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Quarton S, Livesey A, Jeff C, Hatton C, Scott A, Parekh D, Thickett D, McNally A, Sapey E. Metagenomics in the Diagnosis of Pneumonia: Protocol for a Systematic Review. JMIR Res Protoc 2024; 13:e57334. [PMID: 39293053 PMCID: PMC11447427 DOI: 10.2196/57334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 07/16/2024] [Accepted: 07/18/2024] [Indexed: 09/20/2024] Open
Abstract
BACKGROUND Causative pathogens are currently identified in only a minority of pneumonia cases, which affects antimicrobial stewardship. Metagenomic next-generation sequencing (mNGS) has potential to enhance pathogen detection due to its sensitivity and broad applicability. However, while studies have shown improved sensitivity compared with conventional microbiological methods for pneumonia diagnosis, it remains unclear whether this can translate into clinical benefit. Most existing studies focus on patients who are ventilated, readily allowing for analysis of bronchoalveolar lavage fluid (BALF). The impact of sample type on the use of metagenomic analysis remains poorly defined. Similarly, previous studies rarely differentiate between the types of pneumonia involved-community-acquired pneumonia (CAP), hospital-acquired pneumonia (HAP), or ventilator-associated pneumonia (VAP)-which have different clinical profiles. OBJECTIVE This study aims to determine the clinical use of mNGS in CAP, HAP, and VAP, compared with traditional microbiological methods. METHODS We aim to review all studies (excluding case reports of a series of fewer than 10 people) of adult patients with suspected or confirmed pneumonia that compare metagenomic analysis with traditional microbiology techniques, including culture, antigen-based testing, and polymerase chain reaction-based assays. Relevant studies will be identified through systematic searches of the Embase, MEDLINE, Scopus, and Cochrane CENTRAL databases. Screening of titles, abstracts, and subsequent review of eligible full texts will be done by 2 separate reviewers (SQ and 1 of AL, CJ, or CH), with a third clinician (ES) providing adjudication in case of disagreement. Our focus is on the clinical use of metagenomics for patients with CAP, HAP, and VAP. Data extracted will focus on clinically important outcomes-pathogen positivity rate, laboratory turnaround time, impact on clinical decision-making, length of stay, and 30-day mortality. Subgroup analyses will be performed based on the type of pneumonia (CAP, HAP, or VAP) and sample type used. The risk of bias will be assessed using the QUADAS-2 tool for diagnostic accuracy studies. Outcome data will be combined in a random-effects meta-analysis, and where this is not possible, a narrative synthesis will be undertaken. RESULTS The searches were completed with the assistance of a medical librarian on January 13, 2024, returning 5750 records. Screening and data extraction are anticipated to be completed by September 2024. CONCLUSIONS Despite significant promise, the impact of metagenomic analysis on clinical pathways remains unclear. Furthermore, it is unclear whether the use of this technique will alter depending on whether the pneumonia is a CAP, HAP, or VAP or the sample type that is collected. This systematic review will assess the current evidence base to support the benefit of clinical outcomes for metagenomic analysis, depending on the setting of pneumonia diagnosis or specimen type used. It will identify areas where further research is needed to advance this methodology into routine care. TRIAL REGISTRATION PROSPERO CRD42023488096; https://tinyurl.com/3suy7cma. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/57334.
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Affiliation(s)
- Samuel Quarton
- National Institute for Health Research Birmingham Biomedical Research Centre, Birmingham, United Kingdom
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
| | - Alana Livesey
- National Institute for Health Research Welcome Trust Clinical Research Facility, University Hospitals Birmingham, Birmingham, United Kingdom
| | - Charlotte Jeff
- National Institute for Health Research Birmingham Biomedical Research Centre, Birmingham, United Kingdom
| | - Christopher Hatton
- National Institute for Health Research Midlands Patient Safety Research Collaboration, University of Birmingham, Birmingham, United Kingdom
| | - Aaron Scott
- National Institute for Health Research Birmingham Biomedical Research Centre, Birmingham, United Kingdom
| | - Dhruv Parekh
- National Institute for Health Research Birmingham Biomedical Research Centre, Birmingham, United Kingdom
| | - David Thickett
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
| | - Alan McNally
- National Institute for Health Research Birmingham Biomedical Research Centre, Birmingham, United Kingdom
| | - Elizabeth Sapey
- National Institute for Health Research Birmingham Biomedical Research Centre, Birmingham, United Kingdom
- National Institute for Health Research Midlands Patient Safety Research Collaboration, University of Birmingham, Birmingham, United Kingdom
- National Institute for Health Research Midlands Applied Research Collaborative, University of Birmingham, Birmingham, United Kingdom
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Rukyaa J, Mushi MF, Silago V, Damiano P, Keenan K, Sabiiti W, Holden MTG, Seni J, Mshana SE. Etiology and antimicrobial susceptibility patterns of bacteria causing pneumonia among adult patients with signs and symptoms of lower respiratory tract infections during the COVID-19 pandemic in Mwanza, Tanzania: a cross-sectional study. Pneumonia (Nathan) 2024; 16:16. [PMID: 39232828 PMCID: PMC11375869 DOI: 10.1186/s41479-024-00137-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Accepted: 06/26/2024] [Indexed: 09/06/2024] Open
Abstract
BACKGROUND Bacterial pneumonia is among the leading causes of morbidity and mortality worldwide. The extensive misuse and overuse of antibiotics observed during the Corona Virus Disease 2019 (COVID-19) pandemic may have changed the patterns of pathogens causing bacterial pneumonia and their antibiotic susceptibility profiles. This study was designed to establish the prevalence of culture-confirmed bacterial pneumonia and describe their antimicrobial susceptibility profile in adult patients who presented with signs and symptoms of lower respiratory tract infections (LRTIs) during the COVID-19 pandemic. METHODOLOGY This hospital-based cross-sectional study was conducted from July 2021 to July 2022 at a zonal referral hospital and two district hospitals in Mwanza, Tanzania. Demographic and clinical data were collected using a standardized questionnaire. Sputum samples were processed by conventional culture followed by the identification of isolates and antibiotic susceptibility testing. Descriptive data analysis was performed using STATA version 15.0. RESULTS A total of 286 patients with a median age of 40 (IQR 29-60) years were enrolled in the study. More than half of the patients enrolled were females (52.4%, n = 150). The overall prevalence of bacterial pneumonia was 34.3% (n = 98). The majority of the bacterial pathogens isolated were Gram-negative bacteria (GNB) (61.2%, 60/98), with a predominance of Klebsiella spp., 38.8% (38/98), followed by Streptococcus pyogenes (21.4%, 21/98). Multi drug resistant (MDR) bacteria were detected in 72/98 (73.5%) of the isolates. The proportions of GNB-resistant strains were 60.0% (36/60) for ciprofloxacin, 60% (36/60) for amoxicillin, 60% (36/60) for amoxicillin, 68.3% (41/60) for trimethoprim-sulfamethoxazole and 58.3% (35/60) for ceftriaxone. CONCLUSION One-third of the patients with signs and symptoms of LRTIs had laboratory-confirmed bacterial pneumonia with a predominance of Gram negative MDR bacteria. This calls for continuous antimicrobial resistance (AMR) surveillance and antimicrobial stewardship programs in the study setting and other settings in developing countries as important strategies for tackling AMR.
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Affiliation(s)
- Johannes Rukyaa
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, P. O. Box 1464, Mwanza, Tanzania.
| | - Martha F Mushi
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, P. O. Box 1464, Mwanza, Tanzania
| | - Vitus Silago
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, P. O. Box 1464, Mwanza, Tanzania
| | - Prisca Damiano
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, P. O. Box 1464, Mwanza, Tanzania
| | - Katherine Keenan
- Division of Infection and Global Health, School of Medicine, University of St. Andrews, St. Andrews, KY16 9AL, UK
| | - Wilber Sabiiti
- Division of Infection and Global Health, School of Medicine, University of St. Andrews, St. Andrews, KY16 9AL, UK
| | - Matthew T G Holden
- Division of Infection and Global Health, School of Medicine, University of St. Andrews, St. Andrews, KY16 9AL, UK
| | - Jeremiah Seni
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, P. O. Box 1464, Mwanza, Tanzania
| | - Stephen E Mshana
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, P. O. Box 1464, Mwanza, Tanzania
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Teferi M, Addisu E, Wodajo S, Muche A, Endawekie A, Adane B, Dessie T, Kebede N. Time to recovery from severe community-acquired pneumonia and its predictors among 6 to 59 months of age children admitted to South Wollo zone public hospitals, North East Ethiopia: a prospective follow-up study. Pneumonia (Nathan) 2024; 16:14. [PMID: 39098940 PMCID: PMC11299310 DOI: 10.1186/s41479-024-00135-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 05/30/2024] [Indexed: 08/06/2024] Open
Abstract
INTRODUCTION Ethiopia is one of those countries with higher burden of community acquired pneumonia among its people, under five children are the members of society that are highly affected by pneumonia particularly Severe Community Acquired Pneumonia. However, there are limited studies on time to recovery and its predictors in under-five children and most of them are retrospective which fails to address important variables that affect the time to recovery. Therefore, the aim of this study was to estimate the median time to recovery and its predictors among under five children admitted to South Wollo zone public hospitals, North East Ethiopia. METHODS An institution-based prospective cohort study was conducted from March 10 to May 10, 2021, with 270 study subjects. A systematic random sampling technique was used. Data was collected by interview and chart review. The data were entered and analyzed using Epi Data version 3.1 and STATA version 14.0, respectively. Kaplan-Meier and Cox regression models were used to test the time and predictors of recovery from severe community-acquired pneumonia. RESULTS The overall incidence of recovery rate (95% confidence interval) from Severe Community-Acquired Pneumonia was 20.45(17.84-23.46) per 100 person days observation with median (IQR) time to recovery of [3, 5] days. The predictors of time to recovery from Severe Community-Acquired Pneumonia were having comorbidities on admission [AHR = 0.49 (95%CI: 0.32,0.75)], reaching hospitals after 5 days of onset of symptoms [AHR = 0.35 (95%CI: 0.20,0.60)], having Middle Upper Arm Circumference < = 12.5 cm [AHR = 0.21 (95%CI: 0.12,0.37)], the presence of smoker in the house [AHR = 0.21 (95%CI: 0.10,0.42)] and being not fully immunized for age [AHR = 0.35 (95%CI: 0.24,0.53)]. CONCLUSION AND RECOMMENDATIONS Generally the recovery time of children with Severe Community Acquired Pneumonia in the study area was within the recommended national standards. Due attention should be given to children with the identified predictors while treating them.
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Affiliation(s)
- Mekonnen Teferi
- Department of Biostatistics and Epidemiology, Kemisse Health Sciences College, Kemisie, Ethiopia
| | - Elsabeth Addisu
- Department of reproductive and family health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia.
| | - Shambel Wodajo
- Department of Biostatistics and Epidemiology, School of public health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Amare Muche
- Department of Biostatistics and Epidemiology, School of public health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Abel Endawekie
- Department of Biostatistics and Epidemiology, School of public health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Bezawit Adane
- Department of Biostatistics and Epidemiology, School of public health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Tilahun Dessie
- Department of Pediatrics and child health, School of Medicine, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Natnael Kebede
- Department of Health Promotion, School of public health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Howroyd F, Chacko C, MacDuff A, Gautam N, Pouchet B, Tunnicliffe B, Weblin J, Gao-Smith F, Ahmed Z, Duggal NA, Veenith T. Ventilator-associated pneumonia: pathobiological heterogeneity and diagnostic challenges. Nat Commun 2024; 15:6447. [PMID: 39085269 PMCID: PMC11291905 DOI: 10.1038/s41467-024-50805-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 07/22/2024] [Indexed: 08/02/2024] Open
Abstract
Ventilator-associated pneumonia (VAP) affects up to 20% of critically ill patients and induces significant antibiotic prescription pressure, accounting for half of all antibiotic use in the ICU. VAP significantly increases hospital length of stay and healthcare costs yet is also associated with long-term morbidity and mortality. The diagnosis of VAP continues to present challenges and pitfalls for the currently available clinical, radiological and microbiological diagnostic armamentarium. Biomarkers and artificial intelligence offer an innovative potential direction for ongoing future research. In this Review, we summarise the pathobiological heterogeneity and diagnostic challenges associated with VAP.
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Affiliation(s)
- Fiona Howroyd
- Therapy Services, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, UK.
- Institute of Inflammation and Ageing, The University of Birmingham, Edgbaston, Birmingham, UK.
| | - Cyril Chacko
- Department of Critical Care Medicine and Anaesthesia, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
- Institute of Acute Care, Royal Wolverhampton Hospital and University of Wolverhampton, Wolverhampton, UK
| | - Andrew MacDuff
- Department of Critical Care Medicine and Anaesthesia, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
- Institute of Acute Care, Royal Wolverhampton Hospital and University of Wolverhampton, Wolverhampton, UK
| | - Nandan Gautam
- Critical Care Department, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, UK
| | - Brian Pouchet
- Critical Care Department, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, UK
| | - Bill Tunnicliffe
- Critical Care Department, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, UK
| | - Jonathan Weblin
- Therapy Services, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, UK
| | - Fang Gao-Smith
- Institute of Inflammation and Ageing, The University of Birmingham, Edgbaston, Birmingham, UK
| | - Zubair Ahmed
- Institute of Inflammation and Ageing, The University of Birmingham, Edgbaston, Birmingham, UK.
| | - Niharika A Duggal
- Institute of Inflammation and Ageing, The University of Birmingham, Edgbaston, Birmingham, UK.
| | - Tonny Veenith
- Department of Critical Care Medicine and Anaesthesia, The Royal Wolverhampton NHS Trust, Wolverhampton, UK.
- Institute of Acute Care, Royal Wolverhampton Hospital and University of Wolverhampton, Wolverhampton, UK.
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Kanwal K, Asif M, Khalid SG, Liu H, Qurashi AG, Abdullah S. Current Diagnostic Techniques for Pneumonia: A Scoping Review. SENSORS (BASEL, SWITZERLAND) 2024; 24:4291. [PMID: 39001069 PMCID: PMC11244398 DOI: 10.3390/s24134291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 06/22/2024] [Accepted: 06/28/2024] [Indexed: 07/16/2024]
Abstract
Community-acquired pneumonia is one of the most lethal infectious diseases, especially for infants and the elderly. Given the variety of causative agents, the accurate early detection of pneumonia is an active research area. To the best of our knowledge, scoping reviews on diagnostic techniques for pneumonia are lacking. In this scoping review, three major electronic databases were searched and the resulting research was screened. We categorized these diagnostic techniques into four classes (i.e., lab-based methods, imaging-based techniques, acoustic-based techniques, and physiological-measurement-based techniques) and summarized their recent applications. Major research has been skewed towards imaging-based techniques, especially after COVID-19. Currently, chest X-rays and blood tests are the most common tools in the clinical setting to establish a diagnosis; however, there is a need to look for safe, non-invasive, and more rapid techniques for diagnosis. Recently, some non-invasive techniques based on wearable sensors achieved reasonable diagnostic accuracy that could open a new chapter for future applications. Consequently, further research and technology development are still needed for pneumonia diagnosis using non-invasive physiological parameters to attain a better point of care for pneumonia patients.
