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Giannis D, Goldin M, Rahman H, Sison CP, Lesser ML, Ngu S, Tsang J, Qiu M, Sanghani S, Yeh J, Matsagkas M, Arnaoutoglou E, Spyropoulos AC. Risk Factors for Postdischarge Major Thromboembolism and Mortality in Hospitalized Patients with COVID-19 with Cardiovascular Comorbidities: Insights from the CORE-19 Registry. Thromb Haemost 2023; 123:1089-1099. [PMID: 37146648 DOI: 10.1055/a-2087-3003] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) is associated with venous and arterial thromboembolism (VTE and ATE) and all-cause mortality (ACM) in hospitalized patients. High-quality data are needed on postdischarge outcomes in patients with cardiovascular disease. OBJECTIVES To analyze outcomes and identify risk factors for ATE, VTE, and ACM in a high-risk subgroup of hospitalized COVID-19 patients with baseline cardiovascular disease. METHODS We investigated postdischarge rates and associated risk factors of ATE, VTE, and ACM in 608 hospitalized COVID-19 patients with coronary artery disease, carotid artery stenosis (CAS), peripheral arterial disease (PAD), or ischemic stroke. RESULTS Through 90 days postdischarge, outcome rates were: ATE 27.3% (10.2% myocardial infarction, 10.1% ischemic stroke, 13.2% systemic embolism, 12.7% major adverse limb event); VTE 6.9% (4.1% deep vein thrombosis, 3.6% pulmonary embolism); composite of ATE, VTE, or ACM 35.2% (214/608). Multivariate analysis showed significant association between this composite endpoint and age >75 years (odds ratio [OR]: 1.90, 95% confidence interval [CI]: 1.22-2.94, p = 0.004), PAD (OR: 3.23, 95% CI: 1.80-5.81, p ≤ 0.0001), CAS (OR: 1.74, 95% CI: 1.11-2.75, p = 0.017), congestive heart failure (CHF) (OR: 1.84, 95% CI: 1.02-3.35, p = 0.044), previous VTE (OR: 3.08, 95% CI: 1.75-5.42, p < 0.0001), and intensive care unit (ICU) admission (OR: 2.93, 95% CI: 1.81-4.75, p < 0.0001). CONCLUSION COVID-19 inpatients with cardiovascular disease experience high rates of ATE, VTE, or ACM through 90 days postdischarge. Age >75 years, PAD, CAS, CHF, previous VTE, and ICU admission are independent risk factors.
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Affiliation(s)
- Dimitrios Giannis
- Institute of Health Systems Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, United States
- Department of Vascular Surgery, University of Thessaly, Larissa, Greece
- Department of Medicine, Anticoagulation and Clinical Thrombosis Services, Northwell Health at Lenox Hill Hospital, New York, New York, United States
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
| | - Mark Goldin
- Institute of Health Systems Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, United States
- Department of Medicine, Anticoagulation and Clinical Thrombosis Services, Northwell Health at Lenox Hill Hospital, New York, New York, United States
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
| | - Husneara Rahman
- Institute of Health Systems Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, United States
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
| | - Cristina P Sison
- Institute of Health Systems Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, United States
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
| | - Martin L Lesser
- Institute of Health Systems Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, United States
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
| | - Sam Ngu
- Institute of Health Systems Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, United States
- Department of Medicine, Anticoagulation and Clinical Thrombosis Services, Northwell Health at Lenox Hill Hospital, New York, New York, United States
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
| | - James Tsang
- Institute of Health Systems Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, United States
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
| | - Michael Qiu
- Institute of Health Systems Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, United States
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
| | - Shreya Sanghani
- Institute of Health Systems Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, United States
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
| | - Jackson Yeh
- Institute of Health Systems Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, United States
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
| | - Miltiadis Matsagkas
- Department of Vascular Surgery, University of Thessaly, Larissa, Greece
- Department of Anesthesiology, University of Thessaly, Larissa, Greece
| | - Eleni Arnaoutoglou
- Department of Vascular Surgery, University of Thessaly, Larissa, Greece
- Department of Anesthesiology, University of Thessaly, Larissa, Greece
| | - Alex C Spyropoulos
- Institute of Health Systems Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, United States
- Department of Medicine, Anticoagulation and Clinical Thrombosis Services, Northwell Health at Lenox Hill Hospital, New York, New York, United States
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
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West LJ, Tomko C, Sessanna L, Paplham P, Austin-Ketch T. Perceived Needs Among Healthcare Providers Caring for Seriously Ill Adults Regarding Electronic Health Record Triggers for Palliative Care Referral. Comput Inform Nurs 2023; 41:853-860. [PMID: 37562432 DOI: 10.1097/cin.0000000000001021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
Many healthcare facilities in the United States currently utilize electronic health record triggers to promote and facilitate palliative care referral. The purpose of this study was to explore perceived needs regarding electronic health record trigger criteria for palliative care referral among healthcare providers caring for seriously ill adult hospitalized patients in a teaching hospital in New York State. A qualitative descriptive approach was utilized with use of individual semistructured interviews. Braun and Clarke's Reflexive Thematic Analysis method was used to analyze data. Data analysis generated one overarching theme, I'm in Favor of an Electronic Health Record Automatic Trigger for Palliative Care , and three key themes, Build a Checklist Screening Tool Into Epic With Predefined Conditions and a Palliative Consult in the Admission Order Set , If Providers Call a Palliative Care Consult Sooner, We Give Patients a Better Quality of Life , and Providers Need to Be Aware of the Different Facets of What Palliative Care Actually Does. Findings revealed that all participants supported incorporating electronic health record palliative care triggers. Future research is needed exploring provider palliative care education approaches to promote understanding of palliative care services and to address personal and/or professional bias.
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Affiliation(s)
- Lori-Jeanne West
- Author Affiliations: Upstate Medical University College of Nursing, Syracuse (Drs West, Tomko, and Austin-Ketch); and University at Buffalo, School of Nursing, Buffalo (Drs Sessanna and Paplham), NY
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253
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Kim J, Lee S, Moodley Y, Yagnik L, Birnie D, Dwivedi G. The role of the host-microbiome and metabolomics in sarcoidosis. Am J Physiol Cell Physiol 2023; 325:C1336-C1353. [PMID: 37746695 DOI: 10.1152/ajpcell.00316.2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/19/2023] [Accepted: 09/19/2023] [Indexed: 09/26/2023]
Abstract
Sarcoidosis is a complex inflammatory fibrotic disease that affects multiple organ systems. It is characterized by the infiltration of lymphocytes and mononuclear phagocytes, which form non-caseating granulomas in affected organs. The lungs and intrathoracic lymph nodes are the most commonly affected organs. The underlying cause of sarcoidosis is unknown, but it is believed to occur in genetically predisposed individuals who are exposed to pathogenic organisms, environmental contaminants, or self and non-self-antigens. Recent research has suggested that the microbiome may play a role in the development of respiratory conditions, including sarcoidosis. Additionally, metabolomic studies have identified potential biomarkers for monitoring sarcoidosis progression. This review will focus on recent microbiome and metabolomic findings in sarcoidosis, with the goal of shedding light on the pathogenesis and possible diagnostic and therapeutic approaches.
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Affiliation(s)
- Junwoo Kim
- Department of Advanced Clinical and Translational Cardiovascular Imaging, Harry Perkins Institute of Medical Research, Murdoch, Western Australia, Australia
- School of Medicine, The University of Western Australia, Crawley, Western Australia, Australia
| | - Silvia Lee
- Department of Advanced Clinical and Translational Cardiovascular Imaging, Harry Perkins Institute of Medical Research, Murdoch, Western Australia, Australia
- School of Medicine, The University of Western Australia, Crawley, Western Australia, Australia
| | - Yuben Moodley
- Department of Advanced Clinical and Translational Cardiovascular Imaging, Harry Perkins Institute of Medical Research, Murdoch, Western Australia, Australia
- School of Medicine, The University of Western Australia, Crawley, Western Australia, Australia
- Department of Respiratory Internal Medicine, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Lokesh Yagnik
- Department of Advanced Clinical and Translational Cardiovascular Imaging, Harry Perkins Institute of Medical Research, Murdoch, Western Australia, Australia
- School of Medicine, The University of Western Australia, Crawley, Western Australia, Australia
- Department of Respiratory Internal Medicine, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - David Birnie
- Department of Advanced Clinical and Translational Cardiovascular Imaging, Harry Perkins Institute of Medical Research, Murdoch, Western Australia, Australia
- School of Medicine, The University of Western Australia, Crawley, Western Australia, Australia
- Division of Cardiology, Department of Medicine, University of Ottawa, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Girish Dwivedi
- Department of Advanced Clinical and Translational Cardiovascular Imaging, Harry Perkins Institute of Medical Research, Murdoch, Western Australia, Australia
- School of Medicine, The University of Western Australia, Crawley, Western Australia, Australia
- Division of Cardiology, Department of Medicine, University of Ottawa, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Department of Cardiology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
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254
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Zhang Y, Yi J, Sun D, Su Y, Zuo Y, Zhu M, Zhang S, Huang K, Guo X, Zhang Y. The association of chest computed tomography-defined visual emphysema and prognosis in patients with nonsmall cell lung cancer. ERJ Open Res 2023; 9:00195-2023. [PMID: 38020560 PMCID: PMC10658642 DOI: 10.1183/23120541.00195-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 08/25/2023] [Indexed: 12/01/2023] Open
Abstract
Background Although computed tomography (CT)-defined emphysema is considered a predictor of lung cancer risk, it is not fully clear whether CT-defined emphysema is associated with the prognosis of lung cancer. We aimed to assess the clinical impact of CT-defined emphysema on the survival of lung cancer. Methods In the prospective cohort study of nonsmall cell lung cancer (NSCLC), the correlation between CT-defined emphysema and clinical variables was analysed. A multivariable Cox regression model was built to assess the association between CT-defined emphysema and overall survival (OS) for up to 8.8 years. The differences in survival analyses were derived by Kaplan-Meier analysis and log-rank testing. Low attenuation area (LAA%) was defined as the per cent of voxels below -950 HU. Results 854 patients were included and CT-defined emphysema was present in 300 (35.1%) at diagnosis. Epidermal growth factor receptor (EGFR) wild-type (OR 1.998; p<0.001) and anaplastic lymphoma kinase (ALK) wild-type (OR 2.277; p=0.004) were associated with CT-defined emphysema. CT-defined emphysema remained a significant predictor of prognosis adjusting for age, sex, smoking history, tumour histology and Eastern Cooperative Oncology Group Performance Status (ECOG PS), whether in I-IIIA stage (adjusted hazard ratio (HR) 1.745; p=0.017) or in IIIB-IV stage (adjusted HR 1.291; p=0.022). Stratified analyses showed that OS rate among the driver oncogene groups with different CT-defined emphysema status differed significantly (log-rank p<0.001). Furthermore, patients with centrilobular emphysema (CLE) with LAA% >17% displayed poorer survival than those with LAA% ≤17% (median 432 versus 670 days; HR 1.564; p=0.020). Conclusions CT-defined emphysema, especially CLE with LAA%>17%, is an independent predictor of NSCLC prognosis. Moreover, prospective studies are needed to further explore this association.
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Affiliation(s)
- Yixiao Zhang
- Department of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Respiratory Medicine, Beijing, China
- These authors contributed equally to this work
| | - Jiawen Yi
- Department of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Respiratory Medicine, Beijing, China
- These authors contributed equally to this work
| | - Dan Sun
- Department of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Respiratory Medicine, Beijing, China
- These authors contributed equally to this work
| | - Yanping Su
- Department of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Respiratory Medicine, Beijing, China
| | - Yingting Zuo
- Beijing Institute of Respiratory Medicine, Beijing, China
- Department of Clinical Epidemiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Min Zhu
- Department of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Respiratory Medicine, Beijing, China
| | - Shu Zhang
- Department of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Respiratory Medicine, Beijing, China
| | - Kewu Huang
- Department of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Respiratory Medicine, Beijing, China
| | - Xiaojuan Guo
- Department of Radiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yuhui Zhang
- Department of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Respiratory Medicine, Beijing, China
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255
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Scheier TC, Carlin S, Wills NK, Wasserman S, Mertz D, Eikelboom JW. Efficacy and Safety of Intensified vs Standard Prophylactic Anticoagulation Therapy in Patients Hospitalized With Coronavirus Disease 2019: Updated Systematic Review and Meta-analysis. Open Forum Infect Dis 2023; 10:ofad506. [PMID: 37953813 PMCID: PMC10633781 DOI: 10.1093/ofid/ofad506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 10/06/2023] [Indexed: 11/14/2023] Open
Affiliation(s)
| | - Stephanie Carlin
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Nicola K Wills
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Sean Wasserman
- Department of Medicine, University of Cape Town, Cape Town, South Africa
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Dominik Mertz
- Population Health Research Institute, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methodology, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - John W Eikelboom
- Population Health Research Institute, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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256
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Abstract
Lung cancer represents a large burden on society with a staggering incidence and mortality rate that has steadily increased until recently. The impetus to design an effective screening program for the deadliest cancer in the United States and worldwide began in 1950. It has taken more than 50 years of numerous clinical trials and continued persistence to arrive at the development of modern-day screening program. As the program continues to grow, it is important for clinicians to understand its evolution, track outcomes, and continually assess the impact and bias of screening on the medical, social, and economic systems.
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Affiliation(s)
- Hai V N Salfity
- Division of Thoracic Surgery, Department of Surgery, University of Cincinnati School of Medicine, 231 Albert Sabin Way Suite 2472, Cincinnati, OH 45267, USA.
| | - Betty C Tong
- Division of Thoracic Surgery, Department of Surgery, Duke University School of Medicine, Box 3531 DUMC, Durham, NC 27710, USA
| | - Madison R Kocher
- Division of Cardiothoracic Imaging, Department of Radiology, Duke University School of Medicine, Box 3808 DUMC, Durham, NC 27710, USA
| | - Tina D Tailor
- Division of Cardiothoracic Imaging, Department of Radiology, Duke University School of Medicine, Box 3808 DUMC, Durham, NC 27710, USA
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257
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Riehani A, Soubani AO. The spectrum of pulmonary amyloidosis. Respir Med 2023; 218:107407. [PMID: 37696313 DOI: 10.1016/j.rmed.2023.107407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 08/21/2023] [Accepted: 09/08/2023] [Indexed: 09/13/2023]
Abstract
Amyloidosis is a disease caused by misfolded proteins that deposit in the extracellular matrix as fibrils, resulting in the dysfunction of the involved organ. The lung is a common target of Amyloidosis, but pulmonary amyloidosis is uncommonly diagnosed since it is rarely symptomatic. Diagnosis of pulmonary amyloidosis is usually made in the setting of systemic amyloidosis, however in cases of localized pulmonary disease, surgical or transbronchial tissue biopsy might be indicated. Pulmonary amyloidosis can be present in a variety of discrete entities. Diffuse Alveolar septal amyloidosis is the most common type and is usually associated with systemic AL amyloidosis. Depending on the degree of the interstitial involvement, it may affect alveolar gas exchange and cause respiratory symptoms. Localized pulmonary Amyloidosis can present as Nodular, Cystic or Tracheobronchial Amyloidosis which may cause symptoms of airway obstruction and large airway stenosis. Pleural effusions, mediastinal lymphadenopathy and pulmonary hypertension has also been reported. Treatment of all types of pulmonary amyloidosis depends on the type of precursor protein, organ involvement and distribution of the disease. Most of the cases are asymptomatic and require only close monitoring. Diffuse alveolar septal amyloidosis treatment follows the treatment of underlying systemic amyloidosis. Tracheobronchial amyloidosis is usually treated with bronchoscopic interventions including debulking and stenting or with external beam radiation. Long-term prognosis of pulmonary amyloidosis usually depends on the type of lung involvement and other organ function.
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Affiliation(s)
- Anas Riehani
- Division of Pulmonary, Critical Care and Sleep Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - Ayman O Soubani
- Division of Pulmonary, Critical Care and Sleep Medicine, Wayne State University School of Medicine, Detroit, MI, USA.
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258
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Kosyreva A, Vishnyakova P, Tsvetkov I, Kiseleva V, Dzhalilova DS, Miroshnichenko E, Lokhonina A, Makarova O, Fatkhudinov T. Advantages and disadvantages of treatment of experimental ARDS by M2-polarized RAW 264.7 macrophages. Heliyon 2023; 9:e21880. [PMID: 38027880 PMCID: PMC10658332 DOI: 10.1016/j.heliyon.2023.e21880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 09/20/2023] [Accepted: 10/31/2023] [Indexed: 12/01/2023] Open
Abstract
Innate immunity reactions are core to any immunological process, including systemic inflammation and such extremes as acute respiratory distress syndrome (ARDS) and cytokine storm. Macrophages, the key cells of innate immunity, show high phenotypic plasticity: depending on microenvironmental cues, they can polarize into M1 (classically activated, pro-inflammatory) or M2 (alternatively activated, anti-inflammatory). The anti-inflammatory M2 macrophage polarization-based cell therapies constitute a novel prospective modality. Systemic administration of 'educated' macrophages is intended at their homing in lungs in order to mitigate the pro-inflammatory cytokine production and reduce the risks of 'cytokine storm' and related severe complications. Acute respiratory distress syndrome (ARDS) is the main mortality factor in pneumonia including SARS-CoV-associated cases. This study aimed to evaluate the influence of infusions of RAW 264.7 murine macrophage cell line polarized towards M2 phenotype on the development of LPS-induced ARDS in mouse model. The results indicate that the M2-polarized RAW 264.7 macrophage infusions in the studied model of ARDS promote relocation of lymphocytes from their depots in immune organs to the lungs. In addition, the treatment facilitates expression of M2-polarization markers Arg1, Vegfa and Tgfb and decreases of M1-polarization marker Cd38 in lung tissues, which can indicate the anti-inflammatory response activation. However, treatment of ARDS with M2-polarized macrophages didn't change the neutrophil numbers in the lungs. Moreover, the level of the Arg1 protein in lungs decreased throughtout the treatment with M2 macrophages, which is probably because of the pro-inflammatory microenvironment influence on the polarization of macrophages towards M1. Thus, the chemical polarization of macrophages is unstable and depends on the microenvironment. This adverse effect can be reduced through the use of primary autologous macrophages or some alternative methods of M2 polarization, notably siRNA-mediated.
