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Seminars in Respiratory and Critical Care Medicine

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https://www.readbyqxmd.com/read/27960215/nonantibiotic-adjunctive-therapies-for-community-acquired-pneumonia-corticosteroids-and-beyond-where-are-we-with-them
#1
Oriol Sibila, Ana Rodrigo-Troyano, Antoni Torres
Community-acquired pneumonia (CAP) is a leading cause of hospitalization, morbidity, and mortality. Despite advances in antibiotic treatments, mortality among patients with CAP is still high. For this reason, interest has been focused on nonantibiotic therapeutic measures directed to the host response rather than the microorganism. The development of an efficacious adjunctive treatment has important implications for reducing mortality in CAP. Some clinical studies performed in the last decade have shown a clinically beneficial effect of corticosteroids, possibly by diminishing local and systemic inflammatory host response...
December 2016: Seminars in Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/27960214/principles-of-antibiotic-management-of-community-acquired-pneumonia
#2
Michael T Bender, Michael S Niederman
Community-acquired pneumonia (CAP) encompasses a broad spectrum of disease severity and may require outpatient, inpatient, or intensive care management. Successful treatment hinges on expedient delivery of appropriate antibiotic therapy tailored to both the likely offending pathogens and the severity of disease. This review summarizes key principles in starting treatment and provides recommended empiric therapy regimens for each site of care. In addition, we discuss the antimicrobial and anti-inflammatory role macrolides play in CAP, as well as specific information for managing individual CAP pathogens such as community-acquired methicillin-resistant Staphylococcus aureus and drug-resistant Streptococcus pneumoniae...
December 2016: Seminars in Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/27960213/complication-of-community-acquired-pneumonia-including-cardiac-complications
#3
Marcos I Restrepo, Luis F Reyes, Antonio Anzueto
Community-acquired pneumonia (CAP) represents an important public health problem and carries significant morbidity, mortality, and costs. The incidence of CAP is highest among children and elderly patients, but the mortality is much higher in patients older than 65 years. Despite the advances in medicine, the administration of antimicrobials, and the overall better care, there are still patients with CAP dying due to systemic complications all over the world. A continuum of CAP disease progression may involve multiple organs beyond the pulmonary parenchyma...
December 2016: Seminars in Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/27960212/severity-assessment-and-the-immediate-and-long-term-prognosis-in-community-acquired-pneumonia
#4
Martin Kolditz, Dionne Braeken, Santiago Ewig, Gernot Rohde
Severity assessment is a crucial step in the initial management of patients with community-acquired pneumonia (CAP). While approximately half of patients are at low risk of death and can be safely treated as outpatients, around 20% are at increased risk. While CURB-65 (confusion, respiratory rate, blood pressure, urea) and pneumonia severity index (PSI) scores are equally useful as an adjunct to clinical judgment to identify patients at low risk, the so-called minor American Thoracic Society/Infectious Diseases Society of America criteria are predictive of patients in need of intensified treatment (i...
December 2016: Seminars in Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/27960211/the-modern-diagnostic-approach-to-community-acquired-pneumonia-in-adults
#5
James D Chalmers
Respiratory tract infections, the majority of which are community acquired, are among the leading causes of death worldwide and a leading indication for hospital admission. The burden of disease demonstrates a "U"-shaped distribution, primarily affecting young children as the immune system matures, and older adults as the process of immunosenescence and accumulation of comorbidities leads to increased susceptibility to infection. Diagnosis of community-acquired pneumonia (CAP) is traditionally based on demonstration of a new infiltrate on a chest radiograph in a patient presenting with an acute respiratory illness or sepsis...
December 2016: Seminars in Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/27960210/community-acquired-pneumonia-in-latin-america
#6
Hernán A Iannella, Carlos M Luna
Community-acquired pneumonia (CAP) is associated with significant morbidity and mortality in Latin America and the Caribbean (LAC) region. Poverty, socioeconomic factors, and malnutrition influence the incidence and outcome of CAP in LAC. In LAC, Streptococcus pneumoniae is the most frequent microorganism responsible for CAP, (incidence: 24-78%); the incidence of atypical microorganisms is similar to other regions of the world. Human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) is a growing problem in the LAC region, with the Caribbean being the second most affected area worldwide after Sub-Saharan Africa...
