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1.
Zhongguo Zhong Yao Za Zhi ; 46(16): 4265-4273, 2021 Aug.
Artigo em Chinês | MEDLINE | ID: mdl-34467741

RESUMO

To systematically evaluate the efficiency and safety of Tanreqing Injection in the treatment of stroke-associated pneumonia(SAP). Seven domestic and foreign databases(CNKI, Wanfang, VIP, CBM, PubMed, Cochrane Library, EMbase) were retrieved from the establishment to July 2020. According to the inclusion and exclusion criteria, randomized controlled trial of the effect of Tanreqing Injection in the treatment of SAP was selected. NoteExpress software was used to screen out literatures. RevMan 5.4 software was used for data analysis. GRADE system was used to evaluate the evidence quality of the outcome indicators. A total of 1 755 cases in 21 studies were retrieved, including 879 cases in experimental group and 876 cases in control group. In general, the quality of stu-dies received was not high. According to Meta-analysis,(1) in terms of shortening the length of hospital stay, Tanreqing Injection combined with conventional western medicine was better than conventional western medicine(MD=-4.04, 95%CI[-4.43,-3.65], P<0.000 01);(2) in terms of increasing effective rate, Tanreqing Injection combined with conventional western medicine was better than conventional western medicine(RR=1.22, 95%CI[1.17, 1.27], P<0.000 01);(3) in terms of reducing inflammation indicators, Tanreqing Injection combined with conventional western medicine was better than conventional western medicine(MD_(CRP)=-10.75, 95%CI[-15.61,-5.88], P<0.000 01; MD_(WBC count)=-1.62, 95%CI[-2.55,-0.69], P=0.000 6; MD_(PCT)=-0.58, 95%CI[-0.89,-0.26], P=0.000 3];(4) in terms of improving symptoms and signs, Tanreqing Injection combined with conventional wes-tern medicine was better than conventional western medicine(MD_(cough)=-2.73, 95%CI[-4.93,-0.53], P=0.02; MD_(antipyretic)=-1.07, 95%CI[-1.17,-0.98), P<0.000 01];(5) in terms of decreasing the NIHSS scores, Tanreqing Injection combined with conventional western medicine was better than conventional western medicine(MD=-3.02, 95%CI[-4.91,-1.13], P=0.002);(6) in terms of adverse reactions, there was no statistically significant difference between Tanreqing Injection combined with conventio-nal western medicine compared with conventional western medicine treatment(RR=1.19, 95%CI[0.61,2.29], P=0.61). GRADE system showed that the evidence levels of above outcome indicators were low and extremely low. The results proved that Tanreqing Injection combined with conventional western medicine had a good advantage in the treatment of SAP, with better observation indicators better than western medicine conventional treatment, and no increase in the incidence of adverse reactions. However, this study had certain limitations. The overall quality of the included studies was low, which affected the reliability of the results. Therefore, the conclusions of this study shall be used cautiously.


Assuntos
Medicamentos de Ervas Chinesas , Pneumonia , Acidente Vascular Cerebral , Humanos , Pneumonia/tratamento farmacológico , Reprodutibilidade dos Testes , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/tratamento farmacológico
2.
Ann Palliat Med ; 10(8): 9267-9275, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34488412

RESUMO

In recent years, immune checkpoint inhibitors (ICIs) have become a standard treatment for patients with advanced lung cancers. With the widespread use of immunotherapy in clinical practice, immune-related adverse events (irAEs) have become increasingly common. This case report details a 72-year-old man with small-cell lung cancer (SCLC) who developed pneumonitis, appendicitis, and biliary obstruction during treatment with toripalimab. The patient was initially diagnosed with limited-stage SCLC in January 2019 and completed 5 sequential cycles of etoposide/cisplatin (EP) and radiotherapy (60 Gy/30 F). The overall response was complete response (CR) after first line treatment. He developed radiation pneumonitis after completion of radiotherapy, which responded well to symptomatic treatment. Due to newly diagnosed bone metastasis, he was administered toripalimab intravenously every 3 weeks and 12 mg anlotinib orally once a day from January 2020. By the third cycle, the patient presented with electrocardiographic abnormalities, gingival swelling and pain, and hoarseness, and consequently, the anlotinib was suspended. After 4 cycles, he developed suppurative appendicitis, which was managed successfully with anti-inflammatory agents. He then presented with shortness of breath on exertion and after a comprehensive examination, he was diagnosed with ICI-related-pneumonitis. After 6 weeks of treatment with methylprednisolone, the shortness of breath was mostly relieved and treatment continued. In June 2020, the patient developed severe vomiting. Computed tomography (CT) indicated biliary obstruction, and at endoscopic retrograde cholangiopancreatography (ERCP) there was edema of the major papilla of the duodenum. The patient's symptoms were relieved after treatment with gastric acid suppression and antiemetics. Re-examination by magnetic resonance imaging (MRI) showed that the biliary obstruction had been resolved. Although the disease progressed after immunotherapy, no tumor tissue related to the biliary obstruction was detected, and this was therefore classified as an irAE.


