Effectiveness-of-post-operative-physiotherapy-after-emergency-laparotomy-to-prevent-post-pulmonary-complications-and-promote-early-mobilization—a-case-report

Laparotomy is the traditional surgical procedure where the large incision is made into an abdomen to explore and visible the abdominal internal organs so it is also called Exploratory Laparotomy. It's main purpose is to determine the source of pain, extent of injury and perform repair of damaged organs. It is a life saving technique for cancer and tumour cases. In critical conditions, the emergency laparotomy1 is performed to save patient's life. After surgery mainly due to midline incision the patient develops restricted pattern of breathing; thereby increasing risk of chest infections, atelectasis and other post pulmonary complications. Prolonged bed rest in same position may also develop oedema, pressure sores, muscle weakness to wasting. In this case 53 years old male with known HTN was admitted with abdominal pain, on – off fever, mild dyspnea after treating the symptoms further evaluation revealed carcinoma of stomach. After stabilizing, the patient under goes emergency laparotomy. But after the surgery the patient may highly prone to post pulmonary complications. The early post operative physiotherapy plays crucial role to avert post pulmonary complications and assist in recovery

Clinical application of metagenomic next-generation sequencing in acquired immunodeficiency syndrome patients with pulmonary infections / 中华传染病杂志

Objective:To investigate the pathogen spectrum of acquired immunodeficiency syndrome (AIDS) patients with pulmonary opportunistic infections in the local area, and to evaluate the clinical application of metagenomic next-generation sequencing (mNGS) in these patients.Methods:From January to December 2021, AIDS patients with pulmonary infections admitted to Zhongnan Hospital of Wuhan University were enrolled. Their bronchoalveolar lavage fluid (BALF) was subjected to mNGS and coventional pathogen detection.Routine pathogen detection methods included smear, culture, polymerase chain reaction (PCR), and immunochromatographic colloidal gold. Fisher′s exact probability method was used for statistical analysis.Results:A total of 69 patients were included, and all of them were tested positive for mNGS. Among them, 53 cases (76.8%) were positive for fungi and viruses, 40 cases (58.0%) were positive for bacteria (excluding Mycobacterium tuberculosis (MTB) and nontuberculous mycobacteria (NTM)), six cases were positive for MTB, 11 cases were positive for NTM, and seven cases were positive for other pathogens. Mixed infections with two or more pathogens were found in 89.9%(62/69) of the patients. Among the conventional pathogen detections of BALF, 79.7%(55/69) of the patients were positive for pathogens, including 42 cases positive for Pneumocystis jirovecii PCR, 16 cases positive for BALF culture, nine cases positive for MTB PCR, and five cases positive for Cryptococcus antigen. The total detection rate of mNGS was 100.0%(69/69), which was higher than that of the conventional pathogen detection rate of 79.7%(55/69), and the difference was statistically significant (Fisher′s exact probability method, P<0.001). The specificity of mNGS detection was 88.4%. Combining clinical and two detection methods, the top five pathogens were Pneumocystis jirovecii (62.3%(43/69)), Candida (29.0%(20/69)), MTB (20.3%(14/69)), NTM and Talaromyces marneffei (15.9%(11/69), each). Fifty-three patients (76.8%) had co-infection with virus. Conclusions:The main cause of pulmonary infection in AIDS patients in this area is mixed infection, and Pneumocystis jirovecii is the most common pathogen. mNGS could significantly improve the pathogen detection rate in AIDS patients with pulmonary infections.

Clinical and epidemiological features of tuberculosis isolated from critically ill patients / Tuberculosis en la unidad de cuidados intensivos: características clínicas y epidemiológicas

Human tuberculosis is still a major world health concern. In Uruguay, contrary to the world trend, an increase in cases has been observed since 2006. Although the incidence of MDR-resistant strains is low and no cases of XDR-TB were registered, an increase in the number of patients with severe tuberculosis requiring critical care admission was observed. As a first aim, we performed the analysis of the genetic structure of strains isolated from patients with severe tuberculosis admitted to an intensive care unit. We compared these results with those corresponding to the general population observing a statistically significant increase in the Haarlem genotypes among ICU patients (53.3% vs 34.7%; p;<;0.05). In addition, we investigated the association of clinical outcomes with the genotype observing a major incidence of hepatic dysfunctions among patients infected with the Haarlem strain (p;<;0.05). The cohort presented is one of the largest studied series of critically ill patients with tuberculosis.

