Journal of Pulmonology Research & Reports
Journal of Pulmonology Research & Reports is an open access peer-reviewed journal from the publishers of Scientific Research and Community (SRC) which publishes articles in the form of written, video and power-point presentations from the arena of Pulmonology Research & Reports. The journal focuses to build up accessing the complete content of articles freely from online for reader’s perusal. Article acceptance will be in the form of research, review, case reports, analysis, magazines, editorials, opinion, communications, mini-review, short communications, picturized, book review, video type and power point presentations (PPTs). Articles can be submitted through online from https://srcpublishers.com/pulmonology-research/user/register or can send through an e-mail with attachment for pulmonologysciences@onlinescientificresearch.info or jprr@onlinescientificresearch.net 0.5 Impact Factor 84.5% Citations 90% Acceptance
Understanding Acute Respiratory Failure: When Oxygen Alone Doesn’t Tell the Full Story
The Number We All Look at First One of the first numbers we look at when assessing a patient is oxygen saturation (SpO₂). Acute Respiratory Failure (ARF) is one of the most common reasons for admission to the Intensive Care Unit (ICU), making rapid respiratory assessment an essential part of patient care.
Copyright (c) 2026 Journal of Pulmonology Research & Reports
Relationship Between Clinical Symptoms Control, Oxidative Stress Status and Serum Vitamin D among Adults with Bronchial Asthma
Background: The most common chronic lung disease in the world is bronchial asthma. Nonetheless, oxidative stress indicators have been linked to the onset of asthma in a number of recent investigations. However, vitamin D has a role in the pathogenesis of asthma. Objective: The aim of this study was to determine the relationship between serum vitamin D levels, oxidative stress state, and clinical symptom control in individuals with bronchial asthma. Material and Methods: The average age and Body Mass Index (BMI) of two hundred Saudi patients with bronchial asthma, both male and female, were 42.36 ± 6.24 years and 26.88 ± 2.95 kg/m2. Participants were chosen from Abassia Chest Hospital, Cairo, Egypt. The study excluded participants who were pregnant, smokers, had hepatitis, pulmonary failure, renal failure, or heart failure. Participants were divided into three groups according to their vitamin D levels. Results: Malondialdehyde (MDA) mean values were significantly higher in the vitamin D deficiency group (A) than in the vitamin D insufficiency group (B) and the normal vitamin D group (C). Furthermore, compared to groups (B) and (C), group (A) had considerably lower serum levels of glutathione (GSH), glutathione peroxidase (GPx), superoxide dismutase (SOD), and the Asthma Control Test (ACT). Furthermore, in all three groups, vitamin D was highly inversely connected with MDA levels (P<0.05) and directly correlated with levels of forced vital capacity (FVC), forced expiratory volume in one second (FEV1), Asthma Control Test (ACT), GPX, GSH, and SOD. Conclusion: Vitamin D deficiency is associated with abnormal levels of oxidative stress biomarkers and the treatment of clinical symptoms in bronchial asthma patients.
The Role of Nurses in Interventional Pulmonology: Comprehensive Care Across Procedures - Reflections from a Nursing Fellowship Program in India
As a respiratory nurse working at the Bronchoscopy Unit in Kenya’s National Referral Hospital (K.N.H) & having specialized training in Interventional Pulmonology at Yashoda Hospital, India, I have gained extensive experience in the diverse range of procedures that define this rapidly evolving subspecialty. My fellowship journey has provided unique insights into the critical role that nursing professionals play across the entire spectrum of interventional pulmonology procedures, from diagnostic bronchoscopy to complex therapeutic interventions.
Chest Sonography in the Diagnostic Stratification of Pleural Effusion
Background: Pleural effusion is a common clinical finding in respiratory and systemic disorders. Differentiating between transudative and exudative effusions is critical for determining etiology and management. Conventional biochemical methods based on Light’s criteria require invasive sampling, whereas Thoracic Ultrasonography (TUS) offers a safe, bedside, radiation-free alternative capable of characterizing pleural fluid by internal echo patterns and dynamic signs. Objectives: To evaluate the diagnostic accuracy of TUS in distinguishing exudative from transudative pleural effusions, using biochemical Light’s criteria as the reference standard. Methods: This prospective study included 216 patients with radiologically confirmed pleural effusion attending the Department of Respiratory Medicine, Ashwini Hospital, Cuttack (May 2023-October 2024). Each underwent standardized thoracic ultrasound examination followed by diagnostic thoracentesis. Sonographic parameters-echogenicity, complexity, septations, and dynamic signs (“jellyfish,” “plankton,” “hematocrit”)-were compared with biochemical classification. Results: Of 216 patients (mean age 54.7 ± 13.7 years; 61.1 % male), 193 (89.4 %) effusions were exudative and 23 (10.6 %) transudative by Light’s criteria. Ultrasound classified 176 (81.5 %) as exudates and 40 (18.5 %) as transudates, yielding sensitivity 91.2 %, specificity 100 %, PPV 100 %, and NPV 57.5 %. Anechoic, non-septate patterns with “jellyfish” sign correlated with transudates, whereas complex, septate, “plankton,” and “hematocrit” signs indicated exudates (p < 0.05). Conclusion: TUS demonstrates excellent diagnostic accuracy for differentiating pleural effusions and can serve as a first-line, non-invasive diagnostic tool, particularly valuable in critical-care and resource-limited settings.
