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Background: Previous studies have shown that patients with pre-existing chronic obstructive pulmonary diseases (COPD) were more likely to be infected with coronavirus disease (COVID-19) and lead to more severe lung lesions. However, few studies have explored the severity and prognosis of COVID-19 patients with different phenotypes of COPD. Purpose: The aim of this study is to investigate the value of the deep learning and radiomics features for the severity evaluation and the nucleic acid turning-negative time prediction in COVID-19 patients with COPD including two phenotypes of chronic bronchitis predominant patients and emphysema predominant patients. Methods: A total of 281 patients were retrospectively collected from Hohhot First Hospital between October 2022 and January 2023. They were divided to three groups: COVID-19 group of 95 patients, COVID-19 with emphysema group of 94 patients, COVID-19 with chronic bronchitis group of 92 patients. All patients underwent chest computed tomography (CT) scans and recorded clinical data. The U-net model was pretrained to segment the pulmonary involvement area on CT images and the severity of pneumonia were evaluated by the percentage of pulmonary involvement volume to lung volume. The 107 radiomics features were extracted by pyradiomics package. The Spearman method was employed to analyze the correlation of the data and visualize it through a heatmap. Then we establish a deep learning model (model 1) and a fusion model (model 2) combined deep learning with radiomics features to predict nucleic acid turning-negative time. Results: COVID-19 patients with emphysema was lowest in the lymphocyte count compared to COVID-19 patients and COVID-19 companied with chronic bronchitis, and they have the most extensive range of pulmonary inflammation. The lymphocyte count was significantly correlated with pulmonary involvement and the time for nucleic acid turning negative (r=-0.145, P < 0.05). Importantly, our results demonstrated that model 2 achieved an accuracy of 80.9% in predicting nucleic acid turning-negative time. Conclusion: The pre-existing emphysema phenotype of COPD severely aggravated the pulmonary involvement of COVID-19 patients. Deep learning and radiomics features may provide more information to accurately predict the nucleic acid turning-negative time, which is expected to play an important role in clinical practice. [ABSTRACT FROM AUTHOR]

Objectives: This cross-sectional study aimed to determine the prevalence, manifestation, and risk factors of pulmonary involvement in newly diagnosed, untreated rheumatoid arthritis (RA) and psoriatic arthritis (PsA) patients, and to evaluate the efficacy of various diagnostic tools in screening for pulmonary involvement. Methods: Untreated, newly diagnosed patients with RA and PsA underwent an extensive multimodal diagnostic approach including clinical and laboratory assessment, pulmonary function tests, and chest radiography. Results: We recruited 50 arthritis patients (26 RA, 24 PsA) and 26 control subjects. Respiratory symptoms were found in 36.0 % of arthritis patients and 11.5 % of controls (p = 0.031). Pathologically reduced breathing width (< 3.0 cm) was significantly more common in arthritis patients (64.0 %) than in controls (23.1 %) (p < 0.001). Pulmonary function test results did not differ significantly between groups. Chest radiography revealed pulmonary involvement in 37.0 % of arthritis patients, higher in RA (50.0 %) than in PsA (22.7 %). Notably, only 35.3 % of arthritis patients with radiographic pulmonary involvement were symptomatic, with 64.7 % being asymptomatic. Radiographic pulmonary involvement was associated with advanced age (p = 0.002) and increased rheumatoid factor levels (p = 0.024). Conclusion: Our research underscores the significant prevalence of largely asymptomatic pulmonary involvement in newly diagnosed RA and PsA patients. These findings highlight the importance of an early, multidisciplinary screening approach, particularly for high-risk individuals. Further large-scale studies are needed to develop comprehensive screening protocols to improve early detection and treatment of pulmonary involvement in arthritis. [ABSTRACT FROM AUTHOR]

Objective: Pulmonary infection is one of the leading causes of death in patients with ANCA-associated vasculitis (AAV). It is sometimes difficult to differentiate pulmonary infection from pulmonary involvement of vasculitis in AAV patients. Fiberoptic bronchoscopy and bronchoalveolar lavage fluid (BALF) assays are useful diagnostic methods. In addition to conventional microbiological tests (CMTs), metagenomic next-generation sequencing (mNGS) facilitates rapid and sensitive detection of various pathogens. The current study aimed to evaluate the advantages of additional BALF mNGS in the management of pulmonary infection in AAV patients. Methods: 27 patients with active AAV and suspected pulmonary infection whose BALF samples were tested by mNGS and CMTs and 17 active AAV patients whose BALF were tested by CMTs alone were retrospectively recruited. The results of microbiological tests, and adjustments of treatment following BALF mNGS, were described. The durations of antimicrobial treatment and in-hospital mortality in patients were compared. Results: Among the 27 patients whose BALF samples were tested by mNGS, 25.9% of patients did not have evidence of pathogenic microorganism in their BALF samples, 55.6% had polymicrobial infections, including bacteria, fungi and viruses. Of these 27 patients, 40.7% did not have evidence of pathogenic microorganism in their BALF or serum samples according to CMTs. Patients in the BALF mNGS/CMT group received a significantly shorter duration of antibacterial and total antimicrobial treatment than patients in the CMT alone group (17.3 ± 14.7 vs. 27.9 ± 19.0 days, P = 0.044; 18.9 ± 15.0 vs. 29.5 ± 17.7 days, P = 0.040, respectively). Fewer patients in the BALF mNGS/CMT group died than in the CMT alone group (4/27 vs. 7/17, P = 0.049). Conclusion: Compared with CMT alone, additional mNGS tests may shorten the duration of antimicrobial treatment and possibly decrease death from severe infection by providing precise and quick diagnosis of infection. [ABSTRACT FROM AUTHOR]

Simple Summary: Diagnosis of hairy cell leukemia is based on the presence of hairy cells in bone marrow and peripheral blood as well as the characteristic immunophenotype. Moreover, in classic HCL, most patients present with a BRAF V600E mutation. The typical symptoms of classic hairy cell leukemia include pancytopenia, massive splenomegaly and increased risk of infection. However, rarer manifestations of HCL are occasionally reported, including cutaneous symptoms, bone infiltration, arthritis and central nervous system symptoms, as well as gastrointestinal tracts, heart, lungs, ocular involvement and other symptoms. Background: Hairy cell leukemia (HCL) is a rare indolent B-cell lymphoid malignancy. The majority of patients are asymptomatic and HCL is usually diagnosed incidentally during a routine blood cell count. In symptomatic patients, typical symptoms are related to pancytopenia and splenomegaly. In this review, we present rare clinical symptoms in patients with HCL. Methods: A literature search was conducted of PubMed, Web of Science and Google Scholar for articles concerning hairy cell leukemia, leukemia cutis, bone lesions, neurological manifestations, pulmonary symptoms, ocular manifestations, cardiac manifestation and rare symptoms. Publications from January 1980 to August 2024 were scrutinized. Additional relevant publications were obtained by reviewing the references from the chosen articles. Results: Extramedullary and extranodal manifestations of classic HCL are rare. However, leukemic involvement in the skin, bone, central nervous system, gastrointestinal tract, heart, kidney, liver, lung, ocular system and other organs have been reported. [ABSTRACT FROM AUTHOR]

Abstract Background Previous studies have shown that patients with pre-existing chronic obstructive pulmonary diseases (COPD) were more likely to be infected with coronavirus disease (COVID-19) and lead to more severe lung lesions. However, few studies have explored the severity and prognosis of COVID-19 patients with different phenotypes of COPD. Purpose The aim of this study is to investigate the value of the deep learning and radiomics features for the severity evaluation and the nucleic acid turning-negative time prediction in COVID-19 patients with COPD including two phenotypes of chronic bronchitis predominant patients and emphysema predominant patients. Methods A total of 281 patients were retrospectively collected from Hohhot First Hospital between October 2022 and January 2023. They were divided to three groups: COVID-19 group of 95 patients, COVID-19 with emphysema group of 94 patients, COVID-19 with chronic bronchitis group of 92 patients. All patients underwent chest computed tomography (CT) scans and recorded clinical data. The U-net model was pretrained to segment the pulmonary involvement area on CT images and the severity of pneumonia were evaluated by the percentage of pulmonary involvement volume to lung volume. The 107 radiomics features were extracted by pyradiomics package. The Spearman method was employed to analyze the correlation of the data and visualize it through a heatmap. Then we establish a deep learning model (model 1) and a fusion model (model 2) combined deep learning with radiomics features to predict nucleic acid turning-negative time. Results COVID-19 patients with emphysema was lowest in the lymphocyte count compared to COVID-19 patients and COVID-19 companied with chronic bronchitis, and they have the most extensive range of pulmonary inflammation. The lymphocyte count was significantly correlated with pulmonary involvement and the time for nucleic acid turning negative (r=-0.145, P

