Endobronchial metastases due to renal cell carcinoma are rare. We present a rare case of a 63-year-old male who presented with a right massive pleural effusion as a result of metastatic renal cell carcinoma, which caused a right trapped lung, due to endobronchial obstruction. Reviewing the literature on the treatment of trapped lungs, it is observed that it is based on draining the effusion either by minimally invasive techniques or surgically, which aims to reduce dyspnea. This is because the management of trapped lungs from pleural causes of non-expandable lungs has been mainly studied. In our patient this approach did not treat the cause of the trapped lung, nor did it relieve the symptoms of dyspnea. In this case, the finding of a trapped lung is due to an endobronchial lesion. For this patient with advanced-stage endobronchial metastasis palliative therapy is available, including trans-thermal traps, forceps capture under a rigid bronchoscope, intrabronchial radiation (brachytherapy), photodynamic therapy, electro-coagulation, prosthetic stents, intrathoracic ethanol injections, and Nd:Yag laser ablation therapy. These treatments are intended to enhance the quality of life rather than to heal the patient.
Cystic fibrosis (CF) is a genetic disorder caused by mutations in the CFTR gene. We report a 21-year-old male of Andalusian descent with elevated sweat chloride levels and recurrent pulmonary infections. Initial testing identified a maternally inherited F508del mutation, but a second variant was not detected. Advanced genetic analysis revealed a novel paternal variant, c.4345_*486delinsTTG, involving a complex rearrangement of coding and non-coding regions, likely impacting CFTR protein function. Despite these findings, the patient displayed a mild CF phenotype with stable lung function, no digestive symptoms, and normal pancreatic function. Imaging showed no bronchiectasis, and infections were managed with intermittent antibiotics. The variant, absent from major genetic databases, expands the known CFTR mutation spectrum and highlights the importance of advanced genetic diagnostics in atypical cases. This case emphasizes the variability of CF presentations and the value of comprehensive genetic analysis in identifying rare mutations, contributing to better diagnosis and management strategies. Further studies are needed to clarify the functional impact of this novel variant.
INTRODUCTION Tobacco use among healthcare workers (HCWs) undermines their role as health advocates and presents a significant public health issue. Despite their professional knowledge, smoking remains prevalent among HCWs, especially in low-and middle-income countries. This study aimed to evaluate the prevalence, patterns, determinants, and motivational factors for smoking cessation among HCWs in Kirkuk, Iraq. METHODS A cross-sectional study was conducted from January to August 2025 involving 1618 HCWs employed in hospitals and primary healthcare centers throughout Kirkuk Governorate, Iraq. Data were gathered using a structured, validated self-administered questionnaire that assessed sociodemographic characteristics, use of any tobacco product, smoking behaviors, perceptions, and motivations for quitting. A multistage cluster sampling method was employed, and the sample size was calculated with a design effect of 1.5. Descriptive statistics, chi-squared tests, and binary and ordinal logistic regression analyses were used to identify predictors of smoking behavior. Principal component analysis (PCA) with Varimax rotation was conducted to uncover underlying factors influencing cessation motivation. RESULTS Among the 1618 participants, mean age of 35.7 +/- 9.7 years, 54.8% were female. The overall smoking prevalence was 13.5%, while 2.9% were former smokers. Smoking was strongly associated with being male (AOR= 28.1; 95% CI: 15.9-49.6, p<0.001). Participants with family members who smoked had more than three times the odds of smoking themselves (AOR=3.22; 95% CI: 2.13-4.86, p<0.001). Those with longer work experience (>20 years) were less likely to smoke (AOR=0.27; 95% CI: 0.12-0.65, p=0.004). Opposing smoking in the workplace served as a protective factor (AOR=0.10; 95% CI: 0.03-0.25, p<0.001). PCA identified two main motivational factors for quitting: health-driven motivation (concerns about health and finances) and support-oriented motivation (education, medical advice, and pharmacological aids), which together explained 69.5% of the total variance. CONCLUSIONS Smoking remains prevalent among HCWs in Kirkuk, particularly among males and those with smokers in their social environment. Both personal motivation and institutional support appear important for smoking cessation. Strengthening smoke-free workplace policies and providing targeted cessation support may help inform tobacco control strategies within healthcare settings.
