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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. Oral Care and Mortality in Older Adults with Pneumonia in Hospitals or Nursing Homes: Systematic Review and Meta-Analysis.

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    Sjögren, Petteri; Wårdh, Inger; Zimmerman, Mikael; Almståhl, Annica; Wikström, Maude

    2016-10-01

    The objectives of the study were to compare the effect of intensified oral care interventions given by dental or nursing personnel on mortality from healthcare-associated pneumonia (HAP) in elderly adults in hospitals or nursing homes with the effect of usual oral care. Systematic literature searches were conducted in PubMed, the Cochrane Library, and the Health Technology Assessment database of the National Health Service Centre for Reviews and Dissemination (August 2015). Randomized controlled trials (RCTs) were considered for inclusion. Data were extracted and risk of bias was assessed independently and agreed on in consensus meetings. Five RCTs, with some or major study limitations, fulfilled the inclusion criteria. Based on meta-analyses, oral care interventions given by dental personnel reduced mortality from HAP (risk ratio (RR) = 0.43, 95% confidence interval (CI) = 0.25-0.76, P = .003), whereas oral care interventions given by nursing personnel did not result in a statistically significant difference in mortality from HAP (RR = 1.20, 95% CI = 0.97-1.48, P = .09), in elderly adults in hospitals or nursing homes from usual oral care. Oral care interventions given by dental personnel may reduce mortality from HAP (low certainty of evidence, Grading of Recommendations Assessment, Development and Evaluation (GRADE) ⊕⊕○○), whereas oral care interventions given by nursing personnel probably result in little or no difference from usual care (moderate certainty of evidence, GRADE ⊕⊕⊕○) in elderly adults in hospitals or nursing homes.

  3. Pneumonia - adults - discharge

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    ... this page: //medlineplus.gov/ency/patientinstructions/000017.htm Pneumonia in adults - discharge To use the sharing features on this page, please enable JavaScript. You have pneumonia, which is an infection in your lungs. In ...

  4. 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.

  5. In-hospital mortality risk factors in community acquired pneumonia: evaluation of immunocompetent adult patients without comorbidities

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    Miguel Hernan Vicco

    2015-04-01

    Full Text Available Summary Objective: several scores were developed in order to improve the determination of community acquired pneumonia (CAP severity and its management, mainly CURB-65 and SACP score. However, none of them were evaluated for risk assessment of in-hospital mortality, particularly in individuals who were non-immunosuppressed and/or without any comorbidity. In this regard, the present study was carried out. Methods: we performed a cross-sectional study in 272 immunocompetent patients without comorbidities and with a diagnosis of CAP. Performance of CURB- 65 and SCAP scores in predicting in-hospital mortality was evaluated. Also, variables related to death were assessed. Furthermore, in order to design a model of in-hospital mortality prediction, sampled individuals were randomly divided in two groups. The association of the variables with mortality was weighed and, by multiple binary regression, a model was constructed in one of the subgroups. Then, it was validated in the other subgroup. Results: both scores yielded a fair strength of agreement, and CURB-65 showed a better performance in predicting in-hospital mortality. In our casuistry, age, white blood cell counts, serum urea and diastolic blood pressure were related to death. The model constructed with these variables showed a good performance in predicting in-hospital mortality; moreover, only one patient with fatal outcome was not correctly classified in the group where the model was constructed and in the group where it was validated. Conclusion: our findings suggest that a simple model that uses only 4 variables, which are easily accessible and interpretable, can identify seriously ill patients with CAP

  6. Ventilator-associated pneumonia and mortality

    NARCIS (Netherlands)

    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

  7. [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.

  8. Clinical Profile and Mortality in Children with Pneumonia

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    Ashvinii Manivel

    2015-06-01

    Full Text Available Background: Pneumonia is the leading killer in under-five children. Therefore, by identifying the danger signs, we are able to predict children who are at higher risk of mortality. The objective of the study is to identify the relationship between the clinical profile and mortality in children with pneumonia at Dr. Hasan Sadikin General Hospital, Bandung. Methods: This was an analytical study with a retrospective case control approach using medical records with patient’s age limitation of 1–60 month. The study period started on January 1st 2010 and ended on December 31st 2011. All types of pneumonia included whereas congenital anomalies, immunocompromised and Down’s syndrome patients were excluded in this study. Data were presented as frequency distribution. Results: During the study period, there were 653 children under age of 5 with pneumonia. Only 56 subjects met the inclusion and exclusion criteria. Twenty-eight patients with pneumonia were cured and 28 died. Based on the phi’s coefficient, tachycardia (α-value = 0.019 and hepatomegaly (α-value = 0.001 were significant predictors of death and based on the Mantel-Haenszel analysis, hepatomegaly (OR=9.62, CI 95% 2.349–39.35 was significant as a risk for mortality. Inability to drink, cyanosis, tachypnea, grunting, vomiting, convulsion, and unconsciousness were not related to mortality. Conclusion: Tachycardia and hepatomegaly have a significant relationship with mortality in under-five children with pneumonia.

  9. 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.

  10. 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.

  11. 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.

  12. Incidence of Hospitalized Pneumococcal Pneumonia among Adults in Guatemala, 2008-2012.

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    Carmen Lucía Contreras

    Full Text Available Streptococcus pneumoniae is a leading cause of pneumonia worldwide. However, the burden of pneumococcal pneumonia among adults in low- and middle-income countries is not well described.Data from 2008-2012 was analyzed from two surveillance sites in Guatemala to describe the incidence of pneumococcal pneumonia in adults. A case of hospitalized pneumococcal pneumonia was defined as a positive pneumococcal urinary antigen test or blood culture in persons aged ≥ 18 years hospitalized with an acute respiratory infection (ARI.Among 1595 adults admitted with ARI, 1363 (82% had either urine testing (n = 1286 or blood culture (n = 338 performed. Of these, 188 (14% had pneumococcal pneumonia, including 173 detected by urine only, 8 by blood culture only, and 7 by both methods. Incidence rates increased with age, with the lowest rate among 18-24 year-olds (2.75/100,000 and the highest among ≥65 year-olds (31.3/100,000. The adjusted incidence of hospitalized pneumococcal pneumonia was 18.6/100,000 overall, with in-hospital mortality of 5%.An important burden of hospitalized pneumococcal pneumonia in adults was described, particularly for the elderly. However, even adjusted rates likely underestimate the true burden of pneumococcal pneumonia in the community. These data provide a baseline against which to measure the indirect effects of the 2013 introduction of the pneumococcal conjugate vaccine in children in Guatemala.

  13. Mortality in adult congenital heart disease

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    Verheugt, Carianne L.; Uiterwaal, Cuno S. P. M.; van der Velde, Enno T.; Meijboom, Folkert J.; Pieper, Petronella G.; van Dijk, Arie P. J.; Vliegen, Hubert W.; Grobbee, Diederick E.; Mulder, Barbara J. M.

    2010-01-01

    Mortality in adults with congenital heart disease is known to be increased, yet its extent and the major mortality risks are unclear. The Dutch CONCOR national registry for adult congenital heart disease was linked to the national mortality registry. Cox's regression was used to assess mortality pre

  14. Lung ultrasound for the diagnosis of pneumonia in adults

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    Long, Ling; Zhao, Hao-Tian; Zhang, Zhi-Yang; Wang, Guang-Ying; Zhao, He-Ling

    2017-01-01

    Abstract Background: Pneumonia is a common and serious infectious disease that can cause high mortality. The role of lung ultrasound (LUS) in the diagnosis of pneumonia is becoming more and more important. Methods: In the present study, we collected existing evidence regarding the use of LUS to diagnose pneumonia in adults and conducted a systematic review to summarize the technique's diagnostic accuracy. We specifically searched the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, and Embase databases and retrieved outcome data to evaluate the efficacy of LUS for the diagnosis of pneumonia compared with chest radiography or chest computed tomography. The pooled sensitivity (SEN) and specificity (SPE) were determined using the Mantel–Haenszel method, and the pooled diagnostic odds ratio (DOR) was determined using the DerSimonian–Laird method. We also assessed heterogeneity of sensitivity, specificity, and diagnostic odds ratio using the Q and I2 statistics. Results: Twelve studies containing 1515 subjects were included in our meta-analysis. The SEN and SPE were 0.88 (95% CI: 0.86–0.90) and 0.86 (95% CI: 0.83–0.88), respectively. The pooled negative likelihood ratio (LR) was 0.13 (95% CI: 0.08–0.23), the positive LR was 5.37 (95% CI: 2.76–10.43), and the DOR was 65.46 (95% CI: 29.24–146.56). The summary receiver operating characteristic curve indicated a relationship between sensitivity and specificity. The area under the curve for LUS was 0.95. Conclusion: LUS can help to diagnose adult pneumonia with high accuracy. PMID:28099332

  15. Mortality in adult congenital heart disease

    NARCIS (Netherlands)

    C.L. Verheugt (Carianne); C.S.P.M. Uiterwaal (Cuno); E.T. van der Velde (Enno); F.J. Meijboom (Folkert); P.G. Pieper (Petronella); A.P.J. van Dijk (Arie); H.W. Vliegen (Hubert); D.E. Grobbee (Diederick); B.J.M. Mulder (Barbara)

    2010-01-01

    textabstractAimsMortality in adults with congenital heart disease is known to be increased, yet its extent and the major mortality risks are unclear.Methods and resultsThe Dutch CONCOR national registry for adult congenital heart disease was linked to the national mortality registry. Cox's regressio

  16. Risk Factors for Aspiration Pneumonia in Older Adults

    OpenAIRE

    2015-01-01

    BackgroundsAspiration 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.Methodology and Principal FindingsWe conducted an observational study using data from a nationwide survey of geri...

  17. Risk Factors for Aspiration Pneumonia in Older Adults

    OpenAIRE

    2015-01-01

    Backgrounds 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. Methodology and Principal Findings We conducted an observational study using data from a nationwide survey of g...

  18. [Nutritional status and mortality in community acquired pneumonia].

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    Rodríguez-Pecci, María Soledad; Carlson, Damián; Montero-Tinnirello, Javier; Parodi, Roberto L; Montero, Antonio; Greca, Alcides A

    2010-01-01

    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 tool to appraise the nutritional status. Ninety-eight patients with CAP requiring hospitalization were included consecutively from October 2004 to September 2006. The clinical, bacteriological and laboratory features were recorded. Patient's nutritional condition was assessed using the SGA. The monitoring was performed until discharge, death or shunt. Persistent cough or fever, the presence of pleural effusion, malignancies or long hospitalization were associated with worse prognosis. Mortality increased in proportion to the degree of malnutrition. Thirty two CAP patients (32.65%) were classified as SGA-category A; 44 (44.90%) as SGA-B, and 22 (22.45%) as SGA-C. Pneumonia resulted in death in 3/32 SGA-A (9.37%), 8/44 SGA-B (18.18%) and 10/22 SGA-C patients. SGA-C patients showed significantly higher odds ratios for death in comparison to SGA-A patients (OR = 6.085, CI95%: 1.071-34.591; p = 0.042). Considering death as the outcome variable, SGA-A class had the highest negative predictive value (0.906), while SGA-C class showed the highest positive predictive value (0.455). These results link the nutritional status to the NAC evolution prognostic. SGA provides a simple estimation of the nutritional status and it is a good predictor of the risk of death in CAP patients.

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

    NARCIS (Netherlands)

    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.

  1. 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.

  2. 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.

  3. Ventilator-associated pneumonia: the influence of bacterial resistance, prescription errors, and de-escalation of antimicrobial therapy on mortality rates

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    Ana Carolina Souza-Oliveira

    Full Text Available Abstract Ventilator-associated pneumonia is the most prevalent nosocomial infection in intensive care units and is associated with high mortality rates (14–70%. Aim This study evaluated factors influencing mortality of patients with Ventilator-associated pneumonia (VAP, including bacterial resistance, prescription errors, and de-escalation of antibiotic therapy. Methods This retrospective study included 120 cases of Ventilator-associated pneumonia admitted to the adult adult intensive care unit of the Federal University of Uberlândia. The chi-square test was used to compare qualitative variables. Student's t-test was used for quantitative variables and multiple logistic regression analysis to identify independent predictors of mortality. Findings De-escalation of antibiotic therapy and resistant bacteria did not influence mortality. Mortality was 4 times and 3 times higher, respectively, in patients who received an inappropriate antibiotic loading dose and in patients whose antibiotic dose was not adjusted for renal function. Multiple logistic regression analysis revealed the incorrect adjustment for renal function was the only independent factor associated with increased mortality. Conclusion Prescription errors influenced mortality of patients with Ventilator-associated pneumonia, underscoring the challenge of proper Ventilator-associated pneumonia treatment, which requires continuous reevaluation to ensure that clinical response to therapy meets expectations.

  4. Spectrum of excess mortality due to carbapenem-resistant Klebsiella pneumoniae infections.

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    Hauck, C; Cober, E; Richter, S S; Perez, F; Salata, R A; Kalayjian, R C; Watkins, R R; Scalera, N M; Doi, Y; Kaye, K S; Evans, S; Fowler, V G; Bonomo, R A; van Duin, D

    2016-06-01

    Patients infected or colonized with carbapenem-resistant Klebsiella pneumoniae (CRKp) are often chronically and acutely ill, which results in substantial mortality unrelated to infection. Therefore, estimating excess mortality due to CRKp infections is challenging. The Consortium on Resistance against Carbapenems in K. pneumoniae (CRACKLE) is a prospective multicenter study. Here, patients in CRACKLE were evaluated at the time of their first CRKp bloodstream infection (BSI), pneumonia or urinary tract infection (UTI). A control cohort of patients with CRKp urinary colonization without CRKp infection was constructed. Excess hospital mortality was defined as mortality in cases after subtracting mortality in controls. In addition, the adjusted hazard ratios (aHR) for time-to-hospital-mortality at 30 days associated with infection compared with colonization were calculated in Cox proportional hazard models. In the study period, 260 patients with CRKp infections were included in the BSI (90 patients), pneumonia (49 patients) and UTI (121 patients) groups, who were compared with 223 controls. All-cause hospital mortality in controls was 12%. Excess hospital mortality was 27% in both patients with BSI and those with pneumonia. Excess hospital mortality was not observed in patients with UTI. In multivariable analyses, BSI and pneumonia compared with controls were associated with aHR of 2.59 (95% CI 1.52-4.50, p pneumonia is associated with the highest excess hospital mortality. Patients with BSI have slightly lower excess hospital mortality rates, whereas excess hospital mortality was not observed in hospitalized patients with UTI.

  5. 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.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.)

  7. 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

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

    OpenAIRE

    Scott, JA; Brooks, WA; Peiris, JS; Holtzman, D.; Mulholland, EK

    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...

  9. Pneumococcal colonisation density: a new marker for disease severity in HIV-infected adults with pneumonia

    Science.gov (United States)

    Albrich, Werner C; Madhi, Shabir A; Adrian, Peter V; van Niekerk, Nadia; Telles, Jean-Noel; Ebrahim, N; Messaoudi, Melina; Paranhos-Baccalà, Glaucia; Giersdorf, Sven; Vernet, Guy; Mueller, Beat; Klugman, Keith P

    2014-01-01

    Objective A high genomic load of Pneumococcus from blood or cerebrospinal fluid has been associated with increased mortality. We aimed to analyse whether nasopharyngeal colonisation density in HIV-infected patients with community-acquired pneumonia (CAP) is associated with markers of disease severity or poor outcome. Methods Quantitative lytA real-time PCR was performed on nasopharyngeal swabs in HIV-infected South African adults hospitalised for acute CAP at Chris Hani Baragwanath Hospital, Soweto, South Africa. Pneumonia aetiology was considered pneumococcal if any sputum culture or Gram stain, urinary pneumococcal C-polysaccharide-based antigen, blood culture or whole blood lytA real-time PCR revealed pneumococci. Results There was a moderate correlation between the mean nasopharyngeal colonisation densities and increasing CURB65 scores among all-cause patients with pneumonia (Spearman correlation coefficient r=0.15, p=0.06) or with the Pitt bacteraemia score among patients with pneumococcal bacteraemia (p=0.63). In patients with pneumococcal pneumonia, nasopharyngeal pneumococcal colonisation density was higher among non-survivors than survivors (7.7 vs 6.1 log10 copies/mL, respectively, p=0.02) and among those who had pneumococci identified from blood cultures and/or by whole blood lytA real-time PCR than those with non-bacteraemic pneumococcal pneumonia (6.6 vs 5.6 log10 copies/mL, p=0.03). Nasopharyngeal colonisation density correlated positively with the biomarkers procalcitonin (Spearman correlation coefficient r=0.37, p<0.0001), proadrenomedullin (r=0.39, p=0.008) and copeptin (r=0.30, p=0.01). Conclusions In addition to its previously reported role as a diagnostic tool for pneumococcal pneumonia, quantitative nasopharyngeal colonisation density also correlates with mortality and prognostic biomarkers. It may also be useful as a severity marker for pneumococcal pneumonia in HIV-infected adults. PMID:25113557

  10. 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.

  11. 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.

  12. 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

  13. 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

  14. Risk Factors for Aspiration Pneumonia in Older Adults.

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    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

  15. Adherence to clinical practice guidelines on community acquired pneumonia and its relation to mortality rates.

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    María Caridad Fragoso Marchante

    2010-08-01

    Full Text Available Background: Community acquired pneumonia is a common disease that is associated with significant morbidity and mortality rates. In the General University Hospital ´´Dr. Gustavo Aldereguía Lima¨ in Cienfuegos, there are guidelines for the management of patients with community-acquired pneumonia, but no studies have been conducted as to the relation between their compliance and the mortality rate. Objective: To assess the adherence to guidelines for diagnosis and treatment of community-acquired pneumonia and its relation to mortality in hospitalized patients. Methods: A descriptive, observational and prospective case series study was conducted in all patients with a diagnosis of pneumonia or bronchopneumonia at the moment of admission and discharge from June 2006 to May 31, 2007. The relation between the different variables and the mortality rate was analyzed as to the different types of risks and the overall compliance with the guidelines for each risk with mortality. A multivariate analysis (logistic regression was performed, with a 95% confidence interval. Results: The results are presented in tables of numbers and percent. Variables independently associated with mortality were: age (over 65 years old people, radiological lesions in more than one lobe or bilateral, atypical pneumonia debut, negative assessments as to the adherence to guidelines and inadequate treatments. Conclusion: The variables included in the study were enough to explain the final outcome of the patients, so it could be determined, for the first time in Cienfuegos, that the non-compliance with the guidelines of good clinical practice is related to mortality rates.

  16. 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.

  17. 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.

  18. Risk prediction models for mortality in patients with ventilator-associated pneumonia

    DEFF Research Database (Denmark)

    Larsson, Johan Erik; Itenov, Theis Skovsgaard; Bestle, Morten Heiberg

    2016-01-01

    PURPOSE: Ventilator-associated pneumonia (VAP) is a common and serious complication in patients requiring mechanical ventilation in the intensive care unit. The aims of this study were to identify models used to predict mortality in VAP patients and to assess their prognostic accuracy. METHODS...

  19. 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.

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

    DEFF Research Database (Denmark)

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

    2004-01-01

    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...

  1. 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.

  2. Incident pneumonia and mortality in patients with chronic obstructive pulmonary disease. A double effect of inhaled corticosteroids?

    Science.gov (United States)

    Festic, Emir; Scanlon, Paul D

    2015-01-15

    Inhaled corticosteroids are commonly prescribed for patients with severe chronic obstructive pulmonary disease. Although their use improves quality of life and reduces exacerbations, it is associated with increased risk of pneumonia. Curiously, their use has not been associated with increased risk of pneumonia-related or overall mortality. We review pertinent literature to further explore the effects of inhaled corticosteroids on incident pneumonia and mortality in patients with chronic obstructive pulmonary disease. The association of use of inhaled corticosteroids and incident pneumonia is substantial and has been present in the majority of the studies on the topic. This includes both randomized controlled trials and observational studies. However, all of the studies have substantial risk of bias. Most randomized trials are limited by lack of systematic ascertainment of pneumonia; they depended on adverse event reporting. Many observational studies included proper radiographic assessment of pneumonia, but they are limited by their retrospective, observational design. The unadjusted higher risk of pneumonia is associated with longer duration of use, more potent ICS compounds, and higher doses. That implies a dose-effect relationship. Unlike pneumonia, mortality is a precise outcome. Despite the robust association of inhaled corticosteroid use with increased risk of pneumonia, all studies find either no difference or a reduction in pulmonary-related and overall mortality associated with the use of inhaled corticosteroids. These observations suggest a double effect of inhaled corticosteroids (i.e., an adverse effect plus an unexplained mitigating effect).

  3. Association of radiologic findings with mortality in patients with avian influenza H7N9 pneumonia.

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    Feng Feng

    Full Text Available BACKGROUND: The novel H7N9 virus causes severe illness, including pneumonia and acute respiratory distress syndrome, with high rates of mortality. We investigated the association of initial radiologic characteristics obtained at admission with clinical outcomes in patients with avian influenza H7N9 pneumonia. METHODS: Demographics, comorbidities, clinical findings, radiologic appearance and scores of the affected lung parenchyma were compared between survivor group (n = 15 and mortality group (n = 7. Two radiologic scores were calculated, one using chest radiography and one using CT. Follow-up CT scans at discharge were analyzed in 12 patients of the survival group. RESULTS: All the patients in mortality group developed acute respiratory distress syndrome and required mechanical ventilation, while in the survival group 33% (5/15 developed acute respiratory distress syndrome (P<0.05 and 27% (4/15 required mechanical ventilation (P<0.05. The mean radiographic and CT scores of the mortality group were 50% higher compared to the survival group (P<0.05. ROC analysis revealed an area under curve of 0.738 for the radiographic score with an optimal cutoff value of a score of 19 for prediction of mortality, with a sensitivity of 71% and a specificity of 67%, and an area under curve of 0.833 for the CT score with an optimal cutoff value of a CT score of 21 for prediction of mortality, with a sensitivity of 86% and a specificity of 73%. The mean CT score of the affected lung parenchyma at discharge was 30% lower than the initial CT examination (P<0.05. CONCLUSION: High initial radiologic score is associated with mortality in patients with avian influenza H7N9 pneumonia.

  4. Pneumonia

    Science.gov (United States)

    ... of pneumonia. Be sure to get the following vaccines: Flu vaccine can help prevent pneumonia caused by the flu virus. Pneumococcal vaccine lowers your chances of getting pneumonia from Streptococcus ...

  5. Predictors of Mortality for Nursing Home-Acquired Pneumonia: A Systematic Review

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    Naveen Dhawan

    2015-01-01

    Full Text Available Background. Current risk stratification tools, primarily used for CAP, are suboptimal in predicting nursing home acquired pneumonia (NHAP outcome and mortality. We conducted a systematic review to evaluate current evidence on the usefulness of proposed predictors of NHAP mortality. Methods. PubMed (MEDLINE, EMBASE, and CINAHL databases were searched for articles published in English between January 1978 and January 2014. The literature search elicited a total of 666 references; 580 were excluded and 20 articles met the inclusion criteria for the final analysis. Results. More studies supported the Pneumonia Severity Index (PSI as a superior predictor of NHAP severity. Fewer studies suggested CURB-65 and SOAR (especially for the need of ICU care as useful predictors for NHAP mortality. There is weak evidence for biomarkers like C-reactive protein and copeptin as prognostic tools. Conclusion. The evidence supports the use of PSI as the best available indicator while CURB-65 may be an alternative prognostic indicator for NHAP mortality. Overall, due to the paucity of information, biomarkers may not be as effective in this role. Larger prospective studies are needed to establish the most effective predictor(s or combination scheme to help clinicians in decision-making related to NHAP mortality.

  6. Trends in mortality from septicaemia and pneumonia with economic development: an age-period-cohort analysis.

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    Irene O L Wong

    Full Text Available BACKGROUND: Hong Kong population has experienced drastic changes in its economic development in the 1940s. Taking advantage of Hong Kong's unique demographic and socioeconomic history, characterized by massive, punctuated migration waves from Southern China, and recent, rapid transition from a pre-industrialized society to the first ethnic Chinese community reaching "first world" status over the last 60 years (i.e., in two or three generations, we examined the longitudinal trends in infection related mortality including septicemia compared to trends in non-bacterial pneumonia to generate hypotheses for further testing in other recently transitioned economies and to provide generalized aetiological insights on how economic transition affects infection-related mortality. METHODS: We used deaths from septicemia and pneumonia not specified as bacterial, and population figures in Hong Kong from 1976-2005. We fitted age-period-cohort models to decompose septicemia and non-bacterial pneumonia mortality rates into age, period and cohort effects. RESULTS: Septicaemia-related deaths increased exponentially with age, with a downturn by period. The birth cohort curves had downward inflections in both sexes in the 1940s, with a steeper deceleration for women. Non-bacterial pneumonia-related deaths also increased exponentially with age, but the birth cohort patterns showed no downturns for those born in the 1940s. CONCLUSION: The observed changes appeared to suggest that better early life conditions may enable better development of adaptive immunity, thus enhancing immunity against bacterial infections, with greater benefits for women than men. Given the interaction between the immune system and the gonadotropic axis, these observations are compatible with the hypothesis that upregulation of the gonadotropic axis underlies some of the changes in disease patterns with economic development.

  7. E. coli bacteremia in comparison to K. pneumoniae bacteremia: influence of pathogen species and ESBL production on 7-day mortality

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    R. Leistner

    2016-10-01

    Full Text Available Abstract In a previous study, we demonstrated prolonged length of hospital stay in cases of extended-spectrum beta-lactamase (ESBL-positive K. pneumoniae bacteremia compared to bacteremia cases due to E. coli (ESBL-positive and –negative and ESBL-negative K. pneumoniae. The overall mortality was significantly higher in bacteremia cases resulting from ESBL-positive pathogens but also in K. pneumoniae cases disregarding ESBL-production. In order to examine whether pathogen species rather than multidrug resistance might affect mortality risk, we reanalyzed our dataset that includes 1.851 cases of bacteremia.

  8. 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

  9. 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.

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

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    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

  11. 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

  12. Rapid urine antigen testing for Streptococcus pneumoniae in adults with community-acquired pneumonia: clinical use and barriers.

    Science.gov (United States)

    Harris, Aaron M; Beekmann, Susan E; Polgreen, Philip M; Moore, Matthew R

    2014-08-01

    Streptococcus pneumoniae (pneumococcus) is the most common bacterial etiology of community-acquired pneumonia (CAP) in adults, a leading cause of death. The majority of pneumococcal CAP is diagnosed by blood culture, which likely underestimates the burden of disease. The 2007 CAP guidelines recommend routine use of the rapid pneumococcal urinary antigen (UAg) test. To assess the how pneumococcal UAg testing is being used among hospitalized adult CAP patients and what barriers restrict its use, a Web-based survey was distributed in 2013 to 1287 infectious disease physician members of the Emerging Infectious disease Network of the Infectious Disease Society of America. Of 493 eligible responses, 65% use the pneumococcal UAg test. The primary barrier to UAg use was availability (46%). UAg users reported ordering fewer other diagnostic tests and tailoring antibiotic therapy. Increased access to UAg tests could improve pneumonia management and pneumococcal CAP surveillance.

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

    Directory of Open Access Journals (Sweden)

    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. Association between pneumonia in acute stroke stage and 3-year mortality in patients with acute first-ever ischemic stroke.

    Science.gov (United States)

    Yu, Yi-Jing; Weng, Wei-Chieh; Su, Feng-Chieh; Peng, Tsung-I; Chien, Yu-Yi; Wu, Chia-Lun; Lee, Kuang-Yung; Wei, Yi-Chia; Lin, Shun-Wen; Zhu, Jun-Xiao; Huang, Wen-Yi

    2016-11-01

    The influence of pneumonia in acute stroke stage on the clinical presentation and long-term outcomes of patients with acute ischemic stroke is still controversial. We investigate the influence of pneumonia in acute stroke stage on the 3-year outcomes of patients with acute first-ever ischemic stroke. Nine-hundred and thirty-four patients with acute first-ever ischemic stroke were enrolled and had been followed for 3years. Patients were divided into two groups according to whether pneumonia occurred during acute stroke stage or not. Clinical presentations, risk factors for stroke, laboratory data, co-morbidities, and outcomes were recorded. The result showed that a total of 100 patients (10.7%) had pneumonia in acute stroke stage. The prevalence of older age, atrial fibrillation was significantly higher in patients with pneumonia in acute stroke stage. Total anterior circulation syndrome and posterior circulation syndrome occurred more frequently among patients with pneumonia in acute stroke stage (Ppneumonia in acute stroke stage is a significant predictor of 3-year mortality (hazard ratio=6.39, 95% confidence interval=4.03-10.11, Ppneumonia during the acute stroke stage is associated with increased risk of 3-year mortality. Interventions to prevent pneumonia in acute stroke stage might improve ischemic stroke outcome.

  15. The role of Streptococcus pneumoniae in community-acquired pneumonia among adults in Europe: a meta-analysis.

    Science.gov (United States)

    Rozenbaum, M H; Pechlivanoglou, P; van der Werf, T S; Lo-Ten-Foe, J R; Postma, M J; Hak, E

    2013-03-01

    The primary objective of this meta-analysis was to estimate the prevalence of adult community-acquired pneumonia (CAP) caused by Streptococcus pneumoniae in Europe, adjusted for possible independent covariates. Two reviewers conducted a systematic literature search using PubMed on English-language articles that involved human subjects with CAP during the period from January 1990 to November 2011 across European countries. A mixed-effects meta-regression model was developed and populated with 24,410 patients obtained from 77 articles that met the inclusion criteria. The model showed that the observed prevalence of S. pneumoniae in CAP significantly varies between European regions, even after adjusting for explanatory covariates, including patient characteristics, diagnostic tests, antibiotic resistance, and health-care setting. The probability of detecting S. pneumoniae was substantially higher in studies that performed more frequently a diagnostic polymerase chain reaction assay compared to all the other diagnostic tests included. Furthermore, S. pneumoniae was more likely to be confirmed as the cause of a CAP in studies with intensive care unit patients as compared to those with hospital- or community-treated patients. This study provides estimates of the average observed prevalence of S. pneumoniae, which could be used for projecting the health and economic benefits of pneumococcal immunization.

  16. Community-onset Klebsiella pneumoniae pneumonia in Taiwan: clinical features of the disease and associated microbiological characteristics of isolates from pneumonia and nasopharynx.

    Science.gov (United States)

    Lin, Yi-Tsung; Wang, Yu-Ping; Wang, Fu-Der; Fung, Chang-Phone

    2015-01-01

    Klebsiella pneumoniae is an important cause of community-onset pneumonia in Asian countries and South Africa. We investigated the clinical characteristics of K. pneumoniae causing community-onset pneumonia, and the associated microbiological features between K. pneumoniae isolates from pneumonia and those from the nasopharynx in Taiwan. This study was conducted at the Taipei Veterans General Hospital during July, 2012 to February, 2014. The clinical characteristics in patients with community-onset K. pneumoniae pneumonia were analyzed. K. pneumoniae isolates from the nasopharynx of adults attending otorhinolaryngology outpatient clinics were collected to compare their microbiological features with those from pneumonia. Capsular genotypes, antimicrobial susceptibility, and multilocus sequence type (MLST) were determined among these strains. Ninety-one patients with community-onset K. pneumoniae pneumonia were enrolled. We found a high mortality (29.7%) among these patients. Capsular types K1, K2, K5, K20, K54, and K57 accounted for ∼70% of the K. pneumoniae isolates causing pneumonia, and ∼70% of all the K. pneumoniae strains isolated from the nasopharynx of patients in outpatient clinics. The MLST profiles further demonstrated the genetic relatedness between most pneumonia isolates and those from the nasopharynx. In conclusion, our results show that community-onset pneumonia caused by K. pneumoniae was associated with high mortality and could have a reservoir in the nasopharynx. To tackle this high-mortality disease, the distribution of capsular types in the nasopharynx might have implications for future vaccine development.

  17. 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...... 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...... 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....

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

    Directory of Open Access Journals (Sweden)

    Yamauchi Y

    2016-06-01

    Full Text Available Yasuhiro Yamauchi,1 Hideo Yasunaga,2 Wakae Hasegawa,1 Yukiyo Sakamoto,1 Hideyuki Takeshima,1 Taisuke Jo,1,3 Hiroki Matsui,2 Kiyohide Fushimi,4 Takahide Nagase1 1Department of Respiratory Medicine, Graduate School of Medicine, 2Department of Clinical Epidemiology and Health Economics, School of Public Health, 3Division for Health Service Promotion, The University of Tokyo, 4Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan 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

  19. Mortality of adult Stomoxys calcitrans fed isolates of Bacillus thuringiensis.

    Science.gov (United States)

    Lysyk, T J; Kalischuk-Tymensen, L D; Selinger, L B

    2012-10-01

    We examined the ability of five isolates of Bacillus thuringiensis Berliner to cause mortality in adult stable flies, Stomoxys calcitrans (L.). Isolates Bacillus thuringiensis tolworthi 4L3 (serotype 9), Bacillus thuringiensis darmstadiensis 4M1 (serotype 10a10b), Bacillus thuringiensis thompsoni 401 (serotype 12), Bacillus thuringiensis thuringiensis HD2 (serotype 1), and Bacillus thuringiensis kurstaki HD945 (serotype 3a3b3c) were administered to adult flies in diets containing blood only, sugar only, and both sugar and blood combined. B. t. tolworthi 4L3 had no effect on adult mortality regardless of the feeding substrate. The remaining isolates tended to cause the greatest mortality when administered in blood alone. B. t. thompsoni 401 was the only isolate that consistently caused adult mortality when fed in blood at concentrations ranging from 0.21 to 50.0 microg of protein per ml of blood. This isolate also caused mortality when applied topically. The time to 50% mortality declined with dose and reached a lower asymptote at approximately equal to 1.3 d at an oral dose of 8.75 microg/ml and at a topical dose of 0.14 microg per fly.

  20. 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

  1. 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....... in people aged ≥60 years. METHODS: Relative mortality and mortality rate advancement periods (RAPs) were estimated by Cox proportional hazards models for the population-based prospective cohort studies from Europe and the U.S. (CHANCES [Consortium on Health and Ageing: Network of Cohorts in Europe and the U...

  2. 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.

  3. A Case of Influenza A (H3N2) Complicated by Community-Acquired Pneumonia and Death in a Young Healthy Adult during the 2013–2014 Season

    Science.gov (United States)

    Collins, Lauren F.; Anderson, Benjamin D.; Gray, Gregory C.

    2017-01-01

    With multiple available vaccines and antivirals, seasonal influenza A is typically a self-limited acutely debilitating illness in young healthy adults. Here, we illustrate unexpected morbidity and mortality in a relatively young and healthy patient seen at a large tertiary care academic medical center for seasonal influenza A (H3N2) complicated by community-acquired pneumonia, hypoxic respiratory failure, septic shock, and death.

  4. Risk Factors for Long-Term Mortality after Hospitalization for Community-Acquired Pneumonia: A 5-Year Prospective Follow-Up Study.

    Directory of Open Access Journals (Sweden)

    Jan C Holter

    Full Text Available Contributors to long-term mortality in patients with community-acquired pneumonia (CAP remain unclear, with little attention paid to pneumonia etiology. We examined long-term survival, causes of death, and risk factors for long-term mortality in adult patients who had been hospitalized for CAP, with emphasis on demographic, clinical, laboratory, and microbiological characteristics.Two hundred and sixty-seven consecutive patients admitted in 2008-2011 to a general hospital with CAP were prospectively recruited and followed up. Patients who died during hospital stay were excluded. Demographic, clinical, and laboratory data were collected within 48 hours of admission. Extensive microbiological work-up was performed to establish the etiology of CAP in 63% of patients. Mortality data were obtained from the Norwegian Cause of Death Registry. Cox regression models were used to identify independent risk factors for all-cause mortality.Of 259 hospital survivors of CAP (median age 66 years, 79 (30.5% died over a median of 1,804 days (range 1-2,520 days. Cumulative 5-year survival rate was 72.9% (95% CI 67.4-78.4%. Standardized mortality ratio was 2.90 for men and 2.05 for women. The main causes of death were chronic obstructive pulmonary disease (COPD, vascular diseases, and malignancy. Independent risk factors for death were the following (hazard ratio, 95% CI: age (1.83 per decade, 1.47-2.28, cardiovascular disease (2.63, 1.61-4.32, COPD (2.09, 1.27-3.45, immunocompromization (1.98, 1.17-3.37, and low serum albumin level at admission (0.75 per 5 g/L higher, 0.58-0.96, whereas active smoking was protective (0.32, 0.14-0.74; active smokers were younger than non-smokers (P < 0.001. Microbial etiology did not predict mortality.Results largely confirm substantial comorbidity-related 5-year mortality after hospitalization for CAP and the impact of several well-known risk factors for death, and extend previous findings on the prognostic value of serum albumin

  5. The Modern Diagnostic Approach to Community-Acquired Pneumonia in Adults.

    Science.gov (United States)

    Chalmers, James D

    2016-12-01

    Respiratory tract infections, the majority of which are community acquired, are among the leading causes of death worldwide and a leading indication for hospital admission. The burden of disease demonstrates a "U"-shaped distribution, primarily affecting young children as the immune system matures, and older adults as the process of immunosenescence and accumulation of comorbidities leads to increased susceptibility to infection. Diagnosis of community-acquired pneumonia (CAP) is traditionally based on demonstration of a new infiltrate on a chest radiograph in a patient presenting with an acute respiratory illness or sepsis. Advances in diagnosis have been slow, and although there are increasing data on the value of computed tomography or lung ultrasound as more sensitive diagnostic methodologies, they are not widely used as initial diagnostic tests. There are a wide range of differential diagnoses and pneumonia "mimics" which should be considered in patients presenting with CAP. Once the diagnosis of CAP has been made, identifying the causative microorganism is the next stage in the diagnostic process. Traditional culture-based approaches are relatively insensitive and achieve a positive diagnosis in only 30 to 70% of cases, even when rigorously applied. Urinary antigen tests, polymerase chain reaction assays, and even next-generation sequencing technologies have become available and are increasing the rates of positive diagnosis. In an era of increasing antimicrobial resistance, the accurate diagnosis of CAP and determining the causative pathogen are ever more important. Getting these both right is key in reducing both morbidity and mortality from CAP, and appropriate antimicrobial stewardship which is now an international healthcare priority.

