Publications by authors named "Peter Fsadni"

18 Publications

  • Page 1 of 1

Rituximab therapy in a patient with steroid-refractory bird fancier's lung.

BMJ Case Rep 2020 Dec 22;13(12). Epub 2020 Dec 22.

Department of Respiratory Medicine, Mater Dei Hospital, L-Imsida, Malta.

A 62-year-old woman presented with a 3-month history of shortness of breath on exertion and dry cough. On examination, she was noted to have fine end-inspiratory crepitations over the upper zone of the lungs. Pulmonary function tests (PFTs) showed a restrictive defect. Initial chest radiography revealed diffuse reticular interstitial shadowing while high-resolution CT scan of the thorax showed fibrotic changes. Avian precipitins were also highly positive for pigeons, parrots and budgerigars. Taking into account these results, the patient was diagnosed with hypersensitivity pneumonitis. Antigen avoidance, oral glucocorticoids and azathioprine achieved an initial improvement in PFTs and symptoms; however, the patient still deteriorated, requiring long-term oxygen therapy. While working the patient up for lung transplantation, rituximab was given to good effect (acting as a bridging therapy) as it achieved symptomatic relief and stabilisation of her PFTs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bcr-2020-237232DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7757452PMC
December 2020

Haemoptysis following shallow breath-hold diving in a cannabis user.

BMJ Case Rep 2020 Jun 9;13(6). Epub 2020 Jun 9.

Respiratory, Mater Dei Hospital, Msida, Malta.

We report the first case of a healthy 24-year-old male with a 6-year history of regular cannabis use, who presented with haemoptysis after a shallow 3 m breath-hold dive. Blood investigations showed mild neutrophilia. CT thorax revealed focal ground-glass changes in the superior segment of the lower lobe. With a suspicion of pneumonia, oral antibiotics were initiated to poor effect. Through bronchoscopic visualisation and lavage, a diagnosis of diffuse alveolar haemorrhage was established. The clinical course was benign with resolution of symptoms and changes on CT thorax within 6 weeks of stopping marijuana use. Since all other causes of haemoptysis were excluded, pathophysiology was attributed to cannabis-induced lung parenchymal damage, exacerbated by a shallow breath-hold dive. To ensure appropriate management, a clinician should therefore have a high index of suspicion for drug use and other factors known to cause chronic lung damage in whom other causes of diffuse alveolar haemorrhage are excluded.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bcr-2020-234921DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7287494PMC
June 2020

Pulmonary Rehabilitation in patients with Interstitial Lung Disease: The effects of a 12-week programme.

Respir Med 2019 01 23;146:49-56. Epub 2018 Nov 23.

University of Malta, Msida, Malta. Electronic address:

Background: The inclusion of Pulmonary Rehabilitation as part of the management of Interstitial Lung Disease, although being highly recommended in most recent guidelines, still has limited studies exploring the outcomes from such an intervention. The present study aims to contribute to the available literature by investigating the effects of a high intensity, 12 week PR programme on functional and quality of life measures in patients with a diagnosis of Interstitial Lung Disease.

Method: ology: This paper reports outcomes of an observational, prospective, quasi experimental type of study. A total of 120 participants were recruited: 60 patients formed part of the active group, and another 60 patients were enrolled in an inactive group. Each participant was classified according to the modified Medical Research Council dyspnoea scale and placed in one of 5 categories (0-4) according to self-perceived breathlessness during daily activities. The following outcomes were measured: Lung function tests including plethysmography and diffusion capacity of carbon monoxide (DCO), functional tests (6-min walking distance test, Dyspnoea Borg Scale) and health status measures (St George's Respiratory Questionnaire and Hospital Anxiety and Depression Score).

Results: A 12-week PR programme for patients with Interstitial Lung Disease, led to significant improvements in the active group of patients in the 6 min walking distance test, the modified Borg Scale, mMRC scores and in the health status measures. Lung function measures did not show any significant improvement following this intervention.

Conclusion: This 12week Pulmonary Rehabilitation programme resulted in improvements in functional aspects for patients with Interstitial Lung Disease. Further studies are recommended as Pulmonary Rehabilitation for Interstitial Lung Disease may have an impact at both an individual level and at global organisational/financial levels.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.rmed.2018.11.007DOI Listing
January 2019

Impact of School Air Quality on Children's Respiratory Health.

