[Exacerbation of obstructive pulmonary diseases by SARS-CoV-2 infection in patients treated in the Pulmonology Clinic of Târgu Mures]. / Obstruktív tüdobetegségek súlyosbodása SARS-CoV-2-fertozés hatására a marosvásárhelyi Pulmonológiai Klinika beteganyagában.

INTRODUCTION: Literature data show an increased severity of SARS-CoV-2 infection in patients with cardiovascular, renal comorbidities, chronic obstructive pulmonary disease (COPD), asthma, obesity, diabetes, tumors and immunosuppression. METHOD: This retrospective study includes 90 patients with SARS-CoV-2 infection associated with COPD or asthma exacerbations from 303 patients hospitalized during a 7-month period (29.7%). The clinical aspect of COPD/asthma exacerbations overlapped to the one by SARS-CoV-2 infection, therefore, we compared our group with 90 patients with SARS-CoV-2 without obstructive disease. We excluded from both groups the patients with known severe cardiac impairment, diabetes, or tumors in order to not having interference with other unfavorable prognostic factors. We assessed the cases severity on clinical basis, pulzoximetry, CT/chest x-ray, and inflammatory markers. RESULTS: 72.2% of our group (48/52 with COPD and 17/38 with asthma) had moderate/severe pneumonia (bilateral interstitial-alveolar infiltrates, increased inflammatory markers, respiratory dysfunction) compared with 56.6% from the nonobstructive group. 14 patients required intensive therapy (including mechanical ventilation). We recorded 4 deaths in COPD group, 1 in asthma group, compared to 2 in non-obstructive patients (fatality 7.6% in COPD compared to 2.2% in nonobstructive group). Treatment included maximized inhaled bronchodilators ± corticosteroids, oxygen, antivirals, anticoagulants, corticosteroids, symptomatic. All patients were referred for clinical-functional and CT scan reassessment 2 months after discharge. CONCLUSION: The association of SARS-CoV-2 infection in patients with COPD or asthma was common, leading to exacerbation with significant severity. Fatality increased in COPD. Outpatient follow-up aims to restage adjust the treatment and monitor post-COVID-19 possible sequels. Orv Hetil. 2023; 164(2): 43-50.

Pediatric pulmonology 2021 year in review: Asthma.

Asthma is the most common chronic disease in children, affecting an estimated 6.1 million children in the United States. SARS-CoV2 had a significant impact on asthma exacerbations and healthcare utilization of patients with asthma in 2021. Additionally, studies in 2021 influenced the field of asthma with improvements in diagnostic testing and monitoring, treatment of severe exacerbations, social determinants of health, and evaluation of medical costs. This article is part of our 2021 "Year in Review" series, in which we summarize publications in major pulmonary topics, in the context of selected literature from other journals relevant to our discipline.

[Clinical update in critical care of pulmonary medicine 2022].

In this review, we outlined the clinical studies in critical care field of pulmonary medicine from October 1, 2021 to September 30, 2022. For critically ill patients, frailty before disease onset was a predictor of mortality with increasing ICU length of stay, and the complaints of dyspnea in intubated phase was independently associated with posttraumatic stress disorder. Compared with transbronchial lung biopsy (TBLB) for patients with acute hypoxemic respiratory failure, transbronchial lung cryobiopsy (TBLC) had a positive significance to in leading to an increased chance of establishing a more accurate diagnosis, which could significantly improve the patients' prognosis. M-ROSE (microbiological rapid on-site evaluation) had high diagnostic value for lower respiratory tract pathogens, and the application of M-ROSE in the ICU could contribute to promoting a decrease in patients' inflammation levels and reducing the mortality of patients with invasive mechanical ventilation. EIT (electrical impedance tomography), DPL (transpulmonary driving pressure) and DPaw (airway driving pressure) had excellent positive values on dynamic assessment, guiding individualized respiratory support and prognostic evaluation. In critically ill hospitalized patients with COVID-19 who had received invasive mechanical ventilation or extracorporeal membrane oxygenation, treatment with baricitinib compared with placebo (in combination with standard of care, including corticosteroids) might reduce mortality. Delayed antimicrobial treatment significantly increased the incidence of severe infection and the mortality of shock patients, however, timing of antimicrobial therapy and control of the source of infection was critical. NIV (non-invasive ventilation) alternating with high-flow nasal oxygen immediately after extubation significantly decreased the risk of reintubation and death compared with high-flow nasal oxygen alone in obese or overweight patients at high risk of extubation failure. The effect of Pes-guided positive end-expiratory pressure (PEEP), compared with empirical high PEEP, was associated with lower mortality for more severe acute respiratory distress syndrome (ARDS) ventilated patients (APACHE Ⅱ>27.5). Prone-positioning during veno-venous extracorporeal membrane oxygenation was safe and effective and was associated with a higher probability of surviving and being weaned-off extracorporeal membrane oxygenation at 90 days. Therefore, individualized respiratory support strategies based on dynamic monitoring and assessment were essential for critically ill patients.

