Search Results (336)

Chronic obstructive pulmonary disease (COPD) and tuberculosis (TB) increasingly co-occur in low- and middle-income countries and aging populations. Prior pulmonary TB is a robust, smoking-independent determinant of COPD and is linked to persistent systemic inflammation, endothelial dysfunction, dyslipidemia, and hypercoagulability axes that also amplify cardiovascular disease (CVD) risk. We conducted a targeted narrative non-systematic review (2005–2025) of PubMed/MEDLINE, Embase, Scopus, and Web of Science, selecting studies for clinical relevance across epidemiology, clinical phenotypes, pathobiology, biomarkers, risk scores, sleep-disordered breathing, and management. No quantitative synthesis or formal risk-of-bias assessment was performed. Accordingly, findings should be interpreted as a qualitative synthesis rather than pooled estimates. Prior TB is associated with a distinctive COPD phenotype characterized by mixed obstructive–restrictive defects, reduced diffusing capacity (DLCO), radiographic sequelae, and higher exacerbation/hospitalization burden. Mechanistic insights: Convergent mechanisms chronic immune activation, endothelial injury, prothrombotic remodeling, molecular mimicry, and epigenetic reprogramming provide biologic plausibility for excess CVD, venous thromboembolism, and pulmonary hypertension. Multimarker panels spanning inflammation, endothelial injury, myocardial strain/fibrosis, and coagulation offer incremental prognostic value beyond clinical variables. While QRISK4 now includes COPD, it does not explicitly model prior TB or COPD-TB outcomes, but data specific to post-TB cohorts remain limited. Clinical implications: In resource-constrained settings, pragmatic screening, prioritized PAP access, guideline-concordant pharmacotherapy, and task-shifting are feasible adaptations. A history of TB is a clinically meaningful modifier of cardiopulmonary risk in COPD. An integrated, multimodal assessment history, targeted biomarkers, spirometry/lung volumes, DLCO, 6 min walk test, and focused imaging should guide individualized care while TB-aware prediction models and implementation studies are developed and validated in high-burden settings. Full article

Background/Objectives: Heart failure is a major global health problem. Among the available treatment options, cardiac resynchronization therapy (CRT) has been shown to improve both quality of life (QoL) and mortality; however, not all patients respond adequately. Our study aimed to identify echocardiographic parameters that predict a positive response to CRT. Methods: A total of 33 patients (10 women and 23 men) were prospectively recruited, all met the standard criteria for CRT implantation. Biochemical, clinical, QoL, 6 min walk test, and echocardiographic evaluations were performed prior to CRT implantation and reassessed after 6 months. A ≥15% reduction in left ventricular end-systolic volume was taken as the defining parameter of positive response. Based on response level, patients were divided into two groups: responders and non-responders. Results: Comparing the overall population before and after CRT, a positive impact was observed on biochemical, electrocardiographic, and echocardiographic parameters. Fourteen patients (42%) were classified as responders and nineteen (58%) as non-responders. Only two basal echocardiographic parameters showed significant baseline differences between groups: Global Longitudinal Strain (GLS) and the Kapetanakis index. ROC curve analysis showed that baseline GLS and Kapetanakis index had excellent discriminative ability for predicting CRT response. Also, binary logistic regression analysis identified the association of GLS and Kapetanakis index with CRT response. Finally, Rho Spearman analysis showed a positive correlation between the degree of response to CRT and the QoL, (ρ) of 0.663 with p = 0.001. Conclusions: Our findings confirm the overall clinical, biochemical, echocardiographic, and QoL benefits of CRT. In addition, two echocardiographic parameters proved to be potential response predictors. Full article