La tuberculosis (TB) aún representa un problema mayor de salud pública. En Uruguay, contrariamente a la tendencia mundial, se ha observado un incremento en el número de casos desde 2006. Aunque la incidencia de casos de multidrogorresistencia (MDR) es baja y no se han reportados casos de resistencia a fármacos de primera y segunda línea de tratamiento (XDR), se ha observado un incremento en el número de casos con TB grave, que requieren internación en unidad de terapia intensiva (CTI). Como primer objetivo del presente trabajo, se analizó la estructura genética de cepas de Mycobacterium tuberculosis aisladas de pacientes internados en CTI. Comparamos estos resultados con los obtenidos con cepas circulantes en la comunidad. Observamos un incremento estadísticamente significativo del genotipo Haarlem en los pacientes internados en CTI (53,3 vs. 34,7%; p;<;0,05). Además, investigamos la asociación del desenlace clínico con el genotipo, y encontramos una mayor incidencia de disfunción hepática en los pacientes infectados con la cepa Haarlem (p;<;0,05). La cohorte presentada en este trabajo corresponde a una de las series con mayor número de pacientes con tuberculosis que requirieron internación en CTI.

Analysis of clinico-demographic risk factors for postoperative pulmonary complications following gastrointestinal surgery

Background: Postoperative pulmonary complications (PPC) are one of the commonest complications following gastrointestinal surgery. They lead to increased mortality, increased length of intensive care unit (ICU) stay, and higher cost of treatment. Identifying the risk factors of PPC helps in predicting its occurrence and to develop preventive measures. The objectives of the present study were to study the clinical and demographic risk factors for PPC following gastrointestinal surgery.Methods: The study was designed as an observational descriptive analytic study. All the patients ≥18 years of age undergoing gastrointestinal surgery were included. The patients with preoperative lung pathology requiring ICU care or ventilatory support and patients with lung metastasis were excluded. The demographic and clinical parameters at admission were recorded. The details of pulmonary complications like the time of occurrence after surgery and the mode of treatment for pulmonary complications were noted. The risk association was assessed for statistical significance.Results: A total of 100 patients were underwent various gastrointestinal surgeries during the study period. The incidence of PPC was 34% in our study. Age, education status, smoking, and presence of comorbidities were found to be positively associated with an increased incidence of PPCs. The serum albumin of less than 3.5gm and the haemoglobin of less than 8 gm were also associated with an increased incidence of PPC. Pleural effusion was the commonest PPC seen in 15 (44.1%) patients followed by pneumonia in 9 (26.5%).Conclusions: Age, smoking, education status, serum albumin, haemoglobin, emergency surgery, elective postoperative ventilation, nasogastric intubation and blood loss in the intraoperative period were found to associated with increased risk of PPCs.

Role of bronchoscopy in diagnosis of pulmonary infections in non-HIV immune compromised host

