RESUMO
OBJECTIVE: To determine whether the prior usage of the flu vaccine is a risk factor for bacterial co-infection in patients with severe influenza. DESIGN: This was a retrospective observational cohort study of subjects admitted to the ICU. A propensity score matching, and logistic regression adjusted for potential confounders were carried out to evaluate the association between prior influenza vaccination and bacterial co-infection. SETTINGS: 184 ICUs in Spain due to severe influenza. PATIENTS: Patients included in the Spanish prospective flu registry. INTERVENTIONS: Flu vaccine prior to the hospital admission. RESULTS: A total of 4175 subjects were included in the study. 489 (11.7%) received the flu vaccine prior to develop influenza infection. Prior vaccinated patients were older 71 [61-78], and predominantly male 65.4%, with at least one comorbid condition 88.5%. Prior vaccination was not associated with bacterial co-infection in the logistic regression model (OR: 1.017; 95%CI 0.803-1.288; p=0.885). After matching, the average treatment effect of prior influenza vaccine on bacterial co-infection was not statistically significant when assessed by propensity score matching (p=0.87), nearest neighbor matching (p=0.59) and inverse probability weighting (p=0.99). CONCLUSIONS: No association was identified between prior influenza vaccine and bacterial coinfection in patients admitted to the ICU due to severe influenza. Post influenza vaccination studies are necessary to continue evaluating the possible benefits.
Assuntos
Infecções Bacterianas , Coinfecção , Vacinas contra Influenza , Influenza Humana , Infecções Bacterianas/complicações , Infecções Bacterianas/epidemiologia , Estudos de Coortes , Coinfecção/epidemiologia , Feminino , Humanos , Vacinas contra Influenza/efeitos adversos , Influenza Humana/complicações , Influenza Humana/epidemiologia , Influenza Humana/prevenção & controle , Unidades de Terapia Intensiva , Masculino , Estudos Prospectivos , Fatores de RiscoRESUMO
OBJECTIVE: To determine whether the prior usage of the flu vaccine is a risk factor for bacterial co-infection in patients with severe influenza. DESIGN: This was a retrospective observational cohort study of subjects admitted to the ICU. A propensity score matching, and logistic regression adjusted for potential confounders were carried out to evaluate the association between prior influenza vaccination and bacterial co-infection. SETTINGS: 184 ICUs in Spain due to severe influenza. PATIENTS: Patients included in the Spanish prospective flu registry. INTERVENTIONS: Flu vaccine prior to the hospital admission. RESULTS: A total of 4175 subjects were included in the study. 489 (11.7%) received the flu vaccine prior to develop influenza infection. Prior vaccinated patients were older 71 [61-78], and predominantly male 65.4%, with at least one comorbid condition 88.5%. Prior vaccination was not associated with bacterial co-infection in the logistic regression model (OR: 1.017; 95%CI 0.803-1.288; p=0.885). After matching, the average treatment effect of prior influenza vaccine on bacterial co-infection was not statistically significant when assessed by propensity score matching (p=0.87), nearest neighbor matching (p=0.59) and inverse probability weighting (p=0.99). CONCLUSIONS: No association was identified between prior influenza vaccine and bacterial coinfection in patients admitted to the ICU due to severe influenza. Post influenza vaccination studies are necessary to continue evaluating the possible benefits.
RESUMO
BACKGROUND: Community-acquired pneumonia (CAP) severity scores can identify patients at low risk for mortality who may be suitable for ambulatory care. Here, we follow the clinical course of hospitalized patients with CAP due to 2009 H1N1 influenza. OBJECTIVE: To evaluate the role of CAP severity scores as predictors of mortality. METHODS: This was a secondary data analysis of patients hospitalized with CAP due to 2009 H1N1 influenza confirmed by reverse transcriptase polymerase chain reaction enrolled in the CAPO (Community-Acquired Pneumonia Organization) international cohort study. CAP severity scores PSI (Pneumonia Severity Index), CURB-65 (confusion, urea, respiratory rate, blood pressure, age ≥ 65 years) and CRB-65 (confusion, respiratory rate, blood pressure, age ≥ 65 years) were calculated. Actual and predicted mortality rates were compared. A total of 37 predictor variables were evaluated to define those associated with mortality. RESULTS: Data from 250 patients with CAP due to 2009 H1N1 influenza were analyzed. Patients with low predicted mortality rates (0-1.5%) had actual mortality rates ranging from 2.6% to 17.5%. Obesity and wheezing were the only novel variables associated with mortality. CONCLUSIONS: The decision to hospitalize a patient with CAP due to 2009 H1N1 influenza should not be based on current CAP severity scores, as they underestimate mortality rates in a significant number of patients. Patients with obesity or wheezing should be considered at an increased risk for mortality.
Assuntos
Infecções Comunitárias Adquiridas/mortalidade , Vírus da Influenza A Subtipo H1N1/isolamento & purificação , Influenza Humana/mortalidade , Pneumonia Viral/mortalidade , Adulto , Idoso , Estudos de Coortes , Infecções Comunitárias Adquiridas/fisiopatologia , Infecções Comunitárias Adquiridas/virologia , Feminino , Previsões , Hospitalização , Humanos , Influenza Humana/complicações , Influenza Humana/fisiopatologia , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Pneumonia Viral/fisiopatologia , Pneumonia Viral/virologia , Sons Respiratórios/fisiopatologia , Fatores de Risco , Índice de Gravidade de DoençaRESUMO
BTEX removal under aerobic conditions by unleaded gasoline acclimated biomass and BTEX acclimated biomass, and the effect of surfactant on BTEX biodegradation were evaluated. The effect of BTEX concentration as the sole source of carbon for biomass acclimation and the effect of yeast extract on cell growth in unleaded gasoline-fed reactors were also evaluated. For the unleaded gasoline acclimated biomass, benzene was shown the most recalcitrant among all BTEX, followed by o-xylene and toluene with 16-23%, 35-41% and 57-69% biodegradation, respectively. Ethylbenzene was consistently the fastest BTEX chemical removed with 99% biodegradation for the four bioreactor acclimated biomasses tested. For the 1,200 ppm BTEX acclimated biomass, benzene showed the highest removal efficiency (99%) among the four biomass environmental conditions tested, along with 99% toluene and 99% ethylbenzene biodegradation. O-xylene showed 92-94% removal. In all bioassays tested Tergitol NP-10 was fully removed, and did not have a substantial effect on BTEX biodegradation at the end of a 10-day evaluation.
Assuntos
Reatores Biológicos , Carcinógenos , Poluentes Ambientais/metabolismo , Gasolina , Bactérias Aeróbias , Benzeno/isolamento & purificação , Benzeno/metabolismo , Derivados de Benzeno/isolamento & purificação , Derivados de Benzeno/metabolismo , Biodegradação Ambiental , Biomassa , Poluentes Ambientais/isolamento & purificação , Tolueno/isolamento & purificação , Tolueno/metabolismo , Xilenos/isolamento & purificação , Xilenos/metabolismoRESUMO
This study is based on a review of the present situation of tetanus neonatorum. This study included 34 cases which were diagnosed as tetanus of the newborn. These 34 cases occurred in Dr A. Pumarejo hospital in the city of H. Matamoros, Tamaulipas (Mexico), during the period 1970-1974. It was found that during this pediatric age, in comparison with others, the incidence is high (61.8%) and shows a predominance of males over females of 4.62 to 1. The incidence of this pathology, as Cole & Youngman proposed, was as follows: grade I, 2.94% grade II, 11.76%; and 85.30% corresponding to grade III. The greater number of deaths were in those patients classified as grade III, which corresponded to 12 patients. The number of cases studied during spring and summer was much higher. The living conditions within our environment, our ecology and the unawareness of the basic means to prevent this pathology (correct management of the umbilical cord) were the main causes of this high incidence. Therefore, this case study leads to the conclusion that there is a great need to reorganize our programs of vaccination in order to protect this pediatric group, which is highly exposed.