  6. Education and mortality among older adults in China.

    Science.gov (United States)

    Luo, Ye; Zhang, Zhenmei; Gu, Danan

    2015-02-01

    This study examines the relationship between education and mortality, its underlying mechanisms, and its gender and age variations among older adults in China, using data from the 2002 to 2011 waves of the Chinese Longitudinal Healthy Longevity Survey. There is an inverse relationship between education and mortality risk. The relationship is explained in full by each of the three mechanisms: other socioeconomic attainments, social relationships and activities, and health status, and partially by physical exercise. In addition, primary education has a stronger effect on mortality for men than for women and the effect of education is stronger for the young old than for the oldest old. These findings underscore the importance of national and subpopulation contexts in understanding the relationship between education and mortality.

  7. 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.

  8. Perceived stress and mortality in a Taiwanese older adult population.

    Science.gov (United States)

    Vasunilashorn, Sarinnapha; Glei, Dana A; Weinstein, Maxine; Goldman, Noreen

    2013-11-01

    Perceived stress is associated with poor health outcomes including negative affect, increased susceptibility to the common cold and cardiovascular disease; the consequences of perceived stress for mortality, however, have received less attention. This study characterizes the relationship between perceived stress and 11-year mortality in a population of Taiwanese adults aged 53+ years. Using the Survey of Health and Living Status of the Near Elderly and Elderly of Taiwan, we calculated a composite measure of perceived stress based on six items pertaining to the health, financial situation, and occupation of the respondents and their families. Proportional hazard models were used to determine whether perceived stress predicted mortality. After adjusting for sociodemographic factors only, we found that a one standard deviation increase in perceived stress was associated with a 19% increase in all-cause mortality risk during the 11-year follow-up period (hazard ratio, HR = 1.19, 95% confidence interval, CI 1.13-1.26). The relationship was greatly attenuated when perceptions of stress regarding health were excluded, and was not significant after adjusting for medical conditions, mobility limitations and depressive symptoms. We conclude that the association between perceived stress and mortality is explained by an individual's current health; however, our data do not allow us to distinguish between two possible interpretations of this conclusion: (a) the relationship between perceived stress and mortality is spurious, or (b) poor health acts as the mediator.

  9. 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

    OBJECTIVE: To analyze the possible influence of antibiotic treatment on the results of different diagnostic tests for the diagnosis of lower respiratory tract infections with Streptococcus pneumoniae. MATERIAL AND METHODS: A prospective cohort of 159 unselected adult immunocompetent patients...... of S. pneumoniae. RESULTS: When stratified for antibiotic treatment prior to microbiological sampling, three different groups of patients with documented or probable infection with S. pneumoniae could be identified. The first group comprised 14 patients who were culture positive in one or more culture...... 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...

  10. Corticosteroids for all adult patients with community-acquired pneumonia?

    OpenAIRE

    Ger Rijkers; Simone Spoorenberg; Stefan Vestjens; Werner Albrich

    2015-01-01

    Corticosteroid therapy as adjunctive treatment in community-acquired pneumonia (CAP) is a promising but controversial subject. The potentially beneficial effect of corticosteroids is based on the ability of steroids to dampen an excessive inflammatory response that often occurs in patients with CAP. This excessive inflammatory response can cause damage to the lungs and other organs, and is associated with poor outcome.

  11. KPC-producing Klebsiella pneumoniae rectal colonization is a risk factor for mortality in patients with diabetic foot infections.

    Science.gov (United States)

    Tascini, C; Lipsky, B A; Iacopi, E; Ripoli, A; Sbrana, F; Coppelli, A; Goretti, C; Piaggesi, A; Menichetti, F

    2015-08-01

    To evaluate the relationship between carbapenemase-producing Klebsiella pneumoniae (KPC-Kp) gut colonization and mortality in diabetic patients with a foot infection (DFI) we performed a single-centre, retrospective, matched case-control study. In the study period, we identified 21 patients with DFI who had KPC-Kp gut colonization and 21 controls. The 90-day mortality rate was significantly higher in patients with colonized guts (47%) than the controls (4%) (p 0.013). A multivariate analysis demonstrated that gut colonization with KPC-Kp was the only independent predictor of mortality: odds ratio 13.33, 95% CI 1.90-272.80, p 0.024. In patients with DFI, KPC-Kp gut colonization appears to be an important risk factor for mortality.

  12. 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.

  13. 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

  14. Prior cardiovascular disease increases long-term mortality in COPD patients with pneumonia

    OpenAIRE

    Sibila, Oriol; Mortensen, Eric M.; Anzueto, Antonio; Laserna, Elena; Restrepo, Marcos I.

    2013-01-01

    There is controversy regarding the impact of chronic obstructive pulmonary disease (COPD) in clinical outcomes in elderly patients with pneumonia. Comorbidities such as cardiovascular disease have been reported to play an important role in patients with acute exacerbations of COPD. However, limited data are available regarding the impact of cardiovascular disease in elderly COPD patients who require hospitalisation for pneumonia.

  15. Child Mortality after Discharge from a Health Facility following Suspected Pneumonia, Meningitis or Septicaemia in Rural Gambia: A Cohort Study.

    Directory of Open Access Journals (Sweden)

    Aakash Varun Chhibber

    Full Text Available To measure mortality and its risk factors among children discharged from a health centre in rural Gambia.We conducted a cohort study between 12 May 2008 and 11 May 2012. Children aged 2-59 months, admitted with suspected pneumonia, sepsis, or meningitis after presenting to primary and secondary care facilities, were followed for 180 days after discharge. We developed models associating post-discharge mortality with clinical syndrome on admission and clinical risk factors.One hundred and five of 3755 (2.8% children died, 80% within 3 months of discharge. Among children aged 2-11 and 12-59 months, there were 30 and 29 deaths per 1000 children per 180 days respectively, compared to 11 and 5 respectively in the resident population. Children with suspected pneumonia unaccompanied by clinically severe malnutrition (CSM had the lowest risk of post-discharge mortality. Mortality increased in children with suspected meningitis or septicaemia without CSM (hazard ratio [HR] 2.6 and 2.2 respectively. The risk of mortality greatly increased with CSM on admission: CSM with suspected pneumonia (HR 8.1; 95% confidence interval (CI 4.4 to 15, suspected sepsis (HR 18.4; 95% CI 11.3 to 30, or suspected meningitis (HR 13.7; 95% CI 4.2 to 45. Independent associations with mortality were: mid-upper arm circumference (MUAC of 11.5-13.0 cm compared to >13.0 cm (HR 7.2; 95% CI 3.0 to 17.0, MUAC 10.5-11.4 cm (HR 24; 95% CI 9.4 to 62, and MUAC <10.5 cm (HR 44; 95% CI 18 to 108, neck stiffness (HR 10.4; 95% CI 3.1 to 34.8, non-medical discharge (HR 4.7; 95% CI 2.0 to 10.9, dry season discharge (HR 2.0; 95% CI 1.2 to 3.3, while greater haemoglobin (HR 0.82; 0.73 to 0.91, axillary temperature (HR 0.71; 95% CI 0.58 to 0.87, and oxygen saturation (HR 0.96; 95% CI 0.93 to 0.99 were associated with reduced mortality.Gambian children experience increased mortality after discharge from primary and secondary care. Interventions should target both moderately and severely

  16. [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.

  17. Added sugar intake and cardiovascular diseases mortality among US adults.

    Science.gov (United States)

    Yang, Quanhe; Zhang, Zefeng; Gregg, Edward W; Flanders, W Dana; Merritt, Robert; Hu, Frank B

    2014-04-01

    IMPORTANCE Epidemiologic studies have suggested that higher intake of added sugar is associated with cardiovascular disease (CVD) risk factors. Few prospective studies have examined the association of added sugar intake with CVD mortality. OBJECTIVE To examine time trends of added sugar consumption as percentage of daily calories in the United States and investigate the association of this consumption with CVD mortality. DESIGN, SETTING, AND PARTICIPANTS National Health and Nutrition Examination Survey (NHANES, 1988-1994 [III], 1999-2004, and 2005-2010 [n = 31,147]) for the time trend analysis and NHANES III Linked Mortality cohort (1988-2006 [n = 11 733]), a prospective cohort of a nationally representative sample of US adults for the association study. MAIN OUTCOMES AND MEASURES Cardiovascular disease mortality. RESULTS Among US adults, the adjusted mean percentage of daily calories from added sugar increased from 15.7% (95% CI, 15.0%-16.4%) in 1988-1994 to 16.8% (16.0%-17.7%; P = .02) in 1999-2004 and decreased to 14.9% (14.2%-15.5%; P sugar (71.4%) and approximately 10% consumed 25% or more in 2005-2010. During a median follow-up period of 14.6 years, we documented 831 CVD deaths during 163,039 person-years. Age-, sex-, and race/ethnicity-adjusted hazard ratios (HRs) of CVD mortality across quintiles of the percentage of daily calories consumed from added sugar were 1.00 (reference), 1.09 (95% CI, 1.05-1.13), 1.23 (1.12-1.34), 1.49 (1.24-1.78), and 2.43 (1.63-3.62; P sugar with those who consumed less than 10.0% of calories from added sugar. These findings were largely consistent across age group, sex, race/ethnicity (except among non-Hispanic blacks), educational attainment, physical activity, health eating index, and body mass index. CONCLUSIONS AND RELEVANCE Most US adults consume more added sugar than is recommended for a healthy diet. We observed a significant relationship between added sugar consumption and increased risk for CVD

  18. Mortality in traffic accidents with older adults in Colombia

    Science.gov (United States)

    Cardona, Angela Maria Segura; Arango, Doris Cardona; Fernández, Dedsy Yajaira Berbesí; Martínez, Alejandra Agudelo

    2017-01-01

    ABSTRACT OBJECTIVE To analyze the traffic accident mortality in the Colombian older adults during the 1998-2012 period and show the loss of productive years and mortality from this cause. METHODS Quantitative study of the trend analysis of deaths in Colombia in traffic accidents, from 1998 to 2012, according to death records and population projected by the Colombian National Administrative Department of Statistics. Frequency distribution profile of the deceased, death rates per hundred thousand inhabitants, potential years of life lost and calculation of excess mortality by age in the over 60 were made. RESULTS In the study period 100,758 deaths occurred in traffic accidents, 6,717 annual average, of which 18.5% occurred in people aged 60 years and over. The predominated deaths were men; the risk of dying was 32.15 per hundred thousand people in this age range, with double risk of dying those under 60 years. CONCLUSIONS The young population has a higher proportion of deaths, but those over 60 years are at increased risk of death, leading to the need to turn our gaze to the improvement of road infrastructure and standards, to educate the population in self-care and compliance with safety measures and prepare society for an ever more adult population, more numerous and more prone to take risks.

  19. Eosinophilic pneumonia due to toxocariasis: an adult case report.

    Science.gov (United States)

    Demirci, Mustafa; Unlü, Mehmet; Fidan, Fatma; Kaya, Selçuk

    2012-01-01

    Toxocara is a roundworm, a common parasite of dogs (T. canis) and cats (T. cati). Toxocariasis or Visceral larva migrans (VLM) are diseases caused by the larvae of Toxocara sp., which may involve many organs, but pulmonary symptoms such as coughing and wheezing and allergic symptoms are seen in more than 80% of patients. It is known that, although the risk of infection is present, the worldwide diagnosis of toxocariasis is difficult since clinical and laboratory data provide insufficient evidence for the diagnosis. Nowadays, the diagnosis of toxocariasis is performed by serologic methods. We describe herein a case of toxocariasis with eosinophilic pneumonia that was diagnosed using serologic methods.

  20. 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

  1. Meningitis in a Canadian adult due to high level penicillin-resistant, cefotaxime-intermediate Streptococcus pneumoniae

    OpenAIRE

    Cécile Tremblay; Anne-Marie Bourgault; Pierre St-Antoine

    1996-01-01

    Invasive penicillin-resistant pneumococcal (PRSP) infections are increasing worldwide. In Canada, the incidence of penicillin resistance among Streptococcus pneumoniae isolates is estimated at greater than 6%. In Quebec, only one case of PRSP meningitis has been reported and involved an infant. An adult patient is described who presented with meningitis caused by high level penicillin-resistant, cefotaxime-intermediate S pneumoniae.

  2. Increases in generative concern among older adults following reminders of mortality.

    Science.gov (United States)

    Maxfield, Molly; Greenberg, Jeff; Pyszczynski, Tom; Weise, David R; Kosloff, Spee; Soenke, Melissa; Abeyta, Andrew A; Blatter, Jamin

    2014-01-01

    According to terror management theory, people are motivated to protect themselves from the potential for anxiety resulting from awareness of mortality. It was hypothesized that increased concern for future generations, and the symbolic immortality this produces, may be particularly important to older adults when awareness of their mortality is increased. In two studies, older and younger adults' generative concern was examined following mortality or control primes. As hypothesized, older adults' generative concern and preference for pro-social over pro-self generativity were greater following reminders of mortality, whereas neither effect was observed among younger adults. For both studies, age differences were only observed when mortality salience was heightened; older and younger adults' generative concern did not differ in control conditions. Results provide support for the hypothesis that younger and older adults differ in their responses to increased awareness of mortality and suggest that older adults respond to death reminders by adopting a more pro-social generative orientation.

  3. Pneumonia Mortality among Children under 5 in China from 1996 to 2013: An Analysis from National Surveillance System.

    Directory of Open Access Journals (Sweden)

    Chunhua He

    Full Text Available We investigated the mortality rate of pneumonia (PMR among children under 5 and its time trend from 1996 to 2013 to determine the priorities for ending preventable deaths from pneumonia in children under 5, and share China's successful experience in reducing PMR with other developing countries.We used data from China's Under 5 Child Mortality Surveillance System (U5CMSS to calculate the PMR and the proportion of pneumonia deaths to total deaths of children under 5. The data were grouped by urban and rural areas with Cochran-Mantel-Haensel (CMH test and Chi-square test to examine the differences of PMR and proportion. The time trend was tested by Cochran-Armitage trend test.The overall PMR of children under 5 was reduced by 85.5% (from 1053.2 to 153.2 per 100,000 live births from 1996 to 2013, with the urban and rural areas reduced by 69.1% (from 188.4 to 58.2 per 100,000 live births and 84.7% (from 1252.8 to 191.9 per 100,000 live births, respectively. The overall proportion of pneumonia deaths to total deaths was also declined from 23.4% in 1996 to 12.8% in 2013, with the rural areas decreased from 24.4% to 13.2% and the urban areas decreased from 11.1% to 9.7%. The PMRs in neonates (0-27 days, post-neonates (1-11 months, and childhood (12-59 months were reduced by 80.7%, 77.4%, and 80.1%, respectively in rural areas, and 71.7%, 69.6%, and 39.0%, respectively in urban areas. During 1996-2013, the PMR in children under 5 years was 4.9 fold higher in rural areas relative to that in urban areas, with relative risk (RR of 3.6 and 6.4 in neonates and 1- to 59-month-old children, respectively.PMR in children under 5 significantly declined in China from 1996 to 2013, especially in rural areas. However, huge disparities still existed between rural and urban areas. Infants had the highest PMR, which indicated that interventions aiming at prevention and control of infant pneumonia should be the priority for further reducing PMR in China.

  4. 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.

  5. Bacteremia with Streptococcus pneumoniae

    DEFF Research Database (Denmark)

    Christensen, J S; Jensen, T G; Kolmos, H J

    2012-01-01

    We conducted a hospital-based cohort study among adult patients with first-time Streptococcus pneumoniae bacteremia (SPB) from 2000 through 2008. Patients were identified in a population-based bacteremia database and followed up for mortality through the Danish Civil Registration System (CRS...... age of the patients was 65 years. The focal diagnosis of the SPB was pneumonia in 381 (79 %) patients, followed in frequency by meningitis in 33 (7 %) patients. Of the 481 patients, 390 (81 %) had community-acquired SPB. Of these, 23 (6 %) did not have sepsis, 132 (34 %) had sepsis, 224 (57 %) had...

  6. 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...

  7. 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.

  8. 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; Pcarbapenem-containing regimens.

  9. Sensitivity and specificity of the Streptococcus pneumoniae urinary antigen test for unconcentrated urine from adult patients with pneumonia: a meta-analysis.

    Science.gov (United States)

    Horita, Nobuyuki; Miyazawa, Naoki; Kojima, Ryota; Kimura, Naoko; Inoue, Miyo; Ishigatsubo, Yoshiaki; Kaneko, Takeshi

    2013-11-01

    Studies on the sensitivity and specificity of the Binax Now Streptococcus pneumonia urinary antigen test (index test) show considerable variance of results. Those written in English provided sufficient original data to evaluate the sensitivity and specificity of the index test using unconcentrated urine to identify S. pneumoniae infection in adults with pneumonia. Reference tests were conducted with at least one culture and/or smear. We estimated sensitivity and two specificities. One was the specificity evaluated using only patients with pneumonia of identified other aetiologies ('specificity (other)'). The other was the specificity evaluated based on both patients with pneumonia of unknown aetiology and those with pneumonia of other aetiologies ('specificity (unknown and other)') using a fixed model for meta-analysis. We found 10 articles involving 2315 patients. The analysis of 10 studies involving 399 patients yielded a pooled sensitivity of 0.75 (95% confidence interval: 0.71-0.79) without heterogeneity or publication bias. The analysis of six studies involving 258 patients yielded a pooled specificity (other) of 0.95 (95% confidence interval: 0.92-0.98) without no heterogeneity or publication bias. We attempted to conduct a meta-analysis with the 10 studies involving 1916 patients to estimate specificity (unknown and other), but it remained unclear due to moderate heterogeneity and possible publication bias. In our meta-analysis, sensitivity of the index test was moderate and specificity (other) was high; however, the specificity (unknown and other) remained unclear.

  10. 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

  11. 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.

  12. 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

  13. 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.

  14. Single versus combination antibiotic therapy in adults hospitalised with community acquired pneumonia.

    Science.gov (United States)

    Rodrigo, Chamira; Mckeever, Tricia M; Woodhead, Mark; Lim, Wei Shen

    2013-05-01

    The benefits of β-lactam/macrolide combination therapy over β-lactam therapy alone for the treatment of hospitalised community-acquired pneumonia (CAP) in relation to pneumonia severity are uncertain. We studied 5240 adults hospitalised with CAP from 72 secondary care trusts across England and Wales. The overall 30-day inpatient (IP) death rate was 24.4%. Combination therapy was prescribed in 3239 (61.8%) patients. In a multivariable model, combination therapy was significantly associated with lower 30-day IP death rate in patients with moderate-severity CAP (adjusted OR 0.54, 95% CI 0.41 to 0.72) and high-severity CAP (adjusted OR 0.76, 95% CI 0.60 to 0.96) but not low-severity CAP.

  15. 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)

  16. 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...... therapy. OBJECTIVE: To study variables obtained on hospital admission for possible prognostic value of short-term (3-month) outcome of PCP. DESIGN AND PATIENTS: Prospective observational study of 176 consecutive HIV-1-infected individuals with PCP between 1990 and 1999. METHOD: Cox proportional...... of outcome of PCP in patients treated in the era of adjunctive corticosteroid therapy....

  17. 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....

  18. 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.

  19. Meningitis in a Canadian Adult due to High Level Penicillin-Resistant, Cefotaxime-Intermediate Streptococcus pneumoniae

    Directory of Open Access Journals (Sweden)

    Cécile Tremblay

    1996-01-01

    Full Text Available Invasive penicillin-resistant pneumococcal (PRSP infections are increasing worldwide. In Canada, the incidence of penicillin resistance among Streptococcus pneumoniae isolates is estimated at greater than 6%. In Quebec, only one case of PRSP meningitis has been reported and involved an infant. An adult patient is described who presented with meningitis caused by high level penicillin-resistant, cefotaxime-intermediate S pneumoniae.

  20. 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.

  1. Cancer incidence, hospital morbidity, and mortality in young adults in Brazil.

    Science.gov (United States)

    Santos, Sabrina da Silva; Melo, Leticia Rodrigues; Koifman, Rosalina Jorge; Koifman, Sergio

    2013-05-01

    There are still relatively few studies in the world on cancer incidence and mortality in young adults. The current study aimed to explore cancer distribution in young adults in Brazil. A descriptive study was conducted on cancer incidence (selected State capitals), hospital morbidity, and mortality (Brazil and selected capitals) in the 20-24-year age strata in 2000-2002, and trends in cancer mortality rates in Brazil in 1980-2008 in the same population. Testicular cancer was the principal anatomical site in young adult males; in young adult women, the main sites were thyroid, uterine cervix, and Hodgkin disease. Brain cancer was the principal cause of death from cancer in both sexes, and time trends in mortality showed an increase in mortality from brain cancer in men and from lymphocytic leukemia in both sexes. As a whole, the results show an epidemiological pattern of cancer in young adults with regional distribution characteristics.

  2. Prevention of hospital-acquired pneumonia in non-ventilated adult patients: a narrative review

    Directory of Open Access Journals (Sweden)

    Leonor Pássaro

    2016-11-01

    Full Text Available Abstract Background Pneumonia is one of the leading hospital-acquired infections worldwide and has an important impact. Although preventive measures for ventilator-associated pneumonia (VAP are well known, less is known about appropriate measures for prevention of hospital-acquired pneumonia (HAP. Aim The purpose of this narrative review is to provide an overview of the current standards for preventing HAP in non-ventilated adult patients. Methods A search of the literature up to May 2015 was conducted using Medline for guidelines published by national professional societies or professional medical associations. In addition, a comprehensive search for the following preventive measures was performed: hand hygiene, oral care, bed position, mobilization, diagnosis and treatment of dysphagia, aspiration prevention, viral infections and stress bleeding prophylaxis. Findings Regarding international guidelines, several measures were recommended for VAP, whilst no specific recommendations for HAP prevention in non-ventilated patients are available. There is reasonable evidence available that oral care is associated with a reduction in HAP. Early mobilization interventions, swift diagnosis and treatment of dysphagia, and multimodal programmes for the prevention of nosocomial influenza cross-infection, have a positive impact on HAP reduction. The impact of bed position and stress bleeding prophylaxis remains uncertain. Systematic antibiotic prophylaxis for HAP prevention should be avoided. Conclusion Scant literature and little guidance is available for the prevention of HAP among non-ventilated adult patients. In addition, the criteria used for the diagnosis of HAP and the populations targeted in the studies selected are heterogeneous. Oral care was the most studied measure and was commonly associated with a decrease in HAP rate, although a broad range of interventions are proposed. No robust evidence is available for other measures. Further high

  3. Improving outcomes in patients with community-acquired pneumonia

    OpenAIRE

    Bewick, Thomas

    2012-01-01

    Community-acquired pneumonia (CAP) is a leading cause of adult morbidity and mortality worldwide despite decades of effective antibiotics and vaccination initiatives. There have been no recent significant improvements in outcomes, including 30-day mortality. The bacterium Streptococcus pneumoniae is the most prevalent causative pathogen in CAP, being found in up to half of cases. In September 2006 a childhood pneumococcal vaccine (PCV-7) was introduced, leading to reductions in vaccine-type (...

  4. 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

  5. [Impact of PCV10 pneumococcal vaccine on mortality from pneumonia in children less than one year of age in Santa Catarina State, Brazil].

    Science.gov (United States)

    Kupek, Emil; Vieira, Ilse Lisiane Viertel

    2016-03-01

    The aim of this study was to evaluate the impact of PCV10 pneumococcal vaccine on mortality from pneumonia in children less than one year of age in Santa Catarina State, Brazil, comparing the four years prior and the four years subsequent to the vaccine's introduction in 2010. This ecological study used data from the Mortality Information System and vaccination coverage of children less than one year. Data were grouped by municipalities of residence and regions. Average mortality from pneumonia in children under one year decreased from 29.69 to 23.40 per 100,000, comparing 2006-2009 and 2010-2013, or a reduction of 11%. However there were differences between regions with a drop in mortality (Grande Florianópolis, Sul, Planalto Norte, and Nordeste) and others with an increase in the annual rates (Oeste, Itajaí, and Serra). In short, the state as a whole showed 11% reduction in mortality from pneumonia in children less than one year of age, four years after implementing routine PCV10 vaccination in the National Immunization Program, but with heterogeneous effects when comparing regions of the state.

  6. Molecular epidemiology of extended-spectrum beta-lactamase (ESBL)-positive Klebsiella pneumoniae from bloodstream infections and risk factors for mortality.

    Science.gov (United States)

    Gürntke, Stephan; Kohler, Christian; Steinmetz, Ivo; Pfeifer, Yvonne; Eller, Christoph; Gastmeier, Petra; Schwab, Frank; Leistner, Rasmus

    2014-12-01

    The prevalence of extended-spectrum beta-lactamase (ESBL)-positive Klebsiella pneumoniae is growing worldwide. Infections with these bacteria are suspected to be related to increased mortality. We aimed to estimate the distribution of ESBL genotypes and to assess the impact on mortality associated with ESBL positivity in cases of bloodstream infection (BSI) due to K. pneumoniae. We performed a cohort study on patients with K. pneumoniae BSI between 2008 and 2011. Presence of ESBL genes was analyzed by PCR and sequencing. Risk factors for mortality were analyzed by Cox-proportional hazard regression. We identified 286 ESBL-negative (81%) and 66 (19%) ESBL-positive cases. 97% (n = 64) of the ESBL-positive isolates were susceptible for meropenem. The most common ESBL genotypes were CTX-M-15 (60%), SHV-5 (27%) and CTX-M-3 (5%). Significant risk factors for mortality were chronic pulmonary disease (HR 1.747) and moderate/severe renal disease (HR 2.572). ESBL positivity was not associated with increased mortality.

  7. “Silent” Dissemination of Klebsiella pneumoniae Isolates Bearing K. pneumoniae Carbapenemase in a Long-term Care Facility for Children and Young Adults in Northeast Ohio

    Science.gov (United States)

    Viau, Roberto A.; Hujer, Andrea M.; Marshall, Steven H.; Perez, Federico; Hujer, Kristine M.; Briceño, David F.; Dul, Michael; Jacobs, Michael R.; Grossberg, Richard; Toltzis, Philip

    2012-01-01

    Background. Klebsiella pneumoniae isolates harboring the K. pneumoniae carbapenemase gene (blaKPC) are creating a significant healthcare threat in both acute and long-term care facilities (LTCFs). As part of a study conducted in 2004 to determine the risk of stool colonization with extended-spectrum cephalosporin-resistant gram-negative bacteria, 12 isolates of K. pneumoniae that exhibited nonsusceptibility to extended-spectrum cephalosporins were detected. All were gastrointestinal carriage isolates that were not associated with infection. Methods. Reassessment of the carbapenem minimum inhibitory concentrations using revised 2011 Clinical Laboratory Standards Institute breakpoints uncovered carbapenem resistance. To further investigate, a DNA microarray assay, PCR-sequencing of bla genes, immunoblotting, repetitive-sequence-based PCR (rep-PCR) and multilocus sequence typing (MLST) were performed. Results. The DNA microarray detected blaKPC in all 12 isolates, and blaKPC-3 was identified by PCR amplification and sequencing of the amplicon. In addition, a blaSHV-11 gene was detected in all isolates. Immunoblotting revealed “low-level” production of the K. pneumoniae carbapenemase, and rep-PCR indicated that all blaKPC-3-positive K. pneumoniae strains were genetically related (≥98% similar). According to MLST, all isolates belonged to sequence type 36. This sequence type has not been previously linked with blaKPC carriage. Plasmids from 3 representative isolates readily transferred the blaKPC-3 to Escherichia coli J-53 recipients. Conclusions. Our findings reveal the “silent” dissemination of blaKPC-3 as part of Tn4401b on a mobile plasmid in Northeast Ohio nearly a decade ago and establish the first report, to our knowledge, of K. pneumoniae containing blaKPC-3 in an LTCF caring for neurologically impaired children and young adults. PMID:22492318

  8. Ventilator-associated pneumonia in a tertiary care intensive care unit: Analysis of incidence, risk factors and mortality

    Directory of Open Access Journals (Sweden)

    Neelima Ranjan

    2014-01-01

    Full Text Available Background: Ventilator-associated pneumonia (VAP is the most common nosocomial infection diagnosed in the intensive care unit (ICU and in spite of advances in diagnostic techniques and management it remains a common cause of hospital morbidity and mortality. Objective: The primary objective of the following study is to determine the incidence, various risk factors and attributable mortality associated with VAP and secondary objective is to identify the various bacterial pathogens causing VAP in the ICU. Materials and Methods: This prospective observational study was carried out over a period of 1 year. VAP was diagnosed using the clinical pulmonary infection score. Endotracheal aspirate (ETA and bronchoalveolar lavage (BAL samples of suspected cases of VAP were collected from ICU patients and processed as per standard protocols. Statistical Analysis: Fisher′s exact test was applied when to compare two or more set of variables were compared. Results: The incidence of VAP in our study was 57.14% and the incidence density of VAP was 31.7/1000 ventilator days. Trauma was the commonest underlying condition associated with VAP. The incidence of VAP increased as the duration of mechanical ventilation increased and there was a total agreement in bacteriology between semi-quantitative ETAs and BALs in our study. The overall mortality associated with VAP was observed to be 48.33%. Conclusions: The incidence of VAP was 57.14%. Study showed that the incidence of VAP is directly proportional to the duration of mechanical ventilation. The most common pathogens causing VAP were Acinetobacter spp. and Pseudomonas aeruginosa and were associated with a high fatality rate.

  9. 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.

  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; 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.

  11. 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....

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

    DEFF Research Database (Denmark)

    Zarulli, Virginia

    2013-01-01

    This article aims to investigate the effect of sudden changes in external conditions on human mortality levels and age-patterns. Although several studies have analysed shocking events such as famines or deportations, a systematic assessment of the effect of the shock on the rate of mortality...

  13. 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.

  14. High mortality amongst adolescents and adults with bacterial meningitis in sub-Saharan Africa: an analysis of 715 cases from Malawi.

    Directory of Open Access Journals (Sweden)

    Emma C Wall

    Full Text Available Mortality from bacterial meningitis in African adults is significantly higher than those in better resourced settings and adjunctive therapeutic interventions such as dexamethasone and glycerol have been shown to be ineffective. We conducted a study analysing data from clinical trials of bacterial meningitis in Blantyre, Malawi to investigate the clinical parameters associated with this high mortality.We searched for all clinical trials undertaken in Blantyre investigating bacterial meningitis from 1990 to the current time and combined the data from all included trial datasets into one database. We used logistic regression to relate individual clinical parameters to mortality. Adults with community acquired bacterial meningitis were included if the CSF culture isolate was consistent with meningitis or if the CSF white cell count was >100 cells/mm(3 (>50% neutrophils in HIV negative participants and >5 cells/mm(3 in HIV positive participants. Outcome was measured by mortality at discharge from hospital (after 10 days of antibiotic therapy and community follow up (day 40.Seven hundred and fifteen episodes of bacterial meningitis were evaluated. The mortality rate was 45% at day 10 and 54% at day 40. The most common pathogens were S.pneumoniae (84% of positive CSF isolates and N.meningitidis (4%. 607/694 (87% participants tested were HIV antibody positive. Treatment delays within the hospital system were marked. The median presenting GCS was 12/15, 17% had GCS<8 and 44.9% had a seizure during the illness. Coma, seizures, tachycardia and anaemia were all significantly associated with mortality on multivariate analysis. HIV status and pneumococcal culture positivity in the CSF were not associated with mortality. Adults with community acquired bacterial meningitis in Malawi present with a severe clinical phenotype. Predictors of high mortality are different to those seen in Western settings. Optimising in-hospital care and minimising treatment delays

  15. Delirium is a predictor of in-hospital mortality in elderly patients with community acquired pneumonia.

    Science.gov (United States)

    Pieralli, Filippo; Vannucchi, Vieri; Mancini, Antonio; Grazzini, Maddalena; Paolacci, Giulia; Morettini, Alessandro; Nozzoli, Carlo

    2014-03-01

    Community acquired pneumonia (CAP) is a common reason for hospitalization and death in elderly people. Many predictors of in-hospital outcome have been studied in the general population with CAP. However, data are lacking on the prognostic significance of conditions unique to older patients, such as delirium and the coexistence of multiple comorbidities. The aim of this study was to evaluate predictors of in-hospital outcome in elderly patients hospitalized for CAP. In this retrospective study, consecutive patients with CAP aged ≥65 years were enrolled between January 2011 and June 2012 in two general wards. Clinical and laboratory characteristics were collected from electronic medical records. The end-point of the study was the occurrence of in-hospital death. 443 patients (mean age 81.8 ± 7.5, range 65-99 years) were enrolled. More than 3 comorbidities were present in 31 % of patients. Mean confusion, blood urea nitrogen, respiratory rate, blood pressure and age ≥65 years (CURB-65) score was 2.5 ± 0.7 points. Mean length of stay was 7.6 ± 5.7 days. In-hospital death occurred in 54 patients (12.2 %). At multivariate analysis, independent predictors of in-hospital death were: chronic obstructive pulmonary disease (COPD) (OR 6.21, p = 0.005), occurrence of at least one episode of delirium (OR 5.69, p = 0.017), male sex (OR 5.10, p patients with CAP older than 65 years are similar to those of younger patients. In this cohort of elderly patients, the occurrence of delirium was highly prevalent and represented a distinctive predictor of death.

  16. 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.

  17. Pneumonia and pneumonia related mortality in patients with COPD treated with fixed combinations of inhaled corticosteroid and long acting β2 agonist: observational matched cohort study (PATHOS)

    OpenAIRE

    Janson, Christer; Larsson, Kjell; Lisspers, Karin H; Ställberg, Björn; Stratelis, Georgios; Goike, Helena; Jorgensen, Leif; Johansson, Gunnar

    2013-01-01

    Objective To investigate the occurrence of pneumonia and pneumonia related events in patients with chronic obstructive pulmonary disease (COPD) treated with two different fixed combinations of inhaled corticosteroid/long acting beta(2) agonist. Design Observational retrospective pairwise cohort study matched (1:1) for propensity score. Setting Primary care medical records data linked to Swedish hospital, drug, and cause of death registry data for years 1999-2009. Participants Patients with CO...

  18. 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

  19. 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.

  20. Use of serology and urine antigen detection to estimate the proportion of adult community-acquired pneumonia attributable to Streptococcus pneumoniae.

    Science.gov (United States)

    Watt, J P; Moïsi, J C; Donaldson, R L A; Reid, R; Ferro, S; Whitney, C G; Santosham, M; O'Brien, K L

    2010-12-01

    Streptococcus pneumoniae is a common cause of community-acquired pneumonia (CAP) but existing diagnostic tools have limited sensitivity and specificity. We enrolled adults undergoing chest radiography at three Indian Health Service clinics in the Southwestern United States and collected acute and convalescent serum for measurement of PsaA and PspA titres and urine for pneumococcal antigen detection. Blood and sputum cultures were obtained at the discretion of treating physicians. We compared findings in clinical and radiographic CAP patients to those in controls without CAP. Urine antigen testing showed the largest differential between CAP patients and controls (clinical CAP 13%, radiographic CAP 17%, control groups 2%). Serological results were mixed, with significant differences between CAP patients and controls for some, but not all changes in titre. Based on urine antigen and blood culture results, we estimated that 11% of clinical and 15% of radiographic CAP cases were due to pneumococcus in this population.

  1. 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 <115 cm) stranded in Mississippi and Alabama during 2011. The proportion of annual 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 < 0.0001), have fetal distress (87 vs. 27%, p < 0.0001), and have 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.

  2. 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…

  3. 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......: FFMI loss is related to increased mortality in older persons....

  4. Cause-Specific Mortality and Death Certificate Reporting in Adults with Moderate to Profound Intellectual Disability

    Science.gov (United States)

    Tyrer, F.; McGrother, C.

