Pulmonary Medicine

Background. Respiratory syncytial virus (RSV), a well-known cause of bronchiolitis in children, can cause community-acquired pneumonia (CAP) in adults, but this condition is not well studied. Hence, we described the characteristics and outcomes of patients hospitalized for CAP due to RSV. Methods. This was a retrospective study of patients admitted to a tertiary-care hospital between 2016 and 2019 with CAP due to RSV diagnosed by a respiratory multiplex PCR within 48 hours of admission. We compared patients who required ICU admission to those who did not. Results. Eighty adult patients were hospitalized with CAP due to RSV (median age 69.0 years, hypertension 65.0%, diabetes 58.8%, chronic respiratory disease 52.5%, and immunosuppression 17.5%); 19 (23.8%) patients required ICU admission. The median pneumonia severity index score was 120.5 (140.0 for ICU and 102.0 for non-ICU patients; ). Bacterial coinfection was rare (10.0%). Patients who required ICU admission had more hypotension (systolic blood  mmHg) and a higher prevalence of bilateral infiltrates on chest X-ray (CXR) (89.5% versus 32.7%; ). Systemic corticosteroids were used in 57.3% of patients (median initial dose was 40 mg of prednisone equivalent) with ICU patients receiving a higher dose compared to non-ICU patients (). Most (68.4%) ICU patients received mechanical ventilation (median duration of 4 days). The overall hospital mortality was 8.8% (higher for ICU patients: 31.6% versus 1.6%, ). Conclusions. Most patients with CAP due to RSV were elderly and had significant comorbidities. ICU admission was required in almost one in four patients and was associated with higher mortality.

Aim. It is known that children and adolescents with obesity are more prone to obstructive sleep apnea syndrome (OSAS) and that their lung function may show some disturbance. Literature is scarce about potential associations; therefore, we aimed to study the relationship between OSAS, lung function, and adiposity in a population of children suspected of OSAS. Material and Methods. We performed home respiratory polygraphy and spirometry in all subjects. The relationships between body mass index -score (zBMI), polygraphy, and spirometry data were analyzed. Results. We recruited 81 subjects aged between 5 and 16 years, 63% being obese. 43.2% of subjects were diagnosed with OSAS (32.1% mild, 4.9% moderate, and 6.2% severe). We found no correlation between respiratory polygraphy and the zBMI. The mean spirometric value FEV₁, FVC, and FEV₁/FVC ratio ’s were normal in all subjects, whereas FVC ’s and FEV₁/FVC ratio ’s were significantly positively related for obesity and negatively for normal weight (). FEV₁’s was inversely correlated to the percentage of analyzed time passed below 90% of SpO₂ (). All subjects with FEV₁ () and/or FVC () ’s below the lower limit for normal (LLN) had an (FEV₁: ; FVC: ), especially subjects with normal weight (FEV₁: ; FVC: ). Conclusion. When comparing normal-weight children and adolescents with obesity, the prevalence of OSAS but not spirometric values was strongly related to BMI -score, probably because obesity engenders advanced puberty and an accelerated growth spurt. FEV₁ was more frequently <LLN in normal-weight children, while obese subjects presented low FEV₁/FVC ratio ’s and FEF_25-75%’s. Moreover, all subjects with abnormal spirometric values were suffering from at least mild OSAS, again more frequently in normal-weight subjects.

Background. Digital health technologies (DHTs) have shown potential to improve health outcomes through improved medication adherence in different disease states. Cystic fibrosis (CF) requires care coordination across pharmacies, patients, and providers. DHTs can potentially support patients, providers, and pharmacists in diseases like CF, where high medication burden can negatively impact patient quality of life and outcomes. Methods. In this prospective cohort study, a CF-specific mobile application (Phlo) was distributed to adults with CF who received care at the University of Utah Cystic Fibrosis Center, used an iPhone, and filled prescriptions through the University of Utah Specialty Pharmacy services. Participants were asked to use Phlo for 90 days with an optional 90-day extension period. Participants completed four surveys at baseline and after 90 days. Changes in patient-reported outcomes, adherence, clinical outcomes, and healthcare resource utilization from baseline to 90 days were tracked. Results. Phlo allowed users to track daily regimen activities, contact their care team, receive medication delivery reminders, and share progress with their healthcare team. A web-based dashboard allowed the care team to review reported performance scores from the app. Most patients (67%) said the app improved confidence in and motivation for continuing their regimen. The most important reported benefit of Phlo was having a single location to manage their whole routine. Conclusions. Phlo is a mobile health technology designed to help patients with CF manage their treatment regimen and improve patient-provider communication.

Tissue inhibitors of matrix metalloproteinases (TIMP) are a family of four endogenous proteins that primarily function to inhibit the activities of proteases such as the matrix metalloproteinases (MMP). Altered MMP/TIMP ratios are frequently observed in several human diseases. During aging and disease progression, the extracellular matrix (ECM) undergoes structural changes in which elastin and collagens serve an essential role. MMPs and TIMPs significantly influence the ECM. Classically, elevated levels of TIMPs are suggested to result in ECM accumulation leading to fibrosis, whereas loss of TIMP responses leads to enhanced matrix proteolysis. Here, we outline the known roles of the most abundant TIMP, TIMP2, in pulmonary diseases but also discuss future perspectives in TIMP2 research that could impact the lungs. TIMP2 directly inhibits MMPs, in particular MMP2, but TIMP2 is also required for the activation of MMP2 through its interaction with MMP14. The protease and antiprotease imbalance of MMPs and TIMPs are extensively studied in diseases but recent discoveries suggest that TIMPs, specifically, TIMP2 could play other roles in aging and inflammation processes.

Introduction/Purpose. Tracheoesophageal fistula (TEF) represents one of the most common congenital developmental malformations of the upper digestive tract. The optimal surgical management has several controversies, particularly in rapidly developing countries. Morbidity and mortality are highly variable between centers and are dependent on various factors. However, complex medical care has considerably improved, especially in developing countries. This study describes the experience of our center in patients with TEF with emphasis on the clinical characteristics, postoperative immediate and long-term respiratory and gastrointestinal complications, and the mortality rate of such cases which would allow us to compare our results with other regional pediatric tertiary centers. Methods. This is a retrospective review of the medical electronic charts of patients with TEF that were followed at Sidra Medicine in the state of Qatar. The review included the patients who were operated upon in the period of 2011-2021 but continued to follow at our institution in the period of 2018-2021. Demographic data, associated anomalies, preoperative, operative, and postoperative courses, and growth parameters were collected. Results. A total of 35 patients with TEF (24 males and 11 females) were collected. 49% were full term. We identified seven patients (20%) with isolated TEF, TEF with VACTERL association in 29% of our patients, other chromosomal anomalies in 17%, or associated with other anomalies (not related to VACTERL) in 34% of the patients. The majority of the patients (94%) were of type C-TEF (TEF with esophageal atresia–EA/TEF). All patients were operated except for one patient who died at 2 days of life due to cardiac complications. Median age at which surgery was performed was 2 days (range 1-270 days). Median follow-up was 32 months (range 7-115 months). Immediate postoperative complications were encountered in eleven patients (33%) and included anastomosis leak in 12%, air leak in 6%, sepsis in 6%, chylothorax in 3%, vocal cord palsy and fistula recurrence (combined) in 3%, and failure of TEF closure in 3% of the patients. Long-term respiratory complications were encountered in 43% of our patients. Long-term gastrointestinal complications included gastroesophageal reflux (GERD) in 63%, dysphagia in 31%, and anastomotic stricture in 34% of the patients. Growth was affected in around a quarter of the patients at 6 months after surgery and 22% at 12-month assessment postoperatively. While only five patients died at our institution, only one was directly related to failure of TEF closure and postoperative complications. Conclusion. This descriptive study reports the clinical outcome of TEF from a rapidly developing country. The distribution of the patients’ characteristics and postoperative complications was almost comparable to those from developed countries. This study would aid in addressing the prognostic factors and establishment of evidence-based management pathways of newborns with TEF to improve the clinical outcome in our center and other pediatric tertiary centers in developing countries.

Goals. We assessed the possibilities of correcting the short-chain fatty acids (SCFA) content and profiles in feces of patients with bronchial asthma. Background. It was established that the high biological diversity of intestinal microorganisms promotes the needed SCFAs production, which induces immune regulatory pathways and contributes to the anti-inflammatory response. Study. A group of 30 patients with allergic bronchial asthma (BA) were investigated in our study. All of the patients were tested for the presence of SIBO by the SCFA spectrum determination. For the SIBO treatment, 10 patients from the studied group were prescribed Rifaximinum with the 200 mg dose at 3 times a day for a week; the other 10 patients were prescribed Rifaximinum at the same dose, followed by the administration of the Lactobalance probiotic in capsules at 3 times a day for a month. A month probiotic course was assigned to the remaining 10 patients without SIBO, as part of the BA complex therapy. The SCFA studies were immediately carried out for all of the patients after the 1 month probiotic therapy course. Results. A normalization of the SCFA spectrum and anaerobic index for all of the studied patients were noted. Upon taking the probiotics, it was revealed in the patients without SIBO that the total content of fatty acids (), acetic and butyric acid () had increased. The Rifaximinum course, followed by administration of the probiotics led to a decrease of the relative amount of isoacids and ratio of isoacids/acids in the studied patients as compared to the patients who had received Rifaximinum for the SIBO treatment only (). Conclusion. The obtained results demonstrate a potential opportunity of the drug influence on the active bacterial metabolites composition and amount in the intestinal biotope; as it was confirmed by the restoration of the intestinal microbiocenosis and microorganism habitat.