African Journal of Thoracic and Critical Care Medicine最新文献

Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has become the gold standard in diagnosing and performing nodal staging in patients with suspected lung cancer and diagnosing other malignant and benign diseases. Studies from countries with low tuberculosis (TB) incidence suggest that it has a sensitivity of 90 - 95% and a specificity of 100%.

Objectives: To investigate the utility of EBUS-TBNA in a community with a high HIV and TB burden.

Methods: We retrospectively reviewed all patients who underwent EBUS-TBNA to confirm a tissue diagnosis during a 2-year period from January 2017 - December 2018. Only patients with complete medical, pathology and radiology records and follow-up were included.

Results: During the 2 years, a total of 201 patients underwent EBUS-TBNA. Some patients (n=19) had incomplete notes or follow-up and 104 cases were ultimately diagnosed with benign nodal disease. In the 182 patients who were ultimately included in the present study, EBUS-TBNA had a sensitivity of 95.1% (95% confidence interval (CI) 88.6 - 98.2), specificity of 100% (95% CI 94.20 - 100), positive predictive value (PPV) of 100.00% (95% CI 95.3 - 100) and negative predictive value (NPV) of 94.1% (95% CI 86.0 - 97.8) for all diagnoses. The overall diagnostic accuracy was 97.3% (95% CI 93.9 - 99.2). Out of the 64 patients who had lung cancer, EBUS-TBNA had a sensitivity of 95.2% (95% CI 86.7 - 99.0), specificity of 100% (95% CI 5.5 - 100), PPV of 100.0% and NPV of 58.3% (95% CI 31.7 - 80.9). The overall diagnostic accuracy for lung cancer was 95.5% (95% CI 87.2 - 99.1%).

Conclusion: EBUS-TBNA has high diagnostic accuracy, even in a population with a high HIV and TB burden.

Background: Lung cancer is the leading cause of cancer-related death globally and in South Africa. Historically, the majority of patients diagnosed with lung cancer are incurable at presentation.

Objectives: To assess the tumour, nodes, metastasis (TNM) staging of lung cancer in a centre with access to both positron emission tomography-computed tomography (PET-CT) and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) using a structured diagnostic approach and to compare results with a historical cohort from 2009 from the same hospital.

Methods: A retrospective descriptive observational study was performed using the registry of a high-volume tertiary hospital's weekly multidisciplinary thoracic oncology meeting (MDT). A structured diagnostic approach was used for staging purposes. All patients with a tissue diagnosis of primary lung cancer and adequate imaging (chest CT and/or PET-CT) who presented at the MDT during the period from 1 January - 31 December 2019 were included. Final staging and tissue diagnoses were documented and compared with a historical cohort from 2009 from the same institution.

Results: Adenocarcinoma was the most common subtype (38.8%; n=116). Less than a tenth of patients (6.3%; n=16/254) with non-small cell lung cancer had potentially curable lung cancer (stage IA to IIIA) at presentation, significantly less than the 2009 cohort (14.5%; n=25/173; p=0.007). The most common procedure administered on patients was transthoracic needle aspiration (37.54%; n=112), followed by conventional bronchoscopic needle aspiration or biopsy (20.4%; n=61), and EBUS-TBNA (17.1%; n=51/299). After PET-CT, 19/30 cases were upstaged including 9/18 from potentially resectable to unresectable. Two of these cases were down-staged to potentially resectable following EBUS-TBNA.

Conclusion: There was a significant decline in resectable and potentially curable lung cancer at presentation over a 10-year period. PET-CT and EBUS-TBNA improved the accuracy of non-small cell lung cancer staging among patients with resectable and potentially curable lung cancer but have exposed a higher stage profile.

Pulmonary hypertension (PH) is a fatal disease with no cure. Combination therapy that includes several specialised medications can improve survival and quality of life. However, there are many challenges, and these include a lack of effective screening tools, misdiagnosis and late diagnosis, a lack of awareness among clinicians and patients, expensive PH medication and the unavailability of these medications in many developing countries. Based on the literature, this paper provides helpful approaches and 'out of the box' ideas to try to surmount these challenges. We make the following recommendations: develop better (contextually fitting) screening tools, investigate novel therapeutics or novel drug targets, implement incentivised and accredited training for clinicians and implement awareness campaigns (by using traditional and social media and promoting awareness at healthcare or educational institutions). Other recommendations include greater advocacy that engages public and private funders, combine scarce skills and networks of social sciences and implementation sciences and invite non-profit organisations to the fight against PH in conjunction with researchers. Furthermore, the implementation of breathlessness clinics in rural areas can be helpful, as well as the investigation of the biomarker potential of genetic mutations or unique gene signatures of patients during research. We hope that healthcare professionals, researchers, scientists and regulatory authorities or research bodies, can use our recommendations in a practical setting, especially in developing countries where resources are limited and the healthcare burden is high.

Background: Central line-associated bloodstream infections (CLABSIs) are frequently encountered device-related healthcare-associated infections in critically ill patients, causing substantial morbidity, mortality and prolonged hospitalisation.

Objectives: To determine the incidence of CLABSI, median catheter dwell-time prior to developing CLABSI, as well as the causative microorganisms of CLABSI among patients admitted to the multidisciplinary intensive care unit (MICU) at Universitas Academic Hospital, Bloemfontein.

Methods: We conducted a retrospective review of medical and laboratory records of all MICU patients who had a central line placed between January and December 2018.

Results: A total of 377 patients were admitted to the MICU in 2018, of which 182 met the inclusion criteria for the present study. From the cohort of 182 patients, 16.5% (n=30) of patients presented with 32 CLABSI episodes, with two patients having had two independent episodes each. A total of 1 215 central line days were recorded, yielding a CLABSI rate of 26.3/1 000-line days. Laboratory analysis identified microorganisms in 38 blood cultures, with Gram-negative organisms (55.3%; n=21) being predominant over Gram-positive organisms (39.5%; n=15) and fungi (5.3%; n=2).

Conclusion: The incidence of CLABSI at the MICU at Universitas Academic Hospital is high. Urgent intervention with strict compliance to prevention bundles is required to reduce the high incidence of CLABSI.

Pyogenic lung abscesses represent a pathological entity with a high mortality rate if left untreated. Most patients respond well to intravenous antibiotics. Following the failure of conservative measures, invasive measures such as open-surgical procedures are required. Minimally-invasive options such as percutaneous catheter drainage of parenchymal lung abscesses, mainly if the respiratory reserve is limited or where the baseline functional status is poor, are also considered viable options. Pyogenic lung abscesses are necrotic cavitary lesions of the lung parenchyma and are often considered to be in the spectrum of anaerobic pleuropulmonary diseases. In this case report, we report on a 33-year-old female who presented with a 3-week history of cough, increasing breathlessness and right-sided pleurisy. She was diagnosed with pyogenic lung abscess and started on intravenous antibiotics. The abscess was drained using a pigtail catheter guided with a bedside ultrasonography.