Bayesian adaptive clinical trial designs for respiratory medicine.

The use of Bayesian adaptive designs for clinical trials has increased in recent years, particularly during the COVID-19 pandemic. Bayesian adaptive designs offer a flexible and efficient framework for conducting clinical trials and may provide results that are more useful and natural to interpret for clinicians, compared to traditional approaches. In this review, we provide an introduction to Bayesian adaptive designs and discuss its use in recent clinical trials conducted in respiratory medicine. We illustrate this approach by constructing a Bayesian adaptive design for a multi-arm trial that compares two non-invasive ventilation treatments to standard oxygen therapy for patients with acute cardiogenic pulmonary oedema. We highlight the benefits and some of the challenges involved in designing and implementing Bayesian adaptive trials.

British Thoracic Society survey of the career intentions of respiratory medicine specialty trainees in the UK.

There were respiratory consultant post vacancies in 82% of surveyed UK hospitals in 2021. Understanding respiratory trainees' career intentions is vital to plan and train a future respiratory workforce. In 2020, the British Thoracic Society surveyed trainee members (n=144) to assess career plans and perceived barriers and facilitators when applying for consultant posts. Most trainees (79, 55.6%) report intending to pursue UK-based posts with general internal medicine responsibilities. Consultant applications are influenced by location, hospital type, previous local experience and availability of subspecialty posts. Insufficient guidance is available regarding consultant applications.

Interventional Pulmonology and the Esophagus: Tracheostomy and Percutaneous Endoscopic Gastrostomy Placement.

Tracheostomy is a procedure commonly performed in intensive care units (ICU) for patients who are unable to be weaned from mechanical ventilation. Both percutaneous and surgical techniques have been validated and are chosen based on the local expertise available. A primary advantage to the percutaneous technique is the ability to perform this procedure in the ICU without transporting the patient to a procedure suite or operating room; this has become particularly important with the novel coronavirus disease 2019 (COVID-19) pandemic. An additional advantage is the ability to perform both the tracheostomy and the gastrostomy tube placement, if needed, during the same anesthetic episode. This decreases the need for additional sedation, interruption of anticoagulation, repeat transfusion, and coordination of care between multiple services. In the context of COVID-19, combined tracheostomy and gastrostomy placement exposes less health care providers overall and minimizes transportation needs.

Fungal Genomics in Respiratory Medicine: What, How and When?

Respiratory infections caused by fungal pathogens present a growing global health concern and are a major cause of death in immunocompromised patients. Worryingly, coronavirus disease-19 (COVID-19) resulting in acute respiratory distress syndrome has been shown to predispose some patients to airborne fungal co-infections. These include secondary pulmonary aspergillosis and mucormycosis. Aspergillosis is most commonly caused by the fungal pathogen Aspergillus fumigatus and primarily treated using the triazole drug group, however in recent years, this fungus has been rapidly gaining resistance against these antifungals. This is of serious clinical concern as multi-azole resistant forms of aspergillosis have a higher risk of mortality when compared against azole-susceptible infections. With the increasing numbers of COVID-19 and other classes of immunocompromised patients, early diagnosis of fungal infections is critical to ensuring patient survival. However, time-limited diagnosis is difficult to achieve with current culture-based methods. Advances within fungal genomics have enabled molecular diagnostic methods to become a fast, reproducible, and cost-effective alternative for diagnosis of respiratory fungal pathogens and detection of antifungal resistance. Here, we describe what techniques are currently available within molecular diagnostics, how they work and when they have been used.

[Archivos in 2021, second year of the COVID-19 pandemic]. / Archivos en 2021, segundo año de la pandemia de COVID-19.

Al igual que ya sucedió en 2020, 2021 ha estado dominado por la pandemia de COVID-19. Si hace un año escribíamos esta Nota Editorial con gran preocupación por la evolución de la situación de la infección originada por el SARS-CoV-2 y, a su vez, con grandes esperanzas puestas en las vacunas como estrategia preventiva, la actual viene marcada por la incertidumbre generada por la irrupción de la nueva variante de preocupación: Omicrón….

Current state and future potential of AI in occupational respiratory medicine.

