Morbimortalidade por pneumonia no estado da Bahia no período pré e durante a pandemia de COVID-19 ­ base de dados do DATASUS / Pneumonia morbidity and mortality in the state of Bahia in the period before and during the COVID-19 pandemic ­ DATASUS database

Introdução: a pneumonia é uma infecção nos pulmões, provocada pela penetração de microrganismos. Outras infeções respiratórias, incluindo a SARS-COV-2, podem agravar a clínica do paciente. Por sua vez, esta é uma doença sistêmica, com foco pulmonar que pode gerar complicações respiratórias, dentre elas a pneumonia. Neste seguimento, estudos evidenciam que 15% dos pacientes com COVID-19 podem apresentar pneumonia leve e 5% evoluir para pneumonia grave. Objetivo: comparar a ocorrência de morbimortalidade por pneumonia no Estado da Bahia, no período pré e durante a pandemia de COVID-19. Metodologia: trata-se de um estudo ecológico, quantitativo, com dados públicos, disponíveis no Sistema Informações em Saúde da plataforma DataSUS/ TABNet, referentes ao Estado da Bahia, no período de jan./2018 a dez./2021. Foram selecionados os dados: internamentos, média de internamento, óbitos e taxa de mortalidade. Os dados foram analisados através da estatística descritiva, frequência relativa, e estatística analítica com o teste de frequências relativas U de Mann-Whitney. Resultados: o Estado da Bahia, registrou um total de 48 mil internações por pneumonia, com média de taxa de permanência de internamento de 6,4 dias e um total de 8 mil óbitos, com média de taxa de mortalidade de 16,91% ao ano. Observa-se que ocorreu redução nas internações e óbitos, e aumento na taxa de mortalidade por pneumonia, no período estudado (P<0,001). Conclusão: contudo, verificou-se que no Estado da Bahia durante o período da pandemia de COVID-19, ocorreram redução no número de internados e óbitos, e aumento na taxa de mortalidade por pneumonia, comparando-se ao mesmo período pré pandemia.

Introduction: pneumonia is an infection in the lungs, caused by exposure to microorganisms. Other respiratory infections, including SARS-COV-2, may aggravate the patient's health condition. In turn, this is a systemic disease, with a pulmonary focus that can lead to respiratory complications, including pneumonia. In this area, studies show that 15% of patients with COVID-19 may have mild pneumonia and 5% progress to severe pneumonia. Objective: to compare the occurrence of morbidity and mortality from pneumonia in the State of Bahia, in the period before and during the COVID-19 pandemic. Methodology: this is an ecological, quantitative study, with public data, available in the Health Information System of the DataSUS/TABNet platform, referring to the State of Bahia, from Jan./2018 to Dec./2021. Selected data: hospitalizations, average hospitalization, deaths and mortality rate. Data were analysed using descriptive statistics, relative frequency, and analytical statistics with the Mann-Whitney U relative frequency test. Results: the State of Bahia recorded a total of 48,000 hospitalizations for pneumonia, with an average hospitalization stay rate of 6.4 days and a total of 8,000 deaths, with an average mortality rate of 16.91% per year. It is observed that there was a reduction in hospitalizations and deaths, and an increase in the mortality rate due to pneumonia, in the studied period (P<0.001). Conclusion: however, it was found that in the State of Bahia during the period of the COVID-19 pandemic, there was a reduction in the number of hospitalizations and deaths, and an increase in the mortality rate due to pneumonia, compared to the same pre-pandemic period.

Clinical implications of Golgi protein 73 and granulocyte colony-stimulating factor and their related factors in children with bronchopneumonia

Abstract Objective: To investigate the clinical implications of Golgi glycoprotein 73 (GP73) and granulocyte colony-stimulating factor (G-CSF) in children with bronchopneumonia (BP). Methods: Seventy-two children with BP (observation group) and 81 healthy children (control group) consecutively brought to the present study's hospital between June 2019 and October 2020 were enrolled. GP73 and G-CSF levels were determined to analyze their diagnostic value for pediatric BP. High-sensitivity C-reactive protein (hs-CRP) was also measured. The clinical implications of GP73 and G-CSF in pediatric BP complicated with respiratory failure and their connections with the inflammatory response were discussed. Results: GP73 and G-CSF levels were remarkably higher in the observation group (p< 0.05). The sensitivity and specificity of combined detection (GP73+G-CSF) in predicting pediatric BP were 72.22% and 86.42%, respectively (p < 0.001 ). GP73 and G-CSF, which are closely related to X-ray classification and complications in the observation group, decreased after treatment and were positively correlated with hs-CRP (p < 0.05), especially in children complicated with respiratory failure. Regression analysis identified the independence of the course of the disease, hs-CRP, X-ray classification, GP73, and G-CSF as influencing factors of respiratory failure in children with BP (p < 0.05). Conclusion: GP73 and G-CSF, with elevated levels in children with BP, are strongly linked to disease progression and are independent influencing factors of respiratory failure, which may be the key to diagnosing and treating pediatric BP in the future.

