Ricardo Lima

Severe asthma is a subset of difficult-to-treat asthma that requires the verification of inhaler technique, the correction of modifiable risk factors, as well as diagnosis and comorbidity review. When severe asthma is suspected, patients should undergo proper phenotyping (T2-high or T2-low) and be referred to a specialized severe asthma clinic. The current biologics for severe asthma treatment include omalizumab (anti-IgE), mepolizumab and reslizumab (anti-IL-5), benralizumab (anti-IL-5 receptor), dupilumab (anti-IL-4/IL-13), and tezepelumab (anti-TSLP). The outcomes to evaluate are the reduction in systemic corticosteroid use, the reduction in exacerbations and healthcare use, and improvement in symptoms and lung function. Comorbidities should be carefully considered, and if possible, addressed with the same biologic. Dupilumab, mepolizumab, and omalizumab are also approved for chronic rhinosinusitis with nasal polyps (CRSwNP), the most common asthma comorbidity. There are currently several clinical trials on biologics for severe asthma. Depemokimab is an ultra-long-acting anti-IL-5 antibody with promising results in phase III trials as a twice-yearly biologic for T2-high asthma. Verekitug follows a similar dosing concept, targeting TSLP, but is still undergoing phase II trials. Itepekimab and astegolimab are two anti-IL-33 antibodies that could have a role in the future treatment of severe asthma. Tezepelumab is in a phase III clinical trial for CRSwNP. Besides new drugs, there is still a need for major research into biologics in severe asthma cases, namely with comparative studies, better biomarkers for predicting response, and the determination of optimal treatment duration.

Background: Pulse oximetry has become an essential tool in clinical practice. With patient self-management becoming more prevalent, pulse oximetry self-monitoring has the potential to become common practice in the near future. This study sought to compare the accuracy of two pulse oximeters, a high-quality standard pulse oximeter and an inexpensive pocket pulse oximeter, and to compare both devices with arterial blood co-oximetry oxygen saturation. Methods: A total of 95 patients (35.8% women; mean [±SD] age 63.1 ± 13.9 years; mean arterial pressure was 92 ± 12.0 mmHg; mean axillar temperature 36.3 ± 0.4°C) presenting to our hospital for blood gas analysis was evaluated. The Bland-Altman technique was performed to calculate bias and precision, as well as agreement limits. Student's t test was performed. Results: Standard oximeter presented 1.84% bias and a precision error of 1.80%. Pocket oximeter presented a bias of 1.85% and a precision error of 2.21%. Agreement limits were −1.69% to 5.37% (sta...

O quilotórax caracteriza-se pela presença de linfa no espaço pleural devido a lesão ou obstrução do ducto torácico. O diagnóstico é feito com base no elevado conteúdo de triglicéridos e na presença de quilomícrons. A etiologia do quilotórax pode ser dividida em traumática e não traumática. A ruptura traumática ocorre após acidentes ou cirurgias. Das causas não traumáticas, a mais comum é o linfoma e, na presença de um quilotórax de etiologia desconhecida, a primeira suspeita diagnóstica deverá ser dirigida para esta entidade, sendo o tipo mais frequente o não Hodgkin. Os autores apresentam o caso de um doente com quilotórax, cujo diagnóstico etiológico foi de linfoma não Hodgkin, discutem os aspectos particulares do quilotórax, bem como a investigação e modalidades de tratamento desta entidade. Chylothorax is the occurrence of lymph in the pleura due to damage or obstruction of the thoracic duct. High content of triglycerides and the presence of chylomicrons make the diagnosis of chylothorax. Its aetiology can be divided in traumatic and non-traumatic. Traumatic rupture occurs after accidents or surgery. Within non-traumatic aetiology, lymphoma is the most common and in the presence of a chylothorax of unknown origin this should be the first suspicion, being non-Hodgkin type the most frequent. The authors present a case report of a patient with chylothorax due to non-Hodgkin lymphoma, discuss the particularities of chylothorax as well as the investigation and its treatment options.

Chylothorax is the occurrence of lymph in the pleura due to damage or obstruction of the thoracic duct. High content of triglycerides and the presence of chylomicrons make the diagnosis of chylothorax. Its aetiology can be divided in traumatic and non-traumatic. Traumatic rupture occurs after accidents or surgery. Within non-traumatic aetiology, lymphoma is the most common and in the presence of a chylothorax of unknown origin this should be the first suspicion, being non-Hodgkin type the most frequent. The authors present a case report of a patient with chylothorax due to non-Hodgkin lymphoma, discuss the particularities of chylothorax as well as the investigation and its treatment options.