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1.
Pan Afr Med J ; 38: 74, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33889240

RESUMEN

Boerhaave's syndrome is an uncommon syndrome characterized by spontaneous rupture of the oesophagus with a high mortality rate. While excessive alcohol intake and binge-eating are the classic precipitants of this syndrome, medication-induced vomiting causing Booerhave's is quite uncommon. Traditionally managed operatively, conservative management is being increasingly reported in selected cases. We report the case of 21-year-old male with who developed sudden onset chest pain and dyspnoea after pentazocine induced vomiting. He was referred after lack of response to initial treatment for acute severe asthma. A chest CT scan showed pneumomediastinum, subcutaneous emphysema and oesophageal tear. He was managed conservatively with oxygen therapy, nil per mouth and antibiotics with improvement of symptoms and discharge after 8 days.


Asunto(s)
Perforación del Esófago/diagnóstico por imagen , Enfermedades del Mediastino/diagnóstico por imagen , Pentazocina/efectos adversos , Vómitos/complicaciones , Analgésicos Opioides/administración & dosificación , Analgésicos Opioides/efectos adversos , Antibacterianos/administración & dosificación , Asma/fisiopatología , Asma/terapia , Dolor en el Pecho/etiología , Disnea/etiología , Perforación del Esófago/etiología , Perforación del Esófago/terapia , Humanos , Masculino , Enfermedades del Mediastino/etiología , Enfermedades del Mediastino/terapia , Terapia por Inhalación de Oxígeno , Pentazocina/administración & dosificación , Tomografía Computarizada por Rayos X , Vómitos/inducido químicamente , Adulto Joven
2.
Rev Med Suisse ; 17(736): 831-834, 2021 Apr 28.
Artículo en Francés | MEDLINE | ID: mdl-33908720

RESUMEN

A significative proportion of patients with pulmonary-related COVID-19 initially present with « silent ¼ or « happy ¼ hypoxemia, a term denoting an absence of dyspnea or other respiratory distress symptoms in face of profound hypoxemia. COVID-19 is a multisystemic disease characterized by the diffusion of SARS-COV-2 through the blood and a widespread secondary immune response. Most of the organs are involved, including the brain and this translates into the development of acute encephalopathy and other complications. Silent hypoxemia and the consequent "vanishing dyspnea" represent a loss of warning signal and may be associated with a rapid clinical worsening and a fatal outcome. In this article, we will describe the physiological basis of ventilation and we will elucidate the different pathophysiological mechanisms underlying the phenomenon of silent hypoxemia in COVID-19.


Asunto(s)
Disnea/etiología , Humanos , Hipoxia/etiología , Pulmón
4.
BMC Pulm Med ; 21(1): 126, 2021 Apr 19.
Artículo en Inglés | MEDLINE | ID: mdl-33874930

RESUMEN

BACKGROUND: Platypnea-orthodeoxia syndrome (POS) is a rare condition characterized by dyspnoea (platypnea) and arterial desaturation in the upright position resolved in the supine position (orthodeoxia). Intracardiac shunt, pulmonary ventilation-perfusion mismatch and others intrapulmonary abnormalities are involved. CASE PRESENTATION: We report a case of POS associated with two pathophysiological issues: one, cardiac POS caused by a patent foramen ovale (PFO) and second, pulmonary POS due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) interstitial pneumonia. POS has resolved after recovery of coronavirus disease 2019 (COVID-19) pneumonia. CONCLUSIONS: Right-to-left interatrial shunt and intrapulmonary shunt caused by SARS-CoV-2 pneumonia contributed to refractory hypoxemia and POS. Therefore, in case of COVID-19 patient with unexplained POS, the existence of PFO must be investigated.


