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1.
J Med Internet Res ; 23(4): e27503, 2021 04 26.
Artigo em Inglês | MEDLINE | ID: mdl-33857011

RESUMO

BACKGROUND: A decrease in the level of pulse oxygen saturation as measured by pulse oximetry (SpO2) is an indicator of hypoxemia that may occur in various respiratory diseases, such as chronic obstructive pulmonary disease (COPD), sleep apnea syndrome, and COVID-19. Currently, no mass-market wrist-worn SpO2 monitor meets the medical standards for pulse oximeters. OBJECTIVE: The main objective of this monocentric and prospective clinical study with single-blind analysis was to test and validate the accuracy of the reflective pulse oximeter function of the Withings ScanWatch to measure SpO2 levels at different stages of hypoxia. The secondary objective was to confirm the safety of this device when used as intended. METHODS: To achieve these objectives, we included 14 healthy participants aged 23-39 years in the study, and we induced several stable plateaus of arterial oxygen saturation (SaO2) ranging from 100%-70% to mimic nonhypoxic conditions and then mild, moderate, and severe hypoxic conditions. We measured the SpO2 level with a Withings ScanWatch on each participant's wrist and the SaO2 from blood samples with a co-oximeter, the ABL90 hemoximeter (Radiometer Medical ApS). RESULTS: After removal of the inconclusive measurements, we obtained 275 and 244 conclusive measurements with the two ScanWatches on the participants' right and left wrists, respectively, evenly distributed among the 3 predetermined SpO2 groups: SpO2≤80%, 80%

Assuntos
/sangue , Hipóxia/sangue , Hipóxia/complicações , Oximetria/normas , Punho , Adulto , Feminino , Voluntários Saudáveis , Humanos , Pneumopatias/sangue , Pneumopatias/complicações , Masculino , Monitorização Fisiológica , Oximetria/efeitos adversos , Oxigênio/sangue , Estudos Prospectivos , Método Simples-Cego , Adulto Jovem
2.
Arch. bronconeumol. (Ed. impr.) ; 57(supl.2): 0-0, abr. 2021.
Artigo em Inglês | IBECS | ID: ibc-196726

RESUMO

INTRODUCTION: Patients with pre-existing respiratory diseases in the setting of COVID-19 may have a greater risk of severe complications and even death. METHODS: A retrospective, multicenter, cohort study with 5847 COVID-19 patients admitted to hospitals. Patients were separated in two groups, with/without previous lung disease. Evaluation of factors associated with survival and secondary composite end-point such as ICU admission and respiratory support, were explored. RESULTS: 1,271 patients (22%) had a previous lung disease, mostly COPD. All-cause mortality occurred in 376 patients with lung disease (29.5%) and in 819 patients without (17.9%) (p < 0.001). Kaplan-Meier curves showed that patients with lung diseases had a worse 30-day survival (HR = 1.78; 95%C.I. 1.58-2.01; p < 0.001) and COPD had almost 40% mortality. Multivariable Cox regression showed that prior lung disease remained a risk factor for mortality (HR, 1.21; 95%C.I. 1.02-1.44; p = 0.02). Variables independently associated with all-cause mortality risk in patients with lung diseases were oxygen saturation less than 92% on admission (HR, 4.35; 95% CI 3.08-6.15) and elevated D-dimer (HR, 1.84; 95% CI 1.27-2.67). Age younger than 60 years (HR 0.37; 95% CI 0.21-0.65) was associated with decreased risk of death. CONCLUSIONS: Previous lung disease is a risk factor for mortality in patients with COVID-19. Older age, male gender, home oxygen therapy, and respiratory failure on admission were associated with an increased mortality. Efforts must be done to identify respiratory patients to set measures to improve their clinical outcomes


