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Pneumonia and steroides

Glenwood Goss, Chun-Ming Tsai, Frances A Shepherd, Lyudmila Bazhenova, Jong Seok Lee, Gee-Chen Chang, Lucio Crino, Miyako Satouchi, Quincy Chu, Toyoaki Hida, Ji-Youn Han, Oscar Juan, Frank Dunphy, Makoto Nishio, Jin-Hyoung Kang, Margarita Majem, Helen Mann, Mireille Cantarini, Serban Ghiorghiu, Tetsuya Mitsudomi
BACKGROUND: Osimertinib (AZD9291) is an oral, potent, irreversible EGFR tyrosine-kinase inhibitor selective for EGFR tyrosine-kinase inhibitor sensitising mutations, and the EGFR Thr790Met resistance mutation. We assessed the efficacy and safety of osimertinib in patients with EGFR Thr790Met-positive non-small-cell lung cancer (NSCLC), who had progressed after previous therapy with an approved EGFR tyrosine-kinase inhibitor. METHODS: In this phase 2, open-label, single-arm study (AURA2), patients aged at least 18 years with centrally confirmed EGFR Thr790Met-positive mutations, locally advanced or metastatic (stage IIIB/IV) NSCLC who progressed on previous EGFR tyrosine-kinase inhibitor therapy received osimertinib 80 mg orally once daily; treatment could continue beyond progression if the investigator observed a clinical benefit...
October 14, 2016: Lancet Oncology
Mayuresh Chaudhari, Sonu Sharma, Rajesh Kumar Jha, Ramandeep Singh Ahuja, Sandeep Bansal
Primary varicella infection in an immunocompetent young adult is very rare, but it has a high mortality rate due to serious complications. We report a rare association of varicella pneumonia presenting in acute respiratory distress with mild chest pain, however with electrocardiographic and biochemical markers suggestive of acute ST elevation myocardial infarction. Coronary angiography was done to exclude infarction, serum antibody titers confirmed varicella, acyclovir was started, and ARDS was successfully treated with steroid pulse therapy and mechanical ventilator support...
September 2016: Indian Heart Journal
Birsen Doğu, Nurhan Atilla, Gözde Yıldırım Çetin, Nezir Yılmaz, Hafize Öksüz
Drug-induced pulmonary disease is an important consideration in the differential diagnosis of patients with rheumatoid arthritis (RA) who present with respiratory symptoms. We report a patient with RA who developed acute respiratory failure two weeks after the administration of abatacept. The clinical findings were consistent with drug-induced acute respiratory failure, most likely acute eosinophilic pneumonia. Pulse steroid was administered at 1000 mg/kg/day in the emergency department. Chest X-ray and arterial blood gas values revealed significant improvement on the second day of hospitalization...
September 2016: Eur J Rheumatol
Elisabetta Fenocchio, Ilaria Depetris, Delia Campanella, Lucia Garetto, Fabrizio Carnevale Schianca, Danilo Galizia, Giovanni Grignani, Massimo Aglietta, Francesco Leone
BACKGROUND: Gemcitabine is currently the standard chemotherapy for the adjuvant treatment of pancreatic cancer. This chemotherapeutic agent is generally well-tolerated, myelosuppression and gastrointestinal toxicity being common side effects. Nevertheless, gemcitabine-induced pulmonary toxicity has been rarely reported. Despite its low incidence, the spectrum of pulmonary injury is wide, including potentially fatal conditions. We report a case of acute interstitial pneumonia related to gemcitabine, completely solved with Imatinib Mesylate (IM)...
October 12, 2016: BMC Cancer
Maria L Calero-Bernal, Isabel Martin-Garrido, Mikel Donazar-Ezcurra, Andrew H Limper, Eva M Carmona
Introduction. Pneumocystis pneumonia (PCP) is rising in the non-HIV population and associates with higher morbidity and mortality. The aggressive immunosuppressive regimens, as well as the lack of stablished guidelines for chemoprophylaxis, are likely contributors to this increased incidence. Herein, we have explored the underlying conditions, immunosuppressive therapies, and clinical outcomes of PCP in HIV-negative patients. Methods. Retrospective analysis of PCP in HIV-negative patients at Mayo Clinic from 2006-2010...
