Objetivos. Determinar las características clínicas y demográficas de la neumonía por el virus de influenza AH1N1/2009 pandémico en un hospital de referencia de Perú. Materiales y métodos. Se realizó un estudio serie de casos en niños hospitalizados por neumonía por influenza AH1N1/2009 pandémico en un hospital de referencia. Revisamos las historias clínicas entre los meses de junio a septiembre 2009. Todos los casos tuvieron confirmación virológica. Resultados. Se encontró 74 casos de neumonía por el virus de Influenza AH1N1/2009 pandémico (NVIp), de los cuales 50 tuvieron el diagnóstico de neumonía adquirida en la comunidad viral (NACv) y 24 con neumonía nosocomial viral (NNv) de los cuales 16 requirieron ventilación mecánica. Fallecieron 12, todos ellos con antecedentes de comorbilidad. Los casos NNv presentaron asociación estadística con mortalidad. En los casos NACv, los menores de 6 años representaron 72 % (36/50). La mediana de tiempo de enfermedad fue de 5 días. Los síntomas más frecuentes fueron fiebre, tos, rinorrea. Recibieron oseltamivir el 82 %. En la radiografía de tórax el 48 % de los casos presentó infiltrado en parches y el 44 % infiltrado intersticial en la radiografía de tórax. La proteína C reactiva (PCR) mayor a 10mg/L tuvo una asociación significativa con insuficiencia respiratoria (p <0,05). Conclusiones. Encontramos casos NNv quienes tuvieron mayor mortalidad, también los que presentaron el PCR elevado y los que presentaron condición preexistente. / ObjectiveTo determine the clinical and demographic characteristics of pneumonia with influenza virus AH1N1/2009 pandemic at the National Institute of Child. Methods. Retrospective case series in children hospitalized for influenza pneumonia pandemic AH1N1/2009 in a pediatric hospital. Reviewed the medical records between the months of June to September 2009. All cases had virological confirmation, we describe the clinical characteristics and conditions of severity. Results. A total of 74 children of pneumonia with influenza virus AH1N1/2009 pandemic (NVIp), of those 50 were community acquire pneumonia viral (NACv) and 24 pneumonia nosocomial viral (NNv), 16 required mechanical ventilation. 12 died, all had preexisting factors. NN cases showed statistical association with mortality. The most frequent factors were malnutrition, respiratory infections, congenital heart disease and neurological deficits In NACv cases the children under 6 years accounted for 72% (36/50). The median disease duration was 5 days. The most frequent symptoms were fever, cough, runny nose. Received oseltamivir 82%. The chest radiograph 48% of cases showed patchy infiltrates and 44% interstitial infiltrate on chest radiograph. Protein c reactive (CRP) more than 10mg / L was significantly associated with respiratory failure (p <0.05). Conclusions. Cases of NN found who had more mortality, even those who had the highest PCR and those with preexisting condition.

La VC est nécessaire à la survie des patients les plus graves et impose le plus souvent sédation profonde et une mise au repos des muscles respiratoires. Si la VC est un traitement de référence en cas d'insuffisance respiratoire aigüe, elle peut cependant entraîner une altération des propriétés contractiles du diaphragme, principal muscle respiratoire, et promouvoir la survenue d'infections nosocomiales, pulmonaires en particulier. Dans ce travail, nous avons tout d'abord montré les effets délétères d'une VC de courte durée en acidose hypercapnique aigüe puis nous avons montré les effets protecteurs de l'acidose hypercapnique modérée et prolongée et du maintien de cycles ventilatoires spontanés sur la dysfonction diaphragmatique en comparaison à la VC. Deuxièmement, dans le cadre des effets délétères de la ventilation prolongée sur l'incidence des complications infectieuses pulmonaires nosocomiales, nous avons rapporté l'intérêt de la prise en compte des facteurs de risque de bactéries multi-résistantes dans le traitement des Pneumonie Acquise sous Ventilation Mécanique (PAVM) et avons ensuite montré l'apport de la surveillance de la colonisation trachéale dans le diagnostic et le traitement précoce de la PAVM. Finalement, nous présentons les perspectives d'interactions entre dysfonction diaphragmatique et sepsis, en particulier d'origine pulmonaire à travers nos projets de travaux expérimentaux et cliniques. / Mechanical ventilation (MV) is a life saving procedure for critically ill and often needs deep sedation and rest muscles. Although MV is a basic treatment for acute respiratory failure, it can alter diaphragmatic contractile properties (Ventilator Induced Diaphragmatic Dysfunction, VIDD) and can promote nosocomial infections, Ventilator Associated Pneumonia (VAP) in particular. In this thesis, we first showed the deleterious effects of acute hypercapnic acidosis and the protective effects of both moderate and prolonged hypercapnic acidosis and by maintaining spontaneous ventilation activity while initiating MV in a healthy piglet model. Second, we reported the potential impact of considering tracheal colonisation as a guide for an early diagnosis and adequate initial treatment of VAP. Finally, we present the potential interactions and futures animal and clinical studies suggesting the potential interaction between VIDD and VAP.

