Cureus最新文献

{"title":"Ultrasound-Guided Rectus Sheath Block With Monitored Anesthesia Care for Necrotic Umbilical Hernia Repair in a Patient With Severe Liver Failure and Refractory Ascites: A Case Report.","authors":"Keisuke Nakazawa, Risyun Ishikawa, Takahiro Suzuki","doi":"10.7759/cureus.80433","DOIUrl":"10.7759/cureus.80433","url":null,"abstract":"<p><p>Patients with severe liver dysfunction present significant perioperative challenges, including the risk of postoperative cognitive dysfunction (POCD) and hepatic encephalopathy (HE), after general anesthesia. While avoiding general anesthesia and deep sedation is crucial for early recovery in this patient population, neuraxial block techniques are often contraindicated due to coagulation disorders. A 73-year-old male patient (190 cm tall, weighing 77 kg) with Child-Pugh C cirrhosis (score 10), coagulopathy (platelets 90,000/μL, prothrombin time (PT) activity 47%), and complex medical history, including treated hepatocellular carcinoma, renal cancer, and bladder cancer, underwent necrotic umbilical hernia repair. The patient, classified as American Society of Anesthesiologists (ASA) physical status IV with a Model for End-Stage Liver Disease (MELD) score of 19, had been hospitalized for two months due to an umbilical hernia infection refractory to antibiotic therapy. After careful preoperative assessment, we selected monitored anesthesia care (MAC) as the preferred anesthetic approach due to the patient's high surgical risk. We performed a bilateral rectus sheath block (RSB) using diluted ropivacaine (0.15%, total 80 mL) with epinephrine (15 μg). Sedation was achieved using dexmedetomidine without a loading dose, supplemented with midazolam and low-dose remifentanil. This approach allowed us to maintain spontaneous breathing while providing adequate analgesia and patient comfort. The surgery was completed successfully with stable hemodynamics and respiratory functions. Throughout the procedure, hemodynamic parameters remained within 20% of baseline values, and bispectral index (BIS) values were maintained between 65 and 80, indicating appropriate sedation depth without excessive anesthetic administration. Ultrasound-guided RSB combined with carefully titrated MAC provides safe and effective anesthesia for umbilical hernia repair in patients with severe liver dysfunction. This approach maintains spontaneous breathing, delivers effective analgesia for somatic and visceral pain, and facilitates clearer differentiation between residual anesthetic effects and worsening HE postoperatively. When coagulopathy precludes neuraxial techniques, this pharmacokinetically informed strategy offers a valuable alternative for high-risk abdominal wall procedures.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 3","pages":"e80433"},"PeriodicalIF":1.0,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11906206/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143627121","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":"Artificial Intelligence and Machine Learning: An Updated Systematic Review of Their Role in Obstetrics and Midwifery.","authors":"Paraskevi Giaxi, Victoria Vivilaki, Angeliki Sarella, Vikentia Harizopoulou, Kleanthi Gourounti","doi":"10.7759/cureus.80394","DOIUrl":"10.7759/cureus.80394","url":null,"abstract":"<p><p>Artificial intelligence (AI) and machine learning (ML) are rapidly evolving technologies with significant implications in obstetrics and midwifery. This systematic review aims to evaluate the latest advancements in AI and ML applications in obstetrics and midwifery. A search was conducted in three electronic databases (PubMed, Scopus, and Web of Science) for studies published between January 1, 2022, and February 20, 2025, using keywords related to AI, ML, obstetrics, and midwifery. The review adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for updated systematic reviews. Studies were selected based on their focus on AI/ML applications in obstetrics and midwifery, while non-English publications and review studies were excluded. The review included 64 studies, highlighting significant advancements in AI and ML applications across various domains in obstetrics and midwifery. Findings indicate that AI and ML models and systems achieved high accuracy in areas, such as assisted reproduction, diagnosis (e.g., 3D/4D ultrasound and MRI), pregnancy risk assessment (e.g., preeclampsia, gestational diabetes, preterm birth), fetal monitoring, mode of birth, and perinatal outcomes (e.g., mortality rates, postpartum hemorrhage, hypertensive disorders, neonatal respiratory distress). AI and ML have significant potential in transforming obstetric and midwifery care. The great number of studies reporting significant improvements suggests that the widespread adoption of AI and ML in these fields is imminent. Interdisciplinary collaboration between clinicians, data scientists, and policymakers will be crucial in shaping the future of maternal and neonatal healthcare.