Gene/Protein
Disease
Symptom
Drug
Enzyme
Compound
Pivot Concepts:
Gene/Protein
Disease
Symptom
Drug
Enzyme
Compound
Target Concepts:
Gene/Protein
Disease
Symptom
Drug
Enzyme
Compound
Query: UMLS:C0032285 (
pneumonia
)
54,520
document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)
Respiratory tract infections (RTI) are among the most common acute conditions leading to GP consultations and to antibiotic prescribing in primary care, even though 70% are viral, and many others are minor self-limiting bacterial infections.
1-4
Between 0.5% and 1.1% of adults have community-acquired
pneumonia
every year in the UK, most of whom are managed in primary care.
4,5
The decision to prescribe antibiotics for an acute RTI in primary care is often based on clinical symptoms, which have low sensitivity and specificity, and high inter-observer variability.
2,4
In primary care, it is very difficult to differentiate between diagnoses without additional tests.
6
Unnecessary antibiotic prescribing may not aid recovery, exposes patients to potential adverse effects, may encourage repeat attendance and contributes to antibiotic resistance.
2,7
One strategy aiming to reduce antibiotic prescribing in primary care is the use of biomarkers (e.g. C-reactive protein [CRP]).
2
In the correct clinical context (e.g. in previously healthy people, not those with chronic lung disease) and as an adjunct to clinical assessment, a biomarker may help in the management of an RTI.
2
In order to be used during the consultation, the results of a biomarker test must be rapidly available (e.g. 'point-of-care' [
POC
] testing).
4
POC
testing for CRP has recently been recommended as part of a national clinical guideline on the diagnosis and management of
pneumonia
.
4
Here, we review the rationale for
POC
CRP testing and its advantages and disadvantages.
...
PMID:Point-of-care CRP testing in the diagnosis of pneumonia in adults. 2773 8
Ectopic ACTH syndrome (EAS) arising years after the diagnosis of a neuroendocrine tumor (NET) is exceedingly rare. We describe a case of EAS occurring five years after the diagnosis of a metastatic lung NET in a 61-year-old woman. She presented with severe hypokalemia but was not overtly Cushingoid on exam. Serum cortisol was 61mcg/dL after an overnight 1mg dexamethasone suppression test (<1.8mcg/dL) and urinary free cortisol was 7544 mcg/24h (<45mcg/24h), establishing the diagnosis of Cushing's syndrome. Plasma levels of peptides which have been associated with EAS, Agouti-related peptide (AgRP) and the
ACTH
precursors
POMC
(31-kDa) and pro-
ACTH
(22-kDa), were elevated. Metyrapone was initiated, but hypercortisolism persisted and the patient succumbed to
pneumonia
shortly after presentation. Retrospective examination of biopsy tissues showed rare
ACTH
immunoreactivity at the time of initial diagnosis, followed by staining in a greater proportion of cells as the disease progressed, consistent with EAS arising years after the diagnosis of NET. Given the increase in mortality associated with EAS, this unusual case highlights the importance of early detection and raises the possibility that early immunohistochemical stains for
ACTH
and measurements of
ACTH
precursors may facilitate the identification of NETs at high risk for EAS.
...
PMID:Ectopic ACTH Syndrome Emerging 5 Years after the Diagnosis of Neuroendocrine Tumor. 3127 66
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