Terapia de REGEN COV como base de terapia inmunomoduladora mixta en pacientes hospitalizados por neumonía por SARS-CoV-2: Serie de casos / REGEN COV Therapy as the Basis of Mixed Immunomodulatory Therapy in Patients Hospitalized for SARS- CoV-2 Pneumonia: Case Series

Los países en desarrollo con sistema de salud de baja inversión encuentran un reto en priorizar el tratamiento de COVID-19 según su eficacia y sus costos. Materiales y métodos: se explora la utilidad hospitalaria de una intervención segura con eficacia ambulatoria comprobada. Se describe la administración de un tratamiento inmunomodulador combinado a base de imdevimab y casirivimab (REGEN COV). Resultados: los resultados individualizados apuntan a resultados prometedores en pacientes de alto riesgo a progresión y mortalidad. Conclusión: se ha demostrado que REGEN COV es eficiente para tratar dicha enfermedad. Sin embargo, se necesitan ensayos clínicos aleatorizados para comprobar su eficacia en combinación. (AU)

Developing countries with low-investment health systems find it challenging to prioritize COVID-19 treatment according to its efficacy and affordability. Materials and methods: therefore, the in-hospital utility of a safe intervention with outpatient efficacy is explored. We describe the administration of immunomodulatory combination therapy based on imdevimab and casirivimab (REGEN COV). Results: individualized results point to promising outcomes in patients at high risk of progression and mortality. Conclusion: REGEN COV has been shown to be efficient in treating said disease. However, randomized clinical trials are needed to verify their efficacy in combination. (AU)

Hospitalization costs of pediatric community-acquired pneumonia in Shanghai / 中华儿科杂志

Objective: To investigate the epidemiology and hospitalization costs of pediatric community-acquired pneumonia (CAP) in Shanghai. Methods: A retrospective case summary was conducted on 63 614 hospitalized children with CAP in 59 public hospitals in Shanghai from January 2018 to December 2020. These children's medical records, including their basic information, diagnosis, procedures, and costs, were extracted. According to the medical institutions they were admitted, the patients were divided into the children's hospital group, the tertiary general hospital group and the secondary hospital group; according to the age, they were divided into <1 year old group, 1-<3 years old group, 3-<6 years old group, 6-<12 years old group and 12-18 years old group; according to the CAP severity, they were divided into severe pneumonia group and non-severe pneumonia group; according to whether an operation was conducted, the patients were divided into the operation group and the non-operation group. The epidemiological characteristics and hospitalization costs were compared among the groups. The χ2 test or Wilcoxon rank sum test was used for the comparisons between two groups as appropriate, and the Kruskal-Wallis H test was conducted for comparisons among multiple groups. Results: A total of 63 614 hospitalized children with CAP were enrolled, including 34 243 males and 29 371 females. Their visiting age was 4 (2, 6) years. The length of stay was 6 (5, 8) days. There were 17 974 cases(28.3%) in the secondary hospital group, 35 331 cases (55.5%) in the tertiary general hospital group and 10 309 cases (16.2%) in the children's hospital group. Compared with the hospitalizations cases in 2018 (27 943), the cases in 2019 (29 009) increased by 3.8% (1 066/27 943), while sharply declined by 76.2% (21 281/27 943) in 2020 (6 662). There were significant differences in the proportion of patients from other provinces and severe pneumonia cases, and the hospitalization costs among the children's hospital, secondary hospital and tertiary general hospital (7 146 cases(69.3%) vs. 2 202 cases (12.3%) vs. 9 598 cases (27.2%), 6 929 cases (67.2%) vs. 2 270 cases (12.6%) vs. 9 397 cases (26.6%), 8 304 (6 261, 11 219) vs. 1 882 (1 304, 2 796) vs. 3 195 (2 364, 4 352) CNY, χ2=10 462.50, 9 702.26, 28 037.23, all P<0.001). The annual total hospitalization costs of pediatric CAP from 2018 to 2020 were 110 million CNY, 130 million CNY and 40 million CNY, respectively. And the cost for each hospitalization increased year by year, which was 2 940 (1 939, 4 438), 3 215 (2 126, 5 011) and 3 673 (2 274, 6 975) CNY, respectively. There were also significant differences in the hospitalization expenses in the different age groups of <1 year old, 1-<3 years old, 3-<6 years old, 6-<12 years old and 12-18 years old (5 941 (2 787, 9 247) vs. 2 793 (1 803, 4 336) vs. 3 013 (2 070, 4 329) vs. 3 473 (2 400, 5 097) vs. 4 290 (2 837, 7 314) CNY, χ2=3 462.39, P<0.001). The hospitalization cost of severe pneumonia was significantly higher than that of non-severe cases (5 076 (3 250, 8 364) vs. 2 685 (1 780, 3 843) CNY, Z=109.77, P<0.001). The cost of patients who received operation was significantly higher than that of whom did not (10 040 (4 583, 14 308) vs. 3 083 (2 025, 4 747) CNY, Z=44.46, P<0.001). Conclusions: The number of children hospitalized with CAP in Shanghai decreased significantly in 2020 was significantly lower than that in 2018 and 2019.The proportion of patients from other provinces and with severe pneumonia are mainly admitted in children's hospitals. Hospitalization costs are higher in children's hospitals, and also for children younger than 1 year old, severe cases and patients undergoing operations.

