Olivia Foley, Natalie Perme, Taylor Billion
et al.
Abstract Background Tuberculosis (TB) is a significant cause of mortality in the United States (US), impairing individual health and causing national financial burden. Although TB-related mortality has declined in recent years, a variety of factors still make TB difficult to prevent, necessitating further analysis of which demographic groups are most impacted by TB. Methods Trends in TB-related mortality in individuals aged 35 to 85 + years in the US from 1999 to 2022 were analyzed utilizing the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database. Following data collection, age-adjusted mortality rate (AAMR) and average annual percent change (AAPC) in TB-related mortality were examined. Data was further stratified by sex, race, age, region, and locality. Results Between 1999 and 2022, there were 26,600 deaths related to TB in the US. Overall TB-related mortality significantly declined between 1999 and 2022 (AAPC, -3.95%). Males had consistently higher AAMR than females, with 16,741 deaths among males and 9,859 deaths among females. All racial groups, including Asian or Pacific Islander, Black or African American, White, and Hispanic or Latino individuals experienced significant declines in mortality (AAPC, -3.24%, -5.75%, -3.83%, -4.70%, respectively). Asian or Pacific Islander, Black or African American, and Hispanic or Latino patients had consistently higher AAMR than White patients between 1999 and 2022, however. Individuals older than 65 experienced significantly higher AAMR than younger individuals. South and West regions had higher AAMR than Northeast and Midwest regions, with the West and South experiencing the smallest and largest declines in mortality that were statistically significant, respectively (AAPC, -3.04%, -4.66%). TB-related mortality was higher in urban areas, with 20,680 deaths compared to 3,707 deaths in rural areas. Conclusion Although TB-related mortality has declined in the US overall, this improvement has not been experienced equally by all demographic groups.
Nocardia pneumonia is rare in immunocompetent hosts. Here, we present a case of a woman who presented to us with a chronic cough, fever, and weight loss of 2 months duration. Chest X-ray showed nonhomogenous opacity. CT thorax showed a mass-like lesion in the right upper lobe. A bronchoscopy was done, and washings taken from the affected lobe confirmed it to be a case of Nocardia pneumonia. She responded well to 6 months of therapy of trimethoprim/sulfamethoxazole with an initial 1-month intensive phase of intravenous Imipenem along with it.
ABSTRACT Occult bronchial foreign bodies are extremely rare in adults. Affected patients typically lack a clear history of aspiration, exhibit no characteristic clinical signs and present with unremarkable chest imaging, often leading to misdiagnosis or missed diagnosis. This paper reports a case of an adult patient with occult bronchial foreign body aspiration that was initially misdiagnosed as pulmonary sequestration. An enhanced chest computed tomography and bronchial arteriography performed at another hospital failed to detect the foreign body. However, contrast‐enhanced chest CT at the respiratory department of our hospital revealed a suspected foreign body along with left lower lobe atelectasis. Endobronchial ultrasound thereafter confirmed complete occlusion of the left lower lobe bronchus with scar hyperplasia. Multiple retrieval attempts were unsuccessful, necessitating referral to the thoracic surgery department for thoracoscopic left lower lobectomy and bronchial foreign body removal. This case highlights the rarity of surgical intervention for occult bronchial foreign bodies complicated by recurrent pneumonia and bronchopulmonary abnormalities.
Background:
Home oxygen therapy (HOT) improves survival in patients with hypoxaemic chronic respiratory disease. Most patients evaluated for HOT are former or active smokers. Oxygen accelerates combustion and smoking may increase the risk of burn injuries and fire hazards; therefore, it is considered a contraindication for HOT in many countries. However, there is variability in the practices and policies regarding this matter. This multidisciplinary Swedish taskforce aimed to review the potential benefits and risks of smoking in relation to HOT, including medical, practical, legal and ethical considerations.
Methods:
The taskforce of the Swedish Respiratory Society comprises 15 members across respiratory medicine, nursing, medical law and ethics. HOT effectiveness and adverse risks related to smoking, as well as practical, legal and ethical considerations, were reviewed, resulting in five general questions and four PICO (population–intervention–comparator–outcome) questions. The strength of each recommendation was rated according to the GRADE (grading of recommendation assessment, development and evaluation) methodology.
Results:
General questions about the practical, legal and ethical aspects of HOT were discussed and summarised in the document. The PICO questions resulted in recommendations about assessment, management and follow-up of smoking when considering HOT, if HOT should be offered to people that meet the eligibility criteria but who continue to smoke, if a specific length of time of smoking cessation should be considered before assessing eligibility for HOT, and identification of areas for further research.
Conclusions:
Multiple factors need to be considered in the benefit/risk evaluation of HOT in active smokers. A systematic approach is suggested to guide healthcare professionals in evaluating HOT in relation to smoking.
Mei-Yu Lv,1,2 Ling-Ling Jin,2,3 Xi-Qiao Sang,2 Wen-Chao Shi,2 Li-Xia Qiang,2 Qing-Yan Lin,4 Shou-De Jin2 1Department of Respiratory Medicine, Harbin Medical University Cancer Hospital, Harbin, 150001, People’s Republic of China; 2Department of Respiratory Medicine, the Fourth Affiliated Hospital of Harbin Medical University, Harbin, 150001, People’s Republic of China; 3Department of Critical Care medicine, the Second Affiliated Hospital of Xi ‘an Jiaotong University, Xi’an, Shaanxi, China; 4Department of Respiratory Medicine, Heilongjiang Provincial Hospital, Harbin, 150001, People’s Republic of ChinaCorrespondence: Shou-De Jin, Department of Respiratory Medicine, The Fourth Affiliated Hospital of Harbin Medical University, No. 37 Yiyuan Street, Nangang District, Harbin, 150001, People’s Republic of China, Tel/Fax +86 0451-85939123, Email jinshoude@163.comPurpose: The typical characteristic of COPD is airway remodeling, affected by environmental and genetic factors. However, genetic studies on COPD have been limited. Currently, the Abhd2 gene is found to play a critical role in maintaining alveolar architecture and stability. The research aims to investigate the predictive value of Abhd2 for airway remodeling in COPD and its effect on TGF-β regulation.Methods: In humans, Abhd2 protein was obtained from peripheral blood monocytes. Peripheral blood TGF-β, pulmonary surfactant proteins (SPs), metalloproteinases, inflammatory indicators (WBC, NEU, NLR, EOS, CRP, PCT, D-Dimer), chest CT (airway diameter and airway wall thickness), pulmonary function, and blood gas analysis were used to assess airway remodeling. In animals, Abhd2 deficient mice (Abhd2Gt/Gt) using gene trapping and C57BL6 mice were injected intraperitoneally with CSE to construct COPD models. HE staining, Masson staining and immunohistochemistry were used to observe the pathological changes of airway in mice, and RT-PCR, WB, ELISA and immunofluorescence were used to detect the expression of secreted proteins and EMT markers.Results: COPD patients with worse pulmonary function and higher airway remodeling-related inflammatory factors had lower Abhd2 protein expression. Moreover, indicators followed the same trend for COPD patients grouped by prognosis (Group A vs Group B). Serum TGF-β was negatively correlated with Abhd2 protein expression, FEV1/FVC, FEV1, and FEV1% PRED. In mice, Abhd2 depletion promoted deposition of TGF-β, leading to more pronounced emphysema, airway thickening, increased alveolar macrophage infiltration, decreased AECII number and SPs, and EMT phenomenon.Conclusion: Downregulation of Abhd2 can promote airway remodeling in COPD by modulating repair after injury and EMT via TGF-β. This study suggests that Abhd2 may serve as a biomarker for assessing airway remodeling and guiding prognosis in COPD.Keywords: alpha/beta hydrolase 2, COPD, TGF-β, airway remodeling, EMT
A rich body of literature indicates that environmental factors interact with the human microbiome and influence its composition and functions contributing to the pathogenesis of diseases in distal sites of the body. This systematic review examines the scientific evidence on the effect of environmental toxicants, air pollutants and endocrine disruptors (EDCs), on compositional and diversity of human microbiota. Articles from PubMed, Embase, WoS and Google Scholar where included if they focused on human populations or the SHIME® model, and assessed the effects of air pollutants and EDCs on human microbiome. Non-human studies, not written in English and not displaying original research were excluded. The Newcastle-Ottawa Scale was used to assess the quality of individual studies. Results were extracted and presented in tables. 31 studies were selected, including 24 related to air pollutants, 5 related to EDCs, and 2 related to EDC using the SHIME® model. 19 studies focussed on the respiratory system (19), gut (8), skin (2), vaginal (1) and mammary (1) microbiomes. No sufficient number of studies are available to observe a consistent trend for most of the microbiota, except for streptococcus and veillionellales for which 9 out of 10, and 3 out of 4 studies suggest an increase of abundance with exposure to air pollution. A limitation of the evidence reviewed is the scarcity of existing studies assessing microbiomes from individual systems. Growing evidence suggests that exposure to environmental contaminants could change the diversity and abundance of resident microbiota, e.g. in the upper and lower respiratory, gastrointestinal, and female reproductive system. Microbial dysbiosis might lead to colonization of pathogens and outgrowth of pathobionts facilitating infectious diseases. It also might prime metabolic dysfunctions disrupting the production of beneficial metabolites. Further studies should elucidate the role of environmental pollutants in the development of dysbiosis and dysregulation of microbiota-related immunological processes.
Kohei Okada, Rie Sakakibara, Takayuki Honda
et al.
A 74-year-old man was referred to our hospital with an abnormal chest shadow. Computed tomography (CT) revealed a mass in the left upper lobe and interstitial pneumonia (IP). The patient underwent CT-guided needle biopsy and was diagnosed as lung adenocarcinoma with cT2aN1M1a Stage IVA (PUL). The patient was administered 6 cycles of CBDCA + nab-paclitaxel as first-line, 3 cycles of atezolizumab as second-line, and 8 cycles of S-1 as third-line treatment but finally showed tumor progression. Because comprehensive genome profiling test revealed KRAS G12C mutation, sotorasib was initiated as fourth-line treatment and showed tumor regression without exacerbation of pre-existing IP.
Ekaterina A. Volchkova, Kristina S. Legkova, Tatiana B. Topchy
Over the past two years, the entire medical community has taken up the fight against the new coronavirus infection. At the initial encounter with COVID-19, it seemed that this virus mainly affects the respiratory system. Still, with long-term observation, it turned out that the consequences of this disease can be much more severe and associated with lung damage and thromboembolic complications, and be a trigger for autoimmune diseases. According to the literature, after suffering COVID-19, some patients debuted systemic lupus erythematosus, hemolytic anemia, thrombocytopenia, developed GuillainBarr syndrome, vasculitis, and multiple sclerosis, and a case of autoimmune hepatitis (AIH) was described in foreign literature. AIH is a fairly rare disease, the prevalence of which in Europe is 1618 cases per 100 thousand inhabitants, affecting mainly women. It is known that chemicals and drugs (minocycline, diclofenac, methyldopa, infliximab, etanercept), viruses (HAV, HEV, EBV, HCV, CMV), environmental factors can serve as triggers of the autoimmune process in the liver. This article presents two clinical cases of AIH that developed after suffering a new coronavirus infection, which we consider as the initial provoking factor of autoimmune inflammation. Given the rarity of AIH, the description of new triggers is of clinical interest. It may be useful for doctors of different specialties since they faced drug-induced liver damage against the background of antiviral and immunobiological therapy. In the domestic literature, there have not yet been any publications devoted to the debut of AIH in adults after coronavirus infection.
Luigi Vetrugno, Daniele Orso, Francesco Corradi
et al.
Abstract Background Diaphragmatic dysfunction is a major factor responsible for weaning failure in patients that underwent prolonged invasive mechanical ventilation for acute severe respiratory failure from COVID-19. This study hypothesizes that ultrasound measured diaphragmatic thickening fraction (DTF) could provide corroborating information for weaning COVID-19 patients from mechanical ventilation. Methods This was an observational, pragmatic, cross-section, multicenter study in 6 Italian intensive care units. DTF was assessed in COVID-19 patients undergoing weaning from mechanical ventilation from 1st March 2020 to 30th June 2021. Primary aim was to evaluate whether DTF is a predictive factor for weaning failure. Results Fifty-seven patients were enrolled, 25 patients failed spontaneous breathing trial (44%). Median length of invasive ventilation was 14 days (IQR 7–22). Median DTF within 24 h since the start of weaning was 28% (IQR 22–39%), RASS score (− 2 vs − 2; p = 0.031); Kelly-Matthay score (2 vs 1; p = 0.002); inspiratory oxygen fraction (0.45 vs 0.40; p = 0.033). PaO2/FiO2 ratio was lower (176 vs 241; p = 0.032) and length of intensive care stay was longer (27 vs 16.5 days; p = 0.025) in patients who failed weaning. The generalized linear regression model did not select any variables that could predict weaning failure. DTF was correlated with pH (RR 1.56 × 1027; p = 0.002); Kelly-Matthay score (RR 353; p < 0.001); RASS (RR 2.11; p = 0.003); PaO2/FiO2 ratio (RR 1.03; p = 0.05); SAPS2 (RR 0.71; p = 0.005); hospital and ICU length of stay (RR 1.22 and 0.79, respectively; p < 0.001 and p = 0.004). Conclusions DTF in COVID-19 patients was not predictive of weaning failure from mechanical ventilation, and larger studies are needed to evaluate it in clinical practice further. Registered: ClinicalTrial.gov (NCT05019313, 24 August 2021).
Background: Death certificates are considered the most reliable source of information to compare cause-specific mortality across countries. The aim of the present study was to examine death certificates of persons who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to (a) quantify the number of deaths directly caused by coronavirus 2019 (COVID-19); (b) estimate the most common complications leading to death; and (c) identify the most common comorbidities. Methods: Death certificates of persons who tested positive for SARS-CoV-2 provided to the National Surveillance system were coded according to the 10th edition of the International Classification of Diseases. Deaths due to COVID-19 were defined as those in which COVID-19 was the underlying cause of death. Complications were defined as those conditions reported as originating from COVID-19, and comorbidities were conditions independent of COVID-19. Results: A total of 5311 death certificates of persons dying in March through May 2020 were analysed (16.7% of total deaths). COVID-19 was the underlying cause of death in 88% of cases. Pneumonia and respiratory failure were the most common complications, being identified in 78% and 54% of certificates, respectively. Other complications, including shock, respiratory distress and pulmonary oedema, and heart complications demonstrated a low prevalence, but they were more commonly observed in the 30–59 years age group. Comorbidities were reported in 72% of certificates, with little variation by age and gender. The most common comorbidities were hypertensive heart disease, diabetes, ischaemic heart disease, and neoplasms. Neoplasms and obesity were the main comorbidities among younger people. Discussion: In most persons dying after testing positive for SARS-CoV-2, COVID-19 was the cause directly leading to death. In a large proportion of death certificates, no comorbidities were reported, suggesting that this condition can be fatal in healthy persons. Respiratory complications were common, but non-respiratory complications were also observed.
The documents of the League of Nations archive concerning the history of a unique emigrant institution — the Russian Ambulatory in Berlin are introduced into scientific circulation in the article. It is reported that for at least 17 years (since 1920), the clinic had pro-vided free assistance to the poor. The annual reports and correspondence of the clinic make it possible not only to assess the scale of the activities of the philanthropists of Russian Berlin and their humanitarian significance, but also to analyze information about the social and demographic processes in the emigrant community in the 1920s—1930s. It is noted that from 1920 to 1934 the clinic received 171,955 patients (more than one and a half thousand people a year, of all ages and nationalities). Information is given that doctors treated a wide range of diseases: cardiovascular, nervous, venereal, respiratory and digestive system, urogenital system, eye and ear, the consequences of injuries and trauma. It has been established that the outpatient clinic distributed free medicines, food, and basic necessities since the early 1930s and provided lunches and places in the Salvation Army dormitory for the homeless. The statistics of the clinic are presented with data on the ethnic composition of Russian Berlin (the most representative of the known ones), the aging of emigration in Germany, and the low birth rate in the 1930s and the spread of poverty associated with the Great Depression.
