Background: The use of HFNC (High Flow Nasal Cannula) in the management of acute respiratory failure has been fully established in clinical practice. Conversely, less data is available supporting its use in chronic hypoxemic-hypercapnic respiratory failure. The aim of the present study is to evaluate the efficacy of HFNC in chronic hypercapnic respiratory failure associated with stable COPD. Methods: In this retrospective single-center longitudinal observational study, 40 patients treated with HFNC at home followed at the COPD Clinic of Respiratory Diseases (University of Campania L. Vanvitelli Monaldi Hospital, Naples) were included. All patients are re-assessed at our clinic at T0, T3, T6 and T12 months through functional respiratory tests and blood gas analysis. Results: After 12 months, significant reductions in pCO2 (arterial partial pressure of carbon dioxide) (from 58.5 to 48.0 mmHg) and lactates (from 1.60 to 0.90 mmol/L) were observed, and MIP and MEP improved significantly. Patients receiving HFNC flows ≥50 L/min experienced greater reductions in pCO2 and fewer exacerbations. Multivariate analysis identified HFNC flow rate (p = 0.0046), hours of use/day (p = 0.0157), lactate levels (p = 0.0301), and FEV1 (forced expiratory volume in 1 s) (p = 0.0491) as independent predictors of reduction in PaCO2. Higher BMI and greater airway obstruction were associated with a reduced response. Conclusions: Treatment with HFNC represents a reasonable therapeutic choice to reduce AEs-COPD and reduce PaCO2 and lactates in stable COPD patients.
In the Article titled "Epidemiology and clinical outcomes of non-COVID viral respiratory infections in children from a low-middle-income country" (doi: 10.4081/monaldi.2025.3227) published on October 9, 2025, there is a change in the order of authorship. The change in authorship order was requested for academic promotion purposes, as authorship order must align with individual contributions. Therefore, revising the order to list Syda Asma Sherazi as first author and Ali Faisal Saleem as the last one ensures appropriate recognition and transparency.
Few data are available regarding the adherence to treatment guidelines in individuals with type 2 diabetes mellitus (T2DM) admitted to Internal Medicine Wards (IMW) while no information is available concerning the possible efficacy of an educational intervention aimed at improving adherence in this setting. To explore guidelines adherence and the associated impact on glycemic control in subjects with T2DM hospitalized in IMW before and after an educational intervention, we conducted a 3-phase, cluster-randomized, multicenter study. During Phase 1, we retrospectively collected data from patients with T2DM hospitalized for any cause in IMW for ≥5 days. In Phase 2, an educational training, based on the method of the educational outreach visits (EOV), was developed in 36 out of the 54 centers involved. In Phase 3, conducted 6 months after the training, we replicated the collection of data performed in Phase 1. Overall, we analyzed data from 1909 and 1662 individuals with T2DM during Phase 1 and Phase 3 of the study, respectively. No changes were observed in the difference between mean fasting glycemia levels at discharge vs at admission in Phase 3 comparing EOV vs NO EOV groups. A statistically significant increase in adherence to guidelines was observed from Phase 1 to Phase 3 and a trend toward higher adherence was detected when comparing the EOV and the no EOV groups. A structured educational intervention improves adherence to guidelines for managing T2DM in individuals admitted to IMW but has no effect on short-term glycemic control.