Beh & ccedil;et's disease (BD) is a multisystemic inflammatory vasculitis with a wide spectrum of clinical manifestations, including cardiac and pulmonary involvement. Cardiac manifestations, particularly right ventricular (RV) thrombus, are rare but potentially life-threatening. Pulmonary artery thrombosis can further complicate the disease course. We report a case of a 21-year-old male diagnosed with BD, presenting with dyspnea, dry cough, and hemoptysis due to concurrent RV thrombus and pulmonary artery thrombosis. The patient was successfully managed with a combination of immunosuppressive therapy (cyclophosphamide and corticosteroids) and anticoagulation, achieving complete thrombus resolution within two months. This case underscores the importance of early recognition, comprehensive diagnostic evaluation, and a multidisciplinary treatment approach to optimize outcomes in such rare and complex presentations.
INTRODUCTION The use of corticosteroids in respiratory infections remains a topic of clinical debate, particularly regarding indications, frequency, and alignment with patient phenotypes. We aimed to analyze prescribing patterns, decision-making processes, and perceived efficacy of corticosteroids across a diverse group of physicians. METHODS Within a cross-sectional survey, we analyzed responses from 203 physicians across various medical specializations, with a majority representing pulmonology (73.89%). The survey was conducted in Italy between March and June 2024 using an anonymous, structured online questionnaire. Eligible participants were practicing physicians with at least one year of experience in managing respiratory infections; trainees and non-clinical professionals were excluded. An anonymous, structured questionnaire explored prescribing rationales, frequencies, inflammatory phenotype considerations, and biomarker utilization. Data were analyzed using descriptive statistics and chi-squared tests, with statistical significance set at p<0.05. RESULTS Key findings revealed that inflammation reduction (60.59%) was the predominant reason for corticosteroid use, with eosinophilic inflammation guiding prescriptions in 39.90% of cases. Inhaled corticosteroids were generally preferred over oral formulations (60.10%). Despite a reliance on clinical judgment (44.33%), biomarker-driven approaches remain underutilized. Statistically significant differences were observed in phenotype-based prescribing and biomarker monitoring, indicating variability in decision-making. CONCLUSIONS These findings underscore the need for standardized guidelines and personalized therapeutic strategies. The observed gaps in biomarker utilization and inflammatory phenotyping highlight areas for improvement. Future research should focus on integrating standardized diagnostic approaches to enhance treatment precision and optimizing patient outcomes.
INTRODUCTION Community-acquired pneumonia (CAP) is a major cause of hospital admissions, workforce loss, and mortality globally. In most patients diagnosed with CAP, the causative pathogen cannot be identified, even with extensive microbiological testing in laboratory settings. The aim of our study was to investigate the relationship between the isolated pathogens from sputum cultures and the duration of hospitalization in patients with CAP. METHODS This cross-sectional study included 298 patients with CAP, mean age of 71.3 +/- 14.1 years, 67.1% male, hospitalized at D & uuml;zce University Hospital between October 2022 and November 2023. Inclusion criteria were age >18 years and a diagnosis of CAP confirmed by clinical and radiological findings. The relationship between isolated pathogens (exposure) and duration of hospitalization (outcome) was analyzed using Mann-Whitney U, chi-squared tests, and nonparametric linear regression. RESULTS Sputum culture samples were obtained from 73.8% of the patients, and 45.5% of these yielded positive results. The most common pathogens identified were Pseudomonas aeruginosa (21%), Klebsiella pneumoniae (17%), Escherichia coli (9%), and Staphylococcus aureus (6%). Hospitalization was significantly longer in patients with positive cultures, those with cardiovascular disease or malignancy, and those with polymicrobial growth (p<0.05); however, no significant difference was found based on the specific cultured organism after adjustment for confounders. CONCLUSIONS This study demonstrates that the duration of hospitalization is longer among patients with multiple isolated pathogens compared to those with a single one.
