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1.
Zhongguo Zhen Jiu ; 41(1): 3-7, 2021 Jan 12.
Artigo em Chinês | MEDLINE | ID: mdl-33559433

RESUMO

OBJECTIVE: To compare the therapeutic effect between Shao 's five-needle therapy combined with conventional western medical treatment and the simple conventional western medical treatment on stroke-associated pneumonia. METHODS: A total of 80 patients were randomized into an observation group and a control group, 40 cases in each group. Conventional western medication treatment i.e. anti-infection combined with rehabilitation swallowing training were adopted in the control group. On the basis of the treatment in the control group, Shao 's five-needle therapy was applied at Feishu (BL 13), Dazhui (GV 14), Fengmen (BL 12), etc. in the observation group, once a day. The treatment was given for 10 days in the both groups. The levels of inflammatory indexes [white blood cell (WBC), C-reactive protein (CRP), percentage of neutrophil (N%)] before and after treatment, the disappearance time of main clinical symptoms and signs, the scores of National Institutes of Health Stroke scale (NIHSS) and the ability of daily living (ADL) were observed, and the clinical therapeutic effect was evaluated in the both groups. RESULTS: Compared before treatment, the levels of WBC, CRP, N% and the NIHSS scores after treatment were decreased (P<0.05), the ADL scores were increased in the both groups (P<0.05), and the improvement of above indexes in the observation group was superior to the control group (P<0.05). The recovery time of temperature and rale, the duration of cough in the observation group were shorter than those in the control group (P<0.05). The effective rate was 97.5% (39/40) in the observation group, which was superior to 85.0% (34/40) in the control group (P<0.05). CONCLUSION: Shao 's five-needle therapy combined with conventional western medical treatment can effectively improve the clinical symptoms in patients with stroke-associated pneumonia, down-regulate the inflammatory indexes and improve the quality of life, the therapeutic effect is superior to the simple conventional western medical treatment.


Assuntos
Terapia por Acupuntura , Pneumonia , Acidente Vascular Cerebral , Pontos de Acupuntura , Humanos , Pneumonia/etiologia , Pneumonia/terapia , Qualidade de Vida , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/terapia , Resultado do Tratamento
2.
Medicine (Baltimore) ; 100(3): e24028, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33546000

RESUMO

RATIONALE: Bronchial involvement alone is a rare initial manifestation of granulomatosis with polyangiitis (GPA). Herein, we report a case of refractory GPA with obstructive pneumonia caused by bronchial involvement. PATIENT CONCERNS: A 65-year-old man complained of a 2-week cough and fever. DIAGNOSES: Considering the presence of opacities and multiple consolidations in both lungs due to obstruction or stenosis on the bronchus, which did not respond to antibiotics, and proteinase-3-antineutrophil cytoplasmic autoantibody positivity, he was diagnosed with GPA. Positron emission tomography- computed tomography scan revealed no abnormal findings in the upper respiratory tract. INTERVENTIONS: He was treated with prednisolone (PSL, 50 mg/d) and intravenous cyclophosphamide. OUTCOMES: His general and respiratory symptoms improved. However, 8 weeks after PSL treatment at 20 mg/d, he developed a relapse of vasculitis along with sinusitis and hypertrophic pachymeningitis. Hence, PSL treatment was resumed to 50 mg/d, and weekly administration of rituximab was initiated. Consequently, the symptoms gradually mitigated. LESSONS: GPA with bronchial involvement is often intractable and requires careful follow-up, which should include upper respiratory tract and hypertrophic pachymeningitis assessment.


Assuntos
Obstrução das Vias Respiratórias/etiologia , Granulomatose com Poliangiite/complicações , Meningite/etiologia , Pneumonia/etiologia , Idoso , Brônquios/patologia , Progressão da Doença , Humanos , Hipertrofia , Masculino
3.
BMJ Case Rep ; 14(1)2021 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-33431437

RESUMO

Communicating bronchopulmonary foregut malformations (CBPFMs) are complex and rare anomalies. Their characteristic feature is an anomalous communication between the respiratory system (trachea, lung or bronchus) on one side and the gastrointestinal tract (oesophagus or stomach) on the other. Though acquired CBPFMs are known, the large majority of them are congenital and single. CBPFMs often go undetected even at surgery and require more than one operation before they are successfully addressed. This is because the symptomatology of CBPFM resembles the more common oesophageal atresia (OA) with tracheoesophageal fistula, wherein it may coexist. We report a patient with OA who had a rare form of CBPFM where the upper lobe of the right lung communicated with the upper oesophagus. This account highlights a novel method of working out the uncertain anatomy, in such cases. There may be associated anomalies of the lung parenchyma and vasculature usually involving the pulmonary arterial supply to the affected lung. Clinical, radiological, endoscopic and pathological characterisation permit precise diagnosis in most instances, with an occasional case that defies definition.


