The development of complications of community-acquired pneumonia of a severe course against the background of parenteral poisoning with a mixture of narcotic substances

Doctors of the clinic of military field therapy of the Military Medical Academy named after S.M. Kirov, the experience of successful treatment of community-acquired pneumonia of a severe course with the development of complications against the background of parenteral poisoning with a mixture of narcotic substances in a young patient was obtained. An important feature in the treatment tactics of this patient was the impossibility of antidote therapy with naloxone (a competitive opioid receptor antagonist) due to the presence of signs of respiratory failure, hypoxic and tissue hypoxia. As a result of the systemic treatment in the young patient, it was possible to arrest a significant septic process and multiple organ disorders of vital functions that arose due to severe endotoxic damage. An important factor in ensuring the survival of patients with severe pneumonia against a background of immune depression due to the use of toxic substances is the rational selection of an antibacterial drug or combinations of antibiotic therapy, constant monitoring of vital functions with prompt correction of emerging disorders, as well as the need to use modern high-tech treatment methods. This example clearly shows the need for urgent, systematic and complex intensive care in a number of manipulations performed in people with complications of community-acquired pneumonia, suffering from drug addiction. In addition, it is important to minimize the time from the detection of a poisoned person to the start of emergency measures, as well as their further evacuation to the stage of providing qualified and specialized medical care. Thus, modern medicine continues to face an extremely urgent problem of drug use by the population. A significant number of people with drug dependence syndrome do not seek medical help for various reasons, continuing to use illegal drugs.

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The epidemiology of hospital death following pediatric severe community acquired pneumonia

Italian Journal of Pediatrics ◽

10.1186/s13052-021-00966-0 ◽

2021 ◽

Vol 47 (1) ◽

Author(s):

Xiao-Xiao Ao

Keyword(s):

Organ Dysfunction ◽

Multiple Organ Dysfunction Syndrome ◽

Severe Pneumonia ◽

Multiple Organ ◽

Community Acquired Pneumonia ◽

Hospital Death ◽

Multiple Organ Dysfunction ◽

Respiratory Dysfunction ◽

Time To Death ◽

Severe Community Acquired Pneumonia

Abstract Background Community acquired pneumonia is the primary cause of pediatric hospitalizations and deaths in children under 5 years of age. But the epidemiology of death in pediatric severe community acquired pneumonia was not well characterized. Methods This retrospective observational study was performed at the academic Emergency department and intensive care unit and we investigated the timing, cause, mode and attribution of death in children with severe community acquired pneumonia. Results Of 962 subjects with severe community acquired pneumonia, there were 57 non-survivors (5.9% mortality). Median time to death was 7 [IQR 3,16] days from severe community acquired pneumonia recognition. Patients dying ≤7 days were younger, had greater illness severity and higher rate of congenital heart disease, who were more likely to die of a cardiovascular cause. Multiple organ dysfunction syndrome predominated in deaths > 7 days. Unsuccessful cardiopulmonary resuscitation was the most common mode of death at all timepoints. Our findings suggested that in pediatric severe community acquired pneumonia, early deaths were due primarily to cardiovascular dysfunction, while later deaths were more commonly due to multiple organ dysfunction syndrome. Conclusions Deaths from non-pulmonary factors accounted for a substantial portion of non-survivors. Respiratory dysfunction accounted for only a minority of deaths. Our study highlighted limitations associated with rescuing patients with severe pneumonia from death if extrapulmonary organ dysfunctions could not be simultaneously managed.

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"CLARITHROMYCIN-MB" CLINICAL EFFICACY IN COMBINED THERAPY OF PATIENTS WITH COMMUNITY-ACQUIRED PNEUMONIA

International Medical Journal ◽

10.37436/2308-5274-2020-2-13 ◽

2020 ◽

pp. 66-69

Author(s):

O. V. Volobuieva ◽

N. V. Shepylieva ◽

V. V. Pavlov ◽

T. V. Sevastianova ◽

O. O. Shevchenko ◽

...

