Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 23.450
Filtrar
1.
J Infect Chemother ; 28(1): 95-98, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34580010

RESUMO

A 60-year-old man presented with dyspnea four days after the second dose of the coronavirus disease (COVID-19) vaccine. Imaging revealed extensive ground-glass opacification. Blood tests were notable for elevated KL-6 levels. Bronchoalveolar lavage fluid analysis showed increased lymphocyte-dominant inflammatory cells and decreased CD4/CD8 ratio. These findings were consistent with the diagnosis of drug-induced interstitial lung disease (DIILD). To the best of our knowledge, this has never been reported in previous literature. Treatment with glucocorticoids relieved his symptoms. This paper highlights that although extremely rare, COVID-19 vaccine could cause DIILD, and early diagnosis and treatment are crucial to improve patient outcomes.


Assuntos
COVID-19 , Doenças Pulmonares Intersticiais , Vacinas contra COVID-19 , Dispneia , Humanos , Pulmão , Doenças Pulmonares Intersticiais/induzido quimicamente , Doenças Pulmonares Intersticiais/diagnóstico , Masculino , Pessoa de Meia-Idade , SARS-CoV-2
2.
Rev Med Chil ; 149(7): 1090-1092, 2021 Jul.
Artigo em Espanhol | MEDLINE | ID: mdl-34751313

RESUMO

In patients with severe COVID-19, it has been proposed as mechanism of respiratory failure, intra and extrapulmonary shunt. However, there are no reported or documented cases of this mechanism. Also, there are studies showing this mechanism is not relevant. In this report, we present the case of a patient with severe COVID-19 pneumonia, who after two months, during his rehabilitation period, presented persistent hypoxemia with orthodeoxia. Persistent oval foramen with shunt from right to left was diagnosed. The patient underwent a percutaneous closure of the defect and at 48 hours oxygen therapy could be discontinued and the patient discharged.


Assuntos
COVID-19 , Forame Oval Patente , Pneumonia , Dispneia , Forame Oval Patente/complicações , Forame Oval Patente/diagnóstico por imagem , Humanos , Hipóxia/etiologia , SARS-CoV-2
3.
Rev Med Suisse ; 17(759): 1975-1978, 2021 Nov 17.
Artigo em Francês | MEDLINE | ID: mdl-34787971

RESUMO

Pulmonary rehabilitation is effective to improve shortness of breath, health status and exercise capacity. Telerehabilitation uses information and communication technologies to deliver rehabilitation program from a distance. A Cochrane review published in 2021 shows its equivalence to conventional pulmonary rehabilitation. The confinement induced by the COVID-19 pandemic has made patients with respiratory failure even more fragile and vulnerable, promoting the development of telerehabilitation. This article describes its modalities, sets out the scientific evidence for its effectiveness and develops perspectives for its development.


Assuntos
COVID-19 , Telerreabilitação , Dispneia , Humanos , Pandemias , SARS-CoV-2
4.
BMJ Case Rep ; 14(11)2021 Nov 17.
Artigo em Inglês | MEDLINE | ID: mdl-34789526

RESUMO

Platypnea-orthodexia syndrome (POS) is a rare but well-characterised condition where hypoxaemia and breathlessness occur while upright but resolve once recumbent. Early recognition can result in excellent outcomes for patients and can prevent unnecessary investigations for patients, especially if they present repeatedly to hospital after missed diagnosis. We present a case of a 75-year-old woman with a chronic history of breathlessness who was picked up after observations at a routine outpatient clinic. Early recognition of the POS allowed for appropriate investigations to take place identifying a patent foramen ovale (PFO). She was referred to the tertiary centre for closure of her PFO with complete resolution of her symptoms.


