Derivación y validación de un nuevo puntaje predictivo de mortalidad por covid-19 en la altura / Derivation and Validation of a New covid-19 Predictive Score for Mortality at High Altitude / Derivação e validação de um novo escore preditivo de mortalidade por covid-19 em altitude

Objetivo: desarrollar un puntaje predictivo de mortalidad para pacientes con covid-19. Materiales y méto-dos: estudio retrospectivo, analítico, observacional y transversal, realizado en dos fases. Se revisaron 620 historias clínicas con una cohorte de derivación de 320 pacientes y una de validación de 300 pacientes. Las variables se analizaron con test de Anova, chi cuadrado de Pearson y análisis multivariante con regresión binaria, que determinaron sensibilidad, especificidad y valor predictivo negativo y positivo. Los puntajes se compararon mediante curvas cor con los scoresnews y hews. Resultados: los dos puntajes obtenidos incluyeron valores de edad, conteo de linfocitos, SatO2/FiO2, leucocitos, plaquetas, ausencia de síntomas, hipertensión arterial, epid y dhl. El área bajo la curva (abc) fue de 0.838 para el puntaje con dhl, con una mortalidad del 100 % para 7.75 puntos o más, y un abc de 0.826 para el primer puntaje. En la cohorte de validación, el abc para el primer puntaje fue de 0.831 y para el score con dhl fue 0.855. El puntaje hewsobtuvo un abc de 0.451, y el news, un abc de 0.396. Conclusiones: se desarrollaron dos herramientas para predecir mortalidad en pacientes con covid-19, con alto poder de discriminación, superior a los puntajes británicos hews y news

Objetivo: desarrollar un puntaje predictivo de mortalidad para pacientes con covid-19. Materiales y méto-dos: estudio retrospectivo, analítico, observacional y transversal, realizado en dos fases. Se revisaron 620 historias clínicas con una cohorte de derivación de 320 pacientes y una de validación de 300 pacientes. Las variables se analizaron con test de Anova, chi cuadrado de Pearson y análisis multivariante con regresión binaria, que determinaron sensibilidad, especificidad y valor predictivo negativo y positivo. Los puntajes se compararon mediante curvas cor con los scoresnews y hews. Resultados: los dos puntajes obtenidos incluyeron valores de edad, conteo de linfocitos, SatO2/FiO2, leucocitos, plaquetas, ausencia de síntomas, hipertensión arterial, epid y dhl. El área bajo la curva (abc) fue de 0.838 para el puntaje con dhl, con una mortalidad del 100 % para 7.75 puntos o más, y un abc de 0.826 para el primer puntaje. En la cohorte de validación, el abc para el primer puntaje fue de 0.831 y para el score con dhl fue 0.855. El puntaje hewsobtuvo un abc de 0.451, y el news, un abc de 0.396. Conclusiones: se desarrollaron dos herramientas para predecir mortalidad en pacientes con covid-19, con alto poder de discriminación, superior a los puntajes británicos hews y news

Objetivo: desenvolver um escore preditivo de mortalidade para pacientes com covid-19. Materiais e Métodos: estudo retrospectivo, analítico, observacional e transversal, realizado em duas fases. Foram revisados 620 prontuários, com uma coorte de derivação de 320 pacientes e uma coorte de validação de 300 pacientes. As variáveis foram analisadas com teste anova, qui-quadrado de Pearson e análise multivariada com regressão binária, determinando sensibilidade, especificidade, valor preditivo nega-tivo e positivo. As pontuações foram comparadas por meio de curvas cor com as pontuações news e hews. Resultados: os dois escores obtidos incluíram valores de: idade, contagem de linfócitos, SatO2/FiO2, leucócitos, plaquetas, ausência de sintomas, hipertensão arterial, epid e dhl. A área sob a curva (abc) foi de 0,838 para o escore dhl, com 100 % de mortalidade para 7,75 pontos ou mais, e uma abc de 0,826 para o primeiro escore. Na coorte de validação, a abc para o primeiro escore foi de 0,831 e para o escore com dhl foi de 0,855. A pontuação hews obteve abc de 0,451 e o news uma abc de 0,396. Conclusões: foram desenvolvidas duas ferramentas para prever mortalidade em pacientes com covid-19, com alto poder de discriminação, superior aos escores britânicos hews e news

Microbial variations in sputum cultures among hospitalized patients with community-acquired pneumonia: differences in sputum microbiota between asthma and COPD patients

