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BACKGROUND: This study aimed to describe the clinical and demographic characteristics of children with confirmed tuberculosis disease and identify associated factors. METHODS: We conducted a retrospective and observational study at the Hospital Civil de Guadalajara Dr. Juan I. Menchaca. Inpatient and outpatient children under 18 years of age who were reported to the National Epidemiological Surveillance System (SINAVE, for its Spanish acronym) for suspected tuberculosis and who had molecular or microbiological tests for mycobacteria were included in the study. Multivariate analysis with logistic regression was used to analyze associated factors. RESULTS: One hundred and nine patients under 18 years of age with suspected tuberculosis were included in the study. About 50.5% (55/109) were male, and the median age was 11 years. Tuberculosis was confirmed in 55% (n = 60): 15% (9/60) had a pulmonary infection, and the rest (51/60) had an extrapulmonary infection. The diagnostic tests used were histopathological study (n = 26), expectoration or gastric aspirate stains (n = 17), polymerase chain reaction (n = 12), and cultures (n = 5). Positive purified protein derivative (PPD) or interferon-gamma release assay (IGRA) tests were found in 33.9%. Malnutrition (odds ratio [OR] 15.9, 95% confidence interval [CI]: 2.3-109), and consumption of unpasteurized products (OR 7.45, 95% CI: 1.02-54.3) were associated with tuberculosis disease in children. CONCLUSIONS: Malnutrition and consumption of unpasteurized dairy products are associated with tuberculosis.
INTRODUCCIÓN: El objetivo de este estudio fue describir las características clínicas y demográficas de niños con enfermedad tuberculosa confirmada e identificar los factores asociados. MÉTODOS: Se realizó un estudio observacional retrolectivo en el Hospital Civil de Guadalajara Dr. Juan I. Menchaca. Se incluyeron menores de 18 años hospitalizados y ambulatorios que se notificaron al Sistema Nacional de Vigilancia Epidemiológica (SINAVE) por sospecha de tuberculosis y que contaron con pruebas moleculares o microbiológicas para micobacterias. El estudio de los factores asociados se realizó mediante análisis multivariado con regresión logística. RESULTADOS: Se incluyeron en el estudio 109 menores de 18 años con sospecha de tuberculosis. El 50.5% (55/109) fueron de sexo masculino y la mediana de edad fue de 11 años. Se confirmó enfermedad tuberculosa en el 55% (n = 60) de los casos: el 15% (9/60) presentaron infección pulmonar y el resto extrapulmonar. Las pruebas diagnósticas utilizadas fueron el estudio histopatológico (n = 26), tinciones de expectoración o aspirado gástrico (n = 17), reacción en cadena de la polimerasa (n = 12) y cultivos (n= 5). 33.9% de los pacientes presentaron prueba de derivado proteico purificado (PPD) o ensayo de liberación de interferón gamma (IGRA) positiva. Se observó que la desnutrición (razón de momios (RM) 15.9, intervalo de confianza (IC) 95% 2.3 109) y el consumo de productos no pasteurizados (RM 7.45, IC 95% 1.02 54.3) se asociaron con enfermedad tuberculosa en niños. CONCLUSIONES: La desnutrición y el consumo de lácteos no pasteurizados se asocian con la enfermedad tuberculosa.
Assuntos
Tuberculose , Humanos , Criança , Masculino , Adolescente , Feminino , Estudos Retrospectivos , México/epidemiologia , Tuberculose/diagnóstico , Tuberculose/epidemiologia , Testes de Liberação de Interferon-gama , HospitaisRESUMO
Abstract Background: This study aimed to describe the clinical and demographic characteristics of children with confirmed tuberculosis disease and identify associated factors. Methods: We conducted a retrospective and observational study at the Hospital Civil de Guadalajara Dr. Juan I. Menchaca. Inpatient and outpatient children under 18 years of age who were reported to the National Epidemiological Surveillance System (SINAVE, for its Spanish acronym) for suspected tuberculosis and who had molecular or microbiological tests for mycobacteria were included in the study. Multivariate analysis with logistic regression was used to analyze associated factors. Results: One hundred and nine patients under 18 years of age with suspected tuberculosis were included in the study. About 50.5% (55/109) were male, and the median age was 11 years. Tuberculosis was confirmed in 55% (n = 60): 15% (9/60) had a pulmonary infection, and the rest (51/60) had an extrapulmonary infection. The diagnostic tests used were histopathological study (n = 26), expectoration or gastric aspirate stains (n = 17), polymerase chain reaction (n = 12), and cultures (n = 5). Positive purified protein derivative (PPD) or interferon-gamma release assay (IGRA) tests were found in 33.9%. Malnutrition (odds ratio [OR] 15.9, 95% confidence interval [CI]: 2.3-109), and consumption of unpasteurized products (OR 7.45, 95% CI: 1.02-54.3) were associated with tuberculosis disease in children. Conclusions: Malnutrition and consumption of unpasteurized dairy products are associated with tuberculosis.
Resumen Introducción: El objetivo de este estudio fue describir las características clínicas y demográficas de niños con enfermedad tuberculosa confirmada e identificar los factores asociados. Métodos: Se realizó un estudio observacional retrolectivo en el Hospital Civil de Guadalajara Dr. Juan I. Menchaca. Se incluyeron menores de 18 años hospitalizados y ambulatorios que se notificaron al Sistema Nacional de Vigilancia Epidemiológica (SINAVE) por sospecha de tuberculosis y que contaron con pruebas moleculares o microbiológicas para micobacterias. El estudio de los factores asociados se realizó mediante análisis multivariado con regresión logística. Resultados: Se incluyeron en el estudio 109 menores de 18 años con sospecha de tuberculosis. El 50.5% (55/109) fueron de sexo masculino y la mediana de edad fue de 11 años. Se confirmó enfermedad tuberculosa en el 55% (n = 60) de los casos: el 15% (9/60) presentaron infección pulmonar y el resto extrapulmonar. Las pruebas diagnósticas utilizadas fueron el estudio histopatológico (n = 26), tinciones de expectoración o aspirado gástrico (n = 17), reacción en cadena de la polimerasa (n = 12) y cultivos (n= 5). 33.9% de los pacientes presentaron prueba de derivado proteico purificado (PPD) o ensayo de liberación de interferón gamma (IGRA) positiva. Se observó que la desnutrición (razón de momios (RM) 15.9, intervalo de confianza (IC) 95% 2.3 - 109) y el consumo de productos no pasteurizados (RM 7.45, IC 95% 1.02 - 54.3) se asociaron con enfermedad tuberculosa en niños. Conclusiones: La desnutrición y el consumo de lácteos no pasteurizados se asocian con la enfermedad tuberculosa.
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INTRODUCTION: Neonatal Candida spp. infections are serious events due to their morbidity and mortality, however, epidemiological information is insufficient in developing countries. The objective of this study was to describe the incidence and factors associated with invasive infection by Candida spp. in a Neonatal Intensive Care Unit in Mexico. METHODS: Case-control study nested in a cohort and matched for birth weight. We estimated the incidence of invasive neonatal infection by Candida spp. For the bivariate analysis of the studied factors, McNemar's test was used to contrast hypotheses and multivariate analysis was made with logistic regression. RESULTS: The incidence of infection was 2.27 events/1000 live newborns. The species identified were C. albicans 35.3% (n 30), C. parapsilosis 30.6% (n 26), C. glabrata 31.8% (n 27) and two events with C. lipolytica. The factors associated with a higher risk were mechanical ventilation (OR 3.04, 95% CI 1.13-8.14), systemic antibiotics (OR 7.48, 95% CI 1.30-42.9), number of antimicrobial regimens (OR 2.02, 95% CI 1.01-4.03), and days with total parenteral nutrition (OR 1.14, 95% CI 1.04-1.25) or with venous catheter central (OR 1.11, 95% CI 1.02-1.20). Fluconazole prophylaxis decreased the risk (OR 0.32, 95% CI 0.12-0.84). CONCLUSIONS: Invasive interventions (central catheter, mechanical ventilation, and parenteral nutrition) and the use of antimicrobials increase the risk of neonatal Candida spp. Infection, while prophylactic fluconazole is protective.
Assuntos
Candidíase Invasiva , Fluconazol , Antifúngicos/uso terapêutico , Candida , Candida albicans , Candidíase , Candidíase Invasiva/tratamento farmacológico , Candidíase Invasiva/epidemiologia , Estudos de Casos e Controles , Fluconazol/uso terapêutico , Humanos , Incidência , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , México/epidemiologiaRESUMO
INTRODUCTION: Neonatal Candida spp. infections are serious events due to their morbidity and mortality, however, epidemiological information is insufficient in developing countries. The objective of this study was to describe the incidence and factors associated with invasive infection by Candida spp. in a Neonatal Intensive Care Unit in Mexico. METHODS: Case-control study nested in a cohort and matched for birth weight. We estimate the incidence of invasive neonatal infection by Candida spp. For the bivariate analysis of the studied factors, McNemar's test was used to contrast hypotheses and multivariate analysis was made with logistic regression. RESULTS: The incidence of infection was 2.27 events/1000 live newborns. The species identified were C. albicans 35.3% (n 30), C. parapsilosis 30.6% (n 26), C. glabrata 31.8% (n 27) and two events with C. lipolytica. The factors associated with a higher risk were mechanical ventilation (OR 3.04; 95% CI 1.13-8.14), systemic antibiotics (OR 7.48; 95% CI 1.30-42.9), number of antimicrobial regimens (OR 2.02; 95% CI 1.01-4.03), and days with total parenteral nutrition (OR 1.14; 95% CI 1.04-1.25) or with venous catheter central (OR 1.11; 95% CI 1.02-1.20). Fluconazole prophylaxis decreased the risk (OR 0.32; 95% CI 0.12-0.84). CONCLUSIONS: Invasive interventions (central catheter, mechanical ventilation, and parenteral nutrition) and the use of antimicrobials increase the risk of neonatal Candida spp. Infection, while prophylactic fluconazole is protective.
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Introducción. La mayor supervivencia de pacientes prematuros ha modificado la epidemiología de las enfermedades del recién nacido, pero la mortalidad neonatal aún es el principal componente de la mortalidad infantil. El objetivo del estudio fue cuantificar la mortalidad neonatal y los factores asociados en recién nacidos internados en una Unidad de Cuidados Neonatales. Material y métodos. Estudio de cohorte prospectivo realizado de enero de 2016 a enero de 2017 en el Hospital Civil de Guadalajara "Dr. Juan I. Menchaca". Se cuantificó la incidencia de muertes y las condiciones asociadas mediante un análisis multivariado con regresión logística. Resultados. Se registraron 9366 nacidos vivos; fueron internados en la Unidad de Cuidados Neonatales el 15% (n: 1410). La mortalidad fue de 125,5 por 1000 recién nacidos internados (IC 95%: 109-144); las principales causas fueron malformaciones o enfermedades genéticas (28,2%), infecciones (24,9%) y síndrome de dificultad respiratoria (20,9%). Las condiciones asociadas a muerte fueron edad gestacional < 37 semanas (OR 2,41; IC 95%: 1,49-3,93), peso al nacer < 1500 gramos (OR 6,30; IC 95%: 4,159,55), dificultad respiratoria moderada/grave a los 10 minutos de vida (OR 1,89; IC 95%: 1,242,86), Apgar < 7 a los 5 minutos de vida (OR 9,40; IC 95%: 5,76-15,31), malformaciones congénitas (OR 5,52; IC 95%: 3,12-9,78) y menos de cinco consultas de control prenatal (OR 1,51; IC 95%: 1,09-2,08). Conclusiones. El nacimiento prematuro, bajo peso al nacer, dificultad respiratoria, Apgar < 7, malformaciones congénitas y antecedente de < 5 consultas de control prenatal se asociaron con mayor riesgo de muerte.
Introduction. The increasing survival rate of preterm infants has altered the epidemiology of neonatal diseases; however, neonatal mortality is still the main component of child mortality. The objective of this study was to evaluate neonatal mortality and associated factors in newborn infants admitted to a neonatal care unit. Material and methods. Prospective cohort study conducted between January 2016 and January 2017 at Hospital Civil de Guadalajara "Dr. Juan I. Menchaca." The incidence of deaths and associated conditions was evaluated using a multivariate logistic regression analysis. Results. A total of 9366 live births were registered; 15% (n: 1410) of these were admitted to the neonatal care unit. The mortality rate was 125.5 per 1000 hospitalized newborn infants (95% confidence interval --#91;CI--#93;: 109-144); the main reasons for admission were congenital malformations or genetic disorders (28.2%), infections (24.9%), and respiratory distress (20.9%). The conditions associated with death were gestational age < 37 weeks (OR: 2.41, 95% CI: 1.49-3.93), birth weight < 1500 grams (OR: 6.30, 95% CI: 4.15-9.55), moderate/severe respiratory distress at 10 minutes (OR: 1.89, 95% CI: 1.24-2.86), Apgar score < 7 at 5 minutes (OR: 9.40, 95% CI: 5.76-15.31), congenital malformations (OR: 5.52, 95% CI: 3.12-9.78), and less than 5 antenatal care visits (OR: 1.51, 95% CI: 1.09-2.08). Conclusions. Preterm birth, low birth weight, respiratory distress, Apgar score < 7, congenital malformations, and a history of < 5 antenatal care visits were associated with a higher risk for death.
Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Doenças do Recém-Nascido/mortalidade , Mortalidade Infantil , Estudos Prospectivos , Fatores de Risco , Unidades Hospitalares , NeonatologiaRESUMO
INTRODUCTION: The increasing survival rate of preterm infants has altered the epidemiology of neonatal diseases; however, neonatal mortality is still the main component of child mortality. The objective of this study was to evaluate neonatal mortality and associated factors in newborn infants admitted to a neonatal care unit. MATERIAL AND METHODS: Prospective cohort study conducted between January 2016 and January 2017 at Hospital Civil de Guadalajara "Dr. Juan I. Menchaca." The incidence of deaths and associated conditions was evaluated using a multivariate logistic regression analysis. RESULTS: A total of 9366 live births were registered; 15% (n: 1410) of these were admitted to the neonatal care unit. The mortality rate was 125.5 per 1000 hospitalized newborn infants (95% confidence interval [CI]: 109-144); the main reasons for admission were congenital malformations or genetic disorders (28.2%), infections (24.9%), and respiratory distress (20.9%). The conditions associated with death were gestational age < 37 weeks (OR: 2.41, 95% CI: 1.49-3.93), birth weight < 1500 grams (OR: 6.30, 95% CI: 4.15-9.55), moderate/severe respiratory distress at 10 minutes (OR: 1.89, 95% CI: 1.24-2.86), Apgar score < 7 at 5 minutes (OR: 9.40, 95% CI: 5.76-15.31), congenital malformations (OR: 5.52, 95% CI: 3.12-9.78), and less than 5 antenatal care visits (OR: 1.51, 95% CI: 1.09-2.08). CONCLUSIONS: Preterm birth, low birth weight, respiratory distress, Apgar score < 7, congenital malformations, and a history of < 5 antenatal care visits were associated with a higher risk for death.
INTRODUCCIÓN: La mayor supervivencia de pacientes prematuros ha modificado la epidemiología de las enfermedades del recién nacido, pero la mortalidad neonatal aún es el principal componente de la mortalidad infantil. El objetivo del estudio fue cuantificar la mortalidad neonatal y los factores asociados en recién nacidos internados en una Unidad de Cuidados Neonatales. MATERIAL Y MÉTODOS: Estudio de cohorte prospectivo realizado de enero de 2016 a enero de 2017 en el Hospital Civil de Guadalajara "Dr. Juan I. Menchaca". Se cuantificó la incidencia de muertes y las condiciones asociadas mediante un análisis multivariado con regresión logística. RESULTADOS: Se registraron 9366 nacidos vivos; fueron internados en la Unidad de Cuidados Neonatales el 15% (n: 1410). La mortalidad fue de 125,5 por 1000 recién nacidos internados (IC 95%: 109-144); las principales causas fueron malformaciones o enfermedades genéticas (28,2%), infecciones (24,9%) y síndrome de dificultad respiratoria (20,9%). Las condiciones asociadas a muerte fueron edad gestacional < 37 semanas (OR 2,41; IC 95%: 1,49-3,93), peso al nacer < 1500 gramos (OR 6,30; IC 95%: 4,159,55), dificultad respiratoria moderada/grave a los 10 minutos de vida (OR 1,89; IC 95%: 1,242,86), Apgar < 7 a los 5 minutos de vida (OR 9,40; IC 95%: 5,76-15,31), malformaciones congénitas (OR 5,52; IC 95%: 3,12-9,78) y menos de cinco consultas de control prenatal (OR 1,51; IC 95%: 1,09-2,08). CONCLUSIONES: El nacimiento prematuro, bajo peso al nacer, dificultad respiratoria, Apgar < 7, malformaciones congénitas y antecedente de < 5 consultas de control prenatal se asociaron con mayor riesgo de muerte.
Assuntos
Doenças do Recém-Nascido/mortalidade , Feminino , Unidades Hospitalares , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Masculino , Neonatologia , Estudos Prospectivos , Fatores de RiscoRESUMO
The aim of our study was to determine the frequency and type of associated congenital anomalies in patients with isolated gastroschisis born at the Dr. Juan I. Menchaca Civil Hospital of Guadalajara (Guadalajara, México), and to explore its possible association with the included outcome variables. One hundred-eight cases with isolated gastroschisis were reviewed from 2009 to 2014. The occurrence of intestinal and extraintestinal associated anomalies (either secondary or primary) was prospectively assessed. The type of gastroschisis, length of hospital stay (LOS), and in-hospital mortality were outcome variables for statistical analysis. Of infants with gastroschisis, 52 (48.1%) had one or more associated anomalies (AA), with increased odds in males (OR = 2.3, 95%CI: 1.1-5.0). AA classified, as secondary and primary were present in 34.3 and 5.6% of patients, respectively. Of secondary AA, 25.9% were intestinal anomalies, and 17.6% were extraintestinal. Primary AA were congenital heart disease (n = 3), meningomyelocele, and hydrocephaly and amniotic band sequence in one instance, respectively. Multivariate logistic regression showed that secondary AA (both intestinal and extraintestinal) were associated with complex gastroschisis, prolonged LOS, and in-hospital death, whereas primary AA were not related to a worse outcome. Our results highlight the pathogenic importance of properly investigating and categorizing the presence of others secondary or primary AA when diagnosis of gastroschisis is made.