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Affiliation(s)
- Kehkashan Kanwal
- College of Speech, Language, and Hearing Sciences, Ziauddin University, Karachi 75000, Pakistan
| | - Muhammad Asif
- Faculty of Computing and Applied Sciences, Sir Syed University of Engineering and Technology, Karachi 75300, Pakistan
| | - Syed Ghufran Khalid
- Department of Engineering, Faculty of Science and Technology, Nottingham Trent University, Nottingham B15 3TN, UK
| | - Haipeng Liu
- Research Centre for Intelligent Healthcare, Coventry University, Coventry CV1 5FB, UK
| | | | - Saad Abdullah
- School of Innovation, Design and Engineering, Mälardalen University, 721 23 Västerås, Sweden
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Srivastava AD, Awasthi S, Jauhari S. Prevalence of persistent pneumonia among severe pneumonia and nutritional status as its associated risk factor: A prospective observational study among under-five children. J Family Med Prim Care 2024; 13:1911-1916. [PMID: 38948562 PMCID: PMC11213408 DOI: 10.4103/jfmpc.jfmpc_1480_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 12/10/2023] [Accepted: 12/12/2023] [Indexed: 07/02/2024] Open
Abstract
Background Malnourishment is a risk factor for persistent pneumonia among under-five children with severe pneumonia. This study aims to determine the prevalence of persistent pneumonia and the association between nutritional status and pneumonia severity in children under 5 years of age. Methodology A prospective observational hospital-based study was conducted in the Department of Paediatrics, King George's Medical University (KGMU) from May 2019 to April 2020 among children aged 1 month to 5 years admitted with a diagnosis of severe pneumonia. An anthropometric assessment along with general and systemic examination was conducted. Weight for age, height for age and weight for height were calculated to assess the nutritional status. Children with severe pneumonia were followed for 4-6 weeks to assess the prevalence of persistent pneumonia. Results The prevalence of persistent pneumonia was 6.8%, while 32 (31.1%) and 64 (62.1%) patients had recurrent and severe pneumonia, respectively. No statistically significant distribution was observed in age, sex, residential area, parent's education or occupation of the child. The statistically significant distribution was seen on assessing nutritional status based on weight for age, height for age and weight for height (P value- 0.001, 0.001, 0.0001). Those with weight for age ≤ 3SD were anaemics and up to 1 year of age had 5.21, 3.52 and 2.83 times more odds of having persistent pneumonia, respectively. Conclusion The prevalence of persistent pneumonia among children less than 5 years of age was 6.8%. Malnutrition can be considered a major determinant of persistent pneumonia among children under 5 years of age.
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Affiliation(s)
- Akanksha D Srivastava
- Department of Pediatrics, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Shally Awasthi
- Department of Pediatrics, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Sugandha Jauhari
- Department of Community Medicine, King George’s Medical University, Lucknow, Uttar Pradesh, India
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Tilahun M, Belete MA, Gedefie A, Debash H, Alemayehu E, Gebretsadik D, Ebrahim H, Mohammed O. Etiology of bacterial pneumonia and multi-drug resistance pattern among pneumonia suspected patients in Ethiopia: a systematic review and meta-analysis. BMC Pulm Med 2024; 24:182. [PMID: 38627640 PMCID: PMC11022327 DOI: 10.1186/s12890-024-03000-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 04/08/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Bacterial pneumonia can affect all age groups, but people with weakened immune systems, young children, and the elderly are at a higher risk. Streptococcus pneumoniae, Klebsiella pneumoniae, Haemophilus influenzae, and Pseudomonas aeruginosa are the most common causative agents of pneumonia, and they have developed high MDR in recent decades in Ethiopia. This systematic review and meta-analysis aimed to determine the pooled prevalence of bacterial pneumonia and multidrug resistance in Ethiopia. METHODS The articles were searched extensively in the electronic databases and grey literature using entry terms or phrases. Studies meeting the eligibility criteria were extracted in MS Excel and exported for statistical analysis into STATA version 14 software. The pooled prevalence of bacterial pneumonia and multidrug resistance were calculated using a random-effects model. Heterogeneity was assessed by using the I2 value. Publication bias was assessed using a funnel plot and Egger's test. A sensitivity analysis was done to assess the impact of a single study on the pooled effect size. RESULT Of the 651 studies identified, 87 were eligible for qualitative analysis, of which 11 were included in the meta-analysis consisting of 1154 isolates. The individual studies reported prevalence of bacterial pneumonia ranging from 6.19 to 46.3%. In this systematic review and metanalysis, the pooled prevalence of bacterial pneumonia in Ethiopia was 37.17% (95% CI 25.72-46.62), with substantial heterogeneity (I2 = 98.4%, p < 0.001) across the studies. The pooled prevalence of multidrug resistance in bacteria isolated from patients with pneumonia in Ethiopia was 67.73% (95% CI: 57.05-78.40). The most commonly isolated bacteria was Klebsiella pneumoniae, with pooled prevalence of 21.97% (95% CI 16.11-27.83), followed by Streptococcus pneumoniae, with pooled prevalence of 17.02% (95% CI 9.19-24.86), respectively. CONCLUSION The pooled prevalence of bacterial isolates from bacterial pneumonia and their multidrug resistance were high among Ethiopian population. The initial empirical treatment of these patients remains challenging because of the strikingly high prevalence of antimicrobial resistance.
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Affiliation(s)
- Mihret Tilahun
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia.
| | - Melaku Ashagrie Belete
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Alemu Gedefie
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Habtu Debash
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Ermiyas Alemayehu
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Daniel Gebretsadik
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Hussein Ebrahim
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Ousman Mohammed
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Darkwah S, Kotey FCN, Ahenkorah J, Adutwum-Ofosu KK, Donkor ES. Sepsis-Related Lung Injury and the Complication of Extrapulmonary Pneumococcal Pneumonia. Diseases 2024; 12:72. [PMID: 38667530 PMCID: PMC11049144 DOI: 10.3390/diseases12040072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 11/18/2023] [Accepted: 11/26/2023] [Indexed: 04/28/2024] Open
Abstract
Globally, sepsis and pneumonia account for significant mortality and morbidity. A complex interplay of immune-molecular pathways underlies both sepsis and pneumonia, resulting in similar and overlapping disease characteristics. Sepsis could result from unmanaged pneumonia. Similarly, sepsis patients have pneumonia as a common complication in the intensive care unit. A significant percentage of pneumonia is misdiagnosed as septic shock. Therefore, our knowledge of the clinical relationship between pneumonia and sepsis is imperative to the proper management of these syndromes. Regarding pathogenesis and etiology, pneumococcus is one of the leading pathogens implicated in both pneumonia and sepsis syndromes. Growing evidence suggests that pneumococcal pneumonia can potentially disseminate and consequently induce systemic inflammation and severe sepsis. Streptococcus pneumoniae could potentially exploit the function of dendritic cells (DCs) to facilitate bacterial dissemination. This highlights the importance of pathogen-immune cell crosstalk in the pathophysiology of sepsis and pneumonia. The role of DCs in pneumococcal infections and sepsis is not well understood. Therefore, studying the immunologic crosstalk between pneumococcus and host immune mediators is crucial to elucidating the pathophysiology of pneumonia-induced lung injury and sepsis. This knowledge would help mitigate clinical diagnosis and management challenges.
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Affiliation(s)
- Samuel Darkwah
- Department of Medical Microbiology, University of Ghana Medical School, Accra P.O. Box KB 4236, Ghana; (F.C.N.K.); (E.S.D.)
| | - Fleischer C. N. Kotey
- Department of Medical Microbiology, University of Ghana Medical School, Accra P.O. Box KB 4236, Ghana; (F.C.N.K.); (E.S.D.)
| | - John Ahenkorah
- Department of Anatomy, University of Ghana Medical School, Accra P.O. Box KB 4236, Ghana; (J.A.); (K.K.A.-O.)
| | - Kevin Kofi Adutwum-Ofosu
- Department of Anatomy, University of Ghana Medical School, Accra P.O. Box KB 4236, Ghana; (J.A.); (K.K.A.-O.)
| | - Eric S. Donkor
- Department of Medical Microbiology, University of Ghana Medical School, Accra P.O. Box KB 4236, Ghana; (F.C.N.K.); (E.S.D.)
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9
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M S, Vaithilingan S. Childhood Pneumonia in Low- and Middle-Income Countries: A Systematic Review of Prevalence, Risk Factors, and Healthcare-Seeking Behaviors. Cureus 2024; 16:e57636. [PMID: 38586234 PMCID: PMC10998654 DOI: 10.7759/cureus.57636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 04/04/2024] [Indexed: 04/09/2024] Open
Abstract
Childhood pneumonia is a major contributor to illness and death in children under the age of five globally. Despite advancements in medical science, the burden of pediatric community-acquired pneumonia (CAP) remains high, particularly in low- and middle-income countries. This systematic review aims to synthesize existing literature on the prevalence, risk factors, and healthcare-seeking behaviors associated with pediatric CAP to inform the development of targeted community-based interventions. An extensive search of various databases such as Medline, EMBASE, Web of Science, Cochrane, PubMed, PubMed Central, Helinet, SpringerLink, Google Scholar, and Biomed Central was performed, resulting in 65 potentially relevant studies. After a thorough evaluation process, 25 studies were selected for the final analysis. These selected studies offered valuable information on the epidemiology, risk factors, and healthcare-seeking behaviors associated with childhood pneumonia. The review revealed that environmental factors such as indoor air pollution, overcrowding, and exposure to tobacco smoke are significant risk factors for pediatric pneumonia. Additionally, socioeconomic factors, including poverty and a lack of access to clean water and sanitation, contribute to the vulnerability of children to this disease. Poor healthcare-seeking behaviors, driven by limited knowledge and awareness of pneumonia symptoms and treatment, further exacerbate the situation. The review also highlighted the critical role of vaccination, particularly against Haemophilus influenzae type b (Hib) and pneumococcus, in preventing pneumonia. However, gaps in vaccination coverage and challenges in accessing healthcare services remain barriers to effective pneumonia control. In light of these findings, the review recommends the implementation of community-based interventions that address the multifaceted determinants of pediatric pneumonia. These interventions should focus on improving environmental conditions, enhancing access to preventive measures such as vaccination, and promoting better healthcare-seeking behaviors through education and awareness campaigns. It is essential for healthcare providers, policymakers, and community members to collaborate in developing and implementing culturally appropriate and sustainable interventions. This cooperation aims to lessen the impact of pneumonia on children and their families.
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Affiliation(s)
- Selvi M
- Community Health Nursing Department, Vinayaka Mission's Research Foundation, Salem, IND
| | - Sasi Vaithilingan
- Community Health Nursing Department, Vinayaka Mission's College of Nursing, Puducherry, IND
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Diboue Betote PH, Del Florence Ndedi Moni E, Matchuenkam SRG, Beack SSB, Fifen R, Ouedraogo R, Agbor GA, Semde R, Nnanga N, Nyegue MA. Sex-dependent vulnerability for Wistar rats model following intranasal instillation with Klebsiella pneumoniae ATCC 43816 causing lobar pneumonia. Pneumonia (Nathan) 2024; 16:5. [PMID: 38523293 PMCID: PMC10962189 DOI: 10.1186/s41479-024-00126-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 02/19/2024] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND Klebsiella pneumoniae has become one of the major threats to public health as it causes nosocomial and community-acquired infections like lobar pneumonia. This infection causes acute inflammation in the lung, characterized by the recruitment of polymorphonuclear cells, generating free radicals, and decreasing the endogenous antioxidant balance system. Many experimental studies have focused on the induction, progression and resolution of infection up to its peak, but these documented processes remain highly random and their sex dependence un-elicited. These fluctuations of physiopathological parameters would impact disease progression depending on the animal's model and bacterial strain used. The present study investigated the sex-dependent vulnerability of Wistar rats to K. pneumoniae ATCC 43816 lobar pneumonia induced by the intranasal instillation method. METHODS Experimental pneumonia was induced by K. pneumoniae ATCC 43816 in male and female Wistar rats following intranasal instillation. The physiopathogenesis of the disease was studied by bacteriological and histopathological exams, histomorphometric analysis of the blood and/or lung tissue, and body weight loss in infected animals. In addition, the overall severity of lesions was determined by the total score obtained by averaging the individual scores from the same group of animals. RESULTS The K. pneumoniae ATCC 43816 strain showed inoculation dose-, incubation time of the disease- and sex-dependent- differences in its ability to induce lobar pneumonia. Evaluation of different parameters showed that the disease peaked on day 15 post-inoculation, with more pathogenic effects on female rats. This observed sex-dependence difference in Wistar rats was mainly highlighted by the determined lethal dose 50 (LD50), bacterial load count in whole blood and lung tissues, body weight loss, inflammatory granulomas forming and diffuse alveolar damages. The pathogenicity was confirmed by scoring the severity of pathologic lesions of lung tissues. CONCLUSIONS The results obtained highlighted the gender-dependency in the physiopathogenesis processes of K. pneumoniae ATCC 43816 induced-lobar pneumonia, in Wistar rats. Female Wistar rats' susceptibility is useful in studying pathology and in preclinical trial investigations of new treatments for infectious pneumonia.
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Affiliation(s)
- Patrick Hervé Diboue Betote
- Laboratory of Drug Development, Centre for Training, Research and Expertise in Drug Sciences, Doctoral School of Sciences and Health, University Joseph Ki-Zerbo, Ouagadougou, Burkina Faso.
- Laboratory of Pharmacology and Drugs Discovery, Centre for Research On Medicinal Plants and Traditional Medicine, Institute of Medical Research and Medicinal Plants Studies, Yaoundé, Cameroon.
- Department of Microbiology, Faculty of Science, University of Yaoundé I, Yaoundé, Cameroon.
