Pneumon最新文献

{"title":"Hypertrophic pulmonary osteoarthropathy on bone scintigraphy and somatostatin receptor scintigraphy","authors":"G. Meristoudis, I. Ilias, V. Giannakopoulos","doi":"10.18332/pne/141590","DOIUrl":"https://doi.org/10.18332/pne/141590","url":null,"abstract":"Dear Editor, Hypertrophic osteoarthropathy (HOA) as a paraneoplastic disorder is most often associated with pulmonary malignancies1. Bone scintigraphy (BS) is known to be useful for detecting HOA1,2. Here, we present a lung cancer patient who demonstrated findings consistent with HOA on BS and somatostatin receptor scintigraphy (SRS). To the best of our knowledge, this is the first report of HOA visualized by SRS. A female aged 67 years, smoker (47 pack-years), presented with a 3-month history of generalized arthralgia, painful edema of the limps, and finger clubbing. BS using 99mTc-MDP demonstrated increased linear periosteal uptake in the long bones of the legs (Figure 1A), a characteristic scintigraphic pattern of HOA. A chest X-ray was done (given her history of smoking) and showed a mass in the right posterior hemithorax confirmed by computed tomography (CT) scan (Figure 2C). Further functional imaging with SRS using 99mTc-octreotide revealed that the pulmonary lesion was positive for somatostatin receptors (Figure 2D). Also, it showed mildly increased tracer uptake along the periosteum of both lower extremities (Figure 1B). Ultimately, histopathological examination revealed lung adenocarcinoma. ΗΟΑ, also named Marie–Bamberger syndrome was first described in the 1890s and is characterized clinically by periostitis of tubular bones, digital clubbing, and arthritic symptoms1. It can be classified as primary (very rare) or secondary (approximately 95% to 97% of cases). Secondary HOA is associated with a wide spectrum of diseases, including a variety of pulmonary disorders, also known as ‘hypertrophic pulmonary osteoarthropathy’ (e.g. primary and metastatic lung cancer, lung abscess, tuberculosis, sarcoidosis, emphysema, bronchiectasis, pulmonary fibrosis, and mesothelioma), cardiovascular disorders (e.g. cyanotic congenital heart disease, infective endocarditis), gastrointestinal disorders (inflammatory bowel disease and hepatic cirrhosis) and various other disorders. Secondary HOA is more frequently related to pulmonary malignancies (in up to 90%), especially lung cancer1. According to published reports, 4% to 32% of lung cancer patients develop HOA3. The clinical manifestations of HOA may precede the diagnosis of the underlying disease. BS is a sensitive imaging modality for evaluating a wide variety of skeletal disorders, including HOA1,2. This modality has higher sensitivity for detecting bone metastases in patients with lung cancer compared to SRS4,5. The exact mechanism of pathogenesis of HOA and clubbing remains unknown. Two models have been proposed: a neurogenic pathway and a humoral pathway. In the neurogenic pathway, diseased organs innervated by the vagus nerve induce a neural reflex leading to vasodilatation and increased blood flow to the extremities6. In the humoral pathway cytokines and growth factors (platelet-derived growth factor, prostaglandin E, and vascular endothelial growth factor) induce connective tissue and periosteal","PeriodicalId":42353,"journal":{"name":"Pneumon","volume":"7 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2021-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84122338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COVID-19 pandemic impact on seasonal flu vaccination: A cross-sectional study","authors":"Ioannis Kopsidas, Evangelia Chorianopoulou, Eleni Kourkouni, C. Triantafyllou, Nafsika-Maria Molocha, Markela Koniordou, S. Maistreli, Christina-Grammatiki Tsopela, S. Maroudi-Manta, Dimitrios K Filippou, T. Zaoutis, G. Kourlaba","doi":"10.18332/pne/136173","DOIUrl":"https://doi.org/10.18332/pne/136173","url":null,"abstract":"INTRODUCTION Vaccination against the flu is the best method for the prevention of illness by influenza viruses. The objective of this study was to assess the impact of the COVID-19 pandemic on the seasonal influenza vaccination attitudes in Greece and to identify factors associated with a positive change in participants’ choice to vaccinate against the flu. METHODS This is a sub-analysis of a cross-sectional nationwide survey (n=1004) that was conducted between 28 April and 3 May 2020 using a mixed methodology for data collection: computer assisted telephone interviewing (CATI) and computer assisted web interviewing (CAWI). Sampling followed a proportionate, stratified by region, systematic procedure to ensure a nationally