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Sample records for adult pneumonia mortality

  1. Predictors of inhospital mortality and re-hospitalization in older adults with community-acquired pneumonia: a prospective cohort study

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    Marrie Tom

    2010-05-01

    Full Text Available Abstract Background A better understanding of potentially modifiable predictors of in-hospital mortality and re-admission to the hospital following discharge may help to improve management of community-acquired pneumonia in older adults. We aimed to assess the associations of potentially modifiable factors with mortality and re-hospitalization in older adults hospitalized with community-acquired pneumonia. Methods A prospective cohort study was conducted from July 2003 to April 2005 in two Canadian cities. Patients aged 65 years or older hospitalized for community-acquired pneumonia were followed up for up to 30 days from initial hospitalization for mortality and these patients who were discharged alive within 30 days of initial hospitalization were followed up to 90 days of initial hospitalization for re-hospitalization. Separate logistic regression analyses were performed identify the predictors of mortality and re-hospitalization. Results Of 717 enrolled patients hospitalized for community-acquired pneumonia, 49 (6.8% died within 30 days of hospital admission. Among these patients, 526 were discharged alive within 30 days of hospitalization of whom 58 (11.2% were re-hospitalized within 90 days of initial hospitalization. History of hip fracture (odds ratio (OR = 4.00, 95% confidence interval (CI = (1.46, 10.96, P = .007, chronic obstructive pulmonary disease (OR = 2.31, 95% CI = (1.18, 4.50, P = .014, cerebrovascular disease (OR = 2.11, 95% CI = (1.03, 4.31, P = .040 were associated with mortality. Male sex (OR = 2.35, 95% CI = (1.13, 4.85, P = .022 was associated with re-hospitalization while vitamin E supplementation was protective (OR = 0.37 (0.16, 0.90, P = .028. Lower socioeconomic status, prior influenza and pneumococcal vaccinations, appropriate antibiotic prescription upon admission, and lower nutrition risk were not significantly associated with mortality or re-hospitalization. Conclusion Chronic comorbidities appear to be the most

  2. Time to first antibiotic and mortality in adults hospitalised with community-acquired pneumonia: a matched-propensity analysis.

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    Daniel, Priya; Rodrigo, Chamira; Mckeever, Tricia M; Woodhead, Mark; Welham, Sally; Lim, Wei Shen

    2016-06-01

    A matched-propensity analysis of national data from the British Thoracic Society community-acquired pneumonia audit was conducted (n=13 725). Overall, time to first antibiotic (TFA) was ≤4 h in 63%. Adjusted 30-day inpatient (IP) mortality was lower for adults with TFA ≤4 h compared with TFA >4 h (adjusted OR 0.84, 95% CI 0.74 to 0.94; p=0.003). Increasing TFA was associated with greater OR of 30-day IP mortality (p value for trend=0.001), but no TFA threshold was evident. Although we found an association between TFA and mortality, we cannot say whether this is causal or whether TFA might just be a quality measure for overall or other processes of care. PMID:26559161

  3. Streptococcus pneumoniae Serotypes and Mortality in Adults and Adolescents in South Africa: Analysis of National Surveillance Data, 2003 - 2008.

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    Cheryl Cohen

    Full Text Available An association between pneumococcal serotypes and mortality has been suggested. We aimed to investigate this among individuals aged ≥15 years with invasive pneumococcal disease (IPD in South Africa.IPD cases were identified through national laboratory-based surveillance at 25 sites, pre-pneumococcal conjugate vaccine (PCV introduction, from 2003-2008. We assessed the association between the 20 commonest serotypes and in-hospital mortality using logistic regression with serotype 4 (the third commonest serotype with intermediate case-fatality ratio (CFR as referent.Among 3953 IPD cases, CFR was 55% (641/1166 for meningitis and 23% (576/2484 for bacteremia (p<0.001. Serotype 19F had the highest CFR (48%, 100/207, followed by serotype 23F (39%, 99/252 and serotype 1 (38%, 246/651. On multivariable analysis, factors independently associated with mortality included serotype 1 (OR 1.9, 95%CI 1.1-3.5 and 19F (OR 2.9, 95%CI 1.4-6.1 vs. serotype 4; increasing age (25-44 years, OR 1.8, 95%CI 1.0-3.0; 45-64 years, OR 3.6, 95%CI 2.0-6.4; ≥65 years, OR 5.2, 95%CI 1.9-14.1; vs. 15-24 years; meningitis (OR 4.1, 95%CI 3.0-5.6 vs. bacteremic pneumonia; and HIV infection (OR1.7, 95%CI 1.0-2.8. On stratified multivariate analysis, serotype 19F was associated with increased mortality amongst bacteremic pneumococcal pneumonia cases, while no serotype was associated with increased mortality in meningitis cases.Mortality was increased in HIV-infected individuals, which may be reduced by increased antiretroviral therapy availability. Serotypes associated with increased mortality are included in the 10-and-13-valent PCV and may become less common in adults due to indirect effects following routine infant immunization.

  4. Pneumonia - adults (community acquired)

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    ... going to the bathroom After changing a baby's diaper After coming in contact with people who are ... pneumoniae. Vaccines are even more important for older adults and people with diabetes, asthma, emphysema, HIV, cancer, ...

  5. CT manifestations of adult mycoplasma pneumoniae pneumonia

    International Nuclear Information System (INIS)

    Objective: To study the conventional CT and HRCT manifestations of adult mycoplasma pneumoniae pneumonia. Methods: Conventional CT and HRCT were performed in 16 adult patients with mycoplasma pneumoniae pneumonia proven by serology. The CT images were retrospectively analyzed. Results: Areas of ground-glass opacity (GGO) were found in 12 cases. GGO showed lobular or patchy distribution in 9 cases. Air-space consolidation was observed in 8 cases, 'tree in bud' sign in 9, thickening of the interlobular septa in 3, and thickening of bronchovascular bundle in 1. 15 cases had two or more findings simultaneously. Conclusion: Mycoplasma pneumoniae pneumonia has some characteristic CT findings, which can help to distinguish it from bacterial pneumonia

  6. Pneumonia - adults - discharge

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    You have pneumonia, which is an infection in your lungs. In the hospital, your doctors and nurses helped you breathe better. ... body get rid of the germs that cause pneumonia. They also made sure you got enough liquids ...

  7. Ventilator-associated pneumonia and mortality

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    Melsen, W.G.

    2012-01-01

    Ventilator-associated Pneumonia (VAP) is one of the most common nosocomial infections among patients admitted to the intensive care unit. It is generally believed that VAP increases the mortality of patients, however exact determination of the attributable mortality of VAP is challenging. This thesi

  8. Pneumonia in adults - discharge

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    ... In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious ... ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 69. Mandell LA. Streptococcus pneumoniae infections. In: Goldman L, Schafer ...

  9. Serotype-specific mortality from invasive Streptococcus pneumoniae disease revisited

    DEFF Research Database (Denmark)

    Martens, Pernille; Worm, Signe Westring; Lundgren, Bettina;

    2004-01-01

    Serotype-specific mortality from invasive Streptococcus pneumoniae disease revisited.Martens P, Worm SW, Lundgren B, Konradsen HB, Benfield T. Department of Infectious Diseases 144, Hvidovre University Hospital, DK-2650 Hvidovre, Denmark. pernillemartens@yahoo.com BACKGROUND: Invasive infection...... with Streptococcus pneumoniae (pneumococci) causes significant morbidity and mortality. Case series and experimental data have shown that the capsular serotype is involved in the pathogenesis and a determinant of disease outcome. METHODS: Retrospective review of 464 cases of invasive disease among adults diagnosed...... with serotype 1 was associated with a decreased risk of death (RR 0.23 (95% CI, 0.06-0.97)). Additionally, older age, relative leucopenia and relative hypothermia were independent predictors of mortality. CONCLUSION: Our study shows that capsular serotypes independently influenced the outcome from invasive...

  10. [National consensus for management of community acquired pneumonia in adults].

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    Saldías P, Fernando; Pérez C, Carlos

    2005-01-01

    Community acquired pneumonia (CAP) is an acute respiratory infection that affects pulmonary parenchyma, and is caused by community acquired microorganisms. In Chile, pneumonia represents the main cause of death due to infectious diseases and is the third specific cause of mortality in adults. In 1999, an experts committee in representation of "Sociedad Chilena de Enfermedades Respiratorias", presented the first National Guidelines for the Treatment of Adult Community Acquired Pneumonia, mainly based in foreign experience and documents, and adapted it to our National Health System Organization. During the last decade, impressive epidemiological and technological changes have occurred, making the update of guidelines for treatment of NAC by several international scientific societies, necessary. These changes include: new respiratory pathogens that are being identified in CAP and affect adult patients (Mycoplasma pneumoniae, Chlamydia pneumoniae, Legionella pneumophila); the increasing senescent adult population that carries multiple co-morbidities; the emergence of antimicrobial resistance among respiratory pathogens associated to massive antibiotic prescription; the development by the pharmaceutical industry of new drugs that are effective for pneumonia treatment (macrolides, ketolides and respiratory fluorquinolones); and the development of new diagnostic techniques for detection of antigens, antibodies, and bacterial DNA by molecular biology, useful in respiratory infections. Based on these antecedents, an Advisory Committee of "Sociedad Chilena de Enfermedades Respiratorias" and "Sociedad Chilena de Infectología" has reviewed the national and international evidence about CAP management in adults in order to update clinical recommendations for our country.

  11. Clinical features of measles pneumonia in adults

    International Nuclear Information System (INIS)

    The clinical features, chest radiographs and computed tomographic (CT) images were evaluated in 11 cases of serologically proved adult measles complicated with pneumonia (10 were previously healthy and one had sarcoidosis). Pneumonia appeared during the rash period in all cases. Respiratory symptoms were cough (9/11), dyspnea (3/11), and hypoxemia (10/11). Pneumonia manifestations were detected in only 4 cases by chest radiograph; on the other hand, they were seen in all cases by CT scan and consisted of ground-glass opacities (73%), nodular opacities (64%) and consolidation (27%). CT seems to be useful method to detect measles pneumonia if it is suspected. Measles pneumonia in previously healthy patients had a good prognosis, as the hypoxemia disappeared within 6 days in all cases. The sarcoidosis patient showed prolonged pneumonic shadows and period of hypoxemia. Measles pneumonia occurring in a host with cellular immunodeficiency may have a severe clinical course. (author)

  12. Imaging findings of measles pneumonia in adults

    International Nuclear Information System (INIS)

    Objective: To illustrate the chest radiography and MSCT findings of measles pneumonia in adults. Methods: One hundred and sixty three measles patients underwent chest radiography, MSCT was performed in 3 of them. Measles pneumonia was confirmed in 10 patients (6.13%). Results: Eight of 10 patients had abnormal appearances in initial chest radiography. The characteristic chest radiographic findings were ground-glass opacities (n=6) and bronchial wall thickening (n=2). MSCT showed bilateral multiple ground-glass opacities in 1 patient, unilateral patchy ground-glass opacities with lobular distribution in the right upper lung in 2 patients. Conclusions: Familiarizing with radiographic and MSCT appearances of measles pneumonia in adults is very important for the differential diagnosis and appropriate management of measles pneumonia. Normal initial chest radiography cannot exclude the involvement of the lungs. (authors)

  13. Bacterial Pneumonia in Older Adults.

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    Marrie, Thomas J; File, Thomas M

    2016-08-01

    Community-acquired pneumonia is common in the elderly person; its presentation in this population is often confounded by multiple comorbid illnesses, including those that result in confusion. Although severity-of-illness scoring systems might aid decision-making, clinical judgment following a careful assessment is key in deciding on the site of care and appropriate therapy.

  14. Impact of admission blood glucose level on outcomes in community-acquired pneumonia in older adults

    OpenAIRE

    Bhattacharya RK; Mahnken JD; Rigler SK

    2013-01-01

    Rajib K Bhattacharya, Jonathan D Mahnken, Sally K RiglerUniversity of Kansas School of Medicine, Kansas City, KS, USABackground: Community-acquired pneumonia (CAP) is a common cause of morbidity and mortality in older adults. Although diabetes mellitus is a risk factor for pneumonia, the clinical impact of blood glucose level at the time of admission is not clear. Our goal was to examine the association between admission hyperglycemia and subsequent mortality, length of stay, and readmission ...

  15. Adult mortality in preindustrial Quebec

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    Claudine Lacroix - - - Bertrand Desjardins

    2012-01-01

    Full Text Available This paper presents the main results of a detailed study on adult mortality in French Canadians born before 1750 and having married inthe colony of New France. Using data from parish registers, mortality is studied using abridged life tables, with staggered entries according to age at first marriage. Survival tables and log-Rank tests are used to support the results. Three features were selected for the study of differential mortality: gender, type of residence area (urban or rural, and cohort. The mortality of French Canadians is compared to that of their French contemporaries.

  16. Predicting pneumonia and influenza mortality from morbidity data.

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    Lise Denoeud

    Full Text Available BACKGROUND: Few European countries conduct reactive surveillance of influenza mortality, whereas most monitor morbidity. METHODOLOGY/PRINCIPAL FINDINGS: We developed a simple model based on Poisson seasonal regression to predict excess cases of pneumonia and influenza mortality during influenza epidemics, based on influenza morbidity data and the dominant types/subtypes of circulating viruses. Epidemics were classified in three levels of mortality burden ("high", "moderate" and "low". The model was fitted on 14 influenza seasons and was validated on six subsequent influenza seasons. Five out of the six seasons in the validation set were correctly classified. The average absolute difference between observed and predicted mortality was 2.8 per 100,000 (18% of the average excess mortality and Spearman's rank correlation coefficient was 0.89 (P = 0.05. CONCLUSIONS/SIGNIFICANCE: The method described here can be used to estimate the influenza mortality burden in countries where specific pneumonia and influenza mortality surveillance data are not available.

  17. HRCT findings of adult mycoplasma pneumonia

    International Nuclear Information System (INIS)

    To analyze the HRCT findings of adult mycoplasma pneumonia and correlate these with clinical information. HRCT was performed in 17 cases of 15 adult patients (M:F=5:10) in whom mycoplasma pneumonia had been serologically confirmed. The pattern, extent and distribution of abnormalities were reviewed retrospectively and a changing pattern of abnormalities during the course of the disease was correlated with clinical symptoms. Unilateral(n=11) and lower lobe(n=12) involvement and multiplicity in involved lobes(n=10) were the most common abnormalities. Abnormalities on HRCT were as follows:nodules(n=15), areas of consolidation(n=14), nodules and areas of consolidation(n=13). Most abnormalities(n=11) were segmental or subsegmental in distribution. The most common nodular pattern was centrilobular micronodules(2/3)) at 2 weeks, and Group 3(prominent areas of nodules(>2/3)) over 3 weeks. The main findings of adult mycoplasma pneumonia were nodules or areas of consolidation with segmental or subsegmental distribution. The early stage of the disease may show a pattern of a similar prapertion of areas of consolidation and of nodules, followed by increase in the propertion of areas of consolidation(>2/3) as the disease progresses. At the resolvtion stage, the extent of lesions will decrease and nodules will be the main finding

  18. Clinical practice guidelines for hospital-acquired pneumonia and ventilator-associated pneumonia in adults

    OpenAIRE

    Coleman Rotstein; Gerald Evans; Abraham Born; Ronald Grossman; R Bruce Light; Sheldon Magder; Barrie McTaggart; Karl Weiss; Zhanel, George G

    2008-01-01

    Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) are important causes of morbidity and mortality, with mortality rates approaching 62%. HAP and VAP are the second most common cause of nosocomial infection overall, but are the most common cause documented in the intensive care unit setting. In addition, HAP and VAP produce the highest mortality associated with nosocomial infection. As a result, evidence-based guidelines were prepared detailing the epidemiology, micro...

  19. ADULT RESPIRATORY-DISTRESS SYNDROME (ARDS) DUE TO BACTEREMIC PNEUMOCOCCAL PNEUMONIA

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    MANNES, GPM; BOERSMA, WG; BAUR, CHJM; POSTMUS, PE

    1991-01-01

    We describe a patient, who had no pre-existing disease, with bacteraemic pneumococcal pneumonia and adult respiratory distress syndrome (ARDS), a rare complication. In spite of the use of antibiotics and intensive treatment the mortality rate of this kind of infection remains high. Streptococcus pne

  20. Adult human metapneumonovirus (hMPV) pneumonia mimicking Legionnaire's disease.

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    Cunha, Burke A; Irshad, Nadia; Connolly, James J

    2016-01-01

    In adults hospitalized with viral pneumonias the main differential diagnostic consideration is influenza pneumonia. The respiratory viruses causing viral influenza like illnesses (ILIs), e.g., RSV may closely resemble influenza. Rarely, extrapulmonary findings of some ILIs may resemble Legionnaire's disease (LD), e.g., adenovirus, human parainfluenza virus (HPIV-3). We present a most unusual case of human metapneumonovirus pneumonia (hMPV) with some characteristic extrapulmonary findings characteristic of LD, e.g., relative bradycardia, as well as mildly elevated serum transaminases and hyphosphatemia. We believe this is the first reported case of hMPV pneumonia in a hospitalized adult that had some features of LD. PMID:26988110

  1. Impact of admission blood glucose level on outcomes in community-acquired pneumonia in older adults

    Directory of Open Access Journals (Sweden)

    Bhattacharya RK

    2013-05-01

    Full Text Available Rajib K Bhattacharya, Jonathan D Mahnken, Sally K RiglerUniversity of Kansas School of Medicine, Kansas City, KS, USABackground: Community-acquired pneumonia (CAP is a common cause of morbidity and mortality in older adults. Although diabetes mellitus is a risk factor for pneumonia, the clinical impact of blood glucose level at the time of admission is not clear. Our goal was to examine the association between admission hyperglycemia and subsequent mortality, length of stay, and readmission outcomes in older adults with CAP.Methods: A retrospective observational study was conducted using hospital data for community-acquired pneumonia admissions in 857 persons from January 1, 2008 to December 31, 2010. We examined the effects of admission glucose level on mortality, length of stay, and 30 day readmission, adjusted for demographic factors and comorbidity.Results: The mean age of the sample was 64 years, and 51% of the subjects were female. Inpatient mortality occurred in 4.6% and the median length of stay was 5 days (interquartile range 3–9 days. Readmission within 30 days occurred in 17%. We found little impact of first glucose measures on in-hospital mortality (P = 0.94, length of stay (P = 0.95, and 30-day readmission (P = 0.56. Subjects 65 years and older trended towards higher in-hospital mortality. Older age, cancer, heart failure, and cirrhosis were associated with adverse outcomes.Conclusion: Glucose level upon admission for community-acquired pneumonia was not associated with adverse outcomes within 30 days in older adults.Keywords: community-acquired pneumonia, hyperglycemia, readmission rates, hospital mortality

  2. Clinical and economic burden of community-acquired pneumonia amongst adults in the Asia-Pacific region.

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    Song, Jae-Hoon; Thamlikitkul, Visanu; Hsueh, Po-Ren

    2011-08-01

    Community-acquired pneumonia (CAP) is an important cause of mortality and morbidity amongst adults in the Asia-Pacific region. Literature published between 1990 and May 2010 on the clinical and economic burden of CAP amongst adults in this region was reviewed. CAP is a significant health burden with significant economic impact in this region. Chronic obstructive pulmonary disease, cardiovascular disease, diabetes mellitus and advanced age were risk factors for CAP. Aetiological agents included Streptococcus pneumoniae, Klebsiella pneumoniae, Gram-negative bacteria, Mycobacterium tuberculosis, Burkholderia pseudomallei, Staphylococcus aureus and atypical pathogens (Mycoplasma pneumoniae, Chlamydophila pneumoniae and Legionella spp.), with important differences in the prevalence of these pathogens within the region. Antibiotic resistance was significant but was not linked to excess mortality. Aetiological pathogens remained susceptible to newer antimicrobial agents. Rational antibiotic use is essential for preventing resistance, and increased surveillance is required to identify future trends in incidence and aetiology and to drive treatment and prevention strategies.

  3. Epidemiology of pneumonia in a burn care unit: the influence of inhalation trauma on pneumonia and of pneumonia on burn mortality

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    Liodaki, E.; Kalousis, K; Mauss, K. L.; Kisch, T; Mailaender, P; F. Stang

    2015-01-01

    The aim of this study is to determine the epidemiological characteristics of burn patients developing pneumonia, as well as the predisposing factors and the mortality of these patients. Infectious complications present serious problems in severely burned patients. Pneumonia, in particular, is a major cause of morbidity and mortality in burn patients. Patients with inhalation injuries are exposed to a greater risk due to the possible development of infectious complications in the lower respira...

  4. Recurrent pseudomonal pneumonia in a young immunocompetent adult something fishy?

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    Saravu K

    2011-05-01

    Full Text Available Community-acquired pneumonia due to Pseudomonasaeruginosa typically occurs in patients with pre-existing lungdisease and immunocompromised individuals. We reportthe case of a previously healthy young adult who presentedwith recurrent episodes of pneumonia due to Pseudomonasaeruginosa complicated by pleural effusion. Careful andextensive evaluation ultimately revealed the unusual reasonbehind the patient’s illness.

  5. Drug-resistance in Streptococcus pneumoniae isolates among Spanish middle aged and older adults with community-acquired pneumonia

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    Raga-Luria Xavier

    2009-03-01

    Full Text Available Abstract Background Pneumococcal diseases remain a major cause of morbidity and mortality worldwide. Updated data on drug-resistance from different populations may be important to recognize changes in disease patterns. This study assessed current levels of penicilin resistance among Streptococcus Pneumoniae causing pneumonia in Spanish middle age and older adults. Methods Antimicrobial susceptibility was tested for 104 consecutive isolates of Streptococcus pneumoniae recovered from patients 50 years or older with radiographically confirmed pneumonia in the region of Tarragona (Spain between 2002 and 2007. According to the minimum inhibitory concentration of tested antimicrobials (penicillin, erythromycin, cefotaxime and levofloxacin strains were classified as susceptible or resistant. Antimicrobial resistance was determined for early cases (2002–2004 and contemporary cases (2005–2007. Results Twenty-seven (25.9% were penicillin-resistant strains (19 strains with intermediate resistance and 8 strains with high resistance. Penicillin-resistance was higher in 2002–2004 than in 2005–2007 (39.5% vs 18.2%, p = 0.017. Of 27 penicillin-resistant strains, 10 (37% were resistant to erythromycin, 8 (29.6% to cefotaxime, 2 (7.4% to levofloxacin, and 4 (14.8% were identified as multidrug resistant. Case-fatality rate was higher among those patients who had an infection caused by any penicillin susceptible strain (16.9% than in those with infections due to penicillin-resistant strains. Conclusion Resistance to penicillin among Streptococcus pneumoniae remains high, but such resistance does not result in increased mortality in patients with pneumococcal pneumonia.

  6. Determinants of differentials in pneumonia mortality in the UK and France.

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    ul Haq, Rizwan; Rivers, Patrick; Umar, Muhammad

    2014-01-01

    Pneumonia is one of the major causes of death in the world. Age-adjusted mortality from pneumonia in the United Kingdom was three times higher than it was in France in 2004. The purpose of this article is to find the underlying determinants of pneumonia mortality differences between these two countries. The main research question is "what are the determinants of pneumonia mortality in the UK and France?" Reviewing the underlying determinants of health inequalities, we expected that behavioral factors, environmental factors, and the health care system would account for the differences, but they do not actually account for much of the differences in Pneumonia mortality between the UK and France. The main difference is due to data quality problems particularly relating to diagnosis and certification in both countries. PMID:25223162

  7. Risk factors for mortality in patients admitted to intensive care units with pneumonia

    OpenAIRE

    Li, Guowei; Cook, Deborah J.; Thabane, Lehana; Friedrich, Jan O.; Crozier, Tim M.; Muscedere, John; Granton, John; Mehta, Sangeeta; Steven C. Reynolds; Lopes, Renato D.; Francois, Lauzier; Freitag, Andreas P; Levine, Mitchell A. H.; ,

    2016-01-01

    Background Despite the high mortality in patients with pneumonia admitted to an ICU, data on risk factors for death remain limited. Methods In this secondary analysis of PROTECT (Prophylaxis for Thromboembolism in Critical Care Trial), we focused on the patients admitted to ICU with a primary diagnosis of pneumonia. The primary outcome for this study was 90-day hospital mortality and the secondary outcome was 90-day ICU mortality. Cox regression model was conducted to examine the relationship...

  8. Etiology and antimicrobial resistance of community-acquired pneumonia in adult patients in China

    Institute of Scientific and Technical Information of China (English)

    TAO Li-li; DENG Wei-wu; HU Bi-jie; HE Li-xian; WEI Li; XIE Hong-mei; WANG Bao-qing; LI Hua-ying; CHEN Xue-hua; ZHOU Chun-mei

    2012-01-01

    Background Appropriate antimicrobial therapy of community-acquired pneumonia (CAP) is mainly based on the distribution of etiology and antimicrobial resistance of major pathogens.We performed a prospective observational study of adult with CAP in 36 hospitals in China.Methods Etiological pathogens were isolated in each of the centers,and all of the isolated pathogens were sent to Zhongshan Hospital for antimicrobial susceptibility tests using agar dilution.Results A total of 593 patients were enrolled in this study,and 242 strains of bacteria were isolated from 225 patients.Streptococcus pneumoniae (79/242,32.6%) was the most frequently isolated pathogen,followed by Haemophilus influenzae (55/242,22.7%) and Klebsiella pneumoniae (25/242,10.3%).Totally 527 patients underwent serological tests for atypical pathogens; Mycoplasma pneumoniae and Chlamydia pneumoniae infections were identified in 205 (38.9%)and 60 (11.4%) patients respectively.Legionella pneumophila infections were identified in 4.0% (13/324) of patients.The non-susceptibility rate of isolated Streptococcus pneumoniae to erythromycin and penicillin was 63.2% and 19.1%respectively.Six patients died from the disease,the 30-day mortality rate was 1.1% (6/533).Conclusions The top three bacteria responsible for CAP in Chinese adults were Streptococcus pneumonia,Haemophitus influenza and Klebsiella pneumonia.There was also a high prevalence of atypical pathogens and mixed pathogens.The resistance rates of the major isolated pathogens were relatively low except for the high prevalence of macrolide resistance in Streptococcus pneumoniae.

  9. Fibrotic idiopathic interstitial pneumonias: HRCT findings that predict mortality

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    Edey, Anthony J.; Hansell, David M. [The Royal Brompton Hospital, Department of Radiology, London (United Kingdom); Devaraj, Anand A. [St. George' s NHS Foundation Trust, Department of Radiology, Tooting (United Kingdom); Barker, Robert P. [Frimley Park Hosptal, Department of Radiology, Frimley, Surrey (United Kingdom); Nicholson, Andrew G. [The Royal Brompton Hospital, Department of Histopathology, London (United Kingdom); Wells, Athol U. [The Royal Brompton Hospital, Interstitial Lung Disease Unit, London (United Kingdom)

    2011-08-15

    The study aims were to identify CT features that predict outcome of fibrotic idiopathic interstitial pneumonia (IIP) when information from lung biopsy data is unavailable. HRCTs of 146 consecutive patients presenting with fibrotic IIP were studied. Visual estimates were made of the extent of abnormal lung and proportional contribution of fine and coarse reticulation, microcystic (cysts {<=}4 mm) and macrocystic honeycombing. A score for severity of traction bronchiectasis was also assigned. Using death as our primary outcome measure, variables were analysed using the Cox proportional hazards model. CT features predictive of a worse outcome were coarse reticulation, microcystic and macrocystic honeycombing, as well as overall extent of lung abnormality (p < 0.001). Importantly, increased severity of traction bronchiectasis, corrected for extent of parenchymal abnormality, was predictive of poor prognosis regardless of the background pattern of abnormal lung (HR = 1.04, CI = 1.03-1.06, p < 0.001). On bivariate Cox analysis microcystic honeycombing was a more powerful determinant of a poor prognosis than macrocystic honeycombing. In fibrotic IIPs we have shown that increasingly severe traction bronchiectasis is indicative of higher mortality irrespective of the HRCT pattern and extent of disease. Extent of microcystic honeycombing is a more powerful determinant of outcome than macrocystic honeycombing. (orig.)

  10. Estimating the attributable mortality of ventilator-associated pneumonia from randomized prevention studies.

    NARCIS (Netherlands)

    Melsen, W.G.; Rovers, M.M.; Koeman, M.; Bonten, M.J.

    2011-01-01

    OBJECTIVE: : To assess the attributable mortality of ventilator-associated pneumonia using results from randomized controlled trials on ventilator-associated pneumonia prevention. DATA SOURCES: : A systematic search was performed in PubMed, Embase, Web of Science, and Cochrane Library from their inc

  11. Pneumonia research to reduce childhood mortality in the developing world

    OpenAIRE

    Scott, J Anthony G; Brooks, W. Abdullah; Peiris, J.S. Malik; Holtzman, Douglas; Mulhollan, E. Kim

    2010-01-01

    Pneumonia is an illness, usually caused by infection, in which the lungs become inflamed and congested, reducing oxygen exchange and leading to cough and breathlessness. It affects individuals of all ages but occurs most frequently in children and the elderly. Among children, pneumonia is the most common cause of death worldwide. Historically, in developed countries, deaths from pneumonia have been reduced by improvements in living conditions, air quality, and nutrition. In the developing wor...

  12. The Community-Acquired Pneumonia immunization Trial in Adults (CAPiTA) : What is the future of pneumococcal conjugate vaccination in elderly?

    NARCIS (Netherlands)

    Van Werkhoven, Cornelis H.; Bonten, Marc Jm

    2015-01-01

    Pneumococcal community-acquired pneumonia (PCAP) and invasive pneumococcal disease (IPD) are important causes of morbidity and mortality in elderly. In the Community-Acquired Pneumonia immunization Trial in Adults (CAPiTA), a randomized double-blind placebo-controlled trial of 84,496 community-dwell

  13. Radiographic findings of mycoplasma pneumonia in adult

    International Nuclear Information System (INIS)

    Mycoplasma pneumonia has known to be a not uncommon disease. However, the differential diagnosis of mycoplasm pneumonia with other viral pneumonia is difficult because of its variable clinical symptoms and atypical radiologic findings. A retrospective review was made of plain chest radiologic findings and clinical manifestations of 33 patients, who were admitted at Yonsei University Hospital from January, 1985 to February, 1990. The most prevalent age was 4th decade (33%) and main symptoms were cough (24/33), fever (2/33) and sputum (20/22). The most frequent season was winter (50%). The radiologic patterns were predominently interstitial (15/33), combined (13/33) and predominently alveolar (5/33) lesion. In alveolar infiltration cases (n 18), unilateral single lobe involvement was the most common (17/18) and left lower lobe (8/18) was predominently involved. Associated radiologic findings were hilar lymphadenopathy (4/33), pleural effusion (4/33) and cardiomegaly (7/33)

  14. latrogenic lipoid pneumonia in an adult horse.

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    Metcalfe, Lucy; Cummins, Carolyn; Maischberger, Eva; Katz, Lisa

    2010-01-01

    A 20-year-old gelding presented with a history of acute respiratory distress which began immediately after administration of a mineral oil and water mix, via nasogastric intubation, for treatment of suspected gastrointestinal dysfunction. An initial presumptive diagnosis of acute lipoid pneumonia was made; this was further supported by evidence of arterial hypoxaemia and oxygen desaturation on arterial blood gas analysis, ultrasonographic signs of bilateral ventral lung consolidation and a mixed bronchoalveolar-interstitial lung pattern seen on thoracic radiographs. Despite intensive supportive therapy the horse's condition continued to deteriorate and the decision was made for humane euthanasia. Gross necropsy findings supported the clinical diagnosis of lipoid pneumonia. PMID:21851746

  15. Latrogenic lipoid pneumonia in an adult horse

    Directory of Open Access Journals (Sweden)

    Metcalfe Lucy

    2010-05-01

    Full Text Available Abstract A 20-year-old gelding presented with a history of acute respiratory distress which began immediately after administration of a mineral oil and water mix, via nasogastric intubation, for treatment of suspected gastrointestinal dysfunction. An initial presumptive diagnosis of acute lipoid pneumonia was made; this was further supported by evidence of arterial hypoxaemia and oxygen desaturation on arterial blood gas analysis, ultrasonographic signs of bilateral ventral lung consolidation and a mixed bronchoalveolar-interstitial lung pattern seen on thoracic radiographs. Despite intensive supportive therapy the horse's condition continued to deteriorate and the decision was made for humane euthanasia. Gross necropsy findings supported the clinical diagnosis of lipoid pneumonia.

  16. Iatrogenic lipoid pneumonia in an adult horse

    OpenAIRE

    Metcalf, L; Cummins, C; Maischberger, E; Katz, L

    2010-01-01

    A 20-year-old gelding presented with a history of acute respiratory distress which began immediately after administration of a mineral oil and water mix, via nasogastric intubation, for treatment of suspected gastrointestinal dysfunction. An initial presumptive diagnosis of acute lipoid pneumonia was made; this was further supported by evidence of arterial hypoxaemia and oxygen desaturation on arterial blood gas analysis, ultrasonographic signs of bilateral ventral lung consolidation and a mi...

  17. Latrogenic lipoid pneumonia in an adult horse

    OpenAIRE

    Metcalfe Lucy; Cummins Carolyn; Maischberger Eva; Katz Lisa

    2010-01-01

    Abstract A 20-year-old gelding presented with a history of acute respiratory distress which began immediately after administration of a mineral oil and water mix, via nasogastric intubation, for treatment of suspected gastrointestinal dysfunction. An initial presumptive diagnosis of acute lipoid pneumonia was made; this was further supported by evidence of arterial hypoxaemia and oxygen desaturation on arterial blood gas analysis, ultrasonographic signs of bilateral ventral lung consolidation...

  18. Risk Factors for Aspiration Pneumonia in Older Adults.

    Directory of Open Access Journals (Sweden)

    Toshie Manabe

    Full Text Available Aspiration pneumonia is a dominant form of community-acquired and healthcare-associated pneumonia, and a leading cause of death among ageing populations. However, the risk factors for developing aspiration pneumonia in older adults have not been fully evaluated. The purpose of the present study was to determine the risk factors for aspiration pneumonia among the elderly.We conducted an observational study using data from a nationwide survey of geriatric medical and nursing center in Japan. The study subjects included 9930 patients (median age: 86 years, women: 76% who were divided into two groups: those who had experienced an episode of aspiration pneumonia in the previous 3 months and those who had not. Data on demographics, clinical status, activities of daily living (ADL, and major illnesses were compared between subjects with and without aspiration pneumonia. Two hundred and fifty-nine subjects (2.6% of the total sample were in the aspiration pneumonia group. In the univariate analysis, older age was not found to be a risk factor for aspiration pneumonia, but the following were: sputum suctioning (odds ratio [OR] = 17.25, 95% confidence interval [CI]: 13.16-22.62, p < 0.001, daily oxygen therapy (OR = 8.29, 95% CI: 4.39-15.65, feeding support dependency (OR = 8.10, 95% CI: 6.27-10.48, p < 0.001, and urinary catheterization (OR = 4.08, 95% CI: 2.81-5.91, p < 0.001. In the multiple logistic regression analysis, the risk factors associated with aspiration pneumonia after propensity-adjustment (258 subjects each were sputum suctioning (OR = 3.276, 95% CI: 1.910-5.619, deterioration of swallowing function in the past 3 months (OR = 3.584, 95% CI: 1.948-6.952, dehydration (OR = 8.019, 95% CI: 2.720-23.643, and dementia (OR = 1.618, 95% CI: 1.031-2.539.The risk factors for aspiration pneumonia were sputum suctioning, deterioration of swallowing function, dehydration, and dementia. These results could help improve clinical management for preventing

  19. Adult mortality and children's transition into marriage

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    Sofya Krutikova

    2008-09-01

    Full Text Available Adult mortality due to HIV/AIDS and other diseases is posited to affect children through a number of pathways. On top of health and education outcomes, adult mortality can have significant effects on children by influencing demographic outcomes including the timing of marriage. This paper examines marriage outcomes for a sample of children interviewed in Tanzania in the early 1990s and re-interviewed in 2004. We find that while girls who became paternal orphans married at significantly younger ages, orphanhood had little effect on boys. On the other hand, non-parental deaths in the household affect the timing of marriage for boys.

  20. Long-term mortality of hospitalized pneumonia in the EPIC-Norfolk cohort.

    Science.gov (United States)

    Myint, P K; Hawkins, K R; Clark, A B; Luben, R N; Wareham, N J; Khaw, K-T; Wilson, A M

    2016-03-01

    Little is known about cause-specific long-term mortality beyond 30 days in pneumonia. We aimed to compare the mortality of patients with hospitalized pneumonia compared to age- and sex-matched controls beyond 30 days. Participants were drawn from the European Prospective Investigation into Cancer (EPIC)-Norfolk prospective population study. Hospitalized pneumonia cases were identified from record linkage (ICD-10: J12-J18). For this study we excluded people with hospitalized pneumonia who died within 30 days. Each case identified was matched to four controls and followed up until the end June 2012 (total 15 074 person-years, mean 6·1 years, range 0·08-15·2 years). Cox regression models were constructed to examine the all-cause, respiratory and cardiovascular mortality using date of pneumonia onset as baseline with binary pneumonia status as exposure. A total of 2465 men and women (503 cases, 1962 controls) [mean age (s.d.) 64·5 (8·3) years] were included in the study. Between a 30-day to 1-year period, hazard ratios (HRs) of all-cause and cardiovascular mortality were 7·3 [95% confidence interval (CI) 5·4-9·9] and 5·9 (95% CI 3·5-9·7), respectively (with very few respiratory deaths within the same period) in cases compared to controls after adjusting for age, sex, asthma, smoking status, pack years, systolic and diastolic blood pressure, diabetes, physical activity, waist-to-hip ratio, prevalent cardiovascular and respiratory diseases. All outcomes assessed also showed increased risk of death in cases compared to controls after 1 year; respiratory cause of death being the most significant during that period (HR 16·4, 95% CI 8·9-30·1). Hospitalized pneumonia was associated with increased all-cause and specific-cause mortality beyond 30 days.

  1. Comparison between pandemic H1N1 2009 influenza pneumonia and seasonal influenza pneumonia in adults

    International Nuclear Information System (INIS)

    We compared 126 cases of seasonal influenza pneumonia (seasonal flu) reported between January, 1996 and March, 2009, with 10 cases of laboratory-confirmed pandemic influenza (H1N1) 2009 influenza virus pneumonia (novel flu), based on clinical condition, computed tomography (CT) findings, severity, treatment, and prognosis, to clarify the characteristics of this novel flu. The mean age of subjects was 52.4 years in the novel flu group and 64 years in the seasonal flu group, and novel flu patients were younger than seasonal flu patients. Seasonal flu patients had more underlying diseases than did novel flu patients. The median duration from illness onset to hospitalization was 4 days in both groups. Primary viral pneumonia was present in 70% of novel flu cases and 31% of seasonal flu cases. The proportion of primary virus pneumonia was higher in novel flu patients, and the disease severity of the seasonal flu group was more severe than that of the novel flu group. White blood cell and lymphocyte counts were lower in novel flu patients, and chest CT images showed bilateral shadows and pure ground-glass opacities more frequently in the novel flu cases. There were no differences in treatment, number of days required for the fever to subside, or mortality between the groups. (author)

  2. Effect of case management on neonatal mortality due to sepsis and pneumonia

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    Black Robert

    2011-04-01

    Full Text Available Abstract Background Each year almost one million newborns die from infections, mostly in low-income countries. Timely case management would save many lives but the relative mortality effect of varying strategies is unknown. We have estimated the effect of providing oral, or injectable antibiotics at home or in first-level facilities, and of in-patient hospital care on neonatal mortality from pneumonia and sepsis for use in the Lives Saved Tool (LiST. Methods We conducted systematic searches of multiple databases to identify relevant studies with mortality data. Standardized abstraction tables were used and study quality assessed by adapted GRADE criteria. Meta-analyses were undertaken where appropriate. For interventions with biological plausibility but low quality evidence, a Delphi process was undertaken to estimate effectiveness. Results Searches of 2876 titles identified 7 studies. Among these, 4 evaluated oral antibiotics for neonatal pneumonia in non-randomised, concurrently controlled designs. Meta-analysis suggested reductions in all-cause neonatal mortality (RR 0.75 95% CI 0.64- 0.89; 4 studies and neonatal pneumonia-specific mortality (RR 0.58 95% CI 0.41- 0.82; 3 studies. Two studies (1 RCT, 1 observational study, evaluated community-based neonatal care packages including injectable antibiotics and reported mortality reductions of 44% (RR= 0.56, 95% CI 0.41-0.77 and 34% (RR =0.66, 95% CI 0.47-0.93, but the interpretation of these results is complicated by co-interventions. A third, clinic-based, study reported a case-fatality ratio of 3.3% among neonates treated with injectable antibiotics as outpatients. No studies were identified evaluating injectable antibiotics alone for neonatal pneumonia. Delphi consensus (median from 20 respondents effects on sepsis-specific mortality were 30% reduction for oral antibiotics, 65% for injectable antibiotics and 75% for injectable antibiotics on pneumonia-specific mortality. No trials were

  3. Attributable mortality of ventilator-associated pneumonia: a meta-analysis of individual patient data from randomised prevention studies

    NARCIS (Netherlands)

    Melsen, W.G.; Rovers, M.M.; Groenwold, R.H.; Bergmans, D.C.; Camus, C.; Bauer, T.T.; Hanisch, E.W.; Klarin, B.; Koeman, M.; Krueger, W.A.; Lacherade, J.C.; Lorente, L.; Memish, Z.A.; Morrow, L.E.; Nardi, G.; Nieuwenhoven, C.A. van; O'Keefe, G.E.; Nakos, G.; Scannapieco, F.A.; Seguin, P.; Staudinger, T.; Topeli, A.; Ferrer, M.; Bonten, M.J.

    2013-01-01

    BACKGROUND: Estimating attributable mortality of ventilator-associated pneumonia has been hampered by confounding factors, small sample sizes, and the difficulty of doing relevant subgroup analyses. We estimated the attributable mortality using the individual original patient data of published rando

  4. Evaluating the impact of pulse oximetry on childhood pneumonia mortality in resource-poor settings.

    Science.gov (United States)

    Floyd, Jessica; Wu, Lindsey; Hay Burgess, Deborah; Izadnegahdar, Rasa; Mukanga, David; Ghani, Azra C

    2015-12-01

    It is estimated that pneumonia is responsible for 15% of childhood deaths worldwide. Recent research has shown that hypoxia and malnutrition are strong predictors of mortality in children hospitalized for pneumonia. It is estimated that 15% of children under 5 who are hospitalized for pneumonia have hypoxaemia and that around 1.5 million children with severe pneumonia require oxygen treatment each year. We developed a deterministic compartmental model that links the care pathway to disease progression to assess the impact of introducing pulse oximetry as a prognostic tool to distinguish severe from non-severe pneumonia in under-5 year olds across 15 countries with the highest burden worldwide. We estimate that, assuming access to supplemental oxygen, pulse oximetry has the potential to avert up to 148,000 deaths if implemented across the 15 countries. By contrast, integrated management of childhood illness alone has a relatively small impact on mortality owing to its low sensitivity. Pulse oximetry can significantly increase the incidence of correctly treated severe cases as well as reduce the incidence of incorrect treatment with antibiotics. We also found that the combination of pulse oximetry with integrated management of childhood illness is highly cost-effective, with median estimates ranging from US$2.97 to $52.92 per disability-adjusted life year averted in the 15 countries analysed. This combination of substantial burden reduction and favourable cost-effectiveness makes pulse oximetry a promising candidate for improving the prognosis for children with pneumonia in resource-poor settings.

  5. Serum Procalcitonin Level and Mortality Risk in Critically ill Patients with Ventilator-Associated Pneumonia

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    Bo Li

    2015-11-01

    Full Text Available Background/Aims: The prognostic role of serum procalcitonin level in critically ill patients with ventilator-associated pneumonia was unclear. The aim of our study was to investigate the relationship between serum procalcitonin level and mortality risk in critically ill patients with ventilator-associated pneumonia. Methods: Data of critically ill patients with ventilator-associated pneumonia were retrospectively collected. Demographics, comorbidities, and serum procalcitonin level were extracted from electronic medical records. The primary outcome was mortality within two months after diagnosis. Multivariable Cox regression analyses were performed to assess the prognostic role of serum procalcitonin level in those patients. Results: A total of 115 critically ill patients with ventilator-associated pneumonia were enrolled in our study. Serum procalcitonin level was not associated with age, gender, or other comorbidities. Univariate Cox regression model showed that high serum procalcitonin level was associated increased risk of morality within 2 months after diagnosis (OR = 2.32, 95% CI 1.25-4.31, P = 0.008. Multivariable Cox regression model showed that high serum procalcitonin level was independently associated increased risk of morality within 2 months after diagnosis (OR = 2.38, 95% CI 1.26-4.50, P = 0.008. Conclusion: High serum procalcitonin level is an independent prognostic biomarker of mortality risk in critically ill patients with ventilator-associated pneumonia, and it's a promising biomarker of prognosis in critically ill patients.

  6. System for rapid assessment of pneumonia and influenza-related mortality-Ohio, 2009-2010.

    Science.gov (United States)

    Rodgers, Loren E; Paulson, John; Fowler, Brian; Duffy, Rosemary

    2015-02-01

    Rapid mortality surveillance is critical for state emergency preparedness. To enhance timeliness during the 2009-2010 influenza A H1N1 pandemic, the Ohio Department of Health activated a drop-down menu within Ohio's Electronic Death Registration System for reporting of pneumonia- or influenza-related deaths approximately 5 days postmortem. We used International Classification of Diseases-Tenth Revision (ICD-10) codes, available 2-3 months postmortem as the standard, and assessed their agreement with drop-down-menu codes for pneumonia- or influenza-related deaths. Among 56 660 Ohio deaths during September 2009-March 2010, agreement was 97.9% for pneumonia (κ = 0.85) and 99.9% for influenza (κ = 0.79). Sensitivity was 80.2% for pneumonia and 73.9% for influenza. Drop-down menu coding enhanced timeliness while maintaining high agreement with ICD-10 codes. PMID:25521902

  7. Clinical Practice Guidelines for Hospital-Acquired Pneumonia and Ventilator-Associated Pneumonia in Adults

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    Coleman Rotstein

    2008-01-01

    Full Text Available Hospital-acquired pneumonia (HAP and ventilator-associated pneumonia (VAP are important causes of morbidity and mortality, with mortality rates approaching 62%. HAP and VAP are the second most common cause of nosocomial infection overall, but are the most common cause documented in the intensive care unit setting. In addition, HAP and VAP produce the highest mortality associated with nosocomial infection. As a result, evidence-based guidelines were prepared detailing the epidemiology, microbial etiology, risk factors and clinical manifestations of HAP and VAP. Furthermore, an approach based on the available data, expert opinion and current practice for the provision of care within the Canadian health care system was used to determine risk stratification schemas to enable appropriate diagnosis, antimicrobial management and nonantimicrobial management of HAP and VAP. Finally, prevention and risk-reduction strategies to reduce the risk of acquiring these infections were collated. Future initiatives to enhance more rapid diagnosis and to effect better treatment for resistant pathogens are necessary to reduce morbidity and improve survival.

  8. Diarrhea, pneumonia, and infectious disease mortality in children aged 5 to 14 years in India.

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    Shaun K Morris

    Full Text Available BACKGROUND: Little is known about the causes of death in children in India after age five years. The objective of this study is to provide the first ever direct national and sub-national estimates of infectious disease mortality in Indian children aged 5 to 14 years. METHODS: A verbal autopsy based assessment of 3 855 deaths is children aged 5 to 14 years from a nationally representative survey of deaths occurring in 2001-03 in 1.1 million homes in India. RESULTS: Infectious diseases accounted for 58% of all deaths among children aged 5 to 14 years. About 18% of deaths were due to diarrheal diseases, 10% due to pneumonia, 8% due to central nervous system infections, 4% due to measles, and 12% due to other infectious diseases. Nationally, in 2005 about 59 000 and 34 000 children aged 5 to 14 years died from diarrheal diseases and pneumonia, corresponding to mortality of 24.1 and 13.9 per 100 000 respectively. Mortality was nearly 50% higher in girls than in boys for both diarrheal diseases and pneumonia. CONCLUSIONS: Approximately 60% of all deaths in this age group are due to infectious diseases and nearly half of these deaths are due to diarrheal diseases and pneumonia. Mortality in this age group from infectious diseases, and diarrhea in particular, is much higher than previously estimated.

  9. Inhaled lactonase reduces Pseudomonas aeruginosa quorum sensing and mortality in rat pneumonia.

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    Sami Hraiech

    Full Text Available RATIONALE: The effectiveness of antibiotic molecules in treating Pseudomonas aeruginosa pneumonia is reduced as a result of the dissemination of bacterial resistance. The existence of bacterial communication systems, such as quorum sensing, has provided new opportunities of treatment. Lactonases efficiently quench acyl-homoserine lactone-based bacterial quorum sensing, implicating these enzymes as potential new anti-Pseudomonas drugs that might be evaluated in pneumonia. OBJECTIVES: The aim of the present study was to evaluate the ability of a lactonase called SsoPox-I to reduce the mortality of a rat P. aeruginosa pneumonia. METHODS: To assess SsoPox-I-mediated quorum quenching, we first measured the activity of the virulence gene lasB, the synthesis of pyocianin, the proteolytic activity of a bacterial suspension and the formation of biofilm of a PAO1 strain grown in the presence of lactonase. In an acute lethal model of P. aeruginosa pneumonia in rats, we evaluated the effects of an early or deferred intra-tracheal treatment with SsoPox-I on the mortality, lung bacterial count and lung damage. MEASUREMENTS AND PRIMARY RESULTS: SsoPox-I decreased PAO1 lasB virulence gene activity, pyocianin synthesis, proteolytic activity and biofilm formation. The early use of SsoPox-I reduced the mortality of rats with acute pneumonia from 75% to 20%. Histological lung damage was significantly reduced but the lung bacterial count was not modified by the treatment. A delayed treatment was associated with a non-significant reduction of mortality. CONCLUSION: These results demonstrate the protective effects of lactonase SsoPox-I in P. aeruginosa pneumonia and open the way for a future therapeutic use.

  10. Predictors of mortality in patients with extensively drug-resistant Acinetobacter baumannii pneumonia receiving colistin therapy.

    Science.gov (United States)

    Choi, Ik Sung; Lee, Yu Ji; Wi, Yu Mi; Kwan, Byung Soo; Jung, Kae Hwa; Hong, Woong Pyo; Kim, June Myong

    2016-08-01

    The ratio of the area under the free (unbound) concentration-time curve to minimum inhibitory concentration (fAUC/MIC) was proposed to be the pharmacokinetic/pharmacodynamic index most strongly linked to the antibacterial effect of colistin against Acinetobacter baumannii. A retrospective study of patients who received colistin to treat pneumonia caused by extensively drug-resistant (XDR) A. baumannii over a 4-year period was performed to assess the impact of the colistin MIC on mortality. A total of 227 patients were included in the analysis. The 7-day and 14-day mortality rates of patients with XDR A. baumannii pneumonia receiving colistin therapy were 15.0% and 23.8%, respectively. In the multivariate analysis, Acute Physiology and Chronic Health Evaluation (APACHE) II score, days from index culture to first dose of colistin, underlying tumour and septic shock at presentation were independent predictors of mortality in patients with XDR A. baumannii pneumonia receiving colistin therapy. In the univariate analysis, the colistin dose based on ideal body weight (IBW) correlated with patient outcome. Therefore, the use of IBW appeared to be more appropriate to calculate the colistin dosage. In addition, these results highlight the clinical significance of colistin MIC in patients with XDR A. baumannii pneumonia receiving colistin therapy. Although MICs were in the 'susceptible' range, patients infected with isolates with high colistin MICs showed a poorer clinical response rate than patients infected with isolates with low colistin MICs. Further clinical studies are needed to evaluate the roles of colistin MIC for predicting mortality in XDR A. baumannii pneumonia with a high colistin MIC. PMID:27423416

  11. Non-invasive mechanical ventilation and mortality in elderly immunocompromised patients hospitalized with pneumonia: a retrospective cohort study

    OpenAIRE

    Johnson, Christopher S; Frei, Christopher R; Metersky, Mark L.; Anzueto, Antonio R.; Mortensen, Eric M

    2014-01-01

    Background Mortality after pneumonia in immunocompromised patients is higher than for immunocompetent patients. The use of non-invasive mechanical ventilation for patients with severe pneumonia may provide beneficial outcomes while circumventing potential complications associated with invasive mechanical ventilation. The aim of our study was to determine if the use of non-invasive mechanical ventilation in elderly immunocompromised patients with pneumonia is associated with higher all-cause m...

  12. Pneumonia

    Science.gov (United States)

    ... restroom and before eating. Use lukewarm water and soap for at least 20 seconds. If soap and water are not available, using an alcohol- ... at higher risk for pneumonia? Do I have bacterial, viral or fungal pneumonia? What’s the best treatment? ...

  13. Severe Community-Acquired Pneumonia Caused by Human Adenovirus in Immunocompetent Adults: A Multicenter Case Series.

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    Dingyu Tan

    Full Text Available Severe community-acquired pneumonia (CAP caused by human adenovirus (HAdV, especially HAdV type 55 (HAdV-55 in immunocompetent adults has raised increasing concerns. Clinical knowledge of severe CAP and acute respiratory distress syndrome induced by HAdV-55 is still limited, though the pathogen has been fully characterized by whole-genome sequencing.We conducted a multicentre retrospective review of all consecutive patients with severe CAP caused by HAdV in immunocompetent adults admitted to the Emergency Department Intensive Care Unit of two hospitals in Northern China between February 2012 and April 2014. Clinical, laboratory, radiological characteristics, treatments and outcomes of these patients were collected and analyzed.A total of 15 consecutive severe CAP patients with laboratory-confirmed adenovirus infections were included. The median age was 30 years and all cases were identified during the winter and spring seasons. HAdV-55 was the most frequently (11/15 detected HAdV type. Persistent high fever, cough and rapid progression of dyspnea were typically reported in these patients. Significantly increased pneumonia severity index (PSI, respiratory rate, and lower PaO2/FiO2, hypersensitive CRP were reported in non-survivors compared to survivors (P = 0.013, 0.022, 0.019 and 0.026, respectively. The rapid development of bilateral consolidations within 10 days after illness onset were the most common radiographic finding, usually accompanied by adjacent ground glass opacities and pleural effusions. Total mortality was 26.7% in this study. Corticosteroids were prescribed to 14 patients in this report, but the utilization rate between survivors and non-survivors was not significant.HAdV and the HAdV-55 sub-type play an important role among viral pneumonia pathogens in hospitalized immunocompetent adults in Northern China. HAdV should be tested in severe CAP patients with negative bacterial cultures and a lack of response to antibiotic

  14. Cardiac complications associated with short-term mortality in schizophrenia patients hospitalized for pneumonia: a nationwide case-control study.

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    Ya-Tang Liao

    Full Text Available BACKGROUND: Pneumonia is one of most prevalent infectious diseases worldwide and is associated with considerable mortality. In comparison to general population, schizophrenia patients hospitalized for pneumonia have poorer outcomes. We explored the risk factors of short-term mortality in this population because the information is lacking in the literature. METHODS: In a nationwide schizophrenia cohort, derived from the National Health Insurance Research Database in Taiwan, that was hospitalized for pneumonia between 2000 and 2008 (n = 1,741, we identified 141 subjects who died during their hospitalizations or shortly after their discharges. Based on risk-set sampling in a 1∶4 ratio, 468 matched controls were selected from the study cohort (i.e., schizophrenia cohort with pneumonia. Physical illnesses were categorized as pre-existing and incident illnesses that developed after pneumonia respectively. Exposures to medications were categorized by type, duration, and defined daily dose. We used stepwise conditional logistic regression to explore the risk factors for short-term mortality. RESULTS: Pre-existing arrhythmia was associated with short-term mortality (adjusted risk ratio [RR] = 4.99, p<0.01. Several variables during hospitalization were associated with increased mortality risk, including incident arrhythmia (RR = 7.44, p<0.01, incident heart failure (RR = 5.49, p = 0.0183 and the use of hypoglycemic drugs (RR = 2.32, p<0.01. Furthermore, individual antipsychotic drugs (such as clozapine known to induce pneumonia were not significantly associated with the risk. CONCLUSIONS: Incident cardiac complications following pneumonia are associated with increased short-term mortality. These findings have broad implications for clinical intervention and future studies are needed to clarify the mechanisms of the risk factors.

  15. Risk factors for septicemia-associated mortality in older adults.

    OpenAIRE

    Salive, M E; Wallace, R B; Ostfeld, A M; Satterfield, S.; Havlik, R J

    1993-01-01

    Septicemia is the 10th leading cause of death among older adults in the United States; its mortality rate has steadily increased over the past decades. Little is known about factors which predispose to septicemia mortality in the elderly. The authors investigated risk factors for septicemia-associated mortality in 10,269 older adults as part of a longitudinal study of three communities (East Boston, MA; New Haven, CT; and Iowa and Washington Counties, IA). During 6 years of followup, 177 pers...

  16. Klebsiella variicola is a frequent cause of bloodstream infection in the stockholm area, and associated with higher mortality compared to K. pneumoniae.

    Science.gov (United States)

    Maatallah, Makaoui; Vading, Malin; Kabir, Muhammad Humaun; Bakhrouf, Amina; Kalin, Mats; Nauclér, Pontus; Brisse, Sylvain; Giske, Christian G

    2014-01-01

    Clinical isolates of Klebsiella pneumoniae are divided into three phylogroups and differ in their virulence factor contents. The aim of this study was to determine an association between phylogroup, virulence factors and mortality following bloodstream infection (BSI) caused by Klebsiella pneumoniae. Isolates from all adult patients with BSI caused by K. pneumoniae admitted to Karolinska University Hospital, Solna between 2007 and 2009 (n = 139) were included in the study. Phylogenetic analysis was performed based on multilocus sequence typing (MLST) data. Testing for mucoid phenotype, multiplex PCR determining serotypes K1, K2, K5, K20, K54 and K57, and testing for virulence factors connected to more severe disease in previous studies, was also performed. Data was retrieved from medical records including age, sex, comorbidity, central and urinary catheters, time to adequate treatment, hospital-acquired infection, and mortality, to identify risk factors. The primary end-point was 30- day mortality. The three K. pneumoniae phylogroups were represented: KpI (n = 96), KpII (corresponding to K. quasipneumoniae, n = 9) and KpIII (corresponding to K. variicola, n = 34). Phylogroups were not significantly different in baseline characteristics. Overall, the 30-day mortality was 24/139 (17.3%). Isolates belonging to KpIII were associated with the highest 30-day mortality (10/34 cases, 29.4%), whereas KpI isolates were associated with mortality in 13/96 cases (13.5%). This difference was significant both in univariate statistical analysis (P = 0.037) and in multivariate analysis adjusting for age and comorbidity (OR 3.03 (95% CI: 1.10-8.36). Only three of the isolates causing mortality within 30 days belonged to any of the virulent serotypes (K54, n = 1), had a mucoid phenotype (n = 1) and/or contained virulence genes (wcaG n = 1 and wcaG/allS n = 1). In conclusion, the results indicate higher mortality among patients infected with

  17. Klebsiella variicola is a frequent cause of bloodstream infection in the stockholm area, and associated with higher mortality compared to K. pneumoniae.

    Directory of Open Access Journals (Sweden)

    Makaoui Maatallah

    Full Text Available Clinical isolates of Klebsiella pneumoniae are divided into three phylogroups and differ in their virulence factor contents. The aim of this study was to determine an association between phylogroup, virulence factors and mortality following bloodstream infection (BSI caused by Klebsiella pneumoniae. Isolates from all adult patients with BSI caused by K. pneumoniae admitted to Karolinska University Hospital, Solna between 2007 and 2009 (n = 139 were included in the study. Phylogenetic analysis was performed based on multilocus sequence typing (MLST data. Testing for mucoid phenotype, multiplex PCR determining serotypes K1, K2, K5, K20, K54 and K57, and testing for virulence factors connected to more severe disease in previous studies, was also performed. Data was retrieved from medical records including age, sex, comorbidity, central and urinary catheters, time to adequate treatment, hospital-acquired infection, and mortality, to identify risk factors. The primary end-point was 30- day mortality. The three K. pneumoniae phylogroups were represented: KpI (n = 96, KpII (corresponding to K. quasipneumoniae, n = 9 and KpIII (corresponding to K. variicola, n = 34. Phylogroups were not significantly different in baseline characteristics. Overall, the 30-day mortality was 24/139 (17.3%. Isolates belonging to KpIII were associated with the highest 30-day mortality (10/34 cases, 29.4%, whereas KpI isolates were associated with mortality in 13/96 cases (13.5%. This difference was significant both in univariate statistical analysis (P = 0.037 and in multivariate analysis adjusting for age and comorbidity (OR 3.03 (95% CI: 1.10-8.36. Only three of the isolates causing mortality within 30 days belonged to any of the virulent serotypes (K54, n = 1, had a mucoid phenotype (n = 1 and/or contained virulence genes (wcaG n = 1 and wcaG/allS n = 1. In conclusion, the results indicate higher mortality among patients infected with

  18. Pneumonia Incidence and Mortality in Mainland China: Systematic Review of Chinese and English Literature, 1985–2008

    OpenAIRE

    Guan, Xuhua; Silk, Benjamin J.; Li, Wenkai; Fleischauer, Aaron T.; Xing, Xuesen; Jiang, Xiaoqing; Yu, Hongjie; Sonja J Olsen; Cohen, Adam L.

    2010-01-01

    Background Pneumonia is a leading infectious disease killer worldwide, yet the burden in China is not well understood as much of the data is published in the non-English literature. Methodology/Principal Findings We systematically reviewed the Chinese- and English-language literature for studies with primary data on pneumonia incidence and mortality in mainland China. Between 1985 and 2008, 37 studies met the inclusion criteria. The quality of the studies was highly variable. For children

  19. Effect of outpatient therapy with inhaled corticosteroids on decreasing in-hospital mortality from pneumonia in patients with COPD

    Science.gov (United States)

    Yamauchi, Yasuhiro; Yasunaga, Hideo; Hasegawa, Wakae; Sakamoto, Yukiyo; Takeshima, Hideyuki; Jo, Taisuke; Matsui, Hiroki; Fushimi, Kiyohide; Nagase, Takahide

    2016-01-01

    Background and objectives Inhaled corticosteroids (ICS) and long-acting inhaled bronchodilators (IBD) are beneficial for the management of COPD. Although ICS has been reported to increase the risk of pneumonia in patients with COPD, it remains controversial whether it influences mortality. Using a Japanese national database, we examined the association between preadmission ICS therapy and in-hospital mortality from pneumonia in patients with COPD. Methods We retrospectively collected data from 1,165 hospitals in Japan on patients with COPD who received outpatient inhalation therapy and were admitted with pneumonia. Patients were categorized into those who received ICS with IBD and those who received IBD alone. We performed multivariate logistic regression analysis to examine the association between outpatient ICS therapy and in-hospital mortality, adjusting for the patients’ backgrounds. Results Of the 7,033 eligible patients, the IBD alone group (n=3,331) was more likely to be older, have lower body mass index, poorer general conditions, and more severe pneumonia than the ICS with IBD group (n=3,702). In-hospital mortality was 13.2% and 8.1% in the IBD alone and the ICS with IBD groups, respectively. After adjustment for patients’ backgrounds, the ICS with IBD group had significantly lower mortality than the IBD alone group (adjusted odds ratio, 0.80; 95% confidence interval, 0.68–0.94). Higher mortality was associated with older age, being male, lower body mass index, poorer general status, and more severe pneumonia. Conclusion Outpatient inhaled ICS and IBD therapy was significantly associated with lower mortality from pneumonia in patients with COPD than treatment with IBD alone.

  20. Pneumonia in the immunocompetent patient.

    Science.gov (United States)

    Reynolds, J H; McDonald, G; Alton, H; Gordon, S B

    2010-12-01

    Pneumonia is an acute inflammation of the lower respiratory tract. Lower respiratory tract infection is a major cause of mortality worldwide. Pneumonia is most common at the extremes of life. Predisposing factors in children include an under-developed immune system together with other factors, such as malnutrition and over-crowding. In adults, tobacco smoking is the single most important preventable risk factor. The commonest infecting organisms in children are respiratory viruses and Streptoccocus pneumoniae. In adults, pneumonia can be broadly classified, on the basis of chest radiographic appearance, into lobar pneumonia, bronchopneumonia and pneumonia producing an interstitial pattern. Lobar pneumonia is most commonly associated with community acquired pneumonia, bronchopneumonia with hospital acquired infection and an interstitial pattern with the so called atypical pneumonias, which can be caused by viruses or organisms such as Mycoplasma pneumoniae. Most cases of pneumonia can be managed with chest radiographs as the only form of imaging, but CT can detect pneumonia not visible on the chest radiograph and may be of value, particularly in the hospital setting. Complications of pneumonia include pleural effusion, empyema and lung abscess. The chest radiograph may initially indicate an effusion but ultrasound is more sensitive, allows characterisation in some cases and can guide catheter placement for drainage. CT can also be used to characterise and estimate the extent of pleural disease. Most lung abscesses respond to medical therapy, with surgery and image guided catheter drainage serving as options for those cases who do not respond. PMID:21088086

  1. Pneumonia

    Science.gov (United States)

    ... better than treating it. Vaccines are available to prevent pneumococcal pneumonia and the flu. Other preventive measures include washing your hands frequently and not smoking. NIH: National Heart, Lung, and Blood Institute

  2. Pneumococcal disease in HIV-infected Malawian adults: acute mortality and long-term survival

    Science.gov (United States)

    Gordon, Stephen B.; Chaponda, Mas; Walsh, Amanda L.; Whitty, Christopher J.M.; Gordon, Melita A.; Machili, C. Edward; Gilks, Charles F.; Boeree, Martin J.; Kampondeni, Sam; Read, Robert C.; Molyneux, Malcolm E.

    2016-01-01

    Objective HIV-infected patients in Africa are vulnerable to severe recurrent infection with Streptococcus pneumoniae, but no effective preventive strategy has been developed. We set out to determine which factors influence in-hospital mortality and long-term survival of Malawians with invasive pneumococcal disease. Design, setting and patients Acute clinical features, inpatient mortality and long-term survival were described among consecutively admitted hospital patients with S. pneumoniae in the blood or cerebrospinal fluid. Factors associated with inpatient mortality were determined, and patients surviving to discharge were followed to determine their long-term outcome. Results A total of 217 patients with pneumococcal disease were studied over an 18-month period. Among these, 158 out of 167 consenting to testing (95%) were HIV positive. Inpatient mortality was 65% for pneumococcal meningitis (n = 64), 20% for pneumococcaemic pneumonia (n = 92), 26% for patients with pneumococcaemia without localizing signs (n = 43), and 76% in patients with probable meningitis (n = 17). Lowered consciousness level, hypotension, and age exceeding 55 years at presentation were associated with inpatient death, but not long-term outcome in survivors. Hospital survivors were followed for a median of 414 days; 39% died in the community during the study period. Outpatient death was associated with multilobar chest signs, oral candidiasis, and severe anaemia as an inpatient. Conclusion Most patients with pneumococcal disease in Malawi have HIV co-infection. They have severe disease with a high mortality rate. At discharge, all HIV-infected adults have a poor prognosis but patients with multilobar chest signs or anaemia are at particular risk. PMID:12131218

  3. Massive empyema caused by Mycoplasma pneumoniae in an adult: A case report

    Directory of Open Access Journals (Sweden)

    Ron Merav

    2006-02-01

    Full Text Available Abstract Background Mycoplasma pneumoniae is responsible for more than 20% of community acquired pneumonia cases, and capable of causing upper respiratory illness as well. Complications of M.pneumoniae infections include CNS involvement but other as pericarditis were also reported. The lack of feasible culture methods and under appreciation of the pathogens ability to cause invasive disease leads to reduced number of diagnosed M.pneumoniae related complications. In contrast to many other respiratory pathogens causing pneumonia, M. pneumoniae related severe pleural complications were almost never reported. Case presentation We report a previously healthy 57 years old woman presented with indolent massive right pleural effusion, leukocytosis and elevated ESR. Extensive microbiological evaluation didn't reveal any pathogen in the pus even before antibiotic treatment was started. Surprisingly, M.pneumoniae DNA was detected in the pus from the empyema using PCR designed to detect M.pneumoniae. A serological assay (Serodia-Myco II using convalescent serum was indeterminate with a titer of 1:80. The patient responded well to a treatment that included right thoracotomy with pleural decortication and a combination of antibiotics and anti-inflammatory medications. Conclusion M.pneumoniae related empyema was never reported before in adult patients and was reported in only a few pediatric patients. In our patient there was no evidence to any common pathogens even before initiating antibiotic treatment. The only pathogen detected was M.pneumoniae. In this patient, serology was not helpful in establishing the diagnosis of M.pneumoniae related diseases, as was suggested before for older patients. We suggest that M.pneumoniae related empyema is probably under-diagnosed complication due to insensitivity of serology in older patients and under use of other diagnosis methods.

  4. Smoking and All-cause Mortality in Older Adults

    DEFF Research Database (Denmark)

    Müezzinler, Aysel; Mons, Ute; Gellert, Carolin;

    2015-01-01

    INTRODUCTION: Smoking is known to be a major cause of death among middle-aged adults, but evidence on its impact and the benefits of smoking cessation among older adults has remained limited. Therefore, we aimed to estimate the influence of smoking and smoking cessation on all-cause mortality...... risk factor for premature mortality in older individuals and cessation remains beneficial even at advanced ages. Efforts to support smoking abstinence at all ages should be a public health priority....

  5. The endogenous bacteria alter gut epithelial apoptosis and decrease mortality following Pseudomonas aeruginosa pneumonia.

    Science.gov (United States)

    Fox, Amy C; McConnell, Kevin W; Yoseph, Benyam P; Breed, Elise; Liang, Zhe; Clark, Andrew T; O'Donnell, David; Zee-Cheng, Brendan; Jung, Enjae; Dominguez, Jessica A; Dunne, W Michael; Burd, Eileen M; Coopersmith, Craig M

    2012-11-01

    The endogenous bacteria have been hypothesized to play a significant role in the pathophysiology of critical illness, although their role in sepsis is poorly understood. The purpose of this study was to determine how commensal bacteria alter the host response to sepsis. Conventional and germ-free (GF) C57Bl/6 mice were subjected to Pseudomonas aeruginosa pneumonia. All GF mice died within 2 days, whereas 44% of conventional mice survived for 7 days (P = 0.001). Diluting the dose of bacteria 10-fold in GF mice led to similar survival in GF and conventional mice. When animals with similar mortality were assayed for intestinal integrity, GF mice had lower levels of intestinal epithelial apoptosis but similar levels of proliferation and intestinal permeability. Germ-free mice had significantly lower levels of tumor necrosis factor and interleukin 1β in bronchoalveolar lavage fluid compared with conventional mice without changes in systemic cytokine production. Under conventional conditions, sepsis unmasks lymphocyte control of intestinal epithelial apoptosis, because sepsis induces a greater increase in gut apoptosis in Rag-1 mice than in wild-type mice. However, in a separate set of experiments, gut apoptosis was similar between septic GF Rag-1 mice and septic GF wild-type mice. These data demonstrate that the endogenous bacteria play a protective role in mediating mortality from pneumonia-induced sepsis, potentially mediated through altered intestinal apoptosis and the local proinflammatory response. In addition, sepsis-induced lymphocyte-dependent increases in gut epithelial apoptosis appear to be mediated by the endogenous bacteria. PMID:23042193

  6. Recurrent pneumonia mortality risk in a HIV/AIDS Puerto Rican cohort.

    Science.gov (United States)

    Mayor, A M; Gomez, M A; Rios, E; Hunter, R F

    2003-12-01

    Recurrent pneumonia (RP) within 12 months is one of the AIDS diagnosis criteria. To gain knowledge of RP infection in HIV-infected patients, we studied 145 RP cases detected in a cohort of 2,996 HIV patients in Puerto Rico between Jan. 1992-Dec. 2001. The RP prevalence was 4.8%; 77.2% were males and 62.1% were injecting drug users (IDU). At the time of RP diagnosis, the mean CD4+ T cell count was 93.8 cells/mm3, 59.3% were in antiretroviral treatment, 13% had received the pneumococcal vaccine and 84.8% had another AIDS related condition. Over 37% received two or more antiretroviral medications. The death rate in the first year after the RP diagnosis was 63.4%. A Cox proportional hazard analysis showed that CD4+ T cells vaccination percent at the time of RP diagnosis. Low CD4+ T cells significantly increased the hazard and mortality risk of the cases studied. Antecedents of antiretroviral therapy in these patients ensure a better outcome with lower mortality. Efforts to increase the vaccination rate should reduce the RP incidence in our HIV-infected population.

  7. Trends in Pneumonia Mortality Rates and Hospitalizations by Organism, United States, 2002-2011(1).

    Science.gov (United States)

    Wuerth, Brandon A; Bonnewell, John P; Wiemken, Timothy L; Arnold, Forest W

    2016-09-01

    Because the epidemiology of pneumonia is changing, we performed an updated, population-based analysis of hospitalization and case-fatality rates for pneumonia patients in the United States. From 2002 to 2011, hospitalization rates decreased significantly for pneumonia caused by pneumococcus and Haemophilus influenzae but increased significantly for Pseudomonas spp., Staphylococcus aureus, and influenza virus. PMID:27532154

  8. Antibiotic Treatment Strategies for Community-Acquired Pneumonia in Adults

    NARCIS (Netherlands)

    Postma, Douwe F.; Van Werkhoven, Cornelis H.; Van Elden, Leontine J R; Thijsen, Steven F T; Hoepelman, Andy I M; Kluytmans, Jan A J W; Boersma, Wim G.; Compaijen, Clara J.; Van Der Wall, Eva; Prins, Jan M.; Oosterheert, Jan J.; Bonten, Marc J M

    2015-01-01

    BACKGROUND The choice of empirical antibiotic treatment for patients with clinically suspected community-acquired pneumonia (CAP) who are admitted to non-intensive care unit (ICU) hospital wards is complicated by the limited availability of evidence. We compared strategies of empirical treatment (al

  9. [Adult mortality from chronic diseases in Chile, 1968-1990].

    Science.gov (United States)

    Taucher, E; Albala, C; Icaza, G

    1994-12-01

    "The paper starts with a brief analysis of the sources and the quality of the data and the mortality indices [for trends in adult mortality from chronic diseases in Chile]....A comparison is made of mortality among the 13 regions of the country and an attempt is made to relate the observed differences to some environmental and life-style factors. Rural-urban and educational differences of mortality by cause of death are also analyzed. The paper ends by comparing mortality by chronic disease in Chile with that of other countries of the Latin American region, noting some difficulties [in] such a comparison and proposing hypotheses for future studies." (SUMMARY IN ENG) PMID:12290226

  10. Older Adults: A Proposal for the Management of Community-acquired Pneumonia

    Directory of Open Access Journals (Sweden)

    Miguel Ángel Serra Valdés

    2016-04-01

    Full Text Available Background: community-acquired pneumonia is the leading cause of hospitalization among older adults. It has a high fatality rate. At present, there are several risk and prognosis scores and different clinical practice guidelines available. Objective: to develop a proposal for the management of community-acquired pneumonia in older adults, applicable in both primary care, and the hospital setting. Methods: a search on community-acquired pneumonia, especially in older adults or the elderly, was conducted using index terms and existing guidelines from different countries, companies and regional consensus included in Clinical Evidence, The Cochrane Library, PubMed, Google Scholar, MEDLINE, LIS, Scielo, Medscape, LILACS, Latindex, HINARI, MEDIGRAPHIC-NEWS and others. The publications providing high-quality evidence in accordance with the criteria of the Grading of Recommendations, Assessment, Development and Evaluations approach were selected. Results: a proposal for practical management of community-acquired pneumonia at any level of care in our health system was developed considering the list of medications currently available in the country. Epidemiology, risk factors, risk stratification, treatment, and fatality rate were considered. Conclusions: community-acquired pneumonia is a current problem and future challenge. This proposal can be used by professionals treating this condition at any level of care. Its application could improve care and quality of life and reduce the fatality rate and costs.

  11. Using data-driven rules to predict mortality in severe community acquired pneumonia.

    Directory of Open Access Journals (Sweden)

    Chuang Wu

    Full Text Available Prediction of patient-centered outcomes in hospitals is useful for performance benchmarking, resource allocation, and guidance regarding active treatment and withdrawal of care. Yet, their use by clinicians is limited by the complexity of available tools and amount of data required. We propose to use Disjunctive Normal Forms as a novel approach to predict hospital and 90-day mortality from instance-based patient data, comprising demographic, genetic, and physiologic information in a large cohort of patients admitted with severe community acquired pneumonia. We develop two algorithms to efficiently learn Disjunctive Normal Forms, which yield easy-to-interpret rules that explicitly map data to the outcome of interest. Disjunctive Normal Forms achieve higher prediction performance quality compared to a set of state-of-the-art machine learning models, and unveils insights unavailable with standard methods. Disjunctive Normal Forms constitute an intuitive set of prediction rules that could be easily implemented to predict outcomes and guide criteria-based clinical decision making and clinical trial execution, and thus of greater practical usefulness than currently available prediction tools. The Java implementation of the tool JavaDNF will be publicly available.

