The common cold is caused by a large range of respiratory viruses and is the most common disease of mankind. There is a great need for a prophylactic treatment for colds. Specific antiviral treatments are only effecti...The common cold is caused by a large range of respiratory viruses and is the most common disease of mankind. There is a great need for a prophylactic treatment for colds. Specific antiviral treatments are only effective against one group of viruses and there is a need for a non-specific treatment that can be used against all respiratory viruses. Carrageenan is a general term used to describe a range of sulfated polysaccharides extracted from edible seaweeds. Large polyanionic molecules such as carrageenan have been shown to have antiviral activity against a wide range of viruses in vitro. The strong anionic charge of carrageenan attracts and traps viruses that have positively charged areas on their surface. The trapped viruses are then unable to infect epithelial cells. Iota-carrageenan exerts its’ antiviral activity by physical means due to its high anionic charge and it does not have any pharmacological properties and therefore does not have any toxicology or known side effects from treatment. Iota-carrageenan does not have any taste or smell and, when used as a nasal spray, does not have any adverse effects. Iota-carrageenan is an ideal prophylactic treatment for the common cold and is safe for use in children. Treatment of common cold with iota-carrageenan has to date been studied in five placebo-controlled clinical trials and these trials support both efficacy as a prophylactic treatment for colds and the safety and tolerability of iota-carrageenan.展开更多
Introduction: Influenza A (Flu A) and B (Flu B) viruses are responsible for severe acute respiratory infections (SARI) worldwide, with a morbidity of 5 million and mortality of 29,000 - 650,000 deaths per year. Influe...Introduction: Influenza A (Flu A) and B (Flu B) viruses are responsible for severe acute respiratory infections (SARI) worldwide, with a morbidity of 5 million and mortality of 29,000 - 650,000 deaths per year. Influenza B viruses are an important cause of respiratory infections in humans, but they tend to be underappreciated due to the predominance of Influenza A. No molecular study on Influenza B has been carried out in the DRC. This study was conducted to document the molecular evolution of the hemagglutinin (HA) gene in the circulating Influenza B strains over the eight consecutive epidemic seasons (from 2015 to 2022). Methods: Samples were collected from outpatient cases suspected of influenza-like illness (ILI) and in all hospitalized patients with SARI from January 2015 to December 2022. Molecular analysis was done to determine influenza type and subtype, and then segments encoding the HA gene of Influenza B viruses were performed. Results: Of 8497 samples collected and tested, 639 (7.5%) were positive for influenza viruses, including 389 (60.8%) for Influenza A viruses and 248 (38,8%) for Influenza B viruses. Of the positive Influenza B samples, 91 were sequenced, including 26 belonging to the B/Yamagata lineage and 65 to the B/Victoria lineage. The HA gene of Influenza B viruses circulating in the DRC showed deletions in the HA1 region. Molecular analysis of Influenza B viruses reflects the genetic diversity of Influenza B/Yam virus clades (Y2, Y3, Y3V1A) alternating with Influenza B/Victoria virus clades (V1A, V1A.3) depending on the year and influenza seasons. The phylogenetic analysis of these Influenza B strains shows compatibility with the corresponding vaccine strains that the WHO had validated for each influenza season. Conclusion: This study underscores the importance of continuous molecular surveillance of Influenza B viruses in the DRC to understand their epidemiology and evolutionary dynamics. Identifying mutations, such as HA deletions, is critical for assessing their impact on transmissibility vaccine efficacy and guiding effective vaccination and control strategies.展开更多
Pseudoephedrine (PSE) is a widely used nasal decongestant. A review by the European Medicines Agency has reported that PSE may be associated with risks of posterior reversible encephalopathy syndrome (PRES) and revers...Pseudoephedrine (PSE) is a widely used nasal decongestant. A review by the European Medicines Agency has reported that PSE may be associated with risks of posterior reversible encephalopathy syndrome (PRES) and reversible cerebral vasoconstriction syndrome (RCVS). PRES and RCVS are rare but serious conditions that affect cerebral blood flow. This review discusses the pharmacology of PSE and potential risks for PRES and RCVS and concludes that considering the common use of PSE, with over 70 million packs of PSE taken each year in the European Union and the United Kingdom, and the rare occurrence of PRES and RCVS, that the risks of developing PRES/RCVS on exposure to PSE are likely to be very low.展开更多
Objectives: To assess respiratory elastance and resistive properties in patients with autoimmune liver disorders using the passive relaxation expiration technique and compare findings to a group of patients with non-a...Objectives: To assess respiratory elastance and resistive properties in patients with autoimmune liver disorders using the passive relaxation expiration technique and compare findings to a group of patients with non-autoimmune liver disease and control subjects. These findings were then related to control of ventilation and gas exchange. A secondary objective was to assess respiratory muscle strength and gas exchange and their relation to respiratory mechanics. Methods: Measurements included respiratory elastance and resistance using the passive relaxation method. Pulmonary function, gas exchange and control of ventilation were assessed using standard methods. Results: a) Compared to control subjects, Ers in patients with liver disease was on average 50% greater than in controls;b) mean respiratory resistance, expressed as the respiratory constants, K<sub>1</sub> and K<sub>2</sub> in the Rohrer relationship, Pao/V’ = K<sub>1</sub> + K<sub>2</sub>V’, was not different from control resistance;c) mean maximal inspiratory and maximal expiratory pressures averaged 36% and 55% of their respective control values;d) inspiratory occlusion pressure in 0.1 sec (P<sub>0.1</sub>) was increased and negatively associated with FVC;and e) increases in P<sub>0.1</sub>, mean inspiratory flow (Vt/Ti) and presence of respiratory alkalosis confirmed the increase in ventilatory drive. Despite inspiratory muscle weakness in patients, P<sub>0.1</sub>/Pimax averaged 5-fold higher than in control subjects. Conclusions: Despite inspiratory muscle weakness and a V’<sub>E</sub> similar to that in normal subjects, central drive is increased in patients with chronic liver disease. The increase in ventilatory drive is related to smaller lung volumes and weakly associated with increase in respiratory elastance. Findings confirm that P<sub>0.1</sub> is a reliable measure of central drive and is an approach that can be used in the evaluation of control of ventilation in patients with chronic liver disease.展开更多
Background: The welding trade includes many industrial activities in both the formal and informal sectors. Workers in this professional environment do not have access to individual and collective means of protection a...Background: The welding trade includes many industrial activities in both the formal and informal sectors. Workers in this professional environment do not have access to individual and collective means of protection adapted to the activity, which exposes them to the dust emitted during their activity and therefore contributes to increasing the risk of developing respiratory disorders in this population. Objective: Our study aimed to evaluate the ventilatory function of metal welders in the city of Dakar. Method: This was a comparative study based on the analysis of the spirometric parameters of metal welders working in the city of Dakar (Senegal) with those of a control group of the same kind, selected from the general population. Measurements of forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), peak expiratory flow (PEF) and maximum mid expiratory flow (MMEF) were measured. Results: A total of 75 men between the ages of 19 and 61 were recruited and divided into two groups (43 controls and 32 welders). The welding population had more frequent distal and central obstructions and pulmonary restriction compared to the control group. The metals most commonly used by welders were aluminum for welders who had an obstruction, while for those who had a restriction, iron was the most used metal. Signs of metal fever were frequently found in welders, especially those with ventilatory disorders. Conclusion: The prevalence of respiratory disorders observed is close to that observed in industrial environments, where exposure levels are the highest. The lack of personal protective equipment could also be a significant risk factor in the development of these disorders.展开更多
