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BACKGROUND: Risk scores (RS) evaluate the likelihood of short-term mortality in patients diagnosed with community-acquired pneumonia (CAP). However, there is a scarcity of evidence to determine the risk of long-term mortality. This article aims to compare the effectiveness of 16 scores in predicting mortality at three, six, and twelve months in adult patients with CAP. METHODS: A retrospective cohort study on individuals diagnosed with CAP was conducted across two hospitals in Colombia. Receiver Operating Characteristic (ROC) curves were constructed at 3, 6, and 12 months to assess the predictive ability of death for the following scoring systems: CURB-65, CRB-65, SCAP, CORB, ADROP, NEWS, Pneumonia Shock, REA-ICU, PSI, SMART-COP, SMRT-CO, SOAR, qSOFA, SIRS, CAPSI, and Charlson Comorbidity Index (CCI). RESULTS: A total of 3688 patients were included in the final analysis. Mortality at 3, 6, and 12 months was 5.2%, 8.3%, and 16.3% respectively. At 3 months, PSI, CCI, and CRB-65 scores showed ROC curves of 0.74 (95% CI: 0.71-0.77), 0.71 (95% CI: 0.67-0.74), and 0.70 (95% CI: 0.66-0.74). At 6 months, PSI and CCI scores showed performances of 0.74 (95% CI: 0.72-0.77) and 0.72 (95% CI: 0.69-0.74), respectively. Finally at 12 months, all evaluated scores showed poor discriminatory capacity, including PSI, which decreased from acceptable to poor with an ROC curve of 0.64 (95% CI: 0.61-0.66). CONCLUSION: When predicting mortality in patients with CAP, at 3 months, PSI, CCI, and CRB-65 showed acceptable predictive performances. At 6 months, only PSI and CCI maintained acceptable levels of accuracy. For the 12-month period, all evaluated scores exhibited very limited discriminatory ability, ranging from poor to almost negligible.
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Infecções Comunitárias Adquiridas , Pneumonia , Curva ROC , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Colômbia/epidemiologia , Infecções Comunitárias Adquiridas/mortalidade , Infecções Comunitárias Adquiridas/diagnóstico , Pneumonia/mortalidade , Pneumonia/diagnóstico , Prognóstico , Estudos Retrospectivos , Medição de Risco/métodos , Índice de Gravidade de Doença , Fatores de TempoRESUMO
BACKGROUND: Children who experience alkaline injury are at risk for the development of esophageal strictures and the need for esophageal dilations. OBJECTIVE: We aimed to assess predictors for a higher number of esophageal dilatations in children following alkali ingestion. METHODS: Single-center retrospective cohort study including children who underwent esophagogastroduodenoscopy (EGD) after alkali ingestion. Possible predictive factors for the need for esophageal dilatations were evaluated. RESULTS: A total of 34 patients were included, and 19 were female (55.9%). The median age at the time of the accidents was 20.6 months (IQR 15-30.7). All alkali ingestions were accidental, in all cases involving liquid products, and most (24/34; 70%) occurred at the child's home. Homemade liquid soap was the agent in half of the cases. The most frequently reported symptom at presentation was vomiting (22/34, 64.7%). The median follow-up time was 3.2 years (IQR 1.1-7.4). On follow-up, the median number of esophageal dilatations required for these patients was 12.5 (IQR 0-34). Among demographic factors, male gender (P=0.04), ingestion of homemade products (P<0.01), and accidents happening outside of the household environment (P=0.02) were associated with a greater number of esophageal dilations on follow-up. An endoscopic classification Zargar of 2B or higher (P=0.03), the presence of stricture at the time of the second EGD (P=0.01), and gastroesophageal reflux disease (GERD) as a late complication (P=0.01) were also associated with a greater number of esophageal dilations on long term follow-up. CONCLUSION: Beyond the endoscopic classification severity - a well-known risk factor for the strictures after alkali ingestions, we found that male gender, accidents with homemade products, and accidents occurring outside the household environment were significantly associated with a greater number of esophageal dilatations in the long-term follow-up of children following alkali ingestion.
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Álcalis , Queimaduras Químicas , Estenose Esofágica , Humanos , Feminino , Masculino , Estudos Retrospectivos , Estenose Esofágica/induzido quimicamente , Pré-Escolar , Álcalis/efeitos adversos , Lactente , Queimaduras Químicas/etiologia , Dilatação , Endoscopia do Sistema Digestório , Fatores de Risco , Cáusticos/intoxicaçãoRESUMO
Regulatory T lymphocytes play a critical role in immune regulation and are involved in the aberrant cell elimination by facilitating tumor necrosis factor connection to the TNFR2 receptor, encoded by the TNFRSF1B polymorphic gene. We aimed to examine the effects of single nucleotide variants TNFRSF1B c.587T>G, c.*188A>G, c.*215C>T, and c.*922C>T on the clinicopathological characteristics and survival of cutaneous melanoma (CM) patients. Patients were genotyped using RT-PCR. TNFRSF1B levels were measured using qPCR. Luciferase reporter assay evaluated the interaction of miR-96 and miR-1271 with the 3'-UTR of TNFRSF1B. The c.587TT genotype was more common in patients younger than 54 years old than in older patients. Patients with c.*922CT or TT, c.587TG or GG + c.*922CT or TT genotypes, as well as those with the haplotype TATT, presented a higher risk of tumor progression and death due to the disease effects. Individuals with the c.*922TT genotype had a higher TNFRSF1B expression than those with the CC genotype. miR-1271 had less efficient binding with the 3'-UTR of the T allele when compared with the C allele of the SNV c.*922C>T. Our findings, for the first time, demonstrate that TNFRSF1B c.587T>G and c.*922C>T variants can serve as independent prognostic factors in CM patients.
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Melanoma , MicroRNAs , Neoplasias Cutâneas , Humanos , Idoso , Pessoa de Meia-Idade , Predisposição Genética para Doença , Polimorfismo de Nucleotídeo Único , Genótipo , MicroRNAs/genética , Receptores Tipo II do Fator de Necrose Tumoral/genéticaRESUMO
OBJECTIVES: Ceftazidime-avibactam (CAZ-AVI) is an option for infections caused by MDR gram-negative bacilli. In this study, we aimed to analyze the in vitro antimicrobial activity of CAZ-AVI and other antimicrobial agents against gram-negative bacilli that were collected in Colombia between 2019 and 2021 from patients with bacteremia and skin and soft-tissue infections (SSTIs). METHODS: A total of 600 Enterobacterales and 259 P. aeruginosa strains were analyzed. The phenotypic resistance of isolates, particularly non-susceptibility to meropenem, multidrug-resistant (MDR) isolates, and difficult-to-treat (DTR) P. aeruginosa, was evaluated according to CLSI breakpoints. RESULTS: Enterobacterales had the most susceptibility to CAZ-AVI (96.5 %) and tigecycline (95 %). Tigecycline and CAZ-AVI were the antimicrobial agents with the most in vitro activity against carbapenem-resistant Enterobacterales (CRE). CAZ-AVI was the antimicrobial treatment with the most activity against P. aeruginosa. CONCLUSIONS: Tigecycline and CAZ-AVI were the antimicrobial agents with the most activity against CRE and MDR Enterobacterales. For P. aeruginosa, CAZ-AVI was the antimicrobial treatment with the most in vitro activity.
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Antibacterianos , Compostos Azabicíclicos , Bacteriemia , Ceftazidima , Combinação de Medicamentos , Bactérias Gram-Negativas , Testes de Sensibilidade Microbiana , Infecções dos Tecidos Moles , Tigeciclina , Humanos , Ceftazidima/farmacologia , Infecções dos Tecidos Moles/microbiologia , Infecções dos Tecidos Moles/tratamento farmacológico , Colômbia , Compostos Azabicíclicos/farmacologia , Antibacterianos/farmacologia , Bacteriemia/microbiologia , Bacteriemia/tratamento farmacológico , Bactérias Gram-Negativas/efeitos dos fármacos , Tigeciclina/farmacologia , Pseudomonas aeruginosa/efeitos dos fármacos , Farmacorresistência Bacteriana Múltipla , Infecções por Bactérias Gram-Negativas/microbiologia , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Enterobacteriaceae/efeitos dos fármacos , Dermatopatias Bacterianas/microbiologia , Dermatopatias Bacterianas/tratamento farmacológicoRESUMO
OBJECTIVES: To evaluate outcomes of oral food challenge (OFC) test to assess tolerance in infants with non-IgE-mediated cow's milk allergy (CMA) with gastrointestinal manifestations and explore clinical data predictive of these outcomes. METHODS: Single-center retrospective study including infants (age < 12 months) who were referred for CMA between 2000 and 2018 and underwent OFC on follow-up. A univariate logistic regression test was performed to evaluate variables associated with the outcomes of the follow-up OFC test. RESULTS: Eighty-two patients were included, 50% were male. Eighteen patients had a positive OFC test (22%). Most patients had presented with hematochezia (77%). The median age of symptom onset was 30 days. Two-thirds of the patients were on appropriate infant formula (extensively hydrolyzed or amino acid-based formula), exclusively or in association with breastfeeding. The median time on an elimination diet before the OFC test was 8 months (Q1 6 - Q3 11 months). All cases with positive follow-up OFC tests (n = 18) had been exposed to cow's milk-based formula before the first clinical manifestation of CMA. Five out of eight cases with Food Protein-Induced Enterocolitis Syndrome (FPIES) had positive OFC tests. Exposure to cow's milk-based formula before diagnosis, a history of other food allergies, hematochezia and diarrhea were predictors of a positive OFC test. CONCLUSIONS: In infants with non-IgE-mediated CMPA with gastrointestinal manifestations, the use of cow's milk-based formula, a history of other food allergies, and hematochezia and diarrhea upon initial presentation were associated factors for the later achievement of tolerance.
Assuntos
Hipersensibilidade Alimentar , Hipersensibilidade a Leite , Lactente , Animais , Feminino , Bovinos , Humanos , Masculino , Hipersensibilidade a Leite/complicações , Hipersensibilidade a Leite/diagnóstico , Estudos Retrospectivos , Hipersensibilidade Alimentar/complicações , Alérgenos , Hemorragia Gastrointestinal , Diarreia/etiologia , Proteínas do LeiteRESUMO
Abstract Objectives To evaluate outcomes of oral food challenge (OFC) test to assess tolerance in infants with non-IgE-mediated cow's milk allergy (CMA) with gastrointestinal manifestations and explore clinical data predictive of these outcomes. Methods Single-center retrospective study including infants (age < 12 months) who were referred for CMA between 2000 and 2018 and underwent OFC on follow-up. A univariate logistic regression test was performed to evaluate variables associated with the outcomes of the follow-up OFC test. Results Eighty-two patients were included, 50% were male. Eighteen patients had a positive OFC test (22%). Most patients had presented with hematochezia (77%). The median age of symptom onset was 30 days. Two-thirds of the patients were on appropriate infant formula (extensively hydrolyzed or amino acid-based formula), exclusively or in association with breastfeeding. The median time on an elimination diet before the OFC test was 8 months (Q1 6 - Q3 11 months). All cases with positive follow-up OFC tests (n= 18) had been exposed to cow's milk-based formula before the first clinical manifestation of CMA. Five out of eight cases with Food Protein-Induced Enterocolitis Syndrome (FPIES) had positive OFC tests. Exposure to cow's milk-based formula before diagnosis, a history of other food allergies, hematochezia and diarrhea were predictors of a positive OFC test. Conclusions In infants with non-IgE-mediated CMPA with gastrointestinal manifestations, the use of cow's milk-based formula, a history of other food allergies, and hematochezia and diarrhea upon initial presentation were associated factors for the later achievement of tolerance.
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ABSTRACT Background: Children who experience alkaline injury are at risk for the development of esophageal strictures and the need for esophageal dilations. Objective: We aimed to assess predictors for a higher number of esophageal dilatations in children following alkali ingestion. Methods: Single-center retrospective cohort study including children who underwent esophagogastroduodenoscopy (EGD) after alkali ingestion. Possible predictive factors for the need for esophageal dilatations were evaluated. Results: A total of 34 patients were included, and 19 were female (55.9%). The median age at the time of the accidents was 20.6 months (IQR 15-30.7). All alkali ingestions were accidental, in all cases involving liquid products, and most (24/34; 70%) occurred at the child's home. Homemade liquid soap was the agent in half of the cases. The most frequently reported symptom at presentation was vomiting (22/34, 64.7%). The median follow-up time was 3.2 years (IQR 1.1-7.4). On follow-up, the median number of esophageal dilatations required for these patients was 12.5 (IQR 0-34). Among demographic factors, male gender (P=0.04), ingestion of homemade products (P<0.01), and accidents happening outside of the household environment (P=0.02) were associated with a greater number of esophageal dilations on follow-up. An endoscopic classification Zargar of 2B or higher (P=0.03), the presence of stricture at the time of the second EGD (P=0.01), and gastroesophageal reflux disease (GERD) as a late complication (P=0.01) were also associated with a greater number of esophageal dilations on long term follow-up. Conclusion: Beyond the endoscopic classification severity - a well-known risk factor for the strictures after alkali ingestions, we found that male gender, accidents with homemade products, and accidents occurring outside the household environment were significantly associated with a greater number of esophageal dilatations in the long-term follow-up of children following alkali ingestion.
RESUMO Contexto: Crianças que sofrem lesões cáusticas correm alto risco de desenvolver estenose esofágica e necessidade de dilatações esofágicas. Objetivo: Objetivamos avaliar preditores de necessidade de maior número de dilatações esofágicas em crianças, após uma ingestão cáustica. Métodos: Estudo de coorte retrospectivo de centro único incluindo crianças submetidas a esofagogastroduodenoscopia (EGD) após ingestão cáustica. Foram avaliados possíveis fatores preditivos para a necessidade de dilatações esofágicas. Resultados: Foram incluídos 34 pacientes, 19 do sexo feminino (55,9%). A idade mediana no momento dos acidentes foi de 20,6 meses (IQR 15-30,7). Todas as ingestões cáusticas foram incidentais, de substâncias líquidas, e a maioria dos acidentes (24/34; 70%) ocorreu no domicílio da criança. Em metade dos casos, a substância ingerida foi um sabão caseiro. O sintoma mais reportado na apresentação foi vômito (22/34 -64,7%). O tempo médio de acompanhamento foi de 3,2 anos (IQR 1,1- 7,4). No seguimento, o número médio de dilatações esofágicas necessárias foi de 12,5 (IQR 0-34). Entre os fatores demográficos, o sexo masculino (P=0,04), acidentes com produtos caseiros (P=<0,01) e a localização do acidente fora do ambiente domiciliar (P=0,02) foram associados a um maior número de dilatações esofágicas no seguimento. A classificação endoscópica Zargar 2B ou mais (P=0,03), a presença de estenose na segunda EGD (P=0,01) e a DRGE como complicação tardia (P=0,01) também se associaram a maior número de dilatações esofágicas no acompanhamento a longo prazo. Conclusão: Além da gravidade da classificação endoscópica - fator de risco bem conhecido para as estenoses após ingestão de cáusticos, observamos que o sexo masculino, os acidentes com produtos caseiros e os acidentes ocorridos fora do ambiente doméstico foram fatores significativamente associados a um maior número de dilatações esofágicas em acompanhamento em longo prazo de crianças após ingestão de soda cáustica.
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BACKGROUND: The COVID-19 pandemic, caused by SARS-CoV-2 infection, has become the most devastating zoonotic event in recent times, with negative impacts on both human and animal welfare as well as on the global economy. Although SARS-CoV-2 is considered a human virus, it likely emerged from animals, and it can infect both domestic and wild animals. This constitutes a risk for human and animal health including wildlife with evidence of SARS-CoV-2 horizontal transmission back and forth between humans and wild animals. AIM: Molecular surveillance in different wildlife rehabilitation centers and wildlife associated institutions in Chile, which are critical points of animal-human interaction and wildlife conservation, especially since the aim of wildlife rehabilitation centers is to reintroduce animals to their original habitat. MATERIALS AND METHODS: The survey was conducted in six WRCs and three wildlife associated institutions. A total of 185 samples were obtained from 83 individuals belonging to 15 different species, including vulnerable and endangered species. Each specimen was sampled with two different swabs: one oropharyngeal or nasopharyngeal according to the nostril diameter, and/or a second rectal sample. RNA was extracted from the samples and two different molecular assays were performed: first, a conventional RT-PCR with pan-coronavirus primers and a second SARS-CoV-2 qPCR targeting the N and S genes. RESULTS: All 185 samples were negative for SARS-CoV-2. CLINICAL RELEVANCE: This study constitutes the first report on the surveillance of SARS-CoV-2 from wildlife treated in rehabilitation centers in Chile, and supports the biosafety procedures adopted in those centers.
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COVID-19 , SARS-CoV-2 , Humanos , Animais , SARS-CoV-2/genética , COVID-19/epidemiologia , COVID-19/veterinária , Animais Selvagens , Pandemias , Teste para COVID-19/veterináriaRESUMO
Introduction: Appendicular plastron is considered a progressive form of acute appendicitis, with a national prevalence of 2-10%. Currently management is often controversial. It is that from this context, it seeks to promote studies that can elucidate the variables associated with the management of this condition. Objective: to determine the epidemiological-clinical characteristics associated with the results of the management of the appendiceal plastron in adult patients in a reference hospital in Peru. Methods: Non-experimental study, with a quantitative approach, observational, analytical and cross-sectional design, whose sample consisted of 100 patients with a diagnosis of appendicular plastron. The data collection sheet was applied as an instrument. Likewise, a Poisson regression model was used to respond to the objectives. Results: The multivariate analysis showed that alcohol consumption (p<0.05 RPa=1.12), nausea and vomiting (p<0.05, RPa=1.48), diarrhea (p<0.05; RPa=1.08), duration of symptoms before admission between 3 and 5 days (p<0.05; RPa=1.09), appendiceal mass (p<0.05, RPa=1.18) and bandemia (p<0.05, RPa=1.12) were significantly associated with unsuccessful management results of the appendiceal plastron. Conclusion: There are epidemiological and clinical characteristics associated with the results of the management of the appendicular plastron.
Introducción: El plastrón apendicular se considera una forma progresiva de apendicitis aguda, teniendo una prevalencia a nivel nacional de 2-10%. Actualmente el manejo suele ser controversial. Ante lo expuesto, se busca promover estudios que puedan dilucidar las variables asociadas al manejo de esta condición. Objetivo: determinar las características epidemiológico-clínicas asociadas a los resultados del manejo del plastrón apendicular en pacientes adultos en un hospital de referencia del Perú. Métodos: Estudio no experimental, de enfoque cuantitativo, diseño observacional, analítico y transversal, cuya muestra estuvo conformada por 100 pacientes con diagnóstico de plastrón apendicular. Se aplicó como instrumento la ficha de recolección de datos. Asimismo, se utilizo un modelo de regresión de Poisson para responder a los objetivos. Resultados: El análisis multivariado evidenció que el consumo de alcohol (p<0.05 RPa=1.12), las náuseas y vómitos (p<0.05, RPa=1.48), diarrea (p<0.05; RPa=1.08), duración de síntomas antes del ingreso entre 3 y 5 días (p<0.05; RPa=1.09), masa apendicular (p<0.05, RPa=1.18) y bandemia (p<0.05, RPa=1.12) se asociaron significativamente a resultados de manejo no exitosos de plastrón apendicular. Conclusión: Existe características epidemiológicas y clínicas asociadas a resultados del manejo de plastrón apendicular.
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BACKGROUND: Since failure in recognition of abnormal cells by the immune system has an important role in bladder cancer development and progression, this study aimed to evaluate whether PD1 (c.627+252C>T) and PD1.5 (c.804C>T) single-nucleotide variants (SNVs) in PDCD1 gene, enrolled in modulation of T lymphocyte activity, influence risk, clinicopathological aspects, and outcome of non-muscle-invasive bladder cancer (NMIBC) patients. MATERIAL AND METHODS: DNA genotyping by real-time polymerase chain reaction was offered to 160 non muscle invasive bladder cancer (NMIBC) patients and 250 controls. One hundred and twenty-seven patients treated with bladder transurethral resection and intravesical bacillus Calmette-Guérin were enrolled in survival analyses. RESULTS: Individuals with PD1.5 CC genotype had 2.3-fold increased risk of developing NMIBC. Similar genotype and haplotype frequencies were seen in patients stratified by clinicopathological aspects. Patients with T allele, CT or TT plus CT or TT genotype and TT haplotype of PD1 and PD1.5 SNVs had up to 4.0-times greater chances of presenting NMIBC relapse and death by any cause than the remaining patients, but analysis of NMIBC specific survival was not possible in study due to the small number of patients evolving to death during follow up. CONCLUSIONS: Our data presented for the first time, preliminary evidence that inherited abnormality in regulation of T lymphocyte activity alters NMIBC risk.