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1.
J Investig Med High Impact Case Rep ; 10: 23247096221084840, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35389278

RESUMO

Organizing pneumonia is a pulmonary disease of undefined etiology, with few reported cases in children. It may be secondary to chemotherapy, radiation therapy, infectious agents, or hematopoietic cell transplantation. We present a case of an 18-year-old boy who presented to a follow-up consult with respiratory symptoms at the age of 11 years, 8 years after finishing treatment for a prostatic relapse of a pelvic rhabdomyosarcoma. Chest radiography revealed nodular opacities in the left lung, the one in the left lower lobe with silhouette sign with the left hemidiaphragm. Chest computerized tomography showed 2 nodular lesions in the left upper lobe, one of them cavitated, and another nodular lesion in the left lower lobe; 2 of these nodules had surrounding ground-glass opacities. Microbiological work-up, including tuberculosis screening, was negative. Biopsy revealed findings suggestive of organizing pneumonia. He presented spontaneous resolution. This case presented a diagnostic challenge due to rarity of this condition and its indetermined association with the patient's history of rhabdomyosarcoma. With this case, the authors alert that organizing pneumonia must be considered in patients presenting with pulmonary lesions with a history of previous hematopoietic stem cell transplants, lung irradiation, or immunosuppression. Pulmonary metastases and secondary tumors must be considered as a differential diagnosis in patients with a heavily treated relapsed rhabdomyosarcoma.


Assuntos
Pneumonia em Organização Criptogênica , Pneumonia , Rabdomiossarcoma , Adolescente , Criança , Pneumonia em Organização Criptogênica/diagnóstico , Pneumonia em Organização Criptogênica/tratamento farmacológico , Pneumonia em Organização Criptogênica/patologia , Humanos , Pulmão/diagnóstico por imagem , Pulmão/patologia , Masculino , Recidiva Local de Neoplasia , Pneumonia/etiologia , Rabdomiossarcoma/diagnóstico , Rabdomiossarcoma/patologia , Rabdomiossarcoma/terapia
2.
Intern Med ; 61(7): 979-988, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35370255

RESUMO

Objective Phosphate is a fundamental element involved in a number of physiological pathways. A previous study showed abnormal laboratory findings and a higher mortality in hypophosphatemic patients than in normophosphatemic patients with pneumonia. Sporadic cases of pneumonia due to Legionella spp., Streptococcus pneumoniae, and viruses have been reported; however, the significance of hypophosphatemia in patients with pneumonia has not been adequately studied. We determined whether or not hypophosphatemia in patients with community-acquired pneumonia (CAP) was associated with specific pathogens, patient factors, disease severity, and mortality. Method We retrospectively analyzed 600 patients with CAP who were admitted to our hospital between January 1, 2010, and December 31, 2019. Results Hypophosphatemia was found in 72 (12.0%) of the 600 patients. The most frequent causative microbial agents of CAP in patients with hypophosphatemia were S. pneumoniae, Legionella spp., and influenza virus, whereas in severely ill patients with hypophosphatemia, influenza virus was the most common. Legionella spp., diabetes mellitus, and severe pneumonia were the independent factors for hypophosphatemia in the multivariable analysis. An impaired performance status, severe status on admission, interstitial pneumonia, bacteremia, and guideline-discordant therapy were the independent factors associated with mortality in the multivariable analysis. Hypophosphatemia was not significantly associated with mortality but showed a trend towards higher mortality in the multivariable analysis. Conclusion Hypophosphatemia was not associated with the prognosis in patients with CAP. However, the significance of hypophosphatemia for clinicians lies in the laboratory findings that predict abnormal glucose metabolism, Legionella infection, and severe disease.


Assuntos
Infecções Comunitárias Adquiridas , Hipofosfatemia , Pneumonia , Infecções Comunitárias Adquiridas/complicações , Humanos , Hipofosfatemia/complicações , Pneumonia/etiologia , Estudos Retrospectivos , Streptococcus pneumoniae
3.
Front Immunol ; 13: 830631, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35464480

RESUMO

Immune checkpointty inhibitors (ICIs), particularly those targeting programmed death 1 (PD-1) and anti-programmed death ligand 1 (PD-L1), enhance the antitumor effect by restoring the function of the inhibited effector T cells and produce durable responses in a large variety of metastatic and late patients with non-small-cell lung cancer. Although often well tolerated, the activation of the immune system results in side effects known as immune-related adverse events (irAEs), which can affect multiple organ systems, including the lungs. The occurrence of severe pulmonary irAEs, especially checkpoint inhibitor pneumonitis (CIP), is rare but has extremely high mortality and often overlaps with the respiratory symptoms and imaging of primary tumors. The development of CIP may be accompanied by radiation pneumonia and infectious pneumonia, leading to the simultaneous occurrence of a mixture of several types of inflammation in the lungs. However, there is a lack of authoritative diagnosis, grading criteria and clarified mechanisms of CIP. In this article, we review the incidence and median time to onset of CIP in patients with non-small-cell lung cancer treated with PD-1/PD-L1 blockade in clinical studies. We also summarize the clinical features, potential mechanisms, management and predictive biomarkers of CIP caused by PD-1/PD-L1 blockade in non-small-cell lung cancer treatment.


