Course Of Community-acquired Pneumonia Research Articles

The role of coronavirus infection in lung injury, which contributes to the occurrence of complicated course of community-acquired pneumonia

Annotation. The review article focuses on the role of coronavirus infection in lung damage, which contributes to the complicated course of community-acquired pneumonia. Based on the scientometric databases Web of science, Scopus, PubMed, a retrospective analysis of the literature on this topic for 2013-2023 was conducted. 32 sources were selected after reviewing the abstracts of the articles and reading their full text. The results of the search indicate that most people infected with SARS-CoV-2 do not develop severe illness, and the infection is likely to be limited to the upper respiratory tract. However, in some people, infection with the virus leads to severe pneumonia dominated by immunopathology, probably caused by lower respiratory tract infection. Alveolar damage can be a direct consequence of cell infection or an indirect consequence caused by local inflammatory reactions. People with severe COVID-19 often have a tendency to have a delayed immune response. Inflammation and coagulation further exacerbate pro-inflammatory and/or profibrotic reactions, which contributes to the development of complications. Uncontrolled inflammation ultimately leads to severe immunopathology characteristic of COVID-19. In this regard, understanding the pathogenesis of SARS-CoV-2 infection and how it contributes to critical illness and its complications may help to improve risk allocation and develop targeted therapies to reduce the acute and long-term consequences of this disease.

ОСОБЕННОСТИ ТЕЧЕНИЯ ВНЕБОЛЬНИЧНОЙ ПНЕВМОНИИ И ОЦЕНКА ЭФФЕКТИВНОСТИ КОМПЛЕКСНОЙ ТЕРАПИИ

Introduction. Community-acquired pneumonia is an urgent problem of our time due to its high prevalence, increasing resistance of microflora to antibacterial therapy, a large number of complications and high mortality. Aim. The aim of the study was features of the course of community-acquired pneumonia and evaluation of the effectiveness of complex therapy. Material and methods. A survey of 120 patients was conducted, with a diagnosis of moderate and severe pneumonia. The patients were divided into 2 groups: group 1 (70 patients), in which, along with the standard therapy of pneumonia, the drug meglumine sodium succinate was included, and group 2 (50 patients), which received standard therapy of pneumonia. In addition to the standard clinical examination of patients with pneumonia, concomitant pathology from other organs and systems was studied. In addition to anamnesis and objective research methods, laboratory and instrumental methods of studying the respiratory and hepatobiliary systems were used. Additionally, procalcitonin was determined in blood serum by immunochromatography, and hepatocyte growth factor and endothelin-1 were determined by enzyme-linked immunosorbent assay. Statistical processing of the results of the study was carried out using parametric and nonparametric methods. Results and discussion. Community- acquired pneumonia is characterized by a moderate course, segmental or lobular lung damage, and the development of a number of complications. With community-acquired pneumonia, the hepatobiliary system is affected and often community-acquired pneumonia occurs against the background of cardiovascular pathology. Conclusion. When meglumine sodium succinate was included in the complex therapy of community-acquired pneumonia, in addition to the positive dynamics of the clinical and laboratory picture of the underlying disease, and a significant reduction in the average duration of hospitalization. In the course of therapy of patients with community-acquired pneumonia with meglumine sodium succinate, a significant decrease in inflammation indicators and an increase in hepatocyte growth factor concentration were observed. When meglumine sodium succinate was included in the therapy of patients with pneumonia, there was a tendency to increase the number of endotheliocytes and a significant increase in the content of endothelin-1, which may reflect an increase in the sanogenetic ability of the body to systemic inflammation in community-acquired pneumonia.

