Pulmonary Disease Research Articles

Genetic characterization of a rare case of pheochromocytoma in a pulmonary transplant patient

BackgroundPheochromocytomas (PCCs) and paragangliomas (PGLs) (PPGLs) are rare tumours arising from the chromaffin cells. There is evidence suggesting a link between hypoxemia and PPGLs. Chronic hypoxia can lead to gain of function somatic variants in the EPAS1 gene that encodes for hypoxia-inducible factor 2-alpha (HIF-2α), involved in PPGL tumorigenesis.ObjectiveTo describe a rare case of PCC in a pulmonary transplant patient and characterize the tumour’s genetic background.Clinical CaseA 47 year-old man underwent a lung transplant for chronic obstructive pulmonary disease associated with alpha-1 antitrypsin deficiency. He required home oxygen therapy for 3 years prior to transplant. Nineteen years after transplant, a CT-scan revealed a 5.8 cm x 3.9 cm heterogeneous right adrenal mass (HU of 7). Initial assessments indicated elevated 24-hour urinary catecholamines. Consequently, the patient underwent laparoscopic right adrenalectomy, confirming the PCC diagnosis.Genetic studies1) Germline PPGL multigene panel: After consent, the patient underwent a panel of 14 susceptibility genes for PPGLs that revealed no pathogenic variants. 2) Somatic genetic analysis for EPAS1 gene found no variants. However, tumoral RNA sequencing unveiled activation of the HIF pathway.ConclusionWe describe a rare case of PCC in a pulmonary transplant recipient, with genetic analyses showing no germline pathogenic variants and no somatic variants in the EPAS1 gene. RNA sequencing highlighted HIF pathway activation and angiogenic implications. Further research is necessary to elucidate the genetic and molecular mechanisms underlying PCCs in this specific case and determine its link with hypoxemia in the context of pulmonary disease.

Electrocardiographic signs of cardiac ischemia at rest and during exercise in patients with COPD traveling to 3,100 m: data from a randomized trial of acetazolamide

IntroductionIn patients with chronic obstructive pulmonary disease (COPD), oxygen delivery to the heart may be impaired during travel at altitude. We assessed electrocardiogram (ECG)-derived signs of cardiac ischemia and the effects of preventive acetazolamide therapy in COPD patients traveling to high altitudes.MethodsPatients with COPD [Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) grades 2–3] and a predicted forced expiratory volume in 1 s (FEV1) of 66 ± 11% (mean ± SD), aged 57 ± 8 years, and living <1,000 m were included in this analysis of secondary outcomes from a randomized placebo-controlled double-blind trial (www.clinicaltrials.gov, NCT03156231). Exercise electrocardiograms were recorded at the National Center of Internal Medicine and Cardiology, Bishkek (760 m) and on the day of arrival at the Tuja Ashu high-altitude clinic (3,100 m), Kyrgyzstan. Acetazolamide (375 mg/day) or placebo was administered 24 h before the ascent and during the stay at 3,100 m. The incidence of a post-exercise ST elevation (STE) ≥0.3 mm in aVR (J + 80 ms) was the main outcome.ResultsAt 760 m, 3 of 49 (6%) patients randomized to placebo and 3 of 50 (6%) randomized to acetazolamide showed a post-exercise STE. At 3,100 m under placebo, two (4%) new STEs developed and one (2%) disappeared compared to 760 m (P = 0.564, McNemar’s test). At 3,100 m under acetazolamide, one (2%) new STE developed and two (4%) disappeared compared to 760 m (P = 0.564). No treatment effect was detected (P = 0.242, Fisher’s exact test). The mean difference (95% CI) in STE between post-peak exercise between 3,100 m and 760 m was 0.22 mm (0.06 to 0.39) and 0.09 mm (−0.06 to 0.24) under placebo and acetazolamide therapy [treatment effect, −0.13 mm (−0.35 to 0.08, P = 0.230)], respectively.ConclusionsIn lowlanders with moderate to severe COPD ascending to 3,100 m, no ECG-derived signs of cardiac ischemia emerged neither at rest nor post-exercise and this was not modified by preventive acetazolamide therapy.

