Annals of Thoracic Medicine最新文献_第5页

The diagnostic accuracy of perfusion-only scan in the diagnosis of pulmonary embolism in the era of COVID-19: A single-center study of 434 patients 新冠肺炎时代仅灌注扫描诊断肺栓塞的准确性:434例患者的单中心研究

4区医学 Q1 Medicine

Annals of Thoracic Medicine

Pub Date : 2023-01-01 DOI: 10.4103/atm.atm_42_23

Turgut Bora Cengiz, Ahmed Abdelrahman, Scott A. Rohren, John Doucette, Munir Ghesani

Abstract: INTRODUCTION: There is a paucity of data in the literature regarding the diagnostic accuracy of perfusion (Q)-only studies in the absence of ventilation images. This study aims to assess the diagnostic accuracy of Q-only imaging in the pandemic era. METHODS: Patients who underwent Q-only imaging for pulmonary embolism between March 2020 and February 2021 were analyzed. Patients who underwent lung quantification analysis were excluded. Q-only test results were reported as per modified PIOPED II criteria and single positron emission tomography/computed tomography (SPECT/CT) imaging was performed as needed. Patients were considered concordant or discordant by correlating the Q-only results with CT angiogram (CTA) or clinical diagnosis made through chart review. The diagnostic accuracy was calculated after excluding intermediate probability and nondiagnostic studies. RESULTS: Four hundred and thirty-four patients were identified. One hundred and twenty-eight patients (29.4%) underwent ultrasound Doppler, 37 patients (8.5%) underwent CTA, and 16 patients (3.6%) underwent both. After excluding patients with intermediate probability or nondiagnostic studies and who did not have follow-up (a total of 87 patients [20%]), 347 patients were enrolled in the final analysis. The combined planar and SPECT/CT sensitivity and specificity were 85.4% (72.2%–93.9% confidence interval [CI]) and 98.7% (96.9%–98.6% CI), respectively. The positive predictive value (PPV) of the Q-only imaging was 89.1% (77.3%–95.1% CI) and the negative predictive value (NPV) was 98.2% (96.4%–99% CI). The sensitivity with SPECT/CT reached 100% (CI: 71.5%–100%) with a specificity of 92.3% (CI: 64%–99.8%). The PPV was 85.7% (CI: 62.1%–95.6%) and the NPV was 100%. CONCLUSION: Q-only imaging provides clinically acceptable results. The sensitivity of the Q-only scan is increased when coupled with SPECT/CT.

摘要:引言:在缺乏通气图像的情况下，关于灌注(Q)研究的诊断准确性，文献中缺乏数据。本研究旨在评估大流行时期仅q成像的诊断准确性。方法:分析2020年3月至2021年2月期间接受肺栓塞Q-only成像的患者。排除进行肺定量分析的患者。根据修改后的piped II标准报告Q-only测试结果，并根据需要进行单正电子发射断层扫描/计算机断层扫描(SPECT/CT)成像。通过将Q-only结果与CT血管造影(CTA)或通过图表复习进行临床诊断的相关性来判断患者是否一致。排除中间概率和非诊断性研究后计算诊断准确性。结果:共鉴定出434例患者。128例患者(29.4%)行超声多普勒检查，37例(8.5%)行CTA检查，16例(3.6%)两者均行。在排除中间概率或非诊断性研究和未随访的患者(共87例[20%])后，最终分析纳入347例患者。平面和SPECT/CT联合检测的敏感性和特异性分别为85.4%(72.2% ~ 93.9%可信区间[CI])和98.7% (96.9% ~ 98.6% CI)。纯q成像阳性预测值(PPV)为89.1% (77.3% ~ 95.1% CI)，阴性预测值(NPV)为98.2% (96.4% ~ 99% CI)。SPECT/CT的敏感性达到100% (CI: 71.5% ~ 100%)，特异性为92.3% (CI: 64% ~ 99.8%)。PPV为85.7% (CI: 62.1% ~ 95.6%)， NPV为100%。结论:纯q成像可提供临床可接受的结果。当与SPECT/CT耦合时，仅q扫描的灵敏度增加。

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引用次数: 0

Optimal positive airway pressure requirement and polysomnography indices of obstructive sleep apnea severity in the Saudi population. 沙特人群阻塞性睡眠呼吸暂停严重程度的最佳气道正压需求和多导睡眠图指标。