Assuntos
Apendicite , Colestase , Neoplasias Pulmonares , Pneumonia , Idoso , Anticorpos Monoclonais Humanizados , Humanos , Neoplasias Pulmonares/tratamento farmacológico , Masculino , Pneumonia/induzido quimicamente , Pneumonia/tratamento farmacológico
3.
Ann Palliat Med ; 10(8): 9288-9296, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34488415

RESUMO

Extensively drug-resistant Acinetobacter baumannii (XDRAB) pulmonary infection is a serious respiratory system infection. Patients are often very sick and even need to be admitted to the ICU for treatment. In this case report, we presented our treatment experience of one XDRAB pulmonary infection patient. A 71-year-old male patient was admitted to our hospital complaining of "fatigue accompanied by fever for 2 days and shortness of breath for 1 day". The patient's admission diagnosis was as follows: severe pneumonia, acute respiratory distress syndrome, I type respiratory failure, septic shock, cardiac insufficiency, liver insufficiency, and hypertension. Imipenem/cilastatin sodium combined with moxifloxacin were first applied. Then, tigecycline, imipenem/cilastatin and caspofungin were used. The drug sensitivity results suggested that the XDRAB strain of this patient's sputum culture was sensitive to polymyxin only. Thus, colistin sulfate and cefoperazone/sulbactam were applied. The medication process of the patient was monitored. We found that a colistin sulfate intravenous injection combined with aerosol route combined with cefoperazone/sulbactam was effective in the treatment of XDRAB pulmonary infection, and no adverse drug reactions were observed during the treatment. The anti-infection therapy of intravenous colistin sulfate combined with nebulization and cefoperazone/sulbactam could be a good choice for the treatment of XDRAB lung infections.


Assuntos
Infecções por Acinetobacter , Acinetobacter baumannii , Preparações Farmacêuticas , Pneumonia , Infecções por Acinetobacter/tratamento farmacológico , Idoso , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Colistina/uso terapêutico , Farmacorresistência Bacteriana Múltipla , Humanos , Masculino , Pneumonia/tratamento farmacológico
4.
Rev Med Chil ; 149(3): 433-438, 2021 Mar.
Artigo em Espanhol | MEDLINE | ID: mdl-34479322

RESUMO

BACKGROUND: Pneumonia is a disease with great relevance in public health, as a leading individual cause of infant mortality worldwide. Legionellosis is a respiratory disease with a bacterial origin and two different clinical forms. AIM: To determine pneumonia and legionellosis mortality in Spain. MATERIAL AND METHODS: Time series study of pneumonia and legionellosis in Spain in two periods, from 1997 to 2001 and from 2011 to 2015. Mortality was calculated according to disease and sex, number of deaths and rates per 100,000 inhabitants. RESULTS: Pneumonia mortality in the first period shows a relatively stable and similar tendency according to sex, preferably affecting males. In the second period, pneumonia mortality increased significantly in recent years. Although pneumonia mortality in Spain decreased in both sexes in some age groups (especially < 5 years), it remained relatively stable in patients aged > 75 years. Deaths due to legionellosis were relevant in 1997, 1998 and 2000 and increased in the last period. CONCLUSIONS: A higher mortality due to pneumonia along the years was identified. Strategies to reduce the incidence and improve the diagnosis of pneumonia, especially in children and older people elderly, are encouraged.


Assuntos
Legionelose , Pneumonia , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Legionelose/epidemiologia , Masculino , Espanha/epidemiologia
5.
Saudi Med J ; 42(9): 994-1001, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34470838

RESUMO

OBJECTIVES: To analyze the prognostic value of serum presepsin value in community-acquired pneumonia focal sepsis using sepsis-3 criteria and its relationship with other biomarkers and clinical severity scores. METHODS: For this prospective observational study, 176 patients above 18 years old, diagnosed with community-acquired pneumonia, pneumonia focal sepsis and septic shock were included. It was performed in a tertiary hospital between May 2020 and December 2020. Blood samples were obtained from patients for presepsin levels at the time of diagnosis in the emergency room. The serum presepsin levels of 3 groups were statistically compared with each other. RESULTS: The sepsis group had significantly higher serum presepsin levels than the pneumonia group (p=0.004).The septic shock group had serum presepsin levels than sepsis group; however, the difference was not statistically significant (p=0.25). Non survivor patients had significantly higher serum presepsin levels than survivors (p=0.001). Significant correlation determined between serum presepsin level and procalcitonin, C-reactive protein, lactate, pneumonia severity index, and quick sequential organ failure assessment (qSOFA). CONCLUSION: Serum presepsin level is a new biomarker that can be used an indicator of sepsis and mortality in community-acquired pneumonia. However, for determining the prognosis of sepsis, there was no superiority detected over other biomarkers and clinical severity scores.


Assuntos
Fragmentos de Peptídeos/sangue , Pneumonia , Sepse , Adulto , Biomarcadores/sangue , Humanos , Receptores de Lipopolissacarídeos , Pneumonia/diagnóstico , Prognóstico , Sepse/diagnóstico
6.
Zhongguo Zhen Jiu ; 41(9): 971-8, 2021 Sep 12.
Artigo em Chinês | MEDLINE | ID: mdl-34491645

