Monaldi Archives for Chest Disease最新文献

Postoperative pulmonary complications (PPCs), including atelectasis, pneumonia, and respiratory failure, are common after thoracic and upper abdominal surgery and are associated with increased morbidity, longer hospital stays, and higher costs. This systematic review and meta-analysis investigated whether positive expiratory pressure (PEP) devices reduce PPCs after thoracic or upper abdominal surgery compared with continuous positive airway pressure (CPAP), usual care/no intervention, or other non-CPAP respiratory treatments. We searched major databases and included randomized controlled trials. A total of 12 studies were included, and 7 contributed to the meta-analysis. Across comparator-stratified analyses, PEP did not demonstrate a consistent reduction in PPCs. Compared with usual care/no intervention, pooled estimates showed no significant benefit, and results were similarly inconclusive when PEP was compared with other non-CPAP treatments; evidence versus CPAP was limited to a single small trial. The overall certainty of evidence was low due to methodological limitations and heterogeneity in outcome definitions and intervention protocols. Overall, current evidence does not support routine use of PEP devices as a primary strategy to prevent PPCs after thoracic or upper abdominal surgery. Further well-designed trials are needed to clarify whether specific patient subgroups or standardized protocols may benefit.

Anti-tuberculosis drug-induced hepatotoxicity is a major challenge in tuberculosis (TB) management, particularly in high-burden countries like India. Early liver function test (LFT) derangements during daily fixed-dose combination (FDC) therapy may reflect subclinical hepatocellular stress and guide timely intervention; however, evidence from Indian programmatic settings remains limited. To determine the prevalence, severity, demographic associations, biochemical trends, and clinical outcomes of early (two-week) LFT abnormalities in adult TB patients initiating daily FDC therapy under the National Tuberculosis Elimination Programme (NTEP). A prospective observational study was conducted among adults with newly diagnosed TB at a tertiary center in Kerala (January-June 2025). Baseline and two-week LFTs were compared using paired t-tests. Associations with demographic and clinical variables were assessed using Chi-square tests. LFT derangement was defined as per the WHO/NTEP criteria. Among 146 participants, 41 (28.1%) developed LFT derangements at two weeks (95% CI: 20.9-36.4%). No significant associations were observed with age (χ²=0.05, p=0.977), sex (χ²=0.11, p=0.898), TB type (χ²=0.00, p=1.000), or weight band (p>0.05). Mean alanine aminotransferase (ALT) increased from 26.6 to 58.1 IU/L (mean difference +31.5 IU/L; 95% CI: 25.8-37.2; p<0.001), and aspartate aminotransferase (AST) from 29.5 to 55.1 IU/L (+25.6 IU/L; 95% CI: 20.1-31.0; p<0.001). Total bilirubin rose from 0.63 to 0.83 mg/dL (+0.20 mg/dL; 95% CI: 0.09-0.31; p<0.01). Severity grading showed 65.9% Grade 1, 22.0% Grade 2, and 12.1% Grade 3 abnormalities; no Grade 4 hepatotoxicity occurred. Clinically, 29/41 (70.7%) patients continued therapy with monitoring, 8 (19.5%) required temporary interruption, 3 (7.3%) were successfully rechallenged, and 1 (2.4%) required permanent regimen modification. No patient developed jaundice, hepatic failure, or required hospitalization. Early LFT derangements are common but predominantly mild and clinically manageable among adults initiating daily FDC ATT. Significant early rises in ALT and AST highlight the value of routine two-week monitoring. Structured early biochemical surveillance under NTEP may prevent severe outcomes and minimize treatment disruption.

