BACKGROUND

Broad  Panel Respiratory Multiplex PCR (Pneumonia Panel) tests a panel of bacteria and viruses associated with community acquired pneumonia (CAP) which help streamline antimicrobial therapy. Recently, pneumonia panel aids clinicians in early streamlining of antimicrobials as opposed to waiting for bacterial culture results [2].

To determine whether the use of pneumonia panel improves the overall survival rate, length of hospital stay, and number of antibiotic free days among hospitalized CAP patients.

In this RCT, adult patients admitted for CAP were randomized to perform pneumonia panel and sputum culture (pneumonia panel group) versus sputum culture only (control group). The results were relayed to the medical team and were incorporated into the medical records. Length of hospital stay, antibiotic free days in day 28, and mortality rates were the primary outcomes measured.

Eighty participants completed the study. There was no significant difference in the length of hospital stay (p-value 0.073, 95% C.I.), duration of antibiotic therapy (p-value 0.332, 95% C.I.), and mortality rates (p-value 0.570, 95% C.I.) between the 2 groups.

Routine use of pneumonia panel does not significantly reduce length of hospital stay, duration of antibiotic therapy, and mortality rates among admitted patients with moderate to severe CAP. The benefit of pneumonia panel was seen on early detection of drug resistant pathogen resulting in early antibiotic escalation and shorter duration of antibiotic therapy. Further studies are necessary to show its benefit in the high risk population.

INTRODUCTION

Lung cancer is the leading cause of cancer-related mortality worldwide with peak mortality rate occurring in patients aged 80 years and above. While NSCLC are often diagnosed at advanced stage when treatment options are few, access to treatment in elderly are even more limited due to treatment tolerability and potential toxicity. At present, Osimertinib is the first line treatment option for patients with metastatic NSCLC with EGFR mutations. Some adverse reactions are diarrhea, nausea, headaches, stomatitis, and rashes that lead to interruption or even stopping of the medication.

Here we present a case about an 89-year-old female with smoking history of 20 pack-years who initially presented at the emergency room with progressive shortness of breath. Chest radiograph showed right pleural effusion for which pigtail was inserted. Bronchoscopy revealed a completely obstructing mass at the right upper lobe. Her biopsy showed EGFR-mutated non-small cell lung adenocarcinoma. Patient underwent radiotherapy and was started on osimertinib 80mg daily. However, patient developed severe diarrhea for which her subsequent dosing was reduced to 40mg once daily. Repeat PET CT scan after 10 months showed significant reduction of the primary mass.

In patients with metastatic EGFR-mutated lung adenocarcinoma, Osimertinib proves to be an effective option and is associated with improved overall survival even on a low-dose. This dose reduction strategy may be an option especially for elderly patients with tolerability issues. Nonetheless, treatment choices should prioritize patients' functional status and comorbidities over age, underscoring the importance of personalized approaches despite chemotherapy's inherent risks.

BACKGROUND

The coronavirus disease (COVID-19) is a global pandemic that caused millions of deaths worldwide. There is no standard risk stratification score for COVID 19 pneumonia. This study aims to determine the accuracy of the MuLBSTA score in predicting the risk of mortality in COVID-19 confirmed moderate to critical pneumonia cases.

A total of 168 COVID-19-confirmed moderate to critical pneumonia patients admitted at Cardinal Santos Medical Center from January 1, 2021 to April 30, 2021 were included by chart review. The MuLBSTA score was determined for each patient using the following information: age, smoking history, co-morbidities, complete blood count, sputum culture, blood culture, chest xray and chest CT scan. All clinical outcomes were based on patient status by the end of the hospital stay (survival versus death). Thereafter, logistic regression was done using the MuLBSTA score and mortality to determine any correlation. In addition, modified regression was used to find any correlation with the MuLBSTAscore and patient co-morbidities as predictors of mortality. Chi-square tests of independence were conducted to assess the specific cut-off values of the MuLBSTAscore in predicting mortality.

The MuLBSTAscore is a significant predictor of mortality (73.08%) and survivability (66.67%). It was determined that the MuLBSTA score's accuracy in predicting mortality increases with diabetics [b = .26, p < .05]. In addition, the intervention of hemoperfusion can skew the predictive accuracy of the scoring [b = -.45, p <.01]. The study showed that a MuLBSTA score of 8 as a cut-off value to delineate high risk patients was more accurate in COVID-19 pneumonia patients compared to the previously established score cut-off of 12 in viral pneumonia [1].

The MuLBSTA score may be used for risk stratification in predicting mortality in COVID-19 pneumonia, especially among diabetic patients. A MuLBSTA score of 8 proves to be the more accurate cut-off in assessing risk of mortality in COVID-19. However, hemoperfusion makes the MulBSTAscore inapplicable.