IF 2.3 4区医学 Q1 Medicine

Annals of Thoracic Medicine

Pub Date : 2023-01-01 Epub Date: 2023-01-25 DOI: 10.4103/atm.atm_183_22

Ahmad A Bamagoos, Shahad A Alshaynawi, Atheer S Gari, Atheer M Badawi, Mudhawi H Alhiniah, Asma A Alshahrani, Renad R Rajab, Reem K Bahaj, Faris Alhejaili, Siraj O Wali

Context: Positive airway pressure (PAP) is the first-line therapy for obstructive sleep apnea (OSA). Overnight PAP titration for determining optimal PAP requirements is expensive and often inconvenient. Prediction of optimal PAP requirements from diagnostic polysomnography via mathematical equations is possible but variable across populations.

Aims: We aimed to (1) determine the optimal PAP requirement, (2) determine differences in optimal PAP requirements across OSA severity groups, (3) determine the relationship between optimal PAP requirement and diagnostic polysomnography measurements of OSA severity, and (4) develop a pilot equation to predict the optimal PAP requirement from diagnostic polysomnography in a sample from the Saudi population.

Methods: We analyzed records pertaining to adult OSA patients (n = 215; 63% of males) who underwent standardized diagnostic and titration polysomnography in our sleep laboratory between 2015 and 2019. Demographic, anthropometric, and clinical information were also collected for the analysis. Inferential statistics were performed for comparisons between diagnostic and titration studies and between OSA severity groups. Regression analyses were also performed to determine the potential predictors of optimal PAP requirements. Data were presented as the mean (± standard deviation) or median (25^th-75^th quartiles) according to normality.

Results: The median optimal PAP requirement was 13 (9-17) cmH₂O. The optimal PAP requirement was significantly greater for male versus female participants (14 [10-17] vs. 12 [8-16] cmH₂O) and for participants with severe OSA (16 [12-20] cmH₂O, n = 119) versus those with moderate (11 [8-14] cmH₂O, n = 63) or mild (9 [7-12] cmH₂O, n = 33) OSA. When combined, nadir oxygen saturation, oxygen desaturation index, and arousal index could be used to predict the optimal PAP requirement (R ²= 0.39, F = 34.0, P < 0.001).

Conclusions: The optimal PAP requirement in the Saudi population is relatively high and directly correlated with OSA severity. Diagnostic polysomnography measurements of OSA severity predicted the optimal PAP requirement in this sample. Prospective validation is warranted.

背景：气道正压通气（PAP）是治疗阻塞性睡眠呼吸暂停（OSA）的一线药物。用于确定最佳PAP要求的过夜PAP滴定是昂贵的并且通常是不方便的。通过数学方程从诊断性多导睡眠图中预测最佳PAP需求是可能的，但在不同人群中是可变的。目的：我们旨在（1）确定最佳PAP要求，（2）确定OSA严重程度组之间最佳PAP需求的差异，（3）确定最优PAP要求与OSA严重性的诊断性多导睡眠图测量之间的关系，和（4）开发一个先导方程，以预测来自沙特人口样本的诊断性多导睡眠图的最佳PAP需求。方法：我们分析了2015年至2019年间在我们的睡眠实验室接受标准化诊断和滴定多导睡眠图检查的成年OSA患者（n=215；63%的男性）的记录。还收集了人口统计学、人体测量和临床信息进行分析。对诊断和滴定研究之间以及OSA严重程度组之间的比较进行推断统计。还进行了回归分析，以确定最佳PAP需求的潜在预测因素。根据正态性，数据以平均值（±标准差）或中位数（第25至75个四分位数）表示。结果：PAP的中位最佳需求量为13（9-17）cmH2O。男性参与者的最佳PAP需求显著高于女性参与者（14[10-17]vs.12[8-16]cmH2O），重度OSA参与者（16[12-20]cmH2O，n=119）的最优PAP需求明显高于中度（11[8-14]cmH2O，n=63）或轻度（9[7-12]cm H2O，n=33）OSA参与者。当将最低点氧饱和度、氧去饱和指数和唤醒指数相结合时，可用于预测最佳PAP需求量（R2=0.39，F=34.0，P<0.001）。结论：沙特人群的最佳PAP需要量相对较高，与OSA严重程度直接相关。OSA严重程度的诊断性多导睡眠图测量预测了该样本的最佳PAP需求。有必要进行前瞻性验证。

