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1.
Braz. j. phys. ther. (Impr.) ; 17(4): 351-358, 23/ago. 2013. tab, graf
Article in English | LILACS | ID: lil-686023

ABSTRACT

BACKGROUND: Symptoms of fatigue and dyspnea, treatment with oral corticosteroids, high circulating levels of cytokines, and oxidant/antioxidant imbalance in patients hospitalized with community-acquired pneumonia (CAP) could affect the patients' exercise tolerance and peripheral muscle strength (PMS). OBJECTIVE: To evaluate the functional capacity (FC) of patients hospitalized for CAP and to correlate the FC with length of hospital stay. METHOD: We prospectively evaluated 45 patients (49±16 years; CAP group) and 20 healthy subjects (53±17 years; control group). They were randomized to perform, on separate days, a 6-minute walk test (6MWT), a test of PMS, and the Glittre test (GT). Additionally, the SF-36 questionnaire and the MRC scale were completed and evaluated. RESULTS: There were significant differences between the groups (CAP and controls) for the 6MWT (381.3±108 vs. 587.1±86.8 m) and GT (272.8±104.3 vs. 174±39 sec). The CAP group also presented worse health-related quality of life (HRQoL) scores, reduced strength (quadriceps and biceps), and higher scores of dyspnea. The time required to perform the GT correlated with the length of hospital stay (r=0.35, P=0.02) and dyspnea (r=0.36, P=0.02). Significant correlations were observed between GT and 6MWT (r=-0.66, P=0.0001) and between GT with the physical functioning domain of SF-36 (r=-0.51, P=0.0001). CONCLUSIONS: Patients hospitalized for CAP presented with reduced FC, PMS, and HRQoL during hospitalization. In addition, GT performance was related to the length of hospital stay. .


Subject(s)
Female , Humans , Male , Middle Aged , Pneumonia, Bacterial/physiopathology , Cross-Sectional Studies , Community-Acquired Infections/physiopathology , Exercise Tolerance , Hospitalization , Length of Stay , Muscle Strength , Prospective Studies , Quality of Life
2.
Rev. bras. ter. intensiva ; 25(2): 123-129, abr.-jun. 2013. ilus, tab
Article in Portuguese | LILACS | ID: lil-681991

ABSTRACT

OBJETIVO: Analisar dados clínicos, laboratoriais e de evolução de pacientes com pneumonia grave por vírus influenza A H1N1 em comparação à pneumonia bacteriana grave adquirida na comunidade. MÉTODOS: Estudo de coorte, retrospectivo. Todos os pacientes admitidos na unidade de terapia intensiva, entre maio de 2009 e dezembro de 2010, com diagnóstico de pneumonia grave por influenza A H1N1 foram incluídos. Trinta pacientes com pneumonia adquirida na comunidade grave admitidos no mesmo período foram usados como grupo controle. Pneumonia adquirida na comunidade grave foi definida como presença de ao menos um critério maior de gravidade (uso de ventilador ou vasopressor) ou de dois critérios menores. RESULTADOS: Foram avaliados os dados de 45 pacientes. Dentre eles, 15 pacientes com H1N1. Em comparação ao grupo com pneumonia adquirida na comunidade, pacientes do grupo H1N1 tiveram contagens de leucócitos significativamente menores na admissão (6.728±4.070 versus 16.038±7.863; p<0,05) e níveis de proteína C-reativa mais baixos (dia 2: 15,1±8,1 vs. 22,1±10,9 mg/dL, p<0,05). Os valores da relação PaO2/FiO2 foram menores na primeira semana em pacientes com H1N1. Não sobreviventes de pneumonia grave por H1N1 tiveram níveis significativamente mais elevados de proteína C-reativa do que os sobreviventes, além de níveis séricos mais altos de creatinina. A taxa de mortalidade foi significativamente mais elevada no grupo H1N1 do que no grupo controle (53% versus 20%, p=0,056, respectivamente. CONCLUSÃO: Diferenças nos perfis de contagem de leucócitos, proteína C-reativa e de oxigenação podem auxiliar no diagnóstico e na avaliação do prognóstico de pacientes com pneumonia grave por vírus influenza A H1N1 e por pneumonia adquirida na comunidade.


OBJECTIVE: To analyze the clinical, laboratory and evolution data of patients with severe influenza A H1N1 pneumonia and compare the data with that of patients with severe community-acquired bacterial pneumonia. METHODS: Cohort and retrospective study. All patients admitted to the intensive care unit between May 2009 and December 2010 with a diagnosis of severe pneumonia caused by the influenza A H1N1 virus were included in the study. Thirty patients with severe community-acquired pneumonia admitted within the same period were used as a control group. Severe community-acquired pneumonia was defined as the presence of at least one major severity criteria (ventilator or vasopressor use) or two minor criteria. RESULTS: The data of 45 patients were evaluated. Of these patients, 15 were infected with H1N1. When compared to the group with community-acquired pneumonia, patients from the H1N1 group had significantly lower leukocyte counts on admission (6,728±4,070 versus 16,038±7,863; p<0.05) and lower C-reactive protein levels (Day 2: 15.1±8.1 versus 22.1±10.9 mg/dL; p<0.05). The PaO2/FiO2 ratio values were lower in the first week in patients with H1N1. Patients who did not survive the H1N1 severe pneumonia had significantly higher levels of C-reactive protein and higher serum creatinine levels compared with patients who survived. The mortality rate was significantly higher in the H1N1 group than in the control group (53% versus 20%; p=0.056, respectivelly). CONCLUSION: Differences in the leukocyte count, C-reactive protein concentrations and oxygenation profiles may contribute to the diagnosis and prognosis of patients with severe influenza A H1N1 virus-related pneumonia and community-acquired pneumonia.


Subject(s)
Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Community-Acquired Infections/physiopathology , Influenza, Human/physiopathology , Pneumonia, Bacterial/physiopathology , Pneumonia, Viral/physiopathology , C-Reactive Protein/metabolism , Cohort Studies , Community-Acquired Infections/mortality , Influenza A Virus, H1N1 Subtype/isolation & purification , Influenza, Human/mortality , Leukocyte Count , Oxygen/metabolism , Prognosis , Prospective Studies , Pneumonia, Bacterial/mortality , Pneumonia, Viral/mortality , Retrospective Studies , Severity of Illness Index
3.
J. bras. med ; 96(4): 32-35, abr. 2009. ilus, tab
Article in Portuguese | LILACS | ID: lil-539059

ABSTRACT

Pneumonia comunitária é um problema comum na prática de clínica médica. O diagnóstico deve ser pensado em casos febris e(ou) com sinais e sintomas respiratórios, nos quais a radiografia torácica é fundamental nesta caracterização. Uma vez estabelecido o diagnóstico, devemos estratificar o paciente por grupos de risco para uma evolução desfavorável, aplicando critérios já bem estudados (CURB-65 e PSI) para definir hospitalização e a intensidade de cuidados médicos necessários. A avaliação clínico-epidemiológica ajuda na seleção da antibioticoterapia mais eficaz. Parâmetros de acompanhamento pragmáticos da resposta terapêutica, incluindo período pós-alta, são fornecidos.


Community acquired pneumonia is a fairly common problem in general practice. Clinical suspicion should arise in febrile cases, with or whitout respiratory symptoms, in which a chest radiograph is pivotal in the diagnosis. Once the diagnosis has been clinched, the patient should be risk stratified by groups, using well stablished criteria (CURB-65, PSI) to define hospital admission and level of medical care. Clinical epidemiologic analysis assists in the definition of the proper antimicrobial agent. Pragmatic therapeutic parameters of clinical response are provided (including post-dischargel).


Subject(s)
Male , Female , Adult , Pneumonia, Bacterial/etiology , Pneumonia, Bacterial/physiopathology , Pneumonia, Bacterial/therapy , Pneumonia, Bacterial/transmission , Anti-Infective Agents , Community-Acquired Infections , Emergency Treatment , Macrolides/therapeutic use , Clinical Protocols/standards , Streptococcus pneumoniae/pathogenicity , beta-Lactamases/therapeutic use
4.
Rev. méd. Chile ; 136(5): 587-593, mayo 2008. tab
Article in Spanish | LILACS | ID: lil-490711

ABSTRACT

Community acquired pneumonia (CAP) in the elderly has unique features and there is little information about the effects of nutrition status on its outcome. Aim: To assess the clinical manifestations and prognostic factors of CAP in immunocompetent elderly patients requiring hospitalization. Patients and methods: Prospective study of all patients with CAP, admitted to Puerto Montt Hospital, Chile over one year. Epidemiológica! and clinical information and laboratory results were recorded. A nutritional assessment was also performed. Outcomes of elderly (>65 years) and young patients were compared. Results: Two hundred patients aged 63± 19 years were studied. Of these, 109 were older than 65 years (78.4±8 years) and 91 were younger than 65years (45.5±11 years). Multiple associated diseases, altered mental status, absence of fever, malnutrition and mortality were more common in the older group. Suspected aspiration pneumonia was more common in younger patients, probably related to alcoholism. Malnutrition was associated with longer hospital stay and mortality at any age. An univariate analysis showed that a low serum albumin (<3.4 g/dl) and a mid arm muscle circumference below the 25th percentile were associated with higher mortality. Conclusions: CAP in the elderly has specific features and malnutrition is associated with a worse prognosis in young and elderly patients.


Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Geriatric Assessment , Nutritional Status , Pneumonia, Bacterial , Age Factors , Analysis of Variance , Community-Acquired Infections/microbiology , Community-Acquired Infections/physiopathology , Length of Stay , Malnutrition/physiopathology , Nutrition Assessment , Nutritional Status/physiology , Pneumonia, Bacterial/microbiology , Pneumonia, Bacterial/physiopathology , Prognosis , Prospective Studies , Serum Albumin/analysis
5.
Med. UIS ; 9(2): 90-100, abr.-jun. 1995.
Article in Spanish | LILACS | ID: lil-232103

ABSTRACT

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


Subject(s)
Humans , Infant , Child, Preschool , Child , Pneumonia, Bacterial/complications , Pneumonia, Bacterial/diagnosis , Pneumonia, Bacterial/etiology , Pneumonia, Bacterial/physiopathology , Pneumonia, Bacterial/rehabilitation
6.
Bol. Hosp. San Juan de Dios ; 42(3): 136-43, mayo-jun. 1995. tab
Article in Spanish | LILACS | ID: lil-156796

ABSTRACT

La neumonía del adulto mayor es una afección frecuente y seria, que tiene características especiales en sus manifestaciones clínicas; en su expresión semiológica y radiológica y en su comportamiento en lo que respecta a evolución, resolución y respuesta al tratamiento antibiótico. Lo anterior se debe a las modificaciones provocadas por la edad y las afecciones crónicas en los mecanismos defensivos celulares y humorales frente a las infecciones respiratorias bacterianas y virales. Dado que su pronóstico depende en gran medida de la oportunidad del tratamiento antibiótico, se enfatiza la necesidad de sospechar y pesquisar la posibilidad de neumopatía aguda, en el sujeto de edad aún frente a manifestaciones clínicas atípicas y larvadas. Se hace hincapié, asimismo, en la utilidad pero también en las limitaciones de los exámenes bacteriológicos y de la radiografía de tórax. Se señala la utilidad de los tratamientos antibióticos asociados. Finalmente se mencionan las principales complicaciones, destacando, entre ellas, la resolución lenta o aún la no resolución de algunas neumonías del anciano, enumerando sus principales causas


Subject(s)
Humans , Aged , Health of the Elderly , Pneumonia, Bacterial/diagnosis , Anti-Bacterial Agents/therapeutic use , Immunity , Immunocompromised Host , Pneumonia, Bacterial/complications , Pneumonia, Bacterial/etiology , Pneumonia, Bacterial/physiopathology , Radiography, Thoracic/methods , Signs in Homeopathy , Signs and Symptoms , Bacteriological Techniques , Treatment Outcome
7.
In. Muñoz Canto, Félix; Caviedes Soto, Iván. Cuidados intensivos respiratorios. Santiago de Chile, Mediterráneo, 1991. p.165-75. (Medicina Serie Práctica).
Monography in Spanish | LILACS | ID: lil-164844
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