Associations between indicators of new semi-quantitative express-test for procalcitonin and indicators of saturation in patients with community-acquired pneumonia

Objective. To evaluate the associations between the indicators of a new semi-quantitative express-test for procalcitonin and saturation levels in hospitalized patients with community-acquired pneumonia.
 Due to a high rate of growth of the incidence of severe community-acquired pneumonia, which leads to disability of the working population and claims thousands of lives, there is a need for early verification of the severity degree and a timely initiation of treatment. Traditional clinical, radiologic, laboratory and bacteriological criteria for inflammatory reactions (fever, increased pulmonary infiltration and leukocytosis, detection of potential pathogens in sputum or hemocultures) are not specific for pneumonia. Similar clinical and radiologic manifestations can also be noted in other pathological conditions, for example, in atelectasis of the lung, lung infarction, congestive heart failure, as well as acute respiratory distress syndrome. In this regard, the study of new diagnostic markers of community-acquired pneumonia is an actual direction in modern therapeutic diagnostics. Being a fast and highly sensitive method, the express test for procalcitonin can be a valuable predictive marker for the severe course of community-acquired pneumonia. Of interest is the relationship of procalcitonin with an indicator reflecting the presence of respiratory failure the level of saturation.
 Materials and methods. A single-stage comparative study involved 123 patients admitted to the hospital with a confirmed diagnosis of community-acquired pneumonia. On the first day after admission to the hospital, all patients underwent a general clinical examination, an overview X-ray of the chest organs, and determination of the plasma procalcitonin level using a semi-quantitative express-test as well as the saturation level. According to the results of the examination, the patients were divided into two groups: patients with saturation 94 % (n=43), and patients with saturation 94 % (n=80). The group of patients with saturation values 94 % consisted of 23 (53.5 %) women and 20 (46.5 %) men. The group of patients with saturation values 94 % consisted of 42 (52.5 %) women and 38 (47.5 %) men. The mean age of the patients was 56.719.1 and 45.620.7 (MSD) years, respectively, p=0.005. Statistical processing of the obtained data was carried out using the SPSS 13.0 software package.
 Results. Patients with low saturation values ( 94 %) had higher heart rate (p=0.001) and respiratory rate (p=0.001), and the levels of erythrocytes (p=0.001), hemoglobin (p=0.003) and albumin (p=0.001) were significantly lower than in patients with higher saturation levels 94 %. For patients with signs of respiratory failure and saturation indices 94 %, a more pronounced increase in the level of express-test for procalcitonin was characteristic (p=0.001). According to regression analysis, the express-test for procalcitonin 2 ng/ml by 13.8 % (CI 1.5131.3), age by 3 %, and heart rate by 11 % increase the risk of low saturation in patients with community-acquired pneumonia.
 Conclusion. Low values of blood oxygen saturation 94 % in hospitalized patients with community-acquired pneumonia are directly associated with high values of the new semi-quantitative express-test for procalcitonin (more than 2 ng/ml), that can be used for individual risk stratification.

Somatopsychic disorders in patients with community-acquired pneumonia associated with coronavirus disease (COVID-19)

OBJECTIVE. To determine the categories of patients with community-acquired pneumonia associated with COVID-19, in which somatopsychic disorders are most common in the acute period of the disease, and to establish the degree of expressiveness of these disorders in order to optimize patient management.
 MATERIALS AND METHODS. 48 patients with community-acquired pneumonia associated with COVID-19 hospitalized in the therapeutic department during the acute period of the disease. Average age – 62.5 (54.0, 68.8); men – 21 (43.7 %), women – 27 (56.3 %).
 The examination included general clinical methods, PCR tests for the verification of COVID-19, computer tomography of the chest cavity, pulse oximetry, determination of the levels of C-reactive protein (CRP), D-dimer, assessment of the mental state of patients using the Hospital Anxiety and Depression Scale (HADS).
 RESULTS AND DISCUSSION. Taking into account the fact that, according to the data of the previous individual analysis, the examined patients had, on the one hand, different degrees of expressiveness of respiratory insufficiency and different levels of laboratory parameters, and, on the other hand, different expressiveness of symptoms of somatopsychic disorders, it was expedient to conduct a cluster analysis for systematization and generalization obtained results.
 It was shown that in patients of cluster 2, which included patients with a moderately severe course of the disease, the indicators of the levels of oxygen saturation, CRP and D-dimer in blood serum, as well as the number of lymphocytes in the general blood analysis were statistically significantly better than in patients cluster 1, which included patients with a severe course of the disease. The expressiveness of somatopsychic disorders according to the HADS-anxiety and HADS-depression questionnaires in patients of cluster 2 was statistically significantly lower than in patients of cluster 1. In addition, symptoms of depression of various degrees of severity were found in almost all patients of cluster 1, and in most patients it was combined with increased anxiety of various degrees of severity.
 CONCLUSIONS. To determine the degree of severity of the course of community-acquired pneumonia associated with COVID-19, not only the area of lung tissue damage according to computer tomography data and the level of oxygen saturation should be used, but additional criteria: levels of CRP, D-dimer and lymphocytes in the peripheral of blood. The moderately severe course of community-acquired pneumonia associated with COVID-19 is characterized not only by a relatively high level of oxygen saturation, but also by low levels of CRP and D-dimer, as well as a normal level of lymphocytes in the peripheral blood. The severe course of community-acquired pneumonia associated with COVID-19 is characterized not only by a relatively low level of oxygen saturation, but also by high levels of CRP and D-dimer, as well as a low level of lymphocytes in the peripheral blood. In patients with community-acquired pneumonia associated with COVID-19, with a low level of oxygen saturation, high levels of CRP and D-dimer, and a normal level of lymphocytes in the peripheral blood in the acute period of the disease, symptoms of depression and increased anxiety are quite often observed, and in half of such patients have moderate or severe symptoms. This may require examination of the mental status of such patients at least through questionnaires, as well as correction of these disorders during the acute period of the disease and during the rehabilitation stages.

