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1.
Artigo em Russo | MEDLINE | ID: mdl-32119209

RESUMO

Among HIV-infected patients there are individuals with masked chronic diseases that affect life quality and life-span. Their timely detection and treatment can improve life quality of HIV-infected patients. The screening examination allows to establish prevalence level, structure and features of concomitant diseases under HIV- infection to provide timely medical preventive care.


Assuntos
Infecções por HIV , Transtornos da Audição , Pneumopatias , Programas de Rastreamento , Infecções por HIV/complicações , Infecções por HIV/diagnóstico , Transtornos da Audição/complicações , Transtornos da Audição/diagnóstico , Humanos , Pneumopatias/complicações , Pneumopatias/diagnóstico , Prevalência , Qualidade de Vida , Sistema Respiratório
4.
J Cardiothorac Surg ; 14(1): 181, 2019 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-31661002

RESUMO

BACKGROUND: Gastrointestinal complications after lung transplatation are associated with an increased risk of morbidity and mortality. This study aims to describe severe gastrointestinal complications (SGC) after lung transplantation. METHODS: We performed a prospective, observational study that included 136 lung transplant patients during a seven year period in a tertiary care universitary hospital. SGC were defined as any diagnosis related to the gastrointestinal or biliary tract leading to lower survival rates or an invasive therapeutic procedure. Early and late complications were defined as those occurring < 30 days and ≥ 30 days post-transplant. The survival function was calculated through the Kaplan-Meier estimator. Variables were analyzed using univariate and multivariate analysis. Statistical significance was defined as p < 0.05. RESULTS: There were 17 (12.5%) SGC in 17 patients. Five were defined as early. Twelve patients (70.6%) required surgical treatment. Mortality was 52.9% (n = 9). Patients with SGC had a lower overall survival rate compared to those who did not (14 vs 28 months, p = 0.0099). The development of arrhythmias in the first 48 h of transplantation was a risk factor for gastrointestinal complications (p = 0.0326). CONCLUSIONS: SGC are common after lung transplantation and are associated with a considerable increase in morbidity-mortality. Early recognition is necessary to avoid delays in treatment, since a clear predictor has not been found in order to forecast this relevant comorbidity.


Assuntos
Gastroenteropatias/mortalidade , Transplante de Pulmão/efeitos adversos , Transplante de Pulmão/mortalidade , Complicações Pós-Operatórias/mortalidade , Adulto , Idoso , Comorbidade , Feminino , Gastroenteropatias/etiologia , Humanos , Estimativa de Kaplan-Meier , Pneumopatias/complicações , Pneumopatias/cirurgia , Masculino , Pessoa de Meia-Idade , Morbidade , Análise Multivariada , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Fatores de Risco , Análise de Sobrevida , Taxa de Sobrevida
5.
Medicine (Baltimore) ; 98(43): e17349, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31651839

RESUMO

RATIONALE: Diffuse pulmonary lymphangiomatos (DPL) is a rare aggressive lymphatic disorder characterized by proliferation of anastomozing lymphatic vessels and extremely rare in adult patients. PATIENT CONCERNS: We report a case of diffuse pulmonary lymphangiomatosis in 59-year-old man presented with cough and sputum for 2 months. DIAGNOSES: Combining clinical manifestations with results of radiological, bronchoscopy, and surgical lung biopsy, it was consistent with the diagnosis of DPL. INTERVENTIONS: After bronchoalveolar lavage and biopsy, symptom of cough got worse suddenly accompanied by excessive chyloptysis. The patient received an emergency surgical intervention and low fat medium chain fat treatment. OUTCOMES: The patient was discharged with a much better health condition. LESSONS: This case report is the oldest patient reported in the English literature, to the best of our knowledge. Serious complications of bronchoscopy should be considered, especially in DPL patients with severely enlarged mediastinum or with thin-walled translucent vesicles under endoscopy.


