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Cui K, Mao Y, Feng S, Luo H, Yang J, Bai L. Development and Validation of a Risk Mortality Prediction Model for Patients with Pulmonary Tuberculosis Complicated by Severe Community-Acquired Pneumonia in the Intensive Care Unit. Infect Drug Resist 2024; 17:3113-3124. [PMID: 39050825 PMCID: PMC11268563 DOI: 10.2147/idr.s459290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 07/05/2024] [Indexed: 07/27/2024] Open
Abstract
Purpose The mortality rate from pulmonary tuberculosis (PTB) complicated by severe community-acquired pneumonia (SCAP) in the intensive care unit (ICU) remains high. We aimed to develop a rapid and simple model for the early assessment and stratification of prognosis in these patients. Patients and Methods All adult patients with PTB complicated by SCAP admitted to the ICU of a tertiary hospital in Chengdu, Sichuan, China between 2019 and 2021 (development cohort) and 2022 (validation cohort) were retrospectively included. Data on demographics, comorbidities, laboratory values, and interventions were collected. The outcome was the 28-day mortality. Stepwise backward multivariate Cox analysis was used to develop a mortality risk prediction score model. Receiver operating characteristic (ROC) and calibration curves were used to evaluate the model's predictive efficiency. Decision curve analysis (DCA) was used to validate the model's clinical value and impact on decision making. Results Overall, 357 and 168 patients were included in the development and validation cohorts, respectively. The Pulmonary Tuberculosis Severity Index (PTSI) score included long-term use of glucocorticoid, body mass index (BMI) <18.5 kg/m2, diabetes, blood urea nitrogen (BUN) ≥7.14 mmol/L, PO2/FiO2 <150 mmHg, and vasopressor use. The area under the ROC curve (AUC) values were 0.817 (95% CI: 0.772-0.863) and 0.814 for the development and validation cohorts, respectively. The PTSI score had a higher AUC than the APACHE II, SOFA, and CURB-65 score. The calibration curves indicated good calibration in both cohorts. The DCA of the PTSI score indicated the high clinical application of the model compared with the APACHE II and SOFA scores. Conclusion This prognostic tool was designed to rapidly evaluate the 28-day mortality risk in individuals with PTB complicated by SCAP. It can stratify this patient group into relevant risk categories, guide targeted interventions, and enhance clinical decision making, thereby optimizing patient care and improving outcomes.
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Affiliation(s)
- Kunping Cui
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, People’s Republic of China
| | - Yi Mao
- Intensive Care Unit, Public Health Clinical Center of Chengdu, Chengdu, Sichuan, 610000, People’s Republic of China
| | - Shuang Feng
- Ultrasonic Medicine, Public Health Clinical Center of Chengdu, Chengdu, Sichuan, 610000, People’s Republic of China
| | - Haixia Luo
- Intensive Care Unit, Public Health Clinical Center of Chengdu, Chengdu, Sichuan, 610000, People’s Republic of China
| | - Jiao Yang
- Intensive Care Unit, Public Health Clinical Center of Chengdu, Chengdu, Sichuan, 610000, People’s Republic of China
| | - Lang Bai
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, People’s Republic of China
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Jamaati H, Bahrami N, Daustany M, Tabarsi P, Farzanegan B, Hashemian SM, Mohamadnia A. Investigating PIK 3R 3 and ATp 2A 1 Genes Expressions in Ventilator-Associated Pneumonia Patients Admitted to the Intensive Care Unit of Masih Daneshvari Hospital in 2016. Rep Biochem Mol Biol 2018; 6:118-124. [PMID: 29765993 PMCID: PMC5941122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 10/09/2016] [Indexed: 06/08/2023]
Abstract
BACKGROUND Infectious diseases such as ventilator- associated pneumonia (VAP) are one of the serious problems in intensive care units (ICU) of hospitals. To date, there has been no appropriate clinical and diagnostic marker for early detection of this disease. In this study, expression of PIK3R3 and ATp2A1 genes in patients with VAP were assessed to be used as biomarkers to identify and confirm the disease. METHODS This study was conducted by using peripheral blood samples of 60 individuals, including 30 patients with VAP and 30 healthy volunteers. First, the peripheral blood samples were taken and then RNA was extracted and converted into cDNA. Finally, the assessment of genes was performed by Real-time PCR. RESULTS In peripheral blood samples, 46.6% and 30% were positive for PIK3R3 expression in patients and healthy groups, respectively. The ATp2A1 expression in patients and healthy controls were found 40% and 23.3%, respectively. Comparing the ΔCT obtained for the PIK3R3 and ATp2A1 genes showed statistically significant differences between the two groups of patients and healthy subjects (p=0.042, p=0.036). CONCLUSION ATp2A1 and PIK3R3 may be used as biomarkers for early detection of VAP disease. However, further studies are required.
