Pre-existing Lung Disease Research Articles

Patient Characteristics and Outcomes of Sinusoidal Obstruction Syndrome with and without Hematopoietic Stem Cell Transplant

Introduction Sinusoidal obstruction syndrome (SOS), also called hepatic veno-occlusive disease (VOD) is a condition causing damage of hepatic vascular endothelial cells, it can progress to multi-organ failure and is associated with high mortality ( >80%). It is known to occur mainly after high dose chemotherapy use in hematopoietic stem cell transplant (HSCT) but with recent advances in chemotherapy, there is an increase in its incidence in non-hematopoietic stem cell transplant patients (non-HSCT). Currently, there is limited literature comparing the patient characteristics and survival of SOS in HSCT vs non-HSCT patients. Therefore we conducted this retrospective analysis. Methods We performed a retrospective analysis using the 2016-2020 National inpatient sample (NIS) database, generated by the Health care cost and utilization project (HCUP). We gathered data on all patients who had SOS/VOD during this time period. They were divided into two cohorts, those who received hematopoietic stem cell transplant (HSCT group) vs those who did not receive hematopoietic stem cell transplant (non-HSCT group). Among the two cohorts we compared the patients characteristics, underlying malignancies, comorbidities and mortality. Results From the NIS database during the study period 1740 cases had documented SOS/VOD. Of those, 520(30%) had a history of HSCT and 1220(70%) did not have HSCT. Of the 520 cases with HSCT, 135 (26%) had Acute lymphoblastic leukemia (ALL), 105 (20.2%) had Acute myeloid leukemia (AML), 55 (10.6%) had Non-Hodgkin lymphoma (NHL), 20 (3.8%) had Chronic myeloid leukemia (CML), 15 (2.9%) had Hodgkin lymphoma (HL), the rest were other malignancies which were not included in the search. Of the 1220 cases without HSCT, 320 (26.2%) had ALL, 150 (12.3%) had AML, 90 (7.4%) had Solid tumors, 55 (4.5%) had NHL, 15 (1.2%) had CML, 15 (1.2%) had HL, the rest were likely malignancies not included in the search. ALL was the predominant cancer in both HSCT and non-HSCT groups (26% and 26.2% respectively), followed by AML, with more AMLs noted in the HSCT group (20%) versus the non-HSCT group (12.3%). The study population predominantly consisted of Whites followed by Hispanics and then African-Americans in both groups. The population also consisted predominantly of males across both cohorts. (Table 1). The solid tumors which were associated with SOS in the non-HSCT group included colorectal cancer, liver cancer, pancreatic cancer and Breast cancer in that order (Table 2). Preexisting liver disease was present in 215 (17.6%) of patients in non-HSCT cohort vs 60 (11.5%) patients in SCT cohort. Pre-existing lung disease was insignificant in both groups. Mortality was compared between the two groups after adjusting for primary cancer, age, sex, race and we found that SCT group had higher odds of mortality compared to non-SCT (14.4% vs 7.4%, aOR 1.866, 95% CI 1.29-2.68, p<0.01). Further multivariate analysis could not be carried out due to low sample size. Discussion Although traditionally, SOS/VOD has been thought to be a complication related to SCT, our study goes on to show that there is actually a higher incidence of SOS in the non-SCT patient population. ALL was the most common hematological malignancy encountered and had similar prevalence in both groups indicating that treatment regimens used in this cancer carry a high risk of SOS. Drugs like inotuzumab ozogamicin are the possible culprits although this information could not be obtained from our database. AML patients also exhibited high rates of SOS, more so in the SCT setting. Patients with preexisting liver disease and hematological malignancies could also benefit from close monitoring for symptoms of SOS with a high index of suspicion based on our results. Despite rising incidence in non-SCT patients, SCT patients with SOS continue to have a higher mortality possibly indicating the higher toxicity of chemotherapy regimens used in this setting. Thus, our study brings forth some important differences between HSCT and non-HSCT SOS and enables clinicians to identify the associated risk factors.

Prevalence of pre-existing lung diseases and their association with income level among patients with lung cancer: a nationwide population-based case-control study in South Korea

BackgroundThis study aimed to estimate the prevalence of pre-existing lung diseases in patients with lung cancer compared to people without lung cancer and examine the association between income levels and...

