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1.
Med Clin North Am ; 104(1): 95-108, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31757240

RESUMO

Asthma affects approximately 300 million people worldwide and approximately 7.5% of adults in the United States. Asthma is characterized by inflammation of the airways, variable airflow obstruction, and bronchial hyperresponsiveness. The diagnosis of asthma is a clinical one with the history and physical examination being significant, but objective measures, such as pulmonary function testing, can be used to aid in the diagnosis. There are multiple associated comorbidities with asthma, including rhinitis, sinusitis, gastroesophageal reflux disease, obstructive sleep apnea, and depression. There is often an allergic component of asthma, and patient education is vital.


Assuntos
Asma/epidemiologia , Adulto , Asma/diagnóstico , Depressão/epidemiologia , Refluxo Gastroesofágico/epidemiologia , Humanos , Testes de Função Respiratória , Rinite/epidemiologia , Sinusite/epidemiologia , Apneia Obstrutiva do Sono/epidemiologia , Estados Unidos/epidemiologia
2.
Isr Med Assoc J ; 12(21): 785-789, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31814340

RESUMO

BACKGROUND: Asthma is a common respiratory disease, which is linked to air pollution. However, little is known about the effect of specific air pollution sources on asthma occurrence. OBJECTIVES: To assess individual asthma risk in three urban areas in Israel characterized by different primary sources of air pollution: predominantly traffic-related air pollution (Tel Aviv) or predominantly industrial air pollution (Haifa bay area and Hadera). METHODS: The medical records of 13,875, 16- 19-year-old males, who lived in the affected urban areas prior to their army recruitment and who underwent standard pre-military health examinations during 2012-2014, were examined. Nonparametric tests were applied to compare asthma prevalence, and binary logistic regressions were used to assess the asthma risk attributed to the residential locations of the subjects, controlling for confounders, such as socio-demographic status, body mass index, cognitive abilities, and education. RESULTS: The asthma rate among young males residing in Tel Aviv was 8.76%, compared to 6.96% in the Haifa bay area and 6.09% in Hadera. However, no statistically significant differences in asthma risk among the three urban areas was found in controlled logistic regressions (P > 0.20). This finding indicates that exposure to both industrial- and traffic-related air pollution is associated with asthma prevalence. CONCLUSIONS: Both industrial- and traffic-related air pollution have a negative effect on asthma risk in young males. Studies evaluating the association between asthma risk and specific air pollutants (e.g., sulfur dioxide, particulate matter, and nitrogen dioxide) are needed to ascertain the effects of individual air pollutants on asthma occurrence.


Assuntos
Poluição do Ar , Asma , Exposição Ambiental , Material Particulado , Emissões de Veículos , Adolescente , Poluição do Ar/prevenção & controle , Poluição do Ar/estatística & dados numéricos , Asma/diagnóstico , Asma/epidemiologia , Asma/prevenção & controle , Exposição Ambiental/efeitos adversos , Exposição Ambiental/análise , Humanos , Israel/epidemiologia , Masculino , Determinação de Necessidades de Cuidados de Saúde , Dióxido de Nitrogênio/efeitos adversos , Dióxido de Nitrogênio/análise , Material Particulado/efeitos adversos , Material Particulado/análise , Prevalência , Medição de Risco , Fatores de Risco , Saúde da População Urbana/normas , Saúde da População Urbana/estatística & dados numéricos , Emissões de Veículos/análise , Emissões de Veículos/prevenção & controle , Adulto Jovem
3.
Zhonghua Nei Ke Za Zhi ; 58(11): 826-828, 2019 Nov 01.
Artigo em Chinês | MEDLINE | ID: mdl-31665859

