Hasil untuk "Diseases of the respiratory system"

Mandeep Chouhan, Mukesh Kumar, Vivek Dhar Dwivedi et al.

Dormancy occurs when <i>Mycobacterium tuberculosis</i> (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.

Xinmei Zhou, Ailifeire Aihemaiti, Anqi Cheng et al.

Introduction Smoking has been identified as a potential risk factor for adverse COVID-19 outcomes. This study aimed to investigate the association between long-term smoking cessation and COVID-19 outcomes. Methods In this nationwide, cross-sectional online survey conducted in China (January–February 2023), 22709 adults with COVID-19, confirmed by nucleic acid amplification test (NAAT) or SARS-CoV-2 antigen testing, were included. Smoking status was self-reported and classified as never smokers, long-term exsmokers (≥10 years), ex-smokers (<10 years), and current smokers. COVID-19 outcomes, including pneumonia, hospitalization, and severe COVID-19, were compared across these groups. Logistic regression models were used to adjust for potential confounders. Sensitivity analyses included all self-reported cases irrespective of test confirmation. Results Among 22709 COVID-19-positive participants, current smokers and ex-smokers <10 years exhibited significantly higher proportion of pneumonia, hospitalization, and severe COVID-19 than never smokers. Current smokers (AOR=3.18; 95% CI: 2.90–3.48) and ex-smokers quit <10 years (AOR=3.48; 95% CI: 2.96–4.09) had increased odds of pneumonia, whereas long-term ex-smokers showed no elevated risk (AOR=1.12; 95% CI: 0.45–2.41). These associations were consistent in sensitivity analyses. Other factors significantly associated with pneumonia included sex, education level, residence, obesity, income, and chronic conditions. Conclusions Long-term smoking cessation was not associated with an elevated risk of COVID-19-related pneumonia compared to never smokers, whereas exsmokers (<10 years) and current smokers remained high-risk groups. These findings support the potential benefits of sustained cessation, although further longitudinal studies are needed to confirm and extend these findings.

Pramitasri Bhattacharyya, Priyanka Ghosh, Aparup Dhua et al.

Context: Tuberculosis (TB) remains a significant global health issue, with a mortality of 23 per lakh population despite treatment efforts. Identifying factors contributing to TB-related deaths is essential for improving outcomes. Aims: This study aims to identify factors associated with TB-related mortality in patients undergoing anti-tubercular drug (ATD) treatment at a tertiary care center in West Bengal, India, from April 2024 to February 2025. Settings and design: A descriptive observational study was conducted at a tertiary care center, including 45 TB patients who died during ATD treatment.Methods and material: Data were collected from hospital records, TB treatment cards, death review forms, and minutes of TB death surveillance and review meetings. Factors like demographics, TB type, comorbidities, and treatment delays were analyzed.Statistical analysis used: Descriptive statistics and logistic regression were used to analyze associations between factors and TB-related mortality. Results: Of the 45 patients, 16 (35.56%) died from TB-related complications. Significant associations were found between prior ATD intake (odds ratio = 24.939 [95% confidence interval 1.437–432.768], P = 0.027) and age (median age 54 years vs. 36.5 years, P = 0.010) with mortality. No significant relationships were found with gender, TB type, comorbidities, or treatment delay. Conclusions: Prior ATD intake and older age were key factors in TB-related mortality, highlighting the need for targeted monitoring of high-risk patients. Further research is needed to explore additional contributing factors.

Lise Hommelgaard, Michael Perch, Elisabeth Bendstrup

Castlemann disease (CD) is a rare but often benign condition of the lymph nodes. Seldomly coinciding with CD are other conditions, such as paraneoplastic phemhigus (PMP) and bronchiolitis obliterans (BO). When these occur, patients are at risk of developing severe complications, such as respiratory failure, which may subsequently result in death. Diagnosing and managing conditions related to CD poses a challenge and may cause diagnostic delay. In this case report, we describe the course of illness in a 31-year-old female diagnosed with CD. Prior to the diagnosis of CD, the patient had been diagnosed with both paraneoplastic phemfigus and an irreversible airway obstruction. Standard surgical treatment for CD, as well as standard medical treatment for airway obstruction, had little effect. Radiologic findings supported the diagnosis of bronchiolitis obliterans. A progressive decline in pulmonary function eventually led to the patient being evaluated for and undergoing lung transplantation. The co-occurrence of CD and PMP has previously been described as increasing the risk of developing BO, irreversible pulmonary function restrictions and poor prognosis. Lung transplant may be a possible treatment for some patients with terminal respiratory failure.