2016: Canadian Respiratory Journal: Journal of the Canadian Thoracic Society
Edward Sames, Heather Paterson, Charles Li
Agranulocytosis is a rare and little-known side effect of hydroxychloroquine use. This report describes the case of a 71-year-old woman with poorly controlled rheumatoid arthritis who developed agranulocytosis after several months of hydroxychloroquine therapy. She had been on several different disease-modifying antirheumatic drugs, including methotrexate and leflunomide, for her rheumatoid arthritis. Treatment became complicated following a diagnosis of leflunomide-induced pulmonary fibrosis that was discovered after an intensive care unit (ICU) admission for severe Pseudomonas pneumonia...
June 2016: Eur J Rheumatol
Roberto W Dal Negro, Massimiliano Mazzolini, Paola Turco, Alessandro Zanasi
BACKGROUND: Cough is one of the most common discomforts affecting general population, which can disrupt subjects' quality of life due to its physical, social, and psychological effects. Aim of the study was to investigate the impact of cough and related beliefs of general population. METHODS: A cross-sectional telephone survey was carried out by means of a specific, validated questionnaire on a representative sample of Italian general population. All the interviews were carried out according to the Computer Assisted Telephone Interview (CATI) methodology by expert, professional interviewers...
2016: Multidisciplinary Respiratory Medicine
Hana Čipčić Paljetak, Linda Tomašković, Mario Matijašić, Mirjana Bukvić, Andrea Fajdetić, Donatella Verbanac, Mihaela Perića
5-LOX - 5-lipoxygenase; ACT - artemisinin-based combination therapies; ADME - absorption, distribution, metabolism and excretion; BAL - broncho alveolar lavage; CABP - community acquired bacterial pneumonia; cAMP - cyclic adenosine monophosphate; CAP - community-acquired pneumonia; CF - cystic fibrosis, BOS bronchiolitis obliterans syndrome; cGMP - cyclic guanosine monophosphate; COPD - chronic obstructive pulmonary disease; COX - cyclooxygenase; DPB - diffuse panbronchiolitis; HDACs - histone deacetylases; IBD - inflammatory bowel disease; IL-1p - interleukin 1p; IL-6 - interleukin 6; MIC - minimal inhibitory concentrations; MLSB - macrolide, lincosamide, streptogramin B; NSAIDs - non-steroidal anti-inflammatory drugs; OVA - ovalbumin; PDE4 - phosphodiesterase 4; PMA - phorbol 12-myristate 13-acetate; RA - rheumatoid arthritis; RTI - respiratory tract infections; SAHA - suberoylanilide hydroxamic acid; SAR - structure-activity-relationship; Th1 - type 1 helper T-cell; TNBS - trinitrobenzene sulfonic acid; TNF-α - tumour necrosis factor α; UN - United Nations, WHO - World Health Organisation...
September 27, 2016: Current Topics in Medicinal Chemistry
N Wah Cheung
Steroid-induced hyperglycaemia is a common problem faced by endocrinologists in hospital wards. In this issue of Diabetologia, Popovic and colleagues (DOI 10.1007/s00125-016-4091-4 ) have conducted a subanalysis within a randomised controlled trial of prednisone therapy for community-acquired pneumonia. The authors found that the presence of diabetes or hyperglycaemia related to steroid therapy did not attenuate the clinical benefits of steroid therapy. The relevance and possible implications of these findings are discussed...
