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Cureus Apr 2024Influenza most often causes a febrile viral syndrome inclusive of pulmonary irritation with cough, shortness of breath, and congestion. However, severe infection can...
Influenza most often causes a febrile viral syndrome inclusive of pulmonary irritation with cough, shortness of breath, and congestion. However, severe infection can also occur, causing significant viral pneumonia with Type 1 respiratory failure. and rare but life-altering complications such as pneumomediastinum, secondary bacterial pneumonia, acute respiratory distress syndrome (ARDS), viremia, and death. This was a case of a 20-year-old male with no significant past medical history who presented to the emergency department with shortness of breath and chest discomfort and was found to have Influenza A with Type I respiratory failure requiring High Flow Nasal Cannula (HFNC) and extensive pneumomediastinum, superimposed bacterial pneumonia, and bilateral pneumothoraces. It is possible that complications secondary to influenza A infections could be under-reported due to the extremely high prevalence of the viral infection in this country. In addition, complicated pneumomediastinum from Influenza infection is sparsely documented in young adult males and children, but its clinical course can be dramatic enough to include life-altering complications. This case should serve as a reminder to all emergency medicine providers that when evaluating unstable Influenza A patients, various tests should be considered on a case-by-case basis to risk-stratify the likelihood of emergent pathology.
PubMed: 38716017
DOI: 10.7759/cureus.57778 -
The Korean Journal of Internal Medicine May 2024Helicobacter pylori infection, prevalent in more than half of the global population, is associated with various gastrointestinal diseases, including peptic ulcers and...
BACKGROUND
Helicobacter pylori infection, prevalent in more than half of the global population, is associated with various gastrointestinal diseases, including peptic ulcers and gastric cancer. The effectiveness of early diagnosis and treatment in preventing gastric cancer highlights the need for improved diagnostic methods. This study aimed to develop a simple scoring system based on endoscopic findings to predict H. pylori infection.
METHODS
A retrospective analysis was conducted on 1,007 patients who underwent upper gastrointestinal endoscopy at Asan Medical Center from January 2019 to December 2021. Exclusion criteria included prior H. pylori treatment, gastric surgery, or gastric malignancies. Diagnostic techniques included rapid urease and 13C-urea breath tests, H. pylori culture, and assessment of endoscopic features following the Kyoto gastritis classification. A new scoring system based on endoscopic findings including regular arrangement of collecting venules (RAC), nodularity, and diffuse or spotty redness was developed for predicting H. pylori infection, utilizing logistic regression analysis in the development set.
RESULTS
The scoring system demonstrated high predictive accuracy for H. pylori infection in the validation set. Scores of 2 and 3 were associated with 96% and 99% infection risk, respectively. Additionally, there was a higher prevalence of diffuse redness and sticky mucus in cases where the initial H. pylori eradication treatment failed.
CONCLUSION
Our scoring system showed potential for improving diagnostic accuracy in H. pylori infection. H. pylori testing should be considered upon spotty redness, diffuse redness, nodularity, and RAC absence on endoscopic findings as determined by the predictive scoring system.
Topics: Humans; Helicobacter Infections; Retrospective Studies; Male; Female; Middle Aged; Helicobacter pylori; Predictive Value of Tests; Adult; Aged; Breath Tests; Endoscopy, Gastrointestinal; Reproducibility of Results; Gastritis; Risk Assessment; Decision Support Techniques
PubMed: 38715232
DOI: 10.3904/kjim.2023.300 -
BMC Sports Science, Medicine &... May 2024This study aimed to explore the effects of different types of resistance training using kettlebells versus the own body mass, in comparison to a passive control, on key...
The effects of kettlebell training versus resistance training using the own body mass on physical fitness and physiological adaptations in obese adults: a randomized controlled trial.
AIM OF STUDY
This study aimed to explore the effects of different types of resistance training using kettlebells versus the own body mass, in comparison to a passive control, on key physical fitness and physiological parameters in young, obese adults.
