Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 4.047
Filtrar
2.
Health Phys ; 122(6): 663-672, 2022 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-35394463

RESUMO

ABSTRACT: When exposed to depleted uranium (DU), the respiratory tract is the main route for DU to enter the body. At present, lung lavage is considered to be a method for removing DU from the lung. However, there is still room for improvement in the efficiency of lung lavage. In this work, a model of DU dust inhalation injury was established in beagle dogs so that chitosan-diethylenetriaminepentaacetic nanoparticles (CS-DTPA NP) could be synthesized. The purpose of this work was to evaluate the removal efficiency of CS-DTPA NP combined with lung lavage in dogs. Results showed that 7 d after DU exposure, the diethylenetriaminepentaacetic (DTPA) and CS-DTPA NP groups showed lower U content in kidney tissue compared with the normal saline (NS) group. In the left lung tissue (lavage fluid and recovery rate of lavage fluid), the U content in the CS-DTPA NP group was higher than in the NS and DTPA groups. In terms of blood levels, the CS-DPTA NP group increased over time at 1, 3 and 7 d of DU exposure without lavage; however, the U levels in the 3 and 7 d lavage groups were significantly lower than in the non-lavage groups. IL-1 in the lavage fluid of the CS-DPTA NP and CS NPs group were lower than in the NS group. In summary, after respiratory exposure to DU, early inhalation of CS-DPTA NP may block insoluble DU particles in the lung, and if combined with lung lavage, the clearance efficiency of DU from lung tissue improves.


Assuntos
Quitosana , Urânio , Animais , Lavagem Broncoalveolar , Cães , Poeira , Pulmão , Ácido Pentético
3.
BMJ Open ; 12(4): e057671, 2022 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-35443958

RESUMO

INTRODUCTION: Pulmonary alveolar proteinosis (PAP) is an ultrarare disorder characterised by the accumulation of alveolar surfactant and the dysfunction of alveolar macrophages that results in hypoxemic respiratory failure. Whole-lung lavage (WLL) is currently the primary therapy for PAP. However, systematic evaluation of the clinical efficacy of WLL is lacking. We aim to perform a systematic review and meta-analysis of existing evidence to support WLL for the clinical treatment of PAP. METHODS AND ANALYSIS: We will search the PubMed (MEDLINE), Cochrane Library, Embase, Web of Science and Google Scholar databases from inception to December 2021 for observational studies using WLL for the treatment of PAP. Two authors will independently screen the eligible studies, assess the quality of the included papers and extract the required information. Review Manager V.5.4 will be used to perform the meta-analysis. We will evaluate the overall quality of evidence using the Grading of Recommendations, Assessment, Development and Evaluation approach. All steps of this protocol will be performed using the Cochrane Handbook for Preferred Reporting Items for Systematic Review and Meta-analysis statement. ETHICS AND DISSEMINATION: This systematic review and meta-analysis will be based on published data. Therefore, ethical approval is not required. We will publish our results in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER: CRD42022306221 (https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022306221).


Assuntos
Proteinose Alveolar Pulmonar , Insuficiência Respiratória , Lavagem Broncoalveolar/métodos , Humanos , Metanálise como Assunto , Proteinose Alveolar Pulmonar/terapia , Revisões Sistemáticas como Assunto
4.
Rev Esp Quimioter ; 35 Suppl 1: 89-96, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35488835

RESUMO

Patients with a compromised immune system suffer a wide variety of insults. Pulmonary complications remain a major cause of both morbidity and mortality in immunocompromised patients. When such individuals present with radiographic infiltrates, the clinician faces a diagnostic challenge. The differential diagnosis in this setting is broad and includes both infectious and non-infectious conditions. Evaluation of the immunocompromised host with diffuse pulmonary infiltrates can be difficult, frustrating, and time-consuming. This common and serious problem results in significant morbidity and mortality, approaching 90%. Infections are the most common causes of both acute and chronic lung diseases leading to respiratory failure. Non-invasive diagnostic methods for evaluation are often of little value, and an invasive procedure (such as bronchoalveolar lavage, transbronchial biopsy or even open lung biopsy) is therefore performed to obtain a microbiologic and histologic diagnosis. Bronchoscopy allows certain identification of some aetiologies, and often allows the exclusion of infectious agents. Early use of computed tomography scanning is able to demonstrate lesions missed by conventional chest X-ray. However, even when a specific diagnosis is made, it might not impact patient's overall survival and outcomes.


