Current Respiratory Medicine Reviews - Volume 19, Issue 2, 2023

Maternal diabetes during pregnancy, regardless of the type, is a risk factor for macrosomia or excessive fetal growth. Macrosomia and subsequent complications are the main short-term consequences of intrauterine exposure to gestational diabetes mellitus (GDM). Additionally, they have an increased risk of neonatal complications, such as congenital heart defects (CHDs) and central nervous system (CNS) congenital birth defects, hyperbilirubinemia, hypoglycemia, hypocalcemia, and polycythemia with their subsequent complications. More and more indisputable data are evidencing long-term consequences on offspring health in the case of diabetes. While most of this research has focused on metabolic and cardiovascular consequences, there is a growing body of evidence suggesting an impact of maternal diabetes on respiratory health, which is influenced by intrinsic and extrinsic environmental factors during fetal and postnatal development, with important implications for respiratory disorders in later life.

Background: Foreign body (FB) aspiration is uncommon, but potentially serious and life-threatening. Foreign body aspiration represents about 0.5% of adult bronchoscopy procedures. When bronchoscopic removal fails, the procedure should stop and a thoracic surgeon must join the procedure, and the most common surgical strategy is lobectomy. Aims: The aim of this study is to describe the outcome and safety of surgical removal of aspirated foreign bodies through minimal thoracic surgery after failure of bronchoscopic removal. Materials and Methods: This is a descriptive hospital study that involved 21 patients hospitalized in two main hospitals in Khartoum, Sudan, between September 2013 and October 2019, for the surgical removal of aspirated foreign bodies. We collected data on the demographics and clinical characteristics of the patients, the nature and anatomical location of the foreign body, and the surgical results. Results: The mean age of the patients was 14 years and 12 of them were women. The incident was accidental in all patients, and the mean time between the foreign body aspiration and surgery was approximately 2 weeks. Foreign bodies were found in the right lung in 15 of the patients. All foreign body removals were achieved by minimally invasive thoracic surgery. In 17 patients, the surgery was conservative, but two patients underwent lobectomy and pneumonectomy was performed in 2 patients. The postoperative course was favorable in all patients and no deaths were reported. Conclusion: Minimally invasive thoracic surgery in our setting has provided a safe approach to the removal of aspirated foreign bodies after failure of bronchoscopic removal.

Objective: COVID-19 pandemic affected smokers’ behavior globally. Our objective was to explore changes in smokers’ behavior in Jordan during the pandemic by studying changes in smoking intensity and purchase of smoking products, and by assessing participants’ knowledge and perception of COVID-19. Methods: This is a cross-sectional study where convenience sampling was used. An electronic questionnaire was distributed on social media. We included current smokers, aged 18 years or older, living in Jordan at the time of participating in the study. We gathered personal information and smoking history. We assessed the participants’ knowledge about COVID-19 and the change in their smoking behavior and thoughts and attempts to quit smoking. Results: A total of 767 participants were included; the majority, 526 (68.6%), were 18-25 years old. 358 (46.7%) have been smokers for one to five years; the predominantly used smoking product was cigarettes (60.1%). Regarding daily smoking behavior during the COVID-19 pandemic, 236 (30.8%) participants increased their daily smoking behavior, mainly due to anxiety followed by boredom and staying at home; 241 (31.6%) decreased it due to health concerns about self or others. Intentions of quitting smoking were reported by (51.1%), but only (9.6%) genuinely quit. Compliance with the COVID-19 protection guidelines was significantly associated with age and gender variables (P < 0.05) as well as change in daily smoking frequency (P < 0.001). Conclusion: Most smokers either had similar or increased daily smoking frequency during the COVID-19 pandemic. Nearly half of the participants intended to quit smoking, and most smokers were compliant with recommended guidelines for COVID-19 infection prevention.

