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1.
Infect Dis Poverty ; 10(1): 45, 2021 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-33789752

RESUMO

BACKGROUND: The management of discharge COVID-19 patients with recurrent positive SARS-CoV-2 RNA is challenging. However, there are fewer scientific dissertations about the risk of recurrent positive. The aim of this study was to explore the relationship between SARS-COV-2 RNA positive duration (SPD) and the risk of recurrent positive. METHODS: This case-control multi-center study enrolled participants from 8 Chinese hospital including 411 participants (recurrent positive 241). Using unadjusted and multivariate-adjusted logistic regression analyses, generalized additive model with a smooth curve fitting, we evaluated the associations between SPD and risk of recurrent positive. Besides, subgroup analyses were performed to explore the potential interactions. RESULTS: Among recurrent positive patients, there were 121 females (50.2%), median age was 50 years old [interquartile range (IQR): 38-63]. In non-adjusted model and adjusted model, SPD was associated with an increased risk of recurrent positive (fully-adjusted model: OR = 1.05, 95% CI: 1.02-1.08, P = 0.001); the curve fitting was not significant (P = 0.286). Comparing with SPD < 14 days, the risk of recurrent positive in SPD > 28 days was risen substantially (OR = 3.09, 95% CI: 1.44-6.63, P = 0.004). Interaction and stratified analyses showed greater effect estimates of SPD and risk of recurrent positive in the hypertension, low monocyte count and percentage patients (P for interaction = 0.008, 0.002, 0.036, respectively). CONCLUSION: SPD was associated with a higher risk of recurrent positive and especially SPD > 28 day had a two-fold increase in the relative risk of re-positive as compared with SPD < 14 day. What's more, the risk may be higher among those with hypertension and lower monocyte count or percentage.


Assuntos
/virologia , RNA Viral/isolamento & purificação , /isolamento & purificação , Adulto , /patologia , Estudos de Casos e Controles , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Faringe/virologia , RNA Viral/genética , Recidiva , Fatores de Risco , Fatores de Tempo , Eliminação de Partículas Virais
2.
BMC Infect Dis ; 21(1): 318, 2021 Apr 06.
Artigo em Inglês | MEDLINE | ID: mdl-33823800

RESUMO

BACKGROUND: Accurate diagnosis in patients with suspected coronavirus disease 2019 (COVID-19) is essential to guide treatment and limit spread of the virus. The combined nasal and throat swab is used widely, but its diagnostic performance is uncertain. METHODS: In a prospective, multi-centre, cohort study conducted in secondary and tertiary care hospitals in Scotland, we evaluated the combined nasal and throat swab with reverse transcriptase-polymerase chain reaction (RT-PCR) for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in consecutive patients admitted to hospital with suspected COVID-19. Diagnostic performance of the index and serial tests was evaluated for a primary outcome of confirmed or probable COVID-19, and a secondary outcome of confirmed COVID-19 on serial testing. The diagnosis was adjudicated by a panel, who recorded clinical, laboratory and radiological features blinded to the test results. RESULTS: We enrolled 1368 consecutive patients (median age 68 [interquartile range, IQR 53-80] years, 47% women) who underwent a total of 3822 tests (median 2 [IQR 1-3] tests per patient). The primary outcome occurred in 36% (496/1368), of whom 65% (323/496) and 35% (173/496) had confirmed and probable COVID-19, respectively. The index test was positive in 255/496 (51%) patients with the primary outcome, giving a sensitivity and specificity of 51.4% (95% confidence interval [CI] 48.8 to 54.1%) and 99.5% (95% CI 99.0 to 99.8%). Sensitivity increased in those undergoing 2, 3 or 4 tests to 60.1% (95% CI 56.7 to 63.4%), 68.3% (95% CI 64.0 to 72.3%) and 77.6% (95% CI 72.7 to 81.9%), respectively. The sensitivity of the index test was 78.9% (95% CI 74.4 to 83.2%) for the secondary outcome of confirmed COVID-19 on serial testing. CONCLUSIONS: In patients admitted to hospital, a single combined nasal and throat swab with RT-PCR for SARS-CoV-2 has excellent specificity, but limited diagnostic sensitivity for COVID-19. Diagnostic performance is significantly improved by repeated testing.


