Tendencias en la mortalidad por neumonía en adultos en Chile, 2000-2016 / Trends in adult pneumonia mortality in Chile, 2000-2016

Objetivo: Analizar y modelar los cambios en la tendencia de la mortalidad por neumonía en la población mayor de 15 años de Chile, entre los años 2000 y 2016. Métodos: Estudio epidemiológico basado en información de bases de datos públicas de estadísticas vitales del Departamento de Estadística e Información en Salud (DEIS) y del Instituto Nacional de Estadística (INE) del Ministerio de Salud (MINSAL) de Chile. Los casos fueron identificados por los códigos CIE-10 J12-J18. Se calculó la tasa de mortalidad estandarizada por edad, según sexo y grupo etario. Se utilizó el análisis de regresión Joinpoint para modelar la mortalidad y estimar el porcentaje de cambio anual (CPA) en las tasas e identificar cambios significativos en las tendencias. Se utilizó el cambio del CPA como medida de resumen. Resultados: Durante el período de estudio, la tasa de mortalidad por neumonía en Chile disminuyó significativamente en un 61,9%, desde 56,3 muertes por 100.000 habitantes el año 2000 a 21,7 muertes por 100.000 habitantes en el año 2016, con un CPA de −4,2%, (p < 0,05). El 90% de los fallecidos tenían más de 65 años. Conclusiones: Las tasas de mortalidad por neumonía en Chile en mayores de 15 años muestran una tendencia a la disminución sostenida significativa en el período comprendido entre los años 2000 y 2016.

Objective: To analyze and model changes in the pneumonia mortality trend in the population over 15 years old of Chile, between 2000 and 2016. Methods: Epidemiological study based on information from public databases of vital statistics of the Department of Health Statistics and Information (DEIS) and the National Institute of Statistics (INE) of the Ministry of Health (MINSAL) of Chile. The cases were identified by the codes ICD-10 J12-J18. We calculated age-standardized overall mortality, according to sex and age group. Joinpoint regression analysis was used to model mortality and estimate the annual percentage of change (APC) in rates and identify significant changes in trends. APC was used as a summary measure. Results: During the period studied, the pneumonia mortality rate in Chile decreased significantly by 61.9%. Mortality rate diminished from 56.3 deaths per 100,000 inhabitants in 2000 to 21.7 deaths per 100,000 inhabitants in 2016 with an APC of −4.2%, (p < 0.05). Almost 90% of the deceased were over 65 years old. Conclusions: Mortality rates for pneumonia in Chile in people over 15 years of age show a significant sustained decreasing trend in the period between 2000 and 2016.

Validación del instrumento para medir los factores ambientales asociados a neumonía en niños menores de 5 años / Validation of the instrument to measure environmental factors associated with pneumonia in children under 5 years of age

La neumonía es una infección respiratoria que afecta a los pulmones y puede llevar a la muerte. Los niños menores de 5 años pueden adquirir la enfermedad a través de bacterias, virus y hongos, lo cual puede generarse por ciertos factores ambientales no propicios. Objetivos: Validar el instrumento para medir los factores ambientales asociados a neumonía en niños menores de 5 años que acuden a consulta externa del hospital Martin Icaza del Cantón Babahoyo, julio - diciembre 2020; determinar la confiabilidad del instrumento para medir los factores ambientales asociados a neumonía en niños menores de 5 años. Materiales y métodos: Se utiliza un diseño no experimental, con enfoque mixto, método deductivo, de tipo transversal, de campo, prospectivo. Se aplicó un plan piloto con el fin de identificar la validez, coherencia y pertinencia del instrumento, y a su vez determinar la confiabilidad del mismo con base al criterio de expertos. El componente cuantitativo constó de un plan piloto a 16 padres, donde 8 niños padecían neumonía, mientras los 8 restantes no; en tanto que la entrevista se realizó a dos representantes de niños con neumonía. Resultados: La validación de los instrumentos vino dada por tres profesionales que fueron seleccionados por su experiencia y prestigio, estos calificaron la validez, pertinencia y coherencia donde se obtuvo la ponderación de muy confiable. Los resultados mostraron que la enfermedad se transmite por contacto con personas que padecen estas enfermedades (62.5%), los principales síntomas son la tos, fiebre y dolor de garganta (50.0%), las personas viven con 4 o 5 personas en la misma casa (56.3%) y poseen animales (75.0%). Se identificó efectos emocionales negativos, tales como desesperación, ansiedad, tristeza, depresión e impotencia. Conclusión: El instrumento analizado es válido, coherente y pertinente, siendo muy confiable para su aplicación(AU)

Pneumonia is a respiratory infection that affects the lungs and can lead to death. Children under 5 years of age can acquire the disease through bacteria, viruses and fungi, which can be generated by certain unfavorable environmental factors. Objectives: To validate the instrument to measure the environmental factors associated with pneumonia in children under 5 years of age who attend the outpatient clinic of the Martin Icaza hospital in Babahoyo Canton, July - December 2020; determine the reliability of the instrument to measure the environmental factors associated with pneumonia in children under 5 years of age. Materials and methods: A non-experimental design is used, with a mixed approach, deductive method, cross-sectional, field, prospective. A pilot plan was applied in order to identify the validity, coherence and relevance of the instrument, and in turn determine its reliability based on expert criteria. The quantitative component consisted of a pilot plan for 16 parents, where 8 children suffered from pneumonia, while the remaining 8 did not; while the interview was conducted with two representatives of children with pneumonia. Results: The validation of the instruments was given by three professionals who were selected for their experience and prestige, they qualified the validity, relevance and coherence where the weighting of very reliable was obtained. The results showed that the disease is transmitted by contact with people suffering from these diseases (62.5%), the main symptoms are cough, fever and sore throat (50.0%), people live with 4 or 5 people in the same house (56.3%) and own animals (75.0%). Negative emotional effects were identified, such as despair, anxiety, sadness, depression and helplessness. Conclusion: The analyzed instrument is valid, coherent and pertinent, being very reliable for its application(AU)

Behavior of clinical and humoral variables on admission as predictors of death in patients with community-acquired pneumonia. Comparative study between adults and older adults. / Comportamiento de variables clínicas y humorales al ingreso, como predictores de fallecimiento en pacientes con neumonía adquirida en la comunidad. Estudio comparativo entre adultos y adultos mayores

Community-acquired pneumonia is recognized as one of the main infectious health problems worldwide. The objective was to determine the condition of predictors of death for a group of selected clinical conditions, and for laboratory variables frequently used in practice. Study with descriptive design, which included 967 patients with pneumonia hospitalized between 2016 and 2019, and whose information was obtained from clinical records. Statistical treatment included bivariate and multivariate analysis (logistic regression); it was used the ratio of crossed products (odds ratio) and its 95% confidence interval. Several manifestations were significantly more frequent in older adults: dyspnea (OR 1.5[1.07,2.1]), absence of productive cough (OR 1.7 [1.3, 2.4]), neuropsychological manifestations (OR 2 [1.4,2.8]), tachypnea (OR 1.5 [1.1,2.1]), arterial hypotension (OR 2.1 [1.2,3.6]), anemia (OR 1.6[1.2,2.2]), elevated creatinine (OR 1.6[1.2,2.3]) and hypoproteinemia (OR 3.3[1.9,5.7]); showed a significant association with death: absence of productive cough, neuropsychological manifestations, temperature below 36 degrees Celsius, blood pressure below 110/70 mmHg, respiratory rate above 20 per minute, hemoglobin below 100 g/L, erythrosedimentation greater than 20 mm/L, leukopenia less than 5 x 109/L and serum creatinine above 130 micromol/L. As conclusions certain clinical and laboratory conditions present in the patient at the time of hospital admission, of routine exploration in the comprehensive assessment of the patient, were predictors of death. Additionally, the existence of evident differences in the number of conditions with a predictive nature of death between the population with pneumonia under 60 years of age and the elderly, as well as in the frequency of these conditions in both subgroups, is verified.