Assuntos
Carcinoma Pulmonar de Células não Pequenas , Neoplasias Pulmonares , Pneumonia , Antígeno B7-H1 , Humanos , Inibidores de Checkpoint Imunológico/efeitos adversos , Neoplasias Pulmonares/patologia , Pneumonia/induzido quimicamente , Pneumonia/etiologia , Receptor de Morte Celular Programada 1
4.
Chest ; 161(4): e219-e223, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35396055

RESUMO

CASE PRESENTATION: A 70-year-old woman who had received a diagnosis of pneumonia in the right lower lobe was treated with antibiotics at a general practitioner's clinic 9 months earlier. Her pneumonia had improved, but the cough and lung infiltrates persisted for > 6 months, so the patient was referred to our hospital. She had undergone surgery for breast cancer 30 years earlier but had no other medical history. She was not taking any medications and had no history of smoking, including passive smoking.


Assuntos
Pneumonia , Idoso , Tosse , Feminino , Humanos , Pulmão , Pneumonia/diagnóstico , Pneumonia/etiologia
5.
COPD ; 19(1): 109-117, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35385359

RESUMO

Triple therapy for chronic obstructive pulmonary disease (COPD) is recommended for some patients, but the inhaled corticosteroids (ICS) may differ in effectiveness and safety. We compared budesonide-based and fluticasone-based triple therapy given in two inhalers on the incidence of exacerbation, mortality and severe pneumonia, using an observational study approach. We identified a cohort of patients with COPD, new users of triple therapy given in two inhalers during 2002-2018, age 50 or older, from the UK's CPRD database, and followed for one year. The hazard ratio (HR) of exacerbation, all-cause death and pneumonia was estimated using the Cox regression model, weighted by fine stratification of the propensity score of treatment initiation. The cohort included 29,716 new users of fluticasone-based triple therapy and 9,646 of budesonide-based. The HR of a first moderate or severe exacerbation with budesonide-based triple therapy was 0.98 (95% CI: 0.94-1.03), relative to fluticasone-based, while for a severe exacerbation it was 0.97 (95% CI: 0.87-1.07). The incidence of all-cause death was lower with budesonide-based therapy among patients with no prior exacerbations (HR 0.80; 95% CI: 0.66-0.98). The HR of severe pneumonia with budesonide-based therapy was 0.84 (95% CI: 0.75-0.95). In a real-world clinical setting of COPD treatment, budesonide-based triple therapy given in two inhalers was generally as effective at reducing exacerbations as fluticasone-based triple therapy. However, the budesonide-based triple therapy was associated with a lower incidence of severe pneumonia and possibly also of all-cause death, especially among patients with no prior exacerbations for whom triple therapy is not recommended.


Assuntos
Pneumonia , Doença Pulmonar Obstrutiva Crônica , Administração por Inalação , Corticosteroides/uso terapêutico , Agonistas de Receptores Adrenérgicos beta 2/uso terapêutico , Broncodilatadores , Budesonida/efeitos adversos , Fluticasona/uso terapêutico , Humanos , Pessoa de Meia-Idade , Pneumonia/epidemiologia , Pneumonia/etiologia
6.
J Immunol Res ; 2022: 8720438, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35437510

RESUMO

Severe pneumonia accounts for the majority of morbidity and mortality in renal allograft recipients due to immunosuppressant maintenance. Regulatory T cells (Tregs), which are involved in tackling infections under immunosuppressive conditions, are rarely uncovered. We aimed to investigate the relationship between various Treg subpopulations and severe pneumonia after kidney transplantation (KTx). KTx recipients with pneumonia were divided into severe pneumonia and mild pneumonia groups. The frequencies and absolute numbers (Ab No.) of total Tregs (CD4+CD25+FoxP3+), six subsets of Tregs (Helios+/-, CD39+/-, and CD45RA+/-), and T cells, B cells, and NK cells were assessed from peripheral blood via flow cytometry using the t or Mann-Whitney test and receiver operating curve analysis. We also determined the median fluorescence intensity (MFI) of human leukocyte antigen- (HLA-) DR on monocytes and CD64 on neutrophils. Logistic regression was used to identify the risk factors of disease progression, and Pearson's correlation analysis was performed to identify relationships between the measured immune indices and patients' clinical information. Our research indicated that Treg subpopulations were strongly associated with severe pneumonia progression post KTx. Based on the monitoring of Treg subpopulations, better-individualized prevention and therapy might be achieved for patients with severe pneumonia post KTx.


