Evaluation of the predictors and frequency of silent hypoxemia in COVID-19 patients and the gap between pulse oximeter and arterial blood gas levels: A cross-sectional study.

Background: Silent hypoxemia is when patients do not experience breathing difficulty in the presence of alarmingly low O2 saturation. It could cause rapid deterioration and higher mortality rates among patients, so prompt detection and identifying predictive factors could result in significantly better outcomes. This study aims to document the evidence of silent hypoxemia in patients with COVID-19 and its clinical features. Methods: A total of 78 hospitalized, nonintubated patients with confirmed COVID-19 infection were included in this study. Their O2 saturation was measured with a pulse oximeter (PO), and arterial blood gas (ABG) was taken. Demographic and clinical features were recorded. The Borg scale was used to evaluate dyspnea status, and patients with a score of less than two accompanied by O2 saturation of less than 94% were labeled as silent hypoxic. Univariate analysis was utilized to evaluate the correlation between variables and their odds ratio (OR) and 95% confidence interval (CI). Results: Silent hypoxemia was observed in 20 (25.6%) of the participants. The average difference between the PO and ABG methods was 4.36 ± 3.43. Based on regression analysis, dyspnea and respiratory rate demonstrated a statistically significant correlation with the O2 saturation difference between PO and ABG (OR: 2.05; p = 0.026; 95% CI: 0.248-3.847 and OR: 0.144; p = 0.048, 95% CI: 0.001-0.286). Furthermore, the Borg scale (OR: 0.29; p = 0.009; 95% CI: 0.116-0.740) had a significant reverse correlation with silent hypoxia. Conclusions: Silent hypoxemia can be a possible complication that affects some COVID-19 patients. Further care should be bestowed upon the younger population and those with underlying neurological or mental illnesses. Furthermore, the respiratory rate, pulse oximeter, and arterial blood gas O2 levels should be considered alongside each other.

Exploring the Relationship Between Bakhour Use and Respiratory Health: A Cross-Sectional Study in the Jazan Region, Saudi Arabia.

Background: Despite deep cultural traditions, incense burning significantly impacts respiratory health. Effects of Arabian bakhour remain unknown in Saudi Arabia's Jazan region with prevalent use. This cross-sectional study addresses this gap by investigating bakhour exposure and respiratory diseases. Methods: This was descriptive cross-sectional study conducted in Jazan area, Saudi Arabia, from October 2023 to March 2024. A total of 1612 participants age more than 18 years, both gender and resident of Jazan Area were included. Those aged less than 18 years were excluded. SPSS v 26 was used for data analysis. Results: The sample (n=1612) had a mean age of 29±11 years and was 63% female. Bakhour use was nearly universal (98%), especially using coal (73%). Higher bakhour frequency significantly associated with increased cough (p<0.01) and dyspnea (p<0.01). Certain bakhour types linked to greater allergic rhinitis prevalence (p<0.01). Regression analysis revealed cough during bakhour use worsened respiratory health (increased respiratory score) by 3.89 times (95% CI 1.13-6.64; p=0.006) while dyspnea increased the score by 7.48 times (95% CI 4.70-10.25; p<0.001). Conclusion: This study provides valuable insights into the association between Bakhour use and respiratory health in the Jazan region. The findings emphasize the need for further research and public health interventions to mitigate potential respiratory risks associated with Bakhour use.

A Rare Case of Platypnea-Orthodeoxia Syndrome in a Patient With Undiagnosed Atrial Septal Defect.

Platypnea-orthodeoxia syndrome (POS) is a rare condition characterized by dyspnea and oxygen desaturation that worsens in the upright position and improves when lying down. We report the case of a 67-year-old male who presented with a 14-month history of dyspnea in the sitting/standing position. Despite treatment for suspected asthma, his symptoms persisted, and he was referred to our hospital for further evaluation. Physical examination and arterial blood gas analysis confirmed the presence of POS, with a significant decrease in PaO2 and SpO2 when moving from a supine to an upright position. Contrast-enhanced CT showed no obvious embolism nor arteriovenous fistula, and ventilation-perfusion scintigraphy demonstrated ventilation-perfusion mismatch with a right-to-left shunt fraction of 9.4%, without any focal defect. Transthoracic echocardiography with a microbubble test demonstrated a right-to-left shunt that increased in the upright position. Transesophageal echocardiography revealed an atrial septal defect (ASD) with an atrial septal aneurysm and the presence of an inferior vena cava valve, causing a bidirectional shunt. The patient was diagnosed with POS secondary to ASD and was referred for percutaneous closure of the defect. Following the procedure, the shunt resolved, and the patient's orthostatic oxygen desaturation improved. This case highlights the importance of considering POS in patients with positional dyspnea and the value of performing diagnostic tests, such as echocardiography, in different positions to identify the underlying cause. Early recognition and appropriate management of POS can significantly improve patients' quality of life and prevent complications associated with chronic hypoxemia.

