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1.
PLoS One ; 17(2): e0263922, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35167608

RESUMO

IMPORTANCE: When hospitals are at capacity, accurate deterioration indices could help identify low-risk patients as potential candidates for home care programs and alleviate hospital strain. To date, many existing deterioration indices are based entirely on structured data from the electronic health record (EHR) and ignore potentially useful information from other sources. OBJECTIVE: To improve the accuracy of existing deterioration indices by incorporating unstructured imaging data from chest radiographs. DESIGN, SETTING, AND PARTICIPANTS: Machine learning models were trained to predict deterioration of patients hospitalized with acute dyspnea using existing deterioration index scores and chest radiographs. Models were trained on hospitalized patients without coronavirus disease 2019 (COVID-19) and then subsequently tested on patients with COVID-19 between January 2020 and December 2020 at a single tertiary care center who had at least one radiograph taken within 48 hours of hospital admission. MAIN OUTCOMES AND MEASURES: Patient deterioration was defined as the need for invasive or non-invasive mechanical ventilation, heated high flow nasal cannula, IV vasopressor administration or in-hospital mortality at any time following admission. The EPIC deterioration index was augmented with unstructured data from chest radiographs to predict risk of deterioration. We compared discriminative performance of the models with and without incorporating chest radiographs using area under the receiver operating curve (AUROC), focusing on comparing the fraction and total patients identified as low risk at different negative predictive values (NPV). RESULTS: Data from 6278 hospitalizations were analyzed, including 5562 hospitalizations without COVID-19 (training cohort) and 716 with COVID-19 (216 in validation, 500 in held-out test cohort). At a NPV of 0.95, the best-performing image-augmented deterioration index identified 49 more (9.8%) individuals as low-risk compared to the deterioration index based on clinical data alone in the first 48 hours of admission. At a NPV of 0.9, the EPIC image-augmented deterioration index identified 26 more individuals (5.2%) as low-risk compared to the deterioration index based on clinical data alone in the first 48 hours of admission. CONCLUSION AND RELEVANCE: Augmenting existing deterioration indices with chest radiographs results in better identification of low-risk patients. The model augmentation strategy could be used in the future to incorporate other forms of unstructured data into existing disease models.


Assuntos
Deterioração Clínica , Tórax/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19/patologia , COVID-19/virologia , Dispneia/patologia , Feminino , Hospitalização , Humanos , Aprendizado de Máquina , Masculino , Pessoa de Meia-Idade , Curva ROC , Respiração Artificial , Estudos Retrospectivos , Fatores de Risco , SARS-CoV-2/isolamento & purificação , Adulto Jovem
2.
PLoS One ; 16(9): e0256480, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34473738

RESUMO

BACKGROUND: The prevalence of pulmonary embolism (PE) in the acute exacerbation of chronic obstructive pulmonary disease (AE-COPD) is highly controversial. We conducted a systematic review and meta-analysis to summarize the epidemiology and characteristics of PE with AE-COPD for current studies. METHODS: We searched the PubMed, EMBASE, Cochrane Library and Web of Science databases for studies published prior to October 21, 2020. Pooled proportions with 95% confidence intervals (95% CIs) were calculated using a random effects model. Odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals were used as effect measures for dichotomous and continuous variables, respectively. RESULTS: A total of 17 studies involving 3170 patients were included. The prevalence of PE and deep vein thrombosis (DVT) in AE-COPD patients was 17.2% (95% CI: 13.4%-21.3%) and 7.1% (95% CI: 3.7%-11.4%%), respectively. Dyspnea (OR = 6.77, 95% CI: 1.97-23.22), pleuritic chest pain (OR = 3.25, 95% CI: 2.06-5.12), lower limb asymmetry or edema (OR = 2.46, 95% CI:1.51-4.00), higher heart rates (MD = 20.51, 95% CI: 4.95-36.08), longer hospital stays (MD = 3.66, 95% CI: 3.01-4.31) were associated with the PE in the AE-COPD patients. Levels of D-dimer (MD = 1.51, 95% CI: 0.80-2.23), WBC counts (MD = 1.42, 95% CI: 0.14-2.70) were significantly higher and levels of PaO2 was lower (MD = -17.20, 95% CI: -33.94- -0.45, P<0.05) in the AE-COPD with PE group. The AE-COPD with PE group had increased risk of fatal outcome than the AE-COPD group (OR = 2.23, 95% CI: 1.43-3.50). CONCLUSIONS: The prevalence of PE during AE-COPD varies considerably among the studies. AE-COPD patients with PE experienced an increased risk of death, especially among the ICU patients. Understanding the potential risk factors for PE may help clinicians identify AE-COPD patients at increased risk of PE. PROSPERO REGISTRATION NUMBER: CRD42021226568.