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 3","pages":"e80394"},"PeriodicalIF":1.0,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11895402/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607544","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":"Prevalence of Chronic Kidney Disease Among Elderly Patients in the Northeastern Region of Romania: A Descriptive, Cross-Sectional, Retrospective Analysis.","authors":"Ionut Nistor, Ana-Maria Turcu, Anca Elena Stefan, Alexandra Covic, Bogdan Agavriloaei, Gheorghe Mahu, Ioana Alexa, Adrian Covic","doi":"10.7759/cureus.80412","DOIUrl":"10.7759/cureus.80412","url":null,"abstract":"<p><p>In Romania, data pertaining to the incidence and prevalence of chronic kidney disease (CKD) are scant, with an even more limited understanding of the elderly demographic. In this study, we used a descriptive cross-sectional retrospective approach, drawing data from the Geriatrics and Gerontology Clinic at Dr. C.I. Parhon Clinical Hospital in Iași, Romania. We assessed renal function through creatinine measurements and estimated glomerular filtration rate (eGFR) computed using the CKD-Epidemiology Collaboration (EPI) 2021 equation. The final analysis incorporates 1080 patients, categorized based on their eGFR. The average age was 79.76 years. CKD stages 3a-5 prevalence was 25.03% (n=780) and CKD stages 1-5 was 34.6% (n=1080). The most prevalent stage was stage 3a with a frequency of 45% (n=486). Regarding age distribution, 26.2% (n=283) were young elderly, 52.1% (n=563) were elderly, and 21.6% (n=234) were old elderly, with CKD stage 3a prevalent in all age groups. This is the first study in Romania conducted exclusively on elderly patients with CKD. This study was conducted in a university center serving a population of 4.5 million patients, featuring a dedicated nephrology clinic. This study delves into the prevalence of CKD within the elderly demographic, examining its correlation with essential biomarkers of malnutrition. This study spans a decade, from 2012 to 2022, focusing on Romania's northeastern region, specifically Moldova. This is the second substantial analysis carried out in Romania and Eastern Europe, with a unique emphasis on patients aged 65 years and older.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 3","pages":"e80412"},"PeriodicalIF":1.0,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11896089/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607561","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":"Efficacy and Safety of Intravenous-to-Oral Lascufloxacin Switch Therapy in Community-Onset Pneumonia: A Single-Arm, Open-Label Clinical Trial.","authors":"Naoki Iwanaga, Naoki Hosogaya, Takahiro Takazono, Yusei Tsukamoto, Ryosuke Morio, Satoshi Irifune, Takuto Miyamura, Yosuke Harada, Yohsuke Nagayoshi, Akira Kondo, Tomo Mihara, Yoshihisa Kohno, Yuichi Fukuda, Tsutomu Kobayashi, Eisuke Sasaki, Toyomitsu Sawai, Yoshifumi Imamura, Toru Morikawa, Kohji Hashiguchi, Yoji Futsuki, Yuichi Inoue, Kiyoyasu Fukushima, Naofumi Suyama, Hiroaki Senju, Hikaru Tanaka, Yurika Kawazoe, Shimpei Morimoto, Yuya Ito, Masataka Yoshida, Kazuaki Takeda, Shotaro Ide, Noriho Sakamoto, Koichi Izumikawa, Katsunori Yanagihara, Hiroshi Mukae","doi":"10.7759/cureus.80404","DOIUrl":"10.7759/cureus.80404","url":null,"abstract":"<p><strong>Background and objective: </strong>For treating community-acquired pneumonia (CAP) in adults, early switching from injectable to oral antimicrobials (switch therapy) is accepted once the clinical course is favorable. Lascufloxacin (LSFX) is a quinolone antibacterial agent, available in intravenous and oral formulations, demonstrating antibacterial activity against a relatively broad spectrum of community-onset pneumonia (COP). No switch therapy using the same drug from injectable to oral antimicrobials has been reported; therefore, we conducted the study to confirm the efficacy and safety of the switch therapy using LSFX.</p><p><strong>Method: </strong>We conducted an open-label, uncontrolled, multicenter study across 16 hospitals from April 2023 to February 2024 to evaluate the efficacy and safety of LSFX switch therapy against mild-to-moderate COP. Once the switch criteria were fulfilled on days 3-5, switch therapy was initiated. The primary endpoint was the cure rate at the time of test of cure (TOC). Secondary endpoints included the proportion of patients receiving switch therapy, clinical efficacy at the end of treatment (EOT), early clinical response, microbiological response at the EOT, and adverse events. The adverse events were collected from the population for the safety analysis set.</p><p><strong>Results: </strong>The median age of the participants was 73 years, and the overall switch therapy implementation rate was 114/120 (95%), aligned with approximately 99/104 (95%) of the switch therapy performed by day three after initiating the therapy. The cure or effective rate was 100/104 (96.2%, 95% confidence interval (CI): 90.44-98.94) at TOC, 101/104 (97.1%, 95% CI: 91.80-99.40) at the early clinical efficacy testing, and 103/104 (99.0%, 95% CI: 94.76-99.98) at EOT. Adverse events related to the study drug were reported in 10.0% of the patients, with hepatic dysfunction as the most common adverse effect. Severe LSFX-induced adverse events were not observed, excluding worsening pneumonia.</p><p><strong>Conclusion: </strong>Switch therapy using LSFX presented high efficacy and acceptable safety profiles against mild-to-moderate severity of COP. This strategy of using the same drug in both intravenous and oral formulations is quite innovative. LSFX may potentially emerge as one of the preferred options for treating COP.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 3","pages":"e80404"},"PeriodicalIF":1.0,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11902907/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143617961","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":"Multidisciplinary Management of Single Organism Emphysematous Splenitis Without Splenectomy: A Case Report.","authors":"Suanne C MacConnell, Anand Trivedi","doi":"10.7759/cureus.80389","DOIUrl":"10.7759/cureus.80389","url":null,"abstract":"<p><p>Emphysematous splenitis traditionally requires a splenectomy, resulting in life-long consequences for the patient. <i>Clostridium perfringens</i> is often seen in an immunocompromised population. This case demonstrates a multidisciplinary team approach consisting of percutaneous drainage and a prolonged intravenous and oral antibiotic regime, including ceftriaxone and metronidazole, as well as amoxicillin and clavulanic acid, to provide a successful outcome in an elderly immunocompetent female. This negated the need to proceed to the traditional operative management of splenectomy and validates an equitable conservative approach to treat a <i>C. perfringens</i>-induced emphysematous splenic infection. This approach was undertaken and was likely successful secondary to the haemodynamic stability and immunocompetent baseline of the patient. Her immunocompetency could be maintained due to the non-operative management and should therefore be considered if the clinical situation allows.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 3","pages":"e80389"},"PeriodicalIF":1.0,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11894861/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607555","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 Effect of 50% Dextrose on Serum Glucose Levels in Adult Hypoglycemic Patients: A Prospective Observational Study.","authors":"Ahmed Al Saidi, Mohammed Al Shamsi, Abdulmunaim Al Farsi, Saif Al Tubi","doi":"10.7759/cureus.80375","DOIUrl":"10.7759/cureus.80375","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to observe changes in serum glucose levels following the administration of 50 mL of 50% dextrose solution (D50) in hypoglycemic patients. Specifically, we seek to determine the prevalence of rebound hyperglycemia episodes, the peak effect, and the duration of action of a single dose of 50 mL D50.</p><p><strong>Method: </strong>This prospective observational study was conducted at four emergency departments (two tertiary care hospitals and two secondary care hospitals) in Oman over a three-year period, from May 1, 2019, to April 30, 2022. Adult patients (>12 years old) presenting with documented hypoglycemia (serum glucose level ≤3.9 mmol/L) were included. All patients underwent bedside serum glucose measurements at predetermined time intervals following the administration of D50. Data were analyzed using the Epidata program (Buenos Aires, Argentina). The mean serum glucose level at each time interval was calculated, along with the prevalence of rebound hyperglycemia. The independent sample t-test, one-way ANOVA, and Pearson's chi-squared test were used for statistical analysis.</p><p><strong>Results: </strong>A total of 102 patients (53 females and 48 males) were included in this study. The majority of patients were diabetic (N = 87), while 15 (14.7%) were non-diabetic. Rebound hyperglycemia was predominantly observed within five minutes of administering 50 mL of D50, with a mean serum glucose level of 12.2 mmol/L and a maximum reading of 22.6 mmol/L. Rebound hyperglycemia occurred more frequently in the non-diabetic group (73.3%) compared to the diabetic group (56.3%). Six patients (5.7%) required a second dose of 50 mL D50, all of whom were diabetic.