scholarly journals Respiratory Candida in Patients with Bronchitis, Mucus Plugging, and Atelectasis

2020 ◽  
Vol 14 (1) ◽  
pp. 87-92
Author(s):  
Douglas C. Johnson ◽  
Suresh K. Chirumamilla ◽  
Armando P. Paez
Keyword(s):  
Retrospective Study ◽  
Respiratory Failure ◽  
Clinical Findings ◽  
Clinical Parameters ◽  
Poor Outcome ◽  
Sputum Production ◽  
Uncertain Significance ◽  
Clinically Significant

Background: The significance of Candida in pulmonary secretions is unclear, and usually is regarded as colonization, not contributing to symptoms or disease. Yet, in our experience, Candida seemed associated with chronic sputum, mucus plugging, atelectasis, and poor outcome. Objective: The aim of this study is to describe the clinical findings of patients with Candida in pulmonary (sputum or bronchoscopy) secretions and the significance of Candida. Methods: Retrospective study of inpatients and outpatients referred for pulmonary consultation with Candida in pulmonary secretions. Clinical parameters and estimates of whether Candida was likely clinically significant, were determined. Results: 82 inpatients and 11 outpatients were identified, of which 61 (66%) had atelectasis and 68 (73%) bronchoscopies. Of patients having bronchoscopies, 56 (82%) had mucus, and 43 (63%) mucus plugging. Of the inpatients death (or probable death) occurred in 43 (63%), 42 (98%) of which were from definite or probable respiratory failure, with 13 (31%) likely related to mucus plugging, 16 (38%) possibly from mucus plugging, 6 (14%) unknown, and 7 (17%) not due to mucus plugging. Candida was felt likely clinically significant in 57 patients (61%), uncertain significance in 23 (25%), and not significant in 13 (14%). All outpatients had exacerbations, including 7 (64%) within a year. Conclusion: Patients requiring pulmonary consultation with Candida in pulmonary secretions often have chronic sputum production, exacerbations, mucus plugging, atelectasis, and death from respiratory failure. Candida was likely clinically significant in most patients. Recommendations to consider Candida in pulmonary secretions as colonization should be reconsidered.

scholarly journals Epidemiological and clinical characteristics of immunocompromised patients infected with Pneumocystis jirovecii in a twelve-year retrospective study from Norway

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Stine Grønseth ◽  
Tormod Rogne ◽  
Raisa Hannula ◽  
Bjørn Olav Åsvold ◽  
Jan Egil Afset ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Fold Increase ◽  
Epidemiological Data ◽  
Opportunistic Pathogen ◽  
Incidence Rates ◽  
Clinical Findings ◽  
Pneumocystis Jirovecii ◽  
Common Denominator ◽  
Study Population ◽  
Cardinal Symptoms

Abstract Background Pneumocystis pneumonia (PCP) severely menaces modern chemotherapy and immunosuppression. Detailed description of the epidemiology of Pneumocystis jirovecii today is needed to identify candidates for PCP-prophylaxis. Methods We performed a 12-year retrospective study of patients with P. jirovecii detected by polymerase chain reaction in Central Norway. In total, 297 patients were included. Comprehensive biological, clinical and epidemiological data were abstracted from patients’ medical records. Regional incidence rates and testing trends were also assessed. Results From 2007 to 2017 we found a 3.3-fold increase in testing for P. jirovecii accompanied by a 1.8-fold increase in positive results. Simultaneously, regional incidence rates doubled from 5.0 cases per 100,000 person years to 10.8. A majority of the study population had predisposing conditions other than human immunodeficiency virus (HIV). Hematological (36.0%) and solid cancers (25.3%) dominated. Preceding corticosteroids were a common denominator for 72.1%. Most patients (74.4%) presented with at least two cardinal symptoms; cough, dyspnea or fever. Main clinical findings were hypoxia, cytopenias and radiological features consistent with PCP. A total of 88 (29.6%) patients required intensive care and 121 (40.7%) suffered at least one complication. In-hospital mortality was 21.5%. Three patients (1.0%) had received prophylaxis. Conclusions P. jirovecii is re-emerging; likely due to increasing immunosuppressants use. This opportunistic pathogen threatens the life of heterogenous non-HIV immunosuppressed populations currently at growth. Corticosteroids seem to be a major risk factor. A strategy to increase prophylaxis is called for.

