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Despite extensive documentation of the adverse impacts of child sexual abuse (CSA), less is known about long-term effects of CSA, that is, the impact in middle and late adulthood, when one is further removed from the CSA. This study describes coping strategies and positive outcomes reported by adult female survivors of child sexual abuse ages 50+ (n = 58). Responses came from an anonymous online survey of adult survivors of CSA. We conducted a qualitative "RADaR" rapid analysis on the survey's open-ended questions. Survivors employed both internal attitudes and specific activities to cope with their childhood CSA. Most (n = 55) reported positive outcomes from CSA: self, others, and relational and/or emotive strengths. Due to survey limitations, we were unable to identify factors that contributed to survivors reporting positive outcomes and survivors who reported negative or no positive outcomes. This study suggests CSA survivors in middle and late adulthood may feel stronger as a result of abuse. More research is needed to identify factors that contribute to resilience.
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Adultos Sobrevivientes del Maltrato a los Niños , Abuso Sexual Infantil , Maltrato a los Niños , Humanos , Femenino , Persona de Mediana Edad , Niño , Anciano , Adulto , Adaptación Psicológica , Encuestas y CuestionariosRESUMEN
IMPORTANCE: SARS-CoV-2 has infected over 200 million people worldwide, resulting in more than 4 million deaths. Randomized controlled trials are the single best tool to identify effective treatments against this novel pathogen. OBJECTIVE: To describe the characteristics of randomized controlled trials of treatments for COVID-19 in the United States launched in the first 9 months of the pandemic. Design, Setting, and Participants We conducted a cross-sectional study of all completed or actively enrolling randomized, interventional, clinical trials for the treatment of COVID-19 in the United States registered on www.clinicaltrials.gov as of August 10, 2020. We excluded trials of vaccines and other interventions intended to prevent COVID-19. Main Outcomes and Measures We used descriptive statistics to characterize the clinical trials and the statistical power for the available studies. For the late-phase trials (i.e., phase 3 and 2/3 studies), we compared the geographic distribution of the clinical trials with the geographic distribution of people diagnosed with COVID-19. RESULTS: We identified 200 randomized controlled trials of treatments for people with COVID-19. Across all trials, 87 (43.5%) were single-center, 64 (32.0%) were unblinded, and 80 (40.0%) were sponsored by industry. The most common treatments included monoclonal antibodies (N=46 trials), small molecule immunomodulators (N=28), antiviral medications (N=24 trials), and hydroxychloroquine (N=20 trials). Of the 9 trials completed by August 2020, the median sample size was 450 (IQR 67-1113); of the 191 ongoing trials, the median planned sample size was 150 (IQR 60-400). Of the late-phase trials (N=54), the most common primary outcome was a severity scale (N=23, 42.6%), followed by a composite of mortality and ventilation (N=10, 18.5%), and mortality alone (N=6, 11.1%). Among these late-phase trials, all trials of antivirals, monoclonal antibodies, or chloroquine/hydroxychloroquine had a power of less than 25% to detect a 20% relative risk reduction in mortality. Had the individual trials for a given class of treatments instead formed a single trial, the power to detect that same reduction in mortality would have been greater than 98%. There was large variability in access to trials with the highest number of trials per capita in the Northeast and the lowest in the Midwest. CONCLUSIONS AND RELEVANCE: A large number of randomized trials were launched early in the pandemic to evaluate treatments for COVID-19. However, many trials were underpowered for important clinical endpoints and substantial geographic disparities were observed, highlighting the importance of improving national clinical trial infrastructure.
