RESUMO
One of the most common gastrointestinal infection after the antibiotic treatment of community or nosocomial pneumonia is caused by the anaerobic spore Clostridium difficile (C. difficile). The aim of this study was to retrospectively assess mortality due to C. difficile infection (CDI) in patients treated for pneumonia. We identified 94 cases of post-pneumonia CDI out of the 217 patients with CDI. The mortality issue was addressed by creating a mortality risk models using logistic regression and multivariate fractional polynomial analysis. The patients' demographics, clinical features, and laboratory results were taken into consideration. To estimate the influence of the preceding respiratory infection, a pneumonia severity scale was included in the analysis. The analysis showed two statistically significant and clinically relevant mortality models. The model with the highest prognostic strength entailed age, leukocyte count, serum creatinine and urea concentration, hematocrit, coexisting neoplasia or chronic obstructive pulmonary disease. In conclusion, we report on two prognostic models, based on clinically relevant factors, which can be of help in predicting mortality risk in C. difficile infection, secondary to the antibiotic treatment of pneumonia. These models could be useful in preventive tailoring of individual therapy.
Assuntos
Antibacterianos/efeitos adversos , Clostridioides difficile/isolamento & purificação , Enterocolite Pseudomembranosa/microbiologia , Enterocolite Pseudomembranosa/mortalidade , Pneumonia/tratamento farmacológico , Enterocolite Pseudomembranosa/diagnóstico , Humanos , Modelos Logísticos , Análise Multivariada , Razão de Chances , Pneumonia/diagnóstico , Pneumonia/microbiologia , Pneumonia/mortalidade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de TempoRESUMO
Bordetella pertussis is a gram-negative aerobic coccobacillus causing contagious respiratory tract disease called whooping cough. The virulence factors consist of pertussis toxin, filamentous hemagglutinin, fimbriae, lipooligosaccharide, and adenylate cyclase toxin. The disease causes a worldwide threat to public health despite a high vaccination coverage. The course of whooping cough in adults is frequently atypical, causing difficulty in diagnosis. In this report we present five patients hospitalized with Bordetella pertussis infection manifesting atypical and severe symptoms. The diagnosis was based on serological tests: serum concentration of specific antibodies against pertussis toxin and sputum cultures. We observed a wide spectrum of symptoms, from benign (sinus pain - 80 %, headaches - 20 %), through moderate (hemoptysis - 40 %; chest pain 60 %) to severe symptoms (cardiac arrhythmia - 40 %; syncope - 60 %). Bordetella pertussis infection can cause life-threatening complications and exacerbation of concomitant chronic diseases. Most vaccination programs cover only the first few months of life. Booster doses should be considered in adults, especially those immunocompromised or with pulmonary complications, but also in healthcare workers who are exposed to the contagion and also may spread the infection.
Assuntos
Bordetella pertussis/isolamento & purificação , Coqueluche , Adulto , Idade de Início , Idoso , Antibacterianos/uso terapêutico , Anticorpos Antibacterianos/sangue , Técnicas Bacteriológicas , Bordetella pertussis/efeitos dos fármacos , Bordetella pertussis/imunologia , Feminino , Hospitalização , Humanos , Esquemas de Imunização , Masculino , Pessoa de Meia-Idade , Vacina contra Coqueluche/administração & dosagem , Testes Sorológicos , Índice de Gravidade de Doença , Escarro/microbiologia , Resultado do Tratamento , Coqueluche/diagnóstico , Coqueluche/tratamento farmacológico , Coqueluche/imunologia , Coqueluche/microbiologiaRESUMO
Granulomatosis with Polyangiitis (GPA) is a rare disease of unknown origin. It may damage all organs and systems, even olfactory and taste sense. The aim of the study was to determine the sense of smell in patients with GPA and to identify factors related to disease course, activity, and duration, which may be associated with olfactory dysfunction. The comparison of olfactory function screening scores with Sniffin' Sticks standardized norms showed that 74% of the investigated patients had olfactory dysfunction. The olfactory performance was diminished in all parts of Sniffin' Sticks test: threshold scores 4.4 vs. 7.1 (p = 0.007); odor discrimination 9.0 vs. 11.9 (p = 0.008); and olfactory identification 9.8 vs. 12.2 (p = 0.011) in the GPA patients vs. control subjects, respectively. Scores acquired during all three parts of the test were combined to assess the TDI-score. The median TDI-score in the GPA group (27.5) was significantly lower than that in the control group (32.0) (p = 0.002). Active nasal and paranasal sinus inflammation in GPA leads to olfactory dysfunction, the patients are often unaware of. The dysfunction is permanent and does not abates along with decreasing intensity of the inflammatory process. GPA therapy should include recommendations on nutrition, personal hygiene, and food poisoning prevention.