Background and Objectives: Evidence on motor performance in children with autism spectrum disorder (ASD) is scarce and inconsistent. The association of motor impairments with autism severity and intelligence remains insufficiently studied. We aimed to examine motor performance parameters in children with ASD compared with typically developing (TD) peers. Materials and Methods: In this cross-sectional study, a convenience sample of 26 children with ASD, aged 4–10 years, was recruited from specialized centers in KSA, alongside 27 age- and sex-matched TD children. For the ASD group, severity (Childhood Autism Rating Scale, CARS-2) and intelligence quotient (Stanford–Binet Intelligence Scale, SB5) were extracted from medical records. CARS-2 score was utilized to categorize children with ASD into two groups (mild-to-moderate and severe groups). All study children were assessed for gross and fine motor skills using the Movement Assessment Battery for Children-2 (MABC-2), balance, muscle strength, endurance, and flexibility. Results: ASD groups recorded significantly lower scores in all MABC-2 component areas when compared to the TD group (p < 0.001). Aiming and catching percentile was significantly lower in the severe ASD group compared to the mild-to-moderate group (p = 0.05). Furthermore, children with ASD exhibited increased hypermobility, predominantly at the elbow joints, reduced grip strength, shorter distance in the modified 6 min walk test, and lower standing long-jump performance (p < 0.001) when compared to TD group; however, no significant difference was recorded between the ASD groups. Spearman correlation revealed that aiming and catching was negatively correlated with autism severity (CARS-2) (r = −0.38, p = 0.05) and positively with IQ (r = 0.51, p = 0.03). Aiming and catching was positively correlated with grip strength (r = 0.55, p = 0.003), endurance (r = 0.58, p = 0.002), and jump distance (r = 0.44, p = 0.03), while balance was positively correlated with grip strength (r = 0.44, p = 0.02). Conclusions: Children with ASD exhibit significant impairments in gross and fine motor performance compared with TD peers, accompanied by hypermobility, reduced strength, and diminished endurance. Notably, aiming and catching ability correlated with both IQ and autism severity as well as specific motor parameters, suggesting its potential as a clinical marker of motor–cognitive interaction in ASD. Full article

Background/Objectives: Evidence on pulmonary rehabilitation (PR) in paediatric post-COVID-19 condition (PPCC) is scarce. This study aimed to evaluate the association of a PR programme with changes in physical and mental health and quality of life in PPCC over a 12-month follow-up. Methods: A quasi-experimental pre–post single-arm study was conducted, with no control group, in PPCC patients attending an outpatient PR unit. The primary outcome was change in exercise capacity (6 min walk test, 6MWT). Secondary outcomes included inspiratory and peripheral muscle strength, quadriceps muscle morphology by ultrasound, fatigue, physical activity, quality of life, and psychiatric symptoms, assessed using validated paediatric instruments. Results: A total of 115 PPCC patients (mean age 13.3 years; 66.1% female) completed the PR. 6MWD distance increased from 509 ± 87 to 546 ± 86 (+37 m; p < 0.001; D: 0.50). Handgrip strength increased by 2.4 kg, maximal inspiratory pressure increased by 15 cmH₂O, physical activity increased by 2.4 points, fatigue score improved by 9.3 points, and quality of life improved by 11 points (all p < 0.001). Rectus femoris thickness increased by 0.56 mm (p = 0.005), psychiatric symptom scores decreased by 4.5 points (p < 0.001), and rectus femoris echo-intensity decreased (p = 0.003). Conclusions: Multidisciplinary PR appears feasible and potentially effective in improving physical function, psychological well-being, and quality of life in PPCC, supporting the need for evidence-based paediatric rehabilitation. Full article

This study aims to evaluate the reliability and minimal detectable change (MDC) of the 2 min marching test (2MMT) for cardiovascular response, as well as to compare its outcomes with those of the 6 min walk test (6MWT), in youth recovering from post-COVID-19 condition. Forty-four youth with post-COVID-19 condition underwent two assessment sessions, separated by five days, utilizing both the 6MWT and 2MMT to measure cardiorespiratory response parameters. Test–retest reliability was found to be excellent for the 6MWT (ICC = 0.83; MDC₉₅ = 8.06%) and good for the 2MMT (ICC = 0.78; MDC₉₅ = 15.61%) between initial and follow-up measurements. The 2MMT demonstrates good reliability and validity for assessing cardiovascular response in youth with post-COVID-19 condition. The reported MDC values provide clinically meaningful thresholds that enable clinicians to distinguish true changes in performance from measurement error. These findings support the use of the 2MMT as a practical tool for clinical assessment, providing preliminary guidance for interpreting changes in performance. However, longitudinal monitoring of patient progress was not directly assessed in this study. Full article