A 65-year-old Caucasian woman was referred to our hospital with global malaise, arthralgia, hypercalcemia, and hypercalciuria. High-resolution computed tomography (HRCT) of the chest revealed bilateral hilar lymphadenopathy along with patchy bilateral pulmonary infiltrates. Laboratory findings were significant for elevated serum creatinine and urea levels, whereas urethrography and renal ultrasound of the urinary tract identified a right-sided obstructive nephrolithiasis. Bronchoscopy with endobronchial ultrasoundguided transbronchial needle aspiration (EBUS-TBNA) was performed, and biopsies obtained revealed non-caseous granulomata. After excluding alternative causes of granulomatous diseases, the diagnosis of sarcoidosis was established, and corticosteroid therapy was applied. The urinary obstruction was treated surgically via the placement of a pigtail catheter, subsequently improving the renal failure. This case highlights the importance of prompt recognition and treatment of renal sarcoidosis, particularly when standardized treatment guidelines are lacking.
Major central airway obstruction is a clinical manifestation of airway malignancy associated with high morbidity and mortality. Various bronchoscopy modalities, including thermal and non-thermal ablation techniques as well as stent insertion, have demonstrated good efficacy but are associated with certain risks and complications. This case report describes a 49-year-old woman with spindle cell sarcoma of the trachea with central airway obstruction. She was managed with laser therapy and rigid bronchoscopy for mass removal, followed by radiotherapy and chemotherapy. After radiation and chemotherapy, the patient developed excessive airway secretions and respiratory infections, which necessitated stent removal. Following stent removal, CT imaging, and a two-year follow-up confirmed that the airway remained patent. Tumor ablation using laser therapy, followed by airway stenting and subsequent radiotherapy and chemotherapy, may be a viable treatment option for unresectable tracheal spindle cell sarcoma with central airway obstruction.
Chronic obstructive pulmonary disease (COPD) and cardiovascular diseases (CVDs) frequently coexist. Patients with COPD are at a higher risk of developing myocardial infarction, stroke, heart failure and atrial fibrillation, and vice versa; patients with CVD have more frequently COPD, compared with age-matched general population individuals. In patients with comorbid COPD and CVD higher rates of morbidity, hospitalization, worsening quality of life (QoL), and mortality are observed, compared to those with either disease. Lung hyperinflation, systemic inflammation, and arterial stiffness, as well as sharing common risk factors, e.g. smoking, are some of the suggested pathophysiological links between the two diseases. Despite the improvement in understanding the underlying mechanisms of the coexistence and the recent evidence suggesting that a better management of COPD may have beneficial cardiovascular effects, patients with COPD and CVD remain underdiagnosed, and thus undertreated. COPD is one of the most common respiratory diseases in Greece, and maybe more than half a million Greek citizens suffer both from COPD and CVD; however, their characteristics and management remain unknown. HELICOPD is a national, multicenter, prospective, non-interventional study designed to contribute to the better understanding and depicting the demographic and clinical characteristics of this population, the COPD- and CVD-related adverse events in a two-years period, their quality of life and the healthcare resources use. The study is initiated and coordinated by the Hellenic Thoracic Society.
Cefiderocol is a novel antimicrobial used for difficult-to-treat infections caused by extremely drug-resistant gram-negative bacteria. Urine discoloration associated with this drug has been reported and it is sometimes attributed to concomitant blood transfusions, intravenous ferrum or gastrointestinal bleeding. We describe a case of a novel urine discoloration noticed during treatment with this drug apparently not associated with any of these factors. Alpha 72-year-old female was admitted to the ICU because of lung infection causing respiratory failure. Her hospitalization was prolonged due to unsuccessful weaning, and she presented a bloodstream infection caused by Klebsiella pneumonia NDM (+). After a 12-day treatment with cefiderocol, the patient's urine presented a light green discoloration. After a full investigation, any other possible causes for this urine color were excluded while the color returned to normal after antibiotic discontinuation.
