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1.
Medicine (Baltimore) ; 100(12): e25213, 2021 Mar 26.
Artículo en Inglés | MEDLINE | ID: mdl-33761707

RESUMEN

ABSTRACT: Poststroke pneumonia (PSP) is a common complication of stroke and an important cause of death following stroke. However, the treatment of PSP remains inadequate due to severe impairment to the respiratory system by PSP. Thus, it is crucial to focus on preventing PSP to improve the prognosis of patients with stroke.This prospective single-center Cohort study aimed to investigate the risk factors for pulmonary infection following an ischemic stroke and identify whether PSP significantly influences the prognosis of patients after stroke.Altogether, 451 patients who were treated for acute ischemic stroke in the First Affiliated Hospital of Chongqing Medical University in China between April 2017 and April 2018 were enrolled. Clinical data from the patients from admission to 3 months after discharge were collected. PSP was the primary outcome and poor prognosis or death at 3 months following discharge was the secondary outcome observed in this study. We performed logistic regression analyses to identify the risk factors for PSP and test an association between pneumonia and poor prognosis or death after stroke.Our findings revealed the following risk factors for PSP: atrial fibrillation odds ratio (OR) = 2.884, 95% confidence intervals (CI) = 1.316-6.322), being bedridden (OR = 2.797, 95%CI = 1.322-5.921), subject to an invasive procedure (OR = 12.838, 95%CI = 6.296-26.178), massive cerebral infarction (OR = 3.994, 95%CI = 1.496-10.666), and dysphagia (OR = 2.441, 95%CI = 1.114-5.351). Pneumonia was a risk factor for poor prognosis (OR = 2.967, 95%CI = 1.273-6.915) and death (OR = 5.493, 95%CI = 1.825-16.53) after stroke.Hence, since pneumonia increases the risk of poor prognosis and death following acute ischemic stroke, preventing, and managing the risk factors for PSP may improve the prognosis and reduce the mortality after stroke.


Asunto(s)
Fibrilación Atrial , Trastornos de Deglución , Neumonía , Factores de Edad , Anciano , Fibrilación Atrial/complicaciones , Fibrilación Atrial/diagnóstico , Personas Encamadas/estadística & datos numéricos , China/epidemiología , Estudios de Cohortes , Trastornos de Deglución/diagnóstico , Trastornos de Deglución/etiología , Femenino , Humanos , /mortalidad , Masculino , Neumonía/diagnóstico , Neumonía/epidemiología , Neumonía/etiología , Neumonía/prevención & control , Pronóstico , Factores de Riesgo , Índice de Severidad de la Enfermedad
2.
J Clin Lab Anal ; 35(2): e23685, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33576536

RESUMEN

BACKGROUND: Pneumonia caused by the 2019 novel Coronavirus (COVID-2019) shares overlapping signs and symptoms, laboratory findings, imaging features with influenza A pneumonia. We aimed to identify their clinical characteristics to help early diagnosis. METHODS: We retrospectively retrieved data for laboratory-confirmed patients admitted with COVID-19-induced or influenza A-induced pneumonia from electronic medical records in Ningbo First Hospital, China. We recorded patients' epidemiological and clinical features, as well as radiologic and laboratory findings. RESULTS: The median age of influenza A cohort was higher and it exhibited higher temperature and higher proportion of pleural effusion. COVID-19 cohort exhibited higher proportions of fatigue, diarrhea and ground-glass opacity and higher levels of lymphocyte percentage, absolute lymphocyte count, red-cell count, hemoglobin and albumin and presented lower levels of monocytes, c-reactive protein, aspartate aminotransferase, alkaline phosphatase, serum creatinine. Multivariate logistic regression analyses showed that fatigue, ground-glass opacity, and higher level of albumin were independent risk factors for COVID-19 pneumonia, while older age, higher temperature, and higher level of monocyte count were independent risk factors for influenza A pneumonia. CONCLUSIONS: In terms of COVID-19 pneumonia and influenza A pneumonia, fatigue, ground-glass opacity, and higher level of albumin tend to be helpful for diagnosis of COVID-19 pneumonia, while older age, higher temperature, and higher level of monocyte count tend to be helpful for the diagnosis of influenza A pneumonia.


