratory, (2) expiratory and (3) inspiratory and expiratory purposes; their training supplemented the decluttering and lower limb muscle exercise that the 4th group concurrently received. The patients underwent 16 rehabilitation sessions over an 8-week period. The variables consisted in: (1) forced expiratory volume in 1s (FEV1) and spirometrically measured peak expiratory and inspiratory flow rates (PEFR and PIFR); (2) fatigability, dyspnea, heart rate and walking distance evaluated during the 6-minute walk test; (3) maximum inspiratory pressure and (4) maximum expiratory pressure as assessed by the Threshold(®) tools and (5) the signs of quality of life in terms of the Saint-George's respiratory questionnaire (SGRQ) score. Results: Only in group 1, there was significant improvement with regard to FEV1 and PEFR. There was no PIFR modification in any of the groups. On the other hand, signs of quality of life scores along with dyspnea, fatigability and heart rate showed significant improvement in the three experimental groups, and significant improvement in maximum inspiratory pressure was observed in groups 1 and 3. Discussion: When associated with decluttering techniques, diaphragmatic rehabilitation and lower limb muscle exercise along with psychological support and educational efforts, respiratory muscle training is beneficial when compared with the usual protocols in rehabilitation of COPD patients.
Tanta University in Egypt
Gehan H. AboEl-Magd finished her MD in 2009 from Tanta University in Egypt, has 18 published papers and now works as a professor in Chest Diseases Department, Faculty of Medicine, Tanta University, Egypt. She is a reviewer in many reputed journals.
Introduction: Left ventricular diastolic dysfunction (LVDD) is found to be frequent in COPD patients. Relationship between airflow obstruction and cardiovascular risk can be explained by inflammation which is considered one of systemic manifestations of COPD.
Objective: To assess the LVDD in COPD patients in relation to disease severity using echocardiography, N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high sensitive C-reactive protein (hs-CRP).
Patients and methods: This prospective study was carried out on 60 stable COPD patients who were recruited from outpatient chest clinics, Tanta University Hospitals. Diagnosis of COPD was made according to criteria of the Global Initiative for Chronic Obstructive Lung Disease. Patients were subjected to medical history and physical examination, chest X ray, pulmonary functions, ECG and echocardiography. Blood samples were withdrawn for assessment of NT-proBNP and hs-CRP.
Results: Diastolic function of the heart was evaluated by echocardiography using: isovolumetric relaxation time (IVRT), deceleration time of early transmitral flow, ratio of the peak velocity of the early E wave/A wave which suggested that LVDD was recorded more in severe/very severe compared to mild/moderate COPD. Significant positive correlations were found between Nt-pro BNP and hs-CRP, IVRT, deceleration time of early transmitral flow and E/A wave ratio. Sensitivity, specificity and accuracy were 83.1, 90 and 0.94% for Nt-pro BNP.
Conclusions: Evaluation of NT-proBNP was important for detection of LVDD in COPD patients, which was correlated with disease severity. Echocardiographic assessment of COPD patients, especially in combination with NT-proBNP can be considered as good diagnostic tools of LVDD in COPD.
Yusup Dwiyanto was an medical doctor from the university Stimik Sinar Nusantara,Indonesia
Coronavirus disease (COVID-19) is caused by SARS-COV2 and represents the causative agent of a potentially fatal disease that is of great global public health concern. The first cases were reported in December 2019. The main clinical symptoms that appear are fever (temperature > 38oC), cough and difficulty breathing. It can also be accompanied by severe shortness of breath, fatigue, myalgia, gastrointestinal symptoms such as diarrhea and other respiratory symptoms. Silent Hypoxemia is a crippling and sometimes fatal complication of this disease. Patients do not show symptoms such as shortness of breath or cough, but when examined the levels of oxidation can down and risk of acute respiratory distress syndrome (ARDS) and organ failure
- 56-year-old male patient came to the emergency room with complaints of shortness of breath since 2 days ago with a dry cough, fever which was also felt since 2 days ago. There is no history of lung disease (asthma, pulmonary tuberculosis, etc.), DM, hypertension is also denied. Physical examination found TD 154/105
mmHg, HR 109x / min, RR 20x / min, Temperature 38oC with 99% SpO2, retraction of lung + / + minimal, rhonki + / +, others are within normal. In addition, a complete blood test was performed, the thorax photo with the following results was leukocytes 7.7 thousand / µL, Hb 15.3 g / dL, Ht 43%, Platelets 167 thousand/µL and thoracic photos were found to increase bronchovascular patterns with the appearance of acute bronchitis. . The patient is then allowed to go home.
