Monaldi Archives for Chest Disease最新文献

{"title":"Pentraxin-3 as a novel biomarker in predicting outcomes of nosocomial pneumonia: a prospective observational study.","authors":"Isha Garg, Nishant Kumar Chauhan, Harsh Vardhan, Shrimanjunath Sankanagoudar, Naveen Dutt, Gopal Durgeshwar, Hariharan Iyer, Nikhil Kothari, Ravisekhar Gadepalli, Deepak Kumar","doi":"10.4081/monaldi.2025.3225","DOIUrl":"https://doi.org/10.4081/monaldi.2025.3225","url":null,"abstract":"<p><p>Pneumonia, among all nosocomial infections, is known for its dismal prognosis, imposing substantial morbidity and mortality. While the diagnostic performance of various blood biomarkers has undergone scrutiny, their prognostic implications remain relatively unexplored. This study aimed to evaluate the prognostic significance of clinical factors, microbial etiology, and blood biomarkers, including procalcitonin, C-reactive protein (CRP), and pentraxin-3, in determining the outcome of nosocomial pneumonia. We enrolled 72 patients with microbiologically confirmed hospital-acquired pneumonia (HAP) or ventilator-associated pneumonia (VAP). Patient data comprising demographics, comorbidities, duration of hospitalization, isolated pathogen, and laboratory parameters, including CRP, procalcitonin, and pentraxin-3 levels, were compiled to assess their correlation with 28-day survival outcomes. The study included 58 VAP and 14 HAP patients. The mean age was 52.78±16.98 years, and the majority were males (68.06%). Out of 72, 30 (41.67%) died. Carbapenem-resistant Acinetobacter baumannii (44.44%) and Carbapenem-resistant Enterobacteriaceae (25%) were the most common isolated pathogens. On univariate analysis, male gender, smoking, opium addiction, underlying neurological condition as comorbidity, presence of septic shock, elevated blood urea, and serum pentraxin-3 levels were significantly associated with 28-day mortality. However, multivariate analysis of subgroup data revealed serum pentraxin-3 levels to be an independent risk factor for mortality in VAP patients. Serum pentraxin-3 levels may be a potential and superior prognostic marker compared to CRP and procalcitonin in predicting mortality in VAP patients.</p>","PeriodicalId":51593,"journal":{"name":"Monaldi Archives for Chest Disease","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144287039","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":"Impact of antifibrotics on post-COVID-19 lung sequelae.","authors":"Yosri Mohamed Kamel Akl, Youssef Amin Soliman, Sabah Ahmed Mohamed, Afnan Nabil Fatehi Abdelghaffar, Aml Ibrahim Bayoumi","doi":"10.4081/monaldi.2025.3301","DOIUrl":"https://doi.org/10.4081/monaldi.2025.3301","url":null,"abstract":"<p><p>Respiratory problems in acute COVID-19 and post-acute COVID-19 syndrome vary greatly, potentially leading to long-term functional difficulties. Off-label usage of antifibrotics, such as pirfenidone, has emerged as a promising treatment for post-COVID interstitial lung problems. Our study aims to assess clinical and radiological lung abnormalities post-COVID-19 and the effect of antifibrotics on the outcome. A retrospective observational study examined data from 90 COVID-19 patients who completed the follow-up period in the post-COVID clinic at the Chest Department, Kasr El Ainy Hospital, from August 2020 to August 2022. Demographic data, comorbidities, exercise tolerance, and chest computed tomography (CT) results were collected 1 and 6 months after the diagnosis. Initial CT scans (1 month following hospital admission) revealed diffuse ground-glass opacities (87.8%) and reticulations (43.3%). After 6 months, 33.3% were back to normal, 41% had persistent reticulations, 22.2% had ground glass opacities, and 3.3% had bronchiectasis. CT scores improved dramatically after 6 months. No significant link was detected between CT score change and off-label use of pirfenidone. Antifibrotic therapy has a modest effect on post-COVID lung problems. One-third of patients showed reticulations as persistent radiological abnormalities, which could guide future treatment choices.