Assuntos
Dor no Peito/epidemiologia , Dispneia/epidemiologia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Edema Pulmonar/epidemiologia , Embolia Pulmonar/epidemiologia , Trombose Venosa/epidemiologia , Doença Aguda , Biomarcadores/sangue , Dor no Peito/patologia , Dispneia/patologia , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Humanos , Tempo de Internação/estatística & dados numéricos , Razão de Chances , Prevalência , Doença Pulmonar Obstrutiva Crônica/patologia , Edema Pulmonar/patologia , Embolia Pulmonar/patologia , Fatores de Risco , Trombose Venosa/patologia
3.
Rev Med Virol ; 31(6): e2288, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34472152

RESUMO

SARS Coronavirus-2 is one of the most widespread viruses globally during the 21st century, whose severity and ability to cause severe pneumonia and death vary. We performed a comprehensive systematic review of all studies that met our standardised criteria and then extracted data on the age, symptoms, and different treatments of Covid-19 patients and the prognosis of this disease during follow-up. Cases in this study were divided according to severity and death status and meta-analysed separately using raw mean and single proportion methods. We included 171 complete studies including 62,909 confirmed cases of Covid-19, of which 148 studies were meta-analysed. Symptoms clearly emerged in an escalating manner from mild-moderate symptoms, pneumonia, severe-critical to the group of non-survivors. Hypertension (Pooled proportion (PP): 0.48 [95% Confident interval (CI): 0.35-0.61]), diabetes (PP: 0.23 [95% CI: 0.16-0.33]) and smoking (PP: 0.12 [95% CI: 0.03-0.38]) were highest regarding pre-infection comorbidities in the non-survivor group. While acute respiratory distress syndrome (PP: 0.49 [95% CI: 0.29-0.78]), (PP: 0.63 [95% CI: 0.34-0.97]) remained one of the most common complications in the severe and death group respectively. Bilateral ground-glass opacification (PP: 0.68 [95% CI: 0.59-0.75]) was the most visible radiological image. The mortality rates estimated (PP: 0.11 [95% CI: 0.06-0.19]), (PP: 0.03 [95% CI: 0.01-0.05]), and (PP: 0.01 [95% CI: 0-0.3]) in severe-critical, pneumonia and mild-moderate groups respectively. This study can serve as a high evidence guideline for different clinical presentations of Covid-19, graded from mild to severe, and for special forms like pneumonia and death groups.


Assuntos
COVID-19/patologia , Tosse/patologia , Dispneia/patologia , Fadiga/patologia , Febre/patologia , SARS-CoV-2/patogenicidade , Antivirais/uso terapêutico , COVID-19/tratamento farmacológico , COVID-19/mortalidade , COVID-19/virologia , Comorbidade , Tosse/tratamento farmacológico , Tosse/mortalidade , Tosse/virologia , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/fisiopatologia , Dispneia/tratamento farmacológico , Dispneia/mortalidade , Dispneia/virologia , Fadiga/tratamento farmacológico , Fadiga/mortalidade , Fadiga/virologia , Febre/tratamento farmacológico , Febre/mortalidade , Febre/virologia , Humanos , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Fatores Imunológicos/uso terapêutico , Prognóstico , Síndrome do Desconforto Respiratório/diagnóstico , Síndrome do Desconforto Respiratório/fisiopatologia , Índice de Gravidade de Doença , Fumar/fisiopatologia , Análise de Sobrevida
5.
PLoS One ; 16(7): e0255141, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34297774

RESUMO

The natural history of COVID-19 and predictors of mortality in older adults need to be investigated to inform clinical operations and healthcare policy planning. A retrospective study took place in 80 long-term nursing homes in Catalonia, Spain collecting data from March 1st to May 31st, 2020. Demographic and clinical data from 2,092 RT-PCR confirmed cases of SARS-CoV-2 infection were registered, including structural characteristics of the facilities. Descriptive statistics to describe the demographic, clinical, and molecular characteristics of our sample were prepared, both overall and by their symptomatology was performed and an analysis of statistically significant bivariate differences and constructions of a logistic regression model were carried out to assess the relationship between variables. The incidence of the infection was 28%. 71% of the residents showed symptoms. Five major symptoms included: fever, dyspnea, dry cough, asthenia and diarrhea. Fever and dyspnea were by far the most frequent (50% and 28%, respectively). The presentation was predominantly acute and symptomatology persisted from days to weeks (mean 9.1 days, SD = 10,9). 16% of residents had confirmed pneumonia and 22% required hospitalization. The accumulated mortality rate was 21.75% (86% concentrated during the first 28 days at onset). A multivariate logistic regression analysis showed a positive predictive value for mortality for some variables such as age, pneumonia, fever, dyspnea, stupor refusal to oral intake and dementia (p<0.01 for all variables). Results suggest that density in the nursing homes did not account for differences in the incidence of the infection within the facilities. This study provides insights into the natural history of the disease in older adults with high dependency living in long-term nursing homes during the first pandemic wave of March-May 2020 in the region of Catalonia, and suggests that some comorbidities and symptoms have a strong predictive value for mortality.


