Current Respiratory Medicine Reviews - Current Issue

Coronavirus disease 2019 (COVID-19) is mainly confirmed through reverse transcription polymerase chain reaction (RT-PCR), which is both expensive and time-consuming and requires specific equipment. Thus, demand for rapid diagnostic methods, such as rapid antigen detection (RAD) tests, has emerged. Here, we assessed the efficiency and reliability of RAD for early diagnosis of COVID-19.

We performed a retrospective study based on systemic COVID-19 screening and diagnosis using RAD and RT-PCR at Taipei City Hospital during the first COVID-19 outbreak week in Taiwan (28 May-6 June 2021). We postulated five strategies for COVID-19 screening in the general population: one RAD test, one RT-PCR test, one RAD test (negative) followed by one RT-PCR, one RAD test (positive) followed by one RT-PCR test, and two RAD tests and calculated their cost and accuracy. We also conducted a cost-effectiveness analysis to identify the most economically efficient strategy for COVID-19 diagnosis. This study included 6368 cases in total.

Although RAD exhibited low sensitivity (mean 66%), other values were acceptable: mean specificity, positive predictive value, negative predictive value, and accuracy were 99%, 82.8%, 97.5%, and 94.2%, respectively. RAD was the most cost-effective method. Additionally, it may be an effective diagnostic strategy in the later stages of the epidemic, warranting further research.

Although RT-PCR remains the standard method for diagnosing COVID-19, RAD is faster and a more cost-effective, convenient, and globally available method, allowing for early detection of SARS-CoV-2.

Asthma is a common chronic inflammatory airway disease. Female sexual dysfunction (FSD) is frequently seen in asthmatics but often unnoticed in clinical practice. This study evaluated the associations between asthma disease characteristics and FSD.

A total of 73 female asthma patients who visited the chest department outpatient clinic and age-matched 73 healthy controls were enrolled. All the participants completed the questionnaires: female sexual function index (FSFI), BECK depression, and BECK anxiety inventory, and underwent pulmonary function tests. Patients with asthma completed an asthma quality of life questionnaire (AQLQ) and asthma control test (ACT). FSD risk factors were analyzed using logistic regression analysis.

About 68.8% of asthmatics had female sexual dysfunction. BECK anxiety and FSFI scores with all six subsets were statistically significantly lower than healthy individuals in asthmatics (p < 0.001). CRP levels, BECK anxiety, and depression scores had inverse (r = -0.386 r = -0.343 r = -0.286), and FEV1% had a positive correlation with FSFI total scores. About 37.5% of asthma patients with FSD were current smokers, the most compromised domain of the FSFI scale was sexual arousal with a mean of 2.94 ± 0.56 and their FEV1% was lower, and CRP was higher than the asthma patients without FSD (p < 0.001, p < 0.021). Smoking, high levels of CRP and BECK anxiety scores, and low FEV1% were found to be risk factors for FSD in regression analysis.

Female sexual dysfunction is frequently present in asthma patients. Smokers, patients who have anxiety, lower FEV1% predicted values, and higher CRP levels tend to be susceptible to sexual dysfunction, which implicates inflammation as an underlying mechanism.

This study aimed to elucidate the association between iron dysregulation and the severity of COVID-19, examining serum levels of iron-related biomarkers in hospitalized patients. The primary objective was to identify reliable predictors for disease severity, specifically focusing on the role of ferritin, Hemoglobin (Hb), Total Iron-binding Capacity (TIBC), and iron.

The study enrolled 117 consecutive COVID-19 patients, classified into mild, severe, and critical groups. Serum levels of Hb, TIBC, iron, and ferritin were measured using standardized methods. Data were analyzed using ROC analysis, logistic regression models, and correlation assessments. The study adhered to ethical guidelines, obtaining informed consent from all participants.

Results revealed a consistent elevation in iron and ferritin levels as disease severity increased, accompanied by a reciprocal decline in Hb and TIBC. Ferritin emerged as a robust predictor for disease prognosis, with an AUC of 0.808, providing a sensitivity of 62.50% and a specificity of 91.74%. Age and education were identified as exacerbating factors influencing patient outcomes. The findings have been found to align with previous studies linking higher ferritin levels to adverse outcomes, supporting ferritin’s utility as a prognostic marker.

The intricate relationship between iron metabolism and COVID-19 severity has been highlighted in this study, emphasizing elevated ferritin levels as potential predictors for severe outcomes and indicators of inflammation-induced cellular damage. These findings may contribute valuable insights into personalized patient management strategies and the potential for targeted interventions in severe COVID-19 cases. Further research involving larger populations is essential to validate these observations and enhance our understanding of the complex host response to SARS-CoV-2.

