Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 64.312
Curr Probl Cardiol ; 48(1): 101428, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36191693


Transcutaneous aortic valve implantation (TAVI) has transformed the management of aortic stenosis (AS) and is increasingly being used for patients with symptomatic, severe aortic stenosis who are ineligible or at high risk for conventional cardiac surgery. PUBMED, Google Scholar, and SCOPUS databases were searched to identify studies reporting heart failure hospitalization after TAVI. Major factors evaluated for HF hospitalization were age, comorbidities such as hypertension, atrial fibrillation (AF), chronic pulmonary disease including COPD, chronic kidney disease, baseline LVEF before the procedure, NYHA symptom class, and society of thoracic surgeons (STS) score. Hazard ratio (HR) with a 95% confidence interval were computed using random-effects models. A total of eight studies were included comprising 77,745 patients who underwent TAVI for severe aortic stenosis. The presence of diabetes mellitus (HR: 1.39, 95% CI [1.17, 1.66], chronic kidney disease (CKD) (HR: 1.39, 95% CI [1.31, 1.48], atrial fibrillation (HR: 1.69, 95% CI [1.42, 2.01], chronic pulmonary disease (HR: 1.33, 95% CI [1.12, 1.58], and a high STS score (HR: 1.07, 95% CI [1.03, 1.11] were positive predictors of 1-year HF hospitalization after TAVI. Patients with diabetes mellitus, AF, CKD, chronic pulmonary disease, and a high STS score are at an increased risk of heart failure hospitalization at 1-year of TAVI, whereas increasing age, hypertension, LVEF <50%, and NYHA class III/IV symptoms did not predict HF hospitalization. Careful follow-up after TAVI in high-risk patients, with closer surveillance for HF particularly, is key to preventing HF hospitalizations and death.

Estenose da Valva Aórtica , Fibrilação Atrial , Insuficiência Cardíaca , Hipertensão , Pneumopatias , Insuficiência Renal Crônica , Substituição da Valva Aórtica Transcateter , Humanos , Valva Aórtica/cirurgia , Substituição da Valva Aórtica Transcateter/efeitos adversos , Fibrilação Atrial/cirurgia , Readmissão do Paciente , Fatores de Risco , Estenose da Valva Aórtica/diagnóstico , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/diagnóstico , Pneumopatias/etiologia , Pneumopatias/cirurgia , Resultado do Tratamento
J Infect Chemother ; 29(1): 82-86, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36162647


An 81-year-old man was admitted to our hospital because of fever and malaise that had persisted for 3 months. The patient had undergone two aortic valve replacements, 10 and 5 years previously, because of aortic valve regurgitation and infectious endocarditis. He also had had asymptomatic Mycobacterium abscessus complex (MABC) pulmonary disease for the two previous years. Contrast-enhanced computed tomography showed a mediastinal abscess and an ascending aortic aneurysm. Mycobacterium abscessus subsp. massiliense was cultured from his blood, suggesting the aortic aneurysm was secondary to infection of an implanted device. After enlargement over only a few days, a leakage of contrast medium to the mediastinal abscess was found on computed tomography. The patient was diagnosed with rupture of an infectious aortic aneurysm, and emergency aortic replacement and drainage of the mediastinal abscess were successful. The patient was treated with several antibiotics, including meropenem, amikacin, and clarithromycin, and his general condition improved. Cultures from both the mediastinal abscess and a pericardial patch that was placed at the time of surgery 5 years previously revealed MABC. In our case, the infected aortic aneurysm most likely resulted from MABC pulmonary disease rather than from previous intraoperative contamination. This route of infection is rare. Physicians should be aware of the possibility of dissemination and subsequent infection of implants related to MABC pulmonary disease.

Aneurisma Aórtico , Pneumopatias , Infecções por Mycobacterium não Tuberculosas , Mycobacterium abscessus , Masculino , Humanos , Idoso de 80 Anos ou mais , Infecções por Mycobacterium não Tuberculosas/diagnóstico , Infecções por Mycobacterium não Tuberculosas/tratamento farmacológico , Infecções por Mycobacterium não Tuberculosas/microbiologia , Abscesso , Claritromicina/uso terapêutico , Antibacterianos/uso terapêutico , Pneumopatias/microbiologia , Testes de Sensibilidade Microbiana
Phytomedicine ; 108: 154475, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36252465