Asunto(s)
/diagnóstico , Técnicas de Laboratorio Clínico , Virus de la Influenza A/fisiología , Neumonía/diagnóstico , Neumonía/virología , /fisiología , /diagnóstico por imagen , Diagnóstico Diferencial , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Neumonía/diagnóstico por imagen , Factores de Riesgo , Tomografía Computarizada por Rayos X
3.
Medicine (Baltimore) ; 100(4): e24478, 2021 Jan 29.
Artículo en Inglés | MEDLINE | ID: mdl-33530263

RESUMEN

ABSTRACT: No guidelines have been established for the evaluation of swallowing function following extubation. The factors of bedside swallowing evaluations (BSEs) that are associated with the development of pneumonia have not been fully elucidated. This study aimed to retrospectively investigate the most appropriate measurements of BSEs for predicting pneumonia.The study subjects were 97 adults who underwent BSEs following cardiovascular surgery. Patients were divided into the pneumonia onset group (n = 21) and the non-onset group (n = 76). Patient characteristics, intraoperative characteristics, complications, BSE results, and postoperative progress were compared between the groups. BSEs were composed of consciousness level, modified water swallowing test (MWST) score, repetitive saliva swallowing test score, speech intelligibility score, and risk of dysphagia in the cardiac surgery score. Univariate and multivariate analyses with the BSE as the independent variable and pneumonia onset as the dependent variable were also performed to identify factors that predict pneumonia. For factors that became significant in univariate analysis, the incidence of pneumonia was shown using the Kaplan-Meier curve.No significant differences were found in patient characteristics, intraoperative characteristics, and complications between the 2 groups. The postoperative progress was significantly different between the 2 groups, the pneumonia-onset group had a significantly longer time until the start of oral intake and a significantly lower median value of Food Intake Level Scale at the time of discharge. According to univariate and multivariate analyses, MWST score was a significant factor for predicting the onset of pneumonia even after adjusting for patient characteristics and surgical factors, and the incidence of pneumonia increased approximately 3 times when the MWST score was 3 points or less.The MWST score after extubation in cardiovascular surgery was the strongest predictor of postoperative pneumonia in BSEs. Furthermore, the incidence of pneumonia increased approximately 3 times when the MWST score was 3 points or less. Predicting cases with a high risk of developing pneumonia allows nurses and attending physicians to monitor the progress carefully and take aggressive preventive measures.


Asunto(s)
Extubación Traqueal/efectos adversos , Trastornos de Deglución/diagnóstico , Neumonía/diagnóstico , Anciano , Anciano de 80 o más Años , Procedimientos Quirúrgicos Cardiovasculares/efectos adversos , Estudios de Casos y Controles , Causalidad , Trastornos de Deglución/etiología , Femenino , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Pruebas en el Punto de Atención , Estudios Retrospectivos , Factores de Riesgo
5.
J Med Case Rep ; 15(1): 41, 2021 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-33522942

RESUMEN

BACKGROUND: Pneumonitis belongs to the fatal toxicities of anti-PD-1/PD-L1 treatments. Its diagnosis is based on immunotherapeutic histories, clinical symptoms, and the computed tomography (CT) imaging. The radiological features were typically ground-glass opacities, similar to CT presentation of 2019 Novel Coronavirus (COVID-19) pneumonia. Thus, clinicians are cautious in differential diagnosis especially in COVID-19 epidemic areas. CASE PRESENTATION: Herein, we report a 67-year-old Han Chinese male patient presenting with dyspnea and normal body temperature on the 15th day of close contact with his son, who returned from Wuhan. He was diagnosed as advanced non-small cell lung cancer and developed pneumonitis post Sintilimab injection during COIVD-19 pandemic period. The chest CT indicated peripherally subpleural lattice opacities at the inferior right lung lobe and bilateral thoracic effusion. The swab samples were taken twice within 72 hours and real-time reverse-transcription polymerase-chain-reaction (RT-PCR) results were COVID-19 negative. The patient was thereafter treated with prednisolone and antibiotics for over 2 weeks. The suspicious lesion has almost absorbed according to CT imaging, consistent with prominently falling CRP level. The anti-PD-1 related pneumonitis mixed with bacterial infection was clinically diagnosed based on the laboratory and radiological evidences and good response to the prednisolone and antibiotics. CONCLUSION: The anti-PD-1 related pneumonitis and COVID-19 pneumonia possess similar clinical presentations and CT imaging features. Therefore, differential diagnosis depends on the epidemiological and immunotherapy histories, RT-PCR tests. The response to glucocorticoid is still controversial but helpful for the diagnosis.