Assuntos
Pneumopatias , Pneumonia , Lavagem Broncoalveolar/efeitos adversos , Broncoscopia/efeitos adversos , Broncoscopia/métodos , Humanos , Hospedeiro Imunocomprometido , Pneumopatias/diagnóstico , Pneumonia/complicações
5.
BMC Pulm Med ; 22(1): 152, 2022 Apr 22.
Artigo em Inglês | MEDLINE | ID: mdl-35459122

RESUMO

BACKGROUND: Pneumoconiosis is a diffuse interstitial fibronodular lung disease, which is caused by the inhalation of crystalline silica. Whole lung lavage (WLL) is a therapeutic procedure used to treat pneumoconiosis. This study is to compare the effects of different negative pressure suction on lung injury in patients with pneumoconiosis undergoing WLL. MATERIALS AND METHODS: A prospective study was conducted with 24 consecutively pneumoconiosis patients who underwent WLL from March 2020 to July 2020 at Emergency General Hospital, China. The patients were divided into two groups: high negative suction pressure group (group H, n = 13, negative suction pressure of 300-400 mmHg) and low negative suction pressure group (group L, n = 11, negative suction pressure of 40-50 mmHg). The arterial blood gas, lung function, lavage data, oxidative stress, and inflammatory responses to access lung injury were monitored. RESULTS: Compared with those of group H, the right and left lung residual were significantly increased in the group L (P = 0.04, P = 0.01). Potential of hydrogen (pH), arterial partial pressure of oxygen (PaO2), arterial partial pressure of carbon dioxide (PaCO2), lactic acid (LAC) and glucose (GLU) varied from point to point in time (P < 0.01, respectively). There was statistical difference in the trend of superoxide dismutase (SOD) and interleukin-10 (IL-10) over time between the two groups (P < 0.01, P = 0.02). In comparison with the group H, the levels of IL-10 (P = 0.01) and SOD (P < 0.01) in WLL fluid were significantly increased in the group L. There was no statistical difference in the trend of maximal volumtary ventilation (MVV), forced vital capacity (FVC), forced expiratory volume in one second (FEV1%), residual volume (RV), residual volume/total lung capacity (RV/TLC), carbon monoxide dispersion factor (DLCO%), forced expiratory volume in one second/ forced vital capacity (FEV1/FVC%) over time between the two groups (P > 0.05, respectively). CONCLUSION: Low negative suction pressure has the potential benefit to reduce lung injury in patients with pneumoconiosis undergoing WLL, although it can lead to increased residual lavage fluid. Despite differing suction strategies, pulmonary function parameters including FEV1%, RV and DLCO% became worse than before WLL. Trial Registration Chinese Clinical Trial registration number ChiCTR2000031024, 21/03/2020.


Assuntos
Doenças Pulmonares Intersticiais , Lesão Pulmonar , Pneumoconiose , Lavagem Broncoalveolar , Humanos , Interleucina-10 , Pulmão , Pneumoconiose/terapia , Estudos Prospectivos , Sucção , Superóxido Dismutase
6.
Can J Vet Res ; 86(2): 116-124, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35388235

RESUMO

There are limited options for treatment of the common disease, equine asthma. The aim of this study was to estimate the feasibility and potential efficacy of using nebulized lidocaine for treating equine asthma, while at the same time treating a separate cohort of asthmatic horses with inhaled budesonide. Nineteen horses with a history consistent with equine asthma were recruited from our referral population for a double-blind, randomized, controlled pilot clinical trial using Consolidated Standards of Reporting Trials (CONSORT) guidelines. After screening, 16 horses met the inclusion criteria for equine asthma and 13 horses actually completed the study. Horses were treated by their owners at home for 14 d before returning to our hospital for follow-up assessment. Interventions consisted of nebulization q12h for 14 d with 1.0 mg/kg body weight (BW) of lidocaine or corticosteroid treatment (nebulized budesonide 1 µg/kg, q12h). Clinical and tracheal mucus score, pulmonary function testing, and respiratory secretion cytology were assessed after 2 weeks of treatment to determine the outcome. Both lidocaine and budesonide cohorts had significant decreases (P < 0.05) in clinical score; the lidocaine cohort showed a significant decrease in bronchoalveolar lavage (BAL) neutrophil percentage and tracheal mucus score. Neither treatment resulted in significant changes in lung function parameters. No adverse events occurred. Lidocaine may be an effective and safe treatment for equine asthma in horses that cannot tolerate treatment with corticosteroids.


