Risultati per: Le cause della polmonite nei bambini

Objective
To investigate the association between the Controlling Nutritional Status (CONUT) score and all-cause and cause-specific mortality in patients with diabetic kidney disease (DKD).

Design
A retrospective cohort study.

Setting and participants
Data on patients with DKD from the National Health and Nutrition Examination Survey 2009–2018.

Primary and secondary outcome measures
All-cause mortality, cardiovascular disease (CVD)-related mortality, diabetes-related mortality and nephropathy-related mortality.

Results
A total of 1714 patients were included, with 1119 (65.29%) in normal nutrition group (a score of 0–1), 553 (32.26%) in mild malnutrition group (a score of 2–4) and 42 (2.45%) in moderate and severe malnutrition group (a score of 5–12), according to the CONUT score. After controlling for age, race, marital status, smoking, hypertension, CVD, diabetic retinopathy, poverty income ratio, antidiabetics, diuretics, urinary albumin to creatinine ratio, uric acid, energy, protein, total fat, sodium and estimated glomerular filtration rate, a higher CONUT score was associated with a significantly greater risk of all-cause death (HR 1.30, 95% CI 1.15 to 1.46, p

Objectives
To estimate all-cause mortality in ventilator-associated pneumonia (VAP) and determine whether antibiotic duration beyond 8 days is associated with reduction in all-cause mortality in patients admitted with VAP in the intensive care unit.

Design
A prospective cohort study of patients diagnosed with VAP based on the National Healthcare Safety Network definition and clinical criteria.

Setting
Single tertiary care hospital in Southern India.

Participants
100 consecutive adult patients diagnosed with VAP were followed up for 28 days postdiagnosis or until discharge.

Outcome measures
The incidence of mortality at 28 days postdiagnosis was measured. Tests for association and predictors of mortality were determined using 2 test and multivariate Cox regression analysis. Secondary outcomes included baseline clinical parameters such as age, underlying comorbidities as well as measuring total length of stay, number of ventilator-free days and antibiotic-free days.

Results
The overall case fatality rate due to VAP was 46%. There was no statistically significant difference in mortality rates between those receiving shorter antibiotic duration (5–8 days) and those on longer therapy. Among those who survived until day 9, the observed risk difference was 15.1% between both groups, with an HR of 1.057 (95% CI 0.26 to 4.28). In 70.4% of isolates, non-fermenting Gram-negative bacilli were identified, of which the most common pathogen isolated was Acinetobacter baumannii (62%).

Conclusion
In this hospital-based cohort study, there is insufficient evidence to suggest that prolonging antibiotic duration beyond 8 days in patients with VAP improves survival.

Stroke, Ahead of Print.

Case presentation An 18-year-old woman presented with a 4-day history of worsening abdominal pain. Physical examination revealed tenderness in the left mid abdomen, without rebound tenderness. Laboratory workups revealed neutrophilia (10 890/µL), elevated C reactive protein (38.59 mg/L) and increased faecal calprotectin ( >50 µg/g). Haemoglobin, liver function, renal function and urinalysis results were within normal range. Immunological investigations, including immunoglobulin levels, antineutrophil cytoplasmic antibodies and antinuclear antibodies, were all normal. An abdominal CT scan demonstrated wall thickening of the distal duodenum and proximal jejunum (figure 1A). To further evaluate the small intestine, a gastrointestinal barium contrast radiograph was performed, which confirmed dilatation of the horizontal duodenum (figure 1B). Consequently, supportive care measures were initiated, including nil by mouth, nasogastric decompression, antibiotic therapy (piperacillin sodium/tazobactam sodium, 4.5 g every 8 hours intravenously) and acid suppression with omeprazole. Despite these interventions, the patient showed no improvement, prompting the need for oesophagogastroduodenoscopy…

Gruppo specialisti di Padova segue bambini maltrattati

This cohort study evaluates the association between bilateral oophorectomy and all-cause mortality among women with BRCA1 or BRCA2 sequence variations.

Objective
The association between haemoglobin-to-red blood cell distribution width ratio (HRR) and all-cause mortality remains poorly understood. This study aimed to examine the influence of HRR at the time of admission mortality over 1 year and 30 days in patients with sepsis.

Design
This was a secondary analysis.

Setting
This study was conducted in intensive care units (ICUs).

Participants
Adult patients with sepsis were identified and included from an intensive care database based on eligibility criteria.

Primary outcome and measure
The primary outcome was the rate of death within 1 year. The secondary outcome was the death rate within 30 days.

Results
A total of 4233 patients with sepsis who met the inclusion criteria were analysed, excluding those ineligible. These participants were divided into quartiles based on their HRR at admission. The overall mortality rates at 1 year and 30 days were 42.9% and 25.5%, respectively. A significant inverse association was observed between HRR quartiles and all-cause mortality (p

La principessa Kate ha atteso. Gli esperti, c’è un momento giusto

Objective
To identify and synthesise relevant existing prognostic factors (PF) and prediction models (PM) for hospitalisation and all-cause mortality within 90 days in primary care patients with acute lower respiratory tract infections (LRTI).

Design
Systematic review.

Methods
Systematic searches of MEDLINE, Embase and the Cochrane Library were performed. All PF and PM studies on the risk of hospitalisation or all-cause mortality within 90 days in adult primary care LRTI patients were included. The risk of bias was assessed using the Quality in Prognostic Studies tool and Prediction Model Risk Of Bias Assessment Tool tools for PF and PM studies, respectively. The results of included PF and PM studies were descriptively summarised.

Results
Of 2799 unique records identified, 16 were included: 9 PF studies, 6 PM studies and 1 combination of both. The risk of bias was judged high for all studies, mainly due to limitations in the analysis domain. Based on reported multivariable associations in PF studies, increasing age, sex, current smoking, diabetes, a history of stroke, cancer or heart failure, previous hospitalisation, influenza vaccination (negative association), current use of systemic corticosteroids, recent antibiotic use, respiratory rate ≥25/min and diagnosis of pneumonia were identified as most promising candidate predictors. One newly developed PM was externally validated (c statistic 0.74, 95% CI 0.71 to 0.78) whereas the previously hospital-derived CRB-65 was externally validated in primary care in five studies (c statistic ranging from 0.72 (95% CI 0.63 to 0.81) to 0.79 (95% CI 0.65 to 0.92)). None of the PM studies reported measures of model calibration.

Conclusions
Implementation of existing models for individualised risk prediction of 90-day hospitalisation or mortality in primary care LRTI patients in everyday practice is hampered by incomplete assessment of model performance. The identified candidate predictors provide useful information for clinicians and warrant consideration when developing or updating PMs using state-of-the-art development and validation techniques.

PROSPERO registration number
CRD42022341233.

Annals of Internal Medicine, Volume 177, Issue 3, Page 407, March 2024.

Annals of Internal Medicine, Volume 177, Issue 3, Page 407, March 2024.

Inaugurata all’ospedale di Udine per il recupero dei pazienti

Evidence shows that e-cigarette use is associated with wheezing, dyspnea, and bronchitis.

Annals of Internal Medicine, Ahead of Print.