Variations in Mortality in Children Admitted with Pneumonia to Kenyan Hospitals

Background

The existing case fatality estimates of inpatient childhood pneumonia in developing countries are largely from periods preceding routine use of conjugate vaccines for infant immunization and such primary studies rarely explore hospital variations in mortality. We analysed case fatality rates of children admitted to nine Kenyan hospitals with pneumonia during the era of routine infant immunization with Hib conjugate vaccine to determine if significant variations exist between hospitals.

Methods

Pneumonia admissions and outcomes in paediatric wards are described using data collected over two time periods: a one-year period (2007–2008) in nine hospitals, and data from a 9.25-year period (1999-March 2008) in one of the participating hospitals. Hospital case fatality rates for inpatient pneumonia during 2007 to 2008 were modeled using a fixed effect binomial regression model with a logit link. Using an interrupted time series design, data from one hospital were analysed for trends in pneumonia mortality during the period between 1997 and March 2008.

Results

Overall, 195 (5.9%) children admitted to all 9 hospitals with pneumonia from March 2007 to March 2008 died in hospital. After adjusting for child’s sex, comorbidity, and hospital effect, mortality was significantly associated with child’s age (p<0.001) and pneumonia severity (p<0.001). There was evidence of significant variations in mortality between hospitals (LR χ² = 52.19; p<0.001). Pneumonia mortality remained stable in the periods before (trend −0.03, 95% CI −0.1 to 0.02) and after Hib introduction (trend 0.04, 95% CI −0.04 to 0.11).

Conclusions

There are important variations in hospital-pneumonia case fatality in Kenya and these variations are not attributed to temporal changes. Such variations in mortality are not addressed by existing epidemiological models and need to be considered in allocating resources to improve child health.     

Two new polyhydroxylated steroidal glycosides from Paris polyphylla var. yunnanensis

Chemical investigation of Paris polyphylla smith var. yunnanensis afforded two new polyhydroxylated steroidal glycosides, named Parisyunnanosides K and L (1–2), together with nine known ones. The chemical structures of the new compounds were elucidated by 1D, 2D NMR and HR-ESI-MS techniques, together with chemical methods. Parisyunnanosides K and L (1–2) are rare C₂₇ steroidal glycosides with two double bonds located at C-5, 6 and C-25, 26 of the aglycone, respectively. The cytotoxic activities of the isolated compounds were evaluated against Caco-2 cells by CCK-8 assay. Among them, compounds 5–11 exhibited potent cytotoxic activity with IC₅₀ values ranging from 1.10 to 14.14 μM compared with the positive control oxaliplatin (1.38 μM).     

Dynamics of Pneumocystis carinii-Specific Immune Complexes in AIDS Patients with P. carinii Pneumonia

Pneumocystis carinii-specitic immune complexes were detected by immunoblot and enzyme-linked immunosorbent assay (ELISA) in 53% of sera from Acquired Immunodeficiency Syndrome (AIDS) patients with P. carinii pneumonia (PCP). Resolution of glycoprotein antigenemia (50–55 kd = dominant species) appears to correlate with successful PCP drug therapy and recovery. An epitope map has been constructed from im-munoblots of P. carinii hydrolysates and from human and murine scrum containing P. carinii antigens.     

Pneumocystis carinii: new separation method from lung tissue.

A new method of separating Pneumocystis carinii from infected rat, human, and mouse lung tissue has been developed, based, in part, on techniques used for the separation of lymphocytes from hematopoietic and lymphoid organs. The lungs are homogenized with a Teflon pestle and fine wire-mesh screen, digested with collagenase and hyaluronidase, and centrifuged on a discontinuous Ficoll-Hypaque density gradient. The method produces no morphologic alterations in P. carinii, as judged by light and electron microscopy. The method has been adapted for the quantitation of P. carinii in tissues and the production of antisera in rabbits.     

Pentamidine Congeners 1: Synthesis of Cis- and Trans-Butamidine Analogues As Anti-Pneumocystis carinii Pneumonia Agents

Butamidine analogues possessing unsaturation in the ether bridge between the bisamidinophenyl or bisimidazolinophenyl functionalities have been synthesized as semirigid congeners of pentamidine. These compounds demonstrated good anti-P. carinii pueumonia activity in a rat model of the disease.     

Karyotypes of Pneumocystis carinii from Korean rats.

Molecular karyotyping was applied to Pneumocystis carinii(Pc) from two strains of experimental rats, Sprague Dawley(SD) and Fisher(F), in Korea. Field inversion gel electrophoresis and contour clamped homogeneous electric field electrophoresis resolved 15 chromosomal bands from the Pc. The size of the bands was estimated 270kb to 684kb from SD rats, and 273kb to 713 kb from F rats. The bands of 283 kb from SD rats and of 273 kb from F rats stained more brightly suggesting duplicated bands. Total number of chromosomes was at least 16, and total genomic size was estimated 7 x 10(6) bp. All of the bands from F rats hybridized to the probe of repeated DNA sequences of Pc and the band of 448 kb size was proved to contain rDNA sequences, but Pc. chromosome bands from SD rats showed no reactions to the probes. The 2 different karyotypes of P. carinii from 2 strains of rats were maintained consistently for 2 years.     

Trends in coronary artery bypass grafting in Ontario from 1981 to 1989.

OBJECTIVES: To determine the trends in overall and age-specific rates of coronary artery bypass grafting (CABG) in Ontario from 1981 to 1989 and to assess whether relative resource scarcity, as manifested in waiting lists, resulted in obvious age-related or sex-related changes in utilization. DESIGN: Computerized compilation of hospital discharge abstracts from the Hospital Medical Records Institute. All separations for every other year from Apr. 1, 1981, to Mar. 31, 1990, were included. Procedures rather than patients were the unit of analysis (repeat procedures were double-counted if associated with separate hospital admissions). SETTING: Ontario acute care hospitals offering CABG. PATIENTS: People aged 20 years and over who underwent one or more CABG procedures. RESULTS: The overall rate of CABG increased by 31% in the study period, plateauing only between 1983 and 1985. By 1989-90 the rate was 66.03 per 100,000. The highest annual increase in the rate was among people aged 65 to 74 years, at 17.61 procedures per 100,000, as compared with 4.64 per 100,000 among people 75 years and over. In 1989-90 those aged 65 and over represented 37% of the total caseload. The overall male:female ratio did not change significantly throughout the study period. CONCLUSIONS: Since the CABG utilization rate continues to increase in Ontario, recent waiting lists must be due to a disproportionate growth in demand. There was no convincing evidence of age-related or sex-related discrimination in allocating this limited resource. Supply-demand mismatch was driven above all by the continued increase in CABG use among elderly people.     

Delayed-type hypersensitivity response in mice to Pneumocystis carinii.

Resistance to Pneumocystis carinii infection appears to be mediated by T lymphocytes but the mechanism and subsets of T cells involved are poorly understood. We used the BALB/c mouse model to study the delayed-type hypersensitivity (DTH) response to rat P. carinii. Mice were sensitized to P. carinii for seven days and then challenged with P. carinii antigens in the right rear footpads and normal rat lung antigens in the left rear footpads. A typical DTH response was observed in the right footpads as evidenced by significant swelling and substantial mononuclear cell infiltration at 24-h post-challenge. The DTH response could be transferred to naive syngeneic mice by adoptively transferring spleen cells from P. carinii-sensitized mice. In addition, by using anti-thy-1, anti-mouse Ig, anti-L3T4 and anti-Lyt-2.2 monoclonal antibodies in in vitro cytolysis experiments, we were able to demonstrate that the DTH response was dependent upon T lymphocytes. The response appeared to require cooperation between both L3T4+ and Lyt 2+ subsets of T lymphocytes.