The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
Diagnostic Approaches to Chronic Fungal and Tuberculous Meningitisinventionjournals
International Journal of Pharmaceutical Science Invention (IJPSI) is an international journal intended for professionals and researchers in all fields of Pahrmaceutical Science. IJPSI publishes research articles and reviews within the whole field Pharmacy and Pharmaceutical Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online.
The document summarizes the findings of a pathology presentation on COVID-19 pulmonary pathology. It describes the histopathological examination of lung tissue from 38 COVID-19 patient deaths in Italy which found evidence of diffuse alveolar damage, hyaline membrane formation, thrombi in small arteries, and type II pneumocyte hyperplasia. It also discusses the similarities to findings from SARS, MERS, and influenza, including epithelial infection, microvascular damage, and organizing pneumonia that can progress to pulmonary fibrosis.
Austin Tuberculosis: Research & Treatment is an open access, peer reviewed, scholarly journal dedicated to publish articles covering all areas of Tuberculosis.
The journal aims to promote research communications and provide a forum for doctors, researchers, physicians and healthcare professionals to find most recent advances in all areas of Tuberculosis. Austin Tuberculosis: Research & Treatment accepts original research articles, reviews, mini reviews, case reports and rapid communication covering all aspects of Tuberculosis.
Austin Tuberculosis: Research & Treatment strongly supports the scientific up gradation and fortification in related scientific research community by enhancing access to peer reviewed scientific literary works. Austin Publishing Group brings universally peer reviewed journals under one roof thereby promoting knowledge sharing, mutual promotion of multidisciplinary science.
mycelial forms of coccidiodes spp. in parasitic phaseIPN
1) The study examined 44 patients with pulmonary coccidioidomycosis in Mexico between 1991-2005 to analyze the association between mycelial parasitic forms of Coccidioides spp. and risk factors like diabetes.
2) Patients with type 2 diabetes were 4 times more likely than non-diabetics to develop mycelial parasitic forms. Mycelial forms took longer than 8 months to develop and were associated with cough, hemoptysis, cavitary lesions on x-ray, and type 2 diabetes.
3) Based on the results, the study proposes incorporating mycelial forms into the parasitic phase definition for Coccidioides spp. in patients with type 2
Pneumonia is a common respiratory infection that affects the lungs. It is broadly divided into community-acquired pneumonia (CAP) or hospital-acquired pneumonia (HAP). The causative microorganisms differ between CAP and HAP depending on whether the pneumonia was acquired in the community or healthcare setting. Mortality from pneumonia is highest in young children and older adults, and is influenced by treatment setting, age, comorbidities, and the specific type of pneumonia such as CAP or HAP.
This document provides an overview of coronaviruses including their viral composition, epidemiology, transmission routes, clinical manifestations, and impact on respiratory and enteric systems. Key points include that coronaviruses are common causes of respiratory illness, especially in winter, and have also been linked to gastrointestinal symptoms in some cases. While they account for a percentage of respiratory infections, evidence also links coronaviruses to conditions like croup, asthma attacks, pneumonia, and some cases of diarrhea.
Clinical Research Centre (CRC) Hospital Kuala Lumpur (HKL) just released their new e-newsletter. This edition focused on COVID-19 experiences by health care providers.
This document discusses mucormycosis, a rare fungal infection caused by exposure to mold found in soil and decaying organic matter. It can be serious for immunocompromised individuals. The document covers what mucormycosis is, how it spreads, associated risk factors like prolonged steroid use in COVID-19 patients, symptoms, challenges in diagnosis, and the need for rapid diagnosis and multi-disciplinary management to improve outcomes. Microscopic examination of tissue samples and culture growth are important for diagnosis but expertise is required. Molecular identification methods can also identify the specific fungal genus and species involved.
Diagnostic Approaches to Chronic Fungal and Tuberculous Meningitisinventionjournals
International Journal of Pharmaceutical Science Invention (IJPSI) is an international journal intended for professionals and researchers in all fields of Pahrmaceutical Science. IJPSI publishes research articles and reviews within the whole field Pharmacy and Pharmaceutical Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online.
The document summarizes the findings of a pathology presentation on COVID-19 pulmonary pathology. It describes the histopathological examination of lung tissue from 38 COVID-19 patient deaths in Italy which found evidence of diffuse alveolar damage, hyaline membrane formation, thrombi in small arteries, and type II pneumocyte hyperplasia. It also discusses the similarities to findings from SARS, MERS, and influenza, including epithelial infection, microvascular damage, and organizing pneumonia that can progress to pulmonary fibrosis.
Austin Tuberculosis: Research & Treatment is an open access, peer reviewed, scholarly journal dedicated to publish articles covering all areas of Tuberculosis.
The journal aims to promote research communications and provide a forum for doctors, researchers, physicians and healthcare professionals to find most recent advances in all areas of Tuberculosis. Austin Tuberculosis: Research & Treatment accepts original research articles, reviews, mini reviews, case reports and rapid communication covering all aspects of Tuberculosis.
Austin Tuberculosis: Research & Treatment strongly supports the scientific up gradation and fortification in related scientific research community by enhancing access to peer reviewed scientific literary works. Austin Publishing Group brings universally peer reviewed journals under one roof thereby promoting knowledge sharing, mutual promotion of multidisciplinary science.
mycelial forms of coccidiodes spp. in parasitic phaseIPN
1) The study examined 44 patients with pulmonary coccidioidomycosis in Mexico between 1991-2005 to analyze the association between mycelial parasitic forms of Coccidioides spp. and risk factors like diabetes.
2) Patients with type 2 diabetes were 4 times more likely than non-diabetics to develop mycelial parasitic forms. Mycelial forms took longer than 8 months to develop and were associated with cough, hemoptysis, cavitary lesions on x-ray, and type 2 diabetes.
3) Based on the results, the study proposes incorporating mycelial forms into the parasitic phase definition for Coccidioides spp. in patients with type 2
Pneumonia is a common respiratory infection that affects the lungs. It is broadly divided into community-acquired pneumonia (CAP) or hospital-acquired pneumonia (HAP). The causative microorganisms differ between CAP and HAP depending on whether the pneumonia was acquired in the community or healthcare setting. Mortality from pneumonia is highest in young children and older adults, and is influenced by treatment setting, age, comorbidities, and the specific type of pneumonia such as CAP or HAP.
This document provides an overview of coronaviruses including their viral composition, epidemiology, transmission routes, clinical manifestations, and impact on respiratory and enteric systems. Key points include that coronaviruses are common causes of respiratory illness, especially in winter, and have also been linked to gastrointestinal symptoms in some cases. While they account for a percentage of respiratory infections, evidence also links coronaviruses to conditions like croup, asthma attacks, pneumonia, and some cases of diarrhea.
Clinical Research Centre (CRC) Hospital Kuala Lumpur (HKL) just released their new e-newsletter. This edition focused on COVID-19 experiences by health care providers.
This document discusses mucormycosis, a rare fungal infection caused by exposure to mold found in soil and decaying organic matter. It can be serious for immunocompromised individuals. The document covers what mucormycosis is, how it spreads, associated risk factors like prolonged steroid use in COVID-19 patients, symptoms, challenges in diagnosis, and the need for rapid diagnosis and multi-disciplinary management to improve outcomes. Microscopic examination of tissue samples and culture growth are important for diagnosis but expertise is required. Molecular identification methods can also identify the specific fungal genus and species involved.
Clinical Case Management of Outbreaks of Influenza-Like Ashraf ElAdawy
1. The document provides guidelines for the clinical case management of outbreaks of influenza-like illness (ILI), including definitions, assessment, and treatment recommendations.
2. It defines ILI and outlines criteria for classifying patients into mild, mild but high-risk, or severe ILI. Patients are assessed for symptoms, risk factors, and disease progression over 72 hours.
3. Treatment recommendations include symptomatic care for mild ILI, antivirals for mild ILI in high-risk groups, and antivirals in a hospital for severe ILI. Laboratory testing and hospital admission are based on illness severity and risk status.
A review of literature covering current knowledge areas about pathophysiology and progression of CoVid-19 in humans. I gave a day to day disease account along with serum markers and clinical condition of patients. My objectives are: Appreciate the background knowledge about CoVid-19 in most recent literature.
Explain the progression of CoVid-19 disease in a human body based on current literature.