Physical activity and motivational readiness for physical activity behavior change in adults with non-communicable diseases in Germany: a trend analysis of two cross-sectional health surveys from the German GEDA study 2014/2015 and 2019/2020

Abstract Background Physical activity (PA) is a cornerstone in maintaining a healthy lifestyle as well as in the prevention and rehabilitation of non-communicable diseases (NCD). First analysis of PA showed lower activity rates in adults with NCD compared to the general population. To improve health monitoring and to address World Health Organization (WHO) recommendations to systematically identify and track efforts to reduce inequalities in PA participation, trend analysis of PA in adults with NCD was performed for the period 2014/15 to 2019/20 for Germany. Furthermore, motivational readiness for PA behavior change was analysed based on the transtheoretical model (TTM). Methods Based on two population-based cross-sectional health surveys (GEDA 2014/15-EHIS and GEDA 2019/20-EHIS) for Germany (N = 46,724), the prevalence of meeting WHO PA guidelines was analysed for adults with certain NCD compared to the general population. PA was assessed by self-report via the European Health Interview Survey– Physical Activity Questionnaire (EHIS-PAQ). Trend analyses and logistic regression models were performed to calculate disease specific Odds Ratios (OR) for fulfilment of PA recommendations. Motivational readiness for PA was assessed with the stages of change according to the TTM with data of GEDA 2014/15-EHIS. Results Reporting any NCD is associated with lower fulfilment of health-enhancing aerobic PA in both surveys for almost all NCD, with lowest levels among adults reporting stroke, type 2 diabetes mellitus, chronic obstructive pulmonary disease, obesity and coronary heart disease. Sufficient muscle-strengthening was higher in adults with musculoskeletal diseases like osteoarthritis, lower back pain and neck pain compared to adults without these diseases. The prevalence of meeting WHO PA recommendations among adults with NCD remains at a low level. Sufficient health-enhancing aerobic PA tend to decrease in adults with NCD from 2014/15 to 2019/20, while sufficient muscle-strengthening increased in the same period. Motivational readiness for PA is lower for most adults with NCD, compared to the general adult population. Conclusion Lower rates of WHO PA recommendation fulfilment is recognized for most NCD groups compared to the population without NCD for both surveys, but the proportion of adults with NCD who meet the WHO PA recommendations differ widely between NCD groups. A positive trend from 2014/15 to 2019/20 can only be seen for adults with osteoarthritis. Based on our findings the implementation of PA promotion particular with regards to motivational readiness and disease specific PA measures is strongly recommended to improve prevention and ambulatory health care for adults with NCD.

The Heme Oxygenase/Biliverdin Reductase System and Its Genetic Variants in Physiology and Diseases

Heme oxygenase (HO) metabolizes heme into ferrous iron, carbon monoxide (CO), and biliverdin-IXα (BV), the latter being reduced into bilirubin-IXα (BR) by the biliverdin reductase-A (BVR). Heme oxygenase exists as two isoforms, HO-1, inducible and involved in the cell stress response, and HO-2, constitutive and committed to the physiologic turnover of heme and in the intracellular oxygen sensing. Many studies have identified genetic variants of the HO/BVR system and suggested their connection in free radical-induced diseases. The most common genetic variants include (GT)n dinucleotide length polymorphisms and single nucleotide polymorphisms. Gain-of-function mutations in the HO-1 and HO-2 genes foster the ventilator response to hypoxia and reduce the risk of coronary heart disease and age-related macular degeneration but increase the risk of neonatal jaundice, sickle cell disease, and Parkinson’s disease. Conversely, loss-of-function mutations in the HO-1 gene increase the risk of type 2 diabetes mellitus, chronic obstructive pulmonary disease, and some types of cancers. Regarding BVR, the reported loss-of-function mutations increase the risk of green jaundice. Unfortunately, the physiological role of the HO/BVR system does not allow for the hypothesis gene silencing/induction strategies, but knowledge of these mutations can certainly facilitate a medical approach that enables early diagnoses and tailored treatments.

Clinical Characteristics and Short-Term Outcomes of COVID-19 Positive Hospitalized Hemodialysis Patients