INTRODUCCIÓN: Los pacientes con enfermedades respiratorias preexistentes pueden tener en el contexto de la covid-19 un mayor riesgo de complicaciones graves e incluso de muerte. MÉTODOS: Estudio de cohortes multicéntrico y retrospectivo de 5.847 pacientes con covid-19 ingresados en hospitales. Los pacientes se separaron en 2 grupos, sin y con enfermedad pulmonar previa. Se evaluaron factores asociados con la supervivencia y criterios combinados de valoración secundarios, como el ingreso en la UCI y la necesidad de asistencia respiratoria. RESULTADOS: Mil doscientos setenta y un (1.271) pacientes (22%) tenían una enfermedad pulmonar previa, principalmente EPOC. La mortalidad por todas las causas ocurrió en 376 pacientes con enfermedad pulmonar (29,5%) y en 819 pacientes sin enfermedad pulmonar (17,9%; p < 0,001). Las curvas de Kaplan-Meier mostraron que los pacientes con enfermedades pulmonares tenían una peor supervivencia a los 30 días (HR: 1,78; IC del 95%: 1,58-2,01; p < 0,001) y la EPOC tenía una mortalidad de casi el 40%. La regresión de Cox multivariante mostró que la enfermedad pulmonar previa seguía siendo un factor de riesgo de mortalidad (HR: 1,21; IC del 95%: 1,02-1,44; p = 0,02). Las variables asociadas de forma independiente con el riesgo de muerte por todas las causas en pacientes con enfermedades pulmonares fueron la saturación de oxígeno inferior al 92% al ingreso (HR: 4,35; IC del 95%: 3,08-6,15) y el dímero D elevado (HR: 1,84; IC del 95%: 1,27-2,67). La edad menor de 60 años (HR: 0,37; IC del 95%: 0,21-0,65) se asoció con una disminución del riesgo de muerte. CONCLUSIONES: La enfermedad pulmonar previa es un factor de riesgo de muerte en pacientes con covid-19. La edad avanzada, el sexo masculino, la oxigenoterapia domiciliaria y la insuficiencia respiratoria al ingreso se asociaron con un aumento de la mortalidad. Se deben realizar esfuerzos para identificar a los pacientes respiratorios y establecer medidas para mejorar sus resultados clínicos


Assuntos
Humanos , Masculino , Feminino , Idoso , Mortalidade Hospitalar , Pneumopatias/mortalidade , Infecções por Coronavirus/mortalidade , Pneumonia Viral/mortalidade , Pandemias , Pneumopatias/complicações , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Estudos Retrospectivos , Prevalência , Fatores Sexuais , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/mortalidade , Estimativa de Kaplan-Meier , Prognóstico , Comorbidade
3.
BMC Surg ; 21(1): 125, 2021 Mar 09.
Artigo em Inglês | MEDLINE | ID: mdl-33750359

RESUMO

BACKGROUND: Cardiac angiosarcoma is a very rare malignant neoplasm, typically showing terrible prognosis. Therefore, early diagnosis is essential for efficacious intervention. Here we report a cardiac angiosarcoma with unique imaging findings because of pulmonary metastases. CASE PRESENTATION: A 55-year-old man presented to our Respiratory Department because of mild morning hemoptysis for five weeks with occasional palpitations, having undergone futile antibiotic therapy for two weeks at his local hospital before admission. Symptoms of hemoptysis were alleviated with venous hemostatic drugs. 18F-FDG PET/CT was performed, showing a right atrial mass with multiple parenchymal nodules in lungs surrounded by ground-glass opacity, and indicated an intracardiac malignant tumor associated with pulmonary metastases, consistent with cardiothoracic CT and ultrasound. No evidence of infection or neoplasm was found using a fiberoptic bronchoscope. After multidisciplinary consultation and discussion, provisional diagnosis was established such that metastatic intrapulmonary hemorrhagic foci were secondary to intracardiac malignancy. A percutaneous biopsy from the left lung was carried out and but showed mild chronic inflammation of the lung. Therefore, urgent wedge resections for biopsy were performed from the right lung and the histopathology revealed angiosarcoma. The patient died of cardiorespiratory failure before anticancer therapy. CONCLUSIONS: Variety of clinical manifestations of cardiac angiosarcoma frequently makes its diagnosis difficult, the imaging features and epidemiology of cardiac malignancy are very significant to clinical diagnosis.


