Current Respiratory Medicine Reviews - Volume 16, Issue 4, 2020

COVID-19 has spread throughout the world causing a significant number of cases of pneumonia and SARS. Patients with COVID-19 may also have other cardiovascular, respiratory, and neuromuscular disorders. These multisystemic complications present the need for comprehensive interventions focused on improving symptoms, functional capacity, and quality of life. Pulmonary rehabilitation has the potential to offer some of these benefits. However, the evidence related to specific aspects of pulmonary rehabilitation evaluation and intervention in COVID19 is limited. We have learned from experiences with other types of chronic lung diseases that have used pulmonary rehabilitation successfully. While the evidence of rehabilitation emerges in COVID-19, it is necessary to establish some initial recommendations, prepared according to the sequelae found until now.

Background: Type 2 diabetes mellitus (T2DM) is a chronic condition with an impairing effect on multiple organs. Numerous respiratory disorders have been observed in patients with T2DM. However, the effect of T2DM on pulmonary function is inconclusive. Aims: In this study, we investigated the effect of T2DM on respiratory function and the correlation of glycemic control, diabetes duration and insulin intake. Methods: 1500 patients were recruited for this study; 560 having T2DM for at least a year were included in the final data, in addition to 540 healthy volunteers. Forced expiratory volume in one second (FEV1), forced vital capacity (FVC), forced expiratory flow at 25-75% (FEF 25-75%), as well as FEV1/FVC ratio values were measured. Results: A two-sample t-test showed that z-scores produced by Al-Qerem et al.’s equations for FEV1, FVC, and FEF 25-75% were significantly lower for the T2DM group than the control group (p < 0.01). FEV1/FVC ratio in the T2DM group was significantly higher (p < 0.01). Multiple linear regression analysis found that glycemic control represented by HbA1c as well as disease duration were negatively associated with the pulmonary function (p < 0.01). However, insulin intake was found to have no significant correlation with pulmonary function. Conclusion: T2DM was linked to reduced pulmonary function and was consistent with a restrictive ventilation pattern. HbA1c, as well as disease duration, were found to be independent risk factors for reduced pulmonary function.

Background: Diagnostic modalities of pulmonary embolism (PE) are still emerging day after day with new tools and promising characteristic features. Objective: The aim of our work was to assess the diagnostic yield of echopulmonography in patients with PE regarding pleural, parenchymal and vascular features of acute events and consequences. Methods: This is a prospective quasi-experimental study in which transthoracic echopulmonography was adopted as a screening method for patients with clinical suspicion of PE in comparison to Multi-Detector Computed Tomography Angiography of the chest, which is the best standard. This study was conducted on 32 patients at the chest department in Mansoura University Hospital and a Specialized Internal Medicine Hospital. Results: Echopulmonography was positive for pulmonary embolism at 68.75% but was of negative value in 31.25%. On the other hand, CTPA was positive for pulmonary embolism in (71.78%) but was of negative value in 28.12%. EPG confirm PE in 87% of patients diagnosed with PE by CTPA with a false-negative result of 13%. EPG could exclude PE in 77.7% of patients who were negative for PE by CTPA with a false-positive result of 22.2%. Conclusion: Echopulmonography might show promising features to be a substitute for computed tomography angiography in the diagnosis of pulmonary embolism.

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is the fourth leading cause of death worldwide. An upward trend is estimated by 2030. One of the causes of mortality is the exacerbations of symptoms that result in hospitalizations. These hospitalizations reduce the quality of life, limit performance in daily life, and increase the costs for the health system and the patient. Objective: This study aimed to determine the differences between hospitalized and non-hospitalized patients with a medical diagnosis of COPD, considering some sociodemographic and clinical variables, and survival rates. Methods: A cross-sectional study was conducted, which included patients diagnosed with COPD who initiated pulmonary rehabilitation (PR) from January to September 2018. The patients were divided into two groups: patients with one or more exacerbations that led to the hospitalization (COPD-H) and patients without hospitalizations in the last year (COPD-NH). Results: There were 128 participants (78 males and 50 females), with a mean age of 71.10±(9.34) in the COPD-H group and 71.30±(8.91) in the COPD-NH group. When comparing both groups, COPD-NH had a higher socioeconomic status (p=0.041), reporting a higher FEV1 44.71± (14.97), p=0.047, and comorbidities according to the COTE index (p<0.001). Conclusions: The patients with the highest number of hospitalizations belonged to a lower socioeconomic stratum and had a higher number of comorbidities. Therefore, it is necessary to identify these factors at the beginning of PR.

Introduction: The detection of cardiac systolic dysfunction is very important for well management of pulmonary critical care patients (PCCPs). However, there is a poor correlation between echocardiographic cardiac systolic function (CSF) parameters and it is not easy to obtain these parameters in PCCPs. Therefore, this cross-sectional observational study was planned for the detection of a more easily obtainable echocardiographic CSF parameter that is well correlated with other CSF parameters in PCCPs. Materials and Methods: Total 88 PCCPs were included. Demographic and clinical information and laboratory tests of all patients were recorded. The CSF parameters of the heart were obtained by transthoracic echocardiography with appropriate technique. LVOT-VTI (Left ventricular outflow tract velocity time integral), CO (cardiac output), EPSS (e point septal separation), Left ventricular EF (ejection fraction) and TAPSE (Tricuspid Annular Plane Systolic Excursion) as an indicator of CSF were tried to obtain from all patients. We also calculated sensitivity, specificity, positive and negative predictive values of LVOT-VTI<20 parameters to diagnose heart failure. Results: The mean age of the patients was 73±12, 40% were female, 38% were intubated and 52% had COPD. LVOT-VTI, EF, CO, EPSS parameters were obtained in 54(61%), 24(27%), 48(54%), 48(54%) patients, respectively. Decreased LVOT-VTI (<20 cm) was well correlated with decreased EF (<45%) (p=0.001, r=0.77), decreased CO (<5 L/dk) (p=0.03, r=0.64) and decreased TAPSE (<17 mm) (p=0.001, r=0.71). Also, there was good agreement between the EF and LVOTVTI measurements (Kappa:0.78, p:0.001). Sensitivity, specificity, positive and negative predictive values of LVOT-VTI<20 for heart failure were 58, 78, 84, 49, repectively. Conclusion: LVOT-VTI is a more easily obtainable and well correlated parameter, which can be used as an indicator of CSF in PCCPs. Clinical Significances: The authors believe that LVOT-VTI measurement has good correlation with other echocardiographic systolic function parameters, and its easy measurement in intensive care patients makes it a very useful test for cardiac systolic function evaluation.

Aims: The objective of this research is to predict the covid-19 cases in India based on the machine learning approaches. Background: Covid-19, a respiratory disease caused by one of the coronavirus family members, has led to a pandemic situation worldwide in 2020. This virus was detected firstly in Wuhan city of China in December 2019. This viral disease has taken less than three months to spread across the globe. Objective: In this paper, we proposed a regression model based on the Support Vector Machine (SVM) to forecast the number of deaths, the number of recovered cases, and total confirmed cases for the next 30 days. Method: For prediction, the data was collected from Github and the ministry of India's health and family welfare from March 14, 2020, to December 3, 2020. The model has been designed in Python 3.6 in Anaconda to forecast the forecasting value of corona trends until September 21, 2020. The proposed methodology is based on the prediction of values using SVM based regression model with polynomial, linear, rbf kernel. The dataset has been divided into train and test datasets with 40% and 60% test size and verified with real data. The model performance parameters were evaluated as a mean square error, mean absolute error, and percentage accuracy. Results and Conclusion: The results show that the polynomial model has obtained 95% above accuracy score, linear scored above 90%, and rbf scored above 85% in predicting cumulative death, conformed cases, and recovered cases.

Background: Asthma, an inflammatory disease of the respiratory tract, is one of the most frequent causes of referral to emergency departments. The aim of this study is to evaluate the efficacy of montelukast as a member of LTRAs for the improvement of pulmonary function and clinical symptoms of patients with asthma. Methods: The study was conducted on 80 patients with acute mild- moderate asthma, divided randomly into two groups of 40 subjects. A double-blind clinical trial was conducted on asthmatic patients who encounter an acute phase asthma attack. The experimental group received two montelukast 5 mg chewable tablets at arrival, accompanied by standard mild-moderate asthma treatment consisting of oxygen and nebulization with albuterol 2.5 mg and ipratropium bromide 0.5 mg in 3 doses for 60 minutes. The control group received standard mild-moderate asthma treatment plus placebo chewable tablets at the beginning without any leukotriene inhibitors. Pulmonary function tests, hemodynamic variables and Borg Dyspnea Scale were evaluated and analyzed at 0, 30, 60, 90 and 150 minutes in both case and control groups. Results: No significant differences were observed between the case and the control group in terms of PEFR and FEV1 measurements during the study at different time points [P > 0.05]. There were no significant differences in terms of hemodynamic variables [blood pressure, pulse and respiration rate, pressure of oxygen in arterial blood] and Borg Dyspnea Scale in both groups as well. Conclusion: The study findings showed that the montelukast administration in mild-moderate acute asthma attack setting had no significant impact on pulmonary function tests and clinical symptoms of the studied patients rather than standard asthma treatment.

Background and Aim: The main challenging issue about coronavirus disease 2019 (COVID-19) is the production of safe and stable vaccines, which is a very long process. Due to the emergency situation, regular and extensive screening of available and traditional drugs, which are commonly used for the treatment of similar viral diseases, can be a reasonable option. The present study aimed to compare the administration of hydroxychloroquine (HCQ) plus arbidol to the use of HCQ alone in the treatment of COVID-19 infection. Methods and Materials: This single-blind randomized controlled trial was carried out on a total of 100 patients with COVID-19 referring to the infection ward of Imam Reza Hospital in Mashhad, Iran, in 2020. The patients were randomly assigned to two HCQ alone and HCQ plus arbidol groups. Results: According to the obtained results, hematological parameters, including white blood cell count, hemoglobin level, lymphocyte count, and platelet count, improved in patients with COVID-19 after the treatment with both HCQ plus arbidol and HCQ alone (P<0.005). The mean values of the reduction time of C-reactive protein (CRP) were 4.48±1.24 and 8.22±2.08 days in the arbidol and HCQ alone groups, respectively, indicating that CRP decreased faster in the arbidol group than that reported for the HCQ alone group (Z=0.-7.85; P<0.000). The mean scores of hospital stay were reported as 5.89±2.04 and 9.35±3.72 days in the arbidol and HCQ alone groups, respectively (Z=-4.31; P<0.005). All the patients in the arbidol group survived, while 6% of the subjects in the HCQ alone group died. In addition, the drug regimen was not changed for any patient, and no subject was transferred to the intensive care unit in the arbidol group. Conclusion: In summary, the administration of both arbidol and HCQ leads to the improvement of the hematological parameters. The present study introduced arbidol as an effective treatment for moderate to severe patients with COVID-19, which not only reduced the time of CRP normalization level but also decreased the hospitalization duration and mortality compared to those reported for HCQ.