Pseudomonas aeruginosa infection is associated with poorer outcomes in non-cystic fibrosis bronchiectasis. It is unknown whether early eradication improves outcomes. This retrospective study assessed clinical and microbiological outcomes of eradication therapy following initial Pseudomonas infection. All patients undergoing Pseudomonas eradication therapy from 2004 to 2010 were identified retrospectively and assessed for microbiological eradication, exacerbation frequency, hospital admissions, clinical symptoms and lung function. 30 patients were identified with median follow-up time 26.4 months. Eradication therapy involved intravenous antibiotics (n = 12), intravenous antibiotics followed by oral ciprofloxacin (n = 13) or ciprofloxacin alone (n = 5), combined with 3 months of nebulised colistin. Pseudomonas was initially eradicated from sputum in 24 patients (80.0%). 13/24 patients remained Pseudomonas-free and 11/24 were subsequently reinfected (median time 6.2 months). Exacerbation frequency was significantly reduced from 3.93 per year pre-eradication and 2.09 post-eradication (p = 0.002). Admission rates were similar, at 0.39 per year pre-eradication and 0.29 post-eradication (p = NS). 20/30 patients reported initial clinical improvement, whilst at one-year follow up, 19/21 had further improved or remained stable. Lung function was unchanged. This study demonstrates that Pseudomonas can be eradicated from a high proportion of patients, which may lead to prolonged clearance and reduced exacerbation rates. This important outcome requires confirmation in a prospective study.
Context:Coronary embolization is potentially a fatal sequela of endocarditis. Although the primary cause of acute coronary syndrome is atherosclerotic disease, it is imperative to consider septic embolism as an etiological factor.Case Report:Herein, we report a case of ventricular fibrillation and ST-segment depression myocardial infarction occurring in a patient who initially presented with fever and increased urinary frequency. Coronary angiography revealed new 99% occlusion of the left main coronary artery (LMCA). Transesophageal echocardiography showed bioprosthetic aortic valve with an abscess and vegetation. Histologic examination of the embolectomy specimen confirmed the presence of thrombus and Enterococcus faecalis bacteria. Subsequently, the patient was discharged to the skilled nursing facility in a stable condition where he completed 6 weeks of intravenous ampicillin.Conclusion:We present a rare case of LMCA embolism due to prosthetic valve endocarditis. The present report also highlights the diagnostic and therapeutic challenges associated with such patients.
Conclusions Results provide evidence that the levels of several prominent breath metabolites, which are potentially related to bacterial activity and lung injury, are significantly altered in patients with this disease. Breath analysis may therefore provide a novel, non-invasive and reliable strategy for the diagnosis of pneumonia. S129PREDICTING OUTCOME FROM HIV-ASSOCIATED PNEUMOCYSTIS PNEUMONIA Background The presentation of Pneumocystis jirovecii pneumonia (PCP) ranges from mild to severe. The former responds to antimicrobial therapy, the latter has a high mortality rate despite treatment. Several studies have described clinical and laboratory factors that are predictive of death from PCP. Our objectives were to create a prognostic scoring model to aid the clinician in predicting outcome from HIV-associated PCP. Methods A prognostic scoring model was built using risk factors identifiable at/soon after hospitalisation, that is, 'by the bedside'd which have previously been identified as being associated with mortality from PCP (a repeat episode of PCP, the patient's age, their haemoglobin (Hb), PaO 2 (breathing room air), both on admission, the presence of co-morbidity (Comorb), such as lymphoma or pregnancy, and the presence of pulmonary Kaposi sarcoma (PKS) (Walzer PD, et al CID 2008;46:625e33). The model was built from data concerning 592 consecutive episodes of PCP that had occurred among 540 patients presenting to a specialist inpatient HIV treatment centre.Results The prognostic scoring model was: [25.5 + (age in years/10) + 2 (if a repeat episode of PCP) + 4 (if PKS detected) + 4 (if Comorb present)ÀPaO 2 e Hb]. The prognostic model produced scores ranging from 0 to 20; median (IQR)¼9 (7e11). Testing interactions between risk factors and time showed the model to be applicable across all time periods. Patients were divided into five groups according to prognostic score: 0e3.9¼group 1, 4e7.9¼group 2, 8e11.9¼group 3, 12e15.9¼group 4, 16 or greater ¼group 5. Abstract S129 Table 1 shows mortality rates among the 540 patients with PCP, grouped according to their prognostic scores.Abstract S129 Table 1 Group Mortality (%) 1 0 2 3 3 1 3 4 2 9 5 5 9Conclusions While this prognostic scoring model requires further validation in patient cohorts from other healthcare institutions, it is potentially a simple 'by the bedside' method of identifying patients early in their hospital admission who are at high and low risk of in-hospital death from PCP and so may aid the clinician in assessing the severity of illness and in deciding on treatment strategies.
BackgroundThe median survival of patients with UIP/IPF is reported in several series as 3 years. Anecdotally, many respiratory physicans have patients who remain stable for many years. This is a disease predominantly of the elderly and many die from non-respiratory causes. Advances in CT scanning have made it possible to diagnose patients with UIP-pattern disease (IPF) without open lung biopsy and HRCT has been shown to a better predictor of outcome than open lung biopsy. We examined median survival and cause of death in our patients with IPF attending a large general hospital in the UK, serving a population of approx. 500,000. Methods 74 cases of IPF (72 confirmed radiologically, 2 on open lung biopsy) between 2000 and 2006 were ascertained by retrospective data collection from our ILD patient register and clinic records. Patients with other forms of IIP or occupational lung disease were excluded. We recorded patient demographics, symptoms, pulmonary function at diagnosis and follow-up, functional status (MRC dyspnea scale), co-morbidities, smoking and occupational history, treatment, date of death. Cause of death was identified from hospital records or death certificates. ResultsLung function at diagnosis: FVC mean 84 % predicted (SD 20.9%, range 35-131). Most of the 17 patients with normal or high FVC had co-existing emphysema. DLco mean 52% predicted ( SD 20, range 16-123). FEV1/FVC ratio mean 0.81 (SD 0.10, range 0.56-0.98). 12 patients (15 %) had an obstructive ratio (FEV1/FVC <0.70).
Brugada syndrome (BrS) is an inherited disorder of cardiac ion channels characterized by peculiar ECG findings predisposing individuals to ventricular arrhythmias, syncope, and sudden cardiac death (SCD). Various electrolyte disturbances and ion channels blocking drugs could also provoke BrS ECG findings without genetic BrS. Clinical differentiation and recognition are essential for guiding the legitimate action. Hyperkalemia is well known to cause a wide variety of ECG manifestations. Severe hyperkalemia can even cause life threatening ventricular arrhythmias and cardiac conduction abnormalities. Most common ECG findings include peaked tall T waves with short PR interval and wide QRS complex. Since it is very commonly encountered disorder, physicians need to be aware of even its rare ECG manifestations, which include ST segment elevation and Brugada pattern ECG (BrP). We are adding a case to the limited literature about hyperkalemia induced reversible Brugada pattern ECG changes.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.