Assuntos
/diagnóstico , Nariz/virologia , Faringe/virologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Hospitalização , Hospitais , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Escócia , Sensibilidade e Especificidade
3.
J Med Case Rep ; 15(1): 148, 2021 Mar 22.
Artigo em Inglês | MEDLINE | ID: mdl-33752743

RESUMO

BACKGROUND: A significant portion of critically ill patients with coronavirus disease 2019 (COVID-19) are at high risk of developing intensive care unit (ICU)-acquired swallowing dysfunction (neurogenic dysphagia) as a consequence of requiring prolonged mechanical ventilation. Pharyngeal electrical stimulation (PES) is a simple and safe treatment for neurogenic dysphagia. It has been shown that PES can restore safe swallowing in orally intubated or tracheotomized ICU patients with neurogenic dysphagia following severe stroke. We report the case of a patient with severe neurogenic post-extubation dysphagia (PED) due to prolonged intubation and severe general muscle weakness related to COVID-19, which was successfully treated using PES. CASE PRESENTATION: A 71-year-old Caucasian female patient with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection developed neurogenic dysphagia following prolonged intubation in the ICU. To avoid aerosol-generating procedures, her swallowing function was evaluated non-instrumentally as recommended by recently published international guidelines in response to the COVID-19 pandemic. Her swallowing function was markedly impaired and PES therapy was recommended. PES led to a rapid improvement of the PED, as evaluated by bedside swallowing assessments using the Gugging Swallowing Screen (GUSS) and Dysphagia Severity Rating Scale (DSRS), and diet screening using the Functional Oral Intake Scale (FOIS). The improved swallowing, as reflected by these measures, allowed this patient to transfer from the ICU to a non-intensive medical department 5 days after completing PES treatment. CONCLUSIONS: PES treatment contributed to the restoration of a safe swallowing function in this critically ill patient with COVID-19 and ICU-acquired swallowing dysfunction. Early clinical bedside swallowing assessment and dysphagia intervention in COVID-19 patients is crucial to optimize their full recovery. PES may contribute to a safe and earlier ICU discharge of patients with ICU-acquired swallowing dysfunction. Earlier ICU discharge and reduced rates of re-intubation following PES can help alleviate some of the pressure on ICU bed capacity, which is critical in times of a health emergency such as the ongoing COVID-19 pandemic.


Assuntos
/terapia , Transtornos de Deglutição/terapia , Terapia por Estimulação Elétrica/métodos , Intubação Intratraqueal/efeitos adversos , Faringe , Recuperação de Função Fisiológica , Idoso , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/fisiopatologia , Feminino , Humanos , Respiração Artificial , Índice de Gravidade de Doença , Resultado do Tratamento
6.
Hua Xi Kou Qiang Yi Xue Za Zhi ; 39(1): 32-37, 2021 Feb 01.
Artigo em Inglês, Chinês | MEDLINE | ID: mdl-33723934

RESUMO

OBJECTIVES: A study was conducted to explore the expression pattern and function of ferritin heavy polypeptide gene (fth1b) in zebrafish pharyngeal teeth development and lay the foundation for subsequent research on teeth development and mineralization. METHODS: The zebrafish embryos were harvested at 56, 72, 96, and 120 h after fertilization. The expression of fth1b in zebrafish pharyngeal teeth development was detected by whole embryo in situ hybridization and compared with the known pharyngeal teeth marker dlx2b. The specific knockout of fth1b gene was performed using clustered regularly interspaced short palindromic repeats (CRISPR)/Cas9 gene editing technology. The development of zebrafish pharyngeal teeth was detected in the fth1b-/- mutant. RESULTS: The expression pattern of fth1b gene was very similar to that of the known zebrafish pharyngeal teeth marker dlx2b and was specifically expressed in the zebrafish pharyngeal teeth during development. After the specific knockout of the gene fth1b, the earliest gene that can be detect in zebrafish pharyngeal teeth-pitx2 was expressed normally during early development. The dlx2b expression was not significantly different from that of wild type zebrafish, but the mineralization of pharyngeal teeth in the mutant was weaker than that of wild type zebrafish. CONCLUSIONS: The gene fth1b is specifically expressed in zebrafish pharyngeal teeth and acts on their early mineralization.


