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2.
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
3.
Georgian Med News ; (290): 48-52, 2019 May.
Artigo em Russo | MEDLINE | ID: mdl-31322514

RESUMO

The recurrent bronchitis (RB) course is caused by the bronchi secretory-evacuation mechanisms state, which provide clearance from pathogens. This mechanism can be disrupted by vegetative reflexes and neuropeptides imbalance that develops in children with the syndrome of the vertebrobasilar arterial system (SVBAS). The objective: study of the neurogenic maintenance of the RB pathogenesis in children with SVBAS by studying the serum content of substances affecting of the bronchial mucosa secretory-evacuation function and inflammatory activity (substance P, vasoactive intestinal peptide - VIP and endothelin-1 - ET-1). 90 children aged 7 to 11 years were examined, 3 observation groups were formed: Group 1 - children with RB and SVBAS (n=30); Group 2 - children with SVBAS without RB (n=30); Group 3 - children with RB without SVBAS (n=30). In the Group 1, compared with the 2nd and 3rd, there was an increase in the children number with high serum content of substance P (by 66.7% and 50.0%, respectively, p<0.05) and ET -1 (by 23.3% and 40.0%, respectively, p<0.05), low content of VIP (by 46.7% and 23.4%, respectively, p<0.05). Children with RB and SVBAS have serum level imbalance of the pro-inflammatory substance P, ET-1 and anti-inflammatory VIP as the bronchitis severe course basis.


Assuntos
Bronquite/diagnóstico , Endotelina-1/sangue , Substância P/sangue , Peptídeo Intestinal Vasoativo/sangue , Insuficiência Vertebrobasilar/diagnóstico , Bronquite/sangue , Criança , Humanos , Insuficiência Vertebrobasilar/sangue
4.
Nat Biotechnol ; 37(7): 783-792, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31235920

RESUMO

The gold standard for clinical diagnosis of bacterial lower respiratory infections (LRIs) is culture, which has poor sensitivity and is too slow to guide early, targeted antimicrobial therapy. Metagenomic sequencing could identify LRI pathogens much faster than culture, but methods are needed to remove the large amount of human DNA present in these samples for this approach to be feasible. We developed a metagenomics method for bacterial LRI diagnosis that features efficient saponin-based host DNA depletion and nanopore sequencing. Our pilot method was tested on 40 samples, then optimized and tested on a further 41 samples. Our optimized method (6 h from sample to result) was 96.6% sensitive and 41.7% specific for pathogen detection compared with culture and we could accurately detect antibiotic resistance genes. After confirmatory quantitative PCR and pathobiont-specific gene analyses, specificity and sensitivity increased to 100%. Nanopore metagenomics can rapidly and accurately characterize bacterial LRIs and might contribute to a reduction in broad-spectrum antibiotic use.


Assuntos
Bactérias/isolamento & purificação , Bronquite/diagnóstico , DNA Bacteriano/genética , Metagenômica/métodos , Nanoporos , Pneumonia Bacteriana/diagnóstico , Antibacterianos/farmacologia , Bactérias/efeitos dos fármacos , Bactérias/genética , Bronquite/microbiologia , Farmacorresistência Bacteriana/genética , Genoma Bacteriano , Sequenciamento de Nucleotídeos em Larga Escala/métodos , Humanos , Projetos Piloto , Pneumonia Bacteriana/microbiologia , Sensibilidade e Especificidade
5.
Photodiagnosis Photodyn Ther ; 27: 85-91, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31082526

RESUMO

The early detection of bronchial inflammation in asthma, through a non-invasive, simple method and under a subclinical state, could lead to a more effective control of this condition. The aim of this study was to identify biomarkers of bronchial inflammation in the saliva of children with asthma through immunoassay and Surface Enhanced Raman Spectroscopy (SERS). We conducted an analytical cross-sectional study in 44 children ages 6-12; the diagnosis of asthma was made according to Global Initiative for Asthma (GINA) standards. The children's saliva was analyzed by immunoassay for the quantification of 37 cytokines, as well as SERS analysis in a confocal Raman microscope at 785 nm. We found a significant association between bronchial obstruction and IL-8 (p = 0.004), IL-10 (p = 0.008) and sCD163 (p = 0.003). The Raman spectra showed significant amplification in the region of 760 to 1750 cm-1. The Principal Component Analysis and Linear Discriminant Analysis (PCA-LDA) method has a sensitivity of 85%, specificity of 82% and an accuracy of 84% for the diagnosis of asthma. These results demonstrate the presence of a subclinical inflammatory state, suggestive of bronchial remodeling in the population studied. The SERS method is a potential tool for identifying bronchial inflammation and its endotype, allowing for a highly sensitive and specific diagnosis.


