Accuracy study of Angiotensin 1-7 composite index test to predict pulmonary fibrosis and guide treatment.

BACKGROUND: Pulmonary fibrosis can develop after acute respiratory distress syndrome (ARDS). The hypothesis is we are able to measure phenotypes that lie at the origin of ARDS severity and fibrosis development. The aim is an accuracy study of prognostic circulating biomarkers. METHODS: A longitudinal study followed COVID-related ARDS patients with medical imaging, pulmonary function tests and biomarker analysis, generating 444 laboratory data. Comparison to controls used non-parametrical statistics; p < 0·05 was considered significant. Cut-offs were obtained through receiver operating curve. Contingency tables revealed predictive values. Odds ratio was calculated through logistic regression. RESULTS: Angiotensin 1-7 beneath 138 pg/mL defined Angiotensin imbalance phenotype. Hyper-inflammatory phenotype showed a composite index test above 34, based on high Angiotensin 1-7, C-Reactive Protein, Ferritin and Transforming Growth Factor-ß. Analytical study showed conformity to predefined goals. Clinical performance gave a positive predictive value of 95 % (95 % confidence interval, 82 %-99 %), and a negative predictive value of 100 % (95 % confidence interval, 65 %-100 %). Those severe ARDS phenotypes represented 34 (Odds 95 % confidence interval, 3-355) times higher risk for pulmonary fibrosis development (p < 0·001). CONCLUSIONS: Angiotensin 1-7 composite index is an early and objective predictor of ARDS evolving to pulmonary fibrosis. It may guide therapeutic decisions in targeted phenotypes.

Evidence to support cultivated fruiting body of Ophiocordyceps sinensis (Ascomycota)'s role in relaxing airway smooth muscle.

ETHNOPHARMACOLOGICAL RELEVANCE: Ophiocordyceps sinensis (O. sinensis) is a genus of Ascomycete fungus that is endemic to the alpine meadows of the Tibetan Plateau and adjoining Himalayas. It has been used traditionally as a tonic to improve respiratory health in ancient China as well as to promote vitality and longevity. Bioactive components found in O. sinensis such as adenosine, cordycepin, 3-deoxyadenosine, L-arginine and polysaccharides have gained increasing interest in recent years due to their antioxidative and other properties, which include anti-asthmatic, antiviral, immunomodulation and improvement of general health. AIM OF THE STUDY: This study's primary aim was to investigate the effect of a cultivated fruiting body of O. sinensis strain (OCS02®) on airways patency and the secondary focus was to investigate its effect on the lifespan of Caenorhabditis elegans. MATERIALS AND METHODS: A cultivated strain, OCS02®, was employed and the metabolic profile of its cold-water extract (CWE) was analysed through liquid chromatography-mass spectrometry (LC-MS). Organ bath approach was used to investigate the pharmacological properties of OCS02® CWE when applied on airway tissues obtained from adult male Sprague-Dawley rats. The airway relaxation mechanisms of OCS02® CWE were explored using pharmacological tools, where the key regulators in airway relaxation and constriction were investigated. For the longevity study, age-synchronised, pos-1 RNAi-treated wild-type type Caenorhabditis elegans at the L4 stage were utilised for a lifespan assay. RESULTS: Various glycopeptides and amino acids, particularly a high concentration of L-arginine, were identified from the LC-MS analysis. In airway tissues, OCS02® CWE induced a significantly greater concentration-dependent relaxation when compared to salbutamol. The relaxation response was significantly attenuated in the presence of NG-Nitro-L-arginine methyl ester (L-NAME), 1H-[1,2,4]oxadiazolo [4,3-a]quinoxalin-1-one (ODQ) and several K+ channel blockers. The longevity effect induced by OCS02® CWE (5 mg/mL and above) was observed in C. elegans by at least 17%. CONCLUSIONS: These findings suggest that the airway relaxation mechanisms of OCS02® CWE involved cGMP-dependent and cGMP-independent nitric oxide signalling pathways. This study provides evidence that the cultivated strain of OCS02® exhibits airway relaxation effects which supports the traditional use of its wild O. sinensis in strengthening respiratory health.

Establishment of a rapid detection method for Mycoplasma pneumoniae based on RPA-CRISPR-Cas12a technology.

