Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 5.321
Filtrar
1.
Clin Nucl Med ; 46(1): 66-68, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33181753

RESUMO

A 60-year-old woman with recurrent urinary tract infection who had several operations for colorectal carcinoma underwent Tc-DMSA renal scintigraphy which showed an unexpected accumulation of radiotracer in the colon. When symptoms were reviewed, we noticed that she was suffering from pneumaturia and fecaluria which raised the suspicion of enterovesical fistula. Rectal contrast-enhanced computer tomography of pelvis demonstrated enterovesical and enterovaginal fistulas. Colonic radioactivity was considered to be related to retrograde peristalsis of Tc-DMSA from bladder activity via enterovesical fistula. In patients with pelvic surgeries and radiotherapy, radioactivity in the colon should raise the suspicion of enterovesical fistula.


Assuntos
Colo/diagnóstico por imagem , Fístula Intestinal/diagnóstico por imagem , Ácido Dimercaptossuccínico Tecnécio Tc 99m , Fístula da Bexiga Urinária/diagnóstico por imagem , Adulto , Colo/patologia , Cistografia , Feminino , Humanos , Fístula Intestinal/complicações , Tomografia Computadorizada por Raios X , Fístula da Bexiga Urinária/complicações , Infecções Urinárias/complicações
3.
N Z Med J ; 133(1527): 71-82, 2020 12 18.
Artigo em Inglês | MEDLINE | ID: mdl-33332329

RESUMO

AIM: To evaluate prospectively a clinical pathway for investigation of haematuria that involves an initial screening using a urinary biomarker of bladder cancer (Cxbladder Triage™ (CxbT)) in combination with either a renal ultrasound or a computed tomography imaging. Only test-positive patients are referred for specialist assessment and flexible cystoscopy. METHODS: The clinical outcomes of 884 patients with haematuria who presented to their general practitioner were reviewed. Outcome measurements included the findings of laboratory tests, imaging, cystoscopies, specialist assessment and histology. RESULTS: Forty-eight transitional cell carcinomas (TCC) and three small cell carcinomas were diagnosed in the study cohort. The clinical pathway missed a solitary, small, low-risk TCC. When combined, imaging and CxbT had a sensitivity of 98.1% and a negative predictive value of 99.9% to detect a bladder cancer. Follow-up for a median of 21 months showed no further new cases of bladder cancer had occurred in the patient cohort. Review of all new bladder cancers diagnosed in the 15 months following the study showed that none had been missed by haematuria assessment using the clinical pathway. CONCLUSIONS: The combination of CxbT and imaging reliably identifies patients with haematuria who can be managed safely in primary care without the need for a secondary care referral and a flexible cystoscopy.


Assuntos
Carcinoma de Células de Transição/diagnóstico por imagem , Carcinoma de Células de Transição/urina , Procedimentos Clínicos , Hematúria/etiologia , Neoplasias da Bexiga Urinária/diagnóstico por imagem , Neoplasias da Bexiga Urinária/urina , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/urina , Carcinoma de Células de Transição/complicações , Cistite/complicações , Cistite/diagnóstico , Cistoscopia , Feminino , Hematúria/diagnóstico por imagem , Humanos , Rim/diagnóstico por imagem , Cálculos Renais/complicações , Cálculos Renais/diagnóstico , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Doenças Prostáticas/complicações , Doenças Prostáticas/diagnóstico , Encaminhamento e Consulta , Tomografia Computadorizada por Raios X , Ultrassonografia , Procedimentos Desnecessários , Neoplasias da Bexiga Urinária/complicações , Infecções Urinárias/complicações , Infecções Urinárias/diagnóstico , Adulto Jovem
4.
PLoS One ; 15(7): e0235207, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32629459

RESUMO

BACKGROUND AND AIMS: The effects of physician specialty on the outcome of heart disease remains incompletely understood because of inconsistent findings from some previous studies. Our purpose is to compare the admission outcomes of heart disease in patients receiving care by cardiologists and noncardiologist (NC) physicians. METHODS: Using reimbursement claims data of Taiwan's National Health Insurance from 2008-2013, we conducted a matched study of 6264 patients aged ≥20 years who received a cardiologist's care during admission for heart disease. Using a propensity score matching procedure adjusted for sociodemographic characteristics, medical condition, and type of heart disease, 6264 controls who received an NC physician's care were selected. Logistic regressions were used to calculate odds ratios (ORs) with 95% confidence intervals (CIs) for complications and mortality during admission for heart disease associated with a cardiologist's care. RESULTS: Patients who received a cardiologist's care had a lower risk of pneumonia (OR = 0.61; 95% CI, 0.53-0.70), septicemia (OR = 0.49; 95% CI, 0.39-0.61), urinary tract infection (OR = 0.76; 95% CI, 0.66-0.88), and in-hospital mortality (OR = 0.37; 95% CI, 0.29-0.47) than did patients who received an NC physician's care. The association between a cardiologist's care and reduced adverse events following admission was significant in both sexes and in patients aged ≥40 years. CONCLUSION: We raised the possibility that cardiologist care was associated with reduced infectious complications and mortality among patients who were admitted due to heart disease.