A Rare Evolution: Mediastinal Mature Teratoma Undergoing Somatic-Type Malignant Transformation to Rhabdomyosarcoma
Mediastinal mature teratomas are typically benign tumours that predominantly occur in the anterior mediastinum. However, rare cases of malignant transformation within mature teratomas have been documented, most commonly involving somatic-type malignancies. This case report presents a 46-year-old female with productive cough and persistent right lung consolidation despite a course antibiotic and Mycobacterium tuberculosis workout negative. Histopathological examination (HPE) revealed a high-grade epithelioid tumour with myogenic and neuroendocrine differentiation, consistent with alveolar rhabdomyosarcoma with neuroendocrine features. The patient underwent chemotherapy. This case report discusses a unique presentation of a mediastinal mature teratoma with somatic-type malignant transformation into rhabdomyosarcoma in a middle-aged female and highlights the importance of considering rare malignancies, such as rhabdomyosarcoma, in the differential diagnosis of a persistent mediastinal mass, though rare, can significantly alter prognosis and treatment strategies
Contrast-Enhanced Computed Tomography (CECT)
A Rare Presentation of Atrial Myxoma Leading to Stroke in a Young Female
Myxoma is a common primary tumour of the heart. The most common site is the left atrium. As per previous reports, cardioembolic stroke accounts for around one-fifth of all acute ischemic strokes. Out of which cardiac myxoma is estimated to account for only 0.5% of the cases, which is very rare. Female patients, especially in the 5th decade, are shown to have a greater predisposition. cardiovascular stroke is life-threatening, requiring urgent recanalization and resection of the tumour. Cardiac myxomas present with variable symptoms like breathing difficulty, chest pain, chest tightness, palpitations, fatigue, etc. CNS Emboli with stroke is one of the rarest presentations, making it a diagnostic challenge. Here we present a case report of a 48-year-old female patient presenting with right-sided tingling, numbness, and syncope, diagnosed with atrial myxoma.
Pulmonary Delivery of Aerosol Biologics for the Treatment of Eosinophilic Asthma
Biological drugs (synonymous known as biologics) are a diverse group of therapeutic agents which are large and complex molecules produced through sophisticated biotechnology [1,2]. The biologics currently used to treat severe asthma are monoclonal antibodies (mAb), and antibody fragment which are administered subcutaneously, or intravenously (reslizumab). Injection of drugs is painful and inconvenient, especially when the drugs are for the treatment of chronic diseases, such as asthma, and cystic fibrosis [3,4]. Moreover, 10% of the patients worldwide suffer from needle phobia leading to poor compliance [5]. Pulmonary delivery of biologics to the lungs improves pharmacokinetics, and toxicity profiles of proteins [6]. It is a non-invasive route, and allows for self-administration, which could improve patient compliance [6,7].
Air of Despair: Unveiling the Enigma of Dual Lung Collapse
Thoracic Endometriosis Syndrome (TES) encompasses a wide variety of manifestations occurring in due to presence of ectopic viable endometrial tissue in thorax. Various manifestations of TES include, pneumothorax, haemoptysis, haemothorax, lung nodule/mass, catamenial chest pain, diaphragmatic hernia and pneumopericardium [1]. Pneumothorax, often catamenial pneumothorax is the commonest presentation of TES, however it’s unilateral, particularly right sided in nearly 97% of cases [2]. Here we are presenting a case of woman of reproductive age group who presented with bilateral pneumothorax secondary to TES, which is one of the rarest presentation of endometriosis with only a handful of cases being reported in literature, with the most recent being reported in 2020 by Christopher S. Sampson and Kathleen White [3].