Keyword(s):

Clinical Efficacy ◽

Inflammatory Process ◽

Clinical Symptoms ◽

Combined Therapy ◽

Clinical Manifestations ◽

Temperature Response ◽

Clinical Effectiveness ◽

Modern Medicine ◽

Community Acquired Pneumonia ◽

Antibacterial Drug

The problem of rational antibiotic therapy of pneumonia is one of the most relevant in modern medicine. So far, a large number of the factors have been identified that determine the optimal quality of antimicrobial therapy: the maximum effectiveness with the lowest toxicity of drugs should be combined with their proper cost. In order to study the clinical efficacy and therapeutic tolerability of the drug class of macrolides, clarithromycin for parenteral use in the treatment of patients with community−acquired pneumonia, 20 patients were examined. All the patients had clinical symptoms of severe infectious lesions of the lower respiratory tract. The complex therapy (detoxification, mucolytic drugs, multivitamins, metabolites) included "Clarithromycin−MB", which was administered intravenously for 60 minutes at a dose of 500 mg 2 times a day for 7−10 days. The clinical effectiveness of antibacterial therapy was assessed by the dynamics of the activity of the inflammatory process in the lungs. For this purpose, the following clinical and laboratory parameters characterizing the activity of the inflammatory process (temperature response, tachycardia, respiratory rate, leukocytosis, number of immature granulocytes, change in erythrocyte sedimentation rate), severity of pain, radiological changes in the lungs were determined. Macrolide "Clarithromycin−MB" in a parenteral form is a highly effective antibacterial drug for the treatment of community−acquired pneumonia with severe course. Positive dynamics of clinical manifestations of the disease was observed on the third day from the beginning of therapy. "Clarithromycin−MB" has good therapeutic tolerability, the dosage regimen allows to maintain the required concentration in the site of inflammation, which affects the clinical and bacteriological efficacy of treatment of the patients with community−acquired pneumonia. Key words: community−acquired pneumonia, macrolides, "Clarithromycin−MB".

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The Epidemiology of Hospital Death Following Pediatric Severe Community Acquired Pneumonia

10.21203/rs.3.rs-118208/v1 ◽

2020 ◽

Author(s):

Xiao-Xiao Ao ◽

Li-Ping Tan ◽

Qiu-Feng Wan ◽

Yong-Qin Li

Keyword(s):

Organ Dysfunction ◽

Multiple Organ Dysfunction Syndrome ◽

Severe Pneumonia ◽

Multiple Organ ◽

Community Acquired Pneumonia ◽

Hospital Death ◽

Multiple Organ Dysfunction ◽

Respiratory Dysfunction ◽

Time To Death ◽

Severe Community Acquired Pneumonia

Abstract BackgroundCommunity acquired pneumonia is the primary cause of pediatric hospitalizations and deaths in children under 5 years of age. But the epidemiology of death in pediatric severe community acquired pneumonia was not well characterized. MethodsThis retrospective observational study was performed at the academic Emergency department and intensive care unit and we investigated the timing, cause, mode and attribution of death in children with severe community acquired pneumonia. ResultsOf 962 subjects with severe community acquired pneumonia, there were 57 non-survivors (5.9% mortality). Median time to death was 7 [IQR 3,16] days from severe community acquired pneumonia recognition. Patients dying ≤ 7 days were younger, had greater illness severity and higher rate of congenital heart disease, who were more likely to die of a cardiovascular cause. Multiple organ dysfunction syndrome predominated in deaths > 7 days. Unsuccessful cardiopulmonary resuscitation was the most common mode of death at all timepoints. Our findings suggested that in pediatric severe community acquired pneumonia, early deaths were due primarily to cardiovascular dysfunction, while later deaths were more commonly due to multiple organ dysfunction syndrome. ConclusionsDeaths from non-pulmonary factors accounted for a substantial portion of non-survivors. Respiratory dysfunction accounted for only a minority of deaths. Our study highlighted limitations associated with rescuing patients with severe pneumonia from death if extrapulmonary organ dysfunctions could not be simultaneously managed.

