Radiologic Diagnosis and Hospitalization among Children with Severe Community Acquired Pneumonia: A Prospective Cohort Study

Objectives. This study was designed to assess the role of chest radiography for the diagnosis of pneumonia and assess the association of clinical characteristics with radiologic findings and predictors of hospitalization among children with severe community acquired pneumonia. Methods. A prospective study was conducted on 122 children between ages of 3 month and 14 years admitted to pediatric emergency unit with diagnosis of severe pneumonia from September 1st to November 30th, 2017. Eligible children were subjected to chest radiography which was read by two senior radiologists independently (R1 and R2). Disagreements between R1 and R2 were resolved by a third senior radiologist (R3). Level of agreement between radiologists was assessed using Cohen’s kappa coefficient. Clinical and laboratory parameters which could explain the variability in the duration of hospital stay were assessed using a linear regression mode. Independent predictors were assessed using multiple linear regression. Results. The median age of the cohort was 10.0 months (interquartile range (IQR): 6.75–24.0); 76 (62.3%) were male. Nearly half, 63 (51.6%) did not have radiologic evidence of pneumonia. There was low level of agreement between R1 and R2 in reporting consolidation (kappa=0.435, p-value≤0.001), haziness (kappa=0.375, p-value≤0.001), and infiltration (kappa=0.267, p-value=0.008). Children with higher recorded temperature were more likely to have radiologic abnormalities suggesting pneumonia (p-value=0.033). The median duration of hospitalization was 3 days (IQR: 1-4 days); 118 (96.7%) were discharged with improvement. Height-for-age z-score (Coef.=0.203, R2=0.041, p-value=0.027); and hemoglobin level (Coef.=-0.249, R2=0.062, p-value=0.006) explained 4.1% and 6.2% of the variability in the duration of hospital stay, respectively. Conclusion. Radiologic evidence of pneumonia was absent in half of the children with severe pneumonia. There was low agreement between senior radiologists in reporting chest radiographic findings, potentially necessitating harmonization activities to uniformly implement the WHO guidelines in reading chest radiographs.

Download Full-text

Efficacy of azoximer bromide in the treatment of hospitalized patients with moderate to severe community-acquired pneumonia

Medical Council ◽

10.21518/2079-701x-2021-18-106-117 ◽

2021 ◽

pp. 106-117

Author(s):

S. K. Zyryanov ◽

O. I. Butranova ◽

A. V. Ershov ◽

Z. Sh. Manasova

Keyword(s):

Combination Therapy ◽

Community Acquired Pneumonia ◽

Hospitalized Patients ◽

Study Group ◽

Therapy Regimen ◽

Duration Of Hospital Stay ◽

Comparator Group ◽

Group 2 ◽

Severe Community Acquired Pneumonia ◽

Group 1

Introduction. The high incidence of community-acquired pneumonia and the high complication rates in the cases of severe pneumonia actualize the search for new pharmacotherapy tools to improve the effectiveness of standard patient management regimens. A high level of severe inflammatory response underlies the high risk for developing septic complications of pneumonia, along with impaired immune responses.The aim is to evaluate the efficacy of azoximer bromide introduction in the combination therapy regimen for hospitalized patients with moderate to severe community-acquired pneumonia.Materials and methods. A prospective, open label, parallel group, randomized study comparing the efficacy of azoximer bromide introduction in the combination therapy of hospitalized patients with moderate to severe community-acquired pneumonia was conducted at the premises of Federal Scientific and Clinical Center for Reanimatology and Rehabilitation. 30 patients were included in the study group and 37 patients in the comparator group. The baseline characteristics were comparable in both groups. Results. The azoximer bromide introduction in the combination therapy of patients with community-acquired pneumonia led to a statistically significant reduction in the duration of hospital stay (Me (LQ; HQ): 9 (8; 10) days for the study group and 13 (10; 14) days for the comparator group, (p = 0.000078), duration of ICU stay (Me (LQ; HQ) 2 days (1.5; 2.5) and 5 days (5.0; 6.0), respectively, (p = 0.00001), the duration of febrile fever 5 (± 0.6) days versus 10 (± 1.2) days (p = 0.0000), the incidence of acute respiratory failure (13.33% in group 1 versus 37.84% in group 2, p = 0.024) and septic shock (10% in group 1 versus 32.43% in group 2, p = 0.0285).Conclusions. The azoximer bromide introduction in the standard therapy regimen for patients with community-acquired pneumonia allowed to reduce the duration of hospital stay, the duration of ICU stay, the length of febrile fever, the incidence of septic shock and respiratory failure. The possible mechanisms of action may include a reduction of the severe inflammatory reactions and an optimization of the patient's immune response to the infectious process.