</p><p><strong>Conclusion: </strong>A single dose of 50 mL D50 effectively restores and maintains the desired serum glucose level in non-diabetic hypoglycemic adult patients for up to 60 minutes. However, diabetic patients may require additional doses or continuous dextrose-containing fluids if they do not begin oral feeding. Using a lower concentration of dextrose-containing fluids may help mitigate the phenomenon of rebound hyperglycemia.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 3","pages":"e80375"},"PeriodicalIF":1.0,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11902882/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143618060","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":"Deep Postanal Abscess With Sacrococcygeal Osteomyelitis: A Case Report.","authors":"Javid Ahmadov, Mustafa Anil Turhan, Ender Erguder, Sezai Leventoğlu, Bulent Mentes","doi":"10.7759/cureus.80341","DOIUrl":"10.7759/cureus.80341","url":null,"abstract":"<p><p>Deep postanal abscesses (DPAs) are uncommon but clinically significant conditions that, if left untreated, can result in severe septic complications. This case report presents a rare instance of sacrococcygeal osteomyelitis as a complication of a long-standing DPA. The patient underwent surgical drainage and seton placement, leading to complete resolution of both the abscess and the osteomyelitis. This case underscores the importance of prompt surgical intervention in the management of DPAs and highlights the potential for rare but serious complications such as osteomyelitis.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 3","pages":"e80341"},"PeriodicalIF":1.0,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11904380/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143627098","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":"Impact of Omega-3 Fatty Acids on Cognitive Outcomes in Children With Autism Spectrum Disorder: A Systematic Review.","authors":"Bushra Sumra, Cyril Kocherry, Hina Shamim, Kiran Jhakri, Moath Al-Shudifat, Lubna Mohammed","doi":"10.7759/cureus.80291","DOIUrl":"10.7759/cureus.80291","url":null,"abstract":"<p><p>Autism spectrum disorder (ASD) is defined as a complex neurodevelopmental disorder that is characterized by a set of deficits not limited to social communication, which is restricted and repetitive behaviors. The prevalence of autism has been seen to be consistently increasing globally. Autism is multifactorial in its etiology, and it involves several physiological systems, including the central nervous system and the gut-brain axis. Omega-3 fatty acids are essential for neural development and functionality, particularly eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). They both play a crucial role in not only reducing the neuroinflammation associated with autism but also supporting cognitive processing as well. Given the low levels of omega-3 noted in ASD individuals, this systematic review aims to assess the influence of omega-3 supplementation on cognitive outcomes in children with ASD. The systematic review was done following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, where different databases were assessed across PubMed, Science Direct, Cochrane Library, Google Scholar, and Scopus. MeSH terms used included keywords \"Omega-3\", \"EPA\", \"DHA\" AND \"Autism Spectrum Disorder\" OR \"ASD\". Articles published between 2007 and 2023 that focused on ages 2 to 18 years were screened, and cognitive outcomes relevant to omega-3 supplementation were included. Studies with inadequate access to full text excluded non-human trials and older individuals. After generating 25,312 articles, 211 were selected for further review, with 11 meeting the inclusion criteria. The articles reviewed panned over five different countries that involved omega-3 supplementation lasting up to one year. Results suggested that DHA and EPA supplementation may improve cognitive functions such as memory, attention, and executive functioning in children with ASD. The prefrontal cortex development was associated with DHA supplementation, whereas EPA showed improved emotional regulation and reduced neuroinflammation. However, conclusive results were not reached as there was variability in study designs, different dosages, and assessment methods. The power of the studies conducted was also noted to be limited. While promising, extensive research and trials are required to standardize the dosage of omega-3 and the length of intervention. Future studies should aim to identify the long-term effects of omega-3 supplementation, understand the gut-brain axis, and investigate the combination of omega-3 with other therapies to improve cognitive functioning.