A Rare Case of Left Main Coronary Artery Coronary Sinus Fistula in an 85-Year-Old Female.

Coronary arteriovenous fistulas (CAVFs) are congenital or acquired communications between the coronary arteries and coronary venous system, and they can also include other cardiac structures or vasculature. We discuss a case of a large fistula between the left main coronary artery and the right atrium in a geriatric patient with a history of gastrointestinal arteriovenous malformations (AVM). The occurrence of CAVFs, an uncommon cardiac irregularity, is particularly infrequent among older adults. Typically, it is discovered by chance when investigating symptoms such as shortness of breath or chest pain, where coronary angiography is necessary to determine the most effective treatment strategy. This case highlights the possible utility of evaluating CAVFs in patients with a history of gastrointestinal AVM who similarly present with clinical symptoms of high-output heart failure. Once identified, this could simplify the treatment approach and improve communication between healthcare providers to minimize the risk of harm to the patient.

Malignant tracheoesophageal fistula treated with septal occluder device.

Septal occluder devices can be used with palliative intent to close tracheoesophageal fistulas and improve the quality of life of patients.

Mycoplasma spp. pneumonia and subsequent pulmonary hypertension in a domestic ferret (Mustela putorius furo).

Treatment of Mycoplasma spp. pneumonia has rarely been described in domestic ferrets (Mustela putorius furo). A 10-month-old, 0.53 kg, female spayed domestic ferret was presented for oxygen-dependent, chronic dyspnea of one-month's duration. Physical examination findings included dyspnea, tachypnea, increased bronchovesicular sounds bilaterally, and an intermittent non-productive cough. Bloodwork abnormalities included a mild leukocytosis (8.6×103/µL), mild neutrophilia (4.0×103/µL), mild hypoalbuminemia (2.7 g/dL), mild hyperglobulinemia (3.3 g/dL), mild hyponatremia (147 mEq/L), and mild hypochloremia (111.4 mEq/L). Radiographs revealed a marked diffuse bronchial pattern with peribronchial cuffing, a mild main pulmonary artery bulge, distended caudal lobar pulmonary arteries, and decreased serosal detail within the abdomen. An echocardiogram revealed indications of moderate pulmonary hypertension and systolic anterior motion of the mitral valve. Polymerase chain reaction testing for Mycoplasma spp. was positive, and treatment was initiated with doxycycline (10 mg/kg PO q 12 hours for 16 weeks), prednisolone (0.4 mg/kg PO q 12 hours for 13 weeks, tapered to 0.2 mg/kg PO q 12 hours for two weeks, then eventually increased to 0.7 mg/kg PO q 12 hours until further notice), sildenafil (0.3 mg/kg PO q 24 hours for 13 weeks), and oxygen supplementation via an oxygen cage for six weeks. On repeat echocardiogram eleven weeks after initiation of doxycycline therapy, the pulmonary hypertension had resolved. At follow up six months later, the ferret was stable on previously prescribed medications and did not require oxygen supplementation. Mycoplasma spp. and pulmonary hypertension should be considered in cases of respiratory distress in ferrets.

Association between severity of pulmonary embolism and health-related quality of life.

Background: Health-related quality of life (QoL) impairment is common after pulmonary embolism (PE). Whether the severity of the initial PE has an impact on QoL is unknown. Objectives: To evaluate the association between severity of PE and QoL over time. Methods: We prospectively assessed PE-specific QoL using the Pulmonary Embolism Quality of Life (lower scores indicate better QoL) questionnaire and generic QoL using the Short Form 36 (higher scores indicate better QoL) questionnaire at baseline and 3 and 12 months in older patients with acute PE. We examined whether QoL differed by PE severity based on hemodynamic status, simplified Pulmonary Embolism Severity Index (sPESI), right ventricular function, and high-sensitivity troponin T in mixed-effects models, adjusting for known QoL predictors after PE. Results: Among 546 patients with PE (median age, 74 years), severe vs nonsevere PE based on the sPESI was associated with a worse PE-specific (adjusted mean Pulmonary Embolism Quality of Life score difference of 6.1 [95% CI, 2.4-9.8] at baseline, 7.6 [95% CI, 4.0-11.3] at 3 months, and 6.7 [95% CI, 2.9-10.4] at 12 months) and physical generic QoL (adjusted mean Short Form 36 Physical Component Summary score difference of -3.8 [95% CI, -5.5 to -2.1] at baseline, -4.8 [95% CI, -6.4 to -3.1] at 3 months, and -4.1 [95% CI, -5.8 to -2.3] at 12 months). Elevated troponin levels were also associated with lower PE-specific QoL at 3 months and lower physical generic QoL at 3 and 12 months. QoL did not differ by hemodynamic status or right ventricular function. Conclusion: Severe PE based on the sPESI was consistently associated with worse PE-specific and physical generic QoL over time as compared to nonsevere PE.

