Chronic Pneumonia Research Articles

Deep learning modified neural networks with chicken swarm optimization-based lungs disease detection and severity classification

Many people around the world are affected by pulmonary disease as well as asthma, pneumonia, lung cancer, and tuberculosis. All of these conditions have one thing in common: airway obstruction. Lung illnesses are a worldwide issue in which chronic obstructive pulmonary disease, pneumonia, asthma, tuberculosis, and fibrosis are few of the most common. An accurate diagnosis of a lung problem is essential, and it has been pursued by many researchers using image processing and machine learning models. Multiple deep learning methods are used to predict lung disease; these include convolutional neural networks, vanilla neural networks, visual geometry group-based neural networks, and the capsule network. Medical data are scarce, so diagnosing pulmonary diseases using chest x-ray pictures from datasets with less than 1000 samples is considered to address the problem. Three deep learning multiple neural networks (DLMNNs) were generated using the chicken swarm optimization (CSO) approach, for which transfer learning was applied to evaluate the performance of each. First, we created an algorithm for segmenting CXR images, and then we compared it with other classification systems. Our results were compared with those of other methods using publicly available data from the Shenzhen and Montgomery lung datasets. However, our technique has a lower number of trainable parameters compared with the best-performing models trained on the Montgomery dataset. The DLMNN-CSO virtually matched the best performance on the Shenzhen dataset, although it was computationally less expensive than the other models. DLMNN-CSO’s validation loss was 0.4, whereas the validation loss for CNN, VDSNet, VGG, and DBN was 0.9, 0.8, 0.6, and 0.5, respectively.

Ruptured arteriovenous malformation mortality: Incidence, risk factors, and inpatient outcome score.

Limited literature exists on the morbidity and mortality of AVM associated intracerebral hemorrhage (ICH) compared with non-AVM ICH. We examine morbidity and mortality in cAVM in a large nationwide inpatient sample to create a prognostic inpatient ruptured AVM mortality score. This retrospective cohort study from 2008 to 2014 compares outcomes in cAVM related hemorrhages and ICH utilizing the National Inpatient Sample database. Diagnostic codes for ICH and AVM underlying ICH were identified. We compared case fatality according to medical complications. Multivariate analysis was used to derive hazard ratios and 95% confidence intervals to assess odds of mortality. We identified 6496 patients with ruptured AVMs comparing them to 627,185 admitted with ICH. Mortality was lower for ruptured AVMs (11%) compared to ICH (22%) [p < 0.01]. Mortality associated factors were liver disease (OR 2.64, CI 1.81-3.85, p < .001), diabetes mellitus (OR 2.42, CI 1.38-4.22, p = 0.002), alcohol abuse (OR 1.81, CI 1.31-2.49, p = 0.001), hydrocephalus (OR 3.35 CI 2.81-4.00, p < 0.001), cerebral edema (OR 1.5, 1.25-1.85, p < 0.001), cardiac arrest (OR 15, CI 7.9-30, p < 0.001), and pneumonia (OR 1.93, CI 1.51-2.47, p < 0.001). A 0-5 ruptured AVM mortality score was developed: Cardiac arrest (=3), age >60 (=1), Black race (=1), chronic liver failure (=1) diabetes mellitus (=1), pneumonia (=1), alcohol abuse (=1) and cerebral edema (=1). Mortality increased with score. No patient with 5 or more points survived. The Ruptured AVM Mortality Score allows for risk stratification on patients with ICH due to ruptured AVM. This scale could prove useful in prognostication and patient education.

Hypersensitivity pneumonitis: Principles in diagnosis and management.

Hypersensitivity pneumonitis: Principles in diagnosis and management.

Invasive cerebral aspergillosis in non-neutropenic patients: A case series from Western India.

Invasive cerebral aspergillosis (ICA) is a rare but fatal infection affecting neutropenic immunocompromised patients. Recently cases have been reported in non-neutropenic settings also. We hereby present a series of ICA cases in non-neutropenic patients diagnosed at our tertiary care centre in Western India between March to October 2021. All patients with clinico-radiological suspicion of CNS infections were analysed. Data regarding Clinico-radiological features, diagnosis, treatment and outcome were collected. After ruling out bacterial, viral and mycobacterial causes, appropriate samples were sent for KOH (potassium hydroxide) wet mount, fungal culture, histopathology and serum/CSF galactomannan. A total of four patients were diagnosed with ICA with a mean age of 43.5 years. Three patients had significant comorbidities; Diabetes mellitus, chronic liver disease and COVID-19 pneumonia treated with dexamethasone, respectively. One patient had no known predisposing factor. Radiologically, one patient presented with a frontal brain abscess and two patients had multiple subcortical hyperintensities. Three patients were diagnosed based on CSF galactomannan (Platelia™ Aspergillus antigen, Bio-Rad, France) with OD >1 and one patient had high serum galactomannan (OD >2). CSF culture grew Aspergillus species in two patients. All patients were treated with Voriconazole. One patient recovered, and the remaining three succumbed due to delayed presentation and extensive cerebral involvement. Even in non-neutropenic patients, a high index of suspicion is warranted for cerebral aspergillosis. CSF galactomannan can be considered a reliable marker for diagnosing ICA in non-neutropenic settings. Early diagnosis allows timely antifungal therapy, which could be a key to improving the outcomes.

