Smoking is one of the major causes of morbidity and mortality worldwide, and Romania makes no exception. On the other hand, work overload has become the second cause of illness among employees in Europe, being a major factor which favors multiple addictions, including smoking. This study is part of a broader investigation that aims to analyze from several perspectives the link between socio-professional factors and smoking.

Rapid-onset Obesity with Hypothalamic Dysfunction, Hypoventilation, and Autonomic Dysregulation (ROHHAD) is a rare disease of unknown etiology, characterized by rapid-onset obesity in young children, hypoventilation, hypothalamic and autonomic dysfunction. Patients between the ages of 2 and 4 present with hyperphagia and weight gain, followed by neuro-hormonal dysfunction and central hypoventilation months or years later. Cardiac arrest may represent the fatal complication of alveolar hypoventilation and early mechanical ventilation is essential for the patient's life. In this paper, we describe a 22-year-old patient with ROHHAD syndrome who had an acute respiratory failure during nocturnal non-invasive ventilation (NIV).

Bronchiectasis, defined as an abnormal and irreversible dilatation of the bronchi, frequently associated with inflammation, is the most common complication of recurrent infections. Effective pulmonary immunity is necessary to prevent chronic bronchial damage due to bacterial infection. Primary immune deficiencies comprise a heterogeneous group of genetically determined disorders that affect development and/or the function of innate or adaptive immunity. In multiple series reported in literature, common variable immunodeficiency (CVID), X-linked agammaglobulinemia (XLA) and chronic granulomatous disease (CGD) were the most common forms of primary immune deficiencies (PIDs) associated with bronchiectasis (1,15). Despite advances in the molecular knowledge of PIDs during the past two decades, there are many undiagnosed or late diagnosed patients (6,14). We report a case of Bruton's disease late diagnosed, already with bronchiectasis, with an early onset of recurrent respiratory infections.

Obstructive sleep apnea syndrome (OSAS) is a health issue of major importance globally. Although OSAS has a prevalence of 4-10% in the general population, it is less diagnosed, with redoubtable consequences on the quality of life and the professional performance. Observational studies showed that lack of sleep is correlated with weight gain and an increased risk of obesity; this relationship was confirmed by mutually reinforcing pathophysiological mechanisms. We report a case that is relevant for the consequences of the pharmaceutical treatment which proved effective in extrinsic allergic alveolitis, but was not supported by an effective intervention on lifestyle (by proper dietary adjustment and increased physical activity) thus exacerbating the obesity, the OSAS and the metabolic syndrome. We believe that this case exemplifies the relevant pathophysiological interdependence between obesity, metabolic syndrome and OSAS.

The progression of tuberculosis (TB) is significantly faster in patients with HIV infection. TB is also the main cause of death for HIV-infected individuals, resulting in fatality for 1 of 3 patients. We present the case of a 26-year-old male who arrived at the hospital having previously been diagnosed with HIV in 2014, but was not compliant to the ARV treatment prescribed. The patient presented with acute onset of fever, cough, hemoptysis and malaise. Investigations such as sputum samples and a lymph node biopsy revealed the presence of M. tuberculosis in optic microscopy, which led to a diagnosis of pulmonary and ganglionary TB. As one of the first opportunistic infections that occur in HIV-infected individuals, TB may be one of the earliest clues of an HIV infection. Current guidelines recommend that all individuals diagnosed with HIV should also undertake testing for TB infections.

Silicosis is an occupational lung disease which is caused by inhalation and accumulation of crystalline silica particles in the lung. It commonly occurs in workers involved in quarrying, mining, sandblasting, tunneling, foundry work, and ceramics. Pneumothorax is one of the complications of silicosis with pleural involvement. The occurrence of pneumothorax in a patient with silicosis is a rare event, but it may be fatal. The rate of pneumothorax recurrence in silicosis is usually low. We report a case of recurrent secondary spontaneous pneumothorax in silicosis.

Tracheobronchial foreign body aspiration represents a life-threatening condition especially in young children. It carries a great amount of mortality and morbidity through the possibility of obstructing the airway and thus resulting in acute respiratory failure. The diagnostic challenges are brought by the great variability of clinical presentation which sometimes only consists of subtle symptoms. For an optimal therapeutic outcome, only a high index of clinical suspicion can ensure a prompt treatment. The mainstay of both diagnostic and therapeutic algorithm resides in bronchoscopy. The article reports the multidisciplinary management of two young children with organic foreign body aspiration, outlining the importance of a step-wise diagnostic approach.

In the last 25 years, there have been important improvements in computed tomography (CT) that may give more details about the lung structure in chronic obstructive pulmonary disease (COPD). The clinical exam and “classic” radiology (chest X-ray, conventional CT) have important roles: they raise the suspicion of hyperinflation, they highlight aspects of pulmonary hypertension, they may detect the triggers of exacerbations, they rule out some COPD complications and other lung diseases that can cause dyspnea (pneumothorax, tumors, bronchiectasis, and fibrosis). The spirometry may confirm the obstructive ventilatory disorder pattern of the disease. The modern CT scan technique - High Resolution CT (HRCT) with Multi-Detector CT procedure (MDCT) gives additional information about morphological details of parenchyma, bronchi, pulmonary vessels or lung function (ventilation/perfusion disorders) without significant lung irradiation. The new techniques provide quantifiable parameters that characterize the emphysema, the main COPD phenotypes and the risk of disease progression. Quantitative volumetric analysis of emphysema provides an early diagnosis of the disease in patients exposed to smoking and pollution. An early personalized diagnostic in COPD offers stronger reasons to prophylaxis by smoking and exposure cessation and an early targeted treatment (inhaled bronchodilators, anti-inflammatory medication, pulmonary rehabilitation, education for lifestyle changes).