Correlate the known risk factors for adverse outcomes with pathogenesis of CoVid-19.
Describe the pharmacologic mechanisms being used to halt disease progression and prevent adverse outcomes.
Clinical case Management Of Severe Acute Respiratory Infection SARIAshraf ElAdawy
This document provides guidance on clinical case management of severe acute respiratory infection (SARI). It defines SARI and outlines the typical clinical presentation. It discusses the principal etiological agents that can cause SARI, including various viruses and bacteria. The document provides guidance on initial patient assessment, diagnostic testing, exposure history, treatment including antivirals and antibiotics, supportive care, oxygen therapy and mechanical ventilation. The goal is to aid clinicians in managing SARI patients and detecting novel respiratory pathogens.
This document summarizes key information about pediatric pneumonia. It discusses the definition, pathophysiology, epidemiology, etiology, and specific considerations of Streptococcus pneumoniae, the most common cause of bacterial pneumonia in young children. Pneumonia is diagnosed in approximately 4% of children per year in the US based on clinical signs or radiographic findings. The causes vary by age, with viruses most common under 2 and bacteria like S. pneumoniae predominant in younger children. Diagnosis of the exact cause is difficult. Antibiotic resistance of S. pneumoniae has increased significantly in recent decades.
Coronaviruses are a large family of viruses that are known to cause illness ranging from the common cold to more severe diseases such as Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS).
A novel coronavirus (COVID-19) was identified in 2019 in Wuhan, China. This is a new coronavirus that has not been previously identified in humans.
Coronaviruses & COVID 19 - Its Morphology, Role, Mechanism of Action, and Tre...Haider Ali Malik
This document discusses COVID-19 and coronaviruses. It defines COVID-19 as a novel coronavirus first identified in Wuhan, China in late 2019. Coronaviruses are a large family of viruses that can cause illnesses ranging from the common cold to more severe diseases like MERS and SARS. The document then provides details on the structure, replication, and transmission of coronaviruses, symptoms of COVID-19, the ongoing global pandemic, and the discovery and identification of SARS-CoV-2 under electron microscopy.
The document discusses the H1N1 influenza virus, including its epidemiology, clinical manifestations, diagnostic tests, treatment, and a study of H1N1 patients in Jordan. It finds that H1N1 posed a risk to young people and those with lung or pregnancy-related conditions. A study of 32 H1N1 patients in Jordan found most common symptoms were fever, cough and sore throat, and average hospitalization was 2.9 days with full recovery in 30 patients and death in 2 patients.
Pulmonary Tuberculosis in Coronavirus Disease-19 Patients: Report of Casesasclepiuspdfs
The coronavirus disease 2019 (COVID-19) is known to cause severe respiratory illness manifesting in a spectrum of related disorders. Amidst the continuous evolution of this pandemic which has caused vast devastation globally, it is crucial to note that tuberculosis (TB), which also causes respiratory diseases, has and still affects over a quarter of the world’s population. Coinfection of both diseases have severe health implications. Therefore, it is vital to understand the effects of this novel virus on the immune system and coinfection with a bacterial infection, like TB. Based on peer-reviewed cases, there seems to be an associational relationship between COVID-19 and TB; research suggests both weaken the immune system and further complicate clinical outcomes, which was further explored in this paper.
This document provides information about coronaviruses, including the Wuhan coronavirus that emerged in 2019. It defines coronaviruses as enveloped RNA viruses that commonly infect mammals and birds, causing respiratory or intestinal illness. It describes the taxonomy and structure of coronaviruses, as well as their replication process and pathogenesis. The document also discusses previous coronavirus outbreaks, such as SARS and MERS, and examines scenarios for the Wuhan outbreak, investigating its potential origin from bats or snakes.
Infection Control In Health Care SettingsSagar Desai
The goal of this report was to assess the current and potential future role of diagnostics in hospital-acquired infection (HAI) control programs. We examined current issues resulting from HAIs and determined which infections needed foremost attention. Then, with input from Prof. Neimz, we selected diagnostics available on the market we could use. The final chapter of the review contains a market analysis with info about costs prevented upon implementation of diagnostic recommendations.
This document provides information about the 2019 Novel Coronavirus (2019-nCoV) outbreak that originated in Wuhan, China in December 2019. It discusses that coronaviruses can be transmitted from animals to humans and between humans. The 2019-nCoV was identified as the cause of the outbreak with many early cases linked to a seafood market, but human-to-human transmission has since been observed. It describes the clinical presentation, diagnosis, treatment and prevention measures for 2019-nCoV infection.
This document summarizes the pathogenesis and morphological features of SARS-CoV-2 in various organs. It begins with an introduction and timeline of the virus. It then discusses the mode of transmission and laboratory handling guidelines. The pathogenesis involves the virus binding to ACE2 receptors in lungs and other organs. This causes cytokine release syndrome and acute respiratory distress syndrome seen in lungs. Effects in other organs like heart, gastrointestinal tract, and kidney are also discussed based on autopsy findings like thrombi, inflammation and necrosis. Long term sequelae could include altered lipid metabolism and cardiovascular complications.
Kuwait influenza case management guidelines for 2nd flu workshop 2016Ashraf ElAdawy
This document provides guidance on clinical case management of influenza patients presenting with influenza-like illness (ILI) or severe acute respiratory illness (SARI). It outlines case definitions and describes potential case scenarios ranging from mild uncomplicated ILI to severe or complicated ILI. For mild cases, it recommends symptomatic care and antivirals for high-risk groups. Severe or complicated cases should be hospitalized, treated with antivirals, and may require intensive care. Clinical signs for hospitalization include respiratory distress, hypoxia, hypotension, or altered mental status.
A cardiologists perspective to current scenario in light of corona pandemic in india and world wide. cardiac procedures , heart disease , aceinhibitors , arni , heart failure , troponin, nt probnp
Middle East Respiratory Syndrome: MERS- CoVGaurav Kamboj
This document provides an overview of Middle East Respiratory Syndrome (MERS) including: the causative coronavirus; epidemiology and current status of MERS cases globally and in South Korea; the dromedary camel as the suspected animal reservoir; modes of transmission between camels and humans and between humans; clinical presentation and course of illness; laboratory diagnosis; treatment and prevention recommendations; and traveler guidelines. MERS is a viral respiratory illness first reported in 2012 with a case fatality rate of 36% that has caused several outbreaks, primarily in the Middle East.
- Middle East Respiratory Syndrome (MERS) is a novel coronavirus that was first detected in 2012. It causes severe respiratory illness, with a mortality rate of 35-50%.
- The virus likely originated in bats and may be transmitted via an animal or environmental reservoir. Person-to-person transmission has occurred, especially in healthcare settings.
- At risk groups include older adults and those with underlying medical conditions. Symptoms include fever, cough, shortness of breath. Diagnosis is made via PCR testing of respiratory samples. There is no vaccine and treatment is supportive.
The document discusses the aetiology, pathogenesis, and clinical presentation of COVID-19. It begins by explaining that COVID-19 is caused by SARS-CoV-2, a coronavirus first identified in China in late 2019. SARS-CoV-2 attaches to cells via the ACE2 receptor and causes respiratory illness. It can be transmitted from person to person through respiratory droplets. The document then details the virus structure, modes of transmission, risk factors for severe disease, and the multi-step process of how the virus infects cells and causes illness, including acute respiratory distress syndrome.
, on 7 January, Chinese authorities confirmed that they had identified a new virus. The new virus is a coronavirus, which is a family of viruses that include the common cold, and viruses such as SARS and MERS.
This new virus was temporarily named “2019-nCoV
This document discusses the potential role of HIV-1 nef protein in the pathogenesis of HIV-associated pulmonary hypertension (HIV-PH). It summarizes that HIV-PH has a poor prognosis and identifying it earlier would benefit patients. The HIV-1 nef protein may affect infected and uninfected pulmonary vascular cells and studies in macaques suggest nef is important in HIV-PH development. The research endeavor focuses on identifying nef mutations in HIV-infected individuals with PH compared to those without to help establish a connection between nef mutations and risk for HIV-PH.
This document discusses lung abscess, including its diagnosis, treatment, and association with mortality. Key points include:
- Lung abscess is caused by bacterial infection leading to pulmonary tissue necrosis and cavity formation. Common causes include aspiration of oral/gastric contents.
