African Journal of Thoracic and Critical Care Medicine最新文献

{"title":"An open intensive care unit (ICU) model is a viable option for the acute expansion of ICU capacity in the state sector: A study of a needs-based strategy during the COVID-19 pandemic in a tertiary ICU in South Africa.","authors":"E S Gwala, A Ramkillawan, M T D Smith","doi":"10.7196/AJTCCM.2025.v31i1.2004","DOIUrl":"https://doi.org/10.7196/AJTCCM.2025.v31i1.2004","url":null,"abstract":"<p><strong>Background: </strong>Both open and closed intensive care unit (ICU) models are used in South Africa (SA). The literature is unclear with regard to which model is superior. The COVID-19 pandemic led to a critical care resource crisis that necessitated expansion of critical care capacity, often beyond the resources required to meet the structure of a closed ICU in the institutions using that model.</p><p><strong>Objectives: </strong>This retrospective study aimed to compare the outcomes of non-COVID patients in a closed ICU setting and a temporary open unit that ran parallel to it during the pandemic, in order to assess this type of resource expansion as a viable option.</p><p><strong>Methods: </strong>Data from the Intensive Care Electronic Record System in the Greys Hospital ICU in Pietermaritzburg, SA, were analysed for patients aged ≥12 years admitted to either the open or the closed ICU between April and August 2020. Data missing from the database were completed by referring to the medical records office. The primary outcome assessed was mortality, while secondary outcomes included adverse events and hospital length of stay.</p><p><strong>Results: </strong>There was no significant mortality difference between the ICU components (16.9% in the open-model group v. 15.1% in the closed model group; p=0.769). The incidence of adverse events also did not differ (45.5% in the open model v. 38.9% in the closed model; p=0.357).</p><p><strong>Conclusion: </strong>Patients requiring ICU admission have complex conditions or have undergone extensive surgery, necessitating specialised treatment and careful monitoring. In the event of an acute surge event, expanding ICU capacity by adding an open-model component in a setting that traditionally runs closed models may be an effective strategy to assist in the management of critically ill patients without significantly affecting outcomes.</p><p><strong>Study synopsis: </strong><b>What the study adds.</b> This retrospective study compared outcomes of non-COVID patients in a closed intensive care unit (ICU) v. a temporary open unit during the pandemic. The efficacy of open v. closed ICU models remains uncertain in the South African context. The study offers insights into the effectiveness of open and closed ICU models, particularly in the context of crises during which institutions may face a critical care resource shortage.<b>Implications of the findings.</b> The study suggests that incorporating open ICU units during crises can manage patient surges effectively without compromising outcomes. It contributes to the existing literature by providing practical implications for resource management, clinical practice and future research, ensuring quality patient care while optimising critical care capacity.</p>","PeriodicalId":52847,"journal":{"name":"African Journal of Thoracic and Critical Care Medicine","volume":"31 1","pages":"e2004"},"PeriodicalIF":0.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12009499/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144045974","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":"Feasibility and safety of transbronchial lung cryobiopsy and mediastinal lymph node cryobiopsy: Experience from a resource limited African setting.","authors":"A Esmail, K Tsoka, R Hofmeyr, J Chokoe Maluleke, H Donson, R Roberts, T Pennell, N Vorajee, M Emhemed, S Eknewir, B Mbena, K Dheda","doi":"10.7196/AJTCCM.2025.v31i1.2448","DOIUrl":"https://doi.org/10.7196/AJTCCM.2025.v31i1.2448","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Transbronchial lung cryobiopsy (TBLC) is a relatively new technique recommended for sampling of lung parenchyma in patients with suspected interstitial lung disease (ILD) and as an alternative to surgical lung biopsy. A more recently introduced technique is endobronchial ultrasound-guided transbronchial mediastinal lymph node lymph node cryobiopsy (EBUS-TMC) to enable tissue biopsy of mediastinal lymph nodes. However, there are no data on the feasibility of implementing these techniques in a resource-limited African setting, where there is a chronic bed shortage and same-day discharges are preferable.