scholarly journals Allergic Bronchopulmonary Aspergillosis, Allergic Aspergillus Sinusitis and their Co-occurrence

2008 ◽  
Vol 1 (1) ◽  
pp. 52-61 ◽  
Author(s):  
Amit Diwakar ◽  
Chandramani Panjabi ◽  
Ashok Shah
Keyword(s):  
Computed Tomography ◽  
At Risk ◽  
Severe Disease ◽  
Allergic Bronchopulmonary Aspergillosis ◽  
Current Approach ◽  
Surgical Removal ◽  
Oral Corticosteroids ◽  
Allergic Mucin ◽  
Criteria For Diagnosis

Allergic bronchopulmonary aspergillosis (ABPA), which requires a set of criteria for diagnosis, occurs in atopic individuals, predominantly asthmatics. Oral corticosteroids are the cornerstone for the management of the disease. Allergic Aspergillus sinusitis (AAS), clinico-pathologically similar to ABPA, is also diagnosed with a set of criteria including demonstration of fungal elements in sinus material. Heterogeneous densities on computed tomography of the para-nasal sinuses are caused by the ‘allergic mucin’ in the sinuses. A combination of oral corticosteroids and surgical removal of impacted sinus mucin is the current approach to treatment. Despite common clinico-immunopathological characteristics, the co-occurrence of both these diseases is a rarely reported phenomenon. This could be due to the fact that the two diseases are often encountered by different specialities. Screening all asthmatics for Aspergillus sensitisation could identify those with severe disease and those at risk for developing ABPA. AAS must be excluded in all patients with ABPA and vice-versa.

scholarly journals Allergic Diseases Caused by Aspergillus Species in Patients with Cystic Fibrosis

Antibiotics ◽  
2021 ◽  
Vol 10 (4) ◽  
pp. 357
Author(s):  
Aidan K. Curran ◽  
David L. Hava
Keyword(s):  
Cystic Fibrosis ◽  
Fungal Infections ◽  
Allergic Bronchopulmonary Aspergillosis ◽  
Hyphal Growth ◽  
Allergic Diseases ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Th2 Immune Response ◽  
Difficulty Breathing ◽  
Oral Corticosteroids

Aspergillus spp. are spore forming molds; a subset of which are clinically relevant to humans and can cause significant morbidity and mortality. A. fumigatus causes chronic infection in patients with chronic lung disease such as asthma, chronic obstructive pulmonary disease (COPD) and cystic fibrosis (CF). In patients with CF, A. fumigatus infection can lead to allergic disease, such as allergic bronchopulmonary aspergillosis (ABPA) which is associated with high rates of hospitalizations for acute exacerbations and lower lung function. ABPA results from TH2 immune response to Aspergillus antigens produced during hyphal growth, marked by high levels of IgE and eosinophil activation. Clinically, patients with ABPA experience difficulty breathing; exacerbations of disease and are at high risk for bronchiectasis and lung fibrosis. Oral corticosteroids are used to manage aspects of the inflammatory response and antifungal agents are used to reduce fungal burden and lower the exposure to fungal antigens. As the appreciation for the severity of fungal infections has grown, new therapies have emerged that aim to improve treatment and outcomes for patients with CF.

scholarly journals Computed Tomography Findings in Intraabdominal Hypertension in Patients with Acute Pancreatitis

2021 ◽  
Author(s):  
Pankaj Gupta ◽  
Rohan Kamat ◽  
Jayanta Samanta ◽  
Harshal Mandavdhare ◽  
Vishal Sharma ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Acute Pancreatitis ◽  
Severe Disease ◽  
Univariate Analysis ◽  
Tissue Perfusion ◽  
Intraabdominal Pressure ◽  
Biliary Dilatation ◽  
Ct Findings ◽  
Contrast Enhanced Ct ◽  
Intraabdominal Hypertension

Abstract Purpose Intraabdominal hypertension (IAH) in acute pancreatitis (AP) may reduce tissue perfusion and impair organ function and has been shown to portend poor prognosis. We investigated the computed tomography (CT) findings in patients with AP with IAH. Methods This retrospective study comprised of consecutive patients with AP from June 2016 to June 2018 in whom intraabdominal pressure (IAP) was measured. The patients who underwent a contrast-enhanced CT within 7 days of IAP measurement were included. Using a cutoff of 12 mm Hg for IAP, the patients were divided into IAH and non-IAH groups. Measures of severity and clinical outcome were evaluated. CT parameters were compared between the groups. Results The IAH group comprised of 41 patients, while there were 20 patients in the non-IAH group. The IAH group was characterized by severe disease, increased incidence of organ failure, increased requirement for drainage and surgery, prolonged hospital and intensive care unit stay. The mortality was not significantly different between the two groups. On univariate analysis, the CT features that were found to be significantly different between the two groups were the presence of collection (p = 0.036), the maximum dimension of collection (p = 0.004), volume of collection (p = 0.019), biliary dilatation (p = 0.011), and the presence of moderate-to-severe pleural effusion (p = 0.009). On multivariate analysis, all these parameters except biliary dilatation were found to be statistically significant. Conclusion CT findings in patients with AP may suggest IAH. This can be used as an additional marker for severity of AP.