Cardiovascular sequelae in post-COVID-19 patients with moderate to severe CT severity score: A follow-up study

Objective: To study cardiovascular sequelae of post-COVID-19 patients with moderate to severe computed tomography (CT) severity score. Methods: A prospective, non-randomized, observational study was conducted on 100 post-COVID-19 patients with moderate to severe CT severity scores from January 2021 to December 2021. Fifty- nine were male [mean age (54.1±12.2) years] and 41 were female [mean age (46.9±15.1) years]. Patients with previous cardiovascular disease, previous chronic lung disease, and pre-existing primary or secondary pulmonary hypertension were excluded. Patients were examined, and serial electrocardiogram and 2D echocardiography were performed to detect any cardiovascular abnormality. Results: Post-COVID-19 patients had persistent symptoms, the most common being fatigue (59%). Most of these symptoms were relieved on follow-up. A rise in systolic, diastolic blood pressure, and pulse rate was observed. The electrocardiographic evaluation revealed ST-T segment changes, sinus tachycardia, ventricular hypertrophy, and arrhythmias among a considerable number of patients. On echocardiography, left ventricular diastolic dysfunction was most common (43%). Pulmonary hypertension, as evidenced by elevated pulmonary artery systolic pressure, was seen in 15% of patients. Conclusions: The present findings reveal an increased incidence of cardiovascular complications after recovery from COVID-19 infection in those without pre-existing cardiovascular or chronic lung disease.

Survival outcomes and mobilization during venovenous extracorporeal membrane oxygenation: a retrospective cohort study.

Venovenous extracorporeal membrane oxygenation (V-V ECMO) can be considered in critically ill patient in severe pulmonary failure. However, the mobilization of patients on V-V ECMO can be challenging due to logistic and safety concerns. This study aimed to investigate whether 30 days survival was improved in patients who were mobilized during V-V ECMO support. We conducted a retrospective cohort all-comer study that included all patients cannulated for V-V ECMO at a single center. Patients with a V-V ECMO duration below 24 h were excluded from the analysis. The patients were grouped based on the ICU mobility scale documented during V-V ECMO support. The primary endpoint was 30 days survival, and secondary endpoints included weaning from ECMO and mechanical ventilation, as well as hospital survival. A total of 343 patients were included in the study, with a median age of 56 years and 32% were female. Among them, 28% had chronic lung disease. The ICU mobilization scale ≥2 during ECMO was documented in 62/343 (18%) patients. There were no significant differences in age, gender and preexisting lung disease. Duration of ICU stay (13.1 vs. 15.6 days), time on ECMO (186 vs. 190 h) and mechanical ventilation (11.2 vs. 13.6 days) were slightly shorter in patients with ICU mobility scale <2 compared to those with ≥2 (all p = 0.0001). However, patients with ICU mobilization scale ≥2 showed significantly better 30 days survival (71.0 vs. 48.0%, OR 2.6 (1.5 to 4.8), p = 0.0012) compared to those with <2. In the ≥2 mobility scale group, a significantly higher number of patients were successfully weaned from the ventilator (61.3 vs. 46.6%, OR 1.8 (1.0 to 3.2), p = 0.049). A stronger correlation was observed between more intense mobilizations, such as being in a standing position (OR 5.0 (1.7 to 14.0), p = 0.0038), and higher 30 days survival. The findings of this study suggest that active mobilization during V-V ECMO support is associated with improved 30 days survival and successful weaning from the respirator. Incorporating mobilization as part of the therapeutic approach during ECMO support may offer potential benefits for critically ill patients.

Comparison of Risk Factors During First and Second Wave of COVID-19 in Patients with Autoimmune Rheumatic Diseases (AIRD): Results from KRACC Subset.