representative sample of the urban/rural population. Data were collected using a structured questionnaire consisting of four parts: 1) demographics;2) knowledge about COVID-19;3) attitudes toward COVID-19;and 4) practices to control COVID-19 and vaccination against the flu. RESULTS Of the respondents, 66.3% (n=665) had not been vaccinated for seasonal influenza during the 2019–2020 season, the period prior to the COVID-19 pandemic. However, of those, 21.8% showed willingness to receive the vaccine (n=145) the upcoming flu season 2020–2021. Factors independently associated with increased intention to vaccinate in those that had not been vaccinated the previous flu season included: age ≥65 years;the belief that vaccination against the flu is considered preventive against the spread of the coronavirus;not believing that coronavirus was man-made in a laboratory;and not believing that the pandemic will end once a large percentage of the population is infected. CONCLUSIONS Factors that shift public opinion in favor of seasonal flu vaccination can be utilized to design effective strategies to increase vaccination uptake. © 2021 Kopsidas I. et al.","PeriodicalId":42353,"journal":{"name":"Pneumon","volume":"3 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2021-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86185466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interventional bronchoscopic management of recalcitrant adenoid cystic carcinoma obstructing central airways","authors":"E. Chousein, Demet Turan, E. Tanrıverdi, B. Yıldırım, Mustafa Çörtük, H. Çınarka, M. Özgül, E. Çetinkaya","doi":"10.18332/pne/136174","DOIUrl":"https://doi.org/10.18332/pne/136174","url":null,"abstract":"INTRODUCTION Adenoid cystic carcinoma (ACC) of the lung is a rare tumor with a propensity to cause central airway obstruction. Prolonged patient survival with high recurrence rates despite surgery, oncologic treatment or interventional bronchoscopic procedures (IBPs) poses long-term management challenges. With this study we aimed to review IBPs and their outcome in patients with ACC. METHODS We retrospectively reviewed the demographics, bronchoscopic findings, IBP treatment modalities and outcomes of patients with a diagnosis of ACC between January 2009 and December 2020. RESULTS There were 13 patients (9 male, 69.2%) with a mean age of 54.61±8.7 years. Trachea was the most involved site (10 cases, 76.9%) and percentage of obstruction was 77±13.9%. Bronchoscopy most commonly identified an endoluminal lesion (84.6%). There was a total of 77 procedures, including 44 rigid and 31 flexible bronchoscopies. Seven patients underwent a single procedure and 6 patients more than one procedure. Most common interventional bronchoscopic treatment modalities used were argon plasma coagulation (40.2%) and mechanical resection (38.9%). Airway stents were inserted in 4 (30.7%) patients. Airway patency was restored following first-line IBP in 93% of patients. The rate of early complications within the first 24 hours was 6.8%. Late complications were seen in 33.7% and were all stent related. No procedure related mortality was observed. CONCLUSIONS ACC affects central airways and most frequently the trachea. IBPs can be repeatedly used in the treatment of ACC because of their low early complication rates. Patients treated with airway stents should be closely followed up for late complications. ABBREVIATIONS ACC: adenoid cystic carcinoma, APC: argon plasma coagulation, CAO: central airway obstruction, COPD: chronic obstructive pulmonary disease, EBUS: endobronchial ultrasonographies, FB: flexible bronchoscopies, IBP: interventional bronchoscopic procedure, IP: interventional pulmonology, RB: rigid bronchoscopies. INTRODUCTION Adenoid cystic carcinomas (ACC) are rarely encountered tumors with a propensity for frequent recurrences originating from secretory glands of the tracheobronchial system that comprise 0.04–0.2% of all lung cancers. Previously classified as benign tumoral lesions, they are currently grouped under low-grade malignant tumors1. Although uncommonly encountered, they can lead to life threatening central airway obstruction (CAO). They progress insidiously, slowly growing longitudinally within the airways. Frequently patients are incorrectly diagnosed with and treated for asthma or chronic obstructive pulmonary disease (COPD). In patients who have already been diagnosed with ACC, worsening respiratory symptoms can be erroneously attributed to comorbidities or side effects of oncologic treatments. Consequently, both the initial diagnosis and the detection of disease progression can be delayed1,2. The treatment