Mycoplasma pneumoniae can cause respiratory infections and pneumonia, posing a serious threat to the health of children and adolescents. Early diagnosis of Mycoplasma pneumoniae infection is crucial for clinical treatment. Currently, diagnostic methods for Mycoplasma pneumoniae infection include pathogen detection, molecular biology techniques, and bacterial culture, all of which have certain limitations. Here, we developed a rapid, simple, and accurate detection method for Mycoplasma pneumoniae that does not rely on large equipment or complex operations. This technology combines the CRISPR-Cas12a system with recombinase polymerase amplification (RPA), allowing the detection results to be observed through fluorescence curves and immunochromatographic lateral flow strips.It has been validated that RPA-CRISPR/Cas12a fluorescence analysis and RPA-CRISPR/Cas12-immunochromatographic exhibit no cross-reactivity with other common pathogens, and The established detection limit was ascertained to be as low as 102 copies/µL.Additionally, 49 clinical samples were tested and compared with fluorescence quantitative polymerase chain reaction, demonstrating a sensitivity and specificity of 100%. This platform exhibits promising clinical performance and holds significant potential for clinical application, particularly in settings with limited resources, such as clinical care points or resource-constrained areas.

Diagnostic Value of Chest Computed Tomography Scan for Identification of Foreign Body Aspiration in Children: A Systematic Review and Meta-analysis.

Introduction: Foreign body aspiration (FBA) is a common, life-threatening pediatric emergency and was shown to be associated with high risk of morbidity and mortality. This systematic review and meta-analysis aimed to investigate the diagnostic value of chest computed tomography (CT) scan for identification of FBA in children. Methods: From inception to May 2024, a systematic search was carried out across multiple databases including Medline, Scopus, and Web of Science, considering published papers in English language. Quality assessment of the included studies was performed using seven domains of Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). Results: The systematic literature search yielded 7203 articles. The pooled sensitivity and specificity of chest CT scan for identification of FBA were 0.99 (95% CI: 0.98-0.99) and 0.97 (95% CI: 0.96-0.98), respectively. The pooled positive likelihood ratio was 10.12 (95% CI: 4.59-22.20), and pooled negative likelihood ratio was 0.05 (95% CI: 0.02-0.1). Furthermore, the area under the summarized receiver operating characteristic (SROC) curve was 0.98. Conclusion: Our meta-analysis revealed that despite high heterogeneity, in the diagnostic characteristics of chest CT scan among studies, it has high diagnostic value in identifying FBA in suspected pediatric cases.

Method to Assess Immunosenescent CD8+ T Cells in Respiratory Viral Infections.

Immunosenescence is a well-characterized phenomenon that occurs with increasing age in all immune and somatic cells. In order to best study immunosenescence, it is imperative to develop methods to accurately identify immunosenescent cells. Elderly patients are known to have impaired immune responses to respiratory viruses, and it is hypothesized that this is due, in part, to immunosenescent, terminally exhausted CD8+ T cells. To test this hypothesis, we developed an aged mouse model and a flow cytometry protocol using the Cytek® Aurora to assess the CD8+ T-cell response during respiratory viral infection and identify immunosenescent CD8+ T cells. This protocol and our aged mouse model have great potential to be incredibly valuable for future studies elucidating how to rejuvenate and possibly reverse immunosenescent CD8+ T cells, which could improve the immune response to respiratory viruses in this at-risk population.

Prevalência de Influenza A, vírus sincicial respiratório eSARS-CoV-2 em pacientes com síndrome respiratóriaaguda grave em Passo Fundo, Rio Grande do Sul / Prevalence of Influenza A, respiratory syncytial virus andSARS-CoV-2 in patients with severe acute respiratorysyndrome in Passo Fundo, Rio Grande do Sul

A síndrome respiratória aguda grave (SRAG) é caracterizada por sintomas de febre alta, tosse e dispneia, e, na maioria dos casos, relacionada a uma quantidade reduzida de agentes infecciosos. O objetivo foi avaliar a prevalência dos vírus respiratórios Influenza A (FluA), vírus sincicial respiratório (RSV) e do novo coronavírus (SARS-CoV-2) em pacientes com internação hospitalar por SRAG. Estudo transversal, com pacientes em internação hospitalar com SRAG entre novembro de 2021 e maio de 2022. Dados sociodemográficos e clínicos e amostras da nasofaringe foram coletados/as, as quais foram submetidas à extração de RNA e testadas quanto à positividade para Influenza A, RSV e SARS-CoV-2 por meio da técnica de PCR em tempo real pelo método SYBR Green. Foram incluídos 42 pacientes, sendo 59,5% do sexo feminino, 57,1% idosos, 54,8% com ensino fundamental. A maior parte dos pacientes reportou hábito tabagista prévio ou atual (54,8%), não etilista (73,8%) e 83,3% deles apresentavam alguma comorbidade, sendo hipertensão arterial sistêmica e diabetes mellitus tipo 2 as mais prevalentes. Um total de 10,5% dos pacientes testou positivo para FluA, nenhuma amostra positiva para RSV e 76,3% positivos para SARS-CoV-2. Na população estudada, SRAG com agravo hospitalar foi observado em maior proporção, em mulheres, idosos e pessoas com comorbidades, embora sem significância estatística, sendo o novo coronavírus o agente etiológico mais relacionado, o que evidencia a patogenicidade desse agente e suas consequências ainda são evidentes após quase 2 anos de período pandêmico.