  12. Cecal ligation and puncture followed by MRSA pneumonia increases mortality in mice and blunts production of local and systemic cytokines

    OpenAIRE

    Jung, Enjae; Perrone, Erin E.; Liang, Zhe; Elise R Breed; Dominguez, Jessica A.; Clark, Andrew T.; Fox, Amy C.; Dunne, W. Michael; Burd, Eileen M.; Farris, Alton B.; Richard S Hotchkiss; Coopersmith, Craig M.

    2012-01-01

    Mortality in the ICU frequently results from the synergistic effect of two temporally-distinct infections. This study examined the pathophysiology of a new model of intraabdominal sepsis followed by methicillin-resistant Staphylococcus aureus (MRSA) pneumonia. Mice underwent cecal ligation and puncture (CLP) or sham laparotomy followed three days later by an intratracheal injection of MRSA or saline. Both CLP/saline and sham/MRSA mice had 100% survival while animals with CLP followed by MRSA ...

  13. Resting heart rate is a risk factor for mortality in chronic obstructive pulmonary disease, but not for exacerbations or pneumonia

    DEFF Research Database (Denmark)

    Warnier, Miriam J; Rutten, Frans H; de Boer, Anthonius;

    2014-01-01

    BACKGROUND: Although it is known that patients with chronic obstructive pulmonary disease (COPD) generally do have an increased heart rate, the effects on both mortality and non-fatal pulmonary complications are unclear. We assessed whether heart rate is associated with all-cause mortality, and non......-fatal pulmonary endpoints. METHODS: A prospective cohort study of 405 elderly patients with COPD was performed. All patients underwent extensive investigations, including electrocardiography. Follow-up data on mortality were obtained by linking the cohort to the Dutch National Cause of Death Register...... and information on complications (exacerbation of COPD or pneumonia) by scrutinizing patient files of general practitioners. Multivariable cox regression analysis was performed. RESULTS: During the follow-up 132 (33%) patients died. The overall mortality rate was 50/1000 py (42-59). The major causes of death were...

  14. Cecal ligation and puncture followed by MRSA pneumonia increases mortality in mice and blunts production of local and systemic cytokines

    Science.gov (United States)

    Jung, Enjae; Perrone, Erin E.; Liang, Zhe; Breed, Elise R.; Dominguez, Jessica A.; Clark, Andrew T.; Fox, Amy C.; Dunne, W. Michael; Burd, Eileen M.; Farris, Alton B.; Hotchkiss, Richard S.; Coopersmith, Craig M.

    2011-01-01

    Mortality in the ICU frequently results from the synergistic effect of two temporally-distinct infections. This study examined the pathophysiology of a new model of intraabdominal sepsis followed by methicillin-resistant Staphylococcus aureus (MRSA) pneumonia. Mice underwent cecal ligation and puncture (CLP) or sham laparotomy followed three days later by an intratracheal injection of MRSA or saline. Both CLP/saline and sham/MRSA mice had 100% survival while animals with CLP followed by MRSA pneumonia had 67% seven-day survival. Animals subjected to CLP/MRSA had increased bronchoalveolar lavage (BAL) concentrations of MRSA compared to sham/MRSA animals. Animals subjected to sham/MRSA pneumonia had increased BAL levels of IL-6, TNF-α, and G-CSF compared to those given intratracheal saline while CLP/MRSA mice had a blunted local inflammatory response with markedly decreased cytokine levels. Similarly, animals subjected to CLP/saline had increased peritoneal lavage levels of IL-6 and IL-1β compared to those subjected to sham laparotomy while this response was blunted in CLP/MRSA mice. Systemic cytokines were upregulated in both CLP/saline and sham/MRSA mice, and this was blunted by the combination of CLP/MRSA. In contrast, no synergistic effect on pneumonia severity, white blood cell count or lymphocyte apoptosis was identified in CLP/MRSA mice compared to animals with either insult in isolation. These results indicate that a clinically relevant model of CLP followed by MRSA pneumonia causes higher mortality than could have been predicted from studying either infection in isolation, and this was associated with a blunted local (pulmonary and peritoneal) and systemic inflammatory response and decreased ability to clear infection. PMID:21937950

  15. CT-morphological characterization of respiratory syncytial virus (RSV) pneumonia in immune-compromised adults

    International Nuclear Information System (INIS)

    Characterization and follow-up evaluation of chest CT of RSV pneumonia in immune-compromised adults during a seasonal epidemic. Retrospective analysis of 132 chest CT examinations of 51 adult immune-compromised patients (29 m/22f, diameter 58 years) with clinical signs of pneumonia and positive RSV test in winter 2011/2012. Two experienced chest radiologists evaluated the morphology (bronchial wall thickening, tree-in-bud, nodules, halo, ground-glass opacities, consolidations, pleural fluid) of the CT scans by consensus. Pathological findings were in 86 % of the chest CT scans: Areas of ground-glass attenuation in 64 %, consolidations in 56 %, nodules in 55 % (diameter 8 mm in maximal diameter, with halo in 71 %), pleural fluid in 44 % (diameter 2 cm), tree-in-bud in 36 %, bronchial wall thickening in 27 % and more than one morphological finding in 72 %. There were no pathological CT findings in 14 % of patients with clinical symptoms of pneumonia because these patients did not undergo follow-up. Radiological progression was found in 45 % of patients and regression in 33 % in follow-up examinations. In 37 % an additional examination of the paranasal sinuses was performed and showed sinusitis in 63 % of cases. 90 % of the patients had sinusitis as well as pneumonia. In addition to RSV, a further pathogenic agent was found in bronchoalveolar lavage of five patients (Aspergillus spec., herpes simplex virus, Pseudomonas aeruginosa). The most characteristic signs in chest CT scans were at the beginning of pneumonia with nodules and tree-in-bud often combined with bronchial wall thickening. The following CT scans showed characteristic but not pathognomonic chest CT findings of RSV pneumonia. These morphological findings should be recognized seasonally (winter) especially at the beginning of the case of pneumonia. RSV-associated additional sinusitis is probably common and should be noticed.

  16. Birth dimensions, parental mortality, and mortality in early adult age: a cohort study of Danish men born in 1953

    DEFF Research Database (Denmark)

    Andersen, Anne-Marie Nybo; Osler, Merete

    2004-01-01

    length were strongly associated with adult mortality risk, but no relationship between low ponderal index at birth and mortality was found. The relationship between birth size and early adult mortality was only slightly attenuated after adjustment for early-life social position and/or maternal...... liver cirrhosis. Offspring birth dimensions showed an inverse association with parental mortality, which was most pronounced for maternal mortality. CONCLUSIONS: The strong inverse association between birth dimensions and adult mortality, but lack of association between ponderal index and mortality...... in relative risk of cause-specific mortality, and the heterogeneity in the association between birth dimensions and maternal and paternal mortality, respectively, indicate that several mechanisms (factors related to social position, common genetic factors, and specific organ programming) may account...

  17. Regulation of Naturally Acquired Mucosal Immunity to Streptococcus pneumoniae in Healthy Malawian Adults and Children

    OpenAIRE

    Sarah J Glennie; Banda, Dominic; Mulwafu, Wakisa; Nkhata, Rose; Neil A Williams; Heyderman, Robert S.

    2012-01-01

    Worldwide, invasive pneumococcal disease caused by Streptococcus pneumoniae is most common in young children. In adults, disease rates decline following intermittent colonization and the acquisition of naturally acquired immunity. We characterized mucosal and systemic pneumococcal-specific T-cell responses in African children and adults who contend with intense rates of colonization, up to 100% and 60% respectively. We find most Malawian children have high pneumococcal-specific T-cell respons...

  18. FastStats: Pneumonia

    Science.gov (United States)

    ... this? Submit What's this? Submit Button NCHS Home Pneumonia Recommend on Facebook Tweet Share Compartir Data are ... Mortality data Centers for Disease Control and Prevention: Pneumonia American Lung Association : Pneumonia Get Email Updates To ...

  19. Impact of cefepime therapy on mortality among patients with bloodstream infections caused by extended-spectrum-β-lactamase-producing Klebsiella pneumoniae and Escherichia coli.

    Science.gov (United States)

    Chopra, Teena; Marchaim, Dror; Veltman, Jennifer; Johnson, Paul; Zhao, Jing J; Tansek, Ryan; Hatahet, Dania; Chaudhry, Khawar; Pogue, Jason M; Rahbar, Hiro; Chen, Ting-Yi; Truong, Thientu; Rodriguez, Victor; Ellsworth, Joseph; Bernabela, Luigino; Bhargava, Ashish; Yousuf, Adnan; Alangaden, George; Kaye, Keith S

    2012-07-01

    Extended-spectrum-β-lactamase (ESBL)-producing pathogens are associated with extensive morbidity and mortality and rising health care costs. Scant data exist on the impact of antimicrobial therapy on clinical outcomes in patients with ESBL bloodstream infections (BSI), and no large studies have examined the impact of cefepime therapy. A retrospective 3-year study was performed at the Detroit Medical Center on adult patients with BSI due to ESBL-producing Klebsiella pneumoniae or Escherichia coli. Data were collected from the medical records of study patients at five hospitals between January 2005 and December 2007. Multivariate analysis was performed using logistic regression. One hundred forty-five patients with BSI due to ESBL-producing pathogens, including K. pneumoniae (83%) and E. coli (16.5%), were studied. The mean age of the patients was 66 years. Fifty-one percent of the patients were female, and 79.3% were African-American. Fifty-three patients (37%) died in the hospital, and 92 survived to discharge. In bivariate analysis, the variables associated with mortality (P catheter. In multivariate analysis, the predictors of in-hospital mortality included stay in the intensive care unit (odds ratio [OR], 2.17; 95% confidence interval [CI], 0.98 to 4.78), presence of a central-line catheter prior to positive culture (OR, 2.33; 95% CI, 0.77 to 7.03), presence of a rapidly fatal condition at the time of admission (OR, 5.13; 95% CI, 2.13 to 12.39), and recent prior hospitalization (OR, 1.92; 95% CI, 0.83 to 4.09). When carbapenems were added as empirical therapy to the predictor model, there was a trend between empirical carbapenem therapy and decreased mortality (OR, 0.61; 95% CI, 0.26 to 1.50). When added to the model, receipt of empirical cefepime alone (n = 43) was associated with increased mortality, although this association did not reach statistical significance (OR, 1.66; 95% CI, 0.71 to 3.87). The median length of hospital stay was shorter for patients

  20. Time trends in primary-care morbidity, hospitalization and mortality due to pneumonia.

    NARCIS (Netherlands)

    Gageldonk-Lafeber, A.B. van; Bogaerts, M.A.H.; Verheij, R.; Sande, M.A.B. van der

    2009-01-01

    Most studies reporting pneumonia morbidity are restricted to hospitalized patients, although only a minority of pneumonia patients are admitted to hospital. To get a better understanding of the burden of disease in the general population, we conducted a population-based retrospective study to examin

  1. Pneumonia in the immunocompetent patient

    OpenAIRE

    Reynolds, J. H.; McDonald, G; Alton, H; Gordon, S B

    2010-01-01

    Pneumonia is an acute inflammation of the lower respiratory tract. Lower respiratory tract infection is a major cause of mortality worldwide. Pneumonia is most common at the extremes of life. Predisposing factors in children include an under-developed immune system together with other factors, such as malnutrition and over-crowding. In adults, tobacco smoking is the single most important preventable risk factor. The commonest infecting organisms in children are respiratory viruses and Strepto...

  2. Resting heart rate is a risk factor for mortality in chronic obstructive pulmonary disease, but not for exacerbations or pneumonia.

    Directory of Open Access Journals (Sweden)

    Miriam J Warnier

    Full Text Available BACKGROUND: Although it is known that patients with chronic obstructive pulmonary disease (COPD generally do have an increased heart rate, the effects on both mortality and non-fatal pulmonary complications are unclear. We assessed whether heart rate is associated with all-cause mortality, and non-fatal pulmonary endpoints. METHODS: A prospective cohort study of 405 elderly patients with COPD was performed. All patients underwent extensive investigations, including electrocardiography. Follow-up data on mortality were obtained by linking the cohort to the Dutch National Cause of Death Register and information on complications (exacerbation of COPD or pneumonia by scrutinizing patient files of general practitioners. Multivariable cox regression analysis was performed. RESULTS: During the follow-up 132 (33% patients died. The overall mortality rate was 50/1000 py (42-59. The major causes of death were cardiovascular and respiratory. The relative risk of all-cause mortality increased with 21% for every 10 beats/minute increase in heart rate (adjusted HR: 1.21 [1.07-1.36], p = 0.002. The incidence of major non-fatal pulmonary events was 145/1000 py (120-168. The risk of a non-fatal pulmonary complication increased non-significantly with 7% for every 10 beats/minute increase in resting heart rate (adjusted HR: 1.07 [0.96-1.18], p = 0.208. CONCLUSIONS: Increased resting heart rate is a strong and independent risk factor for all-cause mortality in elderly patients with COPD. An increased resting heart rate did not result in an increased risk of exacerbations or pneumonia. This may indicate that the increased mortality risk of COPD is related to non-pulmonary causes. Future randomized controlled trials are needed to investigate whether heart-rate lowering agents are worthwhile for COPD patients.

  3. Varicella pneumonia in adults: 13 years′ experience with review of literature

    Directory of Open Access Journals (Sweden)

    Alanezi Mohammed

    2007-01-01

    Full Text Available Pneumonia is a serious complication of varicella infection in adults. This study investigates the clinical characteristics in 19 patients admitted to our hospital with diagnosis of Varicella pneumonia . Materials and Methods : A retrospective chart review study was performed in adult patients admitted with diagnosis of Varicella pneumonia over 13 years (1992-2005. The study documented the clinical characteristics, laboratory investigations, hospital course, complications, treatment received and the outcomes. Results : Nineteen patients were identified with a mean age of 41 (±15.4. All were males except two. Eleven patients (58% were smokers. Eleven patients (58% had direct contact with persons with chickenpox infection. One patient had underlying chronic pulmonary disease (sarcoidosis. Sixteen patients (84% were admitted to the intensive care unit due to respiratory failure; eight of them required mechanical ventilation. The mean duration of ICU stay was 4.4 days. All patients were treated with acyclovir and IV antibiotics. Three patients received IV steroid. There was one death. Conclusion : Patients with Varicella pneumonia are at high risk for respiratory failure and the need for mechanical ventilation. However, early implementation of supportive therapy seems to positively influence the recovery rate and outcome.

  4. Clinical data analysis of 19 cases of community-acquired adenovirus pneumonia in immunocompetent adults.

    Science.gov (United States)

    Yu, Hong-Xia; Zhao, Mao-Mao; Pu, Zeng-Hui; Wang, Yun-Qiang; Liu, Yan

    2015-01-01

    The aim of this study was to investigate the characteristics of clinical manifestations, laboratory tests and imaging changes of community-acquired adenovirus pneumonia in immunocompetent adults. A retrospective study was performed on 19 adult community-acquired adenovirus pneumonia cases in Yantai, whereby the clinical data were collected and analyzed. Of 19 cases, 14 (73.68%) had fever and 17 (89.47%) had cough symptoms. Moreover, 14 cases (73.68%) had normal white blood cell counts, while 11 cases (57.89%) exhibited a reduction in lymphocyte proportion. Among the 19 cases, 17 cases exhibited lesions in a single lung, while 2 cases involved bilateral lungs. The lesions predominantly exhibited ground glass-like changes. The clinical manifestations of adult community-acquired adenovirus pneumonia patients with normal immune functions were mild, with such presenting symptoms as fever, cough, and sputum; most patients did not exhibit high levels of white blood cells or low lymphocyte counts, and the imaging features (ground glass-like effusion) were indicative of single-lung involvement.

  5. Identifying and targeting mortality disparities: a framework for sub-saharan Africa using adult mortality data from South Africa.

    Directory of Open Access Journals (Sweden)

    Benn Sartorius

    Full Text Available BACKGROUND: Health inequities in developing countries are difficult to eradicate because of limited resources. The neglect of adult mortality in Sub-Saharan Africa (SSA is a particular concern. Advances in data availability, software and analytic methods have created opportunities to address this challenge and tailor interventions to small areas. This study demonstrates how a generic framework can be applied to guide policy interventions to reduce adult mortality in high risk areas. The framework, therefore, incorporates the spatial clustering of adult mortality, estimates the impact of a range of determinants and quantifies the impact of their removal to ensure optimal returns on scarce resources. METHODS: Data from a national cross-sectional survey in 2007 were used to illustrate the use of the generic framework for SSA and elsewhere. Adult mortality proportions were analyzed at four administrative levels and spatial analyses were used to identify areas with significant excess mortality. An ecological approach was then used to assess the relationship between mortality "hotspots" and various determinants. Population attributable fractions were calculated to quantify the reduction in mortality as a result of targeted removal of high-impact determinants. RESULTS: Overall adult mortality rate was 145 per 10,000. Spatial disaggregation identified a highly non-random pattern and 67 significant high risk local municipalities were identified. The most prominent determinants of adult mortality included HIV antenatal sero-prevalence, low SES and lack of formal marital union status. The removal of the most attributable factors, based on local area prevalence, suggest that overall adult mortality could be potentially reduced by ∼90 deaths per 10,000. CONCLUSIONS: The innovative use of secondary data and advanced epidemiological techniques can be combined in a generic framework to identify and map mortality to the lowest administration level. The

  6. Impact of diabetes mellitus on pneumonia mortality in a senior population:results from the NHANES III follow-up study

    Institute of Scientific and Technical Information of China (English)

    Jian Liu

    2013-01-01

    Objective To examine whether diabetes mellitus increases the risk of pneumonia mortality among seniors in the U.S. general popula-tion. Methods&Results The NHANES III follow-up study data were used. After excluding individuals from other minorities, being hos-pitalized with pneumonia in the previous year at baseline, or death of pneumonia during the first year of follow-up, a total of 3,707 subjects aged 65 years or older (1,794 men and 1,913 women) who had no missing information on variables for the analysis were included. Approxi-mately 16% of seniors at baseline were diabetics, which was defined as either having been diagnosed by a physician, currently taking pills/insulin lowering blood glucose, or HbA1c higher than 6.4%. During an average 11 years of follow-up, a total of 98 deaths due to pneu-monia were recorded (ICD-10:J12-J18). Cox-regression models were used to estimate the risk association between pneumonia mortality and diabetes mellitus. After adjustment for the covariates at baseline, the hazard ratios of pneumonia death were 1.30 (95%CI:0.64-2.70) for pre-diabetics and 2.28 (95%CI:1.18-4.39) for diabetics, respectively. Among those covariates, only age (HR (95%CI);1.16 (1.13-1.20)), gender as female (0.35 (0.22-0.61)) and physical fitness measured as having no problem walking 1+mile during the previous month (0.38 (0.20-0.67)) reached statistical significance. Conclusions The results suggest that diabetes mellitus is a strong risk predictor of pneumonia mortality and the evaluation of physical fitness may also be useful in the risk prediction of pneumonia mortality for seniors.

  7. Epidemiology of invasive Streptococcus pneumoniae infections in adults in Finland.

    Science.gov (United States)

    Sankilampi, U.; Herva, E.; Haikala, R.; Liimatainen, O.; Renkonen, O. V.; Leinonen, M.

    1997-01-01

    Laboratory-based surveillance of invasive pneumococcal infections in adults in Finland from 1983 to 1992 identified 862 episodes of pneumococcal bacteraemia and 97 episodes of meningitis. The overall incidence of invasive pneumococcal infections was 9.1 per 100,000 for all adults per year, but 27.1, 35.8, and 44.5 per 100,000 in those aged 65 years or over, 75 years or over, and 85 years or over, respectively. Most (99.7%) of the pneumococcal strains were sensitive to penicillin. Ninety-five percent of the strains belonged to serogroups/types present in the 23-valent pneumococcal polysaccharide vaccine. Group/type distribution was different in patients aged 16-64 years compared to those 65 years or over (P < 0.001), in bacteraemia compared to meningitis (P < 0.001), and in the years 1983-7 compared to 1988-92 (P < 0.05). PMID:9042030

  8. Selective IgM deficiency in an adult presenting with Streptococcus pneumoniae septic arthritis.

    Science.gov (United States)

    Phuphuakrat, Angsana; Ngamjanyaporn, Pintip; Nantiruj, Kanokrat; Luangwedchakarn, Voravich; Malathum, Kumthorn

    2016-02-01

    Septic arthritis caused by Streptococcus pneumoniae is uncommon. Most of the patients who have invasive pneumococcal infection have underlying diseases associated with impaired immune function. We report a case of polyarticular pneumococcal septic arthritis in a previously healthy adult as the first manifestation of selective immunoglobulin (Ig)M deficiency. The patient had no evidence of autoimmune disease or malignancy. Serum IgG, IgA, and complement levels were normal. Numbers of lymphocyte subsets were in normal range except that of CD4+ cells, which was slightly low. Invasive pneumococcal disease in a healthy adult should lead to further investigation for underlying diseases including primary immunodeficiencies.

  9. Prognostic markers of short-term mortality in AIDS-associated Pneumocystis carinii pneumonia

    DEFF Research Database (Denmark)

    Benfield, T L; Helweg-Larsen, J; Bang, D;

    2001-01-01

    BACKGROUND: Since 1990, corticosteroids have been recommended as adjunctive therapy for patients with AIDS-associated Pneumocystis carinii pneumonia (PCP) and respiratory failure. We hypothesized that the natural course of AIDS-associated PCP has changed in the era of adjunctive corticosteroid...

  10. Long-term mortality among adults with asthma

    DEFF Research Database (Denmark)

    Ali, Zarqa; Dirks, Christina Glattre; Ulrik, Charlotte Suppli

    2013-01-01

    ABSTRACT BACKGROUND: Data from long-term follow-up studies of well-characterised patients with asthma are limited. We studied all-cause and cause-specific mortality, and risk factors, in a large cohort of adults with asthma. METHODS: A total of 1.075 adult asthmatics were recruited consecutively...... from an out-patient clinic in 1974 to 1990, and followed up until the end of 2011. Subjects were classified as having allergic or non-allergic asthma on the basis of detailed history, spirometric tests, tests for IgE-mediated allergy (skin prick tests and RAST), and bronchial challenge tests...... compared with controls (261 cases vs. 124 controls; relative risk (RR) 2.1, 95% confidence interval (CI) 1.4 to 3.0; pasthma was significantly associated with age (p

  11. Effectiveness of the 10-Valent Pneumococcal Conjugate Vaccine (PCV-10) in Children in Chile: A Nested Case-Control Study Using Nationwide Pneumonia Morbidity and Mortality Surveillance Data

    Science.gov (United States)

    Toscano, Cristiana M.; Alencar, Gizelton P.; Alvarez, Andrés; Valenzuela, Maria T.; Andrus, Jon; del Aguila, Roberto; Hormazábal, Juan C.; Araya, Pamela; Pidal, Paola; Matus, Cuauhtemoc R.; de Oliveira, Lucia H.

    2016-01-01

    Background The ten-valent pneumococcal conjugate vaccine (PCV10) was introduced into the Chilean National Immunization Program (NIP) in January 2011 with a 3+1 schedule (2, 4, 6 and 12 months) without catch-up vaccination. We evaluated the effectiveness of PCV10 on pneumonia morbidity and mortality among infants during the first two years after vaccine introduction. Methods This is a population-based nested case-control study using four merged nationwide case-based electronic health data registries: live birth, vaccination, hospitalization and mortality. Children born in 2010 and 2011 were followed from two moths of age for a period of two years. Using four different case definitions of pneumonia hospitalization and/or mortality (all-cause and pneumonia related deaths), all cases and four randomly selected matched controls per case were selected. Controls were matched to cases on analysis time. Vaccination status was then assessed. Vaccine effectiveness (VE) was estimated using conditional logistic regression. Results There were a total of 497,996 children in the 2010 and 2011 Chilean live-birth cohorts. PCV10 VE was 11.2% (95%CI 8.5–13.6) when all pneumonia hospitalizations and deaths were used to define cases. VE increased to 20.7 (95%CI 17.3–23.8) when ICD10 codes used to denote viral pneumonia were excluded from the case definition. VE estimates on pneumonia deaths and all-cause deaths were 71.5 (95%CI 9.0–91.8) and 34.8 (95% CI 23.7–44.4), respectively. Conclusion PCV10 vaccination substantially reduced the number of hospitalizations due to pneumonia and deaths due to pneumonia and to all-causes over this study period. Our findings also reinforce the importance of having quality health information systems for measuring VE. PMID:27058873

  12. Lipoid pneumonia in adults: findings on high-resolution computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Marchiori, Edson [Universidade Federal Fluminense (UFF), Niteroi, RJ (Brazil). Dept. of Radiology]. E-mail: edmarchiori@gmail.com; Zanetti, Glaucia [Faculdade de Medicina de Petropolis, RJ (Brazil); Escuissato, Dante L. [Universidade Federal do Parana (UFPR), Curitiba, PR (Brazil); Souza Junior, Arthur Soares [Faculdade de Medicina de Sao Jose do Rio Preto (FAMERP), SP (Brazil); Araujo Neto, Cesar [Universidade Federal da Bahia (UFBA), Salvador, BA (Brazil); Nobre, Luiz Felipe [Universidade Federal de Santa Catarina (UFSC), Florianopolis, SC (Brazil); Irion, Klaus L. [The Cardiothoracic Centre NHS Trust, Liverpool (United Kingdom); Rodrigues, Rosana [Universidade Federal do Rio de Janeiro (UFRJ), RJ (Brazil). Hospital Universitario Clementino Fraga Filho (HUCFF); Mancano, Alexandre Dias [Hospital Regional de Taguatinga, Brasilia, DF (Brazil); Capone, Domenico [Universidade Estadual do Rio de Janeiro (UERJ), RJ (Brazil); Fialho, Suzane Mansur [Centro Nuclear da Guanabara, Rio de Janeiro, RJ (Brazil); Souza, Carolina Althoff [University of Ottawa (Canada)

    2007-09-15

    Objective: The present study was aimed at describing the findings on high-resolution computed tomography in patients with exogenous lipoid pneumonia secondary to mineral oil aspiration. Materials and methods: Eight adult patients - four men and four women - with mean age of 69.4 years were studied. All of the patients were users of mineral oil for treating intestinal constipation. High-resolution computed tomography studies of these patients were blindly evaluated by two radiologists. Results: Air-space consolidation with areas of fat density and crazy paving pattern were the most frequent findings. The lesions were bilateral in six cases and unilateral in two. Conclusion: Air-space consolidation with areas of fat density, associated with a clinical history of mineral oil ingestion virtually indicates a diagnosis of exogenous lipoid pneumonia. (author)

  13. Lipoid pneumonia in adults: findings on high-resolution computed tomography

    International Nuclear Information System (INIS)

    Objective: The present study was aimed at describing the findings on high-resolution computed tomography in patients with exogenous lipoid pneumonia secondary to mineral oil aspiration. Materials and methods: Eight adult patients - four men and four women - with mean age of 69.4 years were studied. All of the patients were users of mineral oil for treating intestinal constipation. High-resolution computed tomography studies of these patients were blindly evaluated by two radiologists. Results: Air-space consolidation with areas of fat density and crazy paving pattern were the most frequent findings. The lesions were bilateral in six cases and unilateral in two. Conclusion: Air-space consolidation with areas of fat density, associated with a clinical history of mineral oil ingestion virtually indicates a diagnosis of exogenous lipoid pneumonia. (author)

  14. Pneumonia associada à ventilação mecânica: impacto da multirresistência bacteriana na morbidade e mortalidade Ventilator-associated pneumonia: impact of bacterial multidrug-resistance on morbidity and mortality

    Directory of Open Access Journals (Sweden)

    Paulo José Zimermann Teixeira

    2004-12-01

    Full Text Available INTRODUÇÃO: A pneumonia associada à ventilação mecânica é a infecção hospitalar mais comum nas unidades de terapia intensiva. OBJETIVO: Determinar o impacto da multirresistência dos microorganismos na morbidade e mortalidade dos pacientes com pneumonia associada à ventilação mecânica. MÉTODO: Estudo de coorte retrospectivo. Em 40 meses consecutivos, 91 pacientes sob ventilação mecânica tiveram o diagnóstico de pneumonia. Os casos foram divididos entre causados por microorganismo multirresistente e causados por microorganismo sensível à antibioticoterapia. RESULTADOS: Pneumonia foi causada por microorganismo multirresistente em 75 casos (82,4% e por microorganismo sensível 16 (17,6% deles. As características clínicas e epidemiológicas não foram estatisticamente diferentes entre os grupos. O Staphylococcus aureus foi responsável por 27,5% dos episódios de pneumonia associada à ventilação mecânica e a Pseudomonas aeruginosa por 17,6%. A doença foi de início recente em 33 pacientes (36,3% e de início tardio em 58 deles (63,7%. Os tempos de ventilação mecânica, de internação em unidade de terapia intensiva e de internação hospitalar total não diferiram. O tratamento empírico foi considerado inadequado em 42 pacientes com pneumonia por microorganismo multirresistente (56% e em 4 com pneumonia por microorganismo sensível (25% (p = 0,02. Óbito ocorreu em 46 pacientes com a pneumonia por microorganismo multirresistente (61,3%, e em 4 daqueles com pneumonia por microorganismo sensível (25% (p = 0,008. CONCLUSÃO: A multirresistência bacteriana não determinou nenhum impacto na morbidade, mas esteve associada à maior mortalidade.BACKGROUND: Ventilator-associated pneumonia is the most common nosocomial infection occurring in intensive care units. OBJECTIVE: To determinate the impact of multidrug-resistant bacteria on morbidity and mortality in patients with ventilator-associated pneumonia. METHOD

  15. Is 13-Valent Pneumococcal Conjugate Vaccine (PCV13) Combined With 23-Valent Pneumococcal Polysaccharide Vaccine (PPSV23) Superior to PPSV23 Alone for Reducing Incidence or Severity of Pneumonia in Older Adults? A Clin-IQ

    Science.gov (United States)

    Hayward, Starla; Thompson, Lou Ann; McEachern, Andrea

    2016-01-01

    Pneumonia infection is a significant cause of morbidity and mortality worldwide. In addition to the public health concerns, pneumonia also accounts for a significant cost to the health care system. Currently there are two leading vaccines targeted against S. pneumoniae: 23-valent pneumococcal polysaccharide vaccine (PPSV23) and 13-valent pneumococcal conjugate vaccine (PCV13). Until recently the recommendation for adult pneumonia vaccination has been a single dose of PPSV23 for all adults 65 years and older. However, concerns were raised regarding the vaccine’s efficacy due to the persistent burden of pneumococcal disease in the elderly population. This paper focuses on two trials which evaluate the safety and efficacy of PCV13 in the adult population. The first study reveals improved immune response with the addition of PCV13 to PPSV23, while the second shows PCV13 was effective in the prevention of vaccine-type community-acquired pneumonia. The two studies observed adequate safety profiles for PCV13 in series with PPSV23 and with PCV13 compared to placebo. PMID:27376105

  16. Is 13-Valent Pneumococcal Conjugate Vaccine (PCV13 Combined With 23-Valent Pneumococcal Polysaccharide Vaccine (PPSV23 Superior to PPSV23 Alone for Reducing Incidence or Severity of Pneumonia in Older Adults? A Clin-IQ

    Directory of Open Access Journals (Sweden)

    Starla Hayward

    2016-04-01

    Full Text Available Pneumonia infection is a significant cause of morbidity and mortality worldwide. In addition to the public health concerns, pneumonia also accounts for a significant cost to the health care system. Currently there are two leading vaccines targeted against Streptococcus pneumoniae: 23-valent pneumococcal polysaccharide vaccine (PPSV23 and 13-valent pneumococcal conjugate vaccine (PCV13. Until recently, the recommendation for adult pneumonia vaccination has been a single dose of PPSV23 for all adults aged 65 years or older. However, concerns were raised regarding the vaccine’s efficacy due to the persistent burden of pneumococcal disease in the elderly population. This paper focuses on two trials that evaluated the safety and efficacy of PCV13 in the adult population. The first study reveals improved immune response with the addition of PCV13 to PPSV23, while the second shows PCV13 was effective in the prevention of vaccine-type community-acquired pneumonia. Both studies observed adequate safety profiles for PCV13 in series with PPSV23 and with PCV13 compared to placebo.

  17. Regulation of naturally acquired mucosal immunity to Streptococcus pneumoniae in healthy Malawian adults and children.

    Directory of Open Access Journals (Sweden)

    Sarah J Glennie

    Full Text Available Worldwide, invasive pneumococcal disease caused by Streptococcus pneumoniae is most common in young children. In adults, disease rates decline following intermittent colonization and the acquisition of naturally acquired immunity. We characterized mucosal and systemic pneumococcal-specific T-cell responses in African children and adults who contend with intense rates of colonization, up to 100% and 60% respectively. We find most Malawian children have high pneumococcal-specific T-cell responses in tonsil tissue and peripheral blood. In addition, frequent commensalism generates CD25(hi (Tregs which modulate mucosal pneumococcal-specific T-cell responses in some children and ≥50% of adults. We propose that immune regulation may prolong pneumococcal colonization and predispose vulnerable individuals to disease.

  18. Differences in Acinetobacter baumannii strains and host innate immune response determine morbidity and mortality in experimental pneumonia.

    Directory of Open Access Journals (Sweden)

    Anna de Breij

    Full Text Available Despite many reports documenting its epidemicity, little is known on the interaction of Acinetobacter baumannii with its host. To deepen our insight into this relationship, we studied persistence of and host response to different A. baumannii strains including representatives of the European (EU clones I-III in a mouse pneumonia model. Neutropenic mice were inoculated intratracheally with five A. baumannii strains and an A. junii strain and at several days morbidity, mortality, bacterial counts, airway inflammation, and chemo- and cytokine production in lungs and blood were determined. A. baumannii RUH875 and RUH134 (EU clone I and II, respectively and sporadic strain LUH8326 resulted in high morbidity/mortality, whereas A. baumannii LUH5875 (EU clone III, which is less widespread than clone I and II caused less symptoms. A. baumannii type strain RUH3023(T and A. junii LUH5851 did not cause disease. All strains, except A. baumannii RUH3023(T and A. junii LUH5851, survived and multiplied in the lungs for several days. Morbidity and mortality were associated with the severity of lung pathology and a specific immune response characterized by low levels of anti-inflammatory (IL-10 and specific pro-inflammatory (IL-12p40 and IL-23 cytokines at the first day of infection. Altogether, a striking difference in behaviour among the A. baumannii strains was observed with the clone I and II strains being most virulent, whereas the A. baumannii type strain, which is frequently used in virulence studies appeared harmless.

  19. Fetal distress and in utero pneumonia in perinatal dolphins during the Northern Gulf of Mexico unusual mortality event.

    Science.gov (United States)

    Colegrove, Kathleen M; Venn-Watson, Stephanie; Litz, Jenny; Kinsel, Michael J; Terio, Karen A; Fougeres, Erin; Ewing, Ruth; Pabst, D Ann; McLellan, William A; Raverty, Stephen; Saliki, Jeremiah; Fire, Spencer; Rappucci, Gina; Bowen-Stevens, Sabrina; Noble, Lauren; Costidis, Alex; Barbieri, Michelle; Field, Cara; Smith, Suzanne; Carmichael, Ruth H; Chevis, Connie; Hatchett, Wendy; Shannon, Delphine; Tumlin, Mandy; Lovewell, Gretchen; McFee, Wayne; Rowles, Teresa K

    2016-04-12

    An unusual mortality event (UME) involving primarily common bottlenose dolphins Tursiops truncatus of all size classes stranding along coastal Louisiana, Mississippi, and Alabama, USA, started in early 2010 and continued into 2014. During this northern Gulf of Mexico UME, a distinct cluster of perinatal dolphins (total body length pneumonia not associated with lungworm infection (65 vs. 19%, p = 0.0001). The percentage of perinates with Brucella sp. infections identified via lung PCR was higher among UME perinates stranding in Mississippi and Alabama compared to reference perinates (61 vs. 24%, p = 0.01), and multiple different Brucella omp genetic sequences were identified in UME perinates. These results support that from 2011 to 2013, during the northern Gulf of Mexico UME, bottlenose dolphins were particularly susceptible to late-term pregnancy failures and development of in utero infections including brucellosis. PMID:27068499

  20. Multidisciplinary Comprehensive Care for Early Recommencement of Oral Intake in Older Adults With Severe Pneumonia.

    Science.gov (United States)

    Koyama, Tamami; Shamoto, Hiroshi; Anzai, Hideaki; Koganei, Yutaka; Maeda, Keisuke; Wakabayashi, Hidetaka

    2016-10-01

    HOW TO OBTAIN CONTACT HOURS BY READING THIS ARTICLE INSTRUCTIONS 1.3 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded once you register, pay the registration fee, and complete the evaluation form online at http://goo.gl/gMfXaf. To obtain contact hours you must: 1. Read the article, "Multidisciplinary Comprehensive Care for Early Recommencement of Oral Intake in Older Adults With Severe Pneumonia" found on pages 21-29, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz. 2. Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study. 3. Go to the Villanova website listed above to register for contact hour credit. You will be asked to provide your name; contact information; and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certificate will be automatically generated. This activity is valid for continuing education credit until September 30, 2019. CONTACT HOURS This activity is co-provided by Villanova University College of Nursing and SLACK Incorporated. Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. ACTIVITY OBJECTIVES 1. Describe the effect of multidisciplinary comprehensive care

  1. Multidisciplinary Comprehensive Care for Early Recommencement of Oral Intake in Older Adults With Severe Pneumonia.

    Science.gov (United States)

    Koyama, Tamami; Shamoto, Hiroshi; Anzai, Hideaki; Koganei, Yutaka; Maeda, Keisuke; Wakabayashi, Hidetaka

    2016-10-01

    HOW TO OBTAIN CONTACT HOURS BY READING THIS ARTICLE INSTRUCTIONS 1.3 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded once you register, pay the registration fee, and complete the evaluation form online at http://goo.gl/gMfXaf. To obtain contact hours you must: 1. Read the article, "Multidisciplinary Comprehensive Care for Early Recommencement of Oral Intake in Older Adults With Severe Pneumonia" found on pages 21-29, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz. 2. Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study. 3. Go to the Villanova website listed above to register for contact hour credit. You will be asked to provide your name; contact information; and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certificate will be automatically generated. This activity is valid for continuing education credit until September 30, 2019. CONTACT HOURS This activity is co-provided by Villanova University College of Nursing and SLACK Incorporated. Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. ACTIVITY OBJECTIVES 1. Describe the effect of multidisciplinary comprehensive care

  2. The endogenous bacteria alter gut epithelial apoptosis and decrease mortality following Pseudomonas aeruginosa pneumonia

    OpenAIRE

    Fox, Amy C.; McConnell, Kevin W.; Yoseph, Benyam P.; Breed, Elise; Liang, Zhe; Clark, Andrew T.; O'Donnell, David; Zee-Cheng, Brendan; Jung, Enjae; Dominguez, Jessica A.; Dunne, W. Michael; Burd, Eileen M.; Coopersmith, Craig M.

    2012-01-01

    The endogenous bacteria have been hypothesized to play a significant role in the pathophysiology of critical illness, although their role in sepsis is poorly understood. The purpose of this study was to determine how commensal bacteria alter the host response to sepsis. Conventional and germ free (GF) C57Bl/6 mice were subjected to Pseudomonas aeruginosa pneumonia. All GF mice died within two days while 44% of conventional mice survived for 7 days (p=0.001). Diluting the dose of bacteria 10-f...

  3. [Detection and Serotyping of Streptococcus pneumoniae Carried in Healthy Adults with a Modified PCR Method].

    Science.gov (United States)

    Ishihara, Yuka; Okamoto, Akira; Ohta, Michio

    2015-05-01

    Detection of Streptococcus pneumoniae colonized in the pharynx of healthy carriers currently relies on conventional culture methods of direct plating with pharyngeal swab specimens. The accurate measurement of the carriage of pneumococci, however, has not been necessarily achieved with these methods due to low density colonization and contamination of numerous oral streptococci that express α-hemolysis. A PCR-based detection method of pneumococci-specific for lytA as well as PCR serotyping of S. pneumoniae was recently developed and their effectiveness was confirmed. We modified the reaction conditions of these methods to improve the detection rate and applied them to the measurement of S. pneumoniae carried in healthy adults. Pharyngeal swab specimens obtained from 110 healthy volunteers over 40 and living in Nagoya were enriched for 5 hours with broth medium supplemented with rabbit serum and the template DNA for PCR was extracted from the mixed enriched culture. Of 110 specimens 36 (32.7%) were lytA-positive, the rate of which was much higher than the results of previous culture-based studies. The DNA template preparations were then used for PCR-based serotyping with primers specific for each of the types included in pneumococcal 23 valent vaccine (PPV23). We found that 28 out of 36 lytA-positive carriers were identified as being positive for the serotypes belonging to PPV23, although serotypes 6A and 6B were indistinguishable with the PCR method. The most frequent serotype was serotype 14, and serotypes 4, 18C, and 6A/B were also frequently identified. Five lytA-positive carriers were previously vaccinated with PPV23, and among them, 4 were positive for serotypes contained in PPV23. We recommend PCR-based identification and serotyping of S. pneumoniae in broth enrichment culture of pharyngeal swab specimens as a reliable method for the surveillance of healthy carriers with low density colonization. PMID:26552129

  4. The Pneumonia Severity Index as a Predictor of In-Hospital Mortality in Acute Exacerbation of Chronic Obstructive Pulmonary Disease.

    Directory of Open Access Journals (Sweden)

    Guoping Hu

    Full Text Available To determine whether the pneumonia severity index (PSI can predict in-hospital mortality for AECOPD patients and compare its usefulness with the CURB65 and BAP65 indexes to predict mortality.Demographics, clinical signs and symptoms, comorbidities, and laboratory and radiographic findings of hospitalized AECOPD patients were obtained. Univariate and multiple logistic regression analyses were used to identify the risk factors for in-hospital mortality. The PSI, CURB65 and BAP65 scores were calculated. Receiver operating characteristic (ROC curve analysis was used to identify the PSI, CURB65 and BAP65 scores that could discriminate between non-survivors and survivors. To control for the confounding factor of invasive mechanical ventilation (IMV regarding the mortality of AECOPD, subgroup analysis was performed when excluded patients who had met the criteria of IMV but who had not received the cure of IMV according to their wishes.During the in-hospital period, 73 patients died and 679 patients recovered. Age, PaO2<60 mmHg, pH < 7.35, PaCO2≥50 mmHg, nursing home residency, congestive heart failure, liver disease, sodium<130 mmol/L, lower FEV1% and altered mental status were risk factors for in-hospital mortality. The areas under the ROC curves (AUCs of the PSI for death were 0.847 (95% CI: 0.799-0.895. The cut-off value was 116.5 with a sensitivity of 82.2% and a specificity of 77.6%. However, the AUCs of the CURB65 and BAP65 for death were only 0.744 (95% CI: 0.680-0.809 and 0.665 (95% CI: 0.594-0.736, respectively. Subgroup analysis also showed that the PSI score could predict the mortality of AECOPD patients with an AUC = 0.857 (95% CI: 0.802-0.913, with exclusion of the patients who met the criteria of IMV but who did not receive the cure of IMV.The PSI score may be used to predict in-hospital mortality for hospitalized AECOPD patients, with a prognostic capacity superior to CURB65 and BAP65.

  5. Carbapenemase-producing Klebsiella pneumoniae bloodstream infections: lowering mortality by antibiotic combination schemes and the role of carbapenems.

    Science.gov (United States)

    Daikos, George L; Tsaousi, Sophia; Tzouvelekis, Leonidas S; Anyfantis, Ioannis; Psichogiou, Mina; Argyropoulou, Athina; Stefanou, Ioanna; Sypsa, Vana; Miriagou, Vivi; Nepka, Martha; Georgiadou, Sarah; Markogiannakis, Antonis; Goukos, Dimitris; Skoutelis, Athanasios

    2014-01-01

    Carbapenemase-producing Klebsiella pneumoniae strains (CP-Kps) are currently among the most important nosocomial pathogens. An observational study was conducted during 2009 to 2010 in two hospitals located in a high-prevalence area (Athens, Greece). The aims were (i) to evaluate the clinical outcome of patients with CP-Kp bloodstream infections (BSIs), (ii) to identify predictors of mortality, and (iii) to evaluate the various antibiotic schemes employed. A total of 205 patients with CP-Kp BSIs were identified: 163 (79.5%) were infected with KPC or KPC and VIM, and 42 were infected with VIM producers. For definitive treatment, 103 patients received combination therapy (two or more active drugs), 72 received monotherapy (one active drug), and 12 received therapy with no active drug. The remaining 18 patients died within 48 h after the onset of bacteremia. The all-cause 28-day mortality was 40%. A significantly higher mortality rate was observed in patients treated with monotherapy than in those treated with combination therapy (44.4% versus 27.2%; P=0.018). The lowest mortality rate (19.3%) was observed in patients treated with carbapenem-containing combinations. In the Cox proportion hazards model, ultimately fatal disease (hazards ratio [HR], 3.25; 95% confidence interval [CI], 1.51 to 7.03; P=0.003), the presence of rapidly fatal underlying diseases (HR, 4.20; 95% CI, 2.19 to 8.08; Ptherapy was strongly associated with survival (HR of death for monotherapy versus combination, 2.08; 95% CI, 1.23 to 3.51; P=0.006), mostly due to the effectiveness of the carbapenem-containing regimens.

  6. Predictors of mortality in patients with bloodstream infections caused by KPC-producing Klebsiella pneumoniae and impact of appropriate antimicrobial treatment.

    Science.gov (United States)

    Zarkotou, O; Pournaras, S; Tselioti, P; Dragoumanos, V; Pitiriga, V; Ranellou, K; Prekates, A; Themeli-Digalaki, K; Tsakris, A

    2011-12-01

    Bloodstream infections (BSIs) caused by Klebsiella pneumoniae carbapenemases (KPC)-producing K. pneumoniae (KPC-KP) are associated with high mortality rates. We investigated outcomes, risk factors for mortality and impact of appropriate antimicrobial treatment in patients with BSIs caused by molecularly confirmed KPC-KP. All consecutive patients with KPC-KP BSIs between May 2008 and May 2010 were included in the study and followed-up until their discharge or death. Potential risk factors for infection mortality were examined by a case-control study. Case-patients were those who died from the BSI and control-patients those who survived. Appropriate antimicrobial therapy was defined as treatment with in vitro active antimicrobials for at least 48 h. A total of 53 patients were identified. Overall mortality was 52.8% and infection mortality was 34%. Appropriate antimicrobial therapy was administered to 35 patients; mortality due to infection occurred in 20%. All 20 patients that received combination schemes had favourable infection outcome; in contrast, seven of 15 patients given appropriate monotherapy died (p 0.001). In univariate analysis, risk factors for mortality were age (p catheter-related bacteraemia (p 0.04), prior surgery (p 0.014) and other therapeutic interventions (p 0.015) were significantly associated with survival. Independent predictors of mortality were age, APACHE II score at infection onset and inappropriate antimicrobial treatment. Among them, appropriate treatment is the only modifiable independent predictor of infection outcome.

  7. Respiratory Review of 2012: Pneumonia

    OpenAIRE

    Yoon, Young-Soon

    2012-01-01

    Pneumonia is the cause of significant morbidity and mortality, despite advances in diagnosis and antibacterial treatment. Pneumonia is often misdiagnosed and mistreated up until recently. Recent classification of pneumonia consists of community-acquired pneumonia, health care-associated pneumonia, hospital-acquired pneumonia, and ventilator-associated pneumonia. The etiology, risk factors, and treatment are different among them. This article briefly introduces new concepts and ideas in biomar...

  8. Reading and interpretation of chest X-ray in adults with community-acquired pneumonia

    Directory of Open Access Journals (Sweden)

    Diana Carolina Moncada

    2011-12-01

    Full Text Available INTRODUCTION: Traditional reading of chest X-rays usually has a low prognostic value and poor agreement. OBJECTIVE: This study aimed to determine the interobserver and intraobserver agreement using two reading formats in patients with community-acquired pneumonia, and to explore their association with etiology and clinical outcomes. METHODS: A pulmonologist and a radiologist, who were blind to clinical data, interpreted 211 radiographs using a traditional analysis format (type and location of pulmonary infiltrates and pleural findings, and a quantitative analysis (pulmonary damage categorized from 0 to 10. For both, the interobserver and intraobserver agreement was estimated (Kappa statistic and intraclass correlation coefficient. The latter was assessed in a subsample of 25 radiographs three months after the initial reading. Finally, the observers made a joint reading to explore its prognostic usefulness via multivariate analysis. RESULTS: Seventy-four chest radiographs were discarded due to poor quality. With the traditional reading, the mean interobserver agreement was moderate (0.43. It was considered good when the presence of pleural effusion, and the location of the infiltrates in the right upper lobe and both lower lobes, were evaluated; moderate for multilobar pneumonia; and poor for the type of infiltrates. The mean intraobserver agreement for each reviewer was 0.71 and 0.5 respectively. The quantitative reading had an agreement between good and excellent (interobserver 0.72, intraobserver 0.85 and 0.61. Radiological findings were neither associated to a specific pathogen nor to mortality. CONCLUSION: In patients with pneumonia, the interpretation of the chest X-ray, especially the smallest of details, depends solely on the reader.

  9. The Lebanese Society for Infectious Diseases and Clinical Microbiology (LSIDCM) guidelines for adult community-acquired pneumonia (Cap) in Lebanon.

    Science.gov (United States)

    Moghnieh, Rima; Yared Sakr, Nadine; Kanj, Souha S; Musharrafieh, Umayya; Husni, Rula; Jradeh, Mona; Al-Awar, Ghassan; Matar, Madona; Jureij, Wafa; Antoine, Saad; Azar, Eid; Abi Hanna, Pierre; Minari, Afaf; Hammoud, Jamale; Kfoury, Joumana; Mahfouz, Tahsin; Abou Chakra, Diaa; Zaatari, Mohamad; Tabbarah, Zuhayr A

    2014-01-01

    Adult community-acquired pneumonia (CAP) is a common cause of morbidity and mortality which is managed by different disciplines in a heterogeneous fashion. Development of consensus guidelines to standardize these wide variations in care has become a prime objective. The Lebanese Society of Infectious Diseases and Clinical Microbiology (LSIDCM) convened to set Lebanese national guidelines for the management of CAP since it is a major and a prevalent disease affecting the Lebanese population. These guidelines, besides being helpful in direct clinical practice, play a major role in establishing stewardship programs in hospitals in an effort to contain antimicrobial resistance on the national level. These guidelines are intended for primary care practitioners and emergency medicine physicians. They constitute an appropriate starting point for specialists' consultation being based on the available local epidemiological and resistance data. This document includes the following: 1/ Rationale and scope of the guidelines; 2/ Microbiology of CAP based on Lebanese data; 3/ Clinical presentation and diagnostic workup of CAP; 4/ Management and prevention strategies based on the IDSA/ATS Consensus Guidelines, 2007, and the ESCMID Guidelines, 2011, and tailored to the microbiological data in Lebanon; 5/ Comparison to regional guidelines. The recommendations made in this document were graded based on the strength of the evidence as in the 2007 IDSA/ATS Consensus Guidelines. Hopefully, these guidelines will be an important step towards standardization of CAP care in Lebanon and set the agenda for further research in this area. PMID:24684125

  10. Adult Klebsiella pneumoniae meningitis in Qatar:clinical pattern of ten cases

    Institute of Scientific and Technical Information of China (English)

    Fahmi; Yousef; Khan; Mohammed; Abukhattab; Mohanuned; Abukamar; Deshmukh; Anand

    2014-01-01

    Objective:To describe the clinical presentation,underlying diseases,antimicrobial susceptibility,treatment and outcome of Klebsiella pneumoniae meningitis patients.Methods:This retrospective study involved all patients with 15 years of age or older who admit ted to Hamad General Hospital with culture proven Klebsiella pneumoniae meningitis from January 1,2007 to December 31,2012.Results:A total of ten cases were identified mine males and one female).Their mean age was i43.3±12.8) years.Eight patients(80%) had nosocomial meningitis with neurosurgery being the most frequent associated condition.Fever and altered consciousness were the most frequent symptom.Cerebrospinal fluid showed elevated protein and glucose levels.Oram slain showed Gram—negative rods in 50%of cases,while positive cerebrospinal fluid culture results were found in all patients.Multidrug resistance was observed in two cases,and all patients had received appropriate empirical and definitive antibiotic treatments.The mean duration of intravenous antimicrobial treatment was(19.3±7.0) d and all patients with external ventricular drains underwent removal of the device,while in—hospital mortality was 50%.Conclusions:The number of cases was too small to come up with therapeutic and prognostic conclusions.Further large-scale prospective study is needed.

  11. Adult Klebsiella pneumoniae meningitis in Qatar:clinical pattern of ten cases

    Institute of Scientific and Technical Information of China (English)

    Fahmi Yousef Khan; Mohammed Abukhattab; Mohammed AbuKamar; Deshmukh Anand

    2014-01-01

    Objective: To describe the clinical presentation, underlying diseases, antimicrobial susceptibility, treatment and outcome of Klebsiella pneumoniae meningitis patients. Methods:This retrospective study involved all patients with 15 years of age or older who admitted to Hamad General Hospital with culture proven Klebsiella pneumoniae meningitis from January 1, 2007 to December 31, 2012. Results: A total of ten cases were identified (nine males and one female). Their mean age was (43.3±12.8) years. Eight patients (80%) had nosocomial meningitis with neurosurgery being the most frequent associated condition. Fever and altered consciousness were the most frequent symptom. Cerebrospinal fluid showed elevated protein and glucose levels. Gram stain showed Gram-negative rods in 50%of cases, while positive cerebrospinal fluid culture results were found in all patients. Multidrug resistance was observed in two cases, and all patients had received appropriate empirical and definitive antibiotic treatments. The mean duration of intravenous antimicrobial treatment was (19.3±7.0) d and all patients with external ventricular drains underwent removal of the device, while in-hospital mortality was 50%. Conclusions: The number of cases was too small to come up with therapeutic and prognostic conclusions. Further large-scale prospective study is needed.

  12. The pandemic influenza A (H1N1 2009 vaccine does not increase the mortality rate of idiopathic interstitial pneumonia: a matched case-control study.

    Directory of Open Access Journals (Sweden)

    Hiroshi Yokomichi

    Full Text Available BACKGROUND: Evidence regarding the mortality rate after administration of the pandemic influenza A (H1N1 2009 vaccine on patients with underlying diseases is currently scarce. We conducted a case-control study in Japan to compare the mortality rates of patients with idiopathic interstitial pneumonia after the vaccines were administered and were not administered. METHODS: Between October 2009 and March 2010, we collected clinical records in Japan and conducted a 1:1 matched case-control study. Patients with idiopathic interstitial pneumonia who died during this period were considered case patients, and those who survived were considered control patients. We determined and compared the proportion of each group that received the pandemic influenza A (H1N1 2009 vaccine and estimated the odds ratio. Finally, we conducted simulations that compensated for the shortcomings of the study associated with adjusted severity of idiopathic interstitial pneumonia. RESULTS: The case and control groups each comprised of 75 patients with idiopathic interstitial pneumonia. The proportion of patients who received the pandemic influenza A (H1N1 2009 vaccine was 30.7% and 38.7% for the case and control groups, respectively. During that winter, the crude conditional odds ratio of mortality was 0.63 (95% confidence interval, 0.25-1.47 and the adjusted conditional odds ratio was 1.18 (95% confidence interval, 0.33-4.49; neither was significant. The simulation study showed more accurate conditional odds ratios of 0.63-0.71. CONCLUSIONS: In our study, we detected no evidence that the influenza A (H1N1 2009 vaccine increased the mortality rate of patients with idiopathic interstitial pneumonia. The results, however, are limited by the small sample size and low statistical power. A larger-scale study is required.

  13. General health checks in adults for reducing morbidity and mortality from disease

    DEFF Research Database (Denmark)

    Krogsbøll, Lasse T; Jørgensen, Karsten Juhl; Grønhøj Larsen, Christian;

    2012-01-01

    To quantify the benefits and harms of general health checks in adults with an emphasis on patient-relevant outcomes such as morbidity and mortality rather than on surrogate outcomes.......To quantify the benefits and harms of general health checks in adults with an emphasis on patient-relevant outcomes such as morbidity and mortality rather than on surrogate outcomes....

  14. Specific serum immunoglobulin g to chlamydia pneumoniae in healthy children and adults (south-east of iran)

    International Nuclear Information System (INIS)

    Chlamydia pneumoniae (C. pneumonia) is an obligate intracellular bacterium and recognized as a risk factor for several diseases such as asthma, atherosclerosis and arthritis. The aim of this study was to determine the sero-prevalence of C. pneumonia in healthy subjects in different age groups. Methods: The serum levels of anti C. pneumonia IgG were measured by using of ELISA. Results: Totally, 630 subjects (164 children and 466 adults) were included into study. The sero-prevalence and the mean titer of anti C. pneumonia antibody were 11.3% and 14.48 ± 2.18 RU/mL; at age = 10 years, 15% and 17.47 ± 2.40 RU/mL at age 11-20 years, 21% and 25.15 ± 4.56 RU/mL at age 21-30 years group, 40% and 53.77 ± 6.40 RU/mL at age 31-40 years, 94% and 146.41 ± 8.95 RU/mL at age 41-50 years, 98% and 153.59+-10.38 RU/mL at age 51-60 years, 96% and 138.80 ± 12.78 RU/mL at age 61-70 years, respectively. The differences of the sero-prevalence and the mean titer of anti C. pneumonia antibody between age groups were significant (p<0.0001). The sero-prevalence and the mean titer of anti C. pneumonia antibody were 11.6% and 14.33 ± 1.49 RU/mL in children and 65.5% and 97.40 ± 4.46 RU/mL in adults. The sero-prevalence and the mean titer of anti C. pneumonia antibody were significantly higher in adults in comparison with those in children (p<0.0001). Conclusion: These findings showed that the sero-prevalence and titer of anti C. pneumonia IgG were increased with advanced ages and were higher in adults as compared to children. (author)

  15. Study Development of Adult Mycoplasma Pneumoniae Infection%成人肺炎支原体感染研究进展

    Institute of Scientific and Technical Information of China (English)

    易海峰

    2011-01-01

    Mycoplasma pneumoniae is a common pathogen of respiratory tract, which is frequently complicated with respiratory infections and extrapulmonary disorders.Adult Mycoplasma pneumoniae infection has been increasingly recognized.Adult form is significantly different from pediatric form.Due to the small number of studies, more concepts of adult Mycoplasma pneumoniae infection require to be supplemented and standardized.This article reviews epidemiology, pathogenesis, clinical features, laboratory diagnosis, and pharmacotherapy of adult Mycoplasma pneumoniae infection.%肺炎支原体是呼吸道常见致病原,常引起呼吸道感染及各种肺外并发症.近年来成人肺炎支原体感染受到重视,成人肺炎支原体感染在许多方面有其不同于儿童的特点,由于研究相对较少,许多认识有待完善和统一,现就成人肺炎支原体感染的流行病学、致病机制、临床表现、实验诊断、药物治疗等方面的研究进展予以简要综述.

  16. Pneumonia Can Be Prevented -- Vaccines Can Help

    Science.gov (United States)

    ... What's this? Submit Button Past Emails CDC Features Pneumonia Can Be Prevented—Vaccines Can Help Language: English ... of an adult patient with pneumonia. What Is Pneumonia? Pneumonia is an infection of the lungs that ...

  17. Severe respiratory failure secondary to Varicella zoster pneumonia

    Directory of Open Access Journals (Sweden)

    Lütfiye Mülazımoğlu

    2010-09-01

    Full Text Available Varicella is one of the most contagious diseases of childhood. Whenever varicella is seen in adults, it can cause serious complications. Pneumonia is one of the most serious complications of varicella during adulthood and it has a high mortality rate. Cases of varicella pneumonia which need mechanical ventilation in intensive care unit, have %50 of mortality rate.This report presents a patient who was diagnosed as varicella pneumonia in our intensive care unit. Our treatment and diagnostic approach is presented together with actual literature.

  18. Increasing incidence but decreasing in-hospital mortality of adult Staphylococcus aureus bacteraemia between 1981 and 2000

    DEFF Research Database (Denmark)

    Benfield, Thomas; Espersen, F; Frimodt-Møller, N;

    2007-01-01

    ) and 15% were of undetermined acquisition (UA). Incidence rates increased from 18.2 to 30.5 cases/100,000 population. Annual rates increased by 6.4% for CA, by 2.2% for HA and by 3.6% for UA cases, respectively. Case-mortality associated with HA bacteraemia decreased from 36.2% to 20.7% (43% rate...... reduction, p 0.0001), compared with a decrease from 34.5% to 26.5% (23% rate reduction, p 0.0001) for CA bacteraemia. Following multivariate analysis, age, pneumonia, endocarditis and chronic illness were associated with increased mortality, regardless of the mode of acquisition. Overall, mortality......Staphylococcus aureus is a leading cause of bacteraemia. This study analysed temporal trends from 18,702 adult cases of S. aureus bacteraemia in Denmark between 1981 and 2000. After stratification for mode of acquisition, 57% of cases were hospital-acquired (HA), 28% were community-acquired (CA...

  19. Estado nutricional y mortalidad en neumonía de la comunidad Nutritional status and mortality in community acquired pneumonia

    Directory of Open Access Journals (Sweden)

    María Soledad Rodríguez-Pecci

    2010-04-01

    Full Text Available Las neumonías constituyen una causa mayor de morbimortalidad, y entre los factores de riesgo se incluye el estado nutricional. En el presente estudio se analizó la relación entre malnutrición y mortalidad en Neumonía Aguda de la Comunidad (NAC y se utilizó la Escala de Evaluación Global Subjetiva (EGS como método de valoración del estado nutricional de los pacientes con NAC. En este estudio prospectivo observacional se incluyeron en forma consecutiva 98 pacientes con NAC que requirieron hospitalización, de octubre de 2004 a septiembre de 2006. Se registraron características clínicas, bacteriológicas y de laboratorio y se evaluó nutricionalmente a cada paciente utilizando la EGS. El seguimiento se realizó hasta el alta médica, derivación o muerte. La persistencia de tos o fiebre, la presencia de derrame pleural, neoplasias o larga hospitalización se asociaron a peor pronóstico. La mortalidad aumentó proporcionalmente con el grado de desnutrición. Treinta y dos pacientes (32.65% fueron clasificados como categoría EGS-A; 44 (44.90% como EGS-B, y 22 (22.45% como EGS-C. Fallecieron 3 de 32 EGS-A (9.37%, 8 de 44 EGS-B (18.18% y 10 de 22 EGS-C. El riesgo de muerte fue significativamente mayor en el grupo EGS-C que en el EGS-A; OR = 6.085 (CI95% 1.071- 34.591 p = 0.042. Considerando la muerte como variable de egreso, la categoría EGS-A mostró el mayor valor predictivo negativo (0.906, y EGS-C el mayor valor predictivo positivo (0.455. La EGS realizada al ingreso fue un instrumento útil para identificar el estado nutricional y un buen pronosticador de riesgo de muerte en NAC.Pneumonias are a major cause of morbidity and mortality and their prognosis depends on many factors including nutritional status. This study analyzed the relationship between malnutrition and the risk of death in Community Acquired Pneumonia (CAP patients. This is a prospective observational study. The Subjective Global Assessment (SGA was used as a screening

  20. The Effects of Childhood, Adult, and Community Socioeconomic Conditions on Health and Mortality among Older Adults in China

    OpenAIRE

    Wen, Ming; Gu, Danan

    2011-01-01

    Using a large, nationally representative longitudinal sample of Chinese aged 65 and older, this study examines the effects of childhood, adult, and community socioeconomic conditions on mortality and several major health outcomes. The role of social mobility is also tested. We find that childhood socioeconomic conditions exert long-term effects on functional limitations, cognitive impairment, self-rated health, and mortality independent of adult and community socioeconomic conditions. Achieve...

  1. Spatio-temporal dynamics of pneumonia in bighorn sheep

    Science.gov (United States)

    Cassirer, E. Frances; Plowright, Raina K.; Manlove, Kezia R.; Cross, Paul C.; Dobson, Andrew P.; Potter, Kathleen A.; Hudson, Peter J.

    2013-01-01

    Bighorn sheep mortality related to pneumonia is a primary factor limiting population recovery across western North America, but management has been constrained by an incomplete understanding of the disease. We analysed patterns of pneumonia-caused mortality over 14 years in 16 interconnected bighorn sheep populations to gain insights into underlying disease processes. 2. We observed four age-structured classes of annual pneumonia mortality patterns: all-age, lamb-only, secondary all-age and adult-only. Although there was considerable variability within classes, overall they differed in persistence within and impact on populations. Years with pneumonia-induced mortality occurring simultaneously across age classes (i.e. all-age) appeared to be a consequence of pathogen invasion into a naïve population and resulted in immediate population declines. Subsequently, low recruitment due to frequent high mortality outbreaks in lambs, probably due to association with chronically infected ewes, posed a significant obstacle to population recovery. Secondary all-age events occurred in previously exposed populations when outbreaks in lambs were followed by lower rates of pneumonia-induced mortality in adults. Infrequent pneumonia events restricted to adults were usually of short duration with low mortality. 3. Acute pneumonia-induced mortality in adults was concentrated in fall and early winter around the breeding season when rams are more mobile and the sexes commingle. In contrast, mortality restricted to lambs peaked in summer when ewes and lambs were concentrated in nursery groups. 4. We detected weak synchrony in adult pneumonia between adjacent populations, but found no evidence for landscape-scale extrinsic variables as drivers of disease. 5. We demonstrate that there was a >60% probability of a disease event each year following pneumonia invasion into bighorn sheep populations. Healthy years also occurred periodically, and understanding the factors driving these

  2. Income inequality, individual income, and mortality in Danish adults

    DEFF Research Database (Denmark)

    Osler, Merete; Prescott, Eva; Grønbaek, Morten;

    2002-01-01

    To analyse the association between area income inequality and mortality after adjustment for individual income and other established risk factors.......To analyse the association between area income inequality and mortality after adjustment for individual income and other established risk factors....

  3. Vitamin D supplementation for prevention of mortality in adults

    DEFF Research Database (Denmark)

    Bjelakovic, Goran; Gluud, Lise Lotte; Nikolova, Dimitrinka;

    2014-01-01

    Available evidence on the effects of vitamin D on mortality has been inconclusive. In a recent systematic review, we found evidence that vitamin D3 may decrease mortality in mostly elderly women. The present systematic review updates and reassesses the benefits and harms of vitamin D...

  4. Spatial risk for gender-specific adult mortality in an area of southern China

    Directory of Open Access Journals (Sweden)

    Ochiai Rion

    2007-07-01

    Full Text Available Abstract Background Although economic reforms have brought significant benefits, including improved health care to many Chinese people, accessibility to improved care has not been distributed evenly throughout Chinese society. Also, the effects of the uneven distribution of improved healthcare are not clearly understood. Evidence suggests that mortality is an indicator for evaluating accessibility to improved health care services. We constructed spatially smoothed risk maps for gender-specific adult mortality in an area of southern China comprising both urban and rural areas and identified ecological factors of gender-specific mortality across societies. Results The study analyzed the data of the Hechi Prefecture in southern in China. An average of 124,204 people lived in the area during the study period (2002–2004. Individual level data for 2002–2004 were grouped using identical rectangular cells (regular lattice of 0.25 km2. Poisson regression was fitted to the group level data to identify gender-specific ecological factors of adult (ages 15– Conclusion We found a disparity in mortality rates between rural and urban areas in the study area in southern China, especially for adult men. There were also differences in mortality rates between poorer and wealthy populations in both rural and urban areas, which may in part reflect differences in health care quality. Spatial influences upon adult male versus adult female mortality difference underscore the need for more research on gender-related influences on adult mortality in China.

  5. Predictors of mortality in patients with bloodstream infections caused by KPC-producing Klebsiella pneumoniae and impact of appropriate antimicrobial treatment.

    Science.gov (United States)

    Zarkotou, O; Pournaras, S; Tselioti, P; Dragoumanos, V; Pitiriga, V; Ranellou, K; Prekates, A; Themeli-Digalaki, K; Tsakris, A

    2011-12-01

    Bloodstream infections (BSIs) caused by Klebsiella pneumoniae carbapenemases (KPC)-producing K. pneumoniae (KPC-KP) are associated with high mortality rates. We investigated outcomes, risk factors for mortality and impact of appropriate antimicrobial treatment in patients with BSIs caused by molecularly confirmed KPC-KP. All consecutive patients with KPC-KP BSIs between May 2008 and May 2010 were included in the study and followed-up until their discharge or death. Potential risk factors for infection mortality were examined by a case-control study. Case-patients were those who died from the BSI and control-patients those who survived. Appropriate antimicrobial therapy was defined as treatment with in vitro active antimicrobials for at least 48 h. A total of 53 patients were identified. Overall mortality was 52.8% and infection mortality was 34%. Appropriate antimicrobial therapy was administered to 35 patients; mortality due to infection occurred in 20%. All 20 patients that received combination schemes had favourable infection outcome; in contrast, seven of 15 patients given appropriate monotherapy died (p 0.001). In univariate analysis, risk factors for mortality were age (p infection onset (p appropriate antimicrobial treatment (p 0.003), combinations of active antimicrobials (p 0.001), catheter-related bacteraemia (p 0.04), prior surgery (p 0.014) and other therapeutic interventions (p 0.015) were significantly associated with survival. Independent predictors of mortality were age, APACHE II score at infection onset and inappropriate antimicrobial treatment. Among them, appropriate treatment is the only modifiable independent predictor of infection outcome. PMID:21595793

  6. Cecal ligation and puncture followed by methicillin-resistant Staphylococcus aureus pneumonia increases mortality in mice and blunts production of local and systemic cytokines.

    Science.gov (United States)

    Jung, Enjae; Perrone, Erin E; Liang, Zhe; Breed, Elise R; Dominguez, Jessica A; Clark, Andrew T; Fox, Amy C; Dunne, W Michael; Burd, Eileen M; Farris, Alton B; Hotchkiss, Richard S; Coopersmith, Craig M

    2012-01-01

    Mortality in the intensive care unit frequently results from the synergistic effect of two temporally distinct infections. This study examined the pathophysiology of a new model of intra-abdominal sepsis followed by methicillin-resistant Staphylococcus aureus (MRSA) pneumonia. Mice underwent cecal ligation and puncture (CLP) or sham laparotomy followed 3 days later by an intratracheal injection of MRSA or saline. Both CLP/saline and sham/MRSA mice had 100% survival, whereas animals with CLP followed by MRSA pneumonia had 67% 7-day survival. Animals subjected to CLP/MRSA had increased bronchoalveolar lavage concentrations of MRSA compared with sham/MRSA animals. Animals subjected to sham/MRSA pneumonia had increased bronchoalveolar lavage levels of interleukin 6 (IL-6), tumor necrosis factor α, and granulocyte colony-stimulating factor compared with those given intratracheal saline, whereas CLP/MRSA mice had a blunted local inflammatory response with markedly decreased cytokine levels. Similarly, animals subjected to CLP/saline had increased peritoneal lavage levels of IL-6 and IL-1β compared with those subjected to sham laparotomy, whereas this response was blunted in CLP/MRSA mice. Systemic cytokines were upregulated in both CLP/saline and sham/MRSA mice, and this was blunted by the combination of CLP/MRSA. In contrast, no synergistic effect on pneumonia severity, white blood cell count, or lymphocyte apoptosis was identified in CLP/MRSA mice compared with animals with either insult in isolation. These results indicate that a clinically relevant model of CLP followed by MRSA pneumonia causes higher mortality than could have been predicted from studying either infection in isolation, and this was associated with a blunted local (pulmonary and peritoneal) and systemic inflammatory response and decreased ability to clear infection. PMID:21937950

  7. The Effect of Mortality Shocks on the Age-Pattern of Adult Mortality

    DEFF Research Database (Denmark)

    Zarulli, Virginia

    2013-01-01

    increase by age is missing. In the case of a shock, three scenarios may occur: mortality may be raised proportionally at all ages, more at older ages, or more at younger ages. Two cases of natural mortality experiments were analysed: Australian civilian prisoners in a Japanese camp during the Second World...... experiments need to be analysed and more evidence collected....

  8. GHb level and subsequent mortality among adults in the U.S.

    Science.gov (United States)

    Saydah, Sharon; Tao, Min; Imperatore, Giuseppina; Gregg, Edward

    2009-08-01

    OBJECTIVE To examine the association of hyperglycemia, as measured by GHb, with subsequent mortality in a nationally representative sample of adults. RESEARCH DESIGN AND METHODS We included adults aged > or =20 years who participated in Third National Health and Nutrition Examination Survey (1988-1994) and had complete information, including baseline diabetes status by self-report and measured GHb (n = 19,025) and follow-up through the end of 2000 for mortality. RESULTS In the overall population, higher levels of GHb were associated with increased risk of mortality from all causes, heart disease, and cancer. After adjustment for potential risk factors, the relative hazard (RH) for adults with GHb > or =8% compared with adults with GHb GHb > or =8% compared with GHb GHb category. Among adults without diagnosed diabetes, there was no significant association of all-cause, heart disease, or cancer mortality and GHb category. CONCLUSIONS These results highlight the importance of GHb levels in mortality risk among a nationally representative sample of adults with and without diagnosed diabetes and indicate that higher levels are associated with increased mortality in adults with diabetes.

  9. Mortality Salience Effects on the Life Expectancy Estimates of Older Adults as a Function of Neuroticism

    Directory of Open Access Journals (Sweden)

    Molly Maxfield

    2010-01-01

    Full Text Available Research has shown that reminders of mortality lead people to engage in defenses to minimize the anxiety such thoughts could arouse. In accord with this notion, younger adults reminded of mortality engage in behaviors aimed at denying vulnerability to death. However, little is known about the effects of mortality reminders on older adults. The present study examined the effect of reminders of death on older adults' subjective life expectancy. Mortality reminders did not significantly impact the life expectancy estimates of old-old adults. Reminders of death did however lead to shorter life expectancy estimates among young-old participants low in neuroticism but longer life expectancy estimates among young-old participants high in neuroticism, suggesting that this group was most defensive in response to reminders of death.

  10. Socioeconomic Determinants of Adult Mortality in Namibia Using an Event History Analysis.

    Science.gov (United States)

    Kandjimbi, Alina; Nickanor, Ndeyapo; Kazembe, Lawrence N

    2014-01-01

    Adult mortality remains a neglected public health issue in sub-Saharan Africa, with most policy instruments concentrated on child and maternal health. In developed countries, adult mortality is negatively associated with socioeconomic factors. A similar pattern is expected in developing countries, but has not been extensively demonstrated, because of dearth of data. Understanding the hazard and factors associated with adult mortality is crucial for informing policies and for implementation of interventions aimed at improving adult survival. This paper applied a geo-additive survival model to elucidate effects of socioeconomic factors on adult mortality in Namibia, controlling for spatial frailties. Results show a clear disadvantage for adults in rural areas, for those not married and from poor households or in female-headed households. The hazard of adult mortality was highly variable with a 1.5-fold difference between areas, with highest hazard recorded in north eastern, central west and southern west parts of the country. The analysis emphasizes that, for Namibia to achieve its national development goals, targeted interventions should be aimed at poor-resourced adults, particularly in high-risk areas. PMID:26208512

  11. GHb Level and Subsequent Mortality Among Adults in the U.S.

    OpenAIRE

    Saydah, Sharon; Tao, Min; Imperatore, Giuseppina; Gregg, Edward

    2009-01-01

    OBJECTIVE To examine the association of hyperglycemia, as measured by GHb, with subsequent mortality in a nationally representative sample of adults. RESEARCH DESIGN AND METHODS We included adults aged ≥20 years who participated in Third National Health and Nutrition Examination Survey (1988–1994) and had complete information, including baseline diabetes status by self-report and measured GHb (n = 19,025) and follow-up through the end of 2000 for mortality. RESULTS In the overall population, ...

