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1.
Nutrients ; 13(9)2021 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-34579084

RESUMO

Although body mass index (BMI) is a potential risk factor for bronchiectasis in young adults, the association between BMI and incident bronchiectasis has not been well elucidated. This study included 6,329,838 individuals aged 20-40 years from the Korean National Health Insurance Service database 2009-2012 who were followed up until the date of the diagnosis of bronchiectasis, death, or 31 December 2018. We evaluated the incidence and risk of bronchiectasis according to the BMI category. The incidence rate of bronchiectasis increased as BMI decreased in a dose-dependent manner (p for trend <0.01). In multivariable Cox regression analysis, being underweight was an independent risk factor for the development of bronchiectasis, with a hazard ratio of 1.24 (95% confidence interval, 1.19-1.30) compared to being normal weight. In subgroup analysis, the effect of being underweight on the development of bronchiectasis was more evident in males and older individuals (30-40 years) than females and younger individuals (20-29 years), respectively (p for interaction <0.01 for both). These results remained significant in subgroup analysis in which subjects with comorbidities related to being underweight were excluded. Being underweight may be a novel risk factor for the development of bronchiectasis in young adults.


Assuntos
Bronquiectasia/epidemiologia , Bronquiectasia/etiologia , Adulto , Bases de Dados Factuais , Feminino , Humanos , Incidência , Masculino , Análise Multivariada , República da Coreia/epidemiologia , Fatores de Risco , Adulto Jovem
2.
Br J Hosp Med (Lond) ; 82(7): 1-9, 2021 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-34338026

RESUMO

Bronchiectasis is a common respiratory condition, characterised by abnormal bronchial dilatation, that often leads to recurrent airway infection and inflammation. It is an increasingly recognised respiratory condition, both as a primary lung disease but also co-existing with other respiratory diseases, such as chronic obstructive pulmonary disease and asthma. Diagnosis can have important treatment implications. There are shared systematic approaches to treatment, such as sputum clearance techniques, prompt treatment of exacerbations and, in certain circumstances, regular antibiotic therapy. It is vital to target antibiotic therapy appropriately, and knowledge of the patient's airway microbiology can assist with this. Certain infective and colonising organisms, such as Pseudomonas aeruginosa, cause worse patient outcomes and so need prompt treatment with appropriate antibiotics. In addition to this general management approach, there are many different underlying causes of bronchiectasis that should be identified wherever possible, to support more targeted therapy and prevent disease progression. This article provides a guide to the key principles of diagnosing and managing bronchiectasis, and outlines situations where more specialist respiratory support is required.


Assuntos
Bronquiectasia , Infecções por Pseudomonas , Antibacterianos/uso terapêutico , Bronquiectasia/diagnóstico , Bronquiectasia/etiologia , Bronquiectasia/terapia , Humanos , Infecções por Pseudomonas/complicações , Infecções por Pseudomonas/diagnóstico , Infecções por Pseudomonas/tratamento farmacológico , Pseudomonas aeruginosa , Sistema Respiratório
3.
Semin Arthritis Rheum ; 51(5): 1067-1080, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34450505

RESUMO

OBJECTIVES: We performed a systematic review and meta-analysis for the prevalence and risk factors of rheumatoid arthritis-related bronchiectasis (RA-BR). METHODS: We queried PubMed and EMBASE databases to identify published literature related to prevalence and risk factors for RA-BR among patients with RA. Data extraction included study design, country, year, method of RA-BR detection, RA characteristics, numerator of RA-BR cases and denominator of patients with RA, and associations with RA-BR presence. We performed a meta-analysis using random or fixed effects models to estimate the prevalence of RA-BR among RA. RESULTS: Out of a total of 253 studies, we identified 41 total studies that reported on prevalence (n = 34), risk factors (n = 5), or both (n = 2). The included studies had heterogeneous methods to identify RA-BR. Among the 36 studies reporting prevalence, 608 RA-BR cases were identified from a total of 8569 patients with RA. In the meta-analysis, the pooled overall prevalence of RA-BR among RA was 18.7% (95%CI 13.7-24.3%) using random effects and 3.8% (95%CI 3.3-4.2%) using fixed effects. Among studies that used high-resolution chest computed tomography (HRCT) imaging, the prevalence of RA-BR was 22.6% (95%CI 16.8-29.0%) using random effects. When only considering retrospective studies (n = 12), the pooled prevalence of RA-BR among RA was 15.5% (95%CI 7.5-25.5%); among prospective studies (n = 24), the pooled prevalence was 20.7% (95% CI 14.7-27.4%). Risk factors for RA-BR included older age, longer RA duration, genetics (CFTR and HLA), and undetectable circulating mannose binding lectin (MBL) as a biomarker. CONCLUSION: In this systematic review and meta-analysis, the prevalence of RA-BR was nearly 20% among studies with HRCT imaging, suggesting that bronchiectasis may be a common extra-articular feature of RA. Relatively few factors have been associated with RA-BR. Future studies should standardize methods to identify RA-BR cases and investigate the natural history and clinical course given the relatively high prevalence among RA.


