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Acute respiratory distress syndrome (ARDS) is associated with significant morbidity and mortality, and neutrophils are critical to its pathogenesis. Neutrophil activation is closely regulated by inhibitory tyrosine phosphatases including Src homology region 2 domain-containing phosphatase-1 (Shp1). Here, we report that loss of neutrophil Shp1 in mice produced hyperinflammation and lethal pulmonary hemorrhage in sterile inflammation and pathogen-induced models of acute lung injury (ALI) through a Syk kinase-dependent mechanism. We observed large intravascular neutrophil clusters, perivascular inflammation, and excessive neutrophil extracellular traps in neutrophil-specific Shp1-KO mice, suggesting an underlying mechanism for the observed pulmonary hemorrhage. Targeted immunomodulation through the administration of a Shp1 activator (SC43) reduced agonist-induced reactive oxygen species in vitro and ameliorated ALI-induced alveolar neutrophilia and NETs in vivo. We propose that the pharmacologic activation of Shp1 has the potential to fine tune neutrophil hyperinflammation that is central to the pathogenesis of ARDS.

Mucus plugs occlude airways to obstruct airflow in asthma. Studies in patients and in mouse models show that mucus plugs occur in the context of type 2 inflammation, and studies in human airway epithelial cells (HAECs) show that IL-13-activated cells generate pathologic mucus independently of immune cells. To determine how HAECs autonomously generate pathologic mucus, we used a magnetic microwire rheometer to characterize the viscoelastic properties of mucus secreted under varying conditions. We found that normal HAEC mucus exhibited viscoelastic liquid behavior and that mucus secreted by IL-13-activated HAECs exhibited solid-like behavior caused by mucin cross-linking. In addition, IL-13-activated HAECs shows increased peroxidase activity in apical secretions, and an overlaid thiolated polymer (thiomer) solution shows an increase in solid behavior that was prevented by peroxidase inhibition. Furthermore, gene expression for thyroid peroxidase (TPO), but not lactoperoxidase (LPO), was increased in IL-13-activated HAECs and both TPO and LPO catalyze the formation of oxidant acids that cross-link thiomer solutions. Finally, gene expression for TPO in airway epithelial brushings was increased in patients with asthma with high airway mucus plug scores. Together, our results show that IL-13-activated HAECs autonomously generated pathologic mucus via peroxidase-mediated cross-linking of mucin polymers.

The appearance of senescent cells in age-related diseases has spurred the search for compounds that can target senescent cells in tissues, termed senolytics. However, a major caveat with current senolytic screens is the use of cell lines as targets where senescence is induced in vitro, which does not necessarily reflect the identity and function of pathogenic senescent cells in vivo. Here, we developed a new pipeline leveraging a fluorescent murine reporter that allows for isolation and quantification of p16Ink4a+ cells in diseased tissues. By high-throughput screening in vitro, precision-cut lung slice (PCLS) screening ex vivo, and phenotypic screening in vivo, we identified a HSP90 inhibitor, XL888, as a potent senolytic in tissue fibrosis. XL888 treatment eliminated pathogenic p16Ink4a+ fibroblasts in a murine model of lung fibrosis and reduced fibrotic burden. Finally, XL888 preferentially targeted p16INK4a-hi human lung fibroblasts isolated from patients with idiopathic pulmonary fibrosis (IPF), and reduced p16INK4a+ fibroblasts from IPF PCLS ex vivo. This study provides proof of concept for a platform where p16INK4a+ cells are directly isolated from diseased tissues to identify compounds with in vivo and ex vivo efficacy in mice and humans, respectively, and provides a senolytic screening platform for other age-related diseases.

Pulmonary arterial hypertension (PAH) is a devastating and progressive disease with limited treatment options. Endothelial dysfunction plays a central role in the development and progression of PAH, yet the underlying mechanisms are incompletely understood. The endosome-lysosome system is important to maintain cellular health, and the small GTPase RAB7 regulates many functions of this system. Here, we explored the role of RAB7 in endothelial cell (EC) function and lung vascular homeostasis. We found reduced expression of RAB7 in ECs from patients with PAH. Endothelial haploinsufficiency of RAB7 caused spontaneous pulmonary hypertension (PH) in mice. Silencing of RAB7 in ECs induced broad changes in gene expression revealed via RNA-Seq, and RAB7-silenced ECs showed impaired angiogenesis and expansion of a senescent cell fraction, combined with impaired endolysosomal trafficking and degradation, suggesting inhibition of autophagy at the predegradation level. Furthermore, mitochondrial membrane potential and oxidative phosphorylation were decreased, and glycolysis was enhanced. Treatment with the RAB7 activator ML-098 reduced established PH in rats with chronic hypoxia/SU5416. In conclusion, we demonstrate for the first time to our knowledge the fundamental impairment of EC function by loss of RAB7, causing PH, and show RAB7 activation to be a potential therapeutic strategy in a preclinical model of PH.

Purpose: To compare five pulmonary surfactant (PS) administration strategies for neonates with respiratory distress syndrome (RDS), including intubation-surfactant-extubation (InSurE), thin catheter administration, laryngeal mask airway (LMA), surfactant nebulization (SN), and usual care, with a particular emphasis on the comparison of the LMA and SN with other strategies. Methods: We conducted a systematic search of MEDLINE, EMBASE, PUBMED, and Cochrane CENTRAL databases up to November 2023. Two authors independently conducted data extraction, and assessed bias using the Cochrane Risk of Bias Tool. Frequency-based random-effects network meta-analyses were executed. Results: A total of 36 trials and 4035 infants were included in the analysis. LMA (OR: 0.20, 95%CI: 0.09 to 0.42) and Less Invasive Surfactant Administration (LISA) (OR: 0.17, 95%CI: 0.09 to 0.32) significantly reduced intubation rates compared to usual care. SN had a higher intubation rate compared to LISA (OR: 3.36, 95%CI: 1.46 to 7.71) and LMA (OR: 2.92, 95%CI: 1.10 to 7.71). LMA had a higher incidence of BPD compared to LISA (OR: 2.59, 95%CI: 1.21 to 5.54). SN ranked second to LISA in preventing BPD and death, but its efficacy decreased after excluding high-risk studies. SN and LMA had the lowest incidence of adverse events during administration.SN had the highest likelihood of secondary administration. Most results were rated as low or very low quality, with findings related to SN significantly impacted by high-risk trials. Conclusions: The thin catheter strategy minimized intubation risk and showed a better composite effect in reducing both mortality and BPD incidence. SN and LMA each showed safety and some clinical benefits in the subpopulations where they were studied, but their efficacy needs further validation through high-quality studies. Registration: This study was registered in PROSPERO (CRD42023463756). [ABSTRACT FROM AUTHOR]

Background: Pulmonary embolism (PE) is one of the most challenging diagnoses in emergency medicine, mainly because symptoms range from asymptomatic disease to sudden death. The role of echocardiography in the workup of suspected PE has been supportive and used primarily to assess the right ventricular (RV) size and function, which is important for risk stratification. Several echocardiographic parameters described in the literature lack the desired accuracy. Recently, a potential value of less well-recognized RV outflow tract (RVOT) Doppler variables has been reported. The early systolic notching (ESN) pattern was observed in 92% of patients with high and intermediate risk PE, making it a promising sign in selected PE patients. Case presentation: In this case series, we demonstrate a typical ESN pattern on RVOT Doppler evaluation in three patients with intermediate-risk PE presenting to our emergency department (ED). None of the patients had been previously diagnosed with pulmonary hypertension or other chronic pulmonary and cardiac disease. The pre-test probability was low. Massive proximal emboli were found on CT angiograms, involving pulmonary truncus or main pulmonary arteries. Previously, the ESN pattern was identified on a focused echocardiogram, which was the only echocardiographic indicator of increased pulmonary vascular resistance. Conclusions: RVOT Doppler flow pattern of ESN has potential clinical utility for the detection of PE in ED patients. ESN could identify patients at higher risk, which are otherwise stratified as low risk according to the latest guidelines. Moreover, this case series illustrates that even in the absence of other echocardiographic findings of RV strain, the presence of ESN should alert to the possibility of acute PE. Further prospective studies are needed to assess its diagnostic value in a selected subgroup of patients, similar to the cases presented, that would have no other obvious reason for the altered RVOT Doppler curve. [ABSTRACT FROM AUTHOR]