Nocardiosis is an uncommon but serious opportunistic infection caused by Nocardia spp., typically affecting immunocompromised individuals and patients with chronic lung disease. We present the case of an 83-year-old man with severe COPD on long-term oxygen therapy and nocturnal bilevel positive airway pressure, who was admitted with worsening dyspnea, persistent cough, and fever unresponsive to outpatient antibiotics. Imaging revealed upper lobepredominant nodular infiltrates with a tree-in-bud pattern, and sputum cultures confirmed pulmonary infection with Nocardia spp. Blood cultures and CNS imaging were negative. The patient had no known immunodeficiency but had frequent corticosteroid use and low body mass index (BMI). Targeted treatment with intravenous trimethoprim-sulfamethoxazole and imipenem/cilastatin resulted in clinical and radiographic improvement. He was discharged on oral therapy and remained well at follow-up. This case highlights the importance of considering pulmonary nocardiosis in COPD patients who fail to respond to standard treatment, particularly those on chronic respiratory support. Early microbiological diagnosis and appropriate antimicrobial therapy are essential for improved outcomes.
We present a case of a 65-year-old Caucasian man with a six-month history of persistent non-productive cough, weight loss, and decreased exercise tolerance. Laboratory tests performed revealed significant eosinophilia in peripheral blood. Chest computed tomography identified extensive peripheral ground-glass opacities. Diagnostic bronchoscopy showed an eosinophilicrich bronchoalveolar lavage representing 85% of the total white blood cell count, confirming the diagnosis of chronic eosinophilic pneumonia. The cause remained unknown. Our patient was treated with prednisone 40 mg/ day complicated by recurrent infections. When trying to gradually reduce the dose of prednisone, the disease relapsed. Emerging use of mepolizumab, an interleukin-5-inhibiting monoclonal antibody, was associated with improvement of the clinical condition, reduction of peripheral blood eosinophils, regression of changes in imaging tests and remission maintenance without systemic steroids.
INTRODUCTION Early effective detection and confirmation of infectious pathogens in patients with lower respiratory tract infections (LRTIs) is very difficult, especially in grassroots hospitals. This study aims to evaluate the clinical practicality of targeted next-generation sequencing (t-NGS) detection of pathogens. METHODS A retrospective observational study was conducted in 140case final enrolled patients with LRTIs. We comprehensively analyzed the interrelationships between the distributions of positive pathogens and related factors such as age, disease type and underlying diseases by different distribution maps made by Graph-board Template Chooser. The accuracy and agreement tests were conducted separately using Pearson chi-squared test and qualitative data consistency test. RESULTS Among enrolled patients, the potential pathogens detectable by t-NGS in the bronchoalveolar lavage fluid (BALF) were bacteria, with the highest proportion 57.86%, followed by viruses 45.0% and fungi 44.29%. The vast majority of patients showed co-infected pathogens, among those in advanced age (aged >= 80 years), with multiple underlying diseases, and acute exacerbation of chronic obstructive pulmonary disease (AECOPD); the joint infection was the most significant, followed by CAP/P in 2-type DM. The accuracy of detecting positive pathogens by t-NGS method was significantly higher than that of CMTs method (all p <= 0.001). The consistency between the detection results of various pathogens and final clinical confirmed pathogen (FCCP) was significant (all kappa coefficients >= 0.80). Early use of t-NGS also reduced the antibiotic replacement rate in elderly patients after 3 days of CONCLUSIONS The t-NGS is a pathogen detection method with clinical prospects in grassroots hospitals because of higher positive detection rate, higher rate of accuracy and consistency, lower antibiotic replacement rate, especially for advanced age patients compared to the CMT method. Iota t is crucial and a challenge for clinical physicians on how to evaluate the results of t-NGS detection.
