scholarly journals Infectious Pneumonia and Lower Airway Microorganisms in Patients with Rheumatoid Arthritis

2021 ◽  
Vol 10 (16) ◽  
pp. 3552
Author(s):  
Shuhei Ideguchi ◽  
Kazuko Yamamoto ◽  
Masahiro Tahara ◽  
Tomohiro Koga ◽  
Shotaro Ide ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Decision Tree ◽  
Respiratory Tract ◽  
Lower Respiratory Tract ◽  
Performance Status ◽  
Lower Airway ◽  
Control Group ◽  
Decision Tree Analysis ◽  
Oral Flora ◽  
Tree Analysis

The relationship between microorganisms present in the lower respiratory tract and the subsequent incidence of pneumonia in patients with rheumatoid arthritis is unclear. A retrospective cohort study was designed to include a total of 121 patients with rheumatoid arthritis who underwent bronchoscopy at three hospitals between January 2008 and December 2017. Data on patient characteristics, microorganisms detected by bronchoscopy, and subsequent incidences of pneumonia were obtained from electronic medical records. Patients were divided into groups based on the microorganisms isolated from the lower respiratory tract. The cumulative incidence of pneumonia was assessed using the Kaplan–Meier method, and decision tree analysis was performed to analyze the relation between the presence of microorganisms and the occurrence of pneumonia. The most frequently isolated microbes were Pseudomonas aeruginosa, Staphylococcus aureus, and Haemophilus influenzae. Patients whose samples tested negative for bacteria or positive for normal oral flora were included in the control group. The rate of the subsequent incidence of pneumonia was higher in the P. aeruginosa group than in the control group (p = 0.026), and decision tree analysis suggested that P. aeruginosa and patient performance status were two important factors for predicting the incidence of pneumonia. In patients with rheumatoid arthritis, the presence of P. aeruginosa in the lower respiratory tract was associated with the subsequent incidence of pneumonia.

scholarly journals Pneumonia in patients with rheumatoid arthritis: effect of microbial airway colonization

2021 ◽  
Author(s):  
Shuhei Ideguchi ◽  
Kazuko Yamamoto ◽  
Masahiro Tahara ◽  
Tomohiro Koga ◽  
Shotaro Ide ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Respiratory Tract ◽  
Lower Respiratory Tract ◽  
Proportional Hazards ◽  
Patient Characteristics ◽  
Incidence Rates ◽  
Cox Proportional Hazards ◽  
Rank Test ◽  
Control Group ◽  
Kaplan Meier

Rheumatoid arthritis frequently complicates airway diseases and is associated with high rates of pneumonia and mortality. The relationship between microorganisms colonizing the lower respiratory tract and the subsequent incidence of pneumonia in patients with rheumatoid arthritis is unclear. In this study, we aimed to identify microorganisms colonizing the lower respiratory tract in patients with rheumatoid arthritis related to the risk of developing subsequent pneumonia in these patients. A retrospective cohort study was designed to include a total of 121 patients with rheumatoid arthritis (median age, 67 years; women, 78.5%) who underwent bronchoscopy at three hospitals from January 2008 to December 2017. The following information was extracted from their electronic medical records: patient characteristics, microorganisms detected by bronchoscopy, and subsequent incidences of pneumonia. The patients were divided into groups based on the microorganisms isolated from the lower respiratory tract and compared with control subjects. The cumulative incidence of pneumonia was assessed using the Kaplan-Meier method and log-rank test. Risk factors for pneumonia were analyzed using the Cox proportional-hazards analysis. The most frequently isolated microbes from the lower respiratory tract in descending order were Pseudomonas aeruginosa, Staphylococcus aureus, and Haemophilus influenzae. The annual incidence rates of pneumonia per 1000 patients were 100, 62, 132, and 38, in the P. aeruginosa, S. aureus, H. influenzae, and control group, respectively. Patients colonized with P. aeruginosa had a higher frequency of macrolide use and a higher degree of bronchiectasis than patients in the control group. The rate of the subsequent incidence of pneumonia was higher in the P. aeruginosa group (P = 0.038), and P. aeruginosa was an independent risk factor for pneumonia (hazard ratio, 3.504; 95% confidence interval, 1.153-10.330). The colonization of the lower respiratory tract by P. aeruginosa in patients with rheumatoid arthritis was associated with the subsequent incidence of pneumonia.