We aimed to examine the association between relative monocytosis and the recurrence of pulmonary Langerhans Cell Histiocytosis. Clinical, laboratory, radiographic and treatment data for 86 patients with a histopathological diagnosis of Langerhans Cell Histiocytosis over a 20-year duration. Parameters such as biological sex, age at diagnosis, time to diagnosis, molecular diagnostic data and imaging were collected. Treatment responses were assessed predominantly through radiography, with RECIST 1.1 criteria applied to MRI or CT scans and PERCIST utilized for serial PET imaging. Investigators also assessed peripheral blood absolute monocyte count at various time points, including initial diagnosis and the most recently available value. While peripheral blood absolute monocyte count between the earliest assessed timepoint and latest value did not differ, the mean value on progression (0.94 K/µL), however, was significantly higher than that following re-institution of therapy (0.31, p = 0.000794. Our observation of relative monocytosis on LCH disease progression may be related to an increase in circulating LCH on disease progression or from increased monocyte production for later differentiation into mature dendritic cells that participate in MHC Class 1 upregulation. This trend is especially evident in pulmonary LCH which is incited by tissue trauma and irritation by environmental factors. The phenomena observed in our study parallel other non-LCH cohorts, specifically in published findings from our own group in patients with Rosai Dorfman and Erdheim Chester Disease. To further elucidate the molecular underpinnings of LCH and explore the etiology of this monocyte trend, expanded integrated genomic-transcriptomic sequencing analyses to evaluate the molecular character of LCH and ultimately clarify the origin of this monocyte trend are in progress. These studies are poised to offer invaluable insight to the molecular mechanisms underlying LCH, specifically as they pertain to monocyte signaling and differentiation. [ABSTRACT FROM AUTHOR]

The structure and delivery of preclerkship undergraduate medical education has changed significantly over the past decade. Asynchronous didactic lectures are now routinely paired with in-person sessions that emphasize active and small-group learning. In this environment, educators tasked with teaching pulmonary medicine should be familiar with the growing number of educational technologies that can transform how and where content is delivered to students. In this Perspective, we review how educational technologies have been integrated into the preclerkship pulmonary module at the Northwestern University Feinberg School of Medicine. We hope our experience provides a road map for the integration of these tools in other educational settings. We cover how educational technology can facilitate asynchronous learning (prerecorded lectures and online message boards) as well as active in-person learning (audience response systems and technology-enhanced learning spaces). Throughout, we highlight best practices for the technologies discussed. [ABSTRACT FROM AUTHOR]

Contactless measurement methods offer a novel approach to assessing respiratory parameters. This study investigates the feasibility of classifying chronic obstructive pulmonary disease, asthma, and healthy individuals using depth-based plethysmography (DPG). The approach involves calculating Pearson's correlation coefficient for all pixel-wise signals against each other, with the cumulative result visualized in patient-specific masks. A convolutional neural network is used for the classification process. For evaluation, on a recorded data set (N=53), a classification accuracy of 57.7% and Cohen's Kappa of 0.28 were reached. These findings provide indications that DPG might effectively classify respiratory conditions by analyzing respiratory motion dynamics. [ABSTRACT FROM AUTHOR]

In the last year, there have been many remarkable articles published in the Italian Journal of Pediatrics. This review highlights papers that can be potentially helpful in healthcare practice among the most cited or accessed papers on the journal website. We have chosen key articles on allergy, analgesics, cardiology, endocrinology, gastroenterology, genetics, global health, infectious diseases, neonatology, neurology and pulmonology. Advances in understanding risk factors, mechanisms, diagnosis, treatment options and prevention of pediatric diseases have been discussed and in the context of the subsequent steps. We think that progresses achieved in 2023 will have a significant impact on the management of diseases in childhood. [ABSTRACT FROM AUTHOR]

Venous thromboembolism is responsible for a significant burden of disease worldwide. Despite the publication of multiple international guidelines, anecdotal evidence suggests significant clinical variation exists in the diagnostic and management pathways of pulmonary embolism (PE). We conducted a retrospective cohort study using electronic medical records to examine clinical variation in patients admitted to a tertiary referral center in Australia with a diagnosis of PE between November 2018 and January 2020. Three hundred cases met the inclusion criteria; we found variation in rates of compression ultrasonography, acute investigation of the right ventricle, and planning of repeat imaging at specialist follow‐up. Guidelines do not address the use of compression ultrasonography in already diagnosed PE, are conflicting in their recommendation for acute investigation of the right ventricle, and recommend repeat imaging only if there are persistent symptoms at the time of specialist follow‐up. The variations we found in this study may in part be due to physician preference or due to the paucity of evidence for some of these diagnostic practices. Robust future studies are required to guide the use of these investigations in PE. [ABSTRACT FROM AUTHOR]

Endobronchial ultrasound (EBUS) guided transbronchial needle aspiration (TBNA) is a widely used procedure in interventional pulmonology, known for its diagnostic accuracy and low complication rates. We report a rare complication of EBUS-TBNA involving the damage of the TBNA needle during sampling of a mediastinal lymph node, resulting in an impacted needle spring in the airway. Despite its rarity, awareness of such potential issues is crucial for all practitioners performing EBUS-TBNA to ensure patient safety and optimal outcomes. [ABSTRACT FROM AUTHOR]

Reciprocal interactions between alveolar fibroblasts and epithelial cells are crucial for lung homeostasis, injury repair, and fibrogenesis, but underlying mechanisms remain unclear. To investigate, we administered the fibroblast-selective TGF-β1 signaling inhibitor epigallocatechin gallate (EGCG) to interstitial lung disease (ILD) patients undergoing diagnostic lung biopsy and conducted single-cell RNA-Seq on spare tissue. Biopsies from untreated patients showed higher fibroblast TGF-β1 signaling compared with nondisease donor or end-stage ILD tissues. In vivo, EGCG downregulated TGF-β1 signaling and several proinflammatory and stress pathways in biopsy samples. Notably, EGCG reduced fibroblast secreted frizzled-related protein 2 (sFRP2), an unrecognized TGF-β1 fibroblast target gene induced near type II alveolar epithelial cells (AEC2s) in situ. Using AEC2-fibroblast coculture organoids and precision-cut lung slices (PCLSs) from nondiseased donors, we found TGF-β1 signaling promotes a spread AEC2 KRT17+ basaloid state, whereupon sFRP2 then activates a mature cytokeratin 5+ (Krt5+) basal cell program. Wnt-receptor Frizzled 5 (Fzd5) expression and downstream calcineurin signaling were required for sFRP2-induced nuclear NFATc3 accumulation and KRT5 expression. These findings highlight stage-specific TGF-β1 signaling in ILD and the therapeutic potential of EGCG in reducing idiopathic pulmonary fibrosis-related (IPF-related) transcriptional changes and identify TGF-β1/noncanonical Wnt pathway crosstalk via sFRP2 as a mechanism for dysfunctional epithelial signaling in IPF/ILD.

BACKGROUNDInformation about the size, airway location, and longitudinal behavior of mucus plugs in asthma is needed to understand their role in mechanisms of airflow obstruction and to rationally design muco-active treatments.METHODSCT lung scans from 57 patients with asthma were analyzed to quantify mucus plug size and airway location, and paired CT scans obtained 3 years apart were analyzed to determine plug behavior over time. Radiologist annotations of mucus plugs were incorporated in an image-processing pipeline to generate size and location information that was related to measures of airflow.RESULTSThe length distribution of 778 annotated mucus plugs was multimodal, and a 12 mm length defined short ("stubby", ≤12 mm) and long ("stringy", >12 mm) plug phenotypes. High mucus plug burden was disproportionately attributable to stringy mucus plugs. Mucus plugs localized predominantly to airway generations 6-9, and 47% of plugs in baseline scans persisted in the same airway for 3 years and fluctuated in length and volume. Mucus plugs in larger proximal generations had greater effects on spirometry measures than plugs in smaller distal generations, and a model of airflow that estimates the increased airway resistance attributable to plugs predicted a greater effect for proximal generations and more numerous mucus plugs.CONCLUSIONPersistent mucus plugs in proximal airway generations occur in asthma and demonstrate a stochastic process of formation and resolution over time. Proximal airway mucus plugs are consequential for airflow and are in locations amenable to treatment by inhaled muco-active drugs or bronchoscopy.TRIAL REGISTRATIONClinicaltrials.gov; NCT01718197, NCT01606826, NCT01750411, NCT01761058, NCT01761630, NCT01716494, and NCT01760915.FUNDINGAstraZeneca, Boehringer-Ingelheim, Genentech, GlaxoSmithKline, Sanofi-Genzyme-Regeneron, and TEVA provided financial support for study activities at the Coordinating and Clinical Centers beyond the third year of patient follow-up. These companies had no role in study design or data analysis, and the only restriction on the funds was that they be used to support the SARP initiative.