RESUMO

This study aims to explore the diagnostic value of specific immunoglobulin E (sIgE) and specific immunoglobulin G (sIgG) of Aspergillus fumigatus in the diagnosis of allergic broncho-pulmonary aspergillosis (ABPA) and severe asthma with fungal sensitization (SAFS). A total of 17 ABPA patients and 14 SAFS patients were enrolled. The levels of sIgG [2 294.00 (1 527.00, 14 170.00) U/ml vs. 972.60 (650.90, 1 792.00) U/ml] and sIgE [8.77 (1.64, 16.85) kU/L vs. 1.04 (0.70, 2.05) kU/L] in ABPA patients were significantly higher than those in SAFS patients (P<0.05). Aspergillus fumigatus sIgG was strongly correlated with Aspergillus fumigatus sIgE (r(s)=0.797, P<0.001) in ABPA patients. When combined with Aspergillus fumigatus sIgG (>1 000.00 U/mL) and Aspergillus fumigatus sIgE (>1.00 kU/L), the sensitivity was 82.3% and specificity 78.6% for the differential diagnosis of ABPA and SAFS. It demonstrates the diagnostic value of Aspergillus fumigatus sIgG and sIgE.


Assuntos
Aspergilose Broncopulmonar Alérgica/diagnóstico , Aspergillus fumigatus/isolamento & purificação , Asma/complicações , Imunoglobulina E/sangue , Imunoglobulina G/sangue , Anticorpos Antifúngicos/imunologia , Aspergilose Broncopulmonar Alérgica/sangue , Aspergilose Broncopulmonar Alérgica/imunologia , Aspergilose Broncopulmonar Alérgica/microbiologia , Aspergillus fumigatus/imunologia , Asma/sangue , Asma/diagnóstico , Humanos , Imunoglobulina E/imunologia , Imunoglobulina G/imunologia , Índice de Gravidade de Doença
4.
Ther Umsch ; 76(6): 287-292, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31762419

RESUMO

Asthma, COPD or overlap? Symptoms and diagnostic procedures Abstract. Medical history combined with spirometry before and after bronchodilation provides important information, and allows distinguishing between asthma and Chronic obstructive pulmonary disease (COPD) in most of the cases. COPD and asthma are sometimes difficult to discriminate, mainly in older patients with a smoking history and /or history of atopia. Symptoms and the results of diagnostic tests are the basis on which therapeutic decisions are made. Differentiation between asthma and COPD is of great importance because management approaches and goals for these conditions differ. Asthma-COPD-overlap has to be considered if a significant interleave of clinical features of both conditions is identified. If it is not possible to differentiate between the two conditions, ways of additional diagnostic testing are described in this article.


Assuntos
Asma , Doença Pulmonar Obstrutiva Crônica , Idoso , Asma/diagnóstico , Diagnóstico Diferencial , Humanos , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Espirometria
5.
Med. intensiva (Madr., Ed. impr.) ; 43(8): 474-479, nov. 2019. tab
Artigo em Inglês | IBECS | ID: ibc-185884

RESUMO

Purpose: To evaluate the consequences of using nebulized drugs in patients subjected to noninvasive ventilation (NIV) with total face mask (TFM) and helmet. Design: A descriptive analytical study of a prospective patient cohort was carried out. Ambit: Pediatric intensive care unit (PICU) of a tertiary hospital. Patients: Consecutive sampling was used to include all patients admitted to the PICU and requiring NIV with helmet or TFM over a period of 29 months. No patients were excluded. Interventions: Nebulized treatment was added according to medical criteria. Variables of interest: Independent variables were age, sex, diagnosis, disease severity, ventilation parameters and nebulized drugs (if administered). Secondary outcomes were duration and failure of NIV, and length of PICU stay. Results: The most frequent diagnoses were bronchiolitis (60.5%) and asthma (23%). Patients received NIV for a median of 43h. Nebulized drugs were administered in 40% of the cases during NIV, and no adverse effects were registered. Using Bayesian statistics, the calculated probability of suffering an adverse effect was 1.3% with helmet and 0.5% with TFM (high density 95% probability intervals). Patients with helmet and nebulized therapy were in more serious condition than those who did not receive nebulization; nevertheless, no differences were observed regarding the need to change to bilevel modality. With TFM, PICU stay was shorter for the same degree of severity (p=0.033), and the NIV failure rate was higher in patients who did not receive inhaled drugs (p=0.024). Conclusions: The probability of suffering an adverse effect related to nebulization is extremely low when using a helmet or TFM. Inhaled therapy with TFM may shorten PICU stay in some patients