La neumonía adquirida en la comunidad está reconocida como uno de los principales problemas de salud de tipo infeccioso al nivel mundial. La investigación tuvo como objetivo determinar el carácter de predictores de fallecimiento de un grupo de condiciones clínicas seleccionadas, y de variables de laboratorio de uso frecuente en la práctica. Se realizó un estudio con diseño descriptivo, que incluyó a 967 pacientes con neumonía hospitalizados entre 2016 y 2019, y cuya información se obtuvo de los expedientes clínicos. El tratamiento estadístico incluyó análisis bivariante y multivariado (regresión logística); como estadígrafo se utilizó la razón de productos cruzados (odds ratio) y su intervalo de confianza de 95%. Entre los resultados se destacan los siguientes: varias manifestaciones fueron significativamente más frecuentes en los adultos mayores: disnea (OR 1,5[1,07;2,1]), ausencia de tos productiva (OR 1,7[1,3;2,4]), manifestaciones neuropsicológicas (OR 2[1,4;2,8]), taquipnea (OR 1,5[1,1;2,1]), hipotensión arterial (OR 2,1[1,2;3,6]), anemia (OR 1,6[1,2;2,2]), creatinina elevada (OR 1,6[1,2;2,3]) e hipoproteinemia (OR 3,3[1,9;5,7]); mostraron asociación significativa con el fallecimiento: ausencia de tos productiva, manifestaciones neuropsicológicas, temperatura por debajo de 36 grados Celsius, tensión arterial inferior a 110/70 mmHg, frecuencia respiratoria por encima de 20 por minuto, hemoglobina inferior a 100 g/L, velocidad de sedimentación eritrocitaria superior a 20 mm/L, leucopenia inferior a 5 x 109/L y creatinina sérica por encima de 130 micromol/L. Se concluye que ciertas condiciones clínicas y de laboratorio presentes en el paciente al momento del ingreso hospitalario, de exploración habitual en la valoración integral del enfermo, constituyeron predictores de fallecimiento. Adicionalmente, se comprueba la existencia de evidentes diferencias en el número de condiciones con carácter predictor de muerte entre la población con neumonía menor de 60 años y los adultos mayores, así como en la frecuencia de estas condiciones en ambos subgrupos.

Anatomopathological findings of Testudines necropsied in the Distrito Federal, Brazil / Achados anatomopatológicos de Testudines necropsiados no Distrito Federal, Brasil

In order to determine the main anatomopathological findings of Testudines necropsied in the Distrito Federal, all necropsy records performed at the "Laboratório de Patologia Veterinária" of the "Universidade de Brasília" (LPV-UnB) on Testudines during the period from January 2008 to July 2020 were reviewed. The 72 cases reviewed were grouped and classified according to species, sex, origin, season of occurrence, and diagnosis. In 69.44% of the cases the species was informed in the necropsy protocols, which included Phrynops geoffroanus (38%), Trachemys dorbigni (36%), Chelonoidis carbonaria (14%), Chelonoidis denticulata (10%) and Podocnemis expansa (2%). In 30.55% of the cases this parameter was not informed and were classified only as Testudines. In 41.66% of the cases the sex was informed, being female 22.22%, male 19.44%, and 58.33% were not informed. Of these animals 79.16% were from environmental agencies and 20.84% from zoos and/or guardians. In 70.83% of the animals analyzed they were directly related to the autumn and winter seasons, with June being the most frequent month (29.17%). The conclusive diagnosis was possible in 68.05% of the cases. The category of disorders caused by injurious agents (48.97%) was the most prevalent, followed by inflammatory disorders (32.65%) and nutritional and metabolic disorders (28.57%). The main diagnoses were carapace and/or plastron fracture with 30.61%, hepatic steatosis (20.40%) and pneumonia (10.22%). Most cases of carapace or plastron fracture and hepatic steatosis occurred in animals from environmental agencies.(AU)

Com o objetivo de determinar os principais achados anatomopatológicos de Testudines necropsiados no Distrito Federal, foram revisadas todas as fichas de necropsia realizadas no Laboratório de Patologia Veterinária da Universidade de Brasília (LPV-UnB) em Testudines, durante o período de janeiro de 2008 a julho de 2020. Os 72 casos revisados foram agrupados e classificados quanto à espécie, sexo, procedência, estação do ano de ocorrência e diagnóstico. Em 69,44% dos casos havia a espécie informada nos protocolos de necropsia, que incluíam Phrynops geoffroanus (38%), Trachemys dorbigni (36%), Chelonoidis carbonaria (14%), Chelonoidis denticulata (10%) e Podocnemis expansa (2%). Em 30,55% dos casos não tiveram esse parâmetro informado e foram classificados apenas como Testudines. Em 41,66% casos foi informado o sexo, sendo fêmea 22,22%, macho 19,44% e não informados 58,33%. Destes animais 79,16% eram de órgão ambiental e 20,84% de zoológicos e ou tutores. Em 70,83% dos animais analisados tiveram direta relação com as estações de outono e inverno, sendo o mês de junho o mais frequente (29,17%). O diagnóstico conclusivo foi possível em 68,05% dos casos. A categoria de distúrbios causados por agentes lesivos (48,97%) foi a mais prevalente, seguido por distúrbios inflamatórios (32,65%) e dos distúrbios nutricionais e metabólicos (28,57%). Os principais diagnósticos foram fratura de carapaça e ou plastrão com 30,61%, esteatose hepática (20,40%) e pneumonia (10,22%). A maior parte dos casos de fratura de carapaça ou plastrão e de esteatose hepática ocorreram em animais provenientes de órgão ambiental.(AU)

Anatomopathological findings of Testudines necropsied in the Distrito Federal, Brazil / Achados anatomopatológicos de Testudines necropsiados no Distrito Federal, Brasil