Copyright (c) 2025 Journal of Pulmonology Research & Reports
Cancers in Red Sea State, Sudan: A Decade of Incidence, Distribution and Trends: Estimates for (2016 - June 2025)
Cancer incidence refers to the rate at which new cancer cases occur in specific population over a defined period, it is a key measure for understanding the burden of cancer and tracking trends in cancer occurrence. These are is generally regarded as an important measure for public health planning, monitoring trends and researches and resource allocation purposes. The number of new cases in a year is an indicator of the need for resources for diagnostic investigations and first-line treatment. While the prevalence of cancer in a population, the number or proportion of people alive at a specific date who have been diagnosed with cancer prior to that date. The annual number of cancer deaths is an indicator of the need for resources for palliation and terminal care. However, data on prevalence, which is generally regarded as an important measure for health planning and resource allocation, are relatively scarce. Materials and Methods: This review is the first papers that focuses up-to-date on adult cancer, its distribution, trend and cancer Prevalence in Red Sea State (RSS) at Eastern Sudan, based upon, registry data of Port Sudan Oncology Centre (POC) results in a period between 2016 up to thirty of June 2025. These reviews are meant to provide a better understanding and knowledge required to plan appropriate cancer-control and prevention strategies in this state, and whole country. this paper provided cancer statistics of 3265 patients registered from all districts of Red Sea State diagnosed at the (POC). This Centre established in 2016 to covers approximately all adult patients with cancer in this state, therefore, it considered representative for the cancer situation in this state, to develop a system that will facilitate creation and maintenance of local and regional data and assemble these data into a single centrally accessible system. Also, this study has reviewed and addressed the impact of war conflict setting of Sudan in April 2023 and the displacement of patients with cancer, where access to healthcare and resources of cancer management is disrupted in many affected states and the changes in statistic measures made by displacement of patients with cancer from war conflict-affected states to POC. Cancer diagnoses were made by standard clinical, pathological and radiological methods. Epidemiological data were categorized by age, gender, resident state, marital status etc. and subjected to statistical analyses by SPSS. Population Data: Red Sea State is one of 18 states of Sudan, it lies at eastern of the country, bordering the Red Sea, and has an area of 212,800 km2 and an estimated urban/rural population of approximately 1482,053. The sex ratio are slightly more females than males with sex ratio of approximately 98.34 male per 100 females, (Sudan demographics 2024- Statistics Times.com) Port-Sudan is the capital of the state. The original inhabitants of the state are Beja people, tribes who constitute above 60% of current population. Results: The cancer prevalence rate per year was 300-350 among adult patients, female were more affected than male. The five most common tumour types in both sexes were breast cancer, leukemia, head and neck tumours, prostatic carcinoma, and esophageal cancer. Remarkably, most of the patients was in the age period (59-78) years, regarding ethnic varsities (49,8%) of patients were descendants of Bni aamer tribes, (22.3%) of patients from Northern Sudan, and (19.0%) were Hadandawa tribe. Most of the patients (84,6%) lived in Port Sudan, the capital of the state. Conclusion: This is the largest survey on cancer burden in Red Sea State. It may serve as basis for local governmental programs for assessing risk factors, improving cancer prevention (e.g. by educational and vaccination programs) and cancer therapy in the future.
Is it Already Time to Recognize Diabetes as an Etiology of Interstitial Lung Disease? A Short Review of the Evidence
By now it is well known amongst the Medical Fraternity that Diabetes Mellitus (DM) is not a single disease but rather a heterogenous metabolic dysfunction demonstrating increased blood glucose levels (hyperglycemia) as its major manifestation. However, Diabetes is far more complex and insidious to be labelled as a mere increase in the blood glucose levels. The dysfunction of glucose control transcends the boundaries of blood vessels, neuromuscular and various other organ systems, ultimately leading to any combination of renal, ocular, cardiac, skin, neurological and other organ damage, which makes it is a Legion of diseases, rather than a single pathology.
Comparative Long-Term Effectiveness of Nintedanib and Pirfenidone in Idiopathic Pulmonary Fibrosis: A Systematic Literature Review
Introduction: Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive interstitial lung disease. Pirfenidone and nintedanib slow progression, but no head-to-head randomized trials have tested their long-term effectiveness, particularly in real-world and advanced disease. Objective: To synthesize and appraise the long-term comparative effectiveness and safety of nintedanib versus pirfenidone in IPF. Methods: We conducted a systematic review (PubMed, Embase, Cochrane CENTRAL; to March 2025) of studies ≥12 months in adults with IPF. Outcomes included forced vital capacity (FVC) decline, mortality, exacerbations, hospitalizations, adverse events, and quality of life. Risk of bias was assessed with Cochrane RoB 2.0, Newcastle–Ottawa Scale, and AMSTAR-2. Results: Fourteen studies met criteria. Both agents reduced annual FVC decline by ~50% versus placebo. Long-term extensions showed sustained effects: pirfenidone ~141–150 mL/year and nintedanib ~125 mL/year. A post hoc analysis (CleanUP-IPF) favored nintedanib at 12 months for FVC (+106 mL; 95% CI, 34–178), a difference that diminished by 24 months. Mortality and exacerbation rates were broadly comparable. Safety profiles differed: pirfenidone more often produced gastrointestinal and cutaneous events; nintedanib was associated with diarrhea and transaminase elevations. Conclusions: Evidence supports broadly comparable long-term efficacy of pirfenidone and nintedanib in IPF, with distinct tolerability profiles that may guide individualized selection. Real-world data corroborate benefits in advanced disease and comorbidity. The absence of direct randomized comparisons limits certainty; adequately powered head-to-head RCTs and biomarker-guided treatment strategies are needed.
