Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 7.345
Filtrar
4.
Infection ; 48(2): 267-274, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32008182

RESUMEN

OBJECTIVES: Current risk stratification in community-acquired pneumonia (CAP) does not incorporate the dynamic nature of CAP evolution. Study aim was to evaluate the predictive value of early blood pressure (BP) drop and its consideration within the CRB-65 score. METHODS: We performed a retrospective cohort study including consecutive adult hospitalized CAP patients 2013-2014 without documented treatment limitations or direct ICU admission. The CRB-65 score was calculated initially and re-calculated including any BP below the threshold (BP drop) within the first 24 h (CRB-65[BP24]). The primary endpoint was need for mechanical ventilation or vasopressors (MVVS) occurring after 24 h. Prognostic values were evaluated by uni- and multivariate and ROC curve analyses. RESULTS: 28/294 patients (9.5%) met the primary endpoint. Only 3 (11%) of them showed an initial BP of < 90 mmHg systolic or ≤ 60 mmHg diastolic, but 21 (75%) developed a BP drop within the first 24 h. 24/178 (13%) with and only 4/116 (3%) without any low BP during the first 24 h needed MVVS (p = 0.004). After multivariate analysis, the predictive value of BP drop was independent of other score parameters and biomarkers (all p < 0.01). In ROC analysis, the new CRB-65(BP24) showed a better prediction than the CRB-65 score (AUC 0.69 vs. 0.62, p = 0.04). 7/13 patients (54%) with MVVS despite an admission CRB-65 of 0 or 1 showed a BP drop. CONCLUSIONS: In the evaluated cohort, BP drop within the first 24 h was significantly associated with more need for MVVS in CAP, and its consideration improved the prognostic value of the CRB-65 score.


Asunto(s)
Presión Sanguínea , Infecciones Comunitarias Adquiridas/diagnóstico , Hospitalización/estadística & datos numéricos , Neumonía/diagnóstico , Anciano , Estudios de Cohortes , Infecciones Comunitarias Adquiridas/mortalidad , Humanos , Estimación de Kaplan-Meier , Neumonía/mortalidad , Neumonía/patología , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo
5.
J Korean Med Sci ; 35(6): e79, 2020 Feb 17.
Artículo en Inglés | MEDLINE | ID: mdl-32056407

RESUMEN

Since mid-December of 2019, coronavirus disease 2019 (COVID-19) infection has been spreading from Wuhan, China. The confirmed COVID-19 patients in South Korea are those who came from or visited China. As secondary transmissions have occurred and the speed of transmission is accelerating, there are rising concerns about community infections. The 54-year old male is the third patient diagnosed with COVID-19 infection in Korea. He is a worker for a clothing business and had mild respiratory symptoms and intermittent fever in the beginning of hospitalization, and pneumonia symptoms on chest computerized tomography scan on day 6 of admission. This patient caused one case of secondary transmission and three cases of tertiary transmission. Hereby, we report the clinical findings of the index patient who was the first to cause tertiary transmission outside China. Interestingly, after lopinavir/ritonavir (Kaletra, AbbVie) was administered, ß-coronavirus viral loads significantly decreased and no or little coronavirus titers were observed.


Asunto(s)
Infecciones por Coronavirus , Inhibidores del Citocromo P-450 CYP3A , Lopinavir , Neumonía Viral , Neumonía , Ritonavir , Betacoronavirus/genética , China , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/tratamiento farmacológico , Infecciones por Coronavirus/transmisión , Inhibidores del Citocromo P-450 CYP3A/uso terapéutico , Combinación de Medicamentos , Humanos , Lopinavir/uso terapéutico , Masculino , Persona de Mediana Edad , Neumonía/diagnóstico , Neumonía/tratamiento farmacológico , Neumonía/etiología , Neumonía Viral/complicaciones , Neumonía Viral/tratamiento farmacológico , Neumonía Viral/transmisión , Reacción en Cadena en Tiempo Real de la Polimerasa , República de Corea , Ritonavir/uso terapéutico , Carga Viral
6.
BMC Infect Dis ; 20(1): 73, 2020 Jan 23.
Artículo en Inglés | MEDLINE | ID: mdl-31973742