Background: The occurrence of pulmonary infections is a common life threatening complication in immunocompromised patients, necessitating timely diagnosis and specific treatment. In our study bronchoscopic diagnostic techniques that include fiber optic bronchoscopy (FOB) and bronchoalveolar lavage (BAL) were applied in non-HIV immunocompromised conditions to determine the aetiology infectious microorganisms and comparing the clinical characteristics with bronchoscopic yield and to assess the influence of these methods on therapeutic outcome in this population.Methods: This prospective observational study was conducted at Rajiv Gandhi Government General Hospital, Park Town, Chennai, for a period of 8 months from January 2016 � August 2016.After meeting the requirements of eligibility criteria, the study included 65 immunocompromised patients consecutively who presented with pulmonary diseases. The primary outcome measure was the diagnostic yield of bronchoscopy among non-HIV immunocompromised patients. The secondary outcome measures were collecting the data including etiology of different microorganisms and non-infectious causes of pulmonary diseases among non- HIV immunocompromised patients, comparing the symptoms at the time of presentation, different radiological pattern with bronchoscopic yield and comparing the different subgroups of non-HIV immunocompromised patients with regards to presenting symptoms, radiological patterns, bronchoscopic yield, treatment modification, different spectrum of infections and complications.Results: The mean age of the patients was 41.91 ranging from 15-74 years. Majority (n=36) patients showed chest symptoms alone. On bronchoscopy, 52 cases (80%) out of 65 showed positive results and negative result was noticed in 13 cases (20%). Among them bacterial infections were predominant with 24%. After BAL culture bacterial culture was positive in 23 (35%) patients and fungal culture was positive in 15 (23%) cases. After bronchoscopy, current treatment plan was changed in 37 patients and clinical improvement was seen in 26 cases i.e. yield of bronchoscopy was 71%. Minor complications were noticed in 16 cases after bronchoscopy.Conclusion: Our study concludes, in clinically stable patients FOB was the preferred technique for finding the cause of lung infiltrates in non-HIV immunocompromised patients. Because our results signifies that the yield of bronchoscopy was high (80%) despite empirical antimicrobial therapy.

Comparative study on the clinical outcome following different doses of amphotericin B liposome in the treatment of patients with invasive pulmonary fungal infections after renal transplantation / 中华器官移植杂志

ObjectiveTo compare the clinical effectiveness and adverse effects following low doses versus traditional doses of amphotericin B liposome (L-AmB) in the treatment of patients with invasive pulmonary fungal infections (IPFI) after renal transplantation.MethodsA total of 26 postrenal transplantation patients with IPFI between Jan. 2005 and Mar. 2011in Zhujiang hospital received L-AmB treatment identified low doses group (0.2-0.5 mg·kg-1·d-1,n =19) or traditional doses group (1-5 mg· kg-1,d-1,n =7) were reviewed.ResultsThe treatment duration in low doses group and traditional doses group was 20.3 +12.7 and19.3 ±13.2 days respectively (P＞0.05).The effective rate in low doses group and traditional doses group was 84.2％ and 57.1％ respectively (P＞0.05).The overall dosage was significantly less in the low doses group (414.7 ± 241.7 mg) than in the traditional doses group (1158.8 ± 928.0 mg) (P＜0.05).The incidence of adverse effect was significantly lower in the low doses group than in the traditional doses group (21.1％ vs.85.7％,P＜0.05).ConclusionThe effectiveness of low doses of L-AmB protocol in the treatment of IPFI postrenal transplantation patients was similar to that of traditional doses of L-AmB protocol,but the incidence of adverse effects in low doses of L-AmB protocol was significantly lower.

Gérmenes oportunistas en infección pulmonar asociadas a pacientes con vih/sida. hospital universitario departamental de nariño. 2006-2008

Objetivo: Describir casos de pacientes con infección pulmonar diagnosticados con VIH-SIDA hospitalizados en el Hospital Universitario Departamental de Nariño (HUDN) en el periodo enero del 2006 a diciembre del 2008. Diseño: Serie de casos clínicos de tipo retrospectivo realizada en pacientes hospitalizados en el servicio de medicina interna entre 1 de enero de 2006 y 31 de diciembre de 2008 en el HUDN. Metodología: Se revisaron expedientes clínicos de 114 pacientes con diagnóstico de VIH/SIDA asociado a otra infección, se aplicaron criterios de inclusión y exclusión, y se obtuvo una población final de 39 pacientes con diagnóstico de infección pulmonar con VIH/SIDA a quienes se les aplicó un instrumento de recolección de información que contenía variables sociodemográficas, clínicas de diagnóstico y tratamiento, para su posterior análisis. Las enfermedades fueron clasificadas de acuerdo con la Clasificación Internacional de las Enfermedades (CIE-10). Resultados: Las infecciones pulmonares estuvieron presentes en 39 pacientes, 26 fueron hombres y 13 mujeres. La neumonía se presentó en el 35,7%, acompañada por tuberculosis en el 25,5%. Klebsiella pneumoniae fue la más representativa (28,2%), seguido de Branhamella catarrhalis (10,3%), Cándida albicans se encontró en uno de los casos. Los signos y síntomas más frecuentes fueron la tos en 64,1%, la disnea en 51,3% y los estertores 46,2%. Conclusiones: las infecciones pulmonares bacterianas son las más frecuentes en pacientes con VIH/SIDA, siendo Klebsiella pneumoniae la más representativa en pacientes hospitalizados en el servicio de medicina interna del HUDN.

