Hasil untuk "Diseases of the respiratory system"

Rachael L Murray, Richard Hubbard, Tricia M McKeever et al.

Background Chronic obstructive pulmonary disease (COPD) incurs significant mortality worldwide. Less is known about the burden in the last decade across Europe. We report trends and variations in mortality for patients with COPD across 27 European countries from 2011 to 2021.Methods COPD mortality was extracted from the EUROSTAT database, using the International Classification of Diseases 10 codes J43 and J44 for each country. Age-standardised and sex-standardised mortality rates (SMR) were calculated and joinpoint regression identified average annual percentage change (AAPC) in deaths from 2011 to 2021. Global Burden of Disease tobacco prevalence data were used to try and best contextualise the mortality.Results The overall SMR in Europe for this period was 32.1 (95% CI 32.0 to 32.1) per 100 000 person-years, with substantial geographical heterogeneity. There was a fivefold difference in mortality rates between the countries with the greatest versus the least deaths. Although there was an apparent 3% (95% CI −4.4% to −1.6%) decrease in average annual deaths from 2011 to 2021 across Europe, there was no significant change in deaths from 2011 to 2018, prior to the UK leaving the dataset (a noticeably high outlier in SMR) and the COVID-19 pandemic. A 2% reduction (95% CI −2.6% to −1.2%) in annual mortality rate was noted in males from 2011 to 2018, while females increased (AAPC 1.3% (95% CI 0.1% to 2.6)%) in the same time frame.Conclusion The plateau in COPD-related deaths across Europe from 2011 to 2018 demands focus. Geographical variation in mortality suggests under-reporting in some countries, which may underestimate the true burden.

Crizaldy Tugade, Jopeth Ramis

Human airways maintain homeostasis through intricate cellular interactomes combining secretome-mediated signalling and mechanotransduction feedback loops. This review presents the first unified map of bidirectional mechanobiology–secretome interactions between airway epithelial cells (AECs), smooth muscle cells (ASMCs), and chondrocytes. We unify a novel three-component regulatory architecture: epithelium functioning as environmental activators, smooth muscle as mechanical actuators, and cartilage as calcium-dependent regulators. Critical mechanotransduction pathways, particularly YAP/TAZ signalling and TRPV4 channels, directly couple matrix stiffness to cytokine release, creating a closed-loop feedback system. During development, ASM-driven FGF-10 signalling and peristaltic contractions orchestrate cartilage formation and epithelial differentiation through mechanically guided morphogenesis. In disease states, these homeostatic circuits become pathologically dysregulated; asthma and COPD exhibit feed-forward stiffness traps where increased matrix rigidity triggers YAP/TAZ-mediated hypercontractility, perpetuating further remodelling. Aberrant mechanotransduction drives smooth muscle hyperplasia, cartilage degradation, and epithelial dysfunction through sustained inflammatory cascades. This system-level understanding of airway cellular networks provides mechanistic frameworks for targeted therapeutic interventions and tissue engineering strategies that incorporate essential mechanobiological signalling requirements.

Jefferson Antonio Buendía, Juan Antonio Buendia Sánchez, Diana Guerrero Patino

Abstract Background Ventilator-associated pneumonia (VAP) is a significant clinical challenge due to its morbidity, mortality, and economic burden, especially in low- and middle-income countries. This study evaluates the cost-utility of tobramycin and colistin as nebulized adjunct therapies to systemic antibiotics for managing VAP in Colombia. Methods A decision tree model was constructed comparing three interventions: tobramycin + systemic antibiotics, colistin + systemic antibiotics, and systemic antibiotics alone. The model used a one-year time horizon from a third-payer perspective. Clinical probabilities, costs, and utilities were sourced from literature and local databases. Sensitivity analyses (deterministic and probabilistic with 10,000 iterations) assessed uncertainty. Costs were reported in 2023 USD, adjusted by GDP deflator. Results Tobramycin demonstrated the highest cost-effectiveness. Incremental QALYs were 0.06 for tobramycin and 0.02 for colistin; incremental costs were US$338.09 and US$130.63, respectively. The ICER was US$5625.86 for tobramycin and US$5422.31 for colistin. At a willingness-to-pay threshold of US$5180/QALY, tobramycin had a 56.5% probability of being cost-effective. Conclusion Tobramycin is more cost-effective than colistin as an adjunctive nebulized treatment for ventilator-associated pneumonia (VAP) in Colombia. These findings may help inform clinical guidelines and reimbursement decisions. Further research is needed to evaluate long-term outcomes and to incorporate utility data specific to the Colombian population.