Abstract Objective Pulmonary infection is one of the leading causes of death in patients with ANCA-associated vasculitis (AAV). It is sometimes difficult to differentiate pulmonary infection from pulmonary involvement of vasculitis in AAV patients. Fiberoptic bronchoscopy and bronchoalveolar lavage fluid (BALF) assays are useful diagnostic methods. In addition to conventional microbiological tests (CMTs), metagenomic next-generation sequencing (mNGS) facilitates rapid and sensitive detection of various pathogens. The current study aimed to evaluate the advantages of additional BALF mNGS in the management of pulmonary infection in AAV patients. Methods 27 patients with active AAV and suspected pulmonary infection whose BALF samples were tested by mNGS and CMTs and 17 active AAV patients whose BALF were tested by CMTs alone were retrospectively recruited. The results of microbiological tests, and adjustments of treatment following BALF mNGS, were described. The durations of antimicrobial treatment and in-hospital mortality in patients were compared. Results Among the 27 patients whose BALF samples were tested by mNGS, 25.9% of patients did not have evidence of pathogenic microorganism in their BALF samples, 55.6% had polymicrobial infections, including bacteria, fungi and viruses. Of these 27 patients, 40.7% did not have evidence of pathogenic microorganism in their BALF or serum samples according to CMTs. Patients in the BALF mNGS/CMT group received a significantly shorter duration of antibacterial and total antimicrobial treatment than patients in the CMT alone group (17.3 ± 14.7 vs. 27.9 ± 19.0 days, P = 0.044; 18.9 ± 15.0 vs. 29.5 ± 17.7 days, P = 0.040, respectively). Fewer patients in the BALF mNGS/CMT group died than in the CMT alone group (4/27 vs. 7/17, P = 0.049). Conclusion Compared with CMT alone, additional mNGS tests may shorten the duration of antimicrobial treatment and possibly decrease death from severe infection by providing precise and quick diagnosis of infection.

Abstract Introduction VEXAS syndrome, characterized by a UBA1 gene mutation, is a rare and severe systemic inflammatory disease predominantly affecting men. Since its initial description in 2020, it has been noted for its broad clinical phenotype and frequent misdiagnosis. Case Presentation A 76-year-old Caucasian male patient diagnosed with VEXAS syndrome is presented in this case report. He presented with typical symptoms including pulmonary manifestations (infiltrates and effusions), systemic inflammation, and haematological abnormalities. The diagnosis was challenging due to the disease's heterogeneous presentation, often resembling autoimmune or haematological diseases. This patient’s case featured ground-glass opacities and pleural effusions, underlining the significant pulmonary involvement seen in 50–67% of VEXAS patients. His condition was further complicated by recurrent fever and systemic inflammation affecting multiple organs. Conclusion VEXAS syndrome demands an aggressive treatment approach due to its high mortality rate and refractory nature. This case underscores the importance of including VEXAS syndrome in differential diagnoses, particularly for patients with systemic inflammation and pulmonary symptoms, and calls for multidisciplinary management and extensive research to understand its full range of clinical phenotypes.

Introduction: VEXAS syndrome, characterized by a UBA1 gene mutation, is a rare and severe systemic inflammatory disease predominantly affecting men. Since its initial description in 2020, it has been noted for its broad clinical phenotype and frequent misdiagnosis. Case Presentation: A 76-year-old Caucasian male patient diagnosed with VEXAS syndrome is presented in this case report. He presented with typical symptoms including pulmonary manifestations (infiltrates and effusions), systemic inflammation, and haematological abnormalities. The diagnosis was challenging due to the disease's heterogeneous presentation, often resembling autoimmune or haematological diseases. This patient's case featured ground-glass opacities and pleural effusions, underlining the significant pulmonary involvement seen in 50–67% of VEXAS patients. His condition was further complicated by recurrent fever and systemic inflammation affecting multiple organs. Conclusion: VEXAS syndrome demands an aggressive treatment approach due to its high mortality rate and refractory nature. This case underscores the importance of including VEXAS syndrome in differential diagnoses, particularly for patients with systemic inflammation and pulmonary symptoms, and calls for multidisciplinary management and extensive research to understand its full range of clinical phenotypes. Established facts and novel insights: VEXAS syndrome is a rare systemic inflammatory disease with UBA1 gene mutation. VEXAS syndrome involves various UBA 1 gene mutations, including the p.splice c.118-1G > C. It mainly affects men, often misdiagnosed due to its broad clinical phenotype. Novel insights: Significant pulmonary involvement in VEXAS, including ground-glass opacities and pleural effusions. Patients with the same mutation exhibit a broad range of disease phenotypes A specific UBA1 mutation as the p.splice c.118-1G > C cannot be directly linked to a distinct disease phenotype Need for aggressive treatment strategies targeting the mutated clone and cytokine storms [ABSTRACT FROM AUTHOR]

This study investigates the correlation between COVID-19 and avascular necrosis of the femoral head, considering the potential contribution of medication-induced effects. This research spans the period from August 2022 to January 2024 and includes 32 patients diagnosed with avascular necrosis. While steroid usage, particularly in high doses, is known to predispose individuals to this condition, this study aims to discern if COVID-19 itself plays a role beyond the influence of medication. Notably, COVID-19 is associated with disturbances in the coagulation system, potentially leading to thromboembolic complications. Of the patients, six did not have COVID-19, while seven had the virus but did not receive steroid treatment. However, 19 patients with COVID-19 exhibited severe pulmonary involvement and were administered both high-dose steroids and antiviral medication. Among the observed patients, 14 were female and 18 were male. Notably, three patients presented bilateral necrosis, all of whom had COVID-19 and significant pulmonary involvement. Diagnostic assessments included frontal and profile X-rays, as well as MRI scans for all patients. [ABSTRACT FROM AUTHOR]

Background: Interstitial lung disease (ILD) is a common pulmonary manifestation of Sjögren's syndrome (SjS) and associated with an increased risk of death. Early detection and treatment of ILDs and knowing the risk factors are very important for prognosis in rheumatic diseases. Aims: This study was performed to determine ILD and associated factors in patients with SjS. Methods: Four hundred three SjS patients were evaluated in this cross-sectional cohort study. Clinical, laboratory, serological, and imaging features were compared of patients with and without pulmonary involvement. Logistic regression analyses were used to identify risk factors for lung involvement and to identify independent risk factors. Results: Thirty-five (8.7%) of SjS patients had ILD and 368 (91.3%) had no ILD. The presence of Raynaud's phenomenon was significantly more common in ILD. The geriatric age group over the age of 65 years (OR 8198; 95% CI 3788–17,742; p < 0.001), Raynaud's phenomenon (OR 17,852; 95% CI 6155–51,779; p < 0.001), and smoking (OR 3598; 95% CI 1495–8657; p = 0.003) were risk factors to be associated for ILD in the multivariable analysis. The most common abnormality was non-specific interstitial pneumonia in 20 patients (57.1%) and usual interstitial pneumonia in 15 (42.9%) patients. Conclusions: The distribution of male patients compared to female patients was higher in patients with lung involvement than in patients without lung involvement. This may be related to older age, higher smoking rate, and longer nicotine consumption in men. Age, smoking, and severity of lung involvement are more important than inflammation status and autoantibodies for prognosis. [ABSTRACT FROM AUTHOR]