Assuntos
Anormalidades Múltiplas/diagnóstico , Esôfago/anormalidades , Pulmão/anormalidades , Pneumonia/etiologia , Fístula Traqueoesofágica/diagnóstico , Administração Oral , Sulfato de Bário/administração & dosagem , Broncoscopia , Pré-Escolar , Meios de Contraste/administração & dosagem , Diagnóstico Diferencial , Endoscopia do Sistema Digestório , Esôfago/diagnóstico por imagem , Feminino , Humanos , Pulmão/diagnóstico por imagem , Recidiva , Tomografia Computadorizada por Raios X , Fístula Traqueoesofágica/cirurgia
4.
Zhonghua Wei Chang Wai Ke Za Zhi ; 24(2): 185-190, 2021 Feb 25.
Artigo em Chinês | MEDLINE | ID: mdl-33508925

RESUMO

Gastric cancer is a common digestive system malignancy. Surgical operation is the main treatment of radical treatment for gastric cancer. Pulmonary infection is a common postoperative complication of gastric cancer. Because there is no clear and unified definition of pulmonary complications, the current researches show that the incidence of postoperative pulmonary infection of gastric cancer is about 1.8%-18.1%. The incidence of postoperative pulmonary infection will prolong the hospital stay, increase the cost of hospitalization, and even develop into respiratory failure leading to early postoperative death. There are many factors affecting postoperative pulmonary infection of gastric cancer, including age, smoking history, pulmonary function, pulmonary disease history, operation method, operation time, intraoperative bleeding volume, gastric tube retention time, postoperative lying time and so on. There are also many perioperative interventions. This article reviews the risk factors and perioperative interventions of postoperative pulmonary infection of gastric cancer.


Assuntos
Gastrectomia/efeitos adversos , Assistência Perioperatória/métodos , Pneumonia/terapia , Neoplasias Gástricas , Humanos , Pneumonia/etiologia , Pneumonia/prevenção & controle , Estudos Retrospectivos , Fatores de Risco , Neoplasias Gástricas/complicações , Neoplasias Gástricas/cirurgia
5.
Medicine (Baltimore) ; 100(1): e24018, 2021 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-33429766

RESUMO

INTRODUCTION: Pembrolizumab, a monoclonal antibody targeting programmed cell death-1 (PD-1), is approved as a therapy for unresectable or metastatic melanoma. Immunotherapy-associated pneumonitis is an uncommon event. PATIENT CONCERNS: A 73-year-old man was admitted to our hospital with a history of melanoma on the left side of the face (resected in December 2012) and metastasis to the left lung upper lobe (resected in November 2016). Recurrence of metastasis to the bilateral lungs and left pleura was detected in April 2018. A complete response was achieved following treatment with pembrolizumab, with lower limb rashes the only adverse events occurring during therapy. The patient was readmitted in March 2019 with a productive cough, shortness of breath, and mild fever, and sputum culture identified Escherichia coli. DIAGNOSIS: A diagnosis of pneumonia was made, and although cough and shortness of breath responded to ceftazidime and levofloxacin, but fever and poor appetite persisted. Computed tomography showed no improvement in the bilateral lower lobe lesions. Prednisone was initiated based on a clinical diagnosis of immunotherapy-related pneumonitis. The response to prednisone confirmed the diagnosis. INTERVENTIONS: The patient first received ceftazidime and levofloxacin, but the symptoms persisted. Prednisone was initiated based on a clinical diagnosis of immunotherapy-related pneumonitis. OUTCOME: Complete resolution of the bilateral lung lesions occurred after 45 days of prednisone therapy. CONCLUSION: This case report highlights that both pneumonitis and bacterial pneumonia can occur as complications of anti-PD-1 immunotherapy.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Imunoterapia/efeitos adversos , Melanoma/tratamento farmacológico , Pneumonia Bacteriana/etiologia , Pneumonia/etiologia , Idoso , Tosse/etiologia , Dispneia/etiologia , Febre/etiologia , Humanos , Imunoterapia/métodos , Imunoterapia/normas , Masculino , Melanoma/complicações , Metástase Neoplásica/tratamento farmacológico , Metástase Neoplásica/fisiopatologia , Pneumonia/fisiopatologia , Pneumonia Bacteriana/fisiopatologia
6.
Immunopharmacol Immunotoxicol ; 43(1): 37-50, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33406943

