No abstract

Community acquired pneumonia (CAP) is a relevant public health problem, constituting an important cause of morbidity and mortality. It accounts for a significant number of adult hospital admissions and a large number of those patients ultimately die, especially the population who needed mechanical ventilation or vasopressor support.Thus, early identification of CAP patients and its rapid and appropriate treatment are important features with impact on hospital resource consumption and overall mortality. Although CAP diagnosis may sometimes be straightforward, the diagnostic criteria commonly used are highly sensitive but largely unspecific. Biomarkers and microbiological documentation may be useful but have important limitations.Evaluation of clinical response is also critical especially to identify patients who fail to respond to initial treatment since these patients have a high risk of in-hospital death. However, the criteria of definition of non-response in CAP are largely empirical and frequently markedly diverse between different studies. In this review, we aim to identify criteria defining nonresponse in CAP and the pitfalls associated with this diagnosis. We also aim to overview the main causes of treatment failure especially in severe CAP and the possible strategies to identify and reassess non-responders trying to change the dismal prognosis associated with this condition.

Objective:To investigate the influence of the site of measurement of transcutaneous bilirubin (forehead or sternum) in reproducibility of results as compared to plasma bilirubin.Methods:A cohort study including 58 term newborns with no hemolytic disease. Transcutaneous measurements were performed on the forehead (halfway between the headline and the glabella, from the left toward the right side, making consecutive determinations, one-centimeter apart) and the sternum (five measurements, from the suprasternal notch to the xiphoid process with consecutive determinations, one-centimeter apart) using Bilicheck® (SpectRx Inc, Norcross, Georgia, USA). The correlation and agreement between both methods and plasma bilirubin were calculated.Results:There was a strong linear correlation between both determinations of serum bilirubin at the forehead and sternum (r=0.704; p<0.01 and r=0.653; p<0.01, respectively). There was correspondence of the mean values of transcutaneous bilirubin measured on the sternum (9.9±2.2mg/dL) compared to plasma levels (10.2±1.7mg/dL), but both differ from the values measured on the forehead (8.6±2.0mg/dL), p<0.05.Conclusion:In newborn term infants with no hemolytic disease, measuring of transcutaneous bilirubin on the sternum had higher accuracy as compared to serum bilirubin measurement on the forehead.

Objective: To translate into Portuguese and validate the LATCH breastfeeding assessment scale. Methods: This was a methodological study through translation and validation of the instrument. The following steps were followed: translation, back-translation, committee of judges, pre-test and validation. The validation process includes the analysis of 160 women in breastfeeding in the first postpartum days during hospitalization. Results:The results indicate that the LATCH instrument translated into Portuguese can be used by nurses for breastfeeding assessment, enabling the early detection of possible problems presented by the mother-baby binomial during breastfeeding. Conclusion: The study fulfilled the objective of adapting the LATCH breastfeeding assessment instrument to the Portuguese language and verifying its psychometric properties. The LATCH instrument validity measures what it was designed to do and is applicable in clinical practice. ResumoObjetivo: Traduzir para a língua portuguesa e validar a escala de avaliação da amamentação LATCH. Métodos: Tratou-se de um estudo do tipo metodológico, por meio da tradução e validação de instrumento. Seguiu-se as etapas estabelecidas: tradução, back-translation, comitê de juízes, pré-teste e validação. O processo de validação inclui a análise de 160 mamadas de mulheres nos primeiros dias pós-parto, durante a internação hospitalar. Resultados: Os resultados obtidos indicam que o instrumento LATCH traduzido para o português pode ser utilizado na avaliação do aleitamento materno pelo profissional enfermeiro, possibilitando a detecção precoce de possíveis problemas apresentados pelo binômio mãe-bebê durante a amamentação. Conclusão: O estudo cumpriu o objetivo de adaptar para a língua portuguesa e verificar as propriedades psicométricas do instrumento de avaliação de aleitamento materno LATCH. A validade do instrumento LATCH mede o que foi concebido para medir, sendo ele aplicável na prática clínica.

Background: Respiratory virome is an integral part of the human microbiome and its characterization may contribute to a better understanding of the changes that arise in the disease and, consequently, influence the approach and treatment of patients with acute lower respiratory infections. The aim of this study was to evaluate the presence of respiratory viruses in the lower airways of individuals undergoing invasive mechanical ventilation, with and without acute lower respiratory infection (respectively WRI and WORI groups). Methods: We studied 44 mini-bronchoalveolar lavage samples (collected with a double catheter, Combicath® kit) from patients with mean age in the seventh decade, 20 from WORI group and 24 from WRI group, who were hospitalized for acute respiratory failure in Intensive Care Units of two hospitals in the Lisbon area. Real-time PCR was applied to verify analyse the presence of 15 common respiratory viruses (adenovirus, human bocavirus, influenza virus A and B, repiratory syncytial virus, human parainfluenza virus types 1, 2, 3 and 4, human enterovirus, human rhinovirus, human metapneumovirus, human coronavirus group 1 (229E, NL63) and 2 (OC43, HKU1). Results: Respiratory viruses were detected in six of the 20 patients in the WORI group: influenza AH3 (n = 2), parainfluenza virus 1/3 (n = 2), human rhinovirus (n = 2), respiratory syncytial virus (n = 1) and human metapneumovirus (n = 1). In the WRI group, respiratory viruses were detected in 12 of the 24 patients: influenza AH3 (n = 3), human rhinovirus (n = 3), respiratory syncytial virus (n = 3), human metapneumovirus (n = 3), human bocavirus (n = 2) and human enterovirus (n = 1). Simultaneous detection of two viruses was recorded in two samples in both groups. Conclusions: The results of this study suggest the presence of common respiratory viruses in the lower respiratory tract without causing symptomatic infection, even in carefully collected lower samples. This may have important implications on the interpretation of the results on the diagnostic setting.