DOCK 8 IMMUNODEFICIENCY

Autosomal recessive (AR) DOCK8 deciency is a well-known actinopathy, a combined primary immune deciency with impaired actin polymerization that results in altered cell mobility and immune synapse. DOCK8-decient patients present early in life with eczema, viral cutaneous infections, chronic mucocutaneous candidiasis, bacterial pneumonia and abscesses, together with eosinophilia, thrombocytosis, lymphopenia, and variable dysgammaglobulinemia that usually includes Hyper-IgE. In fact, before its genetic aetiology was known, patients were described as having a form of Hyper-IgE syndrome, a name now deprecated in favour of genetic defects. We describe a school-age female patient with a clinical picture suggestive of DOCK8 deciency, except for high serum IgE or a family history: early onset, failure to thrive, oral fungating lesion, generalized maculopapular rashes, bronchiolitis, pneumonia, recurrent otitis media, bronchiectasis, candidiasis, leucocytosis, eosinophilia, high IgA, low IgG and low CD4+ T cells. We were able to conrm the diagnosis through protein expression and whole-exome sequencing. We review the clinical, laboratory, and genetic features of 200 DOCK8-decient patients. Despite this, the constellation of signs, symptoms, and ndings allow the suspicion of DOCK8 deciency and other actinopathies.

Clinical features and treatment of activated PI3K-delta syndrome in Peruvian children: A case series

IntroductionActivated phosphoinositide 3-kinase δ (PI3Kδ) syndrome (APDS) is an inborn error of immunity (IEI) caused by a gain-of-function mutation in the PIK3CD gene. It is characterized by recurrent respiratory infections, chronic herpes infections, lymphoproliferation, mucosal lymphoid hyperplasia, enteropathy and immune dysregulation. This condition can be misdiagnosed with other diseases, such as lymphoma or other IEI. Additionally, limited knowledge of APDS in physicians could generate delay in diagnosis, treatment and lead to worse outcomes, especially in developing countries. This study aimed to describe the clinical features and treatment of APDS in Peruvian children evaluated in two centers. MethodsWe retrospectively analyzed data from eight patients with APDS evaluated in the two main Peruvian clinical immunology centers. Demographics, clinical features, laboratory analysis, and treatment data were included. ResultsAll patients were female. At the onset of symptoms and diagnosis, the mean age was 1.4 (SD: 0.98) and 6 (SD: 2.1) years, respectively. The mean delay in diagnosis was 4.5 (SD: 2.7) years. No consanguinity was reported, and only one patient had a family history of IEI. The mortality rate was 25% (2 patients). The main clinical manifestations were lymphadenopathy and hepatomegaly (100%), chronic diarrhea and recurrent pneumonia (87.5%), and splenomegaly (62.5%). All the patients had E1021K mutation. Seven patients (87.5%) had elevated IgG and 50% had elevated IgM. Regarding treatment, all the patients received intravenous immunoglobulin (IVIG), 50% were treated with everolimus and only one patient received hematopoietic stem cell transplantation. ConclusionLymphadenopathy, hepatosplenomegaly, chronic diarrhea, pneumonia, and IVIG treatment were the main features. Our cohort had limited treatment options with calcineurin inhibitors and transplantation and laboratory testing such as lymphocyte population and functional antibody tests. Although genetic testing was done on all the patients, it was supported by international collaboration. Therefore, further studies are needed to evaluate the diagnosis and management impact on patients with APDS in our setting.

