In late 2019, an acute, severe lower respiratory tract illness of unknown etiology, linked to contact with a live seafood and animal market, was reported in Wuhan City, Hubei Province, China, subsequently shown to be caused by a novel coronavirus termed the Severe Acute Respiratory Syndrome (SARS) Coronavirus (CoV)-2. The infection caused by this virus is referred to as coronavirus disease 2019, or COVID-19. SARS-CoV-2 infects human cells through binding of viral surface spike protein to human angiotensin-converting enzyme 2 receptors, predominantly expressed on Type II alveolar cells, in the lung. SARS-CoV-2 is highly transmissible, and affected patients can transmit the infection while asymptomatic. Patients commonly complain of fever, dry cough, fatigue, myalgias, headache, and dyspnea. Most infected patients have mild disease and recover, with more severe disease and mortality more commonly present in older individuals and patients with comorbidities, such as hypertension, diabetes, and chronic cardiovascular and respiratory conditions. The diagnosis of COVID-19 is typically established through identification of viral nucleic acid at real-time reverse transcriptase polymerase chain reaction on respiratory tract samples. Chest radiography in COVID-19 infection may be normal; when abnormal, patchy areas of lower lobe ground-glass opacity and/or consolidation are seen. Computed tomography is more sensitive than chest radiography for detection of the infection and commonly shows multifocal, bilateral, peripheral, and basal predominant round or oval areas of ground-glass opacity that may subsequently transition to consolidation. Treatment for COVID-19 is currently supportive, with various ongoing trials evaluating a number of potentially therapeutic agents.
In late 2019, an acute, severe lower respiratory tract illness of unknown etiology, linked to contact with a live seafood and animal market, was reported in Wuhan City, Hubei Province, China, subsequently shown to be caused by a novel coronavirus termed the Severe Acute Respiratory Syndrome (SARS) Coronavirus (CoV)-2. The infection caused by this virus is referred to as coronavirus disease 2019, or COVID-19. SARS-CoV-2 infects human cells through binding of viral surface spike protein to human angiotensin-converting enzyme 2 receptors, predominantly expressed on Type II alveolar cells, in the lung. SARS-CoV-2 is highly transmissible, and affected patients can transmit the infection while asymptomatic. Patients commonly complain of fever, dry cough, fatigue, myalgias, headache, and dyspnea. Most infected patients have mild disease and recover, with more severe disease and mortality more commonly present in older individuals and patients with comorbidities, such as hypertension, diabetes, and chronic cardiovascular and respiratory conditions. The diagnosis of COVID-19 is typically established through identification of viral nucleic acid at real-time reverse transcriptase polymerase chain reaction on respiratory tract samples. Chest radiography in COVID-19 infection may be normal; when abnormal, patchy areas of lower lobe ground-glass opacity and/or consolidation are seen. Computed tomography is more sensitive than chest radiography for detection of the infection and commonly shows multifocal, bilateral, peripheral, and basal predominant round or oval areas of ground-glass opacity that may subsequently transition to consolidation. Treatment for COVID-19 is currently supportive, with various ongoing trials evaluating a number of potentially therapeutic agents.
NUT (nuclear protein in testis) carcinoma is a poorly differentiated aggressive subtype of squamous cell carcinoma. NUT carcinoma is characterized by genetic rearrangements involving the NUT gene, resulting in the formation of oncogenic fusion proteins, most commonly NUT-BRD4. Originally described as a thymic carcinoma with NUT gene rearrangement in children and young adults, NUT carcinoma has been shown to occur in adults in a variety of locations. It is typically seen as an aggressive large soft tissue mass infiltrating adjacent structures. Because of the aggressive nature of NUT carcinoma, patients typically present in late stages of the disease and rapidly succumb to the disease. There are no pathognomonic, radiologic, or histopathologic features, and therefore NUT carcinoma is diagnosed via molecular assay, including a commercially available immunohistochemical assay. Additional molecular assays can be performed to demonstrate NUTM1 rearrangement and also to identify the oncogenic fusion protein. With more recent widespread availability of these assays, the reported incidence of NUT carcinoma is expected to increase. Prognosis remains poor for those diagnosed with NUT carcinoma, as there is no proven effective treatment. Recent research into the oncogenic fusion proteins driven by NUT rearrangement and clinical trials with targeted inhibitors offer hope for future therapy.