Asunto(s)
Anticuerpos Monoclonales Humanizados/efectos adversos , Antineoplásicos Inmunológicos/efectos adversos , Neoplasias Pulmonares/tratamiento farmacológico , Anciano , Diagnóstico Diferencial , Humanos , Masculino , Anamnesis , Neumonía/inducido químicamente , Neumonía/diagnóstico , Receptor de Muerte Celular Programada 1/antagonistas & inhibidores , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Tomografía Computarizada por Rayos X
6.
BMJ Case Rep ; 14(2)2021 Feb 09.
Artículo en Inglés | MEDLINE | ID: mdl-33563667

RESUMEN

Goodpasture's syndrome is a rare vasculitis associated with anti-glomerular basement membrane (anti-GBM) autoantibodies that target type IV collagen found in the basement membranes of glomeruli and alveoli. We present a case of a 79-year-old man with seronegative Goodpasture's syndrome with predominant respiratory symptoms and mild acute kidney injury that initially improved. Final diagnosis was made by immunofluorescent staining on open lung biopsy which also revealed concomitant organising pneumonia. The patient underwent treatment with corticosteroids, cyclophosphamide, haemodialysis and plasmapheresis. This was an atypical presentation wherein the patient only exhibited pulmonary symptoms early in the course of illness in the setting of negative anti-GBM antibody serum testing, which made diagnosis challenging. With this case, we emphasise that clinicians should have a high suspicion for Goodpasture's syndrome in the setting of unexplained severe pulmonary or renal disease despite negative anti-GBM antibody testing.


Asunto(s)
Lesión Renal Aguda/diagnóstico , Enfermedad por Anticuerpos Antimembrana Basal Glomerular/diagnóstico , Neumonía/diagnóstico , Lesión Renal Aguda/terapia , Anciano , Enfermedad por Anticuerpos Antimembrana Basal Glomerular/terapia , Antiinfecciosos/uso terapéutico , Biomarcadores/análisis , Broncoscopía , Diagnóstico Diferencial , Resultado Fatal , Humanos , Intubación Intratraqueal , Masculino , Plasmaféresis , Neumonía/terapia , Diálisis Renal , Esteroides/uso terapéutico
7.
BMJ Open ; 11(2): e044388, 2021 02 08.
Artículo en Inglés | MEDLINE | ID: mdl-33558358

RESUMEN

OBJECTIVE: In Italy, the first diagnosis of COVID-19 was confirmed on 20 February 2020 in the Lombardy region. Given the rapid spread of the infection in the population, it was suggested that in Europe, and specifically in Italy, the virus had already been present in the last months of 2019. In this paper, we aim to evaluate the hypothesis on the early presence of the virus in Italy by analysing data on trends of access to emergency departments (EDs) of subjects with a diagnosis of pneumonia during the 2015-2020 period. DESIGN: Time series cohort study. SETTING: We collected data on visits due to pneumonia between 1 October 2015 and 31 May 2020 in all EDs of the Agency for Health Protection of Milan (ATS of Milan). Trend in the winter of 2019-2020 was compared with those in the previous 4 years in order to identify unexpected signals potentially associated with the occurrence of the pandemic. Aggregated data were analysed using a Poisson regression model adjusted for seasonality and influenza outbreaks. PRIMARY OUTCOME MEASURES : Daily pneumonia-related visits in EDs. RESULTS : In the studied period, we observed 105 651 pneumonia-related ED visits. Compared with the expected, a lower occurrence was observed in January 2020, while an excess of pneumonia visits started in the province of Lodi on 21 February 2020, and almost 10 days later was observed in the remaining territory of the ATS of Milan. Overall, the peak in excess was found on 17 March 2020 (369 excess visits compared with previous years, 95% CI 353 to 383) and ended in May 2020, the administrative end of the Italian lockdown. CONCLUSIONS : An early warning system based on routinely collected administrative data could be a feasible and low-cost strategy to monitor the actual situation of the virus spread both at local and national levels.


Asunto(s)
Servicio de Urgencia en Hospital/estadística & datos numéricos , Monitoreo Epidemiológico , Neumonía/diagnóstico , Adolescente , Adulto , Anciano , Estudios de Cohortes , Control de Enfermedades Transmisibles , Femenino , Humanos , Italia/epidemiología , Masculino , Persona de Mediana Edad , Neumonía/epidemiología , Adulto Joven
8.
Virol J ; 18(1): 33, 2021 02 10.
Artículo en Inglés | MEDLINE | ID: mdl-33568204

RESUMEN

PURPOSE: To investigate the predictive significance of different pneumonia scoring systems in clinical severity and mortality risk of patients with severe novel coronavirus pneumonia. MATERIALS AND METHODS: A total of 53 cases of severe novel coronavirus pneumonia were confirmed. The APACHE II, MuLBSTA and CURB-65 scores of different treatment methods were calculated, and the predictive power of each score on clinical respiratory support treatment and mortality risk was compared. RESULTS: The APACHE II score showed the largest area under ROC curve in both noninvasive and invasive respiratory support treatment assessments, which is significantly different from that of CURB-65. Further, the MuLBSTA score had the largest area under ROC curve in terms of death risk assessment, which is also significantly different from that of CURB-65; however, no difference was noted with the APACHE II score. CONCLUSION: For patients with COVID, the APACHE II score is an effective predictor of the disease severity and mortality risk. Further, the MuLBSTA score is a good predictor only in terms of mortality risk.