RESUMEN

BACKGROUND: Community acquired pneumonia (CAP) remains a significant cause of morbidity and in-hospital mortality, and readmission rates are rising for older persons (> 65 years). Optimized treatment and nursing care will benefit patients and the health economy. Hence, there is a need to describe gaps between current clinical practice and recommendations in evidence-based guidelines for diagnostic procedures, medical treatment and nursing interventions for older patients with CAP. METHODS: Structured observations, individual ad hoc interviews and audits of patient records were carried out in an emergency department and three medical units. Data were analysed by manifest content analysis and descriptive statistics. RESULTS: Thirty patients (median age 74 years) admitted with CAP and 86 physicians, nurses, physiotherapists were included. The median length of stay (LOS) was 6.5 days, in-hospital mortality was10 and 40.7% were readmitted within one month. The severity assessment tool (CURB-65) was used in 16.7% of the patients, correct antibiotic treatment prescribed for 13.3% and chest radiography (≤6 weeks post-discharge) prescribed for 22.2%. Fluid therapy, nutrition support and mobilisation plans were found to be developed sporadically, and interventions to be performed unsystematically and sparingly. Positive Expiratory Pressure therapy and oral care were the nursing interventions with lowest adherence, ranging from 18.2 to 55.6%. CONCLUSIONS: Adherence to recommendations was low for several central treatment and nursing care interventions for patients with CAP with possible consequences for patients and the use of resources. Thus, there is an urgent need to identify and remove barriers to adherence to recommendations in the neglected areas in view of the potential to improve patient outcomes.


Asunto(s)
Antibacterianos/uso terapéutico , Infecciones Comunitarias Adquiridas/terapia , Medicina Basada en la Evidencia , Adhesión a Directriz , Neumonía/terapia , Guías de Práctica Clínica como Asunto , Anciano , Anciano de 80 o más Años , Infecciones Comunitarias Adquiridas/diagnóstico , Infecciones Comunitarias Adquiridas/mortalidad , Estudios Transversales , Dinamarca/epidemiología , Servicio de Urgencia en Hospital , Femenino , Mortalidad Hospitalaria , Hospitalización , Humanos , Tiempo de Internación , Masculino , Alta del Paciente , Neumonía/diagnóstico , Neumonía/mortalidad
8.
Oncology ; 98(2): 123-130, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31665718

RESUMEN

INTRODUCTION: Predicting the factors that increase the risk of immune-related pneumonitis, a potentially life-threatening complication of treatment with immune checkpoint inhibitors for cancer, is a clinical challenge. Baseline clinical factors such as asthma may portend the development of pneumonitis due to pre-existing airway inflammation prior to immunotherapy. OBJECTIVE: The purpose of the study was to investigate whether a prior diagnosis of asthma is associated with an increased risk of immune-related pneumonitis in patients undergoing cancer immunotherapy. METHODS: Patients at the Moores Cancer Center at UC San Diego Health undergoing immunotherapy were identified on an IRB-approved protocol. Clinical charts were reviewed for asthma documented in the medical records and CT scans were reviewed during and after treatment. Pneumonitis was defined as the onset of new pulmonary symptoms with characteristic imaging findings during or after a patient's first course of immunotherapy that could not be readily explained as infection or a progression of malignancy. It was graded according to the Common Terminology Criteria for Adverse Events. RESULTS: A total of 187 patients were included. A diagnosis of asthma was found in the records of 26 cases (13.9%). Pneumonitis was found in 10 cases (5.35%); 50% were grade 2 and 50% were grade 3-4. Two of the grade 3-4 cases (40%) occurred in patients with non-small-cell lung cancer. Three patients with asthma developed pneumonitis (11.5% of patients with asthma), all grade 3-4. Only 28.6% of the non-asthma-pneumonitis cases were grade 3-4. All (100%) of the asthma-pneumonitis patients were former smokers, while 71.4% of the non-asthma-pneumonitis patients were former smokers. CONCLUSION: A history of asthma may be associated with a higher grade of pneumonitis if it develops, and a history of smoking may augment this relationship.


