RESUMO
Both obesity and asthma are highly prevalent, complex diseases modified by multiple factors. Genetic, developmental, lung mechanical, immunological and behavioural factors have all been suggested as playing a causal role between the two entities; however, their complex mechanistic interactions are still poorly understood and evidence of causality in children remains scant. Equally lacking is evidence of effective treatment strategies, despite the fact that imbalances at vulnerable phases in childhood can impact long-term health. This review is targeted at both clinicians frequently faced with the dilemma of how to investigate and treat the obese asthmatic child and researchers interested in the topic. Highlighting the breadth of the spectrum of factors involved, this review collates evidence regarding the investigation and treatment of asthma in obese children, particularly in comparison with current approaches in 'difficult-to-treat' childhood asthma. Finally, the authors propose hypotheses for future research from a systems-based perspective.
Assuntos
Asma/diagnóstico , Asma/terapia , Obesidade/diagnóstico , Obesidade/terapia , Fatores Etários , Asma/complicações , Asma/epidemiologia , Asma/etiologia , Criança , Pré-Escolar , Humanos , Obesidade/complicações , Obesidade/epidemiologia , Obesidade/etiologia , Biologia de Sistemas/métodosRESUMO
Assuntos
Tuberculose Latente/diagnóstico , Programas de Rastreamento/métodos , Serviços de Saúde Escolar/economia , Migrantes/estatística & dados numéricos , Adolescente , Criança , Pré-Escolar , Análise Custo-Benefício , Feminino , Custos de Cuidados de Saúde , Humanos , Incidência , Tuberculose Latente/economia , Tuberculose Latente/epidemiologia , Masculino , Programas de Rastreamento/economia , Prevalência , Anos de Vida Ajustados por Qualidade de Vida , Estudos Retrospectivos , Suíça/epidemiologia , Teste TuberculínicoRESUMO
A-13 year old boy had an accident with his bike with a blunt thorax trauma and presented shortly after with facial swelling. Due to respiratory insufficiency, intubation was done during the transport to the clinic. First, a chest radiograph was performed, which showed a unilateral pneumothorax. Later a CT scan revealed bilateral pneumothorax and pneumomediastinum. Bilateral chest tube insertions improved the respiratory situation. Bronchoscopy showed a tracheal lesion two cm posterior to the main carina. After good wound healing, the patient was dismissed after 21 days in good health. Conservative treatment can be recommended in selected patients with a tracheal lesion when having a stable respiratory situation. If the patient does not improve after 48 h or if the clinical condition worsens, surgical management should be considered.