Presence of bronchial nodules, younger age, and heavier body weight are associated with a diagnosis of eosinophilic lung disease in dogs with cough

Abstract OBJECTIVE To describe the association between a diagnosis of eosinophilic lung disease (ELD) in dogs with signalment and bronchoscopic features and evaluate the accuracy of visualization of nodules for the diagnosis of ELD. ANIMALS 781 dogs with cough that underwent bronchoscopy between 2014 and 2016. PROCEDURES Data were extracted from the medical records of each included dog. Multivariable logistic regression was performed to investigate associations between ELD and patient characteristics. RESULTS ELD was diagnosed in 113 (14.5%) dogs. More than 3 nodular lesions of the bronchial mucosa were detected in 64 (8.2%) dogs. The odds of having ELD were greater in dogs with nodules (adjusted OR [aOR], 26.0; 95% CI, 13.0 to 52.0) and static bronchial collapse (aOR, 2.3; 95% CI, 1.1 to 4.6), and lower in dogs having focal versus diffuse inflammation (aOR, 0.05; 95% CI, 0.01 to 0.37). The odds of having ELD decreased for each 1-year increase in age (aOR, 0.86; 95% CI, 0.80 to 0.92), and increased for each 1-kg increase in weight (aOR, 1.04; 95% CI, 1.01 to 1.06). Visualization of nodules during bronchoscopy had a overall accuracy of 89.4% (95% CI, 87.0% to 91.4%), sensitivity of 41.6% (32.4% to 51.2%), and specificity of 97.5% (96.0% to 98.5%) for a diagnosis of ELD. CLINICAL RELEVANCE On the basis of high specificity and negative predictive value, lack of visualization of bronchial nodules during bronchoscopy can be used to preliminarily rule out ELD. However, visualization of bronchial nodules does not imply presence of ELD. This could be especially relevant when results of BAL cytology are available several days after the actual bronchoscopy.

Download Full-text

Factors associated with the development of ocular candidiasis and ocular prognosis with echinocandin therapy for candidemia

Journal of Ophthalmic Inflammation and Infection ◽

10.1186/s12348-021-00248-0 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Daiki Sakai ◽

Wataru Matsumiya ◽

Sentaro Kusuhara ◽

Makoto Nakamura

Keyword(s):

Candida Albicans ◽

Medical Records ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Patient Characteristics ◽

Antifungal Drugs ◽

Factors Associated ◽

Logistic Analysis ◽

Multivariate Logistic Analysis ◽

Systemic Antifungal Therapy

Abstract Purpose To evaluate the factors associated with the development of ocular candidiasis (OC) and ocular prognosis with echinocandin therapy for candidemia. Methods The medical records of 56 consecutive patients with a positive blood culture for Candida species between November 2016 and October 2019 were retrospectively reviewed. Information on patient characteristics, isolated Candida species, treatment details for candidemia, and ocular findings were extracted to identify factors associated with OC development. Results The leading pathogen of candidemia was Candida albicans (C.albicans) (41.1%). Of 56 patients, 18 (32.1%) were diagnosed with chorioretinitis, categorized as either probable (8 patients) or possible OC (10 patients). There was no case of endophthalmitis with vitritis. The incidence of probable OC was not significantly different between the groups treated with echinocandins and other antifungal drugs (15.2% vs. 11.1%, p = 1.00). In all probable OC cases, systemic antifungal therapy was switched from echinocandins to azoles, and no case progressed to endophthalmitis. A multivariate logistic analysis revealed that female sex (adjusted odds ratio [aOR], 8.93; 95% confidence interval [CI], 1.09–72.9) and C. albicans (aOR, 23.6; 95% CI, 1.8–281) were independent factors associated with the development of probable OC. Conclusion One-seventh of patients with candidemia developed probable OC. Given the evidence of female and C. albicans as the factors associated with OC development, careful ophthalmologic management is required with these factors, especially in candidemia. Although echinocandins had no correlation with OC development and did not lead to the deterioration of ocular prognosis, further investigation is required.

Download Full-text

1631. Mycobacterium septicum: A 6-year Clinical Experience from a Tertiary Hospital and Reference Laboratory

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1811 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S807-S807

Author(s):

John Raymond U Go ◽

Cristina G Corsini Campioli ◽

Omar Abu Saleh ◽

John Wilson ◽

Sharon Deml ◽

...