Ultrasound-Guided Fine-Needle Aspiration of Superficial Lymphadenopathy Performed by Interventional Pathologists: The Applicability of the Sydney System from 2 Years of Experience and 363 Cases

2021 ◽  
pp. 1-10
Author(s):  
Héctor Enrique Torres Rivas ◽  
Karen Villar Zarra ◽  
Lisseth Andrea Pérez Pabón ◽  
María de la Paz González Gutierréz ◽  
Nuria Zapico Ortiz ◽  
...  
Keyword(s):  
Lymph Node ◽  
Retrospective Study ◽  
Fine Needle Aspiration ◽  
Diagnostic Procedure ◽  
Needle Aspiration ◽  
Ultrasound Guided ◽  
Fine Needle ◽  
Specialized Hospital ◽  
Uncertain Significance ◽  
Sydney System

<b><i>Introduction:</i></b> The Sydney system proposal for the study and reporting of lymphadenopathy by fine-needle aspiration (FNA) constitutes one of the first attempts to standardize this procedure. Here, we review its applicability. <b><i>Materials and Methods:</i></b> A retrospective study in which all ultrasound-guided FNAs (USFNAs) of superficial lymphadenopathy (palpable or not) performed by interventional pathologists in 2 specialized hospital centers were quantified over 2 years. The procedure was systematized, and the diagnoses were reclassified according to the Sydney system categories. <b><i>Results:</i></b> We analyzed 363 USFNAs of lymphadenopathies. The distribution of cases by categories was as follows: insufficient (<i>n</i> = 13; 3.58%), benign (<i>n</i> = 208; 57.30%), atypia of uncertain significance (<i>n</i> = 7; 1.93%), suspicious (<i>n</i> = 21; 5.79), and malignant (<i>n</i> = 114; 31.40%). The risks of malignancy calculated for categories I, II, III, IV, and V were 27%, 3%, 50%, 100%, and 100%, respectively. <b><i>Conclusion:</i></b> The implementation of the Sydney system allows the systematization and standardization of the lymph node FNA methodology, with increased efficacy and efficiency. Assimilating the recommendations enables the qualification of the diagnostic procedure.

Salzburg Criteria, A Useful Tool in Non-Convulsive Status Epilepticus Diagnosis: A Retrospective Study

2021 ◽  
pp. 155005942199171
Author(s):  
Adriana Gómez Domínguez ◽  
Raidili C. Mateo Montero ◽  
Alba Díaz Cid ◽  
Antonio J. P. Mazarro ◽  
Ignacio R. Bailly-Bailliere ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Status Epilepticus ◽  
Prospective Studies ◽  
Correct Diagnosis ◽  
Original Description ◽  
Neurological Deficits ◽  
Convulsive Status Epilepticus ◽  
Poor Outcome

Introduction. Non-convulsive status epilepticus (NCSE) has been traditionally a challenging electroencephalographic (EEG) diagnosis. For this reason, Salzburg consensus criteria (SCC) have been proposed to facilitate correct diagnosis. Methods. We retrospectively reanalyzed 41 cases referred to our department (from 2016 to 2018) under the suspicion of NCSE. In this study, we compared the original description (standard criteria) versus the updated description (SCC) of the same EEG. Results. Originally, 15 patients were diagnosed as NCSE (37%) and 26 patients as no NCSE (63%), using the standard criteria. Then, we analyzed EEGs according to the SCC, which led to the following results: 9 patients fulfilled the criteria for definite NCSE (22%), 20 patients were diagnosed as possible NCSE (49%) and 12 patients were diagnosed as no NCSE (29%). Subsequently, when we analyze the outcome of possible NCSE cases, we note that 50% of these patients presented mild-poor outcome (neurological deficits, deceased). Indeed, we observed worse outcomes in patients previously diagnosed as no NCSE and untreated, specifically post-anoxic cases. Conclusions. Salzburg criteria seem to be a useful tool to support NCSE diagnosis, introducing the category of possible NCSE. In our study, we observed that it contributes to improving the prognosis and management of the patients. However, more prospective studies are needed to demonstrate the accuracy of SCC.