ABSTRACT Objective: To assess differences in the sputum microbiota of community-acquired pneumonia (CAP) patients with either COPD or asthma, specifically focusing on a patient population in Turkey. Methods: This retrospective study included hospitalized patients > 18 years of age with a diagnosis of pneumonia between January of 2021 and January of 2023. Participants were recruited from two hospitals, and three patient groups were considered: CAP patients with asthma, CAP patients with COPD, and CAP patients without COPD or asthma. Results: A total of 246 patients with CAP were included in the study, 184 (74.8%) and 62 (25.2%) being males and females, with a mean age of 66 ± 14 years. Among the participants, 52.9% had COPD, 14.2% had asthma, and 32.9% had CAP but no COPD or asthma. Upon analysis of sputum cultures, positive sputum culture growth was observed in 52.9% of patients. The most commonly isolated microorganisms were Pseudomonas aeruginosa (n = 40), Acinetobacter baumannii (n = 20), Klebsiella pneumoniae (n = 16), and Moraxella catarrhalis (n = 8). CAP patients with COPD were more likely to have a positive sputum culture (p = 0.038), a history of antibiotic use within the past three months (p = 0.03), utilization of long-term home oxygen therapy (p < 0.001), and use of noninvasive ventilation (p = 0.001) when compared with the other patient groups. Additionally, CAP patients with COPD had a higher CURB-65 score when compared with CAP patients with asthma (p = 0.004). Conclusions: This study demonstrates that CAP patients with COPD tend to have more severe presentations, while CAP patients with asthma show varied microbial profiles, underscoring the need for patient-specific management strategies in CAP.

Caracterización clínica epidemiológica de pacientes graves con infecciones adquiridas en la comunidad durante la COVID-19

Introducción: los pacientes graves requieren ingreso en las unidades de cuidados intensivos por infecciones adquiridas en la comunidad. Objetivo: caracterizar, desde el punto de vista clínico y epidemiológico, a los pacientes graves con infecciones adquiridas en la comunidad durante la COVID-19. Métodos: estudio observacional, descriptivo, de serie de casos, en el periodo comprendido desde el 1ero de septiembre de 2020 hasta el 31 de enero de 2022. Se incluyeron a 277 pacientes. Se obtuvieron variables epidemiológicas y clínicas. El análisis estadístico se basó en medidas de resumen de la estadística descriptiva y de asociación. Resultados: el 52,7 % de los pacientes correspondieron al sexo femenino. La media de la edad fue 40,2 años (IC 95 %: 37,8-42,4). El Acute Physiology and Chronic Health Evaluation II (APACHE II) medio se estimó en 11, 8 (IC 95 %: 9,7-12,2). La escala Secuencial Organ Failure Assessment (SOFA) promedio fue de 1,8 (IC 95 %:1,4-2,2). El 31,7 % de los pacientes fueron hipertensos y 19,4 % diabéticos. La infección intraabdominal fue la localización principal (52,7 %), seguida de la neumonía (34,7 %). El 98,7 % tenía antimicrobianos al ingreso y el 26,3 % ventilación mecánica artificial. Conclusiones: los pacientes se caracterizan en su mayoría por pertenecer al sexo femenino, estar en la cuarta década de la vida, desarrollar alteraciones de sus sistemas fisiológicos y disfunción de órganos y tener hipertensión arterial y diabetes mellitus; infección intraabdominal o neumonía, así como requerir tratamiento con antimicrobianos, ventilación mecánica invasiva y drogas vasoactivas.

Introduction: critically ill patients require admission to intensive care units due to community-acquired infections. Objective: to characterize, from a clinical and epidemiological point of view, critical ill patients with community-acquired infections during COVID-19. Results: 52.7% of the patients were female. The mean age was 40.2 years (95% CI: 37.8-42.4). The mean Acute Physiology and Chronic Health Evaluation II (APACHE II) was estimated at 11.8 (95% CI: 9.7-12.2). The mean Sequential Organ Failure Assessment (SOFA) scale was 1.8 (95% CI: 1.4-2.2). 31.7% of the patients were hypertensive and 19.4% diabetic. Intra-abdominal infection was the main location (52.7%), followed by pneumonia (34.7%). 98.7% had antimicrobials on admission and 26.3% had artificial mechanical ventilation. Conclusions: the patients are mostly characterized by being female, being in the fourth decade of life, developing alterations in their physiological systems and organ dysfunction, and having high blood pressure and diabetes mellitus; intra-abdominal infection or pneumonia as well as requiring treatment with antimicrobials, invasive mechanical ventilation and vasoactive drugs.

Introdução: pacientes críticos necessitam de internação em unidades de terapia intensiva devido a infecções adquiridas na comunidade. Objetivo: caracterizar, do ponto de vista clínico e epidemiológico, pacientes graves com infecções comunitárias durante a COVID-19. Métodos: estudo observacional, descritivo, de série de casos, no período de 1º de setembro de 2020 a 31 de janeiro de 2022. Foram incluídos 277 pacientes. Foram obtidas variáveis epidemiológicas e clínicas. A análise estatística baseou-se em medidas-resumo de estatística descritiva e de associação. Resultados: 52,7% dos pacientes eram do sexo feminino. A média de idade foi de 40,2 anos (IC 95%: 37,8-42,4). A média do Acute Physiology and Chronic Health Evaluation II (APACHE II) foi estimada em 11,8 (IC 95%: 9,7-12,2). A média da escala Sequential Organ Failure Assessment (SOFA) foi de 1,8 (IC 95%: 1,4-2,2). 31,7% dos pacientes eram hipertensos e 19,4% diabéticos. A infecção intra-abdominal foi a principal localização (52,7%), seguida de pneumonia (34,7%). 98,7% tinham antimicrobianos na admissão e 26,3% tinham ventilação mecânica artificial. Conclusões: a maioria dos pacientes é do sexo feminino, na quarta década de vida, desenvolve alterações de seus sistemas fisiológicos e disfunção orgânica, além de hipertensão arterial e diabetes mellitus; infecção intra-abdominal ou pneumonia, além de necessitar de tratamento com antimicrobianos, ventilação mecânica invasiva e drogas vasoativas.

