Monaldi Archives for Chest Disease最新文献

Pediatric hypertrophic cardiomyopathy (HCM) has a wide range of clinical manifestations. Left ventricular outflow tract obstruction (LVOTO) at rest is present in up to one-third of children with HCM, with a further 50-60% of symptomatic children developing a gradient under exertion. Treatment options are limited, and there is a relative lack of data on the pediatric population. Disopyramide is a sodium channel blocker with negative inotropic properties. This therapy effectively reduces LVOTO in adults with HCM and delays surgical interventions, but it is not licensed for use in children. We aimed to review and analyze the influence of disopyramide over the pathophysiological, clinical, electrocardiographic, and echocardiographic characteristics of patients with HCM in infancy, childhood, adolescence, and adult age. While disopyramide remains a cornerstone in the management of pediatric HCM, the advent of mavacamten and aficamten heralds a new era of potential advancements. These emerging therapies could significantly improve the quality of life and prognosis for young patients with HCM.

Silicosis is associated with preventable but irreversible lung damage. Early quantifiable assessment of silicosis workers would promote early interventional steps to reduce health deterioration. The objectives of this study were to correlate spirometry findings and post-six-minute walk test oxygen desaturation (post-6MWT OD) in chronic simple silicosis with age, duration of silica exposure (DSE), smoking pack years (SPY), occupation, and mean pulmonary artery pressure. Based on occupational exposure to silica and radiologic confirmation of chronic simple silicosis, 104 patients (all males) were enrolled and grouped based on SPY (nil, 1-10, 11-20, and >20) and occupation (drillers and dressers). They were further investigated with spirometry, post-6MWT OD, and transthoracic echocardiography (TTE), and findings were statistically analyzed. Abnormal spirometry findings were seen in 62.5% of total cases (65/104), with the highest percentage in the >20 SPY group (84%; 21/25) and drillers (68.3%; 28/41). The post-6MWT OD was seen in 50.96% of cases (53/104) with the highest percentage in the >20 SPY group (56%; 14/25) and drillers (63.4%; 26/41). Normal and restrictive patterns were predominant among <20 SPY groups, while obstructive and mixed patterns were prevalent in the >20 SPY group. Normal, obstructive, and restrictive patterns were predominant among dressers, while mixed patterns were in drillers. Mean age and mean DSE were higher for >20 SPY group and dressers; obstructive and mixed patterns; and patients with post-6MWT OD. Pulmonary hypertension was significantly associated with the presence of abnormal spirometry patterns (69.3%; 45/65) and post-6MWT OD (79.3%; 42/53). Mean forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) was significantly lower for the >20 SPY group. Mean FEV1 had an inverse relation with SPY, and mean FVC was lower for drillers than dressers. Spirometry, post-6MWT OD, and TTE assessment give a complete overview of the cardiopulmonary exercise capacity of chronic silicosis patients and facilitate early interventions with special consideration for workers involved in machine-based mining activity.

Preserved ratio impaired spirometry (PRISm), defined by reduced forced expiratory volume in 1 second (FEV1) without meeting criteria for airway obstruction, is often encountered in clinical practice. The management of this heterogeneous condition in individuals with chronic respiratory symptoms is challenging, especially under limited diagnostic resources. Since 2020, all consecutive patients referred for spirometry at our institution have been invited to participate in our registry. Other than spirometry, no other physiological lung function testing is available in this public health service. Therefore, we reviewed our databank with the aim of assessing: i) the proportion of symptomatic patients aged 18 years or older referred for spirometry presenting with PRISm; ii) the rate of inhaled medication used in this group, suggesting a referral diagnosis of obstructive airway disease (OAD); and iii) the relationship between symptoms and results on spirometry in PRISM compared to a group with obstruction matched by FEV1. To this end, the COPD Assessment Test (CAT) and the Asthma Control Test (ACT) were conjointly responded to by 1032 participants, irrespective of the clinical suspicion. We found that 22% had PRISM, of whom 200 were paired with obstruction by FEV1 (68±10% of predicted). The CAT and ACT results were well-correlated in both groups (r=-0.727 and -0,698, respectively; p<0.001) and used to measure symptoms. Participants in the final sample (n=400) were aged 62±13 years; 70% were ever smokers; and 55% reported household exposure to biomass smoke (at least 5 years). The CAT responses were in the range of moderate symptoms (17±9) and ACT borderline for uncontrolled symptoms (19±5). The main differences were higher body mass index (33±7 versus 29±7 kg/m2; p<0.001) and proportion of females (72 versus 49%; p<0.001) in PRISm compared to obstruction. This group had lower exposure to tobacco (65 versus 76% of ever-smokers) but greater exposure to biomass smoke (61 versus 49%) (p<0.05 for all). The rate of inhaled medication use was as high in PRISm as in obstruction (80%). Notwithstanding matched FEV1, we found less prominent signs of airway disease in PRISM: marginally reduced FEV1/forced vital capacity (FVC) ratio (94±8% of predicted); higher expiratory flow between 25% and 75% of vital capacity, despite presumed lower lung volumes (lower FVC); and lower rate of bronchial hyperresponsiveness. In an identical multivariate model, FEV1 predicted symptoms of obstruction only. In conclusion, these data raise suspicion of a substantial rate of misclassification of individuals with PRISM as having OAD in healthcare facilities with constraints on diagnostic resources.

