Renata Amato Vieira

Characteristics associated with activity restriction induced by fear of falling in community-dwelling elderly

OBJECTIVES The aim of this study was to determine the social-demographic, clinical, functional and psychological factors associated to activity restriction due to fear of falling in community-dwelling elderly and identify which variables best discriminate groups of elderly with different levels of activity restriction and fear of falling. METHODS One hundred and thirteen community-dwelling elderly (74.5±7 years old) participated in the study. Activity restriction induced by fear of falling, previous falls, fall related self-efficacy, frailty phenotype, functional capacity, depressive symptoms, health self-perception, socio-demographic and clinical factors were assessed. Descriptive statistics, chi-square, ANOVA and Kruskal Wallis tests were used to analyze the associations between activity restriction due to fear of falling and all other variables. Path analysis (CHAID) method was used to verify which variables better discriminated groups in relation to activity restriction (α=0.05). RESULTS The participants who reported fear of falling and activity restriction demonstrated higher depression (p=0.038), lower fall related self-efficacy (p<0.001), lower gait velocity (p=0.043) and independence level for instrumental daily living activities (p=0.017), higher number of diseases (p=0.048), worse health self-perception (p=0.040) and more depressive symptom (p=0.023). The best variables to discriminate groups were depression (p=0.004), exhaustion (frailty phenotype) (p=0.010) and social participation activities (p=0.016). CONCLUSION Activity restriction due to fear of falling may have negative effects on functional capacity and psychological aspects in community-dwelling elderly. Psychosocial factors seem to better discriminate the elderly who avoid activities due to fear of falling.

Incidence of respiratory viruses in preterm infants submitted to mechanical ventilation

The objectives of this study were to determine the incidence of infection by respiratory viruses in preterm infants submitted to mechanical ventilation, and to evaluate the clinical, laboratory and radiological patterns of viral infections among hospitalized infants in the neonatal intensive care unit (NICU) with any kind of acute respiratory failure. Seventy-eight preterm infants were studied from November 2000 to September 2002. The newborns were classified into two groups: with viral infection (Group I) and without viral infection (Group II). Respiratory viruses were diagnosed in 23 preterm infants (29.5%); the most frequent was respiratory syncytial virus (RSV) (14.1%), followed by influenza A virus (10.2%). Rhinorrhea, wheezing, vomiting and diarrhea, pneumonia, atelectasis, and interstitial infiltrate were significantly more frequent in newborns with nosocomial viral infection. There was a correlation between nosocomial viral infection and low values of C-reactive protein. Two patients with mixed infection from Group I died during the hospital stay. In conclusion, RSV was the most frequent virus in these patients. It was observed that, although the majority of viral lower respiratory tract infections had a favorable course, some patients presented a serious and prolonged clinical manifestation, especially when there was concomitant bacterial or fungal infection.

Correlation between inflammatory mediators in the nasopharyngeal secretion and in the serum of children with lower respiratory tract infection caused by respiratory syncytial virus and disease severity

OBJECTIVE To determine whether the concentrations of inflammatory mediators (CCL5, soluble intercellular adhesion molecule type 1 [sICAM-1], TNF-alpha, IL-6 and IL-10) in the nasopharyngeal secretion and in the serum of children with lower respiratory tract infection (LRTI) caused by respiratory syncytial virus (RSV) correlate with the clinical markers of disease severity. METHODS Between July of 2004 and December of 2005, 30 children less than three months of age, diagnosed with LRTI caused by RSV and admitted to a neonatal ICU, were included in this study. RESULTS The severity of disease at hospital admission, as determined with a modified clinical scoring system, presented a significant positive correlation with sICAM-1 and IL-10 concentrations in the nasopharyngeal secretion, as well as with IL-6 concentrations in the serum, of the patients. In addition, serum IL-6 concentrations presented a significant positive correlation with the duration of oxygen therapy and with the length of hospital stay. CONCLUSIONS At hospital admission, the concentrations of sICAM-1 and IL-10 in the nasopharyngeal secretion, as well as the concentration of IL-6 in the serum, could be used as markers of severity in patients with LRTI caused by RSV. The serum levels of IL-6 determined at admission could also be used to predict prolonged oxygen supplementation and hospital stay.

Clinical and laboratory study of newborns with lower respiratory tract infection due to respiratory viruses.

Objectives: To determine the prevalence of lower respiratory tract infection due to respiratory viruses in the neonatal period at admission to the neonatal intensive care unit and to compare the clinical, laboratory and radiological aspects of the clinical course, according to the etiological agent, in the neonatal period. Methods: Ninety newborns were studied, from January 1999 to January 2001, with bronchiolitis and/or pneumonia. The newborns were classified into three groups, according to the etiological agent identified initially: viral infection (group A), mixed viral-bacterial infection (group B), and bacterial infection (group C). Results: The virus was identified in 72 newborns (80.0%); the most prevalent was respiratory syncytial virus (RSV) (44.4%), followed by influenza A virus (22.2%). Coughing, wheezing and an interstitial infiltrate were significantly more frequent in newborns with viral infection. Mixed infection was more associated with sepsis. There was a correlation between viral infection and low values of initial and subsequent white blood cell count and C-reactive protein. RSV was the most important virus in these patients. Conclusions: It was observed that, although the majority of viral respiratory infections had a favorable course, some patients presented a serious and prolonged clinical manifestation, especially when there was concomitant bacterial infection.

Prevalência de sepse por bactérias Gram negativas produtoras de beta-lactamase de espectro estendido em Unidade de Cuidados Intensivos Neonatal

OBJECTIVE: To determine the neonatal sepsis prevalence and the mortality of extended-spectrum beta-lactamase producing Gram-negative bacteria (ESBL) in a Neonatal Intensive Care Unit. METHODS: This is a descriptive and retrospective study of 236 newborn infants with sepsis suspicion from 2000 to 2004. The diagnosis was confirmed by clinical signs and positive blood culture. Screening for ESBL was carried out following the National Committee for Clinical Laboratory Standards criteria. RESULTS: Eighty-four (36%) neonates showed positive blood culture. Klebsiella pneumoniae was the most prevalent agent (47%). Among the neonates with Klebsiella pneumoniae infection, seven presented ESBL infection, with an infection rate of 0.4%. All the patients with one exception had length of hospital stay greater than 21 days and needed mechanical ventilation; all the newborns used central catheters, parenteral nutrition and broad-spectrum antibiotics. Among the 84 patients with confirmed sepsis, 36 (43%) died and their blood cultures were positive for gram-negative bacteria (67%) and fungous (19%). In relation to ESBL Klebsiella pneumoniae, three (43%) neonates died. CONCLUSIONS: The prevalence of sepsis by ESBL Klebsiella pneumoniae was 0.4% and the mortality rate was 42.8%. It is important to detect and to control the spread of this infectious agent with its negative impact on the survival rate of premature and/or sick newborn infants.

Brain abscess by citrobacter diversus in infancy: case report

Citrobacter diversus is closely related to brain abscess in newborn infants. We describe a case of brain abscess by this bacteria in a newborn infant and his clinical and cranial computed tomographic evaluation until the fourth month of life and discuss therapeutic management of this patient.

Diffuse congenital cystic lung disease with spontaneous regression

Congenital pulmonary cystic lesions are rare and may present in a variety of clinical manifestations. The frequency of this finding in the neonatal period is unknown, and many patients may be asymptomatic and diagnosed in later life [1,2]. The occurrence of pulmonary cystic lesions associated with severe respiratory distress, however, may be quite difficult to manage clinically, particularly if associated with significant pulmonary hypertension. Congenital cystic lesions of the lung parenchyma may vary in aspect, location, clinical manifestations, and prognosis, according to their embryonic origins. In addition to the classification of the type of cystic lesion, it is essential to distinguish congenital from acquired cysts, such as pneumatoceles of staphylococcal pneumonia or cysts from histiocytosis X [1]. Therapy of cystic malformations is essentially surgical, even if they are asymptomatic at the time of diagnosis, but timing for surgical resection may be dependent on the extent and clinical impact of the cysts [2]. Congenital cystic malformations diagnosed prenatally may disappear spontaneously during pregnancy [3,4], and there is also a recent description of postnatal regression of localized congenital cystic adenomatoid malformation in a premature infant [5]. We describe herein an interesting case of diffuse congenital cystic lung disease in a newborn infant with spontaneous regression, emphasizing the need for a careful approach in some instances. ACL, a white female newborn infant, was born by vaginal route at 37 weeks of gestation, weighing 2660 g with Apgar scores of 8/9. There was no available information regarding prenatal follow-up. Hypoglycemia was detected in the first day of life, resolved with intravascular glucose. On the 2 day of life she developed respiratory distress with tachypnea, retractions, cyanosis, and grunting, and therefore supplemental oxygen by hood and intravenous antibiotics were started. The initial chest radiograph showed diffuse infiltrates and cystic lesions distributed in both lungs, of different sizes (Figure 1). She did not receive either mechanical ventilation or positive pressure in the delivery room or at any time during her hospitalization. She also did not present clinical signs of sepsis during that period. The newborn was transferred to our Neonatal Intensive Care Unit on the 28 day of life, due to persistence of the respiratory distress and maintenance of the radiologic pattern. On admission, the neonate showed a good appearance, with mild to moderate tachypnea and retractions. Oxygen saturation was kept above 93% by supplementing oxygen via a nasal cannula, 1 liter per minute. The mother reported that fetal ultrasound had not been performed during pregnancy. Cardiac echo showed patent foramen ovale; brain and abdominal ultrasonography were normal. Laboratory workup performed at admission showed a white blood cell count of 17 200/mm, 46% polymorphonuclear leukocytes, and a C-reactive protein level of 53.2 mg/L. Laboratory investigations for congenital infections (Chlamydia trachomatis, toxoplasmosis, cytomegalovirus, HIV, and rubella) were all negative. Immunofluorescence for respiratory viruses in nasal aspirate was also negative. Chest computed tomography performed at admission showed diffuse cystic lesions of different sizes and with thin walls, predominantly distributed in the left upper lobe and bilateral basilar regions (Figure 2). The patient received only supportive therapy and was not submitted to biopsy or a surgical approach due to the diffuse distribution of the lesions. On the 10 day of hospitalization there was a marked improvement in the clinical condition The Journal of Maternal-Fetal and Neonatal Medicine, November 2006; 19(11): 745–748

Score for Neonatal Acute Physiology-ii: Use in Neonates With Congenital Diaphragmatic Hernia

Pediatric Critical Care Medicine www.pccmjournal.org 1017 CDH, but we do not have ECMO available in our hospital. From 2000 to 2015, 69 inborn and outborn infants were admitted in our NICU with CDH with and without good prognostic factors. Of these 69 neonates with CDH, 69% survived and 31% died. The SNAP-II score proved to be a good predictor of mortality rate in all patients with and without good prognostic factors. The amount of SNAP-II was greater than 30 for all patients who presented complicated clinical course, and some cases reached high values in this score (such as 89). All infants who survived had value of SNAP-II score below 30 (unpublished data). The intrauterine lung-to-head ratio (LHR) also helped Snoek et al (1) in to predict the prognosis of patients with CDH (4). In our hospital, fetal LHR greater than 1 is predictive of good prognosis in neonates with CDH. In conclusion, the SNAP-II score provides an easy-to-use bedside tool for predicting outcome among neonates with CDH. Early bedside application may assist the provider and the family in evaluating survival probability and help with the difficult decision regarding more aggressive intervention such as ECMO. The authors have disclosed that they do not have any potential conflicts of interest.