Multidisciplinary Respiratory Medicine最新文献

Introduction: Infective thoracic aortic aneurysms are uncommon, especially presenting with haemoptysis.

Case presentation: We report the case of an 81-year-old male who presented with fever and pleuritic chest pain and was initially misdiagnosed with community-acquired pneumonia. A CT scan later  revealed a saccular, ruptured thoracic aortic aneurysm. Despite antibiotic therapy, the patient developed haemoptysis, necessitating thoracic endovascular aortic repair (TEVAR). Post-procedure, the patient showed significant clinical improvement and was discharged in stable condition 45 days later.

Conclusions: Infected thoracic aortic aneurysms presenting as haemoptysis are exceptionally rare but life-threatening. Early clinical suspicion (manifested by haemoptysis, fever and thoracic pain) is essential, particularly in patients with risk factors such as immunosuppression or previous infections. This case emphasizes the importance of prompt diagnosis and intervention, along with the use of appropriate imaging techniques to reduce morbidity and mortality associated with this rare yet severe condition.

Pidotimod is a synthetic dipeptide that exerts immunomodulatory activity, modifying innate and adaptive immunity. Pidotimod firstly acts on Toll-like receptors, then on antigen-presenting cells and other immunocompetent cells. Pidotimod also affects immunoglobulin production and their switching. Evidence shows that pidotimod effectively and safely prevents respiratory infections, mainly in children with recurrent and frequent infectious episodes. In addition, pidotimod may be helpful as an add-on strategy in managing children with infections. Finally, there is evidence that pidotimod, thanks to its immunomodulatory activity and preventing respiratory infections (the main trigger for asthma exacerbation), may be beneficial in managing subjects with asthma and allergic diseases. The present review presents and discusses the most recent studies conducted in children with asthma, allergic rhinitis, recurrent respiratory infections and acute infections. Lastly, pidotimod is safe and well-tolerated in children.

Background: Inhaled drug therapy is an essential treatment in Chronic Obstructive Pulmonary Disease (COPD) patients as it reduces symptoms, exacerbation rate and mortality risk. Errors in inhaler use can affect drug delivery to the lungs and minimize treatment benefits. The aim of the study was to evaluate the effect of a nurse-lead educational intervention on inhaler use in a group of patients with COPD during a Respiratory Rehabilitation Program.

Methods: COPD patients attending a Respiratory Rehabilitation Unit for a pulmonary rehabilitation program participated in the educational training program. The nurse-lead educational intervention included a specific checklist used to evaluate each patient's inhalation technique. Errors were scored and classified as device- dependent, device-independent and critical one. Patients completed a pre and post-intervention survey to compare pre and post nurse-lead educational intervention results.

Results: One-hundred twenty-three COPD patients attending a Respiratory Rehabilitation Unit participated in the training program. A high frequency of total errors has been found at baseline (72.1%) whose critical errors represented 35%, irrespective of the severity of airway obstruction, the length of disease history and the educational level. The structured educational intervention resulted in changes on patients' attitudes and skills on inhaler use with a significant reduction in the frequency of all types of errors (P-value < 0.01), particularly total and critical errors (35% and 12.9%, respectively), but not completely eliminated them.

Conclusions: Patient training in the use of the inhaler and regular review of the patient's competence in using the devices by health care professionals remains a crucial aspect of effective inhalation therapy regardless of the disease trajectory. These interventions are feasible and may impact the ability to engage patients in the chronic care journey.

Introduction: Chronic pulmonary aspergillosis (CPA) often develops in residual lesions of pulmonary tuberculosis (PTB). Every year, 112,000 to 160,000 people worldwide will develop post-PTB CPA. The simultaneous occurrence of CPA with the first episode of PTB is rare. During the COVID-19 pandemic, COVID-19- associated invasive aspergillosis (CAPA) occurred in patients receiving high doses of corticosteroids and  mechanical ventilation. However, CPA and COVID-19 are rarely reported simultaneously. This case study presents a patient with CPA in the first episode of PTB during hospitalization for COVID-19. The favorable evolution is highlighted, including the resolution of the cavitation and fungal ball with appropriate and early treatment.

Case presentation: A 48-year-old female patient from the Central West of Brazil was admitted with a history of cough, yellow sputum, fever, and significant weight loss for two months. The respiratory symptoms worsened one week before admission. She tested positive for COVID-19 by RT-PCR. She had a history of hypertension and diabetes. Clinical examination revealed tachypnea, slurred speech, and hypoxia. She presented with hyperglycemia, obesity, hypertension, and an episode of hemoptysis. Chest CT revealed cavitation in the right upper lobe with a 45 mm aspergilloma, multifocal morning opacities, and nodular opacities. Laboratory tests confirmed the PTB with positive sputum for acid-fast bacilli and positive culture for Mycobacterium tuberculosis. The sputum culture also showed Aspergillus spp. She received early treatment for bacterial pneumonia with ceftriaxone, dexamethasone, enoxaparin, an anti-TB regimen, and itraconazole. There was a progressive clinical improvement and the patient was discharged after 15 days. She completed six months of anti-TB therapy and 13 months of itraconazole treatment for CPA, with complete resolution of the cavitation and aspergilloma.