Primary graft dysfunction (PGD) limits clinical benefit after lung transplantation, a life-prolonging therapy for patients with end-stage disease. PGD is the clinical syndrome resulting from pulmonary ischemia-reperfusion injury (IRI), driven by innate immune inflammation. We recently demonstrated a key role for NK cells in the airways of mouse models and human tissue samples of IRI. Here, we used 2 mouse models paired with human lung transplant samples to investigate the mechanisms whereby NK cells migrate to the airways to mediate lung injury. We demonstrate that chemokine receptor ligand transcripts and proteins are increased in mouse and human disease. CCR5 ligand transcripts were correlated with NK cell gene signatures independently of NK cell CCR5 ligand secretion. NK cells expressing CCR5 were increased in the lung and airways during IRI and had increased markers of tissue residency and maturation. Allosteric CCR5 drug blockade reduced the migration of NK cells to the site of injury. CCR5 blockade also blunted quantitative measures of experimental IRI. Additionally, in human lung transplant bronchoalveolar lavage samples, we found that CCR5 ligand was associated with increased patient morbidity and that the CCR5 receptor was increased in expression on human NK cells following PGD. These data support a potential mechanism for NK cell migration during lung injury and identify a plausible preventative treatment for PGD.

The Raman effect, or as per its original description, “modified scattering”, is an observation that the number of scattered light waves shifts after photons make nonelastic contact with a molecule. This effect allows Raman spectroscopy to be very useful in various fields. Although it is well known that Raman spectroscopy could be very beneficial in medicine as a diagnostic tool, there are not many applications of Raman spectroscopy in pulmonary medicine. Mostly tumor tissue, sputum and saliva have been used as material for analysis in respiratory medicine. Raman spectroscopy has shown promising results in malignancy recognition and even tumor staging. Saliva is a biological fluid that could be used as a reliable biomarker of the physiological state of the human body, and is easily acquired. Saliva analysis using Raman spectroscopy has the potential to be a relatively inexpensive and quick tool that could be used for diagnostic, screening and phenotyping purposes. Chronic obstructive pulmonary disease (COPD) is a growing cause of disability and death, and its phenotyping using saliva analysis via Raman spectroscopy has a great potential to be a dependable tool to, among other things, help reduce hospitalizations and disease burden. Although existing methods are effective and generally available, Raman spectroscopy has the benefit of being quick and noninvasive, potentially reducing healthcare costs and workload.

Background: Pulmonary arterial hypertension is a life-threatening progressive disorder characterised by high blood pressure (hypertension) in the arteries of the lungs (pulmonary artery). Although treatable, there is no known cure for this rare disorder, and its exact cause is unknown. Mutations in the bone morphogenetic protein receptor type-2 (BMPR2) are the most common genetic cause of familial pulmonary arterial hypertension. This study represents the first-ever trial of treatments aimed at directly rescuing the BMPR2 pathway, repurposing two drugs that have shown promise at restoring levels of BMPR2 signalling: hydroxychloroquine and phenylbutyrate. Methods: This three-armed phase II precision medicine study will investigate BMPR2 target engagement and explore the efficacy of two repurposed therapies in pulmonary arterial hypertension patients with BMPR2 mutations. Patients will be stratified based on two BMPR2 mutation classes: missense and haploinsufficient mutations. Eligible subjects will be randomised to one of the three arms (two active therapy arms and a placebo arm, all plus standard of care) following a Bayesian response-adaptive design implemented independently in each stratum and updated in response to a novel panel of primary biomarkers designed to assess biological modification of the disease. Discussion: The results of this trial will provide the first randomised evidence of the efficacy of these therapies to rescue BMPR2 function and will efficiently explore the potential for a differential response of these therapies per mutation class to address causes rather than consequences of this rare disease. Trial registration: The study has been registered with ISRCTN (ISRCTN10304915, 22/09/2023). [ABSTRACT FROM AUTHOR]

Background: The effect of background noise on auscultation accuracy for different lung sound classes under standardised conditions, especially at lower to medium levels, remains largely unexplored. This article aims to evaluate the impact of three levels of Gaussian white noise (GWN) on the ability to identify three classes of lung sounds. Methods and materials: A pre-post pilot study assessing the impact of GWN on a group of students' ability to identify lung sounds was conducted. The three intensities were applied to the three classes of lung sounds: no GWN, signal-to-noise ratio (SNR), SNR-40 (medium level) and SNR-20 (high). This resulted with three exams, each containing nine questions. Fifty-two participants underwent a 4-day training programme and were tested on their identification of lung sound classes under the three levels of GWN, but seven subjects were excluded for not completing all three assessments. Statistical analysis was performed on 45 subjects, using non-parametric tests to analyse the data. A P -value of 0.05 was considered statistically significant. Results: The GWN did not impact the overall lung sound identification capacity of medical students, with consistent scores of 66.7% across the three noise levels for all three lung sound classes combined. However, when considering sound classes separately, GWN affected the identification of normal (NAS) and discontinuous (DAS), but not continuous (CAS) types. Exam scores for NAS varied significantly across the three noise levels, with respective scores of 66.7%, 100% and 66.7%. Scores for DAS also varied, revealing 66.7%, 33.3% and 66.7%. Conclusion: This study introduces a standardised simulation-based approach to investigate the effect of GWN on the accuracy of auscultation amongst medical students. Findings indicate that whilst CAS sounds are robust to background noise, the identification of NAS and DAS sounds can be compromised. The medium noise levels (SNR-40) of noise pollution had the greatest effect on the DAS lung sounds. [ABSTRACT FROM AUTHOR]

Background: Chronic obstructive pulmonary disease (COPD) is a prevalent condition that can be prevented and treated, defined by ongoing respiratory symptoms and restricted airflow resulting from abnormalities in the alveoli or airways, typically due to significant exposure to harmful particles or gases.1,2. Aim and Objectives: This study aimed to compare the prognostic value of three different scoring methods of Acute exacerbation of COPD(AECOPD): DECAF score, BAP65 score, CAUDA70 score in predicting outcome and mortality in the patient with AECOPD. Material and Methods: Study Design: Prospective hospital-based observational study. Study area: The study was conducted in the Department of Pulmonary Medicine in MVJ MC AND RH. Study Period: 1 year from June 2023-June 2024. Study population: The present study involved 100 cases of chronic obstructive pulmonary disease with acute exacerbation. Sample size: The study consisted of 100 subjects. Sampling method: Simple random Sampling Technique. All these patients with exacerbation of COPD underwent routine clinical, radiological and laboratory assessment and appropriate treatment was initiated as decided by the treating clinician. Investigations followed standard of care. All the data needed for the proposed scoring systems were collected from patients, hospital records. Results: 29.2% died with score >3, 33.3% died with score 0-1, 37.5% died with score>2, There is a significant association between mortality and BAP 65 score. Among the study subjects 14.3% had score>3, 57.1% had score >2, 28.6% had score0-1. 34.8% readmission with score 0-1, 65.2% readmission with score 2 There is a significant association between BAP 65, DECAF, CAUDA70 and 30 day readmissions. Conclusion: Our findings imply that a straightforward clinical prediction tool that incorporates indices that are frequently available at the time of hospital admission will help stratify patients with AECOPD into risk categories that are clinically relevant, which may help clinicians manage these patients. In conclusion, we propose that the DECAF, BAP 65, and CAUDA 70 scores all play a part in clinical practice. [ABSTRACT FROM AUTHOR]

