Dyspnea Research Articles

Ventilatory response and dyspnea on exertion in children with obesity and respiratory symptoms.

Ventilatory response and dyspnea on exertion in children with obesity and respiratory symptoms.

Longitudinal assessment of lung function in patients following COVID-19.

Longitudinal assessment of lung function in patients following COVID-19.

Long COVID and Its Impacts: A Case–Control Study in Brazil

Introduction: Long COVID, or post-COVID-19 syndrome, refers to a set of persistent symptoms following SARS-CoV-2 infection without another identifiable cause. Studies indicate that symptoms can last for up to two years and affect multiple body systems. Objective: The objective of this study is to compare symptom prevalence between infected individuals pre and post-COVID-19 and non-infected individuals in a population from Southeastern Brazil. Materials and Methods: A case–control study was conducted with participants from the MonitoraCovid program in a university in Brazil. The study included adults who responded to a questionnaire about long COVID symptoms. Data were collected virtually between October 2023 and May 2024. Results: Of the 2886 individuals eligible for analysis, 75.5% reported having been positive for COVID-19. Most participants were vaccinated, with 82.99% receiving two doses. In the pre and post comparison, individuals who had COVID-19 were more likely to report increased symptoms after infection, with 95.5% of assessed conditions worsening, particularly cognitive and respiratory issues. A comparison between those who had and had not been infected with COVID-19 showed that only 6.67% of symptoms were more prevalent in the infected group. The most significant post-COVID-19 symptoms included memory problems, fatigue, and shortness of breath, though some conditions, such as anxiety and sleep disturbances, were less common among those who had COVID-19. Conclusions: The findings reinforce that long COVID significantly impacts cognitive health, highlighting the importance of monitoring previously infected individuals. The study also emphasizes the need for further research in Global South contexts to better understand the long-term implications of COVID-19.

Genetic diversity of respiratory syncytial virus in children with community-acquired pneumonia in Guangzhou: an epidemiological update.

Community-acquired pneumonia (CAP) is a common infectious disease with a mortality rate of 2-14%. Respiratory syncytial virus (RSV) frequently causes CAP in children. This study aimed to investigate RSV genetic diversity in children under 15 years of age with CAP, evaluate nucleotide substitution rates, and examine associations with clinical characteristics and outcomes. A retrospective observational study was conducted using nasal swab samples collected from children under 15 years of age diagnosed with CAP. RSV identification involved cell culture and immunofluorescence microscopy, followed by molecular analyses using qPCR, nested PCR, and Sanger sequencing. Bioinformatics tools were applied to assess phylogenetics, evolutionary trends, genetic distance, and nucleotide substitution rates. Statistical analysis of clinical and laboratory data was performed to identify correlations between RSV features and patient characteristics. Among 346 CAP cases, RSV was detected in 26.88%, with the highest prevalence in children aged 1-2 years. Subtype A exhibited higher nucleotide substitution rates than subtype B. Shortness of breath and high fever were significantly associated with increased nucleotide diversity. RSV infections peaked in winter, particularly in 2018 and 2019. Elevated substitution rates were linked to longer hospital stays, greater risk of complications such as secondary bacterial infections, and increased RSV-related morbidity. RSV higher nucleotide substitution rates, especially in children under 3 years of age, were associated with more severe clinical outcomes and prolonged hospitalization. Phylogenetic analysis indicated distinct evolutionary patterns, with subtype B exhibiting a more rapid evolutionary rate than subtype A. This study highlights the high prevalence of respiratory viruses, particularly respiratory syncytial virus (RSV), in children with community-acquired pneumonia in Guangzhou. It provides detailed molecular epidemiological data on RSV, including genetic variation patterns and evolutionary rates. The findings contribute regional data essential for epidemiological research and public health planning in similar geographic areas. These results support clinical decision-making and inform public health strategies, particularly those focused on RSV vaccination and infection control.

Acute Intraoperative Pulmonary Embolism Management in the Era of Pulmonary Embolism Response Teams and Minimally Invasive Therapy: A Case Report.