(1) Background: The Sustainable Development Goals highlight the importance of ensuring healthy lives and promoting well-being for all. Within this framework, it is essential to improve health outcomes for people with disabilities and to continue generating scientific evidence in this field. This study aimed to (I) analyze differences in anthropometric characteristics and cardiorespiratory fitness among adults with disabilities, and (II) analyze the association between anthropometric characteristics and cardiorespiratory fitness in the total sample and by sex. (2) Methods: Fifty-three adults over 50 years of age with disabilities participated in this study. Anthropometric measurements and the 6 min walk test (6MWT) were conducted, recording physical-physiological and mechanical variables (using heart rate monitors and Stryd devices). (3) Results: Significant differences were observed between men and women with disabilities in height (p < 0.001, ES = −1.10), hip-to-chest ratio (p < 0.05, ES = 0.75), mean heart rate (p < 0.05, ES = 0.67), and absolute minimum power (p < 0.05, ES = 0.64) achieved during the 6MWT. A significant correlation was found between anthropometric characteristics and 6MWT performance across the entire sample (r = −0.29 to −0.67, p < 0.05). Among women, these characteristics were associated with distance covered (r = −0.35 to −0.42, p < 0.05), whereas in men, they were associated with relative power (r = −0.60 to −0.83, p < 0.05). (4) Conclusions: The findings suggest that, in this sample, anthropometric characteristics are associated with specific 6MWT performance variables, with patterns differing by sex. Full article

Background/Objectives: Many heart failure (HF) patients exhibit a suboptimal response to cardiac resynchronization therapy (CRT). This study investigated whether sacubitril/valsartan, a drug known to beneficially impact cardiac remodeling, could improve outcomes for patients undergoing CRT implantation. Methods: In this single-center, observational study, 90 HF patients (left ventricular ejection fraction [LVEF] ≤ 35%) receiving a CRT-defibrillator were stratified into a sacubitril/valsartan group (n = 39) and a control group (n = 51). The primary endpoint was a CRT response at 12 months, defined as improvement in New York Heart Association (NYHA) class, left ventricular reverse remodeling (≥15% reduction in left ventricular end-systolic volume [LVESV] or ≥5% improvement in LVEF), and freedom from HF hospitalization. Results: The sacubitril/valsartan group had a significantly higher CRT response rate (87.2% vs. 64.7%, p = 0.016). They also showed greater improvement in the 6 min walk test (p = 0.013), NYHA class (p = 0.017), reduction in LVESV (p = 0.025), and QRS duration (p = 0.005). Multivariable analysis confirmed sacubitril/valsartan as an independent predictor of CRT response (OR = 4.43; 95% CI: 1.33–14.71; p = 0.015). Conclusions: In this study of HF patients receiving CRT, sacubitril/valsartan was independently associated with superior reverse remodeling, enhanced electrical resynchronization, and a higher rate of CRT response. These findings suggest a potential synergistic role for sacubitril/valsartan in optimizing post-CRT outcomes; however, as this was an observational study, they should be considered hypothesis-generating and require validation in larger, randomized controlled trials. Full article