METHODS
Data from 60 sedentary, obese male college students, aged 17-26, were used for final analyses. Participants were randomly assigned to one of three groups: a control group (CG, n = 20, no training), a kettlebell resistance training group (KRTG, n = 20), or a bodyweight resistance training group (BWRTG, n = 20). Selected measures of physical fitness were tested using the 12-minutes run test, the push-up test, the sit-up test, and the sit-and-reach test. Physiological measures included vital capacity, resting and maximum heart rate (HRmax), mean arterial blood pressure, breath holding time, and respiratory rate. Biochemical variables were measured in the morning, in a fasted state, and comprised high and low density lipoprotein, total cholesterol, and triglycerides. The 12-weeks progressive KRTG and BWRTG were specifically tailored using sets, repetitions, and intensity levels.
RESULTS
Notable findings include significant body fat reductions in BWRTG (p < 0.001; d = 1.53) and KRTG (p < 0.001; d = 1.43), and a substantial increase in VO2max for BWRTG (p < 0.001; d = 1.32) and KRTG (p < 0.001; d = 1.34) compared to CG. KRTG also showed significant improvements in vital capacity (p < 0.001; d = 1.61) and reductions in resting heart rate (p = 0.024, d = 1.05) and respiratory rate (p = 0.001, d = 1.55), with BWRTG showing similar trends (resting heart rate: p = 0.041, d = 1.35; respiratory rate: p = 0.001, d = 1.98). Both intervention groups significantly improved breath holding time (KRTG: p = 0.001, d = 1.58; BWRTG: p < 0.001, d = 1.98) and reduced total cholesterol and low-density lipoprotein levels compared to CG.
CONCLUSIONS
This study demonstrates that both KRTG and BWRTG are effective in improving body composition and selected fitness and physiological measures. Thus, resistance training using kettlebells or bodyweight training are recommended if the goal is to improve body composition and fitness in obese male adults.
TRIAL REGISTRATION
OSF, September, 28th 2023. https://doi.org/10.17605/OSF.IO/Z6Y9Gosf.io/2mb98.
PubMed: 38715134
DOI: 10.1186/s13102-024-00894-6 -
Gut and Liver May 2024: Bismuth-based quadruple therapy (BQT) is a treatment option for clarithromycin-resistant (HP) infection. The aim of this study was to compare the efficacy of 7-day...
BACKGROUND/AIMS
: Bismuth-based quadruple therapy (BQT) is a treatment option for clarithromycin-resistant (HP) infection. The aim of this study was to compare the efficacy of 7-day BQT with that of 14-day BQT as first-line treatment for clarithromycin-resistant HP infection.
METHODS
: A total of 162 treatment-naïve patients with peptic ulcer disease and clarithromycin-resistant HP infection confirmed by real-time polymerase chain reaction (RT-PCR) were enrolled. The enrolled patients were prospectively randomized to receive BQT for either 7 or 14 days of treatment. Eradication of HP infection was assessed using a C-urea breath test. Eradication and adverse event rates of the two groups were assessed.
RESULTS
: The overall eradication rates in the intention-to-treat (ITT) and per-protocol (PP) analyses were 83.0% (95% confidence interval [CI], 77.2% to 88.9%; 132/159) and 89.8% (95% CI, 84.9% to 94.7%; 132/147), respectively. The eradication rates in the ITT analysis were 79.0% (64/81) in the 7-day group and 87.2% (68/78) in the 14-day group (p=0.170). The eradication rates in the PP analysis were 86.5% (64/74) in the 7-day group and 93.2% (68/73) in the 14-day group (p=0.182). Clinically significant adverse events occurred in 18.2% of patients. There was no statistically significant difference in the rates of individual or all adverse events between the two groups.
CONCLUSIONS
: Both 7-day and 14-day BQT were effective and safe as first-line therapy for HP infections identified as resistant to clarithromycin by RT-PCR. For clarithromycin-resistant HP infections, 7-day BQT may be sufficient as first-line therapy.