Indian J Occup Environ Med 2018 Sep-Dec;22(3):156-162

Department of Medicine, Faculty of Medicine and Surgery, University of Malta, Msida, Malta.

Background: Asthma is common in children with indoor pollutants influencing the development of the disease. Since children spend most of their time outside their homes within the school environment, school indoor air quality can directly influence their respiratory health.

Aims: This study aims to analyze the indoor and outdoor air quality of Maltese schools and if an association exists between indoor pollutants and respiratory health in children.

Settings And Design: Five primary schools were selected with 9- to 11-year-old students participating.

Materials And Methods: Standardized health questionnaires and lung function tests were utilized. Indoor and outdoor air sampling together with traffic counts were carried out.

Statistical Analysis Used: SPSS version 21 was used and the Chi-squared, logistic regression, and Pearson's correlation were used.

Results: The mean indoor PM 2.5 level of 17.78 μg/m and CO (9.11 ppm) exceeded World Health Organization thresholds. Indoor ozone levels exceeded the mean European school's indoor ozone concentration of 8 μg/m. High exposure to formaldehyde, NO, and ozone was associated with atopy in children. Heavy vehicles passing near the schools were associated with current wheezing ( < 0.001) but not nocturnal cough ( = 0.34).

Conclusions: School indoor and outdoor environment has a direct impact on children's respiratory health. This study has identified significant associations between high exposures to indoor air pollutants, school characteristics, and upper and lower airway inflammation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/ijoem.IJOEM_95_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6309359PMC
January 2019

An unusual presentation of multiple myeloma.

BMJ Case Rep 2018 Nov 28;11(1). Epub 2018 Nov 28.

Respiratory Division, Department of Medicine, Mater Dei Hospital, Msida, Malta.

The authors report a case of a 58-year-old woman, ex-smoker, who was referred to the respiratory clinic with a presumed unresolving airspace shadowing in the right lung. Further evaluation of the shadowing with a CT thorax revealed rib lesions, a pancreatic lesion and multiple liver lesions, making the diagnosis of metastatic pancreatic carcinoma most likely. However, further blood investigations and imaging eventually revealed the cause for the shadowing to be multiple myeloma, since the unresolving shadowing was actually a rib lesion.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bcr-2018-226412DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6301485PMC
November 2018

Food consumption and the risk of childhood allergy.

Asia Pac Allergy 2018 Oct 16;8(4):e35. Epub 2018 Oct 16.

Department of Medicine, Mater Dei Hospital, Msida, Malta.

Background: The prevalence of allergic conditions is increasing in most countries. One possible explanation may be childhood nutrition.

Objective: The aim of the study was to investigate the relationship between consumption of pre-specified types of food in school-aged children and presence of respiratory and allergic symptoms.

Methods: A total of 191 students aged 9-11 years were recruited from 5 schools to geographically cover all of Malta. Data was collected between October 2011 and February 2012. This was part of a bigger study which included clinical and environmental tests besides standardized health questionnaires. For the purposes of this part of the study only the health questionnaires were used. These standardized health questionnaires based on the International Study of Asthma and Allergies in Childhood (ISAAC) were used to identify the presence of respiratory and allergic symptoms and to identify the types of foods and the frequency of consumption of various types of foods.

Results: We found that milk, meat, butter, olive oil, and yoghurt consumption had a negative association with allergic symptoms in children, whilst fish consumption had a detrimental effect. These relationships remained significant after correction for paternal level of education.

Conclusion: The study highlights the fact that nutrition in early childhood may have a significant effect on the risk of allergic conditions. Our results, taken together with data in the literature, suggest that different types of fish might have had different effects. This is probably related to their different fatty acid constitution thus warranting further studies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5415/apallergy.2018.8.e35DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6209597PMC
October 2018

Continuous Positive Airway Pressure: Is it a route for infection in those with Obstructive Sleep Apnoea?

Sleep Sci 2017 Jan-Mar;10(1):28-34

Department of Medicine, Mater Dei Hospital, Msida, Malta.

Introduction: Continuous positive airway pressure (CPAP) is the standard treatment for obstructive sleep apnoea (OSA), with limited data about the prevalence of respiratory infections and microbial colonization in these patients.

