Smaller erector spinae muscle size is associated with inability to recover activities of daily living after pneumonia treatment.

BACKGROUND: Elderly patients who are hospitalized due to pneumonia experience deterioration of their activities of daily living (ADL) during this period; in some cases, this loss of ADL is not recovered at the end of antibiotic treatment. In this study, we examined whether erector spinae muscle cross-sectional area (ESMCSA) measured by computed tomography (CT) could predict a low level of ADL at the end of antibiotic treatment for pneumonia. METHODS: Eighty patients (mean age 74.8 years) with pneumonia, who were admitted to Yamagata university hospital between 2015 and 2016, were analyzed retrospectively. In all cases, chest CT was performed on admission and ESMCSA was measured at the level of the 12th thoracic vertebra. Patient levels of ADL were also measured, both on admission and at the end of treatment, using the Barthel Index. RESULTS: Patients with lower levels of ADL at the end of treatment were significantly older and tended to have a lower body mass index, poorer nutritional status, and more severe pneumonia than did patients who were self-reliant. Significantly smaller ESMCSAs were noted in patients who required assistance at the end of treatment than in those who were self-reliant. In multivariate logistic regression analysis, smaller ESMCSA was significantly associated with a lower level of ADL at the end of treatment, independent of age, sex, severity of pneumonia, nutritional status, or dehydration status. CONCLUSION: These results suggest that ESMCSA can predict ADL level after antibiotic treatment of pneumonia.

National hospitalization trends for pediatric pneumonia and associated complications.

OBJECTIVE: To determine current rates of and trends in hospitalizations for community-acquired pneumonia (CAP) and CAP-associated complications among children. METHODS: We performed a cross-sectional, retrospective, cohort study by using the 1997, 2000, 2003, and 2006 Kids' Inpatient Database. National estimates for CAP and CAP-associated local and systemic complication rates were calculated for children < or =18 years of age. Patients with comorbid conditions or in-hospital birth status were excluded. Percentage changes were calculated by using 1997 (before heptavalent pneumococcal conjugate vaccine [PCV7]) and 2006 (after PCV7) data. RESULTS: There were a total of 619,102 CAP discharges for 1997, 2000, 2003, and 2006, after application of inclusion and exclusion criteria. Overall rates of CAP discharges did not change substantially between 1997 and 2006, but stratification according to age revealed a 22% decrease for children <1 year of age, minimal change for children 1 to 5 years of age, and increases for children 6 to 12 years (22%) and > or =13 years (41%) of age. Systemic complication rates were highest among children <1 year of age but decreased by 36%. In all other age groups, systemic complication rates remained stable. Local complication rates increased 78% overall. Children 1 to 5 years of age had the highest local complication rates. CONCLUSIONS: After the introduction of PCV7 in 2000, rates of CAP-associated systemic complications decreased only for children <1 year of age. Rates of pediatric CAP-associated local complications are increasing in all age groups.

Recurrent pneumonia caused by genetic immunodeficiency: a prophylactic and rehabilitative approach.

Recurrent infections are a consequence of a series of genetic diseases characterized by deficiency in the immunological response. One of these diseases is the agammaglobulinemia, which is characterized by the basic defect in the maturation of lymphocytes B. The carrier of this kind of immunodeficiency, which is linked to the X (XLA) chromosome, has had primary pneumonias that have evolved into secondary pneumonias (chronic lungs with sequelae) after the third or fourth year of life. The clinical and rehabilitative quest for prophylaxis against the XLA immunodeficiency is accomplished in order to avoid the evolution of the bacterial infection into sequelae and loss of pulmonary function, which propitiates the recurrence of the disease and deteriorates the life quality of the patient. Forty cases of recurrent respiratory infections were studied. Some of them were associated with primary respiratory diseases without investigation of serum immunoglobulins and some were not. Casuistics was performed according to data from medical records with pertinent treatments collected from January 1997 to September 2004 at the Specialized Physiotherapy Center. Age average was 2.7 years of life. It is statistically impossible to precise results concerning only the immunosuppressed patients due to the lack of specific diagnosis. That is explained by the fact that recurrent XLA pneumonias may be attributed to the gastroesophageal reflux disease or to bronchial asthma. However, the improved results showed by the pulmonary function as preventive strategy were attributed to the respiratory physiotherapy, since intravenous immunoglobulin replacement therapies were not performed. Respiratory physiotherapy acts as a supportive factor in the healing process and occupies a fundamental role in the prophylaxis against recurrent respiratory clinical features, especially those of obstructive and secretionary characteristics.

