Current Respiratory Medicine Reviews - Volume 16, Issue 2, 2020

Fluoro-edenite (FE) is an asbestos-like amphibole present in the bentonitic lavas extracted from a stone quarry in Biancavilla, a village sited in the Etnean Volcanic Area (Italy). Thoracic pathologies are the results of excessive inflammatory processes that are the early response of the immune system to inhaled fibers. As demonstrated for asbestos, fibers may trigger immune system cells in an acute and/or chronic manner. This review aims to clarify the pathways of inflammation in workers exposed to FE fibers. Based on the articles reviewed, it seems that a permanent stimulus created by repeatedly inhaling the FE fibers and their persistence in the body can act as a trigger both in promoting inflammatory processes and in the immunological induction of autoimmune disease.

Obstructive sleep apnea (OSA) is a heterogenous chronic disorder causing hypoxemia, excessive daytime sleepiness, non-refreshing sleep, nocturia, morning headache, irritability, and memory loss. Cardiovascular disease, cognitive impairment, metabolic disorders, and depression are its long-term consequences. The difficulty in treating patients is due to poor compliance, failure to obtain the desired outcome, and complication arising from the multimodality treatment. Direct targeted therapy may overcome these issues. Identification of its phenotypes improves understanding of the disease mechanism, the risk for adverse effects, and predicting response to targeted therapy. Phenotyping of OSA allows treating patients according to their inherent disease and not based on a “one size fits all” method, which may not be applicable for all patients. This approach may improve patients’ compliance with treatment, minimize the associated morbidities, and consequently improve their quality of life.

Background: Coronaviruses are non-segmented enveloped positive-sense single-strand RNA viruses, and COVID-19 is the seventh known coronavirus, infecting humans. Objective: As the COVID-19 continued to spread the world wildly, every radiologist or clinician needs to be familiar with its imaging findings. Methods: In this study, we reviewed available studies to provide a comprehensive statement on COVID-19 imaging findings. Results: Ground-glass opacities, linear opacities, interlobular septal thickening, consolidation, and Crazy-paving patterns are the most frequent findings in computed tomography (CT) of lungs in patients with COVID-19 pneumonia, which are mostly bilateral, multifocal, and peripheral. Staff needs to follow some rules to reduce infection transmission. Conclusion: COVID-19 pneumonia is a new global concern that has many unknown features. In this article, the radiologic characteristics of COVID-19 pneumonia are discussed. We also discussed appropriate protective measures that the radiology team should be aware of.

Background: The recently identified SARS-CoV-2 coronavirus has resulted in the Covid-19 pandemic with severe morbidity and high mortality, particularly in certain sections of the population. The co-morbidity patterns associated with adverse outcomes are multiple and complex and there is emerging epidemiological, nutritional and molecular biological evidence that an inadequate vitamin D status is a contributing factor. Objective: The aim was to review the role of vitamin D in immune function with particular reference to the mechanisms whereby it supports immune efficiency, host protection and immune modulation. The evidence for the possible benefit of vitamin D supplementation to ameliorate the severity of respiratory infection by SARS-CoV-2 and other pathogens was also reviewed with a view to making a recommendation. Methods: PubMed, MEDLINE and Google Scholar were searched using the terms: Covid-19, coronavirus, SARS-CoV-2, vitamin D, calcitriol, deficiency, adaptive immunity, innate immunity, ventilation, critical care, intensive care, acute respiratory distress syndrome, cytokine storm, respiratory viruses, respiratory tract infection, respiratory syncytial virus, influenza, supplementation. Papers for inclusion were selected on the basis of relevance and quality. Findings: Vitamin D insufficiency is widespread in many parts of the world. Vitamin D is needed for normal protective and surveillance immune function and there is evidence that deficiency increases the risk of some respiratory infections, probably including Covid-19. By binding with dedicated receptors on immune cells vitamin D influences several strands of immune function, including the production of anti-microbial peptides and several cytokines that promote an appropriate immune response. Vitamin D supplementation probably reduces the risk of respiratory infection, with persuasive biological, epidemiological and observational evidence for possible benefit against Covid-19. Conclusion: Despite the lack of direct evidence specific to Covid-19 a cogent theoretical case can be made for giving adults from selected groups, and arguably all adults, routine supplementation with vitamin D to improve immune efficiency and reduce the incidence and severity of respiratory infections. This could be particularly important in sections of the population with a high prevalence of vitamin D insufficiency. Targeted research is required to provide firm evidence to guide practice.

