搜索结果：Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace

Pleural effusion is among the most common forms of paucibacillary extrapulmonary tuberculosis. Diagnosis is often clinical or based on elevated pleural fluid adenosine deaminase (ADA) levels. However, diagnostic uncertainty arises when clinical suspicion remains high despite low ADA levels, especially in patients already on empirical anti-tubercular therapy, which reduces bacillary load. The aim of this study is to evaluate the diagnostic utility of the Cartridge-Based Nucleic Acid Amplification Test (CBNAAT) in pleural biopsy samples with histopathologically confirmed tuberculosis. In this prospective study, 260 patients with undiagnosed pleural effusion who underwent pleural biopsy via thoracoscopy or ultrasound guidance were included. Histopathological examination identified 90 patients with pleural tuberculosis (study group) and 170 with non-tubercular etiology (control group). CBNAAT results from pleural biopsy specimens were analyzed to determine diagnostic performance. This study found the sensitivity, specificity, positive predictive value, and negative predictive value of CBNAAT for detecting pleural tuberculosis were 23.3% (21/90), 98.2% (167/170), 87.5% (21/24), and 70.8% (167/236), respectively. Sensitivity was higher (40%) in patients with pleural fluid ADA >40 IU/L compared to those with ADA <40 IU/L (15%). Notably, 4 of 90 patients (4.4%) in the study group were found to have rifampicin-resistant tuberculosis-these patients were on first-line anti-TB treatment at the time of biopsy. The conclusion of this study was that CBNAAT demonstrates low sensitivity but high specificity for diagnosing pleural tuberculosis from pleural biopsy samples. It is a valuable tool not only for early microbiological confirmation but also for detecting rifampicin resistance.

Assessment of disease severity in interstitial lung disease (ILD) is usually performed using lung function tests, exercise testing, and chest imaging. Each modality has its own benefits and drawbacks. Ultrasound (USG) examination of the diaphragm is a non-invasive imaging modality that has been found to be effective in evaluating diseases like chronic obstructive pulmonary disease and asthma. However, its role in the assessment of stable ILD has been scarcely evaluated. We conducted a cross-sectional study to evaluate the role of diaphragmatic USG in the assessment of disease severity in 55 stable ILD patients. After clinical evaluation, all patients underwent spirometry [forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC)], high-resolution computed tomography (HRCT) of the thorax and 6-minute walk test as per standard criteria. The Warrick score was calculated using HRCT to quantify the radiological extent of disease. Thereafter, USG was performed, and diaphragmatic excursion (DE) and thickness were measured during both quiet and deep breathing (DB). Dyspnea grade, spirometry values, 6-minute walk distance (6MWD), and the Warrick score were correlated with USG variables to assess for any possible association. The mean age of the patients was 57.6&#xb1;12.8 years (M:F=1:1). Idiopathic pulmonary fibrosis (n=15) was the most common ILD. The median FVC%, FEV1%, 6MWD, and Warrick score of the patients were 60 (48-74), 68 (53-90), 360 (245-400) m, and 18 (14-22), respectively. Out of 5 USG variables studied, thickening fraction, DE & diaphragmatic thickness (DB) showed statistically significant correlation (p<0.05) with dyspnea grade, FVC, 6MWD, and Warrick score in decreasing order of strength. On logistic regression analysis, FVC was the only factor that independently predicted thickening fraction (adjusted odds ratio: -1.08; 95% confidence interval 1.03-1.13; p=0.003). Diaphragmatic mobility and thickness showed a strong correlation with dyspnea, lung functions, exercise capacity, and radiological extent of disease in ILD patients. USG of the diaphragm can play an effective role in the assessment of disease severity in ILD.