- Department of Galenical Pharmacy and Pharmaceutical Law, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.
| | | | - Sonia Raïssa Gayap Matchuenkam
- Laboratory of Pharmacology and Drugs Discovery, Centre for Research On Medicinal Plants and Traditional Medicine, Institute of Medical Research and Medicinal Plants Studies, Yaoundé, Cameroon
| | - Sandrine Suzanne Bayengue Beack
- Laboratory of Pharmacology and Drugs Discovery, Centre for Research On Medicinal Plants and Traditional Medicine, Institute of Medical Research and Medicinal Plants Studies, Yaoundé, Cameroon
- Department of Food Sciences and Technology, Faculty of Agriculture and Veterinary Medicine, University of Buea, Buea, Cameroon
| | - Rodrigue Fifen
- Department of Animal Biology and Physiology, Faculty of Science, University of Yaoundé I, Yaoundé, Cameroon
| | - Raogo Ouedraogo
- Laboratory of Drug Development, Centre for Training, Research and Expertise in Drug Sciences, Doctoral School of Sciences and Health, University Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
| | - Gabriel A Agbor
- Laboratory of Pharmacology and Drugs Discovery, Centre for Research On Medicinal Plants and Traditional Medicine, Institute of Medical Research and Medicinal Plants Studies, Yaoundé, Cameroon
| | - Rasmané Semde
- Laboratory of Drug Development, Centre for Training, Research and Expertise in Drug Sciences, Doctoral School of Sciences and Health, University Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
| | - Nga Nnanga
- Department of Galenical Pharmacy and Pharmaceutical Law, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
- Laboratory of Pharmaceutical Technology, Centre for Research On Medicinal Plants and Traditional Medicine, Institute of Medical Research and Medicinal Plants Studies, Yaoundé, Cameroon
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11
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Zhu Q, Che P, Li M, Guo W, Ye K, Yin W, Chu D, Wang X, Li S. Artificial intelligence for segmentation and classification of lobar, lobular, and interstitial pneumonia using case-specific CT information. Quant Imaging Med Surg 2024; 14:579-591. [PMID: 38223078 PMCID: PMC10784088 DOI: 10.21037/qims-23-945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 11/14/2023] [Indexed: 01/16/2024]
Abstract
Background Pneumonia can be anatomically classified into lobar, lobular, and interstitial types, with each type associated with different pathogens. Utilizing artificial intelligence (AI) to determine the anatomical classifications of pneumonia and assist in refining the differential diagnosis may offer a more viable and clinically relevant solution. This study aimed to develop a multi-classification model capable of identifying the occurrence of pneumonia in patients by utilizing case-specific computed tomography (CT) information, categorizing the pneumonia type (lobar, lobular, and interstitial pneumonia), and performing segmentation of the associated lesions. Methods A total of 61 lobar pneumonia patients, 60 lobular pneumonia patients, and 60 interstitial pneumonia patients were consecutively enrolled at our local hospital from June 2020 and May 2022. All selected cases were divided into a training cohort (n=135) and an independent testing cohort (n=46). To generate the ground truth labels for the training process, manual segmentation and labeling were performed by three junior radiologists. Subsequently, the segmentations were manually reviewed and edited by a senior radiologist. AI models were developed to automatically segment the infected lung regions and classify the pneumonia. The accuracy of pneumonia lesion segmentation was analyzed and evaluated using the Dice coefficient. Receiver operating characteristic curves were plotted, and the area under the curve (AUC), accuracy, precision, sensitivity, and specificity were calculated to assess the efficacy of pneumonia classification. Results Our AI model achieved a Dice coefficient of 0.743 [95% confidence interval (CI): 0.657-0.826] for lesion segmentation in the training set and 0.723 (95% CI: 0.602-0.845) in the test set. In the test set, our model achieved an accuracy of 0.927 (95% CI: 0.876-0.978), precision of 0.889 (95% CI: 0.827-0.951), sensitivity of 0.889 (95% CI: 0.827-0.951), specificity of 0.946 (95% CI: 0.902-0.990), and AUC of 0.989 (95% CI: 0.969-1.000) for pneumonia classification. We trained the model using labels annotated by senior physicians and compared it to a model trained using labels annotated by junior physicians. The Dice coefficient of the model's segmentation improved by 0.014, increasing from 0.709 (95% CI: 0.589-0.830) to 0.723 (95% CI: 0.602-0.845), and the AUC improved by 0.042, rising from 0.947 to 0.989. Conclusions Our study presents a robust multi-task learning model with substantial promise in enhancing the segmentation and classification of pneumonia in medical imaging.
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Affiliation(s)
- Qiao Zhu
- Department of Radiology, the Third Hospital of Peking University, Beijing, China
| | - Peishuai Che
- School of Information and Communication Engineering, Beijing University of Posts and Telecommunications, Beijing, China
| | - Meijiao Li
- Department of Radiology, the Third Hospital of Peking University, Beijing, China
| | - Wei Guo
- Department of Radiology, the Third Hospital of Peking University, Beijing, China
| | - Kai Ye
- Department of Radiology, the Third Hospital of Peking University, Beijing, China
| | - Wenyu Yin
- School of Information and Communication Engineering, Beijing University of Posts and Telecommunications, Beijing, China
| | - Dongheng Chu
- School of Information and Communication Engineering, Beijing University of Posts and Telecommunications, Beijing, China
| | - Xiaohua Wang
- Department of Radiology, the Third Hospital of Peking University, Beijing, China
| | - Shufang Li
- School of Information and Communication Engineering, Beijing University of Posts and Telecommunications, Beijing, China
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12
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Pei G, Liu R, Wang L, He C, Fu C, Wei Q. Monocyte to high-density lipoprotein ratio is associated with mortality in patients with coronary artery diseases. BMC Cardiovasc Disord 2023; 23:451. [PMID: 37697241 PMCID: PMC10496218 DOI: 10.1186/s12872-023-03461-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 08/19/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Whether the monocyte to high-density lipoprotein ratio (MHR) is associated with the prognosis of coronary artery disease (CAD) is inconclusive. METHODS Patients with CAD were enrolled and their data were collected. Blood was sampled within 24 h after admission. Multivariate Cox regression analysis was performed to determine the relationship between the MHR and all-cause mortality as well as complications during hospitalization. RESULTS We included 5371 patients in our cohort study. Among them, 114 (2.12%) patients died in hospital. MHR was independently associated with all-cause mortality (hazard ratio [HR], 1.81; 95% confidence interval [CI] 1.35, 2.42), cardiovascular mortality (1.69; 1.17, 2.45) and non-cardiovascular mortality (2.04; 1.27, 3.28). This association was only observed in patients with hypertension (P for interaction = 0.003). Patients with higher MHR levels also have a higher risk of complications, including infection, pneumonia, electrolyte disturbance, gastrointestinal bleeding, multiple organ dysfunction syndrome, and disturbance of consciousness. The receiver operating characteristic (ROC) analysis showed that the MHR had higher prognostic values than monocytes and high-density lipoprotein. CONCLUSION MHR was an independent predictor of all-cause mortality and in-hospital complications in patients with CAD, especially in patients with hypertension.
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Affiliation(s)
- Gaiqin Pei
- Department of Rehabilitation Medicine and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, China
| | - Rui Liu
- Department of Rehabilitation Medicine and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, China
| | - Lu Wang
- Department of Rehabilitation Medicine and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, China
| | - Chengqi He
- Department of Rehabilitation Medicine and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, China
| | - Chenying Fu
- West China Hospital, National Clinical Research Center for Geriatrics, Sichuan University, Chengdu, Sichuan, China.
- Aging and Geriatric Mechanism Laboratory, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Quan Wei
- Department of Rehabilitation Medicine and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China.
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, China.
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McClure JA, Walser E, Allen L, Vinden C, Jones PM, Dubois L, Vogt K. Defining major surgical complications using administrative data in Ontario: a validation study. Can J Surg 2023; 66:E378-E383. [PMID: 37442584 PMCID: PMC10355995 DOI: 10.1503/cjs.013922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Although surgical complications are often included as an outcome of surgical research conducted using administrative data, little validation work has been performed. We sought to evaluate the diagnostic performance of an algorithm designed to capture major surgical complications using health administrative data. METHODS This retrospective study included patients who underwent high-risk elective general surgery at a single institution in Ontario, Canada, from Sept. 1, 2016, to Sept. 1, 2017. Patients were identified for inclusion using the local operative database. Medical records were reviewed by trained clinicians to abstract postoperative complications. Data were linked to administrative data holdings, and a series of code-based algorithms were applied to capture a composite indicator of major surgical complications. We used sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy to evaluate the performance of our administrative data algorithm, as compared with data abstracted from the institutional charting system. RESULTS The study included a total of 270 patients. According to the data from the chart audit, 55% of patients experienced at least 1 major surgical complication. Overall sensitivity, specificity, PPV, NPV and accuracy for the composite outcome was 72%, 80%, 82%, 70% and 76%, respectively. Diagnostic performance was poor for several of the individual complications. CONCLUSION Our results showed that administrative data holdings can be used to capture a composite indicator of major surgical complications with adequate sensitivity and specificity. Additional work is required to identify suitable algorithms for several specific complications.
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Affiliation(s)
- J Andrew McClure
- London Health Sciences Centre, London, Ont. (McClure, Walser, Allen, Vinden, Jones, Dubois, Vogt); ICES Western, London, Ont. (McClure, Vinden, Jones, Dubois); Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont. (Walser, Vinden, Dubois, Vogt); Department of Anesthesia & Perioperative Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ont. (Jones); Department of Epidemiology & Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ont. (Jones, Dubois)
| | - Eric Walser
- London Health Sciences Centre, London, Ont. (McClure, Walser, Allen, Vinden, Jones, Dubois, Vogt); ICES Western, London, Ont. (McClure, Vinden, Jones, Dubois); Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont. (Walser, Vinden, Dubois, Vogt); Department of Anesthesia & Perioperative Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ont. (Jones); Department of Epidemiology & Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ont. (Jones, Dubois)
| | - Laura Allen
- London Health Sciences Centre, London, Ont. (McClure, Walser, Allen, Vinden, Jones, Dubois, Vogt); ICES Western, London, Ont. (McClure, Vinden, Jones, Dubois); Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont. (Walser, Vinden, Dubois, Vogt); Department of Anesthesia & Perioperative Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ont. (Jones); Department of Epidemiology & Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ont. (Jones, Dubois)
| | - Chris Vinden
- London Health Sciences Centre, London, Ont. (McClure, Walser, Allen, Vinden, Jones, Dubois, Vogt); ICES Western, London, Ont. (McClure, Vinden, Jones, Dubois); Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont. (Walser, Vinden, Dubois, Vogt); Department of Anesthesia & Perioperative Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ont. (Jones); Department of Epidemiology & Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ont. (Jones, Dubois)
| | - Philip M Jones
- London Health Sciences Centre, London, Ont. (McClure, Walser, Allen, Vinden, Jones, Dubois, Vogt); ICES Western, London, Ont. (McClure, Vinden, Jones, Dubois); Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont. (Walser, Vinden, Dubois, Vogt); Department of Anesthesia & Perioperative Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ont. (Jones); Department of Epidemiology & Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ont. (Jones, Dubois)
| | - Luc Dubois
- London Health Sciences Centre, London, Ont. (McClure, Walser, Allen, Vinden, Jones, Dubois, Vogt); ICES Western, London, Ont. (McClure, Vinden, Jones, Dubois); Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont. (Walser, Vinden, Dubois, Vogt); Department of Anesthesia & Perioperative Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ont. (Jones); Department of Epidemiology & Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ont. (Jones, Dubois)
| | - Kelly Vogt
- London Health Sciences Centre, London, Ont. (McClure, Walser, Allen, Vinden, Jones, Dubois, Vogt); ICES Western, London, Ont. (McClure, Vinden, Jones, Dubois); Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont. (Walser, Vinden, Dubois, Vogt); Department of Anesthesia & Perioperative Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ont. (Jones); Department of Epidemiology & Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ont. (Jones, Dubois)
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Negsso A, Arega B, Abdissa F, Zewdu B, Teshome A, Minda A, Agunie A. Effect of COVID-19 pandemic on the incidence of acute diarrheal disease and pneumonia among under 5 children in Ethiopia- A database study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0000304. [PMID: 37315030 DOI: 10.1371/journal.pgph.0000304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 05/05/2023] [Indexed: 06/16/2023]
Abstract
COVID-19 has had a devastating impact on preventable and treatable pediatric diseases in Ethiopia. This study looks at the impact of COVID-19 on pneumonia and acute diarrheal diseases in the country, as well as the differences between administrative regions. In Ethiopia, we conducted a retrospective pre-post study to assess the impact of COVID-19 on children under the age of five who had acute diarrhea and pneumonia and were treated in health facilities during the pre-COVID-19 era (March 2019 to February 2020) and the COVID-19 era (March 2020 to February 2021). From the National Health Management District Health Information System (DHIS2, HMIS), we retrieved data on total acute diarrheal disease and pneumonia, along with their regional and monthly distribution. We calculated incidence rate ratios comparing the rates of acute diarrhea and pneumonia during the pre-and post-COVID-19 eras and adjusted for the year, using Poisson regression. The number of under-five children treated for acute pneumonia decreased from 2,448,882 before COVID-19 to 2,089,542 ((14.7% reduction (95%CI;8.72-21.28), p<0.001)) during COVID-19. Similarly, the number of under-five children treated for acute diarrheal disease decreased from 3,287,850 in pre-COVID-19 to, 2,961,771((9.91% reduction (95%CI;6.3-17.6%),p<0.001)) during COVID-19. In the majority of the administrative regions studied, pneumonia and acute diarrhea diseases decreased during COVID-19, but they increased in Gambella, Somalia, and Afar. During the COVID-19 period, the greatest reduction of children with pneumonia (54%) and diarrhea disease (37.3%) was found in Addis Ababa (p<0.001). The majority of administrative regions included in this study have seen a decrease in pneumonia and acute diarrheal diseases among children under the age of five, while three regions namely, Somalia, Gambela, and Afar saw an increase in cases during the pandemic. This emphasizes the importance of using tailored approaches in mitigating the impact of infectious diseases such as diarrhea and pneumonia during situations of a pandemic such as COVID-19.
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Affiliation(s)
| | - Balew Arega
- Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia
| | - Fekadu Abdissa
- Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia
| | - Brook Zewdu
- Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia
| | | | - Abrham Minda
- Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia
| | - Asnake Agunie
- Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia
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15
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Lee S, Kim M, Ahn BJ, Jang Y. Odorant-responsive biological receptors and electronic noses for volatile organic compounds with aldehyde for human health and diseases: A perspective review. JOURNAL OF HAZARDOUS MATERIALS 2023; 455:131555. [PMID: 37156042 DOI: 10.1016/j.jhazmat.2023.131555] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/19/2023] [Accepted: 05/01/2023] [Indexed: 05/10/2023]
Abstract
Volatile organic compounds (VOCs) are gaseous chemicals found in ambient air and exhaled breath. In particular, highly reactive aldehydes are frequently found in polluted air and have been linked to various diseases. Thus, extensive studies have been carried out to elucidate disease-specific aldehydes released from the body to develop potential biomarkers for diagnostic purposes. Mammals possess innate sensory systems, such as receptors and ion channels, to detect these VOCs and maintain physiological homeostasis. Recently, electronic biosensors such as the electronic nose have been developed for disease diagnosis. This review aims to present an overview of natural sensory receptors that can detect reactive aldehydes, as well as electronic noses that have the potential to diagnose certain diseases. In this regard, this review focuses on eight aldehydes that are well-defined as biomarkers in human health and disease. It offers insights into the biological aspects and technological advances in detecting aldehyde-containing VOCs. Therefore, this review will aid in understanding the role of aldehyde-containing VOCs in human health and disease and the technological advances for improved diagnosis.
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Affiliation(s)
- Solpa Lee
- Department of Medical and Digital Engineering, College of Engineering, Hanyang University, Seoul 04736, South Korea
| | - Minwoo Kim
- Department of Medical and Digital Engineering, College of Engineering, Hanyang University, Seoul 04736, South Korea
| | - Bum Ju Ahn
- Department of Pharmacology, College of Medicine, Hanyang University, Seoul 04736, South Korea
| | - Yongwoo Jang
- Department of Medical and Digital Engineering, College of Engineering, Hanyang University, Seoul 04736, South Korea; Department of Pharmacology, College of Medicine, Hanyang University, Seoul 04736, South Korea.
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Lidetu T, Muluneh EK, Wassie GT. Incidence and Predictors of Aspiration Pneumonia Among Stroke Patients in Western Amhara Region, North-West Ethiopia: A Retrospective Follow Up Study. Int J Gen Med 2023; 16:1303-1315. [PMID: 37089139 PMCID: PMC10115200 DOI: 10.2147/ijgm.s400420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 04/12/2023] [Indexed: 04/25/2023] Open
Abstract
Background Aspiration pneumonia is one of the major complications among hospitalized stroke patients, with global incidence ranging from 5-83% and hospital mortality rate of up to 70%. This study aimed to assess the incidence and identify predictors of aspiration pneumonia among stroke patients in Western Amhara region, North-West Ethiopia. Methods An institution-based retrospective follow-up study was conducted on a simple random sample of 568 stroke patients in Western Amhara region admitted at Felege Hiwot Referral Hospital. Log binomial regression model, a generalized linear model with log link, was applied to identify significant predictors of aspiration pneumonia. Results Cumulative incidence of aspiration pneumonia among the 568 sampled patients was 23.06%. Males were 1.71 times more at risk to acquire aspiration pneumonia than females (ARR = 1.71, 95% CI 1.07-2.74). Patients with vomiting and dysphagia were at more risk of acquiring aspiration pneumonia as compared with patients without vomiting and dysphagia (ARR = 1.81, 95% CI 1.04-3.14 and ARR = 1.95, 95% CI 1.10-3.48, respectively). Patients who received antibiotic prophylaxis and patients with Glasgow Coma Scale greater than 12 had less risk of acquiring aspiration pneumonia as compared with those who did not receive antibiotic prophylaxis and patients with Glasgow Coma Scale less than 8 (ARR = 0.10, 95% CI 0.04-0.28 and ARR = 0.45, 95% CI 0.22-0.94, respectively). Conclusion The cumulative incidence of aspiration pneumonia among sampled patients was 23.06%. Vomiting, dysphagia, antibiotic treatment and Glasgow Coma Scale showed significant correlation with the acquiring of aspiration pneumonia. Therefore, we recommend health-care providers should give special attention for patients with these risk factors to prevent aspiration pneumonia.
