Jornal Brasileiro De Pneumologia最新文献

Objective: Despite advances in diagnosis and treatment, approximately 50% of individuals affected by tuberculosis develop post-tuberculosis lung disease (PTLD), leading to functional limitations and reduced quality of life (QoL). Pulmonary rehabilitation programs have demonstrated benefits in patients with PTLD; however, access remains limited, and telerehabilitation may offer a cost-effective solution. This study sought to compare physical capacity and QoL in patients with PTLD following an eight-week telerehabilitation program.

Methods: This was a randomized controlled trial including 30 participants with confirmed PTLD. They were recruited and randomly assigned to an intervention group that received weekly telerehabilitation or a control group that received standard care. The interventions included aerobic training, breathing exercises, strength training, and stretching exercises. Physical capacity and QoL were assessed before and after the interventions by means of isokinetic dynamometry, the six-minute walk test, the five-repetition sit-to-stand test, spirometry, handgrip strength, the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), and the Saint George's Respiratory Questionnaire.

Results: After eight weeks, the intervention group showed significant improvements in all physical capacity parameters and QoL. Quadriceps strength correlated significantly with the physical functioning and mental health domains of the SF-36.

Conclusions: Our findings suggest that telerehabilitation is an effective approach for enhancing physical function and QoL in patients with PTLD.

Objective: Efficient diagnostic pathways in advanced non-small cell lung cancer (NSCLC) are crucial for timely treatment initiation and improved outcomes. This study evaluated the impact of diagnostic delays and the role of minimally invasive techniques in biomarker assessment and survival in a real-world clinical cohort.

Methods: A retrospective cohort study was conducted involving 205 patients with advanced NSCLC diagnosed between January 2020 and December 2023. Diagnostic procedures included EBUS/EUS-B, transthoracic biopsy, and surgical biopsy. The time-to-diagnostic procedure, time-to-therapy, and survival were analyzed using multivariate models.

Results: The time interval to the first diagnostic procedure independently predicted mortality (HR=1.66; p=0.016). EBUS and EUS-B achieved significantly shorter diagnostic times (median 8 and 5 days, respectively) compared to transthoracic (20.5 days) and surgical (24.5 days) biopsies. These endoscopic techniques were also associated with shorter time intervals to systemic therapy initiation (p=0.011). Minimally invasive approaches provided sufficient tissue for complete morphological, immunohistochemical, and molecular profiling in most cases, with no significant differences in adequacy among procedures. Patients with actionable mutations had a 44% lower mortality risk (HR=0.56; p=0.013), while high PD-L1 expression was associated with a 56% reduction in mortality risk (HR=0.44; p=0.003).

Conclusions: Minimally invasive techniques, particularly EBUS and EUS-B, shortened diagnostic delays, ensured adequate biomarker sampling, and enabled earlier initiation of systemic therapy. Since the time-to-diagnosis was independently associated with survival, these approaches may have indirectly contributed to improved outcomes. Our findings highlight the importance of streamlining diagnostic pathways and expanding access to endoscopic methods to optimize care in advanced NSCLC.

Objectives: Several equations for calculating maximal inspiratory pressure (MIP) have been validated for the Brazilian population; however, none exist for maximal dynamic inspiratory muscle pressure (S-Index).

Methods: This cross-sectional study was conducted at two centers following approval by the institutional ethics committee. Healthy Brazilian adults were sequentially randomized to assess either the MIP or S-Index. Pulmonary function (spirometry), peripheral muscle strength (handgrip strength of the dominant upper limb - HGdUL), and physical activity level (IPAQ) were also evaluated. The S-Index and MIP values were reported as absolute values and compared using the Wilcoxon paired test. Multiple linear regression was used to develop reference equations. Lower limits of normality (LLNs) were stratified by sex and age using Z-scores, providing cut-off points to define inspiratory muscle weakness via the S-Index Deviation Score (SDS).