Objective: The objective of the study is to assess the usefulness of cytology, ZN staining and CBNAAT in diagnosis of suspected tubercular lymphadenopathy and to compare the results of cytology and ZN staining with CBNAAT findings in the diagnosis of suspected tubercular lymphadenopathy. Methods: The study was conducted on 100 patients with clinical suspicion of tubercular lymphadenopathy in Department of Pathology in collaboration with Department of Pulmonary Medicine, GMC, Patiala. The study was started after obtaining approval from the Institutional Ethics Committee. The records of suspected 100 EPTB patients who had under gone FNAC, ZN stain and CBNAAT test for EPTB diagnosis during the study period of 1 year were analysed. Results: The results shows male to female ratio of 1:1.4. The youngest patient was 28 days old and oldest was 77 years old. In this study, Granulomatous lymphadenopathy was the most predominant cytological finding (74%) followed by reactive lymphoid hyperplasia (16%), suppurative (08%), carcinomatous deposits (01%) and lymphoma (01%). Out of the total granulomatous lymphadenopathy i.e 74 cases, ZN stain was positive in 39 cases (52.7%) and CBNAAT was positive in 61 cases (82.4%). Out of the total 100 cases, all 39 ZN-positive cases were diagnosed with tuberculosis on FNAC. Among the 67 CBNAAT-positive cases, 61 were diagnosed with tuberculosis on FNAC, while 4 were diagnosed with suppurative lesions and 2 with reactive lymphoid hyperplasia. Conclusion: FNAC combined with CBNAAT emerged as a reliable diagnostic approach due to its rapid turnaround time and high sensitivity, facilitating early diagnosis and management of tubercular lymphadenopathy. [ABSTRACT FROM AUTHOR]

Aim:To study clinico-demographic and lung spirometry profile between non-smoker and smoker COPD patients. Material & Methods: The present cross-sectional observational study was conducted among 200 clinically diagnosed COPD patients attending the Pulmonary Medicine Department at tertiary care centre, Bhopal, Madhyapradesh. Upon diagnosis of COPD, detailed past medical history and any previous exposures was recorded. Patients aged <18 years and patients who do not provide consent were excluded from the patients. Informed consent was taken from all the patients and ethical clearance was obtained form institutional ethical committee. Result: Out of 200 COPD patients, 134(67%) were non smokers and 66(33%) were smokers. Out of 200 COPD patients, 150 were male & 50 were female. Smokers experienced a higher frequency of acute exacerbations (3-5 times) compared to non-smokers, suggesting that smoking exacerbates the severity and recurrence of COPD episodes.(P=0.001) Smokers had a significantly higher mean CAT score compared to non-smokers, indicating more severe COPD symptoms and a greater impact on daily life for smokers.(P=0.001) Smokers had more severe shortness of breath (higher mMRC grades) compared to nonsmokers, indicating a greater impact of smoking on the severity of COPD symptoms. Conclusion: Present study found that an Environmental and occupational exposures are significant contributors to COPD among non-smokers, with biofuel smoke and second-hand smoke being primary risk factors. [ABSTRACT FROM AUTHOR]

Background: Chronic obstructive pulmonary disease (COPD) is associated with subclinical atherosclerosis and endothelial dysfunction, which can be assessed non-invasively through flow-mediated dilation (FMD). In this study, we evaluated the potential impact of inhaled corticosteroid (ICS) therapy on FMD of COPD patients undergoing pulmonary rehabilitation (PR). Methods: Medical records of COPD patients undergoing FMD assessment upon admission to our Pulmonary Rehabilitation Unit were reviewed in this retrospective post hoc analysis. Results: A total of 46 patients with COPD (median age 71.5 years, 28.3% postmenopausal females) were included in the final analysis. Among these, 27 participants were currently receiving ICS therapy, while 19 were not. At baseline, the two groups showed no difference in the main clinical and functional variables. Similarly, no significant difference was observed in vascular reactivity parameters, with a median FMD of 3.12% (IQR: 2.23–4.45) in ICS users and 3.39% (IQR: 2.45–4.08) in ICS nonusers (p = 0.544). After PR, a significant improvement in the main rehabilitation and patient-reported outcomes was observed in all groups, with a significant improvement in FMD documented in both patients treated with steroids (from 3.12%; IQR: 2.23–4.45 to 4.77%; IQR: 3.25–5.63, p = 0.022) and in those who were not (from 3.39%; IQR: 2.45–4.08 to 5.04%; IQR: 3.98–6.06, p = 0.005). FMD changes were of comparable magnitude among groups. Conclusions: Our preliminary findings do not indicate a significant impact of medications containing ICS on the endothelial function of COPD patients, suggesting that the potential beneficial effect of PR on this surrogate marker of cardiovascular risk is independent of inhaled therapy. [ABSTRACT FROM AUTHOR]

Background: Explanations provided by healthcare professionals contribute to patient beliefs. Little is known about how healthcare professionals explain chronic breathlessness to people living with this adverse sensation. Methods: A purpose-designed survey disseminated via newsletters of Australian professional associations (physiotherapy, respiratory medicine, palliative care). Respondents provided free-text responses for their usual explanation and concepts important to include, avoid, or perceived as difficult to understand by recipients. Content analysis coded free text into mutually exclusive categories with the proportion of respondents in each category reported. Results: Respondents (n = 61) were predominantly clinicians (93%) who frequently (80% daily/weekly) conversed with patients about breathlessness. Frequent phrases included within usual explanations reflected breathlessness resulting from medical conditions (70% of respondents) and physiological mechanisms (44%) with foci ranging from multifactorial to single-mechanism origins. Management principles were important to include and phrases encouraging maladaptive beliefs were important to avoid. The most frequent difficult concept identified concerned inconsistent relationships between oxygenation and breathlessness. Where explanations included the term 'oxygen', a form of cognitive shortcut (heuristic) may contribute to erroneous beliefs. Conclusions: This study presents examples of health professional explanations for chronic breathlessness as a starting point for considering whether and how explanations could contribute to adaptive or maladaptive breathlessness beliefs of recipients. [ABSTRACT FROM AUTHOR]

Introduction: Asthma is a common inflammatory disease of airway affecting both adults and children. In a large number of cases asthma remains poorly controlled. There is a need to find an additional therapeutic demeanour alleviating symptoms and lowering the risk complications in a long-term. Recently, increasing number of studies has been examining dietary supplements in regards to their anti-inflammatory, immunomodulatory, anti-remodelling properties and their use in asthmatic patients. Aim of the Study: The aim of the study was to collect and analyse current literature regarding influence of different dietary supplements on the course of asthma in both adults and children. Methods and Materials: Extensive research was conducted using PubMed and Google Scholar, with the primary focus on literature from the past 5 years. Firstly, potential dietary supplements affecting course of asthma were collected. The names of the substances were juxtaposed with term “Asthma” to gather data regarding their effect on occurrence and control of asthma and potential mechanisms responsible for it. Additionally, references from selected articles were included in the analysis. Results: Dietary supplements show promising results in decreasing asthma symptoms and lowering inflammation of airway. However, our study revealed that in current state of knowledge there is a deficit of studies performed on humans, especially large-scale, prospective studies that assess the efficacy of different doses of dietary supplements. Thus, further research of dietary supplements in asthma is needed, especially large-scale randomised controlled trials. [ABSTRACT FROM AUTHOR]

Background/Objectives: Radiography is an essential and low-cost diagnostic method in pulmonary medicine that is used for the early detection and monitoring of lung diseases. An adequate and consistent image quality (IQ) is crucial to ensure accurate diagnosis and effective patient management. This pilot study evaluates the feasibility and effectiveness of the International Atomic Energy Agency (IAEA)'s remote and automated quality control (QC) methodology, which has been tested in multiple imaging centers. Methods: The data, collected between April and December 2022, included 47 longitudinal data sets from 22 digital radiographic units. Participants submitted metadata on the radiography setup, exposure parameters, and imaging modes. The database comprised 968 exposures, each representing multiple image quality parameters and metadata of image acquisition parameters. Python scripts were developed to collate, analyze, and visualize image quality data. Results: The pilot survey identified several critical issues affecting the future implementation of the IAEA method, as follows: (1) difficulty in accessing raw images due to manufacturer restrictions, (2) variability in IQ parameters even among identical X-ray systems and image acquisitions, (3) inconsistencies in phantom construction affecting IQ values, (4) vendor-dependent DICOM tag reporting, and (5) large variability in SNR values compared to other IQ metrics, making SNR less reliable for image quality assessment. Conclusions: Cross-comparisons among radiography systems must be taken with cautious because of the dependence on phantom construction and acquisition mode variations. Awareness of these factors will generate reliable and standardized quality control programs, which are crucial for accurate and fair evaluations, especially in high-frequency chest imaging. [ABSTRACT FROM AUTHOR]

