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1.
Monaldi Arch Chest Dis ; 90(1)2020 Mar 26.
Artículo en Inglés | MEDLINE | ID: mdl-32236089

RESUMEN

Respiratory physiotherapy in patients with COVID-19 infection in acute setting: a Position Paper of the Italian Association of Respiratory Physiotherapists (ARIR) On February 2020, Italy, especially the northern regions, was hit by an epidemic of the new SARS-Cov-2 coronavirus that spread from China between December 2019 and January 2020. The entire healthcare system had to respond promptly in a very short time to an exponential growth of the number of subjects affected by COVID-19 (Coronavirus disease 2019) with the need of semi-intensive and intensive care units.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/terapia , Control de Infecciones/métodos , Ventilación no Invasiva/métodos , Modalidades de Fisioterapia , Neumonía Viral/etiología , Respiración Artificial/métodos , Síndrome de Dificultad Respiratoria del Adulto/terapia , Insuficiencia Respiratoria/terapia , Terapia Respiratoria/métodos , Infecciones por Coronavirus/rehabilitación , Cuidados Críticos , Disnea/etiología , Humanos , Hipoxia/complicaciones , Hipoxia/etiología , Control de Infecciones/normas , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Italia , Ventilación no Invasiva/normas , Pandemias , Neumonía Viral/rehabilitación , Neumonía Viral/terapia , Pronación , Respiración Artificial/normas , Síndrome de Dificultad Respiratoria del Adulto/etiología , Síndrome de Dificultad Respiratoria del Adulto/rehabilitación , Insuficiencia Respiratoria/etiología , Insuficiencia Respiratoria/rehabilitación , Dispositivos de Protección Respiratoria , Terapia Respiratoria/normas
2.
Zhongguo Dang Dai Er Ke Za Zhi ; 22(3): 183-194, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32204751

RESUMEN

The recent ongoing outbreak of severe pneumonia associated with a novel coronavirus (SARS-CoV-2), currently of unknown origin, creates a world emergency that has put global public health institutions on high alert. At present there is limited clinical information of the SARS-CoV-2 and there is no specific treatment recommended, although technical guidances and suggestions have been developed and will continue to be updated as additional information becomes available. Preventive treatment has an important role to control and avoid the spread of severe respiratory disease, but often is difficult to obtain and sometimes cannot be effective to reduce the risk of deterioration of the underlining lung pathology. In order to define an effective and safe treatment for SARS-CoV-2-associated disease, we provide considerations on the actual treatments, on how to avoid complications and the undesirable side effects related to them and to select and apply earlier the most appropriate treatment. Approaching to treat severe respiratory disease in infants and children, the risks related to the development of atelectasis starting invasive or non-invasive ventilation support and the risk of oxygen toxicity must be taken into serious consideration. For an appropriate and effective approach to treat severe pediatric respiratory diseases, two main different strategies can be proposed according to the stage and severity of the patient conditions: patient in the initial phase and with non-severe lung pathology and patient with severe initial respiratory impairment and/or with delay in arrival to observation. The final outcome is strictly connected with the ability to apply an appropriate treatment early and to reduce all the complications that can arise during the intensive care admission.


Asunto(s)
Infecciones por Coronavirus , Neumonía Viral , Insuficiencia Respiratoria , Betacoronavirus , Niño , Infecciones por Coronavirus/complicaciones , Humanos , Neumonía Viral/complicaciones , Insuficiencia Respiratoria/etiología
3.
Orv Hetil ; 161(7): 275-277, 2020 Feb.
Artículo en Húngaro | MEDLINE | ID: mdl-32037871

RESUMEN

A 70-year-old male patient presented with acute respiratory failure. ECG at admission showed atrial tachycardia with macro T-wave alternans that disappeared as soon as normal sinus rhythm had returned. This ECG shape was not accompanied by either QT-prolongation or acute ischaemia. This case draws attention to atrial tachycardia (provoked here in a context of respiratory insufficiency) that may be the sole reason for macro T-wave alternans. Orv Hetil. 2020; 161(7): 275-277.


