Jornal Brasileiro De Pneumologia最新文献

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.

Objective: Fungal pulmonary infections are a significant complication in lung cancer, adversely affecting prognosis and treatment outcomes. This meta-analysis aimed to estimate the prevalence of chronic pulmonary aspergillosis (CPA) and Pneumocystis jirovecii pneumonia (PJP) in lung cancer patients and to identify associated clinical predictors.

Methods: A systematic search of EBSCOhost, Embase, PubMed/MEDLINE, Scopus, and Web of Science retrieved 2,823 records, of which 7 studies were eligible (PROSPERO: CRD42024551104). Meta-analyses of proportions and dichotomous and continuous variables were performed using R (meta package) via Jamovi and RevMan 5, with statistical significance set at p<0.05.

Results: Among 15,901 lung cancer patients, 177 had CPA and 135 had PJP. The pooled prevalence was 1% for CPA and 23% for PJP. CPA was significantly associated with male sex, smoking, COPD, interstitial lung disease, tuberculosis, and squamous cell carcinoma, and negatively associated with adenocarcinoma. CPA patients also had significantly lower BMI. Bilobectomy, radiotherapy, and concurrent chemoradiotherapy were additional risk factors for CPA. High-dose corticosteroid use (≥20 mg/day) was significantly associated with PJP.

Conclusion: CPA occurs in a clinically distinct subset of lung cancer patients with identifiable risk factors, while PJP appears to be strongly linked to immunosuppressive therapy. Improved screening strategies are warranted to mitigate the burden of these infections in vulnerable lung cancer populations.