Monaldi Archives for Chest Disease最新文献

Pulmonary rehabilitation (PR) in chronic respiratory diseases improves symptoms, quality of life, and exercise capacity and has an integral role in lung transplantation (LT). Virtual PR has recently emerged to cater to patients who otherwise may not have regular access to PR. However, little is known about the effect of virtual PR strategies on candidates for LT. The primary objective was to study the effect of a protocolized hybrid PR program on performance status using the Karnofsky Performance Status (KPS) score. Secondary objectives were Eastern Cooperative Oncology Group (ECOG) status, quality of life, symptom severity, sarcopenia, spirometry (pulmonary function test and diffusing capacity of the lung for carbon monoxide), 6-minute walk distance, and eligibility for LT waitlisting. This is a prospective, single-arm, interventional study on patients with end-stage lung disease, meeting referral criteria for LT. A protocolized 12-week hybrid hospital and home-based virtual PR intervention was conducted, and all outcomes were assessed at baseline and at completion of the intervention. A total of 75 patients were enrolled, and the intervention was completed by 51 patients (68%). A total of 35 patients met LT listing criteria, 27 being "unfit" for LT at baseline, 18 of whom completed the intervention. Significant improvement was seen in KPS, ECOG, St. George's Respiratory Questionnaire score, visual analogue scale score for cough and dyspnoea, and sarcopenia for all 51 patients. Of the 18 patients unfit for waitlisting, 12 became fit, and 7 were waitlisted for LT. Patients eligible for LT who do not have access to regular PR may benefit from a hybrid (virtual and hospital-based) PR program, with improvement in KPS, quality of life, sarcopenia, and eligibility for LT waitlisting.

The COVID-19 pandemic has caused the deaths of thousands of physicians, especially in high-risk fields with very close patient contact. This study investigated the impact of the pandemic on the specialty preferences of senior medical students. A cross-sectional survey was conducted among sixth-year students at the Gaziantep University Faculty of Medicine between October and November 2021. Students were invited to participate anonymously in an online survey containing 15 questions regarding student characteristics and specialization preferences. Among the 229 students who participated, 31% reported having contracted COVID-19, and 22.7% reported that at least one family member/relative had died from the disease. As a result of the pandemic, 50.2% of students reported a decreased desire to become physicians, 44.5% reported no change, and 5.2% reported an increased desire. Approximately one-third (30.1%) stated that the pandemic had influenced their specialty preferences. In terms of physical contact with patients, 41% of students preferred specialties considered "somewhat distant", whereas 10.9% preferred those considered "very distant". Overall, the findings suggested that more than half of the students avoided selecting specialties with a high risk of COVID-19 exposure and close patient contact as their first choice.

Airway clearance techniques (ACT) should be included as part of the non-pharmacological treatment of patients with bronchiectasis (BE) following international guidelines. This approach in chronic respiratory patients should be maintained despite a pandemic situation, including SARS-CoV-2. The objective of this study is to evaluate the satisfaction, adherence, effectiveness, and safety of telehealth ACT (tACT) via video consultation for secretion drainage in patients with stable BE. This is an observational pilot study with prospective recruitment describing a cohort of patients with BE and patients with BE and infection due to non-tuberculous mycobacterial pulmonary disease (NTM-PD) included in a tACT program. Patients received an initial tACT visit (V1), another after one week (V7), and a final visit after one month (V30). Adherence, effectiveness and safety data were recorded. Satisfaction with the intervention was determined using a visual analogue scale (0-10). A total of 40 patients with BE and 17 patients with BE and NTM-PD were included, with a mean age of 63 (13). A total of 48 patients evaluated the telehealth intervention at >8 with the VAS, with a mean VAS score at V7 of 9.0 (1.9) and 8.9 (2) at V30. Self-reported adherence to treatment was high, with an average of 6.5/7 and 25/30 days; 94% of the patients managed to expectorate during V1 (effectiveness of the intervention). No relevant side effects were detected. tACT for managing secretions in patients with BE, whether with or without NTM-PD, has proven to be satisfactory, effective, and safe during a critical pandemic situation. This safety strategy could be included in the future as a complementary tool in the management of chronic respiratory patients.

Heart failure with preserved ejection fraction (HFpEF) remains a significant global health challenge, accounting for up to 50% of all heart failure cases and predominantly affecting the elderly and women. Despite advancements in therapeutic strategies, HFpEF's complexity poses substantial challenges in management, particularly due to its high comorbidity burden, including renal failure, atrial fibrillation, and obesity, among others. These comorbidities not only complicate the pathophysiology of HFpEF but also exacerbate its symptoms, necessitating a personalized approach to treatment focused on comorbidity management and symptom alleviation. In heart failure with reduced ejection fraction, exercise training (ET) was effective in improving exercise tolerance, quality of life, and reducing hospitalizations. However, the efficacy of ET in HFpEF patients remains less understood, with limited studies showing mixed results. Exercise intolerance is a key symptom in HFpEF patients, and it has a multifactorial origin since both central and peripheral oxygen mechanisms of transport and utilization are often compromised. Recent evidence underscores the potential of supervised ET in enhancing exercise tolerance and quality of life among HFpEF patients; however, the literature remains sparse and predominantly consists of small-scale studies. This review highlights the critical role of exercise intolerance in HFpEF and synthesizes current knowledge on the benefits of ET. It also calls for a deeper understanding and further research into exercise-based interventions and their underlying mechanisms, emphasizing the need for larger, well-designed studies to evaluate the effectiveness of ET in improving outcomes for HFpEF patients.