Assuntos
Cardiologistas , Clínicos Gerais , Cardiopatias/diagnóstico , Mortalidade Hospitalar/tendências , Pneumonia/diagnóstico , Sepse/diagnóstico , Infecções Urinárias/diagnóstico , Adulto , Idoso , Feminino , Cardiopatias/complicações , Cardiopatias/mortalidade , Cardiopatias/fisiopatologia , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Admissão do Paciente/estatística & dados numéricos , Pneumonia/complicações , Pneumonia/mortalidade , Pneumonia/fisiopatologia , Pontuação de Propensão , Fatores de Risco , Sepse/complicações , Sepse/mortalidade , Sepse/fisiopatologia , Taiwan/epidemiologia , Infecções Urinárias/complicações , Infecções Urinárias/mortalidade , Infecções Urinárias/fisiopatologia
5.
Acta Clin Croat ; 59(1): 63-66, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32724276

RESUMO

There are many reasons for abnormal lymphocyte and platelet counts. In this study, we aimed to assess the prevalence of thrombocytosis, thrombocytopenia, lymphocytosis and lymphocytopenia in patients with lower respiratory tract infection (LRTI) and patients with urinary tract infection (UTI). This retrospective study included 52 LRTI patients and 60 UTI patients. Control group consisted of 70 healthy individuals admitted to the infectiology outpatient unit. No statistically significant relationship was found between the groups of subjects and platelet count. Seven (11.7%) UTI patients and four (7.7%) LRTI patients had lymphocytopenia but there was no statistically significant relationship between the groups of subjects and lymphocyte count. Study results suggested a conclusion that lymphocyte and platelet counts could be within the normal ranges in patients with UTI, as well as in those with LRTI.


Assuntos
Linfocitose , Linfopenia , Infecções Respiratórias , Trombocitopenia , Trombocitose , Infecções Urinárias , Humanos , Linfocitose/epidemiologia , Linfopenia/epidemiologia , Prevalência , Infecções Respiratórias/complicações , Infecções Respiratórias/epidemiologia , Estudos Retrospectivos , Trombocitopenia/epidemiologia , Trombocitose/epidemiologia , Infecções Urinárias/complicações , Infecções Urinárias/epidemiologia
6.
J Urol ; 204(6): 1320-1325, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32614253

RESUMO

PURPOSE: We evaluated the effect of long-term low dose antibiotic prophylaxis on children's gut microbiota. MATERIALS AND METHODS: We conducted 16S ribosomal RNA gene sequencing using stool samples from 35 patients younger than 3 years old (median age 5.2 months; male-to-female ratio 17:18) who underwent antibiotic treatment during the acute phase of febrile urinary tract infection. Samples were collected at 5 time points, ie before, during and at 1 to 2, 3 to 4, and 5 to 6 months after febrile urinary tract infection onset and antibiotic treatment. Continuous antibiotic prophylaxis using trimethoprim-sulfamethoxazole was initiated in 23 patients with grade III or higher vesicoureteral reflux and was not administered in 12 patients without reflux. RESULTS: Within 2 weeks after initiation of treatment for febrile urinary tract infection almost all enteric bacteria belonged to the order Lactobacillales, and gut microbiota diversity decreased compared to the pretreatment level (average Shannon index 2.9 before treatment, 1.4 during treatment). The diversity recovered within 1 to 2 months after febrile urinary tract infection onset in both groups. Diversity was maintained during the study period in both groups (p=0.43). A smaller proportion of gut microbiota component belonged to the order Enterobacteriales (p=0.002) in the antibiotic prophylaxis group. CONCLUSIONS: Our results revealed that patients receiving continuous antibiotic prophylaxis had normal gut microbiota diversity, indicating that the effect of trimethoprim-sulfamethoxazole on gut microbiota was insignificant. Furthermore, prophylaxis with trimethoprim-sulfamethoxazole might selectively suppress the growth of bacteria belonging to the order Enterobacteriales, such as Escherichia coli and Klebsiella species, which are the main causative bacteria of febrile urinary tract infections.


