Torahiko Jinta

Digital Clubbing Is Associated with Higher Serum KL-6 Levels and Lower Pulmonary Function in Patients with Interstitial Lung Disease

Background Although digital clubbing is a common presentation in patients with interstitial lung disease (ILD), little has been reported regarding its role in assessing patients with ILD. This study evaluated patients with ILD for the presence of clubbing and investigated its association with clinical data. Methods We evaluated patients with ILD who visited the teaching hospital at which the study was conducted, between October 2014 and January 2015. Clubbing, evaluated using a Vernier caliper for individual patients, was defined as a phalangeal depth ratiou2009>u20091. We examined the association of clubbing with clinical data. Results Of 102 patients with ILD, we identified 17 (16.7%) with clubbing. The partial pressure of oxygen in arterial blood was lower (65.2u2009±u20095.9u2009mmHg versus 80.2u2009±u20093.1u2009mmHg; p=0.03), serum Krebs von den Lugen-6 (KL-6) levels were higher (1495.0u2009±u2009277.4u2009U/mL versus 839.1u2009±u200970.2u2009U/mL; p=0.001), and the percent predicted diffusing capacity of carbon monoxide was lower (50.0u2009±u20096.0 versus 73.5u2009±u20093.1; p=0.002) in these patients with clubbing. Conclusions Patients with clubbing had lower oxygen levels, higher serum KL-6 levels, and lower pulmonary function than those without clubbing.

Efficacy of early switch from intravenous to oral antimicrobials in patients with aspiration pneumonia: A prospective observational study

BACKGROUNDnPrevious reports have documented the efficacy of an early switch from intravenous to oral antimicrobials in community-acquired pneumonia, but not aspiration pneumonia. Therefore, we assessed the feasibility and efficacy of these newly developed criteria for community-acquired pneumonia in patients with aspiration pneumonia.nnnMETHODSnThis prospective observational study included consecutive patients admitted with aspiration pneumonia over a 10-month period at St. Lukes International Hospital; we excluded patients that required intensive care. The criteria for an early switch were stability of vital signs (temperature ≤ 38 °C; respiratory rate ≤ 24 breaths/min; pulse rate ≤ 100 beats/min for >24 h) and a successful swallow evaluation (repetitive saliva swallowing test score ≥ 2; modified water swallowing test score ≥ 4). Our primary endpoint was successful completion of antimicrobial treatment 30 days after the switch, without reversion to intravenous antimicrobials. Our anticipated success rate was set as 60-75%, based on a previous study.nnnRESULTSnOf the 70 patients admitted with aspiration pneumonia, 32 (45.7%) were excluded, and 38 (54.3%) met the inclusion criteria. Of these 38 patients, 29 (76.3%) met the switch criteria. The median duration of hospital stay for the included patients was 16 (5-30) days and 30 (12-68) days, respectively (P=0.03). Among patients who met the switch criteria, 26 (89.7%) completed oral treatment successfully while 3 (10.3%) reverted to intravenous antimicrobials.nnnCONCLUSIONSnApproximately 75% of patients met the switch criteria; of these, nearly 90% underwent safe conversion to oral therapy. These results demonstrate the efficacy and feasibility of our switch criteria.

Organising pneumonia after near-drowning.

A 38 year-old female with no significant medical history was transferred to a medical centre in Hawaii after near-drowning at the beach. She was noted to have increasing shortness of breath. Subsequently she was placed on non-invasive ventilation and then intubated for respiratory support. She was thought to have early stage acute respiratory distress syndrome after sea water aspiration. By multidisciplinary treatment, she was able to be extubated successfully on hospital day 5, and then flew back to Japan. When visiting our hospital in Japan, further examinations were conducted for prolonged respiratory symptoms and pulmonary infiltrates by CT. A specimen obtained by transbronchial lung biopsy revealed organising pneumonia which was thought to be related to sea water aspiration. Methylprednisolone treatment resolved her respiratory symptoms and pulmonary infiltrates.