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EXPERIENCE OF TARGETED ANTIBACTERIAL THERAPY IN A PATIENT WITH MULTIPLE ORGAN DYSFUNCTION SYNDROME

Health and Ecology Issues ◽

10.51523/2708-6011.2018-15-2-21 ◽

2018 ◽

pp. 103-109

Author(s):

S. A. Tochilo ◽

Yu. G. Nikiforova

Keyword(s):

Antibiotic Therapy ◽

Organ Dysfunction ◽

Multiple Organ Dysfunction Syndrome ◽

Antibacterial Therapy ◽

Severe Pneumonia ◽

Multidrug Resistant ◽

Multiple Organ ◽

Community Acquired Pneumonia ◽

Multiple Organ Dysfunction ◽

Leading Role

Objective : to analyze our own experience and literature data on the use of targeted antibacterial therapy in a patient with severe pneumonia and multiple organ dysfunction syndrome (MODS). Materials. The work presents a clinical case of successful treatment of a patient with community-acquired pneumonia, sepsis, and MODS, caused by multidrug resistant pathogens. Targeted antibiotic therapy was used during the treatment of the patient. Discussion . We have done a review of the literature and our own data on the antibiotic therapy for community-acquired pneumonia. The targeted antibacterial therapy in severe patients having a multidrug-resistant flora and MODS has the following features: it includes several drugs, is administered by courses, is often combined with antimycotic drugs, antibacterial drugs can be used via inhalation. The evaluation of clinical data, blood counts, as well as indicators of procalcitonin, C-reactive protein, and cholesterol provide substantial assistance during the monitoring of the therapy effectiveness. Conclusion. Among all the components of intensive care in a patient with community-acquired pneumonia, sepsis, and MODS, etiotropic therapy plays a leading role.

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Clinical case of periostitis in pregnant women complicated by sepsis

Medical alphabet ◽

10.33667/2078-5631-2020-16-61-63 ◽

2020 ◽

pp. 61-63

Author(s):

S. Sh. Kakvaeva ◽

M. A. Magomedova ◽

A. N. Dzhalilova

Keyword(s):

Pregnant Woman ◽

Multiple Organ Failure ◽

Pregnant Women ◽

Organ Failure ◽

Clinical Case ◽

Clinical Observation ◽

Infectious Agent ◽

Modern Medicine ◽

Multiple Organ ◽

Number Of Patients

One of the most serious problems of modern medicine is sepsis. The number of patients undergoing this complication is 20–30 million (WHO) annually and has no tendency to decrease. Sepsis is characterized by severe multiple organ failure due to a violation of the response of the macroorganism to an infectious agent. Moreover, it is dangerous with high mortality. Sepsis often develops in patients with immunodeficiency conditions, which primarily include pregnant women. The article presents a clinical observation of a case of periostitis in a pregnant woman complicated by a septic state.

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Nanoantioxidant/Antioxidant therapy in 2019-nCoV: A new approach to reactive oxygen species mechanisms

Current Drug Therapy ◽

10.2174/1574885516666210719092931 ◽

2021 ◽

Vol 16 ◽

Author(s):

Ali Fathijouzdani ◽

Rezvan Heidarimoghadam ◽

Maryam Hazhirkamal ◽

Akram Ranjbar

Keyword(s):

Reactive Oxygen Species ◽

High Performance ◽

Membrane Lipids ◽

Reactive Oxygen ◽

Modern Medicine ◽

Multiple Organ ◽

Antioxidant Therapy ◽

Oxygen Species ◽

Medicinal Uses ◽

Organ Failures

: The COVID-19 pandemic has caused serious concerns for people around the world. The COVID-19 is associated with respiratory failure, generation of reactive oxygen species (ROS), and the lack of antioxidants among patients. Specified ROS levels have an essential role as an adjuster of immunological responses and virus cleaners. Still, excessive ROS will oxidize membrane lipids and cellular proteins and quickly destroy virus-infected cells. It can also adversely damage normal cells in the lungs and even the heart, resulting in multiple organ failures. Given the above, a highly potent antioxidant therapy can be offered to reduce cardiac loss due to COVID-19. In modern medicine, nanoparticles containing antioxidants can be used as a high-performance therapy in reducing oxidative stress in the prevention and treatment of infectious diseases. It can provide a free and interactive tool to determine whether antioxidants & nanoantioxidants can be administered for COVID-19. More research and studies are needed to investigate and make definitive opinions about their medicinal uses.