Achromobacter xylosoxidans as emerging pathogen in healthcare settings: A mini review

Microorganisms of the genus Achromobacter have been mentioned as a cause of opportunistic infections, mainly in patients with cystic fibrosis or pulmonary lymphoma, with the species Achromobacter xylosoxidans being identified to a large extent. A. xylosoxidans was first described in 1971 and is an opportunistic pathogen. However, it been reported to cause chronic purulent otitis, meningitis, pneumonia, peritonitis and urinary tract infections, chronic obstructive pulmonary disease and other infections. The present literature review aims to analyze and synthesize the state of the art on A. xylosoxidans and its potential as an emerging pathogen in the healthcare settings. We discuss A. xylosoxidans as an emerging opportunistic pathogen that is associated with healthcare infections. This review further discusses the prevalence of A. xylosoxidans in healthcare settings, the types of infections it can cause, and the risk factors for acquiring an A. xylosoxidans infection. The review also covers the challenges in treating A. xylosoxidans infections, including its potential for drug resistance and the lack of specific treatments. Strategies for preventing and controlling A. xylosoxidans infections in healthcare settings were also discussed.

Histopathological, biochemical and molecular studies on a model of systemic autoimmune disease induced by sodium silicate in non-genetically prone rats

Sodium silicate (Na2SiO3) is an inorganic silica salt used in many products. Few studies reported autoimmune diseases (AIDs) due to Na2SiO3 exposure. This study investigates the role of Na2SiO3 exposure by different routes and doses in AID development in rats. We assigned 40 female rats to four groups: G1 control group, G2 rats were subcutaneously injected with 5 mg Na2SiO3 suspension, and G3 and G4 rats were orally administered 5 mg and 7 mg Na2SiO3 suspension, respectively. Na2SiO3 was administered weekly for 20 weeks. Serum anti-nuclear antibodies (ANA) detection, histopathology of kidney, brain, lung, liver, and heart, oxidative stress biomarkers (MDA and GSH) in tissues, Matrix metalloproteinase activity in serum, TNF-α, and Bcl-2 expression in tissues were performed. ANA was significantly increased in silicate groups, especially G2. Creatinine was significantly increased in silicate groups. Histopathology revealed vasculitis and fibrinoid degeneration of blood vessels, a picture of immune-mediated glomerulonephritis in the kidneys, and chronic interstitial pneumonia with medial hypertrophy of pulmonary blood vessels. The activity of gelatinases (MMP-2 and MMP-9) and collagenase (MMP-13), which play role in inflammation, remodeling, and immune complex degradation, were significantly increased in the silicate-exposed groups. Bcl-2 was significantly decreased, indicating apoptosis. Therefore, oral administration and subcutaneous injection of Na2SiO3 induced immune-mediated glomerulonephritis with elevated ANA levels and overexpression of TNF-α in rats.

Short Telomere Syndrome presenting with pulmonary fibrosis, liver cirrhosis and hepatopulmonary syndrome: a case report

BackgroundIdiopathic pulmonary fibrosis is thought to result from aberrant post-injury activation of epithelial cells leading to fibroblast proliferation and activation. A number of genetic aetiologies have been implicated in this disease process, including, among others, the short telomere syndromes. Short telomere syndromes follow an autosomal dominant pattern of inheritance resulting in shortened telomere length, which consequently leads to accelerated cell death. Organs with rapid cell turnover are most affected.Case presentationWe describe a case of a 53-year-old man with a chief complaint of cough and dyspnea on exertion. His presentation was otherwise significant for features of accelerated aging, including a history of osteoporosis and early greying, and a family history of pulmonary fibrosis in his father. Pulmonary function testing revealed a restrictive pattern with severely reduced diffusion capacity and high resolution CT of the chest showed diffuse lung disease with mild fibrosis, in pattern suggesting an alternative diagnosis to IPF. Biopsy of the lung was in keeping with chronic fibrosing interstitial pneumonia. Imaging of the abdomen showed splenomegaly, hepatic cirrhosis and portal hypertension. Transthoracic contrast echocardiogram showed intrapulmonary shunting consistent with hepatopulmonary syndrome. Given the constellation of early aging, idiopathic pulmonary fibrosis, cryptogenic cirrhosis and a family history of pulmonary fibrosis in this patient, the Short Telomere Syndrome was suspected. Peripheral blood was sent for Flow-cytometry FISH, which demonstrated granulocyte telomere length below the 10th percentile for the patient’s age, consistent with a diagnosis of Short Telomere Syndrome in this clinical context. Targeted genetic testing of mutations known to be associated with short telomere was negative though it was acknowledged that the full spectrum of disease-causing mutations remains unknown. Given the extensive fibrosis on biopsy and his progressive hypoxemia he was treated with mycophenolate and prednisone. Ultimately, he developed progressive respiratory failure and underwent double lung and concurrent liver transplant 18 months after the initial diagnosis was made.ConclusionsShort Telomere Syndrome is a rare cause of end stage organ disease and testing lacks sensitivity making diagnosis challenging. Organ transplant is still the mainstay of treatment. Nevertheless, disease identification is important because of implications for family member screening and the possibility of future treatment options.

