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OBJECTIVE: To evaluate the association between consolidation on chest radiograph and typical bacterial etiology of childhood community acquired pneumonia (CAP) in the Etiology of Pneumonia in the Community study. STUDY DESIGN: Hospitalized children <18 years of age with CAP enrolled in the Etiology of Pneumonia in the Community study at 3 children's hospitals between January 2010 and June 2012 were included. Testing of blood and respiratory specimens used multiple modalities to identify typical and atypical bacterial, or viral infection. Study radiologists classified chest radiographs (consolidation, other infiltrates [interstitial and/or alveolar], pleural effusion) using modified World Health Organization pneumonia criteria. Infiltrate patterns were compared according to etiology of CAP. RESULTS: Among 2212 children, there were 1302 (59%) with consolidation with or without other infiltrates, 910 (41%) with other infiltrates, and 296 (13%) with pleural effusion. In 1795 children, at least 1 pathogen was detected. Among these patients, consolidation (74%) was the most frequently observed pattern (74% in typical bacterial CAP, 58% in atypical bacterial CAP, and 54% in viral CAP). Positive and negative predictive values of consolidation for typical bacterial CAP were 12% (95% CI 10%-15%) and 96% (95% CI 95%-97%) respectively. In a multivariable model, typical bacterial CAP was associated with pleural effusion (OR 7.3, 95% CI 4.7-11.2) and white blood cell ≥15 000/mL (OR 3.2, 95% CI 2.2-4.9), and absence of wheeze (OR 0.5, 95% CI 0.3-0.8) or viral detection (OR 0.2, 95% CI 0.1-0.4). CONCLUSIONS: Consolidation predicted typical bacterial CAP poorly, but its absence made typical bacterial CAP unlikely. Pleural effusion was the best predictor of typical bacterial infection, but too uncommon to aid etiology prediction.
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Infecciones Comunitarias Adquiridas , Derrame Pleural , Neumonía , Radiología , Humanos , Niño , Neumonía/diagnóstico por imagen , Neumonía/epidemiología , Neumonía/etiología , Radiografía , Derrame Pleural/diagnóstico por imagen , Derrame Pleural/etiología , Causalidad , Infecciones Comunitarias Adquiridas/diagnóstico por imagen , Infecciones Comunitarias Adquiridas/etiologíaRESUMEN
As a consequence of systemic inflammation caused by ischemia and reperfusion (I/R) due to aortic occlusion, the lungs can exhibit increased microvascular permeability, local release of pro-inflammatory mediators, and leukocyte infiltration. Lung tissue infiltration by activated neutrophils is followed by acute respiratory distress syndrome, which is linked to acute pulmonary microvascular damage, high mortality rates, and organ dysfunction. Previous studies have demonstrated that female sex hormones modulate the inflammatory response and that prophylactic treatment with 17ß-estradiol (E2) can prevent fatalities and preserve mesenteric perfusion and intestinal integrity after ischemia/reperfusion induced by aortic occlusion. In this study, we focused on the protective effects of estradiol after aortic ischemia/reperfusion by evaluating lung injury and endothelial alterations. Upon anesthesia and mechanical ventilation, male rats were subjected to aortic occlusion for 20 min, followed by 2 h of reperfusion. In parallel, one group of rats received a single injection of estradiol (280 µg/kg, i.v.) 30 min before ischemia. We observed increased serum concentrations of IL-1ß, IL-6 and IL-10 in the I/R rats and E2 was able to reduce them. E2 effects after 2 h of reperfusion resulted mainly in decreasing of edema, iNOS expression and preventing leukocyte infiltration. Overall, our data indicate that estradiol might be a supplementary approach to deal with systemic processes and lung deterioration.
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Neumonía , Daño por Reperfusión , Ratas , Masculino , Femenino , Animales , Daño por Reperfusión/metabolismo , Aorta Torácica , Ratas Wistar , Neumonía/tratamiento farmacológico , Neumonía/etiología , Estradiol/farmacología , Estradiol/uso terapéutico , Estradiol/metabolismo , Pulmón , Isquemia/metabolismoRESUMEN
BACKGROUND: Pneumonia is a common complication in older people who are hospitalized to treat different fractures, which increases morbimortality in this population. OBJECTIVES: Estimating the pneumonia incidence density in older people hospitalized to treat femoral fractures and identifying risk factors for this infection. METHODS: Prospective cohort study whose data were collected from a population of older people who were being treated for femoral fractures at a hospital in the central region of Brazil between September 2016 and February 2017. The pneumonia diagnosis was based on radiography and clinical tests. Incidence density was estimated according to gender, age, Charlson comorbidity index, polypharmacy, chronic pulmonary disease, admission to the intensive care unit, surgical treatment, and nasoenteral tube feeding. Magnitude of the associations was estimated by multiple Poisson regression. RESULTS: Among the 200 patients, the pneumonia incidence density was 13.04/1,000 person-days. For men and older people 80 years old or older, the pneumonia incidence density was 15.6/1,000 person-days and 18.3/1,000 person-days, respectively. After adjusting for age, gender, chronic pulmonary disease, and admission to the intensive care unit, use of nasoenteral tubes remained associated with occurrence of pneumonia in older people, and the risk of developing the infection was eight times higher in the population who received nasoenteral feeding than that calculated for the population that did not use the devices (p ≤ 0.001). CONCLUSION: Using nasoenteral tubes during hospital stays increased the risk of developing pneumonia in hospitalized older people, which reinforces the need for continuous care monitoring regarding use of tubes to prevent complications.
