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1.
Einstein (Sao Paulo) ; 18: eAO5262, 2020.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-32130328

RESUMEN

OBJECTIVE: To compare the frequency of respiratory tract infections in children treated with OM-85 BV and placebo during the 3-month therapy period, and observation for a further 3 months after treatment. METHODS: A randomized, double-blind, placebo-controlled trial was conducted with 54 children (6 months to 5 years old) with no past history of recurrent respiratory infections attending daycare center. Family members were instructed to administer one capsule per day for 10 consecutive days, for 3 months of OM-85 BV or placebo. Telephone interviews were conducted every 30 days. RESULTS: There was no significant difference in the number of respiratory infections between the groups. The mean number of respiratory tract infection in the OM-85 BV Group in the first 3 months was 0.92±0.87, and in the Placebo Group was 0.74±1.02, and at 6 months it was 1.62±1.47 and 1.03±1.34, respectively. CONCLUSION: OM-85 BV was not effective in the primary prevention of respiratory tract infections. Although most authors recommend the use of this immunostimulant in children with a history of recurrent respiratory infections, more studies are needed to define its usefulness in the primary prevention of respiratory infections in healthy children exposed to few risk factors.


Asunto(s)
Adyuvantes Inmunológicos/uso terapéutico , Extractos Celulares/uso terapéutico , Prevención Primaria/métodos , Lactancia Materna , Jardines Infantiles , Preescolar , Método Doble Ciego , Femenino , Humanos , Lactante , Masculino , Proyectos Piloto , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Contaminación por Humo de Tabaco , Resultado del Tratamiento
2.
J Integr Med ; 18(2): 152-158, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-32113846

RESUMEN

OBJECTIVE: In this study we execute a rational screen to identify Chinese medical herbs that are commonly used in treating viral respiratory infections and also contain compounds that might directly inhibit 2019 novel coronavirus (2019-nCoV), an ongoing novel coronavirus that causes pneumonia. METHODS: There were two main steps in the screening process. In the first step we conducted a literature search for natural compounds that had been biologically confirmed as against sever acute respiratory syndrome coronavirus or Middle East respiratory syndrome coronavirus. Resulting compounds were cross-checked for listing in the Traditional Chinese Medicine Systems Pharmacology Database. Compounds meeting both requirements were subjected to absorption, distribution, metabolism and excretion (ADME) evaluation to verify that oral administration would be effective. Next, a docking analysis was used to test whether the compound had the potential for direct 2019-nCoV protein interaction. In the second step we searched Chinese herbal databases to identify plants containing the selected compounds. Plants containing 2 or more of the compounds identified in our screen were then checked against the catalogue for classic herbal usage. Finally, network pharmacology analysis was used to predict the general in vivo effects of each selected herb. RESULTS: Of the natural compounds screened, 13 that exist in traditional Chinese medicines were also found to have potential anti-2019-nCoV activity. Further, 125 Chinese herbs were found to contain 2 or more of these 13 compounds. Of these 125 herbs, 26 are classically catalogued as treating viral respiratory infections. Network pharmacology analysis predicted that the general in vivo roles of these 26 herbal plants were related to regulating viral infection, immune/inflammation reactions and hypoxia response. CONCLUSION: Chinese herbal treatments classically used for treating viral respiratory infection might contain direct anti-2019-nCoV compounds.


Asunto(s)
Infecciones por Coronavirus/tratamiento farmacológico , Medicamentos Herbarios Chinos/uso terapéutico , Neumonía Viral/tratamiento farmacológico , Descubrimiento de Drogas , Evaluación Preclínica de Medicamentos , Medicamentos Herbarios Chinos/farmacología , Humanos , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Virosis/tratamiento farmacológico
3.
J Zoo Wildl Med ; 50(4): 1012-1015, 2020 Jan 09.
Artículo en Inglés | MEDLINE | ID: mdl-31926539

RESUMEN

Adenoviruses have been reported to affect a broad range of host species, tend to be species specific, and often affect the respiratory system. This report describes the isolation of an adenovirus from deep nasal swabs of two wild North American porcupines (Erethizon dorsatum) with respiratory diseases that presented to a wildlife hospital. Partial sequences of the deoxyribonucleic acid polymerase gene of the isolated virus were identical to skunk adenovirus (SkAdV-1), also known as pygmy marmoset adenovirus. Both porcupines survived and were released back to the wild after successful medical treatment and rehabilitation. The significance of the adenovirus isolated from these porcupines is unknown; however, this is the first report of an adenovirus in porcupines, and the first report of SkAdV-1 in a rodent.