Tobacco, being an established risk factor for significant mortality and morbidity, causes over 7 million annual deaths globally. India is a country with over 270 million active tobacco users. On the one hand, although the willingness to quit amongst tobacco users is as high as 55.4%, the actual quit rates translate to less than 20%. Taking a cue from the economic principle of commitment and consistency, paying a nominal fee can serve as a form of public commitment and motivation to decrease the dropout rate amongst those committed to quitting. This study uses contingent valuation assessment to determine the willingness to pay (WTP) values for an effective tobacco cessation service across individuals with different socio-demographic characteristics. A cross-sectional observational study with multistage cluster sampling in Rajasthan was conducted to recruit 360 active tobacco users from 8 districts. Q-Q plots were used to determine the non-parametric distribution, and statistical differences between median WTP values were compared using Mann-Whitney U and Kruskal-Wallis H tests, considering a p-value less than 0.05 to be statistically significant. The majority of participants were males (57.78%) between the ages of 26 and 35 (40.28%), married (82.50%), and with children (65.83%), with an annual income between $7500-10,000 (23.61%) and graduate-level education (40.56%). Exclusive smokers formed the majority of the cohort (48.06%), and 50.83% were willing to quit as well as willing to pay for cessation. Median WTP values were maximum for males ($54.05; p<0.05), age group 26-35 years ($54.05; p<0.05), post-graduates ($81.08; p<0.05), and annual income above $20,000 ($121.62; p<0.05). Weak positive and significant correlations were observed between WTP and annual spending on tobacco, annual spending on health, and annual income. The study emphasizes the critical importance of early-age interventions for effective tobacco cessation prior to transitioning into dependency, resulting in reduced financial parity for availing health services. These are the first such WTP values from the Southeast Asian region, tailored for different population subsets, specifically for tobacco cessation. Our findings contribute to the growing body of evidence to support innovative approaches to enhance tobacco cessation efforts through financial commitments.

Respiratory syncytial virus (RSV) plays a major part in causing lower respiratory tract infections in younger populations, especially in infants and pediatric patients, causing a higher rate of morbidity and mortality in the respective population, affecting 60% of the population globally. Typically, identifying the virus in the patient's respiratory secretions is important for laboratory validation of a clinically suspected RSV infection. Unfortunately, the only available preventive measure to lower the incidence for infants who are at high risk of RSV-induced hospitalization is palivizumab prophylaxis. Treatment strategies to manage RSV involve using an antiviral drug, ribavirin, along with bronchodilators, nebulized adrenaline (epinephrine), and nebulized hypertonic saline. Providing patients with alternative treatment options like vitamin D-cathelicidin as well as probiotics and prebiotics can help reduce the intensity of the infection. This review article focuses on the epidemiology, clinical manifestation, prophylaxis, and available treatment options for RSV infections in infants, children, and young adults.

Tobacco quitline services offer telephone-based counseling to assist tobacco users in quitting through behavioral modification. It is a sponsored scheme by the Ministry of Health and Family Welfare, Government of India. The present study has two objectives: primarily, to study the correlation between socio-demographic variables and tobacco abuse, and secondly, to study the impact of National Tobacco Quit-Line Services (NTQLS) in India. The data for the study were collected from the registered callers who had completed at least 1 year of follow-ups at NTQLS, Vallabhbhai Patel Chest Institute, University of Delhi, between May 2016 and May 2021. The questionnaire was directly administered to the people who had called NTQLS for the first time to quit tobacco use. Callers were provided 1 year of continuous follow-up to ensure they remain long-term abstinent from tobacco and permanently quit. All the data were managed through an electronic database. A total of 85,807 individuals' data was taken for the study. The maximum number of callers was from Uttar Pradesh (28.03%), followed by Rajasthan (24.67%) and Madhya Pradesh (7.59%). The female population represented only 1.43%; the male population was significantly higher (98.57%). Youth (44.83%) and adults (53.78%) were more than seniors (0.9%) and adolescents (0.4%). Smokeless tobacco users (67.32%) were more common than smoking tobacco users (20.11%). Duration of tobacco use among the 71.74% of callers was found to be between 1 and 10 years; the remaining 24.03% had been using tobacco for over 10 years, while 4.23% were novice users. The abstinence rate achieved by NTQLS was 33.42% after one month of quitting and 21.91% after 1 year of quitting. We found a significant association between the tobacco users' socioeconomic and demographic status. The number of male tobacco users was significantly higher than the number of female tobacco users. Among all the tobacco users, youth was persistently using tobacco the most. Individuals from low socio-economic status were more likely to use tobacco as compared to those from high socio-economic status. These associations indicate the need for strengthening the enforcement of tobacco control policies and developing and monitoring comprehensive smoke-free legislation.

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 the <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 the >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.

Low vitamin D levels are associated with different pulmonary diseases, such as chronic obstructive pulmonary disease, bronchial asthma, and obstructive sleep apnea. In this study, we aimed to assess the relation between vitamin D levels and COVID-19 severity. Positive COVID-19 patients were subjected to clinical examination, computed tomography of the chest, and laboratory investigations. Serum vitamin D level was measured and correlated with the severity and the clinical course of the disease. The study included 72 patients, classified into four groups according to the severity of the disease. There was a statistically significant difference between the four groups regarding age, lymphocyte count, serum vitamin D, C-reactive protein, and lactate dehydrogenase levels. Serum vitamin D levels can be correlated with COVID-19 severity and clinical course.

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.