Slavic languages. Baltic languages. Albanian languages
Most published studies on particulate matter (PM) concerning PM2.5 and PM10 have focused on PM-induced effects on the respiratory system (particularly lung) and cardiovascular system effects. However, epidemiological and mechanistic studies suggest that PM2.5 and PM10 also affects the skin, which is a key health issue. In this study, we first reviewed the current status of PM2.5 and PM10 in China, including relevant regulations, concentration levels, chemical components, and emission sources. Next, we summarized the association between PM2.5 and PM10 or its representative components, in relation to skin inflammation as well as inflammatory skin diseases, such as atopic dermatitis, acne, eczema, and skin aging. Finally, we determined the mechanism of oxidative stress or programmed cell death induced through PM, which can provide useful information for future research on PM-induced skin inflammation.
Saumil Datar, Henriette De La Garza, Aditya Srinivasan
et al.
Thymomas are slow-growing neoplasia arising from the epithelial cells of the thymus that usually present with respiratory symptoms, superior vena cava syndrome, or parathymic syndromes. Approximately 30% of thymomas develop myasthenia gravis. An additional 5% of patients with thymomas have other systemic syndromes, including rheumatoid arthritis, thyroiditis, red cell aplasia, systemic lupus erythematosus, and Cushing syndrome. Rarely, patients can present with diarrhea due to thymoma-associated autoimmune gastrointestinal pathologies that include Good syndrome (acquired hypogammaglobulinemia), thymoma- associated multiorgan autoimmunity, and autoimmune enteropathy. We present an uncommon and interesting case of an invasive metastatic thymoma with right upper lobe endobronchial lesion and autoimmune enteropathy in a 27-year-old female. The novelty of this case lay in the findings of extensive metastatic thymoma with right upper lobe endobronchial disease and autoimmune diarrhea.
Gabriela F. Santos, João Portela, Despoina Argyropoulou
et al.
We report a clinical case of a 39-year old male, without any known previous medical condition but with occupational exposure to paints and dust cement, who presented an autoimmune pulmonary alveolar proteinosis (PAP) triggered by exposure to toxic inhalation at his workplace. PAP is a rare lung disease characterized by intra-alveolar abnormal accumulation of surfactant. The presence of a crazy-paving pattern in high-resolution computed tomography scan brings the suspicion of PAP although histopathology results of bronchoalveolar lavage are always required for its final diagnosis. The autoimmune form of PAP due to toxic inhalation, such as the one here described, is rare and it is usually difficult to establish a causal relationship.
Weather conditions due to climate change affect the health directly and indirectly. Previous studies have shown associations with temperature, heat wave, and cold spell, and these do not only result in mortality from cardiovascular disease, respiratory disease, etc., but also in morbidity. This study aimed to quantify the relative risk for hospital admissions related to ambient temperature for genitourinary system diseases, which are representative of metabolic disease. We conducted a nationwide retrospective cohort study using claims data generated by medical services for diseases of the urinary system. The data was based on medical claims data from 16 districts in South Korea, to the nationwide level between 2003 and 2013. A total of 1,255,671 hospital admissions through the emergency department because of diseases of the genitourinary system were reported within the study period. The overall cumulative relative risk at the 99th percentile vs. the minimum morbidity percentile for renal diseases was 1.252 (95% confidence interval 1.211 to 1.294) in Seoul, 1.252 (1.21 to 1.296) in Busan, 1.236 (1.196 to 1.276) in Daegu, 1.237(1.197 to 1.279) in Gwangju, and 1.258 (1.218 to 1.299) in Gyeonggi-do, 1.278 (1.211 to 1.349) in Chungcheongbuk-do, 1.291 (1.235 to 1.35) in Gyeongsangnam-do. In the group of men over 65 years, the overall cumulative RR was high and statistically significant in acute kidney injury (AKI). But we could not find the effect of high temperature for chronic kidney disease (CKD). The association were rather opposite, but not statistically significant. Our nationwide study not only demonstrates relative risk considering lag effects associated with ambient temperature and trends in hospital admissions through the emergency department for genitourinary disorders but also observed differences among disease groups.