Asunto(s)
Infecciones por Adenoviridae/veterinaria , Adenoviridae/clasificación , Puercoespines , Infecciones del Sistema Respiratorio/veterinaria , Adenoviridae/aislamiento & purificación , Infecciones por Adenoviridae/tratamiento farmacológico , Infecciones por Adenoviridae/virología , Animales , Antibacterianos/uso terapéutico , Azitromicina/uso terapéutico , Broncodilatadores/uso terapéutico , Enrofloxacina/uso terapéutico , Masculino , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Infecciones del Sistema Respiratorio/virología , Terbutalina/uso terapéutico
5.
Int J Antimicrob Agents ; 55(3): 105883, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31923574

RESUMEN

The aim of this study was to investigate the susceptibility of respiratory Gram-negative bacteria to ceftolozane/tazobactam and other antibiotics in the Asia-Pacific region during 2015-2016. MICs were determined using the CLSI standard broth microdilution method and interpreted accordingly. Pseudomonas aeruginosa (1574 isolates), Klebsiella pneumoniae (1226), Acinetobacter baumannii (627) and Escherichia coli (476) accounted for 73.1% of 5342 Gram-negative respiratory pathogens. Susceptibility to ceftolozane/tazobactam of individual Enterobacteriaceae was >80%, except for Enterobacter cloacae (76.6%). Ceftolozane/tazobactam inhibited 81.9% of K. pneumoniae and 91.9% of E. coli, with respective MIC50/MIC90 values of 0.5/>32 and 0.25/2 mg/L. For carbapenem-susceptible, ESBL-producing K. pneumoniae and E. coli, susceptibility was 65.5% and 93.3%, respectively, and respective MIC50/MIC90 values were 2/>32 and 0.5/2 mg/L. BlaCTX-M-1 group was most prevalent in selected ESBL-producing K. pneumoniae (40 of 54 isolates) and E. coli (15 of 22 isolates), with ceftolozane/tazobactam susceptibility rates of 50% and 80%, respectively. BlaSHV-ESBL was the second most prevalent, and ceftolozane/tazobactam inhibited 20% of 20 K. pneumoniae isolates with blaSHV-ESBL. The only effective antibiotics for carbapenem-non-susceptible K. pneumoniae (111 isolates) and E. coli (24 isolates) were amikacin and colistin. Ceftolozane/tazobactam was effective against almost all tested P. aeruginosa and carbapenem-non-susceptible strains, with susceptibility of 92.3% and 72.8%, respectively; the respective MIC50/MIC90 values were 1/4 and 2/>32 mg/L. The high susceptibility of ceftolozane/tazobactam remained in different age groups, patient locations, recovery times and countries, except Vietnam. In conclusion, ceftolozane/tazobactam was effective against most respiratory Gram-negative pathogens in the Asia-Pacific region; however, the emergence of carbapenem resistance mandates ongoing surveillance.


Asunto(s)
Antibacterianos/farmacología , Cefalosporinas/farmacología , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Tazobactam/farmacología , Antibacterianos/uso terapéutico , Asia , Cefalosporinas/uso terapéutico , Enterobacteriaceae/efectos de los fármacos , Escherichia coli/efectos de los fármacos , Infecciones por Bacterias Gramnegativas/microbiología , Humanos , Klebsiella pneumoniae/efectos de los fármacos , Pseudomonas aeruginosa/efectos de los fármacos , Infecciones del Sistema Respiratorio/microbiología , Tazobactam/uso terapéutico
6.
Int J Antimicrob Agents ; 55(3): 105887, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31926283

RESUMEN

The STEP surveillance study was designed to increase knowledge about distribution of multidrug-resistant (MDR) Enterobacterales and Pseudomonas aeruginosa in Portugal, focusing on the intensive care unit (ICU). Antimicrobial susceptibility of common agents was also evaluated and compared with that of one of the latest therapeutic introductions, ceftolozane-tazobactam (C/T). Clinical isolates of Enterobacterales (n=426) and P. aeruginosa (n=396) from patients admitted in Portuguese ICUs were included. Activity of C/T and comparators was investigated using standard broth microdilution. Isolates were recovered from urinary tract (UTI, 36.9%), intra-abdominal (IAI, 24.2%) and lower respiratory tract (LRTI, 38.9%) infections. In P. aeruginosa, overall distribution of MDR/extremely-drug resistant (XDR)/pan-drug resistant (PDR) isolates accounted for 21.2%, 23.2% and 0.8%, respectively. C/T was the most potent agent tested against P. aeruginosa and MDR/XDR/PDR phenotypes. In Escherichia coli, extended-spectrum beta-lactamases (ESBL) and carbapenemase (CP) phenotypes accounted for 16.6% and 1.7%, respectively, whereas in Klebsiella spp., ESBL and CP-phenotypes represented 28.5% and 17.9%, respectively. Overall, susceptibility of C/T against Enterobacterales was 86.9%. C/T was the least affected agent in E. coli (99.4% susceptibility), whereas its activity was moderate in Klebsiella spp. (71.5%) and Enterobacter spp. (70.4%), due in part to a high rate of ESBL and CP-phenotypes. In Enterobacterales, blaKPC was the most prevalent CP gene (63.0%), followed by blaOXA-48 (33.3%) and blaVIM (3.7%). These microbiological results reinforce C/T as a therapeutic option in ICU patients with UTI, IAI or LRTI due to P. aeruginosa or Enterobacterales isolates, but not for CP producers.


