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1.
J Clin Immunol ; 2019 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-31828694

RESUMO

Mannose-binding lectin (MBL)-associated serine protease-2 (MASP-2) is an indispensable enzyme for the activation of the lectin pathway of complement. Its deficiency is classified as a primary immunodeficiency associated to pyogenic bacterial infections, inflammatory lung disease, and autoimmunity. In Europeans, MASP-2 deficiency, due to homozygosity for c.359A > G (p.D120G), occurs in 7 to 14/10,000 individuals. We analyzed the presence of the p.D120G mutation in adults (increasing the sample size of our previous studies) and children. Different groups of patients (1495 adults hospitalized with community-acquired pneumonia, 186 adults with systemic lupus erythematosus, 103 pediatric patients with invasive pneumococcal disease) and control individuals (1119 healthy adult volunteers, 520 adult patients without history of relevant infectious diseases, and a pediatric control group of 311 individuals) were studied. Besides our previously reported MASP-2-deficient healthy adults, we found a new p.D120G homozygous individual from the pediatric control group. We also reviewed p.D120G homozygous individuals reported so far: a total of eleven patients with a highly heterogeneous range of disorders and nine healthy controls (including our four MASP-2-deficient individuals) have been identified by chance in association studies. Individuals with complete deficiencies of several pattern recognition molecules of the lectin pathway (MBL, collectin-10 and collectin-11, and ficolin-3) as well as of MASP-1 and MASP-3 have also been reviewed. Cumulative evidence suggests that MASP-2, and even other components of the LP, are largely redundant in human defenses and that individuals with MASP-2 deficiency do not seem to be particularly prone to infectious or autoimmune diseases.

2.
Rev. Fund. Educ. Méd. (Ed. impr.) ; 22(1): 5-10, ene.-feb. 2019. graf
Artigo em Espanhol | IBECS | ID: ibc-181895

RESUMO

La formación de profesionales sanitarios conlleva unos objetivos de aprendizaje concretos que deben traducirse en unos resultados de aprendizaje observables y evaluables y, por lo tanto, que el conocimiento se alcance con un alto grado de pericia. Con el fin de mejorar el aprendizaje de habilidades clínicas se han desarrollado instrumentos para evaluar el aprendizaje autorregulado, un proceso activo en el que la persona selecciona las metas académicas que desea alcanzar y regula una serie de variables que intervienen en el aprendizaje con el objetivo de alcanzarlas. Un ejemplo de ello es la evaluación microanalítica del aprendizaje autorregulado, una entrevista estructurada que intenta captar los pensamientos, sentimientos y acciones dedicados a la ejecución de tareas específicas. La investigación actual en este campo ha demostrado que los estudiantes de alto rendimiento tienden en general a mostrar un pensamiento más estratégico y una mejor regulación al realizar las actividades o tareas. Se pretende establecer el microanálisis como estrategia para identificar el aprendizaje de los alumnos y como meta para poder generalizarse en la educación en ciencias de la salud


The training of healthcare professionals obeys to specific learning objectives that must result in observable and assessable learning achievements, and in mastered knowledge acquisition. In order to improve the learning process of clinical skills, several methods have been developed with the aim of assessing self-regulated learning. Self-regulated learning is an active process where individuals select the academic goals they wish to achieve and, for that purpose, they regulate a set of factors that influence their learning. Self-Regulated Learning Microanalytic Assessment and Training may be taken as an example. This method consists of a structured interview that tries to capture the thoughts, feelings and actions devoted to the execution of specific tasks. Current investigations in this field have shown that high-achievers tend to think more strategically and regulate themselves better when performing activities or tasks. Finally, the microanalysis may be implemented as the strategy used to identify how students learn, and to generalize in healthcare education


Assuntos
Humanos , Aprendizagem , Autocontrole/psicologia , Autoeficácia , Modelos Educacionais , Avaliação Educacional , Ocupações em Saúde/educação , Estudantes de Ciências da Saúde/estatística & dados numéricos , Motivação
3.
J Clin Immunol ; 38(4): 513-526, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29882021

