Interstitial lung disease-associated pulmonary hypertension (ILD-PH) is a frequent and life-limiting complication of fibrotic lung disease, associated with substantial morbidity, impaired functional capacity, and significantly reduced survival. Under-recognition remains common due to overlapping symptoms with ILD, evolving hemodynamic definitions, and the limited accuracy of current noninvasive screening tools. ILD-PH prevalence varies widely across ILD subtypes, ranging from 3-15% in early disease to more than 60% in lung transplant candidates. Even modest elevations in mean pulmonary artery pressure are prognostically meaningful, while right ventricular dysfunction represents a key determinant of mortality. Pathophysiology reflects a complex interaction between parenchymal fibrosis, chronic hypoxemia, endothelial injury, and progressive pulmonary vascular remodeling. Diagnostic evaluation requires a multimodal approach, with right heart catheterization remaining essential for definitive confirmation. Historically, vasodilator therapies have shown limited benefit; however, inhaled treprostinil has demonstrated improvements in exercise capacity, biomarkers, and clinical worsening, establishing the first evidence-based treatment for ILD-PH. Additional inhaled and targeted agents are in development, and the role of combination therapy is an emerging area of investigation. Optimal management also includes supplemental oxygen, pulmonary rehabilitation, and timely evaluation for lung transplantation. ILD-PH represents a distinct vascular phenotype requiring early detection and tailored treatment strategies. Continued advances in screening algorithms, precision therapeutics, and mechanistic research are critical to transforming ILD-PH from a terminal complication into a modifiable component of the ILD spectrum.
BACKGROUND:An increased incidence of auto-inflammatory diseases, such as celiac disease (CD), has been reported following coronavirus disease 2019 (COVID-19) pandemic. The aim of this systematic review and meta-analysis was to assess whether COVID-19 is associated with CD risk. METHODS:We searched MEDLINE (PubMed), Cochrane Library and Clinicaltrial.gov databases up to October 30, 2025, for studies evaluating the incidence of CD following COVID-19 infection (PROSPERO ID: CRD420251174742). We performed qualitative and quantitative syntheses of retrospective studies to evaluate the role of COVID-19 infection in CD incidence. RESULTS:A total of 4 studies were used in the qualitative and quantitative analysis. The studies were conducted between 2023 and 2024 and included 3,465,996 exposed and 7,044,493 non-exposed COVID-19 people. The results from the pooled synthesis showed no significant difference in CD incidence among exposed and non-exposed people with COVID-19 (risk ratio [RR] 1.25, 95% confidence interval [CI; 0.94, 1.66], P=0.12, I2=87%). Similarly, no difference was observed in CD incidence between COVID-19 and non-COVID-19 patients after performing a leave-one-out sensitivity analysis (RR 1.10 95% CI [1.00, 1.22], P=0.06, I2=0%). CONCLUSIONS:These findings suggest that COVID-19 infection does not appear to increase the risk of developing CD.
BACKGROUND:This study aimed to demonstrate the superiority of diclofenac sodium 75 mg/thiocolchicoside 4 mg/4 mL fixed-dose combination (FDC) for intramuscular (IM) injection vs. diclofenac 75 mg alone or placebo in relieving pain in patients suffering from low back pain (LBP). METHODS:Adult patients with acute moderate-severe LBP, i.e., with ≥50 mm at Visual Analogic Scale (VAS) assessment and stable muscle contracture, were randomized to receive diclofenac/thiocolchicoside FDC (N.=68), diclofenac monotherapy (N.=68) or placebo (N.=69), all given IM once-daily in two consecutive days. The primary endpoint was the sum of pain intensity difference from pre-dose to Day 3 in VAS for pain - SPID(0-3). Pain was also measured twice daily up to Day 7. RESULTS:Mean SPID(0-3) was significantly higher with test FDC (116.2 mm) versus diclofenac (94.8 mm) and placebo (62.6 mm). The superiority of FDC over control groups was maintained up to Day 7 - SPID(0-7). Muscle contracture (expressed as Schober's index) decreased more markedly in the test group compared to controls. The results of the 24-item Roland-Morris disability questionnaire confirmed the superiority of FDC over diclofenac and placebo on physical functions. Rescue treatment (oral diclofenac) was used in fewer patients in the FDC group than in control groups. Treatment-related adverse events were reported in fewer patients in the FDC and diclofenac groups (5.9%) compared to the placebo group (16.2%). CONCLUSIONS:IM diclofenac + thiocolchicoside FDC was significantly more effective than diclofenac and placebo in the relief of pain and improvement of mobility in patients with acute moderate-severe LBP, and was well tolerated.
