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1.
Zhonghua Jie He He Hu Xi Za Zhi ; 42(10): 750-754, 2019 Oct 12.
Artigo em Chinês | MEDLINE | ID: mdl-31594108

RESUMO

Objective: To analyzed the clinical characteristics and prognosis of patients with H7N9 avian influenza. Methods: The baseline characteristics, clinical manifestations, treatments, laboratory and imaging findings were collected and analyzed for 20 patients with H7N9 avian influenza admitted to the First Affiliated Hospital of Nanchang University from December 2016 to March 2017. According to the final clinical outcome, the patients were divided into the death group and the survival group. Ten patients in the death group died, and 10 patients in the survival group were discharged. The data with normal distribution were analyzed by t test. The data with non-normal distribution were analyzed by Wilcoxon rank sum test. Results: Of the 20 patients, 13 were males and 7 were females, aging 40-82 years, with a mean age of (60±12) years. Twelve patients had a definite history of poultry exposure and 10 had chronic underlying diseases such as hypertension and diabetes. The clinical manifestations were mainly fever, cough, hemoptysis, respiratory distress, fatigue, etc. In the survival group, the platelet count was(167-315)×10(9)/L, while it was (78-152)×10(9)/L in the death group. The average white blood cell count was (7.78-11.52)×10(9)/L and (9.91-15.93)×10(9)/L in the survival and death groups respectively. The average value of lymphocyte count was (0.69-1.59)×10(9)/L and (0.58-0.86)×10(9)/L in the survival and death groups respectively. In the death group the glutamic-pyruvic transaminase (ALT) value was (14.0-352.0) U/L, the total bilirubin value was (6.9-34.5) µmol/L, the creatine kinase MB (CK-MB) was (16.0-162.0) U/L, the serum calcium value was (1.4-2.0) mmol/L, the C-reactive protein value was (33.1-414.0) mg/L, and the calcium reduction prime value was (0.6-100.0) µg/L. In the survival group,the ALT value was (25.0-181.0) U/L, the total bilirubin value was (4.8-25.9) µmol/L, the CK-MB value was (15.0-40.0) U/L, the serum calcium value was (1.9-2.4) mmol/L, the C-reaction protein value was (12.8-52.5) mg/L, and the procalcitonin value was (0.3-23.3) µg/L. Sixteen cases suffered severe pneumonia. Twelve patients received extracorporeal membrane oxygenation (ECMO), and 4 survived. The cause of death was mainly related to factors such as age, chronic underlying diseases and severity of illness. Conclusions: Human infection with H7N9 avian influenza virus was highly pathogenic, and prone to progress into severe pneumonia, with a high mortality. Decreased platelet count was associated with mortality (t=4.07, P=0.001), predictive of patient outcome.


Assuntos
Antivirais/uso terapêutico , Subtipo H7N9 do Vírus da Influenza A/isolamento & purificação , Influenza Humana/diagnóstico , Influenza Humana/tratamento farmacológico , Síndrome do Desconforto Respiratório do Adulto/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Aves , China/epidemiologia , Tosse/etiologia , Diabetes Mellitus/epidemiologia , Exposição Ambiental , Feminino , Febre/etiologia , Humanos , Hipertensão/epidemiologia , Influenza Aviária , Influenza Humana/epidemiologia , Influenza Humana/mortalidade , Masculino , Pessoa de Meia-Idade , Pneumonia/epidemiologia , Pneumonia/etiologia , Pneumonia/virologia , Prognóstico , Resultado do Tratamento
2.
Pneumologie ; 73(10): 605-616, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31622999

RESUMO

Pneumonia belongs to the most frequent and most deadly infectious diseases worldwide. It represents an increasing problem for the aging population. The incidence and mortality rises with every decade. The clinical presentation of pneumonia differs between elderly and younger patients. Multiple factors including functional status (self-dependency and immobilization), comorbidities, immunosenescence, nutritional status, swallowing disorders have to be accounted for. Pneumonia in the elderly has to be differentiated from nursing home acquired pneumonia. Diagnosis of pneumonia of the elderly demands special attention as the diagnostic value of common biomarkers and prognostic scores is different.


Assuntos
Infecções Comunitárias Adquiridas/epidemiologia , Pneumonia/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Infecções Comunitárias Adquiridas/diagnóstico , Comorbidade , Feminino , Alemanha/epidemiologia , Humanos , Incidência , Masculino , Estado Nutricional , Pneumonia/diagnóstico
3.
Am Surg ; 85(10): 1134-1138, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31657309

RESUMO

Traumatic esophageal injury is a highly lethal but rare injury with minimal data in the trauma population. We sought to provide a descriptive analysis of esophageal trauma (ET) to identify the incidence, associated injuries, interventions, and outcomes. We hypothesized that blunt trauma is associated with higher risk of death than penetrating trauma. The Trauma Quality Improvement Program (2010-2016) was queried for patients with ET. Patients with blunt and penetrating trauma were compared using chi-square and Mann-Whitney U tests. A multivariable logistic regression model was used to determine risk of mortality. Of 1,403,466 adult patients, 651 (<0.01%) presented with ET. The most common associated thoracic injuries were rib fractures (38.7%) and pneumothorax (26.7%). More patients with a penetrating mechanism underwent open repair of the esophagus than those with blunt mechanism (46.2% vs 11.7%, P < 0.001). After controlling for covariates, there was no difference in risk of mortality between blunt and penetrating trauma (P = 0.65). The mortality rate for patients with esophageal injury surviving greater than 24 hours was 7.5 per cent. In this large national database analysis, ET was rare and most commonly associated with rib fractures and pneumothorax. Contrary to our hypothesis, the risk of mortality was equivalent between blunt and penetrating ET.


