Advances in Respiratory Medicine

156 KiB

Open AccessLetter

Antifibrotics for COVID-19 Related Lung Fibrosis: Agents with Benefits?

by Mayank Mishra and Girish Sindhwani

Adv. Respir. Med. 2021, 89(2), 231-233; https://doi.org/10.5603/ARM.a2021.0023 - 30 Apr 2021

Cited by 7 | Viewed by 590

Coronavirus disease 2019 (COVID-19), caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is an exponentially spreading pandemic with more than 36 million confirmed cases and over one million deaths worldwide, all within ten months of its first case in Wuhan, [...] Read more.

Coronavirus disease 2019 (COVID-19), caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is an exponentially spreading pandemic with more than 36 million confirmed cases and over one million deaths worldwide, all within ten months of its first case in Wuhan, China [...] Full article

274 KiB

Open AccessReview

The Role of Screening Questionnaires in the Assessment of Risk and Severity of Obstructive Sleep apnea—Polysomnography Versus Polygraphy

by Aleksandra Małolepsza, Aleksandra Kudrycka, Urszula Karwowska, Tetsuro Hoshino, Erik Wibowo, Péter Pál Böjti, Adam Białas and Wojciech Kuczyński

Adv. Respir. Med. 2021, 89(2), 188-196; https://doi.org/10.5603/ARM.a2021.0038 - 30 Apr 2021

Cited by 5 | Viewed by 527

Abstract

Obstructive sleep apnea (OSA) is a disease of significant importance, which may lead to numerous severe clinical consequences. The gold standard in the diagnosis of this sleep-related breathing disorder (SRBD) is polysomnography (PSG). However, due to the need for high expertise of staff [...] Read more.

Obstructive sleep apnea (OSA) is a disease of significant importance, which may lead to numerous severe clinical consequences. The gold standard in the diagnosis of this sleep-related breathing disorder (SRBD) is polysomnography (PSG). However, due to the need for high expertise of staff who perform this procedure, its complexity, and relatively low availability, some simpler substitutes have been developed; among them is polygraphy (PG), which is most widely used. Also, there is a variety of questionnaires suitable to assess the pre-test probability and severity of OSA. The most frequently used ones are the STOP-BANG questionnaire (SBQ), NoSAS questionnaire, and Berlin questionnaire (BQ). However, they have different sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) when being used in various populations. The aim of this study is to provide a concise and clinically-oriented review of the most frequently used questionnaires, with special attention to its strengths and limitations. Moreover, we discuss whether PSG or PG would be more preferred for confirming OSA diagnosis with the highest likelihood. Full article

1262 KiB

Open AccessReview

Coronavirus Disease 2019 (COVID-19): A Brief Overview of Features and Current Treatment

by Montaha Al-Iede, Eman Badran, Manar Al-lawama, Amirah Daher, Enas Al-Zayadneh, Shereen M Aleidi, Taima Khawaldeh and Basim Alqutawneh

Adv. Respir. Med. 2021, 89(2), 158-172; https://doi.org/10.5603/ARM.a2021.0041 - 30 Apr 2021

Cited by 1 | Viewed by 577

Abstract

Since the report of the first cases of pneumonia caused by SARS-CoV-2 in December 2019, COVID-19 has become a pandemic and is globally overwhelming healthcare systems. The symptoms of COVID-19 vary from asymptomatic infection to severe complicated pneumonia with acute respiratory distress syndrome [...] Read more.

Since the report of the first cases of pneumonia caused by SARS-CoV-2 in December 2019, COVID-19 has become a pandemic and is globally overwhelming healthcare systems. The symptoms of COVID-19 vary from asymptomatic infection to severe complicated pneumonia with acute respiratory distress syndrome (ARDS) and multiple organ failure leading to death. The estimated case-fatality rate among infected patients in Wuhan, the city where the first case appeared, was 1.4%, with 5.1 times increase in the death rate among those aged above 59 years than those aged 30–59 years. In the absence of a proven effective and licensed treatment, many agents that showed activity against previous coronavirus outbreaks such as SARS and MERS have been used to treat SARS-CoV-2 infection. The SARS-CoV-2 is reported to be 80% homologous with SARS-CoV, and some enzymes are almost 90% homologous. Antiviral drugs are urgently required to reduce case fatality-rate and hospitalizations to relieve the burden on healthcare systems worldwide. Randomized controlled trials are ongoing to assess the efficacy and safety of several treatment regimens. Full article