Assuntos
Transplante de Rim , Pneumonia , Citometria de Fluxo , Fatores de Transcrição Forkhead , Antígenos HLA , Humanos , Imunossupressores , Transplante de Rim/efeitos adversos , Pneumonia/etiologia , Linfócitos T Reguladores
7.
BMC Cardiovasc Disord ; 22(1): 181, 2022 04 19.
Artigo em Inglês | MEDLINE | ID: mdl-35439928

RESUMO

BACKGROUND: The influence of cutting the sub-diaphragmatic branch of the vagus nerve on heart rate variability (HRV) and inflammatory reaction to severe hemorrhagic shock has not been determined prior to this study. METHODS: Male Sprague-Dawley rats were divided into four groups of Sham, sub-diaphragmatic vagotomized (Vag), subacute (135 ± 2 min) hemorrhagic shock (SHS), and sub-diaphragmatic vagotomized with SHS (Vag + SHS). Hemodynamic parameters were recorded and HRV calculated during multiple phases in a conscious model of hemorrhagic shock. The expressions of TNF-α and iNOS were measured in the spleen and lung tissues at the conclusion of the protocol. RESULTS: Decreases in blood pressure during blood withdrawal were identical in the SHS and Vag + SHS groups. However, heart rate only decreased in the Nadir-1 phase of the SHS group. HRV indicated increased power in the very-low, low, and high (VLF, LF, and HF) frequency bands during the Nadir-1 phase of the SHS and Vag + SHS groups, albeit the values were higher in the SHS group. In the recovery phase, the HF bands were only lower in the SHS group. After hemorrhagic shock followed by resuscitation, the expression of TNF-α and iNOS increased in the spleen and lung of the SHS group, and the expression of these genes was significantly lower in the Vag + SHS group than in the SHS group. CONCLUSION: Parasympathetic activity increases during the hypotensive phase of hemorrhagic shock, whereas the cardiac vagal tone decreases in the recovery phase. Sub-diapragmatic vagotomy blunts the cardiac vagal tone during hemorrhagic shock, but its effect is reversed in the recovery phase. The vagus nerve plays a role in proinflammatory responses in the lungs and spleen in subacute hemorrhagic shock followed by resuscitation.


Assuntos
Pneumonia , Choque Hemorrágico , Animais , Modelos Animais de Doenças , Feminino , Frequência Cardíaca/fisiologia , Humanos , Masculino , Pneumonia/etiologia , Gravidez , Ratos , Ratos Sprague-Dawley , Fator de Necrose Tumoral alfa , Vagotomia
8.
COPD ; 19(1): 133-141, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35392746

RESUMO

Recent reports provide evidence-based guidelines for the withdrawal of inhaled corticosteroids (ICS) in COPD, but data on patients treated with ICS-based triple therapy are sparse and contradictory. We assessed the effect of ICS discontinuation on the incidence of severe exacerbation and pneumonia in a real-world population of patients with COPD who initiated triple therapy. We identified a cohort of patients with COPD treated with LAMA-LABA-ICS triple therapy during 2002-2018, age 50 or older, from the UK's CPRD database. Subjects who discontinued ICS were matched 1:1 on time-conditional propensity scores to those continuing ICS and followed for one year. Hazard ratios (HR) of severe exacerbation and pneumonia were estimated using Cox regression. The cohort included 42,667 patients who discontinued ICS matched to 42,667 who continued ICS treatment. The hazard ratio of a severe exacerbation with ICS discontinuation relative to ICS continuation was 0.86 (95% CI: 0.78-0.95), while for severe pneumonia it was 0.96 (95% CI: 0.88-1.05). The incidence of severe exacerbation after ICS discontinuation was numerically higher than after continuation among patients with two or more exacerbations in the prior year (HR 1.09; 95% CI: 0.94-1.26) and among those with FEV1 <30% predicted (HR 1.29; 95% CI: 1.04-1.59). This large real-world study in the clinical setting of COPD treatment suggests that certain patients on triple therapy can be safely withdrawn from ICS and remain on bronchodilator therapy. As residual confounding cannot be ruled out, ICS discontinuation is not warranted for patients with multiple exacerbations and with very severe airway obstruction.


Assuntos
Pneumonia , Doença Pulmonar Obstrutiva Crônica , Administração por Inalação , Corticosteroides , Agonistas de Receptores Adrenérgicos beta 2/uso terapêutico , Broncodilatadores , Quimioterapia Combinada , Humanos , Pessoa de Meia-Idade , Antagonistas Muscarínicos/uso terapêutico , Pneumonia/epidemiologia , Pneumonia/etiologia , Doença Pulmonar Obstrutiva Crônica/complicações
9.
BMC Pulm Med ; 22(1): 130, 2022 Apr 07.
Artigo em Inglês | MEDLINE | ID: mdl-35392885

RESUMO

BACKGROUND: Pulmonary infection is common yet serious complication in patients with severe traumatic brain injury (STBI). We aimed to evaluate the predicators of pulmonary infection in STBI patients undergoing tracheostomy, to provide evidence for the clinical nursing care of STBI patients. METHODS: This study was a retrospective cohort design. STBI patients undergoing tracheostomy treatment from January 1, 2019 to August 31, 2021 in our hospital were included. The characteristics of pulmonary infection and no pulmonary infection patients were analyzed. RESULTS: A total 216 STBI patients undergoing tracheostomy were included, the incidence of pulmonary infection was 26.85%. Diabetes (r = 0.782), hypoproteinemia (r = 0.804), duration of coma(r = 0.672), duration of mechanical ventilation(r = 0.724) and length of hospital stay (r = 0.655), length of hospital stay post tracheostomy (r = 0.554), mortality (r = 0.598) were all correlated with pulmonary infection (all p < 0.05). Klebsiella pneumoniae (33.87%) and Staphylococcus aureus (29.03%) were the most commonly seen pathogens in the pulmonary infection of TBI patients. Logistic regression analyses indicated that diabetes (OR 2.232, 95% CI 1.215-3.904), hypoproteinemia with plasma total protein < 60 g/L (OR 1.922, 95% CI 1.083-3.031), duration of coma ≥ 22 h (OR 2.864, 95% CI 1.344-5.012), duration of mechanical ventilation ≥ 5 days (OR 3.602, 95% CI 1.297-5.626), length of hospital stay ≥ 21 days (OR 2.048, 95% CI 1.022-3.859) were the risk factors of pulmonary infection in TBI patients undergoing tracheostomy (all p < 0.05). CONCLUSIONS: Further investigations on the early preventions and treatments targeted on those risk factors are needed to reduce the pulmonary infection in clinical practice.


Assuntos
Lesões Encefálicas Traumáticas , Hipoproteinemia , Pneumonia , Lesões Encefálicas Traumáticas/complicações , Coma/etiologia , Humanos , Hipoproteinemia/etiologia , Tempo de Internação , Pneumonia/etiologia , Respiração Artificial , Estudos Retrospectivos , Traqueostomia/efeitos adversos , Resultado do Tratamento
10.
Clin Interv Aging ; 17: 495-503, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35444412

RESUMO

Background: Pneumonia is a devastating complication following geriatric hip fracture surgery, and preoperative hypoalbuminemia may be a potentially modifiable factor leading to improved outcome. This study aimed to quantify the relationship between preoperative hypoalbuminemia and postoperative pneumonia. Methods: We retrospectively reviewed the medical records of elderly patients (≥60 years) who underwent surgeries for hip fracture in a tertiary referral center between 2016 and 2020. According to the preoperative serum albumin level, they were divided into two groups: <35 g/ L and ≥35 g/ L. To reduce potential confounding, propensity score matching (PSM) in a 1:1 ratio was performed, with the caliper value set as 0.002; and further conditional logistic regression analysis was used to control the other potential confounders to determine the association strength. Results: Among 3,147 eligible patients included, PSM yielded 1,318 matched patients, with 659 in each respective group, suggesting significantly improved balance in most variables (standardized mean deviation improvement range, 20.7% to 99.1%), except for basophil count. The conditional logistic regression analysis, adjusted for PS and other intra- or post-operative variables, showed 6.18-fold (relative ratio, 6.18; 95% CI, 3.15-11.98; P<0.001) increased risk of postoperative pneumonia associated with preoperative hypoalbuminemia. Conclusion: Preoperative hypoalbuminemia was identified to be independently and highly associated with development of postoperative pneumonia in elderly patients undergoing hip fracture surgeries. However, whether the patients who had such condition may benefit from preoperative targeted nutritional support needs to be clarified by more prospective studies.