of choice is surgical resection. The longter","PeriodicalId":42353,"journal":{"name":"Pneumon","volume":"161 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2021-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74306573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spontaneous Pneumomediastinum and Subcutaneous Emphysema in the course of COVID-19 disease: A case report and review of the literature","authors":"M. Kipourou, Konstantinos Karozis, S. Lampridis, Stergios Gkintikas, Dimitrios Molyvas, P. Koutoukoglou, E. Kaitalidou, Irina Giannopoulou, I. Tsanaktsidis, D. Karapiperis","doi":"10.18332/PNE/136001","DOIUrl":"https://doi.org/10.18332/PNE/136001","url":null,"abstract":"The coronavirus disease 2019 (COVID-19), caused by the SARS-CoV-2, has resulted in widespread global morbidity and mortality. Herein, we report a case of spontaneous pneumomediastinum and subcutaneous emphysema of the neck and chest wall in a patient hospitalized with respiratory failure due to COVID-19. Since our patient was not treated with mechanical ventilation, this case demonstrates that spontaneous pneumomediastinum can appear in patients with COVID-19 regardless of barotrauma and highlights the pathophysiology of this complication. © 2021 Kipourou M. et al.","PeriodicalId":42353,"journal":{"name":"Pneumon","volume":"32 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2021-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88732959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Concomitant diagnosis of asthma and allergic bronchopulmonary aspergillosis in a previously healthy 26-year old Afghani male","authors":"F. Sampsonas, M. Katsaras, O. Papaioannou, T. Karampitsakos, L. Kakoullis, A. Tzouvelekis","doi":"10.18332/PNE/135957","DOIUrl":"https://doi.org/10.18332/PNE/135957","url":null,"abstract":"METHODS A 26-year-old male presented with a 3-week history of dyspnea on exertion, chest tightness and productive cough with excretion of copious purulent secretions. The patient did not report fever, weight loss or haemoptysis. He had no history of asthma or atopy. Physical examination revealed a respiratory rate of 19/min and SpO2 of 95% on room air, polyphonic wheezing, crackles in middle lung zones and significant digital clubbing.","PeriodicalId":42353,"journal":{"name":"Pneumon","volume":"42 1","pages":"1-2"},"PeriodicalIF":0.7,"publicationDate":"2021-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78501246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sarcopenia in COPD patients: Prevalence, patients’ characteristics and predictive factors","authors":"V. Poberezhets, S. Skoczyński, A. Demchuk, A. Oraczewska, Ewelina Tobiczyk, Y. Mostovoy, A. Barczyk","doi":"10.18332/PNE/135711","DOIUrl":"https://doi.org/10.18332/PNE/135711","url":null,"abstract":"INTRODUCTION Taking into consideration multifactorial origin of sarcopenia and extrapulmonary manifestations of chronic obstructive pulmonary disease (COPD), our study aimed to determine the prevalence and predictive factors for sarcopenia among COPD patients. METHODS We examined 190 patients with COPD in Ukraine and Poland using bioelectric impedance analysis, hand-grip dynamometry, 6MWT and several questionnaires to assess clinical characteristics of the patients. RESULTS Sarcopenia was detected in 25.3% of all patients with COPD. There was a significant difference between patients with and without sarcopenia in age, acute exacerbations of COPD, CAT, FEV1, BODE and CCI, Borg scope (post 6MWT), hand-grip strength, BMI, fat mass index, level of visceral fat, fat percentage, skeletal muscle index, gait speed, and 6MWT distance. According to regression analysis, factors related to sarcopenia were body mass index, visceral fat level, daily physical activity, percentage of fat and GOLD 3 airflow limitation. CONCLUSIONS Sarcopenia affected almost every fourth COPD patient and was associated with low BMI, high level of visceral fat and percentage of body fat, limited physical activity, and severe airflow limitation. Abbreviations 6MWT: the 6-minute walk test, BMI: body mass index, BODE index: body mass index, airflow obstruction, dyspnoea, exercise capacity index, CAT: the COPD assessment test, CCI: Charlson comorbidity index, COPD: chronic obstructive pulmonary disease, FEV1: forced expiratory volume in one second, mMRC: modified Medical Research Council, SaO2: oxygen saturation, SGRQ: St. George’s respiratory questionnaire. INTRODUCTION Chronic obstructive pulmonary disease (COPD) as a systemic disease is usually present with numerous comorbidities. One of the most common overlapping diseases is a skeletal muscle dysfunction. According