In order to determine the main anatomopathological findings of Testudines necropsied in the Distrito Federal, all necropsy records performed at the "Laboratório de Patologia Veterinária" of the "Universidade de Brasília" (LPV-UnB) on Testudines during the period from January 2008 to July 2020 were reviewed. The 72 cases reviewed were grouped and classified according to species, sex, origin, season of occurrence, and diagnosis. In 69.44% of the cases the species was informed in the necropsy protocols, which included Phrynops geoffroanus (38%), Trachemys dorbigni (36%), Chelonoidis carbonaria (14%), Chelonoidis denticulata (10%) and Podocnemis expansa (2%). In 30.55% of the cases this parameter was not informed and were classified only as Testudines. In 41.66% of the cases the sex was informed, being female 22.22%, male 19.44%, and 58.33% were not informed. Of these animals 79.16% were from environmental agencies and 20.84% from zoos and/or guardians. In 70.83% of the animals analyzed they were directly related to the autumn and winter seasons, with June being the most frequent month (29.17%). The conclusive diagnosis was possible in 68.05% of the cases. The category of disorders caused by injurious agents (48.97%) was the most prevalent, followed by inflammatory disorders (32.65%) and nutritional and metabolic disorders (28.57%). The main diagnoses were carapace and/or plastron fracture with 30.61%, hepatic steatosis (20.40%) and pneumonia (10.22%). Most cases of carapace or plastron fracture and hepatic steatosis occurred in animals from environmental agencies.

Com o objetivo de determinar os principais achados anatomopatológicos de Testudines necropsiados no Distrito Federal, foram revisadas todas as fichas de necropsia realizadas no Laboratório de Patologia Veterinária da Universidade de Brasília (LPV-UnB) em Testudines, durante o período de janeiro de 2008 a julho de 2020. Os 72 casos revisados foram agrupados e classificados quanto à espécie, sexo, procedência, estação do ano de ocorrência e diagnóstico. Em 69,44% dos casos havia a espécie informada nos protocolos de necropsia, que incluíam Phrynops geoffroanus (38%), Trachemys dorbigni (36%), Chelonoidis carbonaria (14%), Chelonoidis denticulata (10%) e Podocnemis expansa (2%). Em 30,55% dos casos não tiveram esse parâmetro informado e foram classificados apenas como Testudines. Em 41,66% casos foi informado o sexo, sendo fêmea 22,22%, macho 19,44% e não informados 58,33%. Destes animais 79,16% eram de órgão ambiental e 20,84% de zoológicos e ou tutores. Em 70,83% dos animais analisados tiveram direta relação com as estações de outono e inverno, sendo o mês de junho o mais frequente (29,17%). O diagnóstico conclusivo foi possível em 68,05% dos casos. A categoria de distúrbios causados por agentes lesivos (48,97%) foi a mais prevalente, seguido por distúrbios inflamatórios (32,65%) e dos distúrbios nutricionais e metabólicos (28,57%). Os principais diagnósticos foram fratura de carapaça e ou plastrão com 30,61%, esteatose hepática (20,40%) e pneumonia (10,22%). A maior parte dos casos de fratura de carapaça ou plastrão e de esteatose hepática ocorreram em animais provenientes de órgão ambiental.

Perfil clínico-epidemiológico de la neumonía grave adquirida en la comunidad en gestantes / Clinical-epidemiological profile of severe community-acquired pneumonia in pregnant women / Perfil clínico-epidemiológico da pneumonia grave adquirida na comunidade em mulheres grávidas

RESUMEN Introducción: La neumonía adquirida en la comunidad durante el embarazo no se ha caracterizado en el Hospital General Docente "Dr. Agostinho Neto". Objetivo: Caracterizar este tipo de neumonía en gestantes ingresadas en el citado hospital durante el 2015-2019. Método: Se realizó un estudio descriptivo, aplicado, y retrospectivo. Se estudiaron indicadores relacionados con la morbilidad y mortalidad por esta enfermedad, edad biológica y gestacional, procedencia, comorbilidad, estadía, y estado al egreso de las gestantes; así como variables clínico- epidemiológicas relacionadas con la neumonía. Los datos se resumieron mediante análisis de frecuencias. Resultados: Ingresaron 67 gestantes con esta afección (9,1 % y 0,24 % respecto al total de pacientes maternas y al total de pacientes ingresados en la unidad por todas las causas, respectivamente). Sobre todo, tenían entre 20 y 29 años de edad (92,5 %) y entre 28 y 42 semanas de gestación (59,7 %), procedieron de áreas urbanas (89,5 %) y presentaron comorbilidad (31,3 %). La forma clínica-radiológica típica fue la más común (92,5 %), el germen causal más usual fue el Streptococcus pneumoniae (41,8 %), el 100 % se trató con fármacos antimicrobianos antivirales, cefalosporinas y macrólidos, el 73,1 % evolucionó de modo satisfactorio. Falleció una paciente. Conclusiones: Se caracterizó la neumonía adquirida en la comunidad durante el embarazo en pacientes del Hospital General Docente "Dr. Agostinho Neto" de Guantánamo durante el periodo 2015-2019, lo que posibilita reconocer que no significa un problema de salud, pero impacta en el perfil de morbilidad materna pues es la primera causa de ingreso de gestantes por enfermedades no obstétricas.

ABSTRACT Introduction: Pneumonia acquired in the community during pregnancy has not been characterized in the Hospital General Docente "Dr. Agostinho Neto". Objective: To characterize this type of pneumonia in pregnant women admitted to the aforementioned hospital during 2015-2019. Method: A descriptive, retrospective and applied study was carried out. Indicators related to morbidity and mortality, biological and gestational age, origin, comorbidity, stay and status at the time discharge of the pregnant women were studied; as well as clinical-epidemiological variables related to pneumonia. Data were summarized using frequency analysis. Results: 67 pregnant women with this condition were admitted (9.1% and 0.24% with respect to the total number of maternal patients and the total number of patients admitted to the unit for all causes, respectively). They were mostly between 20 and 29 years of age (92.5%) and between 28 and 42 weeks of gestation (59.7%); 89.5% came from urban areas and 31.3% presented comorbidity. The typical clinical-radiological form was the most common (92.5%); the most common causative germ was Streptococcus pneumoniae (41.8%); 100% were treated with antiviral antimicrobial drugs, cephalosporins and macrolides; 73.1% evolved satisfactorily. One patient passed away. Conclusions: Community-acquired pneumonia during pregnancy was characterized in patients from the Hospital General Docente "Dr. Agostinho Neto" in Guantánamo during the period 2015-2019, which makes it possible to recognize that this condition does not constitute a health problem, but it impacts on the maternal morbidity profile since it is the first cause of admission of pregnant women due to non-obstetric diseases.