scholarly journals Informing the public health response to COVID-19: a systematic review of risk factors for disease, severity, and mortality

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
M. Flook ◽  
C. Jackson ◽  
E. Vasileiou ◽  
C. R. Simpson ◽  
M. D. Muckian ◽  
...  
Keyword(s):  
Public Health ◽  
Risk Factors ◽  
Systematic Review ◽  
At Risk ◽  
Risk Factor ◽  
Disease Severity ◽  
Severe Disease ◽  
Public Health Response ◽  
Wide Range ◽  
Multivariable Analyses

Abstract Background Severe Acute Respiratory Syndrome coronavirus-2 (SARS-CoV-2) has challenged public health agencies globally. In order to effectively target government responses, it is critical to identify the individuals most at risk of coronavirus disease-19 (COVID-19), developing severe clinical signs, and mortality. We undertook a systematic review of the literature to present the current status of scientific knowledge in these areas and describe the need for unified global approaches, moving forwards, as well as lessons learnt for future pandemics. Methods Medline, Embase and Global Health were searched to the end of April 2020, as well as the Web of Science. Search terms were specific to the SARS-CoV-2 virus and COVID-19. Comparative studies of risk factors from any setting, population group and in any language were included. Titles, abstracts and full texts were screened by two reviewers and extracted in duplicate into a standardised form. Data were extracted on risk factors for COVID-19 disease, severe disease, or death and were narratively and descriptively synthesised. Results One thousand two hundred and thirty-eight papers were identified post-deduplication. Thirty-three met our inclusion criteria, of which 26 were from China. Six assessed the risk of contracting the disease, 20 the risk of having severe disease and ten the risk of dying. Age, gender and co-morbidities were commonly assessed as risk factors. The weight of evidence showed increasing age to be associated with severe disease and mortality, and general comorbidities with mortality. Only seven studies presented multivariable analyses and power was generally limited. A wide range of definitions were used for disease severity. Conclusions The volume of literature generated in the short time since the appearance of SARS-CoV-2 has been considerable. Many studies have sought to document the risk factors for COVID-19 disease, disease severity and mortality; age was the only risk factor based on robust studies and with a consistent body of evidence. Mechanistic studies are required to understand why age is such an important risk factor. At the start of pandemics, large, standardised, studies that use multivariable analyses are urgently needed so that the populations most at risk can be rapidly protected. Registration This review was registered on PROSPERO as CRD42020177714.

Advantages of Modified Computed Tomography Severity Index of Acute Pancreatitis Over Other Scoring System

KYAMC Journal ◽  
2019 ◽  
Vol 10 (2) ◽  
pp. 110-113
Author(s):  
Md Mofazzal Sharif ◽  
Khaleda Parvin Rekha ◽  
Umme Iffat Siddiqua ◽  
Mst Monira Khatun ◽  
AKM Enamul Haque ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Acute Pancreatitis ◽  
Clinical Outcome ◽  
Severe Disease ◽  
Severity Index ◽  
Observer Variation ◽  
Imaging Method ◽  
Close Monitoring ◽  
Early Assessment ◽  
Prompt Treatment

Pancreatitis is one of most complex and clinically challenging of all abdominal disorders. USG and abdominal Computed Tomography (CT) are the most commonly used diagnostic imaging modalities for the evaluation of pancreas. Computed Tomography (CT) is highly accurate and sensitive than USG in both diagnosing as well as demonstrating the extent. Early assessment of the cause and severity of acute pancreatitis is of utmost importance for prompt treatment and close monitoring of patient with severe disease. CT is the imaging method of choice for assessing the extent of acute pancreatitis and for evaluating complications. CT severity index is used to assess prognostic correlation and clinical outcome of acute pancreatitis. Modified CT severity index makes the score easier to calculate and reduces the inter-observer variation. KYAMC Journal Vol. 10, No.-2, July 2019, Page 110-113

Asthma

2020 ◽  
Author(s):  
Haitham Nsour ◽  
Anne E. Dixon
Keyword(s):  
Emergency Department ◽  
Inhaled Corticosteroids ◽  
Early Recognition ◽  
Allergic Bronchopulmonary Aspergillosis ◽  
Significant Proportion ◽  
The United States ◽  
Asthma Prevalence ◽  
Public Health Burden ◽  
Asthma Exacerbations ◽  
Oral Corticosteroids