  12. Cohabitation and U.S Adult Mortality: An Examination by Gender and Race

    Science.gov (United States)

    Liu, Hui; Reczek, Corinne

    2012-01-01

    This study is the first to explore the relationship between cohabitation and U.S. adult mortality using a nationally representative sample. Using data from the National Health Interview Survey-Longitudinal Mortality Follow-up files 1997-2004 (N = 193,851), the authors found that divorced, widowed, and never-married White men had higher mortality…

  13. Treatment Failure and Mortality amongst Children with Severe Acute Malnutrition Presenting with Cough or Respiratory Difficulty and Radiological Pneumonia

    Science.gov (United States)

    Chisti, Mohammod Jobayer; Salam, Mohammed Abdus; Bardhan, Pradip Kumar; Faruque, Abu S. G.; Shahid, Abu S. M. S. B.; Shahunja, K. M.; Das, Sumon Kumar; Hossain, Md Iqbal; Ahmed, Tahmeed

    2015-01-01

    Background Appropriate intervention is critical in reducing deaths among under-five, severe acutely malnourished (SAM) children with danger signs of severe pneumonia; however, there is paucity of data on outcome of World Health Organisation (WHO) recommended interventions of SAM children with severe pneumonia. We sought to evaluate outcome of the interventions in such children. Methods We prospectively enrolled SAM children aged 0–59 months, admitted to the Intensive Care Unit (ICU) or Acute Respiratory Infection (ARI) ward of the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), between April 2011 and June 2012 with cough or respiratory difficulty and radiological pneumonia. All the enrolled children were treated with ampicillin and gentamicin, and micronutrients as recommended by the WHO. Comparison was made among pneumonic children with (n = 111) and without WHO defined danger signs of severe pneumonia (n = 296). The outcomes of interest were treatment failure (if a child required changing of antibiotics) and deaths during hospitalization. Further comparison was also made among those who developed treatment failure and who did not and among the survivors and deaths. Results SAM children with danger signs of severe pneumonia more often experienced treatment failure (58% vs. 20%; p<0.001) and fatal outcome (21% vs. 4%; p<0.001) compared to those without danger signs. Only 6/111 (5.4%) SAM children with danger signs of severe pneumonia and 12/296 (4.0%) without danger signs had bacterial isolates from blood. In log-linear binomial regression analysis, after adjusting for potential confounders, danger signs of severe pneumonia, dehydration, hypocalcaemia, and bacteraemia were independently associated both with treatment failure and deaths in SAM children presenting with cough or respiratory difficulty and radiological pneumonia (p<0.01). Conclusion and Significance The result suggests that SAM children with cough or

  14. KPC-producing Klebsiella pneumoniae enteric colonization acquired during intensive care unit stay: the significance of risk factors for its development and its impact on mortality.

    Science.gov (United States)

    Papadimitriou-Olivgeris, Matthaios; Marangos, Markos; Fligou, Fotini; Christofidou, Myrto; Sklavou, Christina; Vamvakopoulou, Sophia; Anastassiou, Evangelos D; Filos, Kriton S

    2013-10-01

    A prospective observational study of 226 intensive care unit (ICU) patients was conducted during a 25-month period. Rectal samples were taken at day 1, 4, and 7 and, afterwards, once weekly. Klebsiella pneumoniae was identified using standard techniques, whereas the presence of bla(KPC) gene was confirmed by PCR. During ICU stay, 72.6% of the patients were colonized with Klebsiella pneumoniae carbapenemases (KPC)-producing K. pneumoniae (KPC-Kp). Male gender, prior bed occupants, and patients in nearby beds colonized with KPC-Kp, tracheotomy, number of invasive catheters inserted, and number of antibiotics administered were the major risk factors for KPC-Kp colonization. ICU mortality (35.4%) was significantly related to Simplified Acute Physiology II score and respiratory insufficiency upon admission, cortisone administration, aminoglycoside administration, confirmed KPC-Kp infection, and severe sepsis or septic shock. The high prevalence of KPC-Kp enteric carriage in ICU patients and the significant mortality associated with KPC-Kp infection dictate the importance of early identification and isolation of such carriers.

  15. Twenty-year mortality of adult patients with primary immune thrombocytopenia

    DEFF Research Database (Denmark)

    Frederiksen, Henrik; dybdal, Merete Lund; Nørgaard, Mette

    2014-01-01

    Studies have reported a 1·3- to 2·2-fold higher mortality rate among patients with primary immune thrombocytopenia (ITP) compared to the general population. However, long-term mortality estimates as well as cause-specific mortality data are sparse. In our population-based cohort of adult patients...... with newly diagnosed ITP and up to 37 years of follow-up, the 5-year, 10-year and 20-year mortality among the ITP patients was 22%, 34% and 49%, respectively. The mortality in the ITP cohort was consistently higher than in the in the general population cohort yielding an adjusted hazard ratio (HR) of 1·5 [95...... causes were similar in ITP patients and the general population. We conclude that mortality rates among ITP patients are higher than in the general population, predominantly as a result of increased cardiovascular disease, infection, bleeding and haematological cancer cause-specific mortalities....

  16. Effects of Hospital-Based Physical Therapy on Hospital Discharge Outcomes among Hospitalized Older Adults with Community-Acquired Pneumonia and Declining Physical Function

    OpenAIRE

    Kim, Sun Jung; Lee, Joo Hun; Han, Boram; Lam, Julia; Bukowy, Elizabeth; Rao, Avinash; Vulcano, Jordan; Andreeva, Anelia; Bertelson, Heather; Shin, Hyun Phil; Yoo, Ji Won

    2015-01-01

    To examine whether hospital-based physical therapy is associated with functional changes and early hospital readmission among hospitalized older adults with community-acquired pneumonia and declining physical function. Study design was a retrospective observation study. Participants were community-dwelling older adults admitted to medicine floor for community-acquired pneumonia (n = 1,058). Their physical function using Katz activities of daily living (ADL) Index declined between hospital adm...

  17. Age-specific mortality during the 1918 influenza pandemic: unravelling the mystery of high young adult mortality.

    Directory of Open Access Journals (Sweden)

    Alain Gagnon

    Full Text Available The worldwide spread of a novel influenza A (H1N1 virus in 2009 showed that influenza remains a significant health threat, even for individuals in the prime of life. This paper focuses on the unusually high young adult mortality observed during the Spanish flu pandemic of 1918. Using historical records from Canada and the U.S., we report a peak of mortality at the exact age of 28 during the pandemic and argue that this increased mortality resulted from an early life exposure to influenza during the previous Russian flu pandemic of 1889-90. We posit that in specific instances, development of immunological memory to an influenza virus strain in early life may lead to a dysregulated immune response to antigenically novel strains encountered in later life, thereby increasing the risk of death. Exposure during critical periods of development could also create holes in the T cell repertoire and impair fetal maturation in general, thereby increasing mortality from infectious diseases later in life. Knowledge of the age-pattern of susceptibility to mortality from influenza could improve crisis management during future influenza pandemics.

  18. Understanding Pneumonia

    Science.gov (United States)

    ... and Diseases > Lung Disease Lookup > Pneumonia Learn About Pneumonia 5 Facts You Should Know about Pneumonia Pneumonia ... vaccinated and practicing good health habits What Is Pneumonia? Pneumonia is an infection in one or both ...

  19. Dairy consumption and patterns of mortality of Australian adults

    NARCIS (Netherlands)

    Bonthuis, M.; Hughes, M.C.B.; Ibiebele, T.I.; Green, A.C.; Pols, van der J.C.

    2010-01-01

    Background/Objectives: Dairy foods contain various nutrients that may affect health. We investigated whether intake of dairy products or related nutrients is associated with mortality due to cardiovascular disease (CVD), cancer and all causes. Subjects/Methods: We carried out a 16-year prospective s

  20. The role of procalcitonin in adult patients with community-acquired pneumonia--a systematic review

    DEFF Research Database (Denmark)

    Berg, Peter; Lindhardt, Bjarne Ørskov

    2012-01-01

    Promising results in relation to severity assessment and treatment of patients with community-acquired pneumonia (CAP) have recently been presented from the study of procalcitonin (PCT) levels in these patients.......Promising results in relation to severity assessment and treatment of patients with community-acquired pneumonia (CAP) have recently been presented from the study of procalcitonin (PCT) levels in these patients....

  1. [Thousand faces of Streptococcus pneumonia (pneumococcus) infections].

    Science.gov (United States)

    Szabó, Bálint Gergely; Lénárt, Katalin Szidónia; Kádár, Béla; Gombos, Andrea; Dezsényi, Balázs; Szanka, Judit; Bobek, Ilona; Prinz, Gyula

    2015-11-01

    Incidence and mortality rates of infections caused by Streptococcus pneumoniae (pneumococcus) are high worldwide and in Hungary among paediatric as well as adult populations. Pneumococci account for 35-40% of community acquired adult pneumonias requiring hospitalization, while 25-30% of Streptococcus pneumoniae pneumonias are accompanied by bacteraemia. 5-7% of all infections are fatal but this rate is exponentially higher in high risk patients and elderly people. Mortality could reach 20% among patients with severe invasive pneumococcal infections. Complications may develop despite administration of adequate antibiotics. The authors summarize the epidemiology of pneumococcal infections, pathogenesis of non-invasive and invasive disease and present basic clinical aspects through demonstration of four cases. Early risk stratification, sampling of hemocultures, administration of antibiotics and wider application of active immunization could reduce the mortality of invasive disease. Anti-pneumococcal vaccination is advisable for adults of ≥50 years and high risk patients of ≥18 years who are susceptible to pneumococcal disease. PMID:26498896

  2. Determinants of mortality among older adults with pressure ulcers.

    Science.gov (United States)

    Khor, Hui Min; Tan, Juan; Saedon, Nor Izzati; Kamaruzzaman, Shahrul B; Chin, Ai Vyrn; Poi, Philip J H; Tan, Maw Pin

    2014-01-01

    The presence of pressure ulcers imposes a huge burden on the older person's quality of life and significantly increases their risk of dying. The objective of this study was to determine patient characteristics associated with the presence of pressure ulcers and to evaluate the risk factors associated with mortality among older patients with pressure ulcers. A prospective observational study was performed between Oct 2012 and May 2013. Patients with preexisting pressure ulcers on admission and those with hospital acquired pressure ulcers were recruited into the study. Information on patient demographics, functional status, nutritional level, stages of pressure ulcer and their complications were obtained. Cox proportional hazard analysis was used to assess the risk of death in all patients. 76/684 (11.1%) patients had pre-existing pressure ulcers on admission and 30/684 (4.4%) developed pressure ulcers in hospital. There were 68 (66%) deaths by the end of the median follow-up period of 12 (IQR 2.5-14) weeks. Our Cox regression model revealed that nursing home residence (Hazard Ratio, HR=2.33, 95% confidence interval, CI=1.30, 4.17; p=0.005), infected deep pressure ulcers (HR=2.21, 95% CI=1.26, 3.87; p=0.006) and neutrophilia (HR=1.76; 95% CI 1.05, 2.94; p=0.031) were independent predictors of mortality in our elderly patients with pressure ulcers. The prevalence of pressure ulcers in our setting is comparable to previously reported figures in Europe and North America. Mortality in patients with pressure ulcer was high, and was predicted by institutionalization, concurrent infection and high neutrophil counts.

  3. Atypical pneumonia

    Science.gov (United States)

    ... America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis . 2007;44:S27-S72. PMID: 17278083 ... by: Denis Hadjiliadis, MD, Associate Professor of Medicine, Pulmonary, Allergy and Critical Care, Perelman ...

  4. Non-alcoholic fatty liver disease and mortality among US adults: prospective cohort study

    OpenAIRE

    Lazo, Mariana; Hernaez, Ruben; Bonekamp, Susanne; Kamel, Ihab R.; Frederick L Brancati; Guallar, Eliseo; Clark, Jeanne M.

    2011-01-01

    Objective To evaluate the association between non-alcoholic fatty liver disease and all cause and cause specific mortality in a representative sample of the US general population. Design Prospective cohort study. Setting US Third National Health and Nutrition Examination Survey (NHANES III: 1988-94) with follow-up of mortality to 2006. Participants 11 371 adults aged 20-74 participating in the Third National Health and Nutrition Examination Survey, with assessment of hepatic steatosis. Main o...

  5. Increased Mortality in Adult Trauma Patients Transfused with Blood Components Compared with Whole Blood

    OpenAIRE

    Jones, Allison R.; Frazier, Susan K

    2014-01-01

    Hemorrhage is a preventable cause of death among trauma patients, and management often includes transfusion, either whole blood or a combination of blood components (packed red blood cells, platelets, fresh frozen plasma). We used the 2009 National Trauma Data Bank to evaluate the relationship between transfusion type and mortality in adult major trauma patients (n = 1745). Logistic regression analysis identified three independent predictors of mortality: Injury Severity Score, emergency tran...

  6. Dual Sensory Impairment in Older Adults Increases the Risk of Mortality: A Population-Based Study

    OpenAIRE

    Gopinath, Bamini; Schneider, Julie; Catherine M McMahon; Burlutsky, George; Leeder, Stephen R; Mitchell, Paul

    2013-01-01

    Although concurrent vision and hearing loss are common in older adults, population-based data on their relationship with mortality is limited. This cohort study investigated the association between objectively measured dual sensory impairment (DSI) with mortality risk over 10 years. 2812 Blue Mountains Eye Study participants aged 55 years and older at baseline were included for analyses. Visual impairment was defined as visual acuity less than 20/40 (better eye), and hearing impairment as ave...

  7. Snowbirds and infection--new phenomena in pneumonia and influenza hospitalizations from winter migration of older adults: A spatiotemporal analysis

    Directory of Open Access Journals (Sweden)

    Naumova Elena N

    2011-06-01

    Full Text Available Abstract Background Despite advances in surveillance and prevention, pneumonia and influenza (P&I remain among the leading causes of mortality in the United States. Elderly adults experience the most severe morbidity from influenza-associated diseases, and have the highest rates of seasonal migration within the U.S. compared to other subpopulations. The objective of this study is to assess spatiotemporal patterns in influenza-associated hospitalizations in the elderly, by time, geography, and intensity of P&I. Given the high seasonal migration of individuals to Florida, this state was examined more closely using harmonic regression to assess spatial and temporal patterns of P&I hospitalizations by state of residence. Methods Data containing all Medicare-eligible hospitalizations in the United States for 1991-2006 with P&I (ICD-9-CM codes 480-487 were abstracted for the 65+ population. Hospitalizations were classified by state of residence, provider state, and date of admissions, specifically comparing those admitted between October and March to those admitted between April and September. We then compared the hospitalization profile data of Florida residents with that of out-of-state residents by state of primary residence and time of year (in-season or out-of-season. Results We observed distinct seasonal patterns of nonresident P&I hospitalizations, especially comparing typical winter destination states, such as California, Arizona, Texas, and Florida, to other states. Although most other states generally experienced a higher proportion of non-resident P&I during the summer months (April-September, these states had higher nonresident P&I during the traditional peak influenza season (October-March. Conclusions This study is among the first to quantify spatiotemporal P&I hospitalization patterns in the elderly, focusing on the change of patterns that are possibly due to seasonal population migration. Understanding migration and influenza

  8. Epidemiology, outcomes, and predictors of mortality in hospitalized adults with Clostridium difficile infection.

    Science.gov (United States)

    Khanna, Sahil; Gupta, Arjun; Baddour, Larry M; Pardi, Darrell S

    2016-08-01

    Studies have demonstrated an increasing Clostridium difficile infection (CDI) incidence in hospitals and the community, with increasing morbidity and mortality. In this study, we analyzed data from the National Hospital Discharge Survey (NHDS) to evaluate CDI epidemiology, outcomes, and predictors of mortality in hospitalized adults. We identified cases of CDI (and associated comorbid conditions) from NHDS data from 2005 through 2009 using ICD-9 codes. Weighted univariate and multivariate analyses were performed to ascertain CDI incidence, associations between CDI and outcomes [length of stay (LOS), colectomy, all-cause in-hospital mortality, and discharge to a care facility], and predictors of all-cause in-hospital mortality. Of an estimated 162 million adult inpatients, 1.26 million (0.8 %) had CDI. The overall CDI incidence is 77.8/10,000 hospitalizations, with no statistically significant change over the study period. On multivariate analysis, after adjusting for age, gender, and comorbid conditions, CDI is an independent predictor of longer LOS (mean difference, 2.35 days), all-cause mortality [odds ratio (OR) 1.45], colectomy (OR 1.41), and discharge to a care facility (OR 2.12) (all P coagulation abnormalities. Despite stable CDI incidence and advances in management, CDI is associated with increased LOS, colectomy, all-cause in-hospital mortality, and discharge to a care facility in hospitalized, especially elderly, adults. Age older than 65 years should be added to the severity criteria for CDI. PMID:26694494

  9. Impact of pneumococcal vaccination in children on serotype distribution in adult community-acquired pneumonia using the serotype-specific multiplex urinary antigen detection assay.

    Science.gov (United States)

    Pletz, Mathias W; Ewig, Santiago; Rohde, Gernot; Schuette, Hartwig; Rupp, Jan; Welte, Tobias; Suttorp, Norbert; Forstner, Christina

    2016-04-29

    The aim of the study was to compare the distribution of the vaccine-serotypes covered by pneumococcal conjugate vaccines (PCV7 and PCV13) in adult patients with pneumococcal community-acquired pneumonia in Germany between the periods 2002-2006 and 2007-2011 using a novel serotype-specific multiplex urinary antigen detection assay (SSUA). Vaccination of children started with PCV7 in 2007, which was replaced by PCV13 in 2010. Following confirmation of the accuracy of SSUA in long-term stored urine samples from 112 patients with confirmed pneumonia and known pneumococcal serotype, urine samples of 391 CAPNETZ patients with documented pneumococcal pneumonia (i.e. positive BinaxNOW(®) Streptococcus pneumoniae urine antigen test) but unknown serotype were tested for the 13 vaccine-serotypes using SSUA. The proportion of PCV7-serotypes significantly decreased in adult patients with pneumonia from 30.6% (2002-6) to 13.3% (2007-11, ppneumococcal serotypes included by PCV13 remained stable during study period with a coverage of 61.5% (2002-06) and 59.7% (2007-11) in non-bacteremic pneumonia and 79% (for both periods) in bacteremic pneumonia, mainly due to an increase in pneumococcal serotypes 1, 3 and 7F during the second period. Thus, implementation of PCV7 in children in Germany in 2007 was associated with a significant decrease in vaccine-serotypes covered by PCV7 in adult patients with non-bacteremic pneumococcal pneumonia and with an elimination of PCV7 vaccine-serotypes in bacteremic pneumococcal pneumonia. PCV13 coverage remained high up to 2011, mainly due to an increase in serotypes 1, 3 and 7F. German Clinical Trials Register: DRKS00005274. PMID:27016653

  10. Time to positivity in blood cultures of adults with Streptococcus pneumoniae bacteremia

    OpenAIRE

    Ansorena Luis; Garrido Jose; Rodríguez-Lera María; Peralta Galo; Roiz María

    2006-01-01

    Abstract Background previous studies have established that bacterial blood concentration is related with clinical outcome. Time to positivity of blood cultures (TTP) has relationship with bacterial blood concentration and could be related with prognosis. As there is scarce information about the usefulness of TTP, we study the relationship of TTP with clinical parameters in patients with Streptococcus pneumoniae bacteremia. Methods TTP of all cases of Streptococcus pneumoniae bacteremia, detec...

  11. Incidence of asthma and mortality in a cohort of young adults: a 7-year prospective study

    OpenAIRE

    Bugianio Massimilian; Cazzoletti Lucia; Locatelli Francesca; Marco Roberto; Carosso Aurelia; Marinoni Alessandra

    2005-01-01

    Abstract Background Few longitudinal data exist on the incidence of asthma in young adults and on the overall mortality risk due to asthma. A 7-year follow-up prospective study was performed to assess the incidence of asthma and mortality from all causes in a cohort of young adults. Methods The life status of a cohort of 6031 subjects, aged 20–44 years, who replied to a respiratory screening questionnaire between 1991 and 1992, was ascertained in 1999. A new questionnaire investigating the hi...

  12. Pneumococcal pneumonia prevention among adults: is the herd effect of pneumococcal conjugate vaccination in children as good a way as the active immunization of the elderly?

    Science.gov (United States)

    Prato, Rosa; Fortunato, Francesca; Martinelli, Domenico

    2016-01-01

    The indirect protection of adults as a result of pneumococcal conjugate vaccination of infants has been discussed from different epidemiological points of view. In some countries, including Italy, even after pediatric vaccination, vaccine serotypes are still responsible for most pneumonia and invasive diseases in the elderly. Although the Community-Acquired Pneumonia Immunization Trial in Adults (CAPITA) produced encouraging results, it has not showed the efficacy of the 13-valent conjugate vaccine in preventing pneumococcal community-acquired pneumonia regardless of the number of episodes and serotype. Addressing these points by monitoring the direct impact of adult vaccination in real life distinguished from the effects of herd immunity will assist public health decision-making on the most effective adult pneumococcal vaccination strategies.

  13. Obesity, metabolic health, and mortality in adults: a nationwide population-based study in Korea.

    Science.gov (United States)

    Yang, Hae Kyung; Han, Kyungdo; Kwon, Hyuk-Sang; Park, Yong-Moon; Cho, Jae-Hyoung; Yoon, Kun-Ho; Kang, Moo-Il; Cha, Bong-Yun; Lee, Seung-Hwan

    2016-01-01

    BMI, metabolic health status, and their interactions should be considered for estimating mortality risk; however, the data are controversial and unknown in Asians. We aimed to investigate this issue in Korean population. Total 323175 adults were followed-up for 96 (60-120) (median [5-95%]) months in a nationwide population-based cohort study. Participants were classified as "obese" (O) or "non-obese" (NO) using a BMI cut-off of 25 kg/m(2). People who developed ≥1 metabolic disease component (hypertension, diabetes, dyslipidaemia) in the index year were considered "metabolically unhealthy" (MU), while those with none were considered "metabolically healthy" (MH). The MUNO group had a significantly higher risk of all-cause (hazard ratio, 1.28 [95% CI, 1.21-1.35]) and cardiovascular (1.88 [1.63-2.16]) mortality, whereas the MHO group had a lower mortality risk (all-cause: 0.81 [0.74-0.88]), cardiovascular: 0.73 [0.57-0.95]), compared to the MHNO group. A similar pattern was noted for cancer and other-cause mortality. Metabolically unhealthy status was associated with higher risk of all-cause and cardiovascular mortality regardless of BMI levels, and there was a dose-response relationship between the number of incident metabolic diseases and mortality risk. In conclusion, poor metabolic health status contributed more to mortality than high BMI did, in Korean adults. PMID:27445194

  14. Social isolation, C-reactive protein, and coronary heart disease mortality among community-dwelling adults

    OpenAIRE

    Heffner, Kathi L.; Waring, Molly E.; Mary B. Roberts; Charles B Eaton; Gramling, Robert

    2011-01-01

    Social isolation confers increased risk for coronary heart disease (CHD) events and mortality. In two recent studies, low levels of social integration among older adults were related to higher levels of C-reactive protein (CRP), a marker of inflammation, suggesting a possible biological link between social isolation and CHD. The current study examined relationships among social isolation, CRP, and 15-year CHD death in a community sample of US adults aged 40 years and older without a prior his...

  15. Mortality in Young Adults following in Utero and Childhood Exposure to Arsenic in Drinking Water

    Science.gov (United States)

    Marshall, Guillermo; Liaw, Jane; Yuan, Yan; Ferreccio, Catterina; Steinmaus, Craig

    2012-01-01

    Background: Beginning in 1958, the city of Antofagasta in northern Chile was exposed to high arsenic concentrations (870 µg/L) when it switched water sources. The exposure abruptly stopped in 1970 when an arsenic-removal plant commenced operations. A unique exposure scenario like this—with an abrupt start, clear end, and large population (125,000 in 1970), all with essentially the same exposure—is rare in environmental epidemiology. Evidence of increased mortality from lung cancer, bronchiectasis, myocardial infarction, and kidney cancer has been reported among young adults who were in utero or children during the high-exposure period. Objective: We investigated other causes of mortality in Antofagasta among 30- to 49-year-old adults who were in utero or ≤ 18 years of age during the high-exposure period. Methods: We compared mortality data between Antofagasta and the rest of Chile for people 30–49 years of age during 1989–2000. We estimated expected deaths from mortality rates in all of Chile, excluding Region II where Antofagasta is located, and calculated standardized mortality ratios (SMRs). Results: We found evidence of increased mortality from bladder cancer [SMR = 18.1; 95% confidence interval (CI): 11.3, 27.4], laryngeal cancer (SMR = 8.1; 95% CI: 3.5, 16.0), liver cancer (SMR = 2.5; 95% CI: 1.6, 3.7), and chronic renal disease (SMR = 2.0; 95% CI: 1.5, 2.8). Conclusions: Taking together our findings in the present study and previous evidence of increased mortality from other causes of death, we conclude that arsenic in Antofagasta drinking water has resulted in the greatest increases in mortality in adults < 50 years of age ever associated with early-life environmental exposure. PMID:22949133

  16. Pulmonary tuberculosis with airspace consolidation vs mycoplasma pneumonia in adults: high-resolution CT findings

    International Nuclear Information System (INIS)

    To analyse and compare high-resolution CT findings of pulmonary tuberculosis with consolidation and mycoplasma pneumonia. Twenty patients with pulmonary tuberculosis [confirmed by sputum culture (n=9) and bronchoscopic biopsy (n=11)] and airspace consolidation on high-resolution CT and 17 patients with mycoplasma pneumonia, confirmed by serologic test, were included in this study. High-resolution CT findings were analyzed in terms of ground-glass opacities, distribution of consolidation, type of nodules, cavities, interlobular septal thickening, bronchial dilatations, bronchial wall thickening and pleural effusion. In patients with tuberculosis, average age was 33.5 years (range, 20-67); in those with mycoplasma pneumonia it was 32.5 years (range, 17-74). Segmental and subsegmental distributions were most common in both diseases; the preferred site of consolidation was different, however; for tuberculosis it was the upper lobes (13 cases, 65%; bilateral involvement, 7 cases); for mycoplasma pneumonia it was the lower lobes (11 cases, 64.7%). Non-segmental (diffuse and random) distribution of ground-glass opacities were seen in two patients(11.8%) with mycoplasma pneumonia. Centrilobular nodules, branching linear opacities and alveolar nodules were not different in both diseases, but there were nodules above 10mm in 14 cases of tuberculosis and in only one case of mycoplasma pneumonia. Tree-in-bud appearances were seen in five cases of tuberculosis. Cavities without air-fluid level were noted in ten cases of tuberculosis. Other interlobular septal thickening, bronchial wall thickening, bronchial dilatation and pleural effusion were not different in both diseases. There was considerable overlap between high resolution CT findings of tuberculosis with airspace consolidation and those of mycoplasma pneumonia. The location of consolidation, type of nodules, and the presence of tree-in-bud appearance and cavities help in the differentiation of the two diseases, however

  17. Influence of HIV infection on the clinical presentation and outcome of adults with acute community-acquired pneumonia in Yaounde, Cameroon: a retrospective hospital-based study

    Directory of Open Access Journals (Sweden)

    Yone Eric Walter

    2012-08-01

    Full Text Available Abstract Background The impact of HIV infection on the evolution of acute community-acquired pneumonia (CAP is still controversial. The aim of this study was to investigate possible differences in the clinical presentation and in-hospital outcomes of patients with CAP with and without HIV infection in a specialised service in Yaounde. Methods Medical files of 106 patients (51 men aged 15 years and above, admitted to the Pneumology service of the Yaounde Jamot Hospital between January 2008 and May 2012, were retrospectively studied. Results Sixty-two (58.5% patients were HIV infected. The median age of all patients was 40 years (interquartile range: 31.75-53 and there was no difference in the clinical and radiological profile of patients with and without HIV infection. The median leukocyte count (interquartile range was 14,600/mm3 (10,900-20,600 and 10,450/mm3 (6,400-16,850 respectively in HIV negative and HIV positive patients (p = 0.002. Median haemoglobin level (interquartile range was 10.8 g/dl (8.9-12 in HIV negative and 9.7 g/dl (8–11.6 in HIV positive patients (p = 0.025. In-hospital treatment failure on third day (39.5% vs. 25.5.1%, p = 0.137 and mortality rates (9% vs. 14.5%, p = 0.401 were similar between HIV negative and HIV positive patients. Conclusion Clinical and radiological features as well as response to treatment and in hospital fatal outcomes are similar in adult patients hospitalised with acute community-acquired pneumonia in Yaounde. In contrast, HIV infected patients tend to be more anaemic and have lower white cell counts than HIV negative patients. Larger prospective studies are needed to consolidate these findings.

  18. Mortality by causes in HIV-infected adults: comparison with the general population

    Directory of Open Access Journals (Sweden)

    Floristan Yugo

    2011-05-01

    Full Text Available Abstract Background We compared mortality by cause of death in HIV-infected adults in the era of combined antiretroviral therapy with mortality in the general population in the same age and sex groups. Methods Mortality by cause of death was analyzed for the period 1999-2006 in the cohort of persons aged 20-59 years diagnosed with HIV infection and residing in Navarre (Spain. This was compared with mortality from the same causes in the general population of the same age and sex using standardized mortality ratios (SMR. Results There were 210 deaths among 1145 persons diagnosed with HIV (29.5 per 1000 person-years. About 50% of these deaths were from AIDS. Persons diagnosed with HIV infection had exceeded all-cause mortality (SMR 14.0, 95% CI 12.2 to 16.1 and non-AIDS mortality (SMR 6.9, 5.7 to 8.5. The analysis showed excess mortality from hepatic disease (SMR 69.0, 48.1 to 78.6, drug overdose or addiction (SMR 46.0, 29.2 to 69.0, suicide (SMR 9.6, 3.8 to 19.7, cancer (SMR 3.2, 1.8 to 5.1 and cardiovascular disease (SMR 3.1, 1.3 to 6.1. Mortality in HIV-infected intravenous drug users did not change significantly between the periods 1999-2002 and 2003-2006, but it declined by 56% in non-injecting drug users (P = 0.007. Conclusions Persons with HIV infection continue to have considerable excess mortality despite the availability of effective antiretroviral treatments. However, excess mortality in the HIV patients has declined since these treatments were introduced, especially in persons without a history of intravenous drug use.

  19. Using passive acoustic telemetry to infer mortality events in adult herbivorous coral reef fishes

    Science.gov (United States)

    Khan, J. A.; Welsh, J. Q.; Bellwood, D. R.

    2016-06-01

    Mortality is considered to be an important factor shaping the structure of coral reef fish communities, but data on the rate and nature of mortality of adult coral reef fishes are sparse. Mortality on coral reefs is intrinsically linked with predation, with most evidence suggesting that predation is highest during crepuscular periods. We tested this hypothesis using passive acoustic telemetry data to determine the time of day of potential mortality events (PMEs) of adult herbivorous reef fishes. A total of 94 fishes were tagged with acoustic transmitters, of which 43 exhibited a PME. Furthermore, we identified five categories of PMEs based on the nature of change in acoustic signal detections from tagged fishes. The majority of PMEs were characterised by an abrupt stop in detections, possibly as a result of a large, mobile predator. Overall, mortality rates were estimated to be approximately 59 % per year using passive acoustic telemetry. The time of day of PMEs suggests that predation was highest during the day and crepuscular periods and lowest at night, offering only partial support for the crepuscular predation hypothesis. Visually oriented, diurnal and crepuscular predators appear to be more important than their nocturnal counterparts in terms of predation on adult reef fishes. By timing PMEs, passive acoustic telemetry may offer an important new tool for investigating the nature of predation on coral reefs.

  20. Diretrizes brasileiras para pneumonia adquirida na comunidade em adultos imunocompetentes - 2009 Brazilian guidelines for community-acquired pneumonia in immunocompetent adults - 2009

    Directory of Open Access Journals (Sweden)

    Ricardo de Amorim Corrêa

    2009-06-01

    elderly are more susceptible to severe complications, thereby justifying the fact that the prevention measures adopted have focused on these age brackets. Despite the advances in the knowledge of etiology and physiopathology, as well as the improvement in preliminary clinical and therapeutic methods, various questions merit further investigation. This is due to the clinical, social, demographical and structural diversity, which cannot be fully predicted. Consequently, guidelines are published in order to compile the most recent knowledge in a systematic way and to promote the rational use of that knowledge in medical practice. Therefore, guidelines are not a rigid set of rules that must be followed, but first and foremost a tool to be used in a critical way, bearing in mind the variability of biological and human responses within their individual and social contexts. This document represents the conclusion of a detailed discussion among the members of the Scientific Board and Respiratory Infection Committee of the Brazilian Thoracic Association. The objective of the work group was to present relevant topics in order to update the previous guidelines. We attempted to avoid the repetition of consensual concepts. The principal objective of creating this document was to present a compilation of the recent advances published in the literature and, consequently, to contribute to improving the quality of the medical care provided to immunocompetent adult patients with community-acquired pneumonia.

  1. Risk factors for mortality among malnourished HIV-infected adults eligible for antiretroviral therapy

    DEFF Research Database (Denmark)

    Woodd, Susannah L; Kelly, Paul; Koethe, John R;

    2016-01-01

    BACKGROUND: A substantial proportion of HIV-infected adults starting antiretroviral therapy (ART) in sub-Saharan Africa are malnourished. We aimed to increase understanding of the factors affecting their high mortality, particularly in the high-risk period before ART initiation. METHODS: We analy...

  2. Impact of body composition changes on risk of all-cause mortality in older adults

    DEFF Research Database (Denmark)

    Graf, Christophe E; Herrmann, François R; Spoerri, Adrian;

    2016-01-01

    PURPOSE: This study evaluates the relationship between body mass index (BMI), fat mass index (FMI) and fat-free mass index (FFMI) changes and mortality in persons ≥65 years. METHODS: Adults ≥65 years with at least two body composition measurements (BCM) between 1990 and 2011 were included. We...

  3. Dysbiosis of upper respiratory tract microbiota in elderly pneumonia patients.

    Science.gov (United States)

    de Steenhuijsen Piters, Wouter A A; Huijskens, Elisabeth G W; Wyllie, Anne L; Biesbroek, Giske; van den Bergh, Menno R; Veenhoven, Reinier H; Wang, Xinhui; Trzciński, Krzysztof; Bonten, Marc J; Rossen, John W A; Sanders, Elisabeth A M; Bogaert, Debby

    2016-01-01

    Bacterial pneumonia is a major cause of morbidity and mortality in elderly. We hypothesize that dysbiosis between regular residents of the upper respiratory tract (URT) microbiome, that is balance between commensals and potential pathogens, is involved in pathogen overgrowth and consequently disease. We compared oropharyngeal microbiota of elderly pneumonia patients (n=100) with healthy elderly (n=91) by 16S-rRNA-based sequencing and verified our findings in young adult pneumonia patients (n=27) and young healthy adults (n=187). Microbiota profiles differed significantly between elderly pneumonia patients and healthy elderly (PERMANOVA, Pdisease was less clear. A decision tree model based on the relative abundance of five bacterial community members in URT microbiota showed high specificity of 95% and sensitivity of 84% (89% and 73%, respectively, after cross-validation) for differentiating pneumonia patients from healthy individuals. These results suggest that pneumonia in elderly and young adults is associated with dysbiosis of the URT microbiome with bacterial overgrowth of single species and absence of distinct anaerobic bacteria. Whether the observed microbiome changes are a cause or a consequence of the development of pneumonia or merely coincide with disease status remains a question for future research.

  4. Comparative Analysis of Quinolone Resistance in Clinical Isolates of Klebsiella pneumoniae and Escherichia coli from Chinese Children and Adults

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    Ying Huang

    2015-01-01

    Full Text Available The objective of this study was to compare quinolone resistance and gyrA mutations in clinical isolates of Klebsiella pneumoniae and Escherichia coli from Chinese adults who used quinolone in the preceding month and children without any known history of quinolone administration. The antimicrobial susceptibilities of 61 isolates from children and 79 isolates from adults were determined. The mutations in the quinolone resistance-determining regions in gyrA gene were detected by PCR and DNA sequencing. Fluoroquinolone resistance and types of gyrA mutations in isolates from children and adults were compared and statistically analyzed. No significant differences were detected in the resistance rates of ciprofloxacin and levofloxacin between children and adults among isolates of the two species (all P>0.05. The double mutation Ser83→Leu + Asp87→Asn in the ciprofloxacin-resistant isolates occurred in 73.7% isolates from the children and 67.9% from the adults, respectively (P=0.5444. Children with no known history of quinolone administration were found to carry fluoroquinolone-resistant Enterobacteriaceae isolates. The occurrence of ciprofloxacin resistance and the major types of gyrA mutations in the isolates from the children were similar to those from adults. The results indicate that precautions should be taken on environmental issues resulting from widespread transmission of quinolone resistance.

  5. Variability modifies life satisfaction's association with mortality risk in older adults

    Science.gov (United States)

    Boehm, Julia K.; Winning, Ashley; Segerstrom, Suzanne; Kubzansky, Laura D.

    2015-01-01

    Life satisfaction is associated with greater longevity, but its variability across time has not been examined relative to longevity. We investigated whether mean levels of life satisfaction across time, variability in life satisfaction across time, and their interaction were associated with mortality over 9 years of follow-up. Participants were 4,458 Australians initially ≥50 years old. During the follow-up, 546 people died. Adjusting for age, greater mean life satisfaction was associated with reduced risk and greater variability in life satisfaction was associated with increased risk of mortality. These findings were qualified by a significant interaction such that individuals with low mean satisfaction and high variability in satisfaction had the greatest risk of mortality over the follow-up period. In combination with mean levels of life satisfaction, variability in life satisfaction is relevant for mortality risk among older adults. Considering intraindividual variability provides additional insight into associations between psychological characteristics and health. PMID:26048888

  6. Incidence of asthma and mortality in a cohort of young adults: a 7-year prospective study

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    Bugianio Massimilian

    2005-08-01

    Full Text Available Abstract Background Few longitudinal data exist on the incidence of asthma in young adults and on the overall mortality risk due to asthma. A 7-year follow-up prospective study was performed to assess the incidence of asthma and mortality from all causes in a cohort of young adults. Methods The life status of a cohort of 6031 subjects, aged 20–44 years, who replied to a respiratory screening questionnaire between 1991 and 1992, was ascertained in 1999. A new questionnaire investigating the history of asthma was subsequently sent to the 5236 subjects who were still alive and residents in the areas of the study. 3880 subjects (74% replied to the second questionnaire. Results The incidence of adult-onset asthma was 15.3/10,000/year (95%CI:11.2–20.8. The presence of asthma-like symptoms (IRR:4.17; 95%CI:2.20–7.87 and allergic rhinitis (IRR:3.30; 95%CI:1.71–6.36 at baseline were independent predictors of the onset of asthma, which was more frequent in women (IRR:2.32; 95%CI:1.16–4.67 and increased in the younger generations. The subjects who reported asthma attacks or nocturnal asthma symptoms at baseline had an excess mortality risk from all causes (SMR = 2.05; 95%CI:1.06–3.58 in the subsequent seven years. The excess mortality was mainly due to causes not related to respiratory diseases. Conclusion Asthma occurrence is a relevant public health problem even in young adults. The likelihood of developing adult onset asthma is significantly higher in people suffering from allergic rhinitis, in women and in more recent generations. The presence of asthma attacks and nocturnal symptoms seems to be associated with a potential excess risk of all causes mortality.

  7. Procalcitonin versus C-reactive protein for predicting pneumonia in adults with lower respiratory tract infection in primary care

    DEFF Research Database (Denmark)

    Holm, Anette; Pedersen, Svend S; Nexoe, Joergen;

    2007-01-01

    BACKGROUND: The role of procalcitonin in diagnosing bacterial infection has mainly been studied in patients with severe infections. There is no study on the value of procalcitonin measurements in adults with lower respiratory tract infection (LRTI) treated in primary care. AIM: To evaluate the...... accuracy of plasma procalcitonin in predicting radiographic pneumonia, bacterial infection, and adverse outcome in a population of adults with LRTI treated in primary care. DESIGN OF STUDY: Prospective, observational study. SETTING: Forty-two general practices and an outpatient clinic at the Department of...... Infectious Diseases, Odense University Hospital, Denmark. METHOD: A total of 364 patients with LRTI were prospectively enrolled from 42 general practices. Patients were examined with chest radiography, microbiological analyses, and measurements of C-reactive protein (CRP) and procalcitonin. The outcome...

  8. Dying in their prime: determinants and space-time risk of adult mortality in rural South Africa

    Science.gov (United States)

    Sartorius, Benn; Kahn, Kathleen; Collinson, Mark A.; Sartorius, Kurt; Tollman, Stephen M.

    2013-01-01

    A longitudinal dataset was used to investigate adult mortality in rural South Africa in order to determine location, trends, high impact determinants and policy implications. Adult (15-59 years) mortality data for the period 1993-2010 were extracted from the health and socio-demographic surveillance system (HDSS) in the rural sub-district of Agincourt. A Bayesian geostatistical frailty survival model was used to quantify significant associations between adult mortality and various multilevel (individual, household and community) variables. It was found that adult mortality significantly increased over time with a reduction observed late in the study period. Non-communicable disease mortality appeared to increase and decrease in parallel with communicable mortality, whilst deaths due to external causes remained constant. Male gender, unemployment, circular (labour) migrant status, age and gender of household heads, partner and/or other household death, low education and low household socioeconomic status (SES) were identified as significant and highly attributable determinants of adult mortality. Health facility remoteness was also a risk for adult mortality and households falling outside a critical buffering zone were identified. Spatial foci of higher adult mortality risk were observed indicating a strong non-random pattern. Communicable diseases differed from non-communicable diseases with respect to spatial distribution of mortality. Areas with significant excess mortality risk (hotspots) were found to be part of a complex interaction of highly attributable factors that continues to drive differential space-time risk patterns of communicable (HIV/AIDS and Tuberculosis) mortality in Agincourt. The impact of HIV mortality and its subsequent lowering due to the introduction of antiretroviral therapy (ART) was found to be clearly evident in this rural population. PMID:23733287

  9. Neumonía grave del adulto adquirida en la comunidad SEVERE COMMUNITY-ACQUIRED PNEUMONIA IN ADULTS

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    Francisco Arancibia H.

    2005-04-01

    category, high complication rate, prolonged hospital stay and high mortality rate are the rule. The American Thoracic Society (ATS criteria for severe pneumonia establishes the following: main criteria, necessity of mechanical ventilation and presence of septic shock; minor criteria, systolic blood pressure 20 mg/dl and mental confusion. In all patients with CAP it is recommended the evaluation of its severity at admission. This evaluation should be done in conjunction with an experienced physician, and if criteria for poor prognosis are met, an early admission to ICU is recommended. ATS and BTS modified criteria (CURB are useful in this procedure. In severely ill patients with CAP it is recommended to perform the following microbiological analysis: sputum Gram stain and culture, blood culture, pleural fluid Gram stain and culture, if present and tapped, Legionella pneumophila urine antigen test, influenza A and B antigen detection tests (epidemic period: autumn and winter, and serology for atypical bacteria (Mycoplasma pneumoniae and Chlamydia pneumoniae

  10. Aspiration pneumonia

    Science.gov (United States)

    Anaerobic pneumonia; Aspiration of vomitus; Necrotizing pneumonia; Aspiration pneumonitis ... The type of bacteria that caused the pneumonia depends on: Your ... facility, for example) Whether you were recently hospitalized ...

  11. Low-Temperature Stress during Capped Brood Stage Increases Pupal Mortality, Misorientation and Adult Mortality in Honey Bees

    Science.gov (United States)

    Wang, Qing; Xu, Xinjian; Zhu, Xiangjie; Chen, Lin; Zhou, Shujing; Huang, Zachary Y.; Zhou, Bingfeng

    2016-01-01

    Honey bees (Apis mellifera) are key pollinators, playing a vital role in ecosystem maintenance and stability of crop yields. Recently, reduced honey bee survival has attracted intensive attention. Among all other honey bee stresses, temperature is a fundamental ecological factor that has been shown to affect honey bee survival. Yet, the impact of low temperature stress during capped brood on brood mortality has not been systematically investigated. In addition, little was known about how low temperature exposure during capped brood affects subsequent adult longevity. In this study, capped worker broods at 12 different developmental stages were exposed to 20°C for 12, 24, 36, 48, 60, 72, 84 and 96 hours, followed by incubation at 35°C until emergence. We found that longer durations of low temperature during capped brood led to higher mortality, higher incidences of misorientation inside cells and shorter worker longevity. Capped brood as prepupae and near emergence were more sensitive to low-temperature exposure, while capped larvae and mid-pupal stages showed the highest resistance to low-temperature stress. Our results suggest that prepupae and pupae prior to eclosion are the most sensitive stages to low temperature stress, as they are to other stresses, presumably due to many physiological changes related to metamorphosis happening during these two stages. Understanding how low-temperature stress affects honey bee physiology and longevity can improve honey bee management strategies. PMID:27149383

  12. Low-Temperature Stress during Capped Brood Stage Increases Pupal Mortality, Misorientation and Adult Mortality in Honey Bees.

    Directory of Open Access Journals (Sweden)

    Qing Wang

    Full Text Available Honey bees (Apis mellifera are key pollinators, playing a vital role in ecosystem maintenance and stability of crop yields. Recently, reduced honey bee survival has attracted intensive attention. Among all other honey bee stresses, temperature is a fundamental ecological factor that has been shown to affect honey bee survival. Yet, the impact of low temperature stress during capped brood on brood mortality has not been systematically investigated. In addition, little was known about how low temperature exposure during capped brood affects subsequent adult longevity. In this study, capped worker broods at 12 different developmental stages were exposed to 20°C for 12, 24, 36, 48, 60, 72, 84 and 96 hours, followed by incubation at 35°C until emergence. We found that longer durations of low temperature during capped brood led to higher mortality, higher incidences of misorientation inside cells and shorter worker longevity. Capped brood as prepupae and near emergence were more sensitive to low-temperature exposure, while capped larvae and mid-pupal stages showed the highest resistance to low-temperature stress. Our results suggest that prepupae and pupae prior to eclosion are the most sensitive stages to low temperature stress, as they are to other stresses, presumably due to many physiological changes related to metamorphosis happening during these two stages. Understanding how low-temperature stress affects honey bee physiology and longevity can improve honey bee management strategies.

  13. Cause-specific mortality in adult epilepsy patients from Tyrol, Austria: hospital-based study.

    Science.gov (United States)

    Granbichler, Claudia A; Oberaigner, Willi; Kuchukhidze, Giorgi; Bauer, Gerhard; Ndayisaba, Jean-Pierre; Seppi, Klaus; Trinka, Eugen

    2015-01-01

    Epilepsy is a devastating condition with a considerable increase in mortality compared to the general population. Few studies have focused on cause-specific mortality which we analyse in detail in over 4,000 well-characterized epilepsy patients. The cohort comprised of epilepsy patients ≥ 18, treated between 1970 and 2009 at the epilepsy clinic of Innsbruck Medical University, Austria, and living in the province of Tyrol, Austria. Epilepsy diagnosis was based on ILAE guidelines (1989); patients with brain tumor were excluded. Deceased patients and causes of death (ICD-codes) were obtained via record linkage to the national death registry. We computed age-, sex-, and period-adjusted standardized mortality rates (SMR) for 36 diagnoses subgroups in four major groups. Additional analyses were performed for an incidence cohort. Overall cohort: 4,295 patients, 60,649.1 person-years, 822 deaths, overall SMR 1.7 (95 % CI 1.6-1.9), highest elevated cause-specific SMR: congenital anomalies [7.1 (95 % CI 2.3-16.6)], suicide [4.2 (95 % CI 2.0-8.1)], alcohol dependence syndrome [3.9 (95 % CI 1.8-7.4)], malignant neoplasm of esophagus [3.1 (95 % CI 1.2-6.4)], pneumonia [2.7 (95 % CI 1.6-4.2)]. Incidence cohort: 1,299 patients, 14,215.4 person-years, 267 deaths, overall SMR 1.8 (95 % CI 1.6-2.1), highest elevated cause-specific SMR congenital anomalies [10.8 (95 % CI 1.3-39.3)], suicide [6.8 (95 % CI 1.4-19.8)], alcohol dependence syndrome (6.4 [95 % CI 1.8-16.5)], pneumonia [3.9 (95 % CI 1.8-7.4)], cerebrovascular disease at 3.5 (95 % CI 2.6-4.6). Mortality due to mental health problems, such as suicide or alcohol dependence syndrome, malignant neoplasms, and cerebrovascular diseases was highly increased in our study. In addition to aim for seizure freedom, we suggest improving general health promotion, including cessation of smoking, lowering of alcohol intake, and reduction of weight as well as early identification of psychiatric comorbidity in patients with epilepsy.

  14. Dietary magnesium intake is inversely associated with mortality in adults at high cardiovascular disease risk.

    Science.gov (United States)

    Guasch-Ferré, Marta; Bulló, Mònica; Estruch, Ramon; Corella, Dolores; Martínez-González, Miguel A; Ros, Emilio; Covas, Maribel; Arós, Fernando; Gómez-Gracia, Enrique; Fiol, Miquel; Lapetra, José; Muñoz, Miguel Ángel; Serra-Majem, Lluís; Babio, Nancy; Pintó, Xavier; Lamuela-Raventós, Rosa M; Ruiz-Gutiérrez, Valentina; Salas-Salvadó, Jordi

    2014-01-01

    The relation between dietary magnesium intake and cardiovascular disease (CVD) or mortality was evaluated in several prospective studies, but few of them have assessed the risk of all-cause mortality, which has never been evaluated in Mediterranean adults at high cardiovascular risk. The aim of this study was to assess the association between magnesium intake and CVD and mortality risk in a Mediterranean population at high cardiovascular risk with high average magnesium intake. The present study included 7216 men and women aged 55-80 y from the PREDIMED (Prevención con Dieta Mediterránea) study, a randomized clinical trial. Participants were assigned to 1 of 2 Mediterranean diets (supplemented with nuts or olive oil) or to a control diet (advice on a low-fat diet). Mortality was ascertained by linkage to the National Death Index and medical records. We fitted multivariable-adjusted Cox regressions to assess associations between baseline energy-adjusted tertiles of magnesium intake and relative risk of CVD and mortality. Multivariable analyses with generalized estimating equation models were used to assess the associations between yearly repeated measurements of magnesium intake and mortality. After a median follow-up of 4.8 y, 323 total deaths, 81 cardiovascular deaths, 130 cancer deaths, and 277 cardiovascular events occurred. Energy-adjusted baseline magnesium intake was inversely associated with cardiovascular, cancer, and all-cause mortality. Compared with lower consumers, individuals in the highest tertile of magnesium intake had a 34% reduction in mortality risk (HR: 0.66; 95% CI: 0.45, 0.95; P magnesium intake was inversely associated with mortality risk in Mediterranean individuals at high risk of CVD. This trial was registered at controlled-trials.com as ISRCTN35739639.

  15. Pneumonia and in-hospital mortality in the context of neurogenic oropharyngeal dysphagia (NOD) in stroke and a new NOD step-wise concept.

    Science.gov (United States)

    Ickenstein, G W; Riecker, A; Höhlig, C; Müller, R; Becker, U; Reichmann, H; Prosiegel, M

    2010-09-01

    The aim of our work was to develop a step-wise concept for investigating neurogenic oropharyngeal dysphagia (NOD) that could be used by both trained nursing staff as well as swallowing therapists and physicians to identify patients with NOD at an early stage and so enable an appropriate therapy to be started. To achieve this objective, we assessed uniform terminology and standard operating procedures (SOP) in a new NOD step-wise concept. In-house stroke mortality rates and rates of pneumonia were measured over time (2003-2009) in order to show improvements in quality of care. In addition, outcome measures in a stroke-unit monitoring system were studied after neurorehabilitation (day 90) assessing quality of life (QL) and patient feedback. An investigation that was carried out in the context of internal and external quality assurance stroke projects revealed a significant correlation between the NOD step-wise concept and low rates of pneumonia and in-house mortality. The quality of life measures show a delta value that can contribute to "post-stroke" depression. The NOD step-wise concept (NSC) should, on the one hand, be capable of being routinely used in clinical care and, on the other, being able to fulfil the requirements of being scientifically based for investigating different stages of swallowing disorders. The value of our NSC relates to the effective management of clinical resources and the provision of adequate diagnostic and therapeutic options for different grades of dysphagia. We anticipate that our concept will provide substantial support to physicians, as well as swallowing therapists, in clinical settings and rehabilitation facilities, thereby promoting better guidance and understanding of neurogenic dysphagia as a concept in acute and rehabilitation care, especially stroke-unit settings.

  16. Positive affect and mortality risk in older adults: A meta-analysis.

    Science.gov (United States)

    Zhang, Yujing; Han, Buxin

    2016-06-01

    We performed a meta-analysis on the relationship between positive affect (PA) and mortality risk in older adults (55 years and older) and reviewed evidence on the Main Effect Model and the Stress-buffering Model of PA. Four databases (ISI Web of Knowledge, APA PsycNET, PubMed, and Embase) were used to identify potential studies. Three types of effect sizes (ESs), odds ratio, relative risk, and hazard ratio (OR, RR, and HR), were calculated and analyzed within a random effects model. The analysis of the studies in which the effects of other variables were not controlled indicated that older adults with higher levels of positive affect had lower mortality risk (75%, HR = 0.75, 95% confidence interval [CI] = 0.66-0.85) than those with lower positive affect. In studies in which the effects of covariates were controlled, this rate was 85% (HR = 0.85, 95% CI = 0.81-0.89), which was still significant. These results suggest that higher positive affect is associated with lower mortality risk in community-dwelling older adults, even after controlling for medical, psychological, and social factors. The results point to potential methods of improving longevity, and to achieving healthy aging in older adults. PMID:27113246

  17. Clinical Predictors of Mortality in Adults with Intellectual Disabilities with and without Down Syndrome

    Directory of Open Access Journals (Sweden)

    Lilian Thorpe

    2012-01-01

    Full Text Available Background. Mood, baseline functioning, and cognitive abilities as well as psychotropic medications may contribute to mortality in adults with and without Down Syndrome (DS. Methods. Population-based (nonclinical, community-dwelling adults with intellectual disabilities (IDs were recruited between 1995 and 2000, assessed individually for 1–4 times, and then followed by yearly phone calls. Results. 360 participants (116 with DS and 244 without DS were followed for an average of 12.9 years (range 0–16.1 years as of July 2011. 108 people died during the course of the followup, 65 males (31.9% of all male participants and 43 females (27.6% of all female participants. Cox proportional hazards modeling showed that baseline practical skills, seizures, anticonvulsant use, depressive symptoms, and cognitive decline over the first six years all significantly contributed to mortality, as did a diagnosis of DS, male gender, and higher age at study entry. Analysis stratified by DS showed interesting differences in mortality predictors. Conclusion. Although adults with DS have had considerable improvements in life expectancy over time, they are still disadvantaged compared to adults with ID without DS. Recognition of potentially modifiable factors such as depression may decrease this risk.

  18. Obesity, metabolic health, and mortality in adults: a nationwide population-based study in Korea

    Science.gov (United States)

    Yang, Hae Kyung; Han, Kyungdo; Kwon, Hyuk-Sang; Park, Yong-Moon; Cho, Jae-Hyoung; Yoon, Kun-Ho; Kang, Moo-Il; Cha, Bong-Yun; Lee, Seung-Hwan

    2016-01-01

    BMI, metabolic health status, and their interactions should be considered for estimating mortality risk; however, the data are controversial and unknown in Asians. We aimed to investigate this issue in Korean population. Total 323175 adults were followed-up for 96 (60–120) (median [5–95%]) months in a nationwide population-based cohort study. Participants were classified as “obese” (O) or “non-obese” (NO) using a BMI cut-off of 25 kg/m2. People who developed ≥1 metabolic disease component (hypertension, diabetes, dyslipidaemia) in the index year were considered “metabolically unhealthy” (MU), while those with none were considered “metabolically healthy” (MH). The MUNO group had a significantly higher risk of all-cause (hazard ratio, 1.28 [95% CI, 1.21–1.35]) and cardiovascular (1.88 [1.63–2.16]) mortality, whereas the MHO group had a lower mortality risk (all-cause: 0.81 [0.74–0.88]), cardiovascular: 0.73 [0.57–0.95]), compared to the MHNO group. A similar pattern was noted for cancer and other-cause mortality. Metabolically unhealthy status was associated with higher risk of all-cause and cardiovascular mortality regardless of BMI levels, and there was a dose-response relationship between the number of incident metabolic diseases and mortality risk. In conclusion, poor metabolic health status contributed more to mortality than high BMI did, in Korean adults. PMID:27445194

  19. Dual sensory impairment in older adults increases the risk of mortality: a population-based study.

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    Bamini Gopinath

    Full Text Available Although concurrent vision and hearing loss are common in older adults, population-based data on their relationship with mortality is limited. This cohort study investigated the association between objectively measured dual sensory impairment (DSI with mortality risk over 10 years. 2812 Blue Mountains Eye Study participants aged 55 years and older at baseline were included for analyses. Visual impairment was defined as visual acuity less than 20/40 (better eye, and hearing impairment as average pure-tone air conduction threshold greater than 25 dB HL (500-4000 Hz, better ear. Ten-year all-cause mortality was confirmed using the Australian National Death Index. After ten years, 64% and 11% of participants with DSI and no sensory loss, respectively, had died. After multivariable adjustment, participants with DSI (presenting visual impairment and hearing impairment compared to those with no sensory impairment at baseline, had 62% increased risk of all-cause mortality, hazard ratio, HR, 1.62 (95% confidence intervals, CI, 1.16-2.26. This association was more marked in those with both moderate-severe hearing loss (>40 dB HL and presenting visual impairment, HR 1.84 (95% CI 1.19-2.86. Participants with either presenting visual impairment only or hearing impairment only, did not have an increased risk of mortality, HR 1.05 (95% CI 0.61-1.80 and HR 1.24 (95% CI 0.99-1.54, respectively. Concurrent best-corrected visual impairment and moderate-severe hearing loss was more strongly associated with mortality 10 years later, HR 2.19 (95% CI 1.20-4.03. Objectively measured DSI was an independent predictor of total mortality in older adults. DSI was associated with a risk of death greater than that of either vision loss only or hearing loss alone.

  20. Comorbidities as a driver of the excess costs of community-acquired pneumonia in U.S. commercially-insured working age adults

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    Polsky Daniel

    2012-10-01

    Full Text Available Abstract Background Adults with certain comorbid conditions have a higher risk of pneumonia than the overall population. If treatment of pneumonia is more costly in certain predictable situations, this would affect the value proposition of populations for pneumonia prevention. We estimate the economic impact of community-acquired pneumonia (CAP for adults with asthma, diabetes, chronic obstructive pulmonary disease (COPD and congestive heart failure (CHF in a large U.S. commercially-insured working age population. Methods Data sources consisted of 2003 through 2007 Thomson Reuters MarketScan Commercial Claims and Encounters and Thomson Reuters Health Productivity and Management (HPM databases. Pneumonia episodes and selected comorbidities were identified by ICD-9-CM diagnosis codes. By propensity score matching, controls were identified for pneumonia patients. Excess direct medical costs and excess productivity cost were estimated by generalized linear models (GLM. Results We identified 402,831 patients with CAP between 2003 through 2007, with 25,560, 32,677, 16,343, and 5,062 episodes occurring in patients with asthma, diabetes, COPD and CHF, respectively. Mean excess costs (and standard error, SE of CAP were $14,429 (SE=44 overall. Mean excess costs by comorbidity subgroup were lowest for asthma ($13,307 (SE=123, followed by diabetes ($21,395 (SE=171 and COPD ($23,493 (SE=197; mean excess costs were highest for patients with CHF ($34,436 (SE=549. On average, indirect costs comprised 21% of total excess costs, ranging from 8% for CHF patients to 27% for COPD patients. Conclusions Compared to patients without asthma, diabetes, COPD, or CHF, the excess cost of CAP is nearly twice as high for patients with diabetes and COPD and nearly three times as high for patients with CHF. Indirect costs made up a significant but varying portion of excess CAP costs. Returns on prevention of pneumonia would therefore be higher in adults with these comorbidities.

  1. Lipids and All-Cause Mortality among Older Adults: A 12-Year Follow-Up Study

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    Marcos Aparecido Sarria Cabrera

    2012-01-01

    Full Text Available This is a 12-year follow-up cohort study with 800 people (60–85 years old. The association between lipid disorders and mortality was analysed by Cox proportional hazard adjusted model. All-cause mortality was considered the dependent variable, and lipid disorders as independent variables: total cholesterol (TC >200 and 100 and 130, and triglycerides (TG >50. An initial analysis of all subjects was performed and a second was carried out after having excluded individuals with a body mass index (BMI <20 kg/m2 or mortality in ≤2 years. The mortality showed a positive association with low TC and a negative association with high TC and high LDL-c. After the exclusion of underweight and premature mortality, there was a positive association only with TC <170 mg/dl (HR = 1.36, CI95%: 1.02–1.82. The data did not show a higher risk with high levels of TC, LDL-c, and TG. However, they showed higher mortality among older adults with low TC.

  2. Antibiotic treatment and the diagnosis of Streptococcus pneumoniae in lower respiratory tract infections in adults

    DEFF Research Database (Denmark)

    Korsgaard, Jens; Møller, Jens Kjølseth; Kilian, Mogens

    2005-01-01

    patient was positive in both systems, making a total of 22 patients with documented pneumococcal infection. As a positive culture test was dependent on the absence of antibiotic treatment, whereas a positive urine antigen test depended on antibiotic treatment within 48 hours, the two tests were...... complementary in the diagnosis of infection with S. pneumoniae. The third group of patients with probable pneumococcal infection were identified as 26% and 20% of the remaining 137 patients with unknown or known non-pneumococcal etiology, respectively, who received recent antibiotic treatment within 2-4 weeks...... of diagnostic sampling. By comparison, 0% (p < 0.01) with documented pneumococcal infection received antibiotic treatment in weeks 2-4 prior to microbiological sampling. As such a further eight patients should be expected to have infection with S. pneumoniae but would test negative in both culture...

  3. Time to positivity in blood cultures of adults with Streptococcus pneumoniae bacteremia

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    Ansorena Luis

    2006-04-01

    Full Text Available Abstract Background previous studies have established that bacterial blood concentration is related with clinical outcome. Time to positivity of blood cultures (TTP has relationship with bacterial blood concentration and could be related with prognosis. As there is scarce information about the usefulness of TTP, we study the relationship of TTP with clinical parameters in patients with Streptococcus pneumoniae bacteremia. Methods TTP of all cases of Streptococcus pneumoniae bacteremia, detected between January 1995 and December 2004 using the BacT/Alert automated blood culture system in a teaching community hospital was analyzed. When multiple cultures were positive only the shortest TTP was selected for the analysis. Results in the study period 105 patients with Streptococcus pneumoniae bacteremia were detected. Median TTP was 14.1 hours (range 1.2 h to 127 h. Immunosuppressed patients (n = 5, patients with confusion (n = 19, severe sepsis or shock at the time of blood culture extraction (n = 12, those with a diagnosis of meningitis (n = 7 and those admitted to the ICU (n = 14 had lower TTP. Patients with TTP in the first quartile were more frequently hospitalized, admitted to the ICU, had meningitis, a non-pneumonic origin of the bacteremia, and a higher number of positive blood cultures than patients with TTP in the fourth quartile. None of the patients with TTP in the 90th decile had any of these factors associated with shorter TTP, and eight out of ten patients with TTP in the 10th decile had at least one of these factors. The number of positive blood cultures had an inverse correlation with TTP, suggesting a relationship of TTP with bacterial blood concentration. Conclusion Our data support the relationship of TTP with several clinical parameters in patients with Streptococcus pneumoniae bacteremia, and its potential usefulness as a surrogate marker of outcome.

  4. Burden of Severe Pneumonia, Pneumococcal Pneumonia and Pneumonia Deaths in Indian States: Modelling Based Estimates

    OpenAIRE

    Farooqui, H; Jit, M.; Heymann, DL; Zodpey, S.

    2015-01-01

    The burden of severe pneumonia in terms of morbidity and mortality is unknown in India especially at sub-national level. In this context, we aimed to estimate the number of severe pneumonia episodes, pneumococcal pneumonia episodes and pneumonia deaths in children younger than 5 years in 2010. We adapted and parameterized a mathematical model based on the epidemiological concept of potential impact fraction developed CHERG for this analysis. The key parameters that determine the distribution ...

  5. Mortalidad en México por influenza y neumonía (1990-2005 Mortality due to influenza and pneumonia in Mexico between 1990 and 2005

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    Pablo Kuri-Morales

    2006-10-01

    Full Text Available OBJETIVO: Estimar el impacto de la vacuna contra la influenza en personas menores de dos años y mayores de 65, a través del análisis de la mortalidad por influenza y neumonía en la República mexicana entre 1990 y 2005, y determinar el patrón estacional de comportamiento de la mortalidad, la tendencia de mortalidad por volumen de defunciones por periodo estacional y la velocidad de mortalidad. MATERIAL Y MÉTODOS: Los datos se tomaron del Sistema Epidemiológico y Estadístico de Defunciones (SEED-SSA. RESULTADOS: El análisis mostró una tendencia de defunciones a la baja con una rapidez respectiva de 509 y 29 defunciones menos por año, así como una interrupción de la tendencia ascendente de la mortalidad por la vacunación. CONCLUSIONES: La intervención por vacunación tiene costos positivos, tanto económicos como de calidad de vida, por lo que su implementación debe considerarse en un contexto que refleje una menor incidencia de hospitalizaciones y muertes.OBJECTIVE: To estimate the impact of influenza vaccine in infants less than two years of age and in elders more than sixty-five years of age, through the analysis of mortality due to influenza and pneumonia in Mexico, between 1990 and 2005. To determine the seasonal pattern of mortality, the tendency of mortality by volume of deaths per seasonal period, and the speed rate of mortality. MATERIAL AND METHODS: Data were taken from the Epidemiological and Statistical Mortality System (SEED-SSA per its abbreviation in Spanish. RESULTS AND CONCLUSIONS: The analysis showed there is a tendency of deaths decrease at a rate of 509 deaths less per year in the infants group and 29 deaths less in the elders group. Also, the ascending tendency of mortality was interrupted by vaccination. The vaccination intervention has a positive economic effect and also helps improve the quality of life. Therefore, its implementation is expected to lower hospital admissions and deaths.

  6. Effect of the Diagnosis of Inflammatory Bowel Disease on Risk-Adjusted Mortality in Hospitalized Patients with Acute Myocardial Infarction, Congestive Heart Failure and Pneumonia

    Science.gov (United States)

    Ehrenpreis, Eli D.; Zhou, Ying; Alexoff, Aimee; Melitas, Constantine

    2016-01-01

    Introduction Measurement of mortality in patients with acute myocardial infarction (AMI), congestive heart failure (CHF) and pneumonia (PN) is a high priority since these are common reasons for hospitalization. However, mortality in patients with inflammatory bowel disease (IBD) that are hospitalized for these common medical conditions is unknown. Methods A retrospective review of the 2005–2011 National Inpatient Sample (NIS), (approximately a 20% sample of discharges from community hospitals) was performed. A dataset for all patients with ICD-9-CM codes for primary diagnosis of acute myocardial infarction, pneumonia or congestive heart failure with a co-diagnosis of IBD, Crohn’s disease (CD) or ulcerative colitis (UC). 1:3 propensity score matching between patients with co-diagnosed disease vs. controls was performed. Continuous variables were compared between IBD and controls. Categorical variables were reported as frequency (percentage) and analyzed by Chi-square tests or Fisher’s exact test for co-diagnosed disease vs. control comparisons. Propensity scores were computed through multivariable logistic regression accounting for demographic and hospital factors. In-hospital mortality between the groups was compared. Results Patients with IBD, CD and UC had improved survival after AMI compared to controls. 94/2280 (4.1%) of patients with IBD and AMI died, compared to 251/5460 (5.5%) of controls, p = 0.01. This represents a 25% improved survival in IBD patients that were hospitalized with AMI. There was a 34% improved survival in patients with CD and AMI. There was a trend toward worsening survival in patients with IBD and CHF. Patients with CD and PN had improved survival compared to controls. 87/3362 (2.59%) patients with CD and PN died, compared to 428/10076 (4.25%) of controls, p < .0001. This represents a 39% improved survival in patients with CD that are hospitalized for PN. Conclusion IBD confers a survival benefit for patients hospitalized with AMI. A

  7. Lung pathology and infectious agents in fatal feedlot pneumonias and relationship with mortality, disease onset, and treatments

    Science.gov (United States)

    This study charted 237 fatal cases of bovine respiratory disease (BRD) observed from May 2002-May 2003 in one Oklahoma feedyard. The data collected included: agent identification, observed pathology, mortality, and animal treatment information. The cattle died either in the sick pen after treatment ...

  8. Hyperglycemia increases the complicated infection and mortality rates during induction therapy in adult acute leukemia patients

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    Carolina do Nascimento Matias

    2013-01-01

    Full Text Available OBJECTIVE: To determine the prevalence of hyperglycemia during induction therapy in adult patients with acute leukemia and its effect on complicated infections and mortality during the first 30 days of treatment. METHODS: An analysis was performed in a retrospective cohort of 280 adult patients aged 18 to 60 years with previously untreated acute leukemia who received induction chemotherapy from January 2000 to December 2009 at the Hemocentro de Pernambuco (HEMOPE, Brazil. Hyperglycemia was defined as the finding of at least one fasting glucose measurement > 100 mg/dL observed one week prior to induction therapy until 30 days after. The association between hyperglycemia and complicated infections, mortality and complete remission was evaluated using the Chi-square or Fisher's exact tests by the Statistical Package for Social Sciences (SPSS in the R software package version 2.9.0. RESULTS: One hundred and eighty-eight patients (67.1% presented hyperglycemia at some moment during induction therapy. Eighty-two patients (29.3% developed complicated infections. Infection-related mortality during the neutropenia period was 20.7% (58 patients. Mortality from other causes during the first 30 days after induction was 2.8%. Hyperglycemia increased the risk of complicated infections (OR 3.97; 95% confidence interval: 2.08 - 7.57; p-value < 0.001 and death (OR 3.55; 95% confidence interval: 1.77-7.12; p-value < 0.001 but did not increase the risk of fungal infections or decrease the probability of achieving complete remission. CONCLUSION: This study demonstrates an association between the presence of hyperglycemia and the development of complicated infections and death in adult patients during induction therapy for acute leukemia.

  9. The effect of July admission on inpatient morbidity and mortality after adult spinal deformity surgery

    Science.gov (United States)

    De la Garza-Ramos, Rafael; Passias, Peter G.; Schwab, Frank J.; Lafage, Virginie

    2016-01-01

    Background Some studies have suggested patients who undergo surgery in July have worse outcomes compared to patients treated during other months. The purpose of this study is to compare inpatient morbidity and mortality among patients who underwent adult spinal deformity (ASD) surgery in July with those who underwent surgery in other months. Methods Admission data for patients who underwent ASD surgery were extracted from the Nationwide Inpatient Sample for the years 2002 to 2011. Only adult patients (over 21 years of age) and elective admissions to teaching hospitals were included. A multivariable regression analysis was performed to examine the independent effect of July admissions on overall complications, major complications, and inpatient mortality. Results A total of 27,794 patients were identified, with 2,023 (7.8%) admitted in July and 25,771 (92.2%) in other months. Overall complication rates in July (43.1%) were not different from rates in other months (44.9%, p=0.468). Similarly, major complication rates were similar; 12.9% in July and 12.4% in other months (p=0.764). Mortality was not different between groups (p=0.807). After multivariable analysis, July admissions were not found to increase the odds of developing any complication (OR 0.94; 95% CI, 0.77 - 1.12; p=0.403), major complications (OR 1.04; 95% CI, 0.76 - 1.41; p=0.788) or inpatient mortality (OR 1.35; 95% CI, 0.31 - 5.84; p=0.684). Conclusion In this study of a nationwide database, patients who underwent ASD surgery in July did not have increased odds of developing a complication or inpatient mortality compared to patients admitted in other months. PMID:26913223

  10. Infant mortality, season of birth and the health of older Puerto Rican adults.

    Science.gov (United States)

    McEniry, Mary

    2011-03-01

    The increasing prevalence of heart disease and diabetes among aging populations in low and middle income countries leads to questions regarding the degree to which endogenous early life exposures (exposures in utero) are important determinants of these health conditions. We devised a test using infant mortality (IMR) to verify if season of birth is a good indicator of early life (in utero) conditions that precipitate adult onset of disease. We linked annual IMR at the municipality (municipio) level from the late 1920s to early 1940s with individual birth year and place using a representative sample of older Puerto Rican adults (n = 1447) from the Puerto Rican Elderly: Health Conditions (PREHCO) study. We estimated the effects of season of birth on adult heart disease and diabetes for all respondents and then for respondents according to whether they were born when IMR was lower or higher, controlling for age, gender, obesity, respondent's educational level, adult behavior (smoking and exercise) and other early life exposures (childhood health, knee height and childhood socioeconomic status (SES)). The pattern of effects suggests that season of birth reflects endogenous causes: (1) odds of heart disease and diabetes were strong and significant for those born during the lean season in years when IMR was lower; (2) effects remained consistent even after controlling for other childhood conditions and adult behavior; but (3) no seasonality effects on adult health for adults born when IMR was higher. We conclude that in this population of older Puerto Rican adults there is continued support that the timing of adverse endogenous (in utero) conditions such as poor nutrition and infectious diseases is associated with adult heart disease and diabetes. It will be important to test the validity of these findings in other similar populations in the developing world. PMID:20980087

  11. The plasma level of soluble urokinase receptor is elevated in patients with Streptococcus pneumoniae bacteraemia and predicts mortality

    DEFF Research Database (Denmark)

    Wittenhagen, p; Kronborg, Gitte; Nielsen, H;

    2004-01-01

    This multicentre prospective study was conducted to investigate whether the level of the soluble form of urokinase-type plasminogen activator receptor (suPAR) is elevated during pneumococcal bacteraemia and is of predictive value in the early stage of the disease. Plasma levels of suPAR were...... (n = 117; p cerebral symptoms and high serum concentrations of protein YKL-40 and suPAR were associated significantly with mortality (p ....05). In multivariate analysis, only suPAR remained a significant predictor of death (mortality rate of 13 for suPAR levels of > 10 ng/mL; 95% CI: 1.1-158). The increase in suPAR levels may reflect increased expression by vascular or inflammatory cells in the setting of pneumococcal sepsis. This plasma protein may...

  12. Comatose and noncomatose adult diabetic ketoacidosis patients at the University Teaching Hospital, Zambia: Clinical profiles, risk factors, and mortality outcomes

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    Mwanja Kakusa

    2016-01-01

    Full Text Available Background: Diabetic ketoacidosis (DKA is one of the commonly encountered diabetes mellitus emergencies. Aim: This study aimed at describing the clinical profiles and hospitalization outcomes of DKA patients at the University Teaching Hospital (UTH in Lusaka, Zambia and to investigate the role of coma on mortality outcome. Materials and Methods: This was a cross-sectional analytical study of hospitalized DKA patients at UTH. The data collected included clinical presentation, precipitating factors, laboratory profiles, complications, and hospitalization outcomes. Primary outcome measured was all-cause in-hospital mortality. Results: The median age was 40 years. Treatment noncompliance was the single highest identified risk factor for development of DKA, followed by new detection of diabetes, then infections. Comatose patients were significantly younger, had lower baseline blood pressure readings, and higher baseline respiratory rates compared to noncomatose patients. In addition, comatose patients had higher baseline admission random blood glucose readings. Their baseline sodium and chloride levels were also higher. The prevalences of hypokalemia, hypernatremia, and hyperchloremia were also higher among comatose patients compared to noncomatose patients. Development of aspiration during admission with DKA, pneumonia at baseline, development of renal failure, and altered mental status were associated with an increased risk of mortality. Development of renal failure was independently predictive of mortality. Conclusion: The mortality rate from DKA hospitalizations is high at UTH. Treatment noncompliance is the single highest identifiable precipitant of DKA. Aspiration, development of renal failure, altered sensorium, and pneumonia at baseline are associated with an increased risk of mortality. Development of renal failure during admission is predictive of mortality.

  13. Cancer incidence and mortality trends in Australian adolescents and young adults, 1982–2007

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    Haggar Fatima A

    2012-04-01

    Full Text Available Abstract Background Increasing incidence and lack of survival improvement in adolescents and young adults (AYAs with cancer have led to increased awareness of the cancer burden in this population. The objective of this study was to describe overall and type-specific cancer incidence and mortality trends among AYAs in Western Australia from 1982–2007. Methods Age–adjusted incidence and mortality rates were calculated for all malignancies combined and for each of the most common diagnostic groups, using five-year age–specific rates. Joinpoint regression analysis was used to derive annual percentage changes (APC for incidence and mortality rates. Results The annual incidence rate for all cancers combined increased in males from 1982 until 2000 (APC = 1.5%, 95%CI: 0.9%; 2.1% and then plateaued, whilst rates for females remained stable across the study period (APC = −0.1%; 95%CI: −0.2%; 0.4% across the study period. For males, significant incidence rate increases were observed for germ cell tumors, lymphoblastic leukemia and thyroid cancer. In females, the incidence of Hodgkin’s lymphoma, colorectal and breast cancers increased. Significant incidence rate reductions were noted for cervical, central nervous system and lung cancers. Mortality rates for all cancers combined decreased from 1982 to 2005 for both males (APC = −2.6%, 95%CI:−3.3%;−2.0% and females (APC = −4.6%, 95%CI:−5.1%;−4.1%. With the exception of bone sarcoma and lung cancer in females, mortality rates for specific cancer types decreased significantly for both sexes during the study period. Conclusions Incidence of certain AYA cancers increased, whilst it decreased for others. Mortality rates decreased for most cancers, with the largest improvement observed for breast carcinomas. Further research is needed to identify the reasons for the increasing incidence of certain cancers.

