Monaldi Archives for Chest Disease最新文献

{"title":"Interferon-γ release assay.","authors":"Malay Sarkar, Jasmine Sarkar","doi":"10.4081/monaldi.2025.3258","DOIUrl":"10.4081/monaldi.2025.3258","url":null,"abstract":"<p><p>Traditionally, tuberculosis (TB) has been viewed as having two distinct manifestations, known as TB infection (TBI) and TB disease. The spectrum, however, has recently been expanded to include the elimination of TBI with the help of innate and/or adaptive immunity, TBI, incipient and subclinical TB disease, and TB disease. Epidemiologically speaking, identifying individuals with TBI is critical since diagnosis and treatment of TBI are essential in controlling the TB burden. It is important to identify high-risk individuals with TBI who are more likely to progress to active TB disease. There are two diagnostic methods for identifying TBI. These include the conventional tuberculin skin test (TST) and interferon-γ release assay (IGRA). However, these methods are not the 'gold standard.' Furthermore, all of these methods are indirect, relying on the host's adaptive immune response to Mycobacterium tuberculosis-derived protein antigens. This review will describe the various tests for TBI, such as TST, IGRAs, newer skin and blood tests, methods for performing IGRAs, interpretation strategies, and limitations.</p>","PeriodicalId":51593,"journal":{"name":"Monaldi Archives for Chest Disease","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144978059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sonographic diaphragmatic parameters as a predictor of weaning failure in critically ill patients in need of invasive mechanical ventilation: a prospective observational cohort study.","authors":"Prathmesh G Kumbhar, Manvinder Tejpal, Sunaina T Karna, Pooja Singh, Saurabh Saigal, Vaishali Waindeskar","doi":"10.4081/monaldi.2025.3548","DOIUrl":"https://doi.org/10.4081/monaldi.2025.3548","url":null,"abstract":"<p><p>Weaning from invasive mechanical ventilation is difficult in critically ill patients, with diaphragmatic dysfunction being a key factor. This prospective observational study aimed to estimate key sonographic diaphragmatic parameters-thickness, thickening fraction, and excursion-in critically ill patients needing invasive mechanical ventilation and evaluate their association with weaning from mechanical ventilation. Over 18 months, adult patients needing mechanical ventilation were studied in a tertiary care hospital's medical intensive care unit. Besides the demographic and clinical parameters, the sonographic diaphragmatic thickness, thickening fraction, and excursion (DE) were measured via ultrasound at two points: before intubation and at the first spontaneous breathing trial. Patients were followed for 28 days after recruitment in the study to determine weaning outcomes, which were classified as simple or complicated (which included both difficult and prolonged). The baseline diaphragmatic parameters were compared between the outcome groups to determine clinically significant predictors of simple weaning. Out of the 70 patients enrolled in the study, final analysis was possible for 50 of them. Weaning was simple and complicated in 30 and 20 patients, respectively. DE was significant in predicting simple versus complicated weaning (p<0.001). The receiver operating characteristic curve displayed the cut-off of 10.5 mm with an area under the curve of 0.986 (95% confidence interval: 0.903-1.000), with p<0.0001. The test demonstrated a sensitivity of 96.77% and a specificity of 100%. Patients with pre-intubation DE<10.5 mm needed more days for weaning [median (interquartile) range of 8 (7-40)] and intensive care [16.50 (10-50)] as compared to those with DE>10.5 mm [4 (2-40)] and 8.50 (5-52)], which was significant with p<0.001. In conclusion, pre-intubation sonographic DE of less than 10.5 mm can effectively predict complicated weaning and may be an adjunct in prognostication.</p>","PeriodicalId":51593,"journal":{"name":"Monaldi Archives for Chest Disease","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144876713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations between sedentary behavior, physical activity frequency, and asthma: insights from the National Health and Nutrition Examination Survey 2009-2018.","authors":"Yanhao Chen, Xiang Li, Mengqi Wu, Jiaqi Peng, Jiao Zhang, Jie Bao, Yongsheng Fan, Shuo Huang","doi":"10.4081/monaldi.2025.3491","DOIUrl":"https://doi.org/10.4081/monaldi.2025.3491","url":null,"abstract":"<p><p>This study aimed to explore the relationship between sedentary time and asthma prevalence and to examine the relationship between physical activity, sedentary behavior, and asthma symptom improvement among individuals with a history of asthma. As a cross-sectional study, the associations observed do not imply causation. Utilizing data from five survey cycles (2009-2018), the study analyzed sedentary time and physical activity frequency using multivariate logistic regression and generalized additive models. Subgroup analyses and interaction tests evaluated demographic influences on the relationship between sedentary behavior and asthma. Results indicated that extended sedentary behavior was significantly associated with a higher likelihood of asthma, with individuals sitting more than 8 hours daily having 35% greater odds of having asthma. Reduced sedentary time and moderate physical activity may be associated with a lower likelihood of reporting current asthma, with a significant reduction observed when moderate activity occurred ≤2 times per week.