African Journal of Thoracic and Critical Care Medicine最新文献

{"title":"What is the main cause of childhood non-cystic fibrosis bronchiectasis in the developing world - should pulmonary tuberculosis be the number one accused?","authors":"Pierre Goussard, Ernst Eber","doi":"10.7196/AJTCCM.2024.v30i4.2884","DOIUrl":"10.7196/AJTCCM.2024.v30i4.2884","url":null,"abstract":"","PeriodicalId":52847,"journal":{"name":"African Journal of Thoracic and Critical Care Medicine","volume":"30 4","pages":"e2884"},"PeriodicalIF":0.0,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11874178/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558716","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":"Bronchiectasis in children in a high HIV and tuberculosis prevalence setting.","authors":"P Juggernath, K Mopeli, R Masekela, Z Dangor, A Goga, D M Gray, C Verwey","doi":"10.7196/AJTCCM.2024.v30i4.1899","DOIUrl":"10.7196/AJTCCM.2024.v30i4.1899","url":null,"abstract":"<p><strong>Background: </strong>Bronchiectasis, a chronic suppurative lung condition, is a largely neglected disease, especially in low- to middle-income countries (LMICs), from which there is a paucity of data. Post-infectious causes are more common in LMICs, while in high-income countries, inborn errors of immunity (IEIs), recurrent aspiration, primary ciliary dyskinesia (PCD) and cystic fibrosis are more common. Children living with HIV (CLWH), especially those who are untreated, are at increased risk of bronchiectasis. Data on risk factors, diagnosis and follow-up of children with bronchiectasis are required to inform clinical practice and policy.</p><p><strong>Objectives: </strong>To describe the demographics, medical history, aetiology, clinical characteristics and results of special investigations in children with bronchiectasis.</p><p><strong>Methods: </strong>We undertook a retrospective descriptive study of children aged <16 years with chest computed tomography (CT) scan-confirmed bronchiectasis in Johannesburg, South Africa, over a 10-year period. Demographics, medical history, aetiology, clinical characteristics and results of special investigations were described and compared according to HIV status.</p><p><strong>Results: </strong>A total of 91 participants (51% male, 98% black African) with a median (interquartile range) age of 7 (3 - 12) years were included in the study. Compared with HIV-uninfected children, CLWH were older at presentation (median 10 (6 - 13) years v. 4 (3 - 9) years; p<0.01), and more likely to be stunted (p<.01), to have clubbing (p<0.01) and hepatosplenomegaly (p=0.03), and to have multilobar involvement on the chest CT scan (p<0.01). All children had a cause identified, and the majority (86%) of these were presumed to be post-infectious, based on a previous history of a severe lower respiratory tract infection. This group included all 38 CLWH. Only a small proportion of the participants had IEIs, secondary immune deficiencies or PCD.</p><p><strong>Conclusion: </strong>A post-infectious cause for bronchiectasis was the most common aetiology described in children from an LMIC in Africa, especially CLWH. With improved access to diagnostic techniques, the aetiology of bronchiectasis in LMICs is likely to change.</p><p><strong>Study synopsis: </strong><b>What the study adds.</b> In this retrospective descriptive study of children aged <16 years with chest computed tomography scan-confirmed bronchiectasis in Johannesburg, South Africa (SA), over a 10-year period, we report that a post-infectious cause for bronchiectasis was the most commonly described, and that HIV was an important contributor. A large proportion of children with bronchiectasis in low- and middle-income countries such as SA do not benefit from an extensive work-up for the non-infectious causes of bronchiectasis.<b>Implications of the findings.</b> With improved access to diagnostic techniques, including improvements in early diagnosis and access to","PeriodicalId":52847,"journal":{"name":"African Journal of Thoracic and Critical Care Medicine","volume":"30 4","pages":"e1899"},"PeriodicalIF":0.0,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11874181/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558651","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":"Safety and yield of sputum induction for diagnosis of pulmonary tuberculosis in children in a tertiary hospital in Ghana.","authors":"K S Owusu, S Kwarteng-Owusu, N Wireko-Brobby, E Osei, E Abrafi, F A Appiah, A Enimil, J Sylverken, A Owusu-Ofori, D M Gray, D Ansong, H J Zar","doi":"10.7196/AJTCCM.2024.v30i4.1841","DOIUrl":"10.7196/AJTCCM.2024.v30i4.1841","url":null,"abstract":"<p><strong>Background: </strong>Induced sputum (IS) is a sampling technique for obtaining lower airway samples for microbial investigations, including GeneXpert and culture for microbiological confirmation of <i>Mycobacterium tuberculosis</i>.