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Latest & greatest articles for pneumonia
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Correction: Distribution and determinants of pneumonia diagnosis using integrated management of childhood illness guidelines: a nationally representative study in Malawi [This corrects the article DOI: 10.1136/bmjgh-2017-000506.].
Effects of pulmonary rehabilitation on daily life physical activity of fibrotic idiopathic interstitial pneumonia patients Fibrotic idiopathic interstitial pneumonia patients derived benefit from a pulmonary rehabilitation programme in terms of exercise tolerance, anxiety, depression and quality of life without increasing their daily life physical activity http://ow.ly/WV7U30kgNkU.
Proton-Pump Inhibitors and Long-Term Risk of Community-Acquired Pneumonia in Older Adults To estimate associations between long-term use of proton pump inhibitors (PPIs) and pneumonia incidence in older adults in primary care.Longitudinal analyses of electronic medical records.England PARTICIPANTS: Individuals aged 60 and older in primary care receiving PPIs for 1 year or longer (N=75,050) and age- and sex-matched controls (N=75,050).Net hazard ratios for pneumonia incidence in Year 2 (...) of treatment were estimated using the prior event rate ratio (PERR), which adjusts for pneumonia incidence differences before initiation of treatment. Inverse probability weighted models adjusted for 78 demographic, disease, medication, and healthcare usage measures.During the second year after initiating treatment, PPIs were associated with greater hazard of incident pneumonia (PERR-adjusted hazard ratio=1.82, 95% confidence interval=1.27-2.54), accounting for pretreatment pneumonia rates. Estimates were
Distribution and determinants of pneumonia diagnosis using Integrated Management of Childhood Illness guidelines: a nationally representative study in Malawi Pneumonia remains the leading cause of child mortality in sub-Saharan Africa. The Integrated Management of Childhood Illness (IMCI) strategy was developed to standardise care in low-income and middle-income countries for major childhood illnesses and can effectively improve healthcare worker performance. Suboptimal clinical evaluation can (...) result in missed diagnoses and excess morbidity and mortality. We estimate the sensitivity of pneumonia diagnosis and investigate its determinants among children in Malawi.Data were obtained from the 2013-2014 Service Provision Assessment survey, a census of health facilities in Malawi that included direct observation of care and re-examination of children by trained observers. We calculated sensitivity of pneumonia diagnosis and used multilevel log-binomial regression to assess factors associated
Neutrophil-to-lymphocyte Ratio Relation to Sepsis Severity Scores and Inflammatory Biomarkers in Patients with Community-acquired Pneumonia: A Case Series Neutrophil to lymphocyte ratio (NLR) as calculated from the white cell differential blood count is considered a promising marker for the prognosis of patients with various diseases, including sepsis. This study was designed to assess the possible use of neutrophil-to-lymphocyte ratio in the prediction of survival outcomes in patients (...) with community acquired pneumonia (CAP). A secondary objective was to compare the prognostic accuracy of NLR with the commonly used severity scores of sepsis SOFA, APACHE II and SAPS II.This was a retrospective study based on data extracted from 26 patients suffering from acute CAP. The study period was from February 01, 2017 until April 30, 2017. All patients with CAP were presented in the Emergency Department (ED) of the University Hospital of Patras, Greece and were treated after admission in the Internal
Translating Lung Microbiome Profiles into the Next-Generation Diagnostic Gold Standard for Pneumonia: a Clinical Investigatorâ€™s Perspective Severe bacterial pneumonia is a major global cause of morbidity and mortality, yet current diagnostic approaches rely on identification of causative pathogens by cultures, which require extended incubation periods and often fail to detect relevant pathogens. Consequently, patients are prescribed broad-spectrum antibiotics in a "one-size-fits-all" manner (...) , which may be inappropriate for their individual needs and promote antibiotic resistance. My research focuses on leveraging next-generation sequencing of microbial DNA directly from patient samples for the development of new, culture-independent definitions of pneumonia. In this perspective article, I discuss the current state of the field and focus on the conceptual and research design challenges for clinical translation. With ongoing technological advancements and application of computational
Inflammation-Based Prognostic Score Predicts Postoperative Survival of Patients with Interstitial Pneumonia After Undergoing Lung Cancer Resection Idiopathic interstitial pneumonias (IIPs) are associated with an increased risk of lung cancer. Glasgow prognostic score (GPS), which uses serum C-reactive protein (CRP) and albumin levels to indicate systemic inflammatory response and nutrition level, has been reported to be a predictor of overall survival in patients with various types of cancer (...) (p < 0.001), usual interstitial pneumonia pattern (p = 0.006), and GPS of 2 (p = 0.003) as predictive factors associated with CSS, while univariate analysis indicated pTNM (p = 0.042), GPS of 1 (p = 0.044), and %DLCO (p = 0.038) as predictive factors associated with ODSS.GPS is an independent prognostic factor of OS and RFS in lung cancer patients with IIPs undergoing a lung resection procedure. Furthermore, a GPS of 2 was found to be associated with CSS following lung cancer resection, while