Assuntos
Artrite Reumatoide , Bronquiectasia , Idoso , Artrite Reumatoide/complicações , Artrite Reumatoide/diagnóstico por imagem , Artrite Reumatoide/epidemiologia , Bronquiectasia/diagnóstico por imagem , Bronquiectasia/epidemiologia , Bronquiectasia/etiologia , Humanos , Prevalência , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Risco
4.
Pediatr Pulmonol ; 56(9): 3026-3034, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34265867

RESUMO

BACKGROUND: Noncystic fibrosis bronchiectasis (NCFB) is still considered an "orphan disease" in pediatric age. OBJECTIVE: The study describes the clinical and functional features, the instrumental, and microbial findings of a large cohort of patients with NCFB, followed in a single tertiary level hospital. METHODS: Children and adolescents diagnosed with NCFB from January 1, 2010 to December 31, 2019 were included. Data from the diagnosis and during the years of follow-up were recorded retrospectively. RESULTS: One hundred and thirty-eight patients were enrolled. The most common cause of NCFB was postinfectious (33%), followed by primary ciliary dyskinesia (PCD) (30%), esophageal atresia (EA) (9.5%), and secondary immunodeficiency (9.5%). Chronic cough was the most frequent symptom. The median age of symptoms presentation was 3 years (interquartile age [IQR]: 12-84), with a precocious onset in PCD and EA groups. The median age of CT diagnosis was 9 years for all groups but PCD patients who were diagnosed at older age. Lingula, medium, upper, and lower lobes were more involved in PCD group, while diffuse distribution was observed in the postinfectious one. Microbial exams showed Pseudomonas aeruginosa colonization higher in PCD patients (22%). Despite microbial differences in airways colonization, no difference in respiratory exacerbation rate was recorded among groups. Lung function tests demonstrated the stability of forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) over time, except for the secondary immunodeficiency group. CONCLUSIONS: The role of infections in developed countries should not be underestimated and a major effort to obtain an earlier identification of bronchiectasis should be taken. A prompt diagnosis of NFCB could help to reduce the frequency of exacerbations and improve the stability of lung function over time.


Assuntos
Bronquiectasia , Adolescente , Idoso , Bronquiectasia/diagnóstico , Bronquiectasia/epidemiologia , Bronquiectasia/etiologia , Criança , Pré-Escolar , Fibrose , Seguimentos , Volume Expiratório Forçado , Humanos , Estudos Retrospectivos
5.
Zentralbl Chir ; 146(3): 346-358, 2021 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-34154019

RESUMO

Bronchiectasis is a mostly irreversible bronchial dilatation induced by a destruction of elastic and muscular fibers of the bronchial wall. Radiological criteria of bronchiectasis are met, when the inner diameter of the bronchial wall surpasses the outer diameter of the accompanying pulmonary artery. Its incidence increases with age, even though it often lacks true clinical signs of disease. Only when it is accompanied by cough, expectorations and recurring bronchopulmonary infections, it can be considered a true bronchiectatic disease. Cystic fibrosis (CF) is one of its preeminent triggers, but certainly plays a particular role in this entity, which is why the terminus of "non-CF-bronchiectasis" was coined in the first place.Multidisciplinary management consists in extensive diagnostic work-up, treatment of potential triggers of bronchiectasis and supportive care in form of vaccination programs, secretolysis and pulmonary rehabilitation, as well as antibiotic treatment of pulmonary exacerbations.Surgical treatment has to be considered a last resort in case of hemoptysis, recurring severe pneumonia or secondary aspergilloma with complete resection of all pathological findings, ideally by minimally-invasive approach.