Asunto(s)
Disnea , Foramen Oval Permeable , Hipoxia , Pulmón/diagnóstico por imagen , Neumonía Viral , /diagnóstico , Disnea/diagnóstico , Disnea/etiología , Disnea/fisiopatología , Ecocardiografía/métodos , Foramen Oval Permeable/complicaciones , Foramen Oval Permeable/diagnóstico , Foramen Oval Permeable/fisiopatología , Hemodinámica , Humanos , Hipoxia/diagnóstico , Hipoxia/etiología , Hipoxia/fisiopatología , Enfermedades Pulmonares Intersticiales/complicaciones , Enfermedades Pulmonares Intersticiales/fisiopatología , Enfermedades Pulmonares Intersticiales/virología , Masculino , Persona de Mediana Edad , Oxígeno/análisis , Neumonía Viral/complicaciones , Neumonía Viral/diagnóstico , Neumonía Viral/fisiopatología , Postura/fisiología , Síndrome , Resultado del Tratamiento
5.
Sci Rep ; 11(1): 7477, 2021 04 05.
Artículo en Inglés | MEDLINE | ID: mdl-33820944

RESUMEN

We aim to describe a case series of critically and non-critically ill COVID-19 patients in Singapore. This was a multicentered prospective study with clinical and laboratory details. Details for fifty uncomplicated COVID-19 patients and ten who required mechanical ventilation were collected. We compared clinical features between the groups, assessed predictors of intubation, and described ventilatory management in ICU patients. Ventilated patients were significantly older, reported more dyspnea, had elevated C-reactive protein and lactate dehydrogenase. A multivariable logistic regression model identified respiratory rate (aOR 2.83, 95% CI 1.24-6.47) and neutrophil count (aOR 2.39, 95% CI 1.34-4.26) on admission as independent predictors of intubation with area under receiver operating characteristic curve of 0.928 (95% CI 0.828-0.979). Median APACHE II score was 19 (IQR 17-22) and PaO2/FiO2 ratio before intubation was 104 (IQR 89-129). Median peak FiO2 was 0.75 (IQR 0.6-1.0), positive end-expiratory pressure 12 (IQR 10-14) and plateau pressure 22 (IQR 18-26) in the first 24 h of ventilation. Median duration of ventilation was 6.5 days (IQR 5.5-13). There were no fatalities. Most COVID-19 patients in Singapore who required mechanical ventilation because of ARDS were extubated with no mortality.


Asunto(s)
/patología , Adulto , Área Bajo la Curva , Proteína C-Reactiva/metabolismo , Disnea/etiología , Femenino , Humanos , Unidades de Cuidados Intensivos , L-Lactato Deshidrogenasa/metabolismo , Modelos Logísticos , Masculino , Persona de Mediana Edad , Neutrófilos/citología , Estudios Prospectivos , Curva ROC , Respiración Artificial , Frecuencia Respiratoria , Índice de Severidad de la Enfermedad , Singapur
6.
BMJ Open ; 11(3): e044853, 2021 03 31.
Artículo en Inglés | MEDLINE | ID: mdl-33789854

RESUMEN

OBJECTIVES: One major goal of the emergency department (ED) is to decide, whether patients need to be hospitalised or can be sent home safely. We aim at providing criteria for these decisions without knowing the SARS-CoV-2 test result in suspected cases. SETTING: Tertiary emergency medicine. PARTICIPANTS: All patients were treated at the ED of the Charité during the pandemic peak and underwent SARS-CoV-2 testing. Patients with positive test results were characterised in detail and underwent a 14-day-follow-up. PRIMARY AND SECONDARY OUTCOME MEASURES: Logistic regression and classification and regression tree (CART) analyses were performed to identify predictors (primary endpoint), which confirm safe discharge. The clinical endpoint was all-cause mortality or need for mechanical ventilation during index stay or after readmission. RESULTS: The primary test population of suspected COVID-19 consisted of n=1255 cases, 45.2% were women (n=567). Of these, n=110 tested positive for SARS-CoV-2 (8.8%). The median age of SARS-CoV-2-positive cases was 45 years (IQR: 33-66 years), whereas the median age of the group tested negative for SARS-CoV-2 was 42 years (IQR: 30-60 years) (p=0.096). 43.6% were directly admitted to hospital care.CART analysis identified the variables oxygen saturation (<95%), dyspnoea and history of cardiovascular (CV) disease to distinguish between high and low-risk groups. If all three variables were negative, most patients were discharged from ED, and the incidence of the clinical endpoint was 0%. The validation cohort confirmed the safety of discharge using these variables and revealed an incidence of the clinical endpoint from 14.3% in patients with CV disease, 9.4% in patients with dyspnoea and 18.2% in patients with O2 satuaration below 95%. CONCLUSIONS: Based on easily available variables like dyspnoea, oxygen saturation, history of CV disease, approximately 25% of patients subsequently confirmed with COVID-19 can be identified for safe discharge. TRIAL REGISTRATION NUMBER: DRKS00023117.


