Pneumonia in newly diagnosed patients infected with the Omicron variant: a population-based study of Chinese patients in Chongqing.

BACKGROUND: Pneumonia is the main complication of the Omicron variant of SARS-CoV-2; however, the incidence proportions and prognostic factors for Omicron-associated pneumonia have not been established. We conducted this study to characterise the incidence proportions and influence of various factors on prognosis of Omicron-associated pneumonia. METHODS: We collected data from 714 patients infected with the Omicron variant in The First Affiliated Hospital of Chongqing Medical University (Chongqing, China) who were divided into different groups for analysis. RESULTS: We identified 313 patients with Omicron-associated pneumonia at the time of diagnosis of patients infected with the Omicron variant, representing 43.8% of the entire cohort. A total of 82 were 15-59 years old, 71 were 60-69 years old, 76 were 70-79 years old and 84 were >80 years old. 133 were female and 180 were male. Incidence proportions of pneumonia were highest among patients with cardiovascular (82.4% of the basic disease of the cardiovascular system subset) or kidney disease (92.3% of the kidney disease subset), whereas patients with lung cancer (35.7% of the lung cancer subset) had a lower incidence proportion. Several factors were associated with the prognosis of pneumonia in patients infected with the Omicron variant. Patients with a thrombosis or pleural effusion had a longer hospitalisation time. Paxlovid and immunoglobulins improved the prognosis of patients with severe pneumonia. The following measures were significantly different in patients as a function of disease severity: number of neutrophils and lymphocytes, partial oxygen pressure; and myoglobin, lactic dehydrogenase, aspartate transaminase and procalcitonin levels. CONCLUSION: Patients infected with the Omicron variant with coexisting cardiovascular or kidney disease, but not respiratory disease, had a higher incidence proportion of pneumonia. Paxlovid and immunoglobulins can be used in patients with severe infections to improve prognosis.

Occurrence and prognosis of lung cancer metastasis to major organs: a population-based study.

BACKGROUND: Lung cancer metastasis to major organs is an important factor affecting survival. We analyzed the influence of patient characteristics on the incidence and survival of metastasis to major organs. METHODS: We collected data from the Surveillance, Epidemiology, and End Results database on 58 659 patients diagnosed with stage IV primary lung cancer, including age, sex, race, histological type of tumor, laterality, primary site, number of extrametastatic sites, and treatment. RESULTS: Multiple variables affected the incidence of metastasis to major organs and survival. According to histological type of tumor, the following were more common: bone metastasis from adenocarcinoma; brain metastasis from large-cell carcinoma and adenocarcinoma; liver metastasis from small-cell carcinoma; and intrapulmonary metastasis from squamous-cell carcinoma. A larger number of metastatic sites increased the risk of other metastases and shorter survival. Liver metastasis conferred the worst prognosis, followed by bone metastasis, and brain or intrapulmonary metastasis conferred better prognosis. The effect of radiotherapy alone was poorer than chemotherapy alone or combined chemotherapy and radiotherapy. In most cases, the effects of chemotherapy and combined chemotherapy and radiotherapy were equivalent. CONCLUSION: Multiple variables affected the incidence of metastasis to major organs and survival. Compared with radiotherapy alone or combined chemotherapy and radiotherapy, chemotherapy alone may be the most cost-effective option for patients with stage IV lung cancer.

Characteristics of cardiopulmonary exercise test in tracheobronchial tuberculosis patients with central airway stenosis.

BACKGROUND: A typical symptom of central airway stenosis is progressive dyspnea. The exercise capacity and relationship between pulmonary function testing (PFT) and central airway stenosis have not been reported. OBJECTIVES: To investigate, for the first time, the impact of central airway stenosis due to tracheobronchial tuberculosis (TBTB) on exercise capacity in adults. METHODS: Fifty-one patients diagnosed with TBTB and 51 healthy, non-smoking adults (controls) were studied. All participants underwent a maximal cardiopulmonary exercise test (CPET) after completing PFT. RESULTS: All participants completed the PFT and CPET. Significant differences existed between the two groups with respect to PFT parameters. At rest, no significant differences were detected between the two groups with respect to oxygen uptake (VO2), vital volume (VT), minute ventilation (VE), end-tidal carbon dioxide (PetCO2), and oxygen pulse (SPO2). Compared to controls, TBTB patients had lower peak work rate [WR, 100 (83,119) vs. 112 (95,146)], VO2 at maximal exercise (1309.51±323.83 vs. 1522.17±451.15), anaerobic threshold (905.8 ± 219.84 vs. 1024.72±296.27), maximal O2 pulse (8.02±1.61 vs. 9.26±2.36), and breath reserve [BR, 25 (15,42) vs. 49.5(39.4,61.3)]. The change in PetCO2 values at rest and maximal exercise was lower than in controls (P<0.05). However, no difference in VE/carbon dioxide production (VCO2)@AT were demonstrated between the two groups. The correlations between the degree of stenosis, PFT parameters, and VO2 peak were significant. RV/TLC%pred was a good predictor of exercise limitation in these patients. CONCLUSION: The maximal exercise capacity and PFT parameters of TBTB patients with central airway stenosis were impaired. Impaired exercise capacity correlated with the degree of central airway stenosis.

Combine use of glucocorticoid with other immunosuppressants is a risk factor for Pneumocystis jirovecii pneumonia in autoimmune inflammatory disease patients: a meta-analysis.

OBJECTIVE: To determine whether the combined use of glucocorticoid with other immunosuppressants increased the risk of Pneumocystis jirovecii pneumonia (PCP) in autoimmune inflammatory disease (AIID) patients. METHODS: The data were collected from the PubMed, Cochrane Library, and Web of Science databases. We excluded HIV-infected patients and those < 16 years of age, and included patients who combined use of glucocorticoid with other immunosuppressants or used glucocorticoid alone. The number of patients who were affected by PCP after therapy as the primary outcome and the number of patients with fatal outcomes, which included death, endotracheal tube intubation, PO2 < 60 mmHg, and other serious clinical symptoms due to PCP, as the secondary outcome. Odds ratios with 95% confidence intervals and variance tests were used to analyze the data. RESULTS: The outcomes showed that the combined use of glucocorticoid with other immunosuppressants increased the risk of PCP in AIID patients (odds ratio = 2.85, 95% confidence intervals 1.75 to 4.64, I2 = 0%, P < 0.0001), which may be a consequence of the drug regimen reducing the lymphocyte count. Furthermore, the prognosis of patients receiving this drug regimen was poorer than with glucocorticoid alone (odds ratio = 2.31, 95% confidence intervals 1.02 to 5.23, I2 = 0%, P = 0.04). CONCLUSION: The combined use of glucocorticoid with other immunosuppressants increased the risk of PCP in AIID patients and resulted in poorer prognoses. It is therefore clear that appropriate prophylaxis was vital in AIID patients to minimize the risk of PCP. Key Points • We demonstrated that the combined use of glucocorticoid with other immunosuppressants increased the risk of PCP in AIID patients and resulted in poorer prognoses. • As there are no standard prophylactic guidelines, we wish this work will be evidence to guide clinical prophylaxis.