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To determine the feasibility and diagnostic yield of TBLC and EBUS-TMC in a resource-limited African setting.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We performed an audit of lung and lymph node cryobiopsy procedures performed at the E16 Respiratory Clinic at Groote Schuur Hospital, Cape Town, South Africa. Indications, diagnostic performance outcomes and lessons learned were documented and analysed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Sixteen patients underwent 19 cryobiopsy procedures that were performed under general anaesthesia (n=11 TBLC, n=8 EBUS TMC, including 3 patients in whom both TBLC and EBUS-TMC were concurrently performed). The main indications were evaluation of ILD and suspected lymph node malignancy. The diagnostic yield was 63.6% for TBLC (n=7/11; 2 nonspecific interstitial pneumonia, 2 sarcoidosis, 1 espiratory bronchiolitis-ILD, 1 organising pneumonia, 1 nonspecific chronic inflammation) and 50.0% for EBUS-TMC (n=4/8; 1 plasmacytoma, 1 lymphoma, 1 cryptococcus infection, 1 patient with both cryptococcus infection and tuberculosis). Of the patients, 2 had moderate bleeding and 3 had mild bleeding, and 14 were discharged on the day of the procedure.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;TBLC and EBUS-TMC, with avoidance of surgical lung biopsy in most patients and same-day discharge in most patients, are feasible in an African setting. These data inform clinical practice and programme implementation in resource-limited settings.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study synopsis: &lt;/strong&gt;&lt;b&gt;What the study adds.&lt;/b&gt; Although transbronchial lung cryobiopsy (TBLC) is widely accessible in resource-rich settings such as Europe and the USA, there are no data from resource-limited African settings. Endobronchial ultrasound-guided transbronchial mediastinal lymph node cryobiopsy (EBUS-TMC) is a newer technique for which there are limited data. We provide feasibility and implementation data from an African setting.&lt;b&gt;Implications of the findings.&lt;/b&gt; We provide useful programmatic implementational data for resource-limited African settings and show that implementation of these techniques with same-day discharge is feasible in a setting where there is limited access to overnight beds and anaesthetic support. Important implementational lessons learned that will facilitate initiation of a new TLBC/EBUS-TMC servic","PeriodicalId":52847,"journal":{"name":"African Journal of Thoracic and Critical Care Medicine","volume":"31 1","pages":"e2448"},"PeriodicalIF":0.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12009498/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144063261","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 utility of transbronchial cryobiopsy performed under conscious sedation for interstitial lung diseases in a resource constrained setting.","authors":"A D Buckley, N Singh, B W Allwood, U Lalla, C F N Koegelenberg","doi":"10.7196/AJTCCM.2025.v31i1.2618","DOIUrl":"https://doi.org/10.7196/AJTCCM.2025.v31i1.2618","url":null,"abstract":"<p><strong>Background: </strong>Transbronchial biopsy (TBB) with a cryoprobe, also known as transbronchial lung cryobiopsy (TBLC), has become a well established modality for sampling lung parenchyma. TBLC is performed under general anaesthesia in the majority of centres, utilising rigid or flexible bronchoscopy. In resource-constrained settings, however, most diagnostic bronchoscopies, including TBB, are performed under conscious sedation with flexible bronchoscopy without the presence of a specialist anaesthetist.</p><p><strong>Objectives: </strong>Given the paucity of evidence on TBLC performed under conscious sedation for interstitial lung diseases (ILD), specifically in a resource-constrained setting, we aimed to describe its utility in a pilot study.</p><p><strong>Methods: </strong>We prospectively enrolled the first 20 patients who underwent TBLC for ILD at a large tertiary hospital in South Africa. All TBLCs were performed under conscious sedation using a cryoprobe. Patients were actively monitored for complications. The final diagnosis and decision regarding need for a surgical biopsy were made at a multidisciplinary meeting that included at least two specialist pulmonologists with an interest in ILD, a thoracic radiologist, and an anatomical pathologist with an interest in ILD.