Comparison of different methods of sputum aspiration in children with bronchopneumonia / 中国实用护理杂志

Objective:To compare the effect of different methods of sputum aspiration in children with bronchopneumonia and explore the appropriate sputum aspiration methods for children with bronchopneumonia.Methods:This study was a randomized controlled trial. The convenience sampling method was used to select 165 children with bronchopneumonia treated in the Third Affiliated Hospital of Zhengzhou University from October 8, 2020 to September 30, 2021 as the research objects. They were divided into group A, group B and group C by random number table method, with 55 cases in each group. Group A used sputum aspirating tube to aspirate sputum through mouth and nose, group B used olive head to aspirate sputum through nose, and group C used both sputum aspirating tube to aspirate sputum through mouth and olive head through nose. The sputum aspirating effect, respiratory mucosal injury rate and satisfaction degree of children′s parents were compared among the three groups.Results:Finally, there were 53 cases in group A, 54 cases in group B and 53 cases in group C. The total effective rate of sputum aspiration was 96.21%(584/607) in group C, which was higher than that in group A 94.32% (581/616) and in group B 74.12% (464/626), the difference was statistically significant ( χ2=194.62, P<0.01), pairwise comparison among the three groups showed statistical difference ( χ2=95.95, 11.32, 132.16, all P<0.017). The respiratory mucosal injury rate was 1.12% (7/626) in group B, which was lower than that in group C 3.13% (19/607) and in group A 10.39% (64/616), the difference was statistically significant ( χ2=63.53, P<0.01), pairwise comparison among the three groups showed statistical difference ( χ2=49.52, 25.47, 6.04, all P<0.017). The satisfaction degree of children′s parents in group C was 98.11% (52/53), which was higher than that in group B 90.74% (49/54) and in group A 81.13% (43/53), the difference was statistically significant ( χ2=8.54, P<0.05). There was no statistically significant difference in the satisfaction degree of children′s parents between group A and group B, and between group B and group C( P>0.017). There was statistically significant difference in the satisfaction degree of children′s parents between group A and group C ( χ2=8.22, P<0.017). Conclusions:The combination of oral suction tube and nasal suction with olive head can improve the sputum aspirating effect of children with bronchopneumonia and the satisfaction degree of their parents, with a low rate of respiratory mucosal injury and high safety, which is worthy of clinical reference.

Chest x-ray findings of paediatric patients seen at a Teaching Hospital in North-western Nigeria

Introduction: Plain radiography is the first line of radiological examination used for the evaluation of paediatric chest, and also a rapid imaging technique that allows lung abnormality to be identified. X-ray is used to diagnose conditions of the thoracic cavity, including airways, ribs, lungs, heart, and diaphragm. Chest x-ray has a high sensitivity for pulmonary tuberculosis and thus is a valuable tool to identify a differential diagnosis for a patient. Methodology: Two hundred and eleven paediatrics chest x-ray reports were studied between February 2017 to September 2018. Data were collected retrospectively from the hospital archives using a data capture sheet. Results: Two hundred and eleven radiographs were assessed and the age of patients whose radiographs participated in the study ranged from 0-15 years. Also, a greater number of male patients 133(63.03%) participated in the study than female patients 78(36.97%). Among all the radiographs used in this study, the most common age group for this study ranged from 0-3 years. Results from the study also revealed that bronchopneumonia was the most common finding totaling 105(49.76%) followed by radiographs which are normal findings 77(36.49), pulmonary tuberculosis, 19(9.00%), congestive heart failure 4(1.90%), pleural effusion 3(1.42%), enlarged adenoid 2(0.95%) and dextrocardia 1(0.47%). Conclusion: This study report bronchopneumonia was the most common paediatrics radiographic finding in a chest x-ray. Plain radiography is an effective tool to examine various respiratory and cardiac pathologies and is the first line of investigation for chest pathologies.

Efficacy of atomization with budesonide, salbutamol, and acetylcysteine in the adjuvant treatment of bronchopneumonia in children / 中国基层医药

Objective:To investigate the efficacy of atomization with budesonide, salbutamol, and acetylcysteine in the adjuvant treatment of bronchopneumonia in children.Methods:Seventy-two children with bronchopneumonia admitted to Huaiyuan Jingtu Hospital from July 2021 to June 2022 were retrospectively included in this study. These children were divided into BS and BSY groups according to different treatment methods. Based on conventional treatment, the BS group was given atomization treatment with budesonide and salbutamol, and the BSY group was given atomization treatment with budesonide, salbutamol, and acetylcysteine. After two courses of treatment, clinical efficacy, duration to improvements in symptoms and signs, adverse drug reactions, and changes in serum C-reactive protein and procalcitonin levels after treatment relative to those before treatment were compared between the two groups. The optimal medication plan was investigated.Results:The total response rate in the BSY group was 91.67% (33 cases/36 cases), which was significantly higher than 72.22% (26/36) in the BS group ( χ2 = 4.59, P = 0.032). The incidence of adverse drug reactions in the BSY group was 11.11% (4/36), which was significantly lower than 19.44% (7/36) in the BS group ( χ2 = 0.96, P = 0.326). After treatment, the levels of C-reactive protein and procalcitonin in the BSY group were (5.86 ± 5.66) mg/L and (2.59 ± 0.74) μg/L, respectively, which were lower than (15.64 ± 5.85) mg/L and (4.71 ± 0.93) μg/L in the BS group ( t = 7.20, 10.70, both P < 0.001). The durations to the disappearance of symptoms and signs including fever, cough, lung rales, and X-ray lung shadow in the BSY group were significantly shorter compared with the BS group ( t = 11.85, 4.19, 2.72, 2.39, all P < 0.05). Conclusion:Atomization with budesonide, salbutamol, and acetylcysteine in combination for the adjuvant treatment of bronchopneumonia in children can quickly relieve the clinical symptoms of children, improve the lung signs, reduce the degree of inflammation, and has a remarkable therapeutic effect on bronchopneumonia in children.

