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2.
BMC Pulm Med ; 24(1): 135, 2024 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-38491509

RESUMO

BACKGROUND: Household contacts of tuberculosis (TB) patients are at a greater risk of infection and developing TB as well. Despite recommendations to actively screen such high-risk groups for TB, it is poorly implemented in Ethiopia. A community-based household contact screening was conducted to compare the yield of two different screening approaches and to identify factors associated with TB occurrence. METHODS: Smear-positive pulmonary TB index cases from six health facilities in six districts of Silti Zone were identified and enrolled prospectively between September 2020 and December 2022. Trained healthcare workers conducted house visits to screen household contacts for TB. WHO (World Health Organization) recommended symptom-based screening algorithms were used. The yield of screening was compared between a two-time screening at study site I and a single baseline screening at study site II, which is the current programmatic approach. Generalized estimating equation was used to run multivariate logistic regression to identify factors associated with TB occurrence. RESULTS: A total of 387 index TB cases (193 at site I and 194 at site II) with 1,276 eligible contacts were included for analysis. The TB yield of repeat screening approach did not show a significant difference compared to a single screening (2.3% at site I vs. 1.1% at site II, p < 0.072). The number needed to screen was 44 and 87 for the repeat and single screening, respectively, indicating a high TB burden in both settings. The screening algorithm for patients with comorbidities of asthma and heart failure had a 100% sensitivity, 19.1% specificity and a positive predictive value of 5.6%. Cough [AOR: 10.9, 95%CI: 2.55,46.37], fatigue [AOR: 6.1, 95%CI: 1.76,21.29], daily duration of contact with index case [AOR: 4.6, 95%CI; 1.57,13.43] and age of index cases [AOR: 0.9, 95%CI; 0.91-0.99] were associated with the occurrence of TB among household contacts. CONCLUSION: Our study showed that the yield of TB was not significantly different between one-time screening and repeat screening. Although repeat screening has made an addition to case notification, it should be practiced only if resources permit. Cough, fatigue, duration of contact and age of index cases were factors associated with TB. Further studies are needed to establish the association between older age and the risk of transmitting TB.


Assuntos
Busca de Comunicante , Tuberculose , Humanos , Estudos Prospectivos , Etiópia/epidemiologia , Tuberculose/diagnóstico , Tuberculose/epidemiologia , Tosse/diagnóstico , Tosse/epidemiologia
3.
Can Fam Physician ; 70(3): 169-170, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38499366

RESUMO

QUESTION: An 8-month-old boy presented to our clinic with a 3-day history of fever. He has had a cough and rhinorrhea since the onset of the fever, and his 4-year-old sibling has recently had cough and cold symptoms. I have heard that the presence of respiratory symptoms means that urinary tract infection (UTI) is less likely. In infants with fever and respiratory symptoms, who should have a sample collected for urinalysis for UTI? ANSWER: The approach to diagnosing febrile infants who have respiratory symptoms varies by age. Urinalysis should be done for all febrile infants younger than 2 months of age, regardless of whether they have respiratory symptoms. Clinicians should assess risk factors for UTI in every infant between 2 and 24 months of age and should not exclude the diagnosis of UTI based on respiratory symptoms alone. Use of a predictive tool to estimate the pretest probability of UTI would aid decision making about patients in this population.


Assuntos
Infecções Urinárias , Lactente , Masculino , Criança , Humanos , Pré-Escolar , Infecções Urinárias/diagnóstico , Urinálise/efeitos adversos , Febre/diagnóstico , Febre/etiologia , Fatores de Risco , Tosse/diagnóstico , Tosse/etiologia
4.
Respir Res ; 25(1): 128, 2024 Mar 18.
Artigo em Inglês | MEDLINE | ID: mdl-38500141

