Pathologic characteristics of resected squamous cell carcinoma of the trachea: prognostic factors based on an analysis of 59 cases

While squamous cell carcinoma (SCC) is the most common tracheal malignancy, few reports describe the pathologic considerations that may guide intraoperative decisions and prognostic assessment. We reviewed 59 tracheal SCC treated between 1985 and 2008 by segmental resection of the trachea, including resection of the carina in 24% and inferior larynx in 14%. We classified these tumors by grading histologic differentiation and microscopic features used in SCC of other sites. Of 59 tumors, 24% (14 of 59) were well differentiated, 49% (29 of 59) were moderately differentiated, and 27% (16 of 59) were poorly differentiated. Unfavorable prognostic factors were tumor extension into the thyroid gland (all of five so-afflicted patients died of tumor progression within 3 years) and lymphatic invasion (mean survival 4.6 versus 7.6 years). Keratinization, dyskeratosis, acantholysis, necrosis, and tumor thickness did not predict prognosis. As surgical resection is the only curative treatment; the surgeon should establish clean lines of resection using, as appropriate, intraoperative frozen section. The pathologist can provide additional important prognostic information, including tumor differentiation and extent, invasion of surgical margins, and extension into the thyroid

Influenza A(H1N1)pdm09-associated pneumonia deaths in Thailand.

BACKGROUND: The first human infections with influenza A(H1N1)pdm09 virus were confirmed in April 2009. We describe the clinical and epidemiological characteristics of influenza A(H1N1)pdm09-associated pneumonia deaths in Thailand from May 2009-January 2010. METHODS: We identified influenza A(H1N1)pdm09-associated pneumonia deaths from a national influenza surveillance system and performed detailed reviews of a subset. RESULTS: Of 198 deaths reported, 49% were male and the median age was 37 years; 146 (73%) were 20-60 years. Among 90 deaths with records available for review, 46% had no identified risk factors for severe influenza. Eighty-eight patients (98%) received antiviral treatment, but only 16 (18%) initiated therapy within 48 hours of symptom onset. CONCLUSIONS: Most influenza A(H1N1)pdm09 pneumonia fatalities in Thailand occurred in adults aged 20-60 years. Nearly half lacked high-risk conditions. Antiviral treatment recommendations may be especially important early in a pandemic before vaccine is available. Treatment should be considered as soon as influenza is suspected

Enhanced surveillance for severe pneumonia, Thailand 2010–2015

Abstract Background The etiology of severe pneumonia is frequently not identified by routine disease surveillance in Thailand. Since 2010, the Thailand Ministry of Public Health (MOPH) and US CDC have conducted surveillance to detect known and new etiologies of severe pneumonia. Methods Surveillance for severe community-acquired pneumonia was initiated in December 2010 among 30 hospitals in 17 provinces covering all regions of Thailand. Interlinked clinical, laboratory, pathological and epidemiological components of the network were created with specialized guidelines for each to aid case investigation and notification. Severe pneumonia was defined as chest-radiograph confirmed pneumonia of unknown etiology in a patient hospitalized ≤48 h and requiring intubation with ventilator support or who died within 48 h after hospitalization; patients with underlying chronic pulmonary or neurological disease were excluded. Respiratory and pathological specimens were tested by reverse transcription polymerase chain reaction for nine viruses, including Middle East Respiratory Syndrome Coronavirus (MERS-CoV), and 14 bacteria. Cases were reported via a secure web-based system. Results Of specimens from 972 cases available for testing during December 2010 through December 2015, 589 (60.6%) had a potential etiology identified; 399 (67.8%) were from children aged < 5 years. At least one viral agent was detected in 394 (40.5%) cases, with the most common of single vial pathogen detected being respiratory syncytial virus (RSV) (110/589, 18.7%) especially in children under 5 years. Bacterial pathogens were detected in 341 cases of which 67 cases had apparent mixed infections. The system added MERS-CoV testing in September 2012 as part of Thailand’s outbreak preparedness; no cases were identified from the 767 samples tested. Conclusions Enhanced surveillance improved the understanding of the etiology of severe pneumonia cases and improved the MOPH’s preparedness and response capacity for emerging respiratory pathogens in Thailand thereby enhanced global health security. Guidelines for investigation of severe pneumonia from this project were incorporated into surveillance and research activities within Thailand and shared for adaption by other countries

Age distribution of influenza A (H1N1)pdm09 deaths.

<p><u>Detailed legend:</u> Age distribution of influenza A (H1N1)pdm09 deaths reported to the National Avian Influenza Surveillance (NAIS) system, Bureau of Epidemiology, Ministry of Public Health, Thailand and those for whom medical charts were available for review - May 2009-January 2010. Bars represent number of deaths for each age group (Figures are in a separate file).</p

Demographic characteristics and underlying medical conditions of influenza A (H1N1)pdm09 virus-associated pneumonia fatalities in Thailand, May 2009-January 2010.

*<p>According to WHO on Clinical Management of Human Infection with influenza A(H1N1)pdm09 <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0054946#pone.0054946-WHO1" target="_blank">[15]</a>.</p>†<p>Kidney disease includes chronic renal failure, polycystic kidney disease.</p>‡<p>Obesity defined as body mass index (BMI) ≥30 kg/m². BMI calculated as weight in kilograms divided by height in meters squared among non-pregnant patients; 14 patients overall and 13 patients with medical records reviewed had height and weight available BMI calculation.</p>§<p>Chronic lung disease includes obstructive pulmonary disease, chronic bronchitis, and pulmonary tuberculosis.</p

Laboratory-confirmed influenza A (H1N1)pdm09 cases and deaths.

<p><u>Detailed legend</u>: Laboratory-confirmed influenza A (H1N1)pdm09 cases and deaths reported to Bureau of Epidemiology, Ministry of Public Health Thailand from May 2009-March 2010. Bars represent number of deaths. Line represents number of cases.</p

Hospital course of 90 influenza A (H1N1)pdm09 virus-associated pneumonia deaths in Thailand for whom medical record reviews were conducted, May 2009-January 2010.

*<p>Blood culture positive for <i>Acinetobacter baumannii</i> (1), <i>Salmonella</i> group D and <i>pseudomonas</i> spp. (1) and <i>Staphylococcus aureus</i> (1).</p>**<p>Records available for 89 of 90 patients.</p>***<p>Records available for 85 of 90 patients.</p>****<p>Records available for 51 of 90 patients, AST (aspatate aminotransferase), ALT (alanine transaminase); UNL (upper normal limit).</p

Timing of antiviral therapy relative to clinical course of 90 influenza A (H1N1)pdm09 virus-associated pneumonia fatalities in Thailand for whom medical record reviews were conducted, May 2009-January 2010.

*<p>Mann-Whitney U test comparing age <18 to ≥18 years.</p