Assuntos
Esôfago/lesões , Ferimentos não Penetrantes/mortalidade , Ferimentos Penetrantes/mortalidade , Adulto , Distribuição de Qui-Quadrado , Esôfago/cirurgia , Feminino , Mortalidade Hospitalar , Humanos , Incidência , Tempo de Internação , Modelos Logísticos , Masculino , Morbidade , Pneumonia/epidemiologia , Pneumonia/etiologia , Pneumotórax/complicações , Pneumotórax/epidemiologia , Melhoria de Qualidade , Estudos Retrospectivos , Fraturas das Costelas/complicações , Fraturas das Costelas/epidemiologia , Fatores de Risco , Estatísticas não Paramétricas , Stents/estatística & dados numéricos , Taxa de Sobrevida , Ferimentos não Penetrantes/complicações , Ferimentos não Penetrantes/epidemiologia , Ferimentos não Penetrantes/cirurgia , Ferimentos Penetrantes/complicações , Ferimentos Penetrantes/epidemiologia , Ferimentos Penetrantes/cirurgia
4.
BMC Infect Dis ; 19(1): 757, 2019 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-31470805

RESUMO

BACKGROUND: Human metapneumovirus (HMPV) is an important respiratory pathogen that causes seasonal epidemics of acute respiratory illness and contributes significantly to childhood pneumonia. Current knowledge and understanding on its patterns of spread, prevalence and persistence in communities in low resource settings is limited. METHODS: We present findings of a molecular-epidemiological analysis of nasal samples from children < 5 years of age admitted with syndromic pneumonia between 2007 and 2016 to Kilifi County Hospital, coastal Kenya. HMPV infection was detected using real-time RT-PCR and positives sequenced in the fusion (F) and attachment (G) genes followed by phylogenetic analysis. The association between disease severity and HMPV subgroup was assessed using Fisher's exact test. RESULTS: Over 10 years, 274/6756 (4.1%) samples screened were HMPV positive. Annual prevalence fluctuated between years ranging 1.2 to 8.7% and lowest in the recent years (2014-2016). HMPV detections were most frequent between October of one year to April of the following year. Genotyping was successful for 205/274 (74.8%) positives revealing clades A2b (41.0%) and A2c (10.7%), and subgroups B1 (23.4%) and B2 (24.9%). The dominance patterns were: clade A2b between 2007 and 11, subgroup B1 between 2012 and 14, and clade A2c in more recent epidemics. Subgroup B2 viruses were present in all the years. Temporal phylogenetic clustering within the subgroups for both local and global sequence data was seen. Subgroups occurring in each epidemic season were comprised of multiple variants. Pneumonia severity did not vary by subgroup (p = 0.264). In both the F and G gene, the sequenced regions were found to be predominantly under purifying selection. CONCLUSION: Subgroup patterns from this rural African setting temporally map with global strain distribution, suggesting a well-mixed global virus transmission pool of HMPV. Persistence in the local community is characterized by repeated introductions of HMPV variants from the global pool. The factors underlying the declining prevalence of HMPV in this population should be investigated.


Assuntos
Metapneumovirus/classificação , Metapneumovirus/isolamento & purificação , Infecções por Paramyxoviridae , Pneumonia , Idade de Início , Pré-Escolar , Epidemias , Feminino , Genótipo , Hospitais Pediátricos/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Quênia/epidemiologia , Masculino , Metapneumovirus/genética , Infecções por Paramyxoviridae/epidemiologia , Infecções por Paramyxoviridae/virologia , Admissão do Paciente/estatística & dados numéricos , Filogenia , Pneumonia/epidemiologia , Pneumonia/virologia , Vigilância da População , Prevalência , Reação em Cadeia da Polimerase em Tempo Real , Estações do Ano
5.
BMC Infect Dis ; 19(1): 770, 2019 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-31481020

RESUMO

BACKGROUND: We sought to assess reporting in China's Pneumonia of Unknown Etiology (PUE) passive surveillance system for emerging respiratory infections and to identify ways to improve the PUE surveillance system's detection of respiratory infections of public health significance. METHODS: From February 29-May 29, 2016, we actively identified and enrolled patients in two hospitals with acute respiratory infections (ARI) that met all PUE case criteria. We reviewed medical records for documented exposure history associated with respiratory infectious diseases, collected throat samples that were tested for seasonal and avian influenza, and interviewed clinicians regarding reasons for reporting or not reporting PUE cases. We described and analyzed the proportion of PUE cases reported and clinician awareness of and practices related to the PUE system. RESULTS: Of 2619 ARI admissions in two hospitals, 335(13%) met the PUE case definition; none were reported. Of 311 specimens tested, 18(6%) were seasonal influenza virus-positive; none were avian influenza-positive. < 10% PUE case medical records documented whether or not there were exposures to animals or others with respiratory illness. Most commonly cited reasons for not reporting cases were no awareness of the PUE system (76%) and not understanding the case definition (53%). CONCLUSIONS: Most clinicians have limited awareness of and are not reporting to the PUE system. Exposures related to respiratory infections are rarely documented in medical records. Increasing clinicians' awareness of the PUE system and including relevant exposure items in standard medical records may increase reporting.


