Abstract in English:

ABSTRACT Objectives: Several equations for calculating maximal inspiratory pressure (MIP) have been validated for the Brazilian population; however, none exist for maximal dynamic inspiratory muscle pressure (S-Index). Methods: This cross-sectional study was conducted at two centers following approval by the institutional ethics committee. Healthy Brazilian adults were sequentially randomized to assess either the MIP or S-Index. Pulmonary function (spirometry), peripheral muscle strength (handgrip strength of the dominant upper limb - HGdUL), and physical activity level (IPAQ) were also evaluated. The S-Index and MIP values were reported as absolute values and compared using the Wilcoxon paired test. Multiple linear regression was used to develop reference equations. Lower limits of normality (LLNs) were stratified by sex and age using Z-scores, providing cut-off points to define inspiratory muscle weakness via the S-Index Deviation Score (SDS). Results: The final sample comprised 214 eutrophic volunteers, 50% men, with a mean age of 43.1 ± 15.0 years. The median MIP was significantly higher than the median S-Index (97.2 [96.7-112.0] vs. 92.5 [80.0-105.0] cmH2O; p<0.001). The predicted equation for the S-Index, which used age, sex, and HGdUL as predictors, was: S-Index = 69.72 + 10.765×sex (men = 1; women = 0) - 0.211×age + 0.797×HGdUL. Additionally, the LLNs and cut-off points for ventilatory muscle weakness by sex and age group were established. Conclusions: This study provides the first reference values for the S-Index in healthy, eutrophic Brazilian adults, including LLNs and cut-off points for diagnosing ventilatory muscle weakness.

Abstract in English:

ABSTRACT Objective: Efficient diagnostic pathways in advanced non-small cell lung cancer (NSCLC) are crucial for timely treatment initiation and improved outcomes. This study evaluated the impact of diagnostic delays and the role of minimally invasive techniques in biomarker assessment and survival in a real-world clinical cohort. Methods: A retrospective cohort study was conducted involving 205 patients with advanced NSCLC diagnosed between January 2020 and December 2023. Diagnostic procedures included EBUS/EUS-B, transthoracic biopsy, and surgical biopsy. The time-to-diagnostic procedure, time-to-therapy, and survival were analyzed using multivariate models. Results: The time interval to the first diagnostic procedure independently predicted mortality (HR=1.66; p=0.016). EBUS and EUS-B achieved significantly shorter diagnostic times (median 8 and 5 days, respectively) compared to transthoracic (20.5 days) and surgical (24.5 days) biopsies. These endoscopic techniques were also associated with shorter time intervals to systemic therapy initiation (p=0.011). Minimally invasive approaches provided sufficient tissue for complete morphological, immunohistochemical, and molecular profiling in most cases, with no significant differences in adequacy among procedures. Patients with actionable mutations had a 44% lower mortality risk (HR=0.56; p=0.013), while high PD-L1 expression was associated with a 56% reduction in mortality risk (HR=0.44; p=0.003). Conclusions: Minimally invasive techniques, particularly EBUS and EUS-B, shortened diagnostic delays, ensured adequate biomarker sampling, and enabled earlier initiation of systemic therapy. Since the time-to-diagnosis was independently associated with survival, these approaches may have indirectly contributed to improved outcomes. Our findings highlight the importance of streamlining diagnostic pathways and expanding access to endoscopic methods to optimize care in advanced NSCLC.

Abstract in English:

ABSTRACT Objective: Despite advances in diagnosis and treatment, approximately 50% of individuals affected by tuberculosis develop post-tuberculosis lung disease (PTLD), leading to functional limitations and reduced quality of life (QoL). Pulmonary rehabilitation programs have demonstrated benefits in patients with PTLD; however, access remains limited, and telerehabilitation may offer a cost-effective solution. This study sought to compare physical capacity and QoL in patients with PTLD following an eight-week telerehabilitation program. Methods: This was a randomized controlled trial including 30 participants with confirmed PTLD. They were recruited and randomly assigned to an intervention group that received weekly telerehabilitation or a control group that received standard care. The interventions included aerobic training, breathing exercises, strength training, and stretching exercises. Physical capacity and QoL were assessed before and after the interventions by means of isokinetic dynamometry, the six-minute walk test, the five-repetition sit-to-stand test, spirometry, handgrip strength, the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), and the Saint George’s Respiratory Questionnaire. Results: After eight weeks, the intervention group showed significant improvements in all physical capacity parameters and QoL. Quadriceps strength correlated significantly with the physical functioning and mental health domains of the SF-36. Conclusions: Our findings suggest that telerehabilitation is an effective approach for enhancing physical function and QoL in patients with PTLD.

Abstract in English:

ABSTRACT Objective: Apart from the counter-regulation of angiotensin II levels in the renin-angiotensin system, angiotensin-converting enzyme 2 (ACE2) acts as a receptor for SARS-CoV-2, which is activated by transmembrane serine protease 2 (TMPRSS2) in target cells. Sirtuin 1 (SIRT1), an aging-related protein, controls ACE2 transcription in energy stress situations. This study aimed to evaluate the protein expression of ACE2, TMPRSS2, and SIRT1 in the lungs of children, adults, and elderly individuals. Methods: We used immunohistochemistry and software-assisted analysis to evaluate ACE2, TMPRSS2, and SIRT1 protein expression in autopsied lung tissue with minimal histological abnormalities and no clinical diagnosis of pulmonary disease or infection. The study population included 25 children (newborn to 19-year-old), 7 adults (20- to 59-year-old), and 11 elderly individuals (60- to 95-year-old). Of those 43 patients, 19 were female and 24 were male. Results: ACE2, TMPRSS2, and SIRT1 proteins were more expressed in the pulmonary parenchyma of children than in that of adults (p = 0.043, p = 0.008, and p = 0.032, respectively). SIRT1 expression was higher in the alveoli of children than in those of elderly patients (p = 0.008). No sex-based differences were observed. Spearman’s correlation coefficient showed that ACE2, TMPRSS2, and SIRT1 expression decreased with aging. Conclusions: ACE2, TMPRSS2, and SIRT1 were more expressed in the lung parenchyma (but not in the airways) of children than in that of older individuals. This could contribute to less severe COVID-19 lung disease in children.

Abstract in English:

ABSTRACT Introduction: GeneXpert® MTB/RIF Ultra (Ultra) is a method for detecting the Mycobacterium tuberculosis complex (Mtb) with greater sensitivity compared to GeneXpert® MTB/RIF (Xpert). In Brazil, for children and for extrapulmonary tuberculosis (EPTB), “traces detected” results are considered positive for Mtb. Here, we describe the use of Ultra at a reference center for pediatric tuberculosis (TB) in Rio de Janeiro, Brazil. Methods: A cross-sectional study was conducted with children (0-9 years) and adolescents (10-18 years) with presumed EPTB or pulmonary TB (PTB) whose specimens were tested using Ultra. Data were analyzed using descriptive statistics, and Fisher’s exact test (significance level p<0.05) was applied when appropriate. The study was approved by the Ethics Committee of IPPMG-UFRJ (CAAE: 02173518.2.0000.5264). Results: Ninety-three patients with presumed TB were included: 44% with PTB and 56% with EPTB. The final diagnoses revealed 63.4% PTB, 40.4% EPTB, and 49.5% other diagnoses. Among the PTB cases, 9/26 (34%) had positive results exclusively by Ultra. As for the EPTB cases, 11/21 (52%) were positive only by Ultra. For PTB, sensitivity was 50% and specificity was 100% (compared to culture). For EPTB, sensitivity was 85.7% and specificity was 100%. Conclusion: Ultra contributed to the diagnosis of both PTB and EPTB, especially in cases with negative culture results. The test demonstrated higher sensitivity in EPTB than in PTB.