Almustapha A. Wakili, Babajide J. Asaju, Woosub Jung

Breath analysis has emerged as a critical tool in health monitoring, offering insights into respiratory function, disease detection, and continuous health assessment. While traditional contact-based methods are reliable, they often pose challenges in comfort and practicality, particularly for long-term monitoring. This survey comprehensively examines contact-based and contactless approaches, emphasizing recent advances in machine learning and deep learning techniques applied to breath analysis. Contactless methods, including Wi-Fi Channel State Information and acoustic sensing, are analyzed for their ability to provide accurate, noninvasive respiratory monitoring. We explore a broad range of applications, from single-user respiratory rate detection to multi-user scenarios, user identification, and respiratory disease detection. Furthermore, this survey details essential data preprocessing, feature extraction, and classification techniques, offering comparative insights into machine learning/deep learning models suited to each approach. Key challenges like dataset scarcity, multi-user interference, and data privacy are also discussed, along with emerging trends like Explainable AI, federated learning, transfer learning, and hybrid modeling. By synthesizing current methodologies and identifying open research directions, this survey offers a comprehensive framework to guide future innovations in breath analysis, bridging advanced technological capabilities with practical healthcare applications.

Asaju Babajide, Almustapha Wakili, Michaela Barnett et al.

The rapid development of Internet of Things (IoT) technology has significantly impacted various market sectors. According to Li et al. (2024), an estimated 75 billion devices will be on the market in 2025. The healthcare industry is a target to improve patient care and ease healthcare provider burdens. Chronic respiratory disease is likely to benefit from their inclusion, with 545 million people worldwide recorded to suffer from patients using these devices to track their dosage. At the same time, healthcare providers can improve medication administration and monitor respiratory health (Soriano et al., 2020). While IoT medical devices offer numerous benefits, they also have security vulnerabilities that can expose patient data to cyberattacks. It's crucial to prioritize security measures in developing and deploying IoT medical devices, especially in personalized health monitoring systems for individuals with respiratory conditions. Efforts are underway to assess the security risks associated with intelligent inhalers and respiratory medical devices by understanding usability behavior and technological elements to identify and address vulnerabilities effectively. This work analyses usability behavior and technical vulnerabilities, emphasizing the confidentiality of information gained from Smart Inhalers. It then extrapolates to interrogate potential vulnerabilities with Implantable Medical Devices (IMDs). Our work explores the tensions in device development through the intersection of IoT technology and respiratory health, particularly in the context of intelligent inhalers and other breathing medical devices, calling for integrating robust security measures into the development and deployment of IoT devices to safeguard patient data and ensure the secure functioning of these critical healthcare technologies.

Kirsten Nesset, Martin Kolb

Tian M, Li W, He X et al.

