BACKGROUND:Tuberculosis (TB) remains the leading infectious cause of death globally, disproportionately affecting people living with HIV and those with drug-resistant TB. In Portugal, TB incidence and notification rates exceed the European average, with diagnostic delays affecting underserved populations. RESEARCH QUESTION:This study investigated factors contributing to total diagnostic delay among people with TB in Portugal, particularly underserved groups, and identified strategies to reduce these delays. STUDY DESIGN AND METHODS:A convergent-parallel mixed-methods approach was used. Quantitative data came from 55 surveys, and qualitative data through 27 semi-structured interviews and two focus group discussions. Descriptive statistics and thematic analysis identified patterns of total diagnostic delay, contributing factors, and potential interventions. RESULTS:Median total diagnostic delay was 45 days (IQR 21-60 days). In exploratory comparisons, underserved groups reported longer total diagnostic delay than the general population. Key person-related barriers included symptom normalisation, financial and logistical constraints, stigma, and fragmented referral pathways. System-level obstacles such as complex paperwork, limited clinic hours, staff indifference, and language barriers compounded delays. Proposed solutions included clear and non-judgemental communication, mobile screening units, integrated electronic records, anti-stigma campaigns, and social support teams for healthcare navigation. CONCLUSION:Diagnostic delays remain a major challenge in TB control in Portugal, especially among underserved populations. Reducing these delays requires multi-level interventions, including enhanced primary care awareness, stigma reduction, compensation for indirect costs, and simpler administrative procedures. Addressing these barriers is essential to reduce preventable morbidity, limit ongoing transmission, and tackle health inequities, while supporting progress towards national and global TB targets.
BACKGROUND:Excessive sleepiness while driving is a public safety concern. The Bordeaux Sleepiness Scale (BOSS) is a brief patient-reported measure designed to assess driving-related sleepiness. However, a Portuguese version is not currently available. OBJECTIVE:To cross-culturally adapt the BOSS and evaluate its internal consistency and construct validity in a Portuguese population, in accordance with COSMIN recommendations. STUDY DESIGN AND METHODS:We conducted a cross-sectional observational study of adults attending a Sleep Disorders Clinic. The BOSS was translated into Portuguese following a standardised cross-cultural adaptation process. Participants completed the Portuguese BOSS, the Epworth Sleepiness Scale (ESS) and two questions assessing driving-related sleepiness. Internal consistency was evaluated using Cronbach's alpha. Construct validity was assessed through Spearman correlations with the ESS (convergent validity) and by comparing scores between participants with and without a history of sleepiness-related accidents or near-misses (criterion-related validity). ROC curve analysis further assessed criterion validity. RESULTS:A total of 234 patients were included; 94.4% had obstructive sleep apnoea and 9.4% reported sleepiness-related accidents or near-misses in the previous year. The BOSS demonstrated moderate internal consistency (α = 0.683) and acceptable accuracy in identifying patients with sleepiness-related events (AUC = 0.895), compared with the ESS (AUC = 0.842). Both scales showed significantly higher scores in participants with sleepiness-related accidents or near-misses than in those without (p < 0.001). A moderate correlation with ESS (ρ = 0.551, p < 0.001) was observed. CONCLUSION:The Portuguese BOSS shows moderate internal consistency and evidence of construct validity. These findings provide preliminary support for its use in identifying driving-related sleepiness in patients with sleep disorders.