483 KiB

Open AccessArticle

Predictors of Mortality in Patients with Severe COVID-19 Pneumonia—A Retrospective Study

by Mahendra M, Abhishek Nuchin, Ranjith Kumar, Shreedhar S and Padukudru Anand Mahesh

Adv. Respir. Med. 2021, 89(2), 135-144; https://doi.org/10.5603/ARM.a2021.0036 - 30 Apr 2021

Cited by 44 | Viewed by 1273

Abstract

Introduction: The novel coronavirus pandemic has caused significant mortality throughout the world. This study was done as there is scarce data on mortality predictors in severe COVID-19 pneumonia patients admitted to ICU in the Indian population. Material and methods: A retrospective [...] Read more.

Introduction: The novel coronavirus pandemic has caused significant mortality throughout the world. This study was done as there is scarce data on mortality predictors in severe COVID-19 pneumonia patients admitted to ICU in the Indian population. Material and methods: A retrospective study was conducted on COVID-19 pneumonia patients admitted to tertiary care center during June–October 2020. The records of patients admitted to ICU were collected and data included demography, symptoms, comorbidites and vital parameters. Laboratory parameters included complete hemogram, random blood sugar, S.Ferritin, S.LDH, renal function test, liver function test. Treatment-associated information such as the use of remdesivir, timing of initiating rem-desivir after the symptom onset, the use of steroids, use of anticoagulants, use of HFNC, NIV, ventilator were collected. 30 days mortality data post-discharge was collected via telephonic interview. Results: 4,012 confirmed cases of COVID-19 were admitted to hospital, of which 560 (13.95%) with severe pneumonia were included in the study. Mean age was 57.75 ± 13.96 years. The mortality rates were 54.64% among severe COVID-19 cases and 5% among mild to moderate COVID-19 cases. The Cox multinominal regression analysis identified SpO2/FiO2 < 400, age > 50 years, duration of symptom > 4 days, serum ferritin > 450 µg/L, respiratory rate > 23/min, the presence of comorbidities and non-usage of remdesivir were independently associated with increased mortality. Mortality rate at 30 days was 56.60%. Conclusion: Severe COVID-19 pneumonia is associated with very high mortality, especially in a resource-constrained setting. The use of remdesivir may have to be considered early in the course of disease to prevent excess mortality related to COVID-19. Full article

351 KiB

Open AccessArticle

A Clinical Profile and Factors Associated with Severity of the Disease Among Polish Patients Hospitalized Due to COVID-19—An Observational Study

by Tomasz Stachura, Natalia Celejewska-Wójcik, Kamil Polok, Karolina Górka, Sabina Lichołai, Krzysztof Wójcik, Jacek Krawczyk, Anna Kozłowska, Marek Przybyszowski, Tomasz Włoch, Jacek Górka and Krzysztof Sładek

Adv. Respir. Med. 2021, 89(2), 124-134; https://doi.org/10.5603/ARM.a2021.0035 - 30 Apr 2021

Cited by 8 | Viewed by 746

Abstract

Introduction: The coronavirus disease 2019 (COVID-19) is one of the greatest clinical challenges of the last decades. Clinical factors associated with severity of the disease remain unclear. The aim of the study was to characterize Polish patients hospitalized due to COVID-19 and [...] Read more.