Lower Income, Smoking, Cardiopulmonary Comorbidities, and Higher Symptom Burden Influence the Occurrence of Cough in Patients Receiving Chemotherapy.

OBJECTIVES: To identify subgroups of patients with distinct cough occurrence profiles and evaluate for differences among these subgroups. SAMPLE & SETTING: Outpatients receiving chemotherapy (N = 1,338) completed questionnaires six times over two chemotherapy cycles. METHODS & VARIABLES: Occurrence of cough was assessed using the Memorial Symptom Assessment Scale. Latent class analysis was used to identify subgroups with distinct cough occurrence profiles. Parametric and nonparametric tests were used to evaluate for differences. RESULTS: Four distinct cough profiles were identified (None, Decreasing, Increasing, and High). Risk factors associated with membership in the High class included lower annual household income; history of smoking; self-reported diagnoses of lung disease, heart disease, and back pain; and having lung cancer. IMPLICATIONS FOR NURSING: Clinicians need to assess all patients with cancer for cough and provide targeted interventions.

Trapped Lung as a Sequela of Dramatic Tumor Shrinkage of Lung Cancer.

Herein, we report a case of 72-year-old man who had L858R EGFR-mutated lung adenocarcinoma. Chest computed tomography revealed a large lung mass that had completely replaced the right upper lobe. Although the mass dramatically shrank after initiating chemotherapy, non-malignant pleural effusion appeared. Because diffuse pleural thickening and shrinking of the thoracic cage gradually became apparent, the patient was diagnosed with trapped lung. Despite the stabilization of his lung cancer, he experienced severe dyspnea and significant weight loss, ultimately leading to a decreased performance status. Chest physicians should recognize that trapped lung can develop as a sequela of dramatic tumor shrinkage in lung cancer.

Effects of whole-body vibration exercise on functional capacity, muscle strength, and quality of life in individuals with severe chronic obstructive pulmonary disease: a systematic review and meta-analysis.

BACKGROUND: Whole body vibration (WBV) exercise is a therapy used for individuals with low tolerance to conventional exercises, such as patients with chronic obstructive pulmonary disease (COPD). This study aimed to assess the impact of WBV exercise on the functional capacity, muscle strength, and health-related quality of life (HRQoL) in severe COPD patients. METHODS: Studies published until March 2024 were reviewed, encompassing randomized clinical trials (RCTs) without temporal or linguistic constraints, comparing WBV exercise with other interventions. The PubMed/MEDLINE, Scopus, Cochrane Airways Trials Register, and CINAHL databases were queried. The Revised Cochrane risk-of-bias tool for randomized trials 2.0A was employed for quality assessment. RESULTS: Among 351 screened studies, 7 met the criteria, totaling 356 participants (WBV group, n = 182; control group, n = 174). Meta-analysis revealed a significant mean difference of 41.36 m [95%CI (13.28-69.44); p = .004] in the 6-minute walk test distance favoring the WBV group for functional capacity. Lower limb muscle strength improved in 57.14% of included studies. HRQoL meta-analysis demonstrated a 1.13-point difference [95%CI -1.24-3.51; p = .35] favoring WBV, although group differences were not significant. A mean difference of 2.31 points favored the control group in health condition [95%CI (-1.32-5.94); p = .021]. CONCLUSION: WBV exercise is recognized as a promising therapeutic modality for severe COPD patients, notably enhancing functional capacity. Although heterogeneous study protocols weaken the evidence for clinically relevant outcomes, improvements in lower limb muscle strength and HRQoL were also observed, differences between groups were not significant.

Dyspnea, the silent threat in Parkinson's: a mixed methods study.