Intraoperative acute pulmonary embolism (PE) is a rare and life-threatening event with symptoms such as pleuritic chest pain, shortness of breath, and anxiety, which are easily masked by general anesthesia. To diagnose PE in a patient under general anesthesia, anesthesiologists must rely on alternative data points such as hypoxia, decreased end-tidal carbon dioxide (ETCO2), tachycardia, electrocardiogram changes, and intraoperative echocardiography. We present a case of acute intraoperative massive PE in a patient undergoing posterior spinal fusion. We discuss the management of acute perioperative PE, focusing on surgical risk, bleeding potential with thrombolytic therapies and anticoagulation, recent advances in catheter-based therapies, and the role of Pulmonary Embolism Response Teams (PERTs) in the assessment and perioperative management of high-risk patients.

Restrictive Cardiomyopathy due to Secondary Haemochromatosis in a Beta Thalassaemia Major Patient: A Rare Entity

Haemochromatsis occurs due to iron over load. Thalassaemia major is an inherited disorder that can cause secondary haemochromatosis due to haemolysis and repeated blood transfusion. The secondary haemochromatosis in thalassaemia patient can rarely present with restrictive cardiomyopathy. Here, we report a case, where a 30-year-old woman with thalassaemia major presented with shortness of breath with paroxysmal nocturnal dyspnea, orthopnoea , oedema, skin pigmentation, raised Jugular venous pressure(JVP), cyanosis and bilateral basal crepitation. After through investigations, she was diagnosed as a case of heart failure due to restrictive cardiomyopathy with secondary haemochromatosis as a complication of repeated blood transfusion. She was treated with iron chelation therapy, furosemide, beta-blockers, angiotensin receptor blocker (ARB) and discharged with follow up. Iron chelation therapy should be imitated early to prevent secondary haemochromatsosis and its complications in thalassaemia major patient. University Heart Journal 2024; 20(2): 72-76

Postflight Pulmonary Barotrauma in a Pilot Without Underlying Disease

BACKGROUND: Exposure to pressure changes can result in barotrauma in gas-filled cavities when volume expansion exceeds tissue strength, leading to local disruption. While few cases have been reported, we present a case of pulmonary barotrauma developed postflight in a pilot without underlying disease, and the most likely reason is improper pressure-breathing in flight. CASE REPORT: A 25-yr-old healthy male fighter pilot experienced slight chest pain 3 h after a 1-h flight training mission, during which the peak G was 6 G. The symptoms worsened during eating and were accompanied by chest tightness and shortness of breath. Chest CT scans showed pneumothorax and mediastinal emphysema. Symptoms improved after oxygen inhalation and the pilot resumed flying duties (no high-G dynamic flight maneuvers) after 1 mo of observation on the ground. DISCUSSION: The case revealed pulmonary barotrauma in an experienced pilot with no disease history due to inappropriate positive pressure-breathing, suggesting the importance of fully training in positive pressure-breathing for G. We recommend pilots who experience unusual respiratory symptoms after landing report to medical for urgent review and the flight surgeon should, at that time, consider flight-related factors leading to barotrauma. Meng W, Zhou Q, Qing L. Postflight pulmonary barotrauma in a pilot without underlying disease. Aerosp Med Hum Perform. 2025; 96(7):578–580.

Prevalence of Persistent Cardiovascular and Pulmonary Abnormalities on PET/MRI and DECT Imaging in Long COVID Patients.

The objective of this study is to describe the prevalence of inflammatory cardiopulmonary findings in a prospective cohort of long coronavirus disease (LC) patients. Methods: Subjects with a history of coronavirus disease 2019 infection, persistent cardiopulmonary symptoms 9-12 mo after initial infection, and a clinical assessment compatible with LC underwent cardiopulmonary 18F-FDG PET/MRI, dual-energy CT (DECT) of the lungs, and plasma protein analysis (subgroup). A control group that included subjects with a history of acute severe acute respiratory syndrome coronavirus 2 infection but without cardiopulmonary symptoms at recruitment was also characterized. Results: Ninety-eight patients (median age, 48.5 y; 47% men) were enrolled. The most common LC symptom was shortness of breath (80%), and 27% of participants were hospitalized. Of the subjects, 90% presented abnormalities in DECT, with 67% and 59% of participants demonstrating pulmonary infiltrates and abnormal perfusion, respectively. PET/MRI was abnormal for 57% of subjects: 24% showed cardiac involvement suggestive of myocarditis, 22% presented uptake reminiscent of pericarditis, 11% showed periannular uptake, and 30% showed vascular uptake (aortic or pulmonary). There was no myocardial, pericardial, periannular, or pulmonary uptake on the PET/MRI scans of the control group (n = 9). Analysis of plasma protein concentrations showed significant differences between the LC and the control groups. Lastly, the plasma protein profile was significantly different among LC patients with abnormal and normal PET/MRI. Conclusion: In LC subjects evaluated up to a year after coronavirus disease 2019 infection, our results indicate a high prevalence of abnormalities on PET/MRI and DECT, as well as significant differences in the peripheral biomarker profile, which might warrant further monitoring to exclude the development of complications such as pulmonary hypertension and valvular disease.