Asunto(s)
Antineoplásicos Inmunológicos/efectos adversos , Asma/complicaciones , Asma/inmunología , Neoplasias/complicaciones , Neumonía/diagnóstico , Neumonía/etiología , Anciano , Antineoplásicos Inmunológicos/uso terapéutico , Asma/diagnóstico , Susceptibilidad a Enfermedades , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/tratamiento farmacológico , Factores de Riesgo , Índice de Severidad de la Enfermedad
9.
J Cardiothorac Surg ; 14(1): 209, 2019 Nov 29.
Artículo en Inglés | MEDLINE | ID: mdl-31783886

RESUMEN

BACKGROUND: Video-assisted thoracoscopic surgery has been widely used in thoracic surgery worldwide. Our goal was to identify the risk factors for postoperative pneumonia in patients undergoing video-assisted thoracoscopic surgery lobectomy. METHODS: A retrospective analysis of adult patients undergoing video-assisted thoracoscopic surgery lobectomy between 2016 and 05 and 2017-04 was performed. We used univariate analyses and multivariate analyses to examine risk factors for postoperative pneumonia after lobectomy. RESULTS: The incidence of postoperative pneumonia was 19.7% (n = 143/727). Patients with postoperative pneumonia had a higher postoperative length of stay and total hospital care costs when compared to those without postoperative pneumonia. Multivariate analysis showed that body mass index grading ≥24.0 kg/m2 (vs. <24.0 kg/m2: odds ratio 1.904, 95% confidence interval 1.294-2.802, P = 0.001) and right lung lobe surgery (vs. left lung lobe surgery: odds ratio 1.836, 95% confidence interval 1.216-2.771, P = 0.004) were independent risk factors of postoperative pneumonia. Total intravenous crystalloid infusion grading in the postoperative 24 h ≥ 1500 mL was also identified as the risk factors (vs. 1000 to < 1500 mL: odds ratio 2.060, 95% confidence interval 1.302-3.260, P = 0.002). CONCLUSIONS: Major risk factors for postoperative pneumonia following video-assisted thoracoscopic surgery lobectomy are body mass index grading ≥24.0 kg/m2, right lung lobe surgery and total intravenous crystalloid infusion grading in the postoperative 24 h ≥ 1500 mL.


Asunto(s)
Soluciones Cristaloides/efectos adversos , Neoplasias Pulmonares/cirugía , Neumonectomía/efectos adversos , Neumonía/inducido químicamente , Complicaciones Posoperatorias/inducido químicamente , Cirugía Torácica Asistida por Video/efectos adversos , Adulto , Anciano , China/epidemiología , Soluciones Cristaloides/administración & dosificación , Femenino , Humanos , Incidencia , Infusiones Intravenosas , Masculino , Persona de Mediana Edad , Neumonía/diagnóstico , Neumonía/epidemiología , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/epidemiología , Estudios Retrospectivos , Factores de Riesgo
11.
Zhonghua Yi Xue Za Zhi ; 99(42): 3340-3344, 2019 Nov 12.
Artículo en Chino | MEDLINE | ID: mdl-31715672