No description available.

Dapsone has been shown to be an effective agent against Pneumocystis carinii pneumonia, an opportunistic infection in AIDS patients. Oral administration of dapsone is associated with several adverse effects, including methemoglobinemia, hemolytic anemia and photosensitivity reactions. To reduce the adverse effects associated with oral dapsone, an alternative would be to administer the prodrug diacetyldapsone (DADDS) into the lung, which may be hydrolyzed to monoacetyldapsone and the active metabolite dapsone. The purpose of this investigation was to determine the effect of cyclodextrindiacetyldapsone (CD-DADDS) complex upon the cultured lung cells and whether or not cultured lung cells could activate DADDS into dapsone, the active metabolite. The effect of the CD-DADDS complex upon the growth of cultured CRL 7272 lung cells was assessed by the trypan blue dye exclusion technique. There was no significant reduction in cell number as compared to the control for incubations with three different concentrations of CD-DADDS complex. The amount of arylamine produced by hydrolysis was initially monitored by the Bratton-Marshall diazotization technique. Only incubation with 0.01% DADDS in 1% CD showed a significant time dependent hydrolysis of DADDS over a period of 72 hours due to insensitivity of the assay method. Over the same period, cultured lung cells produced 1.65 μmoles of metabolite/106 cells. However interfering substances could contribute to this value. To provide additional evidence for hydrolysis and to quantitatively estimate the amount of dapsone, a more sensitive HPLC method was used. The results obtained from HPLC analysis demonstrated a significant concentration and time dependent increase in the amount of dapsone with 0.001% DADDS, 0.005% DADDS and 0.01% DADDS incubations, respectively. Over a period of 48 hours, 255ng of dapsone/ 106 cells was formed in an incubation containing 0.01% DADDS.

The hepatic acute phase response (APR), stimulated by injury or inflammation, is characterized by significant changes in circulating acute phase protein (APP) concentrations. While individual functions of liver-derived APPs are known, the net consequence of APP changes is unclear. Pneumonia and sepsis elicit systemic inflammation and induce a robust APR. Although APR activation is regarded as a hallmark of infection, direct contributions of liver activation to pulmonary defense during pneumonia and sepsis-induced pneumonia remain unclear. Pneumonia causes a pulmonary inflammatory response coordinated largely by alveolar macrophages, and is typified by cytokine production, leukocyte recruitment and plasma extravasation, the latter of can enable delivery of hepatocyte-derived APPs to the infection site. To determine the functional significance of the hepatic APR during pneumonia, we challenged APR-null mice lacking hepatocyte signal transducer and activator of transcription-3 (STAT3) and RelA with 106 colony-forming units (CFU) Escherichia coli intratracheally. HepSTAT3/RelA-/- mice displayed ablated APP induction, significantly increased mortality, tumor necrosis factor-dependent hepatotoxicity, and pulmonary bacterial burdens. Following a lower (4x105 CFU) E. coli inoculum, hepSTAT3/RelA-/- mice had decreased APP concentrations with reduced pulmonary inflammation and diminished airspace macrophage activation. Similar results were obtained in the context of endotoxemia and pneumonia. We employed an endotoxemia/pneumonia model, whereby 18 hours of intraperitoneal E. coli lipopolysaccharide (5 mg/kg) was followed by intratracheal E. coli (106 CFU) in mice lacking hepatocyte STAT3 (hepSTAT3-/-) or control hepSTAT3+/+ mice. Following endotoxemia and pneumonia, hepSTAT3-/- mice, with significantly reduced levels of circulating and airspace APPs, exhibited significantly elevated lung and blood bacterial burdens and mortality. While neither recruited airspace neutrophils nor lung injury were altered in endotoxemic hepSTAT3-/- mice, in vivo production of reactive oxygen species in alveolar macrophage was significantly decreased. Additionally, bronchoalveolar lavage fluid from this group of hepSTAT3-/- mice allowed greater bacterial growth ex vivo. These results identify a lung-liver axis, whereby the liver response enhances macrophage activation and pulmonary host defense during pneumonia and sepsis-induced pneumonia. Taken together, induction of liver acute phase gene expression programs contributes to countering the deleterious consequences of pneumonia, whether it is alone or in the context of sepsis-induced infection.

