Special Issue:
Challenges and Opportunities in Respiratory Medicine
Zijing Zhang, PhD
School of Electrical and Computer Engineering, Cornell University, Ithaca, NY, USA.
Taeyoung Park, BS
Division of Geriatrics and Palliative Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, USA.
Jamuna K. Krishnan, MD
Division of Pulmonary and Critical Care, Department of Medicine, Weill Cornell Medicine, New York, NY, USA.
Kapil Gangwar, MS
School of Electrical and Computer Engineering, Cornell University, Ithaca, NY, USA.
Jianlin Zhou, PhD
School of Electrical and Computer Engineering, Cornell University, Ithaca, NY, USA.
Thomas B. Conroy, MS
School of Electrical and Computer Engineering, Cornell University, Ithaca, NY, USA.
Edwin C. Kan, PhD
School of Electrical and Computer Engineering, Cornell University, Ithaca, NY, USA.
Veerawat Phongtaknuel, MD, MS
Division of Geriatrics and Palliative Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, USA.
Abstract
Background: The symptom of dyspnea is commonly encountered in patients with underlying serious illness and can lead to distress and poor quality of life. In patients with chronic obstructive lung disease (COPD), the prevalence is reported in up to 95% of patients. With the growth in sensor technologies, continuous monitoring of respiratory metrics provides an opportunity to better understand the relationship between patient-reported dyspnea and objective respiratory measures.
Aims: To assess the feasibility of implementing a radio-frequency (RF) sensor in patients with COPD and describe the relationship between dyspnea and respiratory metrics in patients with COPD when compared to healthy controls.
Methods: A prospective cohort study was conducted to collect data on dyspnea scores and respiratory metrics in patients with COPD and healthy controls while conducting a walking test using a wearable RF sensor.
Results: Of the 12 COPD patients and 15 healthy controls recruited, all participants completed the modified incremental shuttle walking test while wearing the RF sensor; there was no attrition. For every one-point increase in the dyspnea score, there was a mean 1.94 increase in the respiratory rate per minute in the COPD group as compared to a 1.09 increase in respiratory rate in the healthy control group.
Conclusion: Preliminary data demonstrate the potential of using the RF sensors to track respiratory metrics in COPD patients and healthy adults. As this technology develops, it shows considerable promise and could provide significant implications regarding the use of non-invasive continuous monitoring for patients with lung disease.
Richard Thorley
Department of Respiratory Medicine, Bristol Royal Infirmary, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
Joshua Graeme-Wilson
Department of Respiratory Medicine, Bristol Royal Infirmary, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
Katrina Curtis
Department of Respiratory Medicine, Bristol Royal Infirmary, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
Abstract
Prone positioning has been demonstrated to significantly reduce mortality in invasively ventilated patients with moderate to severe acute respiratory distress syndrome through several physiological mechanisms, including optimization of ventilation and perfusion and a reduction in ventilator-associated lung injury. The marked increase of hospitalisation rates of patients with acute hypoxaemic respiratory failure during the COVID-19 pandemic, and associated strain on healthcare resources, led to interest in the use of prone positioning in conscious self-ventilating, or “awake”, patients, as an adjunct to the provision of oxygen therapy and respiratory support. The adoption of this technique was with the intent of reducing the likelihood of progressive respiratory failure and thus the need for invasive mechanical ventilation. In this review we summarize the background, physiological mechanisms and current evidence for the use of awake prone positioning in both COVID-19 related hypoxaemic respiratory failure and that attributed to other aetiologies. Whilst several studies note an improvement in respiratory parameters including oxygenation, the effect on clinically important outcomes such as rates of intubation and mortality remain unclear. The evidence base beyond COVID-19 related respiratory failure remains constrained and there is a paucity of evidence to help identify those most likely to benefit from this therapy. There remains no agreed consensus on how to implement awake prone positioning and significant variation exists in practice. Several clinical questions should be the focus for future research studies of this treatment modality including how to identify early responders and non-responders to therapy.
Zirhirhi Kaoutar
Department of Intensive Care Medicine, Ibn Rochd University Hospital, Faculty of Medicine and Pharmacy of Casablanca, Hassan 2, University, Casablanca, Morocco.
Tougar Sanaa
Department of Intensive Care Medicine, Ibn Rochd University Hospital, Faculty of Medicine and Pharmacy of Casablanca, Hassan 2. University, Casablanca, Morocco
Afif Amine
Department of Intensive Care Medicine, Ibn Rochd University Hospital, Faculty of Medicine and Pharmacy of Casablanca, Hassan 2, University, Casablanca, Morocco.
Elkhaouri Imane
Department of Intensive Care Medicine, Ibn Rochd University Hospital, Faculty of Medicine and Pharmacy of Casablanca, Hassan 2, University, Casablanca, Morocco.
Charra Boubaker
Head of Department of Medical Intensive Care, Ibn Rochd University Hospital, Faculty of Medicine and Pharmacy of Casablanca, Hassan 2 University, Casablanca, Morocco.
Abstract
The Severe Acute Respiratory Syndrome Coronavirus 2 virus has a strong tropism for the cardiovascular system, with direct or indirect interactions mediated by inflammation. The virus can cause cardiovascular lesions that can compromise the prognosis. We report the case of a 43-year-old patient with no particular medical history, admitted with acute respiratory distress syndrome due to coronavirus disease 2019 pneumonia complicated by myocardial injury, whose condition gradually improved with apyrexia, normalization of troponins, inflammatory markers, and restoration of left ventricular function. This case report demonstrates the need to identify cardiac involvement through widespread use of echocardiography and close monitoring of cardiac and inflammatory biomarkers during coronavirus disease 2019 infection, given the prognostic implications of such involvement.
Panagiota Xaplanteri
Department of Microbiology, General Hospital of Eastern Achaia, Kalavrita, Greece
Vasileios Zoitopoulos
Department of Microbiology, General Hospital of Eastern Achaia, Aigio, Greece
Vasiliki Diamanti
Department of Microbiology, General Hospital of Eastern Achaia, Aigio, Greece
Athanasia Moutafidi
Department of Microbiology, General Hospital of Eastern Achaia, Kalavrita, Greece
Panagiota Masoura
Department of Microbiology, General Hospital of Eastern Achaia, Kalavrita, Greece
Charalampos Potsios
Department of Internal Medicine, University General Hospital of Patras, Greece
Konstantina Filioti
Department of Internal Medicine, General Hospital of Eastern Achaia, Aigio, Greece
Angeliki Rapanou
Department of Internal Medicine, General Hospital of Eastern Achaia, Aigio, Greece
Christina-Panagiota Koutsouri
Department of Internal Medicine, General Hospital of Eastern Achaia, Aigio, Greece
Zoi Grammenidou
Department of Internal Medicine, General Hospital of Eastern Achaia, Aigio, Greece
Aimilios Tzoudas
Department of Primary Healthcare, General Hospital of Eastern Achaia, Kalavrita, Greece
Chara Sakarelou
Department of Internal Medicine, General Hospital of Eastern Achaia, Kalavrita, Greece
Tatiana Beqo Rokaj
Department of Primary Healthcare, General Hospital of Eastern Achaia, Kalavrita, Greece
Katerina Ntzinia
Department of Primary Healthcare, General Hospital of Eastern Achaia, Kalavrita, Greece
Elsa Kampos Martinez
Department of Internal Medicine, General Hospital of Eastern Achaia, Kalavrita, Greece
Georgios Papachristopoulos
Department of Internal Medicine, General Hospital of Eastern Achaia, Kalavrita, Greece
Constantinos A Letsas
Department of Internal Medicine, General Hospital of Eastern Achaia, Aigio, Greece
Abstract
Background: Since December 2019 mankind is agonized over the deadly coronavirus disease 2019 (COVID-19) which is due to the novel coronavirus (2019-nCoV) or Severe Acute Respiratory Syndrome Coronavirus-2 (Sars-cov-2).