Maoliang Tian,1,* Wenqiang Li,1,* Xiaoyu He,2 Qian He,3 Qian Huang,4 Zhiping Deng1 1Zigong First People’s Hospital, Zigong City, Sichuan Province, 643000, People’s Republic of China; 2North Sichuan Medical College, Nanchong, Sichuan Province, 637000, People’s Republic of China; 3West China Second Hospital of Sichuan University, Chengdu, Sichuan Province, 610044, People’s Republic of China; 4Dazhou Dachuan District People’s Hospital (Dazhou Third People’s Hospital), Dazhou, Sichuan Province, 635000, People’s Republic of China*These authors contributed equally to this workCorrespondence: Qian Huang, Dazhou Dachuan District People’s Hospital (Dazhou Third People’s Hospital), Dazhou, Sichuan Province, 635000, People’s Republic of China, Email hq15196767955@163.com Zhiping Deng, Zigong First People’s Hospital, Zigong City, Sichuan Province, 643000, People’s Republic of China, Email dengzp1016@163.comBackground: In human health, vitamins play a vital role in various metabolic and regulatory processes and in the proper functioning of cells. Currently, the effect of Vitamin E (VE) intake on multiple causes of death in Chronic obstructive pulmonary disease (COPD) patients is unclear. Therefore, this paper aims to investigate the relationship between VE and multiple causes of death in COPD patients, to guide the rationalization of dietary structure and reduce the risk of COPD death.Methods: This study screened patients with COPD aged ≥ 40 years from the National Health and Nutrition Examination Survey (NHANES) database 2008– 2018. Weighted COX regression was used to analyze the association between VE intake and multiple causes of death in COPD. The restricted cubic spline(RCS) is drawn to show their relationship. Finally, we conducted a subgroup analysis for further verification.Results: A total of 1261 participants were included in this study. After adjustment for multiple covariates, VE intake was associated with all-cause death in COPD patients, and chronic lower respiratory disease (CLRD) deaths were linearly associated with cardiovascular disease (CVD) deaths there was no such correlation. Subgroup analyses showed no interaction between subgroups, further validating the robustness of the relationship.Conclusion: In COPD patients, VE intake was negatively associated with all-cause mortality and CLRD death. Higher VE intake reduces the risk of all-cause mortality and CLRD death in COPD patients.Keywords: vitamin E, COPD, CVD, CLRD, COX regression analyses

D. Shlomi, T. Beck, R. Reuveny et al.

Background Evaluation of unexplained exercise intolerance is best resolved by cardiopulmonary exercise testing (CPET) which enables the determination of the exercise limiting system in most cases. Traditionally, pulmonary function tests (PFTs) at rest are not used for the prediction of a respiratory limitation on CPET.Objective We sought cut-off values on PFTs that might, a priori, rule-in or rule-out a respiratory limitation in CPET.Methods Patients who underwent CPET in our institute were divided into two groups according to spirometry: obstructive and non-obstructive. Each group was randomly divided 2:1 into derivation and validation cohorts respectively. We analyzed selected PFTs parameters in the derivation groups in order to establish maximal and minimal cut-off values for which a respiratory limitation could be ruled-in or ruled-out. We then validated these values in the validation cohorts.Results Of 593 patients who underwent a CPET, 126 were in the obstructive and 467 in the non-obstructive group. In patients with obstructive lung disease, forced expiratory volume in 1 second (FEV1) ≥ 61% predicted could rule out a respiratory limitation, while FEV1 ≤ 33% predicted was always associated with a respiratory limitation. For patients with non-obstructive spirometry, FEV1 of ≥ 73% predicted could rule-out a respiratory limitation. Application of this algorithm might have saved up to 47% and 71% of CPETs in our obstructive and non-obstructive groups, respectively.Conclusion Presence or absence of a respiratory limitation on CPET can be predicted in some cases based on a PFTs performed at rest.

Wang S, Gao B, Shi M et al.

