The Elderly in a Cold Environment
Tom Arie in Health Care of the Elderly, 1981
The heart rate slows in response to cold due to sinus bradycardia or to slow atrial fibrillation. The electrocardiogram usually shows some degree of heart block with an increase of the PR interval (in patients with sinus rhythm) and there is delay in intraventricular conduction. A pathognomonic sign is the appearance of a ‘J’ wave shown by a characteristic deflection at the junction of the QRS and ST segment.24,25 Failure of peripheral vasoconstriction and a decrease in cardiac output lead to a fall in arterial blood pressure. This is an ominous sign. The respirations are slow and shallow, and an appreciable fall in arterial oxygen saturation may occur as a result of this hypopnoea; the effect of anoxia on the tissue metabolism is one of the factors determining prognosis.26 Bronchopneumonia is nearly always present but it may not be detected clinically owing to the absence of the usual physical signs. Acute pancreatitis is also often present in severe hypothermia and this condition too is rarely detected. The clouding of consciousness and the muscular rigidity of the abdominal wall due to hypothermia obscure the usual signs, but pancreatitis should be suspected if the patient is seen to wince when firm pressure is applied to the epigastrium.
Immunotherapy of Graves’ Eye Disease
George S. Eisenbarth in Immunotherapy of Diabetes and Selected Autoimmune Diseases, 2019
The titer of ocular muscle antibodies demonstrated in the serum decreased markedly under cyclosporine therapy.35 Furthermore, like Weetman, we saw a significant fall of microsomal antibodies, which may possibly indicate an intrathyroid effect of the immunosuppressant. Cyclosporine also increases the rate of decline of TSH receptor antibodies.4 Extraocular muscle thickness decreased significantly after 6 months of treatment in the cyclosporine group (on average from 10 mm to 6 mm for the inferior rectus muscle). This contrasts with patients only on prednisone where no alterations occurred.33 After the end of prednisone treatment, there was recurrence within the first 6 months in 8 out of 20 patients in the prednisone only group, but in only one patient in the cyclosporine group after 9 months’ treatment. The side effects of cyclosporine were dose-dependent and reversible. There was a significant rise of the blood urea nitrogen and creatinine (but these were still within the normal range), a moderate elevation of liver transaminases in four patients, as well as hypertension in four cases. Paresthesia, swelling of the gums, and increased body hair were tolerated relatively well, and declined after reduction of the dose. In one female patient, bronchopneumonia, which was successfully treated, occurred after 4 months of therapy.
Hyperphenylalaninemia and defective metabolism of tetrahydrobiopterin
William L. Nyhan, Georg F. Hoffmann, Aida I. Al-Aqeel, Bruce A. Barshop in Atlas of Inherited Metabolic Diseases, 2020
The outcome in BH4-deficient patients is highly variable and correlates with the patient's age at start of treatment. Patients not treated, in whom levels of phenylalanine are not kept from being elevated, may develop the fair hair and skin or relative lack of pigmentation that is characteristic of the patient with PKU [24–26]. Some patients have had episodes of hyperthermia without apparent infection [8]. Severe bronchopneumonia may require intensive care [24]. Death occurs often within the first five years of life. One patient died of sudden infant death syndrome (SIDS) in hospital [24]. Overall, mortality documented in the BIODEF database was about 10 percent, most with delayed diagnosis and treatment [6]. When treatment begins in the neonatal period, patients remain frequently asymptomatic or show less retardation, movement disorders and convulsions. Unfortunately, not all patients who are diagnosed and treated early develop normally, and a mild phenotype can shift to a more severe phenotype with age [43].
LncRNA NEAT1 activates MyD88/NF-κB pathway in bronchopneumonia through targeting miR-155-5p
Published in Autoimmunity, 2021
Ling-jia Chen, Jian-min Li, Wei-dong Zhang, Wei Liu, Xiu-ying Li, Bin Ouyang, Jian-long Tan, Yun Li, Jiang-chuan Chen, Zhi-guang Liu
Bronchopneumonia is actually an inflammation occurring in lung, bronchial, and mucosa tissues [6]. Enormous studies showed that long non-coding RNAs (lncRNAs) and microRNAs (miRNAs) were closely associated with inflammatory diseases [7–9]. Nuclear paraspeckle assembly transcript 1 (NEAT1) is a nuclear restricted lncRNA and forms the key component of the paraspeckle suborganelles [10,11]. NEAT1 played an important role in the growth, migration, and invasion of cancer cells [12–14]. It was reported that NEAT1 regulated lipopolysaccharide (LPS)-induced injury in WI-38 cells through the mediation of miR-193a-3p/TLR4/NF-κB axis [15]. Meanwhile, a previous study showed that NEAT1 was also involved in the inflammatory response [15]. Furthermore, NEAT1 might promote ox-LDL-induced inflammation in vitro via the mediation of miR-128 [16]. Taken together, NEAT1 is an important regulator in the inflammatory response. However, the function of NEAT1 in bronchopneumonia is still largely unknown.
New perspectives in aspiration community acquired Pneumonia
Published in Expert Review of Clinical Pharmacology, 2019
Abraham E. Rodriguez, Marcos I. Restrepo
Radiologic evidence as mentioned plays an important role in diagnosing pneumonia in general. However, there has been evidence that plan radiographs may not be sufficient to rule out pneumonia [78]. Chest computed tomography (CT) is a more sensitive diagnostic modality for diagnosis of pneumonia [78]. Komiya et al. have studied CT findings in aspiration pneumonia. They determined that their patients with confirmed aspiration pneumonia had a bronchopneumonia pattern most commonly seen in the posterior lung fields. They also noted that the distribution in the craniocaudal direction was variable according to the patient’s functional status [79]. Interestingly, organisms most likely to present in an aspiration bronchopneumonia pattern were Staphylococcus aureus, Haemophilus influenzae, Pseudomonas aeruginosa, and Mycoplasma pneumoniae whereas Streptococcus pneumoniae and Klebsiella pneumoniae tend to present more commonly as a lobar pneumonia. Komiya et al. were careful to note that the radiologic appearance and distribution depend on the proportion of each pathogen present, so the pattern cannot be completely reliable to differentiate aspiration pneumonia versus regular CAP [79].
Severe pulmonary infections complicating nivolumab treatment for lung cancer: a report of two cases
Published in Acta Clinica Belgica, 2020
Valentine Inthasot, Marie Bruyneel, Inge Muylle, Vincent Ninane
Case 1: A 69-year-old man was diagnosed with a metastatic lung adenocarcinoma of the upper right lobe. He received first-line treatment with 4 cycles of cisplatin-pemetrexed, followed by 4 cycles of maintenance pemetrexed but discontinued due to intolerance. Tumor progression four months later was treated with a second-line regimen of 18 cycles of nivolumab with a good initial response. At follow-up, the patient was diagnosed with bronchopneumonia. No pathogen was identified and he only showed mild improvement after amoxicillin-clavulanic acid treatment. Given the persistence of symptoms and the evidence of pulmonary infiltrate in the upper right lobe on chest radiograph one month later (Figure 1), a bronchoscopy with bronchoalveolar lavage (BAL) was performed and demonstrated positivity for Mycobacterium tuberculosis in both cultures and by polymerase chain reaction (PCR) analysis. Anti-tuberculosis treatment was started accordingly.
Related Knowledge Centers
- Bacterial Pneumonia
- Bronchus
- Inflammation
- Pneumonia
- Staphylococcus Aureus
- Streptococcus Pneumoniae
- Lobar Pneumonia
- Viral Disease
- Hospital-Acquired Pneumonia
- Community-Acquired Pneumonia