How philanthropy can make you healthy and happy.

When I came to Australia 40 years ago from the European headquarters of Time Magazine I fell in love with this wide brown land. And despite working my tail off as being a top executive, it did not’ matter with such friendly and caring people. I suffered from repeated bronchitis in Amsterdam (originally from USA) for the 10 years I lived there because I was not used to the dampness. So I was so excited about coming to a sunny and warm part of the universe. I have always loved to help needy causes, and as a new citizen, I embraced charity work. Yes, give with gratitude to my new country! And I threw my heart and soul into so many multifarious needy causes. Opera artists, Uni students, Olympics, Legacy, Cochlear Implant for Deaf Children; the list is long. My focus was to raise as much money as possible. My philosophy was and still is, why do people wait until they die and leave their donations to their favourite charities? Why not give whilst you are living, and you can smile knowing you have helped someone in an area, such as The Lung Foundation, or other passionate causes. Guess what? It makes you feel so good. I know it has helped me deal with my lung disease, Bronchiectasis. Yes, I was diagnosed in 2018 after years of chronic pneumonia. I started playing golf at 40 because I love sport. And many of the gentlemen I was dealing with in business went out, had lunch, played golf and did business deals! I was a weekend warrior, and became hooked. And guess what? As a female, I started doing business deals because I could play pretty good golf! Fast forward to 2023, and there are 26 girls who have been scholars and loving their golf. I joined the nascent Australian Golf Foundation in 2020, and presented to the board that if I went out and raised the money every year, I wanted to launch this across the country. Especially in rural and regional communities to young girls who could never even dream of playing golf. First nation, farming communities etc. The game has shrunk dramatically for women over the past 25 years. Today, we have nearly 2000 girls in the past 3 years who have had a scholarship. The fundraising is close to a million dollars, and I am so busy and having so much fun seeing these girls become friends for life with girls they never would have met before. And for the past 2 years, 8 young girls from the scholarship have been chosen to caddy for the lady Pro's on TV at an annual tournament called the Athena. Golf is brilliant exercise for lung diseases. Bonnie Boezeman provides an annual donation to The Lung Foundation for a new Peer To Peer program for Bronchiectasis.

PD43-09 A PREDICTOR OF MORBIDITY AND MORTALITY IN RADICAL NEPHRECTOMY PATIENTS: THE 5-ITEM FRAILTY INDEX IN a PROPENSITY MATCHED ANALYSIS

You have accessJournal of UrologyCME1 Apr 2023PD43-09 A PREDICTOR OF MORBIDITY AND MORTALITY IN RADICAL NEPHRECTOMY PATIENTS: THE 5-ITEM FRAILTY INDEX IN a PROPENSITY MATCHED ANALYSIS Christian Habib Ayoub, Elia Abou Chawareb, Abdallah Kasti, Jose M. EL-Asmar, Anthony Abou, and Albert EL Hajj Christian Habib AyoubChristian Habib Ayoub More articles by this author , Elia Abou ChawarebElia Abou Chawareb More articles by this author , Abdallah KastiAbdallah Kasti More articles by this author , Jose M. EL-AsmarJose M. EL-Asmar More articles by this author , Anthony AbouAnthony Abou More articles by this author , and Albert EL HajjAlbert EL Hajj More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003353.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The 5-item frailty index has been adopted as a preoperative evaluation method and has gained importance in predicting surgical outcomes. Hence, we aimed at assessing the ability of the 5-item frailty index score to predict 30-day morbidity and mortality post-radical nephrectomy (RN). METHODS: We used the American College of Surgeons – National Surgical Quality Improvement Program (ACS-NSQIP) database to select patients who underwent RN from 2011 to 2020. To calculate the 5-item frailty score, a point was assigned for each of the following comorbidities: chronic obstructive pulmonary disease or pneumonia, congestive heart failure, dependent functional status, hypertension, and diabetes. Patients were then divided into 3 frailty groups 0,1, and ≥2. Patient demographics, medical comorbidities, prolonged length of stay and operative time, mortality, and morbidity using the Clavien-Dindo (CVD) classification were compared between different groups. Multivariable logistic regression models and propensity score matching were then performed as a sensitivity analysis to control for possible confounders. RESULTS: The cohort consisted of 52,912 patients. Frailty classes consisted of 17,302 (32.7%) class 0, 23,740 (44.9%) class 1, and 11,870 (22.4%) class ≥2 patients. Patients with higher frailty class were more likely to be older, with higher ASA class, higher BMI, and comorbidities (p<0.001). After multivariable analysis and propensity score matching, patients with frailty classes 1 and ≥2 were more likely to have prolonged length of stay (OR=1.08, 1.25, respectively), mortality (OR=1.45, 1.84, respectively), CVD 1&2 (OR=1.52 for frailty class 1) and CVD≥4 (OR=1.36, 1.76, respectively) as compared to frailty class 0 (p<0.001). CONCLUSIONS: The 5-item frailty score was found to be an independent predictor of prolonged length of stay, morbidity, and mortality after RN. This tool could help in patient counseling and risk assessment before surgery. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1121 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Christian Habib Ayoub More articles by this author Elia Abou Chawareb More articles by this author Abdallah Kasti More articles by this author Jose M. EL-Asmar More articles by this author Anthony Abou More articles by this author Albert EL Hajj More articles by this author Expand All Advertisement PDF downloadLoading ...

