6 research outputs found
Usefulness of sputum gram stain for etiologic diagnosis in community-acquired pneumonia: a systematic review and meta-analysis
Background: implementation of sputum Gram stain in the initial assessment of community-acquired pneumonia (CAP) patients is still controversial. We performed a systematic review and meta-analysis to investigate the usefulness of sputum Gram stain for defining the etiologic diagnosis of CAP in adult patients. Methods: we systematically searched the Medline, Embase, Science Direct, Scopus and LILACS databases for full-text articles. Relevant studies were reviewed by at least three investigators who extracted the data, pooled them using a random effects model, and carried out quality assessment. For each bacterium (Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus, and Gram-negative bacilli), pooled sensitivity, specificity, positive and negative likelihood ratios were reported. Results: after a review of 3539 abstracts, 20 articles were included in the present meta-analysis. The studies included yielded 5619 patients with CAP. Pooled sensitivity and pooled specificity of sputum Gram stain were 0.59 (95% CI, 0.56-0.62) and 0.87 (95% CI, 0.86-0.89) respectively for S. pneumoniae, 0.78 (95% CI, 0.72-0.84) and 0.96 (95% CI, 0.94-0.97) for H. influenzae, 0.72 (95% CI, 0.53-0.87) and 0.97 (95% CI, 0.95-0.99) for S. aureus, and 0.64 (95% CI, 0.49-0.77) and 0.99 (95% CI, 0.97-0.99) for Gram-negative bacilli. Conclusion: Sputum Gram stain test is sensitive and highly specific for identifying the main causative pathogens in adult patients with CAP
Cardiac Adverse Events after VaccinationâA Systematic Review
The Vaccine Adverse Event Reporting System database has been used to report adverse events following several vaccines. We studied the patient population predisposed to such reactions and how these reactions differ with respect to the vaccine type. We searched the electronic databases PubMed, EMBASE, and Scopus up to 9 July 2021 for any study describing cardiac adverse events attributed to the vaccination. A total of 56 studies met the criteria comprising 340 patients. There were 20 studies describing cardiac adverse events following smallpox vaccination, 11 studies describing adverse events after influenza vaccination, and 18 studies describing adverse events after COVID-19 vaccination. There was a total of six studies describing cardiac adverse events after the pneumococcal vaccine, tetanus toxoid, cholera vaccine, and rabies vaccine. Adverse events following influenza vaccination occurred more commonly in older females within an average duration of four days from vaccination. Pericardial involvement was the most reported adverse event. Adverse events following COVID-19 vaccination happened at a mean age of 42.7 years, more commonly in males, and mostly after a second dose. Adverse events following smallpox vaccination occurred more commonly in younger males, with an average onset of symptoms from vaccination around 16.6 days. Adverse events were mostly myopericarditis; however, the acute coronary syndrome has been reported with some vaccines
Cardiac amyloidosisâAn underdiagnosed cause of heart failure: A case report and review of literature
Abstract Restrictive cardiomyopathy secondary to cardiac amyloidosis is an underdiagnosed, but treatable, cause of heart failure involving an extracellular deposition of misfolded protein. Hereby, we report a case of a female patient with history of nephrotic syndrome for 1 year who subsequently presented with symptoms of heart failure. The findings on cardiac imaging supported the suspicion of cardiac amyloidosis. Further laboratory workup for amyloidosis was pursued along with endomyocardial biopsy which confirmed amyloidosisâAL type. Patient was started on chemotherapy. The case underscores the importance of a timely diagnosis with the help of symptomatology and imaging along with a multidisciplinary approach for patient care
The microcirculatory response to endotoxemia and resuscitation is a marker of regional renal perfusion, renal metabolic stress and tubular injury.
AIMS: We sought to investigate the relationship between macrohemodynamic resuscitation and microcirculatory parameters with the response of microcirculatory flow, tissue-specific parameters of metabolic stress and injury. We hypothesized that early resuscitation based on macrohemodynamic parameters does not prevent the development of organ dysfunction in a porcine model of endotoxemic shock, and that sublingual microcirculatory parameters are associated with markers of tissue metabolic stress and injury.
