Pub Date : 2022-01-01DOI: 10.18297/jri/vol6/iss1/2
Julio A. Ramirez
Background: During the ongoing pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), SARS-CoV-2 community-acquired pneumonia (CAP) has been the primary cause of hospitalization. The objective of this study was to evaluate the clinical characteristics and outcomes of 1,013 patients hospitalized with SARS-CoV-2 CAP from September 2020 through March 2021 in Louisville, Kentucky. Methods: This was a retrospective observational study of 1,013 patients hospitalized with SARS-CoV-2 CAP at eight of the adult hospitals in the city of Louisville from Septem- ber 2020 through March 2021. Patients with 1) a positive reverse transcriptase-polymerase chain reaction (RT-PCR) for SARS-CoV-2, 2) fever, cough, or shortness of breath, and 3) an infiltrate on chest imaging were defined as having SARS- CoV-2 CAP. Data were abstracted from each hospital’s electronic health record. Descriptive statistics were performed on clinical and epidemiological characteristics of hospitalized patients with SARS-CoV-2 CAP. Demographic characteristics of the study population were compared with census data from the city of Louisville. Data were analyzed by descriptive and inferential statistics using R version 3.4.0. Results: Of the 1,013 patients hospitalized with SARS-CoV- 2 CAP, the median age was 65 years, 53% were males, 24% reported their race as African American or Black, and 6% identified as Hispanic. The most frequent comorbidities were hypertension (73%), obesity (56%), and diabetes (43%). At the time of admission, 60% required supplemental oxygen. The mortality rate was 19% for the total population and 45% for the 359 patients admitted to the intensive care unit (ICU). For each comorbidity, the proportion of hospital- ized patients with SARS-CoV-2 CAP was significantly different from the Louisville population ( P < 0.001). No significant differences were noted in race or ethnicity compared to the city of Louisville. Conclusions: The elderly, males, and patients with a history of coronary artery disease, cerebrovascular disease, chronic obstructive pulmonary disease, hypertension, diabetes, renal disease, or obesity are overrepresented among hospitalized patients with SARS-CoV-2 CAP compared to the Louisville population. These patients are also more likely to require ICU care and experience worse clinical outcomes, with death oc- curring in approximately one in every five hospitalizations.
{"title":"Epidemiology and Outcomes of Hospitalized Adults with SARS-CoV-2 Community-Acquired Pneumonia in Louisville, Kentucky","authors":"Julio A. Ramirez","doi":"10.18297/jri/vol6/iss1/2","DOIUrl":"https://doi.org/10.18297/jri/vol6/iss1/2","url":null,"abstract":"Background: During the ongoing pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), SARS-CoV-2 community-acquired pneumonia (CAP) has been the primary cause of hospitalization. The objective of this study was to evaluate the clinical characteristics and outcomes of 1,013 patients hospitalized with SARS-CoV-2 CAP from September 2020 through March 2021 in Louisville, Kentucky. Methods: This was a retrospective observational study of 1,013 patients hospitalized with SARS-CoV-2 CAP at eight of the adult hospitals in the city of Louisville from Septem- ber 2020 through March 2021. Patients with 1) a positive reverse transcriptase-polymerase chain reaction (RT-PCR) for SARS-CoV-2, 2) fever, cough, or shortness of breath, and 3) an infiltrate on chest imaging were defined as having SARS- CoV-2 CAP. Data were abstracted from each hospital’s electronic health record. Descriptive statistics were performed on clinical and epidemiological characteristics of hospitalized patients with SARS-CoV-2 CAP. Demographic characteristics of the study population were compared with census data from the city of Louisville. Data were analyzed by descriptive and inferential statistics using R version 3.4.0. Results: Of the 1,013 patients hospitalized with SARS-CoV- 2 CAP, the median age was 65 years, 53% were males, 24% reported their race as African American or Black, and 6% identified as Hispanic. The most frequent comorbidities