Objective: The studies of long-term oxygen therapy (LTOT) for patents with connective tissue disease-related interstitial lung disease (CTD-ILD) are limited. This study aimed to evaluate the prognosis of CTD-ILD patie...Objective: The studies of long-term oxygen therapy (LTOT) for patents with connective tissue disease-related interstitial lung disease (CTD-ILD) are limited. This study aimed to evaluate the prognosis of CTD-ILD patients following the initiation of LTOT, compared to those with idiopathic pulmonary fibrosis (IPF). Methods: We conducted a retrospective analysis of patients with CTD-ILD and IPF who were introduced to LTOT between January 2014 and December 2020. Results: The study included 24 patients with CTD-ILD and 55 patients with IPF. At the initiation of LTOT, female gender, never-smoking history, higher body mass index (BMI), higher lactate dehydrogenase (LDH) level, lower pulmonary Surfactant Protein-D (SP-D) level and lower Gender-Age-Physiology (GAP) scores were more common in the CTD-ILD group (all Conclusion: Although patients with CTD-ILD had longer overall survival than those with IPF, there was no significant difference in prognosis after the initiation of LTOT between the two groups. Early intervention including treatment and management will be needed in CTD-ILD as in IPF.展开更多
This study aimed to perform a systematic review and meta-analysis to determine the LTBI prevalence in prison officers worldwide. A systematic search was performed in PubMed, WoS, Embase, and BVS, including all article...This study aimed to perform a systematic review and meta-analysis to determine the LTBI prevalence in prison officers worldwide. A systematic search was performed in PubMed, WoS, Embase, and BVS, including all articles related to LTBI prevalence and risk factors. After critical evaluation and qualitative synthesis of the identified articles, a meta-analysis was used. Five studies carried out between 2012 and 2022 were included, with a total sample size of 1718 prison officers. The overall LTBI prevalence was 50% [95% confidence interval [CI]: 48% - 52%;n = 816], with high heterogeneity between studies. Smoking [OR = 1.76;CI 95% = 1.26 - 2.46] and males [OR = 2.08;CI 95% = 1.31 - 3.31] were positively related to a higher LTBI prevalence among prison officers. Thus, preventive measures and the rapid and accurate diagnosis of new cases should be emphasized to ensure tuberculosis control, especially among risk groups such as prison officers.展开更多
Real-world evidence (RWE) is clinical evidence on a medical product’s safety and efficacy that is generated using real-world data (RWD) resulting from routine healthcare delivery. This study evaluates the clinical ef...Real-world evidence (RWE) is clinical evidence on a medical product’s safety and efficacy that is generated using real-world data (RWD) resulting from routine healthcare delivery. This study evaluates the clinical efficacy of amoxicillin + clavulanic acid in children with pharyngitis, acute otitis, or acute rhinosinusitis with suspected bacterial origin under normal office and home conditions. Methods: This was a real-life, prospective, observational, pharmacovigilance study. It included children of both sexes between 2 and 12 years old, with a diagnosis of Rhinopharyngitis (tonsillitis), Acute Otitis Media and Rhinosinusitis. The main effectiveness variable evaluated was reduction and time to resolution of symptoms. All patients received Amoxicillin/Clavulanic Acid suspension 600 mg/42.9 mg/5 mL at a dose of 90 mg/Kg/day in two doses, every 12 hours for 7 days. The evaluations were carried out at the beginning, at 72 hours (3rd day) and at 7 days. All patients underwent culture and antibiogram. Results: The majority of cultures were negative for pathogenic germs, suspecting unidentifiable germs, or viral etiology despite the rigorous selection of subjects following validated scores. The most frequently isolated germ was Staphylococcus aureus;growth of gram-negative bacteria was reported in 33.33% of the cultures. There was a significant improvement in symptoms in children with tonsillitis and rhinosinusitis from the first 72 hours of treatment, persisting until the 7 days. In the otitis media group, returning to normal by the tenth day. During the conduction of this investigation, no adverse effects associated with the prescribed therapy were reported.展开更多
The limitations of existing treatments for both Respiratory Syncytial Virus (RSV) and Severe Acute Respiratory Syndrome-related Coronavirus 2 (SARS-CoV-2) lie in their inability to provide universally accessible, easy...The limitations of existing treatments for both Respiratory Syncytial Virus (RSV) and Severe Acute Respiratory Syndrome-related Coronavirus 2 (SARS-CoV-2) lie in their inability to provide universally accessible, easy-to-use, and effective solutions. A commercially available fixed combination of chlorhexidine and lidocaine in both, lozenge and spray form, were assessed for their antiviral efficacy against RSV and SARS-CoV-2 in a suspension test, the viral titres were measured by standard TCID50. Both formulations were able to reduce the RSV titre to undetectable levels (99.9% virus inactivation, 3 log10 reduction) in less than 1 minute. The lozenge formulation inactivated the viral activity of SARS-CoV-2 in 5 minutes (99% virus inactivation, 2 log10 reduction), while the spray formulation led to a reduction of SARS-CoV-2 titre to undetectable levels in less than 1 minute (99.9%, 3 log10 reduction). In conclusion, our results show that preparations combining chlorhexidine and lidocaine significantly reduce certain respiratory viruses in vitro. In this regard, physiological effects of these preparations become more obvious potentially affecting viral transmission to other individuals and spreading to the lower respiratory tract—thereby shortening the duration and severity of symptoms.展开更多
Background: Bronchiectasis, characterized by irreversible bronchial dilation, often affects patients’ long-term health. This study assessed the prevalence and risk factors of bronchiectasis in adults based on CT scan...Background: Bronchiectasis, characterized by irreversible bronchial dilation, often affects patients’ long-term health. This study assessed the prevalence and risk factors of bronchiectasis in adults based on CT scan-finding department (OPD) patients in a single center. Methods: We retrospectively reviewed the medical records of 301 adult OPD patients examined between 2021 and 2022. We diagnosed bronchiectasis based on high-resolution chest CT scans. We analyzed demographic characteristics, tuberculosis (TB) history, and the presence of comorbid conditions using electronic medical records. We conducted univariate and multivariate analyses to identify potential risk factors for bronchiectasis. Results: Among 301 patients who had high-resolution chest CT scans, 139 (46.1%) received a diagnosis of bronchiectasis. Multivariable analysis revealed significant associations between bronchiectasis and the following factors: age greater than 50 years and history of tuberculosis. We found no significant correlation between gender and smoking history. Conclusion: This study found a high prevalence of bronchiectasis (46.1%) among OPD patients in our single center, with older age and a history of tuberculosis identified as independent risk factors.展开更多