Mortality Predictors of COPD Exacerbation Patients in ICU
Background: Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of global mortality, with acute exacerbations frequently necessitating intensive care unit (ICU) admissions. Despite its significant burden, data on specific prognostic factors for ICU outcomes in COPD patients particularly in the Indian context remain limited. Objective: This study aims to identify key clinical, laboratory, and radiological predictors of outcomes in COPD patients admitted to the ICU following acute exacerbations. Methods: A prospective observational study was conducted from August 2022 to April 2024 at a tertiary centre of eastern India. Patients aged 40 years and above with a confirmed diagnosis of COPD (as per GOLD 2023/24 guidelines) and admitted for acute exacerbation were included. Exclusion criteria encompassed terminal illnesses and advanced organ failure. Data were collected using a predefined proforma with variables of demographic status, clinical findings, laboratory values, and radiological findings. Statistical analysis was performed using SPSS v26, with a p-value <0.05 considered statistically significant. Results: Among 205 patients enrolled, the mean age was 64.3 ± 11.5 years, with a predominance of males (70%). ICU mortality was significantly higher in patients aged ≥60 years (p<0.01). Malnutrition, reflected by a BMI <18.5 kg/m² in 45% of patients, was strongly associated with increased mortality (p<0.01). Most patients belonged to GOLD Group D or E, with Group E showing the highest mortality risk (p<0.01). A history of previous exacerbation within the last year was also linked to worse outcomes (p<0.01). Elevated inflammatory markers total leukocyte count >11,000/mm³ and high C-reactive protein (CRP) were significantly associated with poor prognosis (p<0.01). While non-invasive ventilation was the most commonly used modality (62%), and invasive ventilation was employed in 18%, no significant difference in mortality was found between ventilation strategies. The duration of ICU stay was notably longer among non-survivors (7.8 vs. 5.2 days; p<0.05). Interestingly, common comorbidities such as hypertension, diabetes, and coronary artery disease did not independently predict ICU mortality, suggesting the dominance of acute respiratory derangement over chronic health conditions in short-term outcomes. Conclusion: This study underscores the prognostic significance of advanced age, low BMI, prior exacerbation history, GOLD Group E classification, and systemic inflammatory markers in determining ICU outcomes in COPD patients. Surprisingly, the type of ventilatory support and comorbidities were not significant predictors of short-term mortality. These findings advocate for a more personalized, risk-based approach to ICU care in COPD, emphasizing early identification, nutritional intervention, and inflammatory monitoring. Clinical Implications: Routine assessment of BMI and inflammatory markers such as CRP and TLC on admission can aid in early risk stratification. Nutritional support and proactive management strategies should be prioritized for high-risk patients. The use of composite indices like the BODE score may offer a more comprehensive prognostic framework than GOLD staging alone.
Massive Hemoptysis in Severe Idiopathic Pulmonary Hypertension A Rare Presentation
Hemoptysis is not an uncommon presentation of a disease in a pulmonologist’s usual practice. The significance of hemoptysis comes from the fact that even a minimal amount of intrabronchial bleeding can lead to life-threatening airway compromise and escalate the mortality risk. Infections such as tuberculosis and other bacterial or fungal parenchymal infectious causes are often cited as major culprits in hemoptysis cases. We present an unusual case of a young gentleman with no prior comorbidities who initially presented with nasal bleeding and over a span of 2 weeks experienced two major episodes of hemoptysis. He underwent multiple imaging studies and bronchoscopic evaluations but was eventually found to have elevated pulmonary pressures on echocardiogram and a pattern of right heart strain on electrocardiogram. These findings shed light on a rare presentation of idiopathic pulmonary hypertension being the cause of massive hemoptysis. This case was an eye-opener for many reasons including missing important cardiac examination findings during the clinical evaluation and the presence of a dilated pulmonary trunk in contrast CT images ultimately unravelling one of the rarest causes of massive hemoptysis.
Long-Term Pulmonary Sequelae in COVID-19 Survivors: A 3-Year Prospective Cohort Study
Background: Individuals recovering from the initial COVID-19 infection experienced persistent symptoms and radiological lesions. This study is a longterm follow-up of COVID-19 survivors to assess the progression and persistence of pulmonary sequelae. This will provide critical insights into the natural history of post-COVID-19 syndrome. Objectives: To evaluate the long-term radiological changes in COVID-19 survivors over three years and to identify risk factors associated with it. Methodology: This is a prospective, longitudinal cohort study designed to follow a group of COVID-19 survivors over three years. Clinical data during the initial infection such as admission to the ICU, Oxygen requirement, Ventilator assistance, and length of hospital stay were collected from case records. High-resolution computed tomography (HRCT) scans were taken at one-year intervals and CT severity scores were recorded to study the interval changes. Appropriate statistical analysis was done to establish significance. Results: In this study, 40 patients with residual lung lesions on HRCT in the first follow-up visit were enrolled, out of which 6 were excluded from the final analysis. Out of the 34, 55.9% were males and 44.1% were females. The mean age of the study population was 58.26. 41.1% were treated in ICU and 58.9% in the wards. Invasive ventilation was used in 23.5%, NIV in 35.29%, and oxygen alone in 41.1%. The average length of stay was 18 days. CT severity score at presentation was mild in 44.1%, moderate in 29.4%, and severe in 26.47% of patients. During the 3-year follow up CT score improved in 76.47%, remained static in 17.64%, and progressed in 5.88% of patients (p-value <0.001). The age of the patient correlated with the initial CT score and the outcome, follow up CT severity scores improved better in young cohorts when compared to elderly patients. However, ICU admission, use of mechanical ventilation, and length of stay were not correlated with the subsequent CT severity score. Conclusion: This study is expected to provide valuable insights into the long-term health consequences of COVID-19 and identify key factors that contribute to the persistence of symptoms and lung sequelae in survivors.
