Higher, but Not Too High, Dose Is Only One Determinant of Corticosteroid Treatment Success in Severe COVID-19

We read with interest the study from Pitre and colleagues, who systematically reviewed 20 randomized controlled trials published through August 2022, concluding that higher doses of corticosteroids (CSs) probably reduce mortality (relative risk, 0.92; 95% confidence interval [CI], 0.85–0.98) and the need for mechanical ventilation (relative risk, 0.91; 95% CI, 0.87–1.03) compared with lower doses in severe-to-critical coronavirus disease (COVID-19), without significantly impacting either the duration of hospitalization or the incidence of nosocomial infections (1)

Acute respiratory distress syndrome

Since its first description, the acute respiratory distress syndrome (ARDS) has been acknowledged to be a major clinical problem in respiratory medicine. From July 2015 to July 2016 almost 300 indexed articles were published on ARDS. This review summarises only eight of them as an arbitrary overview of clinical relevance: definition and epidemiology, risk factors, prevention and treatment. A strict application of definition criteria is crucial, but the diverse resource-setting scenarios foster geographic variability and contrasting outcome data. A large international multicentre prospective cohort study including 50 countries across five continents reported that ARDS is underdiagnosed, and there is potential for improvement in its management. Furthermore, epidemiological data from low-income countries suggest that a revision of the current definition of ARDS is needed in order to improve its recognition and global clinical outcome. In addition to the well-known risk-factors for ARDS, exposure to high ozone levels and low vitamin D plasma concentrations were found to be predisposing circumstances. Drug-based preventive strategies remain a major challenge, since two recent trials on aspirin and statins failed to reduce the incidence in at-risk patients. A new disease-modifying therapy is awaited: some recent studies promised to improve the prognosis of ARDS, but mortality and disabling complications are still high in survivors in intensive care

Clinical Evaluation of the ButterfLife Device for Simultaneous Multiparameter Telemonitoring in Hospital and Home Settings

We conducted a two-phase study to test the reliability and usability of an all-in-one artificial intelligence-based device (ButterfLife), which allows simultaneous monitoring of five vital signs. The first phase of the study aimed to test the agreement between measurements performed with ButterfLife vs. standard of care (SoC) in 42 hospitalized patients affected by acute respiratory failure. In this setting, the greatest discordance between ButterfLife and SoC was in respiratory rate (mean difference -4.69 bpm). Significantly close correlations were observed for all parameters except diastolic blood pressure and oxygen saturation (Spearman's Rho -0.18 mmHg; p = 0.33 and 0.20%; p = 0.24, respectively). The second phase of the study was conducted on eight poly-comorbid patients using ButterfLife at home, to evaluate the number of clinical conditions detected, as well as the patients' compliance and satisfaction. The average proportion of performed tests compared with the scheduled number was 67.4%, and no patients reported difficulties with use. Seven conditions requiring medical attention were identified, with a sensitivity of 100% and specificity of 88.9%. The median patient satisfaction was 9.5/10. In conclusion, ButterfLife proved to be a reliable and easy-to-use device, capable of simultaneously assessing five vital signs in both hospital and home settings

Editorial: Pulmonary fibrosis: One manifestation, various diseases

This research topic collection entitled “Pulmonary Fibrosis: one manifestation, various diseases”, involving authors from different countries, confirms that this disease is a hot topic (Confalonieri P et al.,2022, Orlandi M et al., 2022). There are over 200 different types of pulmonary fibrosis (PF), the most common is the idiopathic pulmonary fbrosis (IPF), called idiopathic because it has no known cause. Another rare form is familial PF, for which several studies reported correlation with few genes. An important group of PF are due to other diseases, for example, autoimmune diseases such as rheumatoid arthritis, systemic sclerosis or Sjogren’s syndrome (Ruaro et al., 2022, Trombetta AC et al., 2017, Bernero Eet al., 2013). PF could correlate to viral infections (e.g. COVID-19), gastroesophageal reflux disease (GERD) (Baratella E et al, 2021, Ruaro et al., 2018), and the exposure to various materials (including naturally occurring such as bird or animal droppings, and occupational such as asbestos or silica). Furthermore, smoking, radiation treatments, and certain drugs can increase risk of developing PF

Pulmonary fibrosis: one manifestation, various diseases

This research topic collection entitled “Pulmonary Fibrosis: one manifestation, various diseases”, involving authors from different countries, confirms that this disease is a hot topic (Confalonieri P et al.,2022, Orlandi M et al., 2022). There are over 200 different types of pulmonary fibrosis (PF), the most common is the idiopathic pulmonary fbrosis (IPF), called idiopathic because it has no known cause. Another rare form is familial PF, for which several studies reported correlation with few genes. An important group of PF are due to other diseases, for example, autoimmune diseases such as rheumatoid arthritis, systemic sclerosis or Sjogren’s syndrome (Ruaro et al., 2022, Trombetta AC et al., 2017, Bernero Eet al., 2013). PF could correlate to viral infections (e.g. COVID-19), gastroesophageal reflux disease (GERD) (Baratella E et al, 2021, Ruaro et al., 2018), and the exposure to various materials (including naturally occurring such as bird or animal droppings, and occupational such as asbestos or silica). Furthermore, smoking, radiation treatments, and certain drugs can increase risk of developing PF. In the first article (Saketkoo et al.) of the collection, the authors evaluate the use of International Classification of Functioning, Disability, and Health (ICF) approved by World Health Organization (WHO) in patients affected by interstitial lung diseases (ILD)

Editorial: Obstructive sleep apnea syndrome (OSAS). What's new?