BACKGROUND: Opioids are widely used in clinical practice. However, their long-term administration causes respiratory depression, addiction, tolerance, and severe immunosuppression. Traditional Chinese medicine (TCM) can alleviate opioid-induced adverse effects. Compound 511 is particularly developed for treating opioid addiction, based on Jiumi Liangfang, an ancient Chinese drug treatment and rehabilitation monograph completed in 1833 A.D. It is an herbal formula containing eight plants, each of them contributing to the overall pharmacological effect of the product: Panax ginseng C. A. Meyer (8.8%), Astragalus membranaceus (Fisch.) (18.2%), Datura metel Linn. (10.95%), Corydalis yanhusuo W. T. Wang (14.6%), Acanthopanar gracilistµlus W. W. Smith (10.95%), Ophiopogon japonicus (Linn. f.) Ker-Gawl. (10.95%), Gynostemma pentaphyllum (Thunb.) Makino (10.95%), Polygala arvensis Willd. (14.6%). This formula effectively ameliorates opioid-induced immunosuppression. However, the underlying mechanism remains unclear. PURPOSE: To reveal the effects of Compound 511 on the immune response of morphine-induced immunosuppressive mice and their potential underlying molecular mechanism. This study provides information for a better clinical approach and scientific use of opioids. METHODS: Immunosuppression was induced in mice by repeated morphine administration. Th1/Th2/Th17/Treg cell levels were measured using flow cytometry. Splenic transcription factors of Th1/Th2/Th17/Treg and outputs of the regulatory PI3K/AKT/mTOR signaling pathway were determined. Subsequently, methicillin-resistant Staphylococcus aureus (MRSA) was administered intranasally to morphine-induced immunosuppressive mice pretreated with Compound 511. Their lung inflammatory status was assessed using micro-computer tomography (CT), hematoxylin and eosin (H&E) staining, and enzyme-linked immunosorbent assay (ELISA). RESULTS: Compared to morphine, Compound 511 significantly decreased the immune organ indexes of mice, corrected the Th1/Th2 and Treg/Th17 imbalance in the immune organs and peripheral blood, reduced the mRNA levels of FOXP3 and GATA3, and increased those of STAT3 and T-bet in the spleen. It improved immune function and reduced MRSA-induced lung inflammation. CONCLUSION: Compound 511 ameliorates opioid-induced immunosuppression by regulating the balance of Th1/Th2 and Th17/Treg via PI3K/AKT/mTOR signaling pathway. Thus, it effectively reduces susceptibility of morphine-induced immunosuppressive mice to MRSA infection.

Medicamentos de Ervas Chinesas , Pneumopatias , Staphylococcus aureus Resistente à Meticilina , Infecções Estafilocócicas , Animais , Camundongos , Analgésicos Opioides/farmacologia , Terapia de Imunossupressão , Morfina/farmacologia , Morfina/metabolismo , Fosfatidilinositol 3-Quinases/metabolismo , Proteínas Proto-Oncogênicas c-akt/metabolismo , Linfócitos T Reguladores , Células Th17 , Serina-Treonina Quinases TOR/metabolismo , Pneumopatias/tratamento farmacológico , Pneumopatias/microbiologia , Infecções Estafilocócicas/tratamento farmacológico , Medicamentos de Ervas Chinesas/uso terapêutico
rev.cuid. (Bucaramanga.2010) ; 13(1): 1-13, 20221213.
Artigo em Espanhol | LILACS, BDENF - Enfermagem, COLNAL | ID: biblio-1369074


Introducción. El tratamiento farmacológico de la EPOC se realiza progresiva y escalonadamente de acuerdo a la gravedad y puede ser modificado en función de la respuesta al mismo, por lo cual se han desarrollado instrumentos con el fin de evaluar la satisfacción del paciente con los distintos sistemas de inhalación; sin embargo, estos instrumentos han sido diseñados en su mayoría para pacientes con Asma. Objetivo. Validar el instrumento FSI-10 y determinar el nivel de satisfacción de los dispositivos de inhaloterapia en pacientes con EPOC. Materiales y métodos. Estudio transversal prospectivo y de validación de contenido, muestreo probabilístico estratificado con afijación proporcional; población de 337 pacientes con diagnóstico EPOC de la provincia Centro del departamento de Boyacá, Colombia. Se evaluó el cuestionario FSI-10 mediante la prueba de esfericidad de Bartlett, Kaiser-Meyer-Olkin y alfa de Cronbach. Resultados. La prueba de esfericidad resultó estadísticamente significativa, sugiriendo la existencia de correlaciones dentro de la matriz de diez preguntas. La variación total explicable de las diez preguntas que corresponden a la versión del FSI 10 dio cuenta del 81 % de variabilidad. Los pacientes evaluados reportaron un nivel de satisfacción entre bastante a algo con los dispositivos de inhaloterapia. Conclusiones. Las propiedades psicométricas permiten su utilización en la satisfacción del paciente con dispositivos de medicación inhalada, sin presentar diferencias en la comprensión y teniendo resultado fiables. La satisfacción con los dispositivos de inhaloterapia no es muy alta en la mayoría de la población evaluada.