few days later the patient came with the same complaint accompanied by abdominal pain and defecation >5x/day. From the physical
examination found TD 116/89 mmHg, HR 96x / min, RR 18x / min, Temperature 38.7oC with 95% SpO2, retraction lung + / + minimal, rhonki + / +, others are within normal. Investigations were carried out in the form of complete blood, chest radiograph and CT scan without contrast with the following results: leukocytes 3.3 thousand / µL, Hb 14.2 g / dL, Ht 40%, platelets 122 thousand / µL, Diff Count (0/0/0/80 / 15/5), NS 1 Negative, chest radiograph found bilateral pneumonia with CT scan results showed a ground glass opacity. In addition, PCR tests on patients with positive results. So patients are treated in isolation and monitored for several days.
The patient was then monitored within 3 days with the following details, on the first day the patient still complained of fever, dizziness, nausea, shortness of breath and diarrhea. But here patients can still move to take care of themselves properly. On physical examination TD 151/86 mmHg, HR 75x/minute, RR 18x/minute, Temperature 37.1oC with SpO2 99%, retraction lung + / + minimal, rhonki + / +, others are within normal. The results of the following investigations were leukocytes 4.0 thousand/µL, Hb 14.7 g/dL, Ht 41%, platelets 146 thousand/µL, Diff Count (0/0/3/75/16/6), Blood Gas Analysis (pH 7.52, pCO2 25 mmHg, pO2 53 mmHg, HCO3 20 mmol / L, Total CO2 21 mmol / L, O2 Saturation 91%, BE -0.2 mEq / L),
Department of Biomedical science, Ethiopia
Wondu Reta , Department of Biomedical science, Ethiopia
Background: Cardiac arrhythmias are common in COPD patients and are a major cause of morbidity and mortality.
Aim and Objective: The present study aimed to determine the prevalence of cardiac arrhythmias among patients with COPD
Materials and Methods: The study was conducted on COPD patients visiting chest clinic of Jimma Medical Center (JMC) located at Jimma town, South west Ethiopia; from May 18 to August 18, 2017 G.C. A hospital based cross-sectional study was conducted among 80 sampled COPD patients; and an investigation for 12 Lead resting supine ECG was performed. The results of ECG patterns and other variables were entered into EPI data (3.1) and exported to SPSS (20) for further analysis.
Results: The prevalence of arrhythmia accounted for 50% and the magnitude of its types were classified as Sinus origin arrhythmia (30%) specifically [Sinus bradycardia (16.3%), Sinus tachycardia (8.8%) and Sinus arrhythmia (5.0%)], Ectopic arrhythmia (20%) specifically [Premature ventricular Contraction (7.5%), Atrial fibrillation (6.3%), Premature atrial contraction (3.8%), Atrial flutter (1.3%) and Multi focal atrial tachycardia (1.3%)], Conduction block arrhythmia (23.8%) specifically[Bundle branch block (17.5%) for instance: Complete right bundle branch block (3.8%), Complete left bundle branch block (5%), Incomplete right bundle branch block (7.5%), Incomplete left bundle branch block (1.3%), Hemi fasicular block (5%)] and Atrioventricular block (1.3%)], and Other arrhythmia (11.4%) like Prolonged QTc interval (8.8%) and Preexcitation syndrome or Wolf Parkinson white syndrome (2.5%) as a single COPD patient presented with more than one arrhythmias.
Conclusion: Routine ECG investigation should be performed at the setup to screen and initiate early management of Cardio vascular diseases including cardiac arrhythmias for better prognosis COPD patients which was inevitable and very common.
Faculty of Medicine, University of Szeged, H-6720, Szeged, Hungary
Ferenc Petak has completed his PhD at the age of 31 years from University of Szeged, Hungary and postdoctoral studies at the Institute for Child Health Research (Perth, Australia), Boston University (MA, USA) and University of Geneva (Switzerland). He is the founder and head of the Cardiopulmonary Research Unit at the Department of Medical Physics and Informatics, University of Szeged. He has published more than 100 papers in reputed journals and has been serving as an editorial board member of repute at the journal Anesthesiology Research and Practice.