Severe acute respiratory syndrome (SARS) is characterized by symptoms of high fever, cough and dyspnea, and is in most cases related to a reduced amount of infectious agents. The objective was to assess the prevalence of respiratory viruses Influenza A (FluA), respiratory syncytial virus (RSV) and the new coronavirus (SARS-CoV-2) in patients hospitalized for SARS. Cross-sectional study, with patients hospitalized with SARS between November 2021 and May 2022. Sociodemographic and clinical data and nasopharyngeal samples were collected, which were subjected to RNA extraction and tested for positivity for Influenza A, RSV and SARS-CoV-2 using the real-time PCR technique using the SYBR Green method. 42 patients were included, 59.5% female, 57.1% elderly, 54.8% with primary education. Most patients reported previous or current smoking habits (54.8%), non-drinkers (73.8) and 83.3% of them had some comorbidity, with systemic arterial hypertension and type 2 diabetes mellitus being the most prevalent. A total of 10.5% of patients tested positive for FluA, no samples positive for RSV, and 76.3% positive for SARS-CoV-2. In the studied population, SARS with hospital injury was observed more frequently in women and the elderly, with associated comorbidities, with the new coronavirus being the most related etiological agent, which shows, although not statistically significant, that the pathogenicity of this agent and its consequences are still evident after almost 2 years of period pandemic.

Phenotypes based on respiratory drive and effort to identify the risk factors when P0.1 fails to estimate ∆PES in ventilated children.

BACKGROUND: Monitoring respiratory effort and drive during mechanical ventilation is needed to deliver lung and diaphragm protection. Esophageal pressure (∆PES) is the gold standard measure of respiratory effort but is not routinely available. Airway occlusion pressure in the first 100 ms of the breath (P0.1) is a readily available surrogate for both respiratory effort and drive but is only modestly correlated with ∆PES in children. We sought to identify risk factors for P0.1 over or underestimating ∆PES in ventilated children. METHODS: Secondary analysis of physiological data from children and young adults enrolled in a randomized controlled trial testing lung and diaphragm protective ventilation in pediatric acute respiratory distress syndrome (PARDS) (NCT03266016). ∆PES (∆PES-REAL), P0.1 and predicted ∆PES (∆PES-PRED = 5.91*P0.1) were measured daily to identify phenotypes based upon the level of respiratory effort and drive: one passive (no spontaneous breathing), three where ∆PES-REAL and ∆PES-PRED were aligned (low, normal, and high effort and drive), two where ∆PES-REAL and ∆PES-PRED were mismatched (high underestimated effort, and overestimated effort). Logistic regression models were used to identify factors associated with each mismatch phenotype (High underestimated effort, or overestimated effort) as compared to all other spontaneous breathing phenotypes. RESULTS: We analyzed 953 patient days (222 patients). ∆PES-REAL and ∆PES-PRED were aligned in 536 (77%) of the active patient days. High underestimated effort (n = 119 (12%)) was associated with higher airway resistance (adjusted OR 5.62 (95%CI 2.58, 12.26) per log unit increase, p < 0.001), higher tidal volume (adjusted OR 1.53 (95%CI 1.04, 2.24) per cubic unit increase, p = 0.03), higher opioid use (adjusted OR 2.4 (95%CI 1.12, 5.13, p = 0.024), and lower set ventilator rate (adjusted OR 0.96 (95%CI 0.93, 0.99), p = 0.005). Overestimated effort was rare (n = 37 (4%)) and associated with higher alveolar dead space (adjusted OR 1.05 (95%CI 1.01, 1.09), p = 0.007) and lower respiratory resistance (adjusted OR 0.32 (95%CI 0.13, 0.81), p = 0.017). CONCLUSIONS: In patients with PARDS, P0.1 commonly underestimated high respiratory effort particularly with high airway resistance, high tidal volume, and high doses of opioids. Future studies are needed to investigate the impact of measures of respiratory effort, drive, and the presence of a mismatch phenotype on clinical outcome. TRIAL REGISTRATION: NCT03266016; August 23, 2017.