Presentation of Novel Corona virus disease (COVID-19) and its clinical features and outcomes were different in maintenance hemodialysis (MHD) patients than in general population due to relative immunosuppression and high prevalence of co-morbidities in MHD patients. The aim of this study is to identify the clinical characteristics and outcome of MHD patients requiring hospitalization for COVID 19. In this retrospective observational study, a total of 100 adult patients of both sex who were on maintenance hemodialysis therapy having A-V fistula or permanent venous catheter admitted in Nephrology department of Mugda Medical College Hospital due to COVID-19 from April 21, 2020 to April 30, 2021 were included. Demographic data (age, sex, comorbidities), initial clinical presentations (fever, cough, shortness of breath, fatigue), oxygen saturation, chest radiograph and laboratory tests CBC, RBS, Serum Creatinine, SGPT, CRP, LDH, D dimer, Ferritin, Albumin at admission and during hospital stay were retrieved from patient file. Treatment of these hemodialysis patients was given and modified according to the hospital treatment committee including Nephrologist and Medicine specialist. As the patients were followed up from admission in hospital until discharge or death, so they were divided in two groups- Survived and death. All data were compiled and edited meticulously using SPSS version 27 software. The mean age of the patients was 53.8±13.3 (Range 15-90). Male and female ratio was 1.7.1. No significant difference was observed regarding age and sex of the study subjects. Most patients had HTN (78%) followed by DM (52%), IHD (42%), CLD (24%), pulmonary disease (21%) and Stroke (6%). The most common symptoms during admission in hospital were fever 65%, cough 52%, fatigue 43%, SOB 35% and diarrhea 8% respectively. Fever, cough, fatigue and SOB and in case of co-morbidities only IHD were statistically significant. Mean Oxygen saturation during admission was statistically significantly lower in death group (96.0±1.32 vs 90.2±2.9; p<0.001). Regarding biochemical parameters lymphocyte count (1058.4±289.3 vs 2575.9±536.6 p <0.001), albumin (3.38±0.80 vs 3.89±0.57; p<0.001) were statistically significantly low and N:L ratio (10.48±2.77 vs 3.24±0.40; p<0.001), creatinine (9.75±2.28 vs 6.11±2.27; p<0.001), CRP (33.09±12.99 vs 13.29±5.35; p<0.001), LDH (367.09±78.25 vs 294.06±58.1; p<0.001) were significantly high in death group. Lung abnormalities on CXR PA view showed normal CXR in 48.7% patients in survived group and bilateral GGO in 68.2% in death group which were also statistically significant. Outcome of these admitted patients revealed total death rate 22%, ICU admission rate 18% and discharge from hospital rate was 78%. Logistic regression of these risk factors regarding mortality in COVID19 showed oxygen saturation (p=0.00), N:L ratio (p=0.00), and CRP (p=0.035) were statistically significant. In this study, we found a high mortality rate in COVID 19 positive hospitalized maintenance hemodialysis patients. Markers of inflammation neutrophil-to-lymphocyte ratio (N:L ratio), CRP and oxygen status are significant predictors of COVID 19 patients’ morbidity, highlighting the importance of monitoring these parameters for clinical management and risk stratification. Mugda Med Coll J. 2024; 7(2): 58-65

The Perception of the Diaphragm with Ultrasound: Always There Yet Overlooked?

Diaphragm ultrasound makes it possible to diagnose diaphragmatic atrophy and dysfunction. Important indications include unclear dyspnea; diaphragmatic elevation; assessment of diaphragm dysfunction in pulmonary, neuromuscular and neurovascular diseases; and in critically ill patients before noninvasive and mechanical ventilation and follow-up of diaphragm thickness and function during mechanical ventilation with potential prediction of prolonged weaning. In patients with respiratory insufficiency and potential diaphragm dysfunction, it is possible to objectify the contribution of diaphragm dysfunction. In addition, assessment of diaphragmatic hernias, tumors and diaphragmatic dysfunction in COVID-19 and diaphragmatic ultrasound in sports medicine have been described. This narrative review includes the sonomorphology of the diaphragm, standardization of ultrasonographic investigation with transducer positions and ultrasound techniques, normal findings and diagnostic criteria for pathological findings. The correct sonographic measurement, calculation and evaluation can ultimately influence further therapeutic procedures for the patient suffering from diaphragm dysfunction in various diseases.

