Regarding mortality, the presence of severity on admission was th

Regarding mortality, the presence of severity on admission was the only single variable associated with death, similarly to what was found in recent studies performed in low-income countries.17, 18, 19 and 20 The abovementioned demographic, epidemiological, and nutritional transitions were certainly responsible for the changes in morbidity and mortality demonstrated here. Regarding the children who died in the period 1996-2000, 42% had severe disease and 92% were younger than 5 years. Bacterial isolation was achieved in 62%, showing the severity of infection with hematogenous

dissemination of the infection. These findings highlight the importance of severe disease on CFR of children hospitalized with CAP, and suggest that it is safe to start treatment with penicillin G. This finding is similar to that found by the multicenter study on the etiology of CAP and penicillin resistance with the participation of several countries in South America and the Caribbean, including the IPPMG. In that study, S. pneumoniae fully resistant to penicillin was not found, which provided support to the recommendation of penicillin or ampicillin as drugs of choice for the treatment of CAP, even for

penicillin-resistant bacteria, in areas where the minimum inhibitory concentration is not higher than 2 μg/mL, as in Brazil. 23 Similarly, Simbalista et al., 24 in a retrospective study of 154 children hospitalized with CAP in a university hospital in Salvador, Brazil, from 2002 to 2005, concluded that penicillin selleck compound G, used to treat most cases, was highly effective, with improvement within the first 48 hours and no occurrence of deaths. One limitation of the present study was the incapacity to assess the possible impact of vaccination status on the CFR of CAP cases studied. As the conjugate vaccination against pneumococcal agents was only incorporated into the immunization schedule of Brazilian children in 2010, such investigation was not

feasible. In conclusion, the present study demonstrated a significant reduction in CFR in children with CAP in the period 2001-2011, with a change in the profile of children hospitalized for this disease at IPPMG. It is suggested that these findings are related to changes in the socioeconomic profile of the population in this period.25 The use of penicillin in the empiric treatment of Selleck Verteporfin CAP was not related to the observed CFR. The present study received resources from the project funded by the Pan American Health Organization (1998- 2003). The authors declare no conflicts of interest. “
“Each country in the European Union and in USA provides a pre-hospital emergency medical service (EMS) which is a unique component of pre-hospital emergency health-care. Even though these systems have many similar there is no common European or US standard. Some evidence currently exists, showing that education and training of the personnel, organisation and logistics, triage and prioritisation, are of critically importance for EMS system performance.

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