Inpatient management of community-acquired pneumonia at the European Gaza Hospital: a clinical audit. Disease severity scores such as CURB-65 are often used to guide the management of patients with community-acquired pneumonia. Early and adequate empirical antibiotic treatment reduces mortality. The aim of this study was to examine the severity assessment and management of patients presenting with community-acquired pneumonia at the European Gaza Hospital in the Gaza Strip and to compare (...) this to the best available evidence.Medical records of all patients admitted to the European Gaza Hospital with a diagnosis of community-acquired pneumonia between Dec 1, 2015, and March 31, 2016, were reviewed retrospectively. Clinical practice was compared with recommendations for severity assessment and the management of community-acquired pneumonia, as reported in guidelines by the National Institute for Health and Care Excellence and the American Thoracic Society. Ethical approval was obtained from
Anesthesia Assistance in Outpatient Colonoscopy and Risk of Aspiration Pneumonia, Bowel Perforation, and Splenic Injury The increase in use of anesthesia assistance (AA) to achieve deep sedation with propofol during colonoscopy has significantly increased colonoscopy costs without evidence for increased quality and with possible harm. We investigated the effects of AA on colonoscopy complications, specifically bowel perforation, aspiration pneumonia, and splenic injury.In a population-based (...) cohort study using administrative databases, we studied adults in Ontario, Canada undergoing outpatient colonoscopy from 2005 through 2012. Patient, endoscopist, institution, and procedure factors were derived. The primary outcome was bowel perforation, defined using a validated algorithm. Secondary outcomes were splenic injury and aspiration pneumonia. Using a matched propensity score approach, we matched persons who had colonoscopy with AA (1:1) with those who did not. We used logistic regression
The Effects of Gastrointestinal Function on the Incidence of Ventilator-associated Pneumonia in Critically Ill Patients. To investigate the effect of gastrointestinal function on the incidence of ventilator-associated pneumonia (VAP) in critically ill patients.From August 2012 to June 2016, 160 critically ill patients in the ICU (Intensive Care Unit) of our hospital were selected as the research group; patients were divided equally into an observation group and a control group, 80 patients
Overview of pneumonia Overview of pneumonia - Summary of relevant conditions | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search Overview of pneumonia Last reviewed: February 2019 Last updated: June 2018 Introduction Pneumonia is inflammation of the lungs with consolidation or interstitial lung infiltrates, most often categorised according to the causative organism. Typical symptoms might include fever, cough, dyspnoea, and chest pain. Because each (...) specific type of pneumonia may result from a different aetiology and pathogenic mechanism, each subtype also has its characteristic risk factors, signs, and symptoms. Related conditions Condition Description Community-acquired pneumonia (CAP) is defined as pneumonia acquired outside hospital or healthcare facilities. Older patients in particular are often afebrile and may present with confusion and worsening of underlying diseases. The most common cause is Streptococcus pneumoniae (also known
Hospital-acquired pneumonia Hospital-acquired pneumonia - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search Hospital-acquired pneumonia Last reviewed: February 2019 Last updated: June 2018 Summary Most cases are caused by bacteria, especially aerobic gram-negative bacilli, such as Pseudomonas aeruginosa , Escherichia coli , Klebsiella pneumoniae , and Acinetobacter species. Patients with hospital-acquired pneumonia (...) . Definition Hospital-acquired pneumonia (HAP) is an acute lower respiratory tract infection that is by definition acquired after at least 48 hours of admission to hospital and is not incubating at the time of admission. Kalil AC, Metersky ML, Klompas M, et al. Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis. 2016;63:e61-e111. http
Chlamydia pneumoniae infection Chlamydia pneumoniae infection - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search Chlamydia pneumoniae infection Last reviewed: February 2019 Last updated: January 2018 Summary A bacterial respiratory pathogen that is a frequent cause of community-acquired pneumonia in children and adults. An obligate intracellular parasite that can only be isolated in tissue culture, although culture (...) is not widely available. Pneumonia due to Chlamydia pneumoniae cannot be differentiated clinically from pneumonia due to other atypical organisms, especially Mycoplasma pneumoniae . Serological diagnosis is complicated by the requirement for paired sera and the lack of FDA-approved serological assays. Treatment with macrolides, quinolones, or tetracyclines appears equally effective. Definition Chlamydia pneumoniae (an obligate intracellular bacterium) is a frequent respiratory pathogen in humans that occurs
Aspiration pneumonia Aspiration pneumonia - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search Aspiration pneumonia Last reviewed: February 2019 Last updated: January 2018 Summary Diagnosis is based on clinical signs or symptoms of pneumonia in a person with a history or risk factors for aspiration. Sputum or tracheal Gram stain reveals mixed flora. Infection usually involves the dependent lung lobe. Complications (...) of disease include lung abscess and empyema. Definition Aspiration pneumonia results from inhalation of oropharyngeal contents into the lower airways that leads to lung injury and resultant bacterial infection. It commonly occurs in patients with altered mental status who have an impaired gag or swallowing reflex. The bacteriology and presentation of aspiration pneumonia have changed over the past five decades. Older studies characterised an anaerobic pleuropulmonary syndrome, with necrotising pneumonia