  14. Diabetes and Cause-Specific Mortality in a Prospective Cohort of One Million U.S. Adults

    OpenAIRE

    Campbell, Peter T.; Newton, Christina C.; Patel, Alpa V.; Jacobs, Eric J.; Gapstur, Susan M.

    2012-01-01

    OBJECTIVE Diabetes is a major predictor of death from heart disease and stroke; its impact on nonvascular mortality, including specific cancers, is less understood. We examined the association of diabetes with cause-specific mortality, including deaths from specific cancers. RESEARCH DESIGN AND METHODS A prospective cohort of 1,053,831 U.S. adults, without cancer at baseline, enrolled in the Cancer Prevention Study-II in 1982 and was followed for mortality until December 2008. At baseline, pa...

  15. Long-term weight changes in obese young adult men and subsequent all-cause mortality

    DEFF Research Database (Denmark)

    Zimmermann, E; Berentzen, T L; Ängquist, Lars Henrik;

    2013-01-01

    ). All the obese and half the controls were re-examined between 4 and 40 years later (mean age 35 years). Weight changes were defined as: weight loss 0.1 kg m(-2) per year. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated using Cox regression.RESULTS:Among the 908 obese and 1073......BACKGROUND:Although the expectation is that weight gain increases mortality and weight loss among those overweight reduces mortality, results on weight gain and mortality in young adults are conflicting, and weight loss is less explored. We investigated the association between long-term weight...... change and all-cause mortality in a broad range of body mass index (BMI) in young men.METHODS:Among 362200 Danish draftees, examined between 1943 and 1977, all obese (BMI 31.0 kg m(-2); n=1930), and a random 1% sample of the others (n=3601) were identified at a mean age of 20 years (range: 18-25 years...

  16. "I really should've gone to the doctor": older adults and family caregivers describe their experiences with community-acquired pneumonia

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    Lohfeld Lynne

    2006-05-01

    Full Text Available Abstract Background Responding to acute illness symptoms can often be challenging for older adults. The primary objective of this study was to describe how community-dwelling older adults and their family members responded to symptoms of community-acquired pneumonia (CAP. Methods A qualitative study that used face-to-face semi-structured interviews to collect data from a purposeful sample of seniors aged 60+ and their family members living in a mid-sized Canadian city. Data analysis began with descriptive and interpretive coding, then advanced as the research team repeatedly compared emerging thematic categories to the raw data. Searches for disconfirming evidence and member checking through focus groups provided additional data and helped ensure rigour. Results Community-acquired pneumonia symptoms varied greatly among older adults, making decisions to seek care difficult for them and their family members. Both groups took varying amounts of time as they attempted to sort out what was wrong and then determine how best to respond. Even after they concluded something was wrong, older adults with confirmed pneumonia continued to wait for days, to over a week, before seeking medical care. Participants provided diverse reasons for this delay, including fear, social obligations (work, family, leisure, and accessibility barriers (time, place, systemic. Several older adults and family members regretted their delays in seeking help. Conclusion Treatment-seeking delay is a variable, multi-phased decision-making process that incorporates symptom assessment plus psychosocial and situational factors. Public health and health care professionals need to educate older adults about the potential causes and consequences of unnecessary waits. Such efforts may reduce the severity of community-acquired pneumonia upon presentation at clinics and hospitals, and that, in turn, could potentially improve health outcomes.

  17. Mortality among adults: gender and socioeconomic differences in a Brazilian city

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    Belon Ana Paula

    2012-01-01

    Full Text Available Abstract Background Population groups living in deprived areas are more exposed to several risk factors for diseases and injuries and die prematurely when compared with their better-off counterparts. The strength and patterning of the relationships between socioeconomic status and mortality differ depending on age, gender, and diseases or injuries. The objective of this study was to identify the magnitude of social differences in mortality among adult residents in a city of one million people in Southeastern Brazil in 2004-2008. Methods Forty-nine health care unit areas were classified into three homogeneous strata using 2000 Census small-area socioeconomic indicators. Mortality rates by age group, sex, and cause of death were calculated for each socioeconomic stratum. Mortality rate ratios (RR and 95% confidence intervals were estimated for the low and middle socioeconomic strata compared with the high stratum. Results In general, age-specific mortality rates showed a social gradient of increasing risks of death with decreasing socioeconomic status. The highest mortality rate ratios between low and high strata were observed in the 30-39 age group for males (RR = 1.74, 95% CI 1.59-1.89, and females (RR = 1.90, 95% CI 1.65-2.15. Concerning specific diseases and injuries, the greatest inequalities between low and high strata were found for homicides (RR = 2.44, 95% CI 2.27-2.61 and traffic accidents (RR = 1.64, 95% CI 1.45-1.83 among males. For women, the highest inequalities between the low and high strata were for chronic respiratory diseases (RR = 2.19, 95% CI 1.94-2.45 and acute myocardial infarction (RR = 1.93, 95% CI 1.79-2.07. Only breast cancer showed a reversed social gradient (RR = 0.70, 95% CI 0.48-0.92. Inequalities in circulatory and respiratory diseases mortality were greater among females than among males. Conclusions Substandard living conditions are related to unhealthy behaviors, as well as difficulties in accessing health care

  18. Association between serum interleukin-6 concentrations and mortality in older adults: the Rancho Bernardo study.

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    Jeffrey K Lee

    Full Text Available BACKGROUND: Interleukin-6 (IL-6 may have a protective role in acute liver disease but a detrimental effect in chronic liver disease. It is unknown whether IL-6 is associated with risk of liver-related mortality in humans. AIMS: To determine if IL-6 is associated with an increased risk of all-cause, cardiovascular disease (CVD, cancer, and liver-related mortality. METHODS: A prospective cohort study included 1843 participants who attended a research visit in 1984-87. Multiple covariates were ascertained including serum IL-6. Multivariable-adjusted Cox proportional hazards regression analyses were used to examine the association between serum IL-6 as a continuous (log transformed variable with all-cause, CVD, cancer, and liver-related mortality. Patients with prevalent CVD, cancer and liver disease were excluded for cause-specific mortality. RESULTS: The mean (± standard deviation age and body-mass-index (BMI of participants was 68 (± 10.6 years and 25 (± 3.7 Kg/m(2, respectively. During the 25,802 person-years of follow-up, the cumulative all-cause, CVD, cancer, and liver-related mortality were 53.1% (N = 978, 25.5%, 11.3%, and 1.3%, respectively. The median (± IQR length of follow-up was 15.3 ± 10.6 years. In multivariable analyses, adjusted for age, sex, alcohol, BMI, diabetes, hypertension, total cholesterol, HDL, and smoking, one-SD increment in log-transformed serum IL-6 was associated with increased risk of all-cause, CVD, cancer, and liver-related mortality, with hazard ratios of 1.48 (95% CI, 1.33-1.64, 1.38 (95% CI, 1.16-1.65, 1.35 (95% CI, 1.02-1.79, and 1.88 (95% CI, 0.97-3.67, respectively. CRP adjustment attenuated the effects but the association between IL-6 and all-cause and CVD mortality remained statistically significant, independent of CRP levels. CONCLUSIONS: In community-dwelling older adults, serum IL-6 is associated with all-cause, CVD, cancer, and liver-related mortality.

  19. Relationship of 25-hydroxyvitamin D with all-cause and cardiovascular disease mortality in older community-dwelling adults

    OpenAIRE

    Semba, Richard D.; Houston, Denise K.; Bandinelli, Stefania; Sun, Kai; Cherubini, Antonio; Cappola, Anne R.; Guralnik, Jack M.; Ferrucci, Luigi

    2009-01-01

    Background/Objectives Vitamin D deficiency is associated with cardiovascular disease, osteoporosis, poor muscle strength, falls, fractures, and mortality. Although older adults are at a high risk of vitamin D deficiency, the relationship of serum 25(OH)D with all-cause and cardiovascular disease mortality has not been well characterized in the elderly. We hypothesized that low serum 25(OH)D predicted mortality in older adults. Subjects/Methods Serum 25(OH)D and all-cause and cardiovascular di...

  20. Measuring adult mortality using sibling survival: a new analytical method and new results for 44 countries, 1974-2006.

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    Ziad Obermeyer

    2010-04-01

    Full Text Available BACKGROUND: For several decades, global public health efforts have focused on the development and application of disease control programs to improve child survival in developing populations. The need to reliably monitor the impact of such intervention programs in countries has led to significant advances in demographic methods and data sources, particularly with large-scale, cross-national survey programs such as the Demographic and Health Surveys (DHS. Although no comparable effort has been undertaken for adult mortality, the availability of large datasets with information on adult survival from censuses and household surveys offers an important opportunity to dramatically improve our knowledge about levels and trends in adult mortality in countries without good vital registration. To date, attempts to measure adult mortality from questions in censuses and surveys have generally led to implausibly low levels of adult mortality owing to biases inherent in survey data such as survival and recall bias. Recent methodological developments and the increasing availability of large surveys with information on sibling survival suggest that it may well be timely to reassess the pessimism that has prevailed around the use of sibling histories to measure adult mortality. METHODS AND FINDINGS: We present the Corrected Sibling Survival (CSS method, which addresses both the survival and recall biases that have plagued the use of survey data to estimate adult mortality. Using logistic regression, our method directly estimates the probability of dying in a given country, by age, sex, and time period from sibling history data. The logistic regression framework borrows strength across surveys and time periods for the estimation of the age patterns of mortality, and facilitates the implementation of solutions for the underrepresentation of high-mortality families and recall bias. We apply the method to generate estimates of and trends in adult mortality, using the

  1. A compendium for Mycoplasma pneumoniae

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    Gretchen Lynn Parrott

    2016-04-01

    Full Text Available Historically, atypical pneumonia was a term used to describe an unusual presentation of pneumonia. Currently, it is used to describe the multitude of symptoms juxtaposing the classic symptoms found in cases of pneumococcal pneumonia. Specifically, atypical pneumonia is a syndrome resulting from a relatively common group of pathogens including Chlamydophila sp., and Mycoplasma pneumoniae. The incidence of M. pneumoniae pneumonia in adults is less than the burden experienced by children. Transmission rates among families indicate children may act as a reservoir and maintain contagiousness over a long period of time ranging from months to years. In adults, M. pneumoniae typically produces a mild, walking pneumonia and is considered to be one of the causes of persistent cough in patients. M. pneumoniae has also been shown to trigger the exacerbation of other lung diseases. It has been repeatedly detected in patients with bronchitis, asthma, chronic obstructive pulmonary disorder and cystic fibrosis. Recent advances in technology allow for the rapid diagnosis of M. pneumoniae through the use of polymerase chain reaction (PCR or rapid antigen tests. With this, more effort has been afforded to identify the causative etiologic agent in all cases of pneumonia. However, previous practices, including the overprescribing of macrolide treatment in China and Japan, have created increased incidence of macrolide-resistant M. pneumoniae. Reports from these countries indicate that >85% of M. pneumoniae pneumonia pediatric cases are macrolide-resistant. Despite its extensively studied past, the smallest bacterial species still inspires some of the largest questions. The developments in microbiology, diagnostic features and techniques, epidemiology, treatment and vaccines, and upper respiratory conditions associated with M. pneumoniae in adult populations are included within this review.

  2. A Compendium for Mycoplasma pneumoniae.

    Science.gov (United States)

    Parrott, Gretchen L; Kinjo, Takeshi; Fujita, Jiro

    2016-01-01

    Historically, atypical pneumonia was a term used to describe an unusual presentation of pneumonia. Currently, it is used to describe the multitude of symptoms juxtaposing the classic symptoms found in cases of pneumococcal pneumonia. Specifically, atypical pneumonia is a syndrome resulting from a relatively common group of pathogens including Chlamydophila sp., and Mycoplasma pneumoniae. The incidence of M. pneumoniae pneumonia in adults is less than the burden experienced by children. Transmission rates among families indicate children may act as a reservoir and maintain contagiousness over a long period of time ranging from months to years. In adults, M. pneumoniae typically produces a mild, "walking" pneumonia and is considered to be one of the causes of persistent cough in patients. M. pneumoniae has also been shown to trigger the exacerbation of other lung diseases. It has been repeatedly detected in patients with bronchitis, asthma, chronic obstructive pulmonary disorder, and cystic fibrosis. Recent advances in technology allow for the rapid diagnosis of M. pneumoniae through the use of polymerase chain reaction or rapid antigen tests. With this, more effort has been afforded to identify the causative etiologic agent in all cases of pneumonia. However, previous practices, including the overprescribing of macrolide treatment in China and Japan, have created increased incidence of macrolide-resistant M. pneumoniae. Reports from these countries indicate that >85% of M. pneumoniae pneumonia pediatric cases are macrolide-resistant. Despite its extensively studied past, the smallest bacterial species still inspires some of the largest questions. The developments in microbiology, diagnostic features and techniques, epidemiology, treatment and vaccines, and upper respiratory conditions associated with M. pneumoniae in adult populations are included within this review. PMID:27148202

  3. The plasma level of soluble urokinase receptor is elevated in patients with Streptococcus pneumoniae bacteraemia and predicts mortality

    DEFF Research Database (Denmark)

    Wittenhagen, P; Kronborg, G; Weis, N;

    2004-01-01

    This multicentre prospective study was conducted to investigate whether the level of the soluble form of urokinase-type plasminogen activator receptor (suPAR) is elevated during pneumococcal bacteraemia and is of predictive value in the early stage of the disease. Plasma levels of suPAR were...... increased significantly (median 5.5; range 2.4-21.0 ng/mL) in 141 patients with pneumococcal bacteraemia, compared to 31 healthy controls (median 2.6, range 1.5-4.0 ng/mL, p 0.001). Furthermore, suPAR levels were elevated significantly in patients who died from the infection (n = 24) compared to survivors...... (n = 117; p mortality (p

  4. Fetal distress and in utero pneumonia in perinatal dolphins during the Northern Gulf of Mexico unusual mortality event.

    Science.gov (United States)

    Colegrove, Kathleen M; Venn-Watson, Stephanie; Litz, Jenny; Kinsel, Michael J; Terio, Karen A; Fougeres, Erin; Ewing, Ruth; Pabst, D Ann; McLellan, William A; Raverty, Stephen; Saliki, Jeremiah; Fire, Spencer; Rappucci, Gina; Bowen-Stevens, Sabrina; Noble, Lauren; Costidis, Alex; Barbieri, Michelle; Field, Cara; Smith, Suzanne; Carmichael, Ruth H; Chevis, Connie; Hatchett, Wendy; Shannon, Delphine; Tumlin, Mandy; Lovewell, Gretchen; McFee, Wayne; Rowles, Teresa K

    2016-04-12

    An unusual mortality event (UME) involving primarily common bottlenose dolphins Tursiops truncatus of all size classes stranding along coastal Louisiana, Mississippi, and Alabama, USA, started in early 2010 and continued into 2014. During this northern Gulf of Mexico UME, a distinct cluster of perinatal dolphins (total body length dolphin strandings that were perinates between 2009 and 2013 were compared to baseline strandings (2000-2005). A case-reference study was conducted to compare demographics, histologic lesions, and Brucella sp. infection prevalence in 69 UME perinatal dolphins to findings from 26 reference perinates stranded in South Carolina and Florida outside of the UME area. Compared to reference perinates, UME perinates were more likely to have died in utero or very soon after birth (presence of atelectasis in 88 vs. 15%, p dolphins were particularly susceptible to late-term pregnancy failures and development of in utero infections including brucellosis.

  5. Determinants of mortality for adults with cystic fibrosis admitted in Intensive Care Unit: a multicenter study

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    Rabbat Antoine

    2006-01-01

    Full Text Available Abstract Background Intensive care unit (ICU admission of adults with cystic fibrosis (CF is controversial because of poor outcome. This appraisal needs re-evaluation following recent changes in both CF management and ICU daily practice. Objectives were to determine long-term outcome of adults with CF admitted in ICU and to identify prognostic factors. Methods Retrospective multicenter study of 60 ICU hospitalizations for 42 adult CF patients admitted between 2000 and 2003. Reason for ICU admission, ventilatory support provided and one-year survival were recorded. Multiple logistic analysis was used to determine predictors of mortality. Results Prior to ICU admission, all patients (mean age 28.1 ± 8 yr had a severe lung disease (mean FEV1 28 ± 12% predicted; mean PaCO2 47 ± 9 mmHg. Main reason for ICU hospitalization was pulmonary infective exacerbation (40/60. At admission, noninvasive ventilation was used in 57% of cases and was successful in 67% of patients. Endotracheal intubation was implemented in 19 episodes. Overall ICU mortality rate was 14%. One year after ICU discharge, 10 of the 28 survivors have been lung transplanted. Among recognized markers of CF disease severity, only the annual FEV1 loss was associated with a poor outcome (HR = 1.47 [1.18–1.85], p = 0.001. SAPSII (HR = 1.08 [1.03–1.12], p Conclusion Despite advanced lung disease, adult patients with CF admitted in ICU have high survival rate. Endotracheal intubation is associated with a poor prognosis and should be used as the last alternative. Although efforts have to be made in selecting patients with CF likely to benefit from ICU resources, ICU admission of these patients should be considered.

  6. Population structure and characterization of viridans group streptococci (VGS) including Streptococcus pneumoniae isolated from adult patients with cystic fibrosis (CF).

    Science.gov (United States)

    Maeda, Yasunori; Elborn, J Stuart; Parkins, Michael D; Reihill, James; Goldsmith, Colin E; Coulter, Wilson A; Mason, Charlene; Millar, B Cherie; Dooley, James S G; Lowery, Colm J; Ennis, Madeleine; Rendall, Jacqueline C; Moore, John E

    2011-03-01

    A study was undertaken to examine the population structure of viridans group streptococci (VGS) in the sputum of adult patients with cystic fibrosis (CF). Freshly expectorated sputa (n=58) from 45 adult CF patients were examined by selective conventional culture on Mitis-Salivarius agar and yielded 190 isolates of VGS. Sequence analyses of the rpnB and 16-23S rRNA ITS genes identified these isolates to belong to 12 species of VGS and included S. anginosus, S. australis, S. cristatus, S. gordonii, S. infantis, S. mitis, S. mutans, S. oralis, S. parasanguinis, S. pneumoniae, S. salivarius and S. sanguinis. The most frequently VGS organism isolated was S. salivarius (47/190; 24.7%), followed by S. mitis (36/190; 19%), S. sanguinis (25/190; 13.2%), S. oralis (20/190; 11.0%), S. pneumoniae (19/190; 10.0%), S. parasanguinis (16/190; 8.4%), S. infantis (11/190; 5.8%), S. gordonii (7/190; 3.7%), S. anginosus (4/190; 2.1%), S. cristatus (2/190; 1.1%), S. australis (1/190; 0.5%), S. mutans (1/190; 0.5%) and S. agalactiae (1/190; 0.5%). All, but four, patients harboured at least one VGS species, which ranged from one to five streptococcal species, with a mean of 2.85 species per patient. There was no clonality at the subspecies level employing ERIC RAPD PCR. Antibiotic susceptibility was determined by Minimum Inhibitory Concentration (MIC) testing against penicillin, erythromycin and ciprofloxacin. Overall, resistance to penicillin with all VGS was 73/190 (38.4%) and 167/190 (87.9%) for erythromycin. With regard to ciprofloxacin, 27/190 (14.2%) were fully resistant, whilst a further 21/190 (11.1%) showed intermediate resistance, which equated to approximately three quarters (74.7%) of isolates being fully sensitive to this agent. In addition, as a comparator control population, we examined antibiotic susceptibility, as above, in a non-CF population comprising 12 individuals (50 VGS isolates), who were not receiving chronic antibiotics. In comparison, 8% and 38% of VGS

  7. Pneumocystis carinii pneumonia, pulmonary tuberculosis and visceral leishmaniasis in an adult HIV negative patient

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    Antonio Carlos Toledo Jr.

    2001-06-01

    Full Text Available This is a case report of a 29 year old male with pneumocystis pneumonia and tuberculosis, and who was initially suspected of having HIV infection, based on risk factor analyses, but was subsequently shown to be HIV negative. The patient arrived at the hospital with fever, cough, weight loss, loss of appetite, pallor, and arthralgia. In addition, he was jaundiced and had cervical lymphadenopathy and mild heptosplenomegaly. He had interstitial infiltrates of the lung, sputum smears positive for Mycobacterium tuberculosis and Pneumocystis carinii, and stool tests were positive for Strongyloides stercoralis and Schistosoma mansoni. He was diagnosed as having AIDS, and was treated for tuberculosis, pneumocystosis, and strongyloidiasis with a good response. The patient did not receive anti-retroviral therapy, pending outcome of the HIV tests. A month later, he was re-examined and found to have worsening hepatosplenomegaly, pancytopenia, fever, and continued weight loss. At this time, it was determined that his HIV ELISA antibody tests were negative. A bone marrow aspirate was done and revealed amastigotes of leishmania, and a bone marrow culture was positive for Leishmania species. He was treated with pentavalent antimony, 20 mg daily for 20 days, with complete remission of symptoms and weight gain. This case demonstrates that immunosuppression from leishmaniasis and tuberculosis may lead to pneumocystosis, and be misdiagnosed as HIV infection. The occurrence of opportunistic infections in severely ill patients without HIV must always be considered and alternate causes of immunosuppression sought.

  8. Venovenous extracorporeal membrane oxygenation in adult respiratory failure: Scores for mortality prediction.

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    Hsin, Chun-Hsien; Wu, Meng-Yu; Huang, Chung-Chi; Kao, Kuo-Chin; Lin, Pyng-Jing

    2016-06-01

    Despite a potentially effective therapy for adult respiratory failure, a general agreement on venovenous extracorporeal membrane oxygenation (VV-ECMO) has not been reached among institutions due to its invasiveness and high resource usage. To establish consensus on the timing of intervention, large ECMO organizations have published the respiratory extracorporeal membrane oxygenation survival prediction (RESP) score and the ECMOnet score, which allow users to predict hospital mortality for candidates with their pre-ECMO presentations. This study was aimed to test the predictive powers of these published scores in a medium-sized cohort enrolling adults treated with VV-ECMO for acute respiratory failure, and develop an institutional prediction model under the framework of the 3 scores if a superior predictive power could be achieved. This retrospective study included 107 adults who received VV-ECMO for severe acute respiratory failure (a PaO2/FiO2 ratio failure assessment (SOFA) score before VV-ECMO. The predictive power of hospital mortality of each score was presented as the area under receiver-operating characteristic curve (AUROC). The multivariate logistic regression was used to develop an institutional prediction model. The surviving to discharge rate was 55% (n = 59). All of the 3 published scores had a real but poor predictive power of hospital mortality in this study. The AUROCs of RESP score, ECMOnet score, and SOFA score were 0.662 (P = 0.004), 0.616 (P = 0.04), and 0.667 (P = 0.003), respectively. An institutional prediction model was established from these score parameters and presented as follows: hospital mortality (Y) = -3.173 + 0.208 × (pre-ECMO SOFA score) + 0.148 × (pre-ECMO mechanical ventilation day) + 1.021 × (immunocompromised status). Compared with the 3 scores, the institutional model had a significantly higher AUROC (0.779; P failure. PMID:27336901

  9. Epidemiology and outcome of pneumonia caused by methicillin-resistant Staphylococcus aureus (MRSA in Canadian hospitals.

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    Manal Tadros

    Full Text Available BACKGROUND: MRSA remains a leading cause of hospital-acquired (HAP and healthcare-associated pneumonia (HCAP. We describe the epidemiology and outcome of MRSA pneumonia in Canadian hospitals, and identify factors contributing to mortality. METHODS: Prospective surveillance for MRSA pneumonia in adults was done for one year (2011 in 11 Canadian hospitals. Standard criteria for MRSA HAP, HCAP, ventilator-associated pneumonia (VAP, and community-acquired pneumonia (CAP were used to identify cases. MRSA isolates underwent antimicrobial susceptibility testing, and were characterized by pulsed-field gel electrophoresis (PFGE and Panton-Valentine leukocidin (PVL gene detection. The primary outcome was all-cause mortality at 30 days. A multivariable analysis was done to examine the association between various host and microbial factors and mortality. RESULTS: A total of 161 patients with MRSA pneumonia were identified: 90 (56% with HAP, 26 (16% HCAP, and 45 (28% CAP; 23 (14% patients had VAP. The mean (± SD incidence of MRSA HAP was 0.32 (± 0.26 per 10,000 patient-days, and of MRSA VAP was 0.30 (± 0.5 per 1,000 ventilator-days. The 30-day all-cause mortality was 28.0%. In multivariable analysis, variables associated with mortality were the presence of multiorgan failure (OR 8.1; 95% CI 2.5-26.0, and infection with an isolate with reduced susceptibility to vancomycin (OR 2.5, 95% CI 1.0-6.3. CONCLUSIONS: MRSA pneumonia is associated with significant mortality. Severity of disease at presentation, and infection caused by an isolate with elevated MIC to vancomcyin are associated with increased mortality. Additional studies are required to better understand the impact of host and microbial variables on outcome.

  10. Does Parsonnet scoring model predict mortality following adult cardiac surgery in India?

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    Moningi Srilata

    2015-01-01

    Full Text Available Aims and Objectives: To validate the Parsonnet scoring model to predict mortality following adult cardiac surgery in Indian scenario. Materials and Methods: A total of 889 consecutive patients undergoing adult cardiac surgery between January 2010 and April 2011 were included in the study. The Parsonnet score was determined for each patient and its predictive ability for in-hospital mortality was evaluated. The validation of Parsonnet score was performed for the total data and separately for the sub-groups coronary artery bypass grafting (CABG, valve surgery and combined procedures (CABG with valve surgery. The model calibration was performed using Hosmer-Lemeshow goodness of fit test and receiver operating characteristics (ROC analysis for discrimination. Independent predictors of mortality were assessed from the variables used in the Parsonnet score by multivariate regression analysis. Results: The overall mortality was 6.3% (56 patients, 7.1% (34 patients for CABG, 4.3% (16 patients for valve surgery and 16.2% (6 patients for combined procedures. The Hosmer-Lemeshow statistic was <0.05 for the total data and also within the sub-groups suggesting that the predicted outcome using Parsonnet score did not match the observed outcome. The area under the ROC curve for the total data was 0.699 (95% confidence interval 0.62-0.77 and when tested separately, it was 0.73 (0.64-0.81 for CABG, 0.79 (0.63-0.92 for valve surgery (good discriminatory ability and only 0.55 (0.26-0.83 for combined procedures. The independent predictors of mortality determined for the total data were low ejection fraction (odds ratio [OR] - 1.7, preoperative intra-aortic balloon pump (OR - 10.7, combined procedures (OR - 5.1, dialysis dependency (OR - 23.4, and re-operation (OR - 9.4. Conclusions: The Parsonnet score yielded a good predictive value for valve surgeries, moderate predictive value for the total data and for CABG and poor predictive value for combined procedures.

  11. Adult non-communicable disease mortality in Africa and Asia: evidence from INDEPTH Health and Demographic Surveillance System sites

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    P. Kim Streatfield

    2014-10-01

    Full Text Available Background: Mortality from non-communicable diseases (NCDs is a major global issue, as other categories of mortality have diminished and life expectancy has increased. The World Health Organization's Member States have called for a 25% reduction in premature NCD mortality by 2025, which can only be achieved by substantial reductions in risk factors and improvements in the management of chronic conditions. A high burden of NCD mortality among much older people, who have survived other hazards, is inevitable. The INDEPTH Network collects detailed individual data within defined Health and Demographic Surveillance sites. By registering deaths and carrying out verbal autopsies to determine cause of death across many such sites, using standardised methods, the Network seeks to generate population-based mortality statistics that are not otherwise available. Objective: To describe patterns of adult NCD mortality from INDEPTH Network sites across Africa and Asia, according to the WHO 2012 verbal autopsy (VA cause categories, with separate consideration of premature (15–64 years and older (65+ years NCD mortality. Design: All adult deaths at INDEPTH sites are routinely registered and followed up with VA interviews. For this study, VA archives were transformed into the WHO 2012 VA standard format and processed using the InterVA-4 model to assign cause of death. Routine surveillance data also provide person-time denominators for mortality rates. Results: A total of 80,726 adult (over 15 years deaths were documented over 7,423,497 person-years of observation. NCDs were attributed as the cause for 35.6% of these deaths. Slightly less than half of adult NCD deaths occurred in the 15–64 age group. Detailed results are presented by age and sex for leading causes of NCD mortality. Per-site rates of NCD mortality were significantly correlated with rates of HIV/AIDS-related mortality. Conclusions: These findings present important evidence on the distribution of

  12. A Bayesian two part model applied to analyze risk factors of adult mortality with application to data from Namibia.

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    Lawrence N Kazembe

    Full Text Available Despite remarkable gains in life expectancy and declining mortality in the 21st century, in many places mostly in developing countries, adult mortality has increased in part due to HIV/AIDS or continued abject poverty levels. Moreover many factors including behavioural, socio-economic and demographic variables work simultaneously to impact on risk of mortality. Understanding risk factors of adult mortality is crucial towards designing appropriate public health interventions. In this paper we proposed a structured additive two-part random effects regression model for adult mortality data. Our proposal assumed two processes: (i whether death occurred in the household (prevalence part, and (ii number of reported deaths, if death did occur (severity part. The proposed model specification therefore consisted of two generalized linear mixed models (GLMM with correlated random effects that permitted structured and unstructured spatial components at regional level. Specifically, the first part assumed a GLMM with a logistic link and the second part explored a count model following either a Poisson or negative binomial distribution. The model was used to analyse adult mortality data of 25,793 individuals from the 2006/2007 Namibian DHS data. Inference is based on the Bayesian framework with appropriate priors discussed.

  13. Effects of Hospital-Based Physical Therapy on Hospital Discharge Outcomes among Hospitalized Older Adults with Community-Acquired Pneumonia and Declining Physical Function.

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    Kim, Sun Jung; Lee, Joo Hun; Han, Boram; Lam, Julia; Bukowy, Elizabeth; Rao, Avinash; Vulcano, Jordan; Andreeva, Anelia; Bertelson, Heather; Shin, Hyun Phil; Yoo, Ji Won

    2015-06-01

    To examine whether hospital-based physical therapy is associated with functional changes and early hospital readmission among hospitalized older adults with community-acquired pneumonia and declining physical function. Study design was a retrospective observation study. Participants were community-dwelling older adults admitted to medicine floor for community-acquired pneumonia (n = 1,058). Their physical function using Katz activities of daily living (ADL) Index declined between hospital admission and 48 hours since hospital admission (Katz ADL Index 6→5). The intervention group was those receiving physical therapy for ≥ 0.5 hour/day. Outcomes were Katz ADL Index at hospital discharge and all-cause 30-day hospital readmission rate. The intervention and control groups did not differ in the Katz ADL Index at hospital discharge (p = 0.11). All-cause 30-day hospital readmission rate was lower in the intervention than in control groups (OR = 0.65, p = 0.02). Hospital-based physical therapy has the benefits toward reducing 30-day hospital readmission rate of acutely ill older adults with community-acquired pneumonia and declining physical function. PMID:26029475

  14. Examining the Racial Crossover in Mortality between African American and White Older Adults: A Multilevel Survival Analysis of Race, Individual Socioeconomic Status, and Neighborhood Socioeconomic Context

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    Li Yao

    2011-01-01

    Full Text Available We examine whether individual and neighborhood socioeconomic context contributes to black/white disparities in mortality among USA older adults. Using national longitudinal data from the Americans' Changing Lives study, along with census tract information for each respondent, we conduct multilevel survival analyses. Results show that black older adults are disadvantaged in mortality in younger old age, but older black adults have lower mortality risk than whites after about age 80. Both individual SES and neighborhood socioeconomic disadvantage contribute to the mortality risk of older adults but do not completely explain race differences in mortality. The racial mortality crossover persists even after controlling for multilevel SES, suggesting that black older adults experience selective survival at very old ages. Addressing the individual and neighborhood socioeconomic disadvantage of blacks is necessary to reduce mortality disparities that culminate in older adulthood.

  15. Mycoplasma pneumoniae pneumonia: CT features in 16 patients

    International Nuclear Information System (INIS)

    The objective of this study was to assess the computed tomography (CT) features of Mycoplasma pneumoniae pneumonia. We retrospectively reviewed CT findings of 16 patients (M:F=9:7, age range 1-74 years, median 9 years) with serologically proven Mycoplasma pneumoniae pneumonia and with chest CT scan available. Two distinctive patterns of CT features of M. pneumoniae pneumonia were noted between the paediatric (age <18 years) and the adult (age ≥18 years) groups. The pediatric group (n=11) showed lobar or segmental consolidation (100%) with frequent pleural effusion (82%) and regional lymphadenopathy (82%) and mild volume decrease of the involved lobe (73%), while four of the five adult patients showed diffuse and/or multifocal, centrilobular or peribronchovascular areas of ground-glass attenuation (80%) with a lobular distribution, and frequent thickening of interlobular septa (60%) and the bronchial walls (40%) were also detected at high-resolution CT. The CT finding of a lobar or segmental consolidation with a parapneumonic effusion seen in our children with M. pneumoniae pneumonia was similar to that of bacterial lobar pneumonia. In contrast, the CT findings noted in our adult patients consisted of a mixture of a bacterial bronchopneumonia pattern and a viral interstitial pneumonia pattern. (orig.)

  16. Mycoplasma pneumoniae pneumonia: CT features in 16 patients

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Inho; Kim, Tae Sung; Yoon, Hye-Kyung [Sungkyunkwan University School of Medicine, Department of Radiology and Center for Imaging Science, Samsung Medical Center, Seoul (Korea)

    2006-03-15

    The objective of this study was to assess the computed tomography (CT) features of Mycoplasma pneumoniae pneumonia. We retrospectively reviewed CT findings of 16 patients (M:F=9:7, age range 1-74 years, median 9 years) with serologically proven Mycoplasma pneumoniae pneumonia and with chest CT scan available. Two distinctive patterns of CT features of M. pneumoniae pneumonia were noted between the paediatric (age <18 years) and the adult (age {>=}18 years) groups. The pediatric group (n=11) showed lobar or segmental consolidation (100%) with frequent pleural effusion (82%) and regional lymphadenopathy (82%) and mild volume decrease of the involved lobe (73%), while four of the five adult patients showed diffuse and/or multifocal, centrilobular or peribronchovascular areas of ground-glass attenuation (80%) with a lobular distribution, and frequent thickening of interlobular septa (60%) and the bronchial walls (40%) were also detected at high-resolution CT. The CT finding of a lobar or segmental consolidation with a parapneumonic effusion seen in our children with M. pneumoniae pneumonia was similar to that of bacterial lobar pneumonia. In contrast, the CT findings noted in our adult patients consisted of a mixture of a bacterial bronchopneumonia pattern and a viral interstitial pneumonia pattern. (orig.)

  17. [Pneumonia: The urgent problem of 21st century medicine].

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    Chuchalin, A G

    2016-01-01

    The paper analyzes the systematic reviews and meta-analyses on the strategic issues of pneumonia, which have been published in the past 3 years. It discusses the prevalence and mortality rates of acquired pneumonia, hospital-acquired (nosocomial) pneumonia, healthcare-associated pneumonia, ventilator-associated pneumonia, and Mycoplasma pneumonia, and the specific features of their etiology, diagnosis, and treatment. A large number of investigations emphasize the relevance of this problem in current clinical practice.

  18. Comparação da acurácia de preditores de mortalidade na pneumonia associada à ventilação mecânica Comparing the accuracy of predictors of mortality in ventilator-associated pneumonia

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    Renato Seligman

    2011-08-01

    -terminal provasopressin (copeptin, and C-reactive protein (CRP, as well as Sequential Organ Failure Assessment (SOFA scores, are associated with severity and described as predictors of outcome in ventilator-associated pneumonia (VAP. This study sought to compare the predictive value of these biomarkers for mortality in VAP. METHODS: An observational study of 71 patients with VAP. Levels of procalcitonin, MR-proANP, copeptin, and CRP, together with SOFA scores, were determined at VAP onset, designated day 0 (D0, and on day 4 of treatment (D4. Patients received empirical antimicrobial therapy, with modifications based on culture results. Patients who died before D28 were classified as nonsurvivors. RESULTS: Of the 71 patients evaluated, 45 were classified as survivors. Of the 45 survivors, 35 (77.8% received appropriate antimicrobial therapy, compared with 18 (69.2% of the 26 nonsurvivors (p = 0.57. On D0 and D4, the levels of all biomarkers (except CRP, as well as SOFA scores, were lower in eventual survivors than in eventual nonsurvivors. For D0 and D4, the area under the ROC curve was largest for procalcitonin. On D0, MR-proANP had the highest positive likelihood ratio (2.71 and positive predictive value (0.60, but procalcitonin had the highest negative predictive value (0.87. On D4, procalcitonin had the highest positive likelihood ratio (3.46, the highest positive predictive value (0.66, and the highest negative predictive value (0.93. CONCLUSIONS: The biomarkers procalcitonin, MR-proANP, and copeptin can predict mortality in VAP, as can the SOFA score. Procalcitonin alone has the greatest predictive power for such mortality.

  19. Developing a simple preinterventional score to predict hospital mortality in adult venovenous extracorporeal membrane oxygenation: A pilot study.

    Science.gov (United States)

    Cheng, Yu-Ting; Wu, Meng-Yu; Chang, Yu-Sheng; Huang, Chung-Chi; Lin, Pyng-Jing

    2016-07-01

    Despite gaining popularity, venovenous extracorporeal membrane oxygenation (VV-ECMO) remains a controversial therapy for acute respiratory failure (ARF) in adult patients due to its equivocal survival benefits. The study was aimed at identifying the preinterventional prognostic predictors of hospital mortality in adult VV-ECMO patients and developing a practical mortality prediction score to facilitate clinical decision-making.This retrospective study included 116 adult patients who received VV-ECMO for severe ARF in a tertiary referral center, from 2007 to 2015. The definition of severe ARF was PaO2/ FiO2 ratio power on hospital mortality of the scoring system was presented as the area under receiver operating characteristic curve (AUROC).The overall hospital mortality rate was 47% (n = 54). Pre-ECMO MV day > 4 (OR: 4.71; 95% CI: 1.98-11.23; P failure assessment (SOFA) score >9 (OR: 3.16; 95% CI: 1.36-7.36; P = 0.01), and immunocompromised status (OR: 2.91; 95% CI: 1.07-7.89; P = 0.04) were independent predictors of hospital mortality of adult VV-ECMO. A mortality prediction score comprising of the 3 binary predictors was developed and named VV-ECMO mortality score. The total score was estimated as follows: VV-ECMO mortality score = 2 × (Pre-ECMO MV day > 4) + 1 × (Pre-ECMO SOFA score >9) + 1 × (immunocompromised status). The AUROC of VV-ECMO mortality score was 0.76 (95% CI: 0.67-0.85; P < 0.001). The corresponding hospital mortality rates to VV-ECMO mortality scores were 18% (Score 0), 35% (Score 1), 56% (Score 2), 75% (Score 3), and 88% (Score 4), respectively.Duration of MV, severity of organ dysfunction, and immunocompromised status were important preinterventional prognostic predictors for adult VV-ECMO. The 3 prognostic predictors could also constitute a practical prognosticating tool in patients requiring this advanced respiratory support. Physicians in ECMO institutions are encouraged to perform external validations

  20. Prospective associations between household-, work-, and leisure-based physical activity and all-cause mortality among older Taiwanese adults.

    Science.gov (United States)

    Chen, Li-Jung; Fox, Kenneth R; Ku, Po-Wen; Sun, Wen-Jung; Chou, Pesus

    2012-09-01

    Most studies on the health effects of leisure time physical activity have focused on mortality. There has been limited research regarding physical activity undertaken at work or around the home and mortality. This study assessed the associations between leisure, work, and household physical activity and subsequent all-cause mortality among older adults aged 65 years and older (n = 2133) in Taiwan, over 8 years. Physical activity was evaluated with the Physical Activity Scale for the Elderly. Cox proportional hazard models were used to estimate the association of physical activity with the risk of mortality. This study demonstrated that a low level of total physical activity is predictive of increased all-cause mortality in both men and women in an East Asian population. It also indicates that leisure- and household-related but not work-related activity are significant contributors to this relationship.

  1. Creating and validating an algorithm to measure AIDS mortality in the adult population using verbal autopsy.

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    Ben A Lopman

    2006-08-01

    Full Text Available BACKGROUND: Vital registration and cause of death reporting is incomplete in the countries in which the HIV epidemic is most severe. A reliable tool that is independent of HIV status is needed for measuring the frequency of AIDS deaths and ultimately the impact of antiretroviral therapy on mortality. METHODS AND FINDINGS: A verbal autopsy questionnaire was administered to caregivers of 381 adults of known HIV status who died between 1998 and 2003 in Manicaland, eastern Zimbabwe. Individuals who were HIV positive and did not die in an accident or during childbirth (74%; n = 282 were considered to have died of AIDS in the gold standard. Verbal autopsies were randomly allocated to a training dataset (n = 279 to generate classification criteria or a test dataset (n = 102 to verify criteria. A rule-based algorithm created to minimise false positives had a specificity of 66% and a sensitivity of 76%. Eight predictors (weight loss, wasting, jaundice, herpes zoster, presence of abscesses or sores, oral candidiasis, acute respiratory tract infections, and vaginal tumours were included in the algorithm. In the test dataset of verbal autopsies, 69% of deaths were correctly classified as AIDS/non-AIDS, and it was not necessary to invoke a differential diagnosis of tuberculosis. Presence of any one of these criteria gave a post-test probability of AIDS death of 0.84. CONCLUSIONS: Analysis of verbal autopsy data in this rural Zimbabwean population revealed a distinct pattern of signs and symptoms associated with AIDS mortality. Using these signs and symptoms, demographic surveillance data on AIDS deaths may allow for the estimation of AIDS mortality and even HIV prevalence.

  2. Mass mortality of adult male subantarctic fur seals: are alien mice the culprits?

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    P J Nico de Bruyn

    Full Text Available BACKGROUND: Mass mortalities of marine mammals due to infectious agents are increasingly reported. However, in contrast to previous die-offs, which were indiscriminate with respect to sex and age, here we report a land-based mass mortality of Subantarctic fur seals with apparent exclusivity to adult males. An infectious agent with a male-predilection is the most plausible explanation for this die-off. Although pathogens with gender-biased transmission and pathologies are unusual, rodents are known sources of male-biased infectious agents and the invasive Mus musculus house mouse, occurs in seal rookeries. METHODOLOGY/ PRINCIPAL FINDINGS: Molecular screening for male-biased pathogens in this potential rodent reservoir host revealed the absence of Cardiovirus and Leptospirosis genomes in heart and kidney samples, respectively, but identified a novel Streptococcus species with 30% prevalence in mouse kidneys. CONCLUSIONS/ SIGNIFICANCE: Inter-species transmission through environmental contamination with this novel bacterium, whose congenerics display male-bias and have links to infirmity in seals and terrestrial mammals (including humans, highlights the need to further evaluate disease risks posed by alien invasive mice to native species, on this and other islands.

  3. Role of virtual and flexible bronchoscopy in the management of a case of unnoticed foreign body aspiration presented as nonresolving pneumonia in an adult female.

    Science.gov (United States)

    Kshatriya, Ravish Manmohan; Khara, Nimit V; Paliwal, Rajiv P; Patel, Sateesh N

    2016-01-01

    It is not so common to aspirate foreign body in normal adults without any predisposing factors as compared to children and those with the altered neurological state. Endobronchial foreign bodies are one of the causes of obstructive pneumonia and difficult to diagnose as signs and symptoms are often nonspecific. However, once they are diagnosed, they can generally be removed, leading to rapid and drastic resolution of symptoms. Bronchoscopy is the gold standard in the identification and localization of an airway foreign body and also for better management of the ailment. However with the help of virtual bronchoscopy one can decide the location of the foreign body before any invasive intervention and being noninvasive it can be performed in follow-up easily to check the patency of airways. It is not possible to detect the exact size of foreign body with the virtual bronchoscopy. In this article, we report a case of unnoticed foreign body aspiration in a 49-year-old female patient who was initially treated for pneumonia. However, due to nonresolution of opacity contrast enhanced computed tomography thorax with virtual and flexible bronchoscopy were performed, which revealed a foreign body in the right lower lobe bronchus that was removed with biopsy forceps in piecemeal. In her follow-up visit, she underwent virtual broncoscopy that revealed clear airways. Thus, detailed history and high index of suspicion is required for nonresolving pneumonias that may occur due to unnoticed foreign body/ies in an adult. PMID:27578936

  4. Prevención de la neumonía adquirida en la comunidad PREVENTION OF COMMUNITY-ACQUIRED PNEUMONIA IN ADULTS

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    Manuel Barros M.

    2005-04-01

    epidemiaPolysaccharide 23 valent pneumococcal vaccine commercially available from 1983 includes 23 serotypes of Streptococcus pneumoniae, representing near 90% of strains involved in invasive pneumococcal disease in immune competent adults. Vaccine confers protection against invasive pneumococcal disease. Immunization is recommended in adults over 65 years old, in patients affected by chronic diseases (cardiopathies, COPD, nephropathies, diabetes mellitus, hepatic cirrhosis, chronic breakage in brain-blood barrier, functional or anatomical asplenia, alcoholism, in immunocompromised hosts, including HIV infection, chemotherapy treatment and hematological malignancies. Influenza vaccine is prepared with particulated antigens, including two influenza A strains and one influenza B strain, selected according to influenza epidemiological worldwide surveillance the year before. On account of continuous antigenic changes (drifts, it is necessary to modify the vaccine antigen's composition yearly. Cost/effectiveness evaluation has confirmed the efficacy of influenza vaccine in reducing morbidity and mortality associated to influenza epidemic and health economical resources involved in patient care. Besides, clinical trials have confirmed that immunization reduces the risk of acquiring pneumonia, of hospitalization and death in elderly people during the influenza epidemic, when vaccine antigenic composition is similar to the circulating strains. Vaccination is recommended annually in healthy adults over 65 years old, in patients with chronic diseases (cardiopathies, COPD, nephropathies, diabetes mellitus, hepatic cirrhosis, chronic breakage of blood-brain barrier, functional or anatomical asplenia, alcoholism. It is also recommended in women who will be in the second or third trimester of pregnancy during the influenza season, in immunocompromised hosts, in institutionalized patients (geriatrics, health care workers, and travelers to geographical areas that are affected by the

  5. Measuring causes of adult mortality in rural northern Malawi over a decade of change

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    Judith R. Glynn

    2014-04-01

    Full Text Available Background: Verbal autopsy could be more widely used if interpretation by computer algorithm could be relied on. We assessed how InterVA-4 results compared with clinician review in diagnosing HIV/AIDS-related deaths over the period of antiretroviral (ART roll-out. Design: In the Karonga Prevention Study demographic surveillance site in northern Malawi, all deaths are followed by verbal autopsy using a semi-structured questionnaire. Cause of death is assigned by two clinicians with a third as a tie-breaker. The clinician review diagnosis was compared with the InterVA diagnosis using the same questionnaire data, including all adult deaths from late 2002 to 2012. For both methods data on HIV status were used. ART was first available in the district from 2005, and within the demographic surveillance area from 2006. Results: There were 1,637 adult deaths, with verbal autopsy data for 1,615. Adult mortality and the proportion of deaths attributable to HIV/AIDS fell dramatically following ART introduction, but for each year the proportion attributed to HIV/AIDS by InterVA was lower than that attributed by clinician review. This was partly explained by the handling of TB cases. Using clinician review as the best available ‘gold standard’, for those aged 15–59, the sensitivity of InterVA for HIV/AIDS deaths was 59% and specificity 88%. Grouping HIV/AIDS/TB sensitivity was 78% and specificity 83%. Sensitivity was lower after widespread ART use. Conclusions: InterVA underestimates the proportion of deaths due to HIV/AIDS. Accepting that it is unrealistic to try and differentiate TB and AIDS deaths would improve the estimates. Caution is needed in interpreting trends in causes of death as ART use may affect the performance of the algorithm.

  6. Recurrent pneumonia with mild hypogammaglobulinemia diagnosed as X-linked agammaglobulinemia in adults

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    Tsuchiya Shigeru

    2001-04-01

    Full Text Available Abstract Background X-linked agammaglobulinemia (XLA is a humoral immunodeficiency caused by disruption of the Bruton's tyrosine kinase (BTK gene. Typical XLA patients suffer recurrent and severe bacterial infections in childhood. Methods Flow cytometric analysis of the peripheral monocytes using the anti-BTK antibody was used to characterize a 27 year old male patient with mild hypogammaglobulinemia (IgG, 635 mg/dl; IgM, 11 mg/dl; IgA, Results Flow cytometric analysis of cytoplasmic BTK protein in peripheral monocytes indicated that the patient presents a rare case of adult-onset XLA and that his mother is an XLA carrier. Sequencing of the BTK gene revealed a deletion of AG in the codon for Glu605 (AGT, resulting in an aberrant stop codon that truncates the BTK protein in its kinase domain. Conclusions This case suggests that some XLA cases may remain undiagnosed because they only show mild hypogammaglobulinemia and they lack repeated infections in childhood. Flow cytometric analysis is a powerful method to screen these patients.

  7. Molecular epidemiology of nontypeable Haemophilus influenzae causing community-acquired pneumonia in adults.

    Directory of Open Access Journals (Sweden)

    Carmen Puig

    Full Text Available Nontypeable Haemophilus influenzae (NTHi is an opportunistic pathogen which causes a variety of respiratory infections. The objectives of the study were to determine its antimicrobial susceptibility, to characterize the β-lactam resistance, and to establish a genetic characterization of NTHi isolates. Ninety-five NTHi isolates were analyzed by pulsed field gel electrophoresis (PFGE and multi locus sequence typing (MLST. Antimicrobial susceptibility was determined by microdilution, and the ftsI gene (encoding penicillin-binding protein 3, PBP3 was PCR amplified and sequenced. Thirty (31.6% isolates were non-susceptible to ampicillin (MIC ≥ 2 mg/L, with 10 of them producing β-lactamase type TEM-1 as a resistance mechanism. After ftsI sequencing, 39 (41.1% isolates showed amino acid substitutions in PBP3, with Asn526 → Lys being the most common (69.2%. Eighty-four patients were successfully treated with amoxicillin/clavulanic acid, ceftriaxone and levofloxacin. Eight patients died due either to aspiration or complication of their comorbidities. In conclusion, NTHi causing CAP in adults shows high genetic diversity and is associated with a high rate of reduced susceptibility to ampicillin due to alterations in PBP3. The analysis of treatment and outcomes demonstrated that NTHi strains with mutations in the ftsI gene could be successfully treated with ceftriaxone or fluoroquinolones.

  8. Hispanic older adult mortality in the United States: new estimates and an assessment of factors shaping the Hispanic paradox.

    Science.gov (United States)

    Lariscy, Joseph T; Hummer, Robert A; Hayward, Mark D

    2015-02-01

    Hispanics make up a rapidly growing proportion of the U.S. older adult population, so a firm grasp of their mortality patterns is paramount for identifying racial/ethnic differences in life chances in the population as a whole. Documentation of Hispanic mortality is also essential for assessing whether the Hispanic paradox--the similarity in death rates between Hispanics and non-Hispanic whites despite Hispanics' socioeconomic disadvantage--characterizes all adult Hispanics or just some age, gender, nativity, or national-origin subgroups. We estimate age-/sex- and cause-specific mortality rate ratios and life expectancy for foreign-born and U.S.-born Hispanics, foreign-born and U.S.-born Mexican Americans, non-Hispanic blacks, and non-Hispanic whites ages 65 and older using the 1989-2006 National Health Interview Survey Linked Mortality Files. Results affirm that Hispanic mortality estimates are favorable relative to those of blacks and whites, but particularly so for foreign-born Hispanics and smoking-related causes. However, if not for Hispanics' socioeconomic disadvantage, their mortality levels would be even more favorable. PMID:25550142

  9. Early-onset ventilator-associated pneumonia in adults randomized clinical trial: comparison of 8 versus 15 days of antibiotic treatment.

    Directory of Open Access Journals (Sweden)

    Gilles Capellier

    Full Text Available PURPOSE: The optimal treatment duration for ventilator-associated pneumonia is based on one study dealing with late-onset of the condition. Shortening the length of antibiotic treatment remains a major prevention factor for the emergence of multiresistant bacteria. OBJECTIVE: To demonstrate that 2 different antibiotic treatment durations (8 versus 15 days are equivalent in terms of clinical cure for early-onset ventilator-associated pneumonia. METHODS: Randomized, prospective, open, multicenter trial carried out from 1998 to 2002. MEASUREMENTS: The primary endpoint was the clinical cure rate at day 21. The mortality rate was evaluated on days 21 and 90. RESULTS: 225 patients were included in 13 centers. 191 (84.9% patients were cured: 92 out of 109 (84.4% in the 15 day cohort and 99 out of 116 (85.3% in the 8 day cohort (difference = 0.9%, odds ratio = 0.929. 95% two-sided confidence intervals for difference and odds ratio were [-8.4% to 10.3%] and [0.448 to 1.928] respectively. Taking into account the limits of equivalence (10% for difference and 2.25 for odds ratio, the objective of demonstrative equivalence between the 2 treatment durations was fulfilled. Although the rate of secondary infection was greater in the 8 day than the 15 day cohort, the number of days of antibiotic treatment remained lower in the 8 day cohort. There was no difference in mortality rate between the 2 groups on days 21 and 90. CONCLUSION: Our results suggest that an 8-day course of antibiotic therapy is safe for early-onset ventilator-associated pneumonia in intubated patients. TRIAL REGISTRATION: ClinicalTrials.gov NCT01559753.

  10. Pneumonia (image)

    Science.gov (United States)

    Pneumonia is an inflammation of the lungs caused by an infection. Many different organisms can cause it, including bacteria, viruses, and fungi. Pneumonia is a common illness that affects millions of ...

  11. Mycoplasma pneumonia

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/000082.htm Mycoplasma pneumonia To use the sharing features on this page, please enable JavaScript. Mycoplasma pneumonia is an infection of the lungs by ...

  12. Influenza-Related Mortality Among Adults Aged 25–54 Years With AIDS in South Africa and the United States of America

    OpenAIRE

    Cohen, Cheryl; Simonsen, Lone; Sample, Jeannette; Kang, Jong-Won; Miller, Mark; Madhi, Shabir A; Campsmith, Michael; Viboud, Cecile

    2012-01-01

    In the absence of highly active therapy antiretroviral (HAART), adults with AIDS experience substantially elevated influenza-associated mortality in South Africa and the United States. This elevated mortality risk declined with widespread HAART introduction in the United States but did not disappear entirely. These data support increased access to HAART and influenza vaccination for human immunodeficiency virus–infected adults globally.

  13. What doesn't kill you makes you poorer: Adult wages and early-life mortality in India.

    Science.gov (United States)

    Lawson, Nicholas; Spears, Dean

    2016-05-01

    A growing literature indicates that effects of early-life health on adult economic outcomes could be substantial in developing countries, but the magnitude of this effect is debated. We document a robust gradient between the early-life mortality environment to which men in India were locally exposed in their district and year of birth and the wages that they earn as adults. A 1 percentage point reduction in infant mortality (or 10 point reduction in IMR) in an infant's district and year of birth is associated with an approximately 2 percent increase in his subsequent adult wages. Consistent with theories and evidence in the literature, we find that the level of schooling chosen for a child does not mediate this association. Because of its consequences for subsequent wages, early-life health could also have considerable fiscal externalities; if so, public health investments could come at very low net present cost. PMID:26706689

  14. Stroke Prevalence, Mortality and Disability-Adjusted Life Years in Adults Aged 20-64 Years in 1990-2013

    DEFF Research Database (Denmark)

    Krishnamurthi, Rita V; Moran, Andrew E; Feigin, Valery L;

    2015-01-01

    in younger adults. OBJECTIVES: This study aims to estimate prevalence, mortality and disability-adjusted life years (DALYs) and their trends for total, ischemic stroke (IS) and hemorrhagic stroke (HS) in the world for 1990-2013 in adults aged 20-64 years. METHODOLOGY: Stroke prevalence, mortality and DALYs.......8 (95% UI 16.9-22.6) and 13.7 (95% UI 12.1-15.9)) per 100,000). No significant change was detected in IS death rates among younger adults. The total DALYs from all strokes in those aged 20-64 years was 51,429,440 (95% UI 46,561,382-57,320,085). Globally, there was a 24.4% (95% UI 16.6-33.8) increase...... services for stroke is required to substantially narrow these disparities. © 2015 S. Karger AG, Basel....

  15. Serum phosphate predicts early mortality in adults starting antiretroviral therapy in Lusaka, Zambia: a prospective cohort study.

    Directory of Open Access Journals (Sweden)

    Douglas C Heimburger

    Full Text Available BACKGROUND: Patients starting antiretroviral therapy (ART for acquired immunodeficiency syndrome (AIDS in sub-Saharan Africa have high rates of mortality in the initial weeks of treatment. We assessed the association of serum phosphate with early mortality among HIV-infected adults with severe malnutrition and/or advanced immunosuppression. METHODOLOGY/PRINCIPAL FINDINGS: An observational cohort of 142 HIV-infected adults initiating ART in Lusaka, Zambia with body mass index (BMI <16 kg/m(2 or CD4(+ lymphocyte count <50 cells/microL, or both, was followed prospectively during the first 12 weeks of ART. Detailed health and dietary intake history, review of systems, physical examination, serum metabolic panel including phosphate, and serum ferritin and high-sensitivity C-reactive protein (hsCRP were monitored. The primary outcome was mortality. Baseline serum phosphate was a significant predictor of mortality; participants alive at 12 weeks had a median value of 1.30 mmol/L (interquartile range [IQR]: 1.04, 1.43, compared to 1.06 mmol/L (IQR: 0.89, 1.27 among those who died (p<0.01. Each 0.1 mmol/L increase in baseline phosphate was associated with an incremental decrease in mortality (AHR 0.83; 95% CI 0.72 to 0.95. The association was independent of other metabolic parameters and known risk factors for early ART-associated mortality in sub-Saharan Africa. While participant attrition represented a limitation, it was consistent with local program experience. CONCLUSIONS/SIGNIFICANCE: Low serum phosphate at ART initiation was an independent predictor of early mortality among HIV patients starting ART with severe malnutrition or advanced immunosuppression. This may represent a physiologic phenomenon similar to refeeding syndrome, and may lead to therapeutic interventions that could reduce mortality.

  16. Pneumonia lipoídica em adultos: aspectos na tomografia computadorizada de alta resolução Lipoid pneumonia in adults: findings on high-resolution computed tomography

    Directory of Open Access Journals (Sweden)

    Edson Marchiori

    2007-10-01

    Full Text Available OBJETIVO: Apresentar os aspectos na tomografia computadorizada de alta resolução do tórax da pneumonia lipoídica exógena por aspiração de óleo mineral, em pacientes adultos MATERIAIS E MÉTODOS: Foram estudados oito pacientes adultos - quatro mulheres e quatro homens - com média de idade de 69,4 anos, todos usuários de óleo mineral para tratamento de constipação intestinal. Os exames foram avaliados por dois radiologistas, de forma independente RESULTADOS: Os achados tomográficos mais comuns foram as consolidações com áreas de densidade de gordura de permeio, e o padrão de pavimentação em mosaico. As lesões foram bilaterais em seis pacientes, e unilaterais em dois CONCLUSÃO: O encontro de consolidações pulmonares com áreas de densidade de gordura de permeio, associado à história clínica do uso de óleo mineral, é diagnóstico de pneumonia lipoídica exógena.OBJECTIVE: The present study was aimed at describing the findings on high-resolution computed tomography in patients with exogenous lipoid pneumonia secondary to mineral oil aspiration MATERIALS AND METHODS: Eight adult patients - four men and four women - with mean age of 69.4 years were studied. All of the patients were users of mineral oil for treating intestinal constipation. High-resolution computed tomography studies of these patients were blindly evaluated by two radiologists. RESULTS: Air-space consolidation with areas of fat density and crazy paving pattern were the most frequent findings. The lesions were bilateral in six cases and unilateral in two CONCLUSION: Air-space consolidation with areas of fat density, associated with a clinical history of mineral oil ingestion virtually indicates a diagnosis of exogenous lipoid pneumonia.

  17. Comparative radiographic features of community acquired Legionnaires' disease, pneumococcal pneumonia, mycoplasma pneumonia, and psittacosis.

    OpenAIRE

    Macfarlane, J T; Miller, A. C.; Roderick Smith, W H; Morris, A. H.; Rose, D. H.

    1984-01-01

    The features of the chest radiographs of 49 adults with legionnaires' disease were compared with those of 91 adults with pneumococcal pneumonia (31 of whom had bacteraemia or antigenaemia), 46 with mycoplasma pneumonia, and 10 with psittacosis pneumonia. No distinctive pattern was seen for any group. Homogeneous shadowing was more frequent in legionnaires' disease (40/49 cases) (p less than 0.005), bacteraemic pneumococcal pneumonia (25/31) (p less than 0.01) and non-bacteraemic pneumococcal ...

  18. Adult bacteremic pneumococcal pneumonia acquired in the community: A prospective study on 101 patients Neumonía neumocóccica bacteriémica de la comunidad: Un estudio prospectivo en 101 pacientes

    OpenAIRE

    J. H. Gentile; M. D. Sparo; M. E. Mercapide; C. M. Luna

    2003-01-01

    Our objective was to describe incidence, clinical, radiographic and microbiological features of bacteremic pneumococcal pneumonia (BPP) in our environment. A total of 101 patients (7 were treated as outpatients), older than 18 years of age suffering BPP were prospectively evaluated. The incidence was 2.8 cases per 1000 admissions, 50 were males, mean age was 59.9 years (19-97), mortality was 11.8%. Eighty three percent of fatalities occurred within 3 days of admission. Mortality rate increase...

  19. The challenges of the first migration: movement and behaviour of juvenile vs. adult white storks with insights regarding juvenile mortality.

    Science.gov (United States)

    Rotics, Shay; Kaatz, Michael; Resheff, Yehezkel S; Turjeman, Sondra Feldman; Zurell, Damaris; Sapir, Nir; Eggers, Ute; Flack, Andrea; Fiedler, Wolfgang; Jeltsch, Florian; Wikelski, Martin; Nathan, Ran

    2016-07-01

    Migration conveys an immense challenge, especially for juvenile birds coping with enduring and risky journeys shortly after fledging. Accordingly, juveniles exhibit considerably lower survival rates compared to adults, particularly during migration. Juvenile white storks (Ciconia ciconia), which are known to rely on adults during their first fall migration presumably for navigational purposes, also display much lower annual survival than adults. Using detailed GPS and body acceleration data, we examined the patterns and potential causes of age-related differences in fall migration properties of white storks by comparing first-year juveniles and adults. We compared juvenile and adult parameters of movement, behaviour and energy expenditure (estimated from overall dynamic body acceleration) and placed this in the context of the juveniles' lower survival rate. Juveniles used flapping flight vs. soaring flight 23% more than adults and were estimated to expend 14% more energy during flight. Juveniles did not compensate for their higher flight costs by increased refuelling or resting during migration. When juveniles and adults migrated together in the same flock, the juvenile flew mostly behind the adult and was left behind when they separated. Juveniles showed greater improvement in flight efficiency throughout migration compared to adults which appears crucial because juveniles exhibiting higher flight costs suffered increased mortality. Our findings demonstrate the conflict between the juveniles' inferior flight skills and their urge to keep up with mixed adult-juvenile flocks. We suggest that increased flight costs are an important proximate cause of juvenile mortality in white storks and likely in other soaring migrants and that natural selection is operating on juvenile variation in flight efficiency. PMID:27046512

  20. The challenges of the first migration: movement and behaviour of juvenile vs. adult white storks with insights regarding juvenile mortality.

    Science.gov (United States)

    Rotics, Shay; Kaatz, Michael; Resheff, Yehezkel S; Turjeman, Sondra Feldman; Zurell, Damaris; Sapir, Nir; Eggers, Ute; Flack, Andrea; Fiedler, Wolfgang; Jeltsch, Florian; Wikelski, Martin; Nathan, Ran

    2016-07-01

    Migration conveys an immense challenge, especially for juvenile birds coping with enduring and risky journeys shortly after fledging. Accordingly, juveniles exhibit considerably lower survival rates compared to adults, particularly during migration. Juvenile white storks (Ciconia ciconia), which are known to rely on adults during their first fall migration presumably for navigational purposes, also display much lower annual survival than adults. Using detailed GPS and body acceleration data, we examined the patterns and potential causes of age-related differences in fall migration properties of white storks by comparing first-year juveniles and adults. We compared juvenile and adult parameters of movement, behaviour and energy expenditure (estimated from overall dynamic body acceleration) and placed this in the context of the juveniles' lower survival rate. Juveniles used flapping flight vs. soaring flight 23% more than adults and were estimated to expend 14% more energy during flight. Juveniles did not compensate for their higher flight costs by increased refuelling or resting during migration. When juveniles and adults migrated together in the same flock, the juvenile flew mostly behind the adult and was left behind when they separated. Juveniles showed greater improvement in flight efficiency throughout migration compared to adults which appears crucial because juveniles exhibiting higher flight costs suffered increased mortality. Our findings demonstrate the conflict between the juveniles' inferior flight skills and their urge to keep up with mixed adult-juvenile flocks. We suggest that increased flight costs are an important proximate cause of juvenile mortality in white storks and likely in other soaring migrants and that natural selection is operating on juvenile variation in flight efficiency.

  1. Diagnostic aid to rule out pneumonia in adults with cough and feeling of fever. A validation study in the primary care setting

    Directory of Open Access Journals (Sweden)

    Held Ulrike

    2012-12-01

    Full Text Available Abstract Background We recently reported the derivation of a diagnostic aid to rule out pneumonia in adults presenting with new onset of cough or worsening of chronic cough and increased body temperature. The aim of the present investigation was to validate the diagnostic aid in a new sample of primary care patients. Methods From two group practices in Zurich, we included 110 patients with the main symptoms of cough and subjective feeling of increased body temperature, and C-reactive protein levels below 50 μg/ml, no dyspnea, and not daily feeling of increased body temperature since the onset of cough. We excluded patients who were prescribed antibiotics at their first consultation. Approximately two weeks after inclusion, practice assistants contacted the participants by phone and asked four questions regarding the course of their complaints. In particular, they asked whether a prescription of antibiotics or hospitalization had been necessary within the last two weeks. Results In 107 of 110 patients, pneumonia could be ruled out with a high degree of certainty, and no prescription of antibiotics was necessary. Three patients were prescribed antibiotics between the time of inclusion in the study and the phone interview two weeks later. Acute rhinosinusitis was diagnosed in one patient, and antibiotics were prescribed to the other two patients because their symptoms had worsened and their CRP levels increased. Use of the diagnostic aid could have missed these two possible cases of pneumonia. These observations correspond to a false negative rate of 1.8% (95% confidence interval: 0.50%-6.4%. Conclusions This diagnostic aid is helpful to rule out pneumonia in patients from a primary care setting. After further validation application of this aid in daily practice may help to reduce the prescription rate of unnecessary antibiotics in patients with respiratory tract infections.

  2. Relationship between Body Mass Index Reference and All-Cause Mortality: Evidence from a Large Cohort of Thai Adults

    Directory of Open Access Journals (Sweden)

    Vasoontara Yiengprugsawan

    2014-01-01

    Full Text Available We investigate variation in body mass index (BMI reference and 5-year all-cause mortality using data from 87151 adult Open University students nationwide. Analyses focused on BMI reference bands: “normal” (≥18.5 to <23, “lower normal” (≥18.5 to <20.75, “upper normal” (≥20.75 to <23, and “narrow Western normal” (≥23 to <25. We report hazard ratios (HR and 95% Confidence Intervals adjusting for covariates. Compared to lower normal, adults aged 35–65 years who were obese (BMI ≥ 30 were twice as likely to die during the follow-up (HR 2.37; 1.01–5.70. For the same group, when using narrow Western normal as the reference, the results were similar (HR 3.02; 1.26–7.22. However, different combinations of BMI exposure and reference band produce quite different results. Older age persons belonging to Asian overweight BMI category (≥23 to <25 were relatively protected from mortality (HR 0.57; 0.34–0.96 and HR 0.49; 0.28–0.84 when assessed using normal (≥18.5 to <23 and upper normal (≥20.75 to <23 as reference bands. Use of different “normal” reference produced varying mortality relationships in a large cohort of Thai adults. Caution is needed when interpreting BMI-mortality data.

  3. Burden of Severe Pneumonia, Pneumococcal Pneumonia and Pneumonia Deaths in Indian States: Modelling Based Estimates.

    Science.gov (United States)

    Farooqui, Habib; Jit, Mark; Heymann, David L; Zodpey, Sanjay

    2015-01-01

    The burden of severe pneumonia in terms of morbidity and mortality is unknown in India especially at sub-national level. In this context, we aimed to estimate the number of severe pneumonia episodes, pneumococcal pneumonia episodes and pneumonia deaths in children younger than 5 years in 2010. We adapted and parameterized a mathematical model based on the epidemiological concept of potential impact fraction developed CHERG for this analysis. The key parameters that determine the distribution of severe pneumonia episode across Indian states were state-specific under-5 population, state-specific prevalence of selected definite pneumonia risk factors and meta-estimates of relative risks for each of these risk factors. We applied the incidence estimates and attributable fraction of risk factors to population estimates for 2010 of each Indian state. We then estimated the number of pneumococcal pneumonia cases by applying the vaccine probe methodology to an existing trial. We estimated mortality due to severe pneumonia and pneumococcal pneumonia by combining incidence estimates with case fatality ratios from multi-centric hospital-based studies. Our results suggest that in 2010, 3.6 million (3.3-3.9 million) episodes of severe pneumonia and 0.35 million (0.31-0.40 million) all cause pneumonia deaths occurred in children younger than 5 years in India. The states that merit special mention include Uttar Pradesh where 18.1% children reside but contribute 24% of pneumonia cases and 26% pneumonia deaths, Bihar (11.3% children, 16% cases, 22% deaths) Madhya Pradesh (6.6% children, 9% cases, 12% deaths), and Rajasthan (6.6% children, 8% cases, 11% deaths). Further, we estimated that 0.56 million (0.49-0.64 million) severe episodes of pneumococcal pneumonia and 105 thousand (92-119 thousand) pneumococcal deaths occurred in India. The top contributors to India's pneumococcal pneumonia burden were Uttar Pradesh, Bihar, Madhya Pradesh and Rajasthan in that order. Our results

  4. Overall and cause-specific mortality in GH-deficient adults on GH replacement

    DEFF Research Database (Denmark)

    Gaillard, Rolf C; Mattsson, Anders F; Akerblad, Ann-Charlotte;

    2012-01-01

    Hypopituitarism is associated with an increased mortality rate but the reasons underlying this have not been fully elucidated. The purpose of this study was to evaluate mortality and associated factors within a large GH-replaced population of hypopituitary patients.......Hypopituitarism is associated with an increased mortality rate but the reasons underlying this have not been fully elucidated. The purpose of this study was to evaluate mortality and associated factors within a large GH-replaced population of hypopituitary patients....

  5. Epidemiology and etiology of childhood pneumonia in 2010: estimates of incidence, severe morbidity, mortality, underlying risk factors and causative pathogens for 192 countries

    Directory of Open Access Journals (Sweden)

    Igor Rudan

    2013-06-01

    Full Text Available The recent series of reviews conducted within the Global Action Plan for Pneumonia and Diarrhoea (GAPPD addressed epidemiology of the two deadly diseases at the global and regional level; it also estimated the effectiveness of interventions, barriers to achieving high coverage and the main implications for health policy. The aim of this paper is to provide the estimates of childhood pneumonia at the country level. This should allow national policy–makers and stakeholders to implement proposed policies in the World Health Organization (WHO and UNICEF member countries.

  6. Young adult and middle age mortality in Butajira demographic surveillance site, Ethiopia: lifestyle, gender and household economy

    Directory of Open Access Journals (Sweden)

    Högberg Ulf

    2008-07-01

    Full Text Available Abstract Background Public health research characterising the course of life through the middle age in developing societies is scarce. The aim of this study is to explore patterns of adult (15–64 years mortality in an Ethiopian population over time, by gender, urban or rural lifestyle, causes of death and in relation to household economic status and decision-making. Methods The study was conducted in Butajira Demographic Surveillance Site (DSS in south-central Ethiopia among adults 15–64 years old. Cohort analysis of surveillance data was conducted for the years 1987–2004 complemented by a prospective case-referent (case control study over two years. Rate ratios were computed to assess the relationships between mortality and background variables using a Poisson regression model. In the case-referent component, odds ratios (95% confidence intervals were used to assess the effect of certain risk factors that were not included in the surveillance system. Results A total of 367 940 person years were observed in a period of 18 years, in which 2 860 deaths occurred. One hundred sixty two cases and 486 matched for age, sex and place of residence controls were included in the case referent (case control study. Only a modest downward trend in adult mortality was seen over the 18 year period. Rural lifestyle carried a significant survival disadvantage [mortality rate ratio 1.62 (95% CI 1.44 to 1.82, adjusted for gender, period and age group], while the overall effects of gender were negligible. Communicable disease mortality was appreciably higher in rural areas [rate ratio 2.05 (95% CI 1.73 to 2.44, adjusted for gender, age group and period]. Higher mortality was associated with a lack of literacy in a household, poor economic status and lack of women's decision making. Conclusion A complex pattern of adult mortality prevails, still influenced by war, famine and communicable diseases. Individual factors such as a lack of education, low economic

  7. Trends in U.S. Adult Chronic Disease Mortality, 1960–1999: Age, Period, and Cohort Variations

    OpenAIRE

    Yang, Yang

    2008-01-01

    In this paper, I examine temporal changes in U.S. adult mortality by chronic disease cause of death and by sex over a 40-year period in the second half of the twentieth century. I apply age-period-cohort (APC) analyses that combine conventional approaches and a new method of model estimation to simultaneously account for age, period, and cohort variations in mortality rates for four leading causes of deaths, including heart disease, stroke, lung cancer, and breast cancer. The results show tha...

  8. Effects on mortality of a nutritional intervention for malnourished HIV-infected adults referred for antiretroviral therapy

    DEFF Research Database (Denmark)

    Filteau, Suzanne; PrayGod, George; Kasonka, Lackson;

    2015-01-01

    BACKGROUND: Malnourished HIV-infected African adults are at high risk of early mortality after starting antiretroviral therapy (ART). We hypothesized that short-course, high-dose vitamin and mineral supplementation in lipid nutritional supplements would decrease mortality. METHODS: The study...... was a lipid-based nutritional supplement either without (LNS) or with additional vitamins and minerals (LNS-VM), beginning prior to ART initiation; supplement amounts were 30 g/day (150 kcal) from recruitment until 2 weeks after starting ART and 250 g/day (1,400 kcal) from weeks 2 to 6 after starting ART...

  9. HIV/AIDS related mortality among adult medical patients in a tertiary health institution in South-South, Nigeria

    Institute of Scientific and Technical Information of China (English)

    Gyuse AN; Bassey IE; Udonwa NE; Okokon IB; Philip-Ephraim EE

    2010-01-01

    Objective: To determine the causes of death among human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) patients as a step to planning strategies to improve mortality from this condition.Methods: This study retrospectively analyzed the mortality pattern of adult HIV/AIDS patients in the University of Calabar Teaching Hospital from January 2005 to December 2007. The data were obtained from sexually transmitted infection/acquired immunodeficiency syndrome (STI/AIDS) clinic register, admissions and discharge/death registers as well as the patients' case records and the hospitals monthly mortality reviews. Information obtained included age, sex, diagnosis and cause(s) of death. The causes of death considered were the directcauses of death, since the originating antecedent cause of death is the same in all the patients, in this case, HIV/AIDS. Data was analysed using Epi Info 2002.Results: The total number of mortalities during the study period was 350,100 were HIV positive representing 28.6% of all deaths. While advanced HIV/AIDS disease was the leading cause of death in our study representing 27.0%, tuberculosis was the single leading cause of deaths in HIV/AIDS patients constituting about 24.0% of deaths. This was followed by sepsis and septicaemia (13.0%), meningitis and encephalitis, and anaemia accounting for 11.0%, while respiratory diseases constituted 5.0% of the mortality burden. The highest number of deaths occurred in those aged between 21-50 years (82.0%).Conclusions: The study has shown that HIV/AIDS is a major cause of morbidity and mortality in our hospital. The causes of death reflect the varied spectrum of infection and other forms of organ involvement that affect HIV/AIDS patients. The present dismal situation of adult patients living with HIV/AIDS calls for enhanced strategies to decrease the mortality trend observed in Nigeria and sub-Saharan Africa.

