RESUMEN
OBJECTIVE: Pneumonia is considered a focus of infection in patients presenting with community-acquired bacterial meningitis but the impact on disease course is unclear. The aim was to study presenting characteristics, clinical course and outcome of meningitis patients with co-existing pneumonia on admission. METHODS: We evaluated adult patients with community-acquired bacterial meningitis with pneumonia on admission in a nationwide, prospective cohort performed from March 2006 to June 2017. We performed logistic regression analysis to identify clinical characteristics predictive of pneumonia on admission, and to quantify the effect of pneumonia on outcome. RESULTS: Pneumonia was diagnosed on admission in 315 of 1852 (17%) bacterial meningitis episodes and confirmed by chest X-ray in 256 of 308 (83%) episodes. Streptococcus pneumoniae was the causative organism in 256 of 315 episodes (81%). Pneumonia on admission was associated with advanced age (OR 1.03 per year increase, 95% CI 1.02-1.04, p < 0.001), alcoholism (OR 1.96, 95% CI 1.23-3.14, p 0.004), cancer (OR 1.54, 95% CI 1.12-2.13, p 0.008), absence of otitis or sinusitis (OR 0.44, 95% CI 0.32-0.59, p < 0.001) and S. pneumoniae (OR 2.14, 95% CI 1.55-2.95, p < 0.001) in the multivariate analysis. An unfavourable outcome defined as a score of 1-4 on the Glasgow Outcome Scale was observed in 172 (55%) episodes and 87 patients (28%) died. Pneumonia on admission was independently associated with unfavourable outcome and mortality in the multivariate analysis (OR 1.48, 95% CI 1.12-1.96; p 0.005). CONCLUSION: Pneumonia on admission in bacterial meningitis is a frequent coexisting infection and is independently associated with unfavourable outcome and mortality.
Asunto(s)
Infecciones Comunitarias Adquiridas/microbiología , Meningitis Bacterianas/complicaciones , Neumonía/microbiología , Anciano , Antibacterianos/uso terapéutico , Femenino , Humanos , Modelos Logísticos , Masculino , Meningitis Bacterianas/líquido cefalorraquídeo , Meningitis Bacterianas/tratamiento farmacológico , Persona de Mediana Edad , Países Bajos , Neumonía/diagnóstico por imagen , Estudios Prospectivos , Radiografía , Factores de RiesgoRESUMEN
Os autores demonstram conveniencia da apendicectomia profilatica, realizada durante as laparotomias, por outras condicoes cirurgicas que nao a apendicite aguda Comparam-se os resultados pos-operatorios e anatomopatologicos, dando enfase ao alto indice de apendices ileocecais com alteracoes patologicas, a nao dependencia dessa conduta a indicacao cirurgica primaria e o baixo percentual de complicacoes. O estudo finaliza concluindo que esse procedimento e recomendavel e devia ser adotado como rotina
Asunto(s)
Humanos , Apendicectomía , LaparoscopíaRESUMEN
Os autores propoem uma nova tecnica para a realizacao da postectomia. Baseiam-se na experiencia de 281 casos. Analisam comparativamente a tecnica e discutem os resultados
Asunto(s)
Circuncisión MasculinaRESUMEN
Os autores apresentam nota previa de uma tecnica para drenagem do liquido ascitico no sistema venoso profundo atraves de anastomose da safena magna com orificio cirurgico peritoneal
Asunto(s)
Anastomosis Arteriovenosa , AscitisRESUMEN
O autor apresenta modificacao no porta-agulhas de Reverdin que possibilitou a reducao do tempo de cirurgia, de material e de gestos superfluos