Background: Considering the importance of assessing solid organ transplants, infected individuals with coronavirus disease 2019 (COVID-19), and the lack of information in this regard, this descriptive study aimed to investigate the clinical features, immunosuppressive agents, and outcomes of liver transplant recipients in the critical phase of infection with COVID-19. Methods: This descriptive cross-sectional study was conducted on 12 critically ill liver transplant recipients referred to Imam Reza and Montaseriyeh hospitals affiliated with Mashhad University of Medical Sciences, Mashhad, Iran, within 2020-21. The required data, including demographic and clinical information, were gathered and recorded in a checklist, and the correlations between variables were assessed in SPSS software (version 24). Results: Hypertension, diabetes, and chronic kidney disease were reported in 83.3% (n = 10), 58.3% (n = 7), and 41.6% (n = 5) of patients, respectively. The administration of Mycophenolic acid was correlated with conjunctivitis (r = -0.67; P = 0.02), weakness (r = 0.77; P = 0.006), and sore throat (r = -0.67; P = 0.02). Ground glass opacity was reported in all patients, which was along with consolidation in 90.9% of the cases, and acute pulmonary embolism was found in 36.3% of the subjects. Finally, 66.7% (n = 8) of patients passed away. Among immunosuppressive agents, only the use of Mycophenolic acid was correlated with the outcome (r = -0.77; P = 0.006). Conclusion: Due to the high rate of mortality among liver transplant recipients in the critical phase of COVID-19, earlier and more aggressive treatment with antiviral and antibacterial agents should be performed in this group of patients.

Background: Asthma is an important cause of morbidity worldwide. The FOXO3a gene plays an important role in human immune regulation and homeostasis. Loss of function may lead to chronic inflammation and asthma. Objective: To evaluate the association between Foxo3a gene polymorphism and susceptibility to asthma. Methods: We conducted a case-control study in a tertiary care hospital. Participants answered a questionnaire that collected demographic and clinical information. Asthma was confirmed by pre and post bronchodilator spirometry. Genotyping of the FOXO3a polymorphisms was performed using PCR-RFLP. Results: The study population included 41 cases and 33 controls. Among cases, the heterozygous (CT) genotype frequency was greater compared to wild homozygous (CC) and mutant homozygous (TT) variants. In controls, the wild homozygous (CC) genotype frequency was greater compared to heterozygous and mutant homozygous variants. In the general model, the mutant homozygous (TT) group had significantly higher odds of 7.8 (1.78-34.07) of having asthma compared to the wild homozygous (CC) group. The mutant homozygous (TT) group had greater severity of asthma as compared to the wild homozygous (CC) group. The mutant homozygous group (TT) had much lower lung functions, as compared to the wild homozygous (CC) group in asthmatics. Among nonasthmatic controls, lower lung functions were seen in the mutant (TT) group as compared to the wild (CC) group. Conclusion: We found a significant association between the Foxo3a gene polymorphism and asthma. The T allele, a variant of the Foxo3a gene polymorphism, is associated with a higher risk of asthma, and greater asthma severity. It is also associated with lower lung functions in both asthmatics and apparently healthy control subjects.

Introduction: Bronchial asthma is a chronic disorder with high prevalence among women. Visfatin as a pro-inflammatory adipokine has been linked to inflammatory lung diseases such as asthma and can be used as a forthcoming biomarker target to diagnose and treat asthmatic patients. Aim: The aim of this study is to evaluate plasma visfatin level and its correlation with pulmonary function of female asthmatic patients. Methods: This cross-sectional study was conducted on all female asthmatic patients referred to the Be'sat Pulmonary Clinic of Kerman from 1 November 2019 to 20 February 2020. Patients with confirmed diagnosis of asthma were included. The data were collected through a checklist and the corresponding author conducted all face-to-face interviews in the physician’s office of the pulmonary clinic. Then, blood samples (5 cc) were taken from the patients to determine the plasma level of visfatin. Data was analyzed by SPSS Software. Results: 113 women with asthma were studied. The mean ± SD age of patients was 46.71 ± 13.91 years (range: 13 to 75). The mean ± SD of visfatin plasma levels was 26.30 ± 6.98 mg/dl (range: 8.50 to 46.88). The forced expiratory volume in the first second (FEV1) had a significant and negative correlation with plasma visfatin concentrations (P-value = 0.03). Conclusion: The results of this study indicated that plasma visfatin levels were correlated inversely with FEV1 among asthmatic women. Further studies with large samples are recommended to evaluate the role of visfatin in asthma pathogenesis.