The differential influence and outcome of various risk factors on occurrence of COVID-19 among patients with autoimmune rheumatic diseases (AIRD) during different COVID-19 peaks is underreported. To assess the impact and outcome of conventional risk factors, immunosuppressants, and comorbidities on the risk of COVID-19 among AIRD patients during the first two COVID-19 peaks. Prospective, non-interventional longitudinal cohort study. This is a subset of the KRA COVID19 cohort undertaken during the initial wave of COVID-19 (W1) (Apr-Dec2021); and the 2nd-wave (W2) (Jan-Aug2021). Data collected included description of AIRD subsets, treatment characteristics, comorbidities, and COVID-19 occurrence. Risk factors associated with mortality were analysed. The incidence rate was compared with that of the general population in the same geographic region. AIRD patients (n=2969) had a higher incidence of COVID-19 in the W2 (7.1%) than in the W1 (1.7%) as compared to the general population (Government bulletin). Age (p<0.01) and duration of AIRD (p<0.001) influenced COVID-19 occurrence in W2 while major disease subsets and immunosuppressants including glucocorticoids did not. The W2 had lower HCQ usage (Adjusted Odds Ratio [AOR]-0.81) and comorbidities like hypertension (AOR -0.54) and pre-existing lung disease (AOR -0.38;0.19-0.75) compared to W1. Older age (1.11) and coexistent diabetes mellitus (AOR 6.74) were independent risk factors associated with mortality in W2. We report 1.7 times higher occurrence, and no influence of major disease subsets or immunosuppressants including glucocorticoids on COVID-19. Age and diabetes were independent risk factors for mortality.

Risk factors associated with COVID-19 pneumonia in Chinese patients with pre-existing interstitial lung disease during the SARS-CoV-2 pandemic.

In China, the emergence of a nationally widespread epidemic infection of severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) has appeared within a month since December 7, 2022. To evaluate the risk factors for suffering from coronavirus disease 2019 (COVID-19) pneumonia due to infection with SARS-CoV-2 in different kinds of interstitial lung disease (ILD) patients with diverse immunizations, we conducted this retrospective study on 525 patients with ILDs who underwent regular follow-up in our ILD clinic. Among them, 128 ILD patients (24.4%) suffered from COVID-19 pneumonia after SARS-CoV-2 infection. Patients were older with a male predominance in the pneumonia group than in the nonpneumonia group (65.0 ± 10.0 yearsvs. 56.4 ± 11.7 years, p < 0.001, 55.5% vs. 39.5%, p = 0.002, respectively). Connective tissue disease-associated ILD(CTD-ILD) (25%), idiopathic pulmonary fibrosis(23.4%), and interstitial pneumonia with autoimmune features(21.1%) were the main pre-existing ILDs in the pneumonia group. In Cox multivariable analysis, only male sex and corticosteroid use were risk factors for COVID-19 pneumonia after infection. Two or threedoses of vaccination were a protective factor for pre-existing ILD patients suffering from COVID-19 pneumonia. More than twodoses of vaccination were strongly recommended for pre-existing ILD patients, particularly for males who were administered corticosteroids.

Decreased plasma cartilage acidic protein 1 in COVID-19.

Cartilage acidic protein-1 (CRTAC1) is produced by several cell types, including Type 2 alveolar epithelial (T2AE) cells that are targeted by SARS-CoV2. Plasma CRTAC1 is known based on proteomic surveys to be low in patients with severe COVID-19. Using an ELISA, we found that patients treated for COVID-19 in an ICU almost uniformly had plasma concentrations of CRTAC1 below those of healthy controls. Magnitude of decrease in CRTAC1 distinguished COVID-19 from other causes of acute respiratory decompensation and correlated with established metrics of COVID-19 severity. CRTAC1 concentrations below those of controls were found in some patients a year after hospitalization with COVID-19, long COVID after less severe COVID-19, or chronic obstructive pulmonary disease. Decreases in CRTAC1 in severe COVID-19 correlated (r = 0.37, p = 0.0001) with decreases in CFP (properdin), which interacts with CRTAC1. Thus, decreases of CRTAC1 associated with severe COVID-19 may result from loss of production by T2AE cells or co-depletion with CFP. Determination of significance of and reasons behind decreased CRTAC1 concentration in a subset of patients with long COVID will require analysis of roles of preexisting lung disease, impact of prior acute COVID-19, age, and other confounding variables in a larger number of patients.

Anesthesia Management in A Newborn Baby with Tracheoesophageal Fistula: A Case Report

Background: In infants with esophageal atresia/tracheoesophageal fistula, excessive salivation, coughing, choking, cyanosis, and regurgitation associated with attempts to eat may be seen, as well as aspiration of gastric contents. Thus difficulties encountered during anesthetic management include ineffective ventilation due to an endotracheal tube placed in the fistula, massive gastric dilatation, preexisting severe lung disease from aspiration of gastric contents and/or respiratory distress syndrome of prematurity, and associated anomalies, especially cardiac. This study aimed to discuss the anesthetic management of neonates with tracheoesophageal fistula.&#x0D; Case presentation: The patient was a 12-day-old baby girl with type C tracheoesophageal fistula. Anesthesia was performed using general anesthesia. The procedure lasts 3 hours 15 minutes. The patient underwent closure of the esophageal fistula, repair of the trachea in the distal part of the tracheoesophageal fistula, and performed end-to-end anastomosis proximal and distal esophagus. Postoperatively the patient was treated at the neonatal intensive care unit on a ventilator and given a combination of opioid and non-opioid analgesics.&#x0D; Conclusion: The key to successful anesthetic management in the operation of a patient with a tracheoesophageal fistula is airway management, where the ETT must be properly placed on the trachea and try not to get the ETT into the fistula.

Cross-sectional study evaluating the impact of SARS-CoV-2 variants on Long COVID outcomes in UK hospital survivors

ObjectivesCOVID-19 studies report on hospital admission outcomes across SARS-CoV-2 waves of infection but knowledge of the impact of SARS-CoV-2 variants on the development of Long COVID in hospital survivors is...

COVID-19 in Patients with Pre-Existing Interstitial Lung Disease: Potential Value of a Steroid-Based Treatment Strategy.

The prognosis of patients with coronavirus disease 2019 (COVID-19) and pre-existing interstitial lung disease (preILD) is poor, and no effective treatment strategy has been determined. The aim of this study was to assess the effectiveness of a steroid-based treatment strategy for patients with COVID-19 and preILD. We retrospectively reviewed the medical records of 610 consecutive patients with COVID-19 treated at our institution between 1 March 2020 and 30 October 2021 and identified 7 patients with preILD, all of whom were treated with corticosteroids and remdesivir. All the patients were men with a median age of 63 years. Three of four patients with severe disease required invasive positive-pressure ventilation (n = 2) or nasal high-flow therapy (n = 1). All three patients could be weaned from respiratory support; however, one died in hospital. The remaining patient with severe COVID-19 had a do-not-resuscitate order in place and died while hospitalized. All three patients with moderate COVID-19 were discharged. The 30-day mortality was 0%, and the mortality rate during the entire observation period was 28.5%. The prognosis of our patients with COVID-19 and preILD has been better than in previous reports. Our management strategy using corticosteroids may have improved these patients' prognosis.

Abnormalities on baseline chest imaging are risk factors for immune checkpoint inhibitor associated pneumonitis

BackgroundChronic lung disease is a proposed risk factor for immune checkpoint inhibitor pneumonitis (ICI-pneumonitis); however, data is sparse regarding the impact of pre-existing lung disease and baseline chest imaging abnormalities on the risk of developing ICI-pneumonitis. MethodsWe conducted a retrospective cohort study of patients with ICI treatment for cancer from 2015 to 2019. ICI-pneumonitis was determined by the treating physician with corroboration via an independent physician review and exclusion of alternative etiologies. Controls were patients treated with ICI without a diagnosis of ICI-pneumonitis. Fisher's exact tests, Student's t-tests, and logistic regression were used for statistical analysis. ResultsWe analyzed 45 cases of ICI-pneumonitis and 135 controls. Patients with abnormal baseline chest CT imaging (emphysema; bronchiectasis; reticular, ground glass and/or consolidative opacities) had increased risk for ICI-pneumonitis (OR 3.41, 95%CI: 1.68–6.87, p = 0.001). Patients with gastroesophageal reflux disease (GERD) (OR 3.83, 95%CI: 1.90–7.70, p = < 0.0001) also had increased risk for ICI-pneumonitis. On multivariable logistic regression, patients with abnormal baseline chest imaging and/or GERD remained at increased risk for ICI-pneumonitis. Eighteen percent of all patients (32/180) had abnormal baseline chest CT consistent with chronic lung disease without a documented diagnosis. ConclusionPatients with baseline chest CT abnormalities and GERD were at increased risk for developing ICI-pneumonitis. The large proportion of patients with baseline radiographic abnormalities without a clinical diagnosis of chronic lung disease highlights the importance of multidisciplinary evaluation prior to ICI initiation.

