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2.
BMJ Case Rep ; 13(10)2020 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-33028570

RESUMO

In March 2020, a 74-year-old man affected by end-stage renal disease and on peritoneal dialysis was referred to an emergency room in Modena, Northern Italy, due to fever and respiratory symptoms. After ruling out COVID-19 infection, a diagnosis of chronic obstructive pulmonary disease exacerbation was confirmed and he was thus transferred to the nephrology division. Physical examination and blood tests revealed a positive fluid balance and insufficient correction of the uraemic syndrome, although peritoneal dialysis prescription was maximised. After discussion with the patient and his family, the staff decided to start hybrid dialysis, consisting of once-weekly in-hospital haemodialysis and home peritoneal dialysis for the remaining days. He was discharged at the end of the antibiotic course, after an internal jugular vein central venous catheter placement and the first haemodialysis session. This strategy allowed improvement of depuration parameters and avoidance of frequent access to the hospital, which is crucial in limiting exposure to SARS-CoV-2 in an endemic setting.


Assuntos
Infecções por Coronavirus , Falência Renal Crônica , Pandemias , Diálise Peritoneal/métodos , Pneumonia Viral , Doença Pulmonar Obstrutiva Crônica , Diálise Renal/métodos , Idoso , Antibacterianos/administração & dosagem , Betacoronavirus , Terapia Combinada/métodos , Terapia Combinada/tendências , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Diagnóstico Diferencial , Unidades Hospitalares de Hemodiálise , Humanos , Controle de Infecções/métodos , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/fisiopatologia , Falência Renal Crônica/terapia , Masculino , Inovação Organizacional , Pandemias/prevenção & controle , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Exacerbação dos Sintomas
3.
Clin Exp Rheumatol ; 38(5): 807-821, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33034561

RESUMO

Gout is the most prevalent form of inflammatory arthritis, with a strong impact on individual health and healthcare systems. This article reviews clinical and experimental evidences about gout emerged throughout the 2019. Starting with an epidemiological analysis, the review explores new insights on genetic factors influencing the development of gout flare, pathogenetic mechanisms, risk factors for the disease and comorbidities. An overview on pharmacological therapies and recent knowledge on the impact of lifestyle and dietary habits are also included. Finally, the review contains a novel section on animal models, which reflects the renewed interest of researchers in the acute process triggered by monosodium urate crystals.


Assuntos
Gota , Animais , Gota/tratamento farmacológico , Gota/epidemiologia , Supressores da Gota/uso terapêutico , Humanos , Estilo de Vida , Fatores de Risco , Exacerbação dos Sintomas
4.
Int J Chron Obstruct Pulmon Dis ; 15: 2237-2248, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33061341

RESUMO

Purpose: In this study, we investigated the acute exacerbation and outcomes of COPD patients during the outbreak of COVID-19 and evaluated the prevalence and mortality of COPD patients with confirmed COVID-19. Methods: A prospectively recruited cohort of 489 COPD patients was retrospectively followed-up for their conditions during the COVID-19 pandemic from December 2019 to March 2020 in Hubei, China. In addition, the features of 821 discharged patients with confirmed COVID-19 were retrospectively analyzed. Results: Of the 489 followed-up enrolled COPD patients, 2 cases were diagnosed as confirmed COVID-19, and 97 cases had exacerbations, 32 cases of which were hospitalized, and 14 cases died. Compared with the 6-month follow-up results collected 1 year ago, in 307 cases of this cohort, the rates of exacerbations and hospitalization of the 489 COPD patients during the last 4 months decreased, while the mortality rate increased significantly (2.86% vs 0.65%, p=0.023). Of the 821 patients with COVID-19, 37 cases (4.5%) had pre-existing COPD. Of 180 confirmed deaths, 19 cases (10.6%) were combined with COPD. Compared to COVID-19 deaths without COPD, COVID-19 deaths with COPD had higher rates of coronary artery disease and/or cerebrovascular diseases. Old age, low BMI and low parameters of lung function were risk factors of all-cause mortality for COVID-19 patients with pre-existing COPD. Conclusion: Our findings imply that acute exacerbations and hospitalizations of COPD patients were infrequent during the COVID-19 pandemic. However, COVID-19 patients with pre-existing COPD had a higher risk of all-cause mortality.