Assuntos
Neoplasias Cardíacas , Hemangiossarcoma , Pneumopatias , Evolução Fatal , Neoplasias Cardíacas/complicações , Neoplasias Cardíacas/diagnóstico por imagem , Hemangiossarcoma/complicações , Hemangiossarcoma/diagnóstico por imagem , Hemoptise/etiologia , Humanos , Pneumopatias/complicações , Pneumopatias/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons
6.
Inflamm Res ; 70(4): 375-377, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33740066

RESUMO

INTRODUCTION: Coronavirus disease 2019 (COVID-19), a new disease that we do not know yet how to treat, is rapidly evolving and has forced us to stay indoors. Surprisingly, a broad range of symptoms has been reported since COVID-19 emergence. Individual variations in susceptibility to SARS-CoV-2 can be due to non-genetic and genetic factors. Alpha-1-antitrypsin deficiency (AATD) is an inherited condition that is associated with an increased risk of liver and lung diseases which may increase susceptibility to COVID-19 infection. At the same time, there could be a possibility of developing non-hereditary AATD. DISCUSSION: In addition to some evidence showing the role of vitamin D deficiency in COVID-19 pathology, it has been recognized that there is a biological link between AAT and vitamin D. Therefore, here we offer a new perspective that lower vitamin D levels in COVID-19 patients can cause acquired AATD that provide a condition with more disease severity and a higher risk of death. As a consequence, COVID-19 individuals with vitamin D deficiency may have a higher risk of morbidity and mortality. CONCLUSION: Therefore, early vitamin D and AAT assessments and optimal interventions could be helpful to prevent severe COVID-19 outcomes.


Assuntos
/sangue , Deficiência de Vitamina D/complicações , Vitamina D/sangue , Deficiência de alfa 1-Antitripsina/complicações , Suscetibilidade a Doenças , Humanos , Hepatopatias/complicações , Pneumopatias/complicações , Fatores de Risco , Índice de Gravidade de Doença , Resultado do Tratamento , Deficiência de Vitamina D/mortalidade , Deficiência de alfa 1-Antitripsina/mortalidade
7.
Life Sci ; 276: 119402, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-33785335

RESUMO

In our previous study, we observed that donor pulmonary intravascular nonclassical monocytes play a major role in early PGF, but the specific mechanism remained unclear. In this study, we investigated the mechanistic role of monocytes in inducing pyroptosis of human pulmonary microvascular endothelial cells (HPMECs) during IRI. A murine hilar ligation model of IRI was utilized whereby left lungs underwent 1 h of ischemia and 23 h of reperfusion. Monocyte depletion by intraperitoneal clodronate-liposome treatment on pulmonary edema and pyroptosis activation were determined. In vitro experiments, we performed the co-culture experiments under hypoxia-reoxygenation (H/R) conditions to mimic the IRI environment. We monitored the expression of NLRP3, caspase-1 and IL-1ß in co-cultures of monocytes (U937 cells) and HPMECs under H/R conditions. NLRP3, IL-1ß and IL-1R siRNA knockdown, caspase-1 and NF-κB pathway inhibitors were employed to elucidate the mechanism modulating HPMEC pyroptosis during H/R. Treatment of mice with clodronate-liposome attenuated IR-induced pulmonary edema, cytokine production and pyroptosis activation. In vitro, NLRP3 knockdown in monocytes reduced caspase-1 and IL-1ß secretion in co-cultures of monocytes and HPMECs. Reduced HPMEC pyroptosis was also observed either containing HPMECs with genetically engineered IL-1R knockdown or in co-culture treated with a Triplotide inhibitor that disrupts NF-κB signaling. Monocytes play a vital role in the development of transplant-associated ischemia-reperfusion injury. A potential role is that monocytes secrete IL-1ß to induce HPMEC pyroptosis via the IL-1R/NF-κB/NLRP3 pathway.