Invasive mixed fungal disease after covid-19: A series of seven cases

Coronavirus disease 2019 (COVID-19) is a recent global pandemic that is caused by the novel severe acute respiratory syndrome coronavirus 2. The patients of covid-19 are susceptible to a diverse range of secondary infections, fungal being the most common. The increased risk is proposed to be due to the generous use of steroids for the treatment of COVID-19 infection and the presence of comorbidities, such as diabetes mellitus, hypertension, preexisting lung diseases, and/or old age. Invasive mixed fungal disease is potentially life-threatening to the patients of COVID-19. In the present series of seven cases, the authors intend to discuss the clinicopathological profile and gamut of histopathological findings in invasive mixed fungal infection comprising of mucor and Aspergillus in treated patients of COVID-19. Six patients had a clinical diagnosis of sinonasal–orbital invasive fungal disease, while there was a case of lung infection. The acquaintance and knowledge about histomorphology of invasive fungi and the multidisciplinary diagnostic approach not only will aid in early and accurate diagnosis but can guide the clinician for necessary surgical intervention and initiation of appropriate antifungal medications in patients of COVID-19.

Incidence and Risk Factors for Pneumonitis Associated With Checkpoint Inhibitors in Advanced Non-Small Cell Lung Cancer: A Single Center Experience.

Immune checkpoint inhibitor (ICI) pneumonitis causes substantial morbidity and mortality. Estimates of real-world incidence and reported risk factors vary substantially. We conducted a retrospective review of 419 patients with advanced non-small cell lung cancer (NSCLC) who were treated with anti-PD-(L)1 with or without anti-CTLA-4 therapy. Clinical, imaging, and microbiological data were evaluated by multidisciplinary adjudication teams. The primary outcome of interest was grade ≥2 (CTCAEv5) pneumonitis. Clinicopathologic variables, tobacco use, cancer therapies, and preexisting lung disease were assessed for univariate effects using Cox proportional hazards models. We created multivariate Cox proportional hazards models to assess risk factors for pneumonitis and mortality. Pneumonitis, pneumonia, and progression were modeled as time-dependent variables in mortality models. We evaluated 419 patients between 2013 and 2021. The cumulative incidence of pneumonitis was 9.5% (40/419). In a multivariate model, pneumonitis increased the risk for mortality (HR 1.6, 95% CI, 1.0-2.5), after adjustment for disease progression (HR 1.6, 95% CI, 1.4-1.8) and baseline shortness of breath (HR 1.5, 95% CI, 1.2-2.0). Incomplete resolution was more common with more severe pneumonitis. Interstitial lung disease was associated with higher risk for pneumonitis (HR 5.4, 95% CI, 1.1-26.6), particularly in never smokers (HR 26.9, 95% CI, 2.8-259.0). Pneumonitis occurred at a high rate and significantly increased mortality. Interstitial lung disease, particularly in never smokers, increased the risk for pneumonitis.

Pulmonary hypertension associated with lung disease

Pulmonary hypertension (PH) is amultifactorial pulmonary vascular disease. PH associated with pre-existing lung disease is common and classified as group3 in the clinical classification. Patients with chronic obstructive or interstitial lung disease are most likely to develop PH, with up to 20% of patients showing signs of PH. Distinguishing between the symptoms of the underlying lung disease and concomitant PH can be difficult. Clinical assessment, lung function tests, laboratory tests, and echocardiography can be helpful. The hemodynamic definition of PH has recently been changed. PH associated with lung disease is apre-capillary form by definition. A special sub-stratification in group3 is the differentiation of hemodynamic severity. Severe PH in group3 is defined as apulmonary vascular resistance (PVR) greater than 5Wood units (WU). This pulmonary vascular phenotype is characterized by rather mild to moderate impairment of lung function or lung parenchymal destruction but with severe pulmonary vascular disease or right heart strain. Currently, there are no specific PH medications approved for group3. However, the use of specific PH medications for the pulmonary vascular phenotype is being discussed in studies or on acase-by-case basis, while in patients with aPVR below 5WU treatment focuses on the underlying disease.

A Risk-Scoring Model for Severe Checkpoint Inhibitor-Related Pneumonitis: A Case-Control Study.

