Current Issue : July - September Volume : 2019 Issue Number : 3 Articles : 8 Articles
Background: The incidence of pneumonia in Korea started to increase in the 1990â??s after a period of decrease and\nstabilization, and the mortality and hospitalization rates for pneumonia in Korea are alarmingly high. This study was\nperformed to examine geographic variation and factors associated with hospitalization for bacterial pneumonia in\nKorea.\nMethods: Data were acquired from the inpatient claims of the 2015 period of the National Health Insurance\nService. The age- and sex-standardized hospitalization rates for bacterial pneumonia were calculated for three age\ngroups. Geographic variation was measured with the coefficient of variation, the ratio of the 90th to the 10th\npercentile of the distribution of rates, and the systematic component of variation. Considering the results of\nMoranâ??s I statistic which suggested spatial autocorrelation, we estimated spatial regression models using spatial\nerror models.\nResults: The hospitalization rate for bacterial pneumonia was 79.1 per 10,000 population, and the rate was the\nhighest in the age group 0-14 at 325.3, and it was 161.5 among the elderly. The geographic variation statistics\nshowed high variation with the coefficient variation at 0.6. The deprivation score showed positive associations,\nand the number of primary care physicians had a negative association with the hospitalization rates across all age\ngroups but the age group 0-14. The number of beds in hospitals with less than 300 beds had a positive\nassociation with the hospitalization rates for bacterial pneumonia, and the impact was the strongest in the age\ngroup 0-14.\nConclusions: The present study shows that pneumonia can be a major public health issue even in a developed\ncountry. Socioeconomic conditions can still be a concern for pneumonia in developed countries, and the role of\nprimary care physicians in preventing hospitalization for bacterial pneumonia needs to be recognized. Most of all,\nthe strong impact of hospital beds on the hospitalization rates for pneumonia, especially for the children, should be\naddressed. High disease burden of pneumonia in Korea can partly be attributable to oversupply of hospital beds.\nThese factors should be taken into consideration in establishing policy measures for the rise in pneumonia....
Background: Although there are theoretical reasons for believing that asthma and atopy may be negatively\ncorrelated with tuberculosis, epidemiological studies have had conflicting findings.\nObjective: To determine if people with confirmed tuberculosis were less likely to be atopic and less likely to have\natopic disease including asthma compared to those with no previous tuberculosis.\nMethods: Patients in Lima, Peru with a prior history of tuberculosis were identified from clinic records in this cohort\nstudy. A representative sample of individuals without a prior tuberculosis diagnosis was recruited from the same\ncommunity. Allergen skin prick testing was performed to classify atopic status. Allergic rhinitis was identified by\nhistory. Asthma was defined by symptoms and spirometry. Eosinophilic airway inflammation was measured using\nexhaled nitric oxide levels.\nResults: We evaluated 177 patients with, and 161 individuals without, previous tuberculosis. There was a lower\nprevalence of atopy among people with prior tuberculosis on univariate analysis (odds ratio 0.57; 95% confidence\ninterval 0.37-0.88) but, after adjustment for potential confounders, this was no longer statistically significant\n(aOR 0.64, 95% CI 0.41-1.01). The prevalence of allergic rhinitis (aOR 0.76, 95% CI 0.47 to 1.24 and asthma\n(aOR 1.18, 95% CI 0.69 to 2.00) did not differ significantly between the two groups. We also found no significant\ndifference in the prevalence of elevated exhaled nitric oxide (aOR 1.30, 95% CI 0.78 to 2.17) or a combined index of\natopic disease (aOR 0.86, 95% CI 0.54 to 1.36).\nConclusion: In this urban environment in a middle-income country, prior tuberculosis may be associated with a\nreduced risk of atopy but does not protect against asthma and atopic disease....
Background: Self-expandable metallic stents (SEMSs) have enabled a approving management of malignant airway\nstenosis. However, the long-term efficacy and safety of this treatment in patients with benign airway stricture are\nunclear. We conducted this study to retrospectively determine the efficacy and long-term outcomes in patients who\nhave undergone SEMS placement for benign tracheobronchial stenosis.\nMethods: All patients treated with SEMSs from July 2003 to June 2016 were reviewed for symptomatic response,\ncomplications, and long-term outcomes.\nResults: Total 131 stents were successfully deployed in 116 patients. Ninety-eight patients demonstrated clinical\nimprovement after stent insertion (84.48%; 95% confidence interval [CI]: 77.89-91.07). Compared with uncovered stents,\ncovered stents were associated with more sore throats complaints or chest pain (13.89% versus 28.81%, P = 0.036) and with\nhigher incidences of major and minor granulation tissue formation and with recurrent stenosis (4.17% versus\n15.25%, P = 0.029; 11.11% versus 37.29%, P < 0.0001 and 9.72% versus 28.81%, P = 0.005, respectively). Each\ncovered and uncovered stent developing tissue hyperplasia required a median of 2 (range: 1-15) and\n1(range: 1-7) fibrobronchoscope with electrocautery therapy, respectively. At follow-up (median: 1276 days;\nrange: 2-4263), 68 patients had complete resolution, 15 remained under interventional treatment, 8 had\nbronchial occlusions, 7 underwent surgery, 14 were lost to follow-up, and 4 died of stent unrelated causes.\nConclusion: SEMS placement achieved most clinical improvement among patients in our study, if adequate\nendotracheal measures were used to address stent-related complications. The use of permanent SEMSs for\nbenign tracheobronchial stenosis was effective and safe for the majority of patients in a long-term follow-up....
Background: Diffuse lung diseases (DLD) are characterized by different immunophenotypes in the bronchoalveolar\nlavage fluid (BALF). We aimed to evaluate the diagnostic value of BALF NK and NKT cell counts of patients with\nDLD and lymphocytic alveolitis.\nMethods: We assessed 202 patients with DLD, who underwent BALF immunophenotyping. Samples were routinely\nprocessed by flow cytometry and lymphocyte subsets were compared between patients with sarcoidosis (n = 106),\nhypersensitivity pneumonitis (HP; n = 53), and other DLDs (n = 43). We compared absolute counts and percentages\nof NK and NKT cells between patients with HP versus the remaining DLD patients. To assess the accuracy of BALF\nlymphocyte subsets in the diagnosis of HP, we calculated the respective areas under the receiver operating\ncharacteristic curves (AUC-ROC).\nResults: Patients with HP had significantly higher numbers of BALF NK cells, and its percentage was significantly\nassociated with a higher odds of HP, even after adjustment for the NKT and CD8+ cells. For the absolute number\nof BALF NK cells, we found an AUC-ROC of 0.76 (95%CI = 0.68â??0.84) when comparing patients with HP versus the\nremaining DLD. The cut-offs of 2000 NK cells/mL and of 2.4% NK cells in the BALF had a specificity and a negative\npredictive value over 80% for the diagnosis of HP. BALF NK cells absolute counts were significantly higher in HP patients\nwith a restrictive pattern. No such differences were observed for NKT cells.\nConclusions: BALF NK immunophenotyping may be a helpful adjunct to the diagnostic work-up of DLD, particularly in\nthe differential diagnosis of HP....
Background: Osteoporosis is a common comorbidity in non-cystic fibrosis (non-CF) bronchiectasis patients. We\ndetermined whether desaturation during 6-min walk test (6MWT) can be a predictor for osteoporosis risk.\nMethods: This was a retrospective cross-sectional study. Sixty-six non-CF bronchiectasis patients were enrolled.\nLung function, walking distance, the lowest oxygen saturation (SpO2), the fall in SpO2�����...
Background: Postpneumonectomy-like syndrome is a rare condition resulting from unilateral lung disease with\nsevere lung volume loss leading to excessive mediastinal shift and herniation of the healthy lung into the\ncontralateral hemithorax, mimicking the mediastinal shift observed in postpneumonectomy syndrome after\npneumonectomy. We report a unique case of postpneumonectomy-like syndrome caused by an atypical bronchial\ncarcinoid completely occluding the left main bronchus.\nCase presentation: A 25-year-old woman presented with symptoms of chronic exertional dyspnea and productive\ncough. Imaging studies showed complete left lung atelectasis due to a mass occluding the left main bronchus, as well\nas extreme mediastinal deviation and substantial herniation of the right lung into the left hemithorax. Bronchoscopic\nbiopsy of the tumor and subsequent left pneumonectomy with concurrent lymph node dissection revealed an atypical\ncarcinoid. Sixteen months after surgery the patient has been asymptomatic with repeat imaging studies showing no\nchange in mediastinal shifting.\nConclusion: Bronchial carcinoids are notorious for causing bronchial obstruction. The present case represents an extreme\ncomplication of centrally located bronchial carcinoid, resulting in postpneumonectomy-like syndrome with severe\nmediastinal shift and herniation of the healthy lung into the diseased hemithorax....
Background: Hyperimmunoglobulin E syndrome (HIES) is a rare primary immunodeficiency disorder defined by\nhigh serum immunoglobulin E titers that is associated with recurrent respiratory infections, formation of pneumoatoceles,\nrecurrent skin abscesses, and characteristic dental and skeletal abnormalities.\nCase presentation: We report a case of a 56-year-old male with a history of HIES, cavitary mycetomas, and allergic\nbronchopulmonary aspergillosis who presented with recurrent massive hemoptysis. Bronchial artery angiography and\nbronchoscopy failed to identify active hemorrhage, and two embolizations of the bronchial artery did not resolve the\nbleeding. Subsequently, selective pulmonary artery angiography was conducted that demonstrated a subsegmental\npulmonary artery branch pseudoaneurysm with extravasation into an adjacent lung cavity. This was treated successfully\nwith transcatheter embolization.\nConclusions: To our knowledge, this is the first case reported of pulmonary artery pseudoaneurysm in HIES in the\nmedical literature. Pulmonary artery pseudoaneurysm should be considered in the differential diagnosis in patients\nwith HIES and massive hemoptysis....
Background: Pulmonary non-Hodgkin lymphoma (NHL) is rare. The most frequent subtype of pulmonary NHL is\nlow-grade B-cell lymphoma, such as lymphoma of mucosa-associated lymphoma tissue. Extranodal natural killer\ncell/T-cell lymphoma, nasal type (ENKL) is characterized by predominant extranodal involvement and association\nwith Epstein-Barr virus (EBV). ENKL with massive lung involvement has been infrequently reported, and its prognosis\nis extremely poor.\nCase presentation: A 20-year-old Japanese man presented with intermittent fever lasting for 2 months. Radiological\nimaging demonstrated multiple nodules of uneven shape and size in both lungs. Video-assisted thoracic surgical lung\nbiopsy showed abnormal lymphocyte infiltration, which was positive for CD3, CD56, and perforin. In situ hybridization\nfor EBV-encoded RNA was positive. From these findings, he was diagnosed with ENKL with lung involvement. The\npatient was successfully treated with intensive combinational chemotherapy followed by allogeneic cord blood\ntransplantation. He has been alive with continuous complete remission for 1 year after diagnosis.\nConclusions: Although ENKL involving the lung has been reported to have dismal outcomes, our patient showed\nlong-term survival after intensive chemotherapy and up-front allogeneic hematopoietic transplantation. The present\ncase highlights the importance of early diagnosis as well as allogeneic transplantation....
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