Recurrent pneumonia caused by genetic immunodeficiency: a prophylactic and rehabilitative approach

Recurrent infections are a consequence of a series of genetic diseases characterized by deficiency in the immunological response. One of these diseases is the agammaglobulinemia, which is characterized by the basic defect in the maturation of lymphocytes B. The carrier of this kind of immunodeficiency, which is linked to the X (XLA) chromosome, has had primary pneumonias that have evolved into secondary pneumonias (chronic lungs with sequelae) after the third or fourth year of life. The clinical and rehabilitative quest for prophylaxis against the XLA immunodeficiency is accomplished in order to avoid the evolution of the bacterial infection into sequelae and loss of pulmonary function, which propitiates the recurrence of the disease and deteriorates the life quality of the patient. Forty cases of recurrent respiratory infections were studied. Some of them were associated with primary respiratory diseases without investigation of serum immunoglobulins and some were not. Casuistics was performed according to data from medical records with pertinent treatments collected from January 1997 to September 2004 at the Specialized Physiotherapy Center. Age average was 2.7 years of life. It is statistically impossible to precise results concerning only the immunosuppressed patients due to the lack of specific diagnosis. That is explained by the fact that recurrent XLA pneumonias may be attributed to the gastroesophageal reflux disease or to bronchial asthma. However, the improved results showed by the pulmonary function as preventive strategy were attributed to the respiratory physiotherapy, since intravenous immunoglobulin replacement therapies were not performed. Respiratory physiotherapy acts as a supportive factor in the healing process and occupies a fundamental role in the prophylaxis against recurrent respiratory clinical features, especially those of obstructive and secretionary characteristics.

Managing postacute hospital care: a case for biopsychosocial needs.

OBJECTIVE: This study aimed to investigate whether, for an identical diagnosis, patients who were transferred to a postacute care (PAC) facility had a higher biopsychosocial complexity than patients who were discharged home. METHODS: This prospective study employed group comparison that included 166 patients who were consecutively admitted to an acute care internal medicine ward for acute congestive heart failure, pneumonia or exacerbation of chronic obstructive pulmonary disease, and malaise or fall. Patients were evaluated within their first 48 h of stay. Biomedical, functional, quality of life, and case complexity data were collected. Factors associated with a transfer to the PAC facility were identified through logistic regression modeling. RESULTS: Fifty-eight patients (34.9%) were transferred. In the multivariate analyses, case complexity score [per point: odds ratio (OR)=1.29; 95% CI=1.18-1.41] and nursing workload (OR=1.06; 95% CI=1.01-1.12) were associated with the transfer. At a cutoff point of > or =33, the case complexity score predicted transfer to the PAC facility with a sensitivity of 79% and a specificity of 84% (positive predictive value=73.0%; negative predictive value=88.4%) and correctly classified 83% of the cases. CONCLUSIONS: Biomedical characteristics alone did not differentiate patients who were transferred versus those who were discharged home, nor did it predict PAC use. This was also true for specific severity scores of cardiac failure and pneumonia as well as for the comorbidity index. Psychosocial parameters were significantly associated to this process as well as a higher nursing workload.

[Community pneumonia in recruits: the algorithm of complex two-staged rehabilitation treatment].

