Internal medicine
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Objective Community-acquired pneumonia is an acute infectious disease with potentialy life-threatening consequences. Because invasive mechanical ventilation (IMV) requires the attention of many medical staff, early risk prediction at the time of admission is expected to lead to a predictable course of patient care and the appropriate allocation of medical resources. There are a limited number of reports on predictive factors for IMV, such as SMART-COP. ⋯ Results Among 2,227 patients (mean age 67.3 years, 69.0% male), 39 patients required IMV on or after the day following admission. A multivariable analysis showed that predictive factors of IMV were respiratory rate >30 breaths/min [subdistribution hazard ratio (SHR), 5.53; 95% confidence interval (CI), 2.09 to 14.67; p=0.001], PaO2/FiO2 ratio <250 (SHR, 8.02; 95% CI, 2.78 to 23.13; p<0.001), and Legionella pneumonia (SHR, 4.87; 95% CI, 1.56 to 15.13; p=0.006). Conclusion This study revealed that among other factors including mainly vital signs, specific infection by a microorganism itself (Legionella in this study) was a predictive factor for the need of IMV.
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Background Data on the first-line treatment options for patients with Pneumocystis pneumonia (PCP) without human immunodeficiency virus (HIV) infection are limited. Therefore, we evaluated the outcome of pentamidine compared to trimethoprim-sulfamethoxazole (TMP-SMX) in non-HIV patients with PCP. Methods We used data from the Japanese Diagnosis Procedure Combination Inpatient Database. ⋯ Results Among 5,870 eligible patients, 5,456 and 414 received TMP-SMX and pentamidine, respectively. Pentamidine treatment was associated with a higher in-hospital mortality than TMP-SMX treatment in the propensity score overlap weighting analysis (23.6% vs. 40.1%; risk difference, 16.5%; 95% confidence interval, 10.8-22.2%; p<0.001). Conclusions Based on these findings, pentamidine may not be as effective as TMP-SMX for treating PCP in non-HIV patients.
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A 65-year-old man with hepatocellular carcinoma and lung metastasis was treated with a combination of atezolizumab and bevacizumab. Subsequently, the patient developed fever and new liver lesions, which were considered to indicate a pseudoprogression. Despite this, the treatment was continued. ⋯ A partial response was achieved and maintained for two years. A histological examination revealed a predominance of CD8-positive lymphocytes and PD-L1-positive tumor-associated macrophages, which may predict a positive response to this therapy. Pseudoprogression may therefore be a favorable prognostic factor in hepatocellular carcinoma.
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A 32-year-old man presented with cirrhosis. At 8 years of age, he underwent resection of a craniopharyngioma, which resulted in panhypopituitarism. He underwent self-interrupted hormone replacement therapy at 20 years of age. ⋯ Home oxygen therapy and hormone replacement therapy were initiated. Despite these efforts, poorly controlled hypothalamic obesity led to liver failure, and the patient is currently awaiting liver transplantation. Liver cirrhosis associated with long-term panhypopituitarism may have a poor prognosis even with hormone replacement therapy.
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We herein report a case of Systemic Capillary Leak Syndrome (SCLS) attributed to coronavirus disease (COVID-19) that emerged in 2019. A 56-year-old woman presented with a COVID-19 infection 7 days prior to the visit with upper respiratory symptoms, fatigue, and decreased appetite. Secondary SCLS due to COVID-19 was diagnosed, veno-arterial extracorporeal membrane oxygenation (VA-ECMO) was initiated as mechanical support, and intravenous immunoglobulin was administered, marking the transition to the recovery phase with the initiation of fluid resuscitation. This case is noteworthy for successfully employing VA-ECMO in treating secondary SCLS due to COVID-19, mimicking the course of fulminant myocarditis.