Keyword(s):

Lung Disease ◽

Treatment Duration ◽

Retrospective Chart Review ◽

Patient Characteristics ◽

Tertiary Hospital ◽

High Rate ◽

Clinical Microbiology Laboratory ◽

Reference Laboratory ◽

Peritoneal Dialysis Catheter ◽

Increased Risk

Abstract Background Mycobacterium septicum is a rapidly growing non-tuberculous mycobacterium. It is a ubiquitous organism capable of causing infections in both healthy and immunocompromised individuals. Only a few cases have been reported to date, and standard therapeutic regimens, and optimal treatment duration have not been defined. Methods We conducted a retrospective chart review of all patients seen at Mayo Clinic in Rochester, MN from July 2014 to March 2020 from whom Mycobacterium septicum was isolated in culture by our clinical microbiology laboratory. Results There were 12 patients identified with M. septicum infection – 7 males and 5 females. The average age was 67 years, with an age range of 48 to 80 years. Seven of 12 isolates obtained were from sputum samples. Only one patient was on immunosuppressive medication. Three cases were considered clinically significant infections for which directed anti-mycobacterial therapy was instituted. In two of these three cases, co-infection with Mycobacterium avium complex (MAC) was seen. Underlying structural lung disease was present in the two cases of pulmonary infections. Peritoneal dialysis catheter-related peritonitis was seen in the third case. All the isolates were susceptible to amikacin, ciprofloxacin, imipenem, linezolid, moxifloxacin, and trimethoprim-sulfamethoxazole (TMP-SMX). The isolates were resistant to clarithromycin and doxycycline. Patient Characteristics, Associated M. septicum Illness, and Therapy Provided Antimicrobial Susceptibility Profiles of the Mycobacterium septicum Isolates, MIC (mcg/mL) and Interpretation Patient Demographics and Specimen Source of Mycobacerium septicum Isolates Conclusion M. septicum is an unusual cause of non-tuberculous mycobacterial infection. The presence of a foreign body may increase the risk of infection. Individuals with underlying structural lung disease are also likely to be at increased risk of developing pulmonary infection. Generalized treatment recommendations are limited by the lack of prospective controlled trials; hence, optimal antibiotic regimen and treatment duration have not been firmly established. Susceptibility testing should be performed to guide treatment selection, but the use of combination therapy with potentially empiric agents like amikacin, ciprofloxacin, imipenem, linezolid, moxifloxacin, and TMP-SMX as demonstrated in this small study, can be considered. A high rate of macrolide resistance was noted in our study. Disclosures All Authors: No reported disclosures

Download Full-text

Monitoring of Adverse Drug Reaction-Related Parameters in Children and Adolescents Treated With Antipsychotic Drugs in Psychiatric Outpatient Clinics

Frontiers in Psychiatry ◽

10.3389/fpsyt.2021.640377 ◽

2021 ◽

Vol 12 ◽

Author(s):

Lenneke Minjon ◽

Ivona Brozina ◽

Toine C. G. Egberts ◽

Eibert R. Heerdink ◽

Els van den Ban

Keyword(s):

Children And Adolescents ◽

Antipsychotic Drug ◽

Medical Records ◽

Antipsychotic Drugs ◽

Patient Characteristics ◽

Outpatient Clinics ◽

Physical Parameters ◽

Laboratory Parameters ◽

Psychiatric Outpatient ◽

Antipsychotic Drug Treatment

Aim: To assess the frequency of monitoring of adverse drug reaction (ADR) related parameters in children and adolescents treated with antipsychotic drugs in psychiatric outpatient clinics and the considerations when monitoring was not performed.Methods: This retrospective follow-up study included 100 randomly selected outpatients aged ≤18 years who had a first prescription of an antipsychotic drug recorded in the electronic medical records of psychiatric outpatient clinics between 2014 and 2017. They were followed for up to 3 years. This study assessed the frequency of monitoring for physical parameters (weight, height, body mass index, waist circumference, pulse, blood pressure, and an electrocardiogram) and laboratory parameters (glucose, lipids, and prolactin) before the first prescription of an antipsychotic drug as well as during its use. Monitoring frequencies were stratified by the patient characteristics (sex, age, cardiovascular risk factors, and use of other psychotropic drugs), and by location of antipsychotic drug initiation (psychiatric outpatient clinic or elsewhere). Additionally, this study assessed the considerations mentioned in the medical records for not monitoring ADR-related parameters.Results: Overall, physical parameters were monitored more frequently (weight: 85.9% during the first half-year) than laboratory parameters (glucose and cholesterol: both 23.5%). There were no significant differences in monitoring at least one physical as well as in monitoring at least one laboratory parameter during the baseline period and during the total follow-up of antipsychotic drug treatment between the patient characteristics. In total, 3% of the children and adolescents were never monitored for any physical parameter, and 54% were never monitored for any laboratory parameter. For a minority of the children (14.8%) who were never monitored for laboratory parameters, considerations were recorded in their medical records, including refusal by the child or parents and monitoring performed by the general practitioner or elsewhere.Conclusion: Monitoring frequencies of ADR-related parameters in children and adolescents treated with antipsychotic drugs in psychiatric outpatient clinics varied and especially monitoring of laboratory parameters was infrequent. Considerations why monitoring was not performed were rarely recorded. The optimal method of monitoring and documentation thereof should become clear to optimize the benefit-risk balance of antipsychotic drug treatment for each child.