Introduction: COPD pharmacological treatment is progressively staggered according to severity, which can be modified based on its response. Therefore, instruments have been developed to assess patient satisfaction with different inhaler devices. However, these instruments have been designed mostly for patients with asthma. Objective: To validate the FSI-10 instrument and assess the degree of satisfaction with inhaler devices in COPD patients. Materials and Methods: A prospective cross-sectional study for content validation and stratified probability sampling with proportional allocation was conducted with 337 COPD patients in the Central province of the department of Boyacá, Colombia. The FSI-10 questionnaire was assessed using Bartlett's test of sphericity, Kaiser-Meyer-Olkin test and Cronbach's alpha. Results: The test of sphericity was statistically significant, suggesting the presence of a correlation within the ten-question test. Total explained variation of the FSI-10 questions accounted for 81% of the variation. Assessed patients reported a degree of satisfaction between fair to good with the use of inhaler devices. Conclusions: FSI-10 psychometric properties enable its use in assessing patient satisfaction with inhaler devices with no difference in understanding and reliability results. Satisfaction with inhaler devices is not very high among the majority of the population assessed.

Introdução. O tratamento farmacológico da DPOC é progressivo e escalonado de acordo com a gravidade e pode ser modificado de acordo com a resposta ao tratamento, por isso, foram desenvolvidos instrumentos para avaliar a satisfação do paciente com diferentes sistemas de inalação; no enta nto, esses instrumentos foram elaborados principalmente para pacientes com asma. Objetivo. Validar o instrumento FSI-10 e determinar o nível de satisfação com os dispositivos de inaloterapia em pacientes com DPOC. Materiais e métodos. Estudo transversal prospectivo e de validação de conteúdo, amostragem probabilística estratificada com alocação proporcional; população de 337 pacientes diagnosticados com DPOC na província central do departamento de Boyacá, Colômbia. O questionário FSI-10 foi avaliado usando o teste de esfericidade de Bartlett, Kaiser-Meyer-Olkin e o alfa de Cronbach. Resultados. O teste de esfericidade foi estatisticamente significativo, sugerindo a existência de correlações dentro da matriz de dez perguntas. A variação total explicável das dez perguntas correspondentes à versão FSI 10 foi responsável por 81 % da variabilidade. Os pacientes avaliados relataram um nível de satisfação entre bastante e moderada com os dispositivos de inaloterapia. Conclusões. As propriedades psicométricas permitem seu uso na satisfação do paciente com dispositivos de medicamentos inalados, sem diferenças na compreensão e resultados confiáveis. A satisfação com os dispositivos de inaloterapia não é muito alta na maioria da população avaliada.

Humanos , Masculino , Feminino , Reprodutibilidade dos Testes , Pneumopatias
Medicine (Baltimore) ; 101(47): e32075, 2022 Nov 25.
Artigo em Inglês | MEDLINE | ID: mdl-36451482


RATIONALE: IgG4-related lung disease (IgG4-RLD) is an unusual disease, with various clinical manifestations and various chest imaging findings. The patients may have no respiratory symptoms. Therefore, diagnosis is challenging. This can easily cause misdiagnosis and mistreatment. PATIENT CONCERNS: A 71-year-old male presented with chest pain, cough, and shortness of breath. Plain chest computed tomography scans showed multi-locus nodes at the center of the hilum. DIAGNOSIS: Percutaneous lung biopsy was performed, and IgG4-RLD was diagnosed. INTERVENTIONS: Prednisone was orally administered daily. OUTCOMES: The case's symptoms improved. The patient was discharged from the hospital. After 2 months of reexamination, his symptoms were relieved. Reexamination of the chest computed tomography showed that multi-locus nodes of the lung were obviously absorbed compared with those before. LESSONS: IgG4-RLD is a rare respiratory disease. It has atypical clinical manifestations and chest images. We report the first case of IgG4-RLD showing multi-locus nodes centered on the hilar, hypertrophic mucosa; as well as a narrow and even occluded lumen.

Doença Relacionada a Imunoglobulina G4 , Pneumopatias , Masculino , Humanos , Idoso , Tórax , Doença Relacionada a Imunoglobulina G4/diagnóstico , Pulmão/diagnóstico por imagem , Pneumopatias/diagnóstico , Imunoglobulina G
Fisioterapia (Madr., Ed. impr.) ; 44(6): 327-335, nov. - dic. 2022. tab
Artigo em Espanhol | IBECS | ID: ibc-ADZ-1056


