UNASSIGNED: The evidence on the association of fine particulate matter with an aerodynamic diameter of 2.5 μm or less (PM2.5) with pulmonary tuberculosis (PTB) retreatment is limited. There are no data on whether greenness exposure protects air pollution-related PTB retreatment in patients with prior PTB.
UNASSIGNED: In a population-based retrospective study, we aimed to investigate the influence of PM2.5 and residential greenness on the risk of PTB retreatment.
UNASSIGNED: A total of 26,482 patients with incident PTB, registered in a mandatory web-based reporting system between 2012 and 2019 in Zhengzhou, China, were included in the analysis. The exposure to PM2.5 was assessed based on the China High Air Pollutants dataset, and the level of greenness was estimated using the Normalized Difference Vegetation Index (NDVI) values. The associations of PTB retreatment with exposure to PM2.5 and greenness were evaluated, respectively, considering the local socioeconomic level indicated by the nighttime light index.
UNASSIGNED: Among the 26,482 patients (mean age 46.86, SD 19.52 years) with a median follow-up time of 1523 days per patient, 1542 (5.82%) PTB retreatments were observed between 2012 and 2019. Exposure to PM2.5 was observed to be significantly associated with the increased risk of PTB retreatment in fully adjusted models with a hazard ratio of 1.97 (95% CI 1.34-2.83) per 10 μg/m3 increase in PM2.5. Patients living in the regions with relatively high quartiles of NDVI values had a 45% lower risk of PTB retreatment than those living in the regions with the lowest quartile for the 500 m buffers (hazard ratio 0.55, 95% CI 0.40-0.77). Such a protective effect of residential greenness was more pronounced among patients living in lower nighttime light areas. The strength of the association between PM2.5 exposure and the risk of PTB retreatment was attenuated by greenness. No significant association was observed between NDVI and the incidence of drug resistance.
UNASSIGNED: Long-term exposure to PM2.5 might be a risk factor for PTB retreatment, while an increased level of residential greenness was found to be associated with reduced risks of PTB retreatment. Our results suggest strengthening the control of ambient air pollution and improving residential greenness may contribute to the reduction of PTB retreatment.

BACKGROUND: The development of internet technology has greatly increased the ability of patients with chronic obstructive pulmonary disease (COPD) to obtain health information, giving patients more initiative in the patient-physician decision-making process. However, concerns about the quality of website health information will affect the enthusiasm of patients\' website search behavior. Therefore, it is necessary to evaluate the current situation of Chinese internet information on COPD.
OBJECTIVE: This study aims to evaluate the quality of COPD treatment information on the Chinese internet.
METHODS: Using the standard disease name \"\" (\"chronic obstructive pulmonary disease\" in Chinese) and the commonly used public search terms \"\" (\"COPD\") and \"\" (\"emphysema\") combined with the keyword \"\" (\"treatment\"), we searched the PC client web page of Baidu, Sogou, and 360 search engines and screened the first 50 links of the website from July to August 2021. The language was restricted to Chinese for all the websites. The DISCERN tool was used to evaluate the websites.
RESULTS: A total of 96 websites were included and analyzed. The mean overall DISCERN score for all websites was 30.4 (SD 10.3; range 17.3-58.7; low quality), no website reached the maximum DISCERN score of 75, and the mean score for each item was 2.0 (SD 0.7; range 1.2-3.9). There were significant differences in mean DISCERN scores between terms, with \"chronic obstructive pulmonary disease\" having the highest mean score.
CONCLUSIONS: The quality of COPD information on the Chinese internet is poor, which is mainly reflected in the low reliability and relevance of COPD treatment information, which can easily lead consumers to make inappropriate treatment choices. The term \"chronic obstructive pulmonary disease\" has the highest DISCERN score among commonly used disease search terms. It is recommended that consumers use standard disease names when searching for website information, as the information obtained is relatively reliable.

