A narrative review of the potential role of microaspiration and a dysregulated aerodigestive microbiome in lung disease

Background:Interstitial lung disease (ILD) is one of the most significant comorbidities of rheumatoid arthritis (RA), increasing the mortality in these patients [1,2]. Although the pathogenesis of ILD associated to RA (RA-ILD+) remains poorly defined [1], it is known that vascular tissue plays a crucial role in lung physiology [3]. In this context, a population of cells termed endothelial progenitor cells (EPC) are involved in vasculogenesis and endothelial tissue repair [4]. Previous reports suggest the implication of EPC in different conditions such as RA and idiopathic pulmonary fibrosis (IPF), the most common and destructive ILD [5,6]. Nevertheless, little is known about their specific role in RA-ILD+.Objectives:The purpose of this study was to shed light on the potential role of EPC in endothelial damage in RA-ILD+.Methods:Peripheral venous blood was collected from a total of 68 individuals (18 with RA-ILD+, 17 with RA-ILD-, 19 with IPF and 14 healthy controls). All subjects were recruited from the Rheumatology and Pneumology departments of Hospital Universitario Marqués de Valdecilla, Santander, Spain. Quantification of EPC was analyzed by the expression of surface antigens by flow cytometry. The combination of antibodies against the stem cell marker CD34, the immature progenitor marker CD133, the endothelial marker VEGF receptor 2 (CD309) and the common leukocyte antigen CD45 was used. EPC were considered as CD34+, CD45Low, CD309+and CD133+. All statistical analyses were performed using Prism software 5 (GraphPad).Results:EPC frequency was significantly increased in patients with RA-ILD+, RA-ILD-and IPF compared to controls (p=0.001, p=0.002, p< 0.0001, respectively). Nevertheless, patients with RA, both RA-ILD+and RA-ILD-, showed a lower frequency of EPC than those with IPF (p= 0.048, p= 0.006, respectively).Conclusion:Our results provide evidence for a potential role of EPC as a reparative compensatory mechanism related to endothelial damage in RA-ILD+, RA-ILD-and IPF patients. Interestingly, EPC frequency may help to establish a differential diagnostic between patients with IPF and those who have an underlying autoimmune disease (RA-ILD+).References:[1] J Clin Med 2019; 8: 2038;[2] Arthritis Rheumatol 2015; 67: 28-38;[3] Nat Protoc 2015; 10: 1697-1708;[4] Science 1997; 275: 964-966;[5] Rheumatology (Oxford) 2012; 51: 1775-1784;[6] Angiogenesis 2013; 16: 147-157.Acknowledgments:Personal funds, VP-C: PREVAL18/01 (IDIVAL); SR-M: RD16/0012/0009 (ISCIII-ERDF); LL-G: PI18/00042 (ISCIII-ERDF); RL-M: Miguel Servet type I CP16/00033 (ISCIII-ESF).Disclosure of Interests:Verónica Pulito-Cueto: None declared, Sara Remuzgo-Martínez: None declared, Fernanda Genre: None declared, Victor Manuel Mora-Cuesta: None declared, David Iturbe Fernández: None declared, Sonia Fernández-Rozas: None declared, Leticia Lera-Gómez: None declared, Pilar Alonso Lecue: None declared, Javier Rodriguez Carrio: None declared, Belén Atienza-Mateo: None declared, Virginia Portilla: None declared, David Merino: None declared, Ricardo Blanco Grant/research support from: AbbVie, MSD, Roche, Consultant of: Abbvie, Eli Lilly, Pfizer, Roche, Bristol-Myers, Janssen, UCB Pharma and MSD, Speakers bureau: Abbvie, Eli Lilly, Pfizer, Roche, Bristol-Myers, Janssen, UCB Pharma. MSD, Alfonso Corrales Speakers bureau: Abbvie, Jose Manuel Cifrián-Martínez: None declared, Raquel López-Mejías: None declared, Miguel A González-Gay Grant/research support from: Pfizer, Abbvie, MSD, Speakers bureau: Pfizer, Abbvie, MSD

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A Narrative Review of Early Oral Stepdown Therapy for the Treatment of Uncomplicated Staphylococcus aureus Bacteremia: Yay or Nay?

