Chronic obstructive pulmonary disease (COPD) is a common, progressive pulmonary disorder associated with significant morbidity and mortality rates throughout the world. Although several studies suggest that medroxyprogesterone acetate (MPA), a synthetic progesterone, can safely increase ventilatory drive to manage hypercapnic respiratory failure in patients with COPD, a preliminary search of PROSPERO and the Cochrane Database confirmed that no comprehensive systematic review has evaluated its physiological efficacy in this population. This systematic review and meta-analysis aims to evaluate the efficacy of MPA on arterial blood gases and oxygenation parameters in COPD patients. This systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search was conducted in PubMed, Scopus, Cochrane Library, ClinicalTrials.gov, and Web of Science till 15 October 2025. Eligible studies included randomized clinical trials (including crossover trials) and clinical trials involving patients diagnosed with COPD receiving MPA compared with placebo or standard care. Outcomes were pooled using the generic inverse-variance method to account for both crossover and parallel-group designs, with a random-effects model. Data analysis was performed using R version 4.5.3. The certainty of evidence was assessed for each outcome using the GRADE framework. Eight studies were included, comprising 210 randomized participants and 182 analyzed (seven randomized and one non-randomized trial). A significant improvement was observed in the MPA group compared with placebo for arterial partial pressure of carbon dioxide (PaCO₂) (MD − 6.07, 95
Abstract Background The 2024 joint European guidelines could make no recommendation on pleurectomy versus chemical pleurodesis for preventing recurrence of primary spontaneous pneumothorax. We compared recurrence, postoperative complications and long-term harms after the two techniques. Methods We searched PubMed, Cochrane CENTRAL (including trial registry records), eLibrary.ru, CyberLeninka and Google Scholar on 3 October 2026 without date or language limits, and performed forward citation searching and reference-list checking. Direct or extractable comparisons of pleurectomy with chemical pleurodesis in primary spontaneous pneumothorax were eligible provided co-interventions on bullae were balanced; studies in which the balance could not be verified were analyzed separately. Risk ratios were pooled under a random-effects model (restricted maximum likelihood, Knapp–Hartung adjustment); complications were synthesized narratively. Risk of bias was assessed with ROBINS-I and certainty with GRADE, starting from high certainty. The review received no funding. Results Of 3074 records screened and 323 reports assessed in full text, eight non-randomized studies (ten reports) were included. In the primary analysis (five studies, 1082 patients or procedures; 26/428 recurrences after pleurectomy, 15/654 after chemical pleurodesis) the risk ratio was 1.42 (95% confidence interval 0.64–3.18; I² = 0%); sensitivity analyses on this set were not statistically significant, except fixed-effect models using the unstratified data of one study. Adding a multicenter cohort in which the balance of co-interventions could not be verified gave 1.94 (1.14–3.32). Complications showed no consistent difference between groups. In the multicenter cohort of uncertain eligibility, the only study to report long-term harms, chronic chest paresthesia was reported in 56% of patients after partial pleurectomy versus 6% after talc poudrage, and chronic chest pain in 18% versus 0.3%. Certainty of evidence was very low for every outcome. Conclusions The evidence is very uncertain whether pleurectomy and chemical pleurodesis differ in recurrence or postoperative complications. One cohort of uncertain eligibility reported far more chronic chest paresthesia and pain after partial pleurectomy than after talc poudrage — a signal that requires confirmation in independent comparative studies. These findings do not support a general preference for either technique. Systematic review registration PROSPERO CRD420261387101. Registration The review protocol was registered in PROSPERO (CRD420261387101; submitted 13 May 2026, registered 14 May 2026) after pilot work, so registration was not fully prospective. The timing of registration and all deviations from the registered information are reported in the Methods and in Additional file 1. The review is not a clinical trial and no trial registration applies.
Foreign body aspiration in adults is frequently underrecognized, particularly when the aspiration event is unwitnessed or symptoms are chronic and nonspecific. Delayed diagnosis may result in recurrent respiratory symptoms, post-obstructive infection, and granulation tissue formation that can mimic endobronchial malignancy. We report the case of a 72-year-old man presenting with chronic cough and recurrent lower respiratory tract infections. Computed tomography demonstrated obstruction of the lateral basal segment of the right lower lobe with post-obstructive changes, while bronchoscopy revealed a vascularized polypoid lesion highly suspicious for an endobronchial carcinoid tumor. Bronchoscopic resection using a snare and cryoprobe exposed a calcified foreign body beneath extensive granulation tissue. The foreign body was ultimately extracted using a combination of forceps and retrieval basket and was identified as a human tooth. Histopathological examination demonstrated granulation tissue without evidence of malignancy. Retrospective history revealed that the patient had lost a tooth during a syncopal episode approximately three years earlier. This case highlights the diagnostic challenges associated with chronic foreign body aspiration in adults and emphasizes the importance of maintaining a broad differential diagnosis when evaluating endobronchial lesions. Granulation tissue surrounding aspirated foreign bodies may closely resemble neoplastic airway obstruction both radiologically and bronchoscopically. Careful history-taking and flexible bronchoscopic management strategies are essential for accurate diagnosis and successful treatment.
Abstract Background Administrative claims can characterize tuberculosis (TB)-related care, but incomplete diagnostic histories and coding practices complicate interpretation of comorbidities and neoplasm codes. Evidence on these claims-recording patterns and associated inpatient and cost outcomes in Indonesia remains limited. Aim To examine whether recorded pre-index comorbidities were associated with pulmonary or extrapulmonary TB coding patterns and whether TB coding patterns and recorded comorbidities were associated with first observed malignant or benign neoplasm codes, inpatient discharge-coded death, and verified claim costs. Methods We analyzed a BPJS Kesehatan contextual sample with available claims from 2015 to 2024 and included patients whose first observed TB-coded claim occurred in 2024. Claim-level source files were linked and cleaned before derivation of a one-row-per-patient analytic file. The first observed TB code was not assumed to be the first clinical diagnosis. Pre-index conditions were identified in available records before the index date. Follow-up extended from the index date through 31 December 2024 and therefore varied by index date. Exploratory regression models assessed extrapulmonary coding, first observed neoplasm codes on or after index, discharge-coded death among inpatients, and verified claim costs. Results Among 10,770 patients, 4,365 (40.5%) had an extrapulmonary TB code. Pre-index malignancy was associated with an extrapulmonary TB coding pattern (adjusted odds ratio [aOR] 2.96, 95% confidence interval [CI] 2.07–4.24), whereas diabetes showed an inverse association (aOR 0.57, 95% CI 0.44–0.75). An extrapulmonary coding pattern was associated with first recorded malignant (aOR 2.55, 95% CI 1.88–3.45) and benign neoplasm codes (aOR 3.89, 95% CI 3.08–4.90). Because TB coding pattern incorporated all observed 2024 codes, its chronological relationship to neoplasm coding and other outcomes was indeterminate. Among 5,179 inpatients, 315 (6.1%) had discharge coded as death; pre-index malignancy was associated with this outcome (aOR 2.61, 95% CI 1.39–4.91) and with higher conditional verified costs among patients with positive costs (cost ratio 1.86, 95% CI 1.31–2.66). Conclusion Recorded comorbidities, TB coding patterns, neoplasm codes, inpatient discharge status, and verified costs co-occurred within this administrative dataset. These findings describe documentation and healthcare-use patterns, not chronological clinical sequences, disease incidence, or causal effects. Unequal observation time, surveillance intensity, and sparse comorbidity subgroups further limit interpretation.
Abstract Background Nasogastric tube (NGT) placement is frequently used for enteral access in critically ill patients. Esophageal perforation with intrapleural tube migration is rare but can cause major pleural contamination, infection, and respiratory complications. We report an unusual case of recurrent right-sided empyema associated with an NGT traversing a distal esophageal perforation into the right pleural cavity. Case presentation A 90-year-old woman with severe neurological impairment, tracheostomy, and chronic mechanical ventilation was transferred on 11 October 2023 for recurrent right pleural empyema. Chest CT on 12 October showed the distal nasogastric tube (NGT) within the right pleural space, associated with effusion and gas suggestive of esophago-pleural communication. On 14 October, she underwent esophageal repair and right lung decortication. The treating thoracic surgeon reported to the ICU physician in charge an approximately 1 cm lower-third esophageal perforation traversed by the NGT. Histopathology showed inflamed pleural tissue and organizing pneumonia; pleural pus culture yielded moderate growth of vancomycin-resistant Enterococcus faecium, susceptible to linezolid and resistant to vancomycin, ampicillin, penicillin, ciprofloxacin, and levofloxacin. After an inconclusive study and CT concern for a postoperative leak on 22 October, endoscopy and fluoroscopic contrast assessment on 23 October found no gross perforation or contrast leak; the NGT was advanced into the stomach under endoscopic guidance. Enteral feeding was subsequently tolerated. On 31 October, the last available clinical assessment, she was hemodynamically stable but remained ventilator-dependent. The administrative discharge entry on that date represented monthly billing rather than physical discharge. Conclusions Enteral-feed-like material in a pleural drain should prompt urgent evaluation for gastrointestinal–pleural communication and feeding-tube malposition. CT can define the abnormal tube course and associated thoracic complications. This case highlights the importance of reliable NGT position verification before use and prompt multidisciplinary source control when esophageal perforation is accompanied by pleural contamination.
