Current Respiratory Medicine Reviews - Volume 19, Issue 3, 2023

Introduction: There is increasing interest in the application of artificial intelligence (AI) and machine learning (ML) in all fields of medicine to facilitate greater personalisation of management. Methods: ML could be the next step of personalized medicine in chronic obstructive pulmonary disease (COPD) by giving the exact risk (risk for exacerbation, death, etc.) of every patient (based on his/her parameters like lung function, clinical data, demographics, previous exacerbations, etc.), thus providing a prognosis/risk for the specific patient based on individual characteristics (individual approach). Result: ML algorithm might utilise some traditional risk factors along with some others that may be location-specific (e.g. the risk of exacerbation thatmay be related to ambient pollution but that could vary massively between different countries, or between different regions of a particular country). Conclusion: This is a step forward from the commonly used assignment of patients to a specific group for which prognosis/risk data are available (group approach).

Background: The novel SARS-CoV-2 has caused a global pandemic. COVID-19 infection is described by the adverse impact on the population’s health and economy. Coagulopathy is associated with various thrombotic complications and disease severity. Therefore, this review aims to elucidate the pathophysiology of this coagulopathy. Methods: Relevant English language literature was searched and retrieved from the Google Scholar search engine and PubMed database. We used “COVID-19”, “SARS-CoV-2”, “Coagulopathy”, “Thrombosis”, “Anticoagulation”, and “ARDS” as keywords. Results: Several studies showed that the primary targets of SARS-CoV-2 are pneumocytes, immune cells, and vascular endothelial cells. Coagulopathy appears to induce more thrombotic complications than hemorrhagic events. The critically ill patients stimulate the coagulopathy state and thrombosis complication through cytokine storm, systemic inflammation, complement cascade, and platelets. Accordingly, thromboembolic complications cause mortality among COVID-19-infected patients and can negatively affect disease management outcomes and treatment. Conclusion: A pivotal clinical feature of acute COVID-19 infection is coagulopathy and prothrombotic events, which are associated with excessive arterial and venous thrombosis, microvascular thrombosis, and adverse clinical outcomes. Therefore, adopting an approach for preventing, treating, and reducing thrombotic and bleeding events in these patients is necessary.

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for Coronavirus Disease 2019 (COVID-19) pandemic. Cell entry of the virus can be mediated by several enzymes, such as ACE-2, DPP4/CD26, and TMPRSS2, upon viral membrane fusion through SARS-CoV-2 envelope spike glycoproteins. In docked molecular complexes, DPP4/CD26 functional receptors and viral spike proteins have a large interface, potentially leading to inflammation in severe COVID-19. Objective: The aim of this study is to review the role of DPP4/CD26 in the immune system and its effects on the production of cytokine storms in COVID-19. Furthermore, we hypothesize that targeting DPP4/CD26 as a therapeutic strategy could reduce the inflammatory complications of SARS-CoV-2 infection. Methods: The current review was conducted using keywords such as COVID-19, SARS-CoV-2, dipeptidyl peptidase-4, CD26, cytokine storm, and treatment to search for articles in Google Scholar and PubMed databases that were specifically oriented towards our objectives. Results: The regulation or inhibition of DPP4/CD26 might affect one or more stages in COVID-19 immuno- pathogenesis due to its associations with many immunological functions, such as modulating the NF-kB pathway, upregulating CD86 expression, activating proliferation of T cells, and influencing the antiviral response and cytokine storm in COVID-19. In this regard, the applications of DPP4/CD26 inhibitors, DPP4/CD26 siRNAs, and CD26 antibodies have been demonstrated to prevent cytokine storms and airway inflammation. Conclusion: It is suggested to utilize novel technologies such as CRISPR/Cas and chimeric antigen receptor T cells, based on their many advantages, to increase the sensitivity and specificity of future treatment methods.

One of the rapidly growing groups of diseases known as ciliopathies is primary ciliary dyskinesia (PCD), a rare hereditary illness of the motile cilia. Different clinical symptoms of primary ciliary dyskinesia include infertility, left-right lateralization abnormalities, and chronic upper and lower respiratory tract disorders. Our knowledge of the genetics underlying primary ciliary dyskinesia has significantly increased in recent years. Involved in the formation, shape, and operation of motile cilia are axonemal, cytoplasmic, and regulatory proteins that are encoded by a rising number of disease-associated genes and pathogenic mutations. We now have a better grasp of the clinical signs and symptoms of motile ciliopathies because of advances in our understanding of cilia genetics and the function of the proteins expressed. These developments have altered how we approach primary ciliary dyskinesia diagnostic testing. The clinical characteristics of primary ciliary dyskinesia, the evolution of diagnostics, and the discovery of previously unknown genotype-phenotype connections in primary ciliary dyskinesia will all be covered in this review paper.

Severe acute respiratory syndrome-Coronavirus-2(SARS-CoV-2) is very susceptible to transmission, and caused Coronavirus-19 (COVID-19), by spreading throughout the globe in early 2020 after starting in Wuhan, China in late 2019. Intensive care unit (ICU) COVID-19 patients experienced elevated fatality rates as a result of the COVID-19 pandemic. It is also anticipated that, the bacterial co-infection will cause a wave of subsequent bacterial illnesses. A significant infection causes morbidity in critically ill patients with COVID-19, is known as ventilator-associated pneumonia (VAP). A public health emergency has been proclaimed for COVID-19 by the World Health Organization (WHO). As per WHO, more than 113 million COVID-19 cases have been confirmed, and there have been about 2.5 million fatalities. Early research has shown that nosocomial pneumonia, particularly VAP, is significantly more common in people with severe SARS-CoV-2 infections. ICU patients frequently experience Acinetobacter baumannii (AbB) infections, while Aspergillus species are the fungi most frequently responsible for VAP. The review emphasizes the most prevalent microorganisms that caused infections to arise among hospitalized patients throughout the COVID-19 era. The literature identified AbB, Klebsiella pneumonia (KP), Aspergillus, Enterobacter cloacae (EC), Stenotrophomonas maltophilia (Spm), Staphylococcus aureus (SA), Streptococcus pneumonia (SP), Haemophilus influenza (HI), Enterococcus faecalis (EF), Escherichia coli (E. coli), Candida albicans (CA), Pseudomonas aeruginosa (PA), Serratia marcescens (SM), Burkholderia gladioli (BG), Mucor spp. (MS), Rhizopus spp. (RS), Cryptococcus neoformans (CN), Paracoccus yeei (PY). This review may help the health sectors to identify and focus on VAP causative organisms during COVID-19 pandemic period, for the early initiation of prompt therapeutic management.

Introduction: Respiratory incentive, an instrumental technique used to increase transpulmonary pressure, is indicated when patients present decreased volumes and capacities, a condition presented by patients with acute phase coronavirus infection and patients with pulmonary sequelae post COVID-19. Some studies recommend including respiratory incentives in managing COVID-19 patients because of its benefits and limited risk. The objective of this exploratory review was to describe and present the current evidence of the effectiveness of IR in improving pulmonary function in adult patients with acute and post COVID-19. Methods: An exploratory review was performed. An extensive search was made in databases such as BVS (MEDLINE-LILLACS-IBECS), PubMed, OVID, Scielo, PEDro, and EBSCO, the checklist recommended by PRISMA was used and was based on the Johanna Briggs method (JGB), initially conceived by Arksey and O "Malley. To assess the quality of the studies, we used the PEDro Scale, which evaluates the methodological quality of the clinical designs. Results: In this exploratory review, 4 studies published between 2019 and 2022 were identified related to the use of the respiratory incentive in COVID-19 and post COVID-19. The evidence reviewed identified that the respiratory incentive was used in the acute phase of the disease and post COVID-19, improvements in lung function such as FVC and FEV1, clinical parameters such as oxygen saturation, dyspnea and anxiety were obtained. Conclusion: The studies identified in this review describe that IR favors the increase of FVC and FEV1, with occasional benefits in improving dyspnea and oxygen saturation.

Background: Acute respiratory distress syndrome (ARDS) following Covid-19 pneumonia is an important complication; using non-invasive ventilation (NIV) is one of the best supportive options available. In the recent Covid-19 pandemic, we have seen a significant increase in barotrauma incidence following the use of NIV in patients with severe Covid-19 pneumonia. We aimed to identify the risk factors of barotrauma in patients with Covid-19 pneumonia undergoing NIV. Methods: In this retrospective study, all adult patients with severe Covid-19 pneumonia who undergone NIV and suffered from any form of barotrauma from July to September 2021 in Afzalipour Hospital, Kerman, Iran were evaluated. Laboratory tests and NIV machine settings were collected from patients' files. A chi-square test and an independent t-test were used for analytical statistics. Results: Twenty patients with barotrauma secondary to severe Covid-19 pneumonia were enrolled. The most common manifestation of barotrauma was pneumomediastinum in 19 patients (95%). No significant relationship was seen between the occurrence of barotrauma and Laboratory tests. The mean ± SD Inspiratory Positive Airway Pressure (IPAP) level in passed-away patients (17.8 ± 1.1) was significantly higher than in recovered patients (13.5 ± 0.5) (p = 0.04). Conclusion: According to the results of the study, using a low level of IPAP in the ventilator machine settings of patients with barotrauma secondary to severe Covid-19 pneumonia will reduce the mortality rate.

