Abstract English: Solitary fibrous tumours (SFTs) are rare mesenchymal neoplasms with an incidence of less than one case per million people per year, most often exhibiting benign behaviour. Their intrapulmonary localisation is exceptionally uncommon and illustrates the hetero-geneity of pulmonary tumours in both clinical presentation and histopathology. We report the case of a 76-year-old female, aformer smoker (10 pack-years, quit 20 years ago), with advanced cardiometabolic comorbidities. A recent chest computed tomography (CT) scan revealed a large, well-defined pulmonary mass (85 × 64 mm) in the lingular segment of the left upper lobe, associated with condensating-atelectatic changes and ground-glass opacities in the right lower lobe, suggestive of infection and minimal right pleural effusion. Empirical antibiotic therapy was initiated, and the patient was referred to the pulmonology department. Bronchoscopy excluded endobronchial invasion, and CT-guided transthoracic biopsy confirmed SFTs based on morphology and immunohistochemical profile signal transducer and activator of transcription 6, cluster of differentiation 34, pan-cytokeratin [AE1/AE3] and SRY-related HMG-box 10 (STAT6+, CD34+, CK-AE1/3- and SOX10-). Risk assessment using the modified Demicco score indicated a low metastatic potential. Given the patient’s age, comorbidities and low-risk profile, a ‘watchful waiting’ strategy with periodic clinical and imaging follow-up was adopted in agreement with the thoracic surgery team. This case highlights the complexity of SFTs regarding localisation and therapeutic management, emphasising the essential role of a rigorous multidisciplinary approach, particularly in the absence of validated treatment guidelines derived from large patient cohorts.

Abstract Objective This systematic review and meta-analysis aimed to evaluate the proportion of major bleeding events in patients using clopidogrel who underwent thoracentesis or other pleural procedures. As clopidogrel is a widely used antiplatelet agent, its continuation during invasive procedures raises safety concerns. Methods A comprehensive search was conducted in PubMed, Cochrane Library and Embase from inception to July 2025, following PRISMA guidelines. Eligible studies included observational or randomised trials that reported major bleeding outcomes in patients who continued clopidogrel during thoracentesis, small-bore chest tube insertion, or pleural catheter placement. Data extracted included demographic variables, procedural details and bleeding event rates. Study quality was assessed using the Newcastle-Ottawa Scale. The pooled proportion of bleeding events was calculated using a random-effects model. A subgroup analysis was conducted for studies specific to thoracentesis. Heterogeneity was assessed with the I2 statistic. Sensitivity analyses and meta-regression (based on publication year and sample size) were performed to evaluate result stability and potential effect modifiers. Results Twelve studies including 392 patients met the inclusion criteria. The pooled bleeding event rate was 0.0004 (95% CI: 0.0000–0.0102), and for thoracentesis-only studies it was 0.0012 (95% CI: 0.0000–0.0148). Heterogeneity was negligible (I2 = 0%). Leave-one-out analysis confirmed robustness, and no significant publication bias was detected. Meta-regression did not identify any significant moderators. Conclusion The findings suggest that clopidogrel continuation during thoracentesis is associated with a very low risk of major bleeding. Routine discontinuation may not be necessary, although additional high-quality studies are warranted.

Abstract English: Chronic obstructive pulmonary disease (COPD) remains a global challenge. Despite the expanding burden, worldwide study shows that 60%–86% of people with COPD are still not diagnosed. Proyecto Latinoamericano de Investigación en Obstrucción Pulmonar (PUMA) is known as a COPD screening tool in Latin America. This study aims to determine the sensitivity and specificity of the PUMA questionnaire as a COPD screening tool in the Indonesian population. This is a cross-sectional study in several primary care facilities in Jakarta, Indonesia, from July 2019 to January 2020. Participants with PUMA score ≥5 were considered high-risk COPD and proceeded to spirometry examination. COPD diagnoses were based on Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria. A total of 70 high-risk COPD participants were recruited. The receiver operating curve (ROC) curve shows PUMA as a useful diagnostic tool with the area under the curve (AUC) = 0.736 (P = 0.011). The optimal cut-off of PUMA score for COPD diagnosis is 5 with high sensitivity (92%) and enough specificity (60%). There is no difference in PUMA scores among GOLD classifications (P > 0.05). PUMA score with a cut-off value ≥5 can be used as a good screening tool for identifying patients suspected of having COPD.

Abstract The article explores drug-resistant bacteria within the ESKAPE group, commonly associated with nosocomial infections, focusing on the resistance mechanisms of Acinetobacter baumannii and Klebsiella pneumoniae. The study delves into various β-lactamase enzymes and resistance mechanisms exhibited by ESKAPE bacteria, shedding light on the challenges posed by carbapenem-resistant infections. Notably, the article underscores the ongoing need for research to develop more effective treatments and address the persistent challenges associated with drug resistance in the context of nosocomial infections. The examination of this subset of bacteria aims to contribute to a comprehensive understanding of their resistance mechanisms and provides insights into the difficulties encountered in treating infections with carbapenem-resistant pathogens. The article serves as a valuable resource for clinicians, researchers and policymakers, offering a detailed perspective on the current state of drug resistance among nosocomial pathogens and advocating for continuous research to enhance treatment efficacy in the face of evolving challenges.