Introduction: The coronavirus disease 2019 (COVID-19) is one of the greatest clinical challenges of the last decades. Clinical factors associated with severity of the disease remain unclear. The aim of the study was to characterize Polish patients hospitalized due to COVID-19 and to evaluate potential prognostic factors of severe course of the disease. Material and methods: An observational study was conducted from March to July 2020 in the Pulmonology and Allergology Department of the University Hospital in Kraków, Poland. Consecutive patients with confirmed SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) infection were enrolled, and data about past medical history, signs and symptoms, laboratory results, imaging studies results, in-hospital management and outcomes was prospectively gathered. Results: The study sample comprised 100 patients at the mean age of 59.2 (SD 16.1) years among whom 63 (63.0%) were male. Among them 10 (10.0%) died, 47 (47%) presented respiratory failure, 15 (15.0%) were transferred to the intensive care unit, 17 (17.0%) developed acute kidney injury, 7 (7.0%) had sepsis and 10 (10.0%) were diagnosed with pulmonary embolism. Multivariable analysis revealed age (OR 1.1; 95% CI 1.01–1.15), body mass index (BMI; OR 1.24; 95% CI 1.01–1.53), modified early warning score (MEWS; OR 3.95; 95% CI 1.48–12), the highest d-dimer value (OR 1.73; 95% CI 1.03–2.9) and lactate dehydrogenase (LDH; OR 1.16; 95% CI 1.03–1.3) to be associated with severe course of COVID-19. Conclusion: This observational study showed that almost half of hospitalized patients with COVID-19 developed respiratory failure in the course of the disease. Increasing age, BMI, MEWS, d-dimer value and LDH concentration were associated with the severity of COVID-19. Full article

304 KiB

Open AccessArticle

Prognostic Significance of Lung Diffusion Capacity and Spirometric Parameters in Relation to Hemodynamic Status in Heart Transplant Candidates

by Somaye Mohammadi, Mohammad Mostafa Ansari Ramandi, Ali Safaei, Mahsa Mirdamadi, Sepideh Taghavi, Ahmad Amin and Nasim Naderi

Adv. Respir. Med. 2021, 89(2), 115-123; https://doi.org/10.5603/ARM.a2021.0034 - 30 Apr 2021

Cited by 4 | Viewed by 550

Abstract

Introduction: Investigations have described a correlation between the severity of heart failure and the severity of pulmonary function abnormalities. In this study, we investigated the association of resting spirometric parameters, lung diffusion for carbon monoxide (DLCO), and the transfer coefficient (KCO) with [...] Read more.

Introduction: Investigations have described a correlation between the severity of heart failure and the severity of pulmonary function abnormalities. In this study, we investigated the association of resting spirometric parameters, lung diffusion for carbon monoxide (DLCO), and the transfer coefficient (KCO) with hemodynamic variables and outcomes in a cohort of heart transplant candidates. Material and methods: Between January 2018 and January 2020, a total of 100 patients with advanced heart failure who were scheduled for right heart catheterization (RHC) as a pre-transplant evaluation measure were enrolled. Spirometry and D_LCO were performed in all patients within 24 h of their RHC. All selected patients were followed for a median (IQR) time of 6 (2–12) months. The end points of interest were heart failure-related mortality and a combined event involving HF-related mortality, heart transplantation (HTX), and need for the placement of a left ventricular assist device (LVAD). Results: Among 846 patients scheduled for RHC, a total of 100 patients (25% female) with a mean (SD) age of 38.5 (12.8) were enrolled. There was a significant correlation between FEV₁/FVC and CVP (ρ = –0.22, p = 0.02), PCWP (ρ = –0.4, p < 0.001), mPAP (ρ = –0.45, p < 0.001), and PVR (ρ = –0.32, p = 0.001). The cardiac output correlated with D_LCO (ρ = 0.3, p = 0.008). Spirometry parameters, D_LCO parameters, and hemodynamic parameters did not correlate with the combined event. Among the several variables, only PVR had an independent association with the combined event. Conclusion: Both mechanical and gas diffusion parameters of the lung were not associated with outcomes in the homogeneous group of heart transplant candidates. Full article

403 KiB

Open AccessArticle

Comparison of Toxin-Antitoxin Expression among Drug-Susceptible and Drug-Resistant Clinical Isolates of Mycobacterium Tuberculosis

by Hossein Kazemian, Hamid Heidari, Jalil Kardan-Yamchi, Sobhan Ghafourian, Iraj Pakzad, Ebrahim Kouhsari, Hasan Valadbeigi and Nourkhoda Sadeghifard

Adv. Respir. Med. 2021, 89(2), 110-114; https://doi.org/10.5603/ARM.a2021.0033 - 30 Apr 2021

Cited by 5 | Viewed by 567

Abstract

Introduction: Mycobacterium tuberculosis (MTB), the causative agent of tuberculosis (TB), is a significant global public health threat. Besides extensive multidrug resistance, MTB possesses several properties for long-term viability in the host as well as stress adaptation and resistance in harsh conditions. The [...] Read more.