Asunto(s)
/diagnóstico , Neumonía/diagnóstico , APACHE , Adulto , Anciano , Anciano de 80 o más Años , /terapia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neumonía/mortalidad , Neumonía/terapia , Neumonía/virología , Pronóstico , Curva ROC , Medición de Riesgo , Índice de Severidad de la Enfermedad , Adulto Joven
9.
J Med Internet Res ; 23(2): e23390, 2021 02 22.
Artículo en Inglés | MEDLINE | ID: mdl-33534722

RESUMEN

BACKGROUND: The initial symptoms of patients with COVID-19 are very much like those of patients with community-acquired pneumonia (CAP); it is difficult to distinguish COVID-19 from CAP with clinical symptoms and imaging examination. OBJECTIVE: The objective of our study was to construct an effective model for the early identification of COVID-19 that would also distinguish it from CAP. METHODS: The clinical laboratory indicators (CLIs) of 61 COVID-19 patients and 60 CAP patients were analyzed retrospectively. Random combinations of various CLIs (ie, CLI combinations) were utilized to establish COVID-19 versus CAP classifiers with machine learning algorithms, including random forest classifier (RFC), logistic regression classifier, and gradient boosting classifier (GBC). The performance of the classifiers was assessed by calculating the area under the receiver operating characteristic curve (AUROC) and recall rate in COVID-19 prediction using the test data set. RESULTS: The classifiers that were constructed with three algorithms from 43 CLI combinations showed high performance (recall rate >0.9 and AUROC >0.85) in COVID-19 prediction for the test data set. Among the high-performance classifiers, several CLIs showed a high usage rate; these included procalcitonin (PCT), mean corpuscular hemoglobin concentration (MCHC), uric acid, albumin, albumin to globulin ratio (AGR), neutrophil count, red blood cell (RBC) count, monocyte count, basophil count, and white blood cell (WBC) count. They also had high feature importance except for basophil count. The feature combination (FC) of PCT, AGR, uric acid, WBC count, neutrophil count, basophil count, RBC count, and MCHC was the representative one among the nine FCs used to construct the classifiers with an AUROC equal to 1.0 when using the RFC or GBC algorithms. Replacing any CLI in these FCs would lead to a significant reduction in the performance of the classifiers that were built with them. CONCLUSIONS: The classifiers constructed with only a few specific CLIs could efficiently distinguish COVID-19 from CAP, which could help clinicians perform early isolation and centralized management of COVID-19 patients.


Asunto(s)
/diagnóstico , Infecciones Comunitarias Adquiridas/diagnóstico , Aprendizaje Automático , Neumonía/diagnóstico , /patogenicidad , Área Bajo la Curva , /virología , Infecciones Comunitarias Adquiridas/sangre , Femenino , Humanos , Laboratorios , Recuento de Leucocitos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Neumonía/sangre , Polipéptido alfa Relacionado con Calcitonina/sangre , Curva ROC , Estudios Retrospectivos
10.
Sci Rep ; 11(1): 3863, 2021 02 16.
Artículo en Inglés | MEDLINE | ID: mdl-33594193

RESUMEN

Novel coronavirus pneumonia (NCP) has been widely spread in China and several other countries. Early finding of this pneumonia from huge numbers of suspects gives clinicians a big challenge. The aim of the study was to develop a rapid screening model for early predicting NCP in a Zhejiang population, as well as its utility in other areas. A total of 880 participants who were initially suspected of NCP from January 17 to February 19 were included. Potential predictors were selected via stepwise logistic regression analysis. The model was established based on epidemiological features, clinical manifestations, white blood cell count, and pulmonary imaging changes, with the area under receiver operating characteristic (AUROC) curve of 0.920. At a cut-off value of 1.0, the model could determine NCP with a sensitivity of 85% and a specificity of 82.3%. We further developed a simplified model by combining the geographical regions and rounding the coefficients, with the AUROC of 0.909, as well as a model without epidemiological factors with the AUROC of 0.859. The study demonstrated that the screening model was a helpful and cost-effective tool for early predicting NCP and had great clinical significance given the high activity of NCP.