Pleural effusion is among the most common forms of paucibacillary extrapulmonary tuberculosis. Diagnosis is often clinical or based on elevated pleural fluid adenosine deaminase (ADA) levels. However, diagnostic uncertainty arises when clinical suspicion remains high despite low ADA levels, especially in patients already on empirical anti-tubercular therapy, which reduces bacillary load. The aim of this study is to evaluate the diagnostic utility of the Cartridge-Based Nucleic Acid Amplification Test (CBNAAT) in pleural biopsy samples with histopathologically confirmed tuberculosis. In this prospective study, 260 patients with undiagnosed pleural effusion who underwent pleural biopsy via thoracoscopy or ultrasound guidance were included. Histopathological examination identified 90 patients with pleural tuberculosis (study group) and 170 with non-tubercular etiology (control group). CBNAAT results from pleural biopsy specimens were analyzed to determine diagnostic performance. This study found the sensitivity, specificity, positive predictive value, and negative predictive value of CBNAAT for detecting pleural tuberculosis were 23.3% (21/90), 98.2% (167/170), 87.5% (21/24), and 70.8% (167/236), respectively. Sensitivity was higher (40%) in patients with pleural fluid ADA >40 IU/L compared to those with ADA <40 IU/L (15%). Notably, 4 of 90 patients (4.4%) in the study group were found to have rifampicin-resistant tuberculosis-these patients were on first-line anti-TB treatment at the time of biopsy. The conclusion of this study was that CBNAAT demonstrates low sensitivity but high specificity for diagnosing pleural tuberculosis from pleural biopsy samples. It is a valuable tool not only for early microbiological confirmation but also for detecting rifampicin resistance.

Youth is a critical developmental stage marked by curiosity, risk-taking, and strong peer and social influences. Tobacco initiation often occurs during this period, making young adults a key target for prevention. Despite national and state-level tobacco control efforts, smoking remains prevalent among rural youth in India. In Gujarat, easy availability of tobacco products, social acceptance, and limited awareness further reinforce smoking behavior. Understanding context-specific determinants is essential for effective prevention strategies. A descriptive type of qualitative study was conducted in Changa village, Gujarat. Six young adult smokers (aged 19-24 years) and seven parent key informants were selected using snowball and consecutive sampling, respectively. Data were collected through in-depth interviews and a focus group discussion, audio-recorded, transcribed verbatim, and analyzed manually using thematic analysis. Ethical approval was obtained, and informed consent was taken from all participants. Three major themes emerged: health concerns, influencing factors, and governmental norms. Participants were aware of smoking-related health risks; however, peer influence, emotional distress, curiosity, and parental modeling contributed to continued use. Early signs of dependence, normalization of smoking, and desensitization to health warnings were evident. Structural factors, including easy access to cigarettes, weak enforcement of regulations, and low awareness of cessation policies, further sustained smoking practices. Parents emphasized the role of school-based sensitization and community awareness initiatives. Smoking among young adults in rural Gujarat is influenced by individual, social, and systemic factors. Comprehensive, multi-level interventions focusing on education, parental engagement, regulatory enforcement, and accessible cessation support are crucial to reduce smoking initiation and promote cessation.

Assessment of disease severity in interstitial lung disease (ILD) is usually performed using lung function tests, exercise testing, and chest imaging. Each modality has its own benefits and drawbacks. Ultrasound (USG) examination of the diaphragm is a non-invasive imaging modality that has been found to be effective in evaluating diseases like chronic obstructive pulmonary disease and asthma. However, its role in the assessment of stable ILD has been scarcely evaluated. We conducted a cross-sectional study to evaluate the role of diaphragmatic USG in the assessment of disease severity in 55 stable ILD patients. After clinical evaluation, all patients underwent spirometry [forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC)], high-resolution computed tomography (HRCT) of the thorax and 6-minute walk test as per standard criteria. The Warrick score was calculated using HRCT to quantify the radiological extent of disease. Thereafter, USG was performed, and diaphragmatic excursion (DE) and thickness were measured during both quiet and deep breathing (DB). Dyspnea grade, spirometry values, 6-minute walk distance (6MWD), and the Warrick score were correlated with USG variables to assess for any possible association. The mean age of the patients was 57.6±12.8 years (M:F=1:1). Idiopathic pulmonary fibrosis (n=15) was the most common ILD. The median FVC%, FEV1%, 6MWD, and Warrick score of the patients were 60 (48-74), 68 (53-90), 360 (245-400) m, and 18 (14-22), respectively. Out of 5 USG variables studied, thickening fraction, DE & diaphragmatic thickness (DB) showed statistically significant correlation (p<0.05) with dyspnea grade, FVC, 6MWD, and Warrick score in decreasing order of strength. On logistic regression analysis, FVC was the only factor that independently predicted thickening fraction (adjusted odds ratio: -1.08; 95% confidence interval 1.03-1.13; p=0.003). Diaphragmatic mobility and thickness showed a strong correlation with dyspnea, lung functions, exercise capacity, and radiological extent of disease in ILD patients. USG of the diaphragm can play an effective role in the assessment of disease severity in ILD.

Predicting weaning outcomes from mechanical ventilation remains a clinical challenge. Conventional indices such as the Rapid Shallow Breathing Index (RSBI) have limitations. This study evaluates diaphragmatic ultrasound parameters alongside RSBI and modified lung ultrasound score (mLUS) to improve the prediction of weaning success. A total of 50 adult patients requiring invasive mechanical ventilation for more than 24 hours were prospectively enrolled. All underwent a spontaneous breathing trial (SBT), and parameters including RSBI, mLUS, diaphragmatic excursion (DE), and diaphragmatic thickening index (DTI) were recorded. Weaning outcome was defined as successful extubation without need for reintubation within 48 hours. Associations were analyzed using receiver operating characteristic curves and multivariate logistic regression. Of the 50 patients, 34 (68%) passed SBT, and 27 (54%) had successful weaning. RSBI and mLUS were significantly lower, and DE and DTI significantly higher, in the weaning success group. Among all, DTI showed the highest predictive value (area under the curve: 0.948). On multivariate regression, DTI and DE were independent predictors of weaning success. A combination of RSBI and DTI yielded the highest diagnostic accuracy (94%). Diaphragmatic ultrasound parameters, particularly DTI, serve as strong, non-invasive predictors of weaning success. Integration of DTI with conventional indices like RSBI enhances predictive accuracy and may be valuable in guiding weaning protocols.

Bronchiectasis is a chronic respiratory condition characterized by irreversible bronchial dilatation, persistent airway inflammation, and impaired mucociliary clearance. Physical activity (PA) plays a key role in improving respiratory health and quality of life, yet objective data on PA levels and their clinical determinants in bronchiectasis are limited. We aimed to assess PA levels using wrist-worn accelerometry in individuals with non-cystic fibrosis (non-CF) bronchiectasis and to explore their association with clinical, functional, and inflammatory parameters. This cross-sectional study enrolled 27 adults with stable non-CF bronchiectasis (median age: 68.5 years; 40.7% female). Participants wore an AX3 wrist accelerometer for 7 consecutive days and were categorized into light or moderate/vigorous activity groups based on the World Health Organization guidelines. Clinical characteristics, pulmonary function (including airway resistance), and inflammatory markers [eosinophil count, fractional exhaled nitric oxide (FeNO)] were collected and analyzed. Logistic regression models were used to explore associations between these variables and PA levels. Patients with higher PA levels demonstrated lower airway resistance and reduced markers of type 2 inflammation. In univariate analysis, airway resistance, eosinophil count, FeNO, and age were significantly associated with PA levels. However, none of these factors retained significance in the multivariate model. Thus, reduced PA in bronchiectasis appears to be influenced by both airway inflammation and physiological factors such as aging. Inflammatory burden and impaired airway mechanics may limit functional capacity, underscoring the need for comprehensive management strategies that address both inflammation and mobility to improve patient outcomes.

Acute bronchiolitis is a leading cause of lower respiratory tract infections in young children. While multiple viruses contribute to its pathogenesis, their impact on disease severity remains unclear. In this cross-sectional observational study, children with bronchiolitis were enrolled. Baseline characteristics, bronchiolitis severity score, Respiratory Distress Assessment Instrument score, duration of hospitalization, and respiratory support requirements were recorded. Nasopharyngeal aspirates were analyzed via real-time polymerase chain reaction. Among 52 enrolled children (median age: 3 months), viruses were detected in 33 (63.5%) children. Of these, 6 (11.5%) had co-infection with more than one virus. Human rhinovirus (HRV) was the most common (39.4%), followed by respiratory syncytial virus (RSV) (33.3%), parainfluenza virus (PIFV) (21.2%), enterovirus (EV) (12.1%), influenza virus (6.1%), and both human metapneumovirus (hMPV) and human coronavirus (3.0% each). Co-infections involved HRV-RSV (n=2), HRV-EV (n=2), RSV-PIFV (n=1), and EV-PIFV (n=1). HRV was significantly associated with mild bronchiolitis (p=0.03), while other viruses and co-infections did not impact severity. Children aged 13-24 months had a significantly longer median hospital stay than younger age groups (p=0.04). Notably, despite recent concerns about hMPV in younger children, we found only one case, presenting with mild bronchiolitis and no respiratory support requirement. HRV is linked to milder bronchiolitis, while other viruses and co-infections do not significantly influence severity. These findings highlight regional viral variations and the need for larger studies to guide management.

Asthma is an obstructive lung disease with high prevalence. Symptom control in asthma remains poor despite significant advancements in treatment guidelines and inhalational devices. This is often attributed to inadequate patient adherence to the inhaler technique and insufficient education on its long-term use. Through this study, we aimed to assess the impact of reinforcement of proper inhaler technique on asthma symptom control and quality of life. A prospective cohort of 400 asthma patients using dry powder inhalers and metered dose inhalers was recruited in the outpatient clinic of our hospital. At the time of recruitment, the correctness of inhaler technique usage was assessed, and the pre-test Inhaler Technique Score (ITS) was recorded for each patient. Then, a ten-step inhalation technique was taught through demonstration, and the post-test ITS score was recorded again. This was done for each patient at monthly intervals for 3 months. Along with it, two tailored questionnaires, the Asthma Control Test (ACT) and Asthma Quality of Life Questionnaire (AQLQ), were administered at each visit to assess disease control and quality of life. Significant enhancements in inhalation technique were noted from the first to the third visit using the ten-step inhalation usage scores, which improved from 6.91 to 9.87 (out of 10) (p<0.001), paralleled by ACT score increases from 17.06 to 19.37 (out of 25) (p<0.001) from visits one to two, and from 19.37 to 20.52 (out of 25) (p<0.001) from visits two to three, signifying improvement in symptom control. Quality of life similarly improved from 4.45 to 5.12 to 5.45 (out of 7) (p<0.001) across the three visits as assessed by AQLQ. In conclusion, promoting proper inhaler technique through structured education programs is crucial for optimizing long-term asthma management and enhancing patients' quality of life.

Tuberculosis (TB) is a major worldwide health problem, particularly in India, where it accounts for a quarter of infections. Adherence to the Directly Observed Treatment, Short-Course (DOTS), which is necessary for TB treatment, is difficult in resource-limited circumstances. This study addressed the knowledge, attitude, and perceived barriers related to TB and DOTS adherence among patients and caregivers. A cross-sectional survey was undertaken at the selected TB clinics between November 2023 and March 2024. Purposive sample yielded 180 patients and 217 caregivers. Data were obtained using validated, self-structured questionnaires that assessed knowledge, attitude, and perceived barriers to TB and DOTS adherence. Statistical analysis was carried out with IBM SPSS version 23.0. The study found that caregivers had considerably greater TB knowledge than patients (p<0.05). Many patients misunderstood the cause of TB (50.6%) and embraced various misconceptions about the disease, such as TB spreading by shaking hands or sharing food, swimming in a holy river to cure diseases, and TB being the result of sin or karmic retribution. Distance to treatment facilities (95.6%), the necessity to take time off from work (91.7%), and social stigma (65.0%) were identified as the top three barriers to DOTS adherence. The study highlighted considerable gaps in knowledge, distant healthcare facilities, busy work schedules, and social stigma as barriers to TB treatment adherence in Deoghar, Jharkhand. Addressing these challenges via focused education and support activities is essential for enhancing DOTS adherence and TB treatment outcomes.