Checkpoint inhibitor-related pneumonitis (CIP) is one of the most common serious and fatal adverse events associated with immune checkpoint inhibitors (ICIs). The study sought to identify risk factors of all-grade and severe CIP and to construct a risk-scoring model specifically for severe CIP. This observational, retrospective case-control study involved 666 lung cancer patients who received ICIs between April 2018 and March 2021. The study analyzed patient demographic, preexisting lung diseases, and the characteristics and treatment of lung cancer to determine the risk factors for all-grade and severe CIP. A risk score for severe CIP was developed and validated in a separate patient cohort of 187 patients. Among 666 patients, 95 patients were afflicted with CIP, of which 37 were severe cases. Multivariate analysis revealed age ≥65 years, current smoking, chronic obstructive pulmonary disease, squamous cell carcinoma, prior thoracic radiotherapy, and extra-thoracic radiotherapy during ICI were independently associated with CIP events. Five factors, emphysema (odds ratio [OR] 2.87), interstitial lung disease (OR 4.76), pleural effusion (OR 3.00), history of radiotherapy during ICI (OR 4.30), and single-agent immunotherapy (OR 2.44) were independently associated with severe CIP and were incorporated into a risk-score model (score ranging 0-17). The area under the model receiver operating characteristic curve for the model was 0.769 in the development cohort and 0.749 in the validation cohort. The simple risk-scoring model may predict severe CIP in lung cancer patients receiving ICIs. For patients with high scores, clinicians should use ICIs with caution or strengthen the monitoring of these patients.

Investigating the role of obstructive pulmonary diseases and eosinophil count at admission on all-cause mortality in SARS-CoV-2 patients

The impact of asthma and chronic obstructive pulmonary disease (COPD) in the setting of severe acute respiratory syndrome coronavirus 2 (SARS-CoV‑2) infection is not clearly defined. Blood eosinophil count is astandard diagnostic test which, according to the previously published literature, might have apotential prognostic role on mortality in patients with SARS-CoV‑2 infection. To investigate the potential prognostic value of peripheral blood eosinophil count on all-cause mortality of patients hospitalized with SARS-CoV‑2 infection, as well as to assess the impact of asthma or COPD premorbidity on all-cause mortality. We conducted aretrospective registry-based cohort study. Survival analysis was performed by employing the Cox proportional hazards regression model at 30days of follow-up. Prognostic value of eosinophil count on all-cause mortality was assessed using receiver-operating characteristic (ROC) curve analysis. A total of 5653participants were included in the study. Our model did not reveal that pre-existing asthma or COPD is a statistically significant covariate for all-cause mortality but, indicated that higher eosinophil count at admission might have aprotective effect (hazard ratio, HR 0.13 (95% confidence interval, CI 0.06-0.27), p = 0.0001). ROC curve analysis indicates cut-off value of 20cells/mm3 (81% specificity; 30.9% sensitivity). Our results indicate that eosinophil count at hospital admission might have apotential prognostic role for all-cause mortality at 30days of follow-up; however this was not demonstrated for pre-existing obstructive lung diseases.

New Automated Method for Lung Functional Volumes Delineation with Lung Perfusion PET/CT Imaging.

Gallium-68 lung perfusion PET/CT is an emerging imaging modality for the assessment of regional lung function, especially to optimise radiotherapy (RT) planning. A key step of lung functional avoidance RT is the delineation of lung functional volumes (LFVs) to be integrated into radiation plans. However, there is currently no consistent and reproducible delineation method for LFVs. The aim of this study was to develop and evaluate an automated delineation threshold method based on total lung function for LFVs delineation with Gallium-68 MAA lung PET/CT imaging. Patients prospectively enrolled in the PEGASUS trial-a pilot study assessing the feasibility of lung functional avoidance using perfusion PET/CT imaging for lung stereotactic body radiotherapy (SBRT) of primary or secondary lesion-were analysed. Patients underwent lung perfusion MAA-68Ga PET/CT imaging and pulmonary function tests (PFTs) as part of pre-treatment evaluation. LFVs were delineated using two methods: the commonly used relative to the maximal pixel value threshold method (pmax threshold method, X%pmax volumes) and a new approach based on a relative to whole lung function threshold method (WLF threshold method, FVX% volumes) using a dedicated iterative algorithm. For both methods, LFVs were expressed in terms of % of the anatomical lung volume (AV) and of % of the total lung activity. Functional volumes were compared for patients with normal PFTs and pre-existing airway disease. 60 patients were analysed. Among the 48 patients who had PFTs, 31 (65%) had pre-existing lung disease. The pmax and WLF threshold methods clearly provided different functional volumes with a wide range of relative lung function for a given pmax volume, and conversely, a wide range of corresponding pmax values for a given WLF volume. The WLF threshold method provided more reliable and consistent volumes with much lower dispersion of LFVs as compared to the pmax method, especially in patients with normal PFTs. We developed a relative to whole lung function threshold segmentation method to delineate lung functional volumes on perfusion PET/CT imaging. The automated algorithm allows for reproducible contouring. This new approach, relatively unaffected by the presence of hot spots, provides reliable and consistent functional volumes, and is clinically meaningful for clinicians.