Download Full-text

Pulmonary Cavitation – An Under-recognized Late Complication of Severe COVID-19 Lung Disease

10.21203/rs.3.rs-62904/v1 ◽

2020 ◽

Author(s):

Zaid Zoumot ◽

Maria-Fernanda Bonilla ◽

Ali S. Wahla ◽

Irfan Shafiq ◽

Mateen Uzbeck ◽

...

Keyword(s):

Lung Disease ◽

Medical Records ◽

Late Complication ◽

Ground Glass ◽

The Novel ◽

Radiological Findings ◽

Imaging Characteristics ◽

Microbiological Parameters ◽

Novel Coronavirus ◽

High Level

Abstract Background: Pulmonary radiological findings of the novel coronavirus disease 2019 (COVID-19) have been well documented and range from scattered ground-glass infiltrates in milder cases to confluent ground-glass change, dense consolidation, and crazy paving in the critically ill. However, lung cavitation has not been commonly described in these patients. The objective of this study was to assess the incidence of pulmonary cavitation in patients with COVID-19 and describe its characteristics and evolution.Methods: We conducted a retrospective review of all patients admitted to our institution with COVID-19 and reviewed electronic medical records and imaging to identify patients who developed pulmonary cavitation.Results: Twelve out of 689 (1.7%) patients admitted to our institution with COVID-19 developed pulmonary cavitation, comprising 3.3% (n=12/359) of patients who developed COVID-19 pneumonia, and 11% (n=12/110) of those admitted to the intensive care unit. We describe the imaging characteristics of the cavitation and present the clinical, pharmacological, laboratory, and microbiological parameters for these patients. In this cohort six patients have died, two are recovering in hospital and four have been discharged home. Conclusion: Cavitary lung disease in patients with severe COVID-19 disease is not uncommon, and is associated with a high level of morbidity and mortality.

Download Full-text

Body Weight Change During and After Hospitalization for Acute Heart Failure: Patient Characteristics, Markers of Congestion, and Outcomes

JACC Heart Failure ◽

10.1016/j.jchf.2016.09.012 ◽

2017 ◽

Vol 5 (1) ◽

pp. 1-13 ◽

Cited By ~ 36

Author(s):

Andrew P. Ambrosy ◽

Lukasz P. Cerbin ◽

Paul W. Armstrong ◽

Javed Butler ◽

Adrian Coles ◽

...

Keyword(s):

Heart Failure ◽

Body Weight ◽

Acute Heart Failure ◽

Heart Failure Patient ◽

Weight Change ◽

Patient Characteristics ◽

Body Weight Change

Download Full-text

Epidemiological, Clinical, Trichoscopic, and Histopathological Features of Lupus Erythematous Mimicking Alopecia Areata: A Multicenter Retrospective Study

Skin Appendage Disorders ◽

10.1159/000520825 ◽

2022 ◽

pp. 1-5

Author(s):

Daniel Fernandes Melo ◽

Paulo Müller Ramos ◽

Matilde Iorizzo ◽

Caren dos Santos Lima ◽

Erica Baptista Pinto ◽

...

