Orientador: Emílio Carlos Elias Baracat / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-22T04:26:21Z (GMT). No. of bitstreams: 1 Amorim_PollyanaGarcia_M.pdf: 16755241 bytes, checksum: 0957977c7fadfa2ed8d659009f766145 (MD5) Previous issue date: 2013 / Resumo: Objetivos: identificar os fatores sócio-econômicos e clínicos associados à evolução para complicação em crianças internadas com pneumonia adquirida na comunidade (PAC) complicada e não complicada. Métodos: estudo observacional, analítico, prospectivo e longitudinal em crianças entre um e quatro anos e 11 meses de idade internadas em enfermaria geral de pediatria, com diagnóstico de PAC com e sem complicações. Excluídos os diagnósticos de fibrose cística, cardiopatia, má-formação pulmonar, neuropatias e doenças genéticas. Diagnóstico de pneumonia foi definido por características clínicas e radiológicas. Os dados foram coletados dos prontuários médicos e por um questionário semiestruturado, e comparados nas variáveis sócio-econômicas e clínicas. Os dados foram processados com o software SPSS 16.0., utilizando os testes de Qui-quadrado, Exato de Fisher e Regressão Logística, com nível de significância de 5%. Resultados: Sessenta e três crianças foram incluídas no estudo, vinte e nove sem complicações e trinta e quatro com complicações. Não foi observada diferença estatisticamente significante entre os grupos quanto à idade cronólogica à admissão, idade gestacional, peso ao nascer, gênero e variáveis sócio-econômicas. A comparação entre os grupos mostrou diferença estatística nas variáveis pneumonia anterior (p=0,03), antibioticoterapia prévia (p=0,004), tempo de início da doença (p=0,01), duração da febre antes da internação (p<0,001), duração da antibioticoterapia (p<0,001) e tempo de internação (p<0,001). Na análise multivariada, permaneceu no modelo a variável duração da febre antes da internação com OR = 1,97 [IC95%: 1,36-2,84] (p<0,001). Conclusões: Variáveis biológicas tiveram associação com a evolução para complicação em crianças com PAC, com destaque para o tempo de febre anterior à internação / Abstract: Objectives: To identify the socio-economic factors and clinical progression to complications in children hospitalized with community-acquired pneumonia (CAP), complicated and uncomplicated. Methods: A observational analytical prospective longitudinal study in children between one and four years and 11 months old admitted to the pediatric general ward with a diagnosis of CAP with and without complications. Children with the diagnosis of cystic fibrosis, heart disease, pulmonary malformations, neurological disorders and genetic diseases were excluded. Diagnosis of pneumonia was defined by clinical and radiological features. Data were collected from medical records and a structured questionnaire, and compared with the socio-economic and clinical variables. Data were processed with the SPSS 16.0 software, using the chi-square and Fisher's Exact Logistic Regression, with a significance level of 5%. Results: Sixty-three children were included in the study, twenty-nine uncomplicated and thirty-four with complications. There was no statistically significant difference between groups in chronological age at admission, gestational age, birth weight, gender and socioeconomic variables. The comparison between groups showed statistical differences in the variables previous pneumonia (p = 0.03), previous antibiotic therapy (p = 0.004), time of onset (p = 0.01), duration of fever before admission (p <0.001), duration of antibiotic therapy (p <0.001) and hospital stay (p <0.001). In multivariate analysis, remained in the model the variable duration of fever before admission, OR = 1.97 [95% CI: 1.36 to 2.84] (p <0.001). Conclusions: Biological variables were associated with progression to complications in children with CAP, especially the time of fever prior to admission / Mestrado / Saude da Criança e do Adolescente / Mestra em Ciências