RESUMO Introdução: Pneumonia adquirida na comunidade durante a gravidez não foi caracterizada no Hospital General Docente "Dr. Agostinho Neto". Objetivo: Caracterizar este tipo de pneumonia em gestantes internadas no referido hospital durante 2015-2019. Método: Foi realizado um estudo descritivo, aplicado e retrospectivo. Foram estudados indicadores relacionados à morbimortalidade por essa doença, idade biológica e gestacional, procedência, comorbidade, permanência e estado de alta das grávidas; bem como variáveis clínico-epidemiológicas relacionadas à pneumonia. Os dados foram resumidos por análise de frequência. Resultados: Foram internadas 67 grávidas com essa condição (9,1% e 0,24% do total de pacientes maternos e do total de pacientes internados na unidade por todas as causas, respectivamente). Acima de tudo, tinham entre 20 e 29 anos (92,5%) e entre 28 e 42 semanas de gestação (59,7%), eram procedentes da zona urbana (89,5%) e apresentavam comorbidade (31,3%). A forma clínico-radiológica típica foi a mais comum (92,5%), o germe causador mais comum foi Streptococcus pneumoniae (41,8%), 100% foram tratados com antimicrobianos antivirais, cefalosporinas e macrolídeos, 73,1% evoluíram de forma satisfatória. Um paciente faleceu. Conclusões: A pneumonia adquirida na comunidade durante a gravidez foi caracterizada em pacientes do Hospital General Docente "Dr. Agostinho Neto" de Guantánamo no período 2015-2019, o que permite reconhecer que não se trata de um problema de saúde, mas impacta no perfil de morbidade materna por ser a principal causa de internamento de grávidas por doenças não obstétricas.

Depresión en ancianos graves con neumonía adquirida en la comunidad / Depression in seriously-ill elder people with community-acquired pneumonia

RESUMEN Introducción: aquellos países con alto grado de envejecimiento poblacional muestran asociaciones importantes con diferentes enfermedades, por ejemplo, la neumonía adquirida en la comunidad y la depresión en los ancianos. Objetivos: relacionar la depresión con la mortalidad y evaluar efectos de los antidepresivos, en los pacientes con neumonía adquirida en la comunidad, ingresados en la Unidad de Cuidados Intensivos del Hospital Militar Central "Dr. Carlos J. Finlay". Materiales y métodos: se realizó un estudio analítico, longitudinal prospectivo, con todos los pacientes con neumonía adquirida en la comunidad, ingresados en la Unidad de Cuidados Intensivos Emergentes, del Hospital Militar "Dr. Carlos J. Finlay". Periodo correspondiente a enero del 2018 hasta abril del 2019 que cumplieron con los criterios de inclusión. El universo lo constituyó 160 pacientes. Resultados: existieron 55 pacientes con síntomas de depresión previos al ingreso, (34 %). El 78 % de fallecidos presentaron depresión al ingreso. La edad media de los no deprimidos fue de 74, la más alta de los deprimidos fue de 80,80. No presentaron signos de depresión 93 pacientes vivos y 43 que la presentaron y fallecieron con una gran significación estadística p 0,000. RR 6,8. Se observó una marcada relación entre la mortalidad y el no recibir tratamiento para la depresión, (37) p 0,000. Conclusiones: la neumonía y la depresión son enfermedades que tienen una relación íntima. Esta asociación cuenta con una elevada mortalidad, así como el impacto del tratamiento antidepresivo en la evolución del paciente es definitorio en el ámbito de los cuidados intensivos (AU).

ABSTRACT Introduction: those countries with a high level of population ageing show important associations to different diseases, for example, community acquired pneumonia and depression in elder people. Objectives: to establish the relationship of depression with mortality and to evaluate the effect of antidepressants in patients with community-acquired pneumonia admitted in the Intensive Care Unit of the Central Military Hospital "Dr. Carlos J. Finlay". Materials and methods: a prospective, longitudinal, analytic study was carried out with all patients with community-acquired pneumonia, admitted in the Intensive Care Unit of the Central Military Hospital "Dr. Carlos J. Finlay" in the period from January 2018 until April 2019, who fulfilled the inclusion criteria. The universe were 160 patients. Results: there were 55 patients with depression symptoms before the admission. 78 % of the deceased showed depression at the admittance. The medium age of the non-depressed ones was 74 years; the highest age of the depressed ones was 80.80 years. 93 living patients did not present depression signs, and 43 presented them and died with a great statistical significance p: 0.000 RR: 6.8. A remarked relation was observed between mortality and not receiving treatment for depression (37) p 0,000. Conclusions: pneumonia and depression are diseases having a tight relationship. This association yields a high mortality, and the impact of the anti-depression treatment on the patient's evolution is defining in the intensive care settings (AU).

Validación externa del modelo predictivo de mortalidad en ancianos con neumonía adquirida en la comunidad / External validation of the predictive model of mortality in elder people with community-acquired pneumonia

RESUMEN Introducción: la neumonía adquirida en la comunidad es la enfermedad infecciosa que conlleva una mayor mortalidad en los países desarrollados. El diagnóstico pasa por varios momentos, el cuadro clínico, la analítica y las imágenes. Objetivos: realizar la validación externa de un modelo matemático predictivo de mortalidad en pacientes ingresados por neumonía grave adquirida en la comunidad. Material y métodos: estudio longitudinal prospectivo (cohorte) con un grupo, con todos los pacientes que ingresaron en la Unidad de Cuidados intensivos emergentes con el diagnóstico de neumonía adquirida en la comunidad en el Hospital Militar Dr. Carlos J. Finlay, de febrero de 2018 hasta marzo del 2019. El universo estuvo constituido por 160 pacientes y no se tomó muestra alguna. Resultados: índice de Kappa K=1. Test Hosmer Lemenshow 0,650 con elevado ajuste. Resultados del modelo con sensibilidad= 79%. Especificidad: 91% con (VPP): 80 y (VPN)= 91. RR: 9,1. Área bajo la Curva = 0997. Porcentaje de aciertos en la regresión logística de 88,4 %. Conclusiones: el modelo propuesto constituyo una herramienta útil en la detección temprana de pacientes con riesgo de muerte a corto plazo. Permitió unificar en una sola variable el resultado de otras que aparentemente no tienen relación entre ellas; con lo que se hace más fácil la interpretación de los resultados, toda vez que este refleja, el conjunto y no la individualidad (AU).

SUMMARY Introduction: community-acquired pneumonia is the infectious disease leading to higher mortality in developed countries. The diagnosis goes through several moments, clinical symptoms, analytics, and images. Objective: to perform the external validation of a predictive mathematical model of mortality in patients admitted by serious community-acquired pneumonia. Methods: longitudinal prospective (cohort) study with a group formed with all patients who were admitted to the Emergent Intensive Care Unit in the Military Hospital ¨Dr. Carlos Juan Finlay¨ with the diagnosis of community-acquired pneumonia, from February 2018 to March 2019. The universe was formed by 160 patients and no sample was chosen. Results: Kappa index K= 1. Hosmer Lemenshow test= 0.650 with a high adjustment. Result of the model with sensibility= 79 %. Specificity= 91 % with (APV) = 80 and (NPV) = 91. RR= 9.1. Area under the curve= 0997. Percentage of correctness in logistic regression of 88.4 %. Conclusions: The proposed model was a useful tool in the early detection of patients at near-term death risk. It allowed to unite in an only variant the result of others that apparently are not related one to another, making it easier the interpretation of the results, since it reflects the whole and not the individuality (AU).