Mycobacterium chimaera is an environmental non-tuberculous mycobacterium belonging to Mycobacterium avium complex (MAC). It has been widely known to be associated with disseminated infection after cardiac surgery, related to heater-cooler units used during these procedures. Although M. chimaera seems to be a less virulent species compared to M. avium and M. intracellulare among MAC, several cases of M. Chimaera lung infections have been reported in settings of chronic obstructive pulmonary disease (COPD), cystic fibrosis, bronchiectasis, malignancy, or immunosuppression. Here, we present an Italian case report in association with newly diagnosed COPD.

Non-A non-B aortic dissection is considered a rare nosological entity, included in the Stanford classification, representing a small percentage of the total aortic dissections that occur annually. Regarding this form, the literature reports a more complicated disease course compared to other types of dissection. We describe the case of a 76-year-old patient who accessed the triage section of an emergency department for a polytrauma picture and, after surgical treatment of a leg fracture, received a diagnosis of non-A non-B aortic dissection, "localized" to the arch and incidentally detected. The angio-computed tomography (CT) showed that the only intimal tear was located in the central portion of the aortic arch, with no exit tear. No signs of malperfusion or clinical symptoms related to the aortic finding were evident. The Aortic Team decided on a conservative approach, whereby the patient was started on medical therapy to control blood pressure in a monitored bed of a semi-intensive care unit. The persistent asymptomatic state, a condition of hemodynamic stability, and an unchanged angio-CT picture enabled discharge on day 7 and the assignment to a close follow-up.

Chronic obstructive pulmonary disease (COPD) is characterized by permanent airflow obstruction due to abnormalities of the airways and alveoli. This study investigated the potential role of Aspergillus species in acute exacerbations of COPD (AECOPD) and evaluated the diagnostic utility of serum Aspergillus galactomannan antigen. This cross-sectional study, carried out at the Jawaharlal Institute of Postgraduate Medical Education and Research from January 2021 to June 2022, involved COPD patients aged ≥40 years. Serum galactomannan and serum Aspergillus-specific antibodies were analyzed, along with the collection of demographic details, symptoms, and comorbidities. Statistical analyses, including univariate analysis and receiver operating characteristic (ROC) curve analysis, were performed. Among the 61 recruited COPD patients, 24.5% showed serum galactomannan positivity. Significant associations were found between galactomannan positivity, hemoptysis, and previous tuberculosis. ROC analysis revealed modest diagnostic accuracy (area under the ROC=0.6027) with a sensitivity of 44.4% and a specificity of 83.7% at a cut-off of 0.5. Univariate analysis did not show any potential links between diabetes, hypertension, previous exacerbations, and severe gold stages with a risk of exacerbation. Serum galactomannan antigen showed limited sensitivity, and its routine testing may not be justified for predicting exacerbation risk. Further studies are warranted to validate these findings and explore other diagnostic methods using bronchoalveolar lavage galactomannan antigen in AECOPD.

Coronary heart disease (CHD) remains a leading cause of mortality among cancer patients, primarily due to shared risk factors and the impacts of chemotherapeutic drugs, immune checkpoint inhibitors, and radiotherapy. Determining the optimal treatment strategy remains a challenging issue for patients with concurrent CHD and malignant neoplasms. In high-risk patients, managing CHD frequently takes precedence over addressing the oncologic disease. Myocardial revascularization, coupled with optimal medical therapy for CHD, can significantly enhance patient survival by reducing the risks of myocardial infarction and sudden cardiac death. However, selecting a surgical treatment strategy requires careful consideration of the indications, the complexity of coronary lesions, the risk of bleeding and thrombosis, and the overall prognosis of the malignancy. This clinical case demonstrates the importance of risk-benefit assessment, multidisciplinary discussion of cure strategy, and application of novel technologies to provide the most personalized and effective treatment.