Assuntos
Tosse/patologia , Pneumopatias/congênito , Linfangiectasia/congênito , Biópsia , Broncoscopia , Tosse/etiologia , Humanos , Pulmão/patologia , Pneumopatias/complicações , Pneumopatias/patologia , Linfangiectasia/complicações , Linfangiectasia/patologia , Masculino , Pessoa de Meia-Idade , Doenças Raras/patologia , Escarro
6.
Int J Infect Dis ; 89: 51-54, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31562933

RESUMO

We report the case of a patient who presented with viral encephalitis and a pulmonary infection complicated with bilateral acute retinal necrosis after direct contact with diseased swine. Next-generation sequencing of the cerebrospinal fluid and vitreous humor detected pseudorabies virus (PRV) simultaneously. Intravenous acyclovir and dexamethasone treatment improved the symptoms of encephalitis, and vitrectomy surgery with silicone oil tamponade was used to treat the retinal detachment. This case implies that PRV can infect humans; thus, self-protection is imperative when there is contact with animals.


Assuntos
Anti-Inflamatórios/uso terapêutico , Antivirais/uso terapêutico , Encefalite Viral/diagnóstico por imagem , Herpesvirus Suídeo 1/isolamento & purificação , Pneumopatias/diagnóstico por imagem , Síndrome de Necrose Retiniana Aguda/diagnóstico por imagem , Doenças dos Suínos/virologia , Aciclovir/uso terapêutico , Adulto , Animais , Líquido Cefalorraquidiano/virologia , Dexametasona/uso terapêutico , Encefalite Viral/complicações , Encefalite Viral/terapia , Encefalite Viral/virologia , Herpesvirus Suídeo 1/genética , Humanos , Pneumopatias/complicações , Pneumopatias/terapia , Pneumopatias/virologia , Masculino , Descolamento Retiniano/tratamento farmacológico , Síndrome de Necrose Retiniana Aguda/complicações , Síndrome de Necrose Retiniana Aguda/terapia , Síndrome de Necrose Retiniana Aguda/virologia , Óleos de Silicone/uso terapêutico , Suínos , Vitrectomia , Corpo Vítreo/virologia , Zoonoses
9.
Transplant Proc ; 51(6): 2009-2013, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31399181

RESUMO

BACKGROUND: The aim of the study was to investigate the serum concentration of cytokines and biochemical markers of malnutrition in correlation with frailty syndrome in patients qualified for lung transplantation (LTx). METHODS: The study population comprised 31 potential lung recipients, including 18 patients with idiopathic lung disease, 12 patients with chronic obstructive pulmonary disease, and 1 patient with bronchiectasis who qualified for a LTx. Cytokine serum levels were assessed using commercially available enzyme-linked immunosorbent assay kits and the Luminex 200 platform (ProcartaPlex Hu Cytokine/Chemokine Panel 1A 34plex, Invitrogen, Carlsbad, Calif., United States). The patients were also asked to complete a questionnaire, the Clinical Frailty Scale. RESULTS: All patients were found to have higher cytokine concentrations (IL6, IL 2,IL18, IL23, IL 12p70, IL 10, IL 7). No statistically significant differences in the analyzed cytokines were noted when the men's results were compared to those of the women. There were no significant differences between patients who scored 6 vs 7 points on the Canadian Study of Health and Aging Function Scale. In comparing chronic obstructive pulmonary disease to idiopathic lung disease patients, no significant differences were observed in the analyzed cytokine values. Significant correlations were observed between the analyzed cytokines and age of the patients, C-reactive protein, triglycerides, transferrin, total cholesterol, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol. CONCLUSIONS: Our findings indicate that cytokines may not have a statistically significant effect on the parameters of the frailty syndrome. The results require further investigations on larger study groups. The findings suggest that the analyzed cytokines may play a proinflammatory role in the end stages of lung diseases, but further studies are needed to evaluate whether these cytokines could be used as biomarkers in this group of patients.


Assuntos
Citocinas/sangue , Fragilidade/sangue , Pneumopatias/sangue , Transplante de Pulmão/efeitos adversos , Desnutrição/sangue , Adulto , Biomarcadores/sangue , Proteína C-Reativa/análise , Canadá , HDL-Colesterol , Contraindicações de Procedimentos , Ensaio de Imunoadsorção Enzimática , Feminino , Fragilidade/complicações , Fragilidade/cirurgia , Humanos , Interleucina-10/sangue , Pulmão/fisiopatologia , Pneumopatias/complicações , Pneumopatias/cirurgia , Masculino , Desnutrição/complicações , Desnutrição/cirurgia , Pessoa de Meia-Idade , Seleção de Pacientes , Doença Pulmonar Obstrutiva Crônica/sangue , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/cirurgia , Triglicerídeos/sangue , Adulto Jovem
10.
Vet Parasitol ; 273: 1-4, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31442886