Clinical application value of a predictive model for the efficacy of third-generation cephalosporin in treatment of community-acquired spontaneous bacterial peritonitis / 临床肝胆病杂志

ObjectiveTo investigate the clinical application value of a predictive model for the efficacy of third-generation cephalosporin in the treatment of community-acquired spontaneous bacterial peritonitis （CASBP）. MethodsThis prospective study was conducted among 50 patients with liver cirrhosis and CASBP who were admitted to The Ninth Hospital of Nanchang from January 2021 to June 2022， and the patients were randomly divided into optimized treatment group and traditional treatment group， with 25 patients in each group. The patients in the optimized treatment group received ceftazidime or imipenem for initial treatment based on the above predictive model， and those in the traditional treatment group received ceftazidime for initial treatment， with the subsequent use of antibiotics adjusted based on the efficacy of initial treatment. The two groups were compared in terms of the response rate of initial treatment， cure rate on day 5， and 30-day mortality rate. The independent-samples t test or the Mann-Whitney U test was used for comparison of continuous data between two groups， and the chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups. ResultsAll patients completed the study. The optimized treatment group had a significantly higher response rate of initial treatment than the traditional treatment group （88.0% vs 60.0%， χ2=5.094， P=0.024）， while there was no significant difference in the cure rate on day 5 between the two groups （80.0% vs 56.6%， χ2=3.309， P=0.069）. As for the patients who received ceftazidime for initial treatment， the optimized treatment group had a significantly higher response rate of initial treatment than the traditional treatment group （88.9% vs 60.0%， χ2=4.341， P=0.037）， while there was no significant difference in the cure rate on day 5 between the two groups （83.3% vs 56.0%， χ2=2.425， P=0.119）. There was no significant difference in 30-day mortality rate between the two groups （8.0% vs 20.0%， χ2=0.664， P=0.415）. For all patients， there was a significant association between response of initial treatment and cure on day 5 （odds ratio ［OR］=9.643， 95% confidence interval ［CI］： 2.292‍ — ‍40.564） and between cure on day 5 and 30-day mortality （OR=0.138， 95%CI： 0.023‍ — ‍0.813）. ConclusionThis predictive model for efficacy helps clinicians to identify the patients who can benefit from third-generation cephalosporin treatment and improve the efficacy of third-generation cephalosporin in the initial empirical treatment of CASBP.

Seasonal and epidemiological characteristics of community-acquired pneumonia in Chuzhou in 2010 - 2022 / 公共卫生与预防医学

Objective To analyze the seasonal and epidemiological characteristics of community-acquired pneumonia (CAP) in Chuzhou from 2010 to 2022. Methods The epidemiological data of CAP in Chuzhou from 2010 to 2022 were obtained from the center for diseases control and prevention of Chuzhou City, Anhui Province. After inclusion and exclusion, a total of 1 053 cases were enrolled. General data were collected. Then the characteristics of CAP patients in terms of gender, age, regional and seasonal distribution and pathogenic bacteria distribution were analyzed. Results A total of 316 patients with CAP, with a prevalence rate of 30.01%, including 152 males (48.10%) and 164 females (51.90%). Regarding age, 86 cases (27.22%) at 19-40 years, 106 cases (33.54%) at 41-60 years, and 124 cases (39.24%) at >60 years, suggesting a statistical difference in the CAP detection rate among different genders and ages (P<0.05). Seasonally, 118 cases (37.34%) were detected in spring, 13 cases (4.11%) in summer, 49 cases (15.51%) in autumn, and 136 cases (43.04%) in winter, with the highest CAP detection rate in winter, followed by spring. Pathogenic bacteria were positive in 198 of 316 patients, with a detection rate of 62.66%. A total of 125 strains of pathogenic bacteria were detected in sputum culture, of which 138 cases were Gram-negative, mainly Escherichia coli (24.24%, 48/198), and 60 cases were Gram-positive, mainly Streptococcus pneumoniae (14.14%, 28/198). Among 198 patients positive for pathogen detection, 41 cases were detected in spring, 37 cases in summer, 56 cases in autumn and 64 cases in winter. The drug sensitivity results showed that Escherichia coli had the highest resistance rate to ampicillin and cefazolin, and was sensitive to imipenem and other antibiotics; Streptococcus pneumoniae has the highest resistance rate to penicillin and erythromycin, and is sensitive to vancomycin. Conclusion CAP is quite common in elderly population in Chuzhou from 2010 to 2022, with a high prevalence rate in spring and winter, and the prevention work of high-risk groups should be strengthened.

