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Indian Journal of Pediatrics Jul 2023Childhood pneumonia is still a significant clinical and public health problem. India contributes the highest number of deaths due to pneumonia, accounts for about 20% of... (Review)
Review
Childhood pneumonia is still a significant clinical and public health problem. India contributes the highest number of deaths due to pneumonia, accounts for about 20% of global mortality among under five children. Various etiologic agents including bacteria, viruses and atypical organism are responsible for childhood pneumonia. Recent studies suggest that viruses are one of the major causes of childhood pneumonia. Among viruses, respiratory syncytial virus has got great attention and several recent studies are reporting it as an important organism for pneumonia. Lack of exclusive breast feeding during first six months, improper timing of start and content of complimentary feeding, anemia, undernutrition, indoor pollution due to tobacco smoking and use of coal and wood for cooking food and lack of vaccinations are important risk factors. X-ray chest is not routinely performed to diagnose pneumonia while use of lung ultrasound is increasing to detect consolidation, pleural effusion, pneumothorax and pulmonary edema (interstitial syndrome). Role of C-reactive protein (CRP) and procalcitonin is similar, to differentiate between viral and bacterial pneumonia, however duration of antibiotics is better guided by procalcitonin. Newer biomarkers like IL-6, presepsin and triggering receptor expressed on myeloid cells 1 are needed to be evaluated for their use in children. Hypoxia is significantly associated with childhood pneumonia. Therefore, use of pulse oximetry should be encouraged for early detection and prompt treatment of hypoxia to prevent adverse outcomes. Among the available tools for risk of mortality assessment in children due to pneumonia, PREPARE score is the best but external validation will be needed.
Topics: Child; Female; Humans; Infant; Procalcitonin; Pneumonia; Pneumonia, Bacterial; Lung; C-Reactive Protein; Hypoxia; Peptide Fragments; Lipopolysaccharide Receptors
PubMed: 37204597
DOI: 10.1007/s12098-023-04628-3 -
European Journal of Pediatrics Mar 2024Community-acquired pneumonia (CAP) is a common disease in children, and its aetiological and clinical diagnosis are challenging for physicians in both private practice... (Review)
Review
Community-acquired pneumonia (CAP) is a common disease in children, and its aetiological and clinical diagnosis are challenging for physicians in both private practice and hospitals. Over the past three decades, conjugate vaccines have successfully reduced the burden of the former main causes of CAP, Streptococcus pneumoniae and Haemophilus influenzae type b. Today, viruses are by far the most commonly detected pathogens in children with CAP. Conclusion: New insights into the aetiology and treatment of CAP in children in recent years have influenced management and are the focus of this review. In addition to reducing diagnostic uncertainty, there is an urgent need to reduce antibiotic overuse and antimicrobial resistance in children with CAP. What is Known: • Conjugate vaccines against Streptococcus pneumoniae and Haemophilus influenzae type b have shifted the epidemiology of childhood CAP to predominantly viral pathogens and Mycoplasma pneumoniae. • Clinical, laboratory, and radiological criteria cannot reliably distinguish between bacterial and viral aetiology in children with CAP. What is New: • Test results and epidemiological data must be carefully interpreted, as no single diagnostic method applied to non-pulmonary specimens has both high sensitivity and high specificity for determining pneumonia aetiology in childhood CAP. • This review provides a simple and pragmatic management algorithm for children with CAP to aid physicians in providing optimal and safe care and reducing antibiotic prescribing.
Topics: Child; Humans; Pneumonia, Bacterial; Pneumonia; Streptococcus pneumoniae; Bacteria; Anti-Bacterial Agents; Vaccines; Community-Acquired Infections
PubMed: 38112800
DOI: 10.1007/s00431-023-05366-6 -
The Lancet. Microbe Oct 2023
Topics: Humans; Mycoplasma pneumoniae; Pneumonia, Mycoplasma
PubMed: 37393927
DOI: 10.1016/S2666-5247(23)00182-9 -
World Journal of Pediatrics : WJP Jan 2024
Topics: Humans; Pneumonia, Mycoplasma; Mycoplasma pneumoniae; China
PubMed: 38185707
DOI: 10.1007/s12519-023-00783-x -
JCO Oncology Practice Aug 2023Trastuzumab deruxtecan (T-DXd) is an antibody drug conjugate with a topoisomerase I payload that targets the human epidermal growth factor receptor 2 (HER2). T-DXd is... (Review)
Review
Real-World Perspectives and Practices for Pneumonitis/Interstitial Lung Disease Associated With Trastuzumab Deruxtecan Use in Human Epidermal Growth Factor Receptor 2-Expressing Metastatic Breast Cancer.
