Current Respiratory Medicine Reviews - Volume 17, Issue 4, 2021

Abstract: Viral respiratory infections are a leading cause of illness and mortality in all age groups worldwide. The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) that causes Coronavirus disease 2019 (COVID-19) has spread throughout the world, igniting the twenty-first century’s deadliest pandemic. Research has shown that phages, which are bacterial viruses, can help treat viral infections with the effect on the immune system and their antiviral activity. Phages have specific activity and affect only the target without any side effects on other parts of the human body. Human phage-related diseases have not been reported yet; therefore, phages can be a very safe treatment, especially in many viral infections. The results of clinical studies have a promising future regarding the use of phages. It is possible that the phages display technique aided in the production of SARS-CoV-2 specific antibodies against its viral protein, which prevented the virus from binding or replicating and preventing secondary microbial infections, which have been linked to many patient deaths. Furthermore, an effective antiviral vaccine can be produced by using the same technique. Given the growing number of coronaviruses cases around the world, in the present paper, we review the possible mechanisms of phages against the COVID-19 disease and the method that may be a solution to eliminate the virus.

Abstract: Conventional spirometry has long been considered the primary test for assessing respiratory function deficits in children and adults. However, the need to perform forced breathing maneuvers can make it challenging to perform these examinations in an uncooperative child. For these reasons, techniques such as gas dilutions and the Multiple-Breath-Washout (MBW) method have been implemented because they allow for early assessment of damage to the small airways. These methods permit the determination of the possible presence of ventilatory inhomogeneity in the lungs by analyzing the clearance of an inert gas used as a tracer. The equipment consists of a mass spectrometer combined with a flow meter. The Lung Clearance Index (LCI) is most often used to evaluate ventilatory inhomogeneity. This narrative review aimed to review the literature on technical and practical aspects of the MBW test and evaluate the clinical implications of the LCI in pediatric respiratory disease.

Background: There is a growing need for effective therapies for the management of wheezing in the pediatric population. Aim: We conducted a pilot, mono-centre, prospective, follow-up study to assess the efficacy and the safety of Pidotimod (PDT) in the treatment of wheezing in children. Methods: Globally, 90 children (M:F=58:62, mean age 4.7±1.64 years) with recurrent viral wheezing were enrolled in the study between October-November 2018. At baseline, children received treatment with PDT as 1 vial of 400mg daily for 3 consecutive months. We evaluated the therapeutic efficacy of PDT treatment at the end of 3 (T3) months of therapy as well as the long efficacy and preventive efficacy of PDT treatment during a 3-months follow-up (T6) by using the following outcomes: (i) How many patients showed one or more episodes of viral wheezing? (ii) How many patients were taking concomitant medications (ICS, SABA, antibiotics)? (iii) How many patients required ED visits? (iv) How many patients required hospitalization? Results: A significant decrease in the number of patients with at least one or more episodes of wheezing and taking antibiotics was recorded after 3 months of treatment, and a further significant decrease for both outcomes was reported at 3-months follow-up period (p<0.05). Differently, after 3 months of treatment, we found a significant decrease in the number of patients taking ICS and SABA and in the number of patients requiring ED visits and/or hospitalization (p<0.05); however, for all these outcomes, no further significant decrease was reported at follow-up period. Conclusion: We first showed that the administration of PDT is useful in the management of patients with recurrent viral wheezing because we found a reduction in the number of patients requiring ED visits and/or hospitalization as well as the number of patients taking drugs during the treatment period. Moreover, to date, we found a long-term clinical effect over three months after treatment suspension counteracting the recurrence of the disease.

Background: Transplant recipients are at high risk for severe Coronavirus disease-2019 (COVID-19). Transplant recipients are immune-compromised individuals at high risk for severe infection. This study aimed to compare the presentations and outcomes of liver and kidney transplant recipients who were infected with COVID-19 in the Iranian population. Methods: This cross-sectional study was conducted at Imam Reza and Montaserieh Hospitals affiliated with Mashhad University of Medical Sciences, Mashhad, Iran, between 2020 and 2021. In general, 52 patients were selected and divided into two groups of the kidney (n=28) and liver (n=24) transplantation. Two groups were compared in terms of demographic characteristics and clinical findings. Results: Of the 52 patients, severe COVID-19 infection was reported in 61% of the patients. There was no significant difference between the two groups in terms of symptoms, except for cough (χ²=8.09; P=0.004), clinical condition, and laboratory symptoms, except for creatinine (Z=14; P<0.005), alkaline phosphatase (Z=4.55; P=0.03), total bilirubin (Z=8.93; P=0.03), and partial thromboplastin time (Z=5.97; P=0.01). There was no relationship between the outcome and the use of immunosuppressive medications (P>0.05). All patients with kidney transplantation survived, while two cases in the liver transplantation group failed to survive (χ²=2.42; P=0.11). Conclusion: The mortality rate was higher in the liver transplant recipients, compared to the patients who underwent kidney transplantation.