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引用次数: 0

Outcomes of patients admitted to the intensive care unit with community-acquired pneumonia in a tertiary care center in Riyadh, Saudi Arabia 沙特阿拉伯利雅得一家三级医疗中心社区获得性肺炎重症监护病房收治患者的结局

4区医学 Q1 Medicine

Annals of Thoracic Medicine

Pub Date : 2023-01-01 DOI: 10.4103/atm.atm_49_23

Talal Oreibi, Farhan Alenezi, Amjad M. Ahmed, Felwa Bin Humaid, Musharaf Sadat, Hani Mohammed Tamim, Faisal Fouad Baseet, Brintha Naidu, Yaseen M. Arabi

Abstract: BACKGROUND: Community-acquired pneumonia (CAP) is a leading cause of intensive care unit (ICU) morbidity and mortality. Despite extensive international epidemiological and clinical studies to improve those patients’ outcomes, local statistics in Saudi Arabia are limited. The objective of this study is to describe the clinical characteristics and outcomes of patients admitted to the ICU with the diagnosis of CAP reflecting the experience of a tertiary center over an 18-year period. METHODS: A retrospective cohort study included all consecutive adult ICU patients diagnosed with CAP between 1999 and 2017. Baseline demographics, patients’ risk factors, and initial admission laboratory investigations were compared between survivors and nonsurvivors. A multivariate regression model was used to predict mortality. RESULTS: During the study period, there were 3438 patients admitted to the ICU with CAP (median age 67 [Quartile 1, 3 (Q1, Q3) 51, 76] years) and 54.4% were males, of whom 1007 (29.2%) died. The survivors compared with nonsurvivors were younger (65 vs. 70 years), less likely to have chronic liver disease (2.4% vs. 10.5%), chronic renal failure (8.1% vs. 14.4%), and be immunocompromised (10.2% vs. 18.2%), and less frequently required mechanical ventilation or vasopressors (46.2% vs. 80.5% and 29.6% vs. 55.9%, respectively). Acute Physiology and Chronic Health Evaluation (APACHE) II score was significantly higher among nonsurvivors (median score 26 vs. 20) with a longer duration of mechanical ventilation and ICU stay. Using a multivariate regression model, age, APACHE II score, bilirubin level, vasopressors, and mechanical ventilation were significantly associated with increased mortality, while diabetes was associated with lower mortality. CONCLUSION: Around one-third of patients admitted to the ICU with CAP died. Mortality was significantly associated with age, APACHE II score, vasopressor use, and mechanical ventilation. A comprehensive national registry is needed to enhance epidemiological data and to guide initiatives for improving CAP patients’ outcomes.

摘要:背景:社区获得性肺炎(CAP)是重症监护病房(ICU)发病率和死亡率的主要原因。尽管进行了广泛的国际流行病学和临床研究，以改善这些患者的预后，但沙特阿拉伯的当地统计数据有限。本研究的目的是描述被诊断为CAP的ICU患者的临床特征和结果，这些患者反映了三级中心18年来的经验。方法:一项回顾性队列研究纳入了1999年至2017年期间诊断为CAP的所有连续成人ICU患者。在幸存者和非幸存者之间比较基线人口统计学、患者危险因素和初次入院实验室调查。采用多元回归模型预测死亡率。结果:研究期间，ICU共收治CAP患者3438例(中位年龄67[1、3 (Q1、Q3) 51、76]岁)，男性占54.4%，其中死亡1007例(29.2%)。与非幸存者相比，幸存者更年轻(65岁vs 70岁)，患慢性肝病(2.4% vs. 10.5%)、慢性肾功能衰竭(8.1% vs. 14.4%)和免疫功能低下(10.2% vs. 18.2%)的可能性更小，需要机械通气或血管加压药物的频率更低(46.2% vs. 80.5%和29.6% vs. 55.9%)。急性生理和慢性健康评估(APACHE) II评分在机械通气和ICU住院时间较长的非幸存者中明显较高(中位评分26比20)。使用多变量回归模型，年龄、APACHE II评分、胆红素水平、血管加压剂和机械通气与死亡率增加显著相关，而糖尿病与死亡率降低相关。结论:ICU收治的CAP患者中约有三分之一死亡。死亡率与年龄、APACHEⅱ评分、血管加压剂使用和机械通气显著相关。需要一个全面的国家登记来加强流行病学数据并指导改善CAP患者预后的举措。