September 27, 2016: Diabetologia
Junghyun Kim, Jung-Kyu Lee, Eun Young Heo, Hee Soon Chung, Deog Kyeom Kim
BACKGROUND: The hallmark of COPD is chronic airway inflammation, which may be mediated by renin-angiotensin system. The renin-angiotensin system blockers such as angiotensin-converting enzyme inhibitors (ACEi) and angiotensin II receptor blockers (ARBs) have exhibited anti-inflammatory and immunomodulatory effects in patients with various diseases. We explored the effects of ACEi and ARBs on the risk of pneumonia in patients with COPD. METHODS: A nested case-control study was performed on COPD patients recruited from January 2010 to August 2013 in two referral hospitals in Korea...
2016: International Journal of Chronic Obstructive Pulmonary Disease
Aziz İnan Çelik, Ali Deniz, Mustafa Tangalay, Muhammet Buğra Karaaslan, Emine Bağır Kılıç
Eosinophilic myocarditis (EM) is a rare form of myocarditis that usually presents with heart failure due to eosinophilic infiltration. EM is often a component of hypereosinophilic syndrome (HES). HES is a rare disorder characterized by persistent, marked eosinophilia combined with organ system dysfunction. A 38-year-old man was admitted to emergency services with left inguinal pain and fever, and was hospitalized with diagnosis of nephrolithiasis and urinary tract infection. Intravenous antibiotic therapy of 3 grams meropenem per day and analgesic of 50 mg pethidine per day were administered...
September 2016: Türk Kardiyoloji Derneği Arşivi: Türk Kardiyoloji Derneğinin Yayın Organıdır
Capan Konca, Mehmet Tekin, Mehmet Turgut
BACKGROUND: Some studies in the literature support the use of either inhaled or systemic steroids for the treatment of chemical pneumonitis; however, no data have been published on the combined use of inhaled and intravenous (IV) steroids. OBJECTIVES: This brief report describes the effective use of inhaled plus systemic steroids in managing six critical pediatric patients. PATIENTS AND METHODS: Medical records of patients were analyzed retrospectively...
July 2016: Iranian Red Crescent Medical Journal
Ninna Brix, Finn Rasmussen, Venerino Poletti, Elisabeth Bendstrup
Bronchoalveolar lavage fluid (BALF) in patients with idiopathic pulmonary fibrosis (IPF) is typically characterized by a neutrophil inflammatory pattern and to a lesser extent (<25%) a mild eosinophil alveolitis. We here present two patients with a definite usual interstitial pneumonia (UIP) pattern on high-resolution computed tomography of the thorax (HRCT) which demonstrated unusually high eosinophil counts in the BALF (40% and 51%). Based on HRCT, lack of response to steroids and the disease course they were both diagnosed as IPF after a multidisciplinary team discussion...
2016: Respiratory Medicine Case Reports
I García-Cadenas, I Rivera, R Martino, A Esquirol, P Barba, S Novelli, G Orti, J Briones, S Brunet, D Valcarcel, J Sierra
This study aimed to characterize the incidence, etiology and outcome of infectious episodes in patients with steroid refractory acute GvHD (SR-GvHD). The cohort included 127 adults treated with inolimomab (77%) or etanercept (23%) owing to acute 2-4 SR-GvHD, with a response rate of 43% on day +30 and a 4-year survival of 15%. The 1-year cumulative incidences of bacterial, CMV and invasive fungal infection were 74%, 65% and 14%, respectively. A high rate (37%) of enterococcal infections was observed. Twenty patients (15...
September 5, 2016: Bone Marrow Transplantation
Takashi Ishiguro, Noboru Takayanagi, Ryuji Uozumi, Mami Tada, Naho Kagiyama, Yotaro Takaku, Yoshihiko Shimizu, Yutaka Sugita, Satoshi Morita
Objective The long-term clinical course and prognosis of patients with chronic eosinophilic pneumonia (CEP) including factors predictive of the relapse of CEP have not been fully investigated. The aim of the present study was to investigate these issues. Methods We retrospectively investigated the rate of relapse and prognosis in 73 patients diagnosed as having CEP. Results Systemic corticosteroid therapy was administered at a prednisolone dose of 29.4±7.6 mg/day. During a median follow-up period of 1,939 days, 27 patients suffered from relapse of CEP...
