Tuberculosis is a disease of global outreach that may affect the entire human body but is most commonly located in the lungs. Otorhinolaryngological manifestations of tuberculosis are rare, mostly occurring secondary to pulmonary disease but nevertheless represent significant diagnostic challenges. Nasopharyngeal tuberculosis is rare, representing around 1% of all upper air-way localizations and the most common presentation is in the form of adenoids. Tuberculous glossitis (oral tuberculosis) is even scarcer and may present in various clinical forms, usually mimicking a malignant neoplasm, or, less often, trauma or other infectious lesions. Oropharynx tuberculosis is usually misdiagnosed as hypertrophic chronic tonsillitis. We present four rare cases of ENT tuberculosis, primary adenoiditis and tonsillitis in a 13-year-old girl, a curious case of tuberculous glossitis in a 65-year-old woman, clinically diagnosed as a lingual neoplasm and two cases of tuberculous lymphadenopathy uncommonly located in the submandibular and supraclavicular regions. A comprehensive review of literature follows the case presentations. Tuberculous manifestation in the ear, nose and throat area remains a difficult diagnosis to establish, particularly because of its rarity and non-specific clinical appearance, and should be included in the differential diagnosis of pharynx lesions. An early diagnosis is essential to avoid occurrence of complications.
Aims To investigate how nursing experts and experts from other health professions understand the concept of rationing/missed/unfinished nursing care and how this is compared at a cross‐cultural level. Design The mixed methods descriptive study. Methods The semi‐structured questionnaires were sent to the sample of 45 scholars and practitioners from 26 countries. Data were collected from November 2017–February 2018. Results Assigning average cultural values to participants from each country revealed three cultural groups: high individualism‐high masculinity, high individualism‐low masculinity and low individualism‐medium masculinity. Content analysis of the findings revealed three main themes, which were identified across cultural clusters: (a) projecting blame for the phenomenon: Blaming the nurse versus blaming the system; (b) intentionality versus unintentionality; and (c) focus on nurses in comparison to focus on patients. Conclusion Consistent differences in the understanding of missed nursing care can be understood in line with the nation's standing on two main cultural values: individualism and masculinity. Impact The findings call for scholars' caution in interpreting missed nursing care from different cultures, or in comparing levels and types of missed nursing tasks across nations. The findings further indicated that mimicking interventions to limit missed nursing care from one cultural context to the other might be ineffective. Interventions to mitigate the phenomenon should be implemented thoughtfully, considering the cultural aspects.
The fight against smoking through various smoking cessation methods could be very effective by early education especially in young people for preventing the occurrence or the severity of obstructive lung diseases. The aim of the study was to present the impact of varenicline, a selective partial nicotine agonist, in adults of 40-49 year-old, active smokers, recently diagnosed with COPD, from 2009 to 2011, in a Smoking Cessation Center of the Pulmonary Rehabilitation Clinic Iasi, Romania. There were included all male employees, without occupational exposure, active smokers, with a personal history of smoking �10 packs-year cigarettes, recently diagnosed with COPD, who inform consented to be enrolled for counseling and smoking cessation treatment provided by varenicline. All patients received COPD therapy, according to the current GOLD recommendations. The method of evalution the impact of smoking cessation methods consisted in the COPD Assessment Test (CAT) completed by cases before and after 12 weeks program of smoking cessation counseling and therapy and respiratory rehabilitation. The CAT is a short questionnaire, simple and validated tool of COPD symptoms assessment, measuring the severity of COPD on a patient�s quality of life. Results reveals an important decreasing of CAT score with important amelioration of symptoms especially in severe COPD patients. Counseling, smoking cessation and respiratory rehabilitation interventions have shown positive effects of smoking cessation with varenicline among young COPD patients 40-49 year-old.
Association between chronic obstructive pulmonary disease (COPD) and sleep apnea SA (overlap syndrome - OS) includes serious clinical manifestations and high mortality due to early respiratory failure, cardiovascular and metabolic complications from both diseases. 90 COPD patients (85.5% males) were strongly suspected to have concomitant SA after clinical examination and sleep questionnaires. We performed a cardio-ventilatory poligraphy during sleep. 82 patients (91.1%) from our OS group had obstructive sleep apnea (OSA), 8 patients (8.9%) mixed apnea and 20% had also OHS. 17 (18.8%) of OS were overweight and 66 (73.3%) obese. A third of them were in a very active group of age: 49 patients (54.4%) under 60 year-old and 11 patients (12.2%) between 61-65 year/old. We noted severe complication/comorbidities in our OS group: 63.3% hypertension, 43.3% core pulmonale, 31.1% arrhythmia, 32.2% cardiac failure, 38.8% dyslipidemia, 31.1% diabetes. The second night investigation permitted titration for the targeted pressures for CPAP therapy (Continuous Positive Airways Pressure). Treatment of OS patients had an interdisciplinary approach: CPAP in OSA, BPAP (Bi-level Positive Airways Pressure) in OHS, inhaled bronchodilators, treatment of cardiovascular comorbities, pulmonary rehabilitation, weight loss, tobacco/alcohol cessation counseling, and oxygen therapy in remaining hypoxemic patients. 51.2% of patients had not accessibility for long time CPAP (lack of coverage by the public health system). OS included clinical aspects of severity due to both COPD and OSA. Clinical investigation, sleep questionnaires, assessment of the diurnal somnolence and sleep cardiorespiratory poligraphy are recommended in all COPD patients. Obesity was the main risk factor for OSA in COPD patients.
There are a number of benign tumors of the nose and pharynx that are seldomly reported in literature but that can sometimes prove difficult to treat and extremely important for differential diagnosis. The present study presents cases of rare benign tumors localized in the pharynx, nasal and sinus cavities, as well as reviews of literature and historical references for each type of tumor. Unilateral nasal hemangioma in a 72-year-old male which, although not a rare pathology, raised problems due to auto-resection of the tumor. The surgeon was able to pull it out with ease without bleeding; it is possible that the mass would have eventually fallen out. Pilomatrixoma is a relatively uncommon ectodermal benign tumor of the skin derived from hair matrix cells. Surgical resection is curative but recurrence is possible (≤5% risk). The presented case is of a 26-year-old female with a pilomatrixoma of the left cheek who, for aesthetic reasons, refused a classical external surgical approach. Trans-oral resection was performed, which proved feasible but laborious and prone to recurrence. Inverted Schneiderian papilloma is a rare benign tumor of the nasal and sinus cavities with increased potential for invasion, recurrence and malignant transformation compared with other types of papilloma and other benign tumors of the area. The tumor represents 0.5-4.0% of all nasal tumors and has been described under different names, such as villiform cancer and cylindrical/transitional papilloma. The present study reports a rare case of bilateral papilloma in a 68-year-old male. He presented with bilateral evolving nasal obstruction and hyposmia. Following surgery, the patient was treated by a multidisciplinary team and followed by a respiratory rehabilitation program.
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