Características clinicoepidemiológicas de pacientes con infecciones intrahospitalarias en un servicio de medicina interna de Santiago de Cuba / Clinical-epidemiological characteristics of patients with hospital acquired infections in a service of internal medicine from Santiago de Cuba

Introducción: La infección nosocomial o intrahospitalaria constituye un importante problema de salud en todos los hospitales del orbe. Objetivo: Describir las características clínicas y epidemiológicas de pacientes con infecciones intrahospitalarias. Métodos: Se realizó un estudio descriptivo y transversal de 57 pacientes con infecciones intrahospitalarias, ingresados en el Servicio de Medicina Interna del Hospital Provincial Docente Clínico-Quirúrgico Saturnino Lora de Santiago de Cuba, de octubre a diciembre de 2019, para lo cual se analizaron las variables edad, enfermedades asociadas, factores predisponentes, tipo de infección y gérmenes aislados. Resultados: En la serie sobresalieron el grupo etario de 60-69 años y la hipertensión arterial como enfermedad crónica concomitante (26,0 %). Entre los factores predisponentes resultó más frecuente el tabaquismo (32,8 %) y el tipo de infección preponderante fue la bronconeumonía bacteriana (47,0 %), cuyo germen causal en la mayoría de los casos (35,1 %) fue la Klebsiella pneumoniae. Conclusiones: Las infecciones intrahospitalarias aquejaron principalmente a pacientes de edad avanzada con enfermedades crónicas asociadas, como la diabetes mellitus y la hipertensión arterial. Cabe destacar la importancia de conocer la flora microbiana existente en el servicio donde se adquiere la infección, a fin de lograr tanto la prevención como el diagnóstico oportuno y el tratamiento adecuado.

Introduction: The cross or hospital infections constitute an important health problem in all the hospitals of the world. Objective: To describe the clinical and epidemiological characteristics of patients with hospital infections. Methods: A descriptive and cross-sectional study of 57 patients with hospital acquired infections was carried out. They were admitted to the Internal Medicine Service of Saturnino Lora Clinical-surgical Teaching Provincial Hospital of Santiago de Cuba, from October to December, 2019, for which the variables age, associated diseases, predisposing factors, type of infection and isolated germs were analyzed. Results: In the series the 60-69 years age group and hypertension as concomitant chronic disease (26.0 %) were notable. Among the predisposing factors nicotine addiction (32.8 %) was more frequent and the preponderant type of infection was the bacterial bronchopneumonia (47.0 %) whose causal germ in most of the cases (35.1 %) was the Klebsiella pneumoniae. Conclusions: The hospital acquired infections mainly afflicted patients of advanced age with associated chronic diseases, as diabetes mellitus and hypertension. It is necessary to highlight the importance of knowing the existent microbial flora in the service where the infection is acquired, in order to achieve boththe prevention, the opportune diagnosis and the appropriate treatment.

A time series analysis of effects of diurnal temperature range on children with bronchopneumonia in Huzhou, 2014–2019 / 环境与职业医学

Background In the context of global warming, the impact of meteorological factors on human health has gradually become a research hotspot at home and abroad. Objective To describe the distribution of children's bronchopneumonia in Huzhou City, and explore the influence of diurnal temperature range (DTR) on children with bronchopneumonia, so as to provide guidance for identifying vulnerable populations and developing targeted measures. Methods A distributed lag nonlinear model (DLNM) was used to explore the potential nonlinear lag effect of DTR on admission of children with bronchopneumonia in Huzhou City from 2014 to 2019. Then a generalized additive model (GAM) was used to calculate the hospital admission risk of exposure to DTR in total population and sex-, age-, season-stratified populations. Results A total of 17658 hospitalized children with bronchopneumonia were included in the study. When DTR exceeded 7.5 ℃, the relative risk rose abruptly. When DTR reached 17 ℃, the risk of admission to hospital of children with bronchopneumonia was the greatest. In terms of the single-day lag effect, the admission risk of DTR for bronchopneumonia in children began on the same day and persisted until lag day 2; it peaked on the same day, and RR was 1.353 (95%CI: 1.220-1.502). The cumulative lag effect occurred from lag0 to lag0-6, and the highest RR value was at lag0-3, which was 1.938 (95%CI:1.483-2.533). The results of stratified analysis showed that the maximum effect values for boys and girls appeared at lag0-3 (RRboys=2.301, 95%CI: 1.671-3.169) and lag0-2(RRgirls=1.566, 95%CI: 1.152-2.129) respectively, and the effect value and duration of DTR in boys were higher and longer than those in girls. Among different age groups, both children of 0-3 years old and 4-14 years old had the maximum effect value at lag 0-3, the RR values were 1.734 (95%CI: 1.454-2.572) and 1.998 (95%CI: 1.226-2.254) respectively, and the effect value and duration of DTR on the children of 4-14 years old were higher and longer than those of the children of 0-3 years old. As to seasons, no significant increase was found in cumulative effect in summer and autumn (P>0.05); in winter and spring, the maximum effect value appeared at lag0-10, and the RR value was 4.164 (95%CI:1.191-14.561). Conclusion The impact of DTR on bronchopneumonia in children is acute. Boys and children aged 4-14 years old are more sensitive to DTR changes. Therefore, we should be alert to severe DTR changes and take protective measures in advance

Autopsias de pacientes con enfermedad respiratoria aguda / Autopsies of patients with acute respiratory disease