Fisioterapia respiratoria en sujetos adultos cursando internación por neumonía adquirida en la comunidad. Revisión bibliográfica

Introducción: La neumonía adquirida en la comunidad (NAC) es una infección respiratoria en la cual es frecuente observar la indicación de fisioterapia respiratoria (FR). Sin embargo, en la actualidad las recomendaciones respecto a su uso en NAC son controvertidas, no existiendo evidencia que respalde su uso y permita conocer su real alcance. Objetivos: Revisar la evidencia respecto al impacto de la FR en pacientes adultos que cursan internación por NAC. Resultados: 5 estudios cumplieron los criterios de inclusión de esta revisión. Las maniobras de FR incluyeron ejercicios respiratorios, drenaje postural, percusión, vibración, espirometría incentivada, resistencia espiratoria, asistencia torácica durante movimientos respiratorios, tos dirigida y presión positiva intermitente. En los estudios incluidos la FR no disminuyó la mortalidad ni mejoró los valores espirométricos en los pacientes con NAC, así como tampoco los días hasta la curación ni la estadía hospitalaria. Respecto a los costos, el uso de FR en pacientes con NAC presentó un incremento significativo de los mismos. Conclusión: No hay evidencia que respalde el uso de manera rutinaria de FR en los pacientes adultos con NAC. Consideramos que se requieren de futuras investigaciones que permitan conocer el impacto de la FR en pacientes adultos con NAC, así como establecer consensos respecto a su indicación, selección de maniobras, estandarización de técnicas, tiempos y dosificación.

Introduction: Community-acquired pneumonia (CAP) is a respiratory infection in which the indication for respiratory physiotherapy (RF) is frequently observed. However, currently the recommendations regarding its use in CAP are controversial, and there is no evidence to support its use and allow us to know its real scope. Objectives: To review the evidence regarding the impact of RF in adult patients who are hospitalized for CAP. Results: 5 studies met the inclusion criteria of this review. RF maneuvers included breathing exercises, postural drainage, percussion, vibration, incentive spirometry, expiratory resistance, chest support during respiratory movements, directed cough, and intermittent positive pressure. In the included studies, RF did not reduce mortality or improve spirometric values in patients with CAP, nor did it improve days to cure or hospital stay. Regarding costs, the use of RF in patients with CAP presented a significant increase in costs. Conclusion: There is no evidence to support the routine use of RF in adult patients with CAP. We believe that future research is required to determine the impact of RF in adult patients with CAP, as well as to establish consensus regarding its indication, selection of maneuvers, standardization of techniques, times, and dosage.

Fisioterapia respiratoria en sujetos adultos cursando internación por neumonía adquirida en la comunidad. Revisión bibliográfica / Respiratory physiotherapy in adult subjects hospitalized for community-acquired pneumonia. Literature review

Introducción: La neumonía adquirida en la comunidad (NAC) es una infección respiratoria en la cual es frecuente observar la indicación de fisioterapia respiratoria (FR). Sin embargo, en la actualidad las recomendaciones respecto a su uso en NAC son controvertidas, no existiendo evidencia que respalde su uso y permita conocer su real alcance. Objetivos: Revisar la evidencia respecto al impacto de la FR en pacientes adultos que cursan internación por NAC. Resultados: 5 estudios cumplieron los criterios de inclusión de esta revisión. Las maniobras de FR incluyeron ejercicios respiratorios, drenaje postural, percusión, vibración, espirometría incentivada, resistencia espiratoria, asistencia torácica durante movimientos respiratorios, tos dirigida y presión positiva intermitente. En los estudios incluidos la FR no disminuyó la mortalidad ni mejoró los valores espirométricos en los pacientes con NAC, así como tampoco los días hasta la curación ni la estadía hospitalaria. Respecto a los costos, el uso de FR en pacientes con NAC presentó un incremento significativo de los mismos. Conclusión: No hay evidencia que respalde el uso de manera rutinaria de FR en los pacientes adultos con NAC. Consideramos que se requieren de futuras investigaciones que permitan conocer el impacto de la FR en pacientes adultos con NAC, así como establecer consensos respecto a su indicación, selección de maniobras, estandarización de técnicas, tiempos y dosificación.

Introduction: Community-acquired pneumonia (CAP) is a respiratory infection in which the indication for respiratory physiotherapy (RF) is frequently observed. However, currently the recommendations regarding its use in CAP are controversial, and there is no evidence to support its use and allow us to know its real scope. Objectives: To review the evidence regarding the impact of RF in adult patients who are hospitalized for CAP. Results: 5 studies met the inclusion criteria of this review. RF maneuvers included breathing exercises, postural drainage, percussion, vibration, incentive spirometry, expiratory resistance, chest support during respiratory movements, directed cough, and intermittent positive pressure. In the included studies, RF did not reduce mortality or improve spirometric values in patients with CAP, nor did it improve days to cure or hospital stay. Regarding costs, the use of RF in patients with CAP presented a significant increase in costs. Conclusion: There is no evidence to support the routine use of RF in adult patients with CAP. We believe that future research is required to determine the impact of RF in adult patients with CAP, as well as to establish consensus regarding its indication, selection of maneuvers, standardization of techniques, times, and dosage.

