Advances in Respiratory Medicine

10 pages, 858 KiB

Open AccessArticle

Diagnostic Accuracy and Adequacy of Rapid On-Site Evaluation Performed by a Pulmonologist on Transbronchial Needle Aspi-Ration Specimens (DREPA): A Prospective Study

by Kunal Deokar, Poonam Elhence, Naveen Dutt, Ram Niwas Jalandra, Sudeep Khera, Prem Prakash Sharma and Nishant Kumar Chauhan

Adv. Respir. Med. 2022, 90(2), 161-170; https://doi.org/10.5603/ARM.a2022.0020 - 28 Jun 2022

Viewed by 902

Abstract

Introduction: Rapid on-site evaluation (ROSE) during transbronchial needle aspiration (TBNA) is conventionally performed by pathologists. However, availability of a pathologist in the bronchoscopy suite is often an issue. We aimed to study if a pulmonologist, after receiving a short period of training in [...] Read more.

Introduction: Rapid on-site evaluation (ROSE) during transbronchial needle aspiration (TBNA) is conventionally performed by pathologists. However, availability of a pathologist in the bronchoscopy suite is often an issue. We aimed to study if a pulmonologist, after receiving a short period of training in cytopathology, is able to assess the adequacy of onsite samples during TBNA. Material and methods: A pulmonologist was initially trained by a pathologist in examining cytology slides and assessing sample adequacy on TBNA smears. During TBNA, one slide from each needle pass was stained on-site using rapid Giemsa stain and was labelled as ROSE slide. The remaining slides were sent to the pathology laboratory for definitive cytological analysis. The ROSE slides were examined by a pulmonologist and a pathologist blinded to each other’s interpretation. Level of agreement between the pulmonologist and pathologist was assessed by estimating Cohen's kappa. Results: A total of 172 slides from 35 patients were prepared for ROSE and evaluated independently by pulmonologist and pathologist. For adequacy, the pulmonologist and pathologist agreed in 143 out of the 172 slides (83% agreement), κ 0.649 (p < 0.001). For diagnostic categories, the pulmonologist and the pathologist agreed in 143 out of the 172 slides (83% agreement); κ 0.696 (p < 0.001). The sensitivity, specificity and accuracy of ROSE performed by the pulmonologist with respect to that performed by the pathologist was 66.2%, 96.8% and 83.1% respectively. Conclusion: After a short period of training in cytopathology, a pulmonologist can assess for adequacy of TBNA ROSE slides in the bronchoscopy suite. Full article

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1 pages, 88 KiB

Open AccessLetter

Severity of OSA—A multitude of Predictors

by Debasis Behera and Pranav Ish

Adv. Respir. Med. 2022, 90(2), 156; https://doi.org/10.5603/ARM.a2022.0032 - 10 May 2022

Cited by 1 | Viewed by 1554

Abstract

We read with interest the recent article published by Sousa et al [...] Full article

9 pages, 1910 KiB

Open AccessArticle

Prognostic Role of Cardiopulmonary Exercise Testing in Pulmonary Hypertension: A Systematic Review and Meta-Analysis

by Leandro Barbagelata, Walter Masson, Ignacio Bluro, Martín Lobo, Diego Iglesias and Graciela Molinero

Adv. Respir. Med. 2022, 90(2), 109-117; https://doi.org/10.5603/ARM.a2022.0030 - 24 Feb 2022

Cited by 3 | Viewed by 1978

Abstract

Introduction: Several studies have evaluated the relation between variables of cardiopulmonary exercise testing (CPET) and major clinical events in pulmonary hypertension (PH) patients, although the results were conflicting. The main objective of this study was to investigate the prognostic value of the [...] Read more.

Introduction: Several studies have evaluated the relation between variables of cardiopulmonary exercise testing (CPET) and major clinical events in pulmonary hypertension (PH) patients, although the results were conflicting. The main objective of this study was to investigate the prognostic value of the CPET derived parameters on all-cause mortality or urgent transplantation in PH patients. Material and Methods: A meta-analysis of time-to-event outcomes were performed from observational studies that evaluated the predictive value of CEPT-related variables [peak oxygen uptake (VO₂) and the ventilation to CO₂ production slope (VE/VCO₂)] in PH patients, reporting data from mortality or urgent transplantation, after searching the PubMed/MEDLINE, Embase, Science Direct, Scopus, Google Scholar, and Cochrane databases. A random-effects meta-analysis model was then applied. Results: Nine eligible studies, including 986 patients, were identified and considered eligible for the quantitative analyses. This meta-analysis showed that high peak VO₂ was associated with a lower mortality or transplant occurrence (HR: 0.81; 95% CI: 0.78–0.85, I² = 29%). In addition, high VE/VCO₂ slope was associated with a higher incidence of the primary endpoint (HR: 1.04; 95% CI: 1.02-1.06, I² = 78%). The sensitivity analysis showed that the results were robust. Conclusions: Our data suggest that in a population with PH the CPET-related variables have predictive capacity regarding mortality and the risk of transplantation. Future studies should establish the best cut-off points for these CPET-related variables. Full article