Asunto(s)
Antibacterianos/farmacología , Cefalosporinas/farmacología , Infecciones por Enterobacteriaceae/tratamiento farmacológico , Enterobacteriaceae/efectos de los fármacos , Infecciones Intraabdominales/tratamiento farmacológico , Infecciones por Pseudomonas/tratamiento farmacológico , Pseudomonas aeruginosa/efectos de los fármacos , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Tazobactam/farmacología , Infecciones Urinarias/tratamiento farmacológico , Antibacterianos/uso terapéutico , Cefalosporinas/uso terapéutico , Farmacorresistencia Bacteriana Múltiple/efectos de los fármacos , Infecciones por Enterobacteriaceae/microbiología , Humanos , Unidades de Cuidados Intensivos , Portugal , Infecciones por Pseudomonas/microbiología , Tazobactam/uso terapéutico
7.
Medicine (Baltimore) ; 99(2): e18714, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31914082

RESUMEN

To investigate the situation of antibiotic consumption and to assess the inappropriate use on pediatric inpatients of different types hospitals in Sichuan, China.A cross-sectional survey of antibiotic prescriptions among hospitalized children aged 1month -14years were conducted from April 2018 to June 2018 in southwestern China. Antibiotic prescriptions were extracted from electronic records during hospitalization of each inpatient in five different types hospitals.In this study, the antibiotic prescription rate of hospitalized children was 66.9% (1176/1758). Compared with tertiary children hospital (TC) (46.1%), general hospitals and non-tertiary children hospitals has higher rate of antibiotic prescription (almost 85%) (P < .001). 93.4% of inpatients received parenteral antibiotic. Overall, the most common antibiotics were Cefoperazone and enzyme inhibitor, Cefixime and Azithromycin. Lower respiratory tract infection (LRTI) was the leading reason for antibiotic consumption in pediatric wards (56.8%), followed by upper respiratory tract infection (URTI) (22.2%). For children with LRTI, Cephalosporins were heavy prescribed, especially broad-spectrum third-generation Cephalosporins (60.3%). The antibiotic prescription proportion of URTI in general hospitals and non-tertiary children hospitals (more than 18%) was higher than TC (8.1%) (P < .001).There was inappropriate use of antibiotic in hospitalized children including overuse of parenteral administration, overprescribing of antibiotic on URTI and misuse of third-generation Cephalosporins in pediatric inpatients with LRTI. Compared with tertiary freestanding children hospital, the irrational antibiotic prescription of general hospitals and non-tertiary children hospitals were more serious. Management strategy should be implementer on quality improvement of antibiotic use.


Asunto(s)
Antibacterianos/uso terapéutico , Utilización de Medicamentos/estadística & datos numéricos , Hospitales/estadística & datos numéricos , Prescripción Inadecuada/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Adolescente , Antibacterianos/administración & dosificación , Niño , Niño Hospitalizado , Preescolar , China , Estudios Transversales , Femenino , Hospitales Pediátricos/estadística & datos numéricos , Humanos , Lactante , Masculino , Infecciones del Sistema Respiratorio/tratamiento farmacológico
8.
Biomed Chromatogr ; 34(1): e4699, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31524294

RESUMEN

In this study, we developed and validated two reliable high-performance liquid chromatography (HPLC) methods for the qualitative detection of six oral ß-lactams, which are commonly used in pediatric patients with acute respiratory infections (ARIs). Two distinct reverse-phase chromatographic separations of six ß-lactams were obtained. Four ß-lactams (cefadroxil, cephalexin, cefaclor and cefixime) in urine were separated using a gradient program with a mobile phase consisting of K2 HPO4 buffer (20 mm, pH 2.8) and acetonitrile on a LichroCART 250 × 4.6 mm, Purospher STAR C18 end-capped (5 µm) column. Two remained ß-lactams (amoxicillin and cefuroxime) were analyzed using a gradient elution with the mobile phase containing K2 HPO4 buffer (20 mm, pH 3.0) and acetonitrile on a LichroCart® Purospher Star C8 end-capped column (5 µm, 125 × 4.6 mm). Good linearity within the range of 0.3-30 µg/ml for cefadroxil, cephalexin, cefaclor and cefixime, and 0.2-20 µg/ml for amoxicillin and cefuroxime, was attained. The precisions were <14%. The accuracies ranged from 85.87 to 102.8%. The two validated methods were then applied to determine these six antibiotics in 553 urine samples of pediatric patients with ARIs. As a result, 32.2% were positive with one or more of six tested ß-lactams. Cefixime was the most commonly detected agent, accounting for 9.8% of enrolled patients.


Asunto(s)
Cromatografía Líquida de Alta Presión/métodos , Infecciones del Sistema Respiratorio/tratamiento farmacológico , beta-Lactamas/orina , Enfermedad Aguda , Adolescente , Niño , Preescolar , Cromatografía de Fase Inversa/métodos , Humanos , Lactante , Recién Nacido , Límite de Detección , Modelos Lineales , Uso Excesivo de Medicamentos Recetados , Reproducibilidad de los Resultados , beta-Lactamas/uso terapéutico
9.
BMC Complement Altern Med ; 19(1): 353, 2019 Dec 05.
Artículo en Inglés | MEDLINE | ID: mdl-31806007

RESUMEN

BACKGROUND: Plants have been used as a primary source of medicine since ancient times and about 80% of the world's population use herbal medicine to treat different ailments. Plant use knowledge differs in space and time and thus requires documentation to avoid its loss from one generation to another. METHODS: In order to accomplish the survey, semi-structured questionnaires were used. The data collected included names of plant species, parts used, ailments treated, growth habit, methods of preparation and mode of administration of the herbal remedies. Descriptive statistics were used to present the data in form of tables and a graph. RESULTS: Results showed that 50 plant species belonging to 26 families were utilized in the treatment of paediatric diseases of which Asteraceae and Lamiaceae were the most common. Leaves (80%) were the most commonly used and decoctions were the main method of preparation. Twenty nine health conditions were treated out of which digestive disorders, malaria and respiratory tract infections were predominant. Herbs and shrubs were equally dominant. CONCLUSION: Herbal remedies are an important source of treatment for paediatric diseases in Buhunga Parish. However, there is need for collaboration between herbal medicine users and scientific institutions to help in the discovery of new drugs based on indigenous knowledge. Scientists ought to explore suitable methods of preparation and dosage formulations in order to achieve the best benefits from herbal remedies.


Asunto(s)
Etnofarmacología , Medicina Tradicional Africana , Preparaciones de Plantas/uso terapéutico , Plantas Medicinales , Niño , Enfermedades del Sistema Digestivo/tratamiento farmacológico , Femenino , Humanos , Malaria/tratamiento farmacológico , Masculino , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Uganda/etnología
10.
Zhongguo Zhong Yao Za Zhi ; 44(20): 4379-4386, 2019 Oct.
Artículo en Chino | MEDLINE | ID: mdl-31872622

RESUMEN

To evaluate the effectiveness and safety of Yupingfeng Granules in the treatment of recurrent respiratory tract infection.Six Chinese and English databases were retrieved,namely CNKI,Wan Fang,VIP,CBM,PubMed and Cochrane Library. Randomized controlled trials of Yupingfeng Granules in the treatment of recurrent respiratory tract infection were collected and screened. According to the evaluation criteria and tools of Cochrane,the heterogeneity among the studies was analyzed,and the Meta-analysis was carried out by Rev Man 5.3 software. A total of 16 studies were included in this study,with a total sample size of 1 788 cases,including 901 cases in the experimental group and 887 cases in the control group. Among them,11 intervention measures were Yupingfeng Granules combined with Western medicine routine vs routine Western medicine,and 5 research interventions were Yupingfeng Granules combined with pidomod vs pidomod based on routine therapy. Meta-analysis showed that the total effective rate of Yupingfeng Granules combined with Western medicine in the treatment of recurrent respiratory tract infection was better than that of Western medicine( RR= 1. 27,95%CI[1. 21,1. 34],P<0. 000 01). Based on the routine therapy,the total effective rate of Yupingfeng Granules combined with pidomod in the treatment of recurrent respiratory tract infection was better than that of pidomod( RR = 1. 23,95% CI[1. 13,1. 35],P<0. 000 01). A total of 21 cases of adverse events were reported in this study,including 6 cases in the experimental groups combined with traditional Yupingfeng Granules therapy and conventional Western medicine therapy and 15 in the control group. The adverse events were mainly gastrointestinal reactions,such as fatigue,nausea and diarrhea,which can tolerate or disappear with no impact on treatment. The incidence of adverse events in the two groups was not statistically significant( RR = 0. 44,95% CI[0. 19,1. 03],P = 0. 06). The results showed no significant difference in the incidence of adverse events between the two groups during treatment. Based on the routine therapy,no adverse event was reported in Yupingfeng Granules pidomod vs pidomod,indicating that both groups were safe. The analysis showed that Yupingfeng Granules combined with routine Western medicine therapy or combined with pidomod could increase the level of immunoglobulin and T lymphocytes in children. Based on the existing data and methods,Yupingfeng Granules combined with routine Western medicine therapy for recurrent respiratory tract infection can improve the total effective rate,immune function and body immunity,with no serious adverse reaction. However,because of the low quality of the literatures included in this study,it is still necessary to adopt well-designed large-sample clinical trials in conformity to international standards to improve the quality of evidence.


Asunto(s)
Medicamentos Herbarios Chinos/uso terapéutico , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Niño , Humanos , Masculino
11.
Parasit Vectors ; 12(1): 519, 2019 Nov 04.
Artículo en Inglés | MEDLINE | ID: mdl-31685011

RESUMEN

BACKGROUND: Troglostrongylus brevior is a lungworm of wild felids that recently has been recognized as agent of severe respiratory disease in domestic cats in Mediterranean and Balkan countries. Nevertheless, the information on treatment options for feline troglostrongylosis is still poor. The aim of this pilot field trial was to evaluate the efficacy of the spot-on formulation containing 1% w/v moxidectin and 10% w/v imidacloprid (Advocate® spot-on solution for cats, Bayer Animal Health GmbH) in the treatment of T. brevior infection in naturally infected cats in Greece. METHODS: The trial was a negative control, multicentre, clinical efficacy study conducted according to the standards of Good Scientific Practice (GSP). Sixteen cats in two study sites, naturally infected with T. brevior, were allocated to an untreated control group (G1, n = 8) or a treatment group (G2, n = 8), according to a randomization list. Animals assigned to G2 were treated with Advocate® for cats on days 0 and 28 at the recommended dose rate and animals assigned to G1 received a rescue treatment with the same product on days 56 and 84. Efficacy was assessed on days 28 and 56 in G2 and on days 84 and 112 in G1 by faecal larval counts. The primary efficacy criterion was the absence of T. brevior first-stage larvae (L1) following treatment. Other efficacy parameters were the quantitative comparison of L1 presence before (baseline) and after one or two treatments in both groups. RESULTS: All G2 cats were negative for T. brevior L1 at the first post-treatment evaluation (100% efficacy) while G1 cats were persistently shedding L1. The difference of the mean number of L1 per gram between G2 and G1 was statistically significant (P < 0.001). All G1 cats were negative (100% efficacy) for T. brevior L1 at the first post-rescue-treatment evaluation. Therefore, treatment efficacy at study completion was 100% in both groups in terms of stopping the L1 shedding in the faeces of the animals. No adverse effects were observed during the study. CONCLUSIONS: These results indicate that Advocate® spot-on solution for cats represents an option for treating cats naturally infected with T. brevior.


Asunto(s)
Enfermedades de los Gatos/tratamiento farmacológico , Macrólidos/uso terapéutico , Metastrongyloidea/efectos de los fármacos , Neonicotinoides/uso terapéutico , Nitrocompuestos/uso terapéutico , Infecciones del Sistema Respiratorio/veterinaria , Infecciones por Strongylida/veterinaria , Animales , Enfermedades de los Gatos/parasitología , Gatos , Combinación de Medicamentos , Heces/parasitología , Femenino , Grecia , Larva/efectos de los fármacos , Masculino , Metastrongyloidea/aislamiento & purificación , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Infecciones del Sistema Respiratorio/parasitología , Infecciones por Strongylida/tratamiento farmacológico , Infecciones por Strongylida/parasitología
12.
FP Essent ; 486: 11-18, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31710453

RESUMEN

Upper respiratory tract infections (URTIs) include the common cold, rhinosinusitis, pharyngitis, and acute otitis media (AOM). URTIs account for billions of dollars in annual health care costs; acute respiratory tract infections are the most common reason for acute care appointments. Although URTIs typically are viral, these infections are the most common reason for prescription of antibiotics in adults. Recommended therapy for the common cold involves symptom management with over-the-counter drugs, though the Food and Drug Administration advises against use of these drugs in children younger than 6 years. Acute rhinosinusitis also typically is viral. A bacterial etiology is more likely if symptoms last longer than 10 days, the temperature is greater than 39°C (102.2°F), or if symptoms worsen after initial improvement. Antibiotics are not recommended unless symptoms worsen or do not improve after an additional 7 days. Acute pharyngitis also typically is of viral origin. Antibiotics for streptococcal pharyngitis should be prescribed only if test or culture results are positive. AOM can be managed without antibiotics except in children younger than 6 months, children ages 6 to 23 months with bilateral AOM, children older than 2 years with bilateral AOM and otorrhea, and certain high-risk patients.


Asunto(s)
Otitis Media , Faringitis , Infecciones del Sistema Respiratorio , Rinitis , Sinusitis , Enfermedad Aguda , Adulto , Antibacterianos/uso terapéutico , Niño , Humanos , Lactante , Otitis Media/diagnóstico , Otitis Media/tratamiento farmacológico , Infecciones del Sistema Respiratorio/diagnóstico , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Rinitis/diagnóstico , Rinitis/tratamiento farmacológico , Sinusitis/diagnóstico , Sinusitis/tratamiento farmacológico
13.
FP Essent ; 486: 19-25, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31710454

RESUMEN

Acute bronchitis and pneumonia are conditions commonly diagnosed in inpatient and outpatient settings. Acute bronchitis is a lower respiratory tract infection characterized by cough, with or without sputum production, lasting 1 to 3 weeks. It typically is viral. Testing for influenza should be obtained in patients at high risk of influenza complications. Antibiotics are not indicated in patients without chronic lung disease unless Bordetella pertussis infection is suspected. If pertussis is confirmed, macrolide antibiotics should be prescribed. Otherwise, symptom control and patient education are key to management. Community-acquired pneumonia (CAP) is a leading cause of death in children and adults. Diagnosis is based on symptoms and imaging study results. Ultrasonography is more accurate than chest x-rays. Severity scoring systems are used to aid clinical judgement in selecting inpatient versus outpatient management. Antibiotics should be administered according to current guidelines. Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) are nosocomial infections with high mortality rates. Microorganisms responsible for HAP and VAP have high rates of resistance and vary based on geographic regions. Implementation of prevention protocols has decreased rates of VAP.


Asunto(s)
Infección Hospitalaria , Gripe Humana , Neumonía Asociada al Ventilador , Infecciones del Sistema Respiratorio , Adulto , Antibacterianos/uso terapéutico , Niño , Humanos , Gripe Humana/diagnóstico , Infecciones del Sistema Respiratorio/diagnóstico , Infecciones del Sistema Respiratorio/tratamiento farmacológico
14.
BMC Infect Dis ; 19(1): 976, 2019 Nov 20.
Artículo en Inglés | MEDLINE | ID: mdl-31747890

RESUMEN

BACKGROUND: Diagnosing pneumonia can be challenging in general practice but is essential to distinguish from other respiratory tract infections because of treatment choice and outcome prediction. We determined predictive signs, symptoms and biomarkers for the presence of pneumonia in patients with acute respiratory tract infection in primary care. METHODS: From March 2012 until May 2016 we did a prospective observational cohort study in three radiology departments in the Leiden-The Hague area, The Netherlands. From adult patients we collected clinical characteristics and biomarkers, chest X ray results and outcome. To assess the predictive value of C-reactive protein (CRP), procalcitonin and midregional pro-adrenomedullin for pneumonia, univariate and multivariate binary logistic regression were used to determine risk factors and to develop a prediction model. RESULTS: Two hundred forty-nine patients were included of whom 30 (12%) displayed a consolidation on chest X ray. Absence of runny nose and whether or not a patient felt ill were independent predictors for pneumonia. CRP predicts pneumonia better than the other biomarkers but adding CRP to the clinical model did not improve classification (- 4%); however, CRP helped guidance of the decision which patients should be given antibiotics. CONCLUSIONS: Adding CRP measurements to a clinical model in selected patients with an acute respiratory infection does not improve prediction of pneumonia, but does help in giving guidance on which patients to treat with antibiotics. Our findings put the use of biomarkers and chest X ray in diagnosing pneumonia and for treatment decisions into some perspective for general practitioners.


Asunto(s)
Biomarcadores/análisis , Neumonía/diagnóstico , Infecciones del Sistema Respiratorio/diagnóstico , Adulto , Anciano , Antibacterianos/uso terapéutico , Proteína C-Reactiva/análisis , Calcitonina/análisis , Femenino , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Países Bajos , Neumonía/complicaciones , Neumonía/tratamiento farmacológico , Atención Primaria de Salud , Pronóstico , Estudios Prospectivos , Infecciones del Sistema Respiratorio/complicaciones , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Tórax/diagnóstico por imagen
15.
J Biochem Mol Toxicol ; 33(12): e22407, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31581362

RESUMEN

In this study, we investigated the effects of certain respiratory drugs, which are mainly used on human serum paraoxonase-1 (hPON1; EC 3.1.8.1). hPON1 was purified from human serum, with 354.91 fold and 45% yield by using two simple step procedures including, first, ammonium sulfate precipitation, then, Sepharose-4B-l-tyrosine-1-naphthylamine hydrophobic interaction chromatography. SDS-polyacrylamide gel electrophoresis showed a single protein band belonging to hPON1 with 43 kDa. All the pharmaceutical compounds inhibited the PON1 enzyme highly at the micromolar level. The obtained IC50 values for nine different pharmaceutics ranged from 0.219 µM (salbutamol sulfate) to 67.205 µM (montelukast sodium). So, all drugs could be considered as potent hPON1 inhibitors. Ki values and inhibition types were determined by Lineweaver-Burk graphs. While varenicline tartrate and moxifloxacin hydrochloride inhibited the enzyme in a noncompetitive manner, others inhibited it in a mixed manner.


Asunto(s)
Arildialquilfosfatasa/química , Arildialquilfosfatasa/aislamiento & purificación , Broncodilatadores/química , Inhibidores Enzimáticos/química , Suero/enzimología , Arildialquilfosfatasa/antagonistas & inhibidores , Broncodilatadores/efectos adversos , Broncodilatadores/uso terapéutico , Cromatografía en Gel/métodos , Electroforesis en Gel de Poliacrilamida , Inhibidores Enzimáticos/efectos adversos , Inhibidores Enzimáticos/uso terapéutico , Humanos , Interacciones Hidrofóbicas e Hidrofílicas , Infecciones del Sistema Respiratorio/tratamiento farmacológico
16.
Medicine (Baltimore) ; 98(41): e17535, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31593129

RESUMEN

Scedosporium genus as a significant emerging opportunist causes a broad spectrum of disease in not only immunosuppressed but also immunocompetent patients. The lung is one of the most commonly encountered sites of Scedosporium infection. Due to its very high levels of antifungal resistance, surgery has been recommended as an important part in the treatment of pulmonary Scedosporium spp infection, even in immunocompetent cases. However, whether lung surgery could help to reduce the risk of death in immunocompetent patients is not clear.We retrospectively retrieved the records of pulmonary infections with Scedosporium species in immunocompetent patients through a comprehensive literature search. The association of surgery on all-cause mortality was explored using binary logistic regression (BLR). Receiver operating characteristic (ROC) curve analysis was carried out to evaluate the capability of the model.The comprehensive searching strategy yielded 33 case reports and 3 case series in total, with 40 individual patients being included. The overall mortality was 12.50%. The fatality rate was 9.09% (2/22) in cases with surgery and 16.67% (3/18) in cases without surgery (odds ratio, 0.50; 95% confidence interval, 0.07-3.38; P = .48). Consistently, BLR analysis identified no statistical association between surgery and reduced mortality (odds ratio, 1.19; 95% confidence interval, 0.09-15.64; P = .89), after adjusting for age, gender, and antifungal chemotherapy. The area under the ROC curve was 0.88.For immunocompetent patients with pulmonary Scedosporium spp infection, surgical therapy may not be associated with reduced mortality. Surgical excision could be considered but is not imperative in this group of patients.


Asunto(s)
Enfermedades Pulmonares Fúngicas/tratamiento farmacológico , Enfermedades Pulmonares Fúngicas/cirugía , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Infecciones del Sistema Respiratorio/cirugía , Scedosporium/efectos de los fármacos , Adulto , Anciano , Anciano de 80 o más Años , Antifúngicos/uso terapéutico , Farmacorresistencia Fúngica/fisiología , Femenino , Humanos , Huésped Inmunocomprometido/efectos de los fármacos , Enfermedades Pulmonares Fúngicas/microbiología , Enfermedades Pulmonares Fúngicas/mortalidad , Masculino , Persona de Mediana Edad , Mortalidad/tendencias , Micosis/tratamiento farmacológico , Micosis/epidemiología , Micosis/microbiología , Micosis/mortalidad , Estudios Observacionales como Asunto , Cuidados Posoperatorios , Infecciones del Sistema Respiratorio/microbiología , Infecciones del Sistema Respiratorio/mortalidad , Estudios Retrospectivos , Scedosporium/aislamiento & purificación , Voriconazol/administración & dosificación , Voriconazol/uso terapéutico
17.
BMC Infect Dis ; 19(1): 862, 2019 Oct 17.
Artículo en Inglés | MEDLINE | ID: mdl-31623573