Methods: In this retrospective study, laboratory findings and demographic features from all confirmed COVID-19 patients who attended the Emergency Department of both branches of our hospital during the first semester of 2021 were collected and analyzed. The working hypothesis was that initial laboratory data at the time the patients sought medical assistant for the first time, regardless of comorbidities and day of onset of symptoms, can help predict patients’ outcomes. Demographic data and laboratory tests were compared between hospitalized and non-hospitalized patients.
Results: Data from 270 patients were collected and analyzed retrospectively. 31 blood measurement parameters performed in both hospital branches were compared between hospitalized and non-hospitalized patients. Of those, WBC count (p=0.016), neutrophil percentage (p<0.001), lymphocyte percentage (p<0.001), platelet count (p=0.041), glucose (p<0.001), urea (p<0.001), creatinine (p<0.001), SGOT (p=0.024), CK (p<0.053), LDH (p<0.001), GGT (p<0.001), sodium (p<0.001), calcium (p<0.001), high sensitivity Troponin I (p<0.001), and ferritin levels (p<0.001), proved statistically significant. Regarding demographic data, age was significantly linked to patients’ survival.
Conclusion: Our data suggest that common initial laboratory findings of COVID-19 patients who seek first-time medical assistance regardless of comorbidities and time from onset of symptoms can give clues to the patient outcome. Age is also important for patients’ survival. Especially in a Primary Health Care Setting, common blood parameters like WBC count, neutrophil and lymphocyte percentage, platelet count, glucose, urea, creatinine, SGOT, CK, LDH, GGT, sodium, calcium, high sensitivity Troponin I, and ferritin levels, could be really helpful to predict disease severity.
Rahul G. Sangani, MD
Division of Pulmonary, Critical Care and Sleep Medicine, Dept. of Medicine, West Virginia University, Morgantown, WV
Vishal Deepak
Division of Pulmonary, Critical Care and Sleep Medicine, Dept. of Medicine, West Virginia University, Morgantown, WV
Bhanusowmya Buragamadagu
Division of Pulmonary, Critical Care and Sleep Medicine, Dept. of Medicine, West Virginia University, Morgantown, WV
Andrew J. Ghio
US EPA, Chapel Hill, NC
Abstract
Exposure to cigarette smoking is extensive in rural Appalachia where one in four adults’ smokes. The clinical implications of this habit are evident among patients with some of the highest national rates for chronic obstructive pulmonary disease (COPD), lung cancer, and pulmonary fibrosis. Individuals undergoing surgical lung resection for suspicious lung nodules or masses at a major rural academic center in the area demonstrated an excessive burden of histologic emphysema (73.5%). This destructive process of the alveoli was linked to a significant burden of comorbid conditions, various radiologic patterns of interstitial lung diseases and interstitial lung abnormalities, histologic fibrosis, inflammatory processes (respiratory bronchitis, desquamative interstitial pneumonia, peribronchiolar metaplasia), anthracosis, and lung cancer. Physiologically, this combination of injuries imposed substantial limitations. Findings presented may enhance the understanding of concurrent changes occurring in the smoker. The complex inter-relationships and disparities between clinical COPD, radiologic and histologic emphysema are defined. While emphysema remains an irreversible pathology, associated inflammatory and fibrotic conditions are possibly amenable to earlier smoking cessation strategies and available disease-modifying therapies.
Wendel Dierckx
Centre for Research and Innovation in Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Multidisciplinary Medical Center, MedImprove BV, Kontich, Belgium
Wilfried De Backer
Multidisciplinary Medical Center, MedImprove BV, Kontich, Belgium; Laboratory of Experimental Medicine and Paediatrics, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; FLUIDDA NV, Kontich, Belgium
Yinka De Meyer
Multidisciplinary Medical Center, MedImprove BV, Kontich, Belgium; Clinical Operations, FLUIDDA NV, Kontich, Belgium
Eline Lauwers
Laboratory of Experimental Medicine and Pediatrics, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Clinical Operations, FLUIDDA NV, Kontich, Belgium
Erik Franck
Centre for Research and Innovation in Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
Kris Ides
Multidisciplinary Medical Center, MedImprove BV, Kontich, Belgium; Laboratory of Experimental Medicine and Paediatrics, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; CoSys Research Lab, Faculty of Applied Engineering, University of Antwerp, Antwerp, Belgium and Flanders Make Strategic Research Center, Lommel, Belgium; Department of Pediatrics, Antwerp University Hospital, Edegem, Belgium
Abstract
Purpose: Respiratory pump failure in COPD patients can lead to CO2 retention during exercise, but little is known about the factors determining CO2-levels during exercise in COPD patients.
The aim of this study is to investigate the pattern of TcPCO2 in COPD patients during exercise and factors driving this CO2 response.
Patients and methods: 24 COPD patients (age 66(8) y, FEV1 43(18) %pred, TcPCO2 at rest 37(4) mmHg, oxygen users 6/24) performed lung function and cardiopulmonary exercise test (CPET). During CPET TcPCO2 was measured continuously and in O2 users the CPET was performed with supplemental oxygen.
Results: At baseline, 16 patients were normocapnic (TcPCO2 35-45 mmHg) and 8 hypocapnic (TcPCO2<35 mmHg). At the end of the CPET, 9 patients were normocapnic, 2 showed hypocapnia and 10 were hypercapnic. CO2-retention (∆TcPCO2 >4mmHg) was observed in 18 patients.
∆TcPCO2 correlated significantly with VeMax (r=-.64; p=.004), FEV1 %predicted (r = -.53; p = .008), RV %predicted (r = .54; p = .007), RV/TLC (r = .56; p = .005), sRAW (r =.61; p = .005), sGAW (r = -.60; p = .002), and maximal TcPCO2 (r=.63; p<.001), but did not correlate with baseline TcPCO2 (r = -.08; p = .728). Furthermore, baseline TcPCO2 correlated with the maximal TcPCO2 (r = 0.67; p < .001).
Conclusion: The CO2-response of COPD-patients during CPET is heterogeneous with 10/24 developing hypercapnia. This study revealed that the lung mechanics are the most important factor correlating with CO2 retention during exercise while ∆TcPCO2 was not associated with baseline TcPCO2.
