The interrelations of radiologic findings and mechanical ventilation in community acquired pneumonia patients admitted to the intensive care unit: a multicentre retrospective study

BACKGROUND: We evaluated patients admitted to the intensive care units with the diagnosis of community acquired pneumonia (CAP) regarding initial radiographic findings. METHODS: A multicenter retrospective study was held. Chest x ray (CXR) and computerized tomography (CT) findings and also their associations with the need of ventilator support were evaluated. RESULTS: A total of 388 patients were enrolled. Consolidation was the main finding on CXR (89%) and CT (80%) examinations. Of all, 45% had multi-lobar involvement. Bilateral involvement was found in 40% and 44% on CXR and CT respectively. Abscesses and cavitations were rarely found. The highest correlation between CT and CXR findings was observed for interstitial involvement. More than 80% of patients needed ventilator support. Noninvasive mechanical ventilation (NIV) requirement was seen to be more common in those with multi-lobar involvement on CXR as 2.4-fold and consolidation on CT as 47-fold compared with those who do not have these findings. Invasive mechanical ventilation (IMV) need increased 8-fold in patients with multi-lobar involvement on CT. CONCLUSION: CXR and CT findings correlate up to a limit in terms of interstitial involvement but not in high percentages in other findings. CAP patients who are admitted to the ICU are severe cases frequently requiring ventilator support. Initial CT and CXR findings may indicate the need for ventilator support, but the assumed ongoing real practice is important and the value of radiologic evaluation beyond clinical findings to predict the mechanical ventilation need is subject for further evaluation with large patient series

Elastofibroma dorsi management and outcomes: review of 16 cases

Elastofibroma dorsi (ED) is a rare, benign lesion arising from connective tissue, usually found at the inferior pole of the scapula. To date, only a few small series have been reported in the English literature and there are few data about the long-term outcomes after surgery. Our goal is to contribute a better understanding of this tumour and to determine the long-term outcomes after surgery. Sixteen patients with a diagnosis of ED were identified from the unit's database. The clinical presentation, diagnosis, pathological evidences and long-term outcomes were evaluated. There were 11 females and 5 males with a mean age of 61.1 years (range 38-78 years). The tumour was located on the right in 5 (31.2%) patients, on the left in 6 (37.5%) patients and bilaterally in 5 (31.2%). Six patients had painful scapular swelling resulting in restriction of movement of the shoulder whereas 10 reported only painful scapular mass. All 16 patients underwent complete resections. The tumour size ranged from 3 to 15 cm. The mean hospital stay was 3.1 +/- 1.4 days with a morbidity of 18.75% (seroma observed in 3 patients). The mean follow-up was 58.4 +/- 29.5 months (range 11-92 months). In 2 patients (12.5%) a new occurrence on the contralateral side was observed at the follow-up. Elastofibroma dorsi is a rare, ill-defined, pseudotumoural lesion of the soft tissues. Surgical treatment can be proposed if the lesion is symptomatic. Furthermore, at the follow-up, the possibility of new occurrences on the contralateral side should be kept in mind

Immunohistochemical and Molecular Detection of Mannheimia spp. and Pasteurella spp. in Sheep with Pneumonia in Kars Province - Turkey

In this investigation, presence of Mannheimia haemolytica and Pasteurella multocida in sheep brought to Kafkas University Faculty of Veterinary Medicine between 2011 and 2013 with a suspicion of pneumonia was studied by immunohistochemical and bacteriological methods. Study materials were 100 sheep lungs. After routine histopathological investigations lungs were immunohistochemically stained with antibodies prepared against both of the agents. In bacteriological investigations, tissue samples were inoculated into 7% sheep blood agar and Mc Conkey agar and incubated for 24-48 h in aerobic conditions, and the suspected colonies were evaluated for Mannheimia and Pasteurella species. In histological investigations, pneumonias were classified as 28% fibrinous bronchopneumonia, 21% prulent bronchopneumonia, 20% acute-catharal bronchopneumonia, 18% interstitial pneumonia, 11% verminous pneumonia and 2% adenomatous pneumonia. In bacteriological investigations Mannheimia haemolytica and Pasteurella multocida was detected in 19 and 3 cases, respectively, these numbers were 17 and 2, respectively in immunohistochemical investigations. The results of PCR analysis for both Mannheimia haemolytica and Pasteurella multocida paralleled with the findings of microbiological culture. The results of the study showed that Mannheimia haemolytica is an important cause of pneumonia in sheep in Kars, and Pasteurella multocida, although with lesser importance can cause pneumonia in this species

Change in left ventricular systolic function in patients with ST elevation myocardial infarction: Evidence for smoker's paradox or pseudo-paradox?

