WCIM 2014
40 32nd World Congress of Internal Medicine (October 24-28, 2014)
OS-ONC-12 Palliative Care
The Prevalence of Depression among Family Caregivers of Children with Intellectual Disability on a Rural Set- tingin Kenya
Njeri Rahab MBUGUA1, Judy W KAMAU2, Muthoni MATHAI2, Wangari KURIA2, Elizabeth ANN BUKUSI1
Kenya Medical Research Institute, Kenya1, Nairobi University, Kenya2
Background: The objective of the study was to determine the risk of depression in caregivers ofchildren with intellectua ldisability. Caregivers of children with intellectual disability have a great responsibility that may be stressful. The psychological well-be- ing of the care giver may aect the quality of care given to children with intellectual disability.
Methods: The study was conducted at Gachie Catholic Parish, Archdiocese of Nairobi (Kenya). Design. Cross sectional, descriptive study.The study was conducted among 114 caregivers registered at the Gachie Parish program (in Kenya) for the intellectual dis- abled children. A researcher-designed social demographic questionnaire and the Beck depression inventory were administered to those that met the inclusion criteria Results: Seventy-nine percent (79%) of the caregivers were at risk of clinical depres- sion.
Conclusions: Majority of the caregivers of children with intellectual disability were at risk of developing clinical depression.
OS-RES-01 Pulmonology
An Effectiveness of Step-Down Therapy in Hospitalized Patients with Non-Severe Community-Acquired Pneu- monia and Chronic Heart Failure
Vladyslav BEREZNYAKOV1, Oleksii KORZH1, Maryna LEBEDYNSKA1, Igor BEREZNYAKOV1 Kharkiv Medical Academy of Postgraduate Education, Ukraine1
Background: Step-down therapy is well-established option in management of hospi- talized patients with community-acquired pneumonia (CAP) but it is not the same in cases of combination of CAP and chronic heart failure (HF).
Methods: A total of 139 pts with CAP aged 44-73 years were divided into 3 groups.
73 pts with CAP and HF were included in step-down therapy group (1-st gr.), 36 pts with CAP and HF formed parenteral antimicrobial therapy (AMT) group (2-nd gr.), the 3-rd group on step-down therapy consisted of 30 pts with CAP and no co-morbidities.
Step-down therapy was implemented in accordance with national CAP management protocol after achieving of clinical stability on 3 to 5 days after beginning of AMT. An effectiveness of treatment was evaluated in 12±2 days after starting of AMT and was classifi ed as positive results (recovery + improvement), clinical failure or “impossible to evaluate”. Length of stay (LOS) in hospital and duration of AMT were studied also.
Results: There was no difference between groups in frequency of positive results (97.3% in the 1-st group, 91.7% in the 2-nd group and 96.7% in the 3-rd group) and clinical failures (2.7% vs. 8.3% vs. 0, respectively). LOS and duration of AMT in the 1-st group did not differ from the same indices in the 2-nd and 3-rd groups. Decrease in frequency of pts suffering from cough and dyspnoea in the 1-st group was docu- mented earlier than in the 2-nd group (in 7±1 and 12±2 days after starting of AMT, respectively).
Conclusions: An effectiveness of step-down therapy in hospitalized patients with non-severe CAP and HF did not differ from traditional parenteral AMT. There are some clinical indices in favor of step-down therapy in such kind of pts.
OS-RES-02 Respiratory Medicine Clinical Features of 46 Cases with Organizing Pneumo- nia Diagnosed by Transbronchial Lung Biopsy
Masako AMANO1, Tomotaka NISHIZAWA1, Tomohiro OHBA1, Kojirou HONDA1, Ryo OKUDA1, Hidekazu MATSUSHIMA1
Saitama Red Cross Hospital, Japan1
Background: Generally, organizing pneumonia (OP) responds well to steroid therapy with good prognosis. However, relapses sometimes occur, thus a treatment policy based on the cause and background of each case should be carefully considered.
Methods: The medical records of 46 patients with biopsy-proved OP were retrospec- tively reviewed. Their clinical presentations, radiographic studies, bronchoalveolar lavage (BAL) fi ndings, treatment, and outcomes were analyzed. Cases where the fi nal diagnosis was eosinophilic pneumonia were excluded from this study.
Results: The mean age at presentation was 64±13.9 years. Nineteen patients were diagnosed with Cryptogenic organizing pneumonia (COP), 6 patients had drug induced OP, 6 patients were associated with collagen disease, 7 patients had post pneumonia, 4 were post-radiation therapy patients, 3 patients were fi nally diagnosed with nonspe- cifi c interstitial pneumonia (NSIP) and 1 patient was associated with radiofrequency ablation (RFA) for hepatocellular carcinoma. Twenty nine patients were treated with systemic steroid therapy. The mean duration of steroid therapy was 7.2 months. The relapse rate was 10% for COP and 75% for post-radiation therapy patients. The ster- oid-refractory cases were patients with NSIP who needed immunosuppressant drugs for treatment.
Conclusions: The relapse rate was high among radiation therapy patients. Although patients were given more than 6 months to taper off of steroid therapy, relapse still occurred. If the patient is refractory to steroid therapy, then we need to consider that the diagnosis could be NSIP, instead of OP.
OS-RES-03 Respiratory Medicine Characteristics of Patients with Multidrug Resistant MBT
Elena TORKATUIK2, Goar BALASANYANS1, Peter YABLONSKIY2, Pavel GAVRILOV1, Boris VISHNEVSKIY1, Olga NARVSKAYA3
Saint Petersburg Research Institute of Phthisiopulmonology, Russia1, Saint Petersburg State University, Russia2, Saint Petersburg Pasteur Institute, Russia3
Background: To study clinical radiological symptoms and microbiological tests of tu- berculosis with multidrug resistant MBT (MDR-TB).
Methods: 43 patients of MDR-TB treated in Saint-Petersburg Research Institute of Phthisiopulmonology in 2011 year aged from 21 to 64 (34M/9F) were examined by laboratory, radiological, microbiological tests. New cases of tuberculosis were deter- mined at 28% of them, at other patients disease’s duration made from 2 to 8 years.
Results: 76% patients complained of cough. Weakness, fever, a weight loss were in 64% cases. Radiologically at all patients tuberculosis involved both lungs, in 100% of cases were cavities with various sizes and 54% of cavities were multiple.
MDR MBT was found in all patients: in 42% of cases it was fi rst episode of MDR- TB, 1/3 of them had primary resistance of MBT. At 58% cases MDR MBT was detected 1-2 years before and these patients had in past one ineffective course at least. Except resistance to isoniazid and rifampicin second-line drug resistance was identified.
Primary second-line drug resistance to ethionamide was found in 55% of patients’
culture, 45% - to ofl oxacine, 55% - to kanamicine. At patients with TB history resist- ance to ethionamide was detected in 73% cases, to ofl oxacine – in 28%, to kanami- cine – in17%. 12% of patients had extensively drug-resistant tuberculosis (XDR-TB).
The predominant spoligotypes of MBT were Beijing (25-58% MBT isolates), LAM (8- 18% MBT isolates) and Haarlem (4-9% MBT isolates).
Conclusions: MDR-TB characterized by severe currency of tuberculosis with expressed clinical and radiological symptoms. Only 13% cases with MDR MBT had primary MDR- TB, in the most of them MDR MBT followed earlier treatment. Beijing family MBT dominated among patients and associated with MDR-TB. It is necessary also to carry out drug sensibility test to second- line TB drugs as for new cases of tuberculosis and earlier treated.