Community-onset (CO) methicillin-resistant Staphylococcus aureus (MRSA) pneumonia is an evolving problem, and there is a great need for a reliable method to assess MRSA risk at hospital admission. A new MRSA prediction score classifies CO-pneumonia patients into low, medium, and high-risk groups based on objective criteria available at baseline. Our objective was to assess the effect of initial MRSA therapy on mortality in these three risk groups. We conducted a retrospective cohort study using data from the Veterans Health Administration. Patients were included if they were hospitalized with pneumonia and received antibiotics within the first 48 hours of admission. They were stratified into MRSA therapy and no MRSA therapy treatment arms based on antibiotics received in the first 48 hours. MRSA risk groups were analyzed separately. The primary outcome was 30-day patient mortality. Multivariable logistic regression was used to adjust for potential confounders. A total of 80,330 patients met inclusion criteria, of which 36% received MRSA therapy and 64% did not receive MRSA therapy. The majority of patients were classified as either low (51%) or medium (47%) risk, with only 2% classified as high-risk. In the high-risk group, unadjusted 30-day mortality was lower among patients who received initial MRSA therapy (40% versus 58%; p<0.0001). Likewise, multivariable logistic regression analysis also demonstrated that initial MRSA therapy was associated with a lower 30-day mortality in the high-risk group (adjusted odds ratio 0.57; 95% confidence interval 0.42-0.77). There was no benefit of initial MRSA therapy in the low or medium-risk groups. This study demonstrated improved survival with initial MRSA therapy in high-risk CO-pneumonia patients. The MRSA risk score should not replace clinical judgment, but it might be a useful tool to spare MRSA therapy for only those patients who are most likely to benefit. / text

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Thesis (M.Med. (Internal Medicine))--University of the Witwatersrand, Faculty of Health Sciences, 2013. / Background Cryptococcus is a life-threatening opportunistic infection; data is limited regarding early infection. Treatment of cryptococcal antigenaemia may impact on disease progression. Screening those most at risk for cryptococcal antigenaemia is necessary to be cost effective. The prevalence of cryptococcal antigenaemia in patients hospitalised with community acquired pneumonia (CAP) at Chris Hani Baragwanath Academic Hospital (CHBAH) was evaluated. Methods 200 patients admitted to CHBAH with presumed CAP were enrolled. Clinical and laboratory data were collected and a Cryptococcal Lateral Flow Immunoassay was done on whole blood. Results Of the 200 patients, 185 (92.5%) were HIV-infected. Amongst the HIV-infected group, the median CD4 cell count was 47 cells/mm3 and 111 subjects (60%) had a CD4 cell count < 100 cells/mm3. The prevalence of cryptococcal antigenaemia was 0.5% (CI 0.01-2.75). Conclusion The prevalence of cryptococcal antigenaemia amongst inpatients with CAP was low. Routine screening of this group would not be cost-effective.

DSc (Med), Faculty of Health Sciences, University of the Witwatersrand, 2009.

BACKGROUND: After the introduction of PCV7 and PCV13, the number of cases of pneumonia in children caused by vaccine serotypes has decreased significantly. Children with comorbidities, however, are still at high risk for IPD. This study aims to compare children with comorbidities to healthy children in an urban setting to assess current risk factors and potential risk factors for pneumonia. METHODS: Existing clinical data of Boston Medical Center patients under 7 years of age were used to compare age, gender, race, comorbidities, and immune status of children with pneumonia to those of children without pneumonia. A representative random sample of 150 patients with pneumonia and 150 patients without pneumonia was selected. Medical record and chart information were reviewed in order to obtain clinical and demographic data. RESULTS: In our study cohort, 120 of 300 (40%) children whose charts were reviewed had at least one comorbidity. Among 150 children with pneumonia, 76 (50.7%) cases were found to have at least one underlying condition, whereas in children without pneumonia 44 (29.3%) of 150 cases had at least one underlying clinical condition (chi-square value 14.2; p-value <0.001). Children with comorbidities were 2.47 times more likely to have pneumonia compared to children without any chronic conditions (OR 2.47, 95% CI 1.54 - 3.98). The risk of having pneumonia among children who are not Hispanic/Latino/Spanish was approximately 40% less compared to children of Hispanic origin (OR 0.61; 95% CI 0.31 - 1.19; p-value 0.14). CONCLUSIONS: Our study shows that children with underlying conditions are at greater risk for pneumonia compared to healthy children without chronic conditions. Ethnicity is also associated with pneumonia cases, with Hispanic children at increased risk for pneumonia compared to non-Hispanic children.