Respiratory tract infections (RTIs) are among the most common causes of hospital admissions and antibiotic use worldwide, and inappropriate antimicrobial prescribing in such cases significantly contributes to the growing problem of antimicrobial resistance, particularly in tertiary care settings. This prospective observational study was conducted in the Departments of General Medicine and Respiratory Medicine at a tertiary care teaching hospital from March to May 2026 and included 113 adult inpatients (≥18 years) diagnosed with upper or lower RTIs and receiving at least one antimicrobial agent. Data were collected from case records and analyzed using WHO prescribing indicators along with descriptive statistics. The average number of antibiotics prescribed per patient was 1.7. Injectable formulations were predominantly used, accounting for 88% of prescriptions, while oral therapy constituted only 12%. Generic prescribing was observed in 72% of cases, and the mean duration of antimicrobial therapy was 6.2 days. Upper RTIs were the most common diagnosis (42.48%), followed by community-acquired pneumonia (26.55%). Ceftriaxone emerged as the most frequently prescribed antibiotic, used as monotherapy in 26.5% of patients and in combination with azithromycin in 19.5% of cases. A high proportion of prescriptions involved broad-spectrum “Watch” category antibiotics, including piperacillin-tazobactam and meropenem, whereas the use of “Access” antibiotics was relatively limited. Intravenous-to-oral switch therapy was also found to be underutilized. Overall, the study highlights a strong reliance on broad-spectrum and injectable antibiotics in the management of RTIs, with suboptimal utilization of Access-category agents. Although prescribing practices were broadly consistent with guideline recommendations for more severe infections, the excessive use of Watch and Reserve antibiotics indicates a need for stronger antimicrobial stewardship interventions. Enhancing culture-guided therapy, promoting intravenous-to-oral switch strategies, encouraging generic prescribing, and strengthening institutional antimicrobial stewardship programs are essential measures to optimize antibiotic use and help curb antimicrobial resistance in tertiary care settings.
While tuberculosis (TB) propagation is multifactorial, the intersection of biological vulnerability (undernutrition) and cumulative life-course adversities is increasingly recognized as a crucial modifiable determinant. This study aimed to identify the independent biological, socioeconomic, behavioral, and life-course determinants of self-reported TB prevalence among middle-aged and older adults in India. We conducted a cross-sectional analysis using Wave 1 of the Longitudinal Ageing Study in India (LASI, 2017-18). The analytical sample included 59,910 adults aged 45 years and above with non-missing data on TB status and body mass index. The outcome was a self-reported TB diagnosis within the preceding 2 years. Survey-weighted logistic regression was used to examine factors associated with self-reported TB. Firth bias-reduced logistic regression was performed as a sensitivity analysis because of the low prevalence of self-reported TB. Overall, 550 participants (0.92%) reported TB within the preceding two years. Undernutrition was more common among participants with self-reported TB than among those without TB. In adjusted survey-weighted models, undernutrition, history of being bedridden for 1 month or more during childhood, multimorbidity, and residence in the Western region were independently associated with higher odds of self-reported TB. The findings were broadly consistent in the Firth bias-reduced sensitivity analysis. TB prevalence in older Indian adults is independently driven by undernourishment and the cumulative impact of early-life disease/deprivation, alongside the burden of multimorbidity. These findings underscore the need for the National TB Elimination Program to strengthen nutritional support and integrate TB prevention with comprehensive geriatric care and robust pediatric health investments to reduce adult vulnerability.