Background: The prevalence of pulmonary hypertension (PH) in patients who are positive for myositis-specific antibody (MSA) and myositis-associated antibody (MAA) remains unclear. Methods: We conducted a retrospective study of patients with an age of 18 years or older diagnosed with myositis interstitial lung disease (ILD) at our university’s ILD clinic between 2019 and 2022. Echocardiographic PH was defined by tricuspid regurgitation velocity (TRV) ≥ 2.9 m/s on transthoracic echocardiography (TTE) consistent with intermediate probability of PH using 2022 European Society of Cardiology/European Respiratory Society (ESC/ERS) guidelines. We grouped patients based on low probability of PH vs. intermediate to high probability of PH. We examined 6 min walk test (6MWT) data, pulmonary function tests (PFTs), all-cause mortality, and rate of lung transplantation. We also evaluated patients who were on immunosuppression vs. those not on immunosuppression. Results: The intermediate to high probability of PH group had a higher prevalence of dermato-specific antibodies (14.2% vs. 34.5%, p = 0.048). Specifically, MDA-5 was found to be more prevalent in patients with intermediate to high probability of PH (7.1% vs. 24.1%, p = 0.040). There was no difference in 6MWT parameters between groups (363.2 ± 115.6 m vs. 294.9 ± 147.5 m, p = 0.108). FVC and DLCO were lower in patients with intermediate to high probability of PH (71.3 ± 22.4 L vs. 58.8 ± 16.7 L, p = 0.037; 56.3 ± 21.8 mL/min/mmHg vs. 36.9 ± 15.5 mL/min/mmHg, p = 0.003). The all-cause mortality and rate of lung transplantation was higher in the intermediate to high probability of PH group (5.4% vs. 20.7%, p = 0.041, 0% vs. 6.9%, p = 0.049). There was no difference in all-cause mortality between patients who were on immunosuppression vs. those who were not on immunosuppression in patients with intermediate to high probability of PH (33.3% vs. 7.1%; p = 0.169). Conclusions: Patients with MSA/MAA may have an increased risk of PH with reduced lung function, higher mortality, and greater rate of lung transplantation. Our study further elucidates the growing body of evidence that dermato-specific antibodies, such as MDA-5 are associated with an increased risk of PH. Further research is needed to investigate the role of PH and immunosuppression in these patients. Full article

Background/Objectives: The 6 min walk test (6MWT) has been used to measure the level of walking capacity in people with Parkinson’s disease (PD). However, the use of a non-linear circuit has not yet been investigated deeply. Thus, the aim of this study was to evaluate the test–retest reliability of the 6 min walk test in a rectangular circuit in people with PD. Methods: Forty-two people with PD (men = 27, women = 15), mean age 66 ± 9.61 years, participated. All of them were in ON state. Each patient performed the 6MWT on 2 test days separated by 1 week, walking at a constant speed on a 20 m × 3.5 m circuit. Test–retest reliability was assessed using the intraclass correlation coefficient (ICC), minimal detectable change (MDC), and standard error of measurement (SEM), and Student’s t-test was applied to determine whether there were statistically significant differences between the test and the retest. Results: The ICC values for the total sample were excellent (>0.90) in both men and women. In addition, they had similar reliability, although slightly higher in women. The results showed that, for the total sample, a MDC < 17% can be considered as a true change for this procedure. The SEM percentage was 6.1%. Conclusions: The 6MWT, performed on a rectangular circuit, demonstrated excellent test–retest reliability in patients with Parkinson’s disease. Full article

Background/Objectives: Cardiac resynchronization therapy with defibrillator (CRT-D) is a well-established therapy for patients with heart failure (HF) and intraventricular conduction delays, but a non-negligible risk of infection and of lead functionality loss overtime is related to intravascular hardware. The novel DX system enables atrial sensing through a floating dipole integrated into the ICD lead, reducing the intravascular burden. In this prospective non-randomized study, we aimed to evaluate the safety and efficacy of a two-lead DX-based CRT system compared to a conventional three-lead (3L) CRT-D system. Methods: A total of 210 patients meeting CRT indications and no signs of sick sinus syndrome (SSS) (baseline HR ≥ 45 bpm, or at least 85 bpm at 6 min walking test) were enrolled. Patients were assigned to either the CRT-DX or conventional 3L CRT-D group. The primary endpoint was a composite clinical response, defined as the freedom from cardiovascular death, HF hospitalization, or new-onset atrial fibrillation (AF). Results: After a mean follow-up of 46.5 ± 1.9 months, both groups had comparable clinical and instrumental outcomes. CRT-DX patients exhibited higher atrial sensing amplitudes and no significant differences in loss of lead function. Conclusions: In conclusion, the CRT-DX system provides equivalent clinical and echocardiographic benefits compared to conventional CRT-D in patients without an indication for atrial pacing. This supports the use of the DX system as a safe and effective alternative in the majority of CRT recipients. Full article