Background. Pulmonary Langerhans cell histiocytosis (pLCH) is a rare disease, mostly a component of multisystemic LCH. We aimed to investigate the clinical features and treatment results in children with pLCH. Methods. We retrospectively reviewed the clinical, radiological, and treatment data of 37 patients with pLCH, diagnosed from 1974 to 2022. Results. 10% (n=37) of 367 patients with LCH had lung involvement. The median age was 1.8 years (range: 0.4 & 17.7) with a male-to-female ratio of 2.3. At admission 29.7% (n=11) presented with respiratory symptoms. Imaging showed a spectrum from nodular opacities to multiple cysts. All but one patient had multisystem disease. Twenty-nine received vinblastine-containing therapy. Ten-year event-free (EFS) and overall survival (OS) rates were 47.8% and 63.3%, respectively. In children younger and older than two years of age, the 10-year EFS was 53.3% vs. 40.2% and the 10-year OS was 58.7% vs. 68.8%, respectively. In children with and without risk organ involvement, 10-year EFS was 51.9% vs. 46.3% and 10-year OS was 51.9% vs. 73.7%. Conclusions. Lung and multisystem involvement are significant concerns in LCH, highlighting the need for careful management to reduce morbidity and mortality. [ABSTRACT FROM AUTHOR]

Recurrent respiratory papillomatosis (RRP) is a non-malignant disease, characterized by the production of wart-like growths in the respiratory tract, affecting both young people and adults (juvenile-onset recurrent respiratory papillomatosis, JORRP, and adult-onset recurrent respiratory papillomatosis, AORRP, respectively). Infection caused by human papillomavirus (HPV) is known as the main factor involved in RRP development. Complications of RRP may rarely occur, including lung involvement and malignant transformation. The present systematic review aimed to evaluate the prevalence of severe complications, such as lung involvement and lung tumor in JORRP and AORRP patients, and assess the role of HPV genotypes in the progression of disease severity following the guideline for reporting systematic reviews and meta-analysis (PRISMA Statement). A total of 378 studies were found on PubMed and Scopus using the following MESH terms: "recurrent respiratory papillomatosis and lung tumor" and "pulmonary tumor and recurrent respiratory papillomatosis". Basing on inclusion and exclusion criteria, a total of 11 studies were included in the systematic review. We found a pooled prevalence of 8% (95% CI: 4–14%; I2: 87.5%) for lung involvement in RRP patients. In addition, we found a pooled risk difference of 5% in lung involvement between JORRP and AORRP (95% CI: −7–18%; I2: 85.6%, p-value: 0.41). Among patients with lung involvement, we observed a pooled prevalence of lung tumor of 4% (95% CI:1–7%; I2: 67.1%) and a pooled prevalence mortality for this group of 4% (95% CI:2–6%; I2: 0%). Overall, the positivity rate for HPV-6 and -11 in patients with RRP was 91%. Considering only cases with pulmonary involvement, the pooled prevalence for HPV-11 was 21% (95% CI: 5–45%; I2: 77.2%). Our results evidenced a low/middle risk of pulmonary involvement and lung tumor in JORRP and AORRP patients, with an increased risk for HPV-11-positive patients. Further studies should be performed to improve knowledge and adopt preventive measures to contrast the progression to severe diseases in RRP patients. [ABSTRACT FROM AUTHOR]

Juvenile systemic sclerosis (jSSc) is an orphan disease with a prevalence of 3 in 1,000,000 children. Currently there is only one consensus treatment guideline concerning skin, pulmonary and vascular involvement for jSSc, the jSSc SHARE (Single Hub and Access point for pediatric Rheumatology in Europe) initiative, which was based on data procured up to 2014. Therefore, an update of these guidelines, with a more recent literature and expert experience, and extension of the guidance to more aspects of the disease is needed. Treatment options were reviewed, and opinions were provided for most facets of jSSc including general management, some of which differs from adult systemic sclerosis, such as the use of corticosteroids, and specific organ involvement, such as skin, musculoskeletal, pulmonary, and gastroenterology. We are suggesting the treat to target strategy to treat early to prevent cumulative disease damage in jSSc. Conclusions are derived from both expert opinion and available literature, which is mostly based on adult systemic sclerosis (aSSc), given shared pathophysiology, extrapolation of results from aSSc studies was judged reasonable. [ABSTRACT FROM AUTHOR]

Recurrent respiratory papillomatosis (RRP) is a non-malignant disease, characterized by the production of wart-like growths in the respiratory tract, affecting both young people and adults (juvenile-onset recurrent respiratory papillomatosis, JORRP, and adult-onset recurrent respiratory papillomatosis, AORRP, respectively). Infection caused by human papillomavirus (HPV) is known as the main factor involved in RRP development. Complications of RRP may rarely occur, including lung involvement and malignant transformation. The present systematic review aimed to evaluate the prevalence of severe complications, such as lung involvement and lung tumor in JORRP and AORRP patients, and assess the role of HPV genotypes in the progression of disease severity following the guideline for reporting systematic reviews and meta-analysis (PRISMA Statement). A total of 378 studies were found on PubMed and Scopus using the following MESH terms: “recurrent respiratory papillomatosis and lung tumor” and “pulmonary tumor and recurrent respiratory papillomatosis”. Basing on inclusion and exclusion criteria, a total of 11 studies were included in the systematic review. We found a pooled prevalence of 8% (95% CI: 4–14%; I2: 87.5%) for lung involvement in RRP patients. In addition, we found a pooled risk difference of 5% in lung involvement between JORRP and AORRP (95% CI: −7–18%; I2: 85.6%, p-value: 0.41). Among patients with lung involvement, we observed a pooled prevalence of lung tumor of 4% (95% CI:1–7%; I2: 67.1%) and a pooled prevalence mortality for this group of 4% (95% CI:2–6%; I2: 0%). Overall, the positivity rate for HPV-6 and -11 in patients with RRP was 91%. Considering only cases with pulmonary involvement, the pooled prevalence for HPV-11 was 21% (95% CI: 5–45%; I2: 77.2%). Our results evidenced a low/middle risk of pulmonary involvement and lung tumor in JORRP and AORRP patients, with an increased risk for HPV-11-positive patients. Further studies should be performed to improve knowledge and adopt preventive measures to contrast the progression to severe diseases in RRP patients.

Background and Objective: To clarify the prevalence, features and outcomes of small airway disease (SAD) in a Chinese cohort with antineutrophil cytoplasmic antibody (ANCA)‐associated vasculitis (AAV) related pulmonary involvement. Methods: SAD was recorded when the manifestations of either centrilobular nodules or air trapping were observed according to CT scans, except for infection or other airway‐related comorbidities. Baseline and follow‐up data were collected retrospectively. Results: Of the 359 newly diagnosed AAV patients with pulmonary involvement, 92 (25.6%) had SAD, including 79 (85.9%) cases of anti‐MPO‐ANCA positive, 9 (9.8%) cases of anti‐PR3‐ANCA positive and 2 (2.2%) cases of double positive. Patients with SAD were more likely to be younger, female, non‐smokers, have more ear–nose–throat (ENT) involvement, and have higher baseline Birmingham Vasculitis Activity Score (BVAS) compared to patients without SAD. Several AAV‐related SAD patients have improved lung function and CT scans after immunosuppressive therapy. Patients with SAD had a better prognosis compared to those without SAD. When dividing all patients into three groups: isolated SAD (only small airway involvements), SAD with other lower airway involvements, and non‐SAD, patients in the SAD with other lower airway involvements group had the highest risk of infection, while patients in the non‐SAD group had the worst long‐term outcomes. Similar results were observed in anti‐MPO‐ANCA positive patients when performing subgroup analyses. Conclusion: SAD is a unique manifestation of AAV‐related lung involvement and exhibits distinct clinical features. It is vital to focus on SAD because of its association with prognosis and infection in AAV patients, especially in anti‐MPO‐ANCA positive patients. Moreover, SAD might represent a better response to immunosuppressors. [ABSTRACT FROM AUTHOR]