RESUMO

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that causes the coronavirus disease 2019 (COVID-19) has infected millions of individuals and has claimed hundreds of thousands of human lives worldwide. Patients with underlying cardiovascular conditions are at high risk for SARS-CoV-2 infection, and COVID-19 patients have high incidence of cardiovascular complications such as acute cardiac injury, arrhythmias, heart failure, and thromboembolism. The disease has no approved proven effective therapy and hence repurposing of existing approved drugs has been considered as the fastest treatment approach. Statins have been shown to exhibit lipid lowering dependent and independent cardiovascular protective effects as well as favorable effects in various other pathophysiological states. These beneficial properties of statins are a result of their multiple pleotropic effects that include, anti-inflammatory, immunomodulatory, antithrombotic and antimicrobial properties. In this review, we provide a comprehensive description of the mechanisms of the pleotropic effects of statins, the relevant pre-clinical and clinical data pertinent to their role in infections and acute lung injury, the possible cardiovascular benefits of statins in COVID-19, and the implications of the therapeutic potential of statins in COVID-19 disease. We conclude with the rationale for conducting randomized controlled trials of statins in COVID-19 disease.


Assuntos
/tratamento farmacológico , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Lesão Pulmonar Aguda/tratamento farmacológico , Lesão Pulmonar Aguda/etiologia , Anti-Inflamatórios/farmacologia , Antivirais/farmacologia , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/farmacologia , Pneumonia/tratamento farmacológico , Pneumonia/etiologia
7.
Ultrasound Obstet Gynecol ; 57(2): 224-231, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33320401

RESUMO

OBJECTIVE: There are limited, unmatched data reporting low complication rates in pregnant women with coronavirus disease 2019 (COVID-19). The aim of this study was to compare COVID-19-related outcomes between pregnant and non-pregnant women after adjusting for potential risk factors for severe outcomes. METHODS: Data were obtained from the COVID-19 National Data Registry of Mexico, which is an ongoing prospective cohort of people of any age with clinically suspected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and admitted to 475 monitoring hospitals. This study included pregnant and non-pregnant women of reproductive age (15-45 years) with COVID-19 confirmed by reverse transcription polymerase chain reaction. To adjust for underlying risk factors, propensity score matching was conducted for chronic obstructive pulmonary disease, asthma, smoking, hypertension, cardiovascular disease, obesity, diabetes, chronic renal disease, immunosuppression, age, language, nationality and level of health insurance. The primary outcome was death. Secondary outcomes were pneumonia, intubation and intensive care unit (ICU) admission. RESULTS: The cohort comprised 5183 pregnant and 175 905 non-pregnant women with COVID-19. The crude (unmatched) rates of death, pneumonia, intubation and ICU admission in pregnant compared with non-pregnant women were 1.5% vs 1.5%, 9.9% vs 6.5%, 8.1% vs 9.9% and 13.0% vs 6.9%, respectively. After propensity score matching (5183 pregnant and 5183 non-pregnant matched women), pregnant women had a higher odds of death (odds ratio (OR), 1.84; 95% CI, 1.26-2.69), pneumonia (OR, 1.86; 95% CI, 1.60-2.16) and ICU admission (OR, 1.86; 95% CI, 1.41-2.45) than non-pregnant women, but similar odds of intubation (OR, 0.93; 95% CI, 0.70-1.25). CONCLUSION: After adjusting for background demographic and medical factors, pregnancy is a risk factor for death, pneumonia and ICU admission in SARS-CoV-2-infected women of reproductive age. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.


Assuntos
/mortalidade , Pneumonia/etiologia , Complicações Infecciosas na Gravidez/mortalidade , Complicações Infecciosas na Gravidez/virologia , Adolescente , Adulto , /virologia , Estudos de Casos e Controles , Comorbidade , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , México/epidemiologia , Pessoa de Meia-Idade , Mortalidade , Pandemias , Pneumonia/virologia , Gravidez , Pontuação de Propensão , Estudos Prospectivos , Fatores de Risco , /isolamento & purificação , Adulto Jovem
8.
J Stroke Cerebrovasc Dis ; 30(3): 105536, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33338705