PubMed: 38712395
DOI: 10.5009/gnl230453 -
Cureus Apr 2024Tuberculosis is the most frequent cause of death, specifically caused by a single infectious agent, . There are two types of tuberculosis: pulmonary tuberculosis and...
Tuberculosis is the most frequent cause of death, specifically caused by a single infectious agent, . There are two types of tuberculosis: pulmonary tuberculosis and extrapulmonary tuberculosis. Patients with extrapulmonary tuberculosis often have reduced lung function due to the disease's structural abnormalities, which also significantly impair their quality of life. The suggested standard of care for the treatment of extrapulmonary tuberculosis patients is pulmonary rehabilitation. A 35-year-old male patient who complained of shortness of breath, dry cough, and on-and-off fever diagnose with extrapulmonary tuberculosis was the subject of the case study. The patient had extrapulmonary tuberculosis with a history of pleural effusion, which was managed with proper medications. After increasing symptoms of the disease, the patient was referred for pulmonary rehabilitation. Physiotherapy protocol includes breathing exercises, relaxation techniques, and mobility exercises for the upper limb and lower limb. Effective physical rehabilitation was necessary to minimize complications and allow him to resume daily activities. Several outcome measures, like the dyspnea scale, visual analog scale, six-minute walk test, and World Health Organization-Quality of Life (WHO-QOL) questionnaire, were used to monitor the patient's progress during rehabilitation. The benefits of physiotherapy protocols emphasize the need for tailored approaches to addressing individual patient needs for comprehensive recovery as it significantly enhances clinical, physical, psychosocial, and overall quality of life, making it crucial for patients with extrapulmonary tuberculosis. The protocols are beneficial to improve exercise capacity, muscle force, symptoms such as dyspnea, cough, and health-related quality of life in these patients. In this study, the focus was more on breathing exercises such as segmental breathing exercises for lung expansion and increasing air entry in the lungs followed by improving functional capacity and strength.
PubMed: 38707143
DOI: 10.7759/cureus.57495 -
Cureus Apr 2024A 72-year-old woman with recently diagnosed non-small cell lung cancer, who underwent cardiac bypass and bioprosthetic mitral valve replacement presented to our cancer...
A 72-year-old woman with recently diagnosed non-small cell lung cancer, who underwent cardiac bypass and bioprosthetic mitral valve replacement presented to our cancer center with lightheadedness, severe fatigue, and shortness of breath. Initial blood tests showed mild hemolytic anemia. The patient also complained of occasional bright red bleeding per rectum. Esophagogastroduodenoscopy and colonoscopy did not reveal an acute source of bleeding. An initial transesophageal echocardiogram did not show significant valvular or paravalvular abnormalities. Meanwhile, the patient's hemolytic anemia worsened. She received eight units of packed red blood cell transfusions. Schematic workup for hemolytic anemia revealed negative Coomb's test, positive urine hemosiderin, normal ADAMTS13 activity, and absent splenomegaly. A relook of the patient's transesophageal echocardiogram (TEE) showed a small paravalvular leak of the bioprosthetic mitral valve. The patient was referred to a tertiary center, and repair of the perivalvular leak with glue resolved her hemolytic anemia, subsequently improving the lab values, symptoms, and quality of life. This case highlights the schematic workup of hemolytic anemia and also the importance of recognizing the association between hemolytic anemia and valvular abnormalities.
PubMed: 38707129
DOI: 10.7759/cureus.57552 -
Respiratory Research May 2024Asthma is a common chronic disease amongst children. Epidemiological studies showed that the mortality rate of asthma in children is still high worldwide. Asthma control... (Review)
Review
Asthma is a common chronic disease amongst children. Epidemiological studies showed that the mortality rate of asthma in children is still high worldwide. Asthma control is therefore essential to minimize asthma exacerbations, which can be fatal if the condition is poorly controlled. Frequent monitoring could help to detect asthma progression and ensure treatment effectiveness. Although subjective asthma monitoring tools are available, the results vary as they rely on patients' self-perception. Emerging evidence suggests several objective tools could have the potential for monitoring purposes. However, there is no consensus to standardise the use of objective monitoring tools. In this review, we start with the prevalence and severity of childhood asthma worldwide. Then, we detail the latest available objective monitoring tools, focusing on their effectiveness in paediatric asthma management. Publications of spirometry, fractional exhaled nitric oxide (FeNO), hyperresponsiveness tests and electronic monitoring devices (EMDs) between 2016 and 2023 were included. The potential advantages and limitations of each tool were also discussed. Overall, this review provides a summary for researchers dedicated to further improving objective paediatric asthma monitoring and provides insights for clinicians to incorporate different objective monitoring tools in clinical practices.
