Tuberculosis and Respiratory Diseases最新文献

Background: High-resolution chest computed tomography (CT) is a crucial assessment tool for diagnosis of Birt-Hogg-Dubé syndrome (BHD). This study aims to analyze the differences of lung cyst between BHD and other cystic lung diseases.

Methods: From January 2020 to December 2022, we retrospectively screened all patients who underwent chest CT at Gangnam Severance Hospital. We included the patients with multiple lung cysts for the analysis of chest CT images.

Results: Over a three-year period, out of 52,823 patients who underwent a chest CT scan, 301 patients (0.6%) with multiple lung cysts were enrolled, of which 24 (8.0%) were diagnosed with BHD. Notably, 95.8% and 83.3% of BHD patients exhibited bilateral cysts and basal predominance, and had larger cysts with a maximal diameter (averaging 32.1mm [interquartile range 26.5mm to 43.5mm]) than lymphangioleiomyomatosis (17.0mm [13.2;19.1], p<0.001) and others' group (11.3mm [7.9;17.0], p<0.001). Additionally, 95.8% of BHD patients has a diverse range in cyst sizes and morphologies. Multivariate logistic regression analysis identified bilateral cysts (OR 12.393, 95% CI: 1.613-274.682, p=0.038), basal predominance (OR 8.511, 95% CI: 2.252-39.392, p=0.002), maximum diameter (OR 1.053, 95% CI: 1.009-1.108, p=0.032), and diversity of morphology (OR 19.513, 95% CI: 2.833-398.119, p=0.010) as factors associated with BHD diagnosis. By stepwise selection, a multivariate prediction model for BHD diagnosis was established, demonstrating a sensitivity of 95.83%, a specificity of 81.22%, and an AUC of 0.951 (95% CI: 0.914-0.987).

Conclusion: Distinguishing features of lung cyst from other cystic lung diseases include bilateral cysts, basal dominance, large size, and irregular shape. The predictive model can assist in identifying undiagnosed patients with BHD.

This review article explores the multifaceted relationship between air pollution and interstitial lung diseases (ILDs), particularly focusing on idiopathic pulmonary fibrosis (IPF), the most severe form of fibrotic ILD. Air pollutants are mainly composed of particulate matter (PM), ozone (O3), nitrogen dioxide (NO2), carbon monoxide (CO), and sulfur dioxide (SO2). They are recognized as risk factors for several respiratory diseases. However, their specific effects on ILDs and related mechanisms have not been thoroughly studied yet. Emerging evidence suggests that air pollutants may contribute to the development and acute exacerbation of ILDs. Longitudinal studies have indicated that air pollution can adversely affect the prognosis of disease by decreasing lung function and increasing mortality. Lots of in vitro, in vivo, and epidemiologic studies have proposed possible mechanisms linking ILDs to air pollution, including inflammation and oxidative stress induced by exposure to air pollutants, which may induce mitochondrial dysfunction, promote cellular senescence, and disrupt normal epithelial repair processes. Despite these findings, effective interventions to mitigate effects of air pollution on ILD are not well established yet. This review emphasizes the urgent need to address air pollution as a key environmental risk factor for ILDs and calls for further studies to clarify its effects and develop preventive and therapeutic strategies.

Background: In the absence of, or minimal-volume pleural effusion, conventional medical thoracoscopy (MT) is often precluded by the risk of lung injury. Dry medical thoracoscopy (dry MT) aims to ameliorate these dangers by inducing an artificial pneumothorax via needle insufflation or blunt dissection. Veress needle is a device used by surgeons to induce pneumoperitoneum before laparoscopic surgeries, but is not commonly reported in dry MT.

Methods: We present data from a series of 31 patients in which dry MT with artificial pneumothorax induction using Veress needle were performed under thoracic ultrasonography (TUS) guidance. Procedures were deemed technically successful if all the following criteria were met: (i) successful pneumothorax induction, allowing smooth insertion of semi-rigid thoracoscope during the procedure; (ii) no immediate significant procedural-related complications; and (iii) no delayed complications such as persistent air leak, defined as leakage lasting more than 5 days necessitating prolonged chest tube placement.

Results: Complete pneumothorax induction was successful in 25 cases (80.6% technical success rate); nevertheless, biopsies were successfully performed in all cases. The most common histopathological diagnosis was malignancy (n=9, 29.0%), followed by inflammatory pleuritis (n=8, 25.8%) and tuberculosis (n=8, 25.8%). No complications were reported secondary to the procedure.

Conclusion: These findings suggest that TUS-guided dry MT with a Veress needle is technically feasible and safe in the hands of experienced MT performers who are competent in TUS.