Assuntos
Dispneia , Forame Oval Patente , Idoso , Dispneia/etiologia , Feminino , Forame Oval Patente/complicações , Forame Oval Patente/diagnóstico por imagem , Humanos , Hipóxia/etiologia , Síndrome
5.
BMC Nephrol ; 22(1): 376, 2021 11 11.
Artigo em Inglês | MEDLINE | ID: mdl-34763669

RESUMO

BACKGROUND: There have been cases of minimal change disease (MCD) reported following previous vaccines. During the COVID-19 era, only 3 cases of new-onset MCD and a case of MCD relapse were reported following the Pfizer-BioNTech COVID-19 vaccine. We herein report the first case of MCD after receiving the Moderna COVID-19 vaccine. CASE PRESENTATION: A 43-year-old man presented to hospital 3 weeks after receiving the first dose of the Moderna vaccine, with both bilateral lower extremities and scrotal edema. He initially developed a sudden-onset bilateral lower extremities swelling on day 7 post-vaccine. He, then, developed dyspnea and scrotal swelling over a time span of 2 weeks. On physical examination, his blood pressure was 150/92 mmHg. There was a decreased air entry at lung bases, bilateral lower extremities and scrotal edema. Labs revealed hypoalbuminemia, hyperlipidemia and 15 g of proteinuria. His immunologic and serologic work up was negative. Renal biopsy showed concomitant MCD and IgA nephropathy. Patient was treated with oral steroids and had a good response; his edema resolved, serum albumin improved, and proteinuria decreased to 1 g within 2 weeks of treatment. CONCLUSIONS: To the best of our knowledge, MCD has not been previously reported after receiving the Moderna COVID-19 vaccine. It remains unclear whether the COVID-19 mRNA vaccines are associated with the development of MCD, or it coincided with the mass vaccination. Further studies are needed to determine the incidence of MCD post COVID-19 vaccines and the underlying pathophysiology of glomerular injury post vaccination.


Assuntos
Vacinas contra COVID-19/efeitos adversos , COVID-19/prevenção & controle , Edema/etiologia , Extremidade Inferior , Nefrose Lipoide/induzido quimicamente , Escroto , Adulto , Dispneia/etiologia , Glomerulonefrite por IGA/induzido quimicamente , Glomerulonefrite por IGA/complicações , Glomerulonefrite por IGA/patologia , Humanos , Hipoalbuminemia/etiologia , Masculino , Nefrose Lipoide/complicações , Nefrose Lipoide/patologia , SARS-CoV-2
6.
Invest Educ Enferm ; 39(3)2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34822232

RESUMO

OBJECTIVES: To evaluate the ability of the NEWS2-L (National Early Warning Score 2 Lactate) scale to predict the risk of early clinical deterioration (mortality within 48 hours) in patients with dyspnoea treated by the Medical Emergency Services compared with NEWS2 and lactate in isolation. METHODS: Prospective, multi-centre study of a cohort of 638 patients with dyspnoea treated in the ambulance and priority-transferred to a hospital emergency service in the cities of Valladolid, Salamanca, Segovia or Burgos (Spain). We collected clinical, analytical and demographic data. The main outcome measure was all-cause mortality within 48 hours. The recommendations of the Royal College of Physicians were followed to calculate NEWS2. When NEWS2 and LA prehospital values were obtained, the two values were added together to obtain the NEWS2-L. RESULTS: Mortality within 48 hours was fifty-six patients (8.8%). The NEWS2-L scale obtained an area under the curve (AUC) of the receiver operating characteristics (ROC) for mortality within 48 hours of 0.854 (CI 95% 0.790-0.917), at seven days of 0.788 (CI 95% 0.729-0.848) and at 30 days of 0.744 (CI 95% 0.692-0.796); in all cases p<0.001, with a significant decrease between the value at 48 hours and at 30 days. CONCLUSIONS: The NEWS2-L scale was found to be significantly superior to the NEWS2 scale and similar to lactate in predicting early clinical deterioration in patients with dyspnoea. This scale can help a nurse detect these patients early, as part of their regular practice, and thus guide therapeutic efforts.


Assuntos
Deterioração Clínica , Escore de Alerta Precoce , Serviços Médicos de Emergência , Dispneia/etiologia , Mortalidade Hospitalar , Humanos , Ácido Láctico , Estudos Prospectivos
7.
BMJ Case Rep ; 14(11)2021 Nov 23.
Artigo em Inglês | MEDLINE | ID: mdl-34815229

RESUMO

We describe a 56-year-old female patient hospitalised with COVID-19 in April 2020 who had persistent respiratory symptoms after radiographic and microbiologic recovery. X-ray of the chest demonstrated an elevated right hemidiaphragm while fluoroscopy confirmed unilateral diaphragmatic paralysis. Symptoms resolved gradually, concurrent with restoration of right hemidiaphragm function. Thus, we describe a rare cause of postacute sequelae of COVID-19 dyspnoea.


Assuntos
COVID-19 , Paralisia Respiratória , Diafragma/diagnóstico por imagem , Dispneia/etiologia , Feminino , Humanos , Pessoa de Meia-Idade , Paralisia Respiratória/diagnóstico por imagem , Paralisia Respiratória/etiologia , SARS-CoV-2
8.
Clin Chest Med ; 42(4): 687-696, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34774175

RESUMO

Malignant pleural effusions have a significant burden on patients and the health care system. Diagnosis is typically via thoracentesis, although other times more invasive procedures are required. Management centers around relief of dyspnea and patient quality of life and can be done via serial thoracentesis, indwelling pleural catheter, or pleurodesis. This article focuses on the diagnosis and management of malignant pleural effusion.


Assuntos
Derrame Pleural Maligno , Cateteres de Demora/efeitos adversos , Dispneia/diagnóstico , Dispneia/etiologia , Dispneia/terapia , Humanos , Derrame Pleural Maligno/diagnóstico , Derrame Pleural Maligno/terapia , Pleurodese , Qualidade de Vida , Talco
9.
Wiad Lek ; 74(9 cz 1): 2235-2240, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34725308

RESUMO

Pulmonary alveolar microlithiasis is a rare genetic disorder, inherited autosomally recessively, which is characterized by intra-alveolar deposition of microliths built mostly of calcium salts and phosphorus. This case study describing management of patient with pulmonary alveolar microlithiasis. A 49-year-old woman, diagnosed with pulmonary microlithiasis in 1979 was admitted to Pneumology Department due to increased dyspnea. On admission there were no clinical signs of active infection. The chest computer tomography scan confirmed the presence of advanced microlithiasis. Pulmonary function test revealed mild restriction with moderate diffusion impairment, due to severe hypoxemia present on 6-minute walking test patient was sent for specific assessment to local lung transplant team in Zabrze for consideration for lung transplantation. According to International Society for Heart & Lung Transplantation guidelines the patient was observed in 6 months intervals to reveal whether further disease progression will be observed. Clinical condition of our patient does not correlate with radiological scans, severe respiratory symptoms and cardiological complications. Computer tomography scan should not be the only indication for lung transplant.


Assuntos
Calcinose , Pneumopatias , Calcinose/diagnóstico por imagem , Dispneia , Feminino , Doenças Genéticas Inatas , Humanos , Pneumopatias/diagnóstico por imagem , Pessoa de Meia-Idade , Testes de Função Respiratória
10.
MMW Fortschr Med ; 163(20): 22-23, 2021 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-34767208
11.
Drug Discov Ther ; 15(5): 254-260, 2021 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-34719599

RESUMO

Post COVID-19 sequelae are a constellation of symptoms often reported after recovering from COVID-19. There is a need to better understand the clinical spectrum and long-term course of this clinical entity. The aim of this study is to describe the clinical features and risk factors of post COVID-19 sequelae in the North Indian population. This prospective observational study was conducted at a tertiary healthcare centre in Northern India between October 2020 and February 2021. Patients aged >18 years with laboratory-confirmed COVID-19 were recruited after at least two weeks of diagnosis, and details were captured. A total of 1234 patients were recruited and followed up for a median duration of 91 days (IQR: 45-181 days). Among them, 495 (40.1%) had persistent symptoms post-discharge or recovery. In 223 (18.1%) patients, the symptoms resolved within four weeks; 150 (12.1%) patients had symptoms till 12 weeks, and 122 (9.9%) patients had symptoms beyond 12 weeks of diagnosis/symptom-onset of COVID-19. Most common symptoms included myalgia (10.9%), fatigue (5.5%), shortness of breath (6.1%), cough (2.1%), insomnia (1.4%), mood disturbances (0.48%) and anxiety (0.6%). Patients who were hospitalized were more likely to report fatigue as a feature of long COVID. Hypothyroidism (OR: 4.13, 95% CI: 2.2-7.6, p-value < 0.001) and hypoxia (SpO2 ≤ 93%) (OR: 1.7, 95% CI: 1.1-2.4, p-value 0.012) were identified as risk factors for long COVID sequelae. In conclusion, long COVID symptoms were common (22%), and 9.9% had the post COVID-19 syndrome. Myalgias, fatigue and dyspnoea were common symptoms. Patients with hypothyroidism and hypoxia during acute illness were at higher risk of long COVID.


Assuntos
COVID-19/complicações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19/epidemiologia , COVID-19/etiologia , COVID-19/patologia , Tosse/epidemiologia , Tosse/etiologia , Dispneia/epidemiologia , Dispneia/etiologia , Fadiga/epidemiologia , Fadiga/etiologia , Feminino , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Mialgia/epidemiologia , Mialgia/etiologia , Estudos Prospectivos , Fatores de Risco , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Distúrbios do Início e da Manutenção do Sono/etiologia , Adulto Jovem
12.
Front Public Health ; 9: 691554, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34631641

RESUMO

Objective: This paper aimed to systematically review the application methods and components of step counter-based physical activity (PA) promotion programs in patients with chronic obstructive pulmonary disease (COPD). The effects of longer-duration (≥12 weeks) programs on PA, exercise capacity, quality of life, and dyspnea were discussed. Methods: This review was performed in accordance with the preferred reporting items for systematic reviews and meta-analysis. Online data resources PubMed, Web of Science, Embase, and EBSCO were searched. The publication year was limited between January 2000 to August 2020. All randomized controlled trials with ≥12-week duration of step counter-based PA promotion programs of COPD were included. Two researchers independently assessed the quality of the included studies and extracted their characteristics. Results: Nine studies involving 1,450 participants were included. Step counters, counseling, exercise goals, diaries, and tele-communicational approaches were common components of these programs. The PA feedback tools were mostly pedometers (n = 8), whereas accelerometers were often used as assessment tools of PA (n = 5). All studies implemented counseling: five applied behavioral change theories, and three reported motivational interview techniques simultaneously. Six studies reported detailed exercise goals. The usual exercise goal was to reach a total of 8,000-10,000 steps/day. Three research studies used diaries, and five applied tele-communication approaches to deliver interventions. The programs could be implemented alone (n = 4), in combination with exercise training (n = 2), or with pulmonary rehabilitation (n = 2). All studies showed a significant increase in the PA (≥793 steps/day). Three studies observed a significant improvement in exercise capacity (≥13.4 m), and two reported a significant increase in the quality of life (p < 0.05). No study showed significant between-group differences in dyspnea. Conclusion: There are a few studies assessing the impact of long-duration (≥12 weeks) step counter-based interventions in COPD, with different methodologies, although all studies included counseling and exercise goal setting. These interventions seem to have a positive effect on PA. A few studies also showed benefit on exercise capacity and quality of life.


Assuntos
Doença Pulmonar Obstrutiva Crônica , Qualidade de Vida , Dispneia , Exercício Físico , Tolerância ao Exercício , Humanos , Doença Pulmonar Obstrutiva Crônica/terapia
13.
J Invasive Cardiol ; 33(10): E834, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34609329

RESUMO

A 57-year-old woman presented with acute-onset dyspea with a duration of more than 2 days. Four days earlier, she had been thrombolyzed with streptokinase for inferior wall myocardial infarction in a nearby hospital. On examination, we found that the patient had elevated jugular venous pressure and systolic murmur in left lower parasternal region. In addition, there was a ventricular septal rupture in the posterobasal interventricular septum, with at least 2 exit points into the right ventricle. Timely identification of ventricular septal rupture before PCI is of paramount importance, as it has major implications in management of the patient.


Assuntos
Infarto Miocárdico de Parede Inferior , Intervenção Coronária Percutânea , Ruptura do Septo Ventricular , Dispneia/diagnóstico , Dispneia/etiologia , Feminino , Ventrículos do Coração/diagnóstico por imagem , Humanos , Infarto Miocárdico de Parede Inferior/complicações , Infarto Miocárdico de Parede Inferior/diagnóstico , Pessoa de Meia-Idade
16.
BMJ Case Rep ; 14(9)2021 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-34593549

RESUMO

A defect in one part of the immune system may affect the whole system. As a result, there may be a myriad of immunological diseases, which are often masked with the one disease that has the most prominent symptoms. This case report presents a patient with long-lasting allergic rhinitis who recently developed dyspnoea in exertion with suspected asthma development. After extensive diagnostic processing, asthma was dismissed, and diagnosis of selective IgA deficiency and coeliac disease with consequential iron deficiency anaemia was established. The patient was treated with parenteral iron and a gluten-free diet, which corrected her anaemia and led to the disappearance of dyspnoea. This paper aims to show the interplay between different immunological disorders and the possible causal connection between them.


Assuntos
Anemia Ferropriva , Doença Celíaca , Rinite Alérgica , Adulto , Anemia Ferropriva/etiologia , Dieta Livre de Glúten , Dispneia/etiologia , Feminino , Humanos , Rinite Alérgica/complicações
17.
BMJ Case Rep ; 14(10)2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34598972

RESUMO

A 62-year-old man presents with breathlessness 6 months following right pneumonectomy for lung adenocarcinoma. Previous investigations had not yielded a diagnosis and his symptoms were progressing. The patient described worsened symptoms when stood up (platypnoea), with profound hypoxia until laid supine (orthodeoxia). Platypnoea-orthodeoxia syndrome due to a right-to-left interatrial shunt was diagnosed on contrast-enhanced transoesophageal echocardiography with the patient undergoing successful percutaneous patent foramen ovale closure. Patent foramen ovale is often asymptomatic with a population prevalence of around 20%-30%. Anatomical shifts postpneumonectomy can open, or worsen a previously closed interatrial communication leading to right-to-left shunting of blood. Platypnoea-orthodeoxia is under-recognised, impairing quality of life and patient outcome. Investigations can be falsely reassuring, or poorly sensitive for the causative pathology. Percutaneous closure is safe with high success rates and this case highlights the need for a high index of suspicion for shunts, particularly in postpneumonectomy patients.


Assuntos
Neoplasias Pulmonares , Pneumonectomia , Dispneia/etiologia , Humanos , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Síndrome
18.
Am J Case Rep ; 22: e933975, 2021 Oct 26.
Artigo em Inglês | MEDLINE | ID: mdl-34697281

RESUMO

BACKGROUND Platypnea orthodeoxia syndrome (POS) presents with positional dyspnea and hypoxemia defined as arterial desaturation of at least 5% or a drop in PaO2 of at least 4 mmHg. Causes of POS include a variety of cardiopulmonary etiologies and has been reported in patients recovering from severe COVID-19 pneumonia. However, clinical presentation and outcomes in a patient with multiple interrelated mechanisms of shunting has not been documented. CASE REPORT An 85-year-old man hospitalized for hypertensive emergency and severe COVID-19 pneumonia was diagnosed with platypnea orthodeoxia on day 28 of illness. During his disease course, the patient required supplemental oxygen by high-flow nasal cannula but never required invasive mechanical ventilation. Chest imaging revealed evolving mixed consolidation and ground-glass opacities with a patchy and diffuse distribution, involving most of the left lung. Echocardiography was ordered to evaluate for intracardiac shunt, which revealed a patent foramen ovale. Closure of the patent foramen ovale was not pursued. Management included graded progression to standing and supplemental oxygen increases when upright. The patient was discharged to a skilled nursing facility and his positional oxygen requirement resolved on approximately day 78. CONCLUSIONS The present case highlights the multiple interrelated mechanisms of shunting in patients with COVID-related lung disease and a patent foramen ovale. Eight prior cases of POS after COVID-19 pneumonia have been reported to date but none with a known patent foramen ovale. In patients with persistent positional oxygen requirements at follow-up, quantifying shunt fraction over time through multiple modalities can guide treatment decisions.


Assuntos
COVID-19 , Forame Oval Patente , Idoso de 80 Anos ou mais , Dispneia/etiologia , Forame Oval Patente/complicações , Forame Oval Patente/diagnóstico por imagem , Humanos , Hipóxia/etiologia , Masculino , SARS-CoV-2
19.
Arq Gastroenterol ; 58(3): 308-315, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34705964

RESUMO

BACKGROUND: Liver cirrhosis (LC) causes several musculoskeletal changes. OBJECTIVE: To test the hypothesis that the peripheral and inspiratory muscle endurance are reduced in patients with liver cirrhosis. METHODS: Twenty-one patients with LC (LC group; 61±14 years) and 18 age-matched subjects (control group; 56±17 years) had accepted to participate in this cross-sectional observational study. To assess peripheral muscle endurance, all volunteers performed a rhythmic handgrip exercise at 45% of their maximum voluntary contraction. A metronome was used to control the contraction-relaxation cycles at 60/min. The inspiratory muscle endurance was assessed using PowerBreath®. Participants underwent inspiratory muscle exercise at 60% of their maximal inspiratory muscle strength. The time until failure characterized the muscle endurance for both handgrip and inspiratory muscle exercises. Additionally, the quality of life of the participants was assessed. RESULTS: The muscle endurance was lower in the LC group when compared to the control group for both handgrip (67 vs 130 s, P<0.001) and inspiratory muscle exercises (40 vs 114 s, P<0.001). The peripheral muscle endurance was directly correlated with the total quality of life score (r=0.439, P=0.01) and to the following domains: fatigue (r=0.378 e P=0.030), activity (r=0.583, P=0.001), systemic symptoms (r=0.316, P=0.073) and preoccupation (r=0.370, P=0.034). The inspiratory muscle endurance was inversely correlated with the total quality of life score (r=0.573, P=0.001) and the following domains: fatigue (r=0.503, P=0.002), activity (r=0.464, P=0.004), systemic symptoms (r=0.472, P=0.004), abdominal symptoms (r=0.461, P=0.005), emotional function (r=0.387, P=0.02) and preoccupation (r=0.519, P=0.001). CONCLUSION: Both peripheral and inspiratory muscle endurance were lower in LC patients when compared to the control group.


Assuntos
Força da Mão , Qualidade de Vida , Adulto , Idoso , Estudos Transversais , Dispneia , Tolerância ao Exercício , Humanos , Cirrose Hepática , Pessoa de Meia-Idade , Músculos Respiratórios
20.
Rev Med Suisse ; 17(756): 1830-1833, 2021 Oct 27.
Artigo em Francês | MEDLINE | ID: mdl-34704679

RESUMO

Heart failure is a common disease and one of the main reasons of hospital admission. It is a rich research field, marked by regular novelties in the management of heart failure. In the last decades point-of-care ultrasonography has been more prominent in internal medicine, particularly for the management of heart failure. A structured training is required to acquire core competencies. In heart failure, this bedside tool includes focused lung, cardiac and vascular ultrasonography. The combination of these modalities raises diagnostic accuracy, reduce time to diagnosis in dyspneic patients and plays a role in adaptation of decongestive therapy.


Assuntos
Insuficiência Cardíaca , Sistemas Automatizados de Assistência Junto ao Leito , Dispneia , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/terapia , Humanos , Pulmão/diagnóstico por imagem , Ultrassonografia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...