RESUMO

OBJECTIVE: To observe the analgesic and sedative effects of acupuncture in elderly patients with severe pneumonia during invasive mechanical ventilation. METHODS: A total of 188 elderly patients with severe pneumonia were randomly divided into an observation group and a control group, 94 cases in each group. Both groups were treated with routine nursing and treatment of severe pneumonia such as invasive mechanical ventilation, analgesia and sedation. Based on these, the observation group was treated with acupuncture at Neiguan (PC 6), Hegu (LI 4), Yintang (GV 29) and Baihui (GV 20), twice a day until the mechanical ventilation was offline. The critical care pain observation tool (CPOT) score and Richmond agitation-sedation score (RASS) were observed before treatment and 0.5 h after analgesia and sedation; the average time of reaching the standard, the reaching standard rate of shallow sedation and analgesia within 0.5 h and 72 h as well as the dosage of analgesic and sedative drugs and compilations were compared between the two groups. The mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR) and blood oxygen saturation (SpO2) were observed before treatment and 0.5 h, 1 h and 2 h after analgesia and sedation. The levels of partial pressure of blood oxygen (PaO2), partial pressure of carbon dioxide (PaCO2) and lactic acid (Lac) were observed before treatment and 12 h, 24 h, 48 h, 72 h, 96 h, 120 h and 144 h after analgesia and sedation. The white blood cell (WBC), neutrophil percentage (NEUT%), high-sensitivity C-reactive protein (hs-CRP), aspartate aminotransferase (AST), alanine aminotransferase (ALT) and creatinine (Cr) were observed before treatment and 72 h after analgesia and sedation. The tracheal intubation time and ICU hospitalization time were compared between two groups. RESULTS: At the time point of 0.5 h after treatment, the CPOT and RASS scores in the two groups were lower than those before treatment (P<0.05); the average time of reaching the standard in the observation group was shorter than that in the control group (P<0.01); the 30 min reaching standard rates of CPOT and RASS scores as well as the rate of reaching the shallow sedation and analgesia within 72 h in the observation group were higher than those in the control group (P<0.01, P<0.05). The dosage and duration of dexmedetomidine, propofol and butorphanol in the observation group were less than those in the control group (P<0.05), and the occurrence times of hypotension, respiratory depression, bradycardia, constipation as well as average tracheal intubation time and average ICU hospitalization time in the observation group were less than those in the control group (P<0.05). After 0.5 h, 1 h and 2 h of treatment, the HR and RR were lower than those before treatment in the two groups (P<0.05), MAP and SpO2 were higher than those before treatment in the two groups (P<0.05); the MAP 0.5 h after treatment in the observation group was higher than that in the control group (P<0.05); the HR after 1 h and 2 h of treatment in the observation group was lower than that in the control group (P<0.05). Compared before treatment, the levels of PaCO2 and Lac were reduced and the levels of PaO2 were increased 12 h, 24 h, 48 h, 72 h, 96 h, 120 h and 144 h after treatment in both groups (P<0.05); compared before treatment, the WBC, NEUT%, hs-CPR, ALT and Cr were reduced 72 h after treatment in the two groups (P<0.05), and the hs-CRP in the observation group was lower than that in the control group (P<0.05). CONCLUSION: Acupuncture has analgesic and sedative effect in elderly patients with severe pneumonia during invasive mechanical ventilation, which could reduce the dosage of sedative and analgesic drugs and the occurrence of complications, improve blood oxygen, and has good safety.


Assuntos
Terapia por Acupuntura , Analgesia , Pneumonia , Idoso , Humanos , Unidades de Terapia Intensiva , Dor , Respiração Artificial
7.
Medicine (Baltimore) ; 100(35): e27128, 2021 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-34477157

RESUMO

ABSTRACT: To examine the etiological distribution of pathogens in pediatric patients with severe pneumonia and analyze the drug resistance of major pathogen species.Nasopharyngeal secretion specimens were collected for bacterial culture from pediatric patients admitted to the Xiamen children's hospital who were diagnosed with severe pneumonia from January 2016 to December 2019. Pathogen species were detected by quantitative polymerase chain reaction, direct immunofluorescence, and bacterial culture and we examined the drug susceptibility of the bacterial pathogens.At least 1 species of the pathogen was detected in 576 of 734 patients and a total of 444 bacterial samples were isolated, of which 284 were gram-negative and 160 were gram-positive. The most frequently detected bacteria were Haemophilus influenzae, Streptococcus pneumonia, Staphylococcus aureus, Klebsiella pneumoniae, and Escherichia coli. In addition, we isolated 186 viral samples, of which the majority were respiratory syncytial virus (n = 90) and adenovirus (n = 70) as well as 142 Mycoplasma pneumonia samples.Gram-negative bacteria are dominant among the pathogens causing severe pneumonia in pediatric patients and the major pathogen species are resistant to a variety of antibiotics. Appropriate antibiotic use has an important role in preventing the emergence of resistant strains.


Assuntos
Farmacorresistência Bacteriana , Pneumonia/microbiologia , Adolescente , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , Feminino , Interações Hospedeiro-Patógeno , Humanos , Lactente , Pacientes Internados/estatística & dados numéricos , Masculino , Pneumonia/tratamento farmacológico , Estudos Retrospectivos
8.
Zhonghua Jie He He Hu Xi Za Zhi ; 44(9): 800-805, 2021 Sep 12.
Artigo em Chinês | MEDLINE | ID: mdl-34496521

