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Chest Medicine (all articles)

RCT: Lack of significant effect of Paxlovid (nirmatrelvir–ritonavir) on symptom alleviation in Covid-19

26 Apr, 2024 | 11:49h | UTC

Study Design and Population:

This phase 2–3 randomized clinical trial investigated the efficacy of nirmatrelvir in combination with ritonavir for treating mild-to-moderate Covid-19 in adults. Participants, both vaccinated and unvaccinated, were enrolled based on their risk factors for severe Covid-19. The study included 1296 adults who had confirmed Covid-19 with symptom onset within the past 5 days. They were randomly assigned to receive either nirmatrelvir–ritonavir or placebo every 12 hours for 5 days.

 

Main Findings:

The primary endpoint was the time to sustained alleviation of all targeted Covid-19 signs and symptoms. Results showed that the median time to alleviation was 12 days for the treatment group and 13 days for the placebo group, a difference that was not statistically significant (P=0.60). Hospitalizations and deaths were slightly lower in the treatment group (0.8%) compared to the placebo group (1.6%), but this difference was also not statistically significant. Adverse events were similar across both groups, with dysgeusia and diarrhea being the most common in the treatment group.

 

Implications for Practice:

The findings indicate that nirmatrelvir–ritonavir treatment does not significantly reduce the time to symptom alleviation for Covid-19 compared to placebo among vaccinated or unvaccinated adults. These results suggest that further research is needed to explore the potential benefits of this treatment in specific subpopulations or in combination with other interventions.

 

Reference (free full-text):

Reference: Hammond J. et al. (2024). Nirmatrelvir for Vaccinated or Unvaccinated Adult Outpatients with Covid-19. N Engl J Med, 390(13), 1186-1195. DOI: 10.1056/NEJMoa2309003

FDA approves antibiotic Zevtera (ceftobiprole medocaril sodium) for three indications

26 Apr, 2024 | 11:39h | UTC

The FDA has granted approval for Zevtera (ceftobiprole medocaril sodium), an antibiotic formulated for injection, targeting three key bacterial infections. This includes treatment for adults with Staphylococcus aureus bloodstream infections (SAB) with or without right-sided infective endocarditis, acute bacterial skin and skin structure infections (ABSSSI), and community-acquired bacterial pneumonia (CABP) in both adults and pediatric patients aged three months to under 18 years.

The approval follows rigorous clinical trials demonstrating Zevtera’s efficacy. In a multicenter study for SAB, Zevtera achieved a 69.8% success rate, slightly outperforming the comparator drug. For ABSSSI, Zevtera showed a 91.3% early clinical response, and for CABP, it had a clinical cure rate of 76.4% in adults. Pediatric efficacy for CABP was extrapolated from adult data and supported by a smaller pediatric trial.

Common side effects include anemia, nausea, and increased liver enzyme levels, with specific reactions varying by infection treated. Contraindications include severe hypersensitivity to ceftobiprole or other cephalosporins. Zevtera also carries warnings about potential hypersensitivity reactions, central nervous system effects, and Clostridioides difficile-associated diarrhea.

This approval, supported by Priority Review and Fast Track designations, offers a new treatment option for clinicians managing these serious infections.

Source: FDA NEWS RELEASE: FDA Approves New Antibiotic for Three Different Uses

Cohort Study: Inappropriate pneumonia diagnoses and associated risks in 17,290 hospitalized adults

26 Apr, 2024 | 11:25h | UTC

Study Design and Population:

This prospective cohort study analyzed medical records and patient interactions from July 2017 to March 2020 across 48 Michigan hospitals. A total of 17,290 adults admitted for general care were retrospectively assessed for community-acquired pneumonia (CAP) treatment, focusing on those who received antibiotics within the first two days of hospitalization.

 

Main Findings:

The study identified that 12.0% of the patients were inappropriately diagnosed with CAP. Key risk factors for misdiagnosis included older age, presence of dementia, and altered mental status at presentation. Among those misdiagnosed, 87.6% underwent a full course of antibiotics, which did not significantly change the 30-day risk of mortality, readmission, emergency visits, or Clostridioides difficile infections compared to brief treatment but was associated with higher antibiotic-related adverse events.