90 day and 1-year mortality and renal outcomes of patients who started hemodialysis treatment for the first time / Mortalidad a los 90 días y al año y resultados renales de pacientes que iniciaron tratamiento con hemodiálisis por primera vez

ABSTRACT Aim: This study aims to investigate the 90-day and 1-year mortality and the affecting factors of mortality in patients who have started dialysis treatment for the first time. Methods: Patients who started intermittent hemodialysis for the first time in the hemodialysis unit were evaluated. Patients who received hemodialysis treatment for any reason before, patients who underwent hemodialysis due to methyl alcohol, lithium, or mushroom poisoning, and patients who started dialysis in the intensive care unit were excluded from the study. The clinical and laboratory data were obtained from the patients, at admission time, from the electronic data record system and patients' charts.Univariate and multivariate logistic regression analyses were used to identify predictive factors for 90-days and 1-year mortality-dependent variables. Results: 229 patients were included in this study. 133(58.8%) of the patients were male, 96(41.9%) were female, and the median age was 64 years. While 166 patients had pre-existing renal disease, 63 patients had no prior renal disease. The number of patients who died within 90 days, which refers to short-term mortality, was 49 (21.4%). 73 patients (31.9%) died in one year (long-term mortality). At the end of one year, 38% of the whole group of patients continued receiving renal replacement therapy, while 10% of all CKD patients had not a requirement of dialysis, and only 9.17% of the patients had renal recovery. In the multivariate analysis established for short-term mortality, the following parameters showed significant predictive features: ejection fraction (OR = 3.80, 95% CI: 1.05-13.72, p=0.042), CRP (OR = 0.20, 95% CI: 0.04-0.92, p= 0.039), age (OR = 0.21, 95% CI: 0.05-0.91, p= 0.038), and diastolic blood pressure (OR = 0.08, 95% CI: 0.02-0.28, p< 0.001). The multivariate analysis for long-term mortality indicated that systolic blood pressure (OR = 0.26, 95% CI: 0.08-0.82, p= 0.022), diastolic blood pressure (OR = 0.21, 95% CI: 0.68-0.66, p= 0.008), and potassium (OR = 0.27, 95% CI: 0.10-0.70, p= 0.007) were independent predictive markers. Conclusion: Patients with CKD who have not yet started hemodialysis treatment should be followed closely, as hypervolemia, hypotension, and hemodynamic instability increase the risk of death, according to our study. In addition, we recommend that clinical conditions such as hemodynamic instability or sepsis, which may cause hypotension in AKI-D, should be addressed as soon as possible, and optimizing the fluid-electrolyte balance carefully in those patients we determined to be at risk.

RESUMEN Objetivo: Este estudio tiene como objetivo investigar la mortalidad a 90 días y 1 año y los factores que afectan la mortalidad en pacientes que han iniciado tratamiento de diálisis por primera vez. Métodos: Se evaluaron pacientes que iniciaron hemodiálisis intermitente por primera vez en la unidad de hemodiálisis. Se excluyeron del estudio los pacientes que recibieron tratamiento de hemodiálisis por cualquier motivo anteriormente, los pacientes que se sometieron a hemodiálisis por intoxicación con alcohol metílico, litio o hongos y los pacientes que iniciaron diálisis en la unidad de cuidados intensivos. Los datos clínicos y de laboratorio se obtuvieron de los pacientes al momento del ingreso, del sistema de registro electrónico de datos y de las historias clínicas de los pacientes. Se utilizaron análisis de regresión logística univariados y multivariados para identificar factores predictivos para variables dependientes de mortalidad a 90 días y 1 año. Resultados: 229 pacientes fueron incluidos en este estudio. 133 (58,8%) de los pacientes eran hombres, 96 (41,9%) eran mujeres y la mediana de edad fue de 64 años. Mientras que 166 pacientes tenían enfermedad renal preexistente, 63 pacientes no tenían enfermedad renal previa. El número de pacientes que fallecieron dentro de los 90 días, que se refiere a la mortalidad a corto plazo, fue de 49 (21,4%). 73 pacientes (31,9%) fallecieron en un año (mortalidad a largo plazo). Al cabo de un año, el 38% de todo el grupo de pacientes continuaba recibiendo terapia de reemplazo renal, mientras que el 10% de todos los pacientes con ERC no requerían diálisis y solo el 9,17% de los pacientes presentaban recuperación renal. En el análisis multivariante establecido para la mortalidad a corto plazo, los siguientes parámetros mostraron características predictivas significativas: fracción de eyección (OR = 3,80, IC 95%: 1,05-13,72, p=0,042), PCR (OR = 0,20, IC 95%: 0,04 -0,92, p= 0,039), edad (OR = 0,21, IC 95%: 0,05-0,91, p= 0,038) y presión arterial diastólica (OR = 0,08, IC 95%: 0,02-0,28, p< 0,001). El análisis multivariado para la mortalidad a largo plazo indicó que la presión arterial sistólica (OR = 0,26, IC 95%: 0,08-0,82, p= 0,022), la presión arterial diastólica (OR = 0,21, IC 95%: 0,68-0,66, p= 0,008), y el potasio (OR = 0,27, IC 95%: 0,10-0,70, p= 0,007) fueron marcadores predictivos independientes. Conclusión: Los pacientes con ERC que aún no han iniciado tratamiento con hemodiálisis deben ser seguidos de cerca, ya que la hipervolemia, la hipotensión y la inestabilidad hemodinámica aumentan el riesgo de muerte, según nuestro estudio. Además, recomendamos que las condiciones clínicas como la inestabilidad hemodinámica o la sepsis, que pueden causar hipotensión en AKI-D, deben abordarse lo antes posible y optimizar cuidadosamente el balance de líquidos y electrolitos en aquellos pacientes que determinamos que están en riesgo.