Assuntos
Antibacterianos/administração & dosagem , Antibioticoprofilaxia/efeitos adversos , Disbiose/diagnóstico , Microbioma Gastrointestinal/efeitos dos fármacos , Infecções Urinárias/tratamento farmacológico , Refluxo Vesicoureteral/tratamento farmacológico , Antibacterianos/efeitos adversos , Antibioticoprofilaxia/métodos , Bactérias/genética , Bactérias/isolamento & purificação , Pré-Escolar , DNA Bacteriano/isolamento & purificação , Relação Dose-Resposta a Droga , Esquema de Medicação , Disbiose/induzido quimicamente , Disbiose/epidemiologia , Fezes/microbiologia , Feminino , Microbioma Gastrointestinal/genética , Humanos , Lactente , Falência Renal Crônica/etiologia , Falência Renal Crônica/prevenção & controle , Masculino , RNA Ribossômico 16S/genética , Resultado do Tratamento , Combinação Trimetoprima e Sulfametoxazol/administração & dosagem , Combinação Trimetoprima e Sulfametoxazol/efeitos adversos , Infecções Urinárias/complicações , Refluxo Vesicoureteral/diagnóstico , Refluxo Vesicoureteral/etiologia
7.
Medicine (Baltimore) ; 99(27): e20952, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629702

RESUMO

Patients with stroke have a high risk of infection which may be predicted by age, procalcitonin, interleukin-6, C-reactive protein, National Institute of Health stroke scale (NHSS) score, diabetes, etc. These prediction methods can reduce unfavourable outcome by preventing the occurrence of infection.We aim to identify early predictors for urinary tract infection in patients after stroke.In 186 collected acute stroke patients, we divided them into urinary tract infection group, other infection type groups, and non-infected group. Data were recorded at admission. Independent risk factors and infection prediction model were determined using Logistic regression analyses. Likelihood ratio test was used to detect the prediction effect of the model. Receiver operating characteristic curve and the corresponding area under the curve were used to measure the predictive accuracy of indicators for urinary tract infection.Of the 186 subjects, there were 35 cases of urinary tract infection. Elevated interleukin-6, higher NIHSS, and decreased hemoglobin may be used to predict urinary tract infection. And the predictive model for urinary tract infection (including sex, NIHSS, interleukin-6, and hemoglobin) have the best predictive effect.This study is the first to discover that decreased hemoglobin at admission may predict urinary tract infection. The prediction model shows the best accuracy.


Assuntos
Acidente Vascular Cerebral/complicações , Infecções Urinárias/diagnóstico , Idoso , Biomarcadores/sangue , Proteína C-Reativa/análise , Estudos de Casos e Controles , Estudos de Coortes , Feminino , Hemoglobinas/análise , Humanos , Interleucina-6/sangue , Masculino , Pessoa de Meia-Idade , Curva ROC , Medição de Risco/métodos , Infecções Urinárias/sangue , Infecções Urinárias/complicações
8.
PLoS Med ; 17(7): e1003202, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32702001

RESUMO

BACKGROUND: Efforts to reduce unnecessary antibiotic prescribing have coincided with increasing awareness of sepsis. We aimed to estimate the probability of sepsis following infection consultations in primary care when antibiotics were or were not prescribed. METHODS AND FINDINGS: We conducted a cohort study including all registered patients at 706 general practices in the United Kingdom Clinical Practice Research Datalink, with 66.2 million person-years of follow-up from 2002 to 2017. There were 35,244 first episodes of sepsis (17,886, 51%, female; median age 71 years, interquartile range 57-82 years). Consultations for respiratory tract infection (RTI), skin or urinary tract infection (UTI), and antibiotic prescriptions were exposures. A Bayesian decision tree was used to estimate the probability (95% uncertainty intervals [UIs]) of sepsis following an infection consultation. Age, gender, and frailty were evaluated as association modifiers. The probability of sepsis was lower if an antibiotic was prescribed, but the number of antibiotic prescriptions required to prevent one episode of sepsis (number needed to treat [NNT]) decreased with age. At 0-4 years old, the NNT was 29,773 (95% UI 18,458-71,091) in boys and 27,014 (16,739-65,709) in girls; over 85 years old, NNT was 262 (236-293) in men and 385 (352-421) in women. Frailty was associated with greater risk of sepsis and lower NNT. For severely frail patients aged 55-64 years, the NNT was 247 (156-459) in men and 343 (234-556) in women. At all ages, the probability of sepsis was greatest for UTI, followed by skin infection, followed by RTI. At 65-74 years, the NNT following RTI was 1,257 (1,112-1,434) in men and 2,278 (1,966-2,686) in women; the NNT following skin infection was 503 (398-646) in men and 784 (602-1,051) in women; following UTI, the NNT was 121 (102-145) in men and 284 (241-342) in women. NNT values were generally smaller for the period from 2014 to 2017, when sepsis was diagnosed more frequently. Lack of random allocation to antibiotic therapy might have biased estimates; patients may sometimes experience sepsis or receive antibiotic prescriptions without these being recorded in primary care; recording of sepsis has increased over the study period. CONCLUSIONS: These stratified estimates of risk help to identify groups in which antibiotic prescribing may be more safely reduced. Risks of sepsis and benefits of antibiotics are more substantial among older adults, persons with more advanced frailty, or following UTIs.