Download Full-text

Abstract P134: ASSOCIATION OF HYPERTENSION WITH MORTALITY RISK IN PATIENTS WITH COVID 19 PNEUMONIA IN A HOSPITAL IN MEXICO CITY

Hypertension ◽

10.1161/hyp.76.suppl_1.p134 ◽

2020 ◽

Vol 76 (Suppl_1) ◽

Author(s):

José Martín Alanís Naranjo ◽

Gabriela Olguín Contreras ◽

Cristo Raymundo Ibarra Jaimes

Keyword(s):

Severe Pneumonia ◽

Ground Glass Opacity ◽

Cross Sectional Study ◽

Community Acquired Pneumonia ◽

P Value ◽

Cross Sectional ◽

Risk Of Mortality ◽

Chest X Ray ◽

Time Of Admission ◽

First Time

Introduction: The world is currently suffering from the outbreak of a pandemic caused by the SARS-CoV-2 coronavirus, which causes the disease called COVID-19. This disease was reported for the first time in Wuhan, Hubei Province, China, on December 31, 2019. Hypertension, diabetes and cardiovascular disease are common among patients with COVID-19. In Mexico, information on the association between COVID-19 and hypertension is scarce. Methods: This investigation was a descriptive, observational and cross-sectional study that included patients over 18 years of age who had been hospitalized with laboratory-confirmed COVID-19 between April 6, 2020, and May 6, 2020, and exhibited chest X-ray abnormalities (ground-glass opacity, interstitial alterations and/or multilobar infiltrate). Severity of pneumonia (severe vs. nonsevere) at the time of admission was defined using the community-acquired pneumonia guidelines of the American Thoracic Society (ATS). Results: Information was collected from 89 patients with COVID-19 pneumonia, 34 of whom (38.2%) were hypertensive. When studying risk factors in hypertensive patients and their degree of statistical association with risk of mortality, only the severity of pneumonia stood out. The association between severe pneumonia and mortality was statistically significant (OR: 10.9, CI 1.19-99.6, p value = 0.034). Conclusions: Severity of pneumonia upon admission can be regarded as a marker of adverse clinical outcome in hypertensive COVID-19 patients. Among hypertensive COVID-19 patients, in-hospital mortality was high (68%); such mortality was higher in our study than has been reported in other series worldwide.

Download Full-text

Triaging patients with upper gastrointestinal bleeding: the utility of Glasgow-Blatchford score

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20195614 ◽

2019 ◽

Vol 8 (1) ◽

pp. 42

Author(s):

Namita Mohanty ◽

Arjun Nataraj Kannan

Keyword(s):

High Risk ◽

Blood Transfusion ◽

Gastrointestinal Bleeding ◽

Hospital Stay ◽

Upper Gastrointestinal Bleeding ◽

Positive Likelihood Ratio ◽

Low Risk ◽

P Value ◽

Duration Of Hospital Stay ◽

Upper Gastrointestinal

Background: Glasgow-Blatchford bleeding score (GBS), was developed to predict the need for hospital-based intervention (transfusion, endoscopic therapy or surgery) or death following upper gastrointestinal bleeding. Study evaluated the Glasgow Blatchford score’s (GBS) ability to identify high risk patients who needed blood transfusion in patients with UGI haemorrhage.Methods: A total of 270 cases admitted with upper gastrointestinal bleeding in the Medical ICU/Wards of MKCG Medical College were put on Blatchford scoring system and classified as those requiring (high risk = GBS >1) and not requiring blood transfusion (low risk) based on the score assigned on admission and a correlation between initial scoring and requirement of blood transfusion was done.Results: Units of blood transfusion required, the GBS and duration of hospital stay were significantly lower among the low risk group, all with p value <0.001. No blood transfusion was required in patients with GBS <3. There was significant correlation between GB score and requirement of blood transfusion (p <0.001) and duration of hospital stay (p <0.001). GBS had 100% sensitivity, negative predictive value and positive likelihood ratio, when a cut off of > 16 was used in predicting mortality.Conclusions: Patients presenting with Upper GI bleeding can be triaged in casualty with Glasgow Blatchford scoring. Patients with a low score of less than or equal to 3 can be safely discharged and reviewed on follow up thereby reducing admission, allowing more efficient use of hospital resources.