Update on the treatment of chronic pulmonary aspergillosis

Chronic pulmonary aspergillosis is a major global infection in individuals with preexisting structural lung diseases and those with immunodeficiencies, in particular cytokine defects. Current treatment options are confined to just three drug classes, the triazoles, the echinocandins and amphotericin B. However, antifungal resistance is rapidly emerging for the triazoles, the only available oral therapy for this chronic condition. Fortunately, there are now a number of novel antifungals in the development pipeline, mostly now in Phase 3 studies, with a potential for the treatment of chronic pulmonary aspergillosis. However, almost all current randomized triazoles of novel antifungals are primarily undertaken in patients with invasive candidiasis or invasive mould infections. Given the poor outcomes from treatment with antifungals in chronic pulmonary aspergillosis, in part associated with triazole resistance, we urgently need clinical trials of novel agents either as monotherapy or in combination for this disease. In addition, there is an emerging understanding of the role of immunotherapies for the treatment of chronic pulmonary aspergillosis, especially in the context of cytokine defects. Therefore, better understanding of the role of adjunctive immunotherapies such as interferon-gamma is also required. In this review, we give an overview of current management of chronic pulmonary aspergillosis, and novel antifungals and immunotherapies for the future.

Improved outcomes over time and higher mortality in CMV seropositive allogeneic stem cell transplantation patients with COVID-19; An infectious disease working party study from the European Society for Blood and Marrow Transplantation registry.

COVID-19 has been associated with high morbidity and mortality in allogeneic hematopoietic stem cell transplant (allo-HCT) recipients. This study reports on 986 patients reported to the EBMT registry during the first 29 months of the pandemic. The median age was 50.3 years (min - max; 1.0 - 80.7). The median time from most recent HCT to diagnosis of COVID-19 was 20 months (min - max; 0.0 - 383.9). The median time was 19.3 (0.0 - 287.6) months during 2020, 21.2 (0.1 - 324.5) months during 2021, and 19.7 (0.1 - 383.9) months during 2022 (p = NS). 145/986 (14.7%) patients died; 124 (12.6%) due to COVID-19 and 21 of other causes. Only 2/204 (1%) fully vaccinated patients died from COVID-19. There was a successive improvement in overall survival over time. In multivariate analysis, increasing age (p<.0001), worse performance status (p<.0001), contracting COVID-19 within the first 30 days (p<.0001) or 30 - 100 days after HCT (p=.003), ongoing immunosuppression (p=.004), pre-existing lung disease (p=.003), and recipient CMV seropositivity (p=.004) had negative impact on overall survival while patients contracting COVID-19 in 2020 (p<.0001) or 2021 (p=.027) had worse overall survival than patients with COVID-19 diagnosed in 2022. Although the outcome of COVID-19 has improved, patients having risk factors were still at risk for severe COVID-19 including death.

SCREENING, PROGNOSTIC EVALUATION AND SURGERY IN LUNG CANCER

Lung cancer is currently the neoplasm with the highest mortality among men and the second leading cause of mortality in women. OBJECTIVE : to review the importance of early screening and therapeutic possibilities in lung cancer DISCUSSION: The main risk factor for the development is smoking, however, other factors are also related, such as: presence of preexisting lung disease, occupational exposure (asbestos, uranium, chromium, alkylating agents), family history of lung cancer and previous lung cancer. In clinical practice, the prognosis is related to the staging of the disease and the histological type. In most cases, the diagnosis is late with the disease in an advanced stage, making curative treatment impossible. CONCLUSION: Due to the high mortality and the impact on treatment, it is necessary to recommend earlier screening of the population with risk factors, since treatment in the initial phase improves people’s survival and impacts on mortality indicators. METHODOLOGY: This is a literature review study. The research was guided by bibliographic articles from the Scielo, Lilacs; in addition to recommendations available on sites such as the National Cancer Institute and the American Cancer Society.