This study developed a method using machine learning techniques to differentiate between malignant and non-malignant pleural effusions, analyzing texture parameters in computed tomography scans.

The study involved forty-one patients, with their computed tomography examinations classified into three groups: True Positive - patients with both cytopathological analysis and pleural biopsy indicating malignancy; True Negative - patients with negative results in both tests; and False Negative - patients with negative cytopathological analysis but positive pleural biopsy results. Four machine learning methods were applied across three analyses: True Positive versus True Negative, True Positive versus False Negative, and True Negative versus False Negative. The logistic regression model demonstrated notable effectiveness, achieving an Area Under the Curve of 0.84 ± 0.02 in the True Positive versus True Negative analysis and 0.81 ± 0.05 in the True Positive versus False Negative comparison. In the True Negative versus False Negative analysis, the Naive Bayes model achieved an Area Under the Curve of 0.72 ± 0.02.

Statistically significant differences were observed in the liquid Lactate Dehydrogenase and protein content between the True Positive and True Negative groups (p-values of 0.0390 and 0.0249, respectively), and in the liquid pH level between the True Positive and False Negative groups (p-value of 0.0254). The use of textural features in combination with machine learning techniques provided a reliable classification for investigating suspected pleural effusion findings. This method represents a potential tool for assisting in clinical diagnosis and decision-making, enhancing the accuracy of pleural effusion assessments.

In conclusion, our approach not only improves diagnostic accuracy but also offers a faster and non-invasive alternative, significantly benefiting clinical decision-making and patient care.

Limited clinical data are available regarding the impacts of coronavirus disease 2019 (COVID-19) on children.

This study assessed the clinical characteristics, nutritional status, and disease severity in pediatric patients with COVID-19.

A retrospective study examined medical records of children with COVID-19 admitted to Abuzar Hospital (Ahvaz, Iran) for nine months. Data related to their clinical, nutritional status and demographic characteristics were documented.

The present study included medical records of 500 patients. More than half of them were boys. Different levels of COVID-19 severity were observed in 202, 172, and 126 children as mild, moderate, and severe cases, respectively. Children with severe or moderate COVID-19 had substantially elevated levels of various inflammatory markers, blood urea nitrogen (BUN), gamma-glutamyl transferase (GGT), neutrophils, alanine transaminase (ALT), creatinine, bilirubin, and aspartate aminotransferase (AST) compared to those with mild COVID-19 (p < 0.001). They had lower levels of lymphocytes and vitamin D, as well as longer hospital stays than children with mild COVID-19 (p < 0.001). In addition, 52% and 40.2% of patients had malnutrition and anemia, respectively. The majority of underweight and stunted children had moderate or severe COVID-19.

The current study revealed a high prevalence of malnutrition, anemia, insufficient levels of vitamin D, elevated levels of inflammatory markers, and abnormal liver and kidney function tests in children with severe or moderate cases of COVID-19 compared to those with mild COVID-19.

During cardiac or pulmonary rehabilitation exercises, the use of a surgical mask may not be well tolerated by patients, especially those experiencing dyspnea during certain activities due to their underlying health conditions. The purpose of this study was to describe the influence of a surgical mask on exertion perception and some physiological parameters during an incremental test in healthy subjects.

A descriptive study involving 16 healthy adult individuals was conducted. The BRUCE incremental protocol was performed twice, with and without the use of a surgical mask.

No significant changes were found in vital signs, such as heart rate (p: 0.8684), mean arterial pressure (p: 0.2781), and peripheral oxygen saturation (p: 0.5314). However, the respiratory rate showed a significant difference (p: 0.023). Furthermore, significant differences were observed in the distance covered (p: 0.0005), duration (p: 0.0003), and measured intensity (METs) (p: 0.0117). Metabolic acidosis (p: 0.032), hypocapnia (p: 0.238), and hyperlactatemia (p: 0.024) were detected in the analysis of arterial gases. Oxygenation parameters, such as PaO2 (p: 0.038) and PaO2/FiO2 ratio (p: 0.038), were higher in the mask-off trial.

Surgical masks induce negative changes in METs, distance covered, and duration during an incremental treadmill test. Although no significant impact on vital signs was observed, the use of a surgical mask resulted in statistically significant but not clinically relevant decreases in oxygenation parameters. The stages of the Bruce protocol were achieved differently when participants wore a surgical mask.