RESUMO

BACKGROUND AND PURPOSE: The coronavirus disease 2019 (COVID-19) pandemic has had a comprehensive impact on healthcare services worldwide. We sought to determine whether COVID-19 affected the treatment and prognosis of hemorrhagic stroke in a regional medical center in mainland China. METHODS: Patients with hemorrhagic stroke admitted in the Neurosurgery Department of West China Hospital from January 24, 2020, to March 25, 2020 (COVID-19 period), and from January 24, 2019, to March 25, 2019 (pre-COVID-19 period), were identified. Clinical characteristics, hospital arrival to neurosurgery department arrival time (door-to-department time), reporting rate of pneumonia and 3-month mRS (outcome) were compared. RESULTS: A total of 224 patients in the pre-COVID-19 period were compared with 126 patients in the COVID-19 period. Milder stroke severity was observed in the COVID-19 period (NIHSS 6 [2-20] vs. 3 [2-15], p = 0.005). The median door-to-department time in the COVID-19 period was approximately 50 minutes longer than that in the pre-COVID-19 period (96.5 [70.3-193.3] vs. 144.5 [93.8-504.5], p = 0.000). A higher rate of pneumonia complications was reported in the COVID-19 period (40.6% vs. 60.7%, p = 0.000). In patients with moderate hemorrhagic stroke, the percentage of good outcomes (mRS < 3) in the pre-COVID-19 period was much higher than that in the COVID-19 period (53.1% vs. 26.3%, p = 0.047). CONCLUSIONS: COVID-19 may have several impacts on the treatment of hemorrhagic stroke and may influence the clinical outcomes of specific patients. Improvements in the treatment process for patients with moderate stroke may help to improve the overall outcome of hemorrhagic stroke during COVID-19.


Assuntos
Hemorragias Intracranianas/terapia , Pandemias , Acidente Vascular Cerebral/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , China/epidemiologia , Feminino , Humanos , Hemorragias Intracranianas/complicações , Hemorragias Intracranianas/epidemiologia , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Pneumonia/epidemiologia , Pneumonia/etiologia , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Trombectomia , Terapia Trombolítica , Tempo para o Tratamento , Resultado do Tratamento
11.
BMC Infect Dis ; 20(1): 823, 2020 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-33176722

RESUMO

BACKGROUND: The highly pathogenic avian influenza A/H5N1 virus is one of the causative agents of acute lung injury (ALI) with high mortality rate. Studies on therapeutic administration of bone marrow-derived mesenchymal stem cells (MSCs) in ALI caused by the viral infection have been limited in number and have shown conflicting results. The aim of the present investigation is to evaluate the therapeutic potential of MSC administration in A/H5N1-caused ALI, using a mouse model. METHODS: MSCs were prepared from the bone marrow of 9 to 12 week-old BALB/c mice. An H5N1 virus of A/turkey/East Java/Av154/2013 was intranasally inoculated into BALB/c mice. On days 2, 4, and 6 after virus inoculation, MSCs were intravenously administered into the mice. To evaluate effects of the treatment, we examined for lung alveolar protein as an indicator for lung injury, PaO2/FiO2 ratio for lung functioning, and lung histopathology. Expressions of NF-κB, RAGE (transmembrane receptor for damage associated molecular patterns), TNFα, IL-1ß, Sftpc (alveolar cell type II marker), and Aqp5+ (alveolar cell type I marker) were examined by immunohistochemistry. In addition, body weight, virus growth in lung and brain, and duration of survival were measured. RESULTS: The administration of MSCs lowered the level of lung damage in the virus-infected mice, as shown by measuring lung alveolar protein, PaO2/FiO2 ratio, and histopathological score. In the MSC-treated group, the expressions of NF-κB, RAGE, TNFα, and IL-1ß were significantly suppressed in comparison with a mock-treated group, while those of Sftpc and Aqp5+ were enhanced. Body weight, virus growth, and survival period were not significantly different between the groups. CONCLUSION: The administration of MSCs prevented further lung injury and inflammation, and enhanced alveolar cell type II and I regeneration, while it did not significantly affect viral proliferation and mouse morbidity and mortality. The results suggested that MSC administration was a promissing strategy for treatment of acute lung injuries caused by the highly pathogenic avian influenza A/H5N1 virus, although further optimization and combination use of anti-viral drugs will be obviously required to achieve the goal of reducing mortality.