</p><p><strong>Results: </strong>Three patients experienced complications. Two (10%) developed a pneumothorax (neither required any intervention). Bleeding that required 10 minutes of tamponade with the endobronchial blocker was observed in one case. This patient experienced no haemodynamic or respiratory compromise and was discharged the same day. There were no complications arising from the use of conscious sedation. A definitive diagnosis was made in 17/20 (85%) of the patients.</p><p><strong>Conclusion: </strong>TBLC performed at an experienced bronchoscopy centre using a cryoprobe under conscious sedation with a dedicated sedationist was safe and well tolerated. Furthermore, it had a high diagnostic yield, and surgical lung biopsy was avoided in 85% of the patients.</p><p><strong>Study synopsis: </strong><b>What the study adds.</b> There is a paucity of evidence for the use of transbronchial lung cryobiopsy (TBLC) for the diagnosis of interstitial lung diseases (ILD) in resource-constrained settings, especially when performed under conscious sedation. In this pilot study, TBLC performed under conscious sedation was safe and well tolerated, and had a high diagnostic yield.<b>Implications of the findings.</b> TBLC under conscious sedation can safely be rolled out in resource-constrained settings as a first-line diagnostic procedure when lung tissue needs to be obtained in patients with ILD, as its yield is comparable to TBLC under general anaesthesia. It potentially avoids surgical lung biopsy in >80% of cases, together with the need for general anaesthesia.</p>","PeriodicalId":52847,"journal":{"name":"African Journal of Thoracic and Critical Care Medicine","volume":"31 1","pages":"e2618"},"PeriodicalIF":0.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12009501/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144040588","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":"Computed tomography chest imaging for the detection of pulmonary hypertension in patients with post-tuberculosis lung disease.","authors":"M Almubarek, E H Louw, S Griffith-Richards, C Ackermann, N Baines, H Thomson, A J K Pecoraro, C F N Koegelenberg, E M Irusen, B W Allwood","doi":"10.7196/AJTCCM.2025.v31i1.1948","DOIUrl":"https://doi.org/10.7196/AJTCCM.2025.v31i1.1948","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Pulmonary hypertension (PH) after tuberculosis is increasingly recognised as important in high-burden tuberculosis settings. However, the ability of computed tomography (CT) imaging to accurately detect PH remains unclear.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To evaluate the performance of standard CT measurements in detecting PH in patients with post-tuberculosis lung disease (PTLD), and to determine the potential role of CT imaging as a screening tool in this population.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A retrospective study of patients with PTLD was conducted from January 2019 to September 2021. Adult patients with both a CT chest scan and an echocardiogram performed within 9 months of each other were enrolled. A diagnosis of PH by echocardiography was made if the right ventricular systolic pressure (RVSP) was ≥36 mmHg or the peak tricuspid regurgitant jet velocity (TRVmax) &gt;2.8 m/s. Radiological criteria for PH included a pulmonary artery/ascending aorta (PA/AA) diameter ratio &gt;1, pulmonary artery diameter (PAD) ≥29 mm (males) or ≥27 mm (females), and right ventricle/left ventricle (RV/LV) diameter ratio ≥1.28. Spirometry was also performed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 173 patients with PTLD, 52 met the inclusion criteria. Significant correlations were found between the CT-measured PA/AA ratio and RVSP (p=0.0083) and TRVmax (p=0.0582), but not between the CT-measured RV/LV ratio and RVSP (p=0.1729) or TRVmax (p=0.0749). PAD was also significantly correlated with RVSP (p=0.0011) and TRVmax (p=0.0023). The PA/AA ratio identified patients with PH on echocardiography with ~100% sensitivity, 65% specificity and a positive predictive value of 39.1%, indicating a high potential for false-positive diagnosis. The forced vital capacity was 13.7% lower in patients with PH than in those without (p=0.044); however, the forced expiratory volume in 1 second was not statistically different.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;A low PA/AA ratio can be used to rule out the diagnosis of PH in PTLD, but a high PA/AA ratio requires further investigation for PH.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study synopsis: &lt;/strong&gt;&lt;b&gt;What the study adds.