Assuntos
Notificação de Doenças , Necessidades e Demandas de Serviços de Saúde , Pneumonia/epidemiologia , Pneumonia/etiologia , Vigilância da População , Adulto , China/epidemiologia , Doenças Transmissíveis Emergentes/diagnóstico , Doenças Transmissíveis Emergentes/epidemiologia , Diagnóstico Diferencial , Notificação de Doenças/métodos , Notificação de Doenças/normas , Feminino , Necessidades e Demandas de Serviços de Saúde/organização & administração , Necessidades e Demandas de Serviços de Saúde/normas , Hospitalização , Humanos , Influenza Humana/epidemiologia , Masculino , Notificação de Abuso , Testes Obrigatórios/normas , Pessoa de Meia-Idade , Projetos Piloto , Pneumonia/diagnóstico , Vigilância da População/métodos , Padrões de Prática Médica/organização & administração , Padrões de Prática Médica/normas , Avaliação de Programas e Projetos de Saúde , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/etiologia , Engajamento no Trabalho
6.
BMC Infect Dis ; 19(1): 825, 2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31533638

RESUMO

BACKGROUND: Detecting avian influenza virus has become an important public health strategy for controlling the emerging infectious disease. METHODS: The HIS (hospital information system) modified influenza surveillance system (ISS) and a newly built pneumonia surveillance system (PSS) were used to monitor the influenza viruses in Changsha City, China. The ISS was used to monitor outpatients in two sentinel hospitals and to detect mild influenza and avian influenza cases, and PSS was used to monitor inpatients in 49 hospitals and to detect severe and death influenza cases. RESULTS: From 2005 to 2016, there were 3,551,917 outpatients monitored by the ISS system, among whom 126,076 were influenza-like illness (ILI) cases, with the ILI proportion (ILI%) of 3.55%. After the HIS was used, the reported incident cases of ILI and ILI% were increased significantly. From March, 2009 to September, 2016, there were 5,491,560 inpatient cases monitored by the PSS system, among which 362,743 were pneumonia cases, with a proportion of 6.61%. Among pneumonia cases, about 10.55% (38,260/362,743) of cases were severe or death cases. The pneumonia incidence increased each year in the city. Among 15 avian influenza cases reported from January, 2005 to September, 2016, there were 26.7% (4/15) mild cases detected by the HIS-modified ISS system, while 60.0% (9/15) were severe or death cases detected by the PSS system. Two H5N1 severe cases were missed by the ISS system in January, 2009 when the PSS system was not available. CONCLUSIONS: The HIS was able to improve the efficiency of the ISS for monitoring ILI and emerging avian influenza virus. However, the efficiency of the system needs to be verified in a wider area for a longer time span in China.


Assuntos
Influenza Humana/diagnóstico , Pneumonia/diagnóstico , Vigilância em Saúde Pública/métodos , China/epidemiologia , Hospitais , Humanos , Incidência , Virus da Influenza A Subtipo H5N1/isolamento & purificação , Subtipo H7N9 do Vírus da Influenza A/isolamento & purificação , Vírus da Influenza A/isolamento & purificação , Influenza Humana/epidemiologia , Influenza Humana/virologia , Pneumonia/epidemiologia , Gestão de Riscos
7.
BMC Surg ; 19(1): 106, 2019 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-31395044

RESUMO

BACKGROUND: The aim of this study was to investigate the influence of patients' age on postoperative morbidities including pneumonia. METHODS: We reviewed the clinical records of 211 patients with stages I - III gastric cancer undergoing curative distal gastrectomy (DG) or total gastrectomy (TG). Patients were classified into an elderly (≧80 y.o.) or a control (< 80 y.o.) group. We compared patient characteristics (sex ratio, disease stage, degree of lymph node dissection, number of retrieved lymph nodes, and type of reconstruction) and early postoperative outcomes (operation time, intra-operative blood loss, and postoperative morbidity including pneumonia, and mortality) between the two groups separately in DG and TG. RESULTS: There were 134 and 77 patients who underwent DG and TG, respectively. The numbers of patients in the elderly and control groups were 25 and 109 in DG and 12 and 65 in TG. The percentage of female patients in the elderly group was greater than that in the control group in both DG and TG. The extent of lymph node dissection did not differ between two groups in TG; in contrast in DG, the rate of a D1 dissection was greater in the elderly group than in the control group. There were no differences between the two groups in distribution of disease stage, number of retrieved lymph nodes, operation time, and blood loss in DG and in TG. Overall postoperative morbidity did not differ between two groups after DG and after TG. The rate of infectious complications in the elderly group was not different from that in the control group after DG and after TG. The incidence of pneumonia was more frequent in the elderly group compared to the control group after DG (8% vs. 1%, P < 0.05) but not after TG (17% vs. 5%). When patients were compared between the elderly and the control groups regardless of type of gastrectomy, the incidence of pneumonia in the elderly group (4/37 (11%)) was greater than that in the control group (4/174 (2%), P < 0.05). CONCLUSIONS: These results suggest that pneumonia is increased in patients older than 80 years after DG.