    2009-01-01

    Background: The study of premature deaths in people with intellectual disability (ID) has become the focus of recent policy initiatives in England. This is the first UK population-based study to explore cause-specific mortality in adults with ID compared with the general population. Methods: Cause-specific standardised mortality ratios (SMRs) and…

  5. Impact of the use of procalcitonin assay in hospitalized adult patients with pneumonia at a community acute care hospital.

    Science.gov (United States)

    Kook, Janet L; Chao, Stephanie R; Le, Jennifer; Robinson, Philip A

    2012-04-01

    A retrospective, quasi-experimental cohort study compared antibiotic use before and after implementation of a procalcitonin assay at a community acute care hospital. This study demonstrated that the implementation of the procalcitonin assay was associated with a decrease in antibiotic days of therapy in adult patients with pneumonia.

  6. Recent trends of cancer mortality in Romanian adults: mortality is still increasing, although young adults do better than the middle-aged and elderly population.

    Science.gov (United States)

    Tereanu, Carmen; Baili, Paolo; Berrino, Franco; Micheli, Andrea; Furtunescu, Florentina L; Minca, Dana G; Sant, Milena

    2013-05-01

    We analysed the mortality trends (1986-2009) for all cancers combined and selected cancers in adult Romanians by three age groups (15-49, 50-69 and older than 70 years of age) in comparison with 11 other European countries. We extracted mortality data from the WHO database and grouped the countries into four regions: central and eastern Europe (Romania, Bulgaria, the Czech Republic, Hungary), Baltic countries (Estonia, Latvia and Lithuania), western and northern Europe (Austria, the Netherlands and Finland), and southern Europe (Croatia and Slovenia). Mortality rates were age-standardized against the standard European population. Significant changes in mortality trends were identified by Joinpoint regression and annual percentage changes (APCs) were calculated for periods with uniform trends. Cancer mortality in Romania was among the lowest in Europe in 1986, but was higher than most countries by 2009. Despite the declining mortality (APC) in younger Romanians for all cancers combined (men-1.5% from 1997, women-1.2% 1997-2004 and -3.8% 2004-2009), male lung cancer (-2.8% from 1997), female breast (-3.5% from 1999) and cervical (-5.4% from 2004) cancers, mortality has increased in middle-aged and elderly patients for most cancers analysed. The exception was declining stomach cancer mortality in most Romanians, except elderly men. For most cancers analysed, mortality declined in the Baltic countries in young and middle-aged patients, and in western and northern countries for all ages. Lung cancer mortality in women increased in all countries except Latvia. We urge immediate steps to reverse the alarming increase in cancer mortality among middle-aged and elderly Romanians.

  7. Severe respiratory failure secondary to Varicella zoster pneumonia

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    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.

  8. Causative agent distribution and antibiotic therapy assessment among adult patients with community acquired pneumonia in Chinese urban population

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    Liu Yong

    2009-03-01

    Full Text Available Abstract Background Knowledge of predominant microbial patterns in community-acquired pneumonia (CAP constitutes the basis for initial decisions about empirical antimicrobial treatment, so a prospective study was performed during 2003–2004 among CAP of adult Chinese urban populations. Methods Qualified patients were enrolled and screened for bacterial, atypical, and viral pathogens by sputum and/or blood culturing, and by antibody seroconversion test. Antibiotic treatment and patient outcome were also assessed. Results Non-viral pathogens were found in 324/610 (53.1% patients among whom M. pneumoniae was the most prevalent (126/610, 20.7%. Atypical pathogens were identified in 62/195 (31.8% patients carrying bacterial pathogens. Respiratory viruses were identified in 35 (19% of 184 randomly selected patients with adenovirus being the most common (16/184, 8.7%. The nonsusceptibility of S. pneumoniae to penicillin and azithromycin was 22.2% (Resistance (R: 3.2%, Intermediate (I: 19.0% and 79.4% (R: 79.4%, I: 0%, respectively. Of patients (312 from whom causative pathogens were identified and antibiotic treatments were recorded, clinical cure rate with β-lactam antibiotics alone and with combination of a β-lactam plus a macrolide or with fluoroquinolones was 63.7% (79/124 and 67%(126/188, respectively. For patients having mixed M. pneumoniae and/or C. pneumoniae infections, a better cure rate was observed with regimens that are active against atypical pathogens (e.g. a β-lactam plus a macrolide, or a fluoroquinolone than with β-lactam alone (75.8% vs. 42.9%, p = 0.045. Conclusion In Chinese adult CAP patients, M. pneumoniae was the most prevalent with mixed infections containing atypical pathogens being frequently observed. With S. pneumoniae, the prevalence of macrolide resistance was high and penicillin resistance low compared with data reported in other regions.

  9. Using HIV-attributable mortality to assess the impact of antiretroviral therapy on adult mortality in rural Tanzania

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    Chifundo Kanjala

    2014-03-01

    Full Text Available Background: The Tanzanian national HIV care and treatment programme has provided free antiretroviral therapy (ART to HIV-positive persons since 2004. ART has been available to participants of the Kisesa open cohort study since 2005, but data to 2007 showed a slow uptake of ART and a modest impact on mortality. Additional data from the 2010 HIV serological survey provide an opportunity to update the estimated impact of ART in this setting. Methods: The Kisesa Health and Demographic Surveillance Site (HDSS has collected HIV serological data and demographic data, including verbal autopsy (VA interviews since 1994. Serological data to the end of 2010 were used to make two estimates of HIV-attributable mortality, the first among HIV positives using the difference in mortality between HIV positives and HIV negatives, and the second in the population using the difference between the observed mortality rate in the whole population and the mortality rate among the HIV negatives. Four time periods (1994–1999, 2000–2004, 2005–2007, and 2008–2010 were used and HIV-attributable mortality estimates were analysed in detail for trends over time. A computer algorithm, InterVA-4, was applied to VA data to estimate the HIV-attributable mortality for the population, and this was compared to the estimates from the serological survey data. Results: Among HIV-positive adults aged 45–59 years, high mortality rates were observed across all time periods in both males and females. In HIV-positive men, the HIV-attributable mortality was 91.6% (95% confidence interval (CI: 84.6%–95.3% in 2000–2004 and 86.3% (95% CI: 71.1%–93.3% in 2008–2010, while among women, the HIV-attributable mortality was 87.8% (95% CI: 71.1%–94.3% in 2000–2004 and 85.8% (95% CI: 59.6%–94.4% in 2008–2010. In the whole population, using the serological data, the HIV-attributable mortality among men aged 30–44 years decreased from 57.2% (95% CI: 46.9%–65.3% in 2000–2004

  10. Nursing diagnoses, interventions, and patient outcomes for hospitalized older adults with pneumonia.

    Science.gov (United States)

    Head, Barbara J; Scherb, Cindy A; Reed, David; Conley, Deborah Marks; Weinberg, Barbara; Kozel, Marie; Gillette, Susan; Clarke, Mary; Moorhead, Sue

    2011-04-01

    A study was conducted by academic and community hospital partners with clinical information systems that included the standardized nursing language classifications of the North American Nursing Diagnosis Association International (NANDA-I), Nursing Interventions Classification (NIC), and Nursing Outcomes Classification (NOC). The aim of the study was to determine the frequency of NANDA-I, NIC, and NOC (NNN) terms documented for older adults with pneumonia who were discharged from three hospitals during a 1-year period. NNN terms were ranked according to frequency for each hospital, and then the rankings were compared with previous studies. Similarity was greater across hospitals in rankings of NANDA-I and NOC terms than in rankings of NIC terms. NANDA-I and NIC terms are influenced by reimbursement and regulatory factors as well as patient condition. The 10 most frequent NNN terms for each hospital accounted only for a small to moderate percentage of the terms selected.

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

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    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.

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

    Science.gov (United States)

    Gagnon, Alain; Miller, Matthew S; Hallman, Stacey A; Bourbeau, Robert; Herring, D Ann; Earn, David J D; Madrenas, Joaquín

    2013-01-01

    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.

  13. 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

  14. 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

  15. 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.

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

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    Mohammod Jobayer Chisti

    Full Text Available 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.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.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.The result suggests that SAM children with cough or respiratory difficulty and radiologic pneumonia who

  17. Associations between antioxidants and all-cause mortality among US adults with obstructive lung function.

    Science.gov (United States)

    Ford, Earl S; Li, Chaoyang; Cunningham, Timothy J; Croft, Janet B

    2014-11-28

    Chronic obstructive pulmonary disease is characterised by oxidative stress, but little is known about the associations between antioxidant status and all-cause mortality in adults with this disease. The objective of the present study was to examine the prospective associations between concentrations of α- and β-carotene, β-cryptoxanthin, lutein/zeaxanthin, lycopene, Se, vitamin C and α-tocopherol and all-cause mortality among US adults with obstructive lung function. Data collected from 1492 adults aged 20-79 years with obstructive lung function in the National Health and Nutrition Examination Survey III (1988-94) were used. Through 2006, 629 deaths were identified during a median follow-up period of 14 years. After adjustment for demographic variables, the concentrations of the following antioxidants modelled as continuous variables were found to be inversely associated with all-cause mortality among adults with obstructive lung function: α-carotene (P= 0·037); β-carotene (P= 0·022); cryptoxanthin (P= 0·022); lutein/zeaxanthin (P= 0·004); total carotenoids (P= 0·001); vitamin C (Pmortality. No effect modification by sex was detected, but the association between lutein/zeaxanthin concentrations and all-cause mortality varied by smoking status (P interaction= 0·048). The concentrations of lycopene and vitamin C were inversely associated with all-cause mortality in this cohort of adults with obstructive lung function.

  18. Associations between health-related quality of life and mortality in older adults.

    Science.gov (United States)

    Brown, Derek S; Thompson, William W; Zack, Matthew M; Arnold, Sarah E; Barile, John P

    2015-01-01

    This study measures the use and relative importance of different measures of health-related quality of life (HRQOL) as predictors of mortality in a large sample of older US adults. We used Cox proportional hazards models to analyze the association between general self-reported health and three "healthy days" (HDs) measures of HRQOL and mortality at short-term (90-day) and long-term (2.5 years) follow-up. The data were from Cohorts 6 through 8 of the Medicare Health Outcomes Survey, a national sample of older adults who completed baseline surveys in 2003-2005. At the long term, reduced HRQOL in general health and all categories of the HDs were separately and significantly associated with greater mortality (P mortality, at least one HD category remained significant for each measure, but the associations between mental health and mortality were inconsistent. For short-term mortality, the physical health measures had larger hazard ratios, but fewer categories were significant. Hazard ratios decreased over time for all measures of HRQOL except mental health. In conclusion, HRQOL measures were shown to be significant predictors of short- and long-term mortality, further supporting their value in health surveillance and as markers of risk for targeted prevention efforts. Although all four measures of HRQOL significantly predicted mortality, general self-rated health and age were more important predictors than the HDs.

  19. 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.

  20. Serotype-Specific Effect of Influenza on Adult Invasive Pneumococcal Pneumonia

    Science.gov (United States)

    Weinberger, Daniel M.; Harboe, Zitta B.; Viboud, Cécile; Krause, Tyra G.; Miller, Mark; Mølbak, Kåre; Konradsen, Helle B.

    2013-01-01

    Background. Influenza affects host susceptibility to pneumococcus. We sought to evaluate whether this relationship varies by pneumococcal serotype using a large epidemiological database covering 3 decades. Methods. Weekly rates of invasive pneumococcal pneumonia (IPP) were obtained from the Danish National Laboratory Surveillance System, and influenza-like illness (ILI) data were collected from Danish sentinel surveillance, Statens Serum Institut, 1977–2007. We fit Poisson regression models for each age and comorbidity group, with predictors for seasonality and secular changes, ILI activity, and serotype. Results. Among individuals with low levels of comorbidities, influenza had the largest impact on IPP incidence among low-invasiveness serotypes (influenza attributable percent: 17.9%, 95% confidence interval [CI], 13.6–21.9) as compared with high-invasiveness serotypes (6.7%, 95% CI, 3.8%–11.7%). Among those with higher levels of comorbidities, the effect of influenza was smaller, but high-invasiveness serotypes increased more than low-invasiveness serotypes (8.9% [95% CI, 6.6–11.8] vs 1.3% [95% CI, −1.6–5.4]. Conclusions. Influenza was associated with the greatest increases in the incidence of disease caused by serotypes with lower invasive potential and among individuals with low levels of comorbid conditions. The importance of influenza for adult IPP varies by serotype and host comorbidity. PMID:23901093

  1. Spatial patterns of coral survivorship: impacts of adult proximity versus other drivers of localized mortality

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    David A. Gibbs

    2015-11-01

    Full Text Available Species-specific enemies may promote prey coexistence through negative distance- and density-dependent survival of juveniles near conspecific adults. We tested this mechanism by transplanting juvenile-sized fragments of the brooding corals Pocillopora damicornis and Seriatopora hystrix 3, 12, 24 and 182 cm up- and down-current of conspecific adults and monitoring their survival and condition over time. We also characterized the spatial distribution of P. damicornis and S. hystrix within replicate plots on three Fijian reef flats and measured the distribution of small colonies within 2 m of larger colonies of each species. Juvenile-sized transplants exhibited no differences in survivorship as a function of distance from adult P. damicornis or S. hystrix. Additionally, both P. damicornis and S. hystrix were aggregated rather than overdispersed on natural reefs. However, a pattern of juveniles being aggregated near adults while larger (and probably older colonies were not suggests that greater mortality near large adults could occur over longer periods of time or that size-dependent mortality was occurring. While we found minimal evidence of greater mortality of small colonies near adult conspecifics in our transplant experiments, we did document hot-spots of species-specific corallivory. We detected spatially localized and temporally persistent predation on P. damicornis by the territorial triggerfish Balistapus undulatus. This patchy predation did not occur for S. hystrix. This variable selective regime in an otherwise more uniform environment could be one mechanism maintaining diversity of corals on Indo-Pacific reefs.

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

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    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.

  3. Viral and bacterial aetiology of community-acquired pneumonia in adults

    NARCIS (Netherlands)

    Huijskens, Elisabeth G. W.; van Erkel, Adriana J. M.; Palmen, Fernand M. H.; Buiting, Anton G. M.; Kluytmans, Jan A. J. W.; Rossen, John W. A.

    2013-01-01

    BACKGROUND: Modern molecular techniques reveal new information on the role of respiratory viruses in community-acquired pneumonia. In this study, we tried to determine the prevalence of respiratory viruses and bacteria in patients with community-acquired pneumonia who were admitted to the hospital.

  4. Age differential effects of severity of visual impairment on mortality among older adults in China.

    Science.gov (United States)

    Gu, Danan; Zhou, Junshan; Yong, Vanessa; Sautter, Jessica; Saito, Yasuhiko

    2013-10-01

    We use a population-based longitudinal survey in China from 2002 to 2005 to examine age differentials in the association between severity of visual impairment and mortality risk in older adults. Controlling for numerous factors and baseline health, a substantial age difference is found. Young-old women and men aged 65 to 79 with severe visual impairments have 161% (hazard ratio = 2.61) and 52% (hazard ratio = 1.52) higher risk of death respectively as compared to their unimpaired counterparts. Mild impairment does not increase mortality risk among young-old adults, while both mild and severe impairment increase mortality risk by 33% and 32% for women and 24% and 34% for men among the oldest-old as a whole when all factors are controlled for. We conclude that visual impairment is an independent predictor of mortality and severe visual impairment likely plays a stronger role in determining mortality risk among young-old adults than among the oldest-old.

  5. 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.

  6. Weight change and all-cause mortality in older adults: A meta-analysis

    Science.gov (United States)

    This meta-analysis of observational cohort studies examined the association between weight change (weight loss, weight gain, and weight fluctuation) and all-cause mortality among older adults. We used PubMed (MEDLINE), Web of Science, and Cochrane Library to identify prospective studies published in...

  7. Low mortality in the poorest areas of Spain: adults residing in provinces with lower per capita income have the lowest mortality.

    Science.gov (United States)

    Regidor, Enrique; Vallejo, Fernando; Giráldez-García, Carolina; Ortega, Paloma; Santos, Juana M; Astasio, Paloma; de la Fuente, Luis

    2015-08-01

    The objective of this study is to ascertain whether income inequality and per capita income of area of residence show a relationship with mortality in Spain. Data are from a nation-wide prospective study with a 7-year mortality follow-up covering all persons living in Spain's 50 provinces in 2001. In total 28,944,854 subjects aged 25 years or over at baseline were studied. Rate ratio for total mortality and cause-specific mortality, according to provincial income inequality and per capita income in two age groups, 25-64 years (adult population) and 65 years and over (elderly population). Provincial income inequality was not related to total mortality or cause-specific mortality. Total mortality rate ratios among residents of the poorest versus the richest provinces were 0.89 (95% CI 0.95-0.93) in men and 0.91 (0.87-0.96) in women, among the adult population; and 1.02 (0.97-1.08) in men and 1.08 (1.02-1.16) in women, among the elderly population. With the exception of cardiovascular-disease mortality for which no association with per capita income was observed, adult residents of the poorest provinces registered the lowest mortality rate ratio for other causes of death. Elderly residents of the poorest provinces registered the highest mortality rate ratio for cardiovascular disease and the lowest mortality rate ratio for cancer and external causes. Aside from cardiovascular-disease mortality, the lowest mortality for most causes of death was registered by residents of the poorest provinces. Nevertheless, these findings need to be confirmed by similar studies using smaller areas as the unit of analysis.

  8. Atypical pneumonia

    Science.gov (United States)

    Walking pneumonia; Community-acquired pneumonia - atypical ... Bacteria that cause atypical pneumonia include: Mycoplasma pneumonia is caused by the bacteria Mycoplasma pneumoniae . It often affects people younger than age 40. Pneumonia due ...

  9. Accelerometer-measured dose-response for physical activity, sedentary time, and mortality in US adults

    DEFF Research Database (Denmark)

    Matthews, Charles E; Keadle, S. K.; Troiano, Richard P

    2016-01-01

    Background: Moderate-to-vigorous-intensity physical activity is recommended to maintain and improve health, but the mortality benefits of light activity and risk for sedentary time remain uncertain. Objectives: Using accelerometer-based measures, we 1) described the mortality dose-response for se......Background: Moderate-to-vigorous-intensity physical activity is recommended to maintain and improve health, but the mortality benefits of light activity and risk for sedentary time remain uncertain. Objectives: Using accelerometer-based measures, we 1) described the mortality dose......-response for sedentary time and light-and moderateto-vigorous-intensity activity using restricted cubic splines, and 2) estimated the mortality benefits associated with replacing sedentary time with physical activity, accounting for total activity. Design: US adults (n = 4840) from NHANES (2003-2006) wore...... an accelerometer for #7 d and were followed prospectively for mortality. Proportional hazards models were used to estimate adjusted HRs and 95% CIs for mortality associations with time spent sedentary and in light-and moderate-to-vigorous-intensity physical activity. Splines were used to graphically present...

  10. 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

    2013-05-01

    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 demographic surveillance system 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 socio-economic status were identified as significant and highly attributable determinants of adult mortality. Health facility remoteness was 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 (hot spots) 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 was found to be clearly evident in this rural population.

  11. 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

  12. 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.

  13. 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.

  14. 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.

  15. Oral health disparities in older adults: oral bacteria, inflammation, and aspiration pneumonia.

    Science.gov (United States)

    Scannapieco, Frank A; Shay, Kenneth

    2014-10-01

    Poor oral hygiene has been suggested to be a risk factor for aspiration pneumonia in the institutionalized and disabled elderly. Control of oral biofilm formation in these populations reduces the numbers of potential respiratory pathogens in the oral secretions, which in turn reduces the risk for pneumonia. Together with other preventive measures, improved oral hygiene helps to control lower respiratory infections in frail elderly hospital and nursing home patients.

  16. 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.

  17. Epidemiología de la neumonía del adulto adquirida en la comunidad EPIDEMILOGY OF COMMUNITY-ACQUIRED PNEUMONIA IN ADULTS

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    Gonzalo Valdivia C.

    2005-04-01

    first specific one in senescent adults over 80 years old. The incidence and mortality of community acquired pneumonia (CAP increase in both extreme ages of life (less than one year old and over 65 years old. In the population over 65 years old, mortality is extremely increased, rising to rates of 6.6 deaths per 1.000 inhabitants. High variability in pneumonia hospitalization rate has been observed in different geographic areas, probably due to different medical criteria used to evaluate the severity of illness, access to healthcare systems and characteristics of the evaluated population. About 20% of patients affected with CAP require hospitalization due to the severity of pulmonary infection and to the risk of complications or death, and the necessity of healthcare resources are focused in these patients. Several clinical-epidemiological parameters able to modify clinical presentation and severity of pneumonia have been identified, such as advanced age, presence of co-morbidities, host immune competence, tobacco and alcohol consumption, place of acquiring the infection, etiology and environmental pollution

  18. Body mass and weight change in adults in relation to mortality risk.

    Science.gov (United States)

    Adams, Kenneth F; Leitzmann, Michael F; Ballard-Barbash, Rachel; Albanes, Demetrius; Harris, Tamara B; Hollenbeck, Albert; Kipnis, Victor

    2014-01-15

    Using data from the National Institutes of Health-AARP Diet and Health Study, we evaluated the influence of adulthood weight history on mortality risk. The National Institutes of Health-AARP Diet and Health Study is an observational cohort study of US men and women who were aged 50-71 years at entry in 1995-1996. This analysis focused on 109,947 subjects who had never smoked and were younger than age 70 years. We estimated hazard ratios of total and cause-specific mortality for recalled body mass index (BMI; weight (kg)/height (m)(2)) at ages 18, 35, and 50 years; weight change across 3 adult age intervals; and the effect of first attaining an elevated BMI at 4 successive ages. During 12.5 years' follow-up through 2009, 12,017 deaths occurred. BMI at all ages was positively related to mortality. Weight gain was positively related to mortality, with stronger associations for gain between ages 18 and 35 years and ages 35 and 50 years than between ages 50 and 69 years. Mortality risks were higher in persons who attained or exceeded a BMI of 25.0 at a younger age than in persons who reached that threshold later in adulthood, and risks were lowest in persons who maintained a BMI below 25.0. Heavier initial BMI and weight gain in early to middle adulthood strongly predicted mortality risk in persons aged 50-69 years.

  19. 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

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    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.

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

    NARCIS (Netherlands)

    Warnier, Miriam J.; Rutten, Frans H.; De Boer, Anthonius; Hoes, Arno W.; De Bruin, Marie L.

    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-

  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

    an increased risk in the pre-ART period. Participants on tuberculosis treatment at referral had a lower mortality rate (adjusted Rate Ratio 0.44; 95 % CI 0.31, 0.63). CONCLUSION: Among malnourished ART-eligible adults, pre-ART mortality was twice that in the early post-ART period, suggesting many early ART...... deaths represent advanced HIV disease rather than treatment-related events. Therefore, more efforts are needed to promote earlier diagnosis and immediate initiation of ART, as recently recommended by WHO for all persons with HIV worldwide. The positive effect of tuberculosis treatment suggests...... undiagnosed tuberculosis is a contributor to mortality in this population. TRIAL REGISTRATION: Pan African Clinical Trials Registry, PACTR201106000300631 ; registered on 1st June 2011....

  2. Personal networks and mortality risk in older adults: a twenty-year longitudinal study.

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    Lea Ellwardt

    Full Text Available 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 investigate whether effects on and pathways to mortality risk differ between functional and structural characteristics of the personal network. The objective is to inquire which personal network characteristics are the best predictors of mortality risk after adjustment for mental, cognitive and physical health.Empirical tests were carried out by combining official register information on mortality with data from the Longitudinal Aging Study Amsterdam (LASA. The sample included 2,911 Dutch respondents aged 54 to 85 at baseline in 1992 and six follow-ups covering a time span of twenty years. Four functional characteristics (emotional and social loneliness, emotional and instrumental support and four structural characteristics (living arrangement, contact frequency, number of contacts, number of social roles of the personal network as well as mental, cognitive and physical health were assessed at all LASA follow-ups. Statistical analyses comprised of Cox proportional hazard regression models. Findings suggest differential effects of personal network characteristics on survival, with only small gender differences. Mortality risk was initially reduced by functional characteristics, but disappeared after full adjustment for the various health variables. Mortality risk was lowest for older adults embedded in large (HR = 0.986, 95% CI 0.979-0.994 and diverse networks (HR = 0.948, 95% CI 0.917-0.981, and this effect continued to show in the fully adjusted models.Functional characteristics (i.e. emotional and social loneliness are indirectly associated with a reduction in mortality risk, while structural characteristics (i.e. number of contacts and number of social roles have

  3. Volunteering by older adults and risk of mortality: a meta-analysis.

    Science.gov (United States)

    Okun, Morris A; Yeung, Ellen WanHeung; Brown, Stephanie

    2013-06-01

    Organizational volunteering has been touted as an effective strategy for older adults to help themselves while helping others. Extending previous reviews, we carried out a meta-analysis of the relation between organizational volunteering by late-middle-aged and older adults (minimum age = 55 years old) and risk of mortality. We focused on unadjusted effect sizes (i.e., bivariate relations), adjusted effect sizes (i.e., controlling for other variables such as health), and interaction effect sizes (e.g., the joint effect of volunteering and religiosity). For unadjusted effect sizes, on average, volunteering reduced mortality risk by 47%, with a 95% confidence interval ranging from 38% to 55%. For adjusted effect sizes, on average, volunteering reduced mortality risk by 24%, with a 95% confidence interval ranging from 16% to 31%. For interaction effect sizes, we found preliminary support that as public religiosity increases, the inverse relation between volunteering and mortality risk becomes stronger. The discussion identifies several unresolved issues and directions for future research.

  4. Using Standardized Interpretation of Chest Radiographs to Identify Adults with Bacterial Pneumonia--Guatemala, 2007-2012.

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    Jonathan M Wortham

    Full Text Available Bacterial pneumonia is a leading cause of illness and death worldwide, but quantifying its burden is difficult due to insensitive diagnostics. Although World Health Organization (WHO protocol standardizes pediatric chest radiograph (CXR interpretation for epidemiologic studies of bacterial pneumonia, its validity in adults is unknown.Patients (age ≥ 15 years admitted with respiratory infections to two Guatemalan hospitals between November 2007 and March 2012 had urine and nasopharyngeal/oropharyngeal (NP/OP swabs collected; blood cultures and CXR were also performed at physician clinical discretion. 'Any bacterial infection' was defined as a positive urine pneumococcal antigen test, isolation of a bacterial pneumonia pathogen from blood culture, or detection of an atypical bacterial pathogen by polymerase chain reaction (PCR of nasopharyngeal/oropharyngeal (NP/OP specimens. 'Viral infection' was defined as detection of viral pathogens by PCR of NP/OP specimens. CXRs were interpreted according to the WHO protocol as having 'endpoint consolidation', 'other infiltrate', or 'normal' findings. We examined associations between bacterial and viral infections and endpoint consolidation.Urine antigen and/or blood culture results were available for 721 patients with CXR interpretations; of these, 385 (53% had endpoint consolidation and 253 (35% had other infiltrate. Any bacterial infection was detected in 119 (17% patients, including 106 (89% pneumococcal infections. Any bacterial infection (Diagnostic Odds Ratio [DOR] = 2.9; 95% confidence Interval (CI: 1.3-7.9 and pneumococcal infection (DOR = 3.4; 95% CI: 1.5-10.0 were associated with 'endpoint consolidation', but not 'other infiltrate' (DOR = 1.7; 95% CI: 0.7-4.9, and 1.7; 95% CI: 0.7-4.9 respectively. Viral infection was not significantly associated with 'endpoint consolidation', 'other infiltrate,' or 'normal' findings.'Endpoint consolidation' was associated with 'any bacterial infection

  5. Utility of adding Pneumocystis jirovecii DNA detection in nasopharyngeal aspirates in immunocompromised adult patients with febrile pneumonia.

    Science.gov (United States)

    Guigue, Nicolas; Alanio, Alexandre; Menotti, Jean; Castro, Nathalie De; Hamane, Samia; Peyrony, Olivier; LeGoff, Jérôme; Bretagne, Stéphane

    2015-04-01

    Detection of viral and bacterial DNA in nasopharyngeal aspirates (NPAs) is now a routine practice in emergency cases of febrile pneumonia. We investigated whether Pneumocystis jirovecii DNA could also be detected in these cases by conducting retrospective screening of 324 consecutive NPAs from 324 adult patients (198 or 61% were immunocompromised) admitted with suspected pulmonary infections during the 2012 influenza epidemic season, using a real-time quantitative polymerase chain reaction (PCR) assay (PjqPCR), which targets the P. jirovecii mitochondrial large subunit ribosomal RNA gene. These NPAs had already been tested for 22 respiratory pathogens (18 viruses and 4 bacteria), but we found that 16 NPAs (4.9%) were PjqPCR-positive, making P. jirovecii the fourth most prevalent of the 23 microorganisms in the screen. Eleven of the 16 PjqPCR-positive patients were immunocompromised, and five had underlying pulmonary conditions. Nine NPAs were also positive for another respiratory pathogen. Six had PjqPCR-positive induced sputa less than 3 days after the NPA procedure, and five were diagnosed with pneumocystis pneumonia (four with chronic lymphoproliferative disorders and one AIDS patient). In all six available pairs quantification of P. jirovecii DNA showed fewer copies in NPA than in induced sputum and three PjqPCR-negative NPAs corresponded to PjqPCR-positive bronchoalveolar lavage fluids, underscoring the fact that a negative PjqPCR screen does not exclude a diagnosis of pneumocystosis. Including P. jirovecii DNA detection to the panel of microorganisms included in screening tests used for febrile pneumonia may encourage additional investigations or support use of anti-pneumocystis pneumonia prophylaxis in immunocompromised patients.

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

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    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.

  7. 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.

  8. 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.

  9. Comparative analysis of quinolone resistance in clinical isolates of Klebsiella pneumoniae and Escherichia coli from Chinese children and adults.

    Science.gov (United States)

    Huang, Ying; Ogutu, James O; Gu, Jiarui; Ding, Fengshu; You, Yuhong; Huo, Yan; Zhao, Hong; Li, Wenjing; Zhang, Zhiwei; Zhang, Wenli; Chen, Xiaobei; Fu, Yingmei; Zhang, Fengmin

    2015-01-01

    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.

  10. Pneumocystis jirovecii pneumonia

    DEFF Research Database (Denmark)

    Cordonnier, Catherine; Cesaro, Simone; Maschmeyer, Georg

    2016-01-01

    Pneumocystis jirovecii can cause life-threatening pneumonia following treatment for haematological malignancies or after HSCT. The mortality rate of P. jirovecii pneumonia (PCP) in these patients is 30%-60%, especially after HSCT. The clinical presentation of PCP in haematology differs from that ...

  11. Spending on vegetable and fruit consumption could reduce all-cause mortality among older adults

    Directory of Open Access Journals (Sweden)

    Lo Yuan-Ting

    2012-12-01

    Full Text Available Abstract Background Few studies have evaluated the linkage between food cost and mortality among older adults. This study considers the hypothesis that greater food expenditure in general, and particularly on more nutritious plant and animal-derived foods, decreases mortality in older adults. Methods This study uses the 1999–2000 Elderly Nutrition and Health Survey in Taiwan and follows the cohort until 2008, collecting 24-hr dietary recall data for 1781 participants (874 men and 907 women aged 65 y or older. Using monthly mean national food prices and 24-hr recall, this study presents an estimate of daily expenditures for vegetable, fruit, animal-derived, and grain food categories. Participants were linked to the national death registry. Results Of the 1781 original participants, 625 died during the 10-y follow-up period. Among the 4 food categories, the fourth and fifth expenditure quintiles for vegetables and for fruits had the highest survival rates. After adjusting for co-variates, higher (Q4 vegetable and higher fruit (Q4 food expenditures referent to Q1 were significantly predictive of reduced mortality (HR = 0.55, 95% CI: 0.39-0.78 and HR = 0.64, 95% CI: 0.42–0.99, respectively and the risk decreased by 12% and 10% for every NT$15 (US$0.50 increase in their daily expenditures. Animal-derived and grain food spending was not predictive of mortality. Conclusion Greater and more achievable vegetable and fruit affordability may improve food security and longevity for older adults.

  12. 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

  13. 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.

  14. 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

  15. Physical activity, sedentary behavior, and cause-specific mortality in black and white adults in the Southern Community Cohort Study.

    Science.gov (United States)

    Matthews, Charles E; Cohen, Sarah S; Fowke, Jay H; Han, Xijing; Xiao, Qian; Buchowski, Maciej S; Hargreaves, Margaret K; Signorello, Lisa B; Blot, William J

    2014-08-15

    There is limited evidence demonstrating the benefits of physical activity with regard to mortality risk or the harms associated with sedentary behavior in black adults, so we examined the relationships between these health behaviors and cause-specific mortality in a prospective study that had a large proportion of black adults. Participants (40-79 years of age) enrolled in the Southern Community Cohort Study between 2002 and 2009 (n = 63,308) were prospectively followed over 6.4 years, and 3,613 and 1,394 deaths occurred in blacks and whites, respectively. Black adults who reported the highest overall physical activity level (≥32.3 metabolic equivalent-hours/day vs. 12 hours/day vs. mortality in blacks and whites. Blacks who reported the most time spent being sedentary (≥10.5 hours/day) and lowest level of physical activity (mortality risk in black adults.

  16. Evaluación de la gravedad en la neumonía del adulto adquirida en la comunidad EVALUATING SEVERITY OF COMMUNITY-ACQUIRED PNEUMONIA IN ADULTS

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    Fernando Saldías P.

    2005-04-01

    Full Text Available La evolución del paciente con neumonía adquirida en la comunidad puede variar entre un cuadro infeccioso banal de bajo riesgo de complicaciones hasta uno de extrema gravedad con riesgo vital. En general, el adulto inmunocompetente sin co-morbilidad ni criterios de gravedad manejado en el medio ambulatorio tiene bajo riesgo de complicaciones y muerte (letalidad menor de 1-2%, elevándose a 5-15% en los pacientes con co-morbilidad y/o factores de riesgo específicos que son admitidos al hospital y a 20-50% en aquellos admitidos a la Unidad de Cuidados Intensivos. La evaluación de la gravedad en el paciente con neumonía permite predecir la evolución de la enfermedad, orientar el lugar de manejo, la extensión del estudio microbiológico, y el tratamiento antimicrobiano empírico. Se sugiere clasificar a los enfermos en tres categorías de riesgo: pacientes con bajo riesgo (mortalidad inferior a 1-2% susceptibles de tratamiento ambulatorio; pacientes con alto riesgo (mortalidad entre 20-30% que deben ser manejados en unidades especializadas del hospital; y pacientes con riesgo intermedio, con co-morbilidad y/o factores de riesgo de evolución complicada y muerte, pero que no es posible clasificar en una categoría precisa. En el medio ambulatorio, donde no se dispone de exámenes complementarios, se recomienda evaluar la gravedad de los pacientes con neumonía considerando las siguientes variables clínicas: edad sobre 65 años, presencia de co-morbilidad, compromiso de conciencia, alteración de los signos vitales, compromiso radiográfico multilobar o bilateral, presencia de cavitación o efusión pleural, y SaO2 Clinical evolution in patients affected by community acquired pneumonia varies from a mild and low risk infectious disease to an extremely severe, life threatening disease. Commonly, immunocompetent adults without co-morbidities or severe risk factors cared for at out patient clinic have low risk of complications and death (mortality

  17. 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.

  18. 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 ...

  19. 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.

  20. 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.

  1. 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

  2. Predator Exclosures Enhance Reproductive Success but Increase Adult Mortality of Piping Plovers (Charadrius melodus

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    Colleen Barber

    2010-12-01

    Full Text Available Piping Plovers (Charadrius melodus are listed as endangered throughout Canada and the United States Great Lakes region. Most attempts to increase their numbers have focused on enhancing reproductive success. Using 22 years of data collected by Parks Canada in Prince Edward Island National Park of Canada, we examined whether predator exclosures installed around Piping Plover nests increased nest success and hatching and fledging success when compared to nests without exclosures. Nests with exclosures were significantly more likely to hatch at least one egg than nests without exclosures, and they hatched a significantly greater number of young. The greater reproductive success observed in exclosed nests is likely due to the increased protection from predators that the exclosures conferred; significantly fewer exclosed nests were depredated than nonexclosed nests. However, significantly more exclosed than nonexclosed nests were abandoned by adults, and they had significantly greater adult mortality. Whether benefits of increased reproductive success from exclosures outweigh costs of increased abandonment and adult mortality remains unknown, but must be considered.

  3. 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 ...

  4. 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.

  5. 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.