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引用次数: 0

The advantages of inhalational sedation using an anesthetic-conserving device versus intravenous sedatives in an intensive care unit setting: A systematic review 在重症监护病房使用麻醉保存装置吸入镇静与静脉镇静的优势:一项系统综述

4区医学 Q1 Medicine

Annals of Thoracic Medicine

Pub Date : 2023-01-01 DOI: 10.4103/atm.atm_89_23

Zohair Al Aseri, Mariam Ali Alansari, Sara Ali Al-Shami, Bayan Alaskar, Dhuha Aljumaiah, Alyaa Elhazmi

Abstract: BACKGROUND: Sedation is fundamental to the management of patients in the intensive care unit (ICU). Its indications in the ICU are vast, including the facilitating of mechanical ventilation, permitting invasive procedures, and managing anxiety and agitation. Inhaled sedation with halogenated agents, such as isoflurane or sevoflurane, is now feasible in ICU patients using dedicated devices/systems. Its use may reduce adverse events and improve ICU outcomes compared to conventional intravenous (IV) sedation in the ICU. This review examined the effectiveness of inhalational sedation using the anesthetic conserving device (ACD) compared to standard IV sedation for adult patients in ICU and highlights the technical aspects of its functioning. METHODS: We searched the PubMed, Cochrane Central Register of Controlled Trials, The Cochrane Library, MEDLINE, Web of Science, and Sage Journals databases using the terms “anesthetic conserving device,” “Anaconda,” “sedation” and “intensive care unit” in randomized clinical studies that were performed between 2012 and 2022 and compared volatile sedation using an ACD with IV sedation in terms of time to extubation, duration of mechanical ventilation, and lengths of ICU and hospital stay. RESULTS: Nine trials were included. Volatile sedation (sevoflurane or isoflurane) administered through an ACD shortened the awakening time compared to IV sedation (midazolam or propofol). CONCLUSION: Compared to IV sedation, volatile sedation administered through an ACD in the ICU shortened the awakening and extubation times, ICU length of stay, and duration of mechanical ventilation. More clinical trials that assess additional clinical outcomes on a large scale are needed.

摘要:背景:镇静是重症监护病房(ICU)患者管理的基础。它在ICU的适应症是广泛的，包括促进机械通气，允许侵入性手术，以及控制焦虑和躁动。使用专用设备/系统吸入卤化剂镇静，如异氟醚或七氟醚，现在在ICU患者中是可行的。与传统的静脉(IV)镇静相比，使用它可以减少不良事件并改善ICU的预后。本综述比较了ICU成人患者使用麻醉保存装置(ACD)吸入镇静与标准静脉镇静的有效性，并强调了其功能的技术方面。方法:我们检索PubMed、Cochrane中央对照试验注册库、Cochrane图书馆、MEDLINE、Web of Science和Sage期刊数据库，检索2012年至2022年间进行的随机临床研究中的“麻醉保存装置”、“Anaconda”、“镇静”和“重症监护病房”，比较使用ACD和IV镇静的挥发性镇静拔管时间、机械通气持续时间、ICU和住院时间。结果:纳入9项试验。与静脉镇静(咪达唑仑或异丙酚)相比，通过ACD给予挥发性镇静(七氟醚或异氟醚)可缩短苏醒时间。结论:与静脉镇静相比，在ICU中通过ACD给予挥发性镇静可缩短苏醒和拔管次数、ICU住院时间和机械通气时间。需要更多的临床试验来评估更多的大规模临床结果。

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引用次数: 0

Increased airway resistance among exclusive waterpipe smokers detected using impulse oscillometry. 使用脉冲示波法检测到纯水烟吸烟者的气道阻力增加。

IF 2.3 4区医学 Q1 Medicine

Annals of Thoracic Medicine

Pub Date : 2023-01-01 Epub Date: 2023-01-25 DOI: 10.4103/atm.atm_165_22

Hassan A Chami, Nourhan Houjeij, Maha Makki, Lina Itani, Hani Tamim, Ahmad Al Mulla, Bartolome Celli, Salah Zeineldine

Introduction: Waterpipe smoking is increasing in popularity, yet the evidence implicating waterpipe smoking in lung disease is limited. We hypothesized that impulse oscillometry (IOS) would detect airway abnormalities in waterpipe smokers (WPS).

