Background: Interstitial lung disease (ILD) evaluation often requires lung biopsy for definite diagnosis. In recent years, transbronchial cryobiopsy (TBCB) emerged as a procedure with higher diagnostic yield than transbronchial forceps biopsy (TBFB), especially for fibrotic ILDs. Nonetheless, studies comparing these modalities in non-fibrotic ILDs and for specific ILD diagnoses are scarce. Objectives: The aim of this study was to evaluate the diagnostic yield and safety of TBCB and TBFB in patients with fibrotic and non-fibrotic ILDs. Method: An observational retrospective multicenter study including patients with ILD diagnosis by multidisciplinary discussion that underwent TBCB or TBFB between 2017 and 2021. Chest CT scans were reviewed by a chest radiologist. Biopsy specimens were categorized as diagnostic (with specific histological pattern), nondiagnostic, or without lung parenchyma. Nondiagnostic samples were reassessed by a second lung pathologist. TBCB and TBFB diagnostic yields were analyzed by multivariate regression. Procedural complications were evaluated as well. Results: 276 patients were included, 116 (42%) underwent TBCB and 160 (58%) TBFB. Fibrotic ILDs were present in 148 patients (54%). TBCB diagnostic yield was 78% and TBFB 48% (adjusted odds ratio [AOR] 4.2, 95% CI: 2.4–7.6, p < 0.01). The diagnostic yield of TBCB was higher than TBFB among patients with fibrotic ILD (AOR 3.8, p < 0.01), non-fibrotic ILD (AOR 5.8, p < 0.01), and across most ILD diagnoses. TBCB was associated with higher risk for significant bleeding (10% vs. 3%, p < 0.01), but similar risk for pneumothorax. Conclusions: Diagnostic yield of TBCB was superior to that of TBFB for both fibrotic and non-fibrotic ILDs, and across most diagnoses.

Background: The resurgence of COVID-19 cases since June 2021, referred to as the fourth COVID-19 wave, has led to the approval and administration of booster vaccines. Our study aims to identify any associations between vaccine status with the characteristics and outcomes of patients hospitalized with severe COVID-19 disease. Methods: We retrospectively reviewed all COVID-19 patients admitted to a large tertiary center between July 25 and October 25, 2021 (fourth wave in Israel). Univariant and multivariant analyses of variables associated with vaccine status were performed. Findings: Overall, 349 patients with severe or critical disease were included. Patients were either not vaccinated (58%), had the first two vaccine doses (35%) or had the booster vaccine (7%). Vaccinated patients were significantly older, male predominant, and with a higher number of comorbidities including diabetes, hyperlipidemia, ischemic heart disease, heart failure, immunodeficient state, kidney disease and cognitive decline. Time from the first symptom to hospital admission was longer among non-vaccinated patients (7.2 ± 4.4 days, p = 0.002). Critical disease (p<0.05), admissions to the intensive care unit (p = 0.01) and advanced oxygen support (p = 0.004) were inversely proportional to the number of vaccines given, lowest among the booster vaccine group. Death (20%, p = 0.83) and hospital stay duration (8.05± 8.47, p = 0.19) were similar between the groups. Conclusion: Hospitalized vaccinated patients with severe COVID-19 had significantly higher rates of most known risk factors for COVID-19 adverse outcomes. Still, all disease outcomes were similar or better compared with the non-vaccinated patients.

Background: Little is known about the effect of a new pandemic on diagnostic errors.Objective: We aimed to identify delayed second diagnoses among patients presenting to the emergency department (ED) with COVID‐19.Designs: An observational cohort Study.Settings and Participants: Consecutive hospitalized adult patients presenting to the ED of a tertiary referral center with COVID‐19 during the Delta and Omicron variant surges. Included patients had evidence of a second diagnosis during their ED stay.Main Outcome and Measures: The primary outcome was delayed diagnosis (without documentation or treatment in the ED). Contributing factors were assessed using two logistic regression models.Results: Among 1249 hospitalized COVID‐19 patients, 216 (17%) had evidence of a second diagnosis in the ED. The second diagnosis of 73 patients (34%) was delayed, with a mean (SD) delay of 1.5 (0.8) days. Medical treatment was deferred in 63 patients (86%) and interventional therapy in 26 (36%). The probability of an ED diagnosis was the lowest for Infection‐related diagnoses (56%) and highest for surgical‐related diagnoses (89%). Evidence for the second diagnosis by physical examination (adjusted odds ratios [AOR] 2.35, 95% confidence interval [CI] 1.20–4.68) or by imaging (AOR 2.10, 95% CI 1.16–3.79) were predictors for ED diagnosis. Low oxygen saturation (AOR 0.38, 95% CI 0.18–0.79) and cough or dyspnea (AOR 0.48, 95% CI 0.25–0.94) in the ED were predictors of a delayed second diagnosis.

Background: Tezepelumab, a monoclonal antibody targeting thymic stromal lymphopoietin, has demonstrated efficacy for severe asthma in clinical trials, but real-world evidence remains limited. We aimed to evaluate the characteristics and outcomes of patients initiating tezepelumab in a real-world setting. Methods: We conducted a retrospective, multicentre cohort study across four tertiary care centres to evaluate the real-world effectiveness of tezepelumab in patients with severe asthma. Eligible patients were adults with a confirmed diagnosis of severe asthma, treated with tezepelumab. Data on exacerbation rates, pulmonary function and corticosteroid use were collected and analysed at baseline and 1-year follow-up. Results: The study included 103 patients treated with tezepelumab with a median (interquartile range) duration of 323 (267–359) days. Overall, 39% had prior biologic therapy and 32% had an eosinophil count <300 cells·μL⁻¹. At follow-up, there was a 66.7% relative reduction in annual exacerbations. The most pronounced reduction was observed in biologic-naïve patients with peripheral eosinophil counts ≥300 cells·μL⁻¹ (78% reduction). A 62% relative reduction was found among patients with eosinophil counts <150 cells·μL⁻¹. There were significant improvements in forced expiratory volume in 1 s, with 51% of patients demonstrating a ≥10% relative increase. Of patients using maintenance oral corticosteroid (mOCS), 45% discontinued mOCS and 23% reduced their dose by more than 50%. Conclusions: In this real-world cohort, treatment with tezepelumab for a median of 46 weeks was associated with improved asthma control, reductions in exacerbations, mOCS and inhaled corticosteroid doses, and a low symptom burden. These findings were consistent in biologic-experienced or low-eosinophil patients.