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Affiliation(s)
- Tadios Lidetu
- School of Public Health, Bahir Dar University, Bahir Dar, Ethiopia
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Cabreja-Castillo M, Hernandez L, Mustafa A, Hungria G, Bertoli MT. COVID-19 Scientific Literacy in Medical and Nursing Students. JOURNAL OF MICROBIOLOGY & BIOLOGY EDUCATION 2023; 24:00219-22. [PMID: 37089217 PMCID: PMC10117070 DOI: 10.1128/jmbe.00219-22] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 02/23/2023] [Indexed: 05/03/2023]
Abstract
The pandemic brought a whole newfound collection of words into our everyday language, some of which had been terms that were infrequently used outside academic and medical settings. However, as familiar as this new pandemic vocabulary has become, there are still several terms that often get mixed in everyday conversations, media communications, and even in the medical field. Some of these terms are often mistaken, which may lead to issues in the understanding of important concepts. Science communication, as a facet of scientific literacy, intends to educate people in an easy-to-understand manner, and this communication is even more important in health care, when a literate patient's medical decisions depend frequently on this process. In this article, we explore the use and misuse of some of the most common terms utilized during the 2019 coronavirus disease (COVID-19) pandemic by nursing and medical students, i.e., future health care professionals, in the hospital environment. This single-center hospital-based cross-sectional study, performed throughout September 2022, included 30 medical and nursing students. All participants completed a self-administered 15-item anonymous questionnaire at a single time point. Nine multiple-choice questions evaluated knowledge, diagnosis, disease manifestations, and vaccines related to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. Six questions provided demographics and quality assessment information. The analysis of the answers indicated that for at least 75% of the population surveyed, COVID-19 literacy was better for terms related to technology and actions (3/5 questions answered correctly) than for terms related to the disease (1/4 questions answered correctly). The overall median score for questions 1 to 9 was 4.5 of 9 points in total. Based on the results, the language used in the questionnaire was considered easy to understand, with an easy to medium level of complexity, and the perceived time required to complete the questionnaire was less than 5 min. In conclusion, our results showed that efforts need to be made in continuous professional education to increase the knowledge in COVID-19 literacy in the health care environment for medical and nursing students. Larger studies are recommended to identify and to fulfill the challenges that COVID-19 brought to medical and nursing education.
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Affiliation(s)
| | - Leislany Hernandez
- Family Medicine Residency Program, Keralty Hospital Miami, Miami, Florida, USA
| | - Alicia Mustafa
- Keralty Research Center, Keralty Hospital Miami, Miami, Florida, USA
| | - Gregory Hungria
- Keralty Research Center, Keralty Hospital Miami, Miami, Florida, USA
| | - Maria T. Bertoli
- Keralty Research Center, Keralty Hospital Miami, Miami, Florida, USA
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Dykes JKB, Lawton A, Burchett S, Gupta A. Fifteen-minute consultation: A structured approach to children with parapneumonic effusion and empyema thoracis. Arch Dis Child Educ Pract Ed 2023; 108:86-90. [PMID: 34772669 DOI: 10.1136/archdischild-2021-322621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 10/29/2021] [Indexed: 11/04/2022]
Abstract
Parapneumonic effusion is defined as the accumulation of pleural fluid associated with lung infection/pneumonia. Parapneumonic effusions can be uncomplicated or complicated. They are caused by the spread of infection and inflammation to the pleural space, and can develop into empyema thoracis-frank pus in the pleural space. Chest radiograph and thoracic ultrasound are the key imaging modalities for the diagnosis of parapneumonic effusion. Management aims are reducing inflammation and bacteria in the pleural cavity, and enabling full lung expansion. Broad-spectrum intravenous antibiotics, with the addition of chest tube drainage and fibrinolytic therapy for larger collections, are the mainstays of management. This article provides a clear, evidence-based and structured approach to the assessment and management of parapneumonic effusion/empyema thoracis in children and young people.
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Affiliation(s)
- Joanna Kirstin B Dykes
- Paediatric Respiratory Medicine, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- South Bristol Academy, University of Bristol Faculty of Health Sciences, Bristol, UK
| | - Adam Lawton
- Department of Paediatrics, North Middlesex University Hospital NHS Trust, London, UK
| | - Saskia Burchett
- Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - Atul Gupta
- Respiratory Pediatrics, King's College Hospital NHS Foundation Trust, London, UK
- Faculty of Life Sciences and Medicine, King's College London, London, UK
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19
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Thorkildsen MS, Laugsand LE, Nilsen TIL, Mohus RM, Høvik LH, Rogne T, Solligård E, Damås JK, Gustad LT. Insomnia symptoms and risk of bloodstream infections: prospective data from the prospective population-based Nord-Trøndelag Health Study (HUNT), Norway. J Sleep Res 2023; 32:e13696. [PMID: 36068650 PMCID: PMC10078600 DOI: 10.1111/jsr.13696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/14/2022] [Accepted: 06/28/2022] [Indexed: 02/03/2023]
Abstract
Previous research suggests decreased immune function and increased risk of infections in individuals with insomnia. We examined the effect of insomnia symptoms on risk of bloodstream infections (BSIs) and BSI-related mortality in a population-based prospective study. A total of 53,536 participants in the second Norwegian Nord-Trøndelag Health Study (HUNT2) (1995-97) were linked to prospective data on clinically relevant BSIs until 2011. In Cox regression, we estimated hazard ratios (HRs) with 95% confidence intervals (CIs) for a first-time BSI and for BSI-related mortality (BSI registered ≤30 days prior to death) associated with insomnia symptoms. Compared with participants who reported "no symptoms", participants reporting having "difficulty initiating sleep" (DIS) often/almost every night had a HR for a first-time BSI of 1.14 (95% CI 0.96-1.34). Participants reporting "difficulties maintaining sleep" (DMS) often/almost every night had a HR of 1.19 (95% CI 1.01-1.40), whereas those having a feeling of "non-restorative sleep" once a week or more had a HR of 1.23 (95% CI 1.04-1.46). Participants frequently experiencing all three of the above symptoms had a HR of 1.39 (1.04-1.87), whilst those who had both DIS and DMS had a HR of 1.15 (0.93-1.41) and being troubled by insomnia symptoms to a degree that affected work performance was associated with a HR of 1.41 (95% CI 1.08-1.84). The HRs for BSI-related mortality suggest an increased risk with increasing insomnia symptoms, but the CIs are wide and inconclusive. We found that frequent insomnia symptoms and insomnia symptoms that affected work performance were associated with a weak positive increased risk of BSI.
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Affiliation(s)
- Marianne S. Thorkildsen
- Gemini Center for Sepsis Research at Institute of Circulation and Medical ImagingNorwegian University of Science and Technology (NTNU)TrondheimNorway
| | - Lars E. Laugsand
- Clinic of Emergency and Prehospital CareSt. Olavs hospitalTrondheimNorway
- Department of Circulation and Medical ImagingNTNUTrondheimNorway
| | - Tom I. L. Nilsen
- Clinic of Anaesthesia and Intensive CareSt. Olavs HospitalTrondheimNorway
- Department of Public Health and NursingNTNUTrondheimNorway
| | - Randi M. Mohus
- Gemini Center for Sepsis Research at Institute of Circulation and Medical ImagingNorwegian University of Science and Technology (NTNU)TrondheimNorway
- Clinic of Anaesthesia and Intensive CareSt. Olavs HospitalTrondheimNorway
| | - Lise H. Høvik
- Gemini Center for Sepsis Research at Institute of Circulation and Medical ImagingNorwegian University of Science and Technology (NTNU)TrondheimNorway
- Clinic of Anaesthesia and Intensive CareSt. Olavs HospitalTrondheimNorway
| | - Tormod Rogne
- Gemini Center for Sepsis Research at Institute of Circulation and Medical ImagingNorwegian University of Science and Technology (NTNU)TrondheimNorway
- Department of Chronic Disease EpidemiologyYale University School of Public HealthNew HavenConnecticutUSA
- Centre for Fertility and HealthNorwegian Institute of Public HealthOsloNorway
| | - Erik Solligård
- Gemini Center for Sepsis Research at Institute of Circulation and Medical ImagingNorwegian University of Science and Technology (NTNU)TrondheimNorway
- Clinic of Anaesthesia and Intensive CareSt. Olavs HospitalTrondheimNorway
| | - Jan K. Damås
- Gemini Center for Sepsis Research at Institute of Circulation and Medical ImagingNorwegian University of Science and Technology (NTNU)TrondheimNorway
- Centre of Molecular Inflammation ResearchNTNUTrondheimNorway
- Department of Clinical and Molecular MedicineNTNUTrondheimNorway
- Department of Infectious DiseasesSt. Olavs HospitalTrondheimNorway
| | - Lise T. Gustad
- Gemini Center for Sepsis Research at Institute of Circulation and Medical ImagingNorwegian University of Science and Technology (NTNU)TrondheimNorway
- Faculty of Nursing and Health SciencesNord UniversityLevangerNorway
- Department of Medicine and Rehabilitation, Levanger HospitalNord‐Trøndelag Hospital TrustLevangerNorway
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20
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Wang W, Liu S, Xu H, Deng L. COVIDX-LwNet: A Lightweight Network Ensemble Model for the Detection of COVID-19 Based on Chest X-ray Images. SENSORS (BASEL, SWITZERLAND) 2022; 22:8578. [PMID: 36366277 PMCID: PMC9655773 DOI: 10.3390/s22218578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/02/2022] [Accepted: 11/03/2022] [Indexed: 06/16/2023]
Abstract
Recently, the COVID-19 pandemic coronavirus has put a lot of pressure on health systems around the world. One of the most common ways to detect COVID-19 is to use chest X-ray images, which have the advantage of being cheap and fast. However, in the early days of the COVID-19 outbreak, most studies applied pretrained convolutional neural network (CNN) models, and the features produced by the last convolutional layer were directly passed into the classification head. In this study, the proposed ensemble model consists of three lightweight networks, Xception, MobileNetV2 and NasNetMobile as three original feature extractors, and then three base classifiers are obtained by adding the coordinated attention module, LSTM and a new classification head to the original feature extractors. The classification results from the three base classifiers are then fused by a confidence fusion method. Three publicly available chest X-ray datasets for COVID-19 testing were considered, with ternary (COVID-19, normal and other pneumonia) and quaternary (COVID-19, normal) analyses performed on the first two datasets, bacterial pneumonia and viral pneumonia classification, and achieved high accuracy rates of 95.56% and 91.20%, respectively. The third dataset was used to compare the performance of the model compared to other models and the generalization ability on different datasets. We performed a thorough ablation study on the first dataset to understand the impact of each proposed component. Finally, we also performed visualizations. These saliency maps not only explain key prediction decisions of the model, but also help radiologists locate areas of infection. Through extensive experiments, it was finally found that the results obtained by the proposed method are comparable to the state-of-the-art methods.
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Affiliation(s)
| | - Shuxian Liu
- School of Information Science and Engineering, Xinjiang University, Urumqi 830017, China
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21
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Jin L, Zhang Y, Yang J, Zhou H, Jia G, He Y, Wan H. Investigation of Pharmacological Mechanisms of Yinhua Pinggan Granule on the Treatment of Pneumonia through Network Pharmacology and In Vitro. BIOMED RESEARCH INTERNATIONAL 2022; 2022:1602447. [PMID: 36389108 PMCID: PMC9646329 DOI: 10.1155/2022/1602447] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 10/08/2022] [Accepted: 10/17/2022] [Indexed: 10/20/2023]
Abstract
Yinhua pinggan granule (YHPGKL), a traditional Chinese medical compound, could treat pneumonia. Although previous studies demonstrated the protective and therapeutic effects of YHPGKL on pneumonia, its potential molecular mechanisms and its effective components are still elusive. Herein, we performed a network pharmacology analysis to determine the possible signaling pathways involved in the protective effects of components of YHPGKL. A total of 119 components and 257 target proteins of YHPGKL were identified, among which 117 effective components interacted with 113 proteins related to pneumonia. Then, a compound-effective component-target protein network was established to screen the effective hub components. The top three effective components, namely luteolin, kaempferol, and quercetin, were selected. Moreover, Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis of 113 proteins revealed a significant enrichment term associated with host immune and anti-infectious responses. Furthermore, by constructing a protein-protein interaction network between common proteins, ten hub proteins were identified, among which three hub components hit eight proteins. A further molecular docking analysis confirmed that the three effective hub components had a good affinity with six hub proteins. Eventually, the interactions were further visualized and screened on account of an infectious macrophage model in vitro. The results noted that three components could inhibit proinflammatory related hub genes but had no effect on survival-related hub genes. Thus, the three effective hub components and corresponding hub genes may play essential roles in the treatment of YHPGKL on pneumonia.
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Affiliation(s)
- Liang Jin
- School of Life Science, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yumei Zhang
- Department of Oncology, Shanghai East Hospital, School of Medicine, Tongji University, China
| | - Jiehong Yang
- College of Basic Medical Science, Zhejiang Chinese Medical University, Hangzhou, China
| | - Huifen Zhou
- School of Life Science, Zhejiang Chinese Medical University, Hangzhou, China
| | - Gaozhi Jia
- National & Local Joint Engineering Research Center of Orthopedic Biomaterials, Peking University Shenzhen Hospital, Shenzhen, China
| | - Yu He
- College of Pharmaceutical Science, Zhejiang Chinese Medical University, Hangzhou, China
| | - Haitong Wan
- School of Life Science, Zhejiang Chinese Medical University, Hangzhou, China
- College of Basic Medical Science, Zhejiang Chinese Medical University, Hangzhou, China
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22
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Admas M, Teshome M, Petrucka P, Telayneh AT, Alamirew NM. In-hospital mortality and its predictors among adult stroke patients admitted in Debre Markos Comprehensive Specialized Hospital, Northwest Ethiopia. SAGE Open Med 2022; 10:20503121221122465. [PMID: 36093420 PMCID: PMC9459489 DOI: 10.1177/20503121221122465] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 08/05/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction Stroke is the second-leading global cause of death next to ischemic heart disease. The burden of stroke mortality, morbidity, and disability is increasing across the world. In Ethiopia, evidence on the survival status of adult stroke patients is insufficient. The purpose of this study is to estimate in-hospital mortality and its predictors among adult stroke patients. Methods Institution-based retrospective follow-up study was conducted on adult stroke patients who were admitted to Debre Markos Comprehensive Specialized Hospital from 1 November 2015 to 31 October 2020. Through simple random sampling, 382 patient charts were selected from 1125 stroke patients for 5 years follow-up period. Data were entered using EpiData™ version 4.1 and exported to Stata/SE™ version 14 for cleaning, coding, categorizing, and analysis. Predictor variables were selected using 95% confidence interval with a corresponding adjusted hazard ratio. Results In this study, 219 (57.33%) males and the mean (standard deviation) age of 57.65 ± 14.3 years. The in-hospital mortality rate of stroke was 12.8%; the median (interquartile range) time to mortality and Glasgow Coma Scale were 7 (4-13) days and 14 (11-15), respectively. The incidence of in-hospital mortality was 29/1000, 11/1000, 8/1000, and 13.6/1000 person-days in the first, second, third, and end of follow-up weeks, respectively. Pneumonia (adjusted hazard ratio = 3.51 (95% confidence interval = 1.86, 6.61)), hemorrhagic stroke (adjusted hazard ratio = 2.03 (95% confidence interval = 1.03, 3.99)), moderate impairment Glasgow Coma Scale (9-12) (adjusted hazard ratio = 2.16 (95% confidence interval = 1.08, 4.29)), severe impairment Glasgow Coma Scale (3-8) (adjusted hazard ratio = 2.38 (95% confidence interval = 1.01, 5.67)), history of hypertension (adjusted hazard ratio = 2.01 (95% confidence interval = 1.08, 3.74)), and increased intracranial pressure (adjusted hazard ratio = 2.12 (95% confidence interval = 1.10, 4.07)) were statistically significant predictors for in-hospital mortality. Conclusion In-hospital mortality of stroke was relatively high, and the median time to mortality was 8 days. Pneumonia, hemorrhagic stroke, Glasgow Coma Scale, history of hypertension, and increased intracranial pressure were identified predictors.