Piloting Non-Payment Interventions in Tuberculosis Strategic Health Purchasing: Early Experience from Indonesia
Although there has been a 19% decline in Tuberculosis (TB) mortality from 2007 to 2017, TB remains a major health challenge in Indonesia. In 2021, the country issued a Presidential Decree No. 67 to provide guidance on the National Health Insurance (JKN) utilization of control. In 2022, Ministry of Health Decree No. 1936 mandating primary care facilities to comprehensively treat uncomplicated TB case. However, the existing payment structure of JKN does not encourage primary-level TB service delivery. O’Connell and colleagues conducted a study in 2022 that revealed that a significant proportion (81%) of uncomplicated TB patients covered by JKN were unnecessarily referred to hospitals, resulting in suboptimal treatment outcomes and increased healthcare costs. To address these challenges, a TB strategic health purchasing (SHP) pilot program was proposed in 2019. Its objective is to incentivize primary health facilities to deliver quality TB services for individuals with drug-susceptible TB through a combination of nonpayment and payment interventions. Two districts, Medan and Denpasar, were selected to implement these interventions, and the pilot began in 2021. The non-payment components, including health facility certifications and modifications to the JKN contracting process, were successfully implemented in Medan and Denpasar districts from 2021 to 2022. Regulations governing the JKN payment mechanism require substantial modifications before implementing the payment components. Several learnings emerged through implementation and this report summarizes the learnings as a guide for government stakeholders and partners for scale up to other districts in 2023. Amongst these, is the significant level of advocacy and support from high-level government stakeholders, both at the national and sub-national levels, required to reform the regulatory environment to pave the way for implementing the complete interventions. For example, successful implementation of the non-payment components at the sub-national level relied heavily on improved coordination and engagement between the District Health Office (DHO), the BPJSK Branch Office and the health facility associations. This coordination was responsible for the increased involvement of primary care facilities in the DPPM networks. BIMTEK technical trainings and facility TB certification, led by the DHO, are critical inputs into the JKN credentialing process, beginning with facility self-assessments to determine the capacity to provide TB care and the level of training required to raise the capacity of health workers. This certification process has demonstrated positive outcomes in terms of increased engagement, commitment, and adherence to guidelines among private primary health facilities providing TB services. 94% of JKN-empaneled private primary health facilities in Medan and 87% in Denpasar obtained certification, demonstrating increased commitment and capacity to deliver comprehensive TB care from diagnosis to treatment to reporting. The report also outlines other recommendations for policymakers, including adapting the primary health center accreditation scheme as a baseline to continue the health facility readiness certification process, as well as suggestions related to the ongoing TB payment reforms.
“TimBre” Phase-II Pilot Study Conducted Using Multi-Country Longitudinal Training Data for Screening of Pulmonary Tuberculosis Using Cough (Acoustic Sounds), Clinical & Demographic Inputs
TimBre from docturnal offers screening for multiple lung diseases – Pulmonary Tuberculosis, Pneumonia & Lung Cancer. Detailed studies of TimBre in the past used a third-party Microphone Array with an XY arrangement that recorded high fidelity cough sounds with an average length of >5 seconds and basic demographic data such as Gender, Age, Height, Weight, BMI. In the current study, cough sounds were collected from 7 different countries (India, Vietnam, Philippines, Uganda, Tanzania, Madagascar, and South Africa) using Mobile Phones from different manufacturers & recorded solicited & longitudinal cough sounds for a duration of 0.5 seconds as a part of the phase-I study. We used longitudinally obtained cough sounds numbering 724,694 .WAV files with a resolution of 44.1 kHz & 16 bits. The duration was of 0.5 seconds, with the subject clinical and demographic variables added to the model, which anticipated an improved accuracy over the phase-1 study that used 10,000 plus cough files that obtained a sensitivity & specificity of 75.41% and 68.30% respectively with an AUC of 0.78. The current study (Phase-2) resulted in an overall sensitivity of 68.8%, a specificity of 70.4%, and an AUC of 70% when compared with the microbiological reference standard MRS (sputum culture or Xpert, 25% TB prevalence), and sensitivity of 73.8%, specificity of 69.5%, and an AUC of 71% compared to a sputum Xpert Ultra reference standard (22% prevalence). The phase-1 study used true labels of GeneXpert results as some of the culture results were labelled indeterminate. A comparison between the phases is unwarranted given the fact that the MRS definition is GeneXpert OR Culture while, in Phase-1 it is was strictly GeneXpert. The study and its earlier phase demonstrate the usage of mobile phone-based screening for low resource settings or home-based TB screening or countries that are addressing TB elimination or eradication goals.
Occurrence, Sources and Prioritization of Per-and Polyfluoroalkyl Substances (PFASs) in Drinking Water from Yangtze River Delta, China: Focusing on Emerging PFASs
As regulations ban legacy PFASs, many emerging PFASs are being developed, leading to their release into the aquatic environment and drinking water. However, researches on these emerging PFASs in drinking water are limited, and current standards only cover a few legacy PFASs, leaving many emerging PFASs unregulated and their toxicity unknown. Therefore, a machine learning-based suspect screening method was employed to comprehensively identify and quantify both legacy and novel PFAS in drinking water from the Yangtze River Delta, and their potential sources of contamination were determined through pollutant profile analysis. Then, the identified PFASs were prioritized by integrating the PBT (persistence, bioaccumulation, and toxicity) properties of PFASs with environmental exposure data. A total of 30 PFASs were identified, including 16 legacy and 14 novel PFASs, categorized into 11 classes. The pollutant profile analysis suggested that PFASs in the Yangtze River Delta’s drinking water are more likely to originate from pollution in the upper and middle reaches of the Yangtze River rather than from local industrial emissions. In the prioritization and risk assessment process, ten high-concern PFASs had Risk Index (RIs) higher than those of ref-PFOA and ref-PFOS, including eight legacy PFASs and two novel PFASs. The drinking water of Yangtze River Delta originates from the surface water of the lower Yangtze River, which accumulates pollutants from its upper and middle reaches, affecting the health of over 20 million people. Our findings indicated the presence of emerging PFASs in the region’s drinking water and demonstrated conceptual models for integrating chemical information from suspect screening with toxicity prediction and risk assessment. Although the current levels of emerging PFASs are relatively low, legacy PFASs still dominate. Further research is needed to identify, monitor, and assess the health and environmental risks of emerging PFASs.