&lt;/b&gt; This study investigated the use of computed tomography (CT) chest imaging to detect pulmonary hypertension (PH) in patients with post-tuberculosis lung disease (PTLD). It revealed significant correlations between the CT-measured pulmonary artery/ascending aorta (PA/AA) diameter ratio and pulmonary artery diameter (PAD), and echocardiographic measures of PH. Notably, a low PA/AA ratio effectively rules out PH, while a high ratio warrants further investigation.&lt;b&gt;Implications of the findings.&lt;/b&gt; These findings suggest that CT imaging, particularly PA/AA ratio measurements, could serve as a valuable initial screening tool for ruling out PH in patients with PTLD, particularly in settings with limited access to echocardiography. However, a high PA/AA in PTLD requires confirmation of PH by other means, owing to","PeriodicalId":52847,"journal":{"name":"African Journal of Thoracic and Critical Care Medicine","volume":"31 1","pages":"e1948"},"PeriodicalIF":0.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12009497/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144032933","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":"Pulmonary ultrasound in COVID-19 and non-COVID-19 pneumonia in South Africa: An observational study.","authors":"S A van Blydenstein, T Nell, C Menezes, B F Jacobson, S Omar","doi":"10.7196/AJTCCM.2025.v31i1.1887","DOIUrl":"https://doi.org/10.7196/AJTCCM.2025.v31i1.1887","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Pulmonary ultrasound techniques have historically been applied to acute lung diseases to describe lung lesions, particularly in critical care.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To explore the role of lung ultrasound (LUS) in hospitalised patients with hypoxaemic pneumonia during the COVID-19 pandemic.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This was a single-centre prospective, observational study of two groups of adult patients with hypoxaemic pneumonia: those with COVID-19 pneumonia, and those with non-COVID-19 community-acquired pneumonia (CAP). A pulmonologist performed bedside LUS using the Bedside Lung Ultrasound in Emergency (BLUE) protocol, and the findings were verified by an independent study-blinded radiologist.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;We enrolled 48 patients with COVID-19 pneumonia and 24 with non-COVID CAP. The COVID-19 patients were significantly older than those with non-COVID CAP (median (interquartile range (IQR)) age 52 (42 - 62.5) years v. 42.5 (36 - 52.5) years, respectively; p=0.007), and had a lower prevalence of HIV infection (25% v. 54%, respectively; p=0.01) and higher prevalences of hypertension (54% v. 7%; p=0.002) and diabetes mellitus (19% v. 8%; p=0.04). In both groups, close to 30% of the patients had severe acute respiratory distress syndrome. A confluent B-line pattern in the right upper lobe was significantly associated with COVID-19 pneumonia compared with the C pattern (relative risk (RR) 3.8; 95% confidence interval (CI) 1.7 - 8.6). Bilateral changes on LUS rather than unilateral or no changes were associated with COVID-19 pneumonia (RR 1.55; 95% CI 1.004 - 2.387). There were no statistically significant differences in median (IQR) lung scores between patients with COVID-19 pneumonia and those with non-COVID CAP (8 (4 - 11.5) v. 7.5 (4.5 - 12.5), respectively). Patients with COVID-19 pneumonia had a higher than predicted mortality. Logistic regression analysis showed a higher Simplified Acute Physiology Score (SAPS II) (RR 1.11; 95% CI 1.02 - 1.21) and a lower total LUS score indicating B lines v. consolidation (RR 0.80; 95% CI 0.65 - 0.99) to be associated with mortality.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Patients with right upper zone consolidation were more likely to have non-COVID CAP than COVID-19 pneumonia. Finding a B pattern as opposed to consolidation was associated with mortality. The admission LUS score was unable to discriminate between COVID-19 and non-COVID CAP, and did not correlate with the ratio of partial pressure of oxygen to fractional inspired oxygen, clinical severity or mortality.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study synopsis: &lt;/strong&gt;&lt;b&gt;What the study adds.&lt;/b&gt; During the COVID-19 pandemic, in a resource-limited, high-prevalence setting, lung ultrasound (LUS) patterns on admission to hospital were used to distinguish between COVID-19 and other causes in patients with hypoxaemic pneumonia. Patients with right upper zone consolidation were more likely to have non-COVID-1","PeriodicalId":52847,"journal":{"name":"African Journal of Thoracic and Critical Care Medicine","volume":"31 1","pages":"e1887"},"PeriodicalIF":0.