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COVID-19 , Estudios Transversales , Humanos , Pandemias , Ensayos Clínicos Controlados Aleatorios como Asunto , SARS-CoV-2 , Resultado del Tratamiento , Estados Unidos/epidemiologíaRESUMEN
While there has been great deal of research conducted on the effects of child sexual abuse (CSA) on trauma symptoms in children and adults, there is less knowledge on the effects on trauma symptoms in female older adult CSA survivors. The aim of this study was to investigate current symptoms of trauma in adult female survivors of child sexual abuse across each successive decade, beginning with eighteen year olds. This retrospective, anonymous online study gathered a sample of 223 adult female survivors of CSA (38 of whom were aged 50-59 (17%), and 20 of whom were 60+ years of age (9%)), and surveyed their trauma history and their current symptomology. In our sample, the survivors with the most severe trauma symptoms were between 18 and 29 years old. Each subsequent decade reported fewer trauma symptoms, with respondents in the 60+ age group reporting the lowest trauma symptom severity. While a cross-sectional study does not allow us to evaluate individuals' experiences over time, these results suggest that the negative impacts of CSA may abate over the life course. Future research should consider these questions longitudinally to explore whether these results are related to survivorship (those with worse outcomes dying younger) and whether these effects endure as female older adults experience physical and mental challenges in later life.
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Abuso Sexual Infantil , Maltrato a los Niños , Anciano , Niño , Estudios Transversales , Femenino , Humanos , Estudios Retrospectivos , Encuestas y CuestionariosRESUMEN
Grooming is a process whereby an individual who plans to commit a sexual crime uses deception with the victim as well as the people in the environment (such as the victim's family members, the offender's family, etc.) so that the crime goes undetected. Despite the overwhelming presence of grooming in sexual crimes, there is a dearth of research on sex offenders' perceptions of their own grooming behaviors. This paper describes the psychometrics and lessons learned in the pilot study of testing and revising a new instrument for measuring sex offenders' perceptions of their grooming behaviors (Sex Offenders Grooming Assessment; SOGA), with a sample (n = 50) of convicted male sex offenders in community based specialized therapy. Analyses suggest that using behaviorally-specific questions yielded more reliable results than general categorical grooming questions. Understanding how sex offenders perceive and report their grooming behavior provides valuable insight critical to treatment and assessment.
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Abuso Sexual Infantil , Víctimas de Crimen , Criminales , Delitos Sexuales , Animales , Niño , Aseo Animal , Humanos , Masculino , Percepción , Proyectos PilotoRESUMEN
PURPOSE OF REVIEW: Imaging modalities such as computed tomography, ultrasound, magnetic resonance imaging, and molecular imaging are being used to evaluate for disease in systemic sclerosis (SSc) patients. Here, we review novel imaging strategies to detect organ and vascular complications of SSc and novel imaging techniques for assessing interstitial lung disease and pulmonary hypertension in other conditions that may have further applicability to SSc. RECENT FINDINGS: Imaging techniques can be used to identify disease in the lungs, pulmonary vascular system, heart, skin, vascular tissue, and gastrointestinal tract of SSc patients. These show promise in detecting early disease, many without the use of ionizing radiation. Novel imaging techniques in patients with SSc can be used to detect disease in multiple susceptible organs. These imaging strategies have potential for early disease detection, as well as potential for incorporation into clinical trials to accelerate the development of SSc therapies.
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Hipertensión Pulmonar , Enfermedades Pulmonares Intersticiales , Esclerodermia Sistémica , Humanos , Hipertensión Pulmonar/diagnóstico por imagen , Hipertensión Pulmonar/etiología , Enfermedades Pulmonares Intersticiales/diagnóstico por imagen , Enfermedades Pulmonares Intersticiales/etiología , Esclerodermia Sistémica/complicaciones , Esclerodermia Sistémica/diagnóstico por imagenRESUMEN
BACKGROUND: Increasing evidence indicates that climate change is affecting the timing of pollen season and concentrations of allergenic pollens. To date, pollen trends and their associations with meteorological variables have not been studied in most of the United States. OBJECTIVE: The purpose of this study was to investigate the effects of weather and climate on pollen concentrations and pollen season timing in Denver, Colorado. METHODS: We retrospectively analyzed tree, grass, and weed pollen counts and meteorological variables from 2010-2018 using linear and Poisson regression models. RESULTS: Pollen season timing did not demonstrate uniform trends from 2010 to 2018. Certain species demonstrated earlier season start dates (linden, oak) or end dates (birch, maple), and others had later end dates (oak, grass). Only a few species demonstrated changes in season duration (linden, oak, maple, birch) and peak date (maple, birch). Pollen concentrations either remained stable or increased over the years. Temperature and carbon dioxide levels increased over the study period, with the exception of decreased temperature in August. Wind speed remained stable or decreased over the study period. CONCLUSION: This study illustrates the complex interactions between pollens and meteorology. Meteorological variables associated with climate change do appear to affect allergenic pollens, though the relationship is variable both amongst pollens and from year to year.