The impact of proprotein convertase subtilisin/kexin 9 (PCSK9) inhibitors on platelet reactivity in the setting of diabetes mellitus (DM) has not been adequately investigated. Out of 52 outpatients with atherosclerotic cardiovascular disease (ASCVD) with an indication for PCSK9 inhibitor alirocumab, 37 patients (mean age 68.1 ± 5.6 years, 62% males) were included in the study and retrospectively divided into two groups according to the presence of DM (DM+/DM-). A blood sample for platelet function testing was collected at baseline (T0), before initiation of alirocumab, and after 3 months of therapy (T90). Light transmission aggregometry was performed to study platelet aggregation, and results were expressed as percentage of maximum platelet aggregation (MPA). At 90-day follow-up, a significant reduction of total cholesterol and low-density lipoprotein cholesterol levels compared to baseline was observed in both DM+ and DM-groups. At baseline, MPA were comparable between the two groups. At T90, only in the DM + cohort, platelet aggregation induced by adenosine diphosphate (ADP) and arachidonic acid (AA) was significantly reduced compared to baseline (ADP 20 μM: 56.00 ± 28.67% vs 63.16 ± 33.69%, at T90 vs T0 respectively, p = 0.011; AA 1 mM: 28.68 ± 40.10% vs 41.74 ± 46.85%, p = 0.025). No significant change in platelet function from baseline was observed in patients DM- (p > 0.05 for all comparisons). The PCSK9 inhibitor alirocumab significantly reduced AA and ADP residual platelet aggregation after 90 days of therapy in patients with ASCVD and diabetes, but not in those without diabetes.
This study aimed to evaluate and compare the functional and oncological outcomes of different Open Partial Horizontal Laryngectomy (OPHL) techniques, particularly focusing on the time required for swallowing recovery and the functional impact of preserved laryngeal structures. We performed a retrospective analysis of 92 patients with primary or recurrent laryngeal squamous cell carcinoma treated with OPHL Type I, II, or III between September 2018 and March 2023. Patients were categorized by surgical type (OPHL I, OPHL IIa/CHEP, OPHL IIb/CHP, OPHL IIIa/THEP). Primary endpoints included the time (in days) to tracheostomy cannula removal, phonation onset, swallowing recovery, and Nasogastric Tube (NGT) removal. We also assessed the functional role of epiglottis preservation and arytenoid preservation (±ARY/CAU). Statistical analysis used ANOVA or the Mann-Whitney test, with 5-year Laryngo-Esophageal Dysfunction-Free Survival (LEDFS) calculated by the Kaplan-Meier method. Ninety-two patients were included (73 M, 19 F; mean age 63.5 ± 8.1 years). The most common procedures were OPHL IIa (53.3%) and OPHL I (41.3%). Overall, 91 patients (99.0%) were decannulated with a mean time of 6.6 ± 6.9 days. The mean time to swallowing recovery was 12.3 ± 8.3 days, and mean NGT removal was 16.9 ± 9.2 days. Comparative analysis showed that patients undergoing OPHL IIa had significantly earlier recovery outcomes compared to OPHL I: decannulation/pronunciation (p = 0.0087), swallowing recovery (p = 0.0000), and NGT removal (p = 0.0283). Furthermore, OPHL II patients preserving both arytenoids showed a significantly faster recovery of swallowing ability compared to those with arytenoid sacrifice (p = 0.038). Clinically, OPHL IIa was associated with a shorter length of hospital stay than OPHL I (p = 0.0081). The overall 5-year disease-specific survival was 91.3%. The 5-year LEDFS was 86.0% and did not differ significantly between OPHL I and OPHL II (p > 0.05). OPHL techniques provide effective oncological control and good functional preservation for selected intermediate and advanced laryngeal carcinomas. OPHL IIa showed superior speed of functional recovery compared to OPHL I, emphasizing the importance of preserving the epiglottis and the complexity of the reconstructive pexy. Preserving both arytenoids significantly enhances early swallowing recovery in OPHL II.
This manuscript presents two cases of life-threatening ventricular arrhythmias occurring during the acute phase of infectious illnesses, emphasizing the role of triggered mechanisms-both early and late-along with Purkinje cell firing and inflammation in arrhythmogenesis. The first case involves a 43-year-old male with hepatitis who developed recurrent monomorphic ventricular tachycardia, exhibiting changing morphologies. The second case describes a 43-year-old male with a febrile illness who presented with recurrent ventricular fibrillation triggered by short-coupled premature ventricular contractions. These cases highlight distinct cellular mechanisms underlying post-infectious arrhythmias and the importance of targeted therapeutic strategies. Key teaching points include the distinction between early afterdepolarization- and delayed afterdepolarization-mediated arrhythmias, the impact of inflammation on arrhythmogenesis, and the utility of advanced mapping and ablation techniques when arrhythmias persist despite initial medical management.
