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1.
Arch. argent. pediatr ; 119(4): S171-S197, agosto 2021. tab, ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1281039

ABSTRACT

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.


Subject(s)
Humans , Infant, Newborn , Infant , Respiratory Tract Infections/diagnosis , Respiratory Tract Infections/therapy , Pneumonia/diagnosis , Pneumonia/therapy , Pneumonia/epidemiology , Respiratory Tract Infections/epidemiology , Bronchiolitis/diagnosis , Bronchiolitis/therapy , Bronchiolitis/epidemiology , Acute Disease , Risk Factors
2.
Int. j. med. surg. sci. (Print) ; 8(2): 1-15, jun. 2021. tab, graf
Article in Spanish | LILACS | ID: biblio-1284390

ABSTRACT

La importancia de la evaluación inicial de la gravedad del paciente con neumonía es una acción diagnóstica de importancia bien establecida. El objetivo del trabajo fue evaluar la relación entre la frecuencia y calidad del proceso de estratificación de pacientes con neumonía, y el cumplimiento de las sugerencias de ubicación intrahospitalaria y de tratamiento antimicrobiano inicial de un instrumento de estratificación. Se realizó un estudio descriptivo sobre una población de 1,809 pacientes hospitalizados durante 10 años. Se analizó el comportamiento de los índices de ubicación intrahospitalaria y tratamiento antimicrobiano inicial acorde a la sugerencia de un instrumento de estratificación utilizado; en el análisis estadístico se utilizó el Odds ratio y el estadígrafo X2, con un nivel de significación de 95%. En los resultados se destacan que la ubicación intrahospitalaria estuvo acorde a la sugerencia del instrumento en el 96%, con el valor más bajo en los pacientes con neumonía grave y altas probabilidades de recuperación (82%, p<,05). Se constató mayor frecuencia de ubicación intrahospitalaria acorde a la sugerencia del instrumento en los pacientes bien estratificados (p<,05), fundamentalmente en los pacientes con neumonía grave y altas probabilidades de recuperación. La correspondencia del tratamiento antimicrobiano inicial con la propuesta del instrumento fue del 61%; el estrato IIIA mostró el valor más elevado (80%, p<,05). Como conclusiones del estudio se constató un elevado desempeño en el cumplimiento de la sugerencia de ubicación intrahospitalaria del instrumento de estratificación, no así en el cumplimiento de la sugerencia de tratamiento antimicrobiano inicial. Se demostró la existencia de una relación entre el proceso de estratificación y el cumplimiento de la ubicación intrahospitalaria sugerida por el instrumento empleado.


The initial evaluation of the patient's condition with pneumonia is a very important assistance action. The objective was evaluate the relationship between the frequency and quality of the stratification process of the patient with pneumonia, and the execution of suggestions of intrahospitalary location and the initial antimicrobial treatment of stratification instrument. A descriptive study was done on a population of 1,809 patients hospitalized during 10 years. The indexes of intrahospitalary location and of antimicrobian initial treatment were analized according to the suggestions of the instrument; in the statistical analysis it was used the odds ratio and the statistician X2, with a significant level of 95%. The intrahospitalary location was in agreement with the suggestion of the instrument in 96% of the cases, with the lowest value in patients with serious pneumonia and high recovery probabilities (82%, p <,05). The frequency of intrahospitalary location was bigger and veryfied with the suggestion of the instrument in the termed well stratified patients (p <,05), fundamentally in the patients with serious pneumonia and high recovery probabilities. The correspondence of the initial antimicrobial treatment with the proposal of the instrument was of 61%; the stratum IIIA showed the highest value (80%, p <,05). As conclusions, a high performance in the execution of the suggestion of the intrahospitalary location has been one of the characteristics of the process, although as a negative element it stands out the frequent non-fulfillment of the suggestion of the initial antimicrobial treatment. There was a relationship between the stratification process and the execution of the suggestion of the intrahospitalary location.


Subject(s)
Humans , Patient Admission/statistics & numerical data , Pneumonia/diagnosis , Pneumonia/drug therapy , Community-Acquired Infections/diagnosis , Community-Acquired Infections/drug therapy , Anti-Infective Agents/therapeutic use , Severity of Illness Index , Quality Management , Cuba , Patient Acuity , Hospitalization/statistics & numerical data
3.
Säo Paulo med. j ; 139(2): 170-177, Mar.-Apr. 2021. tab, graf
Article in English | LILACS | ID: biblio-1181006

ABSTRACT

ABSTRACT BACKGROUND: Healthcare institutions are confronted with large numbers of patient admissions during large-scale or long-term public health emergencies like pandemics. Appropriate and effective triage is needed for effective resource use. OBJECTIVES: To evaluate the effectiveness of the Pandemic Medical Early Warning Score (PMEWS), Simple Triage Scoring System (STSS) and Confusion, Uremia, Respiratory rate, Blood pressure and age ≥ 65 years (CURB-65) score in an emergency department (ED) triage setting. DESIGN AND SETTING: Retrospective study in the ED of a tertiary-care university hospital in Düzce, Turkey. METHODS: PMEWS, STSS and CURB-65 scores of patients diagnosed with COVID-19 pneumonia were calculated. Thirty-day mortality, intensive care unit (ICU) admission, mechanical ventilation (MV) need and outcomes were recorded. The predictive accuracy of the scores was assessed using receiver operating characteristic curve analysis. RESULTS: One hundred patients with COVID-19 pneumonia were included. The 30-day mortality was 6%. PMEWS, STSS and CURB-65 showed high performance for predicting 30-day mortality (area under the curve: 0.968, 0.962 and 0.942, respectively). Age > 65 years, respiratory rate > 20/minute, oxygen saturation (SpO2) < 90% and ED length of stay > 4 hours showed associations with 30-day mortality (P < 0.05). CONCLUSIONS: CURB-65, STSS and PMEWS scores are useful for predicting mortality, ICU admission and MV need among patients diagnosed with COVID-19 pneumonia. Advanced age, increased respiratory rate, low SpO2 and prolonged ED length of stay may increase mortality. Further studies are needed for developing the triage scoring systems, to ensure effective long-term use of healthcare service capacity during pandemics.


Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Pneumonia/diagnosis , Pneumonia/epidemiology , Triage/methods , Risk Assessment/methods , Emergency Service, Hospital/statistics & numerical data , Early Warning Score , COVID-19/therapy , Turkey , Uremia/etiology , Uremia/epidemiology , Blood Pressure , Retrospective Studies , Respiratory Rate/physiology , Pandemics , SARS-CoV-2 , COVID-19/diagnosis , COVID-19/epidemiology
4.
Rev. inf. cient ; 100(1): 1-11, ene.-feb. 2021. tab
Article in Spanish | LILACS | ID: biblio-1156706

ABSTRACT

RESUMEN Introducción: En el Hospital Pediátrico Docente "Pedro Agustín Pérez" de Guantánamo no se ha caracterizado la neumonía grave adquirida en la comunidad. Objetivo: Identificar el perfil de esta enfermedad en la Unidad de Cuidados Intensivos del citado hospital en el periodo 2016-2019. Método: Se realizó un estudio descriptivo, longitudinal y retrospectivo. El universo estuvo constituido por todos los ingresados en este periodo (N=153). Se estudió el sexo, edad, diagnóstico microbiológico, terapéutica antimicrobiana, aplicación de ventilación mecánica, procederes realizados, complicaciones, estadía, estado al egreso y causa directa de muerte. Los resultados se presentaron en tablas y se resumieron mediante frecuencias absolutas y acumuladas. Resultados: La mayor proporción de los pacientes fueron varones con edad entre 1 y 4 años de edad (30,7 %). El Streptococcus pneumoniae fue el más común (38,5 %). Las cefalosporinas fueron los fármacos más prescritos (36,0 %). El 16,3 % requirió ventilación mecánica y el 22,9 % presentó alguna complicación, la más común fue el derrame pleural paraneumónico (21,5 %). El 96,4 % egresó vivo y la principal causa de muerte fue el choque séptico (57,2 %). Conclusiones: La neumonía continúa siendo una patología frecuente en la edad pediátrica al igual que el predominio del sexo masculino. Después de la introducción de la vacunación, el Streptococcus pneumoniae ha emergido como el principal patógeno bacteriano a cualquier edad, con un predominio importante en los menores de 5 años.


ABSTRACT Introduction: Severe community-acquired pneumonia has not been characterized at the Pediatric Teaching Hospital ¨Pedro Agustín Pérez¨ in Guantanamo. Objective: To profile this affection at the Intensive Care Unit of the already cited institution in the period 2016-2019. Method: A descriptive, longitudinal and retrospective study was carried out. The study population was made out of all the patients in the intensive care unit in that period of time (N=153). The variables analyzed were: gender, age, microbiological diagnosis, antimicrobial therapy, mechanical ventilation application, medical procedures applied, complications, in-hospital stay, state at the time of discharge and cause of death. Results were presented in tables and were summed up in absolute and cumulative frequencies. Results: Most patients were male, ranging from 1 to 4 years of age (30.7%). Streptococcus pneumoniae was the most common infection (36.0%). 16.3% if the cases required mechanical ventilation and the 22.9% presented some complication, the most common being the parapneumonic pleural effusion (22.5%). 96.4% of the patients were discharged alive, and the main cause of death was septic shock (57.2%). Conclusions: Pneumonia remains a frequent pathology in patients in pediatric age; and prevails in male patients as well. After vaccination campaigns started, the Streptococcus pneumoniae emerged as the main bacterial pathogen to cause infections at any age, especially in patients below the 5 years of age.


RESUMO Introdução: No Hospital Pediátrico Docente "Pedro Agustín Pérez" de Guantánamo, pneumonia grave adquirida na comunidade não foi caracterizada. Objetivo: Identificar o perfil desta doença na Unidade de Terapia Intensiva do referido hospital no período 2016-2019. Método: Foi realizado um estudo descritivo, longitudinal e retrospectivo. O universo era composto por todos os admitidos neste período (N=153). Foram estudadas sexo, idade, diagnóstico microbiológico, terapia antimicrobiana, aplicação de ventilação mecânica, procedimentos realizados, complicações, permanência, estado na alta e causa direta do óbito. Os resultados foram apresentados em tabelas e resumidos por meio de frequências absolutas e cumulativas. Resultados: A maior proporção de pacientes eram homens entre 1 e 4 anos (30,7%). Streptococcus pneumoniae foi o mais comum (38,5%). As cefalosporinas foram os medicamentos mais prescritos (36,0%). 16,3% necessitaram de ventilação mecânica e 22,9% apresentaram alguma complicação, sendo a mais comum o derrame pleural parapneumônico (21,5%). 96,4% tiveram alta com vida e a principal causa de morte foi choque séptico (57,2%). Conclusões: A pneumonia continua sendo uma patologia frequente na idade pediátrica, assim como a predominância do sexo masculino. Após a introdução da vacinação, Streptococcus pneumoniae surgiu como o principal patógeno bacteriano em qualquer idade, com predomínio significativo em crianças menores de 5 anos.


