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Viral pneumonia.

About 200 million cases of viral community-acquired pneumonia occur every year-100 million in children and 100 million in adults. Molecular diagnostic tests have greatly increased our understanding of the role of viruses in pneumonia, and findings indicate that the incidence of viral pneumonia has been underestimated.

In children, respiratory syncytial virus, rhinovirus, human metapneumovirus, human bocavirus, and parainfluenza viruses are the agents identified most frequently in both developed and developing countries. Dual viral infections are common, and a third of children have evidence of viral-bacterial co-infection.

In adults, viruses are the putative causative agents in a third of cases of community-acquired pneumonia, in particular influenza viruses, rhinoviruses, and coronaviruses. Bacteria continue to have a predominant role in adults with pneumonia.

Presence of viral epidemics in the community, patient's age, speed of onset of illness, symptoms, biomarkers, radiographic changes, and response to treatment can help differentiate viral from bacterial pneumonia. However, no clinical algorithm exists that will distinguish clearly the cause of pneumonia. No clear consensus has been reached about whether patients with obvious viral community-acquired pneumonia need to be treated with antibiotics. Apart from neuraminidase inhibitors for pneumonia caused by influenza viruses, there is no clear role for use of specific antivirals to treat viral community-acquired pneumonia. Influenza vaccines are the only available specific preventive measures.

Further studies are needed to better understand the cause and pathogenesis of community-acquired pneumonia. Furthermore, regional differences in cause of pneumonia should be investigated, in particular to obtain more data from developing countries.

The Lung Image Database Consortium (LIDC) and Image Database Resource Initiative (IDRI): a completed reference database of lung nodules on CT scans.

The development of computer-aided diagnostic (CAD) methods for lung nodule detection, classification, and quantitative assessment can be facilitated through a well-characterized repository of computed tomography (CT) scans.

The Lung Image Database Consortium (LIDC) and Image Database Resource Initiative (IDRI) completed such a database, establishing a publicly available reference for the medical imaging research community. Initiated by the National Cancer Institute (NCI), further advanced by the Foundation for the National Institutes of Health (FNIH), and accompanied by the Food and Drug Administration (FDA) through active participation, this public-private partnership demonstrates the success of a consortium founded on a consensus-based process.

Below what FEV1 should arterial blood be routinely taken to detect chronic respiratory failure in COPD?

To diagnose and assess chronic respiratory failure in stable chronic obstructive pulmonary disease (COPD) the measurement of arterial blood gases (ABG) is required. It has been suggested that ABG be determined for this purpose when FEV1 ranges between 50% and 30% predicted, but these thresholds are not evidence-based.

OBJECTIVE: To identify the post-bronchodilator (BD) FEV(1) and arterial oxygen saturation (SaO(2)) values that provide the best sensitivity, specificity, and likelihood ratio (LR) for the diagnosis of hypoxaemic and/or hypercapnic chronic respiratory failure in stable COPD.

METHODS: A total of 150 patients were included (39 with PaO(2) < 60 mmHg [8 kPa], 14 of them with a PaCO(2) ≥ 50 mmHg [6.7 kPa]). The best post-BD FEV(1) and SaO(2) cut-off points to predict chronic respiratory failure were selected using the PC and the Receiver Operating Characteristics (ROC) curves.

RESULTS: A post-BD FEV(1) equal to 36% and an SaO(2) of 90% were the best predictive values for hypoxaemic respiratory failure and a post-BD FEV(1) equal to 33% for the hypercapnic variant. An FEV(1) ≥ 45% ruled out hypoxaemic respiratory failure.

CONCLUSION: A post-BD FEV(1) of 36% is the best cut-off point to adequately predict both hypoxaemic and hypercapnic respiratory failure in the patient with stable COPD. For its part, an SaO(2) of 90% is the best value for isolated hypoxaemic failure. These values could be considered for future clinical recommendations/guidelines for COPD.

Bronchial artery embolization in patients with hemoptysis including follow-up.

Hemoptysis can be an acute medical emergency, which can be localized angiographically and controlled by therapeutic intervention. Purpose To evaluate the effectiveness and safety of bronchial artery embolization, and including follow-up in patients with hemoptysis.

Material and Methods Thirty-five vascular interventions were performed in 28 patients (nine women and 19 men, mean age 42 years, age range 20-82 years) treated for hemoptysis between January 1998 and October 2008. Underlying diseases were cystic fibrosis (n = 9), lung cancer (n = 6), chronic inflammatory disease (n = 4), bronchiectasis (n = 3), chronic obstructive pulmonary disease (n = 2), and other (n = 4). Bronchial artery embolization was performed using particles.

Patients were followed up for a median of 23 months (range 1 month to 8 years). Results Bronchial artery embolization was technically successful in all patients (bleeding halted within 24 hours). Recurrent bleeding occurred in four patients with cystic fibrosis (14%) at one, 16, 19 and 48 months, respectively. Within this subset, multirecurrence bleeding occurred in one patient with cystic fibrosis. Cumulative patient survival rate was 74% at eight years. No patient died due to hemoptysis but due to underlying disease.

Conclusion Bronchial artery embolization was highly effective in patients with hemoptysis. It may help to avoid surgery in patients who are poor candidates for surgery. Should hemoptysis recur in these patients, repeated embolization can be performed.

Symptoms, Comorbidities, and Health Care in Advanced Chronic Obstructive Pulmonary Disease or Chronic Heart Failure.

Patients with advanced chronic obstructive pulmonary disease (COPD) or chronic heart failure (CHF) may experience significant symptom distress. For development of palliative care programs that adequately address symptoms of patients with COPD or CHF, it is necessary to know severity of symptom distress and to gain insight in comorbidities and current provision of health care.

Objective of the present cross-sectional observational study was to assess severity of symptoms, presence of comorbidities, and current provision of health care in outpatients with advanced COPD or CHF.

Methods: A total of 105 outpatients with clinically stable but advanced COPD (Global initiative for chronic Obstructive Lung Disease [GOLD] stage III or IV) and 80 patients with advanced CHF (New York Heart Association [NYHA] class III or IV) were assessed for demographics, clinical characteristics, self-reported comorbidities, and severity of symptoms using visual analogue scales. In addition, current health care and symptom-related interventions have been assessed.

Results: Comorbidities were reported by 96.3% of the CHF patients and 61.9% of the COPD patients. Patients suffered from multiple symptoms, like dyspnea, fatigue, muscle weakness, coughing, low mood, sleeplessness, and frequent micturition. For most symptoms, only the minority of patients had received symptom-related treatment. Involvement of allied health care professionals was low. The majority of COPD and CHF patients had received home adaptation and medical aids.

Conclusions: Patients with advanced COPD or CHF experience comorbidities and suffer from multiple symptoms, which are often under treated. Further development and implementation of palliative care programs, consisting of regular assessment of the patients' comorbidities and symptoms as well as the provision of patient-tailored interventions is needed.

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