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Affiliation(s)
- A.M. Kosyreva
- Research Institute of Molecular and Cellular Medicine, Peoples' Friendship University of Russia named after Patrice Lumumba (RUDN), 6 Miklukho-Maklaya Street, 117198, Moscow, Russia
- Avtsyn Research Institute of Human Morphology of Petrovsky National Research Centre of Surgery, 3 Tsyurupy Street, 117418, Moscow, Russia
| | - P.A. Vishnyakova
- Research Institute of Molecular and Cellular Medicine, Peoples' Friendship University of Russia named after Patrice Lumumba (RUDN), 6 Miklukho-Maklaya Street, 117198, Moscow, Russia
- National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov of Ministry of Healthcare of Russian Federation, 4 Oparina Street, 117997, Moscow, Russia
| | - I.S. Tsvetkov
- Avtsyn Research Institute of Human Morphology of Petrovsky National Research Centre of Surgery, 3 Tsyurupy Street, 117418, Moscow, Russia
| | - V.V. Kiseleva
- Research Institute of Molecular and Cellular Medicine, Peoples' Friendship University of Russia named after Patrice Lumumba (RUDN), 6 Miklukho-Maklaya Street, 117198, Moscow, Russia
- National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov of Ministry of Healthcare of Russian Federation, 4 Oparina Street, 117997, Moscow, Russia
| | - D. Sh. Dzhalilova
- Research Institute of Molecular and Cellular Medicine, Peoples' Friendship University of Russia named after Patrice Lumumba (RUDN), 6 Miklukho-Maklaya Street, 117198, Moscow, Russia
- Avtsyn Research Institute of Human Morphology of Petrovsky National Research Centre of Surgery, 3 Tsyurupy Street, 117418, Moscow, Russia
| | - E.A. Miroshnichenko
- Research Institute of Molecular and Cellular Medicine, Peoples' Friendship University of Russia named after Patrice Lumumba (RUDN), 6 Miklukho-Maklaya Street, 117198, Moscow, Russia
- Avtsyn Research Institute of Human Morphology of Petrovsky National Research Centre of Surgery, 3 Tsyurupy Street, 117418, Moscow, Russia
| | - A.V. Lokhonina
- Research Institute of Molecular and Cellular Medicine, Peoples' Friendship University of Russia named after Patrice Lumumba (RUDN), 6 Miklukho-Maklaya Street, 117198, Moscow, Russia
- National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov of Ministry of Healthcare of Russian Federation, 4 Oparina Street, 117997, Moscow, Russia
| | - O.V. Makarova
- Avtsyn Research Institute of Human Morphology of Petrovsky National Research Centre of Surgery, 3 Tsyurupy Street, 117418, Moscow, Russia
| | - T.H. Fatkhudinov
- Research Institute of Molecular and Cellular Medicine, Peoples' Friendship University of Russia named after Patrice Lumumba (RUDN), 6 Miklukho-Maklaya Street, 117198, Moscow, Russia
- Avtsyn Research Institute of Human Morphology of Petrovsky National Research Centre of Surgery, 3 Tsyurupy Street, 117418, Moscow, Russia
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259
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Martins AC, Psaltikidis EM, Cristiano de Lima T, Fagnani R, Gomide HCAC, Gilli FH, Schreiber AZ, de Oliveira Conterno L, Matsuzawa T, Watanabe A, Kamei K, Brandalise SR, Trabasso P, Resende MR, Moretti ML. Clinical outcomes of aspergillosis among paediatric and adult inpatients: A multicentre study in a Brazilian metropolitan area. J Mycol Med 2023; 33:101435. [PMID: 37708696 DOI: 10.1016/j.mycmed.2023.101435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 09/03/2023] [Accepted: 09/04/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Invasive Aspergillosis (IA) is a disease of significant clinical relevance, especially among immunosuppressed patients, and is associated with high mortality rates. In this study, we evaluated the epidemiological features and clinical outcomes in children and adults with IA. METHODS This was an observational, multicentre, prospective surveillance study of inpatients with IA at two different hospitals in Campinas, Brazil, between 2018 and 2021. RESULTS A total of 44 patients were identified (54.5% males), with a median age of 42 years (interquartile range (IQR):19.25-59 years, varying between 1 and 89 years). The following baseline conditions were identified: 61.4% were oncohaematological patients and 20.5% were solid organ transplant recipients. Among oncohaematological patients, 77.8% exhibited severe or persistent neutropenia. The median time between the onset of neutropenia and the diagnosis of fungal infection was 20 days (IQR: 10.5-26 days; range, 0-68 days). The interval between neutropenia onset and fungal infection was longer in paediatric than in general hospital (average, 29 vs. 13.4 days; median 26 vs 11 days; p=0.010). After the diagnosis of IA, the survival rates were 44.2% and 30.0% at 180 and 360 days, respectively. Survival was greater in patients aged ≤ 21 years (p = 0.040; log-rank test). They observed no difference in IA mortality related to COVID-19 pandemic. CONCLUSION High mortality associated with IA was observed in both hospitals. Individuals over the age of 21 have a lower survival rate than younger patients.
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Affiliation(s)
- Antonio Camargo Martins
- School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil; Young Medical Leadership Program of the National Academy of Medicine, Brazil
| | | | | | - Renata Fagnani
- School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | | | | | | | | | | | - Akira Watanabe
- Medical Mycology Research Center, Chiba University, Chiba, Japan
| | - Katsuhiko Kamei
- Medical Mycology Research Center, Chiba University, Chiba, Japan
| | | | - Plinio Trabasso
- School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | | | - Maria Luiza Moretti
- School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
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260
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De Francesco MA. Drug-Resistant Aspergillus spp.: A Literature Review of Its Resistance Mechanisms and Its Prevalence in Europe. Pathogens 2023; 12:1305. [PMID: 38003770 PMCID: PMC10674884 DOI: 10.3390/pathogens12111305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 10/28/2023] [Accepted: 10/30/2023] [Indexed: 11/26/2023] Open
Abstract
Infections due to the Aspergillus species constitute an important challenge for human health. Invasive aspergillosis represents a life-threatening disease, mostly in patients with immune defects. Drugs used for fungal infections comprise amphotericin B, triazoles, and echinocandins. However, in the last decade, an increased emergence of azole-resistant Aspergillus strains has been reported, principally belonging to Aspergillus fumigatus species. Therefore, both the early diagnosis of aspergillosis and its epidemiological surveillance are very important to establish the correct antifungal therapy and to ensure a successful patient outcome. In this paper, a literature review is performed to analyze the prevalence of Aspergillus antifungal resistance in European countries. Amphotericin B resistance is observed in 2.6% and 10.8% of Aspergillus fumigatus isolates in Denmark and Greece, respectively. A prevalence of 84% of amphotericin B-resistant Aspergillus flavus isolates is reported in France, followed by 49.4%, 35.1%, 21.7%, and 20% in Spain, Portugal, Greece, and amphotericin B resistance of Aspergillus niger isolates is observed in Greece and Belgium with a prevalence of 75% and 12.8%, respectively. The prevalence of triazole resistance of Aspergillus fumigatus isolates, the most studied mold obtained from the included studies, is 0.3% in Austria, 1% in Greece, 1.2% in Switzerland, 2.1% in France, 3.9% in Portugal, 4.9% in Italy, 5.3% in Germany, 6.1% in Denmark, 7.4% in Spain, 8.3% in Belgium, 11% in the Netherlands, and 13.2% in the United Kingdom. The mechanism of resistance is mainly driven by the TR34/L98H mutation. In Europe, no in vivo resistance is reported for echinocandins. Future studies are needed to implement the knowledge on the spread of drug-resistant Aspergillus spp. with the aim of defining optimal treatment strategies.
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Affiliation(s)
- Maria Antonia De Francesco
- Department of Molecular and Translational Medicine, Institute of Microbiology, University of Brescia, ASST Spedali Civili, 25123 Brescia, Italy
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261
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Zhu N, Zhou D, Xiong W, Zhang X, Li S. Performance of mNGS in bronchoalveolar lavage fluid for the diagnosis of invasive pulmonary aspergillosis in non-neutropenic patients. Front Cell Infect Microbiol 2023; 13:1271853. [PMID: 38029249 PMCID: PMC10644336 DOI: 10.3389/fcimb.2023.1271853] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 10/03/2023] [Indexed: 12/01/2023] Open
Abstract
The diagnosis of invasive pulmonary aspergillosis (IPA) diseases in non-neutropenic patients remains challenging. It is essential to develop optimal non-invasive or minimally invasive detection methods for the rapid and reliable diagnosis of IPA. Metagenomic next-generation sequencing (mNGS) in bronchoalveolar lavage fluid (BALF) can be a valuable tool for identifying the microorganism. Our study aims to evaluate the performance of mNGS in BALF in suspected IPA patients and compare it with other detection tests, including serum/BALF galactomannan antigen (GM) and traditional microbiological tests (BALF fungal culture and smear and lung biopsy histopathology). Ninety-four patients with suspicion of IPA were finally enrolled in our study. Thirty-nine patients were diagnosed with IPA, and 55 patients were non-IPA. There was significance between the IPA and non-IPA groups, such as BALF GM (P < 0.001), history of glucocorticoid use (P = 0.004), and pulmonary comorbidities (P = 0.002), as well as no significance of the other demographic data including age, sex, BMI, history of cigarette, blood GM assay, T-SPOT.TB, and NEUT#/LYMPH#. The sensitivity of the BALF mNGS was 92.31%, which was higher than that of the traditional tests or the GM assays. The specificity of BALF mNGS was 92.73%, which was relatively similar to that of the traditional tests. The AUC of BALF mNGS was 0.925, which presented an excellent performance compared with other traditional tests or GM assays. Our study demonstrated the important role of BALF detection by the mNGS platform for pathogen identification in IPA patients with non-neutropenic states, which may provide an optimal way to diagnose suspected IPA disease.
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Affiliation(s)
| | | | | | | | - Shengqing Li
- Department of Pulmonary and Critical Care Medicine, Huashan Hospital, Fudan University, Shanghai, China
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Jones JT, Morelli KA, Vesely EM, Puerner CTS, Pavuluri CK, Ross BS, van Rhijn N, Bromley MJ, Cramer RA. The cystic fibrosis treatment Trikafta affects the growth, viability, and cell wall of Aspergillus fumigatus biofilms. mBio 2023; 14:e0151623. [PMID: 37830825 PMCID: PMC10653927 DOI: 10.1128/mbio.01516-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 09/01/2023] [Indexed: 10/14/2023] Open
Abstract
IMPORTANCE PwCF commonly test positive for pathogenic fungi, and more than 90% of the cystic fibrosis patient population is approved for the modulator treatment, Trikafta. Therefore, it is critical to understand how fungal communities, specifically A. fumigatus, respond to Trikafta exposure. Therefore, we sought to determine whether Trikafta impacted the biology of A. fumigatus biofilms. Our data demonstrate that Trikafta reduces biomass in several laboratory strains as well as clinical strains isolated from the expectorated sputum of pwCF. Furthermore, Trikafta reduces fungal viability and the capacity of biofilms to recover following treatment. Of particular importance, Trikafta affects how A. fumigatus biofilms respond to cell wall stressors, suggesting that Trikafta modulates components of the cell wall. Since the cell wall directly affects how a host immune system will respond to and effectively neutralize pathogens, our work, demonstrating that Trikafta impacts the A. fumigatus cell wall, is potentially highly relevant to fungal-induced disease pathogenesis.
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Affiliation(s)
- Jane T. Jones
- Department of Microbiology and Immunology, Dartmouth Geisel School of Medicine, Hanover, New Hampshire, USA
| | - Kaesi A. Morelli
- Department of Microbiology and Immunology, Dartmouth Geisel School of Medicine, Hanover, New Hampshire, USA
| | - Elisa M. Vesely
- Department of Microbiology and Immunology, Dartmouth Geisel School of Medicine, Hanover, New Hampshire, USA
| | - Charles T. S. Puerner
- Department of Microbiology and Immunology, Dartmouth Geisel School of Medicine, Hanover, New Hampshire, USA
| | - Chetan K. Pavuluri
- Department of Microbiology and Immunology, Dartmouth Geisel School of Medicine, Hanover, New Hampshire, USA
| | - Brandon S. Ross
- Department of Microbiology and Immunology, Dartmouth Geisel School of Medicine, Hanover, New Hampshire, USA
| | - Norman van Rhijn
- Manchester Fungal Infection Group, Division of Evolution, Infection, and Genomics, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
- Antimicrobial Resistance Network, University of Manchester, Manchester, United Kingdom
| | - Michael J. Bromley
- Manchester Fungal Infection Group, Division of Evolution, Infection, and Genomics, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
- Antimicrobial Resistance Network, University of Manchester, Manchester, United Kingdom
| | - Robert A. Cramer
- Department of Microbiology and Immunology, Dartmouth Geisel School of Medicine, Hanover, New Hampshire, USA
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Harduin LDO, Barroso TA, Guerra JB, Filippo MG, de Almeida LC, de Castro-Santos G, Oliveira FAC, Cavalcanti DET, Procopio RJ, Lima EC, Pinhati MES, dos Reis JMC, Moreira BD, Galhardo AM, Joviliano EE, de Araujo WJB, de Oliveira JCP. Guidelines on vascular access for hemodialysis from the Brazilian Society of Angiology and Vascular Surgery. J Vasc Bras 2023; 22:e20230052. [PMID: 38021275 PMCID: PMC10648056 DOI: 10.1590/1677-5449.202300522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 05/09/2023] [Indexed: 12/01/2023] Open
Abstract
Chronic kidney disease is a worldwide public health problem, and end-stage renal disease requires dialysis. Most patients requiring renal replacement therapy have to undergo hemodialysis. Therefore, vascular access is extremely important for the dialysis population, directly affecting the quality of life and the morbidity and mortality of this patient population. Since making, managing and salvaging of vascular accesses falls within the purview of the vascular surgeon, developing guideline to help specialists better manage vascular accesses for hemodialysis if of great importance. Thus, the objective of this guideline is to present a set of recommendations to guide decisions involved in the referral, evaluation, choice, surveillance and management of complications of vascular accesses for hemodialysis.
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Affiliation(s)
- Leonardo de Oliveira Harduin
- Universidade Estadual do Estado do Rio de Janeiro - UERJ, Departamento de Cirurgia Vascular, Niterói, RJ, Brasil.
| | | | | | - Marcio Gomes Filippo
- Universidade Federal do Rio de Janeiro - UFRJ, Departamento de Cirurgia, Rio de Janeiro, RJ, Brasil.
| | | | - Guilherme de Castro-Santos
- Universidade Federal de Minas Gerais - UFMG, Escola de Medicina, Departamento de Cirurgia, Belo Horizonte, MG, Brasil.
| | | | | | - Ricardo Jayme Procopio
- Universidade Federal de Minas Gerais - UFMG, Escola de Medicina, Departamento de Cirurgia, Belo Horizonte, MG, Brasil.
| | | | | | | | - Barbara D’Agnoluzzo Moreira
- Universidade Federal do Paraná - UFPR, Hospital de Clínicas, Serviço de Cirurgia Vascular, Curitiba, PR, Brasil.
| | | | - Edwaldo Edner Joviliano
- Universidade de São Paulo - USP, Faculdade de Medicina de Ribeirão Preto - FMRP, Departamento de Anatomia e Cirurgia, Ribeirão Preto, SP, Brasil.
| | - Walter Junior Boim de Araujo
- Universidade Federal do Paraná - UFPR, Hospital de Clínicas, Departamento de Angioradiologia e Cirurgia Endovascular, Curitiba, PR, Brasil.
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Thuo N, Martins T, Manley E, Standifer M, Sultan DH, Faris NR, Hill A, Thompson M, Jeremiah R, Al Achkar M. Factors leading to disparity in lung cancer diagnosis among black/African American communities in the USA: a qualitative study. BMJ Open 2023; 13:e073886. [PMID: 37899158 PMCID: PMC10619042 DOI: 10.1136/bmjopen-2023-073886] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 09/29/2023] [Indexed: 10/31/2023] Open
Abstract
OBJECTIVE This study has two objectives: first, to explore the diagnostic experiences of black/African American (BAA) patients with lung cancer to pinpoint pitfalls, suboptimal experiences and instances of discrimination leading to disparities in outcomes compared with patients of other ethnic backgrounds, especially white patients. The second objective is to identify the underlying causes contributing to health disparities in the diagnosis of lung cancer among BAA patients. METHODS We employed a phenomenological research approach, guiding in-depth interviews with patients self-identifying as BAA diagnosed with lung cancer, as well as caregivers, healthcare professionals and community advocates knowledgeable about BAA experiences with lung cancer. We performed thematic analysis to identify experiences at patient, primary care and specialist levels. Contributing factors were identified using the National Institute of Minority Health and Health Disparities (NIMHD) health disparity model. RESULTS From March to November 2021, we conducted individual interviews with 19 participants, including 9 patients/caregivers and 10 providers/advocates. Participants reported recurring and increased pain before seeking treatment, treatment for non-cancer illnesses, delays in diagnostic tests and referrals, poor communication and bias when dealing with specialists and primary care providers. Factors contributing to suboptimal experiences included reluctance by insurers to cover costs, provider unwillingness to conduct comprehensive testing, provider bias in recommending treatment, high healthcare costs, and lack of healthcare facilities and qualified staff to provide necessary support. However, some participants reported positive experiences due to their insurance, availability of services and having an empowered support structure. CONCLUSIONS BAA patients and caregivers encountered suboptimal experiences during their care. The NIMHD model is a useful framework to organise factors contributing to these experiences that may be leading to health disparities. Additional research is needed to fully capture the extent of these experiences and identify ways to improve BAA patient experiences in the lung cancer diagnosis pathway.