</p>","PeriodicalId":51593,"journal":{"name":"Monaldi Archives for Chest Disease","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144276572","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":"Role of inhaled corticosteroids/formoterol in relieving acute asthma as compared to traditional salbutamol in children 6 to 11 years old on maintenance and reliever therapy step 3 and above as per the Global Initiative for Asthma guideline.","authors":"Danish Abdul Aziz, Werdah Viquar","doi":"10.4081/monaldi.2025.3355","DOIUrl":"https://doi.org/10.4081/monaldi.2025.3355","url":null,"abstract":"<p><p>The recent Global Initiative for Asthma (GINA) guidelines offer two reliever therapy options for patients on step 3 and above: the more popularly used short-acting β-agonists (SABA) and the newly introduced inhaled corticosteroids (ICS)-formoterol combination. Our aim was to assess the effectiveness of the ICS/formoterol combination in comparison to the traditional SABA offered to patients aged 6-11 years old following step 3 and above of the GINA guidelines. A retrospective study was conducted at a tertiary care facility in Karachi, Pakistan. The study involved children aged 6-11 years old who were admitted with an asthma exacerbation and were subsequently discharged on step 3 and above as per the GINA guidelines for 3 months. The patients were then categorized into two groups depending on the type of reliever used (ICS/formoterol or salbutamol). There were 80 pediatric patients enrolled in our study. The emergency room visits with asthma exacerbation in 3 months following discharge were significantly lower in the ICS/formoterol reliever group (1.27±0.83) than in the salbutamol reliever group (1.93±1.36) (p=0.01). Mean admission with asthma in 6 months post-discharge was significantly higher in the salbutamol group (2.18±0.82) as compared to the ICS/formoterol group (1.24±0.83). Moreover, the number of patients requiring step-up control within 3 months of discharge was also significantly lower in the ICS/formoterol group, with 2 patients, than the salbutamol group, with 10 patients (p=0.02). The forced expiratory volume in 1 second value 3 months after discharge was significantly greater in the ICS/formoterol group (91.27±8.32) than in the salbutamol group (84.58±10.44) (p=0.02). Through our analysis, we were able to highlight the superiority of ICS/formoterol as a reliever compared to SABA for moderate asthma.</p>","PeriodicalId":51593,"journal":{"name":"Monaldi Archives for Chest Disease","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144276573","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":"Refractory supraventricular tachycardia from a coronary sinus diverticulum leading to cardiogenic shock: a challenging ablation case.","authors":"Marta Catarina Bernardo, Isabel Moreira, Catarina Ribeiro Carvalho, José Pedro Guimarães, Luís Adão, Sílvia Leão, Sofia Silva Carvalho, José Ilídio Moreira","doi":"10.4081/monaldi.2025.3385","DOIUrl":"https://doi.org/10.4081/monaldi.2025.3385","url":null,"abstract":"<p><p>A 58-year-old male with a past medical history of radiofrequency ablation of a concealed posteroseptal accessory pathway presented to the emergency department with palpitations and acute heart failure. The electrocardiogram showed narrow QRS tachycardia with a heart rate of 170 bpm. Despite boluses of adenosine and amiodarone perfusion, the patient experienced recurrent supraventricular tachycardia (SVT), leading to cardiogenic shock. Extracorporeal membrane oxygenation was initiated for hemodynamic support. Electrophysiologic study identified an accessory pathway in a coronary sinus diverticulum. Successful radiofrequency ablation was performed, resulting in clinical and left ventricular ejection fraction improvement. This case highlights the challenges in managing incessant SVT with cardiogenic shock and complex ablation procedures.</p>","PeriodicalId":51593,"journal":{"name":"Monaldi Archives for Chest Disease","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144267879","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":"Asthma-chronic obstructive pulmonary disease misdiagnosis: cause for concern or false alarm?","authors":"M S Barthwal, Rahul Tyagi, Shrinath V, Manu Chopra, Kislay Kishore","doi":"10.4081/monaldi.2025.3452","DOIUrl":"https://doi.org/10.4081/monaldi.2025.3452","url":null,"abstract":"<p><p>Chronic obstructive pulmonary disease (COPD) and asthma are both heterogeneous disorders characterized by overlapping respiratory symptoms. Due to overlapping symptoms and underuse of spirometry, there is often misdiagnosis between these two disorders. A cross-sectional observational study was carried out at the respiratory outpatient department (OPD) of a tertiary care respiratory center in western Maharashtra for 1 year. All patients over the age of 40 who were diagnosed with asthma or COPD and were referred to the respiratory OPD for management or were already under follow-up at the center were included in the study. Questionnaires and spirometry were used to evaluate all patients. A total of 85 patients who met the inclusion criterion without any exclusion requirements were included; 5 patients out of 45 who were initially labelled as having asthma (11.11%) and 29 patients out of 40 who were initially labelled as having COPD (72.5%) were found to have been misdiagnosed according to study protocol. In conclusion, there is a significant prevalence of misdiagnosis amongst obstructive airway disease. The patients with a diagnostic label of COPD are more likely to be misdiagnosed due to a lack of knowledge of diagnostic protocol, underuse and misinterpretation of spirometry, and overreliance on chest radiography. Use of spirometry is dismally low and correlates with other studies from India. The study clearly indicates the urgent requirement of educating doctors, especially primary care clinicians, about the correct diagnostic protocols used in the diagnosis of COPD and bronchial asthma.