Jornal Brasileiro De Pneumologia最新文献

{"title":"Tumor spread through air spaces in lung cancer: prospective analysis of the accuracy of intraoperative frozen section examination.","authors":"Germano Luciano de Almeida, Bruno Maineri Pinto, Vitor Maineri Pinto, Aline Caldart Tregnago, Renata Fragomeni Almeida, Darcy Ribeiro Pinto Filho","doi":"10.36416/1806-3756/e20240165","DOIUrl":"10.36416/1806-3756/e20240165","url":null,"abstract":"<p><strong>Objective: </strong>To establish the accuracy of frozen section examination in identifying tumor spread through air spaces (STAS), as well as to propose a reproducible technical methodology for frozen section analysis. We also aim to propose a method to be incorporated into the decision making about the need for conversion to lobectomy during sublobar resection.</p><p><strong>Methods: </strong>This was a nonrandomized prospective study of 38 patients with lung cancer who underwent surgical resection. The findings regarding STAS in the frozen section were compared with the definitive histopathological study of paraffin-embedded sections. We calculated a confusion matrix to obtain the positive predictive value (PPV), negative predictive value (NPV), sensitivity, specificity and accuracy.</p><p><strong>Results: </strong>The intraoperative frozen section analysis identified 7 STAS-positive cases that were also positive in the histopathological examination, as well as 3 STAS-negative cases that were positive in the in the histopathological examination. Therefore, frozen section analysis was determined to have a sensitivity of 70%, specificity of 100%, PPV of 100%, NPV of 90.3%, and accuracy of 92% for identifying STAS.</p><p><strong>Conclusions: </strong>Frozen section analysis is capable of identifying STAS during resection in patients with lung cancer. The PPV, NPV, sensitivity, and specificity showed that the technique proposed could be incorporated at other centers and would allow advances directly linked to prognosis. In addition, given the high accuracy of the technique, it could inform intraoperative decisions regarding sublobar versus lobar resection.</p>","PeriodicalId":14845,"journal":{"name":"Jornal Brasileiro De Pneumologia","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11449603/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142365327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"External validation of the parsimonious EuroLung risk models: analysis of the Brazilian Lung Cancer Registry.","authors":"Paula Duarte D'Ambrosio, Ricardo Mingarini Terra, Alessandro Brunelli, Leticia Leone Lauricella, Carolina Adan Cavadas, Jaqueline Schaparini Fonini, Jefferson Luiz Gross, Federico Enrique Garcia Cipriano, Fabio May da Silva, Paulo Manuel Pêgo-Fernandes","doi":"10.36416/1806-3756/e20240226","DOIUrl":"10.36416/1806-3756/e20240226","url":null,"abstract":"<p><strong>Objective: </strong>The purpose of this study was to assess performance in the Brazilian Lung Cancer Registry Database by using the parsimonious EuroLung risk models for morbidity and mortality.</p><p><strong>Methods: </strong>The EuroLung1 and EuroLung2 models were tested and evaluated through calibration (calibration plot, Brier score, and the Hosmer-Lemeshow test) and discrimination (ROC AUCs), in a national multicenter registry of 1,031 patients undergoing anatomic lung resection.</p><p><strong>Results: </strong>The evaluation of performance in Brazilian health care facilities utilizing risk-adjustment models, specifically EuroLung1 and EuroLung2, revealed substantial miscalibration, as evidenced by calibration plots and Hosmer-Lemeshow tests in both models. In terms of calibration, EuroLung1 exhibited a calibration plot with overlapping points, characterized by a slope of 1.11 and a Brier score of 0.15; the Hosmer-Lemeshow test yielded a statistically significant p-value of 0.015; and the corresponding ROC AUC was 0.678 (95% CI: 0.636-0.721). The EuroLung2 model displayed better calibration, featuring fewer overlapping points in the calibration plot, with a slope of 1.22, with acceptable discrimination, as indicated by a ROC AUC of 0.756 (95% CI: 0.670-0.842). Both models failed to accurately predict morbidity and mortality outcomes in this specific health care context.</p><p><strong>Conclusions: </strong>Discrepancies between the EuroLung model predictions and outcomes in Brazil underscore the need for model refinement and for a probe into inefficiencies in the Brazilian health care system.