2016: Internal Medicine
Akashdeep Singh, Deepinder Chhina, R K Soni, Chandan Kakkar, U S Sidhu
BACKGROUND: Pulmonary nocardiosis is a rare but a life-threatening infection caused by Nocardia spp. The diagnosis is often missed and delayed resulting in delay in appropriate treatment and thus higher mortality. AIM: In this study, we aim to evaluate the clinical spectrum and outcome of patients with pulmonary nocardiosis. METHODS: A retrospective, 5-year (2009-2014) review of demographic profile, risk factors, clinical manifestations, imaging findings, treatment, and outcome of patients with pulmonary nocardiosis admitted to a tertiary care hospital...
July 2016: Lung India: Official Organ of Indian Chest Society
V Gounant, S Brosseau, C Naltet, M-A Opsomer, M Antoine, C Danel, A Khalil, J Cadranel, G Zalcman
Immune checkpoint inhibitors are known to induce 'immune pneumonitis' in 3-6% of patients treated for lung cancer. However, their dramatic efficacy in as much as 20% of patients led to recent registrations in squamous, and then non-squamous lung carcinoma, in second line setting after failure of first-line chemotherapy, while large phase 3 trials are on-going, to assess first-line immunotherapy, either alone or in combination with chemotherapy. Pulmonary Sarcomatoid carcinomas consist of a rare subset of highly aggressive and poorly differentiated non-small-cell lung carcinomas (NSCLC), with poor prognosis and chemo-resistance...
September 2016: Lung Cancer: Journal of the International Association for the Study of Lung Cancer
Vikas R Dharnidharka, Mark A Schnitzler, Jiajing Chen, Daniel C Brennan, David Axelrod, Dorry L Segev, Kenneth B Schechtman, Jie Zheng, Krista L Lentine
We examined integrated national transplant registry, pharmacy fill and medical claims data for Medicare-insured kidney transplant recipients in 2000-2011 (n=45,164) from the United States Renal Data System to assess efficacy and safety endpoints associated with 7 early (first 90 days) immunosuppression (ISx) regimens. Risks of clinical complications over 3 years according to IS regimens were assessed with multivariate regression, including adjustment for covariates and propensity for receipt of a non-reference ISx regimen...
August 26, 2016: Transplant International: Official Journal of the European Society for Organ Transplantation
Kosei Nagata, Shinichi Yamamoto, Kota Miyoshi, Masaki Sato, Yusuke Arino, Yoji Mikami
Eosinophilic granulomatosis with polyangiitis (EGPA, Churg-Strauss syndrome) is a rare systemic vasculitis and is difficult to diagnose. EGPA has a number of symptoms including peripheral dysesthesia caused by mononeuropathy multiplex, which is similar to radiculopathy due to lumbar disc hernia or lumbar spinal stenosis. Therefore, EGPA patients with mononeuropathy multiplex often visit orthopedic clinics, but orthopedic doctors and spine neurosurgeons have limited experience in diagnosing EGPA because of its rarity...
August 2016: Acta Medica Okayama
A Pituch-Noworolska, H Mach-Tomalska, A Szaflarska, D Adamek
X-linked agammaglobulinemia (XLA) diagnosed in the first year of life is an immunodeficiency with a life-long indication for substitution of immunoglobulins, due to lack of B lymphocytes in the periphery. The decrease of bacterial infection frequency and severity is an effect of immunoglobulin replacement. However, in the majority of patients bronchiectasis and chronic sinusitis with an overgrown mucous membrane develop despite regular substitution. Autoimmune diseases as co-existing diseases in XLA are noted in a few patients presenting symptoms associated with arthritis, scleroderma and myositis...
June 2016: Polish Journal of Pathology: Official Journal of the Polish Society of Pathologists
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