on. Materials and Methods: The data of patients who were followed up and treated between 1, July 2020 and 5, October 2020 were retrospectively analyzed. Demographic data of the patients (age, gender), acute physiology and chronic health evaluation score II (APACHE II), sequential organ failure assessment (SOFA) score, RT-PCR of oro-nasopharyngeal swabs, the severity of ARDS on the day of tocilizumab admission, time from RT-PCR positivity to tocilizumab administration, respiratory support treatments, all other medical treatments, and ICU outcomes were recorded. Risk factors affecting mortality were evaluated with multiple regression analysis. Results: A total of 60 patients with a median age of 69.8 (24-87) years, 25 females and 35 males were included in the study. The mean APACHE II score was 18.9 ± 8.0, and the SOFA score was 4.5 ± 2.0. Fifty-two (86.7%) patients had positive oro-nasopharyngeal swabs for SARS-CoV-2 by RT-PCR; (13,3%) patients had positive IgM/Ig G rapid antibody tests for SARS-CoV-2. Tocilizumab was given on an average of 2.5th days (± 2.0 days). On the day of tocilizumab administration, 1 (1.7%) patient had mild ARDS, 30 (50.0%) had moderate ARDS, and 29 (48.3%) had severe ARDS. The PaO2/FIO2 ratio of the study group on the day of tocilizumab administration was 96.7 ± 36.6 mmHg. Thirty-four (56.7%) patients were intubated during follow-up. Forty (66.7%) patients died, while 20 (33.3%) patients were transferred to the ward. The mean length of stay in the ICU was 11.4 ± 5.5 days. Advanced age (Hazard ratio (HR) 1.8; 95% confidence interval (CI) 0.88-0.93; p < 0.001), higher APACHE II score (HR 0.81, 95% CI 0.74-0.98; p = 0.001), higher SOFA score on the day of tocilizumab administration (HR 1.47, 95% CI 0.39-0.79; p = 0.001), and lower PaO2/FIO2 ratio (HR 2.54, 95% CI 2.33-3.79; p < 0.001) were determined as independent risk factors for mortality. Conclusion: Patients administered tocilizumab and favipiravir in our ICU were mostly patients with moderate-severe ARDS and had higher inflammatory markers. The reason for the high mortality in this study was attributed to the fact that all of the patients had moderate-severe COVID-19-related ARDS, rather than severe COVID-19.

Background: Heart rate variability (HRV) analysis is a relevant indicator of autonomic nervous system function over the cardiovascular system. The usual way to measure this variability is from the electrocardiogram (ECG). Objective: To assess the validity of HRV measurements obtained from a heart rate monitor (HRM) Polar^® V800 in critically ill adult subjects. Materials and Methods: A prospective, repeated measures, observational study was conducted in two in the Chilean intensive care units. Twenty-one different HRV variables were simultaneously assessed using a Polar^® V800 HRM and an ECG Mortara^® H3 Holter device. The data was collected from the clinical record and physical examinations. The evaluations were conducted for 10 minutes at a time and simultaneously, during which the subjects had to remain supine and at rest. The sampling frequency was 1000 Hz, providing a temporal resolution of 1 millisecond for each RR period. Results: Thirty adult subjects were included with an average age of 33.63 ± 8.91 years. When comparing both HRV assessment methods, only 3 variables showed statistically significant differences (p ≤ 0.05). As well, the correlations showed 4 strong and 17 near-perfect associations, which were positive and statistically significant (p ≤ 0.001). In addition, intraclass correlation coefficients (between 0.744 and 1) and bias determined using the Bland-Altman method found both methods to be concordant. Conclusion: The Polar^® V800 monitor is a valid tool for assessing HRV in critically ill adult subjects.