Objective: This study aims to systematically examine the existing evidence regarding the clinical benefits of carbocysteine as an adjunctive treatment in acute bronchopulmonary and otorhinological processes. Design: S...Objective: This study aims to systematically examine the existing evidence regarding the clinical benefits of carbocysteine as an adjunctive treatment in acute bronchopulmonary and otorhinological processes. Design: Systematic review and meta-analysis. Data sources: An electronic search was conducted across PubMed, Cochrane Library, clinicaltrials.gov, and the European Clinical Trial Register, with the search dated to May 2023. Bibliographic references from other literature reviews and meta-analyses were also reviewed. The search was limited to randomized clinical trials published in any language and year. It was completed by cross-checking the references of the located articles. Methods: Inclusion criteria covered studies assessing systemic or inhaled carbocysteine, regardless of dosing regimen. Concomitant medication use was acceptable if balanced between intervention and control groups. Authors independently extracted data, resolving disagreements through consensus. Methodological quality assessment relied on critical reading of each study. Dichotomous variables were analyzed using odds ratio (OR), and a final effect size was calculated. Statistical significance was established when confidence intervals did not cross the neutral value. Heterogeneity was assessed via the X<sup>2</sup> test and I<sup>2</sup> index. Results: Out of 318 initially identified studies, 4 met inclusion criteria. The meta-analysis for poor general condition yielded an OR of 0.45 in favor of intervention, p = 0.013, with non-significant heterogeneity. Cough events showed a percentage of 15.8% for carbocysteine vs. 27.2% for placebo. On the seventh day, expectoration rates were 18.37% for carbocysteinevs 33.3% for placebo. Conclusions: The observed clinical benefits align with carbocysteine’s mucoactive and muco-regulatory properties, complemented by anti-inflammatory and antioxidant actions. Carbocysteine stands out among mucolytic agents. In the context of persistent infectious diseases, the study emphasizes the need for further exploration of carbocysteine’s therapeutic potential as an adjunctive treatment for acute respiratory infections. These findings underscore its significance in the evolving landscape of respiratory healthcare.展开更多
Introduction: Infections represent a real public health problem aggravating the morbidity and mortality of hospitalized patients. Methods: This was a retrospective study with descriptive purposes over a period of 05 y...Introduction: Infections represent a real public health problem aggravating the morbidity and mortality of hospitalized patients. Methods: This was a retrospective study with descriptive purposes over a period of 05 years, in the Pneumology Department of the University Hospital of Cocody. Results: The average age in our population was 42 years. We observed a male predo- minance of 64.5%, with a sex ratio of 1.8. Medical history was dominated by HIV infection (23.5%), followed by tuberculosis (15.6%). Concerning lifestyle, smoking was found in 38% of cases. Symptoms progressed chronically in 80% of cases. An infectious syndrome was found in 75% of cases. Microbial culture was positive in 42% of cases. Pseudomonas aeruginosa and Klebsiella pneumoniae were encountered in 26.4% of cases each, followed by Echerichia coli in 10.4% of cases. Klebsiella pneumoniae in the first three years topped the list, but gradually. Pseudomonas aeruginosa maintained its leadership over the last three years. Pseudomonas aeruginosa isolates expressed a resistance rate of 9.8% to ceftazidime and 8.1% to imipenem;to aztreonam (36%), ticarcillin (33.3%) and levofloxacin. These strains were susceptible to fosfomycin (100%), mero- penem (96.6%) and amikacin (96%). For isolated strains of Entero- bacteria- ceae, resistance was observed about ticarcillin (83.3%) and amoxicillin clavula- nic acid (71.2%). Streptococcaceae showed resistance to tetracycline (69.2%) and erythromycin (50%). Over the years there has been an increase in re- sistance to amoxicillin-clavulanic acid ceftriaxone. The death rate was 14%. Conclusion: The bacterial profile of infections is dominated by germs respon- sible for nosocomial infection with significant mortality.展开更多
Background and objective: Occupational asthma is responsible for 5 to 20% of adult asthma cases globally, and car painters are among the most at-risk workers. The objective of this study was to determine the prevalenc...Background and objective: Occupational asthma is responsible for 5 to 20% of adult asthma cases globally, and car painters are among the most at-risk workers. The objective of this study was to determine the prevalence and characteristics of car painters with probable occupational asthma in Parakou, Benin. Materials and methods: A prospective cross-sectional study was carried out between April and September 2023 in Parakou, the third most important city in Benin. Results: Overall, 116 workers in 22 car painting shops were included, 64 (55.17%) masters and 52 (44.83%) apprentices. Their mean age was 30.59 (±11.30) years, and their male-female ratio was 28:1. A past history of asthma was reported in 3 (2.59%). There were 113 (97.41%) who used gun spray;49 (42.24%) worked in a confined environment;100 (86.21%) reported breathing discomfort during painting;and 2 (1.72%) used air-filtered masks. The overall prevalence of probable occupational asthma was 10.34% (12/116;95% CI, 6.02 - 17.21), 12.50% (8/64) in masters and 7.69% (4/52) in apprentices (p = 0.398). Preceding occupational rhinitis occurred in 6 (50%). Asthma symptoms were partially controlled in 8 (66.67%) and uncontrolled in one (8.33%). Being a daily smoker (aOR = 4.59;95%CI, 1.01 - 22.00;p = 0.048) was associated with probable occupational asthma, after adjustment for age and permanent residence. Following Peak Expiratory Flow monitoring, four painters provided interpretable records, of whom three were confirmed with occupational asthma based on the Oasys scoring system. Of the 12 with probable occupational asthma, none was followed-up at occupational health departments;3 (25%) were prescribed a short-acting β-2-agonist, and no worker was treated with inhaled corticosteroids. These workers considered the impact of the disease on their productivity at work to be moderate. Conclusion: occupational asthma was common among car painters in Parakou. This calls for raising awareness on this condition, and for actions to improve the prevention and management of the disease among professionals.展开更多
Asthma is one of the most common chronic respiratory pathologies worldwide. The cost of its treatment, particularly for populations in developing countries like Senegal, requires an alternative which consists of devel...Asthma is one of the most common chronic respiratory pathologies worldwide. The cost of its treatment, particularly for populations in developing countries like Senegal, requires an alternative which consists of developing research into new therapeutic approaches with the use of plants from traditional pharmacopoeia. The objective of this study was to determine whether the hydroalcoholic extract of Terminalia avicennioides leaves has a preventive effect on the constriction of tracheal smooth muscle induced by Acetylcholine in Wistar strain rats. Methods: The species used in our experiments were male Wistar rats aged between 12 and 14 weeks. Rings of rat trachea were suspended in isolated organ chambers connected to tension sensors. Two pharmacological agents were used: acetylcholine, for its constrictor effect and adrenaline, for its dilating effect on the pulmonary trachea. Our plant material consisted of a hydroalcoholic extract of Terminalia avicennioides leaves. The experimental protocol was that of the preventive model which consisted of impregnating these rings with the extract at a defined concentration then testing its contractility in the presence of Acetylcholine which was the contractile agonist used in this study. The preventive effect of the extract was studied with an Acetylcholine contraction range on rings pre-incubated with Terminalia avicennioides extract. Results: The results showed that Acetylcholine contracts the trachea and the increase in its contractility was dependent on the dose of Ach added cumulatively (10<sup>−5</sup> to 4 × 10<sup>−5</sup> mol/l). The administration of the hydroalcoholic extract of Terminalia avicennioides leaves led to a modification of the contractile response to Acetylcholine. Indeed, this extract induced a significant attenuation of the contractile responses of the treated tracheal rings compared to those untreated. Conclusion: Terminalia avicennioides had a relaxing effect on tracheal smooth muscle and this effect could play an important role in the prevention of bronchial hyperreactivity in certain respiratory diseases, particularly asthmatic disease.展开更多