Ewing-like sarcomas (ELS) are a heterogenous group of neoplasms that typically occur in the bone and soft tissue of pediatric and young adult patients. ELS share various degrees of morphological, immunohistochemical, molecular, and clinical similarity with Ewing sarcomas. However, these tumors lack the pathognomonic molecular hallmark of Ewing sarcoma, which is defined as translocation between a gene of the RNA-binding TET family (EWSR1 or FUS) with a gene of the ETS-transcription family (FLI1, ERG, ETV1, ETV4, or FEV). Accurate classification and distinction from classical Ewing sarcomas is important for patient management. A subset of ELS harboring the BCOR-CCNB3 fusion has been described recently – the majority of which that have been reported to date are bone-based tumors, though there have been cases of discrete soft tissue-based tumors. We herein present a case of ELS harboring the BCOR-CCNB3 translocation occurring in a pediatric patient presenting with a large abdominal mass discovered on chest CT after failed outpatient treatment for pneumonia with effusion. This patient was a 14-year-old Caucasian boy with a past medical history significant for obesity and three episodes of pneumonia since 6-years-old. Imaging showed a large heterogeneous mass at the posterior left upper quadrant of the abdomen protruding through the posterior aspect of the left hemidiaphragm causing atelectasis. The mass abuts the inferior leftward aspect of the descending thoracic aorta and also protrudes between the 11th and 12th posterior lateral left rib. Pathology revealed this mass to be an Ewing-like sarcoma with a BCOR-CCNB3 fusion. Patient was treated with chemotherapy and radiation. This case demonstrates the importance of determining an accurate diagnosis to provide specific management.

SAMMANFATTNING Titel: Sederingens betydelse för utvecklingen av ventilator associerad pneumoni hos intensivvårdspatienter. Fakultet: Hälsa, natur- och teknikvetenskap Kurs: Examensarbete - omvårdnad, 15 hp Författare: Sanna Willford Handledare: Anna Nordin Examinerande lärare: Inger James Examinator: Jan Nilsson Sidor: 32 Datum för examination: Juni 2022 Nyckelord: Pneumoni, ventilator associerad, Sedering, Intensivvård Introduktion: Ventilator associerad pneumoni (VAP) är en vårdrelaterad infektion som klassas som en vårdskada och som skapar ett vårdlidande för patienten. Vårdskador kan undvikas om rätt åtgärder vidtas av hälso- och sjukvården. Sedering är grundläggande för säkerhet och bekvämlighet hos respiratorbehandlade patienter. Utvecklingen av VAP förekommer oftare hos patienter som får kontinuerlig sedering än hos patienter som har en daglig sederingspaus. Även andra interventioner i sederingen kan ha betydelse för utvecklingen av VAP. Syfte: Syftet med denna studie var att undersöka sederingens betydelse för utvecklingen av VAP hos respiratorbehandlade patienter på IVA. Metod: I denna systematiska litteraturstudie har en narrativ sammanställning av kvantitativa studier genomförts. En induktiv innehållsanalys enligt Bettany-Saltikov och McSherrys niostegs modell samt SBUs riktlinjer för litteraturstudier har använts. Litteraturstudiens resultat har bedömts med GRADE. Resultat: Flera av de inkluderade studierna såg en statistisk signifikant minskning i antalet patienter som utvecklade VAP, trots att de använde sig av olika interventioner i sederingen. Förändringar i sederingsstrategi, sederingsgrad, val av sederande läkemedel och personalens följsamhet i de VAP preventiva interventionerna var av betydelse. Konklusion: Olika interventioner gällande sederingen har betydelse för utvecklingen av VAP. Att minska förekomsten av VAP kan förkorta tiden för respiratorbehandling, förkorta vårdtiden, minska mortaliteten och minska vårdkostnader. / ABSTRACT  Title: The significance of sedation for the development of ventilator-associated pneumonia in intensive care patients. Faculty: Health, Science and Technology  Course: Degree project - nursing, 15 ECTS  Authors: Sanna Willford Supervisor: Anna Nordin Examiner: Inger James Examiner: Jan Nilsson Pages: 32 Date for the examination: June 2022 Key words: Pneumonia, ventilator-associated, Sedation, Intensive care Introduction: Ventilator associated pneumonia (VAP) is a healthcare-associated infection that is classified as a healthcare injury and that creates a patient suffering. Healthcare injuries can be avoided if the right measures are taken by the health service. Sedation is essential for the safety and comfort of respiratory patients. The development of VAP occurs more often in patients who receive continuous sedation than in patients who have a daily sedation break. Other interventions in sedation can also be important for the development of VAP. Aim: The aim of this study was to investigate the significance of sedation for the development of VAP in ventilator-treated patients at IVA. Method: In this systematic literature study, a narrative compilation of quantitative studies has been conducted. An inductive content analysis according to Bettany-Saltikov and McSherry's nine-step model and SBU's guidelines for literature studies have been used. The results of the literature study have been assessed with GRADE. Results: Several of the included studies saw a statistically significant reduction in the number of patients who developed VAP, despite the fact that they used different interventions in sedation. Changes in sedation strategy and degree of sedation affected the presence of VAP. The choice of sedative drugs and the staff's compliance in the VAP preventive interventions were also important. Conclusion: Various interventions regarding sedation are important for the development of VAP. Reducing the incidence of VAP can shorten the time of ventilator treatment, shorten the care time, reduce mortality and reduce care costs.