RESUMO

Pulmonary endarteritis caused by Dirofilaria immitis and pulmonary hypertension (PH) are closely linked and the determination of PH could be validated to assess the severity and chronicity of the vascular damage, i.e. by the use of the Right Pulmonary Artery Distensibility (RPAD) Index. The aim was to evaluate the RPAD Index in dogs 10 months after the last dose of adulticide. The study included 23 client-owned dogs with heartworm brought for adulticide treatment. Echocardiographic exam was carried out to estimate worm burden, RPAD Index as well as other routine echocardiographic values on day 0 (diagnosis), day 120 (discharge), and 10 months after the last dose of adulticide. No significant differences were observed in the RPAD Index over time, neither when microfilaremic status and parasite burden were evaluated. An RPAD Index <29% was found in 52.2% of the dogs on day 0, day 120, and 10 months after the last dose of adulticide. Regarding other echocardiographic parameters, only significant differences were observed on tricuspid annular plane systolic excursion (TAPSE) values between day 0:day 120 (p = 0.008), and day 0:end of the study (p = 0.037). There was not significant improvement in pulmonary damage 10 months after the elimination of the parasites (p = 0.296), suggesting that, once the endarteritis has developed, the vascular changes are chronic and may not be reversible. The modifications of the TAPSE value suggest an improvement in the systolic function of the right ventricle after the disappearance of the worms, independently of the presence of PH. The endarteritis causes a decrease in the elasticity in the pulmonary vasculature and an increase in the resistance that, chronically, and depending on the severity, will cause the development of PH and later right heart failure. This complication of the disease is one of the most damaging and frequent, so it is necessary to adequately monitor PH in dogs undergoing adulticide treatment. Furthermore, knowing the pulmonary status could provide valuable information to help provide an objective prognosis and help assess the need to add additional treatments, once the worms have been eliminated.


Assuntos
Dirofilaria immitis , Dirofilariose/patologia , Doenças do Cão/patologia , Endarterite/veterinária , Pneumopatias/veterinária , Animais , Antiparasitários/uso terapêutico , Dirofilariose/complicações , Dirofilariose/tratamento farmacológico , Doenças do Cão/diagnóstico , Doenças do Cão/tratamento farmacológico , Cães , Endarterite/complicações , Endarterite/diagnóstico , Endarterite/patologia , Concentração de Íons de Hidrogênio , Pneumopatias/complicações , Pneumopatias/diagnóstico , Pneumopatias/patologia , Fatores de Tempo
11.
Dtsch Med Wochenschr ; 144(17): 1209-1211, 2019 08.
Artigo em Alemão | MEDLINE | ID: mdl-31454843

RESUMO

HISTORY: An 80-year old female was referred to our hospital with left internal carotid artery stenosis and a childhood history of hemoptysis. INVESTIGATIONS AND DIAGNOSIS: The ECG showed 2nd degree Mobitz atrio-ventricular block. The chest x-ray and computerized tomography identified a shift of the mediastinum and the heart to the left. The left lung was completely destroyed whilst the right lung was enlarged and crossed the midline. Pulmonary function tests revealed a moderate restrictive ventilation disorder. The diagnosis of autopneumonectomy was based on patient history together with radiological findings. TREATMENT AND COURSE: A pacemaker was implanted with two stimulation electrodes via a left cephalic venous cutdown. A carotid endarterectomy was also performed without any complication. CONCLUSION: After autopneumonectomy, postpneumonectomy like syndrome may occur in very rare cases, whereupon operative treatment is mandatory. Any respiratory infections should be treated with antibiotics. Pacemaker electrode placement via the subclavian vein is contraindicated due to the risk of a catastrophic pneumothorax.