Multicenter Investigation of Current Asthma Coexistence in Allergic Rhinitis Cases.

This study aimed to determine the prevalence of allergic rhinitis (AR) and asthma among the participants and assess the likelihood that any given participant would also have asthma. The study included 1200 patients with AR (599 men and 601 females) who met the inclusion criteria. These patients came from various locations across Turkey. All of the study's subjects had AR symptoms, such as stuffy nose, itching, sneezing, and runny nose. Whether the AR prick test is positive or negative is recorded as 0 for unavailable, 1 for negative, and 2 for positive. Following the GINA standards, they additionally assessed for asthma using the following survey questions: clinical asthma diagnosis, shortness of breath, wheezing, coughing, chest tightness, and asthma severity. The results show that 32.3% of the patients with AR have asthma. Asthma is significantly more common in elderly people with AR. Males with AR are more likely to have asthma (55.4%) than females with AR (9.2%). The rate of positive asthma tests rises in correlation with the reduction of nasal discharge and sneezing. However, as nasal itching and obstruction increased, asthma prevalence increased. The total nasal symptom scores of patients with asthma (13.17 ± 1.76) are significantly lower than those without asthma (15.88 ± 3.47). Asthma was seen in 32.3% of the AR patients. Patients with allergic rhinitis should be closely monitored for the onset of asthma, and prompt diagnosis and treatment are crucial. Collaboration among allergy clinics, pulmonology departments, and otorhinolaryngology practices is vital.

Evaluating the Impact That a Lung Ultrasound Training Program to Detect Acute Heart Failure Has on Paramedic Behavior.

Evaluating the Impact That a Lung Ultrasound Training Program to Detect Acute Heart Failure Has on Paramedic Behavior.

Clinical characteristics and outcomes of non-tuberculous mycobacterial pulmonary infections after hematopoietic stem cell transplantation: A retrospective cohort study.

Clinical characteristics and outcomes of non-tuberculous mycobacterial pulmonary infections after hematopoietic stem cell transplantation: A retrospective cohort study.

An unblinded training exposure to hypoxia enhances subsequent hypoxia awareness.

Malfunctions and human errors in diving rebreathers can cause hypoxia, hyperoxia, and/or hypercapnia. We evaluated whether a prior unblinded hypoxia experience enhances a diver's ability to recognise hypoxia and initiate self-rescue. Forty participants were randomised to receive either an information leaflet describing hypoxia symptoms or an unblinded hypoxia experience, prior to a blinded hypoxia testing exposure during a virtual reality dive over one month later. The primary outcome was the comparison of the proportion of participants in these two groups who initiated self-rescue before reaching a peripheral oxygen saturation of 70% in the blinded exposure. An individual's 'symptom profile' was assessed by comparing symptoms during the unblinded hypoxia experience and blinded testing exposures. During the blinded hypoxia testing exposure, 18/20 (90%) participants in the hypoxia experience group performed a self-initiated rescue compared to 6/18 (33%) in the information leaflet group (P < 0.001). Participants in the information leaflet group had lower mean SpO₂ (73.4% vs 81.4%, mean difference 8% [95% CI = 2.5-13.5%, P = 0.005]) and lower inhaled oxygen fraction (7.6% vs 9.4%, mean difference 1.8% [95% CI = 0.6-3.1%, P = 0.005]) at self-rescue. The most frequent and severe symptoms were light-headedness and shortness of breath. Of the 20 participants completing both hypoxia exposures, 14 (70%) had a consistent hypoxia symptom profile, which was not related to the ability to recognise hypoxia. Self-rescue was approximately three times more likely for participants who had previously experienced hypoxia compared to simply receiving information on relevant symptoms. Most participants exhibited a consistent pattern of individual symptoms, which did not result in earlier or improved detection of hypoxia.