The aim of this study was to assess the prevalence and predictive factors of secondary infectionsin patients with coronavirus disease 2019 (COVID-19) and compare with influenza. A retrospective cohort study which included COVID-19 and influenza patients with samples processed at Karolinska University Hospital Laboratory between 1st March 2020 to 1st January2021 and 1st January 2015 to 1st January 2021 respectively. Blood, urine and respiratory culture results from 7 days before and 7 days after the primary diagnosis collected from laboratory information system. Chi-square and Mann-Whitney U test used for descriptive comparison. Predictive factors of secondary infections analyzed using logistic regression. Data includes 16,354 patients:7470 COVID-19 and 8884 influenza. Secondary infections were significantly fewer in COVID-19 patients (26.6%) compared to influenza patients (30%) p&lt;0.01. Lower proportion of episodes with growth (EWG) in blood culture of COVID-19 patients (1.8%) compared to influenza (2.9%) p&lt;0.001. Lower proportion of EWG in respiratory tract cultures of COVID-19 patients (11.1%) compared to influenza patients (24.5%) p&lt;0.001. Higher proportionof EWG in urinary tract cultures of COVID-19 patients (24.5%) compared to influenza (20.1%)p&lt;0.001. Staphylococcus aureus were common bacteria in blood and respiratory tract in both cohorts. Escherichia coli were the most common bacteria in urine in both cohorts. Fungi were least common with unspecified yeast being the most frequent. Likelihood of secondary infection lower in males compared to females AOR 0.70 (95%CI 0.66-0.76)), lower in other clinicalsettings AOR 0.65 (95%CI 0.56-0.76) and increased with age in both COVID-19 and influenza patients (AOR 1.03(95%CI 1.02-1.04)). Higher probability of secondary infections in young influenza patients compared to young COVID-19 patients. A lower prevalence of secondary infections in blood, respiratory tract cultures of COVID-19 patients compared to influenza. Olderage, female sex, intensive care were predictive factors for secondary infections. Findings important for planning of treatment protocols.

Percutaneous endoscopic placement of feeding gastrostomies (PEG) was pioneered by Gauderer et. al, in 1980. Since then, it has become the preferred method of providing enteral nutritional support in children and adults because of advantages in morbidity and cost. Pneumonia is a known sequel of this procedure, occurring at different rates, depending on the length of follow-up. Some series have shown an incidence of 10% at 30 days and others 56% at 11 months. It does not appear that PEG feeding offers an advantage over the more traditional naso-enteric tube feeding methods in this respect. To study the prevalence of gastroesophageal reflux (GER) in PEG-fed patients, we quantitated GER by 24-hour intraesophageal pH monitoring in a group of patients who developed post-PEG pneumonia and compared it with a control group. Our study demonstrates an increased prevalence of GER in the pneumonia group compared with the control group. However, the exact contribution of this observed increased GER to the development of pneumonia needs to be determined.

Severe acute respiratory syndrome (SARS) is a severe pulmonary infection that has been identified in multiple outbreaks around the world after emerging from mainland China in early 2003, The syndrome is caused by SARS-associated coronavirus, a novel human infection. SARS-associated coronavirus is spread by multiple mechanisms, including direct contact and large-droplet aerosolization, and may be spread by droplet nuclei as well. Clinical disease is characterized by fever, dry cough, interstitial infiltrates, and variable progression to respiratory failure, No treatment has clearly been shown to be effective. Aggressive infection control measures to prevent viral spread are key to outbreak management.