Introducción: Las enfermedades pulmonares restrictivas presentan alteraciones en la mecánica toracopulmonar, reducción de la capacidad funcional y de la función pulmonar. Se pueden encontrar las alteraciones intrínsecas y extrínsecas donde se ven alterados el intersticio, la expansibilidad torácica e incluso afecciones del parénquima pulmonar. La rehabilitación pulmonar podría beneficiar a pacientes con la condición restrictiva y mejorar su condición funcional. Objetivo Establecer el impacto de la rehabilitación pulmonar en pacientes con compromiso respiratorio restrictivo intrínseco y extrínseco en la disnea, capacidad funcional, ansiedad/depresión y calidad de vida relacionada con la salud. Métodos Estudio descriptivo longitudinal con 50 pacientes con enfermedad pulmonar restrictiva y quienes realizaron rehabilitación pulmonar en una clínica de la ciudad de Cali, Colombia. Los participantes vinculados al estudio fueron separados en dos grupos: el primero con enfermedad restrictiva intrapulmonar (ERI) y el segundo grupo con enfermedad restrictiva extrapulmonar (ERE). Resultados La edad media de los pacientes fue de 53,3años. Entre las enfermedades restrictivas intrapulmonares se presentaron: enfermedad intersticial pulmonar difusa (EPID), postcondición de neumonías o síndrome de dificultad respiratoria aguda (SDRA) y secuelas de tuberculosis pulmonar. Y entre las enfermedades respiratorias extrapulmonares: resección pulmonar, resección de lóbulo pulmonar y resección en cuña. Al finalizar la rehabilitación pulmonar el grupo ERI presentó mejorías estadísticamente significativas en la distancia recorrida, consumo de oxígeno estimado (VO2e), disnea, ansiedad y calidad de vida. El grupo ERE presentó incremento significativo en la distancia recorrida y VO2e (AU)

Introduction: Restrictive lung diseases present alterations in thoracic-pulmonary mechanics, reduced functional capacity and lung function. Intrinsic and extrinsic alterations can be found where the interstitium, thoracic expandability and even lung parenchymal conditions are altered. Pulmonary rehabilitation could benefit patients with the restrictive condition and improve their functional condition. Objective Establish the impact of pulmonary rehabilitation in patients with intrinsic and extrinsic restrictive respiratory compromise on dyspnea, functional capacity, anxiety/depression and health-related quality of life. Methods Longitudinal descriptive study with 50 patients with restrictive lung disease who performed pulmonary rehabilitation in a clinic in the city of Cali, Colombia. The participants linked to the study were separated into two groups, the first with intrapulmonary restrictive disease (IRD) and the second group with extrapulmonary restrictive disease (ERD). Results The mean age of the patients was 53.3years. Among the restrictive intrapulmonary diseases there were: diffuse interstitial lung disease (ILD), post-condition pneumonia and/or acute respiratory distress syndrome (ARDS) and sequelae of pulmonary tuberculosis. Extrapulmonary respiratory diseases: lung resection, pulmonary lobe resection, and wedge resection. At the end of pulmonary rehabilitation, the IRD group presented statistically significant improvements in distance covered, estimated oxygen consumption (VO2e), dyspnea, anxiety, and quality of life. The ERD group presented a significant increase in the distance traveled and VO2e. Conclusion Patients with restrictive lung disease improve the distance traveled, VO2e, dyspnea, anxiety and quality of life; patients with extrapulmonary respiratory disease show improvements in functional capacity (AU)

Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Pneumopatias/reabilitação , Dispneia/reabilitação , Qualidade de Vida , Tolerância ao Exercício , Exercícios Respiratórios/métodos , Estudos Longitudinais
Age Ageing ; 51(11)2022 Nov 02.
Artigo em Inglês | MEDLINE | ID: mdl-36413587


OBJECTIVE: to examine the association between different patterns of impaired lung function with the incident risk of dementia and magnetic resonance imaging (MRI)-based brain structural features. METHODS: in UK Biobank, a total of 308,534 dementia-free participants with valid lung function measures (forced expiratory volume in 1 s [FEV1] and forced vital capacity [FVC]) were included. Association was assessed using Cox proportional hazards regression model. Furthermore, the association between impaired lung function and brain MRI biomarkers related to cognitive function was analysed among 30,159 participants. RESULTS: during a median follow-up of 12.6 years, 3,607 incident all-cause dementia cases were recorded. Restrictive impairment (hazard ratio [HR], 1.42; 95% confidence interval [CI], 1.27-1.60) and obstructive impairment (HR, 1.28; 95% CI, 1.15-1.42) were associated with higher risk of all-cause dementia. The restricted cubic splines indicated FEV1% predicted and FVC % predicted had reversed J-shaped associations with dementia. Participants with impaired lung function have higher risks of all-cause dementia across all apolipoprotein E (APOE) risk categories, whereas associations were stronger among those of low APOE risk (P for interaction = 0.034). In addition, restrictive and obstructive impairment were linked to lower total (ß: -0.075, SE: 0.021, Pfdr = 0.002; ß: -0.033, SE: 0.017, Pfdr = 0.069) and frontoparietal grey matter volumes, higher white matter hyperintensity, poorer white matter integrity, lower hippocampus (ß: -0.066, SE: 0.024, Pfdr = 0.017; ß: -0.051, SE: 0.019, Pfdr = 0.019) and other subcortical volumes. CONCLUSIONS: participants with restrictive and obstructive impairments had a higher risk of dementia. Brain MRI indices further supported adverse effects and provided insight into potential pathophysiology biomarkers.

