Monaldi Archives for Chest Disease最新文献

Idiopathic pulmonary fibrosis (IPF) has been widely hypothesized to occur as a result of an interplay between a nexus of environmental and genetic risk factors. However, not much is known about the genetic aspect of this disease. The objective of this review was to identify the genetic polymorphisms associated with the risk of developing IPF. We searched PubMed, EBSCO CINAHL Plus, Web of Science, and Wiley Cochrane Library databases for studies on risk factors of IPF published between March 2000 and November 2023. Studies with an IPF diagnosis based only on the American Thoracic Society and the European Respiratory Society guidelines were included. Thirty-one case-control studies were included with 3997 IPF and 20,925 non-IPF subjects. Two of the studies enrolled biopsy-proven IPF patients; 13 studies diagnosed IPF on the basis of clinical and high-resolution computed tomography (HRCT) findings; and 14 studies diagnosed IPF based on both biopsy and clinical and HRCT findings. 16 studies with MUC5B rs35705950, IL-4 rs2243250, IL-4 rs2070874, and tumor necrosis factor α (TNFα)-308 were eligible for meta-analysis. The allele contrast model (T vs. G) for MUC5B rs35705950 revealed a statistically significant association of the T allele with the risk of IPF [odds ratio (OR) 3.84, 95% confidence interval (CI) 3.20 to 4.61, adjusted p<0.0001], as was the allele contrast model for Asian (OR 2.83, 95% CI 1.51 to 5.32, adjusted p=0.009) and Caucasian (OR 4.11, 95% CI 3.56 to 4.75, adjusted p<0.0001). The allele contrast models for IL-4 rs2243250, IL-4 rs2070874, and TNFα-308 did not demonstrate any significant association with IPF. This review suggests an association of MUC5B rs35705950 T allele with the risk of developing IPF. To our knowledge, this study is the first to aggregate several genetic polymorphisms associated with IPF.

COVID-19 has a negative impact on the survival of respiratory patients, especially those with interstitial lung disease. This review aims to better understand the effect of COVID-19 on patients with idiopathic pulmonary fibrosis (IPF). A systematic search of MEDLINE, PubMed, Embase, and Scopus performed from December 2019 up to July 2024 identified relevant studies. Eligibility criteria included English language, sample size ≥10 patients, COVID-19 infection, and outcome measures. Two independent reviewers assessed studies using the Newcastle-Ottawa Scale for bias and extracted data. Meta-analysis employed a random-effects model, and the Grading of Recommendations Assessment, Development and Evaluation assessed evidence quality. Outcomes considered were hospitalization, intensive care unit admission, and mortality. Of the 1541 initially identified articles, 6 high-quality studies were included. Meta-analysis revealed a 34% mortality rate [95% confidence interval (CI): 21-48%], 36% hospitalization rate (95% CI: 10-75%), and 31% intensive care unit admission rate (95% CI: 7-71%) among IPF patients with COVID-19. The certainty of evidence was low or very low due to publication bias and heterogeneity. This study underscores the elevated risk of hospitalization and death in IPF patients with COVID-19, emphasizing the vulnerability of this population. Prompt and tailored care is crucial to mitigate the impact of COVID-19 on IPF patients, necessitating proactive measures, vaccination, and comprehensive management.

Pulmonary trichomoniasis is an underdiagnosed disease. In most cases, there is an underlying clinical condition related to immunosuppression. The results of molecular biology techniques indicate that trichomonad infections have been significantly underestimated. A 7-year-old girl with a medical history of suspected juvenile rheumatoid arthritis presented with a fever, chills, and a productive cough. Her chest computed tomography scan indicated a pericardial effusion and consolidation in the left lower lobe. In direct microscopy of the bronchoalveolar lavage fluid, we identified a motile and flagellated organism. Based on the morphology, size, and rolling motility, we identified this organism as Trichomonas hominis. The patient's fever stopped after 3 days of intravenous metronidazole administration. In immunocompromised patients with evidence of pneumonia, sputum or bronchial samples should be examined more carefully. The possibility of unusual pathogens should be considered if they do not respond to antibacterial treatments.