Quality of Life after Pyothorax Surgery in the Fes-Meknes Region, Morocco
Pyothorax is defined by the presence of a purulent, cloudy, or clear fluid containing altered polymorphonuclear cells and germs between the two layers of the pleura, as observed through direct examination. The progression to chronicity in pleural empyema results from a failure in medical treatment or a delayed diagnosis. In this case, surgery aims to restore respiratory function and prevent recurrence. The objective of this work is to evaluate the quality of life of patients after pyothorax surgery, as well as the overall impact of this surgical intervention in the medium and long term, and to identify the associated factors. A cross-sectional study was conducted among patients with pyothorax who underwent surgery in the thoracic surgery department at Hassan II University Hospital in Fes during the period from December 2012 to December 2020. Quality of life was assessed using the SF-12 questionnaire, which was translated and validated in Moroccan Arabic dialect. We included 72 subjects in the study. The mean age of the patients was 38.75±15.7 years, with 69.4% being male. The most common etiology was pleuropulmonary tuberculosis, found in 38 patients (52.8%). The average mental quality of life score was 46.11 ±8.14, and the physical score was 50.12 ±6.76. There is a statistically significant association between quality of life and the presence of a history of pleural tuberculosis, secondary pyothorax following subacute pleuritis in its physical component, dyspnea stage, WHO (World Health Organization) score, pain level, occurrence of postoperative infections, weight gain in its physical component, appetite, sleep quality, hospital stay satisfaction in its physical component, and treatment response. Surgery is the ultimate therapeutic option for treating chronic pyothorax, as it can cure or improve the quality of life of these individuals in the medium and long term.
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Purpose: In recent years, microbiome research has made significant progress in under-standing the relationship between human microbiota and pulmonary diseases. The lung and gut microbiota have received extensive attention in lung cancer research. Multiple studies have shown that dysregulation of the lung and gut microbiota is closely related to the occurrence and progression of lung cancer. The skin is the largest organ of the human body, as the first line of defense, it undertakes multiple functions such as de-fending against external pathogens and regulating body temperature and feeling. A complex and diverse microbial community also exists on the skin surface; however, the role of the skin microbiota in cancer has not been fully investigated. In particular, there is almost no research on the causal relationship between skin microbiota and lung can-cer. Methods: In this Two-sample Mendelian randomization (MR) analysis study, we com-piled genome-wide association studies (GWAS) data on 150 different immune cell traits from 597 individuals of European ancestry. Additionally, Data on lung cancer were ob-tained from the FinnGen GWAS database to delve deeper into the potential causal rela-tionship between skin microbiome characteristics and lung cancer. In our MR Analysis, the inverse variance weighting (IVW) method is the main method, supplemented by MR-Egger regression, weighted median (WM), Simple Mode, and weighted mode. In addition, the MR-Egger intercept test, Cochran Q test, MR-PRESSO, and remain-one analysis were used to identify heterogeneity and pleiotropy, to ensure the reliability and stability of the research results. Results: In studying the relationship between lung cancer and skin microbiota, we found that there are different interactions between lung cancer and specific types of skin microbiota. In the forward Mendelian randomization analysis, we included skin micro-biota as the exposure factor and each subtype of lung cancer (including Non-small cell lung cancer, Squamous cell carcinoma, Adenocarcinoma, and Small cell lung cancer) as the outcome factor. A total of 11 microbiota were found to be significantly associated with non-small cell lung cancer (NSCLC), of which 6 were protective and 5 were associated with increased risk of NSCLC. These micro biota are classified into 5 genera, 2 families, and 2 orders. For lung squamous cell carcinoma (LUSC), 5 related micro flora were identified, of which 3 showed protective effects and 2 were regarded as risk fac-tors. These microflora included 4 Genus and 1 Class. In the lung adenocarcinoma (LUAD) study, 13 significantly related microbial groups were found, of which 3 have protective effects and 10 are related to increased risk. These microbial groups are classi-fied into 7 genera, 2 Order, and 2 families. In the study of small cell lung cancer (SCLC), 6 microbiota were found to be significantly associated with the disease, of which 1 had a protective effect and 5 were considered to increase the risk. These mi-crobiota are classified into 5 genera and 1 family. In this study, we also used the reverse Mendelian randomized analysis method to explore the effects of various subtypes of lung cancer (including NSCLC, LUSC, LUAD, and SCLC) on the skin microbiota. The results showed no statistically significant causal relationship was found on the path from lung cancer to skin microbiota. Conclusions: Our study confirms a potential causal relationship between skin microbi-ota and lung cancer, suggesting that these microbiota play a role in the progression of lung cancer. This discovery provides a new perspective on how skin microbiota affects lung cancer and lays a foundation for developing targeted diagnostic and treatment strategies for lung cancer in the future.