Assuntos
Lesão Pulmonar Aguda/etiologia , Lesão Pulmonar Aguda/cirurgia , Virus da Influenza A Subtipo H5N1 , Transplante de Células-Tronco Mesenquimais , Infecções por Orthomyxoviridae/complicações , Pneumonia/etiologia , Pneumonia/cirurgia , Lesão Pulmonar Aguda/prevenção & controle , Lesão Pulmonar Aguda/virologia , Animais , Citocinas/metabolismo , Modelos Animais de Doenças , Pulmão/metabolismo , Pulmão/virologia , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Infecções por Orthomyxoviridae/virologia , Pneumonia/prevenção & controle , Pneumonia/virologia , Resultado do Tratamento
12.
Anaesthesia ; 75(12): 1596-1604, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33090469

RESUMO

Maintaining safe elective surgical activity during the global coronavirus disease 2019 (COVID-19) pandemic is challenging and it is not clear how COVID-19 may impact peri-operative morbidity and mortality in this population. Therefore, adaptations to normal care pathways are required. Here, we establish if implementation of a bespoke peri-operative care bundle for urgent elective surgery during a pandemic surge period can deliver a low COVID-19-associated complication profile. We present a single-centre retrospective cohort study from a tertiary care hospital of patients planned for urgent elective surgery during the initial COVID-19 surge in the UK between 29 March and 12 June 2020. Patients asymptomatic for COVID-19 were screened by oronasal swab and chest imaging (chest X-ray or computed tomography if aged ≥ 18 years), proceeding to surgery if negative. COVID-19 positive patients at screening were delayed. Postoperatively, patients transitioning to COVID-19 positive status by reverse transcriptase polymerase chain reaction testing were identified by an in-house tracking system and monitored for complications and death within 30 days of surgery. Out of 557 patients referred for surgery (230 (41.3%) women; median (IQR [range]) age 61 (48-72 [1-89])), 535 patients (96%) had COVID-19 screening, of which 13 were positive (2.4%, 95%CI 1.4-4.1%). Out of 512 patients subsequently undergoing surgery, 7 (1.4%) developed COVID-19 positive status (1.4%, 95%CI 0.7-2.8%) with one COVID-19-related death (0.2%, 95%CI 0.0-1.1%) within 30 days. Out of these seven patients, four developed pneumonia, of which two required invasive ventilation including one patient with acute respiratory distress syndrome. Low rates of COVID-19 infection and mortality in the elective surgical population can be achieved within a targeted care bundle. This should provide reassurance that elective surgery can continue, where possible, despite high community rates of COVID-19.


Assuntos
Infecções por Coronavirus/epidemiologia , Procedimentos Cirúrgicos Eletivos , Período Perioperatório , Pneumonia Viral/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Estudos de Coortes , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/transmissão , Feminino , Humanos , Lactente , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Pandemias , Pneumonia/epidemiologia , Pneumonia/etiologia , Pneumonia Viral/diagnóstico , Pneumonia Viral/transmissão , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/mortalidade , Respiração Artificial , Estudos Retrospectivos , Centros de Atenção Terciária , Adulto Jovem
13.
Interdiscip Sci ; 12(4): 555-565, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32959234

RESUMO

The novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a major pandemic outbreak recently. Various diagnostic technologies have been under active development. The novel coronavirus disease (COVID-19) may induce pulmonary failures, and chest X-ray imaging becomes one of the major confirmed diagnostic technologies. The very limited number of publicly available samples has rendered the training of the deep neural networks unstable and inaccurate. This study proposed a two-step transfer learning pipeline and a deep residual network framework COVID19XrayNet for the COVID-19 detection problem based on chest X-ray images. COVID19XrayNet firstly tunes the transferred model on a large dataset of chest X-ray images, which is further tuned using a small dataset of annotated chest X-ray images. The final model achieved 0.9108 accuracy. The experimental data also suggested that the model may be improved with more training samples being released. COVID19XrayNet, a two-step transfer learning framework designed for biomedical images.


Assuntos
Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/diagnóstico , Aprendizado Profundo , Pulmão/diagnóstico por imagem , Modelos Biológicos , Redes Neurais de Computação , Pneumonia Viral/diagnóstico , Raios X , Algoritmos , Betacoronavirus , Coronavirus , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico por imagem , Infecções por Coronavirus/virologia , Bases de Dados Factuais , Conjuntos de Dados como Assunto , Humanos , Aprendizado de Máquina , Pandemias , Pneumonia/diagnóstico , Pneumonia/diagnóstico por imagem , Pneumonia/etiologia , Pneumonia/virologia , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico por imagem , Pneumonia Viral/virologia , Radiografia/métodos , Valores de Referência , Tomografia Computadorizada por Raios X/métodos
14.
Stroke ; 51(9): 2674-2682, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32755348