RESUMO

BACKGROUND: Adequate cough or exsufflation flow can indicate an option for safe tracheostomy decannulation to noninvasive management. Cough peak flow via the upper airways with the tube capped is an outcome predictor for decannulation readiness in patients with neuromuscular impairment. However, this threshold value is typically measured with tracheotomy tube removed, which is not acceptable culturally in China. The aim of this study was to assess the feasibility and safety of using cough flow measured with tracheostomy tube and speaking valve (CFSV) > 100 L/min as a cutoff value for decannulation. STUDY DESIGN: Prospective observational study conducted between January 2019 and September 2022 in a tertiary rehabilitation hospital. METHODS: Patients with prolonged tracheostomy tube placement were referred for screening. Each patient was assessed using a standardized tracheostomy decannulation protocol, in which CFSV greater than 100 L/min indicated that the patients' cough ability was sufficient for decannulation. Patients whose CFSV matched the threshold value and other protocol criteria were decannulated, and the reintubation and mortality rates were followed-up for 6 months. RESULTS: A total of 218 patients were screened and 193 patients were included. A total of 105 patients underwent decannulation, 103 patients were decannulated successfully, and 2 patients decannulated failure, required reinsertion of the tracheostomy tube within 48 h (failure rate 1.9%). Three patients required reinsertion or translaryngeal intubation within 6 months. CONCLUSIONS: CFSV greater than 100 L/min could be a reliable threshold value for successful decannulation in patients with various primary diseases with a tracheostomy tube. TRIAL REGISTRATION: This observational study was not registered online.


Assuntos
Respiração , Traqueostomia , Humanos , Intubação Intratraqueal , Pico do Fluxo Expiratório , Tosse/diagnóstico , Estudos Retrospectivos
5.
Respir Med ; 224: 107582, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38428509

RESUMO

BACKGROUND: Cough is considered chronic when it lasts for >8 weeks. When no medical explanation can be found it is often called unexplained chronic cough (UCC), which may affect health-related quality of life (HRQOL). This study aimed to assesses the validity and reliability of the Swedish version of the Leicester Cough Questionnaire (LCQ-S) in patients with UCC. METHODS: Seventy-six consecutively selected patients with UCC replied to: a local questionnaire; the LCQ-S; a Visual Analog Scale (VAS) for cough; the Swedish version of the Hull Airway Reflux Questionnaire (HARQ-S); and the Chemical Sensitivity Scale for Sensory Hyperreactivity (CSS-SHR). To evaluate the reproducibility of the LCQ-S, the VAS and LCQ-S were answered again after two to four weeks. RESULTS: Seventy-four patients (17 men) answered the questionnaires at baseline. Concurrent validity for LCQ-S was regarded as moderate with the VAS for cough and HARQ-S. Internal consistency using Cronbach's alpha was high for the LCQ-S total score (0.92) and satisfactory for the LCQ-S domains (0.78-0.83). Reliability and reproducibility were analysed in 57 patients (14 men). Intra-class correlation for the LCQ-S total score and domains showed strong reliability (≥0.92), without any significant differences over time. The standard error of measurement and the smallest real difference were 1.26 and 3.49, respectively. The Bland-Altman plot showed no systematic change in the mean values. CONCLUSIONS: The LCQ-S has good validity and reliability and can be used in clinical settings to evaluate HRQOL in Swedish-speaking adult patients with UCC.


Assuntos
Qualidade de Vida , Adulto , Masculino , Humanos , Reprodutibilidade dos Testes , Suécia , Tosse/diagnóstico , Inquéritos e Questionários , Doença Crônica
6.
Ann Clin Lab Sci ; 54(1): 112-113, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38514061

RESUMO

OBJECTIVE: To present the case of an athlete with hypereosinophilic syndrome (HES). CASE REPORT: We present a 25-year-old female athlete, with no significant past medical history, who had a two-month history of progressive dry cough, wheezing, exertional dyspnea, and chest pain. Physical examination revealed patient to be febrile to 101.6 degrees Fahrenheit and tachycardic to 120 beats per minute with new leukocytosis of 35.9x109/L and eosinophilia of 24,000/µL. She was also found to have elevated troponins ~1.5 ng/mL and creatine kinase (CK) 203 U/L. Her overall clinical picture was concerning for hypereosinophilic syndrome with multiorgan system involvement. CONCLUSION: Findings endorse the diagnosis of HES. HES is a rare condition that is difficult to diagnose. Early clinical diagnostic signs of HES may include fatigue, cough, breathlessness, and fever.


Assuntos
Síndrome Hipereosinofílica , Humanos , Feminino , Adulto , Síndrome Hipereosinofílica/diagnóstico , Tosse/diagnóstico , Tosse/etiologia , Atletas
7.
Ther Adv Respir Dis ; 18: 17534666241236025, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38501735

RESUMO

BACKGROUND: Chronic cough, defined as a cough lasting 8 or more weeks, affects up to 10% of adults. Refractory chronic cough (RCC) is a cough that is uncontrolled despite comprehensive investigation and treatment of comorbid conditions while unexplained chronic cough (UCC) is a cough with no identifiable cause despite extensive evaluation of comorbid conditions. RCC and UCC are often poorly controlled. Understanding individuals' lived experience of the symptoms and impacts of these conditions may guide therapeutic strategies. OBJECTIVES: The primary objectives of this study were to assess respondents' perceptions of the key symptoms of RCC and UCC and the impacts of RCC and UCC and their symptoms on well-being, health-related quality of life, work productivity, and social relationships. DESIGN: Qualitative study. METHODS: This study enrolled 30 adults with physician-diagnosed RCC or UCC. Two trained qualitative researchers conducted individual, in-depth telephone interviews using a semi-structured interview guide. Interviews were audio-recorded, transcribed, coded, and systematically analyzed to identify content themes. RESULTS: A total of 15 respondents with RCC and 15 with UCC were included in the study. Many respondents had RCC or UCC for a long duration (median 9 years, range: 0-24). Half of the respondents reported having a coughing episode at least once daily. Only 40% of respondents reported that medication had improved their symptoms. In over half of the respondents, RCC or UCC hindered communication, caused embarrassment, frustration, and worry, and lowered quality of life. Perceptions of meaningful treatment benefits in RCC or UCC varied widely across respondents. CONCLUSION: RCC and UCC remained poorly managed in many individuals and were associated with a wide range of symptoms and cough triggers that hindered daily activities and reduced emotional well-being. Understanding individuals' lived experiences may inform the development of RCC and UCC therapeutic strategies.


Patient-reported experiences with refractory or unexplained chronic cough: a qualitative analysisChronic cough, particularly refractory and unexplained chronic cough, remain poorly managed in many individuals and are associated with a wide range of symptoms and cough triggers that hinder daily activities and reduce emotional well-being. Currently there are no US Food and Drug Administration-approved treatments for refractory or unexplained chronic cough. Understanding the experience and treatment preferences of individuals with these conditions may help inform the development of new therapies and clarify the potential impact of such therapies on the lives of individuals with chronic cough. Using in-depth interviews, the present study comprehensively evaluated individuals' experience with refractory or unexplained chronic cough and treatment priorities, a research area that has not been well-studied. This study detailed broad-ranging physical, behavioral, and emotional impacts of chronic cough, which hindered individuals' social well-being.


Assuntos
Carcinoma de Células Renais , Neoplasias Renais , Adulto , Humanos , Doença Crônica , Qualidade de Vida , Tosse/diagnóstico , Tosse/epidemiologia , Tosse/etiologia , Medidas de Resultados Relatados pelo Paciente
8.
PLoS One ; 19(3): e0292980, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38502606

RESUMO

Explainable Artificial Intelligence (XAI) is becoming a disruptive trend in healthcare, allowing for transparency and interpretability of autonomous decision-making. In this study, we present an innovative application of a rule-based classification model to identify the main causes of chronic cough-related quality of life (QoL) impairment in a cohort of asthmatic patients. The proposed approach first involves the design of a suitable symptoms questionnaire and the subsequent analyses via XAI. Specifically, feature ranking, derived from statistically validated decision rules, helped in automatically identifying the main factors influencing an impaired QoL: pharynx/larynx and upper airways when asthma is under control, and asthma itself and digestive trait when asthma is not controlled. Moreover, the obtained if-then rules identified specific thresholds on the symptoms associated to the impaired QoL. These results, by finding priorities among symptoms, may prove helpful in supporting physicians in the choice of the most adequate diagnostic/therapeutic plan.


Assuntos
Asma , Qualidade de Vida , Humanos , Inteligência Artificial , Tosse/diagnóstico , Asma/complicações , Asma/diagnóstico
9.
Ther Adv Respir Dis ; 18: 17534666241231117, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38409671

RESUMO

BACKGROUND: Fractional exhaled nitric oxide (FeNO) measured at multiple exhalation flow rates can be used as a biomarker to differentiate central and peripheral airway inflammation. However, the role of alveolar nitric oxide (CaNO) indicating peripheral airway inflammation remains unclear in gastroesophageal reflux-associated cough (GERC). OBJECTIVES: We aimed to characterize the changes in alveolar nitric oxide (CaNO) and determine its clinical implication in GERC. DESIGN: This is a single-center prospective observational study. METHODS: FeNOs at exhalation flow rates of 50 and 200 ml/s were measured in 102 patients with GERC and 134 patients with other causes of chronic cough (non-GERC). CaNO was calculated based on a two-compartment model and the factors associated with CaNO were analyzed. The effect of anti-reflux therapy on CaNO was examined in 26 GERC patients with elevated CaNO. RESULTS: CaNO was significantly elevated in GERC compared with that in non-GERC (4.6 ± 4.4 ppb versus 2.8 ± 2.3 ppb, p < 0.001). GERC patients with high CaNO (>5 ppb) had more proximal reflux events (24 ± 15 versus 9 ± 9 episodes, p = 0.001) and a higher level of pepsin (984.8 ± 492.5 versus 634.5 ± 626.4 pg/ml, p = 0.002) in sputum supernatant than those with normal CaNO. More GERC patients with high CaNO required intensified anti-reflux therapy (χ2 = 3.963, p = 0.046), as predicted by a sensitivity of 41.7% and specificity of 83.3%. Cough relief paralleled a significant improvement in CaNO (8.3 ± 3.0 versus 4.8 ± 2.6 ppb, p < 0.001). CONCLUSION: Peripheral airway inflammation can be assessed by CaNO measurement in GERC. High CaNO indicates potential micro-aspiration and may predict a necessity for intensified anti-reflux therapy.


Role of CaNO in GERCWhy was the study done? This study aimed to investigate the role of concentration of alveolar nitric oxide (CaNO) as a biomarker for peripheral airway inflammation in patients with gastroesophageal reflux-associated cough (GERC). The evaluation of airway inflammation in GERC has not been widely practiced in clinical settings, and the potential of CaNO as a biomarker remained unclear.What did the researchers do? The researchers conducted a prospective study involving patients diagnosed with GERC and compared the changes in CaNO levels between GERC patients and those with cough due to other causes. The study also identified potential factors contributing to elevated CaNO levels in GERC patients relative to the normal range. Additionally, CaNO level changes were evaluated in a subgroup of GERC patients with initially elevated CaNO levels (n = 26).What did the researchers find? The study found that CaNO levels were significantly increased in GERC patients. Using a reference value for normal CaNO, the GERC patients were divided into a high CaNO cohort and a normal CaNO cohort. More proximal reflux episodes and higher level of pepsin in sputum supernatant were observed in the high CaNO cohort. Moreover, CaNO demonstrated moderate predictive value for the therapeutic efficacy of intensified anti-reflux therapy in GERC patients. After several weeks of anti-reflux therapy, CaNO levels significantly decreased along with the resolution of cough. These findings further confirmed the predictive value of CaNO for anti-reflux therapy.What do the findings mean? The findings suggest that CaNO may have the potential to be used as a non-invasive biomarker for detecting peripheral airway inflammation in GERC patients. Increased CaNO may be associated with potential micro-aspiration. Furthermore, high CaNO may predict the need for intensified anti-reflux therapy.


Assuntos
Refluxo Gastroesofágico , Óxido Nítrico , Humanos , Refluxo Gastroesofágico/diagnóstico , Refluxo Gastroesofágico/complicações , Tosse/diagnóstico , Tosse/etiologia , Inflamação/diagnóstico , Escarro , Testes Respiratórios
10.
Chest ; 165(2): e49-e56, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38336444

RESUMO

CASE PRESENTATION: A 48-year-old woman presented to the ED with a nonproductive cough, shortness of breath, and stridor. She was otherwise healthy and had never used tobacco. The patient was mildly tachycardic but otherwise hemodynamically stable, afebrile, and saturating well on room air. She did not display any signs of increased work of breathing at rest. Although auscultation of her thorax indicated good air entry bilaterally without any adventitious sounds, stridor was elicited with forced expiration.


Assuntos
Dispneia , Sons Respiratórios , Humanos , Feminino , Pessoa de Meia-Idade , Sons Respiratórios/etiologia , Dispneia/diagnóstico , Dispneia/etiologia , Tosse/diagnóstico , Tosse/etiologia
11.
Sensors (Basel) ; 24(4)2024 Feb 10.
Artigo em Inglês | MEDLINE | ID: mdl-38400330

RESUMO

Respiratory diseases represent a significant global burden, necessitating efficient diagnostic methods for timely intervention. Digital biomarkers based on audio, acoustics, and sound from the upper and lower respiratory system, as well as the voice, have emerged as valuable indicators of respiratory functionality. Recent advancements in machine learning (ML) algorithms offer promising avenues for the identification and diagnosis of respiratory diseases through the analysis and processing of such audio-based biomarkers. An ever-increasing number of studies employ ML techniques to extract meaningful information from audio biomarkers. Beyond disease identification, these studies explore diverse aspects such as the recognition of cough sounds amidst environmental noise, the analysis of respiratory sounds to detect respiratory symptoms like wheezes and crackles, as well as the analysis of the voice/speech for the evaluation of human voice abnormalities. To provide a more in-depth analysis, this review examines 75 relevant audio analysis studies across three distinct areas of concern based on respiratory diseases' symptoms: (a) cough detection, (b) lower respiratory symptoms identification, and (c) diagnostics from the voice and speech. Furthermore, publicly available datasets commonly utilized in this domain are presented. It is observed that research trends are influenced by the pandemic, with a surge in studies on COVID-19 diagnosis, mobile data acquisition, and remote diagnosis systems.


Assuntos
Teste para COVID-19 , Doenças Respiratórias , Humanos , Inteligência Artificial , Sons Respiratórios/diagnóstico , Tosse/diagnóstico , Biomarcadores
12.
Int J Tuberc Lung Dis ; 28(2): 93-98, 2024 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-38303040

RESUMO

BACKGROUND: Cough is the key symptom of pulmonary TB (PTB) and is associated with transmission. No tool for measuring the subjective impact of cough in PTB has been previously validated. We sought to measure patientreported cough in PTB and investigate any relationship to objectively quantified daily cough frequency.METHODS: The validity of the Leicester Cough Questionnaire (LCQ) was assessed in sequential patients newly diagnosed with PTB at a UK hospital. Resulting LCQ scores were compared to non-cough clinical variables, and to 24-h, ambulatory, objective cough frequency measured using the Leicester Cough Monitor.RESULTS: The LCQ in 30 patients with PTB was acceptable to users and had high internal reliability (Cronbach's α = 0.93), concurrent validity (correlation with visual analogue scale for cough severity, Spearman's ρ = ???0.69) and responsiveness (substantial median increase score after 2 weeks of TB treatment: 5.1 points, IQR 1.8???9.7; P = 0.003). There was only moderate correlation between patient-reported cough and objectively-measured 24-h cough frequency in PTB (ρ = ???0.48, P = 0.008).CONCLUSION: The LCQ is valid for use in PTB, with applications that include monitoring treatment of the disease. However, there was a mismatch between objective and subjective assessment of cough, which has important implications for delayed diagnosis and transmissibility.