The usefulness of the forced oscillation technique in the diagnosis of bronchial asthma in seniors

ABSTRACT Background Obstructive pulmonary diseases are common in the elderly but often remain underdiagnosed due to limited spirometry availability or challenges with patient cooperation during testing. This study evaluated the potential of the forced oscillation technique (FOT) as a diagnostic tool for bronchial asthma in individuals over 60 years old. Research design and methods A total of 189 patients diagnosed with asthma after age 60 and a control group of nonasthmatic seniors were included. Participants underwent spirometry, FOT, and bronchial reversibility testing using both methods. The primary outcomes were correlations between positive results from resting spirometry and FOT in asthmatics and the agreement between reversibility test results across the two methods. Results FOT parameters (FEV1, V5, R5) effectively distinguished asthmatics from nonasthmatics. Positive reversibility test results were observed in 71 (73.2%) patients using FOT and 68 (70.1%) using spirometry, with both methods aligning in 64 (66%) cases. Conclusion These results highlight the value of FOT, particularly for bronchial reversibility testing, in improving asthma diagnosis in seniors. FOT offers a practical alternative for patients who face difficulties performing spirometry, addressing a critical need in this population.

Accurate identification of oxygen desaturation status in COPD by using classifier ensemble.

The accurate identification of oxygen desaturation (OD) status plays critical role in the clinic diagnosis of chronic obstructive pulmonary disease (COPD), which is a common disease related to the lungs and respiratory tract of the human body. This paper focuses on a specific type of OD status, i.e., exercise-induced oxygen desaturation (EIOD) status in COPD, and try to further improve the performance of EIOD status identification. We propose a new and effective EIOD status identification method by using classifier ensemble strategy. In the proposed method, five different features of each data point from the time series of SpO2 and pulse are extracted and then combined to form the discriminative feature of the corresponding data point; then, multiple base classifiers with different balanced training subsets are trained and then integrated by using AdaBoost Algorithm. The comparative computational results on the 6-min walk test (6MWT) of the recruited participants show that the proposed method achieved the best global performance with AUC (Area Under Curve) value of 0.8532, indicating that the proposed method can be effectively used for the identification of EIOD and could assist the clinic diagnosis of COPD.

Creation of Text Vignettes Based on Patient-Reported Data to Facilitate a Better Understanding of the Patient Perspective: Design Study.

Patient-reported outcome (PRO) data refer to information systematically reported by patients, or on behalf of patients, without the influence of health care professionals. It is a focal point of the health care system's ambition toward becoming more involving and personalized. It is recognized that PROs provide valuable data. However, despite this recognition, there are challenges related to both patients' and clinicians' accurate interpretations of the quantitative data. To overcome these challenges, this study explores text vignettes as a representation of PROs. This study aimed to develop data-informed text vignettes based on data from the Readiness and Enablement Index for Health Technology (READHY) instrument as another way of representing PRO data and to examine how these are perceived as understandable and relevant for both patients and clinicians. The text vignettes were created from participant responses to the READHY instrument, which encompasses health literacy, health education, and eHealth literacy. The text vignettes were created from 13 individual text strings, each corresponding to a scale in the READHY instrument. This study consisted of 3 sequential parts. In part 1, individuals with chronic obstructive pulmonary disease completed the READHY instrument, providing data to be used to create vignettes based on cluster profiles from the READHY instrument. Part 2 focused on the development of scale-based strings representing all READHY dimensions, which were evaluated through iterative cognitive interviews. In part 3, clinicians and patients assessed the understanding and relevance of the text vignettes. Clinicians and patients both understood and related to the text vignettes. Patients viewed the text vignettes as an accurate reflection of their PRO responses, and clinicians perceived the text vignettes as aligned with their understanding of patients' experiences. Text vignettes can be developed using PRO instruments, with individual scales as input strings. This provides an opportunity to present numeric values in a text format that is understandable and recognizable to most patients and clinicians. Challenges with the vignette's language and layout require customization and clinician training to ensure meaningful interpretation. Findings also support the need to expand the study and enhance clinical relevance with alternative or contextually relevant text vignettes.

Geriatric nutritional risk index as a predictor of 30-day and 365-day mortality in patients with acute myocardial infarction: a retrospective cohort study using the MIMIC-IV database