Background: The diagnosis of peripheral pulmonary lesions (PPL) is still challenging. We describe a novel method for sampling PPL without bronchial signs by creating invisible tunnel under electromagnetic navigation without the transbronchial access tool (TABT). Methods: During electromagnetic navigation, we adjust the angle of the edge extended working channel catheter based on the real-time position of the lesion in relation to the locating guide rather than preset route. A biopsy brush or biopsy forceps is used to punch a hole in the bronchial wall. A locating guide is then re-inserted to real-time navigate through the lung parenchyma to the lesion. Safety and feasibility of this method was analyzed. Results: A total of 32 patients who underwent electromagnetic navigation bronchoscopy were retrieved. The mean size of the lesion is 23.1 mm. The mean operative time of all patients was 12.4 min. Ten of the patients did not have a direct airway to the lesion, thus creating an invisible tunnel. For them, the length of the tunnel from the bronchial wall POE to the lesion was 11–30 mm, with a mean length of 16.9 mm and a mean operation time of 14.1 min. Adequate samples were obtained from 32 patients (100%), and the diagnostic yield was 87.5% (28/32). Diagnostic yield of with create the invisible tunnel TBAT was 90% (9/10), and one patient undergone pneumothorax after operation. Conclusions: This method is feasible and safe as a novel approach sampling pulmonary lesions without bronchial signs, and it further improves current tunnel technique. [ABSTRACT FROM AUTHOR]

Introduction Respiratory diseases constitute a major cause of morbidity and mortality worldwide. The objective of our study was to identify the causes and factors associated with the death of patients in the Pulmonology Department of the Treichville University Hospital. Patients and methods This was a retrospective cross-sectional study analyzing patients who died while hospitalized in the Pneumology Department of Treichville University Hospital between April 2019 and April 2020. Results The study covered 514 files, including 177 deaths, representing an overall mortality of 34.4%. There were 109 men and 68 women with an average age of 45.20 years. The main antecedents were HIV infection (42.18%) and tuberculosis (38.1%). The main causes of death were pulmonary tuberculosis (49.69%), pneumocystosis (20.75%), and bacterial pneumonia (18.87%). Severe anemia (53.68%) and severe renal failure (19.85%) were the biological abnormalities associated with pulmonary pathologies. In univariate analysis, the factors associated with deaths were age less than 25 years, HIV seropositivity, nonmedical access to the service, self-medication, the presence of signs of initial clinical and radiological severity, a diagnosis of tuberculosis and neoplastic pathology, also the existence of difficulties during hospitalization. Multivariate analysis revealed HIV infection [odds ratio (OR)=1.46, confidence interval (CI)=0.27–0.77, P=0.003], diagnosed pulmonary tuberculosis (OR=1.51, CI=0.30–0.87, P=0.01), the presence of signs of clinical severity (OR=1.20, CI=0.09–0.42, P=0.00) and initial radiological severity (OR=1.27, CI=0.11–0.64, P=0.003) and the presence of difficulties during hospitalization (OR=1.16, CI=0.05–0.54, P=0.003). Conclusion Mortality remains high in pulmonology hospitalizations. Currently, tuberculosis and HIV infection are the main causes of death. Efforts to combat these two conditions must be strengthened by taking into account these factors associated with deaths.

Objective: This study aims to analyze the efficacy of pulmonary rehabilitation on exercise capacity, lung function, and quality of life (QoL) in advanced lung cancer. Method: This Systematic Review and meta-analysis were conducted based on Randomized Clinical Trials and Prospective articles obtained through searches in PubMed, Google Scholar, Europe PMC, and Cochrane Library. The review focuses on the predetermined topic. The quality of the study was assessed by the Jadad scale for clinical trial studies and Newcastle Ottawa Scale for Cohort. Statistical analysis was done using Review Manager 5.4 software. Result: A total of 6 RCT studies with 251 participants were included in this meta‐analysis. Patients with lung cancer who have received chemotherapy and or radiation therapy and undergo pulmonary rehabilitation programs have a significant impact on exercise capacity The Six Minute Walk Test (MD=72.06 [95% CI 25.45, 118.67], p=0.002), Forced Expiratory Volume (MD=13.03 [95% CI 0.18,25.89], p= 0.05), Forced Vital Capacity (MD=12.44 [95% CI 0.58, 24.30], p= 0.04) dan HRQoL Functional Assessment of Cancer Therapy-Lung Cancer Subscale (MD=1.64 [95% CI 0.07,3.21], p= 0.04). Conclusion: Our study suggests that pulmonary rehabilitation impact exercise capacity (6MWT), improvement in lung function, and quality of life. Keywords: Lung cancer; Pulmonary Rehabilitation; Chemotherapy; Radiotherapy

AIM: The aim of the study was to assess adherence to asthma controller therapy and factors that influence asthma control and to determine the association between asthma knowledge of the caregiver and asthma control among admitted children with asthma. SETTINGS AND DESIGN: A cross-sectional study was conducted between November 2022 and May 2023 in a tertiary care hospital. Children with a diagnosis of asthma aged 2–14 years, who were admitted to the hospital with an exacerbation of asthma were identified. METHODS: Caregivers of the admitted children were interviewed using the Asthma Knowledge Questionnaire and Pediatric Inhaler Adherence Questionnaire. STATISTICAL ANALYSIS USED: Demographic and clinical data were described using descriptive analyses, where mean and standard deviation were used for normally distributed continuous variables, median and interquartile range (IQR), if otherwise. A P < 0.05 was set as a cutoff for statistical significance. RESULTS: A total of 144 caregivers completed the survey. Median score for parents’ knowledge of asthma was 64%, with an IQR of 59–67. Both mother’s and father’s educational levels were associated with a good level of knowledge: odds ratio (OR) = 2.48, 95% confidence interval (CI) = 1.1–5.6, and OR = 5.33, 95% CI = 2.23–12.7, respectively. Median adherence to metered dose inhaler (MDI) was 4 (IQR = 2–6). Children who had been admitted to the general ward in the last 6 months were three times more likely to be nonadherent to MDI (OR = 3.03, 95% CI = 1.18–7.82). Forty-three percent of children who were nonadherent to MDI were less likely to have their asthma controlled (OR = 0.43, 95% CI = 0.17–1.06). CONCLUSION: This study revealed that a low level of knowledge among caregivers of asthma patients is linked to inadequate adherence to asthma controller therapy. As medication adherence is crucial for achieving desirable asthma control and improving the quality of life for this population, efforts need to be made to enhance the knowledge level of parents of children with asthma.

Nader Ahmed Mohammed,1 Abdulrahman OE Adam,2 Monzir Ahmed Hassan Osman,2,3 Hibatallah MA Abass,2,3 Awad MA Salih,2,3 Ameer AM Abaker,2,3 Alamin Mustafa,3,4 Mamoun Magoub5 1Department of Medicine, Faculty of Medicine, University of Kassala, Kassala, Sudan; 2Faculty of Medicine, Omdurman Islamic University, Omdurman, Sudan; 3Patient Support Organization Research Unit, Khartoum, Sudan; 4Faculty of Medicine, Al-Neelain University, Khartoum, Sudan; 5Department of Microbiology & Parasitology, Faculty of Medicine & Health Science, West Bank of Gash River, University of Kassala, Kassala, SudanCorrespondence: Mamoun Magoub, Department of Microbiology & Parasitology, Faculty of Medicine & Health Science, West Bank of Gash River, University of Kassala, Kassala, Sudan, Tel +24991291999, Email mamounmagzoub@kassalauni.edu.sd Alamin Mustafa, Faculty of Medicine, Al-Neelain University, JG37+2RM, 52nd St, Khartoum, Sudan, Tel +249902612984, Email alamin900005@gmail.comBackground: Ascaris lumbricoides is a common infectious parasite of the gastrointestinal tract worldwide, but the invasion of the pleural cavity is rare.Case Report: A 45-year-old man from Eastern Sudan presented to the emergency department complaining of breathlessness, cough stained with blood, and chest pain one month before his presentation. Also, he complained of high-grade fever for two weeks associated with sweating. Diagnosis of hydropneumothorax was made and a chest tube was inserted, two days later we found three adult A. lumbricoides worms in the chest drain.Conclusion: The patient was treated with Albendazole 200 mg, orally twice, daily for seven days, he improved and was referred to a cardiothoracic surgeon for more assessment. Our study highlights that internal medicine specialists should know about pleural ascariasis when patients present with respiratory signs and symptoms, especially in A. lumbricoides endemic regions like Eastern Sudan.Keywords: neglectable tropical diseases, pulmonology, pleural cavity, ascariasis, Ascaris lumbricoides

Abstract Background Chronic obstructive pulmonary disease (COPD) is a progressive disease associated with autoimmune systemic inflammation. The evidence on the role of C-reactive protein (-CRP) in predicting mortality among people with COPD remains mixed. Methods Data from the National Health and Nutrition Examination Survey (1999–2010) were linked with mortality files up to December 31st, 2019, from the National Death Index. Adults ages 20 years or older were included in the analytic sample to assess the relationship between physician-diagnosed self-reported COPD and mortality based on blood CRP levels. Multivariate complex samples Cox regression analyses were conducted to determine the hazards ratios (with 95% CI). Results A total of 30,669 individuals comprised of the final sample with 2215 deaths observed upon follow-up for an average of 10.2 years. Compared to individuals without COPD or elevated CRP, individuals with COPD but without elevated CRP (HR = 1.25, 95% CI = 0.97–1.61) did not have a significantly higher risk of mortality. However, those with both COPD and elevated CRP had a significantly higher risk of mortality (HR = 2.70, 95% CI = 1.08–6.81). Age, health insurance status, and a history of comorbidities modified these relationships. Conclusions Biomarkers such as CRP continue to show promise for long-term COPD-related outcomes. Additional prospective assessments of individuals with airway obstruction are warranted to understand if CRP levels predict the occurrence or worsening of COPD and if those relate to long-term health outcomes.