- Diagnosis is typically made using chest x-rays or CT scans to identify lung cavities. Cultures can identify pathogens like anaerobes, S. aureus, and K. pneumoniae.
- Treatment involves antibiotics like penicillins, carbapenems, or quinolones that are effective against common causative bacteria. Outcomes remain poor for patients with large or right lower lobe abscesses.
Health care-associated pneumonia: Pathogenesis Diagnosis and Preventionsiosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
Clinical Case Management of Outbreaks of Influenza-Like Ashraf ElAdawy
1. The document provides guidelines for the clinical case management of outbreaks of influenza-like illness (ILI), including definitions, assessment, and treatment recommendations.
2. It defines ILI and outlines criteria for classifying patients into mild, mild but high-risk, or severe ILI. Patients are assessed for symptoms, risk factors, and disease progression over 72 hours.
3. Treatment recommendations include symptomatic care for mild ILI, antivirals for mild ILI in high-risk groups, and antivirals in a hospital for severe ILI. Laboratory testing and hospital admission are based on illness severity and risk status.
A review of literature covering current knowledge areas about pathophysiology and progression of CoVid-19 in humans. I gave a day to day disease account along with serum markers and clinical condition of patients. My objectives are: Appreciate the background knowledge about CoVid-19 in most recent literature.
Explain the progression of CoVid-19 disease in a human body based on current literature.
Correlate the known risk factors for adverse outcomes with pathogenesis of CoVid-19.
Describe the pharmacologic mechanisms being used to halt disease progression and prevent adverse outcomes.
Clinical case Management Of Severe Acute Respiratory Infection SARIAshraf ElAdawy
This document provides guidance on clinical case management of severe acute respiratory infection (SARI). It defines SARI and outlines the typical clinical presentation. It discusses the principal etiological agents that can cause SARI, including various viruses and bacteria. The document provides guidance on initial patient assessment, diagnostic testing, exposure history, treatment including antivirals and antibiotics, supportive care, oxygen therapy and mechanical ventilation. The goal is to aid clinicians in managing SARI patients and detecting novel respiratory pathogens.
This document summarizes key information about pediatric pneumonia. It discusses the definition, pathophysiology, epidemiology, etiology, and specific considerations of Streptococcus pneumoniae, the most common cause of bacterial pneumonia in young children. Pneumonia is diagnosed in approximately 4% of children per year in the US based on clinical signs or radiographic findings. The causes vary by age, with viruses most common under 2 and bacteria like S. pneumoniae predominant in younger children. Diagnosis of the exact cause is difficult. Antibiotic resistance of S. pneumoniae has increased significantly in recent decades.
Coronaviruses are a large family of viruses that are known to cause illness ranging from the common cold to more severe diseases such as Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS).
A novel coronavirus (COVID-19) was identified in 2019 in Wuhan, China. This is a new coronavirus that has not been previously identified in humans.
Coronaviruses & COVID 19 - Its Morphology, Role, Mechanism of Action, and Tre...Haider Ali Malik
This document discusses COVID-19 and coronaviruses. It defines COVID-19 as a novel coronavirus first identified in Wuhan, China in late 2019. Coronaviruses are a large family of viruses that can cause illnesses ranging from the common cold to more severe diseases like MERS and SARS. The document then provides details on the structure, replication, and transmission of coronaviruses, symptoms of COVID-19, the ongoing global pandemic, and the discovery and identification of SARS-CoV-2 under electron microscopy.
The document discusses the H1N1 influenza virus, including its epidemiology, clinical manifestations, diagnostic tests, treatment, and a study of H1N1 patients in Jordan. It finds that H1N1 posed a risk to young people and those with lung or pregnancy-related conditions. A study of 32 H1N1 patients in Jordan found most common symptoms were fever, cough and sore throat, and average hospitalization was 2.9 days with full recovery in 30 patients and death in 2 patients.
Pulmonary Tuberculosis in Coronavirus Disease-19 Patients: Report of Casesasclepiuspdfs
The coronavirus disease 2019 (COVID-19) is known to cause severe respiratory illness manifesting in a spectrum of related disorders. Amidst the continuous evolution of this pandemic which has caused vast devastation globally, it is crucial to note that tuberculosis (TB), which also causes respiratory diseases, has and still affects over a quarter of the world’s population. Coinfection of both diseases have severe health implications. Therefore, it is vital to understand the effects of this novel virus on the immune system and coinfection with a bacterial infection, like TB. Based on peer-reviewed cases, there seems to be an associational relationship between COVID-19 and TB; research suggests both weaken the immune system and further complicate clinical outcomes, which was further explored in this paper.
This document provides information about coronaviruses, including the Wuhan coronavirus that emerged in 2019. It defines coronaviruses as enveloped RNA viruses that commonly infect mammals and birds, causing respiratory or intestinal illness. It describes the taxonomy and structure of coronaviruses, as well as their replication process and pathogenesis. The document also discusses previous coronavirus outbreaks, such as SARS and MERS, and examines scenarios for the Wuhan outbreak, investigating its potential origin from bats or snakes.
Infection Control In Health Care SettingsSagar Desai
The goal of this report was to assess the current and potential future role of diagnostics in hospital-acquired infection (HAI) control programs. We examined current issues resulting from HAIs and determined which infections needed foremost attention. Then, with input from Prof. Neimz, we selected diagnostics available on the market we could use. The final chapter of the review contains a market analysis with info about costs prevented upon implementation of diagnostic recommendations.
This document provides information about the 2019 Novel Coronavirus (2019-nCoV) outbreak that originated in Wuhan, China in December 2019. It discusses that coronaviruses can be transmitted from animals to humans and between humans. The 2019-nCoV was identified as the cause of the outbreak with many early cases linked to a seafood market, but human-to-human transmission has since been observed. It describes the clinical presentation, diagnosis, treatment and prevention measures for 2019-nCoV infection.
This document summarizes the pathogenesis and morphological features of SARS-CoV-2 in various organs. It begins with an introduction and timeline of the virus. It then discusses the mode of transmission and laboratory handling guidelines. The pathogenesis involves the virus binding to ACE2 receptors in lungs and other organs. This causes cytokine release syndrome and acute respiratory distress syndrome seen in lungs. Effects in other organs like heart, gastrointestinal tract, and kidney are also discussed based on autopsy findings like thrombi, inflammation and necrosis. Long term sequelae could include altered lipid metabolism and cardiovascular complications.
Kuwait influenza case management guidelines for 2nd flu workshop 2016Ashraf ElAdawy
This document provides guidance on clinical case management of influenza patients presenting with influenza-like illness (ILI) or severe acute respiratory illness (SARI). It outlines case definitions and describes potential case scenarios ranging from mild uncomplicated ILI to severe or complicated ILI. For mild cases, it recommends symptomatic care and antivirals for high-risk groups. Severe or complicated cases should be hospitalized, treated with antivirals, and may require intensive care. Clinical signs for hospitalization include respiratory distress, hypoxia, hypotension, or altered mental status.
A cardiologists perspective to current scenario in light of corona pandemic in india and world wide. cardiac procedures , heart disease , aceinhibitors , arni , heart failure , troponin, nt probnp
Middle East Respiratory Syndrome: MERS- CoVGaurav Kamboj
This document provides an overview of Middle East Respiratory Syndrome (MERS) including: the causative coronavirus; epidemiology and current status of MERS cases globally and in South Korea; the dromedary camel as the suspected animal reservoir; modes of transmission between camels and humans and between humans; clinical presentation and course of illness; laboratory diagnosis; treatment and prevention recommendations; and traveler guidelines. MERS is a viral respiratory illness first reported in 2012 with a case fatality rate of 36% that has caused several outbreaks, primarily in the Middle East.
- Middle East Respiratory Syndrome (MERS) is a novel coronavirus that was first detected in 2012. It causes severe respiratory illness, with a mortality rate of 35-50%.
- The virus likely originated in bats and may be transmitted via an animal or environmental reservoir. Person-to-person transmission has occurred, especially in healthcare settings.
- At risk groups include older adults and those with underlying medical conditions. Symptoms include fever, cough, shortness of breath. Diagnosis is made via PCR testing of respiratory samples. There is no vaccine and treatment is supportive.