Download Full-text

Incidence of hyponatremia and its utility as an indicator of morbidity in children hospitalised with community acquired pneumonia

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20200689 ◽

2020 ◽

Vol 7 (3) ◽

pp. 616

Author(s):

Thrilok Natarajan ◽

Thahsheen Nilofar Sahubar Sadique ◽

Kabilan Shanmugham

Keyword(s):

Mechanical Ventilation ◽

Hospital Stay ◽

Severe Pneumonia ◽

Hemodynamic Instability ◽

Community Acquired Pneumonia ◽

Prolonged Hospital Stay ◽

Previously Treated ◽

A Prospective Study ◽

Prolonged Hospital ◽

Relationship Of

Background: The aims of the study were to determine the incidence of hyponatremia associated with pneumonia and to assess its utility as an indicator of morbidity in children hospitalized with community acquired pneumonia between 2 months and 5 years of age.Methods: This was a prospective study of children aged 2 months to 5 years hospitalized with community acquired pneumonia. 120 children aged 2 months to 5 years with symptoms of lower respiratory tract infection and had radiological evidence of pneumonia were recruited into the study. Children with chronic diseases, previously treated with intravenous fluids and those with chronic drug intake were excluded from study.Results: Of the 120 children, 40.8% (49/120) had hyponatremia at admission. The relationship of hyponatremia to different clinical and laboratory parameters was analyzed. Sixty-one percent (31/51) of children under 1 year and 26% (18/69) of children between 1 to 5 years of age had hyponatremia (p=0.001). Hyponatremia was seen more commonly in children with severe pneumonia, with initial high temperature(p=0.001), with tachycardia (p=0.001), leukocytosis (p=0.001), increased neutrophils (p=0.001) and reactive thrombocytosis (p<0.001) and in children who had hemodynamic instability on admission (p<0.001). All 11(9.2%) children who required mechanical ventilation had hyponatremia (p<0.001). Consolidation was significantly associated with hyponatremia (p<0.001). Hyponatremia also showed a significant association with prolonged hospital stay (p<0.001).Conclusion: The incidence of hyponatremia in children hospitalised with pneumonia is 40.8%. This study concludes that the hyponatremia shows a significant association with the morbidity of the disease like requirement of intensive care and mechanical ventilation, hemodynamic instability and prolonged hospital stay. Hence the presence of hyponatremia at admission can be used as an indicator of morbidity.

Download Full-text

Evaluation of the nutritional status in children with acute lymphoblastic leukemia and its effect on the outcome of induction in a developing country.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e22004 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e22004-e22004

Author(s):

Arifa Khalid ◽

Keyword(s):

