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Open Forum Infectious Diseases Mar 2024Using nasopharyngeal (NP) swab samples instead of lower respiratory tract specimens for polymerase chain reaction (PCR) to diagnose pneumonia (PJP) may be better...
Using nasopharyngeal (NP) swab samples instead of lower respiratory tract specimens for polymerase chain reaction (PCR) to diagnose pneumonia (PJP) may be better tolerated and improve diagnostic accessibility. In this 2-year Australian retrospective cohort study of patients with clinically suspected PJP, PCR on NP swab samples had perfect specificity but low sensitivity (0.66).
PubMed: 38444816
DOI: 10.1093/ofid/ofae071 -
PloS One 2024Primary care physicians (PCPs) suffered from heavy workloads and health problems during COVID-19 pandemics, and building their confidence in pandemic response has great...
Primary care physicians (PCPs) suffered from heavy workloads and health problems during COVID-19 pandemics, and building their confidence in pandemic response has great potential to improve their well-being and work performance. We identified the organizational factors associated with their confidence in pandemic response and proposed potential management levers to guide primary care response for the pandemic. We conducted a cross-sectional survey with 224 PCPs working in 38 community health centers in China. Guided by self-efficacy theory, organization-level factors (organizational structure and organizational culture) and physician-level factors (job skill variety, perceived organizational support, work-family conflict, and professional fulfillment) were selected, and two-level ordinal logit models were built to examine their association with PCPs' confidence in pandemic response. We found that hierarchical culture (OR = 3.51, P<0.05), perceived organizational support (OR = 2.36, P<0.05), job skill variety (OR = 1.86, P<0.05), and professional fulfillment (OR = 2.26, P<0.05) were positively associated with PCPs' confidence in pandemic response. However, the influence of organization structure and work-family conflict seemed limited. The study not only increases our understanding of the influence of organizational context on PCPs' pandemic response confidence, but also points out potential management levers for front-line primary care managers to enhance primary care pandemic response capacity.
Topics: Humans; Cross-Sectional Studies; Pandemics; Physicians, Primary Care; Health Personnel; China; Pneumonia, Pneumocystis
PubMed: 38421982
DOI: 10.1371/journal.pone.0295570 -
BMC Primary Care Feb 2024Physician burnout remains a prevalent issue globally, negatively affecting work satisfaction and patient care. However, exploration of the physical work environments of...
BACKGROUND
Physician burnout remains a prevalent issue globally, negatively affecting work satisfaction and patient care. However, exploration of the physical work environments of physicians, a potential influencing factor for burnout, remains scarce. The physical work environment is everything that surrounds the physician, including the doctor's office, the clinic, the clinic's building, the waiting, and staff rooms. The aims of this study were to describe aspects of the physical work environment of primary care physicians (PCPs) and to explore the association between the physical work environment and burnout.
METHODS
In this cross-sectional study, we emailed questionnaires to an online community of PCPs in Israel in October 2021. We asked physicians about their satisfaction with their physical work environment, evaluated elements of the work environment, and assessed burnout status (with the Shirom-Melamed Burnout Measure, SMBM). We used the Chi-square and Mann-Witney tests to compare categorical and continuous variables and used logistic regression for the final model.
RESULTS
Two hundred twenty-one PCPs answered the questionnaire (27.6% response rate). Over a third (35.7%) of respondents reported high burnout. PCPs who were satisfied with their general physical environment had lower burnout rates than those who were unsatisfied (28.1% vs. 47.8%, p-value < 0.001). We found positive correlations between general satisfaction with the physical work environment and the scores achieved for the doctor's office, the clinic, the clinic's building, and the waiting room. In the multivariate analysis, high satisfaction with the general physical work environment was associated with decreased odds for burnout (OR-0.50, 95% CI 0.25-0.99, p-value-0.048).
CONCLUSION
The doctor's office, the clinic, the clinic's building, and the waiting room affected general satisfaction from the physical work environment. High satisfaction with the physical work environment reduced burnout rates. Future studies are needed to determine whether PCPs and managers should invest in the physical work environment to decrease burnout and increase satisfaction.
Topics: Humans; Cross-Sectional Studies; Physicians, Primary Care; Israel; Burnout, Psychological; Burnout, Professional; Pneumonia, Pneumocystis; Working Conditions
PubMed: 38418978
DOI: 10.1186/s12875-024-02310-x -
Cureus Jan 2024Here, we report a case of an 87-year-old female patient with rheumatoid arthritis (RA) treated with methotrexate (MTX) and golimumab who developed severe pneumocystis...