Abstract Background Primary Systemic Sclerosis (PSS) is a connective tissue disorder characterized by excessive collagen deposition in the skin and internal organs. Interstitial lung disease (ILD) is a late demonstration of PSS and cytokines can contribute to the disease pathology. The purpose of the current study was to determine the association between serum interleukin-6 level and pulmonary involvement in progressive systemic sclerosis. Methods and materials Demographic data and serum interleukin-6 levels were measured for 30 PSS patients with pulmonary involvement (case group) and 30 PSS patients without pulmonary involvement (control group) following informed consent. The disease duration and activity, C-reactive protein (CRP), chest x-ray and highresolution CT scan (HRCT) findings, ejection fraction (EF) and echocardiography findings, and pulmonary artery pressure (PAP) were also determined in both groups. Results The age of patients in case and control groups was 52.5 ± 9.3 and 43.9 ± 9.7 years, respectively (p = 0.001). No significant difference was found between serum levels of IL-6 in case and control groups (73.1 ± 95.4 vs 46.7 ± 83.6 pg/ml, p = 0.267). However, IL-6 level was significantly higher in male case patients compared to male controls (p = 0.007). The duration of PSS was 11.6 ± 6.4 and 7.4 ± 4.2 years in case and control groups, respectively (p = 0.002). The quantitative CRP and PAP was also significantly higher in case patients (p = 0.01 and p

Objectives: Coronavirus disease 2019 (COVID-19) is a disease with high mortality due to acute respiratory distress syndrome (ARDS) secondary to viral pneumonia. In addition to its effects on the respiratory system, coronavirus is known to have serious systemic effects on the cardiovascular system. In this study, we aimed to investigate the association between prolonged QTc duration and COVID-19 specific pulmonary involvement. Methods: Between December 2020 and February 2021, 112 patients who were diagnosed with COVID-19 in our COVID-19 outpatient clinic and met the inclusion criteria were evaluated for the association between cardiac variables (heart rate, PR width, QRS width, fragmented QRS, and corrected QT [QTc] interval), other patient characteristics and lung involvement. Results: A significant difference was found between the QTc intervals of COVID-19 patients with and without lung involvement (p < 0.026). In the ROC analysis for the QTc interval, which was found to be significant in the multivariate regression analysis, the cut-off value of 419.5 ms had a sensitivity of 72% and a specificity of 51.6% in predicting pulmonary involvement. Conclusions: Prolonged QTc duration may be useful in predicting COVID-19 pulmonary involvement in patients admitted to the emergency department. [ABSTRACT FROM AUTHOR]

Background: Computed Tomography (CT) of the thorax plays a pivotal role in understanding the progression of COVID-19 pneumonia. This study aimed to analyze the spectrum and temporal progression of CT findings in COVID-19 patients. Methods: A prospective observational study was conducted on 246 COVID-19 positive patients from August 2020 to July 2021. A total of 288 CT scans were evaluated, with a focus on changes over time and their lobar distribution. Results: Ground Glass Opacities (GGOs) were the most common early finding, seen in 83.3% of patients within 0-4 days and decreasing to 35.29% after 21 days. The presence of GGOs with irregular lines and interfaces increased over time, peaking at 21.0% in the 15-21 day group. Lower lobes were predominantly involved, with the mean CT scores rising from 5 in the early phase to 14.53 in later stages, indicating increased disease severity. Pleural effusion and pneumothorax were noted in a minority of cases. Conclusion: The study provides detailed insights into the temporal radiological progression of COVID-19. The findings underscore the evolving nature of the disease's pulmonary manifestations and reinforce the necessity of serial CT scans for effective patient management. [ABSTRACT FROM AUTHOR]

Background: Primary Systemic Sclerosis (PSS) is a connective tissue disorder characterized by excessive collagen deposition in the skin and internal organs. Interstitial lung disease (ILD) is a late demonstration of PSS and cytokines can contribute to the disease pathology. The purpose of the current study was to determine the association between serum interleukin-6 level and pulmonary involvement in progressive systemic sclerosis. Methods and materials: Demographic data and serum interleukin-6 levels were measured for 30 PSS patients with pulmonary involvement (case group) and 30 PSS patients without pulmonary involvement (control group) following informed consent. The disease duration and activity, C-reactive protein (CRP), chest x-ray and highresolution CT scan (HRCT) findings, ejection fraction (EF) and echocardiography findings, and pulmonary artery pressure (PAP) were also determined in both groups. Results: The age of patients in case and control groups was 52.5 ± 9.3 and 43.9 ± 9.7 years, respectively (p = 0.001). No significant difference was found between serum levels of IL-6 in case and control groups (73.1 ± 95.4 vs 46.7 ± 83.6 pg/ml, p = 0.267). However, IL-6 level was significantly higher in male case patients compared to male controls (p = 0.007). The duration of PSS was 11.6 ± 6.4 and 7.4 ± 4.2 years in case and control groups, respectively (p = 0.002). The quantitative CRP and PAP was also significantly higher in case patients (p = 0.01 and p < 0.001, respectively). There was found reticulonodular pattern in 20 (66.7%) of the cases, whereas 28 (93.3%) of the controls had normal Chest X-rays (CXR) (p < 0.001). EF was significantly lower in case patients compared to control patients (p = 0.001). Conclusion: The serum level of IL-6 did not appear to have a relationship with pulmonary involvement, hence it could not be regarded as a potential therapeutic target. [ABSTRACT FROM AUTHOR]

This study investigates the correlation between COVID-19 and avascular necrosis of the femoral head, considering the potential contribution of medication-induced effects. This research spans the period from August 2022 to January 2024 and includes 32 patients diagnosed with avascular necrosis. While steroid usage, particularly in high doses, is known to predispose individuals to this condition, this study aims to discern if COVID-19 itself plays a role beyond the influence of medication. Notably, COVID-19 is associated with disturbances in the coagulation system, potentially leading to thromboembolic complications. Of the patients, six did not have COVID-19, while seven had the virus but did not receive steroid treatment. However, 19 patients with COVID-19 exhibited severe pulmonary involvement and were administered both high-dose steroids and antiviral medication. Among the observed patients, 14 were female and 18 were male. Notably, three patients presented bilateral necrosis, all of whom had COVID-19 and significant pulmonary involvement. Diagnostic assessments included frontal and profile X-rays, as well as MRI scans for all patients.

Previous studies about multicentric Castleman disease-associated pulmonary manifestations have been limited by small cohorts and not following the Castleman Disease Collaborative Network classification criteria of multicentric Castleman disease. The pulmonary manifestations in idiopathic multicentric Castleman disease-not otherwise specified (iMCD-NOS), a distinct clinical phenotype in the classification criteria, have not been reported. Which pulmonary abnormalities in iMCD-NOS are advanced manifestations and which are reversible after effective treatment? Patients diagnosed with iMCD-NOS with pulmonary involvement were enrolled. The baseline CT scan was evaluated for the presence and anatomic locations of pulmonary abnormalities. Patients were further divided into different subgroups according to baseline CT scan manifestations. Follow-up CT scan was reviewed to assess the changes in pulmonary lesions among patients without and with treatment. Of 162 patients with iMCD-NOS, 58 individuals (35.8%) with pulmonary involvement were identified. Pulmonary manifestations included nodules (96.6%), cysts (65.5%), consolidation (22.4%), interstitial thickening (50.0%-87.9%), and ground-glass opacities (55.2%). Patients (n = 58) were further classified into nodule (n = 15), cyst (n = 33), and consolidation (n = 10) subgroups. Patients in the consolidation (median, 67 months) and cyst (median, 23 months) subgroups had a longer duration of symptoms before the baseline CT examination than those in the nodule subgroup (median, 12 months) (P =.016). During follow-up, the evolution of pulmonary lesions from nodules to cysts was observed in two patients without treatment. After treatment, pulmonary lesions, except for cysts, improved in most patients. Moreover, nodules or cysts progressed into consolidation in two patients. Pulmonary involvement is not rare in iMCD-NOS. Chest CT scan examination is very essential in finding potential pulmonary abnormalities. Pulmonary manifestations follow a unique pattern with evolution from nodules to cysts or consolidation, the latter of which can also form in cystic areas. Timely diagnosis of pulmonary involvement is crucial because of possible reversibility after treatment. [ABSTRACT FROM AUTHOR]