Assuntos
Infecções por Coronavirus , Hospitalização/estatística & dados numéricos , Pandemias , Pneumonia Viral , Doença Pulmonar Obstrutiva Crônica , Exacerbação dos Sintomas , China/epidemiologia , Técnicas de Laboratório Clínico/métodos , Comorbidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/terapia , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade , Avaliação de Processos e Resultados em Cuidados de Saúde , Pneumonia Viral/epidemiologia , Pneumonia Viral/mortalidade , Pneumonia Viral/terapia , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/terapia , Fatores de Risco
5.
Medicine (Baltimore) ; 99(44): e22917, 2020 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-33126351

RESUMO

BACKGROUND: Chinese medicine Sangbaipi decoction is extensively applied to the therapy of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in China. However, owing to the low quality, small sample size, and methodological heterogeneity of these studies, this conclusion is not convincing. Consequently, it is necessary to systematically evaluate the clinical efficacy and safety of Sangbaipi Decoction in the treatment of AECOPD patients, and provide high-quality evidence for its clinical application. METHODS: We will follow the preferred reporting items for systematic review and meta-analysis (PRISMA) for reporting the results of the review in this study. We will utilize the Review Manage software V5.3.0 (The Nordic Cochrane Center, The Cochrane Collaboration, 2014, Copenhagen, Denmark) to assess the risk of bias and visualize the results. We will use Stata software (version 15.0, StataCorp, College Station, TX) to perform the meta-analysis. ETHICS AND DISSEMINATION: This study is a systematic review and meta-analysis protocol of Sangbaipi decoction on AECOPD, participants were not recruited and data were not collected from participants, so ethical ratification is not required. RESULTS: This study will provide high-quality synthesis of the effectiveness and safety of Sangbaipi decoction for AECOPD. Upon completion, the results will be submitted to a peer-reviewed journal. CONCLUSION: The efficacy and safety assessment of Sangbaipi decoction for AECOPD will be supported by this protocol. REGISTRATION NUMBER: PROSPERO CRD 42019138405.


Assuntos
Medicamentos de Ervas Chinesas/farmacologia , Medicina Tradicional Chinesa/métodos , Morus , Doença Pulmonar Obstrutiva Crônica , Humanos , Metanálise como Assunto , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Projetos de Pesquisa , Exacerbação dos Sintomas , Revisões Sistemáticas como Assunto , Resultado do Tratamento
6.
Br J Gen Pract ; 70(700): 528-529, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33122266
7.
Respir Med ; 171: 106085, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32917356

RESUMO

BACKGROUND: Chronic respiratory diseases are risk factors for severe disease in coronavirus disease 2019 (COVID-19). Respiratory tract infection is one of the commonest causes of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). There has not been evidence suggesting the link between COVID-19 and AECOPD, especially in places with dramatic responses in infection control with universal masking and aggressive social distancing. METHODS: This is a retrospective study to assess the number of admissions of AECOPD in the first three months of 2020 in Queen Mary Hospital with reference to the admissions in past five years. Log-linear model was used for statistical inference of covariates, including percentage of masking, air quality health index and air temperature. RESULTS: The number of admissions for AECOPD significantly decreased by 44.0% (95% CI 36.4%-52.8%, p < 0.001) in the first three months of 2020 compared with the monthly average admission in 2015-2019. Compare to same period of previous years, AECOPD decreased by 1.0% with each percent of increased masking (p < 0.001) and decreased by 3.0% with increase in 1 °C in temperature (p = 0.045). The numbers of admissions for control diagnoses (heart failure, intestinal obstruction and iron deficiency anaemia) in the same period in 2020 were not reduced. CONCLUSIONS: The number of admissions for AECOPD decreased in first three months of 2020, compared with previous years. This was observed with increased masking percentage and social distancing in Hong Kong. We postulated universal masking and social distancing during COVID-19 pandemics both contributed in preventing respiratory tract infections hence AECOPD.