</p>","PeriodicalId":14845,"journal":{"name":"Jornal Brasileiro De Pneumologia","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11449598/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142365321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correspondence about the article: Asthma in the Brazilian Unified Health Care System: an epidemiological analysis from 2008 to 2021Authors' replyAsthma in the Brazilian Unified Health Care System an epidemiological analysis from 2008 to 2021Higher Asthma Mortality in Elders and Female Subjects in Brazil A 10-year Series [abstract]. Am J Respir Crit Care.","authors":"Marcelo Fouad Rabahi, Amanda da Rocha Oliveira Cardoso, José Eduardo Delfini Cançado","doi":"10.36416/1806-3756/e20240196","DOIUrl":"10.36416/1806-3756/e20240196","url":null,"abstract":"","PeriodicalId":14845,"journal":{"name":"Jornal Brasileiro De Pneumologia","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11449602/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142365317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic lung disease of prematurity and bronchopulmonary dysplasia.","authors":"Gabriela de Azevedo Bastian de Souza, Maria Paula Hanel, Eduardo da Costa Herter, Leonardo Araujo Pinto, Marcus Herbert Jones","doi":"10.36416/1806-3756/e20240279","DOIUrl":"10.36416/1806-3756/e20240279","url":null,"abstract":"","PeriodicalId":14845,"journal":{"name":"Jornal Brasileiro De Pneumologia","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11449605/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142365315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Latent tuberculosis infection and biologic agents other than TNF-α inhibitors: \"over-screening and over-treatment?\"","authors":"Ana Paula Santos, Fernanda Carvalho de Queiroz Mello","doi":"10.36416/1806-3756/e20240277","DOIUrl":"10.36416/1806-3756/e20240277","url":null,"abstract":"","PeriodicalId":14845,"journal":{"name":"Jornal Brasileiro De Pneumologia","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11449617/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142365322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Drug-induced lung disease: a narrative review.","authors":"Guilherme das Posses Bridi, Eduardo Kaiser Ururahy Nunes Fonseca, Ronaldo Adib Kairalla, Alexandre Franco Amaral, Bruno Guedes Baldi","doi":"10.36416/1806-3756/e20240110","DOIUrl":"10.36416/1806-3756/e20240110","url":null,"abstract":"<p><p>Drug-induced lung disease (DILD) encompasses a broad, highly heterogeneous group of conditions that may occur as a result of exposure to numerous agents, such as antineoplastic drugs, conventional or biological disease-modifying antirheumatic drugs, antiarrhythmics, and antibiotics. Between 3% and 5% of prevalent cases of interstitial lung diseases are reported as DILDs. The pathogenesis of lung injury in DILD is variable, multifactorial, and often unknown. Acute presentation is the most common, can occur from days to months after the start of treatment, and ranges from asymptomatic to acute respiratory failure. The CT patterns are varied and include ground-glass opacities, organizing pneumonia, and diffuse alveolar damage. Notably, there are no clinical manifestations or CT patterns specific to DILD, which makes the diagnosis quite challenging and necessitates a high index of suspicion, as well as the exclusion of alternative causes such as infection, cardiac-related pulmonary edema, exacerbation of a preexisting ILD, and neoplastic lung involvement. Discontinuation of the offending medication constitutes the cornerstone of treatment, and corticosteroid treatment is usually necessary after the onset of clinical manifestations. The prognosis varies widely, with high mortality rates in severe cases. A history of medications related to pulmonary toxicity in patients with new-onset respiratory symptoms should prompt consideration of DILD as a potential underlying cause.</p>","PeriodicalId":14845,"journal":{"name":"Jornal Brasileiro De Pneumologia","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11449616/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142365318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing research integrity and data quality through standardized electronic case report forms.","authors":"Fabia Diniz-Silva, Juliana Carvalho Ferreira","doi":"10.36416/1806-3756/e20240292","DOIUrl":"10.36416/1806-3756/e20240292","url":null,"abstract":"","PeriodicalId":14845,"journal":{"name":"Jornal Brasileiro De Pneumologia","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11449601/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142365319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expert views on screening for tuberculosis infection in