Yeping Sun

The airway epithelial barrier (AEB) is a dynamic interface that maintains respiratory homeostasis. Complex networks of epithelial cells, intercellular junctions, and immune constituents support the structural and functional integrity of the AEB. This review synthesizes how the respiratory exposome components disrupt AEB physiology by compromising junctional integrity, triggering oxidative stress, and inducing inflammation. The review further analyzes how these perturbations lead to maladaptive responses in chronic respiratory diseases (CRDs) and the effectiveness of emerging biologics targeting epithelial-derived alarmins in treating CRDs. By integrating exposome science with epithelial physiology, we provide a unified framework for understanding environmental impacts on airway health.

Robert Sheehy, Samuel McCormack, Caitlin Fermoyle et al.

Background Interstitial lung disease (ILD) encompasses a heterogeneous group of chronic lung conditions with considerable variability in prognosis and response to treatment. People with reduced muscle mass and function, known as sarcopenia, have a higher risk of mortality and adverse clinical outcomes both in the general population and in other chronic disease states. The importance of sarcopenia across the spectrum of patients with ILD is not well established. Objectives In this narrative review, we explore the prevalence and clinical implications of sarcopenia in patients with ILD, evaluate the optimal methods to diagnose sarcopenia in this patient population and review treatment interventions. Findings Almost one third of patients with chronic forms of ILD have evidence of sarcopenia. Sarcopenia is associated with adverse clinical outcomes and increased risk of mortality in select populations with ILD. Screening tests such as the SARC-F (strength, assistance walking, rise from a chair, climb stairs, falls) questionnaire and clinical assessment tools (including grip strength dynamometry) are well validated. Medical imaging modalities, including computed tomography, are hampered by lack of a gold standard and normative values, but have been used in patients with ILD in acute care and research settings. If sarcopenia is identified, multidimensional interventions such as pulmonary rehabilitation are beneficial. Conclusion Sarcopenia is common in patients with ILD and is associated with poorer outcomes. Accordingly, if identified, targeted interventions should be considered. Validated diagnostic criteria exist, but the optimal use of medical imaging techniques in this patient cohort remains an area of uncertainty.

Babu Ram, Valliappan Muthu, Inderpaul S Sehgal et al.

Jae-Hyeong Park, Jin Oh Na, Jae Seung Lee et al.

Pulmonary hypertension (PH) is a condition of increased blood pressure in the pulmonary arteries and is diagnosed with an increased a mean pulmonary artery pressure ≥25 mm Hg. This condition may be associated with multiple clinical situations. Based on pathophysiological mechanisms, clinical presentation, hemodynamic profiles, and treatment strategies, the patients were classified into five clinical groups. Although there have been major advances in the management of PH, it is still associated with significant morbidity and mortality. The diagnosis and treatment of PH have been performed mainly by following European guidelines, even in Korea because the country lacks localized PH guidelines. European treatment guidelines do not reflect the actual status of Korea. Therefore, the European diagnosis and treatment of PH have not been tailored well to suit the needs of Korean patients with PH. To address this issue, we developed this guideline to facilitate the diagnosis and treatment of PH appropriately in Korea, a country where the consensus for the diagnosis and treatment of PH remains insufficient. This is the first edition of the guidelines for the diagnosis and treatment of PH in Korea, and it is primarily based on the ‘2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension.’ with the acceptance and adaptation of recent publications of PH.

Sawadkar Mrudula M., Nayak Varun R

Matthias Welsner, Wolfgang Gruber, Uwe Mellies et al.

Background. Regular physical activity plays an important role in the treatment of patients with cystic fibrosis (CF). This study is aimed at investigating the effects of a 12-month partially supervised exercise program on attributes of health-related and motor performance fitness, lung function (ppFEV1), BMI, and habitual physical activity (HPA, steps/day) in adults with CF. Methods. Attributes of health-related and motor performance fitness were examined at the beginning (T0), after 6 (T1), and 12 months (T2) on the basis of five test items: forward bend (FB), bent knee hip extension (HE), plank leg raise (PLR), standing long jump (SLJ), and standing on one leg (OLS). Additionally, we recorded HPA by accelerometry, peak exercise performance (Wpeak) by an incremental cycle test, ppFEV1, and BMI. During the first six months, there was close supervision by an experienced sport therapist. Results. 26 CF patients (8 female, mean age 26.5±7.9 years; ppFEV1 53.7±21.0) completed the exercise program. Significant improvements were recorded from T0 to T1 (FB: p≤0.05; PLR, OLS: p≤0.01) and from T0 to T2 (FB, PLR: p≤0.01 and HE, OLS: p≤0.05). Wpeak, ppFEV1, BMI, and HPA showed no significant improvement between the single test points and over the entire study period (all p>0.05). Conclusion. Our results show trainability of adults with CF in aspects of health-related and motor performance fitness during a partially supervised exercise program. Close supervision positively influences the results. Using a simple test setup seems to be a promising tool for evaluating the effects of exercise programs in CF and could serve as an additional outcome parameter in future clinical trials. Trial registration: ClinicalTrials.gov (retrospectively registered May 8, 2018).