RESUMO

The pathogenesis of life-threatening influenza A virus (IAV) disease remains elusive, as infection is benign in most individuals. We studied two relatives who died from influenza. We Sanger sequenced GATA2 and evaluated the mutation by gene transfer, measured serum cytokine levels, and analyzed circulating T- and B-cells. Both patients (father and son, P1 and P2) died in 2011 of H1N1pdm IAV infection at the ages of 54 and 31 years, respectively. They had not suffered from severe or moderately severe infections in the last 17 (P1) and 15 years (P2). A daughter of P1 had died at 20 years from infectious complications. Low B-cell, NK- cell, and monocyte numbers and myelodysplastic syndrome led to sequence GATA2. Patients were heterozygous for a novel, hypomorphic, R396L mutation leading to haplo-insufficiency. B- and T-cell rearrangement in peripheral blood from P1 during the influenza episode showed expansion of one major clone. No T-cell receptor excision circles were detected in P1 and P3 since they were 35 and 18 years, respectively. Both patients presented an exuberant, interferon (IFN)-γ-mediated hypercytokinemia during H1N1pdm infection. No data about patients with viremia was available. Two previously reported adult GATA2-deficient patients died from severe H1N1 IAV infection; GATA2 deficiency may predispose to life-threatening influenza in adulthood. However, a role of other genetic variants involved in immune responses cannot be ruled out. Patients with GATA2 deficiency can reach young adulthood without severe infections, including influenza, despite long-lasting complete B-cell and natural killer (NK) cell deficiency, as well as profoundly diminished T-cell thymic output.


Assuntos
Deficiência de GATA2/complicações , Influenza Humana/diagnóstico , Influenza Humana/etiologia , Biomarcadores , Citocinas/sangue , Análise Mutacional de DNA , Evolução Fatal , Feminino , Deficiência de GATA2/diagnóstico , Deficiência de GATA2/genética , Fator de Transcrição GATA2/genética , Humanos , Imunofenotipagem , Vírus da Influenza A , Influenza Humana/virologia , Subpopulações de Linfócitos/imunologia , Subpopulações de Linfócitos/metabolismo , Masculino , Mutação , Linhagem
7.
FEM (Ed. impr.) ; 20(4): 149-160, jul.-ago. 2017. graf, ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-165521

RESUMO

Todas las actuaciones médicas tienen una curva de aprendizaje, pero el razonamiento clínico se mantiene como un elemento clave en cualquiera de ellas. Los médicos experimentados manejan una gran cantidad de información en cualquier proceso clínico. Para conseguir la máxima eficiencia en la utilización de esta información, los clínicos emplean una serie de estrategias que les permiten combinar datos y sintetizarlos en un número reducido de hipótesis diagnósticas, evaluar los riesgos y los beneficios de realizar nuevos procedimientos diagnósticos y aplicar determinados tratamientos, y formular planes en el manejo del paciente. Uno de los objetivos principales de cualquier docente médico es promover el desarrollo de una forma de razonar experta en sus estudiantes. Sin embargo, enseñar estas habilidades cognitivas no es tarea sencilla porque no existe una teoría completa y ampliamente aceptada acerca de los procesos de razonamiento clínico, e incluso los médicos más experimentados a menudo no son conscientes de los métodos de razonamiento que utilizan para alcanzar un diagnóstico. Desde hace más de cuarenta años se ha investigado en este campo. En este artículo se revisan las bases científicas y las teorías propuestas a lo largo de este período acerca del modo de razonar de los clínicos. También se analiza la evolución de las estructuras del conocimiento y se examinan algunos errores frecuentes en razonamiento diagnóstico. Por último, se proponen algunas recomendaciones prácticas específicas para ayudar a los principiantes a fortalecer sus habilidades de razonamiento diagnóstico (AU)