RESUMO

Objective: To retrospectively analyze the high risk factors of death in patients with chronic obstructive pulmonary disease (COPD) and to explore the influence of aspiration on the long-term survival rate of COPD patients. Methods: A retrospective analysis of clinical data of inpatients, who were admitted to the First Affiliated Hospital of Guangzhou Medical University from April 2012 to December 2013 due to COPD exacerbations and had radionuclide aspiration test, was conducted. Meanwhile, we phoned the patients' family members, whose phone numbers were recorded in the electronic patient record system, to follow up the patients' survival status, and learn the causes of death from their death records if patients died during follow-up period. Inquired the resident administration patients belonging to according to their original address to get patient's current contact information if changed. Besides, if family members of patients failed to provide death record, we should look up information concerned from the medical records room of the hospital where they died. Results: The follow-up for the last patient was performed on February 20, 2017.The time span of this study is 58 months, starting from the radionuclide aspiration test for the first patient and ending with the follow-up for the last patient. 16 of the 53 patients(16/53, 30.2%)were tested positive whose average age was slightly higher than patients without aspiration (76.0±6.8 vs 70.9±9.9), but there was no significant difference between them(P=0.064). The aspiration rates among patients over and under the age of seventy were 14/35 and 2/18 respectively, and there was a significant difference between them(P = 0.03). Compared to the aspiration-negative patients, the aspiration-positive patients had higher incidence rate of pneumonia in COPD exacerbations (11/16 vs 9/37, χ²= 9.383, P = 0.002).The major cause of death in the patients with and without aspiration were respectively severe pneumonia and pulmonary encephalopathy(P<0.05 in both cases).Among COPD patients who took radionuclide aspiration test, the median survival time of the patients with and without aspiration were about 3 and 5 years respectively. The high-risk factors influencing long-term survival of the COPD patients with aspiration included ICU-involved medical history and accompanying pneumonia. Conclusions: The incidence rate of aspiration is relatively high in COPD patients over 70 years old. Compared to COPD patients without aspiration, COPD patients with aspiration have higher incidence rate of pneumonia and shorter median survival time. ICU-involved medical history and severe pneumonia are the two high-risk factors influencing long-term survival of COPD patients with aspiration.To improve the survival time of COPD patients with aspiration, we need to attach importance to the prevention and treatment of aspiration.


Assuntos
Pneumonia , Doença Pulmonar Obstrutiva Crônica , Idoso , Progressão da Doença , Humanos , Pacientes Internados , Pulmão , Estudos Retrospectivos
9.
Zhonghua Jie He He Hu Xi Za Zhi ; 44(9): 806-811, 2021 Sep 12.
Artigo em Chinês | MEDLINE | ID: mdl-34496522

RESUMO

Objective: To analyze the clinical characteristics and the diagnosis and treatment of Chlamydia psittaci pneumonia complicated with rhabdomyolysis. Methods: We reported a case of Chlamydia psittaci pneumonia complicated with rhabdomyolysis. We did a literature review on the published reports between January 1978 and May 2020 by searching with the key words of "psittacosis" or "Chlamydia psittaci" and "rhabdomyolysis" in the PubMed database (time frame: January 1, 1967 to May 30, 2020). Results: Our patient was a 64-year-old male presenting with high-grade fever, fatigue, myalgia and dyspnea. A computed tomographic scan of the chest revealed bilateral pneumonia, which was further complicated with rhabdomyolysis during disease progression. This prompted the metagenomic next-generation sequencing, revealing the sequences of Chlamydia psittaci in both the bronchoalveolar lavage fluid and blood. Of the 11 cases in the 3 literature reports that we retrieved, 5 had concomitant rhabdomyolysis (two of which did not have complete clinical information), and the other 6 cases had myositis complicated with an elevated level of creatine phosphokinase. This yielded 3 cases with complete clinical information for our analysis. We had further incorporated their information with the single case managed within our study site. Two were males and the other 2 were females. The patients were aged 66, 46, 44 and 64 years, respectively. All cases had fever and 3 had a contact history with live poultry. Two cases had myalgia and progressed rapidly into having respiratory failure, and the other 2 cases did not develop myalgia and improved significantly after a timely treatment. All 4 cases were cured and discharged after treatment with appropriate antibiotics. No adverse outcomes were observed. Conclusions: The prognosis of Chlamydia psittaci pneumonia complicated with rhabdomyolysis was poor in case of a delayed treatment. Early diagnosis would help reduce the mortality.


Assuntos
Chlamydophila psittaci , Pneumonia , Psitacose , Rabdomiólise , Líquido da Lavagem Broncoalveolar , Chlamydophila psittaci/genética , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Psitacose/complicações , Rabdomiólise/complicações
10.
J Med Case Rep ; 15(1): 394, 2021 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-34364400