The treatment success rate for drug-resistant tuberculosis (DR-TB) in Indonesia remains below the national target. Identifying factors associated with unfavorable treatment outcomes is essential to inform more targeted interventions. This retrospective study analyzed medical records of patients with DR-TB who received treatment at Surabaya Haji Hospital between 2020 and 2024. Demographic, clinical, behavioral, and treatment-related variables were evaluated in relation to unfavorable treatment outcomes, defined as a composite outcome of death, treatment failure, or loss to follow-up. Bivariate and binary logistic regression analyses were performed to estimate crude odds ratios and adjusted odds ratios (aORs) with 95% confidence intervals (95% CIs). A total of 90 eligible patients were included in the analysis. Overall, 52 patients (57.8%) achieved a favorable treatment outcome (cure), whereas 38 (42.2%) experienced unfavorable treatment outcomes, including loss to follow-up (42.1%), death (34.2%), and treatment failure (23.7%). In the bivariable analysis, only a history of previous TB treatment was significantly associated with unfavorable treatment outcomes. After adjustment for diabetes mellitus and BCG vaccination history, previous TB treatment remained an independent predictor of unfavorable treatment outcomes (aOR = 11.47; 95% CI: 4.19-31.41; p<0.001). These findings indicate that patients with a history of previous TB treatment are at substantially greater risk of unfavorable treatment outcomes and underscore the need for closer monitoring and more comprehensive management strategies to improve treatment success.
Colchicine is an anti-inflammatory drug that has emerged as a potential treatment option following myocardial infarction (MI). This meta-analysis assesses the efficacy and safety of colchicine in patients following an MI. A comprehensive literature search was performed using the Cochrane Library, ClinicalTrials.gov, Embase, and MEDLINE, covering studies from their inception to December 2025. RevMan was used to perform a random-effects meta-analysis, and forest plots were used to visualize pooled estimates. The Mantel-Haenszel method was applied to analyze dichotomous outcomes. Nine randomized control trials (RCTs) were included in this meta-analysis, including 13,834 patients. The analysis revealed that there was no statistically significant difference between colchicine and placebo groups in all-cause mortality [relative risk (RR)=0.93, confidence interval (CI)=0.78-1.11], cardiac death (RR=0.95, CI=0.73-1.22), MI (RR=0.82, CI=0.67-1.00), stroke (RR=0.64, CI=0.26-1.58), adverse events (RR=1.01, CI=0.85-1.21), serious adverse events (RR=0.96, CI=0.87-1.05), serious gastrointestinal adverse events (RR=1.35, CI=0.94-1.95), and serious infections (RR=1.00, CI=0.62-1.62). However, there was an increased risk of diarrhea in people with colchicine compared to the placebo (RR=2.12, CI=1.35-3.32). This meta-analysis demonstrates that colchicine following an MI does not have a significant impact on cardiovascular events or major adverse events other than an increased risk of diarrhea. There is a need for more comprehensive RCTs with longer follow-up times to fully comprehend the potential cardiovascular benefits of colchicine.
Malignant pleural effusion (MPE) remains a challenging diagnostic entity within the vast spectrum of pleural effusions. While vascular endothelial growth factor (VEGF) is a widely studied MPE biomarker, its diagnostic performance as a standalone marker is limited. There is growing interest in evaluating whether combined biomarker panels may provide incremental diagnostic information and reduce diagnostic uncertainty. This study aims to explore whether integrating matrix metalloproteinase-9 (MMP-9), tissue inhibitor of metalloproteinase-1 (TIMP-1), and monocyte chemoattractant protein-1 (MCP-1) into VEGF provides incremental diagnostic value in distinguishing malignant from benign pleural effusions. A total of 88 pleural fluid samples were analyzed (33 malignant, 55 benign). Biomarker levels were measured using enzyme-linked immunosorbent assay. Diagnostic performance was assessed via receiver operating characteristic analysis, with optimal cut-off values identified using the Youden Index. Logistic regression models were developed for combined biomarker panels and internally validated using 5-fold cross-validation. VEGF demonstrated moderate individual diagnostic value (area under the curve 0.640; sensitivity 72.7%; specificity 58.2%; and diagnostic odds ratio of 3.71). Other individual markers showed limited accuracy. The four-marker panel (VEGF + MMP-9 + TIMP-1 + MCP-1) showed a modest increase in sensitivity, negative predictive value, and diagnostic odd ratio, although specificity remains limited. These findings suggest that combined pleural fluid biomarkers may provide incremental diagnostic information, but their performance remains modest and requires external validation before clinical application.
