Open Respiratory Medicine Journal最新文献

Traditional testing methods in the Middle East Region, including the United Arab Emirates (UAE), particularly the testing of Respiratory Syncytial Virus (RSV), influenza, group A streptococcus (GAS), and COVID-19 have the potential to be upgraded to new and advanced diagnostics methods that improve lead time to diagnosis, consumption of healthcare resources and patient experience. In addition, based on the research, it was reported that there is an underreporting of respiratory cases, overuse of antibiotics, and prolonged hospitalizations which is posing pressure on UAE healthcare stakeholders. A literature review was done exploring UAE's current diagnostic practices, recommended guidelines, diagnostic gaps, and challenges in RSV, GAS, Influenza, and COVID-19. This was followed by stakeholder discussions focusing on assessing current diagnostic practices, usage of rapid molecular point-of-care (POC) diagnostic tests, current gaps in diagnosis, targeted profiles for POC testing, and potential impact on patient management for targeted respiratory infections. A round table discussion with healthcare experts, insurance experts, key opinion leaders, and pulmonologists discussed challenges and opportunities in treating respiratory diseases. UAE healthcare stakeholders suggest that introducing alternative and up-to-date diagnostic methods such as POC molecular testing is expected to improve healthcare outcomes, optimize resources, and develop a robust case management of respiratory tract infections. It is essential to emphasize that by introducing POC testing, precision medicine is reinforced, efficiency is achieved, and the overall management of population health is enhanced.

Background: Extremely preterm infants (EPIs) often require advanced respiratory support to survive, and one such intervention is the heated, humidified, high-flow nasal cannula (HHHFNC). While the use of this cannula in EPIs has been studied, the relationship between its use and the length of hospital stay is an important yet unexplored research area that we aim to investigate in this study.

Methods: In a quantitative retrospective cohort study, data were extracted from an electronic database. The study included all EPIs younger than 28 weeks of gestational age admitted to the neonatal intensive care unit of a tertiary hospital from January 1, 2020, to December 31, 2022. The descriptive analysis was conducted to describe each infant's demographic, maternal, and neonatal characteristics. A chi-squared test was also conducted, and a p-value of < 0.05 was considered statistically significant.

Results: The findings suggest that infants who receive an HHHFNC have a longer hospital stay than those who do not. Specifically, infants who did not receive a cannula spent 42.5 days on average in the hospital, compared with 99 days among those who received it, with a significant p-value (p=0.0001).

Conclusion: Infants receiving a cannula stay in hospital on average for twice as long as those who do not. However, to reduce the possibility of bias and produce more reliable results, we advise conducting clinical trials or prospective studies in future research.

Background: The role of the ratio between the arterial partial pressure of oxygen and the inspired fraction of oxygen (PaO₂/FiO₂ ratio) during the change in position is not fully established.

Methods: This retrospective, single-center cohort study included 98 patients with severe COVID-19 pneumonia.

Objective: This study aimed to evaluate the predictive value of the PaO₂/FiO₂ ratio for survival in patients with severe COVID-19 pneumonia between changing from supine to prone positions and vice versa. The PaO₂/FiO₂ ratio was measured preproning (T0), 30 min to 1 hour (T1), and 48 h after prone positioning (T2), and 30 min to 1 h after re-supination (T3).

Results: The PaO₂/FiO₂ ratio at T2 and T3 was higher in the survivors than in the non-survivors (T2= 251.5 vs. 208.5, p= 0.032; T3= 182 vs. 108.5, p<0.001). The PaO₂/FiO₂ ratio at T3 was an independent protective factor (Hazard Ratio (HR)= 0.993; 95% Confidence Interval (CI)= 0.989-0.998; p= 0.006) for survival. A threshold of ≤129 for the PaO₂/FiO₂ ratio at T3 predicted non-survival with a sensitivity and specificity of 67.86 and 80.95, respectively (Area Under the Curve (AUC)= 0.782; 95% CI 0.687-0.859).

Conclusion: The PaO₂/FiO₂ ratio is a significant protective factor of survival in severe COVID-19 pneumonia within 30 min-1 hour after returning to the supine position (re-supination).

Chronic Obstructive Pulmonary Disease (COPD) is associated with cough, sputum production, and a reduction in lung function, quality of life, and life expectancy. Currently, bronchodilator combinations (β2-agonists and muscarinic receptor antagonists, dual therapy) and bronchodilators combined with inhaled corticosteroids (ICS), triple therapy, are the mainstays for the management of COPD. However, the use of ICS in triple therapy has been shown to increase the risk of pneumonia in some patients. These findings have laid the foundation for developing new therapies that possess both anti-inflammatory and/or bronchodilation properties. Phosphodiesterase-4 (PDE4) inhibitors have been reported as an effective therapeutic strategy for inflammatory conditions, such as asthma and COPD, but their use is limited because of class-related side effects. Efforts have been made to mitigate these side effects by targeting the PDE4B subtype of PDE4, which plays a pivotal role in the anti-inflammatory effects. Unfortunately, no selective oral PDE4B inhibitors have progressed to clinical trials. This has led to the development of inhaled PDE4 inhibitors to minimize systemic exposure and maximize the therapeutic effect. Another approach, the bronchodilation property of PDE3 inhibitors, is combined with anti-inflammatory PDE4 inhibitors to develop dual inhaled PDE4/PDE3 inhibitors. A few of these dual inhibitors have shown positive effects and are in phase 3 studies. The current review provides an overview of various PDE4 inhibitors in the treatment of COPD. The possibility of studying different selective PDE4 inhibitors and dual PDE3/4 inhibitors in combination with currently available treatments as a way forward to increase their therapeutic effectiveness is also emphasized.

Background: The obesity paradox suggests that obese patients with Chronic Obstructive Pulmonary Disease Exacerbation (COPDE) may have better outcomes. COPD patients are at a higher risk of becoming malnourished, which has been linked to poor outcomes.

Objective: This paper aims to study the impact of malnutrition in patients with and without obesity hospitalized with COPDE.

Methods: Our retrospective study analyzed data from the National Inpatient Sample dataset between 2017 and 2020 to observe patients who were hospitalized with COPDE. The patients were divided into two groups: with and without malnutrition. The outcomes included all-cause mortality, invasive mechanical ventilation, length of stay, and total charge. We adjusted for confounders using multivariate regression model analysis.

Results: The study involved 392,920 patients with COPDE, out of which 5720 (1.45%) were diagnosed with malnutrition. Most of the patients in both groups were female, white, and under Medicare coverage. The mean age was higher in patients with malnutrition (67.6 vs. 64 years). In both groups, the rates of admissions were lowest in 2020 compared to three years prior. The rates and adjusted odds ratios of all-cause mortality were higher in patients with malnutrition (3.59% vs. 0.61%, P <0.01; adjusted odds ratio (aOR) 2.36, P<0.01, CI 1.8-3.7). We observed comparable findings when using invasive mechanical ventilation (13.2% vs. 2.82%, P<0.01, aOR 4.9, P<0.01, 3.9-6). Malnourished patients had a lengthier hospital stay and a greater total charge.

Conclusion: Malnutrition was identified as an independent risk factor associated with worse outcomes in obese patients admitted with COPD exacerbation.

Background: Impulse oscillometry (IOs) is a technique used to evaluate lung function that uses sound waves imposed over tidal breathing to characterize the airways and lung parenchyma. IOs has been particularly useful in the identification of obstructive lung defects. The present analysis seeks to explore the use of IOs in the identification of restrictive lung physiology among a group of Gulf War I veterans exposed to depleted uranium (DU).

Methods: A total of 36 out of a dynamic 85-veteran cohort attended in-person surveillance visits in 2019 and completed both IOs and PFTs. Performance on IOs was evaluated in a cross-sectional analysis of the group overall and in those identified as having restrictive lung defects defined by either spirometry (FEV1/FVC ≥ LLN and FVC < LLN) or lung volumes (TLC < LLN).

Results: A total of 6 individuals were identified as having restriction (4 based on spirometry alone and an additional 2 by lung volumes). When restriction was present, IOs values of both resistance and reactance were significantly more abnormal.

Conclusion: In the assessment of lung function, IOs may be advantageous over PFTs because it is faster to perform and effort-independent. Although little is known about the utility of IOs in identifying restrictive lung physiology, our results support its use.

Background: Electronic health records (EHRs) are live, digital patient records that provide a thorough overview of a person's complete health data. Electronic health records (EHRs) provide better healthcare decisions and evidence-based patient treatment and track patients' clinical development. The EHR offers a new range of opportunities for analyzing and contrasting exam findings and other data, creating a proper information management mechanism to boost effectiveness, quick resolutions, and identifications.

Aim: The aim of this studywas to implement an interoperable EHR system to improve the quality of care through the decision support system for the identification of lung cancer in its early stages.

Objective: The main objective of the proposed system was to develop an Android application for maintaining an EHR system and decision support system using deep learning for the early detection of diseases. The second objective was to study the early stages of lung disease to predict/detect it using a decision support system.

Methods: To extract the EHR data of patients, an android application was developed. The android application helped in accumulating the data of each patient. The accumulated data were used to create a decision support system for the early prediction of lung cancer. To train, test, and validate the prediction of lung cancer, a few samples from the ready dataset and a few data from patients were collected. The valid data collection from patients included an age range of 40 to 70, and both male and female patients. In the process of experimentation, a total of 316 images were considered. The testing was done by considering the data set into 80:20 partitions. For the evaluation purpose, a manual classification was done for 3 different diseases, such as large cell carcinoma, adenocarcinoma, and squamous cell carcinoma diseases in lung cancer detection.

Results: The first model was tested for interoperability constraints of EHR with data collection and updations. When it comes to the disease detection system, lung cancer was predicted for large cell carcinoma, adenocarcinoma, and squamous cell carcinoma type by considering 80:20 training and testing ratios. Among the considered 336 images, the prediction of large cell carcinoma was less compared to adenocarcinoma and squamous cell carcinoma. The analysis also showed that large cell carcinoma occurred majorly in males due to smoking and was found as breast cancer in females.

Conclusion: As the challenges are increasing daily in healthcare industries, a secure, interoperable EHR could help patients and doctors access patient data efficiently and effectively using an Android application. Therefore, a decision support system using a deep learning model was attempted and successfully used for disease detection. Early disease detection for lung cancer was ev

Background: The location and type of a tumor influence the prognosis of lung cancer. Primary Central Lung Tumors (PCLTs) are correlated with poor prognoses and certain histologic types. This study aimed to present a comprehensive exploration of clinical and bronchoscopic assessments for diagnosing the histopathology types of PCLTs and identified the factors associated with certain histologic types.

Methods: This was an observational cross-sectional study of PCLTs, defined as tumors in direct contact with hilar structures or located within the inner two-thirds of the hemithorax. We gathered demographic and clinical data, as well as data on bronchoscopy assessment and histopathology type. Tumor stage, symptoms of superior vena cava syndrome, and enlargement of lymph nodes in the paratracheal and subcarinal regions were also documented.

Results: Of the 895 patients, 37.87% had primary lung tumors, with 17.76% classified as PCLTs. Notably, PCLT cases exhibited a higher proportion of stage III (28.9% vs. 18.3%; p = 0.03) and Squamous Cell Carcinoma (SCC) histopathology (37.1% vs. 17.2%; p = 0.00) compared with non-PCLT cases. Bronchoscopic findings in PCLTs revealed a predilection for central airway masses (25.2%) and compressive distal airway stenosis (25.2%). Subgroup analysis of 159 PCLT cases identified 37.10% as SCC. Multivariate analysis underscored that intraluminal masses predict central SCC (odds ratio 2.075, 95% confidence interval 1.07-3.99; p = 0.028).

Conclusion: The proportion of stage III, SCC histopathological type, and intraluminal lesions was higher in patients with PCLT than in non-PCLT cases. The presence of intraluminal lesions can predict the histopathological type of SCC in patients with PCLTs.

Pulmonary hypertension (PH) is an intricate medical issue resulting from increased pressure in the pulmonary artery (PA). The current gold standard for diagnosis involves an invasive procedure known as right heart catheterization. Nevertheless, cardiac magnetic resonance imaging (cMRI) offers a non-invasive and valuable alternative for evaluating the function, structure, and blood flow through the pulmonary artery (PA) in both the left ventricle (LV) and right ventricle (RV). Additionally, cMRI can be a good tool for predicting mortality by assessing various hemodynamic parameters. We perceive that cMRI may be an underutilized tool in the evaluation of PH. More discussions might be needed to highlight its utility in patients with PH. This article aims to discuss the potential role of cMRI in evaluating PH based on the review of recent literature.

Background: Sickle Cell Disease (SCD) is a hereditary condition characterized by aberrant red blood cell morphology, leading to persistent hemolytic anemia. The consequential impact of SCD on the pulmonary vasculature can result in pulmonary hypertension (PHT), a severe complication that detrimentally affects the well-being and survival of individuals with SCD. The prevalence and risk determinants of PHT in SCD patients exhibit variations across diverse geographical regions and populations. This study aims to ascertain the prevalence of PHT among Sudanese SCD patients and identify associated factors.

Methods: A cohort of thirty-one adult sickle cell disease (SCD) patients, as confirmed by hemoglobin electrophoresis, were recruited for participation in this cross-sectional study. Comprehensive data encompassing demographic, clinical, and laboratory parameters were collected. Doppler echocardiography was employed to quantify pulmonary arterial systolic pressure (PASP) and evaluate right ventricular size and function.

Results: Within our cohort, the prevalence of PHT was 29%. Active cigarette smoking demonstrated a significant association with PHT (P=0.042), while hydroxyurea therapy exhibited no noticeable impact on PHT (P=0.612).

Conclusion: Our investigation revealed a PHT prevalence of less than one-third in our SCD patient population, aligning with prior studies. Notably, independent of other factors, cigarette smoking emerged as a distinct risk factor for PHT in SCD patients. This highlights the potential utility of smoking cessation as an intervention to delay the onset of this condition. However, further research is imperative to elucidate the mechanisms through which smoking contributes to PHT development in individuals with SCD.