The role of hormonal changes in adaptation disorders of young systems in the course of community-acquired pneumonia

Community-acquired pneumoniae are considered as life-threatening infectious diseases and are one of the main causes of morbidity, hospitalization, and mortality. The main goal is to study and assess the role of the hormone imbalance in the adaptation disorders of young organism during the community-acquired pneumonia. To achieve the goals of the research 296 male patients with pneumonia, aged 18-21, were examined. The control group consisted of 63 practically healthy male individuals of the same age. Besides standard examinations, the levels of cortisol, testosterone, prolactin, thyroid stimulating hormone, triiodothyronine, thyroxine, antithyroglobulin and anti-thyroid-peroxidase were determined in the blood serum. The analysis shows that the level of prolactin in all research groups tends to increase; the level of testosterone in all the groups tends to decrease; the level of cortisol in the 18-19 age group tends to decrease; in the 20-21 age group this indicator increases, but it remains below the level of the indicator of the control group. The impact of unfavorable factors of military service, the neuropsychological and physical overstrain, the change in the diet and rations, army-specific conditions, and the unusual situation for some individuals lead to an overstrain and exhaustion of the protective adaptation reactions of the organism, manifested also by hormonal shifts. In the conditions of community-acquired pneumonia, the adaptation process of the organism was accompanied by a similar phasal endocrine shifts, manifested by marginal hyperprolactinemia, a decline in testosterone levels, with no increase in the levels of cortisol detected, regardless of the fact that community-acquired pneumonia was a stress factor for the organism. The main pathogen of the community-acquired pneumonia among the military was mycoplasma pneumoniae and chlamydophila pneumoniae. The course of the pneumonia cases was clinically atypical and rapid, swiftly complicating with hemorrhagic alveolitis. In some cases, the clinical course of the illness lagged behind the findings by X-ray imaging examination results.

The role of hormonal changes in adaptation disorders of young systems in the course of community-acquired pneumonia