Assuntos
Asma/diagnóstico , Bronquite/diagnóstico , Citocinas/análise , Saliva/química , Análise Espectral Raman/métodos , Asma/classificação , Asma/fisiopatologia , Biomarcadores , Bronquite/classificação , Bronquite/fisiopatologia , Criança , Estudos Transversais , Diagnóstico Precoce , Feminino , Humanos , Masculino , México , Análise de Componente Principal , Sensibilidade e Especificidade
7.
Rev. medica electron ; 41(2): 445-453, mar.-abr. 2019.
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1004280

RESUMO

RESUMEN La tos crónica en los adultos puede ser causada por muchas causas, existen cuatro principales: el síndrome de tos de la vía aérea superior, enfermedad por reflujo gastroesofágico, reflujo laringofaríngeo, asma bronquial, y bronquitis eosinofílica no asmática. Todos los pacientes deben evaluarse clínicamente con espirometria, y comenzar con tratamiento empírico. Otras causas potenciales incluyen el uso de inhibidores de la enzima convertidora de la angiotensina, cambios medioambientales, uso del tabaco, enfermedad pulmonar obstructiva crónica, y la apnea obstructiva del sueño. La radiografía del tórax puede orientar hacia causas infecciosas, inflamatorias, y malignas. Los pacientes con tos crónica refractaria pueden remitirse a la consulta especializada de un neumólogo u otorrinolaringólogo, además de un ensayo terapéutico con gabapentin, pregabalin, y psicoterapia.


ABSTRACT Although chronic cough in adults can be caused by many etiologies, four conditions account for most cases: upper airway cough syndrome, gastro-esophageal reflux disease, also known as laryngo- pharyngeal reflux disease, bronchial asthma, and non-asthmatic eosinophilic bronchitis. All patients should be evaluated clinically with spirometry, and empiric treatment should be initiated. Other potential causes include angiotensin-converting enzyme inhibitor use, environmental triggers, tobacco use, chronic obstructive pulmonary disease, and obstructive sleep apnea. Chest radiography can rule out concerning infectious, inflammatory, and malignant thoracic conditions. Patients with refractory chronic cough should be referred to a pulmonologist or otolaryngologist in addition to a therapeutic trial of gabapentin, pregabalin, and psychotherapy.


Assuntos
Humanos , Adulto , Doença Crônica/epidemiologia , Medicina Baseada em Evidências , Tosse/diagnóstico , Tosse/etiologia , Tosse/psicologia , Tosse/tratamento farmacológico , Tosse/terapia , Tosse/epidemiologia , Asma/diagnóstico , Bronquite/diagnóstico , Refluxo Gastroesofágico/diagnóstico , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Pregabalina/uso terapêutico , /uso terapêutico
9.
Rev Mal Respir ; 36(3): 405-414, 2019 Mar.
Artigo em Francês | MEDLINE | ID: mdl-30803816

RESUMO

INTRODUCTION: The management of acute lower respiratory tract infections and, in particular, the decision whether or not to commence antibiotic therapy, still remains difficult in the absence of reliable clinical or radiological criteria allowing confident distinction between bacterial and viral infections. Numerous biomarkers have been developed to help the clinician in his/her diagnostic and therapeutic approach, but the role and significance of each has not been clearly defined. BACKGROUND: Though procalcitonin (PCT) or C-reactive protein (CRP) seem equal in helping the clinician to decide whether to commence antibiotic therapy or not during the course of an exacerbation of asthma or chronic obstructive pulmonary disease (COPD), PCT is currently the most useful biomarker to distinguish sepsis from other causes of inflammation and to determine the bacterial or viral origin of a pneumonia. OUTLOOK: The ability of PCT to reduce the global exposure to antibiotics remains uncertain and the results of randomised trials are contradictory. CONCLUSIONS: Prescription algorithms involving PCT may be used without increased risk for patients even though clinical signs of severity remain important. Changes in PCT also have a prognostic value in identifying those patients with unfavourable outcome.


Assuntos
Biomarcadores/análise , Infecções Respiratórias/terapia , Doença Aguda , Biomarcadores/sangue , Bronquite/diagnóstico , Bronquite/microbiologia , Bronquite/terapia , Proteína C-Reativa/análise , Progressão da Doença , Hospitalização , Humanos , Monitorização Fisiológica/métodos , Valor Preditivo dos Testes , Pró-Calcitonina/análise , Pró-Calcitonina/sangue , Prognóstico , Infecções Respiratórias/sangue , Infecções Respiratórias/diagnóstico
10.
Rev Mal Respir ; 36(1): 63-68, 2019 Jan.
Artigo em Francês | MEDLINE | ID: mdl-30429094

RESUMO

INTRODUCTION: Bronchial mould infection or plastic bronchitis is a rare condition, encountered at any age, but with a predilection for childhood. The clinical diagnosis is made easy by the demonstration of solid, branched expectorations. However, the aetiology is not easy to determine and investigation does not often lead to a pathological diagnosis. CASE REPORT: We report the case of a 24 year-old patient, with a history of pulmonary tuberculosis in January 2016, who had had chronic, persistent, solid and branched expectorations since January 2015. Fibreoptic bronchoscopy revealed thick white secretions plugging the bronchi. Pathological examination of the bronchial plugs showed fibrous tissue infiltrated with predominantly lymphoplasmocytic and histiocytic inflammatory cells. Investigations carried out on the pleura did not establish the aetiological diagnosis. The diagnosis of bronchial mould disease of tuberculous origin complicated by pleurisy was established. Corticosteroid therapy led to a complete regression of the moulds within six weeks. CONCLUSION: The presence of solid and branched sputum should suggest fungal bronchitis and is an indication for bronchoscopy for diagnostic and therapeutic purposes. Early management is important to avoid complications.


Assuntos
Brônquios/patologia , Bronquite/diagnóstico , Empiema Pleural/etiologia , Tuberculose Pulmonar/complicações , Adulto , Antibacterianos/uso terapêutico , Brônquios/microbiologia , Bronquite/tratamento farmacológico , Bronquite/etiologia , Broncoscopia/métodos , Diagnóstico Diferencial , Empiema Pleural/tratamento farmacológico , Glucocorticoides/uso terapêutico , Humanos , Masculino , Escarro/microbiologia , Tomografia Computadorizada por Raios X , Tuberculose Pulmonar/tratamento farmacológico
11.
Am J Emerg Med ; 37(3): 486-488, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30471932

RESUMO

OBJECTIVE: We studied the impact four new urgent care centers (UCCs) had on a hospital emergency department (ED) in terms of overall census and proportion of low acuity diagnoses from 2009 to 2016. We hypothesized that low acuity medical problems frequently seen in UCCs would decrease in the ED population. Since Medicaid was not accepted at these UCCs, we also studied the Medicaid vs non-Medicaid discharged populations to see if there were some differences related to access to urgent care. METHODS: We conducted a retrospective review of computerized billing data. We included all patients from 2009 to 2016 who were seen in the ED. We used the Cochran-Armitage Trend Test to examine trends over time. RESULTS: As hypothesized, the proportion of ED patients with a diagnosis of pharyngitis decreased significantly over this time period from 1% to 0.6% (p < 0.0001). The rate of bronchitis in the total ED population also decreased significantly (0.5% to 0.13%, p < 0.0001).When we looked at the discharged patients with and without Medicaid, we found that significantly more Medicaid than non-Medicaid patients presented with pharyngitis to the ED with an increasing trend from 2009 to 2016: OR = 2.33, p < 0.0001. The overall census of the ED rose over the period 2009 to 2016 (80,478 to 85,278/year). Overall admission rates decreased significantly: 36.9% to 34.5% (p < 0.0001). CONCLUSION: With the introduction of four new urgent care centers (UCCs) within 5 miles of the hospital, the ED diagnoses of pharyngitis and bronchitis, two of the most common diagnoses seen in UCCs, decreased significantly. Significantly more Medicaid discharged patients presented to the ED with pharyngitis than in the non-Medicaid discharged group, likely because Medicaid patients had no access to UCCs.


Assuntos
Instituições de Assistência Ambulatorial/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Utilização de Instalações e Serviços , Acesso aos Serviços de Saúde , Gravidade do Paciente , Bronquite/diagnóstico , Feminino , Humanos , Masculino , Medicaid , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Faringite/diagnóstico , Estudos Retrospectivos , Estados Unidos
12.
Paediatr Respir Rev ; 31: 75-81, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30584049

RESUMO

When children have a wet cough, it suggests the presence of secretions in their airways. This often has an infectious aetiology which is usually a self-limiting viral infection requiring no investigation or treatment. In those with acute wet cough it is, however, important to identify features suggestive of community acquired pneumonia or an inhaled foreign body as these causes require specific management. When there is chronic wet cough, the most common diagnoses are protracted bacterial bronchitis (PBB) and bronchiectasis. The relationship between these two conditions is complex as the development of bronchiectasis manifests as a clinical continuum in which the early features of which are indistinguishable from PBB. It is therefore important to identify PBB and chronic cough endotypes which are associated with an increased risk of bronchiectasis. This article offers a pragmatic approach to the investigation and treatment of children with wet cough. It is hoped this will limit unnecessary investigations whist aiding the prompt diagnosis of conditions needing treatment to reduce symptom burden and prevent further lung damage.


Assuntos
Bronquiectasia/diagnóstico , Bronquite/diagnóstico , Infecções Comunitárias Adquiridas/diagnóstico , Tosse/diagnóstico , Corpos Estranhos/diagnóstico , Pneumonia Bacteriana/diagnóstico , Sistema Respiratório , Viroses/diagnóstico , Doença Aguda , Antibacterianos/uso terapêutico , Bronquiectasia/terapia , Bronquite/terapia , Criança , Doença Crônica , Infecções Comunitárias Adquiridas/terapia , Tosse/terapia , Diagnóstico Diferencial , Corpos Estranhos/terapia , Humanos , Pneumonia Bacteriana/terapia , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/terapia , Viroses/terapia
13.
BMC Med Res Methodol ; 18(1): 149, 2018 11 22.
Artigo em Inglês | MEDLINE | ID: mdl-30466396

RESUMO

BACKGROUND: Bronchiolitis is a common respiratory disorder in children. Although there are specific ICD-9-CM diagnosis codes for bronchiolitis, the illness is often coded using broader diagnosis codes. This creates the potential for subject misclassification if researchers rely on specific diagnosis codes when assembling retrospective cohorts. Here we challenge the common research practice of relying on specific diagnosis codes for bronchiolitis. METHODS: We examined the use of diagnosis codes for the first episode of bronchiolitis, bronchitis, acute asthma, and bronchospasm and wheezing, in children younger than six and 24 months in the State of California Medic-Aid database. We categorized codes as narrow or broad diagnosis codes. We compared patient, geographic, and temporal characteristics of the different diagnoses codes. RESULTS: We identified visits from 48,732 children for first episode of wheezing illness. We retained 48,269 who had the diagnosis codes and data of interest. Diagnosis codes for acute asthma were widely used, even in children younger than six months in whom a diagnosis code for bronchiolitis would have been anticipated. The temporal pattern was similar across all diagnoses. Antipyretics were prescribed more often in those with diagnosis codes for bronchiolitis and bronchitis. Other statistically significant differences were too small to usefully distinguish the groups. There was substantial geographic variability in the diagnosis codes selected. CONCLUSION: Users of Medic-Aid administrative data should generally favor broad rather than narrow definitions of bronchiolitis and should perform sensitivity analysis comparing broad and narrow definitions.


Assuntos
Bronquiolite/diagnóstico , Classificação Internacional de Doenças , Administradores de Registros Médicos/estatística & dados numéricos , Pesquisa , Asma/diagnóstico , Bronquite/diagnóstico , California , Bases de Dados Factuais/estatística & dados numéricos , Feminino , Humanos , Lactente , Masculino , Medicaid/estatística & dados numéricos , Estudos Retrospectivos , Estados Unidos
14.
Clin Chest Med ; 39(4): 785-796, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30390749

RESUMO

Ventilator-associated tracheobronchitis (VAT) might represent an intermediate process between lower respiratory tract colonization and ventilator-associated pneumonia (VAP), or even a less severe spectrum of VAP. There is an urgent need for new concepts in the arena of ventilator-associated lower respiratory tract infections. Ideally, the gold standard of care is based on prevention rather than treatment of respiratory infection. However, despite numerous and sometimes imaginative efforts to validate the benefit of these measures, most clinicians now accept that currently available measures have failed to eradicate VAP. Stopping the progression from VAT to VAP could improve patient outcomes.


Assuntos
Bronquite/diagnóstico , Pneumonia Associada à Ventilação Mecânica/complicações , Pneumonia/diagnóstico , Traqueíte/diagnóstico , Antibacterianos/uso terapêutico , Bronquite/etiologia , Bronquite/patologia , Humanos , Pneumonia/etiologia , Pneumonia/patologia , Pneumonia Associada à Ventilação Mecânica/patologia , Traqueíte/etiologia , Traqueíte/patologia
17.
Pediatr Pulmonol ; 53(11): 1510-1516, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30238646

RESUMO

BACKGROUND: A valid bronchoscopic scoring tool for bronchitis would be useful for clinical and research purposes as currently there are none in children. From 100 digitally recorded flexible bronchoscopies (FB), we related the various macroscopic features to airway neutrophil % to develop a FB-derived bronchitis score (BScoreexp ). We aimed to develop a FB-derived bronchitis tool. METHODS: FB recordings for six visualised features: secretions (amount and color) and mucosal appearance (erythema, pallor, ridging, oedema) based on pre-determined criteria on a pictorial chart were assessed by two physicians independently, blinded to the clinical history. These features were used to obtain various models of BScoreexp that were plotted against bronchoalveolar lavage (BAL) neutrophil % using a receiver operating characteristic (ROC) curve. Inter- and intra-rater agreement (weighted-kappa, K) were assessed from 30 FBs. RESULTS: Using BAL neutrophilia of 20% to define inflammation, the highest area under ROC (aROC) of 0.71, 95%CI 0.61-0.82 was obtained by the giving three times weightage to secretion amount and color and adding it to erythema and oedema. Inter-rater K values for secretion amount (K = 0.87, 95%CI 0.73-1.0) and color (K = 0.86, 95%CI 0.69-1.0) were excellent. Respective intra-rater K were 0.95 (0.87-1.0) and 0.68 (0.47-0.89). Other inter-rater K ranged from 0.4 (erythema) to 0.64 (pallor). CONCLUSION: A repeatable FB-defined bronchitis scoring tool can be derived. However, a prospective study needs to be performed with larger numbers to further evaluate and validate these results.


Assuntos
Bronquite/diagnóstico , Broncoscopia , Neutrófilos , Adolescente , Lavagem Broncoalveolar , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Inflamação/diagnóstico , Masculino , Estudos Retrospectivos , Índice de Gravidade de Doença
19.
Intensive Care Med ; 44(8): 1212-1220, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30003304

RESUMO

PURPOSE: To analyze the impact on patient outcome of ventilator-associated events (VAEs) as defined by the Centers for Disease Control and Prevention (CDC) in 2008, 2013, and the correlation with ventilator-associated pneumonia (VAP) or tracheobronchitis (VAT). METHODS: This was a prospective, observational, multicenter, international study conducted at 13 intensive care units (ICUs); thirty consecutive adults mechanically ventilated for ≥ 48 h per site were eligible, with daily follow-up being recorded in a collaborative web database; VAEs were assessed using the 2013 CDC classification and its 2015 update. RESULTS: A total of 2856 ventilator days in 244 patients were analyzed, identifying 33 VAP and 51 VAT episodes; 30-day ICU mortality was significantly higher (42.8 vs. 19.6%, p < 0.007) in patients with VAP than in those with VAT. According to the 2013 CDC definitions, 117 VAEs were identified: 113 (96%) were infection-related ventilator-associated complication-plus (IVAC-plus), while possible ventilator-associated pneumonia (PVAP) was found in 64 (56.6%) of them. VAE increased the number of ventilator days and prolonged ICU and hospital LOS (by 5, 11, and 12 days, respectively), with a trend towards increased 30-day mortality (43 vs 28%, p = 0.06). Most episodes (26, 55%) classified as IVAC-plus without PVAP criteria were due to atelectasis. PVAP significantly increased (p < 0.05) ventilator days as well as ICU and hospital LOS (by 10.5, 14, and 13 days, respectively). Only 24 (72.7%) of VAP and 15 (29.4%) of VAT episodes met IVAC-plus criteria. CONCLUSIONS: Respiratory infections (mainly VAT) were the most common complication. VAE algorithms only identified events with surrogates of severe oxygenation deterioration. As a consequence, IVAC definitions missed one fourth of the episodes of VAP and three fourths of the episodes of VAT. Identifying VAT (often missed by IVAC-plus criteria) is important, as VAP and VAT have different impacts on mortality.


Assuntos
Antibacterianos/uso terapêutico , Bronquite/diagnóstico , Bronquite/tratamento farmacológico , Pneumonia Associada à Ventilação Mecânica/diagnóstico , Pneumonia Associada à Ventilação Mecânica/tratamento farmacológico , Respiração Artificial/efeitos adversos , Idoso , Bronquite/etiologia , Estudos de Coortes , Técnicas e Procedimentos Diagnósticos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Associada à Ventilação Mecânica/etiologia , Valor Preditivo dos Testes , Estudos Prospectivos
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