Background: SARS-Cov-2 is a highly infectious and contagious disease caused by a coronavirus called severe coronavirus-acute respiratory syndrome (SARS-CoV2). Children with SARS-CoV-2 infection are often asymptomatic or have relatively mild symptoms, often with cough and fever. Today, despite High value information about the manifestations and risk factors for SARS-CoV-2, there is limited information on post-SARS-Cov-2 syndrome, especially in children. Objective: This study aimed to evaluate the symptoms of SARS-Cov-2 syndrome in children with SARS-Cov-2 in Afzalipour Hospital in Kerman. Methods: The present descriptive cross-sectional study was performed on 122 children with SARSCov- 2 in 2020-2021. A checklist including information on age, sex, duration of hospitalization, need for admission in intensive care units, clinical symptoms, mortality during or after discharge, underlying illness, and need for readmission was completed by reviewing patient records and interviews. The collected information was entered into SPSS software version 26 for statistical analysis. Results: The mean age of patients was 46.64±40.39 months. 49.2% of patients were female and 50.8% were male. The most common symptoms were fever (84.4%), weakness (49.2%), cough (34.4%), nausea/vomiting (34.4%), dyspnea (27%), and diarrhea (26.2%). In 122 children, 115 children (94.3%) had symptoms for less than one month, one child had symptoms for one to two months, and 6 children (4.9%) had symptoms for a long duration (more than two months). The most common clinical signs in children with post-SARS-Cov-2 syndrome were weakness (33.3%) and dyspnea (33.3%). Conclusion: Persistent symptoms of post-SARS-Cov-2 syndrome are less common in children with SARS-Cov-2 disease in Iran.

Background: Tuberculosis continues to be a major public health disease to date. The mortality of this disease, which was reducing till 2019, was reversed in 2020 and 2021, as per the global tuberculosis report 2022. The novel coronavirus disease 2019(COVID-19) pandemic has affected tuberculosis management in various aspects. The transient immunosuppression associated with the disease and the treatment modality has been speculated to activate latent tuberculosis infection as well as increase the infection risk with Mycobacterium Tuberculosis. Objective: The aim of this study was to analyze the clinical characteristics of post-COVID-19 pulmonary tuberculosis patients. Methods: We conducted a retrospective descriptive analysis of post-COVID-19 patients admitted from January 2021 to May 2022 with persistent or new-onset respiratory symptoms. The occurrence of pulmonary tuberculosis in these patients and their clinico- demographic details are summarized. Results: About 31(19.4%) of 160 post-COVID-19 patients with respiratory symptoms were diagnosed to have pulmonary tuberculosis. About 21(67.7%) had comorbidities, of which the predominant was diabetes mellitus in 14(45%) patients, and the majority (85%) had poorly controlled blood sugar levels. None of the patients had a history of contact with a pulmonary tuberculosis patient in the previous 2 years, but 4(13%) patients had a previous history of tuberculosis. Moreover,.66% of cases had a history of moderate and severe COVID-19 disease, and 70% had received systemic corticosteroids and other immunosuppressive drugs like tocilizumab during the COVID-19 illness treatment. More than 50% of the patients had negative smears for acid-fast bacilli and were diagnosed using rapid molecular methods like CBNAAT and LPA. Drug-resistant tuberculosis was seen in 6(19%) patients. 4(13%) patients died during the hospitalized course of treatment, and the remaining 27(87%) were discharged with antituberculous treatment, but their final outcome is unknown. Conclusion: A high index of suspicion and use of rapid molecular diagnostic methods is indicated in post-COVID-19 patients with respiratory symptoms for early diagnosis of tuberculosis and prevention of community transmission. Identification of post-COVID-19 patients with latent tuberculosis infection and the feasibility of advocation of tuberculosis preventive therapy in such patients, especially those with other risk factors like diabetes mellitus, need to be considered.