Community-acquired pneumoniae are considered as life-threatening infectious diseases and are one of the main causes of morbidity, hospitalization, and mortality. The main goal is to study and assess the role of the hormone imbalance in the adaptation disorders of young organism during the community-acquired pneumonia. To achieve the goals of the research 296 male patients with pneumonia, aged 18-21, were examined. The control group consisted of 63 practically healthy male individuals of the same age. Besides standard examinations, the levels of cortisol, testosterone, prolactin, thyroid stimulating hormone, triiodothyronine, thyroxine, antithyroglobulin and anti-thyroid-peroxidase were determined in the blood serum. The analysis shows that the level of prolactin in all research groups tends to increase; the level of testosterone in all the groups tends to decrease; the level of cortisol in the 18-19 age group tends to decrease; in the 20-21 age group this indicator increases, but it remains below the level of the indicator of the control group. The impact of unfavorable factors of military service, the neuropsychological and physical overstrain, the change in the diet and rations, army-specific conditions, and the unusual situation for some individuals lead to an overstrain and exhaustion of the protective adaptation reactions of the organism, manifested also by hormonal shifts. In the conditions of community-acquired pneumonia, the adaptation process of the organism was accompanied by a similar phasal endocrine shifts, manifested by marginal hyperprolactinemia, a decline in testosterone levels, with no increase in the levels of cortisol detected, regardless of the fact that community-acquired pneumonia was a stress factor for the organism. The main pathogen of the community-acquired pneumonia among the military was mycoplasma pneumoniae and chlamydophila pneumoniae. The course of the pneumonia cases was clinically atypical and rapid, swiftly complicating with hemorrhagic alveolitis. In some cases, the clinical course of the illness lagged behind the findings by X-ray imaging examination results.

Modern Possibilities of Immunoprophylaxis of Prolonged Course of Community-Acquired Pneumonia in Children

The aim of the study was to develop methods for the prevention of prolonged community-acquired pneumonia in children. 180 children aged 6 months to 15 years with community-acquired pneumonia of a prolonged course, who are being treated in the department of pulmonology, were examined. Analysis of anamnestic data showed that all children, regardless of the development of the disease, had repeatedly suffered acute respiratory infections, pneumonia, intestinal infections, purulent-septic diseases, characterized by a long, recurrent course and difficult to respond to antimicrobial therapy.

Features of the clinical presentation and course of community-acquired pneumonia against the background of type 2 diabetes mellitus

Community-acquired pneumonia remains the leading infectious cause of death around the world. Many factors influence the prognosis and outcome of this disease. Compared with healthy individuals, patients with diabetes mellitus are at increased risk of respiratory tract infections, such as community-acquired pneumonia. Diabetes mellitus contributes to the development of pulmonary thrombotic microangiopathy, changing the functional state of the lungs. In numerous studies involving patients with diabetes mellitus, data on the state of the lungs were obtained by instrumental tests, such as spirometry, ventilation / perfusion scintigraphy, perfusion computed tomography, and diffusing capacity of the lungs for carbon monoxide. In patients with community-acquired pneumonia, diabetes mellitus causes vague clinical symptoms, leads to a severe course of the disease, and contributes to development of complications. Diagnosing the functional state of the lungs in patients with community-acquired pneumonia against the background of diabetes mellitus has not been studied.

Features of the course of community-acquired pneumonia in children before and during the COVID-19 pandemic

Introduction. The basis of the work was a retrospective analysis of the course of community-acquired pneumonia (CAP) in children with COVID-19. Aim. To determine the features of the course of CAP before and during the COVID-19 pandemic in children from birth to 18 years. Materials and methods. A retrospective analysis of the medical records of ninety five children (n = 95) who were treated at the Speransky Children’s Hospital No. 9 before the pandemic (October-November 2019; n = 45) and during the COVID-19 pandemic (April-May 2020 and October-November 2020; n = 50). All the received data are processed statistically. Results. It was found that before the COVID-19 pandemic, mainly adolescents aged 13-17 years were ill, during the pandemic younger children (6-12 years old) became ill more often. With the onset of the pandemic, the course of CAP changed significantly: fever, cough, shortness of breath were typical clinical signs; local signs were more pronounced in children during the pandemic: weakened and hard breathing was more often detected. Leukocytosis and accelerated ESR prevailed in patients with CAP before the pandemic. At the same time, CRP was a more sensitive marker of inflammation. It was revealed that with the beginning of the COVID-19 pandemic, the number of atypical pneumonia decreased, which may be due to anti-epidemic measures, but the prevalence of pneumonia of unknown etiology increased. Decreased oxygen saturation was a more frequent rule in CAP during the pandemic. Lobar pneumonia prevailed in children before the pandemic, and polysegmental pneumonia prevailed in patients during the pandemic. Conclusion. The features presented by the authors of the manifestations of community-acquired pneumonia in children before and during the COVID-19 pandemic make it possible to optimize their diagnosis using clinical and laboratory signs.

