The interplay between physical activity and the immune system has garnered significant attention, especially in the context of respiratory diseases. Understanding this relationship is crucial, given the global burden of respiratory conditions such as COVID-19, influenza, and other upper respiratory tract infections (URTIs). This proposal aims to explore how physical activity can serve as an immunity booster and its potential in treating immunopathological conditions in respiratory diseases. The COVID-19 pandemic has further underscored the importance of maintaining physical activity to mitigate the adverse effects of prolonged inactivity on the immune system. Immobilization due to hospitalization and quarantine can downregulate immune responses, making individuals more susceptible to severe outcomes from respiratory infections. This research has the potential to inform public health recommendations and clinical practices aimed at leveraging physical activity as a non-pharmacological intervention to boost immunity and manage respiratory diseases. By establishing a clear connection between exercise and immune function, this study will contribute to the development of holistic treatment approaches for respiratory conditions, ultimately improving patient outcomes and reducing healthcare burdens.
Abstract Background Idiopathic pulmonary fibrosis (IPF) is a group of chronic interstitial pulmonary diseases characterized by myofibroblast proliferation and extracellular matrix (ECM) deposition. However, current treatments are not satisfactory. Therefore, more effective therapies need to be explored. Cepharanthine (CEP) is a naturally occurring alkaloid that has recently been reported to have multiple pharmacological effects, particularly in chronic inflammation. Methods For in vivo experiments, first, a pulmonary fibrosis murine model was generated via tracheal injection of bleomycin (BLM). Second, the clinical manifestations and histopathological changes of the mice were used to verify that treatment with CEP might significantly reduce BLM-induced fibrosis. Furthermore, flow cytometric analysis was used to analyze the changes in the number of M2 macrophages in the lung tissues before and after treatment with CEP to explore the relationship between macrophage M2 polarization and pulmonary fibrosis. In vitro, we constructed two co-culture systems (THP-1 and MRC5 cells, RAW264.7 and NIH 3T3 cells), and measured the expression of fibrosis-related proteins to explore whether CEP could reduce pulmonary fibrosis by regulating macrophage M2 polarization and fibroblast activation. Results The results showed that the intranasal treatment of CEP significantly attenuated the symptoms of pulmonary fibrosis induced by BLM in a murine model. Our findings also indicated that CEP treatment markedly reduced the expression of fibrosis markers, including TGF-β1, collagen I, fibronectin and α-SMA, in the mouse lung. Furthermore, in vitro studies demonstrated that CEP attenuated pulmonary fibrosis by inhibiting fibroblast activation through modulating macrophage M2 polarization and reducing TGF-β1 expression. Conclusions This study demonstrated the potential and efficacy of CEP in the treatment of pulmonary fibrosis. In particular, this study revealed a novel mechanism of CEP in inhibiting fibroblast activation by regulating macrophage M2 polarization and reducing the expression of fibrosis-associated factors. Our findings open a new direction for future research into the treatment of pulmonary fibrosis.
Abstract Background The COVID-19 pandemic has escalated into a severe global public health crisis, with persistent sequelae observed in some patients post-discharge. However, metabolomic characterization of the reconvalescent remains unclear. Methods In this study, serum and urine samples from COVID-19 survivors (n = 16) and healthy subjects (n = 16) underwent testing via the non-targeted metabolomics approach using UPLC-MS/MS. Univariate and multivariate statistical analyses were conducted to delineate the separation between the two sample groups and identify differentially expressed metabolites. By integrating random forest and cluster analysis, potential biomarkers were screened, and the differential metabolites were subsequently subjected to KEGG pathway enrichment analysis. Results Significant differences were observed in the serum and urine metabolic profiles between the two groups. In serum samples, 1187 metabolites were detected, with 874 identified as significant (457 up-regulated, 417 down-regulated); in urine samples, 960 metabolites were detected, with 39 deemed significant (12 up-regulated, 27 down-regulated). Eight potential biomarkers were identified, with KEGG analysis revealing significant enrichment in several metabolic pathways, including arginine biosynthesis. Conclusions This study offers an overview of the metabolic profiles in serum and urine of COVID-19 survivors, providing a reference for post-discharge monitoring and the prognosis of COVID-19 patients.