Association between handgrip strength and small airway disease in patients with stable chronic obstructive pulmonary disease.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is associated with airflow limitation resulting from a combination of small airway disease (SAD) and parenchymal destruction. Although various diagnostic methods for SAD exist, access to these tools can be limited. OBJECTIVES: This study aimed to explore the correlation between handgrip strength (HGS) and SAD in COPD patients. DESIGN: Cross-sectional prospective study. METHODS: HGS was measured using a hand dynamometer. SAD was evaluated using impulse oscillometry, with results reported as the difference between respiratory resistance at 5 and 20 Hz (R5-R20). SAD was defined as R5-R20 ⩾0.07 kPa/L/s. The receiver operator characteristic (ROC) curves, sensitivity, and specificity values were calculated to determine the optimal cutoff value of HGS for predicting SAD. RESULTS: Sixty-four patients (90.6% male) were included. The average age was 72.1 ± 8.3 years, and body mass index was 23.4 ± 4.2 kg/m2. FEV1 was 71.6 ± 21.3%, and HGS was 30.2 ± 8.1 kg. R5-R20 was 0.11 ± 0.08 kPa/L/s. SAD was found in 64.1% of patients. A negative correlation between HGS and R5-R20 was observed (r = -0.332, p = 0.007). The best cutoff value for HGS in detecting SAD was determined to be 28.25 kg, with a sensitivity of 73.9%, specificity of 65.9%, and an area under ROC curve of 0.685 (95% CI 0.550-0.819, p = 0.015). CONCLUSION: SAD is common in COPD patients, and HGS is significantly negatively correlated with SAD. This tool might serve as an alternative or adjunctive assessment for small airway dysfunction in COPD patients. REGISTRATION: This study was registered with ClinicalTrials.gov with number NCT06223139.

Association of handgrip strength with small airway disease in COPDIn chronic obstructive pulmonary disease (COPD), the condition of small airways (those less than 2 mm wide) is closely linked to disease severity. Small airway disease (SAD) leads to reduced lung function, increased retention of excess gas in the lung, and poorer health in COPD patients. While various diagnostic methods exist for SAD, they may not always be accessible. This study investigated handgrip strength as a potential alternative way to assess SAD. Our findings show a significant negative correlation between handgrip strength and SAD in COPD patients. This suggests that handgrip strength could be used alongside existing methods to evaluate small airway dysfunction in these patients.

Heterogeneous impact of Sighs on mortality in patients with acute hypoxemic respiratory failure: insights from the PROTECTION study.

BACKGROUND: Sigh breaths may impact outcomes in acute hypoxemic respiratory failure (AHRF) during assisted mechanical ventilation. We investigated whether sigh breaths may impact mortality in predefined subgroups of patients enrolled in the PROTECTION multicenter clinical trial according to: 1.the physiological response in oxygenation to Sigh (responders versus non-responders) and 2.the set levels of positive end-expiratory pressure (PEEP) (High vs. Low-PEEP). If mortality differed between Sigh and No Sigh, we explored physiological daily differences at 7-days. RESULTS: Patients were randomized to pressure support ventilation (PSV) with Sigh (Sigh group) versus PSV with no sigh (No Sigh group). (1) Sighs were not associated with differences in 28-day mortality in responders to baseline sigh-test. Contrarily-in non-responders-56 patients were randomized to Sigh (55%) and 28-day mortality was lower with sighs (17%vs.36%, log-rank p = 0.031). (2) In patients with PEEP > 8cmH2O no difference in mortality was observed with sighs. With Low-PEEP, 54 patients were randomized to Sigh (48%). Mortality at 28-day was reduced in patients randomised to sighs (13%vs.31%, log-rank p = 0.021). These findings were robust to multivariable adjustments. Tidal volume, respiratory rate and ventilatory ratio decreased with Sigh as compared with No Sigh at 7-days. Ventilatory ratio was associated with mortality and successful extubation in both non-responders and Low-PEEP. CONCLUSIONS: Addition of Sigh to PSV could reduce mortality in AHRF non-responder to Sigh and exposed to Low-PEEP. Results in non-responders were not expected. Findings in the low PEEP group may indicate that insufficient PEEP was used or that Low PEEP may be used with Sigh. Sigh may reduce mortality by decreasing physiologic dead space and ventilation intensity and/or optimizing ventilation/perfusion mismatch. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov; Identifier: NCT03201263.

Expiratory flow limitation development index (ELDI): a novel method of assessing respiratory mechanics in COPD.

