Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 5.748
Filter
1.
Alerta (San Salvador) ; 8(1): 63-72, ene. 22, 2025. ilus, tab.
Article in Spanish | BISSAL, LILACS | ID: biblio-1586636

ABSTRACT

En El Salvador la neumonía asociada a ventilación mecánica es la tercera infección más frecuente asociada a la atención sanitaria, con un alto impacto por sus costos de atención. Objetivo. Analizar los factores de riesgo para desarrollar neumonía asociada a ventilación mecánica en hospitales de tercer nivel de El Salvador durante el 2022. Metodología. Estudio de casos y controles, la muestra se calculó para un nivel de confianza del 95%, potencia del 80%, Odds ratio (OR) de 2,5, y con una relación de tres controles por caso. Los criterios de inclusión para casos fueron pacientes ventilados que se diagnosticaron como neumonía durante el 2022 con confirmación bacteriológica por cultivo de secreción respiratoria, los controles fueron pacientes con ventilación mecánica mayor a 48 horas sin neumonía posterior a 72 horas de extubación, la información se obtuvo de los expedientes clínicos. Se utilizó un modelo de regresión logística para determinar los factores de riesgo. Resultados. Se revisaron 206 expedientes, 52 casos y 154 controles, el dato de laboratorio más frecuente fue la leucocitosis con un 78,6% de los casos, y el patógeno aislado con mayor frecuencia fue Acinetobacter baumannii con 27,8% de aislamientos; el sexo masculino (OR: 4,94; IC95%: 1,56-15,66), el trauma (OR: 10,52; IC95%: 2,73-40,59) y los días de intubación (OR: 1,24; IC95%: 1,14-1,36) fueron factores independientes de riesgo estadísticamente significativos. Conclusión. El sexo masculino, el antecedente de trauma y los días de intubación fueron factores de riesgo para neumonía asociada a ventilación mecánica en hospitales de tercer nivel de El Salvador.


In El Salvador ventilator associated pneumonia is the third most frequent health care associated infection, it has a high impact because it raises attention costs. Objective. Analize the risk factor for the development of ventilator associated pneumonia in tertiary care hospitals in El Salvador during 2022. Methodology. It was a case-control study, we calculated the sample with a 95% confidence level, 80% statistical power, Odds ratio (OR) of 2.5 and a 3controls per case ratio. Cases were ventilated patients diagnosed with pneumonia between January and December 2022 who have a confirmed microbiological isolation in a respiratory sample, Controls were patients without pneumonia for at least 72 hours after extubation, the information was obtain from the clinical files. We used a logistic regression model to determine risk factors. Results. We reviewed 206 clinical files, 52 cases and 154 controls, the most frequent sign of infection was leukocytosis, it was present in 78.6% of cases. The most isolated pathogen was Acinetobacter baumannii, reported in 27.8% of cultures. Male sex (OR: 4.94 CI95%:1.56-15.66), history of trauma (OR:10.52 CI95%: 2.73-40.59) and intubation days (OR: 1.24; CI95%: 1.14-1.36) were statistically significant independent risk factors. Conclusion. Male gender, history of trauma and intubation days were risk factors for ventilator associated pneumonia in tertiary care hospitals from El Salvador during 2022


Subject(s)
Pneumonia , Respiration, Artificial , Ventilators, Mechanical , Risk Factors , Hospitals , Cross Infection , El Salvador
2.
Int. j. med. surg. sci. (Print) ; 11(3): 1-7, sep. 2024. ilus
Article in Spanish | LILACS | ID: biblio-1584486

ABSTRACT

La enfermedad granulomatosa intestinal crónica es un trastorno que compromete directamente a todo el sistema inmunológico. La incidencia estimada es uno en un millón de habitantes. Entre los factores de riesgo asociados resaltan la presencia de infecciones crónicas y recurrentes. En el presente caso, se trata de una paciente femenina de 39 años con antecedentes de obstrucción intestinal y endometriosis, quien presenta dolor abdominal de hemiabdomen izquierdo y distinción abdominal recurrente sin causa identificable. En los exámenes de laboratorio se evidencia una leucocitosis y neutrofilia leve. En la tomografía se observa dilatación intestinal a nivel yeyunoileal sin zonas de transición, y los exámenes serológicos negativos. Se realiza laparoscopía exploratoria y se encuentra presencia de implantes tumorales en el epiplón, extendiéndose hacia la región abdominal, uterina, intestinal, peritoneal, además de líquido cetrino a nivel abdominal. Los marcadores tumorales son normales. La histopatología detalla una colonización micótica con necrosis eosinofílica y presencia de granulomas, inmunohistoquímica negativa para Aspergillus y cultivo de Lowestein-jensen negativo. Se inicia tratamiento antifúngico y antituberculoso, con disminución de sintomatología y mejoría del cuadro clínico.


Chronic intestinal granulomatous disease is a disorder that directly compromises the entire immune system. The estimated incidence is one in a million inhabitants. Among the associated risk factors, the presence of chronic and recurrent infections stands out. In the present case, it is a 39-year-old female patient with a history of intestinal obstruction and endometriosis, who presents abdominal pain in the left abdomen and recurrent abdominal pain without an identifiable cause. Laboratory tests revealed leukocytosis and mild neutrophilia. The tomography showed intestinal dilation at the jejunoileal level without transition zones, and the serological tests were negative. Exploratory laparoscopy was performed and the presence of tumor implants was found in the omentum, extending to the abdominal, uterine, intestinal, and peritoneal regions, as well as sallow fluid at the abdominal level. Tumor markers are normal. Histopathology details fungal colonization with eosinophilic necrosis and presence of granulomas, negative immunohistochemistry for Aspergillus and negative Lowestein-jensen culture. Antifungal and antituberculous treatment was started, with a decrease in symptoms and improvement in the clinical picture.


Subject(s)
Humans , Female , Adult , Granulomatous Disease, Chronic/complications , Granulomatous Disease, Chronic/diagnosis , Anus Diseases/etiology , Anus Diseases/immunology , Pneumonia/etiology , Pneumonia/immunology , Tomography, X-Ray Computed , Laparoscopy/methods , Abscess/etiology , Abscess/immunology , Granulomatous Disease, Chronic/immunology
3.
Revista Digital de Postgrado ; 13(2): e394, ago.2024. tab
Article in Spanish | LILACS, LIVECS | ID: biblio-1567347

ABSTRACT

Objetivo: Describir los hallazgos imagenológicos en radiografías de tórax y ecografías pulmonares de pacientes con síndrome post-COVID-19. Métodos: estudio descriptivo, prospectivo y transversal que incluyó pacientes con síndrome post-COVID-19, sometidos a radiografías de tórax y ecografías pulmonares en el Servicio de Neumonología Clínica del Hospital Dr. José Ignacio Baldo, entre enero y octubre de 2022, con la finalidad de establecer su evolución imagenológica pulmonar. Se utilizó estadística descriptiva, chi-cuadrado de Pearson y prueba kappa de concordancia, considerando significativo un valor de p < 0,05. Resultados: La muestra consistió en 58 pacientes con una edad media de 55 ± 13 años, predominando el sexo femenino (58,6%). El 60,3% mostró alteraciones en la radiografía de tórax; un 74,3% con patrón intersticial bilateral y un 25,7% con patrón intersticial unilateral. La ecografía reveló patrón intersticial en el 43,1% de los casos y se observaron dos microconsolidaciones subpleurales. Conclusiones: Las radiografías de tórax y las ecografías pulmonares son herramientas imagenológicas eficaces, accesibles y económicas para detectar alteraciones en pacientes con síndrome post-COVID-19. (AU)