</p>","PeriodicalId":51593,"journal":{"name":"Monaldi Archives for Chest Disease","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144876783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health-related quality of life based on the European Questionnaire 5D-5L utility score in patients with multidrug-resistant tuberculosis.","authors":"Oki Nugraha Putra, Nur Indah, Fristia Rif'atul Chumaidah, Telly Purnamasari, Muhammad Arif Saifudin","doi":"10.4081/monaldi.2025.3450","DOIUrl":"https://doi.org/10.4081/monaldi.2025.3450","url":null,"abstract":"<p><p>Patients' health-related quality of life (HRQOL) is negatively impacted by multidrug-resistant tuberculosis (MDR-TB). The HRQOL of MDR-TB patients was assessed in this study using the European Questionnaire 5D-5L (EQ-5D-5L) utility score and HRQOL-related parameters. We conducted a case-control study at the Haji Hospital from June to December 2024. MDR-TB patients and drug-sensitive (DS-TB) patients were divided into case and control groups, respectively. The HRQOL utility score and depression levels were measured using the Indonesian EQ-5D-5L and Patient Health Questionnaire-9 (PHQ-9), respectively. This study included 84 TB patients, 36 and 48 of whom had MDR-TB and DS-TB, respectively. Patients with DR-TB had a significantly higher PHQ-9 score (7.55±5.97 vs. 4.69±4.21; p=0.047) than patients with DS-TB. When compared to the control group, the case's EQ-5D-5L and EQ Visual Analog Scale utility scores were considerably lower, at 0.86±0.11 and 69.30±16.65 (p=0.005) against 0.92±0.07 and 80.70±15.53 (p=0.002), respectively. The EQ-5D-5L utility score was considerably lower in DR-TB patients with depression and a history of TB treatment. In conclusion, the HRQOL of MDR-TB patients was low. Among MDR-TB patients, depression and TB treatment history were associated with quality of life. This study provides insight into the need for healthcare practitioners to evaluate patients' HRQOL, particularly for those with risk factors.</p>","PeriodicalId":51593,"journal":{"name":"Monaldi Archives for Chest Disease","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144876785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nafithromycin: advancements in antibiotic therapy against community-acquired pneumonia-resistant pathogens.","authors":"Akshata Gore, Agadi Hiremath Viswanatha Swamy, Sanatkumar Bharamu Nyamagoud","doi":"10.4081/monaldi.2025.3340","DOIUrl":"https://doi.org/10.4081/monaldi.2025.3340","url":null,"abstract":"<p><p>Nafithromycin (WCK 4873) is a novel lactone ketolide antibiotic developed to address the critical issue of multidrug-resistant bacteria, especially those causing community-acquired pneumonia (CAP). Given the increasing prevalence of antibiotic resistance, there is a pressing need for new antibiotics with improved efficacy and safety profiles. This review synthesizes data from various in vitro studies and clinical trials to evaluate the pharmacological properties, mechanism of action, and clinical potential of nafithromycin. Key clinical trials assessed the drug's pharmacokinetics, safety, and efficacy in both healthy volunteers and patients with CAP. Nafithromycin exhibits strong in vitro antimicrobial activity against a broad spectrum of pathogens, including macrolide-resistant and telithromycin-insensitive strains. Clinical trials demonstrated that nafithromycin has a favorable pharmacokinetic profile, with high lung tissue concentrations and manageable side effects. Phase I studies confirmed its safety and tolerability in healthy adults, while Phase II trials showed its efficacy in treating CAP, with a 3-day treatment regimen proving comparable to a seven-day regimen of moxifloxacin. Nafithromycin holds significant promise as a therapeutic agent against respiratory infections caused by resistant bacteria. Its unique mechanism of action, high tissue penetration, and broad-spectrum activity position it as a valuable addition to the antimicrobial arsenal. Continued research and clinical trials are essential to further define its role in combating antibiotic resistance and ensuring effective treatment options.</p>","PeriodicalId":51593,"journal":{"name":"Monaldi Archives for Chest Disease","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144876787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Histopathological assessment of thymoma based on the World Health Organization 2021 classification with emphasis on transcapsular invasion: experience from a tertiary care center.","authors":"Saloni Saloni, Renuka Malipatel, Sreekar Balasundaram","doi":"10.4081/monaldi.2025.3354","DOIUrl":"https://doi.org/10.4081/monaldi.2025.3354","url":null,"abstract":"<p><p>Histological classification and staging are crucial in the management and prognostication of thymoma. With different staging systems used, the significance of transcapsular invasion is debatable, especially in light of pathological tumor-node-metastasis (pTNM) staging (American Joint Committee on Cancer, 8th edition). The objective of this study was to analyze the histological subtypes, transcapsular invasion, and