Discussion and conclusion: This case study presents a unique case of CPA that manifested as simple aspergilloma and was diagnosed concurrently with the initial episode of PTB in a COVID-19 patient with obesity, hypertension, and diabetes. Remarkably, the fungal ball and cavitation regressed spontaneously. The favorable clinical and radiological results highlight the importance of comprehensive treatment approaches for concurrent respiratory infections and emphasize the need to investigate CPA and PTB during COVID-19 hospitalization.

Topical nasal therapy represents a widespread opportunity to treat upper airway diseases. As a result, specialists in different areas (mainly ENT, pediatrics, and allergology) and general practitioners prescribe intranasal compounds. However, a myriad of products and devices are available, as well as respiratory disorders. Consequently, this matter is debatable, and no guideline organically addresses this issue. Considering these premises, a restricted panel of qualified experts promoted an initial multidisciplinary survey involving only Fellows of some Scientific Societies belonging to ENT, pediatrics, and allergology areas. The survey included a series of queries concerning practical aspects of topical nasal therapy (treated disease, devices, and agents). A web platform served to participate in this survey. Each participant anonymously completed the questionnaire. Four hundred and forty-five doctors participated in the survey. There was a homogeneous distribution in Italy. Most participants were pediatricians (37%), followed by allergologists (31%) and ENT specialists (24%). Almost all doctors (95%) used topical nasal therapy. The most common diseases topically treated were allergic rhinitis (79%), chronic rhinosinusitis (73%), and non-allergic rhinitis. The most popular devices were pre-dosed spray both for nasal irrigation (67%) and nebulization (66%). Corticosteroids (67%), isotonic saline (63%), hyaluronic acid, hypertonic saline, and antihistamines (39%) were the most common agents used for intranasal therapy. Combined antihistamine/corticosteroids were also commonly used (38%). The most frequent schedule was the cyclic treatment. Most doctors (89%) claim they adequately spend time educating patients on this matter. In conclusion, topical nasal therapy is commonly used to manage upper respiratory diseases. However, the disagreement about some issues requires greater knowledge of the topics and the need to develop new studies, including pragmatic ones.

Background: Indoor air pollution, including airborne microorganisms, can cause allergies, respiratory diseases, and immune-toxic diseases. Sneezing generates millions of airborne microbial infections, and ventilation sources alter microbial communities. Few studies exist in developing countries, including Ethiopia, and Harar Town. The aim is to assess microbial indoor air quality and associated factors among private clinics, Harar town, Eastern Ethiopia.

Methodology: A cross-sectional study was conducted on 260 private clinic rooms in Harar town, using a systematic random sampling method and passive air sampling. Data was collected using the settle plate method and an observation checklist. Bivariate and multivariate analysis was performed using binary logistic regression, with a P-value of <0.05 considered statistically significant.

Result: The minimum and maximum bacterial loads were 3933 CFU/m3 and 92 CFU/m3 respectively. Based on the pollution degree of the European Commission, the Mean bacterial load (904 CFU/m3) was at higher bacterial load. The highest, lowest, and mean fungal loads were 1967 CFU/m3, 9 CFU/m3 and 401 CFU/m3 respectively. Temperature of <25 °C (AOR = 1.58, p = 0.04, and 95% CI = 1.05, 1.91), >28 °C (AOR = 1.23, P = 0.03, and 95% CI = 1.51, 2.02) were significantly associated with bacterial indoor air quality. Relative humidity of treatment rooms (AOR = 1.87, p = 0.02, and 95% CI = 1.21, 3.09) had an association with bacterial loads. The clinic treatment rooms with a recorded temperature <25 °C (AOR = 6.32, p = 0.01, and 95% CI = 6.10, 8.25) had associated with fungal loads. But the rooms having a temperature of >28 °C (AOR = 0.41, p = 0.04, and 95% CI = 0.31, 0.78) were 59% less likely to comply with the fungal standards compared to rooms having a temperature of 25-28 °C. The clinic rooms with a relative humidity of <30% (AOR = 7.75, p = 0.02, 95% CI = 7.21, 8.39) were 7.75 times more likely to comply with those with a relative humidity of > 60% in the treatment rooms.

Conclusion: Private clinics in Harar had a moderate fungal load and a higher indoor air bacterial concentration when compared to different indoor air standards. Temperature, humidity, inadequate ventilation and the presence of unsanitary attached toilets are some variables associated with microbial loads.