6 pages, 350 KiB

Open AccessArticle

ΔSpO₂/Distance Ratio from the Six-Minute Walk Test in Evalua-Tion of Patients with Chronic Obstructive Pulmonary Disease

by Heba Wagih Abdelwahab, Ahmed Abdelgawad Radi, Hanan M. Shata and Ahmed Ehab

Adv. Respir. Med. 2022, 90(2), 216-221; https://doi.org/10.5603/ARM.a2022.0029 - 15 Feb 2022

Cited by 2 | Viewed by 1361

Abstract

Introduction: The six-minute walk test (6MWT) contains two independent components: walk distance (6MWD) and oxygen saturation (SpO₂). 6MWD does not give detailed data on nu-merous COPD associated disorders. As oxygen desaturation plays a key role in exercise limitations, a few new [...] Read more.

Introduction: The six-minute walk test (6MWT) contains two independent components: walk distance (6MWD) and oxygen saturation (SpO₂). 6MWD does not give detailed data on nu-merous COPD associated disorders. As oxygen desaturation plays a key role in exercise limitations, a few new parameters integrating oxygen desaturation during exercise along with walk distance are necessary. So, this study was conducted to assess the relationships between ΔSpO₂/distance ratio and pulmonary function test in addition to extent of pulmonary emphysema in COPD patients. Material and methods: 57 stable COPD patients who attended the outpatient clinic of chest medicine department. Mansoura university. were enrolled. Included patients were classified according to GOLD airflow limitation. Age, sex, and modified Medical Research Council dyspnea score (mMRC) were recorded. furthermore, every patient completed the 6MWT and underwent a pulmonary func-tion test and a CT scan to evaluate the degree of pulmonary emphysema. Results: ΔSpO₂/distance ratio was moderately correlated with DLCO%, FVC % and GOLD classification. However, strong correlation was found with FEV1% and RV%. mMRC was weakly correlated with ΔSpO₂/distance ratio. In addition, weak nonsignificant correlation was found between ΔSpO2/distance ratio and extent of pulmonary emphysema as measured by HRCT volumetry. A significant moderate corre-lation was noticed between the ΔSpO₂/distance ratio and 6MWD (r = −0.5, p < 0.001). a significant strong correlation was observed between the ΔSpO₂/distance ratio and ΔSpO₂ (r = 0.87, p < 0.001). Conclusion: ΔSpO₂/distance ratio could be a simple and valuable index for the evaluation of exercise capacity in COPD individuals and might be utilized to predict severity of airway obstruction, pul-monary diffusing capacity disorder and severe hyperinflation Full article

7 pages, 349 KiB

Open AccessArticle

Beyond Apnea-Hypopnea Index: How Clinical and Comorbidity Are Important in Obstructive Sleep Apnea

by Sofia Rodrigues Sousa, Joao Nunes Caldeira and Joaquim Moita

Adv. Respir. Med. 2022, 90(2), 209-215; https://doi.org/10.5603/ARM.a2022.0028 - 14 Feb 2022

Cited by 1 | Viewed by 1555

Abstract

Introduction: The classification of the severity of obstructive sleep apnea (OSA) based on the Apnea/Hypopnea Index (AHI) does not reflect the heterogeneity and prognosis of the disease. The Baveno classification proposes a new assessment system that includes symptoms and comor-bidities. The aim of [...] Read more.

Introduction: The classification of the severity of obstructive sleep apnea (OSA) based on the Apnea/Hypopnea Index (AHI) does not reflect the heterogeneity and prognosis of the disease. The Baveno classification proposes a new assessment system that includes symptoms and comor-bidities. The aim of our study was to evaluate the application of the Baveno classification in clinical practice and to explore its association with sleep indices, adherence to therapy and symptoms over a 6-months period. Material and methods: Prospective study including patients diagnosed with OSA between January and July 2021 was conducted. Patients were divided into 4 groups (A–D) according to the Baveno classification. The adherence to PAP treatment and Epworth Sleepiness Scale (ESS) values were obtained 6 months after initiation of therapy. Results: A total of 91 patients (84% male, 58 ± 13 years) were included in the study. The median ESS score was 10 (6–15), mean AHI was 28.4 ± 22.2 events/hour and the time with SpO2 < 90% (T90) was 9.7 ± 14.9%. At diagnosis, patients were classified into Baveno groups: A: 30%; B: 35%; C: 17%, D: 19%. There were no statisti-cal differences in AHI between the different groups. On the other hand, T90 had higher values in patients with comorbidities (C, D). Regarding the treatment, the prescription of PAP was higher in patients with comorbidities (C, D), and adherence to this treatment at 6 months was higher in group D. Among patients under PAP therapy, there was a statistically significant decrease in daytime sleepiness at 6 months in groups B and D. Conclusions: The Baveno classification distributes pa-tients with OSA evenly across the different phenotypes, regardless of the AHI value. The treatment decision was linked to the comorbidities (C, D) were the ones who had the greatest adherence to treatment at 6 months were in group D. ESS improved with greater emphasis in the most sympto-matic (B, D), while the AHI is essential for the diagnosis of OSA, the Baveno classification may guide physicians better in their treatment decision. Full article