Objective: To describe imaging findings in chest radiographs and lung ultrasounds of patients with post-COVID-19 syndrome. Methods: A descriptive, prospective, and cross-sectional study was carried out that included patients with post-COVID-19 syndrome, who underwent chest radiographs and lung ultrasounds at the Clinical Pneumonology Service of Dr. José Ignacio Baldo Hospital, between January and October 2022. Descriptive statistics, Pearson's chi-square, and kappa concordance test were used, considering a p-value < 0.05 significant. Results: The sample consisted of 58 patients with an average age of 55 ± 13 years, with a predominance of females (58.6%). 60.3% showed alterations in the chest radiograph; 74.3% with a bilateral interstitial pattern and 25.7% with a unilateral interstitial pattern. The ultrasound revealed an interstitial pattern in 43.1% of the cases and two subpleural microconsolidations were observed. Conclusions: Chest radiographs and lung ultrasounds are effective, accessible, and economical imaging tools to detect alterations in patients with post-COVID-19 syndrome. (AU)


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Radiography, Thoracic , COVID-19/diagnosis , Post-Acute COVID-19 Syndrome/drug therapy , Pneumonia/pathology , Quality of Life , Prospective Studies , Lung Diseases, Interstitial/drug therapy
4.
Respirar (Ciudad Autón. B. Aires) ; 16(2): 127-136, Junio 2024.
Article in Spanish | LILACS, UNISALUD, BINACIS | ID: biblio-1556122

ABSTRACT

Introducción: La neumonía por COVID-19 puede presentarse con dos patrones radio-lógicos: daño alveolar difuso o neumonía organizativa. Estos patrones tienen diferente evolución y pronóstico en pacientes sin infección por COVID-19. Nuestro objetivo fue evaluar la prevalencia del patrón radiológico de neumonía organizativa y su asociación con los desenlaces clínicos.Métodos: Se realizó un estudio de cohorte retrospectivo que incluyó a pacientes adultos hospitalizados por COVID-19 grave/crítica a los que se les realizó una tomografía computarizada de tórax en los 21 días posteriores al diagnóstico. Los patrones radiológicos fueron revisados y clasificados por dos radiólogos expertos. Resultados: De los 80 pacientes incluidos, el 89% (n=71) presentaron un patrón compatible con neumonía organizativa. Los principales hallazgos radiológicos fueron la distribución multilobar (98,7%) y bilateral (97,6%) con opacidades en vidrio esmerilado (97,6%). El 44% (n=33) de los sujetos requirió ingreso en cuidados intensivos, de los cuales el 24% (n=19) recibió ventilación mecánica. La presencia de neumonía organizativa se asoció de forma independiente con una disminución de las probabilidades de ventilación mecánica o muerte (Odds ratio 0,14; intervalo de confianza del 95%: 0,02 - 0,96; valor de p 0,045) en un modelo multivariado que incluía la edad, el sexo, el IMC y la afectación pulmonar en la TC.Conclusiones: Un patrón radiológico de neumonía organizativa es altamente prevalen-te en pacientes con COVID-19 grave/crítico y se asocia con mejores resultados clínico


Introduction: COVID-19 pneumonia can present with two distinct radiologic patterns: diffuse alveolar damage or organizing pneumonia. These patterns have been linked to different outcomes in non-COVID-19 settings. We sought to assess the prevalence of organizing pneumonia radiologic pattern and its association with clinical outcomes. Methods: We performed a retrospective cohort study including adult patients hospita- lized for severe/critical COVID-19 who underwent chest computed tomography within 21 days of diagnosis. Radiologic patterns were reviewed and classified by two expert radiologists. Results: Among 80 patients included, 89% (n=71) presented a pattern consistent with organizing pneumonia. The main radiologic findings were multilobar (98.7%) and bilateral (97.6%) distribution with ground glass opacities (97.6%). Intensive care admission was required for 44% (n=33) of subjects, of which 24% (n=19) received mechanical ventilation. The presence of organizing pneumonia was independently associated with a decreased odds of mechanical ventilation or death (Odds ratio 0.14; 95% confidence interval 0.02 - 0.96; p value 0.045) in a multivariate model including age, gender, BMI and lung involvement on CT. Conclusion: A radiologic pattern of organizing pneumonia is highly prevalent in patients with severe/critical COVID-19 and is associated with improved clinical outcomes.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Pneumonia/diagnostic imaging , SARS-CoV-2 , COVID-19/epidemiology , Argentina/epidemiology , Respiration, Artificial , Comorbidity , Clinical Diagnosis , Polymerase Chain Reaction/methods , Prevalence , Cohort Studies , Critical Illness , COVID-19 Serological Testing
5.
Respirar (Ciudad Autón. B. Aires) ; 16(2): 137-150, Junio 2024.
Article in Spanish | LILACS, UNISALUD, BINACIS | ID: biblio-1556149

ABSTRACT

Introducción: SARS-CoV-2 ha causado millones de muertes a nivel global desde su primer caso reportado en China. En Guatemala existen pocos estudios que describan los factores pronósticos. Nuestro objetivo fue determinar los factores asociados de mortalidad a 30 días en pacientes con neumonía (Nm) por SARS-CoV-2 y construir un modelo predictor. Material y Métodos: Estudio retrospectivo en 144 sujetos en el Hospital Roosevelt de marzo a diciembre 2020 con criterios de Nm por SARS-CoV-2. Se revisó el expediente médico para datos clínicos y de laboratorio desde ingreso hasta alta hospitalaria o muerte. Resultados: Se evaluaron 105 hombres y 39 mujeres con media de edad 53 años. El 47% tenía comorbilidades como diabetes mellitus 2 e hipertensión arterial sistémica. Promedio de días de hospitalización: 13. Cuadros leves a moderados de Síndrome de Distrés Respiratorio Agudo (SDRA): 92%. Se indicó ventilación mecánica invasiva (VMI) a 46 pacientes. La mortalidad general fue 35%. Factores asociados a mortalidad a 30 días: edad ≥50 años, inicio de síntomas ≥7 días, SDRA severo, radio NL >4,4, recibir VMI, alteración en LDH y procalcitonina. Nuestro modelo mostró que los mejores predictores de mortalidad eran alteración en procalcitonina (OR: 4,45), recibir VMI (OR: 112) y días de estancia hospitalaria (OR: 1,12) con precisión de 91,5% y área bajo la curva de 94,4%. Conclusiones: Los factores pronósticos de mortalidad en pacientes guatemaltecos con Nm por SARS-CoV-2 son múltiples e incluyen rasgos demográficos, clínicos y serológicos; identificarlos y contar con un modelo pronóstico ayudará a brindar atención médica de precisión.