Encéfalo , Pneumopatias , Humanos , Estudos Longitudinais , Encéfalo/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Pulmão/diagnóstico por imagem , Apolipoproteínas E , Biomarcadores
JBI Evid Implement ; 20(4): 301-312, 2022 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-36378109


OBJECTIVES: The aim of this project was to promote evidence-based practice in the prevention and management of pressure injury in lung disease patients. INTRODUCTION: Pressure injury is a crucial quality indicator for hospital care of patients. The pressure injury incidence threshold in the chest wards has been exceeding that of the general ward (0.128%), which may extend patients' hospital stay. METHODS: Clinical audits were performed using the JBI Practical Application of Clinical Evidence System and Getting Research into Practice (GRiP) audit and feedback tool. Twelve audit criteria representing best practice recommendations for preventing and managing pressure injury among lung disease patients were used. A baseline audit was performed to measure the degree of consistency between existing practice and best practice. This project used the GRiP analysis and multiple strategies to develop care protocols for pressure injury prevention and management. A follow-up audit was conducted to measure changes in clinical practice and pressure injury incidence. RESULTS: Postimplementation audit compliance rates improved for the following criteria: skin assessment for identifying pressure injury indications (from 31 to 81%), identification of pressure injury risk score/category (from 19 to 88%), employment of nutritional assessment tools (from 8 to 93%), and provision of information regarding oral nutritional supplements (from 23 to 84%). Furthermore, patients learning the pressure injury care protocols (from 48 to 93%), the receipt of additional skin protection measures, and repositioning of vulnerable areas to relieve pressure increased to 100 and 93%, respectively. After project implementation, the monthly pressure injury incidence decreased markedly from 0.075 to 0.021%. CONCLUSION: The success factors of this project are attributable to leadership, open communication, multiple learning-by-doing strategies, regular audits, and the promotion of patient and family engagement.

Prática Clínica Baseada em Evidências , Pneumopatias , Humanos , Centros de Atenção Terciária , Avaliação Nutricional
BMC Pulm Med ; 22(1): 425, 2022 Nov 18.
Artigo em Inglês | MEDLINE | ID: mdl-36401235


PURPOSE: This national study aimed to investigate the lung ultrasound (LUS) training and practice of respiratory therapists (RTs) in mainland China. METHODS: A cross-sectional multicenter survey was conducted from May 22, 2021 to August 12, 2021, through online platforms. This survey included RTs in mainland China. The survey was divided into four sections: (1) demographic characteristics and basic information; (2) basic information about LUS training and practice; (3) LUS practice details; and (4) Other ultrasound training and practice. RESULTS: A total of 514 responses were received, and 494 valid responses were included in the analysis. 81.2% (401/494) participants' highest degree of education was a bachelor's degree, and 43.1% (213/494) participants were at level II in terms of job ranking. 99.2%(490/494) participants agreed that the RTs needed to learn lung ultrasound, but only 12.3% (61/494) participants had received a LUS training course. Further, 66.2% (327/494) experienced participants responded to Sect. 3. Most of RTs used LUS when the patient had hypoxia (265/327, 81%) or dyspnea (260/317, 79.5%); they also used it during spontaneous breathing trial(SBT) (191/327, 58.4%) or in prone position (177/327, 54.1%). The A-line (302/327, 92.4%), B-line (299/327, 91.4%), lung slide (263/327, 80.4%), and bat sign (259/327, 79.2%) were well known as LUS signs. Also, 30.6% (100/327) participants did not use the LUS protocol in their clinical practice, and only 25.4%(83/327) participants said they had used LUS scores. Moreover, 55.7% (182/327) participants frequently changed the respiratory therapy strategy according to LUS results. CONCLUSIONS: We should improve the number and workplace of RTs in mainland China in the future. We should also standardize the application of LUS practice and training for RTs in mainland China and establish corresponding certification pathways.

Pneumopatias , Pulmão , Humanos , Estudos Transversais , Ultrassonografia/métodos , Pulmão/diagnóstico por imagem , Terapia Respiratória
Arch Iran Med ; 25(7): 450-455, 2022 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-36404512


Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) continues to be a worldwide healthcare problem. While our knowledge of the interaction of cancer and its management with COVID-19 mortality is gradually evolving, there are still many unanswered questions regarding the impact of COVID-19 on cancer and its prognosis. Several factors activated during COVID-19 have been implicated in tumorigenesis and the development of metastasis. Inflammation, hypoxia, reduced levels of angiotensin converting enzyme 2, elevated levels of Interleukin 6 and some other cytokines that are hallmarks of COVID-19 are capable of inducing tumor relapse and metastasis. On the other hand, there are reports that COVID-19 has been associated with cancer cure. Understanding the interaction between COVID-19 and tumor cells is essential for evaluating the potential long-term risks of COVID-19 in cancer patients, and for scheduling necessary preventive and therapeutic interventions. In this review, we briefly overview the potential impacts that COVID-19 might have on tumorigenesis and cancer relapse, as well as the role that COVID-19 might play in cancer remission and cure.