There are many challenges that are faced in the treatment of Non-Small Cell Lung Cancer (NSCLC) due to the complexities associated with the tumor. Association of different types of mutations are one of the major complexities. Among these mutations, BRAF mutations are significantly gathering more attention due to their impact on disease progression and therapeutic response. This review provides an analysis of the current understanding of BRAF mutations in NSCLC, focusing on the molecular intricacies, clinical implications, and therapeutic advancements. The article explores the diverse spectrum of BRAF mutations, highlighting the prevalence of specific mutations such as V600E and non-V600E alterations. The review also highlights the intricate signalling pathways influenced by BRAF mutations, shedding light on their role in tumorigenesis and metastasis. Therapeutically, we critically evaluate the existing targeted therapies tailored for BRAF-mutant NSCLC, addressing their efficacy, limitations, and emerging resistance mechanisms. Furthermore, we outline ongoing clinical trials and promising investigational agents that hold potential for reshaping the treatment of NSCLC. This review provides comprehensive current information about the role of BRAF mutations in NSCLC. Understanding the molecular diversity, clinical implications, and therapeutic strategies associated with BRAF-mutant NSCLC is crucial for optimizing patient outcomes and steering the direction of future research in this evolving field.

Background: Chronic obstructive pulmonary disease (COPD) interferes with everyday functioning but its impact on the loneliness and the meaning in life of the patients is unclear.

Objectives: to determine whether the COPD severity levels correlate with the sense of loneliness and dimensions of the sense of meaning in life.

Methods: 144 patients with COPD during a period of absence of an infectious exacerbation were examined. The number of infectious exacerbations over the past year, the Modified Medical Research Council (mMRC) dyspnea score, the COPD Assessment Test (CAT) score were determined as well as the feelings of loneliness using the De Jong Gierveld Loneliness Scale (DJGLS) and the sense of meaning in life using the Life Attitude Profile-Revised (LAP-R) questionnaire.

Results: The age, the mMRC and CAT scores, the number of pack/years, as well as the number of infectious exacerbations during the year correlated positively with the feeling of loneliness. These variables (except for age) correlated negatively with the LAP-R scales apart from Existential Vacuum, which correlated positively. The subjects from the COPD severity group D (the most seriously ill people) had the highest level of loneliness, while it was the lowest in the subjects from group A (the least ill people). No statistical difference was observed between groups B and C.

Conclusions: With the increase in the values of the selected parameters determining the severity of COPD the sense of meaning in life decreases and loneliness intensifies.

Background: Bacterial indoor air load refers to the level of bacteria within and around dwellings and other structures. Pathogens, bacterial cell fragments, and bacterial organisms' byproducts can all pose major issues indoors, especially in prison inmate cells. However, there is lack of data on bacterial load and contributing factors in the East Hararghe zone and Harari regional state. The lack of studies on microbiological indoor air quality in prisons with contributing factors will therefore be filled by this investigation.

Objectives: The study aimed to assess bacterial indoor air load and contributing factors in prison inmate cells from October 1 to October 30, 2020.

Methodology: An institutional cross-sectional study was employed. All of the prisons in the East Hararghe zone and the Harari regional state served as the study's and source population. 62 prison cells were used in the investigation. Samples were obtained using the passively settling plate technique. The data were evaluated through the use of SPSS statistical software, Excel, and the statistical procedures of ANOVA, correlation, and chi-square test.

Results: The maximum and minimum bacterial loads, were recorded at 8:00 am (3027 CFU/m3) and 2:00 pm (1048 (CFU/m3) respectively. The correlation between the temperature and bacterial load was strongly positive (r = 0.680, p = 0.047), and the correlation of the moisture content and bacterial load was strongly negative  (r = -0.671, p = 0.039).

Conclusion: The levels of bacteria were higher than the guideline (2000 CFU/m3). While the relative humidity of indoor air was negatively correlated with bacterial load, temperature and bacterial load were significantly positively correlated. Harari regional state and East Hararghe zone prison commissions should be alarmed to alleviate these problems. The building standards need to be completely updated to the latest standards.

Introduction: Gorham-Stout disease is a rare condition characterized by extensive bone loss due to the proliferation of new vascular and lymphatic structures. It can occur in any bone and cause pathologic fractures with poor bone healing. Complications such as effusions and lymphangiomas can also develop. Gorham-Stout disease pathogenesis is still being studied, and treatment options are limited, but sirolimus has shown promise in stabilizing or reducing symptoms.

Case presentation: We present a case of a 19-year-old male with Gorham-Stout disease, multiple cervical lymphangiomas, and several thoracic complications successfully treated with sirolimus.

Conclusions: Rare lymphatic diseases should be considered as a potential cause in adult patients with bone involvement and multiple cystic lesions in the neck, axillary, or abdominal regions after excluding more common causes. The complexity of diagnosing Gorham-Stout disease should be emphasized.