Topics: Humans; Asthma; Child; Spirometry; Monitoring, Physiologic; Disease Management; Fractional Exhaled Nitric Oxide Testing
PubMed: 38702779
DOI: 10.1186/s12931-024-02817-y -
Medicine May 2024Multiple takayasu arteritis (TA) is a chronic nonspecific large to medium vasculitis disease that mainly accumulates the aorta and its branches. Pulmonary vascular... (Observational Study)
Observational Study
BACKGROUND
Multiple takayasu arteritis (TA) is a chronic nonspecific large to medium vasculitis disease that mainly accumulates the aorta and its branches. Pulmonary vascular disease is often seen as stenosis and occlusion, and patients may show no moderate to severe pulmonary hypertension (PH). This study aims to summarize the clinical characteristics and analysis of prognostic factors in patients with PH caused by TA.
METHODS
Patients diagnosed with aortitis involving the pulmonary artery by pulmonary arteriography or pulmonary artery and total aortic computed tomography arteriography (CTA). All patients underwent detailed clinical assessment, laboratory data collection, and analysis of imaging data. Patients were followed up and factors affecting the prognosis of the pulmonary arteries were analyzed.
RESULTS
Most of the patients' complaints were chest tightness, shortness of breath, decreased activity tolerance, hemoptysis and chest pain. 56.90% of the patients were in at the time of admission. Echocardiographic estimation of pulmonary artery systolic pressure was 90.39 ± 22.87 mm Hg. In terms of laboratory tests, 39.66%% of the patients had elevated C-reactive protein and erythrocyte sedimentation rate, and amino-terminal natriuretic peptide precursor on admission. In terms of imaging, all patients had pulmonary artery involvement, which was combined with aortic involvement in 31.03%. Nuclide lung perfusion/ventilation imaging of the patients revealed multiple perfusion defects/absences in the segmental and subsegmental distribution of the lungs. Univariate Cox regression model analysis suggested that patients' WHO functional class at admission, age ≧ 51 years at the time of consultation, and amino-terminal natriuretic peptide precursor ≧ 3500 pg/mL were factors affecting the prognosis. Further multifactorial Cox regression model analysis suggested amino-terminal natriuretic peptide precursor ≧ 3500 pg/mL was an independent predictor of poor prognosis with a hazard ratio (HR) value of 5.248.
CONCLUSION
Electrocardiogram and echocardiogram may suggest an increased right heart load; some patients have elevated serum inflammatory indexes. Characteristic imaging manifestations include widening of the main pulmonary artery, multiple pulmonary segmental and subsegmental stenoses.
Topics: Humans; Takayasu Arteritis; Female; Hypertension, Pulmonary; Retrospective Studies; Adult; Male; Prognosis; Pulmonary Artery; Middle Aged; Young Adult; Echocardiography; Computed Tomography Angiography
PubMed: 38701260
DOI: 10.1097/MD.0000000000037992 -
JGH Open : An Open Access Journal of... May 2024To evaluate the efficacy and safety of minocycline, vonoprazan, amoxicillin, and bismuth quadruple therapy for () treatment.
BACKGROUND AND AIM
To evaluate the efficacy and safety of minocycline, vonoprazan, amoxicillin, and bismuth quadruple therapy for () treatment.
