Resumo em Inglês:

ABSTRACT Objective: To develop a multidimensional weighted score for progressive fibrotic interstitial lung disease (fILD) on the basis of mortality risk and compare the score with the progressive pulmonary fibrosis (PPF) guideline and Efficacy and Safety of Nintedanib in Patients with Progressive Fibrosing Interstitial Lung Disease (INBUILD) trial criteria. Methods: This was a multicenter retrospective cohort study of fILD patients evaluated from January of 2008 to January of 2020. Disease progression was evaluated by changes in dyspnea, HRCT findings, FVC, DLCO, and SpO2. Associations between the disease progression criteria and survival were analyzed by means of Kaplan-Meier curves. By means of univariate Cox regression, a score was determined on the basis of the relative weights for the progression criteria. The score was derived and tested within the same cohort. We compared the score with the PPF guideline and INBUILD trial criteria. Results: A total of 380 patients were evaluated. Cox regression was used in order to assign points to the progression criteria: a decrease of < 90% in SpO2 at rest (2 points); disease progression on HRCT (2 points); worsening dyspnea (1 point); a decrease ≥ 3% in SpO2 at rest (1 point); a decrease of 5-9% in FVC (1 point); and a decrease ≥ 10% in FVC (2 points). The final score was categorized as follows: low risk, 0-2 points (n = 244), median survival = undetermined; intermediate risk, 3-4 points (n = 61), median survival = 81 months (95% CI, 65-96); and high risk, ≥ 5 points (n = 75), median survival = 57 months (95% CI, 38-75; p < 0.001). A total of 136 patients (35.8%) showed disease progression. Kappa concordance was 0.92 (p < 0.001) for the PPF guideline criteria and 0.81 (p < 0.001) for the INBUILD trial criteria. Conclusions: A multidimensional weighted score allows us to estimate the risk of progressive fILD. When dichotomized, the concordance with the PPF guideline and INBUILD trial criteria is high. External validation is required before routine clinical application.

Resumo em Inglês:

ABSTRACT Objective: Insufficient diversity is common among patients and authors in studies supporting guidelines. We hypothesized that the latest severe community-acquired pneumonia (CAP) guidelines suffered from such bias. Methods: We reviewed all original studies supporting the latest severe CAP guidelines. We assessed whether there were language restrictions in the search for studies to be included in each recommendation and recorded the following: the proportion of female patients included in the studies; ethnicity (when available); year of publication; and study location, which was classified by income in accordance with the World Bank classification. We also compiled data on the sex and affiliation of the first and last authors. Results: The guidelines included 115 references in eight sections; 74 unique references supported the recommendations. There was language restriction in the selection of studies in 3 of 8 questions. The proportion of female patients ranged from 4.7% to 70.5% (mean, 36%). Most of the patients were White (72.2-91.2%), and 80.5% of the studies were conducted in high-income countries. Only 6 (5.2%) of the 115 references included patients from low- or middle-income countries. Most of the first and last authors were male (75.6-88.3%) and were based in high-income countries (96.1%). Conclusions: The studies supporting the severe CAP guidelines were found to have insufficient diversity and representativeness of patients, sex, and country of origin of the authors. To enhance the generalizability of severe CAP guidelines, strategies must be devised to increase the diversity of patients and authors.

Resumo em Inglês:

ABSTRACT Objective: To describe the sociodemographic profile of individuals eligible for lung cancer screening according to Brazilian guidelines. Methods: This was a cross-sectional study using data from the Brazilian Longitudinal Study of Aging. We included individuals 50-80 years of age, with a smoking history of ≥ 20 pack-years, who were either current smokers or former smokers who had quit within the past 15 years. Demographic, socioeconomic, and health characteristics were analyzed. Results: Among 8,946 participants, 577 were eligible. Most (57.4%) were male and 37.4% were between 55 and 59 years of age. Black and Brown (mixed-race) participants accounted for 53.5% of the sample, and 60.6% had < 9 years of schooling. Self-rated health was poor/fair in 52.5% of the individuals, 89.3% had no private health insurance, and 41.9% were in the lowest tertile for household income. Our findings show that eligible individuals often present features associated with social vulnerability, such as a low level of education, low income, and limited access to health care. Conclusions: These results highlight the importance of considering sociodemographic factors in the implementation of lung cancer screening strategies, to ensure equity in access and effectiveness of public policies aimed at early diagnosis.

Resumo em Inglês:

ABSTRACT Objective: To describe clinical obstructive sleep apnea (OSA) phenotypes based on emerging groups. Methods: A cross-sectional study was conducted among adult patients referred for home sleep respiratory assessment. Cluster analysis was conducted based on sex, age, Epworth Sleepiness Scale (ESS) score, BMI, neck > 40 cm (women) or > 42 cm (men), hypertension, and time spent with SpO2 below 90% (T<90%). Results: The K-means algorithm identified three groups: 1) Severe obesity, borderline sleepiness (n = 1,026) with a mean BMI of 34.7 kg/m2, ESS score of 9.3, apnea-hypopnea index (AHI) of 31.3 events/h, and T<90% of 4.9 (%); 2) Moderate disease burden, asymptomatic without hypoxemia (n = 497) with a mean BMI = 28.5 kg/m2, ESS score = 6.6, AHI = 25.7 events/h, and T<90% of 1.8%; and 3) Sleepy patients with severe OSA (n = 993) with a mean BMI = 29.5 kg/m2, ESS score = 13.6, AHI = 33.9 events/h, and T<90% of 3.6%. Conclusions: In this large sample of Latin American patients with OSA diagnosed using home respiratory polygraphy, cluster analysis identified three clinically relevant phenotypes. Notably, severe OSA was observed both in patients with severe obesity and borderline daytime symptoms and in overweight patients with excessive daytime sleepiness. These findings highlight the heterogeneity of OSA and emphasize the need for individualized phenotype-based clinical approaches.