Abstract Background We estimated combined protection conferred by prior SARS‐CoV‐2 infection and COVID‐19 vaccination against COVID‐19‐associated acute respiratory illness (ARI). Methods During SARS‐CoV‐2 Delta (B.1.617.2) and Omicron (B.1.1.529) variant circulation between October 2021 and April 2022, prospectively enrolled adult patients with outpatient ARI had respiratory and filter paper blood specimens collected for SARS‐CoV‐2 molecular testing and serology. Dried blood spots were tested for immunoglobulin‐G antibodies against SARS‐CoV‐2 nucleocapsid (NP) and spike protein receptor binding domain antigen using a validated multiplex bead assay. Evidence of prior SARS‐CoV‐2 infection also included documented or self‐reported laboratory‐confirmed COVID‐19. We used documented COVID‐19 vaccination status to estimate vaccine effectiveness (VE) by multivariable logistic regression by prior infection status. Results Four hundred fifty‐five (29%) of 1577 participants tested positive for SARS‐CoV‐2 infection at enrollment; 209 (46%) case‐patients and 637 (57%) test‐negative patients were NP seropositive, had documented previous laboratory‐confirmed COVID‐19, or self‐reported prior infection. Among previously uninfected patients, three‐dose VE was 97% (95% confidence interval [CI], 60%–99%) against Delta, but not statistically significant against Omicron. Among previously infected patients, three‐dose VE was 57% (CI, 20%–76%) against Omicron; VE against Delta could not be estimated. Conclusions Three mRNA COVID‐19 vaccine doses provided additional protection against SARS‐CoV‐2 Omicron variant‐associated illness among previously infected participants.
Background: Refugees in developing countries have poor access to Tuberculosis (TB) care and control services. The understanding of genetic diversity and drug sensitivity patterns of M. tuberculosis (MTB) is important for the TB control program. However, there is no evidence that shows the drug sensitivity profiles and genetic diversity of MTB circulating among refugees residing in Ethiopia. This study aimed to investigate the genetic diversity of MTB strains and lineages, and to identify the drug sensitivity profiles of MTB isolated from refugees residing in Ethiopia. Methods: A cross-sectional study was conducted among 68 MTB positive cases isolated from presumptive TB refugees from February to August 2021. Data and samples were collected in the refugee camp clinics and both rapid TB Ag detection and region of difference (RD)-9 deletion typing were used to confirm the MTBs. Drug susceptibility test (DST) and molecular typing were done using Mycobacterium Growth Indicator Tube (MGIT) method and spoligotyping respectively. Results: DST and spoligotyping results were available for all 68 isolates. The isolates were grouped into 25 spoligotype patterns, which consisted of 1–31 isolates with 36.8% strain diversity. The international shared type (SIT)25 was predominant spoligotype pattern consisting of 31 (45.6%) isolates, followed by SIT24 comprising 5 (7.4%) isolates. Further investigation showed that 64.7% (44/68) of the isolates were belonged to CAS1-Delhi family and 75% (51/68) of the isolates were belonged to lineage(L)-3. Multi-drug resistance (MDR)-TB was observed only in one isolate (1.5%) for first-line anti-TB drugs and the highest level of mono-resistance, 5.9% (4/68), was observed for PZA(Pyrazinamide). Mono-resistance was observed in 2.9 % (2/68) and while 97.0% (66/68) of the MTB positive cases were susceptible to the second-line anti-TB drugs. Conclusion: The findings are useful evidence for the TB screening, treatment and control in refugee populations and surrounding communities in Ethiopia.