Puffy fingers and Raynaud's phenomenon (RP) are important clinical predictors of the development of systemic sclerosis (SSc). We aim to assess the prevalence of SSc-related symptoms, explore pulmonary symptoms, and test the usefulness of skin autofluorescence (SAF) as a non-invasive marker for Advanced Glycation Endproducts (AGEs). Subjects from the Lifelines Cohort Study with known connective tissue disease (CTD) were excluded. Patient characteristics, SAF, self-reported pulmonary symptoms, and spirometry were obtained. Subjects (n = 73,948) were categorized into definite RP (5.3%) with and without SSc-related symptoms and non-RP. Prevalence of at least one potential SSc-related symptom (other than RP) was 8.7%; 23.5% in subjects with RP and 7.1% without RP (p < 0.001). Subjects with RP and additional SSc-related symptoms more frequently reported dyspnea at rest, dyspnea after exertion, and self-reported pulmonary fibrosis, and had the lowest mean forced vital capacity compared to the other groups (RP without SSc-related symptoms and no RP, both p < 0.001). In multivariate regression, dyspnea at rest/on exertion remained associated with an increased risk of SSc-related symptoms in subjects with RP (both p < 0.001). SAF was higher in subjects with RP and SSc-related symptoms compared to the other groups (p < 0.001), but this difference was not significant after correction for potential confounders. The prevalence of SSc-related symptoms was approximately three-fold higher in subjects with RP. Pulmonary symptoms are more prevalent in subjects with RP who also reported additional potential SSc-related symptoms. This might suggest that (suspected) early SSc develops more insidiously than acknowledged. According to this study, SAF is no marker for early detection of SSc. [ABSTRACT FROM AUTHOR]

The long-term sequelae of COVID-19 have now become more common and appreciable. The SARS-CoV-2 virus can cause a variety of infectious and non-infectious pulmonary complications. The purpose of this study is to raise awareness about post-COVID-19 pulmonary sequelae, both infectious and non-infectious, in this geographical area. A retrospective study was conducted from July 1st 2020 to December 20th 2020. A total of 1200 patients were evaluated, with 83 suffering from post-COVID-19 pulmonary complications. The patients' mean age was 62 years (IQR 55-69), with 63 (75.9%) being male. The most common co-morbid illnesses were hypertension (49, 59%) and diabetes (45, 54.2%). The majority of them (37, 44.6%) had severe COVID-19, followed by critical COVID-19 (33, 39.8%). There was no statistically significant difference in recurrence of respiratory symptoms or duration of current illness between non-severe, severe, and critical COVID-19 patients. Non-infectious complications were observed in the majority of patients (n=76, 91.5%), including organizing pneumonia/ground glass opacities in 71 (88%) patients, fibrosis in 44 (55%), pulmonary embolism in 10 (12.5%), pneumomediastinum in 6 (7.4%) and pneumothorax in 7 (8.6%). Infective complications (25, 30.1%) included aspergillus infection in 10 (12.0%) and bacterial infection in 5 (8.47%), with more gram-negative infections and one patient developing Mycobacterium tuberculosis. Post-COVID-19 mortality was 11 (13.3%). The long-term pulmonary sequelae of COVID-19 are not rare. Cryptogenic organizing pneumonia, ground glass opacities, and fibrosis were common post-COVID-19 sequelae in our patients. This necessitates frequent close monitoring of these patients in order to initiate early appropriate management and prevent further morbidity and eventual mortality. [ABSTRACT FROM AUTHOR]

Synovial sarcoma is a rare malignant mesenchymal tumor that can develop at any anatomic site. Pulmonary sarcomas constitute 0.1–0.5% of all primary lung malignancies. Primary pulmonary synovial sarcoma is highly uncommon. Most of the patients present with large intrathoracic masses with complaints of cough, chest pain, shortness of breath, or hemoptysis. Multimodality treatment in the form of wide excision, chemotherapy, and radiotherapy is the mainstay of therapy. Synovial sarcoma is considered a high-grade tumor with a poor prognosis. We hereby present three cases of histologically proven synovial sarcoma with predominantly pulmonary involvement, along with their management and in hospital outcome.

Background: Pulmonary lung involvement is the most common extra-glandular manifestation in patients with primary Sjögren's syndrome (pSS), leading to a worsening of the patient's prognosis. To date, different studies have assessed the prevalence of pulmonary involvement and interstitial lung disease (ILD) in pSS patients with different results. Methods: We performed a systematic literature review and meta-analysis on ILD pooled prevalence in pSS according to the PRISMA and MOOSE guidelines. Furthermore, we explored the pooled prevalence of the two main presentations of pSS-ILD, nonspecific interstitial pneumonia (NSIP) and usual interstitial pneumonia (UIP). Results: We analysed the pSS-ILD prevalence in 30 studies including 8255 pSS patients. The pSS-ILD pooled prevalence was 23% (95% CI: 16–30). For NSIP, we found a pooled prevalence of 52% (CI 41–64), and for UIP we found a pooled prevalence of 44% (CI: 32–55). Regarding the meta-regression analysis, male gender, DLco value, country, and HRCT seem to contribute to the ILD presence. Conclusions: At least 20% of pSS patients have a comorbid ILD, usually NSIP. Male gender and alteration in DLco value may be considered the most important independent factors supporting an active search of lung complications during the clinical history of pSS patients. [ABSTRACT FROM AUTHOR]

Objective: To determine the prevalence of hepatic steatosis and whether there is an association with pulmonary involvement in CT scans of patients with COVID-19. Material and methods: 140 patients with positive PCR for SARS-CoV-2 and with simple chest tomography were evaluated. The tomographic findings of COVID-19 were evaluated by the CO-RADS system, pulmonary involvement was classified with the proposed INER scale and hepatic steatosis was determined at 42 UH. The SPSS program was used for statistical analysis with X2 test. Results: Out of 140 patients we found 91 men (65%) and 49 women (65%). The most affected age was 60.9 ± 15 years. The prevalence of hepatic steatosis was 32.1%, no association was found with the degree of pulmonary involvement by X2 test (p = 0.151). Obesity was observed in 37.1%, overweight in 36.4%, arterial hypertension in 35.7% and diabetes mellitus in 21.8%. Conclusions: There is no association between hepatic steatosis and pulmonary involvement in COVID-19 pneumonia. The prevalence of hepatic steatosis of 32.1% is similar to that reported in other studies. [ABSTRACT FROM AUTHOR]

Copyright of Klinická Mikrobiologie a Infekční Lékařství is the property of TRIOS, spol. sr.o. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives: Pulmonary involvement other than pulmonary artery involvement in Behcet's disease still remains an area of investigation. The aim of this study was to evaluate pulmonary involvement associated with Behcet's disease. Method: We retrospectively investigated all Behcet's disease patients in terms of pulmonary involvement. Twenty-eight patients, whose radiologic examinations were consistent with Behcet's disease–related involvement after excluding other possibilities, were included in this study. Data regarding demographic characteristics, other clinical components of Behcet's disease, treatment modalities, and types of pulmonary involvement were analyzed. Results: Pulmonary involvement was seen more common in male (82.1% vs 17.9%). Mean age for Behcet's disease diagnosis was found 32 years (SD 10.9) and mean age for pulmonary involvement was calculated 37 years (SD 11.4). Deep vein thrombosis (DVT) was the most common associated vascular involvement (53.6%). In our study population, alveolar hemorrhage and/or ground glass appearance were seen in 46.4% (13/28) of BD patients with pulmonary involvement. Totally, pulmonary artery aneurysm (PAA), small-sized pulmonary vasculitis (sPV), and pulmonary thrombosis (PT) were seen in 7 (25%), 13 (46.3%), and 18 (64.4%) of patients, respectively. Intracardiac thrombosis (ICT) in the right ventricle was present in 5 patients. Cyclophosphamide (CYC) was the most common preferred agent (78%) followed by azathioprine (AZA) in the first line. Warfarin was used in 18 patients. Overall mortality was seen in 3 patients: 1 due to PAA bleeding and others with unknown causes. Conclusion: Despite the importance of pulmonary artery involvement and pulmonary thrombosis in Behcet's disease, small-sized pulmonary vasculitis in the form of small vessel involvement is generally overlooked. Our study findings have shown that alveolar hemorrhage and/or ground-glass appearance in the absence of pulmonary artery aneurysm and pulmonary thrombosis are seen commonly as well. Key Points • The characteristics of pulmonary small vasculature involvement in Behcet's disease which is still an area of investigation warrant further attention. • The clinician should bear in mind that the spectrum of pulmonary involvement in Behcet's disease may be variable, but an extensive work up is still of great importance especially in atypical cases. [ABSTRACT FROM AUTHOR]

