Clinical and chest CT features of immune checkpoint inhibitor-related pneumonitis / 中华肿瘤杂志

Objective: To explore the clinical and chest computed tomography (CT) features and the outcome of immune checkpoint inhibitor-related pneumonitis (CIP). Methods: Clinical and chest CT data of 38 CIP patients with malignant tumors from the Cancer Hospital, Chinese Academy of Medical Sciences between August 2017 and April 2021 were retrospectively reviewed, and the outcomes of pneumonitis were followed up. Results: The median time from the administration of immune checkpoint inhibitors (ICIs) to the onset of CIP was 72.5 days in 38 patients with CIP, and 22 patients developed CIP within 3 months after the administration of ICIs. The median occurrence time of CIP in 24 lung cancer patients was 54.5 days, earlier than 119.0 days of non-lung cancer patients (P=0.138), with no significant statistical difference. 34 patients (89.5%) were accompanied by symptoms when CIP occurred. The common clinical symptoms were cough (29 cases) and dyspnea (27 cases). The distribution of CIP on chest CT was asymmetric in 31 cases and symmetrical in 7 cases. Among the 24 lung cancer patients, inflammation was mainly distributed ipsilateral to the primary lung cancer site in 16 cases and diffusely distributed throughout the lung in 8 cases. Ground glass opacities (37 cases) and consolidation (30 cases) were the common imaging manifestations, and organizing pneumonia (OP) pattern (15 cases) was the most common pattern. In 30 CIP patients who were followed up for longer than one month, 17 cases had complete absorption (complete absorption group), and 13 cases had partial absorption or kept stable (incomplete absorption group). The median occurrence time of CIP in the complete absorption group was 55 days, shorter than 128 days of the incomplete absorption group (P=0.022). Compared with the incomplete absorption group, there were less consolidation(P=0.010) and CIP were all classified as hypersensitivity pneumonitis (HP) pattern (P=0.004) in the complete absorption group. Conclusions: CIP often occurs within 3 months after ICIs treatment, and the clinical and CT findings are lack of specificity. Radiologic features may have a profound value in predicting the outcome of CIP.

Clinical Evaluation of a Vancomycin Dosage Strategy Based on a Serum Trough Concentration Model in Elderly Patients with Severe Pneumonia / 生物医学与环境科学（英文）

OBJECTIVE@#This study aimed to evaluate the clinical benefits of a vancomycin dosage strategy based on a serum trough concentration model in elderly patients.@*METHODS@#This prospective single-center, open-label, randomized controlled trial categorized 66 elderly patients with severe pneumonia into study and control groups. The control group received vancomycin using a regimen decided by the attending physician. Meanwhile, the study group received individualized vancomycin therapy with a dosing strategy based on a serum trough concentration model. The primary endpoint was the proportion of patients with serum trough concentrations reaching the target values. The secondary endpoints were clinical response, vancomycin treatment duration, and vancomycin-associated acute kidney injury (VA-AKI) occurrence.@*RESULTS@#All patients were at least 60 years old (median age = 81 years). The proportion of patients with target trough concentration achievement (≥ 15 mg/L) with the initial vancomycin regimen was significantly higher in the study group compared to the control group (75.8% vs. 42.4%, P = 0.006). Forty-five patients (68.2%) achieved clinical success, the median duration of vancomycin therapy was 10.0 days, and VA-AKI occurred in eight patients (12.1%). However, there were no significant differences in these parameters between the two groups. The model for predicting vancomycin trough concentrations was upgraded to: serum trough concentration (mg/L) = 17.194 - 0.104 × creatinine clearance rate (mL/min) + 0.313 × vancomycin daily dose [(mg/(kg∙d)].@*CONCLUSION@#A vancomycin dosage strategy based on a serum trough concentration model can improve the proportion of patients achieving target trough concentrations in elderly patients with severe pneumonia.

Comportamiento de características seleccionadas en pacientes hospitalizados por neumonía adquirida en la comunidad y algunas asociaciones de interés práctico / Behavior of selected characteristics in patients hospitalized for community-acquired pneumonia and some associations of practical interest

La neumonía adquirida en la comunidad constituye una de las afecciones respiratorias que provoca más demanda de asistencia médica, y es responsable del mayor número de fallecidos por enfermedades infecciosas en Cuba. El objetivo del estudio ha sido determinar el comportamiento de características seleccionadas en pacientes hospitalizados por neumonía y precisar la existencia de asociaciones entre algunas de estas características.Se realizó un estudio observacional, con diseño descriptivo, que incluyó 1,809 pacientes hospitalizados por neumonía entre enero de 2012 y febrero de 2020. Fueron analizadas características relacionadas con las condiciones de base, clínico-radiológicas, y relativas al manejo y la evolución, mediante análisis bivariante y multivariante (regresión logística). La serie estuvo constituida fundamentalmente por pacientes ancianos (79%), mientras que el 20% presentaba la condición de encamamiento. Esta condición se asoció significativamente con el estado de demencia avanzada (OR 7,6[5,5;10,4]), y fue determinante en la presentación "solapada" del proceso (OR 1,5[1,09;2]). La presentación "solapada" de la neumonía estuvo significativamente asociada al ingreso tardío (OR 1,6[1,2;2,2]). Como conclusiones se ratifica el lugar que ocupan varios elementos en las características de la morbilidad por neumonía: edad avanzada, presencia de comorbilidades, y presentación no clásica del proceso. Fueron constatadas interrelaciones de importancia práctica entre la presencia de comorbilidades particulares, las formas clínicas de presentación, el momento del ingreso, y la utilización de antimicrobianos durante la atención prehospitalaria del paciente. Se destaca el papel del encamamiento en la extensión radiológica del proceso neumónico y en la presencia de derrame pleural de mediana o gran cuantía al momento del ingreso.