Concerns about getting cancer may increase the desire to quit smoking in smokers. This study was conducted to determine the level of cancer worry in smokers and the relationship between cancer worry and intention to quit smoking. An online survey was administered to smokers aged 18 years and older without a history of cancer between January and February 2025. The questionnaire included questions about socio-demographic characteristics, the Fagerstrom Test for Nicotine Dependence (FTND), the Cancer Worry Scale (CWS) and the Smoking Cessation Intention Scale (SCIS). The mean age of the participants (n=321) was 33.72 years, and the majority were male (75.1%). Mean scores for FTND, CWS, and SBNS were 4.82±3.16, 15.69±5.02, and 28.11±8.39, respectively. High levels of cancer concern (CWS≥14) were found in 67.3% of smokers. A statistically significant, moderate positive correlation was found between CWS and SCIS scores (r=0.362, p<0.001). Participants' SCIS scores were significantly higher among individuals who were 30 years or older compared to younger participants, in married individuals compared to their unmarried counterparts, and in those with a high level of cancer worry compared to those with a low level of worry. Participants with a high cancer worry level were significantly more likely to think about quitting smoking in the next year than participants with a low worry level (p=0.027). The findings show the positive effect of increased cancer worry on the intention to quit smoking. Increased awareness about cancer may increase motivation to quit smoking.
As cytopathological examination of the pleural fluid (PF) has a low yield, it is difficult to differentiate benign from malignant pleural effusions (PEs). There is still a lack of biomarkers in PF that can reliably help in diagnosing malignant PEs. Diagnostic accuracy in diagnosing malignant PEs is enhanced by the presence of tumor markers in PE. This would raise the likelihood of diagnosing malignant PEs with an unclear cause and starting treatment interventions early to lower morbidity and death rates in the patient. Thus, in an effort to enhance the PE diagnosis, novel PF biomarkers such as cancer ratio, cancer ratio plus, carcinoembryonic antigen (CEA), cancer antigen 125 (CA-125), and calprotectin were evaluated. A total of 108 patients with PEs were taken, and after applying inclusion and exclusion criteria, 83 patients with exudative PE were evaluated. After clinical history and routine blood investigations, PF was sent for cytopathology, biochemical examinations, microbiological examinations for aerobic culture, fungal culture, mycobacterial culture, and biomarker (CEA, CA-125, calprotectin) analyses. Out of 83 patients with exudative PE, malignant effusion was diagnosed in 40 patients, while 43 had benign effusions. PF biomarkers adenosine deaminase (ADA), CEA, cancer ratio, calprotectin, age/ADA and serum lactate dehydrogenase (LDH)/calprotectin ratio showed a statistically significant (p<0.0001) difference between benign and malignant PE. PF CEA showed the highest specificity (97.67%) at the cut-off point of 1.96 ng/mL and age/ADA ratio showed the highest sensitivity (97.5%) at the cut-off point of 1.56 for prediction of malignancy. Cancer ratio, PL calprotectin and serum LDH/calprotectin ratio also showed good sensitivity and specificity for the prediction of malignancy. PF CA-125 showed poor sensitivity (50%) and cancer ratio plus did not reveal any statistically significant difference for prediction of malignancy from benign effusion (p=0.486). PF biomarkers (cancer ratio, CEA, age/ADA ratio, calprotectin, and serum LDH/calprotectin ratio) are reliable indicators of malignancy in exudative pleural effusions. Patients with exudative lymphocytic with unexplained pleural effusion can be addressed early using inexpensive and generally available biochemical indicators, such as pleural fluid CEA, calprotectin, cancer ratio, and serum LDH/calprotectin ratio.