Asunto(s)
/diagnóstico , Tamizaje Masivo , Modelos Biológicos , Neumonía/diagnóstico , /fisiología , Adulto , China/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Curva ROC
11.
J Immunother Cancer ; 9(2)2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33574054

RESUMEN

By the beginning of the global pandemic, SARS-CoV-2 infection has dramatically impacted on oncology daily practice. In the current oncological landscape, where immunotherapy has revolutionized the treatment of several malignancies, distinguishing between COVID-19 and immune-mediated pneumonitis can be hard because of shared clinical, radiological and pathological features. Indeed, their common mechanism of aberrant inflammation could lead to a mutual and amplifying interaction.We describe the case of a 65-year-old patient affected by metastatic squamous head and neck cancer and candidate to an experimental therapy including an anti-PD-L1 agent. COVID-19 ground-glass opacities under resolution were an incidental finding during screening procedures and worsened after starting immunotherapy. The diagnostic work-up was consistent with ICIs-related pneumonia and it is conceivable that lung injury by SARS-CoV-2 has acted as an inflammatory primer for the development of the immune-related adverse event.Patients recovered from COVID-19 starting ICIs could be at greater risk of recall immune-mediated pneumonitis. Nasopharyngeal swab and chest CT scan are recommended before starting immunotherapy. The awareness of the phenomenon could allow an easier interpretation of radiological changes under treatment and a faster diagnostic work-up to resume ICIs. In the presence of clinical benefit, for asymptomatic ICIs-related pneumonia a watchful-waiting approach and immunotherapy prosecution are suggested.


Asunto(s)
/diagnóstico , Neoplasias Pulmonares/diagnóstico , Neumonía/diagnóstico , Carcinoma de Células Escamosas de Cabeza y Cuello/diagnóstico , Anciano , Antígeno B7-H1/antagonistas & inhibidores , Antígeno B7-H1/inmunología , /inmunología , Diagnóstico Diferencial , Humanos , /efectos adversos , Inmunoterapia/efectos adversos , Lesión Pulmonar/diagnóstico , Lesión Pulmonar/diagnóstico por imagen , Lesión Pulmonar/patología , Lesión Pulmonar/virología , Neoplasias Pulmonares/tratamiento farmacológico , Neoplasias Pulmonares/secundario , Neoplasias Pulmonares/virología , Masculino , Nasofaringe/metabolismo , Nasofaringe/patología , Metástasis de la Neoplasia , Pandemias , Neumonía/tratamiento farmacológico , Neumonía/inmunología , Neumonía/virología , Carcinoma de Células Escamosas de Cabeza y Cuello/tratamiento farmacológico , Carcinoma de Células Escamosas de Cabeza y Cuello/inmunología , Carcinoma de Células Escamosas de Cabeza y Cuello/virología
12.
Eur Rev Med Pharmacol Sci ; 25(2): 1097-1100, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33577066

RESUMEN

OBJECTIVE: The aim of the present study was to assess the value of inflammatory factors procalcitonin (PCT), interleukin 6 (IL-6), and C-reactive protein (CRP) in the early diagnosis and evaluation of novel coronavirus pneumonia (COVID-19). MATERIALS AND METHODS: The data of 140 patients with pneumonia in our hospital, including 70 who had COVID-19 and 70 who had community-acquired pneumonia (CAP), were statistically analyzed. The levels of PCT, IL-6, and CRP were measured and statistically analyzed to determine the differences between the two groups. The differences in the COVID-19 group were analyzed after subgrouping into the ordinary type, severe type, and critical type. RESULTS: The PCT and CRP levels in the COVID-19 group were statistically lower than those in the CAP group (p < 0.05), but IL-6 was not statistically different between the two groups (p > 0.05). Statistically significant differences existed in IL-6 and CRP when comparing the COVID-19 subgroups of the critical type, severe type, and ordinary type (p < 0.05). However, there was no clinical meaning in the evaluation of the difference in PCT levels among the three subgroups with COVID-19. CONCLUSIONS: PCT and CRP could be used as indicators in the differentiation between COVID-19 and CAP, but IL-6 was of little significance in the differentiation. The higher the IL-6 and CRP, the more severe the condition of COVID-19 might be.


Asunto(s)
Proteína C-Reactiva/metabolismo , /diagnóstico , Interleucina-6/sangre , Polipéptido alfa Relacionado con Calcitonina/sangre , Biomarcadores/sangre , Infecciones Comunitarias Adquiridas/sangre , Infecciones Comunitarias Adquiridas/diagnóstico , Diagnóstico Diferencial , Diagnóstico Precoz , Humanos , Neumonía/sangre , Neumonía/diagnóstico
13.
J Stroke Cerebrovasc Dis ; 30(4): 105605, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33482567