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Affiliation(s)
- Nicholas Thuo
- Family Medicine, Univeristy of Washington, Seattle, WA, USA
| | - Tanimola Martins
- Health and Community Science, University of Exeter, Exeter, UK
- Health and Community Science, University of Exeter, Exeter, UK
| | | | - Maisha Standifer
- Health Policy, Morehouse School of Medicine, Atlanta, Georgia, USA
| | | | - Nicholas R Faris
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, Tennessee, USA
| | - Angela Hill
- Pharmacotherapuetics and Clinical Research, University of South Florida, Tampa, Florida, USA
| | | | - Rohan Jeremiah
- Global Health, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Morhaf Al Achkar
- Oncology, Wayne State University/Karmanos Cancer Institute, Detroit, MI, USA
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265
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Sun L, Liu K, Li M, Sun Y, Zhu X, Chang C. Tracheobronchial Amyloidosis Accompanied with Asthma: A Case Report and a Mini-Review. J Asthma Allergy 2023; 16:1187-1193. [PMID: 37920270 PMCID: PMC10619460 DOI: 10.2147/jaa.s433639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/18/2023] [Indexed: 11/04/2023] Open
Abstract
Tracheobronchial amyloidosis is a rare disease characterized by amyloid deposits on the tracheal and bronchial tissue. Patients with tracheobronchial amyloidosis are asymptomatic or exhibit symptoms, such as chronic wheezing, dyspnea, and cough, that are common manifestations of other disorders, including asthma. A bronchoscopic tissue biopsy using Congo red staining is the key standard for diagnosing tracheobronchial amyloidosis. Treatment strategies vary depending on the degree of airway obstruction. If the obstruction is significant and the patient is symptomatic, repeated bronchoscopic treatment, including local resection, laser therapy, stent placement, and radiation therapy, is considered a safer and better option. It is often misdiagnosed as asthma, but cases of tracheobronchial amyloidosis accompanied with asthma have not been reported. We report a case of intermittent wheezing, cough for 33 years, and shortness of breath on exertion for 7 years, which had aggravated in the previous 22 days. A pulmonary examination revealed diffuse wheezing. Pulmonary function testing revealed an obstructive ventilation dysfunction. Computerized tomography (CT) imaging revealed circumferential and irregular thickening of the tracheobronchial wall tissue with calcification and atelectasis of the right middle and lower lobe of the lung. Bronchoscopy revealed diffuse thickening of the mucosa of the trachea and bilateral main bronchi, with multiple nodular protuberances and relatively narrow lumens. The bronchial biopsies revealed massive amyloid deposits under the bronchial mucosa. The deposits exhibited a green birefringence under crossed polarized light after Congo red positive staining. The patient received standard treatment for asthma, and remains in good general condition without wheezing. It is not difficult to distinguish tracheobronchial amyloidosis through chest CT examination for patients with wheezing as long as this disease was considered. It was interesting that we present a rarer case of patient with tracheobronchial amyloidosis accompanied with asthma which both can cause symptoms such as wheezing.
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Affiliation(s)
- Lina Sun
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, People’s Republic of China
- Research Center for Chronic Airway Diseases, Peking University Health Science Center, Beijing, People’s Republic of China
| | - Kexin Liu
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, People’s Republic of China
- Research Center for Chronic Airway Diseases, Peking University Health Science Center, Beijing, People’s Republic of China
| | - Meijiao Li
- Department of Radiology, Peking University Third Hospital, Beijing, People’s Republic of China
| | - Yongchang Sun
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, People’s Republic of China
- Research Center for Chronic Airway Diseases, Peking University Health Science Center, Beijing, People’s Republic of China
| | - Xiang Zhu
- Department of Pathology, Peking University Third Hospital, Beijing, People’s Republic of China
- Department of Pathology, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, People’s Republic of China
| | - Chun Chang
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, People’s Republic of China
- Research Center for Chronic Airway Diseases, Peking University Health Science Center, Beijing, People’s Republic of China
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Merdji H, Gantzer J, Bonello L, Lamblin N, Roubille F, Levy B, Champion S, Lim P, Schneider F, Cariou A, Khachab H, Bourenne J, Seronde MF, Schurtz G, Harbaoui B, Vanzetto G, Quentin C, Curtiaud A, Kurtz JE, Combaret N, Marchandot B, Lattuca B, Biendel C, Leurent G, Bataille V, Gerbaud E, Puymirat E, Bonnefoy E, Aissaoui N, Delmas C. Characteristics, management, and outcomes of active cancer patients with cardiogenic shock. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2023; 12:682-692. [PMID: 37410588 DOI: 10.1093/ehjacc/zuad072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/21/2023] [Accepted: 07/03/2023] [Indexed: 07/08/2023]
Abstract
AIMS Characteristics, management, and outcomes of patients with active cancer admitted for cardiogenic shock remain largely unknown. This study aimed to address this issue and identify the determinants of 30-day and 1-year mortality in a large cardiogenic shock cohort of all aetiologies. METHODS AND RESULTS FRENSHOCK is a prospective multicenter observational registry conducted in French critical care units between April and October 2016. 'Active cancer' was defined as a malignancy diagnosed within the previous weeks with planned or ongoing anticancer therapy. Among the 772 enrolled patients (mean age 65.7 ± 14.9 years; 71.5% male), 51 (6.6%) had active cancer. Among them, the main cancer types were solid cancers (60.8%), and hematological malignancies (27.5%). Solid cancers were mainly urogenital (21.6%), gastrointestinal (15.7%), and lung cancer (9.8%). Medical history, clinical presentation, and baseline echocardiography were almost the same between groups. In-hospital management significantly differed: patients with cancers received more catecholamines or inotropes (norepinephrine 72% vs. 52%, P = 0.005 and norepinephrine-dobutamine combination 64.7% vs. 44.5%, P = 0.005), but had less mechanical circulatory support (5.9% vs. 19.5%, P = 0.016). They presented a similar 30-day mortality rate (29% vs. 26%) but a significantly higher mortality at 1-year (70.6% vs. 45.2%, P < 0.001). In multivariable analysis, active cancer was not associated with 30-day mortality but was significantly associated with 1-year mortality in 30-day survivors [HR 3.61 (1.29-10.11), P = 0.015]. CONCLUSION Active cancer patients accounted for almost 7% of all cases of cardiogenic shock. Early mortality was the same regardless of active cancer or not, whereas long-term mortality was significantly increased in patients with active cancer.
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Affiliation(s)
- Hamid Merdji
- Faculté de Médecine, Université de Strasbourg (UNISTRA), Strasbourg university hospital, Nouvel Hôpital Civil, Medical intensive care unit, Strasbourg, France
| | - Justine Gantzer
- Department of Medical Oncology, Strasbourg-Europe Cancer Institute (ICANS), Strasbourg, France
| | - Laurent Bonello
- Aix-Marseille Université, F-13385 Marseille, France
- Intensive Care Unit, Department of Cardiology, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, F-13385 Marseille, France
- Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Marseille, France
| | - Nicolas Lamblin
- Urgences et Soins Intensifs de Cardiologie, CHU Lille, University of Lille, Inserm U1167, F-59000, Lille, France
| | - François Roubille
- Cardiology Department, PhyMedExp, Université de Montpellier, INSERM, CNRS, INI-CRT, CHU de Montpellier, Montpellier, France
| | - Bruno Levy
- CHRU Nancy, Réanimation Médicale Brabois, Vandoeuvre-les Nancy, France
| | - Sebastien Champion
- Clinique de Parly 2, Ramsay Générale de Santé, 21 rue Moxouris, 78150 Le Chesnay, France
| | - Pascal Lim
- Service de Cardiologie, Univ Paris Est Créteil, INSERM, IMRB, F-94010 Créteil, France
- AP-HP, Hôpital Universitaire Henri-Mondor, F-94010 Créteil, France
| | - Francis Schneider
- Médecine Intensive-Réanimation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Alain Cariou
- Medical Intensive Care Unit, Cochin Hospital, Assistance Publique- Hôpitaux de Paris, Centre-Université de Paris, Medical School, Paris, France
| | - Hadi Khachab
- Intensive Cardiac Care Unit, Department of Cardiology, CH d'Aix en Provence, Aix en Provence, France, Avenue des Tamaris 13616 Aix-en-Provence cedex 1, France
| | - Jeremy Bourenne
- Service de Réanimation des Urgences, Aix Marseille Université, CHU La Timone 2, Marseille, France
| | | | - Guillaume Schurtz
- Urgences et Soins Intensifs de Cardiologie, CHU Lille, University of Lille, Inserm U1167, F-59000, Lille, France
| | - Brahim Harbaoui
- Cardiology Department, Hôpital Croix-Rousse and Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon, France
- University of Lyon, CREATIS UMR5220; INSERM U1044; INSA-15 Lyon, France
| | - Gerald Vanzetto
- Department of Cardiology, Hôpital de Grenoble, 38700 La Tronche, France
| | - Charlotte Quentin
- Service de Reanimation Polyvalente, Centre Hospitalier Broussais St Malo, 1 rue de la Marne, 35400 St Malo, France
| | - Anais Curtiaud
- Faculté de Médecine, Université de Strasbourg (UNISTRA), Strasbourg university hospital, Nouvel Hôpital Civil, Medical intensive care unit, Strasbourg, France
| | - Jean-Emmanuel Kurtz
- Department of Medical Oncology, Strasbourg-Europe Cancer Institute (ICANS), Strasbourg, France
| | - Nicolas Combaret
- Department of Cardiology, CHU Clermont-Ferrand, CNRS, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Benjamin Marchandot
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Université de Strasbourg, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, 67091 Strasbourg, France
| | - Benoit Lattuca
- Department of Cardiology, Nîmes University Hospital, Montpellier University, Nîmes, France
| | - Caroline Biendel
- Intensive Cardiac Care Unit, Rangueil University Hospital, 31059 Toulouse, France
- Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR-1048, National Institute of Health and Medical Research (INSERM), Toulouse, France
| | - Guillaume Leurent
- Department of Cardiology, CHU Rennes, Inserm, LTSI-UMR 1099, Univ Rennes 1, F-35000, Rennes, France
| | - Vincent Bataille
- Association pour la diffusion de la médecine de prévention (ADIMEP), Toulouse Rangueil University Hospital (CHU), Toulouse, France
| | - Edouard Gerbaud
- Intensive Cardiac Care Unit and Interventional Cardiology, Hôpital Cardiologique du Haut Lévêque, 5 Avenue de Magellan, 33604 Pessac, France
- Bordeaux Cardio-Thoracic Research Centre, U1045, Bordeaux University, Hôpital Xavier Arnozan, Avenue du Haut Lévêque, 33600 Pessac, France
| | - Etienne Puymirat
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, 75015 Paris, France
- Université de Paris, 75006 Paris, France
| | - Eric Bonnefoy
- Intensive Cardiac Care Unit, Lyon Brom University Hospital, Lyon, France
| | - Nadia Aissaoui
- Médecine Intensive-Réanimation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Clément Delmas
- Department of Cardiology, CHU Clermont-Ferrand, CNRS, Université Clermont Auvergne, Clermont-Ferrand, France
- Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR-1048, National Institute of Health and Medical Research (INSERM), Toulouse, France
- Recherche et Enseignement en Insuffisance Cardiaque Avancée Assistance et Transplantation (REICATRA), Institut Saint Jacques, CHU Toulouse, Toulouse, France
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Lynch Y, Vande Vusse LK. Diffuse Alveolar Hemorrhage in Hematopoietic Cell Transplantation. J Intensive Care Med 2023:8850666231207331. [PMID: 37872657 DOI: 10.1177/08850666231207331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Diffuse alveolar hemorrhage (DAH) is a morbid syndrome that occurs after autologous and allogeneic hematopoietic cell transplantation in children and adults. DAH manifests most often in the first few weeks following transplantation. It presents with pneumonia-like symptoms and acute respiratory failure, often requiring high levels of oxygen supplementation or mechanical ventilatory support. Hemoptysis is variably present. Chest radiographs typically feature widespread alveolar filling, sometimes with peripheral sparing and pleural effusions. The diagnosis is suspected when serial bronchoalveolar lavages return increasingly bloody fluid. DAH is differentiated from infectious causes of alveolar hemorrhage when extensive microbiological testing reveals no pulmonary pathogens. The cause is poorly understood, though preclinical and clinical studies implicate pretransplant conditioning regimens, particularly those using high doses of total-body-irradiation, acute graft-versus-host disease (GVHD), medications used to prevent GVHD, and other factors. Treatment consists of supportive care, systemic corticosteroids, platelet transfusions, and sometimes includes antifibrinolytic drugs and topical procoagulant factors. Therapeutic blockade of tumor necrosis factor-α showed promise in observational studies, but its benefit for DAH remains uncertain after small clinical trials. Even with these treatments, mortality from progression and relapse is high. Future investigational therapies could target the vascular endothelial cell biology theorized to contribute to alveolar bleeding and pathways that contribute to susceptibility, inflammation, cellular resilience, and tissue repair. This review will help clinicians navigate through the limited evidence to diagnose and treat DAH, counsel patients and families, and plan for future research.
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Affiliation(s)
- Ylinne Lynch
- Division of Pulmonary, Critical Care & Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Lisa K Vande Vusse
- Division of Pulmonary, Critical Care & Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA, USA
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Burzio C, Balzani E, Corcione S, Montrucchio G, Trompeo AC, Brazzi L. Pneumocystis jirovecii Pneumonia after Heart Transplantation: Two Case Reports and a Review of the Literature. Pathogens 2023; 12:1265. [PMID: 37887781 PMCID: PMC10610317 DOI: 10.3390/pathogens12101265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 10/17/2023] [Accepted: 10/19/2023] [Indexed: 10/28/2023] Open
Abstract
Post-transplant Pneumocystis jirovecii pneumonia (PcP) is an uncommon but increasingly reported disease among solid organ transplantation (SOT) recipients, associated with significant morbidity and mortality. Although the introduction of PcP prophylaxis has reduced its overall incidence, its prevalence continues to be high, especially during the second year after transplant, the period following prophylaxis discontinuation. We recently described two cases of PcP occurring more than one year after heart transplantation (HT) in patients who were no longer receiving PcP prophylaxis according to the local protocol. In both cases, the disease was diagnosed following the diagnosis of a viral illness, resulting in a significantly increased risk for PcP. While current heart transplantation guidelines recommend Pneumocystis jirovecii prophylaxis for up to 6-12 months after transplantation, after that period they only suggest an extended prophylaxis regimen in high-risk patients. Recent studies have identified several new risk factors that may be linked to an increased risk of PcP infection, including medication regimens and patient characteristics. Similarly, the indication for PcP prophylaxis in non-HIV patients has been expanded in relation to the introduction of new medications and therapeutic regimens for immune-mediated diseases. In our experience, the first patient was successfully treated with non-invasive ventilation, while the second required tracheal intubation, invasive ventilation, and extracorporeal CO2 removal due to severe respiratory failure. The aim of this double case report is to review the current timing of PcP prophylaxis after HT, the specific potential risk factors for PcP after HT, and the determinants of a prompt diagnosis and therapeutic approach in critically ill patients. We will also present a possible proposal for future investigations on indications for long-term prophylaxis.
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Affiliation(s)
- Carlo Burzio
- Department of Anesthesia, Intensive Care and Emergency, Città della Salute e della Scienza di Torino Hospital, 10126 Torino, Italy; (C.B.); (G.M.); (A.C.T.); (L.B.)
| | - Eleonora Balzani
- Department of Surgical Science, University of Turin, 10124 Torino, Italy
| | - Silvia Corcione
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10124 Turin, Italy;
- School of Medicine, Tufts University, Boston, MA 02111, USA
| | - Giorgia Montrucchio
- Department of Anesthesia, Intensive Care and Emergency, Città della Salute e della Scienza di Torino Hospital, 10126 Torino, Italy; (C.B.); (G.M.); (A.C.T.); (L.B.)
- Department of Surgical Science, University of Turin, 10124 Torino, Italy
| | - Anna Chiara Trompeo
- Department of Anesthesia, Intensive Care and Emergency, Città della Salute e della Scienza di Torino Hospital, 10126 Torino, Italy; (C.B.); (G.M.); (A.C.T.); (L.B.)
| | - Luca Brazzi
- Department of Anesthesia, Intensive Care and Emergency, Città della Salute e della Scienza di Torino Hospital, 10126 Torino, Italy; (C.B.); (G.M.); (A.C.T.); (L.B.)
- Department of Surgical Science, University of Turin, 10124 Torino, Italy
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Tafenzi HA, Choulli F, Adjade G, Baladi A, Afani L, Fadli ME, Essaadi I, Belbaraka R. Development of a well-defined tool to predict the overall survival in lung cancer patients: an African based cohort. BMC Cancer 2023; 23:1016. [PMID: 37864151 PMCID: PMC10589978 DOI: 10.1186/s12885-023-11355-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 08/31/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND Nomogram is a graphic representation containing the expressed factor of the mathematical formula used to define a particular phenomenon. We aim to build and internally validate a nomogram to predict overall survival (OS) in patients diagnosed with lung cancer (LC). METHODS We included 1200 LC patients from a single institution registry diagnosed from 2013 to 2021. The independent prognostic factors of LC patients were identified via cox proportional hazard regression analysis. Based on the results of multivariate cox analysis, we constructed the nomogram to predict the OS of LC patients. RESULTS We finally included a total of 1104 LC patients. Age, medical urgency at diagnosis, performance status, radiotherapy, and surgery were identified as prognostic factors, and integrated to build the nomogram. The model performance in predicting prognosis was measured by receiver operating characteristic curve. Calibration plots of 6-, 12-, and 24- months OS showed optimal agreement between observations and model predictions. CONCLUSION We have developed and validated a unique predictive tool that can offer patients with LC an individual OS prognosis. This useful prognostic model could aid doctors in making decisions and planning therapeutic trials.