  6. Dietary soy intake is not associated with risk of cardiovascular disease mortality in Singapore Chinese adults.

    Science.gov (United States)

    Talaei, Mohammad; Koh, Woon-Puay; van Dam, Rob M; Yuan, Jian-Min; Pan, An

    2014-06-01

    Although soy food has been recommended because of its presumed cardiovascular benefits, the long-term prospective association between habitual soy food intake and cardiovascular disease mortality remains unclear. This study aimed to evaluate the relation of soy protein and isoflavone intake with the risk of cardiovascular disease mortality in middle-aged and older Chinese adults residing in Singapore. The Singapore Chinese Health Study is a population-based study that recruited 63,257 Chinese adults aged 45-74 y from 1993 to 1998. Usual diet was measured at recruitment by using a validated semiquantitative food-frequency questionnaire, and mortality information was identified via registry linkage until 31 December 2011. Cox proportional hazards models were used to calculate HRs, with adjustment for potential confounders. The median intake was 5.2 g/d for soy protein, 15.8 mg/d for soy isoflavones, and 87.4 g/d for soy expressed as tofu equivalents. We documented 4780 cardiovascular deaths during 890,473 person-years of follow-up. After adjustment for sociodemographic, lifestyle, and other dietary factors, soy protein intake was not significantly associated with cardiovascular disease mortality: HRs (95% CIs) were 1.00 (reference), 1.02 (0.94, 1.11), 1.02 (0.93, 1.11), and 1.06 (0.97, 1.17) for increasing quartiles of soy protein (P-trend = 0.24). Similarly, no significant association was observed for soy isoflavones and total tofu equivalents and when deaths from coronary heart disease (n = 2697) and stroke (n = 1298) were considered separately. When stratified by sex, HRs for cardiovascular disease mortality across quartiles of soy protein were 1.00, 1.00, 1.05, and 1.16 (95% CI: 1.03, 1.31) in men (P-trend = 0.02) and 1.00, 1.01, 0.96, and 0.95 (95% CI: 0.81, 1.10) in women (P-trend = 0.31), although the interaction was not significant (P-interaction = 0.12). In conclusion, soy intake was not significantly associated with risk of cardiovascular disease mortality

  7. 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

  8. SWAB/NVALT (Dutch Working Party on Antibiotic Policy and Dutch Association of Chest Physicians) Guidelines on the Management of Community-Acquired Pneumonia in Adults

    NARCIS (Netherlands)

    Wiersinga, W. J.; Bonten, M. J.; Boersma, W. G.; Jonkers, R. E.; Aleva, R. M.; Kullberg, B. J.; Schouten, J. A.; Degener, J. E.; Janknegt, R.; Verheij, T. J.; Sachs, A. P. E.; Prins, J. M.

    2012-01-01

    The Dutch Working Party on Antibiotic Policy (SWAB) and the Dutch Association of Chest Physicians (NVALT) convened a joint committee to develop evidence-based guidelines on the diagnosis and treatment of community-acquired pneumonia (CAP). The guidelines are intended for adult patients with CAP who

  9. 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...... (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...

  10. 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

    BACKGROUND: Recent evidence suggests that stroke is increasing as a cause of morbidity and mortality in younger adults, where it carries particular significance for working individuals. Accurate and up-to-date estimates of stroke burden are important for planning stroke prevention and management...... 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...... were estimated using the Global Burden of Disease (GBD) 2013 methods. All available data on rates of stroke incidence, excess mortality, prevalence and death were collected. Statistical models were used along with country-level covariates to estimate country-specific stroke burden. Stroke...

  11. 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.

  12. Mycoplasma pneumonia

    Science.gov (United States)

    Walking pneumonia; Community-acquired pneumonia - mycoplasma; Community-acquired pneumonia - atypical ... Mycoplasma pneumonia usually affects people younger than 40. People who live or work in crowded areas such as schools ...

  13. Association of age with mortality and virological and immunological response to antiretroviral therapy in rural South African adults.

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    Portia C Mutevedzi

    Full Text Available OBJECTIVE: To assess whether treatment outcomes vary with age for adults receiving antiretroviral therapy (ART in a large rural HIV treatment cohort. DESIGN: Retrospective cohort analysis using data from a public HIV Treatment & Care Programme. METHODS: Adults initiating ART 1(st August 2004-31(st October 2009 were stratified by age at initiation: young adults (16-24 years mid-age adults (25-49 years and older (≥50 years adults. Kaplan-Meier survival analysis was used to estimate mortality rates and age and person-time stratified Cox regression to determine factors associated with mortality. Changes in CD4 cell counts were quantified using a piecewise linear model based on follow-up CD4 cell counts measured at six-monthly time points. RESULTS: 8846 adults were included, 808 (9.1% young adults; 7119 (80.5% mid-age adults and 919 (10.4% older adults, with 997 deaths over 14,778 person-years of follow-up. Adjusting for baseline characteristics, older adults had 32% excess mortality (p = 0.004 compared to those aged 25-49 years. Overall mortality rates (MR per 100 person-years were 6.18 (95% CI 4.90-7.78; 6.55 (95% CI 6.11-7.02 and 8.69 (95% CI 7.34-10.28 for young, mid-age and older adults respectively. In the first year on ART, for older compared to both young and mid-aged adults, MR per 100 person-years were significantly higher; 0-3 months (MR: 27.1 vs 17.17 and 21.36 and 3-12 months (MR: 9.5 vs 4.02 and 6.02 respectively. CD4 count reconstitution was lower, despite better virological response in the older adults. There were no significant differences in MR after 1 year of ART. Baseline markers of advanced disease were independently associated with very early mortality (0-3 months whilst immunological and virological responses were associated with mortality after 12 months. CONCLUSIONS: Early ART initiation and improving clinical care of older adults are required to reduce high early mortality and enhance immunologic recovery, particularly

  14. 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.

  15. Association between delirium superimposed on dementia and mortality in hospitalized older adults: A prospective cohort study

    Science.gov (United States)

    Curiati, Jose A. E.; Jacob-Filho, Wilson

    2017-01-01

    Background Hospitalized older adults with preexisting dementia have increased risk of having delirium, but little is known regarding the effect of delirium superimposed on dementia (DSD) on the outcomes of these patients. Our aim was to investigate the association between DSD and hospital mortality and 12-mo mortality in hospitalized older adults. Methods and findings This was a prospective cohort study completed in the geriatric ward of a university hospital in São Paulo, Brazil. We included 1,409 hospitalizations of acutely ill patients aged 60 y and over from January 2009 to June 2015. Main variables and measures included dementia and dementia severity (Informant Questionnaire on Cognitive Decline in the Elderly, Clinical Dementia Rating) and delirium (Confusion Assessment Method). Primary outcomes were time to death in the hospital and time to death in 12 mo (for the discharged sample). Comprehensive geriatric assessment was performed at admission, and additional clinical data were documented upon death or discharge. Cases were categorized into four groups (no delirium or dementia, dementia alone, delirium alone, and DSD). The no delirium/dementia group was defined as the referent category for comparisons, and multivariate analyses were performed using Cox proportional hazards models adjusted for possible confounders (sociodemographic information, medical history and physical examination data, functional and nutritional status, polypharmacy, and laboratory covariates). Overall, 61% were women and 39% had dementia, with a mean age of 80 y. Dementia alone was observed in 13% of the cases, with delirium alone in 21% and DSD in 26% of the cases. In-hospital mortality was 8% for patients without delirium or dementia, 12% for patients with dementia alone, 29% for patients with delirium alone, and 32% for DSD patients (Pearson Chi-square = 112, p < 0.001). DSD and delirium alone were independently associated with in-hospital mortality, with respective hazard ratios

  16. 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

  17. 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.

  18. "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.

  19. Psychosis following mycoplasma pneumonia.

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    Banerjee, Bonita; Petersen, Kyle

    2009-09-01

    Extrapulmonary manifestations of Mycoplasma pneumoniae are well described, including a subset of central nervous system (CNS)-associated syndromes. In pediatric populations, frequencies of CNS sequelae occur in 0.1% to 7% of patients. Neurologic illness associated with M. pneumoniae, such as meningitis, encephalitis, polyradiculitis, Guillain-Barre, and stroke have been reported; however, the incidence of M. pneumoniae-associated organic brain syndrome is rare. We present the case of a 20-year-old midshipman with acute psychosis following resolution of M. pneumoniae pneumonia and review 6 other adult cases found in the literature. M. pneumoniae remains one of the most common causes of respiratory illnesses in the military recruit setting and therefore should always be suspected as an organic cause of mental status changes in young persons such as recruits, cadets, and midshipmen particularly with antecedent respiratory illnesses.

  20. 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

    . Furthermore, the relationship between offspring birth dimensions and parental mortality is addressed. METHODS: In all 10 753 male singletons born in the metropolitan area of Copenhagen, Denmark in 1953 whose birth certificates had been traced manually in 1965 were followed from 1968 to 2002 for information...... on parents' and own vital status by linkage with the Civil Registration System. Causes of death for the cohort members were identified by record linkage with the Cause-of-Death Registry. Hazard ratios and 95% CI were calculated using Cox regression models. RESULTS: Low birthweight and especially short birth...... and paternal lifespan. The associations between birthweight/birth length and mortality were stronger for the age group 35-49 years compared with the age group 15-34 years. Cause-specific mortality was inversely related to small birth dimensions for all causes of death, but strongest and graded for death from...

  1. Estimate of the effects of ultraviolet radiation on the mortality of Artemia franciscana in naupliar and adult stages

    Science.gov (United States)

    Dattilo, Arduino M.; Bracchini, Luca; Carlini, Laura; Loiselle, Steven; Rossi, Claudio

    2005-07-01

    The impact of different doses of artificial ultraviolet (UV) radiation on the growth stages of a marine zooplankton was investigated using laboratory microcosms. Mortality percentages of naupliar and adult samples of Artemia franciscana were recorded in relation to different UV doses (single exposure: 75, 150, 300, 600, 1,200, 2,400, 3,900, 7,800 J m-2) at specific observation times after exposure (24, 48, 72, 96 and 120 h). The relationship between mortality percentage and UV dose showed significant differences in relation to the zooplankton growth stage. The elevated susceptibility of the naupliar samples to UV radiation is described through a mortality model based on a logistic equation. The data analysis shows that the slope of mortality versus dose remains the same for the two growth stages while the lethal dose in the naupliar stage was 3.3 smaller than that determined for the adult stage. The slope of the UV mortality rate versus post-incubation time was found to be significantly different (P<0.05) at low UV doses for the two life stages examined, i.e. naupliar and adult. The lower value of LD50 in naupliar stages compared to that for adults confirms that in the early growth stage this marine zooplankton is more susceptible to UV radiation.

  2. 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.

  3. 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.

  4. 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.

  5. Time trend and age-period-cohort effects on acute myocardial infarction mortality in Korean adults from 1988 to 2007.

    Science.gov (United States)

    Jhun, Hyung-Joon; Kim, Ho; Cho, Sung-Il

    2011-05-01

    We examined time trend and age-period-cohort effects on acute myocardial infarction (AMI) mortality in Korean adults from 1988 to 2007. Annual AMI mortality data and population statistics from 1988 to 2007 were obtained from the STATISTICS KOREA website. Age adjusted mortality for four 5-yr calendar periods (1988-1992 to 2003-2007) was calculated by direct standardization using the Year 2000 WHO world standard population. A log-linear Poisson regression model was used to estimate age, period, and cohort effects on AMI mortality. In both genders, age-adjusted AMI mortality increased from period one (1988-1992) to period three (1998-2002) but decreased in period four (2003-2007). An exponential age effect was noted in both genders. The rate ratio of the cohort effect increased up to the 1943 birth cohort and decreased gradually thereafter, and the rate ratio of the period effect increased up to period three (1998-2002) and decreased thereafter. Our results suggest that AMI mortality in Korean adults has decreased since the period 1998-2002 and age, period, and cohort effects have influenced on AMI mortality.

  6. 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.

  7. 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.

  8. Delayed effects of obese and overweight population conditions on all-cause adult mortality rate in the USA

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    Albert A Okunade

    2016-09-01

    Full Text Available Currently, there are few studies separating the linkage of pathological obese and overweight body mass indices (BMI to the all-cause mortality rate in adults. Consequently, this paper, using annual Behavioral Risk Factor Surveillance System (BRFSS data of the 50 US states and the District of Columbia (DC estimates empirical regression models linking the US adult population overweight and obesity rates separately to the all-cause mortality rate. The biochemistry of multi-period cumulative adiposity (saturated fatty acid from unexpended caloric intakes (net energy storage provides the natural theoretical foundation for tracing unhealthy BMI to all-cause mortality. Cross-sectional and panel data regression models are separately estimated for the delayed effects of obese and overweight BMIs on the all-cause mortality rate. Controlling for the independent effects of economic, socio-demographic and other factors on the all-cause mortality rate, our findings confirm that the estimated panel data models are more appropriate. The panel data regression results reveal that the obesity-mortality link strengthens significantly after multiple years in the condition. The faster mortality response to obesity detected here is conjectured to arise from the significantly more obese. Compared with past studies postulating a static (rather than delayed effects, the statistically significant lagged effects of adult population BMI pathology in this study are novel and insightful. And, as expected, these lagged effects are more severe in the obese than overweight population segment. Public health policy implications of this social science study findings agree with those of the clinical sciences literature advocating timely lifestyle modification interventions (e.g., smoking cessation to slow premature mortality linked to unhealthy BMIs.

  9. 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

  10. Clinical cure and mortality outcomes with ceftobiprole medocaril versus ceftazidime plus linezolid in patients with early versus late-onset hospital-acquired pneumonia.

    NARCIS (Netherlands)

    Scheeren, Thomas; Welte, T.; Capellier, G.; Saulay, Mikal; Engelhardt, M.

    2015-01-01

    Objectives: Ceftobiprole, the active moiety of the prodrug ceftobiprole medocaril, is a novel cephalosporin for intravenous use, approved in certain European countries for the treatment of community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP) excluding ventilator-associated pneumo

  11. 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.

  12. 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.

  13. The Huge Reduction in Adult Male Mortality in Belarus and Russia: Is It Attributable to Anti-Alcohol Measures?

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    Pavel Grigoriev

    Full Text Available Harmful alcohol consumption has long been recognized as being the major determinant of male premature mortality in the European countries of the former USSR. Our focus here is on Belarus and Russia, two Slavic countries which continue to suffer enormously from the burden of the harmful consumption of alcohol. However, after a long period of deterioration, mortality trends in these countries have been improving over the past decade. We aim to investigate to what extent the recent declines in adult mortality in Belarus and Russia are attributable to the anti-alcohol measures introduced in these two countries in the 2000s.We rely on the detailed cause-specific mortality series for the period 1980-2013. Our analysis focuses on the male population, and considers only a limited number of causes of death which we label as being alcohol-related: accidental poisoning by alcohol, liver cirrhosis, ischemic heart diseases, stroke, transportation accidents, and other external causes. For each of these causes we computed age-standardized death rates. The life table decomposition method was used to determine the age groups and the causes of death responsible for changes in life expectancy over time.Our results do not lead us to conclude that the schedule of anti-alcohol measures corresponds to the schedule of mortality changes. The continuous reduction in adult male mortality seen in Belarus and Russia cannot be fully explained by the anti-alcohol policies implemented in these countries, although these policies likely contributed to the large mortality reductions observed in Belarus and Russia in 2005-2006 and in Belarus in 2012. Thus, the effects of these policies appear to have been modest. We argue that the anti-alcohol measures implemented in Belarus and Russia simply coincided with fluctuations in alcohol-related mortality which originated in the past. If these trends had not been underway already, these huge mortality effects would not have occurred.

  14. Elevated Plasma Vitamin B12 Concentrations Are Independent Predictors of In-Hospital Mortality in Adult Patients at Nutritional Risk.

    Science.gov (United States)

    Cappello, Silvia; Cereda, Emanuele; Rondanelli, Mariangela; Klersy, Catherine; Cameletti, Barbara; Albertini, Riccardo; Magno, Daniela; Caraccia, Marilisa; Turri, Annalisa; Caccialanza, Riccardo

    2016-12-23

    Background: Elevated plasma vitamin B12 concentrations were identified as predictors of mortality in patients with oncologic, hepatic and renal diseases, and in elderly and critically ill medical patients. The association between vitamin B12 concentrations and in-hospital mortality in adult patients at nutritional risk has not been assessed. Methods: In this five-year prospective study, we investigated whether high vitamin B12 concentrations (>1000 pg/mL) are associated with in-hospital mortality in 1373 not-bed-ridden adult patients at nutritional risk (Nutrition Risk Index B12 > 1000 pg/mL. Two hundred and four patients died in the hospital (14.9%). The adjusted odds ratio of in-hospital mortality in patients with high vitamin B12 was 2.20 (95% CI, 1.56-3.08; p B12 also had a longer length of stay (LOS) than those with normal concentrations (median 25 days, (IQR 15-41) versus 23 days (IQR 14-36); p = 0.014), and elevated vitamin B12 was an independent predictor of LOS (p = 0.027). Conclusions: An independent association between elevated vitamin B12 concentrations, mortality and LOS was found in our sample of hospitalized adult patients at nutritional risk. Although the underlying mechanisms are still unknown and any cause-effect relation cannot be inferred, clinicians should be aware of the potential negative impact of high vitamin B12 concentrations in hospitalized patients at nutritional risk and avoid inappropriate vitamin supplementation.

  15. 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.

  16. Cardiovascular disease is the main cause of long-term excess mortality after ischemic stroke in young adults.

    Science.gov (United States)

    Rutten-Jacobs, Loes C A; Arntz, Renate M; Maaijwee, Noortje A M; Schoonderwaldt, Hennie C; Dorresteijn, Lucille D; van Dijk, Ewoud J; de Leeuw, Frank-Erik

    2015-03-01

    Adults with stroke at a young age (18-50 years) remain at an increased risk of death for decades. It is unclear what cause underlies this long-term excess mortality and whether this is sex and time specific. Therefore, we investigated sex-specific temporal changes in cause of death after transient ischemic attack or ischemic stroke in young adults aged 18 to 50 years. We included all 845 consecutive 30-day survivors, of a first-ever transient ischemic attack (n=261) or ischemic stroke (n=584), admitted to our hospital between 1980 and 2010. Survival status was assessed at April 1, 2013. Observed cause-specific mortality was compared with expected mortality, derived from mortality rates in the general population with similar age, sex, and calendar-year characteristics. During a median follow-up of 9.2 years, 146 patients (17.3%) died, such that 29 years of life was lost by each individual. For all causes of death, observed mortality exceeded expected mortality. The absolute excess risk of death was for 74% attributable to a vascular cause (absolute excess risk, 2.8 per 1000 person-years [95% confidence interval, 1.8-4.1] for stroke and absolute excess risk, 4.3 per 1000 person-years [95% confidence interval, 2.9-5.9] for other vascular causes). The absolute excess risk was highest between 10 and 15 years after stroke and this peak was most pronounced in men and mainly attributable to vascular death. Long-term excess death after stroke in young adults is mainly attributable to a vascular cause and most pronounced in men. Attempts to reduce the risk of vascular disease after stroke in young adults should extend beyond the acute phase into the long term.

  17. Etiología de la neumonía adquirida en la comunidad en el adulto inmunocompetente ETIOLOGY OF COMMUNITY-ACQUIRED PNEUMONIA IN IMMUNOCOMPETENT ADULTS

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    Rodrigo Moreno B.

    2005-04-01

    Full Text Available En la situación clínica ideal, el tratamiento antimicrobiano empírico prescrito en la neumonía del adulto adquirida en la comunidad (NAC debería estar basado en el resultado de los estudios microbiológicos realizados en el medio nacional. La información disponible sobre la etiología en el medio ambulatorio y la UCI es relativamente escasa, en comparación con la referida al medio intrahospitalario. En los estudios diseñados específicamente para estudiar los agentes causales, en 40-50% de los casos no se identifica el patógeno respiratorio, lo que pone de manifiesto las dificultades de los métodos diagnósticos. En todos los escenarios de atención, Streptococcus pneumoniae es el principal patógeno respiratorio aislado en la NAC del adulto, siendo responsable de 16% de los casos tratados en el medio ambulatorio y de alrededor de 22% de los casos admitidos al hospital y la UCI. Aproximadamente un tercio de los casos son causados por un conjunto de varios microorganismos: Haemophilus influenzae, Mycoplasma pneumoniae, Chlamydia pneumoniae, virus respiratorios, Staphylococcus aureus, bacilos gramnegativos y Legionella sp, siendo cada uno responsable de menos de 10% de los casos. En general, la distribución de los microorganismos varía escasamente en los tres entornos de atención: ambulatorio, sala de cuidados generales y UCI. Entre las excepciones destaca una mayor frecuencia de infección por bacilos gramnegativos, S. aureus y Legionella sp en la UCI, y de C. pneumoniae en el medio ambulatorio. En Chile, la etiología de la NAC en el adulto hospitalizado es similar a la comunicada en estudios extranjeros, y no se dispone de información específica sobre la NAC de manejo ambulatorio y de la que cursa en forma graveIn an ideal clinical setting, empiric antimicrobial treatment prescribed in adult community acquired pneumonia (CAP should be based on national etiological surveillance and in vitro susceptibility assays. Available

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

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    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.

  19. Polytrauma Increases Susceptibility to Pseudomonas Pneumonia in Mature Mice.

    Science.gov (United States)

    Turnbull, Isaiah R; Ghosh, Sarbani; Fuchs, Anja; Hilliard, Julia; Davis, Christopher G; Bochicchio, Grant V; Southard, Robert E

    2016-05-01

    Pneumonia is the most common complication observed in patients with severe injuries. Although the average age of injured patients is 47 years, existing studies of the effect of injury on the susceptibility to infectious complications have focused on young animals, equivalent to a late adolescent human. We hypothesized that mature adult animals are more susceptible to infection after injury than younger counterparts. To test this hypothesis, we challenged 6 to 8-month-old mature mice to a polytrauma injury followed by Pseudomonas aeruginosa pneumonia and compared them to young (8-10-week-old) animals. We demonstrate that polytrauma injury increases mortality from pneumonia in mature animals (sham-pneumonia 21% vs. polytrauma-pneumonia 62%) but not younger counterparts. After polytrauma, pneumonia in mature mice is associated with higher bacterial burden in lung, increased incidence of bacteremia, and elevated levels of bacteria in the blood, demonstrating that injury decreases the ability to control the infectious challenge. We further find that polytrauma did not induce elevations in circulating cytokine levels (TNF-alpha, IL-6, KC, and IL-10) 24  h after injury. However, mature mice subjected to polytrauma demonstrated an exaggerated circulating inflammatory cytokine response to subsequent Pseudomonas pneumonia. Additionally, whereas prior injury increases LPS-stimulated IL-6 production by peripheral blood leukocytes from young (8-10-week-old) mice, injury does not prime IL-6 production by cell from mature adult mice. We conclude that in mature mice polytrauma results in increased susceptibility to Pseudomonas pneumonia while priming an exaggerated but ineffective inflammatory response.

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

    Science.gov (United States)

    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.

  1. Genomic Load from Sputum Samples and Nasopharyngeal Swabs for Diagnosis of Pneumococcal Pneumonia in HIV-Infected Adults

    Science.gov (United States)

    Madhi, Shabir A.; Adrian, Peter V.; Telles, Jean-Noel; Paranhos-Baccalà, Glaucia; Klugman, Keith P.

    2014-01-01

    Quantitative lytA real-time PCR (rtPCR) results from nasopharyngeal (NP) swabs distinguish community-acquired pneumococcal pneumonia (CAP) from asymptomatic colonization. The use of an optimized cutoff value improved pneumococcal etiology determination compared to that of traditional diagnostic methods. Here, we compare the utility of lytA rtPCR from induced sputum and from NP swabs. Pneumococcus was considered the cause of CAP in HIV-infected South African adults if blood culture, induced-sputum culture or Gram stain, urine antigen test, or whole-blood lytA rtPCR revealed pneumococcus or if lytA rtPCR from NP swabs gave a result of >8,000 copies/ml. lytA rtPCR was also performed on induced sputum. Pneumococcus was detected by lytA rtPCR from sputum in 149 (67.1%) of 222 patients with available induced sputum, whereas the results of either Gram stain or culture of sputum were positive in 105 of 229 patients (45.9%; P < 0.001). The mean copy numbers from sputum were higher when the sputum cultures were positive than when the sputum cultures were negative (7.9 versus 5.6 log10 copies/ml; P < 0.001). Against the composite diagnostic standard, a cutoff value of 10,000 copies/ml for good-quality sputum lytA rtPCR had a sensitivity of 78.1% and a specificity of 80.0%. This cutoff value performed similarly to the previously identified cutoff value of 8,000 copies/ml for NP swab lytA rtPCR (area under the curve receiver operating characteristic [AUC-ROC], 80.4% for sputum of any quality versus 79.6% for NP swabs). The AUC-ROC for good-quality sputum was 83.2%. Overall, lytA rtPCR performs similarly well on induced sputum as on NP swabs for most patients but performs slightly better if good-quality sputum can be obtained. Due to the ease of specimen collection, NP swabs may be preferable for the diagnosis of pneumococcal pneumonia. PMID:25253798

  2. Characterisation of aerobic bacteria isolated from endotracheal aspirate in adult patients suspected ventilator associated pneumonia in a tertiary care center in Mangalore

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    Ramakrishna Pai Jakribettu

    2012-01-01

    Full Text Available Background and Objectives: Despite advances in antimicrobial therapy, better supportive care modalities and use of a wide range of preventive measures, ventilator-associated pneumonia (VAP continues to be an important cause of morbidity and mortality in intensive care unit (ICU. VAP requires a rapid diagnosis and initiation of appropriate antibiotic treatment, to prevent mortality and morbidity. Inappropriate and inadequate antibiotic treatment causes emergence of drug resistance in pathogens and poor prognosis in patients. Early detection of pathogens causing VAP helps to control their spread by administration of suitable antibiotics and proper infection control measures. The study was conducted to know the pathogens causing VAP in Fr. Muller Medical College Hospital, Mangalore, and their susceptibility pattern. Methods: A total of 100 patients, on mechanical ventilation for more than 48 h, who were suspected to have VAP were included in the study between December 2008 and November 2009. Their endotracheal aspirates (ETAs were collected and processed. From 100 ETA, 138 isolates of count >10 5 CFU/ mL were characterized and antibiogram was determined using standard antibiotics regime. Results: Incidence of VAP was found to be 44.2% among the mechanically ventilated patients. Klebsiella pneumoniae (34% was the most common pathogen isolated, followed by Pseudomonas aeruginosa (20%. Among them, most of the K. pneumoniae and P. aeruginosa isolates were resistant to penicillins, cephalosporins, fluoroquinolones was observed but were sensitive to piperacillin/tazobactum, cefaperazone/sulbactum, and carbapenems. All isolates were sensitive to amikacin. Interpretation and Conclusion: The present study shows prevalence of multidrug-resistant organisms in the study region. Klebsiella species was the most common pathogen isolated in ETA. Acinetobacter species were the most resistant pathogens prevailing in our ICU setup, leading to the increased mortality

  3. 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.

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

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    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.

  5. 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....

  6. 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

    the relationship between CRT (using two existing definitions and as a continuous variable) and short-term mortality. METHODS: We included all acutely admitted adult patients to a medical admission unit. We measured CRT, blood pressure, pulse, temperature and peripheral oxygen saturation. We presented the data...... descriptively. Difference between continuous data was analysed using Wilcoxon Rank Sum Test and categorical data using χ(2) test. The primary endpoint was 1-day all-cause mortality. RESULTS: 3046 patients were enrolled and CRT was measured on 1935. In univariate analyses, we found increasing all-cause 1-day...

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

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    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

  8. 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.

  9. 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

  10. 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.

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

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    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.

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

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    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

  13. 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.

  14. 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

  15. 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 an individually-randomised phase III trial conducted in ART clinics in Mwanza, Tanzania, and Lusaka, Zambia. Participants were 1,815 ART-naïve non-pregnant adults with body mass index (BMI) ... 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...

  16. Elevated Plasma Vitamin B12 Concentrations Are Independent Predictors of In-Hospital Mortality in Adult Patients at Nutritional Risk

    Science.gov (United States)

    Cappello, Silvia; Cereda, Emanuele; Rondanelli, Mariangela; Klersy, Catherine; Cameletti, Barbara; Albertini, Riccardo; Magno, Daniela; Caraccia, Marilisa; Turri, Annalisa; Caccialanza, Riccardo

    2016-01-01

    Background: Elevated plasma vitamin B12 concentrations were identified as predictors of mortality in patients with oncologic, hepatic and renal diseases, and in elderly and critically ill medical patients. The association between vitamin B12 concentrations and in-hospital mortality in adult patients at nutritional risk has not been assessed. Methods: In this five-year prospective study, we investigated whether high vitamin B12 concentrations (>1000 pg/mL) are associated with in-hospital mortality in 1373 not-bed-ridden adult patients at nutritional risk (Nutrition Risk Index 1000 pg/mL. Two hundred and four patients died in the hospital (14.9%). The adjusted odds ratio of in-hospital mortality in patients with high vitamin B12 was 2.20 (95% CI, 1.56–3.08; p < 0.001); it was independent of age, gender, body mass index, six-month previous unintentional weight loss, admission ward, presence of malignancy, renal function, C-reactive protein and prealbumin. Patients with high vitamin B12 also had a longer length of stay (LOS) than those with normal concentrations (median 25 days, (IQR 15–41) versus 23 days (IQR 14–36); p = 0.014), and elevated vitamin B12 was an independent predictor of LOS (p = 0.027). Conclusions: An independent association between elevated vitamin B12 concentrations, mortality and LOS was found in our sample of hospitalized adult patients at nutritional risk. Although the underlying mechanisms are still unknown and any cause-effect relation cannot be inferred, clinicians should be aware of the potential negative impact of high vitamin B12 concentrations in hospitalized patients at nutritional risk and avoid inappropriate vitamin supplementation. PMID:28025528

  17. Elevated Plasma Vitamin B12 Concentrations Are Independent Predictors of In-Hospital Mortality in Adult Patients at Nutritional Risk

    Directory of Open Access Journals (Sweden)

    Silvia Cappello

    2016-12-01

    Full Text Available Background: Elevated plasma vitamin B12 concentrations were identified as predictors of mortality in patients with oncologic, hepatic and renal diseases, and in elderly and critically ill medical patients. The association between vitamin B12 concentrations and in-hospital mortality in adult patients at nutritional risk has not been assessed. Methods: In this five-year prospective study, we investigated whether high vitamin B12 concentrations (>1000 pg/mL are associated with in-hospital mortality in 1373 not-bed-ridden adult patients at nutritional risk (Nutrition Risk Index <97.5, admitted to medical and surgical departments. Results: Three hundred and ninety-six (28.8% patients presented vitamin B12 > 1000 pg/mL. Two hundred and four patients died in the hospital (14.9%. The adjusted odds ratio of in-hospital mortality in patients with high vitamin B12 was 2.20 (95% CI, 1.56–3.08; p < 0.001; it was independent of age, gender, body mass index, six-month previous unintentional weight loss, admission ward, presence of malignancy, renal function, C-reactive protein and prealbumin. Patients with high vitamin B12 also had a longer length of stay (LOS than those with normal concentrations (median 25 days, (IQR 15–41 versus 23 days (IQR 14–36; p = 0.014, and elevated vitamin B12 was an independent predictor of LOS (p = 0.027. Conclusions: An independent association between elevated vitamin B12 concentrations, mortality and LOS was found in our sample of hospitalized adult patients at nutritional risk. Although the underlying mechanisms are still unknown and any cause-effect relation cannot be inferred, clinicians should be aware of the potential negative impact of high vitamin B12 concentrations in hospitalized patients at nutritional risk and avoid inappropriate vitamin supplementation.

  18. 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

    Several reports indicate that asthma mortality has increased during the last few decades. International comparisons reveal some striking differences in the pattern of asthma mortality. The authors investigated the asthma mortality rate in the Danish child and youth population 1973-1994 and studied...... the validity of death certificates. The authors reviewed all death certificates coded as asthma death in the International Classification of Diseases (ICD 8-ICD 10 (1994)) and adjacent respiratory code numbers for the age group 1-19 yrs. Hospital records and autopsy reports were assessed to validate the cause...... of death. Age-standardized and age-specific mortality rates were calculated. From 1973 to 1987 there was a significant upward trend in the mortality. On subdivision, this trend was limited to the age group 15-19 yrs. Generally the mortality rate decreased from 1988 to 1994. Four per cent coded as asthma...

  19. 成人肺炎支原体感染的临床分析%Result Analysis of adult Mycoplasma Pneumoniae Pneumonia

    Institute of Scientific and Technical Information of China (English)

    刘鸿梅; 任春阳

    2013-01-01

    Objective:To analysis the clinical infection and drug resistance characteristics in isolates of Mycoplasma Pneumoniae(MP), and provide evidence for clinical therapy.Methods:Col ecting 1288 throat swabs of patients with acute respiratory tract infection to detecting Mycoplasma Pneumoniae by Rapid Identification Culturing And Chemosensitivity Kit.Results:255 strains of MP were isolated from 1288 cases,the positive rate was 19.79%. MP had the higher susceptible rate to azithromycin, lavo-ofloxacin, galtixacin, sparfloxacin and the highest resistance rate to erythrocin. Conclusions:Azithromycin can be used as the first-choice drugs in MP treatment.%目的:了解我院成人肺炎支原体(MP)感染及耐药特征,为临床合理使用抗生素提供依据。方法:采用MP快速鉴定培养药敏试剂盒对1288例急性呼吸道感染的患者咽拭子标本进行MP快速鉴定培养与药敏试验。结果:MP培养共有255例阳性,阳性率19.79%;MP对阿奇霉素、左氧氟沙星、加替沙星和司帕沙星的敏感率高;对红霉素的耐药率最高。结论:临床治疗MP应该根据药敏试验结果选用药物,其耐药性不容忽视,阿奇霉素是较理想选择。

  20. Hypervirulent Klebsiella pneumoniae clones causing bacteraemia in adults in a teaching hospital in Barcelona, Spain (2007-2013).

    Science.gov (United States)

    Cubero, M; Grau, I; Tubau, F; Pallarés, R; Dominguez, M A; Liñares, J; Ardanuy, C

    2016-02-01

    Virulent hypermucoviscous Klebsiella pneumoniae strains associated with the magA and rmpA genes have mainly emerged in Asia. We analysed the frequency and the clinical and molecular epidemiology of K. pneumoniae bacteraemia isolates obtained over a 7-year period (2007-2013). Fifty-three of 878 K. pneumoniae invasive isolates (5.4%) showed a hypermucoviscous phenotype (by the string test). Of these, 16 (30.2%) were magA(+)/rmpA(+), 12 (22.6%) were magA(-)/rmpA(+), and the remaining 25 (47.2%) were magA(-)/rmpA(-). After multilocus sequence typing and wzi sequencing, all magA(+)/rmpA(+) isolates were serotype K1 and sequence type (ST)23. Of the 12 magA(-)/rmpA(+) isolates, nine were K2 (ST380, ST86, ST65, ST25 and ST493), and three magA(-)/rmpA(+) isolates had the new wzi allele 122, an unknown serotype, and the new ST1013. The remaining isolates, which were magA(-)/rmpA(-), showed different serotypes and STs. Patients with magA(+)/rmpA(+) or magA(-)/rmpA(+)K. pneumoniae bacteraemia more frequently had pyogenic liver abscesses (PLAs) and pneumonia than patients with magA(-)/rmpA(-)K. pneumoniae bacteraemia (respectively: 21.4% vs. 8%, p 0.26; and 17.9% vs. 0%, p 0.05). In fact, magA(-)/rmpA(-) isolates were similar to the those termed 'classic' K. pneumoniae isolates causing bacteraemia, the urinary and biliary tracts being the main foci of infection. In conclusion, hypervirulent clones (CC23K1, CC86K2, CC65K2, and CC380K2) were infrequent among K. pneumoniae isolates causing bacteraemia in our geographical area. A hypermucoviscous phenotype as determined with the string test is not enough to recognize these clones; additional molecular studies are needed. Patients with magA(+) and/or rmpA(+)K. pneumoniae bacteraemia more frequently had PLAs and pneumonia than patients without hypermucoviscosity genes.

  1. Pneumonia and bacteremia in a golden-headed lion tamarin (Leontopithecus chrysomelas) caused by Klebsiella pneumoniae subsp. pneumoniae during a translocation program of free-ranging animals in Brazil.

    Science.gov (United States)

    Bueno, Marina G; Iovine, Renata O; Torres, Luciana N; Catão-Dias, José L; Pissinatti, Alcides; Kierulff, Maria C M; Carvalho, Vania M

    2015-05-01

    Klebsiella pneumoniae is an important emerging pathogen in humans, particularly the invasive hypermucoviscosity (HMV) phenotype. In addition, the organism is an important public health concern because of nosocomial infections and antimicrobial resistance. Nonhuman primates in captivity are susceptible to Klebsiella, particularly when a stress factor is involved. Infections vary depending on the species but can cause significant morbidity and mortality in these animals. The objective of this study was to describe a case of bronchopneumonia and bacteremia caused by Klebsiella pneumoniae in a free-ranging golden-headed lion tamarin (Leontopithecus chrysomelas) caught and maintained in quarantine during a translocation program for conservation purposes. An adult male, that had showed emaciation and apathy, was clinically examined and, despite being provided supportive therapy, died 2 days after onset of clinical signs. At postmortem examination, generalized bilateral pneumonia and pericarditis were observed. Tissue samples were fixed in 10% formalin for histology, and pulmonary tissues and cardiac blood were collected for microbiologic diagnostic procedures. Bacteria that were shown to be HMV K. pneumoniae subsp. pneumoniae strains were isolated from the pulmonary fluids and cardiac blood in pure cultures. Severe bronchopneumonia was the main pathological finding. The consequences of the confirmed presence of the HMV phenotype of K. pneumoniae subsp. pneumoniae in this wildlife species for human, animal, and ecosystem health should be determined. These results demonstrate the importance of quarantine and potential pathogen screening during wildlife translocation procedures.