RESUMEN

BACKGROUND: Idiopathic CD4 lymphocytopenia (ICL) is a rare clinical disease with relative CD4 deficiency in the absence of HIV infection. The pathogenicity of ICL is poorly understood with an unclear incidence rate in the general population. Sequelae of ICL includes AIDS-defining infections, which most commonly includes Cryptococcus neoformans. Typically, C. neoformans infections present with CNS involvement but rarely with extra-CNS manifestations. Here, we present a rare case of ICL with exclusively primary pulmonary cryptococcus and a review of the literature. CASE PRESENTATION: A 56-year-old female presented to our tertiary care hospital requiring a right hip open reduction intervention. The patient became febrile during admission, prompting a work-up that included a chest X-ray showing a peripheral pulmonary solitary nodule. Transthoracic biopsy revealed encapsulated yeast forms in keeping with C. neoformans. CD4 counts, repeated at least one month apart, were < 200 cells/mm3, with negative HIV testing. Flow cytometry and genetic testing were completed to elucidate the etiology of the immune deficiency, both of which were unremarkable. She was subsequently treated with 12 months of posaconazole with clinical resolution. CONCLUSIONS: Our patient highlights a rare clinical disease, which a review of literature revealed only five cases in the literature with exclusive pulmonary Cryptococcus in ICL/ This case demonstrates the strong clinical acumen required to properly diagnose and ultimately manage the patient.


Asunto(s)
Criptococosis/diagnóstico , Cryptococcus neoformans/aislamiento & purificación , Linfopenia/diagnóstico , Infecciones del Sistema Respiratorio/diagnóstico , Antifúngicos/uso terapéutico , Recuento de Linfocito CD4 , Criptococosis/tratamiento farmacológico , Criptococosis/microbiología , Femenino , Humanos , Pulmón/microbiología , Pulmón/patología , Linfopenia/etiología , Persona de Mediana Edad , Infecciones del Sistema Respiratorio/complicaciones , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Infecciones del Sistema Respiratorio/microbiología , Tórax/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Triazoles/uso terapéutico
19.
Molecules ; 24(19)2019 Sep 27.
Artículo en Inglés | MEDLINE | ID: mdl-31569633

RESUMEN

Herbal medicine, including traditional Chinese medicine (TCM), is widely used worldwide. Herbs and TCM formulas contain numerous active molecules. Basically, they are a kind of cocktail therapy. Herb-drug, herb-food, herb-herb, herb-microbiome, and herb-disease interactions are complex. There is potential for both benefit and harm, so only after understanding more of their mechanisms and clinical effects can herbal medicine and TCM be helpful to users. Many pharmacologic studies have been performed to unravel the molecular mechanisms; however, basic and clinical studies of good validity are still not enough to translate experimental results into clinical understanding and to provide tough evidence for better use of herbal medicines. There are still issues regarding the conflicting pharmacologic effects, pharmacokinetics, drug interactions, adverse and clinical effects of herbal medicine and TCM. Understanding study validation, pharmacologic effects, drug interactions, indications and clinical effects, adverse effects and limitations, can all help clinicians in providing adequate suggestions to patients. At present, it would be better to use herbs and TCM formulas according to their traditional indications matching the disease pathophysiology and their molecular mechanisms. To unravel the molecular mechanisms and understand the benefits and harms of herbal medicine and TCM, there is still much work to be done.


Asunto(s)
Antivirales/química , Antivirales/farmacología , Medicamentos Herbarios Chinos/química , Medicamentos Herbarios Chinos/farmacología , Medicina China Tradicional , Animales , Biomarcadores , Manejo de la Enfermedad , Composición de Medicamentos , Interacciones de Hierba-Droga , Humanos , Microbiota/efectos de los fármacos , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Infecciones del Sistema Respiratorio/metabolismo , Infecciones del Sistema Respiratorio/virología , Transducción de Señal/efectos de los fármacos
20.
BMJ Case Rep ; 12(9)2019 Sep 24.
Artículo en Inglés | MEDLINE | ID: mdl-31551321

RESUMEN

Parainfectious optic neuritis is a very rare cause of acute vision loss. We present a case of a 51-year-old man with a recent upper respiratory tract infection, presumably of viral aetiology, who showed up with complains of painless right eye vision loss, followed by the same symptoms on the left eye 3 weeks later. Ophthalmological examination revealed optic disc swelling (sequential in severity) which was confirmed by optic disc imaging. The remaining evaluations (lumbar puncture, MRI, laboratory and genetic testing) were completely normal. Considering a postviral aetiology, 5-day intravenous methylprednisolone treatment was performed. Follow-up examinations revealed slight visual acuity and visual fields recovery, with subsequent optic disc atrophy and microcystic macular oedema, bilaterally. This case illustrates how important a correct clinical history is to guide a correct diagnosis and posterior management.


Asunto(s)
Edema Macular/etiología , Neuritis Óptica/etiología , Papiledema/etiología , Infecciones del Sistema Respiratorio/complicaciones , Glucocorticoides/uso terapéutico , Humanos , Edema Macular/tratamiento farmacológico , Masculino , Metilprednisolona/uso terapéutico , Persona de Mediana Edad , Neuritis Óptica/tratamiento farmacológico , Papiledema/tratamiento farmacológico , Infecciones del Sistema Respiratorio/tratamiento farmacológico
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