Assuntos
Fraturas do Quadril , Hipoalbuminemia , Pneumonia , Idoso , Fraturas do Quadril/complicações , Fraturas do Quadril/cirurgia , Humanos , Hipoalbuminemia/complicações , Hipoalbuminemia/epidemiologia , Modelos Logísticos , Pneumonia/complicações , Pneumonia/etiologia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Pontuação de Propensão , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Risco , Albumina Sérica/análise
11.
World J Pediatr ; 18(5): 333-342, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35334045

RESUMO

BACKGROUND: The high risks for childhood respiratory diseases are associated with exposure to ambient air pollution. However, there are few studies that have explored the association between air pollution exposure and respiratory diseases among young children (particularly aged 0-2 years) based on the entire population in a megalopolis. METHODS: Daily hospital admission records were obtained from 54 municipal hospitals in Wuhan city, China. We included all children (aged 0-2 years) hospitalized with respiratory diseases between January 2017 and December 2018. Individual air pollution exposure assessment was used in Land Use Regression model and inverse distance weighted. Case-crossover design and conditional logistic regression models were adopted to estimate the hospitalization risk associated with air pollutants. RESULTS: We identified 62,425 hospitalizations due to respiratory diseases, of which 36,295 were pneumonia. Particulate matter with an aerodynamic diameter less than 2.5 µm (PM2.5) and nitrogen dioxide (NO2) were significantly associated with respiratory diseases and pneumonia. ORs of pneumonia were 1.0179 (95% CI 1.0097-1.0260) for PM2.5 and 1.0131 (95% CI 1.0042-1.0220) for NO2 at lag 0-7 days. Subgroup analysis suggested that NO2, Ozone (O3) and sulfur dioxide (SO2) only showed effects on pneumonia hospitalizations on male patients, but PM2.5 had effects on patients of both genders. Except O3, all pollutants were strongly associated with pneumonia in cold season. In addition, children who aged elder months and who were in central urban areas had a higher hospitalization risk. CONCLUSIONS: Air pollution is associated with higher hospitalization risk for respiratory diseases, especially pneumonia, among young children, and the risk is related to gender, month age, season and residential location.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , Pneumonia , Poluentes Atmosféricos/efeitos adversos , Poluentes Atmosféricos/análise , Poluição do Ar/efeitos adversos , Poluição do Ar/análise , Pré-Escolar , China/epidemiologia , Estudos Cross-Over , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Dióxido de Nitrogênio/análise , Material Particulado/efeitos adversos , Material Particulado/análise , Pneumonia/epidemiologia , Pneumonia/etiologia
12.
CNS Neurosci Ther ; 28(6): 913-921, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35233938

RESUMO

BACKGROUND AND PURPOSE: Dysphagia is common and is associated with aspiration pneumonia. However, little is known about the prevalence of and factors influencing dysphagia screening (DS) and pneumonia after subarachnoid hemorrhage (SAH). METHODS: We used data on SAH patients admitted to 1476 hospitals from the China Stroke Center Alliance (CSCA) from August 2015 to July 2019 to analyze the rates of DS and pneumonia. We then conducted univariate and multivariable analyses to examine the relationship between DS and pneumonia. RESULTS: Among 4877 SAH patients who were eligible for DS and had complete data on pneumonia status, 3527 (72.3%) underwent DS, and 1006 (20.6%) developed pneumonia. Compared with patients without pneumonia, patients with pneumonia were older (mean: 63.4 vs. 57.8 years of age), had lower Glasgow Coma Scale (GCS) scores at admission (mean: 13.5 vs. 14.3), were more likely to have dysphagia (15.2% vs. 3.3%), and were more likely to have undergone aneurysm isolation (19.1% vs. 10.0%). In multivariable analyses, factors independently associated with a higher risk of pneumonia were dysphagia [odds ratio (OR), 3.77; 95% confidence interval (CI), 2.85-4.98], age (OR, 1.50 per 10-year increase; 95% CI, 1.40-1.60), male sex (OR, 1.23; 95% CI, 1.02-1.49), arrival at the hospital by emergency medical services (OR, 1.36; 95% CI, 1.16-1.58), nimodipine treatment (OR, 1.42; 95% CI, 1.11-1.81), endovascular embolization of aneurysms (OR, 1.23; 95% CI, 1.03-1.47), cerebral ventricular shunt placement (OR, 2.24; 95% CI, 1.41-3.54), and treatment at a higher grade hospital (OR, 1.44; 95% CI, 1.21-1.71). CONCLUSION: More than a quarter of patients with SAH did not have documented DS, while one-fifth developed pneumonia. DS performance was associated with a lower risk of pneumonia. Randomized controlled trials may be needed to determine the effectiveness of DS.


