African Journal of Thoracic and Critical Care Medicine最新文献

{"title":"Pioneering endobronchial ultrasound-guided transbronchial needle aspiration in North Africa: Results from a prospective Moroccan case series.","authors":"A Moumen, S Boubia, H El Attar, R Cherkab, M Ridai","doi":"10.7196/AJTCCM.2026.v32i2.4054","DOIUrl":"10.7196/AJTCCM.2026.v32i2.4054","url":null,"abstract":"<p><strong>Background: </strong>Mediastinal and hilar lymphadenopathy pose a diagnostic challenge, especially in regions with a high prevalence of tuberculosis (TB) and lung cancer.</p><p><strong>Objectives: </strong>To evaluate the feasibility, safety and diagnostic performance of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in a Moroccan centre.</p><p><strong>Methods: </strong>This prospective observational study evaluated patients undergoing EBUS-TBNA from December 2021 to March 2025. Samples were analysed using rapid on-site cytology, cell block histology, and additional tests including GeneXpert and molecular profiling when indicated. Final diagnoses were established using a composite reference standard based on surgical pathology or clinical follow-up.</p><p><strong>Results: </strong>A total of 180 patients were included, of whom 104 were men and 76 women (sex ratio 1.37), with a mean age of 61 years. EBUS TBNA was performed for primary lung cancer diagnosis or staging in 57.2% of cases, for evaluation of suspected mediastinal metastases in 24.4%, and for investigation of unexplained mediastinal lymphadenopathy in 18.3%. The procedure provided a diagnosis in 91.5% of patients, yielding 151 true positives and 12 true negatives (17 false negatives), corresponding to a sensitivity of 91% and a specificity of 100%, with no complications reported. Final diagnoses included 103 lung cancers, 39 metastatic carcinomas, 5 lymphomas, 5 cases of sarcoidosis and 3 cases of TB, with only 9 patients subsequently requiring mediastinoscopy.</p><p><strong>Conclusion: </strong>In TB-endemic regions, EBUS-TBNA is safe and effective for mediastinal evaluation, providing reliable diagnoses for both malignant and granulomatous diseases. Its implementation is justified as a first-line modality in resource-limited settings.</p><p><strong>Study synopsis: </strong><b>What the study adds.</b> This prospective case series reports one of the first and largest North African experiences with endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in a tuberculosis-endemic setting. Among 180 patients evaluated for mediastinal and hilar lymphadenopathy, EBUS-TBNA demonstrated high diagnostic performance and excellent safety, while enabling molecular and microbiological analyses when required.<b>Implications of the findings.</b> These findings support the use of EBUS-TBNA as a first-line minimally invasive diagnostic modality in resource-limited settings, with the potential to reduce the need for surgical mediastinoscopy and facilitate earlier diagnosis and management of both malignant and granulomatous diseases.</p>","PeriodicalId":52847,"journal":{"name":"African Journal of Thoracic and Critical Care Medicine","volume":"32 2","pages":"e4054"},"PeriodicalIF":0.0,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13440553/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148680725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The profile of pleural effusions in oncological patients referred to the cardiothoracic surgery department in a tertiary hospital in Pretoria, South Africa: A retrospective study.","authors":"P M Leeuw, D J du Plessis, R Fourie, P J Becker","doi":"10.7196/AJTCCM.2026.v32i2.3989","DOIUrl":"10.7196/AJTCCM.2026.v32i2.3989","url":null,"abstract":"<p><strong>Background: </strong>The presence of a pleural effusion in any oncological patient (patient with known underlying current or previous malignancy) tends to be classified as advanced disease with few curative measures.</p><p><strong>Objectives: </strong>To establish the aetiology of pleural effusions in oncological patients in our subpopulation. The primary objective was to determine the percentage of proven malignant pleural effusions (MPEs). Secondary objectives were to determine the causes of proven MPEs and proven benign (non-malignant) pleural effusions (non-MPEs), and to determine whether proven non-MPEs change the initial cancer staging of patients.</p><p><strong>Methods: </strong>This was a retrospective record review of oncological patients admitted with suspected MPE to the Steve Biko Academic Hospital Cardiothoracic Surgery Unit during the period January 2018 - June 2020.</p><p><strong>Results: </strong>Ninety-one patients met the inclusion criteria. The median (interquartile range) age was 56 (41 - 66) years, and there were 54 females (59.3%) and 37 males (40.7%). Pleural biopsy results confirmed MPE in 80.2% (95% confidence interval 70.6 - 87.8) of cases (n=73/91) and non-MPE in 19.8% (n=18/91). The aetiologies of MPEs in descending order were breast (42.5%), lung (24.7%), genitourinary tract (15.1%), lymphoma (9.6%), other (6.8%) and gastrointestinal tract (1.4%) carcinomas. The aetiologies of the non-MPEs were inflammatory (88.9%) and infective (11.1%) in nature. Among the proven non-MPEs, the results led to a possible cancer downstaging in 6/18 patients (33.3%).