Introduction: Mycobacterium tuberculosis (MTB), the causative agent of tuberculosis (TB), is a significant global public health threat. Besides extensive multidrug resistance, MTB possesses several properties for long-term viability in the host as well as stress adaptation and resistance in harsh conditions. The role of toxin-antitoxin (TA) systems in disseminating and maintaining antimicrobial resistance in bacterial populations has also been demonstrated. This study aimed to evaluate differences in expression of MazEF (a well-known TA system) related genes (mazE3, mazF3, mazE6, and mazF6) amongst drug-susceptible and resistant MTB isolates in Iran. Material and methods: A total of 20 confirmed clinical isolates of MTB including 10 drug-susceptible and 10 drug-resistant (nine MDR, and one XDR) species were included in this study. M. tuberculosis H37Rv was used as the standard strain. RNA extraction, cDNA synthesis, and relative quantitative real-time PCR were performed according to the standard procedures. Results: Our analysis indicated significant enhanced expression of the mazE6 antitoxin gene in drug-susceptible isolates compared to drug-resistant isolates and the standard strain. The expression of the mazF6 toxin gene was also increased in drug-susceptible isolates compared with the standard strain. In drug-resistant isolates, the expression levels of mazF3 and mazF6 genes were significantly higher than that in the susceptible isolates and the standard strain. Conclusions: In this study, there was significant overexpression of mazE6 in drug-susceptible isolates. As well, mazF3 and F6 were overexpressed in drug-resistant isolates when compared with the standard strain. The changes in expression levels of MazEF6 associated genes were greater than that of MazEF3 in both groups of isolates. Full article

187 KiB

Open AccessLetter

Long COVID-19: An Emerging Pandemic in Itself

by Karthikeyan P. Iyengar, Vijay K. Jain, Raju Vaishya and Pranav Ish

Adv. Respir. Med. 2021, 89(2), 234-236; https://doi.org/10.5603/ARM.a2021.0040 - 22 Apr 2021

Cited by 10 | Viewed by 706

Abstract

The novel coronavirus SARS-CoV-2 disease is predominantly a respiratory illness that is highly contagious and is spread by droplet transmission. It causes a spectrum of illnesses from a mild sore throat to serious viral pneumonia requiring hospitalisation [...] Full article

966 KiB

Open AccessArticle

The Relationship Between the Severity and Mortality of SARS-CoV-2 Infection and 25-hydroxyvitamin D Concentration—A Metaanalysis

by Teodoro J Oscanoa, Jose Amado, Xavier Vidal, Eamon Laird, Rawia A Ghashut and Roman Romero-Ortuno

Adv. Respir. Med. 2021, 89(2), 145-157; https://doi.org/10.5603/ARM.a2021.0037 - 22 Apr 2021

Cited by 31 | Viewed by 1290

Abstract

Introduction: There is increasing scientific interest in the possible association between hypovitaminosis D and the risk of SARS-CoV-2 infection severity and/or mortality. Objective: To conduct a metanalysis of the association between 25-hydroxyvitamin D (25(OH)D) concentration and SARS-CoV-2 infection severity or mortality. [...] Read more.

Introduction: There is increasing scientific interest in the possible association between hypovitaminosis D and the risk of SARS-CoV-2 infection severity and/or mortality. Objective: To conduct a metanalysis of the association between 25-hydroxyvitamin D (25(OH)D) concentration and SARS-CoV-2 infection severity or mortality. Material and methods: We searched PubMed, EMBASE, Google scholar and the Cochrane Database of Systematic Reviews for studies published between December 2019 and December 2020. Effect statistics were pooled using random effects models. The quality of included studies was assessed with the Newcastle–Ottawa Scale (NOS). Targeted outcomes: mortality and severity proportions in COVID-19 patients with 25(OH)D deficiency, defined as serum 25(OH)D < 50 nmol/L. Results: In the 23 studies included (n = 2692), the mean age was 60.8 (SD ± 15.9) years and 53.8% were men. Results suggested that vitamin 25(OH)D deficiency was associated with increased risk of severe SARS-CoV-2 disease (RR 2.00; 95% CI 1.47–2.71, 17 studies) and mortality (RR 2.45; 95% CI 1.24–4.84, 13 studies). Only 7/23 studies reported C-reactive protein values, all of which were > 10 mg/L. Conclusions: 25(OH)D deficiency seems associated with increased SARS-CoV-2 infection severity and mortality. However, findings do not imply causality, and randomized controlled trials are required, and new studies should be designed to determine if decreased 25(OH)D is an epiphenomenon or consequence of the inflammatory process associated with severe forms of SARS-CoV-2. Meanwhile, the concentration of 25(OH)D could be considered as a negative acute phase reactant and a poor prognosis in COVID-19 infection. Full article