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Fracturas del Fémur , Neumonía , Anciano , Anciano de 80 o más Años , Brasil/epidemiología , Estudios de Cohortes , Hospitalización , Humanos , Masculino , Neumonía/epidemiología , Neumonía/etiología , Estudios Prospectivos , Factores de RiesgoRESUMEN
BACKGROUND: A transthoracic esophagectomy is associated with high rates of morbidity. Minimally invasive esophagectomy has emerged to decrease such morbidity. The aim of this study was to accurately determine surgical outcomes after totally minimally invasive Ivor-Lewis Esophagectomy (TMIE). METHODS: A systematic literature search was performed to identify original articles analyzing patients who underwent TMIE. Main outcomes included overall morbidity, major morbidity, pneumonia, arrhythmia, anastomotic leak, chyle leak, and mortality. A meta-analysis was conducted to estimate the overall weighted proportion and its 95% confidence interval (CI) for each analyzed outcome. RESULTS: A total of 5619 patients were included for analysis; 4781 (85.1%) underwent a laparoscopic/thoracoscopic esophagectomy and 838 (14.9%) a robotic-assisted esophagectomy. Mean age of patients was 63.5 (55-67) years and 75.8% were male. Overall morbidity and major morbidity rates were 39% (95% CI, 33%-45%) and 20% (95% CI, 13%-28%), respectively. Postoperative pneumonia and arrhythmia rates were 10% (95% CI, 8%-13%) and 12% (95% CI, 8%-17%), respectively. Anastomotic leak rate across studies was 8% (95% CI, 6%-10%). Chyle leak rate was 3% (95% CI, 2%-5%). Mortality rate was 2% (95% CI, 2%-2%). Median ICU stay and length of hospital stay were 2 (1-4) and 11.2 (7-20) days, respectively. CONCLUSIONS: Totally minimally invasive Ivor-Lewis esophagectomy is a challenging procedure with high morbidity rates. Strategies to enhance postoperative outcomes after this operation are still needed.
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Neoplasias Esofágicas , Laparoscopía , Neumonía , Anciano , Fuga Anastomótica/etiología , Esofagectomía/métodos , Femenino , Humanos , Laparoscopía/métodos , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Neumonía/epidemiología , Neumonía/etiología , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Poisoning by Trema micrantha commonly causes hepatocellular necrosis in cattle, sheep, and goats and edema and cerebral hemorrhage in horses. This plant can cause toxic pneumopathy in sheep, and there is only one report of the natural form and one of the experimental form in the State of Rio Grande do Sul. This study aimed to report an outbreak of the respiratory form of natural poisoning by T. micrantha in sheep. Six sheep developed clinical respiratory signs after consumption of the plant and four of them died and two recovered after treatment with dexamethasone. The sheep presented tachypnea, noisy breathing, edema of the face, eyelids, and vulva, and subcutaneous emphysema on the face and neck. Necropsy (Sheep 2, 3, and 4) showed uncollapsed, heavy, diffuse red lungs with evident costal impressions and a moderate amount of serosanguineous fluid flowed at section. The liver had a moderate diffuse evident lobular pattern. The histopathology of the lungs of the three necropsied sheep showed congestion and edema with the formation of hyaline membranes within accentuated diffuse alveoli, in addition to thickening of the alveolar septa due to mild to moderate diffuse type II pneumocyte hyperplasia and also mild to moderate diffuse infiltrate of macrophages, lymphocytes, plasma cells, and neutrophils in the lumen of alveoli, bronchi, and bronchioles. Sheep 3 also showed type II pneumocytes with enlarged and hyperchromatic nuclei, sometimes binucleated with evident nucleoli, and, in some regions, the pneumocytes were desquamated to the alveolar lumen forming small syncytia and mild multifocal hyperplasia in the bronchial epithelium. The anti-cytokeratin IHC evaluation showed marked diffuse intracytoplasmic staining in hyperplastic type II pneumocytes in the bronchiolar epithelium of the three evaluated sheep. The liver of the three sheep had mild multifocal centrilobular necrosis. It seems to be the second report of spontaneous poisoning by T. micrantha in sheep developing lung lesions described in Brazil and the first in the State of Santa Catarina.
A intoxicação por Trema micrantha, comumente causa em bovinos, ovinos e caprinos necrose hepatocelular e, edema e hemorragia cerebral em equinos. Essa planta em ovinos pode causar pneumopatia tóxica, existindo descrição apenas de um relato da forma natural e um da forma experimental no estado do Rio Grande do Sul. O objetivo deste trabalho é relatar, um surto, da forma respiratória de intoxicação natural por T. micranta em ovinos. Seis ovinos desenvolveram sinais clínicos respiratórios após o consumo da planta e destes quatro morreram e dois após o tratamento com dexametasona se recuperaram. Os ovinos apresentaram taquipneia, respiração ruidosa, edema de face, pálpebras, vulva e enfisema subcutâneo na face e pescoço. Na necropsia (Ovinos 2, 3 e 4) observou-se pulmões não colabados, pesados, vermelhos difusos com impressões costais evidentes e ao corte fluindo moderada quantidade de líquido serosanguinolento. O fígado apresentava padrão lobular evidente difuso moderado. Na histopatologia, em pulmões dos três ovinos necropsiados havia congestão e edema com formação de membranas hialinas no interior de alvéolos difusos acentuados, além de espessamento dos septos alveolares devido a hiperplasia de pneumócitos tipo II difuso discreta à moderada, havia ainda, infiltrado de macrófagos, linfócitos, plasmócitos e neutrófilos difuso discreto a moderado no lúmen de alvéolo, brônquios e bronquíolos. No Ovino 3, observou-se ainda pneumócitos tipo II com núcleos aumentados e hipercromáticos, por vezes binucleados com nucléolos evidentes, e em algumas regiões estes pneumócitos estavam descamados para a luz alveolar formando pequenos sincícios e no epitélio de brônquios havia hiperplasia multifocal discreta. A avaliação IHQ anti-citoqueratina demonstrou marcação intracitoplasmática difusa acentuada em pneumócitos tipo II hiperplásicos no epitélio bronquiolar dos três ovinos avaliados. No fígado dos três ovinos havia necrose centrolobular multifocal discreta. Este parece ser o segundo relato da intoxicação espontânea por T. micrantha em ovinos desenvolvendo lesões pulmonares, descrito no Brasil e o primeiro no estado de Santa Catarina.