Kyle M. Hocking, PhD
Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
Jessica Huston, MD
Department of Medicine, Division of Cardiovascular Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
Jeffery Schmeckpeper, MD, PhD
Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
Monica Polcz, MD
Department of Surgery, Atrium Health, Carolinas Medical Center, Charlotte, NC, USA
Marisa Case, RN
Department of Anesthesiology, Division of Critical Care, Vanderbilt University Medical Center, Nashville, TN, USA
Meghan Breed, MD
Department of Emergency Medicine, TriStar Skyline Medical Center, Nashville, TN, USA
Lexie Vaughn, MD
Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
Dawson Wervey, BS
Department of Anesthesiology, Division of Critical Care, Vanderbilt University Medical Center, Nashville, TN, USA
Colleen Brophy, MD
Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
JoAnn Lindenfeld, MD
Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
Bret D Alvis, MD
Department of Surgery, Atrium Health, Carolinas Medical Center, Charlotte, NC, USA; Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
Abstract
Introduction: A cornerstone of heart failure assessment is the right heart catheterization and the pulmonary capillary wedge pressure measurement it can provide. Clinical and hemodynamic parameters such as weight and jugular venous distention are less invasive measures often used to diagnose, manage, and treat these patients. To date, there is little data looking at the association of these key parameters to measured pulmonary capillary wedge pressure (PCWP). This is a large, retrospective, secondary analysis of a right heart catheterization database comparing clinical and hemodynamic parameters against measured PCWP in heart failure patients.
Methods: A total of 538 subjects were included in this secondary analysis. Spearman’s Rho analysis of each clinical and hemodynamic variable was used to compare their association to the documented PCWP. Variables analyzed included weight, body mass index (BMI), jugular venous distention (JVD), creatinine, edema grade, right atrial pressure (RAP), pulmonary artery systolic pressure (PASP), systemic vascular resistance, pulmonary vascular resistance, cardiac output (thermal and Fick), systolic blood pressure, diastolic blood pressure, heart rate, respiratory rate, oxygen saturation (SpO2), and pulmonary artery diastolic pressure (PADP).
Results: Ten out of 17 selected parameters had a statistically significant association with measured PCWP values. PADP had the strongest association (0.73, p<0.0001), followed by RAP and PASP (0.69, p<0.0001 and 0.67, p<0.0001, respectively). Other significant parameters included weight (0.2, p<0.001), BMI (0.2, p<0.001), SpO2 (-0.17, p<0.0091), JVD (0.24, p<0.005) and edema grade (0.2, p<0.0001).
Conclusion: This retrospective analysis clarifies the associations of commonly used clinical and hemodynamic parameters to the clinically used gold standard for volume assessment in heart failure patients, PCWP.
Paige M. Shaffer
Division of Health Systems Science, Department of Medicine, University of Massachusetts Chan Medical School
Abigail Helm
Division of Health Systems Science, Department of Medicine, University of Massachusetts Chan Medical School
Michael Andre
Division of Health Systems Science, Department of Medicine, University of Massachusetts Chan Medical School
Herschelle Reaves
Division of Health Systems Science, Department of Medicine, University of Massachusetts Chan Medical School
Kathryn E. Bruzios
Division of Health Systems Science, Department of Medicine, University of Massachusetts Chan Medical School
Jennifer Harter
Division of Health Systems Science, Department of Medicine, University of Massachusetts Chan Medical School
David Smelson
Division of Health Systems Science, Department of Medicine, University of Massachusetts Chan Medical School
Abstract
Background: People with co-occurring substance use and mental health disorders (COD) who experience chronic homelessness often have difficulty engaging in treatment and support services. During the Coronavirus Disease 2019 (COVID-19) pandemic this problem was compounded by community agencies reducing or eliminating in-person care to minimize transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This study examined the rapid adaptations that were made during COVID-19 to a community-based multicomponent intervention, Maintaining Independence and Sobriety Thorough Systems Integration, Outreach and Networking (MISSION), and how these changes impacted engagement in treatment and fidelity to the intervention prior to and during the COVID-19 pandemic.
Methods: Guided by the Model for Adaptation Design and Impact (MADI) framework, this mixed-methods study (1) qualitatively examines the nature of the rapid adaptations made to the MISSION model with n=4 MISSION clinical program staff and (2) quantitatively examines patterns of engagement and fidelity to the MISSION model prior to and during the pandemic among n=109 people with COD who are experiencing chronic homelessness in an urban region of Massachusetts.
Results: In consultation with the MISSION developers, clinical staff made rapid innovative adaptations to MISSION. These changes, identified through the qualitative interviews, included developing safe in-person session procedures (e.g., shortening sessions, adapting group sessions to individual sessions) and strategies to engage incarcerated individuals to provide continuity of care (e.g., mailing letters and coordinating with jail staff). Despite the adaptations, adherence to the MISSION model remained consistent during COVID-19 and compared to pre-COVID-19. However, there was more adherence to the structured components of care compared to the unstructured components of care during the pandemic. Interestingly, linkages to other needed treatments and community supports increased by 522% despite the pandemic closures.
Conclusions: This mixed-methods study demonstrated that a community-based multicomponent intervention for people experiencing chronic homelessness with COD can be adapted rapidly during a pandemic to help maintain COD treatment and with good fidelity, and that the MADI framework can help document those changes. Thus, these findings provide treatment settings with helpful guidance for community-based COD interventions and public health emergency preparedness.
Larry L Mweetwa
DDT College of Medicine, Department for Pharmacy and Pharmaceutical Sciences, P.O. Box 70587, Gaborone Botswana, Africa, Tel: +267(0)3904924/5, Cell: +267(0) 77100000 Fax: +267(0)3904935.
Derrick D Tlhoiwe
DDT College of Medicine, Department for Pharmacy and Pharmaceutical Sciences, P.O. Box 70587, Gaborone Botswana, Africa, Tel: +267(0)3904924/5, Cell: +267(0) 77100000 Fax: +267(0)3904935.
Tumelo Tlhoiwe
DDT College of Medicine, Department for Pharmacy and Pharmaceutical Sciences, P.O. Box 70587, Gaborone Botswana, Africa, Tel: +267(0)3904924/5, Cell: +267(0) 77100000 Fax: +267(0)3904935.
Kabo Osmas Tshiamo
DDT College of Medicine, Department for Pharmacy and Pharmaceutical Sciences, P.O. Box 70587, Gaborone Botswana, Africa, Tel: +267(0)3904924/5, Cell: +267(0) 77100000 Fax: +267(0)3904935.
Sody Mweetwa Munsaka
University of Zambia, School of Health Sciences, P. O. Box 32379 Lusaka, Africa.
Thatoyaone J Kenaope
Department of Pharmacy, Boitekanelo College, Plot 5824 Masetlheng Rd, Gaborone 00000, Botswana.
Getrude Mothibe
Department of Pharmacy, Boitekanelo College, Plot 5824 Masetlheng Rd, Gaborone 00000, Botswana.
Ogorogile Mokate
DDT College of Medicine, Department for Pharmacy and Pharmaceutical Sciences, P.O. Box 70587, Gaborone Botswana, Africa, Tel: +267(0)3904924/5, Cell: +267(0) 77100000 Fax: +267(0)3904935.