RESUMEN

Objective: To explore the diagnostic performance of CT guided percutaneous lung biopsy (PTLB) with pathology, culture and rapid on-site evaluation (ROSE) in patients with pulmonary infectious diseases. Methods: From January 2016 to June 2018, a retrospective study was implemented in the Department of Pulmonary and Critical Care Medicine of the First Affiliated Hospital of Wenzhou Medical University. Patients who received PTLB, suspected with lung infection were included. The basic information, clinical symptoms, imaging findings, diagnostic methods, complications, and changes in treatment of cases were collected. The diagnostic sensitivity of histopathology, microbial culture, and ROSE were evaluated at the same time. Results: A total of 529 cases were enrolled, including 354 males and 175 females, (59±14) years old in average. Tuberculosis was identified in 197 cases, non-tuberculosis mycobacteria (NTM) pulmonary disease in 8, cryptococcosis in 95, pulmonary aspergillosis in 27, filamentous fungal pneumonia in 3, talaromyces marneffei pulmonary infection in 3 and pulmonary candidiasis in 1, bacterial pneumonia in 39, and pathogen were unknown in 156 cases. A total of 417 cases were submitted for histopathology and microbial culture at the same time, the diagnostic value of pathology and microbial culture were 35.0% (146/417) and 45.6% (190/417), respectively. Combined pathology with microbial culture, the diagnostic value increased to 62.8% (262/417). The diagnostic accuracy of ROSE was 51.8% (71/137). The most common complication of PTLB was pneumothorax 26.1% (138/529). 56.1% (297/529) of the patients received targeted treatment after the diagnosis was confirmed, and 43.9% (232/529) maintained the original treatment. Conclusion: The pathology, microbial culture, and ROSE of PTLB have relative high diagnostic value for pulmonary infectious diseases.


Asunto(s)
Pulmón , Neumonía , Anciano , Biopsia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Micobacterias no Tuberculosas , Neumonía/diagnóstico , Estudios Retrospectivos
12.
BMC Infect Dis ; 19(1): 973, 2019 Nov 15.
Artículo en Inglés | MEDLINE | ID: mdl-31730464

RESUMEN

BACKGROUND: Diabetes is one of the underlying risk factors for developing community-acquired pneumonia (CAP). The high prevalence of diabetes among population and the rising incidence of this illness, converts it as an important disease to better control and manage, to prevent its secondary consequences as CAP. The objective of this research is to describe the characteristics of the patients with diabetes and the differences with the no diabetes who have had an episode of CAP in the context of the primary care field. METHODS: A retrospective, observational study in adult patients (> 18 years-old) who suffer from CAP and attended at primary care in Spain between 2009 and 2013 was developed using the Computerized Database for Pharmacoepidemiological Studies in Primary Care (BIFAP). We carried out a descriptive analysis of the first episodes of CAP, in patients with or without diabetes as comorbidity. Other morbidity (CVA, Anaemia, Arthritis, Asthma, Heart disease, Dementia, Depression, Dysphagia, Multiple sclerosis, Epilepsy, COPD, Liver disease, Arthrosis, Parkinson's disease, Kidney disease, HIV) and life-style factors were also included in the study. RESULTS: A total of 51,185 patients were included in the study as they suffer from the first episode of CAP. Of these, 8012 had diabetes as comorbidity. There were differences between sex and age in patients with diabetes. Patients without diabetes were younger, and had less comorbidities including those related to lifestyles such as smoking, alcoholism, social and dental problems than patients with diabetes. CONCLUSIONS: Patients who developed an episode of CAP with diabetes have more risk factors which could be reduced with an appropriate intervention, including vaccination to prevent successive CAP episodes and hospitalization. The burden of associated factors in these patients can produce an accumulation of risk. Health care professional should know this for treating and control these patients in order to avoid complications. Diabetes and those other risk factors associated could be reduced with an appropriate intervention, including vaccination to prevent the first and successive CAP episodes and the subsequent hospitalization in severe cases.


Asunto(s)
Infecciones Comunitarias Adquiridas/diagnóstico , Complicaciones de la Diabetes/diagnóstico , Neumonía/diagnóstico , Factores de Edad , Anciano , Anciano de 80 o más Años , Infecciones Comunitarias Adquiridas/complicaciones , Comorbilidad , Complicaciones de la Diabetes/complicaciones , Femenino , Humanos , Estilo de Vida , Masculino , Persona de Mediana Edad , Neumonía/complicaciones , Atención Primaria de Salud , Estudios Retrospectivos , Factores de Riesgo , Factores Sexuales , España
13.
BMC Infect Dis ; 19(1): 976, 2019 Nov 20.
Artículo en Inglés | MEDLINE | ID: mdl-31747890

RESUMEN

BACKGROUND: Diagnosing pneumonia can be challenging in general practice but is essential to distinguish from other respiratory tract infections because of treatment choice and outcome prediction. We determined predictive signs, symptoms and biomarkers for the presence of pneumonia in patients with acute respiratory tract infection in primary care. METHODS: From March 2012 until May 2016 we did a prospective observational cohort study in three radiology departments in the Leiden-The Hague area, The Netherlands. From adult patients we collected clinical characteristics and biomarkers, chest X ray results and outcome. To assess the predictive value of C-reactive protein (CRP), procalcitonin and midregional pro-adrenomedullin for pneumonia, univariate and multivariate binary logistic regression were used to determine risk factors and to develop a prediction model. RESULTS: Two hundred forty-nine patients were included of whom 30 (12%) displayed a consolidation on chest X ray. Absence of runny nose and whether or not a patient felt ill were independent predictors for pneumonia. CRP predicts pneumonia better than the other biomarkers but adding CRP to the clinical model did not improve classification (- 4%); however, CRP helped guidance of the decision which patients should be given antibiotics. CONCLUSIONS: Adding CRP measurements to a clinical model in selected patients with an acute respiratory infection does not improve prediction of pneumonia, but does help in giving guidance on which patients to treat with antibiotics. Our findings put the use of biomarkers and chest X ray in diagnosing pneumonia and for treatment decisions into some perspective for general practitioners.


Asunto(s)
Biomarcadores/análisis , Neumonía/diagnóstico , Infecciones del Sistema Respiratorio/diagnóstico , Adulto , Anciano , Antibacterianos/uso terapéutico , Proteína C-Reactiva/análisis , Calcitonina/análisis , Femenino , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Países Bajos , Neumonía/complicaciones , Neumonía/tratamiento farmacológico , Atención Primaria de Salud , Pronóstico , Estudios Prospectivos , Infecciones del Sistema Respiratorio/complicaciones , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Tórax/diagnóstico por imagen
14.
Am Surg ; 85(9): 1061-1065, 2019 Sep 01.
Artículo en Inglés | MEDLINE | ID: mdl-31638525

RESUMEN

As minimally invasive operations evolve, it is imperative to evaluate the advantages and risks involved. The aim of our study was to evaluate our institution's experience in incorporating a robotic platform for transhiatal esophagectomy (THE). Patients undergoing robotic THE were prospectively followed. Data are presented as median (mean ± SD). Forty-five patients were of 67 (67 ± 6.9) years and BMI 26 (27 ± 5.5) kg/m². Nine per cent of operations were converted to "open," but none in the last 25 operations. Operative duration of robotic THE was 334 (364 ± 108.8) minutes and estimated blood loss was 200 (217 ± 144.0) mL, which decreased with time (P = 0.017). Length of stay was 8 (12 ± 11.1) days. Twenty per cent had respiratory failure requiring intubation that resolved, 4 per cent developed pneumonia, 11 per cent developed a surgical site infection, 2 per cent developed renal insufficiency, and 2 per cent developed a UTI. Two per cent (one patient) died within 30 days postoperatively, because of cardiac arrest. Our experience with robotic THE promotes robotic application because we endeavor to achieve high-level proficiency. With experience, we improved estimated blood loss and converted fewer transhiatal esophagectomies to "open." Our length of hospital stay seems long but reflects the ill-health of patients, as does the variety of complications. Our data support the evolving future of THE, which will integrally include a robotic approach.


Asunto(s)
Esofagectomía/efectos adversos , Esofagectomía/métodos , Procedimientos Quirúrgicos Robotizados/efectos adversos , Procedimientos Quirúrgicos Robotizados/métodos , Anciano , Pérdida de Sangre Quirúrgica , Índice de Masa Corporal , Conversión a Cirugía Abierta , Femenino , Estudios de Seguimiento , Mortalidad Hospitalaria , Humanos , Intubación Intratraqueal , Tiempo de Internación , Masculino , Persona de Mediana Edad , Tempo Operativo , Neumonía/diagnóstico , Complicaciones Posoperatorias , Estudios Prospectivos , Insuficiencia Respiratoria/terapia , Infección de la Herida Quirúrgica , Infecciones Urinarias
15.
Dis Markers ; 2019: 1089107, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31583025