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Animales , Intoxicación por Plantas/veterinaria , Neumonía/etiología , Neumonía/patología , Neumonía/epidemiología , Enfermedades de las Ovejas , Trema/envenenamiento , Brasil , Oveja DomésticaRESUMEN
Mechanical ventilation (MV) is essential for the treatment of critical patients since it may provide a desired gas exchange. However, MV itself can trigger ventilator-associated lung injury in patients. We hypothesized that the mechanisms of lung injury through redox imbalance might also be associated with pulmonary inflammatory status, which has not been so far described. We tested it by delivering different tidal volumes to normal lungs undergoing MV. Healthy Wistar rats were divided into spontaneously breathing animals (control group, CG), and rats were submitted to MV (controlled ventilation mode) with tidal volumes of 4 mL/kg (MVG4), 8 mL/kg (MVG8), or 12 mL/kg (MVG12), zero end-expiratory pressure (ZEEP), and normoxia (FiO2 = 21%) for 1 hour. After ventilation and euthanasia, arterial blood, bronchoalveolar lavage fluid (BALF), and lungs were collected for subsequent analysis. MVG12 presented lower PaCO2 and bicarbonate content in the arterial blood than CG, MVG4, and MVG8. Neutrophil influx in BALF and MPO activity in lung tissue homogenate were significantly higher in MVG12 than in CG. The levels of CCL5, TNF-α, IL-1, and IL-6 in lung tissue homogenate were higher in MVG12 than in CG and MVG4. In the lung parenchyma, the lipid peroxidation was more important in MVG12 than in CG, MVG4, and MVG8, while there was more protein oxidation in MVG12 than in CG and MVG4. The stereological analysis confirmed the histological pulmonary changes in MVG12. The association of controlled mode ventilation and high tidal volume, without PEEP and normoxia, impaired pulmonary histoarchitecture and triggered redox imbalance and lung inflammation in healthy adult rats.
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Lesión Pulmonar/patología , Neumonía/patología , Respiración Artificial/efectos adversos , Animales , Citocinas/metabolismo , Lesión Pulmonar/etiología , Lesión Pulmonar/metabolismo , Masculino , Oxidación-Reducción , Neumonía/etiología , Neumonía/metabolismo , Ratas , Ratas Wistar , Volumen de Ventilación PulmonarRESUMEN
Acetylcholine (ACh), the neurotransmitter of the cholinergic system, regulates inflammation in several diseases including pulmonary diseases. ACh is also involved in a non-neuronal mechanism that modulates the innate immune response. Because inflammation and release of pro-inflammatory cytokines are involved in pulmonary emphysema, we hypothesized that vesicular acetylcholine transport protein (VAChT) deficiency, which leads to reduction in ACh release, can modulate lung inflammation in an experimental model of emphysema. Mice with genetical reduced expression of VAChT (VAChT KDHOM 70%) and wild-type mice (WT) received nasal instillation of 50 uL of porcine pancreatic elastase (PPE) or saline on day 0. Twenty-eight days after, animals were evaluated. Elastase instilled VAChT KDHOM mice presented an increase in macrophages, lymphocytes, and neutrophils in bronchoalveolar lavage fluid and MAC2-positive macrophages in lung tissue and peribronchovascular area that was comparable to that observed in WT mice. Conversely, elastase instilled VAChT KDHOM mice showed significantly larger number of NF-κB-positive cells and isoprostane staining in the peribronchovascular area when compared to elastase-instilled WT-mice. Moreover, elastase-instilled VAChT-deficient mice showed increased MCP-1 levels in the lungs. Other cytokines, extracellular matrix remodeling, alveolar enlargement, and lung function were not worse in elastase-instilled VAChT deficiency than in elastase-instilled WT-controls. These data suggest that decreased VAChT expression may contribute to the pathogenesis of emphysema, at least in part, through NF-κB activation, MCP-1, and oxidative stress pathways. This study highlights novel pathways involved in lung inflammation that may contribute to the development of chronic obstrutive lung disease (COPD) in cholinergic deficient individuals such as Alzheimer's disease patients.
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Acetilcolina/deficiencia , Enfisema/inmunología , Neumonía/etiología , Acetilcolina/metabolismo , Animales , Líquido del Lavado Bronquioalveolar/citología , Citocinas/metabolismo , Modelos Animales de Enfermedad , Enfisema/metabolismo , Inflamación/patología , Pulmón/patología , Macrófagos/metabolismo , Masculino , Ratones , FN-kappa B/metabolismo , Neutrófilos/metabolismo , Elastasa Pancreática/efectos adversos , Elastasa Pancreática/farmacología , Neumonía/fisiopatología , Enfisema Pulmonar/metabolismo , Transducción de Señal , Proteínas de Transporte Vesicular de Acetilcolina/deficiencia , Proteínas de Transporte Vesicular de Acetilcolina/genética , Proteínas de Transporte Vesicular de Acetilcolina/metabolismoRESUMEN
(1) Background: The lung cholinergic pathway is important for controlling pulmonary inflammation in acute lung injury, a condition that is characterized by a sudden onset and intense inflammation. This study investigated changes in the expression levels of nicotinic and muscarinic acetylcholine receptors (nAChR and mAChR) in the lung during acute lung injury. (2) Methods: acute lung injury (ALI) was induced in wild-type and cholinergic-deficient (VAChT-KDHOM) mice using intratracheal lipopolysaccharide (LPS) instillation with or without concurrent treatment with nicotinic ligands. Bronchoalveolar lavage fluid was collected to evaluate markers of inflammation, and then the lung was removed and processed for isolation of membrane fraction and determination of acetylcholine receptors level using radioligand binding assays. (3) Results: LPS-induced increase in lung inflammatory markers (e.g., neutrophils and IL-1ß) was significantly higher in VAChT-KDHOM than wild-type mice. In contrast, LPS treatment resulted in a significant increase in lung's α7 nicotinic receptor level in wild-type, but not in VAChT-KDHOM mice. However, treatment with PNU 282987, a selective α7 nicotinic receptor agonist, restored VAChT-KDHOM mice's ability to increase α7 nicotinic receptor levels in response to LPS-induced acute lung injury and reduced lung inflammation. LPS also increased muscarinic receptors level in VAChT-KDHOM mice, and PNU 282987 treatment reduced this response. (4) Conclusions: Our data indicate that the anti-inflammatory effects of the lung cholinergic system involve an increase in the level of α7 nicotinic receptors. Pharmacological agents that increase the expression or the function of lung α7 nicotinic receptors have potential clinical uses for treating acute lung injury.
