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Merida Vieyra J, De Colsa Ranero A, Palacios Reyes D, Murata C, Aquino Andrade A. Chlamydophila pneumoniae-associated community-acquired pneumonia in paediatric patients of a tertiary care hospital in Mexico: molecular diagnostic and clinical insights. Sci Rep 2023; 13:21477. [PMID: 38052876 PMCID: PMC10698025 DOI: 10.1038/s41598-023-48701-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 11/29/2023] [Indexed: 12/07/2023] Open
Abstract
Chlamydophila pneumoniae is a cause of community-acquired pneumonia (CAP) and responsible for 1-2% of cases in paediatric patients. In Mexico, information on this microorganism is limited. The aim of this study was to detect C. pneumoniae using two genomic targets in a real-time PCR and IgM/IgG serology assays in paediatric patients with CAP at a tertiary care hospital in Mexico City and to describe their clinical characteristics, radiological features, and outcomes. A total of 154 hospitalized patients with diagnosis of CAP were included. Detection of C. pneumoniae was performed by real-time PCR of the pst and arg genes. Complete blood cell count, C-reactive protein measurement and IgM and IgG detection were performed. Clinical-epidemiological and radiological data from the patients were collected. C. pneumoniae was detected in 25 patients (16%), of whom 88% had underlying disease (P = 0.014). Forty-eight percent of the cases occurred in spring, 36% in girls, and 40% in children older than 6 years. All patients had cough, and 88% had fever. Interstitial pattern on chest-X-ray was the most frequent (68%), consolidation was observed in 32% (P = 0.002). IgM was positive in 7% and IgG in 28.6%. Thirty-six percent presented complications. Four percent died. A high proportion showed co-infection with Mycoplasma pneumoniae (64%). This is the first clinical report of C. pneumoniae as a cause of CAP in Mexican paediatric patients, using two genomic target strategy and serology. We found a frequency of 16.2% with predominance in children under 6 years of age. In addition; cough and fever were the most common symptoms. Early detection of this pathogen allows timely initiation of specific antimicrobial therapy to reduce development of complications. This study is one of the few to describe the presence of C. pneumoniae in patients with underlying diseases.
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Affiliation(s)
- Jocelin Merida Vieyra
- Laboratory of Molecular Microbiology, Instituto Nacional de Pediatria, Insurgentes Sur 3700C, Insurgentes Cuicuilco, Coyoacan, 04530, Mexico City, Mexico
| | - Agustín De Colsa Ranero
- Department of Paediatric Infectious Diseases, Instituto Nacional de Pediatria, Mexico City, Mexico
| | - Deborah Palacios Reyes
- Department of Paediatric Infectious Diseases, Instituto Nacional de Pediatria, Mexico City, Mexico
| | - Chiharu Murata
- Department of Research Methodology, Instituto Nacional de Pediatria, Mexico City, Mexico
| | - Alejandra Aquino Andrade
- Laboratory of Molecular Microbiology, Instituto Nacional de Pediatria, Insurgentes Sur 3700C, Insurgentes Cuicuilco, Coyoacan, 04530, Mexico City, Mexico.
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McCulloch H, Breneol S, Stewart SA, Magalhaes S, Somerville M, Sheriko J, Best S, Burgess S, Jeffers E, Standing MA, King S, Clegg J, Curran JA. Identifying children with medical complexity in administrative datasets in a Canadian context: study protocol. BMJ Open 2022; 12:e057843. [PMID: 35304399 PMCID: PMC8935171 DOI: 10.1136/bmjopen-2021-057843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Children with medical complexity and their families are an important population of interest within the Canadian healthcare system. Despite representing less than 1% of the paediatric population, children with medical complexity require extensive care and account for one third of paediatric healthcare expenditures. Opportunities to conduct research to assess disparities in care and appropriate allocation of health resources relies on the ability to accurately identify this heterogeneous group of children. This study aims to better understand the population of children with medical complexity in the Canadian Maritimes, including Nova Scotia (NS), New Brunswick (NB) and Prince Edward Island (PEI). This will be achieved through three objectives: (1) Evaluate the performance of three algorithms to identify children with medical complexity in the Canadian Maritimes in administrative data; then using the 'best fit' algorithm (2) Estimate the prevalence of children with medical complexity in the Canadian Maritimes from 2003 to 2017 and (3) Describe patterns of healthcare utilisation for this cohort of children across the Canadian Maritimes. METHODS AND ANALYSIS The research will be conducted in three phases. In Phase 1, an expert panel will codevelop a gold-standard definition of paediatric medical complexity relevant to the Canadian Maritime population. A two-gate validation process will then be conducted using NS data and the gold-standard definition to determine the 'best fit' algorithm. During phase 2 the 'best fit' algorithm will be applied to estimate the prevalence of children with medical complexity in NS, NB and PEI. Finally, in phase 3 will describe patterns of healthcare utilisation across the Canadian Maritimes. ETHICS AND DISSEMINATION Ethics approval for this protocol was granted by the institutional research ethics board at the IWK Health Centre (REB # 1026245). A waiver of consent was approved. This study will use an integrated knowledge translation approach, where end users are involved in each stage of the project, which could increase uptake of the research into policy and practice. The findings of this research study will be submitted for publication and dissemination through conference presentations and with our end users.
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Affiliation(s)
- Holly McCulloch
- Children's Health Program, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Sydney Breneol
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Samuel A Stewart
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sandra Magalhaes
- NB Institute for Research, Data and Training, University of New Brunswick, Fredericton, New Brunswick, Canada
| | - Mari Somerville
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jordan Sheriko
- Pediatrics, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Shauna Best
- Children's Health Program, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Stacy Burgess
- Children's Health Program, IWK Health Centre, Halifax, Nova Scotia, Canada
| | | | - Mary-Ann Standing
- Centre for Health and Community Research, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
| | - Sarah King
- Children's Health Program, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Julie Clegg
- Children's Health Program, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Janet A Curran
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
- Pediatrics, IWK Health Centre, Halifax, Nova Scotia, Canada
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Lindley LC, Fortney CA, Cozad MJ. Predictive Ability of an Illness Severity Measure: Implications for Nursing Research. J Nurs Meas 2021; 29:213-226. [PMID: 33795485 DOI: 10.1891/jnm-d-19-00106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Illness severity among children with life-limiting illnesses is measured with the pediatric complex chronic conditions (CCC) measure. Developed in 2000/2001, it was revised in 2014 to include infant-specific categories. METHODS Discrimination, calibration, accuracy, and validation tests were used to examine the predictive performance of the measures. RESULTS Among the 10,175 infants in the analysis, both measures poorly discriminated-palliative care consultation (C-statistics 0.6396 vs. C-statistics 0.5905) and any inpatient procedure (C-statistics 0.6101 vs. C-statistics 0.5160). The Hosmer-Lemeshow goodness-of-fit tests revealed good calibration for both measures. The original measure was more accurate in predicting end-of-life outcomes-palliative care consultation (Brier Score 0.3892 vs. 0.7787) and any inpatient procedures (Brier Score 0.3115 vs. 0.4738). CONCLUSIONS The revised measure did not perform any better than the original in predicting end-of-life outcomes among infants.
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