Long-term consequences of viral pneumonia on lung function depend on virus-specific tissue injury. Persistent impairment of alveolar-blood gas transport has been described after SARS-CoV-2 pneumonia but has not been investigated following respiratory syncytial virus (RSV) pneumonia. Possible long-term effects of these two viral infections were never compared after their clinical resolution in terms of lung physiology. The aim of this paper was to compare long-term sequelae of RSV and SARS-CoV-2 pneumonia on lung function and blood gas transport. Adults (>18 years) with previous RSV or SARS-CoV-2 pneumonia were investigated after complete computed tomography scan resolution. Collected variables included demographics, body mass index, hemoglobin, SpO₂, modified British Medical Research Council dyspnea score, spirometry, diffusing capacity [diffusing capacity for carbon oxide (DLCO), carbon monoxide transfer coefficient (KCO)], single-breath diffusing capacity for nitric oxide (DLNO) and DLCO, DLNO/DLCO ratio, and lung capillary blood volume (Vc). 38 post-SARS-CoV-2 and 37 post-RSV patients were studied. Groups were comparable and showed similar spirometric values. Compared with RSV, SARS-CoV-2 patients had significantly lower SpO₂, DLCO, and KCO (p<0.01). Vc was markedly reduced (p<0.001), with a corresponding increase in the DLNO/DLCO ratio (p<0.001). Only post-RSV patients were dyspnea-free. In conclusion, viral pneumonia may cause long-lasting lung function impairment depending on virus-specific tissue damage. Unlike RSV, SARS-CoV-2 pneumonia induces a persistent reduction of lung Vc, leading to impaired gas exchange despite radiological resolution.
Pregnancy is generally well tolerated in patients with arrhythmogenic cardiomyopathy (AC), but there are limited data comparing right-dominant AC (ARVC) and left-dominant AC (ALVC), as well as gene-positive but phenotype-negative (G+/P-) individuals. Recent guidelines have also introduced the non-dilated left ventricular cardiomyopathy (NDLVC). This study examines disease expression in pregnant women with AC and family members with pathogenic genetic variants but a negative phenotype (G+/P-). We also included those with NDLVC. We reviewed data from 22 patients diagnosed with definite AC and 9 G+/P- patients. Four patients meeting criteria for NDLVC were also analyzed. Each underwent at least one cardiovascular evaluation during pregnancy, which included a 12-lead ECG, echocardiography, and 24-h ambulatory monitoring. Events were defined as new or worsening arrhythmias, heart failure, or thromboembolic events. All AC patients, including those with ARVC and ALVC, tolerated pregnancy well. None of the G+/P- patients was diagnosed with AC during pregnancy. One G+/P- patient had ECG changes, while three with PKP2 mutations experienced mild left ventricular dysfunction but fully recovered postdelivery. Among the four NDLVC patients, only one developed left ventricular dysfunction. There was no increase in arrhythmias, and 31% of the cases required caesarean sections. All pregnancies resulted in live births, and no major maternal complications were reported. Pregnancy is typically safe for women with AC and G+/P- individuals, provided that they are hemodynamically stable. Patients with NDLVC also manage pregnancy well. However, careful monitoring during and after pregnancy is essential, even without obvious clinical signs of the disease.