Aim: This study aimed to evaluate the prevalence of Coronavirus Disease 2019 (COVID-19) positive cases meeting clinical brain death criteria; moreover, it was attempted to assess the uncommon manifestations of the infection in this study. Materials and Methods: This retrospective observational study was conducted on all brain-dead patients who were referred to the emergency department of hospitals in Mashhad, Iran, from February to October 2020. The demographic characteristics, clinical information, and laboratory data were collected and recorded in a researcher-made checklist. Results: In general, 70 patients were entered in this study. The PCR test result was positive for COVID-19 in 54% of the patients, and syncope was reported in 16.1% of the cases (n=10). Furthermore, the majority of the patients (52.9%) showed Central Nervous System (CNS) hemorrhagic manifestations. A comparison was made between the patients with positive and negative PCR test result in terms of syncope; accordingly, there was a significant difference between them in this regard (χ²=4.5; P=0.03). The CNS hemorrhagic manifestations were significantly higher in patients with positive PCR compared to those with negative PCR (χ²=4.57, P=0.03). Moreover, the grand glass opacity and pleural effusion were the most common findings of the chest computed tomography in brain-dead patients with COVID-19. Conclusion: Due to the high prevalence of COVID-19 among brain-dead patients, it seems that syncope attack should be regarded as one of the possible symptoms of COVID-19. Moreover, syncope as a result of COVID-19 may itself cause traumatic events. It is worth mentioning that CNS hemorrhagic manifestations have been reported in more than half of the patients with brain death.

Objective: Diffuse Interstitial Lung Disease (DILD) is a pathology with a high mortality rate in Colombia as well as around the world. Linking patients to pulmonary rehabilitation programs is essential to improve their quality of life and aerobic capacity; thus, all patients perform the six-minute walk test (6-MWT). This study aimed to describe the changes in physiological and aerobic capacity-related variables in patients with DILD in the 6-MWT at admission to a pulmonary rehabilitation program and determine possible differences between patients with Idiopathic Pulmonary Fibrosis (IPF) and other DILDs. Methods: This is a cross-sectional descriptive study on patients with DILD who performed the 6- MWT between January 2017 and February 2019. Sociodemographic, clinical, physiological, and exercise tolerance variables were taken into account at four different times of the 6-MWT: Rest time, the end, and the first and the fifth minute after the end of the test. The Human Ethics Committee endorsed the study, and all participants signed the informed consent form. Results: There were 64 patients with DILD. The average age was 60.84 years, 53.1% were female, 73.4% required home oxygen, and 53.1% had a diagnosis of IPF. There were no statistically significant differences in the Heart Rate (HR), Respiratory Rate (RR), peripheral oxygen saturation (SpO2), Borg scale, and fatigue in lower limbs at the four evaluated moments of the test for both groups of patients with DILD (p=0.000); moreover, the FEV1/FVC ratio for patients with other DILD was higher (p=0.000). The distance traveled for IPF was 339.26 ± 124.84, while for other DILDs, it was 365.63 ± 113.00 (p=0.382). Conclusion: Patients with other DILDs have better FEV1/FVC and travel longer distances with less dyspnea and fatigue than patients with IPF during the 6-MWT. Both groups' HR, RR, SpO2, Borg, and fatigue variables presented significant changes during the 6-MWT.

Background: It seems that transplant recipients are at high risk for severe COVID-19, especially in the presence of comorbidities and immunosuppression. This study aimed to determine the effects of previous treatment with immunosuppressants and received dosage and the risk of COVID-19 severity and mortality in liver transplant recipients in various post-transplantation phases in the Iranian population. Methods: This was a cross-sectional study conducted among 24 patients in the post liver transplant course, who were referred to two transplant centers (Imam Reza and Montaseriyeh hospitals) affiliated to Mashhad University of Medical Sciences, Mashhad, Iran, during 2020-2021. The demographic and clinical characteristics of the patients were recorded in a checklist, and the relationships between various variables were analyzed. Results: The majority of the post liver transplant patients (96%) were in the late phase of post-transplantation, and 8.3% of the cases expired. COVID-19 severity and mortality did not show a significant relationship with previous treatment with immunosuppressants and received dosage (P>0.05). In addition, there was no relationship between the symptoms of COVID-19 and immunosuppressant dosages, except for a headache. No significant correlation was found between immunosuppressants dosage and laboratory findings, and only prednisolone dosage was found to be correlated with heart rate (r=-0.62, P=0.03), BUN (r=-0.84, P=0.002), and D-dimer (r=-0.72, P=0.01). Conclusion: Severe SARS-CoV-2 infection was reported in the majority of liver transplant recipients. The severity of COVID-19 was not related to previous treatment with immunosuppressants and received dosage.