BACKGROUND: Expiratory flow limitation (EFL) can be detected using oscillometric reactance and is associated with a worse clinical presentation in chronic obstructive pulmonary disease (COPD). Reactance can show negative swings upon exhalation, which may develop at different rates between patients. We propose a new method to quantify the rate of EFL development; the EFL Development Index (ELDI). METHODS: A retrospective analysis of data from 124 COPD patients was performed. Data included lung function tests, Impulse Oscillometry (IOS), St Georges Respiratory Questionnaire (SGRQ), modified Medical Research Council (mMRC) scale and COPD Assessment Test (CAT) score. Fifty four patients had repeat data after 6 months. Twenty two patients had data recorded after 5 days of treatment with long acting bronchodilator therapy. EDLI was calculated as the mean expiratory reactance divided by the minimum expiratory reactance. RESULTS: The mean ELDI was used to categorise patients with rapid onset of EFL (> 0.63; n = 29) or gradual onset (≤ 0.63; n = 34). Those with rapid development had worse airflow obstruction, lower quality of life scores, and greater resting hyperinflation, compared to those with gradual development. In patients with EFL, ELDI correlated with symptoms scores, airflow obstruction, lung volumes and gas diffusion. Both EFL and ELDI were stable over 6 months. EFL and EDLI improved with bronchodilator treatment. CONCLUSIONS: COPD patients with rapid EFL development (determined by ELDI) had worse clinical characteristics than those with gradual EFL development. The rate of EFL development appears to be associated with clinical and physiological characteristics.

Characterization of pesticide exposures and their associations with asthma morbidity in a predominantly low-income urban pediatric cohort in Baltimore City.

BACKGROUND: Pesticides may impact respiratory health, yet evidence of their impact on pediatric asthma morbidity is limited, particularly among urban children. OBJECTIVE: To characterize pesticide biomarker concentrations and evaluate their associations with pediatric asthma morbidity among predominantly low-income, Black children in Baltimore City, USA. METHODS: We measured urinary concentrations of 10 biomarkers for pyrethroid insecticides (cyfluthrin:4F-3PBA, permethrin:3PBA), organophosphate insecticides (chlorpyrifos:TCPY, malathion:MDA, parathion:PNP, diazinon:IMPY), and herbicides (glyphosate:AMPA, GPS; 2,4-dicholorphenoxyacetic acid:2,4-D; 2,4,5-tricholorphenoxyacetic acid:2,4,5-T) among 148 children (5-17 years) with established asthma. Urine samples and asthma morbidity measures (asthma symptoms, healthcare utilization, lung function and inflammation) were collected every three months for a year. Generalized estimating equations were used to examine associations between pesticide biomarker concentrations and asthma morbidity measures, controlling for age, sex, race, caregiver education, season, and environmental tobacco smoke. In sensitivity analyses, we assessed the robustness of our results after accounting for environmental co-exposures. RESULTS: Frequently detected (≥90% detection) pesticide biomarker concentrations (IMPY, 3PBA, PNP, TCPY, AMPA, GPS) varied considerably within children over the follow-up period (intraclass correlation coefficients: 0.1-0.2). Consistent positive significant associations were observed between the chlorpyrifos biomarker, TCPY, and asthma symptoms. Urinary concentrations of TCPY were associated with increased odds of coughing, wheezing, or chest tightness (adjusted Odds Ratio, aOR, TCPY:1.60, 95% Confidence Interval, CI:1.17-2.18). Urinary concentrations of TCPY were also associated with maximal symptom days (aOR:1.38, CI:1.02-1.86), exercise-related symptoms (aOR:1.63, CI:1.09-2.44), and hospitalizations for asthma (aOR:2.84, CI:1.08-7.43). We did not observe consistent evidence of associations between the pesticide exposures assessed and lung function or inflammation measures. CONCLUSION: Among predominantly Black children with asthma, we found evidence that chlorpyrifos is associated with asthma morbidity. Further research is needed to assess the contribution of pesticide exposures to pediatric respiratory health and characterize exposure sources among vulnerable populations to inform targeted interventions against potentially harmful pesticide exposures.

How likely are Eastern European and central Asian countries to achieve global NCD targets: multi-country analysis.