Assuntos
Bronquiectasia , Fibrose Cística , Bronquiectasia/diagnóstico , Bronquiectasia/etiologia , Bronquiectasia/terapia , Fibrose , Humanos , Pulmão , Recidiva Local de Neoplasia
6.
AJR Am J Roentgenol ; 217(2): 304-313, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34076456

RESUMO

OBJECTIVE. Cystic fibrosis (CF) is a multisystemic life-limiting disorder. The leading cause of morbidity in CF is chronic pulmonary disease. Chest CT is the reference standard for detection of bronchiectasis. Cumulative ionizing radiation limits the use of CT, particularly as treatments improve and life expectancy increases. The purpose of this article is to summarize the evidence on low-dose chest CT and its effect on image quality to determine best practices for imaging in CF. CONCLUSION. Low-dose chest CT is technically feasible, reduces dose, and renders satisfactory image quality. There are few comparison studies of low-dose chest CT and standard chest CT in CF; however, evidence suggests equivalent diagnostic capability. Low-dose chest CT with iterative reconstructive algorithms appears superior to chest radiography and equivalent to standard CT and has potential for early detection of bronchiectasis and infective exacerbations, because clinically significant abnormalities can develop in patients who do not have symptoms. Infection and inflammation remain the primary causes of morbidity requiring early intervention. Research gaps include the benefits of replacing chest radiography with low-dose chest CT in terms of improved diagnostic yield, clinical decision making, and patient outcomes. Longitudinal clinical studies comparing CT with MRI for the monitoring of CF lung disease may better establish the complementary strengths of these imaging modalities.


Assuntos
Fibrose Cística/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adulto , Bronquiectasia/diagnóstico por imagem , Bronquiectasia/etiologia , Fibrose Cística/complicações , Feminino , Humanos , Pulmão/diagnóstico por imagem , Masculino , Doses de Radiação , Adulto Jovem
8.
Ned Tijdschr Geneeskd ; 1652021 03 04.
Artigo em Holandês | MEDLINE | ID: mdl-33720564

RESUMO

Esophageal atresia is a rare congenital anomaly. Due to increased survival rates, the population of adults born with this malformation is growing. These patients turn out to have an increased risk to develop Barrett's esophagus, esophageal carcinoma or lung abnormalities like bronchiectasis. This is illustrated by three cases: a 42-year-old man with an irresectable esophageal squamous cell carcinoma; a 23-year-old man with a Barrett's esophagus without any reflux complaints; and a 51-year-old women with a reflux esophagitis and extensive bronchiectasis due to a combination of gastroesophageal reflux with chronic aspiration and a reduced sputum clearance because of a history of tracheomalacia. It is important for healthcare providers to be aware of these risks and the possible absence of symptoms, in order to detect abnormalities at an early stage and improve quality of life of these patients.


Assuntos
Esôfago de Barrett/etiologia , Bronquiectasia/etiologia , Atresia Esofágica/complicações , Neoplasias Esofágicas/etiologia , Carcinoma de Células Escamosas do Esôfago/etiologia , Esofagite/etiologia , Adulto , Esôfago/patologia , Feminino , Refluxo Gastroesofágico/complicações , Humanos , Pulmão/patologia , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Sobreviventes , Adulto Jovem
9.
Adv Respir Med ; 89(1): 15-22, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33660244