Methods: We studied 210 participants, 40 years or older, from the community, of whom 92 were exclusive WPS and 118 were never-smokers. Waterpipe smoking history was assessed using a validated questionnaire. All participants underwent spirometry, and IOS and absolute and percentage predicted results (for age, sex, height, and weight) were compared between WPS and nonsmokers. The association of IOS parameters with waterpipe smoking duration and extent (waterpipe smoked/day * smoking duration) was evaluated using linear regression.

Results: WPS smoked on average 1.8 ± 1.2 waterpipes/day, over an average duration of 23.3 ± 39.8 years. WPS and nonsmokers were largely asymptomatic and had similar age, body mass index, sex distribution, and spirometric values. Nevertheless, WPS had higher IOS measured resistance at 5Hz compared to nonsmokers, (0.53 ± 0.2 vs. 0.48 ± 0.2 kPa/L/s, P = 0.03) and higher percentage-predicted resistance (124.5 ± 36.3 vs. 115.7% ± 35.6%, P = 0.04). Waterpipe smoking duration was also associated with resistance (β = 0.04 kPa/L/s/year, P = 0.01) and with percentage-predicted resistance (β = 0.05/year, P = 0.02). Waterpipe smoking extent was associated with resistance (β = 0.009 kPa/L/s/waterpipe-year, P = 0.04), while the association with percentage-predicted resistance was near significance (β = 0.009/waterpipe-year, P = 0.07).

Conclusions: Waterpipe smoking is associated with increased airway resistance assessed by IOS but not by spirometry in largely asymptomatic individuals from the community.

引言：水烟越来越受欢迎，但水烟与肺部疾病有关的证据有限。我们假设脉冲示波法（IOS）可以检测水管吸烟者（WPS）的气道异常。方法：我们研究了来自社区的210名40岁或以上的参与者，其中92人是专门的WPS，118人从不吸烟。使用经验证的问卷对水烟管吸烟史进行评估。所有参与者都接受了肺活量测定，并比较WPS和非吸烟者的IOS以及绝对和百分比预测结果（年龄、性别、身高和体重）。使用线性回归评估IOS参数与水烟管吸烟持续时间和程度（水烟管/天*吸烟持续时间）的相关性。结果：WPS平均每天抽1.8±1.2根水管，平均持续时间为23.3±39.8年。WPS和非吸烟者大多无症状，年龄、体重指数、性别分布和肺活量测定值相似。然而WPS在5Hz下具有比不吸烟者更高的IOS测量电阻，（0.53±0.2 vs.0.48±0.2 kPa/L/s，P=0.03）和较高的预测阻力百分比（124.5±36.3 vs.115.7%±35.6%，P=0.04）。水烟持续时间也与阻力相关（β=0.04 kPa/L/s/年，P=0.01）和预测阻力百分比相关（β0.05/年，P=0.02）（β=0.009 kPa/L/s/水管道年，P=0.04），而与预测阻力百分比的相关性接近显著（β=0.009/水管道每年，P=0.07）。结论：在社区中大部分无症状的个体中，水管道吸烟与IOS评估的气道阻力增加有关，但与肺活量测量无关。

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引用次数: 1

Retransplantation for COVID-19-related lung graft failure: A case report of successful outcome in a critically ill lung transplant recipient 新冠肺炎相关肺移植失败再移植一例危重患者肺移植成功

4区医学 Q1 Medicine

Annals of Thoracic Medicine

Pub Date : 2023-01-01 DOI: 10.4103/atm.atm_107_23

Prince Ntiamoah, Marie Budev, Jason Turowski, Charles Randall Lane, Kenneth R. McCurry

Abstract: End-stage lung disease from nonrecovered COVID-19 acute respiratory distress syndrome has become an increasingly frequent indication for lung transplant. Although reports of lung transplant recipients (LTRs) with COVID-19 suggest an increased risk for hospitalization, respiratory failure, and death, little is known about retransplant for COVID-19-related lung graft failure. In this manuscript, we present a 49-year-old man who received bilateral lung retransplantation for COVID-19-related lung graft failure, 7½ years after his initial transplant for idiopathic pulmonary fibrosis. Our case suggests that retransplantation may be a viable option for critically ill LTRs with COVID-19-related graft failure, even in the presence of other organ dysfunction, provided that they are in good condition and have an immunologically favorable donor.