Causes of death in growing-finishing pigs in two technified farms in southern Brazil / Causas de morte em suínos de crescimento e terminação em duas granjas tecnificadas no Sul do Brasil

The aim of this study was to investigate the main causes of death in growing-finishing pigs in southern Brazil. During a one-year period (from 2018 to 2019), two industrial pig herds (18 and 20 thousand pigs each farm) in southern Brazil were monitored along the four seasons of the year (12 days per season on each farm), in order to perform necropsies of all pigs that died in that period. The two farms had an average monthly mortality rate ranging from 0.94 to 3.93% in the evaluated months. At necropsy, tissues were collected, fixed in 10% formalin solution and processed routinely for histopathological examination. When necessary, samples were sent for bacterial culture and PCR to identify etiologic agents. A total of 601 necropsies were performed, with 94.9% of conclusive diagnoses. Infectious diseases corresponded to 64.4% of conclusive diagnosis and non-infectious diseases to 35.6%. The most prevalent causes of death were: pneumonia (33%), gastric ulcers (15.4%), circovirosis (9.9%), systemic bacterial embolism (5.4%), polyserositis (4.4%), dilated cardiomyopathy and torsion of abdominal organs (4.3% each), and bacterial pericarditis (3.4%). Regarding pneumonias (199/601), the main agents identified in these cases were Pasteurella multocida, Influenza A virus and Mycoplasma hyopneumoniae, mainly in associations.(AU)

O objetivo do presente trabalho foi investigar as principais causas de morte de suínos em fase de crescimento e terminação no Sul do Brasil. Durante o período de um ano (entre 2018 e 2019), duas granjas tecnificadas de suínos no Sul do Brasil foram acompanhadas nas quatro estações (12 dias por estação em cada granja), para realização de necropsias dos suínos que morreram nesse período. As duas propriedades apresentavam mortalidade mensal média entre 0,94 e 3,93% nos meses avaliados. Na necropsia, amostras de órgãos foram colhidas, fixadas em formol 10% e processadas rotineiramente para o exame histopatológico. Quando necessário, amostras foram enviadas para o cultivo bacteriano e PCR para identificação de agentes etiológicos. Foram realizadas um total de 601 necropsias, com 94,9% de diagnósticos conclusivos. As doenças infecciosas corresponderam a 64,4% dos diagnósticos conclusivos e as não infecciosas a 35,6%. As principais causas de morte foram: pneumonias (33%), úlcera gástrica (15,4%), circovirose (9,9%), embolia bacteriana sistêmica (5,4%), polisserosite (4,4%), cardiomiopatia dilatada e torção de órgãos abdominais (4,3% cada) e pericardite bacteriana (3,4%). Com relação às pneumonias (199/601), os principais agentes associadas as lesões foram Pasteurella multocida, vírus da Influenza A e Mycoplasma hyopneumoniae, principalmente associados entre si.(AU)

Causes of death in feedlot beef cattle and their control: a brief review / Causas de morte em bovinos de corte confinados e seu controle: uma breve revisão

This review reports the leading causes of death in feedlot beef cattle. It describes economic losses resulting from these deaths and suggests control alternatives. Diseases associated with the respiratory and digestive systems were the most frequently observed. In different geographical areas, the importance of each one might vary. Outbreaks of diseases such as botulism occur occasionally and can cause important economic losses. Cattle tick fever can cause significant losses in zones of enzootic tick instability. Technical assistance and sanitary and food management are critical for the best productivity in feedlot cattle.(AU)

Esta revisão discute as principais causas de morte em bovinos de corte em confinamento. Descreve as perdas econômicas resultantes dessas mortes e sugere alternativas de controle. As doenças associadas aos sistemas respiratório e digestivo foram as mais frequentemente observadas. Em diferentes áreas geográficas, a importância de cada uma pode variar. Surtos de doenças como o botulismo ocorrem ocasionalmente e podem causar importantes perdas econômicas. A tristeza parasitária bovina pode causar perdas significativas em zonas de instabilidade enzoótica do carrapato. A assistência técnica e um bom gerenciamento sanitário e alimentar são essenciais para a melhor produtividade em bovinos de corte confinados.(AU)

Aberrant expression of calcitonin gene-related peptide and its correlation with prognosis in severe childhood pneumonia

OBJECTIVES: The purpose of this study was to evaluate the relationship between the serum levels of calcitonin gene-related peptide (CGRP) and the prognosis of pediatric patients with severe pneumonia. METHODS: Children diagnosed with severe pneumonia (n=76) were stratified into the survival (n=58) and non-survival groups (n=18) according to their 28-day survival status and into the non-risk (n=51), risk (n=17) and high-risk (n=8) categories based on the pediatric critical illness score (PCIS). Demographic data and laboratory results were collected. Serum CGRP levels were determined by enzyme-linked immunosorbent assay (ELISA). A receiver operating characteristic (ROC) curve was generated to determine the cutoff score for high CGRP levels. RESULTS: Serum CGRP levels were significantly higher in the survival group than in the non-survival group and were significantly higher in the non-risk group than in the risk and high-risk groups. The ROC curve for the prognostic potential of CGRP yielded a significant area under the curve (AUC) value with considerable sensitivity and specificity. CONCLUSION: Our findings show that CGRP downregulation might be a diagnostic marker that predicts the prognosis and survival of children with severe pneumonia.

Modelo predictivo del riesgo de muerte por neumonía asociada a la ventilación mecánica / Predictive model of the risk of death due to pneumonia associated with mechanical ventilation

Introducción: En la unidad de terapia intensiva del Hospital Dr. Agostinho Neto, Guantánamo, Cuba, no hay disponible un instrumento para valorar el riesgo de muerte del paciente con neumonía asociada a la ventilación mecánica. Objetivo: Diseñar un instrumento para la predicción del riesgo de muerte por neumonía asociada a la ventilación mecánica. Método: Estudio observacional, prospectivo y longitudinal de 144 pacientes, de los que se consideró la edad, sexo, diagnóstico, estadía, tipo y etiología de la neumonía, tiempo y duración de la ventilación, y complicaciones. Se elaboró y validó un modelo predictivo de la muerte por esta neumonía. Resultados: La aplicación del modelo mostró su nivel de precisión, pues sobre todo fue muy específico para predecir este riesgo. Conclusiones: Se diseñó un modelo de probabilidad de muerte del paciente con neumonía asociada a la ventilación mecánica, que contribuyó a la valoración más objetiva de su pronóstico(AU)

Introduction: In the intensive care unit of the Hospital Dr. Agostinho Neto, Guantanamo, Cuba, there is no instrument available to assess the risk of death of patients with pneumonia associated with mechanical ventilation. Objective: Design an instrument for predicting the risk of death from pneumonia associated with mechanical ventilation. Method: Observational, prospective and longitudinal study of 144 patients. Age, sex, diagnosis, stay, type and etiology of pneumonia, time and duration of ventilation, as well as complications were considered. A predictive model of death from this pneumonia was developed and validated. Results: The application of the model showed its level of precision, since above all it was very specific to predict this risk. Conclusions: A model of the probability of death of the patient with pneumonia associated with mechanical ventilation was designed, which contributed to the more objective assessment of the prognosis(AU)

Intervención nutricional precoz en ancianos con neumonía adquirida en la comunidad / Precocious nutritional intervention in elder people with community-acquired pneumonia

RESUMEN Introducción: la nutrición tiene importancia capital en la evolución de los pacientes ingresados. La prevalencia de malnutrición oscila entre 30% y 60% de los enfermos hospitalizados. Objetivo: evaluar impacto en la mortalidad y complicaciones a corto plazo de una intervención nutricional precoz. Material y método: se realizó un estudio caso control con todos los pacientes que ingresaron en la Unidad de Cuidados intensivos emergentes con el diagnóstico de neumonía adquirida en la comunidad asociada a desnutrición en Hospital Militar Dr. Carlos J. Finlay, de noviembre de 2017 hasta mayo del 2018. Resultados: la media de la edad del estudio fue de 80,73 ± 9,01 años. El 46 % fueron mujeres. La mortalidad global estuvo en el 26 %. El 69 % de los pacientes presento alguna complicación. Existió una mayor sobrevida en el grupo de estudio (7 fallecidos y 29 vivos), que en el grupo de control donde hubo 12 fallecidos y 24 vivos x2 = 0,18. En la tabla 2 se evidencia que existe diferencia entre los grupos según las complicaciones aparecidas. Fue marcada la diferencia entre los grupos en relación a la cantidad de pacientes con diarreas. La incidencia fue mayor tanto en el subgrupo de vivos(8) como en el de fallecidos(3) del grupo control. Por otro lado la hiperglucemia fue mucho mayor en el grupo de estudio(11) y sin embargo, no hubo impacto en la mortalidad x2 = 0,03. En la tabla 3 se evidencia una fuerte evidencia que relaciona al estado nutricional deficiente con una peor evolución. Entre los fallecidos solo 1 tenía un estado nutricional catalogado como desnutrido ligero, sin embargo entre los 22 fallecidos 14 presentaron desnutrición severa. Conclusiones: el estado nutricional al ingreso impacta negativamente en la mortalidad a corto plazo y la estrategia nutricional mixta precoz no reduce ese aspecto sin embargo si reduce el número de complicaciones aunque se asoció a mayor incidencia de hiperglucemia sin impactar en la mortalidad (AU).

SUMMARY Introduction: nutrition has a capital importance in the evolution of in-patients. Malnutrition prevalence ranges from 30 % to 60 % of the admitted patients. Objective: to evaluate the impact on mortality and the short time complications of the precocious nutritional intervention. Material and Method: a case control study was carried out with all patients who entered the Emergency Intensive Care Unit with the diagnosis of community-acquired pneumonia associated to malnutrition in the Military Hospital "Dr, Carlos J. Finlay" from November 2017 to May 2018. Results: the average age was 80.73 ± 9.01 years. 46 % were female patients. Global mortality was 26 %. 69 % of patients had complications. The group of study showed a higher survival (7 deads and 29 survivors) than the control one where there were 12 deads and 24 survivors (2=0.18). Table 2 shows that there are differences between groups according to the complications found. The difference between groups was remarkable in relation to the quantity of patients with diarrhea. The incidence was higher both in the group of survivors(8) and in the group of dead peoples(3) of the control group. On the other hand, hyperglycemia was much higher in the group of study(11) but without striking on mortality (2= 0.03). Table 3 shows strong evidence relating deficient nutritional status to a worth evolution. Among the deceased patients only 1 had a nutritional status classified as slightly malnutrition, but among the 22 deceased, 14 had severe malnutrition. Conclusions: the nutritional status at admission negatively strikes on short term mortality, and mixed precocious nutritional strategy does not reduce that aspect. However it does reduce the number of complications, though it was associated to a higher incidence of hyperglycemia without striking on mortality (AU).

Utilidad de la proteína C reactiva sérica en el diagnóstico y tratamiento del adulto inmunocompetente hospitalizado por neumonía adquirida en la comunidad / Immunocompetent adults hospitalized for a community-acquired pneumonia: Serum C-reactive protein as a prognostic marker

Background: C-reactive protein (CRP) is used to monitor patients' response during treatment of infectious diseases. Morbidity and mortality associated with community-acquired pneumonia (CAP) is high, particularly in hospitalized patients. Better risk prediction during hospitalization could improve management and ultimately reduce mortality rates. Aim: To evaluate CRP measured at admission and the third day of hospitalization as a predictor for adverse events in CAP. Material and Methods: A prospective cohort study of adult patients hospitalized with CAP at an academic hospital. Major adverse outcomes were admission to ICU, mechanical ventilation, prolonged hospital length of stay, hospital complications and 30-day mortality. Predictive associations between CRP (as absolute levels and relative decline at third day) and adverse events were analyzed. Results: Eight hundred and twenty-three patients were assessed, 19% were admitted to ICU and 10.6% required mechanical ventilation. The average hospital stay was 8.8 ± 8.2 days, 42% had nosocomial complications and 8.1% died within 30 days. Ninety eight percent of patients had elevated serum CRP on admission to the hospital (18.1 ± 14.1 mg/dL). C-reactive protein measured at admission was associated with the risk of bacterial pneumonia, bacteremic pneumonia, septic shock and use of mechanical ventilation. Lack of CRP decline within three days of hospitalization was associated with high risk of complications, septic shock, mechanical ventilation and prolonged hospital stay. Conclusions: CRP responses at third day of hospital admission was a valuable predictor of adverse events in hospitalized CAP adult patients.

La anamnesis como pronóstico de mortalidad en la neumonía adquirida en la comunidad / Anamnesis as mortality prognosis in the community acquired pneumonia

RESUMEN Introducción: La neumonía adquirida en la comunidad constituye un importante problema de salud a nivel global, en Cuba es la cuarta causa de muerte. Los índices pronósticos ayudan a detectar tempranamente los pacientes de alto riesgo, pero esto tiene baja sensibilidad y especificidad. Objetivo: determinar durante la anamnesis factores pronósticos de mortalidad en la neumonía adquirida en la comunidad. Materiales y métodos: estudio analítico longitudinal retrospectivo con un grupo donde se aplicaron pruebas no paramétricas y cálculo de riesgo relativo. Resultados: edad de 78 ± 10 años con 53 % femeninas. La mortalidad global de 57 % antecedentes de diabetes mellitus, 53 % enfermedad cerebro vascular anterior 34 %, el 42 % estaba encamados. El 38 % tenían más de cinco días enfermos y el 69 % estaba consumiendo antimicrobianos antes del ingreso. El 23 % padecían de insuficiencia cardiaca congestiva y el 73 % de enfermedad pulmonar obstructiva crónica. El síndrome confusional fue un buen predictor de mortalidad (x2=0,05) (RR=2,8). El encamamiento prolongado no predijo mortalidad a los cinco días (x2=0,43). El uso de antimicrobianos previos incremento el riesgo en (RR=0,8) con (x2=0,05). La insuficiencia cardiaca fue el mejor predictor (x2=0,006) (RR=1,2). La enfermedad pulmonar obstructiva crónica predijo con(x2=0,019) y (RR=1,47). Conclusiones: se considera como factores fuertemente predictivos el antecedente de insuficiencia cardiaca, de enfermedad pulmonar obstructiva crónica y el paciente que acude con síndrome confusional.

ABSTRACT Introduction: community acquired pneumonia is an important health problem around the world, and in Cuba it is the fourth cause of death. Prognostic indexes help to detect early the patients at high risk, but they have low sensibility and specificity. Objective: to determine the mortality prognostic factors in the community acquired pneumonia during the anamnesis. Material and methods: analytic, retrospective, longitudinal study in a group applying non-parametric tests and relative risk calculation. Results: age: 78 ± 10 years; 53 % of women. Global mortality of 57 %; 53 % had antecedents of diabetes mellitus; 34 % had previous cerebro-vascular disease, and 42 % were bedridden patients. 38 % was sick more than five days and 69 % took antimicrobials before being admitted. 23 % suffered congestive heart failure and 73 % chronic obstructive pulmonary disease. Confusional syndrome was a good predictor of mortality (x2=0.05) (RR=2.8). Long confinement to bed did not predict mortality at the fifth day (x2=0.43). The previous use of antimicrobials increased the risk (RR=0.8) con (x2=0.05). Heart failure was the best predictor (x2=0.006) (RR=1.2). Chronic obstructive pulmonary disease predicted with (x2=0.019) y (RR=1.47). Conclusions: antecedents of heart failure and chronic obstructive pulmonary disease, and the patient arriving with confusional syndrome are considered strongly predictive factors.

Proteína 3 contendo um domínio NACHT, porção C-terminal rica em repetições de leucina e de domínio pirina e LL-37: valor prognóstico de novos biomarcadores em pneumonia adquirida na comunidade / NACHT, LRR, and PYD domains-containing Protein 3 and LL-37: prognostic value of new biomarkers in community-acquired pneumonia

RESUMO Objetivo Este estudo teve como objetivo determinar os níveis séricos de proteína 3 contendo um domínio NACHT, porção C-terminal rica em repetições de leucina e de domínio pirina (NLRP3) e catelicidina LL-37, bem como investigar sua importância prognóstica em pneumonia adquirida na comunidade (PAC). Métodos Este estudo prospectivo incluiu 76 pacientes com PAC. Foram obtidos dados demográficos e características clínicas. Os níveis séricos de NLRP3 e LL-37 foram determinados por meio do teste ELISA. A correlação entre NLRP3 e LL-37 foi estimada por intermédio da análise de Spearman. A associação entre NLRP3 e LL-37 com 30 dias de taxa de sobrevida e de mortalidade foi avaliada pela curva de Kaplan-Meier e análise de regressão logística. Resultados Os níveis séricos de NLRP3 estavam elevados, enquanto os níveis de LL-37 apresentaram redução significativa em pacientes com PAC grave. Observou-se correlação significativa entre os níveis séricos de NLRP3 e LL-37 em pacientes com PAC. Pacientes com níveis elevados de NLRP3 e níveis reduzidos de LL-37 exibiram maior taxa de sobrevida em 30 dias e de mortalidade quando comparados com aqueles com níveis inferiores de NLRP3 e LL-37. Conclusões Pacientes com PAC grave tendem a apresentar níveis séricos elevados de NLRP3 e níveis reduzidos de LL-37, o que pode ser utilizado como um potencial biomarcador prognóstico.

ABSTRACT Objective This study aimed to determine the serum levels of NACHT, Leucine-rich repeat (LRR), and Pyrin (PYD) domains-containing Protein 3 (NLRP3) and cathelicidin LL-37, and investigate their prognostic significance in community-acquired pneumonia (CAP). Methods The sample of this prospective study was composed of 76 consecutive patients with CAP. Demographic data and clinical characteristics were collected. Serum levels of NLRP3 and LL-37 were determined by ELISA. Spearman's analysis was used to evaluate the correlation between NLRP3 and LL-37. Association of NLRP3 and LL-37 with 30-day survival and mortality rates was assessed using the Kaplan-Meier curve and logistic regression analysis. Results Serum NLRP3 significantly increased whereas serum LL-37 significantly decreased in patients with severe CAP. Significant correlation was observed between serum NLRP3 and LL-37 in CAP patients. Patients with higher levels of NLRP3 and lower levels of LL-37 showed lower 30-day survival rate and higher mortality compared with those with lower NLRP3 and higher LL-37 levels. Conclusion Severe CAP patients tend to present higher serum NLRP3 and lower serum LL-37, which might serve as potential biomarkers for CAP prognosis.

Lower long-term mortality in obese patients with community-acquired pneumonia: possible role of CRP

OBJECTIVE: The present study aimed to investigate the relationship between obesity and mortality in patients with community-acquired pneumonia (CAP) in China. METHODS: In total, 909 patients with CAP were recruited for this study from January 2010 to June 2015. All patients were selected and divided into 4 groups according to their body mass index (BMI) values. All patients' clinical information was recorded. The associations among mortality; BMI; the 30-day, 6-month and 1-year survival rates for different BMI classes; the etiology of pneumonia in each BMI group; and the risk factors for 1-year mortality in CAP patients were analyzed. RESULT: With the exception of the level of C-reactive protein (CRP), no other clinical indexes showed significant differences among the different BMI groups. No significant differences were observed among all groups in terms of the 30-d and 6-month mortality rates (p>0.05). There was a significantly lower risk of 1-year mortality in the obese group than in the nonobese group, (p<0.05). Logistic regression analysis showed that there were seven independent risk factors for 1-year mortality in CAP patients, namely, age, cardiovascular disease, cerebrovascular disease, obesity, APACHE II score, level of CRP and CAP severity. CONCLUSION: Compared with nonobese patients with CAP, obese CAP patients may have a lower mortality rate, especially with regard to 1-year mortality, and CRP may be associated with the lower mortality rate in obese individuals than in nonobese individuals.

Do N-terminal pro-brain natriuretic peptide levels determine the prognosis of community acquired pneumonia? / Os níveis de pró-peptídeo natriurético cerebral N-terminal determinam o prognóstico de pneumonia adquirida na comunidade?