Chronic obstructive pulmonary disease (COPD) is often associated with cardiovascular complications such as atrial fibrillation (AF), heart failure, and myocardial infarction. AF is highly prevalent in COPD, yet the mechanisms linking them remain unclear. This study investigates the role of atrial electromechanical delay (AEMD) in predicting cardiovascular outcomes in COPD patients. This prospective cohort study included 60 COPD patients (forced expiratory volume in 1 second/forced vital capacity <0.7) from August 2022 to March 2024. Patients with pre-existing heart disease and other major comorbidities were excluded. Participants underwent spirometry, electrocardiogram (ECG), echocardiography, and N-terminal pro b-type natriuretic peptide (NT-proBNP) testing. AEMD was measured at the lateral and medial mitral annuli and tricuspid annulus. Primary endpoints included AF incidence, heart failure, stroke, and COPD exacerbations, while secondary endpoints were hospitalization and mortality. AEMD values were significantly higher in patients with AF (75.4&#xb1;5.9 ms vs. 70.4&#xb1;4.1 ms, p=0.004), heart failure, and COPD exacerbations, particularly at the lateral and medial mitral annuli. AEMD at the tricuspid annulus was strongly associated with mortality (p=0.04). P wave dispersion (41.2&#xb1;6.4 ms vs. 36.1&#xb1;4.2 ms, p=0.001) and QT dispersion (49.3&#xb1;8.9 ms vs. 42.1&#xb1;6.8 ms, p=0.002) were significantly elevated in patients with adverse outcomes. Elevated NT-proBNP levels (>1000 pg/mL) correlated with prolonged AEMD, suggesting cardiac stress. AEMD, particularly at the mitral and tricuspid annuli, is a strong predictor of AF, heart failure, and COPD exacerbations. P wave and QT dispersion are associated with increased hospitalization and mortality, highlighting their role in risk stratification. These findings support the use of AEMD and ECG parameters as early markers for cardiovascular complications in COPD. Further validation in larger cohorts is needed.

Globally, acute myocardial infarction (AMI) is a predominant cause of morbidity and mortality. Identifying reliable biomarkers to enhance risk prediction models remains a priority. This study assesses the role of growth differentiation factor-15 (GDF-15) as a predictor of AMI and its incremental value in refining current risk assessment models. A case-control study was established involving 45 AMI cases and 45 controls. Demographic, clinical, and biochemical parameters were evaluated. Logistic regression models were developed to assess the relationship between GDF-15 and AMI, adjusting for conventional risk factors and biomarkers. The prediction ability of models with and without GDF-15 was compared using the area under the curve (AUC). GDF-15 values were markedly elevated in AMI patients relative to controls. Incorporating GDF-15 into predictive models substantially improved their discriminative ability, demonstrating that GDF-15 was a robust independent predictor of AMI, enhancing diagnostic sensitivity and specificity across multiple models. Adjusting for demographic, lifestyle, and clinical risk factors, inclusion of GDF-15 led to notable AUC enhancements in Model 2 (32.88%) and Model 3 (19.66%). Models 4 and 5, which included additional biomarkers, demonstrated modest AUC improvements (2.57% and 0.61%, respectively), highlighting GDF-15's incremental value, even in models already incorporating a wide range of established biomarkers. In conclusion, GDF-15 is a robust and independent predictor of AMI, consistently improving the diagnostic performance of multivariable models. Its incorporation enhanced sensitivity, specificity, predictive values, and AUC (up to 0.999), underlining its effectiveness in risk stratification and early diagnosis of AMI.

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.

The role of fungi as the dominant allergen in asthma pathogenesis has been extensively explored. Most intriguing has been the relationship between asthma and Aspergillus fumigatus, given its ubiquitous presence and tendency to cause a wide spectrum of diseases in humans. Existing literature suggests that Aspergillus sensitization is associated with increased asthma severity, but prospective data comparing treatment outcomes between Aspergillus-sensitized and non-sensitized asthma patients remain limited. This study aimed to (i) determine the prevalence of Aspergillus fumigatus sensitization in an asthma cohort and (ii) prospectively compare longitudinal treatment outcomes, including symptom control, quality of life, and lung function, between sensitized and non-sensitized groups. A total of 124 patients with asthma were recruited. Patients were divided into two groups: Aspergillus-sensitized and non-sensitized, as determined by skin prick tests with Aspergillus fumigatus antigen. A total of 36 patients (29.03%) were found to be sensitive to Aspergillus fumigatus. Aspergillus-sensitized patients were evaluated for allergic bronchopulmonary aspergillosis, and 5 were identified and excluded from the study. The remaining 119 asthma patients, 31 sensitized and 88 non-sensitized, were included in the analysis. Baseline clinical characteristics, spirometry findings, and symptom questionnaire scores (Asthma Control Test and mini Asthma Quality of Life Questionnaire) were obtained. Asthma symptom control was assessed as per the Global Initiative for Asthma guidelines. All patients received standard asthma therapy and were followed up at a three-month interval. At baseline, both groups were similar in clinical characteristics, asthma symptom control, lung function, and symptom questionnaire scores. On follow-up, no differences were found between the two groups in asthma symptom control, symptom questionnaire scores, or exacerbation frequency. Aspergillus fumigatus sensitization was not associated with increased asthma severity or poorer treatment outcomes. Testing for Aspergillus sensitization may be reserved for patients with a poor therapeutic response or a strong clinical suspicion of allergic bronchopulmonary aspergillosis.

The relationship between increased pericardial fat volume (PFV) and coronary plaque characteristics in patients with metabolic syndrome (MetS) is unclear. We aimed to assess PFV and coronary plaque characteristics, including type, stenosis severity, and presence of multiple plaques, among patients with MetS being evaluated for suspected coronary artery disease (CAD). This retrospective study included patients with suspected CAD who underwent computed tomography coronary angiography to exclude the presence of occlusive CAD. MetS diagnosis was based on the American Association of Clinical Endocrinologists criteria. The study included 811 individuals with suspected CAD who underwent MDCT examinations: 127 were in the MetS group, 71 were in the diabetes mellitus (DM) group, and 613 were in the control group (neither DM nor MetS). PFV was higher in the MetS group compared to the DM and the control groups (p=0.003). The MetS group had a higher prevalence of multiple (p<0.001) and mixed coronary plaques (p<0.001) compared to other groups. Increased age [odds ratio (OR) confidence interval (CI)=1.1(1-1.2), p=0.039] and PFV [OR (CI)=1 (1-1.2), p=0.027] showed an independent association with multiple plaque presence, while PFV was an independent predictor of mixed plaque presence [OR (CI)=1.1 (1-1.2), p=0.008]. In conclusion, patients with MetS had larger PFV and a higher prevalence of mixed and multiple coronary plaques than patients without MetS. PFV showed an independent and significant association with mixed and multiple coronary plaques among patients with MetS.

Tuberculosis has remained an intractable challenge for mankind. The Cascade of Care approach is adopted, emphasizing early detection of latent tuberculosis infections through screening and primordial prevention of disease holistically. Currently available tests include the tuberculin skin test (TST) and interferon-&#x3b3; release assays (IGRA). Our study aims at identifying the adequacy of prevailing operational knowledge about these tests amongst the interns and postgraduates who form the future medical fraternity. We conducted a prospective questionnaire-based study among interns and postgraduates. Further data compilation was done using Microsoft Excel. Comparison between groups was done using appropriate statistical tests. In our study conducted on 196 participants, we found that 53.41% of the total questions were answered rightly. The correct responses for the questions on TST were 65.29%, while for IGRA, they were 33.45%. Our study discloses the problem of a significant gap in operational knowledge about the screening tests, silently delaying the achievement of the vision, mission, and goals of the National Tuberculosis Elimination Program. India is both committed and concerned: as a solution, there is an urgent need to address this through continued medical education and periodic training workshops by utilizing the existing resources and allocations.

Hypertriglyceridemia (HTG) increases cardiovascular and pancreatitis risk. Antisense oligonucleotide (ASO) therapies like volanesorsen and olezarsen target ApoC-III mRNA to reduce ApoC-III, enhancing lipoprotein lipase activity and lowering triglycerides (TGs). This meta-analysis evaluates the efficacy and safety of these ASOs in severe HTG. A systematic review (PROSPERO: CRD42024577110) was conducted following PRISMA, sourcing studies from PubMed, Scopus, Cochrane CENTRAL, and ClinicalTrials.gov until July 2024. Randomized controlled trials (RCTs) involving severe HTG (&#x2265;200 mg/dL) treated with volanesorsen or olezarsen vs. placebo were included. Data were synthesized using a random effects model in RevMan 5.4, and bias was assessed with the Cochrane tool. Of 31 identified articles, 9 RCTs (341 patients treated with ASOs, 209 controls) were included. ASOs significantly reduced TG levels [mean difference (MD): -53.72; 95% confidence interval (CI): -77.04 to -30.40; p<0.00001]. Reductions were also seen in very low-density lipoprotein cholesterol (MD: -55.76; p<0.00001), ApoC-III (MD: -74.78; p<0.00001), and APOB48 (MD: -69.45; p<0.00001). Olezarsen uniquely reduced APOB (MD: -15.60; p<0.00001). Non-high-density lipoprotein cholesterol (HDL-C) decreased (MD: -23.25; p<0.00001), while HDL-C increased (MD: +42.14; p<0.00001). Volanesorsen was linked to higher low-density lipoprotein-cholesterol (MD: +62.74; p=0.004). For safety, local injection reactions, thrombocytopenia, and nausea were more common with volanesorsen. Acute pancreatitis occurred only in the placebo group (relative risk: 0.15; p=0.0004), indicating ASO protection. This meta-analysis confirms that ASOs effectively lower TGs and improve lipid profiles in severe HTG.

Bronchiectasis is a chronic respiratory condition characterized by irreversible bronchial dilatation, persistent airway inflammation, and impaired mucociliary clearance. Physical activity (PA) plays a key role in improving respiratory health and quality of life, yet objective data on PA levels and their clinical determinants in bronchiectasis are limited. We aimed to assess PA levels using wrist-worn accelerometry in individuals with non-cystic fibrosis (non-CF) bronchiectasis and to explore their association with clinical, functional, and inflammatory parameters. This cross-sectional study enrolled 27 adults with stable non-CF bronchiectasis (median age: 68.5 years; 40.7% female). Participants wore an AX3 wrist accelerometer for 7 consecutive days and were categorized into light or moderate/vigorous activity groups based on the World Health Organization guidelines. Clinical characteristics, pulmonary function (including airway resistance), and inflammatory markers [eosinophil count, fractional exhaled nitric oxide (FeNO)] were collected and analyzed. Logistic regression models were used to explore associations between these variables and PA levels. Patients with higher PA levels demonstrated lower airway resistance and reduced markers of type 2 inflammation. In univariate analysis, airway resistance, eosinophil count, FeNO, and age were significantly associated with PA levels. However, none of these factors retained significance in the multivariate model. Thus, reduced PA in bronchiectasis appears to be influenced by both airway inflammation and physiological factors such as aging. Inflammatory burden and impaired airway mechanics may limit functional capacity, underscoring the need for comprehensive management strategies that address both inflammation and mobility to improve patient outcomes.

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&#xb1;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&#xb1;4.3 seconds and 10.69&#xb1;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.

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 (&#x3b2;=-0.360, p<0.001), lower WHOQOL-BREF scores (&#x3b2;=-0.302, p<0.001), higher fatigue severity (&#x3b2;=0.230, p=0.007), and lower 6MWT percentage of predicted distance (&#x3b2;=-0.165, p=0.023) independently predicted higher kinesiophobia. The model explained 60.3% of the variance (R&#xb2;=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.

Interstitial lung diseases (ILDs) comprise a heterogeneous group of disorders characterized by varying degrees of inflammation and fibrosis, necessitating precise epidemiological characterization. This ambispective observational study evaluated the clinical spectrum and diagnostic distribution of 1201 patients at a tertiary center in North India, utilizing a multidisciplinary discussion (MDD) framework for final diagnostic consensus. The mean age of the cohort was 52.7 (&#xb1;13.04) years, with a female predominance of 55.6%. Idiopathic interstitial pneumonia (IIP) was the most prevalent diagnosis (48.8%), followed by connective tissue disease-associated ILD (CTD-ILD; 19.8%) and hypersensitivity pneumonitis (14.6%). Within the IIP subgroup, idiopathic pulmonary fibrosis predominated (49.7%), followed by nonspecific interstitial pneumonia (39.2%). Statistical analysis identified tobacco use as a significant driver for IIP phenotypes (odds ratio: 3.36; 95% confidence interval: 2.37-4.75; p<0.01). Physiological assessment revealed a restrictive ventilatory defect in 83.9% of the cohort. Patients with sarcoidosis (13.4%) exhibited significantly higher functional reserve (mean forced vital capacity %: 74.1&#xb1;17.9%) compared to more fibrotic subtypes (p<0.01), and demonstrated superior exercise capacity (mean 6-minute walk distance: 392.4&#xb1;85.6 m vs. 347.7&#xb1;90.1 m in CTD-ILD; p<0.01). These findings establish that fibrotic IIPs constitute the primary disease burden in North India, highlighting the clinical necessity of standardized, MDD-based pathways to ensure accurate phenotype differentiation and timely initiation of targeted therapies in a region characterized by complex environmental triggers.

Identification of the chronic obstructive pulmonary disease (COPD) phenotype allows selection of the most appropriate drug for each patient. Blood eosinophilia, as a surrogate marker for airway eosinophilia, has been associated with a phenotype of COPD exacerbators. Thus, blood eosinophilia and/or sputum eosinophilia enable healthcare providers to assess disease severity and guide treatment decisions in COPD patients. Understanding these factors can aid in effective COPD management and improve patient outcomes. A prospective observational study was conducted at a tertiary care hospital. A total of 140 diagnosed COPD patients who met the eligibility criteria and attended the Department of Tuberculosis and Respiratory Diseases were included in the study. All recruited patients underwent a thorough clinical assessment, including detailed history taking (with emphasis on exacerbations), physical examination, complete blood count, including absolute eosinophil count (AEC), sputum cytology, and chest X-ray. Eosinophilia was defined as an AEC>150 cells/&#xb5;L and/or sputum eosinophilia &#x2265;2%. If sputum cytology showed <2% eosinophils and <60% neutrophils, the sample was considered paucicellular, and those patients were excluded from statistical analysis. Appropriate statistical tests were applied to derive inferences. Of the 140 enrolled COPD patients, 83 (59.3%) had stable COPD and 57 (40.7%) were experiencing acute exacerbation. Blood eosinophilia (AEC>150 cells/&#xb5;L) was present in 76 (54.3%) patients. After excluding sputum samples with paucicellularity (n=69), sputum eosinophilia (&#x2265;2%) was present in 41 (57.7%) of the remaining 71 patients. A statistically significant association was observed between blood eosinophilia and a history of exacerbations (p<0.001). Similarly, sputum eosinophilia was significantly associated with a history of COPD exacerbations (p=0.008). COPD severity (GOLD stage) was significantly associated with blood eosinophilia (p=0.044). However, no statistically significant correlation was found between sputum eosinophilia and blood eosinophilia (p=0.5). Measurement of blood and sputum eosinophils facilitates phenotyping of COPD patients and enhances precision in treatment without delay. The use of inhaled corticosteroids targets eosinophilic inflammation in patients with COPD exacerbations. Therefore, we recommend measuring blood eosinophil counts in all patients at the time of COPD diagnosis.

Cardiorespiratory physiotherapy (CRP) is an evidence-based process for individuals with both acute and chronic cardiorespiratory health conditions, yet access to center-based CRP in Italy is limited. Home-based and telehealth alternatives remain scarcely explored. This study investigated the status of CRP in the Lombardy region through a cross-sectional online survey distributed to physiotherapists registered with the Interprovincial Professional Register of eight provinces. A total of 388 responses were analyzed: 32 (8.2%) reported performing home-based CRP, and 9 (2.3%) reported telerehabilitation. Peripheral oxygen saturation was the most frequently assessed parameter (86%). Positive expiratory pressure devices were used for airway clearance (75%), and exercise reconditioning was consistently performed (79%). Variation was noted in lung re-expansion techniques, with some outdated methods still in use. Specific training in the use of telehealth facilities was often limited, and technological resources were essential for delivering telerehabilitation. The findings indicate that CRP beyond the clinic is still underutilized in Lombardy. Strengthening training programs and implementing standardized protocols could enhance access to and the quality of care. However, results are preliminary and limited by low representativeness and potential selection bias; therefore, they should not be considered generalizable.

Dry powder inhalers (DPIs) are the newer devices whereby medicine is dispensed as a fine powder inhaled deeply into the lungs, which is more simplified and stable compared to the pressurized metered dose inhalers. DPIs were developed primarily for respiratory disorders such as asthma and chronic obstructive pulmonary disease, but are being investigated for other uses. This review explicates the features of DPIs and how they are made, looking at their effectiveness in respiratory therapy, noting features such as usability, stability of the drugs, and flexibility. It also discusses the potential of systemic drug delivery using other routes, such as insulin for diabetes, calcitonin for osteoporosis, antibacterial agents, vaccines, dermal treatments, and ocular treatments, considering issues like stability and patients' compliance. Issues related to jet milling, spray drying, and supercritical fluid technology are also covered with regard to improving DPI performance. Hindrances, including formulation stability and regulatory issues, have been discussed as a way of demonstrating how innovation is needed to go beyond respiratory therapy.

Chronic cough-related diseases increase the risk of urinary incontinence (UI) due to repeated intra-abdominal pressure affecting the pelvic floor. Existing studies focus on specific diseases rather than UI as a broader consequence. To determine the prevalence of UI in patients with chronic cough-related diseases and compare it with the prevalence in healthy populations. A systematic review was conducted using Medline, Embase, Cochrane, OVID, Scopus, ProQuest, PEDro, and EBSCO. Two independent reviewers screened studies using predefined criteria in a Microsoft Excel spreadsheet. Only prevalence studies were included. Data were extracted, synthesized, and assessed using the GRADE approach for evidence quality and the STROBE checklist for reporting quality. Prevalence estimates varied widely based on demographic characteristics. UI prevalence ranged from 2.2% to 45% in pediatric patients, 30.4% to 74% in adult women, and 2.4% to 39% in adult men. The quality of evidence was low, while reporting quality was acceptable. UI is a common complication in patients with chronic cough, with a higher prevalence than in healthy populations. Due to the stigma surrounding urogenital disorders, clinicians should actively inquire about UI during patient history-taking and refer affected individuals for appropriate treatment.

Airway clearance techniques (ACT) should be included as part of the non-pharmacological treatment of patients with bronchiectasis (BE) following international guidelines. This approach in chronic respiratory patients should be maintained despite a pandemic situation, including SARS-CoV-2. The objective of this study is to evaluate the satisfaction, adherence, effectiveness, and safety of telehealth ACT (tACT) via video consultation for secretion drainage in patients with stable BE. This is an observational pilot study with prospective recruitment describing a cohort of patients with BE and patients with BE and infection due to non-tuberculous mycobacterial pulmonary disease (NTM-PD) included in a tACT program. Patients received an initial tACT visit (V1), another after one week (V7), and a final visit after one month (V30). Adherence, effectiveness and safety data were recorded. Satisfaction with the intervention was determined using a visual analogue scale (0-10). A total of 40 patients with BE and 17 patients with BE and NTM-PD were included, with a mean age of 63 (13). A total of 48 patients evaluated the telehealth intervention at >8 with the VAS, with a mean VAS score at V7 of 9.0 (1.9) and 8.9 (2) at V30. Self-reported adherence to treatment was high, with an average of 6.5/7 and 25/30 days; 94% of the patients managed to expectorate during V1 (effectiveness of the intervention). No relevant side effects were detected. tACT for managing secretions in patients with BE, whether with or without NTM-PD, has proven to be satisfactory, effective, and safe during a critical pandemic situation. This safety strategy could be included in the future as a complementary tool in the management of chronic respiratory patients.

Valvular heart disease (VHD) remains a significant global health concern, with mortality rates ranging from 1% to 15%. In Indonesia, the most prevalent form of VHD is rheumatic heart disease, which is associated with a hospital mortality rate of 6.5% following valve surgery. Previous studies have shown that, post-surgery, morbidity rates remain high: 30.8% of patients experience prolonged intensive care unit stays (>96 hours), 30.67% require extended mechanical ventilation (>24 hours), and 52% need prolonged use of inotropic agents (&#x2265;14 days). Right ventricular (RV) dysfunction is closely associated with these three morbidity parameters, as well as with 30-day postoperative mortality. However, limited research in Indonesia has explored the most effective parameters for evaluating RV function as a predictor of postoperative morbidity and mortality following heart valve surgery. This prospective cohort study was conducted at the Department of Cardiology and Vascular Medicine, Universitas Indonesia, and the National Cardiovascular Center Harapan Kita (NCCHK) from October 2023 to July 2024. During this period, 174 patients with VHD who underwent surgical valve replacement were enrolled. After applying exclusion criteria, 26 patients were excluded, resulting in a final study population of 148 patients. All participants underwent preoperative echocardiographic assessment of RV function, performed by two operators within 1 week prior to surgery. Among the 148 subjects, females comprised the majority (60.1%). Atrial fibrillation (AF) was the most common comorbidity, affecting 62.8% of the cohort. The most frequent morbidity outcome was prolonged mechanical ventilation, observed in 27.7% of cases. Of the total mortality events, 70% were cardiac-related, while the remaining 30% were due to non-cardiac causes. Multivariate analysis revealed that a preoperative S'<10 cm/s was significantly associated with cardiac-related mortality [odds ratio (OR) 3.46; 95% confidence interval (CI) 1.01-11.87; p=0.049]. Additionally, a preoperative S'<11 cm/s was significantly associated with overall clinical outcomes, including both morbidity and all-cause mortality (OR 3.08; 95% CI 1.43-6.65; p=0.004). In conclusion, S', an echocardiographic parameter reflecting RV function, demonstrates potential as a predictive marker for postoperative morbidity and mortality in patients undergoing heart valve surgery.