Acute Lymphoblastic Leukemia ◽

Nutritional Status ◽

Hospital Stay ◽

Nutritional Support ◽

Lymphoblastic Leukemia ◽

P Value ◽

Z Score ◽

Female Ratio ◽

Duration Of Hospital Stay ◽

End Of Treatment

e22004 Background: Acute Lymphoblastic Leukemia (ALL) is the most frequently occurring cancer among the children and adolescents. Cure rate is improved up to 90% with early diagnosis and better supportive care. Under nutrition among pediatric acute leukemia patients is more in developing countries 60% as compared to 10% in developed countries. The poor nutritional status is found to be associated with poor outcome. Therefore, optimum nutritional support can play a vital role in the outcome of induction. Methods: The population of research was newly diagnosed patients of ALL, reported from June 2016 to January 2017, in the Pediatric Hematology & Oncology Department of Children’s Hospital, Lahore. A sample of 151 patients of Acute Lymphoblastic Leukemia was analyzed prospectively. The study subjects were stratified into undernourished & well nourished based on the Z-score for weight for age.The data was collected irrespective of any discrimination based on demographic factors. and the following characters were recorded in both the groups: Mid treatment & end of treatment bone marrow response, culture proved infection, duration of hospital stay & outcome. Results: Among the 151 patients of ALL 80.1 % (n = 121) were Pre-B and 19.8% (n = 30) were Pre-T .Male to female ratio was 1.5:1. Malnutrition was established in 98 (64.9%) patients on the bases of Z-score. The undernourished group had significantly increased rate of culture proven sepsis (11% vs. 2%) respectively and required longer duration of hospital stay (p < 0.001).Rapid early response was observed in 21.8% malnourished and 32.8% well-nourished patients. End of treatment complete response was recorded in 63% vs. 69.1% respectively with significant p value. Expiry was observed in 9.1% malnourished patients. Conclusions: On the basis of this study it is concluded that the nutritional status at the initial presentation had a significant impact on the induction outcome. The undernourished patients of ALL are more prone to infections, requiring longer duration of hospital stay. Therefore, optimum nutritional support to such patients can help to decrease the chances of infections & ultimately improve the outcome.

Download Full-text

Current Antibiotic Treatment and Outcome for Lower Respiratory Tract Infections

Canadian Journal of Infectious Diseases ◽

10.1155/1998/527248 ◽

1998 ◽

Vol 9 (suppl e) ◽

pp. 30E-34E

Author(s):

Alasdair P MacGowan ◽

Tracey Halladay ◽

Andrew M Lovering

Keyword(s):

Respiratory Tract ◽

Hospital Stay ◽

Lower Respiratory Tract ◽

Community Acquired Pneumonia ◽

Economic Evaluations ◽

Chronic Obstructive ◽

National Guidelines ◽

Obstructive Pulmonary Disease ◽

Duration Of Hospital Stay ◽

Tract Infections

A number of national guidelines have been published to aid the antimicrobial management of community-acquired pneumonia. However, data on prescriptions for lower respiratory tract infection (LRTI) indicate considerable variation in the choice of first-line and subsequent therapy at national and local levels. Outcomes research in LRTI, whether based on clinical, economic or patient-focused criteria, is still evolving. Clinical outcomes are best studied for both pneumonia and exacerbation of chronic obstructive pulmonary disease. Economic evaluations often do not encompass all of the costs, for example, time off from work or the economic impact of antibacterial resistance. Duration of hospital stay is a good marker of costs for hospital providers and may be affected by age. marital status and comorbidities. Antibiotic choice may have an impact on the duration of hospital stay by increasing side effects, predisposing patients to hospitalacquired infection or reduced clinical efficacy. Patient expectation is largely unstudied in pulmonary infection.

Download Full-text

COMPARISON OF EFFICACY OF TRANEXAMIC ACID 10 MG/KG AND 15 MG/KG IN REDUCING BLEEDING AND TRANSFUSIONS IN TOTAL KNEE ARTHROPLASTY

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2019.v12i3.31006 ◽

2019 ◽

pp. 535-538

Author(s):

HIMA R NAMBIAR ◽

SHAILA S KAMATH

Keyword(s):