Objectives: The aim of this study was to determine if CPAP use is associated with respiratory infections and to identify the organisms that colonize or infect these patients.

Method: A retrospective, case-controlled study in patients diagnosed with OSA was carried out. 137 patients were recruited and interviewed using a questionnaire. A nasal swab was taken from each patient. Patients using CPAP machines had swabs taken from masks and humidifiers.

Results: 66 (48.2%) patients received CPAP treatment with 60.6% of them having a heated humidifier. 78.8% were male, with the majority using a full face mask (63.6%). No significant difference was seen in the prevalence of rhinosinusitis, lower respiratory tract infections and hospital admissions for pneumonia between CPAP and non-CPAP treated patients. The presence of a humidifier did not influence the prevalence of infections. Commensal flora was predominantly cultured from nasal swabs from both patient groups. Coagulase Negative Staphylococci and Diphtheroids were the main organisms cultured from masks and humidifiers respectively.

Conclusions: This study shows that the use of CPAP, choice of mask and humidifier have no significant impact on the prevalence of infections and micro-organisms isolated. This is very reassuring to the physician prescribing CPAP therapy and users.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5935/1984-0063.20170005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5611769PMC
October 2017

Respiratory medicine training in Malta.

Breathe (Sheff) 2017 Sep;13(3):245-246

Dept of Respiratory Medicine, Mater Dei Hospital, Msida, Malta.

In Malta, respiratory medicine is quite a popular speciality. It is attractive because of the interesting case mix and the interventional element of the speciality.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1183/20734735.009417DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5584720PMC
September 2017

Association between obstructive sleep apnea and atopy in adult Maltese patients.

Ann Allergy Asthma Immunol 2016 Oct 27;117(4):441-442. Epub 2016 Aug 27.

Department of Medicine, Mater Dei Hospital, Msida, Malta.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.anai.2016.07.040DOI Listing
October 2016

Stridor: a rare presentation of oesophageal malignancy.

BMJ Case Rep 2015 Nov 30;2015. Epub 2015 Nov 30.

Department of Medicine, Mater Dei Hospital, Msida, Malta.

A middle-aged ex-smoker, with a history of curative surgery for oesophageal squamous cell carcinoma 7 years earlier, presented to the casualty department at Mater Dei Hospital with stridor and a 2-week history of progressively worsening dyspnoea. A thoracic CT scan showed the presence of a posterior mediastinal mass involving the upper half of the stomach and posterior wall of the trachea. Histology of an exophytic ulcerating lesion at 25 cm of the oesophagus was that of squamous cell carcinoma. Bronchoscopy performed to ascertain the cause of the stridor showed the trachea to be 70% occluded. The patient showed symptomatic improvement with radiotherapy and intravenous dexamethasone; however, he passed away a few weeks later due to respiratory failure secondary to tracheal occlusion.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bcr-2015-212408DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4680269PMC
November 2015

Association of prevalence of rhinitis, atopic eczema, rhinoconjunctivitis and wheezing with mortality from infectious diseases and with antibiotic susceptibility at a country level.

Asia Pac Allergy 2015 Jul 29;5(3):145-55. Epub 2015 Jul 29.

Department of Medicine, Mater Dei Hospital, Msida, MSD 2090, Malta. ; Faculty of Medicine and Surgery, University of Malta, Msida, MSD 2090, Malta.

Background: It was previously reported that there is a positive correlation between incidence of type 1 diabetes and prevalence of asthma and atopic eczema. A negative correlation between the prevalence of type 1 diabetes and mortality from infectious diseases as well as a positive correlation with antibiotic susceptibility at a country level have also been reported.

Objective: The aim of this study was to investigate the association between country prevalence of rhinitis, atopic eczema, rhinoconjunctivitis, and wheezing with mortality from infectious diseases and also with antibiotic susceptibility at a country level.

Methods: Data for prevalence of rhinitis, eczema, rhinoconjunctivitis, and wheezing was obtained from the International Study of Asthma and Allergies in Childhood study (ISAAC). ISAAC Phase one was a multicentre multicountry cross sectional study involving over 700,000 children in 2 age groups of school children, 13-14 years old (adolescents) and 6-7 years old (children) in 156 centres from 56 countries. Mortality from infectious diseases was taken from World Health Organisation data. The Alexander project was used to identify antibiotic susceptibilities to common bacteria.