228 KiB

Open AccessLetter

Missed Diagnosis in the COVID-19 Era: Are We Losing Ourselves?

by Arunachalam Meenakshisundaram, Anant Mohan, Karan Madan, Sandeep Aggarwal, Pawan Tiwari, Vijay Hadda, Miying Ering and Saurabh Mittal

Adv. Respir. Med. 2021, 89(2), 227-228; https://doi.org/10.5603/ARM.a2021.0004 - 21 Apr 2021

Cited by 1 | Viewed by 404

Abstract

The current pandemic of coronavirus disease 2019 (COVID-19) has taken a toll on our already overburdened healthcare system [...] Full article

601 KiB

Open AccessReview

Pulmonary Complications of Sickle Cell Disease: A Narrative Clinical Review

by Amina Pervaiz, Firas El-Baba, Kunwardeep Dhillon, Asil Daoud and Ayman O Soubani

Adv. Respir. Med. 2021, 89(2), 173-187; https://doi.org/10.5603/ARM.a2021.0011 - 21 Apr 2021

Cited by 5 | Viewed by 815

Abstract

Sickle cell disease (SCD) is associated with vaso-occlusive episodes that affect different organs. Pulmonary involvement is a major cause of morbidity and mortality in this patient population. We performed a literature search in the PubMed database for articles addressing SCD and pulmonary diseases. [...] Read more.

Sickle cell disease (SCD) is associated with vaso-occlusive episodes that affect different organs. Pulmonary involvement is a major cause of morbidity and mortality in this patient population. We performed a literature search in the PubMed database for articles addressing SCD and pulmonary diseases. Acute chest syndrome is defined as a new radiodensity on chest radiograph imaging with a history consistent of the disease. Management includes broad spectrum antibiotics, pain control, and blood transfusions. Microvasculature infarcts lead to functional asplenia, which in turn increases the risk of being infected with encapsulated organisms. Universal vaccinations and antibiotic prophylaxis play a significant role in decreasing mortality from pulmonary infections. Venous thromboembolism in patients with SCD should be treated in the same manner as in the general population. Pulmonary hypertension in patients with SCD also increases mortality. The American Thoracic Society treatment modalities are based on the underlying etiology which is either directed at treating SCD itself, using vasodilator medications if the patient is in group 1, or using long-term anticoagulation if the patient is group 4 (in terms of etiology). Patients with SCD are more likely to suffer from asthma in comparison to controls. Sleep disorders of breathing should be considered in patients with unexplained nocturnal and daytime hypoxemia, or recurrentvaso-occlusive events. Lastly, the utility of pulmonary function tests still needs to be established. Full article

717 KiB

Open AccessArticle

Risk Factors for Acute Exacerbation Following Bronchoalveolar Lavage in Patients with Suspected Idiopathic Pulmonary Fibrosis: A Retrospective Cohort Study

by Mitsuhiro Abe, Kenji Tsushima, Daisuke Ishii, Kohei Shikano, Keiichiro Yoshioka, Masashi Sakayori, Masaki Suzuki, Yasutaka Hirasawa, Tsukasa Ishiwata, Takeshi Kawasaki, Jun Ikari, Jiro Terada and Koichiro Tatsumi

Adv. Respir. Med. 2021, 89(2), 101-109; https://doi.org/10.5603/ARM.a2021.0012 - 21 Apr 2021

Cited by 6 | Viewed by 628

Abstract

Introduction: Bronchoalveolar lavage (BAL) is useful for diagnosing diffuse lung disease and excluding other conditions. However, acute exacerbations (AEs) are recognized as important complications of BAL in patients with idiopathic pulmonary fibrosis (IPF). This study aimed to identify risk factors for BAL-induced [...] Read more.

