Current Respiratory Medicine Reviews - Volume 16, Issue 3, 2020

The whole world is suffering from a pandemic known as SARS-CoV-2. In India also, few states are at the border of the community transmission stage of the virus. It is an alarming condition, so new scientific techniques can play a crucial role in eroding the global problem. This report focuses on how India, a developing country, is trying to prevent the spread of coronavirus disease and how artificial intelligence (AI) plays an essential role in controlling and monitoring the condition. The study also focuses on the challenges faced by a developing country such as India.

Age-related (physiological) AH is an important problem in pediatric otorhinolaryngology. Since the beginning of the 70s, there has been an increase in the proportion of children with pharyngeal tonsil hypertrophy. Functional disorders of the oropharynx in children occupy the second place based on their incidence (after disorders of the musculoskeletal system). In previous years, there has been an increase in the incidence and prevalence of obstructive sleep apnea syndrome (OSAS) among children. In most cases of pediatric OSAS, upper airway obstruction occurs from the nasopharynx to the oropharynx, caused by upper airway stenosis. Consequences of untreated OSAS in children can be inattention and behavioral problems, daytime sleepiness, and in more severe cases are associated with a variety of comorbidities. The current review discusses the links between hypertrophied adenoids, craniofacial development and OSAS in children taking into account physiological and pathophysiological aspects as well as clinical evaluation of the problem.

Novel coronavirus-2019 (nCoV-2019) emerged as a potentially infectious respiratory disease caused by newly discovered β-coronavirus. nCoV-19 has emerged as a global pandemic due to the rapid transmission and high infection rate commonly involved in acute respiratory illness. Literature search includes various databases like Google Scholar, PubMed, ScienceDirect, and Scopus for studies published using a different combination of keywords “coronavius”, “COVID-19”, “SARS”, “MERS”, “antiviral drugs”, “vaccines”, and “immunity”. We collected epidemiology data from the Worldometer portal (data available till 9 October, 2020). Fever, dry cough, dyspnea, sore throat, or fatigue are common clinical symptoms of the infection. Cytotoxic T-cells and T-helper cells plus Cytotoxic T cells (CD8+) account for maximum (approximately 80%) of total infiltrate in the pulmonary region of the affected nCoV individuals and act as a significant contributor to the clearance of the infection. This review intends to outline the literature concerning the mode of actual transmission, immune response, and possible therapeutic approach against the virus.

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) posed a severe threat to global health. Therefore, new findings on effective treatment for symptomatic patients with COVID-19 are considered among emergency issues. This systematic review investigated the effectiveness of pharmacologic interventions in the management of patients with COVID-19. All the articles published in three electronic databases, including Google Scholar, PubMed, and Web of Science, were searched from September 15 to September 30, 2020. Eventually, 24 papers published till September 30 remained to be included in this review. The effectiveness of immunomodulatory and antiviral agents in the treatment of patients with COVID-19 was assessed in this review. The obtained results of the current review rejected the potential of HCQ for the treatment of COVID; however, there was a clinical improvement in patients treated with ruxolitinib in comparison to that reported for the control group. Methylprednisolone, dexamethasone, and calcifediol were suggested as beneficial treatments for patients with COVID-19. The potential efficacy of these antiviral drugs against the SARS-CoV-2 virus is controversial; nevertheless, the triple combination of antiviral and immunomodulatory agents is effective in suppressing the shedding of SARS-CoV-2. There have been no supportive data on the superiority of favipiravir and LPV/r to standard care in the treatment of COVID-19. In addition, no difference was observed between favipiravir and arbidol for the treatment of these patients. There was an association between remdesivir treatment and a reduction of 5 days in clinical improvement among COVID-19 patients. It is required to carry out further RCTs with an in-depth research basis on COVID-19.

Background: Cystic fibrosis (CF) is an autosomal recessive disease characterized by a progressive and recurrent lung infection.

Objective: This study aimed to evaluate the levels of pro-inflammatory cytokines and their correlations with lung function in CF patients.

Methods: A matched case-control study was conducted among 18 CF (children and adults) and 18 control patients (age and gender-matched) who were admitted to Masih Daneshvari Hospital (Tehran, Iran). The controls had no obvious inflammatory lung disease. The samples of bronchoalveolar lavage (BAL) fluid, serum, and sputum of participants were collected to determine concentrations of inflammatory cytokines such as interleukins (IL-8, IL-1β) and tumour necrosis factor- alpha (TNF-α) using enzyme-linked immunosorbent assay (ELISA). Spirometry was applied and functional pulmonary indices [forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1)] were assessed.

