Idiopathic Pulmonary Hemosiderosis: Favorable Response to Corticosteroids

A 50-year-old Taiwanese woman had a history of massive hemoptysis occurring every 6 months for the past 4 years. After each bout of hemoptysis, chest roentgenography would show diffuse alveolar infiltration of bilateral lungs, which would usually resolve within 7 days. Transbronchial biopsy revealed diffuse alveolar hemorrhage and hemosiderin-laden macrophage infiltration. Idiopathic pulmonary hemosiderosis was diagnosed by excluding other glomerular, cardiac and immunological disorders. An initial dose of 20 mg prednisolone daily was tapered to 10 mg daily 1 month later. The patient is currently undergoing steroid therapy, and there have been no further episodes of hemoptysis

Tracheostomy versus Endotracheal Intubation Prior to Admission to a Respiratory Care Center: A Retrospective Analysis

Background: This study was conducted to examine the hypothesis that a tracheostomy prior to admission to a respiratory care center (RCC) with a specialized weaning setting would improve the outcome of patients transferred from intensive care unit previously maintained on prolonged mechanical ventilation. Methods: A retrospective review of medical records from intubated adult patients admitted to the Chi-Mei Medical Center, a 16-bed RCC in Southern Taiwan from January 1, 2001 through July 31, 2012, was performed. The outcomes at weaning (without ventilator support within 120 hours), mortality, and expenditure at hospital discharge were compared between the tracheostomy group (n = 1216) and the endotracheal tube group (n = 1187), and the predictors of weaning in all patients were determined. Results: The overall weaning rate and the in-hospital mortality rate were 68.2% and 16.4%, respectively. The tracheostomy group showed significantly higher weaning rate and shorter hospital stay (73.5% vs. 62.8% and 57.4 vs. 61.0 days, both p < 0.01) compared with the endotracheal tube group. In-hospital mortality, total ventilator days, and cost of hospitalization were comparable between groups. Factors predictive of successful weaning were surgical origin [odds ratio (OR) 2.165], higher albumin (OR 1.937), tracheostomy group (OR 1.543), higher PaO2/fraction of inspired oxygen (OR 1.345), and lower blood urea nitrogen (OR 0.984). Conclusion: Tracheostomy creation prior to RCC admission was associated with a significantly higher weaning rate and reduced hospital stays. The provision of assessment of the aforementioned markers may be helpful in the clinical setting to facilitate the optimal management and the accreditation of medical care quality of patients with prolonged mechanical ventilation

Prolonged Mechanical Ventilation Assistance Interacts Synergistically with Carbapenem for Clostridium difficile Infection in Critically Ill Patients

Objectives: Interactions between mechanical ventilation (MV) and carbapenem interventions were investigated for the risk of Clostridium difficile infection (CDI) in critically ill patients undergoing concurrent carbapenem therapy. Methods: Taiwan&rsquo;s National Intensive Care Unit Database (NICUD) was used in this analytical, observational, and retrospective study. We analyzed 267,871 intubated patients in subgroups based on the duration of MV support: 7&ndash;14 days (n = 97,525), 15&ndash;21 days (n = 52,068), 22&ndash;28 days (n = 35,264), and 29&ndash;60 days (n = 70,021). The primary outcome was CDI. Results: Age (&gt;75 years old), prolonged MV assistance (&gt;21 days), carbapenem therapy (&gt;15 days), and high comorbidity scores were identified as independent risk factors for developing CDI. CDI risk increased with longer MV support. The highest rate of CDI was in the MV 29&ndash;60 days subgroup (adjusted hazard ratio (AHR) = 2.85; 95% confidence interval (CI) = 1.46&ndash;5.58; p &lt; 0.02). Moreover, higher CDI rates correlated with the interaction between MV and carbapenem interventions; these CDI risks were increased in the MV 15&ndash;21 days (AHR = 2.58; 95% CI = 1.12&ndash;5.91) and MV 29&ndash;60 days (AHR = 4.63; 95% CI = 1.14&ndash;10.03) subgroups than in the non-MV and non-carbapenem subgroups. Conclusions: Both MV support and carbapenem interventions significantly increase the risk that critically ill patients will develop CDI. Moreover, prolonged MV support and carbapenem therapy synergistically induce CDI. These findings provide new insights into the role of MV support in the development of CDI

The effects of human parvovirus VP1 unique region in a mouse model of allergic asthma.

