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3.
J Diabetes ; 12(4): 347-348, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32162476
5.
Wiad Lek ; 73(1): 196-200, 2020.
Artículo en Polaco | MEDLINE | ID: mdl-32124834

RESUMEN

Pareneteral manifestations of Crohn's disease (ChLC), apart from the most common skin and joint symptoms include also complications from the respiratory system. In addition chronic pharmacotherapy of ChLC, especially 5-aminosalicylic acid or anti-TNF- α drugs, is associated with possible pulmonologic side effects, sometimes difficult to differentiate. In this study, we describe a patient with ChLC, with a history of pneumocystic pneumonia, who was diagnosed with exfoliative institial pneumonitis as a result of chronic use of mesalazine. This disease is characterized by accumulation of alveolar macrophages in the lumen of the alveoli and intrabepticular septum. The most common etiologic factor is exposure to tobacco smoke. Our patient, non-smoker, was finally diagnosed after lung biopsy and histopathological evaluation. The gradual clinical improvement after mesalazine was an additional factor confirming the etiology of the disease. This side effect of mesalazine is not common but it should be considered in all patient treated with 5-aminosalicylic acid.


Asunto(s)
Enfermedad de Crohn , Neumonía , Antiinflamatorios no Esteroideos , Humanos , Mesalamina , Factor de Necrosis Tumoral alfa
6.
Artículo en Inglés | PAHO-IRIS | ID: phr-51949

RESUMEN

[ABSTRACT]. The World Health Organization (WHO) was informed on December 2019 about a coronavirus pneumonia outbreak in Wuhan, Hubei province (China). Subsequently, on March 12, 2020, 125,048 cases and 4,614 deaths were reported. Coronavirus is an enveloped RNA virus, from the genus Betacoronavirus, that is distributed in birds, humans, and other mammals. WHO has named the novel coronavirus disease as COVID-19. More than 80 clinical trials have been launched to test coronavirus treatment, including some drug repurposing or repositioning for COVID-19. Hence, we performed a search in March 2020 of the clinicaltrials.gov database. The eligibility criteria for the retrieved studies were: contain a clinicaltrials.gov base identifier number; describe the number of participants and the period for the study; describe the participants' clinical conditions; and utilize interventions with medicines already studied or approved for any other disease in patients infected with the novel coronavirus SARS-CoV-2 (2019-nCoV). It is essential to emphasize that this article only captured trials listed in the clinicaltrials.gov database. We identified 24 clinical trials, involving more than 20 medicines, such as human immunoglobulin, interferons, chloroquine, hydroxychloroquine, arbidol, remdesivir, favipiravir, lopinavir, ritonavir, oseltamivir, methylprednisolone, bevacizumab, and traditional Chinese medicines (TCM). Although drug repurposing has some limitations, repositioning clinical trials may represent an attractive strategy because they facilitate the discovery of new classes of medicines; they have lower costs and take less time to reach the market; and there are existing pharmaceutical supply chains for formulation and distribution.


[RESUMEN]. En diciembre de 2019 fue informado a la Organización Mundial de la Salud (OMS) un brote de neumonía por coronavirus en Wuhan, provincia de Hubei, China. Al 12 de marzo de 2020, se habían notificado 125 048 casos y 4 614 muertes. El coronavirus es un virus ARN envuelto del género Betacoronavirus distribuido en aves, seres humanos y otros mamíferos. La OMS ha denominado a la nueva enfermedad por coronavirus COVID- 19. Se han puesto en marcha más de 80 ensayos clínicos para evaluar un tratamiento para el coronavirus, que incluyen algunos ensayos de reposicionamiento de medicamentos para la COVID-19. En marzo de 2020 se llevó a cabo una búsqueda de los ensayos clínicos registrados en la base de datos clinicaltrials.gov. Los criterios de elegibilidad para los estudios recuperados fueron tener un número de identificación de la base de datos clinicaltrials.gov; describir el número de participantes y el período del estudio; describir las condiciones clínicas de los participantes; y emplear intervenciones con medicamentos ya estudiados o aprobados para cualquier otra enfermedad en pacientes infectados con el nuevo coronavirus SARS-CoV-2 (2019-nCoV). Es esencial destacar que este artículo solo recoge los ensayos que figuran en la base de datos clinicaltrials. gov. Se identificaron 24 ensayos clínicos relacionados con más de 20 medicamentos, como inmunoglobulina humana, interferones, cloroquina, hidroxicloroquina, arbidol, remdesivir, favipiravir, lopinavir, ritonavir, oseltamivir, metilprednisolona, bevacizumab y medicina tradicional china. Aunque el reposicionamiento de medicamentos tiene algunas limitaciones, el reposicionamiento de los ensayos clínicos puede representar una estrategia atractiva porque facilita el descubrimiento de nuevas clases de medicamentos; estos tienen costos más bajos y tardan menos en llegar al mercado; y existen cadenas de suministro farmacéutico que apoyan la formulación y la distribución.