</p><p><strong>Conclusion: </strong>Among oncological patients with pleural effusions referred to our unit, a statistically significant proportion (80.2%) had MPE by pleural tissue confirmation, with breast carcinoma being the most common cause. Of those with proven non-MPE, only a third had a possible cancer downstaging.</p><p><strong>Study synopsis: </strong><b>What the study adds.</b> This study adds to the growing local evidence-based research by various authors that can be compared with other local and international literature. It also adds to the information needed when establishing or revising protocols in oncological patients with pleural effusions.<b>Implications of the findings.</b> In our population subgroup, the pleural effusions in oncological patients were mostly malignant in nature. The most common cause was breast carcinoma. This is not just a reflection of local referrals, as our unit also receives referrals from other provinces such as Mpumalanga, and sometimes Limpopo.</p>","PeriodicalId":52847,"journal":{"name":"African Journal of Thoracic and Critical Care Medicine","volume":"32 2","pages":"e3989"},"PeriodicalIF":0.0,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13440548/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148680806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-segment tracheal stenosis with left pulmonary artery sling in a low- to middle-income country setting: Value of imaging and bronchoscopy: CASE REPORT.","authors":"P Goussard, J Janson, E Eber, A Gie, J Verster, L Ebert, S Andronikou","doi":"10.7196/AJTCCM.2026.v32i2.4286","DOIUrl":"10.7196/AJTCCM.2026.v32i2.4286","url":null,"abstract":"","PeriodicalId":52847,"journal":{"name":"African Journal of Thoracic and Critical Care Medicine","volume":"32 2","pages":"e4826"},"PeriodicalIF":0.0,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13440539/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148680793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rare presentation of endobronchial tuberculosis: A case series: CASE REPORT.","authors":"R Kancherla, T Guru, G Sivakumar, J Rajgopal, D Ram","doi":"10.7196/AJTCCM.2026.v32i2.3544","DOIUrl":"10.7196/AJTCCM.2026.v32i2.3544","url":null,"abstract":"","PeriodicalId":52847,"journal":{"name":"African Journal of Thoracic and Critical Care Medicine","volume":"32 2","pages":"e3544"},"PeriodicalIF":0.0,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13440545/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148680783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Time for action: Endobronchial ultrasound-guided transbronchial needle aspiration in low- and middle-income countries.","authors":"C F N Koegelenberg","doi":"10.7196/AJTCCM.2026.v32i2.5223","DOIUrl":"10.7196/AJTCCM.2026.v32i2.5223","url":null,"abstract":"","PeriodicalId":52847,"journal":{"name":"African Journal of Thoracic and Critical Care Medicine","volume":"32 2","pages":"e5223"},"PeriodicalIF":0.0,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13440546/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148680840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic accuracy of the Canada Lymph Node Score for predicting malignant mediastinal lymphadenopathy in patients undergoing endobronchial ultrasound-guided transbronchial needle aspiration in a tuberculosis-endemic setting: A cross-sectional study.","authors":"N Baishya, K S Kumar, N Chowdhury, R Singh, L Kumar Saini, P Sharma, R Dua, G Sindhwani, M Mishra","doi":"10.7196/AJTCCM.2026.v32i2.4396","DOIUrl":"10.7196/AJTCCM.2026.v32i2.4396","url":null,"abstract":"<p><strong>Background: </strong>Endoscopic ultrasound features predicting malignant mediastinal lymphadenopathy have been extensively studied. The Canada Lymph Node Score (CLNS) comprises four endoscopic ultrasound characteristics, at least three of which have been shown to predict malignancy in a Western population. Two of the CLNS variables are commonly described in tuberculous mediastinal lymphadenopathy as well, thus posing a diagnostic challenge.</p><p><strong>Objectives: </strong>To evaluate the diagnostic accuracy of the CLNS in predicting malignant mediastinal involvement (primary objective), and to study other endoscopic ultrasound variables to formulate a new predictive model (secondary objective).</p><p><strong>Methods: </strong>In this prospective cross-sectional study from North India, consecutive patients undergoing endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) were included. Nodal endoscopic ultrasound features were recorded in real time before needle aspiration, and the CLNS was determined for each lymph node. The primary outcome was diagnostic accuracy of the CLNS, determined by the area under the curve (AUC). The secondary outcome was the identification of additional ultrasound predictors to develop a new model by logistic regression.