Assuntos
Qualidade de Vida , Tuberculose , Humanos , Reprodutibilidade dos Testes , Inquéritos e Questionários , Tosse/diagnóstico , Tosse/etiologia
13.
Urol Pract ; 11(2): 402-408, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38305190

RESUMO

INTRODUCTION: Our objectives were to evaluate the Male Stress Incontinence Grading Scale to stratify male patients with stress urinary incontinence for either artificial urinary sphincter or sling using a standing cough test and determine if an emptier bladder at the time of assessment carries increased risk of treatment failure. METHODS: Retrospective chart review of male patients undergoing sling and artificial urinary sphincter placement. The standing cough test score and bladder scan results were documented at initial evaluation. RESULTS: Forty patients underwent sling and 43 underwent naïve artificial sphincter placement. Median follow-up was 7.11 months. Thirty-six/forty slings had complete incontinence resolution or reduction to a safety pad vs 40/43 after sphincter (90% vs 93%, P = .62). Four sling patients (10%) had persistence or recurrence of incontinence. Cough test scores were similar between sling failure (67% grade 0, 33% grade 1) and success groups (83% grade 0, 3% grade 1, 14% grade 2). Bladder scan mean was 18.5 cc in the sling failure (SD 21.1) and 38.0 cc in the success groups (38.3), with 32% of success patients having bladder scans of 0 cc, and 63% of < 50 cc. Mean for sphincter patients was 45 cc (56.9). Ten patients with scan = 0 and 7 patients with scans < 30 cc demonstrated grade 4 incontinence. CONCLUSIONS: Cough test is a noninvasive, reliable tool to assess stress urinary incontinence severity. Our data suggest it is reliable even when bladders are nearly empty and can effectively stratify patients for sling vs artificial urinary sphincter with a high rate of success.


Assuntos
Slings Suburetrais , Incontinência Urinária por Estresse , Incontinência Urinária , Humanos , Masculino , Incontinência Urinária por Estresse/diagnóstico , Bexiga Urinária/diagnóstico por imagem , Estudos Retrospectivos , Slings Suburetrais/efeitos adversos , Incontinência Urinária/complicações , Tosse/diagnóstico
14.
HNO ; 72(3): 210-220, 2024 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-38319354

RESUMO

Approximately 10% of the population suffer from a cough lasting longer than 8 weeks. Compared to acute cough, which usually occurs in the context of banal respiratory tract infections, the differential diagnoses of chronic cough require an increased use of diagnostic tests and thus a structured, evidence-based approach according to current international guidelines. A targeted history (smoking status, medication, previous diseases) and ENT status are always followed by chest x­ray and pulmonary function tests before extended diagnostics. In the case of angiotensin-converting enzyme (ACE) inhibitor use and unremarkable physical examination, a drug discontinuation test can be carried out first. In case of inconspicuous findings, a disease entity that can be treated empirically such as upper airway cough syndrome is most likely. If the cough remains unexplained, cough suppression techniques, physiotherapy or speech therapy should be sought before off-label-use of medication.


Assuntos
Anormalidades do Sistema Respiratório , Infecções Respiratórias , Adulto , Humanos , Doença Crônica , Tosse/diagnóstico , Tosse/etiologia , Tosse/terapia
15.
PLoS One ; 19(2): e0297655, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38300934

RESUMO

Accurate identification of porcine cough plays a vital role in comprehensive respiratory health monitoring and diagnosis of pigs. It serves as a fundamental prerequisite for stress-free animal health management, reducing pig mortality rates, and improving the economic efficiency of the farming industry. Creating a representative multi-source signal signature for porcine cough is a crucial step toward automating its identification. To this end, a feature fusion method that combines the biological features extracted from the acoustic source segment with the deep physiological features derived from thermal source images is proposed in the paper. First, acoustic features from various domains are extracted from the sound source signals. To determine the most effective combination of sound source features, an SVM-based recursive feature elimination cross-validation algorithm (SVM-RFECV) is employed. Second, a shallow convolutional neural network (named ThermographicNet) is constructed to extract deep physiological features from the thermal source images. Finally, the two heterogeneous features are integrated at an early stage and input into a support vector machine (SVM) for porcine cough recognition. Through rigorous experimentation, the performance of the proposed fusion approach is evaluated, achieving an impressive accuracy of 98.79% in recognizing porcine cough. These results further underscore the effectiveness of combining acoustic source features with heterogeneous deep thermal source features, thereby establishing a robust feature representation for porcine cough recognition.