RESUMEN

BACKGROUND: Pneumonia, the most common post-acute ischemic stroke (AIS) infection, accounts for up to 30% of deaths after a stroke. Multiple chronic inflammatory diseases, such as rheumatoid arthritis, psoriasis, and inflammatory bowel disease, are associated with increased risk of stroke and stroke morbidity. This study assessed the relationship between chronic inflammatory diseases and stroke-associated pneumonia (SAP). METHODS: Using data from the 2015-2017 National Inpatient Sample, we classified hospital discharges with a diagnosis of AIS as having ulcerative colitis, Crohn's disease, rheumatoid arthritis, psoriasis, systemic lupus erythematosus, other chronic inflammatory diseases, multiple chronic inflammatory diseases, or none. With multivariable logistic regression, we assessed for associations between chronic inflammatory disease and in-hospital SAP or death. RESULTS: Among AIS discharges, there was a decreased risk of SAP among those with psoriasis or other chronic inflammatory diseases (adjusted odds ratio (aOR) 0.70, 95%CI 0.63-0.99; aOR 0.64, 95%CI, 0.46-0.89, respectively), compared to those without psoriasis and without other chronic inflammatory disease, respectively. Rheumatoid arthritis, psoriasis, and other chronic inflammatory diseases were associated with reduced in-hospital mortality (aOR 0.89, 95%CI 0.78-1.00; aOR 0.77, 95%CI 0.59-1.00; aOR 0.69, 95%CI 0.50-0.94, respectively). CONCLUSIONS: The risk of SAP and in-hospital mortality varies by chronic inflammatory disease - psoriasis and other chronic inflammatory diseases are associate with reduced rates of SAP, whereas rheumatoid arthritis, psoriasis and other chronic inflammatory disease were associated with reduced in-hospital mortality. Further investigations are needed to determine a relationship between the potential role of immunomodulation and the reduction in SAP and mortality in chronic inflammatory diseases.


Asunto(s)
Inflamación/epidemiología , Neumonía/epidemiología , Accidente Cerebrovascular/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Enfermedad Crónica , Bases de Datos Factuales , Femenino , Mortalidad Hospitalaria , Humanos , Inflamación/diagnóstico , Inflamación/mortalidad , Pacientes Internos , Masculino , Persona de Mediana Edad , Neumonía/diagnóstico , Neumonía/mortalidad , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/mortalidad , Estados Unidos/epidemiología , Adulto Joven
14.
Artículo en Inglés | MEDLINE | ID: mdl-33503151

RESUMEN

Round pneumonia is an unusual radiological manifestation of a bacterial lung infection. We present the case of an elderly male patient who arrived at the emergency room with a productive cough and exertional dyspnea. His chest x-ray and CT showed a round opacity and air bronchograms in the right upper lobe. Taken together, the patient's symptoms and images strongly suggest a pulmonary infection. Empirical antibiotic therapy with ceftriaxone and clarithromycin was started. The sputum culture was positive for Enterobacter hormaechei and the bacterium was sensitive to levofloxacin; therefore, the antibiotic therapy was changed. Despite the treatment, the patient progressed to respiratory failure and septic shock, dying six days after admission. Although round pneumonia is uncommon, it is a potentially curable disease and clinicians should always consider it in their differential diagnosis.


Asunto(s)
Enterobacter/aislamiento & purificación , Infecciones por Enterobacteriaceae/diagnóstico , Pulmón/diagnóstico por imagen , Neumonía/diagnóstico , Adulto , Anciano , Antibacterianos/uso terapéutico , Tos , Disnea , Infecciones por Enterobacteriaceae/tratamiento farmacológico , Humanos , Levofloxacino/uso terapéutico , Masculino , Neumonía/microbiología , Esputo/microbiología , Resultado del Tratamiento
15.
BMJ Case Rep ; 14(1)2021 Jan 25.
Artículo en Inglés | MEDLINE | ID: mdl-33495170

RESUMEN

It is recognised that infective endocarditis is frequently a challenging diagnosis to make, as it may present with a range of non-specific symptoms. A middle-aged man was admitted with an 8-day history of profuse non-bloody diarrhoea and vomiting. He had no medical history and no identifiable risk factors for infective endocarditis, and so this in combination with the patient's atypical symptoms presented a diagnostic challenge. The patient was eventually diagnosed with a Staphylococcus aureus right-sided infective endocarditis. This case report explores the events which led to this diagnosis and demonstrates a number of unique learning points. It also highlights the importance of maintaining an open mind and being prepared to revise an initial diagnosis in the face of medical uncertainty.


Asunto(s)
Bacteriemia/diagnóstico , Disentería/diagnóstico , Endocarditis Bacteriana/diagnóstico por imagen , Neumonía/diagnóstico , Embolia Pulmonar/diagnóstico por imagen , Insuficiencia de la Válvula Tricúspide/diagnóstico por imagen , Bacteriemia/complicaciones , Cultivo de Sangre , Proteína C-Reactiva , Diagnóstico Diferencial , Diarrea/fisiopatología , Puntuación de Alerta Temprana , Ecocardiografía , Endocarditis Bacteriana/complicaciones , Endocarditis Bacteriana/fisiopatología , Humanos , Hipoxia , Ácido Láctico , Leucocitosis , Masculino , Persona de Mediana Edad , Embolia Pulmonar/etiología , Infecciones Estafilocócicas , Insuficiencia de la Válvula Tricúspide/etiología , Vómitos/fisiopatología
16.
BMJ Case Rep ; 14(1)2021 Jan 25.
Artículo en Inglés | MEDLINE | ID: mdl-33495195

