Pulmonary Medicine最新文献

Background: Pulmonary cryptococcosis is an important opportunistic fungal infection in immunocompromised individuals, including those with an infection of the human immunodeficiency virus (HIV) but it can be increasingly seen in non-HIV patients.

Methods: We retrospectively reviewed the medical records of 58 non-HIV-infected patients with International Classification of Diseases, Ninth Revision, Clinical Modification Code B45.0 (pulmonary cryptococcosis) who were admitted to the Chi-Mei Hospital, Taiwan from January 2016 to April 2022.

Results: Of the enrolled 58 cases, 56 patients had no evidence of disease outside the lungs, and only two patients (3.4%) had disseminated diseases. Thirty-nine patients had pathologically confirmed pulmonary cryptococcosis, and 19 patients had clinically confirmed disease. Pulmonary cryptococcus patients with cancer had a nonsignificant numerically higher rate of ICU use (14.29% vs. 5.13%; p = 0.348). There were similar mortality rates in both cancer and noncancer patients with pulmonary cryptococcosis (4.76% vs. 2.70%; p = 0.581). Patients in the cancer and noncancer groups had a similar duration of hospital stay (7 vs. 6 days, p = 0.799) and low mortality rates (4.76% vs. 2.70%, p = 0.581) on standard antifungal therapy.

Conclusions: Cancer and noncancer patients had similar good outcomes after receiving appropriate standard antifungal treatment. Asymptomatic patients with pulmonary cryptococcosis diagnosed incidentally are self-limited and require no antifungal therapy.

Trial registration: IRB number: 11111-004.

Abstract: Dyspnea and chronic fatigue stand out as prevalent manifestations in the postacute phase of COVID, resulting in substantial adverse effects on patients' quality of life and functional capacity. Although these symptoms have been widely documented, there is no clear consensus on the pathophysiological mechanisms that underlie them. The available literature reveals a dispersion of clinical and laboratory data, and the variability in the methods of assessment of fatigue and dyspnea, as well as in the laboratory variables examined, limits the standardized understanding of this complex condition.

Objective: This study was aimed at identifying and synthesizing the evidence on the main clinical and laboratory characteristics related to dyspnea and fatigue in patients during long COVID from 2021 onwards.

Methods: The main databases used to select the studies were PubMed and Medline, also using LitCovid and Embase.

Results: A total of 42 articles that met the inclusion criteria were included, covering a total population of 30,682 patients diagnosed with COVID-19. The findings underscore the significant impact of long COVID on patients' quality of life, with persistent symptoms such as fatigue and dyspnea affecting a considerable proportion of individuals for durations ranging from 1 to 24 months.

Conclusion: The heterogeneity in research approaches highlights the urgent need for collaborative initiatives to elucidate the determinants of long COVID symptomatology and create more consistent evaluation protocols.

Background: This study was aimed at determining whether stress echocardiography could detect exercise pulmonary hypertension (ePH) in patients with mild chronic thromboembolic pulmonary disease (CTEPD) as compared with right-heart catheterization (RHC).

Methods: Thirty-six symptomatic patients with persistent residual perfusion defects detected using ventilation/perfusion scintigraphy underwent a haemodynamic assessment by RHC and echocardiography at rest and during exercise. We compared pulmonary pressures in echocardiography with RHC values using the definitions in current ESC/ERS guidelines for ePH [mean pulmonary artery pressure/cardiac output (mPAP/CO) slope > 3 mmHg/L/min] and PH (mPAP > 20 mmHg).