BACKGROUND:In the general population, supernormal lung function is associated with a lower risk of all-cause mortality. RESEARCH QUESTION:It remains unclear whether sleep-disordered breathing (SDB) affects this relationship. METHODS:This cohort analysis included 4,839 adults. Lung function was categorised as supernormal (FEV1 > ULN), normal (LLN ≤ FEV1 ≤ ULN), and below normal (FEV1 < LLN). SDB severity was classified using apnoea-hypopnoea index categories: no SDB (<5 events/hour), mild SDB (5-<15 events/hour), moderate SDB (15-<30 events/hour), and severe SDB (≥30 events/hour). The association between lung function and all-cause mortality was assessed using Cox proportional hazards models with subgroup analyses according to SDB severity and formal testing for interaction. Analyses were repeated using FVC-defined lung function groups as an alternative definition of supernormal lung function. RESULTS:Among the included participants, 4,068 (84.1%) had normal lung function, 369 (7.6%) had supernormal lung function, and 402 (8.3%) had below normal lung function. During 52 421.5 person-years of follow-up (median 11.72 years; IQR, 10.46-12.56), 1,188 deaths occurred. Compared with the normal lung function group, the supernormal lung function group had a lower prevalence of baseline hypertension and cardiovascular disease. The association between lung function and all-cause mortality varied across SDB severity strata (P for interaction = 0.034). A lower mortality risk associated with supernormal lung function was observed in participants without SDB (HR: 0.24, 95% CI: 0.06-0.97), whereas this association was not statistically significant in the mild, moderate, or severe SDB strata. Below normal lung function was generally associated with an increased all-cause mortality risk. Sensitivity analyses using FVC-defined lung function groups yielded broadly consistent findings. CONCLUSION:Supernormal lung function was associated with lower all-cause mortality primarily among individuals without SDB. These findings underscore the importance of considering SDB severity when assessing the health implications of lung function.
BACKGROUND:Cone-beam CT-guided navigation bronchoscopy (CBCT-NB) is a minimally invasive technique for diagnosing pulmonary nodules combining endoscopic navigation with real-time 3D imaging. The procedure requires advanced bronchoscopic skills and interpretation of multiple imaging modalities. Despite evidence that simulation-based education enhances procedural safety and performance, no standardised training programmes for CBCT-NB have yet been established. This study describes the development and evaluation of a structured training programme for pulmonologists new to CBCT-NB. METHODS:A multidisciplinary expert panel developed a stepwise CBCT-NB training programme comprising online theoretical e-learning, live case observation at an expert centre, a structured one-day hands-on simulation session, and on-site supervision during the initial clinical procedures. Pulmonologists from Dutch hospitals preparing to implement CBCT-NB were enrolled. Participants' expectations, perceived learning needs, and post-training experiences were explored through semi-structured interviews and analysed using thematic analysis. RESULTS:Nine pulmonologists from five hospitals participated. Participants expressed a strong need for structured, practical instructions, particularly regarding procedural workflow, multimodal image interpretation, equipment handling, and use of augmented fluoroscopy software. Following completion of the programme, all reported increased self-confidence and improved perceived competency. Hands-on simulation was consistently identified as a key component for developing technical and cognitive skills and was considered essential preparation before independent clinical practice. CONCLUSION:The structured multimodal CBCT-NB training programme facilitates confidence and addresses learner-identified competency needs among novice navigation bronchoscopists. The findings offer practical guidance for the structured implementation and training of novel medical technological interventions. Future research should evaluate long-term skill retention, objective competency outcomes, and clinical effectiveness.
BACKGROUND:Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) with pulmonary hypertension (PH) worsen outcomes, yet reliable prognostic biomarkers remain lacking. RESEARCH QUESTION:We aimed to determine the prognostic value of serum high-mobility group Box 1 (HMGB1) in individuals experiencing AECOPD with concurrent PH and to examine its relationship with inflammatory and vascular markers. STUDY DESIGN AND METHODS:Total 127 patients were divided into AECOPD-non-PH group (n = 71) and AECOPD-PH group (n = 56). Serum levels of HMGB1, interleukin-6 (IL-6), endothelin-1, tumour necrosis factor-α (TNF-α) and vascular endothelial growth factor (VEGF) were measured. Predictive performance was evaluated using receiver operating characteristic and multiple logistic regression analyses. RESULTS:The AECOPD-PH group had significantly higher serum HMGB1, endothelin-1 and PaCO2 than the AECOPD-non-PH group. The combination of HMGB1, endothelin-1 and PaCO2 demonstrated superior diagnostic accuracy for PH, with an area under the curve of 0.751. HMGB1 levels correlated positively with IL-6 (ρ=0.295, p = 0.001) and TNF-α (ρ=0.302, p = 0.001), but negatively with VEGF (ρ=-0.232, p = 0.009). In risk stratification, HMGB1 ≥ 38.24 ng/mL predicted intermediate-high risk PH with 69.2% sensitivity, 64.7% specificity and an area under the curve of 0.700. CONCLUSION:Serum HMGB1 was moderately associated with PH in patients with AECOPD, demonstrating its utility in risk assessment. However, these findings are specific to the acute exacerbation setting and should not be extrapolated to stable-phase COPD-associated PH; further studies in stable COPD populations are warranted.