Laporan Kasus Hipokalemi Periodik Paralisis pada Pasien dengan Graves’ Disease

Hypokalemia periodic paralysis (HPP) characterized by episodes of flaccid weakness or paralysis that may be associated with abnormalities of the serum potassium level. HPP often associated with hyperthyroidism and Graves’ disease. HPP prevalence is 1 in 100.000. Each individual has different clinical manifestations, so it’s necessary to adjust therapy based on the etiology. This case report was developed to provide more information regarding Graves’ disease, considering lack of information about management and description of HPP with Graves’ disease. A 27-year-old male with sudden weakness in both legs radiating to upper extremity, shortness of breath, palpitations, and sweating. Over the last 2 months, the patient’s weight has dropped drastically even though his appetite was increased. There were no complaints of nausea, vomiting, or increased frequency of defecation and urination. Previously, the patient had the similar experiences and received potassium transfusion twice. The patients revealed tachycardia, diffuse thyroid gland, fine hand tremor, superior motor streght 222/222 and inferior 111/111, hypokalemia (1.40 mmol/L), T4 total 197.80 nmol/L, and fluorescence T4 &gt;320 m/U/mL. Graves’ disease that has become thyrotoxicosis can be accompanied by a picture of HPP or also called thyrotoxicosis periodic paralysis (TPP). Hypokalemia in TPP are not caused by potassium loss but due to intracellular potassium movement, so there’s a high possibility to hyperkalemia rebound. Treatment of TTP due to Grave’s disease is to prevent potassium transfer by administering beta blocker, potassium replacement, and treating hyperthyroidism.

Exercise Intolerance and Response to Training in Patients With Postacute Sequelae of SARS-CoV2 (Long COVID): A Scientific Statement From the American Heart Association.

The postacute sequelae of SARS-CoV-2, also known as Long COVID, may affect 10% to 25% of individuals diagnosed with SARS-CoV-2. More than 100 symptoms have been reported among patients with Long COVID, but almost all patients report severe fatigue, orthostatic intolerance, shortness of breath, and reductions in exercise tolerance. Emerging data suggest that cardiovascular deconditioning plays a major role in the development of this syndrome and that reductions in functional capacity among patients with Long COVID are comparable to reductions seen among individuals with cardiovascular deconditioning resulting from bed rest. Concern has been raised about the use of exercise training as part of the management strategy for patients with Long COVID. However, exercise training appropriately tailored to the patient with cardiovascular deconditioning may be an effective strategy to facilitate improvement in symptoms. This American Heart Association scientific statement provides a concise yet comprehensive overview of mechanisms contributing to development of Long COVID and methods by which exercise training may be applied to this unique patient population to alleviate symptoms and improve quality of life. In addition, methods of reintroducing exercise and return to play among athletes affected by COVID-19 are discussed.

Retrospective Analysis of Clinical Profile, Management and Outcomes of Pulmonary Embolism in Western Nepal, A Single Center Study

Background: Pulmonary embolism (PE) is a potentially life threatening condition. Symptoms can be vague mimicking other conditions. Severity depends on the size and location of the embolism. A thorough medical history is crucial to identify the risk factors. This study aims at identifying clinical presentations, management and outcome of PE. Methods: This was a retrospective analysis of the patients presenting with acute PE for four years, from May 2020 to May 2024 at Gautam Buddha Community Heart Hospital.Results: Altogether 51 patients admitted for acute PE were included in the study. The mean age was 54.39±18. Majority were male 30(58.8%). The most common age group affected was 41–60 years (43.1%). The majority of them were categorized as low risk 37(72.5%). Clinically 16 patients (31.4%) had provoked conditions, whereas 35 patients (68.6%) presented with non-provoked conditions. The most common clinical presentation was shortness of breath 44(86%) followed by chest pain 15(23.4%). The most common ECG and Echocardiogram finding was sinus tachycardia 43(84.4%) and dilated right atrium and right ventricle 45(88.2%) respectively. Direct acting anticoagulants was used in 17(33.3%) patients. The mean hospital stay for the cohort was 4.4 ± 1.8 days. There were five mortalities with mean simplified PESI score of 3±0.7. Conclusion: Acute PE is a life-threatening condition resulting from the obstruction of the pulmonary arteries. Prompt diagnosis and treatment are crucial to reducing morbidity and mortality.