Subject(s)
Male , Female , Infant , Child, Preschool , Pneumonia/complications , Pneumonia/diagnosis , Pneumonia/etiology , Pneumonia/microbiology , Intensive Care Units, Pediatric , Epidemiology, Descriptive , Retrospective Studies , Longitudinal Studies
5.
Medicina (B.Aires) ; 80(supl.6): 44-47, dic. 2020. graf
Article in English | LILACS | ID: biblio-1250318

ABSTRACT

Abstract The Coronavirus Disease 2019 (COVID-19) pandemic has strained the world's health systems, highlighting the need to optimize its clinical management and treatment. The usefulness of blood cultures in patients with COVID-19 pneumonia has not been proved. We aim to describe the diagnostic yield of early blood cultures in patients with COVID-19 pneumonia in a public hospital in Buenos Aires City. This descriptive observational study included all adult patients with COVID-19 pneumonia admitted to the Internal Medicine ward of Hospital Durand between April 1, 2020 and July 30, 2020, who had blood cultures drawn within 5 days from hospital admission. Among 267 patients hospitalized with COVID-19 pneumonia, 38 had early blood cultures drawn. No clinically relevant microorganism was isolated from blood and contaminant microorganisms were recovered in 7 (18.4%) patients. This study found no evidence of bacteremia in patients with COVID-19 pneumonia. Furthermore, the rate of contaminated blood cultures nearly doubles the reported in patients with community acquired pneumonia (10%), which may be explained by unfamiliarity of additional personal protective equipment worn by healthcare workers. Our results advocate against the routine indication of blood cultures upon admission to the Internal Medicine Ward of patients with COVID-19 pneumonia. We suggest that blood cultures could only be useful in case of clinical deterioration or suspected hospital-acquired infection.


Resumen La pandemia por COVID-19 ha puesto en jaque a los sistemas de salud del mundo, priorizando la necesidad de optimizar su manejo clínico. Aunque los protocolos de varios hospitales de nuestro país para COVID-19 incluyen hemocultivo al ingreso, no se ha demostrado su utilidad en pacientes con neumonía por COVID-19. Nuestro objetivo fue describir el rédito diagnóstico de los hemocultivos tempranos en pacientes con neumonía por COVID-19 en un hospital público de la Ciudad de Buenos Aires. Este estudio observacional descriptivo incluyó todos los pacientes adultos ingresados en la sala de Clínica Médica del Hospital Durand entre el 1 de abril y el 30 de julio de 2020, con neumonía por COVID-19 y hemocultivos realizados dentro de los 5 días del ingreso. De los 267 pacientes con neumonía por COVID-19, a 38 se les realizó hemocultivos tempranos. No se aisló ningún microorganismo clínicamente relevante en ninguno de ellos y se recuperaron microorganismos contaminantes en 7 (18.4%). Este estudio no encontró evidencia de bacteriemia en pacientes con neumonía por COVID-19. Además, la tasa de hemocultivos contaminados casi duplicó la tasa en pacientes con neumonía adquirida en la comunidad, lo que probablemente se deba a la falta de familiaridad de equipos de protección personal adicional utilizado por el personal de salud. Nuestros resultados abogan en contra de la realización rutinaria de hemocultivos al ingreso de pacientes con neumonía por COVID-19. Sugerimos que los hemocultivos solo sean utilizados ante el deterioro clínico o la sospecha de infección intrahospitalaria.


Subject(s)
Humans , Adult , Pneumonia/diagnosis , COVID-19 , Pandemics , Blood Culture , SARS-CoV-2
6.
Rev. medica electron ; 42(6): 2530-2539, nov.-dic. 2020. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1150035

ABSTRACT

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


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


Subject(s)
Humans , Male , Female , Aged , Frail Elderly , Depression/diagnosis , Pneumonia/diagnosis , Pneumonia/mortality , Pneumonia/psychology , Critical Care/methods , Health Services for the Aged/trends , Immunity/physiology
7.
Rev. medica electron ; 42(6): 2560-2574, nov.-dic. 2020. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1150037

ABSTRACT

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


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


Subject(s)
Humans , Male , Female , Aged , Pneumonia/mortality , Aged/physiology , Pneumonia/complications , Pneumonia/diagnosis , Critical Care/methods , Forecasting/methods , Patient Care/methods
8.
Rev. méd. Urug ; 36(2): 121-129, 2020. tab, graf
Article in Spanish | LILACS, BNUY | ID: biblio-1115814

ABSTRACT

Resumen: Introducción: el cumplimiento de las guías de práctica clínica en el manejo de la neumonía aguda comunitaria se desconoce en Uruguay. Objetivo: evaluar el cumplimiento de las guías de práctica clínica en pacientes inmunocompetentes hospitalizados con diagnóstico de neumonía aguda comunitaria en una Clínica Médica del Hospital de Clínicas. Metodología: estudio observacional retrospectivo. Se estudiaron variables patronímicas, clínicas e indicadores de calidad asistencial de acuerdo con estándares internacionales. El nivel de cumplimiento de los indicadores se clasificó como óptimo cuando el cumplimiento fue > 90%, intermedio entre 60% y 90% y bajo cuando fue < 60%. Se utilizaron como guías de referencia ConsenSur II e IDSA. Resultados: se incluyeron 143 pacientes, 62,9% de sexo femenino (88/140), con una mediana de edad de 57 (38-73) años. La población estudiada se caracterizó por una mediana de Charlson de 1 (0-3), mediana de internación de 10 (7-14) días y 26,6% (38/143) de pacientes con criterios de neumonía severa. En cuanto al cumplimento de indicadores de calidad: ninguno se cumple en nivel óptimo, tres en nivel intermedio (hemocultivos en pacientes con neumonía severa, hemocultivos previo a antibióticos y administración de antibióticos dentro de las primeras 8 horas), mientras que cuatro variables que evalúan el uso de antibiótico apropiado, según las guías y la prevención de la neumonía, tienen un cumplimiento en nivel bajo. Conclusiones: ninguno de los indicadores evaluados alcanzó un nivel óptimo. Se deben realizar intervenciones para mejorar la calidad en asistencia en la neumonía.