Emmanuel T Oluwabusola
DDT College of Medicine, Department for Pharmacy and Pharmaceutical Sciences, P.O. Box 70587, Gaborone Botswana, Africa, Tel: +267(0)3904924/5, Cell: +267(0) 77100000 Fax: +267(0)3904935.
Abstract
Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) or Coronavirus was initially detected in Wuhan China in December 2019 and has subsequently resulted in the COVID-19 pandemic. The disease presents asymptomatically in some of individuals yet also causes symptoms ranging from those associated with influenza and pneumonia, acute respiratory distress syndrome (ARDS) and even death. The world is currently relying on physical (social) distancing, hygiene and repurposed medicines; however, it was predicted that an effective vaccine will be necessary to ensure comprehensive protection against COVID-19. There was a global effort to develop an effective vaccine against SARS-CoV-2 with approximately 300 vaccines in clinical trials, and over 200 more in different stages of development and anticipated that their success will change research clinical trials processes. Although every one of these vaccines comes with its own particular set of characteristics and difficulties, they were all developed as a direct result of research and development efforts that were carried out on a scale that had never been seen before. It is the first time in the history of vaccination that a worldwide immunization campaign has begun during a time of severe pandemic activity that is defined by high virus transmission. This achievement marks an important milestone in the history of vaccination. More than anything else, the most important aspect of the new game change in drug design is that the traditional drug discovery rules have been rewritten. This is especially significant for the development of vaccines, as it is possible for all clinical trials to be accelerated, which would bring a vaccine or drug molecule to market within a year rather than the traditional fifteen years for each phase of drug clinical trials. This review provides insight in respect to first generation COVID-19 vaccines, which were in clinical use as of December 2020 and focused on the Pfizer/ BioNTech/Fosun, Moderna mRNA-1273, Johnson and Johnson and AstraZeneca/Oxford AZD1222 vaccines.
Sandra Maria Barbalho
Department of Biochemistry and Pharmacology, School of Medicine, University of Marília (UNIMAR), Avenida Hygino Muzzi Filho, 1001, 17.525–902, Marília, São Paulo, Brazil; Postgraduate Program in Structural and Functional Interactions in Rehabilitation – (UNIMAR), Avenida Hygino Muzzi Filho, 1001, 17.525–902, Marília, SP, Brazil
Katia P Sloan
Texas Institute for Kidney and Endocrine Disorders, Lufkin, Texas, USA. 10 Medical Center Blvd, STE A – Lufkin TX 75904 – USA
Lance A Sloan
Texas Institute for Kidney and Endocrine Disorders, Lufkin, Texas, USA. 10 Medical Center Blvd, STE A – Lufkin TX 75904 – USA; University of Texas Medical Branch, Department of Internal Medicine, Galveston, Texas, USA. 301 University Blvd, Galveston TX 77555 – USA
Ricardo A Goulart
Postgraduate Program in Structural and Functional Interactions in Rehabilitation – (UNIMAR), Avenida Hygino Muzzi Filho, 1001, 17.525–902, Marília, SP, Brazil
Karina R. Quesada
Department of Biochemistry and Pharmacology, School of Medicine, University of Marília (UNIMAR), Avenida Hygino Muzzi Filho, 1001, 17.525–902, Marília, São Paulo, Brazil
Lucas Fornari Laurindo
Department of Biochemistry and Pharmacology, School of Medicine, University of Marília (UNIMAR), Avenida Hygino Muzzi Filho, 1001, 17.525–902, Marília, São Paulo, Brazil
Tereza Lais Menegucci Zutin
Department of Biochemistry and Pharmacology, School of Medicine, University of Marília (UNIMAR), Avenida Hygino Muzzi Filho, 1001, 17.525–902, Marília, São Paulo, Brazil
Marcelo Dib Bechara
Department of Biochemistry and Pharmacology, School of Medicine, University of Marília (UNIMAR), Avenida Hygino Muzzi Filho, 1001, 17.525–902, Marília, São Paulo, Brazil; Postgraduate Program in Structural and Functional Interactions in Rehabilitation – (UNIMAR), Avenida Hygino Muzzi Filho, 1001, 17.525–902, Marília, SP, Brazil
Abstract
Despite the possible effects of Vitamin D (VD) in decreasing the risk of infections and mortality in some viral diseases, the role of therapeutic VD supplementation in individuals infected with COVID is still obscure. This article reviews the possible effects of VD on COVID-19 severity. MEDLINE–PubMed, EMBASE, and Cochran were searched following PRISMA guidelines. Some studies have reported that VD does not seem to augment the immunogenicity of seasonal vaccines, nor does it significantly reduce the incidence or duration of upper respiratory tract infection, although others have. The reason for not getting a positive or significant difference may be due to inadequate VD treatment levels, and VD may not be that important in immunized individuals with adaptive immunity. VD deficiency is most prevalent in the elderly, obese, men, ethnic minorities with darker skin, people with diabetes, hypertension, and in nursing homes or institutionalized. These are individuals that are at increased risk of severe consequences of COVID-19 such as acute respiratory distress syndrome with the need for mechanical ventilation and death. Perhaps supplementation of VD to adequate VD levels will improve the inflammatory reaction and modulate a faster patient recovery with decreased morbidity and mortality.
Gautam S
Department of Respiratory Medicine, J.N. Medical College, KLE Academy of Higher Education and Research, Nehru Nagar, Belagavi, India.
Guruprasad Antin
Department of Respiratory Medicine, J.N. Medical College, KLE Academy of Higher Education and Research, Nehru Nagar, Belagavi, India.
Kirankumar Pujar
Department of Respiratory Medicine, J.N. Medical College, KLE Academy of Higher Education and Research, Nehru Nagar, Belagavi, India.
Abstract
Background and Objectives: Chronic Obstructive Pulmonary Disease (COPD) is a common, costly and preventable disease and is at present the fourth leading cause of death globally. To study the outcome of patients with acute exacerbation of COPD and to analyse the risk factors predicting adverse outcomes in patients with acute exacerbation of COPD.
Patients and Methods: A Prospective study was conducted over a period of one year, from December 2021 to December 2022, Minimum of 50 patients, both male and female with AECOPD getting admitted to a Tertiary care centre were included in this study.
Results: Of the 50 patients studied, 42 were males; all of them were smokers (84%). The mean age was 64.34 ± 10.47 years. The mean duration of the disease was 10.04±6 years. All patients presented with cough, recent worsening of Dyspnea and increased sputum purulence/volume. 70% patients had one or more associated co-morbid illness, majority had hypertension (40%). Of 32 patients with Respiratory failure on admission 17(53.12%) patients had Type II and 15(46.28%) had Type I failure. 44 patients received medical management and 6 patients required invasive mechanical ventilation (IMV). Overall mortality was 5 (10%). 20 variables were compared between survivors and non-survivors. Univariate sensitivity analysis revealed that presence of altered sensorium (P=0.001), Hypotension (P=0.02), cyanosis (P=0.00463), pedal edema (P=0.02), presence of infection (P=0.024) Severe Acidosis (P=0.012), Hypercapnia (P=0.016), cor pulmonale (P=0.04), at the time of admission and need for invasive mechanical ventilation (P<0.001) as predictors of mortality.
