RESUMO
BACKGROUND: Community acquired pneumonia (CAP) is a major cause of mortality and morbidity in our environment. Recent data on the role of complications on outcome of CAP are not readily available in Nigeria. AIM: This study aims to analyze the influence of complications on the outcome of CAP in a tertiary health center in Eastern Nigeria. SUBJECTS AND METHODS: A prospective observational study was carried out on 80 patients with CAP, who met the inclusion criteria. Data relating to their age, gender, and clinical details; severity assessment using CURB 65 (C- confusion, Serum urea > 7mmol/L, R-respiratory rate > 30, B-systolic BP > 90 and diastolic BP ≤ 60, age > 65 years.) scoring system, laboratory results, complications, and outcome (mortality) were collected. The statistical package used for data analysis is SPSS version 17.0 (Chicago IL USA). Data were presented in tables and charts. Sample means, standard deviation, and Chi-square test were used for statistical significance. Severity was assessed using CURB65 scoring system. Outcome of interest was 30 day mortality. In all P value of 0.05 was regarded as significant. RESULTS: Eighty patients were recruited for the study, 39 males and 41 females; giving male:female ratio of 1:1.05. The mean age range was 56 (18.0) years. A total of 37 patients were managed as out-patients while 43 were managed as in-patients. Complications were observed in 25 patients. Severe hemodynamic changes and pleural effusion 8/25 (32%) were the most common complications observed. Total mortality was 12/80 (15%). Mortality was higher in in-patients than out-patients however, this was not statistically significant. Mortality in those with complications was 6/25 (24%) compared to 6/55 (11%) in those without complications (P = 0.10). CONCLUSION: Mortality rate in patients with CAP though higher in patients with complications numerically were not found to be significantly higher than in those without complications. We posit that other factors like presence of higher severity assessment scores (CURB-65 scores) and co-morbidities may be more important predictors of mortality in CAP patients and should be further studied.
RESUMO
BACKGROUND: Assessment of patients prior to cytotoxic chemotherapy usually includes absolute neutrophils count. Other cellular markers of susceptibility to infection as well as immunocompetence include the T Helper lymphocyte count. In cancer patients, decrease in these lymphocytes has been observed to be associated with decreased overall survival. AIM: To assess the degree of CD4 lymphopenia encountered during cytotoxic chemotherapeutic treatment for cancer and evaluate the differences observed for the various drug combinations. SUBJECTS AND METHODS: Eighty patients with various histologically diagnosed malignancies had their CD4 lymphocyte counts carried out at days 0 and 12 of the first cycle of their various chemotherapeutic regimens. They were adult patients who had been diagnosed with breast cancer 36/80 cases (45%), non-Hodgkin's lymphoma 8/80 cases (10%), Hodgkin's lymphoma 13/80 cases (16.3%), multiple myeloma 7/80 cases (8.8%), colorectal carcinoma 6/80 cases (7.5%), and other malignancies 10/80 cases (12.5%). CD4 lymphocyte count was done using the Partec Cyflow(®) 2000 CD4 cell counter, and their socio-demographic data of the patients were assessed using a questionnaire. RESULTS: The mean (sd) CD4 lymphocyte count pre- and post-chemotherapy was observed to be 567 (341) cells/µLand 349 (207) cells/µL while the median values were 454 cells/µLand 349 cells/µL respectively. There were significant differences in CD4 lymphocyte counts after chemotherapy compared to the pre-chemotherapy values. CONCLUSION: Epirubicin combinations used in breast cancer patients as well as (Adriamycin, Bleomycin, Vinblastine, Dacarbazine) ABVD regimen used in treatment of Hodgkin's lymphoma were found to be significantly less lymphotoxic than other chemotherapeutic combinations. These drugs or their combinations may be less immunotoxic than other known regimen used for these malignancies.