Порушення функції печінки в дітей раннього віку з позагоспітальною пневмонією: роль маркерів інфекційно-запального процесу

Today, pneumonia remains the leading cause of infant mortality and morbidity worldwide. Pneumonia increases inflammatory processes, accompanied by the activation of inflammatory mediators, and can provoke significant metabolic disorders in the body. Purpose - to determine liver dysfunction in young children with community-acquired pneumonia based on the study of markers of infectious-inflammatory process. Materials and methods. The results of clinical and laboratory examination of 338 children aged 1 month to 3 years with community-acquired pneumonia were analyzed. The children were hospitalized in the Infectious Diseases Boxed Department for Young Children of the Vinnytsia Regional Children’s Clinical Hospital. Verification of the diagnosis was made using the recommendations of the British Thoracic Society. All patients had pneumonia of varying severity, depending on which they were divided into two groups: group I - 129 children who were diagnosed with community-acquired pneumonia of moderate severity; group II - 209 patients with severe pneumonia. Comparison group - 40 healthy children. Results. Markers of infectious-inflammatory process were studied to determine the levels of pro-inflammatory cytokines - interleukin (IL-1, IL-6) and proteins of the acute phase of inflammation - C-reactive protein (CRP) and fibrinogen in the serum of young children with outpatients. Aminotransferase hyperenzymemia is closely correlated with the activity of the infectious-inflammatory process, which indicates a positive correlation between the level of IL-1 and ALT (rxy=+0.047) and AST (rxy=+0.111). At the same time, there is a negative correlation between the levels of IL-1, CRP and the activity of aminotransferases in blood plasma. Conclusions. It was found that the course of community-acquired pneumonia is accompanied by an increase in the serum of children with concentrations of IL-1 and IL-6 in parallel with the severity of the disease. The synthesis of pro-inflammatory cytokines stimulates the production of acute CRP, but reduces the concentration of fibrinogen in the blood of sick children. The identified links between the content of the studied cytokines at the systemic level and multidirectional changes in the acute phase of inflammation indicate a violation of the liver, where proteins are synthesized. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors. Key words: cytokines, C-reactive protein, fibrinogen, alanine aminotransferase, aspartate aminotransferase, liver, community-acquired pneumonia, children, early age.

Cytokine profile of bronchoalveolar secretion in prolonged course of community acquired pneumonia

Despite existing studies on pathogenetic role of cytokine (CK) system in lung damage in pneumonia, there are still controversial issues of cytokine-mediated processes that lead to the prolongation of the inflammatory process in lung tissue in this pathology. The article presents the study of the cytokine profile of bronchoalveolar secretion (BAS) in the prolonged course of community-acquired pneumonia (CAP). To achieve the purpose of the research, in patients with prolonged CAP on the first and last 1-2 days of hospital stay the concentration of pro-inflammatory (IL-1β, IL-2, TNFα, IL-6, IL-8) and anti-inflammatory CK (IL-4 and IL-10) in BAS was determined. When studying the cytokine profile of BAS in the acute period of CAP, it was found that patients with a prolonged course of the disease subsequently had an increase in the concentration of pro-inflammatory CK (IL-1β, IL-6, IL-8, TNF-α and IL -2), reduction of anti-inflammatory (IL-4, IL-10) and more significant disproportion of the ratio of their opposition pools (IL-1β/IL-10 and TNF-α/IL-10) in BAS. In the conditions of the generally accepted therapy in patients with prolonged and not prolonged CAP course, various rate of improvement of indicators of CK in BAS is defined. In patients with prolonged CAP, the rate of progress of pro-inflammatory and anti-inflammatory CK was slower. At the time of discharge from the hospital, most patients had an imbalance of pro-inflammatory and anti-inflammatory CK with a predominance of pro-inflammatory activity in the bronchoalveolar space.

Course of community-acquired pneumonia - a descriptive study on the influence of nutritional status

Rationale: The objectives were to identify the effects of nutritional risk on length of stay (LOS) and on the immune response, in adults hospitalized with Community Acquired Pneumonia (CAP). Furthermore, to elucidate if patients in nutritional risk have increased risk of readmission, losing handgrip strength (HGS) or physical function during hospitalization.