Assuntos
Dente , Peixe-Zebra , Animais , Hibridização In Situ , Odontogênese , Faringe , Peixe-Zebra/genética
7.
J Laryngol Otol ; 135(2): 153-158, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33551000

RESUMO

BACKGROUND: Transoral robotic surgery is frequently described, driven by the desire to offer a less morbid alternative to chemoradiation. However, the objective evaluation of post-operative function has rarely been reported. Therefore, high-resolution manometry was used in this study to evaluate the impact of changes in peri-operative swallowing function on pharyngeal pressure events. METHODS: Ten patients with various stages of oropharyngeal cancer underwent transoral surgery. High-resolution manometry and videofluoroscopic swallow studies were performed before surgery and two months afterwards. The following parameters were obtained: velopharyngeal and mesopharyngeal post-deglutitive upper oesophageal sphincter pressures, velo-meso-hypopharyngeal contractile integral, upper oesophageal sphincter relaxation pressure, and pharyngeal velocity. RESULTS: There was no significant difference in pharyngeal pressure or contractile integral pre- versus post-operatively. However, pharyngeal velocity was significantly higher post-operatively than pre-operatively. CONCLUSION: High-resolution manometry showed that transoral surgery in patients without pre-operative dysphagia preserved pharyngeal constriction. However, transoral surgery might produce scar formation in the pharynx, which could lead to narrowing of the pharynx.


Assuntos
Deglutição/fisiologia , Neoplasias Orofaríngeas/cirurgia , Faringe/fisiopatologia , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Transtornos de Deglutição/fisiopatologia , Esfíncter Esofágico Superior/fisiologia , Feminino , Humanos , Masculino , Manometria/métodos , Pessoa de Meia-Idade , Contração Muscular/fisiologia , Estadiamento de Neoplasias , Neoplasias Orofaríngeas/patologia , Período Pós-Operatório , Pressão , Procedimentos Cirúrgicos Robóticos/métodos , Carcinoma de Células Escamosas de Cabeça e Pescoço/epidemiologia , Carcinoma de Células Escamosas de Cabeça e Pescoço/patologia , Carcinoma de Células Escamosas de Cabeça e Pescoço/cirurgia
8.
Am J Orthod Dentofacial Orthop ; 159(4): e301-e310, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33541787

RESUMO

INTRODUCTION: The objective of this research was to observe changes in aerodynamics and anatomic characteristics of the upper airway after mini-implants assisted rapid maxillary expansion and to evaluate the correlation between the 2 changes of the upper airway in young adults. METHODS: Thirty consecutive patients (mean age, 23.82 ± 3.90 years; median, 24.5 years; 9 males, 21 females) were involved. Cone-beam computed tomography was taken before activation and over 3 months. Three-dimensional models of the upper airway were reconstructed on the basis of cone-beam computed tomography. The anatomic characteristics of the upper airway, including volume, area, transverse, and sagittal diameter, were measured. The aerodynamic characteristics of the upper airway were calculated on the basis of 3-dimensional models using computational fluid dynamics. The correlation between the changes in aerodynamics and anatomic characteristics of the upper airway was explored. RESULTS: The enlargements of the volume of the total pharynx, nasopharynx, and oropharynx were found (9.99%, 20.7%, and 8.84%, respectively). The minimum cross-sectional area increased significantly (13.6%). The airway resistance (R) and maximum velocity (Vmax) decreased significantly in both the inspiration and expiration phase (inspiration: R, -26.8%, Vmax, -15.7%; expiration: R, -24.7%, Vmax, -16.5%). The minimum wall shear stress reduced significantly only in the inspiration phase (-26.3%). The correlations between decreased R and increased volume and minimum cross-sectional area were observed. CONCLUSIONS: Mini-implants assisted rapid maxillary expansion is an effective device for improving anatomic characteristics represented by the total volume of the upper airway and minimum cross-sectional area, which contributed to the respiratory function depending on the favorable changes of aerodynamic characteristics including resistance, velocity, and minimum wall shear stress.


Assuntos
Implantes Dentários , Técnica de Expansão Palatina , Adulto , Tomografia Computadorizada de Feixe Cônico , Feminino , Humanos , Imageamento Tridimensional , Masculino , Maxila/diagnóstico por imagem , Nariz , Orofaringe/diagnóstico por imagem , Faringe/diagnóstico por imagem , Adulto Jovem
9.
Am J Orthod Dentofacial Orthop ; 159(4): e377-e388, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33583695

RESUMO

INTRODUCTION: The purpose of this cross-sectional retrospective study was to evaluate the patterns of pharyngeal airway volume change determined by cervical vertebral maturation (CVM) stage and compare it with that which was characterized by chronological age. Correlations between hyoid bone positions and airway volumes were also examined. METHODS: CVM staging was determined from cone-beam computed tomography scans of 420 white patients aged 9-15 years. Patients were stratified on the basis of sex and skeletal pattern to establish pharyngeal airway volume clusters for each CVM stage. The horizontal and vertical positions of hyoid bones were measured using Hyoidius and Sella. RESULTS: Males had larger pharyngeal airway volumes compared with females. In males, the largest increases in pharyngeal airway volumes occurred at an earlier CVM stage than females. No statistically significant differences in pharyngeal airway volumes were noted in subjects with skeletal Class I, II, and III malocclusion. The hyoid bone in males was more anteriorly and inferiorly positioned compared with females. The Class III group had a further forward position of the hyoid bone than the Class I and II groups. CONCLUSIONS: The patterns of pharyngeal airway change obtained using CVM staging did not correlate well with traditional maturational models for skeletal growth. It implies that chronologic age could be a relatively reliable indicator for the assessment of pharyngeal airway volumes in adolescents, as outlined in part 1 of the present study. Subjects with anteriorly and superiorly positioned hyoid bones exhibited smaller pharyngeal airway volumes, which highlights the role of soft tissue and its influence on airway patency.


Assuntos
Osso Hioide , Má Oclusão de Angle Classe III , Adolescente , Cefalometria , Criança , Tomografia Computadorizada de Feixe Cônico , Estudos Transversais , Feminino , Humanos , Osso Hioide/diagnóstico por imagem , Masculino , Mandíbula , Faringe/diagnóstico por imagem , Estudos Retrospectivos
10.
Bratisl Lek Listy ; 122(3): 206-211, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33618530

RESUMO

INTRODUCTION: Coronavirus disease 2019 (COVID-19) has become a serious public health problem for    183 out of 197 countries in the world. Understanding the routes and pathogenesis of the coronavirus is important and it is considered that the studies on host cell receptor Angiotensin Converting Enzyme 2 (ACE2) may be valuable for the treatment and prevention of the disease. AIM: To evaluate the possibility of inhibition of SARS-CoV-2 at throat. METHODS: A comprehensive literature search was conducted. CONCLUSION: In view of the fact that the mouth and nose have higher number of ACE2 expressed cells, they serve as a gateway for the virus to enter. Thus, blocking the gate could be a good choice to reduce or even prevent the transmission. Small interfering RNAs (siRNAs) are double-stranded RNA molecules and could be designed easily and directed against many strains of a virus. Due to their features, siRNAs can provide a potential strategy to interfere with the replication of viral diseases. We think that since oral and nasal epithelial cells are relatively easily accessible it may allow to develop siRNA molecules to inhibit SARS-CoV-2 already at the entry where it continues to replicate for a period (Fig. 1, Ref. 50).


Assuntos
Infecções por Coronavirus , Humanos , Peptidil Dipeptidase A/genética , Faringe
11.
Artigo em Chinês | MEDLINE | ID: mdl-33541003

RESUMO

Osteoma of lingual base is a rare disease which consists of well-developed bone surrounded by epithelial tissue on the surface of tongue. This article reported a case of osteoma of lingual base in the oral-cavity. The patient was admitted to hospital on March 2019 and developed foreign body sensation in pharynx in the last 2 weeks, without pharyngeal pain and fever, cough and sputum, breathing and swallowing difficulties. No obvious abnormality was found in chest radiograph, electrocardiogram and biochemical test of hematuria. There was a nodular mass in the size of 0.7 cm×0.8 cm×0.4 cm on the left side of the base of the tongue, which was higher than the surface of the base of the tongue. The surface of the mass was smooth, gray in color, with clear boundaries of touch, no tenderness, and hard texture. The clinical diagnosis was a mass at the base of the tongue.


Assuntos
Osteoma , Neoplasias da Língua , Osso e Ossos , Humanos , Faringe , Língua
12.
Zool Res ; 42(2): 161-169, 2021 Mar 18.
Artigo em Inglês | MEDLINE | ID: mdl-33554485

RESUMO

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease 2019 (COVID-19) continue to impact countries worldwide. At present, inadequate diagnosis and unreliable evaluation systems hinder the implementation and development of effective prevention and treatment strategies. Here, we conducted a horizontal and longitudinal study comparing the detection rates of SARS-CoV-2 nucleic acid in different types of samples collected from COVID-19 patients and SARS-CoV-2-infected monkeys. We also detected anti-SARS-CoV-2 antibodies in the above clinical and animal model samples to identify a reliable approach for the accurate diagnosis of SARS-CoV-2 infection. Results showed that, regardless of clinical symptoms, the highest detection levels of viral nucleic acid were found in sputum and tracheal brush samples, resulting in a high and stable diagnosis rate. Anti-SARS-CoV-2 immunoglobulin M (IgM) and G (IgG) antibodies were not detected in 6.90% of COVID-19 patients. Furthermore, integration of nucleic acid detection results from the various sample types did not improve the diagnosis rate. Moreover, dynamic changes in SARS-CoV-2 viral load were more obvious in sputum and tracheal brushes than in nasal and throat swabs. Thus, SARS-CoV-2 nucleic acid detection in sputum and tracheal brushes was the least affected by infection route, disease progression, and individual differences. Therefore, SARS-CoV-2 nucleic acid detection using lower respiratory tract samples alone is reliable for COVID-19 diagnosis and study.


Assuntos
/veterinária , /genética , Animais , Anticorpos Antivirais , Modelos Animais de Doenças , Haplorrinos , Humanos , Estudos Longitudinais , Faringe/virologia , Valor Preditivo dos Testes , Manejo de Espécimes , Escarro/virologia
13.
Oral Maxillofac Surg Clin North Am ; 33(2): 295-303, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33581977

RESUMO

Uvulopalatopharyngoplasty is a generally safe and widely accepted surgical procedure for the treatment of obstructive sleep apnea. Unfortunately, uvulopalatopharyngoplasty does not always result in success, and patients who initially experienced improvement in the severity of their obstructive sleep apnea may relapse. Proper patient selection and performing uvulopalatopharyngoplasty in conjunction with other surgical procedures that are directed at other sites of upper airway collapsibility may yield favorable outcomes.


Assuntos
Apneia Obstrutiva do Sono , Úvula , Humanos , Faringe/cirurgia , Apneia Obstrutiva do Sono/cirurgia , Úvula/cirurgia
14.
J Stroke Cerebrovasc Dis ; 30(4): 105349, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33549862

RESUMO

INTRODUCTION/OBJECTIVE: The aim of this study is to analyze the influence of sour taste and cold temperature in the initiation of the pharyngeal swallow (IPS) and bolus location at pharyngeal swallow onset in individuals after stroke. METHODS: Cross-sectional prospective study. The study included 52 individuals with unilateral ischemic stroke. Each individual was assessed by videofluoroscopic swallowing study with 5ml of paste bolus offering four different stimuli (natural, cold, sour, and sour-cold). The individuals were divided into two groups according to the offer sequence. Group 1 (G1) - received a randomized sequence of stimuli (24 individuals), and Group 2 (G2) -the stimuli were offered in the following order: natural, cold, sour, and sour-cold(28 individuals). The IPS time and bolus location at pharyngeal swallow onset were analyzed. The bolus location at pharyngeal swallow onset was defined using six different levels. RESULTS: Individuals in G1 did not show a significant difference in IPS time between stimuli. However, individuals in G2 presented a significantly shorter IPS time with the sour and sour-cold stimuli than with natural or cold stimuli. The bolus location at pharyngeal swallow onset did not show significant difference between stimuli in both groups. On the other hand, in the G2 it was observed higher frequency of swallowing with sour-cold stimulus at level 1 (the bolus head was located in any region between the fauces pillar and the point where the tongue crosses the inferior border of the mandible). CONCLUSION: The sour and sour-cold stimuli influenced the IPS time when they were offered in a sequential order. Moreover, both the IPS time and bolus location at pharyngeal swallow onset were not influenced by the sour and sour cold-bolus when offered in a random sequence.


Assuntos
Temperatura Baixa , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/fisiopatologia , Deglutição , Faringe/fisiopatologia , Acidente Vascular Cerebral/complicações , Paladar , Idoso , Estudos Transversais , Transtornos de Deglutição/diagnóstico por imagem , Feminino , Fluoroscopia , Humanos , Masculino , Estudos Prospectivos , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Percepção Gustatória , Sensação Térmica , Fatores de Tempo , Gravação em Vídeo
16.
Indian J Med Microbiol ; 39(1): 122-124, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33610243

RESUMO

The route of transmission of Novel SARS-CoV-2 virus is ambiguous. In this regard we planned a study to find out SARS-CoV-RNA shedding in various clinical samples of 9 COVID-19 positive patients. SARS-CoV-RNA was detected in nasal swab (NS), throat swab (TS) and faecal sample but was not detected in serum and urine samples. We also report that SARS-CoV-2-RNA persisted in faeces for >20 days. Persistence of faecal RNA might impose challenge in infection control and the disease may spread to household contacts if discharged. Perineal cleaning and hygiene may be advised at the time of vaginal delivery.


Assuntos
/epidemiologia , RNA Viral , Adolescente , Adulto , Criança , Pré-Escolar , Fezes/virologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cavidade Nasal/virologia , Faringe/virologia , Fatores de Tempo , Carga Viral , Adulto Jovem
17.
Artigo em Inglês | MEDLINE | ID: mdl-33435182

RESUMO

The aim was to compare the influence of fixed orthodontic therapy (OT) on the pharyngeal airway space dimensions after correction of class-I, -II and -III skeletal profiles and among untreated adolescent patients. A control group comprising of untreated patients was also included. Demographics and OT-related information was retrieved from patients' records. Measurements of airway spaces in the nasopharynx, oropharynx and hypopharynx were performed on lateral cephalograms. p-values under 0.05 were considered statistically significant. The results showed no statistically significant differences in the naso-, oro- and hypo-pharyngeal airway spaces among patients with class-I, -II and -III skeletal profiles and individuals in the control group. There were no statistically significant differences when naso-, oro- and hypo-pharyngeal airway spaces were compared among patients with class-I, -II and -III skeletal profiles. In conclusion, in non-extraction cases without maxillary expansion, fixed OT does not affect the naso-, oro- and hypo-pharyngeal airway spaces in patients with skeletal Class-I, -II and -III skeletal profiles. Further studies involving patients undergoing ME and premolar extraction are needed to elucidate the influence of fixed OT on the naso-, oro- and hypo-pharyngeal airway spaces.


Assuntos
Mandíbula , Faringe , Adolescente , Cefalometria , Humanos , Nasofaringe , Orofaringe
18.
Respiration ; 100(2): 116-126, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33486496

RESUMO

BACKGROUND: There is still no clinical evidence available to support or to oppose corticosteroid treatment for coronavirus disease 2019 (COVID-19) pneumonia. OBJECTIVE: To investigate the efficacy and safety of corticosteroid given to the hospitalized patients with COVID-19 pneumonia. METHODS: This was a prospective, multicenter, single-blind, randomized control trial. Adult patients with COVID-19 pneumonia who were admitted to the general ward were randomly assigned to either receive methylprednisolone or not for 7 days. The primary end point was the incidence of clinical deterioration 14 days after randomization. RESULTS: We terminated this trial early because the number of patients with COVID-19 pneumonia in all the centers decreased in late March. Finally, a total of 86 COVID-19 patients underwent randomization. There was no difference of the incidence of clinical deterioration between the methylprednisolone group and control group (4.8 vs. 4.8%, p = 1.000). The duration of throat viral RNA detectability in the methylprednisolone group was 11 days (interquartile range, 6-16 days), which was significantly longer than that in the control group (8 days [2-12 days], p = 0.030). There were no significant differences between the 2 groups in other secondary outcomes. Mass cytometry discovered CD3+ T cells, CD8+ T cells, and NK cells in the methylprednisolone group which were significantly lower than those in the control group after randomization (p < 0.05). CONCLUSIONS: From this prematurely closed trial, we found that the short-term early use of corticosteroid could suppress the immune cells, which may prolong severe acute respiratory syndrome coronavirus 2 shedding in patients with COVID-19 pneumonia. TRIAL REGISTRATION: ClinicalTrials.gov, NCT04273321.


Assuntos
/tratamento farmacológico , Glucocorticoides/uso terapêutico , Hospitalização , Metilprednisolona/uso terapêutico , Faringe/química , RNA Viral/isolamento & purificação , Eliminação de Partículas Virais , Adulto , Idoso , Antibacterianos/uso terapêutico , Antivirais/uso terapêutico , Complexo CD3 , Linfócitos T CD8-Positivos , /terapia , Progressão da Doença , Intervenção Médica Precoce , Oxigenação por Membrana Extracorpórea , Feminino , Humanos , Células Matadoras Naturais , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Oxigenoterapia , Quartos de Pacientes , Faringe/virologia , Modelos de Riscos Proporcionais , Respiração Artificial , Método Simples-Cego , Subpopulações de Linfócitos T , Linfócitos T , Fatores de Tempo , Resultado do Tratamento
19.
BMJ Case Rep ; 14(1)2021 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-33462063

RESUMO

Swallowed partial dentures in elderly patients is an emergency situation that requires a swift response. Here, we report a case involving a patient with severe intellectual disability who swallowed his denture, which lodged at the oesophagus inlet. After failure of endoscopic removal, denture with clasp was removed using long forceps through intraoral approach under intravenous sedation. At the pharynx and oesophagus inlet level, removal of foreign body via intraoral approach should be preferentially considered over open surgery for faster patient recovery.


Assuntos
Prótese Parcial , Esôfago , Corpos Estranhos/diagnóstico , Corpos Estranhos/etiologia , Deficiência Intelectual/psicologia , Faringe , Corpos Estranhos/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade
20.
Am Fam Physician ; 103(2): 97-106, 2021 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-33448766

RESUMO

Dysphagia is common but may be underreported. Specific symptoms, rather than their perceived location, should guide the initial evaluation and imaging. Obstructive symptoms that seem to originate in the throat or neck may actually be caused by distal esophageal lesions. Oropharyngeal dysphagia manifests as difficulty initiating swallowing, coughing, choking, or aspiration, and it is most commonly caused by chronic neurologic conditions such as stroke, Parkinson disease, or dementia. Symptoms should be thoroughly evaluated because of the risk of aspiration. Patients with esophageal dysphagia may report a sensation of food getting stuck after swallowing. This condition is most commonly caused by gastroesophageal reflux disease and functional esophageal disorders. Eosinophilic esophagitis is triggered by food allergens and is increasingly prevalent; esophageal biopsies should be performed to make the diagnosis. Esophageal motility disorders such as achalasia are relatively rare and may be overdiagnosed. Opioid-induced esophageal dysfunction is becoming more common. Esophagogastroduodenoscopy is recommended for the initial evaluation of esophageal dysphagia, with barium esophagography as an adjunct. Esophageal cancer and other serious conditions have a low prevalence, and testing in low-risk patients may be deferred while a four-week trial of acid-suppressing therapy is undertaken. Many frail older adults with progressive neurologic disease have significant but unrecognized dysphagia, which significantly increases their risk of aspiration pneumonia and malnourishment. In these patients, the diagnosis of dysphagia should prompt a discussion about goals of care before potentially harmful interventions are considered. Speech-language pathologists and other specialists, in collaboration with family physicians, can provide structured assessments and make appropriate recommendations for safe swallowing, palliative care, or rehabilitation.


Assuntos
Transtornos de Deglutição/etiologia , Deglutição/fisiologia , Medicina de Família e Comunidade/métodos , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/terapia , Esôfago/patologia , Feminino , Humanos , Masculino , Faringe/anatomia & histologia , Exame Físico/métodos
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