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Int J Palliat Nurs ; 27(1): 46-52, 2021 Feb 02.
Artigo em Inglês | MEDLINE | ID: mdl-33629907


BACKGROUND: Dyselectrolytaemia and dehydration are common symptoms in people with terminal stomach cancer. AIMS: To determine factors related to dyselectrolytemia and dehydration in patients with terminal stomach cancer. METHODS: An analysis of 134 patients with terminal stomach cancer admitted to the palliative care unit was conducted, through an audit of the patients' medical records. The average age of women was 63.1 years and that of men was 64.9 years. FINDINGS: Dehydrated patients were more likely to: have dyselectrolytaemia; have a higher PS scale score; be taking opioids as an analgesic; have a high sodium concentration; experience dyspnoea, constipation, nausea and vomiting during hospitalisation; and require glucocorticoids administration both during and before hospitalisation. Patients with dyselectrolytaemia were more likely to: be admitted to the palliative care unit from the emergency department; experience cachexia and dehydration during hospitalisation and constipation at discharge; have a lower albumin level; and have a higher glucose level. Patients with dyselectrolytaemia also had a shorter duration of treatment and a 2.48 greater chance for death compared with those who did not have it. CONCLUSIONS: Knowledge of the adverse factors connected with dehydration and dyselectrolytaemia will allow health professionals to avoid dangerous clinical symptoms and prolong the life of those with terminal stomach cancer, as they might be able to foresee the occurrence of these conditions based on the medication the patient has been taking and symptoms they have been experiencing. Nurses will have a greater understanding of the importance of fluid therapy to resolve ionic disturbances and the need to address dehydration and dyselectrolytemia as a means to prolong and improve quality of life.

Desidratação/complicações , Neoplasias Gástricas/complicações , Doente Terminal , Desequilíbrio Hidroeletrolítico/complicações , Analgésicos Opioides/uso terapêutico , Glicemia/análise , Caquexia/complicações , Constipação Intestinal/complicações , Desidratação/etiologia , Delusões/complicações , Uso de Medicamentos , Dispneia/complicações , Feminino , Glucocorticoides/uso terapêutico , Alucinações/complicações , Hemoglobinas/análise , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Náusea/complicações , Prognóstico , Estudos Retrospectivos , Albumina Sérica/análise , Sódio/sangue , Neoplasias Gástricas/mortalidade , Vômito/complicações , Desequilíbrio Hidroeletrolítico/etiologia
BMJ Case Rep ; 14(2)2021 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-33541953


A previously healthy 40-year-old man was referred to our emergency department with pruritic skin lesions and dyspnoea. Laboratory investigation revealed hypereosinophilia. Further diagnostic work-up confirmed the diagnosis of idiopathic hypereosinophilic syndrome (iHES), a rare myeloproliferative disease with a heterogeneous clinical presentation. We describe a unique case with cardiac, pulmonary, hepatic and cutaneous involvement at time of presentation. This case accentuates the importance of an extensive multidisciplinary diagnostic work-up, since iHES is a condition with potential rapid progressive multiorgan failure which requires prompt analysis and treatment. In addition, this case emphasises the importance of being aware of tunnel vision, especially during the COVID-19 pandemic, which might give rise to an increased risk of missing rare diagnoses. Our patient was treated with prednisolone, after which both his clinical condition and eosinophil concentrations markedly improved.

Síndrome Hipereosinofílica/diagnóstico , Síndrome Hipereosinofílica/patologia , Adulto , Anti-Inflamatórios/uso terapêutico , Biópsia/métodos , Diagnóstico Diferencial , Dispneia/complicações , Eosinófilos/patologia , Humanos , Síndrome Hipereosinofílica/complicações , Síndrome Hipereosinofílica/tratamento farmacológico , Masculino , Prednisolona/uso terapêutico , Dermatopatias/complicações , Dermatopatias/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
J Neurovirol ; 27(1): 154-159, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33528827


As the SARS-COV-2 becomes a global pandemic, many researchers have a concern about the long COVID-19 complications. Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is a persistent, debilitating, and unexplained fatigue disorder. We investigated psychological morbidities such as CFS and post-traumatic stress disorder (PTSD) among survivors of COVID-19 over 6 months. All COVID-19 survivors from the university-affiliated hospital of Tehran, Iran, were assessed 6 months after infection onset by a previously validated questionnaire based on the Fukuda guidelines for CFS/EM and DSM-5 Checklist for PTSD (The Post-traumatic Stress Disorder Checklist for DSM-5 or PCL-5) to determine the presence of stress disorder and chronic fatigue problems. A total of 120 patients were enrolled. The prevalence rate of fatigue symptoms was 17.5%. Twelve (10%) screened positive for chronic idiopathic fatigue (CIF), 6 (5%) for CFS-like with insufficient fatigue syndrome (CFSWIFS), and 3 (2.5%) for CFS. The mean total scores in PCL-5 were 9.27 ± 10.76 (range:0-44), and the prevalence rate of PTSD was 5.8%. There was no significant association after adjusting between CFS and PTSD, gender, comorbidities, and chloroquine phosphate administration. The obtained data revealed the prevalence of CFS among patients with COVID-19, which is almost similar to CFS prevalence in the general population. Moreover, PTSD in patients with COVID-19 is not associated with the increased risk of CFS. Our study suggested that medical institutions should pay attention to the psychological consequences of the COVID-19 outbreak.

/psicologia , Tosse/psicologia , Demência/psicologia , Dispneia/psicologia , Síndrome de Fadiga Crônica/psicologia , Febre/psicologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Adulto , Idoso , Antivirais/uso terapêutico , /tratamento farmacológico , Tosse/complicações , Tosse/tratamento farmacológico , Tosse/virologia , Demência/complicações , Demência/tratamento farmacológico , Demência/virologia , Combinação de Medicamentos , Dispneia/complicações , Dispneia/tratamento farmacológico , Dispneia/virologia , Síndrome de Fadiga Crônica/complicações , Síndrome de Fadiga Crônica/tratamento farmacológico , Síndrome de Fadiga Crônica/virologia , Feminino , Febre/complicações , Febre/tratamento farmacológico , Febre/virologia , Humanos , Hidroxicloroquina/uso terapêutico , Lopinavir/uso terapêutico , Masculino , Pessoa de Meia-Idade , Oseltamivir/uso terapêutico , Projetos de Pesquisa , Ritonavir/uso terapêutico , /patogenicidade , Índice de Gravidade de Doença , Transtornos de Estresse Pós-Traumáticos/complicações , Transtornos de Estresse Pós-Traumáticos/tratamento farmacológico , Transtornos de Estresse Pós-Traumáticos/virologia , Inquéritos e Questionários , Sobreviventes/psicologia
PLoS One ; 16(1): e0245690, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33481912


BACKGROUND: The number of hospitalized young coronavirus disease 2019 (COVID-19) patients has increased significantly. However, specific data about COVID-19 patients under 65 years old who are admitted to the hospital are scarce. METHODS: The COVID-19 patients under 65 years old who were admitted to the hospital in Sichuan Province, Renmin Hospital of Wuhan University, and Wuhan Red Cross Hospital were included in this study. Demographic information, laboratory data and clinical treatment courses were extracted from electronic medical records. Risk factors associated with oxygen therapy were explored. RESULTS: Eight hundred thirty-three COVID-19 patients under 65 years old were included. Of the included patients, 29.4% had one or more comorbidities. Oxygen therapy was required in 63.1% of these patients, and the mortality was 2.9% among the oxygen therapy patients. Fever (odds ratio [OR] 2.072, 95% confidence interval [CI] 1.312-3.271, p = 0.002), dyspnea (OR 2.522, 95% CI 1.213-5.243, p = 0.013), chest distress (OR 2.278, 95% CI 1.160-4.473, p = 0.017), elevated respiratory rate (OR 1.114, 95% CI 1.010-1.228, p = 0.031), and decreased albumin (OR 0.932, 95% CI 0.880-0.987, p = 0.016) and globulin levels (OR 0.929, 95% 0.881-0.980, p = 0.007) were independent factors related to oxygen therapy. CONCLUSIONS: Oxygen therapy is highly required in COVID-19 patients under 65 years old who are admitted to the hospital, but the success rate is high. Respiratory failure-related symptoms, elevated respiratory rate, low albumin and globulin levels, and fever at admission are independent risk factors related to the requirement of oxygen.

/terapia , Oxigenoterapia/métodos , Adulto , Fatores Etários , /epidemiologia , China/epidemiologia , Dispneia/complicações , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Oxigenoterapia/efeitos adversos , Fatores de Risco , Resultado do Tratamento
J Neurovirol ; 27(1): 86-93, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33417193


The COVID-19 pandemic has infected more than 22 million people worldwide. Although much has been learned about COVID-19, we do not know much about its neurological features and their outcome. This observational study was conducted on the patients of Imam Hossein Hospital, and 361 adult patients (214 males) with confirmed diagnosis of COVID-19 from March 5, 2020 to April 3, 2020, were enrolled. Data was gathered on age, sex, comorbidities, initial symptoms, symptoms during the disease course, neurological symptoms, and outcome. The mean age of the patients was 61.90 ± 16.76 years. The most common initial symptoms were cough, fever, and dyspnea. In 21 patients (5.8%), the initial symptom was neurological. History of dementia was associated with severe COVID-19 disease (odds ratio = 1.28). During the course of the disease, 186 patients (51.52%) had at least one neurological symptom, the most common being headache (109 [30.2%]), followed by anosmia/ageusia (69, [19.1%]), and dizziness (54, [15%]). Also, 31 patients had neurological complications (8.58%). Anosmia, ageusia, dizziness, and headache were associated with favorable outcome (P < 0.001), while altered mental status and hemiparesis were associated with poor outcome. The mortality rate of patients who had neurological complications was more than twice than that of patients without neurological complication (P = 0.008). Almost half of the patients experienced at least one neurological symptom, which may be the initial presentation of COVID-19. Dementia appears to be associated with severe COVID-19. Mortality was higher in patients with neurological complications, and these patients needed more intensive care.

/complicações , Demência/complicações , Dispneia/complicações , Cefaleia/complicações , Paresia/complicações , /patogenicidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Ageusia/complicações , Ageusia/diagnóstico , Ageusia/mortalidade , Ageusia/virologia , /diagnóstico , /virologia , /mortalidade , Tosse/complicações , Tosse/diagnóstico , Tosse/mortalidade , Tosse/virologia , Demência/diagnóstico , Demência/mortalidade , Demência/virologia , Dispneia/diagnóstico , Dispneia/mortalidade , Dispneia/virologia , Feminino , Febre/complicações , Febre/diagnóstico , Febre/mortalidade , Febre/virologia , Cefaleia/diagnóstico , Cefaleia/mortalidade , Cefaleia/virologia , Humanos , Masculino , Pessoa de Meia-Idade , Paresia/diagnóstico , Paresia/mortalidade , Paresia/virologia , Estudos Retrospectivos , Índice de Gravidade de Doença , Análise de Sobrevida
Nutr. hosp ; 37(6): 1281-1284, nov.-dic. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-198318


INTRODUCCIÓN: la nutrición parenteral (NP) es una modalidad de soporte nutricional con posibles complicaciones, en parte asociadas al catéter venoso central (CVC). El quilotórax consiste en el derrame de líquido linfático de origen intestinal en el espacio pleural. CASO CLÍNICO: varón de 57 años ingresado para colecistectomía. Presenta un postoperatorio complicado que requiere reposo digestivo y NP. Posteriormente presenta disnea y dolor torácico con derrame pleural bilateral y pericárdico. Inicialmente se interpretó como un quilotórax, por su aspecto lechoso y su contenido en triglicéridos. La TC confirmó la malposición del CVC con salida de NP a nivel del tronco venoso innominado. Fue intervenido quirúrgicamente, realizándose un lavado del mediastino anterior y la reparación de la perforación. La evolución posterior fue favorable. DISCUSIÓN: la extravasación de la NP al espacio pleural es una complicación infrecuente pero posible de la administración de NP por vía central. Por tanto, debe tenerse en cuenta en el diagnóstico diferencial

INTRODUCTION: parenteral nutrition (PN) is commonly used as a nutritional support option. It may cause complications, partly due to a central venous access. Chylothorax is an accumulation of lymphatic fluid in the pleural space. CASE REPORT: a 57-year-old man was admitted for cholecystectomy. A complicated postoperative period required PN. Cardiorespiratory symptoms started while receiving PN, and a bilateral pleural and pericardial effusion was identified. It was initially interpreted as chylothorax due to its milky appearance and high triglyceride content. A CT scan confirmed a malposition of the CVC with PN leakage at the level of the innominate venous trunk. It was surgically repaired. DISCUSSION: parenteral nutrition leakage is an unusual complication of PN. It should be included in the differential diagnosis of pleural effusion

Humanos , Masculino , Pessoa de Meia-Idade , Nutrição Parenteral Total/efeitos adversos , Quilotórax/diagnóstico por imagem , Derrame Pleural/diagnóstico por imagem , Esternotomia/métodos , Quilotórax/complicações , Complicações Pós-Operatórias , Dispneia/complicações , Dor no Peito/etiologia , Hematemese/complicações , Diagnóstico Diferencial , Radiografia Torácica
Rev. esp. patol. torac ; 32(3): 166-178, oct. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-197926


INTRODUCCIÓN: la presentación tardía de síntomas relacionados con el cáncer de pulmón (CP) y la demora en consultar es frecuente. OBJETIVO: conocer los síntomas referidos por los pacientes con CP, la demora hasta la primera consulta y valorar los factores relacionados con la misma. MÉTODOS: estudio prospectivo observacional de pacientes ingresados con CP. Se recogieron los síntomas sospechosos de CP referidos espontáneamente y tras mostrarles un listado estructurado de síntomas mediante entrevista personal; definiendo la fecha del primer síntoma reconocido espontáneamente y el tiempo hasta la primera consulta. RESULTADOS: se incluyeron 317 pacientes diagnosticados de CP (85,2% varones; edad media: 66 ± 10,6 años) El 89,9% presentaban comorbilidades: EPOC: 42%, patología cardiovascular: 37,5% y neoplasia previa: 19,6%. El 53% valoraban no tener o ser muy bajo su riesgo para desarrollar un CP, y un 49,2% no reconocían los síntomas del CP. Los síntomas más frecuentes referidos espontáneamente fueron: tos (52,1%), aumento de disnea (29%), cambios en la expectoración (24,9%) y dolor torácico (29,3%); aumentando su frecuencia al mostrarles un listado de síntomas. La demora hasta la primera consulta fue de 22,27 ± 53,4 días. La pérdida de peso, la ausencia de hemoptisis y la ausencia de comorbilidades, destacando la presencia de patología psiquiátrica se relacionaron con mayores demoras hasta la primera consulta. CONCLUSIONES:- Los síntomas sospechosos de CP fueron infravalorados, demorando su primera consulta más de 20 días.- La percepción de riesgo y los conocimientos acerca del CP fueron escasos.- La pérdida de peso, la ausencia de hemoptisis y de comorbilidades se asociaron con una mayor demora hasta la primera consulta

INTRODUCTION: The late presentation of symptoms related to lung cancer (LC) and delayed consultation is frequent. OBJECTIVE: To learn the symptoms referred to by patients with LC, the delay until the first consultation and to evaluate the factors related to this delay. METHODS: A prospective observational study in patients hospitalized with LC. Suspected LC symptoms referred to spontaneously and after showing patients a structured list of symptoms were recorded during a personal interview, determining the date of the first spontaneously recognized symptom and the time until the first consultation.RESULTS: 317 patients diagnosed with LC were included (85.2% male; average age: 66 ± 10.6 years). Of these, 89.9% had comorbidities: COPD, 42%; cardiovascular disease, 37.5%; and previous neoplasm, 19.6%. 53% considered themselves to have no or a very low risk of developing LC and 49.2% did not recognize the symptoms of LC. The most frequent symptoms referred to spontaneously were cough (52.1%), increased dyspnea (29%), changes in expectoration (24.9%) and chest pain (29.3%), increasing their frequency after showing patients a list of symptoms. The delay until the first consultation was 22.27 ± 53.4 days. Weight loss, the absence of hemoptysis and the absence of comorbidities, emphasizing the presence of psychiatric disorders, were associated with greater delays until the first consultation. CONCLUSIONS:- Suspected symptoms of LC were underestimated, delaying the first consultation more than 20 days.- The perception of risk and knowledge about LC were lacking.- Weight loss, the absence of hemoptysis and comorbidities were associated with a greater delay until the first consultation

Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Neoplasias Pulmonares/diagnóstico , Tempo para o Tratamento , Fatores de Tempo , Fatores de Risco , Estudos Prospectivos , Comorbidade , Dispneia/complicações , Dor no Peito/etiologia , Hemoptise/complicações , Perda de Peso , Intervalos de Confiança
Rev. esp. patol. torac ; 32(3): 243-247, oct. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-197931


Se presenta el caso de un paciente diagnosticado a raíz de cuadros de disnea recurrentes de traqueobroncomegalia o Síndrome de Mounier-Kunh, patología congénita, muy infrecuente, clasificada como una clase de traqueomalacia del tipo cartilaginosa, cursando por ello con un colapso dinámico de la vía aérea causante de los episodios de disnea. Otros síntomas frecuentemente observados son la tos no productiva, retención de secreciones o infecciones recurrentes.El paciente es tratado inicialmente de forma conservadora mediante la colocación de una prótesis intratraqueal de silicona (Stent Dumon) en forma de "Y" que permite, de forma provisional, la estabilización de la vía aérea y mejoría de su calidad de vida. Posteriormente, se le practica un tratamiento quirúrgico definitivo o traqueobroncoplastia, que reconfigura la estructura traqueal evitando el colapso espiratorio y permitiendo la retirada del stent intratraqueal

We present the case of a patient diagnosed based on recurrent dyspnea from tracheobronchomegaly or Mounier-Kuhn syndrome, a very rare congenital disease classified as a type of cartilaginous tracheomalacia, leading to a dynamic collapse of the airway causing episodes of dyspnea. Other frequently observed symptoms are nonproductive cough, secretion retention and recurrent infections.The patient is initially treated conservatively by placing a Y-shaped silicone intratracheal prosthesis (Dumon stent) which provisionally allows for airway stabilization and improved quality of life. Later, the patient undergoes a definitive surgical treatment or tracheobronchoplasty, which reconfigures the tracheal structure, avoiding expiratory collapse and allowing the intratracheal stent to be removed

Humanos , Masculino , Pessoa de Meia-Idade , Stents , Traqueobroncomegalia/cirurgia , Dispneia/diagnóstico , Traqueobroncomegalia/diagnóstico , Dispneia/complicações , Qualidade de Vida , Traqueomalácia/cirurgia , Intubação Intratraqueal , Tomografia Computadorizada por Raios X
BMC Infect Dis ; 20(1): 716, 2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-32993540


BACKGROUND: A healthy 25-year-old woman developed COVID-19 disease with clinical characteristics resembling Multisystem Inflammatory Syndrome in Children (MIS-C), a rare form of COVID-19 described primarily in children under 21 years of age. CASE PRESENTATION: The patient presented with 1 week of weakness, dyspnea, and low-grade fevers, followed by mild cough, sore throat, vomiting, diarrhea, and lymph node swelling. She was otherwise healthy, with no prior medical history. Her hospital course was notable for profound acute kidney injury, leukocytosis, hypotension, and cardiac dysfunction requiring ICU admission and vasopressor support. MIS-C-like illness secondary to COVID-19 was suspected due to physical exam findings of conjunctivitis, mucositis, and shock. She improved following IVIG, aspirin, and supportive care, and was discharged on hospital day 5. CONCLUSION: MIS-C-like illness should be considered in adults presenting with atypical clinical findings and concern for COVID-19. Further research is needed to support the role of IVIG and aspirin in this patient population.

Betacoronavirus/genética , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Síndrome de Resposta Inflamatória Sistêmica/complicações , Adulto , Aspirina/administração & dosagem , Aspirina/uso terapêutico , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/virologia , Tosse/complicações , Diarreia/complicações , Dispneia/complicações , Feminino , Febre/complicações , Humanos , Imunoglobulinas Intravenosas/administração & dosagem , Imunoglobulinas Intravenosas/uso terapêutico , Pandemias , Faringite/complicações , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/virologia , Reação em Cadeia da Polimerase , Síndrome de Resposta Inflamatória Sistêmica/tratamento farmacológico , Síndrome de Resposta Inflamatória Sistêmica/virologia , Resultado do Tratamento , Vômito/complicações
BMC Infect Dis ; 20(1): 662, 2020 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-32907540


BACKGROUND: The outbreak of the novel coronavirus (COVID-19) that was firstly reported in Wuhan, China, with cases now confirmed in more than 100 countries. However, COVID-19 pneumonia with spontaneous pneumothorax is unknown. CASE PRESENTATION: We reported a case of 66-year-old man infected with COVID-19, presenting with fever, cough and myalgia; The patient received supportive and empirical treatment including antiviral treatment, anti-inflammatory treatment, oxygen supply and inhalation therapy; The symptoms, CT images, laboratory results got improved after the treatments, and a throat swab was negative for COVID-19 PCR test; However, on the hospital day 30, the patient presented with a sudden chest pain and dyspnea. CT showed a 30-40% left-sided pneumothorax. Immediate thoracic closed drainage was performed and his dyspnea was rapidly improved. With five more times negative PCR tests for SARS-CoV-2 virus, the patient was discharged and home quarantine. CONCLUSION: This case highlights the importance for clinicians to pay attention to the appearance of spontaneous pneumothorax, especially patients with severe pulmonary damage for a long course, as well as the need for early image diagnose CT and effective treatment once pneumothorax occurs.

Betacoronavirus , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Pneumotórax/complicações , Idoso , Betacoronavirus/patogenicidade , Dor no Peito/complicações , Infecções por Coronavirus/terapia , Infecções por Coronavirus/virologia , Tosse/complicações , Drenagem , Dispneia/complicações , Febre/complicações , Humanos , Masculino , Pandemias , Alta do Paciente , Pneumonia Viral/terapia , Pneumonia Viral/virologia , Pneumotórax/terapia
Med. clín (Ed. impr.) ; 155(5): 202-204, sept. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-188495


ANTECEDENTES Y OBJETIVO: La pandemia por Covid-19 afecta especialmente a pacientes con cáncer con mayor incidencia y mortalidad según series publicadas de focos originales de pandemia. El estudio pretende conocer la mortalidad en nuestro centro por covid-19 en pacientes con cáncer durante las primeras3 semanas de epidemia. MATERIAL Y MÉTODOS: Se han revisado los pacientes con cáncer fallecidos por covid-19 durante el periodo de análisis describiendo las características oncológicas, de la infección por covid-19 y de los tratamientos instaurados. RESULTADOS: Casos confirmados covid-19: 1069 con 132 fallecimientos (12,3%). Con cáncer 36 pacientes (3.4%), 15 fallecidos (41,6%). De los fallecidos solo6 pacientes (40%) se encontraban en tratamiento activo. El tumor más frecuente asociado fue pulmón (8/15 pacientes, 53,3%), 11 con enfermedad metastásica (11/15, 73,3%). El 40% (6/15) no recibió tratamiento específico contra covid-19, el resto fue tratado con los protocolos activos. CONCLUSIÓN: La mortalidad por covid-19 en pacientes con cáncer casi cuadriplica la de la población general. Hasta disponer de tratamientos eficaces o una vacuna efectiva la única posibilidad de proteger a nuestros pacientes es impedir el contagio con las medidas adecuadas

BACKGROUND AND OBJECTIVE: The Covid-19 pandemic especially affects cancer patients with higher incidence and mortality according to published series of original pandemic foci. The study aims to determine the mortality in our center due to covid-19 in cancer patients during the first 3 weeks of the epidemic. MATERIAL AND METHODS: The cancer patients who died of covid-19 during the analysis period have been reviewed describing the oncological and the covid-19 infection characteristics and the treatments established. RESULTS: Confirmed cases covid-19: 1069 with 132 deaths (12.3%). With cancer 36 patients (3.4%), 15 deceased (41.6%). Of the deceased, only 6 patients (40%) were in active treatment. The most frequent associated tumor was lung (8/15 patients, 53.3%), 11 with metastatic disease (11/15, 73.3%). No specific treatment wasestablished in 40 % (6/15) of the patients. The rest of them received treatments with the active protocols. CONCLUSION: Covid-19 mortality in cancer patients is almost four times higher than that of the general population. Until we have effective treatments or an effective vaccine, the only possibility to protect our patients is to prevent the infection with the appropriate measures

Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Infecções por Coronavirus/mortalidade , Neoplasias/epidemiologia , Comorbidade , Neoplasias/complicações , Febre/complicações , Tosse/complicações , Dispneia/complicações , Hidroxicloroquina/administração & dosagem , Lopinavir/administração & dosagem , Azitromicina/administração & dosagem , Antineoplásicos/administração & dosagem , Unidades de Terapia Intensiva/estatística & dados numéricos
PLoS One ; 15(8): e0237973, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32853275


INTRODUCTION: Exercise modalities offered as part of traditional pulmonary rehabilitation (PR) do not always translate to successful performance of Activities of Daily Living (ADL) and may hinder gains in patient's sense of well-being. Data is lacking on the efficacy of incorporation of ADL-focused training in PR. The aim of this study was to determine the impact of incorporation of ADL simulation and energy-conservation training in PR as part of a quality-initiative on health-related-quality-of-life (HRQOL), dyspnea, fatigue, and six-minute-walk-test among PR patients. METHODS: Retrospective study where medical records of consecutive patients with chronic respiratory diseases who completed PR from 2016 to 2018 were reviewed. ADL-focused energy-conservation training was added to traditional PR in September 2017 by replacing three monthly sessions of traditional PR with energy-conservation training as a quality-improvement-initiative. The change from baseline on HRQOL measured by COPD assessment test (CAT), six-minute-walk-test, MMRC dyspnea score and CRQ-dyspnea and CRQ-fatigue questionnaires, were compared between patients who received traditional PR versus energy-conservation PR. Within and between group differences were calculated via repeated-measures ANOVA. RESULTS: The baseline characteristics of 91 patients who participated in traditional PR versus energy-conservation PR (n = 85) were similar (mean age = 68.6±10.4 years, 49% men). While improvement from baseline was similar and significant for both groups for MMRC, CRQ-dyspnea and CRQ-fatigue scores, and six-minute walk test, patients who participated in energy-conservation PR had significantly higher improvement in HRQOL CAT scores (p = 0.01) than those who completed traditional PR. CONCLUSION: Tailoring patient's training programs to include energy-conservation training exercises specific to ADL in PR improved HRQOL over traditional PR in patients with chronic respiratory diseases despite no significant change in functional status. Future randomized-controlled trials will be needed to confirm these initial findings.

Atividades Cotidianas , Dispneia/terapia , Terapia por Exercício , Qualidade de Vida , Idoso , Dispneia/complicações , Dispneia/fisiopatologia , Dispneia/reabilitação , Feminino , Humanos , Masculino , Doença Pulmonar Obstrutiva Crônica/complicações , Inquéritos e Questionários , Caminhada
Rev Med Suisse ; 16(698): 1243-1249, 2020 Jun 17.
Artigo em Francês | MEDLINE | ID: mdl-32558453


Dysfunctional breathing is a group of respiratory disorders that cause dyspnea, with no organic cause, or that are disproportionate to the organ involvement. Hyperventilation syndrome is the best-known manifestation of dysfunctional breathing. It is very often associated or secondary to anxiety disorders. When the diagnosis of dysfunctional breathing is not considered, it can lead to multiple and unnecessary investigations, further increasing anxiety. The diagnosis is based on various tests, none of which is really specific, and remains based on a bundle of arguments. Management must be adapted for each patient and is based on respiratory rehabilitation techniques.

Dispneia , Hiperventilação , Ansiedade/complicações , Transtornos de Ansiedade/complicações , Dispneia/complicações , Dispneia/diagnóstico , Dispneia/reabilitação , Humanos , Hiperventilação/complicações , Hiperventilação/diagnóstico , Hiperventilação/reabilitação
Eur J Nucl Med Mol Imaging ; 47(10): 2453-2460, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32556400


PURPOSE: The aim of this series of cases is to show the aspects of ventilation/perfusion single-photon emission computed tomography combined with computed tomography (V/Q SPECT/CT) in patients hospitalized for COVID-19 pneumonia, with the worsening of respiratory symptoms raising the suspicion of a pulmonary embolism. Patients did not benefit from CT angiography for various reasons: a contraindication, unavailability of the CT angiography, or a low clinical probability for pulmonary embolism. METHODS: We retrospectively describe the results of the V/Q SPECT/CT of five patients hospitalized for COVID-19 pneumonia in the nuclear medicine departments of the Centre Cardiologique du Nord and of the Delafontaine hospital in Saint-Denis (Ile-de-France, France) between April 2, 2020, and April 10, 2020. These patients had persistent dyspnea or chest pain suggesting pulmonary embolism. RESULTS: The V/Q SPECT/CT allowed to diagnose a pulmonary embolism in one of these five patients. We also noted several characteristics of the perfusion and ventilation depending on the lung lesions on the CT scan. The areas affected by COVID-19 were most often responsible for ventilatory anomalies with a relatively preserved perfusion. In more advanced cases of pneumonia, with alveolar fillings, the perfusion was also reduced or absent in accordance with large ventilation defects. In addition, the healthy parenchyma appeared to benefit from an uptake in ventilation and perfusion. CONCLUSION: V/Q SPECT/CT can play a role in the management of patients hospitalized for COVID-19 for the diagnosis of embolic complications with meticulous hygienic precautions. The different characteristics of the ventilatory and perfusion anomalies related to COVID-19 pneumonia will be confirmed with the next cases. In addition, in this pandemic context and facing a significant infectious risk, the utility of ventilation will also have to be specified.

Infecções por Coronavirus/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Pneumonia Viral/diagnóstico por imagem , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único , Adulto , Idoso , Coagulação Sanguínea , Progressão da Doença , Dispneia/complicações , Feminino , França , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Probabilidade , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/virologia , Estudos Retrospectivos , Relação Ventilação-Perfusão
Rev. cuba. med. mil ; 49(2): e292, abr.-jun. 2020. fig
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1138998


Introducción: A partir de los años 50, la presentación clínica clásica de la endocarditis infecciosa ha variado. Debido al uso de antibióticos, drogas ilícitas, catéteres venosos, etc., las manifestaciones tradicionales no son frecuentes. Objetivo: Presentar un caso con endocarditis infecciosa y comentar las manifestaciones embolígenas, así como las medidas preventivas con las nuevas técnicas. Caso clínico: Enfermo con insuficiencia renal crónica, diabético, hipertenso, con catéter venoso central, que presentó, después de una sección de hemodiálisis; escalofríos intensos, fiebre de 39,5 0C, cefalea intensa, toma del estado general, dolor torácico intenso punzante, tos, expectoración con sangre roja rutilante, disnea, soplo regurgitante holosistólico. Se le realizó ecocardiograma dópler que muestra múltiples vegetaciones pequeñas, hemocultivos positivos a estafilococos dorado. Fue tratado según los resultados del antibiograma durante 6 semanas y resolvió su extrema gravedad. Conclusiones: La endocarditis infecciosa puede tener manifestaciones muy diferentes al de décadas anteriores; puede aparecer como cuadro agudo fulminante por manifestaciones embólicas y sépticas múltiples(AU)

Introduction: Since the 1950s, the classical clinical presentation of infectious endocarditis (E.I) has varied. Due to the use of antibiotics, illicit drugs, venous catheters, traditional manifestations are not frequent. Objectives: To review the embolic presentation of endocarditis and pecify the preventive measures with the new techniques. Clinical case: A patient with chronic renal insufficiency, diabetic, hypertensive, with central venous catheter, intense chills, fever of 39.5 ° C, intense headache, general state, severe chest pain, cough, expectoration with bright red blood, dyspnea, holosystolic regurgitant murmur, after a section of hemodialysis. Doppler echocardiogram was performed, visualizing multiple small vegetation's, positive blood cultures to golden staphylococci, treatment according to antibiograms for 6 weeks, at the end of which the extreme severity was resolved. Comments: Infective endocarditis can have a very different behavior from previous decades; it can appear as an acute fulminating disease due to embolic, septic, multiple manifestations(AU)

Humanos , Masculino , Pessoa de Meia-Idade , Testes de Sensibilidade Microbiana , Diálise Renal/instrumentação , Dispneia/complicações , Insuficiência Renal Crônica/diagnóstico
Pneumologie ; 74(5): 300-303, 2020 May.
Artigo em Alemão | MEDLINE | ID: mdl-32392615


A guest on a cruise ship must be disembarked during the voyage due to a probable malignant pleural effusion recurring after puncture and draining part of the fluid. As in this case, patients are often advised by their general practitioners or specialists to take part in an already planned cruise, although complications of existing underlying diseases cannot always be well treated in the on-board hospital. The diagnostic and therapeutic possibilities in the on-board hospital are clearly limited in many aspects compared to hospitals ashore and disembarkation is not desirable everywhere.

Dispneia , Derrame Pleural Maligno , Derrame Pleural/etiologia , Navios , Drenagem , Dispneia/complicações , Humanos
Pediatr Emerg Care ; 36(4): e227-e228, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32195985


OBJECTIVES: Patients with immune thrombocytopenia are at risk of both bleeding complications and venous thromboembolism. There is no standard to treating life-threatening pulmonary embolism in this population. This case illustrates the difficulty of treating significant thromboembolism in pediatric patients who have reduced clotting capacity. CASE: This case focuses on a 16-year-old pediatric patient with a history of immune thrombocytopenia presenting with mild chest discomfort and dyspnea on exertion. The d-dimer was mildly elevated, and the subsequent computed tomography angiogram revealed bilateral pulmonary embolisms with right ventricular strain. CONCLUSIONS: The patient underwent thromboembolectomy by interventional radiology with subsequent administration of intravenous immunoglobulin, high-dose steroids, and enoxaparin therapy. There is no standard of care for patients with life-threatening pulmonary embolism in this population. Several authors suggest medical therapy options, but do not include patients with potential hemodynamic instability.

Embolia Pulmonar/diagnóstico , Púrpura Trombocitopênica Idiopática/complicações , Adolescente , Anticoagulantes/uso terapêutico , Angiografia por Tomografia Computadorizada , Dispneia/complicações , Ecocardiografia , Enoxaparina/uso terapêutico , Feminino , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/patologia , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Embolia Pulmonar/etiologia , Embolia Pulmonar/terapia , Tórax/diagnóstico por imagem , Resultado do Tratamento