Introduction: SARS-CoV-2 has caused millions of deaths globally since its first case was reported in China. In Guatemala, few studies describe prognostic factors. Our objective was to determine the factors associated with 30 day mortality in patients with Pneumonia (Nm) due to SARS-CoV-2 and to build a predictor model. Material and Methods: Retrospective study in 144 subjects at Roosevelt Hospital from March to December 2020 with Nm criteria for SARS-CoV-2. The medical record was rviewed, obtaining clinical and laboratory data from admission to hospital discharge or death. Results: 105 men and 39 women with an average age of 53 years were evaluated. 47% had comorbidities, with type 2 diabetes mellitus and systemic arterial hypertension being common. The average number of days of hospitalization was 13. 92% had mild to moderate acute respiratory distress syndrome (ARDS). Invasive mechanical ventila-tion (IMV) was indicated for 46 patients. Overall mortality was 35%. The factors asso-ciated with 30-day mortality were age ≥50 years, the onset of symptoms ≥7 days, severe ARDS, N/L ratio >4.4, receiving IMV, alterations in LDH, and procalcitonin. Our model showed that the best predictors of mortality were altered procalcitonin (OR: 4.45), receiving IMV (OR: 112), and days of hospital stay (OR: 1.12) with precision of 91.5% and area under the curve of 94.4%. Conclusions: The prognostic factors of mortality in Guatemalan patients with Nm due to SARS-CoV-2 are multiple and include demographic, clinical and serological features; identifying them and having a prognostic model will help provide precision medical care.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Pneumonia/mortality , Prognosis , SARS-CoV-2 , COVID-19/epidemiology , Oxygen Inhalation Therapy , Respiration, Artificial , Respiratory Distress Syndrome, Newborn/mortality , Comorbidity , Polymerase Chain Reaction , Ultrasonography , Age Factors , Guatemala/epidemiology
6.
Respirar (Ciudad Autón. B. Aires) ; 16(2): 177-182, Junio 2024.
Article in Spanish | LILACS, UNISALUD, BINACIS | ID: biblio-1556164

ABSTRACT

La bronquitis plástica es una enfermedad infrecuente y poco estudiada. Se caracteriza por la obstrucción parcial o total de la vía aérea inferior por moldes o yesos gomosos y firmes, compuestos por múltiples sustancias como fibrina, mucina y otros, que se acumulan en la luz bronquial. En la actualidad, no hay un consenso de la fisiopatología real. Puede presentarse con síntomas leves como tos, sibilancias y disnea, hasta eventos fatales de insuficiencia respiratoria. Se clasifican en tipo I (inflamatorios) y tipo II (acelulares). La presencia de la bronquitis plástica es una complicación de varias enfermedades y está relacionada con procedimientos correctivos de cardiopatías congénitas (procedimiento de Fontan). El diagnóstico se hace a través de la identificación de los yesos bronquiales, ya sea cuando el paciente los expectora o por broncoscopía. Se han utilizado múltiples terapias que solo tienen evidencias anecdóticas. En los últimos años se han observado buenos resultados con el uso de heparinas, así como el alteplasa nebulizado e instilado por broncoscopia.


Plastic bronchitis is a rare and little-studied disease. It is characterized by partial or total obstruction of the lower airway by rubbery and firm molds or plasters, made up of multiple substances that accumulate in the bronchial lumen. Currently, there is no consensus on real pathophysiology. It can present itself with mild symptoms such as cough, wheezing and dyspnea, to fatal events of respiratory failure. They are classified into type I (inflammatory) and type II (acellular). The presence of plastic bronchitis is a complication of several diseases and in corrective procedures for congenital heart disease (Fontan procedure). Diagnosis is made by identifying bronchial casts, either by the patient expectorating them or by bronchoscopy. Multiple therapies have been used that only have anecdotal evidence. In recent years, good results have been observed with the use of heparins and tPA nebulized and instilled by bronchoscop.


Subject(s)
Humans , Female , Adult , Bronchitis/diagnosis , Bronchoscopy , Fontan Procedure , Pneumonia , Respiratory Insufficiency , Shock, Septic , Fibrin , Tracheostomy , Respiratory Sounds , Cough , Airway Obstruction/diagnosis , Dyspnea
7.
Respirar (Ciudad Autón. B. Aires) ; 16(1): 5-15, Marzo 2024.
Article in Spanish | LILACS, UNISALUD, BINACIS | ID: biblio-1538330

ABSTRACT

Objetivos: Millones de pacientes con COVID-19 fueron internados en terapia intensiva en el mundo, la mitad desarrollaron síndrome de dificultad respiratoria aguda (SDRA) y recibieron ventilación mecánica invasiva (VMI), con una mortalidad del 50%. Analiza-mos cómo edad, comorbilidades y complicaciones, en pacientes con COVID-19 y SDRA que recibieron VMI, se asociaron con el riesgo de morir durante su hospitalización.Métodos: Estudio de cohorte observacional, retrospectivo y multicéntrico realizado en 5 hospitales (tres privados y dos públicos universitarios) de Argentina y Chile, durante el segundo semestre de 2020.Se incluyeron pacientes >18 años con infección por SARS-CoV-2 confirmada RT-PCR, que desarrollaron SDRA y fueron asistidos con VMI durante >48 horas, durante el se-gundo semestre de 2020. Se analizaron los antecedentes, las comorbilidades más fre-cuentes (obesidad, diabetes e hipertensión), y las complicaciones shock, insuficiencia renal aguda (IRA) y neumonía asociada a la ventilación mecánica (NAV), por un lado, y las alteraciones de parámetros clínicos y de laboratorio registrados.Resultados: El 69% era varón. La incidencia de comorbilidades difirió para los diferentes grupos de edad. La mortalidad aumentó significativamente con la edad (p<0,00001). Las comorbilidades, hipertensión y diabetes, y las complicaciones de IRA y shock se asociaron significativamente con la mortalidad. En el análisis multivariado, sólo la edad mayor de 60 años, la IRA y el shock permanecieron asociados con la mortalidad. Conclusiones: El SDRA en COVID-19 es más común entre los mayores. Solo la edad >60 años, el shock y la IRA se asociaron a la mortalidad en el análisis multivariado.