were hypertension (73%), obesity (56%), and diabetes (43%). At the time of admission, 60% required supplemental oxygen. The mortality rate was 19% for the total population and 45% for the 359 patients admitted to the intensive care unit (ICU). For each comorbidity, the proportion of hospital- ized patients with SARS-CoV-2 CAP was significantly different from the Louisville population ( P < 0.001). No significant differences were noted in race or ethnicity compared to the city of Louisville. Conclusions: The elderly, males, and patients with a history of coronary artery disease, cerebrovascular disease, chronic obstructive pulmonary disease, hypertension, diabetes, renal disease, or obesity are overrepresented among hospitalized patients with SARS-CoV-2 CAP compared to the Louisville population. These patients are also more likely to require ICU care and experience worse clinical outcomes, with death oc- curring in approximately one in every five hospitalizations.","PeriodicalId":91979,"journal":{"name":"The University of Louisville journal of respiratory infections","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82788709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: The degree of association and type of causal versus non-causal relationship between pneumonia and lung cancer (LC) are evolving discussions. We reviewed English- language publications on the degree of association between pneumonia and subsequent LC. Methods: We searched the PubMed database using key- words for pneumonia, LC, and Chlamydia infection. We selected peer-reviewed studies of patients with pneumonia and LC. Case reports and other literature reviews were excluded from this review. Results: Five studies examined the incidence and/or risk of LC for a total of 415,750 patients, and four studies examined cases with Chlamydia pneumoniae chronic infection at the time of diagnosis of LC for a total of 1,467 patients. The overall risk and/or incidence of LC after pneumonia was from 2.3% to 10% for a median follow-up ranging from 109 days to 4.2 years. Three studies reported current tobacco smok- ing status, which ranged from 27.7% to 45% among those with LC. A history of prior malignancy was reported in 22.5% of patients with LC. Chlamydia immunoglobulin (Ig) A and LC were statistically non-significantly associated regardless of the age of the patients. In one study, Chlamydia heat shock protein (HSP)-60 IgG ≥ 1:50 was associated with significantly increased odds of LC in two respective models (odds ratios of [95% confidence interval (CI) 1.06–1.69] and 1.30 [95% CI 1.02–1.67]). A fourth study reported C. pneumoniae IgA ≥ 64 titers to be 58%, 29%, and 5.5% among patients with LC, those without LC, and healthy blood donors, respectively. Conclusions: The incidence of LC was reported to range from 2.3% to 10.3% following an episode of pneumonia. There is limited evidence of the association of chronic Chlamydia infection with LC, and Chlamydia could be a causal cofactor of LC. causal cofactor of lung cancer. Metagenomic studies are needed to examine the changes in the lung microbiome triggering upregulation of the P13K signaling pathway.
导论:肺炎与肺癌(LC)之间的关联程度和因果关系与非因果关系的类型正在不断发展。我们回顾了关于肺炎与随后的LC之间关联程度的英文出版物。方法:以肺炎、LC、衣原体感染为关键词检索PubMed数据库。我们选择了肺炎和LC患者的同行评议研究。病例报告和其他文献综述被排除在本综述之外。结果:5项研究调查了LC的发病率和/或风险，共415,750例患者，4项研究调查了LC诊断时肺炎衣原体慢性感染的病例，共1,467例患者。在109天至4.2年的中位随访期间，肺炎后LC的总体风险和/或发生率为2.3%至10%。三项研究报告了目前的吸烟状况，在LC患者中吸烟的比例从27.7%到45%不等。22.5%的LC患者有既往恶性肿瘤病史。衣原体免疫球蛋白(Ig) A和LC与患者年龄无关，无统计学意义。在一项研究中，衣原体热休克蛋白(HSP)-60 IgG≥1:50与两个模型中LC的几率显著增加相关(比值比为[95%置信区间(CI) 1.06-1.69]和1.30 [95% CI 1.02-1.67])。第四项研究报道，在LC患者、无LC患者和健康献血者中，肺炎原体IgA≥64滴度分别为58%、29%和5.5%。结论:据报道，肺炎发作后LC的发生率为2.3%至10.3%。慢性衣原体感染与LC相关的证据有限，衣原体可能是LC的一个因果辅助因素。肺癌的辅助因素。需要宏基因组研究来检查肺微生物组的变化触发P13K信号通路的上调。
{"title":"Association of Lung cancer with Pneumonia and Chlamydia pneumoniae infection","authors":"J. Zakhour, D. Muller, Alex Glynn, J. Bordón","doi":"10.55504/2473-2869.1227","DOIUrl":"https://doi.org/10.55504/2473-2869.1227","url":null,"abstract":"Introduction: The degree of association and type of causal versus non-causal relationship between pneumonia and lung cancer (LC) are evolving discussions. We reviewed English- language publications on the degree of association between pneumonia and subsequent LC. Methods: We searched the PubMed database using key- words for pneumonia, LC, and Chlamydia infection. We selected peer-reviewed studies of patients with pneumonia and LC. Case reports and other literature reviews were excluded from this review. Results: Five studies examined the incidence and/or risk of LC for a total of 415,750 patients, and four studies examined cases with Chlamydia pneumoniae chronic infection at the time of diagnosis of LC for a total of 1,467 patients. The overall risk and/or incidence of LC after pneumonia was from 2.3% to 10% for a median follow-up ranging from 109 days to 4.2 years. Three studies reported current tobacco smok- ing status, which ranged from 27.7% to 45% among those with LC. A history of prior malignancy was reported in 22.5% of patients with LC. Chlamydia immunoglobulin (Ig) A and LC were statistically non-significantly associated regardless of the age of the patients. In one study, Chlamydia heat shock protein (HSP)-60 IgG ≥ 1:50 was associated with significantly increased odds of LC in two respective models (odds ratios of [95% confidence interval (CI) 1.06–1.69] and 1.30 [95% CI 1.02–1.67]). A fourth study reported C. pneumoniae IgA ≥ 64 titers to be 58%, 29%, and 5.5% among patients with LC, those without LC, and healthy blood donors, respectively. Conclusions: The incidence of LC was reported to range from 2.3% to 10.3% following an episode of pneumonia. There is limited evidence of the association of chronic Chlamydia infection with LC, and Chlamydia could be a causal cofactor of LC. causal cofactor of lung cancer. Metagenomic studies are needed to examine the changes in the lung microbiome triggering upregulation of the P13K signaling pathway.","PeriodicalId":91979,"journal":{"name":"The University of Louisville journal of respiratory infections","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48756497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-08-17DOI: 10.18297/jri/vol5/iss1/24
Hernan Terroba, Alejandra González, Diana Vera Gonzalez, Roxana Mariela Godoy, A. Santos, Marisol Arrojo
Asymptomatic infection due to Strongyloides stercoralis may result in severe disease after treatment with systemic steroids. A case of S. stercoralis hyperinfection in a woman who was treated with systemic steroids for cerebral tuberculosis is reported. A 52-year-old female patient was admitted for a brain space–occupying lesion. A biopsy revealed tuberculoid-like giant cells necrotizing granulomatous reaction. Antituberculous (anti-tb) therapy and corticosteroids were started for suspected cerebral tuberculosis. Ten days after admission, the patient developed respiratory failure. A chest computed tomography showed multiple dense peripheral nodular infiltrates not seen at admission chest x-ray. Taking the patient’s epidemiological background into account, ivermectin treatment was initiated, leading to clear improvement in her clinical condition. S. stercoralis was isolated from a fecal sample. Ivermectin empirical treatment before initiation of high-dose corticosteroids in patients from endemic areas could be the best strategy for prevention of hyperinfection by this parasite.
{"title":"Strongyloides stercoralis hyperinfection and disseminated tuberculosis","authors":"Hernan Terroba, Alejandra González, Diana Vera Gonzalez, Roxana Mariela Godoy, A. Santos, Marisol Arrojo","doi":"10.18297/jri/vol5/iss1/24","DOIUrl":"https://doi.org/10.18297/jri/vol5/iss1/24","url":null,"abstract":"Asymptomatic infection due to Strongyloides stercoralis may result in severe disease after treatment with systemic steroids. A case of S. stercoralis hyperinfection in a woman who was treated with systemic steroids for cerebral tuberculosis is reported. A 52-year-old female patient was admitted for a brain space–occupying lesion. A biopsy revealed tuberculoid-like giant cells necrotizing granulomatous reaction. Antituberculous (anti-tb) therapy and corticosteroids were started for suspected cerebral tuberculosis. Ten days after admission, the patient developed respiratory failure. A chest computed tomography showed multiple dense peripheral nodular infiltrates not seen at admission chest x-ray. Taking the patient’s epidemiological background into account, ivermectin treatment was initiated, leading to clear improvement in her clinical condition. S. stercoralis was isolated from a fecal sample. Ivermectin empirical treatment before initiation of high-dose corticosteroids in patients from endemic areas could be the best strategy for prevention of hyperinfection by this parasite.","PeriodicalId":91979,"journal":{"name":"The University of Louisville journal of respiratory infections","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75742008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-03-05DOI: 10.18297/JRI/VOL5/ISS1/3
J. Ramirez, F. Blasi
Section(s) Topics 1–2 Introductions 3 Foundations of best practice 4 COVID-19 as stimulus for innovation 5 Adapting and evolving therapeutic approach 6 Age and comorbidities as risk factors 7 Over-capacity ICU 8 Adapting the ER for COVID-19 9 Training personnel for COVID-19 10 Psychological support, healthcare heroes, and COVID fatigue 11 Increased oxygen requirement 12–13 Milan’s multi-disciplinary unit 14 Standardizing respiratory support measures 15 Nutrition, sedation, and life support 16 CPAP successes and failures 17 Prone and lateral positioning of patients on CPAP 18 Different COVID-19 phenotypes? 19 Thromboembolism risk score, age, and comorbidities 20 Cardiorespiratory considerations: hypertension, echocardiography 21 Thrombosis and thromboembolism 22 Hypertension and anti-hyperintensive drugs 23 Inflammation and steroid therapies 24 Lung transplantation 25 Possible genetic risk factors 26 Dr. Blasi’s summary 27–28 Hypertension and COVID-19 pneumonia 29–30 Smoking, COPD, bronchiectasis, and cystic fibrosis 31–35 Pathophyiology of COVID-19; treatment with steroids 36–39 Lung transplantation in the Time of COVID 40–41 “COVID fatigue” 42–43 Vaccination 44–45 Thanks and sign-off
{"title":"International Respiratory Infections Society COVID Research Conversations: Podcast 1 with Dr. Francesco Blasi","authors":"J. Ramirez, F. Blasi","doi":"10.18297/JRI/VOL5/ISS1/3","DOIUrl":"https://doi.org/10.18297/JRI/VOL5/ISS1/3","url":null,"abstract":"Section(s) Topics 1–2 Introductions 3 Foundations of best practice 4 COVID-19 as stimulus for innovation 5 Adapting and evolving therapeutic approach 6 Age and comorbidities as risk factors 7 Over-capacity ICU 8 Adapting the ER for COVID-19 9 Training personnel for COVID-19 10 Psychological support, healthcare heroes, and COVID fatigue 11 Increased oxygen requirement 12–13 Milan’s multi-disciplinary unit 14 Standardizing respiratory support measures 15 Nutrition, sedation, and life support 16 CPAP successes and failures 17 Prone and lateral positioning of patients on CPAP 18 Different COVID-19 phenotypes? 19 Thromboembolism risk score, age, and comorbidities 20 Cardiorespiratory considerations: hypertension, echocardiography 21 Thrombosis and thromboembolism 22 Hypertension and anti-hyperintensive drugs 23 Inflammation and steroid therapies 24 Lung transplantation 25 Possible genetic risk factors 26 Dr. Blasi’s summary 27–28 Hypertension and COVID-19 pneumonia 29–30 Smoking, COPD, bronchiectasis, and cystic fibrosis 31–35 Pathophyiology of COVID-19; treatment with steroids 36–39 Lung transplantation in the Time of COVID 40–41 “COVID fatigue” 42–43 Vaccination 44–45 Thanks and sign-off","PeriodicalId":91979,"journal":{"name":"The University of Louisville journal of respiratory infections","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46287288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.18297/JRI/VOL5/ISS1/2
Ahmed A Eladely, Javaria Anwer Mbbs, Ashwini Gotimukul Mbbs, Manish Kc Mbbs, Jessica Petrey Msls, A. Ma, Dnp Ruth M Carrico PhD, J. Ramirez
We reviewed the COVID-19 vaccines that reached phase III of clinical development. For each of the 10 vaccines identified, we described the technology used for vaccine development, the available data from phase III clinical trials, data on vaccine safety, and the role of new SARS-CoV-2 variants on vaccine efficacy.
{"title":"An Update on the Leading COVID-19 Vaccines","authors":"Ahmed A Eladely, Javaria Anwer Mbbs, Ashwini Gotimukul Mbbs, Manish Kc Mbbs, Jessica Petrey Msls, A. Ma, Dnp Ruth M Carrico PhD, J. Ramirez","doi":"10.18297/JRI/VOL5/ISS1/2","DOIUrl":"https://doi.org/10.18297/JRI/VOL5/ISS1/2","url":null,"abstract":"We reviewed the COVID-19 vaccines that reached phase III of clinical development. For each of the 10 vaccines identified, we described the technology used for vaccine development, the available data from phase III clinical trials, data on vaccine safety, and the role of new SARS-CoV-2 variants on vaccine efficacy.","PeriodicalId":91979,"journal":{"name":"The University of Louisville journal of respiratory infections","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85839899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.18297/jri/vol5/iss1/23
J. Ramirez
Healthcare systems are institutions that deliver healthcare services to meet the health needs of individuals or a community. Healthcare services are delivered in defined settings, such as hospitals, long-term care facilities, or clinics. Healthcare research is defined as the creation of knowledge by performing studies in healthcare settings. This type of research is performed by multidisciplinary teams of healthcare practitioners with the primary goal of generating new knowledge that will improve the quality of patient care. During the planning phase of a healthcare study, it is important to select an optimal study design. In this perspective, definitions of common study designs will be reviewed and the increasing role of pragmatic clinical trials and realworld data in healthcare research will be described.
{"title":"The Increasing Role of Pragmatic Clinical Trials and Real-World Data in Healthcare Research","authors":"J. Ramirez","doi":"10.18297/jri/vol5/iss1/23","DOIUrl":"https://doi.org/10.18297/jri/vol5/iss1/23","url":null,"abstract":"Healthcare systems are institutions that deliver healthcare services to meet the health needs of individuals or a community. Healthcare services are delivered in defined settings, such as hospitals, long-term care facilities, or clinics. Healthcare research is defined as the creation of knowledge by performing studies in healthcare settings. This type of research is performed by multidisciplinary teams of healthcare practitioners with the primary goal of generating new knowledge that will improve the quality of patient care. During the planning phase of a healthcare study, it is important to select an optimal study design. In this perspective, definitions of common study designs will be reviewed and the increasing role of pragmatic clinical trials and realworld data in healthcare research will be described.","PeriodicalId":91979,"journal":{"name":"The University of Louisville journal of respiratory infections","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90491010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.18297/jri/vol5/iss1/33
R. Frierson
Consultation/liaison (C/L) psychiatry is a subspecialty that focuses on treating people with mental health disorders that co-exist with medical conditions.[1, 2] As part of patient evaluations, the C/L psychiatrist relates to and contends with the issues of others beside the patient: physicians, nurses, family, visitors, and patient roommates.[3] Dealing with pain and/or preoccupation with medical concerns, as well as being surrounded by hospital alarms and monitors, creates additional obstacles to establishing rapport and empathy.
{"title":"Consultation/Liaison Psychiatry During Covid-19","authors":"R. Frierson","doi":"10.18297/jri/vol5/iss1/33","DOIUrl":"https://doi.org/10.18297/jri/vol5/iss1/33","url":null,"abstract":"Consultation/liaison (C/L) psychiatry is a subspecialty that focuses on treating people with mental health disorders that co-exist with medical conditions.[1, 2] As part of patient evaluations, the C/L psychiatrist relates to and contends with the issues of others beside the patient: physicians, nurses, family, visitors, and patient roommates.[3] Dealing with pain and/or preoccupation with medical concerns, as well as being surrounded by hospital alarms and monitors, creates additional obstacles to establishing rapport and empathy.","PeriodicalId":91979,"journal":{"name":"The University of Louisville journal of respiratory infections","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85416410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.18297/jri/vol5/iss1/19
D. Antimisiaris
The editor-in-chief of the Lancet, Richard Horton, recently called the intersection of the COVID-19 pandemic with the epidemic of increasing chronic disease burden an “acute-on-chronic health emergency”.[1] The Institute for Health Metrics and Evaluation at the University of Washington describes the rising worldwide chronic disease burden and public health failures as “fueling” the COVID-19 pandemic.[1, 2] Prior to the pandemic, polypharmacy per capita was steadily increasing over decades due to many factors, but especially because of increased chronic disease burden among the general population worldwide.[3, 4]
