Objectives: To compare positive airway pressure (PAP) adherence between patients with or without excessive daytime sleepiness (EDS) in mild, moderate and severe obstructive sleep apnea (OSA). Methods: Patients >18 years diagnosed with OSA in 2018 and 2019, without previous history of PAP usage and with adherence registration in the first medical consultation after treatment initiation, were included. EDS was defined as a score of >10 on the Epworth Scale. Patients were divided into two groups according to the adherence to PAP: "Adherent" if using the device for >4 h for >70% of the nights and "Nonadherent" otherwise. Simple and multiple logistic regression models for adherence were determined.Results: 321 patients were included, most male (64.2%), with mean age 56.56 years. Most patients had severe OSA (n = 159; 49.5%), and median AHI was 29.3/h [16.8; 47.5]. Being older or having a severe OSA resulted in an increased adherence (OR = 1.020, CI95% = [1.002; 1.039] and OR = 2.299, CI95% = [1.273; 4.191], respectively). In patients without EDS a statistically significant difference was found in adherence between those with severe OSA and both mild and moderate OSA categories (OR = 0.285, p = 0.023 and OR = 0.387, p = 0.026, respectively), with patients with severe OSA being adherent. There was no sta-tistical difference in adherence between patients with or without EDS (OR 1.083; p = 0.876), nor in the different degrees of severity in those with EDS.Conclusion: In our study there were no differences in PAP therapy adherence between patients with or without excessive daytime sleepiness. Older age and higher OSA severity resulted in higher adherence rates.& COPY; 2023 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Background: COPD and emphysema due to alpha-1 antitrypsin deficiency (AATD) are the 1st and 5th indications for lung transplantation (LT) worldwide, respectively. A different prognosis can occur in both entities. Aims: Comparative analysis of characteristics, surgical complications and post-operative survival between both groups (g). Methods: Retrospective analysis of pts who underwent LT between 2010-2017 in our center. Log-rank tests and Kaplan-Meier methods were used. Results: 38 pts were included: 23 (60,5%) with COPD and 15 (39,5%) with AATD, with average age of 56,2y vs. 50,4y, male predominance (87% vs. 60%) and average of smoking package per-year of 44 vs. 30,3. Most pts in the AATD-g were PiZZ (n=14, 93,3%) and 10pts (66,7%) were under substitution therapy. At the time of LT, COPD-g had an average FEV1 of 19,5% (±5,65) and 6-min-walk distance (6MWD) of 265,94m (±103,98). AATD-g had: FEV1 of 18,43% (±6,18) and 6MWD of 247,25m (±137) (NS). BODE index was similar (7,11±1,4 vs. 7,67±1,6). The median length of stay was higher for COPD-g (46 vs. 39 days), with no differences for surgical complications and acute graft rejection. AATD-g had more infectious complications (86,7% vs. 73,9%). Six-months post-LT, the average for FEV1 was 70,5% (±30,2) vs. 78,14% (±20,63) and 6MWD was 419,6m (±136,8) vs. 446,83m (±148,3), for COPD-g vs. AATD-g, respectively (NS). The 1st-year survival was 80,5% for COPD-g vs. 71% for AATD-g (NS). Conclusions: Despite the small sample, both groups had similar characteristics before and after LT, with a tendency for a lower survival rate in AATD-g.

Background: Atrial arrhythmias (AAs) including atrial fibrillation (AF) and atrial tachycardia (AT) are common after lung transplantation (LT) and their treatment can be challenging. Aims: Evaluate the prevalence and timing of perioperative AAs, identify risk factors, management and its impact on outcomes. Methods: Retrospective analysis of consecutive patients (pts) submitted to LT between 2015-2017, in our center. Results: 74pts were included with average age of 47,2±14 years(y). The most common indications for LT were COPD (n=23, 31,1%), IPF (n=14, 18,9%) and cystic fibrosis (n=10, 13,5%). No patient had preoperative AAs, and 32pts (43,2%) developed postoperative AAs: 28pts (87,5%) had AF and 4 (12,5%) had AT. Incidence of AAs peaked 3 days after LT (n=16, 50%). Older age (>50y) was the only risk factor associated with increased risk for AAs (42,5y±14,6 vs. 53,3y±10,4, p=0,009). Pharmacologic treatment consisted of rhythm control agents in 23pts (71,9%), rate-control agents in 2pts (6,2%) and both in 7pts (21,9%). Due to failure of medical therapy, electrical cardioversion was used in 8pts (25%). At discharge, 30pts (93,75%) had sinus rhythm conversion and 2pts (6,2%) remained in FA. 24pts (75%) were discharged with rate-control agents, 6pts (18,75%) with rhythm control agents and 2pts (6,2%) with both agents. The length of stay was higher for AAs-g with a significant correlation (p=0,007). The 1st-year survival was 73,9% for AAs-g vs. 77,5% for non-AAs-g (p=0,874). Conclusions: AAs after LT are common, with occurrence peaking 3 days after LT. Older age is associated with elevated risk. AAs-g had increased length of stay, although with no long-term survival impact.