BackgroundThe Geriatric Nutritional Risk Index (GNRI) is a clinical indicator for evaluating the nutritional status of patients, but its role in the short-term prognosis of patients with acute myocardial infarction is still not fully understood. This study aims to explore the correlation between the GNRI and the overall mortality within 30 days and 365 days in those with acute myocardial infarction (AMI).MethodsA retrospective analysis was performed utilizing the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. The study included 895 patients diagnosed with AMI and identified through ICD9 and ICD10 codes (410, I21, I23) who were hospitalized for the first time due to AMI. Subjects were classified into four groups according to GNRI: high (GNRI <82, n = 110), moderate (82 ≤ GNRI <92, n = 205), low (92 ≤ GNRI <98, n = 225), and no nutritional risk (GNRI ≥98, n = 355). Restricted cubic splines (RCS) and threshold effect analyses were applied to explore the non-linear relationship between GNRI and mortality. Subgroup analyses were conducted based on gender, hypertension, diabetes, stroke, hyperlipidemia, chronic obstructive pulmonary disease, and age. A mediation study was conducted to investigate the impact of lymphocytes on the association between GNRI and mortality.ResultsIn an overall sample of 895 patients, an elevated GNRI correlated with reduced 30-day (HR = 0.937, 95% CI: 0.917–0.957, p < 0.001) and 365-day mortality (HR = 0.937, 95% CI: 0.923–0.950, p < 0.001). The trend analysis for GNRI categories indicated a significant decline in mortality associated with rising GNRI (P for trend <0.001). Subgroup analysis validated the consistency of such results throughout diverse patient characteristics. The lymphocytes significantly mediated the relationship between GNRI and 30-day mortality (ACME: 0.022, 95% CI: 0.003–0.180, p < 0.001). A landmark analysis at 20 days after admission further demonstrated the impact of GNRI on mortality during different phases of recovery.ConclusionThis study highlights the prognostic value of GNRI in predicting short-term and long-term mortality in AMI patients, emphasizing the significance of nutritional status and inflammatory indicators in the therapy and risk assessment of these individuals.

Long-Term Monitoring of Individuals With Chronic Obstructive Pulmonary Disease Using Digital Health Technology: Qualitative Study.

Digital health adoption in clinical practice has been widespread, yet there remains further potential for optimizing care specifically for chronic obstructive pulmonary disease (COPD). This study therefore conducted qualitative research involving 35 health care professionals from a range of hospitals in Taiwan. This study aims to investigate barriers and facilitators related to the implementation of digital health technology (DHT) in the long-term monitoring of individuals with COPD based on clinical experiences in Taiwan. The perspectives of Taiwanese health care professionals provided valuable insights into the challenges and opportunities associated with using DHT for the management and enhancement of respiratory rehabilitation and long-term monitoring of patients with COPD. Several key themes related to the development of DHT were identified. Barriers encompassed concerns pertaining to digital safety, insurance coverage, constraints related to medical resources, and the presence of a digital divide. Facilitators included the potential for cost reduction, personalized prescriptions, and instilling motivation in users. To enhance the acceptance and use of DHT, embracing a user-centered approach that prioritizes the distinct needs of all parties involved is recommended. Moreover, optimizing and leveraging the effective use of DHT in managing the health of individuals with COPD promises to deliver care characterized by greater precision and efficiency. Overall, the benefits of using DHT for the long-term care of patients with COPD outweigh the disadvantages. After the COVID-19 pandemic, there has been an increased emphasis in Taiwan on the effectiveness of DHT in managing chronic diseases. Relevant studies including this paper have suggested that web-based exercise management systems could benefit patients with COPD in rehabilitation and tracking. Our findings provide meaningful directions for future research endeavors and practical implementation. By addressing identified barriers and capitalizing on facilitators, advancements can be made in the development and use of DHT, especially in overcoming challenges such as information security and operational methods. The implementation of the recommended strategies will likely lead to improved COPD care outcomes.

Phenotypic Differences between Patients with Smoking Chronic Obstructive Pulmonary Disease and Non-smoking Chronic Obstructive Pulmonary Disease

ABSTRACT Background: In low- and middle-income countries, causes other than tobacco smoking contribute more to the development of chronic obstructive pulmonary disease (COPD). In India, non-smoking-related COPD (NS-COPD) is common due to the high prevalence of pulmonary tuberculosis and biomass fuel exposure. Our study aims to know the phenotypic differences between smoking-related COPD (S-COPD) and NS-COPD patients. Materials and Methods: The study included 217 patients, who visited the outdoor department of a tertiary care center. A detailed clinical history was obtained; radiological and hematological investigations, spirometry, and a 6-min walk test were performed. Results: Of 217 patients, 100 had S-COPD, and 117 had NS-COPD. Male patients were predominantly affected (P < 0.001) in both groups. There were significant differences in the age group (P < 0.001), body mass index (P < 0.045), blood hemoglobin levels (P < 0.02), forced vital capacity (FVC) (P = 0.02), postbronchodilator reversibility in forced expiratory volume in 1 s (FEV1) (P < 0.006), and FEV1/FVC ratio (P < 0.001) between patients with smoking and S-COPD and NS-COPD. Emphysema was more common in S-COPD, whereas COPD-bronchiectasis overlap was more common among NS-COPD patients. Cough was more common, and airflow obstruction was less severe in nonsmokers. There was no significant difference in the exercise capacity. Conclusion: The NS-COPD patients present at younger age, with more COPD-bronchiectasis overlap phenotype. They have less severe airflow obstruction and more postbronchodilator reversibility. Understanding phenotypic characteristics is necessary for accurate diagnosis and management of COPD in nonsmokers.

