Risk factors and interventions for developing recurrent pneumonia in older adults.

Background: Pneumonia is common among older adults and often recurrent. Several studies have been conducted on the risk factors for pneumonia; however, little is known about the risk factors for recurrent pneumonia. This study aimed to identify the risk factors for developing recurrent pneumonia among older adults and to investigate methods of prevention. Methods: We analysed the data of 256 patients aged 75 years or older who were admitted for pneumonia between June 2014 and May 2017. Moreover, we reviewed the medical records for the subsequent 3 years and defined the readmission caused by pneumonia as recurrent pneumonia. Risk factors for recurrent pneumonia were analysed using multivariable logistic regression analysis. Differences in the recurrence rate based on the types and use of hypnotics were also evaluated. Results: Of the 256 patients, 90 (35.2%) experienced recurrent pneumonia. A low body mass index (OR: 0.91; 95% CI: 0.83‒0.99), history of pneumonia (OR: 2.71; 95% CI: 1.23‒6.13), lung disease as a comorbidity (OR: 4.73; 95% CI: 2.13‒11.60), taking hypnotics (OR: 2.16; 95% CI: 1.18‒4.01) and taking histamine-1 receptor antagonist (H1RA) (OR: 2.38; 95% CI: 1.07‒5.39) were risk factors. Patients taking benzodiazepine as hypnotics were more likely to experience recurrent pneumonia than patients not taking hypnotics (OR: 2.29; 95% CI: 1.25-4.18). Conclusion: We identified several risk factors for recurrent pneumonia. Among them, restricting the use of H1RA and hypnotics, in particular benzodiazepines, may be useful in preventing the recurrence of pneumonia in adults aged 75 years or older.

[HUMIDIFIER LUNG WITH ORGANIZING PNEUMONIA DETECTED BY BRONCHOSCOPY: A CASE REPORT].

A 58-year-old man presented with dyspnea on exertion and diffuse ground-glass opacities with mosaicism on chest computed tomography in April 201X. A transbronchial lung biopsy revealed organizing pneumonia and lymphocytic infiltration, and steroids were administered. During steroid tapering, the shortness of breath and ground-glass opacities recurred, and a transbronchial lung re-biopsy revealed organizing pneumonia without a granuloma again. Based on the clinical history, imaging features, and amount of humidifier usage, hypersensitivity pneumonitis caused by a humidifier was suspected. The inhalation challenge test was considered positive, and the diagnosis was confirmed. There have been some reports of unidentified granuloma in patients with humidifier lungs. Therefore, this case suggests that humidifier lung should be considered as a possibility even if pathological examination does not reveal granulomas and inflammatory changes such as organizing pneumonia are the only findings.

Disseminated cryptococcosis in a renal transplant recipient.

Skin cryptococcosis often manifests as an umbilicated papule, and chest computed tomography findings of multiple nodules and cavities are also characteristic. The combination of characteristic cutaneous manifestations and radiological findings can help clinicians make an "at-a-glance" diagnosis of disseminated cryptococcosis.

Mendelson's syndrome complicated by bacterial aspiration pneumonia triggered by right putamen bleeding: A case report.

We present the case of an 80-year-old woman with Mendelson's syndrome complicated by bacterial aspiration pneumonia caused by consciousness loss followed by vomiting resulting from putamen bleeding. Her condition worsened rapidly to develop respiratory failure, within a few hours; thereafter, she was intubated. Streptococcus agalactiae and Klebsiella oxytoca were detected from the aspirated sputum sample culture. She was diagnosed with acute respiratory distress syndrome with Mendelson's syndrome complicated by bacterial aspiration pneumonia. Corticosteroid and antibiotic administration improved her condition and led to successful extubation; therefore, these treatment modalities were invaluable. We suggest the clinical considerations for the corticosteroid and antibiotic use in such cases.

Myeloperoxidase anti-neutrophil cytoplasmic antibody-associated vasculitis with a unique imaging presentation of organizing pneumonia: A case report.

Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) constitutes a group of blood vessel inflammation diseases of autoimmune origin. Myeloperoxidase (MPO) ANCA is closely related to ANCA associated AAV. The MPO-ANCA positive AAV patients have lung involvement at high rates; however, there are only a few reported cases with organizing pneumonia (OP). A 78-year-old man was presented to our hospital due to a fever of 38 °C despite a whole month of antibiotics treatment. Chest computed tomography image revealed restricted consolidations visible in the middle lobe of the right lung and the upper lobe of the left lung, which suggested an OP pattern. MPO-ANCA and urine occult blood tests were positive. Histopathological examination of the transbronchial biopsy revealed OP and mucus plug. Histological findings on renal biopsy showed necrotizing glomerulonephritis related to AAV. The patient was diagnosed with MPO-ANCA positive AAV and was treated with systemic corticosteroid therapy, from which he recovered rapidly. Thus, when diagnosing OP, the possibility of AAV should be considered by ordering patients' serum ANCA and occult hematuria tests.

Effects of morphine on two types of nucleus raphe dorsalis neurons in awake cats.

Forty-nine neurons recorded within the nucleus raphe dorsalis (NRD) in awake cats were classified into 2 groups: 29 regularly firing (clock-like) and 20 irregularly firing (non-clock-like) neurons. Hardly any of the clock-like neurons were influenced either by noxious stimulation (0.1 ml of 5% formalin, s.c.) or by a single dose (1 mg/kg, i.p.) or cumulative doses (0.25, 0.5, 1 mg/kg) of morphine. In contrast, about half the non-clock-like neurons were activated both by noxious stimulation and by administration of morphine. Morphine-induced activation of non-clock-like neurons was dose-related and reversed by naloxone (0.2 mg/kg, i.p.). These findings suggest that clock-like neurons in the NRD are not involved in morphine analgesia. Non-clock-like neurons, however, may play a role in the mediation of such analgesia.

Arthritis induced in cat by sodium urate: a possible animal model for tonic pain.

An attempt has been made to determine whether cats rendered arthritic by the injection of monosodium urate (MSU) crystals (rod-shaped 40-130 micrometers length) into one knee joint capsule can be used as animal model of tonic (chronic) pain. A limp and a decrease in body weight supported by the injected hind leg's paw occurred approximately 1 h after the MSU (20 mg) injection, reached a maximum at 2-3 h, and lasted for more than 6 h before a gradual return to pre-injection levels. They were diminished by systemic administration and local (the dorsal part of the nucleus raphe dorsalis) application of morphine, this effect being blocked by naloxone. This suggests that the limping and the paw pressure decrease are the reflexion of pain. It is suggested that the animal model of the MSU-induced arthritis is useful for the study of tonic pain.

Antinociceptive action of morphine and pentazocine on unit activity in the nucleus centralis lateralis, nucleus ventralis lateralis and nearby structures of the cat.

Single neuronal activity has been recorded extracellularly from the nucleus centralis lateralis (CL), ventralis lateralis (VL) and medialis dorsalis (MD) of the cat thalamus. The majority of the CL, VL and MD neurons were excited by nociceptive stimulation such as pinching the skin with serrated forceps and/or intra-arterial injection of bradykinin. The nociceptive neurons were also driven by non-nociceptive stimulation such as tap of deep tissues, bending hairs and an air-puff and/or joint rotation, and their receptive fields were large. After intravenous administration of either morphine or pentazocine, most nociceptive neurons became unresponsive to nociceptive stimuli, although they were driven by non-nociceptive stimuli. This suggests that morphine and pentazocine have a specific antinociceptive action on these nociceptive neurons. Intravenous naloxone reversed the antinociceptive action of morphine, but failed to reduce the action of pentazocine. This differentiation has an important functional significance.

An improved radiant heat algometer and its application to pain threshold measurements in man.

A radiant heat algometer system is described which enables the psychophysical and clinical study of cutaneous pain sensations and reactions by means of a precise, stabilized power source. In this system DC electric power consumption of a bulb is automatically controlled, and no calibration is necessary to be controlled frequently. Moreover, attention is drawn to the significance of using the blackened sticky tape and of the pre-heating procedure. The application of this algometer is also described for a pain threshold determination with the intensity and time methods.