Viral pneumonia: a new look at an old problem (review)

The relevance of pneumonia remains at the forefront and has recently attracted the attention of not only the entire medical community, but also all political and economic institutions of most countries of the planet. This nosology continues to be in the center of attention, identifying one of the key causes in the frequency of mortality of the population. The presented article accumulates the most up-to-date theses regarding viral pneumonia on the basis of a review of a large number of scientific literature, domestic and foreign studies. Although the term “viral pneumonia” has been used in medical practice for more than a century, nevertheless, there is no final diagnostic algorithm and an established final concept. The article reflects special historical medical and philosophical aspects in the study of pneumonia from the time of Hippocrates to the present. The epidemiological features, etiology, and also the terminological base of viral pneumonia are updated, thereby the concept of viral pneumonia in medical categories is fixed. A promising classification of viral pneumonia according to ICD-XI is presented. Attention is drawn to the autopsy morphological characteristics of the bronchopulmonary organ complex in viral pneumonia, post-mortem descriptions are given with links to authoritative research sources. The main modern diagnostic capabilities of the scientific medical community in the detection of pneumonia are described, the issues of the formation of new diagnostic algorithms are reflected. The clinical picture of viral pneumonia is described in detail, the clinical concept of the phase course of the disease based on pathomorphological data is presented for the first time. The main modern groups of drugs for etiotropic and pathogenetic treatment of the disease are considered. The conclusion reflects the main problematic postulates and prospects for further study of the disease.

Integrated Care Pathways and The Aortovascular Hub

Aortovascular medicine and surgery in relation to vascular health of the population requires input from a broad range of specialists and institutions throughout a patient life as well as integration with allied health care providers. This paper presents the essence of the novel clinical concept of the ‘Aortovascular Hub’ .

Gelotophobia, attitudes to illness and self-stigmatisation in patients with non-psychotic mental disorders and brain injuries

Gelotophobia, or the fear of being laughed at, has been described as an inability to enjoy humour and laughter in social interaction. A number of studies have shown its increased levels under various mental disorders. Gelotophobia in psychiatric patients may appear either as a primary syndrome, or as a secondary disorder connected to the patient’s reaction to their social position (self-stigmatization). In turn, self-stigmatization is closely related to the personality of the patient and, in particular, to their attitudes to illness. Since the fear of being laughed at has been studied within both the clinical concept and the continual model of individual differences, the question of differentiation between normal and pathological fear of being laughed at is topical, while borderline groups are of particular interest. The aim of the present study was to examine the relationship between gelotophobia, attitudes to illness, and self-stigmatization in patients with minor, non-psychotic mental disorders, as well as those with brain injuries, who also had mild mental disorders, without having the status of psychiatric patients. The sample consisted of 73 patients with non-psychotic mental disorders, and 30 patients with brain injuries. The methods used included PhoPhiKat-30, ISMI-9 (Internalized Stigma of Mental Illness Inventory), and TOBOL (Types of the Attitudes to Disease). The results revealed at least a slight level of gelotophobia in 31% patients with non-psychotic mental disorders, and 20% in those with brain injuries. Gelotophobia correlated with certain types of attitude to illness in each group. Subjects displaying high levels of gelotophobia were in general characterized by disadvantageous attitudes to illness. In the group of psychiatric patients, gelotophobia was associated with self-stigmatization, whereas in the group of neurological patients it was not. Thus, in this study gelotophobia was examined for the first time in patients with non-psychotic mental disorders, as well as in those with brain injuries. Different mechanisms of gelotophobia development were suggested for the two groups.

COHD-COVID: Columbia Open Health Data for COVID-19 Research (Preprint)