Technegas at Last! Implementing Technegas into Clinical Practice in the United States: Considerations, Challenges, and Recommendations.

Technegas, 99mTc-labeled aerosolized carbon nanoparticles, has been used internationally since 1986 for pulmonary ventilation imaging. Unlike traditional gases, Technegas exhibits only a gaslike behavior, allowing deep and uniform deposition in the lungs' subsegmental regions. This hydrophobic property minimizes central airway clumping, as is particularly advantageous for patients with chronic obstructive pulmonary disease. Approved by the U.S. Food and Drug Administration in September 2023, Technegas is now available in the United States for diagnosing pulmonary embolism and broader ventilation and airway evaluations. The Technegas Plus system, which produces the radioaerosol onsite by heating [99mTc]sodium pertechnetate in a carbon crucible at ultrahigh temperatures, requires a specific infrastructure, including a 220-volt power supply and an argon gas source. Its rapid administration-often requiring only 1-3 breaths-streamlines workflows while ensuring patient comfort, especially for those with respiratory limitations. Additionally, Technegas supports SPECT and SPECT/CT imaging, enabling sensitivity and specificity superior to those of traditional planar methods. Despite the global adoption of ventilation-perfusion SPECT as the standard for pulmonary embolism diagnosis, its use in the United States remains limited. Now that Technegas is available in the United States, U.S. nuclear medicine departments can transition to advanced ventilation imaging, aligning with international best practices. This paper outlines essential considerations for Technegas implementation: infrastructure requirements, staff training, protocol development, and imaging optimization, including clinical experiences and perspectives from the staff at Barnes Jewish Hospital in St. Louis, Missouri. By integrating Technegas, departments can enhance diagnostic accuracy, improve workflow efficiency, and expand clinical applications, particularly for patients with complex pulmonary conditions.

A normal electrocardiogram indicates a better prognosis in patients with moderate to very severe chronic obstructive pulmonary disease

The role of electrocardiography (ECG) in predicting mortality in patients with chronic obstructive pulmonary disease (COPD) has not been sufficiently established. Research question: Is a normal ECG associated with a better prognosis than an abnormal ECG in patients with COPD? ECG parameters were assessed in patients enrolled in the Czech Multicenter Research Database of COPD. We assessed ECGs from baseline (August 2013) until December 31, 2019, or until death. The primary endpoint was 5-year overall survival depending on the ECG findings. A total of 300 subjects were enrolled in the study and 143 died during follow-up. This multicenter noninterventional observational prospective study revealed a significant difference in 5-year overall survival between COPD patients with normal ECGs and those with prognostically significant or other ECG abnormalities (76.8%, 38.2%, and 63.4%, respectively; P < 0.001). Patients with prognostically significant ECG abnormalities had a 2.537-fold greater mortality risk at 5 years than those with normal ECGs. In the COPD setting, patients with normal ECGs had a better prognosis than those with prognostically significant abnormalities suggesting that ECG may be a valuable tool for predicting mortality risk in these patients.

Barriers and enablers to medicine-taking behaviours in chronic obstructive pulmonary disease: a qualitative interview study.

Chronic Obstructive Pulmonary Disease (COPD) is associated with low health-related quality of life and high costs to healthcare systems, particularly due to hospital admissions and exacerbations. Medicines, inhalers especially, reduce the risk of hospitalisations and exacerbations, but factors influencing medicine-taking behaviours are not fully understood. To explore experiences of people with COPD related to medicines, and followingly identify and characterise any barriers and enablers related to medicine-taking behaviours using the Theoretical Domains Framework (TDF). Semi-structured qualitative interviews were conducted and included ten people with COPD who had previously been admitted to hospital. Systematic text condensation was used inductively in the primary analysis of the interviews. In the secondary analysis, meaning units from the primary analysis were mapped to the TDF and summarised as barriers and enablers. Five major themes were developed in the primary analysis: (1) health literacy and information needs, (2) patient autonomy, (3) lack of access to medicines, (4) lack of effect from medicines, and (5) experiences of medicines-related issues. In the secondary analysis, thirteen barriers and nine enablers were mapped to nine out of the fourteen domains of the TDF. People with COPD experience challenges related to medicines which need to be addressed by researchers and healthcare providers. The identified barriers and enablers mapped to the TDF can guide and inform future design of interventions and health care services.