9 pages, 429 KiB

Open AccessArticle

Emotional Distress Among Health Professionals Involved in Care of Inpatients with COVID-19: A Survey Based Cross-Sectional Study

by Ram Niwas Jalandra, Aneesa S. Shahul, Shahir Asfahan, M.K. Garg, Naresh Nebhinani, Naveen Dutt, Nishant Kumar Chauhan, Mukesh Kumar Swami, Pradeep Kumar Bhatia, Pankaj Bhardwaj, Navratan Suthar, Ashok Kumar, Rajani Kumawat, Rupesh Andani and Sanjeev Misra

Adv. Respir. Med. 2022, 90(2), 200-208; https://doi.org/10.5603/ARM.a2022.0026 - 01 Feb 2022

Cited by 2 | Viewed by 1339

Abstract

Introduction: Health care workers (HCWs) are directly involved in processes linked with diagnosis, management, and assistance of coronavirus disease-19 (COVID-19) patients which could have direct implications on their physical and emotional health. Emotional aspects of working in an infectious pandemic situation is often [...] Read more.

Introduction: Health care workers (HCWs) are directly involved in processes linked with diagnosis, management, and assistance of coronavirus disease-19 (COVID-19) patients which could have direct implications on their physical and emotional health. Emotional aspects of working in an infectious pandemic situation is often neglected in favour of the more obvious physical ramifica-tions. This single point assessment study aimed to explore the factors related to stress, anxiety and depression among HCWs consequent to working in a pandemic. Material and Methods: This was a cross-sectional study involving healthcare workers who were working in COVID-19 inpatient ward, COVID-19 screening area, suspect ward, suspect intensive care unit (ICU) and COVID-19 ICU across four hospitals in India. A web-based survey questionnaire was designed to elicit responses to daily challenges faced by HCWs. The questionnaire was regressed using machine-learning algo-rithm (Cat Boost) against the standardized Depression, Anxiety and Stress Scale-21 (DASS 21) which was used to quantify emotional distress experienced by them. Results: A total of 156 participants were included in this study. As per DASS-21 scoring, severe stress was seen in ~17% of respondents. We could achieve an R² of 0.28 using our machine-learning model. The major factors responsible for stress were decreased time available for personal needs, increasing age, being posted out of core area of expertise, setting of COVID-19 care, increasing duty hours, increasing duty days, marital status and being a resident physician. Conclusions: Factors elicited in this study that are associated with stress in HCWs need to be addressed to provide wholesome emotional support to HCWs bat-tling the pandemic. Targeted interventions may result in increased emotional resilience of the health-care system. Full article

3 pages, 193 KiB

Open AccessLetter

A Meta-Analysis on Incidence of Barotrauma in Patients with COVID-19 ARDS Undergoing Invasive Mechanical Ventilation

by Hasan Fareed Siddiqui, Aqsa Saleem, Syed Owais Javed, Sheema Saadia, Palvisha Qasim, Syed Saad Ali, Ali Bin Sarwar Zubairi and Akbar Shoukat Ali

Adv. Respir. Med. 2022, 90(2), 153-155; https://doi.org/10.5603/ARM.a2022.0027 - 01 Feb 2022

Viewed by 1659

Abstract

Barotrauma is a common complication in patients with Acute Respiratory Distress Syndrome (ARDS) undergoing Invasive Mechanical Ventilation (IMV) [...] Full article

1 pages, 89 KiB

Open AccessLetter

Monitoring Organising Pneumonia Pattern in CT among Mild COVID-19: Unclear Clinical Utility

by Pirabu Sakthivel and Pranav Ish

Adv. Respir. Med. 2022, 90(2), 152; https://doi.org/10.5603/ARM.a2022.0024 - 01 Feb 2022

Cited by 1 | Viewed by 1385

Abstract

We read with interest the recent article published by Raoufi et al [...] Full article

9 pages, 317 KiB

Open AccessReview

Therapeutic Use of Intravenous Selenium in Respiratory and Immunological Diseases: A Narrative Review

by Carlos Rocha Oliveira, Emille Tejo Viana, Thaina Ferreira Gonçalves, José Roberto Mateus Silva and Rodolfo P Vieira

Adv. Respir. Med. 2022, 90(2), 134-142; https://doi.org/10.5603/ARM.a2022.0018 - 31 Jan 2022

Cited by 4 | Viewed by 1784

Abstract

The oxidative stress caused by systemic inflammatory response syndrome (SIRS), septic shock, and sepsis, is a risk factor triggering an increase in mortality in patients diagnosed with these pathologies. Selenium (Se) is an essential mineral that has antioxidant and cytoprotective functions, being strongly [...] Read more.