We present a case of necrotizing pneumonia in an 87-year-old man without severe respiratory instability. Clinical suspicion arose due to the need for supplementary oxygen and persistent fever during treatment for comm...We present a case of necrotizing pneumonia in an 87-year-old man without severe respiratory instability. Clinical suspicion arose due to the need for supplementary oxygen and persistent fever during treatment for community-acquired pneumonia. The diagnosis was confirmed by chest computed tomography. Although necrotizing pneumonia typically requires major surgical intervention upon diagnosis, we chose conservative management with antimicrobials and chest drainage alone. The patient experienced significant improvement and resolution of pneumonia with conservative management.展开更多
Ventilator-associated pneumonia (VAP) is a complication in as many as 28% of patients who receive mechanical ventilation. Studies have consistently shown that a delay in diagnosis and treatment increases the mortality...Ventilator-associated pneumonia (VAP) is a complication in as many as 28% of patients who receive mechanical ventilation. Studies have consistently shown that a delay in diagnosis and treatment increases the mortality risk. The aim of this work was to clarify the role of the serum procalcitonin (PCT) in the diagnosis and the prognosis of ventilator associated pneumonia. Methods: Forty two VAP patients, 20 non VAP-ICU (on mechanical ventilation) admitted patients and 20 healthy control subjects of similar age and sex were included in the study. PCT levels in serum samples were measured in all subjects. Results: There was a highly statistically significant difference (p value 0.001) between VAP patients on one side and non VAP-ICU patients and healthy control subjects on the other side regarding the mean values of PCT. Also, the mean values of PCT were statistically significantly higher (p 0.001) among died VAP group than the survivor VAP group. There was a statistically positive correlation (p = 0.449), CRIP (R = 0.403) and SOFA (R = 0.437)) and initial PCT serum levels. Conclusions: This study found that the increased PCT serum level is an important diagnostic tool for VAP and the PCT serum levels can predict the outcome of VAP patients. We recommend other larger studies to augment our findings.展开更多
Introduction: The objective of this study was the comparison of the results of T-SPOT.TB using pleural effusion (PE) with those of IGRAs using peripheral blood (PB) or other diagnostic methods for the diagnosis of tub...Introduction: The objective of this study was the comparison of the results of T-SPOT.TB using pleural effusion (PE) with those of IGRAs using peripheral blood (PB) or other diagnostic methods for the diagnosis of tuberculous (TB) pleurisy. Methods: We measured adenosine deaminase (ADA) in PE, QuantiFERON TB-Gold In-Tube (QFT), and T-SPOT.TB using PB, and T-SPOT.TB using PE. The definite group of TB pleurisy included 12 patients and other disease group 33 patients. Main find-ings: Sensitivity for QFT using PB was 83% and specificity was 85%, sensitivity for T-SPOT.TB using PB was 92% and specificity was 82%, while sensitivity for ADA in PE was 83% and specificity was 76%. When we adopted the same cut-off level of a positive response for T-SPOT.TB as PB using PE, sensitivity for T-SPOT.TB using PE was 100% and specificity was 82%, respectively. Although there were no significant differences among the four diagnostic methods, sensitivity for T-SPOT.TB using PE gave the most accurate diagnosis of TB-definite patients compared to ADA in PE or QFT using PB. Conclusions: If we performed T-SPOT.TB using a local specimen from the infection site, we could obtain a higher sensitivity than IGRAs using PB or ADA in PE and the numbers of ESAT-6 and CFP-10-positive SFCs were 3 to 5 fold higher in PEMCs than in PBMCs. T-SPOT.TB using PE may become a useful diagnostic method for TB pleurisy.展开更多
Objectives: We analyzed the clinical characteristics of patients with pulmonary mycobacterial disease diagnosed as coincidental pulmonary infection due to Mycobacterium species. Materials and Methods: One hundred sixt...Objectives: We analyzed the clinical characteristics of patients with pulmonary mycobacterial disease diagnosed as coincidental pulmonary infection due to Mycobacterium species. Materials and Methods: One hundred sixty patients satisfied the diagnostic criteria of nontuberculous mycobacterial disease proposed by American Thoracic Society during the last seven years. Six patients (3.8%) were coincidental pulmonary infection due to two Mycobacterium species. We investigated the background, laboratory findings, microbiological findings, radiological findings, treatment and prognosis. Results: There were six patients, 3 males and 3 females, with a mean age of 71.7 years. The causative microorganisms of coincidental pulmonary infection consisted of Mycobacterium avium + Mycobacterium intracellulare in two patients, Mycobacterium avium + Mycobacterium kansasii in one, Mycobacterium intracellulare + Mycobacterium chelonae in one, Mycobacterium intracellulare + Mycobacterium abscessus in one, and Mycobacterium intracellulare + Mycobacterium tuberculosis in one. Regarding the radiological findings, the distribution of the lesion was frequently shown in both the right middle and left lingula lobes, but the extent of the lesion was limited within the unilateral lung field. Centrilobular small nodules with bronchiectasis were recognized in all patients and cavities or infiltration shadows were recognized in half of them on chest computed tomography. A definite diagnosis was obtained by bronchoalveolar lavage fluid in four patients and expectorated sputum in two. Combined chemotherapy was performed for two patients and that for pulmonary tuberculosis in one. Conclusions: Coincidental pulmonary infection due to Mycobactterium species occurred at a low percentage. Although most patients were elderly with underlying disease and clinical features were compatible with pulmonary Mycobacterium avium complex disease, the prognosis was comparatively good with and without treatment.展开更多
Background/Aim: Although numerous prognostic factors have been described for non-small cell lung cancer (NSCLC), there is still a requirement for better and non-invasive markers. FDG-PET is a non invasive diagnostic t...Background/Aim: Although numerous prognostic factors have been described for non-small cell lung cancer (NSCLC), there is still a requirement for better and non-invasive markers. FDG-PET is a non invasive diagnostic tool that is being used increasingly in the diagnosis of lung cancer. This study evaluates the prognostic values of PET/CT defined SUV measurements and other patient/tumor characteristics in newly diagnosed stage IIIB and IV NSCLC. Method: This ret- rospective study included 111 patients admitted between 2005 and 2006 with stage IIIB and IV NSCLC, whose diag- noses were verified with biopsy and staging performed with PET/CT. The prognostic values of standart uptake values (SUV) of the primary lesion on PET/CT, and other patient/tumor characteristics were analyzed using survival analysis. Results: SUV was found to be unrelated with survival. Only the presence of distant metastasis, type of metastasis (bone, brain, or the contralateral lung) and the type of radiotherapy used (curative or palliative) were found to be related to survival. SUV values in epidermoid carcinoma were found to be significantly higher compared to adenocarcinoma (16.15 ± 7.18 and 12.32 ± 5.52, respectively, p = 0.021).Conclusion: Our findings do not support that SUV of the pri- mary lesion in inoperable NSCLC has a prognostic value with respect to survival. This condition may be explained by the inclusion of significantly advanced NSCLC patients who are known to have a low survival and a high mortality, and also the relatively small sampling size.展开更多