patients commencing treatment with a biologic agent.","authors":"Adiba Sultana, Giovanni Battista Migliori, Lia D'Ambrosio, José-María García-García, Denise Rossato Silva, Luis Adrian Rendon, Luigi R Codecasa, Francois-Xavier Blanc, Simon Tiberi, Catherine W M Ong, Courtney Heffernan, Giovanni Sotgiu, Rosella Centis, Claudia Caroline Dobler","doi":"10.36416/1806-3756/e20240082","DOIUrl":"10.36416/1806-3756/e20240082","url":null,"abstract":"<p><strong>Objective: </strong>Many biologic agents cause some degree of immunosuppression, which can increase the risk of reactivation of tuberculosis infection (TBI). This risk is variable between individual biologics. We aimed to assess current (and recommended) clinical practice of TBI screening and treatment among patients initiating treatment with biologic agents.</p><p><strong>Methods: </strong>An online questionnaire was distributed via email to members of the Global Tuberculosis Network and associated professional organisations to seek insights into the screening for and treatment of TBI in patients treated with biologics.</p><p><strong>Results: </strong>A total of 163 respondents in 27 countries answered at least one question. For all biologics described in the questionnaire, respondents advised increasing screening relative to current practice. Observed and supported TBI screening rates in patients treated with TNF-a inhibitors were high, especially for older TNF-a inhibitors. Most participants supported TBI screening in patients treated with B- or T-cell inhibitors but not in those treated with interleukin inhibitors. Guideline awareness was higher for TNF-a inhibitors than for other biologic classes (79% vs. 34%).</p><p><strong>Conclusions: </strong>Although respondents stated that TBI screening rates are lower than what they consider ideal, there was a tendency to recommend TBI screening in patients treated with biologics not known to be associated with an increased risk of TBI. As a result, there is a potential risk of over-screening and over-treatment of TBI, potentially causing harm, in patients treated with biologics other than TNF-a inhibitors. There is a need to research the risk of TBI associated with biologics and for guidelines to address the spectrum of TBI risk across all types of biologics.</p>","PeriodicalId":14845,"journal":{"name":"Jornal Brasileiro De Pneumologia","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11449592/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142365320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of the exercise physiology laboratory in disease management: pulmonary arterial hypertension.","authors":"Eloara V M Ferreira, Julina S Lucena, Rudolf K F Oliveira","doi":"10.36416/1806-3756/e20240240","DOIUrl":"10.36416/1806-3756/e20240240","url":null,"abstract":"","PeriodicalId":14845,"journal":{"name":"Jornal Brasileiro De Pneumologia","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11449595/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142365324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thoracic ultrasound: a review of the state-of-the-art.","authors":"Philippe de Figueiredo Braga Colares, Thiago Thomaz Mafort, Felipe Marquesini Sanches, Laura Braga Monnerat, Carlos Augusto Metidieri Menegozzo, Alessandro Wasum Mariani","doi":"10.36416/1806-3756/e20230395","DOIUrl":"10.36416/1806-3756/e20230395","url":null,"abstract":"<p><p>Thoracic ultrasound (TUS) is a tool that has become increasingly essential in the daily practice of thoracic medicine. Driven by the need to assess patients during the COVID-19 pandemic, there has been an increase in the use of point-of-care TUS, which has demonstrated several benefits, either as a complement to clinical decision-making for diagnosis or as a real-time guide for procedures, whether as a predictor or measure of treatment response. Here, we present a review of TUS, based on the most recent scientific evidence, from equipment and techniques to the fundamentals of pulmonary ultrasound, describing normal and pathological findings, as well as focusing on the management of lung disease and guidance for invasive thoracic procedures at the bedside. Finally, we highlight areas of perspective and potential lines of research to maintain interest in this valuable tool, in order to improve the diagnostic process and expand the treatment arsenal.</p>","PeriodicalId":14845,"journal":{"name":"Jornal Brasileiro De Pneumologia","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11449623/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142365325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}