Conclusions: 64% of AECOPD presented with respiratory failure, majority were type II. Overall mortality was 10%. Altered Sensorium, pedal edema, presence of infection, cyanosis, hypotension, severe acidosis, hypercapnia and presence of cor pulmonale at the time of admission predict adverse outcome. Those who need invasive mechanical ventilation had high mortality. Survivors had less hospital stay.
Mari L. Tesch
Research & Development, Dr. Ferrer BioPharma, Miami, FL, USA
Jonna B. Westover
Institute for Antiviral Research, Utah State University, Logan, Utah, USA
Marcos A. Sanchez-Gonzalez, MD, PhD
Research & Development, Dr. Ferrer BioPharma, Miami, FL, USA; Lake Erie College of Osteopathic Medicine, Bradenton, FL, USA
Franck F. Rahaghi
Department of Pulmonary and Critical Care Medicine, Cleveland Clinic, Weston, FL, USA
Abstract
The emergence of respiratory viruses has been attracting considerable interest due to their potential to cause pandemics, such as the 1918 Spanish flu, the 2019 Coronavirus disease, and recently the Respiratory syncytial virus (RSV) in pediatric populations. There is a critical need to identify potential agents that can be included as part of the countermeasures to aid in the preparedness for a rapid public health response in case of a pandemic. This study aimed to explore the antiviral potential of sugar alcohols against respiratory viruses with pandemic potential.
Methods: The antiviral activity of three sugar alcohols commonly utilized in the food and pharmaceutical industry, namely sorbitol, erythritol, and xylitol, were evaluated against Influenza (H1N1), RSV (A2), and SARS-CoV-2 (B.1.617.2; Delta) via a highly differentiated, three-dimensional, in vitro model of normal, intact, human-derived tracheal/bronchial epithelial cells. The sugar alcohol solutions were tested at a 5% concentration in duplicate inserts of the three-dimensional tissue models of the human airway.
Results: Antiviral activity was measured in virus yield reduction assays by calculating the log reduction value defined as the average reduction of virus compared to the average virus control on day 3 (Influenza), day (RSV), and day 6 (SARS-CoV-2) after infection. Antiviral agents utilized as comparators were Ribavirin (Influenza, RSV) and Remdesivir (SARS-CoV-2). Erythritol displayed antiviral efficacy against Influenza with a log reduction value of 3.17. RSV was effectively inactivated by both sorbitol and xylitol with 2.49 and 2.65 log reduction values, respectively. All tested sugar alcohols inactivated SARS-CoV-2 Delta with a median log reduction value of 3.50.
Conclusion: The results of this study suggest that alone or in combination, sugar alcohols can inactivate respiratory viruses known to have pandemic potential. Additional research is needed to advance the development of sugar alcohols as chemotherapeutic countermeasures against other pandemic respiratory viruses.
Daria Lahoda
Doctor of Philosophy in Medicine (PhD), Assistant Professor of the Department of Family Medicine and Polyclinic Therapy, Odesa National Medical University, ave. 2 Valikhovskyi St., Odesa, Ukraine 65000, 0966419743
Abstract
Diseases of the respiratory tract occupy one of the leading places among pathologies in people of working age in the world. According to the data of world studies, it can be considered that these two comorbidities are mutually aggravating, but scientists do not have a unanimous opinion about whether this is a simple coincidence or whether these pathologies are pathogenetically related. There is considerable evidence that asthma patients do not achieve adequate asthma control worldwide. Yes, according to Maria Sandra Magnoni et al. 77.8% of patients with asthma have an uncontrolled course of asthma, although 68.4% of them believe that they have sufficient asthma control, and their treatment does not require correction. Therefore, taking into account all of the above and taking into account the low level of asthma control in patients with comorbid pathology who often suffer from bacterial and viral diseases, we believe that a more detailed study of the immunological status of these individuals is necessary in order to optimize treatment and prevention measures. Aim: to investigate the effectiveness of alternative ways of asthma control in patients with bronchial asthma against the background of overweight or obesity. Materials and methods. At the I stage, 255 patients with BA were examined. According to the study design, patients were selected according to the “inclusion/exclusion” criteria at this stage. The study was randomized. Allocation of patients into groups was carried out by the method of simple randomization with elements of stratification. Groups are statistically significant. Statistical processing of the results was carried out using parametric and non-parametric analysis methods. Resalts. Overweight or obese patients had a more severe course of bronchial asthma than patients with a normal body mass index. Overweight or obese patients were found to have higher levels of systemic inflammation, namely eosinophilic cationic protein levels and erythrocyte sedimentation rate, than patients with a normal body mass index. In addition, a close direct correlation was established between the severity of the course of bronchial asthma and indicators of eosinophil cationic protein (r=0.97; p˂0.001). After pharmacological correction, there was an increase in asthma control in patients with different severity of the course (р˂0.001; p˂0.001; p˂0.001, respectively), a decrease in the frequency of exacerbations (p˂0.05), a reduction in the number of hospitalizations (p˂0, 05) and the number of acute respiratory diseases (p˂0.05) in patients with bronchial asthma against the background of excess body weight or obesity. The use of the developed treatment-prophylactic complex using the drug bacterial lysate and inosine pranobex together with training in the Asthma School and standard treatment contributes to increasing asthma control and compliance with the doctor, reducing the number of exacerbations and hospitalizations per year in patients with bronchial asthma against the background overweight or obesity.
Abdelilah Bensliman
Department of Epidemiology, Clinical Research, and Health Community, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdellah University, Fez, Morocco
Khaoula El Kinany
Department of Epidemiology, Clinical Research, and Health Community, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdellah University, Fez, Morocco
Inge Huybrechts
International Agency for Research on Cancer (IARC) World Health Organization; Lyon, France
Zineb Hatime
Department of Epidemiology, Clinical Research, and Health Community, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdellah University, Fez, Morocco
Meimouna Mint Sidi Deoula
Department of Epidemiology, Clinical Research, and Health Community, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdellah University, Fez, Morocco
Mohamed Chakib Benjelloun
Respiratory Department, Hassan II University Hospital Center, Fez, Morocco.
Mohamed El Biaz
Respiratory Department, Hassan II University Hospital Center, Fez, Morocco.
Chakib Nejjari
Mohammed VI University of Health Sciences, Casablanca, Morocco.
Karima El Rhazi
Department of Epidemiology, Clinical Research, and Health Community, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdellah University, Fez, Morocco
Abstract
Objective: The protective effect of the Mediterranean diet (MD) is known for several diseases, but the evidence in low- and middle-income countries was still missing. This article assesses the impact of MD and its components on Chronic Obstructive Pulmonary Disease (COPD) among Moroccan adults.
Methods: in population-based cross-sectional study, A total of 744 adults with acceptable spirometry according to the GOLD guidelines were randomly selected from a sample frame, of Moroccan adults lived in the areas of the Saïs district-Fez city. Dietary data were collected through a validated food frequency questionnaire. Mediterranean Diet Score (MDS) was used to assess Adherence to the Mediterranean food model, A value of 0 or 1 has been assigned to each of the eight indicated food components according to their beneficial or deleterious effect on health.