Although kidney transplantation is the best therapeutic option for patients with chronic kidney disease, the immunosuppression required greatly increases susceptibility to infections that are responsible for high post-transplant mortality. Pulmonary tuberculosis (TB) represents a major cause of such infections, and its early diagnosis is therefore quite important. In view of that, we researched the manifestations of active pulmonary TB in kidney transplant recipients, through chest X-ray and computed tomography (CT), as well as determining the number of cases of active pulmonary TB occurring over a 3.5-year period at our institution. We identified four cases of active pulmonary TB in kidney transplant recipients. The CT scans provided information complementary to the chest X-ray findings in all four of those cases. We compared our CT findings with those reported in the literature. We analyzed our experience in conjunction with an extensive review of the literature that was nevertheless limited because few studies have been carried out in lowand middle-income countries, where the incidence of TB is higher.
Apesar de o transplante renal ser a melhor opção terapêutica para pacientes com doença renal crônica, a imunodepressão decorrente desse tratamento eleva muito a suscetibilidade desses pacientes a infecções, responsáveis por altas taxas de mortalidade pós-operatórias. A tuberculose (TB) pulmonar é uma significativa causa dessas infecções, sendo muito importante o seu diagnóstico precoce. Assim, nós pesquisamos as manifestações da TB pulmonar ativa nessa população de transplantados renais por meio de radiografias simples e tomografia computadorizada (TC) do tórax, também para estabelecer o número de casos de TB pulmonar ativa em nossa instituição após levantamento de 3,5 anos. Encontramos quatro casos de TB pulmonar ativa em pacientes transplantados renais. A TC forneceu informações adicionais em relação às radiografias de tórax em 100% dos casos analisados. Comparamos os nossos achados de TC com os relatados na literatura. Somamos a experiência obtida com extensa revisão da literatura, ainda limitada nessa questão, com poucos estudos realizados em países em desenvolvimento onde a incidência de TB é maior.

BACKGROUND: Digitally assisted health care services and technologies are gaining popularity. They assist patients in managing their conditions, thereby reducing the burden on health care staff. Digital health care enables individuals to receive care that is more tailored to their needs and preferences. When implemented properly, it can promote equity by considering each person\'s opportunities and limitations in the context of health care needs, preferences, values, and capabilities.
OBJECTIVE: This study aims to understand the needs, values, and preferences of individuals with chronic obstructive pulmonary disease (COPD) who are provided with a 24/7 digital health care service. Furthermore, we aim to understand the dynamics of the communities to which they belong and how these communities intersect. This will provide us with the essential knowledge to establish new methods of providing education, including the development of educational activities for health professionals to engage, train, and empower people living with COPD.
METHODS: The study included 7 informants diagnosed with COPD who received 24/7 digital health care service support from a regional project in Region Zealand, Denmark. The informants were visited 4 times during 2 months, including a \"Hello\" visit, a day with a semistructured interview, and 2 days with field observations. The informants participated in a semistructured interview, following participant observation and an ethnographic approach. The interview content was analyzed using an inductive methodology to categorize the empirical data.
RESULTS: Using the inductive approach, we identified 3 main categories related to the informants\' needs, values, and preferences: (1) Health, (2) Value Creation, and (3) Resources. These 3 main categories were based on 9 subcategories: (1) health and barriers, (2) self-monitoring, (3) medication, (4) behavior, (5) motivation, (6) hobbies, (7) social networks, (8) health professionals, and (9) technology. These findings revealed that the informants placed value on maintaining their daily activities and preserving their sense of identity before the onset of COPD. Furthermore, they expressed a desire not to be defined by their COPD, as conversations about COPD often shifted away from the topic.
CONCLUSIONS: Digital health solutions and the health care professionals who offer them should prioritize the individuals they serve, considering their needs, values, and preferences rather than solely focusing on the medical condition. This approach ensures the highest level of daily living and empowerment for those living with long-term health conditions. The communities surrounding individuals must engage in constant interaction and collaboration. They should work together to incorporate people\'s needs, values, and preferences into future digital health services, thereby promoting empowerment and self-management. New educational programs aimed at developing the digital health service competencies of registered nurses should facilitate collaboration between the 2 communities. This collaboration is essential for supporting patients with long-term health conditions in their daily activities.

UNASSIGNED: The use of chronic disease information systems in hospitals and communities plays a significant role in disease prevention, control, and monitoring. However, there are several limitations to these systems, including that the platforms are generally isolated, the patient health information and medical resources are not effectively integrated, and the \"Internet Plus Healthcare\" technology model is not implemented throughout the patient consultation process.
UNASSIGNED: The aim of this study was to evaluate the efficiency of the application of a hospital case management information system in a general hospital in the context of chronic respiratory diseases as a model case.
UNASSIGNED: A chronic disease management information system was developed for use in general hospitals based on internet technology, a chronic disease case management model, and an overall quality management model. Using this system, the case managers provided sophisticated inpatient, outpatient, and home medical services for patients with chronic respiratory diseases. Chronic respiratory disease case management quality indicators (number of managed cases, number of patients accepting routine follow-up services, follow-up visit rate, pulmonary function test rate, admission rate for acute exacerbations, chronic respiratory diseases knowledge awareness rate, and patient satisfaction) were evaluated before (2019-2020) and after (2021-2022) implementation of the chronic disease management information system.
UNASSIGNED: Before implementation of the chronic disease management information system, 1808 cases were managed in the general hospital, and an average of 603 (SD 137) people were provided with routine follow-up services. After use of the information system, 5868 cases were managed and 2056 (SD 211) patients were routinely followed-up, representing a significant increase of 3.2 and 3.4 times the respective values before use (U=342.779; P<.001). With respect to the quality of case management, compared to the indicators measured before use, the achievement rate of follow-up examination increased by 50.2%, the achievement rate of the pulmonary function test increased by 26.2%, the awareness rate of chronic respiratory disease knowledge increased by 20.1%, the retention rate increased by 16.3%, and the patient satisfaction rate increased by 9.6% (all P<.001), while the admission rate of acute exacerbation decreased by 42.4% (P<.001) after use of the chronic disease management information system.
UNASSIGNED: Use of a chronic disease management information system improves the quality of chronic respiratory disease case management and reduces the admission rate of patients owing to acute exacerbations of their diseases.

