Search Results (63)

Introduction: There are a limited number of epidemiological studies describing the global burden of chronic diffuse interstitial lung diseases (ILD) and their subtypes’ heterogeneity worldwide. Our main is to characterize new-onset ILDs in Algeria and compare our results with data from other populations. Materials and Methods: Newly diagnosed ILDs were prospectively collected in a single-center observational cohort study including all patients diagnosed as ILDs in the pulmonology, phthisiology, and allergology departments between 2015 and 2019. Detailed anamnestic and clinical data were collected at the time of diagnosis. The results of high-resolution computed tomography (HRCT), serological tests, biology data, and respiratory functional exploration were systematically performed and collected. Results: A total of 455 cases were included. The mean age was 59.4 ± 13.2 years. There was a slight predominance of females (300; 65.9%). The most common disease was ILD secondary to connective tissue disease (CTD) or ILD-CTD (48.1%), followed by idiopathic interstitial pneumonias (IIPs) (23.5%), sarcoidosis (16.9%), interstitial pneumonia with autoimmune features (IPAF) (12.1%), and hypersensitivity pneumonitis (HP) (2.4%). Idiopathic pulmonary fibrosis (IPF) was present in 8.6% and unclassifiable ILD in 4.6% of the total ILD cases. Conclusions: ILD-CTD, IIP, and sarcoidosis were the most frequently observed ILDs in this Algerian population. Similarities and many differences were found compared to previous data from other countries. Full article

Hypercoagulability in COVID-19 patients was associated with increased mortality risk during the pandemic. This retrospective, observational study investigated whether the use of a thromboelastography (TEG)-guided anticoagulation protocol could decrease death and bleeding in critically ill COVID-19 patients. A TEG-guided protocol was instituted in one of two intensive care units. Primary outcomes of composite scores were the following: (0) major bleed and death; (1) death without major bleed; (2) major bleed without death; and (3) no bleed or death. Out of 134 patients, 67 in the TEG group were propensity matched to 67 in the comparator group based on age, gender, body mass index, presence of chronic kidney disease, cardiovascular disease, diabetes, and duration of non-invasive ventilation. There were no significant differences in rates of composite outcomes of bleeding or death in patients managed with or without a TEG-guided protocol (p = 0.22, Bowker symmetry testing). Out of the 67 patients in the TEG group, the TEG protocol led to anticoagulation change in 26 patients. Death was lower in this TEG-changed group (54%) compared to the comparator group (81%), although not significant (p = 0.07). TEG-guided protocol use did not reduce composite outcomes of death and bleeding, Future studies may further elucidate potential benefits. Full article

In this study, we present a novel approach to differentiate normal and diseased lungs based on exhaled flows from 3D-printed lung models simulating normal and asthmatic conditions. By leveraging the sequential learning capacity of the Long Short-Term Memory (LSTM) network and the automatic feature extraction of convolutional neural networks (CNN), we evaluated the feasibility of the automatic detection and staging of asthmatic airway constrictions. Two asthmatic lung models (D1, D2) with increasing levels of severity were generated by decreasing the bronchiolar calibers in the right upper lobe of a normal lung (D0). Expiratory flows were recorded in the mid-sagittal plane using a high-speed camera at 1500 fps. In addition to the baseline flow rate (20 L/min) with which the networks were trained and verified, two additional flow rates (15 L/min and 10 L/min) were considered to evaluate the network’s robustness to flow deviations. Distinct flow patterns and vortex dynamics were observed among the three disease states (D0, D1, D2) and across the three flow rates. The AlexNet-LSTM network proved to be robust, maintaining perfect performance in the three-class classification when the flow deviated from the recommendation by 25%, and still performed reasonably (72.8% accuracy) despite a 50% flow deviation. The GoogleNet-LSTM network also showed satisfactory performance (91.5% accuracy) at a 25% flow deviation but exhibited low performance (57.7% accuracy) when the deviation was 50%. Considering the sequential learning effects in this classification task, video classifications only slightly outperformed those using still images (i.e., 3–6%). The occlusion sensitivity analyses showed distinct heat maps specific to the disease state. Full article