RESUMO

BACKGROUND: Herpes virus remains dormant in human cells and could reactivate under immunosuppressed conditions, such as prolonged critical illnesses. The phenomenon of viral replication during intensive care is well known, even in patients without a history of immunosuppression, but it usually does not have a clinical impact. Systemic reactivation leads to viral DNA in blood. It remains unclear whether this replication is a marker of morbimortality or a true pathogenic process. Therefore, it is unclear what medical treatment is most appropriate for simple replication. In organ damage suspected to be induced by herpes virus, there is no consensus on the most appropriate treatment duration. Here, we report a rarely described case of multiorgan failure implicating herpes simplex virus and discuss its treatment. CASE REPORT: A 53-year-old Caucasian immunosuppressed woman was admitted to the intensive care unit for septic shock. She presented pneumonia due to Klebsiella pneumoniae. Two weeks after admission, she showed multiorgan failure with acute respiratory distress syndrome and circulation failure. She had digestive and cutaneous lesions typical of herpes simplex virus 1. Blood and respiratory polymerase chain reaction was strongly herpes simplex virus-1 positive. No other bacteria, fungi, or viruses were found. The evolution was rapidly favorable after the initiation of antiviral treatment. Treatment was stopped after 3 weeks of well-conducted antiviral therapy. Curative-dose treatment was interrupted despite continuous strongly positive blood polymerase chain reaction results. In this context, prophylactic treatment was continued. CONCLUSION: We report an exceptional presentation of multiorgan failure in the intensive care unit due to herpes simplex virus-1. The diagnosis was made based on typical herpes simplex virus-1 visceral lesions and the absence of other responsible microorganisms. Intense viral replication is a key diagnostic element. There is no consensus regarding the most appropriate treatment duration, but such decisions should not be based on blood polymerase chain reaction.


Assuntos
Herpes Simples , Herpesvirus Humano 1 , Pneumonia , Choque Séptico , Antivirais/uso terapêutico , Feminino , Herpes Simples/complicações , Herpes Simples/diagnóstico , Herpes Simples/tratamento farmacológico , Humanos , Pessoa de Meia-Idade , Pneumonia/tratamento farmacológico , Choque Séptico/tratamento farmacológico
11.
Front Cell Infect Microbiol ; 11: 695134, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34368015

RESUMO

The objective of this study was to evaluate the value of molecular methods in the management of community-acquired pneumonia (CAP) in children. Previously developed mass spectrometry (MS)-based methods combined with quantitative real-time PCR (combined-MS methods) were used to describe the aetiology and evaluate antibiotic therapy in the enrolled children. Sputum collected from 302 children hospitalized with CAP were analyzed using the combined-MS methods, which can detect 19 viruses and 12 bacteria related to CAP. Based on the results, appropriate antibiotics were determined using national guidelines and compared with the initial empirical therapies. Respiratory pathogens were identified in 84.4% of the patients (255/302). Co-infection was the predominant infection pattern (51.7%, 156/302) and was primarily a bacterial-viral mixed infection (36.8%, 111/302). Compared with that using culture-based methods, the identification rate for bacteria using the combined-MS methods (61.8%, 126/204) increased by 28.5% (p <0.001). Based on the results of the combined-MS methods, the initial antibiotic treatment of 235 patients was not optimal, which mostly required switching to ß-lactam/ß-lactamase inhibitor combinations or reducing unnecessary macrolide treatments. Moreover, using the combined-MS methods to guide antibiotic therapy showed potential to decrease the length of stay in children with severe CAP. For children with CAP, quantitative molecular testing on sputum can serve as an important complement to traditional culture methods. Early aetiology elucidated using molecular testing can help guide the antibiotic therapy.


Assuntos
Infecções Comunitárias Adquiridas , Pneumonia , Antibacterianos/uso terapêutico , Bactérias/genética , Criança , Infecções Comunitárias Adquiridas/tratamento farmacológico , Humanos , Espectrometria de Massas , Pneumonia/tratamento farmacológico
12.
Mikrobiyol Bul ; 55(3): 342-356, 2021 Jul.
Artigo em Turco | MEDLINE | ID: mdl-34416801

RESUMO

Limited data exists to date on the predictors for the development of pneumonia in patients with mild and moderate coronavirus (COVID-19). In this study, it was aimed to evaluate the demographic characteristics and clinical findings of mild and moderate COVID-19 and to determine the risk factors for the development of COVID-19 pneumonia in patients admitted to the pandemic outpatient clinic of a university hospital. A total of 414 patients with laboratory confirmed COVID-19 were included. Of these, 220 (53.1%) were male, the mean age was 38.3 ± 12.7. Median duration of hospital admission from the onset of symptoms was three days (0-11). Of the confirmed COVID-19 cases, 154 (37.2%) had a history of family contact and the most common symptoms were weakness (68.4%), myalgia (61.8%), headache (56.5%), loss of smell (45.2%), loss of taste (43.2%) and anorexia (42.8%). Among females, weakness (p= 0.016), headache (p= 0.008), sore throat (p= 0.032), nausea (p= 0.003), anorexia (p= 0.045), loss of taste (p= 0.005) and loss of smell (p<0.001) were more common. Loss of taste (47.6% vs. 25%, p<0.001) and loss of smell (50% vs. 26.3%, p<0.001) were more common in patients with under the age of 50 and cough (43.4% vs. 29.3%, p= 0.003) was more common in patients with above the age of 40. Among 46 (11.1%) patients with asymptomatic COVID-19, there was no significant difference (p= 0.500) between the genders. Pneumonia was detected in 150 (43.8%) of 339 patients who underwent thorax computed tomography. In the univariate analysis; advanced age (p<0.001, odds ratio (OR)= 1.44), obesity (p<0.001 OR= 2.5), not being actively smoking (p<0.001, OR= 6.19), fever at first admission (p= 0.002, OR= 2.02), cough (p<0.001, OR= 3.26), shortness of breath (p<0.001, OR= 23.37), weakness (p= 0.042, OR= 1.63), anorexia (p= 0.009, OR= 1.79) and elevation of D-dimer (p= 0.014, OR= 1.92) were associated with the development of pneumonia. In multivariate analysis, obesity (p= 0.005, OR= 2.69), not being actively smoking (p<0.001, OR= 5.43), cough at first admission p= 0.017, OR= 2.16) and shortness of breath (p= 0.008, OR= 16.22) was determined as an independent risk factor for the development of pneumonia. CRP (p<0.001), D-dimer (p<0.001), ferritin (p<0.001) values among 108 (26.1%) patients with a body-mass index(BMI) >30 were high, and 60.9% of the patients had pneumonia (p<0.001) . CRP (p<0.001), D-dimer (p= 0.010) values were low, lymphocyte count (p= 0.001) was high among 106 (25.6%) active smokers, and 15.6% of the patients had pneumonia (p<0.001). Of the patients reported with persistent symptoms, 25.9% had loss of smell, 25% had weakness, and 23.1% had loss of taste on the seventh day; 21.1% had loss of smell, 21.1% had myalgia, and 19.7% had loss of taste on the 14th day. During their follow-up, the COVID-19 polymerase chain reaction (PCR) test was studied in 286 patients for control purposes. The median time of being negative for COVID-19 PCR test was eight days (3-56). In conclusion, symptoms may last longer than 14 days in 20- 30% of patients presenting with mild-moderate clinical findings. In addition, obesity should be considered as an important risk factor for COVID-19 pneumonia.