Background: Some patients present clinical features of both asthma and chronic obstructive pulmonary disease (COPD), which has led to the recent proposal of asthma-COPD overlap (ACO) as a diagnosis. Fractional exhaled...Background: Some patients present clinical features of both asthma and chronic obstructive pulmonary disease (COPD), which has led to the recent proposal of asthma-COPD overlap (ACO) as a diagnosis. Fractional exhaled nitric oxide (FeNO) is a candidate biomarker to diagnose ACO. We assessed the effect of an add-on treatment with budesonide/formoterol (BUD/FM) combination in patients with ACO, which was diagnosed by FeNO. Methods: This was a prospective, single-arm, open-label, before and after comparison study. Subjects included 83 patients with COPD who attended outpatient clinics for routine checkups at Shizuoka General Hospital between June and November 2016. All patients fulfilled the GOLD definition of COPD and were receiving long-acting muscarinic antagonist (LAMA) or LAMA/long-acting β2 agonist (LABA) combinations. After an 8-week run-in period, BUD/FM was added to the patients with FeNO levels of ≥35 ppb, defined as having ACO. For patients receiving LAMA/LABA, BUD/FM was added after the discontinuation of LABA. The modified British Medical Research Council (mMRC) score, COPD assessment test (CAT) score, spirometric indices, forced oscillation parameters, and FeNO were assessed before and after 8 weeks of BUD/ FM add-on treatment. Results: Twenty-four patients (28.9%) had FeNO levels ≥ 35 ppb, and 17 patients completed the study (mean age: 73 years and GOLD I/II/III/IV, 5/10/1/1). The mean CAT scores significantly improved (9.2 to 5.4, p = 0.015) and 10 patients (58.8%) showed ≥2 points improvement, a minimal clinically important difference. The mean FeNO levels significantly decreased from 63.0 to 34.3 ppb (p Conclusions: FeNO-guided treatment with BUD/FM improves symptoms in patients with ACO.展开更多
文摘The common cold is caused by a large range of respiratory viruses and is the most common disease of mankind. There is a great need for a prophylactic treatment for colds. Specific antiviral treatments are only effective against one group of viruses and there is a need for a non-specific treatment that can be used against all respiratory viruses. Carrageenan is a general term used to describe a range of sulfated polysaccharides extracted from edible seaweeds. Large polyanionic molecules such as carrageenan have been shown to have antiviral activity against a wide range of viruses in vitro. The strong anionic charge of carrageenan attracts and traps viruses that have positively charged areas on their surface. The trapped viruses are then unable to infect epithelial cells. Iota-carrageenan exerts its’ antiviral activity by physical means due to its high anionic charge and it does not have any pharmacological properties and therefore does not have any toxicology or known side effects from treatment. Iota-carrageenan does not have any taste or smell and, when used as a nasal spray, does not have any adverse effects. Iota-carrageenan is an ideal prophylactic treatment for the common cold and is safe for use in children. Treatment of common cold with iota-carrageenan has to date been studied in five placebo-controlled clinical trials and these trials support both efficacy as a prophylactic treatment for colds and the safety and tolerability of iota-carrageenan.
文摘Introduction: Influenza A (Flu A) and B (Flu B) viruses are responsible for severe acute respiratory infections (SARI) worldwide, with a morbidity of 5 million and mortality of 29,000 - 650,000 deaths per year. Influenza B viruses are an important cause of respiratory infections in humans, but they tend to be underappreciated due to the predominance of Influenza A. No molecular study on Influenza B has been carried out in the DRC. This study was conducted to document the molecular evolution of the hemagglutinin (HA) gene in the circulating Influenza B strains over the eight consecutive epidemic seasons (from 2015 to 2022). Methods: Samples were collected from outpatient cases suspected of influenza-like illness (ILI) and in all hospitalized patients with SARI from January 2015 to December 2022. Molecular analysis was done to determine influenza type and subtype, and then segments encoding the HA gene of Influenza B viruses were performed. Results: Of 8497 samples collected and tested, 639 (7.5%) were positive for influenza viruses, including 389 (60.8%) for Influenza A viruses and 248 (38,8%) for Influenza B viruses. Of the positive Influenza B samples, 91 were sequenced, including 26 belonging to the B/Yamagata lineage and 65 to the B/Victoria lineage. The HA gene of Influenza B viruses circulating in the DRC showed deletions in the HA1 region. Molecular analysis of Influenza B viruses reflects the genetic diversity of Influenza B/Yam virus clades (Y2, Y3, Y3V1A) alternating with Influenza B/Victoria virus clades (V1A, V1A.3) depending on the year and influenza seasons. The phylogenetic analysis of these Influenza B strains shows compatibility with the corresponding vaccine strains that the WHO had validated for each influenza season. Conclusion: This study underscores the importance of continuous molecular surveillance of Influenza B viruses in the DRC to understand their epidemiology and evolutionary dynamics. Identifying mutations, such as HA deletions, is critical for assessing their impact on transmissibility vaccine efficacy and guiding effective vaccination and control strategies.
文摘Pseudoephedrine (PSE) is a widely used nasal decongestant. A review by the European Medicines Agency has reported that PSE may be associated with risks of posterior reversible encephalopathy syndrome (PRES) and reversible cerebral vasoconstriction syndrome (RCVS). PRES and RCVS are rare but serious conditions that affect cerebral blood flow. This review discusses the pharmacology of PSE and potential risks for PRES and RCVS and concludes that considering the common use of PSE, with over 70 million packs of PSE taken each year in the European Union and the United Kingdom, and the rare occurrence of PRES and RCVS, that the risks of developing PRES/RCVS on exposure to PSE are likely to be very low.
文摘Objectives: To assess respiratory elastance and resistive properties in patients with autoimmune liver disorders using the passive relaxation expiration technique and compare findings to a group of patients with non-autoimmune liver disease and control subjects. These findings were then related to control of ventilation and gas exchange. A secondary objective was to assess respiratory muscle strength and gas exchange and their relation to respiratory mechanics. Methods: Measurements included respiratory elastance and resistance using the passive relaxation method. Pulmonary function, gas exchange and control of ventilation were assessed using standard methods. Results: a) Compared to control subjects, Ers in patients with liver disease was on average 50% greater than in controls;b) mean respiratory resistance, expressed as the respiratory constants, K<sub>1</sub> and K<sub>2</sub> in the Rohrer relationship, Pao/V’ = K<sub>1</sub> + K<sub>2</sub>V’, was not different from control resistance;c) mean maximal inspiratory and maximal expiratory pressures averaged 36% and 55% of their respective control values;d) inspiratory occlusion pressure in 0.1 sec (P<sub>0.1</sub>) was increased and negatively associated with FVC;and e) increases in P<sub>0.1</sub>, mean inspiratory flow (Vt/Ti) and presence of respiratory alkalosis confirmed the increase in ventilatory drive. Despite inspiratory muscle weakness in patients, P<sub>0.1</sub>/Pimax averaged 5-fold higher than in control subjects. Conclusions: Despite inspiratory muscle weakness and a V’<sub>E</sub> similar to that in normal subjects, central drive is increased in patients with chronic liver disease. The increase in ventilatory drive is related to smaller lung volumes and weakly associated with increase in respiratory elastance. Findings confirm that P<sub>0.1</sub> is a reliable measure of central drive and is an approach that can be used in the evaluation of control of ventilation in patients with chronic liver disease.