The discovery of the efficacy of tyrosine kinase inhibitors (TKIs) in epidermal growth factor receptor (EGFR)-mutated non-small-cell lung cancer (NSCLC) patients has revolutionized lung cancer therapy. Although almost all responders acquire drug resistance within a few years, many studies have revealed several acquired-resistant mechanisms and developed therapeutic strategies countervailing them, most notably against the EGFR T790M gatekeeper mutation. However, little progress has been made in terms of elucidating the mechanisms of primary resistance. Primary resistance may be defined into two types of resistance, clinically representing patients that do not respond (non-responders) to EGFR-TKIs. The first group consists of approximately 10% of patients that are insensitive to EGFR-TKIs from the outset (intrinsic primary resistance), and 20–30% of the second group consists of patients that seem to clinically benefit at first, but experience early relapse within six months (late primary resistance). In this review, we first provide an overview of drug-induced lung cancer dynamics. We then delve into the mechanisms of primary resistance, with a primary focus on two specific subtypes of resistance. We suggest that “intrinsic primary resistance” is characterized by pre-existing somatic and genomic changes and cell of origins, while “late primary resistance” is correlated with the drug-tolerant persister state. Developing therapeutic strategies to overcome primary resistance is crucial to prolonging the duration of EGFR-TKI therapy. Ultimately, this will allow for an enhanced understanding of lung cancer’s evolutional process, leading to the reversal of acquired resistance and the complete eradication of lung cancer. Full article

Thoracentesis is a fundamental procedure in interventional pulmonology, providing both diagnostic and therapeutic value. This review article offers a comprehensive analysis of thoracentesis, delving into pleural anatomy, procedural techniques, indications, and recent advancements. The article details the evolution of thoracentesis, including the crucial role of ultrasound guidance and emerging approaches that enhance precision and minimize complications. It addresses the wide range of indications for thoracentesis in diverse clinical scenarios, from the diagnosis of pleural effusions to therapeutic drainage of pleural collections. Furthermore, this review explores the management of coagulopathy and anticoagulation pertaining to thoracentesis. It will also provide strategies for preventing and managing complications, ensuring that thoracentesis remains a well-tolerated procedure with minimal risks. This article concludes by examining future directions in thoracentesis, including potential innovations and trends that will shape the landscape of interventional pulmonary medicine. This review serves as an essential resource for pulmonologists, interventional radiologists, and healthcare professionals, offering a comprehensive update on thoracentesis. Full article

Interstitial lung disease (ILD), which is characterized by pulmonary fibrosis, is a diverse group of disorders. Nintedanib, an antifibrotic drug, is known to attenuate disease progression in ILD with progressive fibrosis, but its efficacy in autoimmune-disease-related ILD remains uncertain. We conducted a comprehensive search for relevant randomized controlled trials, systematic reviews and meta-analyses included in PubMed, ScienceDirect and Scopus databases as of 23 June 2022 and manually reviewed reference lists. Among the 689 titles and abstracts screened, 24 studies were considered, with 4 randomized controlled trials included in our review. Nintedanib, administered at 150 mg twice daily for 52 weeks, consistently slowed forced vital capacity decline. Enhanced efficacy was observed when combining nintedanib with immunomodulators, and the most common adverse effect was diarrhea. In conclusion, our study suggests that nintedanib is a safe option for mitigating the progression of autoimmune-disease-related ILD, providing valuable insights into its potential therapeutic role in this context. Full article

The COVID-19 pandemic had an immense effect on the well-being of healthcare professionals. In this study, researchers utilized a quantitative cross-sectional study design to investigate the degree of compassion satisfaction and fatigue amongst respiratory therapists in the state of Mississippi as a result of providing care to patients during the COVID-19 pandemic. Quantitative data were collected using an anonymous online survey that assessed the well-being and satisfaction of licensed respiratory therapists in the state of Mississippi. More specially, survey responses (n = 326) were quantitatively evaluated to measure the association between demographic variables and compassion satisfaction (CS), burnout (BO), and secondary traumatic stress (STS). Ninety-seven percent of participants reported a medium to high CS level, while 74% indicated having a medium to high level of BO, and 69% reported a medium to high level of STS. Neither age nor gender had a significant difference in CS (p = 0.504; p = 0.405), BO (p = 0.161; p = 0.285), or STS (p = 0.145; p = 0.252). Those working for more than 10 years at their current employer had higher CS (M = 38.7) and lower BO (M = 24.9) and STS (M = 24.8) scores. The number of hours worked, specifically overtime, had a significant impact on BO (β = 0.09, p = 0.028) and STS (β = 0.0.11, p = 0.019), but not CS (β = 0.02, p = 0.655). These findings suggest that the number of years employed in the field impacts the level of compassion satisfaction and contributes to lower levels of burnout and secondary traumatic stress. The age of a patient may also affect levels of compassion and burnout. The results of this study highlight the importance of developing incentive plans in an effort to retain employees. Full article

Introduction: Asthma and bronchiectasis are often partners in a complex but uneven relationship with asthma receiving more attention. The aim of this study is to describe how bronchiectasis is investigated in some Severe Asthma (SA) Centers, scattered throughout the Italian territory. Materials and Methods: We enrolled 92 patients with SA and bronchiectasis from eight Italian SA Centers and recorded diagnostic approaches to investigate SA and bronchiectasis at the time of enrollment (T0), at the 6-month (T1), and at the 12-month (T2) follow-up visits. Results: A statistically significant heterogeneous diagnostic approach emerged across the centers under study. In fact, while, as expected, all involved centers made an in-depth investigation of SA, only a few of them provided a complete investigation of bronchiectasis in order to provide specific treatment. Discussion: This real-life multicenter study confirmed that patients with coexistent SA and bronchiectasis are mainly investigated for pheno-endotyping asthma but rarely for the complete assessment of bronchiectasis. We believe that the diagnostic flowchart of SA patients with suspicion or confirmed bronchiectasis needs to be clarified and implemented as the association of these conditions strongly influences the final outcome and management of these patients. Full article