</p><p><strong>Objectives: </strong>To investigate the safety and yield of IS in children admitted to a tertiary hospital in Ghana with presumed pulmonary tuberculosis (PTB).</p><p><strong>Methods: </strong>A prospective cross-sectional study was carried out in children aged 3 months - 14 years at Komfo Anokye Teaching Hospital in Kumasi, Ghana, over the 6-month period January - June 2022. All children with breathing difficulty and other signs of respiratory distress were given respiratory support, and IS samples were obtained when respiratory distress had resolved. One or two IS samples were collected from each child within 48 hours of admission by a trained nurse after at least 4 hours of fasting. Children were monitored during and for 30 minutes after the procedure, with recording of respiratory rate, oxygen saturation, temperature and pulse rate. They were also monitored for any adverse events such as vomiting, wheezing and nosebleeds.</p><p><strong>Results: </strong>A total of 144 children were sampled, with approximately two-thirds sampled a second time. Nearly half of the participants were aged <2 years (49.3%; n=71/144), and the median (interquartile range (IQR)) age was 2.5 (0.9 - 6.8) years. Ninety-eight children (68.1%) tested positive for PTB by Xpert Ultra, with 19/98 (19.4%) being rifampicin resistant; 47/102 (46.1%) were positive by Ziehl-Neelsen staining, and 57/102 (55.9%) were positive by Auramine O staining. Three children (2.1%) had an episode of epistaxis following the procedure. No other adverse events were observed. Measurements before and 30 minutes to 1 hour after the procedure (median (IQR)) were similar: temperature 36.5°C (36.5 - 37.5°C) v. 36.5°C (36.2 - 37.1°C), oxygen saturation 98% (92 - 99%) v. 98% (93 - 99%), pulse rate 120 (106 - 139) v. 125 (112 - 142) bpm, and respiratory rate 38 (30 - 48) v. 33 (30 - 45) cycles per minute.</p><p><strong>Conclusion: </strong>We found sputum induction to be a safe and well-tolerated procedure in the paediatric population, with minimal clinical risk and a high microbiological yield for PTB.</p><p><strong>Study synopsis: </strong><b>What the study adds.</b> This study is the first to provide information on the performance and safety of induced sputum (IS) in Ghanaian children. It shows that IS can be performed safely in this population, despite safety concerns that resulted in its late introduction in the country. In addition, it shows that IS procedures can provide quality sputum samples to improve bacteriological confirmation of pulmonary tuberculosis (PTB) in children with presumed tuberculosis. Lastly, it adds to the existing body of literature showing that with requisite training, sputum induction can be performed in low-income settings","PeriodicalId":52847,"journal":{"name":"African Journal of Thoracic and Critical Care Medicine","volume":"30 4","pages":"e1841"},"PeriodicalIF":0.0,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11874176/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558653","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":"Is this airway safe?","authors":"C Jacobs, P Goussard, M Merven, A Gie, S S B Venkatakrishna, S Andronikou","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":52847,"journal":{"name":"African Journal of Thoracic and Critical Care Medicine","volume":"30 4","pages":"176"},"PeriodicalIF":0.0,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11880898/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143568813","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":"A critical perspective on paediatric pulmonary tuberculosis and diagnostic advancements.","authors":"K Mochankana, R Masekela","doi":"10.7196/AJTCCM.2024.v30i4.2883","DOIUrl":"10.7196/AJTCCM.2024.v30i4.2883","url":null,"abstract":"","PeriodicalId":52847,"journal":{"name":"African Journal of Thoracic and Critical Care Medicine","volume":"30 