Background/Objectives: Community ambulation after stroke depends on locomotor capacity and confidence in everyday environments. We compared functional performance across three community walking levels and identified constructs independently associated with being an independent community walker in individuals with chronic stroke. Methods: Adults admitted to an acute-care general hospital or an inpatient rehabilitation hospital were enrolled. Community walking level was classified by a self-reported questionnaire. Primary constructs were gait speed, gait endurance, and balance self-efficacy measured with standard clinical tests. Additional measures described balance, lower-limb motor function, and task-based mobility. Group differences were examined with one-way analysis of variance with Bonferroni comparisons. Community walking status was modeled with binary logistic regression using forward stepwise selection. Results: Fifty-nine individuals were analyzed. Performance differed across levels. Effect sizes were small, medium, or large overall. Independent community walkers showed faster gait speed, longer walking distance, and higher balance self-efficacy, with the same direction for balance and lower-limb motor scores and shorter times on task-based tests. In univariable models, age, sex, and time since stroke were not associated with independence, whereas assistive device use related to lower odds. In the multivariable model, gait speed, gait endurance, and balance self-efficacy retained independent associations with independent community walking. Other measures were not retained after adjustment. Conclusions: Community walking status in chronic stroke relates most closely to gait speed, gait endurance, and balance self-efficacy. Evaluation can emphasize the 10 m Walk Test, 6 Min Walk Test, and Activities-specific Balance Confidence Scale, with impairment and task-based tests used to guide intervention planning. Full article

Background: Exhaled NO concentrations at different flow rates can be used to calculate pulmonary NO dynamics in the conductive and peripheral airways and can be described by the total bronchial flux of NO (JawNO) and alveolar NO concentration (CANO), respectively. Changes in these parameters have been shown in pre-capillary pulmonary hypertension (PH); however, data from studies with low sample sizes are controversial and did not prospectively assess JawNO and CANO after adequate therapy. Methods: Patients with untreated pre-capillary PH (group 1: N = 23, group 3: N = 11, group 4: N = 18) and control subjects (N = 27) were recruited in a single-center observational study. Patients with group 1 (N = 15) and group 4 PH (N = 13) also attended a single follow-up visit when on pulmonary vasodilators or following interventions. Exhaled NO concentrations were measured at 50 mL/s and 100–250 mL/s expiratory flows and the two-compartment linear model was used for the calculation of JawNO and CANO. Results: CANO was higher in patients (median (interquartile range) 3.84 (2.64–7.29) ppb) than in control subjects (2.70 (1.85–4.29) ppb, p < 0.01; Mann–Whitney test) without a difference among PH groups or an association with survival. CANO showed moderate negative associations with the diffusion capacity of the lung for carbon monoxide (Spearman r = −0.41, p < 0.01) and a trend for mortality risk categories in groups 1 and 4 (r = −0.30, p = 0.06). Only JawNO changed at follow-up (0.69 (0.14–1.10) vs. 0.91 (0.40–1.68) nL/s, p = 0.02; Wilcoxon test), and there was a positive correlation between its increase and the improvement in 6 min walk distance (r = 0.40, p = 0.04). Conclusions: Alveolar NO concentration is increased in patients with pre-capillary PH, and the change in JawNO is related to the improvement in exercise capacity in PH groups 1 and 4. This is the first study implying that JawNO might be a non-invasive marker responsive to improved pulmonary hemodynamics in PH. Full article

Background/Objectives: Hypertension (HTN) is highly prevalent among middle-aged and older adults in Saudi Arabia, affecting nearly half of those attending primary care clinics. This growing burden contributes not only to cardiovascular disease, but also to functional decline and reduced mobility in aging Saudis. The objective of this paper was to examine the relationship between HTN and objective measures of mobility and endurance in Saudi adults aged ≥50 years, and to assess whether any associations differ by sex. Methods: In a cross-sectional study, 47 hypertensive and 53 non-hypertensive (no chronic disease) community-dwelling adults were recruited from various regions of Saudi Arabia. Participants completed mobility tests (five repetitions of sit-to-stand (5×STS) and timed up-and-go (TUG)) and an endurance test (6 min walk test (6MWT)). Multivariable linear regressions adjusted for age, body mass index, and sociodemographic factors were used to evaluate the association of HTN with each performance measure in men and women separately. Results: Participants with HTN were older (mean 63 vs. 57 years) and had higher BMI than controls (p < 0.05), as well as performing worse on all functional tests: they required more time for 5×STS and TUG, and walked a shorter distance during the 6MWT (all p ≤ 0.003). In sex-stratified analyses, HTN was associated with slower TUG in men (≈2 s longer, p = 0.027), while among women, HTN predicted significantly slower 5×STS (+8.4 s) and TUG (+2.8 s) times, and a 114 m-shorter 6MWT distance (p < 0.05 each). Conclusion: HTN is linked to impaired mobility and endurance in middle-aged and older Saudi adults, with hypertensive women exhibiting particularly pronounced deficits. Future research is needed to determine whether incorporating routine functional assessments and exercise-based counseling into HTN care may help identify and address early declines in physical independence among aging adults. Full article

