Search Results (303)

Insulin resistance (IR), a core component in the development of type 2 diabetes mellitus (T2DM), is increasingly recognized for its role in cardiovascular and pulmonary complications. This review explores the relationship between IR, right ventricular dysfunction (RVD), and decreased lung volume in patients with T2DM. Emerging evidence suggests that IR contributes to early structural and functional alterations in the right ventricle, independent of overt cardiovascular disease. The mechanisms involved include oxidative stress, inflammation, dyslipidemia, and obesity—factors commonly found in metabolic syndrome and T2DM. These pathophysiological changes compromise right ventricular contractility, leading to reduced pulmonary perfusion and respiratory capacity. RVD has been associated with chronic lung disease, pulmonary hypertension, and obstructive sleep apnea, all of which are prevalent in the diabetic population. As RVD progresses, it can result in impaired gas exchange, interstitial pulmonary edema, and exercise intolerance—highlighting the importance of early recognition and management. Therapeutic strategies should aim to improve insulin sensitivity and cardiac function through lifestyle interventions, pharmacological agents such as SGLT2 inhibitors and GLP-1/GIP analogs, and routine cardiac monitoring. These approaches may help slow the progression of RVD and its respiratory consequences. Considering the global burden of diabetes and obesity, and the growing incidence of related complications, further research is warranted to clarify the mechanisms linking IR, RVD, and respiratory dysfunction. Understanding this triad will be crucial for developing targeted interventions that improve outcomes and quality of life in affected patients. Full article

Lower respiratory tract infections remain a leading cause of morbidity and mortality among Intensive Care Unit patients, with severe cases often progressing to acute respiratory distress syndrome (ARDS). This life-threatening syndrome results from alveolar–capillary membrane injury, causing refractory hypoxemia and respiratory failure. Early detection and management are critical to treat the underlying cause, provide protective lung ventilation, and, eventually, improve patient outcomes. The 2012 Berlin definition standardized ARDS diagnosis but excluded patients on non-invasive ventilation (NIV) or high-flow nasal cannula (HFNC) modalities, which are increasingly used, especially after the COVID-19 pandemic. By excluding these patients, diagnostic delays can occur, risking the progression of lung injury despite ongoing support. Indeed, sustained, vigorous respiratory efforts under non-invasive modalities carry significant potential for patient self-inflicted lung injury (P-SILI), underscoring the need to broaden diagnostic criteria to encompass these increasingly common therapies. Recent proposals expand ARDS criteria to include NIV and HFNCs, lung ultrasound, and the SpO₂/FiO₂ ratio adaptations designed to improve diagnosis in resource-limited settings lacking arterial blood gases or advanced imaging. However, broader criteria risk overdiagnosis and create challenges in distinguishing ARDS from other causes of acute hypoxemic failure. Furthermore, inter-observer variability in imaging interpretation and inconsistencies in oxygenation assessment, particularly when relying on non-invasive measurements, may compromise diagnostic reliability. To overcome these limitations, a more nuanced diagnostic framework is needed—one that incorporates individualized therapeutic strategies, emphasizes lung-protective ventilation, and integrates advanced physiological or biomarker-based indicators like IL-6, IL-8, and IFN-γ, which are associated with worse outcomes. Such an approach has the potential to improve patient stratification, enable more targeted interventions, and ultimately support the design and conduct of more effective interventional studies. Full article

Background/Objectives: In late 2019, the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) caused a pandemic called the ‘coronavirus disease 2019’ (COVID-19). After the acute SARS-CoV-2 infection, many individuals (up to 33%) complained of unexplained symptoms involving multiple organ systems and were diagnosed as having Long COVID-19 (LC-19). Currently, LC-19 is inadequately defined, requiring the formation of consistent diagnostic parameters to provide a foundation for ongoing and future studies of epidemiology, risk factors, clinical characteristics, and therapy. LC-19 represents a significant burden on multiple levels. The reduced ability of workers to return to work or compromised work efficiency has led to consequences at national, economic, and societal levels by increasing dependence on community services. On a personal scale, the isolation and helplessness caused by the disease and its subsequent impact on the patient’s mental health and quality of life are incalculable. Methods: In this paper, we used Walker and Avants’ eight-step approach to perform a concept analysis of the term “Long COVID-19” and define its impact across these parameters. Results: Using this methodology, we provide an improved definition of LC-19 by connecting the clinical symptomology with previously under-addressed factors, such as mental, psychological, economic, and social effects. This definition of LC-19 features can help improve diagnostic procedures and help plan relevant healthcare services. Conclusions: LC-19 represents a complex and pressing public health challenge with diverse symptomology, an unpredictable timeline, and complex pathophysiology. This concept analysis serves as a tool for improving LC-19 definition, but it remains a dynamic disease with evolving diagnostic and therapeutic approaches, requiring deeper investigation and understanding of its long-term effects. Full article

