Inhaled corticosteroids and adverse outcomes among chronic obstructive pulmonary disease patients with community-acquired pneumonia: a population-based cohort study

IntroductionWhile inhaled corticosteroids (ICS) may increase pneumonia risk in patients with chronic obstructive pulmonary disease (COPD), the impact of ICS on pneumonia outcomes is debated. We examined whether ICS use is associated with adverse outcomes among COPD patients with community-acquired pneumonia (CAP).Materials and methodsPopulation-based cohort study of all COPD patients with an incident hospitalization for CAP between 1997 and 2013 in Northern Denmark. Information on medications, COPD severity, comorbidities, complications, and death was obtained from medical databases. Adjusted risk ratios (aRRs) for pleuropulmonary complications, intensive care unit (ICU) admissions, and 30-day mortality in current and former ICS users were compared with those in non-users, using regression analyzes to handle confounding.ResultsOf 11,368 COPD patients with CAP, 6,073 (53.4%) were current ICS users and 1,733 (15.2%) were former users. Current users had a non-significantly decreased risk of pleuropulmonary complications [2.6%; aRR = 0.82 (0.59–1.12)] compared to non-users (3.2%). This was also observed among former users [2.5%; aRR = 0.77 (0.53–1.12)]. Similarly, decreased risks of ICU admission were observed among current users [aRR = 0.77 (0.57–1.04)] and among former users [aRR = 0.81 (0.58–1.13)]. Current ICS users had significantly decreased 30-day mortality [9.1%; aRR = 0.72 (0.62–0.85)] compared to non-users (12.6%), with a stronger association observed among patients with frequent exacerbations [0.58 (0.39–0.86)]. No significant association was observed among former ICS users [0.89 (0.75–1.05)].ConclusionOur results suggest a decreased risk of death with ICS use among COPD patients admitted for CAP

Prognostic value of right ventricular dilatation on computed tomography pulmonary angiogram for predicting adverse clinical events in severe COVID-19 pneumonia

BackgroundRight ventricle dilatation (RVD) is a common complication of non-intubated COVID-19 pneumonia caused by pro-thrombotic pneumonitis, intra-pulmonary shunting, and pulmonary vascular dysfunction. In several pulmonary diseases, RVD is routinely measured on computed tomography pulmonary angiogram (CTPA) by the right ventricle-to-left ventricle (LV) diameter ratio > 1 for predicting adverse events.ObjectiveThe aim of the study was to evaluate the association between RVD and the occurrence of adverse events in a cohort of critically ill non-intubated COVID-19 patients.MethodsBetween February 2020 and February 2022, non-intubated patients admitted to the Amiens University Hospital intensive care unit for COVID-19 pneumonia with CTPA performed within 48 h of admission were included. RVD was defined by an RV/LV diameter ratio greater than one measured on CTPA. The primary outcome was the occurrence of an adverse event (renal replacement therapy, extracorporeal membrane oxygenation, 30-day mortality after ICU admission).ResultsAmong 181 patients, 62% (n = 112/181) presented RVD. The RV/LV ratio was 1.10 [1.05–1.18] in the RVD group and 0.88 [0.84–0.96] in the non-RVD group (p = 0.001). Adverse clinical events were 30% and identical in the two groups (p = 0.73). In Receiving operative curves (ROC) analysis, the RV/LV ratio measurement failed to identify patients with adverse events. On multivariable Cox analysis, RVD was not associated with adverse events to the contrary to chest tomography severity score > 10 (hazards ratio = 1.70, 95% CI [1.03–2.94]; p = 0.04) and cardiovascular component (> 2) of the SOFA score (HR = 2.93, 95% CI [1.44–5.95], p = 0.003).ConclusionRight ventricle (RV) dilatation assessed by RV/LV ratio was a common CTPA finding in non-intubated critical patients with COVID-19 pneumonia and was not associated with the occurrence of clinical adverse events

Pneumocystis jiroveci Dihydropteroate Synthase Genotypes in Immunocompetent Infants and Immunosuppressed Adults, Amiens, France

To date, investigations of Pneumocystis jiroveci circulation in the human reservoir through the dihydropteroate synthase (DHPS) locus analysis have only been conducted by examining P. jirovecii isolates from immunosuppressed patients with Pneumocystis pneumonia (PCP). Our study identifies P. jirovecii genotypes at this locus in 33 immunocompetent infants colonized with P. jirovecii contemporaneously with a bronchiolitis episode and in 13 adults with PCP; both groups of patients were monitored in Amiens, France. The results have pointed out identical features of P. jirovecii DHPS genotypes in the two groups, suggesting that in these two groups, transmission cycles of P. jirovecii infections are linked. If these two groups represent sentinel populations for P. jirovecii infections, our results suggest that all persons parasitized by P. jirovecii, whatever their risk factor for infection and the form of parasitism they have, act as interwoven circulation networks of P. jirovecii