The management of persistent malignant pleural effusion (MPE) or uremic pleural effusions requires the removal of pleural fluid and the prevention of recurrence through pleurodesis. Pleurodesis involves injecting a sclerosing agent into the pleura to encourage adhesion between the two layers, ultimately obliterating the pleural space. Povidone-iodine is a potential pleurodesing agent. This quasi-experimental study was conducted at the Department of Pulmonology, Shaikh Zayed Hospital, Federal Postgraduate Medical Institute, Lahore, Pakistan, over 1 year (March 2021 - March 2022). A total of 70 patients with MPE, uremic pleural effusions, and secondary spontaneous pneumothorax (SSP) were enrolled after meeting the inclusion criteria. The pleurodesis procedure involved administering a mixture of 20 mL of 10% povidone-iodine solution and 30 mL of normal saline through a chest tube, followed by clamping for 3 hours. Patients were scheduled for follow-up visits at 2, 4, 8, and 12 weeks. Data was analyzed using SPSS version 20.0. The average age of participants was 53.26 years (+13.71). Of the 70 patients, 39 (55.7%) were male and 31 (44.3%) were female. 62 patients (88.57%) had pleural effusion, and 8 patients (11.42%) had pneumothorax. The procedure was successful in 84.3% of patients, with varying success rates by diagnosis: MPE (81%), uremic pleural effusion (92%), and SSP (75%). Statistical analysis revealed significant positive effects of povidone-iodine on procedure outcomes (p=0.048) and effectiveness in preventing pleural effusion recurrence (p=0.028). This study indicates that 10% povidone-iodine can serve as a viable alternative to other pleurodesis agents, yielding standard-quality pleurodesis in 84.3% of patients. It is readily available, cost-effective, and has minimal adverse effects.

An 18-year-old male presented with syncope during a training break. Post-syncope, he developed effort dyspnea, which he associated with the Pfizer-BioNTech COVID-19 vaccine received a week earlier. The electrocardiogram showed T inversion in V1-V3, III, and aVF, while 24-hour Holter monitoring revealed frequent ventricular premature beats. A transthoracic echocardiogram showed severe biventricular dilation and mild left ventricular (LV) dysfunction. Cardiac magnetic resonance (CMR) imaging confirmed these findings, showing moderate right ventricular (RV) systolic dysfunction with akinesia of the inferior and inferolateral walls. T2 hypersignal in the middle segment of the inferior interventricular septum suggested myocardial edema. Extensive transmural late gadolinium enhancement was noted in the RV and LV walls. An implantable loop recorder was implanted. Three months later, the patient was admitted with palpitations, fever, and a positive SARS-CoV-2 test. Sustained ventricular tachycardia (VT) episodes were documented and managed with amiodarone and β-blockers. Follow-up CMR showed a slight improvement in LV ejection fraction and resolution of edema. A single-chamber implantable cardioverter-defibrillator (ICD) was implanted. Genetic testing for arrhythmogenic RV cardiomyopathy (ARVC) was negative, and family screening was normal. Two years later, pre-syncope episodes occurred, and ICD interrogation revealed nonsustained VT. The patient is awaiting VT ablation. This case highlights the diagnostic and therapeutic challenges of ARVC, particularly in differentiating it from myocarditis. The "hot-phase" presentation, vaccine association, and subsequent SARS-CoV-2 infection added complexity. CMR was crucial for diagnosis, and VT management required a combination of medical therapy and invasive procedures.