Results: Although no significant associations were found between COPD and the overall MD. score, associations were found between some of the MD components and COPD when stratifying for overall MDS adherence level (low, middle, high adherence). For the high adherence group, the high consumption of cereals, fruits and nuts were inversely associated with COPD risk with OR = 0.64; 95% CI = 0.26-0.89, and OR= 0.67; 95% CI = 0.44-0.96, respectively. The high consumption of meats and dairy products was positively associated with the risk of COPD, with OR = 1.37; 95% CI = 1.22-2.87, and OR= 1.83; 95% CI = 1.21-2.76, respectively.
Conclusion: The results of this study confirmed previous results showing significant associations of COPD risk with some components of MDS. Extensive studies are needed to explore MDS components better and suggest more effective interventions to maintain healthy eating habits and reduce COPD risk.
Boubaker Charra
Department of Intensive Care Medicine, Ibn Rochd University Hospital, Faculty of medicine and Pharmacy of Casablanca, Hassan 2 University, Casablanca, Morocco
Yassine Bou-ouhrich
Department of Intensive Care Medicine, Ibn Rochd University Hospital, Faculty of medicine and Pharmacy of Casablanca, Hassan 2 University, Casablanca, Morocco
Abstract
Background: Coronavirus disease of 2019 or COVID-19 is characterised by two main features: the first is the respiratory compromise which corresponds to acute respiratory distress syndrome while the second corresponds to the state of hypercoagulability responsible for thromboembolic complications particularly pulmonary embolism which is the subject of this work. Indeed, a high prevalence of pulmonary embolism has been reported throughout the pandemic period with a significant morbidity and mortality. This reflects the severity of this life-threatening emergency chiefly in the elderly, hemodynamically unstable patients, and patients with severe underlying conditions, mainly cardio-pulmonary comorbidities. The aim of our study is to point out the incidence, the risk factors, the clinical and paraclinical features, the management strategies, and the overall prognosis of pulmonary embolism in critically ill COVID-19 and non-COVID-19 patients.
Patients and methods: It is a retrospective observational study carried out over a two-year-period from January 2019 (non-COVID-19) to December 2020 (COVID-19). Over the study period, 42 cases of COVID-19 and non-COVID-19 pulmonary embolism were collected from an overall set of 611 patients admitted to the medical intensive care unit of the IBN ROCHD university hospital of Casablanca.
Results: The mean age in the COVID-19 group was 64-year-old versus 46-year-old in the non-COVID-19 group. The sex ratio was 1.2 and 0.94 in the non-COVID-19 and COVID-19 group, respectively. Clinical symptomatology was dominated by respiratory failure and chest pain in non-COVID-19 patients while in the COVID-19 group, semiology was dominated by dyspnea, cough, and chest pain. The major sign of severity in both groups was tachypnea.
The chest X-ray was performed in all our patients, it displayed radiological abnormalities in all patients mainly hyper clarity in pulmonary fields. D-dimers were performed in all patients within the two study groups. A chest computed tomography angiogram was performed for all patients and showed unilateral pulmonary embolism in 61% of cases in the non-COVID-19 group versus 61.3% in the COVID-19 group. Cardiac ultrasound was performed for all patients. It showed dilatation of right cavities in both groups (81.8% in non-COVID-19 versus 93.5% in COVID-19 patients). Venous ultrasound of the lower limbs was performed in 96.8% of COVID-19 patients and in 72.7% of non-COVID-19 patients.
With regards to management, all COVID-19 and non-COVID-19 patients received anticoagulation therapy based on standard heparin and anti-vitamin K. Mortality accounted for 54.5% in non-COVID-19 patients versus 74.2% in COVID-19 patients.
Conclusion: COVID-19 pulmonary embolism is often associated with significantly higher morbidity and mortality as compared with non-COVID-19 pulmonary embolism.
Katelin Omecinski, BS
McGowan Institute for Regenerative Medicine, University of Pittsburgh; Department of Bioengineering, University of Pittsburgh
William Federspiel, PhD
McGowan Institute for Regenerative Medicine, University of Pittsburgh; Department of Bioengineering, University of Pittsburgh; Department of Chemical and Petroleum Engineering, University of Pittsburgh; Department of Critical Care Medicine, University of Pittsburgh Medical Center; Clinical and Translational Science Institute, University of Pittsburgh
Abstract
Respiratory disease remains a pervasive medical condition amongst the pediatric health population. Mechanical ventilation and extracorporeal membrane oxygenation (ECMO) are used to bridge patients to transplant or recovery when conventional therapy fails. Patients undergoing these treatments may be sedated for extended periods of time, resulting in deconditioning of the patient’s musculature. Patients who remain awake on ECMO, however, can participate in physical therapy and combat muscle wasting. Typical ECMO circuits are complex and present a major consumer of hospital resources for these patients undergoing rehabilitation and ambulation. Our research group has pursued the integration of mechanical circulatory and respiratory assistance into a compact platform device, the ModELAS, to address this clinical need. The aim of this review is to summarize published work on the pediatric application of the ModELAS. A breadth of topics will be reviewed, including the design requirements, device evolution, in-vitro results, and in-vivo results of the device.
Christian Elmshaeuser
Stem Cell Therapy Division, Institute of Medical Microbiology, University of Giessen, Giessen Germany & International Senior Professional Institute (ISPI) e.V. Giessen, Germany. 2Biochemistry Institute, University of Giessen, Giessen, Germany.
Ina Zoeller
Stem Cell Therapy Division, Institute of Medical Microbiology, University of Giessen, Giessen Germany & International Senior Professional Institute (ISPI) e.V. Giessen, Germany. 2Biochemistry Institute, University of Giessen, Giessen, Germany.
Darisuren Anhlan
Biochemistry Institute, University of Giessen, Giessen, Germany.
Ewald Beck
Biochemistry Institute, University of Giessen, Giessen, Germany.
Bruno Peault
INSERM U506, Groupe Hospitalier Paul Brousse, Villejuif Cedex, France & Orthopaedic Hospital Research Center and Broad Stem Cell Research Center, David Geffen School of Medicine, University of California, Los Angeles, LA, United States & MRC Centre Institute for Regenerative Medicine and Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom.
Olivier Tabary
Sorbonne Université, INSERM UMR S 938, Centre de Recherche Saint Antoine (CRSA), Paris, France.
Una Chen
Stem Cell Therapy Division, Institute of Medical Microbiology, University of Giessen, Giessen Germany & International Senior Professional Institute (ISPI) e.V. Giessen, Germany. ; 5Research Experience of Stem Cells in Europe Society (RESCUES) e.V., Giessen, Germany.
Abstract
Background-Purpose of this study: Tissue-specific stem cell lines are useful tools for cell biology studies. Information on respiratory tissue cell lines is limited. A doxycycline-regulated epithelial precursor cell line was established from the lung tissue of a tTAxSV40 Tag double transgenic mouse. In this study, we have characterized this cell line in vitro & in vivo, and found to mimic a rare subpopulation of club- and pneumocyte type II-dual cells.