Clinical characteristics and factors associated with COVID-19-related mortality and hospital admission during the first two epidemic waves in 5 rural provinces in Indonesia: A retrospective cohort study.

Data on coronavirus disease 2019 (COVID-19) clinical characteristics and severity from resource-limited settings are limited. This study examined clinical characteristics and factors associated with COVID-19 mortality and hospitalisation in rural settings of Indonesia, from 1 January to 31 July, 2021. This retrospective cohort included individuals diagnosed with COVID-19 based on polymerase chain reaction or rapid antigen diagnostic test, from five rural provinces in Indonesia. We extracted demographic and clinical data, including hospitalisation and mortality from a new piloted COVID-19 information system named Sistem Informasi Surveilans Epidemiologi (SISUGI). We used mixed-effect logistic regression to examine factors associated with COVID-19-related mortality and hospitalisation. Of 6,583 confirmed cases, 205 (3.1%) died and 1,727 (26.2%) were hospitalised. The median age was 37 years (Interquartile range 26-51), with 825 (12.6%) under 20 years, and 3,371 (51.2%) females. Most cases were symptomatic (4,533; 68.9%); 319 (4.9%) had a clinical diagnosis of pneumonia and 945 (14.3%) presented with at least one pre-existing comorbidity. Age-specific mortality rates were 0.9% (2/215) for 0-4 years; 0% (0/112) for 5-9 years; 0% (1/498) for 10-19 years; 0.8% (11/1,385) for 20-29 years; 0.9% (12/1,382) for 30-39 years; 2.1% (23/1,095) for 40-49 years; 5.4% (57/1,064) for 50-59 years; 10.8% (62/576) for 60-69 years; 15.9% (37/232) for ≥70 years. Older age, pre-existing diabetes, chronic kidney disease, liver diseases, malignancy, and pneumonia were associated with higher risk of mortality and hospitalisation. Pre-existing hypertension, cardiac diseases, COPD, and immunocompromised condition were associated with risk of hospitalisation but not with mortality. There was no association between province-level density of healthcare workers with mortality and hospitalisation. The risk of COVID-19-related mortality and hospitalisation was associated with higher age, pre-existing chronic comorbidities, and clinical pneumonia. The findings highlight the need for prioritising enhanced context-specific public health action to reduce mortality and hospitalisation risk among older and comorbid rural populations.

Clinical results of carbon ion radiotherapy for inoperable stage I non-small cell lung cancer: A Japanese national registry study (J-CROS-LUNG)

Background and purposeRadiotherapy is a standard treatment for inoperable stage I non-small cell lung cancer (NSCLC), and carbon-ion radiation therapy (CIRT) may be used for such treatment. Although CIRT for stage I NSCLC has demonstrated favorable outcomes in previous reports, the reports covered only single-institution studies. We conducted a prospective nationwide registry study including all CIRT institutions in Japan. Materials and methodsNinety-five patients with inoperable stage I NSCLC were treated by CIRT between May 2016 and June 2018. The dose fractionations for CIRT were selected from several options approved by the Japanese Society for Radiation Oncology. ResultsThe median patient age was 77 years. Comorbidity rates for chronic obstructive pulmonary disease and interstitial pneumonia were 43% and 26%, respectively. The most common schedule for CIRT was 60 Gy (relative biological effectiveness (RBE)) in four fractions, and the second most common was 50 Gy (RBE) in one fraction. The 3-year overall survival, cause-specific survival, and local control rates were 59.3%, 77.1%, and 87.3%, respectively. Female sex and ECOG performance status of 0–1 were favorable prognostic factors for overall survival in a multivariate analysis. No grade 4 or higher adverse event was observed. The 3-year cumulative incidence of grade 2 or higher radiation pneumonitis was 3.2%. The risk factors for grade 2 or higher radiation pneumonitis were a force expiratory volume in 1 second (FEV1) of <0.9 L and a total does of ≥ 67 Gy(RBE). ConclusionThis study provides real-world treatment outcomes of CIRT for inoperable.stage I NSCLC in Japan.

Joint modeling of longitudinal change in pulse rate and survival time of heart failure patients treated at Arbaminch General Hospital, Southern Ethiopia.

Heart failure is a chronic progressive disease in which the heart muscle is unable to pump enough blood to meet the body's need. It is a severe health problem around the world with high re-hospitalization and death rates. The main aim of this study was to identify the factors associated with longitudinal change of pulse rate and survival time to death of congestive heart failure patients treated at Arba Minch General Hospital. A retrospective study design was undertaken on congestive heart failure patients admitted to the Arba Minch General Hospital from January 2017 to December 2020. Data was collected from a total of 199 patients. After evaluating the longitudinal data with a linear mixed model and the survival time to death data with cox proportional model, Bayesian joint model of both sub models was fitted in R software using JMbayes2 package. Findings from Bayesian joint model revealed that the estimated value for the association parameter was positive and statistically significant. This indicates that there is significant evidence of an association between the mean longitudinal change of pulse rate and the risk of death. Weight of patients at baseline, gender, chronic kidney disease, left ventricular ejection fraction, New York Heart Association classification, diabetes, tuberculosis, pneumonia and family history were statistically significant factors associated with mean evolution of pulse rate of congestive heart failure patients. Left ventricular ejection fraction, etiology of congestive heart failure, type of congestive heart failure, chronic kidney disease, smoking, family history, alcohol and diabetes were found to be statistically significant factors associated with survival time to death. To reduce the risk level, health professionals should give attention to congestive heart failure patients with high pulse rate, co-morbidities of chronic kidney disease, tuberculosis, diabetic, smoking status, family history, and pneumonia in the study area.

Using Electronic Medical Record To Identify Changes In Inpatient Learner Experience

Background: COVID-19 has been disruptive to inpatient medical care. While changes in prevalence of inpatient diagnoses have been published, little has been published about the impact on learner exposure to various diagnoses. Such changes are likely impacted by national and global trends, as well as local disease prevalence and policies. We hypothesized that the electronic medical record (EMR) may offer a tool to track learner experiences as they evolve in a time of rapid change. Methods: The top 20 most common diagnoses between April-July 2019 vs April-July 2020 on the resident inpatient internal medicine service were extracted from the Epic EMR and compared. This data was analyzed using a chi squared test and Bonferroni correction to identify statistically significant changes in case distribution in this time frame. Changes over this period were also compared for the nonteaching service. Results: The resident teaching service saw a statistically significant decrease in pulmonary cases (13% vs 2%, p &lt; 0.005) from 2019 to 2020. Acute exacerbation of chronic obstructive pulmonary disease (COPD) and pneumonia, previously the 5th and 7th most common diagnoses in the 2019 period, dropped off the top twenty list for the teaching service. These 2 diagnoses remained on the non-teaching common encounter list, suggesting that COVID-19-related service/team assignments rather than disease prevalence may be a factor. There was also a statistically significant increase from 2019 to 2020 in cases pertaining to substance use intoxication on both teaching and non-teaching teams (0 vs 0.05 and 0 vs 0.02, respectively), mirroring trends in national data. Conclusion: Use of the EMR was able to rapidly identify changes in the most common diagnoses on the teaching service. This may be a tool to monitor the inpatient experience of learners over time, particularly in times of rapid local, regional, or global change.

Validity of diagnoses of respiratory diseases recorded in a Japanese administrative database

BackgroundValidating the information recorded in administrative databases is essential. However, no study has comprehensively validated the accuracy of Japanese Diagnosis Procedure Combination (DPC) data on various respiratory diseases. Therefore, this study aimed to evaluate the validity of diagnoses of respiratory diseases in the DPC database. MethodsWe conducted chart reviews of 400 patients hospitalized in the departments of respiratory medicine in two acute-care hospitals in Tokyo, between April 1, 2019 and March 31, 2021, and used them as reference standards. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of DPC data on 25 respiratory diseases were determined. ResultsSensitivity ranged from 22.2% (aspiration pneumonia) to 100% (chronic eosinophilic pneumonia and malignant pleural mesothelioma) and was <50% for eight diseases, while specificity was >90% for all diseases. PPV ranged from 40.0% (aspiration pneumonia) to 100% (coronavirus disease 2019, bronchiectasis, chronic eosinophilic pneumonia, pulmonary hypertension, squamous cell carcinoma, small cell carcinoma, lung cancer of other histological types, and malignant pleural mesothelioma) and was >80% for 16 diseases. Except for chronic obstructive pulmonary disease (82.9%) and interstitial pneumonia (other than idiopathic pulmonary fibrosis) (85.4%), NPV was >90% for all diseases. These validity indices were similar in both hospitals. ConclusionsThe validity of diagnoses of respiratory diseases in the DPC database was high in general, thereby providing an important basis for future studies.

Risk Factor Analysis of Hospital Readmissions at St. Petersburg General Hospital.

Decreased readmission rates are largely seen as an indicator of effective care and improved resource management. The case management team at St. Petersburg General Hospital in St. Petersburg, Florida identified chronic obstructive pulmonary disease (COPD) exacerbation, pneumonia, and sepsis as 3 of the leading diagnoses on index admission that later led to 30-day readmissions. By examining patients with these 3 diagnoses on index admission, we decided to investigate potential readmission risk factors including patient age, sex, race, body mass index (BMI), length of stay during the index admission, insurance type during index admission, discharge placement after index admission, coronary artery disease, heart failure, and type 2 diabetes. We conducted a retrospective study with data from 4180 patients at St. Petersburg General Hospital from 2016 through 2019 with index admission diagnoses of COPD exacerbation, pneumonia, and sepsis. A univariate analysis was conducted on patient sex, race, BMI, length of stay during the index admission, health insurance type during the index admission, discharge placement after the index admission, presence of coronary artery disease, presence of heart failure, and presence of type 2 diabetes. Subsequently, a bivariate analysis was run on these variables in relation to 30-day readmissions. Then a multivariable analysis was completed using binary logistic regression and pairwise analysis to determine the significance between variables within the categories of discharge disposition and insurance type. Of the 4180 patients included in this study, 926 (22.2%) were readmitted within 30 days of discharge. In the bivariate analysis race, BMI, mean length of stay during the index admission, coronary artery disease, heart failure, and type 2 diabetes were not significantly associated with readmission. The bivariate analysis revealed that patients discharged to skilled nursing facilities had the highest readmission rates (28%), followed by home care (26%) (P = .001). Medicaid patients (24%) and Medicare patients (23%) demonstrated higher read-mission rates than those with private insurance (17%) (P = .001). Readmitted patients were slightly younger (62.14 vs. 63.69 years; P = .02) in the bivariate analysis. However, in the multi-variable analysis, only patients with type 2 diabetes and patients with non-private insurance were associated with increased readmission rates. Pairwise analysis of the variables within insurance and discharge disposition categories demonstrates decreased readmission for individuals with Private/Other when compared to other insurance subtypes and decreased readmission for Other when compared to discharge disposition subtypes. Our data demonstrate that hospital readmissions are associated with a diagnosis of type 2 diabetes and having a non-private insurance status. Our findings lead us to suggest further investigation into changes in hospital policies and procedures for these groups that will aim to decrease readmission rates in the future.

Impaired Dynamic Response of Oxygen Saturation During the 6-min Walk Test Is Associated With Mortality in Chronic Fibrosing Interstitial Pneumonia.

The 6-min walk test (6MWT) is a common assessment of exercise-induced hypoxemia and exercise capacity used in patients with chronic fibrosing interstitial pneumonia (CFIP). However, whether the dynamic changes in SpO2 and heart rate during the 6MWT are associated with mortality in patients with CFIP has been undefined. This retrospective study enrolled 63 subjects with mild to severe CFIP who underwent the 6MWT. Subjects with CFIP were divided into 2 groups according to disease severity: mild, diffusing capacity of the lungs for carbon monoxide percentage predicted (%DLCO) > 55% and %FVC > 75%; and severe, %DLCO ≤ 55% and/or %FVC ≤ 75%. This study aimed to evaluate dynamic changes in the 6MWT including 6-min walk distance, change in SpO2 (ΔSpO2 ), SpO2 reduction time, SpO2 recovery time, change in heart rate (Δ heart rate), heart rate acceleration time, slope of heart rate acceleration, heart rate recovery at 1 min of rest after the 6MWT (HR-recovery), and dyspnea on exertion that are reflected by static pulmonary function and are related to exacerbation of CFIP and mortality. Compared with subjects with mild CFIP, subjects with severe CFIP had significantly larger ΔSpO2 and longer SpO 2 reduction time and recovery time. The slope of heart rate, heart rate immediately after the 6MWT, and HR-recovery were lower in subjects with severe CFIP than in those with mild CFIP. In multiple regression analysis, percent vital capacity was significantly associated with SpO2 reduction time, and %DLCO was significantly associated with ΔSpO2 and SpO2 recovery time. Subjects with ΔSpO2 of > 10% and SpO2 recovery time of > 79 s had a significantly higher risk for exacerbation and mortality. Dynamic changes in SpO2 and heart rate during the 6MWT were associated with risk for exacerbation and mortality in subjects with CFIP. Impaired dynamic response of SpO2 could reflect likelihood of exacerbation and increased mortality in CFIP.

