Excess incidence and risk factors for recurrent pneumonia in bipolar disorder

Study of factors related to recurrence within 30 days after pneumonia treatment for community-onset pneumonia

INTRODUCTION

It is not uncommon for patients hospitalized with pneumonia to experience an early relapse. Here, we investigated the factors related to pneumonia recurrence in Japan.

PURPOSE

We aimed to elucidate the factors related to early recurrence after completion of pneumonia treatment.

METHODS

We examined 696 patients with community-acquired pneumonia (CAP) and nursing and healthcare-associated pneumonia (NHCAP) who were admitted to our hospital between October 2010 and February 2018, excluding those who died during hospitalization. Logistic regression analysis was used to assess the endpoint of recurrence within 30 days after the end of antibiotic treatment.

RESULTS

NHCAP, chronic lung disease and duration of antibiotic treatment were significant risk factors for recurrence of pneumonia within 30 days after antibiotic discontinuation. Aspiration pneumonia was not be a significant factor in the early recurrence of pneumonia.

CONCLUSIONS

Long-term use of antimicrobials may be a risk factor in early recurrence of pneumonia.

Excess mortality and life-years lost in people with bipolar disorder: an 11-year population-based cohort study

AIMS

Bipolar disorder is associated with premature mortality, but evidence is mostly derived from Western countries. There has been no research evaluating shortened lifespan in bipolar disorder using life-years lost (LYLs), which is a recently developed mortality metric taking into account illness onset for life expectancy estimation. The current study aimed to examine the extent of premature mortality in bipolar disorder patients relative to the general population in Hong Kong (HK) in terms of standardised mortality ratio (SMR) and excess LYLs, and changes of mortality rate over time.

METHODS

This population-based cohort study investigated excess mortality in 12 556 bipolar disorder patients between 2008 and 2018, by estimating all-cause and cause-specific SMRs, and LYLs. Trends in annual SMRs over the 11-year study period were assessed. Study data were retrieved from a territory-wide medical-record database of HK public healthcare services.

RESULTS

Patients had higher all-cause [SMR: 2.60 (95% CI: 2.45-2.76)], natural-cause [SMR: 1.90 (95% CI: 1.76-2.05)] and unnatural-cause [SMR: 8.63 (95% CI: 7.34-10.03)] mortality rates than the general population. Respiratory diseases, cardiovascular diseases and cancers accounted for the majority of deaths. Men and women with bipolar disorder had 6.78 (95% CI: 6.00-7.84) years and 7.35 (95% CI: 6.75-8.06) years of excess LYLs, respectively. The overall mortality gap remained similar over time, albeit slightly improved in men with bipolar disorder.

CONCLUSIONS

Bipolar disorder is associated with increased premature mortality and substantially reduced lifespan in a predominantly Chinese population, with excess deaths mainly attributed to natural causes. Persistent mortality gap underscores an urgent need for targeted interventions to improve physical health of patients with bipolar disorder.

Clinical efficacy enhancement of a Chinese herbal injection in the treatment of mycoplasma pneumonia in children: A protocol of randomized controlled trial

BACKGROUND

Mycoplasma pneumonia is a common disease in pediatrics, and macrolides is the first choice for the treatment. However, the increase of antibiotic resistance of macrolides makes it more and more complicated for clinical treatment. Due to the long term treatment of macrolides, it may increase the incidence of nausea, vomiting, abdominal pain, diarrhea, and other gastrointestinal symptoms, vascular phlebitis, liver and kidney function damage. Tanreqing injection, a Chinese herbal extraction injection, has advantages in the treatment of mycoplasma pneumonia in children, and it could improve the curative effect, shortening the course of disease, and reducing the side effects. Yet there is a lack of standard clinical studies to verify it, so this randomized controlled trial (RCT) will evaluate the efficacy and safety of Tanreqing injection combined with azithromycin in the treatment of mycoplasma pneumonia in children.

METHODS

This is a prospective RCT to study the efficacy and safety of Tanreqing injection combined with azithromycin in the treatment of mycoplasma pneumonia in children. It is approved by the Clinical Research Society of our hospital. According to the 1:1 ratio, the patients will be randomly divided into Tanreqing injection combined with azithromycin group (observation group) and azithromycin group (control group). Duration of hospitalization, clinical improvement 7 days after admission, changing laboratory tests, pulmonary function, immunoglobulin level, and adverse reactions will be compared between the 2 groups. The data will be analyzed by SPSS 16.0 software.

DISCUSSION

This study will evaluate the efficacy and safety of Tanreqing injection combined with azithromycin in the treatment of mycoplasma pneumonia in children. The results of this experiment will provide clinical basis for the treatment of mycoplasma pneumonia in children with Tanreqing injection combined with azithromycin.

TRIAL REGISTRATION

OSF Registration number: DOI 10.17605/OSF.IO/X6VFS.

Supportive and palliative care for people with respiratory problems and preexisting serious mental illness

PURPOSE OF REVIEW

People living with serious mental illness are at a higher risk of developing respiratory problems that can lead to increased morbidity and early mortality. This review aimed to identify recent advances in care provision for people with respiratory problems and preexisting serious mental illness to ease symptom burden and reduce the risk of premature mortality.

RECENT FINDINGS

Intervention-based studies in this area are scarce. The evidence reviewed originated from observational studies. Concluding comments from the synthesis suggest there are specific needs for proactive screening of respiratory function as part of routine physical health checks across care settings for people living with serious mental illness, more stringent monitoring of comorbid chronic lung conditions and increased attention in reducing the frequency respiratory infections. Integrated services across care settings are needed to support people with serious mental illness to limit the impact of modifiable lifestyle factors known to be detrimental to respiratory health, such as smoking.

SUMMARY

Key priorities are identified to improve accessibility and inclusivity of respiratory care pathways for people living with serious mental illness to support early detection and proactive monitoring of respiratory problems to help reduce the risk of early mortality.

Assessment of levels of D-dimer and interferon-γ in pediatric patients with Mycoplasma pneumoniae pneumonia and its clinical implication

Levels of D-dimer and interferon-γ (INF-γ) in pediatric patients with Mycoplasma pneumoniae pneumonia (MPP) were assessed to explore its clinical implication in evaluating the disease severity and patients' prognosis. Enrolled in this study as subjects were 185 pediatric patients with MPP who were admitted to the Department of Pediatrics of the Second Affiliated Hospital of Qiqihar Medical University and the First Hospital of Qiqihar City from January 2017 to October 2017 and 115 healthy children who underwent physical examination during the same time period. Patients were divided into two groups according to the severity of their pneumonia: Severe pneumonia group with 95 patients and mild pneumonia group with 90 patients. A total of 92 healthy children were assigned to the control group. Immunoassay was performed to measure the serum levels of D-dimer and INF-γ. The levels of these two markers were compared. In terms of D-dimer, the levels in pediatric patients in pneumonia groups were all higher than that in the healthy children (p<0.0001). After treatment for 120 h, the D-dimer and INF-γ levels in both pneumonia groups were lower than those before treatment (p<0.001). Among the patients in both the mild and severe pneumonia groups, those who developed extra-pulmonary complications had higher levels of D-dimer and INF-γ than those who did not developed extra-pulmonary complications (p<0.001). Increased levels of D-dimer and INF-γ were observed in pediatric patients with MPP. Assessment of the levels of D-dimer and INF-γ in serum may help with the diagnosis of severe MPP in children and predicting the occurrence of complications. This study provided more theoretical basis for the early diagnosis and identification of MPP in children, and can be used as a guideline in evaluating the severity and preventing complications.