Adenosine deaminase (ADA) in pleural fluid is widely used to support the diagnosis of tuberculous pleural effusion. However, ADA levels between 40 and 60 IU/L represent a gray area where both tuberculous and non-tuberculous conditions can coexist. It can potentially lead to empirical antitubercular therapy and a delay in the diagnosis of other conditions. The aim of this study was to create and validate a prediction model to improve the diagnosis of tuberculosis (TB) in patients with exudative pleural effusions and intermediate ADA levels. This retrospective diagnostic modeling study included 125 consecutive adults with exudative pleural effusions, meeting Light’s criteria, and pleural fluid ADA levels between 40 and 60 IU/L. These patients were referred to a tertiary respiratory care center in northern India. Univariable receiver operating characteristic curve analysis was used to shortlist candidate predictors with an area under the curve (AUC) of ≥0.60 and p≤0.05. A multivariable logistic regression model was developed using the forward stepwise procedure, including ADA, pleural fluid protein, and patient age. The performance of the model was assessed for discrimination, calibration, and classification and compared to the performance of ADA alone. Internal validation was done using 10-fold stratified cross-validation. Of 125 patients, 77 (62%) had TB and 48 (38%) had non‑TB aetiologies (malignancy ≈30%; acute inflammatory/parapneumonic effusion ≈12%; chronic inflammatory conditions ≈6%). The 3‑predictor model achieved an AUC of 0.89 [95% confidence interval (CI) 0.83-0.95] and an overall accuracy of 85%, with sensitivity 89%, specificity 79%, positive predictive value 84% and negative predictive value 86% at a probability cut‑off of 0.50. ADA alone yielded an AUC of 0.72 (95% CI 0.62-0.82) and accuracy of 68%, with sensitivity 70% and specificity 65%. Ten‑fold stratified cross‑validation showed stable performance (mean cross‑validated AUC 0.87±0.04; optimism 0.02). Independent predictors were ADA [odds ratio (OR) 1.24 per IU/L], protein (OR 1.65 per g/dL) and age (OR 0.93 per year; all p<0.001). In exudative pleural effusions with an ADA level of intermediate values, a simple model combining ADA, pleural protein concentration, and patient age improves the diagnostic discrimination for TB over ADA alone, with a marked improvement in negative predictive probability. External validation in a prospective multicenter study is needed before its use in clinical practice.
Chronic obstructive pulmonary disease (COPD) is characterized by progressive airway obstruction and systemic inflammation, frequently accompanied by metabolic comorbidities, including dyslipidemia. The Atherogenic Index of Plasma (AIP), calculated as log10[triglycerides/high-density lipoprotein (HDL)-cholesterol], is strongly associated with atherosclerotic cardiovascular disease risk, yet its relationship with COPD-associated dyslipidemia remains underexplored. This study investigates the association between atherogenic dyslipidemia profiles and COPD duration, utilizing AIP as an evaluation metric. A hospital-based cross-sectional analytical study was conducted among 100 COPD patients without acute exacerbations. Fasting serum lipid profiles were analyzed using standardized protocols, and AIP was calculated for each participant. Patients were stratified into three AIP risk categories: low risk (AIP<0.21), moderate risk (AIP 0.21-0.5), and high risk (AIP>0.5). Associations between COPD duration, smoking status, demographic variables, and lipid parameters were examined using chi-square analysis. 60% of COPD patients demonstrated high atherogenic index profiles (AIP>0.5), indicating substantial cardiovascular risk. A significant positive correlation was found between COPD duration and AIP (r=0.456, p<0.001), as well as with triglycerides (r=0.341, p<0.001) and low-density lipoprotein-cholesterol (r=0.405, p<0.001). Conversely, COPD duration demonstrated a nonsignificant trend toward an inverse correlation with HDL-cholesterol (r=-0.173, p=0.089). Seventy-one percent of patients demonstrated low HDL-cholesterol (<40 mg/dL). Smoking status was significantly associated with elevated very low-density lipoprotein-cholesterol (p=0.002). The high prevalence of atherogenic dyslipidemia in COPD patients, as quantified by AIP, suggests that lipid profile alteration is progressive and correlates with disease duration. AIP represents a clinically relevant, cost-effective screening tool for identifying COPD patients at elevated cardiovascular risk, facilitating early intervention and personalized risk stratification strategies.
