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1.
Molecules ; 24(3)2019 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-30717123

RESUMO

Colistin is administered as its inactive prodrug colistimethate (CMS). Selection of an individualized CMS dose for each patient is difficult due to its narrow therapeutic window, especially in patients with chronic kidney disease (CKD). Our aim was to analyze CMS use in patients with CKD. Secondary objectives were to assess the safety and efficacy of CMS in this special population. In this prospective observational cohort study of CMS-treated CKD patients, CKD was defined as the presence of a glomerular filtration rate (GFR) < 60 mL/min/m² for more than 3 months. The administered doses of CMS were compared with those recently published in the literature. Worsened CKD at the end of treatment (EOT) was evaluated with the RIFLE (Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease) criteria. Colistin plasma concentrations (Css) were measured using high-performance liquid chromatography. Fifty-nine patients were included. Thirty-six (61.2%) were male. The median age was 76 (45⁻95) years and baseline GFR was 36.6 ± 13.6. The daily mean CMS dosage used was compared with recently recommended doses (3.36 vs. 6.07; p < 0.001). Mean Css was 0.9 (0.2⁻2.9) mg/L, and Css was <2 mg/L in 50 patients (83.3%). Clinical cure was achieved in 43 (72.9%) patients. Worsened renal function at EOT was present in 20 (33.9%) patients and was reversible in 10 (52.6%). The CMS dosages used in this cohort were almost half those currently recommended. The mean achieved Css were under the recommended target of 2 mg/dL. Despite this, clinical cure rate was high. In this patient cohort, the incidence of nephrotoxicity was similar to those found in other recent studies performed in the general population and was reversible in 52.6%. These results suggest that CMS is safe and effective in patients with CKD and may encourage physicians to adjust dosage regimens to recent recommendations in order to optimize CMS treatments.


Assuntos
Antibacterianos/farmacocinética , Bronquite/tratamento farmacológico , Colistina/análogos & derivados , Pneumonia Bacteriana/tratamento farmacológico , Infecções por Pseudomonas/tratamento farmacológico , Insuficiência Renal Crônica/tratamento farmacológico , Infecções Urinárias/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/sangue , Antibacterianos/farmacologia , Bronquite/sangue , Bronquite/complicações , Bronquite/fisiopatologia , Colistina/sangue , Colistina/farmacocinética , Colistina/farmacologia , Esquema de Medicação , Cálculos da Dosagem de Medicamento , Feminino , Taxa de Filtração Glomerular , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Bacteriana/sangue , Pneumonia Bacteriana/complicações , Pneumonia Bacteriana/fisiopatologia , Estudos Prospectivos , Infecções por Pseudomonas/sangue , Infecções por Pseudomonas/complicações , Infecções por Pseudomonas/fisiopatologia , Pseudomonas aeruginosa/efeitos dos fármacos , Pseudomonas aeruginosa/crescimento & desenvolvimento , Pseudomonas aeruginosa/patogenicidade , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/fisiopatologia , Resultado do Tratamento , Infecções Urinárias/sangue , Infecções Urinárias/complicações , Infecções Urinárias/fisiopatologia
2.
Int Heart J ; 59(4): 873-876, 2018 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-29794380

RESUMO

We present a 16-year-old male patient with hypoplastic left heart syndrome who developed protein-losing enteropathy (PLE) and plastic bronchitis (PB) after a Fontan operation. He received medical therapies, including albumin infusion, unfractionated heparin, and high-dose anti-aldosterone therapy but could not obtain clinical relief. Biphasic cuirass ventilation (BCV) led to expectoration of bronchial casts and prompt resolution of PB. Notably, clinical symptoms related to PLE were dramatically improved after starting BCV. A brief period of BCV increased stroke volume from 26±1.4 to 39±4.0 mL. This case suggests that BCV could be an effective treatment for PLE in patients with failing Fontan circulation.


Assuntos
Albuminas/uso terapêutico , Técnica de Fontan/efeitos adversos , Heparina/uso terapêutico , Síndrome do Coração Esquerdo Hipoplásico , Antagonistas de Receptores de Mineralocorticoides/uso terapêutico , Complicações Pós-Operatórias , Enteropatias Perdedoras de Proteínas , Respiração Artificial/métodos , Adolescente , Anticoagulantes/uso terapêutico , Bronquite/diagnóstico , Bronquite/etiologia , Bronquite/fisiopatologia , Bronquite/terapia , Baixo Débito Cardíaco/diagnóstico , Baixo Débito Cardíaco/etiologia , Pressão Venosa Central , Técnica de Fontan/métodos , Humanos , Síndrome do Coração Esquerdo Hipoplásico/fisiopatologia , Síndrome do Coração Esquerdo Hipoplásico/cirurgia , Masculino , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/terapia , Enteropatias Perdedoras de Proteínas/diagnóstico , Enteropatias Perdedoras de Proteínas/etiologia , Enteropatias Perdedoras de Proteínas/fisiopatologia , Enteropatias Perdedoras de Proteínas/terapia , Resultado do Tratamento
3.
Respir Investig ; 56(3): 230-237, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29773294