Results: The mean age of CF patients was 15.43 ± 5.970 years (range 4-24). The FVC in a majority of the CF patients (66.7%) was below 60% and only 33.3% of the patients exhibited normal or mild respiratory dysfunction. There were significant differences between FVC and FEV1 measurements before and after bronchoscopy. In addition, IL-8 levels in all three samples (serum, sputum, and BAL) of CF patients and levels of IL-1β and TNF-α in BAL and sputum samples of CF patients were significantly higher than the control group (p<0.001). However, increased cytokine levels were not associated with lung function.

Conclusion: Increased IL-8 and TNF-α levels seemed to be associated with signs of clinical deterioration and might be useful as diagnostic markers.

Background: Cigarette smoke (CS) is inhaled into the lung. Alveolar macrophage (AM) is known to play an important role in the lung immune system. However, the relationship between AM functions and antibody production by CS is not fully investigated. Objective: Therefore, we investigated the effects of AM from CS exposed mice on antibody production. Mice were exposed to 20 cigarettes/day for 10 days. AM were obtained by broncho-alveolar lavage. Antibody production was analyzed by plaque-forming cell assay using seep red blood cell (SRBC) as antigen. Methods: B cell proliferation was analyzed by 3H-thymidine incorporation. Phagocytic activity using fluorescein isothiocyanate-labeled SRBC and expressions of surface antigens on AM were analyzed by flow cytometry. Cytokines and NF-ΚB mRNA expressions of AM were analyzed by RTPCR. Results and Discussion: Antibody production was decreased at the induction phase, but not at the expression phase by AM from smoked mice (SM) compared with non-smoked mice (NSM). B cell proliferation was decreased by cigarette extracts dose-dependently. Phagocytic activity of AM was decreased in SM compared with NSM. Expression of surface antigens on AM was decreased in SM compared with NSM. Cytokines or NF-ΚB mRNA expressions of AM were decreased in SM compared with NSM. Conclusion: These results suggest that the inhibition of antibody production by cigarette smoking is caused by the inhibition of phagocytosis and expressions of surface antigens associated with antigen presentation. Such inhibition of AM functions may increase the risk of bacterial and virus infections.

Background and Objective: Reduction of exercise tolerance is associated with expiratory flow-limitation (EFL) and lung hyperinflation; those are only partially reversible to bronchodilator. Lung hyperinflation lowers the diaphragm muscle provoking a mechanical disadvantage that, eventually, reduces maximal inspiratory (MIP) and expiratory (MEP) pressures. We aimed to assess the influence of the dynamic lung hyperinflation on respiratory pressures changes at rest and after a submaximal exercise test in COPD patients with and without a bronchodilator. Methods: We prospectively analyzed 16 COPD patients (FEV1 36.4±10% pred.; age 61.0±8 years, height 165±12 cm and BMI 25.9±6 kg/m²). MIP and MEP were measured before and after performing the six minutes walking test (6MWT) with and without bronchodilator (400 mcg of albuterol). Results: Nine of 16 patients increased IC more than 150 ml after bronchodilator use. Right after the 6MWT was accomplished without bronchodilator, IC decreased by 7.05% as compared to the 6MWT baseline value (p<0.01). Nine patients decreased IC more than 150ml. After bronchodilator use, patients performed the 6MWT without any IC significant reduction (p>0.05). Twelve patients increased the MIP (ranging from 70±11cmH2O to 77±10cmH2O, p = 0.0043) using 400mcg of albuterol. Thirteen patients reduced MIP after the 6MWT without bronchodilator use (p <0.007). There was no significant reduction (p> 0.05) in MIP when patients performed the 6MWT after bronchodilator use. We also found a significant correlation between MIP and inspiratory capacity (IC) and MEP and the IC before and after the 6MWT (r=0.61, p=0.0054; r=0.60, p=0.0031, respectively). Conclusion: Dynamic pulmonary hyperinflation directly interferes with the ability of respiratory muscles to generate inspiratory and expiratory pressures. The previous use of bronchodilators in patients with COPD reduced dynamic hyperinflation when accomplishing a sub-maximal exercise.