Convective water vapor thermal therapy (WVTT, Rezum™) is an established minimally invasive surgical technique for men with LUTS secondary to benign prostatic hyperplasia (BPH). Despite increasing adoption, patient selection, peri-procedural management, technical execution, and training remain heterogeneous. We conducted a live modified Delphi consensus to define pragmatic, expert-driven recommendations for WVTT practice in Italy. A 10-member steering committee screened the literature and drafted candidate statements across eight predefined domains. A live modified Delphi process was conducted with 22 Italian urologists. Panelists voted using a four-level response scale; justifications were required for any response other than full agreement. Statements below the predefined consensus threshold were discussed, reformulated when appropriate, and re-voted. Consensus was defined a priori as ⩾75% full agreement. Twenty-six statements were voted. Consensus was achieved for 21/26 (80.8%) statements. Five statements did not reach consensus: routine preoperative cystoscopy (72.8%), routine semen culture (31.8%), restricting general anesthesia to selected cases/early learning curve (50.0%), continuation of antibiotics for the entire catheterization period (68.2%), and mandatory "complete" follow-up at 6 months (72.7%). Two items underwent iterative reformulation and re-voting: prostate volume ⩽ 80 cm3 (77.3% → 100%) and supervision during the initial learning curve (31.8% → 61.9% → 90.5%). This live Delphi consensus provides practice-oriented guidance for WVTT and defines areas of strong expert agreement alongside persistent evidence gaps. The findings support standardized adoption of WVTT within defined indications while prioritizing future research on peri-procedural protocols and follow-up pathways.
Heart transplantation (HT) and durable left ventricular assist device (LVAD) support are established surgical treatment options for patients with end-stage systolic heart failure (HF) and/or nonrecoverable cardiogenic shock. HT is currently considered the gold standard therapy, with reported median survival of approximately 10-13 years. However, its utility in the lifetime management of younger patients (under 50 years of age) is limited, given low rates of re-transplantation. With continued advancements in durable LVAD technology, median survival following LVAD implantation in younger patients now exceeds 7 years. In an era marked by increasing HF prevalence, persistent donor heart shortages, evolving organ allocation policies, growing concerns regarding equity of care, and progress in the cardiac function enhancement therapies, LVAD and HT should be considered synergistic rather than competing therapies in selected advanced HF populations. Specifically, the strategy of intentional LVAD implantation as a first-line approach in transplant-eligible younger adults and older adolescents might extend the therapeutic horizon and optimize lifetime management.
Unilateral cochlear implant (CI) recipients with contralateral moderate-to-profound hearing loss may either adopt a contralateral hearing aid (HA) or rely on CI-only listening. Bimodal stimulation (BS), combining electric and acoustic input, has been shown to improve speech perception in noise; however, some patients decline contralateral amplification despite residual hearing. This study aimed to characterize the audiological profiles of CI recipients who refuse contralateral HA use and to compare their speech-in-noise performance with that of BS users using the Italian Matrix Sentence Test. Unilateral CI users with contralateral moderate-to-profound sensorineural hearing loss were enrolled and divided into BS users and CI-only users. Pure-tone audiometry (PTA), word recognition score (WRS), and speech-in-noise performance were assessed. BS users were tested in both CI-only and CI+HA conditions. PTA and WRS in quiet did not differ significantly between groups (p = 0.12, p = 0.14, respectively). Within the BS group, speech-in-noise performance improved significantly with CI+HA compared with CI-only listening (p = 0.008). CI-only users showed slightly better residual contralateral hearing. BS provides a significant within-subject benefit for speech perception in noise. Significance: Refusal of contralateral amplification may reflect an experience-driven perception of limited benefit, highlighting the importance of individualized counselling and outcome-based hearing device selection.