ABSTRACT Objective: Pneumonia is a leading cause of mortality worldwide, especially in the elderly. The use of clinical risk scores to determine prognosis is complex and therefore leads to errors in clinical practice. Pneumonia can cause increases in the levels of cardiac biomarkers such as N-terminal pro-brain natriuretic peptide (NT-proBNP). The prognostic role of the NT-proBNP level in community acquired pneumonia (CAP) remains unclear. The aim of this study was to evaluate the prognostic role of the NT-proBNP level in patients with CAP, as well as its correlation with clinical risk scores. Methods: Consecutive inpatients with CAP were enrolled in the study. At hospital admission, venous blood samples were collected for the evaluation of NT-proBNP levels. The Pneumonia Severity Index (PSI) and the Confusion, Urea, Respiratory rate, Blood pressure, and age ≥ 65 years (CURB-65) score were calculated. The primary outcome of interest was all-cause mortality within the first 30 days after hospital admission, and a secondary outcome was ICU admission. Results: The NT-proBNP level was one of the best predictors of 30-day mortality, with an area under the curve (AUC) of 0.735 (95% CI: 0.642-0.828; p < 0.001), as was the PSI, which had an AUC of 0.739 (95% CI: 0.634-0.843; p < 0.001), whereas the CURB-65 had an AUC of only 0.659 (95% CI: 0.556-0.763; p = 0.006). The NT-proBNP cut-off level found to be the best predictor of ICU admission and 30-day mortality was 1,434.5 pg/mL. Conclusions: The NT-proBNP level appears to be a good predictor of ICU admission and 30-day mortality among inpatients with CAP, with a predictive value for mortality comparable to that of the PSI and better than that of the CURB-65 score.

RESUMO Objetivo: A pneumonia é uma das principais causas de mortalidade no mundo, especialmente em idosos. O uso de escores de risco clínico para determinar o prognóstico é complexo e, portanto, leva a erros na prática clínica. A pneumonia pode causar aumento nos níveis de biomarcadores cardíacos, como o N-terminal pro-brain natriuretic peptide (NT-proBNP, pró-peptídeo natriurético cerebral N-terminal). O papel prognóstico do nível de NT-proBNP na pneumonia adquirida na comunidade (PAC) continua incerto. O objetivo deste estudo foi avaliar o papel prognóstico do nível de NT-proBNP em pacientes com PAC, bem como sua correlação com escores de risco clínico. Métodos: Pacientes consecutivos internados com PAC foram incluídos no estudo. Na internação hospitalar, foram coletadas amostras de sangue venoso para avaliação dos níveis de NT-proBNP. Foram calculados o Pneumonia Severity Index (PSI, Índice de Gravidade de Pneumonia) e o escore Confusão mental, Ureia, frequência Respiratória, Blood pressure (pressão arterial) e idade ≥ 65 anos (CURB-65). O desfecho primário de interesse foi mortalidade por todas as causas nos primeiros 30 dias após a admissão hospitalar, e um desfecho secundário foi admissão na UTI. Resultados: O nível de NT-proBNP foi um dos melhores preditores de mortalidade em 30 dias, com uma área sob a curva (ASC) de 0,735 (IC95%: 0,642-0,828; p < 0,001), assim como o PSI, que teve uma ASC de 0,739 (IC95%: 0,634-0,843; p < 0,001), enquanto CURB-65 teve uma ASC de apenas 0,659 (IC95%: 0,556-0,763; p = 0,006). O nível de corte do NT-proBNP que mostrou ser o melhor preditor de admissão na UTI e de mortalidade em 30 dias foi de 1.434,5 pg/ml. Conclusões: O nível de NT-proBNP parece ser um bom preditor de admissão na UTI e de mortalidade em 30 dias entre pacientes internados com PAC, com um valor preditivo para mortalidade comparável ao do PSI e superior ao do CURB-65.

Morbilidad y mortalidad por neumonía grave adquirida en la comunidad, Hospital General Docente Dr. Agostinho Neto 2018 / Morbidade e mortalidade por pneumonia grave adquirida na comunidade, Hospital Geral de Ensino Dr. Agostinho Neto 2018 / Morbidity and mortality due to severe pneumonia acquired in the community, General Teaching Hospital Dr. Agostinho Neto 2018

Introducción: la neumonía adquirida en la comunidad es un problema de salud aún no resuelto y en Guantánamo no se esclarecido la influencia de las estaciones del año en su frecuencia. Objetivo: determinar la morbilidad y mortalidad por neumonía grave adquirida en la comunidad en la citada unidad durante el 2018. Método: se hizo un estudio retrospectivo del total de pacientes ingresados (N=85) por ésta causa. Las variables estudiadas fueron: edad, sexo, índice de gravedad, comorbilidad, estancia en la unidad, necesidad de ventilación mecánica, estado al egreso. Todas se relacionaron con las estaciones del año. Resultados: el mayor número de pacientes ingresó durante el invierno (35,3 por ciento). No hubo relación significativa entre la estación del año y la variable sexo (p<0,05), pero sí con la edad, estancia en la unidad, comorbilidad, riesgo de fallo respiratorio y necesidad de tratamiento con ventilación mecánica (p<0,05). Conclusiones: la morbilidad de la neumonía grave adquirida en la comunidad mostró una distribución estacional, ya que en invierno fue mayor su frecuencia, pero no determinó su letalidad, la que estuvo más mediada por la comorbilidad del paciente(AU)

Introduction: community acquired pneumonia is a health problem that has not yet been resolved and in Guantanamo the influence of the seasons of the year on its frequency has not been clarified. Objective: to determine the morbidity and mortality due to severe pneumonia acquired in the community in said unit during 2018. Method: a retrospective study of the total number of patients admitted (N=85) for this cause was made. The variables studied were: age, sex, severity index, comorbidity, stay in the unit, need for mechanical ventilation, state at discharge. All related to the seasons. Results: the largest number of patients admitted during the winter (35.3 percent). There was no significant relationship between the season of the year and the sex variable (p<0.05), but with age, stay in the unit, comorbidity, risk of respiratory failure and need for treatment with mechanical ventilation (p<0.05). Conclusions: the morbidity of severe pneumonia acquired in the community showed a seasonal distribution, since in winter its frequency was higher, but it did not determine its lethality, which was more mediated by the comorbidity of the patient(AU)

Introdução: a pneumonia adquirida na comunidade é um problema de saúde que ainda não foi resolvido e em Guantánamo não foi esclarecida a influência das estações do ano em sua frequência. Objetivo: determinar a morbimortalidade por pneumonia grave adquirida na comunidade na referida unidade em 2018. Método: estudo retrospectivo do número total de pacientes admitidos (N=85) por essa causa. As variáveis estudadas foram: idade, sexo, índice de gravidade, comorbidade, permanência na unidade, necessidade de ventilação mecânica, estado na alta. Tudo relacionado às estações do ano. Resultados: o maior número de pacientes internados no inverno (35,3 por cento). Não houve relação significativa entre a estação do ano e a variável sexo (p <0,05), mas com a idade, permanência na unidade, comorbidade, risco de insuficiência respiratória e necessidade de tratamento com ventilação mecânica (p<0,05) Conclusões: a morbidade por pneumonia grave adquirida na comunidade apresentou distribuição sazonal, uma vez que no inverno sua frequência era maior, mas não determinava sua letalidade, mais mediada pela comorbidade do paciente(AU)