Introduction: Bronchoalveolar lavage (BAL) is useful for diagnosing diffuse lung disease and excluding other conditions. However, acute exacerbations (AEs) are recognized as important complications of BAL in patients with idiopathic pulmonary fibrosis (IPF). This study aimed to identify risk factors for BAL-induced AEs in patients with IPF. Material and methods: We retrospectively analyzed the data of 155 patients with suspected IPF who had undergone BAL between January 2013 and December 2018. BAL-related AE was defined as the development of AE within 30 days after the procedure. We compared clinical features and parameters between patients with AE (AE group) and without AE (non-AE group). We also reviewed the relevant reported literature. Results: Among the 155 patients, 5 (3.2%) developed AE within 30 days after BAL. The average duration from BAL to AE onset was 7.8 days (2–16 days). Results from the univariate analysis revealed PaO₂ < 75 mm Hg (p = 0.036), neutrophil content in BAL ≥ 7% (p = 0.0061), %DLCO < 50% (p = 0.019), Gender-Age-Physiology (GAP) stage III (p = 0.034), and BAL recovery rates < 30% (p < 0.001) as significant risk factors for post-BAL AE. All five patients who developed AE recovered and were discharged. Conclusions: Disease severity, high neutrophil levels in BAL, and poor BAL recovery rates may be risk factors for BAL-induced AEs. Full article

189 KiB

Open AccessLetter

Timing of Anti-Viral Therapy in COVID-19: Key to Success

by Manu Madan, Anant Mohan, Karan Madan, Vijay Hadda, Pawan Tiwari, Randeep Guleria and Saurabh Mittal

Adv. Respir. Med. 2021, 89(2), 237-239; https://doi.org/10.5603/ARM.a2021.0020 - 19 Apr 2021

Cited by 4 | Viewed by 420

Abstract

Since the onset of the current coronavirus disease 2019 (COVID-19) pandemic, there have been attempts to identify medications for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [...] Full article

142 KiB

Open AccessLetter

EBUS-TBNA in Children: The Road Less Travelled

by Saurabh Mittal, Karan Madan and Anant Mohan

Adv. Respir. Med. 2021, 89(2), 229-230; https://doi.org/10.5603/ARM.a2021.0039 - 19 Apr 2021

Cited by 1 | Viewed by 391

Abstract

The ultrasonographic evaluation and sam-pling of mediastinal lesions by endobronchial ul-trasound-guided transbronchial needle aspiration (EBUS-TBNA) or endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is the standard of care for adult patients [...] Full article

235 KiB

Open AccessCase Report

The Feasibility and Tolerability of Using Inspiratory Muscle Training with Adults Discharged from the Hospital with Community-Acquired Pneumonia

by Harry J. Pick, Mark A. Faghy, Gareth Creswell, Deborah Ashton, Charlotte E. Bolton, Tricia McKeever, Wei Shen Lim and Thomas Bewick

Adv. Respir. Med. 2021, 89(2), 216-220; https://doi.org/10.5603/ARM.a2021.0002 - 17 Feb 2021

Cited by 3 | Viewed by 644

Abstract

Introduction: Patients experience substantial morbidity following discharge from hospital and during recovery from communi-ty-acquired pneumonia (CAP). Inspiratory muscle training (IMT) has demonstrated improved functional capacity and reduced patient-reported symptoms. To date the safety and tolerability of these methods have not been determined [...] Read more.

Introduction: Patients experience substantial morbidity following discharge from hospital and during recovery from communi-ty-acquired pneumonia (CAP). Inspiratory muscle training (IMT) has demonstrated improved functional capacity and reduced patient-reported symptoms. To date the safety and tolerability of these methods have not been determined in CAP patients recovering following hospitalization. Accordingly, this study aimed to assess the safety and tolerability of IMT in adults discharged from hospital with CAP. Material and methods: Participants received an IMT device (POWERbreathe KHP2) and completed 9-weeks IMT training with weekly follow-up. Frequency (twice daily) and load (50% PImax) were fixed throughout, but training volume increased incrementally (2-week habituation phase, 7-week training phase). Primary outcomes of interest included IMT safety and tolerability. Results: Twenty-two participants were recruited; 16 were male, mean age 55.2 years (range 27.9–77.3). From 1183 possible training days, side effects were reported on 15 occasions by 10 individual participants. All reported side-effects were assessed as grade 1 and did not prevent further training. Participant-reported IMT acceptability was 99.4%. Conclusion: Inspiratory muscle training is safe and tolerable in patients following hospitalisation for CAP. Patient satisfaction with IMT is high and it is viewed by patients as being helpful in their recovery. Distinguishing CAP-related symptoms and device-related side effects is challenging. Symptom prevalence declined during follow-up with concurrent improvements in spirometry observed. Further research is required to determine the efficacy of IMT interventions following CAP and other acute respiratory infections. Full article