Objetivo: Evaluar las consecuencias de la medicación nebulizada en pacientes con ventilación no invasiva (VNI) con mascarilla facial total (MFT) y casco. Diseño: Estudio analítico descriptivo sobre una cohorte prospectiva de pacientes. Ámbito: UCIP de hospital de tercer nivel. Pacientes: Todos los pacientes ingresados en UCIP (muestreo consecutivo) con VNI con casco o MFT durante 29 meses. No se excluyeron pacientes. Intervenciones: Se añadió tratamiento nebulizado según criterio médico. Variables de interés: Independientes: edad, sexo, diagnóstico, gravedad, parámetros ventilatorios y medicación nebulizada (si se utilizaba). Secundarias: duración, fallo de VNI y estancia en UCIP. Resultados: Los diagnósticos más frecuentes fueron bronquiolitis (60,5%) y asma (23%). La mediana de conexión a VNI fue de 43 horas. Se administraron nebulizaciones durante la VNI en un 40% sin registrarse efectos adversos. La probabilidad calculada de tener un efecto adverso fue 1,3% con casco y 0,5% con MFT (estadística bayesiana, intervalo de probabilidad 95%). Los pacientes con casco y aerosolterapia tenían mayor gravedad que los que no recibieron nebulizaciones, sin encontrarse diferencias en la necesidad de cambiar a modalidad con doble nivel de presión. En los pacientes con MFT la estancia en UCIP fue menor (p=0,033) a pesar de no existir diferencias en el nivel de gravedad; la tasa de fallo de VNI fue mayor en los que no recibieron nebulizaciones (p=0,024). Conclusiones: La probabilidad de tener un efecto adverso relacionado con la nebulización es baja utilizando casco o MFT. La terapia inhalada con MFT puede disminuir la estancia en UCIP en algunos pacientes


Assuntos
Humanos , Lactente , Segurança do Paciente , Aerossóis/uso terapêutico , Respiração Artificial/métodos , Máscaras Faciais , Estudos Prospectivos , Unidades de Terapia Intensiva , Bronquiolite/diagnóstico , Asma/diagnóstico , Análise Multivariada
6.
Evid. actual. práct. ambul ; 22(3): e002021, nov. 2019.
Artigo em Espanhol | LILACS | ID: biblio-1047108

RESUMO

Una joven de 23 años con asma leve intermitente se presenta a la consulta médica. Se plantea cuál es la mejor alternativa para su tratamiento: el uso de broncodilatadores de acción corta a demanda (SABA, por sus iniciales en inglés) o de broncodilatadores de acción rápida en asociación con corticoides inhalatorios (ICS/FABA, por sus iniciales en inglés) a demanda. Tras revisar la bibliografía se encontraron una revisión sistemática y dos ensayos clínicos que indican que los ICS/FABA serían superiores a los SABA; sin embargo este efecto fue solamente estudiado en casos de asma persistente.Es importante discutir estos hallazgos con los pacientes, junto a sus implicancias económicas, incorporando sus valores y preferencias a la hora de tomar una decisión terapéutica. (AU)


A 23-year-old woman with mild intermittent asthma comes to the doctor's office. The best alternative for treatment is considered: the use of short-acting bronchodilators on demand (SABA) or fast-acting bronchodilators in association with inhaled corticosteroids (ICS/FABA) on demand. After a literature search, a systematic review and two clinical trials werefound, which indicate that the ICS/FABA would be superior to the SABA; however, this effect was only studied in cases of persistent asthma. It is important to discuss these findings with the patients, alongside with their economic implications,incorporating their values and preferences when making a therapeutic decision.


