Current Respiratory Medicine Reviews - Volume 19, Issue 4, 2023

Background: Pulmonary interstitial emphysema (PIE) is a rare pathology characterized by the abnormal and harmful presence of air in the interstitial tissues of the lung. This condition is often related to barotrauma caused by mechanical ventilation, but it can be exceptionally seen in healthy infants. The main causes of PIE are respiratory distress syndrome (RDS), mechanical ventilation or positive pressure ventilation, prematurity, meconium aspiration syndrome, pulmonary infection, amniotic fluid aspiration, and incorrect endotracheal tube placement. To date, there is no standard treatment for PIE, based on the clinical and localization of PIE conservative and non-- conservative therapies are described.Methods: We describe a case of a very premature infant with severe respiratory failure secondary to RDS and unilateral left sided PIE with lung herniation treated with conservative therapy like selective intubation, steroid therapy, lateral position, and lastly, oxygen supplementation without ventilatory assistance. Furthermore, we have carried out a systematic literature review for the past 15 years (2007-2022). A systematic review, using an evidence-based algorithmic approach, was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.Results: Our search, after the selection, produced a total of 24 articles, which were revised.Conclusion: In our case oxygen supplementation without ventilatory assistance resulted in successful resolution of the left PIE. Discontinuation of ventilatory care played a crucial role. Considering the management reported in literature, our aim is to perform a systematic literature review by adding our experience to the available knowledge on therapy for unilateral PIE.

Background: The concept of atopic march was introduced about 15 years ago to define the temporal progression of different allergic conditions, from atopic dermatitis and food allergies in earliest childhood to the development of asthma and allergic rhinitis in older children.Case Presentation: The authors describe a case report of a young girl who went through the stages of atopic march. The child first showed atopic dermatitis and food allergy in infancy, and, afterwards, she manifested allergic rhinitis and asthma in childhood.Discussion: This timeline reflects the atopic march's spatial evolution, beginning with the skin and gastrointestinal tract and progressing to the upper and lower airways.Conclusion: In accord with the most recent evidence, rather than being defined in terms of chronological progression, atopic diseases should be investigated as a spectrum of atopic disorders that might take various developmental paths. According to this theory, the use of Component Resolved Diagnosis in atopic children can be beneficial for highlighting and predicting the atopic profile during the earliest years of life before symptoms arise, helping to stratify the clinical risk and preventing the onset of the atopic march and severe responses.

Background: Long COVID affects 8 to 10 % of children. Currently, the COVID-19 follow- up protocols in children include chest auscultation, collection of growth parameters, including weight, height and body mass index, execution of the six-minute walking test, basal spirometry, and afterwards, bronchodilation test and lung ultrasound.Case Presentation: In this paper, the authors describe a case series of long COVID followed up for 9 months at the Department of Pediatrics of the University Luigi Vanvitelli. The review of the literature was performed on PubMed using the keywords COVID-19, follow-up, children, and lung ultrasound. The aim of this article was to highlight the need to create custom follow-up programs for long Covid in children through the description of a case followed up at our Pediatric Department and a review of the current literature.Discussion: The reversal of pathological lung ultrasound signs occurred in six or nine months despite the early improvement of respiratory symptoms and pulmonary function. There are limited studies on the ultrasonography follow-up of kids with COVID-19 in the literature, and there are still no follow-up COVID-19 guidelines for paediatric population.Conclusion: Pathological lung ultrasound in children recovered from COVID-19, may take time to resolve; therefore, evaluating patients with lung ultrasound in the following months could be a radiation- saving approach useful for children who have fully recovered and have no warning signs.

Background: Dyspnea is a common symptom that afflicts many patients with pulmonary disease and may be the primary manifestation of not only lung disease but also myocardial dysfunction, anemia, neuromuscular disorders, obesity, etc. Dyspnea can be induced by physical activity, which is referred to as exercise-induced dyspnea (EID). It can be caused by various etiologies, sometimes concomitant. In pediatrics, the three most common causes of exertional dyspnea are exercise-induced bronchoconstriction, inducible laryngeal obstruction, and being physically untrained. Case Presentation: We report two cases of adolescents who developed EID and their management approach. The first patient had an inducible laryngeal obstruction (EILO), while the second had an exercise-induced bronchoconstriction (EIB). Discussion: The diagnosis of EIB is based on clinical symptoms (e.g., exercise-related symptoms of dyspnea, cough, or wheezing) and lung function testing (LFT). This test shows a reversible airflow limitation in response to exercise. A decrease in FEV1 137;¥ 10% is considered positive. A major goal is to ensure that patients with EIB continue physical activity. Therapy is based on non-pharmacologic and pharmacologic measures. Conclusion: Our aim is to add our experience to the available knowledge on the diagnosis of EID. In conclusion, when faced with a child with exertional dyspnea, before declaring that he is not trained, it is always necessary to collect an accurate medical history, examination and carry out LFT, excluding pathologies of the upper and lower respiratory tract, such as EILO and EIB.

Tuberculous pleural effusion (TPE) is a common medical condition more frequently encountered in poor countries. It is the second most common form of extra-pulmonary tuberculosis. The diagnosis of TPE is problematic because the clinical features are non-specific, and most laboratory tests are not diagnostic. An accurate diagnosis requires the detection of TB bacilli in the pleural fluid or tissue sample from the pleura, which is not an easy task due to the scarcity of bacilli in the pleural fluid and the need for invasive maneuvers to get pleural tissue for histopathological, bacteriological or molecular confirmation for the TB bacilli.Different markers in pleural fluid have been evaluated to aid in diagnosing TPE. Among those biomarkers, Adenosine deaminase (ADA) was the most studied marker. It is an enzyme predominantly produced by T-lymphocytes and catalyzes the conversion of adenosine to inosine and deoxyadenosine. It is a hallmark of active cellular immunity. A high level of ADA can be found in exudative effusion of different etiologies such as parapneumonic, tuberculous and malignant effusions.Although there is still a debate over the diagnostic accuracy of ADA as a marker for TPE, many studies recommend its use. A correct diagnosis is crucial for the start of treatment for TPE. Therefore, it is crucial to assess the diagnostic value of adenosine deaminase in diagnosing tuberculous pleural effusion. The ADA optimal cutoff value is still under investigation.

Coughing and sneezing are the body's reflexes to various acute and chronic respiratory illnesses like asthma, COPD, lung cancer, etc.Mucus is a sticky, gelatinous material produced by the mucus gland to protect the airways. Mucolytics, antitussives and expectorants may help in treating hypersecretion of mucin that may lead to cough, cystic fibrosis, asthma, and COPD. Mucolytics if given along with the drugs like corticosteroids, albuterol sulphate, and levalbuterol HCl in asthma and for the management of COPD like corticosteroids and bronchodilators, may help in loosening the viscosity of the mucus and clearing it out.Mucolytics can be synthetic or herbal in origin and work by one of the three processes, viz. enzymatic degradation, disulphide bond cleavage and calcium chelation. Mucolytics breaks down mucin structure and loosen the mucus, helping it to expel out from the body. Some examples of synthetic mucolytics are Bromhexine and N-acetylcysteine. Herbal mucolytics have traditionally been used for the treatment of cough by indigenous people of India. Malva sylvestris, Zizyphus vulgaris are some of the examples of herbal mucolytics.