Arsenicum albumas a treatment for pneumonia in snakes: three serial cases

two Python bivittatussnakes were received at Project Selva Viva, a zoo in Taubaté, Brazil, both presenting respiratory noises and oro-nasal discharge. A thoracic ultrasonographic examination was performed for evaluation on February 25th,2022, which diagnosed the presence of multiple vertical hyperechoic artifactsemerging from the pleural line, coalescing in some of the examined areas, and the presence a hypoechoic structure located in the subpleural region. Another serpent, from the Boa constrictor species, was apprehended and arrived at the same zoo without medical history, showing a low body score. During a thoracic ultrasonographic evaluation realized on April 1st,2022, B lines emerging from the pleural line were found. These vertical reverberating lines are a result of respiratory illness (SOLDATI et al., 2014).Methodology:The report was authorized by the owner of the zoo. All the patients received homeopathic therapy with 2 globules of Arsenicum album30 cH/ BID into the mouth, after being diagnosed with the respiratory condition by the ultrasonographic examination. The medication was chosen according to the similarity with the symptoms. The snakes had a runny nose and hissing breathing noise. Weekly ultrasound scans were performed on the Python bivittatus snakes to follow up on the respiratory condition. Results: On March 04th, it was observed that both snakes showed a reduction in respiratory noises and were more active. Ars 30 cH was maintained BID. On March 25th, both presented significant improvement in the ultrasound images, which showed only A lines, compatible with a healthy lung, and the treatment was suspended. Boa constrictor snake ́streatment started on April 1st. On April 8th, the ultrasonographic examination performed only presented A lines, which are characterized in ultrasound by parallel horizontal lines in the near field with the loss of image continuity in the far field, indicating improvement of the condition (LICHTENSTEIN et al., 2003). Conclusion:Given these results, the homeopathic treatment is an option to be considered for the treatment of respiratory symptoms in snakes, although the duration of the therapy varies based on the stage and chronicity of the disease.

Acupoint selection rules of acupuncture and moxibustion for stroke-related pneumonia / 中国针灸

Using data mining technology, the rules of acupoint selection of acupuncture and moxibustion were explored in treatment of stroke-related pneumonia. The clinical articles of acupuncture and moxibustion in treatment of stroke-related pneumonia were retrieved from CNKI, SinoMed, Wanfang and VIP databases from their inception through to January l 2021, and then, the acupuncture-moxibustion prescription database was set up for stroke-related pneumonia. SPSS Modeler 18.0 Apriori algorithm was adopted to analyze the association rules of acupoints and draw complex network diagrams. SPSS26.0 was used in clustering analysis of acupoints. Finally, a total of 44 articles were included, with 51 acupoint prescriptions and 82 acupoints extracted. The total frequency of acupoints was 340 times. The high-frequency acupoints in treatment with acupuncture and moxibustion for stroke-related pneumonia were Feishu (BL 13), Fenglong (ST 40), Hegu (LI 4), etc. These acupoints were mainly distributed on the limbs and back and mostly from yang meridians. Of these extracted acupoints, the five-shu points, convergent points and back-shu points were selected specially. Regarding acupoint combination, the association of Quchi (LI 11) had the highest support with Hegu (LI 4) and Zusanli (ST 36). The core prescription of acupuncture-moxibustion treatment for stroke-related pneumonia could be composed of Quchi (LI 11), Hegu (LI 4), Zusanli (ST 36), Fenglong (ST 40) and Taichong (LR 3).

Recomendaciones para el manejo de las infecciones respiratorias agudas bajas en menores de 2 años. Actualización 2021 / Recommendations for the management of acute lower respiratory infections in children under 2 years of age. Update 2021

Las infecciones respiratorias agudas bajas (IRAB) continúan representando una importante causa de morbimortalidad en nuestro medio. El manejo normatizado de casos constituye una valiosa herramienta para enfrentarlas.Además de los aspectos relacionados con el diagnóstico y tratamiento de estas enfermedades, el análisis de factores de riesgo (tanto biológicos como socioambientales), desde una perspectiva local y actual, permitie implementar medidas efectivas de control y/o prevención, así como identificar aquellos pacientes susceptibles de presentar formas graves o complicaciones.Desde 1996 la Sociedad Argentina de Pediatría asumió el desafío de generar un documento que guíe el manejo integral de los pacientes con IRAB. En esta cuarta actualización se incluyen los últimos adelantos en el tema.

Acute lower respiratory infections (ARI) continue being an important cause of morbidity and mortality in our region. Standardized case management is a valuable tool to deal with them.In addition to aspects related to the diagnosis and treatment of these diseases, the analysis of risk factors (both biological and socio-environmental) from a local and current perspective, allows the implementation of effective control and/or prevention measures, as well as identifying those patients susceptible to presenting serious forms or complications.Since 1996, the Sociedad Argentina de Pediatría asumed the challenge of generating a document that guides the comprehensive management of patients with ARI. This fourth update includes the latest advances on the subject.

Neumonitis química grave secundaria a la inhalación de talco. A propósito de un caso pediátrico / Severe chemical pneumonitis secondary to talc inhalation. A pediatric case

El talco, un silicato de magnesio hidratado, formó parte durante décadas del cuidado tradicional de lactantes y niños pequeños. Si bien en los niños su inhalación aguda, que suele ser accidental durante el cambio de pañales, no es frecuente, es una condición potencialmente peligrosa, que puede provocar dificultad respiratoria grave e incluso cuadros mortales. Se describe el grave compromiso respiratorio por neumonitis química asociado con la inhalación accidental de talco en un lactante de 14 meses. El niño presentó un cuadro de dificultad respiratoria con requerimiento de asistencia respiratoria mecánica (ARM) durante una semana. En cuanto al tratamiento, no existe un estándar, se utilizaron antibióticos y corticoides sistémicos y aerosolterapia. No presentó complicaciones en otros órganos o sistemas. Su evolución fue favorable, se pudo externar al décimo día de internación y presentó posteriormente episodios aislados de hiperreactividad bronquial.

Talc is a hydrated magnesium silicate. It was part of traditional infant and young child care for decades. In children, its acute inhalation, generally accidental during diaper changes, although not frequent, is a potentially dangerous condition, and can cause severe respiratory distress and even death. We describe the case of a 14-month child who had an accidental inhalation of talc, chemical pneumonitis and severe respiratory compromise. The patient had acute respiratory distress syndrome requiring mechanical ventilation for one week. There is no standard treatment, we used systemic antibiotics and corticosteroids and aerosol therapy. He did not have complications in other organs or systems. He was hospitalized for ten days. In the follow up, he had isolated episodes of bronchial hyperresponsiveness.

Cuadro clínico del COVID-19 / Clinical presentation of COVID-19

El Coronavirus SARS-CoV-2 produce la enfermedad COVID-19, cuya manifestación más grave y potencialmente letal es la neumonía. En este artículo revisaremos las manifestaciones clínicas del COVID-19, la fisiopatología de la neumonía, el manejo intrahospitalario previo al ingreso a Unidades de Cuidados Intensivos, la embolia pulmonar que es una complicación muy frecuente de esta enfermedad y el seguimiento de los pacientes posterior al alta. Para esta publicación nos hemos basado en publicaciones médicas y en estudios que hemos hecho durante esta pandemia en nuestro Centro de Enfermedades Respiratorias. i:es

The SARS-CoV-2 Coronavirus causes the COVID-19 disease, the most severe and potentially fatal manifestation of which is pneumonia. In this article, we will review the clinical manifestations of COVID-19, the pathophysiology of pneumonia, in-hospital management prior to admission to Intensive Care Units, pulmonary embolism, which is a very frequent complication of this disease, and the follow-up of patients after hospitalization. For this publication we have relied on medical publications and studies that we have done during this pandemic at our Center for Respiratory Diseases. i:en

Risk factors of postoperative pulmonary infection of gastric cancer and perioperative intervention measures / 中华胃肠外科杂志

Gastric cancer is a common digestive system malignancy. Surgical operation is the main treatment of radical treatment for gastric cancer. Pulmonary infection is a common postoperative complication of gastric cancer. Because there is no clear and unified definition of pulmonary complications, the current researches show that the incidence of postoperative pulmonary infection of gastric cancer is about 1.8%-18.1%. The incidence of postoperative pulmonary infection will prolong the hospital stay, increase the cost of hospitalization, and even develop into respiratory failure leading to early postoperative death. There are many factors affecting postoperative pulmonary infection of gastric cancer, including age, smoking history, pulmonary function, pulmonary disease history, operation method, operation time, intraoperative bleeding volume, gastric tube retention time, postoperative lying time and so on. There are also many perioperative interventions. This article reviews the risk factors and perioperative interventions of postoperative pulmonary infection of gastric cancer.

Factores predisponentes que conllevan a los pacientes a una neumonía asociada ventilación mecánica de la unidad de cuidados intensivos del hospital Teodoro Maldonado Carbo. Periodo 2018 ­ 2019 / Predisposing factors that lead patients to pneumonia associated with mechanical ventilation in the Teodoro Maldonado carbo hospital's intensive care unit. period 2018 ­ 2019

Hay varios factores de riesgo que pueden conllevar a una neumonía asociada a ventilación mecánica, tanto intrínseco como extrínseco, y el porcentaje de la neumonía asociada a ventilación mecánica va en aumento, por lo que el personal médico tiene una dura lucha para tratar de disminuir esta problemática. Objetivo: Determinar los factores predisponentes que conllevan a los pacientes a una neumonía asociada a la ventilación mecánica en la Unidad de Cuidados Intensivos del Hospital Teodoro Maldonado Carbo durante el periodo 2018 ­ 2019. Materiales y Métodos: paradigma positivista, enfoque cuantitativo; de modalidad de campo, no experimental. De tipo descriptivo y transversal. La población fue 285 pacientes y la muestra de 60, seleccionado de manera probabilística y sistemático. La técnica fue la encuesta y el instrumento el cuestionario con 15 ítems, revisados y validados por juicios de expertos en el tema, que dieron una confiabilidad de 95%. Resultados: Se evidenció que los factores predominantes, que aumentan los riesgos de padecer una NAVM son elementos de tipo Extrínseco, entre ellos los más comunes son: intubación prolongada, re intubaciones, aspiraciones de secreciones y el traslado del paciente. Mientras que los del factor intrínseco son: desnutrición, edad y etnia. Conclusión: se evidenció la importancia de un diagnóstico oportuno y seguir las normas de bioseguridad establecidas antes, durante y después del proceso de entubación como mecanismo de disminución de probabilidad de que el paciente desarrolle un NAVM(au)

There are several risk factors can lead to pneumonia associated with mechanical ventilation both, intrinsic and extrinsic, and the percentage of pneumonia associated with mechanical ventilation is increasing, which is why medical personnel have a tough fight to try to reduce this problem. Objective: To determine the predisposing factors that lead patients to pneumonia associated with mechanical ventilation in the Teodoro Maldonado Carbo Hospital's Intensive Care Unit during the period 2018 - 2019. Materials and Methods: positivist paradigm, quantitative approach; field modality, not experimental. Descriptive and transversal. The population was 285 patients and the sample of 60, selected in a probabilistic and systematic way. The technique was the survey and the instrument was the questionnaire with 15 items, reviewed and validated by expert judgments on the subject, which gave a reliability of 95%. Results: It was evident that the predominant factors that increase the risks of suffering from AVM are extrinsic elements, among them the most common are prolonged intubation, re-intubations, aspiration of secretions and the transfer of the patient. While those of the intrinsic factor are malnutrition, age and ethnicity. Conclusion: the importance of a timely diagnosis and following the biosafety standards established before, during and after the intubation process was evidenced as a mechanism to decrease the probability that the patient develops a VAP(AU)

Characteristics of primary care and rates of pediatric hospitalizations in Brazil

ABSTRACT OBJECTIVE To evaluate the association among characteristics of primary health care center (PHCC) with hospitalizations for primary care sensitive conditions (PCSC) in Brazil. METHOD In this study, a cross-sectional ecological study was performed. This study analyzed the 27 capitals of Brazil's federative units. Data were aggregated from the following open access databases: National Program for Access and Quality Improvement in Primary Care, the Hospital Information System of Brazilian Unified Health System and Annual Population Census conducted by the Brazilian Institute of Geography and Statistics. Associations were estimated among characteristics of primary care with the number of three PCSC as the leading causes of hospitalization in children under-5 population in Brazil: asthma, diarrhea, and pneumonia. RESULTS In general, PHCC showed limited structural adequacy (37.3%) for pediatric care in Brazil. The capitals in South and Southeast regions had the best structure whereas the North and Northeast had the worst. Fewer PCSC hospitalizations were significantly associated with PHCC which presented appropriate equipment (RR: 0.98; 95%CI: 0.97-0.99), structural conditions (RR: 0.98; 95%CI: 0.97-0.99), and signage/identification of professionals and facilities (RR: 0.98; 95%CI: 0.97-0.99). Higher PCSC hospitalizations were significantly associated with PHCC with more physicians (RR: 1.23, 95%CI: 1.02-1.48), it forms (RR: 1.01, 95%CI: 1.01-1.02), and more medications (RR: 1.02, 95%CI: 1.01-1.03) CONCLUSION Infrastructural adequacy of PHCC was associated with less PCSC hospitalizations, while availability medical professional and medications were associated with higher PCSC hospitalizations.

Kinesiología respiratoria en niños con disquinesia ciliar primaria / Respiratory phisioterapy in children with primary ciliary dyskinesia

Primary ciliary dyskinesia is a rare autosomal recessive disease with compromised mucociliary drainage. Among the most commonly recommended non-pharmacological therapeutic strategies are secretion drainage techniques. However, the evidence for the use and effectiveness of these techniques is low, and they are generally based on extrapolated evidence of cystic fibrosis. This article reviews the recommendations and available evidence of chest physiotherapy, mainly manual and instrumental techniques of bronchial drainage and physical exercise in children with primary ciliary dyskinesia.

La disquinesia ciliar primaria es una enfermedad autosómica recesiva rara con compromiso del drenaje mucociliar. Entre las estrategias terapéuticas no farmacológicas más comúnmente recomendadas se encuentra las técnicas de drenaje de secreciones. Sin embargo, la evidencia del uso y efectividad de estas técnicas es reducida y generalmente se basan en evidencia extrapolada de la fibrosis quística. Este artículo revisa las recomendaciones y la evidencia disponible de la kinesiología respiratoria, principalmente las técnicas manuales e instrumentales de drenaje bronquial y el ejercicio físico en niños con disquinesia ciliar primaria.

Funcionalidade do apoio à família da criança com pneumonia / Funcionalidad del apoyo a la familia del niño con neumonía / Functionality of the support to the family of children with pneumonia

Resumo OBJETIVO Conhecer a composição e o funcionamento do apoio social utilizado pela família da criança adoecida por pneumonia. MÉTODO Pesquisa qualitativa, realizada com quatorze famílias de crianças menores de cinco anos internadas por pneumonia, provenientes de regiões de maior vulnerabilidade social de um município do interior paulista, no período de novembro de 2015 a maio de 2016. Utilizou-se como referencial teórico o Modelo Calgary de Avaliação Familiar, e a Análise de Conteúdo Temática de Bardin como método. RESULTADOS A família nuclear e a extensa constituem o apoio social utilizado; a rede de apoio acessada engloba a Atenção Primária de Saúde, Unidades de Pronto Atendimento e hospitais, observando falha na referência e contra-referência intersetoriais. CONSIDERAÇÕES FINAIS A reorganização familiar mostrou-se relevante e efetiva em períodos de crise; as famílias buscam no nível secundário de atenção à saúde a resolutividade para o adoecimento de seu filho.

Resumen OBJETIVOConocer la composición y el funcionamiento del apoyo social utilizado por la familia del niño enfermo por neumonía. MÉTODO Investigación cualitativa, realizada con catorce familias de niños menores de cinco años internados por neumonía, provenientes de regiones de mayor vulnerabilidad social de un municipio del interior paulista, en el período de noviembre de 2015 a mayo de 2016. Se utilizó el modelo Calgary de evaluación familiar como referencial teórico, y el análisis de contenido temático de Bardin como método. RESULTADOS La familia nuclear y la extensa constituyen el apoyo social utilizado. La red de apoyo accedida engloba la Atención Primaria de la Salud, Unidades de Atención de Emergencias y hospitales, donde se observa una falla en la referencia y contra-referencia intersectoriales. CONSIDERACIONES FINALES La reorganización familiar se mostró relevante y efectiva en períodos de crisis. Las familias buscan en el nivel secundario de la atención a la salud la resolutividad para la enfermedad de su hijo.

Abstract OBJECTIVE To know the composition and functioning of the social support used by the family of children with pneumonia. METHODS A qualitative study was carried out with fourteen families of children under five years old hospitalized for pneumonia, coming from regions of greater social vulnerability in a city in the state of São Paulo, from November 2015 to May 2016. The theoretical reference used was the Calgary Family Assessment Model, and the Bardin Thematic Content Analysis was used as method. RESULTS The nuclear family and the extended family constitute the social support used; the support network accessed includes the Primary Health Care, Emergency Care Units and hospitals, observing intersectoral referral and counter-referral failure. FINAL CONSIDERATIONS The family reorganization proved to be relevant and effective in times of crisis; the families seek the secondary level of health care to solve the illness of their child.

Costs incurred by caregivers of under-five inpatients with community-acquired pneumonia at a university hospital in south-western Ethiopia

Background: Pneumonia is one of the commonest diseases among children in Ethiopia resulting in deaths and hospitalisations. The objective of the current study was to determine the cost incurred by caregivers of under-five children with community-acquired pneumonia admitted to the paediatric ward of Jimma University Specialized Hospital, south-western Ethiopia.Methods: An institution-based cross-sectional study was conducted from 01 January to 28 February 2017, through interviews with caregivers. Data on costs incurred before hospital visit, direct medical and non-medical costs, and indirect costs incurred by caregivers of the children were collected. The collected data were analysed using Statistical Package for Social Sciences version 23.Results: Among the 120 caregivers in the study, a median total cost of 304.5 Ethiopian birr (13.22 USD) was reported. This was mostly contributed by indirect costs associated with earnings lost by caregivers related to travel and stay at hospital with the children. Factors, including permanent residence, family size, hospital stay, wealth index, education and major occupation, were found to have statistically significant association with the level of cost incurred by caregivers.Conclusion: This study identified that a significant level of cost is incurred by caregivers of the children in the hospital, a majority of which was contributed by the lost earnings because of the time spent at the hospital with the children

Aplicación de redes neuronales en la predicción de mortalidad por neumonía / Neuronal networks as predictors of death in pneumonia

RESUMEN Introducción: la neumonía adquirida en la comunidad constituye un importante problema de salud a nivel global. En nuestro país es la cuarta causa de muerte. Los índices pronósticos ayudan a detectar tempranamente los pacientes de alto riesgo, pero estos tienen baja sensibilidad y especificidad. Objetivo: proponer un modelo matemático predictivo de mortalidad de la neumonía adquirida en la comunidad. Materiales y métodos: estudio analítico longitudinal en un universo de 73 pacientes, muestra no probabilística de 48. El test de Mann Withney se utilizó para obtener variables con significación en la mortalidad. Se calculó correlación de Pearson a las variables con significación y luego se elaboró el modelo matemático, el cual se probó en una red neuronal creada y entrenada al efecto. Posteriormente se llevó a la curva ROC para encontrar el área bajo la curva así como las coordenadas del punto de corte. Resultados: se obtuvo para la edad de 79 ± 11 años con 50 % femeninas. La mortalidad global estuvo en el orden del 27 %. Las variables con diferencias de comportamiento fueron la presión arterial sistólica (x2=0,001), así como la presión arterial diastólica (x2=0,001). El valor de la creatinina se comportó con (x2=0,03). La frecuencia respiratoria de (x2=0,01). La presión de oxigeno de (x2=0,036) al igual que las cifras de hemoglobina, el nivel de sodio (Na) (x2=0,004) con marcada diferencia entre los grupos y la edad (x2=0,003) IC=0,32. Conclusiones: este modelo matemático es una herramienta útil a pie de cama del paciente teniendo en cuenta que ayuda al juicio clínico en hacer un pronóstico más acertado (AU).

ABSTRACT Background: the community-acquired pneumonia represents an important problem around the world. It is the fourth cause of death in our country. Prognoses indexes are helpful to early detect the high risk patients, but they have low sensibility and specificity. Objective: to propose a predictive mathematical model of mortality by community-acquired pneumonia. Materials and methods: longitudinal, analytic study in a universe of 73 patients and a non-probabilistic sample of 48. The Mann Whitney's test was used to find variables with signification for mortality. Pearson correlation was applied to the significant variables and after that a mathematical model was elaborated and tested in a neuronal net created and trained for that. Later, data were introduced in a ROC curve to find the area under the curve as well as the coordinates of the cut-off point. Results: the average age was 79 ±11 years and 50 % of the patients were women. Global mortality was around 27 %. The variables with behavioral differences were systolic arterial hypertension (x2=0.001), as well as the diastolic arterial pressure (x2=0.001). The creatinine value was (x2=0.03) and the respiratory frequency (x2=0.01). The oxygen pressure (x2=0.036), and also hemoglobin values and sodium (Na) level (x2=0.004) show a significant difference between groups and ages (x2=0.003) IC=0, 32. Conclusions: this mathematical model is a useful tool at the patients´ bedside taking into account its help to clinical judgment when arriving to a more accurate prognosis (AU).

Neumonía asociada a cuidados de la salud: revisión de la evidencia publicada / Health-care associated pneumonia: review of published evidence

El concepto de neumonía asociada a cuidados de la salud (NACS) surgió a partir de la presunción de que los patógenos causantes del cuadro tendrían mayores probabilidades de ser microorganismos multiresistentes (MOMR), por lo que el esquema de tratamiento antibiótico debía ser diferente al requerido en neumonía adquirida en la comunidad (NAC). Sin embargo, la evidencia que sustenta esa idea no es lo suficientemente robusta. Dado lo complejo del tema, y su elevado impacto en el consumo exagerado de antibióticos, se presenta esta revisión. Es posible que la ausencia de los factores de riesgo usualmente descriptos, o la presencia de solo uno, sugiera poca probabilidad deMOMR, por lo que el abordaje terapéutico debería ser similaral de NAC. Por el contrario, ante la acumulación de factoresde riesgo o frente a cuadros severos se podría considerarla cobertura de MOMR mediante un esquema de espectroampliado

The concept of health-care-associated pneumonia (HCAP) arose from the presumption that the pathogens that cause the disease would be more likely to be multi-resistant microorganisms (MRMO), so the antibiotic treatment scheme should be different from the one required in community acquired pneumonia (CAP). However, the evidence supporting this idea is not robust enough. Given the complexity of the topic, and its high impact on the exaggerated consumption of antibiotics, this review is presented. It is possible that the absence of risk factors usually described, or the presence of only one, suggests a low probability of MRMO, so the therapeutic approach should be similar to that ofCAP. On the contrary, in view of the accumulation of risk factors or in severecases, MRMO coverage could be considered, through an extended spectrum scheme

Effects of hypothermia on lung inflammation in a rat model of meconium aspiration syndrome

Abstract Purpose: To evaluate the effects of hypothermia treatment on meconium-induced inflammation. Methods: Fifteen rats were instilled with human meconium (MEC, 1.5 mL/kg, 65 mg/mL) intratracheally and ventilated for 3 hours. Eight rats that were ventilated and not instilled with meconium served as a sham group. In MEC-hypothermia group, the body temperature was lowered to 33±0.5°C. Analysis of the blood gases, interleukin (IL)-1β, IL-6, IL-8, and tumor necrosis factor (TNF)-α in bronchoalveolar lavage (BAL) fluid samples, and histological analyses of the lungs were performed. Results: The BAL fluid TNF-α, IL-1β, IL-6 and IL-8 concentrations were significantly higher in the MEC-hypothermia group than in the MEC-normothermia (p < 0.001, p < 0.001, p = 0.001, p < 0.001, respectively) and sham-controlled groups (p < 0.001, p < 0.001, p < 0.001, p < 0.001, respectively). Conclusion: Meconium-induced inflammatory cytokine production is affected by the body temperature control.

Infecção respiratória aguda baixa em crianças indígenas guarani, brasil / Acute lower respiratory infection in guarani indigenous children, brazil

RESUMO Objetivo: Descrever o perfil clínico e o tratamento realizado nas crianças da etnia Guarani menores de cinco anos hospitalizadas por infecção respiratória aguda baixa (IRAB), residentes em aldeias nos estados do Rio de Janeiro ao Rio Grande do Sul. Métodos: Das 234 crianças, 23 foram excluídas (dados incompletos), sendo analisadas 211. Os dados foram extraídos dos prontuários por meio de formulário. Com base no registro de sibilância e padrão radiológico, a IRAB foi classificada em: bacteriana, viral e viral-bacteriana. Foi utilizada regressão multinomial para análise bivariada. Resultados: A mediana de idade foi de 11 meses. Do total da amostra, os casos de IRAB foram assim distribuídos: viral (40,8%), bacteriana (35,1%) e viral-bacteriana (24,1%). Verificou-se que 53,1% das hospitalizações não possuíam evidências clínico-radiológico-laboratoriais que as justificassem. Na análise de regressão multinomial, ao comparar a IRAB bacteriana com a viral-bacteriana, a chance de ter tosse foi 3,1 vezes maior na primeira (intervalos de 95% de confiança - IC95% 1,11-8,70) e de ter tiragem 61,0% menor (Odds Ratio - OR 0,39, IC95% 0,16-0,92). Na comparação da IRAB viral com a viral-bacteriana, a chance de ser do sexo masculino foi 2,2 vezes maior na viral (IC95% 1,05-4,69) e de ter taquipneia, 58,0% menor (OR 0,42, IC95% 0,19-0,92) na mesma categoria. Conclusões: Identificou-se maior proporção de processos virais do que processos bacterianos, bem como a presença de infecção viral-bacteriana. A tosse foi um sintoma indicativo de infecção bacteriana, enquanto a tiragem e a taquipneia apontaram infecção viral-bacteriana. Parte da resolubilidade da IRAB não grave ocorreu em âmbito hospitalar; portanto, propõe-se que os serviços priorizem ações que visem à melhoria da assistência à saúde indígena na atenção primária.

ABSTRACT Objective: To describe the clinical profile and treatment of Brazilian Guarani indigenous children aged less than five years hospitalized for acute lower respiratory infection (ALRI), living in villages in the states from Rio de Janeiro to Rio Grande do Sul. Methods: Of the 234 children, 23 were excluded (incomplete data). The analysis was conducted in 211 children. Data were extracted from charts by a form. Based on record of wheezing and x-ray findings, ALRI was classified as bacterial, viral and viral-bacterial. A bivariate analysis was conducted using multinomial regression. Results: Median age was 11 months. From the total sample, the ALRI cases were classified as viral (40.8%), bacterial (35.1%) and viral-bacterial (24.1%). It was verified that 53.1% of hospitalizations did not have clinical-radiological-laboratorial evidence to justify them. In the multinomial regression analysis, the comparison of bacterial and viral-bacterial showed the likelihood of having a cough was 3.1 times higher in the former (95%CI 1.11-8.70), whereas having chest retractions was 61.0% lower (OR 0.39, 95%CI 0.16-0.92). Comparing viral with viral-bacterial, the likelihood of being male was 2.2 times higher in the viral (95%CI 1.05-4.69), and of having tachypnea 58.0% lower (OR 0.42, 95%CI 0.19-0.92). Conclusions: Higher proportion of viral processes was identified, as well as viral-bacterial co-infections. Coughing was a symptom indicative of bacterial infection, whereas chest retractions and tachypnea showed viral-bacterial ALRI. Part of the resolution of non-severe ALRI still occurs at hospital level; therefore, we concluded that health services need to implement their programs in order to improve indigenous primary care.

Oxigenoterapia de alto flujo: ¿Todas las insuficiencias son iguales? / High flow nasal cannula oxygen therapy. Are all respiratory failure the same?

INTRODUCTION: High-flow nasal cannula is an oxygenation therapy in patients with acute respiratory failure. There are, some questions about this technique which answer is needed. MATERIAL AND METHODS: We analyzed all patients that require high-flow nasal cannula oxygen therapy admitted to a polyvalent intensive care unit of a university tertiary hospital. We select those patients who require the therapy as initial support for their acute respiratory failure. We analyzed the mortality and connection to mechanical ventilation (V.M.) rate. We performed a global analysis and then a sub analysis for underlying pathology. Our objective is to describe which pathology has the best results with this treatment. Patients who require therapy to support scheduled extubation, heart failure, pulmonary thromboembolism, thoracic trauma and decreased level of consciousness were excluded. RESULTS: We analysed a total of 128 patients. 76 Men, Mean age 57.4 years, APACHE II 19; SOFA 8.2; SAPS II 55.2; Mean income 13.3 days; Patients required the therapy an average of 2.8 days. 65 patients required connection to M.V. after HFNC therapy. Those patients who were intubated in the first 48 hours had a mortality rate of 45% while those in which the therapy was delayed more than 48 hours had a mortality rate of 56% (P = 0.3). Patients were divided according to their underline pathology. Acute respiratory failure: Extra pulmonary or intra pulmonary (Pneumonia in immunosuppressed and Pneumonia in immuno competent). In the first group, connection to MV was required in 54% of the cases, with a mortality rate of 54% in those intubated in the first 48 hours vs 40% later. In the group of pneumonia in immunosuppressed patients, M.V. was required in the 60.5% of the cases with a mortality rate of 75% in those intubated in the first 48 hours vs 71% posteriorly. In the group Pneumonia in immuno competent, M.V. was required in 42% of the cases with a mortality rate of 10% in the ones intubated the first 48 hours vs 50% later. Statistically significant differences were observed regarding the need of M.V connection according to base pathology. CONCLUSIONS: Results of HFNC oxygen therapy do not appear to be different in pulmonary or extrapulmonary respiratory failure. The severity of the patient ilness is related to the need of mechanical ventilation and mortality rate. The patient who benefits the most from the early identification of the failure of this therapy, is the one who presents acute respiratory failure due to pneumonia in immunocompetent patient.

INTRODUCCIÓN: La oxigenoterapia de alto flujo es una técnica de oxigenación en los pacientes con insuficiencia respiratoria aguda. Existen, algunas preguntas acerca de esta técnica que necesitan respuesta. MATERIAL Y MÉTODOS: Analizamos todos los pacientes que requieren oxigenoterapia de alto flujo ingresados en una Unidad de Cuidados Intensivos polivalente de un hospital terciario universitario. Seleccionamos aquellos pacientes que requieren la terapia como soporte inicial de su insuficiencia respiratoria aguda. Analizamos la mortalidad y conexión a ventilación mecánica (V.M.). Realizamos un análisis global y posteriormente un subanálisis por patología subyacente. Nuestro objetivo es describir en que patología presenta mejores resultados. Se excluyen los pacientes que requieren la terapia como apoyo a la extubación programada, insuficiencia cardiaca, tromboembolismo pulmonar, trauma torácico y disminución del nivel de conciencia. RESULTADOS: Analizamos un total de 128 pacientes. Setenta y seis varones, edad media 57,4 años, APACHE II 19; SOFA 8,2; SAPS II 55,2; días de ingreso medio 13,3; Los pacientes requieren la terapia una media de 2,8 días. Sesenta y cinco pacientes requieren conexión a V.M. tras uso de esta terapia. Aquellos pacientes que son intubados en las primeras 48 horas presentan una mortalidad de 45%, mientras que aquellos en los que la terapia se alarga más de 48 horas la mortalidad es del 56% (p = 0,3). Se divide a los pacientes según su patología de base. Insuficiencia respiratoria de causa: Extrapulmonar, neumonía en inmunodeprimido y neumonía en inmuno competente. En el primer grupo se objetiva conexión a V.M en un 54% de los casos, con una mortalidad del 54% en aquellos intubados en las primeras 48 horas vs 40% posteriormente. En el grupo neumonía en inmunodeprimido se requiere V.M en el 60,5% con una mortalidad del 75% en aquellos intubados en las primeras 48 horas vs 71% posteriormente. En el grupo neumonía en inmunocompetente objetivamos conexión a V.M. en el 42% con una mortalidad del 10% en los intubados las primeras 48 horas vs 50% posteriormente. Se objetivan diferencias estadísticamente significativas respecto a necesidad de conexión a V.M. según patología de base. CONCLUSIONES: Los resultados de la terapia de alto flujo no parece ser diferente en la insuficiencia respiratoria de causa pulmonar o extrapulmonar. La gravedad del enfermo se relaciona con la necesidad de ventilación mecánica y mortalidad. El paciente que más se beneficia de la rápida identificación del fracaso de esta terapia es el que presenta insuficiencia respiratoria por neumonía en paciente inmunocompetente.

Factores de riesgo asociados a infecciones por Staphylococcus aureus meticilino resistente en pacientes con neumonía adquirida en la comunidad asistidos en terapia intensiva / RISK FACTORS ASSOCIATED WITH METHICILLIN STAPHYLOCOCCUS AUREUS RESISTANT IN PATIENTS WITH ACQUIRED PNEUMONIA IN THE COMMUNITY, ASSISTED AT INTENSIVE CARE UNITS

Introducción: La incidencia creciente de infecciones invasivas por Staphylococcus aureus meticilino-resistente adquirido en la comunidad (SAMR-AC) obliga a considerar a este patógeno como posible agente etiológico de la neumonía adquirida en la comunidad (NAC). Es importante reconocer variables específicas que se asocien con un mayor riesgo de padecer esta enfermedad, a fin de mejorar la terapia antibiótica empírica y limitar el tratamiento anti-SAMR. Objetivos: Identificar factores de riesgo asociados a SARM-AC en pacientes con NAC hospitalizados en Unidades de Cuidados Intensivos (UCI). Materiales y métodos: Se analizaron de manera retrospectiva todos los episodios de NAC ingresados en la UCI de un hospital público entre los años 2006 y 2014 en los que se logró identificar el agente etiológico. Se dividió a la población en dos grupos según el agente causal: SAMR-AC (NAC-S) o no SAMR-AC (NAC- no S). Se compararon diferentes variables demográficas, epidemiológicas y clínicas entre ambos grupos (análisis univariado). Para identificar factores de riesgo asociados con NAC por SAMR-AC se realizó análisis de regresión logística de las variables que resultaron significativamente diferentes en el análisis univariado. Para valorar diferencias entre ambos grupos se utilizó estadística descriptiva, test de Fisher y análisis de regresión logística. Se utilizó el software EPIcalc-2000. Se consideró significativo un valor de p<0.05. Resultados: Se incluyeron 239 episodios de NAC, de las cuales 39 fueron causadas por SAMR-AC, y 200 por otros agentes, con la siguiente distribución:niae 6 (3%), H1N1 5 (2,5%), Mycoplasma pneunoniae 4 (2%), Moraxella catharralis 3 (1,5%), SAMS 3 (1,5%), otros 6 (3%). Los pacientes del grupo NAC-S fueron significativamente más jóvenes (edad promedio 35.7 años ± 13.0 vs 43.2 ±12.4, p<0.0001), tuvieron en menor proporción infección por virus de la inmunodeficiencia humana (VIH) (23.1% vs 56.0%, p<0.0001) y presentaron con mayor frecuencia requerimiento de ventilación mecánica (VM) en las primeras 24 horas (38.5% vs 18.0%, p=0.008). Los pacientes del grupo NAC-S mostraron un promedio de score de APACHE II significativamente mayor al ingreso (17.0 ±5.3 vs 13.3 ±4.4, p<0.0001). La mortalidad fue significativamente más elevada en el grupo de NAC-S (35.9% vs 11.0%, p=0.0002). En el resto de las variables analizadas no se observaron diferencias significativas. El análisis de regresión logística mostró que las variables que se asociaron con NAC-S fueron edad ≤35 años (OR 3.60, IC 95% 1.77-7.29), score de APACHE II ≥ 15 (OR 4.37, IC 95% 2.08-9.16) y requerimiento de VM (OR 2.85, IC 95% 1.36-5.86). En cambio, la infección por VIH fue una variable que se asoció con menor probabilidad de desarrollar NAC-S (OR 0.24, IC 95% 0.11-0.52). Conclusión: En los pacientes con NAC que ingresan en una UCI, la edad ≤35 años, el score de APACHE II ≥ 15 y la necesidad de VM se asociaron significativamente con mayor probabilidad de infección por SAMR-AC Streptococcus pneumoniae 113 (56,5%); Haemophillus influenzae 39 (19,5%), Chlamydia psitacii 13 (6,5%), Pseudomonas aeruginosa 8 (4%), Klebsiella pneumo

Risk factors associated with methicillin resistant Staphylococcus aureus community acquired pneumonia in patients assisted at Intensive Care Units Introduction: The increasing incidence of invasive infections by Community Acquired methicilin-resistant Staphylococcus aureus (CA-MRSA) makes it necessary to consider this pathogen as a possible etiological agent in Community Acquired Pneumonia (CAP). It is important to recognize specific variables that are associated with an increased risk of this disease, in order to improve empirical antibiotic therapy and to limit anti-MRSA treatment. Objectives: To identify risk factors associated with CA-MRSA in patients with CAP hospitalized in Intensive Care Units (ICUs). Material and methods: We analyse retrospectively all CAP episodes admitted to the ICU of a public hospital between 2006 and 2014 in which the etiologic agent was identified. The population was divided in two groups, according the etiological agent: CA-MRSA (CAP-MRSA) o not CA-MRSA (CAP-no MRSA). Different demographic, epidemiological and clinical variables were compared between both groups (univariate analysis). Logistic regression analysis of variables that were significantly different in the univariate analysis was performed to identify risk factors associated with CAP by CA-MRSA. Descriptive statistic was used, Fisher´s test was performed to assess differences between both groups and logistic regression test was made to know risks factors associated. EPIcalc-2000 software was used. A value of p <0.05 was considered significant. Results: 239 CAP episodes were includes; 39 were caused by CA-MRSA and 200 by others agents. The etiological distribution was: Streptococcus pneumoniae 113 (56,5%); Haemophillus influenzae 39 (19,5%), Chlamydia psitacii 13 (6,5%), Pseudomona aeruginosa 8 (4%), Klebsiella pneumoniae 6 (3%), H1N1 5 (2,5%), Mycoplasma pneunoniae 4 (2%), Moraxella catharralis 3 (1,5%), MSSA 3 (1,5%), others 6 (3%). Patients in the CAP-MRSA group were significant younger (mean age 35.7 years old ± 13.0 vs 43.2 ±12.4, p<0.0001), had a lower proportion of HIV infections (23.1% vs 56.0%, p<0.0001) and needed of mechanical ventilation (MV) in the first 24 hours with higher frequency (38.5% vs 18.0%, p=0.008). Patients in the CAP-MRSA showed a significantly higher APACHE II score on admission (17.0 ±5.3 vs 13.3 ±4.4, p<0.0001). Mortality rate was significantly higher in CAP-MRSA group (35.9% vs 11.0%, p=0.0002). In the other analysed variables, no significant range differences were observed. Logistic regression analysis showed that the variables that were associated with CAP by MRSA were age ≤35 years (OR 3.60, 95% CI 1.77-7.29), APACHE II score ≥ 15 (OR 4.37, CI 95% 2.08-9.16) and MV requirement (OR 2.85, 95% CI 1.36-5.86). HIV infection was associated with lower probability to have CAP-MSA (OR 0.24, CI 95% 0.11-0.52). Conclusion: In patients with CAP who entered an ICU, age ≤35 years, APACHE II score ≥15 and the need for MV were significantly associated with a greater likelihood of CAP-MRSA infection.