Keyword(s):

Retrospective Study ◽

Early Diagnosis ◽

Hair Loss ◽

Alopecia Areata ◽

Lupus Erythematosus ◽

Medical Records ◽

High Specificity ◽

Histopathological Features ◽

Brown Discoloration ◽

Perivascular Inflammation

Introduction: All types of lupus erythematosus (LE) may cause hair loss. Nonscarring alopecia was correlated with systemic LE, based on its high specificity. Discoid LE can also appear as nonscarring patches in early stages. Patchy alopecia LE-specific may also mimic alopecia areata (AA) – which can co-occur with LE. The distinction is fundamental to early diagnosis and effective treatment. This study aims to analyze clinical, epidemiological, trichoscopic, and histopathological features of patients with patchy LE-specific alopecia, nonscarring type, mimicking AA. Methods: This is a multicentric retrospective study. We reviewed the medical records of patients with a confirmed diagnosis of LE mimicking AA. Results: Ten patients were included (90% female) with a mean age of 45.9 years. Clinically, 60% showed erythema and 70% presented incomplete hair loss. The most common trichoscopic findings were interfollicular arborizing vessels (90%) and scattered brown discoloration (80%). On histopathology, perivascular inflammation (85.7%), peribulbar lymphocytes (85.7%), and dermal pigment incontinence (71.4%) were present in most cases. Discussion/Conclusion: Trichoscopy was found as an essential first step for the patchy alopecia diagnosis, enabling to differentiate LE from AA. Putting it mildly, trichoscopy raises the suspicion that leads to a biopsy, increasing the diagnostic accuracy with better outcome for patients.

Download Full-text

Treatment patterns and clinical outcomes with palbociclib-based therapy received in US community oncology practices

Future Oncology ◽

10.2217/fon-2020-0744 ◽

2020 ◽

Author(s):

Junji Lin ◽

Lynn McRoy ◽

Maxine D Fisher ◽

Nan Hu ◽

Cralen Davis ◽

...

Keyword(s):

Breast Cancer ◽

Clinical Outcomes ◽

Real World ◽

Medical Records ◽

Metastatic Breast ◽

Patient Characteristics ◽

Treatment Patterns ◽

Community Oncology ◽

Label Indication ◽

Free Rate

Background: Limited studies have evaluated palbociclib-based therapy use in patients with advanced/metastatic breast cancer in the real world. This retrospective study used medical records from US community oncology practices to address the gap. Materials & methods: Eligible patients receiving palbociclib-based therapy per label indication from 3 February 2015 to 31 December 2017 were included. Descriptive analyses were conducted for patient characteristics, treatment patterns and clinical outcomes. Results: The study included 233 patients who received palbociclib + aromatase inhibitor (P+AI) and 48 who received palbociclib + fulvestrant (P+F). Real-world progression-free rate for P+AI was 69.8% (46.8%) at 12 (24) months (P+F: 43.5% [39.9%]) months. Real-world survival rate was 89.8% (71.4%) at 12 (24) months (P+F: 76.3% [65.0%]). Conclusion: The study findings are consistent with previous studies of palbociclib-based therapy.

Download Full-text

Influence of Patient Characteristics on The Type of Insulin Therapy Obtained by Diabetes Type 2 Outpatient in Denpasar Municipality

Udayana Journal of Social Sciences and Humanities (UJoSSH) ◽

10.24843/ujossh.2017.v01.i02.p03 ◽

2017 ◽

Vol 1 (2) ◽

pp. 139

Author(s):

Luh Putu Febrayana Larasanty ◽

I GNA. Dewantara Putra ◽

Rhyce Dewata Sari ◽

Komang Dede Saputra ◽

I GA. Gede Minanjaya ◽

...

Keyword(s):

Diabetes Mellitus ◽

Blood Glucose ◽

Blood Glucose Level ◽

Insulin Therapy ◽

Glucose Level ◽

Medical Records ◽

Fasting Blood Glucose ◽

Patient Characteristics ◽

Postprandial Blood Glucose

This study aims to investigate the influence of patient characteristics on the choice of insulin therapy in type 2 diabetes mellitus outpatients in Denpasar municipality. This is a descriptive analysis study using the patient's medical records as research material. Patients who meet inclusion and exclusion criteria are being recorded based on their medical records. Characteristics that are taken are age, gender, fasting blood glucose level (FBG), 2-hour postprandial blood glucose level (2-hours PPG) and HbA1c values of patients. Types of insulin therapy gained from patient medical records and drug use report in pharmacy. Characteristics data and type of insulin analyzed using correlation test to determine the effect of the patient characteristics on the selection of insulin therapy. 43 patients became the research subject. Males gendered patients (72.09%) and the patients aged less than 65 years (90.70%) are the dominant characteristics of the research subjects. The average value of FBG of patients is 212 mg / dL; 2-hours PPG 280 mg / dL and HbA1c 10.1%. There is a correlation between sex, age, HbA1c value and FBG with the type of insulin obtained by patients (p <0.05). Based on the results of statistical tests, age and gender have a strong correlation on insulin choice, HbA1c and FBG level has a moderate influence and 2-hours PPG have a weak correlation. Patient characteristics had an influence on the type of insulin choice for diabetes mellitus type 2 outpatient in the Denpasar municipality.