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Affiliation(s)
- Hassan Abdelilah Tafenzi
- Medical Oncology Department, Mohammed VI University Hospital of Marrakech, Marrakech, Morocco.
- Faculty of Medicine and Pharmacy, Biosciences and Health Laboratory, Cadi Ayyad University, Marrakech, Morocco.
| | - Farah Choulli
- Medical Oncology Department, Mohammed VI University Hospital of Marrakech, Marrakech, Morocco
- Faculty of Medicine and Pharmacy, Biosciences and Health Laboratory, Cadi Ayyad University, Marrakech, Morocco
| | - Ganiou Adjade
- Medical Oncology Department, Mohammed VI University Hospital of Marrakech, Marrakech, Morocco
| | - Anas Baladi
- Medical Oncology Department, Mohammed VI University Hospital of Marrakech, Marrakech, Morocco
| | - Leila Afani
- Medical Oncology Department, Mohammed VI University Hospital of Marrakech, Marrakech, Morocco
| | - Mohammed El Fadli
- Medical Oncology Department, Mohammed VI University Hospital of Marrakech, Marrakech, Morocco
| | - Ismail Essaadi
- Faculty of Medicine and Pharmacy, Biosciences and Health Laboratory, Cadi Ayyad University, Marrakech, Morocco
- Medical Oncology Department, Avicenna Military Hospital of Marrakech, Marrakech, Morocco
| | - Rhizlane Belbaraka
- Medical Oncology Department, Mohammed VI University Hospital of Marrakech, Marrakech, Morocco
- Faculty of Medicine and Pharmacy, Biosciences and Health Laboratory, Cadi Ayyad University, Marrakech, Morocco
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270
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Shen L, Chen L, Zhou Y, Chen T, Han H, Xia Q, Liu Z. Temporal trends and barriers for inpatient palliative care referral in metastatic gynecologic cancer patients receiving specific critical care therapies. Front Oncol 2023; 13:1173438. [PMID: 37927460 PMCID: PMC10620795 DOI: 10.3389/fonc.2023.1173438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 09/29/2023] [Indexed: 11/07/2023] Open
Abstract
Objective Existing evidence suggests that palliative care (PC) is highly underutilized in metastatic gynecologic cancer (mGCa). This study aims to explore temporal trends and predictors for inpatient PC referral in mGCa patients who received specific critical care therapies (CCT). Methods The National Inpatient Sample from 2003 to 2015 was used to identify mGCa patients receiving CCT. Basic characteristics were compared between patients with and without PC. Annual percentage change (APC) was estimated to reflect the temporal trend in the entire cohort and subgroups. Multivariable logistic regression was employed to explore potential predictors of inpatient PC referral. Results In total, 122,981 mGCa patients were identified, of whom 10,380 received CCT. Among these, 1,208 (11.64%) received inpatient PC. Overall, the rate of PC referral increased from 1.81% in 2003 to 26.30% in 2015 (APC: 29.08%). A higher increase in PC usage was found in white patients (APC: 30.81%), medium-sized hospitals (APC: 31.43%), the Midwest region (APC: 33.84%), and among patients with ovarian cancer (APC: 31.35%). Multivariable analysis suggested that medium bedsize, large bedsize, Midwest region, West region, uterine cancer and cervical cancer were related to increased PC use, while metastatic sites from lymph nodes and genital organs were related to lower PC referral. Conclusion Further studies are warranted to better illustrate the barriers for PC and finally improve the delivery of optimal end-of-life care for mGCa patients who receive inpatient CCT, especially for those diagnosed with ovarian cancer or admitted to small scale and Northeast hospitals.
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Affiliation(s)
- Li Shen
- Department of Oncology, the Affiliated Aoyang Hospital of Jiangsu University, Zhangjiagang, China
| | - Longpei Chen
- Department of Oncology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Yun Zhou
- Department of Radiation Oncology, the Affiliated Aoyang Hospital of Jiangsu University, Zhangjiagang, China
| | - Tianran Chen
- Department of Oncology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Hedong Han
- Department of Health Statistics, Naval Medical University, Shanghai, China
| | - Qiuyan Xia
- Department of Oncology, the Affiliated Aoyang Hospital of Jiangsu University, Zhangjiagang, China
| | - Zhanguo Liu
- Department of Oncology, the Affiliated Aoyang Hospital of Jiangsu University, Zhangjiagang, China
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271
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Kusunose K, Toma Y. Value and challenges of lung ultrasound in stratifying ST-elevation myocardial infarction risk. Heart 2023; 109:1580-1581. [PMID: 37423741 DOI: 10.1136/heartjnl-2023-322949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/11/2023] Open
Affiliation(s)
- Kenya Kusunose
- Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Ryukyus, Nakagami-gun, Japan
| | - Yuichiro Toma
- Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Ryukyus, Nakagami-gun, Japan
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272
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O'Dowd EL, Tietzova I, Bartlett E, Devaraj A, Biederer J, Brambilla M, Brunelli A, Chorostowska J, Decaluwe H, Deruysscher D, De Wever W, Donoghue M, Fabre A, Gaga M, van Geffen W, Hardavella G, Kauczor HU, Kerpel-Fronius A, van Meerbeeck J, Nagavci B, Nestle U, Novoa N, Prosch H, Prokop M, Putora PM, Rawlinson J, Revel MP, Snoeckx A, Veronesi G, Vliegenthart R, Weckbach S, Blum TG, Baldwin DR. ERS/ESTS/ESTRO/ESR/ESTI/EFOMP statement on management of incidental findings from low dose CT screening for lung cancer. Eur J Cardiothorac Surg 2023; 64:ezad302. [PMID: 37804174 PMCID: PMC10876118 DOI: 10.1093/ejcts/ezad302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/06/2023] [Indexed: 10/09/2023] Open
Abstract
BACKGROUND Screening for lung cancer with low radiation dose computed tomography has a strong evidence base, is being introduced in several European countries and is recommended as a new targeted cancer screening programme. The imperative now is to ensure that implementation follows an evidence-based process that will ensure clinical and cost effectiveness. This European Respiratory Society (ERS) task force was formed to provide an expert consensus for the management of incidental findings which can be adapted and followed during implementation. METHODS A multi-European society collaborative group was convened. 23 topics were identified, primarily from an ERS statement on lung cancer screening, and a systematic review of the literature was conducted according to ERS standards. Initial review of abstracts was completed and full text was provided to members of the group for each topic. Sections were edited and the final document approved by all members and the ERS Science Council. RESULTS Nine topics considered most important and frequent were reviewed as standalone topics (interstitial lung abnormalities, emphysema, bronchiectasis, consolidation, coronary calcification, aortic valve disease, mediastinal mass, mediastinal lymph nodes and thyroid abnormalities). Other topics considered of lower importance or infrequent were grouped into generic categories, suitable for general statements. CONCLUSIONS This European collaborative group has produced an incidental findings statement that can be followed during lung cancer screening. It will ensure that an evidence-based approach is used for reporting and managing incidental findings, which will mean that harms are minimised and any programme is as cost-effective as possible.
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Affiliation(s)
- Emma L O'Dowd
- Nottingham University Hospitals NHS Trust, Nottingham, UK
- University of Nottingham, Faculty of Medicine and Health Sciences, Nottingham, UK
| | - Ilona Tietzova
- Charles University, First Faculty of Medicine, Department of Tuberculosis and Respiratory Diseases, Prague, Czech Republic
| | - Emily Bartlett
- Royal Brompton and Harefield NHS Foundation Trust, Radiology, London, UK
| | - Anand Devaraj
- Royal Brompton and Harefield NHS Foundation Trust, Radiology, London, UK
| | - Jürgen Biederer
- University of Heidelberg, Diagnostic and Interventional Radiology, Heidelberg, Germany
- German Center for Lung Research DZL, Translational Lung Research Center TLRC, Heidelberg, Germany
- University of Latvia, Faculty of Medicine, Riga, Latvia
- Christian-Albrechts-Universität zu Kiel, Faculty of Medicine, Kiel, Germany
| | - Marco Brambilla
- Azienda Ospedaliero-Universitaria Maggiore della Carità di Novara, Novara, Italy
| | | | - Joanna Chorostowska
- Institute of Tuberculosis and Lung Diseases, Warsaw, Genetics and Clinical Immunology, Warsaw, Poland
| | | | - Dirk Deruysscher
- Maastricht University Medical Centre, Department of Radiation Oncology (MAASTRO Clinic), GROW-School for Oncology and Developmental Biology, Limburg, The Netherlands
| | - Walter De Wever
- Universitaire Ziekenhuizen Leuven, Radiology, Leuven, Belgium
| | | | - Aurelie Fabre
- University College Dublin School of Medicine, Histopathology, Dublin, Ireland
| | - Mina Gaga
- Sotiria General Hospital of Chest Diseases of Athens, 7th Respiratory Medicine Department, Athens, Greece
| | - Wouter van Geffen
- Medical Centre Leeuwarden, Department of Respiratory Medicine, Leeuwarden, The Netherlands
- University of Groningen, University Medical Center Groningen, Department of Pulmonary Diseases, Groningen, The Netherlands
| | - Georgia Hardavella
- Sotiria General Hospital of Chest Diseases of Athens, Respiratory Medicine, Athens, Greece
| | - Hans-Ulrich Kauczor
- University of Heidelberg, Diagnostic and Interventional Radiology, Heidelberg, Germany
- German Center for Lung Research DZL, Translational Lung Research Center TLRC, Heidelberg, Germany
| | - Anna Kerpel-Fronius
- National Koranyi Institute of Pulmonology, Department of Radiology, Budapest, Hungary
| | | | - Blin Nagavci
- Institute for Evidence in Medicine, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Ursula Nestle
- Kliniken Maria Hilf GmbH Monchengladbach, Nordrhein-Westfalen, Germany
| | - Nuria Novoa
- University Hospital of Salamanca, Thoracic Surgery, Salamanca, Spain
| | - Helmut Prosch
- Medical University of Vienna, Department of Biomedical Imaging and Image-guided Therapy, Vienna, Austria
| | - Mathias Prokop
- Radboud University Nijmegen Medical Center, Department of Radiology, Nijmegen, The Netherlands
| | - Paul Martin Putora
- Kantonsspital Sankt Gallen, Radiation Oncology, Sankt Gallen, Switzerland
- Inselspital Universitatsspital Bern, Radiation Oncology, Bern, Switzerland
| | | | - Marie-Pierre Revel
- Cochin Hospital, APHP, Radiology Department, Paris, France
- Université de Paris, Paris, France
| | | | - Giulia Veronesi
- Humanitas Research Hospital, Division of Thoracic and General Surgery, Rozzano, Italy
| | | | - Sabine Weckbach
- UniversitatsKlinikum Heidelberg, Heidelberg, Germany
- Bayer AG, Research and Development, Pharmaceuticals, Radiology, Berlin, Germany
| | - Torsten G Blum
- HELIOS Klinikum Emil von Behring GmbH, Lungenklinik Heckeshorn, Berlin, Germany
| | - David R Baldwin
- University of Nottingham, Faculty of Medicine and Health Sciences, Nottingham, UK
- Nottingham University Hospitals NHS Trust, Department of Respiratory Medicine, Nottingham, UK
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Kosyreva AM, Miroshnichenko EA, Tsvetkov IS, Lokhonina AV, Sentyabreva AV, Dzhalilova DS, Fatkhudinov TK, Makarova OV. Morphofunctional Characteristics of Lung Macrophages in Rats with Acute Respiratory Distress Syndrome. Bull Exp Biol Med 2023; 175:822-827. [PMID: 37979023 DOI: 10.1007/s10517-023-05954-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Indexed: 11/19/2023]
Abstract
A comprehensive morphofunctional study of the lungs and alveolar macrophages was carried out in Sprague-Dawley rats with acute respiratory distress syndrome (n=10) induced by intratracheal administration of E. coli LPS 0111:B4 in a dose of 15 mg/kg. On the first day after LPS administration, bronchopneumonia was observed in the lungs, the number of macrophages of the bone marrow origin and the number of M1 macrophages with the proinflammatory phenotype in the bronchoalveolar lavage increased, the expression of proinflammatory cytokines increased and the expression of anti-inflammatory cytokines decreased, which was accompanied by an increase in LPS and C-reactive protein in the blood serum. The revealed changes correspond to the development of acute respiratory distress syndrome in humans, and the decrease in the number of macrophages in the lungs and their predominant polarization to the M1-proinflammatory phenotype substantiate the use of cell therapy with reprogrammed M2 macrophages.
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Affiliation(s)
- A M Kosyreva
- A. P. Avtsyn Research Institute of Human Morphology, B. V. Pet-rovsky Russian Research Center of Surgery, Moscow, Russia.
| | - E A Miroshnichenko
- A. P. Avtsyn Research Institute of Human Morphology, B. V. Pet-rovsky Russian Research Center of Surgery, Moscow, Russia
| | - I S Tsvetkov
- A. P. Avtsyn Research Institute of Human Morphology, B. V. Pet-rovsky Russian Research Center of Surgery, Moscow, Russia
| | - A V Lokhonina
- A. P. Avtsyn Research Institute of Human Morphology, B. V. Pet-rovsky Russian Research Center of Surgery, Moscow, Russia
| | - A V Sentyabreva
- A. P. Avtsyn Research Institute of Human Morphology, B. V. Pet-rovsky Russian Research Center of Surgery, Moscow, Russia
| | - D Sh Dzhalilova
- A. P. Avtsyn Research Institute of Human Morphology, B. V. Pet-rovsky Russian Research Center of Surgery, Moscow, Russia
| | - T Kh Fatkhudinov
- A. P. Avtsyn Research Institute of Human Morphology, B. V. Pet-rovsky Russian Research Center of Surgery, Moscow, Russia
| | - O V Makarova
- A. P. Avtsyn Research Institute of Human Morphology, B. V. Pet-rovsky Russian Research Center of Surgery, Moscow, Russia
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de Oliveira VF, Viana JA, Sawamura MVY, Magri ASGK, Benard G, Costa AN, Abdala E, Mariani AW, Magri MMC. Challenges, Characteristics, and Outcomes of Chronic Pulmonary Aspergillosis: A 11-Year Experience in A Middle-Income Country. Mycopathologia 2023; 188:683-691. [PMID: 36239834 DOI: 10.1007/s11046-022-00676-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 09/27/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Chronic pulmonary aspergillosis (CPA) is a research priority in fungal diseases with a need for new studies to reduce misdiagnosis with more common diseases, discuss improvement in diagnostic methods and better characterize gaps in antifungal and surgical treatments to improve clinical outcomes. METHODS In this retrospective study, we reviewed medical records of patients diagnosed with CPA from January 2010 to June 2021 at University of São Paulo, São Paulo, Brazil. We evaluated clinical characteristics, radiological findings, serology, treatment, and outcomes. RESULTS The study included 91 participants, with 43 (47.3%) patients who underwent surgery and 69 (75.8%) received antifungal therapy. We found a predominance of middle-aged adults (median 51 years), males (n = 58, 64%) with lower BMI (median 21.3 kg/m2). The most common underlying lung disease was pulmonary tuberculosis (n = 70, 76.9%). The commonest symptoms were cough (n = 67, 74%), haemoptysis, and dyspnea (n = 63, 70%). The most common chest computerized tomography abnormalities were cavity (n = 86, 94.5%), with a predominance of mycetomas (n = 78, 91%). The serology was positive in 81% (61/75). The one-year mortality was low (3.3%). Clinical improvement and stability occurred in 89% of participants for constitucional symptoms and 86% for pulmonary symptoms. While serological improvement and stability occurred in 71%. Radiological improvement and stability occurred in 75%. CONCLUSION We observed a good outcome after 1-year follow-up, in which the majority had improvement or stability of pulmonary and constitutional symptoms, decrease in CIE titers and low mortality.