The Fellows of the Collegium Ramazzini

Background: Workers whose occupations put them in contact with infected persons and the public are at increased risk of COVID-19 infection. Recommendations: The Collegium Ramazzini calls on governments at all levels to protect worker health by strengthening public health systems; maintaining comprehensive social insurance systems; establishing policies that presume all COVID-19 infections in high-risk workers are work-related; enforcing all occupational health standards; and developing pandemic preparedness plans. The Collegium Ramazzini calls on all employers – large and small, public and private – to protect the health of all workers by developing disease preparedness plans; implementing basic infection control measures; establishing disease identification and isolation policies; reducing hazardous exposures; supporting personal protective equipment (PPE) programs; and restricting unnecessary travel. Conclusion: Governments and employers have legal obligations to protect worker health. They are not relieved of these duties during pandemics.

M. Zahari, V. Offeddu, M.K.Y. Mah et al.

Elena Insley, Chad Pezzano, Shashikanth Ambati et al.

There is paucity of literature regarding the use of esophageal balloon manometry in the management of Pediatric Acute Respiratory Distress Syndrome. We describe our first ever experience of successful usage of esophageal balloon pressure manometry in a child with acute respiratory distress syndrome. This is a six-year-old girl who presented with shortness of breath and fever and was found to be in severe acute respiratory distress syndrome due to septic shock secondary to group A streptococcus. The patient was managed using an esophageal balloon manometry for positive end-expiratory pressure titration. She was liberated from invasive mechanical ventilation on day 7 of hospital course. Esophageal balloon manometry guided positive end-expiratory pressure for 103 out of 155 hours of ventilation with no obvious sequelae. Our case shows the feasibility of transpulmonary pressure measurements in pediatric patients. This practice may be useful to optimize management in pediatric acute respiratory distress syndrome to improve outcomes.

K. A. Glebov, V. A. Guseva, I. A. Burmistrova et al.

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Daisuke Minami, Yuki Takigawa, Hiroe Kayatani et al.

A 46‐year‐old male with a superior mediastinal mass presented with a one‐month history of hoarseness and chest pain and was referred to our hospital. Although endobronchial, ultrasound‐guided, transbronchial needle aspiration (EBUS‐TBNA) was initially performed, we could not obtain an adequate specimen because of his severe cough and an inadequate EBUS view. During the same endoscopic session, we performed endoscopic, ultrasound‐guided, bronchoscopic fine‐needle aspiration (EUS‐B‐FNA) via a transoesophageal approach using the BF‐UC290F (Olympus, Tokyo, Japan), a third‐generation EBUS‐TBNA endoscope. The BF‐UC290F enabled smooth access through the oesophagus and a clear EBUS view of the mass, attributable, respectively, to the compact distal tip and the powerful angulation. Rapid on‐site cytology revealed that an adequate specimen had been obtained, and we terminated the procedure without inducing a severe cough. Histologically, the mass was a squamous cell carcinoma. EUS‐B‐FNA employing the BF‐UC290F was useful to diagnose the superior mediastinal mass.

A. Reese, Claudette Fonshell, Serge Ginzburg et al.

G. V. Panov, S. N. Andreevskaya, E. E. Larionova et al.

Goal of the study: to identify profile of mutations of tuberculous mycobacteria responsible for resistance to anti-tuberculosis drugs in HIV positive and HIV negative tuberculosis patients without prior history of treatment.Materials and methods. 165 strains of tuberculous mycobacteria from HIV positive patients and 166 strains of tuberculous mycobacteria from HIV negative patients were studied in Sverdlovsk Region (TB Dispensary, Yekaterinburg). Mutations in genes were identified using microchips of TB-BIOCHIP® and TB-BIOCHIP®-2 in compliance with the manufacturer's guidelines (OOO Biochip-IMB, Moscow).Results. It was observed that 85/165 (51.52%) strains isolated from HIV positive tuberculosis patients and 58/166 (34.94%) strains isolated from tuberculosis patients not associated with HIV possessed MDR genotype (p &lt; 0.01). The majority of MDR strains had mutations in the 531th codon of rpoB (Ser→Leu) and 315th codon of katG (Ser→Thr) (64/85, 75.29% and 38/58, 65.52% respective the groups), resulting in the high level of resistance to rifampicin and isoniazid. Each group also had approximately equal ratio (11/165, 6.67% and 12/166, 7.23% respective the groups) of strains with genomic mutations defining the resistance to isoniazid, rifampicin and fluoruquinolones. No confident difference was found in mutation patterns of genome of tuberculous mycobacteria isolated from HIV positive and HIV negative tuberculosis patients.