BACKGROUND: In Europe, mortality rates from noncommunicable diseases (NCDs) among persons 30-69 years of age ("NCD premature mortality rates") have declined significantly, except in twelve countries of Eastern Europe and Central Asia, namely Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia, Tajikistan, Turkmenistan, Ukraine and Uzbekistan. Data on long-term trends in NCD mortality in these countries are limited. We analyzed NCD premature mortality rates, identified change points in NCD mortality trends and forecasted how likely countries are to achieve the global NCD targets, stratified by gender and NCD type. METHODS: We used the 1990-2019 Global Burden of Disease database to analyze NCD trends and identified country-specific change points by using piecewise linear regression. We assessed the likelihood of achieving the global targets for reducing NCD premature mortality rates among persons 30-69 years of age from four NCDs: cancers, diabetes, cardiovascular and chronic respiratory diseases. The global NCD targets are 25% reduction in mortality from 2010 to 2025 (WHO 25X25 target) and 33%-from 2015 to 2030 (SDG 3.4.1). We applied the analysis to both genders and four NCDs. RESULTS: Only Kazakhstan and Russia are likely to achieve the global NCD targets. For Kazakhstan, WHO 25X25 and SDG 3.4.1 global targets for mortality rates were 494.3 and 374.8 per 100,000 population respectively; the corresponding predicted values (PVs) were 360.6 [CI 260.1-461.1] and 245.1 [CI 113.4-376.8]. For Russia, WHO 25X25 and SDG 3.4.1 global targets were 560.5 and 442.8 per 100,000 population respectively; the corresponding PVs were 427.7 [CI 270.3-585.1] and 311.0 [CI 102.8-519.1]. Achieving NCD global targets is less likely for Kyrgyzstan, while it is unlikely for the rest of countries. Most countries had higher mortality rates and slower progress among men compared with women. The likelihood of achieving overall global NCD targets was mainly explained by reduction in cardiovascular mortality. CONCLUSIONS: In most Eastern Europe and Central Asia countries, progress towards achieving NCD global targets is slow, or there's a reverse trend. Further quantitative and qualitative research is needed to understand the underlying reasons. Separate indicators are needed to monitor trends for cancers, diabetes and chronic respiratory diseases.

The clinical application of metagenomic next-generation sequencing in immunocompromised patients with severe respiratory infections in the ICU.

BACKGROUND: Early targeted antibiotic therapy is crucial for improving the prognosis of immunocompromised patients with severe respiratory infections (SRIs) in the intensive care unit (ICU). Metagenomic next-generation sequencing (mNGS) has shown significant value in pathogen detection, but research on lower respiratory tract microorganisms remains limited. METHODS: This study enrolled 234 patients with SRIs in the ICU, and individuals were categorized into immunocompromised and immunocompetent groups. We compared the diagnostic performance of mNGS using bronchoalveolar lavage fluid (BALF) with conventional microbiological tests (CMTs) and analyzed the value of mNGS in immunocompromised patients with SRIs in the ICU. RESULTS: Among all patients, the pathogenic microorganism detection rate of mNGS was higher than that of CMTs (94.02% vs 66.67%, P < 0.05), both in the immunocompromised group (95.0% vs 58.75%, P < 0.05) and the immunocompetent group (93.51% vs 71.43%, P < 0.05). mNGS detected more pathogens than CMTs did (167 vs 51), identifying 116 organisms that were missed by CMTs. The proportion of antibiotic regimen adjustments based on mNGS results was significantly higher compared to CMTs in both the immunocompromised (70.00% vs 17.50%, P < 0.05) and immunocompetent groups (48.70% vs 15.58%, P < 0.05). In the immunocompromised group, patients who had their antibiotic treatment adjusted on mNGS results had improved prognosis, with significantly lower ICU mortality (8.93% vs 50%, P < 0.05) and 28-day mortality rates (30.36% vs 68.75%, P < 0.05) than CMTs. In the immunocompetent group, no statistically significant differences were observed in ICU mortality or 28-day mortality (20.00% vs 33.33%, P > 0.05; 42.67% vs 45.83%, P > 0.05). CONCLUSION: mNGS shows significant value in detecting pathogens in immunocompromised patients with SRIs in ICU. For immunocompromised patients who respond poorly to empirical treatment, mNGS can provide an etiological basis, helping adjust antibiotic regimens more precisely and thereby improving patient prognosis.

Obstructive Ventilatory Dysfunctions-Functional Assessment and Rehabilitation Program.