Asunto(s)
/epidemiología , Toma de Decisiones , Servicio de Urgencia en Hospital/estadística & datos numéricos , Adulto , Anciano , /terapia , /estadística & datos numéricos , Estudios de Cohortes , Tos/etiología , Disnea/etiología , Servicio de Urgencia en Hospital/organización & administración , Femenino , Fiebre/etiología , Alemania/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Respiración Artificial/estadística & datos numéricos
8.
Reumatismo ; 72(4): 189-196, 2021 Jan 18.
Artículo en Inglés | MEDLINE | ID: mdl-33677945

RESUMEN

The role of 25-OH-vitamin D in the assessment of coronavirus disease 19 (COVID-19) has not been investigated. We sought to investigate the prevalence of 25-OH-vitamin D deficiency among COVID-19 patients, and to determine the associations between 25-OH-vitamin D status and the severity of the disease. We have conducted a retrospective observational study of COVID-19 patients admitted to the University of Verona Hospital Trust. Demographic, clinical and biochemical parameters were collected at hospital admission, and serum 25-OH-vitamin D levels were measured. The following outcomes were assessed: arterial partial oxygen pressure (PaO2); C-reactive protein (CRP); length of hospitalization; requirement of oxygen therapy; non-invasive ventilation (NIV); mechanical ventilation; and death. Among 61 patients enrolled, 72.1% was 25-OH-vitamin D deficient (<20 ng/mL) and 57.4% had 25-OHvitamin D <15 ng/mL. Patients with arterial PaO2 <60 mmHg had significantly lower mean 25-OH-vitamin D levels compared to patients with PaO2 ≥60 mmHg (13.3 ng/mL vs 20.4 ng/mL respectively, p=0.03). Vitamin D deficiency was associated with 3-fold higher risk of having arterial pO2 <60 mmHg. 25-OH-vitamin D deficiency was associated with increased CRP and dyspnea. 25-OH-vitamin D deficiency was associated with more severe systemic inflammatory response and respiratory failure in COVID-19 patients.


Asunto(s)
/sangre , Vitamina D/sangre , Adulto , Anciano , Anciano de 80 o más Años , Proteína C-Reactiva/análisis , Comorbilidad , Susceptibilidad a Enfermedades , Disnea/etiología , Femenino , Fibrinógeno/análisis , Humanos , Italia/epidemiología , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Oxígeno/sangre , Presión Parcial , Prevalencia , Respiración Artificial/estadística & datos numéricos , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Deficiencia de Vitamina D/sangre , Deficiencia de Vitamina D/epidemiología
11.
JAMA ; 325(15): 1525-1534, 2021 04 20.
Artículo en Inglés | MEDLINE | ID: mdl-33729425

