RESUMO
UNLABELLED: Amiodarone-induced pulmonary toxicity (APT) is a serious adverse event that can lead to death. The aims of our study are to determine factors associated with mortality and to describe outcome and sequelae of patients with APT. METHODS: Forty-six patients with APT were divided into two groups according to survival at day 90 for a clinical, functional, biological and radiological comparaison. We then evaluated the evolution of 15 survivors at a median of three months [1-6 months] and/or 12 months [8-36 months]. RESULTS: Mortality of APT at day 90 was 37% (17 patients) and was linked to the speed of onset of symptoms and a high HRCT alveolar score. Angiotensin system antagonist treatment was prescribed significantly more in the survival group (p = 0.042, HR 0.34 (95% CI 0.12-0.96)). In surviving patients, dyspnea, vital capacity and HRCT alveolar score improved significantly while HRCT fibrosis score deteriorated gradually during the first six months. At the end of the study, all the surviving patients presented functional and/or radiological sequelae. CONCLUSIONS: Severity of APT is linked to the extent and speed of onset of pulmonary damage. After the initial episode, the patients who survived improved slowly but with persistent sequelae.
Assuntos
Amiodarona/efeitos adversos , Antiarrítmicos/efeitos adversos , Pneumopatias/induzido quimicamente , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Glucocorticoides/uso terapêutico , Hospitalização , Humanos , Estimativa de Kaplan-Meier , Pneumopatias/diagnóstico por imagem , Pneumopatias/tratamento farmacológico , Pneumopatias/fisiopatologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Testes de Função Respiratória , Estudos Retrospectivos , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X/métodosRESUMO
PURPOSE: The reduction in acquired infections (AI) due to methicillin-resistant Staphylococcus aureus (MRSA) with the mupirocin/chlorhexidine (M/C) decontamination regimen has not been well studied in intubated patients. We performed post hoc analysis of a prior trial to assess the impact of M/C on MRSA AI and colonization. METHODS: We conducted a multicenter, placebo-controlled, randomized, double-blind study with the primary aim to reduce all-cause AI. The two regimens used [topical polymyxin and tobramycin (P/T), nasal mupirocin with chlorhexidine body wash (M/C), or corresponding placebos for each regimen] were administered according to a 2 × 2 factorial design. Participants were intubated patients in the intensive care units of three French university hospitals. The patients enrolled in the study (n = 515) received either active P/T (n = 130), active M/C (n = 130), both active regimens (n = 129), or placebos only (n = 126) for the period of intubation and an additional 24 h. The incidence and incidence rates (per 1,000 study days) of MRSA AI were assessed. Due to the absence of a statistically significant interaction between the two regimens, analysis was performed at the margins by comparing all patient receiving M/C (n = 259) to all patients not receiving M/C (n = 256), and all patients receiving P/T (n = 259) to all patients not receiving P/T (n = 256). RESULTS: Incidence [odds ratio (OR) 0.39, 95 % confidence interval (CI) (0.16-0.96), P = 0.04] and incidence rates [incidence rate ratio (IRR) 0.41, 95 % CI 0.17-0.97, P = 0.05] of MRSA AI were significantly lower with the use of M/C. We also observed an increase in the incidence (OR 2.50, 95 % CI 1.01-6.15, P = 0.05) and the incidence rate (IRR 2.90, 95 % CI 1.20-8.03, P = 0.03) of MRSA AI with the use of P/T. CONCLUSION: Among our study cohort of intubated patients, the use of M/C significantly reduced MRSA AI.
Assuntos
Antibacterianos/uso terapêutico , Clorexidina/uso terapêutico , Intubação/efeitos adversos , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Mupirocina/uso terapêutico , Infecções Estafilocócicas/prevenção & controle , Administração Tópica , Adulto , Idoso , Idoso de 80 Anos ou mais , Método Duplo-Cego , Quimioterapia Combinada/métodos , Feminino , França , Hospitais Universitários , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Placebos/administração & dosagem , Polimixinas/uso terapêutico , Infecções Estafilocócicas/microbiologia , Tobramicina/uso terapêutico , Resultado do Tratamento , Adulto JovemRESUMO
The Mobile Team of Parasitology-Mycology is a movable entity of the Parasitology-Mycology laboratory of Tours University Hospital, France. In contrast to the usual prerogatives of biomedical laboratories, the Mobile Team of Parasitology-Mycology is requested to intervene directly at bedside in various clinical departments, or even outside the hospital facility. Although its actions are of course primarily devoted to specialized diagnostic and therapeutic purposes, the Mobile Team also plays an important educational role in the medical training of undergraduate or graduate students.
Assuntos
Unidades Móveis de Saúde , Micologia/educação , Parasitologia/educação , Educação de Pacientes como Assunto/métodos , França , Acessibilidade aos Serviços de Saúde , Humanos , Equipe de Assistência ao PacienteRESUMO
BACKGROUND: Since the first description of Hashimoto's Encephalitis (HE) in 1966 by Lord Brain, the number of reported cases has continued to increase. In addition, cases of status epilepticus have been reported, suggesting a role for intensive care unit (ICU) practitioners in taking care of patients with HE. METHODS: A retrospective cohort study in ICU patients with HE was performed at the University Hospital of Tours, France. RESULTS: Eight HE cases were admitted to the ICU between 1/1/2000 and 1/1/2012. Herein, we describe the characteristics of the patients, with an emphasis on ICU disease management and its outcome. CONCLUSION: ICU practitioners should be aware of this disease, since it can include life-threatening presentations.
Assuntos
Encefalopatias/diagnóstico , Cuidados Críticos/métodos , Doença de Hashimoto/diagnóstico , Estado Epiléptico/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Encefalopatias/complicações , Encefalopatias/terapia , Estudos de Coortes , Encefalite , Feminino , Doença de Hashimoto/complicações , Doença de Hashimoto/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estado Epiléptico/etiologiaRESUMO
Kidney transplantation is the favored method to treat end-stage renal disease. Some recipients develop severe diseases requiring admission to an intensive care unit (ICU). Acute kidney injury (AKI) is a common complication among critically ill patients but few data are available among renal transplant recipients. The aim of this monocenter retrospective study was to describe renal function in kidney transplant recipients admitted to an ICU and to evaluate their renal functional recovery after this stay. We identified all renal transplant recipients admitted to our medical ICU from January 1, 2001, to December 31, 2010: namely, 79 stays by 62 patients. We used the glomerular filtration rate criteria of the RIFLE classification to evaluate AKI during the ICU stay. During the ICU stay, 56 patients (70.9%) were classified as "no AKI" according to the RIFLE classification; 11 (13.9%) belonged to class R, 10 (12.7%) to class I, and 2 (2.5%) to class F. Overall, 24% of the patients needed dialysis during the ICU stay. Mortality rate at 3 months after the ICU stay was 25.3%. Among the patients who survived, 40 (68%) recovered to their baseline renal function at 3 months, most of them being classified as no AKI during the ICU stay. We have herein reported the evolution of renal function among kidney graft recipients after an ICU stay.
Assuntos
Injúria Renal Aguda/etiologia , Hospitalização , Unidades de Terapia Intensiva , Transplante de Rim/efeitos adversos , Rim/fisiopatologia , Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/mortalidade , Injúria Renal Aguda/fisiopatologia , Injúria Renal Aguda/terapia , Idoso , Feminino , França , Taxa de Filtração Glomerular , Mortalidade Hospitalar , Humanos , Transplante de Rim/mortalidade , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Recuperação de Função Fisiológica , Diálise Renal , Estudos Retrospectivos , Fatores de Tempo , Resultado do TratamentoRESUMO
Cellulitis due to Escherichia coli is rare and usually secondary to a cutaneous portal of entry. Skin and soft tissue infections (SSTI) secondary to E. coli bacteraemia have been reported exclusively in immunodeficient patients. Here, we report two cases of serious cellulitis secondary to E. coli bacteraemia in patients with haematological malignancies. Both isolated strains belonged to phylogenetic group B2 and harboured some of the main virulence factor genes commonly found in extra-intestinal pathogenic E. coli (ExPEC), including neuC, iro and fimH. Cellulitis due to E. coli seems to be linked to the immunocompromised status of patients rather than to a highly virulent clone. Nevertheless, some of the virulence factors appear to be important because both isolates belong to phylogenetic group B2. This aetiology should be considered in SSTI in patients with haematological malignancies.
Assuntos
Celulite (Flegmão)/microbiologia , Escherichia coli/genética , Escherichia coli/patogenicidade , Hospedeiro Imunocomprometido , Mieloma Múltiplo/complicações , Idoso , Bacteriemia/complicações , Bacteriemia/microbiologia , Doença Crônica , Escherichia coli/classificação , Escherichia coli/isolamento & purificação , Infecções por Escherichia coli/complicações , Infecções por Escherichia coli/microbiologia , Proteínas de Escherichia coli/genética , Humanos , Leucemia Linfoide/complicações , Masculino , Pessoa de Meia-Idade , Infecções dos Tecidos Moles/microbiologia , Fatores de Virulência/genéticaAssuntos
Oxigenação por Membrana Extracorpórea/métodos , Síndrome do Desconforto Respiratório/terapia , Desmame do Respirador/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Vírus da Parainfluenza 3 Humana , Respiração Artificial , Síndrome do Desconforto Respiratório/etiologia , Infecções por Respirovirus/complicações , Infecções por Respirovirus/terapiaRESUMO
Aortic false aneurysms are rare complications of aortic valve replacement and cardiac surgical procedures in general. Aortic false aneurysms can also presents as a mediastinal mass. A false aneurysm etiology should always be considered in mediastinal mass exploration of patients with a cardiac surgery history. Although, a computed tomography (CT) scan can detect a mediastinal mass, it can equally misdiagnose an aneurysm in the absence of tumour contrast enhancement. We present the case of a 60-year-old woman who was hospitalized for a laryngeal dyspnea. She had undergone aortic valve replacement 3 years earlier and had no other relevant medical history. In the last 3 months, she presented a progressively worsening dyspnea and cough. A chest radiograph showed a large mass in the superior mediastinum. A contrast-enhanced CT-scan showed an anterior mediastinal mass (9 cm × 8 cm × 9 cm) not enhanced by contrast product, suggestive of a tissue density tumour. The mass was in fact an aortic false aneurysm where the communication with the aorta was too narrow to be filled by the contrast product in arterial phase imaging. The aneurysm was excised and successfully replaced with a prosthetic graft during deep hypothermic and circulatory arrest. In this case report, we discuss the unusual clinical presentation of this pseudoaneurysm and the absence of contrast enhancement during CT-scan, which could have lead to a catastrophic error.
Assuntos
Obstrução das Vias Respiratórias/etiologia , Falso Aneurisma/complicações , Aneurisma da Aorta Torácica/complicações , Falso Aneurisma/diagnóstico por imagem , Aneurisma da Aorta Torácica/diagnóstico por imagem , Feminino , Humanos , Pessoa de Meia-Idade , RadiografiaAssuntos
Surtos de Doenças , Encefalite/epidemiologia , Listeria monocytogenes/isolamento & purificação , Listeriose/epidemiologia , Meningite por Listeria/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Dano Encefálico Crônico/etiologia , Proteínas do Líquido Cefalorraquidiano/análise , Comorbidade , Confusão/etiologia , Doenças dos Nervos Cranianos/etiologia , Progressão da Doença , Encefalite/líquido cefalorraquidiano , Encefalite/complicações , Encefalite/tratamento farmacológico , Encefalite/microbiologia , Feminino , França/epidemiologia , Humanos , Hospedeiro Imunocomprometido , Listeriose/líquido cefalorraquidiano , Listeriose/complicações , Listeriose/tratamento farmacológico , Listeriose/microbiologia , Meningite por Listeria/líquido cefalorraquidiano , Meningite por Listeria/complicações , Meningite por Listeria/tratamento farmacológico , Meningite por Listeria/microbiologia , Pessoa de Meia-IdadeRESUMO
In autologous and allogeneic hematopoietic SCT (HSCT) neutropenia may be associated with severe infection. Immunodeficiency associated with GVHD and its treatment in allogeneic HSCT is also a risk for severe infection. In both periods, patients may develop severe sepsis with organ failure. To gain insights into treatment possibilities, HISTORY, a multicenter retrospective study reviewed HSCT patient records on mortality, organ dysfunction, platelet count and bleeding events. All transplantation records from 16 European centers were reviewed for 1.5 years. Of 2092 patients screened, 160 were documented for HSCT with respiratory and/or cardiovascular organ dysfunction because of sepsis and/or GVHD. Mortality was 53.1% at 28 days and 65.6% at 100 days. HSCT patients with sepsis and organ dysfunction are at highest risk of death (49.5%). Death from refractory septic shock was 15.2%, and it was 20% from respiratory failure and 64.7% from sepsis. Fewer than 3% of HSCT patients died from bleeding complications; however, individuals at increased risk of bleeding were excluded. Despite low platelet counts, an increased risk of bleeding could be established only if thrombocytopenia dropped below 13 x 10(9)/l. Thus, there might be a therapeutic window for treatment strategies for severe sepsis in HSCT, such as drotrecogin alpha (activated).
Assuntos
Doença Enxerto-Hospedeiro/etiologia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Transplante de Células-Tronco Hematopoéticas/métodos , Hemorragia/etiologia , Sepse/etiologia , Adulto , Idoso , Europa (Continente) , Feminino , Neoplasias Hematológicas/mortalidade , Neoplasias Hematológicas/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas , Estudos Retrospectivos , Risco , Resultado do TratamentoRESUMO
The aim of the present prospective multicentric study was to develop a simple rule for the prediction of poor outcome in patients presenting to emergency departments with initially non-life threatening-chronic obstructive pulmonary disease (COPD) exacerbations in a real-life setting. All patients with an acute exacerbation of COPD visiting the emergency departments of 103 hospitals during a 3-month period were included, except those who immediately required intensive care unit admission and/or ventilatory support. The data collected included patient characteristics, in-hospital outcomes (mortality and length of stay) and mode of discharge (unsupported or need for post-hospital assistance). The in-hospital mortality rate was 7.4% (59 out of 794). Independent prognostic factors were age, number of clinical signs of severity (among cyanosis, impaired neurological status, lower limb oedema, asterixis and use of accessory inspiratory or expiratory muscles) and dyspnoea grade in the stable state. The need for post-hospital support was also predicted by female sex. In order to construct and validate a prediction score for mortality based on these items, patients were randomly allocated to a derivation and a validation cohort. The prediction score showed good discrimination, with a c-statistic of 0.79 in the derivation cohort and 0.83 in the validation cohort. Thus simple purely clinical factors can reliably predict the risk of death and requirement for post-hospital support in an initially non-life threatening-acute exacerbation of chronic obstructive pulmonary disease. Their use needs to be prospectively validated.
Assuntos
Medicina de Emergência/normas , Doença Pulmonar Obstrutiva Crônica/terapia , Idoso , Medicina de Emergência/métodos , Serviço Hospitalar de Emergência , Feminino , Departamentos Hospitalares , Unidades Hospitalares , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Exposição Ocupacional , Prognóstico , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Fatores de Risco , Resultado do TratamentoRESUMO
INTRODUCTION: Our university hospital serves a population of 300 000 inhabitants. Stroke is the leading cause of admission in our department of neurology. In June 2003, when the Emergency Department (ED) was closed in our institution, was created an acute stroke network (ASN), comprising 2 beds of direct admission and thrombolysis in the intensive care unit, and 4 beds dedicated to stroke care in the department of neurology, in which standardized stroke care protocols were implemented. OBJECTIVE: The aim of this study was to evaluate changes in stroke care related to the creation of the ASN in terms of delays of arrival, imaging, use of intravenous (IV) thrombolysis, and outcome of patients. We conducted a prospective study during 18 months to evaluate characteristics of patients admitted with suspected stroke or transient ischemic attack (TIA) in the newly created ASN and to assess conditions of treatment with IV thrombolysis in terms of safety and efficacy. We also compared the outcome data before and after the creation of the ASN. METHODS: For each patient admitted in our hospital for suspected stroke or TIA, were prospectively collected clinical and outcome data (age, mode of transport, delay of arrival after the onset of symptoms (OS), treatment with IV thrombolysis, outcome and discharge). This study was conducted in the ED during six months in 2002, and in the ASN during 18 months, for all patients admitted for stroke. RESULTS: Three hundred and sixty four patients were admitted in the ASN. Emergency medical services (EMS) were used in half of cases for transport, and median delay of admission after the OS was 2h and 52 min. Median delay of imaging was 1 h and 45 min. Seventeen patients (8.5 p. 100 of ischemic stroke patients) were treated with IV thrombolysis, with an initial good outcome in 9 patients, 7 with a dramatic recovery). The main reason for therapeutic abstention for untreated patients admitted in the first 3 hours was a mild deficit with a NIHSS<6. Compared with the previous management in the ED, patients in the ASN were younger, had more severe neurological symptoms, the EMS transport was the main mode of transport (versus used in 17 p. 100 of cases in 2002), and the delay of admission was significantly lower: 2 h 52 versus 5 h 10 (p<0.02). After adjustment on the main predictive factors, only patients with hemorrhagic strokes had a better outcome after the creation of the ASN. CONCLUSIONS: Creation of an ASN was associated with a significant decrease of admission and imaging delays, due to a strong collaboration with EMS, and with a better outcome for hemorrhagic stroke patients. Treatment with intravenous thrombolysis in the first 3 hours could be used widely and was efficient and safe. However, the creation of dedicated stroke units for all stroke patients remains necessary to improve quality of care and outcome.
Assuntos
Redes Comunitárias/organização & administração , Fibrinolíticos/uso terapêutico , Acidente Vascular Cerebral/terapia , Idoso , Isquemia Encefálica/complicações , Hemorragia Cerebral/complicações , Diagnóstico Diferencial , Serviços Médicos de Emergência , Feminino , Fibrinolíticos/efeitos adversos , França , Humanos , Trombose Intracraniana/complicações , Trombose Intracraniana/tratamento farmacológico , Ataque Isquêmico Transitório/diagnóstico , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/etiologia , Transporte de Pacientes , Resultado do TratamentoRESUMO
INTRODUCTION: Stroke is a leading cause of death and disability. Patients with suspected stroke are usually managed in emergency departments (ED). Stroke units must be created in our country, but only few French epidemiological data are available to define needs in stroke care. OBJECTIVE: A prospective study was planned to evaluate epidemiology and stroke care for patients with suspected stroke admitted in the 22 ED of our region in the center of France during a two-month period. METHODS: Patients with suspected stroke seen at the 22 ED were prospectively followed until discharge or one month after admission. Data on demographic characteristics, mode of transport, delay of arrival and imaging, clinical findings at arrival, department of admission, diagnosis, Rankin scale at day 7, in-hospital mortality, and outcome at a month were collected. A global statistical analysis and a comparison between rural and urban ED were performed. RESULTS: Five hundred and ninety-eight patients were included. Mean age was 75 years. Median admission delay was 4 hours and 52 minutes. Predominant mode of transport was a private ambulance. A CT scan was obtained in 91 p.cent of cases with a median delay of 2 hours and 30 minutes. Only a third of the patients were admitted in departments of Neurology. Final diagnosis was: ischemic stroke (61 p.cent), transient ischemic attack (16 p.cent), hemorrhagic stroke (10 p.cent), other vascular disease (3 p.cent), non vascular disease (10 p.cent). In-hospital mortality was 20 p.cent, factors significantly associated with death rate were elevated age and a Glasgow coma scale<10 at admission. Mean length of stay was 12 days for stroke patients. At one month, 63 percent of patients were discharged to their home, 28 percent were transferred to an institution or in a rehabilitation unit, and 15 percent were still hospitalized. Significant differences in stroke care were found between rural and urban ED. CONCLUSION: This prospective study provides epidemiological data for our region. Creation of stroke units and definition of acute stroke networks are necessary to improve stroke care.
Assuntos
Serviços Médicos de Emergência , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/terapia , Idoso , Feminino , França/epidemiologia , Escala de Resultado de Glasgow , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Estudos Prospectivos , Acidente Vascular Cerebral/diagnóstico , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
INTRODUCTION: Mycobacteria are only exceptionally responsible for infection of the skin and soft tissues. A Mycobacterium chelonae myositis occurred in an immunodepressed patient. OBSERVATION: A 49 year-old man, treated for many years with corticosteroids for vasculitis of the lower limbs associated with rheumatoid polyarthritis, was hospitalized for invasive pulmonary aspergillosis. Ten days later he developed myositis of the right arm with multiple subcutaneous abscesses. Culture of the purulent substance isolated Mycobacterium chelonae. Treatment with ciprofloxacine and clarithromycine led to the regression of the lesions. He was followed-up for 12 months. DISCUSSION: M. chelonae is found in large quantities in the environment. Infection with this mycobacteria is enhanced by immunodepression, notably that secondary to corticosteroid therapy. Resistance to antibiotics are frequent. Clarithromycine is highly effective against this mycobacteria. Bi-therapy is recommended to avoid the emergence of resistance.
Assuntos
Infecções por Mycobacterium não Tuberculosas/diagnóstico , Mycobacterium chelonae/isolamento & purificação , Miosite/microbiologia , Corticosteroides/uso terapêutico , Anti-Infecciosos/uso terapêutico , Artrite Reumatoide/complicações , Ciprofloxacina/uso terapêutico , Claritromicina/uso terapêutico , Humanos , Hospedeiro Imunocomprometido , Perna (Membro)/irrigação sanguínea , Masculino , Pessoa de Meia-Idade , Infecções por Mycobacterium não Tuberculosas/tratamento farmacológico , Miosite/tratamento farmacológico , Vasculite/complicações , Vasculite/tratamento farmacológicoRESUMO
CURRENT SITUATION: Despite its impact on public health and numerous recommendations COPD remains under-diagnosed and its care pathways are not well known. Exacerbations are common presentations of the illness and contribute greatly to its impact on the health of the individual and the community. Despite this the methods of their management in hospital have not been precisely described. The purpose of the prospective study "COPD emergency 2003" is to describe these different aspects of the management of COPD and to study their determining factors. MATERIALS AND METHODS: It is a prospective, multicentre observational study of all the exacerbations of COPD managed as emergencies in public and private hospitals during a two-month period. Enrolment takes place between October 2003 and January 2004. The analysis will begin when the last patient has been discharged from hospital. EXPECTED RESULTS: The data obtained will allow identification of those aspects of the management of COPD and its exacerbations that are heterogeneous or in conflict with the current guidelines as well as the patient care pathways. In the future this study should help target the approaches aimed at improving the outcomes of patients suffering from COPD.
Assuntos
Hospitalização , Doença Pulmonar Obstrutiva Crônica/terapia , Adulto , Coleta de Dados , Tratamento de Emergência , Humanos , Guias de Prática Clínica como Assunto , Estudos Prospectivos , Índice de Gravidade de DoençaAssuntos
Neoplasias das Glândulas Suprarrenais/diagnóstico por imagem , Neoplasias das Glândulas Suprarrenais/patologia , Isquemia Miocárdica/diagnóstico por imagem , Isquemia Miocárdica/patologia , Feocromocitoma , Vasos Coronários , Humanos , Masculino , Pessoa de Meia-Idade , Necrose , Feocromocitoma/diagnóstico por imagem , Feocromocitoma/patologia , Feocromocitoma/cirurgia , Tomografia Computadorizada por Raios XAssuntos
Anti-Inflamatórios não Esteroides/efeitos adversos , Hemorragia/induzido quimicamente , Proteína C/efeitos adversos , Proteínas Recombinantes/efeitos adversos , Sepse/tratamento farmacológico , Anti-Inflamatórios não Esteroides/uso terapêutico , Humanos , Proteína C/uso terapêutico , Proteínas Recombinantes/uso terapêutico , Fatores de Risco , Índice de Gravidade de DoençaAssuntos
Anti-Infecciosos/uso terapêutico , Insuficiência de Múltiplos Órgãos/tratamento farmacológico , Insuficiência de Múltiplos Órgãos/etiologia , Seleção de Pacientes , Proteína C/uso terapêutico , Proteínas Recombinantes/uso terapêutico , Sepse/complicações , Sepse/tratamento farmacológico , Algoritmos , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Medição de Risco , Índice de Gravidade de DoençaRESUMO
Asthma from exposure to inhalation of isocyanates is an affection recognised under the title of work place diseases within table no 62 in the General Regulations and no 43 in the Agricultural Regulations. If workplace induced asthma is the most frequent of the workplace respiratory illnesses with a frequency of 2 to 15% of the asthmatic population, 1 patient in 2 will only be the object of a declaration and 1 in 3 the objective of a survey by the administrative authorities. The frequency of isocyanate asthma is on average 16.4% amongst workplace asthmas (19.6% in the industrial environment and 1.5% in an agricultural environment); if this prevalence is dose-dependent according to Baür, 30% of patients exposed to weak doses of isocyanate (0.3% ppb according to White) develop asthmatic disease whilst Bernstein estimates as 5 to 10% the frequency of asthmatic disease per 100,000 persons who are exposed to isocyanates.