  10. 血清降钙素原在肺炎诊断及严重程度判断中的研究%Roles of serum procalcitonin in the diagnosis and severity evaluation of pneumonia in adult patients

    Institute of Scientific and Technical Information of China (English)

    王珊; 刘双

    2012-01-01

    Objective:To evaluate the usefulness of serum procalcitonin (PCT) level as a predictor of diagnosis in adult patients with pneumonia and to discuss the value of PCT in the severity assessment of pneu-monia. Methods; It is a prospective study, in the 51 patients with pneumonia were enrolled in this trial. Pa-tients' data were collected, including basic information, associated diseases, imaging examination, microbiolo-gy , blood gases analysis, and CURB-65 Score (respiratory rate, blood pressure, renal function, consciousness, age ). Meanwhile, the values of PCT, CRP and WBC, IL-6, endotoxin were detected within the first 24h of ad-mission. Results; 1. The level of PCT of the group with positive sputum culture was higher than that of myco-plasma or chlamydia pneumonia group, the varies had statistics significant between the two groups ( P = 0. 006) , it is also higher than that of the patients without etiology ( P = 0. 004) . However, the levels of WRC、 CRP.,IL-6 and endotoxin among the groups had no significant differences (P >0. 05). 2. Patients with compli-cations had a higher PCT level than those who did not. Pneumonia Severity Classification (CURB-65 Score) is an objective standard for estimating the severity of condition of pneumonia. According to this score, with 2 scores as critical value, patients was divided into two groups, using 0. lug/L as critical values, the values of PCT were divided into two groups, significant difference was observed between mortality low group and mortality intermediate or high group (P = 0. 026). Conclusion: PCT may have a role to predict the etiological diagnosis in patients with pneumonia and have an advantage over CRP N endotoxin " WBC and IL-6. The study also sug-gests that PCT may have a role to predict the severity in the patients with pneumonia.%目的:评价血清降钙素原(PCT)对肺炎诊断及严重程度评估中的应用价值.方法:本研究为前瞻性,收集肺炎患者51例,检测患者的血清PCT、C-反

  11. Serum Phosphate Predicts Early Mortality among Underweight Adults Starting ART in Zambia: A Novel Context for Refeeding Syndrome?

    Science.gov (United States)

    Koethe, John R; Blevins, Meridith; Nyirenda, Christopher K; Kabagambe, Edmond K; Chiasera, Janelle M; Shepherd, Bryan E; Zulu, Isaac; Heimburger, Douglas C

    2013-01-01

    Background. Low body mass index (BMI) at antiretroviral therapy (ART) initiation is associated with early mortality, but the etiology is not well understood. We hypothesized that low pretreatment serum phosphate, a critical cellular metabolism intermediate primarily stored in skeletal muscle, may predict mortality within the first 12 weeks of ART. Methods. We prospectively studied 352 HIV-infected adults initiating ART in Lusaka, Zambia to estimate the odds of death for each 0.1 mmol/L decrease in baseline phosphate after adjusting for established predictors of mortality. Results. The distribution of phosphate values was similar across BMI categories (median value 1.2 mmol/L). Among the 145 participants with BMI refeeding syndrome. Further studies of cellular metabolism in this population are needed.

  12. Serum Phosphate Predicts Early Mortality among Underweight Adults Starting ART in Zambia: A Novel Context for Refeeding Syndrome?

    Science.gov (United States)

    Koethe, John R.; Blevins, Meridith; Nyirenda, Christopher K.; Kabagambe, Edmond K.; Chiasera, Janelle M.; Shepherd, Bryan E.; Zulu, Isaac; Heimburger, Douglas C.

    2013-01-01

    Background. Low body mass index (BMI) at antiretroviral therapy (ART) initiation is associated with early mortality, but the etiology is not well understood. We hypothesized that low pretreatment serum phosphate, a critical cellular metabolism intermediate primarily stored in skeletal muscle, may predict mortality within the first 12 weeks of ART. Methods. We prospectively studied 352 HIV-infected adults initiating ART in Lusaka, Zambia to estimate the odds of death for each 0.1 mmol/L decrease in baseline phosphate after adjusting for established predictors of mortality. Results. The distribution of phosphate values was similar across BMI categories (median value 1.2 mmol/L). Among the 145 participants with BMI refeeding syndrome. Further studies of cellular metabolism in this population are needed. PMID:23691292

  13. Mortality of Bemisia tabaci biotype B (sternorrhyncha: aleyrodidae adults by aliphatic and aromatic synthetic sucrose esters

    Directory of Open Access Journals (Sweden)

    Mariangela Alves

    2008-12-01

    Full Text Available The B-strain of Bemisia tabaci Gennadius is a key pest of several crops and chemical control is the main control method used by growers, although reduction in efficacy due to insecticide resistance has already been reported. The aim of this work was to investigate the insecticidal effect of an array of synthetic sucrose esters with the aliphatic and aromatic groups on whitefly adults. Sucrose butyrate, caprate, octanoate, palmitate, oleate, octaacetate, phthalate, benzoate, and sucrose diacetate hexaisobutyrate were tested. The solutions were prepared and applied on the adults caught on yellow sticky traps using the Potter spray tower. Long-chains sucrose aliphatic esters were more effective against the silverleaf whiteflies and the highest mortality was obtained with sucrose oleate and sucrose octanoate. Since these compounds were tensoactive, sodium dodecylsulphate was also tested for the comparison but no effect was observed. Sucrose butyrate and other aliphatic and aromatic sucrose polyesters showed negligible effect on the silverleaf whiteflies.O biótipo B de B. tabaci Gennadius tem se destacado como uma praga-chave de diversas culturas. O controle químico tem sido a principal tática de controle utilizada, embora já se tenha observado redução na eficiência dos produtos devido ao desenvolvimento de resistência. Assim, o objetivo do presente trabalho foi avaliar o efeito de diversos ésteres de sacarose com grupos alifáticos ou aromáticos sobre adultos de mosca-branca. Butirato de sacarose, caprato, octanoato, palmitato, oleato, actaacetato, ftlato, benzoato e diacetato hexaisobutirato de sacarose foram testados. Soluções de éster de sacarose foram preparadas e aplicadas sobre adultos capturados em armadilhas adesivas utilizando Torre de Potter. Ésteres alifáticos de sacarose com longas cadeias foram mais efetivos contra mosca-branca e as maiores taxas de mortalidade foram obtidas com oleato e octanoato de sacarose. Uma vez que

  14. A population-based cohort study of late mortality in adult autologous hematopoietic stem cell transplant recipients in Australia.

    Science.gov (United States)

    Ashton, Lesley J; Le Marsney, Renate E; Dodds, Anthony J; Nivison-Smith, Ian; Wilcox, Leonie; O'Brien, Tracey A; Vajdic, Claire M

    2014-07-01

    We assessed overall and cause-specific mortality and risk factors for late mortality in a nation-wide population-based cohort of 4547 adult cancer patients who survived 2 or more years after receiving an autologous hematopoietic stem cell transplantation (HSCT) in Australia between 1992 and 2005. Deaths after HSCT were identified from the Australasian Bone Marrow Transplant Recipient Registry and through data linkage with the National Death Index. Overall, the survival probability was 56% at 10 years from HSCT, ranging from 34% for patients with multiple myeloma to 90% for patients with testicular cancer. Mortality rates moved closer to rates observed in the age- and sex-matched Australian general population over time but remained significantly increased 11 or more years from HSCT (standardized mortality ratio, 5.9). Although the proportion of deaths from nonrelapse causes increased over time, relapse remained the most frequent cause of death for all diagnoses, 10 or more years after autologous HSCT. Our findings show that prevention of disease recurrence remains 1 of the greatest challenges for autologous HSCT recipients, while the increasing rates of nonrelapse deaths due to the emergence of second cancers, circulatory diseases, and respiratory diseases highlight the long-term health issues faced by adult survivors of autologous HSCT. PMID:24631736

  15. Effect of feeding status on mortality response of adult bed bugs (Hemiptera: Cimicidae) to some insecticide products.

    Science.gov (United States)

    Choe, Dong-Hwan; Campbell, Kathleen

    2014-06-01

    Fresh and aged residual deposits of several insecticide products were tested against bed bug adults to determine if a recent bloodmeal affected their mortality response to the residues. The bed bugs with a recent bloodmeal survived significantly longer compared with the unfed ones on their exposure to fresh or aged residual deposits of chlorfenapyr and aged residual deposits of deltamethrin on a wooden substrate. Even though the survival time of fed bed bugs was significantly longer than that of unfed ones on their exposure to fresh residue of deltamethrin and aged residue of desiccant pyrethrin dust, these treatments resulted in similarly high final mortalities regardless of feeding status of the insects. Mortality responses of fed and unfed bed bugs were similar to fresh or aged residual deposits of imidacloprid + cyfluthrin combination and fresh residual deposits of desiccant pyrethrin dust. Topical application assays indicated that a recent bloodmeal significantly increased the bed bug's survival time for chlorfenapyr, but not for deltamethrin. Pyrethroid-resistant bed bugs also showed a similar increase in their survival time for chlorfenapyr after a bloodmeal. The comparison of mortality responses between fed and unfed bed bugs treated with similar amount of chlorfenapyr per fresh body weight indicated that increased body mass was not the primary cause for this bloodmeal-induced tolerance increase for chlorfenapyr. Because the surviving bed bugs can continue ovipositing, the effectiveness of chlorfenapyr residual deposits in bed bug harborages could be significantly affected by the feeding status of the adult bed bug populations. PMID:25026684

  16. High local unemployment and increased mortality in Danish adults; results from a prospective multilevel study

    OpenAIRE

    Osler, M; Christensen, U; Lund, R; Gamborg, M; Godtfredsen, N; Prescott, E

    2003-01-01

    Methods: Prospective cohort study with record linkage to mortality and unemployment registers. Data were pooled data from two population studies conducted in Copenhagen, Denmark. The association between unemployment at parish level and mortality was examined in Cox proportional hazard analysis. A total of 15 980 men and women, aged 20–67 years and employed at 1 January 1980, were studied. All-cause mortality was followed from January 1981 to December 1998.

  17. Effect of irradiation and exposure to nitrogen on the mortality of adults. Tribolium confusum J. du V

    International Nuclear Information System (INIS)

    For insect control irradiation can be improved by combination with other methods in order to limit the dose and hence to preserve the sensory qualities of some foods like fresh fruits, or to kill more rapidly the adult stage for avoiding the risk that a shipment be rejected because of the presence of living insects. The effect of irradiation with long exposure to inert gaz has not been reported yet. This study presents preliminary results on Tribolium confusum. Irradiation alone from 120 to 1000 Gy killed 100% of adults T. confusum in 12 to 15 days. At 60 Gy 10% insects were living after 28 days and at 40 Gy no mortality was observed. Mortality of adults T. confusum observed 10 days after exposure to nitrogen increased with the exposure time. 100 % mortality was reached for 17 hours exposure. When insects were exposed to nitrogen before or after irradiation synergic effects were observed. The greatest efficiency was obtained when insects were irradiated at 600 Gy after 9 hr exposure. When insects were exposed to nitrogen during irradiation the protective effectt of a short exposure (1/2 hr) was observed only for low doses (< 60 Gy). For a long exposure (9 hr) early irradiation at 600 Gy was more efficient than late irradiation

  18. Viral pneumonia

    Science.gov (United States)

    ... off infection. Vaccines may help prevent pneumonia in children, the elderly, and people with diabetes, asthma, emphysema , HIV, cancer, or other chronic conditions. A drug called palivizumab ( ...

  19. Serum Phosphate Predicts Early Mortality among Underweight Adults Starting ART in Zambia: A Novel Context for Refeeding Syndrome?

    Directory of Open Access Journals (Sweden)

    John R. Koethe

    2013-01-01

    Full Text Available Background. Low body mass index (BMI at antiretroviral therapy (ART initiation is associated with early mortality, but the etiology is not well understood. We hypothesized that low pretreatment serum phosphate, a critical cellular metabolism intermediate primarily stored in skeletal muscle, may predict mortality within the first 12 weeks of ART. Methods. We prospectively studied 352 HIV-infected adults initiating ART in Lusaka, Zambia to estimate the odds of death for each 0.1 mmol/L decrease in baseline phosphate after adjusting for established predictors of mortality. Results. The distribution of phosphate values was similar across BMI categories (median value 1.2 mmol/L. Among the 145 participants with BMI <18.5 kg/m2, 28 (19% died within 12 weeks. Lower pretreatment serum phosphate was associated with increased mortality (odds ratio (OR 1.24 per 0.1 mmol/L decrement, 95% CI: 1.05 to 1.47; P=0.01 after adjusting for sex, age, and CD4+ lymphocyte count. A similar relationship was not observed among participants with BMI ≥18.5 kg/m2 (OR 0.96, 95% CI: 0.76 to 1.21; P=0.74. Conclusions. The association of low pretreatment serum phosphate level and early ART mortality among undernourished individuals may represent a variant of the refeeding syndrome. Further studies of cellular metabolism in this population are needed.

  20. Perfectionism and the Five-factor Personality Traits as Predictors of Mortality in Older Adults

    NARCIS (Netherlands)

    Fry, Prem S.; Debats, Dominique L.

    2009-01-01

    The major hypothesis of the study was that perfectionism as a personality trait, along with the five-factor personality traits and dispositional optimism, is strongly associated with mortality in late life. After baseline assessment of health and personality traits as predictors of mortality, 450 pa

  1. [Estimated coverage of death counts and adult mortality in Mozambique based on census data].

    Science.gov (United States)

    Alberto, Serafim Adriano; Queiroz, Bernardo Lanza

    2015-10-01

    In 1997 and 2007, the questionnaire used in the Population Census in Mozambique included a question on deaths at home in the previous 12 months. This study aimed to evaluate the quality of mortality data for the country as a whole and its three major geographic regions. More specifically, based on formal demographic methods, the authors sought to evaluate the quality of information in terms of degree of coverage of death counts and mortality structure, summarized by the probability of death between 15 and 60 years of age. The 2007 census enumerated between 65% and 90% of deaths in Mozambique, suggesting that mortality estimates using direct methods underestimate mortality in the country. The study showed that there has been progress in the quality of death counts in the census, and that in the absence of high-quality vital statistics, population censuses can be a good source of mortality data in developing countries.

  2. Trends in young-adult mortality between the 1990s and the 2000s in urban and non-urban areas in Belgium: the role of a changing educational composition in overall mortality decline.

    Science.gov (United States)

    De Grande, Hannelore; Vandenheede, Hadewijch; Deboosere, Patrick

    2014-11-01

    This study probes into the evolution in young-adult mortality according to urbanisation degree in Belgium and moves beyond mere description through decomposing mortality trends into changes in educational distribution and in overall mortality. As most of young-adult deaths are preventable and an enormous cost and loss to society, this study addresses a highly relevant public-health topic. Individual record-linked data between the Belgian censuses of 1991 and 2001 and register data on death and emigrations are used. Age-standardized mortality rates (ASMR), directly standardized to the European Population of 2013 are calculated with 95% confidence intervals (CI), as well as a decomposition measure to pinpoint the proportion mortality change attributable to differences in educational composition over time. The young-adult population consists of 2,458,637 19-34 year-olds in 1991, with 11,898 deaths in a five-year period, and is slightly smaller in 2001 with 2,174,368 young adults and 8138 deaths. Overall, there is a positive evolution towards lower young-adult mortality, with the strongest declines in men living in large urban areas (ASMR from 149.0 [CI 142.1-155.8] in 1991-1996 to 94.6 [88.9-100.3] in 2001-2006). Decomposition analysis shows that the decrease in male mortality in non-urban areas over time is largely due to changes in the educational composition, while mortality in urban areas mainly decreases because of a decline in overall mortality. In urban areas all educational groups have benefitted over time. This clearly demonstrates that living and growing up in an urban area does not always have to imply a health penalty, but can have health advantages as well.

  3. Influence of media type and moisture on adult development and pupal mortality in Rhagoletis indifferens (Diptera: Tephritidae).

    Science.gov (United States)

    Yee, Wee L

    2013-06-01

    The influence of media type and moisture on adult development and pupal mortality in western cherry fruit fly, Rhagoletis indifferens Curran (Diptera:Tephritidae), was assessed using the pupal-adult and the larval-pupal stage. Inside containers, a higher percent of flies that emerged from dry loam was deformed (44.2%, 1-cm-depth loam; 84.4%, 5-cm-depth loam) than flies from 16% moist loam and dry and 16% moist lab soil (peat moss-sand mix) (0-14.9%). Percent of flies deformed from dry sand (22.1%, 1-cm depth; 49.5%, 5-cm depth) was greater than from 16% moist sand and dry and 16% moist peat moss (0-10.5%). Percents of flies deformed from 8% moist loam, lab soil, sand, and peat moss (0-5.8%) did not differ. Pupae suffered higher mortality at 7 and 14 d after larvae were dropped onto dry loam and dry sand (68.2-94.0%) than dry lab soil and dry peat moss (3.0-53.0%); respective mortalities at 21 and 28 d were similar (81.3-96.0 versus 64.7-97.9%). Pupal mortality in moist media was lower (0.5-40.3%) than in dry media. In outdoor tests, pupal mortality was also higher in dry loam than other dry media. In nature, 60.9% of pupae in dry sandy loams in late summer were dead. Results suggest R. indifferens has not yet evolved to fully cope with dry soils and that pupation in media with traits similar to those of peat moss or a peat moss-sand mix could reduce negative effects of dry environments on fly survival.

  4. CT-morphological characterization of respiratory syncytial virus (RSV) pneumonia in immune-compromised adults; Morphologische Charakterisierung und Verlaufsbeurteilung von Respiratory Syncytial Virus (RSV) Pneumonien bei immunkompromittierten Erwachsenen in der Thorax-CT

    Energy Technology Data Exchange (ETDEWEB)

    Mayer, J.L.; Kauczor, H.U. [Univ. Hospital Heidelberg (Germany). Diagnostic and Interventional Radiology; Lehners, N.; Egerer, G. [Univ. Hospital Heidelberg (Germany). Internal Medicine V of Hematology, Oncoloy and Rheumatology; Heussel, C.P. [Thoracic Hospital at Univ. Hospital Heidelberg (Germany). Diagnostic and Interventional Radiology with Nuclear Medicine

    2014-07-15

    Characterization and follow-up evaluation of chest CT of RSV pneumonia in immune-compromised adults during a seasonal epidemic. Retrospective analysis of 132 chest CT examinations of 51 adult immune-compromised patients (29 m/22f, diameter 58 years) with clinical signs of pneumonia and positive RSV test in winter 2011/2012. Two experienced chest radiologists evaluated the morphology (bronchial wall thickening, tree-in-bud, nodules, halo, ground-glass opacities, consolidations, pleural fluid) of the CT scans by consensus. Pathological findings were in 86 % of the chest CT scans: Areas of ground-glass attenuation in 64 %, consolidations in 56 %, nodules in 55 % (diameter 8 mm in maximal diameter, with halo in 71 %), pleural fluid in 44 % (diameter 2 cm), tree-in-bud in 36 %, bronchial wall thickening in 27 % and more than one morphological finding in 72 %. There were no pathological CT findings in 14 % of patients with clinical symptoms of pneumonia because these patients did not undergo follow-up. Radiological progression was found in 45 % of patients and regression in 33 % in follow-up examinations. In 37 % an additional examination of the paranasal sinuses was performed and showed sinusitis in 63 % of cases. 90 % of the patients had sinusitis as well as pneumonia. In addition to RSV, a further pathogenic agent was found in bronchoalveolar lavage of five patients (Aspergillus spec., herpes simplex virus, Pseudomonas aeruginosa). The most characteristic signs in chest CT scans were at the beginning of pneumonia with nodules and tree-in-bud often combined with bronchial wall thickening. The following CT scans showed characteristic but not pathognomonic chest CT findings of RSV pneumonia. These morphological findings should be recognized seasonally (winter) especially at the beginning of the case of pneumonia. RSV-associated additional sinusitis is probably common and should be noticed.

  5. Plasma Free Fatty Acids, Fatty Acid-binding Protein 4, and Mortality in Older Adults (From the Cardiovascular Health Study)

    Science.gov (United States)

    Miedema, Michael D.; Maziarz, Marlena; Biggs, Mary L.; Zieman, Susan J.; Kizer, Jorge R.; Ix, Joachim H.; Mozaffarian, Dariush; Tracy, Russell P.; Psaty, Bruce M.; Siscovick, David S.; Mukamal, Kenneth J.; Djousse, Luc

    2014-01-01

    Plasma free fatty acids (FFA) are largely derived from adipose tissue. Elevated levels of FFA and fatty acid-binding protein 4 (FABP4), a key cytoplasmic chaperone of fatty acids, have been associated with adverse cardiovascular outcomes but limited data are available on the relation of these biomarkers with cardiovascular and total mortality. We studied 4,707 participants with a mean age of 75 years who had plasma FFA and FABP4 measured in 1992–1993 as part of the Cardiovascular Health Study, an observational cohort of community dwelling older adults. Over a median follow-up of 11.8 years, 3,555 participants died. Cox proportional hazard regression was used to determine the association between FFA, FABP4, and mortality. In fully adjusted models, FFA were associated with dose-dependent significantly higher total mortality (hazard ratio (HR) per standard deviation (SD): 1.14, 95% confidence interval (CI) 1.09–1.18), but FABP4 levels were not (HR 1.04, 95% CI 0.98–1.09). In a cause-specific mortality analysis, higher concentrations of FFA were associated with significantly higher risk of death due to cardiovascular disease, dementia, infection, and respiratory causes, but not cancer or trauma. We did not find evidence of an interaction between FFA and FABP4 (p=0.45), but FABP4 appeared to be associated with total mortality differentially among men and women (HR 1.17 (1.08–1.26) for men, HR 1.02 (0.96–1.07) for women, interaction p-value <0.001). In conclusion, in a cohort of community-dwelling older individuals, elevated plasma concentrations of FFA, but not FABP4, were associated with cardiovascular and non-cardiovascular mortality. PMID:25073566

  6. β-Blockers and All-Cause Mortality in Adults with Episodes of Acute Bronchitis: An Observational Study.

    Directory of Open Access Journals (Sweden)

    Frans H Rutten

    Full Text Available Recent observational studies suggest that β-blockers may improve long-term prognosis in patients with chronic obstructive pulmonary disease (COPD. We assessed whether β-blocker use improves all-cause mortality in patients with episodes of acute bronchitis.An observational cohort study using data from the electronic medical records of 23 general practices in the Netherlands. The data included standardized information about daily patient contacts, diagnoses, and drug prescriptions. Cox regression was applied with time-varying treatment and covariates.The study included 4,493 patients aged 45 years and older, with at least one episode of acute bronchitis between 1996 and 2006. The mean (SD age of the patients was 66.9 (11.7 years, and 41.9% were male. During a mean (SD follow up period of 7.7 (2.5 years, 20.4% developed COPD. In total, 22.7% had cardiovascular comorbidities, resulting in significant higher mortality rates than those without (51.7% vs. 12.0%, p<0.001. The adjusted hazard ratio of cardioselective β-blocker use for mortality was 0.62 (95% confidence interval [CI], 0.50-0.77, and 1.01 (95% CI 0.75-1.36 for non-selective ones. Some other cardiovascular drugs also reduced the risk of mortality, with adjusted HRs of 0.60 (95% CI 0.46-0.79 for calcium channel blockers, 0.88 (95% CI 0.73-1.06 for ACE inhibitors/angiotensin receptor blockers, and 0.42 (95% CI 0.31-0.57 for statins, respectively.Cardiovascular comorbidities are common and increase the risk of mortality in adults with episodes of acute bronchitis. Cardioselective β-blockers, but also calcium channel blockers and statins may reduce mortality, possibly as a result of cardiovascular protective properties.

  7. High local unemployment and increased mortality in Danish adults; results from a prospective multilevel study

    DEFF Research Database (Denmark)

    Osler, M; Christensen, Ulla; Lund, Rikke;

    2003-01-01

    registers. Data were pooled data from two population studies conducted in Copenhagen, Denmark. The association between unemployment at parish level and mortality was examined in Cox proportional hazard analysis. A total of 15 980 men and women, aged 20-67 years and employed at 1 January 1980, were studied......AIMS: To examine the relation between unemployment rates in area of residence and all-cause mortality, taking the individuals' unemployment experience and a number of social and behavioural factors into account. METHODS: Prospective cohort study with record linkage to mortality and unemployment...... gradually with increasing age. CONCLUSION: This prospective study suggests that high local unemployment and individuals' experience of unemployment increase mortality risk, even after adjustment for other social and behavioural factors....

  8. Mortality in adult offspring of immigrants: a Swedish national cohort study.

    Directory of Open Access Journals (Sweden)

    Hélio Manhica

    Full Text Available Higher risks of psychiatric disorders and lower-than-average subjective health in adulthood have been demonstrated in offspring of immigrants in Sweden compared with offspring of native Swedes, and linked to relative socioeconomic disadvantage. The present study investigated mortality rates in relation to this inequity from a gender perspective.We used data from national registers covering the entire Swedish population aged 18-65 years. Offspring of foreign-born parents who were either Swedish born or had received residency in Sweden before school age (<7 years were defined as "offspring of immigrants." We used Cox regression models to examine the association between parental country of birth and mortality between 1990 and 2008, with adjustment for education, income, age and family type.Male offspring of immigrants from the Middle East (HR:2.00, CI:1.66-2.26, other non-European countries (HR:1.80, CI:1.36-2.36 and Finland (HR:1.56, CI:1.48-1.65 showed an age-adjusted excess mortality risk from all causes of death when compared to offspring with Swedish-born parents. Income, but not education, greatly attenuated these increased mortality risks. No excess mortality rates were found among female offspring of immigrants, with the exception of external cause of death among offspring of Finnish immigrants.The study demonstrates high mortality rates in male offspring of immigrants from Finland and non-European countries that are associated with economic, but not educational, disadvantage. No increased mortality rates were found among female offspring of immigrants. Future studies are needed to explain this gender differential and why income, but not education, predicts mortality in male offspring of immigrants.

  9. A Case of Pneumonia Caused by Pneumocystis Jirovecii and Cryptococcus Neoformans in a Patient with HTLV-1 Associated Adult T- Cell Leukemia/Lymphoma: Occam's Razor Blunted.

    Science.gov (United States)

    Desai, Anish; Fe, Alexander; Desai, Amishi; Ilowite, Jonathan; Cunha, Burke A; Mathew, Joseph P

    2016-02-01

    Adult T-cell leukemia/lymphoma (ATLL) is usually preceded by infection with human T-cell lymphotropic virus I (HTLV-I). Patients with ATLL frequently get opportunistic infections of the lungs, intestines, and central nervous system. Pneumocystis pneumonia is commonly known as an AIDS defining illness. Grocott's methenamine silver stain of bronchoalveolar lavage (BAL) samples obtained via bronchoscopy remain the gold standard for diagnosis. Pulmonary cryptococcosis is seen in patients with T-cell deficiencies and a diagnosis is made by culture of sputum, BAL, or occasionally of pleural fluid. We present the second case of coinfection with these two organisms in a patient with ATLL who was successfully treated with trimethoprim-sulfamethoxazole, corticosteroids, and fluconazole. We illustrate the need for high clinical vigilance for seeking out an additional diagnosis, especially in immunocompromised patients if they are not improving despite receiving appropriate treatment. PMID:27024978

  10. Postnatal growth rates covary weakly with embryonic development rates and do not explain adult mortality probability among songbirds on four continents

    Science.gov (United States)

    Martin, Thomas E.; Oteyza, Juan C.; Mitchell, Adam E.; Potticary, Ahva L.; Lloyd, P.

    2016-01-01

    Growth and development rates may result from genetic programming of intrinsic processes that yield correlated rates between life stages. These intrinsic rates are thought to affect adult mortality probability and longevity. However, if proximate extrinsic factors (e.g., temperature, food) influence development rates differently between stages and yield low covariance between stages, then development rates may not explain adult mortality probability. We examined these issues based on study of 90 songbird species on four continents to capture the diverse life-history strategies observed across geographic space. The length of the embryonic period explained little variation (ca. 13%) in nestling periods and growth rates among species. This low covariance suggests that the relative importance of intrinsic and extrinsic influences on growth and development rates differs between stages. Consequently, nestling period durations and nestling growth rates were not related to annual adult mortality probability among diverse songbird species within or among sites. The absence of a clear effect of faster growth on adult mortality when examined in an evolutionary framework across species may indicate that species that evolve faster growth also evolve physiological mechanisms for ameliorating costs on adult mortality. Instead, adult mortality rates of species in the wild may be determined more strongly by extrinsic environmental causes.

  11. Metabolic syndrome vs.its components for prediction of cardiovascular mortality: A cohort study in Chinese elderly adults

    Institute of Scientific and Technical Information of China (English)

    Dong-Ling Sun; Jian-Hua Wang; Bin Jiang; Liang-Shou Li; Lan-Sun Li; Lei Wu; Hai-Yun Wu; Yao He

    2012-01-01

    Objective The predictive value of the metabolic syndrome (MetS) for mortality from all-cause and cardiovascular disease (CVD) in the Chinese population is unclear. The aim of this present study was to compare MetS with its individual components as predictors of mortality in Chinese elderly adults. Methods A cohort of 1,535 subjects (994 men and 541 women) aged 50 years or older was selected from employees of a machinery factory in 1994 and followed until 2009. Cox models were used to estimate the hazard ratios (HRs) predicted by MetS according to the harmonized definition and by its individual components. Results The baseline prevalence of MetS was 28.0% in men and 48.4% in women. During a median follow-up of 15 years, 414 deaths occurred, of these, 153 participants died from CVD. Adjusted for age and gender, the HRs of mortality from all-cause and CVD in participants with MetS were 1.47 (95% confidence interval (CI): components. On evaluating the MetS components individually, we found that, independent of MetS, only hypertension and impaired glucose predicted higher mortality. Conclusions The number of positive MetS components seems no more informative than classifying (dichotomous) MetS for CVD risks assessment in this Chinese cohort.

  12. Association between body mass index and mortality in a prospective cohort of Chinese adults.

    Science.gov (United States)

    Sun, Hao; Ren, Xiaoxia; Chen, Zhichao; Li, Chunsheng; Chen, Shuohua; Wu, Shouling; Chen, Youren; Yang, Xinchun

    2016-08-01

    Obesity is associated with an increased risk of diabetes mellitus, hypertension, and coronary artery disease; however, the relation between body mass index (BMI) and the risk of all-cause mortality is controversial. We prospectively examined the relationship between BMI and all-cause mortality in 123,384 Chinese men and women who participated in the Kailuan health examination study from 2006 to 2007 and 2008 to 2009. Cases included 6218 deaths (5770 men and 448 women) that occurred during a mean follow-up period of 7.39 years. Relative risk was adjusted for factors such as age, serum lipid levels (ie, triglyceride, high-density lipoprotein, and low-density lipoprotein cholesterol), history of smoking and drinking, and physical activity, as well as a medical history of hypertension, diabetes, myocardial infarction, and stroke. Within the cohort, the lowest risk of all-cause mortality was seen among persons with a BMI of 24 to 28 kg/m in male, and the risk was elevated among persons with BMI levels lower or higher than that range. Moreover, all-cause mortality was greatest in the group with a BMI of <18.5 kg/m. In contrast, in female, a high BMI was associated with increased mortality, and a BMI of <18.5 kg/m was associated with the lowest risk. Further, a U-shaped association was seen between BMI and the risk of death from any cause among men and women, even after adjusting for confounding factors. In conclusion, underweight was associated with a substantially increased risk of all-cause mortality in males. The excess risk of all-cause mortality with a high BMI, however, was seen among females. PMID:27512844

  13. Educational level and adult mortality in Russia: an analysis of routine data 1979 to 1994.

    Science.gov (United States)

    Shkolnikov, V M; Leon, D A; Adamets, S; Andreev, E; Deev, A

    1998-08-01

    The investigation of socio-economic differences in mortality in Russia was effectively prohibited in the Soviet period. The extent and nature of any such differences is of considerable interest given the very different principles upon which Russian society has been organised for most of this century compared to the West where socio-economic differences in health have been extensively documented. Using cross-sectional data on mortality in Russia around the 1979 and 1989 Censuses, we have analysed mortality gradients according to length of education. Our results show that educational differences in mortality are at least as big as seen in Western countries, and are most similar to the recently reported differences observed for other former communist countries such as the Czech Republic, Estonia and Hungary. As observed in many other countries the strength of association of mortality with education declines with age, varies by cause of death and is generally stronger among men than women. Differentials are particularly large for accidents and violence, where for men and women the mortality rate among those with primary or basic secondary education is over twice that of people with higher education. Even larger effects are seen for causes directly related to alcohol (including alcoholic cirrhosis and accidental poisoning by alcohol), and for infectious and parasitic diseases and respiratory diseases. These educational differences may in part be related to educational differences in alcohol consumption. Of particular significance is the fact that there are indications that socio-economic differences in mortality have widened considerably in the 1990s, a period during which there was a huge increase in the national burden of alcohol-related deaths. This widening of socio-economic differences at this time suggest that these increases in consumption were especially acute among those with less education. At a more general level the fact that large educational differences in

  14. Fatal purpura fulminans and Waterhouse-Friderichsen syndrome from fulminant Streptococcus pneumoniae sepsis in an asplenic young adult.

    Science.gov (United States)

    Hale, Andrew J; LaSalvia, Mary; Kirby, James E; Kimball, Allison; Baden, Rachel

    2016-01-01

    Asplenic patients are at increased risk for sepsis and fulminant infection. Sepsis in these patients is typically secondary to encapsulated bacteria, with Streptococcus pneumoniae being the most frequent pathogen. Rare complications of severe sepsis include purpura fulminans and bilateral adrenal hemorrhage (Waterhouse-Friderichsen syndrome). We present the case of a 36-year-old woman, healthy except for splenectomy years prior for idiopathic thrombocytopenic purpura treatment, who presented with fever. Upon presentation to our hospital, three hours after symptoms onset, she had purpura fulminans and shock. Despite timely antimicrobials and maximal resuscitative efforts, her disease progressed and she expired 12 hours after symptoms onset. Autopsy revealed bilateral adrenal hemorrhage; acute adrenal crisis likely contributed to her refractory shock. Prior to her presentation, she had not received guideline-based post-splenectomy care. Sepsis in asplenic patients can be fulminant and rapidly fatal. Streptococcus pneumoniae remains the most frequent cause, despite decreasing rates in recent years related to widespread pneumococcal vaccination. Guideline-based vaccinations and "pill-in-pocket" therapy can be life-saving for asplenic patients. Purpura fulminans represents an extreme manifestation of disseminated intravascular coagulation, is more common in asplenic patients, and portends a poor prognosis. Waterhouse-Friderichsen syndrome can be seen concurrently with purpura fulminans and further portends a poor prognosis; pre-mortem diagnosis requires a high index of suspicion.

  15. Fatal purpura fulminans and Waterhouse-Friderichsen syndrome from fulminant Streptococcus pneumoniae sepsis in an asplenic young adult.

    Science.gov (United States)

    Hale, Andrew J; LaSalvia, Mary; Kirby, James E; Kimball, Allison; Baden, Rachel

    2016-01-01

    Asplenic patients are at increased risk for sepsis and fulminant infection. Sepsis in these patients is typically secondary to encapsulated bacteria, with Streptococcus pneumoniae being the most frequent pathogen. Rare complications of severe sepsis include purpura fulminans and bilateral adrenal hemorrhage (Waterhouse-Friderichsen syndrome). We present the case of a 36-year-old woman, healthy except for splenectomy years prior for idiopathic thrombocytopenic purpura treatment, who presented with fever. Upon presentation to our hospital, three hours after symptoms onset, she had purpura fulminans and shock. Despite timely antimicrobials and maximal resuscitative efforts, her disease progressed and she expired 12 hours after symptoms onset. Autopsy revealed bilateral adrenal hemorrhage; acute adrenal crisis likely contributed to her refractory shock. Prior to her presentation, she had not received guideline-based post-splenectomy care. Sepsis in asplenic patients can be fulminant and rapidly fatal. Streptococcus pneumoniae remains the most frequent cause, despite decreasing rates in recent years related to widespread pneumococcal vaccination. Guideline-based vaccinations and "pill-in-pocket" therapy can be life-saving for asplenic patients. Purpura fulminans represents an extreme manifestation of disseminated intravascular coagulation, is more common in asplenic patients, and portends a poor prognosis. Waterhouse-Friderichsen syndrome can be seen concurrently with purpura fulminans and further portends a poor prognosis; pre-mortem diagnosis requires a high index of suspicion. PMID:27583208

  16. Serotype Distribution in Non-Bacteremic Pneumococcal Pneumonia

    DEFF Research Database (Denmark)

    Benfield, Thomas; Skovgaard, Marlene; Schønheyder, Henrik Carl;

    2013-01-01

    There is limited knowledge of serotypes that cause non-bacteremic pneumococcal pneumonia (NBP). Here we report serotypes, their associated disease potential and coverage of pneumococcal conjugate vaccines (PCV) in adults with NBP and compare these to bacteremic pneumonia (BP).......There is limited knowledge of serotypes that cause non-bacteremic pneumococcal pneumonia (NBP). Here we report serotypes, their associated disease potential and coverage of pneumococcal conjugate vaccines (PCV) in adults with NBP and compare these to bacteremic pneumonia (BP)....

  17. High local unemployment and increased mortality in Danish adults; results from a prospective multilevel study

    DEFF Research Database (Denmark)

    Osler, M; Christensen, U; Lund, R;

    2003-01-01

    AIMS: To examine the relation between unemployment rates in area of residence and all-cause mortality, taking the individuals' unemployment experience and a number of social and behavioural factors into account. METHODS: Prospective cohort study with record linkage to mortality and unemployment...... was also a risk factor (hazard ratio(yes/no) 1.38:1.16-1.64). These estimates attenuated somewhat when other social and behavioural covariates were taken into account. The effects were similar in men and women, but the influence of individuals' unemployment experience during one and five years decreased...... gradually with increasing age. CONCLUSION: This prospective study suggests that high local unemployment and individuals' experience of unemployment increase mortality risk, even after adjustment for other social and behavioural factors....

  18. Does educational status impact adult mortality in Denmark? A twin approach

    DEFF Research Database (Denmark)

    Madsen, Mia; Andersen, Anne-Marie Nybo; Christensen, Kaare;

    2010-01-01

    design. The study is based on data from the Danish Twin Registry and Statistics Denmark. Using Cox regression, they estimated hazard ratios for mortality according to the highest attained education among 5,260 monozygotic and 11,088 dizygotic same-sex twin pairs born during 1921-1950 and followed during......To disentangle an independent effect of educational status on mortality risk from direct and indirect selection mechanisms, the authors used a discordant twin pair design, which allowed them to isolate the effect of education by means of adjustment for genetic and environmental confounding per...... 1980-2008. Both standard cohort and intrapair analyses were conducted separately for zygosity, gender, and birth cohort. Educational differences in mortality were demonstrated in the standard cohort analyses but attenuated in the intrapair analyses in all subgroups but men born during 1921...

  19. Risk Factors for Increased Hospital Resource Utilization and In-Hospital Mortality in Adults With Single Ventricle Congenital Heart Disease.

    Science.gov (United States)

    Collins, Ronnie Thomas; Doshi, Pratik; Onukwube, Jennifer; Fram, Ricki Y; Robbins, James M

    2016-08-01

    Most patients with single ventricle congenital heart disease are now expected to survive to adulthood. Co-morbid medical conditions (CMCs) are common. We sought to identify risk factors for increased hospital resource utilization and in-hospital mortality in adults with single ventricle. We analyzed data from the 2001 to 2011 Nationwide Inpatient Sample database in patients aged ≥18 years admitted to nonteaching general hospitals (NTGHs), TGHs, and pediatric hospitals (PHs) with either hypoplastic left heart syndrome, tricuspid atresia or common ventricle. National estimates of hospitalizations were calculated. Elixhauser CMCs were identified. Length of stay (LOS), total hospital costs, and effect of CMCs were determined. Age was greater in NTGH (41.5 ± 1.3 years) than in TGH (32.8 ± 0.5) and PH (25.0 ± 0.6; p <0.0001). Adjusted LOS was shorter in NTGH (5.6 days) than in PH (9.7 days; p <0.0001). Adjusted costs were higher in PH ($56,671) than in TGH ($31,934) and NTGH ($18,255; p <0.0001). CMCs are associated with increased LOS (p <0.0001) and costs (p <0.0001). Risk factors for in-hospital mortality included increasing age (odds ratio [OR] 5.250, CI 2.825 to 9.758 for 45- to 64-year old vs 18- to 30-year old), male gender (OR 2.72, CI 1.804 to 4.103]), and the presence of CMC (OR 4.55, CI 2.193 to 9.436) for 2 vs none). No differences in mortality were found among NTGH, TGH, and PH. Cardiovascular procedures were more common in PH hospitalizations and were associated with higher costs and LOS. CMCs increase costs and mortality. In-hospital mortality is increased with age, male gender, and the presence of hypoplastic left heart syndrome.

  20. Educational level as a contextual and proximate determinant of all cause mortality in Danish adults

    DEFF Research Database (Denmark)

    Osler, M; Prescott, E

    2003-01-01

    , exercise, alcohol use, and body mass index) and contextual factors (local area unemployment, income share, and household composition) were included in the Cox model. CONCLUSION: In this study the educational level of an area influenced subject's mortality, but first after adjustment for behavioural......): 0.87 (95% CI 0.77 to 0.98) and individual level (HR: 0.76 (95% CI 0.64 to 0.88) were inversely associated with mortality, when comparing the higest educated groups with the least educated. However, at parish level the effect was only present, when information on subject's income, behaviour (smoking...

  1. Viral pneumonia

    Science.gov (United States)

    More serious infections can result in respiratory failure, liver failure, and heart failure. Sometimes, bacterial infections occur during or just after viral pneumonia, which may lead to more serious forms ...

  2. Loss of function of the yellow-e gene causes dehydration-induced mortality of adult Tribolium castaneum.

    Science.gov (United States)

    Noh, Mi Young; Kramer, Karl J; Muthukrishnan, Subbaratnam; Beeman, Richard W; Kanost, Michael R; Arakane, Yasuyuki

    2015-03-15

    Yellow protein (dopachrome conversion enzyme, DCE) is involved in the melanin biosynthetic pathway that significantly accelerates pigmentation reactions in insects. Recent studies have suggested that the insect yellow genes represent a rapidly evolving gene family generating functionally diverse paralogs, but the exact physiological functions of several yellow genes are still not understood. To study the function(s) of one of the yellow genes, yellow-e (TcY-e), in the red flour beetle, Tribolium castaneum, we performed real-time PCR to analyze its developmental and tissue-specific expression, and utilized immunohistochemistry to identify the localization of the TcY-e protein in adult cuticle. Injection of double-stranded RNA for TcY-e (dsTcY-e) into late instar larvae had no effect on larval-pupal molting or pupal development. The pupal cuticle, including that lining the setae, gin traps and urogomphi, underwent normal tanning. Adult cuticle tanning including that of the head, mandibles and legs viewed through the translucent pupal cuticle was initiated on schedule (pupal days 4-5), indicating that TcY-e is not required for pupal or pharate adult cuticle pigmentation in T. castaneum. The subsequent pupal-adult molt, however, was adversely affected. Although pupal cuticle apolysis and slippage were evident, some of the adults (~25%) were unable to shed their exuvium and died entrapped in their pupal cuticle. In addition, the resulting adults rapidly became highly desiccated. Interestingly, both the failure of the pupal-adult molt and desiccation-induced mortality were prevented by maintaining the dsTcY-e-treated insects at 100% relative humidity (rh). However, when the high humidity-rescued adults were removed from 100% rh and transferred to 50% rh, they rapidly dehydrated and died, whereas untreated beetles thrived throughout development at 50% rh. We also observed that the body color of the high humidity-rescued dsTcY-e-adults was slightly darker than that of

  3. General health checks in adults for reducing morbidity and mortality from disease

    DEFF Research Database (Denmark)

    Krogsbøll, Lasse T; Jørgensen, Karsten Juhl; Grønhøj Larsen, Christian;

    2012-01-01

    General health checks are common elements of health care in some countries. These aim to detect disease and risk factors for disease with the purpose of reducing morbidity and mortality. Most of the commonly used screening tests offered in general health checks have been incompletely studied. Also...

  4. Childhood intelligence and adult mortality, and the role of socio-economic status

    NARCIS (Netherlands)

    J.S. Cramer

    2012-01-01

    The initial purpose of this study was to establish the effect of childhood conditions on longevity from the Brabant data set. This data set combines information at ages 12, 43, 53 and mortality between 53 and 71 for a sample of some 3000 individuals born around 1940 in the Dutch province of North Br

  5. Kematian Akibat Pneumonia Berat pada Anak Balita

    Directory of Open Access Journals (Sweden)

    Diah Asri Wulandari

    2013-03-01

    Full Text Available Pneumonia is one of the leading causes of morbidity and mortality in children, mainly in developing countries with a 10–15 times higher mortality rate than developed countries. The aim of the study was to know the mortality rate and its risk factors among under five years old children who were hospitalized due to severe pneumonia. This cross-sectional study was conducted to 1 to 59 months old children with pneumonia at the Department of Pediatric Dr. Hasan Sadikin Bandung Hospital from November 2007 to January 2009. Three hundred and eighteen children were enrolled in this study. The median age was 11.16 months, and 237 (74.5% were ≤12 months of age. Very severe pneumonia was diagnosed in 93 (29.2% and severe pneumonia in 225 (70.8% children. Twenty three (7.2% children died during hospitalization, 20 were hospitalized with very severe pneumonia (p<0.001, OR 20.274, 95%CI: 5.855─70.197. Congenital heart disease (p=0.002, OR 5.795, 95%CI: 2.115–15.407 and leucocytosis (≥15,500/mm3, p=0.002, OR 3.879, 95%CI: 1.547–9.727 were significantly associated to the mortality. Pathogenic bacteria were identified in 11 of 23 patients. In conclusions, the mortality of severe pneumonia is still high. Very severe pneumonia, congenital heart disease and leucocytosis are factors that increase mortality among under-five years old children with pneumonia.

  6. Thirty years after Alma-Ata: a systematic review of the impact of community health workers delivering curative interventions against malaria, pneumonia and diarrhoea on child mortality and morbidity in sub-Saharan Africa

    Directory of Open Access Journals (Sweden)

    Lewin Simon

    2011-10-01

    Full Text Available Abstract Background Over thirty years have passed since the Alma-Ata Declaration on primary health care in 1978. Many governments in the first decade following the declaration responded by developing national programmes of community health workers (CHWs, but evaluations of these often demonstrated poor outcomes. As many CHW programmes have responded to the HIV/AIDS pandemic, international interest in them has returned and their role in the response to other diseases should be examined carefully so that lessons can be applied to their new roles. Over half of the deaths in African children under five years of age are due to malaria, diarrhoea and pneumonia - a situation which could be addressed through the use of cheap and effective interventions delivered by CHWs. However, to date there is very little evidence from randomised controlled trials of the impacts of CHW programmes on child mortality in Africa. Evidence from non-randomised controlled studies has not previously been reviewed systematically. Methods We searched databases of published and unpublished studies for RCTs and non-randomised studies evaluating CHW programmes delivering curative treatments, with or without preventive components, for malaria, diarrhoea or pneumonia, in children in sub-Saharan Africa from 1987 to 2007. The impact of these programmes on morbidity or mortality in children under six years of age was reviewed. A descriptive analysis of interventional and contextual factors associated with these impacts was attempted. Results The review identified seven studies evaluating CHWs, delivering a range of interventions. Limited descriptive data on programmes, contexts or process outcomes for these CHW programmes were available. CHWs in national programmes achieved large mortality reductions of 63% and 36% respectively, when insecticide-treated nets and anti-malarial chemoprophylaxis were delivered, in addition to curative interventions. Conclusions CHW programmes could

  7. Streptococcus pneumoniae carriage in the Gaza strip.

    Directory of Open Access Journals (Sweden)

    Gili Regev-Yochay

    Full Text Available BACKGROUND: Pneumococcal infections cause major morbidity and mortality in developing countries. We report the epidemiology of S. pneumoniae carriage in a developing region, the Gaza strip, and evaluate the theoretical coverage of carriage strains by pneumococcal conjugate vaccines (PCVs. METHODOLOGY: In 2009 we conducted a cross-sectional survey of S. pneumoniae carriage in healthy children and their parents, living throughout the Gaza strip. Data were collected and nasopharyngeal swabs were obtained. Antibiotic susceptibilities were determined by Vitek-2 and serotypes by the Quellung reaction. PRINCIPAL FINDINGS: S. pneumoniae carriage was detected in 189/379 (50% of children and 30/376 (8% of parents. Carriage prevalence was highest in children <6 months of age (63%. Significant predictors for child carriage were number of household members and DCC attendance. The proportion of pediatric and adults isolates with serotypes included in PCV7 were 32% and 20% respectively, and 46% and 33% in PCV13 respectively. The most prominent non-vaccine serotypes (NVT were 35B, 15B/C and 23B. Penicillin-nonsusceptible strains were carried by 70% of carriers, penicillin-resistant strains (PRSP by 13% and Multi-drug-resistant (MDR by 30%. Of all PRSP isolates 54% belonged to serotypes included in PCV7 and 71% in the PCV13. Similarly, 59% and 73% of MDR-SP isolates, would theoretically be covered by PCV7 and PCV13, respectively. CONCLUSIONS: This study demonstrates that, PCV13-included strains were carried by 46% and 33% of pediatric and adult subjects respectively. In the absence of definitive data regarding the virulence of the NVT strains, it is difficult to predict the effect of PCVs on IPD in this region.

  8. Eficacia y seguridad de la fisioterapia respiratoria en pacientes adultos con neumonía adquirida en la comunidad Efficacy and safety of chest physiotherapy in adult patients with community-acquired pneumonia

    Directory of Open Access Journals (Sweden)

    Fernando Saldías P

    2012-09-01

    tratamiento adyuvante de rutina en pacientes adultos con neumonía comunitaria no complicada.Pneumonia is one of the most common health problems affecting all age groups around the world. Chest physiotherapy includes a variety of techniques, such as conventional chest physiotherapy (i.e., percussion and postural drainage, active cycle of breathing techniques, positive expiratory pressure (using devices to maintain 10 to 25 cm of water pressure during expiration, and osteopathic manipulation. In theory, these techniques could help keep airways open, improve secretion clearance, and increase gas exchange. Chest physiotherapy has been widely used as an adjunctive therapy for pneumonia in adults without any reliable evidence. We evaluate the evidence examining the efficacy and safety of chest physiotherapy in adult patients with community-acquired pneumonia. Results: Six randomized controlled trials have assessed four types of chest physiotherapy, namely conventional chest physiotherapy, osteopathic manipulative treatment (including paraspinal inhibition, rib raising, and diaphragmatic or soft myofascial release, active cycle of breathing techniques (including active breathing control, thoracic expansion exercises andforced expiration technique and positive expiratory pressure, in community-acquired pneumonia hospitalized patients. None of these techniques (versus no physiotherapy or placebo therapy reduce mortality or improve cure rate. Limited evidence indicates that osteopathic manipulative treatment (versus placebo therapy and positive expiratory pressure (versus no physiotherapy can slightly reduce the duration of hospital stay (by 2.0 and 1.4 days, respectively. In addition, positive expiratory pressure (versus no physiotherapy can slightly reduce the duration offever by 0.7 day, and osteopathic manipulative treatment (versus placebo therapy might reduce the duration of antibiotic use by 1.93 days. No severe adverse events were reported. In summary, the available evidence

  9. High mortality and prevalence of HIV and tuberculosis in adults with chronic cough in Malawi: a cohort study

    Science.gov (United States)

    MacPherson, P.; Mukaka, M.; Mdolo, A.; Mwapasa, M.; Kaswaswa, K.; Msefula, C.; Chipungu, G.; Mwandumba, H. C.; Corbett, E. L.

    2016-01-01

    SUMMARY BACKGROUND: Adults with suspected tuberculosis (TB) in health facilities in Africa have a high risk of death. The risk of death for adults with suspected TB at community-level is not known but may also be high. METHODS: Adults reporting cough of ⩾ 2 weeks (coughers) during a household census of 19 936 adults in a poor urban setting in Malawi were randomly sampled and age-frequency matched with adults without cough ⩾ 2 weeks (controls). At 12 months, participants were traced to establish vital status, offered human immunodeficiency virus (HIV) testing and investigated for TB if symptomatic (sputum for Xpert® MTB/RIF, smear microscopy and culture). RESULTS: Of 345 individuals with cough, 245 (71%) were traced, as were 243/345 (70.4%) controls. TB was diagnosed in 8.9% (16/178) of the coughers and 3.7% (7/187) of the controls (P = 0.039). HIV prevalence among coughers was 34.6% (56/162) and 18.8% (32/170) in controls (P = 0.005); of those who were HIV-positive, respectively 26.8% and 18.8% were newly diagnosed. The 12-month risk of death was 4.1% (10/245) in coughers and 2.5% (6/243) in controls (P = 0.317). CONCLUSION: Undiagnosed HIV and TB are common among adults with chronic cough, and mortality is high in this urban setting. Interventions that promote timely seeking of HIV and TB care are needed. PMID:26792472

  10. Personal networks and mortality risk in older adults : A twenty-year longitudinal study

    NARCIS (Netherlands)

    Ellwardt, Lea; Tilburg, Theo G. van; Aartsen, Marja; Wittek, Rafael; Steverink, Nardi

    2015-01-01

    Background: Research on aging has consistently demonstrated an increased chance of survival for older adults who are integrated into rich networks of social relationships. Theoretical explanations state that personal networks offer indirect psychosocial and direct physiological pathways. We investig

  11. Personal Networks and Mortality Risk in Older Adults : A Twenty-Year Longitudinal Study

    NARCIS (Netherlands)

    Ellwardt, Lea; van Tilburg, Theo; Aartsen, Marja; Wittek, Rafael; Steverink, Nardi

    2015-01-01

    Background Research on aging has consistently demonstrated an increased chance of survival for older adults who are integrated into rich networks of social relationships. Theoretical explanations state that personal networks offer indirect psychosocial and direct physiological pathways. We investiga

  12. Widespread mortality of adult seabirds in Alaska, August-September 1983

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — A widespread die-off of adult seabirds, affecting primarily the black-legged kittiwake (Rissa tridactyla), and short-tailed shearwater (Puffinus tenuirostris),...

  13. Comprehensive geriatric assessment predicts mortality and adverse outcomes in hospitalized older adults

    OpenAIRE

    Avelino-Silva, Thiago J; Jose M Farfel; Curiati, Jose AE; Amaral, Jose RG; Campora, Flavia; Jacob-Filho, Wilson

    2014-01-01

    Background Comprehensive Geriatric Assessment (CGA) provides detailed information on clinical, functional and cognitive aspects of older patients and is especially useful for assessing frail individuals. Although a large proportion of hospitalized older adults demonstrate a high level of complexity, CGA was not developed specifically for this setting. Our aim was to evaluate the application of a CGA model for the clinical characterization and prognostic prediction of hospitalized older adults...

  14. Does C-reactive protein independently predict mortality in adult community-acquired bacteremia patients with known sepsis severity?

    DEFF Research Database (Denmark)

    Gradel, Kim O; Jensen, Thøger G; Kolmos, Hans J;

    2013-01-01

    We evaluated whether sepsis severity and C-reactive protein (CRP) level on admission prognostically corroborated or annulled each other in adult patients with incident community-acquired bacteremia (Funen, Denmark, 2000-2008). We used logistic regression and area under the receiver operating...... characteristic curve (AUC) to evaluate 30-day mortality in four models: (i) age, gender, comorbidity, bacteria, and ward. (ii) Model 1 and sepsis severity. (iii) Model 1 and CRP. (iv) Model 1, sepsis severity, and CRP. Altogether, 416 of 1999 patients died within 30 days. CRP independently predicted 30-day...... mortality [Model 4, odds ratio (95% CIs) for 100 mg/L: 1.16 (1.06-1.27)], but it did not contribute to the AUC (Model 2 vs Model 4: p = 0.31). In the 963 non-severe sepsis patients, CRP independently predicted 30-day mortality [Model 4: 1.42 (1.20-1.69)] and it increased the AUC (Model 2 vs Model 4: p = 0...

  15. The Impact of Body Mass Index and Weight Changes on Disability Transitions and Mortality in Brazilian Older Adults

    Directory of Open Access Journals (Sweden)

    Flávia Cristina Drumond Andrade

    2013-01-01

    Full Text Available The aim of this study was to examine the association between body mass index and weight changes on disability transitions and mortality among Brazilian older adults. Longitudinal data from the Health, Well-Being, and Aging in Latin America and the Caribbean Study conducted in São Paulo, Brazil (2000 and 2006, were used to examine the impact of obesity on disability and mortality and of weight changes on health transitions related to disability. Logistic and multinomial regression models were used in the analyses. Individuals who were obese were more likely than those of normal weight to have limitations on activities of daily living (ADL, instrumental activity of daily living (IADL, and Nagi's limitations. Obesity was associated with higher incidence of ADL and IADL limitations and with lower recovery from Nagi's limitations. Compared to those who maintained their weight, those who gained weight experienced higher incidence of ADL and Nagi's limitations, even after controlling for initial body mass index. Higher mortality among overweight individuals was only found when the reference category was “remaining free of Nagi limitations.” The findings of the study underline the importance of maintaining normal weight for preventing disability at older ages.

  16. 30 day mortality in adult palliative radiotherapy – A retrospective population based study of 14,972 treatment episodes

    International Nuclear Information System (INIS)

    Background: 30-day mortality (30DM) has been suggested as a clinical indicator of the avoidance of harm in palliative radiotherapy within the NHS, but no large-scale population-based studies exist. This large retrospective cohort study aims to investigate the factors that influence 30DM following palliative radiotherapy and consider its value as a clinical indicator. Methods: All radiotherapy episodes delivered in a large UK cancer centre between January 2004 and April 2011 were analysed. Patterns of palliative radiotherapy, 30DM and the variables affecting 30DM were assessed. The impact of these variables was assessed using logistic regression. Results: 14,972 palliative episodes were analysed. 6334 (42.3%) treatments were delivered to bone metastases, 2356 (15 7%) to the chest for lung cancer and 915 (5.7%) to the brain. Median treatment time was 1 day (IQR 1–7). Overall 30DM was 12.3%. Factors having a significant impact upon 30DM were sex, primary diagnosis, treatment site and fractionation schedule (p < 0.01). Conclusion: This is the first large-scale description of 30-day mortality for unselected adult palliative radiotherapy treatments. The observed differences in early mortality by fractionation support the use of this measure in assessing clinical decision making in palliative radiotherapy and require further study in other centres and health care systems

  17. Clinical and microbiologic characteristics of adult patients with recurrent bacteraemia caused by extended-spectrum β-lactamase-producing Escherichia coli or Klebsiella pneumoniae.

    Science.gov (United States)

    Lee, C-H; Su, L-H; Chen, F-J; Tang, Y-F; Chien, C-C; Liu, J-W

    2015-12-01

    The characteristics of patients with recurrent bacteraemia caused by extended-spectrum β-lactamase (ESBL)-producing Escherichia coli or Klebsiella pneumoniae (EK) are rarely described. Flomoxef belongs to the cephamycins group and demonstrates in vitro activity against ESBL-producing organisms. Whether flomoxef may be used for the treatment of such infections remains controversial. This retrospective case-control study enrolled adult patients who had bacteraemia caused by ESBL-EK during 2005-2011. Case patients were those who had more than one episode of ESBL-EK bacteraemia. Controls were those who were matched for age and interval time of blood sampling and had only one episode of ESBL-EK bacteraemia with subsequent bacteraemia episodes caused by other non-ESBL-EK bacteria. Pulsed-field gel electrophoresis and microbiologic profiles of the initial and subsequent ESBL-EK isolates were analysed. During the study period, 424 patients were found to have at least one positive blood culture after the first ESBL-EK bacteraemia episode, and 67 (15.8%) had a second episode of ESBL-EK bacteraemia. Bacteraemia resulting from vascular catheter-related infection (odds ratio, 3.24; 95% confidence interval, 1.31-8.05), and definitive therapy with flomoxef (odds ratio, 2.99; 95% confidence interval, 1.10-8.15) were both independent risk factors for the recurrence. Among the 56 patients with available ESBL-EK isolates for analysis, 38 (67.8%) were infected by genetically similar strains. In three of these 38 recurrent ESBL-EK bacteraemia cases caused by an identical strain, the minimum inhibitory concentrations of carbapenem for the subsequent K. pneumoniae isolates were fourfold or higher than the initial isolates. Recurrent bacteraemia was not uncommon in our patients with ESBL-EK bacteraemia, and most of the episodes were caused by identical strains.

  18. How Is Pneumonia Treated?

    Science.gov (United States)

    ... page from the NHLBI on Twitter. How Is Pneumonia Treated? Treatment for pneumonia depends on the type ... can go back to their normal routines. Bacterial Pneumonia Bacterial pneumonia is treated with medicines called antibiotics. ...

  19. Spatial risk for gender-specific adult mortality in an area of southern China

    OpenAIRE

    Ochiai Rion; Park Jin; De Zhou; Kim Deok; Jin Yang; Ali Mohammad; Dong Baiqing; Clemens John D; Acosta Camilo J

    2007-01-01

    Abstract Background Although economic reforms have brought significant benefits, including improved health care to many Chinese people, accessibility to improved care has not been distributed evenly throughout Chinese society. Also, the effects of the uneven distribution of improved healthcare are not clearly understood. Evidence suggests that mortality is an indicator for evaluating accessibility to improved health care services. We constructed spatially smoothed risk maps for gender-specifi...

  20. Association of low level viremia with inflammation and mortality in HIV-infected adults.

    Directory of Open Access Journals (Sweden)

    Abigail Eastburn

    Full Text Available Whether HIV viremia, particularly at low levels is associated with inflammation, increased coagulation, and all-cause mortality is unclear.The associations of HIV RNA level with C-reactive protein (CRP, fibrinogen, interleukin (IL-6 and mortality were evaluated in 1116 HIV-infected participants from the Study of Fat Redistribution and Metabolic Change in HIV infection. HIV RNA level was categorized as undetectable (i.e., "target not detected", 1-19, 20-399, 400-9999, and ≥ 10,000 copies/ml. Covariates included demographics, lifestyle, adipose tissue, and HIV-related factors.HIV RNA level had little association with CRP. Categories of HIV RNA below 10,000 copies/ml had similar levels of IL-6 compared with an undetectable HIV RNA level, while HIV RNA ≥ 10,000 copies/ml was associated with 89% higher IL-6 (p<0.001. This association was attenuated by ~50% after adjustment for CD4+ cell count. Higher HIV RNA was associated with higher fibrinogen. Compared to an undetectable HIV RNA level, fibrinogen was 0.6%, 1.9%, 4.5%, 4.6%, and 9.4% higher across HIV RNA categories, respectively, and statistically significant at the highest level (p = 0.0002 for HIV RNA ≥ 10,000 copies/ml. Higher HIV RNA was associated with mortality during follow-up in unadjusted analysis, but showed little association after adjustment for CD4+ cell count and inflammation.HIV RNA ≥ 10,000 copies/ml was associated with higher IL-6 and fibrinogen, but lower levels of viremia appeared similar, and there was little association with CRP. The relationship of HIV RNA with IL-6 was strongly affected by CD4 cell depletion. After adjustment for CD4+ cell count and inflammation, viremia did not appear to be substantially associated with mortality risk over 5 years.

  1. Childhood Intelligence and Adult Mortality, and the Role of Socio-Economic Status

    OpenAIRE

    Cramer, Jan S.

    2012-01-01

    The initial purpose of this study was to establish the effect of childhood conditions on longevity from the Brabant data set. This data set combines information at ages 12, 43, 53 and mortality between 53 and 71 for a sample of some 3000 individuals born around 1940 in the Dutch province of North Brabant. Proportional hazard analysis confirms the known association of early intelligence or cognitive ability with longevity, with a standardized hazard ratio of .80; this is the only significant c...

  2. Mortality in Adult Offspring of Immigrants: A Swedish National Cohort Study

    OpenAIRE

    Hélio Manhica; Susanna Toivanen; Anders Hjern; Mikael Rostila

    2015-01-01

    Background Higher risks of psychiatric disorders and lower-than-average subjective health in adulthood have been demonstrated in offspring of immigrants in Sweden compared with offspring of native Swedes, and linked to relative socioeconomic disadvantage. The present study investigated mortality rates in relation to this inequity from a gender perspective. Methods We used data from national registers covering the entire Swedish population aged 18-65 years. Offspring of foreign-born parents wh...

  3. Lipoid Pneumonia in a Gas Station Attendant

    OpenAIRE

    Gladis Isabel Yampara Guarachi; Valeria Barbosa Moreira; Angela Santos Ferreira; Selma M. De A. Sias; Rodrigues, Cristovão C.; Graça Helena M. do C. Teixeira

    2014-01-01

    The exogenous lipoid pneumonia, uncommon in adults, is the result of the inhalation and/or aspiration of lipid material into the tracheobronchial tree. This is often confused with bacterial pneumonia and pulmonary tuberculosis due to a nonspecific clinical and radiologic picture. It presents acutely or chronically and may result in pulmonary fibrosis. We describe here a case of lipoid pneumonia in a gas station attendant who siphoned gasoline to fill motorcycles; he was hospitalized due to pr...

  4. Antiviral therapy and outcomes of patients with pneumonia caused by influenza A pandemic (H1N1 virus.

    Directory of Open Access Journals (Sweden)

    Shi-gui Yang

    Full Text Available BACKGROUND: There is limited data on the clinical outcome of patients with pandemic H1N1 (pH1N1 pneumonia who received oseltamivir treatment, especially when the treatment was administered more than 48 hours after symptom onset. METHODS: During the pandemic in 2009, a cohort of pH1N1 influenza pneumonia was built in China, and their clinical information was collected systematically, and analyzed with Cox models. RESULTS: 920 adults and 541 children with pneumonia who didn't receive corticosteroids were analyzed. In-hospital mortality was higher in adults who did not receive antiviral therapy (18.2% than those with who received oseltamivir ≤ 2 days (2.9%, between 2-5 days (4.6% and >5 days after illness onset (4.9%, p5 days, respectively. For males patients, aged ≥ 14 years and baseline PaO(2/FiO(23.8 mg/kg/d did not improve clinical outcome (mortality, higher dose 2.5% vs standard dose 2.8%, p>0.05. CONCLUSIONS: Antiviral therapy might reduce mortality of patients with pH1N1 pneumonia, even when initiated more than 48 hours after onset of illness. Greater protective effects might be in males, patients aged 14-60 years, and patients with PaO(2/FiO(2<200.

  5. Accuracy of Lung Ultrasonography versus Chest Radiography for the Diagnosis of Adult Community-Acquired Pneumonia: Review of the Literature and Meta-Analysis.

    Directory of Open Access Journals (Sweden)

    Xiong Ye

    Full Text Available Lung ultrasonography (LUS is being increasingly utilized in emergency and critical settings. We performed a systematic review of the current literature to compare the accuracy of LUS and chest radiography (CR for the diagnosis of adult community-acquired pneumonia (CAP. We searched in Pub Med, EMBASE dealing with both LUS and CR for diagnosis of adult CAP, and conducted a meta-analysis to evaluate the diagnostic accuracy of LUS in comparison with CR. The diagnostic standard that the index test compared was the hospital discharge diagnosis or the result of chest computed tomography scan as a "gold standard". We calculated pooled sensitivity and specificity using the Mantel-Haenszel method and pooled diagnostic odds ratio using the DerSimonian-Laird method. Five articles met our inclusion criteria and were included in the final analysis. Using hospital discharge diagnosis as reference, LUS had a pooled sensitivity of 0.95 (0.93-0.97 and a specificity of 0.90 (0.86 to 0.94, CR had a pooled sensitivity of 0.77 (0.73 to 0.80 and a specificity of 0.91 (0.87 to 0.94. LUS and CR compared with computed tomography scan in 138 patients in total, the Z statistic of the two summary receiver operating characteristic was 3.093 (P = 0.002, the areas under the curve for LUS and CR were 0.901 and 0.590, respectively. Our study indicates that LUS can help to diagnosis adult CAP by clinicians and the accuracy was better compared with CR using chest computed tomography scan as the gold standard.

  6. Asthma mortality in Danish children and young adults, 1973-1994

    DEFF Research Database (Denmark)

    Jørgensen, I M; Bülow, S; Jensen, V B;

    2000-01-01

    in Denmark increased in adolescents during 1973-1987 and decreased from 1988 to 1994. A possible explanation may be an increased awareness of asthma symptoms combined with a steadily improved treatment of asthma. Even in children and young adults under the age of 20 yrs, validity problems still make...

  7. A prospective cohort study of stroke mortality and arsenic in drinking water in Bangladeshi adults

    Science.gov (United States)

    2014-01-01

    Background Arsenic in drinking water causes increased coronary artery disease (CAD) and death from CAD, but its association with stroke is not known. Methods Prospective cohort study with arsenic exposure measured in well water at baseline. 61074 men and women aged 18 years or older on January 2003 were enrolled in 2003. The cohort was actively followed for an average of 7 years (421,754 person-years) through December 2010. Based on arsenic concentration the population was categorized in three groups and stroke mortality HR was compared to the referent. The risk of stroke mortality Hazard Ratio (HR) and 95% Confidence Interval was calculated in relation to arsenic exposure was estimated by Cox proportional hazard models with adjustment for potential confounders. Results A total of 1033 people died from stroke during the follow-up period, accounting for 23% of the total deaths. Multivariable adjusted HRs (95% confidence interval) for stroke for well water arsenic concentrations <10, 10-49, and ≥50 μg/L were 1.0 (reference), 1.20 (0.92 to 1.57), and 1.35 (1.04 to 1.75) respectively (Ptrend=0.00058). For men, multivariable adjusted HRs (95%) for well water arsenic concentrations <10, 10-49, and ≥50 μg/L were 1.0 (reference), 1.12 (0.78 to 1.60), and 1.07 (0.75 to 1.51) respectively (Ptrend=0.45) and for women 1.0 (reference),1.31 (0.87 to 1.98), and 1.72 (1.15 to 2.57) respectively (Ptrend=0.00004). Conclusion The result suggests that arsenic exposure was associated with increased stroke mortality risk in this population, and was more significant in women compared to men. PMID:24548416

  8. Osteopathic manipulative treatment as a useful adjunctive tool for pneumonia.

    Science.gov (United States)

    Yao, Sheldon; Hassani, John; Gagne, Martin; George, Gebe; Gilliar, Wolfgang

    2014-05-06

    Pneumonia, the inflammatory state of lung tissue primarily due to microbial infection, claimed 52,306 lives in the United States in 2007 (1) and resulted in the hospitalization of 1.1 million patients (2). With an average length of in-patient hospital stay of five days (2), pneumonia and influenza comprise significant financial burden costing the United States $40.2 billion in 2005 (3). Under the current Infectious Disease Society of America/American Thoracic Society guidelines, standard-of-care recommendations include the rapid administration of an appropriate antibiotic regiment, fluid replacement, and ventilation (if necessary). Non-standard therapies include the use of corticosteroids and statins; however, these therapies lack conclusive supporting evidence (4). (Figure 1) Osteopathic Manipulative Treatment (OMT) is a cost-effective adjunctive treatment of pneumonia that has been shown to reduce patients' length of hospital stay, duration of intravenous antibiotics, and incidence of respiratory failure or death when compared to subjects who received conventional care alone (5). The use of manual manipulation techniques for pneumonia was first recorded as early as the Spanish influenza pandemic of 1918, when patients treated with standard medical care had an estimated mortality rate of 33%, compared to a 10% mortality rate in patients treated by osteopathic physicians (6). When applied to the management of pneumonia, manual manipulation techniques bolster lymphatic flow, respiratory function, and immunological defense by targeting anatomical structures involved in the these systems(7,8, 9, 10). The objective of this review video-article is three-fold: a) summarize the findings of randomized controlled studies on the efficacy of OMT in adult patients with diagnosed pneumonia, b) demonstrate established protocols utilized by osteopathic physicians treating pneumonia, c) elucidate the physiological mechanisms behind manual manipulation of the respiratory and

  9. Moxidectin causes adult worm mortality of human lymphatic filarial parasite Brugia malayi in rodent models.

    Science.gov (United States)

    Verma, Meenakshi; Pathak, Manisha; Shahab, Mohd; Singh, Kavita; Mitra, Kalyan; Misra-Bhattacharya, Shailja

    2014-12-01

    Moxidectin is a macrocyclic lactone belonging to milbemycin family closely related to ivermectin and is currently progressing towards Phase III clinical trial against human infection with the filaria Onchocerca volvulus (Leuckart, 1894). There is a single report on the microfilaricidal and embryostatic activity of moxidectin in case of the human lymphatic filarial parasite Brugia malayi (Brug, 1927) in Mastomys coucha (Smith) but without any adulticidal action. In the present study, the in vitro and in vivo antifilarial efficacy of moxidectin was evaluated on, B. malayi. In vitro moxidectin showed 100% reduction in adult female worm motility at 0.6 μM concentration within 7 days with 68% inhibition in the reduction of MTT (3-(4, 5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide dye) (which is used to detect viability of worms). A 50% inhibitory concentration (IC50) of moxidectin for adult female parasite was 0.242 μM, for male worm 0.186 μM and for microfilaria IC50 was 0.813 μM. In adult B. malayi-transplanted primary screening model (Meriones unguiculatus Milne-Edwards), moxidectin at a single optimal dose of 20 mg/kg by oral and subcutaneous route was found effective on both adult parasites and microfilariae. In secondary screening (M coucha, subcutaneously inoculated with infective larvae), moxidectin at the same dose by subcutaneous route brought about death of 49% of adult worms besides causing sterilisation in 54% of the recovered live female worms. The treated animals exhibited a continuous and sustained reduction in peripheral blood microfilaraemia throughout the observation period of 90 days. The mechanism of action of moxidectin is suggested to be similar to avermectins. The in silico studies were also designed to explore the interaction of moxidectin with glutamate-gated chloride channels of B. malayi. The docking results revealed a close interaction of moxidectin with various GluCl ligand sites of B. malayi. PMID:25651699

  10. Ekstrapulmonale komplikationer ved mycoplasma pneumoniae-infektioner

    DEFF Research Database (Denmark)

    Bjørn, Anne-Mette Bay; Lebech, Anne-Mette K

    2002-01-01

    Mycoplasma pneumoniae is a common cause of atypical pneumonia in children and young adults. The infection is generally mild and only a very few patients are admitted to hospital. However, extrapulmonary complications are well recognised--mostly as manifestations from the central nervous system (CNS)....

  11. Oropharyngeal or gastric colonization and nosocomial pneumonia in adult intensive care unit patients. A prospective study based on genomic DNA analysis.

    OpenAIRE

    Garrouste-Orgeas, Maïté; Chevret, S; Arlet, G; Marie, O.; Rouveau, M.; Popoff, N.; Schlemmer, B

    1997-01-01

    Colonization of the digestive tract has been supposed to be the source of many hospital-acquired infections, especially nosocomial pneumonia. To assess the relationship between oropharyngeal and gastric colonization and subsequent occurrence of nosocomial pneumonia, we prospectively studied 86 ventilated, intensive care unit (ICU) patients. Oropharyngeal or gastric colonizations were detected and quantified on admission and twice weekly during ICU stay. When nosocomial pneumonia was suspected...

  12. Depression and all-cause mortality in persons with diabetes mellitus: Are older adults at higher risk? Results from the translating research into action for diabetes study

    OpenAIRE

    Kimbro, LB; Mangione, CM; Steers, WN; Duru, OK; McEwen, L.; Karter, A; Ettner, SL

    2014-01-01

    Objectives To compare the strength of the association between depression and mortality between elderly and younger individuals with diabetes mellitus. Design A survival analysis conducted in a longitudinal cohort study of persons with diabetes mellitus to test the association between depression and mortality in older (≥65) and younger (18-65) adults. Setting Managed care. Participants Persons aged 18 and older with diabetes mellitus who participated in the Wave 2 survey of the Translating Res...

  13. Risk Factors for Increased Hospital Resource Utilization and In-Hospital Mortality in Adults With Single Ventricle Congenital Heart Disease.