Assuntos
Transtornos de Deglutição , Pneumonia , Acidente Vascular Cerebral , Hemorragia Subaracnóidea , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/epidemiologia , Transtornos de Deglutição/etiologia , Hospitalização , Humanos , Masculino , Pneumonia/complicações , Pneumonia/etiologia , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/terapia , Hemorragia Subaracnóidea/complicações , Hemorragia Subaracnóidea/epidemiologia , Hemorragia Subaracnóidea/terapia , Resultado do Tratamento
13.
Lung Cancer ; 166: 84-93, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-35245844

RESUMO

INTRODUCTION: Immune-mediated adverse events (imAEs), including all-cause immune-mediated pneumonitis, were reported in approximately 25% of patients in the placebo-controlled, phase III PACIFIC trial of durvalumab monotherapy (for up to 12 months) in patients with unresectable, stage III NSCLC and no disease progression after concurrent chemoradiotherapy; only 3.4% of patients experienced grade 3/4 imAEs. With broad application of the PACIFIC regimen (consolidation durvalumab after chemoradiotherapy), now standard-of-care in this setting, there is a need to better characterize the occurrence of imAEs with this regimen. METHODS: We performed descriptive, post-hoc, exploratory analyses to characterize the occurrence of imAEs (pneumonitis and non-pneumonitis) in PACIFIC in terms of: incidence, severity, and timing; clinical management and outcomes; and associations between the occurrence of imAEs and (1) all-cause AEs and (2) baseline patient, disease, and treatment characteristics. RESULTS: Any-grade immune-mediated pneumonitis (9.4%) and non-pneumonitis imAEs (10.7%) occurred infrequently and were more common with durvalumab versus placebo. Grade 3/4 immune-mediated pneumonitis (1.9%) and non-pneumonitis imAEs (1.7%) were uncommon with durvalumab, as were fatal imAEs (0.8%; all pneumonitis). The most common non-pneumonitis imAEs with durvalumab were thyroid disorders, dermatitis/rash, and diarrhea/colitis. Dermatitis/rash had the shortest time to onset (from durvalumab initiation), followed by pneumonitis; dermatitis/rash had the longest time to resolution, followed by thyroid disorders. Most patients with immune-mediated pneumonitis (78.4%) and non-pneumonitis imAEs (56.3%) had these events occur ≤ 3 months after initiating durvalumab. ImAEs were well managed with administration of systemic corticosteroids, administration of endocrine replacement therapy, and interruption/discontinuation of durvalumab. Time elapsed from completion of prior radiotherapy to trial randomization (<14 vs. ≥ 14 days) did not impact either incidence or severity of imAEs. Durvalumab had a manageable safety profile broadly irrespective of whether patients experienced imAEs. CONCLUSION: The risk of imAEs should not deter use of the PACIFIC regimen in eligible patients, as these events are generally well managed through appropriate clinical intervention.


Assuntos
Carcinoma Pulmonar de Células não Pequenas , Dermatite , Exantema , Neoplasias Pulmonares , Pneumonia , Anticorpos Monoclonais , Carcinoma Pulmonar de Células não Pequenas/terapia , Quimiorradioterapia/efeitos adversos , Dermatite/tratamento farmacológico , Dermatite/etiologia , Exantema/etiologia , Humanos , Neoplasias Pulmonares/terapia , Pneumonia/diagnóstico , Pneumonia/epidemiologia , Pneumonia/etiologia
14.
J Paediatr Child Health ; 58(5): 752-757, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35244959

RESUMO

While deaths from pneumonia during childhood in New Zealand (NZ) are now infrequent, childhood pneumonia remains a significant cause of morbidity. In this viewpoint, we describe pneumonia epidemiology in NZ and identify modifiable risk factors. During recent decades, pneumonia hospitalisation rates decreased, attributable in part to inclusion of pneumococcal conjugate vaccine in NZ's immunisation schedule. Irrespective of these decreases, pneumonia hospitalisation rates are four times higher for Pacific and 60% higher for Maori compared with children of other ethnic groups. Consistent with other developed countries, hospitalisation rates for pneumonia with pleural empyema increased in NZ during the 2000s. Numerous factors contribute to childhood pneumonia acquisition, hospitalisation and morbidity in NZ include poor quality living environments, malnutrition during pregnancy and early childhood, incomplete and delayed vaccination during pregnancy and childhood and variable primary and secondary care management. To reduce childhood pneumonia disease burden, interventions should focus on addressing modifiable risk factors for pneumonia. These include using non-polluting forms of household heating; decreasing cigarette smoke exposure; reducing household acute respiratory infection transmission; improving dietary nutritional content and nutrition during pregnancy and early childhood; breastfeeding promotion; vaccination during pregnancy and childhood and improving the quality of and decreasing the variance in primary and secondary care management of pneumonia.