This study aimed to identify the key concepts involved in designing epidemiological surveys to estimate the prevalence of second-hand tobacco smoke (SHS) exposure in Portugal and Brazil. A two-round Delphi study was conducted. Firstly, a group of experts was asked for their opinions on the relevance of various concepts (exposure scenarios, recall, time, environmental context, exposure intensity, and relationship to smoking) and domains. Based on their responses, a new questionnaire was developed. The experts ranked the importance of different questions. A thematic analysis was carried out. The experts considered it important to evaluate SHS exposure in general, as well as in specific settings, such as the home, workplace, public and private transport (with or without children), and leisure settings. They reported that recalling the number of hours of exposure spent indoors and outdoors on working and non-working days, and in the last month, provided a more detailed assessment. They also stated that exposure intensity should be assessed either by the presence and number of smokers or by the perception of a smoke-heavy environment. Differences in responses according to the country in which experts reside were minimal. The researchers provided clear, precise, and consistent recommendations for collecting comparable data across studies to enact smoke-free policies. This reinforces the feasibility of using standardised questionnaires to evaluate SHS exposure across countries.
BACKGROUND:Sleep apnoea (SA) is prevalent and correlated with multiple comorbidities. Nevertheless, SA remains underdiagnosed and underrecognized in the Chinese population. This study aimed to evaluate the comorbidity burden and healthcare utilisation among SA patients from the Beijing Medical Insurance Database. METHODS:This study extracted data from the Beijing Medical Insurance Database spanning 2016 to 2021. Patients with SA documented in the discharge diagnosis on the front page of medical records were enrolled as the case group, and one control subject matched by age, gender, and admission date was randomly assigned to each case. Propensity score matching (PSM) was performed to balance additional covariates. Primary indicators included comorbidity burden, hospitalisation frequency, length of stay, and medical expenditures. Generalised linear models were used to evaluate the associations. RESULTS:A total of 50 379 pairs were initially identified, and 33 439 pairs were included in the final analysis after PSM. The comorbidity burden was significantly increased among SA patients. SA was independently associated with higher medical expenditures, including daily cost, per-visit cost, annual cost, and cumulative cost, as well as longer hospital length of stay and greater hospitalisation frequency. Subgroup analyses revealed that the increased healthcare utilisation was more pronounced among females, individuals aged ≥65 years, unemployed subjects, and patients with related comorbidities. CONCLUSION:The comorbidity burden and healthcare utilisation are significantly increased in SA patients. There is an urgent need to enhance awareness of SA as a prevalent disorder and to implement early screening and proactive interventions.
INTRODUCTION:Catathrenia is a rare sleep-related breathing disorder marked by groaning during prolonged expiration, often underrecognized or misdiagnosed as obstructive or central sleep apnoea (OSA or CSA) or parasomnia. Understanding its clinical and polysomnographic features is essential for accurate diagnosis and management. MATERIALS AND METHODS:We performed a retrospective observational study of adult patients diagnosed with catathrenia at Serviço de Medicina do Sono de Coimbra. Diagnosis was established by attended overnight polysomnography (PSG) with synchronised audio-video recording. Demographic data, symptoms, comorbidities, PSG variables, treatment modalities, and outcomes were reviewed. Catathrenia events were defined as deep inhalation followed by prolonged exhalation with monotonous groaning. RESULTS:Ten patients were included. Median age was 46 years (range 27-78), mostly female (70%). Common comorbidities included obesity (n = 4), depression (n = 2), Parkinson's disease (n = 1), and restless legs syndrome (n = 1). Six patients (60%) had concomitant obstructive sleep apnoea (OSA). Seven patients had excessive daytime sleepiness (Epworth Sleepiness Scale > 10). All catathrenia episodes occurred exclusively during REM sleep. Continuous positive airway pressure (CPAP) therapy was the most frequently used treatment and was associated with objective or subjective improvement in most patients. Two patients experienced spontaneous remission. CONCLUSION:Catathrenia remains underdiagnosed and can mimic other sleep disorders. Recognition of its REM-sleep predominance and PSG pattern is essential. Individualised treatment, often involving PAP therapy, may improve symptoms and patient outcomes.