December 2016: Seminars in Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/27960209/community-acquired-pneumonia-in-sub-saharan-africa
#7
Stephen J Aston, Jamie Rylance
Community-acquired pneumonia (CAP) in sub-Saharan Africa is a common cause of adult hospitalization and is associated with significant mortality. Human immunodeficiency virus (HIV) prevalence in the region leads to differences in CAP epidemiology compared with most high-income settings: patients are younger, and coinfection with tuberculosis and opportunistic infections is common and difficult to diagnose. Resource limitations affect the availability of medical expertise as well as radiological and laboratory diagnostic services...
December 2016: Seminars in Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/27960208/community-acquired-pneumonia-in-the-asia-pacific-region
#8
Jae-Hoon Song, Kyungmin Huh, Doo Ryeon Chung
Community-acquired pneumonia (CAP) is an important cause of mortality and morbidity worldwide. Aging population, dense urbanization, and poor access to health care make the Asia-Pacific region vulnerable to CAP. The high incidence of CAP poses a significant health and economic burden in this region. Common etiologic agents in other global regions including Streptococcus pneumoniae, Mycoplasma pneumoniae, Haemophilus influenzae, Chlamydophila pneumoniae, Staphylococcus aureus, and respiratory viruses are also the most prevalent pathogens in the Asia-Pacific region...
December 2016: Seminars in Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/27960207/antibiotic-resistance-in-community-acquired-pneumonia-pathogens
#9
Richard G Wunderink, Yudong Yin
The overwhelming majority of cases of community-acquired pneumonia (CAP) can be treated with the standard antibiotic regimens of a macrolide and cephalosporin or a fluoroquinolone. Despite high rates, current levels of β-lactam resistance generally do not result in treatment failure for patients with CAP when appropriate agents and doses are used. Following the introduction of the pneumococcal conjugate vaccines, the incidence of invasive pneumococcal disease declined drastically, coinciding with a decrease in penicillin resistance...
December 2016: Seminars in Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/27960206/role-of-atypical-pathogens-in-the-etiology-of-community-acquired-pneumonia
#10
Forest W Arnold, James T Summersgill, Julio A Ramirez
Atypical pneumonia has been described for over 100 years, but some of the pathogens attributed to it have been identified only in the past decades. The most common pathogens are Chlamydia pneumoniae, Mycoplasma pneumoniae, and Legionella pneumophila. The epidemiology and pathophysiology of these three pathogens have been studied since their discovery, and are reviewed herein to provide better insight when evaluating these patients, which hopefully translates into improved care. The incidence of atypical pathogens has been shown to be approximately 22% worldwide, but this probably varies with location...
December 2016: Seminars in Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/27960205/the-role-of-streptococcus-pneumoniae-in-community-acquired-pneumonia
#11
Charles Feldman, Ronald Anderson
Streptococcus pneumoniae (the pneumococcus) remains one of the most common causes of bacterial community-acquired pneumonia (CAP), encompassing infections mild enough to be treated on an outpatient basis, as well as those requiring hospital care, or even intensive care unit admission. This microorganism is associated with a significant burden of disease, causing substantial morbidity and mortality worldwide, and generating considerable health-care costs. The reason that pneumococcal CAP remains such a common cause of disease relates to the presence of several risk factors for this infection in patients throughout the world...
December 2016: Seminars in Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/27960204/community-acquired-pneumonia-a-global-perspective
#12
Grant W Waterer
Community-acquired pneumonia (CAP) is a global disease responsible for a large proportion of deaths and having significant economic cost. As diagnostic tools have increased in sensitivity, our understanding of the etiology of CAP has begun to change with a significant increase in confirmed viral infections and the recognition that multiple pathogens are frequently present. Empiric therapy remains the standard of care and guidelines are mostly based on published data from the United States or Europe. Blindly applying guidelines without any consideration of local etiological differences can lead to a risk of under or overtreatment...
December 2016: Seminars in Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/27960203/community-acquired-pneumonia-a-global-perspective
#13
Charles Feldman, James D Chalmers
No abstract text is available yet for this article.