The prognostic qualities of the hematological biomarker neutrophil to lymphocyte ratio (NLR) have not yet been evaluated in pleural empyema. Therefore, we aimed to find if NLR can predict adverse outcome in such clinical setting.

Retrospectively we studied 84 patients with pleural empyema who were operated in emergency setting in a clinic of thoracic surgery of an academic hospital over a 34-month period (01.2021- 10.2023). To assess the prognostic performance of NLR we used the area under the receiver operating characteristics (AUROC) curves.

Of a total of 84 patients, nine (10.7%) died. Using ROC Curve analysis we found that NLR has an excellent prognostic ability and outperformed systemic immune inflammation index (SII), platelet to lymphocyte ratio (PLR), quick- sequential organ failure (qSOFA) score and systemic inflammation response syndrome (SIRS) (AUROC = 0.904 vs 0.782 vs 0.749 vs 0.747 vs 0.676, respectively) in outcome prediction. An optimal threshold NLR > 9.88 x 10⁹/L for prognostication of death was identified with a sensitivity of 85.7% and a specificity of 83.6%.

In pleural empyema the neutrophil to lymphocyte ratio demonstrates excellent ability to predict the unfavorable outcome.

Assessment of exercise tolerance should be an integral part of the follow-up of COVID-19 survivors.

We aimed in this study to investigate the correlation between the 5 Times Sit to Stand Test (5STST) and the 6-Minute Walk Test (6MWT) and to determine their place in assessing exercise tolerance and disability in COVID-19 survivors.

This was a cross-sectional study that included 201 survivors of COVID-19. All patients underwent a detailed medical questionnaire, assessment of disability by the Lawton scale, and sub-maximal exercise tolerance by 6MWT and 5STST. Our study population was divided into two groups based on the Length of Hospital Stay (LHS) (<10 or ≥10 days).

Compared with the group with a LHS < 10 days, the group with prolonged LHS (≥10 days) had a significantly greater mean value of 5STST. In contrast, the mean values of 6-minute Walk Distance (6MWD) and Minimal Oxygen Saturation (MOS) were significantly lower. A significant correlation of 5STST with Lawton score (r = -0.373; p < 0.0001) and 6MWD (r = -0.563; p < 0.0001) was also found.

Our results showed that the 5STST was correlated with the 6MWD and Lawton score. Hence, it could be proposed to assess physical capacity and disability, especially in patients who had a prolonged LHS for COVID-19.

Tuberculosis (TB) was one of the most challenging diseases in terms of diagnosis, treatment, and control during the COVID-19 pandemic. The present study was conducted to investigate the impact of the COVID-19 pandemic on the incidence of tuberculosis.

This study was cross-sectional, based on a census of all patients with tuberculosis whose information was available in the tuberculosis registration system of the Health Vice-Chancellor of Jiroft University of Medical Sciences from 2016 to 2021. In this study, demographic information and variables related to the type of tuberculosis, disease case, treatment result, and treatment regimen were collected using a researcher-made questionnaire.

The incidence of tuberculosis during the COVID-19 pandemic was significantly reduced by 57% compared to the pre-pandemic period. There was no significant difference between the pre-COVID-19 era and the pandemic era in terms of demographic variables and several determining factors in TB patients.

The COVID-19 pandemic was found to impact the control of the tuberculosis program. Delays in referral, diagnosis, and treatment led to an increase in the spread of tuberculosis, particularly within households, an increase in the number of deaths, and an increase in drug resistance of the tuberculosis microbe. Therefore, it is recommended that awareness programs for the public about tuberculosis be organized and that more education be provided to health and treatment staff about tuberculosis to ensure that the control measures implemented in recent decades are not wasted.

Nonspecific symptoms and variable clinical course are the hurdles in diagnosing pulmonary alveolar proteinosis (PAP), a rare lung disease. We report a pediatric case of hereditary PAP caused by mutations in the gene encoding granulocyte Macrophage colony-stimulating factor (GMCSF) receptor.

A 3 years 10-month-old female child, born to 3^rd-degree consanguineous parents presented with fever, intermittent cough, and breathing difficulty ten days before hospitalization. Chest X-ray revealed bilateral diffuse alveolar infiltrates; Computed tomography (CT) showed diffuse interstitial thickening along with a crazy pavement pattern. Bronchoscopy and broncho-alveolar lavage (BAL) was performed. PAP was confirmed with BAL and genetic testing. Serum GM-CSF autoantibody test was normal but serum GM-CSF concentration was high (115.7 pg/mL). There was a continuous heterozygous deletion encompassing exon region 13 of the SLC34A2 gene, suggestive of pulmonary alveolar microlithiasis.