摘要:新冠肺炎(COVID-19)急性呼吸窘迫综合征终末期肺部疾病已日益成为肺移植的常见指征。尽管关于COVID-19肺移植受者(LTRs)的报告表明住院、呼吸衰竭和死亡的风险增加，但对与COVID-19相关的肺移植衰竭的再移植知之甚少。在这篇文章中，我们报道了一名49岁的男性，他在因特发性肺纤维化而首次移植7年半后，因covid -19相关的肺移植失败接受了双侧肺移植。我们的病例表明，对于患有covid -19相关移植物衰竭的危重LTRs，即使存在其他器官功能障碍，只要他们身体状况良好并且有一个免疫有利的供体，再移植可能是一个可行的选择。

引用次数: 0

Post-COVID-19 pulmonary fibrosis: An ongoing concern covid -19后肺纤维化:一个持续的问题

4区医学 Q1 Medicine

Annals of Thoracic Medicine

Pub Date : 2023-01-01 DOI: 10.4103/atm.atm_7_23

Nuha Nasser Alrajhi

Abstract: Coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 rapidly spread across the globe causing over 6 million deaths and major compromization of health facilities. The vast majority of survivors post-COVID-19 are left with variable degrees of health sequelae including pulmonary, neurological, psychological, and cardiovascular complications. Post-COVID-19 pulmonary fibrosis is one of the major concerns arising after the recovery from this pandemic. Risk factors for post-COVID-19 pulmonary fibrosis include age, male sex, and the severity of COVID-19 disease. High-resolution computed tomography provides diagnostic utility to diagnose pulmonary fibrosis as it provides more details regarding the pattern and the extent of pulmonary fibrosis. Emerging data showing similarities between post-COVID-19 pulmonary fibrosis and idiopathic pulmonary fibrosis, finding that needs further exploration. The management of post-COVID-19 pulmonary fibrosis depends on many factors but largely relies on excluding other causes of pulmonary fibrosis, the extent of fibrosis, and physiological impairment. Treatment includes immunosuppressants versus antifibrotics or both.

摘要:由严重急性呼吸综合征冠状病毒2引起的冠状病毒病(COVID-19)在全球迅速蔓延，造成600多万人死亡，并对卫生设施造成重大损害。绝大多数2019冠状病毒病后幸存者都留下了不同程度的健康后遗症，包括肺部、神经系统、心理和心血管并发症。covid -19后肺纤维化是本次大流行复苏后出现的主要问题之一。COVID-19后肺纤维化的危险因素包括年龄、男性性别和COVID-19疾病的严重程度。高分辨率计算机断层扫描提供了诊断肺纤维化的实用工具，因为它提供了更多关于肺纤维化模式和范围的细节。新数据显示covid -19后肺纤维化与特发性肺纤维化存在相似性，这一发现有待进一步探索。covid -19后肺纤维化的管理取决于许多因素，但主要取决于排除肺纤维化的其他原因、纤维化程度和生理损伤。治疗包括免疫抑制剂与抗纤维化药物或两者兼而有之。

引用次数: 0

When single-inhaler triple therapy is a preferred option in asthma management? 何时单吸入器三联疗法是哮喘治疗的首选?

IF 2.3 4区医学 Q1 Medicine

Annals of Thoracic Medicine

Pub Date : 2022-10-01 Epub Date: 2022-10-07 DOI: 10.4103/atm.atm_341_22

Mohamed S Al-Moamary, Riyad Al-Lehebi, Majdy M Idrees, Mohammed O Zeitouni

Asthma control is the main goal of management. Unfortunately, most asthma patients with moderate-severe asthma remain uncontrolled despite receiving standard treatment of inhaled corticosteroids (ICS) with long-acting β2 agonists (LABA). The addition of long-acting antimuscarinic agents (LAMA) has been shown to improve different aspects of asthma control, including symptoms, lung functions, and probably exacerbations. Such an option could be considered for low-T2 asthma phenotype. Umeclidinium and glycopyrronium bromide are other LAMA agents that have been recently made available in combination with ICS and LABA in single-inhaler triple therapy (SITT) devices. Here, we discuss the position of SITT as a new novel therapeutic option in asthma management and its clinical benefits, potential cost saving, and improved compliance.

哮喘控制是哮喘管理的主要目标。不幸的是，大多数中重度哮喘患者尽管接受了吸入性皮质类固醇(ICS)和长效β2激动剂(LABA)的标准治疗，但仍未得到控制。添加长效抗毒蕈碱剂(LAMA)已被证明可以改善哮喘控制的不同方面，包括症状、肺功能和可能的恶化。对于低t2型哮喘患者，可以考虑这种选择。Umeclidinium和glycopyronium溴化铵是最近在单吸入器三联治疗(SITT)装置中与ICS和LABA联合使用的其他LAMA药物。在这里，我们讨论了SITT作为一种新的哮喘治疗选择的地位，以及它的临床效益、潜在的成本节约和提高的依从性。

引用次数: 1

Coinfection of pulmonary tuberculosis with other lower respiratory tract infections: A retrospective cross-sectional study. 肺结核合并其他下呼吸道感染的回顾性横断面研究。

IF 2.3 4区医学 Q1 Medicine

Annals of Thoracic Medicine

Pub Date : 2022-10-01 Epub Date: 2022-08-26 DOI: 10.4103/atm.atm_200_22

Marwh G Aldriwesh, Raghad A Alaqeel, Aisha M Mashraqi, Mutaib M Mashraqi, Bayan A Albdah, Azzah S Alharbi

Background: Little attention has been given to the development of lower respiratory tract infections (LRTIs) in patients with pulmonary tuberculosis (PTB) during their anti-tuberculosis (anti-TB) treatment and how that might affect patients' health status. Here, the prevalence and etiologies of other LRTIs in a cohort of PTB patients were determined, and the clinical features and outcomes were described.

Methods: Adult patients with PTB between 2015 and 2020 were recruited and monitored during their anti-TB treatment for the presence of LRTIs. Clinical data were retrospectively collected from patients' medical records.

Results: Data from 76 PTB patients (57 [75%] males) were reviewed. The median age was 61.0 (interquartile range 83.5-35.5) years, and other LRTIs were detected in 45 (59.2%) PTB patients. Of the 126 episodes of LRTIs, 84 (66.7%) were due to bacterial infections, 37 (29.4%) were due to fungal infections, and 5 (3.9%) were due to viral infections. The development of LRTIs was significantly more common in older (P = 0.012) and hypertensive patients with PTB (P = 0.019). Patients with PTB and LRTIs experienced significantly more frequent extrapulmonary infections (P = 0.0004), bloodstream infections (P = 0.001), intensive care unit stays (P = 0.001), and invasive mechanical ventilation use (P = 0.03) than patients who did not develop LRTI.

Conclusions: The identification of host-related risk factors for LRTI development among patients with PTB could be used to develop a prediction model for LRTI development. Hence, initiating antimicrobials early, in parallel with appropriate anti-TB treatment, may mitigate PTB-related health and economic consequences.

背景:肺结核(PTB)患者在抗结核治疗过程中发生下呼吸道感染(LRTIs)及其对患者健康状况的影响很少受到关注。本文确定了PTB患者队列中其他下呼吸道感染的患病率和病因，并描述了临床特征和结果。方法:招募2015年至2020年期间患有PTB的成年患者，并在其抗结核治疗期间监测下呼吸道感染的存在。回顾性收集患者病历中的临床资料。结果:回顾了76例PTB患者的资料，其中57例(75%)为男性。中位年龄为61.0岁(四分位间距为83.5-35.5岁)，在45例(59.2%)PTB患者中检测到其他下呼吸道感染。126例LRTIs中，细菌感染84例(66.7%)，真菌感染37例(29.4%)，病毒感染5例(3.9%)。老年(P = 0.012)和高血压合并肺结核(P = 0.019)患者中lrti的发生更为常见。PTB和LRTI患者的肺外感染(P = 0.0004)、血流感染(P = 0.001)、重症监护病房住院时间(P = 0.001)和有创机械通气使用(P = 0.03)明显高于未发生LRTI的患者。结论:识别肺结核患者下呼吸道感染发生的宿主相关危险因素可用于建立下呼吸道感染发生的预测模型。因此，尽早开始使用抗微生物药物，同时进行适当的抗结核治疗，可减轻结核病相关的健康和经济后果。

