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Worcester MA 01655
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Cystic Lung Disease Among Patients With SjÃ¶gren Syndrome: Frequency, Natural History, and Associated Risk Factors. - Chest
Cystic lung disease (CLD) in SjÃ¶gren syndrome (SS) is a condition with unclearÂ prognostic implications. Our objectives in this study are to determine its frequency, progression over time, and associated risk factors and complications.Eighty-four patients with primary or secondary SS and chest imaging, chest radiograph, or CT scan were retrospectively evaluated for CLD. Thirteen patients with cysts were found. Baseline characteristics of all patients were collected. A multivariate logistic regression model was used to look for predictors of CLD in patients with CT scan. Additional imaging, SSÂ activity, and complications from CLD and SS were collected for the patients with cysts.CLD had a frequency of 15.4%Â for all patients with chest imaging. Not all cysts were evident on radiography, and CLD frequency was 30.9%Â for the patients with chest CT scan. Six patients had cysts without other radiographic findings. CLD was associated with older age (OR, 1.1; 95%Â CI, 1.0-1.16), a diagnosis of secondary SS (OR, 12.1; 95%Â CI, 1.12-130.4), and seropositivity for anti-SS-related antigen A/Ro autoantibodies (OR, 26.9; 95%Â CI, 1.44-93.61). There was no radiologic progression of CLD for 12 patients after a 4-year median follow-up. Lung function did not exhibit temporal worsening. CLD did not correlate with a specific pattern in pulmonary function testing. Two patients had secondary infectious complications of the cysts.CLD is a relatively common condition in SS that does not progress on serial radiologic and lung function follow-up. CLD, without other radiographic findings, may represent a direct manifestation of SS.Copyright Â© 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
Body mass index predicts major bleeding risks in patients on warfarin. - Journal of thrombosis and thrombolysis
Despite the lack of an optimum dosing strategy in obese patients, warfarin remains the most commonly used anticoagulant. Body mass index (BMI) >30 has been linked to increased time to obtain a therapeutic international normalized ratio on initiation of warfarin as well as higher maintenance dose. Despite higher dosage requirements, few studies have examined the relationship between warfarin and bleeding events in obese individuals. We examined the performance of BMI in predicting the incidence of bleeding at an anticoagulation clinic (ACC) over a 1 year period. Eight hundred and sixty-three patients followed in the ACC over a 1 year period were evaluated for bleeds in relation to BMI [defined as weight (kg)/height (m(2))]. Seventy-one of the 863 patients had a bleeding event (8.2Â %); mean age 69.5Â years and 44Â % females. BMI categories were normal weight (21Â %), overweight (38Â %), obese class I (21Â %), II (9Â %), and III (11.3Â %), respectively. Prevalence of major and minor bleeding events were 4.4 and 3.8Â %, respectively. In univariate analyses, hazard ratio (HR) for major bleeding risks increases with higher obesity categories (HR 1.3, 1.85, and 1.93 for classes I, II, III, respectively). In multivariable adjusted model obesity classes II and III significantly increased the risk of major bleeds (HR 1.84, pÂ <Â 0.001). Bleeding risk is higher in obese compared to normal weight individuals who are on warfarin. These results suggests that BMI plays a role in bleeding events in patients on warfarin.
Legionella pneumophila cases in a community hospital: A 12-month retrospective review. - SAGE open medicine
Legionella pneumonia has long been recognized as an important cause of community-acquired pneumonia associated with significant morbidity and mortality; however, the description of the incidence of this disease is restricted to sporadic cases in the literature. With the advent of an inexpensive and rapid urine antigen test, routine testing has become more common. We report findings of a retrospective review of 266 patients who were admitted with a clinical diagnosis of community-acquired pneumonia over a 12-month period and were tested for Legionella pneumophila serogroup 1, reporting the prevalence and determinants of Legionella infection.Chart reviews of 266 patients admitted for community-acquired pneumonia and who underwent urine antigen testing for Legionella pneumophila during a 1-year time period were conducted, looking at demographic information as well as clinical and laboratory presentation, reporting on the prevalence and determinants of urine antigen positivity using multivariate logistic regression analysis.Legionella pneumophila serogroup 1 was found in 2.3% of cases of community-acquired pneumonia. We also found that altered mental status, diarrhea, history of lung disease, and alcohol intake were significantly associated with pneumonia associated with Legionella. The presence of these four factors had a low sensitivity in predicting Legionella infection (33%); however, they had a positive predictive value of 98%, with a specificity of 100. All the Legionella-infected patients in our study required admission to the intensive care unit, and one of them developed Guillain-BarrÃ© syndrome, which to our knowledge represents the only reported case of this syndrome related to Legionella infection in an adult in the English scientific literature.Legionella pneumophila serogroup 1 is a common cause of sporadic cases of community-acquired pneumonia associated with a high morbidity and protean manifestations. Clinical features have a poor sensitivity in identifying cases, and routine urine antigen testing in patients with suggestive clinical symptoms appears to be a rational approach in the evaluation of community-acquired pneumonia.
Absence of dry season Plasmodium parasitaemia, but high rates of reported acute respiratory infection and diarrhoea in preschool-aged children in KaÃ©di, southern Mauritania. - Parasites & vectors
The epidemiology of malaria in the Senegal River Gorgol valley, southern Mauritania, requires particular attention in the face of ongoing and predicted environmental and climate changes. While "malaria cases" are reported in health facilities throughout the year, past and current climatic and ecological conditions do not favour transmission in the dry season (lack of rainfall and very high temperatures). Moreover, entomological investigations in neighbouring regions point to an absence of malaria transmission in mosquito vectors in the dry season. Because the clinical signs of malaria are non-specific and overlap with those of other diseases (e.g. acute respiratory infections and diarrhoea), new research is needed to better understand malaria transmission patterns in this region to improve adaptive, preventive and curative measures.We conducted a multipurpose cross-sectional survey in the city of KaÃ©di in April 2011 (dry season), assessing three major disease patterns, including malaria. Plasmodium spp. parasite rates were tested among children aged 6-59 months who were recruited from a random selection of households using a rapid diagnostic test and microscopic examination of Giemsa-stained thick and thin blood films. Acute respiratory infection and diarrhoea were the two other diseases investigated, administering a parental questionnaire to determine the reported prevalence among participating children.No Plasmodium infection was found in any of the 371 surveyed preschool-aged children using two different diagnostic methods. Acute respiratory infections and diarrhoea were reported in 43.4% and 35.0% of the participants, respectively. About two thirds of the children with acute respiratory infections and diarrhoea required medical follow-up by a health worker.Malaria was absent in the present dry season survey in the capital of the Gorgol valley of Mauritania, while acute respiratory infections and diarrhea were highly prevalent. Surveys should be repeated towards the end of rainy season, which will enhance our understanding of the potential changes in malaria transmission in a region known as 'hot spot' of predicted climate change.
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