Multidimensional Consequences of Delayed Surgical Tracheostomy in a Critically Ill Adult: A Case Report and Systems-Based Analysis

Background Delays in surgical tracheostomy can impact patients, families, and ICU systems. This case highlights the consequences of delays and gives suggestions on how to optimize care delivery. Patient case A 32-year-old female diagnosed with severe pneumococcal pneumonia presented with progressive shortness of breath, chest pain and cough. She continued to deteriorate despite non-invasive respiratory support, resulting in tracheal intubation and prolonged invasive ventilation. Intervention She required surgical tracheostomy to aid weaning because of anticipated difficulty with bedside percutaneous dilatational tracheostomy (PDT). Logistical and operating room scheduling problems led to a five-day delay. Outcome Delayed surgical tracheostomy resulted in significantly prolonged sedation burden, likely contributed to post-emergence delirium, delayed laryngeal and physical rehabilitation, distress for the relatives, and pressure on the healthcare system in terms of bed-days and economic costs. Conclusion Minimizing delays between decision for ICU tracheostomy and insertion improves outcomes for patients, their relatives, and hospital systems. Innovations enabling more ICU bedside PDT to be undertaken could reduce delays.

Idiopathic pulmonary fibrosis in a patient with rheumatoid arthritis

ABSTRACT. The purpose of this paper is to draw the attention of practicing physicians to the importance of timely treatment and difficulties in managing patients with idiopathic pulmonary fibrosis (IPF), especially in cases of combination with other chronic diseases, in particular rheumatoid arthritis. The paper describes a clinical case of IPF, which due to its gradual progressive course was not perceived by the patient as a clinically important disease. A feature of the course of IPF in this patient was the discovery of numerous widespread bronchiectasis with bullae up to 7.5 cm in diameter, a complication was their infection with a multidrug-resistant strain of Acinetobacter baumannii, which made further effective treatment impossible. The patient was referred for inpatient treatment due to the existing active respiratory tract infection, which was accompanied by severe intoxication, shortness of breath, cough and general weakness. Despite the combination therapy, the patient's condition progressively worsened. Subsequently, the patient developed a septic state and multiple organ failure. The patient died on the 33rd day of hospitalization. This case demonstrates the complexity of managing patients with comorbid pathology and existing IPF, emphasizes the importance of early diagnosis and the availability of affordable antifibrotic therapy, as well as timely monitoring of disease progression and infectious complications.

Idiopathic pulmonary fibrosis in a patient with rheumatoid arthritis

ABSTRACT. The purpose of this paper is to draw the attention of practicing physicians to the importance of timely treatment and difficulties in managing patients with idiopathic pulmonary fibrosis (IPF), especially in cases of combination with other chronic diseases, in particular rheumatoid arthritis. The paper describes a clinical case of IPF, which due to its gradual progressive course was not perceived by the patient as a clinically important disease. A feature of the course of IPF in this patient was the discovery of numerous widespread bronchiectasis with bullae up to 7.5 cm in diameter, a complication was their infection with a multidrug-resistant strain of Acinetobacter baumannii, which made further effective treatment impossible. The patient was referred for inpatient treatment due to the existing active respiratory tract infection, which was accompanied by severe intoxication, shortness of breath, cough and general weakness. Despite the combination therapy, the patient's condition progressively worsened. Subsequently, the patient developed a septic state and multiple organ failure. The patient died on the 33rd day of hospitalization. This case demonstrates the complexity of managing patients with comorbid pathology and existing IPF, emphasizes the importance of early diagnosis and the availability of affordable antifibrotic therapy, as well as timely monitoring of disease progression and infectious complications.