Evaluation of pulmonary tuberculosis disease burden in Shenyang, China, 2023

BackgroundPulmonary tuberculosis (PTB) is one of the most serious infectious diseases worldwide and poses a great threat to people’s health. China has a vast territory with substantial regional disparities in the PTB disease burden. However, there have been no studies conducted to evaluate the PTB disease burden in Shenyang. The aim was to elucidate the magnitude, composition, and distribution of PTB disease burden in Shenyang.MethodsThe disability-adjusted life years (DALYs) calculated based on Global Burden of Disease (GBD) framework was used to assess the disease burden of PTB in Shenyang in 2023, and descriptive epidemiological methods were employed to elucidate the magnitude, composition, and distribution characteristics of PTB disease burden in Shenyang.ResultsIn 2023, 4,169 PTB cases were reported in Shenyang, including 2,901 males and 1,268 females. The incidence of PTB was 45.50/105, of which 64.29/105 for males and 27.30/105 for females. The incidence among males was higher than that among females (X2 = 688.56, p<0.001). The highest incidence was 107.00/105 in the group of the population aged 80 and above (X2 = 1171.75, p<0.001). In 2023, 189 PTB deaths were reported in Shenyang, including 156 males and 33 females. The mortality of PTB was 2.06/105 of which 3.46/105 for males and 0.71/105 for females. The mortality among males was higher than that among females (X2 = 83.69, p<0.001). The highest mortality was 16.04/105 in the group of the population aged 80 and above (X2 = 285.61, p<0.001). The PTB DALYs rate was 58.25/105, of which 91.73/105 for males and 21.22/105 for females. The DALYs rate among males was higher than that among females (X2 = 44.04, p<0.001). The highest DALYs rate was 149.86/105 in the group of the population aged 80 and above (X2 = 305.35, p<0.001). Years of life lost (YLLs) due to PTB accounted for 71.38% of total DALYs, of which 74.33% for males and 52.89% for females.ConclusionThe PTB DALYs rate in Shenyang was 58.25/105, which was lower than that in China, equivalent to 80% of the national PTB disease burden rate. The disease burden showed a characteristic of increasing with age, and the PTB DALYs rate for males was higher than that for females, being equivalent to 4 times the female rate. The predominant disease burden of PTB was attributed to YLLs, accounting for as much as 71.38%, indicating that PTB primarily results in premature mortality rather than disability. Therefore, the focus should be shifted towards early intervention to reduce transmission, especially for the aged males.

Unusual presentation of anomalous origin of the right pulmonary artery from the ascending aorta: case report.

Anomalous origin of the right pulmonary artery (AORPA) from the ascending aorta is a rare congenital anomaly, representing approximately 0.12% of all congenital heart defects. Early diagnosis and timely intervention are essential to prevent severe complications such as heart failure and pulmonary vascular disease. We report a case of a full term neonate presented with respiratory distress and cyanosis. Echocardiography revealed an anomalous right pulmonary artery (RPA) origin from the ascending aorta, a large patent ductus arteriosus (PDA) with right-to-left shunt, and moderate tricuspid regurgitation. Despite initial management with prostaglandin E1 (PGE1) infusion, discontinuation of the drug led to clinical deterioration characterized by severe metabolic acidosis and low cardiac output syndrome. Resuming PGE1 infusion stabilized the patient's hemodynamics and improved systemic blood flow, allowing for successful surgical repair. In cases of AORPA associated with aortic arch flow reversal, pulmonary hypertension, and inadequate interatrial communication, maintaining PDA patency with PGE1 infusion until surgical repair is critical for survival. The right-to-left flow across the PDA counteracts the steal from the aorta and decompresses the right ventricle, preventing right ventricular failureand maintaining systemic blood flow.