Cigarette combustion has the potential to generate over 7000 chemicals, the majority of which are reactive free radicals that are known to trigger pro-inflammatory and carcinogenic responses. Numerous contemporary investigations have proposed that the pathophysiological and cellular mechanisms underlying the release of extracellular vesicles (EVs) in response to cigarette smoke (CS) may serve as potential pathways for CS-induced pathogenesis, while also reflecting the physiological state of the originating cells. This review provides a concise overview of the pathophysiological mechanisms linked to CS-induced EVs in various lung diseases, including chronic obstructive pulmonary disease, lung cancer, pulmonary fibrosis, and pulmonary hypertension. Additionally, it explores the potential and prospects of EVs as diagnostic biomarkers for CS-related lung diseases. Full article

The coronavirus (COVID-19) pandemic caused sicknesses ranging from mild to deadly, which disrupted lives and healthcare systems across the globe. Despite the availability of vaccines that are effective in significantly reducing the risks of death and severe disease, misperceptions of COVID-19 vaccine safety, efficacy, risks, and mistrust in institutions responsible for vaccination campaigns have been reported as factors contributing to vaccine hesitancy, leading to an unsatisfactory vaccination rate, which resulted in some countries implementing mandatory COVID-19 vaccination to increase vaccine uptake. This scoping review aimed at mapping global countries that have adopted mandatory COVID-19 vaccination and the reaction of citizens. PRISMA Extension for Scoping Reviews was used. Google Scholar was used to identify papers published in English from December 2019 to February 2022, irrespective of their methodology. A total of 140 studies were identified. After screening for duplication, access, and relevance, 24 were eligible for review. Approximately eleven countries implemented mandatory vaccination, mostly among healthcare workers. Citizens’ reactions towards the policy varied, with some in support of the policy but with a preference for the healthcare workers, and some in support but with the condition that it will only apply to travel, schools, and shopping areas, while others rejected the policy. Studies that may be relevant but were excluded due to eligibility criteria may be a limiting factor to this study. Several ethical considerations should be explicitly addressed when evaluating whether mandatory COVID-19 vaccination is an ethically justifiable policy option as recommended by the WHO policy brief. Full article

Background: TB is a significant public health problem around the world, with South Africa being one of the 30 high-burden TB countries, accounting for 87 percent of all estimated incident TB cases. In South Africa, which accounts for 3% of all instances worldwide, research on students’ experiences and understanding of underlying factors is lacking. These future leaders are still in a key time of physical and psychological development. This study aimed to test students’ understanding of pulmonary tuberculosis (PTB) and its causes at a rural institution of higher learning. Methodology: Quantitative method was used using a cross-sectional design. The study was conducted in the 2020 Vhembe District, Limpopo, South Africa. In the poll, 199 students living in overcrowded campus housing were interviewed. A self-administered questionnaire was used to collect data at the Thohoyandou campus. Data were analysed using version 26.0 of the Statistical Package for Social Sciences (SPSS), with a Spearman’s rank-order correlation run. Results: The findings of this study revealed that 25.6 percent of male students and 74.4 percent of female students, respectively, understood PTB, while students at the selected tertiary institution have insufficient awareness of the causes of PTB. The association between education and TB knowledge among the respondents was determined using Spearman’s rank-order correlation. There was a statistically significant positive association between education and TB knowledge (Spearman’s rho = 0.669, p = 0.035). Conclusions: The study found that students at a higher education institution lacked sufficient general Knowledge regarding PTB. PTB control measures should be adopted to implement better the NSP, NDP, Global STOP TB strategy and the SDGs. Full article

Background: Pulmonary rehabilitation (PR) allows for the treatment of patients with chronic obstructive pulmonary disease (COPD) as an intervention strategy that improves functional capacity, dyspnea, and health-related quality of life. However, adherence to such programs might be improved. This study aimed to describe the differences in sociodemographic and clinical variables, functional capacity, and health-related quality of life in patients diagnosed with COPD adherent and non-adherent to pulmonary rehabilitation at a clinic in Cali, Colombia. Methods: This study followed a descriptive cross-sectional model with 150 patients diagnosed with COPD. Adherence was classified by taking into account the number of sessions completed: low (<35%), moderate (35–85%), and high (>85%). Sociodemographic, clinical, functional capacity, and health-related quality of life variables were considered. Results: Adherence to the PR was rated as high in 57.3% of patients. Variables such as sex, health system affiliation, height, functional capacity, resting SaO₂, and health-related quality of life presented significant differences (p-value ≤ 0.05). The main causes of non-adherence to the program were medical recommendations that prevented continuing in the program due to clinical and safety issues and economic issues that prevented reaching the rehabilitation site, as it was unaffordable. Conclusions: It can be concluded that adherence to pulmonary rehabilitation was rated as high in 57.3% of patients. The high adherence to the PR program occurred in male patients with a capacity to pay the Colombian health system (contributory regime). Full article