Results: The final sample comprised 214 eutrophic volunteers, 50% men, with a mean age of 43.1 ± 15.0 years. The median MIP was significantly higher than the median S-Index (97.2 [96.7-112.0] vs. 92.5 [80.0-105.0] cmH2O; p<0.001). The predicted equation for the S-Index, which used age, sex, and HGdUL as predictors, was: S-Index = 69.72 + 10.765×sex (men = 1; women = 0) - 0.211×age + 0.797×HGdUL. Additionally, the LLNs and cut-off points for ventilatory muscle weakness by sex and age group were established.

Conclusions: This study provides the first reference values for the S-Index in healthy, eutrophic Brazilian adults, including LLNs and cut-off points for diagnosing ventilatory muscle weakness.

Objective: To compare the former tuberculosis treatment regimen including one fluoroquinolone (ofloxacin, levofloxacin, or moxifloxacin) and a second-line injectable drug (amikacin, kanamycin, or capreomycin) plus three to five oral drugs (regimen 1) with the current regimen including the three WHO group A drugs (regimen 2) in terms of efficacy and safety at two tuberculosis referral centers in Mexico.

Methods: This was a retrospective study based on a review of the clinical records of all consecutive rifampin-resistant or multidrug-resistant tuberculosis (RR/MDR-TB) patients treated from January of 2010 to October of 2023. Patients included were microbiologically confirmed cases of RR/MDR-TB with pulmonary involvement and who received at least 30 days of regimen 1 or regimen 2. Outcomes and adverse events were classified in accordance with WHO definitions.

Results: One hundred and twenty-six RR/MDR-TB patients met the inclusion criteria. Of those, 87 were treated with regimen 1 and 39 received regimen 2. Success rates were not significantly different between the two groups of patients, although those treated with the oral regimen including bedaquiline from regimen 2 had higher success rates. Regimen 2 patients experienced a shorter time to culture conversion, and the regimen length was shortened accordingly, the median duration being 16.1 months [IQR, 15-17.3 months]. In patients receiving the all-oral regimen 2, adverse events were significantly associated with a history of type 2 diabetes mellitus (OR = 15.4; 95% CI, 2.73-87.29; p = 0.002) and were mainly related to linezolid use.

Conclusions: Oral regimens appear to be effective, although toxicity to linezolid requires strict patient monitoring.

Objective: To develop and validate a portable volumetric capnograph for collecting data on ventilatory mechanics during spontaneous breathing for outpatient use.

Methods: The device was developed by integrating the following commercially available sensors: a Hamilton® flow sensor (variable orifice; Hamilton Medical AG, Graubünden, Switzerland); an SDP810-125PA differential pressure sensor (Sensirion AG, Stäfa, Switzerland); and a Capnostat 5 CO2 sensor (Philips Respironics, Murrysville, PA, USA). An Arduino UNO-R3® microcontroller (Arduino, Monza, Italy) was used as an interface between the sensors and a laptop computer, and a Python application was used to acquire data at 10 ms intervals (100 Hz). Validation included static tests (flow: 0-45 L/min; partial pressure of CO2: 0-100 mmHg) and tests with five healthy volunteers (n = 115 respiratory cycles), in comparison with the reference equipment (a CO2SMO Plus® DX-8100 oxycapnograph; Philips Respironics).

Results: The static tests showed excellent linear correlation for flow and CO2 concentration. For the tests conducted with the five volunteers, no significant differences were observed between the portable volumetric capnograph and the reference equipment for any of the variables analyzed. Intracycle variability was observed in the capnography curves, reflecting the physiological characteristics of spontaneous breathing.

Conclusions: Our portable volumetric capnograph demonstrated the ability to collect accurate data on flow and partial pressure of CO2 during spontaneous breathing, with performance equivalent to that of the reference equipment. The variability in the capnography curves represents an intrinsic characteristic of spontaneous breathing that must be considered when developing algorithms for calculating physiological indicators.