文摘Background: The welding trade includes many industrial activities in both the formal and informal sectors. Workers in this professional environment do not have access to individual and collective means of protection adapted to the activity, which exposes them to the dust emitted during their activity and therefore contributes to increasing the risk of developing respiratory disorders in this population. Objective: Our study aimed to evaluate the ventilatory function of metal welders in the city of Dakar. Method: This was a comparative study based on the analysis of the spirometric parameters of metal welders working in the city of Dakar (Senegal) with those of a control group of the same kind, selected from the general population. Measurements of forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), peak expiratory flow (PEF) and maximum mid expiratory flow (MMEF) were measured. Results: A total of 75 men between the ages of 19 and 61 were recruited and divided into two groups (43 controls and 32 welders). The welding population had more frequent distal and central obstructions and pulmonary restriction compared to the control group. The metals most commonly used by welders were aluminum for welders who had an obstruction, while for those who had a restriction, iron was the most used metal. Signs of metal fever were frequently found in welders, especially those with ventilatory disorders. Conclusion: The prevalence of respiratory disorders observed is close to that observed in industrial environments, where exposure levels are the highest. The lack of personal protective equipment could also be a significant risk factor in the development of these disorders.
文摘Objective: The studies of long-term oxygen therapy (LTOT) for patents with connective tissue disease-related interstitial lung disease (CTD-ILD) are limited. This study aimed to evaluate the prognosis of CTD-ILD patients following the initiation of LTOT, compared to those with idiopathic pulmonary fibrosis (IPF). Methods: We conducted a retrospective analysis of patients with CTD-ILD and IPF who were introduced to LTOT between January 2014 and December 2020. Results: The study included 24 patients with CTD-ILD and 55 patients with IPF. At the initiation of LTOT, female gender, never-smoking history, higher body mass index (BMI), higher lactate dehydrogenase (LDH) level, lower pulmonary Surfactant Protein-D (SP-D) level and lower Gender-Age-Physiology (GAP) scores were more common in the CTD-ILD group (all Conclusion: Although patients with CTD-ILD had longer overall survival than those with IPF, there was no significant difference in prognosis after the initiation of LTOT between the two groups. Early intervention including treatment and management will be needed in CTD-ILD as in IPF.
文摘This study aimed to perform a systematic review and meta-analysis to determine the LTBI prevalence in prison officers worldwide. A systematic search was performed in PubMed, WoS, Embase, and BVS, including all articles related to LTBI prevalence and risk factors. After critical evaluation and qualitative synthesis of the identified articles, a meta-analysis was used. Five studies carried out between 2012 and 2022 were included, with a total sample size of 1718 prison officers. The overall LTBI prevalence was 50% [95% confidence interval [CI]: 48% - 52%;n = 816], with high heterogeneity between studies. Smoking [OR = 1.76;CI 95% = 1.26 - 2.46] and males [OR = 2.08;CI 95% = 1.31 - 3.31] were positively related to a higher LTBI prevalence among prison officers. Thus, preventive measures and the rapid and accurate diagnosis of new cases should be emphasized to ensure tuberculosis control, especially among risk groups such as prison officers.
文摘Real-world evidence (RWE) is clinical evidence on a medical product’s safety and efficacy that is generated using real-world data (RWD) resulting from routine healthcare delivery. This study evaluates the clinical efficacy of amoxicillin + clavulanic acid in children with pharyngitis, acute otitis, or acute rhinosinusitis with suspected bacterial origin under normal office and home conditions. Methods: This was a real-life, prospective, observational, pharmacovigilance study. It included children of both sexes between 2 and 12 years old, with a diagnosis of Rhinopharyngitis (tonsillitis), Acute Otitis Media and Rhinosinusitis. The main effectiveness variable evaluated was reduction and time to resolution of symptoms. All patients received Amoxicillin/Clavulanic Acid suspension 600 mg/42.9 mg/5 mL at a dose of 90 mg/Kg/day in two doses, every 12 hours for 7 days. The evaluations were carried out at the beginning, at 72 hours (3rd day) and at 7 days. All patients underwent culture and antibiogram. Results: The majority of cultures were negative for pathogenic germs, suspecting unidentifiable germs, or viral etiology despite the rigorous selection of subjects following validated scores. The most frequently isolated germ was Staphylococcus aureus;growth of gram-negative bacteria was reported in 33.33% of the cultures. There was a significant improvement in symptoms in children with tonsillitis and rhinosinusitis from the first 72 hours of treatment, persisting until the 7 days. In the otitis media group, returning to normal by the tenth day. During the conduction of this investigation, no adverse effects associated with the prescribed therapy were reported.
文摘The limitations of existing treatments for both Respiratory Syncytial Virus (RSV) and Severe Acute Respiratory Syndrome-related Coronavirus 2 (SARS-CoV-2) lie in their inability to provide universally accessible, easy-to-use, and effective solutions. A commercially available fixed combination of chlorhexidine and lidocaine in both, lozenge and spray form, were assessed for their antiviral efficacy against RSV and SARS-CoV-2 in a suspension test, the viral titres were measured by standard TCID50. Both formulations were able to reduce the RSV titre to undetectable levels (99.9% virus inactivation, 3 log10 reduction) in less than 1 minute. The lozenge formulation inactivated the viral activity of SARS-CoV-2 in 5 minutes (99% virus inactivation, 2 log10 reduction), while the spray formulation led to a reduction of SARS-CoV-2 titre to undetectable levels in less than 1 minute (99.9%, 3 log10 reduction). In conclusion, our results show that preparations combining chlorhexidine and lidocaine significantly reduce certain respiratory viruses in vitro. In this regard, physiological effects of these preparations become more obvious potentially affecting viral transmission to other individuals and spreading to the lower respiratory tract—thereby shortening the duration and severity of symptoms.
文摘Background: Bronchiectasis, characterized by irreversible bronchial dilation, often affects patients’ long-term health. This study assessed the prevalence and risk factors of bronchiectasis in adults based on CT scan-finding department (OPD) patients in a single center. Methods: We retrospectively reviewed the medical records of 301 adult OPD patients examined between 2021 and 2022. We diagnosed bronchiectasis based on high-resolution chest CT scans. We analyzed demographic characteristics, tuberculosis (TB) history, and the presence of comorbid conditions using electronic medical records. We conducted univariate and multivariate analyses to identify potential risk factors for bronchiectasis. Results: Among 301 patients who had high-resolution chest CT scans, 139 (46.1%) received a diagnosis of bronchiectasis. Multivariable analysis revealed significant associations between bronchiectasis and the following factors: age greater than 50 years and history of tuberculosis. We found no significant correlation between gender and smoking history. Conclusion: This study found a high prevalence of bronchiectasis (46.1%) among OPD patients in our single center, with older age and a history of tuberculosis identified as independent risk factors.