Liver dysfunction in children with community-acquired pneumonia: the role of infectious and inflammatory markers

Markers of infectious-inflammatory process were studied by determining the levels of pro-inflammatory cytokines - interleukin (IL) 1 and IL-6 and proteins of the acute phase of inflammation - C-reactive protein (CRP) and fibrinogen in the serum of children with community-acquired pneumonia. 
 It was found that the course of community-acquired pneumonia is accompanied by an increase in serum concentrations of IL-1 and IL-6 in children in parallel with the disease severity. The synthesis of pro-inflammatory cytokines stimulates the production of acute CRP, but reduces the concentration of fibrinogen in the serum of sick children. The revealed connections between the content of the studied cytokines at the systemic level and multidirectional changes in the indicators of the acute phase of inflammation indicate a violation of the liver, where proteins are synthesized in the study.
 It is shown that with increasing severity of pneumonia, the enzyme activity of aminotransferases - alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in the serum of children increases with a simultaneous decrease in the de Ritis coefficient, indicating "hepatic" genesis. High levels of aminotransferase is closely correlated with the activity of the infectious-inflammatory process, as indicated by the positive correlation between the level of IL-1 and ALT (r = 0.047) and AST (r = 0.111). At the same time, there is a negative correlation between the levels of IL-1, CRP and the activity of aminotransferases in blood serum.

Risk factors for complicated community-acquired pneumonia course in patients treated with β-lactam monotherapy.

We aimed to investigate community-acquired pneumonia (CAP) requiring hospitalisation, empirically treated with b-lactam monotherapy, with 30-day mortality and risk factors predicting its complicated course. A prospective observational study was conducted at the Pulmonology and Allergology Department in a tertiary care university hospital. 253 consecutive patients diagnosed with CAP requiring hospitalisation were enrolled. Hospital admission was based on PSI or CRB-65 scores, severe comorbidities, signs of intoxication, aspiration risk, social risk consider-ations, ineffective prior antibiotic treatment. Fourty seven percent of the subjects had complications on admission, 13% developed new CAP complications during inpatient treatment. Overall, 53% of individuals had a complicated CAP course. 30-day mortality rate was 5.9%. The factors predicting a complicated CAP course were as follows: neuromuscular disease, multilobar opacities on chest X-ray (or computed tomography), and clinically unstable condition as evaluated using Halm's criteria. The mortality rate in CAP patients treated with b-lactam monotherapy is low. Neuromuscular disease, multilobar opacities, and clinically unstable condition as evaluated using Halm's criteria predict a complicated CAP course.

Diagnostics of complicated course of community-acquired pneumonia of viral etiology (COVID-19) via using chest computed tomography

BACKGROUND. To date, radiological criteria for the diagnosis of viral pneumonia associated with SARS-CoV-2 have been established, and treatment regimens for patients depending on the severity of coronavirus disease (COVID-19) have been developed for both outpatient and inpatient settings. Many patients, regardless of the form and severity of the coronavirus infection, suffer from a range of symptoms for weeks or even months that reduce their quality of life. Therefore, the diagnostics of complicated course of community-acquired pneumonia of viral etiology (COVID-19) via using computed tomography (CT) of the chest becomes relevant.
 OBJECT. To diagnose a complicated course of community-acquired pneumonia of viral etiology (COVID-19) according to CT of the chest.
 MATERIALS AND METHODS. A group of patients referred for treatment to the National Institute of Phthisiology and Pulmonology named after F.G. Yanovsky of the NAMS of Ukraine with complications of pneumonia from other medical institutions where they were treated for community-acquired pneumonia of viral etiology (COVID-19) 2-3 months ago. Chest CT of 20 patients (12 men and 8 women aged from 24 to 66 years) were analyzed. All patients complained of shortness of breath, cough, lack of significant improvement in general condition after discharge from the hospital.
 RESULTS AND DISCUSSION. Typical complications of community-acquired pneumonia of viral etiology (COVID-19) were determined by CT: 10 % of patients showed gradual progression of viral pneumonia (numerous opacities were identified as “ground glass”, consolidation and the “crazy paving” symptom); 15 % – signs of thrombosis of the pulmonary arteries branches; 25 % – exacerbation of chronic obstructive pulmonary disease with preservation of signs of bilateral polysegmental viral pneumonia; 20 % – exacerbation of asthma with signs of bilateral polysegmental viral pneumonia in the regression phase; 30 % – bullous pulmonary emphysema (“vanishing lung syndrome”).
 CONCLUSIONS. Typical complications of pneumonia of viral etiology (COVID-19) indicate that the inflammatory process does not end after inpatient treatment and the presence of a negative PCR test, and patients need further careful monitoring and correction of treatment. CT is an objective and most informative diagnostic method of complicated community-acquired pneumonia of viral etiology (COVID-19).