</p><p><strong>Results: </strong>A total of 132 nodes from 82 patients were sampled. Characteristics examined were short-axis diameter, central hilar structure, coagulation necrosis sign (CNS), margins, echogenicity, vascular patterns, conglomeration, shape and calcification. The CNS (odds ratio (OR) 4.28, p=0.005), heterogeneous echogenicity (OR 2.45, p=0.036) and round shape (OR 3.02, p=0.03) significantly predicted malignant involvement. The mean (standard deviation) AUC for the CLNS and the new model (comprising the CNS, round shape and heterogeneous echogenicity) was 0.72 (0.04) (95% confidence interval (CI) 0.635 - 0.814) and 0.74 (95% CI 0.635 - 0.844), respectively.</p><p><strong>Conclusion: </strong>The CLNS predicts malignant mediastinal involvement at a cut-off score of 3 in a tuberculosis-endemic setting. The proposed new model demonstrated comparable diagnostic performance to that of the CLNS for discriminating malignant from non-malignant nodes.</p><p><strong>Study synopsis: </strong><b>What the study adds.</b> In a tuberculosis (TB)-endemic setting, the Canada Lymph Node Score (CLNS) maintains reasonable diagnostic accuracy for predicting malignant mediastinal lymph node involvement. A new model, comprising the coagulation necrosis sign, round shape and heterogeneous echotexture, shows equivalent diagnostic performance.<b>Implications of the findings.</b> The CLNS is a clinically valuable tool for differentiating malignant from non-malignant mediastinal nodes in TB-prevalent regions. However, overlapping endoscopic ultrasound features between granulomatous and malignant conditions may reduce its specificity.</p>","PeriodicalId":52847,"journal":{"name":"African Journal of Thoracic and Critical Care Medicine","volume":"32 2","pages":"e4396"},"PeriodicalIF":0.0,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13440535/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148680654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recurrent croup in a young child from a low- to middle-income setting.","authors":"P Goussard, M Merven, A Gie","doi":"10.7196/AJTCCM.2026.v32i2.4853","DOIUrl":"https://doi.org/10.7196/AJTCCM.2026.v32i2.4853","url":null,"abstract":"","PeriodicalId":52847,"journal":{"name":"African Journal of Thoracic and Critical Care Medicine","volume":"32 2","pages":"4843"},"PeriodicalIF":0.0,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13440547/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148680812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emerging role of Dupilumab for COPD with type 2 inflammation.","authors":"J Manga","doi":"10.7196/AJTCCM.2026.v32i2.5486","DOIUrl":"10.7196/AJTCCM.2026.v32i2.5486","url":null,"abstract":"","PeriodicalId":52847,"journal":{"name":"African Journal of Thoracic and Critical Care Medicine","volume":"32 2","pages":"e5486"},"PeriodicalIF":0.0,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13440544/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148680629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics and outcomes of infants with bronchopulmonary dysplasia discharged on home oxygen at Charlotte Maxeke Johannesburg Academic Hospital, South Africa.","authors":"L A Mushiana, D A White, R T Saggers","doi":"10.7196/AJTCCM.2026.v32i2.4336","DOIUrl":"10.7196/AJTCCM.2026.v32i2.4336","url":null,"abstract":"<p><strong>Background: </strong>Bronchopulmonary dysplasia (BPD) poses a considerable burden of disease in preterm infants, with incidence rising as survival of preterm infants improves. Home oxygen plays a role in the management of infants with BPD, allowing for earlier hospital discharge while requiring supplemental oxygen.</p><p><strong>Objectives: </strong>To describe the incidence, clinical characteristics and outcomes of infants with BPD at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), South Africa, focusing on those discharged on home oxygen. A secondary objective was to compare characteristics of infants discharged on home oxygen with those discharged on room air.</p><p><strong>Methods: </strong>A retrospective descriptive study of infants diagnosed with BPD was conducted at CMJAH between 1 January 2015 and 31 December 2021. Clinical features, respiratory support and outcomes were described and compared between infants discharged on home oxygen and those discharged on room air.</p><p><strong>Results: </strong>Among 866 infants, the incidence of BPD was 9.8% overall and 28.1% in very low-birthweight infants. Most cases (93.5%) were mild to moderate. Home oxygen use was low (2.1%), and systemic steroid use was high at 59.4%. Infants discharged on home oxygen had a longer hospital stay (85.1 days v. 58.3 days, p<0.001) and higher discharge weight (2 528 g v. 1 834 g, p<0.001). No significant differences in perinatal factors and comorbidities were found. By 1 year corrected age, 54.5% of those on home oxygen had been weaned off it, and 33.3% had had readmissions, mainly for respiratory tract infections.