Aim: Idiopathic pulmonary fibrosis (IPF) is a devastating lung disorder that is characterized by aggressive and dysbalanced wound healing. IPF is mainly a disease of the elderly and thus is likely to share common pathophysiologic mechanisms with other more age-related diseases. Emerging evidence has linked disturbance of sirtuin-1 (SIRT1) expression and activity with aging and diseases of the elderly. In the present study, we aimed to evaluate SIRT1 expression in the peripheral blood mononuclear cells (PBMCs) of patients with IPF given the lack of studies in the literature. Methods: We enrolled 34 IPF patients and 22 healthy volunteers (age and sex-matched). In both groups, SIRT1 levels were assessed in plasma, cell pellets of PBMCs, and supernatant from PBMCs’ culture with and without the addition of 10% human serum. We also measured transforming growth factor β1 (TGF-β1) concentration in plasma from IPF patients and controls. Results: The mean (SD) age (years) of the healthy volunteers was 68.57±6.97 and of the IPF patients was 71.28±5.39 years (p>0.05). The mean SIRT1 concentration was found significantly decreased in the supernatant of PBMCs culture (without the addition of serum) in IPF subjects versus controls (1.97±0.59 ng/ml versus 2.40±0.74 ng/ml, respectively, p=0.047). No significant differences were observed between the two groups in the SIRT1 concentration of all the other materials. TGFβ1 concentration of IPF subjects was significantly increased when compared to controls (1281.38±2742.74 versus 131.11±156.06 ng/ml, respectively, p=0.032). Decreased SIRT1 levels in no-serum supernatant were predictive of IPF, after adjustment for age and sex (p=0.014, OR=0.124 [95%CI: 0.023-0.653]). Conclusion: The findings of decreased concentration of SIRT1 in PBMCs supernatant and increased concentration of TGFβ1 in plasma in IPF patients versus controls provide important insights into the role of SIRT1 in IPF and could serve as a tool for the diagnosis and evaluation of patients with IPF.

Background: Bacterial co-infections in patients with viral pneumonia might increase mortality. In this study we aimed to evaluate their effect on the mortality of critically ill patients with viral pneumonia. Methods: A systematic search was conducted in PubMed, Web of Science, Scopus and Cochrane from inception until 30 March 2025. We included studies comparing the effect on mortality of bacterial co-infections in critically ill patients with viral pneumonia. The risk of bias was assessed by the Newcastle–Ottawa Scale. Results: From 3643 studies, 10 were included in our study with a total of 2862 COVID-19 patients and 4573 influenza patients. Seven studies were retrospective and three prospective. In total, 359/2862 of the COVID-19 and 904/4573 of the influenza patients were co-infected. Co-infections increased mortality in five out of the six studies evaluating COVID-19 patients and in two out of the eight studies evaluating influenza patients. Conclusions: The majority of the included studies were retrospective, which may limit the accuracy of these results. The exclusion of non-English literature may have led to the omission of relevant data. Based on our results, the impact of bacterial co-infection may be more pronounced in patients with COVID-19 pneumonia admitted to the ICU than in patients with influenza pneumonia.

Background: Critically ill patients after Intensive Care Unit (ICU) discharge may present disability in their cognitive and physical functions. Objectives: To investigate the quality of life (QoL) of both COVID-19 and non-COVID-19 patients following ICU discharge, lung function, and physical performance of participants. Methods: This study was prospective and conducted between 2020 and 2021 in the “X” hospital. If patients were Mechanically-Ventilated (MV) > 48 h, they were included. Results: Fifty COVID-19 and seventy-two non-COVID-19 participants were included in this study. The mean (SD) of the total SF-36 scores at COVID-19 patients at hospital discharge and 3 and 12 months were 46.5 (14.5), 68.6 (17.8), and 82.3 (8.9) (p < 0.05), while non-COVID-19 participants were 48.5 (12.1), 72.2 (9.9), and 82.7 (5.4) (p < 0.05). The forced expiratory volume in one second (FEV1) and 6-minute walking distance (6MWD) were assessed at 3 and 12 months and significantly improved over 12 months. Conclusion: The QoL of COVID-19 patients improved significantly over time as FEV1 and 6MWD.

In the present report, we describe a patient presenting in the intensive care unit with fever, respiratory failure, and multiple lesions on cardiac valves. The patient, with a history of multiple myeloma under treatment, was intubated due to ARDS from influenza, and cardiac ultrasonography revealed lesions in the aortic, mitral, and tricuspid valves. There is a step-by-step approach in the case presentation, with clinical questions, while there is a review of the current literature concerning the issue.

Mechanically ventilated (MV) patients often develop ventilator-associated pneumonia (VAP) with increased mortality risk, especially in VAP caused by multidrug-resistant (MDR) microorganisms. We evaluated MV patients and monitored VAP presentation, microbiologically confirmed. The patients underwent bronchoalveolar lavage (BAL) and blind bronchial aspiration (AC) at baseline. Systematic bronchial secretion and radiologic assessments were performed daily. The patients were classified as MDR-VAP, non-MDR-VAP, or non-VAP. The APACHE II and SOFA scores, microbiology, inflammatory markers, respiratory system characteristics, and ventilator settings were evaluated. BAL and AC were assessed for total protein levels, cellular number and profile, and IL-1β and TNF-α levels. Of the VAP patients, 46.1% presented with MDR-VAP due to Acinetobacter baumannii, Pseudomonas aeruginosa, Klebsiella pneumoniae, or Stenotrophomonas maltophilia, and 53.8%—with non-MDR-VAP. The VAP patients had higher APACHE II scores and airway pressure but a lower baseline PO₂/FIO₂ compared to the non-VAP patients, while PO₂/FIO₂ was increased in MDR-VAP compared to non-MDR-VAP. BAL protein, IL-1β, and cellular levels were increased in VAP vs. non-VAP and in non-MDR-VAP compared to MDR-VAP. Macrophages and polymorphonuclears were 34.36% and 23.76% in VAP, statistically significant increased compared to non-VAP. Their percentages were also increased in non-MDR-VAP compared to MDR-VAP. These differences imply a different immunological profile in non-MDR-VAP patients. In conclusion, MDR-VAP patients may present significant differences in baseline clinical characteristics and molecular biomarkers, which may help in prompt diagnosis and an improved therapeutic approach.

Targeted temperature management (TTM), particularly the avoidance of hyperpyrexia, is a cornerstone of intensive care, especially in conditions such as cerebral edema and increased intracranial pressure. Management becomes more complex in pregnancy, where maternal neuroprotection must be weighed against fetal safety. Both invasive and noninvasive methods for temperature control have been described, but evidence regarding their safety in pregnancy remains limited. We present the case of a 24-year-old pregnant woman admitted to the ICU with cerebral edema due to subdural empyema. The Arctic Sun surface cooling system was employed for fever control, with continuous maternal and fetal monitoring. The system effectively maintained normothermia without immediate adverse effects on either the mother or the fetus. However, on the third day of its use, the patient experienced a spontaneous preterm delivery of a stillborn fetus. Although a causal link between surface cooling and preterm labor cannot be established from this single case, the event underscores the need for caution and further investigation. This case highlights both the feasibility and the uncertainties of using advanced TTM devices in critically ill pregnant patients. It emphasizes the importance of multidisciplinary monitoring and the urgent need for evidence-based guidelines to balance maternal benefits with fetal safety.