Although vaping has been promoted by manufacturers as a safe alternative to traditional smoking, the dangers of vaping and e-cigarette use have come to the forefront of the medical community, particularly the risks associated with tetrahydrocannabinol-containing products. Although many patterns of vaping-associated lung injuries have been reported in the literature, one of the most concerning is that of diffuse alveolar damage. As e-cigarette and vaping use is becoming increasingly popular, particularly in the younger population, it is important to become familiar with this entity to ensure proper and timely diagnosis to prevent lifelong sequelae.
Bronchial asthma is an extended chronic inflammatory respiratory disease that represents a serious health problem. Management of asthmatic patients should be ensured by the use of asthma guidelines such as Global Initiative for Asthma (GINA). The last changes made in the GINA guide have generated controversy. This article reviews the reasons for the changes in the guide and the problems that could emerge in the management of the asthmatic patient.
Electronic cigarettes were developed for the inhalation of flavored nicotine, tetrahydrocannabinol and cannabidiol via cannabis oil. Recently, there has been an outbreak of vaping-induced lung injuries ranging in severity. We report 3 previously healthy male patients, who presented with acute respiratory failure with a recent history of electronic cigarette use, ultimately diagnosed with lipoid pneumonia. All 3 patients received intravenous high-dose, pulse corticosteroids for short duration with dramatic improvement.
Synopsis: Analysis of imaging characteristics in smokers with COPD compared with smoking controls identified 2 distinct COPD subtypes and correlated disease stage with degree of spirometric impairment and timing of functional decline. Source: Young A, Bragman F, Rangelov B, et al. Disease progression modeling in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2020;20:294–302.
Guidelines for treatment in severe chronic obstructive pulmonary disease with hyperinflation now include endobronchial lung volume reduction. Since December 2018, 2 valve systems have been Food and Drug Administration (FDA) approved, which has generated widespread interest in this new therapy for chronic obstructive pulmonary disease treatment. Although the technical placement of the endobronchial valves is relatively straightforward, this paper focuses on the multidisciplinary approach to identification, evaluation, and follow-up in addition to procedural techniques for endoscopic lung volume reduction implementation.
macrolides in patients with non-cystic fibrosis bronchiectasis: a meta-analysis of randomized controlled trials. BMC Infect Dis. 2015; 15:160–169. 4. Serisier DJ, Martin ML, McGuckin MA, et al. Effect of long-term, low-dose erythromycin on pulmonary exacerbations among patients with non-cystic fibrosis bronchiectasis: the BLESS randomized controlled trial. JAMA. 2013;309:1260–1267. 5. Wong C, Jayaram L, Karalus N, et al. Azithromycin for prevention of exacerbations in non-cystic fibrosis bronchiectasis (EMBRACE): a randomized, double-blind, placebo-controlled trial. Lancet. 2012;380: 660–667.
SARS-CoV-2 in bats was transmitted to humans by a peridomestic mammal in China and it was transmitted from humans to humans very quickly through coughing and sneezing and is spread all over the world and created coronavirus disease 2019. The disease causes a variety of symptoms in patients and it has killed a significant number of people around the world, especially people with underlying diseases such as heart disease, diabetes, and high blood pressure. Early diagnosis of patients is very important to prevent the transmission of the disease from humans to humans and the spread of the virus. The virus causes abnormal computed tomography scans, lymphopenia, leukopenia, increased C-reactive protein, lactate dehydrogenase, aspartate aminotransferase, and alanine aminotransferase in a significant number of patients. The standard method for diagnosing SARS-CoV-2 infection is real-time reverse transcriptase polymerase chain reaction with 2 genes RdRp and E being identified together in 1 experiment. Other methods such as cell culture, reverse transcription loop-mediated isothermal amplification, next-generation sequencing, fluorescence in situ hybridization, and antigenic assessment can be used to study and identify the virus. IgG and IgM antibodies against S and N proteins are evaluated to recognize people who have been previously infected with the virus.