December 2016: Seminars in Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/27732999/small-cell-lung-cancer
#14
Gregory P Kalemkerian
Small cell lung cancer (SCLC) is a high-grade neuroendocrine tumor characterized by rapid growth, early metastatic spread, and initial responsiveness to therapy. Although the incidence of SCLC is declining, it remains one of the common causes of cancer-related mortality. Initial evaluation of patients with SCLC should focus on determining the extent of disease and the ability of the patient to tolerate specific therapy. Positron emission tomography (PET) can improve the accuracy of staging and treatment planning in many patients...
October 2016: Seminars in Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/27732998/immunotherapy-for-lung-cancer-no-longer-an-abstract-concept
#15
Kristen A Marrone, Jarushka Naidoo, Julie R Brahmer
The treatment paradigm for lung cancer has been transformed in recent years by the use of immunotherapy, specifically, immune checkpoint antibodies (mAb), which are agents designed to reinvigorate an immune-mediated anticancer response by releasing the effects of tumor-mediated immunosuppression. Late-phase clinical trials of these agents in patients with advanced lung cancers have translated into improved clinical outcomes compared with standard-of-care chemotherapy for the treatment of metastatic non-small cell lung cancer, and have resulted in FDA approvals for two immune checkpoint mAbs in the second-line setting...
October 2016: Seminars in Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/27732997/predictive-and-prognostic-biomarkers-in-non-small-cell-lung-cancer
#16
Manish K Thakur, Shirish M Gadgeel
Therapy of non-small cell lung cancer (NSCLC) patients has evolved over the past few years with the incorporation of targeted therapy and immune therapy. These changes have increased the importance of prognostic and predictive biomarkers to enable practicing physicians in making the most appropriate treatment decisions for NSCLC patients. A variety of prognostic factors based on clinical and pathologic features determine the overall outcome of the patient and these factors do influence decisions regarding initiation of therapy...
October 2016: Seminars in Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/27732996/palliative-care-in-lung-cancer-a-review
#17
Brett C Bade, Gerard A Silvestri
Lung cancer patients are at high risk of suffering due to severe and refractory symptoms, concomitant respiratory comorbidity, frequent disease progression, and treatment that can worsen and compromise quality of life. Palliative care (PC) has shown multiple benefits to cancer patients such as better quality of life, higher patient and family satisfaction, improved disease understanding, less symptom burden, fewer depressive symptoms, less aggressive end of life care, and even improved survival with early implementation...
October 2016: Seminars in Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/27732995/metastatic-lung-cancer-emerging-therapeutic-strategies
#18
Sana Saif Ur Rehman, Suresh S Ramalingam
Advanced stage nonsmall cell lung cancer had been treated mainly with platinum-based doublet chemotherapy, and other cytotoxic agents that offered significant survival advantage over best supportive care, until recently. Modest improvements were achieved with the addition of antibodies targeting the vascular endothelial growth factor, and the introduction of maintenance chemotherapy. Improvements in our knowledge of lung cancer biology have shifted the current treatment paradigm from being based on histology to one based on molecular biomarkers...
October 2016: Seminars in Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/27732994/stage-iii-non-small-cell-lung-cancer
#19
Valerie W Rusch
More than 20% of non-small cell lung cancers (NSCLCs) are classified as stage III disease at diagnosis because they are locoregionally advanced tumors. Local therapy alone (surgery or radiation) leads to poor overall survival in stage III NSCLC because most of the patients with NSCLC die of distant metastases. Therefore, during the past 20 years, studies have focused on developing effective chemotherapy regimens that can be combined with local therapies (surgery and/or radiation). The role of surgery has been extensively evaluated and the selection criteria for resection defined...
October 2016: Seminars in Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/27732993/radiation-therapy-for-stage-i-nonoperable-or-medically-inoperable-lung-cancer
#20
Amar U Kishan, Percy Lee
Non-small cell lung cancer (NSCLC) is the second most common solid malignancy in the United States of America, and the leading cause of cancer-related mortality. Nearly 15% of patients present with early-stage disease, for which the standard of care is lobectomy. However, the median age at diagnosis ranges from 65 to 74 years, and many patients have significant comorbidities that preclude surgical treatment. Previously, the standard of care for these patients was definitive radiotherapy (RT) with conventional fractionation (i...
October 2016: Seminars in Respiratory and Critical Care Medicine
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