RESUMEN

The focus of sepsis has shifted from inflammation to organ dysfunction on the basis of a recent definition based on the sequential organ failure score (SOFA). A diagnostic and prognostic marker is necessary under this definition but is currently unknown. We enrolled 80 sepsis patients consecutively admitted to an intensive care unit through the emergency department and 80 healthy control patients who received routine health check-ups from August 2018 to January 2019. SEPSIS-3 criteria were used for the diagnosis of patients based on SOFA score ≥ 2 from the baseline along with evidence of infection. Concentrations of 28 cytokines, eight chemokines, and nine growth factors were measured on the day of diagnosis. Hierarchical cluster analysis was performed for molecules. The majority of infections were pneumonia (45% of patients) and urinary tract infections (40% of patients). Most of the measured molecules were increased in patients with sepsis. Area under receiver operating characteristic curve (AUROC) values were found to be as follows: hepatic growth factor (HGF), 0.899; interleukin-1 receptor antagonist (IL-1RA), 0.893; C-C motif ligand 5 (CCL5) 5, 0.887; C-X-C motif chemokine 10 (CXCL10), 0.851; CCL2, 0.840; and IL-6, 0.830. IL-1RA, IL-6, IL-8, IL-15, and CCL11 concentrations correlated with SOFA score with statistical significance. Prognosis multivariate analysis revealed an odds ratio of 0.968 for epidermal growth factor (EGF). Three clusters were formed, of which Clusters 2 and 3 were associated with nonsurvivors. Diagnosis of sepsis was performed using cytokines, chemokines, and growth factors. HGF revealed the highest diagnostic capability, and EGF predicted favorable prognosis among the tested molecules.


Asunto(s)
Citocinas/sangre , Factor de Crecimiento de Hepatocito/sangre , Neumonía/diagnóstico , Sepsis/diagnóstico , Infecciones Urinarias/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Área Bajo la Curva , Biomarcadores/sangre , Estudios de Casos y Controles , Factor de Crecimiento Epidérmico/sangre , Femenino , Humanos , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Puntuaciones en la Disfunción de Órganos , Neumonía/sangre , Neumonía/mortalidad , Neumonía/patología , Pronóstico , Curva ROC , Estudios Retrospectivos , Sepsis/sangre , Sepsis/mortalidad , Sepsis/patología , Análisis de Supervivencia , Infecciones Urinarias/sangre , Infecciones Urinarias/mortalidad , Infecciones Urinarias/patología
16.
J Korean Med Sci ; 34(38): e250, 2019 Oct 07.
Artículo en Inglés | MEDLINE | ID: mdl-31583870

RESUMEN

BACKGROUND: Chest radiographs (CXR) are the most commonly used imaging techniques by various clinicians and radiologists. However, detecting lung lesions on CXR depends largely on the reader's experience level, so there have been several trials to overcome this problem using post-processing of CXR. We investigated the added value of bone suppression image (BSI) in detecting various subtle lung lesions on CXR with regard to reader's expertise. METHODS: We applied a software program to generate BSI in 1,600 patients in the emergency department. Of them, 80 patients with subtle lung lesions and 80 patients with negative finding on CXR were retrospectively selected based on the subtlety scores on CXR and CT findings. Ten readers independently rated their confidence in deciding the presence or absence of a lung lesion at each of 960 lung regions on the two separated imaging sessions: CXR alone vs. CXR with BSI. RESULTS: The additional use of BSI for all readers significantly increased the mean area under the curve (AUC) in detecting subtle lung lesions (0.663 vs. 0.706; P < 0.001). The less experienced readers were, the more AUC differences increased: 0.067 (P < 0.001) for junior radiology residents; 0.064 (P < 0.001) for non-radiology clinicians; 0.044 (P < 0.001) for senior radiology residents; and 0.019 (P = 0.041) for chest radiologists. The additional use of BSI significantly increased the mean confidence regarding the presence or absence of lung lesions for 213 positive lung regions (2.083 vs. 2.357; P < 0.001) and for 747 negative regions (1.217 vs. 1.195; P = 0.008). CONCLUSION: The use of BSI increases diagnostic performance and confidence, regardless of reader's expertise, reduces the impact of reader's expertise and can be helpful for less experienced clinicians and residents in the detection of subtle lung lesions.