Results: There were significant positive correlations between atopic eczema and mortality from all infectious diseases studied, diarrhoeal illness, tropical infections, and childhood infections. A negative correlation exists between the prevalence of rhinitis and Streptococcus pneumoniae susceptibility to penicillin and to erythromycin, rhinitis and Haemophilus influenzae susceptibility to ampicillin and between rhinoconjunctivitis and H. influenzae susceptibility to ampicillin.

Conclusion: Th1/Th2 responses might influence the pathogenesis of infectious disease mortality, while antibiotic overprescription could explain the negative association between atopy and antibiotic susceptibility.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5415/apallergy.2015.5.3.145DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4521163PMC
July 2015

Systemic and venous thromboembolism: think about paradoxical embolism.

BMJ Case Rep 2015 Jul 28;2015. Epub 2015 Jul 28.

Department of Medicine, Mater Dei Hospital, Msida, Malta.

Patent foramen ovale (PFO) is one of the most important causes of paradoxical embolism; it is found in about 25-30% of the population. In most patients, it is asymptomatic and diagnosis is usually made during routine echocardiography. In a small proportion of patients, PFO is diagnosed after paradoxical embolism is suspected. We present a case of a middle-aged smoker who was admitted with lower limb deep vein thrombosis and pulmonary embolism, who developed acute upper limb ischaemia during his inpatient stay. Since doctors might dismiss such cases as routine, this report highlights the importance of detailed history taking and examination in patients with venous thromboembolism. Paradoxical embolism should always be considered as a possible diagnosis when managing patients with concomitant venous and arterial embolism.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bcr-2015-211174DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4521559PMC
July 2015

Outcome of central hypoventilation secondary to childhood pertussis encephalitis in adulthood.

BMJ Case Rep 2015 Jan 23;2015. Epub 2015 Jan 23.

Mater Dei Hospital, Msida, Malta.

We present a rare case of central hypoventilation secondary to pertussis encephalopathy occurring during childhood. The patient was successfully managed by negative pressure ventilation initially until portable non-invasive ventilators became available. The patient was, unfortunately, lost to follow-up. She was reviewed in adulthood following several years of non-compliance to treatment and found asymptomatic despite chronic hypercapnoea.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bcr-2014-206471DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4307069PMC
January 2015

Primary laryngeal tuberculosis: An unusual cause of hoarseness.

Ear Nose Throat J 2014 Oct-Nov;93(10-11):E15-7

Department of Medicine, Mater Dei Hospital, Msida MSD 2090, Malta.

Tuberculosis (TB) of the larynx is usually associated with concomitant pulmonary TB, but approximately 20% of cases represent primary disease. We report the case of an 85-year-old woman with asthma who presented with a 6-month history of persistent hoarseness. Bronchoscopy confirmed the presence of a lesion in the hemilarynx, and histology identified tuberculoid granulomas that were suggestive of TB. Treatment with a combination of isoniazid, rifampicin, pyrazinamide, and ethambutol led to a complete resolution of symptoms. A high index of suspicion for laryngeal TB is required in patients who present with hoarseness.
View Article and Find Full Text PDF

Download full-text PDF

Source
October 2015

A delayed diagnosis of Mounier-Kuhn syndrome.

BMJ Case Rep 2014 Jun 2;2014. Epub 2014 Jun 2.

Department of Respiratory Medicine, Mater Dei Hospital, Msida, Malta.

Following a provisional diagnosis of asthma of several years' duration by his general practitioner, a 43-year-old otherwise healthy man who was a non-smoker was referred to a pulmonologist with worsening productive cough and exertional breathlessness. A thoracic CT scan revealed dilated airways (tracheal diameter 35 mm, left bronchial diameter 20 mm, right bronchial diameter 18 mm). Inflamed and easily collapsible airways were seen on bronchoscopy. The patient remained stable and was followed up with regular spirometry. A follow-up CT scan 7 years later showed tracheobronchomegaly (tracheal diameter 42 mm, left bronchial diameter 25 mm, right bronchial diameter 23 mm) with large cystic spaces consistent with Mounier-Kuhn syndrome. Repeat bronchoscopy showed a massively dilated trachea and generalised collapse on expiration with a dilated thin-walled bronchial tree. He was deemed ineligible for lung transplantation due to the extent of airway involvement making it difficult to anastomose donor lung to native tissue.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bcr-2014-203674DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4054406PMC
June 2014

Chronic cough as a complication of treatment with statins: a case report.