PURPOSE OF REVIEW: The COVID-19 pandemic has accelerated the pace of technological development relating to pulmonary diseases. The advent of newer technologies, such as Artificial Intelligence (AI), continues to be adapted for diagnostic purposes. AI offers comparable precision to trained physicians under certain circumstances, as well as the unique ability to process the information characteristic of Big Data. With respect to individual susceptibilities/pre-existing diseases, AI seems poised to integrate such individualized information and contribute to a greater implementation of precision medicine. RECENT FINDINGS: AI can match trained clinicians in specific applications, but AI has limitations that require clearly defined questions and a high quality of data. Data collected for this purpose is predicted to increase both in quality and volume, as technology concerned with personal health (FitBit, Apple Watch) proliferates. However, the role of AI with respect to physicians in a clinical setting is still being debated. AI generally aims to increase objectivity through its correlational methodology. SUMMARY: AI continues to be a proliferative field of study. It has defined strengths and weaknesses which, if accounted for, has the potential to increase healthcare access as well as the quality of care delivered.

Saudi experts' recommendation for RSV prophylaxis in the era of COVID-19: Consensus from the Saudi Pediatric Pulmonology Association.

Respiratory syncytial virus (RSV) is the most common cause of bronchiolitis and viral pneumonia in pediatrics worldwide. In the Kingdom of Saudi Arabia (KSA), the prevalence of RSV is 23.5% in pediatric patients with acute lower respiratory tract illness. Coronavirus disease (COVID-19) poses critical public health and socioeconomic challenges in KSA. The Saudi Pediatric Pulmonology Association (SPPA), a subsidiary of the Saudi Thoracic Society (STS), developed a task force to determine the potential challenges and barriers to the RSV immunoprophylaxis program during the era of COVID-19 and to compose a practical, nationwide, and multidisciplinary approach to address these challenges. Some of the recommendations to manage these challenges include increasing the number of RSV immunoprophylaxis clinics, drive-thru visits, home-care services, and swift referrals to the RSV immunoprophylaxis program specialists. Additional training is required for healthcare personnel to add RSV immunoprophylaxis to the regular immunization schedule.

A new call for influenza and pneumococcal vaccinations during COVID-19 pandemic in Italy: A SIP/IRS (Italian Respiratory Society) and SITA (Italian Society of Antiinfective therapy) statement.

Influenza and pneumococcal disease represent a well-known burden on healthcare systems worldwide, as well as they still have an attributed morbidity and mortality, especially in elderly individuals and vulnerable populations. In the context of the ongoing pandemic of COVID-19, a series of considerations in favor of extensive influenza and pneumococcal vaccination campaign are emerging, including a possible reduction of hospital extra burden and saving of sanitary resources. In addition, recent studies have suggested that prior vaccinations towards non SARS-CoV-2 pathogens might confer some protection against COVID-19. In this paper the authors consider all factors in support of these hypotheses and provide a consensus statement to encourage influenza and pneumococcal vaccinations in targeted populations.

Telehealth and its implementation in respiratory sleep medicine.

PURPOSE OF REVIEW: The COVID-19 pandemic has clearly demonstrated that the technological progress in digitization is also essential for the medical sector. In the field of sleep-disordered breathing, the novel eHealth methods already do offer smart solutions for currently insufficiently addressed problems. RECENT FINDINGS: In general, the potential of telemedicine tools can be focused on three basic aspects: interaction between clinicians, interaction between clinician and patient, and interaction between patient and the mobile health technology. The pandemic situation resulted in a rapid development of reimbursement for telehealth services. In recent years, evidence on the positive benefits of using telemedicine-based support as part of respiratory therapy follow-up is increasing. It is important to consider patient groups, telemedicine methodology, type of intervention, and targeting criteria in all studies conducted. SUMMARY: Given the scarcity of resources for leading common diseases, we must keep an eye on the new digitization concepts in respiratory medicine care. It must be implemented precisely, cost-effectively, and also more connecting between sectors and disciplines and at eye level with our patients. By means of patient engagement systems, an important part of modern precision medicine can be established. Digital support systems are valuable for supporting medical staff. They are not meant to replace medical staff but to facilitate their work and improve its quality.

[S1 Guideline Post-COVID/Long-COVID]. / S1-Leitlinie Post-COVID/Long-COVID.

The German Society of Pneumology initiated the AWMFS1 guideline Post-COVID/Long-COVID. In a broad interdisciplinary approach, this S1 guideline was designed based on the current state of knowledge.The clinical recommendation describes current post-COVID/long-COVID symptoms, diagnostic approaches, and therapies.In addition to the general and consensus introduction, a subject-specific approach was taken to summarize the current state of knowledge.The guideline has an expilcit practical claim and will be continuously developed and adapted by the author team based on the current increase in knowledge.