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Affiliation(s)
- Maru Admas
- Debre Markos Comprehensive Specialized Hospital, Debre Markos, Ethiopia
| | - Muluken Teshome
- Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Pammla Petrucka
- College of Nursing, University of Saskatchewan, Saskatoon, SK, Canada.,School of Life Sciences and Bioengineering, Nelson Mandela African Institute of Science and Technology, Arusha, Tanzania
| | - Animut Takele Telayneh
- Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Nakachew Mekonnen Alamirew
- Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
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23
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B.K. RK, Shrestha S, Adhikari S, Maharjan S. Pneumonia among Children Admitted to the Department of Medicine in a Tertiary Care Centre: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc 2022; 60:785-788. [PMID: 36705121 PMCID: PMC9794941 DOI: 10.31729/jnma.7859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION Pneumonia is one of the most common infectious causes of death in children around the world, accounting for 14% of all deaths of children under five years of age. The study aimed to find out the prevalence of pneumonia among children admitted to the Department of Medicine of a tertiary care hospital. METHODS A descriptive cross-sectional study was conducted in the Department of Medicine of paediatrics tertiary care centre from 1 July 2021 to 30 June 2022 among children aged 2-59 months. Ethical approval was obtained from the Institutional Review Committee (Reference number: 94). Convenience sampling method was used. Data were collected from hospital records during the study period. Point estimate and 95% Confidence Interval were calculated. RESULTS Among 385 children, pneumonia was seen in 76 (19.74%) (15.76-23.72, 95% Confidence Interval) children. A total of 30 (39.47%) patients were in the age group of 2-11 months, 52 (68.42%) were males, 38 (50%) required O2 supplementation, 26 (34.21%) required transfer to the Intensive Care Unit, and 53 (69.74%) patients stayed for <7 days in the hospital. CONCLUSIONS The prevalence of pneumonia in children admitted to the Department of Medicine was found to be higher than similar studies conducted in similar settings, with higher prevalence in young infants and the male sex than other age groups and genders, respectively.
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Affiliation(s)
- Raj Kumar B.K.
- Kanti Children Hospital, Maharajgunj, Kathmandu, Nepal,Correspondence: Dr Raj Kumar B.K., Kanti Children Hospital, Maharajgunj, Kathmandu, Nepal. , Phone: +977-9858047111
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24
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Karpiel I, Starcevic A, Urzeniczok M. Database and AI Diagnostic Tools Improve Understanding of Lung Damage, Correlation of Pulmonary Disease and Brain Damage in COVID-19. SENSORS (BASEL, SWITZERLAND) 2022; 22:s22166312. [PMID: 36016071 PMCID: PMC9414394 DOI: 10.3390/s22166312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/17/2022] [Accepted: 08/18/2022] [Indexed: 05/02/2023]
Abstract
The COVID-19 pandemic caused a sharp increase in the interest in artificial intelligence (AI) as a tool supporting the work of doctors in difficult conditions and providing early detection of the implications of the disease. Recent studies have shown that AI has been successfully applied in the healthcare sector. The objective of this paper is to perform a systematic review to summarize the electroencephalogram (EEG) findings in patients with coronavirus disease (COVID-19) and databases and tools used in artificial intelligence algorithms, supporting the diagnosis and correlation between lung disease and brain damage, and lung damage. Available search tools containing scientific publications, such as PubMed and Google Scholar, were comprehensively evaluated and searched with open databases and tools used in AI algorithms. This work aimed to collect papers from the period of January 2019-May 2022 including in their resources the database from which data necessary for further development of algorithms supporting the diagnosis of the respiratory system can be downloaded and the correlation between lung disease and brain damage can be evaluated. The 10 articles which show the most interesting AI algorithms, trained by using open databases and associated with lung diseases, were included for review with 12 articles related to EEGs, which have/or may be related with lung diseases.
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Affiliation(s)
- Ilona Karpiel
- Łukasiewicz Research Network—Institute of Medical Technology and Equipment, 41-800 Zabrze, Poland
- Correspondence:
| | - Ana Starcevic
- Laboratory for Multimodal Neuroimaging, Institute of Anatomy, Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia
| | - Mirella Urzeniczok
- Łukasiewicz Research Network—Institute of Medical Technology and Equipment, 41-800 Zabrze, Poland
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25
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Sharma A, Singh K, Koundal D. A novel fusion based convolutional neural network approach for classification of COVID-19 from chest X-ray images. Biomed Signal Process Control 2022; 77:103778. [PMID: 35530169 PMCID: PMC9057938 DOI: 10.1016/j.bspc.2022.103778] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 04/09/2022] [Accepted: 04/27/2022] [Indexed: 01/31/2023]
Abstract
Coronavirus disease is a viral infection caused by a novel coronavirus (CoV) which was first identified in the city of Wuhan, China somewhere in the early December 2019. It affects the human respiratory system by causing respiratory infections with symptoms (mild to severe) like fever, cough, and weakness but can further lead to other serious diseases and has resulted in millions of deaths until now. Therefore, an accurate diagnosis for such types of diseases is highly needful for the current healthcare system. In this paper, a state of the art deep learning method is described. We propose COVDC-Net, a Deep Convolutional Network-based classification method which is capable of identifying SARS-CoV-2 infected amongst healthy and/or pneumonia patients from their chest X-ray images. The proposed method uses two modified pre-trained models (on ImageNet) namely MobileNetV2 and VGG16 without their classifier layers and fuses the two models using the Confidence fusion method to achieve better classification accuracy on the two currently publicly available datasets. It is observed through exhaustive experiments that the proposed method achieved an overall classification accuracy of 96.48% for 3-class (COVID-19, Normal and Pneumonia) classification tasks. For 4-class classification (COVID-19, Normal, Pneumonia Viral, and Pneumonia Bacterial) COVDC-Net method delivered 90.22% accuracy. The experimental results demonstrate that the proposed COVDC-Net method has shown better overall classification accuracy as compared to the existing deep learning methods proposed for the same task in the current COVID-19 pandemic.
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Affiliation(s)
- Anubhav Sharma
- Computer Science and Engineering Department, Thapar Institute of Engineering and Technology, Patiala, Punjab, India
| | - Karamjeet Singh
- Computer Science and Engineering Department, Thapar Institute of Engineering and Technology, Patiala, Punjab, India
| | - Deepika Koundal
- Department of Virtualization, School of Computer Science, University of Petroleum & Energy Studies, Dehradun, Uttrakhand, India
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26
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Padinharayil H, Varghese J, John MC, Rajanikant GK, Wilson CM, Al-Yozbaki M, Renu K, Dewanjee S, Sanyal R, Dey A, Mukherjee AG, Wanjari UR, Gopalakrishnan AV, George A. Non-small cell lung carcinoma (NSCLC): Implications on molecular pathology and advances in early diagnostics and therapeutics. Genes Dis 2022. [DOI: 10.1016/j.gendis.2022.07.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
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27
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Guin D, Yadav S, Singh P, Singh P, Thakran S, Kukal S, Kanojia N, Paul PR, Pattnaik B, Sardana V, Grover S, Hasija Y, Saso L, Agrawal A, Kukreti R. Human genetic factors associated with pneumonia risk, a cue for COVID-19 susceptibility. INFECTION, GENETICS AND EVOLUTION 2022; 102:105299. [PMID: 35545162 PMCID: PMC9080029 DOI: 10.1016/j.meegid.2022.105299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 03/30/2022] [Accepted: 05/02/2022] [Indexed: 01/08/2023]
Abstract
Pneumonia, an acute respiratory tract infection, is one of the major causes of mortality worldwide. Depending on the site of acquisition, pneumonia can be community acquired pneumonia (CAP) or nosocomial pneumonia (NP). The risk of pneumonia, is partially driven by host genetics. CYP1A1 is a widely studied pulmonary CYP family gene primarily expressed in peripheral airway epithelium. The CYP1A1 genetic variants, included in this study, alter the gene activity and are known to contribute in lung inflammation, which may cause pneumonia pathogenesis. In this study, we performed a meta-analysis to establish the possible contribution of CYP1A1 gene, and its three variants (rs2606345, rs1048943 and rs4646903) towards the genetic etiology of pneumonia risk. Using PRISMA guidelines, we systematically reviewed and meta-analysed case-control studies, evaluating risk of pneumonia in patients carrying the risk alleles of CYP1A1 variants. Heterogeneity across the studies was evaluated using I2 statistics. Based on heterogeneity, a random-effect (using maximum likelihood) or fixed-effect (using inverse variance) model was applied to estimate the effect size. Pooled odds ratio (OR) was calculated to estimate the overall effect of the risk allele association with pneumonia susceptibility. Egger's regression test and funnel plot were used to assess publication bias. Subgroup analysis was performed based on pneumonia type (CAP and NP), population, as well as age group. A total of ten articles were identified as eligible studies, which included 3049 cases and 2249 healthy controls. The meta-analysis findings revealed CYP1A1 variants, rs2606345 [T vs G; OR = 1.12 (0.75–1.50); p = 0.02; I2 = 84.89%], and rs1048943 [G vs T; OR = 1.19 (0.76–1.61); p = 0.02; I2 = 0.00%] as risk markers whereas rs4646903 showed no statistical significance for susceptibility to pneumonia. On subgroup analysis, both the genetic variants showed significant association with CAP but not with NP. We additionally performed a spatial analysis to identify the key factors possibly explaining the variability across countries in the prevalence of the coronavirus disease 2019 (COVID-19), a viral pneumonia. We observed a significant association between the risk allele of rs2606345 and rs1048943, with a higher COVID-19 prevalence worldwide, providing us important links in understanding the variability in COVID-19 prevalence.
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28
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Reay WR, Geaghan MP, Cairns MJ. The genetic architecture of pneumonia susceptibility implicates mucin biology and a relationship with psychiatric illness. Nat Commun 2022; 13:3756. [PMID: 35768473 PMCID: PMC9243103 DOI: 10.1038/s41467-022-31473-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 06/17/2022] [Indexed: 01/25/2023] Open
Abstract
Pneumonia remains one of the leading causes of death worldwide. In this study, we use genome-wide meta-analysis of lifetime pneumonia diagnosis (N = 391,044) to identify four association signals outside of the previously implicated major histocompatibility complex region. Integrative analyses and finemapping of these signals support clinically tractable targets, including the mucin MUC5AC and tumour necrosis factor receptor superfamily member TNFRSF1A. Moreover, we demonstrate widespread evidence of genetic overlap with pneumonia susceptibility across the human phenome, including particularly significant correlations with psychiatric phenotypes that remain significant after testing differing phenotype definitions for pneumonia or genetically conditioning on smoking behaviour. Finally, we show how polygenic risk could be utilised for precision treatment formulation or drug repurposing through pneumonia risk scores constructed using variants mapped to pathways with known drug targets. In summary, we provide insights into the genetic architecture of pneumonia susceptibility and genetics informed targets for drug development or repositioning.
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Affiliation(s)
- William R Reay
- School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, 2308, Australia
- Precision Medicine Program, Hunter Medical Research Institute, Newcastle, NSW, 2305, Australia
| | - Michael P Geaghan
- School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, 2308, Australia
- Precision Medicine Program, Hunter Medical Research Institute, Newcastle, NSW, 2305, Australia
| | - Murray J Cairns
- School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, 2308, Australia.
- Precision Medicine Program, Hunter Medical Research Institute, Newcastle, NSW, 2305, Australia.
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29
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Kim T, Yeo HJ, Jang JH, Kim D, Jeon D, Kim YS, Cho WH. Prognostic impact of preoperative respiratory colonization on early-onset pneumonia after lung transplantation. J Thorac Dis 2022; 14:1900-1908. [PMID: 35813721 PMCID: PMC9264098 DOI: 10.21037/jtd-21-1724] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 04/29/2022] [Indexed: 11/15/2022]
Abstract
Background The number of lung transplantation procedures is rapidly increasing worldwide. Little is known about the effect of perioperative respiratory microbial colonization on pneumonia during lung transplantation. We evaluated the microbiome composition and incidence of early pneumonia in patients undergoing lung transplantation. We investigated factors related to post-transplant pneumonia (PTP) after lung transplantation. Methods A retrospective analysis of patients subjected to lung transplantation between May 2013 and December 2019 was performed. Perioperative microbial colonization, and its relationship with early pneumonia, were examined in specimens from bronchial washing, bronchoalveolar lavage, and sputum aspiration before and after surgery. One-year mortality, as the primary outcome, was analyzed using the Kaplan-Meier curve model. Results Among 76 patients who underwent lung transplantation, 34 donors (44.7%) and 28 recipients (36.8%) showed positive respiratory cultures with respect to preoperative respiratory colonization. A separate analysis of donors and recipients showed that 42 donors and 48 recipients were in respiratory non-colonized state, and 28 (53.8%) donors and 36 (69.2%) recipients survived 1 year after lung transplantation. Acinectobacter baumannii was the most common respiratory multidrug-resistant (MDR) pathogen. PTP was significantly lower in the survivor group (38.5% vs. 70.8%, P=0.009). Out of the recipients with preoperative respiratory colonization, 57.1% survived 1 year after lung transplantation. Patients with PTP had significantly higher 1-year mortality than those without PTP (P=0.009). Preoperative respiratory colonization of the recipients (P=0.010) and PTP patients (P=0.005) was associated with high 1-year mortality rate. Perioperative respiratory colonization of donors was not associated with the incidence of PTP and 1-year survival. Conclusions Perioperative colonization of recipients was a powerful predictive factor for PTP, which was associated with 1-year mortality in patients subjected to lung transplantation. Our results suggest that donor acceptance criteria may change to better address potential shortages in organ donation.
