Monaldi Archives for Chest Disease最新文献

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. The 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 anti-tuberculous treatment 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.

Tuberculosis (TB) poses a significant occupational hazard for healthcare workers (HCWs) in India, a country bearing a substantial portion of the global TB burden. This systematic review and meta-analysis aims to determine the prevalence of TB among HCWs in India. Analyzing 10 studies up to 2024, we found a pooled prevalence of 2391.6 cases per 100,000 individuals, underscoring the critical occupational risk. Factors contributing to this high prevalence include inadequate ventilation, insufficient personal protective equipment, and frequent exposure to multidrug-resistant TB strains. Our findings emphasize the urgent need for stringent infection control measures, routine TB screening, and comprehensive educational programs. Policy recommendations include developing national TB screening guidelines and improving healthcare infrastructure. Protecting HCWs is crucial to achieving India's goal of TB elimination by 2025.

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.

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.