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Effectiveness of protected aminopenicillins in treatment of non-social pneumonia in children

Лечащий врач ◽

10.51793/os.2021.24.10.003 ◽

2021 ◽

Author(s):

Е.Е. Краснова ◽

В.В. Чемоданов ◽

Е.Г. Кузнецова

Keyword(s):

Viral Infections ◽

Respiratory Infections ◽

Acquired Resistance ◽

Age Groups ◽

Clinical Manifestations ◽

Severe Pneumonia ◽

Physical Symptoms ◽

Community Acquired Pneumonia ◽

Natural Activity ◽

Respiratory Viral Infections

Пневмония – острое инфекционно-воспалительное заболевание легких преимущественно бактериальной этиологии, характеризующееся выраженной в разной степени дыхательной недостаточностью, токсическими и респираторными нарушениями, локальными физикальными симптомами, а также инфильтративными изменениями на рентгенограмме. Заболеваемость внебольничными пневмониями повышается в октябре-декабре, достигая максимума в январе-апреле, коррелируя с сезонным повышением уровня острых респираторных вирусных инфекций. Схожесть симптомов дебюта пневмонии с проявлениями острых респираторных вирусных инфекций может привести к несвоевременной ее диагностике и, как следствие, к отсроченному началу лечения. Поэтому в период сезонной заболеваемости респираторными инфекциями должна повышаться настороженность врачей-педиатров в отношении внебольничной пневмонии. Антибактериальная терапия оказывает решающее влияние на прогноз пневмонии, поэтому при достоверном диагнозе или у больного в тяжелом состоянии с вероятным диагнозом ее следует начать незамедлительно. Выбор антибиотика в каждом случае внебольничной пневмонии проводят индивидуально с учетом природной активности препаратов в отношении предполагаемого возбудителя и их возможной приобретенной резистентности, тяжести и течения заболевания, наличия у пациента противопоказаний к использованию тех или иных антибиотиков. В статье приводятся сведения о диагностических критериях внебольничных пневмоний. Рассмотрены вопросы антибактериального лечения типичной нетяжелой пневмонии у детей разных возрастных групп амоксициллином с клавулановой кислотой и показана его эффективность. Результаты проведенного исследования позволяют заключить, что пероральное использование одного курса защищенного аминопенициллина эффективно при лечении типичной внебольничной нетяжелой пневмонии у детей разного возраста, о чем свидетельствует ликвидация основных клинических проявлений болезни в короткие сроки. Pneumonia is an acute infectious and inflammatory lung disease of predominantly bacterial etiology, characterized by respiratory failure, toxic and respiratory disorders, local physical symptoms, and infiltrative changes on the roentgenogram. The incidence of community-acquired pneumonia increases in October-December, reaching a maximum in January-April, correlating with the seasonal increase in the level of acute respiratory viral infections. The similarity of the symptoms of the onset of pneumonia with the manifestations of acute respiratory viral infections can lead to its untimely diagnosis and, as a consequence, to a delayed start of treatment. Therefore, during the period of seasonal morbidity with respiratory infections, the alertness of pediatricians in relation to community-acquired pneumonia should increase. Antibiotic therapy has a decisive influence on the prognosis of pneumonia, therefore, with a reliable diagnosis or in a patient in serious condition with a probable diagnosis, it should be started immediately. The choice of antibiotic in each case of community-acquired pneumonia is carried out individually, taking into account the natural activity of the drugs in relation to the alleged pathogen and their possible acquired resistance, the severity and course of the disease, the patient's contraindications to the use of certain antibiotics. The article provides information on the diagnostic criteria for community-acquired pneumonia. The issues of antibacterial treatment of typical non-severe pneumonia in children of different age groups with amoxicillin with clavulanic acid are considered and its effectiveness is shown. The results of the study allow us to conclude that the oral use of one course of protected aminopenicillin is effective in the treatment of typical community-acquired non-severe pneumonia in children of different ages, as evidenced by the elimination of the main clinical manifestations of the disease in a short time.

