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What should be considered in the treatment of bacterial infections by multi-drug therapies : a mathematical perspective?

Pimenta, Francisco; Abreu, Ana Cristina; Simões, Lúcia C.; Simões, M.
Fonte: Elsevier Publicador: Elsevier
Tipo: Artigo de Revista Científica
Publicado em //2014 ENG
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Bacterial infections are a global health concern with high levels of mortality and morbidity associated. The resistance of pathogens to drugs is one leading cause of this problem, being common the administration of multiple drugs to improve the therapeutic effects. This review critically explores diverse aspects involved in the treatment of bacterial infections through multi-drug therapies, from a mathematical and within-host perspectives. Five recent models were selected and are reviewed. These models fall into the following question: which drugs to select, the respective dose, the administration period to effectively eradicate the infection in the shortest period of time and with reduced side effects? In this analysis, three groups of variables were considered: pharmacokinetics, pharmacodynamics and disturbance variables. To date, there is no model that fully answers to this issue for a living organism and it is questionable whether this would be possible for any case of infection.

Antibacterial activity of the essential oil of Origanum vulgare L. (Lamiaceae) against bacterial multiresistant strains isolated from nosocomial patients

Costa,Adalberto Coelho da; Santos,Bernadete Helena Cavalcanti dos; Santos Filho,Lauro; Lima,Edeltrudes de Oliveira
Fonte: Sociedade Brasileira de Farmacognosia Publicador: Sociedade Brasileira de Farmacognosia
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/03/2009 EN
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Antibiotics are considered the main therapeutic option to treat bacterial infections; however, there is the disadvantage of increasing bacterial resistance. Thus, the research of antimicrobials of plant origin has been an important alternative. This work aimed at determining the in vitro antibacterial activity of the essential oil of Origanum vulgare L. (Lamiaceae) on multiresistant bacteria isolated from biological materials. 24 strains of nosocomial bacteria were used and divided into six different species that were inhibited by the essential oil in the preliminary "screening" which was accomplished by the diffusion technique in agar. MIC was determined by the microdilution method, beginning with solutions with the final concentrations: 8 up to 0.125% with the following results: The four samples (100%) of Escherichia coli, Enterococcus faecalis and MRSA were inhibited by the essential oil at the concentration of 0.125%. Three samples (75%) of Acinetobacter baumannii at 0.125% and a sample (25%) at 0.5%; Klebsiella pneumoniae (75%) at 0.125% and 25% at 0.25%; Pseudomonas aeruginosa (75%) at 0.5% and 25% at 0.25%. MIC varied from 78 to 83%. It was concluded through the obtained data that there was not difference in the minimum bactericidal concentration (0.5%) of the referred oil for Gram positive as well for Gram negative microorganisms.

Comparative study of bacterial infection prevalence between cirrhotic patients with and without upper gastrointestinal bleeding

Almeida,Delvone; Lopes,Antônio A; Santos-Jesus,Rogerio; Paes,Igelmar; Bittencourt,Helito; Paraná,Raymundo
Fonte: Brazilian Society of Infectious Diseases Publicador: Brazilian Society of Infectious Diseases
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/06/2001 EN
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Bacterial infection is a frequent complication in patients with chronic liver disease, mainly during the advanced stages. There is evidence that the main factors that contribute to a predisposition to infection in cirrhotic patients are related to hepatic failure with consequent immunodeficiency. Invasive procedures (diagnostic or therapeutic) can predispose to bacterial infections, and upper gastrointestinal bleeding (UGB) is considered a potentially important risk factor. A group of cirrhotic patients (child B and C Pugh groups ) were evaluated retrospectively by chart reviews regarding the prevalence of bacterial infection during hospitalization to determine whether UGB was a risk factor. An infection was considered present if a specific organ system was identified or if fever (>38ºC) persisted for more than 24 hours with associated leukocytosis. Spontaneous bacterial peritonitis was based on classical criteria. Eighty-nine patients were evaluated. Fourty-six patients presented with UGB, and 43 patients had no UGB (control). There were infections recorded in 25/46 (54%) patients with UGB, and 15/43 (35%) in those without UGB (p=0.065). The ratio of the number of infections/admitted patients, was significantly larger in the group with UGB (0.78 ± 0.89 vs. 0.39 ± 0.62; p=0.028) since patients had more than one infection. In the UGB group compared to non UGB group...