clinical outcome of thymoma with regard to the World Health Organization (WHO) 2021 classification. This retrospective study included all thymectomy specimens diagnosed as thymoma over a period of 10 years, from 2013 to 2023. Clinical details and histopathology slides were reviewed and histologically subtyped as per the WHO 2021 classification. Transcapsular invasion was assessed, and pTNM and modified Masoka staging were done. Descriptive statistics were used to summarize data. A total of 45 thymoma cases were identified; two with extensive infarction were excluded. The mean age was 46.5 years (range 25-68 years); in this study, there were 28 males and 15 females with a male-to-female ratio of 1.8:1. Myasthenia gravis was the presenting feature in 31 (72.9%) cases. B2 and B3 subtypes constituted half of the cases (22/43), with mixed patterns in 4 (9.3%). A total of 9 cases showed macroscopic invasion, 80% being the B3 subtype, and out of the 23 cases that showed transcapsular invasion, the three most common subtypes are listed here, with B3 being the most common, followed by AB and B2. Masaoka staging showed 11 (25.5%) stage I, 22 stage IIa (51.1), 6 stage IIb (13.9%), 1 stage III (2.3%), 2 stage IVa (4.6%), and 1 stage IVb (2.3%). Follow-up available in 38 out of 43 cases (range 4-127 months) showed recurrence in one case of the B3 subtype, stage IVb. None of the stage I and stage II (as per Masoka staging) patients had recurrence. The Masaoka stage is a widely used staging system where transcapsular invasion is an important parameter for upgrading stage I to stage II. However, in the present study, Masaoka stage I and II patients had no recurrence, questioning the significance of capsular invasion for staging. Accurate histological subtyping in thymoma is challenging but can be achieved by adherence to the morphological criteria of the WHO 2021 classification.</p>","PeriodicalId":51593,"journal":{"name":"Monaldi Archives for Chest Disease","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144876786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating hematological and inflammatory biomarkers in tuberculosis management.","authors":"Sanatkumar Bharamu Nyamagoud, Princy Domnic Dsouza, Sai Phalguna Prakash Chitralu, Kadambari Solankure, Agadi Hiremath Viswanatha Swamy","doi":"10.4081/monaldi.2025.3433","DOIUrl":"https://doi.org/10.4081/monaldi.2025.3433","url":null,"abstract":"<p><p>Tuberculosis (TB) remains a significant public health concern, particularly in resource-limited settings. Accurate and timely diagnosis and effective monitoring of disease progression and treatment response remain a challenge. This research aims to evaluate the function of hematological and inflammatory biomarkers, including hemoglobin (HB), serum amyloid A (SAA), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and white blood cell (WBC) count, in TB patients. Overall, 80 TB patients were analyzed to evaluate the association of these biomarkers with disease status and demographic characteristics. The findings revealed significant alterations in inflammatory markers, with elevated WBC, SAA, CRP, and ESR levels, indicating an ongoing inflammatory response. Additionally, decreased HB levels were observed, suggesting the presence of anemia, which is commonly associated with chronic infections such as TB. Pearson's correlation analysis revealed a significant negative connection between HB and inflammatory markers, reinforcing the link between anemia and TB-associated inflammation. However, no noteworthy associations were found between biomarker levels and demographic parameters, including age and gender, residence, or treatment duration. These findings emphasize the potential utility of these biomarkers in TB diagnosis, prognosis, and treatment monitoring, especially in regions where advanced diagnostic tools are not readily available. The study suggests that routine hematological and inflammatory markers can serve as cost-effective adjunctive tools in TB administration. Additional investigation is needed to confirm these results and determine their role in predicting treatment outcomes and disease severity.</p>","PeriodicalId":51593,"journal":{"name":"Monaldi Archives for Chest Disease","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144876784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Suction pressures generated during thoracentesis using wall suction-based automated drainage: an <i>in vitro</i> and <i>in vivo</i> analysis.","authors":"Abdias Rodriguez, Anuradha Ramaswamy, Aravind A Menon, Noah Belkhayat, Victoria E Forth, Scott L Schissel, Majid Shafiq","doi":"10.4081/monaldi.2025.3484","DOIUrl":"https://doi.org/10.4081/monaldi.2025.3484","url":null,"abstract":"<p><p>Equipoise exists regarding the optimal method to drain pleural fluid during thoracentesis. While several institutions use wall-based automated suction, others point to the risk of excessively high suction pressures and therefore elevated barotrauma risk as a reason to avoid it. We first performed in vitro experiments involving drainage of a 1-liter saline bag using standard thoracentesis apparatus, a digital manometer, and either manual drainage (using a 60 mL syringe) or automated drainage (using wall suction at the maximum setting). The proceduralist was blinded to measurements during manual