</p><p><strong>Conclusion: </strong>The incidence of BPD is increasing locally, but home oxygen use remains low compared with high-income countries. Limited uptake may contribute to prolonged hospitalisation. Development of local guidelines and prospective evaluation of home oxygen use are needed to optimise outcomes and reduce the healthcare burden in resource-limited settings.</p><p><strong>Study synopsis: </strong><b>What the study adds.</b> Our study showed a high incidence of bronchopulmonary dysplasia (BPD), exceeding earlier local rates but remaining below those of high-income countries. Notably, home oxygen use was low. Infants discharged on home oxygen had longer hospital stays than those discharged on room air, and no clear predictors for home oxygen use were identified.<b>Implications of the findings.</b> Development of standardised local protocols for home oxygen use in infants with BPD is essential. Earlier integration of home oxygen into management plans should be considered, as timely initiation may facilitate shorter hospital stay.</p>","PeriodicalId":52847,"journal":{"name":"African Journal of Thoracic and Critical Care Medicine","volume":"32 2","pages":"e4336"},"PeriodicalIF":0.0,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13440552/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148680710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acquired subglottic stenosis in children younger than 1 year in a resource-restricted hospital in South Africa.","authors":"T Kemp, P Goussard, L van Wyk, M Merven","doi":"10.7196/AJTCCM.2026.v32i1.3684","DOIUrl":"10.7196/AJTCCM.2026.v32i1.3684","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Subglottic stenosis (SGS) is a congenital or acquired condition and is the most common site of airway narrowing in children. The pathogenesis of SGS includes subglottic mucosal pressure necrosis, leading to mucosal ulceration, perichondritis and mature scar formation. Acquired SGS accounts for 90% of laryngotracheal stenosis in children.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To describe the associated disease factors, management and outcomes of infants with acquired SGS in a middle-income country.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A retrospective, descriptive study was performed between January 2018 and August 2022, including all infants aged ≤1 year who had bronchoscopically confirmed SGS. Data regarding demographics, intubation and invasive ventilation, various disease parameters, findings at bronchoscopy and short-term outcomes were collected. Descriptive statistical analysis was performed. Ethical approval was provided by Stellenbosch University.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;During the research period, 44 infants were diagnosed with acquired SGS, of whom 29 were included in the study. Most infants were born at term and underwent diagnostic bronchoscopy at a mean chronological age of &lt;2 months. All infants were intubated and ventilated at birth, for a variety of diagnoses. Bronchoscopy showed grade 2 or worse stenosis in the majority, and most infants were managed successfully with balloon dilatation. An inappropriately sized endotracheal tube was used in 52% of infants, one-third of infants required multiple invasive ventilation periods, and one-third experienced unexpected extubation episodes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;In a resource-limited setting, SGS often develops as a result of preventable causes, with the majority of children being successfully treated with endoscopic procedures.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study synopsis: &lt;/strong&gt;&lt;b&gt;What the study adds.&lt;/b&gt; The characteristics and management of subglottic stenosis (SGS) in infants aged ≤1 year are described in this retrospective study done at Tygerberg Hospital, South Africa. This is the first report of acquired SGS in infants aged ≤1 year from a resource limited setting. Potential preventable risk factors were identified, specifically looking at the tertiary referral setting. The most common factor was use of an endotracheal tube (ETT) of the incorrect size. A few possible novel associations were also identified, that require further investigation. Balloon dilatation was noted to be an effective treatment option, and is feasible for use in resource-limited settings.&lt;b&gt;Implications of the findings.&lt;/b&gt; The findings of this study highlight the importance of having correct intubation practices in place to reduce the risk of acquired SGS. Training, supervision and correct documentation of airway management will contribute to a reduction in intubation attempts and unplanned extubations, and improve knowledge on the correct size of ETT to be used. The findings als","PeriodicalId":52847,"journal":{"name":"African Journal of Thoracic and Critical Care Medicine","volume":"32 1","pages":"e3684"},"PeriodicalIF":0.0,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13277382/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148297347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}