A multicenter comparative study of cefepime versus broad-spectrum antibacterial therapy in moderate and severe bacterial infections

Badaró,Roberto; Molinar,Fernando; Seas,Carlos; Stamboulian,Daniel; Mendonça,João; Massud,João; Nascimento,Luiz Olympio
Fonte: Brazilian Society of Infectious Diseases Publicador: Brazilian Society of Infectious Diseases
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/10/2002 EN
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The safety and efficacy of cefepime empiric monotherapy compared with standard broad-spectrum combination therapy for hospitalized adult patients with moderate to severe community-acquired bacterial infections were evaluated. In an open-label, multicenter study, 317 patients with an Acute Physiology and Chronic Health Evaluation (APACHE II) score ranging from >5 to =19 were enrolled with documented pneumonia (n=196), urinary tract infection (n=65), intra-abdominal infection (n=38), or sepsis (n=18). Patients were randomly assigned 1:1 to receive cefepime 1 to 2 g IV twice daily or three times a day or IV ampicillin, cephalothin, or ceftriaxone ± aminoglycoside therapy for 3 to 21 days. For both treatment groups, metronidazole, vancomycin, or macrolide therapy was added as deemed necessary. The primary efficacy variable was clinical response at the end of therapy. Two hundred ninety-six (93%) patients met evaluation criteria and were included in the efficacy analysis. Diagnoses included the following: 180 pneumonias (90 cefepime, 90 comparator), 62 urinary tract infections (29 cefepime, 33 comparator), 37 intra-abdominal infections (19 cefepime, 18 comparator), and 17 sepses (8 cefepime, 9 comparator). At the end of therapy, overall clinical success rates were 131/146 (90%) for patients treated with cefepime vs 125/150 (83%) for those treated with comparator (95% confidence interval [CI]: - 2.6% to 16.3%). The clinical success rate for patients with community-acquired pneumonia...

Enhancement of Bacterial Infections in Mice by Newcastle Disease Virus

Hugh, Rudolph; Huang, Kun-Yen; Elliott, Thomas B.
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /03/1971 EN
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This report describes an attempt to define the factors which incite secondary bacterial pneumonias. Groups of mice were given bacteria intraperitoneally and, at various intervals, Newcastle disease virus intravenously. There was an increase in the number of deaths and in the rates of death in these groups, when compared with a control group which was given only bacteria. These results were obtained with Streptococcus pneumoniae (Diplococcus pneumoniae), Pseudomonas aeruginosa, and Salmonella enteritidis ser. typhimurium. Newcastle disease virus increased the mortality rate of mice with bacterial infections when the two agents were given within 24 hr.

Noninvasive Biophotonic Imaging for Monitoring of Catheter-Associated Urinary Tract Infections and Therapy in Mice

Kadurugamuwa, Jagath L.; Modi, Kshitij; Yu, Jun; Francis, Kevin P.; Purchio, Tony; Contag, Pamela R.
Fonte: American Society for Microbiology Publicador: American Society for Microbiology
Tipo: Artigo de Revista Científica
Publicado em /07/2005 EN
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Urinary tract infections (UTIs) are among the most common bacterial infections acquired by humans, particularly in catheterized patients. A major problem with catheterization is the formation of bacterial biofilms on catheter material and the risk of developing persistent UTIs that are difficult to monitor and eradicate. To better understand the course of UTIs and allow more accurate studies of in vivo antibiotic efficacy, we developed a catheter-based biofilm infection model with mice, using bioluminescently engineered bacteria. Two important urinary tract pathogens, Pseudomonas aeruginosa and Proteus mirabilis, were made bioluminescent by stable insertion of a complete lux operon. Segments of catheter material (precolonized or postimplant infected) with either pathogen were placed transurethrally in the lumen of the bladder by using a metal stylet without surgical manipulation. The bioluminescent strains were sufficiently bright to be readily monitored from the outside of infected animals, using a low-light optical imaging system, including the ability to trace the ascending pattern of light-emitting bacteria through ureters to the kidneys. Placement of the catheter in the bladder not only resulted in the development of strong cystitis that persisted significantly longer than in mice challenged with bacterial suspensions alone but also required prolonged antibiotic treatment to reduce the level of infection. Treatment of infected mice for 4 days with ciprofloxacin at 30 mg/kg of body weight twice a day cured cystitis and renal infection in noncatheterized mice. Similarly...

