Multidisciplinary Respiratory Medicine最新文献

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.

Background: Smoking is well known for its harmful effect on the respiratory system, but whether vaping is less harmful is unknown. Therefore, the aim of this study was to assess the association of smoking/vaping habits with self-reported respiratory symptoms in vapers and cigarette smokers.

Methods: An online survey was developed and shared on different vaping and smoking social media platforms and communities.

Results: Out of the 891 respondents, 788 were vapers (77 pure vapers and 711 ex-smokers) and 103 were cigarette smokers. Smokers reported more frequently respiratory symptoms such as chest pain, wheezing and whistling, sputum production, cough, dry mouth, and smokers suffered from more shortness of breath, sore throat and disturbed sleep compared to vapers. The self-reported respiratory symptoms in vapers were mainly related to the nicotine strength of the product and number of puffs per use. There were no significant differences between pure vapers and vapers who were ex-smokers.

Conclusion: Self-reported severe respiratory symptoms were less frequent in vapers than smokers, irrespective of their smoking history. This suggests that vaping is less harmful than cigarette smoking.

Aims: to measure the clinical impact of contrast-enhanced ultrasound (CEUS) in the diagnosis of -community-acquired pneumonia (CAP), compared to clinical, radiological and ultrasound diagnosis.

Methods: 84 patients (47/37 males/females, mean age:78,57±11,7 Y) with clinical suspicion of pneumonia and with ultrasound findings of peripheral lung lesions, were investigated with CEUS for a better characterization. Final diagnosis of 65 cap was obtained with complete disappearance of symptoms and pulmonary nodule(s); 19 neoplasms: 16 patients performed histologically with bronchoscopy; 3 refused (non-invasive diagnosis with basal CT-scan and positron emission tomography (PET) with fluorodeoxyglucose (FDG)). Sensitivity, specificity, overall diagnostic accuracy (ODA) (and corresponding AUROC) of clinical-data (CD), chest X-ray(CXR), Lung-ultrasound(LUS), CEUS were calculated with SPSS 26.0 software.

Results: Final diagnosis: 65 CAP, and 19 chest cancers. 9/65 (13%) patients died, of these 7/9 with older age and heart disease as comorbidity. CD: True-Positive (TP):23, True-negative (TN): 17; False-Positive (FP):2; False-negative (FN):42 (sens:35,4% spec:89,5% ODA10%: PPV:92%, NPV:28,8%) (AUROC±SEauc:0,46±0,076); CXR: TP: 36, TN:14; FP:5, FN:29; (sens: 55,4%; spec: 73,7%; ODA: 32%; PPV:87,5%, NPV:32,66%) (AUROC±SEauc:0,645±0,068). US: TP:59; TN: 14; FP:5, FN:6 (sens: 90,8%, spec: 73,7%, ODA: 84,9%, PPV:92,2%, NPV:70%) (AUROC±SEauc:0,9417±0,024); CEUS: TP: 63; TN: 19; FP:0; FN:2 (sens: 96,9%; spec: 100% ODA: 97,5%; PPV: 100%, NPV:90,5%) (AUROC±SEauc:0,98±0,01).

Conclusions: Clinical-data and chest X-RAYS are insufficient to obtain a correct diagnosis of CAP in elderly population; US demonstrated a good accuracy to establish CAP, but with a relatively low specificity; in these cases, CEUS is able to give a correct characterization, allowing you to save the need for a chest contrast-enhanced-CT (CECT).

Background: The management of chronic obstructive pulmonary disease (COPD) lacks standardization due to the diverse clinical presentation, comorbidities, and limited acceptance of recommended approaches by physicians. To address this, a multicenter study was conducted among Italian respiratory physicians to assess consensus on COPD management and pharmacological treatment.

Methods: The study employed the Delphi process using the Estimate-Talk-Estimate method, involving a scientific board and expert panel. During a 6-month period, the scientific board conducted the first Delphi round and identified 11 broad areas of COPD management to be evaluated while the second Delphi round translated all 11 items into statements. The statements were subsequently presented to the expert panel for independent rating on a nine-point scale. Consensus was considered achieved if the median score was 7 or higher. Consistently high levels of consensus were observed in the first rating, allowing the scientific board to finalize the statements without requiring further rounds.