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Affiliation(s)
- Vítor Falcão de Oliveira
- Department of Infectious and Parasitic Diseases of Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
| | - Joshua Araújo Viana
- Department of Radiology of Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Adriana Satie Gonçalves Kono Magri
- Department of Infectious and Parasitic Diseases of Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Gil Benard
- Laboratory of Medical Mycology (LIM-53), Instituto de Medicina Tropical, Division of Clinical Dermatology, Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Andre Nathan Costa
- Department of Pneumology of Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Edson Abdala
- Department of Infectious and Parasitic Diseases of Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Alessandro Wasum Mariani
- Department of Thoracic Surgery of Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Marcello Mihailenko Chaves Magri
- Department of Infectious and Parasitic Diseases of Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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Callender T, Imrie F, Cebere B, Pashayan N, Navani N, van der Schaar M, Janes SM. Assessing eligibility for lung cancer screening using parsimonious ensemble machine learning models: A development and validation study. PLoS Med 2023; 20:e1004287. [PMID: 37788223 PMCID: PMC10547178 DOI: 10.1371/journal.pmed.1004287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 08/29/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Risk-based screening for lung cancer is currently being considered in several countries; however, the optimal approach to determine eligibility remains unclear. Ensemble machine learning could support the development of highly parsimonious prediction models that maintain the performance of more complex models while maximising simplicity and generalisability, supporting the widespread adoption of personalised screening. In this work, we aimed to develop and validate ensemble machine learning models to determine eligibility for risk-based lung cancer screening. METHODS AND FINDINGS For model development, we used data from 216,714 ever-smokers recruited between 2006 and 2010 to the UK Biobank prospective cohort and 26,616 high-risk ever-smokers recruited between 2002 and 2004 to the control arm of the US National Lung Screening (NLST) randomised controlled trial. The NLST trial randomised high-risk smokers from 33 US centres with at least a 30 pack-year smoking history and fewer than 15 quit-years to annual CT or chest radiography screening for lung cancer. We externally validated our models among 49,593 participants in the chest radiography arm and all 80,659 ever-smoking participants in the US Prostate, Lung, Colorectal and Ovarian (PLCO) Screening Trial. The PLCO trial, recruiting from 1993 to 2001, analysed the impact of chest radiography or no chest radiography for lung cancer screening. We primarily validated in the PLCO chest radiography arm such that we could benchmark against comparator models developed within the PLCO control arm. Models were developed to predict the risk of 2 outcomes within 5 years from baseline: diagnosis of lung cancer and death from lung cancer. We assessed model discrimination (area under the receiver operating curve, AUC), calibration (calibration curves and expected/observed ratio), overall performance (Brier scores), and net benefit with decision curve analysis. Models predicting lung cancer death (UCL-D) and incidence (UCL-I) using 3 variables-age, smoking duration, and pack-years-achieved or exceeded parity in discrimination, overall performance, and net benefit with comparators currently in use, despite requiring only one-quarter of the predictors. In external validation in the PLCO trial, UCL-D had an AUC of 0.803 (95% CI: 0.783, 0.824) and was well calibrated with an expected/observed (E/O) ratio of 1.05 (95% CI: 0.95, 1.19). UCL-I had an AUC of 0.787 (95% CI: 0.771, 0.802), an E/O ratio of 1.0 (95% CI: 0.92, 1.07). The sensitivity of UCL-D was 85.5% and UCL-I was 83.9%, at 5-year risk thresholds of 0.68% and 1.17%, respectively, 7.9% and 6.2% higher than the USPSTF-2021 criteria at the same specificity. The main limitation of this study is that the models have not been validated outside of UK and US cohorts. CONCLUSIONS We present parsimonious ensemble machine learning models to predict the risk of lung cancer in ever-smokers, demonstrating a novel approach that could simplify the implementation of risk-based lung cancer screening in multiple settings.
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Affiliation(s)
- Thomas Callender
- Department of Respiratory Medicine, University College London, London, United Kingdom
| | - Fergus Imrie
- Department of Electrical and Computer Engineering, University of California, Los Angeles, California, United States of America
| | - Bogdan Cebere
- Department of Applied Mathematics and Theoretical Physics, University of Cambridge, Cambridge, United Kingdom
| | - Nora Pashayan
- Department of Applied Health Research, University College London, London, United Kingdom
| | - Neal Navani
- Department of Respiratory Medicine, University College London, London, United Kingdom
| | - Mihaela van der Schaar
- Department of Applied Mathematics and Theoretical Physics, University of Cambridge, Cambridge, United Kingdom
- Cambridge Centre for AI in Medicine, University of Cambridge, Cambridge, United Kingdom
- Alan Turing Institute, London, United Kingdom
| | - Sam M. Janes
- Department of Respiratory Medicine, University College London, London, United Kingdom
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276
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de Oliveira VF, Taborda M, Arcieri VC, Kruschewsky WLL, Costa AN, Duarte NJC, Romano P, de Almeida Rezende Ebner P, Magri ASGK, Abdala E, Levin AS, Magri MMC. Itraconazole Serum Trough Concentrations Using Oral Capsules for the Treatment of Chronic Pulmonary Aspergillosis: What is the Target? Mycopathologia 2023; 188:693-698. [PMID: 37526790 DOI: 10.1007/s11046-023-00781-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 07/23/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND In regions where there is only itraconazole capsule as a therapeutic option for treatment of chronic pulmonary aspergillosis (CPA), measuring the serum concentrations becomes even more important for therapeutic success. OBJECTIVE Evaluate the initial itraconazole serum trough concentrations after the administration of oral capsule of itraconazole for the treatment of CPA. METHODS The measurement was performed at least 7-days after initiation of therapy. The standard treatment at our institution was a 200 mg capsule every 12 h. We defined that an adequate serum trough concentration of itraconazole during treatment was 1-4 mg/L. RESULTS This study recruited 28 patients. The median value was 0.30 mg/L (IQR 0.01-0.70). Only 11% (n = 3) had adequate serum concentrations based on guideline recommendation. All patients with clinical deterioration had itraconazole serum levels ≤ 0.8 mg/L. CONCLUSION The initial serum concentrations of itraconazole after capsule formulation administration were low. Increasing the dose should be considered when the itraconazole concentration is low, especially if it is ≤ 0.8 mg/L, and the patient presents with clinical deterioration. Larger studies are needed to evaluate the adequate concentrations recommended for CPA.
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Affiliation(s)
- Vítor Falcão de Oliveira
- Department of Infectious and Parasitic Diseases, Hospital das Clínicas, Universidade de São Paulo, São Paulo, Brazil.
| | - Mariane Taborda
- Department of Infectious and Parasitic Diseases, Hospital das Clínicas, Universidade de São Paulo, São Paulo, Brazil
| | - Vitor Ciampone Arcieri
- Department of Infectious and Parasitic Diseases, Hospital das Clínicas, Universidade de São Paulo, São Paulo, Brazil
| | - Wdson Luis Lima Kruschewsky
- Department of Infectious and Parasitic Diseases, Hospital das Clínicas, Universidade de São Paulo, São Paulo, Brazil
| | - Andre Nathan Costa
- Department of Pneumology, Hospital das Clínicas, Universidade de São Paulo, São Paulo, Brazil
| | - Nilo José Coêlho Duarte
- Central Laboratory Division, Hospital das Clínicas, Universidade de São Paulo, São Paulo, Brazil
| | - Paschoalina Romano
- Central Laboratory Division, Hospital das Clínicas, Universidade de São Paulo, São Paulo, Brazil
| | | | | | - Edson Abdala
- Department of Infectious and Parasitic Diseases, Hospital das Clínicas, Universidade de São Paulo, São Paulo, Brazil
| | - Anna S Levin
- Department of Infectious and Parasitic Diseases, Hospital das Clínicas, Universidade de São Paulo, São Paulo, Brazil
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277
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Connors JM, Ariëns RAS. Uncertainties about the roles of anticoagulation and microclots in postacute sequelae of severe acute respiratory syndrome coronavirus 2 infection. J Thromb Haemost 2023; 21:2697-2701. [PMID: 37495081 DOI: 10.1016/j.jtha.2023.07.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/13/2023] [Accepted: 07/14/2023] [Indexed: 07/28/2023]
Abstract
Three years after the start of the pandemic, approaches to the prevention and treatment of acute COVID-19 have been established. However, postacute sequelae of SARS-CoV-2 infection (PASC) is now the focus of current investigations searching for the etiology of the symptoms and developing diagnostic and treatment strategies, as up to 10% of those with acute COVID-19 will go on to develop PASC, a significant public health burden. Some have suggested that ongoing microvascular thrombosis and microclots may play a role in the persistent sequelae of COVID-19 infection. Treatments are being given to address the presumed role of thrombosis in PASC, and some suggest that randomized controlled trials of anticoagulants in patients with PASC should be performed. In this Forum article, we focus on findings from patients with PASC that have led to the suggestion of using anticoagulants and discuss alternative considerations.
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Affiliation(s)
- Jean M Connors
- Hematology Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
| | - Robert A S Ariëns
- Discovery and Translational Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, UK
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278
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Dumoulin E, Thornton CS. Endoscopic Removal of Pulmonary Aspergilloma in a Nonsurgical Candidate. Ann Am Thorac Soc 2023; 20:1516-1520. [PMID: 37772939 DOI: 10.1513/annalsats.202303-218cc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 07/27/2023] [Indexed: 09/30/2023] Open
Affiliation(s)
| | - Christina S Thornton
- Department of Medicine and
- Department of Microbiology, Immunology and Infectious Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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279
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Arnouk S, Whitsett M, Papadopoulos J, Stewart Lewis Z, Dagher NN, Feldman DM, Park JS. Successful Treatment of Tenofovir Alafenamide-Induced Lactic Acidosis: A Case Report. J Pharm Pract 2023; 36:1260-1263. [PMID: 35635046 DOI: 10.1177/08971900221105042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
Nucleoside or nucleotide analogues (NAs) have the potential to cause lactic acidosis by inhibiting DNA polymerase-γ of human mitochondria and impairing aerobic metabolism. Patients may be asymptomatic, have mild non-specific symptoms, or present in multisystem organ failure. There is a paucity of data to guide management of life-threatening lactic acidosis due to NA therapy. Here we describe a case of a 60-year old critically ill male with decompensated cirrhosis secondary to hepatitis B virus (HBV) infection who developed severe lactic acidosis (13.8 mmol/L) 2 days after initiation of tenofovir alafenamide (TAF). All other possible etiologies for the elevated lactate were ruled out. Lactic acidosis resolved rapidly with TAF discontinuation and supplementation with cofactors supporting mitochondrial oxidative phosphorylation, including coenzyme Q10, levocarnitine, riboflavin, and thiamine. This case highlights the ability of TAF to cause lactic acidosis early after therapy initiation, especially in susceptible hosts, and reviews the potential role for cofactor supplementation for drug-induced mitochondrial injury.
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Affiliation(s)
- Serena Arnouk
- Department of Pharmacy, NYU Langone Health, New York, NY, USA
| | - Maureen Whitsett
- Department of Transplant Hepatology, Cleveland Clinic, Cleveland, OH, USA
| | | | | | - Nabil N Dagher
- Transplant Institute, NYU Langone Health, New York, NY, USA
| | - David M Feldman
- Department of Medicine, Division of Gastroenterology & Hepatology - NYU Langone Health, New York, NY, USA
| | - James S Park
- Department of Medicine, Division of Gastroenterology & Hepatology - NYU Langone Health, New York, NY, USA
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280
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Kassem R, Barzilai A, Pras E, Sizopoulou C, Pavlotsky F. Bath psoralen plus ultraviolet-A photochemotherapy for chronic graft-versus-host disease: a retrospective cohort study. Int J Dermatol 2023; 62:1261-1265. [PMID: 37568259 DOI: 10.1111/ijd.16806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 05/20/2023] [Accepted: 08/01/2023] [Indexed: 08/13/2023]
Abstract
BACKGROUND Chronic graft-versus-host disease is a severe complication of allogeneic stem cell and bone marrow transplantation. First-line immunosuppressive agents, such as steroids, are used to prevent this disease; however, they have multiple side effects. Therefore, bath psoralen plus ultraviolet-A (PUVA) is an alternative second-line treatment. This study aimed to evaluate the clinical efficacy of bath PUVA for managing chronic graft-versus-host disease. METHODS This retrospective, case-control study included 14 patients with extensive cutaneous chronic graft-versus-host disease, resistant to systemic corticosteroid, treated with bath PUVA. Major and partial responses were defined as clinical improvements of >70% and 50-70%, respectively. We analyzed the graft-versus-host disease clinical presentation and timing after allogeneic stem cell and bone marrow transplantation, bath PUVA doses, background diseases, additional treatments, and adverse effects. RESULTS We observed eight major (three lichenoid and five sclerodermatoid) and six partial (three lichenoid and three sclerodermatoid) responses after a mean of 28 treatment sessions. After 6 to 25 months, four of the eight patients with sclerodermatoid lesions and all those with lichenoid lesions experienced relapse but responded to additional treatment cycles. CONCLUSIONS Bath PUVA is well-tolerated and effective for extensive cutaneous chronic graft-versus-host disease. It allows rapid tapering of adjuvant immunosuppressants; however, most patients require prolonged maintenance phototherapy.
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Affiliation(s)
- Riad Kassem
- Department of Dermatology, Sheba Medical Center, Tel HaShomer, Ramat Gan, 52621, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, 69978, Israel
| | - Aviv Barzilai
- Department of Dermatology, Sheba Medical Center, Tel HaShomer, Ramat Gan, 52621, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, 69978, Israel
- Dermatopathology Service, Institute of Pathology, Sheba Medical Center, Tel HaShomer, Ramat Gan, 52621, Israel
| | - Elon Pras
- Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, 69978, Israel
- Institute of Genetics, Sheba Medical Center, Tel HaShomer, Ramat Gan, 52621, Israel
| | - Christina Sizopoulou
- Department of Dermatology, Sheba Medical Center, Tel HaShomer, Ramat Gan, 52621, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, 69978, Israel
| | - Felix Pavlotsky
- Department of Dermatology, Sheba Medical Center, Tel HaShomer, Ramat Gan, 52621, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, 69978, Israel
- Phototherapy Unit, Department of Dermatology, Sheba Medical Center, Tel HaShomer, Ramat Gan, 52621, Israel
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281
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Sousa C, Pasini RA, Pasqualotto A, Marchiori E, Altmayer S, Irion K, Mançano A, Hochhegger B. Imaging Findings in Aspergillosis: From Head to Toe. Mycopathologia 2023; 188:623-641. [PMID: 37380874 DOI: 10.1007/s11046-023-00766-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 06/16/2023] [Indexed: 06/30/2023]
Abstract
Aspergillosis is a mycotic infection induced by airborne fungi that are ubiquitous. Inhalation of Aspergillus conidia results in transmission through the respiratory tract. The clinical presentation is dependent on organism and host specifics, with immunodeficiency, allergies, and preexisting pulmonary disease constituting the most important risk factors. In recent decades, the incidence of fungal infections has increased dramatically, due in part to the increased number of transplants and the pervasive use of chemotherapy and immunosuppressive drugs. The spectrum of clinical manifestations can range from an asymptomatic or mild infection to a swiftly progressive, life-threatening illness. Additionally, invasive infections can migrate to extrapulmonary sites, causing infections in distant organs. Recognition and familiarity with the various radiological findings in the appropriate clinical context are essential for patient management and the prompt initiation of life-saving treatment. We discuss the radiological characteristics of chronic and invasive pulmonary aspergillosis, as well as some of the typically unexpected extrapulmonary manifestations of disseminated disease.
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Affiliation(s)
- Célia Sousa
- Radiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | | | - Alessandro Pasqualotto
- Radiology Department, Universidade Federal de Ciências da Saúde de Porto Alegre, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil
| | - Edson Marchiori
- Radiology Department, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | | | - Klaus Irion
- Radiology Department, University of Florida, Gainesville, FL, USA
| | | | - Bruno Hochhegger
- Radiology Department, University of Florida, Gainesville, FL, USA.
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282
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Delgado-Corcoran C, Wawrzynski SE, Flaherty B, Kirkland B, Bodily S, Moore D, Cook LJ, Olson LM. Extracorporeal membrane oxygenation and paediatric palliative care in an ICU. Cardiol Young 2023; 33:1846-1852. [PMID: 36278475 DOI: 10.1017/s1047951122003018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Compare rates, clinical characteristics, and outcomes of paediatric palliative care consultation in children supported on extracorporeal membrane oxygenation admitted to a single-centre 16-bed cardiac or a 28-bed paediatric ICU. METHODS Retrospective review of clinical characteristics and outcomes of children (aged 0-21 years) supported on extracorporeal membrane oxygenation between January, 2017 and December, 2019 compared by palliative care consultation. MEASUREMENTS AND RESULTS One hundred children (N = 100) were supported with extracorporeal membrane oxygenation; 19% received a palliative care consult. Compared to non-consulted children, consulted children had higher disease severity measured by higher complex chronic conditions at the end of extracorporeal membrane oxygenation hospitalisation (5 versus. 3; p < 0.001), longer hospital length of stay (92 days versus 19 days; p < 0.001), and higher use of life-sustaining therapies after decannulation (79% versus 23%; p < 0.001). Consultations occurred mainly for longitudinal psychosocial-spiritual support after patient survived device deployment with a median of 27 days after cannulation. Most children died in the ICU after withdrawal of life-sustaining therapies regardless of consultation status. Over two-thirds of the 44 deaths (84%; n = 37) occurred during extracorporeal membrane oxygenation hospitalisation. CONCLUSIONS Palliative care consultation was rare showing that palliative care consultation was not viewed as an acute need and only considered when the clinical course became protracted. As a result, there are missed opportunities to involve palliative care earlier and more frequently in the care of extracorporeal membrane survivors and non-survivors and their families.