Assuntos
Gastrectomia , Pneumonia/etiologia , Complicações Pós-Operatórias/etiologia , Neoplasias Gástricas/cirurgia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Gastrectomia/métodos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Pneumonia/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Fatores de Risco
8.
BMJ ; 366: l4563, 2019 08 12.
Artigo em Inglês | MEDLINE | ID: mdl-31405902

RESUMO

OBJECTIVE: To determine any changes in total hospital revisits within 30 days of discharge after a hospital stay for medical conditions targeted by the Hospital Readmissions Reduction Program (HRRP). DESIGN: Retrospective cohort study. SETTING: Hospital stays among Medicare patients for heart failure, acute myocardial infarction, or pneumonia between 1 January 2012 and 1 October 2015. PARTICIPANTS: Medicare fee-for-service patients aged 65 or over. MAIN OUTCOMES: Total hospital revisits within 30 days of discharge after hospital stays for medical conditions targeted by the HRRP, and by type of revisit: treat-and-discharge visit to an emergency department, observation stay (not leading to inpatient readmission), and inpatient readmission. Patient subgroups (age, sex, race) were also evaluated for each type of revisit. RESULTS: Our study cohort included 3 038 740 total index hospital stays from January 2012 to September 2015: 1 357 620 for heart failure, 634 795 for acute myocardial infarction, and 1 046 325 for pneumonia. Counting all revisits after discharge, the total number of hospital revisits per 100 patient discharges for target conditions increased across the study period (monthly increase 0.023 visits per 100 patient discharges (95% confidence interval 0.010 to 0.035)). This change was due to monthly increases in treat-and-discharge visits to an emergency department (0.023 (0.015 to 0.032) and observation stays (0.022 (0.020 to 0.025)), which were only partly offset by declines in readmissions (-0.023 (-0.035 to -0.012)). Increases in observation stay use were more pronounced among non-white patients than white patients. No significant change was seen in mortality within 30 days of discharge for target conditions (-0.0034 (-0.012 to 0.0054)). CONCLUSIONS: In the United States, total hospital revisits within 30 days of discharge for conditions targeted by the HRRP increased across the study period. This increase was due to a rise in post-discharge emergency department visits and observation stays, which exceeded the decline in readmissions. Although reductions in readmissions have been attributed to improvements in discharge planning and care transitions, our findings suggest that these declines could instead be because hospitals and clinicians have intensified efforts to treat patients who return to a hospital within 30 days of discharge in emergency departments and as observation stays.


Assuntos
Readmissão do Paciente/estatística & dados numéricos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Unidades de Observação Clínica/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Pesquisa sobre Serviços de Saúde/métodos , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/terapia , Humanos , Masculino , Medicare/estatística & dados numéricos , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/terapia , Alta do Paciente , Readmissão do Paciente/tendências , Pneumonia/epidemiologia , Pneumonia/terapia , Estudos Retrospectivos , Fatores Sexuais , Fatores de Tempo , Estados Unidos/epidemiologia
9.
Tuberk Toraks ; 67(2): 108-115, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31414641

RESUMO

Introduction: The recently introduced concept of health care-associated pneumonia (HCAP), referring to patients with frequent healthcare contacts and at higher risk of contracting resistant pathogens is controversial. Materials and Methods: A prospective study comparing patients with HCAP and community-acquired pneumonia (CAP) in the our center. The primary outcome was 30 day mortality. Result: A total of the 169 patients HCAP 36 (21.3%); CAP 133 (78.7%) were evaluated. HCAP patients were older than patients with CAP [median age was 72.5 (43-96), 60.0 (18-91) years p<0.05]. The most common Klebsiella pneumoniae (16.6%) and Pseudomonas aeruginosa (8.3%) were gram-negative bacteria in the SBIP group; In the TGP group, gram-positive bacteria were more frequently isolated. Polymicrobial agents (22.2% vs. 3.7% p<0.05) and MDR pathogens (57.1% vs. 24% p<0.05) were more common in patients with HCAP. Mortality rate (22.2% vs. 6% p<0.05) was also higher in HCAP more than CAP. Conclusions: HCAP was common among patients with pneumonia requiring hospitalization and mortality rate was high. The patients with HCAP were different from CAP in terms of demographic and clinical features, etiology, outcome.


Assuntos
Infecções Comunitárias Adquiridas/epidemiologia , Pneumonia Associada a Assistência à Saúde/epidemiologia , Hospitalização , Pneumonia/epidemiologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Infecções Comunitárias Adquiridas/etiologia , Infecções Comunitárias Adquiridas/mortalidade , Comorbidade , Feminino , Pneumonia Associada a Assistência à Saúde/etiologia , Pneumonia Associada a Assistência à Saúde/mortalidade , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Pneumonia/etiologia , Pneumonia/mortalidade , Prognóstico , Estudos Prospectivos , Fatores de Risco , Índice de Gravidade de Doença
10.
Zhonghua Er Ke Za Zhi ; 57(8): 592-596, 2019 Aug 02.
Artigo em Chinês | MEDLINE | ID: mdl-31352743

RESUMO

Objective: To investigate the clinical characteristics of invasive Haemophilus influenzae (HI) infection in children. Methods: The clinical manifestations, laboratory examinations and treatment outcomes of 84 children with HI infection confirmed by bacterial culture in 7 tertiary children's hospitals from 2014 to 2018 were analyzed retrospectively. Results: Among the 84 cases, 50 were males. The age was 1.54 years (ranged from 5 days to 13 years).Twenty cases (24%) had underlying diseases and 48 cases (57%) had not received antibiotics before collecting specimens. Eighty-two cases (98%) had fever and 75 cases (89%) had clear infection foci, among which 31 cases (37%) had meningitis and 27 cases (32%) had pneumonia. Blood culture was positive in 62 cases (74%), cerebrospinal fluid culture was positive in 10 cases (12%), blood culture and cerebrospinal fluid culture were both positive in 11 cases (13%). Antibiotics susceptibility test showed that 27% (22/82) of all HI strains produced ß-lactamases and 48% (37/77) strains were resistant to ampicillin. The drug resistance rates to cefuroxime, ampicillin-sulbactam, trimethoprim-sulfamethoxazole and azithromycin were 25% (20/80) , 20% (9/45) , 71% (44/62) and 19%(11/58), respectively. All strains were sensitive to meropenem, levofloxacin and ceftriaxone. After sensitive antibiotic therapy, 83% (70/84) of all patients were cured and improved, the mortality rate and loss of follow-up rate were 13% (11/84) and 4% (3/84) respectively. Conclusions: Meningitis and pneumonia are common presentation of invasive HI infections in children. Mortality in HI meningitis children is high and the third generation of cephalosporins, such as ceftriaxone can be used as the first choice for the treatment of invasive HI infection.


Assuntos
Antibacterianos/uso terapêutico , Ceftriaxona/uso terapêutico , Infecções por Haemophilus/diagnóstico , Infecções por Haemophilus/tratamento farmacológico , Haemophilus influenzae/isolamento & purificação , Adolescente , Cefalosporinas/farmacologia , Cefalosporinas/uso terapêutico , Criança , Pré-Escolar , Farmacorresistência Bacteriana , Feminino , Infecções por Haemophilus/epidemiologia , Haemophilus influenzae/efeitos dos fármacos , Humanos , Lactente , Masculino , Meningite/epidemiologia , Testes de Sensibilidade Microbiana , Pneumonia/epidemiologia , Estudos Retrospectivos , Resultado do Tratamento , beta-Lactamases/metabolismo
11.
Rev Bras Enferm ; 72(3): 760-766, 2019 Jun 27.
Artigo em Inglês | MEDLINE | ID: mdl-31269143

RESUMO

OBJECTIVE: To evaluate the risk factors related to Klebsiella pneumoniae carbapenemase infection after renal transplantation. METHODS: This was a retrospective epidemiological (case-control) study, conducted from October 2011 to march 2016. Transplanted patients with infection by this bacteria during hospitalization were selected as cases. The controls were paired by age, sex, type of donor and transplant time. The proportion of cases and controls was 1:2. RESULTS: Thirty hundred and five patients were included in the study (45 cases and 90 controls). The risk factors found for infection by KPC were: time of hospitalization after the transplant (OR: 4.82; CI95% 2.46-9.44), delayed kidney function (OR: 5.60; CI95% 1.91-11.01) and previous infectious for another microorganism ( OR: 34.13 CI95% 3.52-132.00). CONCLUSION: The risk of acquisition of this bacterium was directly related to invasive procedures and exposure to the hospital environment. The findings reinforce the importance of prevention measures and control of infection by this microorganism.


Assuntos
Proteínas de Bactérias/efeitos adversos , Transplante de Rim/efeitos adversos , Infecções por Klebsiella/etiologia , Pneumonia/etiologia , beta-Lactamases/efeitos adversos , Adulto , Proteínas de Bactérias/metabolismo , Brasil/epidemiologia , Estudos de Casos e Controles , Feminino , Humanos , Transplante de Rim/métodos , Infecções por Klebsiella/epidemiologia , Infecções por Klebsiella/metabolismo , Klebsiella pneumoniae/metabolismo , Klebsiella pneumoniae/patogenicidade , Masculino , Pessoa de Meia-Idade , Pneumonia/induzido quimicamente , Pneumonia/epidemiologia , Estudos Retrospectivos , Fatores de Risco , beta-Lactamases/metabolismo
12.
Medicine (Baltimore) ; 98(25): e16158, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31232972

RESUMO

RATIONALE: Pembrolizumab, a monoclonal antibody against the programmed cell death 1 (PD-1) protein, can induce a stable regression of some malignancies refractory to conventional chemotherapy. Despite such therapeutic benefits, pembrolizumab can induce immune-related adverse events, with pneumonitis being the most critical problem. PATIENT CONCERNS: All 3 patients complained of fever, cough, and dyspnea after a variable time interval (1-21 days) from pembrolizumab treatment. DIAGNOSES: Chest computed tomography invariably showed ground glass opacity. All tests for possible infectious agents were negative. Based on high procalcitonin level, one of 3 patients was diagnosed to have accompanying bacterial pneumonia. INTERVENTIONS: All patients received antibiotics and steroid treatments (methylprednisolone, 1 mg/kg). OUTCOMES: The 3 patients showed different clinical courses ranging from mild pneumonitis to rapidly progressing respiratory failure. Among the 3 patients, 2 fully recovered with steroid treatment; 1 died from superimposed bacterial pneumonia. LESSONS: The prognosis of pembrolizumab-induced pneumonitis with a superimposed bacterial pneumonia would be poor. It is important to distinguish pure pneumonitis from that with a superimposed bacterial pneumonia.


Assuntos
Anticorpos Monoclonais Humanizados/efeitos adversos , Pneumonia/etiologia , Anticorpos Monoclonais Humanizados/ultraestrutura , Antineoplásicos Imunológicos/efeitos adversos , Antineoplásicos Imunológicos/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Neoplasias do Colo/tratamento farmacológico , Tosse/etiologia , Dispneia/etiologia , Feminino , Febre/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Nasofaríngeas/tratamento farmacológico , Pneumonia/epidemiologia , Pneumonia Bacteriana/epidemiologia , Tomografia Computadorizada por Raios X/métodos
13.
BMC Infect Dis ; 19(1): 510, 2019 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-31182036

RESUMO

BACKGROUND: Pneumococcal infections are major causes of morbidity and mortality worldwide. We use routine hospital admissions data and time-series modelling analysis to estimate the impact of the seven and thirteen valent pneumococcal conjugate vaccines (PCV7 and PCV13) on hospital admissions due to pneumococcal disease in England. METHODS: Hospital admissions for pneumococcal meningitis, bacteraemia and pneumonia between January 1, 2003 and December 31, 2015 were identified from the national Hospital Episode Statistics database for all age groups in England. We model the impact of pneumococcal vaccination using interrupted time series analysis. Hospital admissions prior to vaccine introduction were extrapolated to predict the expected number of admissions in the absence of pneumococcal vaccines. Admissions avoided over time were estimated by comparing the fitted interrupted time series and the expected model for no vaccination in a Bayesian framework. RESULTS: Overall, there were 43,531 (95% credible interval (CrI): 36486-51,346) fewer hospital admissions due to bacteraemia, meningitis and pneumonia in England during the period from 2006 to 2015 than would have been expected if pneumococcal vaccines had not been implemented, with the majority of hospital admissions avoided due to pneumonia. Among young children reductions in meningitis were more common, while among adults reductions in pneumonia admissions were relatively more important, with no evidence for reduced bacteraemia and meningitis among older adults. We estimated that 981 (95% CrI: 391-2018), 749 (95% CrI: 295-1442) and 1464 (95% CrI: 793-2522) bacteraemia, meningitis and pneumonia related hospital admissions, respectively, were averted in children < 2 years of age. CONCLUSIONS: Substantial reductions in hospital admissions for bacteraemia, meningitis and pneumonia in England were estimated after the introduction of childhood vaccination, with indirect effects being responsible for most of the hospital admissions avoided.


Assuntos
Hospitalização/estatística & dados numéricos , Infecções Pneumocócicas/diagnóstico , Vacinas Pneumocócicas/imunologia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Inglaterra/epidemiologia , Feminino , Humanos , Lactente , Análise de Séries Temporais Interrompida , Masculino , Meningite Pneumocócica/diagnóstico , Meningite Pneumocócica/epidemiologia , Pessoa de Meia-Idade , Infecções Pneumocócicas/epidemiologia , Pneumonia/diagnóstico , Pneumonia/epidemiologia , Vacinação , Vacinas Conjugadas/imunologia , Adulto Jovem
14.
Environ Sci Pollut Res Int ; 26(23): 24112-24120, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31228058

RESUMO

To determine the association between daily air pollution and the hospital admissions for respiratory diseases in children aged from 0 to 17 years in Jinan, China. Generalized linear models were used to explore the acute effects of ambient fine particulate matter (PM2.5) on the children's hospital admissions for respiratory diseases. We evaluated the lag associations (including lag 0 to lag 3, lag 01, and lag 03) between daily PM2.5 and the number of children's hospital admissions for respiratory diseases, and stratified by gender, age group (baby group: age 0-1 years; child group: age 1-5 years; student group: age 6-17 years), and cause-specific disease (including upper infection, pneumonia, and acute bronchitis) during 2011-2015. PM2.5 had significant positive impacts on the number of children's hospital admissions for respiratory disease. The results showed that per 10 µg/m3 increase of PM2.5 at lag 1 was associated with an increase in total and male hospital admissions of 0.23% (95% CI, 0.02%-0.45%) and 0.32% (95% CI, 0.04%-0.06%). The corresponding risk of the student group (age 6-17 years) hospital admissions was increased 0.90% (95% CI, 0.39%-1.42%) at lag 1 day. The corresponding risk of the upper infection was increased 0.96% (95% CI, 0.37-1.55%) at lag 1 day. Males and student groups (age 6-17 years) were more vulnerable to PM2.5 exposure. Upper infection admission was identified as the sensitive disease for children. It is a better way to reduce children's outdoor activities to avoid health effects when the air pollution increases.


Assuntos
Poluição do Ar/efeitos adversos , Poluição do Ar/análise , Hospitalização/estatística & dados numéricos , Doenças Respiratórias/epidemiologia , Adolescente , Bronquite/epidemiologia , Criança , Pré-Escolar , China/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido , Modelos Lineares , Masculino , Material Particulado/efeitos adversos , Material Particulado/análise , Pneumonia/epidemiologia
15.
Comp Immunol Microbiol Infect Dis ; 64: 153-158, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31174691

RESUMO

PURPOSE: The etiology of community-acquired pneumonia (CAP) in hospital patients is often ambiguous due to the limited pathogen detection. Lack of a microbiological diagnosis impairs precision treatment in CAP. METHODS: Specimens collected from the lower respiratory tract of 195 CAP patients, viruses were measured by the Single-plex real-time PCR assay and the conventional culture method was exploited for bacteria. RESULTS: Among the 195 patients, there were 46 (23.59%) pure bacterial infections, 20 (10.26%) yeast infections, 32 (16.41%) pure viral infections, 8 (4.10%) viral-yeast co-infections, and 17 (8.72%) viral-bacterial co-infections. The two most abundant bacteria were Acinetobacter baumannii and klebsiella pneumoniae, whereas the most common virus was influenza A. CONCLUSIONS: Non-influenza respiratory microorganisms frequently co-circulated during the epidemic peaks of influenza, which easily being ignored in CAP therapy. In patients with bacterial and viral co-infections, identifying the etiologic agent is crucial for patient's therapy.


Assuntos
Infecções Comunitárias Adquiridas/epidemiologia , Influenza Humana/epidemiologia , Pneumonia/epidemiologia , Pneumonia/microbiologia , Infecções por Acinetobacter/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , China/epidemiologia , Coinfecção/epidemiologia , Coinfecção/microbiologia , Coinfecção/virologia , Feminino , Humanos , Lactente , Recém-Nascido , Influenza Humana/microbiologia , Infecções por Klebsiella/epidemiologia , Masculino , Pessoa de Meia-Idade , Micoses/epidemiologia , Reação em Cadeia da Polimerase em Tempo Real , Adulto Jovem
16.
Lancet ; 394(10196): 407-418, 2019 08 03.
Artigo em Inglês | MEDLINE | ID: mdl-31230828

RESUMO

BACKGROUND: Asthma is a common chronic airway disease worldwide. Despite its large population size, China has had no comprehensive study of the national prevalence, risk factors, and management of asthma. We therefore aimed to estimate the national prevalence of asthma in a representative sample of the Chinese population. METHODS: A representative sample of 57 779 adults aged 20 years or older was recruited for the national cross-sectional China Pulmonary Health (CPH) study using a multi-stage stratified sampling method with parameters derived from the 2010 census. Ten Chinese provinces, representative of all socioeconomic settings, from six geographical regions were selected, and all assessments were done in local health centres. Exclusion criteria were temporary residence, inability to take a spirometry test, hospital treatment of cardiovascular conditions or tuberculosis, and pregnancy and breastfeeding. Asthma was determined on the basis of a self-reported history of diagnosis by a physician or by wheezing symptoms in the preceding 12 months. All participants were assessed with a standard asthma questionnaire and were classed as having or not having airflow limitation through pulmonary function tests before and after the use of a bronchodilator (400 µg of salbutamol). Risk factors for asthma were examined by multivariable-adjusted analyses done in all participants for whom data on the variables of interest were available. Disease management was assessed by the self-reported history of physician diagnosis, treatments, and hospital visits in people with asthma. FINDINGS: Between June 22, 2012, and May 25, 2015, 57 779 participants were recruited into the CPH study. 50 991 (21 446 men and 29 545 women) completed the questionnaire survey and had reliable post-bronchodilator pulmonary function test results and were thus included in the final analysis. The overall prevalence of asthma in our sample was 4·2% (95% CI 3·1-5·6), representing 45·7 million Chinese adults. The prevalence of asthma with airflow limitation was 1·1% (0·9-1·4), representing 13·1 million adults. Cigarette smoking (odds ratio [OR] 1·89, 95% CI 1·26-2·84; p=0·004), allergic rhinitis (3·06, 2·26-4·15; p<0·0001), childhood pneumonia or bronchitis (2·43, 1·44-4·10; p=0·002), parental history of respiratory disease (1·44, 1·02-2·04; p=0·040), and low education attainment (p=0·045) were associated with prevalent asthma. In 2032 people with asthma, only 28·8% (95% CI 19·7-40·0) reported ever being diagnosed by a physician, 23·4% (13·9-36·6) had a previous pulmonary function test, and 5·6% (3·1-9·9) had been treated with inhaled corticosteroids. Furthermore, 15·5% (11·4-20·8) people with asthma reported at least one emergency room visit and 7·2% (4·9-10·5) at least one hospital admission due to exacerbation of respiratory symptoms within the preceding year. INTERPRETATION: Asthma is prevalent but largely undiagnosed and undertreated in China. It is crucial to increase the awareness of asthma and disseminate standardised treatment in clinical settings to reduce the disease burden. FUNDING: National Key R&D Program of China, Ministry of Science and Technology of China; the Special Research Foundation for Public Welfare of Health, Ministry of Health of China; the Chinese National Research Program for Key Issues in Air Pollution Control; and the National Natural Science Foundation of China.


Assuntos
Asma/tratamento farmacológico , Asma/epidemiologia , Bronquite/epidemiologia , Fumar Cigarros/epidemiologia , Pneumonia/epidemiologia , Rinite Alérgica/epidemiologia , Administração por Inalação , Corticosteroides/uso terapêutico , Adulto , Asma/etiologia , Bronquite/complicações , China/epidemiologia , Fumar Cigarros/efeitos adversos , Estudos Transversais , Gerenciamento Clínico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia/complicações , Prevalência , Rinite Alérgica/complicações , Fatores de Risco , Inquéritos e Questionários
17.
Chin Med J (Engl) ; 132(12): 1429-1434, 2019 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-31205100

RESUMO

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) pneumonia is an important issue with significant morbidity and mortality in clinical practice, especially in diabetes mellitus (DM). Studies focusing on S. aureus pneumonia in DM is limited, we sought to make a relatively comprehensive exploration of clinical characteristics, antimicrobial resistance, and risk factors for mortality of S. aureus pneumonia in DM and non-diabetics mellitus (non-DM). METHODS: A retrospective study was conducted in Ruijin Hospital from 2014 to 2017. The characteristics of DM and non-DM patients were assessed, including demographics, comorbidities, using of invasive mechanical ventilation, Hemoglobin A1c (HbA1C), confusion, urea, respiratory rate, blood pressure, age ≥65 years (CURB-65) score, length of hospital stay, clinical outcomes, antimicrobial susceptibility. Independent risk factors for mortality were identified by univariate and multivariate logistic regression analysis. RESULTS: A total of 365 patients with S. aureus pneumonia were included in our study, including 144 with DM and 221 non-DM. DM patients were more susceptible to MRSA infection (65.3% vs. 56.1%, P > 0.05), suffered from much severer pneumonia with a higher CURB-65 score, invasive mechanical ventilation rate (46.5% vs. 28.1%, P < 0.01) and mortality rates (30.6% vs. 23.1%, P > 0.05); almost all DM patients had higher antimicrobial resistance than non-DM patients, the DM group had a higher co-infection rate (47.2% vs. 45.7%, P > 0.05), and Acinetobacter baumannii was the most common bacterium in DM, while Klebsiella pneumoniae ranked first in patients with non-DM. Independent risk factors for pneumonia-related mortality were MRSA and CURB-65. Higher HbA1c levels were linked to a higher MRSA infection and co-infection rate and more severe pneumonia, leading to an increase in mortality. CONCLUSIONS: DM patients with poor glucose control are more susceptible to MRSA infection. They suffer from higher antimicrobial resistance, a higher co-infection rate, and much severer pneumonia than non-DM. MRSA itself is an independent risk factor for mortality in all patients.


Assuntos
Diabetes Mellitus/microbiologia , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Staphylococcus aureus Resistente à Meticilina/patogenicidade , Pneumonia/microbiologia , Infecções Estafilocócicas/microbiologia , Idoso , Antibacterianos/uso terapêutico , Feminino , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Análise Multivariada , Pneumonia/tratamento farmacológico , Pneumonia/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/epidemiologia
19.
Sci Total Environ ; 677: 524-529, 2019 Aug 10.
Artigo em Inglês | MEDLINE | ID: mdl-31063895

RESUMO

Epidemiological evidence has shown that air pollution is associated with chronic obstructive pulmonary disease (COPD). The objective of this study was to investigate the effects of air pollution on patients with COPD and pneumonia. A case-control study of patients who had undergone thoracentesis for pleural effusion drainage in a hospital was recruited for this study. COPD and non-COPD patients with pneumonia respectively served as the case and control groups. Increases in particulate matter of <2.5 µm in aerodynamic diameter (PM2.5) and NO2 increased the risk of pneumonia in COPD patients (adjusted odd ratio (OR) = 4.136, 95% confidence interval (CI) = 1.740-9.832 for PM2.5; adjusted OR = 1.841, 95% CI = 1.117-3.036 for NO2). COPD patients with pneumonia had higher levels of CD14 in pleural effusion than did non-COPD with pneumonia (p < 0.05). An increase in CD14 of the pleural effusion increased the risk of pneumonia in COPD patients (adjusted OR = 1.126, 95% CI = 1.009-1.256). We further observed that an increase in Cu and a decrease in Zn in the pleural effusion increased the risk of pneumonia in COPD patients (adjusted OR = 1.005, 95% CI = 1.000-1.010 for Cu; adjusted OR = 0.988, 95% CI = 0.978-0.997 for Zn). In conclusion, our results suggest that COPD patients had a high risk of pneumonia occurring due to air pollution exposure.


Assuntos
Poluentes Atmosféricos/efeitos adversos , Exposição Ambiental , Pneumonia/epidemiologia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Adulto , Idoso , Estudos de Casos e Controles , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Material Particulado/efeitos adversos , Pneumonia/induzido quimicamente , Fatores de Risco , Taiwan/epidemiologia , Adulto Jovem
20.
Anticancer Res ; 39(5): 2671-2678, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31092467

RESUMO

BACKGROUND/AIM: Postoperative pneumonia after esophageal cancer can lead to additional pain, prolonged hospital stay, and respiratory failure. These adverse events might lead to early recurrence and/or death. We investigated the influence of postoperative pneumonia on the esophageal cancer survival and recurrence after curative surgery. PATIENTS AND METHODS: This study included 122 patients who underwent curative surgery for esophageal cancer between 2008 and 2018. The patients were classified into: i) those with postoperative pneumonia (pneumonia group) and ii) those without postoperative pneumonia (non-pneumonia group). The risk factors for the overall survival (OS) and recurrence-free survival (RFS) were identified. The rate of postoperative pneumonia was measured by the revised Uniform Pneumonia Score. RESULTS: Postoperative complications were found in 34 of the 122 patients (27.9%). The OS rate at 5 years following surgery was 28.2% in the pneumonia group and 55.1% in the non-pneumonia group (p=0.006). The RFS rate at 5 years after surgery was 18.9% in the pneumonia group and 49.2% in the non-pneumonia group (p=0.061). A multivariate analysis showed that postoperative pneumonia was a significant independent risk factor for OS. CONCLUSION: The development of postoperative pneumonia was a risk factor for a decreased overall survival in patients who underwent curative surgery for esophageal cancer. The surgical procedure, perioperative care and surgical strategy should be carefully planned in order to avoid postoperative pneumonia.


Assuntos
Neoplasias Esofágicas/epidemiologia , Recidiva Local de Neoplasia/epidemiologia , Pneumonia/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Sobreviventes de Câncer , Intervalo Livre de Doença , Neoplasias Esofágicas/complicações , Neoplasias Esofágicas/patologia , Neoplasias Esofágicas/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/cirurgia , Pneumonia/etiologia , Pneumonia/patologia , Pneumonia/cirurgia , Complicações Pós-Operatórias/patologia , Complicações Pós-Operatórias/cirurgia , Fatores de Risco
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