Here, we report a case of an 87-year-old female patient with rheumatoid arthritis (RA) treated with methotrexate (MTX) and golimumab who developed severe pneumocystis pneumonia (PCP), also known as pneumonia. The patient presented with chief complaints of dyspnea on exertion, dry cough, and fatigue. A high-resolution chest CT scan revealed diffuse, unevenly distributed ground-glass opacities throughout both lungs. The patient was clinically diagnosed with PCP based on the clinical settings, imaging, and a high level of serum β-D-glucan. While the patient required high-flow oxygen therapy, low-dose trimethoprim/sulfamethoxazole and corticosteroid therapy improved her condition, and the patient was discharged on day 25. Although to our knowledge no case report has been published regarding PCP in patients with RA treated with golimumab, this case emphasizes the importance of attention to opportunistic infections in elderly patients receiving immunosuppressive therapy. MTX use alongside tumor necrosis factor inhibitors like golimumab may increase the risk of serious infections such as PCP. The case underscores the necessity of prophylactic measures and early intervention for PCP, highlighting the delicate balance between immunosuppression benefits and infection risks in RA management.
PubMed: 38406039
DOI: 10.7759/cureus.52944 -
BioRxiv : the Preprint Server For... Feb 2024pneumonia (PjP) poses a serious risk to individuals with compromised immune systems, such as individuals with HIV/AIDS or undergoing immunosuppressive therapies for...
pneumonia (PjP) poses a serious risk to individuals with compromised immune systems, such as individuals with HIV/AIDS or undergoing immunosuppressive therapies for cancer or solid organ transplants. Severe PjP triggers excessive lung inflammation, resulting in lung function decline and consequential alveolar damage, potentially culminating in acute respiratory distress syndrome. Non-HIV patients face a 30-60%mortality rate, emphasizing the need for a deeper understanding of inflammatory responses in PjP. Prior research emphasized macrophages in infections, neglecting neutrophils' role in tissue damage. Consequently, the overemphasis on macrophages led to an incomplete understanding of the role of neutrophils and inflammatory responses. In the current investigation, our RNAseq studies on a murine surrogate model of PjP revealed heightened activation of the NLRP3 inflammasome and NETosis cell death pathways in their lungs. Immunofluorescence staining confirmed Neutrophil Extracellular Trap (NET) presence in the lungs of the -infected mice, validating our findings. Moreover, isolated neutrophils exhibited NETosis when directly stimulated with . While isolated NETs did not compromise viability, our data highlight the potential role of neutrophils in promoting inflammation during pneumonia through NLRP3 inflammasome assembly and NETosis. These pathways, essential for inflammation and pathogen elimination, bear the risk of uncontrolled activation leading to excessive tissue damage and persistent inflammation. This pioneering study is the first to identify the formation of NETs and inflammasomes during infection, paving the way for comprehensive investigations into treatments aimed at mitigating lung damage and augmenting survival rates for individuals with PjP.
PubMed: 38405901
DOI: 10.1101/2024.02.16.580773 -
Biomedicines Feb 2024This study aimed to develop a simple predictive model for early identification of the risk of adverse outcomes in kidney transplant-associated pneumonia (PCP) patients.
BACKGROUND
This study aimed to develop a simple predictive model for early identification of the risk of adverse outcomes in kidney transplant-associated pneumonia (PCP) patients.
METHODS
This study encompassed 103 patients diagnosed with PCP, who received treatment at our hospital between 2018 and 2023. Among these participants, 20 were categorized as suffering from severe PCP, and, regrettably, 13 among them succumbed. Through the application of machine learning techniques and multivariate logistic regression analysis, two pivotal variables were discerned and subsequently integrated into a nomogram. The efficacy of the model was assessed via receiver operating characteristic (ROC) curves and calibration curves. Additionally, decision curve analysis (DCA) and a clinical impact curve (CIC) were employed to evaluate the clinical utility of the model. The Kaplan-Meier (KM) survival curves were utilized to ascertain the model's aptitude for risk stratification.
RESULTS
Hematological markers, namely Procalcitonin (PCT) and C-reactive protein (CRP)-to-albumin ratio (CAR), were identified through machine learning and multivariate logistic regression. These variables were subsequently utilized to formulate a predictive model, presented in the form of a nomogram. The ROC curve exhibited commendable predictive accuracy in both internal validation (AUC = 0.861) and external validation (AUC = 0.896). Within a specific threshold probability range, both DCA and CIC demonstrated notable performance. Moreover, the KM survival curve further substantiated the nomogram's efficacy in risk stratification.
CONCLUSIONS
Based on hematological parameters, especially CAR and PCT, a simple nomogram was established to stratify prognostic risk in patients with renal transplant-related PCP.
PubMed: 38397968
DOI: 10.3390/biomedicines12020366 -
Journal of Fungi (Basel, Switzerland) Jan 2024is an opportunistic fungus that causes potentially fatal pneumonia (PCP) in immunocompromised patients. The objective of this study was to determine the prevalence of...
is an opportunistic fungus that causes potentially fatal pneumonia (PCP) in immunocompromised patients. The objective of this study was to determine the prevalence of in HIV patients through phenotypic and molecular study, to investigate the genetic polymorphisms of at the mitochondrial gene mtLSU and at the nuclear dihydropteroate synthase gene (), and by analysis of molecular docking to study the effect of mutations on the enzymatic affinity for sulfamethoxazole. A PCP prevalence of 28.3% was detected, with mtLSU rRNA genotypes 3 (33.3%) and 2 (26.6%) being the most common. A prevalence of 6.7% (1/15) mutations in the gene was detected, specifically at codon 55 of the amino acid sequence of dihydropteroate synthase. Molecular docking analysis showed that the combination of mutations at 55 and 98 codons is required to significantly reduce the affinity of the enzyme for sulfamethoxazole. We observed a low rate of mutations in the gene, and molecular docking analysis showed that at least two mutations in the gene are required to significantly reduce the affinity of dihydropteroate synthase for sulfamethoxazole.