Asunto(s)
Arritmias Cardíacas/etiología , Taquicardia Supraventricular/diagnóstico , Anciano , Electrocardiografía , Humanos , Síndrome de QT Prolongado , Masculino , Insuficiencia Respiratoria/etiología , Taquicardia Supraventricular/complicaciones
7.
Autops. Case Rep ; 9(4): e2019119, Oct.-Dec. 2019. ilus
Artículo en Inglés | LILACS | ID: biblio-1024159

RESUMEN

Congenital acinar dysplasia is a lethal, developmental lung malformation resulting in neonatal respiratory insufficiency. This entity is characterized by pulmonary hypoplasia and arrest in the pseudoglandular stage of development, resulting in the absence of functional gas exchange. The etiology is unknown, but a relationship with the disruption of the TBX4-FGF10 pathway has been described. There are no definitive antenatal diagnostic tests. It is a diagnosis of exclusion from other diffuse embryologic lung abnormalities with identical clinical presentations that are, however, histopathologically distinct.


Asunto(s)
Humanos , Femenino , Recién Nacido , Insuficiencia Respiratoria/etiología , Pulmón/anomalías , Enfermedades Pulmonares/congénito , Autopsia , Resultado Fatal , Pulmón/patología
8.
PLoS One ; 14(12): e0227221, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31887206

RESUMEN

INTRODUCTION: Domiciliary High-flow, humidified, nasal cannula (HFNC) is a possible add-on in patients with chronic respiratory diseases. This post-hoc study investigates benefit of HFNC in subgroups of advanced COPD patients with chronic hypoxic failure on reduction of exacerbations and hospitalizations. METHODS: One hundred patients were randomized to HFNC in a previous trial. Subgroups with 0-1 (N = 32) respectively two or more (2+) (N = 68) exacerbations 12 months pre-study were investigated. Changes in number of exacerbations and hospitalizations pre- and in study were analyzed, corrected for HFNC days with HFNC. RESULTS: Patients were comparable at baseline. Exacerbations increased in subgroup 0-1 (p = 0.01) and decreased in subgroup 2+ (p = 0.03). Correcting for HFNC days no correlation was seen in subgroup 0-1 (p = 0.08), but in subgroup 2+ (p<0.001). Number of hospitalizations increased in subgroup 0-1 (p = 0.01) with no change in days of hospitalization (p = 0.08). Number and days of hospitalization decreased in subgroup 2+ (p = 0.002 resp. 0.025). Correcting for HFNC days no correlation was found in number or days of hospitalization in subgroup 0-1 (p = 0.48 and p = 0.65). Positive correlation was found in subgroup 2+ (both p<0.001). CONCLUSION: In patients with advanced COPD, chronic hypoxic failure and two or more exacerbations per year, HFNC significantly reduced exacerbations and hospitalizations.


Asunto(s)
Hipoxia/terapia , Terapia por Inhalación de Oxígeno/métodos , Oxígeno/administración & dosificación , Enfermedad Pulmonar Obstructiva Crónica/terapia , Insuficiencia Respiratoria/terapia , Anciano , Anciano de 80 o más Años , Cánula , Terapia Combinada/instrumentación , Terapia Combinada/métodos , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Hipoxia/etiología , Masculino , Persona de Mediana Edad , Terapia por Inhalación de Oxígeno/instrumentación , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Insuficiencia Respiratoria/etiología , Brote de los Síntomas , Resultado del Tratamiento
9.
Acta Clin Croat ; 58(Suppl 1): 118-123, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31741570

RESUMEN

Multiply injured patients with severe chest trauma have different combinations of associated extra thoracic injuries making their treatment complex. Severe pain is a prominent symptom in a vast majority of severe chest injuries and causes deterioration of respiratory function. Epidural analgesia provides efficient pain relief but its use in this group of patients is burdened with complications, contraindications and technical difficulties. We present two cases in which epidural analgesia was successfully used in polytrauma patients with severe chest injuries and hypoxemic respiratory failure, and discuss advantages, possible pitfalls and complications.


Asunto(s)
Analgesia Epidural , Traumatismo Múltiple/complicaciones , Dolor/tratamiento farmacológico , Traumatismos Torácicos/complicaciones , Adulto , Analgesia Epidural/efectos adversos , Contraindicaciones , Humanos , Masculino , Persona de Mediana Edad , Dolor/etiología , Insuficiencia Respiratoria/etiología
10.
Am Surg ; 85(11): 1308-1309, 2019 Nov 01.
Artículo en Inglés | MEDLINE | ID: mdl-31775976

RESUMEN

We present a previously undescribed complication after noninvasive ventilation (NIV) for respiratory failure in a patient who required percutaneous endoscopic gastrostomy (PEG) tube placement for long-term nutrition after a complicated coronary bypass operation. A 54-year-old female diagnosed with unilateral vocal cord paralysis after emergent coronary artery bypass grafting (CABG) underwent an uncomplicated PEG tube placement. She was placed on intermittent NIV because of respiratory failure 24 hours after PEG placement, and NIV was continued for several days. Three days later, she was noted to have pneumoperitoneum on an upright chest X-ray. Abdominal CT scan revealed a large amount of pneumoperitoneum with the PEG tube in the correct position and no extravasation of enteric contrast from the stomach. Tube feeds were held and NIV was discontinued. Nonetheless, six days later, the patient was found on CT scan to have partial displacement of the PEG tube with leakage from the gastrotomy requiring operative repair. This case highlights the vulnerability of PEG tubes to management practices in the early postoperative period. Abdominal distention secondary to NIV likely caused pressure necrosis of the PEG site with dislodgement of the tube. This case elicits considerations regarding future management practices of patients receiving NIV in the early postoperative period after PEG placement.


Asunto(s)
Gastrostomía/efectos adversos , Intubación Gastrointestinal , Ventilación no Invasiva/efectos adversos , Neumoperitoneo/etiología , Complicaciones Posoperatorias/etiología , Puente de Arteria Coronaria/efectos adversos , Femenino , Gastrostomía/instrumentación , Humanos , Intubación Gastrointestinal/efectos adversos , Intubación Gastrointestinal/instrumentación , Persona de Mediana Edad , Neumoperitoneo/diagnóstico por imagen , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/terapia , Insuficiencia Respiratoria/etiología , Insuficiencia Respiratoria/terapia , Tomografía Computarizada por Rayos X
11.
Rinsho Shinkeigaku ; 59(11): 716-722, 2019 Nov 08.
Artículo en Japonés | MEDLINE | ID: mdl-31656262

RESUMEN

We analyzed the registration data of inpatients with facioscapulohumeral muscular dystrophy (FSHD) receiving care at 27 specialized institutions for muscular dystrophy in Japan from 1999 to 2013 using data from October 1 of each year. The number of inpatients of each year ranged from 63 to 72 (67.1 ± 3.3) throughout the study period. Those aged over 50 years gradually increased during the study period, while the oldest inpatient was 82.8 years old. Most could not walk. The rate of respirator dependency increased from 21.0% in 1999 to 71.0% in 2013, while the rate of patients receiving oral nutrition was 98.4% in 1999 and then reduced to 75.4% in 2013. There were 36 death cases reported in the database, including 15 patients with respiratory failure and 4 with heart failure. Our findings indicate that FSHD patients in a severe condition are impacted by respiratory and nutritional problems and their prognosis for survival is related to respiratory failure.


Asunto(s)
Hospitalización/estadística & datos numéricos , Hospitales Especializados/estadística & datos numéricos , Pacientes Internos/estadística & datos numéricos , Distrofia Muscular Facioescapulohumeral/mortalidad , Adulto , Factores de Edad , Anciano , Causas de Muerte , Femenino , Insuficiencia Cardíaca/epidemiología , Insuficiencia Cardíaca/etiología , Humanos , Japón/epidemiología , Masculino , Persona de Mediana Edad , Limitación de la Movilidad , Distrofia Muscular Facioescapulohumeral/complicaciones , Distrofia Muscular Facioescapulohumeral/fisiopatología , Distrofia Muscular Facioescapulohumeral/terapia , Apoyo Nutricional , Insuficiencia Respiratoria/epidemiología , Insuficiencia Respiratoria/etiología , Índice de Severidad de la Enfermedad , Factores de Tiempo , Ventiladores Mecánicos/estadística & datos numéricos
12.
Medicine (Baltimore) ; 98(41): e17139, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31593077

RESUMEN

BACKGROUND: The molecular studies showed that Nitric oxide (NO) is an essential factor which regulates pulmonary artery tension. However, the conclusions of existing clinical studies were inconsistent. OBJECTIVE: This meta-analysis is aimed to determine whether the inhalation of NO could improve oxygenation and reduce rate of death and use of extracorporeal membrane oxygenation (ECMO). METHODS: The strategies used to search PubMed, The Cochrane Central Register of Controlled trials in the Cochrane Library, Embase, Web of science, Clinical Trials Registry, and China Biology Medicine disc, from inception to February, 2018. The primary outcomes were death or use of ECMO, death before hospital discharge, use of ECMO before hospital discharge, change in PaO2 after treatment. We assess the risk of bias in each included study by Cochrane Handbook, and calculated typical estimates of RR, each with its 95% CI, and for continuous outcomes, WMD or a summary estimate for SMD, each with its 95% CI. RESULTS: Nine randomized controlled trials (RCTs) with a total of 856 participants were included in this meta-analysis. This meta-analysis revealed that the experimental group had significantly lower death or use of ECMO (RR 0.66, 95% CI 0.57-0.77, I = 0%, P < .00001) and lower use of ECMO before hospital discharge (RR 0.89, 95% CI 0.50-0.71, I = 0%, P < .00001) compared to control group. And in the infants without diaphragmatic hernia, experimental group had significantly higher change in PaO2 after treatment (MD 50.40, 95% CI 32.14-68.66, P < .00001). The meta-analysis also showing a tendency to improve in the death before hospital discharge (RR 0.89, 95% CI 0.60-1.31, I = 0%, P = .55) and the change in PaO2 after treatment of the infants with diaphragmatic hernia (MD 6.70, 95% CI -2.32 to 15.72, P < .00001, P = .15), but no difference between experimental group and control group. CONCLUSION: We found that NO inhalation can improve oxygenation and reduce rate of death and use of ECMO in this meta-analysis. Therefore, we recommend the use of NO inhalation for infants born at or near term with respiratory failure.


Asunto(s)
Broncodilatadores/administración & dosificación , Oxigenación por Membrana Extracorpórea/estadística & datos numéricos , Óxido Nítrico/administración & dosificación , Insuficiencia Respiratoria/terapia , Administración por Inhalación , Oxigenación por Membrana Extracorpórea/métodos , Femenino , Edad Gestacional , Hernias Diafragmáticas Congénitas/complicaciones , Hernias Diafragmáticas Congénitas/mortalidad , Hernias Diafragmáticas Congénitas/terapia , Humanos , Recién Nacido , Masculino , Ensayos Clínicos Controlados Aleatorios como Asunto , Insuficiencia Respiratoria/etiología , Insuficiencia Respiratoria/mortalidad , Nacimiento a Término , Resultado del Tratamiento
15.
Neurology ; 93(19): e1756-e1767, 2019 11 05.
Artículo en Inglés | MEDLINE | ID: mdl-31619483

RESUMEN

OBJECTIVE: To determine the effects of 10 years of enzyme replacement therapy (ERT) in adult patients with Pompe disease, focusing on individual variability in treatment response. METHODS: In this prospective, multicenter cohort study, we studied 30 patients from the Netherlands and France who had started ERT during the only randomized placebo-controlled clinical trial with ERT in late-onset Pompe disease (NCT00158600) or its extension (NCT00455195) in 2005 to 2008. Main outcomes were walking ability (6-minute walk test [6MWT]), muscle strength (manual muscle testing using Medical Research Council [MRC] grading), and pulmonary function (forced vital capacity [FVC] in the upright and supine positions), assessed at 3- to 6-month intervals before and after the start of ERT. Data were analyzed with linear mixed-effects models for repeated measurements. RESULTS: Median follow-up duration on ERT was 9.8 years (interquartile range [IQR] 8.3-10.2 years). At the group level, baseline 6MWT was 49% of predicted (IQR 41%-60%) and had deteriorated by 22.2 percentage points (pp) at the 10-year treatment point (p < 0.001). Baseline FVC upright was 54% of predicted (IQR 47%-68%) and decreased by 11 pp over 10 years (p < 0.001). Effects of ERT on MRC sum score and FVC supine were similar. At the individual level, 93% of patients had initial benefit of ERT. Depending on the outcome measured, 35% to 63% of patients had a secondary decline after ≈3 to 5 years. Still, at 10 years of ERT, 52% had equal or better 6MWT and/or FVC upright compared to baseline. CONCLUSIONS: The majority of patients with Pompe disease benefit from long-term ERT, but many patients experience some secondary decline after ≈3 to 5 years. Individual variation, however, is considerable. CLASSIFICATION OF EVIDENCE: This study provides Class IV evidence that for the majority of adults with Pompe disease, long-term ERT positively affects, or slows deterioration in, muscle strength, walking ability, and/or pulmonary function.


Asunto(s)
Terapia de Reemplazo Enzimático , Enfermedad del Almacenamiento de Glucógeno Tipo II/tratamiento farmacológico , alfa-Glucosidasas/uso terapéutico , Adulto , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Francia , Enfermedad del Almacenamiento de Glucógeno Tipo II/complicaciones , Enfermedad del Almacenamiento de Glucógeno Tipo II/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Limitación de la Movilidad , Fuerza Muscular , Debilidad Muscular/etiología , Debilidad Muscular/fisiopatología , Países Bajos , Ventilación no Invasiva/estadística & datos numéricos , Estudios Prospectivos , Ensayos Clínicos Controlados Aleatorios como Asunto , Insuficiencia Respiratoria/etiología , Insuficiencia Respiratoria/fisiopatología , Insuficiencia Respiratoria/terapia , Resultado del Tratamiento , Capacidad Vital , Prueba de Paso , Silla de Ruedas
16.
J Vet Emerg Crit Care (San Antonio) ; 29(6): 662-667, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31625672

RESUMEN

OBJECTIVE: To describe the use of mechanical ventilation (MV) in the management of Eastern coral snake envenomation in 7 dogs and a cat. DESIGN: Retrospective study (2011-2016). SETTING: University teaching hospital. ANIMALS: Seven dogs and 1 cat receiving MV for ventilatory failure secondary to Eastern coral snake envenomation. INTERVENTIONS: None. MEASUREMENT AND MAIN RESULTS: The medical records of 8 animals that received MV following Eastern coral snake envenomation were reviewed. Data collected included signalment, time to veterinary assessment, physical and laboratory characteristics at arrival, clinical course during hospitalization, management including antivenom administration, MV settings, duration of ventilation, length of hospitalization, cost of care, and survival to discharge. The mean ± SD age was 4 ± 3.2 years. Median (range) time to onset of clinical signs was 30 (5-240) minutes. Coral snake antivenom was administered to 7 of the 8 animals following arrival at a median (range) of 30 (5-90) minutes. All animals had progressive hypoventilation and received MV, specifically volume controlled, synchronized intermittent mandatory ventilation with pressure support. The median (range) duration of MV was 58 (25-84) hours and the median (range) duration of hospitalization was 8.2 (6-11) days. Ventilator associated complications occurred in all animals, but overall outcome was excellent with 7 of 8 surviving to discharge. No dog, but the 1 cat, had an adverse reaction to antivenom. CONCLUSIONS: Ventilatory failure secondary to Eastern coral snake envenomation necessitating MV carries an excellent prognosis and is better than reported for other causes of lower motor neuron disease. Successful response to ventilation was achieved even with associated complications being common in this cohort of animals.


Asunto(s)
Antivenenos/administración & dosificación , Serpientes de Coral , Respiración Artificial/veterinaria , Insuficiencia Respiratoria/veterinaria , Mordeduras de Serpientes/veterinaria , Proteínas Adaptadoras Transductoras de Señales , Animales , Gatos , Proteínas de Ciclo Celular , Estudios de Cohortes , Perros , Hospitalización , Hospitales Universitarios , Humanos , Masculino , Registros Médicos , Respiración con Presión Positiva , Insuficiencia Respiratoria/etiología , Insuficiencia Respiratoria/terapia , Estudios Retrospectivos , Mordeduras de Serpientes/terapia
17.
Rev Invest Clin ; 71(5): 311-320, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31599877

RESUMEN

Background: Severe hypoxemic respiratory failure (SHRF) due to Pneumocystis jiroveci pneumonia (PJP) in AIDS patients represents the main cause of admission and mortality in respiratory intensive care units (RICUs) in low- and middle-income countries. Objective: The objective of this study was to develop a predictive scoring system to estimate the risk of mortality in HIV/AIDS patients with PJP and SHRF. Methods: We analyzed data of patients admitted to the RICU between January 2013 and January 2018 with a diagnosis of HIV infection and PJP. Multivariate logistic regression and Kaplan-Meier method were used in data analysis. The RICU and inhospital mortality were 25% and 26%, respectively. Multivariate analysis identified four independent predictors: body mass index, albumin, time to ICU admission, and days of vasopressor support. A predictive scoring system was derived and validated internally. The discrimination was 0.869 (95% confidence interval: 0.821-0.917) and calibration intercept (α) and slope (ß) were 0.03 and 0.99, respectively. The sensitivity was 47.2%, specificity was 84.6%, positive predictive value was 89.2%, and negative predictive value was 82.6%. Conclusions: This scoring system is a potentially useful tool to assist clinicians, in low- and medium-income countries, in estimating the RICU and inhospital mortality risk in patients with HIV/AIDS and SHRF caused by PJP.


Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/mortalidad , Infecciones por VIH/mortalidad , Neumonía por Pneumocystis/mortalidad , Insuficiencia Respiratoria/mortalidad , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Adulto , Estudios de Cohortes , Femenino , Infecciones por VIH/complicaciones , Mortalidad Hospitalaria , Humanos , Hipoxia/etiología , Hipoxia/mortalidad , Unidades de Cuidados Intensivos , Masculino , Neumonía por Pneumocystis/etiología , Valor Predictivo de las Pruebas , Pronóstico , Estudios Prospectivos , Insuficiencia Respiratoria/etiología , Sensibilidad y Especificidad
18.
Lupus ; 28(11): 1354-1359, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31551032

RESUMEN

With the wide use of immunosuppressive agents, life-threatening cytomegalovirus-associated acute respiratory failure occurs frequently. However, this condition is yet to be fully recognized and the therapeutic approach to it can only be based on comprehensive protocols rather than the biological characteristics of cytomegalovirus. We describe three acute respiratory failure events that were related to the pathogenicity of cytomegalovirus, the primary cytopathic effect and secondary antiviral immunity-mediated damage. All cytomegalovirus infection occurred after immunosuppressive usage while the acute respiratory failure events took place in different clinical settings. The first acute respiratory failure event originated from the immunoinflammatory response after cytomegalovirus infection was circumscribed, while the second resulted from cytomegalovirus reactivation and the third was caused by the combined effect of acute cytomegalovirus infection and the subsequent immunoinflammatory response. According to the clinical setting, corresponding therapeutic approaches (sequential or combined strategy) were carried out. All the patients here presented were responsive to the above therapeutic strategies. Consequently, cytomegalovirus-associated acute respiratory failure in systemic lupus erythematosus patients should be carefully differentiated and a sequential or combined strategy should be carried out according to the clinical setting. Overall, we find that there are three patterns of cytomegalovirus-associated acute respiratory failure in systemic lupus erythematosus patients and propose a novel therapeutic strategy in relation to cytomegalovirus biology.


Asunto(s)
Infecciones por Citomegalovirus/complicaciones , Inmunosupresores/efectos adversos , Lupus Eritematoso Sistémico/tratamiento farmacológico , Insuficiencia Respiratoria/etiología , Enfermedad Aguda , Adolescente , Antivirales/administración & dosificación , Citomegalovirus/aislamiento & purificación , Infecciones por Citomegalovirus/etiología , Infecciones por Citomegalovirus/terapia , Femenino , Humanos , Inmunosupresores/administración & dosificación , Masculino , Insuficiencia Respiratoria/terapia , Adulto Joven
19.
BMJ Case Rep ; 12(9)2019 Sep 18.
Artículo en Inglés | MEDLINE | ID: mdl-31537595

RESUMEN

Myelodysplastic syndrome (MDS) is frequently complicated by pulmonary disease. Here, we describe secondary pulmonary alveolar proteinosis (sPAP) that developed during corticosteroid therapy for organising pneumonia (OP) associated with MDS. A 75-year-old woman with MDS complained of cough for 2 weeks. Chest CT showed bilateral patchy consolidations with reversed halo sign. Bronchoalveolar lavage (BAL) examination showed remarkably increased cell density with an increased lymphocyte proportion. Abnormal radiological findings improved rapidly on administration of systemic corticosteroid under the diagnosis of OP; however, they relapsed a few weeks later. Transbronchial lung biopsy showed periodic acid-Schiff stain-positive amorphous materials. Autoantibodies against granulocyte-macrophage colony-stimulating factor (GM-CSF) in serum and BAL fluid (BALF) were both negative, while GM-CSF level in BALF was elevated. The patient was diagnosed with sPAP. When chest radiological findings show exacerbation during corticosteroid therapy for OP in a patient with MDS, physicians should consider sPAP complication as a differential diagnosis.


Asunto(s)
Corticoesteroides/efectos adversos , Síndromes Mielodisplásicos/complicaciones , Neumonía/complicaciones , Proteinosis Alveolar Pulmonar/inducido químicamente , Corticoesteroides/uso terapéutico , Anciano , Grupo de Ascendencia Continental Asiática , Líquido del Lavado Bronquioalveolar/inmunología , Diagnóstico Diferencial , Resultado Fatal , Femenino , Factor Estimulante de Colonias de Granulocitos y Macrófagos/inmunología , Humanos , Neumonía/diagnóstico por imagen , Neumonía/tratamiento farmacológico , Proteinosis Alveolar Pulmonar/complicaciones , Insuficiencia Respiratoria/etiología , Tomografía Computarizada por Rayos X/métodos
20.
Artículo en Inglés | MEDLINE | ID: mdl-31500215

RESUMEN

Air pollution has emerged as one of the world's largest environmental health threats, with various studies demonstrating associations between exposure to air pollution and respiratory and cardiovascular diseases. Regional air quality in Southeast Asia has been seasonally affected by the transboundary haze problem, which has often been the result of forest fires from "slash-and-burn" farming methods. In light of growing public health concerns, recent studies have begun to examine the health effects of this seasonal haze problem in Southeast Asia. This review paper aims to synthesize current research efforts on the impact of the Southeast Asian transboundary haze on acute aspects of public health. Existing studies conducted in countries affected by transboundary haze indicate consistent links between haze exposure and acute psychological, respiratory, cardiovascular, and neurological morbidity and mortality. Future prospective and longitudinal studies are warranted to quantify the long-term health effects of recurrent, but intermittent, exposure to high levels of seasonal haze. The mechanism, toxicology and pathophysiology by which these toxic particles contribute to disease and mortality should be further investigated. Epidemiological studies on the disease burden and socioeconomic cost of haze exposure would also be useful to guide policy-making and international strategy in minimizing the impact of seasonal haze in Southeast Asia.


Asunto(s)
Enfermedad Aguda , Contaminación del Aire/efectos adversos , Salud Pública , Contaminantes Atmosféricos/análisis , Asia Sudoriental , Macrodatos , Enfermedades Cardiovasculares , Humanos , Insuficiencia Respiratoria/etiología
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