BACKGROUND The novel coronavirus disease-2019 (COVID-19) has threatened the health of tens of millions of people all over the world. Massive research efforts have been made in response to the COVID-19 pandemic. Utilization of clinical data can accelerate these research efforts to fight against the pandemic since important characteristics of the patients are often found by examining the clinical data. Publicly accessible clinical data on COVID-19, however, remain limited despite the immediate need. OBJECTIVE To provide shareable clinical data to catalyze COVID-19 research, we present Columbia Open Health Data for COVID-19 Research (COHD-COVID), a publicly accessible database providing clinical concept prevalence, clinical concept co-occurrence, and clinical symptom prevalence for hospitalized COVID-19 patients. COHD-COVID also provides data on hospitalized influenza patients and general hospitalized patients as comparator cohorts. METHODS The data used in COHD-COVID were obtained from NewYork Presbyterian Hospital/Columbia University Irving Medical Center’s electronic health records database. Condition, drug, and procedure concepts were obtained from the visits of identified patients from the cohorts. Rare concepts were excluded and the true concept counts were perturbed using Poisson randomization to protect patient privacy. Concept prevalence, concept prevalence ratio, concept co-occurrence, and symptom prevalence were calculated using the obtained concepts. RESULTS Concept prevalence and concept prevalence ratio analyses showed clinical characteristics of COVID-19 cohorts, confirming well-known conditions of COVID-19 (e.g., acute lower respiratory tract infection and cough) recorded high prevalence and high prevalence ratio in the COVID-19 cohort compared to the hospitalized influenza cohort and general hospitalized cohort. Concept co-occurrence analyses showed potential associations between specific concepts. In case of acute lower respiratory tract infection in the COVID-19 cohort, it showed high co-occurrence ratio with COVID-19 related concepts and commonly used drugs (e.g., disease due to coronavirus and acetaminophen). Symptom prevalence analysis indicated symptom-level characteristics of the cohorts confirming that well-known symptoms of COVID-19 (e.g., fever, cough, and dyspnea) showed higher prevalence than the hospitalized influenza cohort and general hospitalized cohort. CONCLUSIONS We present COHD-COVID, a publicly accessible database providing useful clinical data for hospitalized COVID-19 patients, hospitalized influenza patients, and general hospitalized patients. We expect COHD-COVID will provide researchers and clinicians quantitative measures of COVID-19 related clinical features to better understand and fight against the pandemic.

Are Absence and Limbic Seizures Mutually Exclusive?: An Experimental Approach to Enigmatic Clinical Concept

The impressive advances in the several disciplines including neurophysiology, molecular biology, neuroimmunology, neurogenetics, neuroimaging, and neuropharmacology of epilepsies have been stimulating a mutual interaction among basic scientists, clinicians, and professionals from other disciplines, leading to the identification of clinical questions and then the design of basic science paradigms to test enigmatic clinical issues. Based on a clinical observation that the coexistence of genetic (idiopathic) generalized typical absence and mesial temporal lobe epilepsy in the same patient is extremely rare and debatable, we addressed the rare coexistence in the same individual, designed an experimental approach to test the validity of this clinical concept and to study the underlying mechanisms involved. Here we presented evidence of a mutual cross-interaction in the circuits involved in typical absence and temporal lobe epilepsy. This article delineates a phenomenological picture and comprehends a theoretical understanding of a mutual cross-interaction in typical absence as a representative of genetic generalized epilepsies and limbic epilepsy in which seizures often start from the mesial temporal lobe.

Ambiguity in medical concept normalization: An analysis of types and coverage in electronic health record datasets

Objectives Normalizing mentions of medical concepts to standardized vocabularies is a fundamental component of clinical text analysis. Ambiguity—words or phrases that may refer to different concepts—has been extensively researched as part of information extraction from biomedical literature, but less is known about the types and frequency of ambiguity in clinical text. This study characterizes the distribution and distinct types of ambiguity exhibited by benchmark clinical concept normalization datasets, in order to identify directions for advancing medical concept normalization research. Materials and Methods We identified ambiguous strings in datasets derived from the 2 available clinical corpora for concept normalization and categorized the distinct types of ambiguity they exhibited. We then compared observed string ambiguity in the datasets with potential ambiguity in the Unified Medical Language System (UMLS) to assess how representative available datasets are of ambiguity in clinical language. Results We found that <15% of strings were ambiguous within the datasets, while over 50% were ambiguous in the UMLS, indicating only partial coverage of clinical ambiguity. The percentage of strings in common between any pair of datasets ranged from 2% to only 36%; of these, 40% were annotated with different sets of concepts, severely limiting generalization. Finally, we observed 12 distinct types of ambiguity, distributed unequally across the available datasets, reflecting diverse linguistic and medical phenomena. Discussion Existing datasets are not sufficient to cover the diversity of clinical concept ambiguity, limiting both training and evaluation of normalization methods for clinical text. Additionally, the UMLS offers important semantic information for building and evaluating normalization methods. Conclusions Our findings identify 3 opportunities for concept normalization research, including a need for ambiguity-specific clinical datasets and leveraging the rich semantics of the UMLS in new methods and evaluation measures for normalization.