to the GOLD 2020 Report, skeletal muscle dysfunction is characterized by loss of muscle cells and dysfunction of the remaining cells1. This definition is similar to the definition of the sarcopenia from the latest revision of European Working Group on Sarcopenia in Older People (EWGSOP2), according to which sarcopenia should be defined as low muscle strength combined with low muscle quantity or quality2. EWGSOP2 highlighted the role of sarcopenia as an important factor responsible for the impairment of daily physical activity, development of the cardiometabolic syndrome, and other complications. Presence of sarcopenia should be considered as being associated with an overall mortality and COPD-related mortality risk factor3, increased length of hospital stay, risk for hospitalization, lower probability of being discharged home4 and independently increasing hospital costs at hospital admission from 34% to 58.5% depending on the age of the population5. According to Goates et al.6, sarcopenia results in a great economic burden on the US healthcare system with total costs of hospitalizations amounting to more than US$ 19 bi","PeriodicalId":42353,"journal":{"name":"Pneumon","volume":"76 4 1","pages":"1-7"},"PeriodicalIF":0.7,"publicationDate":"2021-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77506494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pulmonary laceration and contusion in a young male patient due to a motorcycle accident","authors":"V. Apollonatou, G. Verykokou, Aggeliki Lazaratou, A. Papaioannou, Mirto Kardara, I. Papadiochos, Veroniki Papakosta, S. Vassiliou, E. Koursoumi, Panteleimon Messaropoulos, C. Kontopoulou, S. Loukides, E. Manali, S. Papiris","doi":"10.18332/PNE/136153","DOIUrl":"https://doi.org/10.18332/PNE/136153","url":null,"abstract":"Chest trauma injuries are one of the main causes of death in young people and include lung contusions, lacerations, pneumothorax, hemothorax, rib fractures and tracheobronchial injuries. Pulmonary contusions are the most common identified entities after trauma, and they result in alveolar hemorrhage without loss of the physiological structure of lung parenchyma. On the other hand, pulmonary lacerations, which are often associated with contusions, result in rupture of the alveoli causing formation of cavities. Patients present symptoms ranging from minimal to severe, including cough, chest pain, hemoptysis, dyspnea, tachypnea, and hypoxemia. Findings may not be apparent immediately after injury and chest CT is the most sensitive imaging technique for diagnosis. Contusions usually resolve with supportive care in 5–7 days. In this report, we present a case of lung contusion and laceration in a 19-year-old patient after a motorcycle accident. INTRODUCTION Chest trauma injuries are one of the main causes of death in young people and include lung contusions, lacerations, pneumothorax, hemothorax, rib fractures and tracheobronchial injuries1,2. Pulmonary contusion is the most common identified entity after trauma and usually results from blunt chest trauma (traffic accidents, falls from great heights), shock waves associated with penetrating chest injury, or explosion injuries3,4. Unlike contusion, pulmonary laceration results in disruption of the architecture of the lung and could potentially cause more serious damage. Pulmonary lacerations are commonly caused by penetrating trauma and result in formation of one or multiple cavities filled with air, blood, or both5. In this report, we present a case of lung contusion and laceration in a 19-year-old patient after a motorcycle accident. CASE PRESENTATION A 19-year-old patient, non-smoker, without previous medical history, presented to the emergency room due to fever and pain at the right periorbital area of the face after a motorcycle collision twenty-four hours ago. The patient was examined initially by general surgeons. He was febrile (38°C) and hemodynamically stable. His oxygen saturation was normal (SatO2: 98% breathing room air) and he had normal breath sounds in auscultation. From physical examination, he presented with bruise injuries in the right side of the face and a right periorbital hematoma. His laboratory examinations revealed normal hemoglobin (15.9 g/dL), elevated white blood cell count (14.90 K/μL with 78.7% neutrophils), elevated creatine kinase (956 U/L) and elevated C reactive protein (96.9 mg/L). After exclusion of SARS-Cov-2 infection, he underwent computed tomography (CT) of the head which showed fracture displacement AFFILIATION 1 2nd Pulmonary Medicine Department, Attikon University General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece 2 Western Attica General Hospital Agia Barbara, Athens, Greece 3 Clinic of Oral & Maxillofacial Su","PeriodicalId":42353,"journal":{"name":"Pneumon","volume":"289 1","pages":"1-6"},"PeriodicalIF":0.7,"publicationDate":"2021-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72765702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ferritin levels in critically ill patients with COVID-19: A marker of outcome?","authors":"G. Dimopoulos, A. Sakelliou, A. Flevari, K. Tzannis, E. Giamarellos‐Bourboulis","doi":"10.18332/PNE/135958","DOIUrl":"https://doi.org/10.18332/PNE/135958","url":null,"abstract":"Dear Editor, The severe form of Coronavirus Disease 2019 (COVID-19) is a systemic disease associated with high mortality rate1,2. Elderly, mainly men with comorbidities, are at increased risk of death. Νevertheless, younger individuals, without underlying diseases, may also develop lethal complications (myocarditis, disseminated intravascular coagulopathy, neurological complications etc.)3,4. In the ICU of ATTIKON University Hospital (one of the 5 Reference Hospitals for COVID-19 in Athens, Greece), from 5 August to 30 September 2020, 16 (100%) critically ill patients with COVID-19 were admitted (median age 70.5 years, IQR 58–79). The patients were divided into survivors [Group A: 9 (56.3%)] and non-survivors [Group B: 7 (43.7%)](Table1). At the time of ICU admission, the viral load of coronavirus (expressed in Circles trough: Ct) was significantly higher in non-survivors [Group A: 23 (IQR 21–25) vs Group B: 21 (IQR 20–22), p=0.042], while ferritin levels were similar in both groups [Group A: 1290 ng/mL (IQR 550–3572) vs Group B: 980 (IQR 543–3915), p=0.71]. During ICU stay, the viral load remained permanently high in non-survivors [Group A: 32 (IQR 32–37) vs Group B: 22 (IQR 19–24), p=0.001], but it was gradually diminished among survivors [Group A: 39.1% (IQR 30.4–42.9) vs Group B: 0 (IQR -4.8–14.30), p=0.001]. In parallel, ferritin levels were increased by 109.7% (IQR 25.7–382), whatever was higher in non-survivors [Group A: 55.7% (IQR 13.3–85) vs Group B: 486.1% (IQR 137.2–761.9), p=0.007] (Table 1). The HScore, which is an indicator of macrophage activation, was higher in non-survivors [Group A: 54 (IQR 19–70) vs Group B: 87 (IQR 68–99), p=0.048)]. Finally, in this cohort, 9 (56.3%) patients survived and 7 (43.7%) died because of ARDS/Multiple Organ Failure (MOF) (one of the patients developed myocarditis). A consistent proportion of COVID-19 patients will develop acute respiratory distress syndrome (ARDS) related to increased production of cytokines (the so-called cytokine storm) and a small subset secondary haemophagocytic lymphohistiocytosis (sHLH), a T-cell driven hyperinflammatory, ‘hyperferritinemic syndrome’5. These are the two main causes of mortality in the severe form of COVID-19. The sHLH development reflects the ability of coronavirus to bind TLRs and to activate inflammasome through IL-1β release, but the relationship is not clear since many COVID-19 patients, even with bad prognosis, do not meet the classification criteria of HScore (Table 2)6,7. In light of the absence of highly increased HScore, ferritin remains high and reveals constant macrophage activation albeit not to such an extent as to be the full-blown sHLH8-10. In our cohort, high viral load and ferritin levels have been observed in non-survivors indicating a relation between the activity of the disease and the outcome of the patients. A future research perspective could be focused on the following three questions: a) ‘Is COVID-19 a hyperferritinemic syndrome withou","PeriodicalId":42353,"journal":{"name":"Pneumon","volume":"18 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2021-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83705022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Secondary bacterial infections in patients with COVID-19","authors":"A. Lachana, E. Chrysanthopoulou, Fotini Vakiarou, G. Dimopoulos","doi":"10.18332/PNE/136152","DOIUrl":"https://doi.org/10.18332/PNE/136152","url":null,"abstract":"Coronavirus Disease 2019 (COVID-19) has been classified as a global threat, affecting millions of people and killing thousands. It is caused by the SARS-CoV-2 virus, which emerged at the end of 2019 in Wuhan, China, quickly spreading worldwide. Patients’ clinical features vary, and secondary infections represent a constant risk of increased mortality among those who need hospitalization. Damaged respiratory epithelium and dysregulation of the immune response are the main pathophysiological mechanisms of increased microbial adhesion to the airway epithelial cells and the development of secondary infections. However, the exact incidence of secondary infections in COVID-19 patients is not thoroughly known (3.2%–80%) due to limited and heterogeneous studies that lead to conflicting or non-comparable results. Infection-risk stratification in critically ill patients includes early ICU admission (within 48 hours from hospitalization), age, comorbidity, immunosuppressive drugs administration, and disease severity indexes (oxygenation, inflammation, and cytolysis score). In treating secondary infections, the local epidemiology (which usually includes multidrug-resistant strains) and the modification of any antibiotic regimen according to the cultures’ results are critical. Prompt and appropriate antimicrobial agents represent the cornerstone in secondary infection treatment for COVID-19 hospitalized patients. © 2021 Lachana A. et al.","PeriodicalId":42353,"journal":{"name":"Pneumon","volume":"31 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2021-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84421014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Older age, disease severity and co-morbidities independently predict mortality in critically ill patients with COPD exacerbation","authors":"M. Galani, A. Kyriakoudi, Efrosyni Filiou, M. Kompoti, Gabriel Lazos, Sofia-Antiopi Gennimata, I. Vasileiadis, M. Daganou, A. Koutsoukou, N. Rovina","doi":"10.18332/pne/139637","DOIUrl":"https://doi.org/10.18332/pne/139637","url":null,"abstract":"INTRODUCTION Mechanically ventilated critically ill patients with acute COPD exacerbation (AECOPD) have significantly higher rates of morbidity and mortality compared to patients hospitalized for AECOPD but not requiring ventilatory support. The aim of this study was to describe the characteristics and outcomes of ventilated critically ill AECOPD patients and to identify prognostic variables associated with 28-day ICU mortality. METHODS One hundred and twenty-seven patients admitted to the University respiratory ICU in ‘Sotiria’ Hospital due to AECOPD were retrospectively studied. Data were extracted from the medical records of the ICU database. Demographic features, comorbidities, disease severity, exacerbation rate, and treatment, were recorded along with SOFA and APACHE-II scores and laboratory variables. RESULTS Thirty-five percent of the patients died in the ICU (mean age 73±8 vs 67±8 years in survivors, p<0.001). Non-survivors had significantly more comorbidities compared to survivors (p<0.001), significantly higher APACHE II score (30±7 vs 22±7, p<0.001), and significantly higher rates of multi-organ failure (MOF) (62% vs 10.2%, p<0.001). Independent factors associated with ICU mortality were older age (OR=1.13 per year increase; 95% CI: 1.04–1.22, p=0.004), APACHE II score on admission (OR=1.11 per unit increase; 95% CI: 1.04–1.22, p=0.004), Charlson Comorbidity Index (CCI) (OR=1.79 per unit increase; 95% CI: 1.25–2.55, p=0.001), admission lactate levels (OR=2.60 per mEq/L increase; 95% CI: 1.17-5.80, p=0.019), and COPD severity (OR=4.57; 95% CI: 1.14–18.22, p=0.032). CONCLUSIONS Severe physiological derangement upon ICU admission, COPD disease severity and high co-morbidity burden are predictive factors of 28-day mortality in critically ill AECOPD patients. INTRODUCTION Chronic obstructive pulmonary disease (COPD), a chronic inflammatory disease leading to irreversible airflow limitation, is the third leading cause of death and a substantial source of disability, worldwide1. Acute exacerbations of COPD (AECOPD) contribute at large to the progressive decline in the quality of life and the functional status of these patients2. Moreover, moderate to severe AECOPD may lead to respiratory failure, requiring invasive mechanical ventilation and admission to the intensive care unit (ICU). Critically ill patients with AECOPD admitted to the ICU have significantly higher rates of morbidity and mortality compared to patients hospitalized for AECOPD but not requiring ventilatory support3-7. The severity of the disease per se, the co-existence of multiple co-morbidities, as well as the ICUrelated complications may justify, in part, this fact8-11. Infectious exacerbations or end-stage disease have been identified as major causes of ICU admittance12-14. As yet, many studies have attempted to identify independent predictors of the outcomes of these patients in the ICU, however, the results are not consistent across studies, except for Acute Physiology a","PeriodicalId":42353,"journal":{"name":"Pneumon","volume":"25 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83415446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}