文摘Objective: This study aims to systematically examine the existing evidence regarding the clinical benefits of carbocysteine as an adjunctive treatment in acute bronchopulmonary and otorhinological processes. Design: Systematic review and meta-analysis. Data sources: An electronic search was conducted across PubMed, Cochrane Library, clinicaltrials.gov, and the European Clinical Trial Register, with the search dated to May 2023. Bibliographic references from other literature reviews and meta-analyses were also reviewed. The search was limited to randomized clinical trials published in any language and year. It was completed by cross-checking the references of the located articles. Methods: Inclusion criteria covered studies assessing systemic or inhaled carbocysteine, regardless of dosing regimen. Concomitant medication use was acceptable if balanced between intervention and control groups. Authors independently extracted data, resolving disagreements through consensus. Methodological quality assessment relied on critical reading of each study. Dichotomous variables were analyzed using odds ratio (OR), and a final effect size was calculated. Statistical significance was established when confidence intervals did not cross the neutral value. Heterogeneity was assessed via the X<sup>2</sup> test and I<sup>2</sup> index. Results: Out of 318 initially identified studies, 4 met inclusion criteria. The meta-analysis for poor general condition yielded an OR of 0.45 in favor of intervention, p = 0.013, with non-significant heterogeneity. Cough events showed a percentage of 15.8% for carbocysteine vs. 27.2% for placebo. On the seventh day, expectoration rates were 18.37% for carbocysteinevs 33.3% for placebo. Conclusions: The observed clinical benefits align with carbocysteine’s mucoactive and muco-regulatory properties, complemented by anti-inflammatory and antioxidant actions. Carbocysteine stands out among mucolytic agents. In the context of persistent infectious diseases, the study emphasizes the need for further exploration of carbocysteine’s therapeutic potential as an adjunctive treatment for acute respiratory infections. These findings underscore its significance in the evolving landscape of respiratory healthcare.
文摘Introduction: Infections represent a real public health problem aggravating the morbidity and mortality of hospitalized patients. Methods: This was a retrospective study with descriptive purposes over a period of 05 years, in the Pneumology Department of the University Hospital of Cocody. Results: The average age in our population was 42 years. We observed a male predo- minance of 64.5%, with a sex ratio of 1.8. Medical history was dominated by HIV infection (23.5%), followed by tuberculosis (15.6%). Concerning lifestyle, smoking was found in 38% of cases. Symptoms progressed chronically in 80% of cases. An infectious syndrome was found in 75% of cases. Microbial culture was positive in 42% of cases. Pseudomonas aeruginosa and Klebsiella pneumoniae were encountered in 26.4% of cases each, followed by Echerichia coli in 10.4% of cases. Klebsiella pneumoniae in the first three years topped the list, but gradually. Pseudomonas aeruginosa maintained its leadership over the last three years. Pseudomonas aeruginosa isolates expressed a resistance rate of 9.8% to ceftazidime and 8.1% to imipenem;to aztreonam (36%), ticarcillin (33.3%) and levofloxacin. These strains were susceptible to fosfomycin (100%), mero- penem (96.6%) and amikacin (96%). For isolated strains of Entero- bacteria- ceae, resistance was observed about ticarcillin (83.3%) and amoxicillin clavula- nic acid (71.2%). Streptococcaceae showed resistance to tetracycline (69.2%) and erythromycin (50%). Over the years there has been an increase in re- sistance to amoxicillin-clavulanic acid ceftriaxone. The death rate was 14%. Conclusion: The bacterial profile of infections is dominated by germs respon- sible for nosocomial infection with significant mortality.
文摘Background and objective: Occupational asthma is responsible for 5 to 20% of adult asthma cases globally, and car painters are among the most at-risk workers. The objective of this study was to determine the prevalence and characteristics of car painters with probable occupational asthma in Parakou, Benin. Materials and methods: A prospective cross-sectional study was carried out between April and September 2023 in Parakou, the third most important city in Benin. Results: Overall, 116 workers in 22 car painting shops were included, 64 (55.17%) masters and 52 (44.83%) apprentices. Their mean age was 30.59 (±11.30) years, and their male-female ratio was 28:1. A past history of asthma was reported in 3 (2.59%). There were 113 (97.41%) who used gun spray;49 (42.24%) worked in a confined environment;100 (86.21%) reported breathing discomfort during painting;and 2 (1.72%) used air-filtered masks. The overall prevalence of probable occupational asthma was 10.34% (12/116;95% CI, 6.02 - 17.21), 12.50% (8/64) in masters and 7.69% (4/52) in apprentices (p = 0.398). Preceding occupational rhinitis occurred in 6 (50%). Asthma symptoms were partially controlled in 8 (66.67%) and uncontrolled in one (8.33%). Being a daily smoker (aOR = 4.59;95%CI, 1.01 - 22.00;p = 0.048) was associated with probable occupational asthma, after adjustment for age and permanent residence. Following Peak Expiratory Flow monitoring, four painters provided interpretable records, of whom three were confirmed with occupational asthma based on the Oasys scoring system. Of the 12 with probable occupational asthma, none was followed-up at occupational health departments;3 (25%) were prescribed a short-acting β-2-agonist, and no worker was treated with inhaled corticosteroids. These workers considered the impact of the disease on their productivity at work to be moderate. Conclusion: occupational asthma was common among car painters in Parakou. This calls for raising awareness on this condition, and for actions to improve the prevention and management of the disease among professionals.
文摘Asthma is one of the most common chronic respiratory pathologies worldwide. The cost of its treatment, particularly for populations in developing countries like Senegal, requires an alternative which consists of developing research into new therapeutic approaches with the use of plants from traditional pharmacopoeia. The objective of this study was to determine whether the hydroalcoholic extract of Terminalia avicennioides leaves has a preventive effect on the constriction of tracheal smooth muscle induced by Acetylcholine in Wistar strain rats. Methods: The species used in our experiments were male Wistar rats aged between 12 and 14 weeks. Rings of rat trachea were suspended in isolated organ chambers connected to tension sensors. Two pharmacological agents were used: acetylcholine, for its constrictor effect and adrenaline, for its dilating effect on the pulmonary trachea. Our plant material consisted of a hydroalcoholic extract of Terminalia avicennioides leaves. The experimental protocol was that of the preventive model which consisted of impregnating these rings with the extract at a defined concentration then testing its contractility in the presence of Acetylcholine which was the contractile agonist used in this study. The preventive effect of the extract was studied with an Acetylcholine contraction range on rings pre-incubated with Terminalia avicennioides extract. Results: The results showed that Acetylcholine contracts the trachea and the increase in its contractility was dependent on the dose of Ach added cumulatively (10<sup>−5</sup> to 4 × 10<sup>−5</sup> mol/l). The administration of the hydroalcoholic extract of Terminalia avicennioides leaves led to a modification of the contractile response to Acetylcholine. Indeed, this extract induced a significant attenuation of the contractile responses of the treated tracheal rings compared to those untreated. Conclusion: Terminalia avicennioides had a relaxing effect on tracheal smooth muscle and this effect could play an important role in the prevention of bronchial hyperreactivity in certain respiratory diseases, particularly asthmatic disease.
文摘We present a case of necrotizing pneumonia in an 87-year-old man without severe respiratory instability. Clinical suspicion arose due to the need for supplementary oxygen and persistent fever during treatment for community-acquired pneumonia. The diagnosis was confirmed by chest computed tomography. Although necrotizing pneumonia typically requires major surgical intervention upon diagnosis, we chose conservative management with antimicrobials and chest drainage alone. The patient experienced significant improvement and resolution of pneumonia with conservative management.