Secretory leukocyte protease inhibitor as a marker of proinflammatory response in children with community-acquired pneumonia

The study of the secretory leukocyte protease inhibitor (SLPI) level in children with pneumonia is important because it may indicate protease-antiprotease imbalance and predict local regulation of proteolytic activity at different degrees of pneumonia in children. The aim of the study was to assess the level of SLPI as a marker of proinflammatory response in the serum of young children, depending on the severity of pneumonia, including the presence or absence of lesions of the hepatobiliary system. The study investigated the SLPI as a marker of the inflammatory response in children with community-acquired pneumonia, depending on the severity of the disease, lesions of the hepatobiliary system, age and sex. The level of SLPI in the serum was determined by enzyme-linked immunosorbent assay using a diagnostic test system from “IMMUNOTECH” (France). “IBM SPSS Statistica” Version 12 (20) was used for statistical processing of the results. It was found that the course of community-acquired pneumonia is accompanied by an increase in the serum level of SLPI in children in parallel with the severity of the disease. The development of a lesion from the GBS reduces the level of a protease inhibitor in the blood serum of children with pneumonia, which indicates a decrease in the body's defense systems. In children 1-12 months, the level of SLPI is higher than in children 13-36 months, which indicates more significant protective capabilities of the body of children in the first year of life. It has been shown that an increase in the level of SLPI correlates with an increase in the level of inflammatory cytokines, which indicates a unidirectional change in the formation of local immunity in response to damage to the lung tissue. At the same time, a negative correlation was found between the level of SLPI and the activities of AST, GGT and CRP (rxy= -0.054; rxy= -0.215; rxy= -0.215, respectively), which indicates a violation of liver function during the development of an infectious-inflammatory process in the body. Studies of the nature of the effects of cytokines and protease inhibitors (protective factors) on the development and maintenance of inflammatory process in the lungs in young children with community-acquired pneumonia with lesions of the hepatobiliary system may be the basis for predicting its course.

Pharmacoeconomic analysis of the choice of antimicrobial drugs for the treatment of community-acquired pneumonia by physicians and final year medical students

The authors of the article conduct a pharmacoeconomic analysis of antimicrobial agents (AMA) prescriptions based on a survey of graduates of the medical faculty of a medical university and outpatient healthcare practitioners in Moscow. In addition to the pharmacoepidemiological part, the article also contains a pharmacoeconomic aspect to obtain a more complete picture, reflecting the choice of drugs not only in primary healthcare, but also among graduates of the medical faculty, who can potentially become its members without preliminary training in medical residency.The purpose of this study is to conduct a comparative pharmacoeconomic analysis of the AMA choice in the treatment of community-acquired pneumonia based on the data of a survey of general practitioners, district physicians and graduates of the medical faculty.Methodology. The 206 physicians took part in the anonymous voluntary survey.Results. 177 (85.9 %) of surveyed doctors were women and 62 (14.1 %) were men who made up Group 1. The average age of the surveyed doctors was 47.8±13.3 years, the average medical experience was 21.4±13.4 years. Group 2 consisted of 240 students, of which 178 were women (74.17 %) and 62 were men (25.83 %). The average age of the respondents in the group 2 was 24.8±3.3 years. When calculating the average cost of a treatment course of community-acquired pneumonia, depending on the structure of prescriptions, the value in Group 1 amounted to 420.82 rubles and 367.44 rubles in Group 2, while the share of costs for aminopenicillin drugs directly recommended for prescription to treat community-acquired pneumonia amounted to 8.35 and 4.97 %, respectively. Despite the current recommendations, respondents prefer to choose second-line AMAs, which are more expensive drugs. Respondents in both groups underestimate the first-line drugs that meet the current recommendations, namely aminopenicillins. Despite their low cost and ease of use in an outpatient setting, the frequency of their prescription remains low. The authors believe that more attention should be paid to the problem of rational use of antimicrobial agents. This problem can be solved through educational interventions at all levels of education, which can change the picture of drugs prescriptions in future, will allow practitioners and graduates of medical faculties to refer more often to clinical guidelines and patient treatment protocols. Comprehensive measures in this direction can not only positively affect the quality of medical care, but also reduce antibiotic resistance in the outpatient setting.

Ретроспективный анализ внебольничной пневмонии у детей раннего возраста из многодетных семей

The study of the clinical course of community-acquired pneumonia in young children from large families was conducted. The study was retrospective. Children suffered from community-acquired pneumonia of moderate and severe severity. Revealed that community-acquired pneumonia often suffers from young children, mostly boys.

Особенности течения внебольничной пневмонии у коморбидных пациентов, госпитализированных в стационар в период эпидемии респираторных вирусных инфекций

Особенности течения внебольничной пневмонии у коморбидных пациентов, госпитализированных в стационар в период эпидемии респираторных вирусных инфекций

Evaluation and selection of high-frequency chest wall oscillation modes in children with community-acquired pneumonia based on pulse oximetry

The high-frequency chest wall oscillation (HFCWO) is a method of airway clearance therapy, which helps to restore the drainage function of the bronchial glands, improve the pulmonary function and pulmonary gas exchange in children with cystic fibrosis, atelectasis, and bronchiectasis.Aim: to select effective modes of high-frequency chest wall oscillation for increase oxygen saturation in children with community-acquired pneumonia based on pulse oximetry data.Materials and methods. The selection and evaluation of the HFCWO modes were performed in 261 children (girls – 47.1 % and boys – 52.9 %) aged 6–17 years with a moderate degree and acute course of community-acquired pneumonia (CAP) using eight oscillation modes of the Vest Airway Clearance System, Model 105. The effectiveness of the HFCWO modes was assessed on the 1st and 10th day of the disease by measuring the degree of arterial hemoglobin oxygen saturation (SpO2) using noninvasive transmission pulse oximetry with the use of a pulse oximeter, Series YX 300. The ROC analysis was performed, the area under the ROC curve (AUC) was presented with the associated 95 % confidence interval (CI).Results. According to a comparison of the sensitivity and specificity of the ROC analysis method, the 1st mode of HFCWO is recommended to apply for preschool children of asthenic somatotype, which is confirmed by the highest AUC – 0.95 (95 % CI 0.86–1.00). The 2d mode of HFCWO should be included in the complex therapy for preschool children of normosthenic somatotype, which is confirmed by the highest AUC – 0.94 (95 % CI 0.88–1.00). For prepubertal children of asthenic somatotype the 3rd mode of HFCWO should be used based on the highest value of AUC – 0.93 (95 % CI 0.81–1.00). For prepubertal children of normosthenic somatotype, we recommend including the 4th mode of HFCWO with an AUC value of 0.94 (95 % CI 0.84–1.00) in the comprehensive treatment of CAP. Regarding the adolescents of asthenic somatotype, we recommend applying the 5th mode of HFCWO, the AUC of which is 0.97 (95 % CI 0.91–1.00). As for the adolescents of normosthenic somatotype, the 6th mode of HFCWO should be used based on the AUC– 0.98 (95 % CI 0.91–1.00).Conclusions. To increase the effectiveness of community-acquired pneumonia treatment, it is necessary to include HFCWO in the daily therapy taking into account the optimal oscillation parameters. Modes 1-6 of HFCWO influence the level of oxygen saturation, improving it. It is recommended to use sparing oscillation modes (1, 3 and 5) for children with asthenic somatotype in complex therapy of pneumonia compared to children with normosthenic somatotype.