Rigid bronchoscopy (RB) forms an indispensable part of the interventional bronchoscopist's skills, allowing the performance of complex airway interventions for a variety of benign and malignant airway disorders. Experiential data on the procedure is limited, particularly in adults. We conducted a retrospective analysis of medical records from 82 adult patients who underwent RB at our center. The primary objective was to evaluate the clinical indications, procedural outcomes, complication rates, and overall efficacy of RB in this cohort. Collected data included patient demographics, presenting symptoms, etiological diagnoses, and anesthesia-related parameters such as induction agents, maintenance protocols, sedation strategies, and the use of neuromuscular blockade. Post-procedural outcomes and follow-up mortality were also assessed. The mean patient age was 56.2±12.6 years, with 71.9% males. Common symptoms were cough (90.2%) and dyspnea (82.9%). Malignancies accounted for 90.2% of cases, with lung cancer being the most prevalent (68.2%). RB was primarily performed for stenting (63.4%) and tumor debulking (29.2%). Total intravenous anesthesia was used in 92.6%, with mean induction and reversal times of 75.3±4.3 seconds and 10.69±2.4 minutes, respectively. Minor complications occurred in 29.3% (bleeding 29.3%, bronchospasm 17.1%, and hypoxia 13.4%) and major complications in 2.4%. After the procedure, immediate extubation was achieved in 49 patients (59.8%), while 24 (29.3%) required short-term ventilator support (<24 h) and 9 (11.0%) required prolonged support (>24 h). The median hospital stay was 7 days (interquartile range 5-11). Symptomatic improvement at discharge was observed in 72/82 patients (87.8%). In-hospital mortality was 6.1% (5/82), mainly due to severe infections (hospital-acquired or ventilator-associated pneumonia) or massive endobronchial bleeding. Among patients with available follow-up (n=52), 3-month mortality was 11.5% (n=6). In this real-world cohort, RB demonstrated a high success rate with minimal complications, reinforcing its role as a critical tool in managing complex airway conditions. The procedure demonstrated high efficacy, particularly in malignant cases, with acceptable complication rates. Dedicated training is essential to enhance experience, gain expertise, and ensure optimal outcomes while minimizing procedural risks.
Background: Return to work (RTW) after acute coronary syndrome (ACS) or acute heart failure (HF) is a pivotal outcome reflecting functional recovery and quality of life (QoL). While survival after cardiac events has improved through reperfusion and guideline-directed pharmacotherapy, sustainable RTW depends on an integrated set of clinical, psychological, social, and occupational determinants. Objective: This study aimed to synthesize and expand the evidence on predictors of RTW, delineate practical workload-matching rules using METs and CPET, and position multidisciplinary cardiac rehabilitation (CR) as the bridge from clinical recovery to durable vocational reintegration. Key findings: Beyond left ventricular ejection fraction (LVEF), depression, anxiety, illness perceptions, and RTW self-efficacy are robust predictors of vocational outcomes. CPET-guided exercise prescriptions and MET-based job matching ensure adequate metabolic reserve; sustained task demand should remain at ≤35-40% of maximal capacity, with peak capacity ≥2× average job demand. CR (Class IA in the 2023 ESC ACS Guidelines) improves exercise tolerance, medication adherence, psychosocial well-being, and deployment of vocational support, including stepwise reintegration plans and ergonomic adaptations. Telerehabilitation extends monitoring and counseling into the workplace and maintains adherence after RTW. Conclusions: Comprehensive CR that integrates exercise training, psychosocial counseling, lifestyle modification, and vocational interventions offers the most effective pathway to stable RTW, improved QoL, and reduced socio-economic burden. Early identification of vulnerable subgroups and personalized, digitally supported follow-up are essential for long-term job retention.
Pleural mesothelioma (PM) is a rare and aggressive cancer arising from pleural mesothelial cells with a strong association to asbestos exposure. Among the diagnostic strategies available are noninvasive techniques including thoracic ultrasound (TUS), computed tomography (CT) scans, positron emission tomography (PET-CT), and invasive procedures such as thoracoscopy and pleural biopsy. Accurate identification of the histological subtype is critical for tailoring treatment strategies. The standard treatment for unresectable PM has traditionally been chemotherapy, particularly platinum and pemetrexed. However, recent advances in translational clinical research, including immune checkpoint inhibitors (ICIs), are changing the therapeutic landscape, offering new opportunities for personalized treatment. The recent FDA approval of nivolumab and ipilimumab combination therapy as a first-line treatment has significantly improved outcomes, especially for nonepithelioid subtypes. Ongoing studies are exploring additional immune-targeted therapies such as VISTA, LAG-3, and dendritic cell-based therapies. Early detection, refined biomarker identification, and a deeper understanding of the tumor microenvironment remain essential to improving PM prognosis and patient survival. This review provides a comprehensive exploration of the epidemiology, etiology, clinical manifestations, diagnostic approaches (including immunohistochemical and molecular markers), staging, and current treatment strategies for PM.