Diseases of the respiratory system, Infectious and parasitic diseases
Abstract The importance of mindfulness in promoting mental health and well-being has been increasingly recognised in recent years. As a result, mindfulness-based interventions have been introduced to improve various aspects of life, including quality of life and social support. The aim of this study was to examine the effectiveness of a seven-week mindfulness-based workshop programme in improving quality of life and social support among participants in the intervention compared to a control group. A total of 257 participants (65+) were recruited and assigned to either the intervention group, which participated in the seven-week mindfulness-based workshop programme, or the control group, which received no intervention. The workshop programme combined two evidence-based programmes: The Chronic Disease Self-Management Programme (CDSMP) and the Mindfulness-based Living Programme. Participants completed two questionnaires (EQ-5D-5L and OSSS-3) to assess quality of life and social support before and after the intervention. Data were analysed using appropriate statistical tests to compare pre- and post-intervention outcomes between groups. The intervention group showed significant improvement in quality of life (p<.001) and social support scores (p = 0.002) after the seven-week mindfulness-based workshop programme. The control group, on the other hand, showed no significant changes in these measures. The significant improvement indicates the effectiveness of the mindfulness-based workshop programme. The results of this study show the positive effects of a seven-week mindfulness-based workshop programme on the quality of life and social support of older people. The results suggest that mindfulness-based interventions can be an effective tool for improving mental health and well-being by promoting quality of life and strengthening social support networks. Key messages • The seven-week mindfulness-based workshop programme improves the quality of life and social support of older people, which can have an impact on overall mental health and well-being in general. • The results of this study can ensure a sustainable impact on achieving better health outcomes and saving resources in the health care system through reduced and more effective use of services.
Mgsns Perera The legendary health, Sasc Karunarathna system of Sri Lanka, Vcn Vithana
et al.
Background: New variants of COVID-19 are emerging as part of the evolutionary cycle of the viruses. Therefore, a combination of positive behaviours is still endorsed to gain maximum protection from COVID-19. In this context, many behaviour-related models have been adopted to understand the behaviour dynamics of the disease. The MOA model is a well-known model used to understand consumer behaviour.Objectives: The aim of this study is to determine the motivation, opportunity and ability to perform key positive COVID-19 preventive behaviours among a sample of internet users to help to get an insight into future behavioural interventions in Sri Lanka.Methods: An online descriptive cross-sectional survey was conducted through the HPBSL official Viber channel to assess nine selected behaviours’ (Handwashing, Cough Etiquette, Avoid touching the face, Wearing face masks, Surface cleaning, Keeping a 1m distance, Avoiding crowds, Avoiding ill, Self-isolation) motivation, opportunity and ability during December 2020 to January 2021. A ten-point unipolar Likert behaviour scale was developed for the three selected attributes (motivation, opportunity and ability). An unrestricted self-selected survey sampling method was followed.Results: Out of the invitations sent, 475 respondents answered the survey giving response rate of 88.4%. The motivation, opportunity and ability were high for mask-wearing out of the selected nine behaviours. Overall, females had higher motivation for the selected nine behaviours. Even though motivation and ability are higher for washing hands, the opportunities are low for washing hands. Similar motivation, opportunity and ability were seen for cough etiquette. Furthermore, higher education qualifications and increasing age had higher motivation, opportunity, and ability than lower education qualifications and younger age groups.Conclusions and recommendations: The MOA model provides a good insight into the practicality of COVID-19 preventive behaviours in the field. The findings of this study can be used to implement successful behaviour change programmes at the field level in the future.
Janaka Akarawita Cover Story, VJ Meegoda, Emnt Nawarathna
et al.
Background: Patients diagnosed with COVID-19 demonstrate a wide spectrum of cutaneous manifestations, some of which are at a high prevalence. These manifestations, of which some are unique, have been considered to occur due to COVID-19 infection and the associated inflammatory response. Furthermore, there are reports on exacerbation of previously diagnosed dermatoses and cutaneous side effects of medications and vaccines administered.Methodology: The first phase of the study included a descriptive cross-sectional study conducted at the National Hospital of Sri Lanka (NHSL) among PCR-positive COVID patients to identify their skin conditions. Secondly, to ascertain an overall understanding of the country’s situation, a comprehensive questionnaire was circulated among the members of the Sri Lanka College of Dermatologists, to obtain information on the patients they have encountered.Results: Out of the patients at NHSL only 1.7% (n=8) had developed associated skin manifestations. Two (0.4%) developed novel conditions: thrombophlebitis and a maculopapular exanthem. Six (1.3%) patients had exacerbation of pre-existing conditions including eczema, psoriasis and discoid lupus erythematosus. The dermatologists revealed a wide variety of manifestations with the majority experiencing an exacerbation of pre-existing conditions and a few developing novel lesions including COVID-toes and Kawasaki-like diseases in children which are considered specific for COVID-19.Conclusions: The study demonstrates a range of COVID-19-associated dermatoses. These can present before or with other COVID-19 symptoms. Further, studies are necessary to precisely determine the timing and pathophysiology of different manifestations. Dermatological findings are important and should prompt the early involvement of dermatologists as appropriate.