The document discusses the aetiology, pathogenesis, and clinical presentation of COVID-19. It begins by explaining that COVID-19 is caused by SARS-CoV-2, a coronavirus first identified in China in late 2019. SARS-CoV-2 attaches to cells via the ACE2 receptor and causes respiratory illness. It can be transmitted from person to person through respiratory droplets. The document then details the virus structure, modes of transmission, risk factors for severe disease, and the multi-step process of how the virus infects cells and causes illness, including acute respiratory distress syndrome.
, on 7 January, Chinese authorities confirmed that they had identified a new virus. The new virus is a coronavirus, which is a family of viruses that include the common cold, and viruses such as SARS and MERS.
This new virus was temporarily named “2019-nCoV
This document discusses the potential role of HIV-1 nef protein in the pathogenesis of HIV-associated pulmonary hypertension (HIV-PH). It summarizes that HIV-PH has a poor prognosis and identifying it earlier would benefit patients. The HIV-1 nef protein may affect infected and uninfected pulmonary vascular cells and studies in macaques suggest nef is important in HIV-PH development. The research endeavor focuses on identifying nef mutations in HIV-infected individuals with PH compared to those without to help establish a connection between nef mutations and risk for HIV-PH.
This document discusses lung abscess, including its diagnosis, treatment, and association with mortality. Key points include:
- Lung abscess is caused by bacterial infection leading to pulmonary tissue necrosis and cavity formation. Common causes include aspiration of oral/gastric contents.
- Diagnosis is typically made using chest x-rays or CT scans to identify lung cavities. Cultures can identify pathogens like anaerobes, S. aureus, and K. pneumoniae.
- Treatment involves antibiotics like penicillins, carbapenems, or quinolones that are effective against common causative bacteria. Outcomes remain poor for patients with large or right lower lobe abscesses.
Health care-associated pneumonia: Pathogenesis Diagnosis and Preventionsiosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
1) The document discusses community acquired pneumonia (CAP), including its definition, classification, etiology, clinical presentation, diagnosis, treatment and risk factors.
2) CAP is defined as an acute lung infection associated with symptoms of infection and infiltrates on chest x-ray, occurring in a patient not recently hospitalized. The most common causes are Streptococcus pneumoniae and atypical bacteria.
3) Diagnosis is based on symptoms, physical exam findings and chest x-ray showing consolidation. Treatment involves initial broad-spectrum antibiotics, later narrowed based on cultures. Factors like age, comorbidities and clinical signs determine hospitalization need.
Pneumonia is an inflammation of the lung tissue that is commonly caused by a microbial infection. It can be classified based on its causative agent such as bacteria, viruses, or fungi. Common symptoms include cough, fever, shortness of breath, and chest pain. Diagnosis involves physical examination, sputum culture, chest x-ray, and other tests. Treatment focuses on relieving symptoms, using antibiotics if caused by bacteria, and preventing complications through rest and fluid intake.
This document discusses various types of lower respiratory problems including acute bronchitis, pertussis, pneumonia, and tuberculosis. It provides information on the pathogenesis, clinical manifestations, risk factors, diagnostic testing, and nursing management of each condition. Key learning outcomes focus on comparing and contrasting the different problems, prioritizing nursing care, and describing collaborative treatment approaches.
Covid-19: Summary Recommendations - Brazilian Medical Association (AMB)
Authors: S. E. TANNI, H.A. BACHA, C. E. FERNANDES, J. E. L. DOLCI, A.N. BARBOSA, W. BERNARDO
Publication date: 2021
Journal: World Medical Journal
ISSN: 2256-0580
Volume: 2
Pages: 37-52
Publisher
World Medical Association
Pneumonia is an inflammatory condition of the lungs that is usually caused by a bacterial or viral infection. Globally, pneumonia affects around 450 million people per year and causes about 4 million deaths, mostly in developing countries. Symptoms include cough, chest pain, fever, and difficulty breathing. Diagnosis is usually based on symptoms and chest x-ray findings. Treatment involves antibiotics, antivirals, fluids, and rest. Prevention strategies include staff education, infection control measures, and vaccination.
This document discusses the management of severe viral pneumonia in the ICU. It begins with an introduction that outlines the major concerns of viral pneumonia for intensivists due to high mortality and morbidity rates. It then discusses the various viruses that can cause respiratory infections in the ICU such as influenza, RSV, adenovirus, SARS-CoV, and others. The pathophysiology, clinical presentation, diagnostic tools including imaging and labs, and treatment approaches including antiviral therapy, corticosteroids, oxygenation and ventilation are summarized. Non-invasive ventilation is discussed as a first-line treatment for acute respiratory failure but criteria for NIV failure requiring intubation are also provided.
Splenic Abscess: Etiology, clinical spectrum and Therapyiosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
This review article summarizes the evidence that COVID-19 causes multi-system effects beyond just lung infection. It discusses how COVID-19 can affect the digestive system, liver, heart, blood vessels, brain, skin and more. While most patients experience respiratory symptoms, between 11-17% experience gastrointestinal symptoms like diarrhea and nausea. The virus may directly infect cells in multiple organs via the ACE2 receptor. COVID-19 is also associated with increased liver enzymes, myocarditis, neurological issues and skin rashes. It concludes that COVID-19 should be considered a multi-organ infectious disease rather than just a respiratory one.
COVID-19 is a new strain of Coronaviruses virus declared by the World Health Organization (WHO) as a pandemic on March 11th, 2020. While the majority of patients with COVID-19 typically have characteristic respiratory presentations subsequently
COVID-19 is a new strain of Coronaviruses virus declared by the World Health Organization (WHO) as a pandemic on March 11th, 2020. While the majority of patients with COVID-19 typically have characteristic respiratory presentations subsequently
COVID-19 is a new strain of Coronaviruses virus declared by the World Health Organization (WHO) as a pandemic on March 11th, 2020. While the majority of patients with COVID-19 typically have characteristic respiratory presentations subsequently
COVID-19 is a new strain of Coronaviruses virus declared by the World Health Organization (WHO) as a pandemic on March 11th, 2020. While the majority of patients with COVID-19 typically have characteristic respiratory presentations subsequently
COVID-19 is a new strain of Coronaviruses virus declared by the World Health Organization (WHO) as a pandemic on March 11th, 2020. While the majority of patients with COVID-19 typically have characteristic respiratory presentations subsequently
COVID-19 is a new strain of Coronaviruses virus declared by the World Health ...semualkaira
COVID-19 is a new strain of Coronaviruses virus declared by the World Health Organization (WHO) as a pandemic on March 11th, 2020. While the majority of patients with COVID-19 typically have characteristic respiratory presentations subsequently
COVID-19 is a new strain of Coronaviruses virus declared by the World Health Organization (WHO) as a pandemic on March 11th, 2020. While the majority of patients with COVID-19 typically have characteristic respiratory presentations subsequently
Non-resolving pneumonia can have several causes, including misdiagnosis of the pathogen, host factors like comorbidities or immune deficiencies, or development of complications from the initial infection. Normal resolution of pneumonia involves improvement within 3-5 days, while slow resolution may take over a month. Factors like age, severity of illness, and the infectious agent can impact the rate of resolution. Evaluation of non-resolving cases should consider multidrug-resistant bacteria, non-bacterial pathogens, underlying host conditions, or non-infectious mimickers of pneumonia.
Clinical analysis of 228 patients with pulmonary fungal diseases iWilheminaRossi174
Clinical analysis of 228 patients with pulmonary fungal diseases in China
Abstract
Background: Due to the lack of specific clinical manifestations and imaging features, the diagnosis of pulmonary fungal diseases is difficult. This study aims to investigate the clinical features of pulmonary fungal diseases.
Methods: We retrospectively analyzed the demographics, types of fungus,radiological characteristics,underlying diseases, the usage of steroid and immunosuppresants, laboratory tests of 228patients with pulmonary fungal disease diagnosed by pathological examination or laboratory culture from October 2011 to July 2018in Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology.
