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

Active tuberculosis, sequelae and COVID-19 co-infection: first cohort of 49 cases.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease (COVID-19) pandemic has attracted interest because of its global rapid spread, clinical severity, high mortality rate, and capacity to overwhelm healthcare systems [1, 2]. SARS-CoV-2 transmission occurs mainly through droplets, although surface contamination contributes and debate continues on aerosol transmission [3\u20135]

Epidemiology and Clinical Features of Pulmonary Nontuberculous Mycobacteriosis in Nagasaki, Japan

Background and Objectives: Recent reports indicate that the incidence of nontuberculous mycobacterial-lung disease (NTM-LD) is increasing. This study aimed to investigate the epidemiology and clinical features of NTM-LD patients in Nagasaki prefecture, Japan to identify the negative prognostic factors for NTM-LD in Japan. Methods: The medical records of patients newly diagnosed with NTM-LD in eleven hospitals in Nagasaki prefecture between January 2001 and February 2010 were reviewed. Data regarding the annual population of each region and the incidence of all forms of tuberculosis were collected to assess geographic variations in NTM-LD incidence, isolates, and radiological features. Results: A total 975 patients were diagnosed with NTM-LD. The incidence increased over the study period and reached 11.0 and 10.1 per 100,000 population in 2008 and 2009, respectively. M. intracellulare was the most common pathogen in the southern region, and M. avium most common in other regions. The most common radiographic pattern was the nodular-bronchiectatic pattern. Age >60 years, body mass index <18.5 kg/m2, underlying lung disease, and cavitary pattern were the negative prognostic factors at the 1-year follow-up. Conclusions: The incidence of NTM-LD has been increasing in Nagasaki prefecture. The isolates and radiographic features of patients vary markedly by region

Comparison of different therapeutic strategies in hypertension: a low-dose combination of perindopril/indapamide versus a sequential monotherapy or a stepped-care approach.

OBJECTIVE: To compare the efficacy and the tolerability of three different strategies in the treatment of hypertension (low-dose combination, sequential monotherapy and stepped-care). DESIGN: Hypertensive patients were randomized to a 9-month treatment with the aim to lower blood pressure below 140/90 mmHg. Treatment adjustments were allowed at months 3 and 6. The study was discontinued for patients with normal blood pressure at month 6. In the 'low-dose combination' group, perindopril (2 mg) and indapamide (0.625 mg) were first administered with the possibility to increase the doses in two steps up to respectively, 4 and 1.25 mg. In the 'sequential monotherapy' group, the treatment was initiated with atenolol (50 mg), replaced if necessary by losartan (50 mg), and then by amlodipine (5 mg). In the 'stepped-care' group, valsartan, was given first at a 40 mg dose, then at a 80 mg dose, to be co-administered finally if needed with hydrochlorothiazide, 12.5 mg. All study tablets were encapsulated to conceal their identity and had to be taken once a day. PATIENTS: Patients with uncomplicated essential hypertension were recruited (n = 180 in the 'low-dose combination' group, n = 176 in the 'sequential monotherapy' group and n = 177 in the 'stepped-care' group). RESULTS: The percentage of patients having achieved the target blood pressure was significantly greater in the 'low-dose combination' group (62%) than in the 'sequential monotherapy' (49%, P = 0.02) and the 'stepped-care' group (47%, P = 0.005). The percentage of patients having normalized their blood pressure without experiencing drug-related adverse events was also significantly higher in the 'low-dose combination' group (56%) than in the 'sequential monotherapy' (42%, P = 0.002) and the 'stepped-care' group (42%, P = 0.004). CONCLUSIONS: A first line management of hypertension based on a low-dose combination of perindopril and indapamide allows the normalization of blood pressure in significantly more patients than a 'sequential monotherapy' strategy involving atenolol, losartan and amlodipine, and a 'stepped-care' strategy involving valsartan and hydrochlorothiazide. These better blood pressure results were not obtained at the expense of a worsening of tolerability

Osteoarticular tuberculosis: a case series of 118 patients from five French hospitals

International audienc

Épidémiologie des infections à mycobactéries non tuberculeuses d’expression respiratoire en Guyane française, étude rétrospective 2008–2018

International audienceIntroductionL’épidémiologie des infections causées par les mycobactéries non tuberculeuses d’expression respiratoire (MBNTER) est mal connue en Amérique latine, et en Guyane française en particulier. L’objectif principal de cette étude était de déterminer les caractéristiques de ces infections en Guyane. Les objectifs secondaires étaient de déterminer l’incidence des maladies pulmonaires liées aux MBNTER (MBNT-MP), et les caractéristiques spécifiques des malades infectés à Mycobacterium avium complexe (MAC) ou M. abscessus et de ceux infectés par le VIH.MéthodesIl s’agit d’une étude rétrospective observationnelle multicentrique entre 2008 et 2018, réalisée sur tous les hôpitaux de Guyane. Étaient inclus les patients ayant eu au moins une culture positive à MBNTER sur prélèvement respiratoire. Les cas étaient classés en 2 catégories : porteurs non malades et malades dues à une atteinte pulmonaire liée à MBNTER selon les critères définis par l’American Thoracic Society/Infectious Disease Society of America (ATS/IDSA) en 2007.RésultatsSur la période d’étude, 178 cas ont été inclus, parmi lesquels 147 étaient porteurs non malades et 31 malades. Les patients étaient plutôt des hommes (61 %), jeunes (âge médian 49 ans), vivant dans la précarité (64 %) avec des comorbidités respiratoires (33 %) ou une immunodépression avec des CD4 ≤ 50/mm3 dans 39 % des 46 % de patients séropositifs pour le VIH. Les MAC suivies de M. fortuitum puis M. abscessus étaient les plus fréquentes (38 %, 19 % et 6 % respectivement). Le taux d’incidence annuel moyen de MBNT-MP était à 1,07/100 000 habitants par an. La MBNT-MP était significativement associée à l’infection par le VIH, à la dénutrition, et aux espèces MAC et M. abscessus qui représentaient respectivement 81 % et 16 % des maladies pulmonaires à MBNT. La mortalité à un an toutes causes confondues était de 29 % chez les malades.ConclusionIl s’agit de la première étude réalisée sur les infections à MBNTER en Guyane. L’épidémiologie des MBNTER y est spécifique avec une population différente de celle de France métropolitaine. MAC et M. abscessus sont les espèces responsables de maladies respiratoires favorisées par une infection par le VIH, ou par des comorbidités respiratoires et la dénutrition, respectivement. Les caractéristiques chez le séropositif pour le VIH sont différentes et les critères ATS/IDSA n’y sont pas extrapolables rendant le diagnostic difficile. La mortalité est plus élevée en Guyane qu’en France métropolitaine

The WISDOM of inhaled corticosteroids in COPD

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