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Alérgenos/análisis , Cambio Climático , Polen , Tiempo (Meteorología) , Dióxido de Carbono/análisis , Ciudades , Colorado , Monitoreo del Ambiente , Malezas , Poaceae , Estaciones del Año , ÁrbolesRESUMEN
There are a multitude of behaviors that child sexual abusers use to 'groom' children into becoming vulnerable to abuse. In this study of 277 adult survivors of child sexual abuse, participants advised the many ways they were groomed into being abused by up to three perpetrators. The effects of three categories of grooming (Verbal Coercion, Grooming that used Drugs/Alcohol, and Threatening/Violent Grooming) were examined for their effects on trauma symptom severity. Using Linear Regressions, each grooming category had a significant predictive effect on trauma symptom severity. Multiple Linear Regressions revealed that for most trauma symptoms, Threatening/Violent Grooming was a significant predictor of trauma symptom severity, even when other more well-known variables were controlled for (including age at onset of abuse, relationship to perpetrator, and severity of abuse), with a notable exception of verbal coercion as a significant predictor of sexual problems in adulthood (i.e. not satisfied, low drive, overactivity, confusion, bad thoughts or feelings).
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Adultos Sobrevivientes del Maltrato a los Niños/psicología , Abuso Sexual Infantil/psicología , Relaciones Interpersonales , Trauma Psicológico/psicología , Adolescente , Adulto , Niño , Coerción , Femenino , Humanos , Índice de Severidad de la Enfermedad , Adulto JovenRESUMEN
An acquired immune deficiency due to interferon gamma (IFN-γ) autoantibodies was diagnosed in a 78-year-old Japanese man with treatment-refractory disseminated nontuberculous mycobacterial infection. In addition to standard antimycobacterial therapy, he was successfully treated with rituximab to eliminate B cells and thereby the autoantibody. Subsequently, he obtained a sustained remission from infection.
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Anticuerpos Monoclonales de Origen Murino/uso terapéutico , Autoanticuerpos/inmunología , Factores Inmunológicos/uso terapéutico , Interferón gamma/inmunología , Infecciones por Mycobacterium no Tuberculosas/tratamiento farmacológico , Infecciones por Mycobacterium no Tuberculosas/inmunología , Anciano , Autoanticuerpos/sangre , Humanos , Masculino , RituximabRESUMEN
OBJECTIVE: This study examined the psychometric properties of a new scale, the Emotional Betrayal from Child Sexual Abuse Measure (EBCSAM), which assesses feelings of betrayal in adult survivors of child sexual abuse (CSA). Emotional betrayal is examined with respect to the perpetrator as well as others in the survivor's immediate environment (i.e., family, friends, etc.) during the time of the abuse. METHOD: A sample of 342 CSA survivors were anonymously surveyed online in order to examine the psychometric properties of the EBCSAM. RESULTS: The original 16-item measure did not produce a good-fitting model, nor was it considered reliable or valid. Instead, a shortened six-item measure produced a successful model, was reliable (overall Cronbach's α = .85), and exploratory/confirmatory factor analyses suggested two valid latent subscales (Perpetrator Betrayal and Environmental Betrayal). CONCLUSION: This measure could be useful to clinicians treating survivors of child sexual abuse, as well as researchers, to reveal and evaluate aspects of emotional betrayal that impacted survivors.CSA). Emotional betrayal is examined with respect to the perpetrator as well as others in the survivor's immediate environment (i.e., family, friends, etc.) during the time of the abuse. METHOD: A sample of 342 CSA survivors were anonymously surveyed online in order to examine the psychometric properties of the (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Adultos Sobrevivientes del Maltrato a los Niños , Abuso Sexual Infantil , Maltrato a los Niños , Adulto , Humanos , Niño , Abuso Sexual Infantil/psicología , Traición , Psicometría , Maltrato a los Niños/psicología , Adultos Sobrevivientes del Maltrato a los Niños/psicologíaRESUMEN
Although the issue of dissociative amnesia in adult survivors of child sexual abuse has been contentious, many research studies have shown that there is a subset of child sexual abuse survivors who have forgotten their abuse and later remembered it. Child sexual abuse survivors with dissociative amnesia histories have different formative and therapeutic issues than survivors of child sexual abuse who have had continuous memory of their abuse. This article first discusses those differences in terms of the moderating risk factors for developing dissociative amnesia (e.g., age, ethnicity, gender, etc.) and then mediating risk factors (e.g., social support, trait dissociativity, etc.). The differences between the two types of survivors are then explored in terms of treatment issues.
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Amnesia/psicología , Abuso Sexual Infantil/psicología , Trastornos Disociativos/psicología , Sobrevivientes/psicología , Adulto , Factores de Edad , Amnesia/terapia , Niño , Abuso Sexual Infantil/rehabilitación , Trastornos Disociativos/terapia , Humanos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Factores Sexuales , Apoyo Social , Factores Socioeconómicos , Sobrevivientes/clasificación , Factores de TiempoRESUMEN
BACKGROUND: Prior studies have demonstrated improved efficacy when intra-articular (IA) therapeutics are injected using ultrasound (US) guidance. The aim of this study was to determine if clinical improvement in pain and function after IA hyaluronic acid injections using US is associated with changes in SF volumes and biomarker proteins at 3 months. METHODS: 49 subjects with symptomatic knee OA, BMI < 40, and KL radiographic grade II or III participated. Subjects with adequate aspirated synovial fluid (SF) volumes received two US-guided IA-HA injections of HYADD4 (24 mg/3 mL) 7 days apart. Clinical evaluations at 3, 6, and 12 months included WOMAC, VAS, PCS scores, 6 MWD, and US-measured SF depth. SF and blood were collected at 3 months and analyzed for four serum OA biomarkers and fifteen SF proteins. RESULTS: Statistical differences were observed at 3, 6, and 12 months compared to baseline values, with improvements at 12 months for WOMAC scores (50%), VAS (54%), and PCS scores (24%). MMP10 levels were lower at 3 months without changes in SF volumes, serum levels of C2C, COMP, HA, CPII, or SF levels of IL-1 ra, IL-4, 6, 7, 8, 15, 18, ILGFBP-1, 3, and MMP 1, 2, 3, 8, 9. Baseline clinical features or SF biomarker protein levels did not predict responsiveness at 3 months. CONCLUSIONS: Clinical improvements were observed at 12 months using US needle guidance for IA HA, whereas only one SF protein biomarker protein was different at 3 months. Larger studies are needed to identify which SF biomarkers will predict which individual OA patients will receive the greatest benefit from IA therapeutics.
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Epidemiological studies demonstrated that the number of emergency-room visits for respiratory indications increases during periods of Florida Red Tides. The purpose of this study was to examine whether or not repeated brevetoxin inhalation, as may occur during a Florida Red Tide, affects pulmonary responses to influenza A. Male F344 rats were divided into four groups: (1) sham aerosol/no influenza; (2) sham aerosol/influenza; (3) brevetoxin/no influenza; and (4) brevetoxin/influenza. Animals were exposed by nose-only inhalation to vehicle or 50 µg brevetoxin-3/m3, 2 h/d for 12 d. On d 6 of aerosol exposure, groups 2 and 4 were administered 10,000 plaque-forming units of influenza A, strain HKX-31 (H3N2), by intratracheal instillation. Subgroups were euthanized at 2, 4, and 7 d post influenza treatment. Lungs were evaluated for viral load, cytokine content, and histopathologic changes. Influenza virus was cleared from the lungs over the 7-d period; however, there was significantly more virus remaining in the group 4 lungs compared to group 2. Influenza virus significantly increased interleukins-1α and -6 and monocyte chemotactic protein-1 in lung; brevetoxin exposure significantly enhanced the influenza-induced response. At 7 d, the severity of perivascular and peribronchiolar inflammatory cell infiltrates was greatest in group 4. Bronchiolitis persisted, with low incidence and severity, only in group 4 at d 7. These results suggest that repeated inhalation exposure to brevetoxin may delay virus particle clearance and recovery from influenza A infection in the rat lung.
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Subtipo H3N2 del Virus de la Influenza A/crecimiento & desarrollo , Pulmón/efectos de los fármacos , Pulmón/inmunología , Toxinas Marinas/toxicidad , Infecciones por Orthomyxoviridae/inmunología , Infecciones por Orthomyxoviridae/virología , Oxocinas/toxicidad , Administración Intranasal , Animales , Bronquiolitis Viral/inmunología , Bronquiolitis Viral/patología , Bronquiolitis Viral/virología , Citocinas/metabolismo , Susceptibilidad a Enfermedades , Floraciones de Algas Nocivas , Inmunidad Mucosa/efectos de los fármacos , Subtipo H3N2 del Virus de la Influenza A/inmunología , Subtipo H3N2 del Virus de la Influenza A/aislamiento & purificación , Pulmón/patología , Pulmón/virología , Masculino , Toxinas Marinas/administración & dosificación , Infecciones por Orthomyxoviridae/metabolismo , Infecciones por Orthomyxoviridae/patología , Oxocinas/administración & dosificación , Distribución Aleatoria , Ratas , Ratas Endogámicas F344 , Factores de Tiempo , Carga ViralRESUMEN
Ricin is a highly toxic ribosome-inactivating protein derived from the castor bean (Ricinus communis). Due to the relative ease of producing ricin, it is characterized as a category B priority pathogen by the Center for Disease Control and Prevention. The purpose of this study was to compare the acute toxicity, associated histopathology, as well as the regional respiratory tract deposition and clearance kinetics of inhaled ricin in rats and mice using a single pure preparation. Acute toxicity was evaluated in five groups of six animals per species exposed nose-only to ricin aerosols and followed up to 7 days post-exposure. Tissues were collected for histopathology. The calculated median lethal doses (LD50s) were 0.24 µg/kg (rats) and 0.58 µg/kg (mice). Histological changes were noted in nose, larynges, trachea, lung, thymus, and spleen of both species. Pulmonary deposition in rats inhaling 94-99 ng/L ricin for 20 min (low dose) or 40 min (high dose) were 45.9 and 96 ng/g lung, respectively. Clearance was best described by a single-component negative exponential function. Estimated lung doses were 0.38 and 1.43 µg/g·h among the low and high dose rats, respectively. In mice inhaling 94 ng/L ricin for 20 min, pulmonary deposition was 91.1 ng/g lung and the estimated tissue dose was 1.72 µg/g·h. No ricin was detected in extra-respiratory tract tissue or in excreta. Results of this study demonstrate differences exist in pulmonary deposition, clearance rates, and tissue dose and histopathological changes between rats and mice inhaling ricin.
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Sustancias para la Guerra Química/farmacocinética , Sustancias para la Guerra Química/toxicidad , Lesión Pulmonar/inducido químicamente , Lesión Pulmonar/metabolismo , Ricina/farmacocinética , Ricina/toxicidad , Animales , Femenino , Exposición por Inhalación , Dosificación Letal Mediana , Longevidad/efectos de los fármacos , Lesión Pulmonar/patología , Ratones , Ratones Endogámicos BALB C , Ratas , Ratas Sprague-Dawley , Sistema Respiratorio/efectos de los fármacos , Sistema Respiratorio/metabolismo , Sistema Respiratorio/patología , Especificidad de la Especie , Bazo/efectos de los fármacos , Bazo/metabolismo , Bazo/patología , Timo/efectos de los fármacos , Timo/metabolismo , Timo/patología , Pruebas de Toxicidad AgudaRESUMEN
In this retrospective study of 244 adult survivors of child sexual abuse (CSA), their experiences of childhood polyvictimization were analyzed as to their cumulative effect on trauma symptoms, education, and income levels. The data were gathered by anonymously sampling adult survivors of CSA from websites that were specific to this population (such as online peer support groups). Their experiences of victimization were examined as to Cumulative Polyvictimization, Witnessing Traumas (such as witnessing intimate partner violence), and Experiencing Traumas (such as child physical abuse). The majority of the sample (87%) experienced polyvictimization in childhood (in combination with CSA), with the largest part of the sample (83%) experiencing emotional abuse by someone close to them, and the smallest part of the sample (22%) experiencing child physical abuse by someone with whom they were not close. The results of the linear regressions showed that both experiencing and witnessing trauma were significantly associated with trauma symptoms for CSA survivors. These results suggest that both types of victimization (experiencing and witnessing) need to be treated as direct traumas, and a more holistic approach toward survivors of CSA is needed toward assessment and treatment.
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Adultos Sobrevivientes del Maltrato a los Niños , Abuso Sexual Infantil , Maltrato a los Niños , Víctimas de Crimen , Adulto , Niño , Humanos , Abuso Físico , Estudios Retrospectivos , SobrevivientesRESUMEN
OBJECTIVE: Recent cohort studies have identified obesity as a risk factor for poor outcomes in coronavirus disease 2019 (COVID-19). To further explore the relationship between obesity and critical illness in COVID-19, the association of BMI with baseline demographic and intensive care unit (ICU) parameters, laboratory values, and outcomes in a critically ill patient cohort was examined. METHODS: In this retrospective study, the first 277 consecutive patients admitted to Massachusetts General Hospital ICUs with laboratory-confirmed COVID-19 were examined. BMI class, initial ICU laboratory values, physiologic characteristics including gas exchange and ventilatory mechanics, and ICU interventions as clinically available were measured. Mortality, length of ICU admission, and duration of mechanical ventilation were also measured. RESULTS: There was no difference found in respiratory system compliance or oxygenation between patients with and without obesity. Patients without obesity had higher initial ferritin and D-dimer levels than patients with obesity. Standard acute respiratory distress syndrome management, including prone ventilation, was equally distributed between BMI groups. There was no difference found in outcomes between BMI groups, including 30- and 60-day mortality and duration of mechanical ventilation. CONCLUSIONS: In this cohort of critically ill patients with COVID-19, obesity was not associated with meaningful differences in respiratory physiology, inflammatory profile, or clinical outcomes.
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Índice de Masa Corporal , COVID-19/complicaciones , Obesidad/complicaciones , Anciano , COVID-19/epidemiología , Enfermedad Crítica , Femenino , Hospitalización , Humanos , Unidades de Cuidados Intensivos , Masculino , Massachusetts , Persona de Mediana Edad , Respiración Artificial , Estudios Retrospectivos , Factores de RiesgoRESUMEN
BACKGROUND: There are currently no effective disease-modifying drugs to prevent cartilage loss in osteoarthritis and synovial fluid is a potentially valuable source of biomarkers to understand the pathogenesis of different types of arthritis and identify drug responsiveness. The aim of this study was to compare the differences between SF cytokines and other proteins in patients with OA (n = 21) to those with RA (n = 27) and normal knees (n = 3). METHODS: SF was obtained using ultrasound (US) guidance and an external pneumatic compression device. RA patients were categorized as active (n = 20) or controlled (n = 7) based upon SF white blood cell counts (> or <300 cells/mm3). Samples were cryopreserved and analyzed by multiplex fluorescent bead assays (Luminex). Between-group differences of 16 separate biomarker proteins were identified using ANOVA on log10-transformed concentrations with p values adjusted for multiple testing. RESULTS: Only six biomarkers were significantly higher in SF from active RA compared to OA-TNF-α, IL-1-ß IL-7, MMP-1, MMP-2, and MMP-3. Only MMP-8 levels in RA patients correlated with SF WBC counts (p < 0.0001). Among OA patients, simultaneous SF IL-4, IL-6, IL-8, and IL-15 levels were higher than serum levels, whereas MMP-8, MMP-9, and IL-18 levels were higher in serum (p < 0.05). CONCLUSION: These results support the growing evidence that OA patients have a pro-inflammatory/catabolic SF environment. SF biomarker analysis using multiplex testing and US guidance may distinguish OA phenotypes and identify treatment options based upon targeted inflammatory pathways similar to patients with RA.
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IMPORTANCE: Prone positioning improves clinical outcomes in moderate-to-severe acute respiratory distress syndrome and has been widely adopted for the treatment of patients with acute respiratory distress syndrome due to coronavirus disease 2019. Little is known about the effects of prone positioning among patients with less severe acute respiratory distress syndrome, obesity, or those treated with pulmonary vasodilators. OBJECTIVES: We characterize the change in oxygenation, respiratory system compliance, and dead-space-to-tidal-volume ratio in response to prone positioning in patients with coronavirus disease 2019 acute respiratory distress syndrome with a range of severities. A subset analysis of patients treated with inhaled nitric oxide and subsequent prone positioning explored the influence of pulmonary vasodilation on the physiology of prone positioning. DESIGN SETTING AND PARTICIPANTS: Retrospective cohort study of all consecutively admitted adult patients with acute respiratory distress syndrome due to coronavirus disease 2019 treated with mechanical ventilation and prone positioning in the ICUs of an academic hospital between March 11, 2020, and May 1, 2020. MAIN OUTCOMES AND MEASURES: Respiratory system mechanics and gas exchange during the first episode of prone positioning. RESULTS: Among 122 patients, median (interquartile range) age was 60 years (51-71 yr), median body mass index was 31.5 kg/m2 (27-35 kg/m2), and 50 patients (41%) were female. The ratio of Pao2 to Fio2 improved with prone positioning in 90% of patients. Prone positioning was associated with a significant increase in the ratio of Pao2 to Fio2 (from median 149 [123-170] to 226 [169-268], p < 0.001) but no change in dead-space-to-tidal-volume ratio or respiratory system compliance. Supine ratio of Pao2 to Fio2, respiratory system compliance, positive end-expiratory pressure, and body mass index did not correlate with absolute change in the ratio of Pao2 to Fio2 with prone positioning. However, patients with ratio of Pao2 to Fio2 less than 150 experienced a greater relative improvement in oxygenation with prone positioning than patients with ratio of Pao2 to Fio2 greater than or equal to 150 (median percent change in ratio of Pao2 to Fio2 62 [29-107] vs 30 [10-70], p = 0.002). Among 12 patients, inhaled nitric oxide prior to prone positioning was associated with a significant increase in the ratio of Pao2 to Fio2 (from median 136 [77-168] to 170 [138-213], p = 0.003) and decrease in dead-space-to-tidal-volume ratio (0.54 [0.49-0.58] to 0.46 [0.44-0.53], p = 0.001). Subsequent prone positioning in this subgroup further improved the ratio of Pao2 to Fio2 (from 145 [122-183] to 205 [150-232], p = 0.017) but did not change dead-space-to-tidal-volume ratio. CONCLUSIONS AND RELEVANCE: Prone positioning improves oxygenation across the acute respiratory distress syndrome severity spectrum, irrespective of supine respiratory system compliance, positive end-expiratory pressure, or body mass index. There was a greater relative benefit among patients with more severe disease. Prone positioning confers an additive benefit in oxygenation among patients treated with inhaled nitric oxide.
