Advances in respiratory medicine最新文献

Background: Severe asthma is associated with significant morbidity and risk of complications. Some patients, suffering from eosinophilic asthma, may benefit from biological therapies, especially anti IL-5 (anti-interleukin-5). The purpose of the study was to compare the efficacy evaluation of mepolizumab and benralizumab in the treatment of eosinophilic asthma.

Methods: A retrospective, single-centre study including 59 patients with severe eosinophilic asthma treated with biologics (mepolizumab and benralizumab). Clinical outcomes, including peripheral blood morphotic characteristics, spirometry parameters, asthma control questionnaire (ACQ), mini-Asthma Quality of Life Questionnaire (mini-AQLQ) scores, daily oral corticosteroid use, body mass index, exacerbation rate, and exercise tolerance, were examined at the beginning and after 6 months of biological treatment.

Results: A total of 38 patients were treated with mepolizumab and 21 with benralizumab. Significant improvements (p < 0.05) in eosinophil count, required daily dose of glucocorticoids, ACQ, mini-AQLQ scores, and exacerbation rate were observed in both groups after six months of treatment. There was no statistical difference (p < 0.05) in the abovementioned parameters between the groups.

Conclusions: In patients with severe eosinophilic asthma, mepolizumab and benralizumab were associated with significant improvements in clinical state. Patients with type 2 asthma will benefit from the therapy with both anti-IL5 biologic drugs.

Poor sleep quality and excessive daytime sleepiness are commonly reported by individuals with cystic fibrosis. The potential impact of comorbid sleep-disordered breathing (SDB), particularly obstructive sleep apnea (OSA), has not been extensively studied in the CF population. At present, there are no specific recommendations available to help clinicians identify patients with CF who are at increased risk of sleep disorders. Home sleep apnea testing using a validated peripheral arterial tonometry (PAT) device may offer an accurate diagnosis of OSA in a more convenient and low-cost method than in-lab polysomnography. In this single-center study of 19 adults with CF, we found an increased prevalence of OSA among individuals with CF compared to general population estimates. Although associations with an FEV < 70% predicted and a modified Mallampati score ≥ 3 were observed, these odds ratios did not reach statistical significance, likely reflecting limited power in this small pilot sample. There was no association found between the self-reported presence of nocturnal cough or snoring and OSA. We also found no association between OSA and abnormal scores on commonly used, validated sleep questionnaires, suggesting that CF-specific scales may be needed for effective screening in the CF clinic.

Dormancy occurs when Mycobacterium tuberculosis (Mtb) enters a non-replicating and metabolically inactive state in response to hostile environment. During this state, it is highly resistant to conventional antibiotics, which increase the urgency to develop new potential drugs against dormant bacilli. In view of this, the dormancy survival regulator (DosR) protein is thought to be an essential component that plays a key role in bacterial adaptation to dormancy during hypoxic conditions. Herein, the NP-lib database containing natural product compounds was screened virtually against the binding site of the DosR protein using the MTiopen screen web server. A series of computational analyses were performed, including redocking, intermolecular interaction analysis, and MDS, followed by binding free energy analysis. Through screening, 1000 natural product compounds were obtained with docking energy ranging from -8.5 to -4.1 kcal/mol. The top four lead compounds were then selected for further investigation. On comparative analysis of intermolecular interaction, dynamics simulation and MM/GBSA calculation revealed that M3 docked with the DosR protein (docking score = -8.1 kcal/mol, RMSD = ~7 Å and ΔG Bind = -53.51 kcal/mol) exhibited stronger stability than reference compound Ursolic acid (docking score = -6.2 kcal/mol, RMSD = ~13.5 Å and ΔG Bind = -44.51 kcal/mol). Hence, M3 is recommended for further validation through in vitro and in vivo studies against latent tuberculosis infection.

For the self-medication of nasal congestion following a common cold, decongestant nasal sprays can be recommended according to the medicine guidelines. In Germany, these are only available in community pharmacies (CPs) with free pricing. The aim was to analyze the medication recommendation, counseling, and pricing. A covert simulated patient study, internationally recognized as the "gold standard", was conducted in all CPs of two medium-sized cities in north-eastern Germany. Each CP was visited twice (86 visits) with the identical scenario by one female and one male simulated patient. At the beginning, they asked for a nasal spray and, when asked, stated that they had had nasal congestion for three days. Slightly more than half (54.7%, 47/86) of the recommended nasal sprays were free of preservatives. The median counseling score was 2.0 out of 8 points, with a significantly higher score observed for the female SP (p = 0.004). Information on the maximum intake duration of five days recommended in the German pharmacy guideline was not provided during any visits. The prices varied in total from EUR 1.95 to EUR 6.22. Therefore, measures by the legislator and the chambers of pharmacists are necessary to sustainably improve the medication recommendation, the counseling, and the price transparency.