  2. 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.

  3. 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.

  4. 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

  5. [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.

  6. 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.

  7. 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.

  8. 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 ...

  9. 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.

  10. Assessing, treating and preventing community acquired pneumonia in older adults: findings from a community-wide survey of emergency room and family physicians

    Directory of Open Access Journals (Sweden)

    Loeb Mark

    2005-08-01

    Full Text Available Abstract Background Respiratory infections, like pneumonia, represent an important threat to the health of older Canadians. Our objective was to determine, at a community level, family and emergency room physicians' knowledge and beliefs about community acquired pneumonia (CAP in older adults and to describe their self-reported assessment, management and prevention strategies. Methods All active ER and family physicians in Brant County received a mailed questionnaire. An advance notification letter and three follow-up mailings were used to maximize physician participation rate. The questionnaire collected information about physicians' assessment, management, and prevention strategies for CAP in older adults (≥60 years of age plus demographic, training, and practice characteristics. The analysis highlights differences in approaches between office-based and emergency department physicians. Results Seventy-seven percent of physicians completed and returned the survey. Although only 16% of physicians were very confident in assessing CAP in older adults, more than half reported CAP to be a very important health concern in their practices. In-service training for family physicians was associated with increased confidence in CAP assessment and more frequent use of diagnostic tests. Family physicians who reported always requesting chest x-rays were also more likely to request pulse oximetry (OR 5.6, 95% CI 1.40 to 22.5 and recommend both follow-up x-rays (OR 5.4, 95% CI 1.7 to 16.6 and pneumococcal vaccination (OR 3.4, 95% CI 1.1 to 10.0. Conclusion The findings of this study provide a snapshot of how non-specialists from a non-urban Ontario community assess, manage and prevent CAP in older adults and highlight differences between office-based and emergency department physicians. This information can guide researchers and clinicians in their efforts to improve the management and prevention of CAP in older adults.

  11. Mass mortality of adult Razorbills Alca torda in the Skagerrak and North Sea area, autumn 2007

    DEFF Research Database (Denmark)

    Heubek, Martin; Aarvak, T.; Isaksen, K.

    2011-01-01

    of Denmark into the Kattegat began a month earlier than normal. This preceded heavy mortality of the species that lasted several weeks, and numbered thousands of individuals. Unusually for the time of year, Razorbills greatly outnumbered Common Guillemots Uria aalge in reports of live and dead birds. Of 376...... that while not on the scale of that in the Skagerrak and Kattegat, Razorbill mortality was abnormally high over a wide area of the North Sea in autumn 2007. The age and sex structure of the mortality and its possible causes are discussed....

  12. 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

  13. 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......-1935, and no effect modification by zygosity was observed. Hence, the results are most compatible with an effect of early family environment in explaining the educational inequality in mortality. However, large educational differences were still reflected in mortality risk differences within twin pairs, thus...

  14. Risk factors for and mortality of extended-spectrum-β-lactamase-producing Klebsiella pneumoniae and Escherichia coli nosocomial bloodstream infections Fatores de risco e mortalidade de infecções da corrente sanguínea por Klebsiella pneumoniae and Escherichia coli produtores de beta-lactamase de espectro estendido

    Directory of Open Access Journals (Sweden)

    Silvana Vargas Superti

    2009-08-01

    Full Text Available A case-control study, involving patients with positive blood cultures for Klebsiella pneumoniae (KP or Escherichia coli (EC EC and controls with positive blood cultures for non-ESBL-KP or EC, was performed to assess risk factors for extended-spectrum-β-lactamase (ESBL production from nosocomial bloodstream infections (BSIs. Mortality among patients with BSIs was also assessed. The study included 145 patients (81, 59.5% with K. pneumoniae and 64, 44.1% with E. coli BSI; 51 (35.2% isolates were ESBL producers and 94 (64.8% nonproducers. Forty-five (55.6% K. pneumoniae isolates were ESBL producers, while only six (9.4% E. coli isolates produced the enzyme. Multivariate analysis showed that recent exposure to piperacillin-tazobactam (adjusted Odds Ratio [aOR] 6.2; 95%CI 1.1-34.7 was a risk factor for ESBL BSI. K. pneumoniae was significantly more likely to be an ESBL-producing isolate than E. coli (aOR 6.7; 95%CI 2.3-20.2. No cephalosporin class was independently associated with ESBLs BSI; however, in a secondary model considering all oxymino-cephalosporins as a single variable, a significant association was demonstrated (aOR 3.7; 95%CI 1.3-10.8. Overall 60-day mortality was significantly higher among ESBL-producing organisms. The finding that piperacillin-tazobactam use is a risk factor for ESBL-production in KP or EC BSIs requires attention, since this drug can be recommended to limit the use of third-generation cephalosporins.Estudo de caso-controle, onde os casos foram pacientes com hemocultura positiva para Klebsiella pneumoniae (KP ou Escherichia coli (EC produtores de beta lactamase de espectro estendido (ESBL e os controles foram pacientes com hemoculturas positivas para EC ou KP não produtores de ESBL foi realizado para avaliar os fatores de risco para produção destas enzimas em infecções da corrente sanguínea (ICS. Mortalidade dos pacientes com ICS também foi avaliada. Foram incluídos 145 pacientes (81, 59,5% tinham Klebsiella

  15. 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

  16. 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.

  17. 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

  18. 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.

  19. Osteopontin promotes host defense during Klebsiella pneumoniae-induced pneumonia.

    Science.gov (United States)

    van der Windt, G J W; Hoogerwerf, J J; de Vos, A F; Florquin, S; van der Poll, T

    2010-12-01

    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 OPN knockout (KO) mice were intranasally infected with 10⁴ colony forming units of K. pneumoniae, or administered Klebsiella lipopolysaccharides (LPS). In addition, recombinant OPN (rOPN) was intranasally administered to WT and CD44 KO mice. During Klebsiella pneumonia, WT mice displayed elevated pulmonary and plasma OPN levels. OPN KO and WT mice showed similar pulmonary bacterial loads 6 h after infection; thereafter, Klebsiella loads were higher in lungs of OPN KO mice and the mortality rate in this group was higher than in WT mice. Early neutrophil recruitment into the bronchoalveolar space was impaired in the absence of OPN after intrapulmonary delivery of either Klebsiella bacteria or Klebsiella LPS. Moreover, rOPN induced neutrophil migration into the bronchoalveolar space, independent from CD44. In vitro, OPN did not affect K. pneumoniae growth or neutrophil function. In conclusion, OPN levels were rapidly increased in the bronchoalveolar space during K. pneumoniae pneumonia, where OPN serves a chemotactic function towards neutrophils, thereby facilitating an effective innate immune response.

  20. 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.

  1. Oral delivery of double-stranded RNAs induces mortality in nymphs and adults of the Asian citrus psyllid, Diaphorina citri

    Science.gov (United States)

    Galdeano, Diogo Manzano; Breton, Michèle Claire; Lopes, João Roberto Spotti; Falk, Bryce W.

    2017-01-01

    The Asian citrus psyllid (ACP), Diaphorina citri Kuwayama, is one of the most important citrus pests. ACP is the vector of the phloem-limited bacteria Candidatus Liberibacter americanus and Candidatus Liberibacter asiaticus, the causal agents of the devastating citrus disease huanglongbing (HLB). The management of HLB is based on the use of healthy young plants, eradication of infected plants and chemical control of the vector. RNA interference (RNAi) has proven to be a promising tool to control pests and explore gene functions. Recently, studies have reported that target mRNA knockdown in many insects can be induced through feeding with double-stranded RNA (dsRNA). In the current study, we targeted the cathepsin D, chitin synthase and inhibitor of apoptosis genes of adult and nymph ACP by feeding artificial diets mixed with dsRNAs and Murraya paniculata leaves placed in dsRNAs solutions, respectively. Adult ACP mortality was positively correlated with the amount of dsRNA used. Both nymphs and adult ACP fed dsRNAs exhibited significantly increased mortality over time compared with that of the controls. Moreover, qRT-PCR analysis confirmed the dsRNA-mediated RNAi effects on target mRNAs. These results showed that RNAi can be a powerful tool for gene function studies in ACP and perhaps for HLB control. PMID:28282380

  2. Comparison of Luminex xTAG® RVP fast assay and real time RT-PCR for the detection of respiratory viruses in adults with community-acquired pneumonia.

    Science.gov (United States)

    Luchsinger, Vivian; Prades, Yara; Ruiz, Mauricio; Pizarro, Rolando; Rossi, Patricio; Lizama, Luis; Garmendia, María Luisa; Meza, Angela; Larrañaga, Carmen; Avendaño, Luis F

    2016-07-01

    Community-acquired pneumonia (CAP) is the third cause of death worldwide. Viruses are frequently detected in adult CAP. Highly sensitive diagnostic techniques should be used due to poor viral shedding. Different sampling methods can affect viral detection, being necessary to establish the optimal type of sample for identifying respiratory viruses in adults. The detection rates of respiratory viruses by Luminex xTAG® RVP fast assay, real time RT-PCR (rtRT-PCR) (Sacace®), and immunofluorescence assay (IFA) in adult CAP were performed in nasopharyngeal swabs (NPS) and aspirates (NPA) from 179 hospitalized adults. Positivity was 47.5% for Luminex®, 42.5% for rtRT-PCR (P = 0.3), and 2.7% for IFA (2.7%) (P viruses in 112 NPA and 35 (34.3%) and 31 (30.4%) in 102 NPS, respectively (P viruses in CAP adults. Both molecular techniques yielded better results with nasopharyngeal aspirate than swabs.

  3. 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

  4. Mortality in active adults age 70-79 years in relation to performance in a long-distance corridor walk.

    Science.gov (United States)

    Singer, Richard B

    2009-01-01

    The authors conducted the source study to determine if a brisk corridor walk of 400 meters could be used to classify the performance of active older adults and relate this performance to mortality and other outcomes over a 6-year follow-up. The cohort consisted of 3075 adults resident in designated ZIP codes in Pittsburgh, Pa, and Memphis, Tenn, participating in the Health Aging and Body Composition Study. Out of this cohort, 395 subjects were excluded after evaluation revealed abnormal vital signs or ECG findings, recent cardiac symptoms, recent surgery, recent chest pain, shortness of breath or fainting. Another 356 subjects were unable to complete the 400-meter walk. The 2324 subjects who completed the walk were divided into quartiles according to the time in seconds required for completion (the overall time required ranged widely from 201 to 942 seconds). These 3 groups were designated as "excluded," "stopped," and "completed." Outcomes reported for the 3075 subjects in the total cohort included mortality, new cardiovascular disease events, mobility limitation, and mobility disability. Cardiovascular events were reported for the 2234 subjects (73% of the total) who were free of cardiovascular disease at entry. Results in the article were given in tables and figures and included numbers of entrants, exposures, and events, annual event rates and hazard ratios with SDs. Out of the 3075 entrant subjects, 430 died in the 6 years of follow-up (FU). Excess mortality measured as excess death rate (EDR) was much higher in the excluded and stopped groups (about 22 per 1000 per year) compared with an EDR of 6.4 per 1000 in the completed group. The corresponding mortality ratios (MR), designated as a hazard ratio in the article were about 220% and 135%. Results for comparative morbidity are also given in this abstract.

  5. Leukocyte telomere length and mortality among U.S. adults: Effect modification by physical activity behaviour.

    Science.gov (United States)

    Loprinzi, Paul D; Loenneke, Jeremy P

    2017-02-17

    The purpose of this study was to examine the association between leukocyte telomere length (LTL) and mortality (outcome variable), with consideration by physical activity behaviour. Data from the 1999-2002 National Health and Nutrition Examination Survey were employed (N = 6,611; 20-85 yrs), with follow-up mortality assessment through 31 December 2006. DNA was extracted from whole blood to assess LTL via quantitative polymerase chain reaction. Compared to those in the first LTL tertile, the adjusted hazard ratio for all-cause mortality for those in the 2(nd) and 3(rd) LTL tertiles, respectively, was 0.82 (95% CI: 0.60-1.12; P = .22) and 0.76 (95% CI: 0.50-1.14; P = .18). However, after adjustments, LTL tertile 3 (vs. 1) was associated with all-cause mortality (HR = 0.37; 95% CI: 0.14-0.93; P = .03) for those who engaged in moderate-intensity exercise. Similarly, LTL was associated with CVD-specific mortality for those who engaged in moderate-intensity exercise (HR = 0.17; 95% CI: 0.04-0.73; P = .02). Longer telomeres are associated with increased survival, particularly among men and those who are active, underscoring the importance of promotion of physical activity behaviour.

  6. First Report of Chronic Pulmonary Infection by KPC-3-Producing and Colistin-Resistant Klebsiella pneumoniae Sequence Type 258 (ST258) in an Adult Patient with Cystic Fibrosis

    Science.gov (United States)

    Delfino, Emanuele; Del Bono, Valerio; Coppo, Erika; Marchese, Anna; Manno, Graziana; Morelli, Patrizia; Minicucci, Laura; Viscoli, Claudio

    2015-01-01

    The spread of Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae continues to increase, and the possible development of KPC-producing K. pneumoniae infections in cystic fibrosis (CF) patients is a matter of concern. Here, we describe the establishment of a chronic lung infection due to a colistin-resistant KPC-producing K. pneumoniae isolate in an Italian CF patient. PMID:25653395

  7. Associations of birth defects with adult intellectual performance, disability and mortality: population-based cohort study.

    Science.gov (United States)

    Eide, Martha G; Skjaerven, Rolv; Irgens, Lorentz M; Bjerkedal, Tor; Oyen, Nina

    2006-06-01

    Infants born with birth defects have poorer outcomes in terms of mortality and disability, but the long-term intellectual outcome in children with birth defects is generally unknown. We assessed the long-term associations of various birth defects with mortality and disability, and evaluated whether high mortality and disability were reflected in impaired intellectual performance at age 18. In this nationwide cohort study, records of 9,186 males with and 384,384 without birth defects, registered in the Medical Birth Registry of Norway (1967-1979) were linked to the National Conscript Service (1984-1999). Mortality and disability before military draft, and intelligence test score at conscription were the main outcome measures. Males with birth defects had a relative risk for disability of 6.0 compared with males without defects. Disability was low within categories of birth defects associated with low mortality, and high within defect categories associated with high mortality. The relative risk for not being drafted was highest if maternal educational level was low. Heart defects and cleft palate were the only subgroups in which intellectual performance was lower after adjustment for maternal education, maternal age, marital status and birth order. In particular, intellectual performance was not impaired among those with multiple compared with single defects. We conclude that for the majority of birth defect categories in the present birth cohort, our hypothesis that intellectual performance would be impaired was not confirmed. Thus, there seems to be little reason to fear an adverse intellectual outcome in non-disabled surviving infants with birth defects.

  8. Adult children's socioeconomic positions and their parents' mortality: a comparison of education, occupational class, and income.

    Science.gov (United States)

    Torssander, Jenny

    2014-12-01

    Recent research has shown that the parents of well-educated children live longer than do other parents and that this association is only partly confounded by the parent's own socioeconomic position. However, the relationships between other aspects of children's socioeconomic position (e.g., occupational class and economic resources) and parental mortality have not been examined. Using the Swedish Multi-generation Register that connects parents to their children, this paper studies the associations of children's various socioeconomic resources (education, occupation, and income) and parents' mortality. The models are adjusted for a range of parental socioeconomic resources and include the resources of the parents' partners. In addition to all-cause mortality, five causes of death are analyzed separately (circulatory disease mortality, overall cancer, lung cancer, breast cancer, and prostate cancer). The results show net associations between all included indicators of children's socioeconomic position and parents' mortality risk, with the clearest association for education. Children's education is significantly associated with all of the examined causes of death except prostate cancer. Breast cancer mortality is negatively related to offspring's education but not the mothers' own education. To conclude, children's education seems to be a key factor compared with other dimensions of socioeconomic position in the offspring generation. This finding suggests that explanations linked to behavioral norms or knowledge are more plausible than those linked to access to material resources. However, it is possible that children's education - to a greater degree than class and income - captures unmeasured parental characteristics. The cause-specific analyses imply that future research should investigate whether offspring's socioeconomic position is linked to the likelihood of developing diseases and/or the chances of treating them. A broader family perspective in the description

  9. Adult mortality in the cities of Bulawayo and Harare, Zimbabwe: 1979-2008

    Directory of Open Access Journals (Sweden)

    Dlodlo Riitta A

    2011-07-01

    Full Text Available Abstract Background Zimbabwe has been severely affected by the HIV/AIDS and tuberculosis epidemics, with an estimated 80% of tuberculosis patients being HIV infected. We set out to use annual population-mortality records from the cities of Harare and Bulawayo to describe trends and possible causes of mortality from 1979 to 2008. The specific objectives were to document overall, sex and age-specific mortality, proportion of deaths attributed to AIDS and tuberculosis, and changes in death rates since the start of antiretroviral therapy in 2004. Methods This retrospective descriptive study used existing mortality records of the Health Services departments in Harare and Bulawayo. Data points included: estimated yearly total population; groupings by sex and age; deaths (total and by sex and age groups for each year of the study period; and most frequently reported causes of death (for age groups Results In both cities, crude death rates were lowest in the late 1980s, increased three- to five-fold by the early 2000s, and began a slow and, in the case of Bulawayo, intermittent decline from 2004. Sex-specific death rates followed a similar trend, being higher in males than in females. The death rates in the age groups Conclusions This study used routinely collected population-mortality data that are rare in resource-limited settings, and it described, for the first time in Zimbabwe, the effects of the HIV/AIDS epidemic and the introduction of antiretroviral therapy on death rates in two large cities. After a substantial rise in crude mortality rates, there has been a decline associated with the introduction of ART. Such routine population data must continue to be collected, collated and analyzed.

  10. 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...

  11. 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.

  12. Adult trees cause density-dependent mortality in conspecific seedlings by regulating the frequency of pathogenic soil fungi.

    Science.gov (United States)

    Liang, Minxia; Liu, Xubing; Gilbert, Gregory S; Zheng, Yi; Luo, Shan; Huang, Fengmin; Yu, Shixiao

    2016-12-01

    Negative density-dependent seedling mortality has been widely detected in tropical, subtropical and temperate forests, with soil pathogens as a major driver. Here we investigated how host density affects the composition of soil pathogen communities and consequently influences the strength of plant-soil feedbacks. In field censuses of six 1-ha permanent plots, we found that survival was much lower for newly germinated seedlings that were surrounded by more conspecific adults. The relative abundance of pathogenic fungi in soil increased with increasing conspecific tree density for five of nine tree species; more soil pathogens accumulated around roots where adult tree density was higher, and this greater pathogen frequency was associated with lower seedling survival. Our findings show how tree density influences populations of soil pathogens, which creates plant-soil feedbacks that contribute to community-level and population-level compensatory trends in seedling survival.

  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

    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...

  14. 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

  15. 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),...

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

    NARCIS (Netherlands)

    Ellwardt, L.; Tilburg, van T.G.; Aartsen, M.J.; Wittek, R.; Steverink, N.

    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

  17. 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

  18. 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

  19. 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.

  20. 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...

  1. Clinical analysis of Mycoplasma pneumoniae infection in 30 cases of adult%30例成人肺炎支原体感染的临床分析

    Institute of Scientific and Technical Information of China (English)

    王娟; 杨兴仁; 李东升

    2014-01-01

    Objective:To investigate Mycoplasma pneumoniae infection in adult clinical features.Methods:The clinical data of 30 cases of Mycoplasma pneumoniae infection in adult patients were analyzed retrospectively.Results:The Results of this group of patients with multiple cough /or fever as the first symptom,mostly manifested as persistent paroxysmal cough,some patients myalgia,arthralgia,nausea,vomiting,diarrhea and other extrapulmonary symptoms. Lung X-ray manifestation lack of specificity,serum mycoplasma antibody (MP ~IgM)to detect meaningful.30 cases after treatment with azithromycin Se-quential cured 24 cases,effective in 6 cases,total effective rate was 100%,without sequelae.Conclusions:Master Mycoplasma pneumoniae infection in adult clinical features are critical for proper diagnosis and treatment.%目的:探讨成人肺炎支原体感染的临床特点。方法:对30例成人肺炎支原体感染患者的临床资料进行回顾性分析。结果:本组患者多以咳嗽伴/或发热为首发症状,大多表现为顽固的阵发性咳嗽,部分患者出现肌痛,关节痛,恶心、呕吐、腹泻等肺外症状。肺部X线片表现多样缺乏特异性,血中支原体抗体(MP~IgM)检测有意义。30例经阿奇霉素贯序治疗后,治愈24例,显效6例,总有效率为100%,无后遗症。结论:掌握成人肺炎支原体感染的临床特点是正确诊治的关键。

  2. Epidemiological Study Of Burn Cases And Their Mortality Experiences Amongst Adults From A Tertiary Level Care Centre

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    Kumar P

    1997-01-01

    Full Text Available Research question: How to use hospital statistics in establishing epidemiology of burns amongst adults? Objectives: To identify epidemiological determinants for Ii Various burn injuries and ii their mortality experiences. Study design: Hospital based study carried out for a period of one year (1st January 1991 to 31st December 1991. Settings: Wards of department of Burn & Plastic Surgery, BJ Medical College, Ahmedabad. Participants: 386 adults (20 years and above admitted at the centre for burn injuries during 1991. Study variables: Epidemiological determinants (age, sex, temporal, place, etc. for various burn injuries and the determinants of mortality (type of burn, extent of burn, referral time lag etc. Outcome profile: Common profile of burn victims with relation to the epidemiological factors and other factors responsible for high mortality in burn cases. Statistical analysis: Chi- square and Z tests. Results:Burns occured more in females specially in the age group of 20-24 years. Eighty five percent were flame burns. Flame burns were more in females, while electric burns were more in males. Burns were less during monsoon (27.7% than winter (32.6% and summer (39.6%, but electric burns were twice more common during monsoon. Maximum burns (81.9% were domestic, occurring mainly either in kitchen or living room. They were seen more in late evening. Sixty two percent cases were severe as total burn surface area (TBSA was >40%. Case fatality correlated positively with TBSA and death was almost universal with TBSA >60%. Early referral reduced fatality significantly in less severe burns (TBSA<40% but failed to influence it in severe burns. Appraisal of alleged suicide cases (2.6% and of stove bursting (4.4% revealed that young females carry additional risk of burn injuries.

  3. Increased rates of intensive care unit admission in patients with Mycoplasma pneumoniae: a retrospective study.

    Science.gov (United States)

    Khoury, T; Sviri, S; Rmeileh, A A; Nubani, A; Abutbul, A; Hoss, S; van Heerden, P V; Bayya, A E; Hidalgo-Grass, C; Moses, A E; Nir-Paz, R

    2016-08-01

    Mycoplasma pneumoniae is a leading cause of respiratory disease. In the Intensive Care Unit (ICU) setting M. pneumoniae is not considered a common pathogen. In 2010-13 an epidemic of M. pneumoniae-associated infections was reported and we observed an increase of M. pneumoniae patients admitted to ICU. We analysed the cohort of all M. pneumoniae-positive patients' admissions during 2007 to 2012 at the Hadassah-Hebrew University Medical Centre (a 1100-bed tertiary medical centre). Mycoplasma pneumoniae diagnosis was made routinely using PCR on throat swabs and other respiratory samples. Clinical parameters were retrospectively extracted. We identified 416 M. pneumoniae-infected patients; of which 68 (16.3%) were admitted to ICU. Of these, 48% (173/416) were paediatric patients with ICU admission rate of 4.6% (8/173). In the 19- to 65-year age group ICU admission rate rose to 18% (32/171), and to 38.8% (28/72) for patients older than 65 years. The mean APACHE II score on ICU admission was 20, with a median ICU stay of 7 days, and median hospital stay of 11.5 days. Of the ICU-admitted patients, 54.4% (37/68) were mechanically ventilated upon ICU admission. In 38.2% (26/68), additional pathogens were identified mostly later as secondary pathogens. A concomitant cardiac manifestation occurred in up to 36.8% (25/68) of patients. The in-hospital mortality was 29.4% (20/68) and correlated with APACHE II score. Contrary to previous reports, a substantial proportion (16.3%) of our M. pneumoniae-infected patients required ICU admission, especially in the adult population, with significant morbidity and mortality.

  4. 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...

  5. 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

    the two examinations, life-style factors nor exclusion of diseased individuals influenced the results.CONCLUSIONS:Although there were increased mortality of the weight-stable obese compared with controls, there was no association between weight loss and mortality in the obese. Weight gain increased...... 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......). 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...

  6. 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

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    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.

  7. Associations of Metabolic Syndrome and its Components With Mortality in the Elderly: A Cohort Study of 73,547 Taiwanese Adults.

    Science.gov (United States)

    Yen, Yung-Feng; Hu, Hsiao-Yun; Lin, I-Feng; Lai, Yun-Ju; Su, Vincent Yi-Fong; Pan, Sheng-Wei; Ting, Wen-Ying; Su, Wei-Juin

    2015-06-01

    Available evidence shows that metabolic syndrome (Mets) has clear adverse effects for middle-aged and pre-elderly adults; however, the effect of Mets on mortality among elderly adults remains unclear. In addition, the comparative utility of Mets and its component for predicting mortality among the elderly has not been clearly established. Using data from a large Taiwanese cohort, we evaluated the effect of Mets and its components on subsequent all-cause and cause-specific mortality overtime among the elderly. A total of 73,547 elders (age ≥65 years) participated in the Taipei Elderly Health Examination Program from 2007 to 2010. Mets was diagnosed using the adult treatment panel III criteria, and mortality was ascertained by using national death records. Time-dependent analysis was used to evaluate associations of Mets and its components with all-cause mortality, cardiovascular disease (CVD) mortality, and expanded CVD mortality. This retrospective cohort study found that 42.6% of elders had Mets. During 194,057 person-years of follow-up, 2944 deaths were observed. After adjusting for sociodemographic characteristics and comorbidities, Mets was associated with increased risk of expanded CVD mortality (hazard ratio [HR], 1.27; 95% CI, 1.10-1.46) but not all-cause or CVD mortality. Among Mets components, decreased high-density lipoprotein cholesterol (HDL-C, HR 1.25, 95% CI 1.13-1.37) and hyperglycemia (HR 1.21, 95% CI 1.12-1.31) were associated with a significant increase in all-cause mortality. Hypertension and low HDL-C were predictors of CVD mortality and expanded CVD mortality, and, as compared with Mets, were associated with a higher risk of expanded CVD mortality. The present findings indicate that, in elderly adults, individual components of Mets are better predictors of all-cause and cause-specific mortality than is Mets as a whole. Our results suggest that future efforts should focus on preventing and managing individual risk factors (particularly

  8. Community-acquired, health care-associated, and ventilator-associated pneumonia: three variations of a serious disease.

    Science.gov (United States)

    Scott, Susan S; Kardos, Cynthia B

    2012-09-01

    Pneumonia affects millions of people every year in the United States. Hospital-acquired pneumonia is associated with a mortality rate as high as 50%. Pneumonia is classified according to where it was acquired or by the infecting organism. This article explores the similarities and differences in three types of pneumonia seen routinely in the intensive care unit: community-acquired pneumonia, ventilator-associated pneumonia, and health care-associated pneumonia.

  9. 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

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    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

  10. 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.

  11. Garenoxacin in the treatment of community-acquired pneumonia

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    Biswanath Biswas

    2014-12-01

    Full Text Available Community-acquired pneumonia (CAP is a major cause of adult mortality in Asia. Empirical use of antibiotics depends on the pathogens that are commonly responsible. Evolution of resistant pathogens in CAP has added to the burden of treating physicians. Microbiological culture and antibiotic sensitivity testing are helpful for the treatment of such respiratory tract infections. Klebsiella pneumoniae though uncommon pathogen of CAP has been reported in many cases. Garenoxacin a newer fl uoroquinolone has found its utility in the treatment of respiratory tract infections. Providing symptomatic relief to the patient with the use of analgesics, antipyretics and cough preparations are also an essential part of the management. [Int J Basic Clin Pharmacol 2014; 3(6.000: 1093-1095

  12. Serotype distribution in non-bacteremic pneumococcal pneumonia

    DEFF Research Database (Denmark)

    Benfield, Thomas Lars Vibe; 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)....

  13. 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...... in the LNS group (83.7/100 person-years) and 184 (82.6/100 person-years) in the LNS-VM group (rate ratio (RR), 0.99; 95% CI, 0.80-1.21; P = 0.89). The intervention did not affect SAEs or BMI, but decreased the incidence of low serum phosphate (RR, 0.73; 95% CI, 0.55-0.97; P = 0.03) and increased...

  14. 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

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    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

  15. Streptococcus pneumoniae carriage in the Gaza strip.

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    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.

  16. 200例成人社区获得性肺炎病原体研究%200 Cases of Adult Community-Acquired Pneumonia Pathogens Research

    Institute of Scientific and Technical Information of China (English)

    田占红

    2013-01-01

    Objective Through investigation and analysis of adult community-acquired pneumonia pathogens and pathogenic characteristics of the crowd,provide a basis for clinical treatment.Methods A retrospective analysis of our hospital in March 2010 to February 2012 period 200 cases of community-acquired pneumonia in patients with sputum culture and treatment of clinical data and the results were summarized.Results Information on a total of 200 cases,including 60 years of age were 30 cases,170 cases more than 60 years of age;to mostly elderly patients.Which cured 106 patients(53%),improved in 60 cases (30%) healed in 15 cases (7.5%),9 deaths(4.5%),10 patients left the hospital (5%).Status of sputum culture results showed that:sputum culture within 60 years as Vice mainly Haemophilus influenzae in 11 cases,36.7%.Patients over the age of 60 sputum culture results Haemophilus parainfluenzae in 68 cases,40%;results,mainly in patients with sputum culture Haemophilus parainfluenzae infection based.Conclusion Adult patients with community-acquired pneumonia,mostly elderly,Haemophilus parainfluenzae is a community-acquired pneumonia is one of the main pathogens.%  目的通过调查分析成人社区获得性肺炎致病人群及致病菌特点,为临床治疗提供依据。方法回顾性分析我院2010年3月~2012年2月期间200例社区获得性肺炎患者痰培养临床资料及治疗情况,并对结果进行总结。结果资料共200例,其中60岁以下者共30例,60岁以上者170例;以老年患者居多。其中治愈106例(53%),好转60例(30%),未愈15例(7.5%),9例死亡(4.5%),10例自动出院(5%)。痰培养结果状况显示:60岁以内的痰培养主要为副流感嗜血杆菌11例,36.7%。60岁以上患者痰培养结果显示副流感嗜血杆菌68例,占40%;结果显示,患者痰培养主要为副流感嗜血杆菌感染为主。结论成人社区获得性肺炎患者以老年人居多,副流感嗜血杆

  17. Evolving trends in Streptococcus pneumoniae resistance: implications for therapy of community-acquired bacterial pneumonia.

    Science.gov (United States)

    Jones, Ronald N; Jacobs, Michael R; Sader, Helio S

    2010-09-01

    Pneumonia is a major infectious disease associated with significant morbidity, mortality and utilisation of healthcare resources. Streptococcus pneumoniae is the predominant pathogen in community-acquired pneumonia (CAP), accounting for 20-60% of bacterial cases. Emergence of multidrug-resistant S. pneumoniae has become a significant problem in the management of CAP. Although pneumococcal conjugate vaccine usage in children has led to significant decreases in morbidity and mortality due to S. pneumoniae in all age groups, disease management has been further complicated by the unexpected increase in resistant serotypes, such as 19A, in some regions. Until rapid and accurate diagnostic tests become available, initial treatment of CAP will remain empirical. Thus, selection of appropriate antimicrobial therapy for CAP must be based on prediction of the most likely pathogens and their local antimicrobial susceptibility patterns. This article reviews information on antimicrobial resistance patterns amongst S. pneumoniae and implications for managing CAP.

  18. BMI, weight stability and mortality among adults without clinical co-morbidities: a 22-year mortality follow-up in the finnish twin cohort

    DEFF Research Database (Denmark)

    Korkeila, Maarit; Rissanen, Aila; Sørensen, Thorkild I A

    2009-01-01

    with mortality were estimated by Cox proportional hazards model for all individuals and conditional logistic regression analysis for pairwise analyses. RESULTS: Mortality increased with increasing BMI for all causes and coronary heart disease (CHD) in men, and there were no associations for all natural causes......, cerebrovascular disease, and violent deaths. After adjustment for multiple co-variates and changes in co-variates between 1975 and 1981, BMI was associated with CHD mortality in all men (hazard ratio (HR) = 1.22, 95% CI 1.06-1.41) and in men with stable weight between 1975 and 1981 (HR = 1.26, 95% CI 1...

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

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    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

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

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    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

  1. 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.

  2. Changes in self-perceived economic satisfaction and mortality at old ages: evidence from a survey of middle-aged and elderly adults in Taiwan.

    Science.gov (United States)

    Lee, Miaw-Chwen; Huang, Nicole

    2015-04-01

    Experiencing a low socioeconomic status (SES) throughout the life course has been reported to be correlated with poor health outcomes. Several studies have suggested that income, wealth, and perceptions of economic status are associated with increased risk of death among elderly people. Few studies have investigated the association between lifetime SES and mortality among elderly adults. The analysis in this study was based on 2310 elderly adults for whom SES data from the four phases of the longitudinal survey of Health and Living Status of the Elderly in Taiwan (1989, 1993, 1996, and 1999) were available, and who were alive in 1999. The SES measures included in the analysis were annual income, the household wealth, and the self-perceived economic satisfaction. A group-based trajectory modelling approach was employed to create SES trajectories. Cox proportional hazard models were employed to examine the association between SES trajectories and 8-year all-cause mortality (1999-2007). Irrespective of whether income, wealth, or self-perceived economic satisfaction was used, the elderly adults with consistently low SES trajectory throughout early old age were independently and significantly associated with higher hazards of mortality than were those in a consistently high SES trajectory. Downward or upward mobility of income and wealth were associated with increased hazard of mortality. However, decreased self-perceived economic satisfaction was not significantly associated with increased hazard of mortality. According to the results, the strong distinction between trajectory patterns of income, wealth, and self-perceived economic satisfaction among elderly adults indicate that neither should be overlooked when investigating the role of SES mobility in mortality. Retirement policies or strategies for maintaining and promoting favorable SES in early old age may benefit the health of elderly adults later in life.

  3. Is type 2 diabetes mellitus in mechanically ventilated adult trauma patients potentially related to the occurrence of ventilator-associated pneumonia?

    Directory of Open Access Journals (Sweden)

    Hadi Darvishi Khezri

    2016-01-01

    Full Text Available Background: Ventilator-associated pneumonia (VAP is a type of lung infection that typically affects critically ill patients undergoing mechanical ventilation (MV in the intensive care unit (ICU. Patients with type 2 diabetes mellitus (T2DM are considered to be more susceptible to several types of infections including community-acquired pneumonia. However, it is not clear whether T2DM is a risk factor for the development of VAP. The purpose of this study was to determine the risk of VAP for diabetic and nondiabetic mechanically ventilated trauma patients. Materials and Methods: This study is a secondary analysis of a prospective observational study of the history of T2DM in the ICU over a period of 1 year at Imam Khomeini Hospital in Iran. A total of 186 critically ill trauma patients who required at least 48 h of MV were monitored for the occurrence of VAP by their clinical pulmonary infection score (CPIS until ICU discharge, VAP diagnosis, or death. Results: Forty-one of the 186 patients developed VAP. The median time from hospitalization to VAP was 29.09 days (95% CI: 26.27-31.9. The overall incidence of VAP was 18.82 cases per 1,000 days of intubation (95% CI: 13.86-25.57. Risk of VAP in diabetic patients was greater than nondiabetic patients after adjustments for other potential factors [hazard ratio (HR: 10.12 [95% confidence interval (CI: 5.1-20.2; P < 0.0001]. Conclusion: The findings show that T2DM is associated with a significant increase in the occurrence of VAP in mechanically ventilated adult trauma patients.

  4. Hydrocarbon pneumonia

    Science.gov (United States)

    Pneumonia - hydrocarbon ... Coughing Fever Shortness of breath Smell of a hydrocarbon product on the breath Stupor (decreased level of ... Most children who drink or inhale hydrocarbon products and develop ... hydrocarbons may lead to rapid respiratory failure and death.

  5. 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).