Results: Ten of the 36 patients (28%) exhibited an increase in the invasive mPAP/CO slope of > 3 mmHg/L/min. The correlation between echocardiographic and invasive measures of the mPAP/CO slope and systolic pulmonary pressure (sPAP) during peak exercise was ρ = 0.75 (95% C I = 0.53-0.97) and ρ = 0.75 (95% C I = 0.53-0.96), respectively. In bivariate logistic regression analyses, ePH was associated with the echocardiographic sPAP during peak exercise [o d d s  r a t i o (OR) = 1.13, 95% C I = 1.02-1.24] and with the echocardiographic mPAP/CO slope (OR = 3.86, 95% C I = 1.24-12.03). In ROC analysis, AUC was 0.89 (95% C I = 0.78-1.00) for the optimal exercise sPAP cut-off value of 56 mmHg (s e n s i t i v i t y = 90%, s p e c i f i c i t y = 87%), and 0.84 (95% C I = 0.66-1.00) for the optimal mPAP/CO slope cut-off value of 3.7 mmHg/L/min (s e n s i t i v i t y = 89%, s p e c i f i c i t y = 79%).

Conclusion: Stress echocardiographic assessments of the exercise sPAP and mPAP/CO slope predicted ePH as measured using RHC with good discrimination and acceptable calibration, providing promising evidence in diagnosing ePH in patients with CTEPD.

Trial registration: ClinicalTrials.gov identifier: NCT03405480.

Background: Pulmonary cryptococcosis is an important opportunistic fungal infection in immunocompromised individuals, including those with an infection of the human immunodeficiency virus (HIV) but it can be increasingly seen in non-HIV patients.

Methods: We retrospectively reviewed the medical records of 58 non-HIV-infected patients with International Classification of Diseases, Ninth Revision, Clinical Modification Code B45.0 (pulmonary cryptococcosis) who were admitted to the Chi-Mei Hospital, Taiwan from January 2016 to April 2022.

Results: Of the enrolled 58 cases, 56 patients had no evidence of disease outside the lungs, and only two patients (3.4%) had disseminated diseases. Thirty-nine patients had pathologically confirmed pulmonary cryptococcosis, and 19 patients had clinically confirmed disease. Pulmonary cryptococcus patients with cancer had a nonsignificant numerically higher rate of ICU use (14.29% vs. 5.13%; p = 0.348). There were similar mortality rates in both cancer and noncancer patients with pulmonary cryptococcosis (4.76% vs. 2.70%; p = 0.581). Patients in the cancer and noncancer groups had a similar duration of hospital stay (7 vs. 6 days, p = 0.799) and low mortality rates (4.76% vs. 2.70%, p = 0.581) on standard antifungal therapy.

Conclusions: Cancer and noncancer patients had similar good outcomes after receiving appropriate standard antifungal treatment. Asymptomatic patients with pulmonary cryptococcosis diagnosed incidentally are self-limited and require no antifungal therapy.

Trial registration: IRB number: 11111-004.

Background: Post-COVID syndrome (PCS) in adolescents, marked by persistent symptoms such as dyspnea and fatigue, remains poorly understood, particularly in those referred for exercise intolerance.

Objective: The objective of this study is to describe the clinical presentation and cardiorespiratory fitness (CRF) of adolescents with PCS and identify factors distinguishing those with normal versus reduced CRF.

Study design: In this cross-sectional study, 31 adolescents (90% female) with PCS underwent cardiopulmonary exercise testing (CPET), pulmonary function tests, and completed validated questionnaires assessing fatigue, depression, hyperventilation, physical activity, and quality of life (QoL). Patients were grouped by CRF status and compared.

Results: Symptoms were more prevalent than in general PCS literature, likely due to referral bias. Moderate depression risk was present in 35%, and 75% reported QoL impairment comparable with chronic conditions. Nearly half (48%) had reduced CRF. CRF was not associated with acute infection severity but correlated with orthostatism, reduced O₂ pulse, and increased static air trapping (p < 0.05). Preinfection physical activity was positively associated with CRF (p = 0.014), whereas postinfection activity levels were similar across groups.

Conclusion: PCS significantly impacts CRF, QoL, and psychological well-being in adolescents with exercise intolerance. Reduced CRF appears multifactorial, involving autonomic dysfunction, pulmonary limitations, and deconditioning. These findings underscore the need for comprehensive evaluation and targeted management strategies in this vulnerable population.

Background: Pneumonia, including influenza, COVID-19, and community-acquired pneumonia, is a major global health burden associated with high morbidity, mortality, and frequent progression to respiratory failure requiring intubation. Early identification of patients at risk of endotracheal intubation is essential to improve outcomes and optimize ICU resource allocation, yet existing prognostic tools remain limited in predicting this need. This study evaluated the performance of machine learning (ML) algorithms in predicting endotracheal intubation among patients with pneumonia during hospital stay.

Methods: We systematically searched five databases to evaluate the diagnostic accuracy of ML models. Pooled estimates of area under the receiver operating characteristic curve (AUROC), sensitivity, and specificity were calculated. Subgroup analysis and meta-regression were conducted. Risk of bias was assessed using PROBAST+AI and certainty of evidence with GRADE.

Results: This systematic review of 34 studies (26 in meta-analysis) included 195,214 pneumonia patients. The pooled AUROC was 0.79 (95% CI: 0.75-0.82), with sensitivity of 0.74 (95% CI: 0.61-0.84), specificity of 0.71 (95% CI: 0.50-0.86), and a DOR of 7 (95% CI: 2-20), indicating moderate diagnostic accuracy. Heterogeneity was substantial across analyses (I² = 90.45% for sensitivity and 94.58% for specificity). Risk of bias was lowest in development (59%) and highest in application domains (41% high risk). Despite a nonsignificant Deeks' test (p = 0.252), the funnel plot suggests selective publication of positive results, likely inflating the pooled AUROC. GRADE rated the evidence as moderate to low due to heterogeneity and imprecision.

Conclusion: ML algorithms demonstrate a modest and highly variable accuracy in predicting the need for endotracheal intubation among pneumonia patients. High heterogeneity and methodological variability highlight the need for standardized ML approaches before clinical adoption.

Introduction: Heated, humidified high-flow air (HHHFA) has been shown to reduce exacerbations in patients with COPD or bronchiectasis with significant sputum production. This pilot study evaluated the short-term effects of nocturnal HHHFA in COPD patients with chronic bronchitis.

Methods: This was a prospective, single-center, open-label, randomized, placebo-controlled trial. Participants with COPD, chronic bronchitis, and ≥ 2 exacerbations in the prior year were randomized to either nocturnal HHHFA or usual care. Assessments included sleep quality, dyspnea, quality of life, cough, lung function, imaging, and exercise capacity at baseline and 6 weeks.

Results: Of 11 eligible participants, seven completed the study (four intervention, three control). Baseline characteristics were generally similar, though the intervention group had a higher BMI and a lower emphysema percentage. No statistically significant differences were observed between groups in primary or secondary outcomes.

Conclusions: Nocturnal HHHFA over 6 weeks did not improve clinical or imaging outcomes in this small cohort of COPD patients with chronic bronchitis. The study was likely underpowered due to recruitment challenges. Larger trials are needed to assess the potential of HHHFA in this population.

Trial registration: ClinicalTrials.gov identifier: NCT03959982.

Background: Cystic fibrosis (CF) is an autosomal recessive disorder caused by variants in the CFTR gene. Although the F508del mutation is common globally, the Middle East exhibits a higher prevalence of rare, region-specific variants. The triple-combination therapy elexacaftor/tezacaftor/ivacaftor (ETI) has revolutionized CF management; however, its efficacy in individuals with rare variants, often underrepresented in clinical trials, remains less certain. This study is aimed at evaluating the real-world outcomes of ETI therapy in CF patients with rare CFTR variants predominantly found in the Middle East.

Methods: This retrospective, single-center study included 12 patients with CF carrying rare Middle Eastern variants. Data on percent predicted Forced Expiratory Volume in 1 second (ppFEV1), body mass index (BMI), and annual exacerbation frequency were collected before and after 12 months of ETI treatment. Nine of these patients were previously on ivacaftor and were switched to ETI. Changes in clinical outcomes were analyzed using Wilcoxon signed-rank tests due to nonnormally distributed data.