Results: A total of 228 patients, had a median age of 49years, which included 130 (57%) males and 98(43%) females. The most common fungal species identified were aspergillus (39.5 %), cryptococcus (18.4%), and mucormycosis (3.5 %).The main imaging findings were nodules or mass in 144 patients (63.2%), cavitation in 57 patients (25%),consolidation shadows or ground glass infiltrates in 15 patients (6.6%), and reverse halo sign in 12 patients (5.3%). The main infection sites were right upper lobe (26.8%), right lower lobe (21.5%) and the bronchus infection were 18 (7.9%) persons. For the underlying diseases, the prevalence of diseases was pulmonary tuberculosis (17.5%), bronchiectasis (16.2%), diabetes mellitus (9.2%) and the previous thoracic malignancy (6.6%) was common. The number of patients using steroid was 50% and the number of patients using immunosuppressant was 7%.
Conclusions: The imaging findings and the underlying diseases of patients should be taken into account when making diagnosis of pulmonary funga1disease for the purpo se to speculate the probable fungal pathogen and choose the most appropriate diagnostic tool.
Keywords:Pulmonary fungal disease; pathogen; imaging manifestation; Underlying disease; Clinical analysis; Chinese
(pneumomycosis; pulmonary mycosis?)invasive mould infection (IMI)Invasive fungal infections (IFIs),invasive aspergillosis
invasive mold disease, invasive aspergillosis, diabetes mellitus.
1. INTRODUCTION
In environment, the fungi produce small spores that are routinely inhaled and rapidly cleared from the normal host. However after long standing inhalation makes people more vulnerable to get effected .Moreover pulmonary fungal diseases are an opportunistic infection that predominantly attacks immunocompromised just as immunocompetent patients, however extensive utilization of gluccocorticoids and chemotherapeutics utilizes in patients make the pulmonary fungal disease no longer an uncommon occurrence. The complex underlying conditions such as pulmonary tuberculosis, bronchectasis, COPD and diabetes mellitus in the patients of pulmonary fungal disease and the non-specific nature of pathogen can confound identification and lead to under diagnosis. Due to its vague nature the dia ...
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Congenital Agenesis Of The Corpus Callosum With Intracerebral Lipoma And Fron...iosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
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The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
Correlation of Estrogen and Progesterone Receptor expression in Breast Canceriosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
Analytical Study of Urine Samples for Epidemiology of Urinary Tract Infection...iosrphr_editor
The current study was carried out in District Abbottabad aimed to determine the common urinary
tract infections in local community to determine the epidemiology of significant diseases in asymptomatic patients
of renal disorder. In this study a total of 1000 urine samples were examined during 3rd February to 1st April 2015
from patients attending Ayub Teaching Hospital Abbottabad by using dipstick and microscopic analysis of urine.
There were 638 females and 362 males patients examined during this period. The range of age groups is between
1.5 years to 80 years. Results of this study was reported as Pyuria 11%, Proteinuria 21.1%, Hematuria 10.4%,
Epithelial Cells 8.2%, pH 7.8 %, Granular casts 7.3%, Triple phosphate 6.6%, Calcium oxalate 6.4%, Glycosuria
6.3%, Bacteria 6.2% and mucous 4.1%. This study concludes that routing urinalysis should be performed for all
individuals to diagnose the asymptomatic diseases that will help in simple therapeutic measurements as urinalysis
is a simple step to determine the root of Urinary tract disorders.
Chest sonography images in neonatal r.d.s. And proposed gradingiosrphr_editor
BACKGROUND : Lung sonography has been used to monitor the patients of R.D.S. in
N.I.C.U. in recent times.
AIMS : To Describe and Grade the changes of R.D.S. by lung sonography.
SETTING & DESIGN : Tertiary care institutional set up in a rural medical college.
STUDY DURATION : September 2014 to May 2015. Follow-up variable, upto 2 weeks.
PROSPECTIVE, ANALYTICAL STUDY.
MATERIALS AND METHODS -This was a single institute study approved by the institutional ethics
committee. Prior informed consent was obtained from the parents. 100 consecutive patients admitted in
N.I.C.U. WITH gestational age < 36 weeks with respiratory complaints were enrolled. Chest x-ray was
obtained within few hours of admission and lung sonography was performed within 24 hours. Follow – up
sonography was performed as and when necessary. Sonography image was graded and correlated with chest
xray and clinical picture
The Comprehensive Review on Fat Soluble Vitaminsiosrphr_editor
This review article deals with brief description of fat soluble vitamins with figures and tables
showing statistical analytical data duly quoting the references wherever necessary. The word “soluble” actually
means “able to be dissolved.” Whether a vitamin is classified as 'fat-soluble' or 'water-soluble' has to do with
how the vitamin is absorbed, stored and removed from the body. Vitamins are tiny organic compounds with a
huge impact on the health and well-being of the body. The body needs a small amount of fat soluble vitamins in
order to stay in optimal health. Fat soluble vitamins play an important role in keeping the body healthy and
functioning from immune system and muscle and heart function, easy flow and clotting of blood as well as eye
health. They are critical to health and wellness–particularly reproductive health and wellness. Low-fat, no-fat
and vegan diets are woefully lacking in fat soluble vitamins. However a diet based on traditional foods can
naturally provide these vitamins. Science is still learning about many of the functions of vitamins. "Too much
vitamin A, D, or K can lead to increased levels that are unhealthy and can cause serious health consequences.
Diseased conditions leading to decreased fat absorption leads to decreased absorption of vitamins. The fatsoluble
vitamins work most safely and effectively when obtained them from natural foods within the context of a
diet rich in all their synergistic partners. If fat soluble vitamins are stored for lengthy time they generate threat
for toxicity than water soluble vitamins and such situation even aggravated, provided they are consumed in
excess. Vitamin products, above the legal limits are not considered food supplements and must be registered as
prescription or non-prescription (over-the-counter drugs) due to their potential side effects. Vitamin A and E
supplements do not provide health benefits for healthy individuals, instead they may enhance mortality, and it is
held proved that beta-carotene supplements can be harmful to smokers
Sulphasalazine Induced Toxic Epidermal Necrolysis A Case Reportiosrphr_editor
The document describes a case study of an 18-year-old female patient who developed toxic epidermal necrolysis as a severe adverse reaction to the drug sulfasalazine, which she had been taking for ankylosing spondylitis. She was admitted to the intensive care unit and treated with high dose corticosteroids, fluid replacement, and supportive care. She improved with treatment and was discharged with only post-inflammatory hypopigmentation.
Evaluation the efficacy of IVIgG in treatment of Hemolytic Disease of Newborniosrphr_editor
Hemolytic disease of newborn (HDN) is an important cause of hyperbilirubinemia in the
neonatal period,and delayed diagnosis and treatment may lead to permanent brain damage. Traditional
neonatal treatment of HDN is intensive phototherapy and exchange transfusion.Intravenous
immunoglobulin(IVIgG) has been introduced as an alternative therapy to exchange transfusion. This study was
conducted to assess the effect of IVIG in HDN .
FIBROLIPOMATOUS HAMARTOMA OF ULNAR NERVE: A RARE CASE REPORT.iosrphr_editor
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nerves,in which the epineurium and perineurium are enlarged and distorted by excess of fatty and fibrous tissue
s that infiltrate between and around nerve boundaries. The median nerve is more likely to develop a hamartoma
than other nerves with a predilection for the carpal tunnel.
A fibrolipomatous hamartoma – is a rare, benign, congenital lesion most commonly found in the median nerve,
usually at the level of the wrist or hand.
We report a case of this rare condition in ulnar nerve.
SELF MEDICATION PRACTICES FOR ORAL HEALTH PROBLEMS AMONG DENTAL PATIENTS IN B...iosrphr_editor
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Clinico-haematological Profile of Falciparum Malaria in a Rural Hospital of T...iosrphr_editor
Aim: To study the clinico-haematological profile malaria in a rural hospital of Tripura.
Material and methods: A cross-sectional hospital-based study was done from at Kulai District
Hospital,Tripura. This hospital based cross sectional study was done on 60 confirmed cases of falciparum
malaria (either by peripheral smear or rapid diagnostic test) admitted in Kulai District Hospital. A case sheet
proforma was prepared and data (demographic profile,clinical feature, investigation, treatment, and
complication) from all indoor patients was collected and analyzed.
Result: Out of 60 patients, 40(66.6%) were males and 20 (33.4%) were females. Most of the patients were
between the age group 21-40 years with the highest prevalence between the age group of 21-30. Fever was the
most common symptom. Anemia was present in 42(70%) patients, out of which 6(10%) patients had severe
anemia. Thrombocytopenia was present in 36(60%) patients.Abnormal liver function tests were observed in
26(43.3%) subjects while abnormal kidney function tests were observed in16(26.6%) patients. All the 60
patients received Artemisinin based antimalarial drugs.
