Made by DATEXIS (Data Science and Text-based Information Systems) at Beuth University of Applied Sciences Berlin
Deep Learning Technology: Sebastian Arnold, Betty van Aken, Paul Grundmann, Felix A. Gers and Alexander Löser. Learning Contextualized Document Representations for Healthcare Answer Retrieval. The Web Conference 2020 (WWW'20)
Funded by The Federal Ministry for Economic Affairs and Energy; Grant: 01MD19013D, Smart-MD Project, Digital Technologies
A 2014 systematic review of clinical trials does not support using routine rapid viral testing to decrease antibiotic use for children in emergency departments. It is unclear if rapid viral testing in the emergency department for children with acute febrile respiratory infections reduces the rates of antibiotic use, blood testing, or urine testing. The relative risk reduction of chest x-ray utilization in children screened with rapid viral testing is 77% compared with controls. In 2013 researchers developed a breath tester that can promptly diagnose lung infections.
The diagnosis is usually suspected following a CT scan. Typical features on CT include solid and sub-solid nodules, ground glass change and reticulation. There may be features of multi-system involvement such as adenopathy and splenomegaly.
The commonest abnormality on lung function testing is a decrease in gas transfer. Both obstructive and restrictive patterns on spirometry have been reported.
The differential diagnosis includes infection, other interstitial lung diseases and malignant disease including lymphoma. Exclusion of infection is therefore an important step in management, but confirmation of the diagnosis requires lung biopsy. In people who have lung disease prior to a diagnosis of CVID, the differential diagnosis includes sarcoidosis. Sarcoid is also characterised by granulomatous involvement of the lung and therefore patients being investigated for sarcoid should have serum immunoglobulins measured to exclude CVID.
Normal surgical masks and N95 masks appear equivalent with respect to preventing respiratory infections.
Respiratory diseases may be investigated by performing one or more of the following tests
- Biopsy of the lung or pleura
- Blood test
- Bronchoscopy
- Chest x-ray
- Computed tomography scan, including high-resolution computed tomography
- Culture of microorganisms from secretions such as sputum
- Ultrasound scanning can be useful to detect fluid such as pleural effusion
- Pulmonary function test
- Ventilation—perfusion scan
Respiratory disease is a common and significant cause of illness and death around the world. In the US, approximately 1 billion "common colds" occur each year. A study found that in 2010, there were approximately 6.8 million emergency department visits for respiratory disorders in the U.S. for patients under the age of 18. In 2012, respiratory conditions were the most frequent reasons for hospital stays among children.
In the UK, approximately 1 in 7 individuals are affected by some form of chronic lung disease, most commonly chronic obstructive pulmonary disease, which includes asthma, chronic bronchitis and emphysema.
Respiratory diseases (including lung cancer) are responsible for over 10% of hospitalizations and over 16% of deaths in Canada.
In 2011, respiratory disease with ventilator support accounted for 93.3% of ICU utilization in the United States.
1)positive tuberclin test
2)chest radiograph
3)CT scan
4)cytology/biopsy (FNAC)
5)AFB staining
6)mycobacterial culture
There is very little information written by, and for patients with GLILD. However, interest in the condition is increasing and multi-centre studies such as STILPAD are in progress.
Primary diagnosis usually starts off with a thorough physical exam and evaluation of medical history. To further investigate, a dermoscope, a diagnostic tool, is used by the dermatologist to examine the skin using a magnified lens. A complete blood count (CBC) along with other blood tests can also be done to rule out any sort of other infections. Lastly, a skin biopsy test may be ordered to arrive at a definitive diagnosis. This pathological examination of the skin biopsy helps to arrive at the correct diagnosis via a fungal culture(mycology). The biopsy is put together with clinical and microscope findings and study of the special tissues if need be. The signs and symptoms of MG are similar to many other clinical conditions and therefore it is necessary to perform all of the additional tests in order for a physician to correctly rule out all other possible diagnoses.
Diagnosis is often made by visualization of yeast cells in tissue, or superficial scrapings. Radiography of the chest reveals interstitial infiltrates in the majority of cases.
The exact cause of Majocchi's granuloma is not well established however a dysfunctinoal immune system may be a causative factor. The first form of MG, the superficial perifollicular form occurs predominately on the legs of otherwise healthy young women who repeatedly shave their legs and develop hair follicle occlusions that directly or indirectly disrupt the follicle and allow for passive introduction of the organism into the dermis. Hence, the physical barrier of the skin is important because it prevents the penetration of microorganisms. Physical factors that play a major role in inhibiting dermal invasion include the interaction among keratin production, the rate of epidermal turnover, the degree of hydration and lipid composition of the stratum corneum, CO levels, and the presence or absence of hair. Keratin and/or necrotic material can also be introduced into the dermis with an infectious organism to further enhance the problem. In immunocompromised individuals, the use of topical corticosteroids may lead to a dermatophyte infection due to local immunosuppression.
Incision drainage with proper evacuation of the fluid followed by anti-tubercular medication.
Antibiotics do not help the many lower respiratory infections which are caused by parasites or viruses. While acute bronchitis often does not require antibiotic therapy, antibiotics can be given to patients with acute exacerbations of chronic bronchitis. The indications for treatment are increased dyspnoea, and an increase in the volume or purulence of the sputum. The treatment of bacterial pneumonia is selected by considering the age of the patient, the severity of the illness and the presence of underlying disease. Amoxicillin and doxycycline are suitable for many of the lower respiratory tract infections seen in general practice.
Lower respiratory tract infections place a considerable strain on the health budget and are generally more serious than upper respiratory infections.
Screening tools for contact granulomas are not currently available. Diagnosis of contact granulomas require visualization using laryngoscopy, and may require further biopsy for differential diagnosis. A combination of symptoms and lifestyle factors may be linked with the development of a contact granuloma, however symptoms vary greatly by individual. Some lifestyle factors that have been linked with elevated risk of development of contact granulomas include frequent use of the voice, especially when in loud environments, and concurrent use of the voice with alcohol consumption (increasing risk of gastroesophageal reflux symptoms). Contact granuloma may also arise after intubation, and so following intubation, patients should be monitored if voice symptoms arise. Symptoms may or may not include hoarse voice, described as "huskiness" by some patients, "aching" in the throat related to increased effort to produce voice, and the feeling of having a lump in one's throat when swallowing. It is also possible to have no such symptoms, especially if the granuloma is small. A patient presenting with such symptoms or risk factors should therefore be referred for further visualization. It is therefore recommended to obtain a diagnosis from a doctor.
Pulmonary aspiration resulting in pneumonia, in some patients, particularly those with physical limitations, can be fatal.
Aspiration pneumonia is typically caused by aspiration of bacteria from the oral cavity into the lungs, and does not result in the formation of granulomas. However, granulomas may form when food particles or other particulate substances like pill fragments are aspirated into the lungs. Patients typically aspirate food because they have esophageal, gastric or neurologic problems. Intake of drugs that depress neurologic function may also lead to aspiration. The resultant granulomas are typically found around the airways (bronchioles) and are often accompanied by foreign-body-type multinucleated giant cells, acute inflammation or organizing pneumonia. The finding of food particles in lung biopsies is diagnostic.
In hospitalised patients who develop respiratory symptoms and fever, one should consider the diagnosis. The likelihood increases when upon investigation symptoms are found of respiratory insufficiency, purulent secretions, newly developed infiltrate on the chest X-Ray, and increasing leucocyte count. If pneumonia is suspected material from sputum or tracheal aspirates are sent to the microbiology department for cultures. In case of pleural effusion thoracentesis is performed for examination of pleural fluid. In suspected ventilator-associated pneumonia it has been suggested that bronchoscopy(BAL) is necessary because of the known risks surrounding clinical diagnoses.
In more severe cases, it is treated by administering intravenous antibiotics and may require admission to an intensive care unit (ICU) for intubation and supportive ventilation if the airway swelling is severe. During an intensive care admission, various methods of invasive and non-invasive monitoring may be required, which may include ECG monitoring, oxygen saturation, capnography and arterial blood pressure monitoring.
The lungs are normally protected against aspiration by a series of "protective reflexes" such as coughing and swallowing. Significant aspiration can only occur if the protective reflexes are absent or severely diminished (in neurological disease, coma, drug overdose, sedation or general anesthesia). In intensive care, sitting patients up reduces the risk of pulmonary aspiration and ventilator-associated pneumonia.
Measures to prevent aspiration depend on the situation and the patient. In patients at imminent risk of aspiration, tracheal intubation by a trained health professional provides the best protection. A simpler intervention that can be implemented is to lay the patient on their side in the recovery position (as taught in first aid and CPR classes), so that any vomitus produced by the patient will drain out their mouth instead of back down their pharynx. Some anesthetists will use sodium citrate to neutralize the stomach's low pH and metoclopramide or domperidone (pro-kinetic agents) to empty the stomach.
People with chronic neurological disorders, for example, after a stroke, are less likely to aspirate thickened fluids.
The location of abscesses caused by aspiration depends on the position one is in. If one is sitting or standing up, the aspirate ends up in the posterior basal segment of the right lower lobe. If one is on one's back, it goes to the superior segment of the right lower lobe. If one is lying on the right side, it goes to the posterior segment of the right upper lobe, or the posterior basal segment of the right upper lobe. If one is lying on the left, it goes to the lingula.
Various methods are used to diagnose contact granuloma which aid in differentiating it from other vocal fold pathology. Laryngoscopy can allow visualization of the suspected granuloma while also checking for signs of vocal abuse. Laryngoscopy, as well as an acoustic analysis of the voice, can help rule out vocal fold paresis as an underlying cause. Microscopic examination of the tissue can help determine that the lesion is benign rather than cancerous, as would be the case in contact granuloma. Other methods such as laryngeal electromyography and reflux testing can also be used to evaluate the function of the vocal folds and determine if laryngopharyngeal reflux is contributing to the pathology.
The basis of management is to find and correct the underlying cause. Many times cats with EGC will respond to treatment with corticosteroids or to ciclosporin.
Little is known in terms of effective means of prevention. Due to the low likelihood of transmission even from an infected mother, it is not recommended to expose the mother and child to the additional risks of caesarean section to prevent the transmission of this disease during vaginal childbirth. Opting for a caesarean section does not guarantee that transmission will not still occur.
According to a Cochrane review, single oral dose of nasal decongestant in the common cold is modestly effective for the short term relief of congestion in adults; however, "there is insufficient data on the use of decongestants in children." Therefore, decongestants are not recommended for use in children under 12 years of age with the common cold. Oral decongestants are also contraindicated in patients with hypertension, coronary artery disease, and history of bleeding strokes.
The granulomas of tuberculosis tend to contain necrosis ("caseating tubercules"), but non-necrotizing granulomas may also be present. Multinucleated giant cells with nuclei arranged like a horseshoe (Langhans giant cell) and foreign body giant cells are often present, but are not specific for tuberculosis. A definitive diagnosis of tuberculosis requires identification of the causative organism by microbiologic cultures.
There is no good evidence supporting the effectiveness of over-the-counter cough medications for reducing coughing in adults or children. Children under 2 years old should not be given any type of cough or cold medicine due to the potential for life-threatening side effects. In addition, according to the American Academy of Pediatrics, the use of cough medicine to relieve cough symptoms should be avoided in children under 4 years old, and the safety is questioned for children under 6 years old.