Assuntos
COVID-19 , Pneumonia , Adulto , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia/epidemiologia , Pneumonia/etiologia , Fatores de Risco , SARS-CoV-2
13.
Ned Tijdschr Geneeskd ; 1652021 08 05.
Artigo em Holandês | MEDLINE | ID: mdl-34351720

RESUMO

Community-acquired pneumonia (CAP) is frequently seen in the general population and has high morbidity and a substantial mortality. Several studies investigated the role of short course of corticosteroids (CS) as adjuvant treatment next to antibiotics. In patients with severe CAP admitted to the ICU, CS seems to be effective with a reduction of length of stay (LOS) and a reduction in mortality. However, these studies are of moderate quality. In patients with CAP admitted to a general ward CS may result in a more rapid clinical stability and reduction of LOS with one day. The disadvantage of adjuvant CS are an increased risk for CAP related rehospitalisation and hyperglycaemia. Further research with CS is needed, especially in those patients with a hyperinflammation state.


Assuntos
Infecções Comunitárias Adquiridas , Pneumonia , Corticosteroides/uso terapêutico , Infecções Comunitárias Adquiridas/tratamento farmacológico , Hospitalização , Humanos , Tempo de Internação , Pneumonia/tratamento farmacológico
14.
Sci Rep ; 11(1): 16071, 2021 08 09.
Artigo em Inglês | MEDLINE | ID: mdl-34373554

RESUMO

To speed up the discovery of COVID-19 disease mechanisms by X-ray images, this research developed a new diagnosis platform using a deep convolutional neural network (DCNN) that is able to assist radiologists with diagnosis by distinguishing COVID-19 pneumonia from non-COVID-19 pneumonia in patients based on chest X-ray classification and analysis. Such a tool can save time in interpreting chest X-rays and increase the accuracy and thereby enhance our medical capacity for the detection and diagnosis of COVID-19. The explainable method is also used in the DCNN to select instances of the X-ray dataset images to explain the behavior of training-learning models to achieve higher prediction accuracy. The average accuracy of our method is above 96%, which can replace manual reading and has the potential to be applied to large-scale rapid screening of COVID-9 for widely use cases.


Assuntos
Algoritmos , COVID-19/prevenção & controle , Aprendizado Profundo , Redes Neurais de Computação , Pneumonia/diagnóstico , COVID-19/complicações , COVID-19/virologia , Diagnóstico Diferencial , Humanos , Pneumonia/complicações , Radiografia Torácica/métodos , SARS-CoV-2/fisiologia , Sensibilidade e Especificidade , Raios X
15.
R I Med J (2013) ; 104(7): 46-49, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34437666

RESUMO

A 21-year-old male with no past medical history presented with a sore throat, cough, and shortness of breath after attending a party days earlier. He was initially treated for community-acquired pneumonia, but subsequently developed a new oxygen requirement. CT imaging of the chest showed multifocal airspace disease, concerning for COVID-19. Testing for SARS-CoV-2 was negative by RT-PCR and antibody testing. Blood cultures subsequently grew Streptococcus anginosus. A CT scan of his neck demonstrated a right peritonsillar abscess and right internal-jugular thrombus, consistent with Lemierre's syndrome. He underwent incision and drainage of the peritonsillar abscess and completed 4 weeks of IV antibiotics, which improved his symptoms. It is important to recognize that the differential diagnosis of multifocal pneumonia is broad and includes Lemierre's syndrome. The COVID-19 pandemic presents challenges with regards to anchoring bias for multifocal pneumonia.