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Affiliation(s)
- Claudia Delgado-Corcoran
- Division of Critical Care, Department of Pediatrics, University of Utah, 295 Chipeta Way, PO BOX 581289, Salt Lake City, UT, USA
- Division of Pediatric Palliative Care, Department of Pediatrics, University of Utah, 100 N. Mario Capecchi Dr. Salt Lake City, UT, USA
| | - Sarah E Wawrzynski
- Pediatric Critical Care Services, Primary Children's Hospital, Intermountain Healthcare, 100 N. Mario Capecchi Dr. Salt Lake City, UT, USA
- University of Utah, College of Nursing, 10 S 2000 E, Salt Lake City, UT, USA
| | - Brian Flaherty
- Division of Critical Care, Department of Pediatrics, University of Utah, 295 Chipeta Way, PO BOX 581289, Salt Lake City, UT, USA
| | - Brandon Kirkland
- Division of Critical Care, Department of Pediatrics, University of Utah, 295 Chipeta Way, PO BOX 581289, Salt Lake City, UT, USA
| | - Stephanie Bodily
- Pediatric Critical Care Services, Primary Children's Hospital, Intermountain Healthcare, 100 N. Mario Capecchi Dr. Salt Lake City, UT, USA
| | - Dominic Moore
- Division of Critical Care, Department of Pediatrics, University of Utah, 295 Chipeta Way, PO BOX 581289, Salt Lake City, UT, USA
- Division of Pediatric Palliative Care, Department of Pediatrics, University of Utah, 100 N. Mario Capecchi Dr. Salt Lake City, UT, USA
| | - Lawrence J Cook
- Division of Critical Care, Department of Pediatrics, University of Utah, 295 Chipeta Way, PO BOX 581289, Salt Lake City, UT, USA
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283
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O'Dowd EL, Tietzova I, Bartlett E, Devaraj A, Biederer J, Brambilla M, Brunelli A, Chorostowska-Wynimko J, Decaluwe H, Deruysscher D, De Wever W, Donoghue M, Fabre A, Gaga M, van Geffen W, Hardavella G, Kauczor HU, Kerpel-Fronius A, van Meerbeeck J, Nagavci B, Nestle U, Novoa N, Prosch H, Prokop M, Putora PM, Rawlinson J, Revel MP, Snoeckx A, Veronesi G, Vliegenthart R, Weckbach S, Blum TG, Baldwin DR. ERS/ESTS/ESTRO/ESR/ESTI/EFOMP statement on management of incidental findings from low dose CT screening for lung cancer. Eur Respir J 2023; 62:2300533. [PMID: 37802631 DOI: 10.1183/13993003.00533-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/06/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Screening for lung cancer with low radiation dose computed tomography has a strong evidence base, is being introduced in several European countries and is recommended as a new targeted cancer screening programme. The imperative now is to ensure that implementation follows an evidence-based process that will ensure clinical and cost effectiveness. This European Respiratory Society (ERS) task force was formed to provide an expert consensus for the management of incidental findings which can be adapted and followed during implementation. METHODS A multi-European society collaborative group was convened. 23 topics were identified, primarily from an ERS statement on lung cancer screening, and a systematic review of the literature was conducted according to ERS standards. Initial review of abstracts was completed and full text was provided to members of the group for each topic. Sections were edited and the final document approved by all members and the ERS Science Council. RESULTS Nine topics considered most important and frequent were reviewed as standalone topics (interstitial lung abnormalities, emphysema, bronchiectasis, consolidation, coronary calcification, aortic valve disease, mediastinal mass, mediastinal lymph nodes and thyroid abnormalities). Other topics considered of lower importance or infrequent were grouped into generic categories, suitable for general statements. CONCLUSIONS This European collaborative group has produced an incidental findings statement that can be followed during lung cancer screening. It will ensure that an evidence-based approach is used for reporting and managing incidental findings, which will mean that harms are minimised and any programme is as cost-effective as possible.
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Affiliation(s)
- Emma L O'Dowd
- Nottingham University Hospitals NHS Trust, Nottingham, UK
- University of Nottingham, Faculty of Medicine and Health Sciences, Nottingham, UK
| | - Ilona Tietzova
- Charles University, First Faculty of Medicine, Department of Tuberculosis and Respiratory Diseases, Prague, Czech Republic
| | - Emily Bartlett
- Royal Brompton and Harefield NHS Foundation Trust, Radiology, London, UK
| | - Anand Devaraj
- Royal Brompton and Harefield NHS Foundation Trust, Radiology, London, UK
| | - Jürgen Biederer
- University of Heidelberg, Diagnostic and Interventional Radiology, Heidelberg, Germany
- German Center for Lung Research DZL, Translational Lung Research Center TLRC, Heidelberg, Germany
- University of Latvia, Faculty of Medicine, Riga, Latvia
- Christian-Albrechts-Universität zu Kiel, Faculty of Medicine, Kiel, Germany
| | - Marco Brambilla
- Azienda Ospedaliero-Universitaria Maggiore della Carità di Novara, Novara, Italy
| | | | | | | | - Dirk Deruysscher
- Maastricht University Medical Centre, Department of Radiation Oncology (MAASTRO Clinic), GROW-School for Oncology and Developmental Biology, Limburg, The Netherlands
| | - Walter De Wever
- Universitaire Ziekenhuizen Leuven, Radiology, Leuven, Belgium
| | | | - Aurelie Fabre
- University College Dublin School of Medicine, Histopathology, Dublin, Ireland
| | - Mina Gaga
- Sotiria General Hospital of Chest Diseases of Athens, 7th Respiratory Medicine Department, Athens, Greece
| | - Wouter van Geffen
- Medical Centre Leeuwarden, Department of Respiratory Medicine, Leeuwarden, The Netherlands
- University of Groningen, University Medical Center Groningen, Department of Pulmonary Diseases, Groningen, The Netherlands
| | - Georgia Hardavella
- Sotiria General Hospital of Chest Diseases of Athens, Respiratory Medicine, Athens, Greece
| | - Hans-Ulrich Kauczor
- University of Heidelberg, Diagnostic and Interventional Radiology, Heidelberg, Germany
- German Center for Lung Research DZL, Translational Lung Research Center TLRC, Heidelberg, Germany
| | - Anna Kerpel-Fronius
- National Koranyi Institute of Pulmonology, Department of Radiology, Budapest, Hungary
| | | | - Blin Nagavci
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Ursula Nestle
- Kliniken Maria Hilf GmbH Monchengladbach, Nordrhein-Westfalen, Germany
| | - Nuria Novoa
- University Hospital of Salamanca, Thoracic Surgery, Salamanca, Spain
| | - Helmut Prosch
- Medical University of Vienna, Department of Biomedical Imaging and Image-guided Therapy, Vienna, Austria
| | - Mathias Prokop
- Radboud University Nijmegen Medical Center, Department of Radiology, Nijmegen, The Netherlands
| | - Paul Martin Putora
- Kantonsspital Sankt Gallen, Radiation Oncology, Sankt Gallen, Switzerland
- Inselspital Universitatsspital Bern, Radiation Oncology, Bern, Switzerland
| | | | - Marie-Pierre Revel
- Cochin Hospital, APHP, Radiology Department, Paris, France
- Université de Paris, Paris, France
| | | | - Giulia Veronesi
- Humanitas Research Hospital, Division of Thoracic and General Surgery, Rozzano, Italy
| | | | - Sabine Weckbach
- UniversitatsKlinikum Heidelberg, Heidelberg, Germany
- Bayer AG, Research and Development, Pharmaceuticals, Radiology, Berlin, Germany
| | - Torsten G Blum
- HELIOS Klinikum Emil von Behring GmbH, Lungenklinik Heckeshorn, Berlin, Germany
| | - David R Baldwin
- Nottingham University Hospitals NHS Trust, Nottingham, UK
- University of Nottingham, Faculty of Medicine and Health Sciences, Nottingham, UK
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284
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Akatsuka M, Yama N. Bronchiolitis Obliterans With Recurrent Pneumothorax After Allogeneic Bone Marrow Transplantation. Cureus 2023; 15:e46633. [PMID: 37936997 PMCID: PMC10627074 DOI: 10.7759/cureus.46633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2023] [Indexed: 11/09/2023] Open
Abstract
Bronchiolitis obliterans syndrome (BOS) is a non-infectious pulmonary complication that can occur in patients who have undergone allogeneic bone marrow transplantation (BMT). BOS is characterized by the irreversible narrowing and obstruction of bronchi, resulting in severe respiratory distress and poor outcomes. This case report focuses on the complex management of a patient with a multifaceted medical history. A 20-year-old man was initially diagnosed with precursor B lymphoblastic lymphoma and subsequently underwent allogeneic BMT. Nine months later, the patient was diagnosed with bronchiolitis obliterans with graft-versus-host disease, resulting in the development of BOS. Remarkably, 12 years after BMT, the patient was registered for lung transplantation. However, one year after registration, the patient developed a left pneumothorax. Despite rigorous efforts, including continuous thoracic drainage and autologous pleurodesis, the pneumothorax did not respond to treatment and required video-assisted thoracic surgery (VATS) bullectomy. The preoperative assessment revealed a challenging clinical finding characterized by the need for home oxygen therapy (5 L/min with a nasal cannula), severe Hugh-Jones classification IV-V, and marked hypercapnia (partial pressure of carbon dioxide (pCO2), 76 mmHg). Imaging studies, including high-resolution computed tomography and chest radiography, revealed hyperinflation, emphysematous changes, and bronchiectasis across all lung lobes, further complicating the patient's condition. Intraoperative management had the unique challenges of persistent hypoxia (P/F ratio 65-80), positive end-expiratory pressure of 5 cmH2O, and low tidal volumes (1.6-2.0 mL/kg) during one-lung ventilation. To address these problems, both-lung ventilation had to be performed intermittently. However, hyperventilation remained unmanageable, with maximum pCO2 values reaching 140 mmHg. Following surgery, the patient had to be admitted to the intensive care unit in an intubated state. Fortunately, the following day, the patient's condition improved markedly, his state of consciousness was clear (Glasgow Coma Scale 15) and his pCO2 level improved (66 mmHg) with spontaneous breath. This course of events allowed extubation and the patient was discharged to the general ward only two days after surgery. This case highlights the critical importance of a comprehensive preoperative assessment, including advanced imaging, when managing patients with BOS and complex pulmonary complications. Furthermore, it highlights the complexity and difficulty of perioperative respiratory management in such cases.
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Affiliation(s)
- Masayuki Akatsuka
- Department of Intensive Care Medicine, Sapporo Medical University School of Medicine, Sapporo, JPN
| | - Naoya Yama
- Department of Diagnostic Radiology, Sapporo Medical University School of Medicine, Sapporo, JPN
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285
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Lyons PG, McEvoy CA, Hayes-Lattin B. Sepsis and acute respiratory failure in patients with cancer: how can we improve care and outcomes even further? Curr Opin Crit Care 2023; 29:472-483. [PMID: 37641516 PMCID: PMC11142388 DOI: 10.1097/mcc.0000000000001078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
PURPOSE OF REVIEW Care and outcomes of critically ill patients with cancer have improved over the past decade. This selective review will discuss recent updates in sepsis and acute respiratory failure among patients with cancer, with particular focus on important opportunities to improve outcomes further through attention to phenotyping, predictive analytics, and improved outcome measures. RECENT FINDINGS The prevalence of cancer diagnoses in intensive care units (ICUs) is nontrivial and increasing. Sepsis and acute respiratory failure remain the most common critical illness syndromes affecting these patients, although other complications are also frequent. Recent research in oncologic sepsis has described outcome variation - including ICU, hospital, and 28-day mortality - across different types of cancer (e.g., solid vs. hematologic malignancies) and different sepsis definitions (e.g., Sepsis-3 vs. prior definitions). Research in acute respiratory failure in oncology patients has highlighted continued uncertainty in the value of diagnostic bronchoscopy for some patients and in the optimal respiratory support strategy. For both of these syndromes, specific challenges include multifactorial heterogeneity (e.g. in etiology and/or underlying cancer), delayed recognition of clinical deterioration, and complex outcomes measurement. SUMMARY Improving outcomes in oncologic critical care requires attention to the heterogeneity of cancer diagnoses, timely recognition and management of critical illness, and defining appropriate ICU outcomes.
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Affiliation(s)
- Patrick G Lyons
- Department of Medicine, Oregon Health & Science University
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University
- Knight Cancer Institute, Oregon Health & Science University
| | - Colleen A McEvoy
- Department of Medicine, Washington University School of Medicine
- Siteman Cancer Center, Washington University School of Medicine
| | - Brandon Hayes-Lattin
- Department of Medicine, Oregon Health & Science University
- Knight Cancer Institute, Oregon Health & Science University
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286
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Gamalathge DR, Perera SDHS. Allergic Bronchopulmonary Aspergillosis in a Patient With Poorly Controlled Bronchial Asthma. Cureus 2023; 15:e46666. [PMID: 37942376 PMCID: PMC10628675 DOI: 10.7759/cureus.46666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2023] [Indexed: 11/10/2023] Open
Abstract
Allergic bronchopulmonary aspergillosis (ABPA) is a notable complication in patients with chronic lung diseases, such as chronic bronchial asthma and cystic fibrosis, presenting challenges in diagnosis and management. ABPA is an allergic response to multiple antigens expressed by Aspergillus fumigatus in the lung mucosa, resulting in airway inflammation and damage. This study discusses a 58-year-old male patient with a history of longstanding bronchial asthma for 28 years who presented with worsening respiratory symptoms. The patient's blood investigations showed peripheral eosinophilia, increased total serum immunoglobulin IgE, and positive Aspergillus serology. Bronchoalveolar lavage samples showed a significant increase in Aspergillus antigens, along with positive radiological findings, leading to the diagnosis of ABPA. He was successfully treated with a combination of dual antifungal therapy, systemic corticosteroids, inhaled corticosteroids, and bronchodilators. This study emphasizes the importance of considering ABPA in patients with chronic bronchial asthma experiencing deteriorating respiratory symptoms and highlights the significance of a multidisciplinary approach for accurate diagnosis and effective management of this condition.
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287
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Shkunnikova S, Mijakovac A, Sironic L, Hanic M, Lauc G, Kavur MM. IgG glycans in health and disease: Prediction, intervention, prognosis, and therapy. Biotechnol Adv 2023; 67:108169. [PMID: 37207876 DOI: 10.1016/j.biotechadv.2023.108169] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/01/2023] [Accepted: 05/02/2023] [Indexed: 05/21/2023]
Abstract
Immunoglobulin (IgG) glycosylation is a complex enzymatically controlled process, essential for the structure and function of IgG. IgG glycome is relatively stable in the state of homeostasis, yet its alterations have been associated with aging, pollution and toxic exposure, as well as various diseases, including autoimmune and inflammatory diseases, cardiometabolic diseases, infectious diseases and cancer. IgG is also an effector molecule directly involved in the inflammation processes included in the pathogenesis of many diseases. Numerous recently published studies support the idea that IgG N-glycosylation fine-tunes the immune response and plays a significant role in chronic inflammation. This makes it a promising novel biomarker of biological age, and a prognostic, diagnostic and treatment evaluation tool. Here we provide an overview of the current state of knowledge regarding the IgG glycosylation in health and disease, and its potential applications in pro-active prevention and monitoring of various health interventions.
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Affiliation(s)
- Sofia Shkunnikova
- Genos Glycoscience Research Laboratory, Borongajska cesta 83H, Zagreb, Croatia
| | - Anika Mijakovac
- University of Zagreb, Faculty of Science, Department of Biology, Horvatovac 102a, Zagreb, Croatia
| | - Lucija Sironic
- Genos Glycoscience Research Laboratory, Borongajska cesta 83H, Zagreb, Croatia
| | - Maja Hanic
- Genos Glycoscience Research Laboratory, Borongajska cesta 83H, Zagreb, Croatia
| | - Gordan Lauc
- Genos Glycoscience Research Laboratory, Borongajska cesta 83H, Zagreb, Croatia; University of Zagreb, Faculty of Pharmacy and Biochemistry, Ulica Ante Kovačića 1, Zagreb, Croatia
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Yilmaz Aİ, Gül Y, Kapaklı H, Ünal G, Çağlar HT, Ercan F, Reisli İ, Keleş S, Poyraz N, Pekcan S. Successful treatment of postinfectious bronchiolitis obliterans with gamma globulin in a tertiary center: 10 years of experience. Pediatr Pulmonol 2023; 58:2769-2776. [PMID: 37469295 DOI: 10.1002/ppul.26577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 05/23/2023] [Accepted: 06/18/2023] [Indexed: 07/21/2023]
Abstract
INTRODUCTION Bronchiolitis obliterans is characterized by partial or total occlusion of the bronchioles due to inflammation and fibrosis, and the most common form is postinfectious bronchiolitis obliterans (PIBO). This study aimed to retrospectively present our intravenous immunoglobulin (IVIG) treatment experience in PIBO patients with a clinically severe course despite receiving commonly used treatment protocols. MATERIALS AND METHODS The study included patients aged 0-18 with subtle immunological abnormalities who were followed up in our center for PIBO between 2010 and 2021. Clinical evaluation, body mass index (BMI), computerized tomography (CT) image scoring, and immunological parameters were recorded before and after IVIG treatment. RESULTS Of the 11 patients included in the study, 90% were male, the mean age at diagnosis was 27.1 months (range: 5-68 months) and the mean current age was 81.4 months (range: 15-188 months). The number of hospital visits due to infection and the frequency of hospitalizations decreased markedly in the patients who underwent IVIG therapy. Oxygen therapy was discontinued in all patients, and improvements in radiological severity scores were observed. BMI z-scores improved over the baseline values after IVIG therapy. CONCLUSION Corticosteroids are considered the best first-line treatment to control inflammation in PIBO. In our study group, PIBO patients showed favorable clinical and radiological responses to regular IVIG treatment, possibly due to minor immune deficiency secondary to steroids or as a result of undetected adaptive and innate immune defects involved in the etiology of severe PIBO.