Respiratory Tract Infections and Environmental Exposures: A Study of Rural Indonesian Communities
This study explores community perceptions and experiences regarding clean air and water access in rural Indonesia. Using an interpretive phenomenological analysis, we conducted in-depth interviews in three distinct rural regions. Findings reveal significant air and water quality issues, including high levels of particulate matter, ground-level ozone, fecal coliform bacteria, nitrates, and arsenic contamination. These environmental hazards have led to severe health impacts, such as increased respiratory and waterborne diseases, adverse birth outcomes, and psychological distress. Despite existing policies and community led initiatives, there are notable gaps in implementation. This study highlights the critical need for locally tailored, community-centered interventions to address these pressing environmental health challenges.
Copyright (c) 2024 Journal of Pulmonology Research & Reports
Mexican Delphi Consensus for use Immunotherapy with MV130 Vaccine in Patients with Recurrent Respiratory Infectious Diseases (Expert Panel)
Background and Objectives: Recurrent respiratory infections are currently a public health problem due to their high costs and resistance to treatments as well increase morbidity and mortality. An imbalance in the homeostasis of progressive cellular and humoral immunity the application of immunotherapy with trained immunity vaccines (IvIE) is currently a therapeutic option in all patients with recurrent respiratory infections by training innate and adaptive immunity by reducing episodes of respiratory exacerbations and improving the quality of life of patients. Methods: Using Delphi method and a panel of experts, a questionnaire was developed that included questions regarding the benefit and non-benefit of the treatment of patients with persistence of recurrent respiratory infections by specific criteria, from diagnosis, identification of risk factors and comorbidities, ideal candidate by consensus to receive the therapy, follow-up, and presentation of clinical data for reduction of recurrence of the conditions. There was a consensus on determining the use of immunotherapy MV130 vaccine in patients with specific criteria as long- and short-term use. Conclusion: Immunotherapy with trained immunity vaccines (IvIE) is currently a therapeutic option in all patients with recurrent respiratory infections and associated comorbidities in patients with chronic respiratory illnesses, autoimmune diseases, hematological malignancies for improvement clinical infections and improvement quality of life.
Boon of the BPal Regime: Bane for Multi Drug Resistant Tuberculosis in India
A novel regime for treatment of MDR TB has been launched consisting of BDQ, PRT and LNZ. Immense potential lies in its short term (6 months), efficacious drugs and lesser adverse events. A very good cure rate of around 90% have been achieved in Clinical trials including one from India. A contingent as well as circumspect roll out of the regime in all parts of India may be momentous for MDR TB control and TB elimination.
Specific Biobank for Chronic Thromboembolic Pulmonary Hypertension (Perspectives and Implementation)
Chronic thromboembolic pulmonary hypertension (CTEPH) is a disease characterized by incomplete resolution of the thrombus after an acute pulmonary embolism (PE), accompanied by changes in the pulmonary vasculature with thickening of the intima, changes in pulmonary endothelial cells and subsequent fibrosis. These changes lead to an increase in pulmonary vascular resistance, right ventricular dysfunction and, ultimately, to this day we do not have a complete explanation of its pathophysiology. In recent years, knowledge of molecular mechanisms and metabolic changes have provided elements but a window remains open for further exploration. The development of Biobanks offers an opportunity as a tool in translational research in several lines. This article aims to show the development of a specific biobank for chronic thromboembolic pulmonary hypertension, its lines of work and future potential
Biorepository Chronic Thromboembolic Pulmonary Hypertension
Alveolar Microlithiasis in Clinical Practice: Case Report
Pulmonary alveolar microlithiasis is a rare disease characterized by the deposition of microliths in the alveoli due to mutations in the SLC34A2 gene. The diagnosis is made more frequently between the second and fourth decade of life incidentally in chest images, it has a progressive course, with clinicalradiological dissociation, with no known effective treatment except for lung transplantation. The case of a 37-year-old man with no personal history of exertional dyspnea is presented. Assessed by pulmonology with HRCT, which shows subpleural nodules and micronodules with diffuse pulmonary hyperdensity due to calcification, a pattern that suggests alveolar microlithiasis confirmed by histopathological study.
Diagnostic Performance of Bronchoscopy in Lung Cancer and/or Pulmonary Metastasis: A Real Aspect of our Country
Objective: To evaluate the diagnostic performance of different bronchoscopic sampling techniques in patients with suspected lung cancer and/or pulmonary metastasis at the General Hospital of Mexico, a center without access to endobronchial ultrasound (EBUS). Methods: A retrospective analysis was conducted on bronchoscopies performed between 2018 and 2023 in patients with suspected lung cancer. Diagnostic results obtained from endobronchial biopsies, bronchial brushing, and bronchoalveolar lavage were analyzed. Histopathological results were used to determine the efficacy of each technique. Results: A total of 122 bronchoscopies were performed, of which 100 resulted in positive diagnoses of lung cancer via bronchoscopy, and 22 cases were subsequently confirmed by surgical biopsy. The endobronchial biopsy had a success rate of 98.4% in endobronchial tumors, while bronchial brushing and bronchoalveolar lavage showed diagnostic rates of 7.8% and 1.6%, respectively. The most frequent histological types were lung adenocarcinoma (27.0%) and squamous cell carcinoma (23.8%). Postoperative complications occurred in 27.3% of patients undergoing surgery, with a mortality rate of 13.6%. Conclusions: Bronchoscopy is an essential tool in the diagnosis of lung cancer at the General Hospital of Mexico, especially in the absence of EBUS. Endobronchial biopsy demonstrated high diagnostic efficacy, in contrast to bronchial brushing and bronchoalveolar lavage, which were significantly less effective. These findings underscore the need to improve diagnostic techniques in centers with technological limitations.
