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Introduction: Inhalation injury is a particularly lethal form of thermal burn injury, and is associated with increased morbidity and mortality. Pneumonia is a common complication of inhalation injury, due to the increased susceptibility of lungs that have been stripped of their biologic defense mechanisms, as well as the general susceptibility of the burn population to infections. While older series suggest that pneumonia is associated with worse mortality and morbidity, recent reports suggest that this may not be the case in all populations. Methods: We attempted to clarify the impact of pneumonia in terms of mortality, length of mechanical ventilation, need for tracheostomy, and discharge disposition, in patients admitted with inhalation injury by performing a retrospective review of patients admitted to a regional burn center 2002-2009. Burn registry and electronic chart review were used to obtain demographic, clinical and outcome data. Univariate and multivariate analysis was used to compare outcomes in patients who developed pneumonia versus those who did not. Results: The study cohort comprised 166 patients, of whom 21 (13%) were diagnosed with pneumonia. Development of pneumonia was not predicted by age, surface area burned or other complications such as acute respiratory distress syndrome. Surprisingly, pneumonia was associated with reduced inpatient mortality (p = 0.006). However, patients who developed pneumonia were also more likely to have prolonged ventilator dependence (19 vs 5 days, p < 0.001), require intensive respiratory therapy (p < 0.001), receive tracheostomy (p < 0.001) and have an increased overall length of stay (33 vs. 10 days, p < 0.001). They were significantly less likely to be discharged home and more likely to be transferred to a nursing facility or rehabilitation center upon discharge (p = 0.002).
We encountered the Great East Japan Earthquake on March 11, 2011. The magnitude of the earthquake is 9.0 and it is one of the greatest from A.D. 1900 to now. The earthquake developed large tsunami and many people living on the pacific coast of east Japan died from lung disorder caused by near drowning with tsunami. We also encountered three cases of lung disorders caused by near drowning. All three were females, and two of them were old elderly. All segments of both lungs were involved in all the three patients, necessitating ICU admission and endotracheal intubation and mechanical ventilation. All three died within three weeks. In at least two cases, misswallowing of oil was suspected from the features noted at the time of the detection. Many bacteria were detected from the phlegm of two cases.
Pneumonia is a common cause of mortality and morbidity
in under-5 children throughout the world. Globally an estimated 156 million new
episodes of pneumonia occur each year in children and 2 million children die
from pneumonia each year which is 20 percent of all deaths of children under
five years old. Ceftriaxone is a commonly used drug for empiric treatment of
community acquired pneumonia (CAP) in children. Levofloxacin may be an adequate
option for empiric therapy in treatment of CAP in children because it gives the
broad spectrum activity against both bacterial and atypical pathogens causing
CAP and studies suggest that it can be safely used in children. This open
labeled, randomized, comparative clinical trial was carried out in the Department
of Pediatrics, Sylhet MAG Osmani Medical College Hospital, Bangladesh during
January, 2011 & December, 2012 to compare the efficacy of levofloxacin and
ceftriaxone in the treatment CAP in children. A total 70 cases of CAP were
enrolled. 35 cases were allocated to levofloxacin group and another 35 cases to
ceftriaxone group. At first the study cases were selected by systematic random
sampling. Group allocation to either levofloxacin or ceftriaxone group was done
by lottery method. Total duration for receiving study drugs was seven days.
Dose of levofloxacin was 10 mg/kg/day children ≥5 years, where as it was 10 mg/kg
12 hourly in 6 months to <5 years age groups. Dose of ceftriaxone was 75 mg/kg/day.
Response to treatment was assessed initially after 3 days and also after 7 days
by clinical symptoms and signs. Clinical cure rate was determined by
disappearance of the clinical signs and symptoms of pneumonia and resolution of
radiological findings reported at admission. Clinical
responses were categorized as cured and treatment failure. 91.43% cases
were cured in levofloxacin group, whereas
cure rate of ceftriaxone group was 68.57% which was statistically
significant (p = 0.0168). Adverse effects of levofloxacin were found as skin
rash in 1 case and vomiting in 2 cases whereas skin rash was found in 1 case in
ceftriaxone group. So it can be concluded that levofloxacin is more effective
than ceftriaxone in the treatment of CAP in children.