Abstract Objective To identify essential competencies required for equipping pulmonologists to manage respiratory diseases such as the Covid-19 pandemic. Methods A descriptive and qualitative study was conducted. Focus group, which consisted of five Syrian members who were affiliated with the Syrian Association of Thoracic Medicine and Surgery were invited to formulate a preliminary list of competencies. Delphi technique with three cycles was also employed to evaluate the resulted list. The number of pulmonologists who accepted to take part was 67 out of 110. All competencies suggested by at least 80% of experts were included in the final list. Reliability was tested using Cronbach’s alpha, Descriptive statistics including Mean and standard deviation were performed. Findings Forty-five essential competencies were identified including ten competencies in cognitive domain, 11 skills, and 24 competencies related to attitude domain. Conclusion A list of 45 competencies has been identified. It is hoped that they will guide and enable pulmonologists to provide the best health care to patients with respiratory infections, especially during the COVID-19 pandemic. It will also guide decision makers to design training programs that can address these competencies.

Abstract Bronchiolitis obliterans organizing pneumonia (BOOP) is a diffuse interstitial lung disease, currently classified as cryptogenic organizing pneumonia (COP) when idiopathic, respectively organizing pneumonia (OP) in case of a specified etiology. We present the case of a 48-year-old patient, former smoker (20PY), diabetic, who accused moderate dyspnea, persistent febrile syndrome. The chest radiography showed multiple areas of condensation distributed bilaterally diffusely and the laboratory data revealed an important inflammatory syndrome. More than 100 colonies of Candida albicans were isolated from the sputum, therefore antifungal therapy was initiated. The computer tomography scan (CT scan) highlighted multiple micronodular and nodular lesions, some with tendency of excavation and hydroaeric level present and a polyseptate lesion in the right lower lobe; no proliferative elements were found during bronchoscopy and the bronchoalveolar lavage was non-specific; To obtain a final diagnosis, a CT-guided transthoracic needle biopsy was performed and the histological examination was compatible with organized pneumonia.

Abstract Introduction Interstitial lung disease (ILD) includes more than 200 progressive conditions classified based on common clinical, imaging or pathophysiological factors. Case presentation A 37-year-old male, former smoker, with unknown exposure and a family history of incompletely identified ILD, underwent functional and imaging investigations that raise the suspicion of an ILD with a pattern of non-specific interstitial pneumonia (NSIP). High-resolution computer tomography (HRCT) imaging detects the progression of lesions. The severely altered functional status does not allow a lung biopsy to be performed to elucidate the aetiology and establish the optimal therapeutic approach. Bronchoscopy with bronchial aspirate sampling and bronchoalveolar lavage does not suggest a specific ILD aetiology. A diagnosis of diffuse fibrosing and progressive ILD – an unclassifiable phenotype – was established, and after a multidisciplinary discussion, antifibrotic treatment was initiated. A genetic test was performed for a possible familial ILD with a genetic component. The test identified the presence of an autosomal recessive combined immunodeficiency due to NF-κB inducing kinase (NIK) deficiency associated with the MAP3K14 gene leading to the suspicion of a familial ILD. Discussion Genetic testing is essential for diagnosis of ILD, especially in young patients with a family history. Antifibrotics are the only available option for such cases; if immunosuppressive therapy should be initiated still remains a question. Is a lung transplant a realistic solution in such cases? Conclusions Familial aggregation and genetic changes should be sought for in diffuse ILD diagnosis.

Abstract Pulmonary arterial hypertension (PAH) is a rare and severe disease characterised by the progressive narrowing of the small pulmonary arteries resulting in right-sided heart failure. Despite advances in treatment, some PAH patients require lung transplantation, which carries risks of long-term complications. We report the case of a male patient with no significant comorbidities, who developed progressive dyspnoea on exertion at the age of 38 years. After echocardiography and right heart catheterisation, he was confirmed with idiopathic PAH and was started treatment with bosentan, sildenafil and beraprost. After 3 years of stability, the PAH worsened. Treatment with continuous intravenous epoprostenol was introduced in a national premiere, unfortunately with little effect. The patient underwent lung transplantation at the age of 43 years. Afterwards, he developed several complications, including chronic lung allograft dysfunction, post-transplant lymphoproliferative disorder and pulmonary embolism. He died at the age of 52 years of invasive pulmonary aspergillosis. The case is noteworthy due to the above-average post-transplant survival despite multiple complications.