Download Full-text

Generalized myoclonus in COVID-19

Neurology ◽

10.1212/wnl.0000000000009829 ◽

2020 ◽

Vol 95 (6) ◽

pp. e767-e772 ◽

Cited By ~ 23

Author(s):

Pablo Rábano-Suárez ◽

Laura Bermejo-Guerrero ◽

Antonio Méndez-Guerrero ◽

Javier Parra-Serrano ◽

Daniel Toledo-Alfocea ◽

...

Keyword(s):

Medical Records ◽

Startle Response ◽

Respiratory Arrest ◽

University Hospital ◽

Voluntary Movements ◽

Inflammatory Phase ◽

Immune Mediated ◽

The University ◽

Order Structures ◽

Rule Out

ObjectiveTo report 3 patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) who developed generalized myoclonus.MethodsPatient data were obtained from medical records from the University Hospital “12 de Octubre,” Madrid, Spain.ResultsThree patients (2 men and 1 woman, aged 63–88 years) presented with mild hypersomnia and generalized myoclonus following the onset of the so-called inflammatory phase of coronavirus disease 2019 (COVID-19). All of them had presented previously with anosmia. Myoclonus was generalized with both positive and negative jerks, predominantly involving the facial, trapezius, sternocleidomastoid, and upper extremities muscles. These myoclonic jerks occurred spontaneously and were extremely sensitive to multisensory stimuli (auditive and tactile) or voluntary movements, with an exaggerated startle response. Other causes of myoclonus were ruled out, and none of the patients had undergone respiratory arrest or significant prolonged hypoxia. All of them improved, at least partially, with immunotherapy.ConclusionsOur 3 cases highlight the occurrence of myoclonus during the COVID-19 pandemic as a post- or para-infectious immune-mediated disorder. However, we cannot rule out that SARS-CoV-2 may spread transneuronally to first- and second-order structures connected with the olfactory bulb. Further investigation is required to clarify the full clinical spectrum of neurologic symptoms and optimal treatment.

Download Full-text

Natural, innate improvements in multiple sclerosis disability

Multiple Sclerosis Journal ◽

10.1177/1352458512439119 ◽

2012 ◽

Vol 18 (10) ◽

pp. 1412-1421 ◽

Cited By ~ 17

Author(s):

Helen Tremlett ◽

Feng Zhu ◽

John Petkau ◽

Joel Oger ◽

Yinshan Zhao ◽

...

Keyword(s):

Multiple Sclerosis ◽

Clinical Trials ◽

Observational Studies ◽

Disease Duration ◽

Patient Characteristics ◽

Expanded Disability Status Scale ◽

Younger Age ◽

Disability Status ◽

Immunomodulatory Drug ◽

One Year

Background: Improvements in multiple sclerosis (MS) disability have recently been reported in immunomodulatory drug (IMD) clinical trials and observational studies. However, improvements have rarely been examined in natural history or IMD naive patients. We investigated annual and biennial improvements in Expanded Disability Status Scale (EDSS) scores in British Columbia, Canada. Methods: The British Columbian MS database was accessed for definite MS patients (1980–2009). Consecutive IMD-free EDSS scores one and two years apart (± 3 months) were examined; improvements (≥0.5,≥1,≥2 EDSS points) and sustained improvements (confirmed at one year) were described. The influence of patient characteristics on improvements was examined using logistic regression. Results: From 16,132 EDSS scores, 7653 yearly and 5845 biennial EDSS intervals were available for 2961 and 2382 patients respectively. Of the yearly intervals, 14.9% showed an improvement (≥0.5 points), 8.3% ≥1 point and 2.2% ≥2 point improvement, with nearly half being sustained. Corresponding worsenings were observed in 32.9%, 20.5% and 7.9% respectively, with stability in just over half (53%). Biennial findings were similar. Characteristics generally associated with improvements included: female sex, younger age, shorter disease duration, relapsing-onset and presence of moderate disability (compared with mild or advanced) and a previous episode of worsening (disassociated from a relapse). However, improvements were also observed after periods of stability and in primary-progressive MS. Conclusion: Improvements in MS disability over one or two years are not unusual. We suggest the term ‘innate improvements’. Our findings have implication for the design of clinical trials and observational studies in MS targeting improvements on the EDSS.

Download Full-text