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MMWR Morb Mortal Wkly Rep ; 68(46): 1081-1086, 2019 Nov 22.
Artigo em Inglês | MEDLINE | ID: mdl-31751322


CDC, the Food and Drug Administration (FDA), state and local health departments, and public health and clinical stakeholders are investigating a nationwide outbreak of e-cigarette, or vaping, product use-associated lung injury (EVALI) (1). CDC has published recommendations for health care providers regarding EVALI (2-4). Recently, researchers from Utah and New York published proposed diagnosis and treatment algorithms for EVALI (5,6). EVALI remains a diagnosis of exclusion because, at present, no specific test or marker exists for its diagnosis, and evaluation should be guided by clinical judgment. Because patients with EVALI can experience symptoms similar to those associated with influenza or other respiratory infections (e.g., fever, cough, headache, myalgias, or fatigue), it might be difficult to differentiate EVALI from influenza or community-acquired pneumonia on initial assessment; EVALI might also co-occur with respiratory infections. This report summarizes recommendations for health care providers managing patients with suspected or known EVALI when respiratory infections such as influenza are more prevalent in the community than they have been in recent months (7). Recommendations include 1) asking patients with respiratory, gastrointestinal, or constitutional symptoms about the use of e-cigarette, or vaping, products; 2) evaluating those suspected to have EVALI with pulse oximetry and obtaining chest imaging, as clinically indicated; 3) considering outpatient management for clinically stable EVALI patients who meet certain criteria; 4) testing patients for influenza, particularly during influenza season, and administering antimicrobials, including antivirals, in accordance with established guidelines; 5) using caution when considering prescribing corticosteroids for outpatients, because this treatment modality has not been well studied among outpatients, and corticosteroids could worsen respiratory infections; 6) recommending evidence-based treatment strategies, including behavioral counseling, to help patients discontinue using e-cigarette, or vaping, products; and 7) emphasizing the importance of annual influenza vaccination for all persons aged ≥6 months, including patients who use e-cigarette, or vaping products.

Surtos de Doenças , Lesão Pulmonar/terapia , Guias de Prática Clínica como Assunto , Vaping/efeitos adversos , Humanos , Lesão Pulmonar/epidemiologia , Estados Unidos/epidemiologia
Disaster Med Public Health Prep ; 7(3): 251-6, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23103394


OBJECTIVE: Following a sudden-onset disaster (SOD), rapid information is needed. We assessed the relevance of information available for relief planning on a main Internet portal following a major SOD. METHODS: We reviewed all information posted on the Reliefweb Web site in the first 7 days following the 2005 South Asian earthquake using a predeveloped registration form focusing on essential indicators. These data were compared with Pakistani government figures posted by the Centre for Research on the Epidemiology of Disasters. RESULTS: A total of 820 reports were reviewed. More reports came from nongovernmental organizations (NGOs; 35%) than any other source. A total of 42% of reports addressed only national level information, while 32% specified information at the provincial level. Fewer than 12% of all reports discussed the earthquake at the more local division and district levels. Only 13 reports provided pre-earthquake estimates of the number of people living in the affected areas. A third of all reports cited a common figure of 2.5 million made homeless. These were lower than official figures of 5 million homeless. A total of 43% reported on the estimated number of deaths. The estimated number peaked on day 4 at 40 000. All of these reports were lower than official data, which reported 73 000 deaths in total. CONCLUSION: Early reports heavily underestimated the number of affected, homeless, injured, and dead. Many reports repeated information provided from previous unnamed sources rather than providing unique contributions from eyewitness reports or from contextual information based on previous work in the area. Better information on predisaster essential indicators should be available and used in combination with post-SOD information to better adapt humanitarian relief and funding according to needs.

Desastres , Terremotos , Internet , Relatório de Pesquisa , Ásia , Determinação de Necessidades de Cuidados de Saúde/estatística & dados numéricos