  6. 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.

  7. Therapeutic effects of garenoxacin in murine experimental secondary pneumonia by Streptococcus pneumoniae after influenza virus infection.

    Science.gov (United States)

    Fukuda, Yoshiko; Furuya, Yuri; Nozaki, Yusuke; Takahata, Masahiro; Nomura, Nobuhiko; Mitsuyama, Junichi

    2014-02-01

    In a pneumococcal pneumonia murine model following influenza virus infection, garenoxacin was more effective than other fluoroquinolones and demonstrated high levels of bacterial eradication in the lung, low mortality, and potent histopathological improvements. Garenoxacin could potentially be used for the treatment of secondary pneumococcal pneumonia following influenza.

  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. 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.

  10. 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

  11. A liver abscess deprived a healthy adult of eyesight: endogenous endophthalmitis associated with a pyogenic liver abscess caused by serotype K1 Klebsiella pneumonia.

    Science.gov (United States)

    Maruno, Takahisa; Ooiwa, Yoko; Takahashi, Ken; Kodama, Yuzo; Takakura, Shunji; Ichiyama, Satoshi; Chiba, Tsutomu

    2013-01-01

    Klebsiella pneumonia usually causes urinary tract infections, pneumonia, and other infectious diseases in hospitalized and immunocompromised patients. Among the types of Klebsiella pneumonia, serotype K1 is known to be a highly virulent pathogen. We herein report the case of a healthy 63-year-old man with a pyogenic liver abscess and bilateral endogenous endophthalmitis caused by serotype K1 Klebsiella pneumonia. Although the patient received percutaneous abscess drainage and antibiotic therapy, he lost his eyesight. To improve the poor prognoses of ocular complications, providing both an earlier diagnosis and treatment is critical.

  12. 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)....

  13. 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.

  14. Lymphocytic Interstitial Pneumonia.

    Science.gov (United States)

    Panchabhai, Tanmay S; Farver, Carol; Highland, Kristin B

    2016-09-01

    Lymphocytic interstitial pneumonia (LIP) is a rare lung disease on the spectrum of benign pulmonary lymphoproliferative disorders. LIP is frequently associated with connective tissue diseases or infections. Idiopathic LIP is rare; every attempt must be made to diagnose underlying conditions when LIP is diagnosed. Computed tomography of the chest in patients with LIP may reveal ground-glass opacities, centrilobular and subpleural nodules, and randomly distributed thin-walled cysts. Demonstrating polyclonality with immunohistochemistry is the key to differentiating LIP from lymphoma. The 5-year mortality remains between 33% and 50% and is likely to vary based on the underlying disease process.

  15. 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.

  16. Ventilator associated pneumonia and infection control

    NARCIS (Netherlands)

    Alp, E.; Voss, A.

    2006-01-01

    Ventilator associated pneumonia (VAP) is the leading cause of morbidity and mortality in intensive care units. The incidence of VAP varies from 7% to 70% in different studies and the mortality rates are 20-75% according to the study population. Aspiration of colonized pathogenic microorganisms on th

  17. Serotype Distribution and Antimicrobial Susceptibilities of Invasive Streptococcus pneumoniae Isolates from Adults in Korea from 1997 to 2012.

    Science.gov (United States)

    Kim, Chung Jong; Song, Jin-Su; Choi, Su-Jin; Song, Kyoung Ho; Choe, Pyeong Gyun; Park, Wan Beom; Bang, Ji Hwan; Kim, Eu Suk; Park, Sang Won; Kim, Hong Bin; Kim, Nam-Joong; Kim, Eui-Chong; Oh, Myoung-don

    2016-05-01

    In Republic of Korea, a 7-valent pneumococcal conjugated vaccine (PCV7) was licensed for use in infants in 2003, and 13-valent PCV (PCV13) replaced it since 2010. We investigated trends in serotype distribution and antibiotic susceptibility of pneumococcal isolates from adult patients with invasive pneumococcal diseases (IPD). Invasive pneumococcal isolates from adult patients of ≥ 16 years of age were collected from 1997 to 2012. Serotypes of the isolates were determined by the Quellung reaction. Distribution of serotypes was analyzed according to the vaccine types. Antibiotic susceptibility was tested by using E-test strips. A total of 272 invasive pneumococcal isolates were included. The most common serotypes were serotype 19F (8.5%, 23/272), and serotype 3 (8.1%, 22/272), and 24.6% (67/272) of the isolates were of non-vaccine serotypes. Of the 272 isolates, 2.6% (7/272) were penicillin MICs of ≥ 4 µg/mL. The proportion of the PCV13 serotypes decreased from 63.3% (50/79) in 1997-2003 to 48.6% (17/35) in 2011-2012, whereas that of non-vaccine serotypes was 26.6% (21/79) and 25.7% (9/35), respectively, for the same periods. The proportion of the PCV13 serotypes showed a decreasing trend among adult patients with IPD over the study period.

  18. 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

  19. Physical activity and risk of all-cause and cardiovascular disease mortality in diabetic adults from Great Britain: pooled analysis of 10 population-based cohorts.

    Science.gov (United States)

    Sadarangani, Kabir P; Hamer, Mark; Mindell, Jenny S; Coombs, Ngaire A; Stamatakis, Emmanuel

    2014-04-01

    OBJECTIVE To examine associations between specific types of physical activity and all-cause and cardiovascular disease (CVD) mortality in a large nationally representative sample of adults with diabetes from Great Britain. RESEARCH DESIGN AND METHODS There were a total of 3,038 participants (675 deaths) with diabetes in the Health Survey for England and the Scottish Health Surveys conducted between 1997 and 2008. Participants aged ≥50 years at baseline were followed up for an average of 75.2 months for all-cause and CVD mortality. Data were collected on self-reported frequency, duration, and intensity of participation in sports and exercise, walking, and domestic physical activity, from which the number of MET-hours/week were derived. Sex-specific medians of time spent in each type of physical activity (for those physically active) were calculated, and Cox proportional hazards regression conducted to examine type-specific associations between the level of physical activity and all-cause and CVD mortality risk. RESULTS Inverse associations with all-cause and CVD mortality were observed for overall physical activity in a dose-response manner after adjusting for covariates. Compared with those who individuals were inactive, participants who reported some activity, but below the recommended amount, or who met the physical activity recommendations had a 26% (95% CI 39-11) and 35% (95% CI 47-21) lower all-cause mortality, respectively. Similar results were found for below/above median physical activity levels. Sports and exercise participation was inversely associated with all-cause (but not CVD) mortality, as were above average levels of walking. Domestic physical activity was not associated with mortality. CONCLUSIONS Moderate physical activity levels were associated with better prognosis in diabetic adults.

  20. Sexual Orientation and All-Cause Mortality Among US Adults Aged 18 to 59 Years, 2001-2011.

    Science.gov (United States)

    Cochran, Susan D; Björkenstam, Charlotte; Mays, Vickie M

    2016-05-01

    To determine whether sexual minorities have an earlier mortality than do heterosexuals, we investigated associations between sexual orientation assessed in the 2001 to 2010 National Health and Nutrition Examination Surveys (NHANES) and mortality in the 2011 NHANES-linked mortality file. Mortality follow-up time averaged 69.6 months after NHANES. By 2011, 338 individuals had died. Sexual minorities evidenced greater all-cause mortality than did heterosexuals after adjusting for demographic confounding. These effects generally disappeared with further adjustment for NHANES-detected health and behavioral differences.

  1. 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

  2. Comparison of predictive value between two kinds of score system in hospital mortality of pneumonia patients%两种基础疾病评分预测肺炎患者预后的比较

    Institute of Scientific and Technical Information of China (English)

    崔云亮; 张树柳; 田昭涛; 陈德昌; 林兆奋

    2016-01-01

    目的 比较慢性健康状态评分(chronic health score,CHS)和查尔森合并症指数(Charlson's weighted index of comorbidities,WIC)对ICU肺部感染患者住院死亡风险的影响.方法 回顾性分析多中心2013年9月至2014年9月肺炎患者的临床资料;记录性别、年龄、既往基础疾病、是否严重脓毒症;计算入院时WIC、入院后24h急性生理与慢性健康状况(APACHE)评分Ⅱ,包括CHS、急性生理状况评分(acute physiology score,APS)和脓毒症相关性器官功能衰竭评分(sepsis related organ failure assessment,SOFA).结果 在293名入组患者中,男性195例(66.6%),女性98例(33.4%),存活197例(67.2%),死亡96例(32.8%).年龄(62.5±17.0)岁.与存活组比较,死亡组的WIC评分较高.而两组的CHS评分比较无统计学意义.随着WIC和CHS分值的增高,患者的病死率呈增高趋势.单因素Logistic回归分析显示年龄、APACHEⅡ、SOFA、APS、CHS、WIC、是否严重脓毒症、基础疾病中Ⅱ型糖尿病、卒中、充血性心力衰竭与患者的预后相关.CHS(方程1)和WIC评分(方程2)分别联合入院急性生理状况评分及年龄等因素建立方程行多因素Logistic回归分析提示年龄、APS、CHS、WIC、是否严重脓毒症与患者的28 d预后独立相关.CHS评分的受试者工作曲线下面积(AUC)为0.557,95% CI:(0.49~0.623)低于(P =0.021 7,Z=2.296) WIC评分的AUC =0.649 95%CI:(0.586 ~0.712),联合多变量建立方程后的AUC明显优于APACHEⅡ评分(P <0.001).结论 WIC评分是预测ICU肺炎患者住院病死率的独立风险因素;WIC评分较CHS评分可以更好的评价基础疾病对患者病死率的影响.%Objective To compare the value in predicting hospital mortality of pneumonia patients between Charlson's weighted index of comorbidities (WIC) and chronic health score (CHS),in Intensive Care Units (ICU).Methods The clinical data of pneumonia patients collected from September 2013 to September 2014 in ICU of

  3. Evaluation of the use of electronic health data to classify four-year mortality risk for older adults undergoing screening colonoscopies.

    Science.gov (United States)

    Synnestvedt, Marie B; Weiner, Mark G

    2011-01-01

    Current cancer screening recommendations often apply coarse age cutoffs for screening requirements without regard to predicted life expectancy. Using these cutoffs, healthier older patients may be under-screened, and sicker younger patients may be screened too often. Mortality risk classification using EHR data could be used to tailor screening reminders to physicians in ways that better align screening recommendations with patients who are more likely to live long enough to benefit from early detection. We have evaluated the performance of an existing prognostic index for 4-year mortality using data readily available in the electronic health record (EHR), and investigated the effect of the index in retrospective cohorts of adults age 65 and older undergoing screening colonoscopy. Risk scores in this adaptation of a four-year prognostic index were found to be associated with actual death rates and consistent with mortality rates from a national sample. Our results demonstrate that data extracted from electronic health records can be used to classify mortality risk. With improvements, including extension to a 5-year mortality model with inclusion of additional variables and extension of variable definitions, informatics methods to implement mortality models may prove to be clinically useful in tailoring screening guidelines.

  4. Chlamydia Pneumoniae Pneumonia: An Evolving Clinical Spectrum

    Directory of Open Access Journals (Sweden)

    David Megran

    1995-01-01

    Full Text Available Chlamydia pneumoniae is a recently recognized respiratory tract pathogen. It accounts for 6 to 10% of all cases of community acquired pneumonia requiring admission to hospital. Two patients hospitalized with C pneumoniae pneumonia are presented to illustrate its range of severity and the extrapulmonary manifestations.

  5. Chlamydia pneumoniae pneumonia: An evolving clinical spectrum

    Science.gov (United States)

    Megran, David; Peeling, Rosanna W; Marrie, Thomas J

    1995-01-01

    Chlamydia pneumoniae is a recently recognized respiratory tract pathogen. It accounts for 6 to 10% of all cases of community acquired pneumonia requiring admission to hospital. Two patients hospitalized with C pneumoniae pneumonia are presented to illustrate its range of severity and the extrapulmonary manifestations. PMID:22514396

  6. 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.

  7. [Fatal pneumonia caused by carbapenem resistant Klebsiella pneumoniae].

    Science.gov (United States)

    van Apeldoorn, Marjan; Lettinga, Kamilla; Bernards, Alexandra; Paltansing, Sunita; alNaiemi, Nashwan; Kalpoe, Jayant

    2010-01-01

    A 63-year-old Dutch man became colonized with a carbapenem resistant Klebsiella pneumoniae during a period of hospitalization in India. His recovery in the Netherlands was complicated by pneumonia due to this difficult-to-control multiresistant bacteria to which he eventually succumbed. Carbapenem resistance in Enterobacteriaceae, such as K. pneumoniae, is usually caused by carbapenemase (a betalactamase) production. Carbapenemase producing Enterobacteriaceae (CPE) are spreading throughout the world and cause difficult-to-treat infections that are associated with high mortality. This case report illustrates the clinical challenges associated with infection with these multiresistant Enterobacteriaceae. In the Netherlands, there are no guidelines for detection of CPE and carbapenemase production can frequently go undetected in clinical microbiology laboratories. As a consequence, adequate treatment of CPE infections and infection control measures to prevent the spread of CPE can be delayed. Expeditious development and implementation of existing Dutch draft guidelines for detection methods of CPE is therefore warranted.

  8. 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.

  9. 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

  10. Ventilator-associated pneumonia caused by colistin-resistant KPC-producing Klebsiella pneumoniae: a case report and literature review.

    Science.gov (United States)

    Viaggi, Bruno; Sbrana, Francesco; Malacarne, Paolo; Tascini, Carlo

    2015-05-01

    Klebsiella pneumoniae producing KPC-type carbapenemase causes severe nosocomial infection at a high mortality rate. Nosocomial pneumonia in particular is associated with high mortality, likely due to the unfavorable pulmonary pharmacokinetics of the antibiotics used against this agent. Therefore, early and accurate microbiological identification and susceptibility evaluation are crucial in order to optimize antibiotic therapy. We report a case of ventilator-associated pneumonia caused by colistin-resistant K. pneumoniae producing KPC-type carbapenemase treated using a carbapenem-sparing therapy and tailored according to the serum procalcitonin concentration in order to limit the duration of antibiotic therapy.

  11. 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.

  12. Nursing home-acquired pneumonia.

    Science.gov (United States)

    El Solh, Ali A

    2009-02-01

    Nursing home-acquired pneumonia (NHAP) was first described in 1978. Since then there has been much written regarding NHAP and its management despite the lack of well-designed studies in this patient population. The most characteristic features of patients with NHAP are the atypical presentation, which may lead to delay in diagnosis and therapy. The microbial etiology of pneumonia encompasses a wide spectrum that spans microbes recovered from patients with community-acquired pneumonia to organisms considered specific only to nosocomial settings. Decision to transfer a nursing home patient to an acute care facility depends on a host of factors, which include the level of staffing available at the nursing home, patients' advance directives, and complexity of treatment. The presence of risk factors for multidrug-resistant pathogens dictates approach to therapy. Prevention remains the cornerstone of reducing the incidence of disease. Despite the advance in medical services, mortality from NHAP remains high.

  13. Coronary heart disease mortality among young adults in Scotland in relation to social inequalities:time trend study

    OpenAIRE

    O'Flaherty, Martin; Bishop, Jennifer; Redpath, Adam; McLaughlin, Terry; Murphy, David; Chalmers, James; Capewell, Simon

    2009-01-01

    Objective To examine recent trends and social inequalities in age specific coronary heart disease mortality.Design Time trend analysis using joinpoint regression.Setting Scotland, 1986-2006.Participants Men and women aged 35 years and over.Main outcome measures Age adjusted and age, sex, and deprivation specific coronary heart disease mortality.Results Persistent sixfold social differentials in coronary heart disease mortality were seen between the most deprived and the most affluent groups a...

  14. Is patient-prosthesis mismatch an independent risk factor for early and mid-term overall mortality in adult patients undergoing aortic valve replacement?

    Science.gov (United States)

    Urso, Stefano; Sadaba, Rafael; Aldamiz-Echevarria, Gonzalo

    2009-09-01

    A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: is patient-prosthesis mismatch an independent risk factor for 30-day and mid-term overall mortality in adult patients undergoing aortic valve replacement (AVR)? Altogether, almost 400 papers were found using the reported search, of which 22 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. The majority of the selected articles have focused their analysis on moderate mismatch defined mostly by the presence of an indexed effective orifice area (IEOA)prosthesis mismatch (PPM) (indexed IEOA0.65 cm(2)/m(2)) is an independent risk factor for 30-day or mid-term overall mortality for adult patients undergoing AVR. An exception could be represented by patients with poor ejection fraction, a condition that can make moderate mismatch a predictor of overall mortality after AVR. On the other hand, severe mismatch is a predictor of overall 30-day or mid-term mortality for patients undergoing AVR independently from the presence of poor ejection fraction. In conclusion, our review suggests that the condition of severe PPM should be always avoided, while the presence of moderate mismatch could be tolerated in patients with normal ejection fraction without any impact on overall survival.

  15. 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

  16. 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

  17. Recognising and managing community-acquired pneumonia.

    Science.gov (United States)

    Gibson, Vanessa

    2015-11-18

    Pneumonia remains a significant cause of morbidity and mortality in the UK and yet the seriousness of the disease is underestimated. Pneumonia can be life-threatening because the delicate tissues of the alveoli and pulmonary capillaries are susceptible to damage from the inflammatory response. This damage leads to consolidation that prevents the diffusion of oxygen and carbon dioxide, and this in turn can lead to respiratory failure. This article summarises guidance on the diagnosis and management of community-acquired pneumonia, and also includes information on the prevention of pneumonia. This information should be valuable to nurses working in a variety of clinical areas since patients with community-acquired pneumonia are encountered in primary, intermediate, secondary and critical care.

  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. 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....

  20. 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....

  1. How Is Pneumonia Treated?

    Science.gov (United States)

    ... to cure the infection and prevent complications. Bacterial pneumonia Bacterial pneumonia is treated with medicines called antibiotics. ... fewer symptoms such as cough and fever. Viral pneumonia Antibiotics don't work when the cause of ...

  2. What Is Pneumonia?

    Science.gov (United States)

    ... Share this page from the NHLBI on Twitter. Pneumonia Pneumonia is a bacterial, viral, or fungal infection of ... and trouble breathing. Many factors affect how serious pneumonia is, such as the type of germ causing ...

  3. Pneumocystis Pneumonia (For Parents)

    Science.gov (United States)

    ... Feeding Your 1- to 2-Year-Old Pneumocystis Pneumonia KidsHealth > For Parents > Pneumocystis Pneumonia A A A What's in this article? About PCP Diagnosing PCP Treating PCP Pneumocystis pneumonia (PCP) is an infection caused by Pneumocystis jiroveci , ...

  4. Pneumonia in Immunocompromised People

    Science.gov (United States)

    ... Alternative preventive drug treatments are dapsone , atovaquone , and pentamidine (which can be taken as an aerosol, inhaled ... ACZONE trimethoprim No US brand name atovaquone MEPRON pentamidine NEBUPENT Pneumonia Overview of Pneumonia Aspiration Pneumonia and ...

  5. Electrocardiogram in pneumonia.

    Science.gov (United States)

    Stein, Paul D; Matta, Fadi; Ekkah, Maan; Saleh, Tarek; Janjua, Muhammad; Patel, Yash R; Khadra, Helmi

    2012-12-15

    Findings on electrocardiogram may hint that pulmonary embolism (PE) is present when interpreted in the proper context and lead to definitive imaging tests. However, it would be useful to know if electrocardiographic (ECG) abnormalities also occur in patients with pneumonia and whether these are similar to ECG changes with PE. The purpose of this investigation was to determine ECG findings in patients with pneumonia. We retrospectively evaluated 62 adults discharged with a diagnosis of pneumonia who had no previous cardiopulmonary disease and had electrocardiogram obtained during hospitalization. The most prevalent ECG abnormality, other than sinus tachycardia, was minor nonspecific ST-segment or T-wave changes occurring in 13 of 62 (21%). Right atrial enlargement occurred in 4 of 62 (6.5%). QRS abnormalities were observed in 24 of 62 (39%). Right-axis deviation and S(1)S(2)S(3) were the most prevalent QRS abnormalities, which occurred in 6 of 62 (9.7%). Complete right bundle branch block and S(1)Q(3)T(3) pattern occurred in 3 of 62 (4.8%). ECG abnormalities that were not present within 1 month previously or abnormalities that disappeared within 1 month included left-axis deviation, right-axis deviation, right atrial enlargement, right ventricular hypertrophy, S(1)S(2)S(3), S(1)Q(3)T(3), low-voltage QRS complexes, and nonspecific ST-segment or T-wave abnormalities. In conclusion, electrocardiogram in patients with pneumonia often shows QRS abnormalities or nonspecific ST-segment or T-wave changes. ECG findings are similar to ECG abnormalities in PE and electrocardiogram cannot assist in the differential diagnosis.

  6. [Specificities of pneumonia in geriatrics].

    Science.gov (United States)

    Pepersack, T

    2014-09-01

    Pneumonia is a major cause of morbidity and mortality leading to a high rate of hospitalization especially in theelderly. It is often a sign of frailty and is associated with a poor prognosis. However, taking into account the geriatric specificities (risk factors, atypical clinical presentations with "geriatric syndromes", ethical debate) using an interdisciplinary and a comprehensive geriatric approach remains an important responsibility of the general practitionner. This article summarizes these specificities and offers interventions targeted on the characteristics of elderly patients.

  7. 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

  8. 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.

  9. THE PARADOXICAL EFFECT ON PNEUMONIA OF CHRONIC INHALED CORTICOSTEROIDS

    OpenAIRE

    Sibila, Oriol; Anzueto, Antonio; Restrepo, Marcos I.

    2013-01-01

    Community-acquired pneumonia (CAP) is the leading infectious cause of death in developed countries. Several studies have shown that the risk of pneumonia is increased in patients with Chronic Obstructive Pulmonary Disease (COPD) who are receiving chronic inhaled corticosteroids (ICS). The impact of ICS On pneumonia prognosis is controversial. Recent studies have shown that COPD patients with prior ICS use have less mortality after developing CAP as compared with patients with COPD without pri...

  10. Health care-associated pneumonia: an evidence-based review.

    Science.gov (United States)

    Attridge, Russell T; Frei, Christopher R

    2011-08-01

    Health care-associated pneumonia is a relatively new classification of pneumonia that includes community-dwelling pneumonia patients having contact with the health care system. Current data indicate that health care-associated pneumonia patients present with more severe disease, are more likely to be infected with drug-resistant pathogens, and suffer increased mortality compared with community-acquired pneumonia patients. Guidelines recommend that these patients receive empiric antibiotics similar to those recommended for nosocomial pneumonia; however, it is not currently known if outcomes are improved when health care-associated pneumonia patients are treated with these therapies. In addition, the individual health care-associated pneumonia risk factors are based on limited data and are a poor predictor of patients likely to be infected with drug-resistant pathogens. Many questions remain on how to most appropriately care for this growing group of pneumonia patients. This review is an evidence-based discussion of current health care-associated pneumonia data, the individual health care-associated pneumonia risk factors, and limitations and additional considerations for the health care-associated pneumonia classification system.

  11. Impact of Glasgow Coma Scale score and pupil parameters on mortality rate and outcome in pediatric and adult severe traumatic brain injury: a retrospective, multicenter cohort study.

    Science.gov (United States)

    Emami, Pedram; Czorlich, Patrick; Fritzsche, Friederike S; Westphal, Manfred; Rueger, Johannes M; Lefering, Rolf; Hoffmann, Michael

    2017-03-01

    OBJECTIVE Prediction of death and functional outcome is essential for determining treatment strategies and allocation of resources for patients with severe traumatic brain injury (TBI). The aim of this study was to evaluate, by using pupillary status and Glasgow Coma Scale (GCS) score, if patients with severe TBI who are ≤ 15 years old have a lower mortality rate and better outcome than adults with severe TBI. METHODS A retrospective cohort analysis of patients suffering from severe TBI registered in the Trauma Registry of the German Society for Trauma Surgery between 2002 and 2013 was undertaken. Severe TBI was defined as an Abbreviated Injury Scale of the head (AIShead) score of ≥ 3 and an AIS score for any other part of the body that does not exceed the AIShead score. Only patients with complete data (GCS score, age, and pupil parameters) were included. To assess the impact of GCS score and pupil parameters, the authors also used the recently introduced Eppendorf-Cologne Scale and divided the study population into 2 groups: children (0-15 years old) and adults (16-55 years old). Each patient's outcome was measured at discharge from the trauma center by using the Glasgow Outcome Scale. RESULTS A total of 9959 patients fulfilled the study inclusion criteria; 888 (8.9%) patients were ≤ 15 years old (median 10 years). The overall mortality rate and the mortality rate for patients with a GCS of 3 and bilaterally fixed and dilated pupils (19.9% and 16.3%, respectively) were higher for the adults than for the pediatric patients (85% vs 80.9%, respectively), although cardiopulmonary resuscitation rates were significantly higher in the pediatric patients (5.6% vs 8.8%, respectively). In the multivariate logistic regression analysis, no motor response (OR 3.490, 95% CI 2.240-5.435) and fixed pupils (OR 4.197, 95% CI 3.271-5.386) and bilateral dilated pupils (OR 2.848, 95% CI 2.282-3.556) were associated with a higher mortality rate. Patients ≤ 15 years old had a

  12. 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...

  13. 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

    2014-09-15

    Plasma-free fatty acids (FFAs) 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 to 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 SD: 1.14, 95% confidence interval [CI] 1.09 to 1.18), but FABP4 levels were not (HR 1.04, 95% CI 0.98 to 1.09). In a cause-specific mortality analysis, higher concentrations of FFA were associated with significantly higher risk of death because of 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 in men and women (HR 1.17, 95% CI 1.08 to 1.26 for men; HR 1.02, 95% CI 0.96 to 1.07 for women, interaction p value <0.001). In conclusion, in a cohort of community-dwelling older subjects, elevated plasma concentrations of FFA, but not FABP4, were associated with cardiovascular and noncardiovascular mortality.

  14. 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

  15. 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

  16. 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

  17. 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

  18. Outcome of community-acquired pneumonia with cardiac complications

    Directory of Open Access Journals (Sweden)

    R. Eman Shebl

    2015-07-01

    Conclusions: Cardiac complications are common in the admitted patients with pneumonia and they are associated with increased pneumonia severity and increased cardiovascular risk, these complications adds to the risk of mortality, so optimal management of these events may reduce the burden of death associated with this infection.

  19. Laboratory investigation of the macrolide-resistant Streptococcus pneumoniae strains isolated from adults%成人耐大环内酯类抗生素肺炎链球菌的实验研究

    Institute of Scientific and Technical Information of China (English)

    康悦; 吴菊芳; 徐晓刚; 叶信予

    2012-01-01

    Objective To investigate the resistance profile of S. Pneumoniae strains isolated from adults in China and provide useful information for rational treatment of community acquired respiratory tract infections. Methods S. Pneumoniae strains were isolated from adults with confirmed community-acquired pneumonia or acute exacerbation of chronic bronchitis. Microdilution method was used to test the sensitivity of S. Pneumoniae to 15 commonly used antimicrobial agents. The resistant phenotype was identified by erythromycin and clindamycin double disk diffusion method. PCR was used to amplify the relevant resistant genes. Results Seventy-one strains of S. Pneumoniae were included in this study. About 98. 6% (70/71) of the strains were susceptible to penicillin. One strain (1.4%, 1/71) was intermediate to penicillin. Most of the strains (84.5%, 60/71) were resistant to macrolides. Majority (90%, 54/60) of these strains were cMLSb phenotype. Five (8. 3%, 5/60) strains showed iMLSB phenotype and 1 (1. 7%, 1/60) strain belonged to M phenotype. ermB gene was identified in 59 (98. 3%) of the 60 strains of macrolide-resistant S. Pneumoniae. Conclusions S. Pneumoniae strains associated with community acquired respiratory infections isolated from Chinese adults are highly resistant to macrolides. Macrolides should be used cautiously in community acquired respiratory infections according to the results of susceptibility testing or in combination with (β-lactam antibiotics.%目的 了解近年我国成人患者中分离的肺炎链球菌的耐药现状,为社区获得性呼吸道感染的抗菌药物选用提供依据.方法 对临床明确诊断为社区获得性肺炎(CAP)及慢性气管炎急性加重(AECB)患者中分离获得肺炎链球菌;采用微量稀释法测定15种常用抗菌药物对肺炎链球菌的体外药敏结果;进行克林霉素诱导耐药性D试验;PCR扩增方法检测耐药基因.结果 71株肺炎链球菌中,青霉素敏感肺炎链球菌(PSSP)70

  20. 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.

  1. 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

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

    OpenAIRE

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

    2016-01-01

    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, ...

  3. Antimicrobial Resistant Streptococcus pneumoniae

    Directory of Open Access Journals (Sweden)

    B Khanal

    2010-09-01

    Full Text Available Introduction: Pneumococcal infections are important cause of morbidity and mortality. Knowledge of antimicrobial susceptibility patterns plays important role in the selection of appropriate therapy. Present study was undertaken to analyze the susceptibility patterns of pneumococcal isolates against commonly used antimicrobials with special reference to determination of minimum inhibitory concentration (MIC of penicillin in a tertiary care hospital in eastern Nepal. Methods: Twenty-six strains of S. pneumoniae isolated from various clinical specimens submitted to microbiology laboratory were evaluated. All isolates were tested for antimicrobial susceptibility by disk diffusion method. MIC of penicillin was tested by broth dilution method. Results: Of the total isolates 19 (73% were from invasive infections. Seven isolates were resistant to cotrimoxazole. No resistance to penicillin was seen in disk diffusion testing. Less susceptibility to penicillin (MIC 0.1-1.0 mg/L was observed in five (17% isolates. High level resistance to penicillin was not detected. One isolate was multidrug resistant. Conclusions: S. pneumoniaeisolates with intermediate resistance to penicillin prevail in Tertiary Care Hospital in eastern Nepal, causing invasive and noninvasive infections. As intermediate resistance is not detected in routine susceptibility testing, determination of MIC is important. It helps not only in the effective management of life threatening infections but is also essential in continuous monitoring and early detection of resistance. In addition, further study on pneumococcal infections, its antimicrobial resistance profile and correlation with clinical and epidemiological features including serotypes and group prevalence is recommended in future. Keywords: antimicrobial susceptibility pattern, penicillin, Streptococcus pneumoniae.

  4. Influencing factor of gram negative bacteria for adult patients with community-acquired pneumonia%社区获得性肺炎革兰氏阴性菌感染的影响因素

    Institute of Scientific and Technical Information of China (English)

    边喜明

    2016-01-01

    目的:探讨社区获得性肺炎( CAP)成年患者革兰氏阴性细菌感染的影响因素。方法选取确诊为社区获得性肺炎的成人患者186例。采集患者痰标本检测致病菌;对患者一般资料进行统计分析。结果186例CAP患者中,60例患者检测出92株细菌,占32.26%;其中革兰氏阳性菌19株(14例),革兰氏阴性菌73株(46例),分别占20.65%和79.35%。46革兰氏阴性菌CAP患者与186例CAP患者在年龄、入院前应用抗生素、合并基础疾病、白细胞异常、中性粒细胞、营养不良、总胆红素、CD4+和CD4+/CD8+比值存在显著性差异(P<0.05或P<0.01)。分析显示,入院前应用抗生素、合并基础疾病、白细胞异常、中性粒细胞、营养不良、总胆红素和CD4+/CD8+比值为CAP成年患者革兰氏阴性细菌感染的独立影响因素( P<0.05或P<0.01)。结论入院前应用抗生素、合并基础疾病、白细胞异常、中性粒细胞、营养不良、总胆红素和 CD4+/CD8+比值为CAP成年患者革兰氏阴性细菌感染的独立影响因素。%Objective To investigate the influencing factor of gram negative bacteria for adult patients with community-acquired pneumonia. Methods 186 adult patients with community acquired pneumonia were selected. The sputum samples were detected for pathogenic bacterium, and their general data were analyzed. Results Among 60 patients, 92 strains were detected, accounting for 32. 26%. There were 19 strains of gram positive strains (14 ca-ses) and 73 strains of gram negative strains (46 cases), accounting for 20. 65% and 79. 35%, respectively. There were significant differences in age, antibiotics use before admission, underlying disease, leukocyte disorder, neutro-phile granulocyte, malnutrition, total bilirubin, CD4+ and CD4+ /CD8+ between gram negative strains infected commu-nity acquired pneumonia and total community acquired pneumonia ( P <0. 05 or P <0. 01 ) . Logistic regression showed that

  5. Occupational versus leisure-time physical activity in reducing cardiovascular risks and mortality among ethnic Chinese adults in Taiwan.

    Science.gov (United States)

    Hu, Gwo-Chi; Chien, Kuo-Liong; Hsieh, Shiau-Fu; Chen, Chun-Yen; Tsai, Wen-Hsiang; Su, Ta-Chen

    2014-11-01

    The aim of the study was to investigate the associations of occupational physical activity (OPA) and leisure-time physical activity (LTPA) with the risk of cardiovascular disease (CVD) and mortality. Physical activity data from the Baeck questionnaire was available for 1706 participants. During a follow-up period, there were 215 cases of CVD and 438 deaths. With the lowest tertile as the reference, the hazard ratios (HRs) for CVD and mortality in the highest tertiles of LTPA were 0.65 (95% confidence interval [CI] = 0.46-0.92) and 0.73 (95% CI = 0.58-0.92). In contrast, the HRs for CVD and mortality in the highest tertiles of OPA were 1.75 (95% CI = 1.10-2.80) and 1.53 (95% CI = 1.06-2.22). The association between OPA and the risk of CVD and mortality was significant in men but not in women. Our findings suggest that high OPA imposes harmful effects on the risk of CVD and mortality, particularly among men.

  6. 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

  7. 成人及儿童社区与医院获得肺炎链球菌的耐药性分析%Analysis on drug resistance of community acquired and hospital acquired Streptococcus pneumoniae in adults and children

    Institute of Scientific and Technical Information of China (English)

    张勇昌; 张九进; 陈月新; 赖伟忠

    2014-01-01

    目的:探讨成人及儿童社区与医院获得肺炎链球菌对常用抗菌药物的耐药性,为临床合理用药提供参考依据。方法对2010年1月-2012年12月分离肺炎链球菌411株,采用法国生物梅里埃公司的VITEK-2 Com-pact全自动细菌鉴定仪进行鉴定及药物敏感试验,采用SPSS 17.0统计软件进行分析。结果共411株肺炎链球菌社区获得肺炎链球菌为349株,成人占23.50%、儿童占76.50%;医院获得肺炎链球菌62株,成人占51.61%、儿童占48.39%;儿童社区获得与医院获得肺炎链球菌对青霉素、阿莫西林、红霉素、磺胺甲噁唑/甲氧苄啶、头孢噻肟的耐药率均高于成人社区获得与医院获得肺炎链球菌,而对左氧氟沙星、莫西沙星的耐药率低于成人社区获得与医院获得肺炎链球菌,差异均有统计学意义。结论儿童社区获得肺炎链球菌对β-内酰胺抗菌药物的耐药率高于成人,临床治疗应减少经验性用药,建议依据药敏结果选择抗菌药物进行治疗。%OBJECTIVE To discuss the drug resistance of community acquired and hospital acquired Streptococcus pneumoniae to commonly antibiotics used in adults and children ,so as to provide the basis for the clinical medica-tion .METHODS Using the France Biomeriex VITEK-2 Compact ,411 strains of Streptococcus pneumoniae from Jan .2010 to Dec .2012 were isolated and tested for the drug sensitivity .Data were analyzed by SPSS 17 .0 . RESULTS Among 411 strains of S . pneumoniae ,349 were community acquired ,including 23 .50% in adults , 76 .50% in children and 62 were hospital acquired ,including 51 .61% in adults ,48 .39% in children .The resist-ance rates of community and hospital acquired Streptococcus pneumoniae to penicillin ,amoxicilin ,erythromycin , sulfamethoxazole/trimethoprim ,and cefotaxime in children were significanty higher than that in adults ,while the resistances to levofloxacin and moxifloxacin

  8. 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.

  9. 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

  10. [Clinical characteristics and geriatric evaluation of elderly patients with pneumonia in a hospital in Buenos Aires, Argentina].

    Science.gov (United States)

    Regueiro, Martín; Homar, Cecilia; Ovejero, Ricardo; Liu, Antonio; Pieroni, Tomás; Basilico, Romina

    2013-07-01

    In order to determine the clinical and geriatric characteristics of elderly adults with pneumonia in a hospital in Buenos Aires, Argentina, a cross-sectional study was carried out in 2010, included 66 patients hospitalized for pneumonia. The mean age of the study subjects was 82, 54.5% of whom were men. 47.0% of the hospitalizations were due to community-acquired pneumonia. As for the functional evaluation, 31.8% showed dependence in performing basic activities of daily living and 69.4% presented dependence in instrumental activities of daily living. The most frequent clinical characteristics observed were fever, cough, dyspnea and expectoration. The causative agent of pneumonia was identified in 34.8% of the cases, 18 of which were bacterial (27.2%) and 5 viral (7.5%). The crude mortality rate was 28.8%, but was close to 50% in those patients having confusional syndrome. We conclude that pneumonia in elderly patients has special characteristics, which can be observed with a proper diagnostic and geriatric evaluation.