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Affiliation(s)
- Taehwa Kim
- Division of Pulmonology, Allergy and Critical Care Medicine, Research Institute for Convergence of Biomedical Science and Technology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hye Ju Yeo
- Division of Pulmonology, Allergy and Critical Care Medicine, Research Institute for Convergence of Biomedical Science and Technology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jin Ho Jang
- Division of Pulmonology, Allergy and Critical Care Medicine, Research Institute for Convergence of Biomedical Science and Technology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Dohyung Kim
- Department of Cardiovascular and Thoracic Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea.,Department of Internal Medicine, School of Medicine, Pusan National University, Pusan, Korea
| | - Doosoo Jeon
- Division of Pulmonology, Allergy and Critical Care Medicine, Research Institute for Convergence of Biomedical Science and Technology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea.,Department of Internal Medicine, School of Medicine, Pusan National University, Pusan, Korea
| | - Yun Seong Kim
- Division of Pulmonology, Allergy and Critical Care Medicine, Research Institute for Convergence of Biomedical Science and Technology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea.,Department of Internal Medicine, School of Medicine, Pusan National University, Pusan, Korea
| | - Woo Hyun Cho
- Division of Pulmonology, Allergy and Critical Care Medicine, Research Institute for Convergence of Biomedical Science and Technology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea.,Department of Internal Medicine, School of Medicine, Pusan National University, Pusan, Korea
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Hu S, Zhu Y, Dong D, Wang B, Zhou Z, Wang C, Tian J, Peng Y. Chest Radiographs Using a Context-Fusion Convolution Neural Network (CNN): Can It Distinguish the Etiology of Community-Acquired Pneumonia (CAP) in Children? J Digit Imaging 2022; 35:1079-1090. [PMID: 35585465 PMCID: PMC9116701 DOI: 10.1007/s10278-021-00543-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/02/2021] [Accepted: 11/11/2021] [Indexed: 11/25/2022] Open
Abstract
Clinical symptoms and inflammatory markers cannot reliably distinguish the etiology of CAP, and chest radiographs have abundant information related with CAP. Hence, we developed a context-fusion convolution neural network (CNN) to explore the application of chest radiographs to distinguish the etiology of CAP in children. This retrospective study included 1769 cases of pediatric pneumonia (viral pneumonia, n = 487; bacterial pneumonia, n = 496; and mycoplasma pneumonia, n = 786). The chest radiographs of the first examination, C-reactive protein (CRP), and white blood cell (WBC) were collected for analysis. All patients were stochastically divided into training, validation, and test cohorts in a 7:1:2 ratio. Automatic lung segmentation and hand-crafted pneumonia lesion segmentation were performed, from which three image-based models including a full-lung model, a local-lesion model, and a context-fusion model were built; two clinical characteristics were used to build a clinical model, while a logistic regression model combined the best CNN model and two clinical characteristics. Our experiments showed that the context-fusion model which integrated the features of the full-lung and local-lesion had better performance than the full-lung model and local-lesion model. The context-fusion model had area under curves of 0.86, 0.88, and 0.93 in identifying viral, bacterial, and mycoplasma pneumonia on the test cohort respectively. The addition of clinical characteristics to the context-fusion model obtained slight improvement. Mycoplasma pneumonia was more easily identified compared with the other two types. Using chest radiographs, we developed a context-fusion CNN model with good performance for noninvasively diagnosing the etiology of community-acquired pneumonia in children, which would help improve early diagnosis and treatment.
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Affiliation(s)
- Shasha Hu
- Department of Radiology, National Center for Children' Health, Beijing Children's Hospital, Capital Medical University, Beijing, 100045, China
| | - Yongbei Zhu
- CAS Key Laboratory of Molecular Imaging, State Key Laboratory of Management and Control for Complex Systems, Beijing Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beihang University, Beijing, 100191, China
| | - Di Dong
- CAS Key Laboratory of Molecular Imaging, State Key Laboratory of Management and Control for Complex Systems, Beijing Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China
- School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Bei Wang
- Department of Radiology, National Center for Children' Health, Beijing Children's Hospital, Capital Medical University, Beijing, 100045, China
| | - Zuofu Zhou
- Department of Radiology, Fujian Provincial Maternity and Children's Hospital, Fujian Medical University, Fuzhou, 350000, China
| | - Chi Wang
- Department of Radiology, National Center for Children' Health, Beijing Children's Hospital, Capital Medical University, Beijing, 100045, China
| | - Jie Tian
- CAS Key Laboratory of Molecular Imaging, State Key Laboratory of Management and Control for Complex Systems, Beijing Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China.
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beihang University, Beijing, 100191, China.
| | - Yun Peng
- Department of Radiology, National Center for Children' Health, Beijing Children's Hospital, Capital Medical University, Beijing, 100045, China.
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Assefa M. Multi-drug resistant gram-negative bacterial pneumonia: etiology, risk factors, and drug resistance patterns. Pneumonia (Nathan) 2022; 14:4. [PMID: 35509063 PMCID: PMC9069761 DOI: 10.1186/s41479-022-00096-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 04/11/2022] [Indexed: 12/27/2022] Open
Abstract
Bacterial pneumonia is one of the most serious public health issues owing to its medical and economic costs, which result in increased morbidity and mortality in people of all ages around the world. Furthermore, antimicrobial resistance has risen over time, and the advent of multi-drug resistance in GNB complicates therapy and has a detrimental impact on patient outcomes. The current review aimed to summarize bacterial pneumonia with an emphasis on gram-negative etiology, pathogenesis, risk factors, resistance mechanisms, treatment updates, and vaccine concerns to tackle the problem before it causes a serious consequence. In conclusion, the global prevalence of GNB in CAP was reported 49.7% to 83.1%, whereas in VAP patients ranged between 76.13% to 95.3%. The most commonly reported MDR-GNB causes of pneumonia were A. baumannii, K. pneumoniae, and P. aeruginosa, with A. baumannii isolated particularly in VAP patients and the elderly. In most studies, ampicillin, tetracyclines, amoxicillin-clavulanic acid, cephalosporins, and carbapenems were shown to be highly resistant. Prior MDR-GNB infection, older age, previous use of broad-spectrum antibiotics, high frequency of local antibiotic resistance, prolonged hospital stays, ICU admission, mechanical ventilation, and immunosuppression are associated with the MDR-GNB colonization. S. maltophilia was reported as a severe cause of HAP/VAP in patients with mechanically ventilated and having hematologic malignancy due to its ability of biofilm formation, site adhesion in respiratory devices, and its intrinsic and acquired drug resistance mechanisms. Effective combination therapies targeting PDR strains and drug-resistant genes, antibiofilm agents, gene-based vaccinations, and pathogen-specific lymphocytes should be developed in the future.
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Affiliation(s)
- Muluneh Assefa
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, P.O. Box 196, Gondar, Ethiopia.
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Ho CY, Chin SC, Wang YC, Chen SL. Factors affecting patients with concurrent deep neck infection and aspiration pneumonia. Am J Otolaryngol 2022; 43:103463. [PMID: 35417839 DOI: 10.1016/j.amjoto.2022.103463] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 04/04/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Deep neck infection (DNI) is a life-threatening condition of the deep neck spaces with potential to obstruct the airway. Aspiration pneumonia (AP), which results from aspiration of colonized oropharyngeal or upper gastrointestinal contents, is a respiratory infection that affects the lungs, wherein the air sacs are filled with purulent fluid. The cooccurrence of these two diseases can cause severe damage to the respiratory system, leading to morbidity and mortality. However, the risk factors for concurrent DNI and AP have not yet been investigated. This study aimed to address this issue. METHODS A total of 561 DNI patients were enrolled in this study between June 2016 and December 2021. Among these patients, 26 had concurrent DNI and AP at the time of diagnosis. Relevant clinical variables were assessed. RESULTS In the univariate analysis, age > 60 years (OR = 3.593, 95% CI: 1.534-8.414, p = 0.002), C-reactive protein (OR = 1.005, 95% CI: 1.001-1.008, p = 0.003), involvement of ≥3 spaces (OR = 4.969, 95% CI: 2.051-12.03, p < 0.001), and retropharyngeal space involvement (OR = 4.546, 95% CI: 1.878-11.00, p < 0.001) were significant risk factors for concurrent DNI and AP. In the multivariate analysis, age > 60 years (OR = 2.766, 95% CI: 1.142-6.696, p = 0.024) and retropharyngeal space involvement (OR = 3.006, 95% CI: 1.175-7.693, p = 0.021) were independent risk factors for concurrent DNI and AP. The group with concurrent DNI and AP had longer hospital stays (p < 0.001) and lower rates of incision and drainage (I&D) open surgery (p = 0.020) than the group with DNI alone. There were no significant differences in pathogens (p > 0.05) between the groups. CONCLUSIONS Both DNI and AP can independently compromise the airway, and the concurrence of these two conditions makes airway protection more difficult. Age > 60 years and retropharyngeal space involvement were independent risk factors for the concurrence of DNI and AP. The group with concurrent DNI and AP had longer hospital stays and lower rates of I&D open surgery than the group with DNI alone. There were no differences in DNI pathogens according to concurrent AP status.
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Ahmed S, Sultana S, Khan AM, Islam MS, Habib GMM, McLane IM, McCollum ED, Baqui AH, Cunningham S, Nair H. Digital auscultation as a diagnostic aid to detect childhood pneumonia: A systematic review. J Glob Health 2022; 12:04033. [PMID: 35493777 PMCID: PMC9024283 DOI: 10.7189/jogh.12.04033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Frontline health care workers use World Health Organization Integrated Management of Childhood Illnesses (IMCI) guidelines for child pneumonia care in low-resource settings. IMCI guideline pneumonia diagnostic criterion performs with low specificity, resulting in antibiotic overtreatment. Digital auscultation with automated lung sound analysis may improve the diagnostic performance of IMCI pneumonia guidelines. This systematic review aims to summarize the evidence on detecting adventitious lung sounds by digital auscultation with automated analysis compared to reference physician acoustic analysis for child pneumonia diagnosis. Methods In this review, articles were searched from MEDLINE, Embase, CINAHL Plus, Web of Science, Global Health, IEEExplore database, Scopus, and the ClinicalTrial.gov databases from the inception of each database to October 27, 2021, and reference lists of selected studies and relevant review articles were searched manually. Studies reporting diagnostic performance of digital auscultation and/or computerized lung sound analysis compared against physicians’ acoustic analysis for pneumonia diagnosis in children under the age of 5 were eligible for this systematic review. Retrieved citations were screened and eligible studies were included for extraction. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. All these steps were independently performed by two authors and disagreements between the reviewers were resolved through discussion with an arbiter. Narrative data synthesis was performed. Results A total of 3801 citations were screened and 46 full-text articles were assessed. 10 studies met the inclusion criteria. Half of the studies used a publicly available respiratory sound database to evaluate their proposed work. Reported methodologies/approaches and performance metrics for classifying adventitious lung sounds varied widely across the included studies. All included studies except one reported overall diagnostic performance of the digital auscultation/computerised sound analysis to distinguish adventitious lung sounds, irrespective of the disease condition or age of the participants. The reported accuracies for classifying adventitious lung sounds in the included studies varied from 66.3% to 100%. However, it remained unclear to what extent these results would be applicable for classifying adventitious lung sounds in children with pneumonia. Conclusions This systematic review found very limited evidence on the diagnostic performance of digital auscultation to diagnose pneumonia in children. Well-designed studies and robust reporting are required to evaluate the accuracy of digital auscultation in the paediatric population.
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Affiliation(s)
- Salahuddin Ahmed
- Usher Institute, University of Edinburgh, Edinburgh, UK
- Projahnmo Research Foundation, Dhaka, Bangladesh
| | | | - Ahad M Khan
- Usher Institute, University of Edinburgh, Edinburgh, UK
- Projahnmo Research Foundation, Dhaka, Bangladesh
| | - Mohammad S Islam
- Usher Institute, University of Edinburgh, Edinburgh, UK
- Child Health Research Foundation, Dhaka, Bangladesh
| | - GM Monsur Habib
- Usher Institute, University of Edinburgh, Edinburgh, UK
- Bangladesh Primary Care Respiratory Society, Khulna, Bangladesh
| | | | - Eric D McCollum
- Global Program for Pediatric Respiratory Sciences, Eudowood Division of Paediatric Respiratory Sciences, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Abdullah H Baqui
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Steven Cunningham
- Department of Child Life and Health, Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
| | - Harish Nair
- Usher Institute, University of Edinburgh, Edinburgh, UK
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Mackenzie GA, McLellan J, Machuka E, Ndiaye M, Pathirana J, Fombah A, Abatan B, Hossain I, Manjang A, Greenwood B, Hill P. Aetiology of lobar pneumonia determined by multiplex molecular analyses of lung and pleural aspirate specimens in the Gambia: findings from population-based pneumonia surveillance. BMJ Open 2022; 12:e056706. [PMID: 35273059 PMCID: PMC8915295 DOI: 10.1136/bmjopen-2021-056706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To determine the causes of lobar pneumonia in rural Gambia. DESIGN AND SETTING Population-based pneumonia surveillance at seven peripheral health facilities and two regional hospitals in rural Gambia. 7-valent pneumococcal conjugate vaccine (PCV7) was introduced routinely in August 2009 and replaced by PCV13 from May 2011. METHODS Prospective pneumonia surveillance was undertaken among all ages with referral of suspected pneumonia cases to the regional hospitals. Blood culture and chest radiographs were performed routinely while lung or pleural aspirates were collected from selected, clinically stable patients with pleural effusion on radiograph and/or large, dense, peripheral consolidation. We used conventional microbiology, and from 8 April 2011 to 17 July 2012, used a multiplex PCR assay on lung and pleural aspirates. We calculated proportions with pathogens, associations between coinfecting pathogens and PCV effectiveness. PARTICIPANTS 2550 patients were admitted with clinical pneumonia; 741 with lobar pneumonia or pleural effusion. We performed 181 lung or pleural aspirates and multiplex PCR on 156 lung and 4 pleural aspirates. RESULTS Pathogens were detected in 116/160 specimens, the most common being Streptococcus pneumoniae(n=68), Staphylococcus aureus (n=26) and Haemophilus influenzae type b (n=11). Bacteria (n=97) were more common than viruses (n=49). Common viruses were bocavirus (n=11) and influenza (n=11). Coinfections were frequent (n=55). Moraxella catarrhalis was detected in eight patients and in every case there was coinfection with S. pneumoniae. The odds ratio of vaccine-type pneumococcal pneumonia in patients with two or three compared with zero doses of PCV was 0.17 (95% CI 0.06 to 0.51). CONCLUSIONS Lobar pneumonia in rural Gambia was caused primarily by bacteria, particularly S. pneumoniae and S. aureus. Coinfection was common and M. catarrhalis always coinfected with S. pneumoniae. PCV was highly efficacious against vaccine-type pneumococcal pneumonia.