RESULTS: Both resuscitation groups had significant increases in creatinine and NGAL as compared to baseline. Neither the macrovascular response to endotoxemia or resuscitation, nor group allocation predicted the development of AKI. Only an MFI \u3c 2.5 was associated with the development of renal tubular injury and AKI, and with increased renal, liver, peritoneal and sublingual Lactate to Pyruvate ratio (L/P) and lactate. Amongst systemic parameters, only PCO2 gap \u3e 6 and P(a-v)CO2/C(v-a)O2 \u3e1.8 were associated with increased organ L/P ratio and AKI. Innovation and Conclusion: Our findings demonstrate that targeting macrohemodynamics to guide resuscitation during endotoxemic shock failed to predict tissue metabolic stress and the response of the microvasculature to resuscitation, and was unsuccessful at preventing tubular injury and AKI. Mechanistically, our data suggests loss of hemodynamic coherence and decoupling of microvascular flow from tissue metabolic demand during endotoxemia may explain the lack of association between macrohemodynamics and perfusion goals. Finally, we demonstrate that MFI, PCO2 gap and P(v-a)CO2/C(a-v)O2 ratio outperformed marcohemodynamic parameters at predicting renal metabolic stress and tubular injury development, and therefore, that these indices merit further validation as promising resuscitation target
Cardiac Muscle Injury and Echocardiographic Plus Electrocardiographic Findings in Patients With 2019 Novel Coronavirus (COVID-19): A Retrospective Cohort Study
Background: Myocardial injury has been described in coronavirus-2019 (COVID-19). Few studies have reported cardiovascular imaging data with transthoracic echocardiography (TTE) and electrocardiography (ECG) findings in COVID-19 patients, and their correlation with mortality. Methods: We conducted a retrospective cohort study that included COVID-19 patients from March 2020 through February 2021 who had TTE and ECG during hospital admission. Myocardial injury was defined by an elevated high-sensitivity troponin T level > 20 ng/L. Bivariate analysis was used to compare patients with myocardial injury and those without. Multivariate logistic regression analysis was performed to identify the variables associated with mortality. Results: A total of 438 patients were included. The mean age was 62.1 ± 14.9 years, and 58.9% were male. A total of 149 patients died, with a mortality rate of 34%. A total of 260 patients (59.4%) had myocardial injury. The average left ventricular ejection fraction was 59.8% ± 11.2%, with 30 patients (6.8%) having an ejection fraction of 20 ng/L. Une analyse Ă deux variables a Ă©tĂ© utilisĂ©e pour comparer les patients prĂ©sentant une atteinte myocardique et ceux qui nâen prĂ©sentaient pas. Une analyse de rĂ©gression logistique Ă multiples variables a Ă©tĂ© menĂ©e pour dĂ©finir les variables qui Ă©taient associĂ©es Ă la mortalitĂ©. RĂ©sultats: LâĂ©tude comptait un total de 438 patients. LâĂąge moyen Ă©tait de 62,1 ± 14,9 ans; 58,9 % Ă©taient des hommes. Un total de 149 patients sont dĂ©cĂ©dĂ©s, soit un taux de mortalitĂ© de 34 %. Un total de 260 patients (59,4 %) prĂ©sentaient une atteinte myocardique. La fraction dâĂ©jection ventriculaire gauche moyenne Ă©tait de 59,8 % ± 11,2 %, alors que 30 patients (6,8 %) affichaient une fraction dâĂ©jection infĂ©rieure Ă 40 %. Le taux de mortalitĂ© Ă©tait plus Ă©levĂ© chez les patients qui prĂ©sentaient une atteinte myocardique que chez ceux qui nâen prĂ©sentaient pas (p < 0,05, test Ï2). Selon un modĂšle dâanalyse de rĂ©gression multiple, lâĂąge, la race et/ou lâethnicitĂ©, lâapparition du syndrome de dĂ©tresse respiratoire aiguĂ«, lâĂ©tat de choc, le besoin de vasopresseurs, la ventilation artificielle et lâhĂ©modialyse Ă©taient les variables fortement liĂ©es Ă la mortalitĂ©. Conclusion: Parmi les patients atteints de la COVID-19, la mortalitĂ© Ă©tait plus Ă©levĂ©e chez ceux qui prĂ©sentaient une atteinte myocardique que chez ceux qui nâen prĂ©sentaient pas. LâĂąge, la race et/ou lâethnicitĂ©, le syndrome de dĂ©tresse respiratoire aiguĂ«, lâĂ©tat de choc, le besoin de vasopresseurs, la ventilation artificielle et lâhĂ©modialyse Ă©taient les variables cliniques liĂ©es Ă la mortalitĂ©. Les variables dâETT et dâECG Ă©tudiĂ©es nâavaient pas de lien important avec la mortalitĂ©