Since structural and functional alterations of matrix proteins following chronically elevated serum glucose level cause adverse structural and functional changes in the collagen-elastin network, the lungs are expected to be among the most affected organs in DM. Thus, we aimed at characterizing the alterations in the mechanical properties of the airways and respiratory tissues in patients with DM, and we related the lung function outcomes to those obtained in patients without metabolic disorders. In a prospective consecutive study design, forced oscillation technique was used to measure the input impedance spectra of the respiratory system (Zrs) in cardiac surgery patients with diagnosed DM (Group DM, n=124) and in matched controls (Group C, n=281). The airway resistance (Raw), the tissue damping reflecting tissue resistive properties (G), and the elastance representing respiratory tissue stiffness (H) were identified from the Zrs spectra by a well-validated model fitting. Hemoglobin A1c was significantly higher in Group DM (6.97±0.1[SE]%) than in Group C (5.79±0.2%), confirming the overexpression of glycated hemoglobin in the DM patients. Patient in Group DM exhibited significantly elevated Raw (8.8±0.6 vs. 5.7±0.3[SE] cmH2O.s/l, p<0.001), G (12.4±0.7 vs. 8.6±0.3 cmH2O/l, p<0.001) and H (32.6 ±0.3 vs. 27.5±0.3 cmH2O/l, p<0.001). These findings suggest compromised airway function in DM patient, most probably resulting from the sustained contractile response of the bronchial smooth muscle. The deteriorations in respiratory tissue viscoelasticity in DM may be a consequence of lung volume loss, interstitial edema and/or disturbance in the elastin-collagen fiber–fiber interaction.
Jazan University, Saudi Arabia
Assistant professor of Medicine in Jazan University, Saudi Arabia
Researcher in Amsterdam University, The Netherlands. He did the speciality of internal medicine and respiratory diseases in Sweden And has completed a clinical and research fellowship in interventional pulmonology and interstitial lung diseases at Amsterdam University, the Netherlands. He interested in research about lung cancer, Mycobacterial tuberculosis and Interstitial lung diseases. He has reviewed a lot of manuscripts in different journals. Editors in BMC and BMJ journals.
Germ cell tumors are relatively rare, embryologically derived from reproductive cells usually arise in the gonads. Mediastinal germ cell tumor estimated about 1-3 % of all germ cell tumors, generally seen in the anterior mediastinum and the metastatic lesions are mostly seen in the posterior mediastinum. The most aggressive germ cell tumor subtypes are choriocarcinoma, embryonal carcinoma and yolk-sac tumors. While seminomas only very rarely spread distantly. The presentations vary ranging from accidental findings on routine radiography to life-threatening respiratory and cardiovascular compromise, can also present as gigantic big intrathoracic germ cell tumor like our case.
30 years old male patient, not known to have any chronic illness, referred from TB hospital center because history of dyspnea, cough and loss of appetite with weight loss for more than 4 months, no history of chest pain or hemoptysis. Chest x-ray done and showed complete obliteration of the right side of thorax, was suspected pleural effusion and diagnosed as case of pleural TB and empyema, started on ant tuberculosis drugs, antibiotics and received chest drain with a little bloody fluid. Patient not improved and referred to our hospital, Computed hospital of chest with contrast revealed a very big mas obliterating the right side of chest, pushing the trachea and mediastinum to the left side with minimal effusion in both sides. Pleural US revealed mass and effusion but no empyema. Differential diagnosis was mediastina mass, adenocarcinoma, thymic carcinoma, lymphomas, fibroma or fibrosarcoma. US guided transthoracic fine needle biopsy from the right side mass revealed mixed germ cell tumor. The patient’s condition had rapidly deteriorated prior the confirming the diagnosis or starting with treatments and died because of difficult airway breathing due to deviated and compressed airway and possible pneumothorax after transthoracic biopsy.