The program of complex recovery therapy and medical rehabilitation (MR) for treating the patients with mild form of community-acquired pneumonia (CAP) is presented. 89 servicemen-recruits with CAP mild form treated during 2003-2005 in the Field Therapy Clinic of Saratov Military Medical Institute were investigated. MR was conducted on the basis of medical station (MS) and lasted for 15 days. Physiological, laboratory and instrumental parameters were evaluated at the day of antibiotic therapy cancel, on discharge from hospital, on the 5-th and 15-th day of MR. The peroxidation activity, intensity of unspecific resistance mechanisms and obstructive impairment of bronchial passages remained during CAP late phases. Only on the 15th day of extensive medical rehabilitation measures in 80,7% of those suffered from CAP the reserve capacity indices of cardiovascular system reached the lower level of the border state of PWC170 test scales, Skibinskiy's and Bogomazov's tests. The proposed two-staged program of medical rehabilitation in CP cases which includes the combined use of actoprotector and antioxidant, restoration of bronchial tree drainage function, early introduction of breathing exercises and cyclotraining allowed achieving the restoration of working and fighting capacity in short terms. The stay in pulmonologic in-patient department became 3 days less.

Early mobilization of patients hospitalized with community-acquired pneumonia.

STUDY OBJECTIVE: To determine if early mobilization (EM) of hospitalized adults with community-acquired pneumonia (CAP) reduces hospital length of stay. DESIGN: Group randomized trial. SETTING: Three Midwestern hospitals. PARTICIPANTS: Four hundred fifty-eight patients with CAP admitted to 17 general medical units between November 1997 and April 1998. INTERVENTION: EM was defined as sitting out of bed or ambulating for at least 20 min during the first 24 h of hospitalization. Progressive mobilization occurred each subsequent day during hospitalization. MEASUREMENTS AND RESULTS: Intervention (n = 227) and usual-care patients (n = 231) were similar in age, gender, disease severity, door-to-drug delivery time, and IV-to-po switchover time. Hospital length of stay for EM vs usual care was significantly less (mean, 5.8 vs 6.9 days; adjusted absolute difference, 1.1 days; 95% confidence interval, 0.0 to 2.2 days). There were no differences in adverse events or other secondary outcomes between treatment groups. CONCLUSIONS: Like patients hospitalized with acute myocardial infarction and total knee replacements, EM of hospitalized patients with CAP reduces overall hospital length of stay and institutional resources without increasing the risk of adverse outcomes.

[Clinical analysis of pneumonia treated at the hospital]. / Analiza kliniczna przebiegu zapalen pluc leczonych szpitalnie.

104 cases of pneumonia, treated in Department of Pulmonary Diseases of Military Medical Academy in the years 1995-1997, were analysed. Patients were divided into two groups. In the first group were 58 patients which had acute symptoms of pneumonia and the treatment was started in our department without any treatment before. In the second group were 45 patients which had acute symptoms two or three weeks before admission to hospital. In this period these patients received one or more antibiotics. The bacteriological findings and the periods of the treatment were analysed in these both groups.

Neumonía Bacteriana en Niños Adquirida en la Comunidad, Protocolo de Manejo Hospitalario

Las infecciones respiratorias agudas son una de las causas más comunes de muerte entre los niños de los países en desarrollo. A estas de les atribuyen cuatro millones de defunciones de los 15 millones de que se estima ocurren entre menores de cinco años de edad anualmente. Casi todas las muertes por infección respiratoria aguda entre los niños pequeños se deben a infecciones respiratorias inferiores, en particular neumonía. En este artículo se presenta una revisión sobre la importancia de la neumonía bacteriana en pediatría, su clasificación, factores predisponentes, agentes etiológicos, y teniendo en cuenta las dificultades descritas en la literatura para realizar el diagnóstico etiológico, se establece un protocolo de tratamiento antimicrobiano empírico para el manejo de la neumonía en niños adquirida en la comunidad