4","pages":"e2883"},"PeriodicalIF":0.0,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11874177/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558559","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":"Surgery for bronchiectasis in children living with HIV: A case series from a low- to middle-income country.","authors":"H Peens-Hough, P Goussard, D Rhode, L van Wyk, J Janson","doi":"10.7196/AJTCCM.2024.v30i3.1128","DOIUrl":"10.7196/AJTCCM.2024.v30i3.1128","url":null,"abstract":"<p><strong>Background: </strong>Bronchiectasis (BE) in children living with HIV (CLWH) remains a significant cause of morbidity and mortality, especially in tuberculosis (TB)-endemic low- and middle-income countries. Treatment modalities for BE in CLWH currently focus mainly on prevention of infections and management of symptoms, while surgical management is indicated for a select group. In contrast, surgical management in non-cystic fibrosis BE is well established.</p><p><strong>Objectives: </strong>To describe the indications for and complications of surgical resection for BE in CLWH, and to identify variables influencing outcome.</p><p><strong>Methods: </strong>A retrospective medical records review was conducted of all CLWH aged ≤14 years who underwent surgical resection for BE at Tygerberg Hospital, Cape Town, South Africa, between 1 January 2007 and 30 September 2014. The variables collected included immune status, antiretroviral treatment (ART), previous treatment for TB, operative and postoperative complications, and postoperative symptom relief.</p><p><strong>Results: </strong>Twelve CLWH on ART with symptomatic BE underwent surgical resection. The mean age was 7 years and the mean CD4 count 970 cells/µL. Indications for surgery included recurrent infections, chronic cough and persistent lobar collapse. The most common procedures were left lower lobe lobectomy (42%), left pneumonectomy (17%) and right bilobectomy (17%). Complications were limited to persistent pneumothorax after surgery in one child. There were no deaths. Ten children (83%) showed significant improvement of symptoms at follow-up.</p><p><strong>Conclusion: </strong>Surgical resection for BE in CLWH can be performed safely with a low complication rate, resulting in significant improvement of symptoms postoperatively.</p><p><strong>Study synopsis: </strong><b>What the study adds.</b> Bronchiectasis (BE) in children living with HIV (CLWH) is a significant cause of morbidity and mortality. Current treatment focuses on preventing infections and managing symptoms, while surgical management is rarely considered. A retrospective medical records review of 12 children aged ≤14 years in South Africa found that surgical resection for BE can be performed with a low complication rate, resulting in significant improvement of symptoms postoperatively. Variables influencing outcome include immune status, antiretroviral treatment and previous treatment for tuberculosis.<b>Implications of the findings.</b> This study demonstrates that surgery for BE can be performed safely in CLWH, with significant improvement of respiratory symptoms postoperatively.</p>","PeriodicalId":52847,"journal":{"name":"African Journal of Thoracic and Critical Care Medicine","volume":"30 3","pages":"e1128"},"PeriodicalIF":0.0,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11629482/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142808429","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 promise of rituximab in connective tissue disease-associated interstitial lung disease.","authors":"M L Wong","doi":"10.7196/AJTCCM.2024.v30i3.2683","DOIUrl":"https://doi.org/10.7196/AJTCCM.2024.v30i3.2683","url":null,"abstract":"","PeriodicalId":52847,"journal":{"name":"African Journal of Thoracic and Critical Care Medicine","volume":"30 3","pages":"e2683"},"PeriodicalIF":0.0,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11606637/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774788","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":"Interventions to reduce the impact of outdoor air pollution on asthma: A systematic review.","authors":"S T Hlophe, R Mphahlele, K Mortimer, R Masekela","doi":"10.7196/AJTCCM.2024.v30i3.1992","DOIUrl":"10.7196/AJTCCM.2024.v30i3.1992","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Exposure to air pollution can cause adverse health effects in people living with chronic lung disease. In people with asthma, it is not clear whether strategies to reduce outdoor air pollution can affect clinical symptoms and lung function.