Assuntos
Infecções por Coronavirus , Pandemias , Admissão do Paciente/estatística & dados numéricos , Pneumonia Viral , Doença Pulmonar Obstrutiva Crônica , Infecções Respiratórias , Poluição do Ar/análise , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Feminino , Hong Kong/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/terapia , Dispositivos de Proteção Respiratória/estatística & dados numéricos , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/etiologia , Infecções Respiratórias/prevenção & controle , Estudos Retrospectivos , Fatores de Risco , Distância Social , Exacerbação dos Sintomas
8.
Int J Med Sci ; 17(14): 2187-2193, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32922180

RESUMO

Background: The number of asymptomatic infected patients with coronavirus disease 2019 (COVID-2019) is rampaging around the world but limited information aimed on risk factors of asymptomatic infections. The purpose of this study is to investigate the risk factors of symptoms onset and clinical features in asymptomatic COVID-19 infected patients. Methods: A retrospective study was performed in 70 asymptomatic COVID-2019 infected patients confirmed by nucleic acid tests in Hunan province, China between 28 January 2020 and 18 February, 2020. The epidemiological, clinical features and laboratory data were reviewed and analyzed. Presence or absence at the onset of symptoms was taken as the outcome. A Cox regression model was performed to evaluate the potential predictors of the onset of symptoms. Results: The study included 36 males and 34 females with a mean age of 33.24±20.40 years (range, 0.5-84 years). There were 22 asymptomatic carriers developed symptoms during hospitalization isolated observation, and diagnosed as confirmed cases, while 48 cases remained asymptomatic throughout the course of disease. Of 70 asymptomatic patients, 14 (14/70, 20%) had underlying diseases, 3 (3/70, 4.3%) had drinking history, and 11 (11/70, 15.7%) had smoking history. 22 patients developed symptoms onset of fever (4/22, 18.2%), cough (13/22, 59.1%), chest discomfort (2/22, 9.1%), fatigue (1/22, 4.5%), pharyngalgia (1/22, 4.5%) during hospitalization; only one (1/22, 4.5%) patient developed signs of both cough and pharyngalgia. Abnormalities on chest CT were detected among 35 of the 69 patients (50.7%) after admission, except for one pregnant woman had not been examined. 4 (4/70, 5.7%) and 8 (8/70, 11.4%) cases showed leucopenia and lymphopenia. With the effective antiviral treatment, all the 70 asymptomatic infections had been discharged, none cases developed severe pneumonia, admission to intensive care unit, or died. The mean time from nucleic acid positive to negative was 13.2±6.84 days. Cox regression analysis showed that smoking history (P=0.028, hazard ratio=4.49, 95% CI 1.18-17.08) and existence of pulmonary disease (P=0.038, hazard ratio=7.09, 95% CI 1.12-44.90) were risk factors of the onset of symptoms in asymptomatic carries. Conclusion: The initially asymptomatic patients can develop mild symptoms and have a good prognosis. History of smoking and pulmonary disease was prone to illness onset in asymptomatic patients, and it is necessary to be highly vigilant to those patients.