Rayshell Dhandoolal, Shivanni De Gannes, Andrew Dhanoolal et al.

Currently, evidence concerning electronic cigarette (e-cigarette) use in the West Indies is unavailable. This study examines the prevalence and associated factors of e-cigarette use in young Trinidadian adults, 6 years after e-cigarettes were introduced in Trinidad. Young adults between the ages of 18 and 40 years were surveyed from May–June 2016. Based on the survey results, descriptive statistics and logistic regression models were used to identify correlations in e-cigarette use. The prevalence of those who had used e-cigarettes was 24.6%, and 41.9% of these people had used both e-cigarettes and tobacco cigarettes. A high proportion (16.95%) of those who had never used tobacco cigarettes had used e-cigarettes. Males were twice as likely as females to have used e-cigarettes (odds ratio [OR]: 2.60; 95% confidence interval [CI]: 1.85–3.68), and participants aged 18–25 years were more likely than those aged 36–40 years to use e-cigarettes (OR: 0.37; 95% CI: 0.14–0.81). The predictors of e-cigarette use as assessed by univariate analysis were current tobacco cigarette smoking (OR: 9.34; 95% CI: 6.14–14.39; p<0.001) and the belief that e-cigarettes are dangerous to health (OR: 0.61; 95% CI: 0.44–0.85; p=0.004). The predictors as assessed by multivariate logistic regression (adjusted OR) were ethnicity (p=0.043), education (p=0.012), and age group (p=0.007). Those who quit using tobacco cigarettes were 7.98 times more likely to use e-cigarettes (95% CI: 4.21–15.45), and those who knew that e-cigarettes contain nicotine were 2.70 times more likely to use them (95% CI: 1.53–4.86; p<0.001). Two summative scales were constructed that measured knowledge and perception. The perception scale, but not the knowledge scale (Cronbach’s alpha=0.736), was a significant predictor of e-cigarette use. The number of e-cigarette users is high (24.6%) in young adults in Trinidad and in those who have never smoked tobacco (16.95%). Current smokers, as well as those who have quit smoking, are at an increased risk of e-cigarette use. This study established that young adults have a low level of knowledge regarding e-cigarettes and shows that they should be educated on e-cigarette use. Further research to examine the reasons for, and susceptibility to, e-cigarette use is necessary.

Glencora Sharfman, Ursula K. Braun

Mirrakhimov Aibek E, Sooronbaev Talant, Mirrakhimov Erkin M

<p>Abstract</p> <p>Background</p> <p>Obstructive sleep apnea (OSA) is a common disease, affecting approximately 2% of women and 4% of men residing in Western communities. No systematically reviewed data are available about the prevalence of this disease in Asia, the most heavily populated continent.</p> <p>Methods</p> <p>PubMed/Medline, Scopus and Google Scholar were searched for articles published from 1993 to May 2012 that reported the prevalence of OSA diagnosed via sleep monitoring and the prevalence of patients at risk for OSA as assessed by symptomatology and/or sleep questionnaires. We have also searched abstract database of major pulmonary and sleep scientific societies for relevant abstracts presented from 2010 to 2012. The following inclusion criteria were used: articles published in English, age ≥ 18 years, ≥ 100 participants in studies using sleep monitoring for the diagnosis of OSA, ≥ 300 participants in studies using questionnaires to detect patients at high risk for OSA. Exclusion criteria: duplicate publications, studies reporting the prevalence of central sleep apnea only, hospital based studies as well as studies assessing OSA prevalence among patients with resistant arterial hypertension, chronic kidney disease, heart failure and in patients with concomitant neurological disease.</p> <p>Results</p> <p>Twenty four articles were found to meet the inclusion criteria, covering 47,957 subjects (26,042 men and 21,915 women) and four relevant abstracts were noted. OSA prevalence ranged from 3.7% to 97.3%. Male gender, older age, a higher BMI and waist to hip ratio, greater neck circumference, arterial hypertension, smoking, snoring and daytime sleepiness were associated with OSA. Sample size, difference between the populations studied and the fact that some works included patients with a high pre-test probability of OSA explain the difference in prevalence rates.</p> <p>Conclusion</p> <p>This systematic review highlights the lack of data regarding the prevalence of OSA in Asians. Only a few studies provide an approximate estimate of the OSA burden in some Asian communities.</p>