Heart failure (HF) may be associated with pneumonia as HF is one of the most common complications of patients who have a primary diagnosis of pneumonia. Patients who develop HF from pneumonia are associated with higher severity of pneumonia and higher mortality rate. The purpose of this review was to summarize the association between pneumonia and HF with the available literature and discuss the pathophysiology underlying it. Ten studies have been included in this review to support the association between pneumonia and HF. Awareness of this association is essential for clinical management and to improve the outcomes of the patients.
Over the past 20 years, a series of major outbreaks of acute respiratory infections such as 2009 influenza A (H1N1) and the 2019 new coronavirus disease (2019-nCoV) have arisen and posed a major threat to the health of the global population. The outbreak of coronavirus calls to mind the pandemics that have instilled great fear in our memories such as severe acute respiratory syndrome (SARS), Zika virus (ZIKV), Middle East respiratory syndrome (MERS), and H1N1 flu. The 2 prominent outbreaks, 2019-nCoV and H1N1, have markedly affected humans. In this study, therefore, we compared some clinical, demographic, and laboratory findings to determine the differences between H1N1 influenza and coronavirus disease-2019 (COVID-19) to suggest the appropriate drug therapeutic approaches. Subsequent to the inclusion of 4 available studies, which presented all the required data, the findings and results were compared, showing fever and cough as the most prevalent clinical indications of both H1N1 influenza and 2019-nCoV diseases. With respect to the laboratory findings, both 2019-nCoV and H1N1 patients showed leukopenia as the main laboratory findings. Taken together, since similar diagnostic methods are used for H1N1 and 2019-nCoV patients and they have the same clinical and laboratory features, it is safe to say that lopinavir/ritonavir and nucleoside analogues could be drug treatment options for patients suffering from 2019-nCoV. However, given the current urgent condition, the primary and main intervention procedure is controlling the infection so as to halt the dissemination of COVID-19. It is recommended, however, that the providers of public health care maintain a close watch on the situation, because the more information we obtain about this new virus and the ensuing epidemic, the faster we can react.
Pulmonary hypertension (PH) causes significant morbidity and mortality in children, and, while the treatment strategies for PH in adults are well studied and developed, few data exist for pediatric patients. In adult patients, successful transitions from intravenous (IV) epoprostenol to subcutaneous (SC) treprostinil are reported, but this information is limited for pediatric patients. Furthermore, while there are reports of SC to IV treprostinil in adults, there are no reports of the transition from IV to SC treprostinil. This case report recounts a successful transition from IV treprostinil to SC treprostinil in a pediatric patient with WHO Class 3, PH, secondary to interstitial lung disease.
related to antibiotic administration, such as Clostridium difficile colitis. The strengths of this trial include a multicenter design with appropriate blinding, the systematic implementation of VAP prevention bundles in both groups, and the use of a blinded adjudication committee for diagnosis of VAP. Furthermore, the study excluded patients with evidence of overt aspiration at the time of endotracheal intubation; inclusion of this population could have increased the benefit seen from antibiotics. Limitations of the trial include the use of an intravenous antibiotic not available in the United States; however, ampicillin-sulbactam (Unasyn) is available in our country and has comparable coverage. As regards applicability, it is plausible to extend these results to out-of-hospital arrest patients with an initial nonshockable rhythm who undergo TTM, but application to an inhospital arrest population is limited by the increased likelihood that these patients will have MDR organisms. In conclusion, a 2-day course of ampicillin-sulbactam in out-of-hospital cardiac arrest patients undergoing targeted temperature management reduces the incidence of early VAP while posing little immediate risk to the patient.
Synopsis: This retrospective analysis identified the proportion of patients with afebrile bacteremia when admitted for community-acquired pneumonia (CAP) and investigated negative and positive predictors of bacteremia in afebrile CAP patients. A significant proportion of afebrile patients admitted for CAP was bacteremic and had increased mortality when compared with febrile bacteremic patients or nonfebrile nonbacteremic patients. Source: Forstner C, Vladimir P, Rohde G, et al. Rate and predictors of bacteremia in afebrile community-acquired pneumonia. Chest. 2020;157(3):529–539.
Antibiotics form the foundation of comprehensive cystic fibrosis (CF) therapy and are responsible for invaluable gains in life expectancy and quality of life. Although antibiotic stewardship may be perceived to be in conflict with appropriate CF care, there are many potential benefits to antibiotic stewardship in CF. Antimicrobial stewardship teams can provide a collaborative approach to CF care and provide assistance with antibiotic selection, therapeutic drug monitoring, and recommendation of best practices supported by evidenced-based guidelines. The aim of this review is to introduce the rationale for the use of antibiotics in CF care, examine the evidence behind current antibiotic practices, and discuss the potential role of antibiotic stewardship in CF care.
Synopsis: This 52-week, phase 3, randomized, double-blind, parallel-group trial compared the efficacy and safety of twice-daily inhaled triple therapy with budesonide at 2 different doses (160 and 320-μg) plus a LAMA (18-μg of glycopyrrolate) and a LABA (9.6-μg of formoterol) in comparison with either glycopyrrolate-formoterol (18 and 9.6-μg) or budesonide-formoterol (320 and 9.6-μg) in patients with moderate-to-very-severe COPD with at least 1 exacerbation in the past year. Similar to previous trials, there was a significant reduction in the annual rate of moderate-to-severe exacerbations and improved patient-reported outcomes with triple therapy at both doses of budesonide in comparison to either dual therapy of LAMA-LABA or inhaled glucocorticoid-LABA, and lower all-cause mortality in the 320-μg budesonide triple-therapy group in comparison to the LAMA-LABA dual therapy group. Source: Rabe KF, Martinez FJ, Ferguson GT, et al. Triple inhaled therapy at two glucocorticoid doses in moderate-to-very-severe COPD. N Engl J Med. 2020;383:35–48.
Airway complications following lung transplantation are common and may be associated with significant morbidity and mortality. Although there are multiple risk factors, anastomotic ischemia is the major factor for the development of airway complications. Most of the complications can be managed with bronchoscopic interventions. However, some may require surgical intervention even retransplantation. In recent years, a universally accepted definition and grading system have been published by the International Society for Heart and Lung Transplantation (ISHLT). Common airway complications include anastomotic dehiscence, anastomotic infection, bronchomalacia, anastomotic stenosis, bronchial fistula, and granulation tissue formation. Although there is no accepted and standardized treatment for each airway complication, mainly due to lack of prospective and randomized studies, a number of various bronchoscopic interventions have been found to be effective. Although our understanding of the pathophysiology of airway complications and its management strategies are evolving, airway complications continue to be a challenging issue for surgeons, pulmonologists, and patients.
Bronchoscopy is an aerosol-generating procedure with important diagnostic and therapeutic indications. However, in the era of the coronavirus disease 2019 (COVID-19) pandemic, airway procedures can put health care providers at an increased risk of exposure and transmission of COVID-19. We have reviewed and summarized guidelines from various societies of respiratory medicine to stratify the indications for bronchoscopy and optimize preprocedural, procedural, and postprocedural preparation. Appropriate measures can help decrease exposure to health care workers when performing this aerosol-generating procedure.
Idiopathic pulmonary hemosiderosis is a rare interstitial lung disease that occurs mostly in childhood. Usually, it presents with diffuse alveolar hemorrhage with no identified etiology. This report describes a young male patient who presented a clinical pattern of fatigue, dyspnea, and hemoptysis with iron-deficiency anemia. The iron-deficiency anemia in this patient was resistant to oral elemental iron therapy. This patient had typical findings on chest computed tomography (diffuse ground-glass opacities of the lungs) and bronchoalveolar lavage (detected siderophages). The patient obtained corticosteroid therapy after confirmation of idiopathic pulmonary hemosiderosis diagnosis, which led to improvement of symptoms in one week. This case report shows that early diagnosis and quick initiation of corticosteroid therapy is an effective approach, which reveals the symptoms and prevents complications.