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 3","pages":"e80291"},"PeriodicalIF":1.0,"publicationDate":"2025-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11892077/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143598547","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":"Surgical Management for Recurrent Bleeding Stercoral Ulcers.","authors":"Amer Mansoor, Richard C Spinale, Bashar Hmoud","doi":"10.7759/cureus.80282","DOIUrl":"10.7759/cureus.80282","url":null,"abstract":"<p><p>Stercoral ulcers are a common complication from long-term constipation and generally managed on a case-to-case basis, including options such as endoscopic and surgical interventions. However, recurrent bleeding from rectal stercoral ulcers is exceedingly rare. Being an uncommon cause of long-term GI bleeding, these patients often require rapid resuscitation and hemostasis of the ulcers. We report a case of an elderly woman who presented with progressively deteriorating neurologic function and constipation who subsequently had multiple bouts of recurrent rectal bleeding despite multiple interventions performed by the Gastroenterology and General Surgery teams including endoscopic control with probe cautery and surgical approach with oversewing the vessel. With recurrent bleeding, surgical options, such as bowel resections, can be futile and harmful due to the significant comorbidities often associated with such patients.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 3","pages":"e80282"},"PeriodicalIF":1.0,"publicationDate":"2025-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11890588/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143589099","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":"Progression in Fibrotic Interstitial Lung Diseases: Prevalence and Indicators in the Initial Evaluation in a Brazilian Multicentric Cohort.","authors":"Ana C Resende, Soraya Cordero, Eliane V Mancuzo, Karin M Storrer, Maria A Moreira, Fernanda M Baptista, Rimarcs Ferreira, Maria Raquel Soares, Carlos Alberto A Pereira","doi":"10.7759/cureus.80290","DOIUrl":"10.7759/cureus.80290","url":null,"abstract":"<p><strong>Objective: </strong>This retrospective study aimed to determine the prevalence of progression in fibrotic interstitial lung disease (ILD) and the findings at diagnosis most associated with progression after two years of follow-up in a large Brazilian cohort.</p><p><strong>Methods: </strong>This was a retrospective multicenter observational study in Brazil. Progression was defined after two years of follow-up. We excluded patients with an initial peripheral oxygen saturation (SpO2) of less than 88% or an initial forced vital capacity (FVC) of less than 45%. Diagnoses were made by multidisciplinary discussion. Patients with idiopathic pulmonary fibrosis were included for comparison. At least one of the following events was indicative of progressive ILD: (1) a relative decrease in FVC of 10% or more, (2) worsening dyspnea, (3) a greater extent of fibrotic findings on high-resolution computed tomography (HRCT), (4) initiation of oxygen, and (5) death attributed to ILD. Logistic regression analysis was used to identify risk factors for progressive fibrosis.</p><p><strong>Results: </strong>The mean age of patients was 61.7±12.3 years, and 69.5% had Velcro crackles. The mean FVC was 71.6±15.8%, and 26.1% showed honeycombing on HRCT. After two years of follow-up, 40.5% of patients (n=154) showed disease progression. Fibrotic hypersensitivity pneumonitis (FHP) was the most progressive disease (52%), and connective tissue disease-associated ILD (CTD-ILD) was the least progressive (25%). Multivariate analysis showed that a higher score for dyspnea, crackles, and SpO2 at rest ≤94% and ≤85% at the end of exercise were significant indicators of progression. Diffusing lung capacity for carbon monoxide (DLCO) was measured in 172 cases, with values <55% predicting a high odds ratio for progression (OR=4.03; 2.10-7.69).</p><p><strong>Conclusion: </strong>In Brazil, FHP is the most progressive disease and CTD-ILD is the least progressive after two years of follow-up. The degree of dyspnea, crackles, SpO2 at rest and during exercise, and DLCO at baseline are associated with progressive disease.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 3","pages":"e80290"},"PeriodicalIF":1.0,"publicationDate":"2025-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11892080/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143598556","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}