Introducción: La enfermedad respiratoria aguda es la entidad más frecuente en la vida del ser humano y las enfermedades respiratorias agudas se encuentran entre las causas de muerte. La autopsia es el mejor método del estudio del enfermo y su realización es una fortaleza del sistema de salud cubano. Objetivo: Determinar las características demográficas y morfológicas que se encontraron en las autopsias de fallecidos con enfermedad respiratoria aguda. Método: Se realizó un estudio descriptivo y de corte transversal, de los fallecidos a quienes se realizó autopsia, en el periodo de 1986 al 2019. Se estudiaron las variables edad, sexo, comorbilidades, causas de muerte y relación clínico - patológica. Resultados: La población quedó conformada por 390 autopsias que presentaban estas afecciones (2,5 por ciento). El grupo de edades entre 65 a 84 años fue el más afectado en ambos sexos. En las causas directas de muerte predominó la bronconeumonía bacteriana. Se destaca la elevada coincidencia en las causas directas de muerte y las discrepancias en las causas básicas. La línea de tendencia indica el incremento progresivo en el transcurso de los años estudiados. Conclusiones: Las características demográficas muestran que todos los grupos de edades están afectados, con predominio de 65 a 84 años, en ambos sexos. El pulmón fue el órgano más afectado en las causas directas de muerte, con predominio de la bronconeumonía, mientras que la mayoría presenta enfermedad respiratoria aguda como causa básica de muerte, con elevada discrepancia en su relación clínico patológica(AU)

Introduction: Acute respiratory disease is the most frequent entity in human life and acute respiratory diseases are among the causes of death. The autopsy is the best method of studying the patient and it is a strength of the Cuban health system. Objective: To determine the demographic and morphological characteristics found in the autopsies of the deceased with acute respiratory diseases. Method: A descriptive and cross-sectional study was carried out of the deceased who underwent autopsy, in the period from 1986 to 2019. The variables age, sex, comorbidities, causes of death and clinical-pathological relationship were studied. Results: The population was made up of 390 autopsies with these conditions (2.5 percent). The 65 to 84 age group was the most affected in both sexes. In direct causes of death, bacterial bronchopneumonia predominated. The high coincidence in the direct causes of death and the discrepancies in the basic causes stand out. The trend line indicates the progressive increase in the course of the years studied. Conclusions: The demographic characteristics show that all age groups are affected, with a predominance of 65 to 84 years, in both sexes. The lung was the most affected organ in direct causes of death, with a predominance of bronchopneumonia, while the majority had acute respiratory disease as the basic cause of death, with a high discrepancy in its clinical-pathological relationship(AU)

Pseudomonas aeruginosa necrotizing bronchopneumonia

Extremely low birth weight (ELBW) infants are at particularly high risk for infection due to an immature immune system, invasive procedures such as endotracheal intubation, intravascular catheterization, and other factors. Neonatal infections in this population are associated with a high mortality, poor growth, and neurodevelopmental outcomes. Pseudomonas aeruginosa (P. aeruginosa) infection is an uncommon but potentially devastating cause of pneumonia and sepsis in the ELBW population. P. aeruginosa is an important cause of healthcare-associated infections (HAI) or nosocomial infections. P. aeruginosa can perceive unfavorable environmental changes and orchestrate adaptations by developing plasmid-mediated and adaptive resistance to antibiotics. We describe an ELBW infant born at 26 weeks' gestation who succumbed at 13 days of life to P. aeruginosa infection. Some of the factors related to the pathogenesis and multidrug resistance are described.

Caracterización epidemiológica de las infecciones respiratorias agudas graves. Granma, marzo-mayo de 2020 / Epidemiological characterization of severe acute respiratory infections. Granma, March-May 2020 / Caracterização epidemiológica de infecções respiratórias agudas graves. Granma, março a maio de 2020

RESUMEN Existen pocos estudios acerca de la epidemiología de las infecciones respiratorias agudas graves tanto en la literatura mundial como en el país, los estudios se centran fundamentalmente en la epidemiologia y comportamiento de las IRA sin especificar que ocurre con las formas graves. Con la presente publicación se pretende caracterizar el comportamiento de las infecciones respiratorias agudas graves en la provincia Granma, marzo-mayo 2020. Para ello se realizó un estudio descriptivo, retrospectivo y transversal, teniendo en cuenta las siguientes variables: grupos de edad, sexo, municipio de residencia, antecedentes patológicos personales y diagnóstico. Obteniendo como resultados que el periodo que se describe resultaron hospitalizados 175 pacientes con IRAG. La tasa de incidencia de la provincia fue de 21,4 por 100 mil habitantes. Se notificaron casos en todos los municipios, el 62,9 % de los casos de IRAG se registraron en hombres y los de 65 y más años representaron el mayor porcentaje de casos. Se concluye que Bayamo el municipio de mayor tasa de incidencia, predominó el sexo masculino, las edades de 65 y más años, la hipertensión arterial fue la comorbilidad más referida y dentro de las formas clínicas la bronconeumonía.

ABSTRACT There are few studies on the epidemiology of severe acute respiratory infections in both world literature and the country, studies focus primarily on the epidemiology and behavior of undified IRAs that occur with severe forms. This publication is intended to characterize the behavior of severe acute respiratory infections in Granma province, March-May 2020. For this purpose, a descriptive, retrospective and transversal study was carried out, taking into account the following variables: age groups, sex, municipality of residence, personal pathological history and diagnosis. Obtaining as results that the period described was hospitalized 175 patients with IRAG. The incidence rate of the province was 21.4 per 100 thousand inhabitants. Cases were reported in all municipalities, 62.9% of IRAG cases were recorded in men and those in 65 and over accounted for the highest percentage of cases. It is concluded that Bayamo, the municipality with the highest incidence rate, dominated the male sex, the ages of 65 and older, high blood pressure was the most referred comorability and within the clinical forms bronchopneummony.