The oxidative stress caused by systemic inflammatory response syndrome (SIRS), septic shock, and sepsis, is a risk factor triggering an increase in mortality in patients diagnosed with these pathologies. Selenium (Se) is an essential mineral that has antioxidant and cytoprotective functions, being strongly associated with the proper functioning of intracellular metabolic processes. In this context, the present study aims to investigate de therapeutic effects of intravenous selenium use considering pathologies such as SIRS, septic shock, sepsis, acute respiratory distress syndrome (ARDS), ventilator associated pneumonia (VAP), and coronavirus disease (COVID-19). This is an narrative literature review in which six main articles found in databases of SciELO, PubMed, and Google Scholar, were selected and analyzed. As a result, articles were found evidencing the benefit of Se in the inflammatory response, increasing the GPx-3 activity and decreasing the inflammatory cytokines, in addition to generating a lower risk of VAP, shortening the hospitalization time, and mortality. Thus, Se supplementation has beneficial evidence for acute respiratory diseases and should be considered as a viable option as adjuvant therapy. Full article

13 pages, 1575 KiB

Open AccessArticle

Machine Learning-Based COVID-19 Diagnosis by Demographic Characteristics and Clinical Data

by Fatemeh Gorji, Sajad Shafiekhani, Peyman Namdar, Sina Abdollahzade and Sima Rafiei

Adv. Respir. Med. 2022, 90(2), 171-183; https://doi.org/10.5603/ARM.a2022.0021 - 30 Jan 2022

Cited by 5 | Viewed by 962

Abstract

Introduction: To facilitate rapid and effective diagnosis of COVID-19, effective screening can alleviate the challenges facing healthcare systems. We aimed to develop a machine learning-based prediction of COVID-19 diagnosis and design a graphical user interface (GUI) to diagnose COVID-19 cases by recording their [...] Read more.

Introduction: To facilitate rapid and effective diagnosis of COVID-19, effective screening can alleviate the challenges facing healthcare systems. We aimed to develop a machine learning-based prediction of COVID-19 diagnosis and design a graphical user interface (GUI) to diagnose COVID-19 cases by recording their symptoms and demographic features. Methods: We imple-mented different classification models including support vector machine (SVM), Decision tree (DT), Naïve Bayes (NB) and K-nearest neighbor (KNN) to predict the result of COVID-19 test for individ-uals. We trained these models by data of 16973 individuals (90% of all individuals included in data gathering) and tested by 1885 individuals (10% of all individuals). Maximum relevance minimum redundancy (MRMR) algorithms used to score features for prediction of result of COVID-19 test. A user-friendly GUI was designed to predict COVID-19 test results in individuals. Results: Study re-sults revealed that coughing had the highest positive correlation with the positive results of COVID-19 test followed by the duration of having COVID-19 signs and symptoms, exposure to infected individuals, age, muscle pain, recent infection by COVID-19 virus, fever, respiratory distress, loss of smell or taste, nausea, anorexia, headache, vertigo, CT symptoms in lung scans, diabetes and hyper-tension. The values of accuracy, precision, recall, F1-score, specificity and area under receiver oper-ating curve (AUROC) of different classification models computed in different setting of features scored by MRMR algorithm. Finally, our designed GUI by receiving each of the 42 features and symptoms from the users and through selecting one of the SVM, KNN, Naïve Bayes and decision tree models, predict the result of COVID-19 test. The accuracy, AUROC and F1-score of SVM model as the best model for diagnosis of COVID-19 test were 0.7048 (95% CI: 0.6998, 0.7094), 0.7045 (95% CI: 0.7003, 0.7104) and 0.7157 (95% CI: 0.7043, 0.7194), respectively. Conclusion: In this study we implemented a machine learning approach to facilitate early clinical decision making during COVID-19 outbreak and provide a predictive model of COVID-19 diagnosis capable of categorizing populations in to infected and non-infected individuals the same as an efficient screening tool. Full article

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5 pages, 237 KiB

Open AccessArticle

Influence of Age on Adherence to Auto-CPAP: Experience from a Sleep Center in Portugal

by Andreia Barroso, Maria Cristina Carrondo and Joaquim Moita

Adv. Respir. Med. 2022, 90(2), 143-147; https://doi.org/10.5603/ARM.a2022.0014 - 28 Jan 2022

Cited by 2 | Viewed by 1683

Abstract

Introduction: Obstructive sleep apnea (OSA) is a disorder characterized by obstructive apneas, hypopneas, and/or arousals related to respiratory effort caused by repetitive collapse of the upper airway during sleep. Left untreated, or with poor adherence to treatment, is likely to lead to [...] Read more.