RESUMO

BACKGROUND AND PURPOSE: No studies have reported the effect of the coronavirus disease 2019 (COVID-19) epidemic on patients with preexisting stroke. We aim to study the clinical course of COVID-19 patients with preexisting stroke and to investigate death-related risk factors. METHODS: We consecutively included 651 adult inpatients with COVID-19 from the Central Hospital of Wuhan between January 2 and February 15, 2020. Data on the demography, comorbidities, clinical manifestations, laboratory findings, treatments, complications, and outcomes (ie, discharged or death) of the participants were extracted from electronic medical records and compared between patients with and without preexisting stroke. The association between risk factors and mortality was estimated using a Cox proportional hazards regression model for stroke patients infected with severe acute respiratory syndrome coronavirus 2. RESULTS: Of the 651 patients with COVID-19, 49 with preexisting stroke tended to be elderly, male, had more underlying comorbidities and greater severity of illness, prolonged length of hospital stay, and greater hospitalization expenses than those without preexisting stroke. Cox regression analysis indicated that the patients with stroke had a higher risk of developing critical pneumonia (adjusted hazard ratio, 2.01 [95% CI, 1.27-3.16]) and subsequent mortality (adjusted hazard ratio, 1.73 [95% CI, 1.00-2.98]) than the patients without stroke. Among the 49 stroke patients, older age and higher score of Glasgow Coma Scale or Sequential Organ Failure Assessment were independent risk factors associated with in-hospital mortality. CONCLUSIONS: Preexisting stroke patients infected with severe acute respiratory syndrome coronavirus 2 were readily predisposed to death, providing an important message to individuals and health care workers that preventive measures must be implemented to protect and reduce transmission in stroke patients in this COVID-19 crisis.


Assuntos
Infecções por Coronavirus/complicações , Infecções por Coronavirus/mortalidade , Pneumonia Viral/complicações , Pneumonia Viral/mortalidade , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/mortalidade , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , China/epidemiologia , Comorbidade , Infecções por Coronavirus/terapia , Progressão da Doença , Registros Eletrônicos de Saúde , Feminino , Escala de Coma de Glasgow , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/epidemiologia , Insuficiência de Múltiplos Órgãos/etiologia , Pandemias , Pneumonia/etiologia , Pneumonia Viral/terapia , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Acidente Vascular Cerebral/terapia , Resultado do Tratamento
15.
Eur Rev Med Pharmacol Sci ; 24(14): 7796-7800, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32744706

RESUMO

The 2019 Novel Coronavirus disease (COVID-19) broke out in Wuhan, China in December 2019 and spread throughout the world. Early screening and early diagnosis play key roles in prevention and management of the epidemic. Attention should also be paid to the infection of health workers and shortage of medical resources in high-risk areas. Here, we report two cases of patients diagnosed with COVID-19 and evaluated by robotic ultrasound based on 5G-powered technology 700 km east of Wuhan. We here show the advantages of this kind of remote ultrasound scan, which could become a method for the diagnosis and assessment of COVID-19.


Assuntos
Infecções por Coronavirus/patologia , Pneumonia Viral/patologia , Robótica , Ultrassonografia/métodos , Adulto , Betacoronavirus/genética , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/complicações , Infecções por Coronavirus/virologia , Feminino , Humanos , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia/diagnóstico , Pneumonia/etiologia , Pneumonia Viral/complicações , Pneumonia Viral/virologia , RNA Viral/metabolismo , Tecnologia de Sensoriamento Remoto
16.
Environ Sci Pollut Res Int ; 27(35): 44540-44551, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32770471

RESUMO

The indoor air pollution (IAP) is one of the leading risk factors of childhood pneumonia in developing countries. This study makes the first attempt to examine the prevalence trend of pneumonia among under-five children in Pakistan in association with IAP-related factors, using bivariate and multivariate statistical methods. Three waves of Pakistan Demographic Health Survey for 2006-2007, 2012-2013, and 2017-2018 were used. Our study findings showed a steady decline in the prevalence of pneumonia synchronized with the decreased use of polluting fuel during the last decade (2006-2017). In bivariate regression, odd ratios of childhood pneumonia were 1.27 and 1.21 times higher in overcrowded houses in 2006-2007 and 2012-2013, respectively, and 1.25 times higher in families relying on biomass for cooking in 2017-2018. In the multivariate model, polluting fuel and overcrowded homes had higher adjusted odd ratios of pneumonia in all survey years, and children age 37-48 months, older mothers, and large birth sized children had lower AOR of pneumonia in 2006-2007 and 2012-2013. Countrywide promotion of IAP mitigation measures such as sponsoring cleaner fuels, separate place for cooking, and lessening home overcrowding may play a vital role in alleviating the prevalence of childhood pneumonia.