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12009502/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144052509","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":"Resources in the bronchoscopy suite and the utility of cryobiopsy.","authors":"M L Mullin, R Thakrar, N Navani","doi":"10.7196/AJTCCM.2025.v31i1.3223","DOIUrl":"https://doi.org/10.7196/AJTCCM.2025.v31i1.3223","url":null,"abstract":"","PeriodicalId":52847,"journal":{"name":"African Journal of Thoracic and Critical Care Medicine","volume":"31 1","pages":"e3223"},"PeriodicalIF":0.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12009500/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144028264","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":"Intensive care unit models in pandemics and beyond: Striking the balance between efficiency, ethics and equity.","authors":"U Lalla, R Raine","doi":"10.7196/AJTCCM.2025.v31i1.3165","DOIUrl":"https://doi.org/10.7196/AJTCCM.2025.v31i1.3165","url":null,"abstract":"","PeriodicalId":52847,"journal":{"name":"African Journal of Thoracic and Critical Care Medicine","volume":"31 1","pages":"e3165"},"PeriodicalIF":0.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12009503/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144045975","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":"Depemokimab in eosinophilic asthma - a new era in biological therapy?","authors":"S Pillay","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":52847,"journal":{"name":"African Journal of Thoracic and Critical Care Medicine","volume":"31 1","pages":"42"},"PeriodicalIF":0.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12009504/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144028259","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":"Serum chitotriosidase activity in South African patients with sarcoidosis and tuberculosis.","authors":"R Morar, I Sinclair, C Feldman","doi":"10.7196/AJTCCM.2024.v30i4.1832","DOIUrl":"10.7196/AJTCCM.2024.v30i4.1832","url":null,"abstract":"<p><strong>Background: </strong>Chitotriosidase is a chitinase enzyme that is expressed selectively through activated macrophages in humans. Increased activity of chitotriosidase in both bronchoalveolar lavage samples and serum of patients with sarcoidosis has been reported. It has been proposed that chitotriosidase could be used as a potential biomarker for diagnosis, monitoring and prognosis in sarcoidosis patients. However, no studies in a South African (SA) cohort have evaluated this potential role.</p><p><strong>Objectives: </strong>To analyse serum chitotriosidase activity in treated and untreated sarcoidosis patients, healthy controls and patients with tuberculosis (TB). Sarcoidosis and TB are two diseases of differing aetiology that may be clinically difficult to distinguish between in the SA setting, which is a high-burden area for TB. We hoped to determine whether chitotriosidase activity levels could help differentiate the one disease from the other.</p><p><strong>Methods: </strong>Serum chitotriosidase activity was measured in an SA cohort of treated and untreated sarcoidosis patients and compared with controls. In addition, activity in sarcoidosis patients was compared with that in TB patients. Overall, chitotriosidase activity was assayed in the serum of 12 biopsy-proven sarcoidosis patients before treatment, 9 sarcoidosis patients after at least a month's treatment, 10 patients with confirmed pulmonary and/or disseminated TB before treatment, and 12 healthy controls. Plasma chitotriosidase activity was assayed as previously described using 4-methylumbelliferyl-β-D-N,N',N″-triacetylchitotriose as a substrate.</p><p><strong>Results: </strong>Significantly higher serum chitotriosidase activity was observed in sarcoidosis patients, both untreated and treated, compared with controls (p<0.05). Sarcoidosis patients had higher chitotriosidase levels than TB patients, but this difference was not significant. While chitotriosidase activity was lower in patients with TB than in those with sarcoidosis, levels were elevated compared with controls.</p><p><strong>Conclusion: </strong>Chitotriosidase activity in patients with sarcoidosis was greater than in those with TB, and also greater compared with controls. The increased chitotriosidase activity in sarcoidosis suggests that this enzyme may be involved in the disease pathogenesis. Further investigation is required to validate these findings.</p><p><strong>Study synopsis: </strong><b>What the study adds.