Pulmonary Therapy
ESCI-ISI SCOPUS (2015-2023)
2364-1746
2364-1754
Cơ quản chủ quản: Springer Nature , ADIS
Các bài báo tiêu biểu
COVID-19 presentation may include a profound increase in cytokines and associated pneumonia, rapidly progressing to acute respiratory distress syndrome (ARDS). This so-called cytokine storm often leads to refractory edema, respiratory arrest, and death. At present, anti-IL-6, antiviral therapy, convalescent plasma, hydroxychloroquine, and azithromycin among others are being investigated as potential treatments for COVID-19. As the disease etiology and precise therapeutic interventions are still not definitively defined, we wanted to review the roles that complement and the contact system may have in either the treatment or pathogenesis of the disease.
We searched the recent literature (PubMed) on complement and coronavirus; contact system and coronavirus; bradykinin and coronavirus; and angiotensin receptor and coronavirus. The manuscript complies with ethics guidelines and was deemed exempt from institutional review board approval according to Human Subjects Protection Office guidelines.
Mouse models are available for the study of coronavirus and complement. Although complement is effective in protecting against many viruses, it does not seem to be protective against coronavirus. C3 knockout mice infected with SARS-CoV had less lung disease than wild-type mice, suggesting that complement may play a role in coronavirus pathogenesis. Some evidence suggests that the observed pulmonary edema may be bradykinin-induced and could be the reason that corticosteroids, antihistamines, and other traditional interventions for edema are not effective. Angiotensin-converting enzyme 2 (ACE2) is a co-receptor for SARS-CoV-2, and studies thus far have not concluded a benefit or risk associated with the use of either ACE-inhibitors or angiotensin receptor antagonists.
Activation of complement and the contact system, through generation of bradykinin, may play a role in the SARS-CoV-2-induced pulmonary edema, and our search suggests that further work is necessary to confirm our suspicions.
The novel coronavirus disease (COVID-19) pandemic has caused an unprecedented worldwide socio-economic and health impact. There is increasing evidence that a combination of inflammation and hypercoagulable state are the main mechanisms of respiratory failure in these patients. This narrative review aims to summarize currently available evidence on the complex interplay of immune dysregulation, hypercoagulability, and thrombosis in the pathogenesis of respiratory failure in COVID-19 disease. In addition, we will describe the experience of anticoagulation and anti-inflammatory strategies that have been tested. Profound suppression of the adaptive and hyperactivity of innate immune systems with macrophage activation appears to be a prominent feature in this infection. Immune dysregulation together with endotheliitis and severe hypercoagulability results in thromboinflammation and microvascular thrombosis in the pulmonary vasculature leading to severe respiratory distress. Currently, some guidelines recommend the use of prophylactic low molecular weight heparin in all hospitalized patients, with intermediate dose prophylaxis in those needing intensive care, and the use of therapeutic anticoagulation in patients with proven or suspected thrombosis. Strong recommendations cannot be made until this approach is validated by trial results. To target the inflammatory cascade, low-dose dexamethasone appears to be helpful in moderate to severe cases and trials with anti-interleukin agents (e.g., tocilizumab, anakinra, siltuximab) and non-steroidal anti-inflammatory drugs are showing early promising results. Potential newer agents (e.g., Janus kinase inhibitor such as ruxolitinib, baricitinib, fedratinib) are likely to be investigated in clinical trials. Unfortunately, current trials are mostly examining these agents in isolation and there may be a significant delay before evidence-based practice can be implemented. It is plausible that a combination of anti-viral drugs together with anti-inflammatory and anti-coagulation medicines will be the most successful strategy in managing severely affected patients with COVID-19.
Việc loại bỏ nhanh chóng ciprofloxacin hydrochloride khỏi phổi sau khi sử dụng dạng aerosol dẫn đến hiệu quả điều trị kém đối với các nhiễm trùng phổi. Việc phát triển các công thức có khả năng duy trì nồng độ ciprofloxacin trong phổi có tiềm năng cải thiện đáng kể hoạt tính kháng khuẩn. Bài đánh giá hiện tại so sánh hai phương pháp duy trì mức độ ciprofloxacin trong phổi, một công thức liposome nơi ciprofloxacin được bao gồm trong các túi đơn lớp nhỏ, và một công thức bột khô của dạng zwitterionic gần như không tan của thuốc. Hai công thức này vừa hoàn thành các nghiên cứu lâm sàng giai đoạn 3 lớn đa trung tâm trên bệnh nhân giãn phế quản. Do đó, chúng cung cấp một cơ hội độc đáo để xem xét hóa học, sản xuất và kiểm soát các dạng liều bên cạnh khả năng dung nạp và hiệu quả của chúng ở hơn 1000 bệnh nhân giãn phế quản. Cả hai công thức đều được dung nạp tốt với hầu hết các sự kiện bất lợi được xác định là nhẹ đến vừa. Mặc dù các công thức hiệu quả trong việc giảm và/hoặc tiêu diệt nhiễm trùng, điều này không dẫn đến việc giảm các cơn bùng phát phổi, mục tiêu chính. Những thất bại này phản ánh nhiều hơn về tính chất không đồng nhất của bệnh và khó khăn trong việc xác định các bệnh nhân giãn phế quản có khả năng bùng phát, thay vì một giới hạn cố hữu của các công thức. Mặc dù các công thức tương tự ở nhiều khía cạnh, chúng cũng thể hiện một số khác biệt thú vị. Bài đánh giá này khám phá những tác động của những khác biệt này đối với điều trị các nhiễm trùng hô hấp.
Over the past few decades, technology and improvements in artificial intelligence have dramatically changed major sectors of our day-to-day lives, including the field of healthcare. E-health includes a wide range of subdomains, such as wearables, smart-inhalers, portable electronic spirometers, digital stethoscopes, and clinical decision support systems. E-health has been consistently shown to enhance the quality of care, improve adherence to therapy, and allow early detection of worsening in chronic pulmonary diseases. The present review addresses the current and potential future role of major e-health tools and approaches in respiratory medicine, with the aim of providing readers with trustful and updated evidence to increase their awareness of the topic, and to allow them to optimally benefit from the latest innovation technology. Collected literature evidence shows that the potential of technology tools in respiratory medicine mainly relies on three fundamental interactions: between clinicians, between clinician and patient, and between patient and health technology. However, it would be desirable to establish widely agreed and adopted standards for conducting trials and reporting results in this area, as well as to take into proper consideration potentially relevant pitfalls related to privacy protection and compliance with regulatory procedures.