Total Knee Arthroplasty ◽

Tranexamic Acid ◽

Hospital Stay ◽

Knee Arthroplasty ◽

P Value ◽

Duration Of Hospital Stay ◽

Institutional Ethics ◽

Number Of Patients ◽

Total Knee ◽

Group B

Objective: The objective of this study was to compare the efficacy of tranexamic acid 10 mg/kg and 15 mg/kg in reducing bleeding and transfusions in total knee arthroplasty. Methods: After approval from the Institutional Ethics Committee, KMC, Mangaluru, 88 patients fulfilling the inclusion criteria of this study undergoing total knee replacements were informed of the study details and consent was obtained for the same. They were randomized into two groups using computer-generated block randomization, i.e., Group A and Group B, and were administered tranexamic acid 10 mg/kg and 15 mg/kg intravenously, respectively. Intraoperatively, hemodynamic parameters were noted. Postoperatively, hemoglobin levels were assessed on days 1 and 3. Transfusions, thromboembolic complications, and duration of hospital stay were noted. Results: Of the 88 participants of the trial, 44 in Groups A and B each, there were no significant differences in the parameters observed in this study such as intraoperative hemodynamic changes, post-operative fall in hemoglobin on day 3, number of patients requiring transfusions, number of thromboembolic events, and duration of hospital stay. A significant p-value was observed in the fall in hemoglobin in the post-operative day 3 (p=0.043). Conclusion: About 15 mg/kg tranexamic acid proved to have a lesser fall in hemoglobin on day 3 postoperatively when compared to the 10 mg/kg group. However, the fall of hemoglobin on day 3 was statistically significant and warranted a blood transfusion in two patients in the 10 mg/kg group but did not prolong their hospital stay.

Download Full-text

Acute cardiovascular events in patients with community acquired pneumonia: results from the observational prospective FADOI-ICECAP study

BMC Infectious Diseases ◽

10.1186/s12879-021-05781-w ◽

2021 ◽

Vol 21 (1) ◽

Cited By ~ 1

Author(s):

Filippo Pieralli ◽

◽

Vieri Vannucchi ◽

Carlo Nozzoli ◽

Giuseppe Augello ◽

...

Keyword(s):

Heart Failure ◽

Hospital Stay ◽

Cardiovascular Events ◽

Length Of Hospital Stay ◽

Severe Pneumonia ◽

Female Gender ◽

Community Acquired Pneumonia ◽

Newly Diagnosed ◽

Coronary Syndrome ◽

New Onset

Abstract Background The burden of cardiovascular (CV) complications in patients hospitalised for community-acquired pneumonia (CAP) is still uncertain. Available studies used different designs and different criteria to define CV complications. We assessed the cumulative incidence of acute of CV complications during hospitalisation for CAP in Internal Medicine Units (IMUs). Methods This was a prospective study carried out in 26 IMUs, enrolling patients consecutively hospitalised for CAP. Defined CV complications were: newly diagnosed heart failure, acute coronary syndrome, new onset of supraventricular or ventricular arrhythmias, new onset hemorrhagic or ischemic stroke or transient ischemic attack. Outcome measures were: in-hospital and 30-day mortality, length of hospital stay and rate of 30-day re-hospitalisation. Results A total of 1266 patients were enrolled, of these 23.8% experienced at least a CV event, the majority (15.5%) represented by newly diagnosed decompensated heart failure, and 75% occurring within 3 days. Female gender, a history of CV disease, and more severe pneumonia were predictors of CV events. In-hospital (12.2% vs 4.7%, p < 0.0001) and 30-day (16.3% vs 8.9%, p = 0.0001) mortality was higher in patients with CV events, as well as the re-hospitalisation rate (13.3% vs 9.3%, p = 0.002), and mean hospital stay was 11.4 ± 6.9 vs 9.5 ± 5.6 days (p < 0.0001). The occurrence of CV events during hospitalisation significantly increased the risk of 30-day mortality (HR 1.69, 95% CI 1.14–2.51; p = 0.009). Conclusion Cardiovascular events are frequent in CAP, and their occurrence adversely affects outcome. A strict monitoring might be useful to intercept in-hospital CV complications for those patients with higher risk profile. Trial registration NCT03798457 Registered 10 January 2019 - Retrospectively registered

Download Full-text

Etiology and clinical profile of inpatients with Community acquired pneumonia in Manipal Teaching hospital, Pokhara, Nepal

Nepal Journal of Medical Sciences ◽

10.3126/njms.v1i2.6605 ◽

2012 ◽

Vol 1 (2) ◽

pp. 84-88 ◽

Cited By ~ 2

Author(s):

R Shrestha ◽

N Paudel ◽

B Barakoti ◽

D Dhungana ◽

P Sharma

Keyword(s):