BACKGROUND: Dyspnea is considered a silent threat to people diagnosed with Parkinson's disease and may be a common concern in patients, however, little is known about how it affects quality of life. This study explored the experiences of independently mobile people who are affected by dyspnea in daily life. METHODOLOGY: This was a cross-sectional mixed methods study that included an online questionnaire and semi-structured interviews. The participants were included if they were diagnosed with Parkinson's disease; had a self-reported Hoehn and Yahr Score I, II or III; were mobilizing independently; and were Arabic speakers. Participants were excluded if they had any other musculoskeletal, cardiac, respiratory, or neurological diseases; or were previous or current smokers; or had been previously hospitalized due to respiratory complications. RESULTS: A total of 117 participants completed the Arabic version of the Dyspnea-12 Questionnaire. Dyspnea was reported in all participants and that it had an adverse effect on their quality of life, especially during activities of daily living. Additionally, participants reported a lack of knowledge about pulmonary rehabilitation and were unaware of the availability and potential benefits of participation in programs. CONCLUSION: Dyspnea was reported in people in the early stages (Hoehn and Yahr Stages I, II, and III) of Parkinson's disease, and may benefit from routine assessment of lung function, dyspnea management and participation in pulmonary rehabilitation.

Efficacy and cerebral mechanisms of acupuncture for chronic obstructive pulmonary disease: study protocol for a multicenter, randomized controlled neuroimaging trial.

Introduction: Although acupuncture is recommended by chronic obstructive pulmonary disease (COPD) treatment guidelines owing to its effects on dyspnea, the underlying neurobiological mechanisms of these effects remain unclear. This study aims to evaluate the efficacy of acupuncture in patients with stable COPD and explore the possible involvement of specific brain regions. Methods: This is a prospective, multicenter, single-blind, randomized controlled trial. A total of 90 participants will be recruited from three centers and will be randomly assigned in a 1:1 ratio to undergo acupuncture at acupoints on the disease-affected meridian (DAM) or non-acupoints on the non-affected meridian (NAM), in addition to routine pharmacological treatments. All participants will undergo 30 min of acupuncture three times a week for 8 weeks and will be followed up for 12 months. The primary outcome will be the severity of dyspnea, as measured using the Borg Dyspnea Scale and a visual analog scale at rest and after exercise. The secondary outcomes will include the multidimensional profile of dyspnea using Dyspnea-12, the modified Medical Research Council Dyspnea Scale, and the COPD assessment test; quality of life assessments using St George's Respiratory Questionnaire and the Hospital Anxiety and Depression Scale; and additional measurements of exacerbation frequency, pulmonary function, and the 6-min walking distance. Magnetic resonance imaging (MRI) will be performed before and after exercise to explore the potential neurobiological mechanisms of exertional dyspnea. Anxiety and depression will be measured and analyzed for their correlation with the activation of specific brain areas involved in dyspnea. Discussion: This randomized controlled trial aims to use a multidimensional evaluation of the efficacy of acupuncture in relieving dyspnea in patients with COPD in terms of emotion and quality of life and explore the neurobiological mechanisms underlying the effects of acupuncture on dyspnea from an imaging perspective. It is expected to provide strong evidence to support the use of acupuncture in relieving dyspnea in patients with COPD and those with aother diseases involving dyspnea. Additionally, it provides novel insights into the central mechanisms of acupuncture intervention and dyspnea. Trial registration: Chinese Clinical Trial Registry (https://www.chictr.org.cn/): ChiCTR2300071725.

Delayed infected hematoma in retrosternal area following total thyroidectomy: a case report.

Introduction and Importance: Postoperative neck hematoma (PNH), a rare complication following thyroidectomy, occurs in only 1.1-3.15% of cases and can lead to life-threatening outcomes. More rarely, delayed PNHs with atypical clinical manifestations and positions have not yet been reported. Early identification and immediate medical intervention are of utmost importance in such cases. Case Presentation: The authors represented a patient with thyroid cancer adherent to the trachea, who underwent post-thyroidectomy, experienced delayed PNH in the retrosternal region and was infected by respiratory pathogens. Meanwhile, the patient developed recurrent laryngeal nerve (RLN) paralysis after surgery. PNH was not identified in the clinical manifestations; instead, it was detected only through successive cervical ultrasound examinations. Clinical Discussion: Although rare, PNH can lead to serious complications, especially delayed complications or those in atypical positions, without neck swelling. When simultaneously with RLN paralysis, the hematoma may be neglected. Therefore, early diagnosis and treatment are crucial. Conclusion: Clinicians should be vigilant of atypical PNH because neck swelling may be absent. Cervical ultrasonography is essential for diagnosis and can be performed multiple times. Cervical CT scans should be part of the routine procedure, while contrast-enhanced ultrasound can help detect active bleeding. Early postoperative antibiotics are recommended if the tumor is closely attached to the trachea.