  11. Dietary patterns and relationship to obesity-related health outcomes and mortality in adults 75 years of age or greater

    Science.gov (United States)

    Background: The prevalence of obesity-related adverse health outcomes is increasing among older adults. Because it is thought that nutrition plays an important role in successful aging, there has been considerable interest in the association between dietary patterns of older adults and obesity-relat...

  12. 降钙素原对社区获得性肺炎死亡率及病情评估的价值%Value of procalcitonin in predicting mortality and severity of community-acquired pneumonia

    Institute of Scientific and Technical Information of China (English)

    张俨; 李文强

    2015-01-01

    Objective To study the value of procalcitonin (PCT) level in predicting mortality and severity of community-acquired pneumonia (CAP) in the emergency department. Methods The general clinical data and in-flammatory biomarker of 114 patients with CAP were collected. The severity of CAP was assessed by PSI and CURB65 score. An analysis was performed to assess the value of PCT, WBC counts, high-sensitivity C-reactive pro-tein (hs-CRP), and erythrocyte sedimentation rate (ESR) for the prediction of mortality and severity. Results 14 high-risk patients died within 28 days. Compared with the survival group, the death group had significantly increased PCT level (2. 96 ± 1. 54 vs 0. 38 ± 0. 24 ng/ mL, P < 0. 01) and hs-CRP(194. 61 ± 72. 80 vs 101. 26 ± 65. 98 mg/ L, P < 0. 01). The PCT level was significantly higher in the severe group than in the moderate group according to PSI and CURB65 score. Through logistic regression analyses, the area under the receiver operating characteristic curve (ROC) of PCT level were 0. 81. The area under ROC increased significantly while it used PCT combined with PSI and CURB65 score to predict the mortality and severity of CAP. Conclusion The level of PCT is a more versatile tool for predicting mortality and severity of CAP in the emergence department, and the level of procalcitonin as an ad-junct to CAP prediction rules may be valuable for prognosis and severity assessment.%目的:探索降钙素原(PCT)对社区获得性肺炎(CAP)患者的死亡率和病情评估的价值。方法前瞻性研究在急诊科通过症状和 X 线检查诊断为 CAP 的114例患者,收集患者的一般临床资料及炎症标志物。采用肺炎严重性指数(PSI)、CURB65评分评估 CAP 患者的疾病严重性,分析血沉(ESR)、白细胞计数、高敏 C 反应蛋白(Hs-CRP)及 PCT 预测 CAP 患者死亡率和疾病严重性的价值。结果114例患者中14例高危患者28天内死亡。死亡组较存活组 PCT 和 Hs-CRP

  13. Examination of pneumonia risks and risk levels in trauma patients with pulmonary contusion.

    Science.gov (United States)

    Landeen, Carolina; Smith, Hayden L

    2014-01-01

    Development of pneumonia in patients with pulmonary contusion can result in morbidity and mortality. This study examined the utility of a pneumonia risk tool for pulmonary contusion patients, which was originally developed using national level data. The study found a 21% prevalence of pneumonia diagnosis in pulmonary contusion patients at the examined level I trauma center, with patients in the high-risk group having 8 times greater odds for pneumonia diagnosis. The study also revealed increasing age and the use of mechanical ventilation as being significantly associated with pneumonia status. Early identification of risk factors for pneumonia could help direct clinician care strategies.

  14. 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.

  15. Nasopharyngeal carriage of Streptococcus pneumonia in pneumonia-prone age groups in Semarang, Java Island, Indonesia.

    Directory of Open Access Journals (Sweden)

    Helmia Farida

    Full Text Available INTRODUCTION: Streptococcus pneumoniae is a worldwide occurring pathogen Nasopharyngeal carriage of Streptococcus pneumoniae precedes pneumonia and other pneumococcal diseases in the community. Little is known about S. pneumoniae carriage in Indonesia, complicating strategies to control pneumococcal diseases. We investigated nasopharyngeal carriage of S. pneumoniae in Semarang, Indonesia. METHODS: A population-based survey was performed in Semarang, Indonesia. Nasopharyngeal swabs and questionnaires were taken from 496 healthy young (6-60 month-old children and 45-70 year-old adults. RESULTS: Forty-three percent of children aged 6-60 months and 11% of adults aged 45-75 years carried S. pneumoniae. Determinants of carriage were being a child (OR 7.7; 95% CI = 4.5-13.0, passive smoking (OR 2.1; 95% CI = 1.3-3.4, and contact with toddler(s at home (OR 3.0; 95% CI = 1.9-4.7. The most frequent serotypes found were 6A/B and 15B/C. The current commercially available vaccines cover <50% serotypes found in children. Twenty-four percent of S. pneumoniae strains were penicillin non-susceptible, and 45% were resistant to cotrimoxazol. CONCLUSIONS: The limited coverage of commercially available vaccines against the serotypes found in this population, and the high proportion of non-susceptibility to penicillin and cotrimoxazol suggest the need for region-specific information and strategies to control S. pneumoniae.

  16. 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....

  17. 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.

  18. Burden of Serious Infections in Adults with Systemic Lupus Erythematosus

    Science.gov (United States)

    Tektonidou, Maria G.; Wang, Zhong; Dasgupta, Abhijit; Ward, Michael M.

    2015-01-01

    Objective To compare rates of hospitalizations for serious infections, trends in rates from 1996 to 2011, and in-hospital mortality between patients with systemic lupus erythematosus (SLE) and those without SLE in a national sample. Methods We analyzed hospitalizations for pneumonia, bacteremia/sepsis, urinary tract infections, skin infections, and opportunistic infections among adults in the Nationwide Inpatient Sample. We compared rates of hospitalizations yearly among patients with SLE and the general population. We also computed odds ratios for in-hospital mortality. Results In 1996, the estimated number of hospitalizations for pneumonia in patients with SLE was 4382, followed by sepsis (2305), skin infections (1422), urinary tract infections (643), and opportunistic infections (370). Rates were much higher in SLE than those without SLE, with age-adjusted relative risks ranging from 5.7 (95% confidence interval (CI) 5.5, 6.0) for pneumonia to 9.8 (95% CI 9.1, 10.7) for urinary tract infection in 1996. Risks increased over time, so that by 2011, all relative risks exceeded 12.0. Overall risk of in-hospital mortality was higher in SLE only for opportunistic infections (adjusted odds ratio 1.52; 95% CI 1.12, 2.07). However, in pneumonia and sepsis, mortality risks were higher in SLE among those that required mechanical ventilation. Conclusion Hospitalization rates for serious infections in SLE increased substantially between 1996 and 2011, reaching over 12 times higher than in patients without SLE in 2011. Reasons for this acceleration are unclear. In-hospital mortality was higher among patients with SLE and opportunistic infections, and those with pneumonia or sepsis who required mechanical ventilation. PMID:25732901

  19. 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.

  20. Characterization of the inflammatory infiltrate in Streptococcus pneumoniae pneumonia in young and elderly patients.

    Science.gov (United States)

    Menter, Thomas; Giefing-Kroell, Carmen; Grubeck-Loebenstein, Beatrix; Tzankov, Alexandar

    2014-01-01

    There is an increased susceptibility and mortality in the elderly due to pneumonia caused by Streptococcus pneumoniae. We aimed to assess the inflammatory cell composition with respect to age in pneumococcal pneumonia patients. Neutrophilic granulocytes and various lymphocyte and macrophage subpopulations were immunohistochemically quantified on lung tissue specimens of young (n = 5; mean age 8.4 years), middle-aged (n = 8; mean age 55.9 years) and elderly (n = 9; mean age 86.6 years) pneumonia patients with microbiologically proven S. pneumoniae pneumonia. We discovered a higher percentage of neutrophilic granulocytes in elderly as opposed to young patients (95 vs. 75%, p = 0.012). Conversely, young patients versus elderly patients had more alveolar macrophages (CD11c+: 20 vs. 9%, p = 0.029) and M1 macrophages (CD14+: 30 vs. 10%, p = 0.012 and HLA-DR+: 52 vs. 11%, p = 0.019). There was no significant difference concerning M2 macrophages and lymphocytes. Comparison of young patients with middle-aged patients showed similar significant results for alveolar macrophages (p = 0.019) and subsignificant results for M1 macrophages and neutrophilic granulocytes (p pneumonia in situ. Our observations improve the understanding of the innate immune mechanisms of pneumococcal lung infection and point at the potential of therapies for restoring macrophage function and decreasing neutrophilic influx in order to help prevent or cure pneumonia.

  1. 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.

  2. Predictive factors of follow-up non-attendance and mortality among adults with type 2 diabetes mellitus- an analysis of the Malaysian diabetes registry 2009.

    Science.gov (United States)

    Chew, Boon-How; Lee, Ping-Yein; Shariff-Ghazali, Sazlina; Cheong, Ai-Theng; Ismail, Mastura; Taher, Sri-Wahyu

    2015-01-01

    This study examined the factors associated with follow-up non-attendance (FUNA) and mortality among the adult patients with type 2 diabetes mellitus (T2DM). Data on 57780 T2DM patients from the 2009 diabetes registry were analyzed using multinomial logistic mixed model. Out of 57780 patients, 3140 (5.4%) were lost to follow-up and 203 (0.4%) patients had died. Compared with patients who were under active follow-up, men (OR 1.37), neither on insulin (OR 1.72), nor on antiplatelet agents (OR 1.47), having higher HbA1c (OR 1.15), higher LDL-C (OR 1.18) and complications (OR 1.33) were associated with FUNA. Older age (OR 1.09) and higher LDL-C (OR 2.27) have higher mortality. Across the four different health facilities, medication use (insulin and anti-platelet agents) to achieve better disease control in the younger age when diabetes complication is absent would not cause FUNA and might reduce mortality.

  3. Mortality in adult intensive care patients with severe systemic inflammatory response syndromes is strongly associated with the hypo-immune TNF -238A polymorphism.

    Science.gov (United States)

    Pappachan, John V; Coulson, Tim G; Child, Nicholas J A; Markham, David J; Nour, Sarah M; Pulletz, Mark C K; Rose-Zerilli, Matthew J; de Courcey-Golder, Kim; Barton, Sheila J; Yang, Ian A; Holloway, John W

    2009-10-01

    The systemic inflammatory response syndrome (SIRS) is associated with activation of innate immunity. We studied the association between mortality and measures of disease severity in the intensive care unit (ICU) and functional polymorphisms in genes coding for Toll-like receptor 4 (TLR4), macrophage migratory inhibitory factor (MIF), tumour necrosis factor (TNF) and lymphotoxin-alpha (LTA). Two hundred thirty-three patients with severe SIRS were recruited from one general adult ICU in a tertiary centre in the UK. DNA from patients underwent genotyping by 5' nuclease assay. Genotype was compared to phenotype. Primary outcome was mortality in ICU. Minor allele frequencies were TLR4 +896G 7%, MIF 173C 16%, TNF -238A 10% and LTA +252G 34%. The frequency of the hypoimmune minor allele TNF -238A was significantly higher in patients who died in ICU compared to those who survived (p = 0.0063) as was the frequency of the two haplotypes LTA +252G, TNF -1031T, TNF -308G, TNF -238A and LTA +252G, TNF-1031T, TNF-308A and TNF-238A (p = 0.0120 and 0.0098, respectively). These findings re-enforce the view that a balanced inflammatory/anti-inflammatory response is the most important determinant of outcome in sepsis. Genotypes that either favour inflammation or its counter-regulatory anti-inflammatory response are likely to influence mortality and morbidity.

  4. 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

  5. Immunotolerance during bacterial pneumonia and sepsis

    NARCIS (Netherlands)

    Hoogerwerf, J.J.

    2010-01-01

    Bacterial pneumonia and sepsis are a major cause of morbidity and mortality worldwide. Massive use of antibiotics promotes pathogen resistance, and, as a consequence, the incidence of drug-resistant bacteria is increasing. Therefore, it is of the utmost importance to expand our comprehension of host

  6. 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

  7. The association of chronic obstructive pulmonary disease, disability, engagement in social activities, and mortality among US adults aged 70 years or older, 1994–2006

    Directory of Open Access Journals (Sweden)

    Liu Y

    2014-01-01

    Full Text Available Yong Liu,1 Janet B Croft,1 Lynda A Anderson,2 Anne G Wheaton,1 Letitia R Presley-Cantrell,3 Earl S Ford11Epidemiology and Surveillance Branch, 2Healthy Aging Program, Division of Population Health, CDC and Rollins School of Public Health, Emory University, 3Program Development and Services Management, Division of Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USAPurpose: To assess associations among chronic obstructive pulmonary disease (COPD, disability as measured by activities of daily living (ADL and instrumental ADL (IADL, engagement in social activities, and death among elderly noninstitutionalized US residents.Materials and methods: A nationally representative sample of 9,415 adults who were aged ≥70 years and responded to the Second Supplement on Aging survey in 1994–1996 and mortality follow-up study through 2006 were assessed. Multiple logistic regression analyses were performed to assess the risk of all-cause mortality in participants with COPD after accounting for age, sex, race/ethnicity, and smoking status.Results: At baseline, approximately 9.6% of study participants reported having COPD. Compared with participants without COPD, those with COPD were significantly more likely (P<0.05 to have difficulty with at least one ADL (44.3% versus [vs] 27.5% and with at least one IADL (59.9% vs 40.2%, significantly less likely to be engaged in social activities (32.6% vs 26.3%, and significantly more likely to die by 2006 (70.7% vs 60.4%; adjusted risk ratio 1.15, P<0.05. The association between COPD and risk for death was moderately attenuated by disability status.Conclusion: COPD is positively associated with disability and mortality risk among US adults aged ≥70 years. The significant relationship between COPD and mortality risk was moderately attenuated, but was not completely explained by stages of ADL and IADL limitations and social activities.Keywords: chronic obstructive pulmonary

  8. 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.

  9. 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

  10. 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...

  11. A review of adult mortality due to 2009 pandemic (H1N1 influenza A in California.

    Directory of Open Access Journals (Sweden)

    Janice K Louie

    Full Text Available BACKGROUND: While children and young adults had the highest attack rates due to 2009 pandemic (H1N1 influenza A (2009 H1N1, studies of hospitalized cases noted high fatality in older adults. We analyzed California public health surveillance data to better characterize the populations at risk for dying due to 2009 H1N1. METHODS AND FINDINGS: A case was an adult ≥20 years who died with influenza-like symptoms and laboratory results indicative of 2009 H1N1. Demographic and clinical data were abstracted from medical records using a standardized case report form. From April 3, 2009-August 10, 2010, 541 fatal cases ≥20 years with 2009 H1N1 were reported. Influenza fatality rates per 100,000 population were highest in persons 50-59 years (3.5; annualized rate = 2.6 and 60-69 years (2.3; annualized rate = 1.7 compared to younger and older age groups (0.4-1.9; annualized rates = 0.3-1.4. Of 486 cases hospitalized prior to death, 441 (91% required intensive care unit (ICU admission. ICU admission rates per 100,000 population were highest in adults 50-59 years (8.6. ICU case-fatality ratios among adults ranged from 24-42%, with the highest ratios in persons 70-79 years. A total of 425 (80% cases had co-morbid conditions associated with severe seasonal influenza. The prevalence of most co-morbid conditions increased with increasing age, but obesity, pregnancy and obstructive sleep apnea decreased with age. Rapid testing was positive in 97 (35% of 276 tested. Of 482 cases with available data, 384 (80% received antiviral treatment, including 49 (15% of 328 within 48 hours of symptom onset. CONCLUSIONS: Adults aged 50-59 years had the highest fatality due to 2009 H1N1; older adults may have been spared due to pre-existing immunity. However, once infected and hospitalized in intensive care, case-fatality ratios were high for all adults, especially in those over 60 years. Vaccination of adults older than 50 years should be encouraged.

  12. 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%.

  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. [Risk Factor Analysis of Pneumonia after Cardiovascular Surgery].

    Science.gov (United States)

    Maekawa, Yoshiyuki; Abe, Shuichi; Nakamura, Ken; Uchida, Tetsuro; Sadahiro, Mitsuaki; Morikane, Keita

    2016-08-01

    Pneumonia is a major and life-threatening complication after cardiovascular surgery. The objective of our study was to describe epidemiology, clinical characteristics, and risk factors of pneumonia after cardiovascular surgery. From January 2007 to December 2011, 511 consecutive patients (age 67.3±11.9;336 men, 175 women) were enrolled in this study. Pneumonia was diagnosed according to Centers of Disease Control and Prevention surveillance criteria for healthcare associated infection. Data collection included preoperative, intraoperative, and post-operative variables. The overall incidence of pneumonia was 72 cases(14.0%). The mortality in pneumonia group was significantly higher than that in non-pneumonia group (16.6% vs 4.3%, Odds ratio 4.4 ppneumonia after cardiovascular surgery.

  15. 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.

  16. Experimentally produced calf pneumonia.

    Science.gov (United States)

    Gourlay, R N; Howard, C J; Thomas, L H; Stott, E J

    1976-03-01

    Experimental pneumonia was produced in calves by the endobronchial inoculation of pneumonic lung homogenates. Irradiated homogenates produced minimal pneumonia. Ampicillin treatment of the homogenates and the experimental calves reduced the extent of pneumonia. Treatment with tylosin tartrate prevented experimental pneumonia. These results suggest that the total pneumonia was due to organisms susceptible to tylosin tartrate and that the residual pneumonia remaining after ampicillin treatment was due to organisms susceptible to tylosin tartrate but not to ampicillin. Of the organisms isolated from the lungs, the ones in this latter category most likely to be responsible are Mycoplasma dispar and ureaplasmas (T-mycoplasmas).

  17. Acute Chlamydia pneumoniae and Mycoplasma pneumoniae infections in community-acquired pneumonia and exacerbations of COPD or asthma: therapeutic considerations.

    Science.gov (United States)

    Meloni, F; Paschetto, E; Mangiarotti, P; Crepaldi, M; Morosini, M; Bulgheroni, A; Fietta, A

    2004-02-01

    Rates of acute Chlamydia pneumoniae and Mycoplasma pneumoniae infections were determined in 115 adults hospitalized for community-acquired pneumonia (CAP), purulent exacerbations of COPD and acute exacerbations of bronchial asthma, by means of serology and molecular methods. Results were compared with those obtained in a matched control group. Common respiratory pathogens were isolated by cultures in 22.5% and 22.2% of CAP and exacerbated COPD patients, respectively. Cultures from exacerbated asthma patients were always negative. Serological and molecular evidence of current C. pneumoniae infection was obtained in 10.0%, 8.9% and 3.3% of CAP, COPD and asthma cases. The corresponding rates of acute M. pneumoniae infection were 17.5%, 6.7% and 3.3%, respectively. Finally, no difference was found between typical and atypical pathogen rates. These findings highlight the importance of taking into account C. pneumoniae and M. pneumoniae infections in guiding the choice of empirical antibacterial treatment for CAP and purulent exacerbations of COPD.

  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. Laboratory mortality and mycosis of adult Curculio caryae (Coleoptera: Curculionidae) following application of Metarhizium anisopliae in the laboratory and field

    Science.gov (United States)

    The pecan weevil, Curculio caryae, is a key pest of pecans. Our objective was to determine the potential of Metarhizium anisopliae to control emerging C. caryae adults. First, a laboratory test was conducted to compare four Beauveria bassiana strains (Bb GA2, BbLA3, BbMS1, and GHA) and three M. an...

  20. Global divergence in critical income for adult and childhood survival: analyses of mortality using Michaelis-Menten.

    Science.gov (United States)

    Hum, Ryan J; Jha, Prabhat; McGahan, Anita M; Cheng, Yu-Ling

    2012-12-13

    Life expectancy has risen sharply in the last 50 years. We applied the classic Michaelis-Menten enzyme kinetics to demonstrate a novel mathematical relationship of income to childhood (aged 0-5 years) and adult (aged 15-60 years) survival. We treat income as a substrate that is catalyzed to increase survival (from technologies that income buys) for 180 countries from 1970 and 2007. Michaelis-Menten kinetics permit estimates of maximal survival and, uniquely, the critical income needed to achieve half of the period-specific maximum. Maximum child and adult survival rose by about 1% per year. Critical incomes fell by half for children, but doubled for men. HIV infection and smoking account for some, but not all, of the rising critical incomes for adult survival. Altering the future cost curve for adult survival will require more widespread use of current interventions, most notably tobacco control, but also research to identify practicable low-cost drugs, diagnostics, and strategies.DOI:http://dx.doi.org/10.7554/eLife.00051.001.

  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.

  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. 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)

  4. 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

  5. Pneumonia - children - discharge

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000011.htm Pneumonia in children - discharge To use the sharing features ... this page, please enable JavaScript. Your child has pneumonia, which is an infection in the lungs. In ...

  6. Pneumocystis jiroveci pneumonia

    Science.gov (United States)

    ... medlineplus.gov/ency/article/000671.htm Pneumocystis jiroveci pneumonia To use the sharing features on this page, please enable JavaScript. Pneumocystis jiroveci pneumonia is a fungal infection of the lungs. The ...

  7. FastStats: Pneumonia

    Science.gov (United States)

    ... this? Submit What's this? Submit Button NCHS Home Pneumonia Recommend on Facebook Tweet Share Compartir Data are ... visits Number of visits to emergency departments with pneumonia as the primary hospital discharge diagnosis: 674,000 ...

  8. 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

  9. High Prevalence of Mycoplasma pneumoniae and Chlamydia pneumoniae in Children with Acute Respiratory Infections from Lima, Peru

    Science.gov (United States)

    del Valle-Mendoza, Juana; Orellana-Peralta, Fiorella; Marcelo-Rodríguez, Alvaro; Verne, Eduardo; Esquivel-Vizcarra, Mónica; Silva-Caso, Wilmer; Aguilar-Luis, Miguel Angel; Weilg, Pablo; Casabona-Oré, Verónica; Ugarte, Claudia; del Valle, Luis J.

    2017-01-01

    Background Mycoplasma pneumoniae and Chlamydia pneumoniae are atypical pathogens responsible for pneumonia and a leading cause of morbidity and mortality in low income countries. The study objective is to determine the prevalence of this pathogens in Peruvian children with acute respiratory infections. Methods A consecutive cross-sectional study was conducted in Lima, Peru from May 2009 to September 2010. A total of 675 children admitted with clinical diagnoses of acute respiratory infections were tested for Mycoplasma pneumoniae and Chlamydia pneumoniae detection by polymerase chain reaction (PCR), and clinical symptoms were registered by the attending physician. Results Mycoplasma pneumonia was detected in 25.19% (170/675) of nasopharyngeal samples and Chlamydia pneumonia in 10.52% (71/675). The most common symptoms in patients with these atypical pathogens were rhinorrhea, cough and fever. A higher prevalence of Mycoplasma pneumoniae cases were registered in summer, between December 2009 and March 2010. Conclusions Mycoplasma pneumoniae and Chlamydia pneumonia are a significant cause of morbidity in Peruvian children with acute respiratory infections (ARI). Further studies should evaluate the use of reliable techniques such as PCR in Peru in order to avoid underdiagnoses of these atypical pathogens. PMID:28129377

  10. Single immunoglobulin interleukin-1 receptor-related molecule impairs host defense during pneumonia and sepsis caused by Streptococcus pneumoniae.

    Science.gov (United States)

    Blok, Dana C; van Lieshout, Miriam H P; Hoogendijk, Arie J; Florquin, Sandrine; de Boer, Onno J; Garlanda, Cecilia; Mantovani, Alberto; van't Veer, Cornelis; de Vos, Alex F; van der Poll, Tom

    2014-01-01

    Streptococcus pneumoniae is a common cause of pneumonia and sepsis. Toll-like receptors (TLRs) play a pivotal role in the host defense against infection. In this study, we sought to determine the role of single immunoglobulin interleukin-1 receptor-related molecule (SIGIRR a.k.a. TIR8), a negative regulator of TLR signaling, in pneumococcal pneumonia and sepsis. Wild-type and SIGIRR-deficient (sigirr-/-) mice were infected intranasally (to induce pneumonia) or intravenously (to induce primary sepsis) with S. pneumoniae and euthanized after 6, 24, or 48 h for analyses. Additionally, survival studies were performed. sigirr-/- mice showed delayed mortality during lethal pneumococcal pneumonia. Accordingly, sigirr-/- mice displayed lower bacterial loads in lungs and less dissemination of the infection 24 h after the induction of pneumonia. SIGIRR deficiency was associated with increased interstitial and perivascular inflammation in lung tissue early after infection, with no impact on neutrophil recruitment or cytokine production. sigirr-/- mice also demonstrated reduced bacterial burdens at multiple body sites during S. pneumoniae sepsis. sigirr-/- alveolar macrophages and neutrophils exhibited an increased capacity to phagocytose viable pneumococci. These results suggest that SIGIRR impairs the antibacterial host defense during pneumonia and sepsis caused by S. pneumoniae.

  11. 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.

  12. Geriatric oral health and pneumonia risk.

    Science.gov (United States)

    Terpenning, Margaret

    2005-06-15

    The oral cavity is a complex microenvironment consisting of multiple bacterial and fungal species, their associated biofilms, and a cytokine milieu influenced by constant inflammatory stimulation. Multiple infectious consequences of poor oral health have been extensively described and primarily affect older adults. Probably the most common sequelae of poor oral health in aged persons is a risk of aspiration pneumonia. The risk of aspiration pneumonia is greatest when periodontal disease, dental caries, and poor oral hygiene are compounded by swallowing disease, feeding problems, and poor functional status. The effectiveness of oral hygiene interventions for preventing aspiration pneumonia and barriers to oral care of nursing home patients require additional study, but the current state of research in these areas is reviewed in this manuscript. The expense of aspiration pneumonia as a nursing home complication makes dental hygiene a potentially cost-saving intervention.

  13. Drought reduces chytrid fungus (Batrachochytrium dendrobatidis) infection intensity and mortality but not prevalence in adult crawfish frogs (Lithobates areolatus).

    Science.gov (United States)

    Terrell, Vanessa C K; Engbrecht, Nathan J; Pessier, Allan P; Lannoo, Michael J

    2014-01-01

    To fully understand the impacts of the chytrid fungus Batrachochytrium dendrobatidis (Bd) on amphibians it is necessary to examine the interactions between populations and their environment. Ecologic variables can exacerbate or ameliorate Bd prevalence and infection intensity, factors that are positively related when Bd is acting on naive amphibian populations as an epidemic disease. In crawfish frogs (Lithobates areolatus), a North American species with a complex life history, we have shown that Bd acts as an endemic disease with impacts that vary seasonally; the highest infection prevalences and intensities and highest frog mortality occurred during late spring in postbreeding individuals. In this study, conducted between 28 February and 23 August 2011 in southwestern Indiana on the same population, we report an uncoupling of the previously observed relationship between Bd prevalence and intensity following an extreme drought. Specifically, there was a postdrought reduction in Bd infection intensity and mortality, but not in infection prevalence. This result suggests that the relationship between prevalence and intensity observed in Bd epidemics can be uncoupled in populations harboring endemic infections. Further, constant prevalence rates suggest either that crawfish frogs are being exposed to Bd sources independent of ambient moisture or that low-level infections below detection thresholds persist from year to year. Drought has several ecologically beneficial effects for amphibians with complex life histories, including eliminating fish and invertebrate populations that feed on larvae. To these ecologic benefits we suggest another, that drought can reduce the incidence of the severe skin disease (chytridiomycosis) due to Bd infection.

  14. C-reactive protein (CRP): an important diagnostic and prognostic tool in nursing-home-associated pneumonia.

    Science.gov (United States)

    Arinzon, Zeev; Peisakh, Alexander; Schrire, Samuel; Berner, Yitshal

    2011-01-01

    Pneumonia is the second most common infection in long term care (LTC) residents and is a leading cause of death from infection in those groups of patients. Atypical presentations and fewer presenting signs and symptoms in older patients complicate diagnosis and delay initiation of adequate treatment. The aim of this study was to compare laboratory CRP levels to pneumonia severity scores, in prediction of short-term death from pneumonia. Diagnosis of pneumonia was performed according to the criteria of McGeer for the identification of pneumonia at an LTC facility. The severities of pneumonia and mortality prediction were assessed by three indices: PSI (pneumonia severity index), Missouri study index and the nursing home associated pneumonia (NHAP) severity index. A strong positive correlation was found between CRP levels and PSI (r=0.445, pnursing home acquired pneumonia is not specific, it is suggested that CRP should be performed in every patient with a suspicion of pneumonia.

  15. Nasopharyngeal carriage of Klebsiella pneumoniae and other Gram-negative bacilli in pneumonia-prone age groups in Semarang, Indonesia.

    Science.gov (United States)

    Farida, Helmia; Severin, Juliëtte A; Gasem, M Hussein; Keuter, Monique; van den Broek, Peterhans; Hermans, Peter W M; Wahyono, Hendro; Verbrugh, Henri A

    2013-05-01

    Gram-negative bacilli (GNB) cause many cases of pneumonia in Indonesia. We investigated nasopharyngeal carriage of GNB in Semarang, Indonesia. Klebsiella pneumoniae carriage in adults (15%) was higher than in children (7%) (P = 0.004), while that of other GNB was comparable. Poor food and water hygiene are determinants of carriage of these bacteria.

  16. 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

  17. Adult mortality or morbidity is not increased in childhood-onset growth hormone deficient patients who received pediatric GH treatment: an analysis of the Hypopituitary Control and Complications Study (HypoCCS)

    OpenAIRE

    Mo, Daojun; Hardin, Dana Sue; Erfurth, Eva Marie; Melmed, Shlomo

    2013-01-01

    Background The French Safety and Appropriateness of Growth Hormone treatments in Europe (SAGhE) cohort has raised concern of increased mortality risk during follow-up into adulthood in certain patients who had received growth hormone (GH) treatment during childhood. The Hypopituitary Control and Complications Study monitored mortality and morbidity of adult GH-deficient patients including those with childhood-onset GH deficiency (COGHD) who received GH treatment as children. Purpose Evaluate ...

  18. 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.

  19. Low zinc status: a new risk factor for pneumonia in the elderly?

    Science.gov (United States)

    Barnett, Junaidah B; Hamer, Davidson H; Meydani, Simin N

    2010-01-01

    Low zinc status may be a risk factor for pneumonia in the elderly. This special article reviews the magnitude of the problem of pneumonia (its prevalence, morbidity, and mortality) in the elderly, pneumonia's etiology, and the dysregulation of the immune system associated with increasing age. In addition, recent evidence from the literature is presented demonstrating that low zinc status (commonly reported in the elderly) impairs immune function, decreases resistance to pathogens, and is associated with increased incidence and duration of pneumonia, increased use and duration of antimicrobial treatment, and increased overall mortality in the elderly. Inadequate stores of zinc might, therefore, be a risk factor for pneumonia in the elderly. Randomized, double-blind, controlled studies are needed to determine the efficacy of zinc supplementation as a potential low-cost intervention to reduce morbidity and mortality due to pneumonia in this vulnerable population.

  20. Pneumocystis Pneumonia (For Parents)

    Science.gov (United States)

    ... Feeding Your 1- to 2-Year-Old Pneumocystis Pneumonia KidsHealth > For Parents > Pneumocystis Pneumonia Print A A A What's in this article? About PCP Diagnosing PCP Treating PCP Pneumocystis pneumonia (PCP) is an infection caused by Pneumocystis jiroveci , ...

  1. Pneumonia (For Parents)

    Science.gov (United States)

    ... Old Feeding Your 1- to 2-Year-Old Pneumonia KidsHealth > For Parents > Pneumonia A A A What's in this article? Signs ... Doctor Professional Treatment Home Care en español Neumonía Pneumonia is a general term for lung infections that ...

  2. 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

    DEFF Research Database (Denmark)

    Barfod, Charlotte; Laurtizen, Marlene Mp; Danker, Jakob K

    2012-01-01

    outcome in the unselected acute population. The aim of this study was to quantify the association between the main component of the Hillerod 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...

  3. Does health care associated pneumonia really exist?

    Science.gov (United States)

    Lopez, Alejandra; Amaro, Rosanel; Polverino, Eva

    2012-07-01

    The most recent ATS guidelines for nosocomial pneumonia of 2005 describe a new clinical category of patients, Health Care-Associated Pneumonia which includes a number of very heterogeneous conditions possibly associated with a high risk of multi-drug resistant (MDR) infections and of mortality. This paper aims at reviewing the current literature on HCAP and examines the controversial issues of HCAP etiology and outcomes, underlining the need of a profound revision of the HCAP concept in the face of the poor and contrasting scientific evidence supporting its basis.

  4. Relationship of Having Hobbies and a Purpose in Life With Mortality, Activities of Daily Living, and Instrumental Activities of Daily Living Among Community-Dwelling Elderly Adults

    Directory of Open Access Journals (Sweden)

    Kimiko Tomioka

    2016-07-01

    Full Text Available Background: This study’s aim was to clarify the relationship of having hobbies and a purpose in life (PIL; in Japanese, ikigai with mortality and a decline in the activities of daily living (ADL and instrumental ADL (IADL among the community-dwelling elderly. Methods: Prospective observational data from residents aged ≥65 years who were at increased risk for death (n = 1853 and developing a decline in ADL (n = 1254 and IADL (n = 1162 were analyzed. Cox proportional hazard models were used for mortality analysis of data from February 2011 to November 2014. ADL and IADL were evaluated using the Barthel Index and the Tokyo Metropolitan Institute of Gerontology Index of Competence, respectively. ADL and IADL were assessed at baseline and follow-up and were evaluated using logistic regression models. Fully adjusted models included terms for age, gender, BMI, income, alcohol intake, smoking history, number of chronic diseases, cognitive function, and depression. Results: During the follow-up of eligible participants, 248 had died, 119 saw a decline in ADL, and 178 saw a decline in IADL. In fully adjusted models, having neither hobbies nor PIL was significantly associated with an increased risk of mortality (hazard ratio 2.08; 95% confidence interval [CI], 1.47–2.94, decline in ADL (odds ratio 2.74; 95% CI, 1.44–5.21, and decline in IADL (odds ratio 1.89; 95% CI, 1.01–3.55 compared to having both hobbies and PIL. Conclusions: Although effect modifications by cognitive functioning and depression cannot be ruled out, our findings suggest that having hobbies and PIL may extend not only longevity, but also healthy life expectancy among community-dwelling older adults.

  5. Optimal Dietary and Plasma Magnesium Statuses Depend on Dietary Quality for a Reduction in the Risk of All-Cause Mortality in Older Adults

    Directory of Open Access Journals (Sweden)

    Yi-Chen Huang

    2015-07-01

    Full Text Available 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.

  6. 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.

  7. Reporting errors in siblings' survival histories and their impact on adult mortality estimates: results from a record linkage study in Senegal.

    Science.gov (United States)

    Helleringer, Stéphane; Pison, Gilles; Kanté, Almamy M; Duthé, Géraldine; Andro, Armelle

    2014-04-01

    Estimates of adult mortality in countries with limited vital registration (e.g., sub-Saharan Africa) are often derived from information about the survival of a respondent's siblings. We evaluated the completeness and accuracy of such data through a record linkage study conducted in Bandafassi, located in southeastern Senegal. We linked at the individual level retrospective siblings' survival histories (SSH) reported by female respondents (n = 268) to prospective mortality data and genealogies collected through a health and demographic surveillance system (HDSS). Respondents often reported inaccurate lists of siblings. Additions to these lists were uncommon, but omissions were frequent: respondents omitted 3.8 % of their live sisters, 9.1 % of their deceased sisters, and 16.6 % of their sisters who had migrated out of the DSS area. Respondents underestimated the age at death of the siblings they reported during the interview, particularly among siblings who had died at older ages (≥45 years). Restricting SSH data to person-years and events having occurred during a recent reference period reduced list errors but not age and date errors. Overall, SSH data led to a 20 % underestimate of 45 q 15 relative to HDSS data. Our study suggests new quality improvement strategies for SSH data and demonstrates the potential use of HDSS data for the validation of "unconventional" demographic techniques.