Assuntos
Infecções/complicações , Sepse/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , Estudos de Coortes , Prescrições de Medicamentos , Feminino , Idoso Fragilizado , Fragilidade , Humanos , Lactente , Recém-Nascido , Infecções/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Padrões de Prática Médica , Atenção Primária à Saúde , Probabilidade , Encaminhamento e Consulta , Infecções Respiratórias/complicações , Infecções Respiratórias/tratamento farmacológico , Infecções Respiratórias/epidemiologia , Reino Unido/epidemiologia , Infecções Urinárias/complicações , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/epidemiologia , Adulto Jovem
9.
PLoS One ; 15(6): e0234472, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32579580

RESUMO

BACKGROUND: Despite remarkable progress in the reduction of death in under-five children, neonatal mortality has shown little or no concomitant reduction globally. It is also one of the most common causes of neonatal death in Ethiopia. Little is known on predictors of neonatal sepsis. Risk based screening and commencement of treatment appreciably reduces neonatal death and illness. Therefore, the main aim of this study was to identify predictors of neonatal sepsis in public referral hospitals of Northwest Ethiopia. METHODS: Institutional based unmatched case-control study was conducted among a total of 231 neonates in Debre Markos and Felege Hiwot referral hospitals from March 2018- April 2018. Neonates who fulfill the preseted criteria for sepsis were considered as cases and neonates diagnosed with other medical reasons except sepsis were controls. For each case, two consecutive controls were selected by simple random sampling method. Data were collected using structured pretested questionnaire through a face to face interview with index mothers and by reviewing neonatal record using checklist. The collected data were entered into Epi data version 3.1 and exported to STATA/ SE software version 14. Binary and multivariable logistic regression analyses were employed. Statistical significance was declared at P<0.05. RESULT: Multivariable logistic regression analysis showed that, duration of rupture of membrane ≥ 18hours was significantly associated with sepsis (AOR = 10.4, 95%CI = 2.3-46.5). The other independent predictors of neonatal sepsis were number of maternal antenatal care service ≤3 (AOR = 4.4, 95%CI = 1.7-11.5), meconium stained amniotic fluid (AOR = 3.9, 95%CI = 1.5-9.8), urinary tract infection during pregnancy (AOR = 10.8, 95% CI = 3.4-33.9), intranatal fever (AOR = 3.2, 95% CI = 1.1-9.5), first minute APGAR score <7 (AOR = 3.2, 95% CI = 1.3-7.7), resuscitation at birth (AOR = 5.4, 95% CI = 1.9-15.5), nasogastric tube insertion (AOR = 3.7, 95% CI = 1.4-10.2). CONCLUSION: Neonatal invasive procedures, ANC follow up during pregnancy, different conditions during birth like meconium stained amniotic fluid, low APGAR score and resuscitation at birth were the independent predictors of neonatal sepsis.


Assuntos
Mortalidade Infantil , Sepse Neonatal/epidemiologia , Parto , Morte Perinatal/etiologia , Cuidado Pré-Natal , Adulto , Líquido Amniótico , Índice de Apgar , Estudos de Casos e Controles , Etiópia , Feminino , Hospitais Públicos , Humanos , Lactente , Recém-Nascido , Mães , Gravidez , Infecções Urinárias/complicações , Adulto Jovem
10.
J Pediatr ; 224: 150-152, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32565095

RESUMO

This is a single-center US case series of 18 infants <90 days old who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). These infants had a mild febrile illness without significant pulmonary disease. One-half of the infants were hospitalized; 1 had bacterial urinary tract co-infection. Nasopharyngeal viral loads were notably high. Latinx ethnicity was overrepresented.


