Diagnosis of pneumonia in Intensive Care using colour Doppler.
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ABSTRACT:
SUBMITTER: Gomez Carranza A
PROVIDER: S-EPMC8437797 | biostudies-literature | 2021 Sep
REPOSITORIES: biostudies-literature
Publications
Diagnosis of pneumonia in Intensive Care using colour Doppler.
Gómez Carranza A A Santos Peral A A Ortiz Díaz-Miguel R R
Medicina intensiva 20210913
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Project description: Not available
| S-EPMC9453437 | biostudies-literature
Project description:BackgroundReproductive efficiency is paramount in the dairy industry, where early pregnancy detection of dairy cows will allow to detect the non-pregnant animals early, thus enabling to re-synchronize them and getting them pregnant leading to decrease in calving interval, which, in turn, is critical for maximizing productivity and economic gain. The objective of this study was to evaluate the colour Doppler ultrasonography (CDUS) and peripheral blood leukocytes (PBLs)-based pregnancy-associated biomarker mRNAs expression for the earliest detection of pregnancy status in the dairy cows at post insemination. Intensively managed animals were ovulation synchronized and subjected to timed artificial insemination (TAI). On day 20, corpus luteum blood flow (CLBF) was evaluated using CDUS in 30 cows. The percentage of the incoming blood flow (as an area) of the corpus luteum (CL) was determined using an image analysis software. On day 35, the same operator performed a final pregnancy diagnosis using transrectal ultrasonography to confirm the pregnancy. Blood samples were collected on day 20 and 28 after TAI for biomarkers analysis. The mRNA expression levels of ISG15, MX1, MX2, and PAG9 genes in PBLs were determined by quantitative polymerase chain reaction (qPCR).ResultsThe identified CLBF cutoff point resulted 100% sensitivity and negative predictive value (NPV) in determining non-pregnant status on day 20 in the cows. Overall, MX2 and ISG15 mRNAs showed the most significant (P < 0.05) expression levels in pregnant animals on day 20 and 28 compared to non-pregnant animals. Among them, MX2 showed the highest expression levels on both days, ascertaining it as the better candidate biomarker for the earliest identification of pregnancy.ConclusionsThe CDUS-based CLBF analysis on day 20 after TAI can be potentially used for the early identification of non-pregnancy status in dairy cows and MX2 could be a potential mRNA candidate for the identification of pregnancy in cows. Further studies should be conducted in large scale to validate these findings due to the small sample number used in the current study.
| S-EPMC11661188 | biostudies-literature
Project description:Despite the considerable number of studies reported to date, the causative agents of pneumonia are not completely identified. We comprehensively applied modern and traditional laboratory diagnostic techniques to identify microbiota in patients who were admitted to or developed pneumonia in intensive care units (ICUs). During a three-year period, we tested the bronchoalveolar lavage (BAL) of patients with ventilator-associated pneumonia, community-acquired pneumonia, non-ventilator ICU pneumonia and aspiration pneumonia, and compared the results with those from patients without pneumonia (controls). Samples were tested by amplification of 16S rDNA, 18S rDNA genes followed by cloning and sequencing and by PCR to target specific pathogens. We also included culture, amoeba co-culture, detection of antibodies to selected agents and urinary antigen tests. Based on molecular testing, we identified a wide repertoire of 160 bacterial species of which 73 have not been previously reported in pneumonia. Moreover, we found 37 putative new bacterial phylotypes with a 16S rDNA gene divergence ≥ 98% from known phylotypes. We also identified 24 fungal species of which 6 have not been previously reported in pneumonia and 7 viruses. Patients can present up to 16 different microorganisms in a single BAL (mean ± SD; 3.77 ± 2.93). Some pathogens considered to be typical for ICU pneumonia such as Pseudomonas aeruginosa and Streptococcus species can be detected as commonly in controls as in pneumonia patients which strikingly highlights the existence of a core pulmonary microbiota. Differences in the microbiota of different forms of pneumonia were documented.