RESUMO

BACKGROUND: Cough and sputum production (symptoms of bronchitis) are common in chronic obstructive pulmonary disease (COPD). Extrapulmonary comorbidities, such as gastroesophageal reflux disease (GERD) and post-nasal drip, also cause bronchitis symptoms. The impact of extrapulmonary comorbidities on the severity of bronchitis symptoms in COPD is unknown. The aim of this study was to quantify bronchitis symptoms and assess the impact of GERD and nasal symptoms on the severity of bronchitis symptoms in COPD. METHODS: In this cross-sectional study, stable COPD patients were recruited and completed the COPD assessment test (CAT) and Cough and Sputum Assessment Questionnaire (CASA-Q) to quantify bronchitis symptoms. To evaluate extrapulmonary comorbidities, the Frequency Scale for Symptoms of GERD (FSSG) questionnaire and nasal symptom questionnaire were completed. The impact of these comorbidities on the severity of bronchitis symptoms was analyzed. RESULTS: Ninety-nine COPD patients were recruited. The presence of GERD symptoms (24.2% in the study population) was associated with more sputum symptoms. The presence of nasal discharge (43.4%) was associated with more cough and sputum symptoms, whereas post-nasal drip (13.1%) was associated with more sputum symptoms. On multivariate analyses, nasal discharge was associated with more cough symptoms. GERD and post-nasal drip were associated with more sputum symptoms. CONCLUSION: This study showed that the presence of GERD and/or nasal symptoms is associated with an increase in bronchitis symptoms. Careful assessment of extrapulmonary comorbidities is necessary in the evaluation of bronchitis symptoms in COPD patients.


Assuntos
Bronquite/epidemiologia , Refluxo Gastroesofágico/epidemiologia , Doenças Nasais/epidemiologia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Bronquite/diagnóstico , Bronquite/fisiopatologia , Resina de Colestiramina , Comorbidade , Estudos Transversais , Feminino , Humanos , Masculino , Índice de Gravidade de Doença
4.
Respirology ; 23(6): 576-582, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29365367

RESUMO

BACKGROUND AND OBJECTIVE: The relationship between vitamin D and respiratory disease was examined by cross-sectional analysis of a large community-based sample. METHODS: Serum 25-hydroxyvitamin D (25OHD) and history of respiratory disease, symptoms (recorded by questionnaire) and spirometry were measured in 5011 adults aged 45-69 years. Adjustments were made for age, sex, season and smoking (Model A), plus body mass index (BMI) and physical activity level (Model B), plus history of chronic diseases (Model C). RESULTS: Mean (SD) age was 58 (SD 6) years with 45% males, 10% current smokers and 12% taking vitamin D supplements. The prevalence of 25OHD level <50 nmol/L was 8.0%. In all the three models, 25OHD <50 nmol/L was significantly associated with asthma (Model C: odds ratio (OR): 1.32; 95% CI: 1.00, 1.73), bronchitis (1.54; 1.17, 2.01), wheeze (1.37; 1.10, 1.71) and chest tightness (1.42; 1.10, 1.83). Participants with vitamin D level > 100 nmol/L had higher forced vital capacity (FVC) in all the three models (1.17% higher, compared with the 50-100 nmol/L group in Model C). CONCLUSION: Low levels of serum 25OHD were independently associated with asthma, bronchitis, wheeze and chest tightness after three levels of adjustment for potential confounders. Higher vitamin D levels were associated with higher levels of lung function.


Assuntos
Asma/epidemiologia , Bronquite/epidemiologia , Deficiência de Vitamina D/epidemiologia , Vitamina D/análogos & derivados , Idoso , Asma/fisiopatologia , Índice de Massa Corporal , Bronquite/fisiopatologia , Estudos Transversais , Suplementos Nutricionais , Exercício , Feminino , Volume Expiratório Forçado , Envelhecimento Saudável , Humanos , Pulmão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Razão de Chances , Prevalência , Sons Respiratórios/fisiopatologia , Estações do Ano , Fumar/epidemiologia , Espirometria , Inquéritos e Questionários , Capacidade Vital , Vitamina D/sangue , Vitamina D/uso terapêutico , Deficiência de Vitamina D/sangue , Austrália Ocidental/epidemiologia
5.
Echocardiography ; 35(1): 79-84, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29082544

RESUMO

BACKGROUND: It was this study's objective to evaluate the echocardiographic characteristics and flow patterns in abdominal arteries of Fontan patients before the onset of protein-losing enteropathy (PLE) or plastic bronchitis (PB). DESIGN: In this retrospective cohort investigation, we examined 170 Fontan patients from 32 different centers who had undergone echocardiographic and Doppler ultrasound examinations between June 2006 and May 2013. Follow-up questionnaires were completed by 105 patients a median of 5.3 (1.5-8.5) years later to evaluate whether one of the complications had occurred since the examinations. RESULTS: A total of 91 patients never developed PLE or PB ("non-PLE/PB"); they were compared to 14 affected patients. Eight of the 14 patients had already been diagnosed with "present PLE/PB" when examined. Six "future PLE/PB" patients developed those complications later on and were identified on follow-up. The "future PLE/PB" patients presented significantly slower diastolic flow velocities in the celiac artery (0.1 (0.1-0.5) m/s vs 0.3 (0.1-1.0) m/s (P = .04) and in the superior mesenteric artery (0.0 (0.0-0.2) m/s vs 0.2 (0.0-0.6) m/s, P = .02) than the "non-PLE/PB" group. Median resistance indices in the celiac artery were significantly higher (0.9 (0.8-0.9) m/s vs 0.8 (0.6-0.9) m/s, (P = .01)) even before the onset of PLE or PB. CONCLUSION: An elevated flow resistance in the celiac artery may prevail in Fontan patients before the clinical manifestation of PLE or PB.