Siyuan Wang,1,* Beiyao Gao,1,* Minghui Shi,2– 6 Shiwei Qumu,2– 5 Fen Dong,2– 5,7 Peijian Wang,1 Ting Yang,2– 5 Shan Jiang1 1Department of Rehabilitation Medicine, China-Japan Friendship Hospital, Beijing, People’s Republic of China; 2National Center for Respiratory Medicine, Beijing, People’s Republic of China; 3National Clinical Research Center for Respiratory Diseases, Beijing, People’s Republic of China; 4Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China; 5Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, People’s Republic of China; 6Capital Medical University, Beijing, People’s Republic of China; 7Department of Clinical Research and Data management, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, People’s Republic of China*These authors contributed equally to this workCorrespondence: Shan Jiang; Ting Yang, China-Japan Friendship Hospital, 2 Yinghuayuan East St. Hepingli, Chaoyang District, Beijing, 100029, People’s Republic of China, Email landjiang@126.com; dryangting@qq.comObjective: Given the established impact of exercise in reducing arterial stiffness and the potential for intermittent hypoxia to induce its elevation, this study aims to understand how oxygen desaturation during exercise affects arterial stiffness in individuals with COPD.Methods: We enrolled patients with stable COPD from China-Japan Friendship Hospital from November 2022 to June 2023. The 6-minute walk test (6-MWT) was performed with continuous blood oxygen saturation (SpO2) monitoring in these patients. The patients were classified into three groups: non-exercise induced desaturation (EID), mild-EID and severe-EID, according to the changes in SpO2 during the 6-MWT. The Cardio-Ankle Vascular Index (CAVI) and the change in CAVI (ΔCAVI, calculated as CAVI before 6MWT minus CAVI after the 6MWT) were measured before and immediately after the 6MWT to assess the acute effects of exercise on arterial stiffness. GOLD Stage, pulmonary function, and other functional outcomes were also measured in this study.Results: A total of 37 patients with stable COPD underwent evaluation for changes in CAVI (ΔCAVI) before and after the 6-MWT. Stratification based on revealed three subgroups: non-EID (n=12), mild-EID (n=15), and severe-EID (n=10). The ΔCAVI values was − 0.53 (− 0.95 to − 0.31) in non-EID group, − 0.20 (− 1.45 to 0.50) in mild-EID group, 0.6 (0.08 to 0.73) in severe-EID group. Parametric tests indicated significant differences in ΔCAVI among EID groups (p = 0.005). Pairwise comparisons demonstrated significant distinctions between mild-EID and severe-EID groups, as well as between non-EID and severe-EID groups (p = 0.048 and p = 0.003, respectively). Multivariable analysis, adjusting for age, sex, GOLD stage, diffusion capacity, and blood pressure, identified severe-EID as an independent factor associated with ΔCAVI (B = 1.118, p = 0.038).Conclusion: Patients with COPD and severe-EID may experience worsening arterial stiffness even during short periods of exercise.Keywords: COPD, arterial stiffness, exercise-induced oxygen desaturation, rehabilitation

Taijyu Satoh, Nobuhiro Yaoita, Satoshi Higuchi et al.

ABSTRACT Patients with borderline pulmonary hypertension (PH) often experience shortness of breath or exacerbation of PH during exercise, known as exercise‐induced PH. However, the pathogenesis of exercise‐induced post‐capillary PH (post‐EIPH) and its treatment strategies remain unclear. Recent guidelines and consensus documents have highlighted the benefits of sodium‐glucose cotransporter‐2 (SGLT2) inhibitors in heart failure and chronic kidney disease (CKD). This study aimed to investigate the effects of SGLT2 inhibitors in patients with post‐EIPH and CKD. This single‐center prospective cohort study enroled 10 patients with CKD (age, 68 years; female, 60%) who exhibited post‐EIPH between 1 July 2022 and 31 December 2023. Post‐EIPH was defined as a pulmonary capillary wedge pressure (PCWP)/cardiac output (CO) slope > 2 and peak PCWP during exercise ≥ 25 mmHg measured by catheterization. The patients received SGLT2 inhibitor treatment for 6 months. At rest, patients with post‐EIPH had borderline‐PH (21.5 ± 1.8 mmHg), with preserved left and right ventricular function. SGLT2 inhibitors treatment significantly reduced the PCWP/CO slope during exercise (3.9 ± 1.2 vs. 2.4 ± 1.2 mmHg/L/min, p = 0.013) and improved the 6‐min walking distance (489.9 ± 80.2 vs. 568.3 ± 91.9 m, p = 0.014). Magnetic resonance imaging revealed a lower left ventricular global longitudinal strain in patients with post‐EIPH, which was increased by SGLT2 inhibitor treatment (−13.8 ± 2.0 vs. −17.3 ± 2.0%, p = 0.003). SGLT2 treatment inhibitors mitigated post‐EIPH hemodynamic abnormalities and exercise intolerance, suggesting their potential as its therapeutic option.

Shu Wei Chou-Chen, Luis A. Barboza

Respiratory diseases represent one of the most significant economic burdens on healthcare systems worldwide. The variation in the increasing number of cases depends greatly on climatic seasonal effects, socioeconomic factors, and pollution. Therefore, understanding these variations and obtaining precise forecasts allows health authorities to make correct decisions regarding the allocation of limited economic and human resources. This study aims to model and forecast weekly hospitalizations due to respiratory conditions in seven regional hospitals in Costa Rica using four statistical learning techniques (Random Forest, XGboost, Facebook's Prophet forecasting model, and an ensemble method combining the above methods), along with 22 climate change indices and aerosol optical depth as an indicator of pollution. Models are trained using data from 2000 to 2018 and are evaluated using data from 2019 as testing data. Reliable predictions are obtained for each of the seven regional hospitals