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Affiliation(s)
- Hamidreza Jamaati
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Naghmeh Bahrami
- Craniomaxillofacial Research center, Tehran University of Medical Sciences, Tehran, Iran. Oral and Maxillofacial Surgery Department, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mahya Daustany
- Department of Biotechnology, Faculty of Sciences, Islamic Azad University, Tehran, Iran.
| | - Payam Tabarsi
- Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Behrooz Farzanegan
- Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Seyed Mohammadreza Hashemian
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Abdolreza Mohamadnia
- Virology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran. Department of Biotechnology, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Khoundabi B, Kazemnejad A, Mansourian M, Hashemian SM, Kazempoor Dizaji M. Acute Kidney Injury Risk Factors For ICU Patients Following Cardiac Surgery: The Application of Joint Modeling. Trauma Mon 2016; 21:e23749. [PMID: 28180122 PMCID: PMC5282936 DOI: 10.5812/traumamon.23749] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Revised: 11/12/2014] [Accepted: 11/18/2014] [Indexed: 12/29/2022] Open
Abstract
Background Admission to the ICU (intensive care unit) is frequently complicated by early AKI (acute kidney injury). The development of AKI following cardiac surgery is particularly associated with increased mortality and morbidity. According to AKIN (acute kidney injury network) criteria, UO (urinary output) is a predictor for AKI. Objectives The goal of this study was to determine the effects of some AKI risk factors on AKI and also to investigate changes in UO as a predictor of AKI using joint modeling. Patients and Methods In a retrospective study, 300 cardiac-operated patients, who had been admitted over a period of three years, were selected according to the consecutive sample selection method, using the ICU at Masih Daneshvari Hospital in Iran as a referral center. The random mixed effect model and the survival model were used to investigate UO changes and estimate the effect of UO and other risk factors on the hazard rate of AKI in a joint analysis. Results AKI occurred in 38.0% of patients. A significant decrease of UO occurred more often in female and infected patients, as well as those with a low DBP (diastolic blood pressure). The survival model showed that the risk of AKI in females, older patients and patients with low DBP, lower UO and with infection was higher (P = 0.001). Using joint modeling, the association parameter between the risk of AKI and UO was estimated (-0.3, P = 0.002). Conclusions Where there is a relationship between two longitudinal and survival responses, joint modeling can estimate it.
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Affiliation(s)
- Batoul Khoundabi
- Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, IR Iran
| | - Anoshirvan Kazemnejad
- Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, IR Iran
- Corresponding author: Anoshirvan Kazemnejad, Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, IR Iran. Tel: +98-2182883875, Fax: +98-2188006544, E-mail:
| | - Marjan Mansourian
- Department of Epidemiology and Biostatistics, School of Public health , Isfahan University of Medical Sciences, Isfahan, IR Iran
| | - Seyed Mohammadreza Hashemian
- Critical Care, Chronic Respiratory Disease Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Mehdi Kazempoor Dizaji
- Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, IR Iran
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Dabiri Y, Fahimi F, Jamaati H, Hashemian SMR. The comparison of extemporaneous preparations of omeprazole, pantoprazole oral suspension and intravenous pantoprazole on the gastric pH of critically ill-patients. Indian J Crit Care Med 2015; 19:21-6. [PMID: 25624646 PMCID: PMC4296406 DOI: 10.4103/0972-5229.148635] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background: Stress-related mucosal disease occurs in many critically ill-patients within 24 h of admission. Proton pump inhibitor therapy has been documented to produce more potent inhibition of gastric acid secretion than histamine 2 receptor antagonists. This study aimed to compare extemporaneous preparations of omeprazole, pantoprazole oral suspension and intravenous (IV) pantoprazole on the gastric pH in intensive care unit patients. Materials and Methods: This was a randomized single-blind-study. Patients of ≥ 16 years of age with a nasogastric tube, who required mechanical ventilation for ≥ 48 h, were eligible for inclusion. The excluded patients were those with active gastrointestinal bleeding, known allergy to omeprazole and pantoprazole and those intolerant to the nasogastric tube. Fifty-six patients were randomized to treatment with omeprazole suspension 2 mg/ml (40 mg every day), pantoprazole suspension 2 mg/ml (40 mg every day) and IV pantoprazole (40 mg every day) for up to 14 days. Gastric aspirates were sampled before and 1-2.5 h after the drug administration for the pH measurement using an external pH meter. Data were analyzed using SPSS (version 21.0). Results: In this study, 56 critically ill-patients (39 male, 17 female, mean age: 61.5 ± 15.65 years) were followed for the control of the gastric pH. On each of the 14 trial days the mean of the gastric pH alteration was significantly higher in omeprazole and pantoprazole suspension-treated patients than in IV pantoprazole-treated patients (P < 0.001). Conclusion: Omeprazole and pantoprazole oral suspension are more effective than IV pantoprazole in increasing the gastric pH.
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Affiliation(s)
- Yasamin Dabiri
- Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fanak Fahimi
- Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran ; Chronic Respiratory Disease Research Center, National Research Institute of Tuberculosis and Lung Diseases, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamidreza Jamaati
- Tobacco Prevention and Control Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Mohammad Reza Hashemian
- Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Totonchi Z, Jalili F, Hashemian SM, Jabardarjani HR. Tracheal Stenosis and Cuff Pressure: Comparison of Minimal Occlusive Volume and Palpation Techniques. TANAFFOS 2015; 14:252-6. [PMID: 27114727 PMCID: PMC4841992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 08/01/2015] [Indexed: 10/27/2022]
Abstract
BACKGROUND Tracheal stenosis, which has received more emphasis recently, is a common post intubation complication and may develop due to different reasons. One important reason is the endotracheal tube cuff pressure. Therefore, this study sought to examine the accuracy of diagnostic test for palpation and minimal occlusive volume techniques to measure the endotracheal tube cuff pressure. MATERIALS AND METHODS In this cross sectional study, the accuracy of diagnostic tests for palpation and minimal occlusive volume techniques to measure the endotracheal tube cuff pressure was assessed in 101 patients aged over 18 years who had undergone open heart surgery and post-surgical mechanical ventilation in the ICU. RESULTS In the palpation technique, the cuff pressure of 27 patients (26.7%) was reported to be out of the permissible range and for the rest of them (74 patients, 73.3%) it was within the permissible range. Then, the cuff pressure was checked by the standard method using a manometer and after comparing the results it was found that the cuff pressure of 92 patients (91.1%) was not in the permissible range and only nine patients (8.9%) had a cuff pressure within the permissible range (20-30 cm H2O). In minimal occlusive volume method compared with the standard method, 22 patients (21.7%) had cuff pressure within the permissible range of 20-30 cm H2O, and 79 of them (78.2%) had cuff pressure out of the permissible range and higher than the upper limit. CONCLUSION This study recommends that the best way to measure the endotracheal tube cuff pressure is to use a cuff manometer, and when it is not available, the minimal occlusive volume would be a better alternative compared to the palpation technique to keep the cuff pressure within a proper range to avoid tracheotomy complications such as tracheal stenosis.
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Affiliation(s)
- Ziae Totonchi
- Rajaei Cardiovascular Medical & Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Jalili
- Rajaei Cardiovascular Medical & Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Mohammadreza Hashemian
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Reza Jabardarjani
- Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Jamaati HR, Heshmat B, Tamadon R, Rad AH, Mohajerani SA, Radmand G, Hashemian SMR. Association between Severity of Chronic Obstructive Pulmonary Disease and Lung Function Tests. TANAFFOS 2013; 12:36-41. [PMID: 25191448 PMCID: PMC4153230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/05/2012] [Accepted: 11/10/2012] [Indexed: 11/20/2022]
Abstract
BACKGROUND The burden of chronic obstructive pulmonary disease (COPD) is quite high and its prevalence is increasing. We aimed to evaluate the correlation of COPD severity according to the American Thoracic Society (ATS) criteria with spirometric measurements in patients admitted to the emergency ward. MATERIALS AND METHODS In this cross-sectional descriptive study, 50 randomly selected patients with COPD admitted to the emergency ward in a tertiary care center were evaluated. The COPD severity according to the ATS criteria was measured and its association with spirometric findings was evaluated. The statistical analysis was performed by SPSS software and the Kendall's tau-b correlation test. RESULTS The mean age (±standard deviation) was 64.3 ± 11.3 years. Twelve percent were females and 88 percent were males. The COPD severity, according to the ATS criteria, was mild in 16%, moderate in 48%, severe in 32% and very severe in four percent. There was a statistically significant correlation between total lung capacity (TLC) and COPD severity (P = 0.013, r = 275). Besides, there was a statistically significant correlation between functional residual capacity (FRC) and COPD severity (P = 0.022, r = 255). Age, sex, and the other spirometric findings especially FEV1 and FVC had no association with COPD severity (P > 0.05). CONCLUSION According to the obtained results, it is concluded that determining the COPD severity according to the ATS criteria may help the physicians to estimate the patients' prognosis and therapeutic planning. However, the spirometric measurements may not be replaced by ATS criteria.
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Affiliation(s)
| | | | | | | | | | | | - Seyed Mohammad Reza Hashemian
- Chronic Respiratory Disease Research Center, National Research Institute of Tuberculosis & Lung Disease, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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