Catherine Mugide, Gilbert Gilibrays Ocen, Timothy Omara
et al.
Abstract Objective Diseases such as avian influenza, infectious laryngotracheitis and Mycoplasma gallisepticum responsible for huge losses in poultry target the respiratory system of birds. The aim of this study was to design and assemble a system which can be used to detect respiratory diseases among chicken basing on the abnormal vocalization and temperature of chicken. Results The proposed system was assembled and operated in a way that the acoustic and thermal sensors acquire sound and temperature from the chicken environment, sends them to a microcontroller which then interprets the input and in case of abnormal sounds or temperature due to cough or snore, the system administrator and the farmer are notified. The results illustrated that the system could be used to improve the detection of respiratory disease outbreaks in chicken, which can potentially minimize losses in poultry farming.
Relevance. Acute respiratory diseases (ARD) refer to mass infectious diseases, cause significant economic damage by provoking the development of diseases of the circulatory system, and the seasonal incidence of ARI is a predictor of mortality from cardiovascular diseases, which requires timely statistical accounting using the medical information system (MIS).The aim of the study was to quantitatively assess the risk of exposure to ARIs on the occurrence of diseases of the circulatory system using statistical data processing using MIS.Materials and methods. The epidemiological study was carried out in the design of a retrospective analytical cohort study of cases of temporary disability in the adult population, using statistical and analytical methods with the identification of a causal relationship using MIS, which provides the primary collection, storage, selection and grouping of data on the incidence of patients, with subsequent calculations of the relative risk and its 95% confidence interval.Results and discussion. Using the MIS, 88,735 cases of incapacity for work issued for the period from 2014 to 2019 were recorded and analyzed. Thanks to the reference architecture of the MIS, a sample of patients with acute respiratory infections was carried out, and their subsequent grouping according to the incidence rate into the main and control groups. The main group (frequently ill) was represented by patients who were ill more than 3 times per season, and the control group (rarely ill) was represented by patients who were ill from 1 to 2 times per season. The sample consisted of 4,980 patients, of which 1,461 were the main group and 3519 were the control group. A statistically significant relationship was revealed between the incidence of ARI and the development of angina pectoris with documented spasm (I20.1), chronic ischemic heart disease (I25.1), cerebrovascular disease (I67.9), atherosclerosis of the arteries of the extremities (I70.2), phlebitis and thrombophlebitis (I80), varicose veins of the lower extremities (I83), as well as hemorrhoids (I84).Conclusions. The introduction into the practice of MIS, which has a predominantly reference architecture, will optimize the epidemiological surveillance of infectious and non-infectious diseases, using the statistical registration of cases of temporary disability, mortality and hospitalization for taking timely and effective anti-epidemic and preventive measures.
Takashi Ishiguro, Kenji Takano, Naho Kagiyama
et al.
Objective: To clarify what future problems must be resolved and how clinical findings of SARS-CoV-2 infection differ from those of cHCoV infection. Methods: Patients and Methods Clinical characteristics of 14 patients with laboratory-confirmed Coronavirus disease 2019 (COVID-19) and 5 patients with cHCoV pneumonia admitted to our institution and treated up to March 8, 2020, were retrospectively analyzed. Results: On admission, 10 patients had pneumonia, 5 of whom had pulmonary shadows detectable only via computed tomography (CT). During hospitalization, another patient with no pulmonary shadows on admission developed pneumonia. In total, 11 (78.6%) of the 14 patients developed pneumonia, indicating its high prevalence in COVID-19. During hospitalization, the patients' symptoms spontaneously relapsed and resolved, and gastrointestinal symptoms were frequently found. C-reactive protein values showed correlation with the patients’ clinical courses. Ritonavir/lopinavir were administered to 5 patients whose respiratory conditions worsened during admission, all of whom improved. However, the pneumonia in the 6 other patients improved without antivirals. None of the 14 patients died, whereas 5 other patients with cHCoV pneumonia were in respiratory failure on admission, and one patient (20%) died. Conclusion: Both SARS-CoV-2 and cHCoV can cause severe pneumonia. Problems for future resolution include whether antiviral agents administered in cases of mild or moderate severity can reduce the number of severe cases, and whether antivirals administered in severe cases can reduce mortality.