This Research Topic entitled “Obstructive sleep apnea syndrome (OSAS). What's new?”, involving authors from different specializations and numerous countries, confirms that OSAS is a hot topic. OSA syndrome is an airway obstruction (i.e. complete or partial) with numerous etiologies (1–4). Different papers have demonstrated that the prevalence of OSAS is 2–4% in men and 1–2% in women of average age. The reference tools for OSAS diagnosis are clinical polysomnography or nocturnal portable multi-channel monitoring. Frequently, continuous positive airway pressure (CPAP) therapy is the first treatment for a patient (5, 6). Long-term CPAP treatment may present limited compliance, and there is no unanimous opinion on other alternative treatments for OSAS in literature on the subject. This special issue discusses several of these “unmet needs”

Successful treatment of life-threatening mycobacteriosis using adjunctive gamma-interferon therapy with genetic analysis

In our case series of 6 consecutive patients with severe disseminated mycobacterial infection and lymphocytopenia who did not responded to antimycobacterial drugs alone we used adjunctive IFN-γ treatment. IFN-gamma was effective in four out of the six cases. We identified two genes potentially correlating with NTM and TB severity (MUC5AC and FCGBP), and one (CCL4L2) suggesting a positive response to IFN-γ therapy. Further research is required to validate these findings. We propose the extended use of INF-γ as a rescue therapy in non-responder-severe cases of mycobacteriosis and encourage the use of genetic analysis to predict outcome and response to INF-γ treatment

Correlation between Microvascular Damage and Internal Organ Involvement in Scleroderma: Focus on Lung Damage and Endothelial Dysfunction

Background. Systemic sclerosis (SSc) is an incurable connective tissue disease characterized by decreased peripheral blood perfusion due to microvascular damage and skin thickening/hardening. The microcirculation deficit is typically secondary to structural vessel damage, which can be assessed morphologically and functionally in a variety of ways, exploiting different technologies. Objective. This paper focuses on reviewing new studies regarding the correlation between microvascular damage, endothelial dysfunction, and internal organ involvement, particularly pulmonary changes in SSc. Methods. We critically reviewed the most recent literature on the correlation between blood perfusion and organ involvement. Results. Many papers have demonstrated the link between structural microcirculatory damage and pulmonary involvement; however, studies that have investigated correlations between microvascular functional impairment and internal organ damage are scarce. Overall, the literature supports the correlation between organ involvement and functional microcirculatory impairment in SSc patients. Conclusions. Morphological and functional techniques appear to be emerging biomarkers in SSc, but obviously need further investigation

Chronic Thromboembolic Pulmonary Hypertension: An Observational Study

Background and Objectives: Chronic thromboembolic pulmonary hypertension (CTEPH) has a high mortality. The treatment of CTEPH could be balloon pulmonary angioplasty (BPA), medical (MT) or pulmonary endarterectomy (PEA). This study aims to assess the clinical characteristics of CTEPH patients, surgically or medically treated, in a pulmonology referral center. Materials and Methods: A total of 124 patients with PH with suspected CTEPH (53 male subjects and 71 female subjects; mean age at diagnosis 67 ± 6) were asked to give informed consent and then were evaluated. The presence of CTEPH was ascertained by medical evaluations, radiology and laboratory tests. Results: After the evaluation of all clinical data, 65 patients met the inclusion criteria for CTEPH and they were therefore enrolled (22 males and 43 females; mean age at diagnosis was 69 ± 8). 26 CTEPH patients were treated with PEA, 32 with MT and 7 with BPA. There was a statistically significant age difference between the PEA and MT groups, at the time of diagnosis, the PEA patients were younger than the MT patients, whereas there was no statistically significant difference in other clinical characteristics (e.g., smoking habit, thrombophilia predisposition), as well as functional and hemodynamic parameters (e.g., 6-min walk test, right heart catheterization). During three years of follow-up, no patients in the PEA groups died; conversely, eleven patients in the MT group died during the same period (p < 0.05). Furthermore, a significant decrease in plasma BNP values and an increase in a meter at the six-minute walk test, 1 and 3 years after surgery, were observed in the PEA group (p < 0.05). Conclusions: This study seems to confirm that pulmonary endarterectomy (PEA) can provide an improvement in functional tests in CTEP