Severe asthma represents a clinically challenging proportion of the asthma population, characterized by persistent symptoms, frequent exacerbations, and a higher healthcare burden. To address the complexity of uncontrolled disease, specialized severe asthma clinics have emerged as key models for delivering precision medicine through multidimensional assessment and tailored interventions. This paper describes the organization, clinical approach, and multidisciplinary framework of a tertiary Severe Asthma Centre established in Northern Italy in 2017. The center integrates prioritized outpatient access with a structured day-hospital program (Complex Outpatient Macro Activity, MAC), enabling accelerated diagnostic work-up, comprehensive phenotyping/endotyping, and repeated educational interventions. Central elements include confirmation of diagnosis, assessment of type 2 inflammatory biomarkers (FeNO, IgE, blood and sputum eosinophils), evaluation of airway inflammation, and systematic identification of pulmonary and extrapulmonary treatable traits. A broad multidisciplinary network supports the management of comorbidities such as allergic rhinitis, chronic rhinosinusitis, hypereosinophilic disorders, allergic bronchopulmonary aspergillosis, metabolic and endocrine complications, gastroesophageal reflux disease, and vocal cord dysfunction. Pulmonary rehabilitation is integrated as an adjunctive intervention, particularly for patients with severe disease. Our severe asthma clinic implements precision medicine and the treatable traits approach in clinical practice to optimize outcomes, rationalize biologic therapy use, and reduce glucocorticoid exposure. Future perspectives include expansion toward a “united airways disease” clinic, integrating upper and lower airway management to further improve care for complex inflammatory airway diseases.
Tuberculosis (TB) caused by acid-fast bacilli is one of the leading causes of morbidity and mortality in developing countries. Pakistan has the world's fifth-largest prevalence of TB, with 276/100,000 cases in prevalence and a mortality of 34/100,000. Delayed diagnosis, disruptions in treatment continuity and a lack of awareness are the key issues leading to multidrug-resistant TB. The current study aimed to find out the determinants of delayed pulmonary TB in a rural district of Khyber Pakhtunkhwa Province, Pakistan. The cross-sectional study was conducted in six TB control program centers designated by the National TB Control Program from March to December 2024. Data were collected from 250 eligible patients, and after removal of incomplete questionnaires, the data of 229 patients were analyzed. The study was approved by the district TB officer, and participants' consent was obtained before data collection. A delay of >21 days was considered the cutoff point for delayed TB diagnosis. Among 229 patients, 51.1% were male and 48.9% female participants, with a mean age of 33.31±21.32 years. The mean diagnostic delay was 23.66±14.94 days. Descriptive analysis of data showed 52% of delayed TB diagnosis cases; 92.2% of the studied patients were from rural areas, in which 80% of delayed TB diagnosis cases were reported. Male gender [odds ratio (OR)=2.31], getting treatment from public hospitals (OR=4.13), age group 31-45 years (OR=3.10), presence of acute extrapulmonary symptoms of cough, fever, and weight loss (OR=2.84), perception that the symptoms will be relieved by oneself (OR=9.99), economic constraints (OR=6.58), and perception of the poor quality of healthcare services at hospitals (OR=7.32) were found to be significant factors of delayed TB diagnosis. Primary school- (OR=0.20), college- or university-level education (OR=0.42) and high-income groups (OR=0.39) were significant protective factors against delayed TB diagnosis. Marital status, occupation, residence, comorbidities, distance from healthcare facility, previous exposure to TB patients, fever, weight loss, chronic cough, hemoptysis, fear of diagnosis, fear of social isolation, and bad experience of the healthcare staff behavior were found to be non-significant factors for delayed TB diagnosis. The study only focused on delayed diagnosis and did not report healthcare system-related or total delay in tuberculosis management. The study affirmed the significant impact of patient perceptions and socioeconomic status on delayed TB diagnosis.
In the Article titled “Assessment of diaphragmatic thickness as a predictor for intubation in pneumonia patients” published on April 8, 2025 (doi: 10.4081/monaldi.2025.3252), an author name was misspelled. In the byline, the second author, “Salwa Hussein Abdelmoneim” should have been “Salwa Hussein Abdelmoneam”.