Conclusion: Early detection, prompt management, and adequate supportive therapy may reduce mortality due
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Indonesian Wild Ginger (Zingiber sp) Extract: Antibacterial Activity against ...iosrphr_editor
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or delayed reactions occur instead with simple effects histamine, or, in severe cases with respiratory and
anaphylactic shock
The eggplant (Solanum melongena L.) is known to cause food allergies in some Asian countries, but detailed
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Nanoemulsion and Nanoemulgel as a Topical Formulationiosrphr_editor
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of 20-200 nm. Nanoemulsion provides numerous advantages over other carrier such as polymeric nanoparticle
and liposomes, including low cost preparation procedure, high hydrophilic and lipophilic drug loading system
to enhance the longer shelf live upon preserving the therapeutic agents. Incorporating the preparation of
nanoemulsion with hydrogel matrix to produce nanoemulgel exhibited by the two separate systems that forming
it. Nanoemulgel possesses the properties of thixotropic, non-greasy, effortlessly spreadable, easily be removed,
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deduce a pharmacokinetic model for the estimation of methotrexate clearance in Egyptian pediatric ALL
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sittings.
Patients and methods: A total of 94 pediatric patients with B-cell ALL, of whom 70 were the studied population
and 24 were the test population, were treated with four courses of HDMTX doses 2.5 gm/m2
(low-risk arm) or 5
gm/m2
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a part of their treatment protocol. Patients were monitored for the 24 hour MTX concentration and the systemic
methotrexate clearance was calculated for each methotrexate dose
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that no longer constitutes a public health threat. Surveillance is an integral part of tuberculosis (TB) control.
Albania has a highTB notification rate and there are doubts about underreporting. The evolution of the
incidence of tuberculosis is presented, together with more detailed figures over the period 1998-2009. These
figures were obtained by the monthly forms (called 14/Sh) compared with the individual notification data.
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system deficiencies in the Albania from 1998 through 2009. Metodology: The study is descriptive one conductet
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epidemiological departments) to the central level (Public Health Institute). Results: The main findings were:
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regions show a lack of information on the confirmation of diagnosis and laboratory examination type used for
confirmation. Conclusion: TB disease in high-risk populations where it is difficult to detect, diagnose, and treat;
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Chronic Pneumonia: Update on Clinical Manifestations, Diagnosis and Therapy
1. IOSR Journal Of Pharmacy
(e)-ISSN: 2250-3013, (p)-ISSN: 2319-4219
www.iosrphr.org Volume 5, Issue 4 (April 2015), PP. 44-49
44
Chronic Pneumonia: Update on Clinical Manifestations,
Diagnosis and Therapy
Murtaza Mustafa1,
RK.Muniandy2,
MM.Sien3
,J.Sieman4,
A.Ahmed5
,A.Fariz6
1-6
Faculty of Medicine and Health Sciences, University Malaysia Sabah,Kota Kinabalu,
Sabah, Malaysia.
ABSTRACT: Chronic pneumonia syndrome (CPS) has high fatality rate worldwide, economic cost in the
United States, Europe and heavy burden of disease in the Asian countries. Older patients are at high risk of
developing necrotizing pneumonia. Genetic factors play important role in manifestation of tuberculosis and
disseminated cocciodioidomycoses among African and Asians. Occupation and hobbies do play an important
role. Travelers to southeast Asia with abnormal radiography may be suffering from melioidosis.CPS is caused
by Mycobacterium tuberculosis, nontuberculous mycobacteria, endemic fungi, cryptococcosis, and
opportunistic infections like nocardiosis and aspergillosis. Clinical manifestations often nonspecific, including
fever, chills, anorexia, weight loss, indicating chronic illness with pulmonary symptoms. Diagnosis by
radiographic studies, high resolution CT(HRCT),position emission tomography, bronchoalveolar
lavage(BAL),and CT guided transthoracic fine-needle aspiration(FNA).Empirical therapy based on
epidemiologic, clinical, radiographic and microbiologic data. Antifungal therapy with amphotericin B or
voriconazole for invasive mold Bronchoscopy and surgery if indicated.
KEY WORDS: Chronic pneumonia, Clinical manifestations, Diagnosis, and Therapy.
I. INTRODUCTION
Pneumonia is a common illness affecting approximately 450 million people a year and occurring in all
parts of the world[1].It is a major cause of death among all age groups resulting 4 million deaths[1].Rates are
greatest in children less than five, and adults older than 75 years[1].It occurs about five times more frequently in
the developing world than in the developed world[1].In the United States, as of 2009,pneumonia is the 8th
leading cause of death[2].In 2012 the estimated aggregate costs of treating pneumonia in the United States were
20 billion, and in Europe have been estimated at €10 billion[3,4].The countries with greatest burden of disease
include India(43 million),China(21million) and Pakistan(10 million).It is a leading cause of death among
children in low income countries [5,1].Chronic pneumonia syndrome(CPS) is a pulmonary parenchymal process
that can be infectious or noninfectious, has been present for weeks to months rather than for days, and is
manifested by abnormal chest radiographic finding or progressive pulmonary symptoms[6].Older debilitated
patients are at higher risk for development of chronic necrotizing pneumonia caused by aerobic gram negative
bacteria [7].Racial and genetic characteristics are increasing recognized as predisposing factors to severe disease
manifestations from a variety of pathogens e.g. cavitary tuberculosis in blacks, disseminated coccidioidomycosis
is much more likely in darker skinned persons and the Asians[8]. Occupation and hobbies play an important role
in the development of CPS, e.g. tuberculosis among health care workers; coccidioidomycosis among desert rock
collectors, laboratory technicians, archeologists, construction workers and other exposed to desert dust;
histoplasmosis in persons exposed to pigeon or starling roosts[9].CPS is also common among homeless persons,
smokers ,alcoholics,IV drug users and persons infected with human immunodeficiency virus (AIDS)[10].Travel
history of patients is important.A person extensively traveled in Southeast Asia, who subsequently manifests
chronic pneumonia, with roentgenographic abnormalities those of tuberculosis or pulmonary mycosis may be
suffering from melioidosis [11].Diagnosis include laboratory studies, chest radiographic, and high- resolution
computed tomography (HRCT) [12]. Frequently causes of chronic pneumonia include bacteria,fungi and
protozoa.Empirical therapy is advisable, the choice of antimicrobial agents must be based on the available
epidemiologic, clinical, radiographic and microbiologic data [6].Paper reviews the current literature, clinical
presentations, diagnosis and therapy of chronic pneumonia.
II. ETIOLOGIC AGENTS
The infectious causes of chronic pneumonia can be divided into two main groups :(1)agents that typically cause
acute pneumonia and are unusual cause of chronic pneumonia and(2) infectious agents that typically cause
chronic pneumonia. Among these agents that typically cause acute pneumonia, anaerobic bacteria,
Staphylococcus aureus, Haemophilius influenza, the Enterobacteriaceae, and Pseudomonas aeruginosa are the
organisms most likely to produce a persistent chronic pneumonia. This is usually a chronic necrotizing process
that most commonly occurs in patients with significant underlying disease(e.g.alcholism, diabetes mellitus,
2. Chronic Pneumonia:Update on Clinical…
45
intracthoraxic malignancy, chronic obstructive pulmonary disease),hospitalized patients, those requiring long
term ventilator assistance, patients with chronic swallowing and reflux disorders, and others at risk for recurrent
aspiration, such as patients with Parkinson’s disease[13].Acute pneumonia caused by most viruses or by
Streptococcus pneumoniae, Mycoplasma pneumonia, Legionella species, Coxiellaburnetti,or Chlamydophila
pneumoniae rarely progress to a chronic pneumonia[14].
Chronic pneumonia is caused by bacteria, viruses,fungi and parasites.In the otherwise healthy host, the most
considerations are tuberculosis and nontuberculous mycobacteria [15,16].the endemic fungal infections
including histoplasmosis, coccidioidomycosis, blastomycosis, and paracoccidioidomycosis[17-19],in their
geographic areas other mycoses e.g., cryptococcosis[20[],mixed aerobic and anaerobic bacterial infections, and
actinomycosis [21,22].Classic opportunistic infections, including nocardiosis and aspergillosis [23,24].In
persons with acquired immunodeficiency syndrome(AIDS),these same infections are seen[18].Furthermore, in
AIDS patients, chronic pneumonia may be caused by Rhodococcusequi or Pneumocystitis jirovecii(formerly
P.carinii) or by such noninfectious disorders as Kaposi’s scarcoma, lymphoma, and nonspecific interstitial
pneumonitis [25].Protozoan and worms infections are uncommon causes of chronic pneumonia, but they are
important considerations for those live in or have traveled to areas in which these agents are endemic[6].
III. CLINICAL MANIFESTAIONS
There are many causes of chronic pneumonia, and no single symptom complex is common to all
causes. Often, nonspecific and constitutional symptoms, including fever, chills, and malaise, are present
initially, followed by progressive anorexia and weight loss, indicating chronic illness Pulmonary symptoms may
be present early but frequently appear later in the course of the illness. Any patient with a prolonged illness and
nonspecific constitutional complaints plus pulmonary symptoms-including a new or persistent cough, sputum
production, hemoptysis, chest pain(especially pleuritic pain),or dyspnea-deserves medical evaluation, including
a chest roentgenogram and, when findings on routine chest radiographs are nonspecific and suggestive of a
chronic parenchymal process, a computed tomography(CT) examination of the chest[6].
Evidence of extra pulmonary involvement should be explored with each patient. For example, chronic
pneumonia with skin lesions should suggest coccidioidomycosis, blastomycosis, or in the appropriate
epidemiologic setting,paracoccidioidomycosis. Similarly cryptococcosis,nocardiosis,and Kaposi’s sarcoma
should be important consideration for skin lesions in patients with AIDS or other conditions associated with
significant impairment of cell-mediated immune function. Mucous membrane lesion should raise the possibility
of histoplasmosis, paracoccidioidomycosis, Kapsoi’ssarcoma. Monoarticular or poyarticulararthritis,
polyarthralgia,or localized bone tenderness or pain may indicate systemic vasculitis. A history of chronic
pneumonia with persistent headache and abnormal cerebrospinal fluid should raise the suspicion of tuberculosis,
cryptococcossis, orcoccidioidomycosis involving the lungs and central nervous system[6].The presence of focal
neurologic signs and symptoms is strong clinical evidence for a space-occupying lesions in the central nervous
system; such finding in a patient with a cavitary infiltrate seen on chest radiograph suggest the possibility of a
brain abscess associated with chronic suppurative lung disease caused by microaerophilic or anaerobic bacteria,
or nocardiosis [19]. Similarly ,the triad of skin nodules, pulmonary nodules, and central nervous system
abnormalities suggests lymphomatoid granulomatosis[26].
Additional signs of chronic pneumonia. Although the findings on physical examination of the chest are usually
not helpful in differentiating specific causes of the chronic pneumonia, the presence of generalized wheezing or
other signs of bronchospasm, in the absence of underlying lung disease, indicates an asthmatic component to the
pulmonary illness and raise the possibility of a disorder causing both pneumonia and asthma, such as extrinsic
allergic alveolitis, allergic bronchopulmonary aspergillosis, or allergic rhinitis or granulomatosis(Churg-Strauss
syndrome).Similarly, localized wheezing signs suggest the presence of an endobronchial obstructing lesion. The
findings of tachycardia, cardiomegaly, gallop rhythm, and ankle edema provide evidence of cardiac disease and
suggest that the pulmonary symptoms signs result at least in part from cardiovascular causes [6].The presence of
skin lesions, clubbing, cyanosis, or phlebitis is not specific for single pulmonary disorder but may help narrow
the differential diagnosis, especially when considering along with other clinical and epidemiologic information.
The presence of abnormal liver function, lymphadenopathy, hepatomegaly, and/or splenomegaly with chronic
pneumonia suggest a systemic disorder involving the reticuloendothelial system, such as sarcoidosis, chronic
disseminated histoplasmosis or tuberculosis [6].
IV. DIAGNOSIS
Laboratory workout can provide important clues to diagnosis. Pancytopenia suggests military tuberculosis,
disseminated histoplasmosis, or myelophthisic disorder such as metastatic tumor involving the bone marrow.
Isolated anemia is commonly associated with chronic pneumonia and is not particularly helpful in discerning a
cause. A normal leukocyte count does not exclude infection. In particular, chronic fungal pneumonia may be
3. Chronic Pneumonia:Update on Clinical…
46
associated with a normal or minimally elevated leukocyte count [6]. Leukopenia or lymphopenia should raise
the suspicion of a suspicion of an HIV. In addition, leukopenia is consistent with diagnosis of sarcoidosis,
systemic lupus erythematosus , tuberculosis, histoplasmosis or neoplasia. Aleukomoid reaction is nonspecific,
and may be seen in disseminated mycobacteriosis and mycoses. Leukocytosis with polymorphonu clear cell
predominance is suggestive of, but not specific for, a bacterial cause, including actinomycosis[6}
Routine laboratory tests that measure the function of other organs may provide more helpful information. Liver
function test(LFT),including bilirubin, alkaline phosphatase, and serum aspartate aminotransferase
determinations and prothrombin time, should be performed for most patients. Urinalysis, with particular analysis
to urinary sediment, plus tests of renal function including measurement of blood urea nitrogen and creatinine,
should also be done. Abnormalities of liver function (especially elevated enzymes levels), kidney function, or
both should raise suspicion of disorders that are not limited to lung but are known to involve multiple other
organs, including the liver and kidney. Such disorders include disseminated histoplasmosis and disseminated
mycobacteriosis as well as the vasculitides, sarcoidosis and certain neoplastic diseases, especially the
lymphoproliferative disorders [6].
In a patient with an abnormally low serum globulin level, a quantitative serum immunoglobulin determination
should be obtained to evaluate for common variable immunodeficiency disorder or other disorders associated
with hypogammaglobulinemia. Studies that should be performed in patients with suspected vasculitis include
serologic tests for antinuclear antibodies, rheumatoid factor, antineutrophil cytoplasmic autoantibodies((C-
ANCAs),C-reactive protein, and erythrocyte sedimentation rate. In addition, measurement of serum angiotensin-
converting enzyme may be useful, although it is nonspecific test for which levels are increased in patients with
number of granulomatous disorders, including 30% to 80% of patients with sarcoidosis [27].
Radiographic studies. The chest radiograph, including a posteroanterior and a lateral film is a reasonable
screening procedure, but a high resolution CT(HRCT) provides invaluable information[28].Occasionally,
magnetic resonance imaging (IMR) is helpful ,particularly in the evaluation of noninfectious causes of chronic
pneumonia.Position emission tomography (PET) scanning(flurodeoxyglucosePET),which measures metabolism
by glucose uptake has often proved disappointing in distinguishing malignant from infectious lung
lesions[29].Typical radiographic findings may provide clues to specific diagnoses. For example, demonstration
of of anterior mediastinal involvement argues strongly in favor of neoplasia, including lymphoma and metastatic
carcinoma, as the cause of chronic pneumonia syndrome, and argues against an infectious cause[6].Tuberculosis
and nontuberculos mycobacterial diseases , histoplasmosis, coccidiomycosis, sporotrichosis, paragonimiasis,
and the pneumoconiosis, especially silicosis, are characteristically associated with fibrocavitary disease-a
contracted area of lung with linear fibrosis, nodular or rounded densities, and cavitation. In addition,
mycobacterial diseases, histoplasmosis, and silicosis characteristically involve the upper lobes .Many experts
believe that anterior segment upper lobe involvement argues strongly against tuberculosis as a cause. A thin
walled cavity is suggestive of coccidioidomycosis, sporotrichosis, or paragonimiasis, whereas thick walled
cavity surrounded by an area of pneumonitis is more typical of tuberculosis, other mycobacterial infection,
histoplasmosis, aspergillosis, melioidosis, nocardiosis, actinomycosis, pyogenic lung abscess ,sequamous cell
carcinoma, and lung disease caused by Rhodococcusequ. Cavitation is seen but is less common in blastomycosis
and cryptococcosis[30].