Assuntos
Estenose das Carótidas , Pneumopatias , Idoso de 80 Anos ou mais , Estenose das Carótidas/complicações , Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/cirurgia , Eletrocardiografia , Feminino , Humanos , Pneumopatias/complicações , Pneumopatias/diagnóstico por imagem , Pneumopatias/fisiopatologia , Marca-Passo Artificial
13.
Vet Surg ; 48(7): 1309-1317, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31334873

RESUMO

OBJECTIVE: To evaluate the diagnostic and therapeutic utility of bronchoscopy in dogs undergoing computed tomography (CT) and surgery for intrathoracic disease (pyothorax and pneumothorax) secondary to migrating plant awns (MPA) and to report outcomes in dogs that did and did not undergo bronchoscopy in addition to CT and surgery. STUDY DESIGN: Retrospective case series. ANIMALS: Thirty-seven client-owned dogs. METHODS: Medical records from 2008 to 2017 were reviewed for dogs with documented MPA in the thoracic cavity treated with CT and surgery with or without bronchoscopy. Information regarding diagnostics, treatments, complications, and outcomes relating to hospitalization was evaluated. RESULTS: At least one abnormal lung lobe was identified by CT in all dogs. Bronchial abnormalities were identified with bronchoscopy in 21 of 22 dogs (95.4%) with available reports. Agreement between CT and bronchoscopy findings ranged from 50% to 81.8%, depending on lung lobe. Thirty-six dogs had one or more lung lobes surgically removed. Thirty-seven MPA were retrieved via bronchoscopy in 10 of 27 (37%) dogs, and 39 MPA were retrieved at surgery in 26 of 37 (70.3%) dogs. Actinomyces spp. were cultured from surgical samples in 7 of 33 (21.2%) dogs. Thirty-five of 37 (94.6%) dogs survived to discharge. CONCLUSION: Migrating plant awns were successfully retrieved via bronchoscopy. Agreement between CT findings and bronchoscopy was inconsistent, so there may be roles for both modalities. Short- and long-term survival was excellent in this cohort. CLINICAL SIGNIFICANCE: Bronchoscopy may allow for diagnostic and therapeutic advantages compared with CT in dogs with endobronchial MPA. Actinomyces spp appear to be variably present in surgically acquired bacterial cultures in dogs with MPA.


Assuntos
Doenças do Cão/cirurgia , Corpos Estranhos/veterinária , Migração de Corpo Estranho/veterinária , Pneumopatias/veterinária , Animais , Broncoscopia , Cães , Empiema Pleural/cirurgia , Feminino , Corpos Estranhos/complicações , Corpos Estranhos/cirurgia , Migração de Corpo Estranho/cirurgia , Pneumopatias/complicações , Pneumopatias/cirurgia , Masculino , Pneumotórax/veterinária , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/veterinária , Resultado do Tratamento
14.
Am J Case Rep ; 20: 1114-1119, 2019 Jul 28.
Artigo em Inglês | MEDLINE | ID: mdl-31352464

RESUMO

BACKGROUND Pulmonary alveolar microlithiasis is an autosomal recessive disease in which a mutation in the SLC34A2 gene that codes for a sodium phosphate type IIb transporter protein (expressed in human epithelial tissues and functions in the clearance of phosphate ions) leads to the formation of extensive pulmonary intra-alveolar microliths. The subsequent characteristic clinical features of dyspnea and hypoxia are a manifestation of these microliths. There have been fewer than 1000 cases of pulmonary alveolar microlithiasis reported worldwide, and there have been 19 reported lung-transplanted patients. CASE REPORT A 49-year-old Saudi male patient presented with longstanding history of easy fatigability and tiredness on exertion since he was 16 years old. Throughout his follow-up in different hospitals (1986-1989), tuberculosis and pulmonary fibrosis were suspected. The patient was lost to follow-up between 1989 and 2001. In 2002, he presented to the emergency room with coughing, shortness of breath on exertion, abdominal swelling, and pedal edema. An investigation with chest x-rays, CT scan, electrocardiogram, and an echocardiogram was conducted. After referral to a tertiary care center, the patient was diagnosed with pulmonary alveolar microlithiasis. He subsequently developed pulmonary hypertension and polycythemia and therefore received a bilateral lung transplant in 2016. Following the lung transplant, he developed a mild reperfusion injury and tonic-clonic seizures, requiring ICU admission. After a successful extubatation with stable vitals and good recovery, he was discharged home in stable condition with planned follow-up. CONCLUSIONS We report a case of pulmonary alveolar microlithiasis successfully treated with a bilateral lung transplant. Although pulmonary alveolar microlithiasis is a rare entity, healthcare providers should consider it in the differential diagnoses of parenchymal lung diseases and differentiate it from tuberculosis and pulmonary fibrosis.