Asthma is one of the most common diseases in developed nations. A pathognomonic feature of asthma is episodic aggravations of the disease; these exacerbations can be life-threatening and contribute to a significant proportion of the public health burden of asthma. In the emergency department, successful management of asthma exacerbations requires early recognition and intervention before they become severe and potentially fatal. This review summarizes the pathophysiology, stabilization and assessment, diagnosis and treatment, and disposition and outcomes for asthma. Figures show the management of asthma exacerbations in the emergency department and hospital, pooled odds ratio comparing inhaled corticosteroids and oral corticosteroids with oral corticosteroids alone following emergency department discharge, and an asthma discharge plan at the emergency department. Tables list current asthma prevalence among selected demographic groups in the United States, risk factors for fatal asthma exacerbations, differential diagnosis of asthma exacerbations, and dosages of drugs for asthma exacerbations. This review contains 3 figures, 16 tables, and 88 references. Key Words: Asthma, allergic bronchopulmonary aspergillosis, gastroesophageal reflux disease, sinus disease, breathlessness, shortness of breath  

Veterinary approaches to canine mammary tumors and knowledge of the consensus statement in Brazil

2021 ◽  
Vol 14 (1) ◽  
pp. 24-28
Author(s):  
Tainá Zuchi ◽  
◽  
Claudia Lopatini ◽  
Joice Faria
Keyword(s):  
Consensus Statement ◽  
Immunohistochemical Analysis ◽  
Mammary Tumors ◽  
Surgical Removal ◽  
Therapeutic Approaches ◽  
Canine Mammary Tumors ◽  
Preventive Actions ◽  
Criteria For Diagnosis ◽  
Unilateral Mastectomy

Mammary gland tumors are one of the most commonly diagnosed tumors in female dogs, with a reported prevalence ranging from 26 to 73% in Brazil. In recognition of the importance of these tumors veterinary researchers and clinicians in Brazil produced the first consensus statement regarding canine mammary tumors in 2010. The intention was to establish criteria for diagnosis, prognosis, and treatment. This study evaluated the methods of prevention, diagnosis, treatment, and determination of prognosis used by veterinarians in Brazil, and sought to quantify the number of veterinarians who were aware of the consensus statement. One hundred and three veterinary clinics participated in the study, 87.37% of which recommend early neutering as a preventative treatment for mammary tumors. For diagnosis, 100% of these use laboratory testing, 94.17% perform chest radiography, 78.64% incisional biopsies, 44.66% cytological analysis, and 13.59% immunohistochemical analysis. The most common surgical procedure is unilateral mastectomy (72.81%), and chemotherapy is performed in 49.51% of the clinics. Of the 103 clinics, 66.01% were aware of the consensus. Although knowledge of the consensus statement is widespread among veterinarians in Brazil, not all its recommendations are being followed. Preventive actions for canine mammary tumors are well established in most parts of the country. However, the consensus statement has had little influence on informing prognostic and therapeutic approaches, with a poor uptake of surgical removal of lymph nodes and immunohistochemical examination.

Abstract 11726: Novel Non-Invasive Method to Estimate Myocardial Mass at Risk Calculated From Cardiac Computed Tomography Data: Validation Study Using Angiographic Myocardial Jeopardy Scores in Patients With Single Vessel Disease

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Seiko IDE ◽  
Satoru Sumitsuji ◽  
Kensuke Yokoi ◽  
Masatoki Yoshida ◽  
Isamu Mizote ◽  
...  
Keyword(s):  
Computed Tomography ◽  
At Risk ◽  
Heart Disease ◽  
Coronary Artery ◽  
Cardiac Computed Tomography ◽  
Myocardial Mass ◽  
Non Invasive ◽  
Vessel Disease ◽  
Single Vessel ◽  
Single Vessel Disease