Background: This study aimed to compare the serum levels of procalcitonin in the patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and the patients with chronic obstructive pulmonary disease (COPD) in the emergency ward of Afzalipour Hospital in Kerman. Methods: This cross-sectional study was conducted on 45 patients with stable COPD and 45 patients with AECOPD. Patients were divided into four groups based on COPD severity assessment. Serum procalcitonin levels were measured using an ELISA kit. Results: The mean age of patients in the exacerbation and the stable group was 60.97 ± 12.61 and 62.53 ± 11.04 years, respectively. Serum procalcitonin levels in two exacerbation groups (215.22 ± 19.84) were higher than stable groups (127.92 ± 8.97) (P = 0.001). The accuracy of this test for diagnosing acute attack in terms of AECOPD was 77%, and the serum procalcitonin level of 132.6 was found to be the best cut-off point to diagnose acute disease. The mean serum procalcitonin levels of stage D patients in the acute attack group were substantially higher than those of stages D and B patients in the stable group (P = 0.001). Serum procalcitonin levels were related to body mass index (P = 0.01), post-bronchodilator FEV1/FVC (P = 0.028), and the number of hospitalizations per year (P = 0.001). By increasing the serum procalcitonin levels, BMI and number of admissions per year increase, and post-bronchodilator FEV1/FVC decreases. Conclusion: The mean serum levels of procalcitonin in the group with attacks due to COPD was significantly higher than the stable group.

Objective: To date, the vaccine is the only weapon to stop the global pandemic caused by the SARS-CoV-2. But, several clinical cases of complications have been reported in the literature especially allergic reactions. Case Report: We report a case of 35-year-old woman, known asthmatic with history of chronic urticaria, allergic rhinoconjunctivitis and angioedema after taking NSAIDs. The patient was presented 10 minutes after administrating Pfizer-BioNTech vaccine, an immediate allergic reaction complicated 12 hours followed by angioedema. Discussion: During the first wave of COVID-19, and after the initiation of the vaccination program in Morocco, vaccinating people with severe allergies was not recommended. This reality was changed after the second wave of SARS-CoV-2 Delta, on condition of doing it under medical monitoring. We should propose to all risky persons to take premedication if needed to avoid such reactions considering the benefits incurred. The use of anti-histamines seems to be necessary. But as in our patient’s case, anti-histamines alone were not sufficient to avoid this local reaction. They probably reduced the intensity of the reaction but did not avoid it. Therefore, we proposed a combination of drugs made by corticosteroids and anti-histamines as a premedication may be a safe alternative for the patients with risks and last but not least a, close monitoring was proposed. Conclusion: The main purpose of this case is to raise awareness of this side effect among practitioners and make them capable to manage it correctly.

Background: Children with mild or asymptomatic COVID-19 represent the majority of paediatric cases. Hospitalisation and critical care are required only in a small proportion of SARSCoV- 2 positive children who present severe symptoms, like interstitial lung disease. A quarter of children experience persistent symptoms some months later after being hospitalised, and they need to be properly followed up. Case Presentation: The authors describe a case report of long-COVID in a 5 years old child, who was previously hospitalized for a severe case of COVID-19 (an interstitial lung disease requiring oxygen), followed up in 3 months in our Pediatric Department. Results: After 3 months post-hospitalisation, despite his clinic history, the clinical examination was normal, during the six-minute walking test he did not desaturate, the spirometry was in the norm and the lung ultrasound did not show any pathological findings. Conclusion: We reported a case of a child previously hospitalised for interstitial lung disease with long-COVID, who has been followed up 3 months after the hospitalisation by our Department of Pediatrics of the University ‘Luigi Vanvitelli’. Based on our experience, even in children who have experienced a severe form of COVID-19 disease and who continue to exhibit symptoms, a proper follow-up can demonstrate a full recovery in a few months.