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Affiliation(s)
- Grant Austin Mackenzie
- Disease Control and Elimination, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, Gambia
- Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Jessica McLellan
- Disease Control and Elimination, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, Gambia
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Eunice Machuka
- Disease Control and Elimination, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, Gambia
| | - Malick Ndiaye
- Disease Control and Elimination, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, Gambia
| | - Jayani Pathirana
- Disease Control and Elimination, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, Gambia
| | - Augustin Fombah
- Disease Control and Elimination, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, Gambia
| | - Baderinwa Abatan
- Disease Control and Elimination, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, Gambia
| | - Ilias Hossain
- Disease Control and Elimination, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, Gambia
| | - Ahmed Manjang
- Disease Control and Elimination, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, Gambia
| | - Brian Greenwood
- Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Philip Hill
- Centre for International Health, University of Otago, Dunedin, New Zealand
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Global Perspective of Legionella Infection in Community-Acquired Pneumonia: A Systematic Review and Meta-Analysis of Observational Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031907. [PMID: 35162928 PMCID: PMC8835084 DOI: 10.3390/ijerph19031907] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 12/11/2021] [Accepted: 01/20/2022] [Indexed: 01/27/2023]
Abstract
Legionnaires’ disease (LD) (Legionella) is a common cause of community-acquired pneumonia (CAP) in those requiring hospitalization. Geographical variation in the importance of Legionella species as an aetiologic agent of CAP is poorly understood. We performed a systematic review and meta-analysis of population-based observational studies that reported the proportion of Legionella infection in patients with CAP (1 January 1990 to 31 May 2020). Using five electronic databases, articles were identified, appraised and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The quality of the included studies was assessed using the Newcastle–Ottawa Scale. Univariate and multivariate meta-regression analyses were conducted using study design, WHO region, study quality and healthcare setting as the explanatory variables. We reviewed 2778 studies, of which 219 were included in the meta-analysis. The mean incidence of CAP was 46.7/100,000 population (95% CI: 46.6–46.8). The mean proportion of Legionella as the causative agent for CAP was 4.6% (95% CI: 4.4 to 4.7). Consequently, the mean Legionella incidence rate was 2.8/100,000 population (95% CI: 2.7–2.9). There was significant heterogeneity across all studies I2 = 99.27% (p < 0.0001). After outliers were removed, there was a decrease in the heterogeneity (I2 = 43.53%). Legionella contribution to CAP has a global distribution. Although the rates appear highest in high income countries in temperate regions, there are insufficient studies from low- and middle-income countries to draw conclusions about the rates in these regions. Nevertheless, this study provides an estimate of the mean incidence of Legionella infection in CAP, which could be used to estimate the regional and global burden of LD to support efforts to reduce the impact of this infection as well as to fill important knowledge gaps.
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Zaghary WA, Elansary MM, Shouman DN, Abdelrahim AA, Abu-Zied KM, Sakr TM. Can nanotechnology overcome challenges facing stem cell therapy? A review. J Drug Deliv Sci Technol 2021. [DOI: 10.1016/j.jddst.2021.102883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Vientós-Plotts AI, Masseau I, Reinero CR. Comparison of Short- versus Long-Course Antimicrobial Therapy of Uncomplicated Bacterial Pneumonia in Dogs: A Double-Blinded, Placebo-Controlled Pilot Study. Animals (Basel) 2021; 11:3096. [PMID: 34827828 PMCID: PMC8614313 DOI: 10.3390/ani11113096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 10/26/2021] [Accepted: 10/27/2021] [Indexed: 12/14/2022] Open
Abstract
Current treatment for canine bacterial pneumonia relies on protracted courses of antimicrobials (3-6 weeks or more) with recommendations to continue for 1-2 weeks past resolution of all clinical and thoracic radiographic abnormalities. However, in humans, bacterial pneumonia is often treated with 5-10-day courses of antimicrobials, and thoracic radiographs are not considered useful to guide therapeutic duration. The primary study objective was to determine whether a short course of antimicrobials would be sufficient to treat canine bacterial pneumonia. Eight dogs with uncomplicated bacterial pneumonia were enrolled in this randomized, double-blinded, placebo-controlled study comparing clinical and radiographic resolution with differing durations of antimicrobial therapy. Dogs received a course of antimicrobials lasting 10 (A10) or 21 (A21) days. Dogs randomized to the A10 group received placebo for 11 days following antimicrobial therapy. Patients were evaluated at presentation and 10, 30 and 60 days after the initiation of antimicrobials. At 10 days, 6/8 dogs had resolution of both clinical signs and inflammatory leukogram, and 5/8 dogs had improved global radiographic scores. After 60 days, clinical and hematologic resolution of pneumonia was noted in all dogs regardless of antimicrobial therapy duration; however, 3/8 dogs had persistent radiographic lesions. Thoracic radiographs do not appear to be a reliable marker to guide antimicrobial therapy in canine bacterial pneumonia as radiographic lesions may lag or persist despite clinical cure. This pilot study suggests a 10-day course of antimicrobials may be sufficient to treat uncomplicated canine bacterial pneumonia.
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Affiliation(s)
| | - Isabelle Masseau
- Department of Sciences Cliniques, Faculté de Médecine Vétérinaire, Université de Montréal, St-Hyacinthe, Montreal, QC H3T 1J4, Canada;
| | - Carol R. Reinero
- College of Veterinary Medicine, University of Missouri, Columbia, MO 65211, USA;
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Diagnosis and treatment of lobar pneumonia in the pre-antibiotic era Anton Chekhov's medical report (1883). Microbes Infect 2021; 24:104889. [PMID: 34628011 DOI: 10.1016/j.micinf.2021.104889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 09/24/2021] [Accepted: 09/24/2021] [Indexed: 11/20/2022]
Abstract
In the late 19th century, pneumonia was one of the leading causes of death in Europe and the USA. Although at this time doctors knew about the infectious cause of pneumonia, they were not able to offer patients specific antimicrobial therapy. In the current paper, we translated into English for the first time and analyzed the almost forgotten medical report of a pneumonic patient written by the famous Russian writer and physician Anton Chekhov (1860-1904), which describes the classic stages of lobar pneumonia, now no longer observed in clinical practice due to antibacterial treatment. Despite the limited capabilities of lung disease diagnosis compared to the possibilities of modern medicine, physicians were able to diagnose lobar pneumonia using techniques of percussion and auscultation. Therapy in this case was limited to diet and symptomatic treatment and could only relieve some of the symptoms. This case history shows that in the early 1880s, in the one of the leading university clinics in Russia, despite the transition from humoral theory and ideas of natural philosophy to the concept of cellular pathology, there were still contradictory trends in the treatment of diseases.
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Valim C, Olatunji YA, Isa YS, Salaudeen R, Golam S, Knol EF, Kanyi S, Jammeh A, Bassat Q, de Jager W, Diaz AA, Wiegand RC, Ramirez J, Moses MA, D'Alessandro U, Hibberd PL, Mackenzie GA. Seeking diagnostic and prognostic biomarkers for childhood bacterial pneumonia in sub-Saharan Africa: study protocol for an observational study. BMJ Open 2021; 11:e046590. [PMID: 34593486 PMCID: PMC8487183 DOI: 10.1136/bmjopen-2020-046590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Clinically diagnosed pneumonia in children is a leading cause of paediatric hospitalisation and mortality. The aetiology is usually bacterial or viral, but malaria can cause a syndrome indistinguishable from clinical pneumonia. There is no method with high sensitivity to detect a bacterial infection in these patients and, as result, antibiotics are frequently overprescribed. Conversely, unrecognised concomitant bacterial infection in patients with malarial infections occur with omission of antibiotic therapy from patients with bacterial infections. Previously, we identified two combinations of blood proteins with 96% sensitivity and 86% specificity for detecting bacterial disease. The current project aimed to validate and improve these combinations by evaluating additional biomarkers in paediatric patients with clinical pneumonia. Our goal was to describe combinations of a limited number of proteins with high sensitivity and specificity for bacterial infection to be incorporated in future point-of-care tests. Furthermore, we seek to explore signatures to prognosticate clinical pneumonia. METHODS AND ANALYSIS Patients (n=900) aged 2-59 months presenting with clinical pneumonia at two Gambian hospitals will be enrolled and classified according to criteria for definitive bacterial aetiology (based on microbiological tests and chest radiographs). We will measure proteins at admission using Luminex-based immunoassays in 90 children with definitive and 160 with probable bacterial aetiology, and 160 children classified according to the prognosis of their disease. Previously identified diagnostic signatures will be assessed through accuracy measures. Moreover, we will seek new diagnostic and prognostic signatures through machine learning methods, including support vector machine, penalised regression and classification trees. ETHICS AND DISSEMINATION Ethics approval has been obtained from the Gambia Government/Medical Research Council Unit The Gambia Joint Ethics Committee (protocol 1616) and the institutional review board of Boston University Medical Centre (STUDY00000958). Study results will be disseminated to the staff of the study hospitals, in scientific seminars and meetings, and in publications. TRIAL REGISTRATION NUMBER H-38462.
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Affiliation(s)
- Clarissa Valim
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Yekin Ajauoi Olatunji
- Medical Research Council Unit, The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Yasir Shitu Isa
- Medical Research Council Unit, The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Rasheed Salaudeen
- Medical Research Council Unit, The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Sarwar Golam
- Medical Research Council Unit, The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Edward F Knol
- Center of Translational Immunology, Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | | | - Quique Bassat
- Hospital Clínic, Universitat de Barcelona, ISGlobal, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Wilco de Jager
- Center of Translational Immunology, Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
- Luminex Corp, Austin, Texas, USA
| | - Alejandro A Diaz
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Julio Ramirez
- Division of Infectious Diseases, University of Louisville, Louisville, Kentucky, USA
| | - Marsha A Moses
- Vascular Biology Program, Children's Hospital Boston, Boston, Massachusetts, USA
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Umberto D'Alessandro
- Disease Elimination and Control, Medical Research Council Unit, Fajara, Gambia
- London School of Hygiene & Tropical Medicine, London, UK
| | | | - Grant A Mackenzie
- Medical Research Council Unit, The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
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Understanding the Host in the Management of Pneumonia. An Official American Thoracic Society Workshop Report. Ann Am Thorac Soc 2021; 18:1087-1097. [PMID: 34242148 PMCID: PMC8328365 DOI: 10.1513/annalsats.202102-209st] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Pneumonia causes a significant burden of disease worldwide. Although all populations are at risk of pneumonia, those at extremes of age and those with immunosuppressive disorders, underlying respiratory disease, and critical illness are particularly vulnerable. Although clinical practice guidelines addressing the management and treatment of pneumonia exist, few of the supporting studies focus on the crucial contributions of the host in pneumonia pathogenesis and recovery. Such essential considerations include the host risk factors that lead to susceptibility to lung infections; biomarkers reflecting the host response and the means to pursue host-directed pneumonia therapy; systemic effects of pneumonia on the host; and long-term health outcomes after pneumonia. To address these gaps, the Pneumonia Working Group of the Assembly on Pulmonary Infection and Tuberculosis led a workshop held at the American Thoracic Society meeting in May 2018 with overarching objectives to foster attention, stimulate research, and promote funding for short-term and long-term investigations into the host contributions to pneumonia. The workshop involved participants from various disciplines with expertise in lung infection, pneumonia, sepsis, immunocompromised patients, translational biology, data science, genomics, systems biology, and clinical trials. This workshop report summarizes the presentations and discussions and important recommendations for future clinical pneumonia studies. These recommendations include establishing consensus disease and outcome definitions, improved phenotyping, development of clinical study networks, standardized data and biospecimen collection and protocols, and development of innovative trial designs.
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Lee K, Hong K, Kang S, Hwang J. Characteristics and Epidemiology of Discharged Pneumonia Patients in South Korea Using the Korean National Hospital Discharge In-Depth Injury Survey Data from 2006 to 2017. Infect Dis Rep 2021; 13:730-741. [PMID: 34449656 PMCID: PMC8395938 DOI: 10.3390/idr13030068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/16/2021] [Accepted: 08/17/2021] [Indexed: 12/03/2022] Open
Abstract
Despite the use of vaccines and various antibiotics, approximately 30% of the South Korean population is treated for pneumonia each year, and the number of deaths from pneumonia continues to increase. The present study used information on discharged patients in South Korea to investigate the number and characteristics of discharged pneumonia patients across 12 years. Using the Korean National Hospital Discharge In-Depth Injury Survey data, information on discharged patients from 2006 to 2017 were collected. The number of discharged pneumonia patients for each year and their age group was assessed, and the Charlson Comorbidity Index was used to assess the risk of comorbidities in these patients. The number of discharged pneumonia patients varied every year in South Korea. In particular, the total number of patients increased substantially in 2011, with a large increase in the number of infants and children. In addition, the number of discharged pneumonia patients increased in the elderly group compared to the other age groups. Moreover, a recent increase in the severity of comorbidities in pneumonia patients was noted. Given the continued increase in the number of elderly patients with pneumonia, chronic diseases, such as hypertension and diabetes, should be managed first in the elderly. Moreover, appropriate treatment methods should be selected based on the presence of comorbidities.
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Affiliation(s)
- Kyunghee Lee
- Department of Healthcare Management, Eulji University, Seongnam-si 13135, Korea;
| | - Kyunglan Hong
- Team of Medical Record, Seoul National University Hospital, Seoul 03080, Korea;
| | - Sunghong Kang
- Department of Health Policy & Management, Inje University, Gimhae-si 50834, Korea;
| | - Jieun Hwang
- College of Health Science, Dankook University, Cheonan-si 31116, Korea
- Correspondence:
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Artificial Intelligence Framework for Efficient Detection and Classification of Pneumonia Using Chest Radiography Images. J Med Biol Eng 2021. [DOI: 10.1007/s40846-021-00631-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Seeking New Parameters In Differentiating Child Tuberculosis From Community Acquired Pneumonia- Is It Possible?”. JOURNAL OF CONTEMPORARY MEDICINE 2021. [DOI: 10.16899/jcm.823844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Ye C, Zhang N, Zhao Q, Xie X, Li X, Zhu HP, Peng C, Huang W, Han B. Evodiamine alleviates lipopolysaccharide-induced pulmonary inflammation and fibrosis by activating apelin pathway. Phytother Res 2021; 35:3406-3417. [PMID: 33657655 DOI: 10.1002/ptr.7062] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 01/26/2021] [Accepted: 02/12/2021] [Indexed: 01/25/2023]
Abstract
Inflammation can cause a series of inflammatory lung disease, which seriously endangers human health. Pulmonary fibrosis is a kind of inflammatory disease with end-stage lung pathological changes. It has complicated and unknown pathogenesis and is still lack of effective therapeutic drugs. LPS-induced inflammation is a common feature of many infectious inflammations such as pneumonia, bacteremia, glomerulonephritis, etc. Evodiamine, one of the main components of Evodia rutaecarpa, is an alkaloid with excellent antiinflammatory effects. In this study, we evaluated the protective capacities of evodiamine on LPS-induced inflammatory damages in vitro and in vivo. MTT method, flow cytometry, immunofluorescence, and other methods were used for in vitro study to determine the protective capacities of evodiamine. The results suggest that evodiamine can protect murine macrophages from the LPS-nigericin-induced damages by (a) inhibiting cellular apoptosis, (b) inhibiting inflammatory cytokines releasing, and (c) activating the apelin pathway. We also used the exogenous apelin-13 peptide co-cultured with LPS-nigericin in RAW264.7 cells and found that apelin-13 contributes to protecting the effects of evodiamine. In vivo, the ELISA method and immunohistochemistry were used to examine inflammatory cytokines, apelin, and histological changes. BALB/c mice were exposed to LPS and subsequent administration of evodiamine (p.o.)for some time, the results of the alveolar lavage fluid and the tissue slices showed that evodiamine treatment alleviated the pulmonary inflammation and fibrosis, stimulated apelin expression and inhibited the inflammatory cytokines. These results provide a basis for the protective effect and mechanism of evodiamine in LPS-induced inflammation and suggest that it might be potential therapeutics in human pulmonary infections.