Airway obstruction resulting from both malignant and non-malignant etiologies is a growing challenge in pulmonary diseases and critical care medicine, particularly after the COVID-19 pandemic. Conventional silicone and metallic airway stents may be indicated in airway obstructions that lead to palliative relief, but they may lead to complications such as migration, inflammatory reaction to the adjacent tissue, and granulation tissue overgrowth. We conducted this animal pilot study to investigate the biocompatibility of a next-generation nanocomposite silicone airway stent, engineered with 3wt% hydrophobic nano-silica reinforcement. Innovative characteristics of the stent include improved biocompatibility and reduced mucus adhesion due to its hydrophobic properties. A refined stenting technique was applied to implant the stent in the trachea of two sheep models by assembling two endotracheal tubes, Ambu, and the stent. After a two-month follow-up, high-resolution computed tomography imaging, 3D virtual bronchoscopy, bronchoscopy, and biopsy of the tracheal wall were done. Histopathologic assessment demonstrated an inflammatory infiltrate dominated by lymphocytes, without stromal reactions, mucosal and submucosal thickening, or granulation, confirming a favorable tissue tolerance. These preliminary outcomes emphasize the stent's potential as a transformative therapeutic option; however, the study's limited sample size and absence of comparative controls highlight the necessity for further preclinical trials with quantitative airflow parameters to elucidate the clinical translatability of this innovative biomaterial solution for airway obstructions. Additionally, the findings of this study can address the unmet needs in managing complex airway obstructions, particularly for patients refractory to current therapeutic options in the future.
Obstructive sleep apnea (OSA) has several well-established risk factors. Smoking has been documented as a risk factor for several comorbidities associated with OSA. However, its specific contribution to the severity of OSA and its potential as an independent risk factor require further investigation. In this study, we have evaluated the association between smoking behavior and the severity of OSA and have examined the related sleep parameters and comorbidities. A retrospective analysis was conducted on 567 patients who underwent diagnostic polysomnography. Participants were grouped by OSA severity and smoking status (non-smokers, ex-smokers, and current smokers). Demographic and clinical characteristics, comorbidities, and sleep-related indices were compared across groups. Logistic regression analyses were used to identify predictors of severe OSA. Current and ex-smokers had significantly higher apnea-hypopnea index values (p=0.033), more oxygen desaturation, and lower sleep efficiency (p=0.021) compared to non-smokers. Psychiatric comorbidities and higher Mallampati scores were also more prevalent in the smokers' group. Smokers showed a 1.98 times higher risk of severe OSA as compared to non-smokers in univariate analysis (odds ratio=1.98; p=0.036) but were not retained as an independent risk factor in the multivariate model. Ex-smokers continued to show worse sleep parameters than non-smokers, indicating possible long-term effects of tobacco exposure. These results highlight the need for comprehensive management strategies that address both respiratory and systemic impacts in OSA patients with a smoking history.