BACKGROUNDLower respiratory tract infection (LRTI) is a leading cause of death in children worldwide. LRTI diagnosis is challenging because noninfectious respiratory illnesses appear clinically similar and because existing microbiologic tests are often falsely negative or detect incidentally carried microbes, resulting in antimicrobial overuse and adverse outcomes. Lower airway metagenomics has the potential to detect host and microbial signatures of LRTI. Whether it can be applied at scale and in a pediatric population to enable improved diagnosis and treatment remains unclear.METHODSWe used tracheal aspirate RNA-Seq to profile host gene expression and respiratory microbiota in 261 children with acute respiratory failure. We developed a gene expression classifier for LRTI by training on patients with an established diagnosis of LRTI (n = 117) or of noninfectious respiratory failure (n = 50). We then developed a classifier that integrates the host LRTI probability, abundance of respiratory viruses, and dominance in the lung microbiome of bacteria/fungi considered pathogenic by a rules-based algorithm.RESULTSThe host classifier achieved a median AUC of 0.967 by cross-validation, driven by activation markers of T cells, alveolar macrophages, and the interferon response. The integrated classifier achieved a median AUC of 0.986 and increased the confidence of patient classifications. When applied to patients with an uncertain diagnosis (n = 94), the integrated classifier indicated LRTI in 52% of cases and nominated likely causal pathogens in 98% of those.CONCLUSIONLower airway metagenomics enables accurate LRTI diagnosis and pathogen identification in a heterogeneous cohort of critically ill children through integration of host, pathogen, and microbiome features.FUNDINGSupport for this study was provided by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Heart, Lung, and Blood Institute (UG1HD083171, 1R01HL124103, UG1HD049983, UG01HD049934, UG1HD083170, UG1HD050096, UG1HD63108, UG1HD083116, UG1HD083166, UG1HD049981, K23HL138461, and 5R01HL155418) as well as by the Chan Zuckerberg Biohub.

Fractures negatively impact quality of life and survival. We hypothesized that recipient frailty score and genetic profile measured before transplant would predict risk of fracture after lung transplant. We conducted a retrospective cohort study of bone mineral density (BMD) and fracture among lung transplant recipients at a single center. The association between predictors and outcomes were assessed by multivariable time-dependent Cox models or regression analysis. Among the 284 participants, osteoporosis and fracture were highly prevalent. Approximately 59% of participants had posttransplant osteopenia, and 35% of participants developed at least 1 fracture. Low BMD was associated with a polygenic osteoporosis risk score, and the interaction between genetic score and BMD predicted fracture. Pretransplant frailty was associated with risk for spine and hip fracture, which were not associated with chronic lung allograft dysfunction or death. Chest fractures were the most frequent type of fracture and conferred a 2.2-fold increased risk of chronic lung allograft dysfunction or death (time-dependent P < .001). Pneumonia, pleural effusions, and acute rejection frequently occurred surrounding chest fracture. Pretransplant frailty and recipient genotype may aid clinical risk stratification for fracture after transplant. Fracture carries significant morbidity, underscoring the importance of surveillance and osteoporosis prevention.

Introduction: Respiratory diseases constitute a major cause of morbidity and mortality worldwide. The objective of our study was to identify the causes and factors associated with the death of patients in the Pulmonology Department of the Treichville University Hospital. Patients and methods: This was a retrospective cross-sectional study analyzing patients who died while hospitalized in the Pneumology Department of Treichville University Hospital between April 2019 and April 2020. Results: The study covered 514 files, including 177 deaths, representing an overall mortality of 34.4%. There were 109 men and 68 women with an average age of 45.20 years. The main antecedents were HIV infection (42.18%) and tuberculosis (38.1%). The main causes of death were pulmonary tuberculosis (49.69%), pneumocystosis (20.75%), and bacterial pneumonia (18.87%). Severe anemia (53.68%) and severe renal failure (19.85%) were the biological abnormalities associated with pulmonary pathologies. In univariate analysis, the factors associated with deaths were age less than 25 years, HIV seropositivity, nonmedical access to the service, self-medication, the presence of signs of initial clinical and radiological severity, a diagnosis of tuberculosis and neoplastic pathology, also the existence of difficulties during hospitalization. Multivariate analysis revealed HIV infection [odds ratio (OR)=1.46, confidence interval (CI)=0.27–0.77, P=0.003], diagnosed pulmonary tuberculosis (OR=1.51, CI=0.30–0.87, P=0.01), the presence of signs of clinical severity (OR=1.20, CI=0.09–0.42, P=0.00) and initial radiological severity (OR=1.27, CI=0.11–0.64, P=0.003) and the presence of difficulties during hospitalization (OR=1.16, CI=0.05–0.54, P=0.003). Conclusion: Mortality remains high in pulmonology hospitalizations. Currently, tuberculosis and HIV infection are the main causes of death. Efforts to combat these two conditions must be strengthened by taking into account these factors associated with deaths. [ABSTRACT FROM AUTHOR]

Monoterpene and 5-methylcoumarin- or 5-methylchromone-coupled meroterpenoids occurring mainly in the Asteraceae species proved to have high potency against protozoans, worms, and various tumor cells, which make them interesting targets for searching for new bioactive compounds. The African plant Centrapalus pauciflorus was applied in traditional medicine for healing chest pain and stomach aches. Three new meroterpenoids named centrapalus coumarin N (2), pauciflorins P (3), and Q (4), and the already known cyclohoehnelia coumarin (1), were isolated from the chloroform extract of C. pauciflorus, together with centrapalus coumarin O (5), which was obtained for the first time from a natural source. The structures were established from HRESIMS, 1D (1H NMR, 13C NMR JMOD) and 2D NMR (HSQC, HMBC, 1H-1H COSY, NOESY) spectroscopies, and the absolute stereochemistry of 5 was determined by single-crystal X-ray diffraction. Compounds 1, 2, and 5 are hybrid molecules of 5-methylcoumarin–monoterpene origin. Centrapalus coumarin N is the first example of meroterpenoids, where a monoterpene is fused with a coumarin and an acetophenone unit. Pauciflorins P and Q are dimeric meroterpenoid isomers. Centrapalus coumarins N and O were tested for antiproliferative activity against human adherent breast (MCF-7, MDA-MB-231), cervical (HeLa, SiHa), and ovarian (A2780) cancer cell lines, and were additionally included to obtain data concerning cancer selectivity. Both compounds exhibited moderate (IC50 > 10 µM) but selective activity against A2780 cells. [ABSTRACT FROM AUTHOR]

AIM: The aim of the study was to assess adherence to asthma controller therapy and factors that influence asthma control and to determine the association between asthma knowledge of the caregiver and asthma control among admitted children with asthma. SETTINGS AND DESIGN: A cross-sectional study was conducted between November 2022 and May 2023 in a tertiary care hospital. Children with a diagnosis of asthma aged 2--14 years, who were admitted to the hospital with an exacerbation of asthma were identified. METHODS: Caregivers of the admitted children were interviewed using the Asthma Knowledge Questionnaire and Pediatric Inhaler Adherence Questionnaire. STATISTICAL ANALYSIS USED: Demographic and clinical data were described using descriptive analyses, where mean and standard deviation were used for normally distributed continuous variables, median and interquartile range (IQR), if otherwise. A P < 0.05 was set as a cutoff for statistical significance. RESULTS: A total of 144 caregivers completed the survey. Median score for parents' knowledge of asthma was 64%, with an IQR of 59-67. Both mother's and father's educational levels were associated with a good level of knowledge: odds ratio (OR) = 2.48, 95% confidence interval (CI) = 1.1-5.6, and OR = 5.33, 95% CI = 2.23-12.7, respectively. Median adherence to metered dose inhaler (MDI) was 4 (IQR = 2-6). Children who had been admitted to the general ward in the last 6 months were three times more likely to be nonadherent to MDI (OR = 3.03, 95% CI = 1.18-7.82). Forty-three percent of children who were nonadherent to MDI were less likely to have their asthma controlled (OR = 0.43, 95% CI = 0.17-1.06). CONCLUSION: This study revealed that a low level of knowledge among caregivers of asthma patients is linked to inadequate adherence to asthma controller therapy. As medication adherence is crucial for achieving desirable asthma control and improving the quality of life for this population, efforts need to be made to enhance the knowledge level of parents of children with asthma. [ABSTRACT FROM AUTHOR]