Summary: Introduction: the extent to which clinical practice guidelines in the handling of community acquired acute pneumonia are observed is not known in Uruguay. Objective: to assess the degree of compliance with the clinical guidelines in immunocompetent patients hospitalized with a diagnosis of community-acquired pneumonia in a medical clinic of the University Hospital. Method: observational, retrospective study. Patronymic and clinical variables, and quality of health care indicators were analysed as per international standards. The degree of compliance with indicators was classified as ideal when compliance was > 90%, intermediate when it was between 60% and 90% and low when it was < 60%. ConsenSur II and IDSA were the reference guidelines used. Results: 143 patients were included in the study, 6.9 % were female (88/140), with a median age of 57 years old (38-73). The population studied was characterized by Charlson median of 1 (0-3), hospitalization median of 10 (7-14) days and 26.6% (38/143) of patients with acute pneumonia criteria. As to compliance with quality of health care indicators: none of them is ideal, 3 in intermediate level (hemoculture in patients with acute pneumonia, hemoculture prior to antibiotic therapy and administration of antibiotics within the first 8 hours), while 4 variables that assess the use of the appropriate antibiotic according to the guidelines and the prevention of pneumonia evidence a low level of compliance. Conclusions: none of the assessed indicators evidenced an ideal level of compliance. Interventions are required to improve quality in health care for patients with pneumonia.


Resumo: Introdução: o cumprimento das guias de prática clínica no manejo da pneumonia aguda comunitária não é conhecido no Uruguai. Objetivo: avaliar o cumprimento das guias de prática clínica em pacientes imunocompetentes hospitalizados com diagnóstico de pneumonia aguda comunitária em uma Clínica Médica do Hospital de Clínicas. Metodologia: estudo observacional retrospectivo. Foram estudadas variáveis patronímicas e clínicas, e indicadores de qualidade assistencial de acordo com padrões internacionais. O nível de cumprimento dos indicadores foi classificado como ótimo quando o cumprimento foi > 90%, intermédio entre 60 e 90% e baixo quando foi < 60%. As guias ConsenSur II e IDSA foram utilizadas como guias de referência. Resultados: foram incluídos 143 pacientes, sendo 62,9 % de sexo feminino (88/140), com una mediana de idade de 57 (38-73) anos. A população estudada caracterizou-se por uma mediana de Charlson de 1 (0-3), mediana de internação de 10 (7-14) dias e 26,6% (38/143) dos pacientes com critérios de pneumonia severa. Com relação ao cumprimento de indicadores de qualidade: nenhum em nível óptimo, 3 em nível intermédio (hemoculturas em pacientes com pneumonia severa, hemoculturas prévia a antibióticos e administração de antibióticos nas primeiras 8 horas), enquanto 4 variáveis que avaliam o uso de antibiótico apropriado segundo as guias e a prevenção da pneumonia tem um cumprimento em nível baixo. Conclusões: nenhum dos indicadores avaliados alcançou um nível ótimo. É necessário realizar intervenções para melhorar a qualidade da assistência na pneumonia.


Subject(s)
Pneumonia/diagnosis , Quality of Health Care , Community-Acquired Infections , Practice Guidelines as Topic
9.
Article in English | LILACS | ID: biblio-1057212

ABSTRACT

ABSTRACT Objective: To report a case of a child with primary immunodeficiency who at eight years developed digestive symptoms, culminating with the diagnosis of a neuroendocrine tumor at ten years of age. Case description: One-year-old boy began to present recurrent pneumonias in different pulmonary lobes. At four years of age, an immunological investigation showed a decrease in IgG and IgA serum levels. After the exclusion of other causes of hypogammaglobinemia, he was diagnosed with a Common Variable Immunodeficiency and started to receive monthly replacement of human immunoglobulin. The patient evolved well, but at 8 years of age began with epigastrium pain and, at 10 years, chronic persistent diarrhea and weight loss. After investigation, a neuroendocrine tumor was diagnosed, which had a rapid progressive evolution to death. Comments: Medical literature has highlighted the presence of gastric tumors in adults with Common Variable Immunodeficiency, emphasizing the importance of early diagnosis and the investigation of digestive neoplasms. Up to now there is no description of neuroendocrine tumor in pediatric patients with Common Variable Immunodeficiency. We believe that the hypothesis of digestive neoplasm is important in children with Common Variable Immunodeficiency and with clinical manifestations similar to the case described here in the attempt to improve the prognosis for pediatric patients.


RESUMO Objetivo: Relatar um caso de criança portadora de imunodeficiência primária que, aos oito anos, desenvolveu sintomas digestivos, culminando com o diagnóstico de tumor neuroendócrino aos dez anos de idade. Descrição do caso: Menino, com um ano de idade, começou a apresentar pneumonias de repetição em diferentes lobos pulmonares. Aos quatro anos, a investigação imunológica mostrou diminuição dos níveis séricos de IgG e IgA. Após exclusão de outras causas de hipogamaglobulinemia, teve diagnóstico de imunodeficiência comum variável, passando a receber reposição mensal de imunoglobulina humana. Evoluiu bem, porém, aos oito anos, começou com epigastralgia e, aos dez anos, diarreia crônica persistente e perda de peso. O quadro culminou com o diagnóstico de tumor neuroendócrino intestinal, de rápida progressão, com óbito do paciente. Comentários: A literatura tem chamado a atenção para tumores gástricos em adultos com imunodeficiência comum variável, alertando para a importância do diagnóstico precoce e da pesquisa de neoplasias digestivas. Até o momento, não há descrição de tumor neuroendócrino em pacientes pediátricos portadores de imunodeficiência comum variável. Acredita-se ser importante a hipótese de neoplasia digestiva diante de crianças com imunodeficiência comum variável e com manifestações clínicas semelhantes ao caso descrito, na tentativa de melhorar o prognóstico para pacientes pediátricos.


Subject(s)
Humans , Male , Child , Pneumonia/diagnosis , Common Variable Immunodeficiency/complications , Neuroendocrine Tumors/diagnosis , Pneumonia/etiology , Recurrence , Weight Loss , Abdominal Pain/diagnosis , Abdominal Pain/etiology , Common Variable Immunodeficiency/immunology , Neuroendocrine Tumors/pathology , Neuroendocrine Tumors/therapy , Fatal Outcome , Diarrhea/diagnosis , Diarrhea/etiology , Intestinal Neoplasms/surgery , Intestinal Neoplasms/pathology , Intestinal Neoplasms/diagnostic imaging , Neoplasm Metastasis/pathology , Antineoplastic Agents/therapeutic use
10.
Article in English | AIM | ID: biblio-1270381

ABSTRACT

Background. Pneumonia remains the foremost cause of death in young children in sub-Saharan Africa. This phenomenon is largely driven by poor access to healthcare and delay in seeking medical care for childhood pneumonia. Objective. To assess the effectiveness of training caregivers to recognise the early clinical signs of pneumonia. Methods. The study involved a cohort of women presenting to the Child Welfare Clinic at the Komfo Anokye Teaching Hospital in Kumasi, Ghana, between 7 July and 8 September 2016. A total of 90 women with children younger than 10 weeks were recruited. Participants were trained on identifying early signs of pneumonia using low-cost equipment. Follow-up training and assessment sessions formed part of the programme.Results. At pre-training assessment, the majority of the participants (n=83/90; 92.2%) recognised lower chest indrawing as a sign of respiratory disease requiring immediate hospital intervention. Participants' performance in determining rhythms of 50 breaths per minute (bpm) and 60 bpm improved significantly across sessions (p=0.011 and p≤0.001, respectively). After training, 87 participants (96.7%) were able to determine rapid breathing accurately compared with 73 participants (81.1%) before training (p=0.001).Conclusion. The results suggest that caregivers can be effectively trained to identify clinical signs of pneumonia in young children, even in low-resource settings. A training initiative as described in this study could be an effective public health intervention to help address the burden of pneumonia in low-resource settings


Subject(s)
Caregivers , Infant , Pneumonia/diagnosis , Signs and Symptoms , South Africa
11.
Rev. medica electron ; 41(4): 889-898, jul.-ago. 2019. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1094096

ABSTRACT

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


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


Subject(s)
Humans , Pneumonia/diagnosis , Pneumonia/etiology , Pneumonia/mortality , Pneumonia/prevention & control , Prognosis , Mortality , Patient Acuity , Medical History Taking , Retrospective Studies , Longitudinal Studies , Pulmonary Disease, Chronic Obstructive/diagnosis , Emergency Medical Services , Analytical Epidemiology , Heart Failure/diagnosis , Inpatients , Intensive Care Units , Migraine Disorders/diagnosis
12.
Article in English | AIM | ID: biblio-1258812

ABSTRACT

Background:Vitamin D is partly responsible formaintainingcalcium and phosphatehomeostasisbut has been shown to have immune modulatory functions.Objective:To measure serumlevels of vitamin D, and plasma levels of calcium and phosphatein children with pneumonia and compare with those of apparentlyhealthy controls.Methods:A cross-sectional study involving seventy-six childrenwith pneumonia, matched with 76 apparently healthy controls.Results:There was no statistically significant difference in the mean serum vitamin D levels between the cases and the controls (t = 1.190, p = 0.236). The mean serum vitamin D level was significantly higher in childrenwith non-severe pneumonia than in those with severe pneumonia (t = 3.299, p =.002). Themean serum vitamin D level was higher among the controls than those with severe pneumonia (t = 2.674, p = 0.009).The mean plasmacalcium and phosphate levels in the controls were significantly higher than in the cases (t = 2.528, p = .013 and t = 4.594, p < .001 respectively). Plasmacalcium and phosphate levels did not vary with the severity of pneumonia. Pneumonia was independently associated with the occurrence of hypocalcaemia and hypophosphataemia (OR= 4.366, 95% CI = 1.851-10.295, p= 0.001; OR= 7.355, 95% CI = 1.545-35.027, p= 0.01 respectively). Conclusion:Children with severe pneumonia hadlower levels of vitamin D than those with the non-severe disease.Derangements in plasma levels of calcium and phosphateare common in children with pneumonia, and these abnormalities occur independently of low vitamin D levels


Subject(s)
Child , Nigeria , Phosphates , Pneumonia/diagnosis
13.
Pesqui. vet. bras ; 38(11): 2117-2123, Nov. 2018. tab, ilus
Article in English | ID: biblio-976406

ABSTRACT

Lung diseases are common in small animal clinical routine. Diagnosis is usually affected due to nonspecific symptoms. Imaging features such as radiography and chest ultrasound are acceptable screening tests, although lung biopsy can provides a precise diagnosis. Thus thoracoscopy provides a minimally invasive diagnostic assessment for chest diseases and offers the benefits such as improved illumination and magnification of the image when compared with thoracotomy. In this study we evaluated the transdiaphragmatic thoracoscopic-assisted techniques of lung biopsy with a the guillotine cutting needle and biopsy forceps, in dogs presenting radiographic suspicion on pulmonary tumors. Fourteen dogs regardless of breed, gender, age and body weight admitted at the Hospital of Veterinary Clinics (HCV) of the Veterinary College (FAVET) of Universidade Federal do Rio Grande do Sul (UFRGS), were assessed. Inclusion criteria were presence of nodules on chest radiography and triage tests without changes that could hinder general anesthesia and surgical approach. The animals were positioned in dorsal recumbence and two thoracoscopic ports were established: the first port for working instruments; the second paraxyphoid port for the telescope. Three samples were collected using each sampling method from each lesion or from tumors macroscopically similar whenever their size was less than one centimeter. The samples were sent for histopathological examination in the Veterinary Pathology Laboratory of FAVET/UFRGS. Surgical time was recorded from first incision to wound closure and surgical complications were reported. The dogs were evaluated for the presence of subcutaneous emphysema, hematoma, seroma, local infection and dehiscence. No conversion to open surgery was necessary during the thoracoscopic procedure in any patient. Thoracoscopic assisted biopsy using guillotine needle and biopsy forceps was a safe and fast technique, without perioperative complications. Both devices provided good quality samples for histopathological analysis of lung abnormalities. However the cutting guillotine needle was more efficient especially in larger pulmonary nodules. The transdiaphragmatic access provided optimal approach for both hemithoraces.(AU)


As afecções pulmonares são comuns na rotina clínica de pequenos animais, todavia, por apresentarem sintomas inespecíficos, muitas vezes o diagnóstico dessas doenças torna-se limitado. Recursos de imagem como a radiografia e a ultrassonografia torácica são válidos como exames de triagem, mas somente a biopsia pulmonar pode possibilitar um diagnóstico específico da doença. A toracoscopia fornece um meio minimamente invasivo de diagnóstico para as doenças torácicas e oferece os benefícios de melhor iluminação e ampliação da imagem, quando comparado com a toracotomia. O presente estudo teve como objetivo avaliar as técnicas de biópsia pulmonar por meio da agulha cortante guilhotinada e da pinça de biopsia, guiadas por toracoscopia, pelo acesso transdiafragmático em cães que apresentavam imagem sugestiva de nódulo pulmonar em exame radiográfico prévio. Foram utilizados 14 cães, independente de raça, sexo, idade e peso corporal. Somente caninos com nódulos visíveis na radiografia torácica e que apresentaram condições clínicas e laboratoriais de serem anestesiados foram incluídos no estudo. Os cães foram posicionados em decúbito dorsal e foram realizados dois acessos à cavidade torácica: um primeiro portal intercostal, para introdução dos dispositivos de biopsia; e outro portal paraxifoide transdiafragmático para introdução do endoscópio. Com cada instrumento de biopsia foram coletadas três amostras do mesmo nódulo ou de nódulos macroscopicamente semelhantes e próximos quando o tamanho destes era inferior a um centímetro. Posteriormente as amostras foram encaminhadas para exame histopatológico. O tempo cirúrgico foi cronometrado da incisão ao fechamento da ferida, etodas as informações foram registradas. No pós-operatório os cães foram avaliados quanto à presença de enfisema subcutâneo, hematoma, seroma, infecção local e deiscência de pontos. Não foi necessário converter os procedimentos toracoscópicos para cirurgia convencional em nenhum dos caninos. Concluiu-se tratar de uma técnica segura, rápida sem complicações trans e pós-operatórias. Ambos dispositivos permitiram aquisição de material suficiente para análise histopatológica das alterações pulmonares, no entanto a agulha cortante guilhotinada apresentou maior eficácia, principalmente, em nódulos pulmonares de maior diâmetro. O acesso transdiafragmático mostrou-se eficiente para exploração de ambos os hemitórax.(AU)


Subject(s)
Animals , Dogs , Pneumonia/diagnosis , Lung Diseases, Interstitial/diagnosis , Dogs , Lung/pathology , Lung Neoplasms/diagnosis , Thoracoscopy/veterinary , Biopsy, Needle/veterinary , Thoracic Surgery, Video-Assisted/veterinary , Image-Guided Biopsy/veterinary
14.
Medisan ; 22(8)set.-oct. 2018. tab, graf
Article in Spanish | LILACS | ID: biblio-976153

ABSTRACT

Introducción: La enfermedad neumocócica afecta prioritariamente a las personas en las edades extremas de la vida. En este sentido, el Hospital Docente Infantil Sur Dr. Antonio María Béguez César constituye un sitio de vigilancia centinela del Proyecto Nacional Neumococo, lo cual sirvió de motivación para desarrollar la presente investigación sobre esta enfermedad. Objetivo: Describir las características epidemiológicas, clínicas, microbiológicas e imagenológicas en pacientes menores de 5 años ingresados por presentar enfermedad neumocócica. Métodos: Se realizó un estudio observacional, descriptivo y prospectivo de 170 pacientes menores de 5 años de edad, ingresados en el mencionado centro hospitalario en el período 2014-2016 por presentar enfermedad neumocócica. Resultados: En la serie predominaron la supresión precoz de la lactancia materna (52,3 %) y la existencia de fumadores convivientes (44,7 %) como principales factores de riesgo, además de la fiebre (100,0 %), la tos (96,0 %), el tiraje (74,1%) y la polipnea (70,0 %) como síntomas más frecuentes; mientras que la neumonía se presentó en 82,3 % y hubo 10,0 % de positividad al neumococo, por serotipos 19A, 19F, 14 y 6A, con 66,6 % de colonización en lactantes. Por su parte, la letalidad y la mortalidad proporcional por neumonía fueron de 2,85 y 8,0 %, respectivamente, sin decesos por neumococo. Conclusiones: El aislamiento de neumococo resultó bajo, con predominio en lactantes colonizados y con indicadores de mortalidad por neumonía no neumocócica, lo cual sugiere que la corta edad es un riesgo de deceso por dicha causa.


Introduction: Pneumococcal disease affects mainly people in the extreme ages of life. In this sense, Dr. Antonio María Béguez Caesar Southern Teaching Pediatric Hospital constitutes a place of centinel surveillance of the Pneumococcus National Project, which served as motivation to develop the present investigation on this disease. Objective: To describe the epidemiological, clinical, microbiological and imaging characteristics in patients younger than 5 years admitted due to a pneumoccocical disease. Methods: An observational, descriptive and prospective study of 170 patients younger than 5 years admitted to the above mentioned hospital in the period 2014-2016 was carried out, for presenting pneumoccocal disease. Results: The early suppression of the maternal feeding (52.3 %) and the presence of coexisting smokers (44.7 %) as main risk factors, besides fever (100.0 %), cough (96.0 %), chest indrawing (74.1 %) and polypnea (70.0 %) as the most frequent symptoms prevailed in the series; while the pneumonia was presented in 82.3 % and there was 10.0 % positiveness to pneumoccocus, by serotypes 19A, 19F, 14 and 6A, with 66.6 % colonization in infants. On the other hand, lethality and proportional mortality for pneumonia were of 2.85 and 8.0 %, respectively, without deaths due to pneumoccocus. Conclusions: Pneumoccocus isolation was low, with prevalence in colonized infants and with mortality indicators due to non pneumoccocal pneumonia, which suggests that the short age is a death risk due to this cause.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Pneumococcal Infections/diagnosis , Pneumococcal Infections/epidemiology , Otitis Media/diagnosis , Pneumonia/diagnosis , Secondary Care , Meningitis/diagnosis
15.
Rev. medica electron ; 40(4): 1207-1214, jul.-ago. 2018. ilus
Article in Spanish | LILACS, CUMED | ID: biblio-961293