RESUMO

INTRODUCTION: Pulmonary rehabilitation (PR) is an effective approach for patients with chronic pulmonary disease, and it is also recommended for patients with bronchiectasis. The aims of the current study were to evaluate the efficacy of a multidisciplinary PR program and identify factors associated with improvement in patients with bronchiectasis. Material and ethods: We obtained data from patients with bronchiectasis who completed our PR program which consisted of education and training regarding bronchial hygiene. Pulmonary function test results, body composition, exercise capacity, quality of life, and psychological status were assessed before and after the PR program. RESULTS: We enrolled 130 patients in this retrospective study. Most patients had a history of pneumonia. The Medical Research Council (MRC) dyspnea scale, incremental shuttle walking test (ISWT), endurance shuttle walking test (ESWT), St. George's Respiratory Questionnaire (SGRQ), Chronic Respiratory Questionnaire (CRQ), and Hospital Anxiety and Depression (HAD) scores statistically improved after the PR program (all p < 0.001). Improvements were similar regardless of sex, etiology, smoking sta-tus, or number of hospitalizations. Age was negatively correlated with ΔSGRQ (p = 0.024, r = -0.203). Baseline forced expiratory volume in 1s (FEV1) was positively correlated with ΔCRQ (p = 0.015, r = 0.213) and negatively correlated with Δanxiety (p = 0.014, r = -0.215). Baseline MRC was negatively correlated with ΔMRC (p < 0.001, r = -0.563) and ΔSGRQ (p < 0.001, r = -0.308). Baseline ISWT was negatively correlated with ΔISWT (p = 0.043, r = -0.176) and Δanxiety (p = 0.007, r = -0.237). Baseline SGRQ was negatively correlated with ΔMRC (p = 0.003, r = -0.267) and ΔSGRQ (p < 0.001, r = -0.648). CONCLUSIONS: Our PR program is efficacious for patients with bronchiectasis regardless of sex, etiologic cause of bronchiectasis, concomitant chronic obstructive pulmonary disease, smoking status, and/or number of hospitalizations. Improvement varied among patients which highlights the need for more studies to determine which patients will benefit most from the program.


Assuntos
Bronquiectasia/reabilitação , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Doença Pulmonar Obstrutiva Crônica/reabilitação , Perfil de Impacto da Doença , Adulto , Bronquiectasia/etiologia , Tolerância ao Exercício , Feminino , Estado Funcional , Humanos , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Testes de Função Respiratória , Estudos Retrospectivos
11.
Int J Mol Sci ; 22(4)2021 Feb 03.
Artigo em Inglês | MEDLINE | ID: mdl-33546487

RESUMO

Quercetin (QUE)-a plant-derived flavonoid, is recently established as an effective quorum sensing (QS) inhibiting agent in Pseudomonas aeruginosa-the main bacterial pathogen in bronchiectasis lungs. Successful clinical application of QUE, however, is hindered by its low solubility in physiological fluids. Herein we developed a solubility enhancement strategy of QUE in the form of a stable amorphous nanoparticle complex (nanoplex) of QUE and chitosan (CHI), which was prepared by electrostatically driven complexation between ionized QUE molecules and oppositely charged CHI. At its optimal preparation condition, the QUE-CHI nanoplex exhibited a size of roughly 150 nm with a 25% QUE payload and 60% complexation efficiency. The complexation with CHI had no adverse effect on the antibacterial and anticancer activities of QUE, signifying the preservation of QUE's bioactivities in the nanoplex. Compared to the native QUE, the QUE-CHI nanoplex exhibited superior QS inhibition in suppressing the QS-regulated swimming motility and biofilm formation of P. aeruginosa, but not in suppressing the virulence factor production. The superior inhibitions of the biofilm formation and swimming motility afforded by the nanoplex were attributed to (1) its higher kinetic solubility (5-times higher) that led to higher QUE exposures, and (2) the synergistic QS inhibition attributed to its CHI fraction.


Assuntos
Antibacterianos/química , Antibacterianos/farmacologia , Percepção de Quorum/efeitos dos fármacos , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Antineoplásicos/química , Antineoplásicos/farmacologia , Biofilmes/efeitos dos fármacos , Bronquiectasia/tratamento farmacológico , Bronquiectasia/etiologia , Fenômenos Químicos , Quitosana/química , Portadores de Fármacos/química , Humanos , Concentração de Íons de Hidrogênio , Testes de Sensibilidade Microbiana , Estrutura Molecular , Nanopartículas/química , Tamanho da Partícula , Infecções por Pseudomonas/complicações , Infecções por Pseudomonas/tratamento farmacológico , Infecções por Pseudomonas/microbiologia , Pseudomonas aeruginosa/efeitos dos fármacos , Doença Pulmonar Obstrutiva Crônica/complicações , Quercetina/química , Solubilidade , Análise Espectral
13.
Chron Respir Dis ; 18: 1479973121994565, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33590765

RESUMO

Rheumatoid arthritis (RA) is a chronic autoimmune disease primarily affecting joints but often also associated with lung involvement such as bronchiectasis (BE). The aim of the present systematic review and meta-analysis is to provide an update on the current evidence regarding the prevalence and association between RA and BE. This systematic review and meta-analysis was performed in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines with literature search using the terms 'Bronchiectasis AND Rheumatoid Arthritis' without a date limitation on PubMed during May 2020. A total of 28 studies fulfilled the predefined criteria and were included in the present review, with 19 being cross-sectional studies. Twenty-three studies were included in the meta-analysis. The pooled prevalence estimate was 2.69% (95% CI 1.63-4.42) in clinically defined BE, and 24.9% (95% CI 19.21-31.67) in radiologic disease. Many inconsistencies exist regarding potential risk factors for BE in RA patients such as gender, RA duration and severity, as both negative and positive associations have been reported. Although very little is known about possible causative mechanisms between RA and BE, potential pathways might be antigenic stimulation from pulmonary mucus and/or systemic inflammation from joint disease affecting the lungs. At present, the available evidence of bronchiectasis in patients with RA is insufficient to identify RA-associated risk factors for the development of BE, possibly apart from duration of RA, and, consequently, also to fully explore a possible causal relationship between the two disease. However, the increased prevalence of BE in RA patients warrants further studies to explore the association between RA and BE.


Assuntos
Artrite Reumatoide , Bronquiectasia , Artrite Reumatoide/complicações , Artrite Reumatoide/epidemiologia , Bronquiectasia/epidemiologia , Bronquiectasia/etiologia , Estudos Transversais , Humanos , Fatores de Risco
17.
Exp Biol Med (Maywood) ; 246(3): 275-280, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33241711

RESUMO

Bronchiectasis is a chronic airway disease with abnormal and persistent bronchial dilatation caused by a variety of reasons. In recent years, numerous reports have shown that bronchiectasis is heterogeneous, the clinical characteristics of patients with different phenotypes are different, and the efficacy of a treatment regimen may vary greatly in patients with different bronchiectasis phenotypes. This paper summarizes the current clinical phenotypic classification of bronchiectasis from the perspective of etiology, microbiology, and the frequency of acute exacerbation, and cluster analysis was used to determine new clinical phenotypes and their statistical and clinical significance. Different tools for assessing disease severity yield different outcomes. This article summarizes the research progress in the above areas, hoping to provide a more comprehensive understanding of the disease.


Assuntos
Brônquios/patologia , Bronquiectasia , Bronquiectasia/etiologia , Bronquiectasia/patologia , Bronquiectasia/terapia , China , Humanos , Pneumopatias/microbiologia , Lesão Pulmonar/patologia , Fenótipo , Doença Pulmonar Obstrutiva Crônica/patologia , Índice de Gravidade de Doença
18.
Isr Med Assoc J ; 22(12): 794-799, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33381955

RESUMO

BACKGROUND: For most passengers, even those with respiratory disease, air travel is safe and comfortable. Some travelers may experience hypoxia at sea level but may not need supplemental oxygen during air travel in a hypobaric hypoxic environment. For some individuals compensatory pulmonary mechanisms may be inadequate, causing profound hypoxia. In addition, venous thromboembolism/pulmonary emboli may occur, especially during long haul flights. With adequate screening, patients at risk can be identified, therapeutic solutions can be proposed for the flight, and most can travel can continue safely with supplemental oxygen and other preventive measures.


Assuntos
Aeronaves , Doenças Respiratórias/etiologia , Astenia/etiologia , Bronquiectasia/etiologia , COVID-19/etiologia , Humanos , Doença Pulmonar Obstrutiva Crônica/etiologia , Viagem
19.
Arch. argent. pediatr ; 118(6): S164-S182, dic 2020. tab, ilus
Artigo em Espanhol | LILACS, BINACIS | ID: biblio-1146240

RESUMO

Las bronquiectasias se encuentran dentro del espectro de enfermedad pulmonar crónica caracterizada por la dilatación bronquial progresiva y, a menudo, irreversible, causada por cambios estructurales en la pared bronquial e inflamación crónica de las vías respiratorias. El síntoma cardinal es la tos crónica persistente húmeda y productiva, que debe alertar para realizar una intervención oportuna e interrumpir el ciclo de inflamación, infección y daño de la vía aérea. Un diagnóstico precoz a través de la tomografía axial computarizada de alta resolución de tórax y el monitoreo clínico facilitan la implementación de un tratamiento intensivo que reduce y minimiza el daño de la vía aérea. Si bien las acciones terapéuticas actuales para el manejo de bronquiectasias son efectivas, existen pocos estudios clínicos aleatorizados en pediatría. El objetivo del documento es proporcionar una actualización sobre el diagnóstico, seguimiento y tratamiento de las bronquiectasias no relacionadas con fibrosis quística en niños


Bronchiectasis is within the spectrum of chronic lung disease characterized by progressive and often irreversible bronchial dilation caused by structural changes in the bronchial wall and chronic inflammation of the airways. The cardinal symptom is persistent moist and productive chronic cough that should alert to timely intervention and interrupt the cycle of inflammation, infection, and airway damage. Early diagnosis through high-resolution computed tomography of the chest and clinical monitoring facilitate the implementation of intensive treatment that reduces and minimizes damage to the airway. Although current therapeutic actions for the management of bronchiectasis are effective, there are few randomized clinical trials in pediatrics. The objective of the document is to provide an update on the diagnosis, monitoring and treatment of bronchiectasis not related to cystic fibrosis in children


Assuntos
Humanos , Masculino , Feminino , Criança , Bronquiectasia/diagnóstico , Sinais e Sintomas , Bronquiectasia/complicações , Bronquiectasia/etiologia , Bronquiectasia/terapia , Bronquiectasia/epidemiologia , Assistência ao Convalescente
20.
Chest ; 158(5): e245-e249, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33160546

RESUMO

CASE PRESENTATION: A 48-year-old woman sought a second opinion for dyspnea and chronic productive cough; she was a never smoker. Mild respiratory symptoms persisted since childhood and had progressively worsened over the previous decade. In addition, an unintentional 30-pound weight loss had occurred over several years. Six years previously, a diagnosis of hypersensitivity pneumonitis was made following right upper lobe wedge resection that revealed chronic bronchiolitis with interstitial pneumonia and non-necrotizing granulomatous inflammation. Subsequent use of prednisone elicited mild intermittent improvement. She had used feather pillows in the past without any other significant exposures. There were no reports of sinus or GI symptoms.


Assuntos
Alveolite Alérgica Extrínseca/diagnóstico , Aminofenóis/administração & dosagem , Broncoscopia/métodos , Cefazolina/administração & dosagem , Regulador de Condutância Transmembrana em Fibrose Cística/genética , Fibrose Cística , Quinolonas/administração & dosagem , Infecções Estafilocócicas , Antibacterianos/administração & dosagem , Bronquiectasia/diagnóstico , Bronquiectasia/etiologia , Agonistas dos Canais de Cloreto/administração & dosagem , Fibrose Cística/diagnóstico , Fibrose Cística/fisiopatologia , Fibrose Cística/terapia , Diagnóstico Diferencial , Feminino , Testes Genéticos , Humanos , Transtornos de Início Tardio/diagnóstico , Transtornos de Início Tardio/fisiopatologia , Transtornos de Início Tardio/terapia , Pessoa de Meia-Idade , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/tratamento farmacológico , Staphylococcus aureus/isolamento & purificação , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
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