</b> Serum chitotriosidase activity in South African sarcoidosis and tuberculosis (TB) patients was evaluated. The study adds to the research assessing the significance of serum chitotriosidase in patients with sarcoidosis and TB.<b>Implications of the findings.</b> Chitotriosidase enzyme activity could potentially serve as a biomarker of possible diagnostic and/or prognostic value in patients with sarcoidosis.</p>","PeriodicalId":52847,"journal":{"name":"African Journal of Thoracic and Critical Care Medicine","volume":"30 4","pages":"e1832"},"PeriodicalIF":0.0,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11874180/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558610","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 utility of procalcitonin as a biomarker of hospital-acquired infection in severe COVID-19.","authors":"C Schmidt, P S Nyasulu, I Fwemba, U Lalla, B W Allwood, A Parker, J J Taljaard, L N Sigwadhi, J L Tamuzi, A E Zemlin, R T Erasmus, C F N Koegelenberg","doi":"10.7196/AJTCCM.2024.v30i4.1617","DOIUrl":"10.7196/AJTCCM.2024.v30i4.1617","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Hospital-acquired infection (HAI) in patients with COVID-19 admitted to the intensive care unit (ICU) is associated with increased mortality. The 'cytokine storm' associated with COVID-19 leads to extreme elevation of inflammatory biomarkers, including C-reactive protein (CRP). Procalcitonin (PCT) has been shown to be more discriminative than CRP in distinguishing HAI from other inflammatory processes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To investigate the utility of PCT in detecting HAI in patients with severe COVID-19.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Clinical and laboratory data from all patients admitted to a dedicated ICU with confirmed severe COVID-19 from 1 April 2020 to 31 August 2020 were prospectively captured. HAI was confirmed by serial PCT and CRP measurements, as well as microbiological data (positive microbiological cultures in clinical context). Data from patients who were on antibiotics on ICU admission, had a positive culture for a presumed pathogen during the first 48 hours of ICU admission, or already had suspected or proven HAI on admission were excluded. Optimal cut-offs with the highest sensitivity and specificity were determined. The discriminative power of PCT was assessed for each outcome, using receiver operating characteristic (ROC) analysis describing the area under the curve. Similarly, negative predictive values (NPVs) and positive predictive values (PPVs) were determined. The sensitivity and specificity for different PCT cut-off levels were calculated.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 92 patients, 35 had confirmed HAI, which was significantly associated with mechanical ventilation (p&lt;0.001) and mortality (p&lt;0.001). ROC analysis demonstrated that a threshold PCT level of 0.22 μg/L resulted in 97% sensitivity and 40% specificity for predicting HAI. Similarly, sensitivity and specificity for CRP were 91.4% and 38.6%, respectively, when the CRP level was 133 mg/L. In patients with a PCT level &lt;0.25 μg/L, the NPV was 92%, whereas for PCT levels &gt;1.00 μg/L, the PPV was &gt;50%. For PCT levels &gt;40 μg/L, the PPV was 100%.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;During HAI, PCT levels &gt;1.00 μg/L had a moderate PPV of 52%, whereas levels &lt;0.26 μg/L ruled out HAI with an NPV of 92%. With increased PCT values, the PPV rose to 100%, making it a better biomarker than CRP.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study synopsis: &lt;/strong&gt;&lt;b&gt;What the study adds.&lt;/b&gt; During an episode of hospital-acquired infection (HAI) in patients with severe COVID-19, procalcitonin (PCT) levels &gt;1.00 μg/L had a moderate positive predictive value (PPV) of 52%, whereas levels &lt;0.26 μg/L had a negative predictive value (NPV) of 92% for proven HAI. For PCT levels &gt;40 μg/L, the PPV was 100%.&lt;b&gt;Implications of the findings.&lt;/b&gt; At levels &lt;0.26 μg/L, PCT had an NPV &gt;90%. This 'rule-out' characteristic of PCT may be especially valuable in scenarios of diagnostic equipoise with regard to the presence of bacterial co-infection. Clinicians should take care to","PeriodicalId":52847,"journal":{"name":"African Journal of Thoracic and Critical Care Medicine","volume":"30 4","pages":"e1617"},"PeriodicalIF":0.0,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11878409/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558614","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}