Slowly resolving, chronic, and recurrent pneumonia.

Slowly resolving, chronic, and recurrent pneumonias are clinical patterns that are often misunderstood and mistreated. This article reviews the natural history, clinical presentation, roentgenography, bacteriology, and relation to underlying illnesses of each of these atypical forms of community-acquired pneumonia. Standard definitions are presented and provide the physician with a means to classify the pneumonias. Appropriate diagnostic evaluation and therapy are also discussed.     

Langerhans cells and serum precipitating antibodies against fungal antigens in bronchioloalveolar cell carcinoma: possible association with pulmonary eosinophilic granuloma

In an ultrastructural study of 37 cases of bronchioloalveolar cell carcinoma (BAC), we identified seven cases (19%) in which Langerhans cells (LC) were closely associated with tumor cells. Serum precipitating antibodies against Aspergillus species and/or thermophilic actinomyces were present in five BAC patients whose tumors contained LC and in six patients whose tumors lacked LC. In a simultaneous study we identified marked atypical bronchiolar and alveolar lining cell hypertrophy and hyperplasma in pulmonary eosinophilic granuloma (PEG). Our data plus current information suggesting that PEG is a form of hypersensitivity pneumonitis support our hypothesis that those cases of BAC in which LC are present may arise in localized or diffuse pulmonary scars caused by PEG.     

The Creation of a Program of Engagement and Outreach for COVID-19 Among African Americans Through Community-Academic Partnerships

Journal of Community Health - The COVID-19 pandemic has disproportionately affected racial and ethnic minority groups in the U.S. Over a 7-week period in late 2020, with funding from the NC Office...     

Arteriogenese

The remodeling of pre-existing arterioles into functional collateral vessels after occlusion of an artery is termed arteriogenesis. Understanding the molecular mechanisms of collateral growth provides an opportunity for therapeutic stimulation of this natural process and is the aim of arteriogenesis research. This beneficial vascular remodeling is associated with the proliferation of smooth muscle cells (SMC), which leads to an increase of the vascular lumen as well as wall thickness. In animal studies, a ligature of the femoral artery induces arteriogenesis. Subsequent tissue isolation of the collateral arteries allows molecular investigations in order to find the initial trigger of arteriogenesis. Differentially expressed genes, which have been identified in a genome-wide screening of growing collaterals, can be analyzed in terms of significance by targeted gene knock out. To further specify genetic modifications to the vascular wall, gene-targeting strategies that knock out target genes exclusively in a desired tissue while others remain unaffected have been established.     

New diagnostic approaches to the hospitalized patient with pneumonia

The accurate diagnosis of pneumonia remains a formidable challenge in clinical medicine. The use of sputum, blood, and pleural fluid cultures provides a diagnosis in less than 50% of patients. A number of invasive techniques have recently been applied to the diagnosis of pneumonia. The methods are uniformly designed to separate upper respiratory saprophytic bacterial populations from the organisms responsible for the lower respiratory infection. Preeminent among these techniques is the use of fiberoptic bronchoscopy coupled with quantitative bacterial culture and immunofluorescence demonstration of antibody-coated bacteria. The methodology and results of this technique are described in detail in this paper. Recent clinical experience using transtracheal aspiration, percutaneous needle aspiration of the lung, and open lung biopsy are also reviewed.     

The role of penicillin-induced bacterial variants in experimental pyelonephritis

1. After injection into the renal medulla of rats Escherichia coli 06 variants reverted rapidly in vivo in the absence of penicillin. These variants had previously been shown to be stable in vitro. 2. Variants failed to survive following intramedullary injection when animals were receiving penicillin. 3. Late reversion of variants also failed to occur in animals treated with penicillin for only 1 or 2 days. 4. Variants survived and reverted more readily when injected in the renal medulla, compared with liver and spleen. Classical bacteria injected into the kidney, liver, and spleen were recovered in approximately equal numbers. 5. The histologic response to nonreverting variants, medium not containing variants, and killed variants was similar and was characterized by a fibrotic reaction with moderate round cell infiltration. 6. In contrast, the histologic response to reverting variants and to classical E. coli was characterized by an intense, acute, polymorphonuclear leukocytosis typical of acute pyelonephritis.     

Aspergillose of the maxillary sinuses in otherwise healthy patients.

There is an increasing number of reports of fungal infections of the nose and paranasal sinuses, due in part to increasing recognition of this condition in both healthy and immunologically depressed patients. Three cases of aspergillosis of the maxillary sinus are presented, one of which demonstrates bone destruction in an otherwise healthy individual. In diagnosing aspergillosis sinusitis it is important to submit material for microscopic examination, as cultures are often negative for fungus. Treatment consists of surgery to establish good aeration and drainage with the addition of antifungal drugs in selected cases.     

A longitudinal study of a pediatric practice-based versus an agency-based model of care coordination for children and youth with special health care needs

Background Care coordination has been shown to improve the quality of care for children and youth with special health care needs (CYSHCN). However, there are different models for structuring care coordination in relation to the medical home and most Title V agencies use an agency-based model of care coordination. No studies have prospectively compared a practice-based care coordination model to a Title V agency-based care coordination model. Objective Report the results of a prospective cohort study comparing a practice-based nurse care coordinator model with Title V agency-based care coordination model. Design/Methods Three pediatric practices received the intervention, placement of a nurse care coordinator onsite within the practice, along with training and quality improvement on the principles of the medical home. Three practices continued to rely on agency-based care coordination services. CYSHCN in the practices were identified, interviewed at baseline, and re-interviewed after 18 months. We interviewed 262 families/children at baseline and 144 families/children (76 in the intervention and 68 in the comparison group) at 18 months. Families rated the quality of services they received from the care coordinator and the pediatric practice, and their experience of barriers to services for their CYSHCN. Results Families in the practice-based care coordination group were more likely to report improvement in their experience with the care coordinator (P = 0.02), fewer barriers to needed services (P = 0.003), higher overall satisfaction with care coordination (P = 0.03), and better treatment by office staff (P = 0.04). Conclusions We found that for families of CYSHCN, practice-based care coordination in the medical home led to increased satisfaction with the quality of care they received and a reduction of barriers to care. The practice-based care coordination model is utilized by a minority of State Title V agencies and should be considered as a potentially more effective model than the agency-based approach.