    Science.gov (United States)

    Collins, Ronnie Thomas; Doshi, Pratik; Onukwube, Jennifer; Fram, Ricki Y; Robbins, James M

    2016-08-01

    Most patients with single ventricle congenital heart disease are now expected to survive to adulthood. Co-morbid medical conditions (CMCs) are common. We sought to identify risk factors for increased hospital resource utilization and in-hospital mortality in adults with single ventricle. We analyzed data from the 2001 to 2011 Nationwide Inpatient Sample database in patients aged ≥18 years admitted to nonteaching general hospitals (NTGHs), TGHs, and pediatric hospitals (PHs) with either hypoplastic left heart syndrome, tricuspid atresia or common ventricle. National estimates of hospitalizations were calculated. Elixhauser CMCs were identified. Length of stay (LOS), total hospital costs, and effect of CMCs were determined. Age was greater in NTGH (41.5 ± 1.3 years) than in TGH (32.8 ± 0.5) and PH (25.0 ± 0.6; p <0.0001). Adjusted LOS was shorter in NTGH (5.6 days) than in PH (9.7 days; p <0.0001). Adjusted costs were higher in PH ($56,671) than in TGH ($31,934) and NTGH ($18,255; p <0.0001). CMCs are associated with increased LOS (p <0.0001) and costs (p <0.0001). Risk factors for in-hospital mortality included increasing age (odds ratio [OR] 5.250, CI 2.825 to 9.758 for 45- to 64-year old vs 18- to 30-year old), male gender (OR 2.72, CI 1.804 to 4.103]), and the presence of CMC (OR 4.55, CI 2.193 to 9.436) for 2 vs none). No differences in mortality were found among NTGH, TGH, and PH. Cardiovascular procedures were more common in PH hospitalizations and were associated with higher costs and LOS. CMCs increase costs and mortality. In-hospital mortality is increased with age, male gender, and the presence of hypoplastic left heart syndrome. PMID:27291967

  14. High-resolution computed tomography findings from adult patients with Influenza A (H1N1) virus-associated pneumonia

    International Nuclear Information System (INIS)

    Objective: The aim of this study was to assess the high-resolution computed tomography (HRCT) findings at presentation in patients diagnosed with Influenza A (H1N1) virus-associated pneumonia. Materials and methods: We reviewed the HRCT findings from 20 patients diagnosed with Influenza A (H1N1) and compared their HRCT scans with chest radiographs, obtained on the same day. The imaging studies were obtained 4-9 days after the onset of symptoms. The patients included 11 men and 9 women (ages 24-62 years; mean 42.7 years). All patients had a body temperature greater than 100.4 deg. F (>38 deg. C), tachypnea, and cough. Other common symptoms included diarrhea (60%) and sore throat (30%). The radiographs and HRCT scans were reviewed independently by two observers who reached a consensus decision. Results: The predominant HRCT findings consisted of bilateral ground-glass opacities (n = 12), bilateral areas of consolidation (n = 2), or a mixed bilateral pattern of ground-glass opacities and areas of consolidation (n = 6). The abnormalities were bilateral in all of the 20 patients, had a predominantly sub-pleural distribution in 13 patients, and had a random distribution in the remaining 7 patients. The predominant radiographic findings were consolidations. Normal radiographs were found in 4 out of the 20 patients. Conclusion: HRCT may reveal parenchymal abnormalities in patients with Influenza A (H1N1) infection who have normal findings on radiographs. The predominant HRCT findings were bilateral, peripheral, ground-glass opacities and/or bilateral areas of consolidation. The patients who presented consolidations had more severe clinical course.

  15. High-resolution computed tomography findings from adult patients with Influenza A (H1N1) virus-associated pneumonia

    Energy Technology Data Exchange (ETDEWEB)

    Marchiori, Edson [Fluminense Federal University, Rio de Janeiro (Brazil); Federal University of Rio de Janeiro, Rio de Janeiro (Brazil)], E-mail: edmarchiori@gmail.com; Zanetti, Glaucia [Federal University of Rio de Janeiro, Rio de Janeiro (Brazil)], E-mail: glauciazanetti@gmail.com; Hochhegger, Bruno [Federal University of Rio de Janeiro, Rio de Janeiro (Brazil)], E-mail: brunohochhegger@gmail.com; Rodrigues, Rosana Souza [Federal University of Rio de Janeiro, Rio de Janeiro (Brazil); D' OR Institute for Research and Education, Rio de Janeiro (Brazil)], E-mail: rosana.souzarodrigues@gmail.com; Fontes, Cristina Asvolinsque Pantaleao [Fluminense Federal University, Rio de Janeiro (Brazil)], E-mail: cristinasvolinsque@gmail.com; Nobre, Luiz Felipe [Santa Catarina Federal University, Florianopolis (Brazil)], E-mail: luizfelipenobresc@gmail.com; Dias Mancano, Alexandre [Anchieta Hospital, Taguatinga, DF (Brazil)], E-mail: alex.manzano1@gmail.com; Meirelles, Gustavo [Sao Paulo Federal University, Sao Paulo (Brazil)], E-mail: gmeirelles@gmail.com; Irion, Klaus Loureiro [Liverpool Heart and Chest Hospital NHS Trust, Liverpool (United Kingdom); Royal Liverpool and Broadgreen University Hospital NHS, Liverpool (United Kingdom)], E-mail: klaus.irion@btinternet.com

    2010-04-15

    Objective: The aim of this study was to assess the high-resolution computed tomography (HRCT) findings at presentation in patients diagnosed with Influenza A (H1N1) virus-associated pneumonia. Materials and methods: We reviewed the HRCT findings from 20 patients diagnosed with Influenza A (H1N1) and compared their HRCT scans with chest radiographs, obtained on the same day. The imaging studies were obtained 4-9 days after the onset of symptoms. The patients included 11 men and 9 women (ages 24-62 years; mean 42.7 years). All patients had a body temperature greater than 100.4 deg. F (>38 deg. C), tachypnea, and cough. Other common symptoms included diarrhea (60%) and sore throat (30%). The radiographs and HRCT scans were reviewed independently by two observers who reached a consensus decision. Results: The predominant HRCT findings consisted of bilateral ground-glass opacities (n = 12), bilateral areas of consolidation (n = 2), or a mixed bilateral pattern of ground-glass opacities and areas of consolidation (n = 6). The abnormalities were bilateral in all of the 20 patients, had a predominantly sub-pleural distribution in 13 patients, and had a random distribution in the remaining 7 patients. The predominant radiographic findings were consolidations. Normal radiographs were found in 4 out of the 20 patients. Conclusion: HRCT may reveal parenchymal abnormalities in patients with Influenza A (H1N1) infection who have normal findings on radiographs. The predominant HRCT findings were bilateral, peripheral, ground-glass opacities and/or bilateral areas of consolidation. The patients who presented consolidations had more severe clinical course.

  16. Long-Term Trends in Adult Mortality for U.S. Blacks and Whites: An Examination of Period- and Cohort-Based Changes

    OpenAIRE

    Masters, Ryan K.; Hummer, Robert A.; Powers, Daniel A.; Beck, Audrey; Lin, Shih-Fan; Finch, Brian Karl

    2014-01-01

    Black-white differences in U.S. adult mortality have narrowed over the past five decades, but whether this narrowing unfolded on a period or cohort basis is unclear. The distinction has important implications for understanding the socioeconomic, public health, lifestyle, and medical mechanisms responsible for this narrowing. We use data from 1959 to 2009 and age-period-cohort (APC) models to examine period- and cohort-based changes in adult mortality for U.S. blacks and whites. We do so for a...

  17. Heterozygous mutants of TIRAP (S180L) polymorphism protect adult patients with Plasmodium falciparum infection against severe disease and mortality.

    Science.gov (United States)

    Panda, Aditya K; Das, Bidyut K; Panda, Abhinash; Tripathy, Rina; Pattnaik, Sarit S; Mahto, Harishankar; Pied, Sylviane; Pathak, Sulabha; Sharma, Shobhona; Ravindran, Balachandran

    2016-09-01

    Toll-interleukin-1 receptor domain containing adapter protein (TIRAP) plays a crucial role in TLR2 and TLR4 signaling pathways. Glycosylphospatidylinositol (GPI), considered a toxin molecule of Plasmodium falciparum, interacts with TLR2 and 4 to induce an immune inflammatory response. A single nucleotide polymorphism at coding region of TIRAP (S180L) has been reported to influence TLRs signaling. In the present study, we investigated the association of TIRAP (S180L) polymorphism with susceptibility/resistance to severe P. falciparum malaria in a cohort of adult patients from India. TIRAP S180L polymorphism was typed in 347 cases of severe malaria (SM), 232 uncomplicated malaria and 150 healthy controls. Plasma levels of TNF-α was quantified by ELISA. Heterozygous mutation (S/L) conferred significant protection against MOD (multi organ dysfunction), NCSM (non-cerebral severe malaria) as well as mortality. Interestingly, homozygous mutants (L/L) had 16 fold higher susceptibility to death. TIRAP mutants (S/L and L/L) were associated with significantly higher plasma TNF-α levels compared to wild type (S/S). The results of the present study demonstrate that TIRAP S180L heterozygous mutation may protect patients against severe malaria and mortality. PMID:27166096

  18. Prevent Pneumonia

    Centers for Disease Control (CDC) Podcasts

    2015-08-06

    CDC’s Matthew Westercamp explains what pneumonia is, its symptoms, and how to prevent it.  Created: 8/6/2015 by National Center for Immunization and Respiratory Diseases (NCIRD), Division of Bacterial Diseases (DBD), Respiratory Diseases Branch (RDB).   Date Released: 8/6/2015.

  19. Pneumonia and empyema: causal, casual or unknown

    OpenAIRE

    McCauley, Lindsay; Dean, Nathan

    2015-01-01

    Parapneumonic effusions complicating pneumonia are associated with increased morbidity and mortality. Along with increased mortality, complicated parapneumonic effusion and empyema often necessitate prolonged treatment, longer hospital stay and interventions. Parapneumonic effusions arise from inflammation in the lungs and pleural space from direct invasion of bacteria, cascade of inflammatory events and bacteriologic virulence features. Patient factors and comorbidities also contribute to th...

  20. Mortality among adults transferred and lost to follow-up from antiretroviral therapy programmes in South Africa: a multicentre cohort study

    Science.gov (United States)

    CORNELL, Morna; LESSELLS, Richard; FOX, Matthew P.; GARONE, Daniela Belen; GIDDY, Janet; FENNER, Lukas; MYER, Landon; BOULLE, Andrew

    2014-01-01

    Background & objectives Little is known about outcomes after transfer out (TFO) and loss to follow-up (LTF) and how differential outcomes might bias mortality estimates, as analyses generally censor or exclude TFOs/LTF. Using data linked to the National Population Register (NPR), we explored mortality among patients TFO and LTF compared with patients retained and investigated how linkage impacted on mortality estimates. Methods A cohort analysis of routine data on adults with civil-identification numbers starting ART 2004–2009 in four large South African ART cohorts. The number, proportion, timing and mortality of TFOs and LTF were reported. Mortality was compared using Kaplan-Meier curves, Cox’s proportional hazards and competing risks regression. Results Before linkage, 1207 patients (6%) had died, 2624 (13%) were LTF, 1067 (5%) were TFO and 14583 (75%) were retained. Compared with retained, mortality risk was three times higher among TFOs (aHR 3.11, 95% CI 2.42–3.99) and 20 times higher among LTF patients (aHR 22.03, 95% CI 20.05–24.21). Excluding early deaths after TFO or LTF, the risk was comparable among TFOs and retained (aHR 0.75, 95% CI 0.54–1.03) and higher among LTF (aHR 2.85, 95% CI 2.43–3.33). After linkage, corrected mortality was higher than site-reported mortality. Censoring did not however lead to substantial underestimation of mortality among TFOs. Conclusions While TFO and LTF predicted mortality, the lower incidence of TFO and subsequent death compared with LTF meant that censoring TFOs did not bias mortality estimates. Future cohort analyses should explicitly consider proportions TFO/LTF and mortality event rates. PMID:24977471

  1. Intestine-specific Mttp deletion decreases mortality and prevents sepsis-induced intestinal injury in a murine model of Pseudomonas aeruginosa pneumonia.

    Directory of Open Access Journals (Sweden)

    Jessica A Dominguez

    Full Text Available BACKGROUND: The small intestine plays a crucial role in the pathophysiology of sepsis and has been referred to as the "motor" of the systemic inflammatory response. One proposed mechanism is that toxic gut-derived lipid factors, transported in mesenteric lymph, induce systemic injury and distant organ failure. However, the pathways involved are yet to be defined and the role of intestinal chylomicron assembly and secretion in transporting these lipid factors is unknown. Here we studied the outcome of sepsis in mice with conditional, intestine-specific deletion of microsomal triglyceride transfer protein (Mttp-IKO, which exhibit a block in chylomicron assembly together with lipid malabsorption. METHODOLOGY/PRINCIPAL FINDINGS: Mttp-IKO mice and controls underwent intratracheal injection with either Pseudomonas aeruginosa or sterile saline. Mttp-IKO mice exhibited decreased seven-day mortality, with 0/20 (0% dying compared to 5/17 (29% control mice (p<0.05. This survival advantage in Mttp-IKO mice, however, was not associated with improvements in pulmonary bacterial clearance or neutrophil infiltration. Rather, Mttp-IKO mice exhibited protection against sepsis-associated decreases in villus length and intestinal proliferation and were also protected against increased intestinal apoptosis, both central features in control septic mice. Serum IL-6 levels, a major predictor of mortality in human and mouse models of sepsis, were elevated 8-fold in septic control mice but remained unaltered in septic Mttp-IKO mice. Serum high density lipoprotein (HDL levels were reduced in septic control mice but were increased in septic Mttp-IKO mice. The decreased levels of HDL were associated with decreased hepatic expression of apolipoprotein A1 in septic control mice. CONCLUSIONS/SIGNIFICANCE: These studies suggest that strategies directed at blocking intestinal chylomicron secretion may attenuate the progression and improve the outcome of sepsis through effects

  2. Epidemiological and mortality analysis of older adults with HIV in eastern China

    Directory of Open Access Journals (Sweden)

    Xie TS

    2013-11-01

    Full Text Available Tiansheng Xie,1,2 Nanping Wu1,2 1State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital of Zhejiang University, School of Medicine, Zhejiang University, 2Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, People's Republic of China Objective: The aims of this study were to systematically review epidemiological characteristics in older people living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS (PLWHA in low endemic areas of the People's Republic of China, analyze the causes of death and mortality, and provide a basis for targeted prevention in these populations. Methods: Nine counties representative of the distribution and epidemiological factors of the HIV epidemic in Zhejiang Province were selected, and data from 1,115 HIV-positive individuals, including 196 older people (≥50 years, who were confirmed as PLWHA from January 1, 2000 to December 31, 2012, were retrospectively analyzed. Results: The proportion of older PLWHA increased from 0% in 2000 to 22.45% in 2012. Sexual transmission was the main route, accounting for 82.65% of infections in this group. Compared with the younger group (range from 14 to 49 years old, the older group had significantly lower CD4+ cell counts (291.64 versus 363.63; P<0.001 when first diagnosed, and more of this group presented in the AIDS state with opportunistic infections (51.02% versus 34.06%; P<0.001. In the older group, 25 (12.76% patients died directly of AIDS and 171 (87.24% were censored, and in the younger group 50 (5.44% patients died directly of AIDS and 869 (94.56% were censored. Estimated survival time since HIV diagnosis in the older group was 11.54±0.49 years (95% confidence interval [CI] 10.59–12.50, while in the younger group it was 13.85±0.46 years (95% CI 12.94–14.76, the log rank (Mantel–Cox test gave a chi-square value of 3.83, and there was significant

  3. Risk of cardiovascular disease and total mortality in adults with type 1 diabetes: Scottish registry linkage study.

    Directory of Open Access Journals (Sweden)

    Shona J Livingstone

    Full Text Available BACKGROUND: Randomized controlled trials have shown the importance of tight glucose control in type 1 diabetes (T1DM, but few recent studies have evaluated the risk of cardiovascular disease (CVD and all-cause mortality among adults with T1DM. We evaluated these risks in adults with T1DM compared with the non-diabetic population in a nationwide study from Scotland and examined control of CVD risk factors in those with T1DM. METHODS AND FINDINGS: The Scottish Care Information-Diabetes Collaboration database was used to identify all people registered with T1DM and aged ≥20 years in 2005-2007 and to provide risk factor data. Major CVD events and deaths were obtained from the national hospital admissions database and death register. The age-adjusted incidence rate ratio (IRR for CVD and mortality in T1DM (n = 21,789 versus the non-diabetic population (3.96 million was estimated using Poisson regression. The age-adjusted IRR for first CVD event associated with T1DM versus the non-diabetic population was higher in women (3.0: 95% CI 2.4-3.8, p<0.001 than men (2.3: 2.0-2.7, p<0.001 while the IRR for all-cause mortality associated with T1DM was comparable at 2.6 (2.2-3.0, p<0.001 in men and 2.7 (2.2-3.4, p<0.001 in women. Between 2005-2007, among individuals with T1DM, 34 of 123 deaths among 10,173 who were <40 years and 37 of 907 deaths among 12,739 who were ≥40 years had an underlying cause of death of coma or diabetic ketoacidosis. Among individuals 60-69 years, approximately three extra deaths per 100 per year occurred among men with T1DM (28.51/1,000 person years at risk, and two per 100 per year for women (17.99/1,000 person years at risk. 28% of those with T1DM were current smokers, 13% achieved target HbA(1c of <7% and 37% had very poor (≥9% glycaemic control. Among those aged ≥40, 37% had blood pressures above even conservative targets (≥140/90 mmHg and 39% of those ≥40 years were not on a statin. Although many of these risk

  4. Adult mortality attributable to preventable risk factors for non-communicable diseases and injuries in Japan: a comparative risk assessment.

    Directory of Open Access Journals (Sweden)

    Nayu Ikeda

    2012-01-01

    : Tobacco smoking and high blood pressure are the two major risk factors for adult mortality from non-communicable diseases and injuries in Japan. There is a large potential population health gain if multiple risk factors are jointly controlled.

  5. Preventive home visits for mortality, morbidity, and institutionalization in older adults: a systematic review and meta-analysis.

    Directory of Open Access Journals (Sweden)

    Evan Mayo-Wilson

    Full Text Available BACKGROUND: Home visits for older adults aim to prevent cognitive and functional impairment, thus reducing institutionalization and mortality. Visitors may provide information, investigate untreated problems, encourage medication compliance, and provide referrals to services. METHODS AND FINDINGS: DATA SOURCES: Ten databases including CENTRAL and Medline searched through December 2012. STUDY SELECTION: Randomized controlled trials enrolling community-dwelling persons without dementia aged over 65 years. Interventions included visits at home by a health or social care professional that were not related to hospital discharge. DATA EXTRACTION AND SYNTHESIS: Two authors independently extracted data. Outcomes were pooled using random effects. MAIN OUTCOMES AND MEASURES: Mortality, institutionalization, hospitalization, falls, injuries, physical functioning, cognitive functioning, quality of life, and psychiatric illness. RESULTS: Sixty-four studies with 28642 participants were included. Home visits were not associated with absolute reductions in mortality at longest follow-up, but some programs may have small relative effects (relative risk = 0.93 [0.87 to 0.99]; absolute risk = 0.00 [-0.01 to 0.00]. There was moderate quality evidence of no overall effect on the number of people institutionalized (RR = 1.02 [0.88 to 1.18] or hospitalized (RR = 0.96 [0.91 to 1.01]. There was high quality evidence for number of people who fell, which is consistent with no effect or a small effect (odds ratio = 0.86 [0.73 to 1.01], but there was no evidence that these interventions increased independent living. There was low and very low quality evidence of effects for quality of life (standardised mean difference = -0.06 [-0.11 to -0.01] and physical functioning (SMD = -0.10 [-0.17 to -0.03] respectively, but these may not be clinically important. CONCLUSIONS: Home visiting is not consistently associated with differences in mortality or

  6. Treatment of experimental pneumonia due to penicillin-resistant Streptococcus pneumoniae in immunocompetent rats.

    OpenAIRE

    Gavaldà, J.; Capdevila, J A; Almirante, B; Otero, J.; Ruiz, I; Laguarda, M; Allende, H.; Crespo, E; Pigrau, C; Pahissa, A

    1997-01-01

    A model of pneumonia due to Streptococcus pneumoniae resistant to penicillin was developed in immunocompetent Wistar rats and was used to evaluate the efficacies of different doses of penicillin, cefotaxime, cefpirome, and vancomycin. Adult Wistar rats were challenged by intratracheal inoculation with 3 x 10(9) CFU of one strain of S. pneumoniae resistant to penicillin (MICs of penicillin, cefotaxime, cefpirome, and vancomycin, 2, 1, 0.5, and 0.5 microg/ml, respectively) suspended in brain he...

  7. Neumonía adquirida en la comunidad en adultos, en el curso de la campaña de invierno 2003 en el Hospital San Juan de Dios COMMUNITY ACQUIRED PNEUMONIA IN ADULTS DURING WINTER 2003 CAMPAIGN AT A SANTIAGO GENERAL HOSPITAL

    Directory of Open Access Journals (Sweden)

    Karen Dintrans A

    2005-01-01

    etiological agent of CAP. The objective of the present study is to describe the clinical and demographic characteristics, as well as the evolution, of adult patients admitted with CAP to the service of medicine of a Santiago general hospital (Hospital San Juan de Dios. 200 adults admitted with CAP diagnosis during winter 2003, were retrospectively studied. In 170 out of these 200 patients, diagnosis was confirmed. In average the patients were 68 years old. 51% of patients older than 65 y.o. had received influenza vaccination. High blood pressure, diabetes mellitus and heart failure were the most prevalent non respiratory comorbidities (59, 31 and 22% respectively. Chronic obstructive pulmonary disease was the most prevalent respiratory comorbidity (19%. The antibiotic therapy by election was a third generation cephalosporin, associated with a macrolide. The switch therapy was done in 140 patients (82%, using an antipneumococcal fluoroquinolone in 90% of the cases. The median period of hospitalization was 6 days. 40% of the patients required to be transferred to a clinical unit of higher complexity. In patients having a confirmed diagnosis of community acquired pneumonia lethality rose up to 11%. In only one of the patients, a Streptococcus pneumoniae resistant to Penicillin was isolated in the blood culture. Conclusion: CAP is a prevalent disease, especially in elderly patients, with specific clinical and demographic characteristics. CAP`s evolution and mortality rate can be known and modified

  8. Childhood pneumonia and vitamin A

    Directory of Open Access Journals (Sweden)

    Farhad Heidarian

    2014-04-01

    Full Text Available One of the major causes of mortality in children younger than 5 years old is acute lower respiratory tract infections (ALRI. ALRI clinical features are cough, tachypnea, fever, coryza, chest retraction, crackles and wheeze. Increased white blood cell count with left shift might happen in pneumonia. C-reactive protein (CRP and erythrocyte sedimentation rate (ESR might rise in children with respiratory tract infections. Vitamin A deficiency is associated with severe childhood infections. The effect of vitamin A supplementation in childhood pneumonia depends on the prevalence and the level of vitamin A deficiency in the population. Some studies confirmed that retinol levels were significantly higher after recovery from acute pneumonia compared to acute phase. But there were no significant association between serum retinol level and the clinical manifestation.

  9. Community-Acquired Pneumonia: a Comparison between elderly and nonelderly patients

    Directory of Open Access Journals (Sweden)

    S. Jafari

    2006-08-01

    Full Text Available Background: Community-acquired pneumonia could be a life-threatening condition especially in elderly patients. The factors influencing the outcome in elderly patients are thought to be different from those in young adults. We compared the clinical and paraclinical profiles in elderly and nonelderly patients with community-acquired pneumonias. Methods: In this cross-sectional study, seventy nine patients who were hospitalized with community acquired pneumonia over a period of one year were included. Patients' medical records were reviewed; and data related to comorbid conditions, signs and symptoms, laboratory and radiographic findings were gathered using a checklist. Results: The clinical features, laboratory parameters and complications from pneumonia were almost similar in 41 elderly (group I, age ≥65years and 38 young (group II, age<65years subjects. Delirium was seen more in elderly group (p=0.05. The average body temperature and pulse rate were significantly higher in nonelderly group. Sixty one percent of elderly patients and 21% of young patients have Po2 less than 60 (p=0.02. Smoking (29.1%, neurological disturbances (19%, congestive heart failure (15.2%, chronic obstructive pulmonary disease and diabetes mellitus (13.9% were associated comorbidities in both groups. In non elderly group, immune compromise and IV drug use were more common as underlying comorbid conditions. Two of three mortalities were due to elder patients. Conclusion: Community acquired pneumonia could have more serious clinical and abnormal laboratory features in the elderly than younger patients. Mortality rate may be higher in older patients. Comorbid conditions are frequently seen in both elderly and nonelderly patients with community acquired pneumonia, but IV drug use and immune compromise are more frequent in nonelderly patients.

  10. Statin use in adults at high risk of cardiovascular disease mortality: cross-sectional analysis of baseline data from The Irish Longitudinal Study on Ageing (TILDA).

    LENUS (Irish Health Repository)

    Murphy, Catriona

    2015-07-01

    This study aims to examine the extent to which statins are used by adults at high risk of cardiovascular disease (CVD) compared to European clinical guidelines. The high-risk groups examined are those with (1) known CVD, (2) known diabetes and (3) a high or very high risk (≥5%) of CVD mortality based on Systematic COronary Risk Evaluation (SCORE).

  11. Tratamiento de la neumonía del adulto adquirida en la comunidad TREATMENT OF COMMUNITY-ACQUIRED PNEUMONIA IN ADULTS

    Directory of Open Access Journals (Sweden)

    Alejandro Díaz F.

    2005-04-01

    Full Text Available El tratamiento antimicrobiano apropiado reduce la duración de la sintomatología asociada a la neumonía, el riesgo de complicaciones y la mortalidad. En la mayoría de los casos, no es posible identificar el agente microbiológico que ocasiona la infección y por esto el tratamiento antibacteriano se prescribe en forma empírica. En Chile, un tercio de las cepas de Streptococcus pneumoniae muestra susceptibilidad disminuida a penicilina; mientras que la resistencia a eritromicina fluctúa entre 10-15% y a cefotaxima entre 2-10%. Se recomienda clasificar a los pacientes con neumonía comunitaria en cuatro categorías de riesgo: Grupo 1: pacientes bajo 65 años de edad, sin comorbilidad de manejo ambulatorio. Tratamiento: amoxicilina 1 gramo cada 8 horas vía oral durante 7 días. Grupo 2: pacientes sobre 65 años de edad y/o con comorbilidad de manejo ambulatorio. Tratamiento: amoxicilina/ácido clavulánico 500/125 mg cada 8 horas ó 875/125 mg cada 12 horas, o cefuroxima 500 mg cada 12 horas vía oral durante 7 días. Grupo 3: pacientes hospitalizados en sala de cuidados generales que tienen criterios de gravedad moderada. Tratamiento: ceftriaxona 1-2 g/día o cefotaxima 1 g cada 8 horas EV durante 7-10 días. Grupo 4: pacientes con neumonía comunitaria grave que deben ser manejados en la UCI. Tratamiento: ceftriaxona 2 g/día o cefotaxima 1 g cada 8 horas EV asociado a eritromicina 500 mg cada 6 h, levofloxacina 500-1.000 mg/día, o moxifloxacina 400 mg/día EV durante 10-14 días. En presencia de alergia o fracaso de tratamiento con agentes b-lactámicos y/o serología positiva para Mycoplasma, Chlamydia o Legionella sp se recomienda agregar: eritromicina 500 mg cada 6 h EV o VO, claritromicina 500 mg cada 12 h VO, o azitromicina 500 mg/día VOAppropriate antibiotic treatment reduces the duration of symptoms associated to pneumonia, the risk of complications and mortality. In most cases, it is not possible to identify the etiologic agent

  12. Does marriage protect against hospitalization with pneumonia? A population-based case-control study

    Directory of Open Access Journals (Sweden)

    Mor A

    2013-10-01

    Full Text Available Anil Mor, Sinna P Ulrichsen, Elisabeth Svensson, Klara Berencsi, Reimar W Thomsen Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark Background: To reduce the increasing burden of pneumonia hospitalizations, we need to understand their determinants. Being married may decrease the risk of severe infections, due to better social support and healthier lifestyle. Patients and methods: In this population-based case-control study, we identified all adult patients with a first-time pneumonia-related hospitalization between 1994 and 2008 in Northern Denmark. For each case, ten sex- and age-matched population controls were selected from Denmark's Civil Registration System. We performed conditional logistic regression analysis to estimate the odds ratios (ORs for pneumonia hospitalization among persons who were divorced, widowed, or never married, as compared with married persons, adjusting for age, sex, 19 different comorbidities, alcoholism-related conditions, immunosuppressant use, urbanization, and living with small children. Results: The study included 67,162 patients with a pneumonia-related hospitalization and 671,620 matched population controls. Compared with controls, the pneumonia patients were more likely to be divorced (10% versus 7% or never married (13% versus 11%. Divorced and never-married patients were much more likely to have previous diagnoses of alcoholism-related conditions (18% and 11%, respectively compared with married (3% and widowed (6% patients. The adjusted OR for pneumonia-related hospitalization was increased, at 1.29 (95% confidence interval [CI]: 1.25-1.33 among divorced; 1.15 (95% CI: 1.12-1.17 among widowed; and 1.33 (95% CI: 1.29-1.37 among never-married individuals as compared with those who were married. Conclusion: Married individuals have a decreased risk of being hospitalized with pneumonia compared with never-married, divorced, and widowed patients

  13. What Is Pneumonia?

    Science.gov (United States)

    ... page from the NHLBI on Twitter. What Is Pneumonia? Pneumonia (nu-MO-ne-ah) is an infection in ... such as bacteria, viruses, and fungi—can cause pneumonia. The infection inflames your lungs' air sacs, which ...

  14. Mycoplasma pneumoniae Infections

    Science.gov (United States)

    ... Issues Listen Español Text Size Email Print Share Mycoplasma pneumoniae Infections Page Content Article Body Some lung ... walking pneumonia), are caused by an organism called Mycoplasma pneumoniae. It is spread from person to person ...

  15. Pelvic or acetabular fractures Mortality for pediatric versus adult patients%骨盆或髋臼骨折儿童与成人患者死亡率的比较

    Institute of Scientific and Technical Information of China (English)

    Mohit Bhandari; 王簕; 杨云峰

    2013-01-01

    Three registry studies of pediatric versus adult patients with pelvic fractures report on the mortality rates of these patient populations.While pelvic fractures occur in the context of severe traumatic injury,rates of mortality directly attributable to the pelvic fracture are low for both pediatric and adult patients,particularly for pediatric patiens.

  16. Determinants of mortality and loss to follow-up among adults enrolled in HIV care services in Rwanda.

    Directory of Open Access Journals (Sweden)

    Veronicah Mugisha

    Full Text Available BACKGROUND: Antiretroviral therapy (ART improves morbidity and mortality in patients with HIV, however high rates of loss to follow-up (LTF and mortality have been documented in HIV care and treatment programs. METHODS: We analyzed routinely-collected data on HIV-infected patients ≥ 15 years enrolled at 41 healthcare facilities in Rwanda from 2005 to 2010. LTF was defined as not attending clinic in the last 12 months for pre-ART patients and 6 months for ART patients. For the pre-ART period, sub-distribution hazards models were constructed to estimate LTF and death to account for competing risks. Kaplan-Meier (KM and Cox proportional hazards models were used for patients on ART. RESULTS: 31,033 ART-naïve adults were included, 64% were female and 75% were WHO stage I or II at enrollment. 17,569 (56% patients initiated ART. Pre-ART competing risk estimates of LTF at 2 years was 11.2% (95%CI, 10.9-11.6% and 2.9% for death (95%CI 2.7-3.1%. Among pre-ART patients, male gender was associated with higher LTF (adjusted sub-hazard ratio (aSHR 1.3, 95%CI 1.1-1.5 and death (aSHR 1.7, 95%CI 1.4-2.1. Low CD4 count (CD4<100 vs. ≥ 350 aSHR 0.2, 95%CI 0.1-0.3 and higher WHO stage (WHO stage IV vs. stage I aSHR 0.4, 95%CI 0.2-0.6 were protective against pre-ART LTF. KM estimates for LTF and death in ART patients at 2 years were 4.4% (95%CI 4.4-4.5% and 6.3% (95%CI 6.2-6.4%. In patients on ART, male gender was associated with LTF (adjusted hazard ratio (AHR 1.4, 95%CI 1.2-1.7 and death (AHR1.3, 95%CI 1.2-1.5. Mortality was higher for ART patients ≥ 40 years and in those with lower CD4 count at ART initiation. CONCLUSIONS: Low rates of LTF and death were founds among pre-ART and ART patients in Rwanda but greater efforts are needed to retain patients in care prior to ART initiation, particularly among those who are healthy at enrollment.

  17. [Prophylaxis of Community-Acquired Pneumonia Outbreaks with Pneumococcal Polysaccharide Vaccine. Prospects Analysis for Russian Military Community].

    Science.gov (United States)

    Guchev, I A; Klochkov, O I; Sinopalnikov, A I

    2016-01-01

    Pneumococcal pneumonia and other diseases caused by pneumococci still remain the main factors of high morbidity and mortality rates throughout the world. Pneumococci as the leading pathogens of community-acquired pneumonia (CAP), acute otitis media and sinusitis also cause a number of other serious systemic disorders including invasive infections with high mortality in spite of the antimicrobial resistance status and adequate antimicrobials choice. Pneumococcal infections are responsible for 5-35% or more of community-acquired pneumonias. The burden of pneumonia (up to 100-200 per thousand) is recorded among military recruits in training centers. Since the specific environment of the soldiers could be carrected, their health protection requires medical surveillance. For these reasons, polysaccharide and more immunogenic conjugated pneumococcal vaccines were developed. There is now an urgent need to understand whether such vaccines are effective in military conscripts. Controversy about the effectiveness and value of the polysaccharide (PPV-23) vaccine as a CAP morbidity restriction measure still persists. There were implemented plenty of metaanalyses of pneumococcal vaccines in adults. Some of them showed that the vaccine was effective against bacteremic pneumococcal pneumonia in 'low risk' healthy adults and elders. There have been a number of poor quality observational studies in Russia where 'all pneumonia cases' were considered as an endpoint. It remains controversial whether these observational studies provide adequate evidence to justify the use of the polysaccharide vaccine in the groups of healthy young men for whom it is being advocated. In our analysis we found weak evidence supporting pneumococcal vaccination with PPV-23 for this group. Nevertheless, favorable tendency was found to immunize. It is the reason for a trail to find pharmacoepidemiological support for vaccination by novel conjugated vaccines with better immunogenicity. PMID:27337866

  18. Adult bacteremic pneumococcal pneumonia acquired in the community: A prospective study on 101 patients Neumonía neumocóccica bacteriémica de la comunidad: Un estudio prospectivo en 101 pacientes

    Directory of Open Access Journals (Sweden)

    J. H. Gentile

    2003-01-01

    Full Text Available Our objective was to describe incidence, clinical, radiographic and microbiological features of bacteremic pneumococcal pneumonia (BPP in our environment. A total of 101 patients (7 were treated as outpatients, older than 18 years of age suffering BPP were prospectively evaluated. The incidence was 2.8 cases per 1000 admissions, 50 were males, mean age was 59.9 years (19-97, mortality was 11.8%. Eighty three percent of fatalities occurred within 3 days of admission. Mortality rate increased with advancing age. Fever, cough and chest pain were the commonest presenting symptoms and 44% of patients had extrapulmonary manifestations. Cigarette smoking, chronic obstructive lung disease, alcoholism and congestive heart failure (CHF were the commonest underlying conditions. CHF was more frequent in non-survivors (p = 0.002. A lobar pattern at chest radiograph predominated in survivors and a diffuse pattern in non-survivors (p = 0.007. Pleural effusion (20.7%, empyema (7.9% and respiratory failure (7.9% were the main complications. Underlying diseases were present in 100% of non-survivors (p = 0.03. Ninety four percent of patients were treated with beta-lactam antibiotics. Streptococcus pneumoniae was isolated from sputum in 6 cases. Three out of 101 S. pneumoniae isolates recovered from blood samples (one from each patient presented organisms resistant to penicillin. We observed an incidence of BPP that is similar to the observed in other countries. There are clinical and radiographic differences between survivors and non-survivors. Penicillin-resistant S. pneumoniae is still an unusual problem in our area.Se evaluaron en forma prospectiva 101 pacientes > 18 años admitidos al hospital con diagnóstico de NNB. El objetivo fue conocer la incidencia y describir las características de la enfermedad, así como la susceptibilidad antibiótica de cepas invasivas de Streptococcus pneumoniae. Se halló una incidencia de 2.8 casos/1000 admisiones; 50 fueron

  19. Childhood pneumonia and vitamin A

    OpenAIRE

    Farhad Heidarian; Tahereh Ansarinezhad

    2014-01-01

    One of the major causes of mortality in children younger than 5 years old is acute lower respiratory tract infections (ALRI). ALRI clinical features are cough, tachypnea, fever, coryza, chest retraction, crackles and wheeze. Increased white blood cell count with left shift might happen in pneumonia. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) might rise in children with respiratory tract infections. Vitamin A deficiency is associated with severe childhood infections. The...

  20. Passive smoking at home is a risk factor for community-acquired pneumonia in older adults: a population-based case–control study

    Science.gov (United States)

    Almirall, Jordi; Serra-Prat, Mateu; Bolíbar, Ignasi; Palomera, Elisabet; Roig, Jordi; Hospital, Imma; Carandell, Eugenia; Agustí, Mercè; Ayuso, Pilar; Estela, Andreu; Torres, Antoni

    2014-01-01

    Objective To assess whether passive smoking exposure at home is a risk factor for community-acquired pneumonia (CAP) in adults. Setting A population-based case-control study was designed in a Mediterranean area with 860 000 inhabitants >14 years of age. Participants 1003 participants who had never smoked were recruited. Primary and secondary outcome measures Risk factors for CAP, including home exposure to passive smoking, were registered. All new cases of CAP in a well-defined population were consecutively recruited during a 12-month period. Methods A population-based case-control study was designed to assess risk factors for CAP, including home exposure to passive smoking. All new cases of CAP in a well-defined population were consecutively recruited during a 12-month period. The subgroup of never smokers was selected for the present analysis. Results The study sample included 471 patients with CAP and 532 controls who had never smoked. The annual incidence of CAP was estimated to be 1.14 cases×10–3 inhabitants in passive smokers and 0.90×10−3 in non-passive smokers (risk ratio (RR) 1.26; 95% CI 1.02 to 1.55) in the whole sample. In participants ≥65 years of age, this incidence was 2.50×10−3 in passive smokers and 1.69×10−3 in non-passive smokers (RR 1.48, 95% CI 1.08 to 2.03). In this last age group, the percentage of passive smokers in cases and controls was 26% and 18.1%, respectively (p=0.039), with a crude OR of 1.59 (95% CI 1.02 to 2.38) and an adjusted (by age and sex) OR of 1.56 (95% CI 1.00 to 2.45). Conclusions Passive smoking at home is a risk factor for CAP in older adults (65 years or more). PMID:24928592

  1. Silencing abnormal wing disc gene of the Asian citrus psyllid, Diaphorina citri disrupts adult wing development and increases nymph mortality.

    Science.gov (United States)

    El-Shesheny, Ibrahim; Hajeri, Subhas; El-Hawary, Ibrahim; Gowda, Siddarame; Killiny, Nabil

    2013-01-01

    Huanglongbing (HLB) causes considerable economic losses to citrus industries worldwide. Its management depends on controlling of the Asian citrus Psyllid (ACP), the vector of the bacterium, Candidatus Liberibacter asiaticus (CLas), the causal agent of HLB. Silencing genes by RNA interference (RNAi) is a promising tool to explore gene functions as well as control pests. In the current study, abnormal wing disc (awd) gene associated with wing development in insects is used to interfere with the flight of psyllids. Our study showed that transcription of awd is development-dependent and the highest level was found in the last instar (5(th)) of the nymphal stage. Micro-application (topical application) of dsRNA to 5(th) instar of nymphs caused significant nymphal mortality and adult wing-malformation. These adverse effects in ACP were positively correlated with the amounts of dsRNA used. A qRT-PCR analysis confirmed the dsRNA-mediated transcriptional down-regulation of the awd gene. Significant down-regulation was required to induce a wing-malformed phenotype. No effect was found when dsRNA-gfp was used, indicating the specific effect of dsRNA-awd. Our findings suggest a role for awd in ACP wing development and metamorphosis. awd could serve as a potential target for insect management either via direct application of dsRNA or by producing transgenic plants expressing dsRNA-awd. These strategies will help to mitigate HLB by controlling ACP.

  2. Silencing abnormal wing disc gene of the Asian citrus psyllid, Diaphorina citri disrupts adult wing development and increases nymph mortality.

    Directory of Open Access Journals (Sweden)

    Ibrahim El-Shesheny

    Full Text Available Huanglongbing (HLB causes considerable economic losses to citrus industries worldwide. Its management depends on controlling of the Asian citrus Psyllid (ACP, the vector of the bacterium, Candidatus Liberibacter asiaticus (CLas, the causal agent of HLB. Silencing genes by RNA interference (RNAi is a promising tool to explore gene functions as well as control pests. In the current study, abnormal wing disc (awd gene associated with wing development in insects is used to interfere with the flight of psyllids. Our study showed that transcription of awd is development-dependent and the highest level was found in the last instar (5(th of the nymphal stage. Micro-application (topical application of dsRNA to 5(th instar of nymphs caused significant nymphal mortality and adult wing-malformation. These adverse effects in ACP were positively correlated with the amounts of dsRNA used. A qRT-PCR analysis confirmed the dsRNA-mediated transcriptional down-regulation of the awd gene. Significant down-regulation was required to induce a wing-malformed phenotype. No effect was found when dsRNA-gfp was used, indicating the specific effect of dsRNA-awd. Our findings suggest a role for awd in ACP wing development and metamorphosis. awd could serve as a potential target for insect management either via direct application of dsRNA or by producing transgenic plants expressing dsRNA-awd. These strategies will help to mitigate HLB by controlling ACP.

  3. Impact of body size and physical activity during adolescence and adult life on overall and cause-specific mortality in a large cohort study from Iran.

    Science.gov (United States)

    Etemadi, Arash; Abnet, Christian C; Kamangar, Farin; Islami, Farhad; Khademi, Hooman; Pourshams, Akram; Poustchi, Hossein; Bagheri, Mohammad; Sohrabpour, Amir Ali; Aliasgar, Ali; Khoshnia, Masoud; Wacholder, Sholom; Matthews, Charles C; Pharoah, Paul D; Brennan, Paul; Boffetta, Paolo; Malekzadeh, Reza; Dawsey, Sanford M

    2014-02-01

    We conducted this study to examine life-course body size and physical activity in relation to total and cause-specific mortality, which has not previously been studied in the low and middle-income countries in Asia. The Golestan Cohort Study is a population-based cohort in northeastern Iran in which 50,045 people above the age of 40 have been followed since 2004. Participants were shown a validated pictogram to assess body size at ages 15, 30, and the time of recruitment. Information on occupational physical activity at these ages was also collected. Subjects were followed up annually, and cause of death was determined. Cox regression models were adjusted for age at cohort start, smoking, socioeconomic status, ethnicity, place of residence, education, and opium use. Models for body size were also adjusted for physical activity at the same age, and vice versa. During a total of 252,740 person-years of follow-up (mean follow-up duration 5.1 ± 1.3 years) through December 2011, 2,529 of the cohort participants died. Larger body sizes at ages 15 or 30 in both sexes were associated with increased overall mortality. Cancer mortality was more strongly associated with adolescent obesity, and cardiovascular mortality with early adulthood body size. Weight gain between these ages was associated with cardiovascular mortality. Obese adolescents who lost weight still had increased mortality from all medical causes in both sexes. Physical activity during adolescence and early adulthood had no association with mortality, but at cohort baseline higher levels of activity were associated with reduced mortality. Mortality in this Middle-Eastern population was associated with obesity both during adolescence and early adult life. PMID:24557643

  4. Population Structure of Streptococcus pneumoniae Causing Invasive Disease in Adults in Portugal before PCV13 Availability for Adults: 2008-2011

    Science.gov (United States)

    Horácio, Andreia N.; Silva-Costa, Catarina; Diamantino-Miranda, Jorge; Lopes, Joana P.; Ramirez, Mario; Melo-Cristino, José

    2016-01-01

    Among the 1660 isolates recovered from invasive pneumococcal disease (IPD) in adults (> = 18 yrs) in 2008–2011, a random sample of ≥50% of each serotype (n = 871) was chosen for MLST analysis and evaluation for the presence and type of pilus islands (PIs). The genetic diversity was high with 206 different sequence types (STs) detected, but it varied significantly between serotypes. The different STs represented 80 clonal complexes (CCs) according to goeBURST with the six more frequent accounting for more than half (50.6%) of the isolates—CC156 (serotypes 14, 9V and 23F), CC191 (serotype 7F), CC180 (serotype 3), CC306 (serotype 1), CC62 (serotypes 8 and 11A) and CC230 (serotype 19A). Most of the isolates (n = 587, 67.3%) were related to 29 Pneumococcal Molecular Epidemiology Network recognized clones. The overall proportion of isolates positive for any of the PIs was small (31.9%) and declined gradually during the study period (26.6% in 2011), mostly due to the significant decline of serotype 1 which is associated with PI-2. The changes in serotypes that occurred in adult IPD after the introduction of the seven-valent pneumococcal conjugate vaccine (PCV7) for children were mostly due to the expansion of previously circulating clones, while capsular switching was infrequent and not related to vaccine use. The reduction of IPD caused by PCV7 serotypes in the years following PCV7 implementation did not result in a decline of antimicrobial resistance in part due to the selection of resistant genotypes among serotypes 14 and 19A. PMID:27168156

  5. Metropolitan social environments and pre-HAART/HAART era changes in mortality rates (per 10,000 adult residents among injection drug users living with AIDS.

    Directory of Open Access Journals (Sweden)

    Samuel R Friedman

    Full Text Available BACKGROUND: Among the largest US metropolitan areas, trends in mortality rates for injection drug users (IDUs with AIDS vary substantially. Ecosocial, risk environment and dialectical theories suggest many metropolitan areas characteristics that might drive this variation. We assess metropolitan area characteristics associated with decline in mortality rates among IDUs living with AIDS (per 10,000 adult MSA residents after highly active antiretroviral therapy (HAART was developed. METHODS: This is an ecological cohort study of 86 large US metropolitan areas from 1993-2006. The proportional rate of decline in mortality among IDUs diagnosed with AIDS (as a proportion of adult residents from 1993-1995 to 2004-2006 was the outcome of interest. This rate of decline was modeled as a function of MSA-level variables suggested by ecosocial, risk environment and dialectical theories. In multiple regression analyses, we used 1993-1995 mortality rates to (partially control for pre-HAART epidemic history and study how other independent variables affected the outcomes. RESULTS: In multivariable models, pre-HAART to HAART era increases in 'hard drug' arrest rates and higher pre-HAART income inequality were associated with lower relative declines in mortality rates. Pre-HAART per capita health expenditure and drug abuse treatment rates, and pre- to HAART-era increases in HIV counseling and testing rates, were weakly associated with greater decline in AIDS mortality. CONCLUSIONS: Mortality among IDUs living with AIDS might be decreased by reducing metropolitan income inequality, increasing public health expenditures, and perhaps increasing drug abuse treatment and HIV testing services. Given prior evidence that drug-related arrest rates are associated with higher HIV prevalence rates among IDUs and do not seem to decrease IDU population prevalence, changes in laws and policing practices to reduce such arrests while still protecting public order should be

  6. Kinase Activity Profiling of Gram-Negative Pneumonia

    NARCIS (Netherlands)

    Hoogendijk, Arie J.; Diks, Sander H.; Peppelenbosch, Maikel P.; van der Poll, Tom; Wieland, Catharina W.

    2011-01-01

    Pneumonia is a severe disease with high morbidity and mortality. A major causative pathogen is the Gram-negative bacterium Klebsiella (K.) pneumoniae Kinases play an integral role in the transduction of intracellular signaling cascades and regulate a diverse array of biological processes essential t

  7. Kinase activity profiling of gram-negative pneumonia

    NARCIS (Netherlands)

    A.J. Hoogendijk (Arie); S.H. Diks (Sander); M.P. Peppelenbosch (Maikel); T. van der Poll (Tom); C.W. Wieland (Catharina )

    2011-01-01

    textabstractPneumonia is a severe disease with high morbidity and mortality. A major causative pathogen is the Gram-negative bacterium Klebsiella (K.) pneumoniae. Kinases play an integral role in the transduction of intracellular signaling cascades and regulate a diverse array of biological processe

  8. Kinase activity profiling of gram-negative pneumonia

    NARCIS (Netherlands)

    A.J. Hoogendijk; S.H. Diks; M.P. Peppelenbosch; T. van der Poll; C.W. Wieland

    2011-01-01

    Pneumonia is a severe disease with high morbidity and mortality. A major causative pathogen is the Gram-negative bacterium Klebsiella (K.) pneumoniae. Kinases play an integral role in the transduction of intracellular signaling cascades and regulate a diverse array of biological processes essential

  9. A Fatal Case of Klebsiella pneumoniae Mycotic Aneurysm

    OpenAIRE

    Chien-Ming Chao; Kun-Kuang Lee; Chia-Sheng Wang; Ping-Jen Chen; Tsung-Chih Yeh

    2011-01-01

    Mycotic aneurysm is a serious clinical condition with significant morbidity and mortality. Staphylococcus aureus and Salmonella species are the most common causative pathogens. Klebsiella pneumoniae was rarely reported as a possible pathogen causing mycotic aneurysm; therefore, we describe a K. pneumoniae-related fatal bacteremia mycotic aneurysm in a patient in spite of appropriate antimicrobial agents and surgical management.

  10. Educational Inequalities in the Transition to Adulthood in Belgium: The Impact of Intergenerational Mobility on Young-Adult Mortality in 2001-2009

    Science.gov (United States)

    2015-01-01

    Several studies have focused on the association between parental and personal socioeconomic position (SEP) and health, with mixed results depending on the specific health outcome, research methodology and population under study. In the last decades, a growing interest is given to the influence of intergenerational mobility on several health outcomes at young ages. This study addresses the following research question: Is educational intergenerational mobility associated with all-cause and cause-specific mortality in young adulthood? To this end, the Belgian 1991 and 2001 censuses are used, providing characteristics of young persons at two time points (T1 = 01/03/91;T2 = 01/10/01) and follow-up information on mortality and emigration between T2 and 31/12/09 (T3). The study population consists of all official inhabitants of Flanders and the Brussels-Capital Region at T2, born between 1972 and 1982 and alive at T2. Parental and personal education are divided into primary (PE), lower secondary (LSE), higher secondary (HSE) and higher education (HE). We analyse mortality between T2 and T3 calculating age-standardised mortality rates (ASMRs) and using Cox regression (hazard ratios = HR). Personal rather than parental education determines the observed mortality rates, with high all-cause mortality rates among those with PE, irrespective of parental education (e.g., among men ASMRPE-PE = 200.0 [95% CI 158.0–241.9]; ASMRHE-PE = 319.7 [183.2–456.3]) and low all-cause mortality among those in higher education, regardless of parental education (ASMRPE-HE = 41.7 [30.8–52.6]; ASMRHE-HE = 38.0 [33.2–42.8]). There is some variation by gender and according to cause of death. This study shows the strong association between personal education and young-adult mortality. PMID:26657691

  11. Pneumonia lipoídica em adultos: aspectos na tomografia computadorizada de alta resolução Lipoid pneumonia in adults: findings on high-resolution computed tomography

    OpenAIRE

    Edson Marchiori; Gláucia Zanetti; Dante L. Escuissato; Arthur Soares Souza Jr.; César de Araújo Neto; Luiz Felipe Nobre; Klaus L. Irion; Rosana Rodrigues; Alexandre Dias Mançano; Domenico Capone; Suzane Mansur Fialho; Carolina Althoff Souza

    2007-01-01

    OBJETIVO: Apresentar os aspectos na tomografia computadorizada de alta resolução do tórax da pneumonia lipoídica exógena por aspiração de óleo mineral, em pacientes adultos MATERIAIS E MÉTODOS: Foram estudados oito pacientes adultos - quatro mulheres e quatro homens - com média de idade de 69,4 anos, todos usuários de óleo mineral para tratamento de constipação intestinal. Os exames foram avaliados por dois radiologistas, de forma independente RESULTADOS: Os achados tomográficos mais comuns f...

  12. Interactions between Streptococcus pneumoniae and the human host

    NARCIS (Netherlands)

    Mens, S.P. van

    2014-01-01

    Streptococcus pneumoniae, the pneumococcus, is an important human pathogen causing considerable morbidity and mortality worldwide. This thesis addresses several interactions between pneumococcus and man. The first part of the thesis deals with the host immune response against pneumococci. We studied

  13. Childhood Pneumonia Screener: a concept

    Directory of Open Access Journals (Sweden)

    Jukka Räsänen

    2014-06-01

    Full Text Available Childhood pneumonia continues to be the number one cause of death in children under five years of age in developing countries. In addition to mortality, pneumonia constitutes an enormous economic and social burden because late diagnosis is associated with high cost of treatment and often leads to chronic health problems. There are several bottlenecks in developing countries in the case flow of a child with lung infection: 1 recognising the symptoms as a reason to seek care, 2 getting the patient to a first-tier health facility, 3 scarcity of trained healthcare personnel who can diagnose the condition and its severity, 4 access to a second-tier facility in severe cases. These factors are commonly present in rural areas but even in more urban settings, access to a physician is often delayed. The Childhood Pneumonia Screener project aims at bridging the diagnostic gap using emerging technology. Mobile “smart” phone communication with several inexpensive dedicated sensors is proposed as a rapid data-collection and transmission unit that is connected to a central location where trained personnel assisted by sophisticated signal processing algorithms, evaluate the data and determine if the child is likely to have pneumonia and what the level and urgency of care should be.

  14. Acute exposure of mice to high-dose ultrafine carbon black decreases susceptibility to pneumococcal pneumonia

    Directory of Open Access Journals (Sweden)

    Gordon Stephen

    2010-10-01

    Full Text Available Abstract Background Epidemiological studies suggest that inhalation of carbonaceous particulate matter from biomass combustion increases susceptibility to bacterial pneumonia. In vitro studies report that phagocytosis of carbon black by alveolar macrophages (AM impairs killing of Streptococcus pneumoniae. We have previously reported high levels of black carbon in AM from biomass smoke-exposed children and adults. We therefore aimed to use a mouse model to test the hypothesis that high levels of carbon loading of AM in vivo increases susceptibility to pneumococcal pneumonia. Methods Female outbred mice were treated with either intranasal phosphate buffered saline (PBS or ultrafine carbon black (UF-CB in PBS; 500 μg on day 1 and day 4, and then infected with S. pneumoniae strain D39 on day 5. Survival was assessed over 72 h. The effect of UF-CB on AM carbon loading, airway inflammation, and a urinary marker of pulmonary oxidative stress was assessed in uninfected animals. Results Instillation of UF-CB in mice resulted a pattern of AM carbon loading similar to that of biomass-smoke exposed humans. In uninfected animals, UF-CB treated animals had increased urinary 8-oxodG (P = 0.055, and an increased airway neutrophil differential count (P . pneumoniae, whereas morbidity and mortality after infection was reduced in UF-CB treated animals (median survival 48 h vs. 30 h, P . pneumoniae colony forming unit counts, and lower airway levels of keratinocyte-derived chemokine/growth-related oncogene (KC/GRO, and interferon gamma. Conclusion Acute high level loading of AM with ultrafine carbon black particles per se does not increase the susceptibility of mice to pneumococcal infection in vivo.

  15. Respiratory diseases morbidity and mortality among adults attending a tertiary hospital in Nigeria Morbidade e mortalidade relacionadas a doenças respiratórias em adultos atendidos em um hospital terciário na Nigéria

    Directory of Open Access Journals (Sweden)

    Olufemi Olumuyiwa Desalu

    2009-08-01

    Full Text Available OBJECTIVE: To determine the morbidity and mortality related to respiratory diseases among adults attending a tertiary-care hospital in Nigeria. METHODS: We carried out a retrospective study of 183 adult patients (> 15 years of age, diagnosed with respiratory diseases between November of 2006 and October of 2008 at the Federal Medical Centre in Ido-Ekiti, Nigeria. RESULTS: Of the 183 patients enrolled in the study, 78 (42.6% were male and 105 (57.4% were female, the male: female ratio being 1:1.4. Respiratory diseases were predominant in the 25-44 year age bracket (37.2% and lower socioeconomic class (81.4%. Pulmonary TB was the leading cause of morbidity (in 42.1%, followed by asthma (in 17.5% and pneumonia (in 15.3%. Lung cancer was uncommon (in only 0.6%. Pulmonary TB was the leading cause of hospitalization for respiratory disease (in 32%. Pulmonary TB, asthma, pneumonia and pleural pathologies were more common in women, whereas COPD was more common in men. The most common comorbidity was HIV infection (in 11.5%. The overall mean length of hospital stay was 14 days. Overall mortality was 8.7%; 50% of the deaths were attributed to pulmonary TB, 25% were attributed to pleural disease, 12.5% were attributed to pneumonia, and 6.25% were attributed to acute exacerbation of COPD. Mortality was higher in women and in the 25-44 year age bracket. CONCLUSIONS: Pulmonary TB, asthma and pneumonia were the leading causes of respiratory disease-related morbidity. Pulmonary TB was the leading cause of respiratory disease-related mortality among the adult Nigerians evaluated. Therefore, these conditions should be given higher priority in patient care. In addition, antiretroviral therapy should be readily accessible and affordable to HIV-infected individuals.OBJETIVO: Determinar a morbidade e a mortalidade relacionadas a doenças respiratórias em adultos atendidos em um hospital terciário na Nigéria. MÉTODOS: Estudo retrospectivo com 183 pacientes adultos

  16. A cohort study of bacteremic pneumonia

    Science.gov (United States)

    Guillamet, Cristina Vazquez; Vazquez, Rodrigo; Noe, Jonas; Micek, Scott T.; Kollef, Marin H.

    2016-01-01

    Abstract Bacteremic pneumonia is usually associated with greater mortality. However, risk factors associated with hospital mortality in bacteremic pneumonia are inadequately described. The study was a retrospective cohort study, conducted in Barnes-Jewish Hospital (2008–2015). For purposes of this investigation, antibiotic susceptibility was determined according to ceftriaxone susceptibility, as ceftriaxone represents the antimicrobial agent most frequently recommended for hospitalized patients with community-acquired pneumonia as opposed to nosocomial pneumonia. Two multivariable analyses were planned: the first model included resistance to ceftriaxone as a variable, whereas the second model included the various antibiotic-resistant species (methicillin-resistant Staphylococcus aureus, Pseudomonas aeruginosa, and Enterobacteriaceae). In all, 1031 consecutive patients with bacteremic pneumonia (mortality 37.1%) were included. The most common pathogens associated with infection were S aureus (34.1%; methicillin resistance 54.0%), Enterobacteriaceae (28.0%), P aeruginosa (10.6%), anaerobic bacteria (7.3%), and Streptococcus pneumoniae (5.6%). Compared with ceftriaxone-susceptible pathogens (46.8%), ceftriaxone-resistant pathogens (53.2%) were significantly more likely to receive inappropriate initial antibiotic treatment (IIAT) (27.9% vs 7.1%; P mechanical ventilation, immune suppression, prior hospitalization, prior antibiotic administration, septic shock, comorbid conditions, and severity of illness. In the second multivariable analysis that included the antibiotic-resistant species, IIAT was still associated with excess mortality, and P aeruginosa infection was identified as an independent predictor of mortality (OR 1.6, 95% CI 1.1–2.2, P = 0.047), whereas infection with ceftriaxone-resistant Enterobacteriaceae (OR 0.6, 95% CI 0.4–1.0, P = 0.050) was associated with lower mortality. More than one-third of our patients hospitalized with bacteremic

  17. Income inequality, individual income, and mortality in Danish adults: analysis of pooled data from two cohort studies

    DEFF Research Database (Denmark)

    Osler, Merete; Prescott, Eva; Grønbaek, Morten;

    2002-01-01

    To analyse the association between area income inequality and mortality after adjustment for individual income and other established risk factors.......To analyse the association between area income inequality and mortality after adjustment for individual income and other established risk factors....

  18. Education and adult cause-specific mortality--examining the impact of family factors shared by 871 367 Norwegian siblings

    DEFF Research Database (Denmark)

    Næss, Oyvind; Hoff, Dominic A; Lawlor, Debbie;

    2012-01-01

    To estimate the impact family factors shared by siblings has on the association between length of education and cause-specific mortality in adulthood.......To estimate the impact family factors shared by siblings has on the association between length of education and cause-specific mortality in adulthood....

  19. Capillary refill time is a predictor of short-term mortality for adult patients admitted to a medical department

    DEFF Research Database (Denmark)

    Mrgan, Monija; Rytter, Dorte; Brabrand, Mikkel

    2014-01-01

    mortality. Both the Trauma score and Schriger and Baraff definitions had high negative predictive values. The calculations on the Schriger and Baraff defition were based on limited power. CONCLUSIONS: We found a significant association between CRT measured as a continuous variable and short-term mortality...

  20. Clinical Features of Infection in Older Adults.

    Science.gov (United States)

    Norman, Dean C

    2016-08-01

    The impact of infectious diseases on older adults is far greater than on younger adults because of significantly higher morbidity and mortality caused by infection. The reasons for this greater impact include factors such as lower physiologic reserve due to age and chronic disease, age-related changes in host defenses, loss of mobility, higher risk for polypharmacy and adverse drug reactions, and being on drugs that increase the risk for infection (e.g., anticholinergic and other sedating medications increase the risk for pneumonia). PMID:27394015

  1. Association of Mycoplasma pneumoniae infection and childhood asthma

    Institute of Scientific and Technical Information of China (English)

    YADAV Shakti Nrisingh; GAUTAM Mahesh Kumar; JIANG Li

    2015-01-01

    Mycoplasma pneumoniae is a frequent cause of acute respiratory infections in both children and adults.It can cause pharyngitis, otitis, tracheobronchitis, or community-acquired pneumonia, but may also remain totally asymptomatic.Mycoplasma pneumoniae is an organism that reportedly has a strong relationship to asthma.The role of atypical bacterial infection in the pathogenesis of asthma is a subject of continuing debate. There is an increasing body of literature concerning the association between Mycoplasma pneumoniae ( M. pneumoniae) and asthma pathogenesis.Moreover, many studies investigating such a link have been uncontrolled and have provided conflicting evidence, in part due to the difficulty in accurately diagnosing infection with these atypical pathogens. Large, general population-based prospective studies are necessary to investigate the development of asthma induced by M. pneumoniae infection in humans. This manuscript will review the relationship between M.pneumoniae infection and childhood asthma.

  2. Adult Stem Cells for Acute Lung Injury: Remaining Questions & Concerns

    OpenAIRE

    Zhu, Ying-Gang; Hao, Qi; Monsel, Antoine; Feng, Xiao-mei; Lee, Jae W.

    2013-01-01

    Acute lung injury (ALI) or acute respiratory distress syndrome remains a major cause of morbidity and mortality in hospitalized patients. The pathophysiology of ALI involves complex interactions between the inciting event, such as pneumonia, sepsis or aspiration, and the host immune response resulting in lung protein permeability, impaired resolution of pulmonary edema, an intense inflammatory response in the injured alveolus and hypoxemia. In multiple pre-clinical studies, adult stem cells h...

  3. 鲍氏不动杆菌及铜绿假单胞菌肺炎患者死亡相关危险因素分析%Risk factors for mortality of patients with pneumonia caused by Acinetobacter baumannii and Pseudomonas aeruginosa

    Institute of Scientific and Technical Information of China (English)

    王飞; 姚贝; 张捷; 贺蓓

    2013-01-01

    OBJECTIVE To retrospectively investigate the risk factors associated the mortality of the patients with pneumonia caused by Acinetobacter baumannii and Pseudomonas aeruginosa , and focus on the impact of different antimicrobial regimens on the patients with A. baumannii pneumonia so as to guide the clinical treatment. METHODS We searched the qualified respiratory samples (including sputum and endotracheal aspirate) in the hospital during Jan 2012 to Aug 2012, and identified the cases with A. baumannii and/or P. aeruginosa positive isolates. The clinical data of the cases were reviewed and the cases were recruited when they were clinically diagnosed as pneumonia. The clinical and microbiological data of the patients were collected. logistic regression was applied to identify the risk factors of the mortality. RESULTS Totally 79 patients with pneumonia were enrolled in the study, including 46 patients infected with A. baumannii and 33 patients infected with P. aeruginosa; 29 cases died with the mortality of 36. 7%; the multivariate regression analysis showed that the respiratory frequency, blood urea nitrogen, sepsis, albumin level and use of antibiotics were the independent risk factors for the mortality of the patients with A. baumannii or P. aeruginosa pneumonia. The mortality of the patients with A. baumannii pneumonia was 50. 0% , 18. 8% of the patients with P. aeruginosa pneumonia (P = 0. 004) ; A. baumannii infection was an independent factor for the increase in mortality (OR = 4. 33, P = 0. 007). Of all the A. baumannii strains, the multidrug-resistant A. baumannii accounted for 97. 8%; the analysis of treatment program indicated that the use of single carbapenem for the primary treatment may increase the risk of mortality and that the use of other antibiotics had no significant impact on the mortality. CONCLUSION The severity of infection is the independent risk factor for the mortality of the patients with A. baumannii or P. aeruginosa pneumonia. The

  4. Serotype-specific differences in short- and longer-term mortality following invasive pneumococcal disease.

    Science.gov (United States)

    Hughes, G J; Wright, L B; Chapman, K E; Wilson, D; Gorton, R

    2016-09-01

    Invasive pneumococcal disease (IPD), caused by infection with Streptococcus pneumoniae, has a substantial global burden. There are over 90 known serotypes of S. pneumoniae with a considerable body of evidence supporting serotype-specific mortality rates immediately following IPD. This is the first study to consider the association between serotype and longer-term mortality following IPD. Using enhanced surveillance data from the North East of England we assessed both the short-term (30-day) and longer-term (⩽7 years) independent adjusted associations between individual serotypes and mortality following IPD diagnosis using logistic regression and extended Cox proportional hazards models. Of the 1316 cases included in the analysis, 243 [18·5%, 95% confidence interval (CI) 16·4-20·7] died within 30 days of diagnosis. Four serotypes (3, 6A, 9N, 19 F) were significantly associated with overall increased 30-day mortality. Effects were observable only for older adults (⩾60 years). After extension of the window to 12 months and 36 months, one serotype was associated with significantly increased mortality at 12 months (19 F), but no individual serotypes were associated with increased mortality at 36 months. Two serotypes had statistically significant hazard ratios (HR) for longer-term mortality: serotype 1 for reduced mortality (HR 0·51, 95% CI 0·30-0·86) and serotype 9N for increased mortality (HR 2·30, 95% CI 1·29-4·37). The association with serotype 9N was no longer observed after limiting survival analysis to an observation period starting 30 days after diagnosis. This study supports the evidence for associations between serotype and short-term (30-day) mortality following IPD and provides the first evidence for the existence of statistically significant associations between individual serotypes and longer-term variation in mortality following IPD. PMID:27193457

  5. Immunomodulation in community-acquired pneumonia

    NARCIS (Netherlands)

    Remmelts, H.H.F.

    2013-01-01

    Community-acquired pneumonia (CAP) is a common disease with considerable morbidity and mortality, despite effective antibiotic treatment. In this thesis, we showed that the major causative microorganisms in CAP trigger distinct inflammatory response profiles in the host. While an inflammatory respon

  6. Pneumonia in older residents of long-term care facilities.

    Science.gov (United States)

    Furman, Christian Davis; Rayner, Abi V; Tobin, Elisabeth Pelcher

    2004-10-15

    Compared with community-dwelling persons, residents in long-term care facilities have more functional disabilities and underlying medical illnesses and are at increased risk of acquiring infectious diseases. Pneumonia is the leading cause of morbidity and mortality in this group. Risk factors include unwitnessed aspiration, sedative medication, and comorbidity. Recognition may be delayed because, in this population, pneumonia often presents without fever, cough, or dyspnea. Accurate identification of the etiologic agent is hampered because most patients cannot produce a suitable sputum specimen. It is difficult to distinguish colonization from infection. Colonization by Staphylococcus aureus and gram-negative organisms can result from aspiration of oral or gastric contents, which could lead to pneumonia. Aspiration of gastric contents also can produce aspiration pneumonitis. This condition is not infectious initially and may resolve without antibiotics. Antibiotics for the treatment of pneumonia should cover Streptococcus pneumoniae, Haemophilus influenzae, gram-negative rods, and S. aureus. Acceptable choices include quinolones or an extended-spectrum beta-lactam plus a macrolide. Treatment should last 10 to 14 days. Pneumonia is associated with significant mortality for up to two years. Dementia is related independently to the death rate within the first week after pneumonia, regardless of treatment. Prevention strategies include vaccination against S. pneumoniae and influenza on admission to the care facility. This article focuses on recent recommendations for the recognition of respiratory symptoms and criteria for the designation of probable pneumonia, and provides a guide to hospitalization, antibiotic use, and prevention.

  7. Changes of body mass index in relation to mortality: results of a cohort of 42,099 adults.

    Directory of Open Access Journals (Sweden)

    Jochen Klenk

    Full Text Available BACKGROUND: High Body-Mass-Index (BMI is associated with increased all-cause mortality, but little is known about the effect of short- and long-term BMI change on mortality. The aim of the study was to determine how long-term weight change affects mortality. METHODS AND FINDINGS: Within a population-based prospective cohort of 42,099 Austrian men and women (mean age 43 years with at least three BMI measurements we investigated the relationship of BMI at baseline and two subsequent BMI change intervals of five years each with all-cause mortality using Cox proportional Hazard models. During median follow-up of 12 years 4,119 deaths were identified. The lowest mortalities were found in persons with normal weight or overweight at baseline and stable BMI over 10 years. Weight gain (≥0.10 kg/m(2/year during the first five years was associated with increased mortality in overweight and obese people. For weight gain during both time intervals mortality risk remained significantly increased only in overweight (Hazard Ratio (HR: 1.39 (95% confidence interval: 1.01; 1.92 and obese women (1.85 (95% confidence interval: 1.18; 2.89. Weight loss (< -0.10 kg/m(2/year increased all-cause mortality in men and women consistently. BMI change over time assessed using accepted World Health Organisation BMI categories showed no increased mortality risk for people who remained in the normal or overweight category for all three measurements. In contrast, HRs for stable obese men and women were 1.57 (95% CI: 1.31; 1.87 and 1.46 (95% CI: 1.25; 1.71 respectively. CONCLUSION: Our findings highlight the importance of weight stability and obesity avoidance in prevention strategy.

  8. Clinical Investigation of Cavitary Tuberculosis and Tuberculous Pneumonia

    OpenAIRE

    Lee, Ki Man; Choe, Kang Hyeon; Kim, Sung Jin

    2006-01-01

    Background The radiographic characteristics of tuberculous pneumonia in adults are similar to primary tuberculosis that occurs in childhood, and upper lobe cavitary tuberculosis is the hallmark of postprimary tuberculosis. The purpose of this study was to investigate the factors associated with tuberculous pneumonia by making comparison with cavitary tuberculosis. Methods The medical records and radiographic findings of patients with cavitary tuberculosis and tuberculous pneumonia, and who we...

  9. Causes of Rabbit Mortality at Mankon Research Station, Cameroon (1983-1987

    Directory of Open Access Journals (Sweden)

    Nfi, AN.

    1996-01-01

    Full Text Available A study was carried out to determine the causes of mortality in rabbits raised at the Institute of Zootechnical and Veterinary Research Station (IRZV Mankon between 1983-1987. Three breeds of rabbits the Californian, the New Zealand White and their crosses with local rabbits were used in the study. Within the period under review, all dead animals were necropsied and faecal and gastro-intestinal tract samples were examined in the laboratory. It was shown that high mortalities in rabbits were due to snuffles, pneumonia, mucoid enteritis, coccidiosis, mange, enterotoxaemia and Tyzzer's disease. 3060 rabbits died of various diseases comprising 1591 (52 % kittens, 1220 (39.7 % fryers and 280 (9.2 % adults. Kitten mortality compared to fryer and adult was highest ail through the period of study.

  10. Income inequality, individual income, and mortality in Danish adults: analysis of pooled data from two cohort studies

    DEFF Research Database (Denmark)

    Osler, Merete; Prescott, Eva; Grønbaek, Morten;

    2002-01-01

    in the parishes with the least equal income distribution. After adjustment for individual risk factors, parish income inequality was not associated with mortality, whereas individual household income was. Thus, individuals in the highest income quarter had lower mortality than those in the lowest quarter......OBJECTIVE: To analyse the association between area income inequality and mortality after adjustment for individual income and other established risk factors. DESIGN: Analysis of pooled data from two cohort studies. The relation between income inequality in small areas of residence (parishes...... (adjusted hazard ratio for men 0.51 (95% confidence interval 0.45 to 0.59) and for women 0.60 (0.54 to 0.68)). CONCLUSION: Area income inequality is not in itself associated with all cause mortality in this Danish population. Adjustment for individual risk factors makes the apparent effect disappear...

  11. Gender differences in the predictive role of self-rated health on short-term risk of mortality among older adults

    Science.gov (United States)

    Assari, Shervin

    2016-01-01

    Objectives: Despite the well-established association between self-rated health and mortality, research findings have been inconsistent regarding how men and women differ on this link. Using a national sample in the United States, this study compared American male and female older adults for the predictive role of baseline self-rated health on the short-term risk of mortality. Methods: This longitudinal study followed 1500 older adults (573 men (38.2%) and 927 women (61.8%)) aged 66 years or older for 3 years from 2001 to 2004. The main predictor of interest was self-rated health, which was measured using a single item in 2001. The outcome was the risk of all-cause mortality during the 3-year follow-up period. Demographic factors (race and age), socio-economic factors (education and marital status), and health behaviors (smoking and drinking) were covariates. Gender was the focal moderator. We ran logistic regression models in the pooled sample and also stratified by gender, with self-rated health treated as either nominal variables, poor compared to other levels (i.e. fair, good, or excellent) or excellent compared to other levels (i.e. good, fair, or poor), or an ordinal variable. Results: In the pooled sample, baseline self-rated health predicted mortality risk, regardless of how the variable was treated. We found a significant interaction between gender and poor self-rated health, indicating a stronger effect of poor self-rated health on mortality risk for men compared to women. Gender did not interact with excellent self-rated health on mortality. Conclusion: Perceived poor self-rated health better reflects risk of mortality over a short period of time for older men compared to older women. Clinicians may need to take poor self-rated health of older men very seriously. Future research should test whether the differential predictive validity of self-rated health based on gender is due to a different meaning of poor self-rated health for older men and women

  12. The Value of Initial Ionized Calcium as a Predictor of Mortality and Triage Tool in Adult Trauma Patients

    OpenAIRE

    Choi, Young Cheol; Hwang, Seong Youn

    2008-01-01

    Ionized hypocalcemia is a common finding in critically ill patients, but the relationship between ionized hypocalcemia and mortality risk in trauma patients has not been well established. The aim of this study was to assess the usefulness of initial ionized calcium (iCa) in predicting mortality in the trauma population, and evaluate its superiority over the three other triage tools: base deficit, systemic inflammatory response syndrome (SIRS) score, and triage-revised trauma score (t-RTS). A ...

  13. Pneumonia after Major Cancer Surgery: Temporal Trends and Patterns of Care

    Directory of Open Access Journals (Sweden)

    Vincent Q. Trinh

    2016-01-01

    Full Text Available Rationale. Pneumonia is a leading cause of postoperative complication. Objective. To examine trends, factors, and mortality of postoperative pneumonia following major cancer surgery (MCS. Methods. From 1999 to 2009, patients undergoing major forms of MCS were identified using the Nationwide Inpatient Sample (NIS, a Healthcare Cost and Utilization Project (HCUP subset, resulting in weighted 2,508,916 patients. Measurements. Determinants were examined using logistic regression analysis adjusted for clustering using generalized estimating equations. Results. From 1999 to 2009, 87,867 patients experienced pneumonia following MCS and prevalence increased by 29.7%. The estimated annual percent change (EAPC of mortality after MCS was −2.4% (95% CI: −2.9 to −2.0, P<0.001; the EAPC of mortality associated with pneumonia after MCS was −2.2% (95% CI: −3.6 to 0.9, P=0.01. Characteristics associated with higher odds of pneumonia included older age, male, comorbidities, nonprivate insurance, lower income, hospital volume, urban, Northeast region, and nonteaching status. Pneumonia conferred a 6.3-fold higher odd of mortality. Conclusions. Increasing prevalence of pneumonia after MCS, associated with stable mortality rates, may result from either increased diagnosis or more stringent coding. We identified characteristics associated with pneumonia after MCS which could help identify at-risk patients in order to reduce pneumonia after MCS, as it greatly increases the odds of mortality.

  14. Pneumocystis Pneumonia (PCP)

    Science.gov (United States)

    ... 2014 Select a Language: Fact Sheet 515 Pneumocystis Pneumonia (PCP) WHAT IS PCP? HOW IS PCP TREATED? ... BEST? THE BOTTOM LINE WHAT IS PCP? Pneumocystis pneumonia (PCP or pneumocystis) is the most common opportunistic ...

  15. Pattern of Pulmonary Involvement and Outcome of Aspiration Pneumonia in Patients with Altered Consciousness Admitted in Dhaka Medical College Hospital.