Objectives: Millions of patients with COVID-19 were admitted to intensive care world-wide, half developed acute respiratory distress syndrome (ARDS) and received invasive mechanical ventilation (IMV), with a mortality of 50%. We analyzed how age, comor-bidities and complications in patients with COVID-19 and ARDS who received IMV were associated with the risk of dying during their hospitalization.Methods: Observational, retrospective and multicenter cohort study carried out in 5 hospitals (three private and two public university hospitals) in Argentina and Chile, during the second half of 2020.Patients >18 years of age with SARS-CoV-2 infection confirmed by RT-PCR, who devel-oped ARDS and were assisted with IMV for >48 hours, during the second half of 2020, were included. History, the most frequent comorbidities (obesity, diabetes and hyper-tension) and the complications of shock, acute renal failure (AKI) and pneumonia as-sociated with mechanical ventilation (VAP), on the one hand, and the alterations of re-corded clinical and laboratory parameters, were analyzed.Results: 69% were men. The incidence of comorbidities differed for different age groups. Mortality increased significantly with age (p<0.00001). Comorbidities, hyper-tension and diabetes, and complications of ARF and shock were significantly associat-ed with mortality. In the multivariate analysis, only age over 60 years, ARF and shock remained associated with mortality.Conclusions: ARDS in COVID-19 is more common among the elderly. Only age >60 years, shock and ARF were associated with mortality in the multivariate analysis


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Pneumonia/complications , Respiration, Artificial/methods , Respiratory Distress Syndrome, Newborn/complications , Shock/complications , Comorbidity , Renal Insufficiency/complications , SARS-CoV-2 , COVID-19/epidemiology , Argentina/epidemiology , Chile/epidemiology , Risk Factors , Mortality , Multicenter Study
8.
Article in English | WPRIM | ID: wpr-1036005

ABSTRACT

Background@#Studies on previous viral pandemics showed poorer outcomes of patients with concomitant bacterial infection. During the early period of COVID-19 pandemic, empiric antibiotic therapy is commonly given among COVID-19 patients despite lack of strong recommendations for its use.@*Objectives@#We determined the prevalence of bacterial co-infection and of empiric use of antibiotics among COVID-19 admissions. We also determined association between COVID-19 severity, ICU admissions, length of hospital stay, and mortality outcomes of those with and without bacterial co-infection.@*Methods@#A total of 159 patients hospitalized with COVID-19 from April 2020 to April 2021 were analyzed in this crosssectional chart review study. Data on empiric antibiotic administration and cultures taken within 3 days of admission were collected. Chi-square, Fischer-Exact, and T-tests were used to analyze the data.@*Results@#Empiric antibiotics were given in 94.97% of COVID-19 admissions with azithromycin as the most common agent. The prevalence of bacterial co-infection among COVID-19 admitted patients was 10%. There were higher ICU admissions and longer hospital stay among those with bacterial co-infection although it did not reach statistical significance. No mortality was seen among patients with bacterial co-infection.@*Conclusion@#There was a high use of empiric antibiotic treatment in hospitalized COVID-19 patients despite the low prevalence of bacterial co-infection among these cases. This warrants development of strategies for antimicrobial stewardship programs especially during the COVID-19 pandemic.


Subject(s)
COVID-19 , Pneumonia
9.
Article in English | WPRIM | ID: wpr-1012674

ABSTRACT

Background and Objective@#COVID-19 contributes significantly to global morbidity and mortality. Age-related comorbidities elevate the risk of severe cases. Studies have recently demonstrated that widely available medications, including tocilizumab (TCZ), can manage severe symptoms. However, its effectiveness is unclear, particularly among the older population. Therefore, this review aimed to evaluate TCZ’s efficacy in managing severe pneumonia in individuals aged 50 and older.@*Methods@#We systematically search several databases and gray literature including Web of Science, CINAHL, Academic Search Complete, PsycINFO, PsycArticles, SocINDEX, CENTRAL/Cochrane Library, PubMed/MEDLINE for original research articles in English across several study designs published in the year 2020-2022. A narrative synthesis was conducted to summarize the evidence. We employed the NIH quality assessment tool for observational cohort studies to evaluate risk of bias. Additionally, we utilized GRADE to appraise the certainty of evidence.@*Results@#Among 539 screened articles, only five studies met the selection criteria. Tocilizumab's impact on severe COVID-19 pneumonia revealed a diverse effect on mortality rate, with 29% in the TCZ group, and 40% in the controls died within 30 days of intubation (OR 0.61; 95% CI, 0.27-1.36). It is also reported that TCZ was not associated with mortality, despite faster decline in pulmonary function and prolonged fever. Hospital mortality in the TCZ group was significantly lower than in the controls, and age over 60 was the only significant risk factor. Moreover, administering TCZ reduced mechanical ventilation needs, with 82% extubated compared to 53% in controls. However, 45% in TCZ group was associated with a higher ventilator-associated pneumonia rate than in the untreated group which was 20% (P < 0.001). Despite this, TCZ-treated patients had shorter hospital stays.@*Conclusions@#The effects of tocilizumab on reducing mortality risk and improving the survival rate of COVID-19 patients with pneumonia remained inconclusive. Yet, the majority of results suggested that giving tocilizumab leads to shorter hospital stays, lowers the requirement for mechanical ventilation, and decreases the likelihood of ICU transfer. Tocilizumab is linked to the incidence of secondary infections; hence, this medication should be closely monitored for side effects.


Subject(s)
COVID-19 , Pneumonia
10.
Article in English | WPRIM | ID: wpr-1012808

ABSTRACT

Background and Objectives@#The etiology of pneumonia in the pediatric population varies by age group. Among patients one month to 59 months old, viral pathogens are the most common cause of lower respiratory infections. The study aims to determine the frequency distribution of antibiotic prescription among patients one month to 59 months old and to determine the adherence of primary care facilities to local guidelines with recommended antibiotics. @*Methods@#A descriptive retrospective study using electronic medical records was conducted at two primary care sites. Patients aged 1 month to 59 months old seeking consult via telemedicine or face-to-face diagnosed with community acquired pneumonia from April 2019-March 2020 in the rural facility and May 2019-April 2020 in the remote facility were included in the study. The primary outcome was to determine the patterns of antibiotic use in pneumonia in remote and rural areas and adherence to the recommended antibiotics by the 2016 Philippine Academy of Pediatric Pulmonologists pediatric community-acquired pneumonia clinical practice guidelines (CPG). @*Results@#There were 30 pediatric patients diagnosed with pneumonia in the rural facility and 213 in the remote facility. Of these patients with pneumonia, 96.7% and 94.8% were prescribed antibiotics in the rural and remote sites, respectively. The most commonly prescribed antibiotic in the rural facility was co-amoxiclav (26.7%), while amoxicillin (51.6%) was the most common in the remote facility. Adherence to the CPG in the rural site was lower at 23.3% (n=8/30) compared to the remote site which was 55.9% (n=119/213). @*Conclusion@#Primary care physicians prescribed antibiotics in over 90% of the time upon the diagnosis of pneumonia in children aged one month to 59 months old, despite viral pneumonia being the more common in primary care setting. Adherence to recommended antibiotics was higher in the remote setting than in the rural setting. Use of EMR to monitor quality of care can improve patient outcomes and safety, pointing out the importance of improving the quality of documentation in the study sites.


Subject(s)
Pediatrics , Pneumonia , Primary Health Care
12.
Acta Medica Philippina ; : 74-81, 2024.
Article in English | WPRIM | ID: wpr-1032134

ABSTRACT

Objective@#To describe the treatment outcomes of patients who underwent tube thoracostomy for pleural complications in patients with COVID-19 and determine the association between patient profile and treatment outcomes.@*Methods@#A single-institution retrospective review of patients who underwent tube thoracostomy for complications of COVID-19 infection in the University of the Philippines - Philippine General Hospital (UP-PGH) from March 30, 2020, to March 31, 2021, was performed. These patients' demographic and clinical profiles were evaluated using median, frequencies, and percentages. The association between patient profile, and mortality and reintervention rates was assessed using univariable Cox proportional hazards regression analysis.@*Results@#Thirty-four (34) of 3,397 patients (1.00%) admitted for COVID-19 pneumonia underwent tube thoracostomy. Of these, 34, 47.06% were male, 52.94% were female, the median age was 51.5 years old, 85.29% had comorbid conditions, and 29.41% had a previous or ongoing tuberculous infection. The most common indication for tube thoracostomy was pleural effusion (61.76%), followed by pneumothorax (29.41%), and pneumo-hydrothorax (8.82%). The mortality rate was 38.24%, and the reintervention rate was 14.71%. Intubated patients had 14.84 times higher mortality hazards than those on room air. For every unit increase in procalcitonin levels, the mortality hazards were increased by 1.06 times.@*Conclusion@#An increasing level of oxygen support on admission and a level of procalcitonin were directly related to mortality risk in COVID-19 patients who underwent tube thoracostomy for pleural complications. There is insufficient evidence to conclude that patient-related, COVID-19 pneumonia-related, and procedure-related factors included in this study were significantly associated with reintervention risk.


Subject(s)
COVID-19 , Pneumonia
13.
Tanzan. j. of health research ; 25(4): 1310-1323, 2024. figures, tables
Article in English | AIM | ID: biblio-1572220

ABSTRACT

Background:Pneumonia is an acute respiratory infection caused by severe linfectious agents, such as viruses, bacteria,and fungi.It affects the lungs.T his study aimed to assess mothers'knowledge and practices regarding pneumonia inchildren under five years of age in Makambako town. The study focuse don exploring knowledge, awareness, practices, andthe under five which mothers understand the disease and measures taken to protect children to prevent and reduce the disease extent to community-based descriptive cross-sectional study design was used, employing random and purposive sampling techniques to obtain 106 respondents in the study area who filled out the structured questionnaires. All structured questionnaires questionnaires were completeness and then entered into SPSS for analysis. The prevalence is high,as there were cases of of of pneumonia 2017 compared to 1938 cases in 2016. Results:Basedon the study findings, the high prevalence of childhood pneumonia in Makambako town council is is caused low knowledge and poor practices of mothers concerning childhood pneumonia,as 70.8% of mothers do not know what pneumonia isabout,72.6%of mothersdo not know health risk factors associated with childhood pneumonia, and77.3% do not know how pneumonia protect. Some mothers perform cultural and traditional Background:Pneumonia is an acute respiratory infection caused by several infectious agents, suchasviruses,bacteria,andfungi.Itaffectsthelungs.Thisstudyaimedtoassessmothers'knowledgeandpracticesregardingpneumonia inchildren under five years of age in Makambako town. The study focusedon , awareness, practices, andthe extent to whichmothers understand the disease and measures taken to protect childrentoprevent and reduce the disease prevalence.Methodology:A community-based descriptive cross-sectional study design was used, employing random and purposive sampling techniques to obtain 106 respondents in the study area who filled out the structured questionnaires. All questionnaires were checked for completeness and then entered into SPSS for analysis. The prevalence is high,as there were 2647 cases of pneumonia in 2017 compared to 1938 cases in 2016. Results:Basedon the study findings, the high prevalence of childhood pneumonia in Makambako town council is caused by low knowledge and poor practices of mothers concerning childhood pneumonia,as 70.8% of mothers do not know what pneumonia isabout,72.6%of mothersdo not know health risk factors associated with childhood pneumonia, and77.3% do not know how pneumonia is transmitted. Some mothers performcultural and traditional beliefs, while others perform self-medication and take a child to the hospital when the conditions worsen. Most do not know if proper nutrition and immunization, as signified by 99% and 81%, respectively, are the most effective ways to protecta child against pneumonia beliefs, while others perform self-medication and take a child to the hospital when the conditions worsen. Most do not know if proper nutrition and immunization, as signified by 99% and 81%, respectively, are the most effective ways to protecta child against pneumonia Conclusion and recommendations:The study concludes that mothers' knowledge and practices associated with improper nutrition and immunization contribute much to children's pneumonia. Therefore, the study suggests proper nutrition and immunization education should be done appropriately to protect children frompneumonia


Subject(s)
Pneumonia , Awareness , Bacteria , Prevalence , Knowledge , Infections
14.
Revue Congolaise des Sciences et Technologies ; 3(2): 231-240, 2024. figures, tables
Article in English | AIM | ID: biblio-1580431

ABSTRACT

Pneumonia is one of the leading causes of death in children under five and, a major cause of infant mortality in all regions of the world, most deaths occur in sub-Saharan Africa and South Asia. The main agent with the highest prevalence in severe pneumonia is, as the name suggests the bacterium Streptococcus pneumoniae. The general objective of this study is to evaluate the antibacterial activity of the decoction of the leaves of Mitragyna stipulosa on the bacterium S. pneumoniae by the antibiogram test, to determine the minimum inhibitory concentration and, to compare the antibacterial effect of the decoction compared to infusion and maceration, as well as the reference antibiotic used. This work is part of the promotion and enhancement of the African pharmacopoeia in general and the Congolese pharmacopoeia in particular, to overcome a proven and significant public health problem.


La pneumonie est l'une des principales causes de décès chez les enfants de moins de cinq ans et une cause majeure de mortalité infantile dans toutes les régions du monde, la plupart des décès survenant en Afrique subsaharienne et en Asie du Sud. L'agent principal ayant la prévalence la plus élevée dans les pneumonies graves est, comme son nom l'indique, la bactérie Streptococcus pneumoniae. L'objectif général de cette étude est d'évaluer l'activité antibactérienne de la décoction des feuilles de Mitragyna stipulosa sur la bactérie S.pneumoniae par le test de l'antibiogramme, de déterminer la concentration minimale inhibitrice et de comparer l'effet antibactérien de la décoction par rapport à l'infusion et à la macération, ainsi qu'à l'antibiotique de référence utilisé. Ce travail s'inscrit dans le cadre de la promotion et de la valorisation de la pharmacopée africaine en général et de la pharmacopée congolaise en particulier, pour venir à bout d'un problème de santé publique avéré et important.