 

Implications for Practice:

The findings underscore the prevalence of inappropriate pneumonia diagnosis among hospitalized adults, especially in older patients with specific geriatric conditions. This study highlights the potential harms of unnecessary antibiotic use, suggesting a need for improved diagnostic accuracy and treatment decision-making in hospital settings to mitigate adverse outcomes.

 

Reference (free full-text):

Gupta, A. B. et al. (2024). Inappropriate Diagnosis of Pneumonia Among Hospitalized Adults. JAMA Intern Med. Published online March 25, 2024. DOI: 10.1001/jamainternmed.2024.0077.

Nested Case-Control Study: Increased risk of major bleeding in atrial fibrillation patients with concomitant SSRI and oral anticoagulant use

23 Mar, 2024 | 20:48h | UTC

Study Design and Population

This nested case-control study investigated the association between the concomitant use of selective serotonin reuptake inhibitors (SSRIs) and oral anticoagulants (OACs) on the risk of major bleeding among patients with atrial fibrillation. Conducted within the UK’s Clinical Practice Research Datalink, the study included 42,190 cases of major bleeding matched to 1,156,641 controls based on age, sex, cohort entry date, and follow-up duration. Patients initiating OACs between January 2, 1998, and March 29, 2021, were included, with risk-set sampling utilized for control selection.

Main Findings

The study found that concomitant use of SSRIs and OACs was associated with a 33% increased risk of major bleeding compared to OAC use alone, with the highest risk observed within the first 30 days of concurrent use. The increased risk was consistent across different ages, sexes, and patient histories, including those with chronic kidney disease or previous bleeding events. Notably, the elevated risk of bleeding extended up to 6 months of concomitant use but did not vary significantly with the potency of SSRIs or the type of OAC used (direct OACs or vitamin K antagonists).

Implications for Practice

These findings underscore the need for healthcare professionals to closely monitor patients with atrial fibrillation who are prescribed SSRIs in addition to OACs, particularly during the initial months of treatment. This study highlights the importance of managing bleeding risk factors and suggests reconsidering the necessity and duration of concomitant SSRI and OAC use. Future research should focus on strategies to mitigate this bleeding risk and explore alternative treatments for managing depression in patients requiring anticoagulation.

Reference

Rahman AA, Platt RW, Beradid S, et al. (2024). Concomitant Use of Selective Serotonin Reuptake Inhibitors With Oral Anticoagulants and Risk of Major Bleeding. JAMA Netw Open, 7(3):e243208. DOI: 10.1001/jamanetworkopen.2024.3208.

RCT: Clarithromycin improves early clinical and inflammatory responses in hospitalized community-acquired pneumonia patients

23 Mar, 2024 | 20:25h | UTC

Study Design and Population: The ACCESS trial was a phase 3, prospective, double-blind, randomized controlled trial conducted in 18 Greek hospitals, involving adults hospitalized with community-acquired pneumonia who displayed systemic inflammatory response syndrome, had a Sequential Organ Failure Assessment (SOFA) score of 2 or more, and procalcitonin levels of 0.25 ng/mL or more. Participants were randomly assigned to receive either standard of care with intravenous cephalosporins or β-lactam/β-lactamase inhibitor combinations plus oral clarithromycin (500 mg twice daily for 7 days) or placebo. The trial aimed to evaluate the impact of clarithromycin on early clinical and inflammatory responses.

Main Findings: Among 278 participants allocated to clarithromycin (n=139) or placebo (n=139), the primary composite endpoint—indicating early clinical response and inflammatory burden reduction within 72 hours—was met by 68% of patients in the clarithromycin group compared to 38% in the placebo group, showcasing a significant difference (29.6%, odds ratio 3.40, p<0.0001). Serious treatment-emergent adverse events were slightly lower in the clarithromycin group than in the placebo group, although not statistically significant.

Implications for Practice: The addition of clarithromycin to the standard of care for hospitalized patients with community-acquired pneumonia significantly improves early clinical response and reduces inflammatory burden, potentially through modulation of the immune response. These results support the use of clarithromycin alongside β-lactam antibiotics in the treatment of community-acquired pneumonia, highlighting its role in enhancing patient outcomes by targeting early clinical and inflammatory indicators.

Reference

Prof Evangelos J Giamarellos-Bourboulis, MD et al. (2024). Clarithromycin for early anti-inflammatory responses in community-acquired pneumonia in Greece (ACCESS): a randomised, double-blind, placebo-controlled trial. The Lancet Respiratory Medicine, Volume(Issue), Pages. DOI: https://doi.org/10.1016/S2213-2600(23)00412-5. Access the study here: Link

RCT: Lower oxygenation target improves days alive without life support in severe COVID-19 hypoxemia

21 Mar, 2024 | 13:46h | UTC

Study Design and Population: This multicenter randomized clinical trial investigated the impact of different oxygenation targets on the survival of adult patients with COVID-19 and severe hypoxemia in the ICU. Conducted across 11 European ICUs from August 2020 to March 2023, the study involved 726 patients requiring at least 10 L/min of oxygen or mechanical ventilation. Participants were randomly assigned to receive an oxygenation target of either 60 mm Hg (lower oxygenation group, n=365) or 90 mm Hg (higher oxygenation group, n=361) for up to 90 days.

Main Findings: The primary outcome was the number of days alive without life support at 90 days post-intervention. Patients in the lower oxygenation group achieved a median of 80.0 days alive without life support compared to 72.0 days in the higher oxygenation group, a difference that was statistically significant (P=0.009). Although there was a slight reduction in mortality at 90 days in the lower oxygenation group (30.2% vs 34.7% in the higher group), this was not statistically significant. No significant differences were observed in the proportion of patients with serious adverse events or the number of days alive and out of hospital.

Implications for Practice: Targeting a lower Pao2 of 60 mm Hg in ICU patients with COVID-19 and severe hypoxemia appears to increase the days alive without life support compared to a higher target of 90 mm Hg, without increasing serious adverse events. This finding suggests that a lower oxygenation target could be more beneficial for this patient population, potentially guiding clinical practice in managing oxygen therapy for severe COVID-19 cases.

Reference

Reference: Nielsen FM et al. (2024). Randomized Clinical Trial: Effect of Oxygenation Targets on Survival Without Life Support in COVID-19 Patients with Severe Hypoxemia. JAMA, Published online March 19, 2024. DOI: 10.1001/jama.2024.2934. Access the study here: [Link]

Cohort Study | Mortality risk in anti-MDA5 dermatomyositis linked to rapid ILD progression and anti-Ro52 antibody levels

11 Aug, 2023 | 15:21h | UTC

Mortality risk in patients with anti-MDA5 dermatomyositis is related to rapidly progressive interstitial lung disease and anti-Ro52 antibody – Arthritis Research & Therapy

 

Commentary on Twitter

 

Survival ≠ Recovery | A narrative review of post-intensive care syndrome

11 Aug, 2023 | 15:11h | UTC

Survival ≠ Recovery: A Narrative Review of Post-Intensive Care Syndrome – CHEST Critical Care

 

Review | Primary ciliary dyskinesia

11 Aug, 2023 | 15:10h | UTC

Primary Ciliary Dyskinesia – CHEST Pulmonary

 

M-A | Efficacy of vibrotactile positional therapy devices on patients with positional obstructive sleep apnea

9 Aug, 2023 | 15:30h | UTC

Efficacy of vibrotactile positional therapy devices on patients with positional obstructive sleep apnoea: a systematic review and meta-analysis – Thorax

 

M-A | eHealth interventions aid in smoking cessation; effect diminishes over time

9 Aug, 2023 | 15:14h | UTC

Effectiveness of eHealth Smoking Cessation Interventions: Systematic Review and Meta-Analysis – Journal of Medical Internet Research

 

Pictorial Review | Watch out for the early killers: imaging diagnosis of thoracic trauma

9 Aug, 2023 | 15:02h | UTC

Watch Out for the Early Killers: Imaging Diagnosis of Thoracic Trauma – Korean Journal of Radiology

 

Pictorial Review | Occupational lung diseases: spectrum of common imaging manifestations

9 Aug, 2023 | 14:51h | UTC

Occupational Lung Diseases: Spectrum of Common Imaging Manifestations – Korean Journal of Radiology

 

Nationwide Study | Examining survival rates and risk factors in 237 drowned patients receiving ECMO

8 Aug, 2023 | 13:13h | UTC

Results from 237 extracorporeal membrane oxygenation runs with drowned patients: a nationwide retrospective study – Critical Care

 

NICE Updated Guideline | Venous thromboembolic diseases

7 Aug, 2023 | 15:05h | UTC

Venous thromboembolic diseases: diagnosis, management and thrombophilia testing  – National Institute for Health and Care Excellence

 

Study | Removal of thymus in adults linked to increased death, cancer incidence

4 Aug, 2023 | 12:09h | UTC

Health Consequences of Thymus Removal in Adults – New England Journal of Medicine (link to abstract – $ for full-text)

Commentaries:

Doctors have long considered the thymus expendable. But could removing it be fatal? – Science

The thymus withers away after puberty. But it may be important for adults – Science News

Thymus gland critical for adult health, study finds – News Medical

 

Commentary on Twitter

 

NICE Updated Guideline | Diagnosis and management of lung cancer

4 Aug, 2023 | 12:05h | UTC

Lung cancer: diagnosis and management – National Institute for Health and Care Excellence

 

Systematic Review | Interstitial lung disease incidence at 11.7% in metastatic breast cancer patients using trastuzumab deruxtecan

3 Aug, 2023 | 13:36h | UTC

Incidence of interstitial lung disease and cardiotoxicity with trastuzumab deruxtecan in breast cancer patients: a systematic review and single-arm meta-analysis – ESMO Open

 

WHO | Seven out of 10 people protected by at least one tobacco control measure

2 Aug, 2023 | 14:14h | UTC

News Release: Seven out of 10 people protected by at least one tobacco control measure – World Health Organization

See also: MPOWER measures

Report: WHO report on the global tobacco epidemic, 2023: protect people from tobacco smoke – World Health Organization

Commentaries:

While Anti-Smoking Policies Cover 70% of Global Population, Taxation is Under-Utilised – Health Policy Watch

Expert reaction to WHO report on the global tobacco epidemic 2023 – Science Media Centre

 

Commentary on Twitter

 

Study | AI use in lung cancer screening enhances prediction of lung cancer death, CVD death, and all-cause death

1 Aug, 2023 | 14:31h | UTC

AI Body Composition in Lung Cancer Screening: Added Value Beyond Lung Cancer Detection – Radiology (free for a limited period)

Commentary: Study: AI Assessment of Chest CT May Predict Multiple Mortality Risks – Diagnostic Imaging

 

BTS Guideline for pleural disease

31 Jul, 2023 | 14:44h | UTC

British Thoracic Society Guideline for pleural disease – Thorax

 

BTS Clinical Statement on pleural procedures

31 Jul, 2023 | 14:42h | UTC

British Thoracic Society Clinical Statement on pleural procedures – Thorax

 

Opinion Video | Critical analysis of the data behind Covid-19 booster shots

31 Jul, 2023 | 14:40h | UTC

“FLAWED Booster data was used by FDA for Mass Vax Campaign & We PROVE it in our new PAPER” – YouTube Video by Dr Vinay Prassad

Original Publication: Correspondence | Potential “healthy vaccinee bias” in a study of BNT162b2 vaccine against Covid-19

 

Study | New deep learning model effectively detects type 2 diabetes from chest X-rays

28 Jul, 2023 | 14:15h | UTC

Opportunistic detection of type 2 diabetes using deep learning from frontal chest radiographs – Nature Communications

 

Commentary on Twitter

 

A new global definition of Acute Respiratory Distress Syndrome

27 Jul, 2023 | 13:14h | UTC

A New Global Definition of Acute Respiratory Distress Syndrome – American Journal of Respiratory and Critical Care Medicine

 

Commentary on Twitter

 

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