Background: Idiopathic pulmonary fibrosis (IPF) is a progressive disease with a major impact on respiratory function, but also with possible underestimated effects on cognitive function. Although interest in cognitive impairment in chronic respiratory diseases, such as COPD, has increased, data on IPF remain limited and heterogeneous. Objective: This systematic review aimed to synthesize current evidence on cognitive impairment in IPF, identify the most affected domains, and evaluate the certainty of evidence using standardized methodological tools. Methods: A systematic review was conducted according to PRISMA 2020, with a registered PROSPERO protocol (CRD420251041866). Four databases (PubMed, Scopus, Web of Science, Cochrane Library) were searched for studies from 2014 to 2025. Methodological quality and certainty of evidence were appraised with the Joanna Briggs Institute (JBI) and GRADE frameworks. Results: Four studies met the inclusion criteria (two cross-sectional, one descriptive, one case–control). Across investigations, working and verbal memory emerged as the most consistently impaired domains, followed by processing speed and executive function, whereas visuospatial and language abilities were less frequently affected. Cognitive impairment was present even in mild IPF and became more pronounced with lower DLCO, shorter 6 min walk distance, greater desaturation, and obstructive sleep apnea. Certainty of evidence ranged from low to moderate due to small samples and heterogeneous testing. Conclusions: Cognitive dysfunction, particularly in memory, attention, and executive domains, is a frequent but under-recognized feature of IPF. Routine screening with brief, validated tools such as the MoCA may facilitate early detection and guide individualized rehabilitation. Full article

Background: Reduced cardiorespiratory fitness along with poor exercise tolerance are regarded as potential morbidity and mortality predictors within the heart failure (HF) population. Despite the reliability and accuracy of the gold-standard cardiopulmonary exercise test (CPET) for assessing cardiorespiratory fitness, its complexity and tolerability issues among HF patients mean that the 6 min walk test (6MWT) is a cost-saving and well-tolerated complementary assessment. We aimed to systematically review the validity, reliability, and safety of the 6MWT compared to CPET for patients with HF. Methods: This study is a systematic review and meta-analysis. Embase, Medline, and Scopus were searched from inception to November 2023. We applied Fisher’s z-transformation to correlation coefficients and pooled effects under a random-effects model; heterogeneity (I²), leave-one-out sensitivity, and Egger’s test were reported. Results: Twenty studies were finally included, involving 5379 HF participants. A significant moderately strong positive correlation was shown between the 6MWT distance and CPET peak oxygen consumption: (r) = 0.62, 95% CI 0.58–0.66; I² = 56.95%; p < 0.001. The results showed an excellent test–retest reliability, with a pooled intraclass correlation coefficient of 0.93 (95% CI 0.89–0.95; I² = 92.06%; p < 0.001). A pooled weighted mean difference of 15.5 m (95% CI 10.2–20.8) was found for the learning effect between the first and second 6MWT. Although some patients required rest stops or reported symptoms such as fatigue or dyspnea, no 6MWTs were terminated due to serious adverse events. Conclusions: Compared with CPET, the 6MWT distance demonstrated a moderately strong correlation with peak VO₂, excellent test–retest reliability, and a small learning effect. The 6MWT can therefore complement CPET or serve as a pragmatic alternative when CPET is not feasible; it does not replace comprehensive CPET assessment. Full article