RESUMEN

Importance: Little is known about long-term sequelae of COVID-19. Objective: To describe the consequences at 4 months in patients hospitalized for COVID-19. Design, Setting, and Participants: In a prospective uncontrolled cohort study, survivors of COVID-19 who had been hospitalized in a university hospital in France between March 1 and May 29, 2020, underwent a telephone assessment 4 months after discharge, between July 15 and September 18, 2020. Patients with relevant symptoms and all patients hospitalized in an intensive care unit (ICU) were invited for further assessment at an ambulatory care visit. Exposures: Survival of hospitalization for COVID-19. Main Outcomes and Measures: Respiratory, cognitive, and functional symptoms were assessed by telephone with the Q3PC cognitive screening questionnaire and a checklist of symptoms. At the ambulatory care visit, patients underwent pulmonary function tests, lung computed tomographic scan, psychometric and cognitive tests (including the 36-Item Short-Form Health Survey and 20-item Multidimensional Fatigue Inventory), and, for patients who had been hospitalized in the ICU or reported ongoing symptoms, echocardiography. Results: Among 834 eligible patients, 478 were evaluated by telephone (mean age, 61 years [SD, 16 years]; 201 men, 277 women). During the telephone interview, 244 patients (51%) declared at least 1 symptom that did not exist before COVID-19: fatigue in 31%, cognitive symptoms in 21%, and new-onset dyspnea in 16%. There was further evaluation in 177 patients (37%), including 97 of 142 former ICU patients. The median 20-item Multidimensional Fatigue Inventory score (n = 130) was 4.5 (interquartile range, 3.0-5.0) for reduced motivation and 3.7 (interquartile range, 3.0-4.5) for mental fatigue (possible range, 1 [best] to 5 [worst]). The median 36-Item Short-Form Health Survey score (n = 145) was 25 (interquartile range, 25.0-75.0) for the subscale "role limited owing to physical problems" (possible range, 0 [best] to 100 [worst]). Computed tomographic lung-scan abnormalities were found in 108 of 171 patients (63%), mainly subtle ground-glass opacities. Fibrotic lesions were observed in 33 of 171 patients (19%), involving less than 25% of parenchyma in all but 1 patient. Fibrotic lesions were observed in 19 of 49 survivors (39%) with acute respiratory distress syndrome. Among 94 former ICU patients, anxiety, depression, and posttraumatic symptoms were observed in 23%, 18%, and 7%, respectively. The left ventricular ejection fraction was less than 50% in 8 of 83 ICU patients (10%). New-onset chronic kidney disease was observed in 2 ICU patients. Serology was positive in 172 of 177 outpatients (97%). Conclusions and Relevance: Four months after hospitalization for COVID-19, a cohort of patients frequently reported symptoms not previously present, and lung-scan abnormalities were common among those who were tested. These findings are limited by the absence of a control group and of pre-COVID assessments in this cohort. Further research is needed to understand longer-term outcomes and whether these findings reflect associations with the disease.


Asunto(s)
/complicaciones , Hospitalización , Enfermedades Pulmonares/etiología , Pulmón/patología , Anciano , Ansiedad/etiología , Trastornos del Conocimiento/etiología , Estudios de Cohortes , Depresión/etiología , Disnea/etiología , Fatiga/etiología , Femenino , Estudios de Seguimiento , Humanos , Pulmón/diagnóstico por imagen , Enfermedades Pulmonares/diagnóstico por imagen , Enfermedades Pulmonares/patología , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos X
12.
Minerva Anestesiol ; 87(3): 325-333, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33694360

RESUMEN

BACKGROUND: In the early stages of COVID-19 pneumonia, hypoxemia has been described in absence of dyspnea ("silent" or "happy" hypoxemia). Our aim was to report its prevalence and outcome in a series of hypoxemic patients upon Emergency Department admission. METHODS: In this retrospective observational cohort study we enrolled a study population consisting of 213 COVID-19 patients with PaO2/FiO2 ratio <300 mmHg at hospital admission. Two groups (silent and dyspneic hypoxemia) were defined. Symptoms, blood gas analysis, chest X-ray (CXR) severity, need for intensive care and outcome were recorded. RESULTS: Silent hypoxemic patients (68-31.9%) compared to the dyspneic hypoxemic patients (145-68.1%) showed greater frequency of extra respiratory symptoms (myalgia, diarrhea and nausea) and lower plasmatic LDH. PaO2/FiO2 ratio was 225±68 mmHg and 192±78 mmHg in silent and dyspneic hypoxemia respectively (P=0.002). Eighteen percent of the patients with PaO2/FiO2 from 50 to 150 mmHg presented silent hypoxemia. Silent and dyspneic hypoxemic patients had similar PaCO2 (34.2±6.8 mmHg vs. 33.5±5.7 mmHg, P=0.47) but different respiratory rates (24.6±5.9 bpm vs. 28.6±11.3 bpm respectively, P=0.002). Even when CXR was severely abnormal, 25% of the population was silent hypoxemic. Twenty-six point five percent and 38.6% of silent and dyspneic patients were admitted to the ICU respectively (P=0.082). Mortality rate was 17.6% and 29.7% (log-rank P=0.083) in silent and dyspneic patients. CONCLUSIONS: Silent hypoxemia is remarkably present in COVID-19. The presence of dyspnea is associated with a more severe clinical condition.


Asunto(s)
/complicaciones , Hipoxia/epidemiología , Hipoxia/etiología , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Disnea/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Retrospectivos
13.
BMJ Case Rep ; 14(3)2021 Mar 29.
Artículo en Inglés | MEDLINE | ID: mdl-33782068

RESUMEN

A 65-year-old man presented to emergency department with progressive worsening dyspnoea, which was preceded by crushing, substernal chest pain 3 weeks prior that lasted for over 2 days. At the time the patient thought that this was a symptom of COVID-19 so he stayed at home and self-quarantined, until his symptoms worsened to the point of needing hospitalisation. The patient was found to have had myocardial infarction, with coronary angiography showing 100% occlusion of the Left Anterior Descending artery (LAD). Medical management was recommended given late presentation and risk of reperfusion injury.


Asunto(s)
Infarto del Miocardio/diagnóstico por imagen , Anciano , Dolor en el Pecho , Angiografía Coronaria , Vasos Coronarios/patología , Diagnóstico Tardío , Disnea/etiología , Hospitalización , Humanos , Masculino , Pandemias
14.
PLoS One ; 16(3): e0248920, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33765050

RESUMEN

BACKGROUND: Tests are scarce resources, especially in low and middle-income countries, and the optimization of testing programs during a pandemic is critical for the effectiveness of the disease control. Hence, we aim to use the combination of symptoms to build a predictive model as a screening tool to identify people and areas with a higher risk of SARS-CoV-2 infection to be prioritized for testing. MATERIALS AND METHODS: We performed a retrospective analysis of individuals registered in "Dados do Bem," a Brazilian app-based symptom tracker. We applied machine learning techniques and provided a SARS-CoV-2 infection risk map of Rio de Janeiro city. RESULTS: From April 28 to July 16, 2020, 337,435 individuals registered their symptoms through the app. Of these, 49,721 participants were tested for SARS-CoV-2 infection, being 5,888 (11.8%) positive. Among self-reported symptoms, loss of smell (OR[95%CI]: 4.6 [4.4-4.9]), fever (2.6 [2.5-2.8]), and shortness of breath (2.1 [1.6-2.7]) were independently associated with SARS-CoV-2 infection. Our final model obtained a competitive performance, with only 7% of false-negative users predicted as negatives (NPV = 0.93). The model was incorporated by the "Dados do Bem" app aiming to prioritize users for testing. We developed an external validation in the city of Rio de Janeiro. We found that the proportion of positive results increased significantly from 14.9% (before using our model) to 18.1% (after the model). CONCLUSIONS: Our results showed that the combination of symptoms might predict SARS-Cov-2 infection and, therefore, can be used as a tool by decision-makers to refine testing and disease control strategies.


Asunto(s)
/diagnóstico , Aprendizaje Automático , Adulto , Brasil , /virología , Disnea/etiología , Reacciones Falso Negativas , Reacciones Falso Positivas , Femenino , Fiebre/etiología , Humanos , Masculino , Persona de Mediana Edad , Aplicaciones Móviles , Sistema de Registros , Estudios Retrospectivos , Riesgo , Autoinforme
15.
Ned Tijdschr Geneeskd ; 1652021 02 04.
Artículo en Holandés | MEDLINE | ID: mdl-33651513

RESUMEN

We present a 30-year-old male, an 82-year-old male and a 71-year-old female who presented with fever, cough and dyspnea during de COVID-19 pandemic. Chest CT showed a ground-glass opacification and/or crazy paving. In all of these patients the PCR for SARS-CoV-2 was negative, but the COVID-19 pandemic caused a delay in diagnosis and treatment of these patients with big consequences for these patients. We show the risk of being fixated on COVID-19, the need for a careful examination respecting the medical history of the patient. Don't conclude too quickly on a CORADS-4 or 5, but do additional tests and consult other specialists when the PCR for SARS-CoV-2 is negative.


Asunto(s)
/métodos , Diagnóstico Tardío , Pulmón/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Adulto , Anciano , /fisiopatología , Toma de Decisiones Clínicas , Tos/diagnóstico , Tos/etiología , Diagnóstico Tardío/efectos adversos , Diagnóstico Tardío/prevención & control , Diagnóstico Diferencial , Disnea/diagnóstico , Disnea/etiología , Femenino , Fiebre/diagnóstico , Fiebre/etiología , Humanos , Masculino
16.
Kardiologiia ; 61(2): 62-68, 2021 Mar 06.
Artículo en Ruso, Inglés | MEDLINE | ID: mdl-33734048

RESUMEN

Aim      To determine diagnostic capabilities of the expanded protocol for stress echocardiography (stress-EchoCG) with comprehensive evaluation of clinical and echocardiographic indexes in differential diagnosis of dyspnea.Material and methods This study included 243 patients (123 women and 120 men) who were referred to outpatient stress-EchoCG during one calendar month. For 80 patients complaining about shortness of breath, the expanded stress-EchoCG protocol with treadmill exercise was performed. During the exercise, E / e' and tricuspid regurgitation velocity were determined, and clinical features and possible nature of dyspnea were evaluated.Results Shortness of breath had an ischemic origin in 17.5 % of 80 patients; 13.8 % had criteria of elevated left ventricular end-diastolic pressure; 17.5 % of patients had clinical signs of bronco-pulmonary pathology; 5.0 % had moderate and severe mitral regurgitation; 20 % displayed signs of chronotropic insufficiency during exercise including on the background of beta-blocker therapy; 15.0 % of patients displayed a hypertensive response to exercise, which was associated with signs of chronotropic insufficiency in 50 % of them; and 1.3 % had signs of hyperventilation syndrome. In addition to diagnosis of transient ischemia, additional information about the nature of shortness of breath was obtained for 72.5 % of patients. Based on results of the test, objective causes for dyspnea were not identified for 10.0 % of patients.Conclusion      The expanded stress-EchoCG protocol with exercise allows obtaining information about the nature of dyspnea for most patients with shortness of breath of a non-ischemic origin. For this patient category, expanding the stress-EchoCG protocol does not increase duration of the study and is economically beneficial for diagnosis of chronic heart failure and other causes for shortness of breath.


Asunto(s)
Ecocardiografía de Estrés , Esfuerzo Físico , Diástole , Disnea/diagnóstico , Disnea/etiología , Prueba de Esfuerzo , Femenino , Humanos , Masculino , Función Ventricular Izquierda
17.
PLoS One ; 16(3): e0248009, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33724987

RESUMEN

INTRODUCTION: Since the start of the pandemic, millions of people have been infected, with thousands of deaths. Many foci worldwide have been identified in retirement nursing homes, with a high number of deaths. Our study aims were to evaluate the spread of SARS-CoV-2 in the retirement nursing homes, the predictors to develop symptoms, and death. METHODS AND FINDINGS: We conducted a retrospective study enrolling all people living in retirement nursing homes (PLRNH), where at least one SARS-CoV-2 infected person was present. Medical and clinical data were collected. Variables were compared with Student's t-test or Pearson chi-square test as appropriate. Uni- and multivariate analyses were conducted to evaluate variables' influence on infection and symptoms development. Cox proportional-hazards model was used to evaluate 30 days mortality predictors, considering death as the dependent variable. We enrolled 382 subjects. The mean age was 81.15±10.97 years, and males were 140(36.7%). At the multivariate analysis, mental disorders, malignancies, and angiotensin II receptor blockers were predictors of SARS-CoV-2 infection while having a neurological syndrome was associated with a lower risk. Only half of the people with SARS-CoV-2 infection developed symptoms. Chronic obstructive pulmonary disease and neurological syndrome were correlated with an increased risk of developing SARS-CoV-2 related symptoms. Fifty-six (21.2%) people with SARS-CoV-2 infection died; of these, 53 died in the first 30 days after the swab's positivity. Significant factors associated with 30-days mortality were male gender, hypokinetic disease, and the presence of fever and dyspnea. Patients' autonomy and early heparin treatment were related to lower mortality risk. CONCLUSIONS: We evidenced factors associated with infection's risk and death in a setting with high mortality such as retirement nursing homes, that should be carefully considered in the management of PLRNH.


Asunto(s)
/patología , Anciano , Anciano de 80 o más Años , Antagonistas de Receptores de Angiotensina/administración & dosificación , /mortalidad , Disnea/etiología , Femenino , Fiebre/etiología , Heparina de Bajo-Peso-Molecular/uso terapéutico , Humanos , Masculino , Trastornos Mentales/complicaciones , Trastornos Mentales/patología , Neoplasias/complicaciones , Neoplasias/patología , Casas de Salud , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Factores de Riesgo , Factores Sexuales , Tasa de Supervivencia
18.
Harefuah ; 160(3): 144-147, 2021 Mar.
Artículo en Hebreo | MEDLINE | ID: mdl-33749175

RESUMEN

INTRODUCTION: One-sided diaphragmatic paralysis is a common phenomenon which is usually a-symptomatic. In case of acute onset or if there is an underlying lung disease, the phenomenon may be symptomatic and even limiting. In this article, we present a patient who arrived with subacute shortness of breath when lying down. She underwent thorough investigations but, as happens in most cases, the cause of the paralysis was not identified and it remains idiopathic. The authors present an overview of the etiology, differential diagnosis and treatment of diaphragmatic paralysis.


Asunto(s)
Parálisis Respiratoria , Diagnóstico Diferencial , Disnea/diagnóstico , Disnea/etiología , Femenino , Humanos , Parálisis Respiratoria/diagnóstico , Parálisis Respiratoria/etiología
19.
Medicine (Baltimore) ; 100(9): e24930, 2021 Mar 05.
Artículo en Inglés | MEDLINE | ID: mdl-33655957

RESUMEN

BACKGROUND: Rehabilitation training is beneficial for patients with chronic obstructive pulmonary disease (COPD). This study was aimed at evaluating the efficacy of muscle training on dyspnea. METHODS: We used 5 common databases for conducting a meta-analysis included PubMed, the Cochrane Library, Science Direct, Web of Science and Clinical Trials.gov, and eligible randomized controlled trials (RCTs) were included. The main results of include studies were dyspnea of patients who had a clinical diagnosis of COPD measured using Borg score and Medical Research Council (MRC) or modified Medical Research Council (mMRC) scale as the criteria before and after intervention. The intervention measures included respiratory or expiratory muscles or upper limb (UL) or lower limb (LL) training. The mean differences (MD) with the 95% confidence interval (CI) were considered for summary statistics. We also assessed risk of bias using the Cochrane collaboration's tool, and the value of I2 was applied to evaluate the heterogeneity of the trials. RESULTS: Fourteen RCTs with 18 interventions (n = 860 participants) were included. Muscle training significantly improved dyspnea during exercise and in the daily life of patients with COPD (MD, 95% CI: -0.58, -0.84 to -0.32, P  < .0001 and -0.44, -0.65 to -0.24, P  < .0001, respectively). In the subgroup analyses, the trials that used respiratory muscle and UL trainings significantly improved dyspnea during exercise (MD, 95% CI: -0.72, -1.13 to -0.31, P = .0005 and -0.53, -0.91 to -0.15, P = .007, respectively). The studies also showed that the participants in the rehabilitation group, who received respiratory muscle and UL trainings, had a significant improvement of dyspnea in daily life (MD, 95% CI: -0.38, -0.67 to -0.09, P = .01 and -0.51, -0.80 to -0.22, P = .0007, respectively). CONCLUSION: There were some limitations that most of the subjects in this study were patients with moderate to severe COPD and were male, and the training period and duration were different. The analyses revealed that respiratory muscle and UL trainings can improve dyspnea in patients with COPD during exercise and in daily life.


Asunto(s)
Disnea/rehabilitación , Tolerancia al Ejercicio/fisiología , Espiración/fisiología , Modalidades de Fisioterapia , Enfermedad Pulmonar Obstructiva Crónica/rehabilitación , Ensayos Clínicos Controlados Aleatorios como Asunto , Músculos Respiratorios/fisiopatología , Disnea/etiología , Disnea/fisiopatología , Humanos , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Calidad de Vida
20.
Medicine (Baltimore) ; 100(6): e24027, 2021 Feb 12.
Artículo en Inglés | MEDLINE | ID: mdl-33578518

RESUMEN

RATIONALE: Sarcoidosis is a multisystem granulomatous disease with unknown etiology. It affects mainly the lungs, but it can affect almost any other organ. Nevertheless, pleural involvement with the development of pleural effusion is relatively rare. It is usually mild and responsive to treatment with systemic steroids. Here we present a case of rapidly recurring massive unilateral pleural effusion caused by sarcoidosis that was resistant to systemic steroids. PATIENT CONCERNS: A 55-year-old lady presented with shortness of breath of 2-months duration. No other respiratory symptoms were reported. On physical examination, there were signs of left-sided pleural effusion, splenomegaly, and inguinal lymph nodes. These findings were confirmed by chest x-ray showing massive pleural effusion. Work up of the effusion revealed an exudative effusion with lymphocyte predominance. Pan-computed tomography scan revealed multiple thoracic, abdominal and inguinal lymphadenopathy; additionally, a left-sided pleural effusion and an enlarged spleen; that contained variable hypodense nodular lesions. Positron emission tomography-computed tomography showed intense uptake in the spleen and the lymph nodes. Inguinal lymph node biopsy showed non-necrotizing granulomatous inflammation. Due to suspicion of malignancy, left medical thoracoscopy was done, and biopsy of the parietal pleura showed nonspecific inflammation without evidence of malignancy or tuberculosis. DIAGNOSIS: Sarcoidosis was diagnosed based on the finding of the non-necrotizing granulomatous inflammation with no evidence of malignancy or infection on several microbiological and pathological samples. INTERVENTIONS: The patient was treated with repeated pleural fluid drainage. Steroids failed to prevent pleural effusion recurrence. Surgical left side pleurodesis was eventually performed. OUTCOMES: At more than 1 year follow up, the patient showed no recurrence of pleural effusion or development of any other symptoms. LESSONS: Sarcoidosis may rarely present with massive pleural effusion, as this presentation is rare; it is imperative to rule out other causes of massive pleural effusion. Massive pleural effusion in sarcoidosis may be steroid-resistant. Pleurodesis may have a role in such a scenario.


Asunto(s)
Derrame Pleural/etiología , Sarcoidosis/complicaciones , Sarcoidosis/patología , Biopsia , Drenaje/métodos , Disnea/etiología , Exudados y Transudados/citología , Femenino , Humanos , Linfadenopatía/diagnóstico por imagen , Linfadenopatía/etiología , Linfadenopatía/patología , Persona de Mediana Edad , Pleura/cirugía , Derrame Pleural/cirugía , Pleurodesia/métodos , Tomografía Computarizada por Tomografía de Emisión de Positrones/métodos , Radiografía Torácica/métodos , Recurrencia , Sarcoidosis/diagnóstico por imagen , Toracoscopía/métodos , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento
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