医学最新文献

Introduction and objectives: Post-tuberculosis lung disease (PTLD), as other chronic respiratory disorders, may have infectious complications; some of them can be prevented with vaccinations. So far, no document has discussed the potential role of vaccination in PTLD. Therefore, the objective of this review was to describe vaccination recommendations to prevent infections potentially capable of complicating PTLD.

Materials and methods: A non-systematic review of the literature was conducted. The following keywords were used: tuberculosis, vaccination, vaccines and PTLD. PubMed/MEDLINE and Embase were used as the search engine, focusing on English-language literature only.

Results: We identified 9 vaccines potentially useful in PTLD. Influenza, pneumococcal and anti-COVID-19 vaccinations should be recommended. Patients with PTLD can also benefit from vaccination against shingles. Vaccination against pertussis is mainly relevant during childhood. Diphtheria, tetanus and measles vaccination are recommended for general population and should be considered in patients with PTLD not previously vaccinated. Tdap (Tetanus, diphtheria, and pertussis) booster should be repeated in every adult every ten years. Vaccination against BCG retains its importance during early childhood in countries where TB is endemic.

Conclusions: Vaccination deserves to be considered among the strategies to prevent and/or mitigate PTLD complications. Further evidence is necessary to better understand which vaccines have the greatest impact and cost-benefit.

Guidelines for the follow-up of pulmonary subsolid nodule (SSN) vary in terms of frequency and criteria for discontinuation. We aimed to evaluate the growth risk of SSNs and define appropriate follow-up intervals and endpoints. The immediate risk (IR) and cumulative risk (CR) of SSN growth were assessed using the Kaplan-Meier method according to nodule consistency and size. Follow-up plans were proposed based on optimal growth risk threshold of 5%. 892 SSNs, comprising 833 pure ground-glass nodules (pGGNs) and 59 part-solid nodules (PSNs) were included. For pGGNs ≤ 6.6 mm, the CR exceeded 5% at every 3-year interval in the first 9 years. For pGGNs measuring 6.6-8.8 mm and >8.8 mm, the IR remained above 5% for the first 2-7 years, and the 2-year CR for pGGNs measuring 6.6-8.8 mm in the 8th and 9th years achieved 6.66%. For PSNs, the IR peaked in the 4th year (44%) and then declined. Therefore, triennial follow-up for 9 years is recommended for pGGNs ≤ 6.6 mm, annual follow-up for 7 years followed by biennial follow-up for 2 years for pGGNs measuring 6.6-8.8 mm, annual follow-up for 7 years for pGGNs > 8.8 mm, and continuous annual follow-up until nodule growth for PSNs.

Cone-beam computed tomography (CBCT) assisted bronchoscopy shows prospective advantages in diagnosing peripheral pulmonary lesions (PPLs), but its diagnostic value and potential influencing factors remain unclear. What is the clinical value and optimal strategy of CBCT-assisted bronchoscopy in diagnosing PPLs? The references were searched from PubMed, EmBase, and Web of Science. Studies reporting diagnostic yield and potential influencing factors of CBCT-assisted bronchoscopy were included. The navigational success rate, diagnostic rate, complication rate, and potential influencing factors were pooled by random-effects model and meta-regression. A total of 1,441 patients with 1,540 lesions from 15 studies were included in our meta-analysis. The pooled navigational success rate (97.0% vs 81.6%; odds ratio [OR] 5.12) and diagnostic rate (78.5% vs 55.7%; OR 2.51) of the CBCT-assisted group were significantly higher than those without CBCT. The complication rate of CBCT-assisted bronchoscopy was 4.4% (95%CI: 0.02-0.07). Cone-beam CT combined with r-EBUS can achieve the highest diagnostic rate. Applying positive end-expiratory pressure could improve the diagnostic rate and reduce the complication rate (p < 0.05). Lesions located in the upper lobe could achieve a higher diagnostic rate and lesions located in the right lobes could get a lower complication rate (p < 0.05). Cone-beam CT combined with r-EBUS seems to be the effective and optimal approach to ameliorate the navigation success rate and diagnostic rate of diagnosing PPLs.Clinical trial registration: This study was registered in PROSPERO (Registration Number: CRD42022378992). URL: PROSPERO (york.ac.uk).

Introduction: The Spanish Society of Pulmonology and Thoracic Surgery created a registry for hospitalised patients with COVID-19 and the different types of respiratory support used (RECOVID). Objectives. To describe the profile of hospitalised patients with COVID-19, comorbidities, respiratory support treatments and setting. In addition, we aimed to identify varying profiles of patients according to outcomes and the complexity of respiratory support needed.

Methods: Multicentre, observational study in 49 Spanish hospitals. A protocol collected demographic data, comorbidities, respiratory support, treatment setting and 1-year follow-up. Patients were described using either frequency and percentages or median and interquartile range, as appropriate. A cluster analysis made it possible to identify different types of profile among the patients.

Results: In total, 2148 of 2454 hospitalised patients (87.5%) received care in the conventional ward, whilst 126 in IRCU and 180 in ICU. In IRCU, 30% required high-flow nasal oxygen whilst 25%, non-invasive mechanical ventilation and 17%, mechanical ventilation. Four clusters of patients were identified. Two clusters were more likely to require IRCU/ICU admission, although primarily Cluster 2: Cluster (C) 1 consisted of patients without comorbidities and C2, those with comorbidities. Both presented higher inflammatory levels and lower lymphocyte count and SpO2/FiO2; however, C2 showed worse values. Two different clusters identified patients requiring less complex respiratory support. C3 presented higher comorbidities and elevated lymphocyte count, SpO2/FiO2 and low C-reactive protein (CRP). C4 included those without comorbidities except for arterial hypertension, lymphopenia and an intermediate CRP. In-hospital mortality and subsequent 1-year mortality were greater for C2 (28.6% and 7.1%) and C1 (11.1%, 8.3%) than for C4 (3.3%, 1.8%) and C3 (0%, 0%).

Conclusions: The cluster analysis identified four clinical phenotypes requiring distinct types of respiratory support, with great differences present per characteristics and outcomes.

The associations between anxiety, depression, and the prognosis of COPD remain uncertain. The present study aims to investigate the associations of anxiety and depression with 30-day readmission rates and acute exacerbations of COPD (AECOPD). Four databases were searched to identify relevant studies published before 13 March 2024. Studies that report on the impact of anxiety and depression on the prognosis of AECOPD were included. The pooled effect size and its 95% confidence interval (CI) were calculated using a random effects model. The primary outcomes were 30-day readmission and AECOPD within the first year after discharge in COPD patients. Of the 5,955 studies screened, 14 studies were included in the analysis. Patients with anxiety had a higher risk of AECOPD within the first year after discharge compared to those without anxiety (HR: 2.10, 95% CI: 1.28-3.45, p = 0.003). Patients with depression also had a higher risk of AECOPD within the first year after discharge (HR: 1.36, 95% CI: 1.10-1.69, p = 0.004). Similar results were observed in the associations of anxiety and depression with 30-day readmission. Our results suggested that anxiety and depression were associated with an increased risk of 30-day readmission and AECOPD in patients with COPD.