Assuntos
Calcinose/cirurgia , Doenças Genéticas Inatas/cirurgia , Hipertensão Pulmonar/cirurgia , Pneumopatias/cirurgia , Transplante de Pulmão , Policitemia/etiologia , Calcinose/complicações , Calcinose/diagnóstico por imagem , Doenças Genéticas Inatas/complicações , Doenças Genéticas Inatas/diagnóstico por imagem , Humanos , Hipertensão Pulmonar/etiologia , Pneumopatias/complicações , Pneumopatias/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
15.
BMJ Case Rep ; 12(6)2019 Jun 27.
Artigo em Inglês | MEDLINE | ID: mdl-31253662

RESUMO

Blastomycosis-associated acute respiratory distress syndrome (ARDS) has a rare incidence. We report the case of a 29-year-old man with blastomycosis-associated ARDS receiving extracorporeal membrane oxygenation and managed with high-dose liposomal amphotericin B. This case illustrates the importance of timely diagnosis of pulmonary blastomycosis and appropriate dosing of antifungal therapy.


Assuntos
Anfotericina B/uso terapêutico , Blastomicose/complicações , Blastomicose/tratamento farmacológico , Oxigenação por Membrana Extracorpórea , Pneumopatias/complicações , Pneumopatias/tratamento farmacológico , Adulto , Antifúngicos/uso terapêutico , Humanos , Masculino , Síndrome do Desconforto Respiratório do Adulto
16.
Mycoses ; 62(9): 765-772, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31162731

RESUMO

The aim of this study was to describe the characteristics of patients with chronic pulmonary aspergillosis (CPA) in a tertiary care centre in Spain. Retrospective cohort study of all patients diagnosed with CPA between January 2010 and December 2015. The patients were identified through the Microbiology Registry. Demographic, clinical, laboratory, radiological, microbiological and clinical data were recorded. Patients were followed up for 12 months. Fifty-three patients were included; median age was 61.5 years. Forty-seven had a lung condition, 25 suffered from COPD, 19 an active malignancy, 10 had previous pulmonary tuberculosis and 9 lung interstitial disease. Twenty-eight patients presented with chronic cavitary pulmonary form (CCPA) and 20 with subacute invasive aspergillosis (SAIA). Species identified were A fumigatus (34), A niger (5), A terreus (4) and A flavus (3). All-cause 1-year mortality was 56%. Predictors of mortality were cancer history (OR, 9.5; 95% CI, 2.54-35.51; P < 0.01) and SAIA (OR, 5.49; 95% CI, 1.49-19.82; P < 0.01). Previous pulmonary tuberculosis, surgery for the treatment of CPA and CCPA were found to be associated with lower mortality (OR, 0.05; 95% CI, <0.01-0.47; P < 0.01; OR, 0.16; 95% CI, 0.03-0.88; P = 0.035 and OR 0.2, 95% CI, 0.01-0.67; P = 0.01, respectively). This is the first study providing an overview of the features of CPA in patients from Spain. CCPA was the most frequent form of CPA and A fumigatus the most frequently isolated species. Patients with cancer history and SAIA had a worse prognosis.


Assuntos
Pulmão/microbiologia , Aspergilose Pulmonar/microbiologia , Idoso , Aspergilose/complicações , Aspergillus , Doença Crônica , Feminino , Humanos , Pulmão/patologia , Pneumopatias/complicações , Masculino , Pessoa de Meia-Idade , Neoplasias/complicações , Neoplasias/microbiologia , Prognóstico , Aspergilose Pulmonar/diagnóstico , Aspergilose Pulmonar/mortalidade , Sistema de Registros , Estudos Retrospectivos , Espanha , Centros de Atenção Terciária
17.
Clin Rheumatol ; 38(8): 2195-2199, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31037456