The Toll-Like Receptor 4 Agonist Monophosphoryl Lipid A Augments Innate Host Resistance to Systemic Bacterial Infection ▿

Romero, Christopher D.; Varma, Tushar K.; Hobbs, Jason B.; Reyes, Aimee; Driver, Brandon; Sherwood, Edward R.
Fonte: American Society for Microbiology Publicador: American Society for Microbiology
Tipo: Artigo de Revista Científica
Publicado em /09/2011 EN
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Monophosphoryl lipid A (MPLA) is a Toll-like receptor 4 (TLR4) agonist that is currently used as a vaccine adjuvant in humans. In this study, we evaluated the effect of MPLA treatment on the innate immune response to systemic bacterial infections in mice. Mice treated with MPLA after burn injury showed improved survival and less local and systemic dissemination of bacteria in a model of Pseudomonas aeruginosa burn wound infection. Prophylactic treatment with MPLA significantly enhanced bacterial clearance at the site of infection and reduced systemic dissemination of bacteria despite causing attenuation of proinflammatory cytokine production during acute intra-abdominal infection caused by cecal ligation and puncture. Administration of MPLA at 1 h after CLP also improved bacterial clearance but did not alter cytokine production. MPLA treatment increased the numbers of granulocytes, double-positive myeloid cells, and macrophages at sites of infection and increased the percentage and total numbers of myeloid cells mediating phagocytosis of bacteria. Depletion of Ly6G+ neutrophils, but not macrophages, eliminated the ability of MPLA treatment to improve bacterial clearance. The immunomodulatory effects of MPLA were absent in TLR4-deficient mice. In conclusion...

Evaluation of Serum Procalcitonin Levels for Diagnosis of Secondary Bacterial Infections in Visceral Leishmaniasis Patients

Pasyar, Neda; Alborzi, Abdolvahab; Pouladfar, Gholam R.
Fonte: The American Society of Tropical Medicine and Hygiene Publicador: The American Society of Tropical Medicine and Hygiene
Tipo: Artigo de Revista Científica
Publicado em 01/01/2012 EN
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Secondary bacterial infections are a major complication and cause of death in children with visceral Leishmaniasis (VL). Thus, early diagnosis of bacterial infections is an important step in the treatment of patients with VL. The goal of this study was to determine if serum procalcitonin (PCT) could be used as a diagnostic marker of secondary bacterial infections in VL patients. Serum PCT was measured in 35 hospitalized patients with VL before treatment and after defervescence. The level was higher than normal (> 0.5 ng/mL) in 72% (25) of the patients. Twelve (34%) of 35 patients had secondary bacterial infections with PCT levels ranging from 0.1 to 12.29 ng/mL, and those without secondary bacterial infections (23) had PCT levels ranging from 0.1 to 14.58 ng/mL. The results suggest that PCT levels increase significantly in most VL patients but are not correlated with the presence of secondary bacterial infections.

The Role of Prophylaxis of Bacterial Infections in Children With Acute Leukemia/Non-Hodgkin Lymphoma

Castagnola, Elio
Fonte: PAGEPress Publications, Pavia, Italy Publicador: PAGEPress Publications, Pavia, Italy
Tipo: Artigo de Revista Científica
Publicado em 13/06/2014 EN
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Infections represent a well-known complication of antineoplastic chemotherapy that may cause delay of treatment, with alteration of the antineoplastic program and dose-intensity, or even the death of a patient that could heal from his/her neoplasia. Bacterial infections are a major cause of morbidity and mortality in patients who are neutropenic following chemotherapy for malignancy. Therefore a program of antibiotic prophylaxis for febrile neutropenia may be considered in the management strategy of cancer patients.

Relative Roles of the Cellular and Humoral Responses in the Drosophila Host Defense Against Three Gram-Positive Bacterial Infections

Nehme, Nadine T.; Quintin, Jessica; Ferrandon, Dominique; Cho, Ju Hyun; Lee, Jeannie T.; Kocks, Christine; Lafarge, Marie-Celine
Fonte: Public Library of Science Publicador: Public Library of Science
Tipo: Artigo de Revista Científica
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Background: Two NF-kappaB signaling pathways, Toll and immune deficiency (imd), are required for survival to bacterial infections in Drosophila. In response to septic injury, these pathways mediate rapid transcriptional activation of distinct sets of effector molecules, including antimicrobial peptides, which are important components of a humoral defense response. However, it is less clear to what extent macrophage-like hemocytes contribute to host defense. Methodology/Principal Findings: In order to dissect the relative importance of humoral and cellular defenses after septic injury with three different Gram-positive bacteria (Micrococcus luteus, Enterococcus faecalis, Staphylococcus aureus), we used latex bead pre-injection to ablate macrophage function in flies wildtype or mutant for various Toll and imd pathway components. We found that in all three infection models a compromised phagocytic system impaired fly survival – independently of concomitant Toll or imd pathway activation. Our data failed to confirm a role of the PGRP-SA and GNBP1 Pattern Recognition Receptors for phagocytosis of S. aureus. The Drosophila scavenger receptor Eater mediates the phagocytosis by hemocytes or S2 cells of E. faecalis and S. aureus, but not of M. luteus. In the case of M. luteus and E. faecalis...

Persistent bacterial infections, antibiotic tolerance, and the oxidative stress response

Grant, Sarah Schmidt; Hung, Deborah T.
Fonte: Landes Bioscience Publicador: Landes Bioscience
Tipo: Artigo de Revista Científica
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Certain bacterial pathogens are able to evade the host immune system and persist within the human host. The consequences of persistent bacterial infections potentially include increased morbidity and mortality from the infection itself as well as an increased risk of dissemination of disease. Eradication of persistent infections is difficult, often requiring prolonged or repeated courses of antibiotics. During persistent infections, a population or subpopulation of bacteria exists that is refractory to traditional antibiotics, possibly in a non-replicating or metabolically altered state. This review highlights the clinical significance of persistent infections and discusses different in vitro models used to investigate the altered physiology of bacteria during persistent infections. We specifically focus on recent work establishing increased protection against oxidative stress as a key element of the altered physiologic state across different in vitro models and pathogens.

Colistin: the re-emerging antibiotic for multidrug-resistant gram-negative bacterial infections

Li, J.; Nation, R.; Turnidge, J.; Milne, R.; Coulthard, K.; Rayner, C.; Paterson, D.
Fonte: The Lancet Publishing Group Publicador: The Lancet Publishing Group
Tipo: Artigo de Revista Científica
Publicado em //2006 EN
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Increasing multidrug resistance in Gram-negative bacteria, in particular Pseudomonas aeruginosa, Acinetobacter baumannii, and Klebsiella pneumoniae, presents a critical problem. Limited therapeutic options have forced infectious disease clinicians and microbiologists to reappraise the clinical application of colistin, a polymyxin antibiotic discovered more than 50 years ago. We summarise recent progress in understanding the complex chemistry, pharmacokinetics, and pharmacodynamics of colistin, the interplay between these three aspects, and their effect on the clinical use of this important antibiotic. Recent clinical findings are reviewed, focusing on evaluation of efficacy, emerging resistance, potential toxicities, and combination therapy. In the battle against rapidly emerging bacterial resistance we can no longer rely entirely on the discovery of new antibiotics; we must also pursue rational approaches to the use of older antibiotics such as colistin.; Jian Li, Roger L Nation, John D Turnidge, Robert W Milne, Kingsley Coulthard, Craig R Rayner, David L Paterson

Mast cell-derived TNF can exacerbate mortality during severe bacterial infections in C57BL/6-KitW-sh/W-sh mice

Piliponsky, A.; Chen, C.C.; Grimbaldeston, M.; Burns-Guydish, S.; Hardy, J.; Kalesnikoff, J.; Contag, C.; Tsai, M.; Galli, S.
Fonte: Amer Soc Investigative Pathology Inc Publicador: Amer Soc Investigative Pathology Inc
Tipo: Artigo de Revista Científica
Publicado em //2010 EN
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We used mast cell-engrafted genetically mast cell-deficient C57BL/6-Kit(W-sh/W-sh) mice to investigate the roles of mast cells and mast cell-derived tumor necrosis factor in two models of severe bacterial infection. In these mice, we confirmed findings derived from studies of mast cell-deficient WBB6F(1)-Kit(W/W-v) mice indicating that mast cells can promote survival in cecal ligation and puncture (CLP) of moderate severity. However, we found that the beneficial role of mast cells in this setting can occur independently of mast cell-derived tumor necrosis factor. By contrast, using mast cell-engrafted C57BL/6-Kit(W-sh/W-sh) mice, we found that mast cell-derived tumor necrosis factor can increase mortality during severe CLP and can also enhance bacterial growth and hasten death after intraperitoneal inoculation of Salmonella typhimurium. In WBB6F(1)-Kit(W-sh/W-sh) mice, mast cells enhanced survival during moderately severe CLP but did not significantly change the survival observed in severe CLP. Our findings in three types of genetically mast cell-deficient mice thus support the hypothesis that, depending on the circumstances (including mouse strain background, the nature of the mutation resulting in a mast cell deficiency, and type and severity of infection)...


Smith, Mary Ruth; Wood, W. Barry
Fonte: The Rockefeller University Press Publicador: The Rockefeller University Press
Tipo: Artigo de Revista Científica
Publicado em 31/03/1956 EN
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The results of the experimental analysis reported in this and the two preceding papers (10, 11) indicate that in murine pneumococcal infections penicillin per se destroys the invading organisms only in those parts of the lesions where the bacteria are multiplying rapidly and are thus maximally susceptible to the bactericidal action of the drug. In areas where the bacterial growth rate is slowed, either because the pneumococci have reached a maximum population density, or because the accumulated exudate affords a relatively poor medium for rapid growth, the destructive effect of the antibiotic is greatly diminished. In such portions of the lessions the cellular defenses of the host are observed to play a major role in eliminating the bacteria. In sites where frank suppuration has developed, however, even the combined actions of the penicillin and the cellular defenses of the host are relatively ineffective in ridding the tissues of bacteria. Here, because of the poor medium provided by the pus, the pneumococci remain metabolically sluggish and therefore are not killed rapidly by the penicillin. At the same time the leucocytes in the necrotic exudate have deteriorated to the point where they cannot effectively perform their phagocytic functions. As a result...

Nursing staff knowledge of multi-resistant bacterial infections

Moura,Josely Pinto de; Gir,Elucir
Fonte: Escola Paulista de Enfermagem, Universidade Federal de São Paulo Publicador: Escola Paulista de Enfermagem, Universidade Federal de São Paulo
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/09/2007 EN
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OBJECTIVE: To assess professional nurses', associate degree prepared nurses', licensed practical nurses', and nursing assistants' knowledge of the causes of multi-resistant bacterial infections, the risks theses infections pose to health care providers, the chain of transmission of these infections, and patients' susceptibility to colonization of these multi-resistant bacterial infections. METHODS: This descriptive study was conducted in a major general hospital in Minas Gerais, Brazil. The sample consisted of 42 nursing staff from a medical clinical unit. Descriptive statistics were used to analyze and present the data. RESULTS: Nursing staff had unsatisfactory knowledge of the causes of multi-resistant bacterial infections, the chain of transmission of multi-resistant bacterial infections, and patients' susceptibility to colonization of multi-resistant bacterial infections. However, the majority of participants had some knowledge about the risks that multi-resistant bacterial infections posed to health care providers. CONCLUSION: Lack of knowledge among nursing staff compromise adherence to preventive measures and nursing management of multi-resistant bacterial infections.

Clinical correlation between HBV infection and concomitant bacterial infections

Li, Wei; Jin, Ronghua; Chen, Peng; Zhao, Guoxian; Li, Ning; Wu, Hao
Fonte: Nature Publishing Group Publicador: Nature Publishing Group
Tipo: Artigo de Revista Científica
Publicado em 04/12/2015 EN
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Bacterial infections are common in patients suffering viral hepatitis and critical for prognosis. However, any correlation between HBV and concomitant bacterial infections is not well characterized. A retrospective study was conducted from Jan 2012 to Jan 2014 on 1333 hospitalized patients infected with bacteria. Among them, 491 HBV-infected patients were co-infected with E. coli (268), S. aureus (61), P. aeruginosa (64) or K. pneumoniae (98). A group of 300 complication-free chronically HBV-infected patients were controls. We found that HBV DNA levels were elevated in patients with each of the bacterial infections (all P < 0.05). ALT and HBeAg were strong determinants of high HBV DNA concentration. Patterns of determinants varied in infections by Gram-positive and Gram-negative bacteria. Patients with HBV DNA ≥ 2000 IU/mL had higher rates of all four concomitant bacterial infections (all P < 0.001). All types of strains isolated from HBV-positive patients showed less resistance to tested antimicrobials. The HBV DNA serum concentrations were inversely correlated to the number of ineffective antimicrobials in E. coli, P. aeruginosa and K. pneumoniae infections (P = 0.022, 0.017 and 0.016, respectively), but not S. aureus (P = 0.194). In conclusion...


Darini, Ana Lúcia C.; Magalhães, Vanda D.; Crott, Luciana S. P.
Fonte: Universidade de São Paulo. Faculdade de Medicina de Ribeirão Preto Publicador: Universidade de São Paulo. Faculdade de Medicina de Ribeirão Preto
Tipo: info:eu-repo/semantics/article; info:eu-repo/semantics/publishedVersion; ; Formato: application/pdf
Publicado em 30/03/1998 POR
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A tipagem molecular do genoma bacteriano, na maioria das vezes, envolve a análise de fragmentos de restrição do DNA cromossômico. Desde que a ribotipagem foi descrita, em 1986, tem sido amplamente utilizada para analisar relações taxonômicas e/ou epidemiológicas entre os diferentes grupos de organismos. A ribotipagem usa o padrão de restrição do opéron de RNA ribossômico (rrn) como ferramenta epidemiológica e tem fornecido ótimos resultados para a detecção de polimorfismo do comprimento dos fragmentos de restrição (RFLPs). O número de opérons rrn da bactéria está diretamente relacionado ao potencial discriminatório da técnica, fornecendo um maior ou menor número de bandas.  ; Molecular typing usually involves restriction fragment analysis of chromossomal DNA. Since 1986, ribotyping has been used to analyse taxonomic and/or epidemiological relationship among microrganisms. Ribotyping uses, as an epidemiological tool, the restriction profile of the ribosomal RNA operons and it has provided good results in RFLP detection. The number of bacterial rrn operons correlates with the discriminatory potential of the technique.

A descriptive study of adrenal crises in adults with adrenal insufficiency: increased risk with age and in those with bacterial infections

Rushworth, R.L.; Torpy, D.J.
Fonte: BioMed Central Publicador: BioMed Central
Tipo: Artigo de Revista Científica
Publicado em //2014 EN
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BACKGROUND: An adrenal crisis (AC) is a major cause of morbidity in hypoadrenal patients. However, there is little information available on the incidence and underlying causes of AC. METHODS: The aim of the present study was to describe the incidence of AC in New South Wales (NSW), Australia. Using a health department database, we selected de-identified data on all adults aged 20 years and over who were treated in any hospital in NSW between July1, 2000-June 30, 2011, with either a principal or secondary diagnosis of an AC. AC admission rates were calculated overall and within age categories. Frequencies of co-morbid diagnoses were analysed by age and sex groups. Poisson regression was used to assess the significance of the observed change in AC related admissions with age, while controlling for any secular trends by including year in the model. Chi sq tests were used to assess the differences in frequencies of categorical variables between groups. RESULTS: 824 patients received treatment for an AC in hospital, corresponding to 74.9 admissions/year. The majority (62.5%) of the patients were women and 52.8% were aged 60 years and over. Admission rates were significantly associated with increasing age (p < 0.0001). Patients in the 60-69...

Chromosomal effects of infections in malnourished and eutrophic children of Gran La Plata

Padula,G; Seoane,A
Fonte: BAG. Journal of basic and applied genetics Publicador: BAG. Journal of basic and applied genetics
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/06/2008 EN
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The aim of this study was to assess the induction of structural chromosomal aberrations in peripheral blood lymphocytes of malnourished and eutrophic children with bacterial infections. Thirty-six infants concurrent to the Hospital Interzonal de Agudos y Crónicos Dr. Alejandro Korn, La Plata, Argentina were included in this analysis; 11 infected and malnourished (IM), 7 infected and eutrophic (IE) and 18 non-infected and eutrophic (NE). Children aged 1-60 months. Anthropometric and clinic evaluation were performed to assess nutritional condition. We scored structural chromosome aberrations (SCA) in 100 metaphases per individual. Statistical analysis was performed by the Epi Dat 3.0 (OPS-OMS, 2003), through «Test de Diferencias entre dos proporciones muestrales» (p<0.05). Total SCE frequency was five times higher in IM children than that of IE ones (15,1% vs. 3,33% p<0,001) and two times greater in IE than in NE children (3,33% vs. 1,88% p<0.05). Results presented here showed an increase frequency of SCA not only in relation with malnutrition but also with the presence of bacterial infections. It is difficult to discern whether structural chromosome aberrations are due to malnutrition per se, bacterial or viral infections, antibiotics or all of these factors acting on malnourished tissues. In conclusion...

Diagnosis and management of febrile children using the WHO/UNICEF guidelines for IMCI in Dhaka, Bangladesh

Factor,S.H.; Schillinger,J.A.; Kalter,H.D.; Saha,S.; Begum,H.; Hossain,A.; Hossain,M.; Dewitt,V.; Hanif,M.; Khan,N.; Perkins,B.; Black,R.E.; Schwartz,B.
Fonte: World Health Organization Publicador: World Health Organization
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/01/2001 EN
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OBJECTIVE: To determine whether the fever module in the WHO/UNICEF guidelines for the integrated management of childhood illness (IMCI) identifies children with bacterial infections in an area of low malaria prevalence. METHODS: Physicians assessed a systematic sample of 669 sick children aged 2-59 months who presented to the outpatient department of Dhaka Shishu Hospital, Bangladesh. FINDINGS: Had IMCI guidelines been used to evaluate the children, 78% of those with bacterial infections would have received antibiotics: the majority of children with meningitis (100%), pneumonia (95%), otitis media (95%) and urinary tract infection (83%); and 50% or less of children with bacteraemia (50%), dysentery (48%), and skin infections (30%). The current fever module identified only one additional case of meningitis. Children with bacteraemia were more likely to be febrile, feel hot, and have a history of fever than those with dysentery and skin infections. Fever combined with parental perception of fast breathing provided a more sensitive fever module for the detection of bacteraemia than the current IMCI module. CONCLUSIONS: In an area of low malaria prevalence, the IMCI guidelines provide antibiotics to the majority of children with bacterial infections...