  8. 痰热清注射液治疗成人重症肺炎疗效及安全性分析%Efficacy and Safety of Tanreqing Injection on Treating Adults Severe Pneumonia

    Institute of Scientific and Technical Information of China (English)

    张炜; 孟庆阳; 孙丽丹; 王利菊

    2016-01-01

    Objective:We want to analyze the treatment effect and safety of Tanreqing Injection on treating adults' severe pneumonia.Methods:We searched before 2015-08-01 Cochrane Library,Medline,Embase,OVID,VIP and CNKI-Chinese Academic Journal (1980--2015)was published at home and abroad about Tanreqing treatment of adults severe pneumonia abult clinical efficacy of randomized controlled clinical trials literature (randomized clinical trial,RCT).Jadad quality score using the evaluation criteria for inclusion of literature using Review Manager 5.3 software Mate analysis.Results:A total of 10 randomized controlled trials,a total of 762 cases of patients met the inclusion criteria,included in this Meta analysis.Meta-analysis showed:The homogeneity test included seven studies homogeneity (x 2=3.49,P=0.75.,I2=0),using the fixed effects model,the results show Tanreqing group treatment of adults with severe pneumonia,the cure rate than the control group,the comprehensive advantages of ratio (OR)was 0.49,95% CI (0.31,0.76),the overall effectiveness of inspection and Z=3.14,P<0.002; 10studies included homogeneity (x 2=7.16,P=0.62,I2=0),using the fixed effects model,the results show Tanreqing treatment of adults with severe pneumonia group total efficiency than the control group,the comprehensive advantages of the ratio (OR)was 0.31,95% CI (0.21,0.47),the overall effectiveness of inspection and Z=5.56,P<0.00001.Conclusion:The limited evidence suggests Tanreqing treatment of adults with severe pneumonia have a good therapeutic effect and safety plays an important role in the clinical treatment.Because high-quality RCTs lack this study,so the application Tanreqing treatment of adults with severe pneumonia have a good therapeutic effect and safety needs more high-quality clinical studies to be further confirmed.%目的:研究分析痰热清注射液治疗成人重症肺炎的治疗效果及安全性.方法:在Cochrane Librarv、Medline、Embase、OVID、VIP和CNKI

  9. Global initiative for meticillin-resistant Staphylococcus aureus pneumonia (GLIMP)

    DEFF Research Database (Denmark)

    Aliberti, Stefano; Reyes, Luis F; Faverio, Paola

    2016-01-01

    factors for MRSA pneumonia. We aimed to determine the point prevalence of MRSA pneumonia and identify specific MRSA risk factors in community-dwelling patients hospitalised with pneumonia. METHODS: We did an international, multicentre study of community-dwelling, adult patients admitted to hospital...... with pneumonia who had microbiological tests taken within 24 h of presentation. We recruited investigators from 222 hospitals in 54 countries to gather point-prevalence data for all patients admitted with these characteristics during 4 days randomly selected during the months of March, April, May, and June...... in 2015. We assessed prevalence of MRSA pneumonia and associated risk factors through logistic regression analysis. FINDINGS: 3702 patients hospitalised with pneumonia were enrolled, with 3193 patients receiving microbiological tests within 24 h of admission, forming the patient population. 1173 (37%) had...

  10. Efficacy and safety of telithromycin 800 mg once daily for 7 days in community-acquired pneumonia: an open-label, multicenter study

    Directory of Open Access Journals (Sweden)

    Dunbar Lala M

    2005-05-01

    Full Text Available Abstract Background Community-acquired pneumonia (CAP remains a major cause of morbidity and mortality throughout the world. Telithromycin (a new ketolide has shown good in vitro activity against the key causative pathogens of CAP, including S pneumoniae resistant to penicillin and/or macrolides. Methods The efficacy and safety of telithromycin 800 mg orally once daily for 7 days in the treatment of CAP were assessed in an open-label, multicenter study of 442 adults. Results Of 149 microbiologically evaluable patients, 57 (9 bacteremic had Streptococcus pneumoniae. Of the 57 S pneumoniae pathogens isolated in these patients, 9 (2 bacteremic were penicillin- or erythromycin-resistant; all 57 were susceptible to telithromycin and were eradicated. Other pathogens and their eradication rates were: Haemophilus influenzae (96%, Moraxella catarrhalis (100%, Staphylococcus aureus (80%, and Legionella spp. (100%. The overall bacteriologic eradication rate was 91.9%. Of the 357 clinically evaluable patients, clinical cure was achieved in 332 (93%. In the 430 patients evaluable for safety, the most common drug-related adverse events were diarrhea (8.1% and nausea (5.8%. Conclusion Telithromycin 800 mg once daily for 7 days is an effective and well-tolerated oral monotherapy and offers a new treatment option for CAP patients, including those with resistant S pneumoniae.

  11. Associations of objectively measured moderate-to-vigorous-intensity physical activity and sedentary time with all-cause mortality in a population of adults at high risk of type 2 diabetes mellitus.

    Science.gov (United States)

    Bakrania, Kishan; Edwardson, Charlotte L; Khunti, Kamlesh; Henson, Joseph; Stamatakis, Emmanuel; Hamer, Mark; Davies, Melanie J; Yates, Thomas

    2017-03-01

    The relationships of physical activity and sedentary time with all-cause mortality in those at high risk of type 2 diabetes mellitus (T2DM) are unexplored. To address this gap in knowledge, we examined the associations of objectively measured moderate-to-vigorous-intensity physical activity (MVPA) and sedentary time with all-cause mortality in a population of adults at high risk of T2DM. In 2010-2011, 712 adults (Leicestershire, U.K.), identified as being at high risk of T2DM, consented to be followed up for mortality. MVPA and sedentary time were assessed by accelerometer; those with valid data (≥ 10 hours of wear-time/day with ≥ 4 days of data) were included. Cox proportional hazards regression models, adjusted for potential confounders, were used to investigate the independent associations of MVPA and sedentary time with all-cause mortality. 683 participants (250 females (36.6%)) were included and during a mean follow-up period of 5.7 years, 26 deaths were registered. Every 10% increase in MVPA time/day was associated with a 5% lower risk of all-cause mortality [Hazard Ratio (HR): 0.95 (95% Confidence Interval (95% CI): 0.91, 0.98); p = 0.004]; indicating that for the average adult in this cohort undertaking approximately 27.5 minutes of MVPA/day, this benefit would be associated with only 2.75 additional minutes of MVPA/day. Conversely, sedentary time showed no association with all-cause mortality [HR (every 10-minute increase in sedentary time/day): 0.99 (95% CI: 0.95, 1.03); p = 0.589]. These data support the importance of MVPA in adults at high risk of T2DM. The association between sedentary time and mortality in this population needs further investigation.

  12. Analysis of Clinical Features on 55 Adult Mycoplasmal Pneumonia Cases and Cause of Misdiagnosis%成人支原体肺炎55例临床特点及误漏诊原因分析

    Institute of Scientific and Technical Information of China (English)

    曹仕鹏; 尹柯; 傅满姣

    2015-01-01

    目的:分析成人支原体肺炎( adult mycoplasmal pneumonia, AMP)的临床特点及误漏诊原因,以提高AMP的诊断水平。方法回顾性分析我院2012年1月—2014年6月收治的55例AMP临床资料。结果本组主要表现为咳嗽、咳痰和发热,合并多种肺外表现:咽痛(45.5%),关节、肌肉疼痛(36.4%),头痛(27.3%),腹泻(14.5%),皮疹(7.3%),耳痛(3.6%)。76.4%的患者血白细胞计数和中性粒细胞比例正常,9.1%的患者痰细菌培养阳性。影像学表现为磨玻璃影36例(65.5%)、斑片状影13例(23.6%),病灶多累及肺上叶(69.1%)或同时累及双肺(65.5%)。肺炎支原体抗体效价多在病程第2~3周呈阳性,45例(81.8%)间隔7~14 d后复查抗体效价呈4倍或4倍以上增高。本组首诊误漏诊率74.5%(41/55),误诊为浸润型肺结核15例(36.6%),病毒性肺炎14例(34.1%),急性支气管炎5例(12.2%),过敏性肺炎2例(4.9%),漏诊5例(12.2%)。经肺炎支原体抗体检测并结合病史、试验性抗生素治疗等综合分析确诊AMP。确诊后均首选大环内酯类抗生素治疗,其中6例治疗无效后改用氟喹诺酮类抗生素,均治愈。结论临床医师应重视AMP的诊断,对反复呼吸道感染伴随肺外表现者,常规行肺炎支原体抗体检测并动态观察,不应因单次抗体检测阴性而排除诊断。%Objective To analyze the clinical features and misdiagnosis cause of adult mycoplasmal pneumonia ( AMP) patients in order to improve the diagnosis level of AMP. Methods The clinical data of 55 AMP admitted to Chang-sha central hospital during Jan 2012 and June 2014 were collected and retrospectively analyzed. Results The main clinical symptoms of AMP were cough, expectoration and fever, which were combined with a variety of extrapulmonary manifestations:sore throat (45. 5%), joint and, muscle pain (36. 4%), headache (27. 3%), diarrhea (14. 5%), rash (7. 3%), earache (3. 6%). White blood cell counts and neutrophil percentage were mostly

  13. 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

  14. A propensity-matched study of the association of diabetes mellitus with incident heart failure and mortality among community-dwelling older adults.

    Science.gov (United States)

    Roy, Brita; Pawar, Pushkar P; Desai, Ravi V; Fonarow, Gregg C; Mujib, Marjan; Zhang, Yan; Feller, Margaret A; Ovalle, Fernando; Aban, Inmaculada B; Love, Thomas E; Iskandrian, Ami E; Deedwania, Prakash; Ahmed, Ali

    2011-12-15

    Diabetes mellitus (DM) is a risk factor for incident heart failure (HF) in older adults. However, the extent to which this association is independent of other risk factors remains unclear. Of 5,464 community-dwelling adults ≥65 years old in the Cardiovascular Health Study without baseline HF, 862 had DM (fasting plasma glucose levels ≥126 mg/dl or treatment with insulin or oral hypoglycemic agents). Propensity scores for DM were estimated for each of the 5,464 participants and were used to assemble a cohort of 717 pairs of participants with and without DM who were balanced in 65 baseline characteristics. Incident HF occurred in 31% and 26% of matched participants with and without DM, respectively, during >13 years of follow-up (hazard ratio 1.45 for DM vs no DM, 95% confidence interval [CI] 1.14 to 1.86, p = 0.003). Of the 5,464 participants before matching unadjusted and multivariable-adjusted hazard ratios for incident HF associated with DM were 2.22 (95% CI 1.94 to 2.55, p <0.001) and 1.52 (95% CI 1.30 to 1.78, p <0.001), respectively. All-cause mortality occurred in 57% and 47% of matched participants with and without DM, respectively (hazard ratio 1.35, 95% CI 1.13 to 1.61, p = 0.001). Of matched participants DM-associated hazard ratios for incident peripheral arterial disease, incident acute myocardial infarction, and incident stroke were 2.50 (95% CI 1.45 to 4.32, p = 0.001), 1.37 (95% CI 0.97 to 1.93, p = 0.072), and 1.11 (95% CI 0.81 to 1.51, p = 0.527), respectively. In conclusion, the association of DM with incident HF and all-cause mortality in community-dwelling older adults without HF is independent of major baseline cardiovascular risk factors.

  15. 降钙素原与 C-反应蛋白联合检测在成人细菌性肺炎中的临床评价%Clinical evaluation of combined detection of serum procalcitonin and C-reactive protein for bacterial pneumonia in adults

    Institute of Scientific and Technical Information of China (English)

    曹校校; 李强; 陈荣

    2014-01-01

    OBJECTIVE To evaluate clinical effect of combined detection of serum procalcitonin (PCT ) and C-reactive protein (CRP) on diagnosis and treatment of bacterial pneumonia in adults in order to facilitate diagnosis and treatment for diseases . METHODS Patients with bacterial pneumonia , viral pneumonia and mycoplasma pneumonia of each 60 cases treated from Jan .2013 to Jun .2013 in our hospital were randomly selected and respectively received combined PCT and CRP detection .The 60 patients with bacterial pneumonia were grouped according to the severity of illness .PCT and CRP contents in patients of each group were summarized and the data were processed by statistical software SPSS17 .0 .RESULTS PTC of pneumonic patients was (9 .31 ± 4 .76)μg/L in the bacterial pneumonia group ,(1 .30 ± 0 .68)μg/L in the viral pneumonia group and (1 .45 ± 0 .87)μg/L in the mycoplasma pneumonia group .CRP was (64 .21 ± 16 .97) mmol/L in the bacterial pneumonia group ,(30 .05 ± 10 .02) mmol/L in the mycoplasma pneumonia group and (4 .79 ± 1 .22) mmol/L in the viral pneumonia group . The difference between the three groups was significant (P<0 .05) .The level of PCT and CRP increased along with the severity of bacterial pneumonia .CONCLUSION PCT and CRP levels are closely related with bacterial pneumonia ,the combined detection of the two indexes can provide good guidance for diagnosis and treatment as well as prognosis for bacterial pneumonia in adults .%目的:探讨血清降钙素原(PCT)和C-反应蛋白(CRP)联合检测在成人细菌性肺炎诊断与治疗中的临床评价,以利于疾病的诊断治疗。方法随机选取2013年1-6月进行治疗的细菌性肺炎、病毒性肺炎、支原体肺炎患者各60例,分别对其进行PCT和CRP联合的检测,将60例细菌性肺炎患者按病情轻重程度分组,统计各组PCT和CRP含量,采用SPSS17.0统计软件对数据进行处理。结果肺炎患者PCT水平细菌性肺炎组为(9.31±4

  16. 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.

  17. 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.

  18. Nursing strategies to prevent ventilator-associated pneumonia.

    Science.gov (United States)

    Hixson, S; Sole, M L; King, T

    1998-02-01

    Critically ill patients who require mechanical ventilation are at high risk for development of pneumonia during the course of treatment. Ventilator-associated pneumonia leads to higher rates of mortality and morbidity, increased length of hospital stay, and higher hospital costs. The intubation that is necessary for mechanical ventilation impairs the patient's normal defense mechanisms for fighting infection. Impaired defenses, along with such risk factors as age of the patient, equipment used, and failure of the staff to wash hands increase the likelihood of colonization of the lower airways. Colonization and subsequent pneumonia commonly occurs from microaspiration of secretions from the oropharynx and gastrointestinal tract. In this article, the mechanism of microaspiration, diagnosis of ventilator-associated pneumonia, and nursing strategies to reduce the incidence of pneumonia are described.

  19. 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

  20. Mycoplasma pneumoniae and Chlamydia spp. infection in community-acquired pneumonia, Germany, 2011-2012.

    Science.gov (United States)

    Dumke, Roger; Schnee, Christiane; Pletz, Mathias W; Rupp, Jan; Jacobs, Enno; Sachse, Konrad; Rohde, Gernot

    2015-03-01

    Mycoplasma pneumoniae and Chlamydia spp., which are associated with community-acquired pneumonia (CAP), are difficult to propagate, and can cause clinically indistinguishable disease patterns. During 2011-2012, we used molecular methods to test adult patients in Germany with confirmed CAP for infection with these 2 pathogens. Overall, 12.3% (96/783) of samples were positive for M. pneumoniae and 3.9% (31/794) were positive for Chlamydia spp.; C. psittaci (2.1%) was detected more frequently than C. pneumoniae (1.4%). M. pneumoniae P1 type 1 predominated, and levels of macrolide resistance were low (3.1%). Quarterly rates of M. pneumoniae-positive samples ranged from 1.5% to 27.3%, showing a strong epidemic peak for these infections, but of Chlamydia spp. detection was consistent throughout the year. M. pneumoniae-positive patients were younger and more frequently female, had fewer co-occurring conditions, and experienced milder disease than did patients who tested negative. Clinicians should be aware of the epidemiology of these pathogens in CAP.

  1. 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.

  2. Mortality rates across 25-hydroxyvitamin D (25[OH]D levels among adults with and without estimated glomerular filtration rate <60 ml/min/1.73 m2: the third national health and nutrition examination survey.

    Directory of Open Access Journals (Sweden)

    Holly Kramer

    Full Text Available BACKGROUND: Previous studies exploring the association between 25[OH]D levels and mortality in adults with and without kidney disease utilized 25[OH]D thresholds that have recently been scrutinized by the Institute of Medicine Committee to Review Dietary References Intakes for Vitamin D and Calcium. OBJECTIVE: We explored all-cause mortality rates across the spectrum of 25[OH]D levels over an eighteen-year follow-up among adults with and without an estimated glomerular filtration rate (eGFR 20 ng/ml after adjustment for all covariates. CONCLUSIONS: Regardless of presence of eGFR <60 ml/min/1.73 m(2, mortality rates across groups with 25[OH]D levels 20-40 ng/ml are similar.

  3. Combination antibiotic therapy for community-acquired pneumonia

    OpenAIRE

    Caballero, Jesus; Rello, Jordi

    2011-01-01

    Community-acquired pneumonia (CAP) is a common and potentially serious illness that is associated with morbidity and mortality. Although medical care has improved during the past decades, it is still potentially lethal. Streptococcus pneumoniae is the most frequent microorganism isolated. Treatment includes mandatory antibiotic therapy and organ support as needed. There are several antibiotic therapy regimens that include β-lactams or macrolides or fluoroquinolones alone or in combination. Co...

  4. Clinical features of pneumonia in extreme old age

    OpenAIRE

    1995-01-01

    The clinical features of 70 people over the age of 85 with radiologically positive pneumonia were studied. It was shown that the classical presenting symptoms of pneumonia were often absent and 81 % had one or more acute ’geriatric’ features such as acute confusion, recent onset of falls, recent worsening immobility or recent onset of incontinence, at the time of presentation. An increased risk of mortality was associated with acute confusion, dementia, central cyanosis and long term immobili...

  5. 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.

  6. 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

  7. Incidence and trends of cardiovascular mortality after common cancers in young adults:Analysis of surveillance, epidemiology and end-results program

    Institute of Scientific and Technical Information of China (English)

    Sadeer G Al-Kindi; Guilherme H Oliveira

    2016-01-01

    AIM: To describe the incidence of cardiovascular mortality(CVM) in survivors of major cancers and identify its trends over the past two decades. METHODS: We used the surveillance, epidemiology and end-results 19 registry to identify young adults(20-49 years), diagnosed with the following major primary cancers: Lung, breast, liver/intrahepatic bile duct, pancreas, prostate, colorectal, and ovarian from 1990 through 2012 and identified the cumulative incidence of CVM after adjusting for confounding factors. RESULTS: We identified a total of 301923 cancers(breast 173748, lung 38938, colorectal 31722, prostate 22848, ovary 16065, liver 9444, pancreas 9158). A total of 2297(0.8%) of patients had incident CVM. Lung(10-year cumulative CVM 2.4%) and liver(1.73%) cancers had the highest incidence of CVM, while breast(0.6%) and prostate(1.2%) had the lowest CVM mortality, even after multiple adjustments(P < 0.001). Overall, there was a significant improvement in CVM since 1990 [2005-2012 vs 1990-1994, adjusted HR 0.63(0.54-0.72), P < 0.001]. This was driven by improvements in CVM in lung cancers(P = 0.02), breast(P < 0.001), and a trend in ovarian cancer(P = 0.097).There was no statistically significant improvement in CVM among survivors of colorectal, pancreatic, liver, or prostate cancers.CONCLUSION: The risk of CVM differs among different cancers, and is highest among survivors of lung and liver cancers. The incidence of CVM has decreased over the past 2 decades mainly among survivors of lung and breast cancers.

  8. Molecular characteristics of serotype 3 Streptococcus pneumoniae isolates among community-acquired pneumonia patients in Japan.

    Science.gov (United States)

    Isozumi, Rie; Ito, Yutaka; Ishida, Tadashi; Hirai, Toyohiro; Ito, Isao; Maniwa, Ko; Hayashi, Michio; Kagioka, Hitoshi; Hirabayashi, Masataka; Onaru, Koichi; Tomioka, Hiromi; Tomii, Keisuke; Gohma, Iwao; Osawa, Makoto; Imai, Seiichiro; Takakura, Shunji; Iinuma, Yoshitsugu; Chin, Kazuo; Ichiyama, Satoshi; Mishima, Michiaki

    2008-06-01

    In order to understand the spread of the erythromycin-resistant serotype 3 Streptococcus pneumoniae clone in Japan, we have assessed the molecular characteristics of this clone. Among 156 S. pneumoniae isolates recovered from adults with community-acquired pneumonia between 2003 and 2005, 42 were serotype 3 and 40 were sequence type (ST) 180/Netherlands(3)-31 by multilocus sequence typing. Thirty-eight of the 40 ST 180 isolates had acquired resistance to erythromycin via the ermB gene. Although the ermB-positive ST180 clone isolates were more susceptible to penicillin and trimethoprim-sulfamethoxazole than ermB-positive non-ST180 isolates and contained a less mutated pbp1a or pbp2b gene, without a mefA gene, the ST180 clone was highly prevalent among ermB-positive isolates. Routine surveillance for the ST180 S. pneumoniae clone may soon become necessary.

  9. Cytotoxicity of Mycoplasma pneumoniae Membranes

    Science.gov (United States)

    Gabridge, Michael G.; Johnson, Cynthia K.; Cameron, Alexander M.

    1974-01-01

    Organ cultures of adult hamster trachea were used to evaluate the cytotoxic potential of cell fractions of Mycoplasma pneumoniae. Cytoplasm was essentially devoid of activity, whereas viable cells and membrane preparations, at a level of 25 μg of protein per ml, induced necrosis. Damage, as revealed by light and electron microscopy, included ciliostasis, vacuolization, loss of ciliated respiratory epithelial cells, disorganization, and a loss of polarity. Dose response data indicated that the speed and degree of cytotoxicity was directly related to the concentration of membranes. Doses of 30 to 60 μg of protein per ml could reduce relative ciliary activity to 20% of the control level within 4 days. Membranes prepared after freeze-thaw lysis of cells were almost twice as active as those isolated after a combination of osmotic and sonic shock. Membranes of M. fermentans were inactive, though both the FH and M129 strains of M. pneumoniae were toxic. These data indicate that the toxic factor responsible for M. pneumoniae may be located in the cell membrane. Images PMID:16558100

  10. Streptococcus pneumoniae necrotizing fasciitis in systemic lupus erythematosus.

    Science.gov (United States)

    Sánchez, A; Robaina, R; Pérez, G; Cairoli, E

    2016-04-01

    Necrotizing fasciitis is a rapidly progressive destructive soft tissue infection with high mortality. Streptococcus pneumoniae as etiologic agent of necrotizing fasciitis is extremely unusual. The increased susceptibility to Streptococcus pneumoniae infection in patients with systemic lupus erythematosus is probably a multifactorial phenomenon. We report a case of a patient, a 36-year-old Caucasian female with 8-year history of systemic lupus erythematosus who presented a fatal Streptococcus pneumoniae necrotizing fasciitis. The role of computed tomography and the high performance of blood cultures for isolation of the causative microorganism are emphasized. Once diagnosis is suspected, empiric antibiotic treatment must be prescribed and prompt surgical exploration is mandatory.

  11. Pneumonia in immunocompetent patients: combination antibiotic therapy.

    Science.gov (United States)

    Salva, S; Borgatta, B; Rello, J

    2014-04-01

    Pneumonia's burden is still important worldwide not only because of its high incidence and mortality, but also for the elevated costs related to it. Despite the concerted efforts to reduce the incidence of sepsis-related complications, they continue to represent a major human and economic burden. The cornerstone of sepsis management is early appropriate empiric broad spectrum antibiotics, resuscitation, and source control. The association between inappropriate use of antibiotics and increased mortality is the rationale for the use of empiric antibiotic combination therapy in critically ill patients. The aim of this manuscript was to discuss recent literature regarding the management of severe pneumonia, both community-acquired and hospital-acquired/ventilator-associated, in critically ill patients. Use of combination therapy is warranted in severe infections with shock; considerations should be made on the importance of optimal antibiotic administration and adverse reactions, thus providing guidance for a rational use of antibiotics.

  12. Differences between adiposity indicators for predicting all-cause mortality in a representative sample of United States non-elderly adults.

    Directory of Open Access Journals (Sweden)

    Henry S Kahn

    Full Text Available BACKGROUND: Adiposity predicts health outcomes, but this relationship could depend on population characteristics and adiposity indicator employed. In a representative sample of 11,437 US adults (National Health and Nutrition Examination Survey, 1988-1994, ages 18-64 we estimated associations with all-cause mortality for body mass index (BMI and four abdominal adiposity indicators (waist circumference [WC], waist-to-height ratio [WHtR], waist-to-hip ratio [WHR], and waist-to-thigh ratio [WTR]. In a fasting subsample we considered the lipid accumulation product (LAP; [WC enlargement*triglycerides]. METHODS AND FINDINGS: For each adiposity indicator we estimated linear and categorical mortality risks using sex-specific, proportional-hazards models adjusted for age, black ancestry, tobacco exposure, and socioeconomic position. There were 1,081 deaths through 2006. Using linear models we found little difference among indicators (adjusted hazard ratios [aHRs] per SD increase 1.2-1.4 for men, 1.3-1.5 for women. Using categorical models, men in adiposity midrange (quartiles 2+3; compared to quartile 1 were not at significantly increased risk (aHRs1.1, especially black men assessed by WTR (aHR 1.9 [1.4-2.6] and black women by LAP (aHR 2.2 [1.4-3.5]. Quartile 4 of WC or WHtR carried no significant risk for diabetic persons (aHRs 0.7-1.1, but elevated risks for those without diabetes (aHRs>1.5. For both sexes, quartile 4 of LAP carried increased risks for tobacco-exposed persons (aHRs>1.6 but not for non-exposed (aHRs<1.0. CONCLUSIONS: Predictions of mortality risk associated with top-quartile adiposity vary with the indicator used, sex, ancestry, and other characteristics. Interpretations of adiposity should consider how variation in the physiology and expandability of regional adipose-tissue depots impacts health.

  13. 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

  14. A Non-Human Primate Model of Severe Pneumococcal Pneumonia

    Science.gov (United States)

    Reyes, Luis F.; Restrepo, Marcos I.; Hinojosa, Cecilia A.; Soni, Nilam J.; Shenoy, Anukul T.; Gilley, Ryan P.; Gonzalez-Juarbe, Norberto; Noda, Julio R.; Winter, Vicki T.; de la Garza, Melissa A.; Shade, Robert E.; Coalson, Jacqueline J.; Giavedoni, Luis D.; Anzueto, Antonio; Orihuela, Carlos J.

    2016-01-01

    Rationale Streptococcus pneumoniae is the leading cause of community-acquired pneumonia and infectious death in adults worldwide. A non-human primate model is needed to study the molecular mechanisms that underlie the development of severe pneumonia, identify diagnostic tools, explore potential therapeutic targets, and test clinical interventions during pneumococcal pneumonia. Objective To develop a non-human primate model of pneumococcal pneumonia. Methods Seven adult baboons (Papio cynocephalus) were surgically tethered to a continuous monitoring system that recorded heart rate, temperature, and electrocardiography. Animals were inoculated with 109 colony-forming units of S. pneumoniae using bronchoscopy. Three baboons were rescued with intravenous ampicillin therapy. Pneumonia was diagnosed using lung ultrasonography and ex vivo confirmation by histopathology and immunodetection of pneumococcal capsule. Organ failure, using serum biomarkers and quantification of bacteremia, was assessed daily. Results Challenged animals developed signs and symptoms of pneumonia 4 days after infection. Infection was characterized by the presence of cough, tachypnea, dyspnea, tachycardia and fever. All animals developed leukocytosis and bacteremia 24 hours after infection. A severe inflammatory reaction was detected by elevation of serum cytokines, including Interleukin (IL)1Ra, IL-6, and IL-8, after infection. Lung ultrasonography precisely detected the lobes with pneumonia that were later confirmed by pathological analysis. Lung pathology positively correlated with disease severity. Antimicrobial therapy rapidly reversed symptomology and reduced serum cytokines. Conclusions We have developed a novel animal model for severe pneumococcal pneumonia that mimics the clinical presentation, inflammatory response, and infection kinetics seen in humans. This is a novel model to test vaccines and treatments, measure biomarkers to diagnose pneumonia, and predict outcomes. PMID:27855182

  15. Incident opioid drug use and adverse respiratory outcomes among older adults with COPD.

    Science.gov (United States)

    Vozoris, Nicholas T; Wang, Xuesong; Fischer, Hadas D; Bell, Chaim M; O'Donnell, Denis E; Austin, Peter C; Stephenson, Anne L; Gill, Sudeep S; Rochon, Paula A

    2016-09-01

    We evaluated risk of adverse respiratory outcomes associated with incident opioid use among older adults with chronic obstructive pulmonary diseases (COPD).This was a retrospective population-based cohort study using a validated algorithm applied to health administrative data to identify adults aged 66 years and older with COPD. Inverse probability of treatment weighting using the propensity score was used to estimate hazard ratios comparing adverse respiratory outcomes within 30 days of incident opioid use compared to controls.Incident opioid use was associated with significantly increased emergency room visits for COPD or pneumonia (HR 1.14, 95% CI 1.00-1.29; p=0.04), COPD or pneumonia-related mortality (HR 2.16, 95% CI 1.61-2.88; p<0.0001) and all-cause mortality (HR 1.76, 95% CI 1.57-1.98; p<0.0001), but significantly decreased outpatient exacerbations (HR 0.88, 95% CI 0.83-0.94; p=0.0002). Use of more potent opioid-only agents was associated with significantly increased outpatient exacerbations, emergency room visits and hospitalisations for COPD or pneumonia, and COPD or pneumonia-related and all-cause mortality.Incident opioid use, and in particular use of the generally more potent opioid-only agents, was associated with increased risk for adverse respiratory outcomes, including respiratory-related mortality, among older adults with COPD. Potential adverse respiratory outcomes should be considered when prescribing new opioids in this population.

  16. 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, ...

  17. 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

  18. Mechanisms of interferon-γ production by neutrophils and its function during Streptococcus pneumoniae pneumonia.

    Science.gov (United States)

    Gomez, John C; Yamada, Mitsuhiro; Martin, Jessica R; Dang, Hong; Brickey, W June; Bergmeier, Wolfgang; Dinauer, Mary C; Doerschuk, Claire M

    2015-03-01

    Bacterial pneumonia is a common public health problem associated with significant mortality, morbidity, and cost. Neutrophils are usually the earliest leukocytes to respond to bacteria in the lungs. Neutrophils rapidly sequester in the pulmonary microvasculature and migrate into the lung parenchyma and alveolar spaces, where they perform numerous effector functions for host defense. Previous studies showed that migrated neutrophils produce IFN-γ early during pneumonia induced by Streptococcus pneumoniae and that early production of IFN-γ regulates bacterial clearance. IFN-γ production by neutrophils requires Rac2, Hck/Lyn/Fgr Src family tyrosine kinases, and NADPH oxidase. Our current studies examined the mechanisms that regulate IFN-γ production by lung neutrophils during acute S. pneumoniae pneumonia in mice and its function. We demonstrate that IFN-γ production by neutrophils is a tightly regulated process that does not require IL-12. The adaptor molecule MyD88 is critical for IFN-γ production by neutrophils. The guanine nucleotide exchange factor CalDAG-GEFI modulates IFN-γ production. The CD11/CD18 complex, CD44, Toll-like receptors 2 and 4, TRIF, and Nrf2 are not required for IFN-γ production by neutrophils. The recently described neutrophil-dendritic cell hybrid cell, identified by its expression of Ly6G and CD11c, is present at low numbers in pneumonic lungs and is not a source of IFN-γ. IFN-γ produced by neutrophils early during acute S. pneumoniae pneumonia induces transcription of target genes in the lungs, which are critical for host defense. These studies underline the complexity of the neutrophil responses during pneumonia in the acute inflammatory response and in subsequent resolution or initiation of immune responses.

  19. Risk factors for levofloxacin-nonsusceptible Streptococcus pneumoniae in community-acquired pneumococcal pneumonia: a nested case-control study.

    Science.gov (United States)

    Kang, C-I; Song, J-H; Kim, S H; Chung, D R; Peck, K R; So, T M; Hsueh, P-R

    2014-01-01

    This study was performed to evaluate the clinical features of community-onset levofloxacin-nonsusceptible pneumococcal pneumonia and to identify risk factors for levofloxacin resistance. Using the database of a surveillance study of community-acquired pneumococcal infections in Asian countries, we conducted a nested case-control study to identify risk factors for levofloxacin-nonsusceptible S. pneumoniae in community-acquired pneumonia in adults. Of 981 patients with pneumococcal pneumonia, 46 (4.7 %) had levofloxacin-nonsusceptible S. pneumoniae, of whom 39 evaluable cases were included in the analysis. All cases were from Korea, Taiwan, and Hong Kong. Among patients with levofloxacin-susceptible S. pneumoniae, 490 controls were selected based on patient country. Of the 39 cases of levofloxacin-nonsusceptible pneumococcal pneumonia, 23 (59.0 %) were classified as healthcare-associated, while 164 (33.5 %) of the 490 controls of levofloxacin-susceptible S. pneumoniae (P = 0.001) were classified as healthcare-associated. Multivariate analysis showed that previous treatment with fluoroquinolones, cerebrovascular disease, and healthcare-associated infection were significantly associated with levofloxacin-nonsusceptible pneumococcal pneumonia (all P < 0.05). Levofloxacin-nonsusceptible pneumococci pose an important new public health threat in our region, and more information on the emergence and spread of these resistant strains will be necessary to prevent spread throughout the population.

  20. 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...

  1. 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 (Pequations 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.

  2. 烟台市成人社区获得性肺炎病毒病原学分类的研究%Etiological classification of virus in adult community-acquired pneumonia in Yantai

    Institute of Scientific and Technical Information of China (English)

    于红霞; 陈永芹; 蒲增惠; 赵茂茂

    2014-01-01

    To employ multiplex polymerase chain reaction (PCR) to classify the types of virus in 128 patients of community-acquired pneumonia and analyze the relationship between type of virus,age and seasons.The positive rate of viral pneumonia was 34.4% (44/128).In 44 virus positive patients,the rates of influenza A virus,rhinovirus,adenovirus,parainfluenza type 1,human metapneumovirus virus,influenza B virus,parainfluenza type 2,parainfluenza type 3 and enterovirus were 22.7% (10/44),15.9% (7/44),15.9% (7/44),9.1% (4/44),9.1% (4/44)6.8% (3/44),2.3% (1/44),2.3% (1/44) and 2.3% (1/44) respectively.And other 6(13.6%) patients were at least infected by one virus.The viral pneumonia had a high positive rate in spring and winter.And the age group of 20 to 29 years had a high positive rate.The major pathogen contributing to adult community-acquired pneumonia in Yantai were influenza A virus,rhinovirus and adenovirus.%对128例确诊为社区获得性肺炎患者的咽拭子采用多重PCR方法进行病毒分类,分析病毒分类与年龄和季节的关系.病毒性肺炎占34.4% (44/128).44例病毒阳性患者中,甲型流感病毒占22.7%(10/44),鼻病毒、腺病毒各占15.9%(各7/44),副流感病毒1型和人偏肺病毒各占9.1%(各4/44),乙型流感病毒占6.8% (3/44),副流感病毒2型、副流感病毒3型及肠道病毒各占2.3%(各1/44),另有6例为多重病毒感染(13.6%).病毒性肺炎在冬春季节发病高,发病人群中20~ 29岁所占比例高.在烟台市成人社区获得性肺炎病原构成中,病毒性肺炎所占比例较大,尤其以甲型流感病毒、鼻病毒和腺病毒为主.

  3. 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.

  4. 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

  5. Acute lung inflammation in Klebsiella pneumoniae B5055-induced pneumonia and sepsis in BALB/c mice: a comparative study.

    Science.gov (United States)

    Kumar, Vijay; Chhibber, Sanjay

    2011-10-01

    Lungs play an important role in the body's defense against a variety of pathogens, but this network of immune system-mediated defense can be deregulated during acute pulmonary infections. The present study compares acute lung inflammation occurring during Klebsiella pneumoniae B5055-induced pneumonia and sepsis in BALB/c mice. Pneumonia was induced by intranasal instillation of bacteria (10(4) cfu), while sepsis was developed by placing the fibrin-thrombin clot containing known amount of bacteria (10(2) cfu) into the peritoneal cavity of animals. Mice with sepsis showed 100% mortality within five post-infection days, whereas all the animals with pneumonia survived. In animals suffering from K. pneumoniae B5055-induced pneumonia, all the inflammatory parameters (TNF-α, IL-1α, MPO, MDA, and NO) were found to be maximum till third post-infection day, after that, a decline was observed, whereas in septic animals, all the above-mentioned markers of inflammation kept on increasing. Histopathological study showed presence of alternatively activated alveolar macrophages (or foam cells) in lungs of mice with pneumonia after third post-infection day, which might have contributed to the induction of resolution of inflammation, but no such observation was made in lungs of septic mice. Hence, during pneumonia, controlled activation of macrophages may lead to resolution of inflammation.

  6. 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.

  7. Development and implementation of a performance improvement project in adult intensive care units: overview of the Improving Medicine Through Pathway Assessment of Critical Therapy in Hospital-Acquired Pneumonia (IMPACT-HAP) study

    OpenAIRE

    Mangino, Julie E.; Peyrani, Paula; Ford, Kimbal D; Daniel H. Kett; Zervos, Marcus J.; Welch, Verna L.; Scerpella, Ernesto G.; Ramirez, Julio A.; ,

    2011-01-01

    Introduction In 2005 the American Thoracic Society and Infectious Diseases Society of America (ATS/IDSA) published guidelines for managing hospital-acquired pneumonia (HAP), ventilator-associated pneumonia (VAP), and healthcare-associated pneumonia (HCAP). Although recommendations were evidence based, collective guidelines had not been validated in clinical practice and did not provide specific tools for local implementation. We in