Il existe des options limitées pour le traitement de la maladie répandue, l'asthme équin. Le but de cette étude était d'estimer la faisabilité et l'efficacité potentielle de l'utilisation de la lidocaïne nébulisée pour traiter l'asthme équin, tout en traitant en même temps une cohorte distincte de chevaux asthmatiques avec du budésonide inhalé. Dix-neuf chevaux ayant des antécédents compatibles avec l'asthme équin ont été recrutés dans notre population de référence pour un essai clinique pilote contrôlé, randomisé, en double aveugle, conformément aux directives CONSORT (Consolidated Standards of Reporting Trials). Après dépistage, 16 chevaux répondaient aux critères d'inclusion de l'asthme équin et 13 chevaux ont terminé l'étude. Les chevaux ont été traités par leurs propriétaires à domicile pendant 14 jours avant de retourner à notre hôpital pour une évaluation de suivi. Les interventions consistaient en une nébulisation deux fois par jour pendant 14 jours avec 1,0 mg/kg de poids corporel (PC) de lidocaïne ou un traitement aux corticostéroïdes (budésonide nébulisé 1 µg/kg, q12h). Le score clinique et de mucus trachéal, les tests de la fonction pulmonaire et la cytologie des sécrétions respiratoires ont été évalués après 2 semaines de traitement pour déterminer le résultat. Les cohortes de lidocaïne et de budésonide présentaient des diminutions significatives (P < 0,05) du score clinique; la cohorte de lidocaïne a montré une diminution significative du pourcentage de neutrophiles du lavage bronchoalvéolaire (BAL) et du score de mucus trachéal. Aucun des deux traitements n'a entraîné de changements significatifs dans les paramètres de la fonction pulmonaire. Aucun événement indésirable n'est survenu. La lidocaïne peut être un traitement efficace et sûr de l'asthme équin chez les chevaux qui ne tolèrent pas le traitement aux corticostéroïdes.(Traduit par Docteur Serge Messier).


Assuntos
Asma , Doenças dos Cavalos , Administração por Inalação , Animais , Asma/tratamento farmacológico , Asma/veterinária , Lavagem Broncoalveolar/veterinária , Budesonida/uso terapêutico , Método Duplo-Cego , Doenças dos Cavalos/tratamento farmacológico , Cavalos , Humanos , Lidocaína/uso terapêutico
7.
Am J Respir Crit Care Med ; 205(9): 1016-1035, 2022 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-35227171

RESUMO

Autoimmune pulmonary alveolar proteinosis (PAP) is a rare disease characterized by myeloid cell dysfunction, abnormal pulmonary surfactant accumulation, and innate immune deficiency. It has a prevalence of 7-10 per million; occurs in individuals of all races, geographic regions, sex, and socioeconomic status; and accounts for 90% of all patients with PAP syndrome. The most common presentation is dyspnea of insidious onset with or without cough, production of scant white and frothy sputum, and diffuse radiographic infiltrates in a previously healthy adult, but it can also occur in children as young as 3 years. Digital clubbing, fever, and hemoptysis are not typical, and the latter two indicate that intercurrent infection may be present. Low prevalence and nonspecific clinical, radiological, and laboratory findings commonly lead to misdiagnosis as pneumonia and substantially delay an accurate diagnosis. The clinical course, although variable, usually includes progressive hypoxemic respiratory insufficiency and, in some patients, secondary infections, pulmonary fibrosis, respiratory failure, and death. Two decades of research have raised autoimmune PAP from obscurity to a paradigm of molecular pathogenesis-based diagnostic and therapeutic development. Pathogenesis is driven by GM-CSF (granulocyte/macrophage colony-stimulating factor) autoantibodies, which are present at high concentrations in blood and tissues and form the basis of an accurate, commercially available diagnostic blood test with sensitivity and specificity of 100%. Although whole-lung lavage remains the first-line therapy, inhaled GM-CSF is a promising pharmacotherapeutic approach demonstrated in well-controlled trials to be safe, well tolerated, and efficacious. Research has established GM-CSF as a pulmonary regulatory molecule critical to surfactant homeostasis, alveolar stability, lung function, and host defense.