Bula gigante secundaria a neumonía adquirida en la comunidad en niños / Giant Bulla Secondary to Community-Acquired Pneumonia in Children

Introducción: Los neumatoceles y las bulas pulmonares son lesiones que se observan en los niños casi siempre asociadas a neumonías infecciosas, aunque sus causas pueden ser diversas. La importancia clínica de estos procesos radica en el peligro de crecimiento progresivo, que puede comprometer las funciones respiratoria y cardiovascular. Objetivo: Describir las experiencias derivadas del proceso de diagnóstico por imágenes y del tratamiento invasivo de casos atendidos. Presentación de los casos: Desde finales de 2021 y durante un período de un año, se atendieron, en la unidad de cuidados intensivos pediátricos del Hospital Pediátrico Universitario de Cienfuegos, cinco niños con neumonías extensas, que desarrollaron bulas de gran tamaño varios días después del tratamiento antimicrobiano adecuado. Estas necesitaron drenaje y aspiración percutáneos debido a su magnitud y a la presencia de síntomas cardiovasculares. Conclusiones: Las bulas que aparecieron como complicación de la neumonía en el niño pueden presentarse con una frecuencia no despreciable, y hay que mantenerse atentos a su evolución, porque, a diferencia de los neumatoceles, pueden crecer progresivamente y comprometer las funciones respiratoria y cardiovascular. El drenaje percutáneo y aspiración continua por cinco días resultó un método seguro y eficaz para tratar estos procesos(AU)

Introduction: Pneumoatoceles and pulmonary bullae are lesions that are observed in children almost always associated with infectious pneumonia, although their causes may be diverse. The clinical importance of these processes lies in the danger of progressive growth, which can compromise respiratory and cardiovascular functions. Objective: To describe the experiences derived from the imaging process and the invasive treatment of treated cases. Presentation of the cases: Since the end of 2021 and for a period of one year, five children with extensive pneumonia were treated in the pediatric intensive care unit of the University Pediatric Hospital of Cienfuegos, who developed large bullae several days after appropriate antimicrobial treatment. The bullae required percutaneous drainage and aspiration due to their magnitude and the presence of cardiovascular symptoms. Conclusions: The bulla that appeared as a complication of pneumonia in the child can occur with a not negligible frequency, and it is necessary to be attentive to their evolution, because, unlike pneumoatoceles, can grow progressively and compromise respiratory and cardiovascular functions. Percutaneous drainage and continuous aspiration for five days was a safe and effective method to treat these processes(AU)

Investigation of etiology of community-acquired pneumonia in hospitalized patients in a tertiary hospital of São Paulo City, Brazil

Abstract Background Community-Acquired Pneumonia (CAP) is the primary cause of hospitalization in the United States and the third leading cause of death in Brazil. The gold standard for diagnosing the etiology of CAP includes blood culture, Gram-stained sputum, and sputum culture. However, these methods have low sensitivity. No studies investigating the etiology of CAP have been conducted in Brazil in the last 20-years, and the empirical choice of antimicrobials is mainly based on the IDSA guidelines. This is the first national study with this aim, and as a result, there's potential for the Brazilian consensus to be impacted and possibly modify its guidelines rather than adhering strictly to the IDSA's recommendations. Methods The aim of this study is to identify the main microorganisms implicated in CAP by employing a multiplex Polymerase Chain Reaction (mPCR) at the foremost public hospital in Brazil. All patients who were admitted to the emergency department and diagnosed with severe CAP underwent an mPCR panel using nasopharyngeal and oropharyngeal swabs, with the aim of detecting 13 bacterial and 21 viral pathogens. Results A total of 169 patients were enrolled in the study. The mPCR panel identified an etiological agent in 61.5% of patients, with viruses being the most common (42.01%), led by Rhinovirus, followed by Influenza and Coronavirus (non-SARS-CoV-2). Bacterial agents were identified in 34.91% of patients, with S. pneumoniae being the most common, followed by H. influenzae, M. catarrhalis, and S. aureus. Additionally, we found that the prescription for 92.3% of patients could be modified, with most changes involving de-escalation of antibiotics and antiviral therapy. Conclusion Our study revealed different etiological causes of CAP than those suggested by the Brazilian guidelines. Using molecular diagnostic tests, we were able to optimize treatment by using fewer antibiotics.

Comparison of efficacy，safety and economics of bid-winning and original Moxifloxacin hydrochloride tablets in the treatment of outpatient community-acquired pneumonia / 中国药房

OBJECTIVE To compare the efficacy， safety and economics of bid-winning and original Moxifloxacin hydrochloride tablets in the treatment of outpatient community-acquired pneumonia （CAP）. METHODS A retrospective cohort study was conducted to screen and include CAP outpatients during the period of January to December 2021 in Lianyungang First People’s Hospital. They were divided into generic drug group （1 058 cases） and bid-winning drug group （1 121 cases） according to the drug source. Two groups were respectively given original and bid-winning Moxifloxacin hydrochloride tablets， 0.4 g each time， once a day. The efficacy indexes （clinical effective rate， remission time， treatment course， revisiting rate） and safety indexes （allergy， nervous system symptoms， etc.） were compared between the two groups； and the influence factors of clinical treatment failure were analyzed with multi-factor modified Poisson regression model. The economic indicators of the two drugs [quantity， consumption sum， defined daily doses （DDDs）， defined daily dose cost （DDDc）， price ratio， replacement rate] were compared. RESULTS There were no significant differences in the clinical effective rate， treatment course， revisiting rate， the incidence of nervous system symptoms and Q-T interval prolongation between the two groups （P＞0.05）. The remission time of original drug group was significantly shorter than that of bid-winning drug group， and the incidence of total adverse drug reaction， allergy reaction， gastrointestinal symptom reaction and hyperglycemia were significantly lower than those in bid-winning drug group（P＜0.05）. Multivariate Poisson regression analysis showed that bid-winning drug did not increase the risk of clinical treatment failure in CAP outpatients [RR＝1.132， 95%CI （0.883， 1.542）， P＝0.327]. However， antibiotic exposure history， more than 2 items of abnormal clinical manifestations and auxiliary examination all increased the risk of clinical treatment failure （P＜0.05）. Compared with before the implementation of centralized volume-based procurement policy， the quantity and DDDs of Moxifloxacin hydrochloride tablets increased significantly， while the consumption sum decreased significantly， DDDc of bid-winning drug decreased significantly， the price ratio of it to original drug decreased to 0.117， and the replacement rate increased to 69.44% after the implementation of centralized volume- based procurement policy. CONCLUSIONS Compared with original drug， bid-winning Moxifloxacin hydrochloride tablet shows reliable efficacy and obvious price advantage in the treatment of outpatient CAP， but the incidence of adverse drug reactions is higher.

Distribution of non-bacterial pathogens in 1 788 children with community-acquired pneumonia / 中国当代儿科杂志

OBJECTIVES@#To investigate the distribution characteristics of non-bacterial pathogens in community-acquired pneumonia (CAP) in children.@*METHODS@#A total of 1 788 CAP children admitted to Shenyang Children's Hospital from December 2021 to November 2022 were selected. Multiple RT-PCR and capillary electrophoresis were used to detect 10 viral pathogens and 2 atypical pathogens, and serum antibodies of Chlamydial pneumoniae (Ch) and Mycoplasma pneumoniae (MP) were detected. The distribution characteristics of different pathogens were analyzed.@*RESULTS@#Among the 1 788 CAP children, 1 295 children were pathogen-positive, with a positive rate of 72.43% (1 295/1 788), including a viral pathogen positive rate of 59.68% (1 067/1 788) and an atypical pathogen positive rate of 22.04% (394/1 788). The positive rates from high to low were MP, respiratory syncytial virus (RSV), influenza B virus (IVB), human metapneumovirus (HMPV), human rhinovirus (HRV), human parainfluenza virus (HPIV), influenza A virus (IVA), bocavirus (BoV), human adenovirus (HADV), Ch, and human coronavirus (HCOV). RSV and MP were the main pathogens in spring; MP had the highest positive rate in summer, followed by IVA; HMPV had the highest positive rate in autumn; IVB and RSV were the main pathogens in winter. The positive rate of MP in girls was higher than that in boys (P<0.05), and there were no significant differences in other pathogens between genders (P>0.05). The positivity rates of certain pathogens differed among age groups (P<0.05): the positivity rate of MP was highest in the >6 year-old group; the positivity rates of RSV and Ch were highest in the <1 year-old group; the positivity rates of HPIV and IVB were highest in the 1 to <3 year-old group. RSV, MP, HRV, and HMPV were the main pathogens in children with severe pneumonia, while MP was the primary pathogen in children with lobar pneumonia, and MP, IVB, HMPV, RSV, and HRV were the top 5 pathogens in acute bronchopneumonia.@*CONCLUSIONS@#MP, RSV, IVB, HMPV, and HRV are the main pathogens of CAP in children, and there are certain differences in the positive rates of respiratory pathogens among children of different ages, genders, and seasons.

Research progress regarding status of human adenovirus infections and serotyping technology / 中华检验医学杂志

There are many serotypes of human adenovirus (HAdV), and different serotypes can cause infections in different systems of the human body, one example being community acquired pneumonia (CAP). However, the clinical symptoms of HAdV infections are similar to those caused by other pathogens. To detect and serotype adenovirus rapidly and accurately is crucial towards the clinical diagnosis, treatment and prevention of the virus. This can facilitates the control of nosocomial infection and epidemiological monitoring. This article briefly reviews the molecular characteristics, epidemiology, and typing of human adenovirus, aiming to help formulate effective treatments towards HAdV infection in a clinical setting.

Diagnosis of community-acquired bloodstream infection in the elderly at primary care / 中华全科医师杂志

Bloodstream infection (BSI) is a serious clinical condition with high fatality rate. The elderly patients account for a large proportion of community-acquired BSI cases, and general practitioners should play an important role in early identification and diagnosis of community elderly BSI patients. This article reviews the status quo of diagnosis of community-acquired BSI in the elderly. Based on clinical manifestations, accessible biomarkers and blood cultures, general practitioners can make an early diagnosis and timely transfer the patients to reduce the fatality rate of community-acquired BSI.

Research progress on community-acquired pneumonia in elderly immunocompromised patients / 中华老年医学杂志

Community acquired pneumonia(CAP)is characterized by high morbidity and mortality in immunocompromised patients, with the elderly as the main vulnerable population.However, current guidelines in China and elsewhere do not offer specific recommendations on the diagnosis and treatment of such patients.This paper reviews the definition, classification, epidemiology, etiological characteristics, clinical manifestations, diagnosis, treatment and prognosis of CAP in immunocompromised elderly patients, to provide a theoretical framework for its diagnosis and treatment and for the formulation of guidelines.

Clinical analysis of different types of neonatal sepsis: a multi-center retrospective study / 中国新生儿科杂志

Objective:To study the clinical characteristics of different types of neonatal sepsis.Methods:From January 2012 to December 2019, neonates with confirmed sepsis from 5 neonatal centers of central-south China were reviewed. The neonates were assigned into early-onset sepsis (EOS) and late-onset sepsis (LOS) group, and the latter was further subgrouped into hospital-acquired LOS (hLOS) group and community-acquired LOS (cLOS) group. The etiological and clinical characteristics were analyzed. SPSS 26.0 was used for statistical analysis.Results:A total of 580 neonates were enrolled, including 286 (49.3%) in the EOS group and 294 (50.7%) in the LOS group. In LOS group, 147 were in hLOS group and 147 were in cLOS group. The gestational age and birth weight of hLOS group were significantly lower than the other two groups [(32.7±3.6) weeks vs. (37.1±3.7) weeks and (37.7±3.0) weeks, (1 810±717) g vs. (2 837±865) g and (3 024±710) g] ( P<0.05). The common pathogens in EOS and cLOS groups were coagulase-negative staphylococci and Escherichia coli, while Klebsiella pneumoniae was common in hLOS group. Carbapenems usage in the hLOS group was significantly higher than the other two groups [62.6% vs. 28.7% and 16.2%] ( P<0.05). Antibiotics duration in the hLOS group was longer than the other two groups [19 (14, 27) d vs. 15 (12, 20) d and 14 (12, 19) d] ( P<0.05). Conclusions:The clinical characteristics of neonatal sepsis vary among different types of infections, and it is necessary to establish appropriate prevention, control, diagnosis and treatment protocols.

Research progress in evaluating severity and prognosis of children with community acquired pneumonia by scales and biomarkers / 中国小儿急救医学

Community acquired pneumonia(CAP)has a high morbidity and mortality rate, and can bring a heavy social and economic burden.Its etiology is complex.How to identify high-risk children, early diagnosis, prognosis prediction are the focus of clinical research.Early identification and active intervention of high-risk children who need hospitalization or admission to pediatric intensive care unit by using score scales and biomarkers are crucial to improve the survival rate.This review summarized the assessment of severity and prognosis of CAP in children by different score scales and biomarkers.

Current status of metabolomics in pediatric community-acquired pneumonia / 中国小儿急救医学

Community-acquired pneumonia(CAP) is one of the leading causes of death in children under 5 years of age.Early identification and clarification of its severity and appropriate therapeutic measures can improve survival, but there are limitations in the existing laboratory indices applied to diagnose CAP.Therefore, it is still necessary to find new and highly specific biomarkers that can identify the etiology and predict the severity of the disease before it worsens in children, and provides a basis for more effective therapeutic measures.Metabolomics provides a new way to search for biomarkers and pathogenesis through qualitative and quantitative analysis of metabolite changes in biological samples.This review summarized the latest research progress on metabolomics in childhood CAP, hoping to provide ideas for the early diagnosis and treatment of childhood CAP.

Molecular epidemiology progress of community-associated Methicillin-resistant Staphylococcus aureus infection in children / 中华实用儿科临床杂志

Antimicrobial resistance of Staphylococcus aureus is a main factor for the poor prognosis.In China, the detection rate of Methicillin-resistant Staphylococcus aureus (MRSA) in children is annually increasing, especially the community-acquired MRSA (CA-MRSA). This review discussed molecular characteristics, antimicrobial resistance mechanism and antimicrobial resistance progress of CA-MRSA, and analyzed recent molecular epidemiology and changes of drug resistance to CA-MRSA in children from China, thus providing theoretical basis for the prevention and control of CA-MRSA in children.

Research progress on the epidemiology of pneumonia / 预防医学

@#Pneumonia is a common lower respiratory tract infection, which causes a large disease and economic burden worldwide, and is an important public health problem to be solved urgently. Based on review of publications pertaining to the epidemiology of pneumonia from 2013 to 2023, this article summaries the epidemiological characteristics and main influencing factors of pneumonia. It is found that the epidemiological characteristics of pneumonia vary in different areas; men, the elderly and children are the high-risk groups of pneumonia incidence and mortality; and age, smoking, alcohol consumption, air pollution, comorbidity and vaccination are the main factors affecting the incidence and mortality of pneumonia. Strengthening health education, reducing exposure to risk factors and promoting vaccination are recommended to lower the morbidity and mortality of pneumonia in susceptible populations.