There is a learning curve in almost everything doctors do, but judgment remains a key determinant of the value of any clinical intervention. Expert physicians manage huge amounts of information to ensure the quality of patient care by using a set of efficient reasoning strategies. These strategies allow them to combine and synthesize data into a few diagnostic hypotheses, assess benefits and risks of additional diagnostic procedures and treatments, and articulate plans for patient management. A major goal of the medical educators is to foster the development of expert clinical reasoning in apprentices. However, teaching these cognitive skills is a difficult task because there is no generally accepted inclusive theory of the clinical reasoning process and even the most seasoned clinicians are often unaware of the reasoning methods that lead them to achieve accurate diagnoses. Research in this field has been carried out for over 40 years. In this paper we review the scientific background and theories proposed throughout this time about how clinicians reason. We also analyze the evolution of knowledge structures and examine some common errors in diagnostic reasoning. Finally, we provide several practical and specific recommendations to help learners strengthen their diagnostic reasoning skills (AU)


Assuntos
Humanos , Educação Médica/tendências , Competência Clínica , Técnicas e Procedimentos Diagnósticos/tendências , Aptidão , Diagnóstico Clínico
8.
FEM (Ed. impr.) ; 20(3): 111-116, mayo-jun. 2017. ilus, tab, mapas, graf
Artigo em Espanhol | IBECS | ID: ibc-164283

RESUMO

Todos los países, cualquiera que sea su grado de desarrollo, se esfuerzan por proporcionar unos cuidados sanitarios adecuados a sus ciudadanos. Gozar de buena salud es una condición básica para el desarrollo y la seguridad de las personas, a pesar de lo cual persisten enormes desigualdades en salud entre los países. Los educadores médicos tienen un papel clave en la reducción de estas desigualdades al abordar uno de los aspectos esenciales del problema: la acusada escasez de médicos que sufren algunas regiones, especialmente en el África subsahariana. Una de las mayores dificultades para afrontar esta cuestión es la falta de profesores cualificados, lo que podría solventarse mediante estancias cortas de graduados procedentes de países desarrollados que voluntariamente quisieran participar en este tipo de iniciativas. Pero el mundo de la educación médica tampoco es un terreno justo, equilibrado y equitativo, y trabajar en países pobres y alejados supone un reto importante. En este artículo, presentamos la experiencia en el diseño y desarrollo de un proyecto de formación de médicos en la Universidad de Zambeze, en Tete (Mozambique), llevada a cabo desde la Universidad de Las Palmas de Gran Canaria (AU)


Every nation –rich or poor and developed or developing– strives hard to deliver optimal healthcare to its citizens. Good health is the necessary condition for development and human security, but inequities in health persist. Medical educators have a key role to play in reducing inequities in global health by addressing the underlying doctor shortages that have reached crisis levels in some regions. The region in which these health inequities and doctor deficiencies are starkest is sub-Saharan Africa. In poor countries, a major constraint to approach this issue is the scarcity of qualified teachers. One of the options is the short-term placement of graduates from rich countries seeking opportunities to contribute in other countries that are severely deficient in faculty. But the world of medical education is not a level playing field and working in developing countries, and in remote areas in particular, can be challenging. In this article we show a recent experience carried out at the University of Las Palmas de Gran Canaria designing and supporting a project on undergraduate medical education at the University of Zambeze, in Tete, Mozambique (AU)


Assuntos
Humanos , Educação Médica/tendências , Faculdades de Medicina/tendências , Países em Desenvolvimento , Moçambique , Programas de Estudo
9.
Int J Environ Health Res ; 27(2): 144-160, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28245676