BACKGROUND: Obstructive ventilatory dysfunctions have an increased incidence, and through functional assessment determined by the International Classification of Functioning, Disability and Health (ICF), appropriate treatment can be established. AIMS: The objectives of our research are represented by the application of respiratory rehabilitation sessions according to the ICF in patients with obstructive ventilatory dysfunctions-with COPD or asthma, using a unique, international language and the evaluation of the results obtained before and after completion pulmonary rehabilitation. METHODS: We conducted a randomized prospective study between November 2022-April 2023, which included 84 patients diagnosed with obstructive ventilatory dysfunctions and who performed respiratory rehabilitation. They were divided into two categories: category 1-C1 which included 43 patients with Chronic Obstructive Pulmonary Disease-COPD and category 2-C2 which included 41 patients diagnosed with asthma. The rehabilitation program lasted 8 weeks, with exercises performed from Monday to Friday, with a weekend break. Respiratory rehabilitation consisted of physical therapy, inspiratory and expiratory muscle training (IEMT), proper nutrition, and psychotherapy. RESULTS: At the end of the program, most of the patients showed improvements in the ICF qualifiers, a fact that supported us that respiratory recovery is one of the basic therapies of patients with obstructive ventilatory dysfunctions. CONCLUSIONS: The ICF allows the application of a personalized respiratory rehabilitation program. The ICF qualifiers are used for the functional assessment of patients and allow they to be included in individualized medical rehabilitation programs.

Implementation of a Virtual Pulmonary Physiology Course in Latin America.

Background: Knowledge of respiratory physiology is essential for the diagnosis and treatment of respiratory diseases. During the coronavirus disease (COVID-19) pandemic, face-to-face education was inadequate, leading to the implementation of virtual programs for pulmonary fellows from Latin America. Objective: This study describes our experience with the implementation of a virtual education program involving pulmonary function tests (PFTs) for pulmonary fellows in Latin America. Methods: A learning program on PFTs was designed by the Department of Respiratory Physiology at the National Institute of Respiratory Diseases in Mexico City, and fellows in pulmonology were invited to participate in the program by their academic professors. The program was performed virtually on an online platform over 3 months. The topics covered included respiratory mechanics, gas exchange, and cardiopulmonary exercise tests. Students were asked to complete an evaluation before and after each lecture as well as before and after the entire course. Results: A total of 205 fellows from 12 countries participated in the course, and fewer than 50% completed assessments before and after the course. The results showed that fellows had relatively high initial knowledge of oxygen desaturation and cardiopulmonary exercise tests, whereas relative deficiencies were found in maximal respiratory pressure and bronchial challenge tests. The highest grade was in the spirometry test, whereas the lowest was in the bronchial challenge test. Overall, the fellows demonstrated improved performance in the post-course evaluations. Conclusion: Virtual education in PFTs is feasible and can have a positive impact on the training of pulmonary fellows from Latin America.

A bibliometric analysis of respiratory mechanics research related to acute respiratory distress syndrome from 1985 to 2023.

Background: Acute respiratory distress syndrome (ARDS) is a severe condition characterized by lung stiffness and compromised gas exchange, often requiring mechanical ventilation for treatment. In addition to its clinical significance, understanding the publication trends and research patterns in respiratory mechanics related to ARDS can provide insights into the evolution of this field from a bibliometric perspective, aiding in strategic planning and resource allocation for future research endeavors. Objective: This study aimed to explore the trends and identify the hotspots in respiratory mechanics research related to ARDS. Methods: All relevant studies on respiratory mechanics of ARDS published between 1985 and 2023 were retrieved from the Web of Science Core Collection (WoSCC), and the retrieval strategy was topic search "TS = respiratory mechanics OR lung mechanics AND TS = ARDS OR acute respiratory distress syndrome." Annual trends, citation patterns, and contributions from countries, institutions, authors, and journals were analyzed using Bibliometrix Biblioshiny. Networks and overlay of authors, institutions, countries, journals, co-citations, and keywords were analyzed and visualized using VOSviewer. Results: Our analysis included 1,248 articles published between 1985 and 2023, revealing fluctuations in publication output over time. The United States emerged as the leading contributor, with Critical Care Medicine being the most prominent journal. Key research themes included mechanical ventilation, acute lung injury, and protective ventilation strategies. International collaboration was evident, facilitating knowledge exchange and interdisciplinary cooperation. Conclusion: Our study sheds light on the evolving landscape of respiratory mechanics research in ARDS. International collaboration is pivotal in advancing the field, while researchers increasingly focus on personalized approaches to address the complexities of ARDS respiratory mechanics.

Acute extreme hypocapnia and diabetic coma in an elderly patient after surgery: A case report.

Hyperglycemia and diabetic ketoacidosis are serious and life-threatening emergencies in diabetes patients. Early recognition of the symptoms of these disorders and their management are essential. Therapy is adequate rehydration, insulin treatment, electrolyte replacement, and handling of the underlying causative disease. Herein, we present an 83-year-old male with an extremely altered blood gas analysis after a surgical procedure of his left hand due to a phlegmon and describe the successful treatment through intensive care.