BACKGROUND:Respiratory symptoms such as cough and shortness of breath are prevalent among patients with pneumoconiosis. These symptoms reduce their engagement in daily activities and induce psychological distress. RESEARCH QUESTION:Did a 6-week acceptance-based healthy lifestyle programme reduce psychological inflexibility (primary outcome) and enhance the health outcomes among community-dwelling patients with pneumoconiosis? STUDY DESIGN AND METHODS:A two-arm, prospective, multicenter, waitlist pilot randomised controlled trial was conducted. Patients with pneumoconiosis were randomly assigned to either an intervention group or waitlist group at a 1:1 ratio, with intervention group receiving the programme first. The intervention consisted of four biweekly interactive sessions on integrating acceptance-based components into pneumoconiosis management. Psychological inflexibility and health outcomes were assessed at baseline, Week 6, and Week 14 by trained research assistants. A generalized estimating equations model was used to examine the effects of the intervention effect between groups. RESULTS:Eighty patients were recruited and randomly assigned to the two groups. Compared to the waitlist group, the participants in the intervention group showed significant reduction in psychological inflexibility (β = -5.83, p = 0.002) and improvement in exercise self-efficacy (β = 11.68, p = 0.007) at Week 6, and reduction in body weight (β = -1.09, p < 0.001) at Week 14. No significant differences were observed for other outcomes. Moderate effect size was noted on the outcomes of psychological inflexibility and exercise self-efficacy at Week 6. CONCLUSION:The integration of acceptance-based components into pneumoconiosis management may reduce psychological inflexibility and promote engagement in exercise.
Background Depression is a common comorbidity of chronic obstructive pulmonary disease (COPD) and is associated with worse prognosis. However, its association with lung health in individuals with pre-COPD remains unknown. We examined associations of increased depressive symptoms with respiratory symptoms, pre-COPD, and mortality.Methods We analysed data from the National Health and Nutrition Examination Survey (NHANES 2007–2012). Non-COPD individuals with available spirometry and Patient Health Questionnaire-9 (PHQ-9) data were included. Pre-COPD phenotypes included small airway dysfunction (SAD), preserved ratio impaired spirometry (PRISm) and nonobstructive chronic bronchitis (NOCB). Logistic and Cox regression models assessed associations of increased depressive symptoms with respiratory outcomes and all-cause mortality, respectively.Results Among 10 941 participants, increased depressive symptoms were associated with higher risk of PRISm (adjusted OR (aOR) [95% CI] 1.41[1.07,1.85]), NOCB (aOR [95% CI] 1.90[1.49,2.42]), cough (aOR [95% CI] 2.17[1.72,2.73]), phlegm production (aOR [95% CI] 2.86[2.23,3.67]), exertional dyspnoea (aOR [95% CI] 2.53[2.04,3.13]) and wheeze (aOR [95% CI] 1.86[1.51,2.30]). A one-unit increase in PHQ-9 score was also associated with higher risks of respiratory symptoms and pre-COPD. Additionally, increased depressive symptoms were independently associated with higher all-cause mortality risk among participants with pre-COPD, including SAD (aHR [95% CI] 2.85[1.02,7.95]), PRISm (aHR [95% CI] 2.02[1.01,4.01]) and NOCB (aHR [95% CI] 2.45[1.24,4.84]). Similar associations were observed across depression scores and pre-COPD populations.Conclusions Increased depressive symptoms were associated with a higher risk of pre-COPD phenotypes, respiratory symptoms, and mortality. Increased depressive symptoms may be a treatable trait that can help mitigate adverse outcomes in participants with pre-COPD.