Assuntos
Infecções por Coronavirus/diagnóstico , Febre/diagnóstico , Pneumonia Viral/diagnóstico , Betacoronavirus , Chicago , Técnicas de Laboratório Clínico , Feminino , Febre/virologia , Hospitalização , Humanos , Lactente , Masculino , Pandemias , Admissão do Paciente , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Testes Sorológicos , Infecções Urinárias/complicações , Infecções Urinárias/microbiologia , Carga Viral
11.
Pediatrics ; 146(3)2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32527752

RESUMO

In this case series, we describe the clinical course and outcomes of 7 febrile infants aged ≤60 days with confirmed severe acute respiratory syndrome coronavirus 2 infection. No infant had severe outcomes, including the need for mechanical ventilation or ICU level of care. Two infants had concurrent urinary tract infections, which were treated with antibiotics. Although a small sample, our data suggest that febrile infants with severe acute respiratory syndrome coronavirus 2 infection often have mild illness.


Assuntos
Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/diagnóstico , Febre de Causa Desconhecida/etiologia , Pneumonia Viral/diagnóstico , Infecções Respiratórias/diagnóstico , Síndrome Respiratória Aguda Grave/diagnóstico , Infecções Urinárias/diagnóstico , Fatores Etários , Infecções por Coronavirus/epidemiologia , Diagnóstico Diferencial , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Febre de Causa Desconhecida/diagnóstico , Seguimentos , Hospitais Pediátricos , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Pandemias , Pneumonia Viral/epidemiologia , Estudos Prospectivos , Infecções Respiratórias/complicações , Estudos Retrospectivos , Medição de Risco , Síndrome Respiratória Aguda Grave/epidemiologia , Infecções Urinárias/complicações
12.
Am Fam Physician ; 101(12): 721-729, 2020 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-32538597

RESUMO

Despite dramatic reductions in the rates of bacteremia and meningitis since the 1980s, febrile illness in children younger than 36 months continues to be a concern with potentially serious consequences. Factors that suggest serious infection include age younger than one month, poor arousability, petechial rash, delayed capillary refill, increased respiratory effort, and overall physician assessment. Urinary tract infections are the most common serious bacterial infection in children younger than three years, so evaluation for such infections should be performed in those with unexplained fever. Abnormal white blood cell counts have poor sensitivity for invasive bacterial infections; procalcitonin and C-reactive protein levels, when available, are more informative. Chest radiography is rarely recommended for children older than 28 days in the absence of localizing signs. Lumbar puncture is not recommended for children older than three months without localizing signs; it may also be considered for those from one to three months of age with abnormal laboratory test results. Protocols such as Step-by-Step, Laboratory Score, or the Rochester algorithms may be helpful in identifying low-risk patients. Rapid influenza testing and tests for coronavirus disease 2019 (COVID-19) may be of value when those diseases are circulating. When empiric treatment is appropriate, suggested antibiotics include ceftriaxone or cefotaxime for infants one to three months of age and ampicillin with gentamicin or with cefotaxime for neonates. For children three months to three years of age, azithromycin or amoxicillin is recommended if pneumonia is suspected; for urinary infections, suggested antibiotics are cefixime, amoxicillin/clavulanate, or trimethoprim/sulfamethoxazole. Choice of antibiotics should reflect local patterns of microbial resistance.


Assuntos
Tomada de Decisão Clínica , Febre/etiologia , Influenza Humana/diagnóstico , Pneumonia Bacteriana/diagnóstico , Infecções Urinárias/diagnóstico , Algoritmos , Combinação Amoxicilina e Clavulanato de Potássio , Antibacterianos/uso terapêutico , Betacoronavirus , Hemocultura , Proteína C-Reativa/metabolismo , Pré-Escolar , Técnicas de Laboratório Clínico , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Técnicas de Cultura , Humanos , Lactente , Recém-Nascido , Influenza Humana/complicações , Influenza Humana/tratamento farmacológico , Influenza Humana/epidemiologia , Contagem de Leucócitos , Pandemias , Pneumonia Bacteriana/complicações , Pneumonia Bacteriana/tratamento farmacológico , Pneumonia Bacteriana/epidemiologia , Pneumonia Viral , Pró-Calcitonina/metabolismo , Radiografia Torácica , Punção Espinal , Combinação Trimetoprima e Sulfametoxazol , Urinálise , Infecções Urinárias/complicações , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/epidemiologia
13.
Lancet ; 395(10237): 1659-1668, 2020 05 23.
Artigo em Inglês | MEDLINE | ID: mdl-32446408