</p>","PeriodicalId":51593,"journal":{"name":"Monaldi Archives for Chest Disease","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144259365","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":"Evaluation of fibroblast growth factor 23 as a marker of severity in stable chronic obstructive pulmonary disease.","authors":"Simarpreet Singh, Surabhi Jaggi, Seema Gupta, Deepak Aggarwal, Mandeep Kaur Sodhi, Chahat Bhatia, Varinder Saini","doi":"10.4081/monaldi.2025.3271","DOIUrl":"https://doi.org/10.4081/monaldi.2025.3271","url":null,"abstract":"<p><p>Chronic obstructive pulmonary disease (COPD), a multi-component disease, is one of the leading causes of morbidity and mortality globally. Considering the drawbacks of current severity markers of COPD, there is a need to find newer alternatives that are easily accessible and provide insight into the underlying pathophysiology of the disease. This study evaluated fibroblast growth factor 23 (FGF23), a pro-inflammatory hormone, as a severity marker for COPD. A total of 54 stable COPD patients were recruited as per the inclusion and exclusion criteria. All participants were subjected to spirometry and body plethysmography with diffusion capacity of lungs for carbon monoxide (DLCO) evaluation. Plasma FGF23 levels were measured for all participants. This study aimed to evaluate FGF23 as a severity indicator of COPD, along with its association with serum phosphate levels, static lung volumes, and DLCO. The mean age of the study population (n=54) was 59±11 years. The majority of study participants had moderate COPD (50%), followed by severe (27.8%), mild (20.4%), and very severe (1.9%). The mean plasma FGF23 value observed was 115±169 pg/mL. A significant negative correlation was observed between FGF23 levels and forced expiratory volume in 1 second (FEV1) (% predicted), demonstrating the diagnostic role of FGF23. The phosphaturic action of FGF23 was validated by a strong negative correlation observed between serum phosphate and plasma FGF23 levels. Receiver-operating characteristic curve analysis of FGF23 showed that cut-off levels of 73.71 pg/mL can be used to distinguish mild to moderate COPD from severe to very severe, with a sensitivity and specificity of 62.5% and 68.4%, respectively. FGF23 levels were found to be significantly increased in individuals with poor lung function and compromised lung volumes. FGF23 levels were negatively correlated with FEV1 (% predicted) and can be used as a potential severity marker. Hence, plasma FGF23 levels showed a promising role as a severity marker of COPD.</p>","PeriodicalId":51593,"journal":{"name":"Monaldi Archives for Chest Disease","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144259366","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":"Approach to mechanical ventilation: a simplified approach for a pulmonologist.","authors":"Pratap Upadhya, Sanjana H S, Harshith R, Vemuri Mahesh Babu, Karthik Balasoupramaniane, Zeenathaalam Nadaf","doi":"10.4081/monaldi.2025.3476","DOIUrl":"https://doi.org/10.4081/monaldi.2025.3476","url":null,"abstract":"<p><p>Mechanical ventilation is a critical intervention for patients with respiratory failure, providing essential support for oxygenation and ventilation while reducing the work of breathing. It operates through key breath-phase variables: triggering (breath initiation), targeting (flow or pressure delivery), and cycling (ending inspiration). Various ventilation modes, including invasive and non-invasive methods, are tailored to patient needs. Non-invasive ventilation and high-flow nasal cannula are first-line options in acute respiratory distress, whereas invasive mechanical ventilation is necessary for severe cases. Optimal ventilatory strategies aim to prevent complications such as barotrauma, volutrauma, and dynamic hyperinflation by carefully adjusting parameters like tidal volume, respiratory rate, and positive end-expiratory pressure. One major challenge in mechanical ventilation is patient-ventilator dyssynchrony, where the patient's respiratory efforts do not align with the ventilator's cycles, leading to increased work of breathing and