Objective: To describe cases of patients diagnosed with lung infection with HIV-AIDS hospitalized at Hospital Universitario Departamental of Nariño (HUDN) in the period january 2006 to december 2008. Design: Clinical retrospective case series analysis performed in patients hospitalized at the internal medicine service between 1 of january 2006 and 31 of december 2008 in the HUDN. Methodology: We reviewed medical records of 114 patients diagnosed with HIV/AIDS associated with another infection, and we applied inclusion and exclusion criteria. A final population of 39 HIV infected patients were diagnosed with lung infection. A data collection instrument which contained sociodemographic, clinical diagnosis and treatment were used for further analysis. The diseases were classified according to International Classification of Diseases (ICD-10). Results: Pulmonary infections were present in 39 patients, 26 were men and 13 women. Pneumonia was present in 35,7%, accompanied by tuberculosis at 25,5%. Klebsiella pneumoniae was the most representative (28,2%), followed Branhamella catarrhalis (10,3%), Candida albicans was found in one case. Cough with 64.1%, dyspnea with rales 51,3% and 46,2% were the most common signs and symptoms. Conclusions: Bacterial lung infections are more common in patients with HIV/AIDS, being the most representative Klebsiella pneumoniae in patients hospitalized in the internal medicine department HUDN.

The status of diagnosis and treatment on invasive fungal pulmonary infections / 中华临床感染病杂志

Objective To review the status of diagnosis and treatment for invasive fungal pulmonary infections(IFPI)in Lishui Central Hospital.Methods The clinical data of 79 patients with IFPI were retrospectively analyzed.Results The diagnostic status could be classified ills follows:6 eases had confirmed diagnosis,30 had clinical diagnosis,35 had suspected diagnosis and 8 misdiagnosed.The treatments were all effeetive in 6 COnfirmed cases;in 30 clinically diagnosed cases,6 were eriective.21 were inefiective and 3 died;in 35 suspected cases.3 were effective.25 were iHefieetive and 7 cflses did not receive antifungal treatment.Aspergillus and Cryptococcus pulmonary infections were predominant in confirmed cases.and the antifungal treatment lasted for 3 to 6 months.Conclusion Diagnosis and treatment for IFPI need to be improved.

Asociación de Pneumocystis jiroveci con otros patógenos respiratorios en el lavado broncoalveolar / Association of Pneumocystis jiroveci with others respiratory pathogens in bronchoalveolar fluids

Se evaluó la eventual asociación de Pneumocystis jiroveci con otros patógenos respiratorios bacterianos, fúngicos y parasitarios, en 52 muestras de secreciones respiratorias obtenidas por lavado broncoalveolar, pertenecientes a pacientes con sida, internados en la Unidad de Cuidados Intensivos Respiratorios del Hospital Muñiz. Todas ellas fueron procesadas en forma consecutiva en los diferentes laboratorios del Hospital Muñiz, entre enero y septiembre de 2006 y fueron positivas para la presencia de P. jiroveci. En 2 (3.84%) de las muestras se aisló Mycobacterium tuberculosis y en otras 4 (7.69%) cantidades consideradas como significativas de Streptococcus pneumoniae (n = 2), Haemophilus influenzae y Pseudomonasa eruginosa. Los resultados obtenidos revelaron la presencia de al menos un copatógeno respiratorio en el 12% de las muestras examinadas, cifra menor a la esperada, teniendo en cuenta el deterioro inmunológico de los pacientes evaluados. El empleo empírico de antibióticos, la no inclusión de estudios virológicos y el transporte inadecuado podrían disminuir el número de coinfecciones detectadas con diferentes patógenos. Probablemente, el escaso número de coinfecciones podría deberse a que en el momento de tomada la muestra, es P. jiroveci el microorganismo predominante sobre otros eventualmente presentes en el aparato respiratorio.

