ABSTRACT
BACKGROUND: Current risk stratification tools, primarily used for CAP, are suboptimal in predicting nursing home acquired pneumonia (NHAP) outcome and mortality. We conducted a systematic review to evaluate current evidence on the usefulness of proposed predictors of NHAP mortality. METHODS: PubMed (MEDLINE), EMBASE, and CINAHL databases were searched for articles published in English between January 1978 and January 2014. The literature search elicited a total of 666 references; 580 were excluded and 20 articles met the inclusion criteria for the final analysis. RESULTS: More studies supported the Pneumonia Severity Index (PSI) as a superior predictor of NHAP severity. Fewer studies suggested CURB-65 and SOAR (especially for the need of ICU care) as useful predictors for NHAP mortality. There is weak evidence for biomarkers like C-reactive protein and copeptin as prognostic tools. CONCLUSION: The evidence supports the use of PSI as the best available indicator while CURB-65 may be an alternative prognostic indicator for NHAP mortality. Overall, due to the paucity of information, biomarkers may not be as effective in this role. Larger prospective studies are needed to establish the most effective predictor(s) or combination scheme to help clinicians in decision-making related to NHAP mortality.
Subject(s)
Cross Infection/diagnosis , Cross Infection/mortality , Nursing Care/statistics & numerical data , Nursing Homes/statistics & numerical data , Pneumonia, Bacterial/diagnosis , Pneumonia, Bacterial/mortality , Aged , Aged, 80 and over , Cross Infection/therapy , Female , Homes for the Aged/statistics & numerical data , Humans , Incidence , Male , Pneumonia, Bacterial/therapy , Prognosis , Risk Assessment/methods , Severity of Illness Index , Survival Analysis , Treatment OutcomeABSTRACT
Patients with recessive dystrophic epidermolysis bullosa (RDEB) have incurable skin fragility, blistering, and skin wounds due to mutations in the gene that codes for type VII collagen (C7) that mediates dermal-epidermal adherence in human skin. In this study, we evaluated if topically applied human recombinant C7 (rC7) could restore C7 at the dermal-epidermal junction (DEJ) and enhance wound healing. We found that rC7 applied topically onto murine skin wounds stably incorporated into the newly formed DEJ of healed wounds and accelerated wound closure by increasing re-epithelialization. Topical rC7 decreased the expression of fibrogenic transforming growth factor-ß2 (TGF-ß2) and increased the expression of anti-fibrogenic TGF-ß3. These were accompanied by the reduced expression of connective tissue growth factor, fewer α smooth muscle actin (α-SMA)-positive myofibroblasts, and less deposition of collagen in the healed neodermis, consistent with less scar formation. In addition, using a mouse model in which skin from C7 knock out mice was grafted onto immunodeficient mice, we showed that applying rC7 onto RDEB grafts with wounds restored C7 and anchoring fibrils (AFs) at the DEJ of the grafts and corrected the dermal-epidermal separation. The topical application of rC7 may be useful for treating patients with RDEB and patients who have chronic skin wounds.
Subject(s)
Collagen Type VII/therapeutic use , Dermis/metabolism , Epidermis/metabolism , Recombinant Proteins/therapeutic use , Administration, Topical , Animals , Collagen Type VII/administration & dosage , Epidermolysis Bullosa Dystrophica/drug therapy , Fluorescent Antibody Technique , Humans , Mice , Mice, Nude , Recombinant Proteins/administration & dosage , Wound Healing/drug effectsSubject(s)
Gastrointestinal Diseases/diagnostic imaging , Gastrointestinal Diseases/etiology , Gram-Negative Bacterial Infections/diagnostic imaging , Gram-Positive Bacterial Infections/diagnostic imaging , Mycoses/diagnostic imaging , Virus Diseases/diagnostic imaging , Fluoroscopy , Gram-Negative Bacterial Infections/immunology , Gram-Positive Bacterial Infections/immunology , Humans , Immunocompromised Host , Mycoses/immunology , Peritonitis, Tuberculous/diagnostic imaging , Radiography, Abdominal , Tomography, X-Ray Computed , Virus Diseases/immunologyABSTRACT
The postprocedural period is a critical time in which serious complications can manifest. Localization of suspected complications following abdominal and pelvic procedures can be difficult on clinical evaluation alone. For example, abdominal pain after a colonoscopy may vary in etiology and can result from simple colonic spasm to colonic perforation, hemoperitoneum, or even splenic rupture. Vague abdominal pain following a renal biopsy may be due to minimal postprocedural bleeding into and around the kidney or may be due to potentially life-threatening hemorrhage. In such patients, computed tomography can play a crucial role in the rapid identification of complications as well guidance of subsequent patient management. The purpose of this article is to demonstrate the benefit of computed tomography-assisted diagnosis of complications associated with routine procedures performed on or throughout the abdomen and pelvis, including cardiac catheterization, colonoscopy, endoscopy, percutaneous biopsy, and interventional radiology procedures.
Subject(s)
Pelvis/diagnostic imaging , Postoperative Complications/diagnostic imaging , Radiography, Abdominal , Tomography, X-Ray Computed , Biopsy/adverse effects , Cholangiopancreatography, Endoscopic Retrograde/adverse effects , Endoscopy/adverse effects , Humans , Vena Cava Filters/adverse effectsABSTRACT
Acinar cell carcinoma (ACC) is a rare tumor that constitutes 1% of pancreatic neoplasms. ACC is defined as a carcinoma exhibiting pancreatic enzyme production by neoplastic cells. Clinical presentation is usually related to either local spread or metastasis. In this Radiology-Pathology Conference, the clinical presentation and imaging findings of a patient with ACC of the pancreas, along with the differential diagnosis, are reviewed.