Bacterial infection profiles in lung cancer patients with febrile neutropenia

<p>Abstract</p> <p>Background</p> <p>The chemotherapy used to treat lung cancer causes febrile neutropenia in 10 to 40% of patients. Although most episodes are of undetermined origin, an infectious etiology can be suspected in 30% of cases. In view of the scarcity of data on lung cancer patients with febrile neutropenia, we performed a retrospective study of the microbiological characteristics of cases recorded in three medical centers in the Picardy region of northern France.</p> <p>Methods</p> <p>We analyzed the medical records of lung cancer patients with neutropenia (neutrophil count < 500/mm³) and fever (temperature > 38.3°C).</p> <p>Results</p> <p>The study included 87 lung cancer patients with febrile neutropenia (mean age: 64.2). Two thirds of the patients had metastases and half had poor performance status. Thirty-three of the 87 cases were microbiologically documented. Gram-negative bacteria (mainly enterobacteriaceae from the urinary and digestive tracts) were identified in 59% of these cases. <it>Staphylococcus </it>species (mainly <it>S. aureus</it>) accounted for a high proportion of the identified Gram-positive bacteria. Bacteremia accounted for 60% of the microbiologically documented cases of fever. 23% of the blood cultures were positive. 14% of the infections were probably hospital-acquired and 14% were caused by multidrug-resistant strains. The overall mortality rate at day 30 was 33% and the infection-related mortality rate was 16.1%. Treatment with antibiotics was successful in 82.8% of cases. In a multivariate analysis, predictive factors for treatment failure were age >60 and thrombocytopenia < 20000/mm³.</p> <p>Conclusion</p> <p>Gram-negative species were the most frequently identified bacteria in lung cancer patients with febrile neutropenia. Despite the success of antibiotic treatment and a low-risk neutropenic patient group, mortality is high in this particular population.</p

Admission of advanced lung cancer patients to intensive care unit: A retrospective study of 76 patients

<p>Abstract</p> <p>Background</p> <p>Criteria for admitting patients with incurable diseases to the medical intensive care unit (MICU) remain unclear and have ethical implications.</p> <p>Methods</p> <p>We retrospectively evaluated MICU outcomes and identified risk factors for MICU mortality in consecutive patients with advanced lung cancer admitted to two university-hospital MICUs in France between 1996 and 2006.</p> <p>Results</p> <p>Of 76 included patients, 49 had non-small cell lung cancer (stage IIIB n = 20; stage IV n = 29). In 60 patients, MICU admission was directly related to the lung cancer (complication of cancer management, n = 30; cancer progression, n = 14; and lung-cancer-induced diseases, n = 17). Mechanical ventilation was required during the MICU stay in 57 patients. Thirty-six (47.4%) patients died in the MICU. Three factors were independently associated with MICU mortality: use of vasoactive agents (odds ratio [OR] 6.81 95% confidence interval [95%CI] [1.77-26.26], p = 0.005), mechanical ventilation (OR 6.61 95%CI [1.44-30.5], p = 0.015) and thrombocytopenia (OR 5.13; 95%CI [1.17-22.5], p = 0.030). In contrast, mortality was lower in patients admitted for a complication of cancer management (OR 0.206; 95%CI [0.058-0.738], p = 0.015). Of the 27 patients who returned home, four received specific lung cancer treatment after the MICU stay.</p> <p>Conclusions</p> <p>Patients with acute complications of treatment for advanced lung cancer may benefit from MCIU admission. Further studies are necessary to assess outcomes such as quality of life after MICU discharge.</p

Acknowledging previous work is part of scientific process

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Le syndrome d'apnées obstructives du sommeil et chirurgie bariatrique par "sleeve gastrectomy" (données rétrospectives de 2004 à 2012 au centre hospitalier universitaire d'Amiens)