Assuntos
Granulomatose com Poliangiite/diagnóstico , Transtornos do Olfato/diagnóstico , Doenças dos Seios Paranasais/diagnóstico , Adolescente , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Granulomatose com Poliangiite/complicações , Granulomatose com Poliangiite/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos do Olfato/epidemiologia , Doenças dos Seios Paranasais/epidemiologia , Prevalência , Limiar SensorialRESUMO
Clostridium difficile infection (CDI) is one of the most common gastrointestinal complication after antimicrobial treatment. It is estimated that CDI after pneumonia treatment is connected with a higher mortality than other causes of hospitalization. The aim of the study was to assess the relationship between the kind of antibiotic used for pneumonia treatment and mortality from post-pneumonia CDI. We addressed the issue by examining retrospectively the records of 217 patients who met the diagnostic criteria of CDI. Ninety four of those patients (43.3 %) came down with CDI infection after pneumonia treatment. Fifty of the 94 patients went through severe or severe and complicated CDI. The distribution of antecedent antibiotic treatment of pneumonia in these 50 patients was as follows: ceftriaxone in 14 (28 %) cases, amoxicillin with clavulanate in 9 (18 %), ciprofloxacin in 8 (16.0 %), clarithromycin in 7 (14 %), and cefuroxime and imipenem in 6 (12 %) each. The findings revealed a borderline enhancement in the proportion of deaths due to CDI in the ceftriaxone group compared with the ciprofloxacin, cefuroxime, and imipenem groups. The corollary is that ceftriaxone should be shunned in pneumonia treatment. The study demonstrates an association between the use of a specific antibiotic for pneumonia treatment and post-pneumonia mortality in patients who developed CDI.
Assuntos
Antibacterianos/uso terapêutico , Clostridioides difficile/efeitos dos fármacos , Infecções por Clostridium/tratamento farmacológico , Infecção Hospitalar/tratamento farmacológico , Pneumonia/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Amoxicilina/uso terapêutico , Ceftriaxona/uso terapêutico , Cefuroxima/uso terapêutico , Ciprofloxacina/uso terapêutico , Claritromicina/uso terapêutico , Ácido Clavulânico/uso terapêutico , Clostridioides difficile/fisiologia , Infecções por Clostridium/complicações , Infecções por Clostridium/microbiologia , Infecção Hospitalar/complicações , Infecção Hospitalar/microbiologia , Feminino , Hospitalização/estatística & dados numéricos , Interações Hospedeiro-Patógeno/efeitos dos fármacos , Humanos , Imipenem/uso terapêutico , Masculino , Pneumonia/complicações , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Clostridium difficile infection (CDI) is one of the most common gastrointestinal complication after antimicrobial treatment. It is estimated that CDI after pneumonia treatment is connected with a higher mortality than other causes of hospitalization. The aim of the study was to assess the relationship between the kind of antibiotic used for pneumonia treatment and mortality from post-pneumonia CDI. We addressed the issue by examining retrospectively the records of 217 patients who met the diagnostic criteria of CDI. Ninety four of those patients (43.3 %) came down with CDI infection after pneumonia treatment. Fifty of the 94 patients went through severe or severe and complicated CDI. The distribution of antecedent antibiotic treatment of pneumonia in these 50 patients was as follows: ceftriaxone in 14 (28 %) cases, amoxicillin with clavulanate in 9 (18 %), ciprofloxacin in 8 (16.0 %), clarithromycin in 7 (14 %), and cefuroxime and imipenem in 6 (12 %) each. The findings revealed a borderline enhancement in the proportion of deaths due to CDI in the ceftriaxone group compared with the ciprofloxacin, cefuroxime, and imipenem groups. The corollary is that ceftriaxone should be shunned in pneumonia treatment. The study demonstrates an association between the use of a specific antibiotic for pneumonia treatment and post-pneumonia mortality in patients who developed CDI.
RESUMO
Granulomatosis with polyangiitis (GPA), a disease capable of affecting any organ, most often acts upon the upper respiratory tract. Diagnostic imaging is primarily represented by computed tomography (CT) of paranasal sinuses. The aim of this study was to define the characteristic changes in paranasal CT in patients with GPA and to evaluate diagnostic usefulness of the Lund-Mackey scoring system (L-M System). The study encompassed 43 patients with GPA of the mean age of 47.7 ± 12.8 years who were treated topically with mupirocin. We found that inflammation occurred mainly in the maxillary sinuses (72%). The mean L-M score was 5.8 ± 6.1. The right maxillary sinus had the highest percentage (12.6%) of score hits of 1, i.e., partial opacification and the left ostiomeatal complex had the highest percentage (7.6%) of score of 2, i.e., complete opacification or obstruction. The following changes were the most characteristic for GPA: sinus mucosal thickening, widespread bone damage, and osteogenesis. We conclude that the long-term topical mupirocin treatment of GPA may inhibit nasal bone damage, but also may led to permanent rhinological changes of the rhinosinusitis type. The Lund-Mackey staging system is a useful diagnostic imaging option in GPA patients.
Assuntos
Granulomatose com Poliangiite/diagnóstico por imagem , Tomografia Computadorizada Multidetectores , Seios Paranasais/diagnóstico por imagem , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Administração Tópica , Adulto , Antibacterianos/administração & dosagem , Feminino , Granulomatose com Poliangiite/tratamento farmacológico , Humanos , Masculino , Seio Maxilar/diagnóstico por imagem , Pessoa de Meia-Idade , Mupirocina/administração & dosagem , Osso Nasal/diagnóstico por imagem , Mucosa Nasal/diagnóstico por imagem , Osteogênese , Seios Paranasais/efeitos dos fármacos , Valor Preditivo dos Testes , Resultado do TratamentoRESUMO
Simulations and perturbation theory are used to study the molecular origins of friction in an ideal model system, a layer of adsorbed molecules sliding over a substrate. These calculations reproduce several surprising features of experimental results. In most cases, the frictional force on a solid monolayer has a different form from that observed between macroscopic solids. No threshold force or static friction is needed to initiate sliding; instead, the velocity is proportional to the force. As in experiments, incommensurate solid layers actually slide more readily than fluid layers. A comparison of experiment, simulation, and analytic results shows that dissipation arises from anharmonic coupling between phonon modes and substrate-induced deformations in the adsorbate.
RESUMO
Molecular dynamics studies of nanometer-sized rigid grains, droplets and bubbles in nanometer-sized pores indicate that the drag force may have a hydrodynamic form if the moving object is dense and small compared to the pore diameter. Otherwise, the behavior is nonhydrodynamic. The terminal speed is insensitive to whether the falling droplet is made of liquid or a solid. The velocity profiles within droplets and bubbles that move in the pore are usually nonparabolic and distinct from those corresponding to individual fluids. The density profiles indicate motional shape distortion of the moving objects.