The eventual co-infection of Pneumocystis jiroveci withbacterial, fungal and parasitological respiratory pathogensin 52 respiratory secretions was evaluated. The samples obtained by bronchoalveolar lavage belong to AIDS patients treated in the Respiratory Intensive Care Unit of Muñiz Hospital. They were consecutively processed between January and September of 2006 in different laboratories of Muñiz Hospital, resulting all of them positive for P. jiroveci. Mycobacterium tuberculosis was isolated in 2 (3.84%) out of the evaluated samples whilea significant number of Streptococcus pneumoniae(n = 2), Haemophilus influenzae y Pseudomonas aeruginosaappeared in other 4 (7.69%). The obtained results revealed the presence of at least one respiratory pathogenother than P. jiroveci in 12% of evaluated samples, beingthese values lower than those expected by us, on accountof the impaired immunologic status of evaluated patients. The number of detected co-infections with different pathogens could decrease probably because of the empiric treatment with antibiotic, the absence of viral studies and the inadequate transport of the sample. Thescanty number of associations was probably due to the moment of sample recollection; P. jiroveci was the predominant pathogen over the other ones eventually present in the respiratory tract.

Study of biological characteristics of Pseudomonas aeruginosa strains isolated from patients with cystic fibrosis and from patients with extra-pulmonary infections

A total of 120 strains of Pseudomonas aeruginosa, isolated from cystic fibrosis (CF) patients (n = 80) and from patients having extra-pulmonary infections (n = 40) were studied regarding the presence of some virulence factors (hemolysin, gelatinase and elastase production) and presence of the algD and algU genes as detected by polymerase chain reaction-PCR. There was not a significant difference for the production of gelatinase and hemolysin between non-mucoid strains from CF patients and other isolates from extra-pulmonary infections and mucoid strains. The production of elastase was found to be significant among these strains. The algD gene was detected by PCR in all studied strains but the algU gene was detected only in 25 percent of the mucoid strains. Conclusion withdrawn from the results were: (i) hemolysin and gelatinase production although present in many strains of P aeruginosa should not be considered as general virulence factors for the mucoid phenotype but could help in the pathogenic process; (ii) elastase production could be a necessary virulence factor for the initial pathogenesis process; (iii) mucoid and non-mucoid phenotypes could also be expressed according to the host's tissues or environment, and finally, (iv) more than one regulator system for alginate production is probably present in each strain.

The bewilderments and remark of diagnosis and management of pulmonary infections in immunocompromised patients in China / 中国实用内科杂志

There are several bewilderments in diagnosis and management of pulmonary infection in immunocompromised patients,including broadly combinational empirical antimicrobial therapy which joined three enven four or five antimicrobial agents;taking antibiotic therapy protocol change as major issues and ignoring detection of pathogen when fever and lung infilitration was occurred;neglecting the differentiation of non-infectious causes in lung infilitrations of immunocompromised patinets;modulating or halt of corticosteroid for immunocompromised patients with fever and lung infilitration.key words immunocompromised patients pulmonary infections diagnosis and management bewilderment remark

Diagnostic procedures in pulmonary infection of the immunocompromised hosts / 中国实用内科杂志