RESUMO Há poucos estudos sobre a epidemiologia de infecções respiratórias agudas graves tanto na literatura mundial quanto no país, os estudos focam principalmente na epidemiologia e comportamento de IRAs indignos que ocorrem com formas graves. Esta publicação pretende caracterizar o comportamento de infecções respiratórias agudas graves na província de Granma, março a maio de 2020. Para isso, foi realizado um estudo descritivo, retrospectivo e transversal, levando-se em conta as seguintes variáveis: faixas etárias, sexo, município de residência, histórico patológico pessoal e diagnóstico. Obtendo como resultados que o período descrito foi hospitalizado 175 pacientes com IRAG. A taxa de incidência da província foi de 21,4 por 100 mil habitantes. Os casos foram notificados em todos os municípios, 62,9% dos casos de IRAG foram registrados em homens e aqueles em 65 anos ou mais representaram o maior percentual de casos. Conclui-se que Bayamo, município com maior taxa de incidência, dominou o sexo masculino, com idades a 65 anos ou mais, a pressão alta foi a mais referida comorability e dentro das formas clínicas de broncopneummonia.

Bronconeumonía por COVID-19 en un adolescente de 18 años / Bronchopneumonia due to COVID-19 in a 18 years adolescent

Se describe el caso clínico de un adolescente de 18 años de edad con antecedentes patológicos personales de hipertensión arterial crónica esencial y obesidad de grado II, que fue atendido en el Hospital Pediátrico Provincial José Martí Pérez de Sancti Spíritus por presentar tos húmeda ocasional, fiebre y falta de aire. Inicialmente se diagnosticó neumonía en la base del pulmón derecho, que luego evolucionó a bronconeumonía. Durante su hospitalización se recibió el resultado de la prueba de reacción en cadena de la polimerasa en tiempo real, que fue positivo en el coronavirus SARS-CoV-2. Se logró estabilizar el cuadro clínico del paciente, el cual tuvo una evolución favorable; se le dio el alta hospitalaria tras cumplir el periodo de vigilancia epidemiológica.

The case report of an 18 years teenager with a personal pathological history of chronic essencial hypertension and grade II obesity, who was assisted in José Martí Provincial Pediatric Hospital from Sancti Spiritus due to occasional humid cough, fever and lack of air. Initially pneumonia was diagnosed at the base of the right lung, which became a bronchopneumonia later. During his hospitalization, the result of the polymerase reaction test in real time was received, which was positive in the coronavirus SARS-CoV-2. It was possible to stabilize the patient clinical pattern, which had a favorable clinical course; he was discharged after fulfilling the surveillance period.

Can chest x-ray predict pneumonia severity and its outcome in children aged 2 months - 5 years?

Background: Worldwide 16% of death in children under the age 5 years is only due to pneumonia every year. Among the diagnostic modality x-ray chest is simple tool to diagnose the pneumonia especially in developing country like in India. Aims of study was to know the incidence of radiologically proven pneumonia and to see the correlation between x-rays findings and clinical severity of pneumonia, so as to predict the severity of pneumonia on the basis of x-ray chest done on first day of hospitalization.Methods: We did the study in department of pediatrics at tertiary care centre, total 150 patients of pneumonia (2 months to 5 years age) enrolled on clinical basis. X-ray chest done in all patients on first contact.Results: Out of 150 patients, 54% of patient having radiologically proven pneumonia while 46% were normal x-ray findings. We found that interstitial pneumonia were more common in younger children, but lobar pneumonia were more common in older children, but in severe and very severe pneumonia cases most common radiologically proven pneumonia were bronchopneumonia in all age group, which was statistically significant.Conclusions: So the basis of start of treatment should be on the clinical background and clinical severity, not only on the basis of x-ray chest findings. Late x-ray films give more chance of positive findings, multilobar infiltration or diffuse heterogeneous opacity in lungs positively correlated with clinical severity and gives idea about course and duration of hospitalization.

Infecciones respiratorias graves en pacientes pediátricos / Severe respiratory infections in pediatric patients

RESUMEN Introducción: las infecciones respiratorias agudas representan una de las primeras causas de atención médica en todo el mundo, tanto en la consulta ambulatoria como en la internación y se encuentran entre las primeras causas de mortalidad. Objetivo: caracterizar infecciones respiratorias agudas en pacientes ingresados en cuidados intensivos del Hospital Pediátrico Provincial Docente "Pepe Portilla", en el período de marzo 2016 a marzo de 2018. Métodos: se realizó un estudio observacional descriptivo y de corte transversal. La muestra quedó conformada por todos los pacientes que ingresaron con alguna infección respiratoria aguda en el período estudiado (n=261), seleccionados a partir de un muestreo no probabilístico. Para el procesamiento de la información obtenida se emplearon las técnicas de estadística descriptiva. Resultados: predominaron los pacientes del sexo masculino y menores de cinco años (43,3 %). La bronconeumonía (48,5 %) en menores de cinco años y la neumonía (39,2 %) en niños de seis a 10 años, fueron las formas clínicas más frecuentes. El abandono de la lactancia materna, la corta edad, el tabaquismo pasivo y la convivencia con animales, constituyeron los factores de riesgo de mayor incidencia. El derrame pleural paraneumónico fue la complicación intratorácica más representada (51,8 %). Conclusiones: los infantes masculinos y menores de cinco años son propensos a infecciones respiratorias graves, donde la neumonía resulta la forma clínica de mayor incidencia. Estas son un problema de salud en la provincia, que genera a su vez, altos costos hospitalarios.