Mapping a Decade (2014-2024) of Research on Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome: A Visual Analysis with CiteSpace and VOSviewer.

Background: Acute Respiratory Distress Syndrome (ARDS) stands as a primary cause of mortality among critically ill patients. Extracorporeal Membrane Oxygenation (ECMO) is increasingly employed in the rescue therapy of ARDS patients. However, the current status of research in the field of ECMO-assisted ARDS remains unclear. Objective: This research aims to categorize and evaluate the literature regarding Extracorporeal Membrane Oxygenation (ECMO) support for Acute Respiratory Distress Syndrome (ARDS), offering a comprehensive analysis of bibliometric properties, research hotspots, and developmental trends within the domain of ECMO-assisted ARDS. Methods: A literature search was conducted for ECMO-assisted support for patients with ARDS in the Web of Science Core Collection (WoSCC) database from 2014 to 2024. We employed visualization tools such as CiteSpace and VOSviewer to explore and assess connections among nations, institutions, researchers, and co-cited journals, authors, references, and keywords. Results: This study included 1739 publications. The United States leads in publication volume with Columbia University at the forefront of ECMO research. Intensive Care Medicine has been identified as the most cited journal in this field. Alain Combes from France stands out as a key contributor, particularly in his 2018 publication in the New England Journal of Medicine, which is the most cited work in the discipline. Furthermore, keyword analysis identified three distinct research phases: examining complications associated with ECMO therapy, exploring optimal strategies for mechanical ventilation under ECMO support, and compiling insights into the application of ECMO in treating COVID-19 patients and in the development of predictive models for patient outcomes. Conclusion: Using bibliometric visualization techniques, this study revealed significant progress in the use of ECMO for treating ARDS respiratory support, evaluated the impact of these findings, and outlined potential areas for future studies.

Ethanolic Extract from Echinacea purpurea (L.) Moench Inhibits Influenza A/B and Respiratory Syncytial Virus Infection in vitro: Preventive Agent for Viral Respiratory Infections.

Among the most frequent causes of respiratory infections in humans are influenza A virus H1N1 (H1N1), influenza B virus (IVB), and respiratory syncytial virus (RSV). Echinacea is a perennial wildflower belonging to the Asteraceae family. Echinacea purpurea (L.) Moench is a species belonging to the Echinacea genus. Its characteristic compound, chicoric acid (CA), is known for its physiological activities, including antiviral effects and immune enhancement. Activities of E. purpurea 60% ethanol extract (EPE) and CA in inhibiting infections caused by H1N1, IVB, and RSV subtype A (RSV-A) were evaluated through plaque inhibition tests, quantification of viral gene expression, and analysis of transmission electron microscopy (TEM) images. Additionally, inhibitory activities of EPE and CA for hemagglutination and neuraminidase (NA) of H1N1 and IVB were determined. In the plaque reduction assays, both EPE and CA reduced infectivity against H1N1, IVB, and RSV-A. Furthermore, quantitative real-time polymerase chain reaction analysis revealed that EPE and CA reduced gene expression levels for H1N1, IVB, and RSV-A, whereas TEM image analysis confirmed their inhibitory effects on host cell infection by these viruses. Hemagglutination assays exhibited the ability of EPE and CA to hinder H1N1 and IVB attachment to host cell receptors. Furthermore, EPE and CA displayed inhibition activity against the NA of H1N1 and IVB. These findings suggest that EPE and CA can suppress the infection and propagation of H1N1, IVB, and RSV-A, demonstrating their potential as preventive and therapeutic agents for viral respiratory infections or as ingredients for health functional foods.

Monkeypox: A Growing Concern for Pulmonary Health.

The re-emergence of monkeypox as a significant global health concern has highlighted the need to reassess its clinical presentation, particularly its impact on pulmonary health. Traditionally associated with dermatological symptoms, recent outbreaks in non-endemic regions have underscored the virus's potential for widespread transmission and respiratory complications. Emerging evidence indicates that monkeypox infection can lead to respiratory symptoms such as cough, sore throat, and, in severe cases, pneumonia and acute respiratory distress syndrome (ARDS). The virus's capacity for respiratory transmission, coupled with the potential for coinfection with other respiratory pathogens, poses significant challenges for clinical management. Understanding the pathophysiology of monkeypox's impact on the lungs, which may involve direct viral invasion and immune-mediated damage, is critical for developing effective public health strategies. As monkeypox continues to spread, recognizing and addressing its respiratory complications will be essential in mitigating severe outcomes, particularly in vulnerable populations with pre-existing pulmonary conditions.