Trastuzumab deruxtecan (T-DXd) is an antibody drug conjugate with a topoisomerase I payload that targets the human epidermal growth factor receptor 2 (HER2). T-DXd is approved for patients with previously treated HER2-positive or HER2-low (immunohistochemistry [IHC] 1+ or IHC 2+/ISH-) metastatic/unresectable breast cancer (BC). In a second-line HER2-positive metastatic BC (mBC) population (DESTINY-Breast03 [ClinicalTrials.gov identifier: NCT03529110]), T-DXd demonstrated significantly improved progression-free survival (PFS) over ado-trastuzumab emtansine (12-month rate: 75.8% 34.1%; hazard ratio, 0.28; < .001), and in patients with HER2-low mBC treated with one prior line of chemotherapy (DESTINY-Breast04 [ClinicalTrials.gov identifier: NCT03734029]), T-DXd demonstrated significantly longer PFS and overall survival than physician's choice chemotherapy (10.1 5.4 months; hazard ratio, 0.51; < .001, and 23.4 16.8 months; hazard ratio, 0.64; < .001, respectively).Interstitial lung disease (ILD) is an umbrella term used for a group of diseases characterized by lung injury including pneumonitis, which can lead to irreversible lung fibrosis. ILD is a well-described adverse event associated with certain anticancer therapies, including T-DXd. An important part of T-DXd therapy for mBC consists of monitoring for and managing ILD. Although information on ILD management strategies is included in the prescribing information, additional information on patient selection, monitoring, and treatment can be beneficial in routine clinical practice. The objective of this review is to describe real-world, multidisciplinary clinical practices and institutional protocols used for patient selection/screening, monitoring, and management related to T-DXd-associated ILD.
Topics: Humans; Female; Breast Neoplasms; Antibodies, Monoclonal, Humanized; Immunoconjugates; Lung Diseases, Interstitial; Pneumonia
PubMed: 37207306
DOI: 10.1200/OP.22.00480 -
Critical Care (London, England) Jul 2023This systematic review and meta-analysis aimed to investigate the clinical efficacy and safety of systemic corticosteroids in the treatment of patients with severe... (Meta-Analysis)
Meta-Analysis
Efficacy and safety of adjunctive corticosteroids in the treatment of severe community-acquired pneumonia: a systematic review and meta-analysis of randomized controlled trials.
BACKGROUND
This systematic review and meta-analysis aimed to investigate the clinical efficacy and safety of systemic corticosteroids in the treatment of patients with severe community-acquired pneumonia (sCAP).
METHODS
A comprehensive search was conducted using the Medline, Embase, ClinicalTrials.gov, and Scopus databases for articles published until April 24, 2023. Only randomized controlled trials (RCTs) that assessed the clinical efficacy and safety of adjunctive corticosteroids for treating sCAP were included. The primary outcome was the 30-day all-cause mortality.
RESULTS
A total of severe RCTs involving 1689 patients were included in this study. Overall, the study group had a lower mortality rate at day 30 than the control group (risk ratio [RR], 0.61; 95% CI 0.44 to 0.85; p < 0.01) with low heterogeneity (I = 0%, p = 0.42). Compared to the control group, the study group had a lower risk of the requirement of mechanical ventilation (RR 0.57; 95% CI 0.45 to 0.73; p < 0.001), shorter length of intensive care unit (MD - 0.8; 95% CI - 1.4 to - 0.1; p = 0.02), and hospital stay (MD - 1.1; 95% CI - 2.0 to - 0.1; p = 0.04). Finally, no significant difference was observed between the study and the control groups in terms of gastrointestinal tract bleeding (RR 1.03; 95% CI 0.49 to 2.18; p = 0.93), healthcare-associated infection (RR 0.89; 95% CI 0.60 to 1.32; p = 0.56), and acute kidney injury (RR 0.68; 95% CI 0.21 to 2.26; p = 0.53).
CONCLUSIONS
In patients with sCAP, adjunctive corticosteroids can provide survival benefits and improve clinical outcomes without increasing adverse events. However, because the pooled evidence remains inconclusive, further studies are required.