BACKGROUND:Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality. Self-management interventions improve health outcomes but suffer from limited accessibility and sustainability. The usage of digital interventions may offer scalable alternatives. RESEARCH QUESTION:What is the effectiveness of self-management digital interventions in improving health-related outcomes among adults with COPD? METHODS:This umbrella review followed the JBI methodology and was registered in PROSPERO (CRD42024517476). A systematic search across multiple databases was conducted to identify relevant systematic reviews published in any language from database inception to February 2024. Effect sizes and confidence intervals reported in the included reviews were converted into equivalent odds ratios (eORs) to enable standardised comparisons across outcomes. RESULTS:Thirteen systematic reviews (15 363 participants) were included, of which 11 reported meta-analyses and two provided narrative syntheses only. Self-management digital interventions improved physical activity (eOR 2·34 [95% CI 1·14-4·80]), quality of life (eOR 2·02 [1·41-2·90]), lung function (eOR 2·60 [1·04-6·50]), adherence (eOR 5·04 [2·14-11·87]), anxiety (eOR 1·43 [1·15-1·76]), and depression (eOR 1·30 [1·05-1·60]). Effects were inconclusive for dyspnoea, physical capacity, sedentary time, emergency visits, and mortality. Heterogeneity was substantial across most outcomes. The certainty of evidence according to the GRADE approach ranged from very low to moderate. CONCLUSION:Self-management digital interventions appear effective in improving several key outcomes in COPD management. Future research should prioritise standardised methodologies and long-term evaluations to strengthen the evidence base.
Background Accurate prognostication of malignant pleural effusion (MPE) is essential to guide management decisions and provide patients with meaningful survival estimates. LENT and PROMISE scores are widely recognised MPE-specific prognostic tools, although with limited uptake in clinical practice. More objective, serum-based indices such as the Prognostic Index for Cancer Outcomes (PICO) and Modified Glasgow Prognostic Score (mGPS) have shown robust prognostic value in oncology and may offer advantages by allowing reproducible, treatment-responsive reassessment.Methods Retrospective cohort study including patients with MPE, defined by cytological and/or histopathological confirmation, between 2012–2022 at a Portuguese tertiary hospital. Demographic, clinical and biochemical data were extracted from medical records, enabling calculation of LENT, PROMISE, mGPS and PICO scores, as well as a novel serum-based index (SIMPLE).Results 678 patients were included in the cohort. LENT and PROMISE prognostic scoring models underperformed when compared with their serum-based counterparts. PROMISE showed the lowest area under the curve [AUC = 0.735 (95% CI 0.675–0.794)], followed by LENT [AUC = 0.758 (95% CI 0.710–0.808)], PICO [AUC = 0.781 (95% CI 0.725–0.837)] and mGPS [AUC = 0.819 (95% CI 0.745–0.893)]. The most significant serum-based factors (albumin, white blood cell counts and C-reactive protein) were selected for a new prognostic model. SIMPLE showed the highest numerical discriminatory performance [AUC = 0.852 (95% CI 0.782–0.921)], statistically outperforming MPE-specific scores, while demonstrating comparable discrimination to general oncology scores.Conclusion SIMPLE is a promising, accessible prognostic tool for patients with MPE, demonstrating strong discriminatory performance and outperforming LENT and PROMISE in our sample. External validation is required before routine clinical implementation.
INTRODUCTION:Primary Ciliary Dyskinesia (PCD) is a rare genetic disorder caused by defective ciliary structure and function, leading to chronic respiratory and systemic manifestations. Diagnostic pathways have evolved over time, but no single standalone test exists. METHODS:Retrospective study of PCD patients followed at a Portuguese tertiary hospital, between 2001-2024. RESULTS:Thirty-five patients with a confirmed diagnosis were included: 13 children and 22 adults. Median age at diagnosis was 7 years (0-16) in children and 38.5 years (12-64) in adults. Time to diagnosis decreased over the years, coinciding with a shift in the hierarchy of methods from high-speed video microscopy and transmission electron microscopy to genetic testing. The most frequent mutations were DNAH5 (31.3%) and DNAH11 (12.5%). Pulmonary function tended to be better in children (p = 0.085), whereas bronchiectasis were more extensive and bilateral in adults (p = 0.044 and p = 0.002, respectively). Children more frequently received treatment with hypertonic saline (p = 0.003) and adults with bronchodilators (p = 0.035). Pseudomonas aeruginosa was only identified in adults; inhaled antibiotics were only prescribed in this age group (18.2%). CONCLUSION:This represents the largest Portuguese cohort to date and provides relevant clinical and diagnostic insight into age-related differences, supporting the importance of early detection and intervention to limit lung damage.
BACKGROUND:Evidence for hypertonic saline (HS) in nontuberculous mycobacterial lung disease (NTM-LD) remains limited, particularly during watchful waiting when non-antibiotic strategies are needed. We evaluated inhaled 3% HS as a potential adjunct in antibiotic-naïve NTM-LD. METHODS:In this prospective cohort study, antibiotic-naïve NTM-LD patients were enrolled between September 2024 and December 2025. Patients receiving daily inhaled 3% HS were compared with contemporaneous controls. Symptom burden (visual analog scale, 0-60) and sputum smear status at month 3 were analysed using generalised estimating equations. In vitro experiments assessed HS effects on Mycobacterium abscessus growth and macrophage function, including intracellular bacterial burden, viability, phagocytosis, and pro-inflammatory gene expression. RESULTS:Among 45 patients (HS: n = 22; control: n = 23), 3% HS was associated with a significant reduction in symptom burden from baseline (coefficient -4.40, 95% CI -6.43 to -2.37; p < 0.001) and a lower odds of sputum smear positivity at month 3 (odds ratio 0.15, 95% CI 0.03-0.64; p = 0.011) in adjusted analyses. In vitro, HS inhibited extracellular M. abscessus growth in a concentration-dependent manner. Pretreatment of macrophages with 3% HS reduced intracellular M. abscessus burden by 51% (p = 0.021) without impairing viability or phagocytosis, while upregulating pro-inflammatory gene expression, including TNF-α (p = 0.004), IL-6 (p = 0.030), and IL-1β (p = 0.058). CONCLUSIONS:In antibiotic-naïve NTM-LD, inhaled 3% HS was associated with improved symptom burden and reduced progression to sputum smear positivity. Complementary in vitro findings support both direct antimycobacterial effects and enhanced macrophage-mediated control, supporting HS as a biologically active adjunct during conservative management of NTM-LD.
BACKGROUND:Tuberculosis infection (TBI) diagnosis in BCG-vaccinated, high-burden settings remains challenging. RESEARCH QUESTION:We aimed to assess the sensitivity, specificity, and safety of the C-tuberculin skin test (C-TST), compared with PPD RT-23, for tuberculosis infection in BCG-vaccinated adults. STUDY DESIGN AND METHODS:Randomised, double-blind clinical trial in Brazil. Adults with pulmonary tuberculosis (PTB) and asymptomatic controls without known TB exposure or prior TB/TPT underwent C-TST, PPD RT-23, and QuantiFERON-TB Gold Plus (QFT-Plus). Skin tests were read by two strategies: (a) induration only or (b) induration or erythema, at a ≥5-mm cut-off. Sensitivity was assessed in PTB; specificity for C-TST and PPD RT-23 was estimated against QFT-Plus. Adverse events were monitored. RESULTS:Among 446 participants (141 PTB; 305 controls), at the 5-mm cut-off, C-TST showed lower sensitivity but higher specificity than PPD RT-23. With strategy (a) and (b), C-TST sensitivity was 0.67 and 0.68, specificity was 0.92 and 0.9, compared to 0.74 sensitivity and 0.78 specificity for PPD RT-23. Adverse events were more frequent in PTB: 12.1% (C-TST) and 6.4% (PPD RT-23); none were serious. CONCLUSION:In BCG‑vaccinated adults, C-TST showed a trade-off of higher specificity and lower sensitivity than PPD RT-23 at the 5-mm cut-off; and a favourable safety profile. Adding erythema to readings did not improve accuracy, suggesting that C-TST may be a useful alternative for programmatic TBI screening in high-burden settings. TRIAL REGISTRATION:Trial registry number RBR-7tn2ysw (https://ensaiosclinicos.gov.br/ registered on 25 January 2021).
BACKGROUND AND OBJECTIVES:Severe eosinophilic asthma (SEA) is often inadequately controlled. The BETREAT study evaluated the real-world effectiveness of benralizumab, an anti-IL-5 receptor monoclonal antibody, in Portugal, focusing on treatment persistence, asthma control, exacerbation rates, and quality of life (QoL). STUDY DESIGN AND METHODS:Retrospective, observational study including SEA adults who received benralizumab between July 2019 and October 2020 across 16 sites in Portugal. Data from electronic medical records were analysed over 24 months, with evaluations at 3, 6, 12, and 24 months after treatment initiation. Key outcomes included exacerbation rates, oral corticosteroid use, asthma and lung function, and QoL. RESULTS:Of the 74 patients (mean ± SD age 56 ± 11 years and 73.0% female), 66.2% were biologic-naïve. After initiating benralizumab, median eosinophil counts decreased to 0 cells/µL after 3 months. Exacerbation rates decreased from a mean annual rate of 3.12 at baseline to 0.48 by 24 months. Patient-reported asthma control and QoL improved, with ACT and CARAT scores reaching well-controlled levels in most patients by 24 months. Notably, 20.0% of patients achieved clinical remission by the end of the study. CONCLUSIONS:Benralizumab significantly improved SEA outcomes and contributed to clinical remission over a 24-month period, demonstrating potential for long-term disease control and QoL improvement.
BACKGROUND:Cognitive impairment is a relatively prevalent comorbidity in chronic obstructive pulmonary disease (COPD), yet its neuropathological mechanism remains poorly understood. METHODS:We enrolled 48 stable COPD patients, categorized into cognitively normal (CogN, n = 22) and impaired (Cog, n = 26) groups based on Montreal Cognitive Assessment (MoCA) scores, along with 34 matched healthy controls. All participants underwent 3T MRI with quantitative susceptibility mapping (QSM) to quantify regional brain iron content. Group comparisons of whole-brain and region-of-interest susceptibility were performed. Mediation analysis was then used to test whether specific brain iron deposition mediates the relationship of both COPD status and peripheral inflammatory markers with cognitive performance. RESULTS:Cog patients showed increased total iron in the right cerebellum crus I, while CogN patients exhibited higher paramagnetic susceptibility (χpara) in the left orbitofrontal cortex (OFC), right precentral gyrus, and right brainstem. χpara in the left OFC and right brainstem were positively correlated with total MoCA, abstraction, and orientation scores. Mediation analysis demonstrated that χpara of the left OFC mediated the effects of both COPD status and systemic neutrophil counts on impaired abstraction. Additionally, right brainstem χpara mediated the relationship between COPD and deficits in orientation. CONCLUSIONS:COPD patients with cognitive impairment exhibited distinct patterns of brain iron deposition. Importantly, deposition in several key regions served as a potential mediator, linking both COPD and systemic inflammation to specific cognitive deficits. These preliminary findings suggest a possible association between brain iron accumulation and cognitive impairment in COPD, offering candidate neuroimaging markers for early identification. .
BACKGROUND:For patients with acute pulmonary embolism (PE), assessment of prognosis helps with risk stratification, triage for level of care, management strategy, and communication among healthcare workers and patients. We sought to identify prognostic models and individual factors associated with short-term outcomes after acute symptomatic PE. METHODS:We performed a systematic review of prognostic factors for PE, searching MEDLINE, Embase, and Web of Science for records up to 1 June 2024. Studies of any design evaluating potential prognostic models or individual variables (not contained in the models) associated with short-term mortality after acute PE were included. RESULTS:We identified 314 studies that included 2,495,115 patients. Of these, 225 studies included 2,267,952 patients and evaluated 24 prognostic models for patients with acute PE. The most frequently used validated models were the simplified Pulmonary Embolism Severity Index (sPESI) (127 studies), the original PESI (79 studies), and the European Society of Cardiology risk schema (34 studies). Each model-development study had a c-index ≥ 0.7. Individual factors associated with prognosis included older age, presence of coexisting conditions, abnormal clinical signs and symptoms, clot burden, markers of right‑ventricle dilatation/dysfunction and myocardial injury, altered laboratory results indicating impaired haemodynamics, and tests that assess for systemic inflammation. Pooled odds ratios for variables not contained in any eligible prognostic model ranged from 1.43 (for D-dimer) to 2.65 (for right heart thrombi). CONCLUSIONS:This systematic review identified 24 prognostic models and 18 individual variables distinct from the prognostic models associated with short-term mortality after acute PE.