Thomas Williams, James M. McCaw, James M. Osborne

Increasingly, experimentalists and modellers alike have come to recognise the important role of spatial structure in infection dynamics. Almost invariably, spatial computational models of viral infections - as with in vitro experimental systems - represent the tissue as wide and flat, which is often assumed to be representative of entire affected tissue within the host. However, this assumption fails to take into account the distinctive geometry of the respiratory tract in the context of viral infections. The respiratory tract is characterised by a tubular, branching structure, and moreover is spatially heterogeneous: deeper regions of the lung are composed of far narrower airways and are associated with more severe infection. Here, we extend a typical multicellular model of viral dynamics to account for two essential features of the geometry of the respiratory tract: the tubular structure of airways, and the branching process between airway generations. We show that, with this more realistic tissue geometry, the dynamics of infection are substantially changed compared to standard computational and experimental approaches, and that the resulting model is equipped to tackle important biological phenomena that do not arise in a flat host tissue, including viral lineage dynamics, and heterogeneity in immune responses to infection in different regions of the respiratory tree. Our findings suggest aspects of viral dynamics which current in vitro systems may be insufficient to describe, and point to several features of respiratory infections which can be experimentally assessed.

* Global Health Organization Leadership, * Regional Leaders in Health

Dear COP 28 President-Designate Sultan Ahmed Al-Jaber, This year, world leaders gathering in the UAE to take stock of their climate commitments will for the first time engage in official programming focused on health. We, the signatories of this letter, support your leadership in bringing health front and center at COP28. As global health leaders, we are committed to achieving health and well-being for all; this is not possible without a safe and stable climate. The Paris Agreement enshrined the “right to health” as a core obligation for climate action. Yet, communities, health workers, and health systems around the world already face the alarming impacts of a changing climate. Climate change-induced extreme weather events are becoming more frequent and severe; many countries are grappling with the health consequences of extreme heat, unprecedented storms, floods, food and water insecurity, wildfires, and displacement. For COP28 to truly be a “health COP,” it must address the root cause of the climate crisis: the continued extraction and use of fossil fuels, including coal, oil, and gas. We call on the COP28 Presidency and the leaders of all countries to commit to an accelerated, just, and equitable phase-out of fossil fuels as the decisive path to health for all. Ending our dangerous dependency on fossil fuels will improve the health prospects of future generations and will save lives. Keeping the global temperature increase within the 1.5°C target of the Paris Agreement is essential to ensure good health and economic prosperity for all. This will only be possible if we rapidly phase out fossil fuels. Fossil fuel phase-out will limit global warming, thereby protecting health from the devastating impacts of extreme weather, and preventing further ecological degradation and biodiversity loss. Failing to do so will lead to overwhelming health consequences, as well as the loss of key natural resources and ecosystem services that are critical to both human and non-human species health, 1 there by undermining One Health and planetary health. In addition to climate-related health impacts, air pollution caused in part by burning fossil fuels causes 7 million premature deaths annually. 2 The economic costs 3 of air pollution-related health impacts amounted to over US$8.1 trillion, or 6.1% of global GDP, in 2019. By improving air quality, governments can reduce the burden of disease from multiple cancers, heart disease, neurological conditions including stroke, and chronic and acute respiratory diseases, including asthma and chronic obstructive pulmonary disease (COPD). Investments in clean energy sources will save hundreds of billions of dollars in health care costs associated with air pollution every year, while reducing economic losses from extreme weather events with damages worth US$253 billion (in 2021). 