COVID-19 , Pneumopatias , Humanos , SARS-CoV-2 , Recidiva , Carcinogênese
Rev Med Suisse ; 18(805): 2206-2212, 2022 Nov 23.
Artigo em Francês | MEDLINE | ID: mdl-36416507


Macrolides are commonly used antibiotics due to their broad spectrum of activity and good bioavailability. More recently, they have been shown to be effective in certain chronic lung diseases by reducing exacerbation frequency. This narrative review examines the scientific evidence and international recommendation for immunomodulatory macrolides therapy in the most frequent chronic respiratory disorders.

Les macrolides sont des antibiotiques couramment utilisés dans notre pratique en raison d'un spectre d'activité large et d'une bonne biodisponibilité. Plus récemment, ils se sont avérés efficaces pour diminuer la fréquence des exacerbations de certaines pneumopathies chroniques. Cette revue narrative revoit l'évidence scientifique et les recommandations internationales concernant les indications des macrolides à dose immunomodulatrice dans les maladies respiratoires chroniques fréquemment rencontrées par l'interniste et le généraliste.

Pneumopatias , Macrolídeos , Humanos , Macrolídeos/uso terapêutico , Pneumopatias/tratamento farmacológico , Antibacterianos/uso terapêutico
Front Public Health ; 10: 1005721, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36388340


Background: Coal dust is a major risk factor for the occupational health of coal miners, and underground workers with coal mine dust lung disease (Coal miners with coal mine dust lung disease (CMDLD) may have a higher risk of developing Nodular thyroid disease (NTD). The aim of this study was to investigate the relationship between coal mine dust lung disease and the development of Nodular thyroid disease in coal miners. Methods: This was a clinical retrospective observational study that included 955 male coal miners from 31 different coal mining companies in Huainan, Anhui Province, China, who were examined in April 2021 at the Huainan Occupational Disease Prevention and Control Hospital to collect all their clinical physical examination data, including general conditions, laboratory test indices and imaging indices. Based on the presence or absence of Nodular thyroid disease, 429 cases with Nodular thyroid disease were classified as the diseased group and 526 cases without Nodular thyroid disease were classified as the control group. Logistic regression was used to analyse the correlation between the occurrence of Nodular thyroid disease in coal miners, and further single- and multi-factor logistic regression was used to screen the risk exposure factors for Nodular thyroid disease in coal miners. Results: Age, coal mine dust lung disease (CMDLD), red blood cells (RBC), mean red blood cell volume (MCV), albumin (ALB), albumin/globulin (A/G), indirect bilirubin (IBIL), globulin (GLOB), total bilirubin (TBil) and myeloperoxidase (MPO) were associated with the development of Nodular thyroid disease in coal miners (p < 0.05) The results of univariate and multifactorial logistic regression analysis showed that CMDLD (OR:4.5,95%CI:2.79-7.51) had the highest OR and CMDLD was the strongest independent risk exposure factor for the development of Nodular thyroid disease in coal miners. Conclusions: There is a strong correlation between coal mine dust lung disease and Nodular thyroid disease in underground coal miners, and clinicians need to be highly aware of the high risk of NTD in coal miners with CMDLD and adopt individualized clinical prevention strategies.

Doenças Transmissíveis , Pneumopatias , Doenças da Glândula Tireoide , Masculino , Humanos , Poeira , Carvão Mineral , Pneumopatias/epidemiologia , Doenças da Glândula Tireoide/epidemiologia , Mitoxantrona , Bilirrubina , Albuminas
Front Public Health ; 10: 1015876, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36388361


Pulmonary function testing (PFT) has important clinical value for the early detection of lung diseases, assessment of the disease severity, causes identification of dyspnea, and monitoring of critical patients. However, traditional PFT can only be carried out in a hospital environment, and it is challenging to meet the needs for daily and frequent evaluation of chronic respiratory diseases. In this study, we propose a novel method for accurately assessing pulmonary function by analyzing recorded forced cough sounds by mobile device without time and location restrictions. In the experiment, 309 clips of cough sound segments were separated from 133 patients who underwent PFT by using Audacity software. There are 247 clips of training samples and 62 clips of testing samples. Totally 52 features were extracted from the dataset, and principal component analysis (PCA) was used for feature reduction. Combined with biological attributes, the normalized features were regressed by using machine learning models with pulmonary function parameters (i.e., FEV1, FVC, FEV1/FVC, FEV1%, and FVC%). And a 5-fold cross-validation was applied to evaluate the performance of the regression models. As described in the experimental result, the result of coefficient of determination (R2) indicates that the support vector regression (SVR) model performed best in assessing FVC (0.84), FEV1% (0.61), and FVC% (0.62) among these models. The gradient boosting regression (GBR) model performs best in evaluating FEV1 (0.86) and FEV1/FVC (0.54). The result confirmed that the proposed method was capable of accurately assessing pulmonary function with forced cough sound. Besides, the cough sound sampling by a smartphone made it possible to conduct sampling and assess pulmonary function frequently in the home environment.

Tosse , Pneumopatias , Humanos , Tosse/diagnóstico , Pulmão , Testes de Função Respiratória , Pneumopatias/diagnóstico , Aprendizado de Máquina
Eur Rev Med Pharmacol Sci ; 26(21): 8064-8072, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36394726


OBJECTIVE: Pulmonary actinomycosis is a rare and chronic infectious disease that mimics malignancy and is frequently misdiagnosed. There are few reports that address the clinical characteristics of pulmonary actinomycosis. The objective of this research is to evaluate the clinical features, radiological findings, diagnostic approaches and treatment outcomes of pulmonary actinomycosis. PATIENTS AND METHODS: Thirty-seven patients with pulmonary actinomycosis histopathologically diagnosed from 2009 to 2021 were analyzed retrospectively. RESULTS: The mean age at presentation was 53.7 (±13.3) years. Frequent symptoms were cough and hemoptysis. The median diagnosis time from the first symptoms was 60 days (interquartile range 18-195). Pulmonary comorbidity was found in 59.5% of cases. The most common thorax computed tomography finding was mass or nodule. The low-attenuation center within the mass or consolidation was observed in 40% of the lesions. The median maximal standardized uptake value of lesions on positron emission tomography (PET) was 6.5 (interquartile range 2.7-10.3). In the majority of cases (97.3%), the diagnosis of pulmonary actinomycosis was not suspected at admission, and 56.8% of patients were misdiagnosed with lung cancer. The mean duration of antibiotic therapy was 9.4 days (range 3-22) with intravenous antibiotics and 64.7 days (range 5-270) with oral antibiotics. Four patients died due to concomitant comorbidities. Eight cases were lost to follow-up. All other cases were fully cured. CONCLUSIONS: Pulmonary actinomycosis mimics other diseases, often lung cancer. Clinicians should consider the diagnosis of actinomycosis when they detect a mass or consolidation, especially with a low-attenuation center. PET/CT appears not to be useful for differential diagnosis. A shorter course of antibiotic therapy than traditionally recommended appears to be sufficient.

Actinomicose , Pneumopatias , Neoplasias Pulmonares , Humanos , Adulto , Pessoa de Meia-Idade , Idoso , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Estudos Retrospectivos , Actinomicose/diagnóstico , Actinomicose/tratamento farmacológico , Actinomicose/complicações , Pneumopatias/diagnóstico , Pneumopatias/tratamento farmacológico , Neoplasias Pulmonares/tratamento farmacológico , Resultado do Tratamento , Antibacterianos/uso terapêutico
Medicine (Baltimore) ; 101(45): e31684, 2022 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-36397414


BACKGROUND: Postoperative pain after open thoracotomy is known to be very severe and affects sleep quality. This study aimed to investigate the effects of a programmed intermittent epidural bolus injection versus continuous epidural injection for controlling nighttime pain and improving sleep quality after thoracotomy. METHODS: Seventy-six patients scheduled for open thoracotomy for lung cancer or other lung diseases were enrolled. The participants were divided into 2 groups. Group A was continuously injected with 0.2% levobupivacaine at 1.1 mL/h, and group B was injected intermittently with 3 mL 0.2% levobupivacaine at 3 hours intervals through a thoracic epidural catheter via a programmed infusion pump. Within 48 hours after surgery, the degree of pain control using visual analog scale and the patients' sleep conditions on postoperative day (POD) 0 and 1 were evaluated, and other adverse events were investigated. RESULTS: On POD 1 night, the visual analog scale in group B showed lower than group A (P = .009). Comparison of time to fall asleep showed no differences between 2 groups. Total sleep time was no difference on POD 0 but was longer in group B than that in group A on POD 1 (P = .042). Awakening from sleep on POD 0 was lower in group B than that in group A (P = .033), and satisfaction with sleep quality on POD 0 was superior in group B compared to group A (P = .005). Postoperative nausea and vomiting occurred more frequently in group B than in group A (P = .018). CONCLUSION: The programmed intermittent epidural bolus technique of patient-controlled epidural analgesia reduces postoperative nighttime pain and improves sleep quality in patients undergoing thoracotomy for lung cancer or other lung diseases.

Analgesia Epidural , Pneumopatias , Neoplasias Pulmonares , Humanos , Toracotomia/efeitos adversos , Levobupivacaína , Analgesia Epidural/métodos , Qualidade do Sono , Injeções Epidurais , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/prevenção & controle , Dor Pós-Operatória/etiologia , Neoplasias Pulmonares/etiologia , Pneumopatias/etiologia
Saudi Med J ; 43(11): 1217-1223, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36379539


OBJECTIVES: To assess the clinical significance of serum CA-125 levels in elderly patients with pulmonary tuberculosis (PTB). METHODS: We retrospectively analyzed 1613 participants-patients (aged ≥60 years) admitted to the Beijing Shijitan Hospital, Beijing, China from February 2015 to January 2021 and healthy participants, divided into 4 groups: PTB (group 1), pulmonary malignancies (group 2), pulmonary non-malignant diseases (group 3), and healthy participants (group 4). Data concerning demographics, physical examination findings, computed tomography, histopathological examination, and laboratory tests for Mycobacterium tuberculosis and serum CA-125 levels were collected and analyzed. RESULTS: There were 720 healthy individuals and 893 patients in the study. The median levels and abnormal rates of CA-125 in groups 1 (42.5, 57.3%) and 2 (34.4, 49.5%) were higher than those in groups 3 (21.1, 29.2%) and 4 (8.6, 0.4%) (p<0.05). The ordinal logistic regression analysis model revealed significant associations between CA-125 levels and PTB (OR and 95% confidence interval [CI]: 2.749 (1.876-4.027)), hypoproteinemia [OR and 95% CI: 1.519 (1.114-2.070)], serous effusion [OR and 95% CI: 7.364 (5.346-10.143)], pulmonary malignancy [OR and 95% CI: 2.206 (1.518-3.204)], respiratory failure [OR and 95% CI: 3.216 (2.087-4.956)], and cor pulmonale [OR and 95% CI: 2.990 (1.282-6.973)]. CONCLUSION: Although elevated CA-125 levels may serve as a potential marker for diagnosing PTB in the elderly, they are affected by multiple factors, including serous effusion. Hence, caution is warranted while using this marker.

Pneumopatias , Mycobacterium tuberculosis , Tuberculose Pulmonar , Tuberculose , Idoso , Humanos , Estudos Retrospectivos , Tuberculose Pulmonar/diagnóstico , Pulmão , Biomarcadores
Rev Med Suisse ; 18(804): 2143-2149, 2022 Nov 16.
Artigo em Francês | MEDLINE | ID: mdl-36382974


Pulmonary transplantation remains the ultimate therapeutic option for selected patients with an advanced pulmonary disease and terminal respiratory insufficiency when all other therapeutic options have been exhausted. The optimal time-frame to proceed to a first discussion and evaluation about lung transplantation may be difficult to determine. This article describes the pathway of a patient towards lung transplantation and summarizes the criteria, which may help to timely identify eligibility for this therapeutic modality. We will focus mainly on the 2021 update of the International Society for Heart and Lung Transplantation (ISHLT) recommendations for the selection of lung transplant candidates.

La transplantation pulmonaire reste l'ultime option thérapeutique pour des patients sélectionnés présentant une maladie pulmonaire avancée au stade d'insuffisance respiratoire terminale, une fois les autres traitements reconnus épuisés. Le moment idéal pour une première discussion et l'évaluation d'une transplantation pulmonaire peut être difficile à identifier. Cet article décrit le parcours d'un patient vers la transplantation pulmonaire et résume les différents facteurs qui permettent d'identifier son éligibilité pour ce traitement. Nous nous focalisons notamment sur les recommandations pour la sélection des receveurs de transplantation pulmonaire mises à jour en 2021 par l'International Society for Heart and Lung Transplantation (ISHLT).

Transplante de Coração , Pneumopatias , Transplante de Pulmão , Humanos , Seleção de Pacientes
Rev Med Suisse ; 18(804): 2177-2180, 2022 Nov 16.
Artigo em Francês | MEDLINE | ID: mdl-36382979


Actinomycosis is an uncommon disease caused by Actinomyces, a commensal of the oropharyngeal, digestive, and genital tract. Commonly, it manifests as cervicofacial infection and is often related to poor oral health, smoking, chronic alcoholism or immune deficiency. Pulmonary actinomycosis is a rare disease, characterized by unspecific clinical, biological, and radiological manifestations that may be confused with other diseases. It should always be considered in patients suspected of having tuberculosis, lung abscess or pulmonary neoplasia. We describe a case of pulmonary actinomycosis treated successfully with short-term antibiotic therapy of three months, with a short review of the literature.

L'actinomycose est une infection peu fréquente causée par l'espèce Actinomyces, un commensal du tractus oropharyngé, digestif et génital. Elle se manifeste généralement par une infection cervico-faciale, souvent liée à un mauvais état bucco-dentaire, un tabagisme, un éthylisme chronique, ou un déficit immunitaire. L'actinomycose pulmonaire est une affection peu commune, caractérisée par des manifestations cliniques, biologiques et radiologiques peu spécifiques qui peuvent être confondues avec d'autres maladies. Elle doit être évoquée en cas de suspicion de tuberculose, d'abcès et de néoplasie pulmonaire. Nous décrivons un cas d'actinomycose pulmonaire traitée avec succès par une antibiothérapie de courte durée de 3 mois, avec une revue simplifiée de la littérature.

Actinomicose , Pneumopatias , Neoplasias Pulmonares , Humanos , Actinomicose/diagnóstico , Actinomicose/tratamento farmacológico , Actinomyces , Antibacterianos/uso terapêutico , Pneumopatias/diagnóstico , Pneumopatias/tratamento farmacológico , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/tratamento farmacológico