Reflex syncope is the most frequent cause of transient loss of consciousness in the pediatric population. A structured diagnostic approach based on clinical evaluation and 12-lead ECG is mandatory to exclude the cardiac causes of syncope. Additional cardiac investigations, such as echocardiography, a stress test, or 24H Holter ECG monitoring, are needed in case of suspected cardiac syncope at initial evaluation. Cardiovascular autonomic function assessment, including ambulatory blood pressure monitoring and a tilt test, is useful for phenotyping syncope (hypotensive or bradycardic mechanism). In case of unexplained syncope after a comprehensive evaluation and high-risk criteria, an implantable loop recorder is indicated. The management is primarily based on reassurance, education, hydration, increased salt intake, and counter-pressure maneuvers. Pharmacological therapies and intervention strategies may be considered for patients with recurrent or disabling forms that are not responsive to lifestyle modifications. Conclusion: Reflex syncope in the pediatric population should be managed through a structured diagnostic pathway focused on excluding cardiac causes and guiding mechanism-based treatment. Education and lifestyle measures remain the cornerstone of management, while pharmacological or invasive strategies should be reserved for selected patients with recurrent or disabling symptoms. What is Known: • Reflex syncope is the most common cause of transient loss of consciousness in children and adolescents, and initial evaluation should rely on careful history taking, physical examination, and a 12-lead ECG to exclude cardiac causes. • Most pediatric reflex syncope can be managed conservatively through education and reassurance, together with adequate hydration, increased salt intake, and physical counter-pressure maneuvers. What is New: • This review proposes a structured stepwise diagnostic pathway that starts with clinical evaluation and ECG and escalates only when cardiac syncope is suspected or the presentation is high-risk. • It emphasizes the role of brief cardiovascular autonomic assessment (ambulatory blood pressure monitoring and tilt testing) to distinguish hypotensive from bradycardic mechanisms and guide individualized management.
The study aimed to evaluate the relationship of kinesiophobia with functional capacity, psychological distress, pulmonary function, and quality of life in individuals with obstructive airway disease and to determine the variables that independently predict kinesiophobia. A total of 111 clinically stable patients with obstructive airway disease were assessed using the Tampa Scale for Kinesiophobia (TSK), Numerical Rating Scale (NRS), Modified Medical Research Council Dyspnea Scale (mMRC), Fatigue Severity Scale (FSS), 6-Minute Walk Test (6MWT), International Physical Activity Questionnaire (IPAQ), arm curl test, 30-second sit-to-stand and flexibility tests, pulmonary function test, Depression Anxiety Stress Scale-21 (DASS-21), WHO Quality of Life-BREF (WHOQOL-BREF), and WHO Disability Assessment Schedule 2.0 (WHODAS 2.0). Clinically significant kinesiophobia (TSK>37) was observed in 64.8% of participants. TSK scores showed significant positive correlations with NRS (r=0.431), FSS (r=0.554), DASS-21 (r=0.456), WHODAS 2.0 (r=0.434), mMRC (r=0.309), and flexibility (back scratch test (r=0.281); and significant negative correlations with arm curl (r=-0.427), sit-to-stand (r=-0.433), 6MWT (r=-0.421), IPAQ (r=-0.421), and WHOQOL-BREF (r=-0.538), all with p<0.005. In multiple regression, lower forced vital capacity (β=-0.360, p<0.001), lower WHOQOL-BREF scores (β=-0.302, p<0.001), higher fatigue severity (β=0.230, p=0.007), and lower 6MWT percentage of predicted distance (β=-0.165, p=0.023) independently predicted higher kinesiophobia. The model explained 60.3% of the variance (R²=0.603). These findings highlight the high prevalence and multi-dimensional impact of kinesiophobia in obstructive airway disease, emphasizing the importance of addressing fear of movement to improve physical activity, functional capacity, and quality of life in pulmonary rehabilitation settings.
Platypnea-orthodeoxia syndrome (POS) is a rare condition with complex pathophysiology resulting from an anatomical site of shunting, mostly a patent foramen ovale (PFO), and factors promoting a right-to-left (R-L) shunt. A 54-year-old man was referred to our center for unexplained respiratory failure, exacerbated by sitting. A suspicion of POS was raised, and transesophageal echocardiography demonstrated a wide stretched PFO with R-L shunting, related to the presence of an aortic root aneurysm and right hemidiaphragm elevation, both compressing the right atrium, as well as a prominent eustachian valve. The patient underwent valve-sparing aortic root replacement and concomitant PFO closure, with resolution of symptoms. Multiple factors promoting R-L shunt have been associated with POS. The treatment of choice is represented by the correction of the anatomical shunt. Multidisciplinary team discussion is paramount for the diagnosis and management of this complex condition.
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