Ther Adv Respir Dis 2012 Aug 3;6(4):243-6. Epub 2012 Jul 3.

Mater Dei Hospital, 17, Floreat, Triq il-Kbira, Gharghur, Malta (EU).

Statins are widely used for primary and secondary prevention of cardiovascular disease. For this reason, knowledge of the side effects and interactions pertaining to this class of pharmaceuticals is of utmost importance to all physicians. In this text a case report is presented of an eighty year old gentleman, referred to the respiratory clinic at Mater Dei Hospital Malta after developing dry cough on being treated with simvastatin and fluvastatin. An attempt at switching over to a placebo was made with resolution of symptoms. This is the second described case in the literature of lone cough associated with statin therapy necessitating treatment discontinuation in our patient. Possible hypothesis are discussed as well as suggestions for further research to unravel the underlying mechanisms of this association.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1753465812452192DOI Listing
August 2012

Correlation of worldwide incidence of type 1 diabetes (DiaMond) with prevalence of asthma and atopic eczema (ISAAC).

Clin Respir J 2012 Jan 10;6(1):18-25. Epub 2011 May 10.

Department of Medicine, Mater Dei Hospital, Birkirkara, Malta.

Introduction: Environmental factors play a role in pathogenesis of both type 1 diabetes and atopic disease but they remain incompletely understood. T cell-mediated responses primarily of the T helper type 1 (Th1) are involved in type 1 diabetes while T helper type 2 (Th2) responses favour allergic disease. This TH 1/TH 2 paradigm is currently the source of much controversy in various studies.

Objective: The aim of the study was to compare the reported country incidence of type 1 diabetes with the prevalence of atopic disease.

Methods: The prevalence of wheeze, rhinitis, rhinoconjunctivitis and atopic eczema in the preceding 12 months in the 13- to 14-year-old age group was taken from The International Study of Asthma and Allergies in Childhood phase 1 study. These were compared to the age specific incidence of type 1 diabetes in children per 100 000 per year obtained from the Diabetes Mondiale Project Group study from those countries participating in both studies. Data collected from these 31 countries together with latitude was analysed using a Pearson correlation and significance analysis. A multiple regression analysis determined the confounding effect of latitude.

Results: The incidence of type 1 diabetes was found to have a positive correlation with both wheezing (P = 0.009) and atopic eczema (P < 0.01). There was a no correlation between the incidence of type 1 diabetes and the prevalance of rhinitis (r = 0.02, P = 0.88) or of rhinoconjunctivitis (r = 0.026, P = 0.88). Latitude correlated negatively with type 1 diabetes and positively with rhinitis and rhinoconjnctuvits; it was not significantly correlated with wheeze or eczema. Regression analysis showed that latitude is a significant confounding factor in the correlation of rhinitis (P value < 0.0008) and rhinoconjunctivitis (P value < 0.0003) with diabetes.

Conclusions: The study suggests that common environmental and/or genetic factors predispose to type 1 diabetes, wheezing and atopic eczema while factors predisposing to rhinitis and rhinoconjunctivitis appear to be distinct from those predisposing to type 1 diabetes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/j.1752-699X.2011.00239.xDOI Listing
January 2012

Carbamazepine-induced drug reaction with eosinophilia and systemic symptoms syndrome in a 35-year-old man with epilepsy.

Clin Neuropharmacol 2008 Sep-Oct;31(5):295-8

Infectious Diseases Unit, St Luke's Hospital, Gwardamangia, Malta.

The drug reaction with eosinophilia and systemic symptoms syndrome describes a hypersensitivity reaction to a number of drugs. It is characterized by a triad of fever, rash, and internal organ involvement. Carbamazepine is suspected to be the cause of the drug reaction with eosinophilia and systemic symptoms syndrome in this young man who presented with fulminant hepatitis and an exfoliating rash 8 weeks after starting carbamazepine. Symptoms gradually resolved after stopping carbamazepine and starting systemic steroids.Because we encountered only a few similar cases in the literature, we wish to highlight the importance of recognizing these symptoms as a syndrome that can be fatal, especially if not recognized early.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/WNF.0b013e31815a3ed6DOI Listing
May 2009