Asunto(s)
Huesos/diagnóstico por imagen , Enfermedades Pulmonares/diagnóstico , Radiografía Torácica/métodos , Radiólogos/psicología , Anciano , Área Bajo la Curva , Estudios de Casos y Controles , Análisis por Conglomerados , Femenino , Humanos , Enfermedades Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Neumonía/diagnóstico , Neumonía/diagnóstico por imagen , Curva ROC , Interpretación de Imagen Radiográfica Asistida por Computador , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Tuberculosis Pulmonar/diagnóstico , Tuberculosis Pulmonar/diagnóstico por imagen
17.
Zhongguo Fei Ai Za Zhi ; 22(10): 621-626, 2019 Oct 20.
Artículo en Chino | MEDLINE | ID: mdl-31650943

RESUMEN

The increasing use of immunocheckpoint inhibitors in tumors has brought new hope of survival to patients with advanced tumors. However, the immune system activated by immunocheckpoint inhibitors, mainly activated T-cell immunity, may attack normal tissues and organs of the human body and lead to a variety of adverse effects. In the lung, they could induce checkpoint inhibitor associated pneumonitis (CIP). CIP is different from known pulmonary interstitial pneumonitis, and had a potentially fatal risk if it was not being properly treated. We will summarize the characteristics of CIP and give our advice on how to manage immunocheckpoint inhibitor associated pneumonitis.


Asunto(s)
Inmunoterapia/efectos adversos , Neumonía/diagnóstico , Neumonía/terapia , Humanos , Neumonía/etiología
18.
Int J Med Inform ; 132: 103986, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31629312

RESUMEN

BACKGROUND AND PURPOSE: Pneumonia is a common complication after stroke, causing an increased length of hospital stay and death. Therefore, the timely and accurate prediction of post-stroke pneumonia would be highly valuable in clinical practice. Previous pneumonia risk score models were often built on simple statistical methods such as logistic regression. This study aims to investigate post-stroke pneumonia prediction models using more advanced machine learning algorithms, specifically deep learning approaches. METHODS: Using a hospital's electronic health record(EHR) data from 2007-2017, 13,930 eligible patients with acute ischaemic stroke (AIS) were identified to build and evaluate the models (85% of the patients were used for training, and 15% were used for testing). In total, 1012 patients (7.23%) contracted pneumonia during hospitalization. A number of machine learning methods were developed and compared to predict pneumonia in the stroke population in China. In addition to the classic methods (i.e., logistic regression (LR), support vector machines (SVMs), extreme gradient boosting (XGBoost)), methods based on multiple layer perceptron (MLP) neural networks and recurrent neural network (RNNs) (i.e., attention-augmented gated recurrent unit (GRU)) are also implemented to make use of the temporal sequence information in electronic health record (EHR) systems. Prediction models for pneumonia were built for two time windows, i.e., within 7 days and within 14 days after stroke onset. In particular, pneumonia occurring within the 7-day window is considered highly associated with stroke (stroke-associated pneumonia, SAP). MAIN FINDINGS: The attention-augmented GRU model achieved the best performance based on an area under the receiver operating characteristic curve (AUC) of 0.928 for pneumonia prediction within 7 days and an AUC of 0.905 for pneumonia prediction within 14 days. This method outperformed the other machine learning-based methods and previously published pneumonia risk score models. Considering that pneumonia prediction after stroke requires a high sensitivity to facilitate its prevention at a relatively low cost (i.e., increasing the nursing level), we also compared the prediction performance using other evaluation criteria by setting the sensitivity to 0.90. The attention-augmented GRU achieved the optimal performance, with a specificity of 0.85, a positive predictive value (PPV) of 0.32 and a negative predictive value (NPV) of 0.99 for pneumonia within 7 days and a specificity of 0.82, a PPV of 0.29 and an NPV of 0.99 for pneumonia within 14 days. CONCLUSIONS: The deep learning-based predictive model is feasible for stroke patient management and achieves the optimal performance compared to many classic machine learning methods.