Postoperative cognitive dysfunction (POCD) is a common and severe complication after cardiac surgery, characterized by declines in memory, attention, executive function, and processing speed. This narrative review synthesizes current evidence on POCD from neuropsychological, neuroimaging, and rehabilitative perspectives. The underlying mechanisms are multifactorial and include cerebral microembolization, systemic inflammation from cardiopulmonary bypass, hypoperfusion, and patient-specific risk factors such as advanced age and mild cognitive impairment. Neuroimaging studies have identified structural changes, such as new ischemic lesions on diffusion-weighted magnetic resonance imaging (MRI), and functional disruptions within the Default Mode Network and frontoparietal connections, which are associated with neuroinflammation as shown by positron emission tomography (PET). Neuropsychological assessment is limited by the absence of standardized diagnostic criteria and the use of diverse testing protocols, resulting in considerable variability in reported incidence rates. Although formal guidelines are lacking, cognitive rehabilitation interventions, including computerized cognitive training, multitasking exercises, and virtual reality, demonstrate potential for reducing cognitive decline, particularly when implemented before surgery. A significant gap persists in connecting these functional improvements to underlying neurobiological changes. Future research should integrate longitudinal neuropsychological, biomarker, and neuroimaging data within standardized frameworks to clarify POCD mechanisms and to develop effective, individualized prevention and rehabilitation strategies. These efforts are essential for improving long-term patient outcomes and quality of life.
Tracheobronchopathia osteochondroplastica is a rare benign lesion of the airways often managed conservatively. However, advanced obstruction requires reconstruction. This brief commentary explores the emerging role of 3D bioprinting as a curative solution, analyzing recent findings regarding mesenchymal stem cell-laden grafts and identifying vascularization as the critical hurdle preventing clinical translation.
Chronic obstructive pulmonary disease (COPD) remains a leading global health burden, with acute exacerbations accelerating functional decline and impairing quality of life. Reduced inhaler adherence is a well-recognized contributor to exacerbations and poorer outcomes in COPD. While self-management interventions are well established in stable COPD, their initiation during acute exacerbations has been inadequately explored. This randomized controlled trial, conducted in a South Indian tertiary hospital between July 2024 and May 2025, evaluated the effectiveness of a structured self-management program initiated during hospitalization for acute exacerbation of COPD. The intervention included individualized counseling, family engagement, structured telephonic follow-ups (weekly for 3 months, then monthly for 3 months), and scheduled outpatient reviews, while controls received standard care. Primary outcomes were inhaler adherence assessed by the Test of Adherence to Inhalers, health-related quality of life (HRQoL) measured with the St. George’s Respiratory Questionnaire (SGRQ), and functional capacity assessed by the six-minute walk test. At six months, good inhaler adherence was observed in 66.7% of the intervention group compared to 10% of controls (p<0.001). The mean between-group difference in six-minute walk distance at six months was 92.8 meters [95% confidence interval (CI): 58.1 to 127.6; p<0.001], favoring the intervention group. HRQoL also improved significantly, with a mean between-group difference in SGRQ score of -38.2 (95% CI: -46.7 to -29.8; p<0.001). These findings indicate that initiating structured self-management during hospitalization for acute exacerbation of COPD results in significant improvements in inhaler adherence, functional capacity, and quality of life. Integrating self-management into acute care pathways may therefore optimize patient-centered outcomes in this high-risk population.
Amiodarone is an effective and commonly used anti-arrhythmic drug. The radiographic presentations of amiodarone-induced pulmonary toxicity (AIPT) include a broad spectrum of patterns. Three main clinical-radiographic presentations are described with AIPT: isolated reduction of diffusing lung capacity with no clinical implications; alveolar-interstitial pneumonia, which usually requires amiodarone discontinuation and corticosteroid treatment; and acute respiratory distress syndrome, which can obviously be life-threatening. We report 6 cases that depict the described range of clinical and radiographic presentations. The analysis of the cases and of the published review suggests that the computed tomography scan pattern on presentation predicts well the clinical course. The correlation between radiographic and clinical findings can therefore guide the clinician in the management of AIPT.