Assuntos
Humanos , Feminino , Lactente , Adulto , Adulto Jovem , Asma/tratamento farmacológico , Broncodilatadores/uso terapêutico , Asma/diagnóstico , Asma/etiologia , Asma/epidemiologia , Sinais e Sintomas Respiratórios , Fatores Socioeconômicos , Broncodilatadores/administração & dosagem , Bronquiolite , Sons Respiratórios , Corticosteroides/uso terapêutico , Tosse , Tomada de Decisões , Dispneia , Adesão à Medicação
7.
Ann Agric Environ Med ; 26(3): 439-444, 2019 Sep 19.
Artigo em Inglês | MEDLINE | ID: mdl-31559800

RESUMO

INTRODUCTION AND OBJECTIVE: An important role in the pathogenesis of asthma in children is played by individual parameters and environmental factors, in particular, those related to the place of residence. The aim of this study was to assess the impact of the living environment on the basic demographic and clinical parameters of preschool children with IgE-dependent asthma. MATERIAL AND METHODS: 176 children (126 from urban and 52 from rural areas) aged 5.22±0.34 years, with newly-diagnosed IgE-dependent asthma, hospitalised at the Clinic for Lung Diseases and Paediatric Rheumatology of the Prof. Antoni Gebala Children's Hospital of Lublin, were qualified for the study. Medical documentation of the children was analysed, including the implementation of vaccinations. Due to the clinical form of the disease, patients were separated into groups with mild, moderate and severe asthma. RESULTS: No statistically significant differentiation was observed between age and current body weight and height of the children. Similarly, gender and the clinical form of asthma were not significantly correlated with the place of residence. Children with asthma, at the time of exacerbation symptoms of the disease, living in a city, significantly more often (p <0.05) were treated with antibiotics in the hospital during hospitalization, while the value of OR (5.08) indicated that the rural environment enforces more frequent use of OGCs during asthma exacerbation therapy. In children from the urban environment, there was a significant correlation between the current body weight and serum calcium concentration, as well as a negative statistically significant correlation between the current body weight and serum selenium concentration. CONCLUSIONS: Residence does not determine the clinical course of IgE-dependent asthma in preschool children.


Assuntos
Asma/diagnóstico , Meio Ambiente , Habitação , Imunoglobulina E/sangue , Asma/sangue , Asma/imunologia , Asma/terapia , Peso Corporal , Cálcio/sangue , Pré-Escolar , Demografia , Feminino , Humanos , Masculino , Selênio/sangue
8.
Rhinology ; 57(6): 430-435, 2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31545327

RESUMO

BACKGROUND: Chronic rhinosinusitis (CRS) and asthma, when comorbid, may influence each other’s disease course and decrease quality of life (QOL). Our objective was to determine if poorer asthma control due to CRS symptoms could be a mechanism for decreased QOL in asthmatic CRS patients. METHODS: A total of 120 asthmatic CRS patients were recruited. CRS symptom burden was measured using the 22-item Sinonasal Outcome Test (SNOT-22) and patient-reported CRS symptom control, general health-related QOL was measured using the visual analog scale of the 5-dimensional EuroQol quality of life survey (EQ-5D VAS), and asthma control was measured using the Asthma Control Test (ACT). Association was sought between these outcome measures. A mediation model was created and validated to show that asthma control mediated the association between CRS symptom burden and decreased general health-related QOL. RESULTS: ACT score was associated with SNOT-22, EQ-5D VAS was associated with SNOT-22 score, and EQ-5D VAS was associated with ACT score. A statistically significant mediation effect for ACT score in the association between SNOT-22 and EQ-5D VAS), which represented 22.1% of the total effect of SNOT-22 on EQ-5D VAS, was identified. Similar findings were made for patientreported CRS symptom control instead of SNOT-22 score. CONCLUSIONS: In asthmatic CRS patients, a sizeable portion of CRS impact on QOL is indirectly mediated through the effect of CRS on poorer asthma control which may then drive decreased QOL.


Assuntos
Asma/terapia , Qualidade de Vida , Sinusite/complicações , Asma/diagnóstico , Asma/epidemiologia , Doença Crônica , Comorbidade , Estudos Transversais , Indicadores Básicos de Saúde , Humanos , Estudos Prospectivos , Rinite/epidemiologia , Inquéritos e Questionários
10.
Praxis (Bern 1994) ; 108(11): 723-727, 2019 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-31480953

RESUMO

The Mysterious Cough - a Case-Based Proposal of Differential Diagnosis Abstract. Cough is a frequent complaint in the general practice. Avoidance of overdiagnosis and underdiagnosis is essential. In case of acute cough or subacute (<8 week duration), red flags indicate the need for further evaluation, otherwise it is mostly self-limiting. In case of chronic cough (>8 week duration) and normal baseline examination and after cessation of smoking and medication with ACE-I, cough-variant asthma, gastro-esophageal reflux disease and upper airway cough syndrome are the main causes and should be assessed and empirically treated in a systematic manner.


Assuntos
Asma , Tosse , Refluxo Gastroesofágico , Asma/complicações , Asma/diagnóstico , Doença Crônica , Tosse/etiologia , Diagnóstico Diferencial , Refluxo Gastroesofágico/complicações , Refluxo Gastroesofágico/diagnóstico , Humanos
11.
Praxis (Bern 1994) ; 108(11): 729-732, 2019 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-31480959

RESUMO

Cough, Sputum, Fever: a Frequent Triad, but Not Always Banal Abstract. We report on a 72-year-old patient with known asthma who developed pneumonia after an infection-triggered exacerbation of the asthma. Based on this example we discuss the recommended diagnostic steps as well as the therapeutic decision and importance of follow-up observation.


Assuntos
Asma , Bronquite , Pneumonia , Idoso , Asma/complicações , Asma/diagnóstico , Bronquite/complicações , Bronquite/diagnóstico , Tosse , Humanos , Pneumonia/diagnóstico , Pneumonia/etiologia , Escarro
13.
Clin Sports Med ; 38(4): 563-575, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31472767

RESUMO

Respiratory symptoms and infections are common among athletes. Viral upper respiratory infection symptoms may precede dyspneic symptoms seen in asthmatics or worsen symptoms of exercise-induced bronchoconstriction Knowing how to instruct an athlete on use of inhalers and having an asthma action plan are critical in management of these athletes. Other life-threatening conditions that may be seen are pneumothorax and laryngeal/pharyngeal perforation. Prompt recognition and treatment are crucial if an athlete is suspected to have pulmonary compromise. Laryngeal/pharyngeal perforations are a rare cause of issues within the training room but require a high degree of suspicion to be diagnosed and managed properly.


Assuntos
Asma/tratamento farmacológico , Broncoconstrição , Exercício/fisiologia , Pneumotórax , Infecções Respiratórias , Volta ao Esporte , Asma/diagnóstico , Humanos , Laringe/lesões , Substâncias para Melhoria do Desempenho , Faringe/lesões , Pneumotórax/diagnóstico , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/terapia , Disfunção da Prega Vocal/diagnóstico , Ferimentos e Lesões/diagnóstico
14.
Eur. respir. j ; 54(3): 1900588, Sept. 2019.
Artigo em Inglês | BIGG | ID: biblio-1026251

RESUMO

This document provides clinical recommendations for the management of severe asthma. Comprehensive evidence syntheses, including meta-analyses, were performed to summarise all available evidence relevant to the Task Force's questions. The evidence was appraised using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach and the results were summarised in evidence profiles. The evidence syntheses were discussed and recommendations formulated by a multidisciplinary Task Force of asthma experts, who made specific recommendations on 6 specific questions. After considering the balance of desirable and undesirable consequences, quality of evidence, feasibility, and acceptability of various interventions, the Task Force made the following recommendations: 1) Suggest using anti-IL5 and anti IL-5Rα for severe uncontrolled adult eosinophilic asthma phenotypes; 2) suggest using blood eosinophil cut-point of ≥150/µL to guide anti-IL5 initiation in adult patients with severe asthma; and 3) Suggest considering specific eosinophil (≥260/µL) and FeNO (≥19.5 ppb) cutoffs to identify adolescents or adults with the greatest likelihood or response to anti-IgE therapy; 4) Suggest using inhaled tiotropium for adolescents and adults with severe uncontrolled asthma despite GINA step 4-5 or NAEPP step 5 therapies; 5) Suggest a trial of chronic macrolide therapy to reduce asthma exacerbations in persistently symptomatic or uncontrolled patients on GINA step 5 or NAEPP step 5 therapies, irrespective of asthma phenotype; 6) Suggest using anti-IL4/13 for adult patients with severe eosinophilic asthma, and for those with severe corticosteroid-dependent asthma regardless of blood eosinophil levels. These recommendations should be reconsidered as new evidence becomes available.


Assuntos
Humanos , Asma/complicações , Asma/diagnóstico , Asma/prevenção & controle , Estado Asmático/prevenção & controle
15.
BMJ Case Rep ; 12(8)2019 Aug 04.
Artigo em Inglês | MEDLINE | ID: mdl-31383679

RESUMO

Acute airway obstruction in pregnancy remains a challenge to manage. Failure of appropriate and timely airway management may lead to maternal morbidity and mortality such as aspiration pneumonitis or worst hypoxaemic cardiopulmonary arrest. 1 As pregnancy may exacerbate asthma attacks, parturient presenting with wheezing or shortness of breath will commonly be treated as suffering from an asthmatic attack. 2 However, it is important to note other possible differential diagnoses. Thyroid disease is relatively common in women of childbearing age. The thyroid gland undergoes several changes during pregnancy, which may lead to altered function as well as gland enlargement and cause upper airway obstruction and symptoms similar to a bronchial asthma attack. 3 4 With that in mind, we report a case of a parturient with long-standing goitre in her second trimester who presented to our institution with acute respiratory symptoms and cardiopulmonary arrest.


Assuntos
Obstrução das Vias Respiratórias/diagnóstico , Asma/diagnóstico , Bócio Subesternal/diagnóstico , Complicações na Gravidez/diagnóstico , Obstrução das Vias Respiratórias/etiologia , Diagnóstico Diferencial , Feminino , Bócio Subesternal/complicações , Humanos , Gravidez , Complicações na Gravidez/etiologia
16.
West Afr J Med ; 36(2): 158-164, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31385602

RESUMO

OBJECTIVE: Previous reports has shown that asthmatic patients with poor asthma control exhibited cognitive dysfunction. However, there is paucity of information on the cognitive functions of patients with clinically stable asthma particularly in sub-Saharan Africa. Subjects, study setting, materials and methods: This was a cross-sectional study conducted at the Federal Medical Centre, Owo, South West Nigeria from 2014-2016. Forty patients with mild to moderate asthma and forty matched (age, sex and educational status) non-asthmatic control subjects were included. Spirometry was done for all participants. Cognitive performance on domains of psychomotor speed, attention/concentration, memory and vigilance were assessed in all the participants using the Fepsy neuropsychological test battery Results: The mean age of the patients with asthma in years was 38.65±16.67 while that of the control subjects was 39.18±11.64 years. The patients with asthma had prolonged visual and binary choice reaction time relative to controls. Older asthmatic patients had prolonged visual and binary choice reaction time when compared to controls (p<0.05) while other socio-demographic clinical characteristics of the patients did not have impact on their cognitive performance (p>0.05). CONCLUSION: Cognitive performance was similar between the patients with mild to moderate asthma and non-asthmatic controls. Older asthmatic patients have impaired psychomotor speed relative to younger asthmatic patients.


Assuntos
Asma/diagnóstico , Transtornos Cognitivos/etiologia , Cognição/fisiologia , Desempenho Psicomotor/fisiologia , Adolescente , Adulto , Fatores Etários , Asma/complicações , Estudos de Casos e Controles , Transtornos Cognitivos/diagnóstico , Estudos Transversais , Humanos , Memória , Pessoa de Meia-Idade , Testes Neuropsicológicos , Nigéria
17.
Stud Health Technol Inform ; 263: 134-145, 2019 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-31411159

RESUMO

This chapter presents an overview of Resilient Health Care (RHC), introducing two aspects of RHC that are important for designing sustainable digital health systems and for considering implementation outcomes: (1) understanding how normal variation in everyday work can affect implementation of digital health interventions, and (2) the role of information systems in coping with unexpected events. The importance of considering how variation in everyday work can lead to wanted and unwanted outcomes when designing information systems is illustrated through a case study of implementation of a telehealth intervention. We examine how normal variation in everyday work can lead to both safety and error, and discuss how consideration of system resilience when designing and implementing health informatics applications can contribute to improving safety for patients in the future. How health information systems can assist organisations in coping with the unexpected is illustrated through a second case study, of a thunderstorm asthma event in Melbourne, Australia. We briefly present the thunderstorm asthma case, and discuss the role of healthcare informatics in preparing for future unexpected events affecting population health.


Assuntos
Sistemas de Informação , Aplicações da Informática Médica , Asma/diagnóstico , Asma/terapia , Austrália , Programas Governamentais , Humanos , Reprodutibilidade dos Testes
18.
Int J Mol Sci ; 20(16)2019 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-31430856

RESUMO

Asthma is a common chronic airway disease worldwide. Due to its clinical and genetic heterogeneity, the cellular and molecular processes in asthma are highly complex and relatively unknown. To discover novel biomarkers and the molecular mechanisms underlying asthma, several studies have been conducted by focusing on gene expression patterns in epithelium through microarray analysis. However, few robust specific biomarkers were identified and some inconsistent results were observed. Therefore, it is imperative to conduct a robust analysis to solve these problems. Herein, an integrated gene expression analysis of ten independent, publicly available microarray data of bronchial epithelial cells from 348 asthmatic patients and 208 healthy controls was performed. As a result, 78 up- and 75 down-regulated genes were identified in bronchial epithelium of asthmatics. Comprehensive functional enrichment and pathway analysis revealed that response to chemical stimulus, extracellular region, pathways in cancer, and arachidonic acid metabolism were the four most significantly enriched terms. In the protein-protein interaction network, three main communities associated with cytoskeleton, response to lipid, and regulation of response to stimulus were established, and the most highly ranked 6 hub genes (up-regulated CD44, KRT6A, CEACAM5, SERPINB2, and down-regulated LTF and MUC5B) were identified and should be considered as new biomarkers. Pathway cross-talk analysis highlights that signaling pathways mediated by IL-4/13 and transcription factor HIF-1α and FOXA1 play crucial roles in the pathogenesis of asthma. Interestingly, three chemicals, polyphenol catechin, antibiotic lomefloxacin, and natural alkaloid boldine, were predicted and may be potential drugs for asthma treatment. Taken together, our findings shed new light on the common molecular pathogenesis mechanisms of asthma and provide theoretical support for further clinical therapeutic studies.


Assuntos
Asma/diagnóstico , Biologia de Sistemas/métodos , Asma/genética , Asma/metabolismo , Asma/patologia , Biomarcadores/análise , Biomarcadores/metabolismo , Regulação da Expressão Gênica , Redes Reguladoras de Genes , Humanos , Mapas de Interação de Proteínas , Transcriptoma
19.
Phys Chem Chem Phys ; 21(35): 19083-19091, 2019 Sep 21.
Artigo em Inglês | MEDLINE | ID: mdl-31432839

RESUMO

The development of new techniques or instruments for detecting and accurately measuring biomarker concentrations in living organisms is essential for early diagnosis of diseases, and for tracking the effectiveness of treatments. In chronic diseases, such as asthma, precise phenotyping can help predict the response of patients to treatments and reduce the risk of complications. Fractional exhaled nitric oxide (FeNO) is a positive biomarker for eosinophilic asthma in humans, and it can be directly detected in the respiratory tract, at very low and volatile concentrations, which makes real-time measurement a challenge. This work describes the first-principles design and characterization of a molecular- and back-gated electronic field-effect transistor device for the detection and measurement of ultra-low FeNO concentrations (pM-nM) from a person' s exhaled breath, as a cost-efficient alternative to the slower and more expensive techniques based on off-line sputum characterization via mass spectrometry. The proposed device uses a partially oxidized phosphorene semiconducting channel material for FeNO detection, allowing nM L-1 concentration measurements of this analyte in an array configuration with an effective sensing surface area of 8.775 µm2, which results in a predicted limit of detection (LOD) of 19 nM L-1. In spite of the limited stability of phosphorene in oxygen-rich and humid environments, the proposed device would be practical for mobile applications with disposable sensors.


Assuntos
Biomarcadores/análise , Testes Respiratórios/instrumentação , Testes Respiratórios/métodos , Óxido Nítrico/análise , Asma/diagnóstico , Expiração , Humanos , Limite de Detecção
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