    Science.gov (United States)

    Chowdhury, R A; Azad, A K; Sardar, H; Siddiqui, M R; Saad, S; Rahman, S; Sikder, A S

    2016-01-01

    Aspiration is well recognized as a cause of pulmonary disease and is not uncommon in patients with altered consciousness.The mortality rate of aspiration pneumonia is approximately 1% in outpatient setting and upto 25% in those requiring hospitalization. This study was done to see the pattern of pulmonary involvement and outcome of aspiration pneumonia in patients with altered consciousness admitted in medicine department of a tertiary care hospital in our country. This was a prospective observational study conducted among the 52 adult patients of aspiration pneumonia with altered consciousness admitted in the medicine department of Dhaka Medical College Hospital (DMCH), during June 2010 to December 2010. Aspiration pneumonia was confirmed by clinical examination and laboratory investigations. Hematologic measurements (TC of WBC, Hb%, ESR, platelet count), chest X-ray, blood gas analysis, blood urea, creatinine and random blood sugar, sputum for Gram staining, sputum for culture sensitivity and blood culture were done in all patients.Assessment of altered conscious patient was done by application of the Glasgow Coma Scale. Case record forms with appropriate questionnaire were filled for all patients. The mean±SD age was 57.42±13.63 years with ranged from 25 to 90 years. Out of 52 patients, 37(71.15%) patients were male and 15(28.85%) patients were female. Following aspiration 76.92% patients developed pneumonitis, 13.46% patients developed lung abscess and only 9.62% patients developed ARDS. Most (33) of the patients had opacity in right lower zone and 13 patients had opacity in the left lower zone, 6 patients had opacity in right mid zone. Only 10 patients had opacity in both lower zones. In this study overall mortality rate was 23%. If only one lobe was involved radiologically, mortality was 8.33%. If two or more lobes on one or both sides were involved, mortality was in the range of 25-91%.

  16. Population structure and drug resistance patterns of emerging non-PCV-13 Streptococcus pneumoniae serotypes 22F, 15A, and 8 isolated from adults in Ontario, Canada.

    Science.gov (United States)

    Duvvuri, Venkata R; Deng, Xianding; Teatero, Sarah; Memari, Nader; Athey, Taryn; Fittipaldi, Nahuel; Gubbay, Jonathan B

    2016-08-01

    The introduction of pneumococcal conjugate vaccines has led to the emergence of non-vaccine serotypes, which contributed to invasive pneumococcal disease in Canada and worldwide. A significant increase in the prevalence of non-13-valent pneumococcal conjugate vaccine (PCV-13)-included serotypes 22F, 15A, and 8 was observed from 2009 to 2013 in Ontario (all p valuesStreptococcus pneumoniae population structures and dynamics, and its utility in molecular surveillance. PMID:27071529

  17. Subglottic Secretion Drainage for Preventing Venti-lator Associated Pneumonia: A Meta-analysis

    Institute of Scientific and Technical Information of China (English)

    Rong Wang; Xiang Zhen; Bao-Yi Yang; Xue-Zhen Guo; Xue Zeng; Chun-Yan Deng

    2015-01-01

    Objective: Ventilator associated pneumonia ( VAP) has been shown to be associated with signifi-cant morbidity and mortality( Chastre and Fagon, 2002;klompas, 2007) among mechanically venti-lated patients in the intensive care unit ( ICU ) , with the incidence ranging from 9% to 27%;crude mortality ranges from 25% to 50%. 1-3 A meta-analysis of published studies was undertaken to combine information regarding the effect of subglottic secretion drainage ( SSD ) on the inci-dence of ventilated associated pneumonia in adult ICU patients. Methods: Reports of studies on SSD were identified by searching the PUBMED, EMBASE, and COCHRANCE LIBRARY databases ( December 30, 2010) . Randomized trials of SSD compared to usual care in adult mechanically ventilated ICU patients were included in this meta-analysis. Results: Ten RCTs with 2, 314 patients were identified. SSD significantly reduced the incidence of VAP [ relative risk ( RR)=0. 52, 95% confidence interval ( CI): 0. 42-0. 64, P<0. 000 01] . When SSD was compared with the control groups, the overall RR for ICU mortality was 1. 00 ( 95% CI, 0. 84-1. 19) and for hospital mortality was 0. 95 ( 95% CI, 0. 80-1. 13) . Overall, the subglottic drainage effect on the days of mechanical ventilation was -1. 52 days ( 95% CI, -2. 94 to -0. 11) and on the ICU length of stay ( LOS) was -0. 81days ( 95% CI, -2. 33 to -0. 7) . Conclusions: In this meta-analysis, when an endotracheal tube ( ETT) with SSD was compared with an ETT without SSD, there was a highly significant reduction in the VAP rate of approxi-mately 50%. Time on mechanical ventilation ( MV) and the ICU LOS may be reduced, but no re-duction in ICU or hospital mortality has been observed in published trials.

  18. Pneumonia Frequencies with Different Enteral Tube Feeding Access Sites.

    Science.gov (United States)

    Taylor, Henry M.

    2002-01-01

    Over a 24-month period, 25 adults with mental retardation being fed via a gastrostomy tube experienced 40 cases of pneumonia during 508 person-months of observations, whereas 5 individuals being fed via a jejunostromy tube did not experience any pneumonia during 96 person-months of observation. (Contains references.) (Author/CR)

  19. Lipoid pneumonia in a gas station attendant.

    Science.gov (United States)

    Yampara Guarachi, Gladis Isabel; Barbosa Moreira, Valeria; Santos Ferreira, Angela; Sias, Selma M De A; Rodrigues, Cristovão C; Teixeira, Graça Helena M do C

    2014-01-01

    The exogenous lipoid pneumonia, uncommon in adults, is the result of the inhalation and/or aspiration of lipid material into the tracheobronchial tree. This is often confused with bacterial pneumonia and pulmonary tuberculosis due to a nonspecific clinical and radiologic picture. It presents acutely or chronically and may result in pulmonary fibrosis. We describe here a case of lipoid pneumonia in a gas station attendant who siphoned gasoline to fill motorcycles; he was hospitalized due to presenting with a respiratory infection that was hard to resolve. The patient underwent bronchoscopy with bronchoalveolar lavage, which, on cytochemical (oil red O) evaluation, was slightly positive for lipid material in the foamy cytoplasm of alveolar macrophages. Due to his occupational history and radiographic abnormalities suggestive of lipoid pneumonia, a lung biopsy was performed to confirm the diagnosis. The patient was serially treated with segmental lung lavage and showed clinical, functional, and radiological improvement. PMID:25374742

  20. Lipoid Pneumonia in a Gas Station Attendant

    Directory of Open Access Journals (Sweden)

    Gladis Isabel Yampara Guarachi

    2014-01-01

    Full Text Available The exogenous lipoid pneumonia, uncommon in adults, is the result of the inhalation and/or aspiration of lipid material into the tracheobronchial tree. This is often confused with bacterial pneumonia and pulmonary tuberculosis due to a nonspecific clinical and radiologic picture. It presents acutely or chronically and may result in pulmonary fibrosis. We describe here a case of lipoid pneumonia in a gas station attendant who siphoned gasoline to fill motorcycles; he was hospitalized due to presenting with a respiratory infection that was hard to resolve. The patient underwent bronchoscopy with bronchoalveolar lavage, which, on cytochemical (oil red O evaluation, was slightly positive for lipid material in the foamy cytoplasm of alveolar macrophages. Due to his occupational history and radiographic abnormalities suggestive of lipoid pneumonia, a lung biopsy was performed to confirm the diagnosis. The patient was serially treated with segmental lung lavage and showed clinical, functional, and radiological improvement.

  1. Mycoplasma pneumoniae meningoencephalitis: a case report

    Directory of Open Access Journals (Sweden)

    Mehmet Selçuk Bektaş

    2013-01-01

    Full Text Available Nervous system is the most affected area in mycoplasma pneumoniae infections with exception of respiratory system. It is an important agent of childhood acute encephalitis and respiratory system infections in school-age children and young adults. Routine clinical and laboratory findings to identify spesific diagnosis is limited. Twelve-year-old female patient was admitted with fever, fatigue, sore throat, slipping the right eye, withdrawal of the mouth from the right and right hemiclonic seizures. Test of anti-Mycoplasma pneumoniae (M. pneumoniae IgM was positive and IgG antibodies were found to be 4-fold increase in the sera of follow-up. This article was presented with the aim of remembering M. pneumoniae to be an differential diagnosis in children with acute encephalitis.

  2. Correlation between drug resistance of Pseudomonas aeruginosa causing pneumonia and mortality%医院铜绿假单胞菌性肺炎对抗菌药物耐药性及死亡率相关性研究

    Institute of Scientific and Technical Information of China (English)

    冯娜娜; 李华茵; 宋元林; 王琴; 周春妹; 谢红梅

    2012-01-01

    OBJECTIVE To explore the drug resistance of Pseudomonas aeruginosa causing pneumonia and the related risk factors for mortality. METHODS This prospective cohort clinical study was conducted in a tertiary surgical intensive care unit (SICU) in Zhongshan Hospital, Fudan University. From Jan 2007 to Dec 2010. a total of 53 patients who underwent endotracheal intubation and ventilated for more than 48 hours and were with positive culture of P. aeruginosa were enrolled in this study; the drug susceptibility testing was performed by KB method. The vital signs, ventilation parameters, treatment regiments of the patients were recorded, the follow-up of the mortality within 28 days was carried out. RESULTS Of 8 commonly used antibiotics against P. aeruginosa, amikacin was with the lowest resistance rate of 15. 1%, followed by cefoperazone/sulbactam, meropenem, ceftazidime, cefepime, and imipenem) the resistance rate to piperacillin/tazobactam was the highest (47. 2%), the multidrug-resistant rate was 32.1% ; of 53 patients, 17 patients died and 11 patients died within 28 days; the drug resistance rates of P. aeruginosa to piperacillin/tazobactam and imipenem and the multidrug-resistance rate were much higher in death group than in the survival group (76. 5% vs 33. 3%, 58. 8% vs 27. 8%, and 58. 8% vs. 19.4%, respectively) (P<0. 05). There was significant difference between survivors and non-survivors for age (75. 5 vs 56. 0 respectively) (P<0. 05); of the patients in the death group, the survival days of the patients resistant to imipenem were less than those of the patients without imipenem-resistance (P=0. 025) ; multivariate logistic regression analysis showed that there was significant correlation between the age, duration of mechanical ventilation, multidrug-resistance of P. aeruginosa, resistance to piperacillin/tazobactam and the mortality. CONCLUSION For the dead patients,the survival days of imipenem-resistant patients are significantly shortened) the age, duration

  3. Dairy cattle mortality in an organized herd in Bangladesh

    Directory of Open Access Journals (Sweden)

    M. M. Hossain

    2014-05-01

    Full Text Available Aim: The present study was conducted to find out the causes and factors affecting the dairy cattle mortality. Materials and Methods: A retrospective study of dairy cattle mortality on the Central Cattle Breeding and Dairy Farm (CCBDF in Bangladesh was carried out between 1992 and 2007. Sixteen years of data on mortality of dairy cattle were analyzed for the effects of year, season, age, sex, breed, and etiology on mortality rate. Results: The average overall mortality rate was 5.60% and on average, female cattle (55.71% were found to die more than males (44.29%. Mortality was more in crossbred cattle than in indigenous breed. Higher mortality of cattle was observed in rainy season (37.98% followed by winter (33.03% and summer (28.99%. The major causes of death were diseases of the respiratory tract, mainly pneumonia (39.91%. Tuberculosis was the second most common cause of mortality accounting for 20.58% of deaths. The other major cause of death was disease of the alimentary tract, mainly enteritis (15.58%. Other causes of death occurred in the following frequencies: malnutrition (5.91%, debility (4.43%, hairball (3.35%, tympanitis (2.56%, babesiosis (2.27%, internal haemorrhage (2.16%, black quarter (1.76%, and foot and mouth disease (1.48%. Conclusions: Of the four potential risk factors investigated, age was the most important factor and significantly associated with mortality. During the first month of life, calves had a higher risk of mortality than adults.

  4. Subclinical hypothyroidism is associated with increased risk for cancer mortality in adult Taiwanese-a 10 years population-based cohort.

    Directory of Open Access Journals (Sweden)

    Fen-Yu Tseng

    Full Text Available The association between subclinical hypothyroidism (SCH and cancer mortality is seldom discussed.A total of 115,746 participants without thyroid disease history, aged 20 and above, were recruited from four nationwide health screening centers in Taiwan from 1998 to 1999. SCH was defined as a serum thyroid-stimulating hormone (TSH level of 5.0-19.96 mIU/L with normal total thyroxine concentrations. Euthyroidism was defined as a serum TSH level of 0.47-4.9 mIU/L. Cox proportional hazards regression analyses were used to estimate the relative risks (RRs of death from cancer for adults with SCH during a 10-year follow-up period.Among 115,746 adults, 1,841 had SCH (1.6% and 113,905 (98.4% had euthyroidism. There were 1,532 cancer deaths during the 1,034,082 person-years follow-up period. Adjusted for age, gender, body mass index, diabetes, hypertension, dyslipidemia, smoking, alcohol drinking, betel nut chewing, physical activity, income, and education level, the RRs (95% confidence interval of cancer deaths among subjects with SCH versus euthyroid subjects were 1.51 (1.06 to 2.15. Cancer site analysis revealed a significant increased risk of bone, skin and breast cancer among SCH subjects (RR 2.79, (1.01, 7.70. The risks of total cancer deaths were more prominent in the aged (RR 1.71, (1.02 to 2.87, in females (RR 1.69 (1.08 to 2.65, and in heavy smokers (RR 2.24, (1.19 to 4.21.Subjects with SCH had a significantly increased risk for cancer mortality among adult Taiwanese. This is the first report to demonstrate the association between SCH and cancer mortality.

  5. TREND AND VALIDITY OF ANKYLOSING SPONDYLITIS PREVALENCE AND PATIENT MORTALITY RATES IN THE ADULT POPULATION OF THE TULA REGION VERSUS THE RUSSIAN FEDERATION

    Directory of Open Access Journals (Sweden)

    V. N. Sorotskaya

    2015-01-01

    Full Text Available Ankylosing spondylitis (AS is a chronic systemic disease of the axial skeleton. Recently, there has been increased interest among practitioners and researchers in AS. Because of difficulties in conducting epidemiological surveys studying statistical data on its prevalence and patient mortality is of great importance. It permit introduction of necessary corrections into organization of medical care to patients on the basis of analysis of the situation in the region.Objective: to study the trend and validity of data on AS prevalence and patient mortality in the adult population of the Tula Region versus the Russian Federation.Subjects and methods. The investigators used the 2002–2010 statistical guidelines “Prevalence of diseases in adult populationof Russia” by the Ministry of Health of Russia; the 2006–2010 federal statistical inquiry forms No. 14 in the Tula Region and the Russian Federation; the European hospital database; the 2000–2011 mortality databases in the Tula Region, which had been obtained by the automated mortality registration systems, which contained 373,997 records and included all margins of “Medical Death Certificates”.Results and discussion. In the Russian Federation, overall prevalence of AS per 100,000 adult population increased from 27.6 in 2002 to 34.4 in 2010 (the increment was 24.6% while in the Tula Region its trend was unstable in this period. Incidence of AS here decreased by 31.8% from 2002 to 2010; in Russia its increment was 51.6%. From 2000 to 2011 in the Tula Region AS was registered as one of the causes of death in 29 cases.Conclusion. To plan measures aimed at improving the quality of medical care to AS patients, it is necessary to expand a comprehensive study of AS prevalence as well as outpatient and inpatient mortality from AS

  6. The radiological diagnosis of pneumonia in children

    Directory of Open Access Journals (Sweden)

    Kerry-Ann F O'Grady

    2014-06-01

    Full Text Available Despite the importance of paediatric pneumonia as a cause of short and long-term morbidity and mortality worldwide, a reliable gold standard for its diagnosis remains elusive. The utility of clinical, microbiological and radiological diagnostic approaches varies widely within and between populations and is heavily dependent on the expertise and resources available in various settings. Here we review the role of radiology in the diagnosis of paediatric pneumonia. Chest radiographs (CXRs are the most widely employed test, however, they are not indicated in ambulatory settings, cannot distinguish between viral and bacterial infections and have a limited role in the ongoing management of disease. A standardised definition of alveolar pneumonia on a CXR exists for epidemiological studies targeting bacterial pneumonias but it should not be extrapolated to clinical settings. Radiography, computed tomography and to a lesser extent ultrasonography and magnetic resonance imaging play an important role in complicated pneumonias but there are limitations that preclude their use as routine diagnostic tools. Large population-based studies are needed in different populations to address many of the knowledge gaps in the radiological diagnosis of pneumonia in children, however, the feasibility of such studies is an important barrier.

  7. A retrospective analysis of risk factor, pathogen and prognosis of hospital-acquired pneumonia in adult patients in Shanghai%上海地区成人医院获得性肺炎易患因素、病原学及预后分析

    Institute of Scientific and Technical Information of China (English)

    李宁; 沈策; 周龙女; 张伯膺; 程齐俭; 韩立中; 李敏; 黄绍光; 倪语星; 奚峰; 郭雪君; 周新

    2011-01-01

    Objective To investigate the clinical features, risk factors, antibiotic resistance, and clinical outcomes of hospital-acquired pneumonia ( HAP) in adult patients in Shanghai hospitals. Methods From November 2007 to December 2009, the clinical and microbiological data of HAP cases were prospectively reviewed in seven large general hospitals in Shanghai region. Results A total of 204 cases were included in the analysis. The mean age of these patients was (68 ± 17) years (58. 3%>70 years). The underlying conditions included cerebral vascular disease, diabetes mellitus and abdominal surgery. Ventilator-associated pneumonia accounted for 20.6% of the cases. The case mortality was 15. 7%. Increased heart rate, decreased arterial PH, hypoxia, hyperglycemia, increased plasma creatinine and vasopressor use were associated with the poor outcome in these HAP patients. Of all the bacterial strains isolated from HAP, 64.9% were gram-negative bacilli, including A. Baumannii, P. Aeruginosa, K. Pneumoniae, and E. Colt. The prevalence of methicillin-resistant Staphylococcus aureus was 65. 4% in the S. Aureus isolates. No vancomycin-resistant MRSA was identified. Conclusions Advanced age, cerebrovascular diseases and diabetes are risk factors of HAP. Septic shock is the most important complication associated with poor prognosis of HAP. Common pathogens of HAP include A. Baumannii, P. Aeruginosa, K. Pneumoniae, E. Coli, and S. Aureus (MRSA 65.4%).%目的 本研究对上海地区医院获得性肺炎(HAP)的病原菌和临床结局进行前瞻性研究,探讨上海地区HAP的临床特点、易患因素、病原菌的耐药状况及对临床预后的影响因素.方法 采用前瞻性观察性研究方法,收集2007年11月-2009年12月上海市7所大型综合性医院住院并确诊为HAP患者的临床资料及微生物学标本进行细菌培养、鉴定和药敏试验.结果 本组共收集HAP 204例,患者平均年龄(68±17)岁,70岁以上患者占58.3%.患者的基础疾病

  8. Red meat and poultry intakes and risk of total and cause-specific mortality: results from cohort studies of Chinese adults in Shanghai.

    Directory of Open Access Journals (Sweden)

    Yumie Takata

    Full Text Available Most previous studies of meat intake and total or cause-specific mortality were conducted in North America, whereas studies in other areas have been limited and reported inconsistent results. This study investigated the association of red meat or poultry intake with risk of total and cause-specific mortality, including cancer and cardiovascular disease (CVD, in two large population-based prospective cohort studies of 134,290 Chinese adult women and men in Shanghai. Meat intakes were assessed through validated food frequency questionnaires administered in person at baseline. Vital status and dates and causes of deaths were ascertained through annual linkage to the Shanghai Vital Statistics Registry and Shanghai Cancer Registry databases and home visits every 2-3 years. Cox regression was used to calculate hazard ratios (HRs and 95% confidence intervals (CIs for the risk of death associated with quintiles of meat intake. During 803,265 person-years of follow up for women and 334,281 person-years of follow up for men, a total of 4,210 deaths in women and 2,733 deaths in men accrued. The median intakes of red meat were 43 g/day among women and 54 g/day among men, and pork constituted at least 95% of total meat intake for both women and men. Red meat intake was associated with increased total mortality among men, but not among women; the HR (95% CI comparing the highest with the lowest quintiles were 1.18 (1.02-1.35 and 0.92 (0.82-1.03, respectively. This sex difference was statistically significant (P = 0.01. Red meat intake was associated with increased risk of ischemic heart disease mortality (HR = 1.41, 95% CI = 1.05-1.89 and with decreased risk of hemorrhagic stroke mortality (HR = 0.62, 95% CI = 0.45-0.87. There were suggestive inverse associations of poultry intake with risk of total and all-CVD mortality among men, but not among women. Further investigations are needed to elucidate the sex-specific associations between red

  9. Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies.

    NARCIS (Netherlands)

    Whitlock, G.; Lewington, S.; Sherliker, P.; Clarke, R.; Kromhout, D.

    2009-01-01

    Background - The main associations of body-mass index (BMI) with overall and cause-specific mortality can best be assessed by long-term prospective follow-up of large numbers of people. The Prospective Studies Collaboration aimed to investigate these associations by sharing data from many studies. M

  10. Short Term Outcome and Risk Factors for Mortality in Adults with Critical Severe Acute Respiratory Syndrome (SARS)

    Institute of Scientific and Technical Information of China (English)

    胡先明; 邓勇志; 王峻; 李和平; 李梅; 卢祖洵

    2004-01-01

    The independent risk factors to predict mortality of critical severe acute respiratory syndrome (SARS) were investigated. One hundred and two patients diagnosed with critical SARS were admitted to hospitals of Shanxi Province, from March 7, 2003 to June 4, 2003. The patients were prospectively studied after admission to access their short term outcomes and the risk factors associated with adverse outcomes, defined as death. All the demographic and clinical characteristics were studied and univariate and multivariate Logistic regression were employed to access the risk factors.The results showed that of the 102 cases, 23 patients died, with a crude mortality rate of 22.5%.Multivariate Logistic regression revealed that age above 50 [odds ratio (OR) 1.10, 95 % confidence internal (CI) 1.03 to 1. 16, P=0. 004], lymphopenia at early stage (OR 14.62, 95 % CI 1.78 to 11.97, P= 0.01) were independently associated with mortality. On the other side, psychotherapy (OR 0.01, 95 % CI 0.00 to 0.06, P<0.001) was independently associated with aliveness. It was concluded that critical SARS is a new disease entity that carries significant mortality and morbidity. Specific clinical and laboratory parameters predicting unfavorable and favorable outcomes have been identified.

  11. Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies

    DEFF Research Database (Denmark)

    NN, NN; Whitlock, Gary; Lewington, Sarah;

    2009-01-01

    BACKGROUND: The main associations of body-mass index (BMI) with overall and cause-specific mortality can best be assessed by long-term prospective follow-up of large numbers of people. The Prospective Studies Collaboration aimed to investigate these associations by sharing data from many studies....

  12. Effect of a Community-Based Nursing Intervention on Mortality in Chronically Ill Older Adults: A Randomized, Controlled Trial

    OpenAIRE

    Bierman, Arlene S

    2012-01-01

    Arlene Bierman discusses new research findings from a randomized trial evaluating community-based nursing interventions in older adults, and and comments on how we need to to re-engineer health systems to provide greater quality of care.

  13. Conditional transgenic expression of fibroblast growth factor 9 in the adult mouse heart reduces heart failure mortality after myocardial infarction

    OpenAIRE

    Korf-Klingebiel, Mortimer; Kempf, Tibor; Schlüter, Klaus-Dieter; Willenbockel, Christian; Brod, Torben; Heineke, Jörg; Volker J Schmidt; Jantzen, Franziska; Ralf P Brandes; Sugden, Peter H.; Drexler, Helmut; Molkentin, Jeffery D.; Wollert, Kai C.

    2011-01-01

    BACKGROUND: Fibroblast growth factor 9 (FGF9) is secreted from bone marrow cells, which have been shown to improve systolic function after myocardial infarction (MI) in a clinical trial. FGF9 promotes cardiac vascularization during embryonic development but is only weakly expressed in the adult heart. METHODS AND RESULTS: We used a tetracycline-responsive binary transgene system based on the α-myosin heavy chain promoter to test whether conditional expression of FGF9 in the adult myocardiu...

  14. Optimal Dietary and Plasma Magnesium Statuses Depend on Dietary Quality for a Reduction in the Risk of All-Cause Mortality in Older Adults.

    Science.gov (United States)

    Huang, Yi-Chen; Wahlqvist, Mark L; Kao, Mei-Ding; Wang, Jui-Lien; Lee, Meei-Shyuan

    2015-07-13

    The association between dietary or plasma magnesium (Mg) with diabetes incidence and with mortality in free-living elderly was investigated. A total of 1400 participants from the Taiwanese Nutrition Survey, aged ≥ 65 years, and diabetes-free from the 1999-2000 were assessed. The dietary intake and plasma Mg concentration were obtained through 24h dietary recall and health examination at baseline. Participants were classified by quartiles (Q) of dietary Mg or by the plasma Mg normal range (0.75-0.95 mmol/L). Dietary diversity score (DDS, range 1-6) represented the dietary quality. During 8 and 10 years, 231 incident diabetes cases and 475 deaths were identified. Cox's proportional-hazards regression was used to evaluate the association between Mg and health outcomes. The hazard ratios (95% confidence interval) for death in Q2 and Q3 of Mg intakes with DDS > 4 were 0.57 (0.44-0.74) and 0.59 (0.39-0.88), respectively, compared with the lowest intake and DDS ≤ 4 participants. Participants with normal and high plasma Mg in conjunction with high DDS had relative risks of 0.58 (0.37-0.89) and 0.46 (0.25-0.85) in mortality compared with low plasma Mg and lower DDS. Optimal dietary Mg intake and plasma Mg depend on dietary quality to reduce the mortality risk in older adults.

  15. Abnormal vital signs are strong predictors for intensive care unit admission and in-hospital mortality in adults triaged in the emergency department - a prospective cohort study

    Directory of Open Access Journals (Sweden)

    Barfod Charlotte

    2012-04-01

    Full Text Available Abstract Background Assessment and treatment of the acutely ill patient have improved by introducing systematic assessment and accelerated protocols for specific patient groups. Triage systems are widely used, but few studies have investigated the ability of the triage systems in predicting outcome in the unselected acute population. The aim of this study was to quantify the association between the main component of the Hillerød Acute Process Triage (HAPT system and the outcome measures; Admission to Intensive Care Unit (ICU and in-hospital mortality, and to identify the vital signs, scored and categorized at admission, that are most strongly associated with the outcome measures. Methods The HAPT system is a minor modification of the Swedish Adaptive Process Triage (ADAPT and ranks patients into five level colour-coded triage categories. Each patient is assigned a triage category for the two main descriptors; vital signs, Tvitals, and presenting complaint, Tcomplaint. The more urgent of the two determines the final triage category, Tfinal. We retrieved 6279 unique adult patients admitted through the Emergency Department (ED from the Acute Admission Database. We performed regression analysis to evaluate the association between the covariates and the outcome measures. Results The covariates, Tvitals, Tcomplaint and Tfinal were all significantly associated with ICU admission and in-hospital mortality, the odds increasing with the urgency of the triage category. The vital signs best predicting in-hospital mortality were saturation of peripheral oxygen (SpO2, respiratory rate (RR, systolic blood pressure (BP and Glasgow Coma Score (GCS. Not only the type, but also the number of abnormal vital signs, were predictive for adverse outcome. The presenting complaints associated with the highest in-hospital mortality were 'dyspnoea' (11.5% and 'altered level of consciousness' (10.6%. More than half of the patients had a Tcomplaint more urgent than Tvitals

  16. Opium use and mortality in Golestan Cohort Study: prospective cohort study of 50 000 adults in Iran

    OpenAIRE

    Khademi, Hooman; Malekzadeh, Reza; Pourshams, Akram; Jafari, Elham; Salahi, Rasool; Semnani, Shahryar; Abaie, Behrooz; Islami, Farhad; Nasseri-Moghaddam, Siavosh; Etemadi, Arash; Byrnes, Graham; Abnet, Christian C.; Dawsey, Sanford M.; Day, Nicholas E; Pharoah, Paul D

    2012-01-01

    Objectives To investigate the association between opium use and subsequent risk of death. Design Prospective cohort study. Setting The Golestan Cohort Study in north-eastern Iran collected detailed validated data on opium use and other exposures at baseline. Participants were enrolled between January 2004 and June 2008 and were followed to May 2011, with a follow-up success rate of over 99%. Participants 50 045 participants aged 40-75 at baseline. Main outcomes Mortality, all cause and major ...

  17. Association of Age, Systolic Blood Pressure, and Heart Rate with Adult Morbidity and Mortality after Urgent Care Visits

    OpenAIRE

    Hart, MD, James; Woodruff, MD, Michael; Joy, MD, Elizabeth; Dalto, PhD, Joseph; Snow, PhD, Gregory; Srivastava, MD, MPH, Rajendu; Isaacson, PhD, MBA, Brad M.; Allen, MD, Todd

    2016-01-01

    Introduction: Little data exists to help urgent care (UC) clinicians predict morbidity and mortality risk. Age, systolic blood pressure (SBP), and heart rate (HR) are easily obtainable and have been used in other settings to predict short-term risk of deterioration. We hypothesized that there is a relationship between advancing age, SBP, HR, and short-term health outcomes in the UC setting. Methods: We collected retrospective data from...

  18. Impact of varying levels of sanitation on mortality of Tribolium castaneum eggs and adults during heat treatment of a pilot flour mill.

    Science.gov (United States)

    Brijwani, Monika; Subramanyam, Bhadriraju; Flinn, Paul W

    2012-04-01

    The influence of sanitation on responses of life stages of the red flour beetle, Tribolium castaneum (Herbst) (Coleoptera: Tenebrionidae), an economically important pest in flour mills, was investigated in a pilot flour mill subjected to two, 24-h heat treatments. One hundred eggs or 100 adults of T. castaneum were exposed inside each 20-cm diameter by 15-cm high PVC rings holding 0.1-, 0.2-, 1.0-, 3.0-, 6.0-, and 10.0-cm-deep wheat flour to simulate different sanitation levels that may exist in a flour mill. These rings were placed on the first and third floors of a pilot flour mill. On the first floor, temperatures inside rings with eggs reached 50 degrees C in 7-11 h only in 0.1- and 0.2-cm-deep flour treatments. In all other treatments the maximum temperatures attained generally were below 50 degrees C and inversely related to flour depth. Adults of T. castaneum on this floor were less susceptible than eggs. The egg mortality decreased linearly with an increase in flour depth, whereas that of adults decreased exponentially. All eggs and adults in rings on the third floor were killed irrespective of flour depth, because temperatures inside rings reached 50 degrees C in 15-17 h and were held above 50 degrees C for 6-8 h with the maximum temperatures ranging between 55.0 and 57.0 degrees C. Although the protective effects of flour on survival of T. castaneum eggs and adults were evident only if temperatures did not reach 50 degrees C, removal of flour accumulations is essential to improve heat treatment effectiveness.

  19. Performance of Multiple Risk Assessment Tools to Predict Mortality for Adult Respiratory Distress Syndrome with Extracorporeal Membrane Oxygenation Therapy: An External Validation Study Based on Chinese Single-center Data

    Institute of Scientific and Technical Information of China (English)

    Lei Huang; Tong Li; Lei Xu; Xiao-Min Hu; Da-Wei Duan; Zhi-Bo Li; Xin-Jing Gao

    2016-01-01

    Background:There has been no external validation of survival prediction models for severe adult respiratory distress syndrome (ARDS) with extracorporeal membrane oxygenation (ECMO) therapy in China.The aim of study was to compare the performance of multiple models recently developed for patients with ARDS undergoing ECMO based on Chinese single-center data.Methods:A retrospective case study was performed,including twenty-three severe ARDS patients who received ECMO from January 2009 to July 2015.The PRESERVE (Predicting death for severe ARDS on VV-ECMO),ECMOnet,Respiratory Extracorporeal Membrane Oxygenation Survival Prediction (RESP) score,a center-specific model developed for inter-hospital transfers receiving ECMO,and the classical risk-prediction scores of Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ and Sequential Organ Failure Assessment (SOFA) were calculated.In-hospital and six-month mortality were regarded as the endpoints and model performance was evaluated by comparing the area under the receiver operating characteristic curve (AUC).Results:The RESP and APACHE Ⅱ scores showed excellent discriminate performance in predicting survival with AUC of 0.835 (95% confidence interval [CI],0.659-1.010,P =0.007) and 0.762 (95% CI,0.558-0.965,P =0.035),respectively.The optimal cutoff values were risk class 3.5 for RESP and 35.5 for APACHE Ⅱ score,and both showed 70.0% sensitivity and 84.6% specificity.The excellent performance of these models was also evident for the pneumonia etiological subgroup,for which the SOFA score was also shown to be predictive,with an AUC of 0.790 (95% CI,0.571-1.009,P =0.038).However,the ECMOnet and the score developed for externally retrieved ECMO patients failed to demonstrate significant discriminate power for the overall cohort.The PRESERVE model was unable to be evaluated fully since only one patient died six months postdischarge.Conclusions:The RESP,APCHAE Ⅱ,and SOFA scorings systems show good

  20. The History of Mycoplasma pneumoniae Pneumonia.

    Science.gov (United States)

    Saraya, Takeshi

    2016-01-01

    In the United States in the 1930s, although the pathogen was not known, atypical pneumonia was clinically distinguished from pneumococcal pneumonia by its resistance to sulfonamides. Reimann (1938) reported seven patients with an unusual form of tracheo bronchopneumonia and severe constitutional symptoms. He believed the clinical picture of this disease differed from that of the disease caused by influenza viruses or known bacteria and instead suspected "primary atypical pneumonia." For many years, the responsible infectious agent was tentatively classified as a filterable virus that could pass through a Seitz filter to remove bacteria and was reported to be a psittacosis-like or new virus. After that, Eaton et al. (1942, 1944, 1945) identified an agent that was the principal cause of primary atypical pneumonia using cotton rats, hamsters, and chick embryos. Eaton et al. (1942, 1944, 1945) did not perform an inoculation study in human volunteers. During the 1940s, there were three groups engaged in discovering the etiology of the primary atypical pneumonia. (1) Commission on Acute Respiratory Diseases Diseases directed by John Dingle, (2) Dr. Monroe Eaton's group, the Virus Research Laboratory of the California State Public Health Department, (3) The Hospital of the Rockefeller Institute for Medical Research directed by Horsfall. During 1940s, the members of the Commission on Acute Respiratory Diseases concluded that the bacteria-free filtrates obtained from the patients, presumably containing a virus, could induce primary atypical pneumonia in human volunteers via Pinehurst trials. During 1950s, serological approaches for identification of the Eaton agent developed such as Fluorescent-Stainable Antibody, and at the beginning of the1960s, the Eaton agent successfully grew in media, and finally accepted as a cause of primary atypical pneumonia. Thus, technical difficulties with visualizing the agent and failure to recognize the full significance of the Pinehurst

  1. Hypertension and mortality in the Golestan Cohort Study: A prospective study of 50 000 adults in Iran.

    Science.gov (United States)

    Sepanlou, S G; Sharafkhah, M; Poustchi, H; Malekzadeh, M M; Etemadi, A; Khademi, H; Islami, F; Pourshams, A; Pharoah, P D; Abnet, C C; Brennan, P; Boffetta, P; Dawsey, S M; Esteghamati, A; Kamangar, F; Malekzadeh, R

    2016-04-01

    High blood pressure has been the second most important determinant of disease burden in Iran since the 1990s. Despite well-recognized evidence on the association of high blood pressure and mortality in other countries, this relationship has not been fully investigated in the demographic setting of Iran. The current study is the first large-scale longitudinal study of this association in Iran. Briefly, 50 045 subjects between 40 and 75 years of age have been recruited and followed. Blood pressure measurements were carried out at baseline. Causes of death were reported and verified by verbal autopsy throughout the follow-up period. The outcomes of interest were all-cause deaths and deaths due to ischemic heart disease (IHD) or stroke. Cox proportional hazards regression models were used to estimate hazard ratios (HRs). A total of 46 674 subjects free from cardiovascular disease at baseline were analyzed. Absolute mortality rates increased along with increasing systolic or diastolic blood pressure above 120 and 80 mm Hg, respectively. Adjusted HRs (95% confidence intervals) for each 20 mm Hg increase in systolic blood pressure in all age groups were 1.18 (1.13-1.23) for all-cause mortality, 1.21 (1.13-1.31) for deaths due to IHD and 1.50 (1.39-1.63) for deaths due to stroke. Unadjusted and adjusted HRs were higher in younger subjects and decreased with increasing age of the participants. High blood pressure is a serious threat to the health of Iranians. The entire health-care system of Iran should be involved in a comprehensive action plan for controlling blood pressure. PMID:26063561

  2. Reduced renal function is associated with progression to AIDS but not with overall mortality in HIV-infected kenyan adults not initially requiring combination antiretroviral therapy

    Directory of Open Access Journals (Sweden)

    Gupta Samir K

    2011-06-01

    Full Text Available Abstract Background The World Health Organization (WHO has recently recommended that antiretrovirals be initiated in all individuals with CD4 counts of less than 350 cells/mm3. For countries with resources too limited to expand care to all such patients, it would be of value to able to identify and target populations at highest risk of HIV progression. Renal disease has been identified as a risk factor for disease progression or death in some populations. Methods Times to meeting combination antiretroviral therapy (cART initiation criteria (developing either a CD4 count 3 or WHO stage 3 or 4 disease and overall mortality were evaluated in cART-naïve, HIV-infected Kenyan adults with CD4 cell counts ≥200/mm3 and with WHO stage 1 or 2 disease. Cox proportional hazard regression models were used to evaluate the associations between renal function and these endpoints. Results We analyzed data of 7383 subjects with a median follow-up time of 59 (interquartile range, 27-97 weeks. In Cox regression analyses adjusted for age, sex, WHO disease stage, CD4 cell count and haemoglobin, estimated creatinine clearance (CrCl 2 was associated with shorter times to meeting cART initiation criteria (HR 1.39; 95% CI, 1.22-1.58, but not with overall mortality. CrCl and eGFR remained associated with shorter times to cART initiation criteria, but neither was associated with mortality, in weight-adjusted analyses. Conclusions In this large natural history study, reduced renal function was strongly associated with faster HIV disease progression in adult Kenyans not initially meeting cART initiation criteria. As such, renal function measurement in resource-limited settings may be an inexpensive method to identify those most in need of cART to prevent progression to AIDS. The initial association between reduced CrCl, but not reduced eGFR, and greater mortality was explained by the low weights in this population.

  3. How Can Pneumonia Be Prevented?

    Science.gov (United States)

    ... page from the NHLBI on Twitter. How Can Pneumonia Be Prevented? Pneumonia can be very serious and ... t last as long Fewer serious complications Pneumococcal Pneumonia Vaccine A vaccine is available to prevent pneumococcal ...

  4. Projection of the year 2050 burden of diabetes in the US adult population: dynamic modeling of incidence, mortality, and prediabetes prevalence

    Directory of Open Access Journals (Sweden)

    Barker Lawrence E

    2010-10-01

    Full Text Available Abstract Background People with diabetes can suffer from diverse complications that seriously erode quality of life. Diabetes, costing the United States more than $174 billion per year in 2007, is expected to take an increasingly large financial toll in subsequent years. Accurate projections of diabetes burden are essential to policymakers planning for future health care needs and costs. Methods Using data on prediabetes and diabetes prevalence in the United States, forecasted incidence, and current US Census projections of mortality and migration, the authors constructed a series of dynamic models employing systems of difference equations to project the future burden of diabetes among US adults. A three-state model partitions the US population into no diabetes, undiagnosed diabetes, and diagnosed diabetes. A four-state model divides the state of "no diabetes" into high-risk (prediabetes and low-risk (normal glucose states. A five-state model incorporates an intervention designed to prevent or delay diabetes in adults at high risk. Results The authors project that annual diagnosed diabetes incidence (new cases will increase from about 8 cases per 1,000 in 2008 to about 15 in 2050. Assuming low incidence and relatively high diabetes mortality, total diabetes prevalence (diagnosed and undiagnosed cases is projected to increase from 14% in 2010 to 21% of the US adult population by 2050. However, if recent increases in diabetes incidence continue and diabetes mortality is relatively low, prevalence will increase to 33% by 2050. A middle-ground scenario projects a prevalence of 25% to 28% by 2050. Intervention can reduce, but not eliminate, increases in diabetes prevalence. Conclusions These projected increases are largely attributable to the aging of the US population, increasing numbers of members of higher-risk minority groups in the population, and people with diabetes living longer. Effective strategies will need to be undertaken to moderate the

  5. Diagnóstico clínico-radiológico de la neumonía del adulto adquirida en la comunidad CLINICAL AND RADIOLOGICAL DIAGNOSIS OF COMMUNITY-ACQUIRED PNEUMONIA IN ADULTS

    Directory of Open Access Journals (Sweden)

    Rodrigo Gil D.

    2005-04-01

    Full Text Available La neumonía del adulto adquirida en la comunidad es un cuadro de evolución aguda, caracterizado por compromiso del estado general, fiebre, calofríos, tos, expectoración mucopurulenta y dificultad respiratoria; asociado en el examen físico a taquicardia, taquipnea, fiebre y signos focales en el examen pulmonar. La probabilidad que un paciente con síntomas respiratorios agudos tenga una neumonía depende de la prevalencia de la enfermedad en el ambiente donde se presenta y de las manifestaciones clínicas del enfermo. Se estima que la prevalencia de neumonía en los servicios de atención ambulatoria corresponde a 3-5% de las consultas por patología respiratoria. El diagnóstico clínico de neumonía sin confirmación radiográfica carece de precisión ya que el cuadro clínico (historia y examen físico no permite diferenciar con certeza al paciente con neumonía de otras condiciones respiratorias agudas (infecciones de la vía aérea superior, bronquitis, influenza. El diagnóstico de neumonía es clínico-radiográfico: la historia y examen físico sugieren la presencia de una infección pulmonar, pero el diagnóstico de certeza se establece cuando se confirma la presencia de infiltrados pulmonares en la radiografía de tórax. El cuadro clínico y los hallazgos de la radiografía de tórax no permiten predecir con certeza el agente etiológico de la infección pulmonar. La radiografía de tórax permite confirmar el diagnóstico clínico, establecer su localización, extensión y gravedad; además permite diferenciar la neumonía de otras patologías, detectar posibles complicaciones, y puede ser útil en el seguimiento de los pacientes de alto riesgo. La resolución de los infiltrados radiográficos a menudo ocurre varias semanas o meses después de la mejoría clínica, especialmente en el anciano y en la neumonía multilobar manejada en la UCICommunity acquired pneumonia in adults is an acute disease characterized by worsening in

  6. [Epidemiology of community-acquired pneumonia in children. Current data].

    Science.gov (United States)

    Marguet, C; Bocquel, N; Mallet, E

    1998-01-01

    Viruses, particularly syncitial respiratory virus, are the main aetiology of community-acquired lower respiratory tract infections in infants, while bacterial agents are more frequently responsible in children older than 3 years. Antimicrobial therapy must take into account the development of reduced susceptibility of penicillin to strains of Streptoccocus pneumoniae and Haemophilus influenzae with beta-lactamase, and high frequency of Mycoplasma pneumoniae and Chlamydia pneumoniae infections. Although the mortality rate has remained low in France, the morbidity appeared to increase in recent years. PMID:10223154

  7. Traditional and Emerging Lifestyle Risk Behaviors and All-Cause Mortality in Middle-Aged and Older Adults: Evidence from a Large Population-Based Australian Cohort.

    Directory of Open Access Journals (Sweden)

    Ding Ding

    2015-12-01

    Full Text Available Lifestyle risk behaviors are responsible for a large proportion of disease burden worldwide. Behavioral risk factors, such as smoking, poor diet, and physical inactivity, tend to cluster within populations and may have synergistic effects on health. As evidence continues to accumulate on emerging lifestyle risk factors, such as prolonged sitting and unhealthy sleep patterns, incorporating these new risk factors will provide clinically relevant information on combinations of lifestyle risk factors.Using data from a large Australian cohort of middle-aged and older adults, this is the first study to our knowledge to examine a lifestyle risk index incorporating sedentary behavior and sleep in relation to all-cause mortality. Baseline data (February 2006- April 2009 were linked to mortality registration data until June 15, 2014. Smoking, high alcohol intake, poor diet, physical inactivity, prolonged sitting, and unhealthy (short/long sleep duration were measured by questionnaires and summed into an index score. Cox proportional hazards analysis was used with the index score and each unique risk combination as exposure variables, adjusted for socio-demographic characteristics. During 6 y of follow-up of 231,048 participants for 1,409,591 person-years, 15,635 deaths were registered. Of all participants, 31.2%, 36.9%, 21.4%, and 10.6% reported 0, 1, 2, and 3+ risk factors, respectively. There was a strong relationship between the lifestyle risk index score and all-cause mortality. The index score had good predictive validity (c index = 0.763, and the partial population attributable risk was 31.3%. Out of all 96 possible risk combinations, the 30 most commonly occurring combinations accounted for more than 90% of the participants. Among those, combinations involving physical inactivity, prolonged sitting, and/or long sleep duration and combinations involving smoking and high alcohol intake had the strongest associations with all-cause mortality

  8. Symptoms, Diagnosis and Treatment of Pneumonia

    Science.gov (United States)

    ... Lung Health and Diseases > Lung Disease Lookup > Pneumonia Pneumonia Symptoms, Causes, and Risk Factors Anyone can get ... risk for pneumonia. What Are the Symptoms of Pneumonia? Pneumonia symptoms can vary from mild to severe, ...

  9. Plum curculio (Coleoptera: Curculionidae) adult mortality and associated fruit injury after exposure to field-aged insecticides on tart cherry branches.

    Science.gov (United States)

    Hoffmann, Eric J; Vandervoort, Christine; Wise, John C

    2010-08-01

    Plum curculio, Conotrachelus nenuphar (Herbst) (Coleoptera: Curculionidae), adults were exposed to field-aged residues of thiamethoxam, acetamiprid, thiacloprid, indoxacarb, or azinphos-methyl on tart cherry, Prunus cerasus L. variety Montmorency. At 1, 3, 7, and 14 d postapplication, fruit were sampled for chemical residues, and bioassays were used to assess beetle mortality and plant tissue injury. Azinphos-methyl had lethal activity within 1 d of exposure at all postapplication intervals and significant fruit protection extended to 14 d postapplication. All of the neonicotinoids had lethal activity at 3 d posttreatment, with acetamiprid activity extending to 7 d. Antifeedant and oviposition deterrent effects were seen with thiamethoxam and thiacloprid; damage incidence was significantly reduced in the absence of significant beetle mortality or intoxication. Thiamethoxam and acetamiprid penetrated into leaf and fruit tissue and were detected in the interior tissues at 14 d postapplication, but interior thiacloprid residues were not detected after day 1. Indoxacarb provided some fruit protection out to 7 d postapplication, and 14-d-old residues intoxicated beetles, but the slow action of this compound allowed significant damage to occur before beetles were incapacitated. Indoxacarb was only detected as a surface residue after the first day postapplication. These data on the plant-insect-chemistry interactions will support use and management decisions as compounds with acute contact activity are phased out. PMID:20857728

  10. Invasive fungal infections in neutropenic enterocolitis: A systematic analysis of pathogens, incidence, treatment and mortality in adult patients

    Directory of Open Access Journals (Sweden)

    Pauls Katharina

    2006-02-01

    Full Text Available Abstract Background Neutropenic enterocolitis is a life-threatening complication most frequently occurring after intensive chemotherapy in acute leukaemias. Gramnegative bacteria constitute the most important group of causative pathogens. Fungi have also been reported, but their practical relevance remains unclear. The guidelines do not address concrete treatment recommendations for fungal neutropenic enterocolitis. Methods Here, we conducted a metaanalysis to answer the questions: What are frequency and mortality of fungal neutropenic enterocolitis? Do frequencies and microbiological distribution of causative fungi support empirical antimycotic therapy? Do reported results of antimycotic therapy in documented fungal neutropenic enterocolitis help with the selection of appropriate drugs? Following a systematic search, we extracted and summarised all detail data from the complete literature. Results Among 186 articles describing patients with neutropenic enterocolitis, we found 29 reports describing 53 patients with causative fungal pathogens. We found no randomised controlled trial, no good quality cohort study and no good quality case control study on the role of antifungal treatment. The pooled frequency of fungal neutropenic enterocolitis was 6.2% calculated from all 860 reported patients and 3.4% calculated from selected representative studies only. In 94% of the patients, Candida spp. were involved. The pooled mortality rate was 81.8%. Most authors did not report or perform antifungal therapy. Conclusion In patients with neutropenic enterocolitis, fungal pathogens play a relevant, but secondary role compared to bacteria. Evidence concerning therapy is very poor, but epidemiological data from this study may provide helpful clues to select empiric antifungal therapy in neutropenic enterocolitis.

  11. Identification of Streptococcus pneumoniae

    OpenAIRE

    Kaijalainen, Tarja

    2006-01-01

    Objectives: Streptococcus pneumoniae, pneumococcus, is an importanthuman pathogen that causes both serious invasive infections, suchas septicaemia, meningitis and pneumonia, as well as mild upper respiratoryinfections. It also belongs to the normal nasopharyngeal microbialflora. The purpose of this study was to compare bacteriologicalphenotypic methods with genetechnological methods in the identificationof pneumococci, especially among suspect pneumococcal isolateslacking one or more typical ...

  12. Bronchitis and Pneumonia

    Science.gov (United States)

    ... What is the difference between bronchitis and pneumonia? Bronchitis is most often a bacte- rial or viral infection that causes swelling of the tubes (bronchioles) leading to the lungs. Pneumonia is an acute or chronic disease marked by inflammation of the ...

  13. Mycoplasma pneumoniae meningoencephalitis:a case report

    Institute of Scientific and Technical Information of China (English)

    Mehmet Selçuk Bektaş; Fesih Aktar; Mehmet Açıkgöz; Ertan Sal; HüseyinÇaksen

    2013-01-01

    Nervous system is the most affected area inmycoplasma pneumoniaeinfections with exception of respiratory system.It is an important agent of childhood acute encephalitis and respiratory system infections in school-age children and young adults.Routine clinical and laboratory findings to identify spesific diagnosis is limited.Twelve-year-old female patient was admitted with fever, fatigue, sore throat, slipping the right eye, withdrawal of the mouth from the right and right hemiclonic seizures.Test of anti-Mycoplasma pneumoniae(M. pneumoniae)IgM was positive andIgG antibodies were found to be4-fold increase in the sera of follow-up.This article was presented with the aim of rememberingM. pneumoniae to be an differential diagnosis in children with acute encephalitis.

  14. Non-Intensive Care Unit Acquired Pneumonia: A New Clinical Entity?

    OpenAIRE

    Marta Di Pasquale; Stefano Aliberti; Marco Mantero; Sonia Bianchini; Francesco Blasi

    2016-01-01

    Hospital-acquired pneumonia (HAP) is a frequent cause of nosocomial infections, responsible for great morbidity and mortality worldwide. The majority of studies on HAP have been conducted in patients hospitalized in the intensive care unit (ICU), as mechanical ventilation represents a major risk factor for nosocomial pneumonia and specifically for ventilator-associated pneumonia. However, epidemiological data seem to be different between patients acquiring HAP in the ICU vs. general wards, su...

  15. Influenza Virus Infection Decreases Tracheal Mucociliary Velocity and Clearance of Streptococcus pneumoniae

    OpenAIRE

    Pittet, Lynnelle A.; Hall-Stoodley, Luanne; Rutkowski, Melanie R.; Harmsen, Allen G.

    2009-01-01

    Influenza virus infections increase susceptibility to secondary bacterial infections, such as pneumococcal pneumonia, resulting in increased morbidity and mortality. Influenza-induced tissue damage is hypothesized to increase susceptibility to Streptococcus pneumoniae infection by increasing adherence to the respiratory epithelium. Using a mouse model of influenza infection followed by S. pneumoniae infection, we found that an influenza infection does not increase the number of pneumococci in...

  16. R-roscovitine Reduces Lung Inflammation Induced by Lipoteichoic Acid and Streptococcus pneumoniae

    OpenAIRE

    Hoogendijk, Arie J.; Roelofs, Joris J. T. H.; Duitman, JanWillem; van Lieshout, Miriam H. P.; Blok, Dana C; van der Poll, Tom; Wieland, Catharina W.

    2012-01-01

    Bacterial pneumonia remains associated with high morbidity and mortality. The gram-positive pathogen Streptococcus pneumoniae is the most common cause of community-acquired pneumonia. Lipoteichoic acid (LTA) is an important proinflammatory component of the gram-positive bacterial cell wall. R-roscovitine, a purine analog, is a potent cyclin-dependent kinase (CDK)-1, −2, −5 and −7 inhibitor that has the ability to inhibit the cell cycle and to induce polymorphonuclear cell (PMN) apoptosis. We ...

  17. Osteopontin promotes host defense during Klebsiella pneumoniae-induced pneumonia

    NARCIS (Netherlands)

    G.J.W. van der Windt; J.J. Hoogerwerf; A.F. de Vos; S. Florquin; T. van der Poll

    2010-01-01

    Klebsiella pneumoniae is a common cause of nosocomial pneumonia. Osteopontin (OPN) is a phosphorylated glycoprotein involved in inflammatory processes, some of which is mediated by CD44. The aim of this study was to determine the role of OPN during K. pneumoniae-induced pneumonia. Wild-type (WT) and

  18. mPneumonia: Development of an Innovative mHealth Application for Diagnosing and Treating Childhood Pneumonia and Other Childhood Illnesses in Low-Resource Settings.

    Directory of Open Access Journals (Sweden)

    Amy Sarah Ginsburg

    Full Text Available Pneumonia is the leading infectious cause of death in children worldwide. Each year, pneumonia kills an estimated 935,000 children under five years of age, with most of these deaths occurring in developing countries. The current approach for pneumonia diagnosis in low-resource settings--using the World Health Organization Integrated Management of Childhood Illness (IMCI paper-based protocols and relying on a health care provider's ability to manually count respiratory rate--has proven inadequate. Furthermore, hypoxemia--a diagnostic indicator of the presence and severity of pneumonia often associated with an increased risk of death--is not assessed because pulse oximetry is frequently not available in low-resource settings. In an effort to address childhood pneumonia mortality and improve frontline health care providers' ability to diagnose, classify, and manage pneumonia and other childhood illnesses, PATH collaborated with the University of Washington to develop "mPneumonia," an innovative mobile health application using an Android tablet. mPneumonia integrates a digital version of the IMCI algorithm with a software-based breath counter and a pediatric pulse oximeter. We conducted a design-stage usability field test of mPneumonia in Ghana, with the goal of creating a user-friendly diagnostic and management tool for childhood pneumonia and other childhood illnesses that would improve diagnostic accuracy and facilitate adherence by health care providers to established guidelines in low-resource settings. The results of the field test provided valuable information for understanding the usability and acceptability of mPneumonia among health care providers, and identifying approaches to iterate and improve. This critical feedback helped ascertain the common failure modes related to the user interface design, navigation, and accessibility of mPneumonia and the modifications required to improve user experience and create a tool aimed at decreasing

  19. Distribution and antimicrobial susceptibility of bacteria from adults with community-acquired pneumonia or complicated skin and soft tissue infections in France: the nationwide French PREMIUM study.

    Science.gov (United States)

    Leprince, C; Desroches, M; Emirian, A; Coutureau, C; Anais, L; Fihman, V; Soussy, C J; Decousser, J W

    2015-10-01

    The empirical therapy of community-acquired pneumonia (CAP) and complicated skin and soft tissue infections (cSSTIs) must be based on updated bacterial distribution and susceptibility data. A nationwide study consecutively collected 1288 isolates from CAP (n=467) and cSSTIs (n=821) from 18 French hospitals between 2012 and 2013. The MIC values of commonly used antimicrobial agents, including ceftaroline, were determined. Bacterial distribution featured Pneumococcus, Haemophilus influenzae, and Staphylococcus aureus for CAPs and S. aureus, β-hemolytic streptococci and Enterobacteriaceae for cSSTIs. Antimicrobial susceptibility testing indicated i) the sustained third-generation cephalosporins and levofloxacin activity against pneumococci and H. influenzae, ii) no methicillin-resistant Staphylococcus aureus emergence among respiratory pathogens, iii) the high in vitro activity of ceftaroline against staphylococci from cSSTIs (98.7% susceptibility), and iv) the worrisome decreasing fluoroquinolone and third-generation cephalosporin susceptibilities among Enterobacteriaceae. This laboratory-based survey depicts a contrasting situation and supports the scoring of patients for the resistant pathogen risk before empirical therapy. PMID:26166208

  20. Improving antibiotic prescribing for adults with community acquired pneumonia: Does a computerised decision support system achieve more than academic detailing alone? – a time series analysis

    Directory of Open Access Journals (Sweden)

    Black James F

    2008-07-01

    Full Text Available Abstract Background The ideal method to encourage uptake of clinical guidelines in hospitals is not known. Several strategies have been suggested. This study evaluates the impact of academic detailing and a computerised decision support system (CDSS on clinicians' prescribing behaviour for patients with community acquired pneumonia (CAP. Methods The management of all patients presenting to the emergency department over three successive time periods was evaluated; the baseline, academic detailing and CDSS periods. The rate of empiric antibiotic prescribing that was concordant with recommendations was studied over time comparing pre and post periods and using an interrupted time series analysis. Results The odds ratio for concordant therapy in the academic detailing period, after adjustment for age, illness severity and suspicion of aspiration, compared with the baseline period was OR = 2.79 [1.88, 4.14], p Conclusion Deployment of a computerised decision support system was associated with an early improvement in antibiotic prescribing practices which was greater than the changes seen with academic detailing. The sustainability of this intervention requires further evaluation.

  1. Infant Mortality Risk and Paternity Certainty Are Associated with Postnatal Maternal Behavior toward Adult Male Mountain Gorillas (Gorilla beringei beringei)

    Science.gov (United States)

    Rosenbaum, Stacy; Hirwa, Jean Paul; Silk, Joan B.; Vigilant, Linda; Stoinski, Tara S.

    2016-01-01

    Sexually selected infanticide is an important source of infant mortality in many mammalian species. In species with long-term male-female associations, females may benefit from male protection against infanticidal outsiders. We tested whether mountain gorilla (Gorilla beringei beringei) mothers in single and multi-male groups monitored by the Dian Fossey Gorilla Fund’s Karisoke Research Center actively facilitated interactions between their infants and a potentially protective male. We also evaluated the criteria mothers in multi-male groups used to choose a preferred male social partner. In single male groups, where infanticide risk and paternity certainty are high, females with infants infanticide rates and paternity certainty are lower, mothers with new infants exhibited few behavioral changes toward males. The sole notable change was that females with young infants proportionally increased their time near males they previously spent little time near when compared to males they had previously preferred, perhaps to encourage paternity uncertainty and deter aggression. Rank was a much better predictor of females’ social partner choice than paternity. Older infants (2–3 years) in multi-male groups mirrored their mothers’ preferences for individual male social partners; 89% spent the most time in close proximity to the male their mother had spent the most time near when they were infanticide risk are both high, male-female interests align and females behave accordingly. This highlights the importance of considering individual and group-level variation when evaluating intersexual conflict across the reproductive cycle. PMID:26863300

  2. Infant Mortality Risk and Paternity Certainty Are Associated with Postnatal Maternal Behavior toward Adult Male Mountain Gorillas (Gorilla beringei beringei).

    Science.gov (United States)

    Rosenbaum, Stacy; Hirwa, Jean Paul; Silk, Joan B; Vigilant, Linda; Stoinski, Tara S

    2016-01-01

    Sexually selected infanticide is an important source of infant mortality in many mammalian species. In species with long-term male-female associations, females may benefit from male protection against infanticidal outsiders. We tested whether mountain gorilla (Gorilla beringei beringei) mothers in single and multi-male groups monitored by the Dian Fossey Gorilla Fund's Karisoke Research Center actively facilitated interactions between their infants and a potentially protective male. We also evaluated the criteria mothers in multi-male groups used to choose a preferred male social partner. In single male groups, where infanticide risk and paternity certainty are high, females with infants infanticide rates and paternity certainty are lower, mothers with new infants exhibited few behavioral changes toward males. The sole notable change was that females with young infants proportionally increased their time near males they previously spent little time near when compared to males they had previously preferred, perhaps to encourage paternity uncertainty and deter aggression. Rank was a much better predictor of females' social partner choice than paternity. Older infants (2-3 years) in multi-male groups mirrored their mothers' preferences for individual male social partners; 89% spent the most time in close proximity to the male their mother had spent the most time near when they were infanticide risk are both high, male-female interests align and females behave accordingly. This highlights the importance of considering individual and group-level variation when evaluating intersexual conflict across the reproductive cycle. PMID:26863300

  3. A family outbreak of Chlamydia pneumoniae infection.

    Science.gov (United States)

    Ghosh, K; Frew, C E; Carrington, D

    1992-07-01

    Chlamydia pneumoniae, a newly described Chlamydia species, has been shown to be a cause of acute respiratory tract infection in both adults and children, but its role in human infection is still under investigation. Here we present a family outbreak of C. pneumoniae infection where three members of a family presented with a 'flu-like illness' and acute upper respiratory tract infection which did not improve despite penicillin or septrin therapy. No history of exposure to birds, pets or animals was obtained. As C. pneumoniae isolation from respiratory secretions is not without difficulty, diagnosis usually relies currently on serum-based tests. In this study C. pneumoniae specific IgM determined by the micro-immunofluorescence test was detected in the three clinical cases. All three cases had an elevated complement-fixing antibody titre to Psittacosis-LGV antigen, which may have suggested psittacosis, if type-specific tests had not been performed. In addition, three other members of the family had C. pneumoniae-specific IgG antibody although specific IgM was absent. These three younger members of the family had been symptomatic in the month preceding symptoms in their older sibling and their parents. All the symptomatic members of the family made a complete recovery on tetracycline therapy. PMID:1522345

  4. Etiology of community-acquired pneumonia in hospitalized patients in Jordan

    International Nuclear Information System (INIS)

    To ascertain the causative organisms of community acquired pneumonia (Cap) in Jordanian patients requiring hospital admission. A prospective study of both adults and children admitted to Princess Basma and Princess Rahma Teaching Hospitals in Irbid, Jordan with a diagnosis of CAP over a 6-month period from April to October 2002. A total of 35 adult patients were admitted with a mean age of 47 years, and 63 children with a mean age of 3 years. A pathogen was isolated from 25 (71%) adults, and from 17 (27%) children, and sputum cultures gave the best diagnostic yield. In adults Streptococcus pneumoniae was the most common isolate (26%), followed by Chlamydia pneumoniae (23%), Haemophilus influenzae (17%), Mycoplasma pneumoniae (9%), and Legionella pneumophila and Klebsiella pneumoniae (6%) each. Seven of the 9 gram negative isolates were from patients with some co morbid illness. While in children, Chlamydia pneumoniae was the most common (14%), followed by Mycoplasma pneumoniae (6%), and Streptococcus pneumoniae, Haemophilus influenzae, and Pseudomonas aeruginosa (3%) each. Streptococcus pneumoniae and atypical microorganisms are the most common cause of CAP in previously healthy adults; while in those with associated co morbid illness, gram negative organisms are the likely cause. In children, the overall detection rate of causative organisms was low with atypical microorganisms being the most common. (author)

  5. Acute interstitial pneumonia in mink kits inoculated with defined isolates of Aleutian mink disease parvovirus

    DEFF Research Database (Denmark)

    Alexandersen, Søren; Larsen, S; Aasted, B;

    1994-01-01

    The present study addressed the causal role of Aleutian mink disease parvovirus (ADV) in acute interstitial pneumonia in mink kits. All the examined isolates of ADV caused interstitial pneumonia in newborn kits, although the severity of disease and the mortality varied. These findings indicate...

  6. Low zinc status: a new risk factor for pneumonia in the elderly?

    Science.gov (United States)

    Zinc may be a new risk factor for pneumonia in the elderly. In this special article, we reviewed the magnitude of the problem of pneumonia (its prevalence, morbidity and mortality) in the elderly, its etiology, and the dysregulation of the immune system associated with increasing age. In addition, w...

  7. Mortality in mechanically ventilated patients of Guillain Barré Syndrome

    Directory of Open Access Journals (Sweden)

    Archana B Netto

    2011-01-01

    Full Text Available Background: The mortality of patients with Guillain Barré syndrome (GBS has varied widely with rates between 1-18%. Death results from pneumonia, sepsis, adult respiratory distress syndrome (ARDS and less frequently due to autonomic dysfunction or pulmonary embolism. There are only few studies which have used a large sample and have in detail analyzed the circumstances relating to death and the prognostic factors for the same in a cohort, including only mechanically ventilated patients. Objective: The objective of our study was to analyze the circumstances and factors related to mortality in mechanically ventilated patients of GBS. Materials and Methods: Case records of patients of GBS, satisfying National Institute of Neurological and Communicative Disorders and Stroke (NINCDS criteria, and requiring mechanical ventilation from 1984 to 2007, were analyzed. Results: A total of 273 GBS patients were managed with ventilatory support (190 men and 83 women during the period. Besides symmetrical paralysis in all patients, bulbar palsy was present in 186 (68.1%, sensory involvement in 88 (32.2% and symptomatic autonomic dysfunction in 72 (26.4% patients. The mortality was 12.1%. The factors determining mortality were elderly age group (P=0.03, autonomic dysfunction (P=0.03, pulmonary complications (P=0.001, hypokalemia (P=0.001 and bleeding (P=0.001 from any site. Logistic regression analysis showed the risk of mortality was 4.69 times more when pneumonia was present, 2.44 times more when hypokalemia was present, and 3.14 times more when dysautonomia was present. The odds ratio for age was 0.97 indicating that a higher age was associated with a higher risk of mortality. Conclusions: Ventilator associated pulmonary complications, bleeding and hypokalemia especially in elderly patients require optimal surveillance and aggressive therapy at the earliest for reducing the mortality in this group of GBS patients.

  8. Computed tomographic study on Mycoplasma pneumoniae pneumonia

    International Nuclear Information System (INIS)

    Serologically proven 21 patients with Mycoplasma pneumoniae pneumonia that showed infiltrative shadows on chest radiograms were studied by computed tomography (CT). Localization of the lesion and the fashion of its progression through the lung were analyzed. Following 3 loci were defined on the basis of the investigations of critical analysis of the chest radiograms, and of radiopathological analysis of the experimental animal model of mycoplasmal pneumonia with soft X-ray image. I: Peribronchial and periarterial interstitium. II: Bronchiole and its surroundings. III: Lung parenchyma, on hilar area as IIIh, on marginal area as IIIm. Even in the early phase of this disease, radiopathological findings on CT have been distributed in all loci mentioned above. The Shadow disappeared from locus III approximately 14th day from the onset. The shadow have remained, however, loci I, II for a long period. Those findings suggest that locus I and II are one of the major focus of Mycoplasma neumoniae pneumonia. Volume loss in the locus III was observed 78 % of the cases at 28th day from the onset. The shadow on locus IIIh was more prominent than locus IIIm. Reported analytical method with CT could be widely applied to disclose a radiopathological details in other infectious diseases of the lung. (author)

  9. Infant Mortality Risk and Paternity Certainty Are Associated with Postnatal Maternal Behavior toward Adult Male Mountain Gorillas (Gorilla beringei beringei.

    Directory of Open Access Journals (Sweden)

    Stacy Rosenbaum

    Full Text Available Sexually selected infanticide is an important source of infant mortality in many mammalian species. In species with long-term male-female associations, females may benefit from male protection against infanticidal outsiders. We tested whether mountain gorilla (Gorilla beringei beringei mothers in single and multi-male groups monitored by the Dian Fossey Gorilla Fund's Karisoke Research Center actively facilitated interactions between their infants and a potentially protective male. We also evaluated the criteria mothers in multi-male groups used to choose a preferred male social partner. In single male groups, where infanticide risk and paternity certainty are high, females with infants <1 year old spent more time near and affiliated more with males than females without young infants. In multi-male groups, where infanticide rates and paternity certainty are lower, mothers with new infants exhibited few behavioral changes toward males. The sole notable change was that females with young infants proportionally increased their time near males they previously spent little time near when compared to males they had previously preferred, perhaps to encourage paternity uncertainty and deter aggression. Rank was a much better predictor of females' social partner choice than paternity. Older infants (2-3 years in multi-male groups mirrored their mothers' preferences for individual male social partners; 89% spent the most time in close proximity to the male their mother had spent the most time near when they were <1 year old. Observed discrepancies between female behavior in single and multi-male groups likely reflect different levels of postpartum intersexual conflict; in groups where paternity certainty and infanticide risk are both high, male-female interests align and females behave accordingly. This highlights the importance of considering individual and group-level variation when evaluating intersexual conflict across the reproductive cycle.

  10. Infant Mortality Risk and Paternity Certainty Are Associated with Postnatal Maternal Behavior toward Adult Male Mountain Gorillas (Gorilla beringei beringei).

    Science.gov (United States)

    Rosenbaum, Stacy; Hirwa, Jean Paul; Silk, Joan B; Vigilant, Linda; Stoinski, Tara S

    2016-01-01

    Sexually selected infanticide is an important source of infant mortality in many mammalian species. In species with long-term male-female associations, females may benefit from male protection against infanticidal outsiders. We tested whether mountain gorilla (Gorilla beringei beringei) mothers in single and multi-male groups monitored by the Dian Fossey Gorilla Fund's Karisoke Research Center actively facilitated interactions between their infants and a potentially protective male. We also evaluated the criteria mothers in multi-male groups used to choose a preferred male social partner. In single male groups, where infanticide risk and paternity certainty are high, females with infants <1 year old spent more time near and affiliated more with males than females without young infants. In multi-male groups, where infanticide rates and paternity certainty are lower, mothers with new infants exhibited few behavioral changes toward males. The sole notable change was that females with young infants proportionally increased their time near males they previously spent little time near when compared to males they had previously preferred, perhaps to encourage paternity uncertainty and deter aggression. Rank was a much better predictor of females' social partner choice than paternity. Older infants (2-3 years) in multi-male groups mirrored their mothers' preferences for individual male social partners; 89% spent the most time in close proximity to the male their mother had spent the most time near when they were <1 year old. Observed discrepancies between female behavior in single and multi-male groups likely reflect different levels of postpartum intersexual conflict; in groups where paternity certainty and infanticide risk are both high, male-female interests align and females behave accordingly. This highlights the importance of considering individual and group-level variation when evaluating intersexual conflict across the reproductive cycle.

  11. Prevalence, characterization and clinical significance of Klebsiella pneumoniae carbapenemase (KPC producing Klebsiella pneumoniae

    Directory of Open Access Journals (Sweden)

    : Sarita Nayak, Suman Singh, Soeb Jankhwala, Riddhi Pradhan

    2014-11-01

    Full Text Available Klebsiella peumoniae, a capsulated gram negative bacillus is responsible for causing life threatening infections in humans. Carbapenems are the drug of choice for serious infection caused by multidrug resistant Klebsiella pneumoniae. The emergence of carbapenem resistance has made it extremely difficult to treat such infections resulting in significant morbidity and mortality. Aims: To study the prevalence of carbapenem resistance using ertapenem as a marker and to detect Klebsiella pneumoniae Carbapenemase (KPC producing Klebsiella pneumoniae as a mechanism of resistance. Material and Methods: The study included 102 patients from which Klebsiella pneumoniae isolated. Identification and antibiotic susceptibility testing of Klebsiella pneumoniae was performed on miniAPI (Analytical Profile Index, Semiautomated bacterial identification system according to Clinical and Laboratory Standards Institute (CLSI guidelines of 2011. The modified Hodge test was performed for detection of Carbapenemase production. Patient’s clinical and demographic details along with risk factors and co-morbid conditions, type of response to antimicrobial therapy and mortality were collected. Results: The prevalence of carbapenem resistance was found to be 30.41% with 16.6% KPC producing Klebsiella pneumoniae. The co-morbid conditions like immunocompromised state (p =0.042, prior antibiotics therapy (p=0.047, previous hospitalization (p =0.021, intensive care unit stay (p=0.047 and use of indwelling devices (p =0.013 were found to be significantly associated with carbapenem resistance. Adverse clinical outcomes (death or worsening among patients infected with ertapenem resistant patients was found to be statistically significant than ertapenem sensitive strains (p =0.008. Conclusions: A high degree of carbapenem resistance in present study is alarming and poses therapeutic dilemmas for clinicians. Initiating timely and appropriate infection control measures along with a

  12. Nutrition and dietary intake and their association with mortality and hospitalisation in adults with chronic kidney disease treated with haemodialysis: protocol for DIET-HD, a prospective multinational cohort study

    NARCIS (Netherlands)

    Palmer, S.C.; Ruospo, M.; Campbell, K.L.; Garcia Larsen, V.; Saglimbene, V.; Natale, P.; Gargano, L.; Craig, J.C.; Johnson, D.W.; Tonelli, M.; Knight, J.; Bednarek-Skublewska, A.; Celia, E.; Castillo, D. Del; Dulawa, J.; Ecder, T.; Fabricius, E.; Frazao, J.M.; Gelfman, R.; Hoischen, S.H.; Schon, S.; Stroumza, P.; Timofte, D.; Torok, M.; Hegbrant, J.; Wollheim, C.; Frantzen, L.; Strippoli, G.F.; Steiner, K.

    2015-01-01

    INTRODUCTION: Adults with end-stage kidney disease (ESKD) treated with haemodialysis experience mortality of between 15% and 20% each year. Effective interventions that improve health outcomes for long-term dialysis patients remain unproven. Novel and testable determinants of health in dialysis are

  13. ADULT RESPIRATORY DISTRESS SYNDROME SECONDARY TO END-STAGE LIVER DISEASE—SUCCESSFUL OUTCOME FOLLOWING LIVER TRANSPLANTATION1

    OpenAIRE

    Doyle, Howard R.; Marino, Ignazio R.; Miro, Adelaida; Scott, Victor; Martin, Maureen; Fung, John; Kramer, David; Starzl, Thomas E.

    1993-01-01

    The adult respiratory distress syndrome (ARDS) complicating liver failure carries a 100% mortality. Two cases of ARDS that resolved following liver transplantation have been reported, one associated with acute allograft rejection, and the second due to sepsis. There is, however, a great reluctance to transplant these very-high-risk patients. We report the first series of patients with ARDS secondary to liver failure who successfully underwent OLTX. No patient had sepsis or pneumonia. Posttran...

  14. Probiotics: Prevention of Severe Pneumonia and Endotracheal Colonization Trial (PROSPECT): A Feasibility Clinical Trial

    Science.gov (United States)

    2016-03-16

    Ventilator Associated Pneumonia (VAP); Other Infections; Antibiotic-Associated Diarrhea; C-Difficile; Duration of Mechanical Ventilation; Length of ICU Stay; Length of Hospital Stay; ICU and Hospital Mortality

  15. Macrolide Use in the Treatment of Critically Ill Patients with Pneumonia: Incidence, Correlates, Timing and Outcomes

    Directory of Open Access Journals (Sweden)

    Wendy I Sligl

    2013-01-01

    Full Text Available BACKGROUND: Macrolide antibiotics are commonly used to treat pneumonia despite increasing antimicrobial resistance. Evidence suggests that macrolides may also decrease mortality in severe sepsis via immunomodulatory properties.

  16. [Differential diagnosis of pulmonary tuberculosis and community-acquired pneumonia].

    Science.gov (United States)

    Deĭkina, O N; Mishin, V Iu; Demikhova, O V

    2007-01-01

    The purpose of this investigation was to enhance the efficiency of differential diagnosis of pneumonia and pulmonary tuberculosis. A hundred and fifty-nine adult patients were examined. These included 78 patients with pulmonary tuberculosis and 81 with community-acquired p neumonia. The clinical features of infiltrative pulmonary tuberculosis (n = 48) and mild community-acquired pneumonia (n = 51) were compared. The course of caseous pneumonia (n = 30) was compared with that of moderate and severe community-acquired pneumonia (n = 30). Significant differences in the manifestations of the intoxication and bronchopulmonary syndrome were not found in patients with community-acquired pneumonia and infiltrative pulmonary tuberculosis. Physical studies showed that in patients with community-acquired pneumonia, moist rale (54.9%) and crepitation (11.8%) were prevalent, but in those with infiltrative tuberculosis rale was absent in 60.4% of cases and the pattern of respiration was unchanged in 79.2%. Chest X-ray studies indicated that in patients with community-acquired pneumonia, lower lobar inflammatory changes were predominant in 62.8% of cases whereas in those with infiltrative pulmonary tuberculosis the process was mainly bilateral (43.8%) with the presence of destructive changes (83.3%) and bronchogenic dissemination (66.7%). In patients with caseous pneumonia, the intoxication syndrome was more significant than in those with severe community-acquired pneumonia. Chest X-ray studies demonstrated that in patients with caseous pneumonia, specific changes were bilateral with the involvement of 2 lobes or more, with destruction and bronchogenic dissemination while in those with community-acquired pneumonia, the pulmonary processes were predominantly bilateral (76.6%) at the lower lobar site (36.7%).