Michela D’Ascanio,1 Fausta Viccaro,1 Noemi Calabrò,1 Giulio Guerrieri,1 Claudia Salvucci,1 Dario Pizzirusso,1 Rita Mancini,1 Claudia De Vitis,1 Aldo Pezzuto,2 Alberto Ricci1 1Department of Clinical and Molecular Medicine, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy; 2Department of Cardiovascular and Respiratory Sciences, Sant’Andrea Hospital, Rome, ItalyCorrespondence: Michela D’Ascanio Via di Grottarossa 1035/1039, Roma 00189, RM, ItalyTel +390633776768Email dascaniomichela87@gmail.comPurpose: Lung hyperinflation is a feature of chronic obstructive pulmonary disease (COPD) and can determine pivotal consequence on symptoms, exercise tolerance and quality of life. Despite the relevance of assessing lung hyperinflation, there is still no single consensus as to what volume should be taken into account. We investigate which spirometric measurement is more reliable in assessing static lung hyperinflation and which is more related with impulse oscillometry system (IOS) measurements in COPD.Patients and Methods: Fifty-five COPD patients were enrolled. TLC, RV and RV:TLC ratio were obtained both with helium and plethysmography techniques. IOS measurements (X5, Fres and R5-R20) were performed. Pearson and Spearman correlation determined the relationships between the functional parameters that evaluate static hyperinflation (RV: TLC, TLC, RV) and IOS measurements.Results: As expected, we reported a statistically significant difference between these two techniques in terms of mean percentage values of TLC (7.57 ± 3.26 L; p= 0.02) and RV (15.24 ± 7.51 L; p=0.04), while RV:TLC measured with the two methods was similar (5.21 ± 4.69%; p=0.27). The correlation analysis showed that IOS parameters, such as difference in resistance between 5 Hz and 20 Hz (R(5– 20)) and resonant frequency (Fres), were positively correlated with RV:TLC ratio, while reactance at 5 Hz (X(5)) was negatively correlated with it. In particular, we pointed out a weak correlation between RV:TLC (%) (Pleth) and R(5– 20) (r=0.3, p=0.04), Fres (r=0.3; p=0.03), while X5 had a mild correlation with RV:TLC (%) (r=− 0.5;p< 0.0001). Moreover, we noticed a strong relationship between RV:TLC (%)(He) and X5 (r=− 0.7; p=0.0001) and a mild correlation between RV:TLC (%) (He) and Fres (r=0.4; p=0.003). Between R5-R20 and RV:TLC, there was a weak correlation (r=0.3; p=0.001). No correlation between TLC, RV (L,%) (both helium and Pleth derived) and IOS parameters (R(5– 20), X5, Fres) was found.Conclusion: RV:TLC can represent the most reliable parameter in the assessment of hyperinflation, considering the absence of significant difference in its measurement between the two techniques. IOS provides supplementary information in the assessment of static hyperinflation.Keywords: hyperinflation, COPD, IOS
The SARS-CoV-2 can lead to severe illness with COVID-19. Outcomes of patients requiring mechanical ventilation are poor. Awake proning in COVID-19 improves oxygenation, but on data clinical outcomes is limited. This single-centre retrospective study aimed to assess whether successful awake proning of patients with COVID-19, requiring respiratory support (continuous positive airways pressure (CPAP) or high-flow nasal oxygen (HFNO)) on a respiratory high-dependency unit (HDU), is associated with improved outcomes. HDU care included awake proning by respiratory physiotherapists. Of 565 patients admitted with COVID-19, 71 (12.6%) were managed on the respiratory HDU, with 48 of these (67.6%) requiring respiratory support. Patients managed with CPAP alone 22/48 (45.8%) were significantly less likely to die than patients who required transfer onto HFNO 26/48 (54.2%): CPAP mortality 36.4%; HFNO mortality 69.2%, (p=0.023); however, multivariate analysis demonstrated that increasing age and the inability to awake prone were the only independent predictors of COVID-19 mortality. The mortality of patients with COVID-19 requiring respiratory support is considerable. Data from our cohort managed on HDU show that CPAP and awake proning are possible in a selected population of COVID-19, and may be useful. Further prospective studies are required.
Cyclic AMP (cAMP) is involved in many biological processes but little is known regarding its role in shaping immunity. Here we show that cAMP-PKA-CREB signaling (a pattern recognition receptor [PRR]-independent mechanism) regulates conventional type-2 Dendritic Cells (cDC2s) in mice and reprograms their Th17-inducing properties via repression of IRF4 and KLF4, transcription factors essential for cDC2-mediated Th2 induction. In mice, genetic loss of IRF4 phenocopies the effects of cAMP on Th17 induction and restoration of IRF4 prevents the cAMP effect. Moreover, curdlan, a PRR-dependent microbial product, activates CREB and represses IRF4 and KLF4, resulting in a pro-Th17 phenotype of cDC2s. These in vitro and in vivo results define a novel signaling pathway by which cDC2s display plasticity and provide a new molecular basis for the classification of novel cDC2 and cDC17 subsets. The findings also reveal that repressing IRF4 and KLF4 pathway can be harnessed for immuno-regulation.
Amit Dhamija, Saurabh Goyal, Abhinav Guliani
et al.
Background: Drug resistance in tuberculosis (TB) is a major public health problem. It is easy to assess for drug resistance in pulmonary samples, but the resistance pattern of TB in the mediastinal nodes has not been studied. The aim of this study is to assess the incidence of multidrug resistance in tubercular mediastinal adenopathy with the help of endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration. Materials and Methods: This was a prospective study at a tertiary care teaching hospital in New Delhi where 102 patients with positive mycobacterial cultures from mediastinal lymph node aspirates taken with the help of EBUS were enrolled over 24 months and their drug sensitivity to the first-line antitubercular drugs analyzed. Results: There were 30 cases of drug resistance of 102 culture-positive cases. Of them, 8 patients had multidrug resistant TB (MDR-TB), 16 cases had only single drug resistance, and the remaining 6 cases had more than one drug resistance pattern but not MDR. In our study, the overall incidence of MDR-TB is 7.8% (8/102), although the incidence of MDR-TB in new and re-treatment cases is 2.2% (2/89) and 46.1% (6/13), respectively. Conclusion: Such a high percentage of drug-resistant patients is common in tertiary care hospitals; however, similar percentages may be found in other settings as well. Therefore, all efforts should be made to take samples for Mycobacterium tuberculosis culture from the involved nodes before commencing therapy to avoid treatment failures.
Background
Tobacco use is a major preventable cause of
premature death and diseases. India is the second largest consumer of tobacco in the world. About 29% of adults use tobacco on a daily basis and
an additional 5% use it occasionally. This study is contemplated with an aim to assess the prevalence of
tobacco consumption and the associated factors involved in its consumption, as
this group of the population is under constant pressure and account for the
workforce of the country.
Methods
A Cross sectional descriptive study was
conducted among Auto Rickshaw Drivers in Chennai City, who were
working for more than two years and present on the day of examination and who
were willing to participate in the study were included. Cluster random sampling
technique was used. 400 samples were selected from 40 auto stands. Data was collected using a Survey Proforma which comprised
of a Questionnaire which can assess the frequency of consumption, age of
initiation, the amount of consumption, mental stress, economic factors, any
past history of disease and most importantly the awareness towards oral cancer.
Results
Prevalence among auto rickshaw drivers for consumption of tobacco
products was very high (87%). Auto rickshaw drivers were mostly used tobacco in
the form of Gutkha (72%) and bidi (40%) in comparison to other products. It
also shows that they use cheap tobacco products. Awareness level among auto rickshaw driver was high (70%) but still uses
tobacco products because of its addiction (66%). In the opinion of auto
rickshaw drivers increase in tax may reduce it consumption and the majority of
drivers (70%) think that tobacco must be banned.
Conclusions
Prevalence of tobacco use among auto rickshaw drivers was very high. Many were suffering from tobacco
related diseases like cough, ulcer on mouth, lung disorder. They are in
definite need of tobacco cessation activities.
Diseases of the respiratory system, Neoplasms. Tumors. Oncology. Including cancer and carcinogens