373 KiB

Open AccessLetter

Ambulatory Management of Primary Spontaneous Pneumothorax: The Jury Is Still Out

by Vidushi Rathi, Karan Madan, Anant Mohan, Vijay Hadda and Saurabh Mittal

Adv. Respir. Med. 2021, 89(2), 225-226; https://doi.org/10.5603/ARM.a2020.0197 - 03 Feb 2021

Viewed by 369

Abstract

Pneumothorax is a commonly encountered condition in clinical practice [...] Full article

656 KiB

Open AccessCase Report

A Rare Etiology of Diffuse Pulmonary Hemorrhage

by Martin Janík, Veronika Rybárová, Ľubomír Straka and Petr Hejna

Adv. Respir. Med. 2021, 89(2), 223-224; https://doi.org/10.5603/ARM.a2020.0194 - 03 Feb 2021

Viewed by 399

Abstract

A 36-year-old drug addict presented to the emergency room after intravenously injecting 20 milliliters of pure gasoline [...] Full article

705 KiB

Open AccessCase Report

Not Just Skin Deep: Multiple Cutaneous Nodules As the First Presenting Sign of Small Cell Cancer

by Avneet Garg, Harshi Dhingra, Vinita Jindal, Simranjeet Kaur and Vijay Suri

Adv. Respir. Med. 2021, 89(2), 221-222; https://doi.org/10.5603/ARM.a2020.0192 - 03 Feb 2021

Cited by 1 | Viewed by 401

Abstract

A 65 years old male, chronic smoker (30 pack years), presented with complaints of dyspnea (mMRC grade2), cough (dry in nature), loss of appetite, loss of weight (> 5 kgs), weakness, bony pains, feverish feeling and easy fatigability for last 2–3 months [...] [...] Read more.

A 65 years old male, chronic smoker (30 pack years), presented with complaints of dyspnea (mMRC grade2), cough (dry in nature), loss of appetite, loss of weight (> 5 kgs), weakness, bony pains, feverish feeling and easy fatigability for last 2–3 months [...] Full article

980 KiB

Open AccessCase Report

Double Carbapenem Regimen Used As Salvage Therapy to Treat Multidrug-Resistant Klebsiella pneumoniae Causing Ventilator-Associated Pneumonia

by Mandeep Singh, Lakhvir Kaur, Renuka Bajaj and Sumeet Arodhia

Adv. Respir. Med. 2021, 89(2), 203-206; https://doi.org/10.5603/ARM.a2020.0195 - 03 Feb 2021

Cited by 1 | Viewed by 499

Abstract

Carbapenemase-producing Klebsiella pneumoniae is an emerging threat worldwide. The appropriate therapy for infections due to these multidrug-resistant pathogens is not well defined and depends upon the susceptibilities of individual isolates, and the choices are often severely limited. We report a case of a [...] Read more.

Carbapenemase-producing Klebsiella pneumoniae is an emerging threat worldwide. The appropriate therapy for infections due to these multidrug-resistant pathogens is not well defined and depends upon the susceptibilities of individual isolates, and the choices are often severely limited. We report a case of a 8-year-old male child with ARDS with left-sided tubercular pleural effusion who developed ventilator-associated pneumonia due to multidrug-resistant Klebsiella pneumoniae treated successfully with a regimen comprising a combination of colistin and double carbapenem. Full article

1538 KiB

Open AccessCase Report

Continuous Positive Airway Pressure in the Treatment of COVID-19 Patients with Respiratory Failure. A Report of Six Cases with Excellent Outcome

by Dimitrios Velissaris, Diamanto Aretha, Konstantinos Tsiotsios, Charalambos Gogos and Vasileios Karamouzos

Adv. Respir. Med. 2021, 89(2), 197-202; https://doi.org/10.5603/ARM.a2020.0181 - 03 Feb 2021

Viewed by 473

Abstract

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is currently considered a significant threat to global health and global economy. This new rapidly spreading virus causes enormous stress to healthcare systems as large number of patients present with [...] Read more.