Immunocompromised hosts(ICH)is a particular population drawing more current attention with the susceptibility to infections,especially to the opportunistic pathogens.When infections occur in ICH,the mortality increases significantly.The clinical manifestations and radiological characteristics are untypical and non-specific,so the correct diagnosis in good time is arduous.But the rapid and correct diagnosis is primary and principle to lower the mortality of the infections of ICH,so this article aims to generalize the diagnosis phronesis of pulmonary infections of ICH-to elaborate the key points of the assessment and evaluation of ICH;the principle of differential diagnosis of pulmonary infections in ICH;clinical evaluation program of the pulmonary infiltration in ICH. Abstract:Summ ary:Immunocomprom ised hosts(ICH) is a particu lar popu lation draw ing more current attention w ith the susceptib il-ity to infections,espec ially to the opportun istic pathogens.W hen infections occur in ICH,the mortality increases sign ifi-cantly.The c lin icalm an ifestations and rad iological characteristics are untyp ical and non-spec ific,so the correct d iagnosis in good tim e is arduous.But the rap id and correct d iagnosis is prim ary and princ ip le to lower the mortality of the infections of ICH,so th is artic le aim s to generalize the d iagnosis phronesis of pu lmonary infections of ICH-to elaborate the key points of the assessm ent and evaluation of ICH;the princ ip le of d ifferential d iagnosis of pu lmonary infections in ICH;c lin ical e-valuation program of the pu lmonary infiltration in ICH.

Pulmonary infections in the immunocompromised patients must be considered in a particular way / 中国实用内科杂志

Pulmonary infections in the immunocompromised patients have become common problem in clinical work along with the immunocompromised ones increased.The pathogens in those patients were complex.The clinical manifestations were always atypical and may be covered up with immunosuppressors.The state of this illness can deteriorate in many patients.In recent years,many pathogen survey technique and therapy have been developed,and give a positive impact on clinical diagnosis and treatments.It is important to find out the current diagnosis and therapy in the pulmonary infections in immunocompromised patients,and pay more attention to clinical pathway for improving the outcome and reducing complications in those patents. Abstract:Summ ary:Pu lmonary infections in the immunocomprom ised patients have becom e common prob lem in c lin icalwork along w ith the immunocomprom ised ones increased.The pathogens in those patients were comp lex.The c lin ical m an ifestations were always atyp ical and m ay be covered up w ith immunosuppressors.The state of th is illness can deteriorate in m any pa-tients.In recent years,m any pathogen survey techn ique and therapy have been developed,and give a positive impact on c lin ical d iagnosis and treatm ents.It is important to find out the current d iagnosis and therapy in the pu lmonary infections in immunocomprom ised patients,and pay more attention to c lin ical pathway for improving the outcom e and reduc ing com-p lications in those patents.

Pathogenic Bacteria in Plateau Hospital-Acquired Pulmonary Infection and Antimicrobial Susceptibility / 中国药房

OBJECTIVE: To clarify the pathogens in plateau hospital-acquired pulmonary infection and their antimicrobial susceptibility so as to provide scientific basis for clinical first-line treatment in the rational use of antibacterial drugs. METHODS: The bacteriological culture and drug susceptibility experiment on sputum and bronchial douche fluid collected from 1 396 patients with hospital-acquired pulmonary infection in our hospital from 2004 to 2006 as well as the filed medical records were analyzed retrospectively. RESULTS: 789 positive bacteria were isolated, of which, 77.82% (614/789) were gram-negative bacilli (GNB), with Klebsiella spp showing the highest percentage, accounting for 53.91% (331/614); 21.04% (166/789) were gram-positive bacteria, with staph showing the highest percentage, accounting for 46.99% (78/789).Most of the GNB were sensitive to imipenem, sulbactam/cefoperazone, then to aminoglycosides. The susceptibility rate of Gram-positive bacteria to vancomycin was 90.36%. CONCLUSION: Gram-negative bacilli were the main hospital infection pathogens, which were sensitive to imipenem, sulbactam/cefoperazone but highly resistant to ceftazidime, which calls for attention in the clinic.

The Clinical Value of BAL in Treating Serious Pulmonary Infections from Surgical Therapy / 中国医师杂志

Objective To investigate the clinical value of bronchoalveolar lavage(BAL) in treating serious pulmonary infections from surgical therapy. Methods The clinical data of 56 patients with serious pulmonary infections from surgical treatment were retrospectively investigated. 29 patients in the fibrobronchoscopy group(FBG) received treatment of BAL, 27 patients in the non-fibrobronchoscopy group(NFBG) were used as control. Results The total efficacious rate in the FBG and NFBG was 86.21% and 59.25%, respectively(P