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ABSTRACT: COVID-19-related coagulopathy is a known complication of SARS-CoV-2 infection and can lead to intracranial hemorrhage (ICH), one of the most feared complications of extracorporeal membrane oxygenation (ECMO). We sought to evaluate the incidence and etiology of ICH in patients with COVID-19 requiring ECMO. Patients at two academic medical centers with COVID-19 who required venovenous-ECMO support for acute respiratory distress syndrome (ARDS) were evaluated retrospectively. During the study period, 33 patients required ECMO support; 16 (48.5%) were discharged alive, 13 died (39.4%), and 4 (12.1%) had ongoing care. Eleven patients had ICH (33.3%). All ICH events occurred in patients who received intravenous anticoagulation. The ICH group had higher C-reactive protein (Pâ=â0.04), procalcitonin levels (Pâ=â0.02), and IL-6 levels (Pâ=â0.05), lower blood pH before and after ECMO (Pâ<â0.01), and higher activated partial thromboplastin times throughout the hospital stay (Pâ<â0.0001). ICH-free survival was lower in COVID-19 patients than in patients on ECMO for ARDS caused by other viruses (49% vs. 79%, Pâ=â0.02). In conclusion, patients with COVID-19 can be successfully bridged to recovery using ECMO but may suffer higher rates of ICH compared to those with other viral respiratory infections.
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Proteínas Reguladoras de la Apoptosis/sangre , COVID-19/terapia , Oxigenación por Membrana Extracorpórea/métodos , Hemorragias Intracraneales/epidemiología , Proteínas Mitocondriales/sangre , SARS-CoV-2 , Adulto , Biomarcadores/sangre , COVID-19/complicaciones , COVID-19/epidemiología , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Hemorragias Intracraneales/sangre , Hemorragias Intracraneales/etiología , Masculino , Persona de Mediana Edad , Pandemias , Estudios Retrospectivos , Estados Unidos/epidemiologíaRESUMEN
Effects of environmental microbial exposures on human health have long been of interest. Microbes were historically assumed to be harmful, but data have suggested that microbial exposures can modulate the immune system. We focus on the effects of indoor environmental microbial exposure on chronic lung diseases. We found contradictory data in bacterial studies using endotoxin as a surrogate for bacterial exposure. Contradictory data also exist in studies of fungal exposure. Many factors may modulate the effect of environmental microbial exposures on lung health, including coexposures. Future studies need to clarify which method of assessing environmental microbial exposures is most relevant.
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Contaminación del Aire Interior/efectos adversos , Enfermedades Pulmonares/microbiología , Microbiota/fisiología , Enfermedad Crónica , HumanosRESUMEN
A case is described of a 29-year-old female who presented with acute hypoxic respiratory failure due to acute eosinophilic pneumonia, associated with the use of electronic cigarettes to vape tetrahydrocannabinol (THC), together with the contemporary clinical understanding of the syndrome of electronic-cigarette associated lung injury (EVALI). Attention is drawn to acute eosinophilic pneumonia as a potential consequence of vaping-associated lung injury to understand the diagnostic evaluations and therapeutic interventions for acute eosinophilic pneumonia associated with vaping THC.