Subject(s)
Streptococcus pneumoniae , Microbial Sensitivity Tests , Infant Mortality , Public Health , Prevalence , Cause of Death , Anti-Bacterial Agents , Pneumonia
15.
Article in Spanish | LILACS, CUMED | ID: biblio-1569794

ABSTRACT

Introducción: La predicción del desenlace de los pacientes tratados con ventilación invasiva por insuficiencia respiratoria aguda es todo un reto. Objetivo: Analizar los parámetros de monitorización ventilatoria asociados a la mortalidad en pacientes con neumonía adquirida en la comunidad grave. Métodos: Se realizó un estudio de casos y controles en pacientes con neumonía adquirida en la comunidad grave, tratados con ventilación invasiva. Los casos fueron los pacientes fallecidos. Las variables cuantitativas se resumieron con la mediana y el rango intercuartil en la comparación entre casos y controles, se empleó la prueba de U de Mann - Whitney. Se computó la presencia de riesgo de mortalidad y su significación estadística mediante el análisis de los odds ratio (OR), sus intervalos de confianza y la prueba ji al cuadrado de Mantel y Haenszel con nivel de significación ɑ = 0,05. Resultados: Los pacientes con las siguientes variables: presión pico ≥ 32 cmH2O (OR = 9,27), presión meseta ≥ 24 cmH2O (OR = 24,10), presión media ≥ 19 cmH2O (OR = 10,21), presión de conducción ≥ 19 cmH2O (OR = 10,98), compliance estática < 20 ml/cmH2O (OR = 5,90) y compliance dinámica < 15 ml/cmH2O (OR = 14,20), tuvieron más probabilidad de fallecer. Conclusiones: Los parámetros de la presión pico, la presión meseta, la presión media, la presión de conducción, la compliance estática y la compliance dinámica están asociados a la mortalidad en pacientes con neumonía adquirida en la comunidad grave.


Introduction: Predicting the outcome in patients treated with invasive ventilation for acute respiratory failure is fully challenging. Objective: To analyze ventilatory monitoring parameters associated with mortality in patients with severe community-acquired pneumonia. Methods: A case-control study was carried out in severely-ill patients with community-acquired pneumonia and treated with invasive ventilation. The cases were the deceased patients. The quantitative variables were summarized using the median and the interquartile range, while the Mann-Whitney U test was used in the comparison between cases and controls. The presence of mortality risk and its statistical significance were computed by odds ratio (OR) analysis, their confidence intervals, as well as the Mantel and Haenszel chi-squared test, with significance level ɑ = 0.05. Results: The patients more likely to die were those with peak pressure ≥ 32 cmH2O (OR = 9.27), plateau pressure ≥ 24 cmH2O (OR = 24.10), mean pressure ≥ 19 cmH2O (OR = 10.21), driving pressure ≥ 19 cmH2O (OR = 10.98), static compliance < 20 ml/cmH2O (OR = 5.90) and dynamic compliance < 15 ml/cmH2O (OR = 14.20). Conclusions: The variables peak pressure, plateau pressure, mean pressure, driving pressure, static compliance and dynamic compliance were concluded to be associated with mortality in patients with severe community-acquired pneumonia.


Subject(s)
Humans , Respiration, Artificial/adverse effects , Pneumonia/mortality , Case-Control Studies , Statistics, Nonparametric
16.
Rev. inf. cient ; 103: 4609, 2024. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1584029

ABSTRACT

Introducción: La neumonía adquirida en la comunidad es considerada un problema de salud prioritario a nivel internacional. Objetivo: Caracterizar a los pacientes con diagnóstico de neumonía grave adquirida en la comunidad atendidos en la UCI y UCIE del Hospital General Docente Orlando Pantoja Tamayo, Granma, Cuba, según aspectos clínicos y epidemiológicos. Método: Se realizó un estudio observacional, descriptivo y transversal en 107 pacientes con neumonía grave adquirida en la comunidad, entre enero 2021 a diciembre de 2023. Se aplicaron las medidas resúmenes correspondientes para cada tipo de variable clínica y epidemiológica, en la comparación entre las variables según sexo se utilizó la prueba de Jicuadrado de homogeneidad y la prueba U de Mann-Whitney según correspondiera. En la exploración de asociación entre variables se empleó la prueba de Jicuadrado de independencia. Para cada prueba estadística se aplicó un nivel de confianza α=0,05. Resultados: La sepsis estuvo presente en el 47,2 por ciento de los pacientes y la mortalidad alcanzó al 43,0 por ciento de la muestra estudiada. La mediana para la edad fue de 65,0 años (RIC=23,0). Se encontró asociación estadística significativa entre las variables: disfunción múltiple de órganos, sepsis, drogas vasoactivas-inotrópicas positivas, infiltrado multilobar, llene capilar lento y gradiente térmico con el estado al egreso. Conclusiones: La neumonía grave adquirida en la comunidad se presenta a una edad avanzada, con presencia de sepsis y alta tasa de mortalidad; además, la disfunción múltiple de órganos, la sepsis, las drogas vasoactivas-inotrópicas positivas, el infiltrado multilobar, el llene capilar lento y el gradiente térmico están asociados a la mortalidad (AU)


Introduction: Community-acquired pneumonia is considered a priority health problem internationally. Objective: to characterize patients diagnosed with severe community-acquired pneumonia treated in the ICU and UCIE of the Hospital General Docente Orlando Pantoja Tamayo, Granma, Cuba, according to clinical and epidemiological aspects. Method: An observational, descriptive and cross-sectional study was carried out on 107 patients with severe community-acquired pneumonia, between January 2021 and December 2023. The corresponding summary measures were applied for each type of clinical and epidemiological variable, in the comparison between the variables according to sex, the Chi-square test for homogeneity and the Mann-Whitney U test were used as appropriate. The Chi-square test of independence was used to explore the association between variables. For each statistical test, a confidence level α=0.05 was applied. Results: Sepsis was present in 47.2 percent of patients and mortality reached 43.0 percent of the studied sample. The median for age was 65.0 years (IQR=23.0). A significant statistical association was found between the variables: multiple organ dysfunction, sepsis, positive vasoactive-inotropic drugs, multilobar infiltrate, slow capillary refill and thermal gradient with the status at discharge. Conclusions: Severe community-acquired pneumonia occurs at an advanced age, with the presence of sepsis and a high mortality rate; Furthermore, multiple organ dysfunction, sepsis, positive vasoactive-inotropic drugs, multilobar infiltrate, slow capillary refill, and thermal gradient are associated with mortality.


Introdução: A pneumonia adquirida na comunidade é considerada um problema de saúde prioritário internacionalmente. Objetivo: Caracterizar os pacientes com diagnóstico de pneumonia comunitária grave atendidos na UTI e UCIE do Hospital General Docente Orlando Pantoja Tamayo, Granma, Cuba, segundo aspectos clínicos e epidemiológicos. Método: Estudo observacional, descritivo e transversal, realizado em 107 pacientes com pneumonia grave adquirida na comunidade, entre janeiro de 2021 e dezembro de 2023. Foram aplicadas as medidas resumo correspondentes para cada tipo de variável clínica e epidemiológica, na comparação entre as variáveis segundo sexo, foram utilizados o teste Qui-quadrado para homogeneidade e o teste U de Mann-Whitney, conforme apropriado. O teste Qui-quadrado de independência foi utilizado para explorar a associação entre as variáveis. Para cada teste estatístico foi aplicado um nível de confiança α=0,05. Resultados: A sepse esteve presente em 47,2 porcento dos pacientes e a mortalidade atingiu 43,0porcento da amostra estudada. A mediana para idade foi de 65,0 anos (IIQ=23,0). Foi encontrada associação estatística significativa entre as variáveis: disfunção de múltiplos órgãos, sepse, drogas vasoativas-inotrópicas positivas, infiltrado multilobar, enchimento capilar lento e gradiente térmico com o estado na alta. Conclusões: A pneumonia grave adquirida na comunidade ocorre em idade avançada, com presença de sepse e alta mortalidade; Além disso, disfunção de múltiplos órgãos, sepse, drogas inotrópicas vasoativas positivas, infiltrado multilobar, enchimento capilar lento e gradiente térmico estão associados à mortalidade (AU)


Subject(s)
Humans , Pneumonia/diagnosis , Pneumonia/epidemiology , Pneumonia/mortality , Respiratory Insufficiency/complications , Intensive Care Units
17.
Article in Portuguese | LILACS | ID: biblio-1553494

ABSTRACT

Objetivo: Avaliar a atuação da fisioterapia respiratória no tratamento da pneumonia em crianças. Métodos: Trata-se de uma revisão sistemática baseada no método Preferred Reporting Items for Sistematic Reviews and Meta-Análises (PRISMA). Neste estudo foram incluídos artigos originais relacionados com objetivo que aplicaram a fisioterapia respiratória no tratamento de crianças com pneumonia, escritos na língua portuguesa e inglesa, publicados no site da Biblioteca Virtual em Saúde (BVS), nas bases de dados Literatura Latino-Americana e do caribe em ciências da saúde (LILACS), Scientific-Electronic-Library-Online (SciELO), no Physioterapia Evidence Database (PEDro) e PubMed, utilizando os descritores (pneumonia, respiratory physiotherapy, chest therapy, pediatric e child*). Resultados: Inicialmente foram identificados 273 artigos publicados e, de acordo com os critérios de inclusão, exclusão e elegibilidade, ao final cinco foram selecionados para análise qualitativa. Dos artigos selecionados para o estudo, três mostraram que fisioterapia respiratória proporcionou melhorias significativas entre os pacientes de grupo de controle e intervenção, usando técnicas e equipamentos que auxiliavam na desobstrução das vias aéreas e diminuição das internações decorrentes da pneumonia. Contudo, não houve estudos que qualificassem as intervenções fisioterapêuticas como principal recurso para o tratamento dessa doença. Conclusão: Dessa forma, conclui-se que a utilização da fisioterapia respiratória pode ser um adjuvante importante para a melhora dos quadros e funções respiratórias de crianças com pneumonia.


Objective: To evaluate the performance of respiratory physical therapy in the treatment of pneumonia in children. Methods: This is a systematic review was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method. This study included original articles related to the objective that applied respiratory physiotherapy in the treatment of children with pneumonia, written in Portuguese and English, published on the Virtual Health Library (VHL) site, in the Latin American and Caribbean Health Sciences Literature (LILACS), Scientific-Electronic-Library-Online (SciELO), Physiotherapy Evidence Database (PEDro) and PubMed databases, using the descriptors (pneumonia, respiratory physiotherapy, chest therapy, pediatric and child*). Results: Initially 273 published articles were identified and according to the inclusion, exclusion and eligibility criteria, at the end five were selected for qualitative analysis. Of the articles selected for the study, three showed that respiratory physiotherapy provided significant improvements among control and intervention group patients using techniques and equipment that aided in airway clearance and decreased hospitalizations due to pneumonia. However, there were no studies qualifying physical therapy interventions as the main resource for the treatment of this disease. Conclusion: Therefore, we concluded that chest physiotherapy can be an important adjuvant for the improvement of respiratory function in children with pneumonia.


Objetivo: Evaluar el papel de la fisioterapia respiratoria en el tratamiento de la neumonía en niños. Métodos: Esta es una revisión sistemática basada en el método Preferred Reporting Items for Sistematic Reviews and Meta-Análises (PRISMA). Este estudio incluyó artículos originales relacionados con el objetivo de aplicar la fisioterapia respiratoria en el tratamiento de niños con neumonía, escritos en portugués e inglés, publicados en el sitio web de la Biblioteca Virtual en Salud (BVS), en las bases de datos de Literatura Latinoamericana y del Caribe en ciencias de la salud. (LILACS), Scientific-Electronic-Library-Online (SciELO), no Physioterapia Evidence Database (PEDro) e PubMed, utilizando los descriptores (pneumonia, respiratory physiotherapy, chest therapy, pediatric e child*). Resultados: Inicialmente se identificaron 273 artículos publicados y, según los criterios de inclusión, exclusión y elegibilidad, finalmente se seleccionaron cinco para el análisis cualitativo. De los artículos seleccionados para el estudio, tres mostraron que la fisioterapia respiratoria proporcionó mejoras significativas entre los pacientes de los grupos de control e intervención, utilizando técnicas y equipos que ayudaron a despejar las vías respiratorias y reducir las hospitalizaciones por neumonía. Sin embargo, no hubo estudios que calificaran las intervenciones fisioterapéuticas como principal recurso para el tratamiento de esta enfermedad. Conclusíon: Por lo tanto, se concluye que el uso de fisioterapia respiratoria puede ser un coadyuvante importante para mejorar las condiciones y funciones respiratorias de los niños con neumonía.


Subject(s)
Pneumonia , Child , Pediatrics , Early Medical Intervention , Systematic Reviews as Topic , Hospitalization
18.
Medwave ; 23(11): e2719, 31-12-2023. ilus, tab
Article in English, Spanish | LILACS | ID: biblio-1524721

ABSTRACT

Este artículo de revisión narrativa tiene como objetivo explorar el conocimiento actual disponible basado en datos científicos respeto a la definición, la epidemiología, los criterios diagnósticos, la microbiología, el tratamiento y la prevención de la neumonía grave adquirida en la comunidad) en individuos adultos inmunocompetentes. En la actualidad, pese a los grandes avances científicos obtenidos en la evaluación diagnóstica, el manejo clínico, la terapia antimicrobiana y la prevención, la neumonía grave adquirida en la comunidad sigue siendo una causa importante de morbilidad y mortalidad, además de producir un gran impacto económico con la elevación de los costes sanitarios en todo el mundo. Esta patología es considerada una de las principales causas de sepsis/choque séptico, con una tasa de mortalidad global extremadamente elevada, lo que justifica todo el esfuerzo en el diagnóstico precoz, el manejo en un ambiente adecuado y el inicio temprano y apropiado de la terapia antimicrobiana. La inclusión de biomarcadores (aislados o en combinación) asociada a la aplicación de los criterios diagnósticos y escalas pronósticas de gravedad en la práctica clínica, sirven para identificar a los pacientes con neumonía adquirida en la comunidad grave, definir el ingreso inmediato en la unidad de cuidados intensivos y, de esta forma, minimizar los resultados negativos de esta grave patología.


his narrative review article explores the current scientific knowledge on the definition, epidemiology, diagnostic criteria, microbiology, treatment, and prevention of severe community-acquired pneumonia (SCAP) in immunocompetent adults. At present, despite major scientific advances in diagnostic evaluation, clinical management, antimicrobial therapy, and prevention, severe community-acquired pneumonia remains a major cause of morbidity and mortality, as well as having a major economic impact in terms of increased healthcare expenditure worldwide. This pathology is considered one of the leading causes of sepsis/septic shock, with an extremely high overall mortality rate, which justifies all the effort in early diagnosis, proper management, and prompt initiation of antimicrobial therapy. Including biomarkers (isolated or in combination) associated with applying diagnostic criteria and prognostic severity scales in clinical practice helps identify patients with severe community-acquired pneumonia, defines immediate admission to the intensive care unit, and, thus, minimizes the adverse outcomes of this serious pathology.


Subject(s)
Humans , Adult , Pneumonia/diagnosis , Pneumonia/therapy , Pneumonia/epidemiology , Community-Acquired Infections/diagnosis , Community-Acquired Infections/therapy , Community-Acquired Infections/epidemiology , Anti-Infective Agents/therapeutic use , Prognosis , Severity of Illness Index , Biomarkers , Intensive Care Units
19.
Article in Spanish | LILACS | ID: biblio-1535460

ABSTRACT

Introducción: El Íleo biliar (IB) es una obstrucción intestinal mecánica muy poco frecuente, del 1 al 4 % de todas las obstrucciones intestinales, y es más común en pacientes de edad avanzada. Se produce a través de una fístula bilioentérica en el intestino delgado, sobre todo en el íleon distal. Luego de tener un enfoque diagnóstico mediante imagenología, en su gran mayoría, se opta por el tratamiento quirúrgico para eliminar el o los cálculos impactados. El éxito de esta intervención depende en gran medida del tamaño del cálculo biliar, de la ubicación de la obstrucción intestinal y comorbilidades preexistentes. Caso clínico: Mujer de 78 años con cuadro clínico de obstrucción intestinal, emesis de contenido fecaloide y sintomática respiratoria; se evidenció una masa concéntrica a nivel de íleon distal y proceso neumónico concomitante por tomografía toracoabdominal. Se realizó laparotomía exploratoria con enterolitotomía, extracción de cálculo y anastomosis íleo-ileal y fue trasladada a la UCI en donde presentó falla ventilatoria y requerimiento de ventilación mecánica; se confirmó infección viral por SARS-CoV-2 mediante RT - PCR. Discusión: El IB es una obstrucción intestinal que ocurre con mayor frecuencia en pacientes de edad avanzada. Se habla de la fisiopatología y mecanismo de producción de la fístula entérica y se presentan opciones diagnósticas, terapéuticas y quirúrgicas para dirigir el manejo clínico más apropiado. Conclusión: El IB es difícil de diagnosticar. Debido a su baja incidencia, no existe un consenso que paute el manejo a seguir en los pacientes con diagnóstico de IB. Aunque el tratamiento estándar es la intervención quirúrgica, hay diversas opiniones en cuanto al tipo de cirugía a realizar.


Introduction: Biliary ileus (BI) is a very rare mechanical intestinal obstruction, responsible for 1-4% of all intestinal obstructions and more frequent in elderly patients. It occurs through a bilioenteric fistula in the small bowel, mainly in the distal ileum. After a diagnostic imaging approach, the vast majority opt for surgical treatment to remove the impacted stone or stones. The success of this intervention depends largely on the size of the stone, the location of the bowel obstruction and pre-existing comorbidities. Case report: 78-year-old woman with clinical symptoms of intestinal obstruction, fecaloid emesis, respiratory symptoms, concentric mass at the level of the distal ileum and concomitant pneumonic process in the thoraco-abdominal CT scan. Exploratory laparotomy was performed, with total lithotomy, extraction of the calculus and ileo-ileal anastomosis, and she was transferred to the ICU, where she presented ventilatory failure and required mechanical ventilation. SARS-CoV-2 infection was confirmed with RT-PCR. Discussion: IB is an intestinal obstruction that occurs more frequently in elderly patients. The pathophysiology and the mechanism of production of enteric fistula are discussed and diagnostic, therapeutic and surgical options are presented to guide the most appropriate clinical management. Conclusion: Enteric fistula is difficult to diagnose. Due to its low incidence, there is no consensus on the management of patients diagnosed with IB. Although the standard treatment is surgical intervention, there are divergent opinions as to the type of surgery to be performed.


Subject(s)
Humans , Female , Aged , Biliary Tract , Biliary Tract Diseases , Gallstones , SARS-CoV-2 , Ileum , Pneumonia , Biliary Fistula , Intestinal Obstruction , Laparotomy
20.
Actual. SIDA. infectol ; 31(113): 48-54, 20230000. tab
Article in Spanish | LILACS, BINACIS | ID: biblio-1527473

ABSTRACT

Está demostrado en diversos estudios que los avances en el diagnóstico microbiológico reducen el tiempo de entrega de resultados y poseen un impacto clínico eviden-te. Hoy en día, las técnicas basadas en amplificación de ácidos nucleicos nos permiten hacer diagnóstico direc-tamente de la muestra y sumar la posibilidad de detectar más de un agente. Esto impacta tanto en el control de la multiresistencia (MR) como en el inicio de una terapéuti-ca apropiada. La implementación de un sistema de PCR múltiple rápido para neumonía puede ser útil en áreas crí-ticas, donde son frecuentes las infecciones respiratorias agudas (IRA) y el tiempo es un condicionante del éxito terapéutico. El objetivo de nuestro proyecto fue evaluar la implementación del diagnóstico sindrómico rápido por PCR múltiple para neumonía en el manejo del tratamiento de IRA en una unidad de cuidados intensivos. La con-ducta terapéutica fue la variable relevante. Este nuevo diagnóstico nos proporcionó una herramienta ágil, con un tiempo de respuesta de tres a cuatro horas. La ausencia o presencia de genes de resistencia y el microorganismo identificado fueron lo que condujo a la conducta terapéuti-ca acertada en el 75% de los casos. Constituyó una herra-mienta importante para el control de la multirresistencia bacteriana y aumentó la oportunidad de éxito terapéutico


It has been shown in various studies that advances in microbiological diagnosis reduce the delivery time of results and have an evident clinical impact. Today, techniques based on nucleic acid amplification allow us to diagnose directly from the sample and add the possibility of detecting more than one agent. This impacts both the control of MR and the initiation of appropriate therapy. The implementation of a rapid multiplex PCR system for pneumonia can be useful in critical areas where acute respiratory infections (ARI) are frequent and time is a determining factor for therapeutic success. The objective of our project was to evaluate the implementation of rapid syndromic diagnosis by multiple PCR for pneumonia in the management of ARI treatment in an Intensive Care Unit. The therapeutic behavior was the relevant variable. This new diagnosis provided us with an agile tool, with a response time of 3 to 4 hours. The absence or presence of resistance genes and the identified microorganism was what led to the correct therapeutic approach in 75% of the cases. It constituted an important tool for the control of bacterial multiresistance and increased the opportunity for therapeutic success.


Subject(s)
Male , Female , Pneumonia/diagnosis , Homeopathic Therapeutic Approaches , Early Diagnosis , Multiplex Polymerase Chain Reaction
SELECTION OF CITATIONS
SEARCH DETAIL