| S-EPMC3289664 | biostudies-literature
Project description:Severe pneumonia is one of the common acute diseases caused by pathogenic microorganism infection, especially by pathogenic bacteria, leading to sepsis with a high morbidity and mortality rate. However, the existing bacteria cultivation method cannot satisfy current clinical needs requiring rapid identification of bacteria strain for antibiotic selection. Therefore, developing a sensitive liquid biopsy system demonstrates the enormous value of detecting pathogenic bacterium species in pneumonia patients. In this study, we developed a tool named Species-Specific Bacterial Detector (SSBD, pronounce as 'speed') for detecting selected bacterium. Newly designed diagnostic tools combining specific DNA-tag screened by our algorithm and CRISPR/Cas12a, which were first tested in the lab to confirm the accuracy, followed by validating its specificity and sensitivity via applying on bronchoalveolar lavage fluid (BALF) from pneumonia patients. In the validation I stage, we compared the SSBD results with traditional cultivation results. In the validation II stage, a randomized and controlled clinical trial was completed at the ICU of Nanjing Drum Tower Hospital to evaluate the benefit SSBD brought to the treatment. In the validation stage I, 77 BALF samples were tested, and SSBD could identify designated organisms in 4 hr with almost 100% sensitivity and over 87% specific rate. In validation stage II, the SSBD results were obtained in 4 hr, leading to better APACHE II scores (p=0.0035, ANOVA test). Based on the results acquired by SSBD, cultivation results could deviate from the real pathogenic situation with polymicrobial infections. In addition, nosocomial infections were found widely in ICU, which should deserve more attention. SSBD was confirmed to be a powerful tool for severe pneumonia diagnosis in ICU with high accuracy. National Natural Science Foundation of China. The National Key Scientific Instrument and Equipment Development Project. Project number: 81927808. This study was registered at https://clinicaltrials.gov/ (NCT04178382).
| S-EPMC9605691 | biostudies-literature
Project description:We set out to develop a simple objective test of functional colour vision based on eye movements made in response to moving patterns. We exploit the finding that while the motion of a colour-defined stimulus can be cancelled by adding a low-contrast luminance-defined stimulus moving in the opposite direction, the "equivalent luminance contrast" required for such cancellation is reduced when colour vision is abnormal. We used a consumer-grade infrared eye-tracker to measure eye movements made in response to coloured patterns drifting at different speeds. An automated analysis of these movements estimated individuals' red-green equiluminant point and their equivalent luminance contrast. We tested 34 participants: 23 colour vision normal controls, 9 deuteranomalous and 2 protanomalous individuals. We obtained reliable estimates of strength of directed eye movements (i.e. combined optokinetic and voluntary tracking) for stimuli moving at 16 deg/s and could use these data to classify participants' colour vision status with a sensitivity rate of 90.9% and a specificity rate of 91.3%. We conclude that an objective test of functional colour vision combining a motion-nulling technique with an automated analysis of eye movements can diagnose and assess the severity of protanopia and deuteranopia. The test places minimal demands on patients (who simply view a series of moving patterns for less than 90 s), requires modest operator expertise, and can be run on affordable hardware.
| S-EPMC9095692 | biostudies-literature
Project description:The FilmArray® Pneumonia plus Panel (FAPP) is a new multiplex molecular test for hospital-acquired pneumonia (HAP), which can rapidly detect 18 bacteria, 9 viruses, and 7 resistance genes. We aimed to compare the diagnosis performance of FAPP with conventional testing in 100 intensive care unit (ICU) patients who required mechanical ventilation, with clinically suspected HAP. A total of 237 samples [76 bronchoalveolar lavages (BALDS) and 82 endotracheal aspirates (ETADS) obtained at HAP diagnosis, and 79 ETA obtained during follow-up (ETATT)], were analyzed independently by routine microbiology testing and FAPP. 58 patients had paired BALDS and ETADS. The positivity thresholds of semi-quantified bacteria were 103-104 CFUs/mL or 104 copies/mL for BAL, and 105 CFUs/mL or copies/mL for ETA. Respiratory commensals (H. influenzae, S. aureus, E. coli, S. pneumoniae) were the most common pathogens. Discordant results for bacterial identification were observed in 33/76 (43.4%) BALDS and 36/82 (43.9%) ETADS, and in most cases, FAPP identified one supplemental bacteria (23/33 BALDS and 21/36 ETADS). An absence of growth, or polybacterial cultures, explained almost equally the majority of the non-detections in culture. No linear relationship was observed between bin and CFUs/mL variables. Concordant results between paired BALDS and ETADS were obtained in 46/58 (79.3%) patients with FAPP. One of the 17 resistance genes detected with FAPP (mecA/C and MREJ) was not confirmed by conventional testing. Overall, FAPP enhanced the positivity rate of diagnostic testing, with increased recognition of coinfections. Implementing this strategy may allow clinicians to make more timely and informed decisions.