Asunto(s)
Algoritmos , Isquemia Encefálica/complicaciones , Registros Electrónicos de Salud/estadística & datos numéricos , Aprendizaje Automático , Neumonía/diagnóstico , Accidente Cerebrovascular/complicaciones , Anciano , Anciano de 80 o más Años , China/epidemiología , Femenino , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Neumonía/epidemiología , Neumonía/etiología , Valor Predictivo de las Pruebas , Curva ROC
19.
BMC Infect Dis ; 19(1): 843, 2019 Oct 15.
Artículo en Inglés | MEDLINE | ID: mdl-31615438

RESUMEN

BACKGROUND: In recent years, some rare fungi have been increasingly recognized as new human pathogens. Here we reported the first fatal case of human severe pneumonia complicated by multiple organ dysfunction caused by Acrophialophora levis infection. However, its pathogenic mechanism and risk factors are unknown. Acrophialophora genus has only reported in six cases of human infection worldwide, but it has not been reported previously in China. CASE PRESENTATION: A 71-year-old male patient with severe pneumonia complicated with multiple organ dysfunction caused by A. levis infection. The fungal identification was based on micromorphology and sequence analysis of the internal transcriptional spacer (ITS) of ribosomal RNA genes recovered from lower respiratory tract secretions. The microbial characteristics, sensitivity to antifungal drugs of this isolated A. levis were studied. Anti-infective regimen, liposomal amphotericin B combined with tegacycline, was used to prevent infection. The next day, the fever decreased, body temperature fluctuated between 36.5 and 37.8 degree, cough and sputum decreased, and sputum volume decreased, with oxygen uptake for 5 L/min, blood oxygen saturation over 95%. After 17 days of treatment, CT reexamination showed that the lesions in the right lung and left upper lung were absorbed and pleural effusion was reduced. The next 8 days, the patient asked to return to the local hospital for treatment. The local hospital stopped using liposomal amphotericin B because of the absence of liposomal amphotericin B, and died of respiratory failure 2 days later. CONCLUSIONS: This study is the first to report the occurrence, risk factors, molecular determinants, microbial characteristics and susceptibility to antifungal agents of A. levis infection in China. In addition, six published cases of human infection with Acrophialophora were reviewed.


Asunto(s)
Ascomicetos/aislamiento & purificación , Neumonía/diagnóstico , Anciano , Anfotericina B/uso terapéutico , Antifúngicos/uso terapéutico , Humanos , Masculino , Derrame Pleural/etiología , Neumonía/complicaciones , Neumonía/tratamiento farmacológico , Neumonía/patología , Índice de Severidad de la Enfermedad , Tomografía Computarizada por Rayos X
20.
Pneumologie ; 73(10): 605-616, 2019 Oct.
Artículo en Alemán | MEDLINE | ID: mdl-31622999

RESUMEN

Pneumonia belongs to the most frequent and most deadly infectious diseases worldwide. It represents an increasing problem for the aging population. The incidence and mortality rises with every decade. The clinical presentation of pneumonia differs between elderly and younger patients. Multiple factors including functional status (self-dependency and immobilization), comorbidities, immunosenescence, nutritional status, swallowing disorders have to be accounted for. Pneumonia in the elderly has to be differentiated from nursing home acquired pneumonia. Diagnosis of pneumonia of the elderly demands special attention as the diagnostic value of common biomarkers and prognostic scores is different.


Asunto(s)
Infecciones Comunitarias Adquiridas/epidemiología , Neumonía/epidemiología , Anciano , Anciano de 80 o más Años , Infecciones Comunitarias Adquiridas/diagnóstico , Comorbilidad , Femenino , Alemania/epidemiología , Humanos , Incidencia , Masculino , Estado Nutricional , Neumonía/diagnóstico
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA