Predictors Of Pneumonia Research Articles

451. PREDICTIVE FACTORS FOR PNEUMONIA AND ANASTOMOTIC LEAK AFTER TRANSTHORACIC ESOPHAGECTOMY FOR CANCER AND FAILURE TO RESCUE ANALYSIS ON 1355 PATIENTS

Abstract Background Pneumonia (PN) and anastomotic leak (AL) represent the most feared complications after transthoracic esophagectomy for cancer, the former more commonly observed after open and the latter after minimally-invasive (MI) procedures. Studies comparing these two complications with focus on predictive risk factors and procedure-related failure-to-rescue (FTR) are sparse. Aim of the study was to explore such aspects with a large multicentric dataset. Methods All patients who underwent an Ivor Lewis transthoracic esophagectomy for cancer between 2008 and 2022 in four tertiary centers were queried. Predictive risk factors for pneumonia, anastomotic leak and in-hospital mortality were analyzed with univariable models. FTR was defined as in-hospital death following a major complication. Patients were then classified and compared according to the type of operation [open, hybrid-laparoscopic, hybrid-robotic, standard minimally-invasive (MIE) or robotic minimally-invasive (RAMIE)]. Pneumonia and anastomotic leak associated FTR was calculated and compared across the groups. Machine-learning models (neuronal nets, support vector machines and random forests classifier) were applied to predict complications and FTR. Results In total, 1,355 patients were included. Significant (p<0.05) predictors for PN (n=211, 15.6%) were ASA=4, preexisting cardiac and pulmonary conditions, conversion (thoracotomy), neoadjuvant therapy and age. Those for AL (n=160, 11.8%) were preexisting cardiac condition, conversion (thoracotomy) and operation time. Overall FTR-rate was 3.6%. Age>65y, preexisting cardiac and pulmonary condition, AL, PN, postoperative bleeding, sepsis, pulmonary embolism, myocardial infarction, arrhythmia and need for blood transfusion were the risk factors significantly associated with in-hospital mortality. PN- and AL- associated FTR rates did not significantly differ among the different operation types (Figure 1). Machine-learning models were unable to predict complications or FTR properly. Conclusions Our study showed that there is a greater number of factors associated with pneumonia rather than anastomotic leak, probably making the prevention of this complication more challenging to achieve. However, pneumonia- and leak-associated FTR-rates did not significantly differ among the groups, demonstrating that the implementation of minimally-invasive procedures can be safely carried out, if experience is provided.

Predictors of radiographic pneumonia in febrile children with cancer presenting to the emergency department

BackgroundFever is a common presenting complaint to the pediatric emergency department (PED), especially among oncology patients. While bacteremia has been extensively studied in this population, pneumonia has not. Some studies suggest that chest X-ray (CXR) does not have a role in the investigation of neutropenic fever in the absence of respiratory symptoms, yet non-neutropenic pediatric oncology patients were excluded from these studies. ObjectiveWe aimed to determine the incidence of CXRs ordered for febrile pediatric oncology patients, irrespective of their absolute neutrophil count (ANC), and to evaluate the rates of radiographic pneumonia as well as predictors of the latter in this group. MethodThis study was conducted in the PED at the American University of Beirut Medical Center (AUBMC), an Eastern Mediterranean tertiary-care hospital. We conducted a retrospective cohort study of acutely febrile pediatric cancer patients, younger than 18 years, presenting to a tertiary center from 2014 to 2018. We included one randomly selected febrile visit per patient. Fever was defined as a single oral temperature ≥38 °C within 24 h of presentation. We collected data on patient characteristics and outcomes. Our primary outcome was radiographic pneumonia; our secondary outcome was whether a CXR was done or not. We defined radiographic pneumonia as a consolidation, pleural effusion, infiltrate, pneumonia, “infiltrate vs. atelectasis,” or possible pneumonia mentioned by the radiologist. SPSS was used for the statistical analysis. ResultsWe reviewed a total of 664 medical charts and included data from 342 febrile pediatric patients in our analysis. Of these, 64 (18.7%) had a CXR performed. Overall, 16 (25%) had radiographic pneumonia while 48 (75%) did not. Patients were significantly more likely to have a CXR performed if they presented with upper respiratory tract symptoms, cough (p < 0.001 for both), or abnormal lung auscultation at the bedside (p = 0.004). Patients were also less likely to have a CXR done if they were asymptomatic upon admission to the PED (p < 0.001). However, neither cough nor shortness of breath nor abnormal lung examinations were significant predictors of a positive CXR (p = 0.17, 0.43, and 0.669, respectively). Patients with radiographic pneumonia were found to be significantly younger (4.29 vs. 6 years, p = 0.03), with a longer time since their last chemotherapy (15 vs. 7 days, p = 0.005), and were given intravenous (IV) bolus in the PED (87.5% vs. 56.3%, p = 0.02). Interestingly, patients with higher white blood cell (WBC) counts were more likely to have radiographic pneumonia (4850 vs. 1750, p = 0.01). Having a cough and an abnormal lung examination on presentation increased the odds of having a CXR (adjusted odds ratio [aOR]: 6.6; 95% confidence interval [CI]: 3.4–12.8 and aOR: 4.5; 95% CI: 1.1–18.3, respectively). Returning to the PED for the same complaint within 2 weeks was associated with lower odds of a CXR at the index visit (aOR: 0.3; 95% CI: 0.1–0.6). For every year the child is older, the odds of having radiographic pneumonia decreased by 0.8 (95% CI: 0.6–0.98). However, for every day since the last chemotherapy session, the odds increased by 1.1 (95% CI: 1.01–1.12). ConclusionIn our sample, CXR was not commonly performed in the initial assessment of febrile cancer patients in the PED, unless respiratory symptoms or an abnormal lung examination was noted. However, these were not significant predictors of radiographic pneumonia. Further studies are needed to identify better predictors of pneumonia in this high-risk population.

Assessment of sarcopenic obesity as a predictor of pneumonia in patients with stable schizophrenia—A prospective study

The European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO) recently released the first international consensus on the diagnostic criteria for Sarcopenic obesity (SO). The present study aimed to explore the ability of SO to predict the risk of pneumonia in patients with stable schizophrenia. This was a prospective study involving hospitalized patients with schizophrenia aged ≥50 years from two mental health centers in western China. Baseline patient data were collected from September 1 to September 30, 2020. Follow-up data on pneumonia were collected from October 2020 to October 2022. The diagnosis of SO was based on the ESPEN/EASO criteria. Patients were assessed for handgrip strength (HGS), skeletal muscle mass/weight (SMM/W), and fat mass percentage (FM%). Logistic regression analysis was used to explore the effect of SO on the risk of pneumonia in patients with stable schizophrenia. A total of 320 patients with stable schizophrenia were included. Of these, 74 (23.13%) were diagnosed with SO, while 117 (36.56%) developed pneumonia. Compared with patients in the non-low HGS, non-low HGS+non-low SMM/W (or non-low HGS+low SMM/W or low HGS+non-low SMM/W) and non-SO groups, the proportions of patients with pneumonia in the low HGS (42.3% vs. 25.9%, p=0.004), low HGS+low SMM/W (45.3% vs. 33.3%, p=0.048), and SO (47.3% vs. 33.3%, p=0.029) groups, respectively, were higher. However, there was no difference in the proportion of patients with pneumonia in the low SMM/W group and the obese group compared with the non-low SMM/W and non-obese groups. Further logistic regression analysis after adjustment for potential influencing factors showed that compared with the non-low HGS group, patients in the low HGS group had a higher risk of pneumonia (OR=1.892, 95%CI: 1.096-3.264). SO defined according to the ESPEN/EASO criteria was not found to be significantly associated with the development of pneumonia in patients with stable schizophrenia. Further verification of these results is needed with larger sample sizes and the establishment of a cutoff value for this population.

Evolution of the impact of the COVID-19 pandemic on heart transplant recipients: Decreasing risk, improving perspective.

Heart transplant recipients (HTr) have a higher probability of suffer from severe coronavirus disease-2019 (COVID-19) in comparison to general population, but their risk has changed over the course of the pandemic in relation to various factors. We conducted a prospective study including all HTr at risk of COVID-19 in a tertiary center between February 2020 and October 2022. The aim was to analyze how the prognosis (incidence of pneumonia and mortality) of COVID-19 in HTr has evolved over time, contextualizing variants, vaccination, and other treatments. Of 308 HTr included, 124 got the infection (39.2%). COVID and non-COVID HTr had similar baseline characteristics. COVID-19 patients with pneumonia had a poorer prognosis than those with less severe presentations, with a higher rate of hospitalization (93.3vs. 14.1%, p < .001) and death (41.0vs. 1.2%, p < .001). Multivariate analysis identified age ≥60 years (odds ratio [OR] 3.65, 95% confidence interval [CI] 1.16-11.49, p = .027), and chronic kidney disease ≥3a (OR 4.95, 95% CI 1.39-17.54, p = .014) as predictors of pneumonia. Two-dose vaccination (OR 0.20, CI 95% 0.05-0.72, p = .02) and early remdesivir administration (OR 0.17, CI 0.03-0.90, p = .037) were protective factors. Over the course of the pandemic considering three periods in the follow-up (prevaccination February-December 2020, postvaccination January-December 2021, and post early remdesivir indication January-October 2022), we observed a reduction in pneumonia incidence from 62% to 19% (p < .001); and mortality (from 23% to 4%, p < .001). The prognosis of COVID-19 in HTr has improved over time, likely due to vaccination and early administration of remdesivir.

Utility of the Systemic Inflammation Response Index as a Predictor of Pneumonia After Spontaneous Intracerebral Hemorrhage.

We sought to determine whether the initial Systemic Inflammatory Response Index (SIRI) was associated with pneumonia after spontaneous intracerebral hemorrhage (SICH) in hospitalized patients. Patients with SICH admitted to Taizhou People's Hospital between January 2019 and December 2021 were retrospectively analyzed. Baseline variables were compared between stroke-associated pneumonia (SAP) and non-SAP groups. Multivariable logistic regression analyses were utilized to calculate the relationship between SIRI and SAP risk. Of 495 patients included in this research, 192 (38.79%) developed SAP ultimately. The SIRI values exhibited the highest area under the curve value for SAP incidence (area under the curve = 0.736, 95% CI: 0.692-0.781), with respective sensitivity and specificity values of 0.646 and 0.749 at the optimal cutoff threshold of 2.53. In multivariate analysis, high SIRI (≥2.53) was a significant independent predictor of post-SICH SAP even after controlling for other possible confounding variables (odds ratio: 5.11, 95% CI: 2.89-9.04, P < 0.001). According to the restricted cubic splines model, SAP risk increases as SIRI increases. We observed that SIRI values may offer high diagnostic utility as a predictor of SAP risk among patients with SICH during the early stages of the disease.

Diagnostic and Prognostic Roles of Procalcitonin and Other Tools in Community-Acquired Pneumonia: A Narrative Review.

Community-acquired pneumonia (CAP) is among the most common causes of death and one of the leading healthcare concerns worldwide. It can evolve into sepsis and septic shock, which have a high mortality rate, especially in critical patients and comorbidities. The definitions of sepsis were revised in the last decade as "life-threatening organ dysfunction caused by a dysregulated host response to infection". Procalcitonin (PCT), C-reactive protein (CRP), and complete blood count, including white blood cells, are among the most commonly analyzed sepsis-specific biomarkers also used in pneumonia in a broad range of studies. It appears to be a reliable diagnostic tool to expedite care of these patients with severe infections in the acute setting. PCT was found to be superior to most other acute phase reactants and indicators, including CRP as a predictor of pneumonia, bacteremia, sepsis, and poor outcome, although conflicting results exist. In addition, PCT use is beneficial to judge timing for the cessation of antibiotic treatment in most severe infectious states. The clinicians should be aware of strengths and weaknesses of known and potential biomarkers in expedient recognition and management of severe infections. This manuscript is intended to present an overview of the definitions, complications, and outcomes of CAP and sepsis in adults, with special regard to PCT and other important markers.

Increased thoracic fluid content is associated with higher risk for pneumonia in patients undergoing maintenance hemodialysis

Background Pneumonia is the most common infectious disease in patients undergoing maintenance hemodialysis (MHD). The aim of this study is to determine the possible predictive value of thoracic fluid content (TFC) for pneumonia in this population. Method Clinical data were recorded for 1412 MHD patients who were hospitalized for certain comorbidities or complications. Each patient underwent an impedance cardiography (ICG) examination before next dialysis session after admission. Patients were divided into Having-, Will-have-, and Non-pneumonia groups based on whether they had pneumonia at the time of ICG examination after the admission and within five months after the examination. Hemodynamic parameters and other clinical data were compared and analyzed. Results Patients who were going to develop pneumonia were older, and had a higher proportion of diabetes, poorer nutritional status, a higher level of inflammatory, poorer cardiac function, and more fluid volume load than those who did not develop pneumonia. Multivariate binary logistic analysis revealed that for each 1/KΩ increase in TFC and 1 increase in neutrophil-to-lymphocyte ratio (NLR), the risk of the development of pneumonia increased by 3.1% (p ˂ 0.01) and 7.2% (p = 0.035), respectively, whereas for each 1 g/L increase in hemoglobin and 1 g/L increase in serum albumin, the risk of the development of pneumonia decreased by 1.3% (p = 0.034) and 5% (p = 0.048), respectively. Conclusions TFC, NLR, hemoglobin, and serum albumin were independent risk factors for the development of pneumonia in MHD patients. Given the advantages of ICG, TFC can be used clinically as a helpful predictor of pneumonia in MHD patients.

The Predictors of Pneumonia in Children with COVID-19

The purpose of this study was to evaluate the relationship between the presence of pneumonia and blood parameters in casesof Coronavirus disease (COVID-19) and to examine their predictive characteristics in terms of pneumonia. We reviewed the filerecords of 151 pediatric patients with a diagnosis of COVID-19 confirmed by the real time-reverse transcription polymerase chainreaction test in nasopharyngeal swabs. The patients were divided into two groups based on direct chest X-ray and computedtomography results in [Group 1 (n:41), with pneumonia findings, and Group 2 (n:110), with no pneumonia findings]. The groups’demographic data, clinical and laboratory findings were compared. Pulmonary involvement was determined in 41 (27.1%) ofthe 151 patients. The [body mass index (BMI) Z-score], red blood cell distribution width (RDW), mean platelet volume (MPV),neutrophil lymphocyte ratio, passive leg raise, and D-dimer levels were significantly higher in patients with pneumonia than thosewithout pneumonia in our study. Based on multivariate logistic regression analysis, BMI Z-score, MPV, and RDW were found tobe independent risk factors of pneumonia in patients. The current study showed higher levels of blood parameters in patients withcoronavirus disease 2019 (COVID -19) presenting with pneumonia than those without pneumonia. We suggest that BMI-Z scoreand MPV value may assist in predicting pulmonary involvement in patients with COVID-19.

Predictors of pneumonia in patients with acute spontaneous intracerebral hemorrhage in Algarve, Southern Portugal

IntroductionFollowing the hyperacute phase of spontaneous intracerebral hemorrhage (SICH), the severest form of stroke, pneumonia emerges as the leading cause of morbidity and mortality. Prevention of stroke associated pneumonia (SAP) is fundamental to improve the prognosis of SICH patients. AimIdentify clinical, sociodemographic and process of care factors associated with occurrence of SAP after SICH in Algarve, southern Portugal. MethodsObservational, retrospective study of community representative consecutive case series of patients with SICH admitted to the sole public hospital in the region. Logistic regression was used to identify predictors of SAP after SICH. ResultsA total of 525 patients were included. The mean age was 71 ( ± 13) years and 64% were men. SAP occurred in 165 (31.5%). Lower Glasgow Coma Scale score (GCS score): ≤ 8 (OR= 2.087; 95% CI= [1.027;4.424]; p = 0.042) and GCS 9–12 (OR= 1.775; 95% CI= [1.030;3.059]; p = 0.039); prolonged emergency room stay (OR= 8.066; 95%CI=[3.082;21.113]; p < 0.001) and hyperactive delirium (OR=2.860; 95% CI= [1.661;4.925]; p < 0.001) increased the likelihood of SAP. Being younger, ≤ 59 years (OR= 0.391; 95% CI= [0.168; 0.911]; p = 0.029) and 60–71 years (OR= 0.389; 95% CI= [0.185; 0.818]; p = 0.013); and having less severe SICH/intracerebral hemorrhage score (ICH score) ≤ 2 (OR=0.601; 95% CI= [0.370; 0.975]; p = 0.039), decreased the risk of SAP. ConclusionAfter SICH, SAP occurs in approximately a third of patients. Non preventable (admission severity, ageing) and potentially preventable (prolonged emergency room stay, hyperactive delirium) determine the occurrence of SAP. Intensification of preventive intervention in high-risk patients, delirium prevention and improvement of the process of care can potentially reduce the occurrence of SAP after SICH.

Comparison of CRP, Procalcitonin, Neutrophil Counts, Eosinophil Counts, sTREM-1, and OPN between Pneumonic and Nonpneumonic Exacerbations in COPD Patients.

Introduction The patients with community-acquired pneumonia (CAP) and acute exacerbations of COPD (AECOPD) could have a higher risk of acute and severe respiratory illness than those without CAP in AECOPD. Consequently, early identification of pneumonia in AECOPD is quite important. Methods. 52 subjects with AECOPD + CAP and 93 subjects with AECOPD from two clinical centers were enrolled in this prospective observational study. The values of osteopontin (OPN), soluble triggering receptor expressed on myeloid cells-1 (sTREM-1), C-reactive protein (CRP), procalcitonin (PCT), eosinophil (EOS) counts, and neutrophil (Neu) counts in blood on the first day of admission and clinical symptoms were compared in AECOPD and AECOPD + CAP. In addition, subgroup analyses of biomarker difference were conducted based on the current use of inhaled glucocorticoids (ICS) or systemic corticosteroids (SCS). Results Patients with AECOPD + CAP had increased sputum volume, sputum purulence, diabetes mellitus, and longer hospital stays than AECOPD patients (p < 0.05). A clinical logistic regression model showed among the common clinical symptoms, purulent sputum can independently predict pneumonia in AECOPD patients after adjusting for a history of diabetes. At day 1, AECOPD + CAP patients had higher values of Neu, CRP, PCT, and OPN, while serum sTREM-1 levels and EOS counts were similar in the two groups. CRP fared best at predicting AECOPD with CAP (p < 0.05 for the test of difference), while OPN had similar accuracy with Neu, PCT, and purulent sputum (p > 0.05 for the test of difference). Multivariate analysis, including clinical symptoms and biomarkers, suggested that CRP ≥15.8 mg/dL at day 1 was a only promising predictor of pneumonia in AECOPD. CRP and OPN were not affected by ICS or SCS. Conclusions CRP ≥15.8 mg/dL is an ideal promising predictor of pneumonia in AECOPD, and its plasma level is not affected by ICS or SCS. The diagnostic performance of CRP is not significantly improved when combined with clinical symptoms or other markers (OPN, PCT, and Neu).

Preoperative maximum phonation time as a predictor of pneumonia in patients undergoing esophagectomy

Esophagectomy is a highly invasive procedure, associated with several postoperative complications including pneumonia, anastomotic leakage, and sepsis, which may result in multiorgan failure. Pneumonia is considered a major predictor of poor long-term prognosis, so its prevention is important for patients undergoing surgery for esophageal cancer. The subjects of this study were 137 patients who underwent esophagectomy at Keio University Hospital, Tokyo, Japan, between January, 2012 and December, 2016. Patients who underwent R0 or R1 resection or esophagectomy with organ excision were included. Patients who underwent salvage surgery or resection of recurrent laryngeal nerve, and those with preoperative recurrent laryngeal nerve palsy, were excluded. We investigated the effect of the maximum phonation time on the development of postoperative pneumonia. Pneumonia developed more frequently in patients with a long operative time, clinically left recurrent nerve lymph node metastasis, and a short preoperative maximum phonation time (p = 0.074, 0.046, and 0.080, respectively). Pneumonia was also more common in men with an abnormal maximum phonation time (p = 0.010). The maximum phonation time is a significant predictor of postoperative pneumonia after esophagectomy in men.

Epidemiological characteristics of COVID-19 travel-associated cases in Vojvodina, Serbia, during 2020.

Coronavirus disease 2019 (COVID-19) is currently the biggest public health problem worldwide. Intensive international travel and tourism have greatly contributed to its rapid global spreading. This study is the first comprehensive analysis of the epidemiological characteristics and clinical outcomes of the travel-associated COVID-19 cases in Vojvodina, Serbia, from March 6 to December 31, 2020 and it concerns permanent residents of Serbia. A cross-sectional study was conducted using data from the dedicated surveillance database of the Institute of Public Health of Vojvodina. Overall, 650 travel-associated COVID-19 cases were recorded in Vojvodina during the observed period, mainly imported from Bosnia and Herzegovina, followed by Austria and Germany (N = 195, 30%; N = 79, 12.15% and N = 75, 11.54%, respectively). The majority of cases were in the working-age groups, 18–44 and 45–64 years (56.46% and 34.15%, respectively). Overall, 54 (8.31%) patients developed pneumonia. In comparison to patients without pneumonia, those with pneumonia were older (mean age = 55.39 years vs. 41.34 years, p<0.01) and had a higher percentage of comorbidities (57.41% vs. 16.61%). Men were more likely to develop pneumonia than women (OR = 2.22; 95% CI: 1.14–4.30, p = 0.02), as well as those in retired-age group (OR = 4.11; 95% CI: 2.0–8.46, p<0.01). Obesity (OR = 14.40; 95% CI: 3.8–54.6, p<0.01), diabetes (OR = 9.82; 95% CI: 3.15–30.61, p<0.01) and hypertension (OR = 7.99; 95% CI: 3.98–16.02, p<0.01) were the most prominent main comorbidities as predictors of pneumonia. Our results represent general epidemiological and clinical dynamics of COVID-19 disease in Vojvodina. Also, they provide evidence that the predictors of pneumonia were: increasing age, male sex, having underlying comorbidities, an increasing number of days from the return to laboratory confirmation of COVID-19 (OR = 1.08, 95% CI: 1.03–1.12, p<0.01), as well as an increasing number of days from symptoms onset to diagnosis (OR = 1.14, 95% CI: 1.07–1.21, p<0.01), while anosmia and ageusia were protective factors for developing it (OR = 0.31, 95% CI: 0.12–0.79, p = 0.01).

Role of NLR, PLR, ELR and CLR in differentiating COVID-19 patients with and without pneumonia.

ObjectivesNeutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), monocyte/lymphocyte ratio (MLR), eosinophil/lymphocyte ratio (ELR), and C‐reactive protein (CRP)/lymphocyte ratio (CLR) are well‐established inflammatory indices. This study aimed to examine whether NLR, PLR, MLR, ELR and CLR could differentiate coronavirus disease 2019 (COVID‐19) patients with pneumonia from those of without.MethodsWe retrospectively examined the laboratory parameters including CRP, D‐dimer, procalcitonin and complete blood count of 306 COVID‐19 patients (pneumonic = 152 and non‐pneumonic = 154). NLR, PLR, MLR, ELR and CLR values of each patient were calculated. The ability of these indices to distinguish COVID‐19 patients with and without pneumonia was determined by receiver operating characteristic (ROC) analysis.ResultsNLR, PLR and CLR values were higher while ELR value was lower in pneumonic COVID‐19 patients compared with patients with non‐pneumonic COVID‐19 infection. MLR value was similar in the two groups. NLR, PLR and CLR were positively correlated with CRP and procalcitonin. ELR was negatively correlated with CRP. The ROC analysis revealed that the optimal cut‐off value of CLR for discriminating COVID‐19 patients with pneumonia from those without pneumonia was 1.14 and the area under curve (AUC) for CLR was 0.731 (sensitivity = 81.5% and specificity = 55.6%), which was markedly higher than the AUCs of NLR (0.622), PLR (0.585) and ELR (0.613). However, no statistical differences were observed between AUC values of NLR, PLR and ELR (P > .05).ConclusionOur findings showed that NLR, PLR, ELR and CLR indices can be used in differentiating COVID‐19 patients with or without pneumonia. Among them, the CLR index was the best predictor of pneumonia in COVID‐19 patients.

Factors predicting pneumonia in patients admitted with spontaneous supratentorial intracerebral hemorrhage in western region of Nepal

Introduction: Despite the well-documented association of stroke-associated complications and infections with increased mortality, morbidity and worse long-term outcome, there are only limited data available on independent predictors of pneumonia in patients with acute intracerebral hemorrhage. In this study, our objective was to evaluate risk factors and comorbid conditions associated with the diagnosis of hospital acquired pneumonia in the patients admitted with spontaneous intracerebral hemorrhage and to determine the independent predictors of pneumonia in these patients. Methods: A retrospective analysis was done in patients admitted in Intensive Care Unit of Nepalgunj Medical College with spontaneous intracerebral hemorrhage. Various clinic-demographic parameters were tested for association with pneumonia or no pneumonia group using chi square or student’s “t” test. Results: A total of 117 patients, 86 men (73.5%) and 31 women (26.5%) with spontaneous intracerebral hemorrhage were included in the study. There were 36 (30.77%) patients with pneumonia. The association Diabetes mellitus (p&lt;0.01), COPD (p&lt;0.01), smoking (p&lt;0.01), mean GCS (p&lt;0.01), ICH volume (p=0.01), ICH score (p&lt;0.01), operated status (p&lt;0.01), Ganglionic (&lt;0.01), Brain stem (p=0.03) and Ventricular (p=0.01) location of hematoma was statistically significant with pneumonia. Outcome in terms of MRS at discharge was also poorer for patients with pneumonia (p=0.01). Conclusion: Diabetes mellitus, COPD, mean GCS, ICH volume, ICH score, operated status, higher MRS score were associated with increased risk of pneumonia in ICH. Similarly, ganglionic hematoma, brainstem hematoma and those having intraventricular hemorrhages are also associated with increased risk of pneumonia. Outcome in patients in terms of MRS were also poorer in those who had pneumonia.

New coronavirus infection in children in the Moscow region: clinical, epidemiological and treatment aspects

Aim: To assess clinical and epidemiological characteristics, as well as treatment results in COVID-19 pediatric patients hospitalized to the Department of infectious disease in the Moscow region. Materials and methods: We retrospectively analyzed medical records of 124 pediatric patients aged from 1 month to 17 years with confirmed (63.7%) and highly probable (proven epidemiological association with the infection source) COVID-19 infection. The children were hospitalized from March 25, 2020 to August 11, 2020. Among patients that were hospitalized during this time period, 43% had pneumonia and 30% had acute respiratory disorders. All cases of pneumonia were confirmed by computed tomography. The children were treated according to the standard Russian guidelines.Results: The children had been infected with SARS-CoV-2 mostly from family members (75%; 95% confidence interval (CI) 66.4-82.3). In the families of the children with pneumonia, the number of pneumonia cases in their relatives was higher than in the families of the children with acute respiratory infections (1.7 ±1.0 vs. 1.1 ± 0.5 respectively; р &lt; 0.001). The mean age of the hospitalized children was 8 years (7.4-9.6), with an even age distribution. The main COVID-19 signs and symptoms were as follows: fever (75.8%; 95% CI 67.3-83.0), cough (66.1%; 95% CI 57.1-74.4]), fatigues (38.7%; 95% CI 30.1-47.9), and hyposmia (33.9%; 95% CI 25.6-42.9). The severe disease course was rare (2.4%; 95% CI 0.5-6.9). The rates of positive reverse transcriptase polymerase chain reaction tests for SARS-CoV-2 were rapidly decreased at repeated tests: at day 3, 63.7% of the tests were positive, at day 7, 21.8% and at day 14, 5.6% (р &lt; 0.001). The prevalence of pneumonia was 56.4% without any age differences, with mostly minimal areas of lung abnormalities (78.6%). The severity of pneumonia and duration of clinical manifestations in the patients treated with a III generation cephalosporin or its combination with a macrolide were similar. Cough duration in those, who were treated with ipratropium bromide / fenoterol inhalations including their combination with budesonide, was higher than in those who did not use inhalation treatment. Pyrexia of &gt; 5 days duration can be a predictor of pneumonia in a pediatric patient with COVID-1 9 (odds ratio 4.55 (2.1-9.9), sensitivity 61.4%, specificity 74.1%).Conclusion: The results obtained are important to develop further treatment strategies for children with COVID-1 9.

Usefulness of the Neutrophil-to-Lymphocyte Ratio as a Predictor of Pneumonia and Urinary Tract Infection Within the First Week After Acute Ischemic Stroke.

Background: A high Neutrophil-to-Lymphocyte ratio (NLR) in patients with acute ischemic stroke (AIS) has been associated with post-stroke infections, but it's role as an early predictive biomarker for post-stroke pneumonia (PSP) and urinary tract infection (UTI) is not clear.Aim: To investigate the usefulness of NLR obtained within 24 h after AIS for predicting PSP and UTI in the first week.Methods: Clinical and laboratory data were retrieved from the University Hospital Brussels stroke database/electronic record system. Patients were divided into those who developed PSP or UTI within the first week after stroke onset and those who didn't. Receiver operating characteristics (ROC) curves and logistic regression analysis were used to identify independent predictors.Results: Five hundred and fourteen patients were included, of which 15.4% (n = 79) developed PSP and 22% (n = 115) UTI. In univariate analysis, NLR was significantly higher in patients who developed PSP (4.1 vs. 2.8, p < 0.001) but not in those who developed UTI (3.3 vs. 2.9, p = 0.074). Multiple logistic regression analysis for PSP showed that NLR, male gender, dysphagia, and stroke severity measured by the National Institutes of Health Stroke Scale (NIHSS), were independent predictors of PSP. For NLR alone, the area under the curve (AUC) in the ROC curve was 0.66 (95% CI = 0.59–0.73). When combining NLR ≥ 4.7 with age >75 years, male gender, NIHSS > 7, and dysphagia, the AUC increased to 0.84 (95% CI = 0.79–0.89).Conclusion: The NLR within 24 h after AIS appears to have no predictive value for post-stroke UTI, and is only a weak predictor for identifying patients at high risk for PSP. Its predictive value for PSP appears to be much stronger when incorporated in a prediction model including age, gender, NIHSS score, and dysphagia.

Pneumonia remains a leading public health problem among under-five children in peri-urban areas of north-eastern Ethiopia.

Pneumonia is a leading cause of morbidity and mortality among children under five years of age in developing countries, including Ethiopia. However, data on this serious illness among highly susceptible and vulnerable children living in local peri-urban areas are limited. Establishing the prevalence of pneumonia and identifying the associated factors are important for proper planning and intervention. A community-based cross-sectional study was conducted among 560 systematically selected children under the age of five years in peri-urban areas of Dessie City from January through March 2019. Data were collected using a pretested structured questionnaire, physical examination of children and direct observation of housing conditions. Pneumonia was examined using World Health Organization (WHO) guidelines as the presence of the symptoms of fast breathing or indrawn chest with or without fast breathing during the two weeks prior to the study. A principal component analysis was used to construct a household wealth index. Data were analyzed using a binary logistic regression model at 95%CI (confidence interval). The analysis involved estimating the crude odds ratio (COR) using bivariate analysis, and adjusted odds ratio (AOR) using multivariable analysis. From the multivariable analysis, variables at p-value of less than 0.05 were declared statistically significant. The prevalence of pneumonia among children under five was 17.1% (95%CI: 13.9%-19.9%). Of the participating children, 113 (21.0%) had a cough, 92 (17.1%) had fast breathing, 76 (14.1%) had fever, and 40 (7.4%) of the children had chest indrawn. Domestic fuel was the most common source of cooking fuel 383 (71.1%). Majority 445 (82.6%) of children were fully vaccinated and 94 (17.4%) were not fully vaccinated. Most (481, 89.2%) of the children were got exclusive breastfeeding. Slightly more than half (284, 52.7%) of the under-five children had acute malnutrition and 27.1% of the children had a childhood history of ARI. The multivariable analysis showed using domestic fuel as the energy source for cooking (adjusted odds ratio [AOR] = 3.95, 95%CI: 1.47-10.62), cooking in the living room (AOR = 6.23; 95%CI: 1.80-21.68), overcrowding (AOR = 3.37, 95%CI: 1.56-7.27), child history of acute respiratory infection (ARI) (AOR = 6.12 95%CI: 2.77-13.53), family history of ARI (AOR = 4.69, 95%CI: 1.67-13.12) and acute malnutrition (AOR = 2.43, 95%CI: 1.18-5.04) were significantly associated with childhood pneumonia. In this study, pneumonia remains a leading public health problem among under five children in the study area and higher than national averages. Domestic fuel as the energy source for cooking, cooking in the living room, overcrowding, child history of ARI, family history of ARI and acute malnutrition were predictors of pneumonia. Community-based interventions focusing on improving housing conditions, reduced use of domestic biofuels, adequate and balanced food intake, including exclusive breastfeeding of infants, and early treatment of ARIs.

Vitamin D level as a predictor of pneumonia and asthma in children less than 5 years of age

Background: Childhood pneumonia is a global health problem .It the leading cause of death for children under the age of five years. 95% of all pneumonia cases under the age of five occurs in developing countries. Asthma remains the most common chronic disease of childhood in the world. The observation that vitamin D deficiency and asthma share risk factors such as urban residence, obesity and African American ethnicity has generated interest in exploring a link between these two conditions. This study was taken up to assess the role of vitamin D as a predictor of pneumonia and asthma in children less than 5 years of age.Methods: A prospective observational case control study was conducted in MLB Medical college, Jhansi from January 2015 to December 2016 (1 year 11 months). A total of 60 children including 30 asthma cases, 20 pneumonia cases and 10 controls, aged, 6-60 months were enrolled. Controls were healthy children attending outpatient services for immunization.Results: The mean age of the pneumonia patient was 1.5 years, while mean age in asthma patients was 3.1yrs. Ratio of male and female in pneumonia cases was1.5:1, while is asthma ratio was 2:1. In our study 45% pneumonia cases had deficient level of vitamin D (&lt;20ng/ml) and mean level was 11.08±4.68 while 40% of control had deficient level of vitamin D and mean level was 16.04±1.61, p value was 0.0166 and there was significant difference in both the groups. In Asthma cases 53.33% patient had deficient level of vitamin-D and mean level was 10.62±2.908 as compared to 40% control (mean : 16.04±1.62) ‘p’ value was &lt;0.0001 and was highly significant.Conclusions: Our study has illustrated that vitamin-D levels were significantly low in pneumonia and asthma patients as compared to control.

Magnitude and Predictors of Pneumonia among Under-Five Children in Ethiopia: A Systematic Review and Meta-Analysis.

Background Pneumonia is currently the leading cause of morbidity and mortality among under-five children in developing countries, including Ethiopia. Although these problems are easily preventable and treatable, it contributes to more than 18% of deaths of under-five children every year in Ethiopia. Regardless of these facts, there is a paucity of information regarding the magnitude and its predictors of pneumonia in Ethiopia. Therefore, the main objective of this review is to determine the pooled magnitude of pneumonia and its predictors among under-five children in Ethiopia. Methods The international databases such as MEDLINE/PubMed, EMBASE, Google Scholar, and Science Direct were scientifically explored. Articles were also searched by examining the gray literature on institutional databases and by reviewing reference lists of already identified articles. We considered all primary studies reporting the magnitude of pneumonia among under-five children and its predictors in Ethiopia. We retrieved all necessary data by using a standardized data extraction format spreadsheet. STATA 14 statistical software was used to analyze the data, and Cochrane's Q test statistics and I2 test were used to assess the heterogeneity between the studies. Significant variability was found between the studies in such a way that a random-effect model was used. Result The pooled magnitude of pneumonia among under-five children was 20.68% (I2 = 97.9%; P ≤ 0.001) out of 12 studies in Ethiopia. Children who have unvaccinated (OR = 2.45), food cooking in the main house (OR = 2.46), vitamin A supplementation status (OR = 2.85), malnutrition (OR = 2.98), mixed breastfeeding (OR = 2.46), and child history of respiratory tract infection (OR = 4.11) were potential determinates of pneumonia. Conclusion and Recommendations. This review showed that the magnitude of pneumonia was relatively high. Hence, appropriate intervention on potential determinates such as health education on exclusive breastfeeding and nutrition, place of food cooking, increased immunization and vitamin A supplementation, and early control of respiratory tract infection was recommended to prevent those risk factors.

Clinical course of 2019 novel coronavirus disease (COVID-19) in individuals present during the outbreak on the Diamond Princess cruise ship

We investigated the clinical course of individuals with 2019 novel coronavirus disease (COVID-19) who were transferred from the Diamond Princess cruise ship to 12 local hospitals. The conditions and clinical courses of patients with pneumonia were compared with those of patients without pneumonia. Among 70 patients (median age: 67 years) analyzed, the major symptoms were fever (64.3%), cough (54.3%), and general fatigue (24.3%). Forty-three patients (61.4%) had pneumonia. Higher body temperature, heart rate, and respiratory rate as well as higher of lactate dehydrogenase (LDH), aspartate aminotransferase (AST), and C-reactive protein (CRP) levels and lower serum albumin level and lymphocyte count were associated with the presence of pneumonia. Ground-glass opacity was found in 97.7% of the patients with pneumonia. Patients were administered neuraminidase inhibitors (20%), lopinavir/ritonavir (32.9%), and ciclesonide inhalation (11.4%). Mechanical ventilation and veno-venous extracorporeal membrane oxygenation was performed on 14 (20%) and 2 (2.9%) patients, respectively; two patients died. The median duration of intubation was 12 days. The patients with COVID-19 transferred to local hospitals during the outbreak had severe conditions and needed close monitoring. The severity of COVID-19 depends on the presence of pneumonia. High serum LDH, AST and CRP levels and low serum albumin level and lymphocyte count were found to be predictors of pneumonia. It was challenging for local hospitals to admit and treat these patients during the outbreak of COVID-19. Assessment of severity was crucial to manage a large number of patients.