Introduction: Obstructive sleep apnea (OSA) is a disorder characterized by obstructive apneas, hypopneas, and/or arousals related to respiratory effort caused by repetitive collapse of the upper airway during sleep. Left untreated, or with poor adherence to treatment, is likely to lead to negative outcomes, especially cardiac or cerebrovascular diseases. Our objective was to investigate age as a potential factor that may interfere with adherence to treatment with automatic positive airway pressure (APAP). Materials and Methods: This is a cross-sectional study on 1151 patients with OSA and we analyzed the adherence data of all patients who had been on APAP for at least six months during the period from 1 July 2019 to 31 December 2020 at Centro de Medicina do Sono. Spearman correlation was used in the bivariate analysis and to determine the factors associated with APAP adherence, a logistic regression was performed. Results: Of 1151 patients included, 780 patients were men (67.1%) and the majority was under 65 years (59.4%). APAP adherence was higher in older age groups (p < 0.001) and in patients with a higher AHI (p < 0.001), no differences were observed with regards to gender. In the multivariable regression analysis, the main factors associated with adherence were age group over 65 years (OR = 2.435; 95% CI = 1.862–3.185), AHI 15–30/h (OR = 1.733; 95% CI = 1.242–2.416), and AHI > 30/h (OR = 3.406; 95% CI = 2.426–4.782). Conclusions: Patients older than 65 years have better adherence to APAP than younger ones and with moderate but especially severe AHI have better adherence than those with the milder form of the disease. Full article

4 pages, 3037 KiB

Open AccessCase Report

Sarcomatoid Change in Adenocarcinoma Arising in Adulthood Congenital Pulmonary Airway Malformation

by Valentina Tassi, Niccolò Daddi, Annalisa Altimari, Elisa Gruppioni, Lucio Crinò, Giulio Rossi and Sandro Mattioli

Adv. Respir. Med. 2022, 90(2), 148-151; https://doi.org/10.5603/ARM.a2022.0008 - 27 Jan 2022

Cited by 1 | Viewed by 1450

Abstract

Congenital pulmonary airway malformations (CPAM) are rare conditions generally diagnosed in childhood and possibly harboring malignant tumor growths. We describe a unique case of pleomorphic carcinoma in a longstanding type 1 CPAM diagnosed by wedge resection. The patient underwent completion left lower lobectomy [...] Read more.

Congenital pulmonary airway malformations (CPAM) are rare conditions generally diagnosed in childhood and possibly harboring malignant tumor growths. We describe a unique case of pleomorphic carcinoma in a longstanding type 1 CPAM diagnosed by wedge resection. The patient underwent completion left lower lobectomy and lymphadenectomy, but cancer recurred in nodal station #7 six months later. Clinicians should keep in mind that CPAM may hide radiologically undetectable malignancy in a relevant rate of cases, then requiring surgery in all patients. While MIA is the most common histology in type 1 CPAM, sarcomatoid change has herein been demonstrated. Full article

9 pages, 473 KiB

Open AccessArticle

Efficacy of Magnesium Sulfate in the Chronic Obstructive Pulmonary Disease Population: A Systematic Review and Meta-Analysis

by Abdullah Jahangir, Zeeshan Zia, Muhammad Rafay Khan Niazi, Syeda Sahra, Ahmad Jahangir, Muhammad Ans Sharif and Michel N. Chalhoub

Adv. Respir. Med. 2022, 90(2), 125-133; https://doi.org/10.5603/ARM.a2022.0012 - 27 Jan 2022

Cited by 3 | Viewed by 3108

Abstract

Introduction: Magnesium sulfate has been extensively used to treat asthma exacerbations, but its efficacy remains questionable in the chronic obstructive pulmonary disease (COPD) population. The aim of the study was to compare the efficacy of intravenous (IV) magnesium sulfate in COPD. A [...] Read more.

Introduction: Magnesium sulfate has been extensively used to treat asthma exacerbations, but its efficacy remains questionable in the chronic obstructive pulmonary disease (COPD) population. The aim of the study was to compare the efficacy of intravenous (IV) magnesium sulfate in COPD. A systemic review search was conducted on PubMed, Embase, and the Central Cochrane Registry. Randomized clinical trials were included with magnesium sulfate as an intervention arm in the COPD population. Materials and Methods: For continuous variables, standardized mean difference (SMD) and difference in means (MD) were calculated. For discrete variables, the Mantel-Haenszel (MH) odds ratio was used. For effect sizes, a confidence interval of 95% was used. A p-value of less than 0.05 was used for statistical significance. Analysis was done using both random and fixed effect models. Heterogeneity was evaluated using the I² statistic. Results: Seven studies were included in the final analysis. In patients with acute exacerbations of COPD treated with IV magnesium, a significant increase in forced expiratory volume in one second (FEV₁) was observed (MD = 2.537 [0.717 to 4.357], p = 0.006), as well as in peak expiratory flow rate (PEFR) (SMD = 1.073 [0.748 to 1.397], p < 0.001) using the fixed model. Similarly, residual volume decreased significantly in the IV magnesium group (MD = –0.470 [–0.884 to –0.056], p = 0.026). The hospitalization rate was also lower in the magnesium group, (MH odds ratio 0.453 [0.233 to 0.882], p = 0.020). No statistically significant difference was noted in FEV₁ in the stable COPD population. Conclusion: IV magnesium was associated with a favorable deviation of FEV1 and PEFR, decreased residual volume, and decreased odds of admission in the COPD exacerbation population. Therefore, magnesium sulfate can be used as an adjunctive therapy in the treatment of acute exacerbations of COPD. Full article

7 pages, 309 KiB

Open AccessArticle

The Effect of Vitamin D on GATA3 Gene Expression in Peripheral Blood Mononuclear Cells in Allergic Asthma

by Saiedeh Erfanian, Simin Jafaripour, Mohammad Hassan Jokar, Sima Sedighi, Abdolreza Sotoodeh Jahromi, Faezeh Razavi, Mohsen Farhang Zargar and Maliheh Moradzadeh

Adv. Respir. Med. 2022, 90(2), 118-124; https://doi.org/10.5603/ARM.a2022.0004 - 27 Jan 2022

Cited by 1 | Viewed by 1668

Abstract

Introduction: Asthma is becoming a major health problem in many countries. Immune responses in allergic asthma, as the most prevalent asthmatic phenotype, are mediated mostly by a subtype of T lymphocytes referred to as the effector lineage of Type 2 Th cells [...] Read more.

Introduction: Asthma is becoming a major health problem in many countries. Immune responses in allergic asthma, as the most prevalent asthmatic phenotype, are mediated mostly by a subtype of T lymphocytes referred to as the effector lineage of Type 2 Th cells (Th2). The development of Th2 cells is mainly governed by a zinc finger transcription factor, i.e., GATA-binding protein 3 (GATA3). Allergic asthma is a complex disease, and vitamin D deficiency has been named as a non-genetic risk factor for its development. Vitamin D, a steroid hormone belonging to the family of nuclear receptors, has shown significant immunosuppressive effects in previous studies. Material and Methods: In this study, given its immunomodulatory properties, we aimed to investigate the effects of different concentrations of vitamin D on GATA3 gene expression in peripheral blood mononuclear cells (PBMCs), including Th2 cells, and compare GATA3 expression levels between PBMCs taken from allergic asthmatic patients and healthy controls. Results: The total sample size was 40 and the quantitative real-time PCR (qPCR) procedure was applied to assess the mRNA expression levels of GATA3 in different groups. Collectively, our results demonstrated that the expression of GATA3 in PBMCs taken from patients with allergic asthma is lower than in that from healthy controls. In addition, in the control group, cells co-cultured with vitamin D had a significantly increased GATA3 expression. However, in the patient group, such an increase was only observed in cells treated with 10⁻⁷ M-vitamin D. By contrast, incubation with vitamin D at the concentration of 10⁻⁶ M slightly decreased the expression of GATA3 among patients. Conclusion: In summary, it is likely that vitamin D should regulate GATA3 gene expression in the PBMCs in a dose-dependent manner. The impacts of this steroid hormone can also differ between the status of health and allergic asthma in either extent or direction. Full article

12 pages, 443 KiB

Open AccessArticle

Interleukin-26 is Associated with the Level of Systemic Inflammation and Lung Functions in Obese and Non-obese Moderate-to-Severe Asthmatic Patients

by Yanina Avramenko, Olha Izmailova, Oksana Shlykova and Igor Kaidashev

Adv. Respir. Med. 2022, 90(2), 97-108; https://doi.org/10.5603/ARM.a2022.0006 - 27 Jan 2022

Cited by 4 | Viewed by 1715

Abstract

Introduction: Obese asthma is a complex syndrome, which includes different phenotypes of disease. At present, these phenotypes only have started to acquire a sufficient understanding. It was suggested that IL-26 is a potential biomarker of disease severity in asthma without signs of [...] Read more.

Introduction: Obese asthma is a complex syndrome, which includes different phenotypes of disease. At present, these phenotypes only have started to acquire a sufficient understanding. It was suggested that IL-26 is a potential biomarker of disease severity in asthma without signs of Th2-mediated inflammation. In this study, we investigated the serum and exhaled levels of IL-26 and its associations with the level of systemic inflammation, lung functions, and body weight in obese and non-obese moderate-to-severe asthmatic patients. Material and Methods: The study included 10 healthy subjects, 10 obese subjects without lung pathologies, 10 non-obese asthmatics (NOA) (BMI 18.5–24.9 kg/m²), and 40 obese asthmatics (OA) (BMI 25.0–49.9 kg/m²). During the visit, patients' examination and spirometry with the bronchodilator reversibility test were conducted, the exhaled breath condensate (EBC) was obtained, and the blood samples were collected. The level of IL-26, interleukin-1β (IL-1β), interleukin-4 (IL-4), interleukin-6 (IL-6), TNF-α, interleukin-10 (IL-10), total and specific immunoglobulin E (IgE), and high sensitive C reactive protein (hs-CRP) were measured using the ELISA kits. Statistical comparison between 2 groups was analyzed using the Mann–Whitney rank-sum test. Chi-square with Yates' correction was used to compare frequencies. Spearman's rank test was used for correlating nonparametric variables. The Receiver Operating Characteristic (ROC) curve and the area under ROC curve (AUC) were used for evaluating the diagnostic power of IL-26 as a possible biomarker. Results: NOA had a reversible airway obstruction with reduced FEV1, FEV1/FVC, FVC 25/75, and positive post-bronchodilator test (PBT), significantly increased serum levels of IL-10, IL-4, and slightly increased IL-26. NOA had significantly increased exhaled IL-26 in comparison with healthy subjects. The obese subjects had a normal ventilatory pattern without airway obstruction, and differences in serum IL-26, IL-10, and IL-4 concentrations in comparison with healthy subjects. Obese subjects had a significant escalation of hs-CRP and no differences in the levels of exhaled IL-26, IL-10, and hs-CRP as compared with healthy subjects. OA had reduced FEV1, FEV1/FVC, and FEV25–75 in comparison with non-obese asthmatics. OA had elevated IL-26, IL-10, IL-4, and hs-CRP concentrations as compared with healthy subjects. These patients had a partial similarity with both non-obese asthmatics (elevated IL-26, IL-10, and IL-4) and obese subjects (elevated, IL-1β, IL-6, TNF-α, hs-CRP). OA had a reduced concentration of exhaled IL-26 in comparison with NOA and elevated exhaled IL-10 in comparison with obese subjects. Furthermore, OA had an increased concentration of IL-1β and TNF-α in comparison with healthy individuals and NOA. Exhaled IL-26 concentration distinguished non-obese asthmatics from healthy subjects, asthmatic patients from non-asthmatics (healthy and obese subjects), all asthmatic patients from non-asthmatics (healthy and obese subjects). Conclusions: Exhaled IL-26 elevated in obese and non-obese moderate-to-severe asthmatic patients. Exhaled IL-26 might be a perspective biomarker in non-obese and obese asthmatics. The obese asthmatic phenotype comprised the combined systemic and local airway inflammation. Full article

9 pages, 417 KiB

Open AccessArticle

Intelligent Volume Assured Pressure Support (iVAPS) vs. Spontaneous/Timed Mode as a Weaning Strategy for Intubated COPD Patients with Acute Exacerbation

by Suzan Salama, Aliaë Abd-Rabou Mohamed-Hussein, Doaa Magdy Magdy and Sarah M. Hashem

Adv. Respir. Med. 2022, 90(2), 191-199; https://doi.org/10.5603/ARM.a2022.0025 - 01 Jan 2022

Cited by 1 | Viewed by 935

Abstract

Introduction: Noninvasive positive-pressure ventilation (NPPV) is applied to facilitate weaning process and decrease complications associated with prolonged intubation. Interest has emerged in using Intelligent Volume Assured Pressure Support (iVAPS) to facilitate earlier removal of an endotracheal tube. Material and methods: This study was [...] Read more.

Introduction: Noninvasive positive-pressure ventilation (NPPV) is applied to facilitate weaning process and decrease complications associated with prolonged intubation. Interest has emerged in using Intelligent Volume Assured Pressure Support (iVAPS) to facilitate earlier removal of an endotracheal tube. Material and methods: This study was conducted to compare the effective-ness of iVAPS versus standard Spontaneous/timed (S/T) mode in facilitating weaning process of mechanically ventilated chronic obstructive pulmonary disease (COPD) in acute exacerbation. In a prospective randomized study, 80 invasively ventilated COPD patients in acute exacerbations were extubated then immediate application of NPPV using either S/T mode (Group I) or iVAPS mode (Group II) was done. Clinical parameters (heart rate, respiratory rate, and arterial blood gas param-eters at selected time intervals of treatment were recorded for both groups and analyzed. Results: No significant differences were found between both groups regarding age, sex, mMRC dyspnea scale, CAT score and APACHE II score. Heart rate and mean arterial blood pressure in the two groups decreased with time, but no significant differences were found between the two groups. Likewise, there was no significant difference in RR between S/T and iVAPS groups. Regarding ar-terial blood gas analysis, there were no detectable differences in PaCO2 level, PaO2 level or oxygen saturation. The successful outcome was achieved in (82.5%) in the S/T group vs (80%) in the iVAPS group. The two modes achieved comparable levels of comfort as assessed by VAS and the total Mask Fitness Score. There was no statistically significant difference in reintubation, the duration of NPPV, duration of ICU stay or in mortality rate. Conclusion: iVAPS mode is as effective as fixed-pressure S/T mode in facilitating weaning of hypercapnic COPD patients. Full article

8 pages, 471 KiB

Open AccessArticle

Nasal Insertion Overall Satisfaction with EUS-B (NOSE): Evaluating the Feasibility of Transnasal Diagnostic EUS-B

by Gonçalo Samouco, Michele de Santis, Paulo Matos and Lourdes Barradas

Adv. Respir. Med. 2022, 90(2), 184-190; https://doi.org/10.5603/ARM.a2022.0023 - 01 Jan 2022

Cited by 1 | Viewed by 696

Abstract

Esophageal endoscopic ultrasound using an endobronchial ultrasound (EBUS) broncho-scope (EUS-b) has become an important tool in many bronchoscopy units. The procedure is gener-ally performed through the mouth and there are currently no studies published evaluating the fea-sibility of transnasal EUS-b nor comparing it [...] Read more.

Esophageal endoscopic ultrasound using an endobronchial ultrasound (EBUS) broncho-scope (EUS-b) has become an important tool in many bronchoscopy units. The procedure is gener-ally performed through the mouth and there are currently no studies published evaluating the fea-sibility of transnasal EUS-b nor comparing it to the transoral approach. We aimed to evaluate the technical feasibility, patient comfort and safety of transnasal EUS-b. Material and methods: A single-centre prospective study enrolling patients undergoing diagnostic EUS-b was conducted. Nasal in-sertion was attempted in all cases. Procedure difficulty and perceived patient’s comfort were re-ported by the bronchoscopists. Comfort, overall satisfaction and willingness to repeat the procedure were reported by the patients. Data regarding demographics, procedure details, patients’ comfort and overall satisfaction, histological analysis and final diagnosis were collected and analysed. Re-sults: A total of 119 patients were consecutively enrolled. Nasal insertion was successful in 87.4% and the mean duration of the procedure was 15.7 ± 4.9 min. No severe complications were reported. Procedure difficulty was usually graded as “simple” or “very simple” (71.4%). Mean values for bronchoscopists’ assessment of patient comfort and patients’ reported comfort were 4.2 and 4.1, respectively, on a 5-point scale. Only moderate correlation between these values was found (τb = 0.301, P = 0.001). Willingness to repeat transnasal EUS-b was very high (99.0%). Adequate samples were obtained in 88.5% of patients and overall diagnostic yield of EUS-b needle aspiration was 85.9%. Conclusions: EUS-b is an effective procedure that can be performed safely through the nasal cavity without significant discomfort for the patient. Full article

269 KiB

Open AccessCommunication

Diagnostic Yield of Electromagnetic Navigational Bronchoscopy in a Low Volume Center When Performed by Community Pulmonologists

by Ghulam Mustafa Aftab, Kewan Hamid and Douglas Frenia

Adv. Respir. Med. 2022, 90(2), 157-160; https://doi.org/10.5603/ARM.a2022.0011 - 27 Jan 2021

Viewed by 445

Abstract

Introduction: Electromagnetic navigational bronchoscopy (ENB) may be used for evalua-tion of pulmonary nodules. The purpose of this study was to determine the yield of ENB at a low volume center (0–4 cases per month), where the cases were performed by community pul-monologists neither [...] Read more.

Introduction: Electromagnetic navigational bronchoscopy (ENB) may be used for evalua-tion of pulmonary nodules. The purpose of this study was to determine the yield of ENB at a low volume center (0–4 cases per month), where the cases were performed by community pul-monologists neither trained in interventional pulmonology nor an expert in electromagnetic navi-gational bronchoscopy. The primary endpoint was to find the diagnostic yield of ENB at our center. A safety analysis was also performed to evaluate complications during the procedures. Materials and methods: A retrospective chart review of all the patients who had undergone ENB from January 2019 to January 2021 was performed. A total of 29 ENB procedures were performed during that time frame. Four ENB procedures were performed for fiducial placement and were not included in the study. Results: Diagnosis was made in 72% of patients (18 cases out of 25 cases). With the exception of a single pneumothorax, no other complications were found. Conclusions: In conclusion our study shows that ENB, performed at low volume center by physicians not formally trained in interven-tional pulmonology or considered as experts in the procedure, has a high diagnostic yield and a good safety profile. This study shows that ENB may be performed by community pulmonologists at low volume center with a diagnostic yield comparable to high volume centers. This will be help improve access of ENB to more patients. Full article

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Adv. Respir. Med., Volume 90, Issue 2 (May 2022) – 18 articles

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