Results: Following 12 months of ETI therapy, significant improvements were observed. The median ppFEV1 increased by 9.5% (range: 2-15). The median annual frequency of exacerbations decreased by two events (range: 0-4). BMI showed a modest median improvement of 1.5 kg/m², which was not statistically significant. The cohort comprised nine females (75%) and three males (25%), with a median age of 24.3 years (range: 18.5-35.2 years) at the time of ETI initiation or transition.

Conclusion: ETI therapy led to statistically significant improvements in lung function and a reduction in pulmonary exacerbations in CF patients with rare Middle Eastern variants. These findings, from the first report of its kind in this region, support the expansion of ETI access to individuals with rare CFTR variants, particularly in underserved populations, based on functional response. This underscores the benefit of ETI beyond the common F508del mutation.

Introduction: Pulmonary embolism (PE) is the third leading cause of cardiovascular death after stroke and myocardial infarction. Accurate and timely identification of patients could have a significant impact on reducing the mortality rate and better patient management.

Aim: The purpose of this study was to evaluate the diagnostic performance of quantitative parameters measured based on CTPA images to determine the most important and relevant imaging parameters for diagnosing patients with PE.

Methods and materials: In this cross-sectional, multicenter study, the electronic files of 1428 cases suspected of PE were reviewed from 2021 to 2023. The diagnostic performances of anthropometric parameters, right ventricle-to-left ventricle (LV) diameter ratio, and CT obstruction index measured based on CTPA images were evaluated for the diagnosis of PTE.

Results: Radiological manifestations associated with PE were IV septum deviation, RV/LV diameter ratio, CT obstruction score, and pulmonary infarction with OR values of 10.53, 38.71, 6.59, and 78.16, respectively (p < 0.001). CT obstruction index with a threshold of 1 was the best parameter for the diagnosis of PE. Accuracy, sensitivity, specificity, and AUC of the CT obstruction index were 96.10%, 98.68%, 94.84%, and 0.96%, respectively. Pulmonary infarction with multifocal involvement as the second strongest parameter had a sensitivity of 81.58%, specificity of 98.76%, accuracy of 93.25%, kappa coefficient of 0.93, and an AUC of 0.90.

Conclusion: CT obstruction index and pulmonary infarction with multifocal involvement perform better than the reports of the presence of disease in CTPA images. Therefore, these two parameters must be reported by radiologists and implemented as the primary criteria for diagnosing PE.

Introduction: COVID-19 has infected many patients globally, primarily impacting the respiratory system and causing symptoms such as coughing and shortness of breath. Various factors influence the severity of the infection, with obstructive sleep apnea (OSA) being one of them.

Aims: The aim was to investigate the correlation between the severity of OSA and the severity of COVID-19 infection, as indicated by hospitalization, ICU admission, and the duration of recovery from the disease.

Methodology: A retrospective cohort study on OSA patients who follow-up at a tertiary referral hospital sleep clinic and were infected with COVID-19. COVID-19 infection information, such as severity, duration, and vaccination, was collected via phone calls. OSA severity was assessed using the apnea-hypopnea index (AHI). Data were analyzed using SPSS software, and a p value < 0.05 was considered significant.

Results: A total of 136 confirmed OSA and COVID-19-positive patients were included in the study. The majority were elderly and obese. Then, 29% of patients had mild, 30% had moderate, and 41% had severe OSA. The severity of OSA was significantly correlated with the COVID-19 type of treatment and recovery duration (p value = 0.002 and 0.001, respectively. Severe OSA correlated with higher BMI values. Notably, the type of COVID-19 vaccine, number of doses, and whether the COVID-19 infection occurred before or after vaccination did not affect the severity of OSA.

Conclusion: The severity of OSA and COVID-19 infection were correlated. The management of OSA severity and the control over other comorbidities may lower the chance of severe COVID-19 infection among OSA patients.