Background: The ‘smoker's paradox’ refers to the observation of favorable prognosis in current smokers following an acute ST elevation myocardial infarction (STEMI) in the era of fibrinolysis, however, several STEMI studies have demonstrated conflicting results in patients undergoing primary percutaneous coronary intervention (p-PCI). Objective: Aim of the current study was to evaluate the impact of cigarette smoking on left ventricular function in STEMI patients undergoing p-PCI. Methods: Our population is represented by 74 first-time anterior STEMI patients undergoing p-PCI, 37 of whom were smokers. We assessed left ventricular function by left ventricular ejection fraction (LVEF) on the second day after admission and at 3-month follow-up. Early predictors of adverse left ventricular remodelling after STEMI treated by p-PCI were examined. Results: Basal demographics and comorbidities were similar between groups. Although the LVEF during the early phase was higher in smokers compared to non-smokers (44.95 ± 7.93% vs. 40.32 ± 7.28%; p = 0.011); it worsened in smokers at follow-up (mean decrease in LVEF: −2.70 ± 5.95%), whereas it improved in non-smokers (mean recovery of LVEF: +2.97 ± 8.45%). In univariate analysis, diabetes mellitus, peak troponin I, current smoking, and lower TIMI flow grade after p-PCI, pain-to-door time and door-to-balloon times were predictors of adverse left ventricular remodelling. After multivariate logistic regression analysis, smoking at admission, lower TIMI flow grade after p-PCI, the pain-to-door time and door-to-balloon times remained independent predictors of deterioration in LVEF. Conclusion: True or persistent ‘smoker's paradox’ does not appear to be relevant among STEMI patients undergoing p-PCI. The ‘smoker's paradox’ is in fact a pseudo-paradox. Further studies with larger numbers may be warranted

Związek galektyny-3 z liczbą blaszek miażdżycowych w tętnicach wieńcowych i stopniem ciężkości obturacyjnego bezdechu sennego

Background: Obstructive sleep apnoea syndrome (OSAS) is reported to be associated with hypertension, coronary artery disease, atrial fibrillation, and heart failure. Galectin-3 plays an important role in the regulation of inflammation, development of cardiac fibrosis, and remodelling. A significant relationship between galectin-3 and the total number of coronary plaques and the macrocalcified plaque structures of patients with type 2 diabetes mellitus has been reported. Aim: The aim of this study was to investigate the association between galectin-3 level and coronary plaque burden as well as OSAS severity in patients with OSAS. Methods: A total of 87 consecutive patients with a diagnosis of OSAS and 21 age- and gender-matched control subjects were recruited for the present study. The patients with OSAS were also categorised according to their apnoea hypopnoea index (AHI) as follows: mild (AHI = 5–15), moderate (AHI = 15–30), and severe (AHI > 30). All study subjects underwent coronary computed tomography angiography to detect coronary atherosclerosis. Also, all participants of serum galectin-3 concentrations were measured. Results: Mean galectin-3 level was significantly higher in patients with OSAS compared to control subjects (p < 0.001) and in the severe OSAS group, compared to the moderate and mild OSAS groups (p < 0.001). Correlation analysis indicated significant positive relationships between galectin-3 concentrations and the total number of coronary plaques (p < 0.001), high-sensitivity C-reactive protein (p = 0.001), and severity of OSAS (p < 0.001). In multivariate analysis, galectin-3 (p = 0.01) and age (p = 0.025) were significant independent predictors of coronary atherosclerosis, after adjusting for other risk factors. Also, it has been found that galectin-3 concentration is a predictor of OSAS severity (p = 0.001). Conclusions: Galectin-3 is associated with coronary atherosclerosis and OSAS severity in OSAS patients.  Wstęp: Jak podają doniesienia, zespół obturacyjnego bezdechu sennego (OSAS) wiąże się z nadciśnieniem tętniczym, chorobą wieńcową, migotaniem przedsionków i niewydolnością serca. Galektyna-3 odgrywa istotną rolę w regulacji stanu zapalnego, rozwoju zwłóknienia serca i jego przebudowy. Opisywano istotne zależności między stężeniem galektyny-3 a całkowitą liczbą blaszek miażdżycowych w naczyniach wieńcowych i blaszek uwapnionych u chorych na cukrzycę typu 2. Cel: Celem niniejszego badania była ocena związku między stężeniem galektyny-3 a liczbą blaszek miażdżycowych i stopniem ciężkości OSAS u chorych z zespołem obturacyjnego bezdechu sennego. Metody: Do badania włączono 87 kolejnych pacjentów z rozpoznaniem OSAS i 21 dobranych pod względem wieku i płci osób kontrolnych. Chorych z OSAS dodatkowo podzielono na grupy ciężkości OSAS w zależności od wskaźnika stosunku bezdechów do spłyconych oddechów (AHI): łagodny (AHI = 5–15), umiarkowany (AHI = 15–30), ciężki (AHI > 30). U wszystkich uczestników badania wykonano koronarografię metodą tomografii komputerowej w celu wykrycia miażdżycy tętnic wieńcowych oraz zmierzono stężenie galektyny-3 w surowicy. Wyniki: Średnie stężenie galektyny-3 było istotnie wyższe u chorych z OSAS niż u osób z grupy kontrolnej (p < 0,001), a u pacjentów z ciężkim OSAS było istotnie wyższe niż w grupach z umiarkowanym i łagodnym OSAS (p < 0,001). Wykazano istotne dodatnie korelacje między stężeniem galektyny-3 a całkowitą liczbą blaszek miażdżycowych w tętnicach wieńcowych (p < 0,001), stężeniem białka C-reaktywnego mierzonego metodą wysokoczułą (p = 0,001) i stopniem ciężkości OSAS (p < 0,001). W analizie wieloczynnikowej stężenie galektyny-3 (p = 0,01) i wiek (p = 0,025) były istotnymi niezależnymi czynnikami predykcyjnymi miażdżycy tętnic wieńcowych po skorygowaniu względem innych czynników ryzyka. Stwierdzono również, że stężenie galektyny-3 jest czynnikiem predykcyjnym stopnia ciężkości OSAS (p = 0,001). Wnioski: U chorych z OSAS stężenie galektyny-3 wiąże się z nasileniem zmian miażdżycowych i stopniem ciężkości OSAS