4 A full and rapid phase-out of fossil fuels is the most significant way to provide the clean air, water, and environment that are foundational to good health. We cannot rely on unreliable and inadequate solutions, like Carbon Capture and Storage (CCS), which extend the use of fossil fuels but do not generate the real and immediate health improvements which a renewable energy transition provides. False solutions like CCS risk making harmful emissions worse, straining the health of overburdened communities, and delaying our progress toward meaningful climate progress. The energy transition must be just and equitable for all. In transitioning to a clean energy future, there is an opportunity to undo the injustices of the fossil fuel-dependent system, taking a systemic approach and emphasizing health, care and community well-being, leaving no one behind. Global leaders must ensure everyone, including fragile states and the most remote and excluded communities, has access to non-polluting, affordable, reliable, accessible, and resilient clean energy, as well as to emerging technologies that make the best use of this energy. A just transition offers the opportunity to reduce health inequities faced by minority and marginalized communities, especially with respect to the health effects of ongoing fossil fuel use and dependence.  Unlocking finance is essential to deliver a healthy and just transition. Achieving climate and health goals will only be feasible if we stop investing in fossil fuels and invest instead in proven climate and health solutions. Each year, countries spend hundreds of billions of dollars subsidizing the fossil fuel industry, money that could be spent investing in a healthy future. High-income countries, development finance institutions, and the private sector must dramatically increase and fulfill their commitments to drive investments in clean energy, clean air, and economic development for the communities most harmed by climate change and fossil fuel pollution. Fossil fuel interests have no place at climate negotiations. The fossil fuel industry cannot be allowed to continue its decades-long campaign of obstructing climate action at the UNFCCC negotiations and beyond. Just as the tobacco industry is not allowed to participate in the WHO Framework Convention on Tobacco Control, it is imperative to safeguard global collaboration on climate progress from the lobbying, disinformation, and delays in favor of industry interests. Without ambitious climate action, the burden on health care systems and health care workers will be insurmountable. Health gains made in recent decades will be in vain and we will see the harmful impacts of climate change ruin our chances for a safe, equitable and just future.  In this extraordinary year, with health for the first time on the COP agenda, we urge you to deliver real climate progress: commit to an accelerated, just, and equitable phase-out of fossil fuels and invest in a renewable energy transition as the decisive path to health for all.  Sincerely, Global Health Organization Leadership (Alphabetical by organization) • Githinji Gitahi, CEO, Amref Health Africa • Pam Cipriano, President, International Council of Nurses • Salman Khan, Liaison Officer for Public Health Issues, International Federation of Medical Students' Associations • Naveen Thacker, President, International Pediatric Association • Dr Christos Christou, International President, Médecins Sans Frontières • María del Carmen Calle Dávila, Executive Secretary, Organismo Andino du Salud (Andean Health Organization) • Luis Eugenio de Souza, President, World Federation for Public Health Associations • Lujain Alqodmani, President, World Medical Association Regional Leaders in Health (Alphabetical by surname) • Mary T. Bassett, Director, FXB Center for Health and Human Rights, Harvard University • Fiona Godlee, Former Editor-in-chief of the British Medical Journal • (Dr.) Arvind Kumar, Chairman, Institute of Chest Surgery, Chest Onco Surgery and Lung Transplantation, Medanta Hospital, India • Dame Parveen Kumar, Emeritus Professor of Medicine and Education, Barts and The London School of Medicine and Dentistry • Lwando Maki, Secretary, Public Health Association of South Africa • Jemilah Mahmood, Executive Director, Sunway Center for Planetary Health - Malaysia • Kari C. Nadeau, MD, PhD, Chair of the Department of Environmental Health at Harvard School of Public Health • (Dr.) K Srinath Reddy, Past President of Public Health Foundation of India This letter is supported and endorsed by: National Health Organization Leadership (Alphabetical by organization) • Rosana Teresa Onocko Campos, President, Associação Brasileira de Saúde Coletiva (Brazil) • Katie Huffling, DNP, Executive Director, Alliance of Nurses for Healthy Environments (US) • Dr Latifa Patel, Representative Body Chair, British Medical Association • Kamran Abassi, Editor-in-Chief, British Medical Journal (UK) • Frances Peart, President & Board Chair, Climate and Health Alliance (Australia) • Kate Wylie, Executive Director, Doctors for the Environment Australia • Agonafer Tekalenge, President, Ethiopian Public Health Association • Diederik Aarendonk, Forum Coordinator Global Health Organization Leadership, European Forum for Primary Care • Kevin Fenton, President, Faculty of Public Health (UK) • Ansgar Gerhardus, Board Chair, German Public Health Association • Vital Ribeiro, Chair, Associação Civil Projeto Hospitais Saudáveis (Healthy Hospitals Project) • Sheila Sobrany, President, Royal College of Nursing • The Board of the Public Health Association of South Africa • Diana Zeballos, Executive Secretary, Sustainable Health Equity Movement (SHEM) • Adeline Kimambo, Executive Secretary, Tanzania Public Health Association • Richard Smith, Chair, UK Health Alliance on Climate Change