Introduction: Integrated 18 F-fluorodeoxyglucose (FDG) positron emission tomography and computed tomography (PET-CT) is an useful noninvasive technique for the intrathoracic lymph node staging of non-small cell lung cancer (NSCLC). However, invasive staging is usually recommended prior to any operative procedure. Aim: To evaluate the accuracy of PET-CT in intrathoracic lymph node staging of potentially resectable NSCLC. Methods: Fifty-six consecutive patients with NSCLC who had staging PET-CT scans and pathological nodal sampling were included. The results of PET-CT were compared with histopathological findings. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of PET-CT in intrathoracic lymph node staging were determined. Results: At pathological staging, 37 patients had N0 disease (66%), nine had N1 disease (16%), eight had N2 disease (14%) and two had N3 disease (4%). PET-CT correctly identified 28 of 37 patients with N0 disease (76%) and one of the nine patients with N1 disease (11%). None of the 10 patients with N2/N3 disease was correctly determined by PET-CT. PET-CT falsely understaged 17 patients (30.3%) and falsely overstaged 10 patients (18%). PET-CT overall sensitivity was 47%, specificity was 76%, PPV was 50%, NPV was 74% and its accuracy was 66%. Conclusions: Our results show that PET-CT has a low sensitivity and accuracy in identifying intrathoracic lymph node involvement of NSCLC patients. This is in agreement with previous data and highlights the importance of an accurate invasive intrathoracic lymph node staging in order to choose the best treatment approach.

Introduction: The use of severity scores for community acquired pneumonia (CAP) is recommended by many clinical guidelines. However, debate about the preferred system is ongoing. Objective: To compare the performance of 4 systems to identify severe CAP. Material and methods: We reviewed 176 patients diagnosed with CAP, admitted in a Pneumology ward, from January 2007 to July 2009. We compared 4 systems: Pneumonia Severity Index (PSI), CURB65, modified American Thoracic Society criteria for severe pneumonia (ATSm) and SCAP score. We divided the patients in 2 groups: low/intermediate risk and high risk, the later defined as CURB65 ≥3, PSI classes IV/V, ATSm – ≥1 major criteria or ≥ 3 minor criteria and SCAP score – ≥1 major criteria or ≥ 2 minor criteria. We evaluated the performance of these systems in predicting patient adverse outcomes, defined as mortality and need for ICU admission, based on sensitivity, specificity and area under the ROC curve (AUC). Results: Sensitivity and specificity (95% confidence interval in brackets) were, respectively: CURB65 – 27.3% [9.7 - 56.6] and 91.5% [86.3 - 94.9]. PSI – 81.8% [52.3 - 94.9] and 55.8% [48.1 - 63.1]. ATSm – 54.6% [28.0 – 78.7] and 95.8% [91.5 - 97.9]. SCAP – 81.8% [52.3 - 94.9] and 70.9% [63.6 - 71.3]. AUC was: CURB65 – 0.594, PSI – 0.688, ATSm – 0.752 and SCAP – 0.764. Conclusions: PSI and SCAP were the most sensitive systems, while CURB65 and ATSm were the most specific. Although the best discriminative capacity was found in SCAP, it presented many false positives. Probably, a good approach would be to rely on clinical judgment, triage of high risk patients with PSI or SCAP and use of ATSm to determine need for ICU admission.