PubMed: 38392789
DOI: 10.3390/jof10020117 -
Journal de Mycologie Medicale Mar 2024Data published on Panamanian fungal disease are scarce, mostly case reports. To date, there is no paper that compiles the burden of fungal disease Here we estimate for...
Data published on Panamanian fungal disease are scarce, mostly case reports. To date, there is no paper that compiles the burden of fungal disease Here we estimate for the first time the incidence and prevalence of fungal diseases in Panama. Data on fungal disease were obtained from different search engines: PubMed, Google Scholar, Scielo and Lilacs. For population and at risk diseases, we used statistics from worldometer, UNAIDS, and WHO. Incidence, prevalence, and absolute numbers were calculated based on the population at risk. Panamanian population in 2022 was 4,429,739. We estimated that 85,530 (1.93 %) people suffer from fungal diseases. The most frequent fungal infection was recurrent Candida vaginitis (3285/100,000). There are 31,000 HIV-infected people in Panama and based on the number of cases not receiving anti-retroviral therapy (14,570), and previous reports of prevalence of opportunistic infections, we estimated annual incidences of 4.0/100,000 for cryptococcal meningitis, 29.5/100,000 for oral candidiasis, 23.1/100,000 for esophageal candidiasis, 29.5/100,000 for Pneumocystis pneumonia, 15.1/100,000, and for histoplasmosis. For chronic pulmonary aspergillosis (CPA) and fungal asthma we used data from Guatemala and Colombia to estimate COPD and asthma prevalence and WHO report for tuberculosis. We estimated annual incidences of 6.1/100,000 for invasive aspergillosis and prevalence of 31.5/100,000 for CPA, 60.2/100,000 for allergic bronchopulmonary aspergillosis, and 79.5/100,000 for severe asthma with fungal sensitisation. Other incidence estimates were 5.0/100,000 for candidaemia, 0.20/100,000 for mucormycosis, and 4.97/100,000 for fungal keratitis. Even though this report on burden of fungal disease is a forward step, more epidemiological studies to validate these estimates are needed.
Topics: Female; Humans; AIDS-Related Opportunistic Infections; Aspergillosis; Candidiasis; Pulmonary Aspergillosis; Asthma; Candidemia; Incidence; Prevalence
PubMed: 38382172
DOI: 10.1016/j.mycmed.2024.101466 -
Open Forum Infectious Diseases Feb 2024Among 9196 hospitalizations involving pneumonia, those without HIV had higher in-hospital mortality (24.3% vs 10.5%, < .001) when compared with those with HIV. These...
Among 9196 hospitalizations involving pneumonia, those without HIV had higher in-hospital mortality (24.3% vs 10.5%, < .001) when compared with those with HIV. These findings underscore the continued importance of pneumonia clinical awareness and the need for comprehensive prophylaxis guidance, particularly for certain patients without HIV who are immunosuppressed.
PubMed: 38379572
DOI: 10.1093/ofid/ofae054 -
Clinical Medicine (London, England) Jan 2024Pneumocystis jirovecii pneumonia (PJP) is a rare but serious complication of immunosuppression post-solid organ transplantation. We present a case of refractory, severe... (Review)
Review
Pneumocystis jirovecii pneumonia presenting with severe, refractory hypercalcaemia in an immunosuppressed renal transplant patient: Review of the literature and novel biochemical insights.
Pneumocystis jirovecii pneumonia (PJP) is a rare but serious complication of immunosuppression post-solid organ transplantation. We present a case of refractory, severe hypercalcaemia due to PJP in a renal transplant recipient. Treatment of PJP led to normalisation of the patient's calcium levels, and clinical improvement. To further explore the proposed calcitriol-driven mechanism leading to hypercalcaemia in PJP, we performed biochemical analysis on pre- and post-treatment serum and bronchoalveolar lavage sample at the time of PJP diagnosis. We confirmed high circulating and pulmonary levels of calcitriol in acute, untreated PJP with severe hypercalcaemia. PJP treatment led to reduction of circulating calcitriol to within normal range. We present this case, together with a literature review of similar reported cases, and the novel biochemical evidence supporting extra-renal production of calcitriol by activated pulmonary macrophages as the mechanism underpinning hypercalcaemia in PJP.
Topics: Humans; Hypercalcemia; Kidney Transplantation; Pneumonia, Pneumocystis; Calcitriol; Immunocompromised Host
PubMed: 38377731
DOI: 10.1016/j.clinme.2023.100011