Diffuse alveolar hemorrhage (DAH) is characterized by a syndrome of alveolar bleeding, a fall in hemoglobin, and respiratory failure. It can occur because of various immunologic and non-immunologic conditions. The etiology of DAH is important, as treatment varies with the etiology. This retrospective observational study evaluates the diverse etiologies, time to diagnosis from symptom onset, management strategies, and outcome of DAH in a span of 12 months at our tertiary care center. A total of 8 patients were identified with 8 different etiologies. 6/8 (75%) patients had immunologic causes, and 2/8 (25%) had non-immunologic causes of DAH. 6/8 (75%) patients were females, the mean time to DAH diagnosis was 4.25 months from symptom onset, 6/8 (75%) patients improved, and 2/8 (25%) died due to complications. It is necessary to differentiate between the etiologies of DAH and establish an early diagnosis to plan management and improve outcomes.

Asthma is a prevalent chronic respiratory disease affecting all age groups globally, causing significant morbidity and mortality. Small airway involvement, often undetected by traditional spirometry, has emerged as a critical aspect of asthma pathophysiology, especially in severe cases. This retrospective observational study aimed to assess small airway dysfunction using impulse oscillometry (IOS) in 94 severe asthma patients. Results indicated that 27.3% of patients had small airway obstruction. While spirometry showed no statistical differences between groups, IOS parameters were significantly different, highlighting its sensitivity in detecting small airway disease. Patients with small airway involvement exhibited poorer asthma control, emphasizing the clinical relevance of identifying and addressing small airway dysfunction. The study underscores the need for comprehensive evaluation tools like IOS alongside spirometry, especially in severe asthma management. Further large-scale studies are warranted to validate IOS's utility in optimizing therapeutic strategies and improving asthma control, particularly in resource-limited settings. Recognizing and addressing small airway involvement could lead to individualized management approaches and better outcomes in severe asthma patients.

In this prospective study, we evaluated the diagnostic yield and safety of two endobronchial ultrasound (EBUS) biopsy techniques - mediastinal cryobiopsy (EBUS-MCB) and Franseen tip needle biopsy (EBUS-ANB) - in patients with undiagnosed mediastinal lymphadenopathy. The study included 30 patients who underwent both EBUS-MCB and EBUS-ANB, with four biopsies taken from each patient using both methods. The results demonstrated that EBUS-MCB provided a higher diagnostic yield (96.4%) compared to EBUS-ANB (73.3%). Specimens from EBUS-MCB showed fewer artifacts and a higher density of granulomas and were adequate for ancillary studies in all cases. The most common complication observed was minor bleeding, which was more common with EBUS-MCB (36.6% vs. 13.3%, p=0.04). This study demonstrates that EBUS-guided cryobiopsy has a higher diagnostic yield when compared to EBUS-ANB and that both biopsy techniques have an acceptable safety profile. Larger studies comparing these two techniques are necessary to confirm the findings of the current study.

Biological drugs have revolutionized the management of severe asthma, and a tailored treatment approach has made it possible to consider remission as an achievable treatment target. The incidence of autoimmune diseases is increasing worldwide. Patients suffering from severe asthma, eligible for or already treated with an asthma-approved biologic agent, may suffer from another immune-mediated inflammatory disease (IMID) that could require the simultaneous use of a second monoclonal antibody. The real-life studies available in the literature describing the concurrent administration of an asthma-approved biologic agent with another biologic for a different immune disease, obtained through a systematic search on online databases based on monoclonal antibodies, were collected and analyzed. In this review, 26 articles were included according to the prespecified inclusion and exclusion criteria. All included papers were retrospective in nature. Study designs were case reports (n=18), case series (n=3), retrospective chart reviews (n=3), retrospective observational studies (n=1), and cohort studies (n=1). The study is intended to present, within the current literature, all the administered combinations of severe asthma-approved biologics with monoclonal antibodies for a different indication. Those were grouped according to the IMID for whom the second biologic agent, with a different mechanism of action, was prescribed. The combinations prescribed to the cohort of patients specifically treating uncontrolled severe asthma were more deeply evaluated in the discussion section, since an analysis of these therapeutic combinations deriving from real-life experiences may be useful to optimize the management of patients with severe asthma, ultimately leading to improved patient care and outcomes. Prospective registries and future studies are required to assess the safety and efficacy of combination therapies for severe asthmatic patients who suffer from an IMID.