ABSTRACT Introduction: acute respiratory infections represent one of the leading causes of medical care worldwide, both in outpatient and inpatient settings and are among the leading causes of mortality. Objective: to characterize acute respiratory infections in patients admitted the intensive care unit at "Pepe Portilla" Provincial Pediatric Teaching Hospital from March 2016 to March 2018. Methods: a descriptive, cross-sectional and observational study was conducted. The sample consisted of all patients admitted with an acute respiratory infection in the period studied (n=261), chosen from a non-probability sample. Descriptive statistical techniques were applied to process the information collected. Results: predominantly male patients under 5 years of age (43,3 %). Bronchopneumonia (48,5 %) in children younger than 5 years old and pneumonia (39,2 %) in children from 6 to 10 years were the most frequent clinical types. Weaning from breastfeeding, young age, passive smoking and cohabitation with animals were the risk factors with the highest incidence. Parapneumonic pleural effusion was the most represented intrathoracic complication, identifying the 51,8 %. Conclusions: male infants and children under 5 years of age are prone to severe respiratory infections, where pneumonia is the clinical type with the highest incidence. Severe respiratory infections in pediatric patients continue to be a health problem in the province, creating high hospital costs.

A fatal twist in childhood: A post-mortem finding of intestinal volvulus with malrotation

@#Gastrointestinal pathology leading to the death in paediatric age group is uncommon. The diseases that encountered were mostly intestinal obstruction, peritonitis and gastrointestinal bleeding. Due to the severe symptoms, most of the patients presented to hospital in time and were treated appropriately. However, with the presence of contributing factors, certain gastrointestinal pathology can progress rapidly leading to the death. We report a rare case of intestinal volvulus in a 3 years old girl where the deceased presented with one day short history of vomiting before her demise. The contributing factors were bronchopneumonia sepsis and underlying intestinal malrotation identified via post-mortem examination.

Plasmodium falciparum infection complicated by bronchopneumonia in a peacekeeper: a case report / 中国血吸虫病防治杂志

Malaria is an acute febrile illness caused by Plasmodium. In Africa where the burden of malaria is extremely high, febrile symptoms caused by respiratory tract infections may challenge the diagnosis of malaria, and patients with unclear diagnosis and administration of antimalarial drugs require more attention. Hereby, a peacekeeper with Plasmodium falciparum infection complicated with bronchopneumonia was reported.

A study on symptoms of children mechanically ventilated in a paediatric intensive care unit of a minimum resource setting in tertiary care centre

Background: Mechanical ventilation, a lifesaving intervention in a critical care unit is under continuous evolution in modern era. Despite this, the management of children with invasive ventilation in developing countries with limited resources is challenging. The study analyses the clinical profile, indications, complications and duration of ventilator care in limited resource settings.'Methods: A retrospective study of critically ill children mechanically ventilated in an intensive care unit of a tertiary care government hospital.' 'Results: A total of 120 children required invasive ventilation during the study period of 1 year. Infants constituted the majority (70%), and males (65%) were marginally more than female children (35%). Respiratory failure was the most common indication for invasive ventilation (55%). The major underlying etiology for invasive ventilation was bronchopneumonia associated with septic shock (30%); and the same also required a prolonged duration of ventilation of >72 hours (35%). Prolonged ventilator support of >72 hours predisposed to more complications as well as a prolonged hospital stay of >2 weeks and above, which was statistically significant. Upper lobe atelectasis (50%) and ventilator associated pneumonia (25%) were the major complications. The mortality rate of present study population was 40% as opposed to the overall mortality of 10%.' 'Conclusions: Present study highlights that critically ill children can be managed with mechanical ventilation even in limited resource settings. The child should be assessed clinically regarding the tolerance to extubation every day, to minimise the complications associated with prolonged ventilator support.

Diagnostic value of Cytomegalovirus DNA real-time quantitative-polymerase chain reaction in different body fluids for Cytomegalovirus pneumonia in immunocompetent infants / 中华实用儿科临床杂志