RESUMO

Urinary tract infections (UTIs) in children are among the most common bacterial infections in childhood. They are equally common in boys and girls during the first year of life and become more common in girls after the first year of life. Dividing UTIs into three categories; febrile upper UTI (acute pyelonephritis), lower UTI (cystitis), and asymptomatic bacteriuria, is useful for numerous reasons, mainly because it helps to understand the pathophysiology of the infection. A single episode of febrile UTI is often caused by a virulent Escherichia coli strain, whereas recurrent infections and asymptomatic bacteriuria commonly result from urinary tract malformations or bladder disturbances. Treatment of an upper UTI needs to be broad and last for 10 days, a lower UTI only needs to be treated for 3 days, often with a narrow-spectrum antibiotic, and asymptomatic bacteriuria is best left untreated. Investigations of atypical and recurrent episodes of febrile UTI should focus on urinary tract abnormalities, whereas in cases of cystitis and asymptomatic bacteriuria the focus should be on bladder function.


Assuntos
Infecções Urinárias , Antibacterianos/uso terapêutico , Doenças Assintomáticas , Bacteriúria/complicações , Bacteriúria/diagnóstico , Bacteriúria/tratamento farmacológico , Bacteriúria/microbiologia , Criança , Cistite/complicações , Cistite/diagnóstico , Cistite/tratamento farmacológico , Cistite/microbiologia , Humanos , Pielonefrite/complicações , Pielonefrite/diagnóstico , Pielonefrite/tratamento farmacológico , Pielonefrite/microbiologia , Fatores de Risco , Infecções Urinárias/complicações , Infecções Urinárias/diagnóstico , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/microbiologia
14.
PLoS One ; 15(4): e0231374, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32271850

RESUMO

BACKGROUND AND AIMS: Because the sex difference in outcomes of fracture was incompletely understood, we evaluated the post-fracture complications and mortality of female and male patients. METHODS: We conducted a nationwide study of 498,586 fracture patients who received inpatient care using Taiwan's National Health Insurance Research Database 2008-2013 claims data. Female and male fracture patients were selected for comparison by using a propensity-score matching procedure. Age, low income, types of fracture, fracture with surgery, several medical conditions, number of hospitalization and emergency visits were considered as potential confounding factors. Multivariate logistic regressions were used to calculate the adjusted odds ratios (OR), the 95% CI of post-fracture complications and 30-day in-hospital mortality differences between women and men. RESULTS: Male patients had a higher risk of post-fracture pneumonia (OR 1.96, 95% CI 1.83-2.11), acute renal failure (OR 1.85, 95% CI 1.60-2.15), deep wound infection (OR 1.63, 95% CI 1.51-1.77), stroke (OR 1.58, 95% CI 1.49-1.67), septicemia (OR 1.51, 95% CI 1.42-1.61), acute myocardial infarction (OR 1.38, 95% CI 1.09-1.75) and 30-day in-hospital mortality (OR 1.69, 95% CI 1.48-1.93) compared with female patients. However, a lower risk of post-fracture urinary tract infection (OR 0.69, 95% CI 0.65-0.72) was found in men than in women. Male patients also had longer hospital stays and higher medical expenditures due to fracture admission than did the female patients. Higher rates of post-fracture adverse events in male patients were noted in all age groups and all types of fractures. CONCLUSION: We raised the possibility that male patients showed more complications and higher mortality rates after fracture admission compared with female patients, with the exception of urinary tract infections.


Assuntos
Fraturas Ósseas/patologia , Caracteres Sexuais , Adulto , Idoso , Idoso de 80 Anos ou mais , Efeitos Psicossociais da Doença , Bases de Dados Factuais , Feminino , Fraturas Ósseas/complicações , Fraturas Ósseas/mortalidade , Mortalidade Hospitalar , Humanos , Tempo de Internação , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Pneumonia/complicações , Pneumonia/diagnóstico , Estudos Retrospectivos , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico , Taiwan , Infecções Urinárias/complicações , Infecções Urinárias/diagnóstico , Adulto Jovem
15.
Pediatr. aten. prim ; 22(85): 55-58, ene.-mar. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-193445