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Lesión Pulmonar Aguda/tratamiento farmacológico , Antiinflamatorios/farmacología , Benzamidas/farmacología , Compuestos Bicíclicos con Puentes/farmacología , Colinérgicos/metabolismo , Neumonía/prevención & control , Proteínas de Transporte Vesicular de Acetilcolina/metabolismo , Receptor Nicotínico de Acetilcolina alfa 7/metabolismo , Lesión Pulmonar Aguda/inducido químicamente , Lesión Pulmonar Aguda/metabolismo , Lesión Pulmonar Aguda/patología , Animales , Citocinas/metabolismo , Masculino , Ratones , Agonistas Nicotínicos/farmacología , Neumonía/etiología , Neumonía/metabolismo , Neumonía/patología , Proteínas de Transporte Vesicular de Acetilcolina/genética , Receptor Nicotínico de Acetilcolina alfa 7/genéticaRESUMEN
Epidemiological studies have associated long-term exposure to environmental air pollution particulate matter (PM) with the development of diverse health problems. They include infectious respiratory diseases related to the deregulation of some innate immune response mechanisms, such as the host defense peptides' expression. Herein, we evaluated in BALB/c mice the effect of long-standing exposure (60 days) to urban-PM from the south of Mexico City, with aerodynamic diameters below 2.5 µm (PM2.5) and 10 µm (PM10) on the lung's gene expression and production of three host defense peptides (HDPs); murine beta-defensin-3, -4 (mBD-3, mBD-4) and cathelin-related antimicrobial peptide (CRAMP). We also evaluated mRNA levels of Il1b and Il10, two cytokines related to the expression of host defense peptides. Exposure to PM2.5 and PM10 differentially induced lung inflammation, being PM2.5, which caused higher inflammation levels, probably associated with a differential deposition on the airways, that facilitate the interaction with alveolar macrophages. Inflammation levels were associated with an early upregulation of the three HDPs assessed and an increment in Il1b mRNA levels. Interestingly, after 28 days of exposure, Il10 mRNA upregulation was observed and was associated with the downregulation of HDPs and Il1b mRNA levels. The upregulation of Il10 mRNA and suppression of HDPs might facilitate microbial colonization and the development of diseases associated with long-term exposure to PM.
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Contaminantes Atmosféricos/toxicidad , Catelicidinas/metabolismo , Interleucina-1beta/metabolismo , Material Particulado/toxicidad , Neumonía/patología , beta-Defensinas/metabolismo , Animales , Catelicidinas/genética , Interleucina-1beta/genética , Masculino , Ratones , Ratones Endogámicos BALB C , Neumonía/etiología , Neumonía/metabolismo , beta-Defensinas/genéticaRESUMEN
Foreign body aspiration is a rare but life-threatening event. Most accidental aspiration events occur in children. In adults, it can represent up to 25% of cases. Bronchoscopy remains the gold standard for diagnosing and treating foreign body aspiration from the lower respiratory tract. A 63-year-old female smoker with a history of chronic alcoholism and exposure to pyrotechnic smoke presented a productive cough, with whitish expectoration, dyspnea and pleuritic chest pain on the right side. On chest X-ray, she presented opacity in 2/3 of the right hemithorax. Computed axial tomography revealed consolidation with an air bronchogram on the right hemithorax, cylindrical bronchiectasis, ground glass pattern and centrilobular nodules. Bronchoscopic examination revealed a foreign body covered with granulation tissue in the right segmental bronchus (B6). The granulation tissue was integrated into the foreign body. In a second attempt, the foreign body could be removed, which was of bone consistency, seemingly a bird bone, confirmed by pathological anatomy results. After further questioning, the patient reported that two years before, she had choked when eating chicken. She had a cough and an episode of hemoptysis, but she chose not to ask for medical advice.
La aspiración de cuerpo extraño es un evento poco frecuente en adultos, la mayoría de los eventos de aspiración accidental ocurren en niños, en los adultos puede representar hasta el 25% de los casos. La broncoscopía es el estándar de oro para el diagnóstico y el tratamiento de la aspiración de cuerpo extraño de las vías respiratorias bajas. Se reporta el caso de una mujer de 63 años fumadora, con antecedente de alcoholismo crónico y exposición frecuente a humo de pirotecnia. La paciente presentó tos productiva, con expectoración blanquecina, disnea y dolor torácico pleurítico en lado derecho. En la radiografía de tórax presentó opacidad en 2/3 del hemitórax derecho. La tomografía axial computarizada reveló consolidación con broncograma aéreo en la base del hemitórax derecho, bronquiectasias cilíndricas, patrón vidrio deslustrado y nódulos centrilobulillares. A través del examen broncoscópico se observó la presencia de un cuerpo extraño recubierto de tejido de granulación en el bronquio segmentario derecho (B6). El tejido de granulación estaba integrado al cuerpo extraño. En el segundo intento se pudo remover el cuerpo extraño, que resultó ser a simple vista de consistencia ósea, compatible con hueso de ave, lo que fue confirmado con resultados de anatomía patológica. En ampliación de historia clínica se obtuvo el dato que dos años antes tuvo atragantamiento al comer pollo; presentó tos y episodio de hemoptisis que la paciente prefirió no buscar atención médica.
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Bronquios/diagnóstico por imagen , Cuerpos Extraños/diagnóstico por imagen , Neumonía/etiología , Broncografía , Broncoscopía , Tos/etiología , Femenino , Cuerpos Extraños/complicaciones , Humanos , Persona de Mediana Edad , Neumonía/diagnóstico , Tomografía Computarizada por Rayos XRESUMEN
El Coronavirus SARS-CoV-2 produce la enfermedad COVID-19, cuya manifestación más grave y potencialmente letal es la neumonía. En este artículo revisaremos las manifestaciones clínicas del COVID-19, la fisiopatología de la neumonía, el manejo intrahospitalario previo al ingreso a Unidades de Cuidados Intensivos, la embolia pulmonar que es una complicación muy frecuente de esta enfermedad y el seguimiento de los pacientes posterior al alta. Para esta publicación nos hemos basado en publicaciones médicas y en estudios que hemos hecho durante esta pandemia en nuestro Centro de Enfermedades Respiratorias. i:es
The SARS-CoV-2 Coronavirus causes the COVID-19 disease, the most severe and potentially fatal manifestation of which is pneumonia. In this article, we will review the clinical manifestations of COVID-19, the pathophysiology of pneumonia, in-hospital management prior to admission to Intensive Care Units, pulmonary embolism, which is a very frequent complication of this disease, and the follow-up of patients after hospitalization. For this publication we have relied on medical publications and studies that we have done during this pandemic at our Center for Respiratory Diseases. i:en
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Humanos , Neumonía/fisiopatología , Neumonía/terapia , COVID-19/fisiopatología , COVID-19/terapia , Terapia por Inhalación de Oxígeno , Neumonía/etiología , Embolia Pulmonar , Factores de Riesgo , Corticoesteroides/uso terapéutico , Ventilación no Invasiva , SARS-CoV-2/patogenicidad , COVID-19/complicaciones , COVID-19/diagnósticoRESUMEN
RESUMEN Introducción: En el Hospital Pediátrico Docente "Pedro Agustín Pérez" de Guantánamo no se ha caracterizado la neumonía grave adquirida en la comunidad. Objetivo: Identificar el perfil de esta enfermedad en la Unidad de Cuidados Intensivos del citado hospital en el periodo 2016-2019. Método: Se realizó un estudio descriptivo, longitudinal y retrospectivo. El universo estuvo constituido por todos los ingresados en este periodo (N=153). Se estudió el sexo, edad, diagnóstico microbiológico, terapéutica antimicrobiana, aplicación de ventilación mecánica, procederes realizados, complicaciones, estadía, estado al egreso y causa directa de muerte. Los resultados se presentaron en tablas y se resumieron mediante frecuencias absolutas y acumuladas. Resultados: La mayor proporción de los pacientes fueron varones con edad entre 1 y 4 años de edad (30,7 %). El Streptococcus pneumoniae fue el más común (38,5 %). Las cefalosporinas fueron los fármacos más prescritos (36,0 %). El 16,3 % requirió ventilación mecánica y el 22,9 % presentó alguna complicación, la más común fue el derrame pleural paraneumónico (21,5 %). El 96,4 % egresó vivo y la principal causa de muerte fue el choque séptico (57,2 %). Conclusiones: La neumonía continúa siendo una patología frecuente en la edad pediátrica al igual que el predominio del sexo masculino. Después de la introducción de la vacunación, el Streptococcus pneumoniae ha emergido como el principal patógeno bacteriano a cualquier edad, con un predominio importante en los menores de 5 años.
ABSTRACT Introduction: Severe community-acquired pneumonia has not been characterized at the Pediatric Teaching Hospital ¨Pedro Agustín Pérez¨ in Guantanamo. Objective: To profile this affection at the Intensive Care Unit of the already cited institution in the period 2016-2019. Method: A descriptive, longitudinal and retrospective study was carried out. The study population was made out of all the patients in the intensive care unit in that period of time (N=153). The variables analyzed were: gender, age, microbiological diagnosis, antimicrobial therapy, mechanical ventilation application, medical procedures applied, complications, in-hospital stay, state at the time of discharge and cause of death. Results were presented in tables and were summed up in absolute and cumulative frequencies. Results: Most patients were male, ranging from 1 to 4 years of age (30.7%). Streptococcus pneumoniae was the most common infection (36.0%). 16.3% if the cases required mechanical ventilation and the 22.9% presented some complication, the most common being the parapneumonic pleural effusion (22.5%). 96.4% of the patients were discharged alive, and the main cause of death was septic shock (57.2%). Conclusions: Pneumonia remains a frequent pathology in patients in pediatric age; and prevails in male patients as well. After vaccination campaigns started, the Streptococcus pneumoniae emerged as the main bacterial pathogen to cause infections at any age, especially in patients below the 5 years of age.
RESUMO Introdução: No Hospital Pediátrico Docente "Pedro Agustín Pérez" de Guantánamo, pneumonia grave adquirida na comunidade não foi caracterizada. Objetivo: Identificar o perfil desta doença na Unidade de Terapia Intensiva do referido hospital no período 2016-2019. Método: Foi realizado um estudo descritivo, longitudinal e retrospectivo. O universo era composto por todos os admitidos neste período (N=153). Foram estudadas sexo, idade, diagnóstico microbiológico, terapia antimicrobiana, aplicação de ventilação mecânica, procedimentos realizados, complicações, permanência, estado na alta e causa direta do óbito. Os resultados foram apresentados em tabelas e resumidos por meio de frequências absolutas e cumulativas. Resultados: A maior proporção de pacientes eram homens entre 1 e 4 anos (30,7%). Streptococcus pneumoniae foi o mais comum (38,5%). As cefalosporinas foram os medicamentos mais prescritos (36,0%). 16,3% necessitaram de ventilação mecânica e 22,9% apresentaram alguma complicação, sendo a mais comum o derrame pleural parapneumônico (21,5%). 96,4% tiveram alta com vida e a principal causa de morte foi choque séptico (57,2%). Conclusões: A pneumonia continua sendo uma patologia frequente na idade pediátrica, assim como a predominância do sexo masculino. Após a introdução da vacinação, Streptococcus pneumoniae surgiu como o principal patógeno bacteriano em qualquer idade, com predomínio significativo em crianças menores de 5 anos.
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Masculino , Femenino , Lactante , Preescolar , Neumonía/complicaciones , Neumonía/diagnóstico , Neumonía/etiología , Neumonía/microbiología , Unidades de Cuidado Intensivo Pediátrico , Epidemiología Descriptiva , Estudios Retrospectivos , Estudios LongitudinalesRESUMEN
BACKGROUND: Postoperative complications, length of index hospital stay, and unplanned hospital readmissions are important metrics reflecting surgical care quality. Postoperative infections represent a substantial proportion of all postoperative complications. We examined the relationships between identification of postoperative infection prehospital and posthospital discharge, length of stay, and unplanned readmissions in the American College of Surgeons National Surgical Quality Improvement Program database across nine surgical specialties. METHODS: The 30-day postoperative infectious complications including sepsis, surgical site infections, pneumonia, and urinary tract infection were analyzed in the American College of Surgeons National Surgical Quality Improvement Program inpatient data during the period from 2012 to 2017. General, gynecologic, vascular, orthopedic, otolaryngology, plastic, thoracic, urologic, and neurosurgical inpatient operations were selected. RESULTS: Postoperative infectious complications were identified in 5.2% (137,014/2,620,450) of cases; 81,929 (59.8%) were postdischarge. The percentage of specific complications identified postdischarge were 73.4% of surgical site infections (range across specialties 63.7-93.1%); 34.9% of sepsis cases (27.4-58.1%); 26.5% of pneumonia cases (18.9%-36.3%); and 53.2% of urinary tract infections (48.3%-88.0%). The relative risk of readmission among patients with postdischarge versus predischarge surgical site infection, sepsis, pneumonia, or urinary tract infection was 5.13 (95% confidence interval: 4.90-5.37), 9.63 (8.93-10.40), 10.79 (10.15-11.45), and 3.32 (3.07-3.60), respectively. Over time, mean length of stay decreased but postdischarge infections and readmission rates significantly increased. CONCLUSION: Most postoperative infectious complications were diagnosed postdischarge. These were associated with an increased risk of readmission. The trend toward shorter length of stay over time was observed along with an increase both in the percentage of infections detected after discharge and the rate of unplanned related postoperative readmissions over time. Postoperative surveillance of infections should extend beyond hospital discharge of surgical patients.
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Cuidados Posteriores/organización & administración , Complicaciones Posoperatorias/epidemiología , Mejoramiento de la Calidad/estadística & datos numéricos , Servicio de Cirugía en Hospital/organización & administración , Procedimientos Quirúrgicos Operativos/efectos adversos , Adulto , Cuidados Posteriores/estadística & datos numéricos , Anciano , Bases de Datos Factuales/estadística & datos numéricos , Femenino , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Alta del Paciente/estadística & datos numéricos , Readmisión del Paciente/estadística & datos numéricos , Neumonía/epidemiología , Neumonía/etiología , Complicaciones Posoperatorias/etiología , Factores de Riesgo , Sepsis/epidemiología , Sepsis/etiología , Servicio de Cirugía en Hospital/estadística & datos numéricos , Infección de la Herida Quirúrgica/epidemiología , Infección de la Herida Quirúrgica/etiología , Estados Unidos/epidemiología , Infecciones Urinarias/epidemiología , Infecciones Urinarias/etiologíaRESUMEN
OBJECTIVE: There are limited, unmatched data reporting low complication rates in pregnant women with coronavirus disease 2019 (COVID-19). The aim of this study was to compare COVID-19-related outcomes between pregnant and non-pregnant women after adjusting for potential risk factors for severe outcomes. METHODS: Data were obtained from the COVID-19 National Data Registry of Mexico, which is an ongoing prospective cohort of people of any age with clinically suspected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and admitted to 475 monitoring hospitals. This study included pregnant and non-pregnant women of reproductive age (15-45 years) with COVID-19 confirmed by reverse transcription polymerase chain reaction. To adjust for underlying risk factors, propensity score matching was conducted for chronic obstructive pulmonary disease, asthma, smoking, hypertension, cardiovascular disease, obesity, diabetes, chronic renal disease, immunosuppression, age, language, nationality and level of health insurance. The primary outcome was death. Secondary outcomes were pneumonia, intubation and intensive care unit (ICU) admission. RESULTS: The cohort comprised 5183 pregnant and 175 905 non-pregnant women with COVID-19. The crude (unmatched) rates of death, pneumonia, intubation and ICU admission in pregnant compared with non-pregnant women were 1.5% vs 1.5%, 9.9% vs 6.5%, 8.1% vs 9.9% and 13.0% vs 6.9%, respectively. After propensity score matching (5183 pregnant and 5183 non-pregnant matched women), pregnant women had a higher odds of death (odds ratio (OR), 1.84; 95% CI, 1.26-2.69), pneumonia (OR, 1.86; 95% CI, 1.60-2.16) and ICU admission (OR, 1.86; 95% CI, 1.41-2.45) than non-pregnant women, but similar odds of intubation (OR, 0.93; 95% CI, 0.70-1.25). CONCLUSION: After adjusting for background demographic and medical factors, pregnancy is a risk factor for death, pneumonia and ICU admission in SARS-CoV-2-infected women of reproductive age. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.
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COVID-19/mortalidad , Neumonía/etiología , Complicaciones Infecciosas del Embarazo/mortalidad , Complicaciones Infecciosas del Embarazo/virología , Adolescente , Adulto , COVID-19/diagnóstico , COVID-19/virología , Estudios de Casos y Controles , Comorbilidad , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Unidades de Cuidados Intensivos/estadística & datos numéricos , México/epidemiología , Persona de Mediana Edad , Mortalidad , Pandemias , Neumonía/virología , Embarazo , Puntaje de Propensión , Estudios Prospectivos , Factores de Riesgo , SARS-CoV-2/genética , SARS-CoV-2/aislamiento & purificación , Adulto JovenRESUMEN
Traumatic reticuloperitonitis combined with embolic pneumonia and hepatitis is unusual signs of foreign body syndrome in cattle. A 4-year-old Holstein bull presented decreased appetite, dry cough, progressive weight loss, sternal recumbence and reluctance to stand and move. Laboratory tests revealed leucocytosis (18.4 × 103 /µl) accompanied by neutrophilia (10.48 × 103 /µl), and monocytosis (1.28 × 103 /µl), hyperglobulinaemia (6.3 g/dl), hypoalbuminaemia (1.5 g/dl), hyperfibrinogenaemia (10 g/L) and severe increase in gamma-glutamyl transferase activity (1,216 U/L). Reticular ultrasonographical examination showed a large amount of hyperechoic and hypoechoic content between the reticular serosa and the hepatic visceral surface. The main gross findings included fibrin deposition and adhesions between the reticulum, liver and diaphragm surfaces; a 4.0 mm in diameter transmural reticular perforation; a 12.0-cm diameter and scarce small randomly abscesses in the liver's parenchyma. The lungs presented multifocal areas of suppurative embolic foci (pulmonary abscesses), interstitial emphysema and multifocal fibrin deposition on the pleural surface. Ancillary diagnostic tests, such as ultrasonography and laboratory test, associated with clinical evaluation, may increase the accuracy of the correct diagnosis and avoid wasting time and money on untreatable cases.
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Enfermedades de los Bovinos/diagnóstico , Cuerpos Extraños/veterinaria , Hepatitis Animal/diagnóstico , Peritonitis/veterinaria , Neumonía/veterinaria , Animales , Bovinos , Enfermedades de los Bovinos/diagnóstico por imagen , Enfermedades de los Bovinos/etiología , Cuerpos Extraños/complicaciones , Hepatitis Animal/diagnóstico por imagen , Hepatitis Animal/etiología , Masculino , Peritonitis/diagnóstico , Peritonitis/diagnóstico por imagen , Peritonitis/etiología , Neumonía/diagnóstico , Neumonía/diagnóstico por imagen , Neumonía/etiologíaRESUMEN
BACKGROUND: Community-acquired pneumonia (CAP) represents a major cause of hospitalization, especially among young children. In the third world countries, information about CAP etiology is scarce. Therefore, rapid and highly sensitive diagnostic methods are crucial to determine etiologic agents. METHODS: Between March 2016 and March 2017, we have prospectively studied the clinical, radiologic, laboratory, and molecular aspects of patients with CAP at 2 tertiary-level hospitals in Santa Cruz de la Sierra, using a multiplex real-time polymerase chain reaction (RT-PCR). RESULTS: A total of 274 children were evaluated, with a median age of 13 months. An etiologic agent was identified in 187 patients (68.2%): 54% (n = 148) were viruses and 14.2% (n = 39) were bacteria. CAP prevalence was highest among children under 2 years (71%; 195/274); respiratory syncytial virus (RSV) was the most frequent cause in 22% (60/274), especially among infants, followed by influenza (14.5%; 40/274). Streptococcus pneumoniae accounted for 7% of the total (19/274), followed by Staphylococcus aureus (3%;8/274) and Haemophilus influenzae (1.4%;4/274). Together, these cases accounted for 79.5% (31/39) of all bacterial CAP. Pleural effusion (PE) complicated CAP in 13.8% (38/274), of which 29 were of bacterial etiology. RT-PCR increased the detection rate of pneumococcus by 47%. Coinfection occurred in 28 patients (10%); 26 (9.5%) required intensive care and 9 patients (3%) died. CONCLUSIONS: RT-PCR provided additional diagnostic value to conventional, clinical, and laboratory methods. The higher prevalence of RSV, influenza, and Streptococcus pneumoniae reveals the need for preventive measures with better vaccine uptake and future research for RSV vaccines.
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Infecciones Comunitarias Adquiridas , Neumonía , Adolescente , Bolivia , Niño , Preescolar , Infecciones Comunitarias Adquiridas/diagnóstico , Infecciones Comunitarias Adquiridas/epidemiología , Infecciones Comunitarias Adquiridas/etiología , Femenino , Hospitalización , Humanos , Lactante , Recién Nacido , Masculino , Neumonía/diagnóstico , Neumonía/epidemiología , Neumonía/etiología , Estudios Prospectivos , Reacción en Cadena en Tiempo Real de la PolimerasaRESUMEN
ABSTRACT Objective: To describe the clinical manifestations and severity of children and adolescents affected by COVID-19 treated at Sabará Hospital Infantil. Methods: This is a cross-sectional, retrospective, and observational study. All cases of COVID-19 confirmed by RT-qPCR of patients seen at the hospital (emergency room, first-aid room, and ICU) were analyzed. The severity of the cases was classified according to the Chinese Consensus. Results: Among the 115 children included, a predominance of boys (57%) was verified, and the median age was two years. A total of 22 children were hospitalized, 12 in the ICU. Of the total, 26% had comorbidities with a predominance of asthma (13%). Fever, cough, and nasal discharge were the most frequent symptoms. Respiratory symptoms were reported by 58% of children and gastrointestinal symptoms, by 34%. Three children were asymptomatic, 81 (70%) had upper airway symptoms, 15 (13%) had mild pneumonia, and 16 (14%) had severe pneumonia. Hospitalized children were younger than non-hospitalized children (7 months vs. 36 months). In hospitalized patients, a higher frequency of irritability, dyspnea, drowsiness, respiratory distress, low oxygen saturation, and hepatomegaly was observed. Chest radiography was performed in 69 children with 45% of abnormal exams. No child required mechanical ventilation and there were no deaths. Conclusions: Most of children and adolescents affected by COVID-19 had mild upper airway symptoms. Clinical manifestations of COVID-19 were more severe among younger children who exhibited gastrointestinal and respiratory symptoms more frequently.
RESUMO Objetivo: Descrever as manifestações clínicas e a gravidade de crianças e adolescentes acometidos pela COVID-19 atendidos no Sabará Hospital Infantil. Métodos: Trata-se de estudo transversal, retrospectivo e observacional. Foram analisados os atendimentos (pronto-socorro, enfermaria e Unidade de Terapia Intensiva - UTI) que apresentavam diagnóstico de COVID-19 confirmado por RT-qPCR. A gravidade dos casos foi classificada de acordo com o Consenso Chinês. Resultados: Entre as 115 crianças incluídas, houve predominância do sexo masculino (57%) e a mediana de idade foi de 2 anos. Vinte e duas crianças foram hospitalizadas, sendo 12 em UTI. Do total, 26% apresentava comorbidades com predomínio de asma (13%). Febre, tosse e coriza foram os sintomas mais frequentes. Sintomas respiratórios foram relatados por 58% das crianças e gastrintestinais por 34%. Três crianças apresentavam-se assintomáticas, 81 (70%) com sintomas de vias aéreas superiores, 15 (13%) com quadro de pneumonia leve e 16 (14%) com pneumonia grave. As crianças hospitalizadas eram mais jovens do que as não hospitalizadas (7 meses vs. 36 meses). Nas hospitalizadas, observamos maior frequência de irritabilidade, dispneia, sonolência, desconforto respiratório, baixa saturação de oxigênio e hepatomegalia. Radiografia de tórax foi realizada por 69 crianças com 45% de exames alterados. Nenhuma criança necessitou de ventilação mecânica e não houve óbitos. Conclusões: Observamos que crianças e adolescentes acometidos pela Covid-19 apresentaram, em sua maioria, quadros leves e limitados a sintomas de via aérea superior. A gravidade do quadro clínico da Covid-19 foi maior entre as crianças de menor idade que tinham com maior frequência sintomas gastrintestinais e pulmonares.
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Humanos , Masculino , Femenino , Lactante , Preescolar , Niño , Adolescente , Índice de Severidad de la Enfermedad , Prueba de COVID-19/estadística & datos numéricos , COVID-19/diagnóstico , Neumonía/etiología , Brasil , Estudios Transversales , Estudios Retrospectivos , Tos/etiología , Fiebre/etiología , SARS-CoV-2 , COVID-19/complicaciones , COVID-19/terapia , Tiempo de Internación/estadística & datos numéricosRESUMEN
OBJECTIVE: To describe the clinical manifestations and severity of children and adolescents affected by COVID-19 treated at Sabará Hospital Infantil. METHODS: This is a cross-sectional, retrospective, and observational study. All cases of COVID-19 confirmed by RT-qPCR of patients seen at the hospital (emergency room, first-aid room, and ICU) were analyzed. The severity of the cases was classified according to the Chinese Consensus. RESULTS: Among the 115 children included, a predominance of boys (57%) was verified, and the median age was two years. A total of 22 children were hospitalized, 12 in the ICU. Of the total, 26% had comorbidities with a predominance of asthma (13%). Fever, cough, and nasal discharge were the most frequent symptoms. Respiratory symptoms were reported by 58% of children and gastrointestinal symptoms, by 34%. Three children were asymptomatic, 81 (70%) had upper airway symptoms, 15 (13%) had mild pneumonia, and 16 (14%) had severe pneumonia. Hospitalized children were younger than non-hospitalized children (7 months vs. 36 months). In hospitalized patients, a higher frequency of irritability, dyspnea, drowsiness, respiratory distress, low oxygen saturation, and hepatomegaly was observed. Chest radiography was performed in 69 children with 45% of abnormal exams. No child required mechanical ventilation and there were no deaths. CONCLUSIONS: Most of children and adolescents affected by COVID-19 had mild upper airway symptoms. Clinical manifestations of COVID-19 were more severe among younger children who exhibited gastrointestinal and respiratory symptoms more frequently.
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Prueba de COVID-19/estadística & datos numéricos , COVID-19/diagnóstico , Índice de Severidad de la Enfermedad , Adolescente , Brasil , COVID-19/complicaciones , COVID-19/terapia , Niño , Preescolar , Tos/etiología , Estudios Transversales , Femenino , Fiebre/etiología , Humanos , Lactante , Tiempo de Internación/estadística & datos numéricos , Masculino , Neumonía/etiología , Estudios Retrospectivos , SARS-CoV-2RESUMEN
Air pollution is mainly caused by burning of fossil fuels, such as diesel, and is associated with increased morbidity and mortality due to adverse health effects induced by inflammation and oxidative stress. Dimethyl fumarate (DMF) is a fumaric acid ester and acts as an antioxidant and anti-inflammatory agent. We investigated the potential therapeutic effects of DMF on pulmonary damage caused by chronic exposure to diesel exhaust particles (DEPs). Mice were challenged with DEPs (30 µg per mice) by intranasal instillation for 60 consecutive days. After the first 30 days, the animals were treated daily with 30 mg/kg of DMF by gavage for the remainder of the experimental period. We demonstrated a reduction in total inflammatory cell number in the bronchoalveolar lavage (BAL) of mice subjected to DEP + DMF as compared to those exposed to DEPs alone. Importantly, DMF treatment was able to reduce lung injury caused by DEP exposure. Intracellular total reactive oxygen species (ROS), peroxynitrite (OONO), and nitric oxide (NO) levels were significantly lower in the DEP + DMF than in the DEP group. In addition, DMF treatment reduced the protein expression of kelch-like ECH-associated protein 1 (Keap-1) in lung lysates from DEP-exposed mice, whereas total nuclear factor κB (NF-κB) p65 expression was decreased below baseline in the DEP + DMF group compared to both the control and DEP groups. Lastly, DMF markedly reduced DEP-induced expression of nitrotyrosine, glutathione peroxidase-1/2 (Gpx-1/2), and catalase in mouse lungs. In summary, DMF treatment effectively reduced lung injury, inflammation, and oxidative and nitrosative stress induced by chronic DEP exposure. Consequently, it may lead to new therapies to diminish lung injury caused by air pollutants.