Monaldi Archives for Chest Disease最新文献

It has been discovered that many solid tumors express the survivin gene, particularly in tissue samples. On the other hand, limited data exist on the significance of the survivin gene in bronchial aspirates from lung cancer patients. The current study was designed to evaluate the levels of the survivin gene in lung cancer patients and correlate them with other clinical features. The study population consisted of 58 patients with lung cancer. A total of 25 patients with non-malignant lung diseases were used as a comparable group. We used real-time quantitative reverse transcription polymerase chain reaction to assess survivin gene level in bronchial aspirate during bronchoscopy from individuals with lung cancer, as well as those with benign lung diseases. Cases with lung cancer had bronchial aspirates with a substantially greater survivin gene level (3.7±1.8) compared to individuals with benign lung illnesses (1.1±0.9) (p=0.0001). The lung cancer diagnosis had a sensitivity of 74.14% and a specificity of 96% when 2.4 of the survivin gene was used as the cutoff value. The levels of the survivin gene in lung cancer patients were significantly positively correlated with both age and performance status, with p values of 0.012 and 0.0001, respectively. Nonetheless, there was a negative connection between the survivin gene level and the length of symptoms as well as the survival time in months, with p-values of 0.027 and 0.001, respectively. As a molecular marker, survivin gene identification in bronchial aspirate has both diagnostic and prognostic significance for lung cancer.

Acute lower respiratory infections are one of the leading causes of morbidity and mortality in children globally. There is a lack of data reflecting the true burden of viral lower respiratory tract infections from low-middle-income countries like Pakistan. This study aims to describe the epidemiology and outcome of viral lower respiratory infection. This was a cross-sectional and retrospective study carried out from January 1, 2019, to December 31, 2021. We identified 13 different non-COVID viral respiratory pathogens. The statistical association was assessed between different factors, i.e., viral respiratory pathogens, with invasive and non-invasive mechanical ventilation, inotropic support, and mortality. A p-value of <0.05 was taken as significant. Among 234 patients, 187 (80%) had positive viral polymerase chain reaction (PCR). Males were predominant (n=137, 58%). The most common respiratory pathogen was the respiratory syncytial virus (RSV) (n=62, 26%), followed by entero/rhinovirus (n=24, 10%). Half of the patients (n=92, 50%) had a pediatric intensive care stay, and all required non-invasive mechanical ventilation (hi-flow). One-fifth of patients (n=34, 18%) required invasive mechanical ventilation and inotropic support. Overall, 8 (4%) patients with positive viral PCR died during the hospital stay. All the patients had associated comorbidity. RSV is the most common respiratory pathogen identified. Non-invasive mechanical ventilation, particularly high-flow therapy, is crucial in managing patients with viral illnesses, though a subset may still require invasive support. These findings highlight the importance of preventive strategies, including vaccination, which could significantly reduce the burden of viral infections, minimize the need for intensive care interventions, and lower morbidity and mortality.

Dear Editor, The concept of resectability plays a crucial role in determining the operability of non-small cell lung cancer patients...

Dry powder inhalers (DPIs) are the newer devices whereby medicine is dispensed as a fine powder inhaled deeply into the lungs, which is more simplified and stable compared to the pressurized metered dose inhalers. DPIs were developed primarily for respiratory disorders such as asthma and chronic obstructive pulmonary disease but are being investigated for other uses. This review explicates the features of DPIs and how they are made, looking at their effectiveness in respiratory therapy, noting features such as usability, stability of the drugs, and flexibility. It also discusses the potential of systemic drug delivery using other routes, such as insulin for diabetes, calcitonin for osteoporosis, antibacterial agents, vaccines, dermal treatments, and ocular treatments, considering issues like stability and patients' compliance. Issues related to jet milling, spray drying, and supercritical fluid technology are also covered with regard to improving DPI performance. Hindrances, including formulation stability and regulatory issues, have been discussed as a way of demonstrating how innovation is needed to go beyond respiratory therapy.

Acromegaly is a rare disease characterized by elevated levels of growth hormone (GH) and insulin-like growth factor 1 (IGF-1), leading to changes in various organ systems. However, the effects of this disease on pulmonary function are often overlooked. Early detection of pleural thickness and pulmonary function changes could offer significant clinical value. This study aimed to assess the role of thoracic ultrasonography (TUS) and pulmonary function tests in evaluating functional lung changes in patients with acromegaly and to explore the potential of ultrasonographic pleural assessment in predicting pulmonary involvement. This prospective single-center study, conducted at Gazi University Hospital between April and September 2022, included 34 patients with acromegaly and 34 healthy controls. Total lung capacity, residual volume, and forced vital capacity were significantly higher in patients with acromegaly compared to the control group (p=0.004, p=0.004, and p=0.005, respectively), while maximal inspiratory pressure and maximal expiratory pressure (MEP) were significantly lower (p=0.001 and p<0.001, respectively). Additionally, pleural thickness was higher in the acromegaly group (p<0.001). In the acromegaly group, MEP was negatively correlated with GH (r=-0.398, p=0.033), and pleural thickness was positively correlated with IGF-1 upper limit of normal (r=0.349, p=0.047). In conclusion, our study suggests that TUS combined with pulmonary function tests may help detect subtle thoracic changes in patients with acromegaly. This is the first study to evaluate TUS in these patients, and further research is needed to validate our findings.

Dear Editor, The global increase in e-cigarette usage, coupled with its promotion as a harm reduction tool, calls for a deeper examination of the myths vs. the scientific evidence...