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa151 ◽

2020 ◽

Vol 7 (6) ◽

Author(s):

Michael Dagher ◽

Vance G Fowler ◽

Patty W Wright ◽

Milner B Staub

Keyword(s):

Staphylococcus Aureus ◽

Hospital Readmission ◽

Potential Role ◽

Review Article ◽

Narrative Review ◽

Oral Antibiotics ◽

Staphylococcus Aureus Bacteremia ◽

Complete Treatment

Abstract Historically, intravenous (IV) antibiotics have been the cornerstone of treatment for uncomplicated Staphylococcus aureus bacteremia (SAB). However, IV antibiotics are expensive, increase the rates of hospital readmission, and can be associated with catheter-related complications. As a result, the potential role of oral antibiotics in the treatment of uncomplicated SAB has become a subject of interest. This narrative review article aims to summarize key arguments for and against the use of oral antibiotics to complete treatment of uncomplicated SAB and evaluates the available evidence for specific oral regimens. We conclude that evidence suggests that oral step-down therapy can be an alternative for select patients who meet the criteria for uncomplicated SAB and will comply with medical treatment and outpatient follow-up. Of the currently studied regimens discussed in this article, linezolid has the most support, followed by fluoroquinolone plus rifampin.

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Exosomal miRNAs in Lung Diseases: From Biologic Function to Therapeutic Targets

Journal of Clinical Medicine ◽

10.3390/jcm8091345 ◽

2019 ◽

Vol 8 (9) ◽

pp. 1345 ◽

Cited By ~ 18

Author(s):

Julien Guiot ◽

Ingrid Struman ◽

Edouard Louis ◽

Renaud Louis ◽

Michel Malaise ◽

...

Keyword(s):

Lung Disease ◽

Disease Progression ◽

Lung Diseases ◽

Potential Role ◽

Protective Effects ◽

Diagnostic Biomarkers ◽

Exosomal Mirnas ◽

Stress Signals ◽

Therapeutic Tools

Increasing evidence suggests the potential role of extracellular vesicles (EVs) in many lung diseases. According to their subcellular origin, secretion mechanism, and size, EVs are currently classified into three subpopulations: exosomes, microvesicles, and apoptotic bodies. Exosomes are released in most biofluids, including airway fluids, and play a key role in intercellular communication via the delivery of their cargo (e.g., microRNAs (miRNAs)) to target cell. In a physiological context, lung exosomes present protective effects against stress signals which allow them to participate in the maintenance of lung homeostasis. The presence of air pollution alters the composition of lung exosomes (dysregulation of exosomal miRNAs) and their homeostatic property. Indeed, besides their potential as diagnostic biomarkers for lung diseases, lung exosomes are functional units capable of dysregulating numerous pathophysiological processes (including inflammation or fibrosis), resulting in the promotion of lung disease progression. Here, we review recent studies on the known and potential role of lung exosomes/exosomal miRNAs, in the maintaining of lung homeostasis on one hand, and in promoting lung disease progression on the other. We will also discuss using exosomes as prognostic/diagnostic biomarkers as well as therapeutic tools for lung diseases.

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COVID-19: Potential role of prophylactic anticoagulation in preventing thrombotic events and mortality. Narrative review

Iberoamerican Journal of Medicine ◽

10.53986/ibjm.2021.0021 ◽

2021 ◽

Vol 3 (2) ◽

pp. 122-129

Author(s):

Maximiliano Gabriel Castro ◽

◽

Gisel Cuevas ◽

Keyword(s):