Methods: It was partially characterized using cell viability and death assays, H3-thymidine incorporation assay, chloride efflux assay, Western blotting of proteins secreted, RT-PCR assays for RNA isolated. In addition, immune–deficient SCID mice were used as hosts for implantation of this precursor cell line, and feed with/without doxycycline containing water. Immunofluorescent typing using different antibodies were used to characterize the implanted lung.
Results: This cell line was found to mimic a rare subpopulation of club- and pneumocyte type II- dual cells with multiple phenotypes. Cell growth was doxycycline-regulated and observed only when doxycycline was omitted from the medium or present at concentrations up to 1 µg/ml, higher concentrations were inhibitory. ACT+ ciliated cells were found upon implantation into immune-deficient mice, in addition. Cell growth was doxycycline-regulated in vitro. When transplanted subcutaneously into immune–deficient mice, these cells migrated to the lung to form organized chimeric structures of donor and host origins, with club cells in the terminal bronchioles, ACT+ ciliated cells along the epithelial lining, and pneumocyte type II-cells in the alveolar interstices. No such homing of donor cells to the lung was observed when the implanted mice were fed doxycycline-containing water.
Discussions-Conclusions: This lung stem cell line might be able to provide us with an insight into the differentiation pathway of lung epithelial cells as well as with some understanding of the nature of air trophic-pulmonary epithelial cells. The results of this study underline the possibility of a future application for somatic (stem / precursor) cells in tissue replacement and tissue engineering of the damaged lung. Its ability to secrete and deliver soluble protein, might be a potential novel way for drug delivery. In addition, stem cells are thought to proliferate and differentiate in response to a deficiency or as a result of injury. Successful migration to the target organ and subsequent maturation of these precursors could be attributed to a requirement of lung stem cells to search for an aerated environment. Our findings challenge some current concepts of stem cell biology.This lung stem cell line may become a rich source of cells for tissue engineering and cell-based therapy for lung injury. The route and protocol established for cell introduction into the lung may provide a novel alternative to delivery of soluble protein substances through the airways. This lung stem cell line might also be modified to provide models for screening drugs against respiratory infection.
Angelo Gianni Casalini, MD
Unit of Pulmonology and Thoracic Endoscopy, University Hospital of Parma, Italy.
Pier Anselmo Mori, MD
Unit of Pulmonology and Thoracic Endoscopy, University Hospital of Parma, Italy.
Roberta Pisi, BSc
Respiratory Disease and Lung Function Unit, Department of Medicine and Surgery, University of Parma, Italy.
Federico Maria Maniscalco, MD
Department of Medicine and Surgery, University of Parma, Italy
Massimo Corradi, MD
Centre for Research in Toxicology (CERT), University of Parma, Italy
Matteo Goldoni, PhD
Department of Medicine and Surgery, University of Parma, Italy
Abstract
A pleural effusion is defined as eosinophilic when eosinophils represent ≥ 10% of the total nucleated cell count, and accounts for approximately 10% of all pleural effusions. The diagnostic significance of eosinophilic pleural effusion has yet to be determined.
Objective and Methods: A retrospective study was conducted on 65 patients with eosinophilic pleural effusion to evaluate the correlation between the percentage of eosinophils present in the pleural fluid and the benign or malignant nature of the effusion. An original aspect of current study was the evaluation of other variables in association with pleural eosinophilia, in particular pleural fluid lymphocytosis (≥ 50%), and the presence or absence of fever.
Results: Data showed the trend towards a decrease in neoplastic incidence with increasing percentages of eosinophilic counts, although this correlation was not statistically significant. The presence of fever correlated with low incidence of neoplasms (10% of neoplastic effusions in patients with fever) and was the most significant variable (p=0.001), with a Negative Predictive Value of neoplastic disease of 90%, with sensitivity 92.6% and specificity 47.4%.
When evaluated together with fever, eosinophils increased their discriminating sensitivity to the benign or malignant nature of the effusion but lost in specificity.
When evaluated as absence or presence of lymphocytosis (≥50% lymphocytes), associated with eosinophilia, lymphocytes were significantly associated with the neoplastic nature of the effusion.
Conclusions: the study showed that the finding of eosinophilic pleural effusion should not be considered an indicator of benignity of the effusion; the association of other parameters with eosinophilia, lymphocytosis of the pleural fluid and fever can provide more precise prognostic indications; a high percentage of eosinophils, the absence of lymphocytosis and the presence of fever would seem to be associated with a low probability of a neoplastic nature of the effusion.
Luís Dionísio
Faculty of Veterinary Medicine, Lusophone University of Humanities and Technologies, Lisbon, Portugal; Food Safety and Epidemiological Surveillance Department, Military Veterinary Medicine Unit, Lisbon, Portugal
Francisco Medeiros
Equine Military Veterinary Clinic, Army School of Arms, Mafra, Portugal
Manuel Pequito
Egas Moniz Higher Institute, Almada, Portugal
Ana I. Faustino-Rocha
Centre for the Research and Technology of Agro-Environmental and Biological Sciences (CITAB), Inov4Agro, Vila Real, Portugal; Comprehensive Health Research Centre, Évora, Portugal; Department of Zootechnics, School of Sciences and Technology, University of Évora, Évora, Portugal
Abstract
Equine Influenza (EI) is a disease caused by the genus A influenza virus, with a global distribution and under constant review. Equine Influenza is highly contagious and affects the respiratory tract. Vaccination in horses is an adequate prevention method, however some strains have the capacity to infect immunized horses, due to the mutagenic changes that the virus undergoes. This work aimed to study the Veterinary Medicine performance regarding Equine Influenza in Portugal in the years 2018 and 2019, and to compare the clinical practice in Portugal with that of other European countries. The study was based on the responses to a questionnaire consisting of nine questions on: 1) Geographical area of clinical practice; 2) Activity of equines assessed; 3) Number of suspected cases of Equine Influenza in the last two years; 4) Number of cases of Equine Influenza diagnosed with the support of laboratory tests in the last two years; 5) Number of vaccinations against Equine Influenza in the year 2018; 6) Number of vaccinations against Equine Influenza in the year 2019; 7) Whether the vaccination protocol used follows FEI/FEP standards; 8) Whether the vaccination protocol is annual or biannual; and 9) Use of laboratory tests for Equine Influenza in the last two years. The surveys were circulated online in Portugal and in Germany, France, Ireland, Italy, the Netherlands, the United Kingdom and Sweden for anonymous reply. In Portugal, 50 responses to the survey were obtained. Veterinarians reported suspected cases. Only four cases were confirmed using laboratory tests. 22 professionals applied more than 100 vaccines against Equine Influenza in the year 2018, and a decrease was observed in the year 2019. The Veterinarians did not reveal a preference for biannual or annual vaccination. Most professionals (94%) did not use laboratory tests to confirm the suspected infection. In Portugal it was possible to identify an opportunity to improve the clinical practice of Veterinarians in the use of laboratory tests for disease diagnosis and vaccination. The decree law that establishes the compulsorily notifiable diseases does not match the list of the World Organisation for Animal Health (OIE) and therefore the General Directorate of Food and Veterinary (DGAV) does not have the data needed to properly notify the disease. Equine Influenza needs greater attention in Portugal and there are a number of measures that can be adopted to improve disease management in the country.