Assuntos
Empiema Pleural , Pneumonia , Infecções Respiratórias , Criança , Pré-Escolar , Empiema Pleural/epidemiologia , Hospitalização , Humanos , Nova Zelândia/epidemiologia , Pneumonia/epidemiologia , Pneumonia/etiologia , Infecções Respiratórias/epidemiologia
15.
Ann Transplant ; 27: e934773, 2022 Mar 22.
Artigo em Inglês | MEDLINE | ID: mdl-35314666

RESUMO

BACKGROUND Kidney transplantation (KTx) has been considered as the most effective therapeutic method for end-stage renal disease. Immune monitoring of peripheral lymphocyte subsets (PLS) reflects the real immune status and has been used for diagnosis of pneumonia after KTx. We aimed to investigate the association between pre-transplant PLS and pneumonia in renal allograft recipients. MATERIAL AND METHODS A total of 152 patients receive donation after citizen's death (DCD) kidney allografts in our center between January 2018 and December 2019. Among them, 114 patients were enrolled in our study based on inclusion and exclusion criteria. During the first-year follow-up after KTx, 32 recipients developed pneumonia, and the other 82 recipients did not (stable group). The pre-clinical information and PLS (including the percentages and absolute numbers (Ab No.) of peripheral T, B, and NK cells, as well as CD4/CD8 ratio) results in these 2 groups were calculated by the Mann-Whitney test and receiver operating curve (ROC) analysis. Univariate and multivariate logistic regression analyses were employed to identify risk factors. RESULTS Compared to the stable group, the Ab No. of CD3+, CD8+, and CD4+ T cells, as well as B cells and NK cells, were notably reduced in the pneumonia patients. The area under the curve (AUC) of CD3+ T cell Ab No. was 0.7022. Multivariate analysis demonstrated that pre-transplant B cell Ab No. was the independent risk factor for pneumonia progression after KTx (OR=0.353, P=0.037). CONCLUSIONS Pre-transplant Ab No. of PLS were closely related to pneumonia after KTx. Monitoring pre-transplant PLS could provide more timely and effective prevention and therapy for post-operative pneumonia after KTx.


Assuntos
Falência Renal Crônica , Transplante de Rim , Pneumonia , Humanos , Falência Renal Crônica/etiologia , Transplante de Rim/efeitos adversos , Contagem de Linfócitos , Subpopulações de Linfócitos , Pneumonia/etiologia
16.
Front Immunol ; 13: 823767, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35280981

RESUMO

Radiation recall pneumonitis (RRP) is described as an unpredictable acute inflammatory reaction within the previously irradiated lung site during the administration of systematic therapy after radiotherapy. Here, we reported a case of a 54-year-old woman with non-small lung cancer (NSCLC), who had pneumonitis at 3 and 10 months after radiotherapy regarded as radiation pneumonitis (RP) and RRP induced by anti-PD-1 sintilimab, respectively. This unique patient with double pneumonitis (RP and RRP) has drawn attention to the identification of immune or radiation pneumonitis, its potential mechanism, and further treatment strategy after the emergence of RRP.


Assuntos
Carcinoma Pulmonar de Células não Pequenas , Neoplasias Pulmonares , Pneumonia , Pneumonite por Radiação , Anticorpos Monoclonais Humanizados , Carcinoma Pulmonar de Células não Pequenas/complicações , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Carcinoma Pulmonar de Células não Pequenas/radioterapia , Feminino , Humanos , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/radioterapia , Pessoa de Meia-Idade , Pneumonia/complicações , Pneumonia/etiologia , Pneumonite por Radiação/diagnóstico , Pneumonite por Radiação/etiologia
17.
Heart Lung ; 54: 80-84, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35358906

RESUMO

BACKGROUND: Pneumonia is a common complication in older people who are hospitalized to treat different fractures, which increases morbimortality in this population. OBJECTIVES: Estimating the pneumonia incidence density in older people hospitalized to treat femoral fractures and identifying risk factors for this infection. METHODS: Prospective cohort study whose data were collected from a population of older people who were being treated for femoral fractures at a hospital in the central region of Brazil between September 2016 and February 2017. The pneumonia diagnosis was based on radiography and clinical tests. Incidence density was estimated according to gender, age, Charlson comorbidity index, polypharmacy, chronic pulmonary disease, admission to the intensive care unit, surgical treatment, and nasoenteral tube feeding. Magnitude of the associations was estimated by multiple Poisson regression. RESULTS: Among the 200 patients, the pneumonia incidence density was 13.04/1,000 person-days. For men and older people 80 years old or older, the pneumonia incidence density was 15.6/1,000 person-days and 18.3/1,000 person-days, respectively. After adjusting for age, gender, chronic pulmonary disease, and admission to the intensive care unit, use of nasoenteral tubes remained associated with occurrence of pneumonia in older people, and the risk of developing the infection was eight times higher in the population who received nasoenteral feeding than that calculated for the population that did not use the devices (p ≤ 0.001). CONCLUSION: Using nasoenteral tubes during hospital stays increased the risk of developing pneumonia in hospitalized older people, which reinforces the need for continuous care monitoring regarding use of tubes to prevent complications.