Background/aim: Little is known about the prevalence and causes of pulmonary hypertension (PH) in Behçet's disease (BD). This study was conducted to determine the prevalence and causes of PH in BD. Materials and methods: In this descriptive study, we screened 154 patients with BD for PH using transthoracic echocardiography between February 2017 and October 2017. An estimated systolic pulmonary arterial pressure (sPAP = 40 mmHg) was used as the cutoff value to define PH. Patients with BD were categorized into 5 groups according to organ involvement including mucocutaneous/articular, ocular, vascular, gastrointestinal, and neurologic involvement. Additional laboratory and imaging results were obtained from hospital file records to determine the causes of PH. Results: PH was detected in 17 (11%) patients. Nine (52.9%) of these patients had group II PH (due to left heart disease), 4 (23.5%) had IV PH (due to pulmonary arterial involvement), and 1 had III PH (due to chronic obstructive lung disease). The frequency of PH was higher in BD patients with vascular involvement than those without (52.9% vs 28.5%; p = 0.04). Among 10 patients with pulmonary artery involvement (PAI) 4 (40%) had PH. Although the vascular BD group had the highest rate of PH, we observed no statistically significant difference in the frequency of PH between the predefined BD subgroups. Conclusions: PH is not rare in patients with BD. The majority of BD patients with PH are in group II or IV PH. Patients with vascular involvement carry a higher risk for the development of PH. Monitoring BD patients with PAI should be considered for the development of group IV PH. [ABSTRACT FROM AUTHOR]

Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic is a worldwide challenge; regarding the lack of an effective and efficient drug. It seems that the vaccine is the only modality to save the world from this pandemic. Objectives: This study was conducted to assess the effect of vaccination on preventing pulmonary involvement and the disease severity of COVID-19 patients. Patients and Methods: This descriptive-analytical study was conducted on 247 people with coronavirus disease 2019 infection. Demographic characteristics and vaccination status information were collected. Patients’ lung computed tomography scan findings were scored based on the pulmonary involvement percentage, and then according to this score, they were graded into severe, moderate, mild, and without lung involvement. The association between pulmonary involvement and vaccination status were evaluated by Fisher’s exact test and logistic regression. Results: Most participants were male, with a mean age of 53.74 ± 10.96 years. Most people (42.9%) were partial-vaccinated. Lungs in 53.3% were with lung involvement and in 46.6% were without. The correlation between pulmonary involvement and vaccination was significant (P

Two cases of Kawasaki disease (KD) presented as persistent lung consolidation associated with Group A Streptococcus and Influenza A co‐infection, which resolved following intravenous immunoglobulin. Thus, pediatricians should consider the diagnosis of KD in the presence of pneumonia that is nonresponsive to antibiotic therapy with prolonged fever and inflammatory reactions. [ABSTRACT FROM AUTHOR]

Synovial sarcoma is a rare malignant mesenchymal tumor that can develop at any anatomic site. Pulmonary sarcomas constitute 0.1–0.5% of all primary lung malignancies. Primary pulmonary synovial sarcoma is highly uncommon. Most of the patients present with large intrathoracic masses with complaints of cough, chest pain, shortness of breath, or hemoptysis. Multimodality treatment in the form of wide excision, chemotherapy, and radiotherapy is the mainstay of therapy. Synovial sarcoma is considered a high-grade tumor with a poor prognosis. We hereby present three cases of histologically proven synovial sarcoma with predominantly pulmonary involvement, along with their management and in hospital outcome. [ABSTRACT FROM AUTHOR]

Aims: This study aims to investigate the relationship between diabetes mellitus (DM) or hypertension and the distribution and severity of pulmonary involvement and short-term clinical outcome in patients with coronavirus disease 2019 (COVID-19) pneumonia. Materials and Methods: In this case–control study, a group of patients with DM and COVID-19 pneumonia are compared to a group without DM. Demographic information, history of diabetes, hypertension, renal disease, tobacco use, laboratory data, current blood pressure, and chest computed tomography (CT) scan of all patients were extracted. The patients' laboratory tests were performed on the same day that the chest CT scan was performed. The data were analyzed using appropriate statistical tests. Findings: The results show that gender, age, smoking, and history of kidney disease were not significantly associated with the history of diabetes and hypertension (P > 0.05). Furthermore, the history of diabetes and hypertension had no significant relationship with the distribution and severity of pulmonary involvement and short-term clinical outcome (P > 0.05). However, among the laboratory findings, hemoglobin, hematocrit, and erythrocyte sedimentation rate were significantly associated with a history of diabetes and blood urea nitrogen values were associated with a history of hypertension (P < 0.05). Conclusion: Based on the findings of this study, it can be concluded that the history of diabetes and hypertension has no significant relationship with the distribution and severity of pulmonary involvement and short-term clinical outcome.

Abstract Objective The aim of this study was to clarify the clinical characteristics and long-term outcomes of ANCA-associated vasculitis (AAV) patients with pulmonary involvement from a single Chinese cohort. Methods Newly diagnosed AAV patients with pulmonary involvement, as defined by CT, were recruited from January 2010 to June 2020. Clinical data and CT images were collected retrospectively. Baseline CTs were evaluated and re-classified into four categories: interstitial lung disease (ILD), airway involvement (AI), alveolar hemorrhage (AH), and pulmonary granuloma (PG). Results A total of 719 patients were newly diagnosed with AAV, 366 (50.9%) of whom combined with pulmonary involvement at baseline. Among the AAV cases with pulmonary involvement, 55.7% (204/366) had ILD, 16.7% (61/366) had AI alone, 14.8% (54/366) had PG, and 12.8% (47/366) had AH alone. During follow-up of a median duration of 42.0 months, 66/366 (18.0%) patients died, mainly died from infections. Survival, relapse, and infection were all significantly different based on the radiological features. Specifically, the ILD group tends to have a poor long-term prognosis, the PG group is prone to relapse, and the AI group is apt to infection. The AH group has a high risk of both early infection and relapse, thus a poor short-term prognosis. Conclusion AAV patients with diverse radiological features have different clinical characteristics and outcomes. Therefore, the intensity of immunosuppressive therapy must be carefully valued by considering the baseline CT findings among AAV patients with pulmonary involvement.

Difficult-to-treat rheumatoid arthritis (D2T RA) is a multifactorial condition in which disease activity of RA persists despite consecutive treatment with biological or targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs). To evaluate the prevalence and predictive risk factors of D2T RA in our institution, a single-center, retrospective study was conducted. Medical records of RA patients, who visited our hospital from 2011 to 2020 and had a follow-up of more than 6 months, were retrospectively reviewed. D2T RA was defined as RA with a disease activity score of 28 – erythrocyte sedimentation rate (DAS28-ESR) of 3.2 or higher at the last visit, despite the use of at least two b/tsDMARDs. A logistic regression model was used to identify risk factors. A total of 672 patients were enrolled. The mean age at disease onset was 52.1 years and females were dominant (76.3%). After a mean follow-up of 46.6 months, patients with D2T RA accounted for 7.9% of overall patients. Multivariate analysis identified high rheumatoid factor (RF) levels (≥156.4 IU/mL, odds ratio [OR]: 1.95), DAS28-ESR (OR: 1.24), and coexisting pulmonary disease (OR: 2.03) as predictive risk factors of D2T RA. In conclusion, high RF levels, high DAS28-ESR, and coexisting pulmonary disease at baseline can predict the development of D2T RA.