Assuntos
COVID-19 , Síndrome de Lemierre , Pneumonia , Adulto , Humanos , Síndrome de Lemierre/diagnóstico , Masculino , Pandemias , SARS-CoV-2 , Adulto Jovem
16.
Medicina (Kaunas) ; 57(8)2021 Aug 04.
Artigo em Inglês | MEDLINE | ID: mdl-34441006

RESUMO

Background and objectives: The advanced lung inflammation index (ALI) was developed to assess the degree of systemic inflammation and has an association with prognosis in patients with lung malignancy. The prognostic value of ALI has not yet been evaluated in patients with acute respiratory distress syndrome (ARDS). Materials and Methods: Between January 2014 and May 2018, patients with ARDS in the medical intensive care unit (ICU) were reviewed retrospectively. The ALI value was calculated as the (body mass index × serum albumin level)/neutrophil-lymphocyte ratio. The cut-off value for distinguishing low from high ALI was defined according to receiver-operating characteristic curve analysis. Results: A total of 164 patients were analyzed. Their median age was 73 years, and 73% was male. The main cause of ARDS was pneumonia (95.7%, 157/164). ICU and in-hospital mortality rates were 59.8% (98/164) and 64% (105/164), respectively. The 30 day mortality was 60.9% (100/164). The median ALI value in non-survivors was lower than that in survivors at 30 day (3.81 vs. 7.39, p = 0.005). In multivariate analysis, low ALI value (≤5.38) was associated with increased 30 day mortality (odds ratio, 2.944, confidence interval 1.178-7.355, p = 0.021). Conclusions: A low ALI value was associated with increased 30 day mortality in patients with ARDS.


Assuntos
Pneumonia , Síndrome do Desconforto Respiratório , Idoso , Humanos , Unidades de Terapia Intensiva , Masculino , Pneumonia/complicações , Prognóstico , Estudos Retrospectivos
17.
Zhonghua Yu Fang Yi Xue Za Zhi ; 55(8): 945-951, 2021 Aug 06.
Artigo em Chinês | MEDLINE | ID: mdl-34445831

RESUMO

Objective: The hvKP phenotype strains were screened from the sensitive and multi-drug resistant Klebsiella pneumoniae, and the distribution and homology of their clinical infection characteristics were compared. Methods: A total of 158 Klebsiella pneumoniae strains isolated from clinical infection specimens in the Third Affiliated Hospital of Sun Yat-sen University from 2014 to 2018 were retrospectively collected. The string test (ST) was used to screen the hvKP infection, and a total of 65 were screened. The number of patients included 51 males and 14 females, with an average age of 56 years. The composition ratio of Klebsiella pneumoniae was analyzed for clinical infection related information. Matrix assisted laser desorption-ionization time of flight mass spectrometry (MALDI-TOF MS) was used to identify the hypervirulent Klebsiella pneumoniae and establish a new database, and bio-tree cluster analysis and principal component analysis were carried out for all strains that met the experimental conditions by using analysis software and the homology of protein level was obtained. Results: A total of 65 strains hvKP were screened, 62 of which were susceptible strains and 3 were multi-drug resistant strains. The main diseases of infected patients were diagnosed as hepatobiliary disease, encephalopathy and liver abscess. The basic diseases of the population were mainly diabetes and hypertension. Dendrogram cluster analysis divided hvKP into 3 groups at a distance of 550 from the horizontal line; principal component analysis found that some strains were closely related, and the Kc group with the largest proportion was mainly related to hepatobiliary diseases. Ka group was mainly related to infection after surgery. Conclusions: HvKP was highly invasive and the clinical manifestations of infection were diverse. The infected patients were mostly elderly patients with weakened immunity. The rapid homology analysis of MALDI-TOF MS mass spectrometry has important clinical significance for the rapid screening of hvKP infection.


Assuntos
Klebsiella pneumoniae , Pneumonia , Idoso , Antibacterianos/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia/tratamento farmacológico , Estudos Retrospectivos , Virulência
18.
BMC Health Serv Res ; 21(1): 874, 2021 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-34445974

RESUMO

BACKGROUND: Previous research has found that social risk factors are associated with an increased risk of 30-day readmission. We aimed to assess the association of 5 social risk factors (living alone, lack of social support, marginal housing, substance abuse, and low income) with 30-day Heart Failure (HF) hospital readmissions within the Veterans Health Affairs (VA) and the impact of their inclusion on hospital readmission model performance. METHODS: We performed a retrospective cohort study using chart review and VA and Centers for Medicare and Medicaid Services (CMS) administrative data from a random sample of 1,500 elderly (≥ 65 years) Veterans hospitalized for HF in 2012. Using logistic regression, we examined whether any of the social risk factors were associated with 30-day readmission after adjusting for age alone and clinical variables used by CMS in its 30-day risk stratified readmission model. The impact of these five social risk factors on readmission model performance was assessed by comparing c-statistics, likelihood ratio tests, and the Hosmer-Lemeshow goodness-of-fit statistic. RESULTS: The prevalence varied among the 5 risk factors; low income (47 % vs. 47 %), lives alone (18 % vs. 19 %), substance abuse (14 % vs. 16 %), lacks social support (2 % vs. <1 %), and marginal housing (< 1 % vs. 3 %) among readmitted and non-readmitted patients, respectively. Controlling for clinical factors contained in CMS readmission models, a lack of social support was found to be associated with an increased risk of 30-day readmission (OR 4.8, 95 %CI 1.35-17.88), while marginal housing was noted to decrease readmission risk (OR 0.21, 95 %CI 0.03-0.87). Living alone (OR: 0.9, 95 %CI 0.64-1.26), substance abuse (OR 0.91, 95 %CI 0.67-1.22), and having low income (OR 1.01, 95 %CI 0.77-1.31) had no association with HF readmissions. Adding the five social risk factors to a CMS-based model (age and comorbid conditions; c-statistic 0.62) did not improve model performance (c-statistic: 0.62). CONCLUSIONS: While a lack of social support was associated with 30-day readmission in the VA, its prevalence was low. Moreover, the inclusion of some social risk factors did not improve readmission model performance. In an integrated healthcare system like the VA, social risk factors may have a limited effect on 30-day readmission outcomes.