The patient received steroids (x2 weeks), inhalers (bronchodilators & steroids), and intermittent home oxygen therapy (x2 weeks) with a good response.

Due to nonspecific symptomatology, and variation in disease severity, diagnosis of PAP is delayed or missed. Crazy paving on CT, milky fluid on BAL with similar histological features of foamy macrophages, and PAS-positive amorphous material within the alveolus are diagnostic clues.

Asymptomatic patients or those with mild symptoms are managed with supportive care, monitoring, and chest imaging; moderate to severe symptoms require whole lung lavage (WLL); GM-CSF Replacement therapy, an alternative to WLL Immunomodulation therapy is also considered.

PAP can be managed conservatively with supportive therapy with good clinical outcomes and not all patients require WLL. However, patient selection is crucial.

Perivascular epithelioid cell tumors (PEComa) are rare mesenchymal neoplasms characterized by perivascular epithelioid cells. Despite their common occurrence in the uterus, gastrointestinal tract, and retroperitoneum, this study presents an exceptional case of PEComa identified in the lung, warranting unique molecular exploration.

A 50-year-old man was diagnosed with a 6 cm neoplasm in the lower lobe of the right lung without enlarged lymph nodes during a routine examination. Thoracotomy, extended lower bilobectomy, and D3 lymphadenectomy were performed. Histological and immunohistochemical analysis diagnosed a PEComa. No conventional TSC1 and TSC2 mutations specific to PEComa, which resulted in mTOR pathway activation, were detected by whole-exome sequencing. In contrast, mutations were unveiled in the MTOR, EIF4EBP1, and PRAME genes that could be an alternative mechanism governing mTOR activation.

These findings provide novel insights into the molecular intricacies of lung PEComa, showcasing the distinctive roles of MTOR, EIF4EBP1, and PRAME mutations.

Middle Lobe Syndrome (MLS) is a pediatric respiratory condition characterized by the collapse of the middle lobe of the right lung or the lingula of the left lung. Historically linked with tuberculosis, contemporary cases primarily involve asthma and other causes, like foreign body aspiration or mucous plug.

We have, herein, analyzed the clinical features and management of three cases of MLS from a single pediatric center. Additionally, we have reviewed 75 articles on pediatric MLS by using common databases, such as PubMed and Medline.

MLS often poses a diagnostic challenge, presenting with symptoms, like cough, wheezing, and localized rales. Radiological exams, especially chest X-rays and flexible bronchoscopy, are needed for confirming the diagnosis, particulary in challenging cases. Both obstructive and non-obstructive factors contribute to MLS.

A comprehensive understanding of MLS, its diverse causes, and the significance of early diagnosis is crucial for effective management. Treatment should target the underlying cause. Prompt intervention may offer a positive outcome and help prevent complications, like bronchiectasis.

There is no consensus regarding the comparison between nasal continuous positive airway pressure (NCPAP) and high-flow nasal cannula (HFNC) in the treatment of respiratory distress syndrome (RDS) among premature infants.

This randomized controlled trial (RCT) assessed the efficacy of NCPAP compared to HFNC for the treatment of preterm neonates with RDS.

The study was conducted at Imam Hospital (Ahvaz, Iran) among preterm neonates with RDS and gestational ages ranging from 28 to 34 weeks. One hundred twenty preterm neonates were randomly allocated to the HFNC or NCPAP groups (n = 60). Demographic and clinical characteristics were collected.

This trial was carried out with 51 male and 69 female preterm neonates. There were no substantial differences between the HFNC and NCPAP groups in gender distribution, occurrence rates of premature rupture of membranes (PROM), necrotizing enterocolitis (NEC), cardiopulmonary resuscitation (CPR), Cesarean delivery, patent ductus arteriosus (PDA), intraventricular hemorrhage (IVH), pneumothorax, chronic lung disease (CLD), treatment failure, and mortality (P > 0.05). The mean body weight, gestational age, Apgar and RDS scores, duration of invasive mechanical ventilation (IMV), length of oxygen therapy, hospitalization period, duration to reach full feeding, arterial blood pH, or gas levels were not significantly different between the two groups. However, the HFNC group exhibited a lower incidence of nasal trauma, required more surfactant therapy, and had a longer duration of intervention compared to the NCPAP group.

There were no significant differences between NCPAP and HFNC for the treatment of RDS in preterm infants.

IRCT20200616047788N1.