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Đánh giá nồng độ lactate và procalcitonin ở bệnh nhân Covid-19

Journal of Clinical Medicine- Hue Central Hospital ◽

10.38103/jcmhch.2022.75.8 ◽

2022 ◽

Author(s):

Thanh Xuan Nguyen

Keyword(s):

Serum Level ◽

Respiratory Infections ◽

Severe Pneumonia ◽

Cross Sectional Study ◽

Multiple Organ ◽

High Rate ◽

Rt Pcr ◽

Wuhan City ◽

Cross Sectional ◽

The Relationship

TÓM TẮT Đặt vấn đề: Bệnh COVID-19 đa dạng từ không có triệu chứng đến có các triệu chứng nhẹ cho đến viêm phổi nặng, hội chứng suy hô hấp cấp tiến triển (ARDS), nhiễm khuẩn huyết suy đa tạng và tử vong. Người cao tuổi, người có bệnh mạn tính sẽ có nguy cơ diễn biến nặng nhiều hơn. Nghiên cứu này nhằm xác định nồng độ lactate và PCT ở những bệnh nhân Covid-19 và xét mối liên quan giữa lactate và PCT trên bệnh nhân Covid-19. Đối tượng và phương pháp: Nghiên cứu mô tả cắt ngang trên 126 bệnh nhân được chẩn đoán nhiễm Sars-Cov-2 bằng xét nghiệm RT PCR. Kết quả: Tuổi trung bình 55,98 ± 17,1 tuổi (4 - 98 tuổi). Bệnh nhân > 60 tuổi chiếm tỉ lệ cao nhất (42,8%). Trung vị PCT: 3,6 (95%CI:3,21 - 3,75) ng/ml; trung vị lactate 1,5 (95%CI:1,21 - 1,91) mmol/L; lactate có tương quan thuận và yếu với procalcitonin với r = 0,241; p < 0,001. Nồng độ procalcitonin > 0,1 ng/ml; lactate > 2 mmol/l ở bệnh nhân Covid-19 chiếm tỷ lệ cao với 89,7% và 39,7%. Kết luận: Chỉ điểm procalcitonin, lactate tăng cao ở bệnh nhân Covid-19. ABSTRACT ASSESSMENT OF SERUM LEVEL OF LACTATE AND PROCALCITONIN IN COVID-19 PATIENTS Background: Sars-CoV-2 has been identified as the cause of acute respiratory infections in Wuhan city, Hubei province, China, and has since spread worldwide. Sars-CoV-2 is capable of aerosol transmission in enclosed, crowded, and poorly ventilated spaces. COVID-19 illness ranges from asymptomatic to mild symptoms to severe pneumonia, acute respiratory distress syndrome (ARDS), sepsis, multiple organ failure, and death. This study aims to determine lactate and PCT levels in Covid-19 patients and examine the relationship between lactate and PCT in Covid-19 patients. Methods: A cross-sectional study was performed on 126 patients diagnosed with Sars-Cov-2 infection by RT-PCR. Results: Mean age was 55.98 ± 17.1 years (range: 4-98 years). Patients more than 60 years old were accounted for the highest rate (42.8%). Median PCT: 3.6 (95%CI:3.21 - 3.75) ng/ml; median lactate 1.5 (95%CI:1.21 - 1,91) mmol/L; lactate has a positive and weak correlation with procalcitonin with r = 0.241; p < 0.001. Procalcitonin concentration > 0.1 ng/ml; lactate > 2 mmol/l in patients with Covid-19 accounted for a high rate with 89.7% and 39.7%. Conclusion: Serum level of procalcitonin and lactate raise highly in Covid-19 patients. Keywords: Covid-19, procalcitonin, lactate.

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