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Phenotyping community-acquired pneumonia according to the presence of acute respiratory failure and severe sepsis

Background

Acute respiratory failure (ARF) and severe sepsis (SS) are possible complications in patients with community-acquired pneumonia (CAP). The aim of the study was to evaluate prevalence, characteristics, risk factors and impact on mortality of hospitalized patients with CAP according to the presence of ARF and SS on admission.

Methods

This was a multicenter, observational, prospective study of consecutive CAP patients admitted to three hospitals in Italy, Spain, and Scotland between 2008 and 2010. Three groups of patients were identified: those with neither ARF nor SS (Group A), those with only ARF (Group B) and those with both ARF and SS (Group C) on admission.

Results

Among the 2,145 patients enrolled, 45% belonged to Group A, 36% to Group B and 20% to Group C. Patients in Group C were more severe than patients in Group B. Isolated ARF was correlated with age (p < 0.001), COPD (p < 0.001) and multilobar infiltrates (p < 0.001). The contemporary occurrence of ARF and SS was associated with age (p = 0.002), residency in nursing home (p = 0.007), COPD (p < 0.001), multilobar involvement (p < 0.001) and renal disease (p < 0.001). 4.2% of patients in Group A died, 9.3% in Group B and 26% in Group C, p < 0.001. After adjustment, the presence of only ARF had an OR for in-hospital mortality of 1.85 (p = 0.011) and the presence of both ARF and SS had an OR of 6.32 (p < 0.001).

Conclusions

The identification of ARF and SS on hospital admission can help physicians in classifying CAP patients into three different clinical phenotypes.

Immunotherapy Best for Chronic Rhinitis

SAN DIEGO (MedPage Today) -- Treating allergic rhinitis with immunotherapy appeared to reduce the risk of chronic upper respiratory conditions, a Medicaid study showed. (Source: MedPage Today Allergy)

Immunotherapy for Allergies Halts Infection

People who get immunotherapy injections for their allergies are less likely to develop infectious diseases such as chronic pharyngitis, nasopharyngitis, sinusitis, diseases of the tonsils and adenoids, and the flu, a new study shows.

"Allergic rhinitis is a precursor to the allergic march toward asthma and other respiratory disease," said lead investigator Cheryl Hankin, PhD, president and chief scientific officer of BioMedEcon in Moss Beach, California.

However, "after allergy immunotherapy, significantly fewer patients sought out treatment for chronic infections of the upper respiratory tract," she reported.

Dr. Hankin presented the results during a news conference here at the American Academy of Allergy, Asthma & Immunology 2014.

To measure the impact of immunotherapy on other respiratory diseases, Dr. Hankin and her team examined data on retirees living in Florida who were enrolled in Medicaid. They matched 4967 patients who received immunotherapy to 4967 who did not. Demographic characteristics and health conditions, including allergies, were similar in the immunotherapy and control groups.

G‐scores: A method for identifying disease‐causing pathogens with application to lower respiratory tract infections

Lower respiratory tract infections (LRTIs) are well known for the lack of a good diagnostic method. The main difficulty lies in the fact that there are a variety of pathogens causing LRTIs, and their management and treatment are quite different. The development of quantitative real-time loop-mediated isothermal amplification (qrt-LAMP) made it possible to rapidly amplify and quantify multiple pathogens simultaneously.

The question that remains to be answered is how accurate and reliable is this method? More importantly, how are qrt-LAMP measurements utilized to inform/suggest medical decisions? When does a pathogen start to grow out of control and cause infection? Answers to these questions are crucial to advise treatment guidance for LRTIs and also helpful to design phase I/II trials or adaptive treatment strategies. In this article, our main contributions include the following two aspects.

First, we utilize zero-inflated mixture models to provide statistical evidence for the validity of qrt-LAMP being used in detecting pathogens for LRTIs without the presence of a gold standard test. Our results on qrt-LAMP suggest that it provides reliable measurements on pathogens of interest. Second, we propose a novel statistical approach to identify disease-causing pathogens, that is, distinguish the pathogens that colonize without causing problems from those that rapidly grow and cause infection. We achieve this by combining information from absolute quantities of pathogens and their symbiosis information to form G-scores.

Change-point detection methods are utilized on these G-scores to detect the three phases of bacterial growth—lag phase, log phase, and stationary phase. Copyright © 2014 John Wiley & Sons, Ltd.

Asthma and Obstructive Sleep Apnea: Clinical and Pathogenic Interactions.

Related Articles

Asthma and obstructive sleep apnea (OSA) are among the most prevalent chronic human diseases of the 21st century.

They share several risk and aggravating factors such as obesity, smoking, gastroesophageal reflux, sinonasal disease or upper airway involvement, systemic inflammation, etc. Although the association between OSA and chronic obstructive pulmonary disease or "overlap syndrome" is better known and characterized, the association of asthma and OSA or "alternative overlap syndrome" is less clearly defined and understood. Nevertheless, their coexistence has synergistic effects on patient symptoms, response to therapy, and general outcomes. Taxonomically, asthma and OSA are syndromically defined entities that are quite heterogeneous, being characterized by a plethora of clinical phenotypes. The complex interactions between these conditions should take into account more specific etiopathogenic mechanisms or distinct disease endotypes. The potential clinical, pathogenic, and therapeutic significance of the disease endotypes is still emerging and needs further evaluation.

We present here a review on the bidirectional relationships between asthma and OSA, including their clinical, pathophysiologic, and therapeutic connections. Furthermore, we propose here to look at these interactions beyond the development of comprehensive inventories of genotypes, clinical and pathophysiologic phenotypes, but in the larger context of obstructive lung and airway disorders, with the goal to reassess meaningful syndromes based on natural history and predictable patient outcomes, which will help us better stratify therapy in an era of personalized medicine.

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