Assuntos
Algoritmos , Redes Neurais de Computação , Suínos , Animais , Tosse/diagnóstico , Biometria , Som
16.
J Med Internet Res ; 26: e51640, 2024 Feb 06.
Artigo em Inglês | MEDLINE | ID: mdl-38319694

RESUMO

BACKGROUND: The outbreak of SARS-CoV-2 in 2019 has necessitated the rapid and accurate detection of COVID-19 to manage patients effectively and implement public health measures. Artificial intelligence (AI) models analyzing cough sounds have emerged as promising tools for large-scale screening and early identification of potential cases. OBJECTIVE: This study aimed to investigate the efficacy of using cough sounds as a diagnostic tool for COVID-19, considering the unique acoustic features that differentiate positive and negative cases. We investigated whether an AI model trained on cough sound recordings from specific periods, especially the early stages of the COVID-19 pandemic, were applicable to the ongoing situation with persistent variants. METHODS: We used cough sound recordings from 3 data sets (Cambridge, Coswara, and Virufy) representing different stages of the pandemic and variants. Our AI model was trained using the Cambridge data set with subsequent evaluation against all data sets. The performance was analyzed based on the area under the receiver operating curve (AUC) across different data measurement periods and COVID-19 variants. RESULTS: The AI model demonstrated a high AUC when tested with the Cambridge data set, indicative of its initial effectiveness. However, the performance varied significantly with other data sets, particularly in detecting later variants such as Delta and Omicron, with a marked decline in AUC observed for the latter. These results highlight the challenges in maintaining the efficacy of AI models against the backdrop of an evolving virus. CONCLUSIONS: While AI models analyzing cough sounds offer a promising noninvasive and rapid screening method for COVID-19, their effectiveness is challenged by the emergence of new virus variants. Ongoing research and adaptations in AI methodologies are crucial to address these limitations. The adaptability of AI models to evolve with the virus underscores their potential as a foundational technology for not only the current pandemic but also future outbreaks, contributing to a more agile and resilient global health infrastructure.


Assuntos
COVID-19 , Humanos , COVID-19/diagnóstico , SARS-CoV-2 , Inteligência Artificial , Teste para COVID-19 , Pandemias , Tosse/diagnóstico
17.
Ther Adv Respir Dis ; 18: 17534666231220817, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38183243

RESUMO

BACKGROUND: Empiric therapy with multichannel intraluminal impedance-pH monitoring (MII-pH) has been used for the initial treatment of gastroesophageal reflux-induced chronic cough (GERC). However, an algorithm based on the gastroesophageal reflux disease questionnaire (GerdQ) has the potential to achieve a simple, structured, and effective treatment approach for patients with GERC. OBJECTIVES: This study compared the efficacy of anti-reflux therapy based on GerdQ (new structured pathway, NSP) with medical treatment after MII-pH examination (ordinary clinical pathway, OCP) in the management of GERC. DESIGN: For the NSP, we adapted the GerdQ score to establish the basis for a treatment algorithm. For the OCP, treatment was determined using the MII-pH examination results. METHODS: The non-inferiority (NI) hypothesis was used to evaluate NSP versus OCP. RESULTS: Overall, the NSP and OCP-based therapeutic algorithms have similar efficacy for GERC [NI analysis: 95% confidence interval (CI), -4.97 to 17.73, p = 0.009; superiority analysis: p = 0.420]. Moreover, the cough symptom scores and cough threshold improved faster in the NSP group than in the OCP group at week 8 (p < 0.05). In the subgroup analyses using the GerdQ and GerdQ impact scale (GIS) scores, patients with low-likelihood GERC (GerdQ < 8) were more likely to benefit from OCP (NI analysis: 95% CI, -19.73 to 18.02, p = 0.213). On the other hand, in patients with high-likelihood and low-reflux impact GERC patients (GerdQ > 8 and GIS < 4), the NSP arm was not inferior to the standard treatment of OCP (NI analysis: 95% CI, -8.85 to 28.21%, p = 0.04; superiority analysis: p = 0.339), indicating that GerdQ- and GIS-guided diagnosis and management of patients with GERC could be an alternative to MII-pH management, especially in settings with reduced medical resources. CONCLUSIONS: The use of the GerdQ algorithm should be considered when handling patients with GERC in the primary care setting. TRIAL REGISTRATION: This research was registered in the Chinese Clinical Trials Registry (ChiCTR-ODT-12001899).