Assuntos
Poluição do Ar em Ambientes Fechados , Pneumonia , Poluição do Ar em Ambientes Fechados/análise , Criança , Culinária , Humanos , Paquistão/epidemiologia , Pneumonia/epidemiologia , Pneumonia/etiologia , Prevalência
17.
Intern Emerg Med ; 15(8): 1425-1433, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32840805

RESUMO

The association between coronavirus disease 2019 (COVID-19) pneumonia and venous thrombotic disorders is still unclear. We assessed the association between COVID-19 infection-related pneumonia and proximal deep-vein thrombosis (DVT) in a cohort of patients admitted to our hospital during the European outbreak in the front line of Cremona, Lombardy. In a single-center cross-sectional study, all patients hospitalized for more than 5 days in Internal Medicine Department with confirmed COVID-19 pneumonia received 2-point compressive ultrasound assessment (CUS) of the leg vein system during a single day. Ninety-four percent of patients received enoxaparin as standard pharmacological prophylaxis for venous thromboembolism. The presence of DVT was defined as incompressibility of popliteal or common femoral vein. Out of 121 patients with COVID-19 pneumonia (mean age 71.8, 66.3% males) hospitalized on March 31st, 70 stayed in hospital for over 5 days and 66 of them underwent CUS of deep venous system of the legs. The presence of asymptomatic DVT was found in 9 patients (13.6%). No symptomatic DVT was found. Patients with DVT showed mean age = 75.7 years, mean D-dimer levels = 4.02 ng/ml and all of them received enoxaparin for thromboprophylaxis, except one. Computed tomography pulmonary angiogram confirmed pulmonary embolism in five patients. One every seven patients with COVID-19-related pneumonia, hospitalized for more than 5 days, had asymptomatic proximal DVT and half of them had confirmed PE despite standard pharmacological thromboprophylaxis. This observational study suggests the need of an active surveillance through CUS in patients hospitalized with acute SARS-COV-2 and underline the need of a more intense thromboprophylaxis.


Assuntos
Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Pneumonia/etiologia , Trombose Venosa/etiologia , Idoso , Idoso de 80 Anos ou mais , Doenças Assintomáticas/epidemiologia , Infecções por Coronavirus/epidemiologia , Estudos Transversais , Feminino , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia/epidemiologia , Pneumonia Viral/epidemiologia , Prevalência , Tomografia Computadorizada por Raios X/métodos , Ultrassonografia/métodos , Trombose Venosa/epidemiologia , Trombose Venosa/fisiopatologia
18.
N Engl J Med ; 383(7): 617-629, 2020 08 13.
Artigo em Inglês | MEDLINE | ID: mdl-32786187

RESUMO

BACKGROUND: Older patients with acute myeloid leukemia (AML) have a dismal prognosis, even after treatment with a hypomethylating agent. Azacitidine added to venetoclax had promising efficacy in a previous phase 1b study. METHODS: We randomly assigned previously untreated patients with confirmed AML who were ineligible for standard induction therapy because of coexisting conditions, because they were 75 years of age or older, or both to azacitidine plus either venetoclax or placebo. All patients received a standard dose of azacitidine (75 mg per square meter of body-surface area subcutaneously or intravenously on days 1 through 7 every 28-day cycle); venetoclax (target dose, 400 mg) or matching placebo was administered orally, once daily, in 28-day cycles. The primary end point was overall survival. RESULTS: The intention-to-treat population included 431 patients (286 in the azacitidine-venetoclax group and 145 in the azacitidine-placebo [control] group). The median age was 76 years in both groups (range, 49 to 91). At a median follow-up of 20.5 months, the median overall survival was 14.7 months in the azacitidine-venetoclax group and 9.6 months in the control group (hazard ratio for death, 0.66; 95% confidence interval, 0.52 to 0.85; P<0.001). The incidence of complete remission was higher with azacitidine-venetoclax than with the control regimen (36.7% vs. 17.9%; P<0.001), as was the composite complete remission (complete remission or complete remission with incomplete hematologic recovery) (66.4% vs. 28.3%; P<0.001). Key adverse events included nausea of any grade (in 44% of the patients in the azacitidine-venetoclax group and 35% of those in the control group) and grade 3 or higher thrombocytopenia (in 45% and 38%, respectively), neutropenia (in 42% and 28%), and febrile neutropenia (in 42% and 19%). Infections of any grade occurred in 85% of the patients in the azacitidine-venetoclax group and 67% of those in the control group, and serious adverse events occurred in 83% and 73%, respectively. CONCLUSIONS: In previously untreated patients who were ineligible for intensive chemotherapy, overall survival was longer and the incidence of remission was higher among patients who received azacitidine plus venetoclax than among those who received azacitidine alone. The incidence of febrile neutropenia was higher in the venetoclax-azacitidine group than in the control group. (Funded by AbbVie and Genentech; VIALE-A ClinicalTrials.gov number, NCT02993523.).


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Azacitidina/administração & dosagem , Compostos Bicíclicos Heterocíclicos com Pontes/administração & dosagem , Leucemia Mieloide Aguda/tratamento farmacológico , Sulfonamidas/administração & dosagem , Idoso , Idoso de 80 Anos ou mais , Azacitidina/efeitos adversos , Compostos Bicíclicos Heterocíclicos com Pontes/efeitos adversos , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Análise de Intenção de Tratamento , Estimativa de Kaplan-Meier , Leucemia Mieloide Aguda/mortalidade , Leucopenia/induzido quimicamente , Masculino , Pessoa de Meia-Idade , Pneumonia/etiologia , Recidiva , Indução de Remissão , Sulfonamidas/efeitos adversos , Trombocitopenia/induzido quimicamente
19.
Int J Med Sci ; 17(13): 1909-1915, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32788869

RESUMO

Objective: To retrospectively compare the clinical features and chest computed tomography (CT) characteristics of coronavirus disease 2019 (COVID-19) and pneumonia in lymphoma patients. Materials and Methods: Ten lymphoma patients with pneumonia and 12 patients with COVID-19 infections were enrolled from January 15 to March 14, 2020. The clinical features were recorded. All pulmonary lesions on chest CT were assessed for location, shape, density and diffusion degree. Other typical CT features were also evaluated. Results: The most commonly observed patchy lesions were ground-glass opacities (GGOs) and mixed GGOs in both groups. Regarding the diffusion degree, 82% (92/112) of the lesions in the COVID-19 group were relatively limited, while 69% (52/75) of those in the lymphoma group were diffuse (p < 0.001). The proportions of interlobular septal thickening, vascular thickening, pleural involvement and fibrous stripes observed in the lymphoma cases were statistically compatible with those observed in the COVID-19 cases (p > 0.05). Air bronchograms were observed more frequently in COVID-19 patients (45%, 50/112) than in lymphoma patients with pneumonia (5%, 4/75) (p < 0.001). Halo sign (6%) and reversed halo sign (1%) were observed in several COVID-19 patients but not in lymphoma-associated pneumonia patients. Conclusion: Both lymphoma-associated pneumonia and COVID-19 generally manifested as patchy GGOs and mixed GGOs in more than one lobe. Compared to COVID-19, lymphoma-associated pneumonia tended to be relatively diffuse, with fewer air bronchograms, and no halo or reversed halo signs observed on chest CT.


Assuntos
Infecções por Coronavirus/diagnóstico por imagem , Pneumonia Viral/diagnóstico por imagem , Pneumonia/diagnóstico por imagem , Adulto , Idoso , Feminino , Humanos , Pulmão/diagnóstico por imagem , Pulmão/patologia , Pulmão/virologia , Linfoma/complicações , Masculino , Pessoa de Meia-Idade , Pandemias , Pleura/diagnóstico por imagem , Pneumonia/etiologia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
20.
Pneumologie ; 74(10): 678-683, 2020 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-32643764

RESUMO

Chronic granulomatous disease (CGD) should be considered as a differential diagnosis in children and adolescents with frequent infections, especially when caused by certain specific pathogens.This case report describes a 64-year-old female with multiple recurrent and complicated bronchopulmonary infections, caused by common, but also rare pathogens, autoimmune phenomena, malignancies and recurrent organizing pneumonia (OP) with granulomas. Finally, the patient was diagnosed with p47phox-deficient chronic granulomatous disease (CGD).Individuals with a primary immunodeficiency may survive multiple complications and may be diagnosed at an advanced age especially if the affected structure shows residual activity. When confronted with patients with recurrent bronchopulmonary infections, especially with certain specific rare pathogens, in combination with organizing pulmonary granulomas as well as autoimmune phenomena, CGD should be considered even in elderly patients. Delayed diagnosis significantly increases mortality and morbidity in such cases.


Assuntos
Doença Granulomatosa Crônica/diagnóstico , Pneumonia/diagnóstico , Diagnóstico Diferencial , Feminino , Doença Granulomatosa Crônica/complicações , Humanos , Infecções , Pessoa de Meia-Idade , Pneumonia/etiologia
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