aspiration. Separately, in a clinical setting involving consecutive hospitalized adults undergoing thoracentesis, dynamic suction pressures were similarly measured during automated drainage. Total aspirated volume, time-to-evacuation, patient discomfort, and complications were also recorded. In vitro experiments showed that compared to manual aspiration, automated drainage using wall suction resulted in shorter average time-to-evacuation (230 sec vs. 365 sec), lower suction pressures (average maximum: -361±4.5 cmH2O vs. -496±5.1 cmH2O, p<0.0001), and less pressure variation (95% of values within a 20 cmH2O range vs. swings between 0 and -500 cmH2O). Twenty hospitalized adults undergoing thoracentesis via automated drainage (mean aspirated volume: 1649.5±685.5 mL) experienced similar suction pressures to those measured in in vitro experiments using automated drainage (average maximum: -350±59.2 cmH2O) and limited pressure variations (mean interquartile range: 19.3 cmH2O). There were no complications, including pneumothorax, hemothorax, or re-expansion pulmonary edema. Thoracentesis using automated wall suction does not generate excessively high suction pressures and reduces pressure swings. It appears safe and effective and may reduce the time-to-evacuation of a pleural effusion.</p>","PeriodicalId":51593,"journal":{"name":"Monaldi Archives for Chest Disease","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144876714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-invasive ventilation in COVID-19-related acute hypoxemic respiratory failure: a narrative review.","authors":"Luigi Aronne, Raffaella Pagliaro, Angela Schiattarella, Susan Fm Campbell, Maria Vitale, Fabio Perrotta, Klara Komici, Germano Guerra, Andrea Bianco, Filippo Scialò","doi":"10.4081/monaldi.2025.3432","DOIUrl":"https://doi.org/10.4081/monaldi.2025.3432","url":null,"abstract":"<p><p>The high mortality rate and extended ventilator use associated with invasive mechanical ventilation in patients with severe COVID-19 have sparked a debate about the use of non-invasive respiratory support, such as high-flow nasal cannula, continuous positive airway pressure, and non-invasive ventilation (NIV), as treatment options. According to the European Respiratory Society and the American Thoracic Society clinical practice guidelines, NIV is recommended to prevent intubation in hypoxemic acute respiratory failure in patients with community-acquired pneumonia or early acute respiratory distress syndrome without major organ dysfunction. Central to this debate is the role of NIV in managing acute hypoxemic respiratory failure. However, there are concerns that NIV might delay the timely intubation and lung-protective ventilation in patients with more advanced disease, potentially worsening respiratory parameters due to self-inflicted lung injury. This review aims to explore the current literature, focusing on the rationale, patient selection, and outcomes associated with the use of NIV in COVID-19 patients with acute respiratory failure, to better understand its role in this context.</p>","PeriodicalId":51593,"journal":{"name":"Monaldi Archives for Chest Disease","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144700261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vocal resonance: a narrative review.","authors":"Malay Sarkar, Irappa Madabhavi","doi":"10.4081/monaldi.2024.2911","DOIUrl":"10.4081/monaldi.2024.2911","url":null,"abstract":"<p><p>Physical examination is an important ritual of bedside medicine that establishes a strong bond between the patient and the physician. It provides practice to acquire important diagnostic skills. A poorly executed bedside examination may result in the wrong diagnosis and adverse outcomes. However, the ritual of obtaining a patient's history and performing a good clinical examination is declining globally. Even the quality of clinical examination skills is declining. One reason may be the short time spent by physicians at the bedside of patients. In addition, due to the substantial technological advancement, physicians often rely more on technology and consider clinical examinations less relevant. In resource-limited settings, thorough history-taking and physical examinations should always be prioritized. An important aspect of respiratory auscultation is the auscultation over the chest wall to detect abnormalities in the transmission of voice-generated sounds, which may provide an important diagnostic clue. Laënnec originally described in detail three types of voice-generated sounds and named them bronchophonism, pectoriloquism, and egophonism. Subsequently, they are known as bronchophony, whispering pectoriloquy, and egophony. A recent variant of egophony is the E-to-A changes. We searched PubMed, EMBASE, and CINAHL from inception to December 2023. We used the following search terms: vocal resonance, bronchophony, egophony, whispering pectoriloquy, auscultation, etc. All types of studies were chosen. This review will narrate the physics of sound waves, the types of vocal resonance, the mechanisms of vocal resonance, the methods to elicit them, and the accuracy of vocal resonance.</p>","PeriodicalId":51593,"journal":{"name":"Monaldi Archives for Chest Disease","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140869527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}