Assuntos
Bronquite/etiologia , Artéria Celíaca/diagnóstico por imagem , Ecocardiografia/métodos , Técnica de Fontan , Artéria Mesentérica Superior/diagnóstico por imagem , Enteropatias Perdedoras de Proteínas/fisiopatologia , Bronquite/diagnóstico , Bronquite/fisiopatologia , Artéria Celíaca/fisiopatologia , Criança , Estudos de Coortes , Ecocardiografia Doppler em Cores , Feminino , Humanos , Masculino , Artéria Mesentérica Superior/fisiopatologia , Enteropatias Perdedoras de Proteínas/diagnóstico , Enteropatias Perdedoras de Proteínas/etiologia , Estudos Retrospectivos , Fatores de Risco
6.
PLoS One ; 12(12): e0190075, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29281698

RESUMO

INTRODUCTION: Persistent bacterial bronchitis (PBB) is a leading cause of chronic wet cough in young children. This study aimed to characterise the respiratory bacterial microbiota of healthy children and to assess the impact of the changes associated with the development of PBB. Blind, protected brushings were obtained from 20 healthy controls and 24 children with PBB, with an additional directed sample obtained from PBB patients. DNA was extracted, quantified using a 16S rRNA gene quantitative PCR assay prior to microbial community analysis by 16S rRNA gene sequencing. RESULTS: No significant difference in bacterial diversity or community composition (R2 = 0.01, P = 0.36) was observed between paired blind and non-blind brushes, showing that blind brushings are a valid means of accessing the airway microbiota. This has important implications for collecting lower respiratory samples from healthy children. A significant decrease in bacterial diversity (P < 0.001) and change in community composition (R2 = 0.08, P = 0.004) was observed among controls, in comparison with patients. Bacterial communities within patients with PBB were dominated by Proteobacteria, and indicator species analysis showed that Haemophilus and Neisseria were significantly associated with the patient group. In 15 (52.9%) cases the dominant organism by sequencing was not identified by standard routine clinical culture. CONCLUSION: The bacteria present in the lungs of patients with PBB were less diverse in terms of richness and evenness. The results validate the clinical diagnosis, and suggest that more attention to bacterial communities in children with chronic cough may lead to more rapid recognition of this condition with earlier treatment and reduction in disease burden.


Assuntos
Infecções Bacterianas/fisiopatologia , Bronquite/fisiopatologia , Microbiota , Adulto , Estudos de Casos e Controles , Criança , Pré-Escolar , Feminino , Humanos , Masculino
7.
Eur Respir J ; 50(2)2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-28838975

RESUMO

This European Respiratory Society statement provides a comprehensive overview on protracted bacterial bronchitis (PBB) in children. A task force of experts, consisting of clinicians from Europe and Australia who manage children with PBB determined the overall scope of this statement through consensus. Systematic reviews addressing key questions were undertaken, diagrams in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement constructed and findings of relevant studies summarised. The final content of this statement was agreed upon by all members.The current knowledge regarding PBB is presented, including the definition, microbiology data, known pathobiology, bronchoalveolar lavage findings and treatment strategies to manage these children. Evidence for the definition of PBB was sought specifically and presented. In addition, the task force identified several major clinical areas in PBB requiring further research, including collecting more prospective data to better identify the disease burden within the community, determining its natural history, a better understanding of the underlying disease mechanisms and how to optimise its treatment, with a particular requirement for randomised controlled trials to be conducted in primary care.


Assuntos
Antibacterianos/uso terapêutico , Infecções Bacterianas , Bronquite , Austrália , Infecções Bacterianas/diagnóstico , Infecções Bacterianas/fisiopatologia , Infecções Bacterianas/terapia , Bronquite/diagnóstico , Bronquite/microbiologia , Bronquite/fisiopatologia , Bronquite/terapia , Líquido da Lavagem Broncoalveolar/microbiologia , Broncoscopia/métodos , Criança , Gerenciamento Clínico , Europa (Continente) , Humanos , Guias de Prática Clínica como Assunto
8.
Pulm Pharmacol Ther ; 47: 66-71, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28687463

RESUMO

Non-asthmatic eosinophilic bronchitis (NAEB) is an important cause of chronic cough. NAEB shares similar eosinophilic inflammation of airway and response to corticosteroids with asthma. However, in contrast to asthma, NAEB subjects have no airflow obstruction and airway hyperresponsiveness. The pathogenesis of NAEB are involved with many inflammatory cells such as eosinophils, lymphocytes, mast cells, cytokines and inflammatory mediators, includingTh2 cytokines, histamine, leukotrines, prograndins and oxidative stress. The different locations of inflammatory cells and the inflammatory mediators level may explain this difference between EB and asthma. There is no study on dose and duration of treatment. On the prognosis of NAEB, long term follow-up study suggested that NAEB should be a distinct entity rather than an early stage of asthma or COPD. The relapse rate is high after treatment. Assessing sputum eosinophils after treatment is useful to identify those at risk of relapse.


Assuntos
Bronquite/complicações , Tosse/etiologia , Eosinofilia/complicações , Animais , Asma/fisiopatologia , Bronquite/fisiopatologia , Doença Crônica , Eosinofilia/fisiopatologia , Eosinófilos/metabolismo , Humanos , Recidiva , Escarro/metabolismo
9.
J Clin Immunol ; 37(6): 592-602, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28755066

RESUMO

PURPOSE: Common variable immunodeficiency (CVID) is a complex, heterogeneous immunodeficiency characterized by hypogammaglobulinemia, recurrent infections, and poor antibody response to vaccination. While antibiotics and immunoglobulin prophylaxis have significantly reduced infectious complications, non-infectious complications of autoimmunity, inflammatory lung disease, enteropathy, and malignancy remain of great concern. Previous studies have suggested that CVID patients diagnosed in childhood are more severely affected by these complications than adults diagnosed later in life. We sought to discern whether the rates of various infectious and non-infectious conditions differed between pediatric-diagnosed (ages 17 or younger) versus adult-diagnosed CVID (ages 18 or older). METHODS: Using the United States Immunodeficiency Network (USIDNET) database, we performed a retrospective analysis of 457 children and adults with CVID, stratified by age at diagnosis. Chi-squared testing was used to compare pediatric versus adult groups. RESULTS: After correcting for multiple comparisons, we identified few statistically significant differences (p ≤ 0.0004) between pediatric and adult groups. Pediatric-onset CVID patients had more frequent diagnoses of otitis media, developmental delay, and failure to thrive compared with adult-onset CVID patients. Adult CVID patients were more frequently diagnosed with bronchitis, arthritis, depression, and fatigue. Diagnoses of autoimmunity, lymphoma, and other malignancies were higher in adults but not to a significant degree. Serum immunoglobulins (IgG, IgA, and IgM) and lymphocyte subsets did not differ significantly between the two groups. When complications of infections and co-morbid conditions were viewed categorically, there were few differences between pediatric-onset and adult-onset CVID patients. CONCLUSIONS: These results suggest that pediatric CVID is not a distinct phenotype. Major features were comparable across the groups. This study underscores the need for continued longitudinal study of pediatric and early-onset CVID patients to further characterize accrual of features over time.


Assuntos
Artrite/fisiopatologia , Bronquite/fisiopatologia , Imunodeficiência de Variável Comum/fisiopatologia , Depressão/fisiopatologia , Deficiências do Desenvolvimento/fisiopatologia , Insuficiência de Crescimento/fisiopatologia , Otite Média/fisiopatologia , Adolescente , Adulto , Idade de Início , Idoso , Idoso de 80 Anos ou mais , Artrite/epidemiologia , Autoimunidade , Bronquite/epidemiologia , Transformação Celular Neoplásica , Criança , Pré-Escolar , Imunodeficiência de Variável Comum/epidemiologia , Bases de Dados Factuais , Depressão/epidemiologia , Deficiências do Desenvolvimento/epidemiologia , Insuficiência de Crescimento/epidemiologia , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Otite Média/epidemiologia , Fenótipo , Estudos Retrospectivos , Estados Unidos/epidemiologia , Adulto Jovem
10.
PLoS One ; 12(2): e0170622, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28170403

RESUMO

BACKGROUND: Bronchiectasis is accompanied by chronic bronchial infection that may drive disease progression. However, the evidence base for antibiotic therapy is limited. DNA based methods offer better identification and quantification of microbial constituents of sputum than standard clinical culture and may help inform patient management strategies. Our study objective was to determine the longitudinal variability of the non-cystic fibrosis (CF) bronchiectasis microbiome in sputum with respect to clinical variables. Eighty-five patients with non-CF bronchiectasis and daily sputum production were recruited from outpatient clinics and followed for six months. Monthly sputum samples and clinical measurements were taken, together with additional samples during exacerbations. 16S rRNA gene sequencing of the sputum microbiota was successful for 381 samples from 76 patients and analysed in conjunction with clinical data. RESULTS: Microbial communities were highly individual in composition and stability, usually with limited diversity and often containing multiple pathogens. When compared to DNA sequencing, microbial culture had restricted sensitivity in identifying common pathogens such as Pseudomonas aeruginosa, Haemophilus influenzae, Moraxella catarrhalis. With some exceptions, community characteristics showed poor correlations with clinical features including underlying disease, antibiotic use and exacerbations, with the subject showing the strongest association with community structure. When present, the pathogens mucoid Pseudomonas aeruginosa and Haemophilus influenzae may also shape the structure of the rest of the microbial community. CONCLUSIONS: The use of microbial community analysis of sputum added to information from microbial culture. A simple model of exacerbations driven by bacterial overgrowth was not supported, suggesting a need for revision of principles for antibiotic therapy. In individual patients, the management of chronic bronchial infection may be improved by therapy specific to their microbiome, taking into account pathogen load, community stability, and acute and chronic community responses to antibiotics.


Assuntos
Bronquiectasia/complicações , Bronquite/diagnóstico , Bronquite/etiologia , Microbiota , RNA Ribossômico 16S , Escarro/microbiologia , Idoso , Bronquiectasia/diagnóstico , Bronquiectasia/etiologia , Bronquite/fisiopatologia , Estudos Transversais , Humanos , Metagenômica/métodos , Pessoa de Meia-Idade , Testes de Função Respiratória , Fatores de Risco , Tomografia Computadorizada por Raios X
11.
PLoS One ; 12(1): e0170269, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28107494

RESUMO

The GTPase-accelerating protein, regulator of G-protein signalling 2 (RGS2) reduces signalling from G-protein-coupled receptors (GPCRs) that signal via Gαq. In humans, RGS2 expression is up-regulated by inhaled corticosteroids (ICSs) and long-acting ß2-adrenoceptor agonists (LABAs) such that synergy is produced in combination. This may contribute to the superior clinical efficacy of ICS/LABA therapy in asthma relative to ICS alone. In a murine model of house dust mite (HDM)-induced airways inflammation, three weeks of intranasal HDM (25 µg, 3×/week) reduced lung function and induced granulocytic airways inflammation. Compared to wild type animals, Rgs2-/- mice showed airways hyperresponsiveness (increased airways resistance and reduced compliance). While HDM increased pulmonary inflammation observed on hematoxylin and eosin-stained sections, there was no difference between wild type and Rgs2-/- animals. HDM-induced mucus hypersecretion was also unaffected by RGS2 deficiency. However, inflammatory cell counts in the bronchoalveolar lavage fluid of Rgs2-/- animals were significantly increased (57%) compared to wild type animals and this correlated with increased granulocyte (neutrophil and eosinophil) numbers. Likewise, cytokine and chemokine (IL4, IL17, IL5, LIF, IL6, CSF3, CXCLl, CXCL10 and CXCL11) release was increased by HDM exposure. Compared to wild type, Rgs2-/- animals showed a trend towards increased expression for many cytokines/chemokines, with CCL3, CCL11, CXCL9 and CXCL10 being significantly enhanced. As RGS2 expression was unaffected by HDM exposure, these data indicate that RGS2 exerts tonic bronchoprotection in HDM-induced airways inflammation. Modest anti-inflammatory and anti-remodelling roles for RGS2 are also suggested. If translatable to humans, therapies that maximize RGS2 expression may prove advantageous.


Assuntos
Bronquite/fisiopatologia , Modelos Animais de Doenças , Pneumonia/fisiopatologia , Pyroglyphidae/imunologia , Proteínas RGS/fisiologia , Animais , Bronquite/imunologia , Líquido da Lavagem Broncoalveolar , Feminino , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Pneumonia/imunologia , Proteínas RGS/genética
12.
J Assoc Physicians India ; 65(11): 92-93, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29322720

RESUMO

A 19 year female, presented with life threatening haemoptysis and cough with minimum expectoration for 3 months. Bronchoscopy showed multiple nodules in airway. The direct microscopy and culture of sputum revealed fungal elements and Aspergillus flavus respectively. Serum Galactomannan was positive. Thus diagnosis of invasive aspergillus tracheo-bronchitis made. She responded to voriconazole. Aspergillus tracheo-bronchitis is a rare form of invasive pulmonary aspergillosis in immuno-competent host. Aspergillus spp in respiratory samples should not be routinely discarded as colonization.


Assuntos
Aspergillus , Bronquite/microbiologia , Hemoptise , Aspergilose Pulmonar Invasiva , Escarro/microbiologia , Traqueíte/microbiologia , Voriconazol/administração & dosagem , Obstrução das Vias Respiratórias/diagnóstico , Obstrução das Vias Respiratórias/etiologia , Antifúngicos/administração & dosagem , Aspergillus/isolamento & purificação , Aspergillus/fisiologia , Bronquite/fisiopatologia , Bronquite/terapia , Broncoscopia/métodos , Feminino , Hemoptise/diagnóstico , Hemoptise/etiologia , Hemoptise/fisiopatologia , Hemoptise/terapia , Humanos , Aspergilose Pulmonar Invasiva/complicações , Aspergilose Pulmonar Invasiva/diagnóstico , Aspergilose Pulmonar Invasiva/tratamento farmacológico , Aspergilose Pulmonar Invasiva/fisiopatologia , Mananas/análise , Mananas/sangue , Traqueíte/fisiopatologia , Traqueíte/terapia , Resultado do Tratamento , Adulto Jovem
13.
Tech Vasc Interv Radiol ; 19(4): 299-304, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27993326

RESUMO

Pulmonary lymphatic diseases have been recognized for many years and have been referred as pulmonary lymphangiectasia, pulmonary lymphangiomatosis, plastic bronchitis, and idiopathic chylothorax or chylopericardium. The lymphatic etiology of these conditions has been determined by detection of cystic lymphatic structures on biopsy or postmortem examination. Development of new imaging techniques such as dynamic contrast-enhanced magnetic resonance lymphangiography has allowed better understanding of pathophysiology of these conditions. Dynamic contrast-enhanced magnetic resonance lymphangiography demonstrated that the common denominator of these disorders is an abnormal pulmonary lymphatic flow from the thoracic duct toward pulmonary parenchyma. This abnormal lymphatic flow propagates into mediastinum, lung parenchyma, pleural surfaces, and bronchial submucosa and has been termed as pulmonary lymphatic perfusion syndrome (PLPS). Known clinical presentation of PLPS includes spontaneous chylothorax or pericardium, neonatal chylous effusions, and plastic bronchitis. PLPS has been observed in all age groups and can be considered as a congenital anatomical lymphatic variant. The onset of the clinical symptoms can be provoked by increase of the lymphatic flow owing to elevated central venous pressure that results in lymphatic distention, trauma, and severe upper respiratory infection. Reported treatment of PLPS is obliteration of these abnormal lymphatic pathways by percutaneous embolization, a technique similar to thoracic duct embolization in chylothorax.


Assuntos
Bronquite/terapia , Quilotórax/terapia , Embolização Terapêutica/métodos , Pneumopatias/congênito , Linfangiectasia/congênito , Anormalidades Linfáticas/terapia , Sistema Linfático , Derrame Pericárdico/terapia , Radiografia Intervencionista/métodos , Bronquite/diagnóstico por imagem , Bronquite/fisiopatologia , Quilotórax/diagnóstico por imagem , Quilotórax/fisiopatologia , Meios de Contraste/administração & dosagem , Embolização Terapêutica/efeitos adversos , Humanos , Recém-Nascido , Pneumopatias/diagnóstico por imagem , Pneumopatias/fisiopatologia , Pneumopatias/terapia , Linfangiectasia/diagnóstico por imagem , Linfangiectasia/fisiopatologia , Linfangiectasia/terapia , Anormalidades Linfáticas/diagnóstico por imagem , Anormalidades Linfáticas/fisiopatologia , Sistema Linfático/diagnóstico por imagem , Sistema Linfático/fisiopatologia , Linfografia/métodos , Imagem por Ressonância Magnética , Derrame Pericárdico/diagnóstico por imagem , Derrame Pericárdico/fisiopatologia , Valor Preditivo dos Testes , Radiografia Intervencionista/efeitos adversos , Resultado do Tratamento
14.
Eur Respir J ; 48(5): 1320-1328, 2016 11.
Artigo em Inglês | MEDLINE | ID: mdl-27799385

RESUMO

The role of mast cells in the pathogenesis of childhood asthma is poorly understood. We aimed to estimate the implication of airway mucosal mast cells in severe asthma and their relationship with clinical, functional, inflammatory and remodelling parameters.Bronchial biopsies were performed in 36 children (5-18 years) with severe asthma: 24 had frequent severe exacerbations and/or daily symptoms in the previous year (symptomatic group), and 12 had few symptoms and a persistent obstructive pattern (paucisymptomatic group). Nine children without asthma were included as control subjects. We assessed mast cells in the submucosa and airway smooth muscle using c-kit antibodies and in the entire biopsy area using Giemsa.The number of submucosal mast cells was higher in the symptomatic group than in the paucisymptomatic group (p=0.02). The number of submucosal mast cells correlated with the number of severe exacerbations (p=0.02, r=0.37). There were positive correlations between the number of submucosal mast cells (p<0.01, r=0.44), airway smooth muscle mast cells (p=0.02, r= 0.40), mast cells stained by Giemsa (p<0.01, r=0.44) and submucosal eosinophils.Mast cells are associated with severe exacerbations and submucosal eosinophilic inflammation in children with severe asthma.


Assuntos
Asma/fisiopatologia , Brônquios/fisiopatologia , Bronquite/fisiopatologia , Eosinofilia/metabolismo , Mastócitos/citologia , Adolescente , Anticorpos/química , Asma/metabolismo , Biópsia , Bronquite/metabolismo , Criança , Pré-Escolar , Eosinófilos/citologia , Feminino , Humanos , Inflamação , Contagem de Leucócitos , Masculino , Mastócitos/metabolismo , Músculo Liso/patologia , Miócitos de Músculo Liso/metabolismo , Proteínas Proto-Oncogênicas c-kit/imunologia
15.
Respir Res ; 17(1): 115, 2016 09 20.
Artigo em Inglês | MEDLINE | ID: mdl-27646537

RESUMO

BACKGROUND: Nocturnal gastroesophageal reflux (nGER) is associated with respiratory symptoms and sleep-disordered breathing (SDB), but the pathogenesis is unclear. We aimed to investigate the association between nGER and respiratory symptoms, exacerbations of respiratory symptoms, SDB and airway inflammation. METHODS: Participants in the European Community Respiratory Health Survey III in Iceland with nGER symptoms (n = 48) and age and gender matched controls (n = 42) were studied by questionnaires, exhaled breath condensate (EBC), particles in exhaled air (PEx) measurements, and a home polygraphic study. An exacerbation of respiratory symptoms was defined as an episode of markedly worse respiratory symptoms in the previous 12 months. RESULTS: Asthma and bronchitis symptoms were more common among nGER subjects than controls (54 % vs 29 %, p = 0.01; and 60 % vs 26 %, p < 0.01, respectively), as were exacerbations of respiratory symptoms (19 % vs 5 %, p = 0.04). Objectively measured snoring was more common among subjects with nGER than controls (snores per hour of sleep, median (IQR): 177 (79-281) vs 67 (32-182), p = 0.004). Pepsin (2.5 ng/ml (0.8-5.8) vs 0.8 ng/ml (0.8-3.6), p = 0.03), substance P (741 pg/ml (626-821) vs 623 pg/ml (562-676), p < 0.001) and 8-isoprostane (3.0 pg/ml (2.7-3.9) vs 2.6 pg/ml (2.2-2.9), p = 0.002) in EBC were higher among nGER subjects than controls. Albumin and surfactant protein A in PEx were lower among nGER subjects. These findings were independent of BMI. CONCLUSION: In a general population sample, nGER is associated with symptoms of asthma and bronchitis, as well as exacerbations of respiratory symptoms. Also, nGER is associated with increased respiratory effort during sleep. Biomarker measurements in EBC, PEx and serum indicate that micro-aspiration and neurogenic inflammation are plausible mechanisms.


Assuntos
Ritmo Circadiano , Refluxo Gastroesofágico/epidemiologia , Pulmão/fisiopatologia , Respiração , Síndromes da Apneia do Sono/epidemiologia , Sono , Adulto , Idoso , Asma/diagnóstico , Asma/epidemiologia , Asma/fisiopatologia , Biomarcadores/sangue , Testes Respiratórios , Bronquite/diagnóstico , Bronquite/epidemiologia , Bronquite/fisiopatologia , Estudos de Casos e Controles , Progressão da Doença , Expiração , Feminino , Refluxo Gastroesofágico/sangue , Refluxo Gastroesofágico/diagnóstico , Refluxo Gastroesofágico/fisiopatologia , Inquéritos Epidemiológicos , Humanos , Islândia/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Síndromes da Apneia do Sono/sangue , Síndromes da Apneia do Sono/diagnóstico , Síndromes da Apneia do Sono/fisiopatologia , Fatores de Tempo
16.
Vestn Otorinolaringol ; 81(4): 50-53, 2016.
Artigo em Russo | MEDLINE | ID: mdl-27500580

RESUMO

The objective of the present study was to elucidate the causes responsible for a cough in the pregnant women. It involved 92 patients including 23 ones presenting with bronchial asthma and 69 having no manifestations of asthma in their medical histories but suffering from dry cough that started after the beginning of pregnancy. All the patients were given counseling by the otorhinolaryngology and pulmonology specialists. The degree of endoscopic manifestations of gastroesophageal reflux was estimated based on a scoring scale. The study revealed the correlation between cough duration and gestational age. The signs of reflux-induced changes in the larynx were documented in 91% cases among the patients with bronchial asthma and in 97% cases in the pregnant women having no bronchial pathology in their medical histories. The main cause behind the cough during pregnancy in women without bronchial pathology was sluggish bronchitis (7%), arising asthma (12%), gastroesophageal reflux (77%), and allergic rhinitis (4%). This conclusion was confirmed by the results of therapy.


Assuntos
Asma/diagnóstico , Bronquite/diagnóstico , Tosse , Refluxo Gastroesofágico/diagnóstico , Complicações na Gravidez , Adulto , Asma/complicações , Asma/fisiopatologia , Bronquite/complicações , Bronquite/fisiopatologia , Tosse/diagnóstico , Tosse/etiologia , Tosse/fisiopatologia , Diagnóstico Diferencial , Gerenciamento Clínico , Feminino , Refluxo Gastroesofágico/complicações , Refluxo Gastroesofágico/fisiopatologia , Humanos , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/fisiopatologia
17.
Int J Biochem Cell Biol ; 78: 335-348, 2016 09.
Artigo em Inglês | MEDLINE | ID: mdl-27477308

RESUMO

Acute or chronic cold exposure exacerbates chronic inflammatory airway diseases, such as chronic obstructive pulmonary disease (COPD) and asthma. Cold-inducible RNA-binding protein (CIRP) is a cold-shock protein and is induced by various environmental stressors, such as hypothermia and hypoxia. In this study, we showed that CIRP gene and protein levels were significantly increased in patients with COPD and in rats with chronic airway inflammation compared with healthy subjects. Similarly, inflammatory cytokine production and MUC5AC secretion were up-regulated in rats following cigarette smoke inhalation. Cold temperature-induced CIRP overexpression and translocation were shown to be dependent on arginine methylation in vitro. CIRP overexpression promoted stress granule (SG) assembly. In the cytoplasm, the stability of pro-inflammatory cytokine mRNAs was increased through specific interactions between CIRP and mediator mRNA 3'-UTRs; these interactions increased the mRNA translation, resulting in MUC5AC overproduction in response to cold stress. Conversely, CIRP silencing and a methyltransferase inhibitor (adenosine dialdehyde) promoted cytokine mRNA degradation and inhibited the inflammatory response and mucus hypersecretion. These findings indicate that cold temperature can induce an airway inflammatory response and excess mucus production via a CIRP-mediated increase in mRNA stability and protein translation.


Assuntos
Resposta ao Choque Frio , Regulação da Expressão Gênica , Pulmão/metabolismo , Muco/metabolismo , Proteínas de Ligação a RNA/metabolismo , Regiões 3' não Traduzidas/genética , Idoso , Animais , Bronquite/genética , Bronquite/metabolismo , Bronquite/fisiopatologia , Resposta ao Choque Frio/efeitos dos fármacos , Citocinas/genética , Feminino , Regulação da Expressão Gênica/efeitos dos fármacos , Humanos , Inflamação/genética , Inflamação/metabolismo , Inflamação/fisiopatologia , Pulmão/efeitos dos fármacos , Masculino , Metilação/efeitos dos fármacos , Pessoa de Meia-Idade , Mucina-5AC/biossíntese , Transporte Proteico/efeitos dos fármacos , Doença Pulmonar Obstrutiva Crônica/genética , Doença Pulmonar Obstrutiva Crônica/metabolismo , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Proteínas de Ligação a RNA/genética , Ratos , Fumaça/efeitos adversos , Tabaco/química , Transcrição Genética/efeitos dos fármacos , Regulação para Cima/efeitos dos fármacos
18.
Respir Res ; 17: 26, 2016 Mar 10.
Artigo em Inglês | MEDLINE | ID: mdl-26966003

RESUMO

BACKGROUND: Several epidemiological and laboratory studies have evidenced the fact that atmospheric particulate matter (PM) increases the risk of respiratory morbidity. It is well known that the smallest fraction of PM (PM1 - particulate matter having a diameter below 1 µm) penetrates the deepest into the airways. The ratio of the different size fractions in PM is highly variable, but in industrial areas PM1 can be significant. Despite these facts, the health effects of PM1 have been poorly investigated and air quality standards are based on PM10 and PM2.5 (PM having diameters below 10 µm and 2.5 µm, respectively) concentrations. Therefore, this study aimed at determining whether exposure to ambient PM1 at a near alert threshold level for PM10 has respiratory consequences in rats. METHODS: Rats were either exposed for 6 weeks to 100 µg/m(3) (alert threshold level for PM10 in Hungary) urban submicron aerosol, or were kept in room air. End-expiratory lung volume, airway resistance (Raw) and respiratory tissue mechanics were measured. Respiratory mechanics were measured under baseline conditions and following intravenous methacholine challenges to characterize the development of airway hyperresponsiveness (AH). Bronchoalveolar lavage fluid (BALF) was analyzed and lung histology was performed. RESULTS: No significant differences were detected in lung volume and mechanical parameters at baseline. However, the exposed rats exhibited significantly greater MCh-induced responses in Raw, demonstrating the progression of AH. The associated bronchial inflammation was evidenced by the accumulation of inflammatory cells in BALF and by lung histology. CONCLUSIONS: Our findings suggest that exposure to concentrated ambient PM1 (mass concentration at the threshold level for PM10) leads to the development of mild respiratory symptoms in healthy adult rats, which may suggest a need for the reconsideration of threshold limits for airborne PM1.


Assuntos
Hiper-Reatividade Brônquica/induzido quimicamente , Hiper-Reatividade Brônquica/fisiopatologia , Bronquite/induzido quimicamente , Bronquite/fisiopatologia , Exposição Ambiental/efeitos adversos , Material Particulado/efeitos adversos , Animais , Hiper-Reatividade Brônquica/patologia , Bronquite/patologia , Cidades , Hungria , Masculino , Tamanho da Partícula , Ratos , Ratos Wistar , Mecânica Respiratória/efeitos dos fármacos
20.
Adv Exp Med Biol ; 885: 1-9, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26801150

RESUMO

Bronchitis is a common health problem in children. Frequent bronchitis in infancy increases the risk of developing chronic respiratory diseases. The aim of the study was to assess the level of growth and the nutritional status in children and youths with special regard to the level of body fatness assessed by measuring skin-fold thickness. Relationships between somatic development, pulmonary function and the course of the disease were also explored. The study was carried out using anthropometric and spirometric measurements and also information on the severity and course of the disease in 141 children with chronic or recurrent bronchitis. All of the subjects were patients of the Pulmonary Medicine and Allergology Center in Karpacz, Poland. The mean body height did not differ significantly between the children examined and their healthy peers. However, the infection-prone children had excessive body fatness and muscle mass deficiency. The increased level of subcutaneous adipose tissue occurred especially in children with short duration of the disease, i.e. a maximum of 1 year. The functional lung parameters were generally normal. The presence of atopic diseases such as allergic rhinitis or atopic dermatitis did not impair the course of the children's somatic development. Also, long-term disease or the presence of additional allergic diseases did not impair lung function in the examined children. Taking appropriate preventive measures is recommended to achieve and maintain normal body weight in children who receive therapy due to bronchitis.


Assuntos
Bronquite/fisiopatologia , Desenvolvimento Infantil , Pulmão/fisiopatologia , Estado Nutricional , Adolescente , Peso Corporal , Criança , Doença Crônica , Humanos , Recidiva
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