scholarly journals Undetected Causes of Death in Hospitalized Elderly with COVID-19: Lessons from Autopsy

2021 ◽  
Vol 10 (7) ◽  
pp. 1337
Author(s):  
Astrid Malézieux-Picard ◽  
Cecilia Ferrer Soler ◽  
David De Macedo Ferreira ◽  
Emilie Gaud-Luethi ◽  
Christine Serratrice ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Causes Of Death ◽  
Clinical Findings ◽  
Pathological Examination ◽  
Post Mortem ◽  
Hypoxemic Respiratory Failure ◽  
Hospitalized Elderly ◽  
Acute Decompensation ◽  
Clinical Chart ◽  
Full Body

Background: Mechanisms and causes of death in older patients with SARS-CoV-2 infection are still poorly understood. Methods: We conducted in a retrospective monocentric study, a clinical chart review and post-mortem examination of patients aged 75 years and older hospitalized in acute care and positive for SARS-CoV-2. Full body autopsy and correlation with clinical findings and suspected causes of death were done. Results: Autopsies were performed in 12 patients (median age 85 years; median of 4 comorbidities, mainly hypertension and cardiovascular disease). All cases showed exudative or proliferative phases of alveolar damage and/or a pattern of organizing pneumonia. Causes of death were concordant in 6 cases (50%), and undetected diagnoses were found in 6. Five patients died from hypoxemic respiratory failure due to coronavirus disease 2019 (COVID-19), five had another associated diagnosis and two died from alternative causes. Deaths that occurred in the second week were related to SARS-CoV-2 pneumonia whereas those occurring earlier were related mainly to heart failure and those occurring later to complications. Conclusions: Although COVID-19 hypoxemic respiratory failure was the most common cause of death, post-mortem pathological examination revealed that acute decompensation from chronic comorbidities during the first week of COVID-19 and complications in the third week contributed to mortality.

scholarly journals A Cognitive Behavioral Therapy-Informed Self-Management Program for Acute Respiratory Failure Survivors: A Feasibility Study

2021 ◽  
Vol 10 (4) ◽  
pp. 872
Author(s):  
Megan M. Hosey ◽  
Stephen T. Wegener ◽  
Caroline Hinkle ◽  
Dale M. Needham
Keyword(s):  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Feasibility Study ◽  
Psychological Intervention ◽  
Behavioral Therapy ◽  
Management Program ◽  
Self Management ◽  
Management Intervention ◽  
Clinically Significant ◽  
Score Range

Background: The number of people surviving critical illness is rising rapidly around the globe. Survivorship comes at a cost, with approximately half of patients with acute respiratory failure (ARF) experiencing clinically significant symptoms of anxiety, and 32–40% of survivors having substantial anxiety symptoms in the months or years after hospitalization. Methods: This feasibility study reports on 11 consecutive ARF patients receiving up to six sessions of a psychological intervention for self-management of anxiety. Results: All 11 patients accepted and received the psychological intervention. Four patients did not fully complete all 6 sessions due to death (n = 1, 2 sessions completed), and early hospital discharge (n = 3, patients completed 2, 3 and 5 sessions). The median (IQR) score (range: 0–100; minimal clinically important difference: 13) for the Visual Analog Scale-Anxiety (VAS-A) pre-intervention was 70 (57, 75) points. During the intervention, all 11 patients had a decrease in VAS-A, with a median (IQR) decrease of 44 (19, 48) points. Conclusions: This self-management intervention appears acceptable and feasible to implement among ARF patients during and after an ICU stay.