Ryuichi Fujisaki
Department of Internal Medicine, Teikyo University Hospital, Tokyo, Japan
Toshimori Yamaoka
Department of Internal Medicine, Teikyo University Hospital, Tokyo, Japan
Hajime Nishiya
Department of Internal Medicine, Shinyamanote Hospital, Japan Anti-Tuberculosis Association
Abstract
Gram staining is one of the most crucial staining techniques in microbiology.
The use of Gram stain facilitates rapid use of appropriate antimicrobial agents. In bacterial pneumonia, the most useful sample which reflects the status of inflammation in the lung is supposed to be sputum from the infectious areas in the lung. The changing patterns of Gram-stained sputa can be used as the therapeutic marker of effectiveness of antimicrobial agents. When the first administered antimicrobial agent is effective against the target pathogen; S. pneumoniae, M. catarrhalis or Haemophilus influenzae, a decrease in number of the pathogen in the sputa was clear and almost no or little pathogen were seen in the sputum obtained several-hours after the first administration of antimicrobial agent or before the second administration, which is mostly administered 8-12 hours-after the first one, showing that Gram-stained sputum is a definite effective marker of the effectiveness of the agent. In pneumococcal pneumonia, a loss of gram-positive-staining of pneumococci was another early marker of the effectiveness of the agent. We can expect the effectiveness at least 1 h after completion of the first administration of the agent, when a loss of gram-positive-staining of pneumococci with a decrease in the number of cocci is found in the sputa. The reason for the loss of staining is supposed to be by reduction in peptidoglycan synthesis induced by antimicrobial agents distributed in the sputa. To find effective marker showing the effectiveness of administered antimicrobial agent in bacterial pneumonia or bronchitis, we compared the white blood cell count (WBC), serum C-reactive protein (CRP) level, and the decrease in the bacterial density in gram-stained sputa in which the administered antimicrobial agents were effective. The data showed that at least 2 to 4 days were needed to evaluate the effectiveness when the WBC or CRP level was used as a therapeutic marker, but the median duration needed to determine the effectiveness of the agent was 6.5 hours (range, 1 to 12 hours) in Gram-stained sputa, which showed that Gram-stained sputum after the first administration of antimicrobial agents can be used as the quickest therapeutic marker in treating bacterial respiratory infections. We showed that Gram staining of sputum is a useful and effective tool to check the effectiveness of administered antimicrobial agents in bacterial pneumonia and bronchitis.
Andreas Pfützner Marie Schaedlich
Pfützner Science & Health Institute, Mainz, Germany; Department of Oral Diseases, Karolinska Institutet, Huddinge, Schweden
Peter Möller
Dentognostics GmbH, Solingen, Germany
Shipra Gupta
Oral Health Sciences Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, India
Tommi Pätilä
Department of Congenital Heart Surgery and Organ Transplantation, New Children’s Hospital, University of Helsinky, Finland
Ismo T. Räisänen
Department of Oral Diseases, Karolinska Institutet, Huddinge, Schweden
Timo A. Sorsa
Department of Oral Diseases, Karolinska Institutet, Huddinge, Schweden; Department of Oral and Maxillofacial Diseases, Helsinki University and University Hospital, Helsinki, Finnland
Abstract
The SARS-CoV-2 virus leads to symptoms ranging from mild flu symptoms to severe COVID-19 pneumonia requiring mechanical ventilation and even death. According to epidemiological observations, diabetes mellitus is a major risk factor for severe outcome, next to older age, s, hypertension, and other serious chronic illnesses. Recent studies have determined that the oral cavity mucosa is the main entry portal for the SARS-CoV-2 virus into the body. The viruses accumulate in the mouth at locations where the main viral receptor is highly expressed. The oral pathway of the virus into the body and the contributing factors are described in this review. The immune system of people with diabetes is generally impaired. Diabetes induces chronic systemic inflammation, which regularly manifests as periodontitis in the oral cavity. Furthermore, frequent hyperglycemia leads to additional weakening of the mucosal immune barrier. These findings provide plausible explanations for the more frequent severe courses of respiratory viral infections in diabetes patients. An oral examination helps to identify patients at elevated risk. Activated matrix metalloproteinase-8 (aMMP-8) is an established biomarker for measuring the degree of oral inflammation and is an indicator of the destruction of collagen and bone structures in the mouth. aMMP-8 point-of-care tests are readily available. We propose that the current recommendations for the prevention of SARS-CoV-2-associated severe COVID-19 disease should be extended to consider the aspects of measuring and sanitizing oral health, as well as to include preventive regular daily disinfection of the mouth and the pharynx.
Taylor Raffa, MD
The George Washington University Hospital, Department of Surgery, Washington, DC.
Parker Chang, BS
The George Washington University School of Medicine and Health Sciences, Department of Surgery, Washington, DC.
Babak Sarani, MD, FACS, FCCM
The George Washington University Hospital, Department of Surgery, Washington, DC.; The George Washington University School of Medicine and Health Sciences, Department of Surgery, Washington, DC.
Susan Kartiko, MD, PhD, FACS
The George Washington University Hospital, Department of Surgery, Washington, DC.; The George Washington University School of Medicine and Health Sciences, Department of Surgery, Washington, DC.
Abstract
Rib Fractures are a common injury in trauma patients and affect 10% of all injured patients who require admission to the hospital. Currently, there is no consensus on the most efficacious treatment for rib fractures with the debate comparing non-surgical versus surgical management. Medical management of rib fractures often requires admission to the intensive care unit with a focus on pain control to allow good pulmonary hygiene. Pain control involved a multimodal approach with current techniques including epidural anesthesia and paravertebral blocks. Although many patients recover with medical management alone, some patients may benefit from surgical stabilization of rib fractures as a means of augmenting pain control. Flail chest is the most evidence-based indication for surgical stabilization of rib fractures SSRF with many studies showing decreased days on mechanical ventilation, risk of pneumonia, intensive care unit length of stay, and hospital length of stay. Additionally, in patients with non-flail chest and ventilator dependent respiratory failure, surgical stabilization of rib fractures may provide an advantage over medical management for pain control. There are relatively few contraindications and complications associated with surgical stabilization of rib fractures. Therefore, with proper patient selection, surgical stabilization of rib fractures can improve outcomes in patients with rib fractures. Medical management with or without surgical intervention requires a multidisciplinary approach to prevent adverse clinical outcomes.
Vinod Kumar Viswanathan, MD, DNB, MBA, FRCP
Director and Professor, Institute of Thoracic Medicine & Department of Respiratory Medicine, Madras Medical College, Chennai.
Abstract
With the rapid developments in the field of interstitial lung diseases or diffuse parenchymal lung diseases as it is now called, this review provides an overview of ILDs and explains the gamut of knowledge needed to understand the disease, starting from the anatomy of the interstitium to the causes of interstitial involvement in various diseases and the clinicoradiological patterns of involvement in various interstitial lung diseases. The review is in the format of questions and answers to make it easier for the resident to comprehend.