Objective: This research aimed to determine the smoking frequency and smoking-related gestational and postpartum health problems in our study population. We investigated the quit rate during pregnancy and relapse after giving birth. The study was conducted in two university family health centers. A total of 270 women aged 18–45 with children were included in the study. Following receipt of verbal consent, the cases’ demographic data, previous obstetric information, smoking status, and gestational weight gain (GWG) were collected through face-to-face interviews and electronic records. The participants’ mean age was 35.75 ± 6.9 years and 28.1% were current smokers. Forty-one participants (16%) smoked during pregnancy, while the secondhand smoking rate was 30%. Ex-smokers experienced greater GWG (17.5 ± 1.7 kg (p = 0.003)) than current smokers and non-smokers. Small gestational age (SGA) and health problems in the first year of life were more frequent in the babies of smoker mothers (p < 0.05). The relapse rate was 81.4%, and the mean relapse interval was 13.9 ± 1.85 months. Having a smoker spouse (0.42 Exp(B), p = 0.035) and high GWG (0.98 Exp(B), p = 0.01) were identified as independent risk factors for relapse. Our results indicate that many of the smoker women quit during pregnancy. Special interventions may increase the quitting rate in pregnancy and reduce the subsequent relapse rate. Full article

Tuberculosis-related lung damage is very different. Lung ventilation disorders have been studied in patients with pulmonary tuberculosis (TB) during the active process and after treatment, but the main causes of gas exchange changes have not been sufficiently studied. Investigation of diffusing lung capacity in combination with bodyplethysmography is useful for the interpretation of pulmonary gas exchange disorders. The aim was to determine the relationship of gas exchange with the value of alveolar volume (VA) and pulmonary poorly communicating fraction (PCF) in patients with pulmonary TB. A total of 292 patients (117/175 M/W) with verified pulmonary TB with smoking age less than 10 packs-years underwent spirometry, bodyplethysmography, and D_LCO by the single-breath method. PCF was estimated calculating the difference between total lung capacity (TLC) and VA (% TLC). Patients with low D_LCO had statistically significantly lower spirometric values (FVC, FEV₁, FEV₁/FVC, MMEF), lower TLC, higher airway resistance, RV/TLC, air-trapping volume, and PCF. The patients with low level of D_LCO were divided into four groups depending on level VA and PCF. In most patients with infiltrative tuberculosis (50%), the leading syndrome of the D_LCO decrease was alveolar-capillary damage. In patients with tuberculomas, the syndromes of alveolar capillary damage and pulmonary ventilation inhomogeneity were with the same frequency (43%). In patients with disseminated tuberculosis, the most frequent syndrome of the D_LCO decrease was pulmonary ventilation inhomogeneity (33%), then alveolar-capillary damage (29%) and mixed (24%). In patients with cavernous tuberculosis, the leading syndrome of the D_LCO decrease was mixed (39%), then alveolar capillary damage (25%) and pulmonary ventilation inhomogeneity (23%). The syndrome of gas exchange surface reduction in patients with disseminated and cavernous tuberculosis was less common (14%). In conclusion, an additional evaluation of the combination of PCF and VA increases the amount of clinical information obtained using the diffusion lung capacity measurements, since it allows identifying various syndromes of gas exchange impairment. The leading causes of diffusing capacity impairment vary by different types of pulmonary TB. Full article

Before the widespread use of antibiotics, purulent pericarditis was not uncommon and was predominantly a complication of bacterial pneumonia. We present a rare case of Escherichia coli (E. coli) purulent pericarditis without a clear source after a recent COVID-19 infection. Background: COVID-19 has been affecting millions of people worldwide since the outbreak in December 2019, and its involvement in multiple organ systems has been observed and studied. Multiple cardiac complications have been reported, most significantly the virus’ ability to induce acute coronary syndrome and myocarditis. Pericardial disease has also been reported but less frequently. COVID-19 infection is associated with a higher risk of secondary bacterial infection, but it is rare to see purulent pericarditis in the setting of a recent COVID-19 infection. Objective: Our case report depicts a patient who developed E. coli purulent pericarditis in the setting of a recent COVID-19 infection. It indicates a possible association between COVID-19 infection with dysregulation of the immune system. Full article