Thoracic ultrasound (TUS) is a tool that has become increasingly essential in the daily practice of thoracic medicine. Driven by the need to assess patients during the COVID-19 pandemic, there has been an increase in the use of point-of-care TUS, which has demonstrated several benefits, either as a complement to clinical decisionmaking for diagnosis or as a real-time guide for procedures, whether as a predictor or measure of treatment response. Here, we present a review of TUS, based on the most recent scientific evidence, from equipment and techniques to the fundamentals of pulmonary ultrasound, describing normal and pathological findings, as well as focusing on the management of lung disease and guidance for invasive thoracic procedures at the bedside. Finally, we highlight areas of perspective and potential lines of research to maintain interest in this valuable tool, in order to improve the diagnostic process and expand the treatment arsenal. [ABSTRACT FROM AUTHOR]

Background: Chronic obstructive pulmonary disease (COPD) is a progressive disease associated with autoimmune systemic inflammation. The evidence on the role of C-reactive protein (-CRP) in predicting mortality among people with COPD remains mixed. Methods: Data from the National Health and Nutrition Examination Survey (1999–2010) were linked with mortality files up to December 31st, 2019, from the National Death Index. Adults ages 20 years or older were included in the analytic sample to assess the relationship between physician-diagnosed self-reported COPD and mortality based on blood CRP levels. Multivariate complex samples Cox regression analyses were conducted to determine the hazards ratios (with 95% CI). Results: A total of 30,669 individuals comprised of the final sample with 2215 deaths observed upon follow-up for an average of 10.2 years. Compared to individuals without COPD or elevated CRP, individuals with COPD but without elevated CRP (HR = 1.25, 95% CI = 0.97–1.61) did not have a significantly higher risk of mortality. However, those with both COPD and elevated CRP had a significantly higher risk of mortality (HR = 2.70, 95% CI = 1.08–6.81). Age, health insurance status, and a history of comorbidities modified these relationships. Conclusions: Biomarkers such as CRP continue to show promise for long-term COPD-related outcomes. Additional prospective assessments of individuals with airway obstruction are warranted to understand if CRP levels predict the occurrence or worsening of COPD and if those relate to long-term health outcomes. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the diagnostic efficacy and safety of fine needle aspiration cytology performed under ultrasound guidance. Study Design: Comparative prospective study. Place and Duration of Study: Pulmonology Out-Patient Department, Gulab Devi Teaching Hospital, Lahore Pakistan, from Jun 2018 to Dec 2019. Methodology: One hundred and twenty-four patients of age 10-80 years, with pulmonary, mediastinal, pleural or chest wal lesions, fulfiling the minimal fitness criteria were included. Aspiration was done by a 23-gauge needle, smear made, and fixed slides were sent to the Cytology Department for evaluation. Complications were monitored. Findings were recorded on preformed proforma. Results: 121/124(97.6%) aspirates were adequate while 03 cases (2.4%) were reported not representing the lesion. Fifty cases (41.3%) showed malignant cytology, 71/121 aspirates (58.7%) were non-malignant. A specific cel type could be characterized in 84.5% non-malignant and 68.0% malignant aspirates. Complications were a few drops bleeding at needle aspiration site in 7.5 % and minor pain in 12.0 % patients. Conclusion: Fine needle aspiration cytology under ultrasound guidance is an effective and safe diagnostic tool in pulmonary medicine. [ABSTRACT FROM AUTHOR]

Background: Although frailty is one of the aging syndromes, it can occur at a younger age and in individuals with organ diseases. Identifying frailty and pre-frailty in patients with chronic respiratory diseases (CRDs) is an emerging assessment in the field of pulmonary medicine and rehabilitation. The aim of this study was to find out the prevalence of frailty among chronic respiratory disease patients. Methods: A single centre cross-sectional survey study with a total population of 381 patients, adults aged 18-90 years presenting to the pulmonology OPD was included based on the inclusion and exclusion criteria. Primary data collected were demographics, medical history, including comorbidities, use of long-term oxygen therapy (LTOT), BiPAP (Bilevel Positive Airway Pressure), previous hospital admissions, medication history and frailty assessment were done using the Fried frailty index. Results: Univariate analysis showed that sex, ECHO abnormality, patients using LTOT, BiPAP, home nebulizers and patients who did not attend the pulmonary rehabilitation programme had a significant association with frailty. Multivariate analysis showed that female sex, LTOT use and older age were significantly associated with frailty. Conclusion: Frailty is frequent in CRD patients regardless of age. The prevalence of frailty has an association with female sex, patients using LTOT, and home BiPAP. [ABSTRACT FROM AUTHOR]

Introduction: Single-station N2 (ssN2) versus multi-station N2 has been used as a selection criterion for treatment recommendations between surgical versus non-surgical multimodality treatment in stage III-N2 NSCLC. We hypothesized that clinical staging would be susceptible to upstaging on pathologic staging and, therefore, challenge this practice. Methods: A retrospective study of prospectively collected routine clinical data for patients with stage III-N2 NSCLC that had completed computed tomography (CT), positron emission tomography (PET), and staging endobronchial ultrasound (EBUS) and had been confirmed clinical stage III-ssN2 at multidisciplinary team discussion and went on to complete surgical resection as the first treatment to provide pathologic staging. The study was completed in two cohorts (A) across a single cancer alliance in England (Greater Manchester) January 1, 2015 to December 31, 2018 and (B) across five United Kingdom centers to validate the findings in part A January 1, 2016 to December 31, 2020. Results: A total of 115 patients met the inclusion criteria across cohort A (56 patients) and cohort B (59 patients) across 15 United Kingdom hospitals. The proportion of cases in which clinical stage III-ssN2 was upstaged to pathologic stage III-multi-station N2 was 34% (19 of 56) in cohort A, 32% in cohort B (19 of 59), and 33% across the combined study cohort (38 of 115). Most patients had a single radiologically abnormal lymph node on CT and PET (88%, 105 of 115). In the majority, the reasons for missed N2 disease on staging EBUS were due to inaccessible (stations 5, 6, 8, 9) N2 nodes at EBUS (34%, 13 of 38) and accessible lymph nodes not sampled during staging EBUS as not meeting sampling threshold (40%, 15 of 38) rather than false-negative sampling during EBUS (26%, 10 of 38). Conclusions: During multidisciplinary team discussions, clinicians must be aware that one-third of patients with stage III-ssN2 on the basis of CT, PET, and staging EBUS do not truly have ssN2 and this questions the use of this criterion to define treatment recommendations.

PURPOSE: Half of people living with chronic obstructive pulmonary disease (COPD) do not receive high-quality, evidenced-based care as described in international guidelines. We conducted secondary data analysis of a previously published study to assess the ability of a model of lay health coaching to improve provision of guideline-based care in a primary care setting. METHODS: As part of a randomized controlled trial, we recruited English- and Spanish-speaking patients with moderate to severe COPD from primary care clinics serving a low-income, predominantly African American population. Participants were randomized to receive usual care or 9 months of health coaching from primary care personnel informed by a pulmonary specialist practitioner. Outcome measures included prescription of appropriate inhaler therapy, participation in COPD-related education, engagement with specialty care, prescription of smoking cessation medications, and patient ratings of the quality of care. RESULTS: Baseline quality measures did not differ between study arms. At 9 months, coached patients were more likely (increase of 9.3% over usual care; P=0.014) to have received guideline-based inhalers compared to those in usual care. Coached patients were more likely to engage with pulmonary specialty care (increase of 8.3% over usual care with at least 1 visit; P=0.04) and educational classes (increase of 5.3% over usual care; P=0.03). Receipt of smoking cessation medications among patients smoking at baseline in the health coaching group increased 21.1 percentage points more than in usual care, a difference near statistical significance (P=0.06). CONCLUSIONS: Health coaching may improve the provision of quality chronic illness care for conditions such as COPD.