| S-EPMC7477898 | biostudies-literature
Project description:Clinical features and investigations lack predictive value when diagnosing pneumonia, especially when patients are ventilated and when patients develop ventilator associated pneumonia (VAP). New tools to aid diagnosis are important to improve outcomes. This pilot study examines the potential for metabolic profiling to aid the diagnosis in critical care. In this prospective observational study ventilated patients with brain injuries or pneumonia were recruited in the intensive care unit and serum samples were collected soon after the start of ventilation. Metabolic profiles were produced using 1D 1H NMR spectra. Metabolic data were compared using multivariate statistical techniques including Principal Component Analysis (PCA) and Orthogonal Partial Least Squares Discriminant Analysis (OPLS-DA). We recruited 15 patients with pneumonia and 26 with brain injuries, seven of whom went on to develop VAP. Comparison of metabolic profiles using OPLS-DA differentiated those with pneumonia from those with brain injuries (R2Y=0.91, Q2Y=0.28, p=0.02) and those with VAP from those without (R2Y=0.94, Q2Y=0.27, p=0.05). Metabolites that differentiated patients with pneumonia included lipid species, amino acids and glycoproteins. Metabolic profiling shows promise to aid in the diagnosis of pneumonia in ventilated patients and may allow a more timely diagnosis and better use of antibiotics.
| S-EPMC5405179 | biostudies-literature
Project description:BackgroundHospital-acquired and ventilator-associated-pneumonia (HAP/VAP) are one of the most prevalent health-care associated infections in the intensive care unit (ICU). Culture-independent methods were therefore developed to provide faster route to diagnosis and treatment. Among these, metagenomic next-generation sequencing (mNGS) has shown considerable promise.MethodsThis proof-of-concept study describes the technical feasibility and evaluates the clinical validity of the mNGS for the detection and characterization of the etiologic agents causing hospital-acquired and ventilator-associated pneumonia. We performed a prospective study of all patients with HAP/VAP hospitalized in our intensive care unit for whom a bronchoalveolar lavage (BAL) was performed between July 2017 and November 2018. We compared BAL fluid culture and mNGS results of these patients.ResultsA total of 32 BAL fluids were fully analyzed. Of these, 22 (69%) were positive by culture and all pathogens identified were also reported by mNGS. Among the culture-positive BAL samples, additional bacterial species were revealed by mNGS for 12 patients, raising the issue of their pathogenic role (colonization versus coinfection). Among BALF with culture-negative test, 5 were positive in mNGS test.ConclusionsThis study revealed concordant results for pneumonia panel pathogens between mNGS and culture-positive tests and identified additional pathogens potentially implicated in pneumonia without etiologic diagnosis by culture. mNGS has emerged as a promising methodology for infectious disease diagnoses to support conventional methods. Prospective studies with real-time mNGS are warranted to examine the impact on antimicrobial decision-making and clinical outcome.
| S-EPMC10648381 | biostudies-literature
Project description:ObjectiveChronic cerebrospinal venous insufficiency (CCSVI) has been extremely variable, associated with multiple sclerosis in colour-Doppler sonographic studies. We aimed to evaluate inter-rater agreement in a colour-Doppler sonography venous examination.DesignInter-rater agreement study.SettingFirst-referral multiple sclerosis centre.Participants38 patients with multiple sclerosis and 55 age-matched (±5 years) controls.InterventionSonography was carried out in accordance with Zamboni's five criteria by eight sonographers with different expertise, blinded to the status of cases and controls. Each participant was evaluated by two operators.Primary and secondary outcome measuresInter-rater agreement was measured through the κ statistics and the intraclass correlation coefficient.ResultsThe agreement was no higher than chance for criterion 2-reflux in the deep cerebral veins (κ=-0.02) and criterion 4-flow not Doppler detectable in one or both the internal jugular veins (IJVs) or vertebral veins (VVs; -0.09). It was substantially low for criterion 1-reflux in the IJVs and/or VVs (0.29), criterion 3-IJV stenosis or malformations (0.23) and criterion 5-absence of IJV diameter increase when passing from the sitting to the supine position (0.22). The κ value for CCSVI as a whole was 0.20 (95% confidence limit -0.01 to 0.42). Intraclass correlation coefficients for the measure of cross-sectional area ranged from 0.05 to 0.25. Inter-rater agreement was low for CCSVI experts (κ=0.24; -0.11 to 0.59) and non-experts (0.20; -0.33 to 0.73); neurologists (0.21; -0.06 to 0.47) and non-neurologists (0.18; -0.20 to 0.56); cases (0.19; -0.14 to 0.52) and controls (0.21; -0.08 to 0.49). Zamboni-trained neurosonographers ascertained CCSVI more frequently than the non-trained neurosonographers.ConclusionsAgreement was unsatisfactory for the diagnosis of CCSVI as a whole, for each of its five criteria and according to the different subgroups. Standardisation of the method is urgently needed prior to its further application in studies of patients with multiple sclerosis or other neurological diseases.
| S-EPMC3831103 | biostudies-literature