文摘Ventilator-associated pneumonia (VAP) is a complication in as many as 28% of patients who receive mechanical ventilation. Studies have consistently shown that a delay in diagnosis and treatment increases the mortality risk. The aim of this work was to clarify the role of the serum procalcitonin (PCT) in the diagnosis and the prognosis of ventilator associated pneumonia. Methods: Forty two VAP patients, 20 non VAP-ICU (on mechanical ventilation) admitted patients and 20 healthy control subjects of similar age and sex were included in the study. PCT levels in serum samples were measured in all subjects. Results: There was a highly statistically significant difference (p value 0.001) between VAP patients on one side and non VAP-ICU patients and healthy control subjects on the other side regarding the mean values of PCT. Also, the mean values of PCT were statistically significantly higher (p 0.001) among died VAP group than the survivor VAP group. There was a statistically positive correlation (p = 0.449), CRIP (R = 0.403) and SOFA (R = 0.437)) and initial PCT serum levels. Conclusions: This study found that the increased PCT serum level is an important diagnostic tool for VAP and the PCT serum levels can predict the outcome of VAP patients. We recommend other larger studies to augment our findings.
文摘Introduction: The objective of this study was the comparison of the results of T-SPOT.TB using pleural effusion (PE) with those of IGRAs using peripheral blood (PB) or other diagnostic methods for the diagnosis of tuberculous (TB) pleurisy. Methods: We measured adenosine deaminase (ADA) in PE, QuantiFERON TB-Gold In-Tube (QFT), and T-SPOT.TB using PB, and T-SPOT.TB using PE. The definite group of TB pleurisy included 12 patients and other disease group 33 patients. Main find-ings: Sensitivity for QFT using PB was 83% and specificity was 85%, sensitivity for T-SPOT.TB using PB was 92% and specificity was 82%, while sensitivity for ADA in PE was 83% and specificity was 76%. When we adopted the same cut-off level of a positive response for T-SPOT.TB as PB using PE, sensitivity for T-SPOT.TB using PE was 100% and specificity was 82%, respectively. Although there were no significant differences among the four diagnostic methods, sensitivity for T-SPOT.TB using PE gave the most accurate diagnosis of TB-definite patients compared to ADA in PE or QFT using PB. Conclusions: If we performed T-SPOT.TB using a local specimen from the infection site, we could obtain a higher sensitivity than IGRAs using PB or ADA in PE and the numbers of ESAT-6 and CFP-10-positive SFCs were 3 to 5 fold higher in PEMCs than in PBMCs. T-SPOT.TB using PE may become a useful diagnostic method for TB pleurisy.
文摘Objectives: We analyzed the clinical characteristics of patients with pulmonary mycobacterial disease diagnosed as coincidental pulmonary infection due to Mycobacterium species. Materials and Methods: One hundred sixty patients satisfied the diagnostic criteria of nontuberculous mycobacterial disease proposed by American Thoracic Society during the last seven years. Six patients (3.8%) were coincidental pulmonary infection due to two Mycobacterium species. We investigated the background, laboratory findings, microbiological findings, radiological findings, treatment and prognosis. Results: There were six patients, 3 males and 3 females, with a mean age of 71.7 years. The causative microorganisms of coincidental pulmonary infection consisted of Mycobacterium avium + Mycobacterium intracellulare in two patients, Mycobacterium avium + Mycobacterium kansasii in one, Mycobacterium intracellulare + Mycobacterium chelonae in one, Mycobacterium intracellulare + Mycobacterium abscessus in one, and Mycobacterium intracellulare + Mycobacterium tuberculosis in one. Regarding the radiological findings, the distribution of the lesion was frequently shown in both the right middle and left lingula lobes, but the extent of the lesion was limited within the unilateral lung field. Centrilobular small nodules with bronchiectasis were recognized in all patients and cavities or infiltration shadows were recognized in half of them on chest computed tomography. A definite diagnosis was obtained by bronchoalveolar lavage fluid in four patients and expectorated sputum in two. Combined chemotherapy was performed for two patients and that for pulmonary tuberculosis in one. Conclusions: Coincidental pulmonary infection due to Mycobactterium species occurred at a low percentage. Although most patients were elderly with underlying disease and clinical features were compatible with pulmonary Mycobacterium avium complex disease, the prognosis was comparatively good with and without treatment.
文摘Background/Aim: Although numerous prognostic factors have been described for non-small cell lung cancer (NSCLC), there is still a requirement for better and non-invasive markers. FDG-PET is a non invasive diagnostic tool that is being used increasingly in the diagnosis of lung cancer. This study evaluates the prognostic values of PET/CT defined SUV measurements and other patient/tumor characteristics in newly diagnosed stage IIIB and IV NSCLC. Method: This ret- rospective study included 111 patients admitted between 2005 and 2006 with stage IIIB and IV NSCLC, whose diag- noses were verified with biopsy and staging performed with PET/CT. The prognostic values of standart uptake values (SUV) of the primary lesion on PET/CT, and other patient/tumor characteristics were analyzed using survival analysis. Results: SUV was found to be unrelated with survival. Only the presence of distant metastasis, type of metastasis (bone, brain, or the contralateral lung) and the type of radiotherapy used (curative or palliative) were found to be related to survival. SUV values in epidermoid carcinoma were found to be significantly higher compared to adenocarcinoma (16.15 ± 7.18 and 12.32 ± 5.52, respectively, p = 0.021).Conclusion: Our findings do not support that SUV of the pri- mary lesion in inoperable NSCLC has a prognostic value with respect to survival. This condition may be explained by the inclusion of significantly advanced NSCLC patients who are known to have a low survival and a high mortality, and also the relatively small sampling size.
文摘Background: Some patients present clinical features of both asthma and chronic obstructive pulmonary disease (COPD), which has led to the recent proposal of asthma-COPD overlap (ACO) as a diagnosis. Fractional exhaled nitric oxide (FeNO) is a candidate biomarker to diagnose ACO. We assessed the effect of an add-on treatment with budesonide/formoterol (BUD/FM) combination in patients with ACO, which was diagnosed by FeNO. Methods: This was a prospective, single-arm, open-label, before and after comparison study. Subjects included 83 patients with COPD who attended outpatient clinics for routine checkups at Shizuoka General Hospital between June and November 2016. All patients fulfilled the GOLD definition of COPD and were receiving long-acting muscarinic antagonist (LAMA) or LAMA/long-acting β2 agonist (LABA) combinations. After an 8-week run-in period, BUD/FM was added to the patients with FeNO levels of ≥35 ppb, defined as having ACO. For patients receiving LAMA/LABA, BUD/FM was added after the discontinuation of LABA. The modified British Medical Research Council (mMRC) score, COPD assessment test (CAT) score, spirometric indices, forced oscillation parameters, and FeNO were assessed before and after 8 weeks of BUD/ FM add-on treatment. Results: Twenty-four patients (28.9%) had FeNO levels ≥ 35 ppb, and 17 patients completed the study (mean age: 73 years and GOLD I/II/III/IV, 5/10/1/1). The mean CAT scores significantly improved (9.2 to 5.4, p = 0.015) and 10 patients (58.8%) showed ≥2 points improvement, a minimal clinically important difference. The mean FeNO levels significantly decreased from 63.0 to 34.3 ppb (p Conclusions: FeNO-guided treatment with BUD/FM improves symptoms in patients with ACO.