Patients who have severe to critical COVID-19 infection may experience persistent or new symptoms after discharge. Our objective is to determine the first-year post-discharge respiratory and functional outcomes in patients who survived COVID-19 infection. In this prospective and observational study, we recruited Malaysians above 18 years old who survived severe or critical COVID-19 and followed them up for 1 year. Patients completed the post-COVID-19 Functional Status (PCFS) scale, performed the 6-minute walk test, and a standard spirometry. In the final analysis, 94 patients were included. Median age was 57 years (24,86); 55 (57.3%) were men, and 20 (20.8%) required invasive ventilation. Overall, 45 (46.9%) had underlying hypertension, 33 (34.4%) had diabetes mellitus, 43 (44.8%) had hospital-acquired infection, 19 (19.8%) had raised liver enzymes, and 17 (17.7%) suffered pulmonary embolism. From discharge to 1 year following discharge, the percentage of patients with dyspnea reduced from 51.4% to 25.0%, while patients with cough reduced from 16.2% to none, and fatigue from 20.0% to 12.5%. The percentage of patients with PCFS of 0 increased from 48.0 to 62.5%, while no more patients reported PCFS scales of 3 or 4 after 24 weeks. The median 6-minute walk distance within 1 to 8 weeks was 375.0 m (108.0, 540.0). This increased to 500.0 m (330.0, 680.0) at 41 to 48 weeks. Throughout the follow-up, the percentage of patients with normal spirometry findings increased from none at 1 to 8 weeks to 43.8% at 41 to 48 weeks. In conclusion, patients gradually regained their functional status. Follow-up for patients with persistent symptoms and abnormal spirometry is necessary to determine their long-term outcome.

Removal of Expression of Concern for 'Interferon-γ release assay' by Malay Sarkar and Jasmine Sarkar, Accepted Manuscript, https://doi.org/10.4081/monaldi.2025.3258 The Publisher of the Monaldi Archives for Chest Disease is publishing this removal of expression of concern to inform readers that the investigation is complete and all earlier issues have been addressed. This notice supersedes the information provided in the Expression of Concern related to this article (https://doi.org/10.4081/monaldi.2025.3712).

Pertussis is highly prevalent in chronic obstructive pulmonary disease (COPD) patients, but it is underrecognized and underreported in India. This study aims to assess the burden and impact of pertussis in patients with COPD acute exacerbations and also evaluates the correlation between pertussis and COPD exacerbation. This is a prospective, observational, cross-sectional study enrolling 250 COPD patients admitted with moderate to severe exacerbation. Relevant investigations and oropharyngeal swabs for pertussis were collected from the study subjects. Among 250 patients with COPD acute exacerbation, a throat swab was positive for Bordetella pertussis in 40 (16.1%) of subjects. Among positive subjects, 45% had moderate and 55% had severe exacerbation. Pertussis-positive subjects had statistically significantly higher COPD assessment test scores (p=0.02), more exacerbations in the past year (p=0.03), associated coronary artery disease (p=0.007), pulmonary hypertension (p=0.001), significantly lower forced expiratory volume in 1 second values (p=0.04), exercise-induced desaturation (p=0.02), and belonged to group E GOLD category (p=0.01), compared to negative subjects with no significant difference in mortality. 55% of pertussis-positive patients required intensive care unit (ICU) admission compared to negative subjects (p=0.04). Further, within swab-positive patients, physiological indicators like peripheral oxygen saturation and diffusing capacity of the lung for carbon monoxide significantly predicted ICU need. This study demonstrates that COPD patients are potentially at increased risk of pertussis infection, and there is an association between pertussis infection and COPD severity. Vaccination coverage against pertussis among COPD patients is negligible. Large multicenter studies are required to establish the true burden of pertussis in COPD patients, including the healthcare costs.

Diffuse parenchymal lung disease (DPLD) is a group of more than 200 pulmonary diseases that affect the alveoli, pulmonary interstitium, and/or small airways. DPLD patients often present in the outpatient department and inpatient department with acute/subacute worsening in their symptoms. These worsenings are due to a variety of causes that include acute exacerbations (AE), bacterial/viral/fungal infections, pneumothorax, pulmonary thromboembolism, or cardiac compromise. However, regardless of the type of underlying DPLD and the etiology of acute worsening when AE develops, it poses serious difficulties for patients, families, doctors, and the medical system. The current study was performed to evaluate the clinical presentation, etiological factors, and hospital course of DPLD patients presenting with acute/subacute worsening in their respiratory symptoms. A total of 39 hospitalized DPLD patients were recruited as per the inclusion and exclusion criteria. On admission, all relevant investigations were done, and the patients were evaluated thoroughly. All these patients were managed as per standard guidelines with regular monitoring. Based on the clinical course, treatment outcome was categorized as improved (discharged from hospital) or shifted to intensive care unit/mechanical ventilation and improved or died. The mean age of the study subjects was 57.95±11.7 years. The most common symptom reported in the study was dyspnea, followed by cough and fever. The most common etiology observed in the study, leading to hospital admission in DPLD patients, was respiratory infections and AE, followed by cardiac diseases. Out of the total 39 hospitalized DPLD patients, 13 patients required invasive mechanical ventilation, whereas 26 patients (66.7%) were managed with oxygen support/non-invasive ventilation/high-flow nasal oxygen. The univariate logistic analysis showed that patients with diabetes, pedal edema, idiopathic pulmonary fibrosis, regional wall motion abnormalities, and cardiac causes of acute clinical worsening were significant risk factors for the need for mechanical ventilation. On performing multivariate regression, none of the variables was an independent significant risk factor of mechanical ventilation. It is recommended to actively undertake monitoring and treating DPLD in conjunction with managing various concomitant illnesses, which is vital for improving outcomes and lowering the risk of acute clinical worsening and respiratory compromise.