E. Fakhri, M. T. Sultan, A. Manolescu et al.

We report on Ge coated silicon nanowires (SiNWs) sensors synthesized with metal assisted chemical etching and qualify their functionality as human respiratory sensor. The sensors were made from p-type single-crystalline (100) silicon wafers using a silver catalysed top-down etching, afterwards coated by 50 nm Ge thin layer using a magnetron sputtering. The Ge post-treatment were performed by rapid thermal annealing (RTA) at 450 and 700 C degrees. The sensors were characterized by X-ray diffraction diffractogram and scanning electron microscopy. It is demonstrated that the sensors are highly sensitive as human breath detectors, with rapid response and frequency detect-ability. They are also shown to be a good candidate for human respiratory diseases diagnoses.

Dat Ngo, Lam Pham, Huy Phan et al.

This paper presents a deep learning system applied for detecting anomalies from respiratory sound recordings. Our system initially performs audio feature extraction using Continuous Wavelet transformation. This transformation converts the respiratory sound input into a two-dimensional spectrogram where both spectral and temporal features are presented. Then, our proposed deep learning architecture inspired by the Inception-residual-based backbone performs the spatial-temporal focusing and multi-head attention mechanism to classify respiratory anomalies. In this work, we evaluate our proposed models on the benchmark SPRSound (The Open-Source SJTU Paediatric Respiratory Sound) database proposed by the IEEE BioCAS 2023 challenge. As regards the Score computed by an average between the average score and harmonic score, our robust system has achieved Top-1 performance with Scores of 0.810, 0.667, 0.744, and 0.608 in Tasks 1-1, 1-2, 2-1, and 2-2, respectively.

Sangmin Bae, June-Woo Kim, Won-Yang Cho et al.

Respiratory sound contains crucial information for the early diagnosis of fatal lung diseases. Since the COVID-19 pandemic, there has been a growing interest in contact-free medical care based on electronic stethoscopes. To this end, cutting-edge deep learning models have been developed to diagnose lung diseases; however, it is still challenging due to the scarcity of medical data. In this study, we demonstrate that the pretrained model on large-scale visual and audio datasets can be generalized to the respiratory sound classification task. In addition, we introduce a straightforward Patch-Mix augmentation, which randomly mixes patches between different samples, with Audio Spectrogram Transformer (AST). We further propose a novel and effective Patch-Mix Contrastive Learning to distinguish the mixed representations in the latent space. Our method achieves state-of-the-art performance on the ICBHI dataset, outperforming the prior leading score by an improvement of 4.08%.

Yiwen Gong, Yinghua Lv, Hongxia Liu et al.

Objective: This study aimed to quantitatively compare the efficacy and safety of long-acting β2-agonist (LABA)/long-acting muscarinic antagonist (LAMA) fixed-dose combinations (FDCs) for the treatment of stable chronic obstructive pulmonary disease (COPD), especially in terms of their loss of efficacy in lung function. Methods: Randomized controlled clinical trials of LABA/LAMA FDCs for the treatment of stable COPD were comprehensively searched for in public databases. Pharmacodynamic models were established to describe the time course of the primary outcome [trough forced expiratory volume in the first second (FEV 1 )]. Secondary outcomes [COPD exacerbations, St. George’s Respiratory Questionnaire (SGRQ), Transition Dyspnoea Index (TDI), and rescue medication use] and safety outcomes [mortality, serious adverse events (SAEs), and withdrawals due to adverse events (AEs)] were also compared via a meta-analysis. Results: A total of 22 studies involving 16,486 participants were included in this study. The results showed that in terms of primary outcome (change from baseline in trough FEV 1 ), the efficacy of vilanterol/umeclidinium was the highest, while the efficacy of formoterol/aclidinium was the lowest, with a maximum effect value (E max ) of 0.185 L [95% confidence interval (CI): 0.173–0.197 L] and 0.119 L (95% CI: 0.103–0.135 L), respectively. The efficacy of other drugs, such as formoterol/glycopyrronium, indacaterol/glycopyrronium, and olodaterol/tiotropium, were comparable, and their E max values were 0.150–0.177 L. Except for vilanterol/umeclidinium, the other four LABA/LAMA FDCs showed a certain degree of loss of efficacy. Compared with the efficacy at 2 days, the trough FEV 1 (L) relative to baseline at 24 weeks decreased by 0.029–0.041 L. In terms of secondary outcomes, the efficacy of different LABA/LAMA FDCs was similar in TDI and rescue medication use. However, formoterol/aclidinium was better in preventing the COPD exacerbations, while vilanterol/umeclidinium was the best in terms of SGRQ. In addition, different LABA/LAMA FDCs and placebo had similar safety outcomes. Conclusion: The present findings may provide necessary quantitative information for COPD medication guidelines.