ABSTRACT

RESUMEN Se presenta a una paciente de 50 años de edad, atendida durante 2 años por Consulta de Neumología, en la ciudad de Matanzas. Presentaba bronquitis crónica con tratamiento para la misma, hace 3 meses ingresa por Servicio de Medicina Interna por una neumonía de lenta resolución, asociada un síndrome general. Durante el ingreso se manejan varias posibilidades diagnósticas como: posible tuberculosis pulmonar, neoplasia de pulmón o neumonía a gérmenes atípicos. Se confirmó diagnóstico de aspergilosis pulmonar mediante lavado bronquial por broncoscopio. Se aplicó tratamiento con antifúngicos sistémicos y se logró mejoría clínica y radiológica. En esta paciente no existían evidencias de inmunosupresión (AU).


ABSTRACT We present a female patient aged 50 years, attended for two years in the Pulmonology consultation, in the city of Matanzas. She suffered chronic bronchitis with treatment; three months ago she was admitted in the Internal Medicine Service due to a low resolution pneumonia associated to a general syndrome. During her staying in the hospital several diagnostic possibilities were managed: possible pulmonary tuberculosis, lung neoplasia or pneumonia to atypical germs. The diagnosis of pulmonary aspergillosis was confirmed through bronchial lavage `per bronchoscope. no existían evidencias de inmunosupresión. The pronosis is Lung Aspergilosis due to a bronchial washing for bronchoscopy and the treatment begins with systemic antifúngicos, achieving clinical and radiological improvement. There is no evidence of inmunosupression in the patient (AU).


Subject(s)
Humans , Female , Adult , Pulmonary Medicine/methods , Pulmonary Aspergillosis/diagnosis , Antifungal Agents/administration & dosage , Pneumonia/diagnosis , Tuberculosis, Pulmonary/diagnosis , Bronchitis, Chronic/diagnosis , Pulmonary Aspergillosis/epidemiology , Lung/abnormalities
16.
J. bras. pneumol ; 44(4): 261-266, July-Aug. 2018. tab, graf
Article in English | LILACS | ID: biblio-975932

ABSTRACT

ABSTRACT Objective: To describe the patient profile, mortality rates, the accuracy of prognostic scores, and mortality-associated factors in patients with community-acquired pneumonia (CAP) in a general hospital in Brazil. Methods: This was a cohort study involving patients with a clinical and laboratory diagnosis of CAP and requiring admission to a public hospital in the interior of Brazil between March 2014 and April 2015. We performed multivariate analysis using a Poisson regression model with robust variance to identify factors associated with in-hospital mortality. Results: We included 304 patients. Approximately 70% of the patients were classified as severely ill on the basis of the severity criteria used. The mortality rate was 15.5%, and the ICU admission rate was 29.3%. After multivariate analysis, the factors associated with in-hospital mortality were need for mechanical ventilation (OR: 3.60; 95% CI: 1.85-7.47); a Charlson Comorbidity Index score > 3 (OR: 1.30; 95% CI: 1.18-1.43); and a mental Confusion, Urea, Respiratory rate, Blood pressure, and age > 65 years (CURB-65) score > 2 (OR: 1.46; 95% CI: 1.09-1.98). The mean time from patient arrival at the emergency room to initiation of antibiotic therapy was 10 h. Conclusions: The in-hospital mortality rate of 15.5% and the need for ICU admission in almost one third of the patients reflect the major impact of CAP on patients and the health care system. Individuals with a high burden of comorbidities, a high CURB-65 score, and a need for mechanical ventilation had a worse prognosis. Measures to reduce the time to initiation of antibiotic therapy may result in better outcomes in this group of patients.


RESUMO Objetivo: Descrever o perfil dos pacientes, taxas de mortalidade, acurácia de escores prognósticos e fatores associados à mortalidade em pacientes com pneumonia adquirida na comunidade (PAC) em um hospital geral no Brasil. Métodos: Estudo de coorte envolvendo pacientes com diagnóstico clínico e laboratorial de PAC e necessidade de internação hospitalar entre março de 2014 e abril de 2015 em um hospital público do interior do Brasil. Foi realizada a análise multivariada mediante o modelo de regressão de Poisson com variância robusta para avaliar os fatores associados com mortalidade intra-hospitalar. Resultados: Foram incluídos 304 pacientes. Aproximadamente 70% dos pacientes foram classificados como graves de acordo com os critérios de gravidade utilizados. A taxa de mortalidade foi de 15,5% e a de necessidade de internação em UTI foi de 29,3%. Após a análise multivariada, os fatores associados à mortalidade intra-hospitalar foram necessidade de ventilação mecânica (OR = 3,60; IC95%: 1,85-7,47); Charlson Comorbidity Index > 3 (OR = 1,30; IC95%: 1,18-1,43); e mental Confusion, Urea, Respiratory rate, Blood pressure, and age > 65 years (CURB-65) > 2 (OR = 1,46; IC95%: 1,09-1,98). A média do tempo entre a chegada do paciente na emergência e o início da antibioticoterapia foi de 10 h. Conclusões: A taxa de mortalidade intra-hospitalar de 15,5% e a necessidade de internação em UTI em quase um terço dos pacientes demonstram o grande impacto da PAC nos pacientes e no sistema de saúde. Indivíduos com maior carga de comorbidades prévias, CURB-65 elevado e necessidade de ventilação mecânica apresentaram pior prognóstico. Ações para reduzir o tempo até o início da antibioticoterapia podem resultar em melhores desfechos nesse grupo de pacientes.


Subject(s)
Humans , Male , Female , Aged , Pneumonia/diagnosis , Pneumonia/mortality , Pneumonia/drug therapy , Prognosis , Severity of Illness Index , Brazil , Comorbidity , Risk Factors , Cohort Studies , Hospital Mortality , Community-Acquired Infections/diagnosis , Community-Acquired Infections/mortality , Community-Acquired Infections/drug therapy , Hospitals, Public , Inpatients , Intensive Care Units , Anti-Bacterial Agents/therapeutic use
17.
Rev. Paul. Pediatr. (Ed. Port., Online) ; 36(2): 123-131, abr.-jun. 2018. tab
Article in Portuguese | LILACS | ID: biblio-957381

ABSTRACT

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.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Pneumonia/microbiology , Bronchitis/microbiology , Indians, South American , Pneumonia/diagnosis , Pneumonia/therapy , Respiratory Tract Infections/diagnosis , Brazil , Bronchitis/diagnosis , Bronchitis/therapy , Acute Disease , Cross-Sectional Studies
18.
Univ. med ; 59(1)20180000. ilus
Article in Spanish | LILACS, COLNAL | ID: biblio-994838

ABSTRACT

El virus de la inmunodeficiencia humana (VIH) continúa siendo un problema de salud pública mundial, a pesar de la introducción de la terapia antirretroviral y la profilaxis frente a patógenos oportunistas. El pulmón es uno de los órganos más afectados por condiciones tanto infecciosas como no infecciosas en el contexto de la enfermedad retroviral; sin embargo, la prevalencia de las enfermedades de las vías respiratorias ha cambiado en las últimas dos décadas, tanto local como globalmente, por lo que se decidió realizar una búsqueda de la literatura más reciente en las bases de datos Medline y SciELO, incluyendo revisiones de tema y estudios originales, con el objetivo de elaborar una descripción actualizada de las principales enfermedades pulmonares descritas en pacientes con VIH, desde los puntos de vista clínico, paraclínico, radiológico y broncoscópico.


Human immunodeficiency virus (HIV) remains a public health problem worldwide, despite the introduction of antiretroviral therapy and prophylaxis against opportunistic pathogens. The lung is one of the most affected organs by both infectious and non-infectious diseases in the context of HIV, however, the prevalence of respiratory tract diseases has changed over the past two decades, both locally and globally, therefore, the authors decided to conduct a search of the most recent literature on Medline and SciELO databases, including reviews and original studies, with the aim of elaborating an updated description of the main pulmonary diseases in patients with HIV, taking into account clinical, paraclinical, radiological and bronchoscopic aspects.


Subject(s)
Humans , Pneumonia/diagnosis , Tuberculosis/complications , HIV , Bronchoscopy , Mortality
19.
Autops. Case Rep ; 7(1): 13-15, Jan.-Mar. 2017. ilus
Article in English | LILACS | ID: biblio-905123

ABSTRACT

Dialysis-related amyloidosis predominantly occurs in osteo-articular structures and dialysis-related amyloid (DRA) substances also deposit in extra-articular tissues. Clinical manifestations of DRA include odynophagia, gastrointestinal hemorrhage, intestinal obstruction, kidney stones, myocardial dysfunction, and subcutaneous tumors. The pathological characteristics of DRA in the heart of hemodialysis patients have rarely been reported. We report the case of a 73-year-old female with a history of cerebral palsy and end-stage renal disease status post two failed renal transplants who had been on hemodialysis for 30 years. The patient was admitted with the working diagnosis of pneumonia. An echocardiography showed markedly reduced biventricular function manifested by low blood pressure with systolic in the 70s and elevated pulmonary artery pressure of 45 mmHg, which did not respond to therapy. Following her demise, the autopsy revealed bilateral pulmonary edema and pleural effusions. There was cardiac amyloid deposition exclusively in the coronary arteries but not in the perimyocytic interstitium. Amyloids were also found in pulmonary and intrarenal arteries and the colon wall. Previous case reports showed that beta 2-microglobulin amyloid deposits in various visceral organs but less frequently in the atrial and/or the ventricular myocardium. In the present case, amyloids in the heart were present in the intramural coronary arteries causing myocardial ischemia and infarction, which was the immediate cause of death.


Subject(s)
Humans , Female , Aged , Amyloidosis/pathology , Coronary Vessels/pathology , Myocardial Ischemia/pathology , Pleural Effusion/pathology , Pulmonary Edema/pathology , Renal Dialysis/adverse effects , Autopsy , Cause of Death , Infarction/pathology , Pneumonia/diagnosis
20.
Rev. pediatr. electrón ; 14(1): 35-37, 2017.
Article in Spanish | LILACS | ID: biblio-969292

ABSTRACT

La neumonía adquirida en la comunidad ocurre en pacientes previamente sanos y su principal etiología es viral. Dentro de las etiologías bacterianas la principal en el recién nacido es el S. agalactiae y en los mayores es S. pneumoniae. Es la principal causa de muerte en niños menores de 5 años de edad en el mundo. Su diagnóstico se basa en la anamnesis y los hallazgos clínicos clásicos, pudiendo complementarse el estudio con radiografía de tórax e identificación viral con métodos rápidos. Su manejo depende de la etiología, y se indica antibioticoterapia (de elección amoxicilina v.o. o ampicilina e.v.) solo frente a la sospecha fundada de etiología bacteriana. Además se debe dar soporte según los requerimientos del paciente, incluyendo la hospitalización si cumple los criterios para ésta. La necesidad de cirugía está restringida principalmente para el manejo de empiemas.


Community acquired pneumonia occurs in previously healthy children and its ethnology is viral. Bacterial ethnology are S. agalactiaein neonates and S. pneumoniaein the olders. Is the main cause of death in children under 5 years of age. Diagnosis is made base on clinical features and chest X ray. Treatment depends on the etiology and antibiotics, preference oral amoxicilin or iv ampiciline, are indicated when a bacterial ethnology is suspected.


Subject(s)
Humans , Child , Pneumonia/diagnosis , Pneumonia/therapy , Community-Acquired Infections/diagnosis , Community-Acquired Infections/therapy , Pneumonia/complications , Pneumonia/etiology , Community-Acquired Infections/complications , Community-Acquired Infections/etiology
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