Results: Topics generating substantial discussion included the pre-COPD phase, patient-reported outcomes, direct escalation from a single bronchodilator to triple therapy, and the role of adverse events, particularly pneumonia, in guiding triple therapy prescriptions. Notably, these topics exhibited higher standard deviations, indicating greater variation in expert opinions.

Conclusions: The study emphasized the significance that Italian pulmonologists attribute to managing mortality, tailoring treatments, and addressing cardiovascular comorbidities in COPD patients. While unanimous consensus was not achieved for all statements, the results provide valuable insights to inform clinical decision-making among physicians and contribute to a better understanding of COPD management practices in Italy.

Background: Asthma is the most common chronic non-communicable disease in children and one of the most common in adults, and the majority of asthma-related deaths are attributed to middle- and low-income countries. Physicians' knowledge and practice have been recognized as fundamental elements in the approach to the asthmatic patient with an impact on the treatment and control of the disease. This study aimed to assess the knowledge and practice of Angolan physicians in the management of asthma, as well as to identify the main gaps.

Methods: It was a cross-sectional study carried out in Angola. The data were collected through an online questionnaire to assess the knowledge about asthma among the physicians and the Physicians Practice Assessment Questionnaire. Categorical variables were described with frequencies and percentages. All associations between good practice and possible predictors were established with logistic regression analysis. P<0.05 was considered statistically significant.

Results: A total of 204 physicians throughout Angola participated; the majority of whom were female, aged -between 31 and 40, and from the Luanda province. The average percentage of correct answers for all domains was 65.8% (±SD11.1%). The lowest percentages were in the answers about the diagnosis, drugs, and the signs of an asthma attack. Out of the 204 participants, 81.9% of physicians confirmed seeing patients with asthma. The average percentage of them who reported practicing asthma management based on recommended guidelines was 59.8% (±SD27.8%). More than half of the physicians did not achieve that percentage. The lowest percentages of correct answers concerned assessment of the inhaler technique, provision of a written referral for asthma education, and use of the GINA guidelines to assess the patient's asthma control. Concerning the predictors of best practices, our results showed that being a physician of older age and with more work experience, as well as having the category of specialist were significant predictors of adherence to recommended practices for asthma management.

Conclusions: The physicians' level of knowledge about asthma was moderate, but there are important practical gaps in asthma management regarding standard guidelines.

                                                                 Abstract Background: Few studies have addressed the effects of biological therapies on laboratory outcomes and changes in FEV1 in patients with severe asthma (SA) and chronic rhinosinusitis (CRS). We aimed to study the effect of three biological therapies on laboratory outcomes and FEV1 in Saudi Arabian patients with SA and CRS.

Methods: From March to September 2022, a retrospective observational cohort study was undertaken at the severe asthma clinics of the Armed Forces Hospital-Southern Region (AFHSR) and King Khalid University Hospital, Abha, Saudi Arabia, to delineate the effects of 3 biological therapies (benralizumab, dupilumab, and omalizumab) in adults with SA and concomitant CRS in terms of FEV1 and laboratory parameters (serum IgE and eosinophilic counts).

Results: Eighty patients were enrolled, with a mean age of 46.68. There were 45 (56%) females and 35 (44%) males. There were significant improvements in FEV1 and laboratory parameters (serum IgE and eosinophilic counts) after 6 &12 months of biological therapies compared to pre-biological therapies (p<0.001, each). The response was different among different biological therapies. The improvements in FEV1, serum IgE, and eosinophilic counts were manifest with benralizumab and dupilumab but not with omalizumab.

Conclusions: Results from the first study from two large Saudi Arabian tertiary centers for patients with severe asthma and chronic rhinosinusitis agree with and support those of worldwide real-life ones. One-year follow-up of patients with SA and CRS showed the effectiveness of benralizumab and dupilumab, but not omalizumab, regarding FEV1, serum IgE, and eosinophilic counts. Further prospective multicenter studies are warranted.