J. Respir., Volume 5, Issue 1 (March 2025) – 4 articles

Tuberculosis (TB) is a leading cause of death from a single infectious agent in humans. The morbidity and mortality due to TB are further worsened by co-existing health conditions and the emergence of drug-resistant (DR-TB) cases. The WHO has declared TB as a global emergency and endorsed global efforts to improve diagnosis, and treatment while reducing the catastrophic cost in an EndTB strategy in 2013, with a vision to create a TB-free world. In the past decade, molecular diagnostic tools, such as nucleic acid amplification technologies (NAATs), have replaced the conventional smear microscopy of TB, thus offering better bacteriological confirmation and case detection along with drug resistance in pulmonary and extrapulmonary samples. Follow-on testing using a more advanced targeted next-generation sequencing (tNGS) system has improved the diagnosis of cases resistant to first- and second-line anti-TB drugs, including newer ones. TB treatment has been improved with the introduction of newer drugs including an all-oral regimen for DR-TB, thereby improving patient compliance. Improved TB prevention is achieved through the broadening of BCG vaccination as well as preventive therapy for asymptomatic, latent TB (LTBI) cases, which, otherwise, can reactivate to symptomatic disease. However, the recent goal of the WHO’s EndTB-2035 strategy has been met with significant challenges in the areas of implementing improved diagnosis and treatment modalities in resource-limited TB endemic countries. The complexity of global TB management is confounded by malnutrition, comorbidities with other infectious and non-infectious diseases, and the socio-economic landscape of vulnerable populations. Political commitment to universal health coverage (UHC), including service coverage and reduction in catastrophic cost, are some of the essential components that need to be addressed to achieve the EndTB strategy. In this perspective, we have highlighted the intricacies of global TB management and summarized some of the key challenges that may keep the WHO’s EndTB-2035 strategy on the fence. Full article

ChatGPT (Chat-Generative Pre-trained Transformer) is an accessible and innovative tool for obtaining healthcare information. This study evaluates the quality and reliability of information provided by ChatGPT 4.0^® regarding Obstructive Sleep Apnea (OSA), comparing it with responses from sleep medicine specialists. Thirty frequently asked questions about OSA were posed to ChatGPT 4.0^® and two expert physicians. Responses from both sources (V1: AI and V2: Medical Experts) were blindly evaluated by a panel of six specialists using a five-point Likert scale across precision, relevance, and depth dimensions. The AI-generated responses (V1) achieved a slightly higher overall score compared to those from medical experts (V2), although the difference was not statistically significant (p > 0.08). These results suggest that both sources offer comparable quality and content. Additionally, ChatGPT’s responses were clear and easily understandable, providing an accessible explanation of OSA pathology. Full article

Background/Objectives: Since the discovery of oncogenic neurotrophic receptor tyrosine kinase (NTRK) gene fusions in colorectal cancer in 1986, their understanding has evolved, particularly in non-small-cell lung cancer (NSCLC) over the past five years. NTRK rearrangements, involving NTRK1, NTRK2, and NTRK3, drive tumorigenesis and have been identified in various adult and pediatric cancers, with over 80 different fusion variants in several type of cancers. Detecting these rearrangements is crucial for targeted therapy strategies. The aim of this study is detect, compare and analyse these mutations in NSCLC patients of a cohort of 482 cases from Karolinska University Hospital. Methods: We conducted an initial screening using pan-TRK immunohistochemistry (IHC) to analyze the material. Positive cases were further examined through whole-exome sequencing (WES) with next-generation sequencing (NGS) to confirm the presence of fusions. Additionally, to deepen our understanding, we utilized Ingenuity Pathway Analysis (IPA) software, an artificial intelligence-driven technology, to explore the molecular pathways involved in lung cancer. Results: TRK overexpression was detected in 4.56% of cases via IHC. Among 15 pan-TRK-positive cases, WES confirmed fusions in 3, revealing a higher prevalence of NTRK1 (6.6%) and NTRK2 (13.3%) fusions, while no NTRK3 fusions were observed. Conclusions: Our findings confirm the low prevalence of these neoplasms as well as the need for a molecular test to confirm rearrangements or other potentially treatable mutations and raise other questions regarding their clinical use. However, there is an acceptable correlation between pan-TRK IHC and NTRK mutations, but not enough to determine NTRK fusions. Full article

Background: There is a limitation in understanding complete cardiopulmonary function during moments of exhaustive exercise due to invasive measurement techniques. We asked how cardiopulmonary function is perturbed during times of exercise in different age cohorts: 6–11 and 11–18. We sought to broadly analyze how age and oxidative stress during exercise differ across age cohorts. Methods: We present a whole-body physiology model that connects the nervous, cardiovascular, respiratory, and oxygen transport and binding systems. We connect these models using a lumped parameter representation of the cardiovascular and respiratory systems. Results: we observe distinct age-related difference in physiological response to exercise. These responses consist of respiratory, cardiovascular, and nervous system perturbations that are distinct across these age groups. Full article