[RESUMO]. A Organização Mundial da Saúde (OMS) foi informada, em dezembro de 2019, sobre um surto de pneumonia por coronavírus em Wuhan, província de Hubei (China). Posteriormente, em 12 de março de 2020, 125 048 casos e 4 614 mortes haviam sido registrados. O coronavírus é um vírus RNA envelopado do gênero Betacoronavírus, distribuído em aves e em humanos e outros mamíferos. A OMS designou a nova doença por coronavírus como COVID-19. Mais de 80 ensaios clínicos foram iniciados para testar tratamentos para o coronavírus, incluindo alguns de reposicionamento de medicamentos para o COVID-19. Assim, em março de 2020 realizou-se uma busca na base de dados clinicaltrials.gov. Os critérios de elegibilidade para os estudos recuperados foram: conter o número identificador da base de dados clinicaltrials.gov; descrever o número de participantes e o período do estudo; descrever as condições clínicas dos participantes; e utilizar intervenções para tratamento de doentes infectados com o novo coronavírus SARS-CoV-2 (2019-nCoV) com medicamentos já estudados ou aprovados para qualquer outra doença. É essencial salientar que este artigo apenas capturou ensaios listados na base de dados clinicaltrials.gov. Foram identificados 24 ensaios clínicos envolvendo mais de 20 medicamentos, tais como imunoglobulina humana, interferons, cloroquina, hidroxicloroquina, arbidol, remdesivir, favipiravir, lopinavir, ritonavir, oseltamivir, metilprednisolona, bevacizumabe e medicamentos chineses tradicionais. Embora o reposicionamento de medicamentos tenha algumas limitações, os ensaios clínicos de reposicionamento podem representar uma estratégia atraente, porque facilitam a descoberta de novas classes de medicamentos, têm custos mais baixos, levam menos tempo para chegar ao mercado e se beneficiam de cadeias de fornecimento farmacêutico já existentes para formulação e distribuição.


Asunto(s)
Reposicionamiento de Medicamentos , Ensayos Clínicos como Asunto , Infecciones por Coronavirus , Virosis , Neumonía , Pandemias , Reposicionamiento de Medicamentos , Ensayos Clínicos como Asunto , Infecciones por Coronavirus , Virosis , Neumonía Viral , Pandemias , Reposicionamiento de Medicamentos , Ensayos Clínicos como Asunto , Infecciones por Coronavirus , Virosis , Neumonía Viral
7.
Br J Nurs ; 29(5): 290-296, 2020 Mar 12.
Artículo en Inglés | MEDLINE | ID: mdl-32167815

RESUMEN

Poor oral hygiene is an important risk factor for the development of non-ventilator hospital-associated pneumonia (NV-HAP), which imposes a significant burden on the NHS. This study aimed to establish whether the use of a 24-hour oral care kit and an oral care assessment tool can meet the needs of patients on an acute stroke unit. In comparison with the same period the preceding year, the introduction of the oral care kit and assessment tool improved compliance with oral care by more than 4 times; the overall costs of antibiotics to treat NV-HAP patients fell by 79%, with the number of doses falling by 70%, and the mortality rate decreased from 27% to 20%. According to a survey of multidisciplinary team (MDT) members keeping oral care tools available at the point of use saved time, and the oral health of patients on the unit improved after the introduction of the oral care kit and assessment tool. Almost all MDT members would recommend the use of the kit over previous interventions.


Asunto(s)
Antibacterianos/uso terapéutico , Infección Hospitalaria/prevención & control , Atención de Enfermería/métodos , Salud Bucal , Higiene Bucal/enfermería , Neumonía/prevención & control , Anciano , Cariostáticos/uso terapéutico , Femenino , Humanos , Masculino , Neumonía/epidemiología , Factores de Riesgo
8.
S D Med ; 73(2): 54-58, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32135052

RESUMEN

Primary lung tumors are very rare in children and constitute only 0.2 percent of all pediatric malignancies. Carcinoids are the most common primary pediatric lung tumor and account for 80 percent of all primary malignant bronchial tumors. Carcinoid tumors can be histologically categorized as typical or atypical. They are derived from neuroendocrine cells in the bronchial epithelium and are locally infiltrative. Surgical resection of endobronchial carcinoid tumors is the mainstay of treatment with a five-year survival of 95 percent. Endoscopic resection has been reported in adult patients with typical carcinoid tumors (less than 20 mm) with no extrabronchial disease. We present the first pediatric bronchial carcinoid tumor treated with endoscopic resection.


Asunto(s)
Tumor Carcinoide , Neoplasias Pulmonares , Neumonía , Adulto , Tumor Carcinoide/complicaciones , Tumor Carcinoide/diagnóstico , Niño , Humanos , Neoplasias Pulmonares/complicaciones , Neoplasias Pulmonares/diagnóstico , Neumonía/etiología , Síndrome
9.
J Assoc Physicians India ; 68(3): 63-66, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32138487

RESUMEN

Background: Diagnosis and delay in management of encephalopathy in elderly patients is challenging due to the paucity of presenting symptoms and signs. Methods: This was an observational study conducted over a period of one year (1.2.2016 to 31.1.2017) on all elderly patients presenting with encephalopathy. Their demographic profile along with clinical presentation, laboratory, imaging results and final outcome were recorded and analysed. Results: There were 251 elderly patients who presented with encephalopathy, 110 (43.82%) of whom were females. Majority of these patients i.e. 186(74.10%) were in the age group of 60-75 years with a mean age of 70.78 years. There were 112 (44.62%) patients who presented to the hospital within 6 hours of commencement of the altered mental status (AMS). Multiple etiologies for encephalopathy were present in 75 (29.88%) patients with the commonest being neurological in 97 (38.65%) patients, infection/sepsis in 92 (36.65%) patients and metabolic in 84 (33.47%) patients. Hyponatremia was the commonest cause of metabolic encephalopathy present in 38(45.24%) patients followed by hypoglycemia in 25 (29.76%) patients. Pneumonia was the commonest infection present in 41 (44.57%) patients. There were 48(19.12%) deaths with 38(79.17%) of them having one or more co-morbidities. Early presentation to hospital (within 6 hours of commencement of symptoms), higher GCS and conscious level at presentation were the good prognostic markers of outcome in these elderly patients. However patients with septic encephalopathy were found to have worst prognosis. Conclusion: The common etiologies of encephalopathy in the elderly were neurological (38.65%) followed by infection (36.65%) and metabolic (33.47%). The mortality rate was 19.12%. Seeking medical aid within 6 hours of commencement of altered sensorium along with timely diagnosis could reduce the mortality and improve outcomes.


Asunto(s)
Encefalopatías/etiología , Anciano , Encefalopatías/epidemiología , Trastornos de la Conciencia , Femenino , Humanos , Hiponatremia , Persona de Mediana Edad , Neumonía , Sepsis
11.
12.
Int. j. STD AIDS ; 31(4): 345-350, Mar. 2020. tab
Artículo en Inglés | Sec. Est. Saúde SP, SESSP-IIERPROD, Sec. Est. Saúde SP | ID: biblio-1052358

RESUMEN

Community-acquired pneumonia (CAP) is a common cause of hospitalization among people living with human immunodeficiency virus (PLWH), particularly those with severe immunosuppression. Pulmonary disease due to cryptococcosis is uncommonly reported and likely under-diagnosed. There is scarce information about cryptococcal antigen (CrAg) prevalence in PLWH with CAP. The objectives of this study were to identify among PLWH who were hospitalized with CAP: (i) the prevalence of serum CrAg positivity, (ii) the proportion with asymptomatic vs. symptomatic cryptococcosis; and (iii) the prevalence of serum CrAg positivity in CD4þ T-cell count <100 cells/mm3.We performed a sub-analysis of a prospective cohort of hospitalized adults enrolled into a randomized clinical trial testing therapy for CAP. We included 202 participants who had serum CrAg testing performed. We found a 3.5% prevalence of serum CrAg-positivity overall, being higher (5.7%) in CD4þ T-cell count <100 cells/mm3. Overall, asymptomatic and symptomatic cryptococcosis were present in 2.0% and 1.5%, respectively. This study identifies a target population for CrAg testing: PLWH hospitalized with diagnosis of CAP, particularly those with CD4þ T-cell count <100 cells/mm3 where the number needed to test was 18 to detect 1 CrAg-positive person. This approach may facilitate the detection of asymptomatic cryptococcal infection and allow a timely diagnosis of symptomatic cryptococcal disease


Asunto(s)
Humanos , Neumonía , Infecciones por VIH , Criptococosis
13.
Infection ; 48(2): 267-274, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32008182

RESUMEN

OBJECTIVES: Current risk stratification in community-acquired pneumonia (CAP) does not incorporate the dynamic nature of CAP evolution. Study aim was to evaluate the predictive value of early blood pressure (BP) drop and its consideration within the CRB-65 score. METHODS: We performed a retrospective cohort study including consecutive adult hospitalized CAP patients 2013-2014 without documented treatment limitations or direct ICU admission. The CRB-65 score was calculated initially and re-calculated including any BP below the threshold (BP drop) within the first 24 h (CRB-65[BP24]). The primary endpoint was need for mechanical ventilation or vasopressors (MVVS) occurring after 24 h. Prognostic values were evaluated by uni- and multivariate and ROC curve analyses. RESULTS: 28/294 patients (9.5%) met the primary endpoint. Only 3 (11%) of them showed an initial BP of < 90 mmHg systolic or ≤ 60 mmHg diastolic, but 21 (75%) developed a BP drop within the first 24 h. 24/178 (13%) with and only 4/116 (3%) without any low BP during the first 24 h needed MVVS (p = 0.004). After multivariate analysis, the predictive value of BP drop was independent of other score parameters and biomarkers (all p < 0.01). In ROC analysis, the new CRB-65(BP24) showed a better prediction than the CRB-65 score (AUC 0.69 vs. 0.62, p = 0.04). 7/13 patients (54%) with MVVS despite an admission CRB-65 of 0 or 1 showed a BP drop. CONCLUSIONS: In the evaluated cohort, BP drop within the first 24 h was significantly associated with more need for MVVS in CAP, and its consideration improved the prognostic value of the CRB-65 score.


Asunto(s)
Presión Sanguínea , Infecciones Comunitarias Adquiridas/diagnóstico , Hospitalización/estadística & datos numéricos , Neumonía/diagnóstico , Anciano , Estudios de Cohortes , Infecciones Comunitarias Adquiridas/mortalidad , Humanos , Estimación de Kaplan-Meier , Neumonía/mortalidad , Neumonía/patología , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo
14.
Nurse Pract ; 45(3): 16-25, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-32015283

RESUMEN

Pneumonia is a leading cause of morbidity and mortality in the US and a primary cause of hospitalization nationwide. A recent guideline update from the American Thoracic Society and Infectious Diseases Society of America provides evidence-based recommendations for managing adults with community-acquired pneumonia in the outpatient setting.


Asunto(s)
Atención Ambulatoria , Infecciones Comunitarias Adquiridas/terapia , Neumonía/terapia , Guías de Práctica Clínica como Asunto , Adulto , Humanos , Sociedades Médicas , Estados Unidos
17.
Intensive Care Med ; 46(2): 315-328, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-32040667

RESUMEN

With the expanding use of molecular assays, viral pathogens are increasingly recognized among critically ill adult patients with community-acquired severe respiratory illness; studies have detected respiratory viral infections (RVIs) in 17-53% of such patients. In addition, novel pathogens including zoonotic coronaviruses like the agents causing Severe Acute Respiratory Syndrome (SARS), Middle East Respiratory Syndrome (MERS) and the 2019 novel coronavirus (2019 nCoV) are still being identified. Patients with severe RVIs requiring ICU care present typically with hypoxemic respiratory failure. Oseltamivir is the most widely used neuraminidase inhibitor for treatment of influenza; data suggest that early use is associated with reduced mortality in critically ill patients with influenza. At present, there are no antiviral therapies of proven efficacy for other severe RVIs. Several adjunctive pharmacologic interventions have been studied for their immunomodulatory effects, including macrolides, corticosteroids, cyclooxygenase-2 inhibitors, sirolimus, statins, anti-influenza immune plasma, and vitamin C, but none is recommended at present in severe RVIs. Evidence-based supportive care is the mainstay for management of severe respiratory viral infection. Non-invasive ventilation in patients with severe RVI causing acute hypoxemic respiratory failure and pneumonia is associated with a high likelihood of transition to invasive ventilation. Limited existing knowledge highlights the need for data regarding supportive care and adjunctive pharmacologic therapy that is specific for critically ill patients with severe RVI. There is a need for more pragmatic and efficient designs to test different therapeutics both individually and in combination.


Asunto(s)
Antivirales/uso terapéutico , Infecciones por Coronavirus/terapia , Cuidados Críticos/normas , Gripe Humana/terapia , Neumonía Viral/terapia , Respiración Artificial , Síndrome Respiratorio Agudo Grave/terapia , Adulto , Infecciones Comunitarias Adquiridas/terapia , Enfermedad Crítica , Medicina Basada en la Evidencia , Humanos , Unidades de Cuidados Intensivos , Macrólidos/uso terapéutico , Ventilación no Invasiva , Oseltamivir/uso terapéutico , Neumonía , Índice de Severidad de la Enfermedad
18.
Lancet Infect Dis ; 20(3): 280, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-32043978
19.
J Korean Med Sci ; 35(6): e79, 2020 Feb 17.
Artículo en Inglés | MEDLINE | ID: mdl-32056407

RESUMEN

Since mid-December of 2019, coronavirus disease 2019 (COVID-19) infection has been spreading from Wuhan, China. The confirmed COVID-19 patients in South Korea are those who came from or visited China. As secondary transmissions have occurred and the speed of transmission is accelerating, there are rising concerns about community infections. The 54-year old male is the third patient diagnosed with COVID-19 infection in Korea. He is a worker for a clothing business and had mild respiratory symptoms and intermittent fever in the beginning of hospitalization, and pneumonia symptoms on chest computerized tomography scan on day 6 of admission. This patient caused one case of secondary transmission and three cases of tertiary transmission. Hereby, we report the clinical findings of the index patient who was the first to cause tertiary transmission outside China. Interestingly, after lopinavir/ritonavir (Kaletra, AbbVie) was administered, ß-coronavirus viral loads significantly decreased and no or little coronavirus titers were observed.


Asunto(s)
Infecciones por Coronavirus , Inhibidores del Citocromo P-450 CYP3A , Lopinavir , Neumonía Viral , Neumonía , Ritonavir , Betacoronavirus/genética , China , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/tratamiento farmacológico , Infecciones por Coronavirus/transmisión , Inhibidores del Citocromo P-450 CYP3A/uso terapéutico , Combinación de Medicamentos , Humanos , Lopinavir/uso terapéutico , Masculino , Persona de Mediana Edad , Neumonía/diagnóstico , Neumonía/tratamiento farmacológico , Neumonía/etiología , Neumonía Viral/complicaciones , Neumonía Viral/tratamiento farmacológico , Neumonía Viral/transmisión , Reacción en Cadena en Tiempo Real de la Polimerasa , República de Corea , Ritonavir/uso terapéutico , Carga Viral
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