The interrelations of radiologic findings and mechanical ventilation in community acquired pneumonia patients admitted to the intensive care unit: a multicentre retrospective study

Background: We evaluated patients admitted to the intensive care units with the diagnosis of community acquired pneumonia (CAP) regarding initial radiographic findings

Treatment of ventilator-associated pneumonia (VAP) caused by Acinetobacter: results of prospective and multicenter ID-IRI study

Ventilator-associated pneumonia (VAP) due to Acinetobacter spp. is one of the most common infections in the intensive care unit. Hence, we performed this prospective-observational multicenter study, and described the course and outcome of the disease. This study was performed in 24 centers between January 06, 2014, and December 02, 2016. The patients were evaluated at time of pneumonia diagnosis, when culture results were available, and at 72 h, at the 7th day, and finally at the 28th day of follow-up. Patients with coexistent infections were excluded and only those with a first VAP episode were enrolled. Logistic regression analysis was performed. A total of 177 patients were included; empiric antimicrobial therapy was appropriate (when the patient received at least one antibiotic that the infecting strain was ultimately shown to be susceptible) in only 69 (39%) patients. During the 28-day period, antibiotics were modified for side effects in 27 (15.2%) patients and renal dose adjustment was made in 38 (21.5%). Ultimately, 89 (50.3%) patients died. Predictors of mortality were creatinine level (OR, 1.84 (95% CI 1.279-2.657); p = 0.001), fever (OR, 0.663 (95% CI 0.454-0.967); p = 0.033), malignancy (OR, 7.095 (95% CI 2.142-23.500); p = 0.001), congestive heart failure (OR, 2.341 (95% CI 1.046-5.239); p = 0.038), appropriate empiric antimicrobial treatment (OR, 0.445 (95% CI 0.216-0.914); p = 0.027), and surgery in the last month (OR, 0.137 (95% CI 0.037-0.499); p = 0.003). Appropriate empiric antimicrobial treatment in VAP due to Acinetobacter spp. was associated with survival while renal injury and comorbid conditions increased mortality. Hence, early diagnosis and appropriate antibiotic therapy remain crucial to improve outcomes

Community-acquired pneumonia in patients with chronic obstructive pulmonary disease requiring admission to the intensive care unit: Risk factors for mortality

Conclusion: Noninvasive ventilation, hypertension, systemic corticosteroid treatment, and shorter ICU stay are associated with reduced mortality, whereas bilateral infiltration and longer duration of invasive mechanical ventilation are associated with increased risk of mortality in patients with COPD and CAP requiring ICU admission. (C) 2013 Elsevier Inc. All rights reserved

Mortality indicators in community-acquired pneumonia requiring intensive care in Turkey

Background: Severe community-acquired pneumonia (SCAP) is a fatal disease. This study was conducted to describe an outcome analysis of the intensive care units (ICUs) of Turkey