BACKGROUND: Accurate and portable respiratory parameter measurements are critical for properly managing chronic obstructive pulmonary diseases (COPDs) such as asthma or sleep apnea, as well as controlling ventilation for patients in intensive care units, during surgical procedures, or when using a positive airway pressure device for sleep apnea.
OBJECTIVE: The purpose of this research is to develop a new nonprescription portable measurement device that utilizes relative humidity sensors (RHS) to accurately measure key respiratory parameters at a cost that is approximately 10 times less than the industry standard.
METHODS: We present the development, implementation, and assessment of a wearable respiratory measurement device using the commercial Bosch BME280 RHS. In the initial stage, the RHS was connected to the pneumotach (PNT) gold standard device via its external connector to gather breathing metrics. Data collection was facilitated using the Arduino platform with a Bluetooth Low Energy connection, and all measurements were taken in real time without any additional data processing. The device\'s efficacy was tested with 7 participants (5 men and 2 women), all in good health. In the subsequent phase, we specifically focused on comparing breathing cycle and respiratory rate measurements and determining the tidal volume by calculating the region between inhalation and exhalation peaks. Each participant\'s data were recorded over a span of 15 minutes. After the experiment, detailed statistical analysis was conducted using ANOVA and Bland-Altman to examine the accuracy and efficiency of our wearable device compared with the traditional methods.
RESULTS: The perfused air measured with the respiratory monitor enables clinicians to evaluate the absolute value of the tidal volume during ventilation of a patient. In contrast, directly connecting our RHS device to the surgical mask facilitates continuous lung volume monitoring. The results of the 1-way ANOVA showed high P values of .68 for respiratory volume and .89 for respiratory rate, which indicate that the group averages with the PNT standard are equivalent to those with our RHS platform, within the error margins of a typical instrument. Furthermore, analysis utilizing the Bland-Altman statistical method revealed a small bias of 0.03 with limits of agreement (LoAs) of -0.25 and 0.33. The RR bias was 0.018, and the LoAs were -1.89 and 1.89.
CONCLUSIONS: Based on the encouraging results, we conclude that our proposed design can be a viable, low-cost wearable medical device for pulmonary parametric measurement to prevent and predict the progression of pulmonary diseases. We believe that this will encourage the research community to investigate the application of RHS for monitoring the pulmonary health of individuals.

Predicting outcomes in pulmonary tuberculosis is challenging despite effective treatments. This study aimed to identify factors influencing treatment success and culture conversion, focusing on artificial intelligence (AI)-based chest X-ray analysis and Xpert MTB/RIF assay cycle threshold (Ct) values. In this retrospective study across six South Korean referral centers (January 1 to December 31, 2019), we included adults with rifampicin-susceptible pulmonary tuberculosis confirmed by Xpert assay from sputum samples. We analyzed patient characteristics, AI-based tuberculosis extent scores from chest X-rays, and Xpert Ct values. Of 230 patients, 206 (89.6%) achieved treatment success. The median age was 61 years, predominantly male (76.1%). AI-based radiographic tuberculosis extent scores (median 7.5) significantly correlated with treatment success (odds ratio [OR] 0.938, 95% confidence interval [CI] 0.895-0.983) and culture conversion at 8 weeks (liquid medium: OR 0.911, 95% CI 0.853-0.973; solid medium: OR 0.910, 95% CI 0.850-0.973). Sputum smear positivity was 49.6%, with a median Ct of 26.2. However, Ct values did not significantly correlate with major treatment outcomes. AI-based radiographic scoring at diagnosis is a significant predictor of treatment success and culture conversion in pulmonary tuberculosis, underscoring its potential in personalized patient management.

UNASSIGNED: Globally, pulmonary tuberculosis is a significant public health and social problem.
UNASSIGNED: We investigated the factors influencing the hospitalization cost of patients with pulmonary tuberculosis and grouped cases based on a decision tree model to provide a reference for enhancing the management of diagnosis-related groups (DRGs) of this disease.
UNASSIGNED: The data on the first page of the medical records of patients with the primary diagnosis of pulmonary tuberculosis were extracted from the designated tuberculosis hospital. The influencing factors of hospitalization cost were determined using the Wilcoxon rank sum test and multiple linear stepwise regression analysis, and the included cases were grouped using the chi-squared automated interaction test decision tree model, with these influential factors used as classification nodes. In addition, the included cases were grouped according to the ZJ-DRG grouping scheme piloted in Zhejiang Province, and the differences between the two grouping methods were compared.
UNASSIGNED: The length of hospital stay, respiratory failure, sex, and age were the determining factors of the hospitalization cost of patients with pulmonary tuberculosis, and these factors were incorporated into the decision tree model to form eight case combinations. The reduction in variance (RIV) using this grouping method was 60.60%, the heterogeneity between groups was high, the coefficients of variance ranged from 0.29 to 0.47, and the intra-group difference was small. The patients were also divided into four groups based on the ZJ-DRG grouping scheme piloted in Zhejiang Province. The RIV using this grouping method was 55.24, the differences between groups were acceptable, the coefficients of variance were 1.00, 0.61, 0.77, and 0.87, respectively, and the intra-group difference was significant.
UNASSIGNED: When the pulmonary tuberculosis cases were grouped according to the duration of hospital stay, respiratory failure, and age, the results were rather reasonable, providing a reference for DRG management and cost control of this disease.

BACKGROUND: Disease reactivation/refractory remains a major challenge in managing Langerhans cell histiocytosis (LCH). Outcomes and late sequelae should be explored.
METHODS: A multi-institutional retrospective study was conducted to describe clinical characteristics, predictive factors, outcomes and late sequelae of pediatric reactivation/refractory LCH in Thailand.
RESULTS: In all, 47 patients were studied, 25 (53.2%) patients had disease reactivation and 22 (46.8%) patients had refractory LCH. The median reactivation and refractory time were 1.59 and 0.33 years from diagnosis, respectively (p <0.001). The most common site of reactivation/refractory was the bone (n = 26, 55%), and 20 (42.6%) patients developed late sequelae. The 5-year overall survival (OS) was 76.1%. Patients with reactivation and refractory LCH performed similarly in 5-year OS (88% vs. 63%, p = 0.055). Prognostic factors associated with mortality were liver, spleen, hematopoietic system and lung reactivation (p <0.05). Lung reactivation was the only independent risk factor associated with the survival outcome (p = 0.002).
CONCLUSIONS: The outcomes of pediatric patients between reactivation and refractory LCH in Thailand were similarly desirable and mortality was minimal although late sequelae may evolve. Pulmonary reactivation/refractory was an independent risk factor associated with survival.

OBJECTIVE: To assess the risk of developing pulmonary tuberculosis (TB) in accordance with prior history of COVID-19 infection.
BACKGROUND: Since the advent of the COVID-19 pandemic much discussion has been had on the possible role it might play on global efforts to combat TB; most, focusing on the pandemic\'s impact on health care systems\' capabilities to manage TB cases. Mechanisms have also been proposed by which the COVID-19 infection may directly affect individuals\' chance of developing TB infection. Cases have been reported with a history of COVID-19 infection preceding a diagnosis of TB, evidencing its possible role as a risk factor for the disease.
METHODS: A case-control study was conducted enrolling patients diagnosed with pulmonary TB in the absence of major risk factors previous history of TB, (HIV) human immunodeficiency virus infection), end-stage renal disease, organ transplants, and use of immunosuppressive agents) for developing TB. Each patient was age and sex matched with one healthy control. Data regarding prior COVID-19 infection, diabetes, and smoking status as well as the use of corticosteroids and Tocilizumab for the treatment of COVID-19 infection was obtained. Bivariate analysis was conducted and variables with a likely association with TB status were entered in a multivariate model.
RESULTS: Bivariate analysis demonstrated a significant relationship between prior COVID-19 infection and TB (95% confidence interval = 1.1-22.8, odds ratio [OR] = 5). Among other variables the severity of COVID-19 infection was found to have a likely association with TB status (p = .125). In a multivariate model, prior COVID-19 infection per se, was not found to be significantly associated with TB (p = .12, OR = 4.5).
CONCLUSIONS: There seems to be an association between prior history of COVID-19 and a future diagnosis of TB partially linked to the severity of disease. The findings of the current study may serve as a basis for further studies to determine the need for and efficacy of measures to follow-up COVID-19 patients at an increased risk for developing TB.