Assuntos
Refluxo Gastroesofágico , Humanos , Impedância Elétrica , Refluxo Gastroesofágico/complicações , Refluxo Gastroesofágico/diagnóstico , Refluxo Gastroesofágico/tratamento farmacológico , Tosse/diagnóstico , Tosse/etiologia , Tosse/terapia , Algoritmos , Concentração de Íons de Hidrogênio
19.
Sci Rep ; 14(1): 593, 2024 01 05.
Artigo em Inglês | MEDLINE | ID: mdl-38182601

RESUMO

Coughing, a prevalent symptom of many illnesses, including COVID-19, has led researchers to explore the potential of cough sound signals for cost-effective disease diagnosis. Traditional diagnostic methods, which can be expensive and require specialized personnel, contrast with the more accessible smartphone analysis of coughs. Typically, coughs are classified as wet or dry based on their phase duration. However, the utilization of acoustic analysis for diagnostic purposes is not widespread. Our study examined cough sounds from 1183 COVID-19-positive patients and compared them with 341 non-COVID-19 cough samples, as well as analyzing distinctions between pneumonia and asthma-related coughs. After rigorous optimization across frequency ranges, specific frequency bands were found to correlate with each respiratory ailment. Statistical separability tests validated these findings, and machine learning algorithms, including linear discriminant analysis and k-nearest neighbors classifiers, were employed to confirm the presence of distinct frequency bands in the cough signal power spectrum associated with particular diseases. The identification of these acoustic signatures in cough sounds holds the potential to transform the classification and diagnosis of respiratory diseases, offering an affordable and widely accessible healthcare tool.


Assuntos
COVID-19 , Tosse , Humanos , Tosse/diagnóstico , Som , Acústica , Algoritmos , COVID-19/diagnóstico , Teste para COVID-19
20.
Chest ; 165(1): e11-e17, 2024 01.
Artigo em Inglês | MEDLINE | ID: mdl-38199739

RESUMO

CASE PRESENTATION: A 39-year-old man who did not smoke was admitted to the hospital with recurrent cough for 1 year, accompanied by sputum expectoration (with a small amount of white phlegm), acid regurgitation, and belching. Nasal symptoms or other cough-related contributing factors were denied. The patient reported that his cough mainly occurred at nighttime and was aggravated in the supine position. Vomiting could occur when the cough was violent. He denied fever, dysphonia, chest tightness, wheezing, chest pain and hemoptysis, abdominal pain, and bloating. The patient had initially presented to the local hospital and underwent a chest CT scan. The chest CT scan showed slight and scattered patchy infiltration in bilateral lung fields and without other significant pulmonary lesions. Anti-infective treatment was administered but was not effective for ameliorating the cough symptoms. He then received an inhaled corticosteroid, antihistamines, antileukotriene agents, or proton pump inhibitors for 6 months. However, all these treatments failed to alleviate the patient's cough. He had a history of hypertension and hyperlipidemia for > 10 years and was treated with valsartan (an angiotensin II receptor blocker) and atorvastatin. In the past year, the patient had lost 10 kg of weight, and his current BMI was 27.72 kg/m2.


Assuntos
Eructação , Masculino , Humanos , Adulto , Tosse/diagnóstico , Tosse/etiologia , Vômito , Hemoptise
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