Assuntos
Doenças Autoimunes , Proteinose Alveolar Pulmonar , Adulto , Doenças Autoimunes/diagnóstico , Doenças Autoimunes/terapia , Lavagem Broncoalveolar , Criança , Fator Estimulador de Colônias de Granulócitos e Macrófagos/uso terapêutico , Humanos , Proteinose Alveolar Pulmonar/diagnóstico , Proteinose Alveolar Pulmonar/patologia , Proteinose Alveolar Pulmonar/terapia
8.
Med J Malaysia ; 77(2): 261-263, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-35338641

RESUMO

Pulmonary alveolar proteinosis (PAP) is a rare disease and its prognosis can be improved by whole lung lavage (WLL). Herein, we present three cases with idiopathic PAP treated successfully with either single or double WLL in the same setting. All three of them presented with exertional dyspnoea with radiographic findings of pulmonary infiltrates. They showed a marked clinical and physiologic improvement post WLL. Two of them were in remission. These three cases were diagnosed using different lung biopsy modalities, including video-assisted thoracoscopic lung biopsy, computed tomography-guided percutaneous transthoracic tru-cut needle lung biopsy, and transbronchial forceps lung biopsy (TBLB), respectively. The current cases have shown that TBLB may provide adequate diagnostic yield, and the invasive surgical lung biopsy may not be necessary to achieve a definitive diagnosis.


Assuntos
Proteinose Alveolar Pulmonar , Biópsia , Lavagem Broncoalveolar , Humanos , Pulmão/patologia , Proteinose Alveolar Pulmonar/diagnóstico , Proteinose Alveolar Pulmonar/patologia , Proteinose Alveolar Pulmonar/terapia , Tomografia Computadorizada por Raios X
9.
J UOEH ; 44(1): 83-89, 2022.
Artigo em Japonês | MEDLINE | ID: mdl-35249944

RESUMO

A 49-year-old man was diagnosed with autoimmune pulmonary alveolar proteinosis. Chest computed tomography (CT) showed typical CT findings of pulmonary alveolar proteinosis: thickening of septa with ground-glass opacities in both lung fields. The diagnosis of autoimmune pulmonary alveolar proteinosis (PAP) was based on findings of bronchoalveolar lavage (BAL) fluid with milky appearance and elevated serum titer of anti-granulocyte-macrophage colony-stimulating factor antibody. We decided to perform segmental BAL via bronchoscopy. The surgery was performed under a general anesthesia since the patient had severe hypoxemia and strong cough reflex. Following 3 repeated courses of therapy, his respiratory condition and the ground-glass opacity in both lung fields improved remarkably, with no recurrence in 3 years. There are only a few published case reports in the world of the usefulness of segmental BAL under general anesthesia for PAP. We consider that segmental BAL is a useful therapeutic method for PAP in cases with severe hypoxemia, such as the present patient.


Assuntos
Doenças Autoimunes , Proteinose Alveolar Pulmonar , Lavagem Broncoalveolar/métodos , Líquido da Lavagem Broncoalveolar , Humanos , Pulmão , Masculino , Pessoa de Meia-Idade , Proteinose Alveolar Pulmonar/diagnóstico por imagem , Proteinose Alveolar Pulmonar/terapia
10.
Respir Res ; 23(1): 60, 2022 Mar 17.
Artigo em Inglês | MEDLINE | ID: mdl-35300687

RESUMO

BACKGROUND: PAP is an ultra-rare respiratory syndrome characterized by the accumulation of surfactant within the alveoli. Whole lung lavage (WLL) is the current standard of care of PAP, however it is not a standardized procedure and the total amount of fluid used to wash each lung is still debated. Considering ICU hospitalization associated risks, a "mini-WLL" with anticipated manual clapping and reduced total infusion volume and has been proposed in our center. The aim of the study is to retrospectively analyze the efficacy of mini-WLL compared to standard WLL at the Pavia center. METHODS: 13 autoimmune PAP patients eligible for WLL were included: 7 patients were admitted to mini-WLL (9 L total infusion volume for each lung) and 6 patients underwent standard WLL (14 L of infusion volume). Functional data (VC%, FVC%, TLC%, DLCO%) and alveolar-arterial gradient values (A-aO2) were collected at the baseline and 1, 3, 6, 12, 18 months after the procedure. RESULTS: A statistically significant improvement of VC% (p = 0.013, 95%CI 3.49-30.19), FVC% (p = 0.016, 95%CI 3.37-32.09), TLC% (p = 0.001, 95%CI 7.38-30.34) was observed in the mini-WLL group in comparison with the standard WLL group, while no significant difference in DLCO% and A-aO2 mean values were reported. CONCLUSION: Mini-WLL has demonstrated higher efficacy in ameliorating lung volumes, suggesting that a lower infusion volume is sufficient to remove the surfactant accumulation and possibly allows a reduced mechanical insult of the bronchi walls and the alveoli. However, no statistically significant differences were found in terms of DLCO% and Aa-O2.