  17. [Differential diagnosis of pulmonary tuberculosis and community-acquired pneumonia].

    Science.gov (United States)

    Deĭkina, O N; Mishin, V Iu; Demikhova, O V

    2007-01-01

    The purpose of this investigation was to enhance the efficiency of differential diagnosis of pneumonia and pulmonary tuberculosis. A hundred and fifty-nine adult patients were examined. These included 78 patients with pulmonary tuberculosis and 81 with community-acquired p neumonia. The clinical features of infiltrative pulmonary tuberculosis (n = 48) and mild community-acquired pneumonia (n = 51) were compared. The course of caseous pneumonia (n = 30) was compared with that of moderate and severe community-acquired pneumonia (n = 30). Significant differences in the manifestations of the intoxication and bronchopulmonary syndrome were not found in patients with community-acquired pneumonia and infiltrative pulmonary tuberculosis. Physical studies showed that in patients with community-acquired pneumonia, moist rale (54.9%) and crepitation (11.8%) were prevalent, but in those with infiltrative tuberculosis rale was absent in 60.4% of cases and the pattern of respiration was unchanged in 79.2%. Chest X-ray studies indicated that in patients with community-acquired pneumonia, lower lobar inflammatory changes were predominant in 62.8% of cases whereas in those with infiltrative pulmonary tuberculosis the process was mainly bilateral (43.8%) with the presence of destructive changes (83.3%) and bronchogenic dissemination (66.7%). In patients with caseous pneumonia, the intoxication syndrome was more significant than in those with severe community-acquired pneumonia. Chest X-ray studies demonstrated that in patients with caseous pneumonia, specific changes were bilateral with the involvement of 2 lobes or more, with destruction and bronchogenic dissemination while in those with community-acquired pneumonia, the pulmonary processes were predominantly bilateral (76.6%) at the lower lobar site (36.7%). PMID:17338353

  18. Nutritional status of adult patients with pulmonary tuberculosis in rural central India and its association with mortality.

    Science.gov (United States)

    Bhargava, Anurag; Chatterjee, Madhuri; Jain, Yogesh; Chatterjee, Biswaroop; Kataria, Anju; Bhargava, Madhavi; Kataria, Raman; D'Souza, Ravi; Jain, Rachna; Benedetti, Andrea; Pai, Madhukar; Menzies, Dick

    2013-01-01

    Under-nutrition is a known risk factor for TB and can adversely affect treatment outcomes. However, data from India are sparse, despite the high burden of TB as well as malnutrition in India. We assessed the nutritional status at the time of diagnosis and completion of therapy, and its association with deaths during TB treatment, in a consecutive cohort of 1695 adult patients with pulmonary tuberculosis in rural India during 2004 - 2009.Multivariable logistic regression was used to obtain adjusted estimates of the association of nutritional status with deaths during treatment. At the time of diagnosis, median BMI and body weights were 16.0 kg/m(2)and 42.1 kg in men, and 15.0 kg/m(2)and 34.1 kg in women, indicating that 80% of women and 67% of men had moderate to severe under-nutrition (BMInutrition. Half of women and one third of men remained moderately to severely underweight at the end of treatment. 60 deaths occurred in 1179 patients (5%) in whom treatment was initiated. Severe under-nutrition at diagnosis was associated with a 2 fold higher risk of death. Overall, a majority of patients had evidence of chronic severe under-nutrition at diagnosis, which persisted even after successful treatment in a significant proportion of them. These findings suggest the need for nutritional support during treatment of pulmonary TB in this rural population.

  19. Acute exogenous lipoid pneumonia, on a fire eating

    International Nuclear Information System (INIS)

    A case of an adult 19 years of age, fire juggler and manipulator is presented. The young came in to the medical emergency service of the Hospital Dr. Rafael A. Calderon Guardia, because of a sudden episode of right thoracic pain and dyspnea. A right pleural effusion was documented and a round mass at the base of the left lung. A suggestive clinic of bronchopneumonia started after hours, it was localized first as community acquired pneumonia. Considering his work history and clinical characteristics, the case was reoriented and concluded that this is what the medical literature in English is called fire-eater pneumonia, uncommon aspiration pneumonia which was a literature review. (author)

  20. Streptococcus pneumoniae-associated pneumonia complicated by purulent pericarditis: case series *

    Science.gov (United States)

    Cillóniz, Catia; Rangel, Ernesto; Barlascini, Cornelius; Piroddi, Ines Maria Grazia; Torres, Antoni; Nicolini, Antonello

    2015-01-01

    Abstract Objective: In the antibiotic era, purulent pericarditis is a rare entity. However, there are still reports of cases of the disease, which is associated with high mortality, and most such cases are attributed to delayed diagnosis. Approximately 40-50% of all cases of purulent pericarditis are caused by Gram-positive bacteria, Streptococcus pneumoniae in particular. Methods: We report four cases of pneumococcal pneumonia complicated by pericarditis, with different clinical features and levels of severity. Results: In three of the four cases, the main complication was cardiac tamponade. Microbiological screening (urinary antigen testing and pleural fluid culture) confirmed the diagnosis of severe pneumococcal pneumonia complicated by purulent pericarditis. Conclusions: In cases of pneumococcal pneumonia complicated by pericarditis, early diagnosis is of paramount importance to avoid severe hemodynamic compromise. The complications of acute pericarditis appear early in the clinical course of the infection. The most serious complications are cardiac tamponade and its consequences. Antibiotic therapy combined with pericardiocentesis drastically reduces the mortality associated with purulent pericarditis. PMID:26398760

  1. Streptococcus pneumoniae-associated pneumonia complicated by purulent pericarditis: case series

    International Nuclear Information System (INIS)

    Objective: In the antibiotic era, purulent pericarditis is a rare entity. However, there are still reports of cases of the disease, which is associated with high mortality, and most such cases are attributed to delayed diagnosis. Approximately 40-50% of all cases of purulent pericarditis are caused by Gram-positive bacteria, Streptococcus pneumoniae in particular. Methods: We report four cases of pneumococcal pneumonia complicated by pericarditis, with different clinical features and levels of severity. Results: In three of the four cases, the main complication was cardiac tamponade. Microbiological screening (urinary antigen testing and pleural fluid culture) confirmed the diagnosis of severe pneumococcal pneumonia complicated by purulent pericarditis. Conclusions: In cases of pneumococcal pneumonia complicated by pericarditis, early diagnosis is of paramount importance to avoid severe hemodynamic compromise. The complications of acute pericarditis appear early in the clinical course of the infection. The most serious complications are cardiac tamponade and its consequences. Antibiotic therapy combined with pericardiocentesis drastically reduces the mortality associated with purulent pericarditis. (author)

  2. Streptococcus pneumoniae-associated pneumonia complicated by purulent pericarditis: case series

    Energy Technology Data Exchange (ETDEWEB)

    Cilloniz, Catia; Torres, Antoni [Servicio de Neumologia, Hospital Clinic de Barcelona, Ciber de Enfermedades Respiratorias (CIBERES), Instituto de Investigacion Biomedica Agusti Pi i Sunyer, Universidad de Barcelona (Spain); Rangel, Ernesto [Facultad de Medicina, Universidad Autonoma de Nayarit, Tepic (Mexico); Barlascini, Cornelius [Servizio di Igiene e Sanita Pubblica, Ospedale Generale di Sestri Levante, Sestri Levante (Italy); Piroddi, Ines Maria Grazia; Nicolini, Antonello, E-mail: antonellonicolini@gmail.com [Servizio di Pneumologia, Ospedale Generale di Sestri Levante, Sestri Levante (Italy)

    2015-07-15

    Objective: In the antibiotic era, purulent pericarditis is a rare entity. However, there are still reports of cases of the disease, which is associated with high mortality, and most such cases are attributed to delayed diagnosis. Approximately 40-50% of all cases of purulent pericarditis are caused by Gram-positive bacteria, Streptococcus pneumoniae in particular. Methods: We report four cases of pneumococcal pneumonia complicated by pericarditis, with different clinical features and levels of severity. Results: In three of the four cases, the main complication was cardiac tamponade. Microbiological screening (urinary antigen testing and pleural fluid culture) confirmed the diagnosis of severe pneumococcal pneumonia complicated by purulent pericarditis. Conclusions: In cases of pneumococcal pneumonia complicated by pericarditis, early diagnosis is of paramount importance to avoid severe hemodynamic compromise. The complications of acute pericarditis appear early in the clinical course of the infection. The most serious complications are cardiac tamponade and its consequences. Antibiotic therapy combined with pericardiocentesis drastically reduces the mortality associated with purulent pericarditis. (author)

  3. Isolation of Streptococcus pneumoniae type 3 from equine species.

    OpenAIRE

    Benson, C E; Sweeney, C.R.

    1984-01-01

    Streptococcus pneumoniae type 3 was isolated from seven tracheobronchial aspirates and one pleural tap of seven adult horses and one foal. There was no direct evidence in these horses that isolation of the pneumococcus was related to a specific disease syndrome. Presenting complaints included two horses with chronic cough, two horses with decreased exercise tolerance, one horse with exercise-induced pulmonary hemorrhage, and three horses with pneumonia. Antibiotic therapy resolved the primary...

  4. Nutritional status of adult patients with pulmonary tuberculosis in rural central India and its association with mortality.

    Directory of Open Access Journals (Sweden)

    Anurag Bhargava

    Full Text Available Under-nutrition is a known risk factor for TB and can adversely affect treatment outcomes. However, data from India are sparse, despite the high burden of TB as well as malnutrition in India. We assessed the nutritional status at the time of diagnosis and completion of therapy, and its association with deaths during TB treatment, in a consecutive cohort of 1695 adult patients with pulmonary tuberculosis in rural India during 2004 - 2009.Multivariable logistic regression was used to obtain adjusted estimates of the association of nutritional status with deaths during treatment. At the time of diagnosis, median BMI and body weights were 16.0 kg/m(2and 42.1 kg in men, and 15.0 kg/m(2and 34.1 kg in women, indicating that 80% of women and 67% of men had moderate to severe under-nutrition (BMI<17.0 kg/m(2. Fifty two percent of the patients (57% of men and 48% of women had stunting indicating chronic under-nutrition. Half of women and one third of men remained moderately to severely underweight at the end of treatment. 60 deaths occurred in 1179 patients (5% in whom treatment was initiated. Severe under-nutrition at diagnosis was associated with a 2 fold higher risk of death. Overall, a majority of patients had evidence of chronic severe under-nutrition at diagnosis, which persisted even after successful treatment in a significant proportion of them. These findings suggest the need for nutritional support during treatment of pulmonary TB in this rural population.

  5. Hospital-acquired pneumonia

    Science.gov (United States)

    ... tends to be more serious than other lung infections because: People in the hospital are often very sick and cannot fight off ... prevent pneumonia. Most hospitals have programs to prevent hospital-acquired infections.

  6. Pneumonia (For Parents)

    Science.gov (United States)

    ... a medicine to treat your child's cough because cough suppressants stop the lungs from clearing mucus, which isn't helpful in some types of pneumonia. Over-the-counter cough and cold medications are not recommended for any ...

  7. Burden of total and cause-specific mortality related to tobacco smoking among adults aged ≥ 45 years in Asia: a pooled analysis of 21 cohorts.

    Directory of Open Access Journals (Sweden)

    Wei Zheng

    2014-04-01

    Full Text Available BACKGROUND: Tobacco smoking is a major risk factor for many diseases. We sought to quantify the burden of tobacco-smoking-related deaths in Asia, in parts of which men's smoking prevalence is among the world's highest. METHODS AND FINDINGS: We performed pooled analyses of data from 1,049,929 participants in 21 cohorts in Asia to quantify the risks of total and cause-specific mortality associated with tobacco smoking using adjusted hazard ratios and their 95% confidence intervals. We then estimated smoking-related deaths among adults aged ≥45 y in 2004 in Bangladesh, India, mainland China, Japan, Republic of Korea, Singapore, and Taiwan-accounting for ∼71% of Asia's total population. An approximately 1.44-fold (95% CI = 1.37-1.51 and 1.48-fold (1.38-1.58 elevated risk of death from any cause was found in male and female ever-smokers, respectively. In 2004, active tobacco smoking accounted for approximately 15.8% (95% CI = 14.3%-17.2% and 3.3% (2.6%-4.0% of deaths, respectively, in men and women aged ≥45 y in the seven countries/regions combined, with a total number of estimated deaths of ∼1,575,500 (95% CI = 1,398,000-1,744,700. Among men, approximately 11.4%, 30.5%, and 19.8% of deaths due to cardiovascular diseases, cancer, and respiratory diseases, respectively, were attributable to tobacco smoking. Corresponding proportions for East Asian women were 3.7%, 4.6%, and 1.7%, respectively. The strongest association with tobacco smoking was found for lung cancer: a 3- to 4-fold elevated risk, accounting for 60.5% and 16.7% of lung cancer deaths, respectively, in Asian men and East Asian women aged ≥45 y. CONCLUSIONS: Tobacco smoking is associated with a substantially elevated risk of mortality, accounting for approximately 2 million deaths in adults aged ≥45 y throughout Asia in 2004. It is likely that smoking-related deaths in Asia will continue to rise over the next few decades if no effective smoking control programs are

  8. TREATMENT OUTCOME PROFILE OF NON RESOLVING PNEUMONIA AMONG HOSPITALIZED COMMUNITY ACQUIRED PNEUMONIA PATIENTS IN TERTIARY CARE CENTRE: AN OBSERVATIONAL STUDY

    Directory of Open Access Journals (Sweden)

    Raveendra

    2014-07-01

    Full Text Available : BACKGROUND: Most of the times, a Community Acquired Pneumonia (CAP patient is being treated with empirical antibiotics by best guess method by the clinician. Patient who did not show expected clinical improvement or resolution on chest x- ray after 2 weeks of antibiotics is considered as unresolved or non-resolving pneumonia and is a major problem, contributing to increased mortality and morbidity in the medical wards. AIM OF STUDY: 1.Tostudy the clinical profile of unresolved pneumonia among CAP. 2. To know the treatment outcome in these cases. MATERIALS & METHODS: 80 hospitalized CAP patients who did not improve either clinically or radiologically after 2 weeks of broad spectrum antibiotics were included in the study. Details of these patients including investigations done at other higher centers were recorded and patients were followed up for 6 months or till death. RESULTS: Unresolved pneumonia was commonly observed in patients more than 50 years. Pulmonary tuberculosis was the commonest cause, followed by MDR varieties of CAP, Bronchogenic carcinoma. Multiple risk factors were noted, which includes cigarette smoking, alcohol, COPD, Diabetes, HIV positive status. Elderly age, multiple risk factors, antibiotic abuse and resistance resulted in majority of the cases. CONCLUSION: This study highlights the importance of early recognition and appropriate treatment of CAP to prevent unresolved pneumonia and use of invasive and latest investigations to recognize unresolved pneumonia, to decrease mortality and morbidity.

  9. Influence of age, sex and season on morbidity and mortality pattern in goats under village conditions of Madhya Pradesh

    Directory of Open Access Journals (Sweden)

    Amit Kumar Dohare

    2013-12-01

    Full Text Available Aim: To study factors affecting morbidity and mortality pattern in goats in Chambal division of Madhya Pradesh under village conditions. Materials and Methods: The sampling scheme adopted during study was stratified three stage random sampling and data on 549 goats were recorded. Results: The overall morbidity and mortality rate was 20.58% and 10.20% respectively. Proportional mortality due to diarrhoea was highest (35.71% followed by pneumonia (28.57% and miscellaneous causes (12.5%. Pattern of morbidity in male and female was almost similar. Age of goats was the most important factor and accounted for 39.29%, 28.57% and 32.14% mortality in 0-3 month, 6-9 month and above 9 months, respectively. The effect of season on goat mortality was significant (p<0.05.The incidence of mortality were 41.07%, 37.5% and 21.43% in winter, rainy and summer season respectively. Conclusion: In goats mortality was significantly influenced by age groups and suggesting that more care and attention need to be paid in kids 0-3 months age irrespective of season. Mortality due to various diseases in kids and adults could be minimized by identifying the cause and giving proper treatment. [Vet World 2013; 6(6.000: 329-331

  10. Bronchoscopy in lipoid pneumonia.

    OpenAIRE

    Kameswaran, M.; Annobil, S H; Benjamin, B.; Salim, M.

    1992-01-01

    Forcible administration of rendered animal fat to infants is a tradition in south western Saudi Arabia. Accidental inhalation may result in a resistant form of lipoid pneumonia. A series of 24 cases of lipoid pneumonia, 22 of which were diagnosed by bronchoscopy with bronchial lavage and microscopic examination of the aspirate, are reported. The technique is described briefly and the results analysed. A high index of suspicion together with bronchoscopy and bronchial lavage of all cases of re...

  11. Hemorrhagic pneumonia in mink caused by Pseudomonas aeruginosa

    DEFF Research Database (Denmark)

    Salomonsen, Charlotte Mark

    Hemorrhagic pneumonia in mink is an acute and fatal disease caused by Pseudomonas aeruginosa. The mink are typically found dead without prior clinical symptoms. The disease can be highly contagious and varying mortalities on the farm level has been reported. Hemorrhagic pneumonia in mink...... is seasonal with outbreaks almost exclusively occurring from September to November in Denmark. In human medicine, P. aeruginosa is regarded as a pathogen for immune compromised individuals but no underlying disease or immune defect has been identified in mink dying of hemorrhagic pneumonia. In fact, little...... research has been performed in this field and most published work is more than 25 years old. The studies presented in this thesis aim at elucidating varying aspects of the disease: Article I investigates the relationships of P. aeruginosa isolated from mink hemorrhagic pneumonia using pulsed field gel...

  12. Association between decreasing trend in the mortality of adult T-cell leukemia/lymphoma and allogeneic hematopoietic stem cell transplants in Japan: analysis of Japanese vital statistics and Japan Society for Hematopoietic Cell Transplantation (JSHCT)

    International Nuclear Information System (INIS)

    Adult T-cell leukemia/lymphoma (ATLL) is a peripheral T-cell neoplasm with a very poor outcome. However, several studies have shown a progress in the treatment. To evaluate the effect of the progress in the treatment of ATLL in a whole patient population, we used vital statistics data and estimated age-adjusted mortality and trends in the mortality from 1995 to 2009. Since allogeneic hematopoietic stem-cell transplantation (allo-HSCT) has been introduced as a modality with curative potential during study period, we also evaluated the association of the annual number of allo-HSCT and the trend of the mortality of ATLL. Endemic (Kyushu) and non-endemic areas (others) were evaluated separately. Significance in the trend of mortality was evaluated by joinpoint regression analysis. During the study period, a total of 14 932 patients died of ATLL in Japan, and mortality decreased significantly in both areas (annual percent change (95% confidence interval (CI)): Kyushu, −3.1% (−4.3, −1.9); others, −3.4% (−5.3, −1.5)). This decreasing trend in mortality seems to be associated with an increase in the number of allo-HSCTs (Kyushu, R-squared=0.70, P=0.003; and others, R-squared=0.55, P=0.058). This study reveals that the mortality of ATLL is now significantly decreasing in Japan and this decreasing trend might be associated with allo-HSCT

  13. Incidence, risk factors and outcome of nosocomial pneumonia in patients with central nervous system infections

    Directory of Open Access Journals (Sweden)

    Gajović Olgica

    2011-01-01

    Full Text Available Introduction. Pneumonia is the most frequent nosocomial infection in intensive care units. The reported frequency varies with definition, the type of hospital or intensive care units and the population of patients. The incidence ranges from 6.8-27%. Objective. The objective of this study was to determine the frequency, risk factors and mortality of nosocomial pneumonia in intensive care patients. Methods. We analyzed retrospectively and prospectively the collected data of 180 patients with central nervous system infections who needed to stay in the intensive care unit for more than 48 hours. This study was conducted from 2003 to 2009 at the Clinical Centre of Kragujevac. Results. During the study period, 54 (30% patients developed nosocomial pneumonia. The time to develop pneumonia was 10±6 days. We found that the following risk factors for the development of nosocomial pneumonia were statistically significant: age, Glasgow Coma Scale (GCS score <9, mechanical ventilation, duration of mechanical ventilation, tracheostomy, presence of nasogastric tube and enteral feeding. The most commonly isolated pathogens were Klebsiella-Enterobacter spp. (33.3%, Pseudomonas aeruginosa (24.1%, Acinetobacter spp. (16.6% and Staphylococcus aureus (25.9%. Conclusion. Nosocomial pneumonia is the major cause of morbidity and mortality of patients with central nervous system infections. Patients on mechanical ventilation are particularly at a high risk. The mortality rate of patients with nosocomial pneumonia was 54.4% and it was five times higher than in patients without pneumonia.

  14. Dysbiosis of upper respiratory tract microbiota in elderly pneumonia patients

    NARCIS (Netherlands)

    Piters, Wouter A. A. de Steenhuijsen; Huijskens, Elisabeth G. W.; Wyllie, Anne L.; Biesbroek, Giske; van den Bergh, Menno R.; Veenhoven, Reinier H.; Wang, Xinhui; Trzcinski, Krzysztof; Bonten, Marc J.; Rossen, John W. A.; Sanders, Elisabeth A. M.; Bogaert, Debby

    2016-01-01

    Bacterial pneumonia is a major cause of morbidity and mortality in elderly. We hypothesize that dysbiosis between regular residents of the upper respiratory tract (URT) microbiome, that is balance between commensals and potential pathogens, is involved in pathogen overgrowth and consequently disease

  15. Severe Rhodococcus equi pneumonia: case report and literature review

    DEFF Research Database (Denmark)

    Vestbo, Jørgen; Lundgren, Jens Dilling; Gaub, J;

    1991-01-01

    or sputum on standard media, but is frequently regarded as a contaminant. Mortality from Rhodococcus equi pneumonia is high (25%) and early surgical intervention has been recommended. Based on this review, the benefit of surgery seems dubious, whereas good results have been obtained using long...

  16. Predictive Validity of the American College of Cardiology/American Heart Association Pooled Cohort Equations in Predicting All-Cause and Cardiovascular Disease-Specific Mortality in a National Prospective Cohort Study of Adults in the United States.

    Science.gov (United States)

    Loprinzi, Paul D; Addoh, Ovuokerie

    2016-06-01

    The predictive validity of the Pooled Cohort risk (PCR) equations for cardiovascular disease (CVD)-specific and all-cause mortality among a national sample of US adults has yet to be evaluated, which was this study's purpose. Data from the 1999-2010 National Health and Nutrition Examination Survey were used, with participants followed up through December 31, 2011, to ascertain mortality status via the National Death Index probabilistic algorithm. The analyzed sample included 11,171 CVD-free adults (40-79 years of age). The 10-year risk of a first atherosclerotic cardiovascular disease (ASCVD) event was determined from the PCR equations. For the entire sample encompassing 849,202 person-months, we found an incidence rate of 1.00 (95% CI, 0.93-1.07) all-cause deaths per 1000 person-months and an incidence rate of 0.15 (95% CI, 0.12-0.17) CVD-specific deaths per 1000 person-months. The unweighted median follow-up duration was 72 months. For nearly all analyses (unadjusted and adjusted models with ASCVD expressed as a continuous variable as well as dichotomized at 7.5% and 20%), the ASCVD risk score was significantly associated with all-cause and CVD-specific mortality (P<.05). In the adjusted model, the increased all-cause mortality risk ranged from 47% to 77% based on an ASCVD risk of 20% or higher and 7.5% or higher, respectively. Those with an ASCVD score of 7.5% or higher had a 3-fold increased risk of CVD-specific mortality. The 10-year predicted risk of a first ASCVD event via the PCR equations was associated with all-cause and CVD-specific mortality among those free of CVD at baseline. In this American adult sample, the PCR equations provide evidence of predictive validity. PMID:27180122

  17. Pre-treatment ferritin level and alveolar-arterial oxygen gradient can predict mortality rate due to acute/subacute interstitial pneumonia in dermatomyositis treated by cyclosporine a/glucocorticosteroid combination therapy: a case control study [corrected].

    Directory of Open Access Journals (Sweden)

    Kentaro Isoda

    Full Text Available BACKGROUND: Acute/subacute interstitial pneumonia in dermatomyositis (DM-A/SIP is a disease associated with a poor prognosis that resists treatment with glucocorticosteroids (GC and progresses rapidly in a period of weeks to months to death. We retrospectively studied outcomes, prognostic factors, and their relations with survival rate in patients with DM-A/SIP treated with early cyclosporine A (CSA/GC combination therapy and 2-hour postdose blood concentration monitoring. METHODS: This study comprised 32 DM-A/SIP patients who were simultaneously treated with CSA and prednisolone. Clinical and laboratory findings were compared between those who died due to DM-A/SIP and those surviving 24 weeks after beginning of therapy. Prognostic factors were extracted, and their relations with the survival rate were evaluated. RESULTS: Of the 32 DM-A/SIP patients, 25 survived, 5 died of DM-A/SIP, and 2 died of infections. In those who died due to DM-A/SIP, ferritin level and the alveolar-arterial oxygen gradient were significantly increased compared with the survivors (P<0.001 and P = 0.002, respectively. Multivariate analyses showed that ferritin and alveolar-arterial oxygen gradient were independent prognostic factors of poor outcome. The survival rate 24 weeks after beginning of treatment was significantly lower in those with a ferritin level of ≥ 600 ng/ml and alveolar-arterial oxygen gradient of ≥ 45 Torr (P<0.001 and P<0.001, respectively. All patients with both prognostic factors died, and the outcome was significantly poorer in these patients than in those with one or neither of the prognostic factors (P<0.001. CONCLUSIONS: We identified pre-treatment high serum ferritin level and high alveolar-arterial oxygen gradient as poor prognostic factors in DM-A/SIP patients undergoing early CSA/GC combination therapy and showed that the outcomes were poor in patients with both factors.

  18. A severe case of acute exogenous lipoid pneumonia treated with systemic corticosteroid

    OpenAIRE

    Yasui, Hideki; Yokomura, Koshi; Suda, Takafumi

    2016-01-01

    Acute exogenous lipoid pneumonia is a rare disorder in adults. A treatment of choice for lipoid pneumonia has not been established, and systemic corticosteroid use remains controversial. We report the case of a 32-year-old man with schizophrenia who presented with kerosene-induced acute exogenous lipoid pneumonia that was treated with a systemic corticosteroid. In this case, supportive therapy did not improve the patient's condition, so systemic corticosteroid therapy was commenced four days ...

  19. Use of exposure history to identify patterns of immunity to pneumonia in bighorn sheep (Ovis canadensis)

    Science.gov (United States)

    Plowright, Raina K.; Manlove, Kezia; Cassirer, E. Frances; Besser, Thomas H.; Hudson, Peter J.

    2013-01-01

    Individual host immune responses to infectious agents drive epidemic behavior and are therefore central to understanding and controlling infectious diseases. However, important features of individual immune responses, such as the strength and longevity of immunity, can be challenging to characterize, particularly if they cannot be replicated or controlled in captive environments. Our research on bighorn sheep pneumonia elucidates how individual bighorn sheep respond to infection with pneumonia pathogens by examining the relationship between exposure history and survival in situ. Pneumonia is a poorly understood disease that has impeded the recovery of bighorn sheep (Ovis canadensis) following their widespread extirpation in the 1900s. We analyzed the effects of pneumonia-exposure history on survival of 388 radio-collared adults and 753 ewe-lamb pairs. Results from Cox proportional hazards models suggested that surviving ewes develop protective immunity after exposure, but previous exposure in ewes does not protect their lambs during pneumonia outbreaks. Paradoxically, multiple exposures of ewes to pneumonia were associated with diminished survival of their offspring during pneumonia outbreaks. Although there was support for waning and boosting immunity in ewes, models with consistent immunizing exposure were similarly supported. Translocated animals that had not previously been exposed were more likely to die of pneumonia than residents. These results suggest that pneumonia in bighorn sheep can lead to aging populations of immune adults with limited recruitment. Recovery is unlikely to be enhanced by translocating nai¨ve healthy animals into or near populations infected with pneumonia pathogens.

  20. Streptococcus pneumoniae meningitis in Alberta pre- and postintroduction of the 7-valent pneumococcal conjugate vaccine

    Directory of Open Access Journals (Sweden)

    Jennie Johnstone

    2011-01-01

    Full Text Available The objective of this study was to describe the epidemiology, clinical characteristics, microbiology and outcomes of patients of all ages with Streptococcus pneumoniae meningitis between 2000 and 2004; two years pre- and postintroduction of an S pneumoniae 7-valent conjugate vaccine program in Alberta in children younger than two years of age. The high mortality rate associated with S pneumoniae meningitis, despite appropriate therapy, suggests that prevention of S pneumoniae meningitis is critical. Despite implementation of a PCV-7 program in Alberta, rates of S pneumoniae meningitis in children younger than two years of age is still high. Thus, continued research into safe and efficacious vaccines covering a broader range of S pneumoniae serotypes is necessary.

  1. Occupational mortality

    DEFF Research Database (Denmark)

    Lynge, Elsebeth

    2011-01-01

    INTRODUCTION: This paper aims to present the methods and main results from the Danish occupational mortality studies, and to set the Danish studies into the international context of occupational mortality studies. RESEARCH TOPICS: The first Danish occupational mortality study from 1970...

  2. Polyamine transporter in Streptococcus pneumoniae is essential for evading early innate immune responses in pneumococcal pneumonia.

    Science.gov (United States)

    Rai, Aswathy N; Thornton, Justin A; Stokes, John; Sunesara, Imran; Swiatlo, Edwin; Nanduri, Bindu

    2016-01-01

    Streptococcus pneumoniae is the most common bacterial etiology of pneumococcal pneumonia in adults worldwide. Genomic plasticity, antibiotic resistance and extreme capsular antigenic variation complicates the design of effective therapeutic strategies. Polyamines are ubiquitous small cationic molecules necessary for full expression of pneumococcal virulence. Polyamine transport system is an attractive therapeutic target as it is highly conserved across pneumococcal serotypes. In this study, we compared an isogenic deletion strain of S. pneumoniae TIGR4 in polyamine transport operon (ΔpotABCD) with the wild type in a mouse model of pneumococcal pneumonia. Our results show that the wild type persists in mouse lung 24 h post infection while the mutant strain is cleared by host defense mechanisms. We show that intact potABCD is required for survival in the host by providing resistance to neutrophil killing. Comparative proteomics analysis of murine lungs infected with wild type and ΔpotABCD pneumococci identified expression of proteins that could confer protection to wild type strain and help establish infection. We identified ERM complex, PGLYRP1, PTPRC/CD45 and POSTN as new players in the pathogenesis of pneumococcal pneumonia. Additionally, we found that deficiency of polyamine transport leads to up regulation of the polyamine synthesis genes speE and cad in vitro. PMID:27247105

  3. Resistance and serotype distribution of Streptococcus pneumoniae among adults and children in China%我国成人和儿童中分离的肺炎链球菌的耐药性与血清型研究

    Institute of Scientific and Technical Information of China (English)

    肖素坤; 赵春江; 刘春林; 王辉

    2010-01-01

    Objective To investigate the serogroups/types distribution and antimicrobial susceptibility of clinical Streptococcus pneumoniae isolates of different serogroups/types in both children and adults in China, and to explore the significance of vaccines in preventing pneumococcal infections and control of epidemic Streptococcus pneumoniae. Methods A total of 580 consecutive and non-repetitive Streptococcuspneumoniae isolates were collected from 13 hospitals between 2005 and 2008. Agar dilution method was used to determine the minimal inhibitory concentrations ( MIC) of 11 antibacterial agents. Serotyping was performed by latex agglutination test and the Quellung reaction test. Results The most prevalent serogroups/types in 362 isolates from adults were 19F (55, 15.2%), 19A (46, 12.7%), 3 (44, 12.2%), 23F (24, 6.6%), 15 (23, 6.4%), and 17 (11, 3.0%), while in the 218 isolates from children, 19F (71, 32.6%), 19A (31, 14.2%), 23F (13, 6.0%), 15 (12, 5.5%), 14 (11, 5. 0% ) , and 6B ( 10, 4. 6% ) were the most prevalent Resistance to (J-lactams was related to the serotypes. 19F and 19A were more resistant toβ-lactams than the other serotypes. The prevalence of Penicillin Intermediate Streptococcus pneumoniae increased from 7. 4% in 2005 to 24. 9% in 2008. The coverage of pnuemococcal conjugate vaccine (PCV)-7, PCV-10 and PCV-13 among all age groups was 35.5% (206/580), 38.7% (224/580) and 61. 8% (358/580), respectively. The coverage of PCV-7, PCV-10 and PCV-13 among children under 5 years was 55. 7% (78/140), 58. 6% (82/140), and 77. 9% (109/140) respectively. Conclusion Penicillin intermediate isolates were on the rise with years. PCV-7, PCV-10 and PCV-13 vaccines showed a higher coverage in children than in adults.%目的 研究自我国成人和儿童中分离的肺炎链球菌的血清分型,探索不同血清型对常用抗菌药物的敏感度,评估肺炎链球菌疫苗在预防肺炎链球菌感染及控制肺炎链球菌流行传播中的价值.方法 收集2005

  4. Innovative Strategies Designed to Improve Adult Pneumococcal Immunizations in Safety Net Patient-Centered Medical Homes.

    Science.gov (United States)

    Park, Nina J; Sklaroff, Laura Myerchin; Gross-Schulman, Sandra; Hoang, Khathy; Tran, Helen; Campa, David; Scheib, Geoffrey; Guterman, Jeffrey J

    2016-08-01

    Streptococcus pneumoniae is a principal cause of serious illness, including bacteremia, meningitis, and pneumonia, worldwide. Pneumococcal immunization is proven to reduce morbidity and mortality in high-risk adult and elderly populations. Current pneumococcal vaccination practices are suboptimal in part because of recommendation complexity, the high cost of provider-driven immunization interventions, and outreach methods that are not patient-centric. These barriers are amplified within the safety net. This paper identifies efforts by the Los Angeles County Department of Health Services to increase pneumococcal immunization rates for adult indigent patient populations. A 4-part approach will be used to increase vaccination rates: (1) protocol driven care, (2) staff education, (3) electronic identification of eligible patients, and (4) automated patient outreach and scheduling. The proposed analytics plan and potential for scalability are described. (Population Health Management 2016;19:240-247). PMID:26824148

  5. Idiopathic interstitial pneumonia

    International Nuclear Information System (INIS)

    In order to identify and classify the basic CT appearance of interstitial pneumonia, radiologic-pathologic correlative study was performed using inflated and fixed lungs from autopsy and surgery. The patterns of the abnormalities on the CT images of interstitial pneumonia were classified into 7 categories. Important pathological changes which affected the CT images were alveolar collapse and airway dilatation. Based on the result of above study, we analyzed CT of 22 patients with IIP. The lesions which were classified into a hazy density, micronodular densities, confluence of various sized ring like shadows and subpleural bullous changes were frequently recognized together mostly in the periphery of the lung. (author)

  6. Çocukluk çağı pnömonilerinde Mycoplazma pneumoniae'nin rolü

    OpenAIRE

    ÜNLÜTÜRK, Özlem Arslan; İNALHAN, Meral; TEMEL, Özlem; ORAL, Müjgan; ÜNLÜTÜRK, Hasan; SİPAHİER, Neslihan; İnan, Savaş

    2002-01-01

    The role of mycoplasma pneumoniae in childhood pneumoniaes Mycoplasma Pneumoniae is a major cause of respira-tory infection in school -aged children and young adults.Clinically significant disease is unusual before the age of 3 to 4 y ear,the peak incidence occurs from 5 tol5 years. Mycoplasma illnesses are mild and hospitalisation is infrequent. In order to evaluate the incidence of Mycoplasma Pneumoniae pneumonia in children we evaluated the Mycoplasma IgM antibody in 246 pédiatrie patient ...

  7. Desigualdades raciais na mortalidade de mulheres adultas no Recife, 2001 a 2003 Racial inequality in the mortality of adult women in Recife, 2001-2003

    Directory of Open Access Journals (Sweden)

    Sony Maria dos Santos

    2007-08-01

    of black and white adult women living in Recife, between 2001 and 2003. In this cross-sectional study, 2,943 deaths of women aged between 20 and 59 years were included, identified in the Mortality Information System of the National Health System (SUS, with race/skin color white or black (black + mestizo. Proportional mortality, mortality rates and ratios were obtained. The risk of dying was 1.7 times higher for black women compared to whites. Black women had higher risk of death in all age groups and higher proportion of deaths in public hospitals, of women who did not have a partner (single, widow or separated, who were housewives or worked as domestic servants, and who were less educated. Regarding the underlying causes, black women had a higher mortality rate for all chapters of the International Classification of Diseases and for specific causes of death, except for neoplasm in women aged 20 to 29 years and for breast cancer in women aged 30 to 39 and 50 to 59 years. As age decreases, a large difference between black and white women was found in the risk of deaths caused by external causes. Among black women, there was an increase in the risk of dying due to homicides, motor vehicle accidents, ischemic heart diseases, cerebral vascular and hypertensive diseases, diabetes, and tuberculosis. The findings showed inequality in health, with disadvantages for the black women, which are the expression of human rights violation that challenges social rise and the access to decent health conditions.

  8. Estimating pneumonia deaths of post-neonatal children in countries of low or no death certification in 2008.

    Directory of Open Access Journals (Sweden)

    Evropi Theodoratou

    Full Text Available BACKGROUND: Pneumonia is the leading cause of child deaths globally. The aims of this study were to: a estimate the number and global distribution of pneumonia deaths for children 1-59 months for 2008 for countries with low (85% coverage of death certification countries was used. For 87 high child-mortality countries pneumonia death estimates were obtained by applying a regression model developed from published and unpublished verbal autopsy data from high child-mortality settings. The total number of 1-59 months pneumonia deaths for the year 2008 for these 122 countries was estimated to be 1.18 M (95% CI 0.77 M-1.80 M, which represented 23.27% (95% CI 17.15%-32.75% of all 1-59 month child deaths. The country level estimation correlation coefficient between these two methods was 0.40. INTERPRETATION: Although the overall number of post-neonatal pneumonia deaths was similar irrespective to the method of estimation used, the country estimate correlation coefficient was low, and therefore country-specific estimates should be interpreted with caution. Pneumonia remains the leading cause of child deaths and is greatest in regions of poverty and high child-mortality. Despite the concerns about gender inequity linked with childhood mortality we could not estimate sex-specific pneumonia mortality rates due to the inadequate data. Life-saving interventions effective in preventing and treating pneumonia mortality exist but few children in high pneumonia disease burden regions are able to access them. To achieve the United Nations Millennium Development Goal 4 target to reduce child deaths by two-thirds in year 2015 will require the scale-up of access to these effective pneumonia interventions.

  9. Bacteremia with Streptococcus pneumoniae

    DEFF Research Database (Denmark)

    Christensen, J S; Jensen, T G; Kolmos, H J;

    2012-01-01

    severe sepsis, and 11 (3 %) were in septic shock. Overall, the 30-day mortality was 16 %. Mortality increased with the severity of sepsis. There was no association between the focal diagnosis of SPB or the number of diagnoses and mortality. Nosocomial infection, male sex, increasing age, and increasing...

  10. Tetanus-diphtheria-acellular pertussis vaccination of adults in the USA.

    Science.gov (United States)

    Gidengil, Courtney A; Sandora, Thomas J; Lee, Grace M

    2008-07-01

    Pertussis is an important cause of morbidity and mortality, and its incidence has been increasing in adolescents and adults over the past two decades. Waning immunity in adolescents and adults may be partially responsible. Adults can suffer significant illness from pertussis and its complications, such as pneumonia, rib fractures and syncope. Moreover, adults serve as a source of disease for infants, who are more vulnerable to severe complications and even death. The economic burden of pertussis is substantial, in terms of both medical and nonmedical costs. Fortunately, the burden of pertussis disease can now be safely and effectively reduced by vaccinating adults with tetanus-diphtheria-acellular pertussis (Tdap) vaccine. Further research is needed to elucidate the role of vaccination in pregnant women and those over 65 years of age, and also to determine whether further booster doses of Tdap are needed.

  11. Asthma and pneumonia among children less than five years with acute respiratory symptoms in Mulago Hospital, Uganda

    DEFF Research Database (Denmark)

    Nantanda, Rebecca; Tumwine, James K; Ndeezi, Grace;

    2013-01-01

    Pneumonia is considered the major cause of mortality among children with acute respiratory disease in low-income countries but may be over-diagnosed at the cost of under-diagnosing asthma. We report the magnitude of asthma and pneumonia among "under-fives" with cough and difficulty breathing, based...

  12. Exogenous lipid pneumonia

    International Nuclear Information System (INIS)

    Exogenous lipid pneumonia (ELP) is caused by the aspiration of animal, vegetal or, more often, mineral oils. Even though it may also be acute, ELP is most frequently a chronic disease, affecting people with predisposing factors, such as neuromuscular disorders, structural abnormalities and so on; very often exogenous lipid pneumonia is found in tracheotomized patients. The pathology of lipid pneumonia is a chronic inflammatory process evolving in foreign-body-like reaction, and eventually in ''end-stage lung'' condition. Clinically, most patients are asymptomatic; few cases only present with cough, dyspnea and chest pain. Eight cases of ELP, studied over the past 3 years, are described in this paper. All the patients were examined by chest radiographs and standard tomograms; 3 patients underwent CT. X-ray features were mono/bilateral consolidation of the lower zones, with air bronchogram and variable reduction in volume. CT density was not specific for fat tissue. In all cases the diagnosis was confirmed at biopsy. In 5 patients, followed for at least one year, clinical-radiological features showed no change. Thus, complications of ELP (especially malignant evolution) could be excluded. The authors conclude that lipid pneumonia must be considered in differential diagnosis of patients with history of usage of oils and compatible X-ray findings. The usefulness of an accurate follow-up is stressed

  13. Lipoid pneumonia: an overview.

    Science.gov (United States)

    Hadda, Vijay; Khilnani, Gopi C

    2010-12-01

    Lipoid pneumonia is an uncommon disease caused by the presence of lipid in the alveoli. It is classified into two major groups, depending on whether the lipid/oil in the respiratory tract is from an exogenous (exogenous lipoid pneumonia) or endogenous/idiopathic (endogenous lipoid pneumonia) source. The usual presentation occurs with insidious onset and nonspecific respiratory symptoms such as dyspnea and/or cough. The main radiological findings include airspace consolidations, ground-glass attenuation, airspace nodules and 'crazy-paving' pattern. However, the radiological appearance of the disorder can mimic many other lung diseases, including carcinoma. Owing to the nonspecific clinical presentation and radiological features, the diagnosis is often missed or delayed. Pathologically, lipoid pneumonia is a chronic foreign body reaction to fat, characterized by lipid-laden macrophages. Diagnosis of this disease requires a high index of suspicion and can be confirmed by demonstration of lipid-laden macrophages in respiratory samples such as sputum, bronchoalveolar lavage fluid or fine-needle aspiration cytology/biopsy from lung lesions. Treatment protocols for this illness are poorly defined. PMID:21128754

  14. Hypervirulent Klebsiella pneumoniae

    OpenAIRE

    Patel, Payal K.; Russo, Thomas A.; Karchmer, Adolf W.

    2014-01-01

    Hypervirulent strains of Klebsiella pneumoniae are associated with abscess formation, commonly hepatic, and metastatic spread, even in healthy patients. We describe a case of this clinical syndrome, genotypic and phenotypic features of the isolate, and briefly review epidemiology, clinical manifestations, and pathogenesis of this underappreciated syndrome.

  15. Procalcitonin for detecting community-acquired bacterial pneumonia

    Directory of Open Access Journals (Sweden)

    Devi Gusmaiyanto

    2015-03-01

    Full Text Available Background Pneumonia is a major cause of morbidity and mortality in children under five years of age. Pneumonia can be of bacterial or viral origin. It is difficult to distinguish between these two agents based on clinical manifestations, as well as radiological and laboratory examinations. Furthermore, bacterial cultures take time to incubate and positive results may only be found in 10-30% of bacterial pneumonia cases. Procalcitonin has been used as a marker to distinguish etiologies, as bacterial infections tend to increase serum procalcitonin levels. Objective To determine the sensitivity, specificity, positive predictive value and negative predictive value of procalcitonin in community-acquired bacterial pneumonia. Method This cross-sectional study was conducted in the Pediatric Health Department of Dr. M. Djamil Hospital, Padang. Subjects were selected by consecutive sampling. Procalcitonin measurements and PCR screening were performed on blood specimens from 32 pneumonia patients and compared. Results Of the 32 subjects, most were boys (56.25%, under 5 years of age (99%, and had poor nutritional status (68.75%. Using a cut-off point of 0.25 ng/mL, procalcitonin level had a sensitivity of 92%, specificity 50%, positive predictive value 88%, and negative predictive value 60% for diagnosing bacterial pneumonia. Using a cut-off point of 0.5 ng/mL, procalcitonin level had a specificity of 46%, specificity 83%, positive predictive value 91%, and negative predictive value 25%. Conclusion A cut-off point of 0.25 ng/mL of procalcitonin level may be more useful to screen for bacterial pneumonia than a cut-off point of 0.5 ng / mL. However, if the 0.25 ng/mL cut-off point is used, careful monitoring will be required for negative results, as up to 40% may actually have bacterial pneumonia. [Paediatr Indones. 2015;55:65-9.].

  16. Attribution of Causes of Weight Loss and Weight Gain to 3-Year Mortality in Older Adults : Results From the Longitudinal Aging Study Amsterdam

    NARCIS (Netherlands)

    Wijnhoven, Hanneke A. H.; van Zon, Sander K. R.; Twisk, Jos; Visser, Marjolein

    2014-01-01

    Background. Weight loss is associated with a higher mortality risk in old age, but the underlying cause may impact this association. We examined associations between causes of intentional and unintentional weight loss and weight gain and mortality. Methods. We used data of five triannual examination

  17. Lung VITAL: Rationale, design, and baseline characteristics of an ancillary study evaluating the effects of vitamin D and/or marine omega-3 fatty acid supplements on acute exacerbations of chronic respiratory disease, asthma control, pneumonia and lung function in adults.

    Science.gov (United States)

    Gold, Diane R; Litonjua, Augusto A; Carey, Vincent J; Manson, JoAnn E; Buring, Julie E; Lee, I-Min; Gordon, David; Walter, Joseph; Friedenberg, Georgina; Hankinson, John L; Copeland, Trisha; Luttmann-Gibson, Heike

    2016-03-01

    Laboratory and observational research studies suggest that vitamin D and marine omega-3 fatty acids may reduce risk for pneumonia, acute exacerbations of respiratory diseases including chronic obstructive lung disease (COPD) or asthma, and decline of lung function, but prevention trials with adequate dosing, adequate power, and adequate time to follow-up are lacking. The ongoing Lung VITAL study is taking advantage of a large clinical trial-the VITamin D and OmegA-3 TriaL (VITAL)--to conduct the first major evaluation of the influences of vitamin D and marine omega-3 fatty acid supplementation on pneumonia risk, respiratory exacerbation episodes, asthma control and lung function in adults. VITAL is a 5-year U.S.-wide randomized, double-blind, placebo-controlled, 2 × 2 factorial trial of supplementation with vitamin D3 ([cholecalciferol], 2000 IU/day) and marine omega-3 FA (Omacor® fish oil, eicosapentaenoic acid [EPA]+docosahexaenoic acid [DHA], 1g/day) for primary prevention of CVD and cancer among men and women, at baseline aged ≥50 and ≥55, respectively, with 5107 African Americans. In a subset of 1973 participants from 11 urban U.S. centers, lung function is measured before and two years after randomization. Yearly follow-up questionnaires assess incident pneumonia in the entire randomized population, and exacerbations of respiratory disease, asthma control and dyspnea in a subpopulation of 4314 randomized participants enriched, as shown in presentation of baseline characteristics, for respiratory disease, respiratory symptoms, and history of cigarette smoking. Self-reported pneumonia hospitalization will be confirmed by medical record review, and exacerbations will be confirmed by Center for Medicare and Medicaid Services data review.

  18. The burden and etiology of community-onset pneumonia in the aging Japanese population: a multicenter prospective study.

    Directory of Open Access Journals (Sweden)

    Konosuke Morimoto

    Full Text Available The increasing burden of pneumonia in adults is an emerging health issue in the era of global population aging. This study was conducted to elucidate the burden of community-onset pneumonia (COP and its etiologic fractions in Japan, the world's most aged society.A multicenter prospective surveillance for COP was conducted from September 2011 to January 2013 in Japan. All pneumonia patients aged ≥ 15 years, including those with community-acquired pneumonia (CAP and health care-associated pneumonia (HCAP, were enrolled at four community hospitals on four major islands. The COP burden was estimated based on the surveillance data and national statistics.A total of 1,772 COP episodes out of 932,080 hospital visits were enrolled during the surveillance. The estimated overall incidence rates of adult COP, hospitalization, and in-hospital death were 16.9 (95% confidence interval, 13.6 to 20.9, 5.3 (4.5 to 6.2, and 0.7 (0.6 to 0.8 per 1,000 person-years (PY, respectively. The incidence rates sharply increased with age; the incidence in people aged ≥ 85 years was 10-fold higher than that in people aged 15-64 years. The estimated annual number of adult COP cases in the entire Japanese population was 1,880,000, and 69.4% were aged ≥ 65 years. Aspiration-associated pneumonia (630,000 was the leading etiologic category, followed by Streptococcus pneumoniae-associated pneumonia (530,000, Haemophilus influenzae-associated pneumonia (420,000, and respiratory virus-associated pneumonia (420,000, including influenza-associated pneumonia (30,000.A substantial portion of the COP burden occurs among elderly members of the Japanese adult population. In addition to the introduction of effective vaccines for S. pneumoniae and influenza, multidimensional approaches are needed to reduce the pneumonia burden in an aging society.

  19. Hemophagocytic Syndrome Associated with Mycoplasma pneumoniae Pneumonia

    Directory of Open Access Journals (Sweden)

    Yuji Koike

    2013-01-01

    Full Text Available Mycoplasma pneumoniae (Mp sometimes causes immunological complications in children. We present a rare case of hemophagocytic syndrome (HPS caused by Mp in a previously healthy 7-year-old Japanese girl. A chest radiograph obtained to evaluate the source of her fever showed infiltration in the lower right lung with mild splenomegaly. We could diagnose the patient with HPS on the basis of the hemophagocytic-lymphohistiocytosis- (HLH 2004 criteria. She met the criteria for fever, splenomegaly, neutrophil count (265 mg/dL, and ferritin level (>500 ng/mL. Furthermore, a peripheral blood smear showed an increased number of monocytes/macrophages with erythrophagocytosis. Treatment with clarithromycin and prednisolone, which was initiated soon after the diagnosis, was successful. Mp infection might partly progress to HPS in certain conditions. Clinicians should be aware of HPS caused by Mp and start appropriate treatment as soon as possible if the disease is suspected.

  20. ASSOCIATION OF MYCOPLASMA PNEUMONIAE WITH RESPIRATORY TRACT INFECTIONS IN CHILDREN

    Directory of Open Access Journals (Sweden)

    Osama Mohammed Saed Abdul-Wahab

    2013-01-01

    Full Text Available Mycoplasma pneumoniae is one of four most common species of organisms that are responsible for most clinically significant infections in humans. It is a frequent cause of acute respiratory infections in both children and adults. The organism can cause pharyngitis, otitis, tracheobronchitis, or community-acquired pneumonia, but patients may also remain totally asymptomatic. Aim of this prospective study for children, was to investigate the association of M. pneumoniae with respiratory tract infections in a Saudi population. This study was designed as a case-control study in which 90 patients (Mean age of the patients in case group was 5.94±2.73 and in control group was 6.51±2.26 of either sexes were included. These patients were classified into two groups: first group (case group, included 45 patients who had been admitted in hospital with diagnosis of respiratory tract infections and the second group (control group, included 45 healthy patients who had no history of respiratory tract infections. Both the groups were age and sex matched. Presence of IgM antibodies to Mycoplasma pneumoniae was assessed by ELISA technique in both groups. In the case group, 4 (9% cases out of 45 children were positive for anti-mycoplasma antibody whereas in the control group, all children were negative. All positive case group patients had symptoms of acute pneumonia. 18 (40% of the patients were diagnosed with bronchial asthma (40% inclusive of all the four cases diagnosed with Mycoplasma pneumoniae infection. The relative risk for the occurrence of mycoplasma infection was estimated to be 9 (95%C.I = 0.49-162.43. However, on comparing the case and control groups, the result was not found to be statistically significant. (Fischer Exact Test p = 0.0583. Children in Saudi Arabia are at a relatively higher risk of developing Mycoplasma pneumoniae infection especially those predisposed with underlying chronic respiratory illnesses such as asthma. This is a first

  1. Analyze of Ventilator Associated Pneumonia

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    Aysel Sunnetcioglu

    2014-03-01

    Full Text Available Aim: Ventilator-associated pneumonia (VAP is the infection that is an important cause of morbidity and mortality developed in patients whom the invasive mechanical ventilation (MV were performed in intensive care units (ICU. In this study, the factors of VAP developing in patients whom the mechanical ventilation of ICU performed, antibiotic susceptibility to these factors and determining the risk factors were aimed. Material and Method: Between January 2009 and March 2013, 79 cases, followed with the mechanical ventilation for at least for 48 hours and developed VAP, were retrospectively reviewed at Anesthesiology and Intensive Care Unit of Reanimation at Faculty of Medicine at Yuzuncu Yil University, performing endotracheal intubation. The cases were evaluated in terms of microorganisms, antibiotic susceptibility and risk factors. Results: The rate of our VAP speed was calculated to be 19.68 on the day of 1000 ventilator. While a single microorganism could be isolated in 81.1% of the 74 VAP cases whose the active pathogen could be isolated, two or more than two microorganisms were isolated in 18.9% of them.While 83 of the strains (90.2% were gram-negative bacteria, 7 of them (7.6% were gram-positive bacteria. Acinetobacter spp. (40.2% was most commonly isolated as a gram-negative factor, but methicillin-resistant S. aureus (4.3% was isolated as a gram-positive factor. It was determined that the isolated factors in VAP cases were significantly resistant to the broad-spectrum antibiotics. Discussion: As a result, in patients with high-risk factors for the development of VAP, early and appropriate empirical antibiotic treatment should be started according to the results of the sensitivity of the unit and for the multi-drug-resistant microorganisms with common and high mortality.

  2. Neonatal varicella pneumonia, surfactant replacement therapy

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    Mousa Ahmadpour-kacho

    2015-12-01

    Full Text Available Background: Chickenpox is a very contagious viral disease that caused by varicella-zoster virus, which appears in the first week of life secondary to transplacental transmission of infection from the affected mother. When mother catches the disease five days before and up to two days after the delivery, the chance of varicella in neonate in first week of life is 17%. A generalized papulovesicular lesion is the most common clinical feature. Respiratory involvement may lead to giant cell pneumonia and respiratory failure. The mortality rate is up to 30% in the case of no treatment, often due to pneumonia. Treatment includes hospitalization, isolation and administration of intravenous acyclovir. The aim of this case report is to introduce the exogenous surfactant replacement therapy after intubation and mechanical ventilation for respiratory failure in neonatal chickenpox pneumonia and respiratory distress. Case Presentation: A seven-day-old neonate boy was admitted to the Neonatal Intensive Care Unit at Amirkola Children’s Hospital, Babol, north of Iran, with generalized papulovesicular lesions and respiratory distress. His mother has had a history of Varicella 4 days before delivery. He was isolated and given supportive care, intravenous acyclovir and antibiotics. On the second day, he was intubated and connected to mechanical ventilator due to severe pneumonia and respiratory failure. Because of sever pulmonary involvement evidenced by Chest X-Ray and high ventilators set-up requirement, intratracheal surfactant was administered in two doses separated by 12 hours. He was discharged after 14 days without any complication with good general condition. Conclusion: Exogenous surfactant replacement therapy can be useful as an adjunctive therapy for the treatment of respiratory failure due to neonatal chickenpox.

  3. Aetiology and prediction of pneumonia in lower respiratory tract infection in primary care

    DEFF Research Database (Denmark)

    Holm, Anette; Nexoe, Joergen; Bistrup, Lene A;

    2007-01-01

    BACKGROUND: Knowledge of predominant pathogens and their association with outcome are of importance for the management of lower respiratory tract infection (LRTI). As antibiotic therapy is indicated in pneumonia and not in acute bronchitis, a predictor of pneumonia is needed. AIM: To describe...... the aetiology and outcome of LRTI in adults with pneumonic and adults with non-pneumonic LRTI treated in general practice and to identify predictors of radiographic pneumonia. DESIGN OF STUDY: Prospective, observational study. SETTING: Forty-two general practices and an outpatient clinic at the Department....... Primary outcome measure was hospitalisation within 4 weeks. RESULTS: Pneumonia was radiographically verified in 48 of 364 patients (13%). Bacterial infection was seen more often in patients with pneumonia (33% versus 17%, P

  4. Trauma-related mortality among adults in Rural Western Kenya: characterising deaths using data from a health and demographic surveillance system.

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    Frank O Odhiambo

    Full Text Available BACKGROUND: Information on trauma-related deaths in low and middle income countries is limited but needed to target public health interventions. Data from a health and demographic surveillance system (HDSS were examined to characterise such deaths in rural western Kenya. METHODS AND FINDINGS: Verbal autopsy data were analysed. Of 11,147 adult deaths between 2003 and 2008, 447 (4% were attributed to trauma; 71% of these were in males. Trauma contributed 17% of all deaths in males 15 to 24 years; on a population basis mortality rates were greatest in persons over 65 years. Intentional causes accounted for a higher proportion of male than female deaths (RR 2.04, 1.37-3.04 and a higher proportion of deaths of those aged 15 to 65 than older people. Main causes in males were assaults (n=79, 25% and road traffic injuries (n=47, 15%; and falls for females (n=17, 13%. A significantly greater proportion of deaths from poisoning (RR 5.0, 2.7-9.4 and assault (RR 1.8, 1.2-2.6 occurred among regular consumers of alcohol than among non-regular drinkers. In multivariate analysis, males had a 4-fold higher risk of death from trauma than females (Adjusted Relative Risk; ARR 4.0; 95% CI 1.7-9.4; risk of a trauma death rose with age, with the elderly at 7-fold higher risk (ARR 7.3, 1.1-49.2. Absence of care was the strongest predictor of trauma death (ARR 12.2, 9.4-15.8. Trauma-related deaths were higher among regular alcohol drinkers (ARR 1.5, 1.1-1.9 compared with non-regular drinkers. CONCLUSIONS: While trauma accounts for a small proportion of deaths in this rural area with a high prevalence of HIV, TB and malaria, preventive interventions such as improved road safety, home safety strategies for the elderly, and curbing harmful use of alcohol, are available and could help diminish this burden. Improvements in systems to record underlying causes of death from trauma are required.

  5. Multi-model inference of adult and childhood leukaemia excess relative risks based on the Japanese A-bomb survivors mortality data (1950-2000).

    Science.gov (United States)

    Walsh, Linda; Kaiser, Jan Christian

    2011-03-01

    Some relatively new issues that augment the usual practice of ignoring model uncertainty, when making inference about parameters of a specific model, are brought to the attention of the radiation protection community here. Nine recently published leukaemia risk models, developed with the Japanese A-bomb epidemiological mortality data, have been included in a model-averaging procedure so that the main conclusions do not depend on just one type of model or statistical test. The models have been centred here at various adult and young ages at exposure, for some short times since exposure, in order to obtain specially computed childhood Excess Relative Risks (ERR) with uncertainties that account for correlations in the fitted parameters associated with the ERR dose-response. The model-averaged ERR at 1 Sv was not found to be statistically significant for attained ages of 7 and 12 years but was statistically significant for attained ages of 17, 22 and 55 years. Consequently, such risks when applied to other situations, such as children in the vicinity of nuclear installations or in estimates of the proportion of childhood leukaemia incidence attributable to background radiation (i.e. low doses for young ages and short times since exposure), are only of very limited value, with uncertainty ranges that include zero risk. For example, assuming a total radiation dose to a 5-year-old child of 10 mSv and applying the model-averaged risk at 10 mSv for a 7-year-old exposed at 2 years of age would result in an ERR=0.33, 95% CI: -0.51 to 1.22. One model (United Nations scientific committee on the effects of atomic radiation report. Volume 1. Annex A: epidemiological studies of radiation and cancer, United Nations, New York, 2006) weighted model-averaged risks of leukaemia most strongly by half of the total unity weighting and is recommended for application in future leukaemia risk assessments that continue to ignore model uncertainty. However, on the basis of the analysis

  6. Chronic granulomatous disease presenting as refractory pneumonia in late adulthood

    OpenAIRE

    SARWAR, Ghulam; de Malmanche, Theo; Rassam, Loui; Grainge, Christopher; Williams, Andrew; Arnold, David

    2015-01-01

    We present a case of refractory pneumonia in an adult patient with underlying chronic granulomatous disease (CGD). Her lobectomy tissue grew B urkholderia cepacia and histopathology revealed diffuse severe pneumonic consolidation with suppurative/necrotizing granulomata. An initial attempt to find an underlying immune deficiency was unsuccessful. Following recurrent invasive infections, repeat immunological assessment revealed reduced neutrophil function, demonstrating skewed carrier status (...

  7. Rainfall is a risk factor for sporadic cases of Legionella pneumophila pneumonia.

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    Carolina Garcia-Vidal

    Full Text Available It is not known whether rainfall increases the risk of sporadic cases of Legionella pneumonia. We sought to test this hypothesis in a prospective observational cohort study of non-immunosuppressed adults hospitalized for community-acquired pneumonia (1995-2011. Cases with Legionella pneumonia were compared with those with non-Legionella pneumonia. Using daily rainfall data obtained from the regional meteorological service we examined patterns of rainfall over the days prior to admission in each study group. Of 4168 patients, 231 (5.5% had Legionella pneumonia. The diagnosis was based on one or more of the following: sputum (41 cases, antigenuria (206 and serology (98. Daily rainfall average was 0.556 liters/m(2 in the Legionella pneumonia group vs. 0.328 liters/m(2 for non-Legionella pneumonia cases (p = 0.04. A ROC curve was plotted to compare the incidence of Legionella pneumonia and the weighted median rainfall. The cut-off point was 0.42 (AUC 0.54. Patients who were admitted to hospital with a prior weighted median rainfall higher than 0.42 were more likely to have Legionella pneumonia (OR 1.35; 95% CI 1.02-1.78; p = .03. Spearman Rho correlations revealed a relationship between Legionella pneumonia and rainfall average during each two-week reporting period (0.14; p = 0.003. No relationship was found between rainfall average and non-Legionella pneumonia cases (-0.06; p = 0.24. As a conclusion, rainfall is a significant risk factor for sporadic Legionella pneumonia. Physicians should carefully consider Legionella pneumonia when selecting diagnostic tests and antimicrobial therapy for patients presenting with CAP after periods of rainfall.

  8. Socioeconomic position in early life, birth weight, childhood cognitive function, and adult mortality. A longitudinal study of Danish men born in 1953

    DEFF Research Database (Denmark)

    Osler, M; Andersen, Anne-Marie Nybo; Due, P;

    2003-01-01

    characteristics had been traced manually in 1965. This population was followed up from April 1968 to January 2002 for information on mortality. MAIN OUTCOME MEASURES: Mortality from all causes, cardiovascular diseases, and violent deaths. RESULTS: Men whose fathers were working class or of unknown social class at......OBJECTIVE: To examine the relation between socioeconomic position in early life and mortality in young adulthood, taking birth weight and childhood cognitive function into account. DESIGN: A longitudinal study with record linkage to the Civil Registration System and Cause of Death Registry. The...... time of birth had higher mortality rates compared with those whose fathers were high/middle class: hazard ratio 1.39 (95% CI 1.15 to 1.67) and 2.04 (95% CI 1.48 to 2.83) respectively. Birth weight and childhood cognitive function were both related to father's social class and inversely associated with...

  9. All-cause mortality in treated HIV-infected adults with CD4 ≥500/mm3 compared with the general population

    DEFF Research Database (Denmark)

    Lewden, Charlotte; Bouteloup, Vincent; De Wit, Stéphane;

    2012-01-01

    Using data from a large European collaborative study, we aimed to identify the circumstances in which treated HIV-infected individuals will experience similar mortality rates to those of the general population....

  10. High-resolution CT findings of varicella-zoster pneumonia

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    Choo, Hye Jeung; Kim, Kun Il [Busan National Univ. Hospital, Busan (Korea, Republic of); Lee, Ki Nam [College of Medicine, Donga Univ., Busan (Korea, Republic of)

    2003-12-01

    To describe the high-resolution CT findings of varicella-zoster pneumonia. Seven adult patients with clinically and serologically diagnosed varicella-zoster pneumonia underwent HRCT scanning. One had undergone a kidney transplant, and the others were immunocompetent. The HRCT findings were retrospectively analyzed by two radiologists in terms of the presence of a nodule, pneumonia consolidation, ground-glass attenuation and pleural effusion, and with regard to the number, size and distribution of nodules. HRCT findings of varicella pneumonia included nodule (n=7), consolidation (n=3), diffuse ground-glass attenuation (n=1) and pleural effusion (n=1). Nodules were mostly 2-10 mm in size, and multiple (n=6), and zonal predominancy was not apparent. One case in which HRCT demonstrated diffuse ground-glass opacity and slight bilateral pleural effusion involved a patient in whom complications of acute respiratory distress syndrome occured. When HRCT demonstrates the presence of nodules 2-10 mm in size multiple nodules, or nodule surrounded by ground-glass attenuation, or the coalescence of nodules and consolidation is observed in adults with chickenpox, the varicella-zoster pneumonia should be included in the differential diagnosis.

  11. Cause-specific hospital admission and mortality among working men: association with socioeconomic circumstances in childhood and adult life, and the mediating role of daily stress

    OpenAIRE

    Metcalfe, C.; Davey Smith, G; Sterne, J A C; Heslop, P.; Macleod, J.; Hart, C. L.

    2005-01-01

    BACKGROUND: The aim of this study was to investigate the association of childhood and adulthood social class with the occurrence of specific diseases, including those not associated with a high mortality rate, and to investigate daily stress as the mechanism for that part of any association which cannot be accounted for by established risk factors. METHODS: This was a prospective cohort study with 25 years of follow-up for cause-specific morbidity and mortality. A total of 5577 Scottish men w...

  12. Pneumonia relevant to lung transplantation and pathogen distribution

    Institute of Scientific and Technical Information of China (English)

    HE Xuan; DAI Hua-ping; CHEN Qi-rui; MIAO Jin-bai; SUN Bing; BAO Na; HU Bin

    2013-01-01

    Background Pneumonia is the most common cause of morbidity and mortality in lung transplant (LT) recipients.The aim of the present study was to evaluate the incidence,etiology,risk factors and prognosis of pneumonia in LT recipients.Methods The LT cohort consisted of 28 recipients receiving LT in Beijing Chao-Yang Hospital from August 2005 to April 2011.Data collected included demographic data,underlying disorders,time and type of transplant,follow-up information,date of last follow-up,and patient status.A retrospective analysis was made of observational data that were prospectively collected.Results Twenty-two patients of 28 LT recipients had 47 episodes of pneumonia throughout the study period.Thirtyeight episodes of pneumonia in 19 recipients occurred post-LT with a median follow-up of 257.5 days (1-2104 days),the incidence of pneumonia was 192.4 episodes per 100 LT/year and its median time of onset was 100.5 days (0-946 days) post-transplantation.Bacteria,virus and fungi accounted for 62%,16% and 15% of the microbial pathogens,respectively.The most frequent were Pseudomonas aeruginosa (20%),cytomegalovirus (CMV) (15%),and Aspergillus fumigatus (10%).A total of 29% (11/38) of pneumonias occurred in the first month post-LT,and then the incidence decreased gradually.The incidence of CMV pneumonia was 25% (7/28) with a median time of 97 days (10-971 days).More than one bacterial infection and CMV infection were independent risk factors for aspergillus infection.The incidence of pulmonary tuberculosis (TB) was 18% (5/28),and the history of TB was a risk factor for TB relapse.There were 58% (7/12) of recipients who died of infection,and 71% (5/7) of these died in the first year after LT.Conclusions Pneumonia is still a major cause of morbidity and mortality in LT recipients.The most frequent microorganisms were Pseudomonas aeruginosa,CMV,and Aspergillus fumigates.The incidence of CMV pneumonia decreases with a delayed median time of onset

  13. Idiopathic chronic eosinophilic pneumonia

    OpenAIRE

    Cordier Jean-François; Marchand Eric

    2006-01-01

    Abstract Idiopathic chronic eosinophilic pneumonia (ICEP) is characterized by subacute or chronic respiratory and general symptoms, alveolar and/or blood eosinophilia, and peripheral pulmonary infiltrates on chest imaging. Eosinophilia is present in most cases, usually in excess of 1000/mm3. In absence of significant blood eosinophilia, a diagnosis of ICEP is supported by the demonstration of bronchoalveolar lavage eosinophilia. ICEP is typically associated with eosinophil counts higher than ...

  14. Non-Intensive Care Unit Acquired Pneumonia: A New Clinical Entity?

    Science.gov (United States)

    Di Pasquale, Marta; Aliberti, Stefano; Mantero, Marco; Bianchini, Sonia; Blasi, Francesco

    2016-01-01

    Hospital-acquired pneumonia (HAP) is a frequent cause of nosocomial infections, responsible for great morbidity and mortality worldwide. The majority of studies on HAP have been conducted in patients hospitalized in the intensive care unit (ICU), as mechanical ventilation represents a major risk factor for nosocomial pneumonia and specifically for ventilator-associated pneumonia. However, epidemiological data seem to be different between patients acquiring HAP in the ICU vs. general wards, suggesting the importance of identifying non ICU-acquired pneumonia (NIAP) as a clinical distinct entity in terms of both etiology and management. Early detection of NIAP, along with an individualized management, is needed to reduce antibiotic use and side effects, bacterial resistance and mortality. The present article reviews the pathophysiology, diagnosis, treatment and prevention of NIAP. PMID:26927074

  15. Prophylactic antibiotics at the time of tracheotomy lowers the incidence of pneumonia

    DEFF Research Database (Denmark)

    Johansen, Nicklas Järvelä; Hahn, Christoffer Holst

    2015-01-01

    INTRODUCTION: Nosocomial pneumonia in relation to tracheotomy is a well-known complication. The aim of the present study was to study prophylactic antibiotics at the time of tracheotomy as a protective factor against nosocomial pneumonia. METHODS: A retrospective follow-up study was conducted...... for inclusion, forming a group without antibiotics (n = 53) treatment and a group with antibiotics (n = 35) treatment. RESULTS: In the group without antibiotics, 67% (n = 34) developed pneumonia (not including aspirational) versus 44% (n = 14) in the group with antibiotics (p = 0.04). The 30-day mortality...... was 10% (n = 9), and the one-year mortality was 58% (n = 42) for the total population, with no statistically significant differences between the groups. Pneumonia after tracheotomy prolonged the hospitalisation time regardless of grouping. In the group without antibiotics, the median was seven days...

  16. [Pneumonia awareness year, 2004: scientific impact through publications in Archivos de Bronconeumología].

    Science.gov (United States)

    Rajas Naranjo, Olga; Aspa Marco, Javier

    2006-10-01

    Pneumonia is a common and potentially serious infectious disease. Morbidity and mortality rates continue to be high in spite of major advances and steady progress in diagnosis and treatment. The economic impact of the disease is also great. It is therefore necessary to enlist the public, primary care and emergency physicians, and public policy administrators to join forces to treat and prevent pneumonia for the common good. The annual incidence of pneumonia in the population over the age of 14 years is 1.6 to 2.6 episodes/1000 inhabitants. The mortality rate is 14.1 per 100,000 inhabitants, and the associated costs are 115 million euros annually. The RESPIRA Foundation and the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) declared 2004 to be pneumonia awareness year with the aim of coordinating efforts to raise awareness, distribute information, and foster debate. PMID:17067522

  17. Non-Intensive Care Unit Acquired Pneumonia: A New Clinical Entity?

    Directory of Open Access Journals (Sweden)

    Marta Di Pasquale

    2016-02-01

    Full Text Available Hospital-acquired pneumonia (HAP is a frequent cause of nosocomial infections, responsible for great morbidity and mortality worldwide. The majority of studies on HAP have been conducted in patients hospitalized in the intensive care unit (ICU, as mechanical ventilation represents a major risk factor for nosocomial pneumonia and specifically for ventilator-associated pneumonia. However, epidemiological data seem to be different between patients acquiring HAP in the ICU vs. general wards, suggesting the importance of identifying non ICU-acquired pneumonia (NIAP as a clinical distinct entity in terms of both etiology and management. Early detection of NIAP, along with an individualized management, is needed to reduce antibiotic use and side effects, bacterial resistance and mortality. The present article reviews the pathophysiology, diagnosis, treatment and prevention of NIAP.

  18. Pneumonia in HIV-infected persons: increased risk with cigarette smoking and treatment interruption

    DEFF Research Database (Denmark)

    Gordin, Fred M; Roediger, Mollie P; Girard, Pierre-Marie;

    2008-01-01

    RATIONALE: Bacterial pneumonia is a major cause of morbidity for HIV-infected persons and contributes to excess mortality in this population. OBJECTIVES: To evaluate the frequency and risk factors for occurrence of bacterial pneumonia in the present era of potent antiretroviral therapy. METHODS: We...... evaluated data from a randomized trial of episodic antiretroviral therapy. The study, Strategies for Management of Antiretroviral Therapy, enrolled 5,472 participants at 318 sites in 33 countries. Study patients had more than 350 CD4 cells at baseline. Diagnosis of bacterial pneumonia was confirmed...... by a blinded clinical-events committee. MEASUREMENTS AND MAIN RESULTS: During a mean follow-up of 16 months, 116 participants (2.2%) developed at least one episode of bacterial pneumonia. Patients randomized to receive episodic antiretroviral therapy were significantly more likely to develop pneumonia than...

  19. Coxiella burnetii pneumonia.

    Science.gov (United States)

    Marrie, T J

    2003-04-01

    This report reviews the pulmonary and extrapulmonary manifestation of infections due to Coxiella burnetii. Q fever, a zoonosis, is due to infection with C. burnetii. This spore-forming microorganism is a small gram-negative coccobacillus that is an obligate intracellular parasite. The most common animal reservoirs are goats, cattle, sheep, cats, and occasionally dogs. The organism reaches high concentrations in the placenta of infected animals. Aerosolisation occurs at the time of parturition and infection follows inhalation of this aerosol. There are three distinct clinical syndromes of the acute form of the illness: nonspecific febrile illness, pneumonia, and hepatitis. The chronic form of Q fever is almost always endocarditis, but occasionally it is manifest as hepatitis, osteomyelitis or endovascular infection. The pneumonic form of the illness can range from very mild-to-severe pneumonia requiring assisted ventilation. Multiple round opacities are a common finding on chest radiography. Treatment with doxycycline or a fluoroquinolone is preferred. Susceptibility to macrolides is variable. In conclusion, Coxiella burnetii pneumonia should be considered when there is a suitable exposure history and when outbreaks of a pneumonic illness are being investigated. PMID:12762362

  20. Body mass index and all-cause mortality in a large prospective cohort of white and black U.S. Adults.

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    Alpa V Patel

    Full Text Available Remaining controversies on the association between body mass index (BMI and mortality include the effects of smoking and prevalent disease on the association, whether overweight is associated with higher mortality rates, differences in associations by race and the optimal age at which BMI predicts mortality. To assess the relative risk (RR of mortality by BMI in Whites and Blacks among subgroups defined by smoking, prevalent disease, and age, 891,572 White and 38,119 Black men and women provided height, weight and other information when enrolled in the Cancer Prevention Study II in 1982. Over 28 years of follow-up, there were 434,400 deaths in Whites and 18,702 deaths in Blacks. Cox proportional-hazards regression was used to estimate multivariable-adjusted relative risks (RR and 95% confidence intervals (CI. Smoking and prevalent disease status significantly modified the BMI-mortality relationship in Whites and Blacks; higher BMI was most strongly associated with higher risk of mortality among never smokers without prevalent disease. All levels of overweight and obesity were associated with a statistically significantly higher risk of mortality compared to the reference category (BMI 22.5-24.9 kg/m2, except among Black women where risk was elevated but not statistically significant in the lower end of overweight. Although absolute mortality rates were higher in Blacks than Whites within each BMI category, relative risks (RRs were similar between race groups for both men and women (p-heterogeneity by race  = 0.20 for men and 0.23 for women. BMI was most strongly associated with mortality when reported before age 70 years. Results from this study demonstrate for the first time that the BMI-mortality relationship differs for men and women who smoke or have prevalent disease compared to healthy never-smokers. These findings further support recommendations for maintaining a BMI between 20-25 kg/m2 for optimal health and longevity.