COPD can be caused by various factors, including lung infections, asthma, air pollution, childhood growth disorders, and genetic factors, although smoking is a predominant risk factor. The main pathological mechanisms in COPD involve small airway disease, emphysema, mucus hypersecretion, and vascular disorders. COPD in non-smokers is characterized by normal FEV1 decline, equal distribution of sex, younger age of onset, fewer comorbidities, milder airflow obstruction, normal diffusing capacity of the lungs for carbon monoxide (DLCO) and radiological features such as more air-trapping and less severe emphysema, compared to COPD in smokers. COPD in non-smokers is still accompanied by a high prevalence of acute exacerbation almost equal to COPD in smokers. Moreover, COPD per se is an independent risk factor for the development of lung cancer, irrespective of smoking status. Considering that COPD coexists with numerous comorbidities, effective management of these comorbidities is essential, and multifaceted efforts are required for the comprehensive treatment of COPD.

Postoperative pulmonary complications (PPCs) significantly increase morbidity and mortality in surgical patients, particularly those with pulmonary conditions. The incidence of PPCs varies widely, influenced by surgery type, patient age, smoking status, and comorbidities like chronic obstructive pulmonary disease (COPD) and congestive heart failure. Preoperative pulmonary function tests and chest radiographs, while critical for lung resection surgery, should be selectively used based on individual risk factors. Effective risk stratification models, including ASA classification, Arozullah Respiratory Failure Index, Gupta Calculators, and ARISCAT model, aid in predicting PPCs. Key strategies to reduce PPCs involve preoperative optimization of pulmonary conditions, smoking cessation, and respiratory rehabilitation. In COPD and asthma patients, maintaining optimal disease control through inhaled therapies, systemic corticosteroids, and preoperative respiratory exercises is crucial. Anemia and hypoalbuminemia are notable predictors of PPCs, warranting careful management. The type and duration of anesthesia significantly impact PPC risk, with regional anesthesia preferred over general anesthesia when feasible. Comprehensive preoperative evaluation and tailored interventions are essential to improve surgical outcomes and reduce PPC incidence. Further study involving domestic patients is needed to refine national guidelines for managing patients at risk of PPCs.

Background: Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) are correlated with high morbidity and mortality rates. Guidelines that consider local epidemiologic data are fundamental for identifying optimal treatment strategies. However, Korea has no HAP/VAP guidelines.

Methods: This study was conducted by a committee of nine experts from the Korean Academy of Tuberculosis and Respiratory Diseases Respiratory Infection Study Group using the results of Korean HAP/VAP epidemiologic studies. Eleven key questions for HAP/VAP diagnosis and treatment were addressed. The Convergence of Opinion on Suggestions and Evidence (CORE) process was used to derive suggestions, and evidence levels and recommendation grades were in accordance with the Grading of Recommendations Assessment Development and Evaluation (GRADE) methodology.

Results: Suggestions were made for the 11 key questions pertinent to diagnosis, biomarkers, antibiotics, and treatment strategies for adult patients with HAP/VAP.

Conclusion: Using the CORE process and GRADE methodology, the committee generated a series of recommendations for HAP/VAP diagnosis and treatment in the Korean context.

Background: We investigated whether nutritional intake is associated with physical activity (PA) and handgrip strength (HGS) in individuals with airflow limitation.

Methods: This study analyzed data from the 2014 to 2016 Korean National Health and Nutrition Examination Survey. We assessed total protein intake (g/day), caloric intake (kcal/day), and other nutritional intakes using a 24-hour dietary recall questionnaire. HGS was measured three times for each hand using a digital grip strength dynamometer, and PA was assessed as health-enhancing PA. Airflow limitation was defined as a forced expiratory volume/forced vital capacity ratio of 0.7 in individuals over 40 years of age. Participants were categorized into groups based on their PA levels and HGS measurements: active aerobic PA vs. non-active aerobic PA, and normal HGS vs. low HGS.

Results: Among the 622 individuals with airflow limitation, those involved in active aerobic PA and those with higher HGS had notably higher total food, calorie, water, protein, and lipid intake. The correlations between protein and caloric intake with HGS were strong (correlation coefficients = 0.344 and 0.346, respectively). The forest plots show that higher intakes of food, water, calories, protein, and lipids are positively associated with active aerobic PA, while higher intakes of these nutrients are inversely associated with low HGS. However, in the multivariate logistic regression analysis, no significant associations were observed between nutritional intake and active aerobic PA or HGS.

Conclusion: Nutritional intake was not found to be an independent factor associated with PA and HGS. However, the observed correlations suggest potential indirect effects that warrant further investigation.

Latent tuberculosis infection (LTBI) is characterized by immune responses to Mycobacterium tuberculosis antigens without clinical symptoms or evidence of active tuberculosis. Effective LTBI management is crucial for tuberculosis elimination, requiring accurate diagnosis and treatment. In South Korea, LTBI guidelines have been updated periodically, with the latest in 2024. This review discusses the recent changes in the Korean guideline for the diagnosis and treatment of LTBI in adults.