Missed Gastroesophageal Injuries During Antireflux Surgery: Infrequent but Catastrophic Complications

Background: Laparoscopic antireflux surgery (LARS) is widely used to treat gastroesophageal reflux disease (GERD). Iatrogenic gastroesophageal injuries, when recognized intraoperatively, can be managed without major consequences, whereas undetected injuries presenting as postoperative leaks are associated with high morbidity and mortality. Despite their complexity, research on post-LARS leaks is scant. We aim to describe the diagnosis and management of such injuries at a tertiary referral center. Methods: We describe a single-center case series of patients referred for gastroesophageal perforations after LARS. Patients were identified through the personal records of surgeons at our institution. A narrative literature review was conducted to summarize publications on the topic. Results: Five patients (four female [80%]; median age, 73 years [IQR, 67–74]) were included. The median time between LARS and clinical presentation was 2 (IQR, 1–8) days (range 1–15 days). The most frequent symptoms were shortness of breath (all five patients) and pain (three [60%] patients). All patients presented with hypoxia, and four (80%) patients presented with sepsis. Two (40%) patients underwent primary repair, and three (60%) required limited esophagogastrectomy without immediate reconstruction. All patients required both thoracic and abdominal exploration, and all of them experienced significant postoperative complications (Clavien–Dindo ≥ 3). The median hospital stay was 58 days (IQR, 34–59). At a median follow-up of 14 months (IQR, 6–28), all patients were alive. Conclusions: Although infrequent, gastroesophageal perforation after LARS often requires complex surgical interventions and prolonged hospital stays. Additional efforts should focus on prevention and early recognition.

OBESITY AS A PREDICTOR OF FLATFOOT DEVELOPMENT AND POSTURE DISORDERS AND THEIR CORRECTION THROUGH PHYSICAL THERAPY METHODS

The research describes the impact of obesity as a factor contributing to the development of flatfoot and posture disorders, as well as the development of a physical therapy program for their correction. A total of 90 persons were examined, and they were divided into 3 groups: 30 students with normal body weight, proper posture, and without flatfoot. The comparison group consisted of 60 students with obesity, posture disorders and flatfoot, who were further divided into two groups.Comparison Group 1 (CG1) consisted of 30 students who were informed about the risks associated with obesity, posture disorders, flatfoot, and general hypodynamia. They were provided with recommendations on the basics of balanced nutrition according to the WHO [4] and principles for reducing hypodynamia.Comparison Group 2 consisted of 30 students who underwent restorative interventions using a physical therapy program.According to the results of the questionnaire, the condition of students with obesity was characterized by shortness of breath during physical exertion, increased fatigue, discomfort in the body, and psycho-emotional depression. According to the IPAQ, they showed lower time spent on vigorous and moderate physical activity compared to their healthy peers. Weekly energy expenditure was at the level of low physical activity. According to FMS tests, people with obesity lagged behind healthy peers[3]. Their handgrip and leg strength were at a low level. Quality of life, as measured by the EQ-5D-5L questionnaire, was found to be low. Obesity was associated with high body weight and body mass index (BMI)[10], as well as the presence of abdominal obesity. The state of the spine was characterized by low flexibility in the chin-chest, Ott, Sediina, Schober, and Tomayer tests. The feet were characterized by a decrease in arch height, as indicated by Friedland’s index. A deterioration in stability and balance was diagnosed.A physical therapy program was developed, lasting 6 months, and included the following elements: kinesitherapy methods, massage, kinesiological taping, nutrition modification recommendations, and patient education. The comprehensive nature of the program aimed to address the identified disorders across all domains of the ICF (International Classification of Functioning, Disability, and Health) and focused on increasing participation in social life by improving the participants' health.The impact of the developed physical therapy program was reflected in the positive dynamics of the students' subjective condition. Weekly energy expenditure increased according to the IPAQ [6], expanded physical capabilities were established via FMS, muscle strength improved according to the results of dynamometry tests for the legs and hands, and quality of life improved according to the EQ-5D-5L questionnaire. In comparison group 2, there was a reduction in body weight and BMI (to the level of overweight), a decrease in abdominal obesity, an increase in muscle tissue content, and a reduction in body fat. Flexibility in all sections of the spine improved based on the results of the chin-chest, Ott, Sediina, Schober, and Tomayer tests. Functional reserves of the feet showed improvement, with students exhibiting normal arch height and a reduction in the number of individuals with a high degree of flatfoot. Stability during stabilometry improved, indicating better overall coordination and strength of the core and limb stabilizing muscles, as well as the vestibular system.