Coronavirus disease 2019 (COVID-19) is an ongoing global threat that is associated with high risks of infection, morbidities, and mortalities. The majority of patients with severe COVID-19 disease often present with acute respiratory distress syndrome (ARDS). ARDS associated with COVID-19 represents viral pneumonia with two processes, which includes viral pneumonia that eventually leads to ARDS [1]. Patients who develop ARDS present with worsening respiratory symptoms, hypoxemia, and bilateral lungs diseases, which eventually may result in cardiac failure. The prevalence of ARDS in COVID-19 patients is high, accounting for up to 42% of the patients [1]. Up to 61-81% of the patients who develop ARDS require intensive care [1]. This article will describe evidence-based approaches that have been used for the management of ARDS in critically ill patients with COVID-19
The Attitudes of South African Respiratory Physicians towards the Use of Electronic Cigarettes as Smoking Cessation Adjuncts
Background: Tobacco use remains a substantial health hazard. Promotion of smoking cessation is an important healthcare intervention. Current guidelines for smoking cessation are only modestly successful. It is unclear if electronic cigarettes are effective smoking cessation adjuncts. Aim: The purpose of the study was to determine the attitudes of respiratory physicians in South Africa towards the use of e-cigarettes as smoking cessation adjuncts. Setting: Online survey of the attitudes of South African registered respiratory physicians towards e-cigarettes. Methods: The study was cross-sectional in design and consisted of a questionnaire-based online survey sent by electronic mail and completed by respiratory physicians registered with the Health Professions Council of South Africa (HPCSA), who were willing to participate. Results: Fifty-two (63.4%) responses were received. Sixty-seven percent of the participants felt that e-cigarettes were not effective smoking cessation adjuncts. Almost 79% of the respondents were of the opinion that e-cigarettes had less harmful effects on smokers compared to conventional cigarettes. Sixty-two percent of the respondents felt that e-cigarettes could be a gateway to other tobacco product use. More than 80% were in support of strict regulation of e-cigarettes. Conclusion: The majority of the respondents did not believe in the effectiveness of e-cigarettes as smoking cessation adjuncts, and would be happy with strict laws regulating the use of these products being enacted.
Clinical, Radiological and Pathological Characteristics of Hypersensitivity Pneumonitis and its Association with the Duration of Exposure in a Tertiary Centre
Background: Hypersensitivity pneumonitis (HP) has varied presentation, and it is unknown as to which individuals exposed to a potential antigen will develop HP. HP can often progress to permanent lung fibrosis, with significant social and economic consequences, besides reduced survival. To the best of our knowledge, this is the first such paper from India comparing characteristics of HP with duration of exposure. Methods and Materials: A retrospective observational study was conducted on 60 adult patients who meet the criteria of Hypersensitivity pneumonitis according to Schuyler’s criteria, at a tertiary care centre between February 2022 to June 2023. Clinical data including patient’s history, clinical manifestation, laboratory findings and HRCT findings was obtained from patient’s medical record files. Results: 73.3% patients were female. Most common offending antigen was avian droppings. In 11.7% the antigen could not be identified. 56.7% were homemakers. The most common HRCT finding was ground glass haziness (90%) and most common radiological pattern was Fibrotic Non-specific Interstitial pneumonitis (NSIP).71.67% patients had a restrictive ventilatory defect.90% had chronic HP. Longer the duration of exposure, more severe is the restriction and less distance was covered on 6minute walk test(6MWT). With increasing duration of exposure, more patients developed Unique interstitial pneumonitis (UIP) pattern rather than fibrotic or cellular NSIP. Conclusion: Continued long-term exposure causes most patients to develop parenchymal fibrosis. Longer duration of exposure is associated with worse ventilatory parameters and outcomes.
Primary Extraskeletal Pleural Osteosarcoma - A Clinical Case Report
Extraskeletal Osteosarcoma (EOS) is a rare malignant neoplasm producing osteoid in places others than bone or periosteum [1]. The proposed etiology of EOS is metaplasia of connective tissue or embryonal remnant [2]. Previously reported cases of primary thoracic osteosarcoma did not provide a comprehensive profile of clinical manifestations and were characterized by left-sided pleural effusions, recurrent bloody effusions, cough, pleuritic chest pain and progressive dyspnea [3].
Efficacy of Thoracoscopic Guided Brush Cytology in Undiagnosed Pleural Effusion
The accurate diagnosis of pleural effusion remains a challenging clinical problem. Medical thoracoscopy has an established role in achieving the aetiology of pleural effusion. Pleural biopsies provide best results, but if cytological results can be shown to give concordant results, therapy can be instituted early.