Evidence has indicated that viral infection increases the risk of developing asthma. Although the association of human parvovirus B19 (B19V) or human bocavirus (HBoV) with respiratory diseases has been reported, little is known about the influence of the B19V-VP1u and HBoV-VP1u proteins on the symptoms of asthma. Herein, we investigated the systemic influence of subcutaneously injected B19V-VP1u and HBoV-VP1u recombinant proteins in an OVA-sensitized asthmatic mouse model. A significantly higher Penh ratio and IgE level were detected in the serum, bronchoalveolar lavage fluid (BALF) and the supernatant of a lymphocyte culture from mice treated with HBoV-VP1u or B19V-VP1u than in a lymphocyte culture from OVA-sensitized mice. Significantly higher levels of serum and BALF IgE, total IgG, IgG1, OVA-specific IgE and OVA-specific IgG1 were detected in mice treated with HBoV-VP1u or B19V-VP1u than in OVA-sensitized mice. Conversely, a significantly lower IgG2a level was detected in mice from the HBoV-VP1u or B19V-VP1u groups than in mice from the OVA group. The mice treated with HBoV-VP1u or B19V-VP1u exhibited more significant lung inflammatory indices, including elevated serum and BALF IL-4, IL-5, IL-10 and IL-13 levels; BALF lymphocyte, neutrophil and eosinophil counts, MMP-9 and MMP-2 activity; and the amount of lymphocyte infiltration, relative to those in the control mice or in those sensitized with OVA. These findings demonstrate that the subcutaneous injection of HBoV-VP1u or B19V-VP1u proteins in OVA-sensitized mice result in elevated asthmatic indices and suggest that human parvoviruses may increase the risk of developing airway inflammation in a mouse model of asthma

Long-term risk of dementia after acute respiratory failure requiring intensive care unit admission.

This retrospective, population-based cohort study aims to investigate the long-term risk of newly diagnosed dementia in patients discharged for acute respiratory failure that required mechanical ventilation (MV) and intensive care unit (ICU) admission. From the Taiwan National Health Insurance Research Database, first-time ICU patients using MV between June 1, 1998, and December 31, 2012, were enrolled, and they were followed-up until the earliest onset of one of our two endpoints: a new diagnosis of dementia (primary endpoint), or the end of the study. A total of 18,033 patients were enrolled and thirteen hundred eighty-seven patients had been newly diagnosed with dementia (mean onset: 3.2 years post-discharge). Patients ≥ 85 years old had the highest risk (multivariate analysis). Males had a lower risk than did females in both models (HR: 0.81, 95% CI: 0.72-0.9 in model 1; HR: 0.80, 95% CI: 0.72-0.89 in model 2). ICU stays > 5 days, hospital stays > 14 days, and more ICU readmissions were associated with a higher risk of developing dementia. In conclusion, the long-term risks of a subsequent diagnosis of dementia for acute respiratory failure with MV patients who survive to discharge increase with age and are higher in women than in men. Additionally, the longer the ICU or hospital stay is, and the more ICU readmissions a patient has, are both significantly associated with developing dementia

Antimicrobial ability and mechanism analysis of Lactobacillus species against carbapenemase-producing Enterobacteriaceae

Background: This study aims to investigate the antimicrobial ability and mechanism analysis of Lactobacillus species against carbapenemase-producing Enterobacteriaceae (CPE). Methods: Five Lactobacillus spp. strains and 18 CPE clinical isolates were collected. Their anti-CPE effects were assessed by agar well diffusion and broth microdilution assay, as well as time-kill test. Finally, the specific anti-CPE mechanism, especially for the effect of organic acids was determined using broth microdilution method. Results: All of five Lactobacilli isolates displayed the potent activity against most CPE isolates with mean zones of inhibition ranging 10.2–21.1 mm. The anti-CPE activity was not affected by heating, catalase, and proteinase treatment. Under the concentration of 50% LUC0180 cell-free supernatant (CFS), lactic acid, and mix acid could totally inhibit the growth of carbapenem-resistant Klebsiella pneumoniae (CPE0011), and acetic acid could inhibit 67.8%. In contrast, succinic acid and citric acid could not inhibit the growth of CPE0011. While we decreased the concentration to 25%, only lactic acid and mix acid displayed 100% inhibition. In contrast, succinic acid, citric acid and acetic acid did not show any inhibitory effect. Conclusions: Lactobacillus strains exhibit potent anti-CPE activity, and lactic acid produced by Lactobacillus strains is the major antimicrobial mechanism