scholarly journals Fatal Nemaline Myopathy in Infancy

1984 ◽  
Vol 11 (2) ◽  
pp. 305-309 ◽  
Author(s):  
Joseph B. McMenamin ◽  
Bernadette Curry ◽  
Glen P. Taylor ◽  
Laurence E. Becker ◽  
E. Gordon Murphy
Keyword(s):  
Respiratory Failure ◽  
Peripheral Nerves ◽  
Neonatal Period ◽  
Nemaline Myopathy ◽  
Clinical Findings ◽  
Neural Basis ◽  
Limb Muscles ◽  
The Central Nervous System ◽  
Severe Hypotonia ◽  
Clinical Stability

ABSTRACT:The clinical and neuropathological findings in two infants with congenital nemaline myopathy are described. One patient presented at birth with severe hypotonia, respiratory failure and contractures and died shortly after the neonatal period. The other presented at age two months with hypotonia and, following a period of clinical stability, died at age seven months from respiratory failure. Pathological findings in the fatal neonatal case revealed numerous rod bodies in lingual, pharyngeal, diaphragm and limb muscles, correlating with clinical findings. Significant, but less rod body involvement was found in the diaphragm and limb muscles of the second patient. Although a neural basis has been suggested for this disorder, no abnormalities were found in the central nervous system or in the peripheral nerves of these two severely affected patients.

scholarly journals Chest X-rays and associated clinical parameters in pulmonary Tubercolosis cases from the National Tubercolosis Program, Mumbai, India

2012 ◽  
Vol 4 (1) ◽  
pp. 10 ◽  
Author(s):  
Yatin N. Dholakia ◽  
Desiree T.B. D'souza ◽  
Monica P. Tolani ◽  
Anirvan Chatterjee ◽  
Nerges F. Mistry
Keyword(s):  
Glycosylated Hemoglobin ◽  
Diagnostic Delay ◽  
Control Programme ◽  
Male Gender ◽  
Mediastinal Lymphadenopathy ◽  
Clinical Parameters ◽  
X Rays ◽  
X Ray ◽  
Additional Tool ◽  
Poor Outcome

The study was carried out in pulmonary tuberculosis (PTB) patients from the local Tuberculosis control programme, Mumbai, India. It examined features of chest X-rays and their correlation with clinical parameters for possible application in suspected multidrug resistant TB (MDRTB) and to predict outcome in new and treatment failure PTB cases. X-ray features (infiltrate, cavitation, miliary shadows, pleural effusion, mediastinal lymphadenopathy and extent of lesions) were analyzed to identify associations with biological/clinical parameters through univariate and multivariate logistic regression. Failures demonstrated associations between extensive lesions and high glycosylated hemoglobin (GHb) levels (P=0.028) and male gender (P=0.03). An association was also detected between cavitation and MDR (P=0.048). In new cases, bilateral cavities were associated with MDR (P=0.018) and male gender (P=0.01), low body mass index with infiltrates (P=0.008), and smoking with cavitation (P=0.0238). Strains belonging to the Manu1 spoligotype were associated with mild lesions (P=0.002). Poor outcome showed borderline significance with extensive lesions at onset (P=0.053). Furthermore, amongst new cases, smoking, the Central Asian Strain (CAS) spoligotype and high GHb were associated with cavitation, whereas only CAS spoligotypes and high GHb were associated with extensive lesions. The study highlighted associations between certain clinical parameters and X-ray evidence which support the potential of X-rays to predict TB, MDRTB and poor outcome. The use of Xrays as an additional tool to shorten diagnostic delay and shortlist MDR suspects amongst nonresponders to TB treatment should be explored in a setting with limited resources coping with a high MDR case load such as Mumbai.

scholarly journals ANALYSIS OF DIAGNOSTIC PARAMETERS OF RESPIRATORY FAILURE IN PATIENTS WITH BRONCHIAL ASTHMA

2015 ◽  
Vol 4 (2) ◽  
pp. 10-12
Author(s):  
Dmitry Alexandrovich Anisimov ◽  
Lyudmila Nikitichna Goncharov ◽  
Anna Albertovna Dyachkova
Keyword(s):  
Respiratory Failure ◽  
Bronchial Asthma ◽  
Clinical Laboratory ◽  
Pathological Condition ◽  
External Respiration ◽  
Clinical Parameters ◽  
Arterial Blood ◽  
Criteria For Diagnosis ◽  
Invasive Techniques ◽  
Instrumental Methods

Respiratory failure (NAM)-a pathological condition in which there is provided the maintenance of normal blood gas or it is achieved through more intensive operation of external respiration and heart, resulting in decreased functional capacity of the organism [1,2]. The main method of diagnosis of DN is the study of the gas composition of the arterial blood, but because of the complexity of the analysis, which involves complex invasive techniques for obtaining arterial blood by puncture of a major artery in the therapeutic Department is not carried out [1,3]. A plurality of classifications days, the lack of clear criteria for diagnosis was to analyze assessment days by a combination of clinical, laboratory and instrumental methods patient days. As a model of acute respiratory failure were selected from patients with mild intermittent and persistent severity of asthma, which bore a slight aggravation, burdened days 1 severity, number of 30 people. SatO2 blood was the criterion for assessing the severity of DN. In the evaluation of clinical parameters, such as shortness of breath and respiratory rate, it was revealed that the values of these parameters increase is inversely proportional to the drop SatO2 blood. In assessing such clinical parameters as the rate of breathing and instrumental measure FEV1 did not find such dependence. Thus, to assess the severity of DN in patients with bronchial asthma it is necessary to conduct a comprehensive analysis of the clinical and instrumental methods.

scholarly journals Effectiveness of dietetic intervention for people with type 2 diabetes: a meta-analysis

2020 ◽  
Author(s):  
George Siopis ◽  
Stephen Colagiuri AO ◽  
Margaret Allman-Farinelli
Keyword(s):  
Type 2 Diabetes ◽  
Meta Analysis ◽  
Intervention Group ◽  
Nutrition Therapy ◽  
Clinical Parameters ◽  
Qualitative Synthesis ◽  
Registration Number ◽  
Clinically Significant ◽  
Randomised Controlled

Abstract Background Diet is central to treatment of type 2 diabetes. This review aimed to compare the effectiveness of nutrition therapy delivered by dietitians to nutrition advice delivered by other healthcare professionals in adults with type 2 diabetes on metabolic parameters. Methods Cochrane CENTRAL, CINAHL, EMBASE, MEDLINE and PsychINFO were searched for randomised controlled trials of three months duration or longer, published from 1st January 2008 to 18th June 2019. Relevant data were extracted from studies with additional author information. Random-effects meta-analysis assessed mean changes in HbA1c and other clinical parameters. PROSPERO registration number: CRD42019130528. Results Of 2477 records identified, fourteen studies (n = 3338) were eligible for qualitative synthesis and meta-analysis. The mean changes [95% CI] at follow-up in HbA1c, BMI, weight, LDL cholesterol, systolic and diastolic blood pressure were − 0·47 [-0·92, -0·02] %, -0·38 [-0·63, -0·13] kg/m2, -1·49 [-2·14, -0·84] kg, -0·15 [-0·33, 0·04] mmol/L, -0·75 [-2·45, 0·96] mm Hg and − 1·17 [-4·52, 2·17] mm Hg respectively in favour of the intervention group. Conclusions Nutrition therapy provided by dietitians was associated with better clinical parameters of type 2 diabetes, including clinically significant improved glycaemic control, across diverse multiethnic patient groups from all six inhabited continents. This conclusion should be reflected in clinical guidelines.

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