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Affiliation(s)
- Cui Ye
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Nan Zhang
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Qian Zhao
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xin Xie
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiang Li
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Hong-Ping Zhu
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Cheng Peng
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Wei Huang
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Bo Han
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Therapeutic Antibodies for the Treatment of Respiratory Tract Infections-Current Overview and Perspectives. Vaccines (Basel) 2021; 9:vaccines9020151. [PMID: 33668613 PMCID: PMC7917879 DOI: 10.3390/vaccines9020151] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 02/07/2023] Open
Abstract
Respiratorytract infections (RTIs) are frequent and life-threatening diseases, accounting for several millions of deaths worldwide. RTIs implicate microorganisms, including viruses (influenza virus, coronavirus, respiratory syncytial virus (RSV)), bacteria (Pseudomonas aeruginosa, Streptococcus pneumoniae, Staphylococcus aureus and Bacillus anthracis) and fungi (Pneumocystis spp., Aspergillus spp. and very occasionally Candida spp.). The emergence of new pathogens, like the coronavirus SARS-CoV-2, and the substantial increase in drug resistance have highlighted the critical necessity to develop novel anti-infective molecules. In this context, antibodies (Abs) are becoming increasingly important in respiratory medicine and may fulfill the unmet medical needs of RTIs. However, development of Abs for treating infectious diseases is less advanced than for cancer and inflammatory diseases. Currently, only three Abs have been marketed for RTIs, namely, against pulmonary anthrax and RSV infection, while several clinical and preclinical studies are in progress. This article gives an overview of the advances in the use of Abs for the treatment of RTIs, based on the analysis of clinical studies in this field. It describes the Ab structure, function and pharmacokinetics, and discusses the opportunities offered by the various Ab formats, Ab engineering and co-treatment strategies. Including the most recent literature, it finally highlights the strengths, weaknesses and likely future trends of a novel anti-RTI Ab armamentarium.
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Ginsburg AS, Vitorino P, Qasim Z, Lenahan JL, Hwang J, Lamorte A, Valente M, Balouch B, Muñoz Almagro C, Nisar MI, May S, Jehan F, Bassat Q, Volpicelli G. Lung ultrasound patterns in paediatric pneumonia in Mozambique and Pakistan. ERJ Open Res 2021; 7:00518-2020. [PMID: 33569493 PMCID: PMC7861021 DOI: 10.1183/23120541.00518-2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 11/04/2020] [Indexed: 11/12/2022] Open
Abstract
Objective Improved pneumonia diagnostics are needed, particularly in resource-constrained settings. Lung ultrasound (LUS) is a promising point-of-care imaging technology for diagnosing pneumonia. The objective was to explore LUS patterns associated with paediatric pneumonia. Methods We conducted a prospective, observational study among children aged 2 to 23 months with World Health Organization Integrated Management of Childhood Illness chest-indrawing pneumonia and among children without fast breathing, chest indrawing or fever (no pneumonia cohort) at two district hospitals in Mozambique and Pakistan. We assessed LUS and chest radiograph (CXR) examinations, and viral and bacterial nasopharyngeal carriage, and performed a secondary analysis of LUS patterns. Results LUS demonstrated a range of distinctive patterns that differed between children with and without pneumonia and between children in Mozambique versus Pakistan. The presence of LUS consolidation or interstitial patterns was more common in children with chest-indrawing pneumonia than in those without pneumonia. Consolidations were also more common among those with only bacterial but no viral carriage detected (50.0%) than among those with both (13.0%) and those with only virus detected (8.3%; p=0.03). LUS showed high interrater reliability among expert LUS interpreters for overall determination of pneumonia (κ=0.915), consolidation (κ=0.915) and interstitial patterns (κ=0.901), but interrater reliability between LUS and CXR for detecting consolidations was poor (κ=0.159, Pakistan) to fair (κ=0.453, Mozambique). Discussion Pattern recognition was discordant between LUS and CXR imaging modalities. Further research is needed to define and standardise LUS patterns associated with paediatric pneumonia and to evaluate the potential value of LUS as a reference standard. This study explored distinctive lung ultrasound patterns associated with paediatric community-acquired pneumonia in Mozambique and Pakistan, and found reliable pattern recognition critical to identifying pneumoniahttps://bit.ly/3eWWvXr
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Affiliation(s)
| | - Pio Vitorino
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Zunera Qasim
- Dept of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | | | - Jun Hwang
- Dept of Biostatistics, University of Washington, Seattle, WA, USA
| | | | - Marta Valente
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Benazir Balouch
- Dept of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | | | - M Imran Nisar
- Dept of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Susanne May
- Dept of Biostatistics, University of Washington, Seattle, WA, USA
| | - Fyezah Jehan
- Dept of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Quique Bassat
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.,ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,Instituto de Recerca Pediatrica, Hospital Sant Joan de Déu, Barcelona, Spain.,ICREA, Barcelona, Spain.,Consorcio de Investigacion Biomedica en Red de Epidemiologia y Salud Publica (CIBERESP), Madrid, Spain
| | - Giovanni Volpicelli
- Dept of Emergency Medicine, San Luigi Gonzaga University Hospital, Orbassano, Italy
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Ginsburg AS, Lenahan JL, Jehan F, Bila R, Lamorte A, Hwang J, Madrid L, Nisar MI, Vitorino P, Kanth N, Balcells R, Baloch B, May S, Valente M, Varo R, Nadeem N, Bassat Q, Volpicelli G. Performance of lung ultrasound in the diagnosis of pediatric pneumonia in Mozambique and Pakistan. Pediatr Pulmonol 2021; 56:551-560. [PMID: 33205892 PMCID: PMC7898329 DOI: 10.1002/ppul.25176] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 09/28/2020] [Accepted: 11/05/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Improved pneumonia diagnostics are needed in low-resource settings (LRS); lung ultrasound (LUS) is a promising diagnostic technology for pneumonia. The objective was to compare LUS versus chest radiograph (CXR), and among LUS interpreters, to compare expert versus limited training with respect to interrater reliability. METHODS We conducted a prospective, observational study among children with World Health Organization (WHO) Integrated Management of Childhood Illness (IMCI) chest-indrawing pneumonia at two district hospitals in Mozambique and Pakistan, and assessed LUS and CXR examinations. The primary endpoint was interrater reliability between LUS and CXR interpreters for pneumonia diagnosis among children with WHO IMCI chest-indrawing pneumonia. RESULTS Interrater reliability was excellent for expert LUS interpreters, but poor to moderate for expert CXR interpreters and onsite LUS interpreters with limited training. CONCLUSIONS Among children with WHO IMCI chest-indrawing pneumonia, expert interpreters may achieve substantially higher interrater reliability for LUS compared to CXR, and LUS showed potential as a preferred reference standard. For point-of-care LUS to be successfully implemented for the diagnosis and management of pneumonia in LRS, the clinical environment and amount of appropriate user training will need to be understood and addressed.
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Affiliation(s)
| | | | - Fyezah Jehan
- Department of Pediatrics and Child HealthAga Khan UniversityKarachiPakistan
| | - Rubao Bila
- Centro de Investigação em Saúde de Manhiça (CISM)MaputoMozambique
| | | | - Jun Hwang
- Clinical Trial CenterUniversity of WashingtonSeattleWashingtonUSA
| | - Lola Madrid
- ISGlobal, Hospital Clínic, Universitat de BarcelonaBarcelonaSpain
| | | | - Pio Vitorino
- Centro de Investigação em Saúde de Manhiça (CISM)MaputoMozambique
| | - Neel Kanth
- Sindh Government Children's Hospital–Poverty Eradication InitiativeKarachiPakistan
| | - Reyes Balcells
- ISGlobal, Hospital Clínic, Universitat de BarcelonaBarcelonaSpain
| | - Benazir Baloch
- Department of Pediatrics and Child HealthAga Khan UniversityKarachiPakistan
| | - Susanne May
- Clinical Trial CenterUniversity of WashingtonSeattleWashingtonUSA
| | - Marta Valente
- ISGlobal, Hospital Clínic, Universitat de BarcelonaBarcelonaSpain
| | - Rosauro Varo
- ISGlobal, Hospital Clínic, Universitat de BarcelonaBarcelonaSpain
| | - Naila Nadeem
- Department of RadiologyAga Khan UniversityKarachiPakistan
| | - Quique Bassat
- Centro de Investigação em Saúde de Manhiça (CISM)MaputoMozambique
- ISGlobal, Hospital Clínic, Universitat de BarcelonaBarcelonaSpain
- Institució Catalana de Recerca i Estudis Avançats (ICREA)BarcelonaSpain
- Department of Pediatrics, Hospital Sant Joan de DeuUniversitat de BarcelonaBarcelonaSpain
- Consorcio de Investigacion Biomedica en Red de Epidemiologia y Salud Publica (CIBERESP)MadridSpain
| | - Giovanni Volpicelli
- Department of Emergency MedicineSan Luigi Gonzaga University HospitalOrbassanoItaly
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Abstract
Background: Pneumonia, as a fairly prevalent illness, is the main cause of hospital mortality. The major cause of mortality and morbidity of pneumonia is due to bacteria. The presence of multi-drug resistant pathogens and no response to treatment have aroused considerable interest in the use of probiotic components to prevent infections. Objectives: Given that few studies have evaluated the efficacy of probiotics in reducing bacterial pneumonia, the current aimed to evaluate the role of probiotics in decreasing pneumonia. Methods: This double-blind, randomized clinical trial study was conducted on 100 patients diagnosed with bacterial pneumonia in Shahid Beheshti Hospital, Kashan, Iran, during 2018. Patients were randomly classified into two groups (n = 50). One group (case) received two sachets of probiotic/daily for five days, and another group (control) received placebo. Moreover, patients in both groups received the same treatment protocol. All data were extracted from medical records. Chi-square test and independent t-test were used for analysis of data. P < 0.05 was considered statistically significant. Results: No significant difference was seen between case and control groups regarding age, gender, and duration of symptoms before hospitalization (P > 0.05), which implies a completely random classification of two groups. The mean duration of hospitalization, dyspnea, tachypnea, cough, fever, and crackles was significantly decreased in the case group compared to the control group (P < 0.05). Conclusion: The use of probiotics can be effective in reducing the duration of dyspnea, tachypnea, cough, fever, and length of hospitalization. Therefore, probiotics may be considered a promising treatment for the development of new anti-infectious therapy. In addition, the usage of probiotics along with antibiotics is suggested for decreasing pneumonia complications and improving the efficacy of therapy.
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Vlaeminck J, Raafat D, Surmann K, Timbermont L, Normann N, Sellman B, van Wamel WJB, Malhotra-Kumar S. Exploring Virulence Factors and Alternative Therapies against Staphylococcus aureus Pneumonia. Toxins (Basel) 2020; 12:toxins12110721. [PMID: 33218049 PMCID: PMC7698915 DOI: 10.3390/toxins12110721] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/12/2020] [Accepted: 11/15/2020] [Indexed: 12/13/2022] Open
Abstract
Pneumonia is an acute pulmonary infection associated with high mortality and an immense financial burden on healthcare systems. Staphylococcus aureus is an opportunistic pathogen capable of inducing S. aureus pneumonia (SAP), with some lineages also showing multidrug resistance. Given the high level of antibiotic resistance, much research has been focused on targeting S. aureus virulence factors, including toxins and biofilm-associated proteins, in an attempt to develop effective SAP therapeutics. Despite several promising leads, many hurdles still remain for S. aureus vaccine research. Here, we review the state-of-the-art SAP therapeutics, highlight their pitfalls, and discuss alternative approaches of potential significance and future perspectives.
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Affiliation(s)
- Jelle Vlaeminck
- Laboratory of Medical Microbiology, Vaccine and Infectious Diseases Institute, University of Antwerp, 2610 Antwerp, Belgium; (J.V.); (L.T.)
| | - Dina Raafat
- Department of Immunology, Institute of Immunology and Transfusion Medicine, University Medicine Greifswald, 17475 Greifswald, Germany; (D.R.); (N.N.)
- Department of Microbiology and Immunology, Faculty of Pharmacy, Alexandria University, Alexandria 21521, Egypt
| | - Kristin Surmann
- Department of Functional Genomics, Interfaculty Institute for Genetics and Functional Genomics, University Medicine Greifswald, 17475 Greifswald, Germany;
| | - Leen Timbermont
- Laboratory of Medical Microbiology, Vaccine and Infectious Diseases Institute, University of Antwerp, 2610 Antwerp, Belgium; (J.V.); (L.T.)
| | - Nicole Normann
- Department of Immunology, Institute of Immunology and Transfusion Medicine, University Medicine Greifswald, 17475 Greifswald, Germany; (D.R.); (N.N.)
| | - Bret Sellman
- Microbiome Discovery, Microbial Sciences, BioPharmaceuticals R & D, AstraZeneca, Gaithersburg, MD 20878, USA;
| | - Willem J. B. van Wamel
- Department of Medical Microbiology and Infectious Diseases, Erasmus Medical Center Rotterdam, 3015 Rotterdam, The Netherlands;
| | - Surbhi Malhotra-Kumar
- Laboratory of Medical Microbiology, Vaccine and Infectious Diseases Institute, University of Antwerp, 2610 Antwerp, Belgium; (J.V.); (L.T.)
- Correspondence: ; Tel.: +32-3-265-27-52
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Lee SH, Han Y, Kim SJ, Lee SJ, Ryu YJ. Impact of right ventricular systolic pressure in elderly patients admitted to intensive care unit after femur fracture surgery: A retrospective observational study. Medicine (Baltimore) 2020; 99:e22881. [PMID: 33157931 PMCID: PMC7647512 DOI: 10.1097/md.0000000000022881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The number of femoral fractures is expected to continue to increase as the size of the older population rapidly grows. However, old age is accompanied by various comorbidities and is an important postoperative risk factor in itself, meaning that patients who undergo surgery for a femur fracture may require admission to an ICU. We investigated pulmonary complications in patients over the age of 65 admitted to the ICU after femur fracture surgery.In this single-center retrospective observational study, 289 patients over 65 years who admitted to the ICU after femur fracture surgery between June 2008 and December 2016 were investigated.Pulmonary complications occurred in 97 of these patients (33.6%) after surgery. Mean hospitalization days (34.1 ± 25.7 vs 23.1 ± 15.7, P < .001) and mean ICU length of stay (8.4 ± 16.1 vs 2.5 ± 1.1, P = .001) were significantly longer for patients with pulmonary complications than for patients without pulmonary complications after femur fracture surgery. Patients with pulmonary complications were significantly more likely to have pulmonary disease (19.6% vs 8.9%, P = .009) and exhibit sequelae on preoperative chest X-rays (9.3% vs 3.6%, P = .048) than were patients without pulmonary complications. In addition, significant differences were observed in the right ventricular systolic pressure (RVSP) measured during preoperative echocardiography (37.4 ± 10.9 mm Hg vs 40.7 ± 9.3 mm Hg for patients without and with pulmonary complications, P = .010) and in the proportion of each group that had an RVSP of >35 mm Hg, which is a marker for pulmonary hypertension (55.2% vs 76.3% for patients without and with pulmonary complications, P < .001). In multivariate analysis, an RVSP of >35 mm Hg during preoperative echocardiography was associated with pulmonary complications after femur fracture surgery (OR, 2.6; 95% CI, 1.45-4.53).In conclusion, Pulmonary complications in older patients admitted to the ICU after femur fracture surgery was associated with longer hospitalization and ICU stays. Preoperative RVSP measurement could identify those older patients with a high risk of pulmonary complications following transferal to the ICU after femur fracture surgery.
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Affiliation(s)
- Su Hwan Lee
- Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine
| | - Yeji Han
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul
| | - Soo Jung Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul
| | - Seok Jeong Lee
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Yon Ju Ryu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul
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