Abstract in English:

ABSTRACT Objective: To evaluate the relationship between screen time (ST) and lung function in hospitalized children and adolescents with cystic fibrosis (CF). Methods: This was a cross-sectional study of 45 children with CF in the 0- to 17-year age bracket admitted to a public hospital in southern Brazil. ST during hospitalization was measured by means of a recall diary. Questionnaires were used in order to collect data on screen use and personal data. Data on lung function, nutrition, bacteriology, and the Shwachman-Kulczycki clinical score were obtained from patient medical records. Results: Of the study participants, 51.1% were male, with a median age of 9 years, and 80% were White. The mean FEV1 (Z-score) was −2.9 ± 1.9, and FEV1 (in % of predicted) was 63.7 ± 22.3. The median ST was 315 min, and 95.5% of the study participants exceeded the recommended ST. The most prevalent reasons for using electronic devices during hospitalization were boredom and lack of other activities. In a multivariate analysis, ST (the dependent variable) was significantly associated with age (b = 26.591; 95% CI, 14.695-38.487), time spent watching television at home (b = 0.686; 95% CI, 0.304-1.069), and FEV1 Z-score (b = −60.631; 95% CI, −115.399 to −5.864). Conclusions: Excess ST appears to be associated with worse lung function in hospitalized children with CF, as do older age and longer periods of time spent watching television at home.

Abstract in English:

ABSTRACT Pulmonary arterial hypertension (PAH) is a condition that predominantly affects the pulmonary arterial bed, leading to pulmonary vascular remodeling, progressive decrease in pulmonary arterial compliance, and increase in pulmonary vascular resistance. The symptoms of PAH are nonspecific, which often contributes to diagnostic challenges and significant delays in establishing the diagnosis. The investigation of PAH is extensive and involves thorough search for potential clinical conditions that may contribute to its development, as well as the exclusion of other causes of pulmonary hypertension. The proper hemodynamic definition of PAH requires right heart catheterization (RHC) and direct measurements of mean pulmonary artery pressure, pulmonary arterial wedge pressure, cardiac output, and pulmonary vascular resistance. Additionally, RHC allows the assessment of the severity of the disease and, in selected cases, the identification of patients with a positive pulmonary vascular vasoreactivity test. RHC also provides valuable longitudinal information for risk stratification and patient follow-up. In the current manuscript, we review the PAH diagnostic workup, including a detailed review of the most up-to-date recommendations for right RHC and patient risk stratification.

Abstract in English:

ABSTRACT Objective: To conduct a systematic review and meta-analysis of the evidence on the use of ultrasound to assess quadriceps morphology in people with cystic fibrosis (PwCF), focusing on muscle thickness, cross-sectional area, and associations with clinical outcomes. Methods: This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was registered on the International Prospective Register of Systematic Reviews platform (ID: CRD42024590549). The PubMed, Embase, Scopus, Web of Science, SciELO, and Cumulative Index to Nursing and Allied Health Literature databases were comprehensively searched without time restrictions. Gray literature and manual reference screening were also included. Observational studies assessing quadriceps morphology via ultrasound in people with CF and reporting quantitative outcomes were eligible. Two reviewers independently conducted study selection, data extraction, and risk of bias assessment using the Joanna Briggs Institute tool. Meta-analysis was performed with Cochrane’s Review Manager software. Results: Five studies met the inclusion criteria. People with CF showed reduced quadriceps thickness and cross-sectional area, particularly those who were malnourished. Moderate correlations were observed between ultrasound measurements and clinical parameters such as pulmonary function, fat-free mass index, and muscle strength. Meta-analysis revealed a significant reduction in rectus femoris muscle thickness in people with CF when compared with controls (mean difference: −0.50 cm; 95% CI, −0.78 to −0.22; p = 0.0004), with high heterogeneity (I2 = 94%). Risk of bias was moderate because of small sample sizes and methodological variability. Conclusions: Although the evidence is limited and heterogeneous, people with CF appear to show reduced quadriceps morphology, with associations with nutritional and functional status. Further high-quality studies are needed to confirm our findings and determine the clinical utility of ultrasound in this population.