Assuntos
COVID-19 , Dispneia , Febre , Casas de Saúde , SARS-CoV-2 , Idoso , Idoso de 80 Anos ou mais , COVID-19/mortalidade , COVID-19/patologia , COVID-19/fisiopatologia , Comorbidade , Dispneia/mortalidade , Dispneia/patologia , Dispneia/fisiopatologia , Feminino , Febre/mortalidade , Febre/patologia , Febre/fisiopatologia , Humanos , Incidência , Masculino , Estudos Retrospectivos , Espanha/epidemiologia
6.
J Enzyme Inhib Med Chem ; 36(1): 1230-1235, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34074197

RESUMO

The ongoing Covid-19 is a contagious disease, and it is characterised by different symptoms such as fever, cough, and shortness of breath. Rising concerns about Covid-19 have severely affected the healthcare system in all countries as the Covid-19 outbreak has developed at a rapid rate all around the globe. Intriguing, a clinically used drug, acetazolamide (a specific inhibitor of carbonic anhydrase, CA, EC 4.2.1.1), is used to treat high-altitude pulmonary oedema (HAPE), showing a high degree of clinical similarities with the pulmonary disease caused by Covid-19. In this context, this preliminary study aims to provide insights into some factors affecting the Covid-19 patients, such as hypoxaemia, hypoxia as well as the blood CA activity. We hypothesise that patients with Covid-19 problems could show a dysregulated acid-base status influenced by CA activity. These preliminary results suggest that the use of CA inhibitors as a pharmacological treatment for Covid-19 may be beneficial.


Assuntos
Acetazolamida/uso terapêutico , Antivirais/uso terapêutico , COVID-19/tratamento farmacológico , Inibidores da Anidrase Carbônica/uso terapêutico , Anidrases Carbônicas/sangue , Equilíbrio Ácido-Base/efeitos dos fármacos , Doença da Altitude/sangue , Doença da Altitude/tratamento farmacológico , Anticonvulsivantes/uso terapêutico , Bicarbonatos/sangue , COVID-19/sangue , COVID-19/diagnóstico por imagem , COVID-19/virologia , Dióxido de Carbono/sangue , Tosse/sangue , Tosse/tratamento farmacológico , Tosse/patologia , Tosse/virologia , Reposicionamento de Medicamentos , Dispneia/sangue , Dispneia/tratamento farmacológico , Dispneia/patologia , Dispneia/virologia , Febre/sangue , Febre/tratamento farmacológico , Febre/patologia , Febre/virologia , Humanos , Concentração de Íons de Hidrogênio , Hipertensão Pulmonar/sangue , Hipertensão Pulmonar/tratamento farmacológico , Hipóxia/sangue , Hipóxia/tratamento farmacológico , Hipóxia/patologia , Hipóxia/virologia , Oximetria , Projetos de Pesquisa , SARS-CoV-2/patogenicidade , SARS-CoV-2/fisiologia , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X
7.
Sci Rep ; 11(1): 6874, 2021 03 25.
Artigo em Inglês | MEDLINE | ID: mdl-33767311

RESUMO

Dyspnoea is a cardinal symptom of fibrotic interstitial lung disease (ILD), with a lack of proven effective therapies. With emerging evidence of the role of facial and nasal airflow for relieving breathlessness, this pilot study was conducted to examine the feasibility of conducting a clinical trial of a handheld fan (HHF) for dyspnoea management in patients with fibrotic ILD. In this mixed-methods, randomised, assessor-blinded, controlled trial, 30 participants with fibrotic ILD who were dyspnoeic with a modified Medical Research Council Dyspnoea grade ≥ 2 were randomised to a HHF for symptom control or no intervention for 2 weeks. Primary outcomes were trial feasibility, change in Dyspnoea-12 scores at Week 2, and participants' perspectives on using a HHF for dyspnoea management. Study recruitment was completed within nine months at a single site. Successful assessor blinding was achieved in the fan group [Bang's Blinding Index - 0.08 (95% CI - 0.45, 0.30)] but not the control group [0.47 (0.12, 0.81)]. There were no significant between-group differences for the change in Dyspnoea-12 or secondary efficacy outcomes. During qualitative interviews, participants reported that using the HHF relieved breathlessness and provided relaxation, despite initial scepticism about its therapeutic benefit. Oxygen-experienced participants described the HHF being easier to use, but not as effective for symptomatic relief, compared to oxygen therapy. Our results confirmed the feasibility of a clinical trial of a HHF in fibrotic ILD. There was a high level of patient acceptance of a HHF for managing dyspnoea, with patients reporting both symptomatic benefits and ease of use.


Assuntos
Dispneia/terapia , Doenças Pulmonares Intersticiais/complicações , Oxigenoterapia/instrumentação , Oxigenoterapia/métodos , Qualidade de Vida , Autogestão/métodos , Idoso , Estudos de Casos e Controles , Dispneia/etiologia , Dispneia/patologia , Feminino , Humanos , Masculino , Projetos Piloto , Método Simples-Cego
8.
PLoS One ; 16(3): e0248603, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33770113

RESUMO

INTRODUCTION: Patients at intermediate-high risk of developing a pulmonary embolism (PE) are very likely to experience adverse outcomes, such as cardiovascular instability and death. The role of thrombolytic therapy in intermediate-high-risk PE remains controversial. OBJECTIVES: This study aimed to determine the efficacy and safety of low-dose urokinase (UK) thrombolytic therapy for intermediate-high-risk PE. PATIENTS AND METHODS: This retrospective study included 81 consecutive patients with intermediate-high-risk PE from two centers. Patients received low-dose UK or low-molecular-weight heparin (anticoagulant therapy group). The efficacy outcomes were mortality, computed tomography pulmonary angiography (CTPA)-confirmed absorption, and dyspnea. Safety was assessed as the incidence of bleedings. RESULTS: The in-hospital mortality, 9-month mortality, and long-term mortality at the last follow-up were comparable for the low-dose UK group and the anticoagulant therapy group (6.45% vs. 0%, p = 0.144, 9.68% vs. 8.16%, p = 0.815, and 12.90% vs. 12.24%, p = 0.931, respectively). CTPA-confirmed absorption at one month after admission was higher in the low-dose UK group than in the anticoagulant therapy group (p = 0.016). The incidences of short-term dyspnea at discharge and long-term dyspnea at the last follow-up were lower in the low-dose UK group than in the anticoagulant therapy group (27.59% vs. 52%, p = 0.035, 33.33% vs. 58.14%, p = 0.043, respectively). No major bleeding occurred. The incidence of minor bleeding was not significantly different between the two groups (3.23% vs. 6%, p = 0.974). CONCLUSION: In intermediate-high-risk PE, a low-dose UK might increase CTPA-confirmed absorption and improve short-term and long-term dyspnea without affecting mortality or increasing the bleeding risk.


Assuntos
Dispneia/tratamento farmacológico , Embolia Pulmonar/tratamento farmacológico , Terapia Trombolítica , Ativador de Plasminogênio Tipo Uroquinase/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/administração & dosagem , Estudos de Coortes , Angiografia por Tomografia Computadorizada , Dispneia/complicações , Dispneia/diagnóstico por imagem , Dispneia/patologia , Feminino , Hemodinâmica , Hemorragia/diagnóstico por imagem , Hemorragia/tratamento farmacológico , Hemorragia/patologia , Heparina de Baixo Peso Molecular/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/patologia , Fatores de Risco , Ativador de Plasminogênio Tipo Uroquinase/efeitos adversos
9.
Eur J Clin Microbiol Infect Dis ; 40(7): 1427-1431, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33532945

RESUMO

Polymerase chain reaction (PCR)-based diagnostics for Mycoplasma pneumoniae (M. pneumoniae) from the respiratory tract has become widely available, but the interpretation of the results remains unclear. M. pneumoniae has been suggested to cause mainly mild and self-limiting infections or asymptomatic carriage. However, systematic analyses of the association between PCR results and clinical findings are scarce. This study aimed to clarify the clinical features of PCR-positive M. pneumoniae infections in a hospital setting. We reviewed 103 PCR-positive patients cared for in a university hospital during a 3-year period. Data on age, sex, health condition, acute symptoms, other pathogens found, laboratory and X-ray results and treatments were collected. Over 85% of the patients had a triad of typical symptoms: fever, cough and shortness of breath. Symptoms in the upper respiratory tract were rare. In 91% of the cases, M. pneumoniae was the only pathogen found. The highest incidence was found in the age group of 30-40 years, and 68% of the patients did not have any underlying diseases. Most patients were initially empirically treated with beta-lactam antibiotics and needed 2-4 changes in their treatment. Only 6% were discharged without an antibiotic effective against M. pneumoniae. This study shows that M. pneumoniae often led to hospitalisation and that patients needed appropriate antimicrobial treatment to recover. Mixed infections were rare, and situations that could be interpreted as carriage did not occur.


Assuntos
Dispneia/microbiologia , Hospitalização , Mycoplasma pneumoniae , Pneumonia por Mycoplasma/microbiologia , Pneumonia por Mycoplasma/patologia , Reação em Cadeia da Polimerase , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Dispneia/patologia , Humanos , Lactente , Pessoa de Meia-Idade , Adulto Jovem
10.
J Med Virol ; 93(3): 1761-1765, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-32889755

RESUMO

To determine the distribution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) respiratory viral loads (VL) during the acute phase of infection and their correlation with clinical presentation and inflammation-related biomarkers. Nasopharyngeal swabs from 453 adult SARS-CoV-2-infected patients from the Department of Infectious Diseases, Besançon, France, were collected at the time of admission or consultation for reverse transcriptase polymerase chain reaction (RT-PCR) analysis. Clinical information and concentrations of biological parameters (C-reactive protein [CRP], fibrinogen, lactate dehydrogenase [LDH], prealbumin) were noticed. Mean respiratory VL homogeneously decreased from 7.2 log10 copies/ml (95% confidence interval [CI]: 6.6-7.8) on the first day of symptoms until 4.6 log10 copies/ml (95% CI: 3.8-5.4) at day 10 (slope = -0.24; R2 = .95). VL were poorly correlated with COVID-19 symptoms and outcome, excepted for dyspnea and anosmia, which were significantly associated with lower VL (p < .05). CRP, fibrinogen, and LDH concentrations significantly increased over the first 10 days (median CRP concentrations from 36.8 mg/L at days 0-1 to 99.5 mg/L at days 8-10; p < .01), whereas prealbumin concentrations tended to decrease. Since SARS-CoV-2 respiratory VL regularly decrease in the acute phase of infection, determining the level of VL may help predicting the onset of virus shedding in a specific patient. However, the role of SARS-CoV-2 VL as a biomarker of severity is limited.


Assuntos
Teste para COVID-19/métodos , COVID-19/diagnóstico , COVID-19/epidemiologia , Carga Viral/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Anosmia/patologia , Proteína C-Reativa/análise , Dispneia/patologia , Feminino , Fibrinogênio/análise , França/epidemiologia , Humanos , L-Lactato Desidrogenase/sangue , Masculino , Pessoa de Meia-Idade , Nasofaringe/virologia , Pré-Albumina/análise , RNA Viral/análise , SARS-CoV-2 , Resultado do Tratamento , Eliminação de Partículas Virais , Adulto Jovem
11.
Infection ; 49(1): 153-157, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32725597

RESUMO

PURPOSE: The aim of our study was to assess respiratory function at the time of clinical recovery and 6 weeks after discharge in patients surviving to COVID-19 pneumonia. METHODS: Our case series consisted of 13 patients with COVID-19 pneumonia. RESULTS: At the time of clinical recovery, FEV1 (2.07 ± 0.72 L) and FVC (2.25 ± 0.86 L) were lower compared to lower limit of normality (LLN) values (2.56 ± 0.53 L, p = 0.004, and 3.31 ± 0.65 L, p < 0.001, respectively), while FEV1/FVC (0.94 ± 0.07) was higher compared to upper limit of normality (ULN) values (0.89 ± 0.01, p = 0.029). After 6 weeks pulmonary function improved but FVC was still lower than ULN (2.87 ± 0.81, p = 0.014). CONCLUSION: These findings suggest that COVID-19 pneumonia may result in clinically relevant alterations in pulmonary function tests, with a mainly restrictive pattern.


Assuntos
COVID-19/fisiopatologia , Tosse/fisiopatologia , Dispneia/fisiopatologia , Febre/fisiopatologia , Pulmão/fisiopatologia , SARS-CoV-2/patogenicidade , Adulto , Idoso , COVID-19/diagnóstico , COVID-19/patologia , COVID-19/virologia , Tosse/diagnóstico , Tosse/patologia , Tosse/virologia , Dispneia/diagnóstico , Dispneia/patologia , Dispneia/virologia , Feminino , Febre/diagnóstico , Febre/patologia , Febre/virologia , Humanos , Pulmão/diagnóstico por imagem , Pulmão/patologia , Pulmão/virologia , Masculino , Pessoa de Meia-Idade , Testes de Função Respiratória , Espirometria , Tomografia Computadorizada por Raios X
12.
Biomed Res Int ; 2020: 4357910, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33145348

RESUMO

BACKGROUND: Human adenoviruses (HAdVs) are commonly causing respiratory disease. We molecularly genotyped HAdV circulating in Chinese hospitalized children with respiratory infections and summarized the clinical profiles and common inflammatory biomarkers, so as to better determine their associations with disease severity. METHOD: Children with respiratory single HAdV infection cases that occurred from December 2017 to March 2019 were enrolled for a cross-sectional study. Clinical/laboratory features based on the genotypes of respiratory HAdV infection were reviewed for comparative analysis. RESULTS: A total of 84 patients were enrolled, and HAdV types were identified from 82 patients. Species B (HAdV-7, 44%; HAdV-3, 43%, and HAdV-14, 5%) was the most common, followed by C (HAdV-2, 4% and HAdV-1, 1%) and E (HAdV-4, 1%). Severe HAdV infection and HAdV-7 infection groups were associated with significantly longer duration of fever and hospitalized days, higher morbidity of tachypnea/dyspnea, more pleural effusion, more respiratory rales, more frequently required mechanical ventilation, and significantly higher fatality rate. The elevated procalcitonin (PCT) and C-reactive protein (CRP) levels were significantly associated with severe HAdV infection. CONCLUSIONS: HAdV-7 and HAdV-3 were the most common types among children with respiratory adenovirus infection; vaccines against these two genotypes are in urgent need. PCT and CRP are significantly associated with the severity of HAdV infection.


Assuntos
Infecções por Adenoviridae/diagnóstico , Adenovírus Humanos/genética , Proteína C-Reativa/genética , Dispneia/diagnóstico , Derrame Pleural/diagnóstico , Pró-Calcitonina/genética , Infecções Respiratórias/diagnóstico , Infecções por Adenoviridae/mortalidade , Infecções por Adenoviridae/patologia , Infecções por Adenoviridae/virologia , Adenovírus Humanos/classificação , Adenovírus Humanos/isolamento & purificação , Adenovírus Humanos/patogenicidade , Adolescente , Biomarcadores/sangue , Proteína C-Reativa/metabolismo , Criança , Pré-Escolar , Estudos Transversais , Dispneia/mortalidade , Dispneia/patologia , Dispneia/virologia , Feminino , Expressão Gênica , Genótipo , Humanos , Lactente , Tempo de Internação/estatística & dados numéricos , Masculino , Epidemiologia Molecular , Filogenia , Derrame Pleural/mortalidade , Derrame Pleural/patologia , Derrame Pleural/virologia , Pró-Calcitonina/sangue , Respiração Artificial/estatística & dados numéricos , Infecções Respiratórias/mortalidade , Infecções Respiratórias/patologia , Infecções Respiratórias/virologia , Índice de Gravidade de Doença , Análise de Sobrevida
13.
J Rehabil Med ; 52(10): jrm00116, 2020 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-33043382

RESUMO

OBJECTIVE: A better understanding of factors influencing breathing weakness in stroke survivors would help in planning rehabilitation therapies. The main objective of this study was to determine whether the location of cerebral infarct is associated with breathing weakness in patients with subacute stroke. DESIGN: Cross-sectional analysis of a prospective cohort. PATIENTS: Consecutive patients admitted to a neurology rehabilitation unit with first-time ischaemic stroke (n?=?170). METHODS: Breathing weakness was defined as >?70% reduction in maximal inspiratory and expiratory pressures (PImax and PEmax, respectively) compared with reference values. Computed tomography and magnetic resonance imaging were used to locate stroke lesions, which were classified as cortical, subcortical, cortico-subcortical, brainstem, or cerebellum. The affected cerebrovascular territory was identified to classify stroke subtype. The association between maximal respiratory pressure and affected brain area was studied using median regression analysis. RESULTS: Breathing weakness was detected in 151 (88.8%) patients. Those with cortical and cortico-subcortical stroke location had the lowest PImax and PEmax values (median 33 cmH2O). This value differed significantly from maximal respiratory pressures of patients with strokes located in the brainstem and the cerebellum, with PImax median differences (?) of 16 cmH2O (95% confidence interval (95% CI) 4.127.9) and 27 cmH2O (95% CI 7.846.2), respectively, and PEmax median differences of 27 cmH2O (95% CI 11.442.7) and 49 cmH2O (95% CI 23.774.3), respectively, both of which remained significant after adjustments. CONCLUSION: The prevalence of breathing weakness was very high in stroke patients admitted to a neurorehabilitation ward, being more severe in cortical or cortico-subcortical stroke.


Assuntos
Encéfalo/patologia , Infarto Cerebral/patologia , Dispneia/patologia , Respiração , Acidente Vascular Cerebral/patologia , Idoso , Encéfalo/diagnóstico por imagem , Infarto Cerebral/complicações , Infarto Cerebral/diagnóstico por imagem , Estudos de Coortes , Estudos Transversais , Dispneia/diagnóstico por imagem , Dispneia/epidemiologia , Feminino , Humanos , Masculino , Pressões Respiratórias Máximas , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Análise de Regressão , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico por imagem , Reabilitação do Acidente Vascular Cerebral/estatística & dados numéricos
14.
PLoS One ; 15(7): e0236346, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32726327

RESUMO

INTRODUCTION: Interstitial lung diseases (ILDs) include a wide variety of chronic progressive pulmonary diseases characterized by lung inflammation, fibrosis and hypoxemia and can progress to respiratory failure and even death. ILDs are associated with varying degrees of quality of life impairments in affected people. Studies on the quality of life in patients with ILDs are still limited, and there are few studies with long-term follow-up periods in these patients. METHODS: Data from patients who were clinically diagnosed with ILDs in the Respiratory Department, Beijing Chaoyang Hospital, Capital Medical University from January 2017 to February 2018 were collected. Clinical status and HRQoL were assessed at baseline and subsequently at 6- and 12-month intervals with the LCQ, mMRC, HADS, SF-36, and SGRQ. Multivariate linear regression was used to evaluate the determinants of the decline in HRQoL. RESULTS: A total of 139 patients with idiopathic interstitial pneumonia (IIP) and 30 with connective tissue disease-associated ILD (CTD-ILD) were enrolled, 140 of whom completed the follow-up. The mean age was 63.7 years, and 92 patients were men. At baseline, the decline in HRQoL assessed by the SF-36 and SGRQ was significantly associated with the mMRC, LCQ and HADS depression score. In the follow-up, changes in FVC%, DLco%, mMRC and LCQ were significantly associated with changes in HRQoL. CONCLUSIONS: HRQoL in both IIP and CTD-ILD patients deteriorates to varying degrees, and the trend suggests that poor HRQoL in these patients is associated with many determinants, primarily dyspnea, cough and depression. Improving HRQoL is the main aim when treating patients living with ILDs.


Assuntos
Doenças do Tecido Conjuntivo/epidemiologia , Pneumonias Intersticiais Idiopáticas/epidemiologia , Fibrose Pulmonar Idiopática/epidemiologia , Doenças Pulmonares Intersticiais/epidemiologia , Idoso , China/epidemiologia , Doenças do Tecido Conjuntivo/patologia , Tosse/epidemiologia , Tosse/patologia , Dispneia/epidemiologia , Dispneia/patologia , Feminino , Humanos , Pneumonias Intersticiais Idiopáticas/patologia , Fibrose Pulmonar Idiopática/patologia , Doenças Pulmonares Intersticiais/classificação , Doenças Pulmonares Intersticiais/patologia , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Testes de Função Respiratória , Fatores de Risco
15.
Intern Med ; 59(16): 2029-2034, 2020 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-32493848

RESUMO

In the 2013 updated classification of the American Thoracic Society/European Respiratory Society, airway-centered interstitial fibrosis (ACIF) is included as a bronchiolocentric pattern of interstitial pneumonia (IP) among idiopathic IPs. We encountered a case of severe pulmonary hypertension (PH) with chronic IP. The patient initially presented with shortness of breath and often lost consciousness due to PH, and seven years after his first visit, he ultimately died. An autopsy revealed ACIF and usual IP. In particular, the ACIF comprised non-atypical smooth muscle hyperplasia, and pulmonary hypertensive vascular degeneration was detected. This case may represent a new pathological feature of ACIF.


Assuntos
Broncopatias/complicações , Hipertensão Pulmonar/complicações , Doenças Pulmonares Intersticiais/complicações , Idoso , Broncopatias/patologia , Dispneia/patologia , Fibrose , Humanos , Hiperplasia/patologia , Hipertensão Pulmonar/patologia , Pulmão/patologia , Doenças Pulmonares Intersticiais/patologia , Masculino , Músculo Liso/patologia
16.
Thorac Cancer ; 11(7): 2040-2043, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32374517

RESUMO

A 49-year-old man presented to our outpatient clinic complaining of nonproductive cough and exertional dyspnea for two months. He had been diagnosed with large B cell non-Hodgkin's lymphoma seven months previously, and the tumor had almost disappeared after four cycles of rituximab-containing chemotherapy. He then developed a severe dry cough, progressive dyspnea and hypoxia two weeks after the fifth cycle. Bilateral diffuse ground-glass opacities were visible on chest X-ray. Although the patient's symptoms were ameliorated temporarily after two weeks of methylprednisolone administration and multiple antibiotics, exertional dyspnea had progressed slowly starting one month after discontinuation of the corticosteroid. A repeat chest computed tomography (CT) scan showed diffuse ground-glass opacities, bronchoalveolar lavage fluid tests for pathogens were negative and the pathological manifestation of the transbronchial lung biopsy showed nonspecific interstitial pneumonia. Rituximab-induced interstitial lung disease was diagnosed after multidisciplinary discussion. Prednisone was again prescribed and his symptoms and the pulmonary opacities gradually disappeared. Although various pulmonary infections are the most common respiratory complications in patients with non-Hodgkin's lymphoma undergoing rituximab-containing chemotherapy, noninfectious diffuse lung disease, eg, drug-associated interstitial lung disease might be considered as a differential diagnosis of patients treated with rituximab, especially if a patient is nearing the time of administration of a fourth cycle of rituximab.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Dispneia/patologia , Doenças Pulmonares Intersticiais/patologia , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Ciclofosfamida/administração & dosagem , Doxorrubicina/administração & dosagem , Dispneia/induzido quimicamente , Etoposídeo/administração & dosagem , Humanos , Doenças Pulmonares Intersticiais/induzido quimicamente , Linfoma Difuso de Grandes Células B/patologia , Masculino , Pessoa de Meia-Idade , Prednisona/administração & dosagem , Prognóstico , Rituximab/administração & dosagem , Vincristina/administração & dosagem
17.
Encephale ; 46(3): 169-172, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32425222

RESUMO

OBJECTIVES: The ongoing COVID-19 pandemic has caused approximately 2,350,000 infections worldwide and killed more than 160,000 individuals. In Sainte-Anne Hospital (GHU PARIS Psychiatrie & Neuroscience, Paris, France) we have observed a lower incidence of symptomatic forms of COVID-19 among patients than among our clinical staff. This observation led us to hypothesize that psychotropic drugs could have a prophylactic action against SARS-CoV-2 and protect patients from the symptomatic and virulent forms of this infection, since several of these psychotropic drugs have documented antiviral properties. Chlorpromazine (CPZ), a phenothiazine derivative, is also known for its antiviral activity via the inhibition of clathrin-mediated endocytosis. Recentin vitro studies have reported that CPZ exhibits anti-MERS-CoV and anti-SARS-CoV-1 activity. METHODS: In this context, the ReCoVery study aims to repurpose CPZ, a molecule with an excellent tolerance profile and a very high biodistribution in the saliva, lungs and brain. We hypothesize that CPZ could reduce the unfavorable course of COVID-19 infection among patients requiring respiratory support without the need for ICU care, and that it could also reduce the contagiousness of SARS-CoV-2. For this purpose, we plan a pilot, multicenter, randomized, single blind, controlled, phase III therapeutic trial (standard treatment vs. CPZ+standard treatment). CONCLUSION: This repurposing of CPZ for its anti-SARS-CoV-2 activity could offer an alternative, rapid strategy to alleviate infection severity. This repurposing strategy also avoids numerous developmental and experimental steps, and could save precious time to rapidly establish an anti-COVID-19 therapy with well-known, limited and easily managed side effects.


Assuntos
Clorpromazina/uso terapêutico , Infecções por Coronavirus/tratamento farmacológico , Reposicionamento de Medicamentos , Pneumonia Viral/tratamento farmacológico , Antivirais/uso terapêutico , Ansiedade/complicações , Ansiedade/tratamento farmacológico , Ansiedade/epidemiologia , Ansiedade/patologia , Betacoronavirus/patogenicidade , Barreira Hematoencefálica/efeitos dos fármacos , COVID-19 , Vesículas Revestidas por Clatrina/efeitos dos fármacos , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/patologia , Progressão da Doença , Dispneia/tratamento farmacológico , Dispneia/epidemiologia , Dispneia/patologia , Dispneia/psicologia , Endocitose/efeitos dos fármacos , França/epidemiologia , Humanos , Tempo de Internação , Mortalidade , Pandemias , Avaliação de Resultados da Assistência ao Paciente , Projetos Piloto , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Pneumonia Viral/patologia , Recuperação de Função Fisiológica , SARS-CoV-2 , Método Simples-Cego , Tempo para o Tratamento , Resultado do Tratamento
18.
Med Clin North Am ; 104(3): 455-470, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32312409

RESUMO

Respiratory symptoms are common in patients living with serious illness, both in cancer and nonmalignant conditions. Common symptoms include dyspnea (breathlessness), cough, malignant pleural effusions, airway secretions, and hemoptysis. Basic management of respiratory symptoms is within the scope of primary palliative care. There are pharmacologic and nonpharmacologic approaches to treating respiratory symptoms. This article provides clinicians with treatment approaches to these burdensome symptoms.


Assuntos
Tosse/terapia , Estado Terminal/terapia , Dispneia/terapia , Hemoptise/terapia , Derrame Pleural Maligno/tratamento farmacológico , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/efeitos adversos , Analgésicos Opioides/uso terapêutico , Secreções Corporais/efeitos dos fármacos , Terapia Combinada/métodos , Tosse/epidemiologia , Tosse/etiologia , Tosse/patologia , Dispneia/epidemiologia , Dispneia/etiologia , Dispneia/patologia , Hemoptise/epidemiologia , Hemoptise/etiologia , Hemoptise/patologia , Humanos , Mortalidade/tendências , Cuidados Paliativos/normas , Derrame Pleural Maligno/epidemiologia , Derrame Pleural Maligno/mortalidade , Prevalência , Sistema Respiratório/efeitos dos fármacos , Sistema Respiratório/fisiopatologia , Fatores de Risco
19.
J Korean Acad Nurs ; 50(1): 66-80, 2020 Feb.
Artigo em Coreano | MEDLINE | ID: mdl-32131074

RESUMO

PURPOSE: This study aims to examine the effects of nursing interventions based on the Extended Theory of Planned Behavior (ETPB) regarding self-efficacy for exercise (SEE), physical activity (PA), physical function (PF), and quality of life (QOL) in patients with lung cancer who have undergone pulmonary resection. METHODS: This quasi-experimental study was conducted between July 2015 and June 2018 in two university-affiliated hospitals. The intervention included pre-operative patient education, goal setting (action and coping planning), and feedback (behavior intention and perceived behavioral control). The intervention group (IG) (n=51) received nursing interventions from the day before surgery to 12 months after lung resection, while the comparison group (CG) (n=36) received usual care. SEE, PA, PF (dyspnea, functional status, and 6-minute walking distance [6MWD]), and QOL were measured before surgery and at one, three, six, and 12 months after surgery. Data were analyzed using the χ² test, Fisher's exact test, Mann-Whitney U test, t-test, and generalized estimation equations (GEE). RESULTS: There were significant differences between the two groups regarding SEE (χ²=13.53, p=.009), PA (χ²=9.51, p=.049), functional status (χ²=10.55, p=.032), and 6MWD (χ²=15.62, p=.004). Although there were no time or group effects, the QOL mental component (Z=-2.78, p=.005) of the IG was higher than that of the CG one month after surgery. Interventions did not affect dyspnea or the QOL physical component. CONCLUSION: The intervention of this study was effective in improving SEE, PA, functional status, and 6MWD of lung cancer patients after lung resection. Further extended investigations that utilize ETPB are warranted to confirm these results.


Assuntos
Neoplasias Pulmonares/psicologia , Qualidade de Vida , Autoeficácia , Adulto , Idoso , Dispneia/patologia , Tolerância ao Exercício , Feminino , Humanos , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Fatores de Tempo , Caminhada
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