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To determine strategies to reduce air pollution exposure for people with asthma, and to describe the effect of reduced air pollution on asthma outcome.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A systematic review was conducted of six databases for English literature. Any study published between April 2012 and March 2022 that mentioned air pollution exposure reduction and asthma was reviewed. Two reviewers (STH and RMp) screened and extracted the data separately, using a standardised form based on the Cochrane data extraction tool. Risk of bias was assessed using the risk-of bias 2 tool. Outcome measures were the Asthma Control Test (ACT), the Childhood Asthma Control Test, exacerbations, and the forced expiratory volume in the 1st second (FEV&lt;sub&gt;1&lt;/sub&gt; ), forced vital capacity (FVC) and FEV&lt;sub&gt;1&lt;/sub&gt; /FVC ratio. The study was registered with PROSPERO (reg. no. CRD42022341648).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of the 11 116 identified studies, eight met the inclusion criteria, with a total of 11 395 043 participants. Clean air policy implementation modestly improved lung function, as shown by an increase in FVC and FEV&lt;sub&gt;1&lt;/sub&gt; of 0.02 L/year and 0.01 L/year, respectively. Reduction of exposure to outdoor smoke pollution with use of mobile application alerts resulted in behavioural change and improved ACT scores over 8 weeks (mean (standard deviation (SD)) 21.5 (2.3) compared with baseline (20.0 (2.4); p&lt;0.001). Asthma control improved during low levels of pollution related to COVID-19 lockdown, as shown by mean (SD) ACT scores (17.3 (4.7) v. 19.7 (4.5); p&lt;0.001) and associated declines in mean daily hospital admissions (4.5 (3.4) days v. 2.8 (2.5) days; p&lt;0.001).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Air pollution is a major hazard, and strategies to reduce exposure have a positive outcome in terms of the asthma morbidity. This field would benefit from further high-quality randomised clinical trial evidence to inform policy and decision-making.&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 prevalence and burden of asthma are increasing globally. Air pollution exposure is a major cause of worse asthma symptoms. Strategies to reduce air pollution or exposure to it may contribute towards improved quality of life. This study highlights potential strategies and their effect on asthma outcome.&lt;b&gt;Implications of the findings.&lt;/b&gt; A combination of individual activities and actions by governments to reduce air pollution can improve asthma outcome. A focus on education together with behavioural changes can reduce exposure at the individual level. Implementation of clean air policies reduces air pollution exposure and improves lung heal","PeriodicalId":52847,"journal":{"name":"African Journal of Thoracic and Critical Care Medicine","volume":"30 3","pages":"e1992"},"PeriodicalIF":0.0,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11633239/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814849","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":"Severe <i>Mycoplasma pneumoniae</i> infection in a young child: An emerging increase in incidence?","authors":"P Goussard, H Rabie, L Frigati, A Gie, S Irusen, C Jacobs, S Venkatakrishna, S Andronikou","doi":"10.7196/AJTCCM.2024.v30i3.2036","DOIUrl":"10.7196/AJTCCM.2024.v30i3.2036","url":null,"abstract":"","PeriodicalId":52847,"journal":{"name":"African Journal of Thoracic and Critical Care Medicine","volume":"30 3","pages":"e2036"},"PeriodicalIF":0.0,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11633446/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814851","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":"Unveiling the pulmonary burden of idiopathic inflammatory myopathies in South Africa.","authors":"Gregory L Calligaro","doi":"10.7196/AJTCCM.2024.v30i3.2682","DOIUrl":"https://doi.org/10.7196/AJTCCM.2024.v30i3.2682","url":null,"abstract":"","PeriodicalId":52847,"journal":{"name":"African Journal of Thoracic and Critical Care Medicine","volume":"30 3","pages":"e2682"},"PeriodicalIF":0.0,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11606639/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774791","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}