RESUMEN

Takotsubo cardiomyopathy (TCMP) is an important, though under-recognised, syndrome which mimics acute coronary syndrome (ACS) presenting with similar clinical, biochemical and ECG features. A 68-year-old man was referred as ACS for emergency coronary angiography; however, a history of lethargy, weight loss and electrolyte abnormalities prompted further investigations. Angiography was postponed, adrenal insufficiency confirmed and steroid replacement commenced. Echocardiography demonstrated reduced left ventricular (LV) function (45%) with regional wall motion abnormalities, although angiography confirmed unobstructed arteries. Steroid replacement induced a rapid improvement in symptoms and LV function. Few cases of TCMP associated with adrenal insufficiency have been reported. This appears to be the first case describing TCMP precipitated by new-onset secondary adrenal insufficiency following long-term steroid use in a male patient, and highlights the importance of considering TCMP in patients presenting with suspected ACS. Here, prompt recognition and treatment of a serious underlying disorder prevented a potentially life-threatening Addisonian crisis.


Asunto(s)
Síndrome Coronario Agudo/diagnóstico , Insuficiencia Suprarrenal/diagnóstico , Cardiomiopatía de Takotsubo/diagnóstico , Pruebas de Función de la Corteza Suprarrenal , Insuficiencia Suprarrenal/inducido químicamente , Insuficiencia Suprarrenal/complicaciones , Insuficiencia Suprarrenal/tratamiento farmacológico , Anciano , Asma/tratamiento farmacológico , Proteína C-Reactiva/metabolismo , Diagnóstico Diferencial , Ecocardiografía , Eccema/tratamiento farmacológico , Electrocardiografía , Glucocorticoides/efectos adversos , Terapia de Reemplazo de Hormonas , Humanos , Hidrocortisona/uso terapéutico , Hiperpotasemia/etiología , Hiponatremia/etiología , Masculino , Neumonía/complicaciones , Neumonía/diagnóstico , Cardiomiopatía de Takotsubo/complicaciones
17.
Curr Opin Infect Dis ; 34(2): 175-179, 2021 04 01.
Artículo en Inglés | MEDLINE | ID: mdl-33492003

RESUMEN

PURPOSE OF REVIEW: Coronavirus disease 2019 (COVID-19) has produced an extraordinary amount of literature in a short time period. This review focuses on what the new literature has provided in terms of more general information about the management of community-acquired pneumonia (CAP). RECENT FINDINGS: Measures taken to reduce the spread of COVID-19 have caused a significant drop in influenza worldwide. Improvements in imaging, especially ultrasound, and especially in the application of rapid molecular diagnosis are likely to have significant impact on the management of CAP. Therapeutic advances are so far limited. SUMMARY: COVID-19 has taught us that we can do far more to prevent seasonal influenza and its associated mortality, morbidity and economic cost. Improvements in imaging and pathogen diagnosis are welcome, as is the potential for secondary benefits of anti-COVID-19 therapies that may have reach effect on respiratory viruses other than severe acute respiratory syndrome coronavirus 2. As community-transmission is likely to persist for many years, recognition and treatment of severe acute respiratory syndrome coronavirus 2 will need to be incorporated into CAP guidelines moving forward.


Asunto(s)
/diagnóstico , /prevención & control , /epidemiología , Técnicas de Laboratorio Clínico , Infecciones Comunitarias Adquiridas/diagnóstico , Infecciones Comunitarias Adquiridas/prevención & control , Infecciones Comunitarias Adquiridas/terapia , Diagnóstico por Imagen , Humanos , Control de Infecciones , Neumonía/diagnóstico , Neumonía/prevención & control , Neumonía/terapia
19.
Rev. medica electron ; 42(6): 2560-2574, nov.-dic. 2020. tab, graf
Artículo en Español | LILACS, CUMED | ID: biblio-1150037