Assuntos
Doenças Autoimunes/terapia , Autoimunidade , Lavagem Broncoalveolar/métodos , Proteinose Alveolar Pulmonar/terapia , Alvéolos Pulmonares/fisiopatologia , Surfactantes Pulmonares/metabolismo , Adulto , Doenças Autoimunes/imunologia , Doenças Autoimunes/metabolismo , Feminino , Seguimentos , Humanos , Medidas de Volume Pulmonar/métodos , Masculino , Pessoa de Meia-Idade , Proteinose Alveolar Pulmonar/imunologia , Proteinose Alveolar Pulmonar/metabolismo , Estudos Retrospectivos
11.
Wiad Lek ; 75(2): 473-477, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35307679

RESUMO

OBJECTIVE: The aim: To evaluate the dynamics of the interferon and collagen-IV systems in bronchoalveolar lavage in the treatment of chronic obstructive pulmonary disease using the tiotropium bromide medication. PATIENTS AND METHODS: Materials and methods: The study involved 60 COPD patients with bronchial obstruction of the II degree before and on days 30 and 60 of therapy using conventional treatment regimens and inhalations of tiotropium bromide a the dose of 18 mcg once a day. The collagen-IV levels in bronchoalveolar fluid were determined by means of enzyme-linked immunoassay using "StatFax 303 Plus" analyzer and "Biotrin Collagen IV EIA" reagents. The level of IFN-γ was identified with the help of enzyme-linked immunoassay using "StatFax 303 Plus" analyzer and "ProKon" reagents (LLC "Protein Contour", Russia) in bronchoalveolar fluid obtained during fiber-optic bronchoscopy. RESULTS: Results: When examining Group I patients on the 30th day we found out that the content of collagen-IV in the bronchoalveolar fluid had decreased by only 10.29% (p <0.05). Detection of collagen-IV indices in Group II patients on the 30th day of tiotropium bromide use showed the 29.43% (p <0.05) decrease in its content as compared to the initial indices. In Group III patients, the concentration of collagen-IV had a maximum tendency to normalize and made up (24.72 ± 1.15) ng/ml, and decreased by 2.44 times (p <0.05) as compared to the initial indices. Our examination of 12 patients from the comparison group I on the 60th day of treatment revealed even a slight increase in the content of collagen-IV in the bronchoalveolar fluid, as compared with the data obtained on the 30th day. The identified IFN-γ deficiency is indicative for the COPD of the II degree of bronchial obstruction, and its indices were 2.29 times lower than those observed in people from the control group. On day 30, we found out that the content of IFN-γ in Group I patients increased by only 10.29% (p>0.05). Detection of IFN-γ in Group II patients showed 42.27% (p<0,05) increase in its content as compared to the initial indices. The most favorable dynamics of IFN-γ levels in bronchoalveolar contents was observed in Group III patients, and at the time of observation it made up (1.16 ± 0.08) pg/ml, having 2 times (p<0.05) increased as compared to the initial indices. However, in contrast to those taking tiotropium bromide, we examined 12 patients from Group I on the 60th day of treatment and found no significant positive dynamics of IFN-γ content in bronchoalveolar fluid as compared to the indices obtained on day 30. CONCLUSION: Conclusions: The obtained findings indicate the effect of tiotropium bromide on the reduction of interferon-γ and reduce of collagen-IV levels, which depend on the duration of its use.


Assuntos
Doença Pulmonar Obstrutiva Crônica , Derivados da Escopolamina , Lavagem Broncoalveolar , Broncodilatadores/uso terapêutico , Humanos , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Derivados da Escopolamina/efeitos adversos , Derivados da Escopolamina/uso terapêutico , Brometo de Tiotrópio/uso terapêutico
12.
BMJ Case Rep ; 15(3)2022 Mar 24.
Artigo em Inglês | MEDLINE | ID: mdl-35332005

RESUMO

Non-tuberculous mycobacteria (NTM) are one of the predominant microbes observed in immunocompromised patients with structural lung disease. Especially in immunocompromised patients, the treating physician needs to be aware of concurrent lung infections with opportunistic pathogens. In this case report we present a man in his 60s with severe chronic obstructive pulmonary disease (COPD) and bullous emphysema, who was diagnosed with Mycobacterium europaeum but with persistent clinical deterioration despite relevant treatment for NTM. A subsequent bronchoalveolar lavage (BAL) revealed elevated Aspergillus galactomannan antigen which, when seen in relation to imaging-findings of cavitating opacities with aggravating surrounding consolidation, raised suspicion of concurrent subacute invasive aspergillosis. Antifungal treatment was initiated but due to intolerable side effects was discontinued after only a few weeks. This case highlights the importance of concurrent testing for pulmonary aspergillosis in NTM patients and vice versa before treatment initiation and if the disease and symptoms are progressing despite relevant treatment.