ABSTRACTBackground COVID-19 can cause cardiopulmonary involvement. Physical activity and cardiac complications can worsen prognosis, while pulmonary complications can reduce performance.Aims To determine the prevalence and clinical implications of SARS-CoV-2 cardiopulmonary involvement in elite athletes.Methods An observational study between 1 July 2020 and 30 June 2021 with the assessment of coronary biomarkers, electrocardiogram, echocardiography, Holter-monitoring, spirometry, and chest X-ray in Danish elite athletes showed that PCR-tested positive for SARS-CoV-2. The cohort consisted of male football players screened weekly (cohort I) and elite athletes on an international level only tested if they had symptoms, were near-contact, or participated in international competitions (cohort II). All athletes were categorized into two groups based on symptoms and duration of COVID-19: Group 1 had no cardiopulmonary symptoms and duration ≤7 days, and; Group 2 had cardiopulmonary symptoms or disease duration >7 days.Results In total 121 athletes who tested positive for SARS-CoV-2 were investigated. Cardiac involvement was identified in 2/121 (2%) and pulmonary involvement in 15/121 (12%) participants. In group 1, 87 (72%), no athletes presented with signs of cardiac involvement, and 8 (7%) were diagnosed with radiological COVID-19-related findings or obstructive lung function. In group 2, 34 (28%), two had myocarditis (6%), and 8 (24%) were diagnosed with radiological COVID-19-related findings or obstructive lung function.Conclusions These clinically-driven data show no signs of cardiac involvement among athletes who tested positive for SARS-CoV-2 infection without cardiopulmonary symptoms and duration

Abstract Two cases of Kawasaki disease (KD) presented as persistent lung consolidation associated with Group A Streptococcus and Influenza A co‐infection, which resolved following intravenous immunoglobulin. Thus, pediatricians should consider the diagnosis of KD in the presence of pneumonia that is nonresponsive to antibiotic therapy with prolonged fever and inflammatory reactions.

Aims: This study aims to investigate the relationship between diabetes mellitus(DM) or hypertension and the distribution and severity of pulmonary involvement and short-term clinical outcome in patients with coronavirus disease 2019 (COVID-19) pneumonia. Materials and Methods: In this case-control study, a group of patients with DM and COVID-19 pneumonia are compared to a group without DM. Demographic information, history of diabetes, hypertension, renal disease, tobacco use, laboratory data, current blood pressure, and chest computed tomography (CT) scan of all patients were extracted. The patients' laboratory tests were performed on the same day that the chest CT scan was performed. The data were analyzed using appropriate statistical tests. Findings: The results show that gender, age, smoking, and history of kidney disease were not significantly associated with the history of diabetes and hypertension (P > 0.05). Furthermore, the history of diabetes and hypertension had no significant relationship with the distribution and severity of pulmonary involvement and short-term clinical outcome (P > 0.05). However, among the laboratory findings, hemoglobin, hematocrit, and erythrocyte sedimentation rate were significantly associated with a history of diabetes and blood urea nitrogen values were associated with a history of hypertension (P < 0.05). Conclusion: Based on the findings of this study, it can be concluded that the history of diabetes and hypertension has no significant relationship with the distribution and severity of pulmonary involvement and short-term clinical outcome. [ABSTRACT FROM AUTHOR]

Copyright of Klinická Mikrobiologie a Infekční Lékařství is the property of TRIOS, spol. sr.o. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: The study aimed to investigate the connection between an intronic variant in the ABO gene (rs657152) and the severity of COVID-19 in terms of clinical symptoms, haematological complications, inflammatory markers, and lung lesions., Methods: After applying exclusion criteria, the study included 240 patients divided into 3 groups: 88 Outpatients, 84 Ward-hospitalized, and 68 ICU-admitted/failed patients. The tetra-ARMS PCR method was used to genotype ABO polymorphism in the patient. Paraclinical tests of patients at the time of admission (before receiving conventional treatments) included levels of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), as well as a complete blood count (CBC). Also, the severity of lung lesions was evaluated based on the results of spiral computed tomography (CT) of the chest during admission., Results: The statistical analysis using the ANOVA test revealed significant differences in the mean values of allele frequencies (p-value = 0.0020) and genotype proportions (p-value = 0.0017) among clinical groups. The study also found a notable difference in ABO polymorphism across different levels of the inflammatory marker CRP, but not with the ESR levels. Furthermore, the study showed a significant difference in the distribution of lung lesion severity and ABO polymorphism among different clinical groups., Conclusion: To conclude, our findings supported the substantial impact of ABO polymorphism rs657152 on the severity of COVID-19 in Iranian patients, specifically concerning haematological complications, inflammatory markers, and lung lesions. The study underscored the protective effect of the AC genotype and the detrimental impact of the CC genotype on clinical manifestations., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Inc.)

Background: In Rheumatoid Arthritis (RA), pulmonary involvement is one of the most frequent extra-articular manifestations. Several studies have demonstrated an association between RA-related lung disease and the positivity of anti-cyclic citrullinated peptide (anti-CCP) antibodies., Objective: Our aim is to describe the frequency of pulmonary involvement in the RA population and investigate the association between anti-CCP antibodies and diverse lung compartment involvement in RA patients., Methods: An observational retrospective cross-sectional study was conducted, during which data were collected from the medical records of the patients with RA who had been tested for anti-CCP antibodies and had thoracic high resolution computerized tomography (HRCT) evaluation from January 2011 to March 2022. The univariate and multivariate analyses using logistic regression models was performed to calculate odds ratios (ORs) with 95% CIs., Results: A total of 390 patients with RA were included, the mean age of patients was 58.99 ± 12.44 years, with a predominance of females (85.9%). Two hundred and fifty-two (64.6%) patients were positive for anti-CCP antibodies. The frequency of RA-related lung diseases was 14.4% (n=56). The different manifestations observed in the thoracic HRCT included Nodules (67.9%), Interstitial lung disease (ILD) (28.6%), bronchiectasis (25%), fibrosis (21.4%), obliterative bronchiolitis (7.1%), and pleuritis (1.8%). In univariate and multivariate analysis, pulmonary involvement was associated with positive anti-CCP antibodies with an odds ratio (OR) of 5.25 (95% CI: 2.17-12.70, p < 0.0001)., Conclusion: The study demonstrated a positive association between anti-CCP antibodies and pulmonary involvement in RA and highlighted the importance of tight monitoring in RA patients with positive anti-CCP for pulmonary complications., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Over the past several decades, the treatment of rheumatoid arthritis (RA) has advanced significantly, and clinical, structural, and functional remission are achievable therapeutic goals. However, a substantial number of patients show resistance to multiple drugs. In particular, patients whose disease activity cannot be controlled despite the use of two or more biological disease-modifying antirheumatic drugs (DMARDs) or targeted synthetic DMARDs (tsDMARDs) with different mechanisms of action (MOA) have recently been referred to as having difficult-to-treat RA (D2T RA). D2T RA is a heterogeneous and multifactorial disease state, and the major problems are uncontrolled disease activity and decreased quality of life, as well as the economic burden due to frequent healthcare utilization and multiple admissions. Since the concept of D2T RA is relatively new and publication regarding D2T RA is limited, the mechanism underlying DMARD inefficacy and which factors form a “difficult-to-treat” state in such patients are not yet fully understood. It is also possible that factors contributing to D2T RA may differ by patient, sex, country, and race. The present Mini Review introduces the current concept and unsolved problems of D2T RA, including the definition, prevalence, and factors contributing to D2T RA. We then discuss the management and therapeutic strategies for D2T RA. Finally, we explore a clinical approach to prevent patients from developing D2T RA.

Puffy fingers and Raynaud’s phenomenon (RP) are important clinical predictors of the development of systemic sclerosis (SSc). We aim to assess the prevalence of SSc-related symptoms, explore pulmonary symptoms, and test the usefulness of skin autofluorescence (SAF) as a non-invasive marker for Advanced Glycation Endproducts (AGEs). Subjects from the Lifelines Cohort Study with known connective tissue disease (CTD) were excluded. Patient characteristics, SAF, self-reported pulmonary symptoms, and spirometry were obtained. Subjects (n = 73,948) were categorized into definite RP (5.3%) with and without SSc-related symptoms and non-RP. Prevalence of at least one potential SSc-related symptom (other than RP) was 8.7%; 23.5% in subjects with RP and 7.1% without RP (p < 0.001). Subjects with RP and additional SSc-related symptoms more frequently reported dyspnea at rest, dyspnea after exertion, and self-reported pulmonary fibrosis, and had the lowest mean forced vital capacity compared to the other groups (RP without SSc-related symptoms and no RP, both p < 0.001). In multivariate regression, dyspnea at rest/on exertion remained associated with an increased risk of SSc-related symptoms in subjects with RP (both p < 0.001). SAF was higher in subjects with RP and SSc-related symptoms compared to the other groups (p < 0.001), but this difference was not significant after correction for potential confounders. The prevalence of SSc-related symptoms was approximately three-fold higher in subjects with RP. Pulmonary symptoms are more prevalent in subjects with RP who also reported additional potential SSc-related symptoms. This might suggest that (suspected) early SSc develops more insidiously than acknowledged. According to this study, SAF is no marker for early detection of SSc.

