Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative pathogen of coronavirus disease 19 (COVID-19). COVID-19 can manifest with a heterogenous spectrum of disease severity, from mild upper airways infection to severe interstitial pneumonia and devastating acute respiratory distress syndrome (ARDS). SARS-CoV-2 infection may induce an over activation of the immune system and the release of high concentrations of pro-inflammatory cytokines, leading to a “cytokine storm”, a recognized pathogenetic mechanism in the genesis of SARS-CoV-2-induced lung disease. This overproduction of inflammatory cytokines has been recognized as a poor prognostic factor, since it can lead to disease progression, organ failure, ARDS and death. Moreover, the immune system shows dysregulated activity, particularly through activated macrophages and T-helper cells and in the co-occurrent exhaustion of lymphocytes. We carried out a non-systematic literature review aimed at providing an overview of the current knowledge on the pathologic mechanisms played by the immune system and the inflammation in the genesis of SARS-CoV-2-induced lung disease. An overview on potential treatments for this harmful condition and for contrasting the “cytokine storm” has also been presented. Finally, a look at the experimented experimental vaccines against SARS-CoV-2 has been included.

Background: Idiopathic pulmonary fibrosis (IPF) is a chronic, fibrosing and progressive interstitial lung disease of unknown aetiology with a pathogenesis still partly unknown. Several microvascular and macrovascular abnormalities have been demonstrated in the pathogenesis of IPF and related pulmonary hypertension (PH), a complication of the disease.Methods: We carried out a non-systematic, narrative literature review aimed at describing the role of the vasculature in the natural history of IPF.Results: The main molecular pathogenetic mechanisms involving vasculature (i.e.endothelial-to-mesenchymal transition, vascular remodelling, endothelial permeability, occult alveolar haemorrhage, vasoconstriction and hypoxia) and the genetic basis of vascular remodelling are described. The prevalence and clinical relevance of associated PH are highlighted with focus on the vasculature as a prognostic marker. The vascular effects of current antifibrotic therapies, the role of pulmonary vasodilators in the treatment of disease, and new pharmacological options with vascular-targeted activity are described.Conclusions: The vasculature plays a key role in the natural history of IPF from the early phases of disease until development of PH in a subgroup of patients, a complication related to a worse prognosis. Pulmonary vascular volume has emerged as a novel computed tomography finding and a predictor of mortality, independent of PH. New pharmacological options with concomitant vascular-directed activity might be promising in the treatment of IPF.

Severe asthma affects 3-10 % of asthmatic patients. Biologic therapies can act as disease modifying agents in severe asthma. The prevalence of small airways dysfunction (SAD) increases with asthma severity. Forced Oscillatory Technique (FOT) is a reliable method for studying small airways. The aim of the study was to analyze FOT parameters in a cohort of eosinophilic severe asthma patients naïve of biologic therapy, and to describe the presence of correlation with spirometry data. Variations of FOT parameters after 6 and 12 months from the start of biologic therapy were also prospectively recorded and analyzed. 47 severe eosinophilic asthma patients were consecutively enrolled. FOT, spirometry data, levels of asthma biomarkers, number of exacerbations, Asthma Control Test (ACT) were determined at baseline (T0: patients naïve of biologic treatment) and after 6 and 12 months. at T0, a significant linear correlation was found between R5-19 and FEV1/FVC (Forced expiratory volume in 1 s/Forced Vital Capacity) values (p = 0.0008). At T0, FOT R5-19 values were more elevated in obstructed patients. The cut-off value of R5-19 that best discriminates the presence of obstruction (FEV1/FVC <0.70) was determined at 0.81 cmH₂O/(L/s) (sensitivity 0.58, specificity 0.76, ROC-AUC 0.67). A significant relationship was found between FEV1/FVC and FOT R5-19 also after 6 (p = 0.007) and 12 months (p = 0.027) of biologic therapy. No significant correlations were found between any other FOT parameter and blood eosinophils count, FeNO, number of exacerbations or ACT. FOT R5-19 values correlate with FEV1/FVC and are significantly higher in obstruction. This correlation could be explained by the higher resistances of small airways in obstructed patients.

1. Severe asthma (SA) is a heterogeneous and debilitating condition, often associated with a high burden of exacerbations, dependence on oral corticosteroids (OCS), and poor quality of life [1–3]. ...

Disseminated tuberculosis is a rare form of tuberculosis that can cause severe illness if diagnosed and treated late. We present the case of a young Senegalese woman who had a miscarriage due to a pelvic inflammatory disease, followed by the development of a left pleural effusion. Despite laparoscopic findings and a salpinx biopsy that revealed necrotizing granulomas, only microbiological examinations of pleural biopsies revealed the final diagnosis of disseminated, drug-sensitive tuberculosis.