Assuntos
Aspergilose , Aspergilose Pulmonar , Aspergilose/diagnóstico , Lavagem Broncoalveolar , Humanos , Pulmão/diagnóstico por imagem , Masculino , Micobactérias não Tuberculosas , Aspergilose Pulmonar/diagnóstico , Aspergilose Pulmonar/diagnóstico por imagem
13.
Pediatr Pulmonol ; 57(5): 1310-1317, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35170875

RESUMO

OBJECTIVES: To study the utility, safety, and effects of flexible fiberoptic bronchoscopy (FFB) on oxygenation status, ventilation parameters, and hemodynamics in mechanically ventilated children. DESIGN: Retrospective study. PATIENTS: Children aged >1 month to 18 years suffering from critical medical and surgical diseases. RESULTS: First bronchoscopy data of 131 patients were analyzed. Indication, FFB findings, the microbiological yield from bronchoalveolar lavage, and medical and surgical interventions based on FFB results were recorded. Hemodynamic and ventilation parameters before, during, and 3 h after FFB were also captured. The majority of bronchoscopies were done for diagnostic purposes with a positivity rate of 90.8%. Retained mucopurulent secretion in the airways was the commonest finding in 60 patients. A cause for weaning or extubation failure could be identified in 83.3%. Post-FFB radiological resolution of atelectasis was seen in 34/59 (57.6%; p-value: 0.001) chest radiographs. Forty-seven medical and 25 surgical interventions were done depending on FFB and BAL findings. There was a significant drop in oxygenation parameters and a rise in heart rate during FFB (p-value: <0.0001). The peak inspiratory pressure, positive end-expiratory pressure, and mean airway pressure increased significantly during bronchoscopy (p value: <.0001) while patients were on pressure-regulated volume-controlled ventilation. All these changes reversed to pre-FFB levels. There were minor procedure-related complications. CONCLUSION: FFB was an important diagnostic and therapeutic tool for mechanically ventilated children and the results helped plan interventions. It was a safe procedure with transient reversible cardiopulmonary alterations.


Assuntos
Broncoscopia , Respiração Artificial , Lavagem Broncoalveolar/efeitos adversos , Broncoscopia/efeitos adversos , Broncoscopia/métodos , Criança , Humanos , Unidades de Terapia Intensiva Pediátrica , Estudos Retrospectivos
14.
Mycoses ; 65(4): 411-418, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35138675

RESUMO

BACKGROUND: The diagnosis of invasive pulmonary aspergillosis (IPA) in intensive care unit (ICU) patients is challenging, and the role of Aspergillus-PCR in bronchoalveolar lavage (BAL) is unknown. OBJECTIVES: This study evaluated diagnostic accuracy of Aspergillus-PCR in BAL in IPA in three different cohorts: ICU-admitted patients with COVID-19, ICU-admitted patients without COVID-19 and immunocompromised patients. METHODS: All stored available BAL samples collected from three patient groups were tested with Aspergillus-PCR (AsperGenius® ). IPA was diagnosed according to appropriate criteria for each patient group. RESULTS: We included 111 BAL samples from 101 patients: 52 (51%) patients admitted to ICU for COVID-19, 24 (24%) admitted to ICU for other reasons and 25 (25%) immunocompromised. There were 31 cases of IPA (28%). Aspergillus-PCR sensitivity was 64% (95% CI 47-79) and specificity 99% (95% CI 93-100). Aspergillus-PCR sensitivity was 40% (95%CI 19-64) in ICU COVID-19, 67% (95% CI 21-93) in non-COVID-19 ICU patients and 92% (95%CI 67-98) in the immunocompromised. The concordance between positive BAL-GM and BAL-PCR in patients with and without IPA was significantly lower in ICU patients (32%; 43% in COVID-19, 18% in non-COVID-19) than in the immunocompromised (92%), p < .001. CONCLUSIONS: Aspergillus-PCR in BAL improves the diagnostic accuracy of BAL-GM in ICU patients.