Assuntos
Infecções Assintomáticas/epidemiologia , Infecções por Coronavirus/diagnóstico , Pneumopatias/epidemiologia , Pneumonia Viral/diagnóstico , Fumar/epidemiologia , Exacerbação dos Sintomas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antivirais/uso terapêutico , Criança , Pré-Escolar , China/epidemiologia , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Feminino , Humanos , Lactente , Pulmão/diagnóstico por imagem , Pneumopatias/complicações , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Gravidez , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Fumar/efeitos adversos , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Adulto Jovem
9.
PLoS One ; 15(9): e0239055, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32966334

RESUMO

BACKGROUND: Chronic obstructive pulmonary disease (COPD) and asthma exacerbations are associated with ill health, increased mortality, and health care costs. However, there is limited evidence regarding mortality and its predictors among patients treated for COPD and asthma exacerbations in low-income nations, particularly in Ethiopia. METHODS: A-6 month prospective observational study was conducted from April 20-September 20, 2019. Data were collected on socio-demographic, baseline clinical characteristics and outcomes of asthma and COPD exacerbations. Data were entered into Epi-Data version 4.02.01 for cleaning and exported to STATA 14.0 for analysis. Kaplan-Meier (Log-rank test) was used to compare the baseline survival experience of the study participants and Cox proportional hazard regression analysis was conducted to determine the predictors of mortality. Adjusted hazard ratios (AHRs) with two-sided p-value <0.05 were considered statistically significant. RESULTS: A total of 130 patients (60% males) were included. The median (interquartile range (IQR)) age of the study participants was 59(50-70) years. The median (IQR) survival time to death was 17.5 (10-26) days. The total proportion of in-hospital mortality was 10.78% (14/130), and the incidence rate of mortality was 2.56 per 1000 person-years. The duration of oxygen therapy ≥16hours/day (AHR = 6.330, 95% CI [1.092-36.679], and old age (AHR = 1.066, 95% CI [1.0001-1.136] were the independent predictors of in-hospital mortality. CONCLUSION: In this study, the in-hospital mortality rate was very high. Moreover, prolonged oxygen therapy (≥16hours/day) and old age were independently associated with in-hospital mortality. Therefore, special attention should be given to recipients of prolonged oxygen therapy and the elderly during hospital stay.


Assuntos
Asma/mortalidade , Doença Pulmonar Obstrutiva Crônica/mortalidade , Idoso , Progressão da Doença , Etiópia/epidemiologia , Feminino , Mortalidade Hospitalar , Hospitais , Humanos , Estimativa de Kaplan-Meier , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Prognóstico , Modelos de Riscos Proporcionais , Estudos Prospectivos , Transtornos Respiratórios/mortalidade , Fatores de Risco , Exacerbação dos Sintomas
11.
BMC Infect Dis ; 20(1): 708, 2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-32993546

RESUMO

BACKGROUND: Intravesical administration of Bacillus Calmette-Guérin (BCG) has proven useful for treatment and prevention of recurrence of superficial bladder cancer and in situ carcinoma. However, fatal side effects such as disseminated infections may occur. Early diagnosis and accurate therapy for interstitial pneumonitis (IP) are important because exacerbation of IP triggered by infections is the major cause of death. Although some fatality reports have suggested newly appeared IP after intravesical BCG treatment, to our knowledge, there are no reports which have demonstrated acute exacerbation of existing IP. Moreover, autopsy is lacking in previous reports. We report the case of a patient with fatal IP exacerbation after BCG instillation and the pathological findings of the autopsy. CASE PRESENTATION: A 77-year-old man with a medical history of IP was referred to our hospital because of fever and malaise. He had received an intravesical injection of BCG 1 day before the admission. His fever reduced after the use of antituberculosis drugs, so he was discharged home. He was referred to our hospital again because of a high fever 7 days after discharge. On hospitalisation, he showed high fever and systemic exanthema. Hepatosplenomegaly and myelosuppression were also observed. Biopsies revealed multiple epithelioid cell granulomas with Langhans giant cells of the liver and bone marrow. Biopsy DNA analyses of Mycobacterium bovis in the bone marrow, sputum, and blood were negative. His oxygen demand worsened drastically, and the ground-glass shadow expanded on the computed tomography scan. He was diagnosed with acute exacerbation of existing IP. We recommenced the antituberculosis drugs with steroid pulse therapy, but he died on day 35 because of respiratory failure. The autopsy revealed a diffuse appearance of multiple epithelioid cell granulomas with Langhans giant cells in multiple organs, although BCG was not evident. CONCLUSIONS: We report the first case of acute exacerbation of chronic IP by BCG infection. This is also the first case of autopsy of a patient with acute exacerbation of existing IP induced by intravesical BCG treatment. Whether the trigger of acute IP exacerbation is infection or hypersensitivity to BCG is still controversial, because pathological evidence confirming BCG infection is lacking. Physicians who administer BCG against bladder cancer should be vigilant for acute exacerbation of IP.


Assuntos
Antituberculosos/uso terapêutico , Vacina BCG/efeitos adversos , Doenças Pulmonares Intersticiais/tratamento farmacológico , Doenças Pulmonares Intersticiais/etiologia , Infecções por Mycobacterium não Tuberculosas/tratamento farmacológico , Infecções por Mycobacterium não Tuberculosas/etiologia , Esteroides/uso terapêutico , Exacerbação dos Sintomas , Administração Intravesical , Idoso , Autopsia , Vacina BCG/administração & dosagem , Vacina BCG/uso terapêutico , Carcinoma in Situ/tratamento farmacológico , Carcinoma in Situ/prevenção & controle , Evolução Fatal , Humanos , Doenças Pulmonares Intersticiais/microbiologia , Masculino , Infecções por Mycobacterium não Tuberculosas/diagnóstico , Mycobacterium bovis/genética , Resultados Negativos , Recidiva Local de Neoplasia/tratamento farmacológico , Recidiva Local de Neoplasia/prevenção & controle , Pulsoterapia , Resultado do Tratamento , Neoplasias da Bexiga Urinária/tratamento farmacológico , Neoplasias da Bexiga Urinária/prevenção & controle
12.
JAMA ; 324(8): 752-760, 2020 08 25.
Artigo em Inglês | MEDLINE | ID: mdl-32840597

RESUMO

Importance: Severe asthma exacerbations cause significant morbidity and costs. Whether vitamin D3 supplementation reduces severe childhood asthma exacerbations is unclear. Objective: To determine whether vitamin D3 supplementation improves the time to a severe exacerbation in children with asthma and low vitamin D levels. Design, Setting, and Participants: The Vitamin D to Prevent Severe Asthma Exacerbations (VDKA) Study was a randomized, double-blind, placebo-controlled clinical trial of vitamin D3 supplementation to improve the time to severe exacerbations in high-risk children with asthma aged 6 to 16 years taking low-dose inhaled corticosteroids and with serum 25-hydroxyvitamin D levels less than 30 ng/mL. Participants were recruited from 7 US centers. Enrollment started in February 2016, with a goal of 400 participants; the trial was terminated early (March 2019) due to futility, and follow-up ended in September 2019. Interventions: Participants were randomized to vitamin D3, 4000 IU/d (n = 96), or placebo (n = 96) for 48 weeks and maintained with fluticasone propionate, 176 µg/d (6-11 years old), or 220 µg/d (12-16 years old). Main Outcomes and Measures: The primary outcome was the time to a severe asthma exacerbation. Secondary outcomes included the time to a viral-induced severe exacerbation, the proportion of participants in whom the dose of inhaled corticosteroid was reduced halfway through the trial, and the cumulative fluticasone dose during the trial. Results: Among 192 randomized participants (mean age, 9.8 years; 77 girls [40%]), 180 (93.8%) completed the trial. A total of 36 participants (37.5%) in the vitamin D3 group and 33 (34.4%) in the placebo group had 1 or more severe exacerbations. Compared with placebo, vitamin D3 supplementation did not significantly improve the time to a severe exacerbation: the mean time to exacerbation was 240 days in the vitamin D3 group vs 253 days in the placebo group (mean group difference, -13.1 days [95% CI, -42.6 to 16.4]; adjusted hazard ratio, 1.13 [95% CI, 0.69 to 1.85]; P = .63). Vitamin D3 supplementation, compared with placebo, likewise did not significantly improve the time to a viral-induced severe exacerbation, the proportion of participants whose dose of inhaled corticosteroid was reduced, or the cumulative fluticasone dose during the trial. Serious adverse events were similar in both groups (vitamin D3 group, n = 11; placebo group, n = 9). Conclusions and Relevance: Among children with persistent asthma and low vitamin D levels, vitamin D3 supplementation, compared with placebo, did not significantly improve the time to a severe asthma exacerbation. The findings do not support the use of vitamin D3 supplementation to prevent severe asthma exacerbations in this group of patients. Trial Registration: ClinicalTrials.gov Identifier: NCT02687815.


Assuntos
Asma/tratamento farmacológico , Colecalciferol/uso terapêutico , Suplementos Nutricionais , Deficiência de Vitamina D/tratamento farmacológico , Vitaminas/uso terapêutico , Adolescente , Corticosteroides/uso terapêutico , Asma/sangue , Asma/complicações , Criança , Colecalciferol/efeitos adversos , Método Duplo-Cego , Feminino , Humanos , Masculino , Exacerbação dos Sintomas , Falha de Tratamento , Vitamina D/sangue , Deficiência de Vitamina D/complicações , Vitaminas/efeitos adversos
13.
Emergencias (Sant Vicenç dels Horts) ; 32(4): 258-268, ago. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-193946

RESUMO

El presente documento de consenso se ha desarrollado con el fin de proporcionar una herramienta útil para el manejo del paciente asmático que acude al servicio de urgencias (SU) con una crisis asmática. Incluye recomendaciones para tomar la decisión de alta o ingreso, así como indicaciones de derivación para el posterior seguimiento. Un equipo multidisciplinar, constituido por tres especialistas en medicina de urgencias, tres especialistas en neumología y tres especialistas en alergología, se encargó de elaborar una lista de preguntas clínicas que respondieron mediante la ayuda tanto de guías de práctica clínica, como de literatura disponible. Los contenidos y el reparto de tareas en diferentes grupos de trabajo se consensuaron en una reunión presencial. Los materiales resultantes se pusieron en común y sirvieron para la preparación del manuscrito final. Las recomendaciones y los algoritmos incluidos en el mismo van dirigidos a identificar y diagnosticar correctamente las exacerbaciones asmáticas en el SU y a establecer los criterios de hospitalización o alta. Se incluyen también las pautas para el tratamiento de los pacientes y para su derivación al ámbito de atención especializada en caso de alta, incluyendo los criterios de priorización para dicha derivación. El documento ha sido avalado por la Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Sociedad Española de Alergología e Inmunología Clínica (SEAIC), y la Sociedad Española de Urgencias y Emergencias (SEMES)


This consensus paper's purpose is to provide a tool for managing emergency asthma exacerbations that require a decision to admit or discharge the patient. The paper also addresses where to refer the discharged patient for follow up. A multidisciplinary team of 3 emergency physicians, 3 specialists in respiratory medicine, and 3 allergy specialists were charged with drafting a list of clinical questions to answer by consulting practice guidelines and other resources in the literature. The specialists held a face-to-face meeting to distribute tasks and topics to working groups. The groups shared their reports, which provided the basis for drafting the final paper. The recommendations and flow charts included in the paper provide guidance for identifying and correctly diagnosing asthma exacerbations in the emergency department. Criteria for admission or discharge are incorporated. Treatment protocols and recommendations for referring discharged patients to specialists are addressed, along with criteria for priority referrals. The final consensus paper has been endorsed by the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR), the Spanish Society of Allergology and Clinical Immunology (SEAIC), and the Spanish Society of Emergency Medicine (SEMES)


Assuntos
Humanos , Asma/epidemiologia , Serviços Médicos de Emergência/métodos , Encaminhamento e Consulta/normas , Índice de Gravidade de Doença , Indicadores de Qualidade em Assistência à Saúde/normas , Encaminhamento e Consulta/organização & administração , Exacerbação dos Sintomas , Hospitalização , Anamnese , Comunicação Interdisciplinar , Fatores de Risco
14.
New Jersey; BMJ Best Practice; Ago. 6, 2020. 194 p.
Monografia em Inglês | BIGG | ID: biblio-1116708

RESUMO

A potentially severe acute respiratory infection caused by the novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).[1] The clinical presentation is generally that of a respiratory infection with a symptom severity ranging from a mild common cold-like illness, to a severe viral pneumonia leading to acute respiratory distress syndrome that is potentially fatal. Characteristic symptoms include fever, cough, and dyspnea, although some patients may be asymptomatic. Complications of severe disease include, but are not limited to, multi-organ failure, septic shock, and blood clots.


Assuntos
Humanos , Masculino , Feminino , Gravidez , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Pneumonia Viral/complicações , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/diagnóstico por imagem , Grupos de Risco , Portador Sadio/transmissão , Pessoal de Saúde/organização & administração , Infecções por Coronavirus/complicações , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/diagnóstico por imagem , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Pandemias/estatística & dados numéricos , Exacerbação dos Sintomas , Betacoronavirus/patogenicidade , Pneumonia Associada a Assistência à Saúde/diagnóstico , China/epidemiologia
16.
Pediatr Clin North Am ; 67(4): 623-627, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32650858

RESUMO

Pediatric patients with uncontrolled asthma often live in underserved areas such as rural communities where few pediatric asthma specialists exist. There are significant costs associated with acute asthma exacerbations, which are increasingly prevalent in these high-risk populations. Telemedicine is a viable option when addressing barriers in access to care and cost-efficiency. Implementing telemedicine in schools and other local community settings, as well as implementing innovative technology such as smartphone applications, can reduce the burden of asthma; increase patient satisfaction; and, most importantly, improve pediatric asthma outcomes.


Assuntos
Asma/terapia , Telemedicina/métodos , Criança , Assistência à Saúde , Humanos , Aplicativos Móveis , População Rural , Instituições Acadêmicas , Exacerbação dos Sintomas , Telemedicina/economia
17.
N Engl J Med ; 383(3): 218-228, 2020 07 16.
Artigo em Inglês | MEDLINE | ID: mdl-32668112

RESUMO

BACKGROUND: Rheumatoid arthritis, like many inflammatory diseases, is characterized by episodes of quiescence and exacerbation (flares). The molecular events leading to flares are unknown. METHODS: We established a clinical and technical protocol for repeated home collection of blood in patients with rheumatoid arthritis to allow for longitudinal RNA sequencing (RNA-seq). Specimens were obtained from 364 time points during eight flares over a period of 4 years in our index patient, as well as from 235 time points during flares in three additional patients. We identified transcripts that were differentially expressed before flares and compared these with data from synovial single-cell RNA-seq. Flow cytometry and sorted-blood-cell RNA-seq in additional patients were used to validate the findings. RESULTS: Consistent changes were observed in blood transcriptional profiles 1 to 2 weeks before a rheumatoid arthritis flare. B-cell activation was followed by expansion of circulating CD45-CD31-PDPN+ preinflammatory mesenchymal, or PRIME, cells in the blood from patients with rheumatoid arthritis; these cells shared features of inflammatory synovial fibroblasts. Levels of circulating PRIME cells decreased during flares in all 4 patients, and flow cytometry and sorted-cell RNA-seq confirmed the presence of PRIME cells in 19 additional patients with rheumatoid arthritis. CONCLUSIONS: Longitudinal genomic analysis of rheumatoid arthritis flares revealed PRIME cells in the blood during the period before a flare and suggested a model in which these cells become activated by B cells in the weeks before a flare and subsequently migrate out of the blood into the synovium. (Funded by the National Institutes of Health and others.).


Assuntos
Artrite Reumatoide/sangue , Linfócitos B/fisiologia , Expressão Gênica , Células-Tronco Mesenquimais , Análise de Sequência de RNA/métodos , Adulto , Artrite Reumatoide/genética , Artrite Reumatoide/imunologia , Feminino , Fibroblastos/metabolismo , Citometria de Fluxo , Humanos , Masculino , Células-Tronco Mesenquimais/metabolismo , Pessoa de Meia-Idade , Gravidade do Paciente , Inquéritos e Questionários , Exacerbação dos Sintomas , Líquido Sinovial/citologia
19.
Expert Rev Clin Immunol ; 16(8): 751-770, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32722946

RESUMO

INTRODUCTION: Main clinical manifestations of SARS-CoV-2 infection are characterized by fever, dyspnea, and interstitial pneumonia, frequently evolving in acute respiratory distress syndrome (ARDS). AREAS COVERED: Features of coronavirus disease 2019 (COVID-19) presents some common points with interstitial lung disease (ILD) both idiopathic and related to rheumatoid arthritis (RA), typically characterized by a chronic progression over time and possibly complicated by acute exacerbation (AE). The study of common pathogenetic mechanisms, such as the involvement of toll-like receptor 4, could contribute to the knowledge and treatment of idiopathic and RA-ILD. Moreover, hyperinflammation, mainly characterized by increase of effector T-cells and inflammatory cytokines, and activation of coagulation cascade, observed in COVID-19 related ARDS have been already shown in patients with AE of idiopathic and RA-ILD. A literature search was performed in PubMed, Embase, Scopus, and Web of Science, together with a manual search in COVID-resource centers of the main journals. EXPERT OPINION: Despite the uncertainty about pathogenetic aspects about COVID-19- pneumonia, it could be a possible model for other forms of ILD and AE. The great amount of data from studies on COVID-19 could be helpful in proposing safe therapeutic approaches for RA-ILD, in understanding pathogenesis of usual interstitial pneumonia and to develop new therapeutic strategies for AE.


Assuntos
Artrite Reumatoide/patologia , Infecções por Coronavirus/patologia , Doenças Pulmonares Intersticiais/patologia , Pneumonia Viral/patologia , Artrite Reumatoide/terapia , Betacoronavirus/patogenicidade , Infecções por Coronavirus/terapia , Progressão da Doença , Humanos , Fibrose Pulmonar Idiopática/patologia , Fibrose Pulmonar Idiopática/terapia , Pulmão/patologia , Doenças Pulmonares Intersticiais/terapia , Pandemias , Pneumonia Viral/terapia , Exacerbação dos Sintomas , Receptor 4 Toll-Like/metabolismo
20.
Mult Scler Relat Disord ; 45: 102347, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32645636

RESUMO

Neuromyelitis optica spectrum disorder (NMOSD) is a CNS neuroinflammatory disorder, mediated by the pathogenic autoantibody aquaporin-4 (AQP4-IgG). Current treatment includes long-term use of immunomodulatory therapies, leading to increased rates of infections among this population. It is of interest therefore, to study how the COVID-19 pandemic affects NMOSD patients in terms of their disease activity. A 15-point questionnaire was administered to 33 participants living in Northern California with NMOSD, MS and other related disorders. Although none of the participants were diagnosed with COVID-19, our results show that 2 participants with NMOSD experienced new onset of neurological symptoms and 2 experienced worsening of previous neurological symptoms - suggesting a possible effect of pandemic-related stress on this CNS autoimmune disorder.


Assuntos
Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/psicologia , Neuromielite Óptica/complicações , Pneumonia Viral/epidemiologia , Pneumonia Viral/psicologia , Angústia Psicológica , Exacerbação dos Sintomas , Adulto , Betacoronavirus , Feminino , Humanos , Masculino , Pandemias , Projetos Piloto , Inquéritos e Questionários
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