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Affiliation(s)
- Aslı İmran Yilmaz
- Department of Pediatric Pulmonology, Necmettin Erbakan University Faculty of Medicine, Konya, Turkey
| | - Yahya Gül
- Department of Pediatric Allergy and Immunology, Necmettin Erbakan University Faculty of Medicine, Konya, Turkey
| | - Hasan Kapaklı
- Department of Pediatric Allergy and Immunology, Necmettin Erbakan University Faculty of Medicine, Konya, Turkey
| | - Gökçen Ünal
- Department of Pediatric Pulmonology, Necmettin Erbakan University Faculty of Medicine, Konya, Turkey
| | - Hanife Tuğçe Çağlar
- Department of Pediatric Pulmonology, Necmettin Erbakan University Faculty of Medicine, Konya, Turkey
| | - Fatih Ercan
- Department of Pediatric Pulmonology, Necmettin Erbakan University Faculty of Medicine, Konya, Turkey
| | - İsmail Reisli
- Department of Pediatric Allergy and Immunology, Necmettin Erbakan University Faculty of Medicine, Konya, Turkey
| | - Sevgi Keleş
- Department of Pediatric Allergy and Immunology, Necmettin Erbakan University Faculty of Medicine, Konya, Turkey
| | - Necdet Poyraz
- Department of Radiology, Necmettin Erbakan University Faculty of Medicine, Konya, Turkey
| | - Sevgi Pekcan
- Department of Pediatric Pulmonology, Necmettin Erbakan University Faculty of Medicine, Konya, Turkey
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289
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Celik A, Ural D, Sahin A, Colluoglu IT, Kanik EA, Ata N, Arugaslan E, Demir E, Ayvali MO, Ulgu MM, Temizhan A, Cavusoglu Y, Acar RD, Nalbantgil S, Asarcikli LD, Murat S, Birinci S, Yilmaz MB. Trends in heart failure between 2016 and 2022 in Türkiye (TRends-HF): a nationwide retrospective cohort study of 85 million individuals across entire population of all ages. THE LANCET REGIONAL HEALTH. EUROPE 2023; 33:100723. [PMID: 37953995 PMCID: PMC10636276 DOI: 10.1016/j.lanepe.2023.100723] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/10/2023] [Accepted: 08/11/2023] [Indexed: 11/14/2023]
Abstract
Background Data on the burden of heart failure (HF) outside western countries are limited, but available data suggest it may present differently in other countries. The aim of this study was to examine the incidence, prevalence, and survival rates of HF in Türkiye, with a specific focus on how these rates vary according to age, sex, comorbidities, and socioeconomic status (SES). Methods We harnessed the extensive National Electronic Database of the Turkish Ministry of Health, covering Turkey's entire population from January 1, 2016, to December 31, 2022, to identify 2,722,151 cases of HF and their associated comorbidities using ICD-10 codes. Analyzing the primary endpoint of all-cause mortality, our study utilized anonymized data to examine patient demographics, comorbidities, socioeconomic status, and survival patterns, employing statistical techniques to delve into relationships and trends. The data were segmented by gender, socioeconomic status, and age, involving cross-tabulations and statistical metrics to explore connections, odds ratios, and survival rates. Findings The estimated prevalence of HF was 2.114% in Türkiye at the end of 2022, with an annual incidence ranging between 3.00 and 6.06 per 1000 person years. Females were older than males (69.8 ± 13.9 years vs. 66.8 ± 13.9 years, respectively). The most common comorbidities were congenital heart diseases and anemia under the age of 20, and hypertension and atherosclerotic cardiovascular disease in the adult population. Only 23.6% (643,159/2,722,151) of patients were treated with any triple guideline-directed medical therapy (GDMT) and 3.6% (96,751/2,722,151) of patients were on quadruple GDMT. The survival rates for patients with HF at 1, 5, and 7 years were 83.3% (95% CI: 83.2-83.3), 61.5% (95% CI: 61.4-61.6), and 57.7% (95% CI: 57.6-57.8) among females, and 82.1% (95% CI: 82.0-82.2), 58.2% (95% CI: 58.1-58.3), and 54.2% (95% CI: 54.0-54.3) among males. Despite a tendency for an increase from the highest to the lowest SES, the prevalence of HF and mortality were paradoxically lowest in the lowest SES region. Interpretation The prevalence, incidence, and survival rates of HF in Türkiye were comparable to western countries, despite the notable difference of HF onset occurring 8-10 years earlier in the Turkish population. Drug usage statistics indicate there is a need for effective strategies to improve treatment with GDMT. Funding None.
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Affiliation(s)
- Ahmet Celik
- Department of Cardiology, Mersin University, Faculty of Medicine, Mersin, Türkiye
| | - Dilek Ural
- Department of Cardiology, Koç University, Faculty of Medicine, Istanbul, Türkiye
| | - Anil Sahin
- Department of Cardiology, Sivas Cumhuriyet University, Faculty of Medicine, Sivas, Türkiye
| | - Inci Tugce Colluoglu
- Department of Cardiology, Karabük University, Faculty of Medicine, Karabük, Türkiye
| | - Emine Arzu Kanik
- Department of Biostatistics and Medical Informatics, Mersin University, Faculty of Medicine, Mersin, Türkiye
| | - Naim Ata
- General Directorate of Information Systems, Ministry of Health, Ankara, Türkiye
| | - Emre Arugaslan
- Health Science University, Faculty of Medicine, Ankara City Hospital, Ankara, Türkiye
| | - Emre Demir
- Department of Cardiology, Ege University, Faculty of Medicine, Izmir, Türkiye
| | - Mustafa Okan Ayvali
- General Directorate of Information Systems, Ministry of Health, Ankara, Türkiye
| | - Mustafa Mahir Ulgu
- General Directorate of Information Systems, Ministry of Health, Ankara, Türkiye
| | - Ahmet Temizhan
- Health Science University, Faculty of Medicine, Ankara City Hospital, Ankara, Türkiye
| | - Yuksel Cavusoglu
- Department of Cardiology, Osmangazi University, Faculty of Medicine, Eskisehir, Türkiye
| | - Rezzan Deniz Acar
- Department of Cardiology, Health Science University, Faculty of Medicine, Kosuyolu Kartal Heart Training and Research Hospital, Istanbul, Türkiye
| | - Sanem Nalbantgil
- Department of Cardiology, Ege University, Faculty of Medicine, Izmir, Türkiye
| | - Lale Dinc Asarcikli
- Department of Cardiology, Health Science University, Faculty of Medicine, Siyami Ersek Cardiovascular and Thoracic Surgery Training and Research Hospital, Istanbul, Türkiye
| | - Selda Murat
- Department of Cardiology, Osmangazi University, Faculty of Medicine, Eskisehir, Türkiye
| | - Suayip Birinci
- Deputy Minister of Health, Ministry of Health, Ankara, Türkiye
| | - Mehmet Birhan Yilmaz
- Department of Cardiology, Dokuz Eylül University, Faculty of Medicine, Izmir, Türkiye
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290
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El Fakih R, Abdulqawi R, Bugnah A, Arabi TZ, Rasheed W, Ezzat L, Shaheen M, Chaudhri N, Almohareb F, Al-Mutairy EA, Aljurf M. Lung transplantation for pulmonary graft versus host disease: experience from a referral organ transplantation center. Bone Marrow Transplant 2023; 58:1170-1173. [PMID: 37532865 DOI: 10.1038/s41409-023-02074-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/04/2023] [Accepted: 07/24/2023] [Indexed: 08/04/2023]
Affiliation(s)
- Riad El Fakih
- King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia.
- College of Medicine, Alfaisal University, Riyadh, Kingdom of Saudi Arabia.
| | - Rayid Abdulqawi
- King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
| | - Amer Bugnah
- King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
| | - Tarek Ziad Arabi
- College of Medicine, Alfaisal University, Riyadh, Kingdom of Saudi Arabia
| | - Walid Rasheed
- King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
| | - Loui Ezzat
- King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
| | - Marwan Shaheen
- King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
| | - Naeem Chaudhri
- King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
| | - Fahad Almohareb
- King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
| | - Eid A Al-Mutairy
- King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
| | - Mahmoud Aljurf
- King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
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291
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Bandyopadhyay D, Mirsaeidi MS. Sarcoidosis-associated pulmonary fibrosis: joining the dots. Eur Respir Rev 2023; 32:230085. [PMID: 37758275 PMCID: PMC10523156 DOI: 10.1183/16000617.0085-2023] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 08/10/2023] [Indexed: 09/30/2023] Open
Abstract
Sarcoidosis is a multisystem granulomatous disorder of unknown aetiology. A minority of patients with sarcoidosis develop sarcoidosis-associated pulmonary fibrosis (SAPF), which may become progressive. Genetic profiles differ between patients with progressive and self-limiting disease. The mechanisms of fibrosis in SAPF are not fully understood, but SAPF is likely a distinct clinicopathological entity, rather than a continuum of acute inflammatory sarcoidosis. Risk factors for the development of SAPF have been identified; however, at present, it is not possible to make a robust prediction of risk for an individual patient. The bulk of fibrotic abnormalities in SAPF are located in the upper and middle zones of the lungs. A greater extent of SAPF on imaging is associated with a worse prognosis. Patients with SAPF are typically treated with corticosteroids, second-line agents such as methotrexate or azathioprine, or third-line agents such as tumour necrosis factor inhibitors. The antifibrotic drug nintedanib is an approved treatment for slowing the decline in lung function in patients with progressive fibrosing interstitial lung diseases, but more evidence is needed to assess its efficacy in SAPF. The management of patients with SAPF should include the identification and treatment of complications such as bronchiectasis and pulmonary hypertension. Further research is needed into the mechanisms underlying SAPF and biomarkers that predict its clinical course.
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Affiliation(s)
| | - Mehdi S Mirsaeidi
- Division of Pulmonary and Critical Care, University of Florida, Jacksonville, FL, USA
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292
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Casutt A, Lamoth F, Lortholary O, Prior JO, Tonglet A, Manuel O, Bergeron A, Beigelman-Aubry C. Atypical imaging patterns during lung invasive mould diseases: lessons for clinicians. Eur Respir Rev 2023; 32:230086. [PMID: 37758271 PMCID: PMC10523149 DOI: 10.1183/16000617.0086-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 07/13/2023] [Indexed: 09/30/2023] Open
Abstract
Imaging of pulmonary invasive mould diseases (IMDs), which represents a cornerstone in their work-up, is mainly based on computed tomography (CT). The purpose of this review is to discuss their CT features, mainly those related to aspergillosis and mucormycosis. We will especially focus on atypical radiological presentations that are increasingly observed among non-neutropenic emerging populations of patients at risk, such as those receiving novel anticancer therapies or those in the intensive care unit. We will also discuss the interest of other available imaging techniques, mainly positron emission tomography/CT, that may play a role in the diagnosis as well as evaluation of disease extent and follow-up. We will show that any new airway-centred abnormality or caveated lesion should evoke IMDs in mildly immunocompromised hosts. Limitations in their recognition may be due to potential underlying abnormalities that increase the complexity of interpretation of lung imaging, as well as the non-specificity of imaging features. In this way, the differentials of all morphological/metabolic aspects must be kept in mind for the optimal management of patients, as well as the benefit of evaluation of the vascular status.
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Affiliation(s)
- Alessio Casutt
- Division of Pulmonology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- Division of Pulmonology, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
| | - Frédéric Lamoth
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- Institute of Microbiology, Department of Laboratories, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Olivier Lortholary
- University Paris Cité, Necker Enfants Malades University Hospital, AP-HP, IHU Imagine, Paris, France
- Institut Pasteur, National Reference Center for Invasive Mycoses and Antifungals, Paris, France
| | - John O Prior
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Andrea Tonglet
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Oriol Manuel
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- Transplantation Center, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Anne Bergeron
- Department of Pulmonology, Geneva University Hospital, University of Geneva, Geneva, Switzerland
- A. Bergeron and C. Beigelman-Aubry contributed equally to this work
| | - Catherine Beigelman-Aubry
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
- A. Bergeron and C. Beigelman-Aubry contributed equally to this work
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293
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Bonney A, Steinfort D, Manser R. Are current lung cancer screening guidelines and programs racially biased? Transl Lung Cancer Res 2023; 12:1834-1837. [PMID: 37854162 PMCID: PMC10579830 DOI: 10.21037/tlcr-23-444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 08/07/2023] [Indexed: 10/20/2023]
Affiliation(s)
- Asha Bonney
- Department of Respiratory and Sleep Medicine, The Royal Melbourne Hospital, Parkville, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Australia
| | - Daniel Steinfort
- Department of Respiratory and Sleep Medicine, The Royal Melbourne Hospital, Parkville, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Australia
| | - Renee Manser
- Department of Respiratory and Sleep Medicine, The Royal Melbourne Hospital, Parkville, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Australia
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294
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Shimoda M, Morimoto K, Tanaka Y, Ito M, Moue I, Yoshimori K, Ohta K. Analysis of the utility of transbronchial lung biopsy culture under endobronchial ultrasonography with a guide-sheath. Sci Rep 2023; 13:16128. [PMID: 37752193 PMCID: PMC10522693 DOI: 10.1038/s41598-023-43078-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 09/19/2023] [Indexed: 09/28/2023] Open
Abstract
Transbronchial lung biopsy (TBLB) culture is not common in clinical practice, and TBLB culture for patients with mycobacterial disease provide limited value because the diagnostic accuracy of TBLB culture is very low. Recently, bronchoscopic devices have been further developed, such as endobronchial ultrasonography with a guide-sheath (EBUS-GS). Therefore, this study investigated the utility of TBLB culture obtained by using EBUS-GS compared to washing cultures. A total of 31 patients who underwent TBLB culture by using EBUS-GS (GS-TBLB) were collected retrospectively at Fukujuji Hospital from January 2018 to December 2022. The diagnostic accuracies of GS-TBLB culture and bronchial and device washing cultures (namely, washing culture) were compared. The patients comprised 13 individuals with nontuberculous mycobacteriosis, 7 with pulmonary aspergillosis, 6 with lung abscess, and 5 with pulmonary tuberculosis. The diagnostic accuracy of GS-TBLB culture was lower to that of TBLB culture than those of washing culture (n = 11 [35.5%] vs. n = 20 [64.5%], p = 0.016), and there was only one patient with positive GS-TBLB culture results and negative washing culture results. Comparing between patients with mycobacteria and non-mycobacteria, GS-TBLB culture positivity were no significant difference between patients with mycobacteria and non-mycobacteria (n = 6 [33.3%] vs. n = 5 [38.5%], p = 1.000), however, patients with mycobacteria diagnosed by washing culture more than those with non-mycobacteria (n = 15 [83.3%] vs. n = 5 [38.5%], p = 0.021). Our results demonstrate that the utility of TBLB culture for the diagnosis of pulmonary infections might provide limited value even if EBUS-GS is performed and lung tissue is successfully obtained.
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Affiliation(s)
- Masafumi Shimoda
- Respiratory Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association (JATA), 3-1-24 Mastuyama, Kiyose, Tokyo, 204-8522, Japan.
| | - Kozo Morimoto
- Respiratory Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association (JATA), 3-1-24 Mastuyama, Kiyose, Tokyo, 204-8522, Japan
- Division of Clinical Research, Fukujuji Hospital, Japan Anti-Tuberculosis Association, Kiyose, Tokyo, Japan
- Department of Clinical Mycobacteriosis, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yoshiaki Tanaka
- Respiratory Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association (JATA), 3-1-24 Mastuyama, Kiyose, Tokyo, 204-8522, Japan
| | - Masashi Ito
- Respiratory Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association (JATA), 3-1-24 Mastuyama, Kiyose, Tokyo, 204-8522, Japan
| | - Iori Moue
- Respiratory Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association (JATA), 3-1-24 Mastuyama, Kiyose, Tokyo, 204-8522, Japan
| | - Kozo Yoshimori
- Respiratory Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association (JATA), 3-1-24 Mastuyama, Kiyose, Tokyo, 204-8522, Japan
| | - Ken Ohta
- Respiratory Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association (JATA), 3-1-24 Mastuyama, Kiyose, Tokyo, 204-8522, Japan
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295
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Safari LC, Mloka D, Minzi O, Dharsee NJ, Reuben R. Prevalence of blood stream infections and associated factors among febrile neutropenic cancer patients on chemotherapy at Ocean Road Cancer Institute, Tanzania. Infect Agent Cancer 2023; 18:52. [PMID: 37730617 PMCID: PMC10510178 DOI: 10.1186/s13027-023-00533-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/12/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Febrile Neutropenia (FN) caused by bacteria in cancer patients is associated with poor prognosis. The aim of this study was to determine the prevalence of FN and associated factors among cancer patients on chemotherapy at Ocean Road Cancer Institute (ORCI), Tanzania. METHODS A cross-sectional study was conducted from June to September 2019. Study participants were conveniently recruited. A desk review of participants medical records was performed. Standard microbiological procedures used to culture and identify the bacterial isolates from the positive blood cultures of participants that presented with FN. Kirby-Bauer disc diffusion was used to perform the antibiotics susceptibility testing. SPSS version 20.0 and MS Excel were used in data entry and analysis. Chi-Square was used as a measure of association between various factors and neutropenia. P-value less than 0.05 was considered statistically significant. RESULTS A total 213 participants were enrolled. Of these 76.1% were female. Most of the participants came from the Coast region. Majority of participants presented with breast Cancer (36.2%) and GIT (20.2%). The prevalence of FN and bacteremia was 5.6% and 35.3% respectively. Staphylococcus Aureus (60%) and Coagulase-Negative Staphylococci (40%) were the main isolates. Of the 6 isolates tested most were resistant to Co-Trimoxazole 4/6 (66.7%) and Doxycycline 3/6 (50%). FN was positively associated with chemotherapy regimen (P = 0.0001), platelets count (P = 0.0001) and use of G-CSF (P = 0.0001). CONCLUSION The prevalence of FN among the cancer patients on chemotherapy in Tanzania is low but associated with drug-resistant bacteria.
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Affiliation(s)
- Lambert C Safari
- Department of Clinical Pharmacy and Pharmacy Practice, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Huye, Rwanda.
- University Teaching Hospital of Butare (CHUB), Huye, Rwanda.