{"title":"Post-Acute Sequelae of COVID-19 and Polypharmacy: If You Think There’s Too Much Polypharmacy Now, Just Wait","authors":"D. Antimisiaris","doi":"10.18297/jri/vol5/iss1/19","DOIUrl":"https://doi.org/10.18297/jri/vol5/iss1/19","url":null,"abstract":"The editor-in-chief of the Lancet, Richard Horton, recently called the intersection of the COVID-19 pandemic with the epidemic of increasing chronic disease burden an “acute-on-chronic health emergency”.[1] The Institute for Health Metrics and Evaluation at the University of Washington describes the rising worldwide chronic disease burden and public health failures as “fueling” the COVID-19 pandemic.[1, 2] Prior to the pandemic, polypharmacy per capita was steadily increasing over decades due to many factors, but especially because of increased chronic disease burden among the general population worldwide.[3, 4]","PeriodicalId":91979,"journal":{"name":"The University of Louisville journal of respiratory infections","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84894352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.18297/jri/vol5/iss1/32
Ashley M. Wilde, Elena A. Swingler, Sarah E. Moore, B. Bohn, Matthew Song, Ruth, Carrico, Julio A. Ramirez
Rapid diagnostic technologies are revolutionizing the clinical microbiology laboratory. Next generation sequencing (NGS) is poised to be the next powerful tool in standard clinical laboratories building on the widespread adoption of multiplex polymerase chain reaction (PCR) panels and matrix-assisted laser desorption/ionization-time of flight (MALDITOF) technology.[1] NGS can provide a quantitative analysis of all non-human DNA or RNA in a sample without requiring growth on a traditional medium. This improves the diagnostic yield of infections that are difficult to culture due to biofilm production, such as prosthetic joint infections.[2] As these technologies become faster and cheaper, research efforts are urgently needed to guide clinicians to wider applications of NGS, including use in non-sterile sites, such as lower and upper respiratory tract samples. The diagnostic utility of NGS of respiratory samples has already been noted in cases of pneumonia caused by pathogens that are difficult to identify through conventional testing.[3, 4] However, the use of NGS as a diagnostic tool in community-acquired pneumonia (CAP) remains to be elucidated. The characterization of the respiratory microbiome in clinical practice may improve the diagnosis and therefore the treatment of CAP. However, without adequate research, using NGS in patients with suspected CAP may unnecessarily accelerate antimicrobial prescribing simply by providing the names of all commensal organisms present in a respiratory sample.
{"title":"A Research Framework for Evaluating Next Generation Sequencing in Community-Acquired Pneumonia","authors":"Ashley M. Wilde, Elena A. Swingler, Sarah E. Moore, B. Bohn, Matthew Song, Ruth, Carrico, Julio A. Ramirez","doi":"10.18297/jri/vol5/iss1/32","DOIUrl":"https://doi.org/10.18297/jri/vol5/iss1/32","url":null,"abstract":"Rapid diagnostic technologies are revolutionizing the clinical microbiology laboratory. Next generation sequencing (NGS) is poised to be the next powerful tool in standard clinical laboratories building on the widespread adoption of multiplex polymerase chain reaction (PCR) panels and matrix-assisted laser desorption/ionization-time of flight (MALDITOF) technology.[1] NGS can provide a quantitative analysis of all non-human DNA or RNA in a sample without requiring growth on a traditional medium. This improves the diagnostic yield of infections that are difficult to culture due to biofilm production, such as prosthetic joint infections.[2] As these technologies become faster and cheaper, research efforts are urgently needed to guide clinicians to wider applications of NGS, including use in non-sterile sites, such as lower and upper respiratory tract samples. The diagnostic utility of NGS of respiratory samples has already been noted in cases of pneumonia caused by pathogens that are difficult to identify through conventional testing.[3, 4] However, the use of NGS as a diagnostic tool in community-acquired pneumonia (CAP) remains to be elucidated. The characterization of the respiratory microbiome in clinical practice may improve the diagnosis and therefore the treatment of CAP. However, without adequate research, using NGS in patients with suspected CAP may unnecessarily accelerate antimicrobial prescribing simply by providing the names of all commensal organisms present in a respiratory sample.","PeriodicalId":91979,"journal":{"name":"The University of Louisville journal of respiratory infections","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79925983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.18297/jri/vol5/iss1/20
R. Ambadapoodi
It has become increasingly evident that a high percentage of patients that recover from acute COVID-19 infection continue to suffer from a variety of persistent symptoms even months after viral clearance, the most common ones being fatigue, dyspnea, anosmia, dysgeusia, cognitive dysfunction, and psychological problems, including anxiety and depression. This syndrome, known as post-acute sequelae of COVID-19 (PASC), can severely affect quality of life and represents an important health care concern. The exact causes for the symptoms observed in patients with PASC remain to be adequately characterized, but are likely to be associated with multiple factors, including residual disease and/or inflammation, organ damage, effects of hospitalization and/or prolonged ventilation, as well as effects of social isolation and stress. This mini-review discusses evidence that may link both inflammatory and auto-immune processes in the pathophysiology of PASC.
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