Background: Sleep has an essential role in restoring brain activity and balancing physiological, immune, and metabolic factors in the body. Individuals, after being infected with COVID-19, have been reported to have quite a lot of symptoms related to sleep disorders, so we conducted this study to evaluate sleep disorders in patients with COVID-19.Methods: This study involved a cross-sectional design; 547 patients hospitalised due to COVID-19 and aged 18 years and above were included. The study used the questionnaire designed by the Vietnam Society of Sleep Medicine (VSSM). Collected data were statistically analyzed and results have been obtained using SPSS software version 22.0.Results: Nightmares have been found to be increased by 10.1%, sleep quality decreased by 51.2%, and insomnia increased by 19%, compared to pre-infection. There were 24% of participants with daytime sleepiness syndrome, 23% with symptoms of memory impairment, 17% with unexplained anxiety and frustration, and 10% with loud snoring. In addition, the manifestations of sleep disorders also became more and more severe than before the infection. 68.4% of subjects were not satisfied with their current sleeping, 29.1% had sleep difficulties, including maintaining sleep, and 19.4% had trouble falling asleep.Conclusion: Sleep disturbance is a critical and common medical condition in COVID-19 patients. It is necessary to have appropriate treatment measures for insomnia in COVID-19 patients to help improve their health status and avoid post-COVID-19 sequelae.

Background: In developing countries, pulmonary infections are one of the major causes of death because the incidence and prevalence of pulmonary diseases have increased dramatically. Several species of protozoa can be found in the respiratory system. Pulmonary protozoan infections are increasingly identified in clinical settings. Protozoans within the genus Lophomonas are endocommensals of the hindgut of arthropods. Recently the trophozoite forms of Lophomonas have been observed in human tissues. Little is known about the occurrence of these protozoa in the Iranian population.Objective: This study was designed to determine the prevalence of Lophomonas in bronchoalveolar lavage specimens from the patients with respiratory diseases referred in Kerman province, southeast of Iran.Methods: A total of 200 patients were selected by simple random sampling. BAL samples were transferred to the Parasitology lab, direct smears were prepared for each specimen and two staining methods, Giemsa and Trichrome were performed for Lophomonas microscopical identification. The data were analyzed using descriptive statistics and Chi-square test.Results: Lophomonas trophozoites were found in 48 (24%) patients, at least in one of the methods. The mean age of the patients was 58.3 years (58.1 in men, 58.4 in women). Out of 200 samples, 45 (22.5%), 30 (15%), and 11(5.5%) were positive by wet mount microscopy, Giemsa, and Trichrome staining, respectively.Conclusion: This study presented the first finding of Lophomonas infection in patients with pulmonary symptoms in southeast Iran.

Background: Respiratory tract infections caused by viruses are among the most common diseases in humans worldwide. The diagnosis remains difficult as the symptoms overlap significantly with each other.Objectives: The objective of this study is to identify the respiratory viruses other than SARS-CoV- -2 causing Influenza-like illness (ILI) /severe acute respiratory infection (SARI) during COVID-19 pandemic.Methods: A total of 100 samples, including COVID-19 positive (n=50) and negative (n=50), were included in the study. The detailed case record form was filled for each patient including relevant history. Nasopharyngeal and Oropharyngeal swabs were subjected to standardized RT-PCR for the detection of SARS-CoV-2 followed by Multiplex RT-PCR for other respiratory viruses.Results: Other respiratory viruses causing ILI/SARI symptoms similar to SARS-CoV2 during COVID-19 pandemic in non-COVID-19 patients aged more than 18 years were found to be Human metapneumovirus (2%), Human adenovirus (1%), Human parainfluenza virus-1 (1%). The result suggested that other respiratory viral infections are significantly higher among COVID-19 negative individuals presenting with respiratory illness as compared to COVID-19 positive individuals, possibly due to viral interference and competitive advantage of SARS-CoV-2 in modulating the host immune system.Conclusion: The other respiratory viruses in SARS-CoV-2 negative patients had mild to moderate ILI/SARI symptoms, which usually do not require hospitalization but need to be monitored, especially in high-risk patients. Human metapneumovirus, Adenovirus, Parainfluenza virus-1 most commonly occured in more than 60 years age group with comorbidity which can be useful in stratification for future surveillance of other respiratory viruses in health care settings.

Background: Vaccines during the Coronavirus disease 2019 (COVID-19) pandemic entered the market faster than a routine proportionate evaluation cycle. The highest number of deaths and morbidities, especially by the type of B.1.617.2 (Delta) variant, is one of the reasons for this inevitability. Accordingly, evaluation of the effects of vaccines is of great importance.Methods: In this cross-sectional study, we investigated the effects of four current COVID-19 vaccines, such as AstraZeneca, Sputnik, Sinopharm, and Bharat, and the prevalence of COVID-19 occurrence among 600 vaccinated healthcare workers (HCWs) in the Southeast of Iran.Results: The incidence of infection among vaccinated HCWs was 36.3%, without any age and gender difference, statistically. The infection rate with severe acute respiratory syndrome coronavirus- 2 (SARS-CoV-2) following immunization with AstraZeneca, Sputnik V, Bharat, and Sinopharm vaccines were 45.8%, 41.3%, 36.9%, and 18.6%, respectively (P.V=0.001). Those who had a history of previous SARS-CoV-2 infection were more affected again despite vaccination (P.V=0.001). However, out of 218 infected patients, only six patients (2.8%) were hospitalized, while 26 patients (11.9%) received remdesivir and two patients (0.9%) needed to additional target therapy with Iinterleukin-6 inhibitor of Tocilizumab due to cytokine storm.Conclusion: During B.1.617.2 circulating variant, all vaccines after a complete vaccination schedule were relatively associated with protection against severe infection and hospitalization. We found that people who received the Sinopharm vaccine had the lowest incidence of COVID-19 (18.7%), followed by Bharat. The lowest incidence of protection occurred with viral vector-based vaccines, especially AstraZeneca.

Pulmonary aspergillosis is the most common mould infection of the lungs. Patients with chronic lung disease or mild immunodeficiency are at risk. Lung cancer represents an oncological challenge. Limited data are available about aspergillosis in newly diagnosed non-neutropenic lung cancer patients.Objectives: The aim of this work was to evaluate naïve lung cancer patients for the presence of as-pergillosis, identify fungal isolates, and determine antifungal susceptibility. The inhibitory effect of secondary metabolites of fungal isolates on the human fibroblast cell line was also assessed.Methods: Cross-section cohort study recruited newly diagnosed non-neutropenic lung cancer patients. Bronchoalveolar lavage was performed in 69 patients. Isolation of fungi on Sabouraud dextrose agar, morphological and molecular identification of fungal isolates, antifungal susceptibility testing, and cell viability assay with cell culture and MTT assay were done.Results: Aspergillus isolates were detected in 33 BAL samples out of the 69 patients (47.8%). The commonest isolate was A. niger. There was no significant correlation between total fungal count and age of patients. The antifungal Micafungin had a broad-spectrum and potent fungistatic activity against all fungal species, with A. niger being the most sensitive. MTT assay was performed to evaluate the cytotoxic effect of both A. niger and A. fumigatus on normal lung cells (WI-38) and revealed that toxicity was concentration-dependent and A. niger had significantly lower IC 50, indicating more toxicity.Conclusion: In the context of the diagnosis of lung cancer, maintaining vigilance is crucial to diagnose fungal infection as aspergillosis. Initiation of proper management can help improve patient outcomes.

Background: Foreign body aspiration is common among older infants and toddlers and is an important cause of morbidity and mortality. It may escape notice by the physicians due to lack of knowledge of the exact history, high variability of clinical presentation, variable latency of the onset of symptoms, and inconclusive radiographical findings.Case Report: We present a case series about children diagnosed with foreign body aspiration referred to the Pediatric Respiratory Unit of San Marco Hospital in Catania between January 2018 and November 2022. Data regarding demographic characteristics, symptoms, and type of foreign body were collected and analyzed.Conclusion: Early diagnosis is the key to therapeutic success and effective management of foreign body aspiration. We will review the literature to highlight the diagnostic difficulties related to this condition and the useful tools to recognize and manage it. The most essential part of foreign body aspiration treatment is prevention and the need to educate parents and primary care physicians. It is, therefore, of the utmost importance to consider airway foreign bodies as a cause of cough unresponsive to therapy, recurrent wheezing, and relapsing pneumonia.