Concurrent pulmonary zygomycosis and Mycobacterium tuberculosis infection: a case report

A non-smoking 77-year old gentleman of Indian origin was admitted with a 4-month history of intermittent night sweats, haemoptysis and 6 kg of weight loss. CT scan of thorax demonstrated a 2.5 cm mass in the right middle lobe with multiple small nodules within the right lung and confirmed the presence of mediastinal and hilar lymph nodes

Prospective validation of the RAPID clinical risk prediction score in adult patients with pleural infection: the PILOT study

BACKGROUND: Over 30% of adult patients with pleural infection either die and/or require surgery. There is no robust means of predicting at baseline presentation which patients will suffer a poor clinical outcome. A validated risk prediction score would allow early identification of high-risk patients, potentially directing more aggressive treatment thereafter. OBJECTIVES: To prospectively assess a previously described risk score (RAPID - Renal (urea), Age, fluid Purulence, Infection source, Dietary (albumin)) in adults with pleural infection. METHODS: Prospective observational cohort study recruiting patients undergoing treatment for pleural infection. RAPID score and risk category were calculated at baseline presentation. The primary outcome was mortality at 3 months; secondary outcomes were mortality at 12 months, length of hospital stay, need for thoracic surgery, failure of medical treatment, and lung function at 3 months. RESULTS: Mortality data were available in 542 of 546 (99.3%) patients recruited. Overall mortality was 10% (54/542) at 3 months and 19% (102/542) at 12 months. The RAPID risk category predicted mortality at 3 months; low-risk (RAPID score 0-2) mortality 5/222 (2.3%, 95%CI 0.9 to 5.7), medium-risk (RAPID score 3-4) mortality 21/228 (9.2%, 95%CI 6.0 to 13.7), and high-risk (RAPID score 5-7) mortality 27/92 (29.3%, 95%CI 21.0 to 39.2). C-statistics for the score at 3 and 12 months were 0.78 (95%CI 0.71 to 0.83) and 0.77 (95%CI 0.72 to 0.82) respectively. CONCLUSIONS: The RAPID score stratifies adults with pleural infection according to increasing risk of mortality and should inform future research directed at improving outcomes in this patient population

Prospective validation of the RAPID clinical risk prediction score in adult patients with pleural infection: the PILOT study.

BACKGROUND: Over 30% of adult patients with pleural infection either die and/or require surgery. There is no robust means of predicting at baseline presentation which patients will suffer a poor clinical outcome. A validated risk prediction score would allow early identification of high-risk patients, potentially directing more aggressive treatment thereafter. OBJECTIVES: To prospectively assess a previously described risk score (RAPID - Renal (urea), Age, fluid Purulence, Infection source, Dietary (albumin)) in adults with pleural infection. METHODS: Prospective observational cohort study recruiting patients undergoing treatment for pleural infection. RAPID score and risk category were calculated at baseline presentation. The primary outcome was mortality at 3 months; secondary outcomes were mortality at 12 months, length of hospital stay, need for thoracic surgery, failure of medical treatment, and lung function at 3 months. RESULTS: Mortality data were available in 542 of 546 (99.3%) patients recruited. Overall mortality was 10% (54/542) at 3 months and 19% (102/542) at 12 months. The RAPID risk category predicted mortality at 3 months; low-risk (RAPID score 0-2) mortality 5/222 (2.3%, 95%CI 0.9 to 5.7), medium-risk (RAPID score 3-4) mortality 21/228 (9.2%, 95%CI 6.0 to 13.7), and high-risk (RAPID score 5-7) mortality 27/92 (29.3%, 95%CI 21.0 to 39.2). C-statistics for the score at 3 and 12 months were 0.78 (95%CI 0.71 to 0.83) and 0.77 (95%CI 0.72 to 0.82) respectively. CONCLUSIONS: The RAPID score stratifies adults with pleural infection according to increasing risk of mortality and should inform future research directed at improving outcomes in this patient population

Anti reflux surgery

Surgery may be necessary to control gross reflux disease, particularly when anatomical abnormalities underlie the pathophysiology. Treatment is generally less successful when directed at isolated airway reflux and aspiration since the refluxate consists mainly of a gaseous mist which even the tightest ‘wrap’ will not be able to control. When successful however, repeated admissions for recurrent aspiration can be abruptly terminated

Fatores associados à tosse seca, tosse produtiva e tosse noturna em adultos jovens na Nigéria Factors associated with nocturnal, productive and dry cough in the young adult population of Nigeria

OBJETIVO: Determinar os fatores associados à tosse seca, tosse produtiva e tosse noturna entre jovens adultos na Nigéria. MÉTODOS: Foram avaliados 498 indivíduos com 20-44 anos de idade em Ilorin, Nigéria, utilizando-se o questionário European Community Respiratory Health Survey (ECRHS), administrado por entrevistadores treinados. RESULTADOS: A tosse noturna apresentou associações com asma (OR = 10,87; p < 0,01), alergia nasal (OR = 6,33; p < 0,01), tabagismo (OR = 3,10; p < 0,01), trabalho manual e trabalho não manual especializados (OR = 2,86 e 2,10, respectivamente; p < 0,01 para ambos) e gênero feminino (OR = 1,33; p = 0,17). A tosse produtiva apresentou associações com trabalho manual e trabalho não manual especializados (OR = 3,82 e 3,03, respectivamente; p < 0,01 para ambos), tabagismo (OR = 3,10; p < 0,01), asma (OR = 3,27; p < 0,01) e alergia nasal (OR = 5,81; p < 0,01). A tosse seca apresentou associações com asma (OR =5,18; p < 0,01) obesidade (OR =1,88; p = 0,19), tabagismo (OR = 1,77; p = 1,44), alergia nasal (OR = 1,45; p = 0,26) e gênero feminino (OR =1,36; p = 0,33). A idade, o gênero, o tipo de residência e a obesidade não se associaram significativamente a nenhum tipo de tosse (p > 0,05). CONCLUSÕES: A prevenção precoce e o tratamento de condições associadas à tosse, assim como a modificação de fatores sociais comumente associados à tosse, são necessários a fim de reduzir a morbidade respiratória.<br>OBJECTIVE: The aim of this study was to determine the factors associated with nocturnal, productive and dry cough among young adults in Nigeria. METHODS: We evaluated 498 subjects, 20-44 years of age, in Ilorin, Nigeria, using the European Community Respiratory Health Survey (ECRHS) questionnaire, administered by trained interviewers. RESULTS: Nocturnal cough was associated with asthma (OR = 10.87; p < 0.01), nasal allergy (OR = 6.33; p < 0.01), smoking (OR = 3.10; p < 0.01), skilled manual and non-manual work (OR = 2.86 and 2.10, respectively; p < 0.01 for both) and female gender (OR = 1.33; p = 0.17). Productive cough was associated with skilled manual and non-manual work (OR = 3.82 and 3.03, respectively; p < 0.01 for both), smoking (OR = 3.10; p < 0.01), asthma (OR = 3.27; p < 0.01) and nasal allergy (OR = 5.81; p < 0.01). Dry cough was associated with asthma (OR =5.18; p < 0.01) obesity (OR =1.88; p = 0.19), smoking (OR = 1.77; p = 1.44), nasal allergy (OR = 1.45; p = 0.26) and female gender (OR =1.36; p = 0.33). Age, gender, type of residence and obesity were not significantly associated with any type of cough (p > 0.05). CONCLUSIONS: Early prevention and treatment of conditions associated with cough, as well as the modification of social factors commonly associated with cough, are needed in order to reduce respiratory morbidity