Prompt and accurate diagnosis of drug resistance is essential for optimal treatment of drug-resistant tuberculosis. However, only 20% of the more than half a million patients eligible for the treatment of MDR-TB/RR-TB receive an appropriate drug regimen. Drug-resistant TB regimens must include a sufficient number of effective medications, a significant challenge for clinicians worldwide, as most are forced to make therapeutic decisions without any, or very little information on drug susceptibility testing. Although phenotypic DST is still commonly regarded as the gold standard for determining M. tuberculosis susceptibility to antituberculosis drugs, it has several limitations, mainly its prolonged turnaround time. Molecular methods based on M. tuberculosis genomic DNA sequencing have been developed during the past two decades, to identify the most common mutations involved in drug resistance. The Xpert ^® MTB/RIF is a real-time polymerase chain reaction that offers results in less than two hours and has an overall sensitivity for rifampin resistance of 96% and 98% specificity. Line probe assays (LPAs) are commercial DNA strip-based tests for detecting the most frequent mutations responsible for resistance to rifampin, isoniazid, fluoroquinolones, and second-line injectable drugs. Discrepancies between phenotypic and genotyping methods are a problem that the clinician will face in everyday practice. However, any resistance result (with any type of test) in a person with risk factors for harboring resistant microorganisms should be considered appropriate while the results of complementary tests are available.

The incidence of nontuberculous mycobacterial (NTM) pulmonary disease has increased in recent years. It seems that patients with structural lung diseases treated with inhaled corticosteroids (ICS) are at risk of pulmonary NTM infection. This systematic review investigated the articles focused on the association between the use of ICS and pulmonary NTM infection. The current study assessed four categories, namely the association between the use of ICS therapy and NTM infections, bacterial factors involved in the incidence of NTM infection in patients undergoing ICS therapy, the relationship between dosage and long-term use of ICS therapy in the incidence of NTM infection, and main risk factors of the incidence of NTM infection in patients undergoing ICS therapy. Based on the obtained results of the present study, there was an association between the use of ICS therapy and NTM infections. It seems that ICS increases the risk of NTM infection by 1.8 to 8 times. Accordingly, 40-90% of patients with NTM had a history of ICS usage. Mycobacterium avium complex was the most common bacterial factor in NTM patients undergoing ICS therapy. The relationship between a higher dosage of ICS therapy and an increased risk of NTM was confirmed in the majority of the studies. Age, gender, smoking history, and underlying diseases are the main risk factors for the incidence of NTM in patients receiving ICS therapy.

Introduction: Acute lower respiratory tract infection (ALRTI) is a major public health problem that causes significant morbidity and mortality and is the main reason for utilization of health services among children. Objective: The study aimed to evaluate the clinical profile, severity pattern, and sociodemographic risk factors of ALRTI in hospitalized children under the age of five years in two tertiary hospitals in South East Nigeria. Materials and Methods: This is a cross-sectional study of children aged two months to five years in two teaching hospitals in the country. They were evaluated for ALRTI, focusing on their clinical profile and socio-demographic risk factors. Results: Two hundred children presented with features of ALRTI, mostly pneumonias and bronchiolitis. ALRTI occurred throughout the year with a peak in October. The majority had severe disease and risk factors for severity were infancy, type of ALRTI, presence of comorbidity and lack of measles vaccination or vitamin A supplementation, and exposure to wood smoke. Fast breathing was the most sensitive symptom, while breathlessness was the most specific for ALRTI. Conclusion: Bronchopneumonia and bronchiolitis are the most common ALRTI in under-five age children with bronchopneumonia occurring in severe forms. Poor breastfeeding, infancy, poor rate of immunization and exposure to biomass smoke are all risk factors for severity.

Background: Asthma is a common chronic illness worldwide. Identifying and treating impaired health-related quality of life, is now recognized as an important component of asthma management. A high prevalence of behavioral and emotional difficulties was noticed among children with asthma. Methods: This is a cross-sectional study that was conducted over 8 weeks involving 45 asthmatic children, between the ages of 7-17 years old, presented to Jordan University Hospital in Amman, Jordan. General demographic characteristics were collected, and two questionnaires were used: asthma control test (ACT), and the pediatric asthma quality of life questionnaire (PAQLQ). We also used the feeling thermometer scale, and a pulmonary function test was done for patients. SAS Software version 9.4 USA and Pearsons coefficient were used to find associations. Results: Among 45 patients, 53% of the sample had poor asthma control. The mean FEV1 on lung function testing was 80% (± 16.18) of predicted. The mean for clinical asthma scores (ACT) was 18.8 ± 4.53 (out of 25). FEV1 was significantly higher in children with good control compared to those with a low ACT score (P-value <0.05). The mean total PAQLQ score was 5.3 ± 1.06 and it correlated significantly with ACT score (P-value <0.001). Conclusion: This study highlights the association of poorly controlled asthma with a poor quality of life. It is recommended that the quality of life of children should be assessed and observed during clinic visits, for a better comprehensive approach and effective improvement of outcome.