Monaldi Archives for Chest Disease最新文献

Respiratory tract infections (RTIs) are common causes of hospital admissions and are often treated with multiple medications, including antibiotics, contributing to antimicrobial resistance. Effective drug utilization evaluation (DUE) is essential for ensuring rational drug use in RTI management. This study aimed to assess prescription patterns and drug utilization in RTI patients at a tertiary care hospital, focusing on the rationality of drug use, polypharmacy, adherence to clinical guidelines, and implications for antimicrobial stewardship. A cross-sectional study was conducted at Vivekananda General Hospital, Hubballi, India, from August 2023 to January 2024. Data from 200 RTI inpatients, including demographics, medication types, administration routes, and prescription patterns, were analyzed. Descriptive and inferential statistics were used to evaluate adherence to guidelines and rational drug use. DUE revealed that 50.99% of patients were not prescribed cough syrup. Oral (52%) and intravenous (48%) routes were the most common. Budesonide was the most frequently prescribed bronchodilator (26.49%), and 72.45% of patients received oxygen. Ceftriaxone (12.68%) and azithromycin (11.88%) were the most commonly prescribed antibiotics. A high prevalence of polypharmacy was identified, with 39.50% of patients receiving more than three antibiotics, raising concerns about drug interactions and rationality. The study underscores the need for stricter adherence to clinical guidelines and targeted antimicrobial stewardship in RTI management. Enhanced DUE practices could improve patient outcomes and promote rational drug use.

In India, respiratory tract infections (RTIs) are a significant public health concern, particularly among children and the elderly. The quality of life (QoL) of patients is greatly impacted by RTIs. Enhancing patient care and treatment approaches requires an understanding of the variables that influence health-related QoL (HRQoL). Our study's goal was to assess patients' HRQoL using the St. George Respiratory Questionnaire (SGRQ) in those with respiratory diseases. A cross-sectional observational study was carried out in the inpatient department of Vivekananda Hospital, Hubli, over 6 months from August 1, 2023, to January 31, 2024. After fulfilling the inclusion requirements, 200 people were included in the study. In 200 patients, while assessing the QoL, we found a significant correlation between age, diagnosis, some biomarkers, smoking, days of hospitalization, the severity of disease, residency, antibiotics, income, and education with HRQoL using SGRQ questionnaires. Our study highlights that HRQoL is impaired in patients with RTIs. Age was positively correlated with symptoms, activity, and impact, especially the ages of 55-69 years and 70-84 years. No correlation was found between gender, comorbidities, and alcohol consumption. Higher C-reactive protein and erythrocyte sedimentation rate levels were associated with greater impact and activity limitations. Our research concluded that several factors might impact a patient's HRQoL with respiratory disease. Determining these factors in advance can help identify individuals who are more likely to have poorer HRQoL and make interventions that could improve patient outcomes.

This cross-sectional study aimed to investigate the role of peak inspiratory flow rate (PIFR) in the management of inhalation therapy for patients with chronic obstructive pulmonary disease (COPD). Conducted in the Department of Pulmonary Medicine at a tertiary care institute from July 2021 to January 2022, this study included a total of 351 patients who were clinically diagnosed with stable COPD and currently receiving inhaler therapy. Participants underwent comprehensive assessments that included demographic data collection, the use of the ABCD assessment tool to evaluate disease severity, the COPD Assessment Test (CAT) for quality of life measurement, and assessments for adherence to inhaler therapy and inhaler technique proficiency. The primary focus was on determining the prevalence of suboptimal PIFR and identifying associated demographic and clinical factors. The results indicated that 45% of the patients exhibited suboptimal PIFR, which is critical for effective medication delivery in COPD management. Analysis revealed several significant predictors of suboptimal PIFR: female gender, lower CAT scores, the type of inhaler device used, and a Modified Medical Research Council grade of ≥2, which indicates increased levels of breathlessness. These findings underscore the importance of assessing PIFR in COPD patients to ensure effective drug delivery. The study suggests that personalized inhaler device prescriptions tailored to individual PIFR can enhance treatment efficacy and improve overall management outcomes for COPD patients. By addressing factors contributing to suboptimal PIFR, healthcare providers can optimize inhalation therapy and ultimately improve patient quality of life.

Aspiration of scarf pins is a common problem in specific geographical locations where the Muslim population is high, especially in countries like Egypt, Bangladesh, Middle Eastern countries, and certain regions in India. This condition is also referred to as hijab-pin syndrome. We discuss the largest experience of flexible bronchoscopic extraction of aspirated scarf pins from the tracheobronchial tree. A multicenter retrospective observational study was conducted on 146 patients from 4 different centers in Egypt, Bangladesh, India, and Germany. Flexible bronchoscopy was successful in the extraction of aspirated scarf pins in all 146/146 patients with a 100% success rate. 136/146 (93.15%) patients were females, with the most common age group between 12 and 18 years (34.24%). 132/146 (90.4%) remembered the aspiration event before coming to the hospital. Cough was the predominant presenting symptom. (71.22%). In all 146 cases, the foreign body was identified on a standard chest X-ray. The left main bronchus was the most common site of aspiration, 67/146 (45.89%), followed by the right main bronchus, 56/146 (38.35%). 14 patients (9.58%) had a history of unsuccessful attempts to remove by rigid bronchoscopy, and flexible bronchoscopy was successful in these 14 (100%) patients who had a prior unsuccessful attempt to remove. The current series is the largest in literature and demonstrated an excellent success rate in the removal of the aspirated scarf pin.

Following the onset of the new COVID-19 pandemic, particular attention is paid to the long-term outcomes, especially concerning patients affected by the SARS-CoV-2 virus, leading to interstitial pneumonia. The aim of this research is to evaluate the possible evolution over time of interstitial pneumonia into post-inflammatory fibrosing interstitial disease. This research included 42 patients admitted to the COVID ward for SARS-CoV-2 interstitial pneumonia, 10 patients with mild pneumonia and respiratory failure who were treated with O2 only, 32 patients with severe pneumonia in whom O2 and non-invasive ventilation were used for respiratory assistance, and 4 patients treated with invasive mechanical ventilation. At 70±30 days, 6, 12, 24, and 36 months after discharge, the cohort of patients underwent the evaluation of inflammation indices, high-resolution computed tomography (CT) chest scans, and functional respiratory tests. The comparative analysis showed that 83.3% of patients had residual parenchymal lung disease at 36-month follow-up, with a significantly higher rate in those with severe pneumonia and more extensive disease on initial CT. Regarding the pulmonary involvement model, patients presented ground-glass opacity or peripheral parenchymal bands, or a combination of them, and peri- and intralobular interstitial thickening, which may be representative of fibrotic interstitial lung disease. There is a correlation between the severity of pneumonia, the inflammatory state, the need to increase respiratory support, and the quantity and persistence of CT-related lesions. Reductions in respiratory functions and exercise capacity were observed, the latter more pronounced in patients (24%) who had contracted severe pneumonia and required ventilatory support. Pulmonary outcomes from SARS-CoV-2 respiratory infections show a wide range of radiological findings, from complete recovery to stable outcomes of thickening and distortion of the interstitial architecture. From a functional point of view, there is an impairment of the alveolar-capillary diffusion capacity and, in cases of those who had contracted severe pneumonia, desaturation and reduced exercise tolerance in 24% of cases at a 36-month follow-up.

COVID-19 affected millions of people worldwide, and tuberculosis (TB) continues to affect millions of people each year. The combined pandemic of COVID-19 and TB had a catastrophic effect on healthcare policies and healthcare setups around the globe. The clinical profile and factors affecting the outcome of COVID-19 disease in TB patients on treatment in field conditions have not been studied in detail. The present study attempted to study the occurrence of COVID-19 among patients on TB treatment in terms of the severity of COVID-19 disease and outcome of both COVID-19 and TB in patients at National Tuberculosis Elimination Program treatment centers over a period of one year during peak COVID-19 times. Out of 1400 TB patients enrolled, 65 (5%) suffered from COVID-19 disease. Of the 65 TB patients with COVID-19 disease, 37 (57%) were male and under 45 years old, 33 (51%) had a TB diagnosis after first receiving a COVID-19 diagnosis, 29 (45%) had a TB diagnosis first and received anti-TB treatment before receiving a COVID-19 diagnosis, and only 3 patients (5%) had a COVID-19 and TB diagnosis concurrently. The majority of 59 (91%) patients had mild COVID-19 disease. The outcome of TB treatment was available in 25 patients out of these 65 COVID-19-positive patients, with 21 (84%) patients having a favorable outcome. Out of the 65 COVID-19-positive patients, 4/25 (16%) had unfavorable outcomes, with one patient (4%) failing TB treatment and two patients (8%) dying. This is the first study from India that studied the occurrence and course of COVID-19 among a large number of TB patients taking anti-TB treatment under programmatic conditions. Due to the similarity in symptoms of TB and certain viral respiratory illnesses, a protocol should be established for healthcare workers to check patients for both illnesses.

Health workers, and in particular doctors and nurses working in internal medicine units (IMUs), are at high risk of burnout. Overcrowding, complexity and severity of clinical cases, patients' social and family issues, impact of death, and "workload" are all aspects that are specific risk factors that might lead to the development of burnout in this scenario. People suffering from burnout may face several psychological problems (including extreme physical and mental fatigue, emotional exhaustion, loss of enthusiasm concerning work, feelings of cynicism, and a low sense of personal accomplishment) and are also at risk of developing some somatic diseases. Furthermore, the quality of care delivered by a worker in burnout seems to worsen and slip down. In this review, we analyzed the main risk factors and consequences of burnout in IMUs, and we propose individual and organizational measures that may be applied to be able to prevent burnout in this setting.

Cardiovascular disease is the leading cause of mortality and disability worldwide, with important economic and quality-of-life implications. Effective treatment relies on drug adherence, which is impacted by a variety of factors; noncompliance increases morbidity, mortality, and healthcare costs. This study examines the quality of life, treatment adherence factors, and challenges that cardiac patients encounter during their treatment regimen. A cross-sectional study among 111 cardiac patients through purposive sampling was done at the All India Institute of Medical Sciences, Deoghar, between January 2023 and April 2024. Data on demographics, clinical characteristics, quality of life, and treatment adherence were gathered and analyzed using descriptive and inferential statistics while adhering to ethical guidelines and participant privacy. The research of 111 cardiac patients (76.6% male, mean age 56.45 years) revealed that the majority had undergone coronary artery bypass grafting surgery (83.8%), with many preferring private hospitals (58.6%). High medication adherence (82.0%) and regular follow-up (71.2%) were noted, although lifestyle improvements such as smoking cessation were less prevalent. Significant concerns about barriers were reported, including financial difficulties (35.1%) and accessibility of prescribed drugs (45.9%). Quality of life was generally reported as high, with most patients reporting no significant problem. This study reveals excellent adherence to medications and regular follow-up among participants. However, significant impediments such as financial constraints and accessibility issues for prescribed drugs continue to have an influence on treatment. Despite these limitations, patients often report a high quality of life, underscoring the complex interplay of medical, economic, and lifestyle aspects in cardiovascular health management.

The use of ultrasound for pleural procedures is associated with a decreased risk of complications. Handheld ultrasounds allow for easier evaluation of the pleural space. Limited data exists for the use of such devices for pleural procedures. The primary objective of our study was to assess the effectiveness and safety of handheld ultrasound for pleural procedures. We performed a prospective observational study, including all consecutive patients who underwent pleural procedures using the handheld ultrasound between September 2021 and November 2023. A total of 332 pleural procedures were attempted with handheld ultrasound, of which 329 pleural procedures (99.1%) were successfully performed. The median volume of fluid drained was 500 (interquartile range: 300-800). Thoracentesis was performed in 127 patients (38.5%), tube thoracostomy in 179 patients (54.4%), and medical thoracoscopy in 23 patients (7.0%). Exudative pleural effusions were found in 264 patients (80.0%), of which 152 (46.2%) were determined to be due to infectious etiologies. A total of 4 (1.2%) patients had a complication due to the procedure. 2 patients (0.6%) had a pneumothorax, while 2 patients (0.6%) developed a hemothorax. A total of 101 patients had either low platelets (<50×109/L) or use of antiplatelet or anticoagulant drugs. 128 patients (38.8%) were on positive pressure support during the pleural procedure. Our study shows that handheld ultrasounds are effective and safe for pleural procedures, including cases with septated pleural effusions and patients on antiplatelet or anticoagulant drugs.

Diagnosis of peripheral pulmonary lesions (PPL) is the most challenging field in bronchoscopy and interventional pulmonology, which concerns early lung cancer diagnosis. Despite novel techniques and new approaches to the periphery of the lung, almost 25% of PPLs remain undiagnosed. Bronchoscopy with guide systems, virtual and/or electromagnetic navigation, robotic bronchoscopy, and transparenchymal nodule approaches tend to provide a higher percentage of reaching the lesion, but the diagnostic yield rarely exceeds 75%, regardless of the instruments used. Further studies are needed to evaluate what the main constraints of this discrepancy are and if a combined use of these techniques and instruments can provide an increased diagnostic yield.