discomfort. Dyssynchrony can occur during the trigger, target, or cycle phases, requiring waveform analysis and ventilator adjustments to optimize synchrony. Weaning from mechanical ventilation follows a structured process involving readiness assessment, spontaneous breathing trials, and extubation. Successful weaning depends on maintaining stable respiratory function, with close monitoring to prevent post-extubation failure. Identifying and managing ventilatory complications, optimizing patient comfort, and ensuring an individualized approach to ventilator management are key to improving patient outcomes. This review provides a comprehensive understanding of mechanical ventilation, its principles, common challenges, and weaning strategies to guide effective clinical decision-making.</p>","PeriodicalId":51593,"journal":{"name":"Monaldi Archives for Chest Disease","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144259364","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":"Infective endocarditis and oral health: a long-known threat, still a challenge.","authors":"Mohamed Alsergani, Renad Hatim Zaini, Naji Al Kholaif, Mohammed Al Admawi, Maria Teresa Savo, Dan Alexandru Cozac, Donatella Tansella, Basil Ali Aladani, Sara Di Michele, Valeria Pergola","doi":"10.4081/monaldi.2025.3497","DOIUrl":"https://doi.org/10.4081/monaldi.2025.3497","url":null,"abstract":"<p><p>Infective endocarditis (IE) remains a life-threatening condition associated with high morbidity and mortality, often influenced by the complex interplay between systemic and oral health. The increasing recognition of oral health as a risk modifier has led to greater focus on the oral microbiome, dental procedures, and periodontal disease as potential contributors to bacteremia and IE. This review critically examines the relationship between oral health and IE, exploring pathophysiological mechanisms, risk factors, and the evolving epidemiology of the disease. The discussion includes diagnostic challenges, particularly in culture-negative cases, and the emerging role of advanced imaging and molecular diagnostics in improving early detection. A central focus is placed on preventive strategies, highlighting the debate surrounding antibiotic prophylaxis (AP) in high-risk individuals and the potential role of periodontal therapy in reducing systemic inflammation and transient bacteremia. The review also addresses the growing concern of antimicrobial resistance and the necessity of balancing AP recommendations with antimicrobial stewardship. Additionally, this review identifies critical research gaps, including the need for longitudinal studies on the impact of oral health interventions on IE incidence and the importance of interdisciplinary collaboration between dental and medical professionals in optimizing patient care. By synthesizing current guidelines and emerging evidence, this review underscores the necessity of an integrated, multidisciplinary approach to mitigate the burden of IE and establish oral health as a key pillar of infection prevention.</p>","PeriodicalId":51593,"journal":{"name":"Monaldi Archives for Chest Disease","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144175804","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":"Beyond breathlessness: unveiling chronic cough in interstitial lung diseases. A pilot Portuguese cohort.","authors":"Flávia Ferreira, Ana Machado, Vânia Fernandes, Tiago Alfaro, Alda Marques, Ana Oliveira","doi":"10.4081/monaldi.2025.3396","DOIUrl":"https://doi.org/10.4081/monaldi.2025.3396","url":null,"abstract":"<p><p>Dear Editor, Chronic cough, lasting at least 8 weeks, is a prevalent symptom in individuals with interstitial lung disease, posing significant physical, psychological, and social challenges....</p>","PeriodicalId":51593,"journal":{"name":"Monaldi Archives for Chest Disease","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144152816","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":"Post-tuberculosis lung disease patients benefit from vaccinations as other respiratory conditions.","authors":"Giovanni Battista Migliori, Rosella Centis, Lia D'Ambrosio, Dina Visca, Onno W Akkerman, Denise Rossato Silva, Daria Podlekareva, Yousra Kherabi","doi":"10.4081/monaldi.2025.3525","DOIUrl":"https://doi.org/10.4081/monaldi.2025.3525","url":null,"abstract":"<p><p>Dear Editor, A joint statement of the Italian respiratory, infectious diseases and public health societies has been recently published on the best vaccination strategies in respiratory disease...</p>","PeriodicalId":51593,"journal":{"name":"Monaldi Archives for Chest Disease","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144152853","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}