Reference values for the 1-minute sit-to-stand test to assess functional capacity and short-term mortality in people with idiopathic pulmonary fibrosis and fibrotic connective tissue related interstitial lung diseases: a prospective real-world cohort study

BackgroundEarly identification of functional decline in fibrotic interstitial lung disease (F-ILD) is crucial for timely treatment and improved survival. While the 6-minute walk test (6MWT) is the standard for functional evaluation, it has practical limitations. The 1-minute sit-to-stand test (1MSTS) offers a simpler alternative; however, its correlation with the 6MWT in F-ILD patients remains unclear. This study aims to establish reference values for the 1MSTS in assessing functional capacity, evaluate its correlation with the 6MWT, and explore its utility in predicting 18-month mortality in F-ILD patients.MethodsThis prospective study enrolled participants diagnosed with F-ILD based on multidisciplinary team discussions. Assessments included the 1MSTS, 6MWT, pulmonary function test (PFT), GAP score, mMRC scale, and Charlson Comorbidity Index (CCI). The association between 1MSTS repetitions and other variables was calculated using Spearman’s rho. Bland-Altman plots assessed the agreement between 1MSTS repetitions and the 6MWT. Predictors of 18-month mortality were evaluated using ROC curve and Kaplan-Meier curve.ResultsOf the 150 F-ILD patients, 37 (24.6%) had idiopathic pulmonary fibrosis (IPF), and 113 (75.4%) had connective tissue disease-related ILD (CTD-ILD). Using ≤ 23 repetitions as the cutoff for functional impairment in 1MSTS, 74 (47.3%) patients were classified as impaired. The 1MSTS significantly predicted 18-month mortality and demonstrated moderate correlations with GAP score (rs = -0.49), mMRC scale (rs = -0.47), and 6MWT distance (rs = 0.65). Bland-Altman analysis indicated agreement between 1MSTS repetitions and 6MWT distance. Using ≤ 23 repetitions as the cutoff value for the 1MSTS to predict 18-month mortality, the mortality rate was 76.4%, with an AUC of 0.81.ConclusionsThe findings suggest that ≤ 23 repetitions in the 1MSTS can serve as an indicator of functional impairment, demonstrate a good correlation with 6MWT distance, and effectively predict 18-month mortality in patients with F-ILD.Clinical trial numberNot applicable.

Medicinal plants in the treatment and prevention of respiratory diseases (review)

Introduction. The aim of the review is to summaries information on medicinal plants used in the prevention of respiratory diseases.Text. According to Rosstat data, respiratory diseases occupy leading positions in the Russian Federation from year to year. For the treatment of acute respiratory diseases plant medicines are used, including Glycyrrhiza glabra L., Mentha spicata L., Eucalyptus globulus Labill., Citrus sinensis (L.) Pers., Cinnamomum camphora J. Presl.Conclusion. The given extracts of medicinal plants have a long experience of application in traditional and scientific medicine, contain a complex of biologically active substances such as essential oils, saponins, polyphenols and polysaccharides with antibacterial, anti-inflammatory, analgesic and other effects that will allow in the complex therapy of acute tonsillopharyngitis, relieve the symptoms of the disease.

Factors that Affected Mortality Rate of Chronic Obstructive Pulmonary Disease Patients with Respiratory Failure

Background: Chronic obstructive pulmonary disease (COPD) is a health problem with significant morbidity and mortality rates, but until now risk factors of COPD, especially with type II respiratory failure, have not been clearly defined. This research is aimed to determine factors that affect the mortality rate of COPD patients with type II respiratory failure.Methods: Between March and May 2018, 85 MS patients from a large Hospital in the Athens region completed the questionnaires: a) Missoula-VITAS Quality of Life Index-15, which examines 5 dimensions of quality of life, b) Pain Self Efficacy Questionnaire which measures the pain self-efficacy that an individual perceives, c) Fatigue Assessment Scale (FAS) which measures fatigue, d) a questionnaire about the sociodemographic elements. Statistical analysis was performed using the IBM SPSS Statistics version 21. The significance level was set up to 0.001.Results: Variables of gender, age, number of comorbidities, smoking habits, and history of exacerbations weren’t significantly correlated with mortality of COPD patients (p&gt;0.05). Patients who do not routinely use inhalers tend to be more at risk with a mortality rate 19 times greater than patients who use inhalation therapy regularly. In addition, the longer the stay, the lower the risk of experiencing mortality.Conclusion: Factors that affected the mortality rate of COPD patients with type II respiratory failure are routine use of inhalers and length of stay.