Assuntos
Insuficiência Cardíaca , Pneumonia , Idoso , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/terapia , Humanos , Medicare , Readmissão do Paciente , Estudos Retrospectivos , Fatores de Risco , Estados Unidos/epidemiologia , Saúde dos Veteranos
19.
Trials ; 22(1): 571, 2021 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-34454594

RESUMO

BACKGROUND: Community-acquired pneumonia (CAP) is a leading cause of hospitalization worldwide. Bed rest with low levels of physical activity is common during periods of hospitalization and leads to functional decline as well as increased risk of complications. The aim of this study is to assess the effect of supervised physical training during hospitalization with CAP compared with standard usual care for CAP on length of hospital stay, risk of readmission, mortality risk, physical capacity, muscle and fat mass, muscle strength, metabolic function, systemic inflammation, health-related quality of life, and physical activity level. METHODS: This study is a randomized controlled trial with three parallel experimental arms. Based on a sample size calculation, a total of 210 patients admitted with CAP at Nordsjællands Hospital, Hillerød, Denmark, will be recruited. Patients will be randomly allocated (1:1:1) to either (1) standard usual care, (2) standard usual care combined with in-bed cycling, or (3) standard usual care combined with exercises from a booklet. The primary outcome is differences in length of hospital stay between groups, with secondary outcomes being differences between groups in time to (1) 90-day readmission and (2) 180-day mortality. Further secondary outcomes are differences in changes from baseline between groups in (3) lean mass, (4) fat mass, (5) fat-free mass, (6) physical capacity, (7) health-related quality of life, (8) systemic inflammation, and (9) physical activity level after discharge. Data on length of hospital stay, readmission, and mortality will be collected from patient files, while total lean, fat, and fat-free mass will be quantitated by dual-energy x-ray absorptiometry and bioelectrical impedance analysis. Physical function will be assessed using grip strength, 30-s chair stand tests, and Barthel Index-100. Health-related quality of life will be assessed with the EQ-5D-5L questionnaire. Systemic inflammation will be assessed in blood samples, while accelerometers are used for measuring physical activity. DISCUSSION: If a simple physical training program appears to diminish the impact of critical illness and hospitalization on clinical outcome, mobility, and health-related quality of life, it may lead to novel therapeutic approaches in the treatment of patients hospitalized with CAP. TRIAL REGISTRATION: ClinicalTrials.gov NCT04094636 . Registered on 1 April 2019.


Assuntos
Infecções Comunitárias Adquiridas , Pneumonia , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/terapia , Exercício Físico , Humanos , Tempo de Internação , Pneumonia/diagnóstico , Pneumonia/terapia , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto
20.
PLoS One ; 16(8): e0254698, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34383776

RESUMO

BACKGROUND: Pneumonia is a common and severe complication of abdominal surgery, it is associated with increased length of hospital stay, healthcare costs, and mortality. Further, pulmonary complication rates have risen during the SARS-CoV-2 pandemic. This study explored the potential cost-effectiveness of administering preoperative chlorhexidine mouthwash versus no-mouthwash at reducing postoperative pneumonia among abdominal surgery patients. METHODS: A decision analytic model taking the South African healthcare provider perspective was constructed to compare costs and benefits of mouthwash versus no-mouthwash-surgery at 30 days after abdominal surgery. We assumed two scenarios: (i) the absence of COVID-19; (ii) the presence of COVID-19. Input parameters were collected from published literature including prospective cohort studies and expert opinion. Effectiveness was measured as proportion of pneumonia patients. Deterministic and probabilistic sensitivity analyses were performed to assess the impact of parameter uncertainties. The results of the probabilistic sensitivity analysis were presented using cost-effectiveness planes and cost-effectiveness acceptability curves. RESULTS: In the absence of COVID-19, mouthwash had lower average costs compared to no-mouthwash-surgery, $3,675 (R 63,770) versus $3,958 (R 68,683), and lower proportion of pneumonia patients, 0.029 versus 0.042 (dominance of mouthwash intervention). In the presence of COVID-19, the increase in pneumonia rate due to COVID-19, made mouthwash more dominant as it was more beneficial to reduce pneumonia patients through administering mouthwash. The cost-effectiveness acceptability curves shown that mouthwash surgery is likely to be cost-effective between $0 (R0) and $15,000 (R 260,220) willingness to pay thresholds. CONCLUSIONS: Both the absence and presence of SARS-CoV-2, mouthwash is likely to be cost saving intervention for reducing pneumonia after abdominal surgery. However, the available evidence for the effectiveness of mouthwash was extrapolated from cardiac surgery; there is now an urgent need for a robust clinical trial on the intervention on non-cardiac surgery.


Assuntos
Abdome/cirurgia , Clorexidina/uso terapêutico , Modelos Teóricos , Pneumonia/prevenção & controle , COVID-19 , Análise Custo-Benefício , Humanos , Antissépticos Bucais , Pandemias , Complicações Pós-Operatórias/prevenção & controle , Cuidados Pré-Operatórios , Estudos Prospectivos , África do Sul
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