RESUMO

El exantema periflexural asimétrico de la infancia es una entidad benigna y autolimitada que se manifiesta típicamente en lactantes y preescolares con predominio del sexo femenino. La etiología es desconocida, aunque se ha relacionado con infecciones virales principalmente, y también bacterianas. El diagnóstico es clínico y el tratamiento sintomático. A pesar de ser una enfermedad común, es infradiagnosticada debido en parte al desconocimiento de esta. Nuestro objetivo es contribuir para mejorar el conocimiento de este trastorno. Se presenta el caso clínico de una paciente diagnosticada de exantema periflexural asimétrico con el antecedente de pielonefritis aguda la semana anterior a la aparición de las lesiones cutáneas


Asymmetric periflexural exanthem of childhood is a benign and self-limited disease that characteristically occurs in infants and preschool children with a female predominance. The aetiology is unknown, although it has been mainly linked to viral infections. Diagnosis is clinical and treatment is mainly symptomatic. Despite being a common disease, it is unknown and consequently underdiagnosed. Our goal is to help improving the knowledge of this disorder. We present a clinical case of a patient diagnosed with asymmetric periflexural exanthema with a history of acute pyelonephritis the previous week of the skin lesion onset


Assuntos
Humanos , Feminino , Lactente , Exantema/diagnóstico , Infecções Urinárias/complicações , Hidrocortisona/administração & dosagem , Hematúria/etiologia , Proteinúria/etiologia , Administração Tópica
16.
Transplant Proc ; 52(5): 1243-1246, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32220479

RESUMO

INTRODUCTION: Organ availability is limited in the face of the growing number of candidates. Using organs from individuals with an infection at the time of transplantation emerged as a possible but controversial solution. MATERIALS AND METHODS: Retrospective analysis of patients submitted to kidney transplantation in Hospital Garcia de Orta (Almada, Portugal) from January 2008 to March 2019, comparing outcomes between recipients of organs from donors with an active infection and noninfected donors in the referred interval. RESULTS: An active infection in the donor was identified in 55 cases (28.4%) from a total of 194 transplants. The most frequent site of infection was the lung (n = 30), followed by the urinary tract (n = 13); 9 donors (16.4%) had documented bacteremia. None of the identified microorganisms were multidrug-resistant. All recipients from an infected donor received adequate antibiotic prophylaxis (mean duration of 11.1 ± 3.0 days). No significant differences between groups were found regarding patients' demographics, cold ischemia time, duration of hospital stay, delayed graft function, rejection episodes, noninfectious complications, or patient and graft survival. Basiliximab was the preferred induction agent in both groups but was used in a larger proportion of recipients in the infected donor group (87.0% vs 60.6%; P = .001). The rate of infectious complications was significantly lower in the infected donor group (14.5% vs 42.4%; P = .001), and none of the previously isolated agents in the donor was found in the recipient. CONCLUSION: Kidney transplant using infected donors can be performed safely, without worse organ-specific or recipient outcomes, if certain conditions are considered.


Assuntos
Bacteriemia/complicações , Falência Renal Crônica/cirurgia , Transplante de Rim , Segurança do Paciente , Obtenção de Tecidos e Órgãos/métodos , Adulto , Idoso , Antibioticoprofilaxia , Bacteriemia/prevenção & controle , Basiliximab , Seleção do Doador , Feminino , Sobrevivência de Enxerto , Humanos , Rim/microbiologia , Falência Renal Crônica/complicações , Transplante de Rim/efeitos adversos , Tempo de Internação , Pneumopatias/complicações , Pneumopatias/microbiologia , Masculino , Pessoa de Meia-Idade , Portugal , Estudos Retrospectivos , Doadores de Tecidos , Transplantes , Infecções Urinárias/complicações , Infecções Urinárias/microbiologia
17.
Sci Rep ; 10(1): 4469, 2020 03 11.
Artigo em Inglês | MEDLINE | ID: mdl-32161316

RESUMO

This study aimed to investigate the predictive factors of concomitant bacteremia occurring in febrile infants who initially presented with pyuria and fever, and were subsequently diagnosed with culture-proven urinary tract infection (UTI). We conducted a retrospective cohort study for January 2010-October 2018 that included infants younger than six months with febrile UTI at a tertiary hospital. The study included 463 patients, of whom 34 had a concomitant bacteremic UTI. Compared to those in the non-bacteremic urinary tract infection (UTI) group, the bacteremic UTI group had a lower mean age; higher levels of C-reactive protein (CRP), delta neutrophil index (DNI, reflects the fraction of immature granulocytes) and blood urea nitrogen (BUN); lower levels of hemoglobin (Hb) and albumin; and a lower platelet count. Vesicoureteral reflux (VUR) was detected nearly twice as often in patients with bacteremic UTI compared to those with non-bacteremic UTI (59.3% vs. 30.6%; P = 0.003). Univariate logistic analyses showed that age ≤90 days; higher DNI, CRP, and creatinine levels; lower Hb and albumin levels; and the presence of VUR were predictors for bacteremic UTI. On multivariate logistic regression analysis, age ≤90 days, higher DNI and CRP levels, and the presence of VUR were independent predictors of bacteremic UTI. The area under the receiver operating characteristic curve of the multivariate model was 0.859 (95% CI, 0.779-0.939; P < 0.001). Age ≤90 days, higher DNI and CRP values may help predict bacteremia of febrile infants younger than 6 months with UTI. Vesicoureteral reflux imaging is also recommended in infants with bacteremic UTI to evaluate VUR.


