Factors associated with hospital mortality in critically ill patients with exacerbation of COPD.

Introduction: COPD is a leading cause of morbidity and mortality worldwide. Patients with COPD often require admission to intensive care units (ICU) during an acute exacerbation. Objective: This study aimed to identify the factors independently associated with hospital mortality in patients requiring ICU admission for acute exacerbation of COPD. Methods: Patients admitted to the ICU of Frankston Hospital between January 2005 and June 2016 with an admission diagnosis of COPD were retrospectively identified from ICU databases. Patients' comorbidities, arterial blood gas results, and in-patient interventions were retrieved from their medical records. Outcomes analyzed included hospital and ICU length of stay (LOS) and mortality. Results: A total of 305 patients were included. Mean age was 67.4 years. A total of 77% of patients required non-invasive ventilation; and 38.7% required invasive mechanical ventilation (IMV) for a median of 127.2 hours (SD =179.5). Mean ICU LOS was 4.5 days (SD =5.96), and hospital LOS was 11.6 days (SD =13). In-hospital mortality was 18.7%. Multivariate analysis revealed that patient age (odds ratio [OR] =1.06; 95% CI: 1.031-1.096), ICU LOS (OR =1.26; 95% CI: 1.017-1.571), Acute Physiology and Chronic Health Evaluation-II score (OR =1.07; 95% CI: 1.012-1.123), and requirement for IMV (OR =4.09; 95% CI: 1.791-9.324) to be significantly associated with in-hospital mortality. Conclusion: Patient age, requirement for IMV, and illness severity were associated with poor patient outcomes.

Primary lymphoma of the breast: a clinicopathological study.

3 cases of primary non Hodgkins lymphoma of the breast are described, seen over a period of 2 years among 199 cases of breast malignancies. All were diffuse large B cell type. Application of immunohistochemistry greatly aids in differentiating lymphoma from anaplastic carcinoma, with which it can easily be confused. Preoperative diagnosis on a trucut biopsy is an ideal diagnostic method since diagnosis on fine needle aspiration cytology or frozen section may not be possible. Primary breast lymphoma is a rare disease with reported incidence of 0.04-0.53% of all breast malignancies in most series. Accurate diagnosis is essential, so that appropriate treatment may be applied. Two cases were treated with CHOP chemotherapy and radiotherapy along with surgical excision. One case was treated with CHOP chemotherapy.

Memory responses in human immunodeficiency virus type 1-infected individuals with long-term viral load suppression are independent of CD4 cell nadir.

The persistence of memory responses in suppressive highly active antiretroviral therapy (HAART) has been an area of controversy. By using a previously described proliferation assay that augments specific responses, peripheral blood lymphocytes (PBL) from 61 human immunodeficiency virus type 1-seropositive individuals with CD4 counts of >300/mm3 and suppressed viral burdens were studied for response to p24 antigen as a function of time of viral load suppression on HAART. In the majority of cases, proliferative responses could be measured in PBL from patients with plasma viral load suppression. No differences could be found in proliferative responses from PBL between individuals with a low and those with a high CD4 cell nadir. PBL that did not respond to either Casta antigen or p24 were found to have a higher percentage of naive cells than did PBL that responded well to antigen. These data support the contention that, after long-term viral load suppression, PBL from infected individuals have memory cell populations that can respond to antigenic stimulation under inducible conditions.