- Department of Clinical Pharmacy and Pharmacology, School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
| | - Doreen Mloka
- Pharmaceutical Microbiology, School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Omary Minzi
- Department of Clinical Pharmacy and Pharmacology, School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Nazima J Dharsee
- Department of Clinical Oncology, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Ocean Road Cancer Institute, Dar es Salaam, Tanzania
| | - Rabson Reuben
- Ocean Road Cancer Institute, Dar es Salaam, Tanzania
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296
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Fusco-Almeida AM, de Matos Silva S, dos Santos KS, de Lima Gualque MW, Vaso CO, Carvalho AR, Medina-Alarcón KP, Pires ACMDS, Belizario JA, de Souza Fernandes L, Moroz A, Martinez LR, Ruiz OH, González Á, Mendes-Giannini MJS. Alternative Non-Mammalian Animal and Cellular Methods for the Study of Host-Fungal Interactions. J Fungi (Basel) 2023; 9:943. [PMID: 37755051 PMCID: PMC10533014 DOI: 10.3390/jof9090943] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/28/2023] [Accepted: 08/30/2023] [Indexed: 09/28/2023] Open
Abstract
In the study of fungal pathogenesis, alternative methods have gained prominence due to recent global legislation restricting the use of mammalian animals in research. The principle of the 3 Rs (replacement, reduction, and refinement) is integrated into regulations and guidelines governing animal experimentation in nearly all countries. This principle advocates substituting vertebrate animals with other invertebrate organisms, embryos, microorganisms, or cell cultures. This review addresses host-fungus interactions by employing three-dimensional (3D) cultures, which offer more faithful replication of the in vivo environment, and by utilizing alternative animal models to replace traditional mammals. Among these alternative models, species like Caenorhabditis elegans and Danio rerio share approximately 75% of their genes with humans. Furthermore, models such as Galleria mellonella and Tenebrio molitor demonstrate similarities in their innate immune systems as well as anatomical and physiological barriers, resembling those found in mammalian organisms.
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Affiliation(s)
- Ana Marisa Fusco-Almeida
- Department of Clinical Analysis, School of Pharmaceutical Science, Universidade Estadual Paulista (UNESP), Araraquara 14800-903, SP, Brazil; (A.M.F.-A.); (S.d.M.S.); (K.S.d.S.); (M.W.d.L.G.); (C.O.V.); (A.R.C.); (K.P.M.-A.); (A.C.M.d.S.P.); (J.A.B.); (L.d.S.F.); (A.M.)
| | - Samanta de Matos Silva
- Department of Clinical Analysis, School of Pharmaceutical Science, Universidade Estadual Paulista (UNESP), Araraquara 14800-903, SP, Brazil; (A.M.F.-A.); (S.d.M.S.); (K.S.d.S.); (M.W.d.L.G.); (C.O.V.); (A.R.C.); (K.P.M.-A.); (A.C.M.d.S.P.); (J.A.B.); (L.d.S.F.); (A.M.)
- Basic and Applied Microbiology Group (MICROBA), School of Microbiology, Universidad de Antioquia, Medellin 050010, Colombia; (O.H.R.); (Á.G.)
| | - Kelvin Sousa dos Santos
- Department of Clinical Analysis, School of Pharmaceutical Science, Universidade Estadual Paulista (UNESP), Araraquara 14800-903, SP, Brazil; (A.M.F.-A.); (S.d.M.S.); (K.S.d.S.); (M.W.d.L.G.); (C.O.V.); (A.R.C.); (K.P.M.-A.); (A.C.M.d.S.P.); (J.A.B.); (L.d.S.F.); (A.M.)
| | - Marcos William de Lima Gualque
- Department of Clinical Analysis, School of Pharmaceutical Science, Universidade Estadual Paulista (UNESP), Araraquara 14800-903, SP, Brazil; (A.M.F.-A.); (S.d.M.S.); (K.S.d.S.); (M.W.d.L.G.); (C.O.V.); (A.R.C.); (K.P.M.-A.); (A.C.M.d.S.P.); (J.A.B.); (L.d.S.F.); (A.M.)
| | - Carolina Orlando Vaso
- Department of Clinical Analysis, School of Pharmaceutical Science, Universidade Estadual Paulista (UNESP), Araraquara 14800-903, SP, Brazil; (A.M.F.-A.); (S.d.M.S.); (K.S.d.S.); (M.W.d.L.G.); (C.O.V.); (A.R.C.); (K.P.M.-A.); (A.C.M.d.S.P.); (J.A.B.); (L.d.S.F.); (A.M.)
| | - Angélica Romão Carvalho
- Department of Clinical Analysis, School of Pharmaceutical Science, Universidade Estadual Paulista (UNESP), Araraquara 14800-903, SP, Brazil; (A.M.F.-A.); (S.d.M.S.); (K.S.d.S.); (M.W.d.L.G.); (C.O.V.); (A.R.C.); (K.P.M.-A.); (A.C.M.d.S.P.); (J.A.B.); (L.d.S.F.); (A.M.)
| | - Kaila Petrolina Medina-Alarcón
- Department of Clinical Analysis, School of Pharmaceutical Science, Universidade Estadual Paulista (UNESP), Araraquara 14800-903, SP, Brazil; (A.M.F.-A.); (S.d.M.S.); (K.S.d.S.); (M.W.d.L.G.); (C.O.V.); (A.R.C.); (K.P.M.-A.); (A.C.M.d.S.P.); (J.A.B.); (L.d.S.F.); (A.M.)
| | - Ana Carolina Moreira da Silva Pires
- Department of Clinical Analysis, School of Pharmaceutical Science, Universidade Estadual Paulista (UNESP), Araraquara 14800-903, SP, Brazil; (A.M.F.-A.); (S.d.M.S.); (K.S.d.S.); (M.W.d.L.G.); (C.O.V.); (A.R.C.); (K.P.M.-A.); (A.C.M.d.S.P.); (J.A.B.); (L.d.S.F.); (A.M.)
| | - Jenyffie Araújo Belizario
- Department of Clinical Analysis, School of Pharmaceutical Science, Universidade Estadual Paulista (UNESP), Araraquara 14800-903, SP, Brazil; (A.M.F.-A.); (S.d.M.S.); (K.S.d.S.); (M.W.d.L.G.); (C.O.V.); (A.R.C.); (K.P.M.-A.); (A.C.M.d.S.P.); (J.A.B.); (L.d.S.F.); (A.M.)
| | - Lígia de Souza Fernandes
- Department of Clinical Analysis, School of Pharmaceutical Science, Universidade Estadual Paulista (UNESP), Araraquara 14800-903, SP, Brazil; (A.M.F.-A.); (S.d.M.S.); (K.S.d.S.); (M.W.d.L.G.); (C.O.V.); (A.R.C.); (K.P.M.-A.); (A.C.M.d.S.P.); (J.A.B.); (L.d.S.F.); (A.M.)
| | - Andrei Moroz
- Department of Clinical Analysis, School of Pharmaceutical Science, Universidade Estadual Paulista (UNESP), Araraquara 14800-903, SP, Brazil; (A.M.F.-A.); (S.d.M.S.); (K.S.d.S.); (M.W.d.L.G.); (C.O.V.); (A.R.C.); (K.P.M.-A.); (A.C.M.d.S.P.); (J.A.B.); (L.d.S.F.); (A.M.)
| | - Luis R. Martinez
- Department of Oral Biology, College of Dentistry, University of Florida, Gainesville, FL 32610, USA;
- Emerging Pathogens Institute, University of Florida, Gainesville, FL 32610, USA
- Center for Immunology and Transplantation, University of Florida, Gainesville, FL 32610, USA
- Center for Translational Research in Neurodegenerative Disease, University of Florida, Gainesville, FL 32610, USA
| | - Orville Hernandez Ruiz
- Basic and Applied Microbiology Group (MICROBA), School of Microbiology, Universidad de Antioquia, Medellin 050010, Colombia; (O.H.R.); (Á.G.)
- Cellular and Molecular Biology Group University of Antioquia, Corporation for Biological Research, Medellin 050010, Colombia
| | - Ángel González
- Basic and Applied Microbiology Group (MICROBA), School of Microbiology, Universidad de Antioquia, Medellin 050010, Colombia; (O.H.R.); (Á.G.)
| | - Maria José Soares Mendes-Giannini
- Department of Clinical Analysis, School of Pharmaceutical Science, Universidade Estadual Paulista (UNESP), Araraquara 14800-903, SP, Brazil; (A.M.F.-A.); (S.d.M.S.); (K.S.d.S.); (M.W.d.L.G.); (C.O.V.); (A.R.C.); (K.P.M.-A.); (A.C.M.d.S.P.); (J.A.B.); (L.d.S.F.); (A.M.)
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297
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Wang J, Wei SR, Ding T, Zhang LP, Weng ZH, Cheng M, Zhou Y, Zhang M, Liu FJ, Yan BB, Wang DF, Sun MW, Cheng WX. Continuous renal replacement therapy with oXiris ® in patients with hematologically malignant septic shock: A retrospective study. World J Clin Cases 2023; 11:6073-6082. [PMID: 37731565 PMCID: PMC10507551 DOI: 10.12998/wjcc.v11.i26.6073] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/04/2023] [Accepted: 07/14/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND The mortality rate from septic shock in patients with hematological malignancies (HMs) remains significantly higher than that in patients without HMs. A longer resuscitation time would definitely be harmful because of the irreversibly immunocompromised status of the patients. Shortening the resuscitation time through continuous renal replacement therapy (CRRT) with oXiris® would be an attractive strategy in managing such patients. AIM To explore the effects of CRRT and oXiris® in shortening the resuscitation time and modifying the host response by reducing inflammation mediator levels. METHODS Forty-five patients with HM were diagnosed with septic shock and underwent CRRT between 2018 and 2022. Patients were divided into two groups based on the hemofilter used for CRRT (oXiris® group, n = 26; M150 group, n = 19). We compared the number of days of negative and total fluid balance after 7 d of CRRT between the groups. The heart rate, norepinephrine dose, Sequential Organ Failure Assessment (SOFA) score, and blood lactic acid levels at different time points in the two groups were also compared. Blood levels of inflammatory mediators in the 26 patients in the oXiris® group were measured to further infer the possible mechanism. RESULTS The average total fluid balance after 7 d of CRRT in the oXiris® group was significantly lower than that of patients in the M150 hemofilter group. The SOFA scores of patients after CRRT with oXiris® therapy were significantly lower than those before treatment on day 1 (d1), d3 and d7 after CRRT; these parameters were also significantly lower than those of the control group on d7. The lac level after oXiris® therapy was significantly lower than that before treatment on d3 and d7 after CRRT. There were no significant differences in the above parameters between the two groups at the other time points. In the oXiris® group, procalcitonin levels decreased on d7, whereas interleukin-6 and tumor necrosis factor levels decreased significantly on d3 and d7 after treatment. CONCLUSION CRRT with oXiris® hemofilter may improve hemodynamics by reducing inflammatory mediators and playing a role in shortening the resuscitation period and decreasing total fluid balance in the resuscitation phases.
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Affiliation(s)
- Juan Wang
- Intensive Care Unit, Hebei Yanda Hospital, Langfang 065201, Hebei Province, China
| | - Shu-Run Wei
- Intensive Care Unit, Hebei Yanda Hospital, Langfang 065201, Hebei Province, China
| | - Tong Ding
- Intensive Care Unit, Hebei Yanda Hospital, Langfang 065201, Hebei Province, China
| | - Li-Ping Zhang
- Intensive Care Unit, Hebei Yanda Hospital, Langfang 065201, Hebei Province, China
| | - Zhi-Hua Weng
- Intensive Care Unit, Hebei Yanda Hospital, Langfang 065201, Hebei Province, China
| | - Ming Cheng
- Intensive Care Unit, Hebei Yanda Hospital, Langfang 065201, Hebei Province, China
| | - Yang Zhou
- Intensive Care Unit, Hebei Yanda Hospital, Langfang 065201, Hebei Province, China
| | - Meng Zhang
- Intensive Care Unit, Hebei Yanda Hospital, Langfang 065201, Hebei Province, China
| | - Fang-Jun Liu
- Intensive Care Unit, Hebei Yanda Hospital, Langfang 065201, Hebei Province, China
| | - Bei-Bei Yan
- Intensive Care Unit, Hebei Yanda Hospital, Langfang 065201, Hebei Province, China
| | - Dan-Feng Wang
- Intensive Care Unit, Hebei Yanda Hospital, Langfang 065201, Hebei Province, China
| | - Ming-Wen Sun
- Intensive Care Unit, Hebei Yanda Hospital, Langfang 065201, Hebei Province, China
| | - Wei-Xin Cheng
- Department of Emergency, Peking University International Hospital, Beijing 102206, China
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298
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[Chinese expert consensus on the management of long-term complications after hematopoietic stem cell transplantation (2023)]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2023; 44:717-722. [PMID: 38049314 PMCID: PMC10630577 DOI: 10.3760/cma.j.issn.0253-2727.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Indexed: 12/06/2023]
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299
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Kuo CW, Lin CY, Wei SH, Chou YT, Chen CW, Tsai JS, Su PL, Lin CC. Navigating the challenges of invasive pulmonary aspergillosis in lung cancer treatment: a propensity score study. Ther Adv Med Oncol 2023; 15:17588359231198454. [PMID: 37720497 PMCID: PMC10503299 DOI: 10.1177/17588359231198454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 08/15/2023] [Indexed: 09/19/2023] Open
Abstract
Background Invasive pulmonary aspergillosis (IPA) can negatively impact cancer patients' survival. It remains uncertain whether IPA's impact on patient outcomes varies by treatment approach in advanced lung cancer. Objectives To explore the association between IPA and outcomes in patients with advanced lung cancer receiving different treatments. Design A retrospective cohort study. Methods We enrolled patients with advanced-stage lung cancer between 2013 and 2021 at a college hospital in Taiwan and used the 2021 European Organization for Research and Treatment of Cancer/Mycoses Study Group Education and Research Consortium consensus for IPA diagnosis. Multivariable logistic regression was used to identify the IPA risk factors. We compared overall survival (OS) and postgalactomannan (GM) test survival between the IPA and control groups using multivariable Cox proportional hazards regression and the Kaplan-Meier method with propensity score matching (PSM). Results Among 2543 patients with advanced-stage lung cancer, 290 underwent a GM test, of which 34 (11.7%) were diagnosed with IPA. Patients undergoing chemotherapy (HR = 4.02, p = 0.027) and immunotherapy [hazard ratio (HR) = 3.41, p = 0.076] tended to have IPA. Compared to the control group, the IPA group had shorter median OS (14.4 versus 9.9 months, p = 0.030) and post-GM test survival (4.5 versus 1.9 months, p = 0.003). IPA was associated with shorter OS (log-rank p = 0.014 and 0.018 before and after PSM, respectively) and shorter 1-year and 2-year survival post-GM test (HR = 1.65 and 1.66, respectively). Patients receiving chemotherapy or immunotherapy had a shorter post-GM test survival if they had IPA. Conclusions IPA tended to be diagnosed more frequently in patients receiving chemotherapy or immune checkpoint inhibitors. Patients diagnosed with IPA are associated with shorter survival. Larger cohort studies are needed to verify the observations.
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Affiliation(s)
- Chin-Wei Kuo
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan
- Division of Chest Medicine, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
| | - Chien-Yu Lin
- Division of Chest Medicine, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
| | - Sheng-Huan Wei
- Division of Chest Medicine, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
| | - Yun-Tse Chou
- Division of Chest Medicine, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
| | - Chian-Wei Chen
- Division of Chest Medicine, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
| | - Jeng-Shiuan Tsai
- Division of Chest Medicine, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
| | - Po-Lan Su
- Division of Chest Medicine, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
| | - Chien-Chung Lin
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan
- Division of Chest Medicine, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan 704
- Department of Biochemistry and Molecular Biology, College of Medicine, National Cheng Kung University, Tainan
- Institute of Molecular Medicine, College of Medicine, National Cheng Kung University, Tainan
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300
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Traunero A, Peri F, Badina L, Amaddeo A, Zuliani E, Maschio M, Barbi E, Ghirardo S. Hematopoietic Stem Cells Transplant (HSCT)-Related Chronic Pulmonary Diseases: An Overview. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1535. [PMID: 37761496 PMCID: PMC10530143 DOI: 10.3390/children10091535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/03/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023]
Abstract
Recipients of HSCT have a high risk of infective and non-infective pulmonary diseases. Most patients with pulmonary involvement present multiple pathogenetic mechanisms simultaneously with complex interactions. Therefore, it can be difficult to distinguish the contributions of each one and to perform studies on this subject. In this opinion article, we discuss only chronic pulmonary manifestations, focusing on LONIPCs (late-onset non-infectious pulmonary complications). This term embraces drug-related toxicity, allergies, and chronic pulmonary graft versus host disease (GvHD) in all its recently identified clinical variants. Among LONIPCs, GvHD represents the most critical in terms of morbidity and mortality, despite the rapid development of new treatment options. A recently emerging perspective suggests that pulmonary lung rejection in transplant patients shares striking similarities with the pathogenesis of GvHD. In a pulmonary transplant, the donor organ is damaged by the host immune system, whereas in GvHD, the donor immune system damages the host organs. It constitutes the most significant breakthrough in recent years and is highly promising for both hematologists and thoracic transplant surgeons. The number of patients with LONIPCs is scarce, with heterogenous clinical characteristics often involving several pathogenetic mechanisms, making it challenging to conduct randomized controlled trials. Therefore, the body of evidence in this field is scarce and generally of low quality, leading to jeopardized choices in terms of immunosuppressive treatment. Moreover, it risks being outdated by common practice due to the quick evolution of knowledge about the diagnosis and treatment of LONIPCs. The literature is even more pitiful for children with pulmonary involvement related to HSCT.
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Affiliation(s)
- Arianna Traunero
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34126 Trieste, Italy
| | - Francesca Peri
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34126 Trieste, Italy
| | - Laura Badina
- Department of Pediatrics, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, 34137 Trieste, Italy
| | - Alessandro Amaddeo
- Emergency Department, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, 34137 Trieste, Italy
| | - Elettra Zuliani
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34126 Trieste, Italy
| | - Massimo Maschio
- Department of Pediatrics, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, 34137 Trieste, Italy
| | - Egidio Barbi
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34126 Trieste, Italy
- Department of Pediatrics, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, 34137 Trieste, Italy
| | - Sergio Ghirardo
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34126 Trieste, Italy
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