Combination of computed tomography imaging pattern and severity of respiratory failure as factors associated with prognosis for acute exacerbation of idiopathic chronic fibrosing interstitial pneumonia.

The prognosis of idiopathic chronic fibrotic interstitial pneumonitis (CFIP) in patients with acute exacerbation (AE) is variable. We examined whether the imaging pattern on thoracic computed tomography (CT) or the severity of respiratory failure with AE-CFIP is associated with short-term prognosis. Patients admitted to two university hospitals were retrospectively analyzed and divided into derivation and validation cohorts. The distribution of newly appearing parenchymal abnormalities on thoracic CT was classified into peripheral, multifocal, and diffuse patterns. Respiratory failure was defined as severe if a fraction of inspired oxygen ≥ 0.5 was required to maintain percutaneous oxygen saturation ≥ 90% on admission. Factors associated with 90 day-mortality were analyzed using univariate and Cox proportional hazard regression. In 59 patients with AE-CFIP of the derivation cohort, diffuse pattern on CT was associated with higher mortality within 90 days (43%) than peripheral/multifocal pattern (17%, p = 0.03). Additionally, compared with non-severe failure, severe respiratory failure was associated with higher mortality (47% vs. 21%, p = 0.06). Cox proportional hazard regression analysis demonstrated that a combination of diffuse pattern on CT and severe respiratory failure was associated with the poorest prognosis (hazard ratio [HR] 3.51 [interquartile range 1.26-9.80], p = 0.016) in the derivation cohort, which was confirmed in the validation cohort (n = 31, HR 4.30 [interquartile range 1.51-12.2], p = 0.006). The combination of imaging pattern on thoracic CT and severity of respiratory failure was associated with the prognosis of idiopathic AE-CFIP.

Evaluation of Drug Interactions in Hospitalized Patients with Respiratory Disorders in Greece

Background: Patients with respiratory disorders often have additional diseases and are usually treated with more than one medication to manage their respiratory conditions as well as additional comorbidities. Thus, they are frequently exposed to polypharmacy (≥5 drugs), which raises the risk for drug-drug interactions (DDIs) and adverse drug reactions (ADRs). In this work, we present the results regarding the prevalence of DDIs in hospitalized patients with respiratory disorders in Greece. Methods: A 6-month descriptive single-center retrospective observational study enrolled 102 patients with acute or chronic respiratory disorders. Clinical characteristics and medication regimens were recorded upon admission, hospitalization, and discharge. The prevalence of DDIs and their clinical significance was recorded and analyzed. Results: Unspecified acute lower respiratory tract infection (25%), exacerbations of chronic obstructive pulmonary disease (12%) and pneumonia (8%) were the most frequent reasons for admission. Cardiovascular disorders (46%), co-existing respiratory disorders (32%), and diabetes (25%) were the most prevalent comorbidities. Polypharmacy was noted in 61% of patients upon admission, 98% during hospitalization, and 63% upon discharge. Associated DDIs were estimated to be 55% upon admission, 96% throughout hospitalization, and 63% on discharge. Pharmacodynamic (PD) DDIs were the most prevalent cases (81%) and referred mostly to potential risk for QT-prolongation (31.4% of PD-DDIs) or modulation of coagulation process as expressed through the international normalized ratio (INR) (29.0% of DDIs). Pharmacokinetic (PK) DDIs (19% of DDIs) were due to inhibition of Cytochrome P450 mediated metabolism that could lead to elevated systemic drug concentrations. Clinically significant DDIs characterized as "serious-use alternative" related to 7% of cases while 59% of DDIs referred to combinations that could be characterized as "use with caution-monitor". Clinically significant DDIs mostly referred to medication regimens upon admission and discharge and were associated with outpatient prescriptions. Conclusions: Hospitalized patients with respiratory disorders often experience multimorbidity and polypharmacy that raise the risk of DDIs. Clinicians should be conscious especially if any occurring arrhythmias, INR modulations, and prolonged or increased drug action is associated with DDIs.