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is currently considered a significant threat to global health and global economy. This new rapidly spreading virus causes enormous stress to healthcare systems as large number of patients present with respiratory failure, needing intubation and mechanical ventilation. While the industry is racing to meet the rising demand for ventilators, all the alternative respiratory support modalities are employed to save lives in hospitals around the globe. We hereby report 6 patients who were diagnosed with SARS-CoV-2 and treated with continuous positive airway pressure in a negative pressure isolated room in a tertiary center in western Greece. The rapid progression of mild flu-like symptoms to respiratory failure in all patients was controlled with the use of continuous positive airway pressure making this strategy a reasonable alternative to respiratory failure due to SARS-CoV-2 as it may avert intubation and mechanical ventilation. Full article

353 KiB

Open AccessCase Report

Emphysema As a Possible Complication of Infant Respiratory Distress Syndrome Leading to Lung Transplantation

by Fryderyk Zawadzki, Marta Wajda-Pokrontka, Tomasz Stącel, Maciej Urlik, Mirosław Nęcki, Remigiusz Antończyk, Magdalena Latos, Maria Królikowska, Damian Maruszak, Marcelina Łazaj, Małgorzata Kowacka, Alina Kliczka, Marian Zembala and Marek Ochman

Adv. Respir. Med. 2021, 89(2), 211-215; https://doi.org/10.5603/ARM.a2020.0174 - 29 Jan 2021

Viewed by 518

Abstract

Infant respiratory distress syndrome (IRDS) develops among premature infants due to structural immaturity of the lungs and insufficient production of pulmonary surfactant. Nowadays, treatment takes place under conditions of intensive care and includes oxygen therapy, mechanical ventilation, exogenous supplementation of pulmonary surfactant and [...] Read more.

Infant respiratory distress syndrome (IRDS) develops among premature infants due to structural immaturity of the lungs and insufficient production of pulmonary surfactant. Nowadays, treatment takes place under conditions of intensive care and includes oxygen therapy, mechanical ventilation, exogenous supplementation of pulmonary surfactant and antenatal corticosteroid therapy. The treatment of IRDS, especially mechanical ventilation, may lead to complications which can contribute to developing a severe dysfunction of the respiratory system. Unavailability of pharmacological treatment of IRDS and development of pulmonary barotrauma due to mechanical ventilation in our patient led to the forming of severe pulmonary interstitial emphysema. In this Case Report, lung transplantation was performed as an only successful therapeutic option. Full article

834 KiB

Open AccessCase Report

Malignant Pleural Effusion From Squamous Cell Carcinoma of the Vulva: Extremely Rare Metastatic Pattern of A Rarely Metastasizing Cancer

by Zeeshan Hafeez, Sarwat I. Gilani, Lying Han, Gizelka David-West and Oleg Epelbaum

Adv. Respir. Med. 2021, 89(2), 207-210; https://doi.org/10.5603/ARM.a2020.0182 - 29 Jan 2021

Viewed by 497

Abstract

The discovery of a malignant pleural effusion indicates metastatic disease and thus invariably results in the highest possible cancer stage. Although the female reproductive tract overall is a common primary tumor site giving rise to malignant pleural effusion, vulvar carcinoma stands out for [...] Read more.

The discovery of a malignant pleural effusion indicates metastatic disease and thus invariably results in the highest possible cancer stage. Although the female reproductive tract overall is a common primary tumor site giving rise to malignant pleural effusion, vulvar carcinoma stands out for its propensity for locoregional spread rather than distant metastasis. Our case contributes to the extremely limited number of published descriptions of thoracic involvement by vulvar carcinoma, with malignant pleural effusion being a particularly unusual pattern. Full article

Journal Menu

Journal Browser

Adv. Respir. Med., Volume 89, Issue 2 (April 2021) – 22 articles , Pages 101-239

Further Information

Guidelines

MDPI Initiatives

Follow MDPI