Pneumocystis jirovecii pneumonia Pneumocystis jirovecii pneumonia - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search Pneumocystis jirovecii pneumonia Last reviewed: February 2019 Last updated: January 2018 Summary The organism was known formerly as Pneumocystis carinii . Still the most common AIDS-defining opportunistic infection. Suspicion for Pneumocystis pneumonia (PCP) is based on clinical signs or symptoms (...) of pneumonia in a person with immune suppression, especially when due to HIV infection. Diagnosis is made by detection of the organism in either induced sputum or bronchoalveolar lavage (BAL). The treatment of choice is trimethoprim/sulfamethoxazole (TMP/SMX). The incidence of PCP is declining with the use of combination antiretroviral therapy (ART) and PCP prophylaxis. Definition Pneumocystis pneumonia (PCP) is an infection of the lung caused by the fungal organism Pneumocystis jirovecii (formerly known
Atypical pneumonia Atypical pneumonia - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search Atypical pneumonia Last reviewed: February 2019 Last updated: May 2018 Summary Community-acquired and often seen in young adults living in close proximity. Diagnosis is mostly clinical. Molecular-based diagnosis of throat swabs or sputum can be performed. Serology can be used to confirm the diagnosis. Treatment is often outpatient (...) based with a macrolide antibiotic or doxycycline. Extrapulmonary manifestations may occur, especially in M pneumoniae infections. Definition Atypical bacterial pneumonia is caused by atypical organisms that are not detectable on Gram stain and cannot be cultured using standard methods. The most common organisms are Mycoplasma pneumoniae , Chlamydophila pneumoniae , and Legionella pneumophila . Atypical bacterial pneumonia generally is characterised by a symptom complex that includes headache, low
Community-acquired pneumonia Community-acquired pneumonia - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search Community-acquired pneumonia Last reviewed: February 2019 Last updated: February 2019 Summary Risk factors relate to environment, lifestyle factors, patient status, and comorbidities. Typically characterised by a new lung infiltrate on chest x-ray, together with one or more of the following: fever, chills, cough (...) , sputum production, dyspnoea, myalgia, arthralgia, pleuritic pain. Diagnosis should include a chest x-ray, although this has been challenged by studies using CT scanning. Initial treatment is empirical with antibiotics, following international guidelines and local epidemiology. Definition Community-acquired pneumonia (CAP) is defined as pneumonia acquired outside hospital or healthcare facilities. Clinical diagnosis is based on a group of signs and symptoms related to lower respiratory tract infection
Bronchiolitis obliterans organising pneumonia Bronchiolitis obliterans organising pneumonia - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search Bronchiolitis obliterans organising pneumonia Last reviewed: February 2019 Last updated: January 2018 Summary An inflammatory disorder involving both the peripheral bronchioles and alveoli simultaneously. It has distinctive radiographic findings, histological features (...) , and response to corticosteroids (unlike usual interstitial pneumonia). Most common type is idiopathic BOOP; other types include focal nodular, post-infection, drug-related, rheumatological, immunological, organ transplantation, radiotherapy, environmental, and miscellaneous BOOP. Accounts for 20% to 30% of all cases of chronic infiltrative lung diseases. It occurs equally among men and women, and is not related to smoking. High-resolution chest CT scan shows bilateral patchy triangular ground glass
Game Changer? How Many Days of Antibiotics is Best for Treating Community Acquired Pneumonia? Game Changer? How Many Days of Antibiotics is Best for Treating Community Acquired Pneumonia? – Clinical Correlations Search Game Changer? How Many Days of Antibiotics is Best for Treating Community Acquired Pneumonia? January 16, 2018 6 min read By Calvin Ngai, MD Peer Reviewed A 71-year-old Caucasian woman with hypertension presented with a 2-day history of productive cough and fever. She was living (...) alone and had no history of any recent hospitalizations. On examination, she was alert and oriented but slightly tachypneic; her lungs were clear to auscultation bilaterally. Laboratory tests were significant for a white blood cell count of 18,000 m L with 89% neutrophils. The chest x-ray showed a right lower lobe infiltrate. She was admitted and started on antibiotics for treatment of community acquired pneumonia (CAP). She improved clinically, and after remaining afebrile for 48 hours, she
New Sepsis Definition (Sepsis-3) and Community-acquired Pneumonia Mortality. A Validation and Clinical Decision-Making Study The Sepsis-3 Task Force updated the clinical criteria for sepsis, excluding the need for systemic inflammatory response syndrome (SIRS) criteria. The clinical implications of the proposed flowchart including the quick Sequential (Sepsis-related) Organ Failure Assessment (qSOFA) and SOFA scores are unknown.To perform a clinical decision-making analysis of Sepsis-3 (...) in patients with community-acquired pneumonia.This was a cohort study including adult patients with community-acquired pneumonia from two Spanish university hospitals. SIRS, qSOFA, the Confusion, Respiratory Rate and Blood Pressure (CRB) score, modified SOFA (mSOFA), the Confusion, Urea, Respiratory Rate, Blood Pressure and Age (CURB-65) score, and Pneumonia Severity Index (PSI) were calculated with data from the emergency department. We used decision-curve analysis to evaluate the clinical usefulness