Background: The myocardial mass at risk (MMAR), representing volume of myocardium distal to culprit lesion, is one of important factors for predicting adverse cardiac event in ischemic heart disease. However, current non-invasive cardiac imaging fails to quantify MMAR in patients with stable coronary artery disease. We have developed a new software calculating MMAR of any designated coronary artery by reconstructing the 3-dimensional-volume-data of cardiac computed tomography (CCT). The novel index, ratio of MMAR to whole left ventricular volume (%LV-MMAR), calculated with this software would be appealing to obtain MMAR objectively. This study aims to compare the %LV-MMAR with Bypass Angioplasty Revascularization Investigation (BARI) and modified Albert Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) scores, both of which are invasive angiographic methods widely used to estimate MMAR, in patients with single-vessel disease. Methods: Between April 2008 and March 2014, patients suspected of effort angina pectoris without history of previous myocardial infarction were assessed with CCT and invasive coronary angiography. Of those, 48 patients who were revealed single-vessel disease (left anterior descending artery (LAD): n=22, left circumflex artery (LCX): n=11 and right coronary artery (RCA): n=15) were included in this study. %LV-MMAR was calculated on the software. BARI and modified APPROACH score were calculated and compared with %LV-MMAR. Results: Mean %LV-MMAR was 27.6 [18.2-37.1] %. BARI and APPROACH scores showed a significant correlation (r=0.92, p<0.0001). Also, a significant correlation was observed between %LV-MMAR versus BARI and %LV-MMAR versus APPROACH (r=0.95, p<0.0001 and r=0.9, p<0.0001, respectively). %LV-MMAR showed significant correlation with BARI and APPROACH scores in all vessels; LAD (r=0.95, p<0.0001 and r=0.91, p<0.0001, respectively), LCX (r=0.91, p=0.0001 and r=0.83, p=0.0002, respectively) and RCA (r=0.92, p<0.0001 and r=0.85, p<0.0001, respectively). Conclusions: This study revealed %LV-MMAR, calculated from CCT data on novel software, to be a promising index for estimating perfusion territory noninvasively in good agreement with BARI and modified APPROACH score.

scholarly journals Computed tomography findings in patients with H1N1 influenza A infection

2013 ◽  
Vol 46 (5) ◽  
pp. 299-306 ◽  
Author(s):  
Viviane Brandão Amorim ◽  
Rosana Souza Rodrigues ◽  
Miriam Menna Barreto ◽  
Gláucia Zanetti ◽  
Edson Marchiori
Keyword(s):  
Computed Tomography ◽  
Influenza A ◽  
H1n1 Virus ◽  
Severe Disease ◽  
H1n1 Influenza ◽  
Wall Thickening ◽  
High Resolution Computed Tomography ◽  
Air Trapping ◽  
Bronchial Wall

The present study aimed to review high resolution computed tomography findings in patients with H1N1 influenza A infection. The most common tomographic findings include ground-glass opacities, areas of consolidation or a combination of both patterns. Some patients may also present bronchial wall thickening, airspace nodules, crazy-paving pattern, perilobular opacity, air trapping and findings related to organizing pneumonia. These abnormalities are frequently bilateral, with subpleural distribution. Despite their nonspecificity, it is important to recognize the main tomographic findings in patients affected by H1N1 virus in order to include this possibility in the differential diagnosis, characterize complications and contribute in the follow-up, particularly in cases of severe disease.

scholarly journals Clinically Applicable Segmentation of Head and Neck Anatomy for Radiotherapy: Deep Learning Algorithm Development and Validation Study

10.2196/26151 ◽  
2021 ◽  
Vol 23 (7) ◽  
pp. e26151
Author(s):  
Stanislav Nikolov ◽  
Sam Blackwell ◽  
Alexei Zverovitch ◽  
Ruheena Mendes ◽  
Michelle Livne ◽  
...  
Keyword(s):  
Computed Tomography ◽  
At Risk ◽  
Deep Learning ◽  
Clinical Practice ◽  
Head And Neck ◽  
Organs At Risk ◽  
Data Set ◽  
Computed Tomography Scans ◽  
Neck Anatomy ◽  
Organ At Risk

Background Over half a million individuals are diagnosed with head and neck cancer each year globally. Radiotherapy is an important curative treatment for this disease, but it requires manual time to delineate radiosensitive organs at risk. This planning process can delay treatment while also introducing interoperator variability, resulting in downstream radiation dose differences. Although auto-segmentation algorithms offer a potentially time-saving solution, the challenges in defining, quantifying, and achieving expert performance remain. Objective Adopting a deep learning approach, we aim to demonstrate a 3D U-Net architecture that achieves expert-level performance in delineating 21 distinct head and neck organs at risk commonly segmented in clinical practice. Methods The model was trained on a data set of 663 deidentified computed tomography scans acquired in routine clinical practice and with both segmentations taken from clinical practice and segmentations created by experienced radiographers as part of this research, all in accordance with consensus organ at risk definitions. Results We demonstrated the model’s clinical applicability by assessing its performance on a test set of 21 computed tomography scans from clinical practice, each with 21 organs at risk segmented by 2 independent experts. We also introduced surface Dice similarity coefficient, a new metric for the comparison of organ delineation, to quantify the deviation between organ at risk surface contours rather than volumes, better reflecting the clinical task of correcting errors in automated organ segmentations. The model’s generalizability was then demonstrated on 2 distinct open-source data sets, reflecting different centers and countries to model training. Conclusions Deep learning is an effective and clinically applicable technique for the segmentation of the head and neck anatomy for radiotherapy. With appropriate validation studies and regulatory approvals, this system could improve the efficiency, consistency, and safety of radiotherapy pathways.

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