Germ cell tumors are aggressive and rapidly growing cancers, the previous literature reported the nature of the extragonadal mediastinal germ cell tumor can appear as Giant mass occlude whole lung, compressing the great vessels, adherent to chest wall, pericardium, and lung, like our case and this make a worse prognosis, The estimated event-free survival at 10 years after combined treatment is 80.4%. Chemotherapy, debulking and pneumoctomy are the treatment for such cases
Ostrowieckie Centrum Medyczne, Poland
Medical doctor, graduate Warsaw Medical University, Poland in 2017. In 2018 started residency in internal medicine on Cardiology Ward in District Hospital in Ostrowiec Świętokrzyski. Graduate of two year course in aesthetic medicine at International Centre od Anti-Ageing Medicine in Warsaw in 2019, also member of Polish Association of Aesthetic Doctors and Dermatologists. Active member of Polish Association for Good Clinical Practice. Still in college at medical university started his work in clinical trials field as a study coordinator while being at 3rd year. Apart from residency, since graduation is working actively as a sub-investigator in clinical trials in the field of pulmonology, cardiology, rheumatology and dermatology in Ostrowieckie Centrum Medyczne clinical site. Additionally is conducting lectures for nurses at Wyższa Szkoła Biznesu i Przedsiębiorczości. Hobbies: medicine, music – piano, travelling, cooking, sport shooting and extreme sports such as motocross, drifting and skiing.
Diagnosis of the quality of life of chronic obstructive pulmonary disease patients under outpatient care in a specialist clinic in the Świętokrzyskie region in Poland.
Material & Methods
The study included 103 patients with COPD treated in Poland at the Clinic of Tuberculosis and Lung Diseases in the Świętokrzyskie Province with a total populations of 1,263,000 inhabitants. The diagnostic survey method with St George's Hospital Respiratory Questionnaire (SGRQ), specific for patients with chronic obstructive pulmonary disease, was used in the study. The results for individual subscales can occur between 0 and 100 points, whereby zero denotes the highest and 100 corresponds to the lowest quality of life.
The Global Quality of Life assessment (QoL) of patients with COPD has reached an average score of 44.1 ± 14.2 with a median of 41.8. The patients had the highest quality of life on the “Effect on life” subscale, where the average score was 33.6 17.4 with a median of 30.8.
On the “Activity” subscale, the average score was 46.7 ± 15.9 with the median of 41.7. This area included the scope of Physical activity. The lowest QoL concerned the Symptoms subscale with an average of 73.2 ± 12.3 as well as a median of
The quality of life of COPD patients is deteriorated. Patients experienced a lot of medical and psychosocial problems; Somatic symptoms cause difficulties in everyday functioning.
The appropriate therapy that minimizes the symptoms of the disease may significantly improve the quality of life of COPD patients, having at the same time a positive effect on their compliance with medical recommendations.
Russian State Institute for Post-graduate Medical Studies Novokuznetsk(Russia)
Igor Klepikov worked as Pediatric surgeon in Russian State Institute for Post-graduate Medical Studies Novokuznetsk(Russia) and in Tel-Aviv Medical center(Israel). Igor did research in Public Health, Respiratory Medicine and Pulmonology. Continuation of these studies is the current project- "the new doctrine of acute pneumonia-a guarantee of prevention of purulent and destructive complications."
Excessive fascination with antibiotics as a universal remedy gradually and imperceptibly narrowed the perception of the nature of many diseases.Тo date, the main treatment of acute pneumonia (AP) is similar to the treatment of diseases with fundamental differences in their localization, mechanism of development and clinical manifestations, and the result of medical recommendations is an elementary empirical distribution of antibiotics between different categories of patients. Such a primitive approach to treatment inevitably led to the transformation of views on the nature of AP, which in recent years is increasingly interpreted not as an inflammatory, but as an infectious process. Localization of АP in the vascular system of the small circle of blood circulation is its fundamental difference from other inflammatory processes, even in the case of identical pathogens. Reducing the effectiveness of antibiotics and increasing resistance to them microflora every year increase the relevance of this problem. The persistence of high rates of morbidity and mortality in АP, the steady increase in the number of complicated forms, the collapse of hopes for vaccination and the lack of strategic proposals to overcome this situation allow us to consider the study of thirty years ago worthy of close attention of experts. This work was performed and tested in clinical conditions in 1976-1985 in the сlinic of pediatric surgery at The state Institute of advanced training of doctors (Novokuznetsk, USSR). The main and first step in the study was a radical revision of views on the nature and mechanisms of development of АP. The new doctrine was based on well-known scientific medical axioms and facts that already had the previous justification and confirmation. In addition, the following studies were carried out:1.Experimental model AP (4 series of experiments, 44 animals) to obtain a model of pleural complications (certificate for invention № 1631574,A1, November 1,1990, USSR).2.X-ray examination with contrast of 56 anatomical lung preparations with various forms of AP taken from deceased patients.3.Record of comparative rheopulmonography before and after treatment procedures (36 patients).4.Analysis of monitoring and treatment of 994 children with AP and its various destructive and pleural complications. The revised treatment guidelines were applied in 101 patients in the initial period of aggressive forms of АP. The analysis of the results showed that compared with the same group of patients who received the previous complex of care, the number of pleural and pulmonary complications significantly decreased ( T = 8,65; P < 0,001), the length of hospital stay was reduced by three times, respectively, material and financial costs of treatment were significantly reduced, there were no deaths. The received results allow to speak about possibility of the guaranteed prevention of suppurative and destructive complications of the disease. The revised treatment package was also used in 102 patients who already had pleural changes at the time of hospitalization, despite the initial period of the disease. In this group of patients, rapid recovery without lethal outcomes was also achieved, but the final results depended on the nature of initial pleural changes.