Introduction : L obésité (index de masse corporelle (IMC) supérieur à 30 kg/m2) est un risque reconnu de développer un syndrome d apnée obstructive du sommeil (SAOS). La chirurgie bariatrique par sleeve gastrectomy (SG) fait l objet de recommandations dans l obésité morbide ou en présence de co-morbidités. Les patients candidats à cette chirurgie bénéficient d une évaluation de l existence d un SAOS. L objet principal de notre étude était d étudier les différents critères clinico-biologiques et comorbidités cardiovasculaires associés au SAOS dans cette population de patients et secondairement les effets du SAOS sur la chirurgie, et de la chirurgie sur le SAOS après amaigrissement. Matériels et méthode : Il s agit d une étude monocentrique rétrospective de 2004 à 2012 sur 216 patients évalués au CHU d Amiens au laboratoire de pathologie du sommeil et de la vigilance, et suivi par l équipe de chirurgie viscérale et métabolique dans un projet de chirurgie bariatrique par SG. Résultats : Sur 216 patients 36 ont été diagnostiqués pour un SAOS et appareillés, qui étaient plus souvent des hommes (61,1% vs 41,5 p<0,01), avec un IMC significativement plus important (49,23kg/m2 dans le groupe SAOS vs 44,82 kg/m2 p<0,01) et un tour de cou significativement plus important corrélés à l IAH (47,92cm vs 42,35 p<0,01). Il existait une corrélation entre IMC et index d apnées-hypopnées (IAH). Sur les 36 patients SAOS, 24 d entre eux ont été opérés sans qu il soit observé d augmentation de complications per-opératoires ou post opératoires. Parmi ces patients, 17 ont pu être réévalués en polysomnographie après amaigrissement (IMC= 56,74kg/m2 pré opératoire vs 36,89kg/m2 post amaigrissement p<0,01), 15 patients ont été complètement désappareillés (IAH=56,74 vs 10,12p<0,01) avec amélioration significative des gaz du sang sur la pO2 et pCO2. Il est noté chez ces patients une amélioration significative de l architecture du sommeil. Conclusion : Notre étude a mis en évidence une corrélation entre IAH et IMC, tour de cou et tour de taille des patients SAOS. La chirurgie de l obésité par SG montre des résultats intéressant sur le SAOS via l amaigrissement obtenu avec l arrêt de l appareillage du SAOS, une amélioration de l architecture du sommeil et des paramètres gazométriques chez 15 de nos patients réévalués.Background: Obesity (a body mass index (BMI) over 30kg/m2) is a risk factor to develop sleep obstructive apnea syndrom (SOAS). Bariatric surgery with sleeve gastrectomy (SG) is well codified for morbid obese patients or for those with comorbidities. Patients eligible for surgery require evaluation of SOAS before surgery. The main objective of our study was to analyze clinical or biological risks factors associated with SOAS. Secondary objectives were to evaluate effects of SOAS on the bariatric surgery and on the other hand effects of batrictric surgery on SOAS improvement after weigth loss. Methods: This study is a retrospective study conducted from 2004 to 2012 on 216 patients evaluated in the sleep laboratory of Amiens. These patients were followed up for undergoing bariatric surgery with SG technique.Results: On these 216 patients, 36 were diagnosed for a SAS and were treated with continuous positive airway pressure (CPAP). A greater part of them were men (61.1% vs. 41.5 p<0.01), with a significant increase of BMI (49.23kg/m2 in SAS vs. 44.82 kg/m2 p<0.01), an increased of neck circumference (47.92 vs. 42.35 p<0.01). A correlation between BMI and Hypopnea-Apnea index (HAI) was found. Over the 36 patients diagnosed for SOAS, 24 of them underwent SG without an increase of complication rate. Among these 24 patients, 17 underwent a polysomnography after surgery and weight loss. (BMI= 56,74kg/m2 before surgery vs. 36,89kg/m2 after weight loss p<0.01), for 15 of them positive airway pressure had been stopped (HAI 56.74 vs. 10.12, p<0.01) with significant improvement of blood gas (pO2 and pCO2). A best quality of sleep had been observed. Conclusion: This study shows a correlation between HAI and BMI, neck circumference and waist circumference for SOAS patients. SG shows good results on SOAS, having allowed by weight loss a stop of CPAP, an improvement of sleep structure and blood gas on 15 patients.AMIENS-BU Santé (800212102) / SudocSudocFranceF

Kinésithérapie respiratoire au cours de la ventilation mécanique dans la bronchopneumopathie chronique obstructive

La kinésithérapie respiratoire par augmentation du flux expiratoire est recommandée chez le patient BPCO encombré non intubé. L'intubation favorise l'encombrement bronchique. Nous avons évalué l'efficacité et la tolérance de cette kinésithérapie chez treize patients BPCO intubés dans 3 conditions: aspiration endotrachéale, kinésithérapie suivie d'une aspiration et kinésithérapie associée à une pression télé-expiratoire positive (PEEP) de 5 cm d'H2O suivie d'une aspiration. Le volume courant expiré et le volume de sécrétion bronchique étaient plus importants après la kinésithérapie par rapport à l'aspiration seule. L'auscultation pulmonaire était améliorée par les 3 conditions. La saturation en oxygène n'était pas modifiée. L'adjonction d'une PEEP n'apportait pas de gain supplémentaire. Les paramètres de tolérance respiratoire et hémodynamique étaient inchangés. La kinésithérapie améliorerait la clairance des sécrétions bronchiques sans effet indésirable chez le patient BPCO intubéAMIENS-BU Santé (800212102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF