Diagnosis Of Severe Pneumonia Research Articles

Prevalence of persistent pneumonia among severe pneumonia and nutritional status as its associated risk factor: A prospective observational study among under-five children.

Malnourishment is a risk factor for persistent pneumonia among under-five children with severe pneumonia. This study aims to determine the prevalence of persistent pneumonia and the association between nutritional status and pneumonia severity in children under 5 years of age. A prospective observational hospital-based study was conducted in the Department of Paediatrics, King George's Medical University (KGMU) from May 2019 to April 2020 among children aged 1 month to 5 years admitted with a diagnosis of severe pneumonia. An anthropometric assessment along with general and systemic examination was conducted. Weight for age, height for age and weight for height were calculated to assess the nutritional status. Children with severe pneumonia were followed for 4-6 weeks to assess the prevalence of persistent pneumonia. The prevalence of persistent pneumonia was 6.8%, while 32 (31.1%) and 64 (62.1%) patients had recurrent and severe pneumonia, respectively. No statistically significant distribution was observed in age, sex, residential area, parent's education or occupation of the child. The statistically significant distribution was seen on assessing nutritional status based on weight for age, height for age and weight for height (P value- 0.001, 0.001, 0.0001). Those with weight for age ≤ 3SD were anaemics and up to 1 year of age had 5.21, 3.52 and 2.83 times more odds of having persistent pneumonia, respectively. The prevalence of persistent pneumonia among children less than 5 years of age was 6.8%. Malnutrition can be considered a major determinant of persistent pneumonia among children under 5 years of age.

A Study of the Clinical Profile and Respiratory Index of Severity in Children (RISC) Score in Infants Admitted With Acute Respiratory Infections at a Tertiary Care Hospital.

Background Pneumonia is a major infectious cause of mortality in young children worldwide. The Respiratory Index of Severity in Children (RISC) score was designed with the intent to provide an objective mean to quantify the severity of lower respiratory tract infection in young children based on their risk of mortality. Knowledge about the clinical profile of acute respiratory infections and the scoring system predicting the risk of mortality helps in modifying treatment strategies. This study was undertaken at a resource-limited, tertiary-care public hospital in southern India with the objectives of describing the clinical profile of infants admitted with acute respiratory infections and determining the association of the RISC score with mortality. Method This was a retrospective observational study conducted over six months. Case records of infants admitted with acute respiratory infections were reviewed. The socio-demographic and clinical details of each case were recorded. The RISC score was calculated using clinical parameters which included the history of refusal of feeds, oxygen saturation lower than 90%, chest in-drawing, wheezing, and low weight-for-age. The maximum score was six. Descriptive data was represented using mean, standard deviation, and percentage or proportion. The association between any two categorical variables was analyzed using the chi-square test. The differences between any two continuous variables were analyzed using the independent sample t-test. A p-value of < 0.05 was considered statistically significant. Results A total of 75 infants were admitted with a diagnosis of acute respiratory infection during the study period. Of these, 68 were included in the study. The mean age of infants was 6.69 ± 3.96 months; 58.8% were male, 41 (60%) were exclusively breastfed, and 51 (75%) were up-to-date immunized. Twenty (29.4%) infants had a history of exposure to indoor smoke. The majority (67.6%) had pneumonia. Nine (13.2%) were mechanically ventilated. The mean duration of hospital stay was 8.16 ± 5.45 days. Sixty-three (92.64%) infants recovered and there were five deaths. The presence of less than 90% oxygen saturation (p-value=0.004), a diagnosis of severe pneumonia (p-value <0.001), and the need for mechanical ventilation (p-value <0.001) were significantly associated with mortality. A statistically significant (p-value=0.001) association was observed between the RISC score and mortality. Conclusions Addressable factors like the absence of exclusive breastfeeding, partial-immunization status, exposure to indoor smoke, and malnutrition were observed in infants with acute respiratory infections, which reinforces the importance of protective and preventive strategies for the control of pneumonia. The RISC score was observed to be beneficial in predicting mortality in an infant with acute respiratory infection. Triaging and early identification of infants at risk of mortality using this score could be very helpful in initiating timely treatment to reduce mortality, especially in resource-limited settings.

Etiological and clinical characteristics of severe pneumonia in pediatric intensive care unit (PICU)

ObjectiveTo analyze the etiological distribution characteristics of pediatric patients with severe pneumonia admitted to the Pediatric Intensive Care Unit (PICU), in order to provide a reference for the rational use of clinical antimicrobial drugs.MethodsA retrospective analysis of pediatric patients admitted to PICU with a diagnosis of severe pneumonia from January 2018 to December 2021 was performed and statistical analysis of pathogenic characteristics was performed.ResultsA total of 649 pathogens were detected in 515 children, with a positive detection rate of 77.48%. Bacteria were detected at the highest rate (40.52%), followed by viruses (34.35%), atypical pathogens (19.72%) and fungal (4.31%). Gram-positive infections were dominated by Staphylococcus aureus (39.56%) and Streptococcus pneumoniae (32.97%), and Gram-negative infections were dominated by Acinetobacter Bahmani (16.28%) and Haemophilus influenzae (15.12%), followed by Klebsiella pneumoniae (13.95%) and Pseudomonas aeruginosa (12.21%). Viral infections were dominated by respiratory syncytial virus (25.65%) and EB virus (20.43%), fungal infections were dominated by Candida albicans (50.0%). The proportion of children infected with single pathogen (49.62%) was comparable to that of those with mixed infections (50.38%). There were statistically significant differences in the distribution of children with single pathogen infection by gender (P < 0.05). The age distribution of children with single bacterial, single viral and single fungal infections was statistically different (P < 0.05). There was no significant difference in the distribution of onset season in children with single pathogen infections (P > 0.05), but the number of children with single viral infections was significantly higher in winter and spring than that in summer and autumn, and the difference was statistically significant (P < 0.05). A mixture of 2 pathogens (77.61%) accounted for the majority of mixed infections, there were statistical differences in the distribution of bacterial + viral infection in terms of gender, age, and onset season (P < 0.05), children with viral + mycoplasma infection in terms of gender and age (P < 0.05), and children with viral + fungal infection in terms of gender (P < 0.05), and children with bacterial + mycoplasma infection in terms of age and onset season (P < 0.05). Among the children infected with 3 pathogens, there were statistically significant differences in the distribution of bacterial + viral + fungal and viral + mycoplasma + fungal infections in terms of gender (P < 0.05), and children with bacterial + viral + mycoplasma infection in terms of age (P < 0.05), while there was no significant difference in the distribution of onset season (P > 0.05). There were no significant differences in the distribution of children infected with 4 pathogens in terms of gender, age and onset season (P > 0.05).ConclusionThe pathogens of pediatric patients with severe pneumonia in PICU commonly involves bacteria and viruses. As the age of children grows, the detection rate of bacteria shows a decreasing trend, and the pathogenic spectrum gradually changes from bacteria to mycoplasma and viruses, and the number of mixed infections gradually increase. Rational selection of antimicrobial drugs needs to consider pathogenic characteristics of different age, gender, and onset season in clinical practice.

Feasibility and acceptability of bubble continuous positive airway pressure oxygen therapy for the treatment of childhood severe pneumonia and hypoxaemia in Bangladeshi children

Effective management of hypoxaemia is key to reducing pneumonia deaths in children. In an intensive care setting within a tertiary hospital in Bangladesh, bubble continuous positive airway pressure (bCPAP) oxygen therapy was beneficial in reducing deaths in this population. To inform a future trial, we investigated the feasibility of introducing bCPAP in this population in non-tertiary/district hospitals in Bangladesh. We conducted a qualitative assessment using a descriptive phenomenological approach to understand the structural and functional capacity of the non-tertiary hospitals (Institute of Child and Mother Health and Kushtia General Hospital) for the clinical use of bCPAP. We conducted interviews and focus group discussions (23 nurses, seven physicians, 14 parents). We retrospectively (12 months) and prospectively (three months) measured the prevalence of severe pneumonia and hypoxaemia in children attending the two study sites. For the feasibility phase, we enrolled 20 patients with severe pneumonia (age two to 24 months) to receive bCPAP, putting in place safeguards to identify risk. Retrospectively, while 747 of 3012 (24.8%) children had a diagnosis of severe pneumonia, no pulse oxygen saturation information was available. Of 3008 children prospectively assessed with pulse oximetry when attending the two sites, 81 (3.7%) had severe pneumonia and hypoxaemia. The main structural challenges to implementation were the inadequate number of pulse oximeters, lack of power generator backup, high patient load with an inadequate number of hospital staff, and inadequate and non-functioning oxygen flow meters. Functional challenges were the rapid turnover of trained clinicians in the hospitals, limited post-admission routine care for in-patients by hospital clinicians due to their extreme workload (particularly after official hours). The study implemented a minimum of four hourly clinical reviews and provided oxygen concentrators (with backup oxygen cylinders), and automatic power generator backup. Twenty children with a mean age of 6.7 (standard deviation (SD) = 5.0)) months with severe pneumonia and hypoxaemia (median (md) SpO2 = 87% in room air, interquartile range (IQR) = 85-88)) with cough (100%) and severe respiratory difficulties (100%) received bCPAP oxygen therapy for a median of 16 hours (IQR = 6-16). There were no treatment failures or deaths. Implementation of low-cost bCPAP oxygen therapy is feasible in non-tertiary/district hospitals when additional training and resources are allocated.

Characteristics of Deep Vein Thrombosis on Ultrasound in Mechanically Ventilated SARS-Cov-2 Patients

Aim: To evaluate the prevalence of asymptomatic DVT and its characteristics on venous doppler and grey scale ultrasound in lower limbs in mechanically ventilated SARS-Cov-2 Patients with high levels of D-dimer. Methods: This cross-sectional observational study was carried out in the Department of Radiodiagnosis Sri Aurobindo Medical College and P.G. Institute, Indore over the period of one year. Doppler ultrasound (DU) was performed on critically ill SARS-COV-2 patients (n =45) with severe respiratory failure, with the diagnosis of severe pneumonia and high levels of D-dimer by bedside US examination was performed with a high-frequency linear transducer on GE-logiq E machine. DU protocol includes grayscale, colour and spectral Doppler evaluation. The examination included the deep venous system of the thigh, calf, and saphenous veins. Result: Out of Forty-five patients [age, mean age 47.1 years; female/male ratio, 0.66; DVT was diagnosed in 24 patients (53.3%), 6 (25%) in proximal venous territory femoral vein, 4 (16.66%) in popliteal veins and 14 (58.33%) in distal venous territory beneath popliteal vein. CFV diameter was increased to a mean of 13.2 mm (10.8-14.6) (normal range, 9.1-12) and PBFV reduced to a mean of 10.8 cm/s (8.1-14.5) (normal range, 21.3-49.2) on doppler in positive DVT patients. Conclusion: We propose that DU allows the detection of DVT in asymptomatic mechanically ventilated SARS-Cov-2 Patients with elevated D-dimer patients. Low resistant venous return evidenced by larger than normal CFV diameters and lower than normal PBFVs may have facilitated proximal DVT occurrence.

Retracted: Serum MMP-9 and SAA in the Diagnosis of Severe Pneumonia Caused by Radiotherapy of Esophageal Cancer.

[This retracts the article DOI: 10.1155/2021/6032546.].

Sensitivity, Specificity and Predictive Values of Chest Indrawing in the Diagnosis of Severe Pneumonia

Background: Pneumonia is a recognized leading killer disease in under 5 children not only in Bangladesh but also in all developing countries. The presence of lower chest indrawing means that the child has severe pneumonia. This study aimed to determine the sensitivity, specificity and predictive values of chest indrawing in the diagnosis of severe pneumonia. Methods: This analytical study was conducted in the department of pediatrics, Sher-e-Bangla Medical College Hospital, Barisal, from January 2015 to December 2015. A total of 100 cases of severe pneumonia aged from 2 months to 5 years and similar numbers of suitably matched controls who fulfilled inclusion criteria were enrolled in this study. A detailed history was taken, a thorough physical examination was done, data were recorded in a preformed questionnaire and were analyzed using a scientific calculator. Results: Out of 100 cases, 80 (80%) and 100 controls, 72 (72%) were in the age group of 2 months to 1 year. Fast breathing was present in 98 (98%) cases and 88 (88%) controls. Chest indrawing was present in 56 (56%) cases and 42 (42%) controls. Roentgenographically, 44 (44%) cases revealed labor/segmental consolidation, and bilateral patchy consolidation was present in 56 (56%) cases. Among the control group, 28 (28%) patients had hyperlucency of peripheral lung fields in their chest X-rays. In this study, it was found that sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of chest indrawing in the diagnosis of severe pneumonia was 56%, 58%, 57.1% and 56.8% respectively. Conclusion: Chest indrawing alone is not a highly sensitive tool to predict severe pneumonia but in rural areas where X-ray facilities are not available, chest indrawing may play an important role in identifying children with possible severe pneumonia. Mediscope 2022;9(2): 54-59

MO319: AKI in Patients With COVID-19 Supported on ECMO: A Single Center Experience in Mexico

BACKGROUND AND AIMSAKI is a common complication in critically ill patients, during the COVID-19 pandemic, it has been presented directly associated with damage by the virus, due to the severity of the disease and secondary to treatment, that is, secondary to the crosstalk of organs and the crosstalk of support equipment, such as the extracorporeal oxygenation membrane (ECMO), which has been used in patients with severe respiratory failure. According to the international bibliography, the incidence of AKI in ECMO ranges from 26% to 85% depending on the characteristics of the patient, the percentage that requires KRT is around 45%.OBJECTIVEOur hospital is a national reference center for ECMO support therapy as for lung transplantation, it is the only center that has an active program, so understanding the epidemiology of AKI associated with ECMO in our population is important, in addition to representing a part of the experience in Latin America.METHODRetrospective and descriptive studies were included all patients 18 years or older connected to ECMO with a diagnosis of severe pneumonia for COVID-19 from June 2020 to August 2021. Data were collected in Excel and using the ECMO Team platform data that is shared in the ELSO. Descriptive data analysis was performed with SPSS V21 and Excel.RESULTSA total of 48 patients were connected to ECMO for COVID-19 severe pneumonia in our center, of which 39 were men. Average age 49 years (min 21 year, max 68 year), average weight 93 kg (min 55 kg, max 125 kg) 25 patients (52%) with AKI, 22 (45%) required KRT and 100% CKRT. Of them, 10 patients (20%) have kidney recovery function, all of them get out form ECMO. From all, 45% patients died, these 45% were still in ECMO. In most of the cases, the AKI cause is multifactorial, but the most common cause identified was sepsis, the second nephrotoxicity (antibiotics like vancomycin and colistin) and the third hemolysis (an ECMO membrane complication). About the indication of star KRT: 50% fluid overload, 30% acidosis and uremia and 20% anuria. A total of 100% of patients were in ECMO-VV at time CKRT started, all were connected in parallel in ECMO in post-blood pump and return pre-blood pump, with no coagulation problems as long as they have the ECMO anticoagulation, 93% patients with heparin and 7% with argatroban for HIT suspicious. As data to highlight from our population, there is the first bilateral lung transplant secondary to COVID-19 in Latin America and the longest air transfer in ECMO in the world.CONCLUSIONIn our center, the AKI, KRT and mortality in patients with ECMO are much like other centers reported. In COVID-19, there is not yet very clear evidence and more studies should be done. This is the first study in Mexico about ECMO, AKI and COVID-19.

Type-H, and Type-L COVID-19: are they different subtypes or the same?

SARS-CoV-2 infection, which causes severe pneumonia, caused an epidemic that started in Wuhan, China in December 2019 and spread to the whole world. COVID-19 mainly affects the respiratory system and causes the development of severe pneumonia and related acute respiratory distress syndrome (ARDS) in some patients. We aimed to investigate whether COVID-19 pneumonia cases can be evaluated in different categories in clinical and radiological terms. COVID-19 associated ARDS cases being treated with the diagnosis of severe pneumonia between March 21, 2020 and June 15, 2020 in Anesthesia Intensive Care Unit were examined and divided into 2 groups (type-L and type-H, total 29 cases) according to their clinical findings (according to whether they benefited from high PEEP and their lung compliance) and lung computed tomography findings (according to the severity of the ground glass appearance). The groups were compared with each other in terms of inflammatory markers [CRP (C reactive protein), ferritin, D Dimer, PCT (procalcitonin), white blood cell, lymphocyte count, arterial blood gas analysis] and imaging findings. It was observed that the prone position was beneficial in improving oxygenation in both H-type and L-type patients. 7 of 22 L-type patients were intubated and 5 of these patients died. There was no statistical difference between the two groups in terms of intubation times, hospital stays, cytokine levels, prone position application responses and mortality rates. Are there two separate forms of COVID-19 pneumonia, such as h-type and l-type, or are they intertwined and describe the early and late stages of the disease? This question needs to be discussed. In addition, we believe that subtyping COVID-19 pneumonia patients does not make a difference in the treatments to be applied.

Application of metagenomic next-generation sequencing in the diagnosis of severe pneumonia caused by Chlamydia psittaci

PurposePsittacosis is a zoonotic infectious disease caused by the transmission of the bacterium Chlamydia psittaci (C. psittaci) from birds to humans. Infections in humans mainly present as community-acquired pneumonia (CAP). However, most cases are treated without diagnostic testing, and the importance of Chlamydia psittaci infection as a cause of CAP is therefore unclear. Diagnostic tools, including culture, serologic test, and PCR-based methods, are available but prone to false negative results. Metagenomic next-generation sequencing (mNGS) has been increasingly used in the diagnosis of infectious diseases, particularly when conventional diagnostic approaches have limitation.Detection of nucleic acid sequence of C. psittaci in respiratory tract samples by metagenomic next-generation sequencing (mNGS) is effective for early diagnosis of severe C. psittaci pneumonia. Timely treatment based on tetracycline can reduce unnecessary use of antibiotics and improve prognosis of patients with severe C. psittaci pneumonia.MethodsClinical data of thirteen patients with severe C. psittaci pneumonia diagnosed by mNGS were collected. Clinical manifestations, treatment and prognosis of patients were summarized.ResultsThe typical symptoms of pneumonia caused by C. psittaci include fever, headache, myalgia, cough, and dyspnea. In the current study, all patients met the criteria for severe C. psittaci pneumonia and received mechanical ventilation, including noninvasive mechanical ventilation (five/thirteen) and invasive mechanical ventilation (eight/thirteen). The findings showed that patients with C. psittaci pneumonia presented with normal or slightly increased leucocytes and procalcitonin, and high C-reactive protein levels. Computed tomography manifestations included consolidation of lung parenchyma, with air bronchogram and pleural effusion in some patients. mNGS analysis results were obtained within 48–72 h. Eleven patients fully recovered after targeted treatment, however, two patients died from secondary multidrug-resistant Pseudomonas aeruginosa infection.ConclusionsThe findings of the current study show that mNGS is effective in diagnosis of C. psittaci pneumonia, and has significant diagnosis value in patients with severe infection. Patients responds well to the timely use of appropriate antibiotics.

Miliary Tuberculosis with Severe Pneumonia without Abnormal Chest Sounds in a Covid-19 Pandemic

Background: Tuberculosis (TB) is still causing deaths in children in TB endemic countries. Majority (80%) occur in the lungs, with 5% being miliary TB. It is an Interstitial Lung Disease (ILD) with similar clinical, physiological and radiological features to other ILD and affects mainly infants and children with a high mortality rate despite available treatment. Case Presentation: A three-month old male presented during the COVID-19 pandemic with fever of 2 weeks, cough of one week, fast and difficult breathing of 6 days’ duration. He received BCG vaccine 16 days after birth despite being unknowingly exposed to the TB contact from birth. He was acutely ill looking, with severe pneumonia and SPO2 of 76% in room air. Respiratory examination showed broncho vesicular breath sounds with no added sounds. A diagnosis of Severe pneumonia? Pneumocystis Jiroveci Pneumonia (PJP) and R/O COVID-19 was made. Subsequent reviews excluded PJP and COVID-19 and the final diagnosis was Disseminated (Miliary) TB. He was successfully treated with anti-TB medications for 12 months. Conclusion: Miliary TB presents with common and uncommon manifestations that may be confusing, and so a high index of suspicion with a careful history, focused systemic examination, imaging and bacteriological studies are strongly recommended for its early diagnosis.

Serum MMP-9 and SAA in the Diagnosis of Severe Pneumonia Caused by Radiotherapy of Esophageal Cancer.

Objective To explore the relationship and diagnostic value of serum MMP-9 and SAA in severe pneumonia (sCAP) caused by radiotherapy of esophageal cancer. Methods A total of 144 esophageal cancer patients who underwent radiotherapy in our hospital from April 2016 to February 2018 were collected. Among them, 58 patients without radiation pneumonitis (RP) were in the control group, 49 patients with grade 1∼2 RP were in the radiation group, and 37 patients with sCAP were in the severe group. The levels of serum MMP-9 and SAA in every group of patients were detected. The ROC curve was used to determine the diagnostic value of serum MMP-9 and SAA in the diagnosis of RP and sCAP. The correlation between serum MMP-9 and SAA and the patient's lung function indexes was analyzed, and the logistic single-factor and multivariate analyses were performed to analyze the factors of sCAP in esophageal cancer radiotherapy. Results PaO2, FVC, and FEV1 decreased in RP and sCAP, and PaCO2, white blood cells, serum MMP-9, and SAA levels increased (P < 0.05); serum MMP-9 and SAA were negatively correlated with lung function (P < 0.05); the AUC of serum MMP-9 and SAA in RP was 0.833 and 0.823, respectively, and the AUC of the two combined diagnosis of RP was 0.919. The AUC of serum MMP-9 and SAA in sCAP was 0.809 and 0.797, respectively, and the AUC of both combined diagnosis of sCAP was 0.873; logistics multivariate analysis found that serum MMP-9, serum SAA, double lung V5, and V20 were independent risk factors for sCAP caused by radiotherapy for esophageal cancer (P < 0.05). Conclusion Serum MMP-9 and SAA increase in RP and sCAP and are negatively correlated with lung function in patients with pneumonia. They are independent risk factors for severe pneumonia caused by radiotherapy of esophageal cancer and have good diagnostic value.

Clinical epidemiology and mortality on patients with acute respiratory distress syndrome (ARDS) in Vietnam.

BackgroundThe clinical epidemiology and disease prognosis in patients with acute respiratory distress syndrome (ARDS) have not yet been fully elucidated in Vietnam.MethodsWe conducted a retrospective observational study at a national tertiary hospital in Hanoi, Vietnam. Participants were adult patients (age ≥18 years) who were admitted and diagnosed with ARDS during 2015–2017. Data on patients’ general and clinical conditions, radiographic findings, ventilator settings, gas exchange, and treatment methods were collected and compared between survivors and non-survivors. Risk factors for mortality were assessed using logistic regression analysis.ResultsAmong 126 eligible patients with ARDS admitted to the central tertiary hospital in Vietnam, we observed high mortality (57.1%). Of the total patients, 91.3% were transferred from local hospitals with a diagnosis of severe pneumonia and then diagnosed with ARDS at the central hospital. At the time of admission, 53.2% of patients had severe ARDS, 37.3% had moderate ARDS, and 9.5% had mild ARDS. The mean (standard deviation) sequential organ failure assessment (SOFA) score was 9.5 (3.4) in non-survivors and 7.4 (3.4) in survivors (p = 0.002). Although there was no significant difference in PaO2/FiO2 on admission between non-survivors and survivors, that on day 3 after admission was significantly different (p = 0.002). Logistic regression revealed that PaO2/FiO2 on day 3 [odds ratio (OR), 1.010; 95% confidence interval (CI), 1.003–1.017], length of stay in a local hospital before admission to the central hospital (OR, 1.122; 95% CI, 1.042–1.210) due to stable condition, and SOFA score on Day 1 (OR, 0.842; 95% CI, 0.708–1.002) were independent factors in patient survival.ConclusionsPatients with ARDS admitted the central tertiary hospital had severe illness and high mortality. Most patients were transferred from local hospitals. Improvements in human, medical, and sociological resources in local will contribute to reducing the mortality of ARDS in Vietnam.

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.

Association between the clinical findings and chest radiographs in children with severe pneumonia aged 1 month to 5 years

Background: Pneumonia is the main cause of death among children under five years of age particularly in developing countries. According to the WHO, there are more than 15 million cases representing 7-13% of pneumonia cases annually which necessitate hospital admission due to their severity. There is paucity of data regarding the clinical spectrum and the epidemiology of severe pneumonia from eastern part of Nepal. It is important to understand the clinical spectrum and the epidemiology of severe pneumonia at local level to better define problem and to draw inferences for management and policy formulation.&#x0D; Material and Methods: A hospital based retrospective observational study conducted at Department of Pediatrics and Neonatology, Nobel Medical College and Teaching Hospital, Biratnagar, Nepal. One hundred and forty four cases with a diagnosis of severe pneumonia were studied over a period of one year. All the cases from 1 month to 5 years of age fulfilling the standard WHO case definition of severe pneumonia were included in the study. A pre-designed semi-structured questionnaire was used to obtain the clinical profile and investigations.&#x0D; Results: A total of 144 cases were studied and analyzed. The age range was from 1 month to 5 years. The mean age of the cases was 13.56 months. Majority of the cases belonged to age group of 1-6 months 40.27% (n=58). There was a male preponderance in our study comprising 58.3% (n=84) of males and 41.7% (n=60) of females. Fever and cough were the most common symptoms present in all cases, fever being present in 95.8% (n=136) cases and cough was present in 98.6% (n=142) cases. The most common radiological finding in our study was bronchopneumonia in 27.8% (n=40) cases followed by lobar pneumonia in 24.3% (n=35) cases and interstitial pneumonia in 18.8% (n=27) cases. Complications were present in 6.9% (n=10) cases and 22.2% (n=32) of the cases had no radiological abnormalities. Among the studied symptoms and signs of severe pneumonia, hurried breathing (p&lt;0.001), wheeze (p=0.016), refusal of feeds (p=0.001), altered sensorium (p=0.006) and previous history of acute respiratory infections showed significant association with radiological abnormalities.&#x0D; Conclusion: Children of severe pneumonia presenting with fast breathing, wheeze, altered sensorium, refusal of feeding and past history of acute respiratory infections showed significant association with abnormal chest radiographs.

The role of presepsin in the diagnosis and assessment of severity of sepsis and severe pneumonia

The aim of this study was to evaluate marker of inflammation presepsin to improve diagnosis of severe pneumonia, sepsis. Materials and methods. 75 patients with pneumonia, sepsis, other inflammatory diseases aged from 17 to 78 years were examined. These patients have been investigated for the level of the presepsin. Presepsin level was quantified on immunohemilyuministsentny analyzer Pathfast (Mitsubishi Chemical Medience Corporation, Japan) in pg/ml. All patients had obtained an antibacterial therapy in other health care organizations before entering the hospital. Results. Presepsin at the general group of patients with pneumogenic sepsis was 3196.9±1202.16 pg/mL (n=14, x̅±m), with abdominal sepsis - 2506.7±448.32 pg/mL (n=28), with other inflammatory diseases - 671.6±124.55 pg/mL (n=11). Presepsin of patients with pneumogenic sepsis was 1125.3±240.59 pg/mL (n=3), presepsin of patients with severe pneumonia was - 362.6±76.29 pg/mL (n=13, p

Frequency of foreign body inhalation in eight month duration admitted in Paediatric intensive care unit of Abbasi Shaheed hospital (tertiary care centre)

We present four cases of foreign body inhalation in eight month period (May-Dec 2016) admitted in pediatric intensive care unit (p.i.c.u) of Abassi Shaheed Hospital. Age range was eleven months to four years. Male gender was predominant among the case series. All of the cases presented with sudden onset of respiratory distress along with fever and cough. On examination all patients were febrile, tachpneic, tachycardic with subcostal and intercostal recessions. A working diagnosis of severe pneumonia was made and child was put on intravenous antibiotics and nebulizations. After 48 hours of admission, there was no improvement clinically so suspicion of foreign body was made on the basis chest of x-ray. Rigid bronchoscopy was done; foreign body peanut (1), chicken bone (1) and betel nut (2) were found. All children showed rapid improvement after removal of foreign body and were discharged soon after. Parents were counseled regarding addiction of betel nut and avoidance of foreign body inhalation in growing children. Hence we conclude that foreign body inhalation should be kept as a differential diagnosis in every child presenting with respiratory distress without improvement despite treatment. Parents should also be counseled for being vigilant around their children. There is no conflict of interest.

Delirium symptoms during hospitalization predict long-term mortality in patients with severe pneumonia.

Delirium is common in critically ill patients and impact in-hospital mortality in patients with pneumonia. The aim of the study was to evaluate the prevalence of delirium symptoms during hospitalization in patients with severe pneumonia and their impact on one-year mortality. This was an observational, retrospective, cohort study of consecutive patients admitted to the respiratory high dependency unit of the San Gerardo University Hospital, Monza, Italy, between January 2009 and December 2012 with a diagnosis of severe pneumonia. A search through the charts looking for ten key words associated with delirium (confusion, disorientation, altered mental status, delirium, agitation, inappropriate behavior, mental status change, inattention, hallucination, lethargy) was performed by a multidisciplinary team. The primary endpoint was mortality at one-year follow-up. Secondary endpoint was in-hospital mortality. A total of 172 patients were enrolled (78% males; median age 75years). At least one delirium symptom was detected in 53 patients (31%) during hospitalization. The prevalence of delirium symptoms was higher among those who died during hospitalization vs. those who survived (44 vs. 27%, p=0.049, respectively). Seventy-one patients (46%) died during the one-year follow-up. The prevalence of at least one delirium symptom was higher among those who died than those who survived during the one-year follow-up (39 vs. 21%, p=0.014, respectively). At the multivariable logistic regression analysis, after adjustment for age, comorbidities and severe sepsis, the presence of at least one delirium symptom during hospitalization was an independent predictor of one-year mortality (OR 2.35; 95% CI 1.13-4.90; p=0.023). Delirium symptoms are independent predictors of one-year mortality in hospitalized patients with severe pneumonia. Further studies should confirm our results using prospective methods of collecting data.

Circulating MicroRNA Levels In Patients With Different clinical outcomes of The infection with influenza A/H1N1 Virus

Event Abstract Back to Event Circulating MicroRNA Levels In Patients With Different clinical outcomes of The infection with influenza A/H1N1 Virus Juan Moran1, 2, Alfredo Cruz-Lagunas1, Luis A. Jimenez-Alvarez1, Gustavo Ramirez-Martinez1 and Joaquin Zúñiga1* 1 Instituto Nacional de Enfermedades Respiratorias "Ismael Coso Villegas", Inmunologia, Mexico 2 Universidad Nacional Autónoma de México, Posgrado en Ciencias Biológicas, Mexico RATIONALE. Current evidence suggests that the development of severe pneumonia in patients with pandemic (pdm) A/H1N1 infection is associated with an excessive immune activation. High levels of pro-inflammatory mediators have been detected in blood and lung from patients with pdm A/H1N1 infection. Even though cytokines, chemokines, and growth factors are required to control influenza virus infection, their overproduction in an uncontrolled inflammatory response can lead to lung tissue damage. MicroRNAs (miRNAs) regulate most of the cellular processes including antiviral inflammatory responses. The profiles of circulating miRNAs in patients with severe pneumonia associated to pdm A/H1N1 virus have not been described. METHODS. We analyzed the genome-wide circulating miRNA profile by RT-PCR in 29 individuals (8 with diagnosis of severe pneumonia by A/H1N1 virus, 8 with mild pneumonia by A/H1N1, 8 household asymptomatic contacts and 5 healthy controls). Total circulating RNA was extracted from a serum volume of 250μL using Trizol. TaqMan miRNA low-density arrays (TLDAs) covering 768 miRNA species and endogenous controls were used for miRNA profiling in all the individuals. miRNA TLDAs microarray data analyses were performed with an algorithm designed in Perl language. We performed standard normalization using U6 endogenous control. ANOVA and Mann Whitney tests were performed to analyze differences between groups. RESULTS. We found a set of circulating miRNAs that were differentially expressed (p<0.05) in the group of patients with A/H1N1 severe pneumonia (miR-150, 29c, miR-22). In other side miR-210 and miR-145 were marking the symptomatic form of the infection without a distinction between severity and non-severity of the included patients. Interestingly, we found a diminished expression of miR-126 and miR-222 at all the patients that were exposed to (pdm) A/H1N1 virus independently from the clinical outcome of the disease. KEEG pathways enrichment and interactome network (Cytoscape V3.1.1) analysis of the differentially expressed miRNAs in A/H1N1 infection shows a connection between miR29c, miR150, miR-210, miR-145, miR-222 and miR-126 networking principally with the (PI3K)-Akt-mTOR, VEGF, Cancer and antiviral pathways. CONCLUSIONS. The expression of circulating miRNAs is altered in patients with different clinical outcomes of A/H1N1 infection. To our knowledge, this is the first evidence of deregulated miRNA expression in severe A/H1N1 disease, providing insights that may lead to the identification of novel biomarkers and altered molecular pathways of the disease. Keywords: miRNAs, H1N1pdm, Pneumonia, Cytokines, TLDAs Conference: IMMUNOCOLOMBIA2015 - 11th Congress of the Latin American Association of Immunology - 10o. Congreso de la Asociación Colombiana de Alergia, Asma e Inmunología, Medellin, Colombia, 13 Oct - 16 Oct, 2015. Presentation Type: Oral Presentation Topic: Immunogenetics Citation: Moran J, Cruz-Lagunas A, Jimenez-Alvarez LA, Ramirez-Martinez G and Zúñiga J (2015). Circulating MicroRNA Levels In Patients With Different clinical outcomes of The infection with influenza A/H1N1 Virus. Front. Immunol. Conference Abstract: IMMUNOCOLOMBIA2015 - 11th Congress of the Latin American Association of Immunology - 10o. Congreso de la Asociación Colombiana de Alergia, Asma e Inmunología. doi: 10.3389/conf.fimmu.2015.05.00304 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 15 May 2015; Published Online: 15 Sep 2015. * Correspondence: PhD. Joaquin Zúñiga, Instituto Nacional de Enfermedades Respiratorias "Ismael Coso Villegas", Inmunologia, Mexico City, 14080, Mexico, joazu@yahoo.com Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Juan Moran Alfredo Cruz-Lagunas Luis A Jimenez-Alvarez Gustavo Ramirez-Martinez Joaquin Zúñiga Google Juan Moran Alfredo Cruz-Lagunas Luis A Jimenez-Alvarez Gustavo Ramirez-Martinez Joaquin Zúñiga Google Scholar Juan Moran Alfredo Cruz-Lagunas Luis A Jimenez-Alvarez Gustavo Ramirez-Martinez Joaquin Zúñiga PubMed Juan Moran Alfredo Cruz-Lagunas Luis A Jimenez-Alvarez Gustavo Ramirez-Martinez Joaquin Zúñiga Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Does Vitamin D supplementation benefit children with severe pneumonia? Critical appraisal of article Vitamin D supplementation for severe pneumonia - a randomized controlled trial. Nidhi C, Piyush G. Indian Pediatr. 2012;49:449–454

QuestionThe primary objective was to determine the role of Vitamin D in severe pneumonia and secondarily with duration of hospitalization, time of resolution of tachypnea, chest retraction and inability to drink water. MethodEthical consent was obtained from institutional ethical committee and written informed consent from caregiver of the patients. It is a randomized controlled trial with double blinding. The patients aged between 2 months and 5 years with diagnosis of severe pneumonia were included. Excluded were children with severe wasting (weight for height <3SD), chronic illness, recent history of Vitamin D intake and known cases of asthma.Randomization was done using computer generated table into interventional and placebo group. Each sachet of Vitamin D weighing 1 g containing 60,000 IU was mixed with 11 g of lactose. This total amount was divided into 60 equal doses, each weighing 200 mg and containing 1000 IU of Vitamin D. Interventional group received 1000 IU of Vitamin D for 5 days starting from the day of admission. Placebo group received lactose for same duration.Because of safety concern, lack of safety data and absence of Vitamin D level monitoring, low dose short course Vitamin D was given in this study. Also because of above reason children <2 months were excluded.Sample size calculation was done based on the role of Zinc for resolution of severe pneumonia taking one day as meaningful difference with standard deviation of 2.5, type I error 0.05 and power of 80%.Initial data was collected on socio-demographic profile, feeding history (Breast feeding, exclusive breast feeding and complementary feeding), immunization status, past history of pneumonia, fuel use or smoking, socioeconomic status and anthropometry. Monitoring was done on respiratory rate, retraction, axillary temperature, feeding, mental status, oxygen saturation and laboratory variables like hemogram, blood sugar, electrolytes, calcium, phosphate and alkaline phosphatase levels. Main results283 children were diagnosed with severe pneumonia of which 200 were randomized; 100 in interventional and 100 in placebo group. The two groups were compared for all baseline characteristics. The median duration for resolution of severe pneumonia, duration of hospitalization, resolution of tachypnea, chest retraction, fever, inability to feed and lethargy were compared and found to be similar in intervention and placebo group.Out of 200 children, 191 were discharged (97 interventional and 94 placebo group), 2 died (1 from each group), 7 left against medical advice.No difference was observed between interventional and placebo group in resolution of severe pneumonia, duration of hospitalization or time of resolution of each symptoms. ConclusionNo effect was observed of short term 1000 IU dose of Vitamin D on time of resolution of severe pneumonia. Further studies using higher dose of Vitamin D with long term follow up are needed to completely prove it.