Potential Role ◽

Clinical Evidence ◽

Clinical Decision Making ◽

Clinical Decision ◽

Narrative Review ◽

Randomized Controlled ◽

Prophylactic Dose ◽

Published Evidence ◽

Prophylactic Anticoagulation

The COVID-19 pandemic and the limited therapeutic arsenal available strain daily clinical practice. Guidelines have recently recommended routine anticoagulation of hospitalized COVID-19 patients. However, apart from the expert panels’ experience, the provenance of this recommendation is not clear, due to the scarce published evidence. We provide a narrative review with the objective of unraveling the rationale for this practice. First, we analyze the biochemical, histopathological and clinical evidence for a pro-thrombotic profile in COVID-19 patients. Then, we present the clinical data from previous studies and discuss to what extent they aid in clinical decision-making. We conclude that, in the absence of randomized controlled trials, which are of utmost importance, prophylactic-dose anticoagulation should be offered to critically ill patients hospitalized for COVID-19 pneumonia, particularly those with high d-dimer levels, since they are the population most likely to benefit from it.

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A Narrative Review of Gut-Muscle Axis and Sarcopenia: The Potential Role of Gut Microbiota

International Journal of General Medicine ◽

10.2147/ijgm.s301141 ◽

2021 ◽

Vol Volume 14 ◽

pp. 1263-1273

Author(s):

Jiaxi Zhao ◽

Yiqin Huang ◽

Xiaofeng Yu

Keyword(s):

Gut Microbiota ◽

Potential Role ◽

Narrative Review

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Ultrasound in critical care

Anaesthesia, Pain & Intensive Care ◽

10.35975/apic.v22i1.1206 ◽

2020 ◽

Author(s):

Saima Rashid ◽

Muhammad Faisal Khan ◽

Rajkumar Rajendram

Keyword(s):

Critical Care ◽

Intensive Care ◽

21St Century ◽

Potential Role ◽

Point Of Care ◽

Narrative Review ◽

Point Of Care Ultrasound ◽

The 1950S

Ultrasound (US) was introduced in the 1950s and since then its use has increased exponentially. This has been facilitated by significant improvement in the probe technology, increasing access to portable machines and better understanding of lung, heart, abdominal and vascular US. Use of critical care US (CCUS) is now extremely common. It is important for frontline physicians who must make appropriate and timely decisions within seconds. It is safe, convenient and readily available in many centers. The concept of point of care ultrasound (POCUS) differs from US screening by a radiologist or sonographer. It is, rapid focused and goal-orientated. Despite its major limitation, e.g. operator dependence, bedside CCUS can be used for an ever-increasing range of indications. This narrative review will describe the potential role of CCUS as the replacement for the stethoscope in the 21st century and the limitations which must be overcome to achieve this. Received: 3 Nov 2018Reviewed & Accepted: 10 Nov 2018 Citation: Rashid S, Khan MF, Rajendram R. Ultrasound in critical care. Anaesth Pain & Intensive Care 2018;22 Suppl 1:S160-S163

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Current and Emerging Strategies for Prediction and Diagnosis of Prelabour Rupture of the Membranes: A Narrative Review

Malaysian Journal of Medical Sciences ◽

10.21315/mjms2021.28.3.2 ◽

2021 ◽

Vol 28 (3) ◽

pp. 5-17

Author(s):

Saadia Ghafoor

Keyword(s):

Biochemical Markers ◽

Potential Role ◽

Narrative Review ◽

Diagnostic Tools ◽

Published Data ◽

Effective Management ◽

Emerging Trends ◽

Foetal Membranes ◽

Diagnostic Modalities

Prelabour rupture of membranes (PROM) refers to the disruption of foetal membranes before the onset of labour, resulting in the leakage of amniotic fluid. PROM complicates 3% and 8% of preterm and term pregnancies, respectively. Accurate and timely diagnosis is crucial for effective management to prevent adverse maternal- and foetal-outcomes. The diagnosis of equivocal PROM cases with traditional methods often becomes challenging in current obstetrics practice; therefore, various novel biochemical markers have emerged as promising diagnostic tools. This narrative review is sought to review the published data to understand the current and emerging trends in diagnostic modalities in term and preterm pregnancies complicated with PROM and the potential role of various markers for predicting preterm PROM (pPROM) and chorioamnionitis in women with pPROM.

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