RESUMO

ANCA-associated vasculitis (AAV) can present in an atypical manner and obscure the clinical picture. We sought to characterize clinical characteristics and outcomes in these uncommon presentations. We conducted a retrospective study of 171 AAV patients in our vasculitis database to identify patients with atypical presentation of AAV. Patient demographics, serologies, renal indices, and treatment regimens were assessed. Of the 171 patients, eight were identified to have uncommon presentations. These patients were usually extremes of age with three being less than 30 years and four being more than 70 years. Six patients were positive for PR3 antibodies. The mean delay in diagnosis from time of symptom development was 12 months. All patients developed acute kidney injury during their clinical course. Pancreatitis was the most frequent atypical presentation (n = 3), with pulmonary pathologies (cystic lung disease and usual interstitial pneumonia) and splenic infarcts being present in two patients each. The diagnosis of AAV was established by positive ANCA serology and renal or lung biopsy evidence of vasculitis. Six patients received induction therapy with steroids and rituximab, while two received steroids and cyclophosphamide. One patient died of respiratory failure in the first month following diagnosis while the remaining patients achieved disease remission. One patient developed end-stage renal disease. Uncommon presentations of AAV afflict extremes of age with a PR3 ANCA predominance and are associated with subsequent development of AKI. This case series demonstrates that a significant delay in diagnosis can be associated with these presentations. KEY POINTS: • Uncommon manifestations of AAV are seen more often with PR3 ANCA disease and respond to standard induction therapy of AAV. • High index of suspicion is required to avoid delays in diagnosis.


Assuntos
Lesão Renal Aguda/complicações , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/diagnóstico , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/terapia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Anticorpos Anticitoplasma de Neutrófilos/sangue , Ciclofosfamida/administração & dosagem , Bases de Dados Factuais , Diagnóstico Tardio , Feminino , Granulomatose com Poliangiite/imunologia , Humanos , Pneumopatias/complicações , Doenças Pulmonares Intersticiais/complicações , Masculino , Pessoa de Meia-Idade , Pancreatite/complicações , Indução de Remissão , Insuficiência Respiratória/terapia , Estudos Retrospectivos , Rituximab/administração & dosagem , Esteroides/administração & dosagem , Resultado do Tratamento , Adulto Jovem
18.
PLoS One ; 14(5): e0215855, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31059523

RESUMO

BACKGROUND: Approximately 11% of people reported to have tuberculosis (TB) have previously received treatment. Clinical outcomes are consistently poor on retreatment regimens, however reasons for this are unclear. This study aimed to explore factors which may contribute to unsuccessful outcomes in retreatment TB. METHODS AND FINDINGS: A prospective cohort of consecutive patients starting WHO Category II retreatment regimen was recruited at a central hospital in Malawi. Participants were evaluated at baseline, after completion of the intensive phase at 2-months, and at the end of the 8-month treatment course. Patients were assessed for respiratory co-morbidity; anaemia; renal impairment; diabetes; Anti-retroviral (ART) failure; and drug toxicity. Amongst 158 patients entering TB care at the point of a recurrent episode, only 92 (58%) had a microbiologically confirmed diagnosis. The prevalence of drug resistance was low (9.6%). Of the 158 patients, 131 (83%) were HIV-positive, of whom 96 (73%) were on ART. Of 63 patients on ART >1 year, 24 (38%) had ART failure. Chronic lung disease was found in 88% on CT thorax, including scarring (80%), bronchiectasis (61%), COPD (22%), and destroyed lung (19%). Spirometry revealed restrictive deficit in 60%, and obstructive deficit in 7% of patients. Anaemia and renal impairment were common (34% and 45% respectively). Ototoxicity developed in 32%, and nephrotoxicity in 15%. 40% of patients reported peripheral neuropathy. Liver injury developed in 4%. CONCLUSIONS: If outcomes are to be improved in retreatment TB, there is an urgent need to address the impact of other co-morbid medical conditions including chronic lung disease, HIV and ART failure.