Assuntos
Bacteriemia , Febre/diagnóstico , Infecções Urinárias/microbiologia , Biomarcadores , Gerenciamento Clínico , Feminino , Febre/epidemiologia , Febre/etiologia , Humanos , Lactente , Masculino , Prevalência , Prognóstico , Curva ROC , Estudos Retrospectivos , Fatores de Risco , Infecções Urinárias/complicações , Infecções Urinárias/epidemiologia
18.
J Korean Med Sci ; 35(10): e65, 2020 Mar 16.
Artigo em Inglês | MEDLINE | ID: mdl-32174064

RESUMO

BACKGROUND: Neutrophil gelatinase-associated lipocalin (NGAL), a bacteriostatic agent, is known to inhibit erythropoiesis leading to anemia. We aimed to investigate the associations of NGAL, anemia, and renal scarring in children with febrile urinary tract infections (UTIs). METHODS: We retrospectively reviewed the medical records of 261 children with febrile UTIs. The relationship between the presence of anemia and plasma NGAL levels was investigated. NGAL performance in comparison with serum C-reactive protein (CRP) at admission and after 72 hours of treatment was also evaluated for the prediction of renal scarring as well as acute pyelonephritis (APN) and vesicoureteral reflux (VUR). RESULTS: Plasma NGAL levels were elevated in patients with anemia compared with those without anemia. Multiple linear regression analysis showed an inverse relationship between NGAL levels and erythrocyte counts (standard ß = -0.397, P < 0.001). Increased NGAL, but not CRP, was independently associated with the presence of anemia (odds ratio [OR], 2.37; 95% confidence interval [CI], 1.07-5.27; P < 0.05). Receiver operating curve analyses showed good diagnostic profiles of pre- and post-treatment NGAL for identifying APN, VUR, and renal scarring (all P < 0.05). For detecting renal scars, the area under the curve of post-treatment NGAL (0.730; 95% CI, 0.591-0.843) was higher than that of post-treatment CRP (0.520; 95% CI, 0.395-0.643; P < 0.05). The presence of anemia and elevated NGAL at admission (> 150 ng/mL) were independent risk factors for renal scarring in children with febrile UTIs. With anemia, NGAL levels increased consecutively in children with febrile UTI without renal involvement, with APN without scar, and with APN with renal scarring. CONCLUSION: Increased plasma NGAL levels may be associated with the presence of anemia and renal scarring in children with febrile UTIs.


Assuntos
Anemia/complicações , Lipocalina-2/sangue , Infecções Urinárias/complicações , Biomarcadores/sangue , Proteína C-Reativa/análise , Estudos de Casos e Controles , Criança , Feminino , Febre , Humanos , Rim/patologia , Masculino , Razão de Chances , Pielonefrite/complicações , Refluxo Vesicoureteral/complicações
20.
Am J Nurs ; 120(4): 34-42, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32218045

RESUMO

Among adults ages 65 and older, dementia doubles the risk of hospitalization. Roughly one in four hospitalized patients has dementia, and the prevalence of dementia in the United States is rising rapidly. Patients with dementia have significantly higher rates of hospital-acquired complications, including urinary tract infections, pressure injuries, pneumonia, and delirium, which when unrecognized and untreated can accelerate physical and cognitive decline, precipitating nursing home placement and death. The authors discuss the unique needs of patients with dementia who require acute care, highlighting evidence-based strategies for nurses to incorporate into practice.


Assuntos
Demência/enfermagem , Assistência Centrada no Paciente , Guias de Prática Clínica como Assunto , Idoso , Comunicação , Delírio/diagnóstico , Delírio/tratamento farmacológico , Feminino , Hospitalização , Humanos , Casas de Saúde , Pneumonia/diagnóstico , Infecções Urinárias/complicações
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA