Background. Mediastinal lymph node (MLN) enlargement is a common radiological finding in fibrosing interstitial lung diseases (fILDs). However, its clinical and prognostic significance across different disease entities remains poorly characterized. Aim. To assess the prevalence of intrathoracic lymphadenopathy in idiopathic pulmonary fibrosis (IPF), fibrotic hypersensitivity pneumonitis (fHP), and systemic sclerosis-associated fibrosing interstitial lung disease (fILD-SSc), and to determine its associations with disease characteristics, progression, and prognosis. Materials and methods. This retrospective two-center cohort study included 533 patients: 151 with IPF, 279 with fHP, and 103 with fILD-SSc. MLN enlargement was defined as a lymph node short-axis diameter ≥ 10 mm. The number of enlarged MLNs was also assessed semiquantitatively. Logistic regression, Kaplan–Meier analysis, and Cox regression were used to evaluate prognostic significance. Results. Intrathoracic lymphadenopathy was detected in 39.4% of patients with IPF, 57.0% with fHP, and 36.2% with fILD-SSc (p = 0.001). In the overall cohort, enlarged MLNs were associated with a usual interstitial pneumonia pattern (odds ratio – OR 1.69, 95% confidence interval – CI 1.18–2.44; p = 0.004) and mortality (OR 3.39, 95% CI 2.11–5.45; p 0.0001). The association with mortality was confirmed by Kaplan–Meier analysis (p = 0.028) and Cox regression (hazard ratio 1.50, 95% CI 1.03–2.17; p = 0.033). In IPF, MLN enlargement was associated with mortality (OR 5.83; p = 0.001), whereas in fHP it was associated with both disease progression (OR 2.53; p = 0.001) and mortality (OR 3.59; p 0.0001). In fILD-SSc, intrathoracic lymphadenopathy was associated with a greater extent of lung involvement as assessed by the Goh score (β = 0.219; p = 0.026), but not with disease progression or prognosis. Conclusion. MLN enlargement is a radiological feature associated with an unfavorable course of fILD, with the strongest prognostic significance observed in IPF and fHP. Semiquantitative assessment of the number of enlarged MLNs did not demonstrate prognostic significance.
Dendriform pulmonary ossification (DPO) is a rare manifestation of diffuse lung ossification, typically identified incidentally via X-ray or chest computed tomography (CT) scans. This condition is characterized by the formation of mature bone tissue with bone marrow within the interalveolar septa, often remaining asymptomatic for an extended period. The etiology of DPO remains unclear; such ossification may arise without discernible causes or as a secondary consequence of various pulmonary and other pathological processes. The pathogenesis of DPO is not fully elucidated; however, the prevailing hypothesis posits that the disease results from bone metaplasia of fibroblasts in the context of chronic inflammation and lung injury. Clinically relevant to practitioners is the frequently observed association between lung ossification and idiopathic pulmonary fibrosis, as well as chronic venous hypertension. With the recent widespread use of high-resolution CT imaging, the detection rate of DPO has increased significantly. While a definitive diagnosis can generally be established with CT imaging, histological examination of biopsy specimens is essential to prevent diagnostic inaccuracies and inappropriate treatment. Notably, the presence of DPO is associated with a poor prognosis in patients with fibrosing interstitial lung disease. Currently, there is no specific therapy for DPO. This article presents a clinical case of a young patient with a long-term asymptomatic disseminated pulmonary process, in which DPO was confirmed by morphological examination of lung tissue obtained via lung biopsy. An overview of recent literature on lung ossification is also presented, alongside an exploration of the clinical, histological, and radiological characteristics of DPO. The patient's medical history and radiological findings (including changes over time) are also provided, along with pulmonary function tests and a discussion of the potential administration of antifibrotic agents during the early stages of the patient's disease. This clinical observation emphasizes the necessity for meticulous differential diagnosis in cases of disseminated pulmonary processes and underscores the significance of histological verification in guiding appropriate management for affected patients.
Background. Late-onset asthma (after 40 years) is characterized by more severe disease, frequent exacerbations, fixed bronchial obstruction, and high comorbidity; prognostic tools for this age group, including risk models for rehospitalization and mucus plugs, remain insufficiently developed. Aim. To develop and validate predictive models for estimating the probability of frequent severe exacerbations and the presence of mucus plugs on chest X-Ray computed tomography (CT) in hospitalized patients with late-onset asthma. Materials and methods. This prospective study included 130 hospitalized patients with late-onset asthma (71.5% female, mean age 63.5 ± 11.3 years). Clinical, laboratory (IgE, eosinophils, FeNO), and instrumental (spirometry, body plethysmography, chest CT) data were assessed. Logistic regression models with stepwise selection were built for two outcomes: ≥ 2 severe exacerbations within 12 months, and mucus plugs on CT. Evaluation included bootstrap validation (5,000 resamples), the Hosmer–Lemeshow test, and ROC analysis. Results. A T2 endotype was identified in 115 patients (88.5%); the rate of frequent severe exacerbations (≥ 2/year) was 25.4%. The most common phenotypes were allergic, eosinophilic, nonallergic, and asthma with obesity and fixed obstruction; all patients had combinations of these. Mucus plugs on CT were significantly more common with asthma-COPD overlap. Patients with four phenotypes had poorer symptom control and lower pulmonary function. Independent predictors of frequent severe exacerbations were eosinophilic phenotype (OR 3.2, 95% CI 1.3–8.1; p = 0.013) and diabetes mellitus (OR 3.3, 95% CI 1.3–8.8; p = 0.015); AUC 0.726 (95% CI 0.631–0.821), sensitivity 70%, specificity 66%. Reduced PEF% was the only independent predictor of mucus plugs (OR 0.97 per 1% increase, 95% CI 0.95–0.99; p 0.001); AUC = 0.735 (95% CI 0.649–0.821), sensitivity 68.9%, specificity 68.1%. Conclusion. In hospitalized late-onset asthma patients, eosinophilic phenotype and diabetes mellitus are independent predictors of frequent severe exacerbations (OR ~ 3.2–3.3). Reduced PEF% predicts mucus plugs on CT. The models (AUC 0.726–0.735) can be used for risk stratification in routine practice.
Inflammatory and infectious diseases of the oropharynx and oral cavity are among the most common reasons for visiting primary care outpatient specialists. The key challenge is the excessively frequent use of systemic antibacterial agents, although in most cases the disease has a viral etiology. This practice directly contributes to the increase in antimicrobial resistance. The aim of this work is to demonstrate the role of local antiseptic therapy as a tool for limiting the growth of resistance and to identify the most appropriate agent for topical use. The available scientific data and clinical guidelines on the problem of antimicrobial resistance were analyzed. A comparative analysis of the mechanisms of inflammatory processes in periodontal tissues and the pharyngeal mucosa was performed. Information on indications, regimens, and criteria for evaluating the effectiveness of local therapy was systematized. Particular attention was paid to such aspects as the diagnostic minimum, patient routing, and outpatient practice in infectious and inflammatory diseases of the oropharynx and infectious and inflammatory diseases of the oral cavity. The management of such conditions as pharyngitis, tonsillitis, stomatitis, and gingivitis was considered. According to the analysis, β-hemolytic group A streptococcus is detected in only 5–15% of adult patients complaining of sore throat, while antibacterial agents are prescribed in 64% of such cases. In this context, rational local antiseptic therapy is of particular importance, as it allows direct action on the inflammatory focus and helps limit the unjustified use of systemic antibacterial agents. The clinical and pharmacological properties of the local antiseptic drug Miramistin® − benzyldimethyl-[3-(myristoylamino)-propyl] ammonium chloride monohydrate − were reviewed. The drug at a concentration of 0.01% demonstrates a broad spectrum of activity against bacteria, fungi, and viruses, exerts an immunomodulatory effect, and does not lead to the development of resistance in pathogens. The use of the drug Miramistin® as the first-choice agent for local antiseptic therapy of infectious and inflammatory lesions of the oropharynx and oral cavity is pathogenetically justified, especially within the framework of a comprehensive approach to patient treatment.