Circulating free DNA (cfDNA) is genetic material released from various cells into bodily fluids. Among its fractions, circulating tumor DNA (ctDNA) originates from tumor cells and reflects their genetic material, including mutations and epigenetic changes. Methods commonly employed for detecting ctDNA in blood include next-generation sequencing (NGS) and various types of PCR. The presence of ctDNA can be utilized in liquid biopsies for many diagnostic purposes related to various cancers. It is a minimally invasive method of sampling molecular compounds from tumor cells. In this paper, we focus on current knowledge regarding the liquid biopsy of blood ctDNA in the context of lung cancer, one of the leading causes of cancer-related mortality. Currently, as a clinically approved method, liquid biopsy serves as a complementary technique in NSCLC diagnostic and genetic profiling. Other applications of liquid biopsy that are still being investigated include the detection of minimal residual disease (MRD) after curative treatment and response monitoring to systemic treatment. This review discusses current and future potential directions for the development and implementation of ctDNA for patients with NSCLC.

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Introduction: Sleep disturbances are a common and often underestimated complication during intensive care unit (ICU) stays. These disturbances can significantly impact patients' recovery and overall well-being. This study aimed to assess the sleep quality of ICU patients and investigate the environmental and clinical factors that affect sleep quality during their ICU stay.

Methods: We conducted a six-month cross-sectional study involving patients who had stayed in the ICU for at least three nights and were oriented to time and place upon discharge. Sleep quality was assessed using the Arabic version of the Freedman Sleep Questionnaire. Both environmental factors (e.g., noise, light, and nursing interventions) and clinical variables (illness severity and pain) were examined. The differences across three time periods were analyzed using the Wilcoxon test and Spearman's correlation. Multiple regression analysis identified the factors influencing sleep quality. Statistical analyses were performed using JAMOVI software (version 2.3.28).

Results: The study enrolled 328 patients, with an average age of 49.74 ± 17.89 years. Of the participants, 75.3% were adults. The primary reasons for admission were circulatory distress (45.73%) and metabolic disorders (24.09%). Sleep quality was significantly lower in the ICU compared to patients' sleep at home (Z = -14.870, p < 0.001). The EVA and APACHE II scores had a statistically significant effect on sleep quality (p < 0.001 and p = 0.015, respectively). In contrast, the Charlson and Quick SOFA scores did not show significant effects (p = 0.128 and p = 0.894). Environmental factors, including noise (p = 0.008), light (p = 0.009), and nursing interventions (p = 0.009), significantly impacted sleep quality.

Conclusions: Patients in the ICU generally reported poor sleep quality. Our findings suggest that improving pain management, minimizing environmental noise, and reducing staff-related disturbances could significantly enhance sleep quality for patients in the intensive care unit (ICU).

Allergic rhinitis (AR) is a global health problem on the rise. More and more people are affected, and climate change is exacerbating this health problem in the long term. The quality of life of those affected is often severely compromised, and the financial burden on healthcare systems cannot be disregarded. Therefore, effective and safe medicines are needed to counteract this trend. P. hybridus (butterbur) leaf extract (Ze 339) displays a promising alternative to antihistamines in the treatment of AR symptoms. More than two decades after the first market launch it is now possible to draw a meaningful conclusion on its safety and efficacy. This review summarizes the available preclinical and clinical data, real-world data (RWD) as well as data from post-marketing pharmacovigilance monitoring about the herbal medicinal drug Ze 339. It focusses on the current knowledge about the mode of action as well as the evaluation of its efficacy and safety in the treatment of AR. Given its favourable safety profile and lack of sedative side effects, Ze 339 offers a valuable alternative to antihistamines and should therefore continue to be considered by medical practitioners for the treatment of allergic rhinitis symptoms.

Background: Depression and anxiety are common in patients with chronic respiratory diseases (CRDs), but their prevalence in intensive care settings, particularly in low-resource regions, remains underexplored.

Objective: To assess the prevalence and severity of depression and anxiety in patients with CRDs admitted to an intensive care unit (ICU) and identify associated factors.

Methods: A cross-sectional study was conducted at Gulab Devi Teaching Hospital, Lahore, Pakistan. Adult patients with CRDs admitted to the ICU were assessed using the Hamilton Depression Rating Scale. Statistical analyses included Fisher's exact test, Mann-Whitney/Kruskal-Wallis tests, and logistic regression.

Results: Depression was highly prevalent across all CRD categories: 83%, 89%, 84%, and 93% in obstructive, restrictive, infectious, and other respiratory disease categories, and severe depression in 16%, 18%, 14%, and 37%, respectively. Anxiety symptoms were also widespread (77-100%), with no significant differences across disease groups. Depression was significantly associated with older age (p < 0.001, OR 1.08) and anxiety symptoms (p < 0.001, OR 47.07). Female gender was linked to anxiety (p = 0.034, OR 4.17).

Conclusion: The high burden of depression and anxiety in ICU patients with CRDs underscores the need for routine psychiatric screening and integrated mental health care in critical-care settings.