Assuntos
COVID-19 , Aspergilose Pulmonar Invasiva , Aspergillus/genética , Lavagem Broncoalveolar , Líquido da Lavagem Broncoalveolar , COVID-19/diagnóstico , Estado Terminal , Galactose , Humanos , Aspergilose Pulmonar Invasiva/diagnóstico , Mananas/análise , Reação em Cadeia da Polimerase , Sensibilidade e Especificidade
15.
BMC Pulm Med ; 22(1): 49, 2022 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-35105320

RESUMO

BACKGROUND: Recent studies support the diagnostic role of bronchoalveolar lavage lymphocytosis (BALL) in patients with suspected hypersensitivity pneumonitis (HP). Our study aim was to determine the spectrum of BALL findings with elimination of incorporation bias in non-fibrotic and fibrotic patients and assess correlates of positive BALL cut-off and BALL association with long-term outcomes in those with fibrotic disease (f-HP). METHODS: A single-center retrospective cohort study was pursued of patients undergoing diagnostic bronchoscopy for interstitial lung disease. Strict study enrollment was based on recent ATS/JRS/ALAT diagnostic guidance meeting 'moderate' or higher diagnostic confidence. BALL findings were assessed in both fibrotic and non-fibrotic HP patients with regression and survival analysis pursued for correlates of positive BALL cut-off and long-term outcome. RESULTS: A total of 148 patients (88 fibrotic and 60 non-fibrotic) meeting moderate or higher diagnostic confidence were included. Median BALL in f-HP was 15% compared to 19% in non-fibrotic patients, with only 28% of f-HP meeting diagnostic cut-off (≥ 30%) compared to 41% of non-fibrotic. For f-HP, centrilobular nodules on computed tomography was positively correlated with a diagnostic BALL (OR 4.07; p = 0.018) while honeycombing was negatively correlated (OR 6.9 × e-8; p = 0.001). Higher BALL was also associated with lower all-cause mortality (HR 0.98; p = 0.015). CONCLUSION: With elimination of incorporation bias, most patients with well-described HP did not meet diagnostic BALL thresholds. Higher BALL was associated with better long-term survival in those with fibrosis, but its diagnostic role may be more additive than characteristic or distinguishing.


Assuntos
Alveolite Alérgica Extrínseca/epidemiologia , Alveolite Alérgica Extrínseca/patologia , Lavagem Broncoalveolar/estatística & dados numéricos , Linfocitose/epidemiologia , Linfocitose/patologia , Idoso , Idoso de 80 Anos ou mais , Alveolite Alérgica Extrínseca/diagnóstico , Estudos de Coortes , Feminino , Fibrose/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Minnesota/epidemiologia , Estudos Retrospectivos , Taxa de Sobrevida
17.
Nat Commun ; 13(1): 679, 2022 02 03.
Artigo em Inglês | MEDLINE | ID: mdl-35115549

RESUMO

Emergence of mutant SARS-CoV-2 strains associated with an increased risk of COVID-19-related death necessitates better understanding of the early viral dynamics, host responses and immunopathology. Single cell RNAseq (scRNAseq) allows for the study of individual cells, uncovering heterogeneous and variable responses to environment, infection and inflammation. While studies have reported immune profiling using scRNAseq in terminal human COVID-19 patients, performing longitudinal immune cell dynamics in humans is challenging. Macaques are a suitable model of SARS-CoV-2 infection. Our longitudinal scRNAseq of bronchoalveolar lavage (BAL) cell suspensions from young rhesus macaques infected with SARS-CoV-2 (n = 6) demonstrates dynamic changes in transcriptional landscape 3 days post- SARS-CoV-2-infection (3dpi; peak viremia), relative to 14-17dpi (recovery phase) and pre-infection (baseline) showing accumulation of distinct populations of both macrophages and T-lymphocytes expressing strong interferon-driven inflammatory gene signature at 3dpi. Type I interferon response is induced in the plasmacytoid dendritic cells with appearance of a distinct HLADR+CD68+CD163+SIGLEC1+ macrophage population exhibiting higher angiotensin-converting enzyme 2 (ACE2) expression. These macrophages are significantly enriched in the lungs of macaques at 3dpi and harbor SARS-CoV-2 while expressing a strong interferon-driven innate anti-viral gene signature. The accumulation of these responses correlated with decline in viremia and recovery.