Assuntos
Farmacorresistência Bacteriana , Tuberculose/diagnóstico , Tuberculose/tratamento farmacológico , Adulto , Doença Crônica , Estudos de Coortes , Comorbidade , Feminino , Seguimentos , HIV/fisiologia , Humanos , Pneumopatias/complicações , Masculino , Prognóstico , Recidiva , Tuberculose/complicações , Tuberculose/virologia
19.
Clin Respir J ; 13(8): 485-492, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31095884

RESUMO

OBJECTIVE: The demographic characteristics, ratio of aetiologies and biochemical parameters of adult patients with pulmonary hypertension (PH) living in plain and high-altitude regions were investigated and analysed. METHODS: In total, 2846 adult patients with PH hospitalized from 2010 to 2015 in the Second Xiangya Hospital of Central South University and Qinghai Red Cross Hospital were retrospectively investigated. RESULTS: (1) In the present study, the numbers of patients with PH in both the plain and high-altitude regions increased annually (P < 0.05), and the in-hospital prevalence of PH significantly increased over time in the high-altitude region. PH was more common in women in the plain region. Furthermore, compared with PH patients living in the plain region, those living in the high-altitude region were older (P < 0.05) and had higher smoking rates (P < 0.05). In the plain region, the greatest proportion of patients with PH belonged to group 2 (PH because of left heart disease), while in the high-altitude region, group 3 (PH because of lung diseases and/or hypoxia) was the most common (P < 0.05). (2) Haemoglobin levels, red blood cell counts, mean platelet volumes and platelet volume distribution widths were lower in PH patients living in the plain region than in those living in the high-altitude region. Furthermore, platelet counts were higher in patients living in the plain region than in those living in the high-altitude region (P < 0.05). The BNP/NT-proBNP levels were higher in PH patients living in the plain region (45.5%), which were mostly in group 4, than in those living the high-altitude region (P < 0.05). CONCLUSIONS: The data from the hospitals in both the plain and high-altitude regions show a tendency towards increased in-hospital prevalence of PH over the last 6 years. The most common aetiologies of PH in patients living in the plain region and high-altitude regions were left heart disease and lung disease, respectively. Compared with PH patients living in the plain region, those living in the high-altitude region had better cardiac function and less severe PH.


Assuntos
Hospitalização/estatística & dados numéricos , Hipertensão Pulmonar/etiologia , Fumar/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Altitude , Feminino , Cardiopatias/complicações , Hospitalização/tendências , Humanos , Hipertensão Pulmonar/epidemiologia , Hipertensão Pulmonar/fisiopatologia , Hipóxia/complicações , Pneumopatias/complicações , Masculino , Pessoa de Meia-Idade , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Contagem de Plaquetas/tendências , Prevalência , Estudos Retrospectivos , Índice de Gravidade de Doença , Fumar/epidemiologia , Fatores de Tempo
20.
Emerg Radiol ; 26(5): 501-506, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31129737

RESUMO

PURPOSE: To evaluate the clinical outcomes of bronchial artery embolization (BAE) using a gelatin sponge for hemoptysis from pulmonary aspergilloma and compare them with treatment outcomes for hemoptysis from other diseases. METHODS: Fifty-two patients underwent BAE using a gelatin sponge. The etiology of hemoptysis was pulmonary aspergilloma in 8 (PA group) and other diseases in 44 (control group). The technical success rate, clinical success rate, hemoptysis-free rate, and complication rate were compared between the PA group and control group. Technical success was defined as the complete cessation of the targeted feeding artery as confirmed by digital subtraction angiography, and clinical success as the cessation of hemoptysis within 24 h of BAE. Recurrent hemoptysis was defined as a single or multiple episodes of hemoptysis causing > 30 ml of bleeding per day. RESULTS: Technical and clinical success rates were 100% in both groups. Hemoptysis-free rates were 85% at 6 months and 72% at 12-60 months in the control group, and 38% at 6-12 months and 25% thereafter in the PA group (P = 0.0009). No complications were observed following BAE in any case in the two groups. CONCLUSION: BAE using a gelatin sponge may not be effective for hemoptysis from pulmonary aspergilloma.


Assuntos
Artérias Brônquicas , Embolização Terapêutica/métodos , Esponja de Gelatina Absorvível/uso terapêutico , Hemoptise/microbiologia , Hemoptise/terapia , Aspergilose Pulmonar/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiografia Digital , Feminino , Hemoptise/diagnóstico por imagem , Humanos , Pneumopatias/complicações , Masculino , Pessoa de Meia-Idade , Aspergilose Pulmonar/diagnóstico por imagem , Estudos Retrospectivos
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