Pediatric community-acquired pneumonia (CAP) remains a leading cause of hospitalization worldwide. Although antimicrobial therapy is the cornerstone of treatment, severe and complicated cases are frequently characterized by an exaggerated inflammatory response that may not resolve with antibiotics alone. In this narrative review, we summarize current evidence on the use of systemic corticosteroids as adjunctive therapy in pediatric CAP and illustrate their potential role through a representative clinical case. Available data from randomized trials, observational studies, and meta-analyses suggest that corticosteroids may shorten fever duration, improve oxygenation, and reduce length of hospital stay in selected pediatric patients, particularly those with hyperinflammatory features, parapneumonic effusions, or macrolide-refractory Mycoplasma pneumoniae infections. Some studies also indicate a reduced need for surgical intervention in complicated pneumonia. However, results remain heterogeneous, and current guidelines do not support routine corticosteroid use. Adverse effects are generally mild with short treatment courses and include hyperglycemia and transient behavioral changes. In the presented clinical case, adjunctive corticosteroid therapy was associated with rapid clinical and radiological improvement in a child with severe hyperinflammatory pleuropneumonia. Corticosteroids may represent a potential adjunctive option in carefully selected children with severe or complicated CAP; however, current evidence remains limited and heterogeneous, and further prospective pediatric studies are required.
Silicosis remains a critical, 100% preventable occupational lung disease that continues to persist as a global public health crisis in the 21st century. Despite decades of industrial safety knowledge, the disease is currently seeing a modern resurgence, particularly in the engineered stone industry, where high-intensity silica exposure leads to rapid, fatal disease variants. This review synthesizes current global and national evidence to highlight the staggering burden of silicosis, with a specific focus on India, where over 50 million workers are projected to be at risk by 2026. Epidemiological data from high-risk clusters in Rajasthan and Gujarat reveal localized prevalence rates as high as 69%, often complicated by a devastating "syndemic" of silicosis and tuberculosis. The persistence of this disease is fundamentally attributed to an "implementation gap" in occupational health policy, characterized by weak enforcement in the informal sector, the invisibility of migrant labor and diagnostic failures. While engineering controls and medical surveillance are established gold standards, their adoption remains inconsistent in low-resource settings. This review advocates for a transition toward a rights-based accountability model, mandatory digital reporting, and the integration of occupational health into broader public health strategies. Ultimately, eliminating silicosis requires moving beyond clinical observation toward robust inter-ministerial coordination and strict legal liability for workplace safety failures.
Occupational Takotsubo syndrome ("broken heart syndrome") has been reported very rarely, and only twice among healthcare personnel; the present case being, to our knowledge, the third documented occurrence. Here, we describe the case of a 57-year-old female neonatologist who developed the syndrome after 2 years of intense work-related stress, culminating in the management of a particularly delicate emergency. The diagnosis was made through cardiac imaging techniques that demonstrated the typical deformation ("ballooning") of the left ventricle that gives the syndrome its name (takotsubo in Japanese means "octopus trap"). The case draws attention to the risk of Takotsubo cardiomyopathy as a consequence of intense work-related psychophysical stress and to the need for hygiene and organizational measures to prevent both mental and cardiological disorders. Female emergency physicians should be considered a professional category at greater risk of developing the syndrome.
Pulmonary tuberculosis often results in permanent lung damage, such as fibrosis, bronchiectasis, and emphysema, despite a successful microbiological cure. These structural changes lead to post-tuberculosis lung disease (PTLD), which is characterized by chronic respiratory symptoms and impaired lung function. This study aimed to evaluate functional and radiological impairments in patients after completion of anti-tubercular therapy to understand the long-term impact of tuberculosis on respiratory health. This prospective study evaluated 175 adults within 1 year of completing anti-tubercular therapy to assess the prevalence of PTLD. Results revealed spirometric abnormalities in 57.1% of participants, predominantly restrictive patterns (30.3%), followed by obstructive defects (16.6%) and Preserved Ratio Impaired Spirometry or PRISm (10.3%). Sputum smear positive status at diagnosis strongly predicted obstructive disease and severe structural damage. Notably, this impairment affected a young, non-smoking cohort and was largely irreversible. The study concludes that microbiological cure does not equate to respiratory health, highlighting the necessity of integrating assessment of comprehensive respiratory system evaluation and routine spirometry at treatment completion to manage long-term morbidity.