Clinical outcomes after lung transplantation, a life-saving therapy for patients with end-stage lung diseases, are limited by primary graft dysfunction (PGD). PGD is an early form of acute lung injury with no specific pharmacologic therapies. Here, we present a large multicenter study of plasma and bronchoalveolar lavage (BAL) samples collected on the first posttransplant day, a critical time for investigations of immune pathways related to PGD. We demonstrated that ligands for NKG2D receptors were increased in the BAL from participants who developed severe PGD and were associated with increased time to extubation, prolonged intensive care unit length of stay, and poor peak lung function. Neutrophil extracellular traps (NETs) were increased in PGD and correlated with BAL TNF-α and IFN-γ cytokines. Mechanistically, we found that airway epithelial cell NKG2D ligands were increased following hypoxic challenge. NK cell killing of hypoxic airway epithelial cells was abrogated with NKG2D receptor blockade, and TNF-α and IFN-γ provoked neutrophils to release NETs in culture. These data support an aberrant NK cell/neutrophil axis in human PGD pathogenesis. Early measurement of stress ligands and blockade of the NKG2D receptor hold promise for risk stratification and management of PGD.

Background: Dental needle aspiration is a rare complication of oral procedures given the advances in medical technology. Aspirations in general may also be asymptomatic, apart from the possible remote history of upper airway irritation at the time of induction. Clinicians should take a detailed history and examination, along with appropriate diagnostic imaging before discharging these patients from the emergency department. Case presentation: A young patient presented with an acute complaint of pain and coughing post-dental procedure. On arrival at the emergency department, she was vitally and clinically stable, without signs of respiratory distress. There were no complaints reported apart from minor throat pain. Imaging done in the emergency department revealed the presence of a 32 mm needle in the distal airway. She underwent emergency flexible bronchoscopy, and the foreign body was removed under direct visualization. The patient remained stable throughout the procedure and had an uneventful stay until discharge. Conclusion: While needle aspiration is a relatively uncommon occurrence, its early detection is always critical before further damage to local structures can occur. Regardless of presentation and symptoms, basic imaging is mandatory before the disposition is decided. [SJEMed 2024; 5(1.000): 058-060]

Background: Introducing innovations in the healthcare sector often involves testing groundbreaking solutions, ranging from advanced diagnostic technologies to new therapies and modern patient data management systems. Thorough and systematic risk monitoring not only enhances the chances of project success but also constitutes a crucial element in building trust in innovative healthcare solutions. Aim of the study: presenting and discussing risks and risk management strategies in a pilot project implementing telemedical solutions in the field of pulmonology. Materials and methods: The paper analyzed key risks along with remedial actions taken during the implementation of a pilot telemedical project in the field of pulmonology. Systematic analyses covered technological, financial, legal, organizational, external, clinical, and competency areas. The description of a specific project case was used, along with a narrative of personal experiences during its execution in the given year. Results: The telemedical project for patients with chronic obstructive pulmonary disease (COpd), focusing on clinical assessment and observation of spirometric parameters, aimed to address the challenges related to the care of individuals with COpd. The innovative aspects of the pilot project were emphasized, along with its potential impact on improving pulmonological care. The paper discusses aspects related to risk management and remedial actions, identifying areas where the project could serve as a model for further research and practices in the field. Conclusions: The coordination of medical teams, primary care physicians, pulmonology specialists, and nurses with strong and multifaceted administrative support constituted a key element of remedial actions. This collaboration enabled effective counteraction against potential negative consequences of testing telemedical solutions in pulmonology by implementing appropriate corrective measures and efficient remedial actions. [ABSTRACT FROM AUTHOR]

BACKGROUND: This narrative review aims to explore the current state and future perspective of artificial intelligence (AI) in respiratory care. The objective is to provide insights into the potential impact of AI in this field. METHODS: A comprehensive analysis of relevant literature and research studies was conducted to examine the applications of AI in respiratory care and identify areas of advancement. The analysis included studies on remote monitoring, early detection, smart ventilation systems, and collaborative decision-making. RESULTS: The obtained results highlight the transformative potential of AI in respiratory care. AI algorithms have shown promising capabilities in enabling tailored treatment plans based on patient-specific data. Remote monitoring using AI-powered devices allows for real-time feedback to health-care providers, enhancing patient care. AI algorithms have also demonstrated the ability to detect respiratory conditions at an early stage, leading to timely interventions and improved outcomes. Moreover, AI can optimize mechanical ventilation through continuous monitoring, enhancing patient comfort and reducing complications. Collaborative AI systems have the potential to augment the expertise of health-care professionals, leading to more accurate diagnoses and effective treatment strategies. CONCLUSION: By improving diagnosis, AI has the potential to revolutionize respiratory care, treatment planning, and patient monitoring. While challenges and ethical considerations remain, the transformative impact of AI in this domain cannot be overstated. By leveraging the advancements and insights from this narrative review, health-care professionals and researchers can continue to harness the power of AI to improve patient outcomes and enhance respiratory care practices. IMPROVEMENTS: Based on the findings, future research should focus on refining AI algorithms to enhance their accuracy, reliability, and interpretability. In addition, attention should be given to addressing ethical considerations, ensuring data privacy, and establishing regulatory frameworks to govern the responsible implementation of AI in respiratory care. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study is to evaluate the diagnostic value of rapid on‐site evaluation (ROSE) combined with computed tomography‐guided percutaneous needle biopsy (CT‐PNB) or radial endobronchial ultrasound‐guided transbronchial lung biopsy (EBUS‐TBLB) for pulmonary cryptococcosis (PC). Methods: Clinical data of 33 patients diagnosed with PC at the Third Affiliated Hospital of Soochow University between February 2018 and June 2023 were retrospectively analysed. Patients were divided into the CT‐PNB and EBUS‐TBLB groups based on the intervention method, and the diagnostic positivity rate and incidence of complications were compared between the two groups. Results: Compared with the final diagnosis, the positive diagnostic rates of ROSE, histopathology and serum CrAg of all patients were 81.8% (27/33), 72.7% (24/33) and 63.6% (21/33), respectively. The average turnaround times of the three methods were 0.1 (0.1–0.2) h, 96.0 (48.0–120.0) h and 7.8 (4.5–13.6) h, respectively (P < 0.001). The coincidence rate between histopathology and ROSE was 84.8% with a kappa value of 0.574. The positive diagnostic rate for PC was significantly higher in the CT‐PNB group than in the EBUS‐TBLB group (92.9% vs. 57.9%), and the difference was statistically significant (P < 0.05). Combined with the ROSE results, the positive diagnostic rate in the EBUS‐TBLB group increased to 84.2% (16/19). Conclusion: ROSE has commendable accuracy and timeliness, and CT‐PNB offers further advantages in this regard. ROSE enhances the diagnostic efficiency of EBUS‐TBLB for PC and is safe and effective. [ABSTRACT FROM AUTHOR]

Medical professionals in thoracic medicine routinely analyze chest X-ray images, often comparing pairs of images taken at different times to detect lesions or anomalies in patients. This research aims to design a computer-aided diagnosis system that enhances the efficiency of thoracic physicians in comparing and diagnosing X-ray images, ultimately reducing misjudgments. The proposed system encompasses four key components: segmentation, alignment, comparison, and classification of lung X-ray images. Utilizing a public NIH Chest X-ray14 dataset and a local dataset gathered by the Chiayi Christian Hospital in Taiwan, the efficacy of both the traditional methods and deep-learning methods were compared. Experimental results indicate that, in both the segmentation and alignment stages, the deep-learning method outperforms the traditional method, achieving higher average IoU, detection rates, and significantly reduced processing time. In the comparison stage, we designed nonlinear transfer functions to highlight the differences between pre- and post-images through heat maps. In the classification stage, single-input and dual-input network architectures were proposed. The inclusion of difference information in single-input networks enhances AUC by approximately 1%, and dual-input networks achieve a 1.2–1.4% AUC increase, underscoring the importance of difference images in lung disease identification and classification based on chest X-ray images. While the proposed system is still in its early stages and far from clinical application, the results demonstrate potential steps forward in the development of a comprehensive computer-aided diagnostic system for comparative analysis of chest X-ray images. [ABSTRACT FROM AUTHOR]