METHODS
From August 2022 to May 2023, clinical data were collected from patients who received eradication treatment at West China Fourth Hospital, Sichuan University. One group received the MVAB regimen (amoxicillin, minocycline, vonoprazan, and colloidal bismuth pectin), while another group received the FOAB regimen (amoxicillin, furazolidone, omeprazole, and colloidal bismuth pectin), both administered for 14 days. Follow-up assessments of safety and compliance were conducted within 1 week after treatment completion. One and a half months after treatment, the success of eradication was evaluated using the urea breath test.
RESULTS
For the MVAB regimen as a first-line treatment, the eradication rate was 90.1% (127/141, 95% CI: 85.1-95.1%) in the ITT analysis and 93.4% (127/136, 95% CI: 89.2-97.6%) in the PP analysis as a first-line treatment. As a second-line treatment, the eradication rate was 91.3% (21/23, 95% CI: 78.8-103.8%) in both analyses. For the FOAB regimen as a first-line treatment, the eradication rate was 98.0% (50/51, 95% CI: 94.1-101.2%) in the ITT analysis and 100% (50/50, 95% CI: 100%) in the PP analysis. As a second-line treatment, the eradication rate was 100% (6/6, 95% CI: 100%) in both analyses. Moreover, there was no significant difference in the incidence of adverse events between the two groups (MVAB regimen: 5.5% and FOAB regimen: 8.8%; > 0.05).
CONCLUSIONS
The MVAB regimen could indeed be a viable alternative treatment option to conventional therapies.
PubMed: 38699469
DOI: 10.1002/jgh3.13070 -
BMC Pulmonary Medicine May 2024In western Yokohama, our hospital and primary care clinics manage adults with asthma via a coordinated care system. We investigated the changes in the fractional expired...
Changes in fractional exhaled nitric oxide, forced expiratory volume in one second, and forced oscillation technique parameters over three years in adults with bronchial asthma managed under Yokohama Seibu Hospital's coordinated care system.
BACKGROUND
In western Yokohama, our hospital and primary care clinics manage adults with asthma via a coordinated care system. We investigated the changes in the fractional expired nitric oxide (FeNO), forced expiratory volume in 1 second (FEV), and forced oscillation technique (FOT) parameters over 3 years in a cohort of patients in our collaborative system.
METHODS
From 288 adults with well controlled asthma managed under the Yokohama Seibu Hospital coordinated care system between January 2009 and May 2018, we selected 99 subjects to undergo spirometry, FeNO and FOT testing over 3 years and analyzed the changes in these parameters.
RESULTS
Of the 99 patients enrolled, 17 (17.2%) experienced at least one exacerbation (insufficiently controlled (IC)), whereas, 82 (82.8%) remained in well controlled during the 3-year study period. Of well-controlled patients, 54 patients (54.5%) met the criteria for clinical remission under treatment (CR); the remaining 28 patients did not meet the CR criteria (WC). There were no differences in FeNO, FEV, or FOT parameters at baseline among the IC, WC, and CR groups. The levels of FEV decreased gradually, whereas the levels of FeNO decreased significantly over 3 years. The levels of percent predicted FEV (%FEV) significantly increased. We also observed significant improvement in FOT parameters; reactance at 5 Hz (R), resonant frequency (Fres), and integral of reactance up to the resonant frequency (AX). The CR group demonstrated significant relationships between the change in FeNO and the change in FEV and between the change in FEV and the change in FOT parameters. No significant correlations emerged in the IC or WC group.
CONCLUSION
The decrease in FeNO and increase in %FEV, we observed in all study participants suggest that the coordinated care system model benefits patients with asthma. Although it is difficult to predict at baseline which patients will experience an exacerbation, monitoring changes in FeNO and FEV is useful in managing patients with asthma. Furthermore, monitoring changes in R Fres, and AX via forced oscillation technique testing is useful for detecting airflow limitation.
Topics: Humans; Male; Female; Asthma; Forced Expiratory Volume; Middle Aged; Adult; Spirometry; Nitric Oxide; Aged; Fractional Exhaled Nitric Oxide Testing
PubMed: 38698432
DOI: 10.1186/s12890-024-03040-7