Community-acquired pneumonia is one of the respiratory conditions that causes the greatest demand for medical care, and is responsible for the largest number of deaths from infectious diseases in Cuba. The objective of the study was to determine the behavior of selected characteristics in patients hospitalized for pneumonia and to specify the existence of associations between some of these characteristics. An observational study, with a descriptive design, was carried out, which included 1,809 patients hospitalized for pneumonia between January 2012 and February 2020. Characteristics related to the basic, clinical-radiological conditions, and relative to management and evolution were analyzed, through analysis bivariate and multivariate (logistic regression). The series consisted mainly of elderly patients (79%), while 20% were bedridden. This condition was significantly associated with the state of advanced dementia (OR 7.6[5.5;10.4]) and was decisive in the "overlapping" presentation of the process (OR 1.5[1.09;2]). The "overlapping" presentation of pneumonia was significantly associated with late admission (OR 1.6[1.2;2.2]). As conclusions, the place occupied by several elements in the characteristics of pneumonia morbidity is ratified: advanced age, presence of comorbidities, and non-classical presentation of the process. Interrelationships of practical importance were found between the presence of comorbidities, the clinical forms of presentation, the time of admission, and the use of antimicrobials during the patient's prehospital care. The role of bed rest in the radiological extension of the pneumonic process and in the presence of medium or large pleural effusion at the time of admission is highlighted.

Utilidad del panel de PCR multiplex en el diagnóstico microbiológico temprano y adecuación antimicrobiana en pacientes críticos con neumonía / Usefulness of the multiplex PCR panel in the early microbiological diagnosis and antimicrobial suitability in critical patients with pneumonia / Utilidade do painel de PCR multiplex no diagnóstico microbiológico precoce e adequação antimicrobiana em pacientes críticos com pneumonia

Resumen: Introducción: el inicio temprano de la antibioticoterapia adecuada en infecciones graves se asocia con reducción de la mortalidad. La identificación precoz del microorganismo es fundamental para realizar un tratamiento dirigido y disminuir la terapéutica inicial inapropiada. Objetivo: valorar la utilidad de una técnica de biología molecular por amplificación de ácidos nucleicos mediante reacción en cadena de polimerasa en tiempo real para diagnóstico microbiológico temprano y adecuación de la antibioticoterapia en pacientes con neumonías graves. Metodología: estudio retrospectivo observacional llevado a cabo en la unidad de cuidados intensivos del Hospital Maciel. Se analizaron muestras respiratorias de pacientes con diagnóstico o sospecha de neumonía. Se compararon los resultados microbiológicos obtenidos por técnicas convencionales y por biología molecular multiplex (panel neumonía). Resultados: se incluyeron 53 muestras obtenidas de 51 pacientes. El multiplex detectó al menos un microorganismo en 38 (71,7%) muestras frente a 30 (56.6%) desarrollos en cultivos tradicionales. La mayoría de las muestras se obtuvieron bajo antibioticoterapia previa (86.8%). El panel neumonía mostró un porcentaje de concordancia positiva combinado de 100% y un porcentaje de concordancia negativa del 94% para la identificación bacteriana en comparación con los métodos microbiológicos tradicionales. En 27 (51%) casos el resultado del panel de neumonía determinó un cambio en la conducta terapéutica. Conclusiones: la técnica de PCR permite la identificación temprana de microorganismos causantes de neumonía optimizando la terapéutica empírica inicial y racionalizando el uso de antimicrobianos. Un panel negativo aleja el planteo de infección respiratoria a gérmenes habituales y permite considerar diagnósticos diferenciales en cuanto a foco y/o etiología.

Summary: Introduction: the early initiation of the adequate antibiotic therapy in severe infections is associated to a reduction in mortality. Early identification of the microorganism is essential to define directed therapy and decrease the initial inadequate treatment. Objective: to assess usefulness of a molecular biology technique by nucleic acid amplification through a polymerase chain reaction in real time for an early microbiological diagnosis and correction of the antibiotic therapy in patients with severe pneumonias. Method: retrospective, observational study conducted in the intensive care unit of Maciel Hospital. The respiratory samples of patients with a diagnosis of pneumonia or suspicious to have pneumonia were analyzed. The microbiological results obtained were compared using conventional techniques and multiplex molecular biology (pneumonia panel). Results: 53 samples obtained from 51 patients were included in the study. Multiplex detected at least one microorganism in 38 (71.7%) samples compared to 30 (56.6%) in traditional cultures. Most samples were obtained under the previous antibiotic therapy (86.8%). The pneumonia panel showed a combined positive agreement percentage of 100% and a negative agreement of 94% for the identification of bacteria when compared to the traditional microbiological methods. In 27 cases (51%) the pneumonia panel results determined changing the therapeutic behavior. Conclusions: the PCR technique allows for the early identification of microorganisms causing pneumonia, thus optimizing initial empirical therapy and rationalizing the use of antibiotics. A negative panel reduces the suspicion of a respiratory infection caused by the usual germs and enables considering differential diagnosis in terms of etiology or cause.

Resumo: Introdução: o início precoce da antibioticoterapia adequada em infecções graves está associado à redução da mortalidade. A identificação precoce do microrganismo é essencial para realizar o tratamento dirigido e reduzir o uso inicial inadequado de antimicrobianos. Objetivo: avaliar a utilidade de uma técnica de biologia molecular para amplificação de ácidos nucleicos por reação em cadeia da polimerase em tempo real para diagnóstico microbiológico precoce e adequação da antibioticoterapia em pacientes com pneumonia grave. Metodologia: estudo observacional retrospectivo realizado na unidade de terapia intensiva do Hospital Maciel. Amostras respiratórias de pacientes com diagnóstico ou suspeita de pneumonia foram analisadas. Os resultados microbiológicos obtidos por técnicas convencionais e por biologia molecular multiplex (painel de pneumonia) foram comparados. Resultados: foram incluídas 53 amostras obtidas de 51 pacientes. O multiplex detectou pelo menos um microrganismo em 38 (71,7%) amostras em comparação com 30 (56,6%) usando culturas tradicionais. A maioria das amostras foi obtida com antibioticoterapia prévia (86,8%). O painel de pneumonia mostrou uma concordância percentual positiva combinada de 100% e uma concordância percentual negativa de 94% para identificação bacteriana em comparação com métodos microbiológicos tradicionais. Em 27 (51%) casos, o resultado do painel de pneumonia determinou mudança no comportamento terapêutico. Conclusões: a técnica de PCR permite a identificação precoce de microrganismos causadores de pneumonia, otimizando a terapia empírica inicial e racionalizando o uso de antimicrobianos. Um painel negativo afasta a suspeita de infecção respiratória pelos germes usuais e permite considerar diagnósticos diferenciais em termos de foco e/ou etiologia.

Clinical trials and evaluation of Chinese patent medicine for pneumonia / 中国中药杂志

The present study reviewed the clinical randomized controlled trials(RCTs) of Chinese patent medicine for pneumonia to provide references for clinical research, guideline development, and policy formulation, and promote the quality improvement of clinical evidence. On the basis of the collection in the Traditional Chinese Medicine(TCM) Clinical Evidence Database System(EVDS), CNKI, Wanfang, SinoMed were searched for RCTs of Chinese patent medicine for pneumonia from database inception to December 31, 2019. A total of 1 245 RCTs were included, involving 84 Chinese patent medicines, including 45 oral medicines and 39 injections. Specifically, 85.9% of RCTs had treatment course not exceeding 14 d; 43.3% of RCTs had a sample size of more than 100 cases and 6.1% of RCTs more than 200 cases; 13 types of interventions/controls were included in the RCTs, with Chinese patent medicine + western medicine vs western medicine as the top one used(32.6%). In outcome indicators, symptoms/signs(3 285) and physicochemical detection(2 066) were the most frequently applied. In the methodological evaluation, "allocation concealment" was not clearly described or mentioned in 71.2% of RCTs, and "blinding" in 23.9% of RCTs met the normative standards. Registration and research ethics were not clearly reported. There are many methodological deficiencies in terms of design and implementation in included RCTs, which may impact the reliability and practicability of the results of RCTs. Additionally, key standards were unclear(such as disease classification methods and selection of core outcome indicators). In conclusion, RCTs should give priority to the preciseness and scientificity of the protocol, strengthening quality control of the processes and accelerating the standardized research of key links.

Ubicación intrahospitalaria y tratamiento antimicrobiano inicial en pacientes con neumonía adquirida en la comunidad y su relación con la frecuencia y calidad del proceso de estratificación / Intrahospitalary location and antimicrobial initial treatment in patients with acquired pneumonia in the community and their relationship with the frequency and quality of the stratification process

La importancia de la evaluación inicial de la gravedad del paciente con neumonía es una acción diagnóstica de importancia bien establecida. El objetivo del trabajo fue evaluar la relación entre la frecuencia y calidad del proceso de estratificación de pacientes con neumonía, y el cumplimiento de las sugerencias de ubicación intrahospitalaria y de tratamiento antimicrobiano inicial de un instrumento de estratificación. Se realizó un estudio descriptivo sobre una población de 1,809 pacientes hospitalizados durante 10 años. Se analizó el comportamiento de los índices de ubicación intrahospitalaria y tratamiento antimicrobiano inicial acorde a la sugerencia de un instrumento de estratificación utilizado; en el análisis estadístico se utilizó el Odds ratio y el estadígrafo X2, con un nivel de significación de 95%. En los resultados se destacan que la ubicación intrahospitalaria estuvo acorde a la sugerencia del instrumento en el 96%, con el valor más bajo en los pacientes con neumonía grave y altas probabilidades de recuperación (82%, p<,05). Se constató mayor frecuencia de ubicación intrahospitalaria acorde a la sugerencia del instrumento en los pacientes bien estratificados (p<,05), fundamentalmente en los pacientes con neumonía grave y altas probabilidades de recuperación. La correspondencia del tratamiento antimicrobiano inicial con la propuesta del instrumento fue del 61%; el estrato IIIA mostró el valor más elevado (80%, p<,05). Como conclusiones del estudio se constató un elevado desempeño en el cumplimiento de la sugerencia de ubicación intrahospitalaria del instrumento de estratificación, no así en el cumplimiento de la sugerencia de tratamiento antimicrobiano inicial. Se demostró la existencia de una relación entre el proceso de estratificación y el cumplimiento de la ubicación intrahospitalaria sugerida por el instrumento empleado.

The initial evaluation of the patient's condition with pneumonia is a very important assistance action. The objective was evaluate the relationship between the frequency and quality of the stratification process of the patient with pneumonia, and the execution of suggestions of intrahospitalary location and the initial antimicrobial treatment of stratification instrument. A descriptive study was done on a population of 1,809 patients hospitalized during 10 years. The indexes of intrahospitalary location and of antimicrobian initial treatment were analized according to the suggestions of the instrument; in the statistical analysis it was used the odds ratio and the statistician X2, with a significant level of 95%. The intrahospitalary location was in agreement with the suggestion of the instrument in 96% of the cases, with the lowest value in patients with serious pneumonia and high recovery probabilities (82%, p <,05). The frequency of intrahospitalary location was bigger and veryfied with the suggestion of the instrument in the termed well stratified patients (p <,05), fundamentally in the patients with serious pneumonia and high recovery probabilities. The correspondence of the initial antimicrobial treatment with the proposal of the instrument was of 61%; the stratum IIIA showed the highest value (80%, p <,05). As conclusions, a high performance in the execution of the suggestion of the intrahospitalary location has been one of the characteristics of the process, although as a negative element it stands out the frequent non-fulfillment of the suggestion of the initial antimicrobial treatment. There was a relationship between the stratification process and the execution of the suggestion of the intrahospitalary location.

Organizing pneumonia: A late phase complication of COVID-19 responding dramatically to corticosteroids

ABSTRACT Organizing pneumonia emerges as a late phase complication of COVID-19. Corticosteroids are standard therapy for organizing pneumonia, but the question of whether an approach with high dose corticosteroids would be beneficial for patients with organizing pneumonia secondary to COVID-19 remains to be answered.Herein we report a series of three patients, one male and two females, mean age 58.3 years old, admitted for COVID-19 with severe pulmonary disease requiring ventilatory support. The patients underwent chest computed tomography scans due to maintained hypoxemia, which showed a pattern compatible with organizing pneumonia. The patients were treated with a high dose of corticosteroids (prednisone 1 mg/kg PO), showing marked clinical improvement, and decreasing oxygen flow ratio demand. They were discharged after a mean period of 6.3 days of hospitalization.Our report suggests that patients with COVID-19 with organizing pneumonia might benefit from high dose corticosteroids as an adjuvant therapy.

Perfil del lactante con insuficiencia respiratoria que se beneficia del uso de cánula nasal de alto flujo, Bogotá - Colombia / Profile of the infant with respiratory failure benefited from the high flow nasal cannula, Bogota ­ Colombia

OBJETIVO: el propósito de este estudio fue determinar los principales desenlaces clínicos en lactantes con insuficiencia respiratoria aguda (IRA), tratados con cánula nasal de alto flujo (CNAF) en una unidad de cuidado intensivo pediátrico (UCIP). MATERIALES Y MÉTODOS: se realizó un estudio observacional descriptivo de cohorte histórica, se reclutaron niños entre 1 y 24 meses que ingresaron a la UCIP de un hospital de referencia con diagnóstico de IRA (Julio 1, 2016 a junio 30, 2017) tratados con CNAF como terapia inicial. Los datos extraídos incluyeron variables demográficas, clínicas y principales desenlaces. RESULTADOS: se identificaron 112 casos que cumplieron los criterios de inclusión durante el periodo del estudio. El diagnóstico más frecuente fue neumonía multilobar (41%), seguido por bronquiolitis (34%). Se encontró que el 22.4% de los niños poseía alguna comorbilidad, siendo la más frecuente la displasia broncopulmonar. El virus más frecuentemente aislado fue el virus sincitial respiratorio (VSR) en el 37.5% de los casos. De los 112 pacientes, 59 niños (53%) requirieron intubación traqueal. Los factores asociados con el riesgo de intubación fueron el diagnóstico de neumonía multilobar, el uso de sedación, el aislamiento de VSR y el sexo femenino. CONCLUSIONES: la CNAF es un sistema de soporte respiratorio no invasivo, seguro, bien tolerado y capaz de disminuir la necesidad de intubación y los días de estancia en cuidado intensivo. En niños con IRA, el diagnóstico de neumonía multilobar, la necesidad de sedación, la presencia de comorbilidades asociadas y el sexo femenino son factores asociados con la necesidad de requerir ventilación mecánica invasiva.

OBJECTIVE: the purpose of this study was to determine the main clinical outcomes in infants with acute respiratory failure (ARF), treated with a high-flow nasal cannula (CNAF) in a pediatric intensive care unit (PICU). MATERIALS AND METHODS: a retrospective observational study was conducted on a cohort of children between 1 and 24 months of age who were admitted to the PICU entered UCIP of a referral hospital with a diagnosis of ARF treated with CNAF as initial therapy. The data extracted included demographic and clinical variables and main outcomes. RESULTS: 112 cases were identified that met the inclusion criteria during the study period. The most frequent diagnosis was pneumonia (41%), followed by bronchiolitis (34%). It was found that 22.4% of the children had some comorbidity, the most frequent being bronchopulmonary dysplasia. The most frequently isolated virus was respiratory syncytial virus (RSV) in 37.5% of the cases. Of the 112 patients, 59 children (53%) required tracheal intubation. The factors associated with the risk of intubation were the diagnosis of pneumonia, the use of sedation, the isolation of RSV and the female gender. CONCLUSIONS: CNAF is a non-invasive respiratory support system, capable of reducing the need for intubation and days of stay in intensive care. In children with ARF, the diagnosis of pneumonia, the need for sedation, the presence of associated comorbidities, and the female gender are factors associated with the need to require invasive mechanical ventilation.

Meta-analysis of Tanreqing Injection in adjuvant treatment of stroke-associated pneumonia / 中国中药杂志

To systematically evaluate the efficiency and safety of Tanreqing Injection in the treatment of stroke-associated pneumonia(SAP). Seven domestic and foreign databases(CNKI, Wanfang, VIP, CBM, PubMed, Cochrane Library, EMbase) were retrieved from the establishment to July 2020. According to the inclusion and exclusion criteria, randomized controlled trial of the effect of Tanreqing Injection in the treatment of SAP was selected. NoteExpress software was used to screen out literatures. RevMan 5.4 software was used for data analysis. GRADE system was used to evaluate the evidence quality of the outcome indicators. A total of 1 755 cases in 21 studies were retrieved, including 879 cases in experimental group and 876 cases in control group. In general, the quality of stu-dies received was not high. According to Meta-analysis,(1) in terms of shortening the length of hospital stay, Tanreqing Injection combined with conventional western medicine was better than conventional western medicine(MD=-4.04, 95%CI[-4.43,-3.65], P<0.000 01);(2) in terms of increasing effective rate, Tanreqing Injection combined with conventional western medicine was better than conventional western medicine(RR=1.22, 95%CI[1.17, 1.27], P<0.000 01);(3) in terms of reducing inflammation indicators, Tanreqing Injection combined with conventional western medicine was better than conventional western medicine(MD_(CRP)=-10.75, 95%CI[-15.61,-5.88], P<0.000 01; MD_(WBC count)=-1.62, 95%CI[-2.55,-0.69], P=0.000 6; MD_(PCT)=-0.58, 95%CI[-0.89,-0.26], P=0.000 3];(4) in terms of improving symptoms and signs, Tanreqing Injection combined with conventional wes-tern medicine was better than conventional western medicine(MD_(cough)=-2.73, 95%CI[-4.93,-0.53], P=0.02; MD_(antipyretic)=-1.07, 95%CI[-1.17,-0.98), P<0.000 01];(5) in terms of decreasing the NIHSS scores, Tanreqing Injection combined with conventional western medicine was better than conventional western medicine(MD=-3.02, 95%CI[-4.91,-1.13], P=0.002);(6) in terms of adverse reactions, there was no statistically significant difference between Tanreqing Injection combined with conventio-nal western medicine compared with conventional western medicine treatment(RR=1.19, 95%CI[0.61,2.29], P=0.61). GRADE system showed that the evidence levels of above outcome indicators were low and extremely low. The results proved that Tanreqing Injection combined with conventional western medicine had a good advantage in the treatment of SAP, with better observation indicators better than western medicine conventional treatment, and no increase in the incidence of adverse reactions. However, this study had certain limitations. The overall quality of the included studies was low, which affected the reliability of the results. Therefore, the conclusions of this study shall be used cautiously.

Effects of Chinese Medicine on Symptoms, Syndrome Evolution, and Lung Inflammation Absorption in COVID-19 Convalescent Patients during 84-Day Follow-up after Hospital Discharge: A Prospective Cohort and Nested Case-Control Study / 中国结合医学杂志

OBJECTIVE@#To observe the changes of symptoms, Chinese medicine (CM) syndrome, and lung inflammation absorption during convalescence in patients with coronavirus disease 2019 (COVID-19) who had not totally recovered after hospital discharge and whether CM could promote the improvement process.@*METHODS@#This study was designed as a prospective cohort and nested case-control study. A total of 96 eligible patients with COVID-19 in convalescence were enrolled from Beijing Youan Hospital and Beijing Huimin Hospital and followed up from the hospital discharged day. Patients were divided into the CM (64 cases) and the control groups (32 cases) based on the treatment with or without CM and followed up at 14, 28, 56, and 84 days after discharge. In the CM group, patients received the 28-day CM treatment according to two types of CM syndrome. Improvements in clinical symptoms, CM syndrome, and absorption of lung inflammation were observed.@*RESULTS@#All the 96 patients completed the 84-day follow-up from January 21 to March 28, 2020. By the 84th day of follow-up, respiratory symptoms were less than 5%. There was no significant difference in the improvement rates of symptoms, including fatigue, sputum, cough, dry throat, thirst, and upset, between the two groups (P>0.05). Totally 82 patients (85.42%) showed complete lung inflammation absorption at the 84-day follow-up. On day 14, the CM group had a significantly higher absorption rate than the control group (P<0.05) and the relative risk of absorption for CM vs. control group was 3.029 (95% confidence interval: 1.026-8.940). The proportions of CM syndrome types changed with time prolonging: the proportion of the pathogen residue syndrome gradually decreased, and the proportion of both qi and yin deficiency syndrome gradually increased.@*CONCLUSIONS@#Patients with COVID-19 in convalescence had symptoms and lung inflammation after hospital discharge and recovered with time prolonging. CM could improve lung inflammation for early recovery. The types of CM syndrome can be transformed with time prolonging. (Registration No. ChiCTR2000029430).

Study on mechanism of combination of Platycodonis Radix and Lilii Bulbus with homology of medicine and food in treating pneumonia / 中国中药杂志

To investigate the potential molecular mechanism of the combination of Platycodonis Radix and Lilii Bulbus with the homology of medicine and food in the treatment of pneumonia by means of network pharmacology and in vitro verification experiment. Under the condition of bioavailability(OB)≥30% and drug-like(DL)≥0.18, the active components of Platycodonis Radix and Lilii Bulbus were screened in TCMSP database; the prediction targets of active components were searched from TCMSP, DrugBank and other databases, and the potential targets of pneumonia were obtained through GeneCards and OMIM database. The common targets were obtained by the intersection of drug and disease targets. The PPI network of common targets was constructed by STRING 11.0, and the core targets were obtained by topological analysis. Then the core targets received GO and KEGG analysis with use of WebGestalt and Metascape. The "component-target-pathway" network was constructed with the help of Cytoscape 3.7.1 software, and the component-target molecular docking verification was carried out with Discovery Studio 2016 software. Finally, the core targets and pathways were preliminarily verified in vitro. In this study, 12 active components were screened, 225 drug prediction targets and 420 potential diseases targets were obtained based on data mining method, and 14 core targets were obtained by topological analysis, including TNF, MMP9, AKT1, IL4 and IL2. The enrichment results of GO and KEGG showed that "Platycodonis Radix and Lilii Bulbus" drug pair may regulate inflammation, cell growth and metabolism by acting on 20 key signaling pathways such as TNF and IL-17, thereby exerting anti-pneumonia effects. The results of molecular docking showed that 12 active components had good binding ability with 14 core targets. In vitro experiment results showed that the core components of "Platycodonis Radix and Lilii Bulbus" drug pair could inhibit the expression of MMP9 and TNF-α by regulating TNF signal pathway. This study confirmed the scientificity and reliability of the prediction results of network pharmacology, and preliminarily revealed the potential molecular mechanism of the compatibility of Platycodonis Radix and Lilii Bulbus in the treatment of pneumonia. It provides a novel insight on systematically exploring the mechanism of the compatible use of Platycodonis Radix and Lilii Bulbus, and has a certain reference value for the research, development and application of new drugs.

Systematic review of randomized controlled trial of Maxing Shigan Decoction in treatment of community acquired pneumonia / 中国中药杂志

To systemically evaluate the efficacy and safety of Maxing Shigan Decoction in the treatment of community acquired pneumonia(CAP) and provide a reference for the treatment of CAP. Databases of CNKI, Wanfang, VIP, SinoMed, EMbase, Cochrane Library, Web of Science and PubMed were searched(from inception to May 30, 2020) to screen the randomized controlled trials(RCTs) of Maxing Shigan Decoction in treating CAP. Two authors independently screened and selected relevant literature and extracted data based on the inclusion and exclusion criteria. Any disagreement or differences was resolved through discussion. The bias risk assessment tool recommended by Cochrane handbook was used to evaluate the quality of the included studies, and RevMan 5.3 software was used for data analysis. Seventeen RCTs were finally included, involving 1 309 patients. Meta-analysis showed that Maxing Shigan Decoction combined with conventional Western medicine treatment could improve clinical efficacy in patients with CAP more effectively as compared with conventional Western medicine treatment alone, mainly in terms of anti-inflammatory effects, a decrease in C-reactive protein(CRP) content(MD=-6.01, 95%CI[-10.95,-1.06], P=0.02)and white blood cell(WBC) count, a decrease in procalcitonin(PCT) level(MD=-0.74, 95%CI[-0.77,-0.71], P<0.000 1), and shortened recovery time of cough and fever. Maxing Shigan Decoction has certain curative effect on CAP, but there are problems in the methodology of included studies. High-quality stu-dies are still needed for further verification.

Meta-analysis and systematic review of efficacy and safety of Lianhua Qingwen in adjuvant treatment of adult pneumonia / 中国中药杂志

To systematically evaluate the clinical efficacy and safety of Lianhua Qingwen in the treatment of adult pneumonia. The randomized controlled trial of Lianhua Qingwen combined with conventional Western medicine in the treatment of pneumonia were retrieved from PubMed, EMbase, Wanfang database, VIP database, and CNKI from the establishment of database to March 2020. Two researchers independently conducted literature screening and data extraction, and the third researcher was in charge of arbitration in case of any disagreement. Outcome indicators included total clinical effective rate, symptom improvement time, and incidence of adverse events. R 3.6.1 was used for Meta-analysis, and RevMan 5.3 was used for quality evaluation. Twenty-two studies were included, with a total of 2 007 patients, including 1 017 patients in the experimental group and 990 patients in the control group. The results showed that the total clinical effective rate of the experimental group was higher than that of the control group(RR=1.11, 95%CI[1.08, 1.15], P<0.001), and the antifebrile time(MD=-1.81, 95%CI[-2.42,-1.21], P<0.001), cough duration(MD=-2.32, 95%CI[-2.89,-1.76], P<0.001), rale duration(MD=-2.19, 95%CI[-2.74,-1.63], P<0.001), imaging recovery time(MD=-2.17, 95%CI[-2.76,-1.58], P<0.001) and post-treatment CRP(MD=-4.07, 95%CI[-6.39,-1.75], P<0.001] were all significantly lower than those of the control group. However, it did not proved that the experimental group was safer than the control group(RR=0.84, 95%CI[0.57, 1.24], P=0.382). The results confirmed that Lianhua Qingwen combined with conventional Western medicine in the treatment of pneumonia could improve the clinical treatment efficiency, shorten the time of fever, cough, rale disappearance and imaging recovery, improve CRP index and accelerate the recovery of pneumonia patients. However, the literatures included in this study had a low quality, and the conclusions still need to be further confirmed by more high-quality, multi-center, rigorously designed randomized controlled trial.

Analysis of antibiotic usage for viral community-acquired pneumonia in adults / 医学前沿

The rationale for the antibiotic treatment of viral community-acquired pneumonia (CAP) in adults was analyzed to develop a clinical reference standard for this condition. Clinical data from 166 patients diagnosed with viral pneumonia across 14 hospitals in Beijing from November 2010 to December 2017 were collected. The indications for medications were evaluated, and the rationale for the use of antibiotics was analyzed. A total of 163 (98.3%) patients with viral pneumonia were treated with antibiotics. A combination of C-reactive protein (CRP) and procalcitonin (PCT) was used as markers to analyze the possible indications for antibiotic use. With threshold levels set at 0.25 µg/L for PCT and 20 mg/L for CRP, the rate of unreasonable use of antibiotics was 55.2%. By contrast, at a CRP level threshold of 60 mg/L, the rate of antibiotic misuse was 77.3%. A total of 39 of the 163 (23.9%) patients did not meet the guidelines for drug selection for viral CAP in adults. The unreasonable use of antibacterial drugs for the treatment of viral CAP in adults is a serious concern. Clinicians must reduce the unnecessary use of antibiotics.

Pneumonia por toxoplasmose em paciente imunocompetente / Toxoplasma pneumonia in an immunocompetent patient: case repor

Com grande distribuição mundial e incidência significativa, a toxoplamose é uma doença comum em mamíferos e pássaros, causada pelo protozoário Toxoplasma gondii. No homem, o parasitismo na fase proliferativa intracelular pode se apresentar sem sintomas, ou causar clínica transitória caracterizada por febre, fadiga e linfadenopatia. Por se tratar de patologia com sintomas inespecíficos e comuns a muitas outras, é fundamental a correta pesquisa de diagnósticos diferenciais, como citomegalovírus e Epstein-Barr. Relatamos o caso de um jovem e hígido, que desenvolveu pneumonia e, após confirmação sorológica para toxoplasmose e o tratamento adequado, apresentou melhora clínica.

With great worldwide distribution and significant incidence, toxoplamosis is a common disease in mammals and birds, caused by the protozoan Toxoplasma gondii. In humans, the parasitism in its intracellular proliferative phase may present no symptoms, or cause a transient condition characterized by fever, fatigue, and lymphadenopathy. Because it is a pathology with nonspecific symptoms that are common to many other conditions, it is fundamental to find the correct research of differential diagnoses, such as for Cytomegalovirus and Epstein Barr. We report a case of a young and healthy man who developed pneumonia and, after serological confirmation for toxoplasmosis and the appropriate treatment, presented clinical improvement

Community-acquired pneumonia among children: the latest evidence for an updated management / Pneumonia adquirida na comunidade em crianc¸as: as evidências mais recentes para um manejo atualizado

Abstract Objective To provide cutting-edge information for the management of community-acquired pneumonia in children under 5 years, based on the latest evidence published in the literature. Data source A comprehensive search was conducted in PubMed, by using the expressions: "community-acquired pneumonia" AND "child" AND "etiology" OR "diagnosis" OR "severity" OR "antibiotic". All articles retrieved had the title and the abstract read, when the papers reporting the latest evidence on each subject were identified and downloaded for complete reading. Data synthesis In the era of largely implemented bacterial conjugate vaccines and widespread use of amplification nucleic acid techniques, respiratory viruses have been identified as the most frequent causative agents of community-acquired pneumonia in patients under 5 years. Hypoxemia (oxygen saturation ≤96%) and increased work of breathing are signs most associated with community-acquired pneumonia. Wheezing detected on physical examination independently predicts viral infection and the negative predictive value (95% confidence interval) of normal chest X-ray and serum procalcitonin <0.25 ng/dL was 92% (77-98%) and 93% (90-99%), respectively. Inability to drink/feed, vomiting everything, convulsions, lower chest indrawing, central cyanosis, lethargy, nasal flaring, grunting, head nodding, and oxygen saturation <90% are predictors of death and can be used as indicators for hospitalization. Moderate/large pleural effusions and multilobar infiltrates are predictors of severe disease. Orally administered amoxicillin is the first line outpatient treatment, while ampicillin, aqueous penicillin G, or amoxicillin (initiated initially by intravenous route) are the first line options to treat inpatients. Conclusions Distinct aspects of childhood community-acquired pneumonia have changed during the last three decades.

Resumo Objetivo Fornecer informações de ponta para o manejo de crianças menores de cinco anos com pneumonia adquirida na comunidade, com base nas evidências mais recentes publicadas na literatura. Fonte de dados Uma pesquisa abrangente foi feita no PubMed, com as expressões: "community-acquired pneumonia" + "child" + "etiology" ou "diagnosis" ou "severity" ou "antibiotic". Todos os artigos encontrados tiveram o título e o resumo lidos e os artigos que relatavam as evidências mais recentes sobre cada assunto foram identificados e recuperados para leitura completa. Síntese dos dados Na era das vacinas bacterianas conjugadas amplamente usadas e do uso difundido de técnicas de amplificação de ácidos nucléicos, os vírus respiratórios foram identificados como os agentes causadores mais frequentes de pneumonia adquirida na comunidade em pacientes com menos de cinco anos. A hipoxemia (saturação de oxigênio ≤ 96%) e o aumento do esforço respiratório são os sinais mais associados à pneumonia adquirida na comunidade. A sibilância detectada ao exame físico prediz de forma independente a infecção viral e o valor preditivo negativo (intervalo de confiança de 95%) da radiografia de tórax normal e a procalcitonina sérica < 0,25 ng/dL foi de 92% (77-98%) e 93% (90-99%), respectivamente. Incapacidade de beber e se alimentar, vomitar todo o alimento, convulsões, retração torácica subcostal, cianose central, letargia, aleteo nasal, estridor e saturação de oxigênio < 90% são preditores de óbito e podem ser usados como indicadores de hospitalização. Derrames pleurais moderados/grandes e infiltrados multilobulares são preditores de doença grave. A amoxicilina administrada por via oral é a opção de primeira linha para tratar pacientes ambulatoriais e a ampicilina ou penicilina cristalina G ou amoxicilina (administrada inicialmente por via intravenosa) são as opções de primeira linha para tratar pacientes hospitalizados. Conclusões Aspectos distintos da pneumonia adquirida na comunidade durante a infância mudaram durante as últimas três décadas.

Enfermedad pulmonar intersticial por IgG4 / IgG4-related interstitial lung disease

Las enfermedades relacionadas con inmunoglobulina G4 (IgG4) son un grupo heterogéneo de cuadros clínicos que pueden afectar un solo órgano o tener compromiso sistémico. Se presenta el caso de una mujer de 55 años, internada por un cuadro de tos seca, fiebre, disnea progresiva e insuficiencia respiratoria. La tomografía de tórax evidenció áreas de vidrio esmerilado difusas, patrón reticular y consolidación alveolar. Recibió tratamiento habitual para neumonía de la comunidad y corticoides sistémicos, presentando buena evolución y otorgándose el alta. Al mes se reinterna por estenosis subglótica, progresión de infiltrados pulmonares y aumento del volumen palpebral y de las glándulas submaxilares. Se realizaron biopsias transbronquial y de glándulas salivales que mostraron infiltración por IgG4. También se detectó aumento de los niveles de IgG4 en plasma. Recibió tratamiento con inmunosupresores evolucionando con buena respuesta.

IgG4-related disease is a heterogeneous group of diseases that can affect a single organ or manifest as a systemic disease. We present the case of a 55-year-old female, admitted for dry cough, fever, progressive dyspnea and respiratory failure. Chest CT showed areas of diffuse ground glass, reticular pattern and alveolar consolidation. She received treatment for community acquired pneumonia and systemic corticosteroids with good response. One month later, she was admitted again due to subglottic stenosis, progression of pulmonary infiltrates, and increased palpebral and submaxillary glands volume. Transbronchial and salivary gland biopsies showed infiltration by IgG4. Increased levels of plasma IgG4 were also detected. Immunosuppressive therapy was given with good response.

Therapeutic plants used by traditional health practitioners to treat pneumonia in the Limpopo Province, South Africa / Plantas terapéuticas utilizadas por profesionales de la salud tradicionales para tratar la neumonía en la provincia de Limpopo, Sudáfrica

Ethnobotanical studies focusing on the documentation of folk therapies employed for pneumonia are almost non-existence in Africa and elsewhere. Data on plants used to treat this ailments was obtained through informed consent semi-structured face-to-face interview and field observations with 128 conveniently selected Bapedi traditional healers (THs) residing in the Limpopo Province, South Africa. A total of 57 plant species distributed across 54 genera and 32 botanical families, mostly the Asteraceae (21.8%) and Fabaceae (18.7%) were used by THs to treat pneumonia and related symptoms. Therapeutic uses of larger number of the documented species are not recorded elsewhere in literature as treatments of these ailments. Overall, the most widely used species by all interviewed THs were Acacia erioloba, Clerodendrum ternatum, Cryptocarya transvaalensis, Enicostema axillare, Lasiosiphon caffer and Stylochaeton natalensis. Ethnopharmacological studies validating the reported therapeutic claims of the species by Bapedi THs should be a subject of future investigation.

Los estudios etnobotánicos que se centran en la documentación de las terapias populares empleadas para la neumonía son casi inexistentes en África y en otros lugares. Los datos sobre plantas utilizadas para tratar estas dolencias se obtuvieron a través de entrevistas personales semiestructuradas con consentimiento informado y observaciones de campo a 128 curanderos tradicionales (TH) convenientemente seleccionados que residen en la provincia de Limpopo, Sudáfrica. Las TH utilizaron un total de 57 especies de plantas distribuidas en 54 géneros y 32 familias botánicas, en su mayoría Asteraceae (21.8%) y Fabaceae (18.7%) para tratar la neumonía y los síntomas relacionados. Los usos terapéuticos de un gran número de las especies documentadas no se registran en ninguna otra parte de la literatura como tratamientos para estas dolencias. En general, las especies más utilizadas por todos los TH entrevistados fueron Acacia erioloba, Clerodendrum ternatum, Cryptocarya transvaalensis, Enicostema axillare, Lasiosiphon caffer y Stylochaeton natalensis. Los estudios etnofarmacológicos que validan las afirmaciones terapéuticas informadas de las especies por parte de Bapedi TH deben ser un tema de investigación futura.

Clinical, epidemiological, and etiological profile of inpatients with community-acquired pneumonia in a public hospital in the interior of Brazil / Perfil clínico, epidemiológico e etiológico de pacientes internados com pneumonia adquirida na comunidade em um hospital público do interior do Brasil

ABSTRACT Objective: To describe the patient profile, mortality rates, the accuracy of prognostic scores, and mortality-associated factors in patients with community-acquired pneumonia (CAP) in a general hospital in Brazil. Methods: This was a cohort study involving patients with a clinical and laboratory diagnosis of CAP and requiring admission to a public hospital in the interior of Brazil between March 2014 and April 2015. We performed multivariate analysis using a Poisson regression model with robust variance to identify factors associated with in-hospital mortality. Results: We included 304 patients. Approximately 70% of the patients were classified as severely ill on the basis of the severity criteria used. The mortality rate was 15.5%, and the ICU admission rate was 29.3%. After multivariate analysis, the factors associated with in-hospital mortality were need for mechanical ventilation (OR: 3.60; 95% CI: 1.85-7.47); a Charlson Comorbidity Index score > 3 (OR: 1.30; 95% CI: 1.18-1.43); and a mental Confusion, Urea, Respiratory rate, Blood pressure, and age > 65 years (CURB-65) score > 2 (OR: 1.46; 95% CI: 1.09-1.98). The mean time from patient arrival at the emergency room to initiation of antibiotic therapy was 10 h. Conclusions: The in-hospital mortality rate of 15.5% and the need for ICU admission in almost one third of the patients reflect the major impact of CAP on patients and the health care system. Individuals with a high burden of comorbidities, a high CURB-65 score, and a need for mechanical ventilation had a worse prognosis. Measures to reduce the time to initiation of antibiotic therapy may result in better outcomes in this group of patients.

RESUMO Objetivo: Descrever o perfil dos pacientes, taxas de mortalidade, acurácia de escores prognósticos e fatores associados à mortalidade em pacientes com pneumonia adquirida na comunidade (PAC) em um hospital geral no Brasil. Métodos: Estudo de coorte envolvendo pacientes com diagnóstico clínico e laboratorial de PAC e necessidade de internação hospitalar entre março de 2014 e abril de 2015 em um hospital público do interior do Brasil. Foi realizada a análise multivariada mediante o modelo de regressão de Poisson com variância robusta para avaliar os fatores associados com mortalidade intra-hospitalar. Resultados: Foram incluídos 304 pacientes. Aproximadamente 70% dos pacientes foram classificados como graves de acordo com os critérios de gravidade utilizados. A taxa de mortalidade foi de 15,5% e a de necessidade de internação em UTI foi de 29,3%. Após a análise multivariada, os fatores associados à mortalidade intra-hospitalar foram necessidade de ventilação mecânica (OR = 3,60; IC95%: 1,85-7,47); Charlson Comorbidity Index > 3 (OR = 1,30; IC95%: 1,18-1,43); e mental Confusion, Urea, Respiratory rate, Blood pressure, and age > 65 years (CURB-65) > 2 (OR = 1,46; IC95%: 1,09-1,98). A média do tempo entre a chegada do paciente na emergência e o início da antibioticoterapia foi de 10 h. Conclusões: A taxa de mortalidade intra-hospitalar de 15,5% e a necessidade de internação em UTI em quase um terço dos pacientes demonstram o grande impacto da PAC nos pacientes e no sistema de saúde. Indivíduos com maior carga de comorbidades prévias, CURB-65 elevado e necessidade de ventilação mecânica apresentaram pior prognóstico. Ações para reduzir o tempo até o início da antibioticoterapia podem resultar em melhores desfechos nesse grupo de pacientes.