Topics: Humans; Randomized Controlled Trials as Topic; Adrenal Cortex Hormones; Pneumonia; Respiration, Artificial; Community-Acquired Infections
PubMed: 37422686
DOI: 10.1186/s13054-023-04561-z -
JPMA. the Journal of the Pakistan... Jul 2023Long COVID is a term used to describe the persistence of symptoms in people who have had COVID-19 for an extended period. It affects multiple systems including...
Long COVID is a term used to describe the persistence of symptoms in people who have had COVID-19 for an extended period. It affects multiple systems including neurological (fatigue, brain fog, attention issues, memory issues), neuromuscular (sarcopenia, myositis, arthritis and myopathy), cardiovascular (myopericarditis, right ventricular dysfunction, vasculitis and aortic, arterial and venous thrombosis) and respiratory (pulmonary fibrosis, pleurisy, pulmonary embolism and pneumonitis). This results in functional impairments which adversely affect the quality of life of patients. The rehabilitation of persons who have experienced long COVID-19, also known as "long haulers," is a relatively new field of study. We have described potential rehabilitation interventions to improve functional capacity and quality of life in patients with long COVID. These rehabilitation interventions include but are not limited to, endurance, flexibility and strength training, pulmonary rehabilitation, task specific exercises to improve Activities of Daily Living (ADL), psychological rehabilitation, medical rehabilitation, pain management and management of dysphagia.
Topics: Humans; Activities of Daily Living; Post-Acute COVID-19 Syndrome; Quality of Life; COVID-19; Exercise Therapy
PubMed: 37469084
DOI: 10.47391/JPMA.23-54 -
JAMA Dec 2023Artificial intelligence (AI) could support clinicians when diagnosing hospitalized patients; however, systematic bias in AI models could worsen clinician diagnostic... (Comparative Study)
Comparative Study Randomized Controlled Trial
IMPORTANCE
Artificial intelligence (AI) could support clinicians when diagnosing hospitalized patients; however, systematic bias in AI models could worsen clinician diagnostic accuracy. Recent regulatory guidance has called for AI models to include explanations to mitigate errors made by models, but the effectiveness of this strategy has not been established.
OBJECTIVES
To evaluate the impact of systematically biased AI on clinician diagnostic accuracy and to determine if image-based AI model explanations can mitigate model errors.
DESIGN, SETTING, AND PARTICIPANTS
Randomized clinical vignette survey study administered between April 2022 and January 2023 across 13 US states involving hospitalist physicians, nurse practitioners, and physician assistants.
INTERVENTIONS
Clinicians were shown 9 clinical vignettes of patients hospitalized with acute respiratory failure, including their presenting symptoms, physical examination, laboratory results, and chest radiographs. Clinicians were then asked to determine the likelihood of pneumonia, heart failure, or chronic obstructive pulmonary disease as the underlying cause(s) of each patient's acute respiratory failure. To establish baseline diagnostic accuracy, clinicians were shown 2 vignettes without AI model input. Clinicians were then randomized to see 6 vignettes with AI model input with or without AI model explanations. Among these 6 vignettes, 3 vignettes included standard-model predictions, and 3 vignettes included systematically biased model predictions.
MAIN OUTCOMES AND MEASURES
Clinician diagnostic accuracy for pneumonia, heart failure, and chronic obstructive pulmonary disease.
RESULTS
Median participant age was 34 years (IQR, 31-39) and 241 (57.7%) were female. Four hundred fifty-seven clinicians were randomized and completed at least 1 vignette, with 231 randomized to AI model predictions without explanations, and 226 randomized to AI model predictions with explanations. Clinicians' baseline diagnostic accuracy was 73.0% (95% CI, 68.3% to 77.8%) for the 3 diagnoses. When shown a standard AI model without explanations, clinician accuracy increased over baseline by 2.9 percentage points (95% CI, 0.5 to 5.2) and by 4.4 percentage points (95% CI, 2.0 to 6.9) when clinicians were also shown AI model explanations. Systematically biased AI model predictions decreased clinician accuracy by 11.3 percentage points (95% CI, 7.2 to 15.5) compared with baseline and providing biased AI model predictions with explanations decreased clinician accuracy by 9.1 percentage points (95% CI, 4.9 to 13.2) compared with baseline, representing a nonsignificant improvement of 2.3 percentage points (95% CI, -2.7 to 7.2) compared with the systematically biased AI model.
CONCLUSIONS AND RELEVANCE
Although standard AI models improve diagnostic accuracy, systematically biased AI models reduced diagnostic accuracy, and commonly used image-based AI model explanations did not mitigate this harmful effect.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT06098950.
Topics: Adult; Female; Humans; Male; Artificial Intelligence; Heart Failure; Pneumonia; Pulmonary Disease, Chronic Obstructive; Respiratory Insufficiency; Diagnosis; Reproducibility of Results; Bias; Acute Disease; Clinical Competence; Hospitalists; Nurse Practitioners; Physician Assistants; United States
PubMed: 38112814
DOI: 10.1001/jama.2023.22295 -
The Journal of Clinical Investigation Oct 2023Advancing age is the most important risk factor for the development of and mortality from acute and chronic lung diseases, including pneumonia, chronic obstructive... (Review)
Review
Advancing age is the most important risk factor for the development of and mortality from acute and chronic lung diseases, including pneumonia, chronic obstructive pulmonary disease, and pulmonary fibrosis. This risk was manifest during the COVID-19 pandemic, when elderly people were disproportionately affected and died from SARS-CoV-2 pneumonia. However, the recent pandemic also provided lessons on lung resilience. An overwhelming majority of patients with SARS-CoV-2 pneumonia, even those with severe disease, recovered with near-complete restoration of lung architecture and function. These observations are inconsistent with historic views of the lung as a terminally differentiated organ incapable of regeneration. Here, we review emerging hypotheses that explain how the lung repairs itself after injury and why these mechanisms of lung repair fail in some individuals, particularly the elderly.
Topics: Humans; Aged; COVID-19; Pandemics; SARS-CoV-2; Lung; Pneumonia; Aging; Pulmonary Fibrosis; Regeneration
PubMed: 37843280
DOI: 10.1172/JCI170504 -
Critical Care (London, England) Jul 2023The resumption of oral feeding and free from pneumonia are important therapeutic goals for critically ill patients who have been successfully extubated after prolonged... (Randomized Controlled Trial)
Randomized Controlled Trial
Effects of a swallowing and oral-care program on resuming oral feeding and reducing pneumonia in patients following endotracheal extubation: a randomized, open-label, controlled trial.
BACKGROUND
The resumption of oral feeding and free from pneumonia are important therapeutic goals for critically ill patients who have been successfully extubated after prolonged (≥ 48 h) endotracheal intubation. We aimed to examine whether a swallowing and oral-care (SOC) program provided to critically ill patients extubated from prolonged mechanical ventilation improves their oral-feeding resumption and reduces 30-day pneumonia incidence.
METHODS
In this randomized, open-label, controlled trial, participants were consecutively enrolled and randomized to receive the SOC program or usual care. The interventions comprised three protocols: oral-motor exercise, sensory stimulation and lubrication, and safe-swallowing education. Beginning on the day following patient extubation, an SOC nurse provided the three-protocol care for seven consecutive days or until death or hospital discharge. With independent outcome assessors, oral-feeding resumption (yes, no) corresponded to level 6 or level 7 on the Functional Oral Intake Scale (censored seven days postextubation) along with radiographically documented pneumonia (yes, no; censored 30 days postextubation), abstracted from participants' electronic medical records were coded.
RESULTS
We analyzed 145 randomized participants (SOC group = 72, control group = 73). The SOC group received, on average, 6.2 days of intervention (14.8 min daily) with no reported adverse events. By day 7, 37/72 (51.4%) of the SOC participants had resumed oral feeding vs. 24/73 (32.9%) of the control participants. Pneumonia occurred in 11/72 (15.3%) of the SOC participants and in 26/73 (35.6%) of the control participants. Independent of age and intubation longer than 6 days, SOC participants were likelier than their control counterparts to resume oral feeding (adjusted hazard ratio, 2.35; 95% CI 1.38-4.01) and had lower odds of developing pneumonia (adjusted odds ratio, 0.28; 95% CI 0.12-0.65).
CONCLUSIONS
The SOC program effectively improved patients' odds that oral feeding would resume and the 30-day pneumonia incidence would decline. The program might advance dysphagia care provided to critically ill patients extubated from prolonged mechanical ventilation.
TRIAL REGISTRATION
NCT03284892, registered on September 15, 2017.
Topics: Humans; Deglutition; Airway Extubation; Critical Illness; Deglutition Disorders; Pneumonia
PubMed: 37438759
DOI: 10.1186/s13054-023-04568-6