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Tiotropium is a long-acting muscarinic antagonist. Its effect last for 24 hours. It causes relaxation of smooth muscles of the respiratory tract and also helps to decrease the mucus secretion by goblet cells. The chronic obstructive pulmonary disease is characterized by chronic productive cough and shortness of breath. The chronic obstructive pulmonary disease has two components; chronic bronchitis and emphysema. Chronic bronchitis is defined as a productive cough for 3 months for 2 consecutive years. On the other hand, emphysema occurs as a result of the destruction of alveolar walls and air entrapment in the alveoli. The risk factors include cigarette smoking (the most common one), biomass fuel exposure, wood burning smoke, industrial smoke and occupational and chemical exposures, genetics and ageing also have a role in the development and progression of chronic obstructive pulmonary disease (COPD). The noxious stimuli (eg. Cigarette smoke) damages the cilia (hair-like proje...

Paramalignant pleural effusions and malignant pleural effusions are often used interchangeably which is wrong, these are two different types of pleural effusions, Said Dr Kausar Rehanna, assistant professor of the department of pulmonology, Shaheed Zulfiqar Ali Bhutto Medical University, Pakistan Institute of Medical Sciences, Islamabad, Pakistan. Paramalignant and malignant pleural effusions both occur in the presence of a solid tumour, but In case of a malignant effusion , there is direct pleural involvement and pleural fluid cytology shows malignant cells, therefore, an effusion which occurs as a result of metastatic pleural involvement and contains malignant cells is called a malignant effusion.  On the other hand, a paramalignant effusion does not contain malignant cells, it occurs as a result of complication of malignancy, such as hypoalbuminemia due to malnutrition or lymphatic obstruction etc. there is no pleural involvement in case of a para-malignant pleural e...

Chest X-Ray in COPD is often normal. Even in advanced disease chest X-ray can be normal. But if the following signs are found in a chest X-Ray then they will be highly suggesting of COPD. Hyperinflation of lungs . Hyperinflation of lungs can be identified with the help of physical examination or chest X-Ray. On physical examination, you may find the upper border of liver displaced down and a barrel-shaped chest. While on chest X-Ray you may find hyper lucent lungs, flattening of hemi-diaphragms, and seven or more anterior ribs are seen over the lung shadow.  Pruning of Vessels : Central vessels are more prominent while less blood is seen in peripheral lung fields.  Large Bullae It is not necessary for a patient with COPD to have all of the above signs, as it has been mentioned earlier, the chest x-ray can be normal even when the disease is advanced, therefore, if you notice any of the above sign in a chest x-ray, then you may consider COPD as a differential in the absen...

Pulmonary artery hypertension can be caused by a number of drugs. Some drugs are known to cause pulmonary arterial hypertension, while others are thought to be involved. Below is the list of drugs that may cause pulmonary arterial hypertension (PAH) Definitive causes of Pulmonary Artery Hypertension  Aminorex : A drug which was previously prescribed for weight loss, later withdrawn from the market when it was noticed that it causes pulmonary artery hypertension.  Fenfluramine : Another drug which was used in past for the purpose of weight loss, it is an anorectic drug, and decreases appetite. It was also withdrawn because it causes pulmonary artery hypertension.  Dexfenfluramine : An isomer of fenfluramine, was being used to induce weight loss.  Topical rapeseed oil : used as an anti-ageing agent.  Benfluorex : similar structure as that of fenfluramine.  Likely causes of Pulmonary Artery Hypertension.  Amphetamines : CNS stimulant Try...

Dr Siddique Akbar Satti, the supervisor of post-graduates trainees of Department of Medicine of Capital Hospital Islamabad, and also the Examiner of College of Physicians and Surgeons Pakistan for Fellowship - Part 2 Exam, today brought a chest x-ray with an unusual finding. Questions about this X-Ray were also asked from the trainees in the last FCPS-Part II Exam. Today we like to share that x-ray with our readers. Kindly have a look at the X-ray that is shown below and think about it and make your own list of possible abnormalities and differentials before looking at the answer that is given at the end of this article. Here is the  Chest – X-Ray, PA view: This is a posterior-anterior view of chest on X-ray film. What do you see? By looking at this X-Ray, you clearly notice an elongated or vertical opacity along the right border of the sternum . If you look below, it disappears behind the right pericardial border. What is this elongated opacity in the mediastinum?  Also...

Myrin P Forte is used to treat tuberculosis . Patients of tuberculosis always try to know whether they should take the TB medicine before or after taking a meal. The answer to this question is that the patient should take the medicine 1 hour before taking breakfast. It is better to take the drug before breakfast because most of the people have fixed time of having breakfast and this drug is well-absorbed when taken empty stomach. Moreover, after taking the drug, if a person vomits then it is easy to recognize the unabsorbed drug in the vomitus if the stomach was empty. So Myrin-P Forte should be taken one hour before breakfast. Another the most important reason of taking Myrin P Forte before the meal is because, absorption of the two of the important ingredients (i.e, Isoniazid and Rifampicin) of Myrin P forte is decreased when taken with food. So the amount of the drug absorbed in blood decreases and this affects the treatment negatively. Some doctors restart the treatment of tubercu...

Author: Kashif Rauf Mechanical Ventilation When the patient continues to deteriorate or fails to improve with other measures and oxygen therapy, he needs some respiratory support with mechanical ventilation. Mechanical ventilation improves C02 elimination (confirmed by performing ABG Test ) and removes work of breathing, gives relief from exhaustion by giving rest to the respiratory muscles. Types of Mechanical Ventilation: Mechanical ventilation may be non-invasive or invasive. 1. Non- invasive mechanical ventilation In non- invasive respiration is supported with a face mask or nasal mask so that, endotracheal intubation is avoided. The patient should be conscious, cooperative, be able to breathe spontaneously and cough effectively. This technique is commonly used in acute exacerbation of COPD and pneumonia . 2. Invasive mechanical ventilation In invasive mechanical ventilation endotracheal tube is passed. The patient may require full or partial support. In full Support...

HEMOPTYSIS (Blood in Sputum) The expectoration of blood or blood-stained sputum is known as hemoptysis . The source of blood should be below the vocal cords. The lungs are supplied with dual circulation; pulmonary arteries arise from the right ventricle and supply pulmonary parenchyma while the bronchial arteries arise from the aorta or intercostals arteries and supply airways, blood vessels, hila and visceral pleura. The bronchial circulation is only 1-2% of total pulmonary blood flow but is a more common source of bleeding. Bronchial blood flow dramatically increases in inflammation. Causes of Hemoptysis (Blood in Sputum)- 1. Blood From airways in> Bronchitis Bronchiectasis Bronchial adenoma Bronchogenic carcinoma 2. From pulmonary vasculature Mitral stenosis Pulmonary infarction Left ventricular failure A-V malformation 3. From pulmonary parenchyma Pneumonia Bleeding disorders Autoimmune diseases e.g. Goodpasture’s syndrome and Wegner’s syndrome 4. Massive...

The appearance of Blisters around lips is the most common condition experienced by almost every person a few times in his/her lifetime. Most of the people get this disease when they reach the age of 20. This is a Highly contagious infection and transfers from one person to another through intimate contact, sharing towels and other articles. Once it infects somebody, a tendency of recurrent infection always remains there. It is very difficult to eliminate this virus completely. But in the normal healthy individual, this virus doesn’t cause serious complications. It causes serious complication in only immuno-deficient person ( eg., AIDS ). The Causative virus has two subtypes, Herpes simplex type I and Herpes simplex type II. Herpes simplex type 1 causes herpes labialis and it is more common. The Herpes Simplex type II virus causes genital herpes ( see an article about genital herpes, causes and treatment )but it may cause herpes labialis as well. After the first infection, the herp...

Hyperventilation syndrome is characterized by an increase in alveolar ventilation that leads to hypocapnia. Central neurogenic hyperventilation occurs in brain stem injury presenting with a sustained pattern of rapid and deep breathing. Causes of hyperventilation may be organic or functional. Organic causes of Hyperventilation syndrome. Organic causes of Hyperventilation syndrome are pregnancy, hypoxemia, obstructive and infiltrative lung diseases, sepsis hepatic dysfunction, fever and pain Functional hyperventilation may be acute or chronic, usually due to anxiety. In the acute form of Hyperventilation syndrome, patient (usually young females) present with rapid breathing, paresthesias, carpopedal spasm, tetany (due to unionization of calcium), chest pain or discomfort, choking sensation, sweating and anxiety. In the chronic form of Hyperventilation syndrome, the patient presents with fatigue, dyspnea, anxiety, palpitation and dizziness. Diagnosis of Hyperventilation Syndrom...

SLEEP APNEA/HYPOPNEA SYNDROME Sleep apnea or Central Sleep Apnea syndrome is characterized by recurrent upper airway obstruction during sleep when the loss of normal pharyngeal tone allows the pharynx to collapse passively during inspiration Which causes Loud Snoring and Breath Pauses (apnea) in affected person Aetiology and Causes of Sleep Apnea Male gender Obesity Tonsillar hypertrophy Nasal obstruction Hypothyroidism acromegaly Ingestion of alcohol or sedatives before sleep Clinical features of Sleep Apnea If the narrowing is slight, it leads to snoring. If upper airway narrowing progresses to the point of occlusion or near occlusion, a sleeping person increases respiratory effort and try to breathe until the increased effort transiently awaken him. This recurrent cycle of apnea, awakening, apnea, awakening may repeat itself many hundreds of times per night. The patient complains of day - time sleepiness, he feels he has been asleep all night but still he does not feel fresh...

Indication and patient selection for Lung Transplantation patient under 60 years with a life expectancy of fewer than 18 months without transplantation, no underlying malignancy and no serious systemic disease. Following diseases are treated by lung transplantation. Emphysema- smoking-induced or due to alpha- one antitrypsin deficiency. Idiopathic pulmonary fibrosis Cystic fibrosis Eisenmenger’s syndrome Primary pulmonary hypertension Lung transplantation options Single lung transplantation Emphysema Idiopathic pulmonary fibrosis Primary pulmonary hypertension Bilateral lung transplantation Cystic fibrosis Emphysema Primary pulmonary hypertension Bronchiectasis Living related lobar transplantation Cystic fibrosis Bilateral lower lobe transplantation from two Different living donors Heart-lung transplantation Congenital heart diseases with Eisenmenger’s syndrome. Left ventricular failure and end-stage lung disease Recipient selection For Lung Transplantat...

(Arterial blood gases) ABG report tells us about the level of hypoxemia and acid-base balance. A medical student must know how to interpret arterial blood gases (ABG Report) correctly and accurately and he should also know the procedure of taking the sample for arterial blood gases test. Standard Procedure: To take the arterial blood sample; 1. first of all heparinize the syringe with 0.1 ml heparin to prevent clot formation. 2. Draw blood from the radial or brachial artery (femoral artery if none of these is accessible). Prevent Air bubble otherwise, it will affect the results. 3. Immersed the sample in an ice bag immediately to prevent metabolism that can decrease PO2 and increase PCO2 Normal Values: pH: 7.35-7.45 PO2 (partial pressure of oxygen): 75-100 mm of Hg PCO2 (partial pressure of carbon dioxide): 36-46 mm of Hg HCO3 (bicarbonate ion): 22-26 mmol/L O2 saturation: 95-100% (oxygen saturation below 90 per cent produces cyanosis in a person who has a normal level o...

Chest pain is one of the most common problems which a common man may experience. It could be as serious as myocardial infarction ( to understand heart attack in simple language click here ) or just muscular pain. Chest pain may occur due to the pathology of structures present on and inside the chest. The chest is composed of skin, muscles, ribcage and important organs present inside the rib cage. Following important organs are present inside the chest cavity, and any damage to these organs may give rise to chest pain. - Intercostal Muscles, - Heart - Lungs - Blood vessels - Oesophagus - Nerves - Bones and Joints. - Breasts - Lymph nodes The following structures are not present in the chest cavity but are covered by the ribcage. - The upper end of the stomach - liver Now any abnormality or disease of the above structure can cause chest pain. Severe and localized chest pain, in which the patient can tell the exact location of the pain is mostly muscular in origin, which...

Examination of Respiratory System In this flash lecture following topics are discussed: 1. Anterior, Posterior and Lateral Imaginary Lines on Chest. 2. Lobes of the lungs 3. Anterior and Posterior view of the lobes of the lungs 4. Inspection:                Respiratory Movements and type                Respiratory Rate                Chest Deformity 5. Palpation:                Trachea                Apex Beat                Thoracic Expansion                Vocal Fermitus 6. Percussion:                Method of percussion                Factors affect percussion notes             ...

Clubbing Of Nails In Clubbing there is loss of angle between nail and nail base.  Nails are felt swollen on palpation. Causes Of Clubbing Of Nails Diseases of different organ systems may cause clubbing Clubbing Of Nails Respiratory Causes Of Clubbing of Nails 1. Bronchiectasis 2. Lung abscess (lung abscess-treatment-causes-signs and symptoms) 3. Empyema 4. Chronic Obstructive Pulmonary Disease COPD . Which include Emphysema and Chronic Bronchitis. 5. Cystic Fibrosis 6. Fibrosing alveolitis 7. Carcinoma Of Lungs. 8. Mesothelioma 9. Tuberculosis ( tuberculosis and types of tuberculosis ) Cardiovascular Causes Of Clubbing of Nails 1. Cyanotic Heart Disease 2. Tetralogy Of Fallot ( Tetralogy Of Fallot Xray Diagnosis ) 3. Transposition Of Great Vessels.  4. Infective Endocarditis ( clinical features of infective endocarditis ) 5. Atrial Myxoma 6. Total anomalous pulmonary venous return (TAPVR; a rare condition in which the pulmo...

Lung Abscess: Lung abscess refers to a localized area of suppurative necrosis within the lung parenchyma, resulting in the formation of one or more large cavities filled with pus. Causes Of  Lung Abscess: 1. Aspiration of infective material from carious teeth, infected sinuses or tonsils particularly likely during oral surgery, anaesthesia, coma or alcoholic intoxication. 2. Aspiration of gastric contents. 3. As a complication of necrotizing bacterial pneumonia , particularly those caused by S. aureus, S. pyogenes, K. Pneumonia, P. Arigninosa and pneumococci. 4. Bronchial obstruction , particularly with bronchocarcinoma. Bronchial obstruction leads to secondary infections which may complicate to abscess formation. 5. Septic Embolism , from septic thrombophlebitis or from infective endocarditis of right side of the heart. 6. Hematogenous bacterial spread from other sites of infections. (Hematogenous means "through blood") Signs and Symptoms: 1. Pro...

The influenza virus is a single-stranded RNA virus, bound by a nucleoprotein. This nucleoprotein determines the type of the virus whether it is virus type A, B or C. The spherical surface of the virus is a lipid bilayer containing the viral antigens. The viral antigens are "hemagglutinin and "neuraminidase". These two antigens determine the subtype of virus that is H1N1, H3N2 etc.(H stands for Hemagglutinin and N stands for Neuraminidase). When an individual gets an infection of Influenza virus, antibodies are formed against the neuraminidase and hemagglutinin antigens, which prevent future infections with the same subtype of influenza virus. But recurrent infection occurs through mutations of hemagglutinin and neuraminidase antigens that allow the virus to escape from the host antibodies, this phenomenon is called antigenic drift. Visit Home Page

Plexogenic Pulmonary Arteriopathy Plexogenic pulmonary arteriopathy is an arterial disease develop in individuals with long-standing pulmonary hypertension. In this disorder a tuft of capillary formations is present, producing a network or a web that spans the lumens of dilated thin-walled, small arteries Visit Home Page