Mediastinal and/ or hilar lymph node calcification and occasionally parenchymal calcification, is typical of
tuberculosis,histoplasmosis, and coccidioidomycosis but is rare in actinimycosis, nocardiosis,blastomycosis,and
crptococcosis.Abscess of chest wall or osteomyelitis of rib adjacent to the pneumonia or pleural
effusion(empyema necessitans) may be seen in actionmycosis, nocardiosis,, and tuberculosis.Although these
radiographic mamifestations of selected pulmonary diseases are typical in most patients, experience during the
AIDS pandemic has shown that pulmonary diseases in these patients may be highly typical in radiographic
appearance and clinical course[31,32].
Significant radiographicfindings. In all patients with radiographic evidence of localized infiltrates or
cavitation, examination of the sputum is essential. This is in striking contrast to the questionable value of
sputum in setting of an acute community acquired pneumonia [33,34]..The specimen must be a representative
sample-that a deep coughed specimen. Microscopic examination of sputum should include :(a) Gram staining
for bacteria and actinomycetes(b) Acid fast stain for mycobacteria and modified acid fast stain for
nocardia(c)Wet mount for fungi and eggs of Paragonimus (calofluor white potassium hydroxide for preparation
with phase contrast may enhance detection of fungi) (d)Cytologic preparations for neoplastic cells, eosinophils,
and fungi. Expectorated sputum should also be sent to microbiology laboratory for culture of bacteria. Newer
diagnostic techniques (e.g., rapid culture techniques, molecularprobes, and antigen detection assays, and the
enzyme-linked immunosorbent assay(ELISA) can be used in rational and thoughtful manner to facilitate
laboratory diagnosis. In particular, the development of newer polymerase chain reaction (PCR)-based
4. Chronic Pneumonia:Update on Clinical…
47
diagnostics many of which have the ability to perform screening for multiple pathogens on one specimen.
Nucleic acid-based tests for detection of M.tuberculosis are commercially available and diagnostically
helpful[35,36].Tuberculin skin test with purified protein derivatives(PPD) is the single most important test for
the detection of nontuberculous mycobacteria. Serologic tests for HIV should be performed for all patients with
unexplained chronic pneumonia. Complement fixation tests for antibody to Coccidioides species. Serum
capsular antigen may detected in as many as 50% of patients with pulmonary cryptococcosis; a greater
proportion of patients with extra pulmonary disease will have positive serum cryptococcal
antigen[37].Histoplasma antigen in serum or urine is helpful in disseminated histoplasmosis but uncommonly
positive in infection confined to the lung, especially in non immunocom promised patients. The serum Platelia
ELISA galactomannan assay for early diagnosis of early active invasive aspergillosis has proven useful
hematologic malignancy and stem cell transplantation patients, but its usefulness as a diagnostic assay in other
patients is less well established. More recently this assay has been advocated for use in bronchoalveolar
lavage(BAL) and may be more sensitive than the serum assay if identifying patients with probable invasive
aspergillosis[38,39].Among patients with suspected tuberculosis but with negative culture and histologic
studies, the qunatiFERON-gold assay may be useful adjunct to skin testing for diagnosis[40].
Invasive procedures[6].Certain clinical situations dictate a more aggressive diagnostic approach. In patients
who are unable to raise sputum spontaneously and in who attempts to induce sputum production are
unsuccessful. Invasive procedures may be necessary. Fiber optic bronchoscopy is usually the initial procedure. It
is diagnostically helpful when accompanied by BAL, with appropriate microbiologic and histologic
studies[35].Analysis of BAL fluid may increase the diagnostic yield of bronchoscopy, especially in
immunocompromised persons such as patients with AIDS and suspected opportunistic infections or patients
with suspected noninfectious causes of chronic pneumonia[41]. Transbronchial biopsy can be helpful in patients
with diffuse pulmonary infiltrates. In a patient with extensive pleural involvement, thoracentesis and pleural
biopsy(or rigid throracoscopy is selected situations) may be more helpful diagnostically than
bronchoscopy[42].In some situations, open lung biopsy is the procedure of choice for patients with interstitial
lung disease and for immunosuppressed patients with unexplained pulmonary disease because of large sample
size, the expediency of diagnosis, and the safety of the procedure[41].In contrast, in other institutions with
experienced operators, CT guided transthoracic fine-needle aspiration(FNA) of solid lesions in the lung,
particularly those near the pleura, can be diagnostic[43].In patients with adequate ventilator reserve, video
assisted thoracoscopy(VATS) is preferred to open lung biopsy and is associated with low risk of complications
and high sensitivity. VATS requires a chest tube be placed postoperatively [42].
Radiographic evidence with diffuse pulmonary infiltration and fibrosis [6].In patients whose chest
radiographs show predominantly diffuse infiltrative patterns of either the alveolar or interstitial type, pulmonary
function studies may be of greater importance[44].Studies that may be especially useful in this group of patients
include the following:(1)arterial blood gas studies and exercise oximetry(2)tests of pulmonary function,
including spirometry measurements, measurements of lung volume, and measurement of diffusion capacity
(3)studies on sputum, microbiologic and cryptologic(4)lung biopsy-the procedure of choice to make an accurate
morphologic diagnosis(transbronchial biopsy via fiber optic bronchoscope, open ling biopsy or VATS)[45].
V. THERAPY
In many patients no causative agent is identified on the basis of initial stains and cultures, and
definitive diagnosis must await the completion of serologic, histologic, and bacteriologic studies as well as other
diagnostic tests. In such situations, if immediate empirical therapy is advisable, the choice of antimicrobial
agents must be based on the available epidemiologic, clinical, radiographic, and microbiologic data [6].If a
patient has a more chronic indolent illness, is stable, and does not require immediate empirical therapy, a
methodic and through diagnostic evaluation is the initial priority. In a patient with bilateral upper lobe cavitary
disease in whom the initial microscopic examination are nonrevealing, the leading considerations include
tuberculosis, histoplasmosis, and cocciodioidomycosis. If such patient has a positive tuberculin skin response,
tuberculosis should be presumed to be the diagnosis until proven otherwise, and the patient kept in respiratory
isolation until the diagnosis can reasonably be excluded[6].Similarly empirical antifungal therapy, usually with
an amphotericin B formulation(or voriconazole if invasive mold disease is suspected).may be indicated in an
HIV-infected or other immunocompromised patient with severe or rapidly progressing chronic pneumonia.
because fungal pulmonary diseases in this setting can be fatal[6].
Therapy with corticosteroids. The treatment with glucocorticosteroids in the treartment of a patient with
chronic pneumonia is controversial. If the cause of the illness is an infectious agent, particularly a bacterium or
fungus, steroids are rarely indicated. However; some experts advocate a short course of glucocorticosteroid
5. Chronic Pneumonia:Update on Clinical…
48
therapy for patients with advanced pulmonary tuberculosis and severe inanition. Generally. cortocosteroids are
beneficial in chronic pneumonia from noninfectious causes, such as the vasculitides [26], sarcoidosis [46],
chronic eosinophilic pneumonia[47],radiation injury[48],bronchiolitis obliterans organizing pneumonia[45],and
many of the fibrotic lung diseases, including chronic hypersensitivity pneumonitis(along with avoidance of
exposure to the offending antigen[49].
Bronchoscopy and Surgery[6].Bronchoscopy is frequently used as a therapeutic adjunct, especially for patients
who have tenacious secretions that cannot be raised by noninvasive techniques. In other patients, mucus plugs or
foreign bodies may predispose to atelectasis and chronic pneumonia, and therapeutic bronchoscopy may be
necessary to expand the collapsed lung. Surgery plays a limited role in the treatment of chronic pneumonia.
Lobectomy or pneumonectomy should be considered in patients with chronic destructive pneumonia, multiple
macroabscesses or microabscesses involving an entire lobe or lung, and a ventilation-perfussion scan indicating
nonfunction of the involved lung(e.g. Pulmonary gangrene)[50].Thoracotomy may also be indicated to
decorticate the pleura in patients with significant pleural reaction and resultant lung disease[6].
VI.CONCLUSION
Chronic pneumonia syndrome (CPS) is a pulmonary illness with 5 million deaths worldwide. CPS is
more common in developing than developed countries. Despite the advancement in patient care, outcome
remains poor. Future research should focus on early diagnosis and early treatment for better outcome.
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