Chronic respiratory diseases (CRDs) pose a serious public health issue, affecting social functioning and psychological well-being and leading to a deterioration in the quality of life. The aim of this study was to assess the quality of life of patients with CRDs and determine the factors associated with their impairment in Morocco. A cross-sectional study was conducted in the Pulmonology Department of the Hassan II University Hospital in Fez in 2021. Data collection was carried out using an anonymous questionnaire containing sociodemographic, clinical, and therapeutic information. We employed the Moroccan version of the 12-item short-form (SF-12) scale to assess the mental and physical quality of life of patients. Bivariate analysis was performed to investigate the association between various factors and quality of life, using tests appropriate to the types of variables studied. Subsequently, multivariate analysis through multiple linear regression was employed to determine factors associated with quality of life, taking into account confounding factors. The threshold for inclusion in the model was set at 20%. Significant associations are presented as β values along with their 95% confidence intervals (CI). Our study included 209 patients, with 50.7% being female and 74.2% aged over 50 years. The most frequent clinical symptom was coughing. The average physical quality of life was estimated at 34.45±13.78, and the mental quality of life was 33.72±19.79. Multivariate analysis revealed that the deterioration of physical quality of life was associated with marital status (single) [β=-6.84; 95% CI (-11.43; -2.25); p=0.004], stage II dyspnea on the Modified Medical Research Council scale [β=-4.94; 95% CI (-9.41; -0.52); p=0.029], and the presence of cyanosis [β=-9.65; 95% CI (-15.64; -3.67); p=0.002]. The factors negatively associated with mental health in our patients were age ≥50 [β=-7.84; 95% CI (-15.05; -0.62); p=0.033], marital status (single) [β=-7.81; 95% CI (-15.14; -0.48); p=0.037], and presence of cyanosis [β=-10.70; 95% CI (-20.08; -1.32); p=0.026]. The SF-12 calculation reflected an impairment in the quality of life of patients with CRDs. It is imperative to integrate the assessment of quality of life into the management strategy for this pathology.

Acute-on-chronic liver failure (ACLF) is a severe clinical condition for which liver transplantation (LT) is the only curative option. Due to the recipients' generally poor pre-operative clinical conditions and extensive surgery, post-LT respiratory disorders are very common and significantly contribute to related morbidity and mortality. We report the case of a 49-year-old patient with ACLF grade 3 who has been taken care of by the Respiratory Physiotherapy Team since hospital admission. After the extubation, the patient was supported with non-invasive ventilation and mechanical in-exsufflation; meanwhile, early resistance and functional training were started. No adverse events occurred during physiotherapy sessions, and the patient returned home without respiratory support. Respiratory and physical therapy in the intensive care unit after LT were safe and feasible interventions for this patient. Given the high incidence of postoperative pulmonary complications and the high rehabilitation needs, we suggest that physiotherapy should be provided for ACLF recipients.

Several infectious pulmonary diseases affect the eye. An understanding of the association between infectious pulmonary and ocular diseases is pivotal to their successful management. We aimed to review the infections affecting both the lungs and the eye. The electronic database PubMed and the search engine Google Scholar were searched for relevant articles. Ocular tuberculosis (TB), usually not associated with clinical evidence of pulmonary TB, can affect almost all the ocular structures. Confirmation of the diagnosis of ocular TB requires demonstration of Mycobacterium tuberculosis in ocular fluids/tissues. Among the drugs used to treat TB, ethambutol, isoniazid, and linezolid may cause toxic optic neuropathy. Elderly, those with renal disease, diabetes mellitus, malnourished, alcoholics, and those who will receive ethambutol at doses greater than 15 mg/kg/day and for prolonged periods are at high risk of developing toxic optic neuropathy. These individuals should be referred to an ophthalmologist before initiating ATT for a baseline ophthalmic evaluation. Linezolid may also cause toxic retinal neuropathy. Rifampicin may cause yellowish-orange discoloration of tears and contact lenses. Adenovirus, coronavirus, influenza virus, respiratory syncytial virus, and rhinovirus exhibit both pulmonary and ocular tropism. Pneumocystis jirovecii choroiditis is rare and mainly seen when aerosolized pentamidine is used for pneumocystis pneumonia prophylaxis. Further research is needed to develop non-interventional strategies to diagnose ocular TB. Biomarkers for early detection of toxic optic neuropathy are a need of the hour. Genetic factors and mechanisms behind the development of ethambutol, isoniazid, and linezolid-induced toxic optic neuropathy need further study.