Hospital Stay ◽

Treatment Options ◽

Tertiary Hospital ◽

Community Acquired Pneumonia ◽

Clinical Profile ◽

Smear Microscopy ◽

Duration Of Hospital Stay ◽

Co Morbidity ◽

Severity Of The Disease ◽

Gram Negative Organisms

Background: Community acquired pneumonia (CAP) is major cause of morbidity in adults. The presentation may be varied. Severity of the disease is seen to be more if co-morbid conditions are present, especially chronic lung disease. This study was done to analyze the etiology and clinical profile of community acquired pneumonia admitted in a tertiary hospital in Western Nepal, to focus on treatment options and improve outcomes. Methods: Etiology and clinical profile of 100 patients of CAP was studied retrospectively from April 2010 to March 2011. Data regarding clinical features, physical examination, chest x-ray, sputum samples for smear microscopy and culture was collected in a preformed proforma and analyzed. Results: Mean age of patients was 51 years. Forty one patients had associated co-morbidity. None of the patients were vaccinated against influenza and pneumococcus. The duration of hospital stay was longer in patients with higher CURB-65 score. The commonest mode of presentation was cough (76) followed by fever (64). Etiology was determined in 24 patients, commonest being Streptococcus pneumonia which was most commonly sensitive to penicillin group of antibiotics followed by cephalosporines. The mortality rate was 1%. Two patients required care in Intensive care unit and 97 were discharged after improving. Conclusion: Etiology of pneumonia could be identified in 24% of cases. Pneumococcus was found mostly sensitive to penicillins and cepahalosporines. Gram negative organisms were mostly sensitive to ciprofloxacin and aminoglycoside. None of the patients were vaccinated against H.influenza or S.pneumoniae. Higher CURB-65 score was associated with longer duration of hospital stay. DOI: http://dx.doi.org/10.3126/njms.v1i2.6605 Nepal Journal of Medical Sciences. 2012;1(2): 84-8

Download Full-text

Harmonic scalpel versus titanium clips and l-hook in the ligation of cystic duct and artery and gall bladder dissection in laparoscopic cholecystectomy

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20175075 ◽

2017 ◽

Vol 5 (12) ◽

pp. 5145

Author(s):

Anand Vijayvargiya ◽

S. K. Jain ◽

Varsha Soni

Keyword(s):

Laparoscopic Cholecystectomy ◽

Gall Bladder ◽

Hospital Stay ◽

Cystic Duct ◽

Harmonic Scalpel ◽

P Value ◽

Duration Of Hospital Stay ◽

Significant Difference ◽

Conversion To Open Cholecystectomy ◽

Duration Of Surgery

Background: Laparoscopic cholecystectomy is a gold standard for gall bladder stone surgery. The Aim and objective of study was to compare the total duration of surgery, intraoperative complication like bile leak from cystic duct stump, spillage of bile from gallbladder and post op pain and abdomen distension and jaundice.Methods: Study was carried out in dept. of gen Surgery, Govt medical college Kota in yr. 2015-16 in a total of 50 patients with cholelithiasis with cholecystitis. Patient were equally divided randomly into two groups (a) Harmonic scalpel group and (b) Titanium Clip and L hook group. All patients with medical comorbidities, Concomitant CBD calculi, cirrhosis and portal HT were excluded from study. Intraoperatively adhesions, bile spillage from GB and cystic duct stump noted Postoperatively complain like pain abdomen, Jaundice, and fever were noted. Duration of hospital stay was observed. All results were statistically analyzed using Chi square and ANOVA test.Results: Both groups were comparable on the basis of age and sex distribution, as no statistically difference was noted (P value 0.867 and 0.999 respectively). Intraoperative findings were adhesions 5 in clip group and 7 in harmonic group. Spillage from gall bladder was 2 in Clip group and 3 in harmonic group. Mean duration of surgery was 65.20 min in clip group and 63.68 in harmonic group with no statistically significant difference in both the group (P Value 0.727). Average duration of hospital stay was similar in both the groups with a mean of 2.6 days. Postoperative complication was fever, abdomen pain and distension were 3,1,1 were respectively in the clip group and 3,2,2 respectively in harmonic group with the P value of 0.999 which was statistically insignificant. No CBD injury was noted in any case. Conversion to open cholecystectomy was not done in any case. On 1week and 1 month follow up 2 cases in clip group and 1 in HS group had collection in gall bladder fossa and none at I month.Conclusions: Harmonic scalpel offers an effective, alternative and safe method to cystic duct division and Gallbladder dissection from liver bed.

Download Full-text