Objective@#To investigate the value of Cytomegalovirus(CMV) DNA real-time quantitative-polymerase chain reaction(RT-PCR) in different body fluids for diagnosing CMV pneumonia in immunocompetent infants.@*Methods@#The clinical data of immunocompetent infants with CMV pneumonia who were treated in Pediatric Intensive Care Unit of Guangdong Women and Children′s Hospital from January 1st, 2016 to February 5th, 2018 were retrospectively analyzed.The clinical data included CMV DNA load of bronchoalveolar lavage fluid(BALF), urine, blood and cerebrospinal fluid(CSF); blood immunoglobulin(Ig)M CMV, alanine aminotransferase (ALT), X-ray and CT test of chest, combined infection, clinical manifestation and treatment.@*Results@#Nine hundred and twenty-six infants received bronchoalveolar lavage by bronchoscope, and 34 cases were diagnosed as immunocompetent with CMV pneumonia.The infants with CMV pneumonia: the positive percentage of urine CMV DNA, blood CMV DNA, blood IgM CMV and ALT elevation were 100.0%(34/34 cases), 61.8%(21/34 cases), 52.9%(18/34 cases) and 20.6%(7/34 cases), respectively.There was no difference in positive percentage between blood CMV DNA and blood IgM CMV (χ2=0.5, P>0.05). Both the positive percentages of blood CMV DNA and blood IgM CMV were lower than those in the urine CMV DNA, and the differences were statistically significant (χ2=16.1, 20.9, all P<0.05). The positive percentages of ALT elevation were lower than those in the positive percentage of urine CMV DNA, blood CMV DNA and blood IgM CMV, and the differences were statistically significant (χ2=44.8, 11.9, 7.7, all P<0.05). Ten patients′ CSF CMV DNA were tested, and they were all negative.The median load of CMV DNA in BALF, urine and blood was 170.0×105 copies/L, 130.0×105 copies/L and 6.0×105 copies/L.There was no difference in median load between BALF and urine (U=561, P>0.05). BALF CMV DNA load and blood CMV DNA load had a weak positive correlation (r=0.35, P<0.05), BALF CMV DNA load and age had a negative correlation (r=-0.42, P<0.05), and urine CMV DNA load and blood CMV DNA load had a positive correlation (r=0.52, P<0.05). No matter whether blood IgM CMV was positive, BALF CMV DNA load had no differences (U=92, P>0.05). The main radiographic signs were pulmonary interstitial lesions.Thirty-four immunocompetent infants with CMV pneumonia, 18 patients (52.9%) with symptoms lasted for over 2 weeks, 20 patients (58.8%) had complicated infections.They all received inductive treatment of Ganciclovir, 55.9%(19/34 cases) patients′ urine CMV DNA turned to be negative.When patients got combined infections by bacteria or mycoplasma, antibiotics were used.All discharged patients had symptoms relieved and signs improved.@*Conclusions@#BALF RT-PCR is instant, sensitive and distinctive method to diagnose CMV pneumonia.Urine RT-PCR gets specimens conveniently and safely, its positive percentage and DNA load are present well according to BALF, and is suitable for screening and monitoring CMV infection.Blood CMV DNA load and blood IgM CMV indicate viral dissemination and immunocompetence, but it is not recommended for diagnosing CMV pneumonia solely.

Efficacy of massage combined with microwave therapy in treating Children's bronchial pneumonia with syndrome of deficiency of lung-spleen Qi / 国际中医中药杂志

Objective@#To investigate the efficacy of massage combined with microwave therapy in treating Children's bronchial pneumonia with syndrome of deficiency of lung-spleen Qi.@*Methods@#Two hundred forty-four bronchial pneumonia Children were selected in our hospital and randomly divided into the control group and the observation group with 122 cases in each group referring to random number table. The control group was administered with the routine treatment. Based on the control group, the observation group received the massage and microwave therapy. The course was 2 week for both groups. The syndrome scores of traditional Chinese medicine were performed before and after treatment, and the disappearance of gasping, antipyretic, disappearance of moist rale in the lungs, and absorption time of chest X-ray were observed and recorded. the flow cytometry was used to detect peripheral blood levels of CD4+ and CD8+, and serum levels of IL-6 and IL-8 were detected by ELISA. The clinical effect rate was evaluated.@*Results@#The total effective rate was 97.5% (118/121) in the observation group and 91.7% (110/120) in the control group,with statistically significant differences (χ2=4.406, P=0.044). After treatment, the scores of cough, phlegm, shortness of breath, pale face, fatigue, spontaneous perspiration, poor appetite in the observation group were significantly lower than those in the control group (t value were 10.008, 11.529, 11.778, 12.043, 11.309, 10.128, 11.008, P<0.01), and elapsed time of gasping, antifebrile time, disappear time of lung moist crackles, absorption time were significantly earlier than the control group (t value were 15.121, 10.099, 18.441, 14.310, P<0.01). After 2 week’ treatment, the scores of symptoms of deficiency of lung-spleen Qi in the observation group were significantly lower than those of control group (P<0.01). Compared with the control group, the duration of wheezing and antipyretic, duration of lung dampness and chest X-ray absorption in the observation group were significantly decreased (P<0.05). The total effective rate of the observation group was 97.52%, which was significantly higher than the control group 92.67% (P<0.05). After 2 week treatment, the CD4+ (41.03% ± 4.55% vs. 33.52% ± 3.95%, t=14.011) in the observation group was significantly higher, CD8+ (22.71% ± 2.83% vs. 26.65% ± 3.05%, t=10.061) was significantly lower than the control group, serum levels of IL-6 (28.13 ± 3.63 ng/L vs. 40.09 ± 4.61 ng/L, t=14.890) and IL-8 (21.41 ± 2.75 ng/L vs. 29.05 ± 3.61 ng/L, t=11.439) were significantly lower than the control group (P<0.01).@*Conclusions@#Massage combined with microwave therapy for the Children's bronchial pneumonia with deficiency of lung-spleen Qi syndrome can promote the improvement of symptoms, enhance the efficacy, increase the immune function and reduce inflammation level.