Assuntos
Fraturas do Fêmur , Pneumonia , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Estudos de Coortes , Hospitalização , Humanos , Masculino , Pneumonia/epidemiologia , Pneumonia/etiologia , Estudos Prospectivos , Fatores de Risco
19.
Sci Rep ; 12(1): 4270, 2022 03 11.
Artigo em Inglês | MEDLINE | ID: mdl-35277562

RESUMO

Inflammatory burden is associated with COVID-19 severity and outcomes. Residual computed tomography (CT) lung abnormalities have been reported after COVID-19. The aim was to evaluate the association between inflammatory burden during COVID-19 and residual lung CT abnormalities collected on follow-up CT scans performed 2-3 and 6-7 months after COVID-19, in severe COVID-19 pneumonia survivors. C-reactive protein (CRP) curves describing inflammatory burden during the clinical course were built, and CRP peaks, velocities of increase, and integrals were calculated. Other putative determinants were age, sex, mechanical ventilation, lowest PaO2/FiO2 ratio, D-dimer peak, and length of hospital stay (LOS). Of the 259 included patients (median age 65 years; 30.5% females), 202 (78%) and 100 (38.6%) had residual, predominantly non-fibrotic, abnormalities at 2-3 and 6-7 months, respectively. In age- and sex-adjusted models, best CRP predictors for residual abnormalities were CRP peak (odds ratio [OR] for one standard deviation [SD] increase = 1.79; 95% confidence interval [CI] = 1.23-2.62) at 2-3 months and CRP integral (OR for one SD increase = 2.24; 95%CI = 1.53-3.28) at 6-7 months. Hence, inflammation is associated with short- and medium-term lung damage in COVID-19. Other severity measures, including mechanical ventilation and LOS, but not D-dimer, were mediators of the relationship between CRP and residual abnormalities.


Assuntos
COVID-19/patologia , Pneumonia/diagnóstico por imagem , Idoso , Proteína C-Reativa/análise , COVID-19/complicações , COVID-19/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Gravidade do Paciente , Pneumonia/etiologia , Pneumonia/patologia , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Tomografia Computadorizada por Raios X
20.
Eur Rev Med Pharmacol Sci ; 26(5): 1777-1785, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35302231

RESUMO

OBJECTIVE: The first pandemic phase of COVID-19 in Italy was characterized by high in-hospital mortality ranging from 23% to 38%. During the third pandemic phase there has been an improvement in the management and treatment of COVID-19, so mortality and predictors may have changed. A prospective study was planned to identify predictors of mortality during the third pandemic phase. PATIENTS AND METHODS: From 15 December 2020 to 15 May 2021, 208 patients were hospitalized (median age: 64 years; males: 58.6%); 83% had a median of 2 (IQR,1-4) comorbidities; pneumonia was present in 89.8%. Patients were monitored remotely for respiratory function and ECG trace for 24 hours/day. Management and treatment were done following the timing and dosage recommended by international guidelines. RESULTS: 79.2% of patients necessitated O2-therapy. ARDS was present in 46.1% of patients and 45.4% received non-invasive ventilation and 11.1% required ICU treatment. 38% developed arrhythmias which were identified early by telemetry and promptly treated. The in-hospital mortality rate was 10%. At multivariate analysis independent predictors of mortality were: older age (R-R for≥70 years: 5.44), number of comorbidities ≥3 (R-R 2.72), eGFR ≤60 ml/min (RR 2.91), high d-Dimer (R-R for≥1,000 ng/ml:7.53), and low PaO2/FiO2 (R-R for <200: 3.21). CONCLUSIONS: Management and treatment adherence to recommendations, use of telemetry, and no overcrowding appear to reduce mortality. Advanced age, number of comorbidities, severe renal failure, high d-Dimer and low P/F remain predictors of poor outcome. The data help to identify current high-risk COVID-19 patients in whom management has yet to be optimized, who require the greatest therapeutic effort, and subjects in whom vaccination is mandatory.


Assuntos
COVID-19/mortalidade , Departamentos Hospitalares/organização & administração , Mortalidade Hospitalar , Medicina Interna/métodos , Pandemias , Telemetria/métodos , Fatores Etários , Idoso , Cuidados Críticos , Eletrocardiografia , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Oxigênio/sangue , Pneumonia/tratamento farmacológico , Pneumonia/etiologia , Pneumonia/mortalidade , Valor Preditivo dos Testes , Estudos Prospectivos , Síndrome do Desconforto Respiratório/tratamento farmacológico , Síndrome do Desconforto Respiratório/etiologia , Síndrome do Desconforto Respiratório/mortalidade
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