RESUMO

Gran Canaria Island is frequently impacted by Saharan dust, a health hazard of particular concern to the island population and health agencies. Airborne mineral dust has the severest impact on the higher age groups of the population, and those with respiratory conditions; despite that, on average, the ambient particulate matter (PM) concentrations fall within international PM guidelines. During 2010 and 2011, an epidemiological survey, in parallel with an air quality study, was conducted at the Dr Negrín hospital in Gran Canaria. This included the quarterly monitoring of outpatients and recording of emergency patients with respiratory diseases, together with the measurement of aerosol, meteorological, and PM-related air quality levels. The finer more toxic particles were collected with PM2.5 (particulate matter with aerodynamic diameter less than 2.5 µm) aerosol samplers. The filter samples were gravimetrically and chemically analyzed for their elemental, water-soluble ions, carbon, and mineralogical contents. Individual particle morphology was measured by Scanning Electron Microscopy. Statistical analysis of the chemical and clinical data included the analysis of variance and calculation of Spearman correlation coefficients. No statistically significant relations were found between the allergic control group, the emergency room admissions, pulmonary conditions, medication, and elevated Saharan dust levels. However, changing environmental conditions, such as an increase in humidity or a reduction in ambient air temperature made a significant difference to the outcomes recorded on the health statements of the allergic and respiratory illness groups of the Gran Canary population.


Assuntos
Poluentes Atmosféricos/toxicidade , Poeira , Exposição Ambiental , Hipersensibilidade/epidemiologia , Material Particulado/toxicidade , Adolescente , Adulto , Aerossóis/análise , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Poluentes Atmosféricos/análise , Poeira/análise , Monitoramento Ambiental , Feminino , Humanos , Hipersensibilidade/etiologia , Masculino , Pessoa de Meia-Idade , Material Particulado/análise , Espanha/epidemiologia , Adulto Jovem
11.
J Infect ; 73(5): 419-426, 2016 11.
Artigo em Inglês | MEDLINE | ID: mdl-27506395

RESUMO

Community-acquired pneumonia (CAP) is a serious infection that may occasionally rapidly evolve provoking organ dysfunctions. We aimed to characterize CAP presenting with organ dysfunctions at the emergency room, with regard to host factors and causative microorganisms, and its impact on 30-day mortality. 460 of 4070 (11.3%) CAP patients had ≥2 dysfunctions at diagnosis, with a 30-day mortality of 12.4% vs. 3.4% in those with one or no dysfunctions. Among them, the most frequent causative microorganisms were Streptococcus pneumoniae, gram-negatives and polymicrobial etiology. Independent host risk factors for presenting with ≥2 dysfunctions were: liver (OR 2.97) and renal diseases (OR 3.91), neurological disorders (OR 1.86), and COPD (OR 1.30). Methicillin-resistant Staphylococcus aureus (OR 6.41) and bacteraemic episodes (OR 1.68) had the higher independent risk among microorganisms. The number of organ dysfunctions vs. none increased at 30-day mortality: three organs (OR 11.73), two organs (OR 4.29), and one organ (OR 2.42) whereas Enterobacteria (OR 3.73) were also independently related to mortality. The number of organ dysfunctions was the strongest 30-day mortality risk factor while Enterobacteriaceae was also associated with poorer outcome. The assessment of organ dysfunctions in CAP should be implemented for management, allocation and treatment decisions on initial evaluation.


Assuntos
Insuficiência de Múltiplos Órgãos/microbiologia , Insuficiência de Múltiplos Órgãos/mortalidade , Pneumonia/complicações , Idoso , Infecções Comunitárias Adquiridas , Comorbidade , Feminino , Bactérias Gram-Negativas/isolamento & purificação , Infecções por Bactérias Gram-Negativas , Humanos , Modelos Logísticos , Masculino , Insuficiência de Múltiplos Órgãos/etiologia , Pneumonia Estafilocócica , Estudos Prospectivos , Fatores de Risco , Espanha/epidemiologia , Resultado do Tratamento
12.
PLoS One ; 11(1): e0145929, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26727202

RESUMO

BACKGROUND: Severe sepsis, may be present on hospital arrival in approximately one-third of patients with community-acquired pneumonia (CAP). OBJECTIVE: To determine the host characteristics and micro-organisms associated with severe sepsis in patients hospitalized with CAP. RESULTS: We performed a prospective multicenter cohort study in 13 Spanish hospital, on 4070 hospitalized CAP patients, 1529 of whom (37.6%) presented with severe sepsis. Severe sepsis CAP was independently associated with older age (>65 years), alcohol abuse (OR, 1.31; 95% CI, 1.07-1.61), chronic obstructive pulmonary disease (COPD) (OR, 1.75; 95% CI, 1.50-2.04) and renal disease (OR, 1.57; 95% CI, 1.21-2.03), whereas prior antibiotic treatment was a protective factor (OR, 0.62; 95% CI, 0.52-0.73). Bacteremia (OR, 1.37; 95% CI, 1.05-1.79), S pneumoniae (OR, 1.59; 95% CI, 1.31-1.95) and mixed microbial etiology (OR, 1.65; 95% CI, 1.10-2.49) were associated with severe sepsis CAP. CONCLUSIONS: CAP patients with COPD, renal disease and alcohol abuse, as well as those with CAP due to S pneumonia or mixed micro-organisms are more likely to present to the hospital with severe sepsis.


Assuntos
Infecções Comunitárias Adquiridas/complicações , Pneumonia Bacteriana/complicações , Pneumonia Viral/complicações , Sepse/epidemiologia , Idoso , Infecções Comunitárias Adquiridas/microbiologia , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Pneumonia Bacteriana/microbiologia , Pneumonia Viral/virologia , Estudos Prospectivos , Fatores de Risco , Sepse/etiologia , Sepse/mortalidade , Índice de Gravidade de Doença
13.
Ann Am Thorac Soc ; 12(10): 1482-9, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26288389

RESUMO

RATIONALE: Detection of the C-polysaccharide of Streptococcus pneumoniae in urine by an immune-chromatographic test is increasingly used to evaluate patients with community-acquired pneumonia. OBJECTIVES: We assessed the sensitivity and specificity of this test in the largest series of cases to date and used logistic regression models to determine predictors of positivity in patients hospitalized with community-acquired pneumonia. METHODS: We performed a multicenter, prospective, observational study of 4,374 patients hospitalized with community-acquired pneumonia. MEASUREMENTS AND MAIN RESULTS: The urinary antigen test was done in 3,874 cases. Pneumococcal infection was diagnosed in 916 cases (21%); 653 (71%) of these cases were diagnosed exclusively by the urinary antigen test. Sensitivity and specificity were 60 and 99.7%, respectively. Predictors of urinary antigen positivity were female sex; heart rate≥125 bpm, systolic blood pressure<90 mm Hg, and SaO2<90%; absence of antibiotic treatment; pleuritic chest pain; chills; pleural effusion; and blood urea nitrogen≥30 mg/dl. With at least six of all these predictors present, the probability of positivity was 52%. With only one factor present, the probability was only 12%. CONCLUSIONS: The urinary antigen test is a method with good sensitivity and excellent specificity in diagnosing pneumococcal pneumonia, and its use greatly increased the recognition of community-acquired pneumonia due to S. pneumoniae. With a specificity of 99.7%, this test could be used to direct simplified antibiotic therapy, thereby avoiding excess costs and risk for bacterial resistance that result from broad-spectrum antibiotics. We also identified predictors of positivity that could increase suspicion for pneumococcal infection or avoid the unnecessary use of this test.


Assuntos
Antibacterianos/uso terapêutico , Infecções Pneumocócicas/urina , Pneumonia Pneumocócica/tratamento farmacológico , Pneumonia Pneumocócica/urina , Polissacarídeos Bacterianos/urina , Idoso , Idoso de 80 Anos ou mais , Infecções Comunitárias Adquiridas , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prognóstico , Estudos Prospectivos , Sensibilidade e Especificidade , Streptococcus pneumoniae
14.
Int J Med Educ ; 6: 65-75, 2015 Jun 08.
Artigo em Inglês | MEDLINE | ID: mdl-26057355

RESUMO

OBJECTIVE: The purpose of this study was to investigate student's perceptions of Educational Climate (EC) in Spanish medical schools, comparing various aspects of EC between the 2nd (preclinical) and the 4th (clinical) years to detect strengths and weaknesses in the on-going curricular reform. METHODS: This study utilized a cross-sectional design and employed the Spanish version of the "Dundee Ready Education Environment Measure" (DREEM). The survey involved 894 2nd year students and 619 4th year students from five Spanish medical schools. RESULTS: The global average score of 2nd year students from the five medical schools was found to be significantly higher (116.2±24.9, 58.2% of maximum score) than that observed in 4th year students (104.8±29.5, 52.4% of maximum score). When the results in each medical school were analysed separately, the scores obtained in the 2nd year were almost always significantly higher than in the 4th year for all medical schools, in both the global scales and the different subscales. CONCLUSIONS: The perception of the EC by 2nd and 4th year students from five Spanish medical schools is more positive than negative although it is significantly lower in the 4th year. In both years, although more evident in the 4th year, students point out the existence of several important "problematic educational areas" associated with the persistence of traditional curricula and teaching methodologies. Our findings of this study should lead medical schools to make a serious reflection and drive the implementation of the necessary changes required to improve teaching, especially during the clinical period.


Assuntos
Educação de Pós-Graduação em Medicina , Educação de Graduação em Medicina , Percepção , Faculdades de Medicina , Estudantes de Medicina/psicologia , Adulto , Estudos Transversais , Currículo/normas , Feminino , Humanos , Masculino , Controle de Qualidade , Faculdades de Medicina/organização & administração , Faculdades de Medicina/normas , Espanha/epidemiologia , Estudantes de Medicina/estatística & dados numéricos , Inquéritos e Questionários , Adulto Jovem
16.
J Rheumatol ; 41(9): 1801-7, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25086072

RESUMO

OBJECTIVE: To determine the incidence of pneumonia and associated factors in a single-center systemic lupus erythematosus (SLE) cohort. METHODS: We included all our SLE patients [1997 American College of Rheumatology (ACR) criteria] with ≥ 1 pneumonia event, and 196 age and sex-matched SLE controls with no pneumonia events. Cumulative clinical data, weighted Systemic Lupus International Collaborating Clinics/ACR damage index (wSLICC/ACR-DI), comorbidities, and risk factors for pneumonia were retrospectively collected. The standardized incidence ratio (SIR) of pneumonia was estimated. Polymorphisms at genes coding for mannose binding lectin (MBL), MBL-associated serine protease 2, Fc-gamma receptors, and surfactant proteins A1, A2, and D were determined, and their potential association with pneumonia was analyzed. Patients with and without pneumonia were compared using a multivariate logistic regression model for adjustment of pneumonia-associated factors. RESULTS: Thirty-six of 232 patients with SLE had experienced ≥ 1 pneumonia event. SIR for pneumonia was 5.1 (95% CI 3.5-7.4; p < 0.0001). Excluding patients receiving immunosuppressive therapy at the time of pneumonia (13%), associations were found for Katz Severity Index (KSI) (p = 0.016), wSLICC/ACR-DI (p = 0.044), number of SLE criteria (p = 0.005), hospital admissions (p < 0.001), FCGR2A HH genotype (p = 0.03), previous use of immunosuppressive therapy (p = 0.049), cutaneous ulcers (p < 0.001), and vasculitis (p = 0.008) in bivariate analyses. In the multivariate analysis adjusted to previous immunosuppressive treatment, only KSI and FCGR2A HH genotype remained statistically significant (p = 0.05 and p = 0.03, respectively). CONCLUSION: The incidence of pneumonia in patients with SLE is higher than that in the general population, and particularly high in severe SLE, regardless of immunosuppressive therapy. The HH genetic variant of FCGR2A appears to predispose patients with SLE to pneumonia.


Assuntos
Lúpus Eritematoso Sistêmico/genética , Pneumonia/genética , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Predisposição Genética para Doença , Genótipo , Humanos , Imunogenética , Incidência , Lúpus Eritematoso Sistêmico/epidemiologia , Lúpus Eritematoso Sistêmico/imunologia , Masculino , Lectina de Ligação a Manose/genética , Serina Proteases Associadas a Proteína de Ligação a Manose/genética , Pessoa de Meia-Idade , Pneumonia/epidemiologia , Pneumonia/imunologia , Proteína A Associada a Surfactante Pulmonar/genética , Proteína D Associada a Surfactante Pulmonar/genética , Receptores de IgG/genética , Índice de Gravidade de Doença , Adulto Jovem
17.
Chest ; 146(4): 1029-1037, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24811098

RESUMO

BACKGROUND: Active smoking increases the risk of developing community-acquired pneumonia (CAP) and invasive pneumococcal disease, although its impact on mortality in pneumococcal CAP outcomes remains unclear. The aim of this study was to investigate the influence of current smoking status on pneumococcal CAP mortality. METHODS: We performed a multicenter, prospective, observational cohort study in 4,288 hospitalized patients with CAP. The study group consisted of 892 patients with pneumococcal CAP: 204 current smokers (22.8%), 387 nonsmokers (43.4%), and 301 exsmokers (33.7%). RESULTS: Mortality at 30 days was 3.9%: 4.9% in current smokers vs 4.3% in nonsmokers and 2.6% in exsmokers. Current smokers with CAP were younger (51 years vs 74 years), with more alcohol abuse and fewer cardiac, renal, and asthma diseases. Current smokers had lower CURB-65 (confusion, uremia, respiratory rate, BP, age ≥ 65 years) scores, although 40% had severe sepsis at diagnosis. Current smoking was an independent risk factor (OR, 5.0; 95% CI, 1.8-13.5; P = .001) for 30-day mortality of pneumococcal CAP after adjusting for age (OR, 1.06; P = .001), liver disease (OR, 4.5), sepsis (OR, 2.3), antibiotic adherence to guidelines, and first antibiotic dose given < 6 h. The independent risk effect of current smokers remained when compared only with nonsmokers (OR, 4.0; 95% CI, 1.3-12.6; P = .015) or to exsmokers (OR, 3.9; 95% CI, 1.09-4.95; P = .02). CONCLUSIONS: Current smokers with pneumococcal CAP often develop severe sepsis and require hospitalization at a younger age, despite fewer comorbid conditions. Smoking increases the risk of 30-day mortality independently of tobacco-related comorbidity, age, and comorbid conditions. Current smokers should be actively targeted for preventive strategies.


Assuntos
Pneumonia Pneumocócica/mortalidade , Fumar/mortalidade , Streptococcus pneumoniae/isolamento & purificação , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Fumar/efeitos adversos , Taxa de Sobrevida
19.
Eur Respir J ; 41(1): 131-9, 2013 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-22523362

RESUMO

The role of mannose-binding lectin (MBL) deficiency (MBL2; XA/O and O/O genotypes) in host defences remains controversial. The surfactant proteins (SP)-A1, -A2 and -D, other collectins whose genes are located near MBL2, are part of the first-line lung defence against infection. We analysed the role of MBL on susceptibility to pneumococcal infection and the existence of linkage disequilibrium (LD) among the four genes. We studied 348 patients with pneumococcal community-acquired pneumonia (P-CAP) and 2,110 controls. A meta-analysis of MBL2 genotypes in susceptibility to P-CAP and to invasive pneumococcal disease (IPD) was also performed. The extent of LD of MBL2 with SFTPA1, SFTPA2 and SFTPD was analysed. MBL2 genotypes did not associate with either P-CAP or bacteraemic P-CAP in the case-control study. The MBL-deficient O/O genotype was significantly associated with higher risk of IPD in a meta-analysis, whereas the other MBL-deficient genotype (XA/O) showed a trend towards a protective role. We showed the existence of LD between MBL2 and SP genes. The data do not support a role of MBL deficiency on susceptibility to P-CAP or to IPD. LD among MBL2 and SP genes must be considered in studies on the role of MBL in infectious diseases.


Assuntos
Lectina de Ligação a Manose/genética , Pneumonia Pneumocócica/genética , Infecções Comunitárias Adquiridas/genética , Feminino , Predisposição Genética para Doença , Genótipo , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
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