scholarly journals The lung microbiota in Korean patients with non-tuberculous mycobacterial pulmonary disease

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sung-Yoon Kang ◽  
Hyojung Kim ◽  
Sungwon Jung ◽  
Sang Min Lee ◽  
Sang Pyo Lee
Keyword(s):  
Principal Component Analysis ◽  
Respiratory Tract ◽  
Pulmonary Disease ◽  
Beta Diversity ◽  
Lower Respiratory Tract ◽  
Principal Component ◽  
Control Group ◽  
Flexible Bronchoscope ◽  
Bronchial Washing

Abstract Background The microbiota of the lower respiratory tract in patients with non-tuberculous mycobacterial pulmonary disease (NTM-PD) has not been fully evaluated. We explored the role of the lung microbiota in NTM-PD by analyzing protected specimen brushing (PSB) and bronchial washing samples from patients with NTM-PD obtained using a flexible bronchoscope. Results Bronchial washing and PSB samples from the NTM-PD group tended to have fewer OTUs and lower Chao1 richness values compared with those from the control group. In both bronchial washing and PSB samples, beta diversity was significantly lower in the NTM-PD group than in the control group (P = 2.25E-6 and P = 4.13E-4, respectively). Principal component analysis showed that the PSBs and bronchial washings exhibited similar patterns within each group but differed between the two groups. The volcano plots indicated differences in several phyla and genera between the two groups. Conclusions The lower respiratory tract of patients with NTM-PD has a unique microbiota distribution that is low in richness/diversity.

scholarly journals Risk of Pre-Malignancy or Malignancy in Postmenopausal Endometrial Polyps: A CHAID Decision Tree Analysis

Diagnostics ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. 1094
Author(s):  
Michael Wong ◽  
Nikolaos Thanatsis ◽  
Federica Nardelli ◽  
Tejal Amin ◽  
Davor Jurkovic
Keyword(s):  
Decision Tree ◽  
Expectant Management ◽  
Decision Tree Model ◽  
Decision Tree Analysis ◽  
Focal Lesions ◽  
Tree Model ◽  
Normal Endometrium ◽  
Endometrial Polyps ◽  
Tree Analysis ◽  
Interaction Detection

Background and aims: Postmenopausal endometrial polyps are commonly managed by surgical resection; however, expectant management may be considered for some women due to the presence of medical co-morbidities, failed hysteroscopies or patient’s preference. This study aimed to identify patient characteristics and ultrasound morphological features of polyps that could aid in the prediction of underlying pre-malignancy or malignancy in postmenopausal polyps. Methods: Women with consecutive postmenopausal polyps diagnosed on ultrasound and removed surgically were recruited between October 2015 to October 2018 prospectively. Polyps were defined on ultrasound as focal lesions with a regular outline, surrounded by normal endometrium. On Doppler examination, there was either a single feeder vessel or no detectable vascularity. Polyps were classified histologically as benign (including hyperplasia without atypia), pre-malignant (atypical hyperplasia), or malignant. A Chi-squared automatic interaction detection (CHAID) decision tree analysis was performed with a range of demographic, clinical, and ultrasound variables as independent, and the presence of pre-malignancy or malignancy in polyps as dependent variables. A 10-fold cross-validation method was used to estimate the model’s misclassification risk. Results: There were 240 women included, 181 of whom presented with postmenopausal bleeding. Their median age was 60 (range of 45–94); 18/240 (7.5%) women were diagnosed with pre-malignant or malignant polyps. In our decision tree model, the polyp mean diameter (≤13 mm or >13 mm) on ultrasound was the most important predictor of pre-malignancy or malignancy. If the tree was allowed to grow, the patient’s body mass index (BMI) and cystic/solid appearance of the polyp classified women further into low-risk (≤5%), intermediate-risk (>5%–≤20%), or high-risk (>20%) groups. Conclusions: Our decision tree model may serve as a guide to counsel women on the benefits and risks of surgery for postmenopausal endometrial polyps. It may also assist clinicians in prioritizing women for surgery according to their risk of malignancy.

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