Background/Objectives: Continuous ventilation monitoring during pediatric sedation is essential, as respiratory depression may occur silently and may not be detected promptly by conventional methods such as pulse oximetry. Non-invasive capnography has been proposed to improve early detection of respiratory compromise. This prospective observational study evaluated the diagnostic accuracy of non-invasive capnography, compared to pulse oximetry, for detecting respiratory depression in pediatric patients undergoing sedation. Methods: We conducted a single-center, prospective observational study at a tertiary pediatric hospital, enrolling 101 patients (ages 1–17 years) undergoing sedation for diagnostic or therapeutic procedures. Patients were monitored using both pulse oximetry and non-invasive capnography. Episodes of respiratory depression—defined as apnea, hypopneic hypoventilation, bradypneic hypoventilation, and desaturation—were recorded. We compared the diagnostic performance and time to detection between capnography and pulse oximetry. Results: We identified 93 episodes of respiratory depression in 52 patients (51.1%). Capnography detected all apnea episodes and 76.9% of hypopneic hypoventilation episodes that were not identified by pulse oximetry. The median time advantage of capnography over pulse oximetry was 35 s (p = 0.0055). Combining capnography and pulse oximetry identified more events than pulse oximetry alone (93 vs. 53 episodes). Conclusions: Non-invasive capnography improves the early detection of respiratory depression compared to conventional monitoring with pulse oximetry in pediatric procedural sedation. While these findings support its routine use to enhance patient safety, larger multicenter studies are needed to demonstrate its diagnostic accuracy and impact on clinical outcomes. Full article

Climate change and air pollution are reshaping viral circulation patterns and increasing host vulnerability, amplifying the burden of respiratory illness in early childhood. This narrative review synthesizes current evidence on how environmental exposures, particularly to nitrogen dioxide, ozone, and fine particulate matter, contribute to the incidence and severity of bronchiolitis, with a focus on biological mechanisms, epidemiological trends, and public health implications. Bronchiolitis remains one of the leading causes of hospitalization in infancy, with Respiratory Syncytial Virus (RSV) being responsible for the majority of severe cases. Airborne pollutants penetrate deep into the airways, triggering inflammation, compromising mucosal defenses, and impairing immune function, especially in infants with pre-existing vulnerabilities. These interactions can intensify the clinical course of viral infections and contribute to more severe disease presentations. Children in urban areas exposed to high levels of traffic-related emissions are disproportionately affected, underscoring the need for integrated public health interventions. These include stricter emission controls, urban design strategies to reduce exposure, and real-time health alerts during pollution peaks. Prevention strategies should also address indoor air quality and promote risk awareness among families and caregivers. Further research is needed to standardize exposure assessments, clarify dose–response relationships, and deepen our understanding of how pollution interacts with viral immunity. Bronchiolitis emerges as a sentinel condition at the crossroads of climate, environment, and pediatric health, highlighting the urgent need for collaboration across clinical medicine, epidemiology, and environmental science. Full article

The equine respiratory and reproductive tract microbiomes are complex and subject to constant fluctuations. Among the microbial inhabitants, Streptococcus equi subsp. zooepidemicus (SEZ) is recognized as the dominant bacterium. It is an opportunistic pathogen that may occasionally lead to various types of infections. A key virulence factor of SEZ is the streptolysin S (SLS) toxin, which is responsible for the characteristic β-hemolysis on blood agar and tissue damage. Viruses and bacteria may interact and aggravate lesions and disease. This study aimed to evaluate the impact of an SLS-containing supernatant from SEZ on the nasal and vaginal mucosa and the subsequent replication of equine herpesviruses. The SLS-containing supernatant was prepared, and three 10-fold dilutions (optical density “OD” 10⁻², 10⁻³, 10⁻⁴) were applied to equine nasal and vaginal explants. Untreated and EGTA-treated explants served as controls. Epithelial integrity was assessed by measuring the thickness and intercellular spaces. Nasal explants were inoculated with EHV-1 and EHV-4, while vaginal explants received EHV-1 and EHV-3. Viral replication was estimated via immunofluorescence staining and confocal microscopy. SLS-containing supernatants 10⁻² and 10⁻³ compromised epithelial integrity. Viral replication increased in explants treated with SLS 10⁻³, demonstrating SLS’s damaging effects on the epithelium, facilitating equine herpesvirus replication. Full article

Background: Cystic fibrosis (CF) is a chronic genetic disease marked by progressive lung function decline and increased respiratory infections. Emerging evidence supports the role of physical exercise in improving lung function, aerobic capacity, and quality of life in pediatric CF patients. Methods: We reviewed randomized clinical trials and observational studies from the last ten years, sourced from PubMed and Google Scholar. Included studies involved children and adolescents (0–18 years) with CF and assessed physical exercise as a primary intervention to improve lung function, aerobic fitness, quality of life, or hospitalization rates. Results: Aerobic training, particularly when combined with strength training, improves cardiorespiratory fitness and muscle strength without compromising nutritional status. High-Intensity Interval Training and Inspiratory Muscle Training show potential but need further validation. Supervised, personalized exercise programs are key to promoting adherence and optimizing outcomes. Conclusions: Exercise-based interventions in pediatric CF should evolve toward personalized, technology-enhanced, and sustainable models. Integrating wearable devices, adapting programs to individual needs, and leveraging early parental involvement may enhance engagement and outcomes, especially in the era of CFTR modulator therapies. Full article

This study investigates the role of melatonin in alleviating the oxidative stress and apoptosis of TM3 Leydig cells induced by 4-methyl-2,4-bis(4-hydroxyphenyl)pent-1-ene (MBP), the primary active metabolite of Bisphenol A, and clarifies its potential mechanisms involving the SIRT1/PGC-1α pathway. We found that melatonin effectively mitigated MBP-induced cytotoxicity in TM3 cells (p < 0.05). The testosterone levels and steroid hormone synthesis proteins were significantly restored by melatonin. Furthermore, there was a significant reduction in apoptosis after melatonin treatment both in MBP-treated TM3 cells and Bisphenol A-treated testicular interstitial tissues (p < 0.05), along with a significant decrease in the pro-apoptotic markers Bax and cleaved caspase 3, and a significant increase in the anti-apoptotic Bcl-2 level and the Bcl-2/Bax ratio in TM3 cells (p < 0.05). Additionally, the mitochondrial membrane potential improved significantly, ROS and MDA levels were down-regulated, and ATP production was elevated following melatonin treatment in TM3 cells. Mechanistically, melatonin promoted PGC-1α expression and activated the SIRT1 signaling pathway in MBP-treated TM3 cells and Bisphenol A-treated testicular interstitial tissues. This leads to increased expression of NRF2 and its downstream antioxidant genes, mitochondrial respiratory chain complex-related genes, mitochondrial biogenesis genes, and mitochondrial fusion genes while significantly reducing mitochondrial fission genes (p < 0.05). The PGC-1α inhibitor SR-18292 reversed these protective effects, confirming the critical role of this pathway. Conclusively, melatonin exerts a protective effect against MBP-induced oxidative stress and apoptosis in TM3 cells through the SIRT1/PGC-1α pathway, indicating its potential as a therapeutic agent for improving male reproductive health compromised by environmental toxins. Full article

Background: Among patients with congenital heart disease, particularly those with a history of undergoing the Fontan operation, pregnancy presents a significant maternal–fetal risk, especially when complicated by severe valvular dysfunction. Lung reperfusion syndrome (LRS) is a rare but life-threatening complication occurring following valve intervention. Multidisciplinary management, including by Cardio-Obstetrics teams, is essential for optimizing outcomes in such high-risk cases. Methods: We present the case of a 37-year-old pregnant patient with previously repaired tetralogy of Fallot (via the Fontan procedure) who presented at 24 weeks gestation with worsening severe pulmonary stenosis and right-ventricular dysfunction. The patient had been lost to cardiac follow-up for over a decade. She experienced recurrent arrhythmias, including supraventricular and non-sustained ventricular tachycardia, prompting hospital admission. A multidisciplinary team recommended transcatheter pulmonic valve replacement (TPVR), performed at 28 weeks’ gestation. Results: Post-TPVR, the patient developed acute hypoxia and hypotension, consistent with Lung Reperfusion Syndrome, necessitating intensive cardiopulmonary support. Despite initial stabilization, progressive maternal respiratory failure and fetal compromise led to an emergent cesarean delivery. The neonate’s neonatal intensive care unit (NICU) course was complicated by spontaneous intestinal perforation, while the mother required intensive care unit (ICU)-level care and a bronchoscopy due to new pulmonary findings. She was extubated and discharged in stable condition on postoperative day five. Conclusions: This case underscores the complexity of managing severe congenital heart disease and valve pathology during pregnancy. Lung reperfusion syndrome should be recognized as a potential complication following TPVR, particularly in pregnant patients with Fontan physiology. Early involvement of a multidisciplinary Cardio-Obstetrics team and structured peripartum planning are critical to improving both maternal and neonatal outcomes. Full article

Background/Objectives: Attenuation correction (AC) is essential for achieving quantitatively accurate PET imaging. In ⁶⁸Ga-PSMA PET, however, artifacts such as respiratory motion, halo effects, and truncation errors in CT-based AC (CT-AC) images compromise image quality and impair model training for deep learning-based AC. This study proposes a novel artifact-refinement framework that filters out corrupted PET-CT images to create a clean dataset for training an image-domain AC model, eliminating the need for anatomical reference scans. Methods: A residual neural network (ResNet) was trained using paired PET non-AC and PET CT-AC images from a dataset of 828 whole-body ⁶⁸Ga-PSMA PET-CT scans. An initial model was trained using all data and employed to identify artifact-affected samples via voxel-level error metrics. These outliers were excluded, and the refined dataset was used to retrain the model with an L2 loss function. Performance was evaluated using metrics including mean error (ME), mean absolute error (MAE), relative error (RE%), RMSE, and SSIM on both internal and external test datasets. Results: The model trained with the artifact-free dataset demonstrated significantly improved performance: ME = −0.009 ± 0.43 SUV, MAE = 0.09 ± 0.41 SUV, and SSIM = 0.96 ± 0.03. Compared to the model trained on unfiltered data, the purified data model showed enhanced quantitative accuracy and robustness in external validation. Conclusions: The proposed data purification framework significantly enhances the performance of deep learning-based AC for ⁶⁸Ga-PSMA PET by mitigating artifact-induced errors. This approach facilitates reliable PET imaging in the absence of anatomical references, advancing clinical applicability and image fidelity. Full article

Background/Objectives: This systematic review aimed to synthesize current evidence on the use of impulse oscillometry (IOS) in assessing pulmonary function in patients with Parkinson’s disease (PD). IOS, as an effort-independent method, may offer advantages over conventional spirometry in detecting early or subclinical respiratory impairment in neurologically compromised populations. Methods: A systematic search was conducted across PubMed, Web of Science, Scopus, ScienceDirect and Google Scholar for observational studies published up to March 2025. The included studies involved patients diagnosed with PD who underwent respiratory assessment using IOS, either alone or in combination with spirometry. Data on IOS parameters (R5, R20, X5, AX) and their associations with disease severity, spirometric values or autonomic markers were extracted and analyzed qualitatively. Results: Four studies, published between 2020 and 2023, met the inclusion criteria. IOS revealed increased airway resistance in early-stage PD and inverse correlations with spirometric indices such as FEV1 and PEF. One study demonstrated significant correlations between IOS parameters and parasympathetic heart rate variable indices, suggesting autonomic involvement. IOS also showed stability across dopaminergic treatment states, highlighting its reliability in longitudinal monitoring. Conclusions: IOS appears to be a promising adjunct to traditional respiratory assessment in PD, capable of identifying subtle mechanical and autonomic dysfunctions. Despite encouraging results, the current evidence remains limited and further large-scale, longitudinal studies are needed to validate its clinical utility. Full article

Background/Objectives: Primary Ciliary Dyskinesia (PCD) is a rare genetic condition characterized by compromised mucociliary clearance and chronic respiratory manifestations. Anosmia, or the loss of smell, is a lesser-known but clinically relevant symptom that can significantly impact patient safety, nutritional status, and the overall quality of life. The RSPH4A (c.921+3_921+6delAAGT) founder mutation is highly prevalent among Puerto Rican individuals with PCD and may carry distinct phenotypic implications. This study aimed to evaluate olfactory function in Puerto Rican PCD patients with this mutation using the Brief Smell Identification Test (BSIT^®) and to assess associations with age and sex. Methods: We conducted a case–control study involving 30 participants, including 15 PCD patients with genetically confirmed RSPH4A mutations and 15 age- and sex-matched healthy controls. All participants completed the BSIT, and BSIT scores were compared by diagnosis, sex, and age. Results: PCD patients had significantly lower BSIT scores than controls (p = 0.0015). When stratified by sex, both male (p = 0.0289) and female (p = 0.0178) PCD patients demonstrated significantly lower BSIT scores compared to their respective healthy counterparts. Regression analysis showed a significant inverse correlation between age and BSIT score in the PCD group (r² = 0.2873; p = 0.0395), while no such relationship was observed in controls (r² = 0.0096; p = 0.7283). Among PCD patients, age-related decline in olfactory function was more pronounced in females (r² = 0.71; p = 0.005) than in males (r² = 0.31; p = 0.25). Conclusions: These findings demonstrate that the RSPH4A founder mutation is associated with measurable olfactory impairment in PCD patients, particularly in females and with advancing age. The routine assessment of olfactory function should be considered in the clinical evaluation of patients with PCD, as anosmia may represent a key phenotypic feature and contribute to disease burden. Full article

Diffuse alveolar hemorrhage (DAH), a catastrophic complication of connective tissue disorders (CTDs), manifests as rapid-onset hypoxemia, alveolar infiltrates, and progressive bleeding into the airways. While immune-mediated alveolar–endothelial injury primarily drives its pathophysiology, diagnosis is based on bronchoscopy and chest imaging. The clinical urgency lies in securing the compromised airway and stabilizing respiratory failure, a challenge increased by CTD-specific anatomical alterations such as cervical spine instability, cricoarytenoid arthritis, and subglottic stenosis. High-dose corticosteroids and immunosuppression are essential, while severe cases require extracorporeal membrane oxygenation or plasmapheresis. This comprehensive review introduces two novel approaches to address fundamental gaps in the management of CTD-induced DAH: a structured algorithm for a CTD-specific airway risk stratification tool, integrating anatomical screening and the application of lung ultrasounds (LUSs) for post-intubation CTD-induced DAH ventilation management. The need for a multidisciplinary team approach is also discussed. Despite aggressive care, mortality remains high (25–50%), underscoring the necessity for improved early recognition and intervention strategies for these high-risk patients. Full article

Severe burns are among the most traumatic injuries, characterized by tissue damage, systemic inflammation, significant fluid shifts, and a high risk of complications such as infections, organ failure, anemia, malnutrition, and psychological trauma. This article reviews recent literature from the PubMed and Google Scholar databases to outline critical components of burn care, from initial resuscitation and stabilization through rehabilitation. Key topics include early airway management to prevent respiratory compromise, meticulous fluid resuscitation to maintain tissue perfusion while avoiding complications like fluid overload, and optimal pain management. It also discusses nutritional support tailored to the burn patient’s hypermetabolic state and surgical techniques like early debridement and skin grafting. Beyond physical recovery, the review emphasizes the importance of addressing the psychological impact of burn injuries, including depression, anxiety, and post-traumatic stress, which can significantly affect long-term outcomes. By integrating the expertise of a multidisciplinary team with a personalized approach and practical recommendations, this review aims to provide clinicians with a comprehensive framework for managing severe burns, from the initial emergency response to the challenges of inpatient care and, finally, rehabilitation. Full article

Poor air quality within hospitals can contribute to a range of health issues, collectively known as sick hospital syndrome, encompassing respiratory, skin, and nonspecific symptoms. Aspergillus poses a significant risk of severe respiratory infections, particularly within intensive care unit (ICU) patients often with compromised immune systems. This study was conducted in the intensive care units of three selected hospitals in Cracow, Poland. Air samples were obtained using the single-stage impactor MAS-100 NT Ex (Merck). The air samples were taken from each ward, seasonally, four times a year. Sampling of intensive care units’ air for Aspergillus revealed the significant diversity in fungal concentration and unveiled seasonal fluctuations in culturable fungi levels. The highest concentration of Aspergillus species complexes was detected during autumn, while the lowest was in spring. The disturbing occurrence of Aspergillus in hospitals’ air emphasizes the importance of monitoring fungal air bioburden and assessing air control efficiency and highlights the urgent need to develop and validate microbiological standards for fungal air contamination in hospitals. Full article