Aim of the Study: This thesis aims to comprehensively review the pulmonary involvement in rheumatic diseases, elucidating its multifaceted dimensions including epidemiology, pathophysiology, clinical manifestations, diagnostic approaches, and therapeutic strategies. By synthesizing existing literature, the study endeavors to contribute significantly to the understanding of pulmonary complications in rheumatic diseases. Materials and Methods: A systematic and thorough search was conducted across various databases including PubMed, Google Scholar, Embase, and institutional libraries. The search criteria included full-text articles, reviews, and clinical studies published within the last decade, focusing on pulmonary manifestations in rheumatic diseases. Data synthesis involved the examination of prevalence rates, underlying mechanisms, clinical presentations, diagnostic modalities, and treatment options pertaining to pulmonary involvement in rheumatic diseases. Outcomes: The study highlights the diverse pulmonary manifestations associated with rheumatic diseases, emphasizing their impact on morbidity, mortality, and overall disease burden. It underscores the importance of early recognition and management of pulmonary complications to optimize patient outcomes. The long-term consequences of untreated pulmonary involvement, such as progressive respiratory impairment and reduced quality of life, underscore the significance of targeted interventions. Clinical Manifestations and Implications: Pulmonary involvement in rheumatic diseases manifests through a spectrum of respiratory symptoms, radiological findings, and functional impairments. Beyond its respiratory implications, pulmonary involvement contributes to disease complexity and significantly affects patients' quality of life. The study emphasizes the need for a multidisciplinary approach involving rheumatologists, pulmonologists, and other healthcare professionals to effectively manage these complex cases. Diagnostic Approaches: Accurate diagnosis of pulmonary complications in rheumatic diseases necessitates a comprehensive evaluation comprising clinical assessment, pulmonary function tests, imaging studies, and, when indicated, invasive procedures such as bronchoscopy or lung biopsy. Recognizing the varied phenotypic presentations and overlapping features with other pulmonary conditions is crucial for precise diagnosis and tailored management. Interventions and Strategies: Treatment strategies for pulmonary involvement in rheumatic diseases encompass pharmacological agents, pulmonary rehabilitation, and targeted immunomodulatory therapies aimed at controlling systemic inflammation and preserving lung function. The study underscores the role of shared decision-making and patient education in optimizing treatment adherence and long-term outcomes. Conclusion: In conclusion, this abstract underscores the intricate interplay between rheumatic diseases and pulmonary involvement, highlighting the need for a holistic approach to patient care. By elucidating the epidemiology, clinical manifestations, diagnostic challenges, and therapeutic interventions, this study contributes to a deeper understanding of pulmonary complications in rheumatic diseases. It emphasizes the importance of early detection and tailored management strategies to mitigate disease progression and improve patient outcomes. [ABSTRACT FROM AUTHOR]

Chikungunya is caused by an arthropod-borne alphavirus transmitted by the mosquito vectors Aedes aegypti and Aedes albopictus.[1] It is being increasingly reported in India in general and Mumbai in particular. The name chikungunya is derived from an African language and means “that which bends up” or “A disease that makes one walk with a stooped gait” because of the incapacitating arthralgia by the disease. The usual presentation is with inflammatory arthritis/polyarthralgia. Systemic manifestations are rare. In this report, we present a case of chikungunya with pulmonary manifestations, which is very unusual. A 69-year-old male patient with laboratory-confirmed reverse transcription-polymerase chain reaction (RT-PCR) chikungunya fever had lung involvement with acute hypoxemia and electrolyte imbalance. Initially, the patient was suspected to have COVID-19 disease as there was a fever with respiratory involvement, and he had presented right in the middle of a COVID-19 pandemic. Bilateral basal crackles and low SpO2 pointed toward the same. However, TruNAAT-COVID (once), rapid antigen test-COVID (once), and RT-PCR for COVID-19 (twice) were negative. Moreover, his upper respiratory tract Multiplex PCR panel was also negative, thereby truncating the possibility of infection with usual/other viruses. Hence, all the clinical features, X-ray, and high-resolution computed tomography of the chest pointed toward pulmonary involvement because of chikungunya, making this a very unusual presentation.

The aim of this study was to explore the lived experience of COVID-19 patients with pulmonary involvement. The hermeneutic phenomenology was chosen, as this approach can extract the participant experiences as COVID-19 patients. A total of 10 COVID-19 patients with the pulmonary disease were selected as participants after being discharged from the hospital by purposive sampling method until reaching saturation. Data were collected using semi-structured interviews and by using Greatrex-White and van Manen's methods were analyzed. As a result of data analysis, five main themes were emerged: Symptoms of inducing fear, Annoying loneliness, death anxiety, Spirituality healing factor, and Valuable life again. Based on the results of the interviews, the participants' experiences showed that patients infected with COVID-19, after being discharged from the hospital, due to mental and physical problems experienced during hospitalization, need comprehensive attention and care to regain their health during convalescence. [ABSTRACT FROM AUTHOR]

Difficult-to-treat rheumatoid arthritis (D2T RA) is a multifactorial condition in which disease activity of RA persists despite consecutive treatment with biological or targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs). To evaluate the prevalence and predictive risk factors of D2T RA in our institution, a single-center, retrospective study was conducted. Medical records of RA patients, who visited our hospital from 2011 to 2020 and had a follow-up of more than 6 months, were retrospectively reviewed. D2T RA was defined as RA with a disease activity score of 28 – erythrocyte sedimentation rate (DAS28-ESR) of 3.2 or higher at the last visit, despite the use of at least two b/tsDMARDs. A logistic regression model was used to identify risk factors. A total of 672 patients were enrolled. The mean age at disease onset was 52.1 years and females were dominant (76.3%). After a mean follow-up of 46.6 months, patients with D2T RA accounted for 7.9% of overall patients. Multivariate analysis identified high rheumatoid factor (RF) levels (≥156.4 IU/mL, odds ratio [OR]: 1.95), DAS28-ESR (OR: 1.24), and coexisting pulmonary disease (OR: 2.03) as predictive risk factors of D2T RA. In conclusion, high RF levels, high DAS28-ESR, and coexisting pulmonary disease at baseline can predict the development of D2T RA. [ABSTRACT FROM AUTHOR]

Lymphomatoid granulomatosis is a rare extranodal Epstein-Barr virus-driven B-cell lymphoproliferative disease, involving predominantly lung, less often skin, kidney, and central nervous system. Here, we present a pediatric case with primary immunodeficiency, diagnosed with pathologically proven pulmonary grade-III lymphomatoid granulomatosis. 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) imaging demonstrated 18F-FDG avid pulmonary masses with central air-bronchograms and cavitations. Although the definitive diagnosis depends on biopsy, 18F-FDG PET/CT serves as a complementary imaging tool to evaluate the extent of the disease and response to treatment. [ABSTRACT FROM AUTHOR]

Respiratory diseases such as pneumonia are one of the main concerns in the livestock industry. Economic losses owing to pneumonia are prevalent in small ruminants and pathogenic organisms such as Pasteurella and Mannheimia are the principal bacterial agents involved in pneumonic pasteurellosis. Two adult Alpine female goats with signs of respiratory involvement were referred. Clinical examinations of these animals showed fever, anorexia, dyspnea with head and neck strain and open mouth breathing, unilateral serous nasal discharge, abdominal breathing with harsh, and crackles lung sound upon auscultation. Radiography of the thoracic region was performed and severe generalized pulmonary involvement was detected in the goats. Due to the severity of the conflict, both cases were lost despite treatment. At necropsy, consistent findings included non-collapsing lungs with varying degrees of consolidation covered by fibrin and cranioventral consolidation with red-grey discoloration and firm, meaty consistency. Histopathologically, fibrinosuppurative bronchopneumonia was diagnosed in both cases. Finally, following microbiological findings, Pasteurella multocida was isolated from lung lesions of both animals, and pasteurellosis was confirmed. Overall, pasteurellosis is one of the most important pulmonary diseases in goats, and the best way to deal with it is to prevent the disease through vaccination and control stressful behaviors in the environment. [ABSTRACT FROM AUTHOR]