Assuntos
COVID-19/imunologia , Interferons/farmacologia , Células Mieloides/imunologia , SARS-CoV-2/efeitos dos fármacos , Animais , Antivirais , Lavagem Broncoalveolar , Modelos Animais de Doenças , Humanos , Imunidade Inata , Inflamação , Interferon Tipo I/genética , Interferon Tipo I/farmacologia , Interferons/genética , Pulmão/imunologia , Pulmão/patologia , Macaca mulatta , Macrófagos/imunologia , Linfócitos T/imunologia
18.
Chest ; 161(2): e97-e101, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-35131080

RESUMO

CASE PRESENTATION: An 84-year-old man with an active smoking habit presented to the ED with dyspnea, hemoptysis, and thick phlegm that was difficult to clear. He reported no weight loss, no fever, and no chest pain or dysphonia. He denied both international travel and previous contact with confirmed cases of TB or SARS-CoV-2. He had no known occupational exposures. The patient's personal history included a resolved complete atrioventricular block that required a permanent pacemaker, moderate-to-severe COPD, rheumatoid arthritis (treated with oral prednisone, 2.5 mg/d) and B-chronic lymphocytic leukemia (treated with methotrexate and prophylactic oral supplements of ferrous sulfate). Moreover, he was in medical follow up because of a peptic ulcer, atrophic gastritis, and colonic diverticulosis. The patient also had a history of thoracic surgery after an episode of acute mediastinitis from an odontogenic infection, which required ICU management and temporal tracheostomy.


Assuntos
Broncoscopia/métodos , COVID-19/diagnóstico , Compostos Ferrosos , Pneumopatias , Múltiplas Afecções Crônicas/terapia , Aspiração Respiratória , Idoso de 80 Anos ou mais , Biópsia/métodos , Lavagem Broncoalveolar/métodos , COVID-19/epidemiologia , Diagnóstico Diferencial , Compostos Ferrosos/administração & dosagem , Compostos Ferrosos/efeitos adversos , Hematínicos/administração & dosagem , Hematínicos/efeitos adversos , Hemoptise/diagnóstico , Hemoptise/etiologia , Humanos , Pneumopatias/induzido quimicamente , Pneumopatias/diagnóstico por imagem , Pneumopatias/fisiopatologia , Pneumopatias/terapia , Masculino , Aspiração Respiratória/complicações , Aspiração Respiratória/diagnóstico , Aspiração Respiratória/fisiopatologia , SARS-CoV-2 , Tomografia Computadorizada por Raios X/métodos , Suspensão de Tratamento
19.
Transplant Proc ; 54(1): 169-172, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34973839

RESUMO

Pulmonary alveolar proteinosis is a rare disorder that results from impaired clearance of surfactant. There are few case reports in lung transplant recipients. We report the case of a 57-year-old man with chronic hypersensitivity pneumonitis who underwent left single lung transplantation. Approximately 1 year after transplant, he was diagnosed as having pulmonary alveolar proteinosis by surgical lung biopsy. He was successfully treated with bronchoscopic lobar lavage of his allograft but later was diagnosed as having peritoneal mesothelioma. We highlight the challenges in the diagnosis, discuss potential etiologies, and describe a unique therapy of this rare disorder in lung transplant recipients.


Assuntos
Transplante de Pulmão , Proteinose Alveolar Pulmonar , Lavagem Broncoalveolar , Humanos , Pulmão , Transplante de Pulmão/efeitos adversos , Masculino , Pessoa de Meia-Idade , Proteinose Alveolar Pulmonar/diagnóstico , Proteinose Alveolar Pulmonar/terapia , Irrigação Terapêutica , Transplantados
20.
J Cardiothorac Vasc Anesth ; 36(2): 587-593, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-33386193

RESUMO

Pulmonary alveolar proteinosis is a rare disease characterized by progressive accumulation of lipoprotein material in the alveoli as a result of a dysfunction in surfactant clearance. The whole-lung lavage procedure is considered the current standard of care and consists of the sequential lavage of both lungs for mechanical removal of residual material in the alveoli. However, a lack of standardization has resulted in different procedural techniques among institutions. Even though whole-lung lavage is considered to be a safe procedure, unforeseen complications might occur, and proper knowledge of physiologic implications may allow clinicians to establish the appropriate therapy. This review provides an insight into the underlying physiology of the disease, the technical details of the procedure from an anesthesiologist's perspective, and discussion of potential intraoperative complications.


Assuntos
Anestésicos , Proteinose Alveolar Pulmonar , Lavagem Broncoalveolar , Humanos , Pulmão
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...