The roles of exercise stress echocardiography for the evaluation of heart failure with preserved ejection fraction in the heart failure pandemic era.

Heart failure with preserved ejection fraction (HFpEF) accounts for nearly 70% of all HF and has become the dominant form of HF. The increased prevalence of HFpEF has contributed to a rise in the number of HF patients, known as the "heart failure pandemic". In addition to the fact that HF is a progressive disease and a delayed diagnosis may worsen clinical outcomes, the emergence of disease-modifying treatments such as sodium-glucose transporter 2 inhibitors and glucagon-like peptide-1 receptor agonists has made appropriate and timely identification of HFpEF even more important. However, diagnosis of HFpEF remains challenging in patients with a lower degree of congestion. In addition to normal EF, this is related to the fact that left ventricular (LV) filling pressures are often normal at rest but become abnormal during exercise. Exercise stress echocardiography can identify such exercise-induced elevations in LV filling pressures and facilitate the diagnosis of HFpEF. Exercise stress echocardiography may also be useful for risk stratification and assessment of exercise tolerance as well as cardiovascular responses to exercise. Recent attention has focused on dedicated dyspnea clinics to identify early HFpEF among patients with unexplained dyspnea and to investigate the causes of dyspnea. This review discusses the role of exercise stress echocardiography in the diagnosis and evaluation of HFpEF.

Nasogastric tube syndrome: A case of vocal cord paralysis due to a nasogastric tube.

Insertion of a nasogastric tube is one of the most common methods of administering nutrition, but can cause vocal cord paralysis.

Post-Acute Sequelae of SARS-CoV-2 Infection (PASC) for Patients-3-Year Follow-Up of Patients with Chronic Kidney Disease.

Post-acute sequelae of SARS-CoV-2 (PASC) is a significant health concern, particularly for patients with chronic kidney disease (CKD). This study investigates the long-term outcomes of individuals with CKD who were infected with COVID-19, focusing on their health status over a three-year period post-infection. Data were collected from both CKD and non-CKD patients who survived SARS-CoV-2 infection and were followed for three years as part of a research study on the impact, prognosis, and consequences of COVID-19 infection in CKD patients. In this prospective cohort study, we analyzed clinical records, laboratory findings, and patient-reported outcomes assessed at intervals during follow-up. The results indicated no permanent changes in renal function in any of the groups analyzed, although patients without CKD exhibited faster recovery over time. Furthermore, we examined the effect of RAAS-blocker therapy over time, finding no influence on PASC symptoms or renal function recovery. Regarding PASC symptoms, most patients recovered within a short period, but some required prolonged follow-up and specialized post-recovery management. Following up with patients in the post-COVID-19 period is crucial, as there is still insufficient information and evidence regarding the long-term effects, particularly in relation to CKD.

The Effects of a Pulmonary Rehabilitation Programme on Functional Capacity and Strength of Respiratory Muscles in Patients with Post-COVID Syndrome.

Aim: The aim of this study was to estimate the effects of a pulmonary rehabilitation programme (PR) on the functional capacity and respiratory muscle strength of patients with post-COVID syndrome. Methods: A cross-sectional study was conducted using hospital data on patients who participated in a pulmonary rehabilitation programme at the Clinic for Lung Diseases, University Hospital Centre Zagreb, Croatia, between January 2021 and December 2022. Data on the spirometry, respiratory muscle strength, and functional exercise capacity of patients were collected at baseline and three weeks after the start of rehabilitation. The study included 80 patients (43 females, 37 males) with a mean age of 51±10 years. Results: A significant increase in respiratory muscle strength (P<0.001) was observed after pulmonary rehabilitation, with effect sizes ranging from small to large (Cohen's d from 0.39 to 1.07), whereas the effect for PImax expressed as a percentage was large (Cohen's d=0.99). In addition, the pulmonary rehabilitation programme significantly improved the parameters of the six-minute walk test in patients, and the parameters of lung function, FVC, FEV1, and DLCO also improved significantly after PR (P<0.05). Conclusion: The results showed that the pulmonary rehabilitation programme has clinically significant effects on functional capacity and respiratory muscle strength in patients with post-COVID syndrome.

Rare manifestation of pulmonary benign metastasizing leiomyoma: Respiratory failure.

We report a case of a 42-year-old woman diagnosed with pulmonary benign metastasizing leiomyomatosis with a random nodular pattern on image and with a rare clinical condition progressing with respiratory failure and severe hypoxemia. This study is relevant due to the rarity of the tomographic pattern and the patient's clinical presentation. There is no treatment guideline for this comorbidity, which further increases the importance of publishing case reports in the literature.