Diagnostic value of Cytomegalovirus DNA real-time quantitative-polymerase chain reaction in different body fluids for Cytomegalovirus pneumonia in immunocompetent infants / 中华实用儿科临床杂志

Objective To investigate the value of Cytomegalovirus(CMV) DNA real-time quantitative-polymerase chain reaction(RT-PCR) in different body fluids for diagnosing CMV pneumonia in immunocompetent infants.Methods The clinical data of immunocompetent infants with CMV pneumonia who were treated in Pediatric Intensive Care Unit of Guangdong Women and Children's Hospital from January 1st,2016 to February 5th,2018 were retrospectively analyzed.The clinical data included CMV DNA load of bronchoalveolar lavage fluid (BALF),urine,blood and cerebrospinal fluid(CSF);blood immunoglobulin(Ig) M CMV,alanine aminotransferase (ALT),X-ray and CT test of chest,combined infection,clinical manifestation and treatment.Results Nine hundred and twenty-six infants received bronchoalveolar lavage by bronchoscope,and 34 cases were diagnosed as immunocompetent with CMV pneumonia.The infants with CMV pneumonia:the positive percentage of urine CMV DNA,blood CMV DNA,blood IgM CMV and ALT elevation were 100.0％ (34/34 cases),61.8％ (21/34 cases),52.9％ (18/34 cases) and 20.6％ (7/34 cases),respectively.There was no difference in positive percentage between blood CMV DNA and blood IgM CMV (x2 =0.5,P ＞ 0.05).Both the positive percentages of blood CMV DNA and blood IgM CMV were lower than those in the urine CMV DNA,and the differences were statistically significant (x2 =16.1,20.9,all P ＜0.05).The positive percentages of ALT elevation were lower than those in the positive percentage of urine CMV DNA,blood CMV DNA and blood IgM CMV,and the differences were statistically significant (x2 =44.8,11.9,7.7,all P ＜ 0.05).Ten patients' CSF CMV DNA were tested,and they were all negative.The median load of CMV DNA in BALF,urine and blood was 170.0 × 105 copies/L,130.0 x 105 copies/L and 6.0 x 105 copies/L.There was no difference in median load between BALF and urine (U =561,P ＞ 0.05).BALF CMV DNA load and blood CMV DNA load had a weak positive correlation (r =0.35,P ＜ 0.05),BALF CMV DNA load and age had a negative correlation (r =-0.42,P ＜ 0.05),and urine CMV DNA load and blood CMV DNA load had a positive correlation (r =0.52,P ＜ 0.05).No matter whether blood IgM CMV was positive,BALF CMV DNA load had no differences (U =92,P ＞ 0.05).The main radiographic signs were pulmonary interstitial lesions.Thirty-four immunocompetent infants with CMV pneumonia,18 patients (52.9％) with symptoms lasted for over 2 weeks,20 patients (58.8％) had complicated infections.They all received inductive treatment of Ganciclovir,55.9％ (19/34 cases) patients' urine CMV DNA turned to be negative.When patients got combined infections by bacteria or mycoplasma,antibiotics were used.All discharged patients had symptoms relieved and signs improved.Conclusions BALF RT-PCR is instant,sensitive and distinctive method to diagnose CMV pneumonia.Urine RT-PCR gets specimens conveniently and safely,its positive percentage and DNA load are present well according to BALF,and is suitable for screening and monitoring CMV infection.Blood CMV DNA load and blood IgM CMV indicate viral dissemination and immunocompetence,but it is not recommended for diagnosing CMV pneumonia solely.

Efficacy of massage combined with microwave therapy in treating Children's bronchial pneumonia with syndrome of deficiency of lung-spleen Qi / 国际中医中药杂志

Objective To investigate the efficacy of massage combined with microwave therapy in treating Children's bronchial pneumonia with syndrome of deficiency of lung-spleen Qi. Methods Two hundred forty-four bronchial pneumonia Children were selected in our hospital and randomly divided into the control group and the observation group with 122 cases in each group referring to random number table. The control group was administered with the routine treatment. Based on the control group, the observation group received the massage and microwave therapy. The course was 2 week for both groups. The syndrome scores of traditional Chinese medicine were performed before and after treatment, and the disappearance of gasping, antipyretic, disappearance of moist rale in the lungs, and absorption time of chest X-ray were observed and recorded. the flow cytometry was used to detect peripheral blood levels of CD4+ and CD8+, and serum levels of IL-6 and IL-8 were detected by ELISA. The clinical effect rate was evaluated. Results The total effective rate was 97.5% (118/121) in the observation group and 91.7% (110/120) in the control group,with statistically significant differences (χ2=4.406, P=0.044). After treatment, the scores of cough, phlegm, shortness of breath, pale face, fatigue, spontaneous perspiration, poor appetite in the observation group were significantly lower than those in the control group (t value were 10.008, 11.529, 11.778, 12.043, 11.309, 10.128, 11.008,P<0.01), and elapsed time of gasping, antifebrile time, disappear time of lung moist crackles, absorption time were significantly earlier than the control group (t value were 15.121, 10.099, 18.441, 14.310, P<0.01). After 2 week’ treatment, the scores of symptoms of deficiency of lung-spleen Qi in the observation group were significantly lower than those of control group (P<0.01). Compared with the control group, the duration of wheezing and antipyretic, duration of lung dampness and chest X-ray absorption in the observation group were significantly decreased (P<0.05). The total effective rate of the observation group was 97.52%, which was significantly higher than the control group 92.67% (P<0.05). After 2 week treatment, the CD4+(41.03% ± 4.55% vs. 33.52% ± 3.95%, t=14.011) in the observation group was significantly higher, CD8+ (22.71% ± 2.83% vs. 26.65% ± 3.05%, t=10.061) was significantly lower than the control group, serum levels of IL-6 (28.13 ± 3.63 ng/L vs. 40.09 ± 4.61 ng/L, t=14.890) and IL-8 (21.41 ± 2.75 ng/L vs. 29.05 ± 3.61 ng/L, t=11.439) were significantly lower than the control group (P<0.01). Conclusions Massage combined with microwave therapy for the Children's bronchial pneumonia with deficiency of lung-spleen Qi syndrome can promote the improvement of symptoms, enhance the efficacy, increase the immune function and reduce inflammation level.