Muhammed Yunus BEKTAY, Mesut SANCAR, Fatmanur KARAKÖSE OKYALTIRIK et al.

Objective:Clinical prognosis of coronavirus disease-19 (COVID-19) may be severe and unexpected. Patients may quickly progress to respiratory failure, infections, multiple organ dysfunction, and sepsis. The main objective of this study is to investigate the drug-related problems of patients with COVID-19 and related factors.Method:A prospective observational study was conducted on patients with COVID-19 between September 2020 and May 2021. Patients’ demographics, comorbid diseases, prescribed medicines and laboratory findings were recorded. Drug-related problems (DRPs) were identified by a clinical pharmacist according to recent guidelines, UpToDate® clinical decision support system and evidence-based medicine.Results:The median age of 107 patients was 64 and 50.46% of them were male. The median number of comorbidities was 3 (2-4) per patient. The majority of the patients had at least one comorbidity (88.79%) other than COVID-19 and the most frequent comorbidities were hypertension, diabetes mellitus and coronary artery disease. The total number of DRPs was recorded as 201 and at least one DRP was seen in 75 out of 107 patients. The median number of DRPs was 2 (0-8). In multivariate model, number of comorbidities (odss ratio (OR)=1.952; 95% confidence interval (CI)=1.07-3.54, p<0.05, number of medications (OR=1.344; 95% CI=1.12-1.61, p<0.001), and serum potassium levels (OR=5.252; 95% CI=1.57-17.56, p<0.001) were the factors related with DRPConclusion:This study highlights the DRPs and related factors in patients with COVID 19 in hospital settings. Considering unknown features of the infection and multiple medication use, DRPs are likely to occur. It would be beneficial to consider the related factors in order to reduce the number of the DRPs.

Maxime Juventin, Mickael Zbili, Nicolas Fourcaud-Trocmé et al.

In recent years, several studies have tended to show a respiratory drive in numerous brain areas so that the respiratory rhythm could be considered as a master clock promoting communication between distant brain areas. However, outside of the olfactory system it is not known if respiration-related oscillation (RRo) could exist in the membrane potential (MP) of neurons neither if it can structure spiking discharge. To fill this gap, we co-recorded MP and LFP activities in different non-olfactory brain areas: median prefrontal cortex (mPFC), primary somatosensory cortex (S1), primary visual cortex (V1), and hippocampus (HPC), in urethane-anesthetized rats. Using respiratory cycle by respiratory cycle analysis, we observed that respiration could modulate both MP and spiking discharges in all recorded areas. Further quantifications revealed RRo episodes were transient in most neurons (5 consecutive cycles in average). RRo development in MP was largely influenced by the presence of respiratory modulation in the LFP. Finally, moderate hyperpolarization reduced RRo occurence within cells of mpFC and S1. By showing the respiratory rhythm influenced brain activity deep to the MP of non-olfactory neurons, our data support the idea respiratory rhythm could mediate long-range communication.

Francesco Ferrante, Sophie Tarbouriech

This paper deals with the problem of designing a sampled-data state feedback control law for continuous-time linear control systems subject to uniform input quantization. The sampled-data state feedback is designed to ensure the uniform global asymptotic stability (UGAS) of an attractor surrounding the origin. The closed-loop system is rewritten as a hybrid dynamical system. To do this, an auxiliary clock variable triggering the occurrence of sampling events is introduced. A numerically tractable algorithm with feasibility guarantees, based on concave-convex decomposition, is then proposed allowing to minimize the size of the attractor. Theoretical results are illustrated in a numerical example.