RESUMEN

RESUMEN Introducción: la neumonía adquirida en la comunidad es la enfermedad infecciosa que conlleva una mayor mortalidad en los países desarrollados. El diagnóstico pasa por varios momentos, el cuadro clínico, la analítica y las imágenes. Objetivos: realizar la validación externa de un modelo matemático predictivo de mortalidad en pacientes ingresados por neumonía grave adquirida en la comunidad. Material y métodos: estudio longitudinal prospectivo (cohorte) con un grupo, con todos los pacientes que ingresaron en la Unidad de Cuidados intensivos emergentes con el diagnóstico de neumonía adquirida en la comunidad en el Hospital Militar Dr. Carlos J. Finlay, de febrero de 2018 hasta marzo del 2019. El universo estuvo constituido por 160 pacientes y no se tomó muestra alguna. Resultados: índice de Kappa K=1. Test Hosmer Lemenshow 0,650 con elevado ajuste. Resultados del modelo con sensibilidad= 79%. Especificidad: 91% con (VPP): 80 y (VPN)= 91. RR: 9,1. Área bajo la Curva = 0997. Porcentaje de aciertos en la regresión logística de 88,4 %. Conclusiones: el modelo propuesto constituyo una herramienta útil en la detección temprana de pacientes con riesgo de muerte a corto plazo. Permitió unificar en una sola variable el resultado de otras que aparentemente no tienen relación entre ellas; con lo que se hace más fácil la interpretación de los resultados, toda vez que este refleja, el conjunto y no la individualidad (AU).


SUMMARY Introduction: community-acquired pneumonia is the infectious disease leading to higher mortality in developed countries. The diagnosis goes through several moments, clinical symptoms, analytics, and images. Objective: to perform the external validation of a predictive mathematical model of mortality in patients admitted by serious community-acquired pneumonia. Methods: longitudinal prospective (cohort) study with a group formed with all patients who were admitted to the Emergent Intensive Care Unit in the Military Hospital ¨Dr. Carlos Juan Finlay¨ with the diagnosis of community-acquired pneumonia, from February 2018 to March 2019. The universe was formed by 160 patients and no sample was chosen. Results: Kappa index K= 1. Hosmer Lemenshow test= 0.650 with a high adjustment. Result of the model with sensibility= 79 %. Specificity= 91 % with (APV) = 80 and (NPV) = 91. RR= 9.1. Area under the curve= 0997. Percentage of correctness in logistic regression of 88.4 %. Conclusions: The proposed model was a useful tool in the early detection of patients at near-term death risk. It allowed to unite in an only variant the result of others that apparently are not related one to another, making it easier the interpretation of the results, since it reflects the whole and not the individuality (AU).


Asunto(s)
Humanos , Masculino , Femenino , Anciano , Neumonía/mortalidad , Anciano/fisiología , Neumonía/complicaciones , Neumonía/diagnóstico , Cuidados Críticos/métodos , Predicción/métodos , Atención al Paciente/métodos
20.
PLoS One ; 15(12): e0244349, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33347477

RESUMEN

BACKGROUND: Angiotensin-converting enzyme 2 is the receptor that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) uses for entry into lung cells. Because ACE-2 may be modulated by angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs), there is concern that patients treated with ACEIs and ARBs are at higher risk of coronavirus disease 2019 (COVID-19) pneumonia. AIM: This study sought to analyze the association of COVID-19 pneumonia with previous treatment with ACEIs and ARBs. MATERIALS AND METHODS: We retrospectively reviewed 684 consecutive patients hospitalized for suspected COVID-19 pneumonia and tested by polymerase chain reaction assay. Patients were split into two groups, according to whether (group 1, n = 484) or not (group 2, n = 250) COVID-19 was confirmed. Multivariable adjusted comparisons included a propensity score analysis. RESULTS: The mean age was 63.6 ± 18.7 years, and 302 patients (44%) were female. Hypertension was present in 42.6% and 38.4% of patients in groups 1 and 2, respectively (P = 0.28). Treatment with ARBs was more frequent in group 1 than group 2 (20.7% vs. 12.0%, respectively; odds ratio [OR] 1.92, 95% confidence interval [CI] 1.23-2.98; P = 0.004). No difference was found for treatment with ACEIs (12.7% vs. 15.7%, respectively; OR 0.81, 95% CI 0.52-1.26; P = 0.35). Propensity score-matched multivariable logistic regression confirmed a significant association between COVID-19 and previous treatment with ARBs (adjusted OR 2.36, 95% CI 1.38-4.04; P = 0.002). Significant interaction between ARBs and ACEIs for the risk of COVID-19 was observed in patients aged > 60 years, women, and hypertensive patients. CONCLUSIONS: This study suggests that ACEIs and ARBs are not similarly associated with COVID-19. In this retrospective series, patients with COVID-19 pneumonia more frequently had previous treatment with ARBs compared with patients without COVID-19.


Asunto(s)
Bloqueadores del Receptor Tipo 2 de Angiotensina II/efectos adversos , Inhibidores de la Enzima Convertidora de Angiotensina/efectos adversos , Neumonía/complicaciones , Adulto , Anciano , Anciano de 80 o más Años , Bloqueadores del Receptor Tipo 2 de Angiotensina II/uso terapéutico , Femenino , Humanos , Hipertensión/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Neumonía/diagnóstico , Estudios Retrospectivos , Factores de Riesgo
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