Academy of Preventive Medicine of Kazakhstan
Native of Kazakhstan and a citizen of the United States, Dr. Sharman has 30 years experience in the fields of biomedical science, clinical research, and healthcare management. As a researcher Dr. Sharman designed a methodology for integrated population-based HIV and anemia testing which was implemented in several developing countries and has become a standard methodology for the international demographic and health surveys. He was involved in university teaching as Associate at the Johns Hopkins University’s Bloomberg School of Public Health. During the last several years, Dr. Sharman concentrated on healthcare management and academic medicine in Kazakhstan. He was founding CEO of the National Medical Holding (NMH) Chairman of the Board of Center for Life Sciences and Nazarbayev University. Dr. Sharman is current member of the American Public Health Association and President of Kazakhstan Academy of Preventive Medicine
To determine if smokers who switched from combustible cigarettes (CC) to "heat-not-burn" tobacco product (IQOS), reduce their risk for health, we are conducting a 5-year prospective cohort study among IQOS users and CC smokers. We assess changes in lung capacity measured as forced vital capacity (FVC) and forced expiratory volume-one second (FEV1) as well as change of physical capacity measured by six-minute walk test (6MWT).
Two cohorts were recruited for the study: men and women age 40 – 59 residing in Almaty City of Kazakhstan. Among them, there are 800 CC users and 400 IQOS users matched by gender, age, education and pack-year smoking history. For this analysis we included 627 CC smokers and 308 IQOS users who remained on their respective tobacco product use during the first year observation. Spirometry measurements and 6MWT have been performed as part of the baseline and one-year clinical assessments. Statistical comparisons of mean one-year changes between the two cohorts were conducted by using independent t-test.
CC and IQOS users didn’t have statistically significant differences in FEV1 and FVC measurements at baseline (FEV1: 3.15 and 3.22 liters, p>0.1; FVC: 3.83 and 3.79 liters, p>0.1). However, after one year observation, FEV1 was declined by 0.078 and 0.046 liters in CC and IQOS users, respectively (p=0.078). FVC was changed in different directions: by -0.098 liters in CC users and by 0.045 liters in IQOS users (p<0.001). Results of 6MWT were improved in two groups with greater increase in IQOS users (11.0 vs 19.4 meters in CC and IQOS groups, respectively, p=0.004).
IQOS users demonstrated better dynamic in forced vital capacity and physical capacity in comparison to CC smokers after one year of observation.
Isfahan University of Medical Sciences, Isfahan, Iran
Behzad Rahmati was a doctor. He belongs to the department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
Background: Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder which is associated with significant morbidity. The aim of the current study was to do an updated systematic review of literature on studies assessed the accuracy of screening questionnaires for OSA against polysomnography (PSG) as the reference test.
Methods: An English literature search was performed using Medline, Cochrane Database of Systematic Reviews and Scopus between January 2010 till April 2017. The reference list of included studies were also manually searched for finding additional studies.
Results: Thirty-nine studies comprising 18068 subjects included in the systematic review. The sensitivity of STOP-Bang questionnaire (SBQ) in detecting mild (AHI≥5 events/h) and severe (AHI≥30 events/h) OSA was higher in comparison to other screening questionnaires (ranged from 81.08% to 97.55% and 69.2% to 98.7% respectively). However, STOP questionnaire (SQ) had the highest sensitivity in prediction of moderate OSA (AHI≥15 events/h) (ranged from 41.3% to 100%).
Conclusion: The results of the present systematic review suggested SQ and SBQ for screening of OSA among sleep clinic patients. Although further validation studies of screening questionnaires on general populations are required.