RESUMO
BACKGROUND/AIMS: Recently, the incidence of nursing home-acquired pneumonia (NHAP) has been increasing and is now the leading cause of death among nursing home residents. This study was performed to identify risk factors associated with NHAP mortality, focusing on facility characteristics. METHODS: Data on all patients ≥ 70 years of age admitted with newly diagnosed pneumonia were reviewed. To compare the quality of care in nursing facilities, the following three groups were defined: patients who acquired pneumonia in the community, care homes, and care hospitals. In these patients, 90-day mortality was compared. RESULTS: Survival analyses were performed in 282 patients with pneumonia. In the analyses, 90-day mortality was higher in patients in care homes (12.2%, 40.3%, and 19.6% in community, care homes, and care hospitals, respectively). Among the 118 NHAP patients, residence in a care home, structural lung diseases, treatment with inappropriate antimicrobial agents for accompanying infections, and a high pneumonia severity index score were risk factors associated with higher 90-day mortality. However, infection by potentially drug-resistant pathogens was not important. CONCLUSIONS: Unfavorable institutional factors in care homes are important prognostic factors for NHAP.
Assuntos
Infecção Hospitalar/mortalidade , Instituição de Longa Permanência para Idosos , Hospitais , Casas de Saúde , Pneumonia Bacteriana/mortalidade , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Causas de Morte , Infecção Hospitalar/diagnóstico , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/microbiologia , Feminino , Humanos , Prescrição Inadequada , Estimativa de Kaplan-Meier , Masculino , Pneumonia Bacteriana/diagnóstico , Pneumonia Bacteriana/tratamento farmacológico , Pneumonia Bacteriana/microbiologia , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do TratamentoRESUMO
A colonic lipoma is a very rare benign tumor that is usually asymptomatic and is found incidentally by colonoscopy. Patients with a large colonic lipoma may present with symptoms such as abdominal pain, bleeding, and colonic obstruction or intussusceptions. We report two patients with large colonic lipomas and symptoms. Standard endoscopic submucosal dissection (ESD) was performed to remove the lipomas instead of conventional surgical bowel resection. No complications were observed during or after the procedure. The tumors were resected en bloc, and the patients were discharged 2 d after ESD with a regular diet. The results indicate that ESD can be applied as safe and effective treatment for a large colonic lipoma.