Bibliographic record
Abstract
Case Reports: A 25 y/o nonsmoker, atopic male presented with 3 days of viral-like symptoms. CT chest was negative for pulmonary embolism, but revealed scattered ground glass opacities (GGO). He developed acute respiratory failure, initially placed on BiPAP and then emergently intubated (pH 7.14, paCO2 86, paO2 83 on FiO2 1). Peak airway pressures were above 60mmHg and he required paralytics. Bronchoscopy revealed thick secretions and diffuse mucosa erythema. Studies showed 12% eosinophils (64/mm3) on BAL, acute inflammation on cytology, and cor pulmonale on echocardiogram. Chest CT revealed pneumomediastinum and GGO. All immunology, microbiology and viral studies were negative.He was liberated from ventilation after 2 days, and made a rapid recovery on IV steroids and nebulized albuterol. Spirometry, lung volumes and diffusing capacity 4 weeks after discharge were normal. Cor pulmonale was resolved on repeat echocardiogram. CT chest showed resolution of pneumomediastinum and GGO. His alexithymia score was 53 per the 20 question Toronto Alexithymia Scale (TAS-20).Near fatal asthma (NFA) is defined as sudden onset respiratory arrest, need for mechanical ventilation, paCO2 of >50mmHg or pH <7.3 in asthmatic patients1. Mortality rate in those requiring mechanical ventilation is 16.5%2. Pathologically, predominant eosinophilia, remodeling with acute and chronic inflammation and an eosinophilic BAL (average 54/mm3) is seen3.Alexithymia is a psychological trait of difficulty recognizing body sensations and describing emotions which can blunt the perception of the severity of symptoms, such as dyspnea. It is seen in 36% of known asthmatic patients with NFA and can be detected by TAS-204. However, alexithymia has not been found to be associated with newly diagnosed asthmatic patient with NFA.This unique initial presentation of NFA with no clear history of asthma is not described in literature. Our patient’s atopic history, acute respiratory failure with increased airway resistance, barotraumas, increased BAL eosinophils and response to corticosteroid therapy highly suggests asthma presenting with NFA. Alexithymia may have led to under recognition of his symptoms. References:1. Plaza V, Serrano J, Picado C, Sanchis J (High Risk Asthma Research Group). Frequency and clinical characteristics of rapid-onset fatal and near-fatal asthma. Eur Respir J. 2002; 19:846-852.2. Magadle R, Berar-Yanay N, Weiner P. The risk of hospitalization and near-fatal and fatal asthma in relation to the perception of dyspnea. Chest. 2002; 121:329-333.3. Barbers RG, Papnikolaou IC, et al. Near Fatal Asthma: Clinical and Airway Biopsy Characteristics. Pulmonary Medicine. 2012; Epub.4. Serrano J, Plaza V, Sureda B, et al. Alexithymia: a relevant psychological variable in near-fatal asthma. Eur Respir J. 2006; 28:296-302.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.003 |
| Science and technology studies | 0.003 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.004 | 0.003 |
| Insufficient payload (model declined to judge) | 0.086 | 0.049 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".