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引用次数: 0

Comparing the characteristics of positional and nonpositional sleep apnea patients among the Jordanian population. 比较约旦人群中体位和非体位睡眠呼吸暂停患者的特征。

IF 2.3 4区医学 Q1 Medicine

Annals of Thoracic Medicine

Pub Date : 2022-10-01 Epub Date: 2022-10-07 DOI: 10.4103/atm.atm_214_22

Khaled Al Oweidat, Ahmad A Toubasi, Asma S Albtoosh, Eyad Al-Mefleh, Manar M Hasuneh, Ahmed A Abdulelah, Rima A Sinan

Background: Obstructive sleep apnea (OSA) is a common cause of sleep-disordered breathing with a large proportion of the patients exhibiting positional OSA (POSA). In this study, we aimed to evaluate the differences in the demographics, comorbidities, and polysomnographic features between POSA and non-POSA (NPOSA) in a Jordanian sample to further discern the propulsive elements for each group.

Methods: In this study, we evaluated 1037 adult patients with OSA. POSA was defined as an overall apnea and hypopnea index (AHI) >5, an overall AHI severity at least 1.4 times the nonsupine severity (overall/NS-AHI), and a minimum amount of time (i.e., 20 min) in the supine and nonsupine positions. To compare the clinical characteristics between POSA and NPOSA patients, statistical analyses were performed.

Results: The prevalence of POSA was 41.7%. In comparison to NPOSA patients, POSA patients had higher female sex prevalence, milder OSA, lower body mass index, lower hypertension prevalence, and lower hemoglobin A1C levels compared to NPOSA patients. Moreover, sleep efficiency, total sleep time, and supine sleep time were significantly higher in POSA patients. Nonsupine sleep time, total AHI, rapid eye movement (REM) AHI, non-REM (NREM) AHI, supine AHI, nonsupine AHI, left and right AHI, mean oxyhemoglobin saturation (SpO₂) awake, mean REM and NREM SpO₂, SpO₂ nadir, and time SpO₂ below 90% were significantly lower among POSA patients. The multivariate regression analysis showed that only female gender and hypertension were significantly associated with POSA.

Conclusion: POSA is common among OSA patients and demonstrates different clinical characteristics in comparison to NPOSA. Future prospective studies are needed to better characterize the POSA patients and investigate the benefit of positional therapy.

背景:阻塞性睡眠呼吸暂停(OSA)是睡眠呼吸障碍的常见原因，很大一部分患者表现为体位性睡眠呼吸暂停(POSA)。在这项研究中，我们旨在评估约旦样本中POSA和非POSA (NPOSA)之间的人口统计学，合并症和多导睡眠图特征的差异，以进一步辨别每组的促进因素。方法:在本研究中，我们评估了1037例成人OSA患者。POSA被定义为整体呼吸暂停和低通气指数(AHI) >5，整体AHI严重程度至少是非仰卧位严重程度(overall/NS-AHI)的1.4倍，并且在仰卧位和非仰卧位上停留的时间最少(即20分钟)。比较POSA与NPOSA患者的临床特征，进行统计学分析。结果:POSA患病率为41.7%。与NPOSA患者相比，POSA患者具有更高的女性患病率、较轻的OSA、较低的体重指数、较低的高血压患病率和较低的血红蛋白A1C水平。此外，POSA患者的睡眠效率、总睡眠时间和仰卧睡眠时间均显著高于POSA患者。POSA患者非仰卧位睡眠时间、总AHI、快速眼动(REM) AHI、非快速眼动(NREM) AHI、仰卧位AHI、非仰卧位AHI、左右侧AHI、醒时平均血红蛋白氧饱和度(SpO2)、REM和NREM平均SpO2、SpO2最低点、SpO2低于90%的时间均显著降低。多因素回归分析显示，只有女性和高血压与POSA有显著相关。结论:OSA患者中POSA较为常见，但与NPOSA具有不同的临床特征。未来的前瞻性研究需要更好地描述POSA患者并调查体位疗法的益处。

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引用次数: 3