Assuntos
Endotélio Vascular/patologia , Inflamação/patologia , Pneumopatias/complicações , Monócitos/patologia , Piroptose , Traumatismo por Reperfusão/complicações , Doenças Vasculares/patologia , Animais , Endotélio Vascular/metabolismo , Regulação da Expressão Gênica , Humanos , Inflamassomos , Inflamação/etiologia , Inflamação/metabolismo , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Monócitos/metabolismo , NF-kappa B/genética , NF-kappa B/metabolismo , Proteína 3 que Contém Domínio de Pirina da Família NLR/genética , Proteína 3 que Contém Domínio de Pirina da Família NLR/metabolismo , Receptores de Interleucina-1/genética , Receptores de Interleucina-1/metabolismo , Transdução de Sinais , Células U937 , Doenças Vasculares/etiologia , Doenças Vasculares/metabolismo
8.
Med Hypotheses ; 147: 110481, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33421691

RESUMO

Coronavirus disease 2019 (COVID-19) caused more than 52.775.271 million confirmed cases, 1.293.106 deaths, globally, and afflicted 208 countries, areas, or territories; and almost three months have passed since the World Health Organisation (WHO) declared COVID-19 as a pandemic. Despite the dramatic and global impact of the Coronavirus, the knowledge about the SARS-CoV-2 infection has been improved remarkably. Herein, we provided the rationale for SARS-CoV-2 infection as endothelial dysfunction rather than respiratory disease. Accordingly, we strongly invited the researchers to look beyond pulmonary injury and shift their attention from respiratory disease to endothelial disorder. This strategy could be particularly relevant to identifying therapeutic weapons stabilizing the endothelium rather than the lungs.


Assuntos
/complicações , Fibrose Cística/complicações , Fibrose Cística/tratamento farmacológico , Pneumopatias/complicações , Pneumopatias/tratamento farmacológico , Anticorpos Monoclonais Humanizados/uso terapêutico , Antivirais/uso terapêutico , Estado Terminal , Endotélio Vascular/metabolismo , Humanos , Inflamação , Pulmão , Pandemias
9.
J Nutr Health Aging ; 25(1): 18-24, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33367458

RESUMO

OBJECTIVES: The co-occurrence of chronic diseases in the elderly is a common problem. However, the relationship between comorbidities and the prognosis of elderly patients with COVID-19 was not clear. This study was supposed to describe the clinical characteristics of elderly patients with COVID-19 infection from Sichuan province and the effects of comorbidity. DESIGN: A retrospective study. SETTINGS AND PARTICIPANTS: COVID-19 patients from Public Health Clinical Center of Chengdu between December 16, 2019 and February 26, 2020 were included in this study. Patients were divided into elderly group (≥60 years old) and non-elderly group (< 60 years old). RESULTS: Elderly patients with COVID-19 indicated relatively higher proportion of comorbidities, and the most common were atherosclerotic cardiovascular disease (56.5%), hypertension (43.5%) and chronic pulmonary disease (21.7%). The proportion of severe cases was higher in elderly group than that in non-elderly group (73.9% and 42.2%, respectively, P=0.012). During hospitalization, elderly patients indicated relatively higher proportion of complications, such as shock (21.7%), respiratory failure (21.7%). The proportion of patients with a decreased number of CD8+ lymphocytes (82.6%) and B lymphocytes (77.8%) in elderly patients was significantly higher than that in non-elderly group (48.9% and 44.8%, respectively). All 3 deaths were elderly patients with comorbidities and the cell counts of T lymphocyte subsets, B and NK cells of them were significantly decreased at admission. CONCLUSIONS: Elderly patients with COVID-19 had a high proportion of severe cases and comorbidities, more likely to show low immune function, and indicate higher proportion of complications.


Assuntos
/complicações , Comorbidade , Avaliação Geriátrica , Adulto , Idoso , Idoso de 80 Anos ou mais , Aterosclerose/complicações , /imunologia , China/epidemiologia , Feminino , Hospitalização , Humanos , Hipertensão/complicações , Pneumopatias/complicações , Masculino , Pessoa de Meia-Idade , Prognóstico , Insuficiência Respiratória/complicações , Estudos Retrospectivos , Choque/complicações , Adulto Jovem
10.
BMC Infect Dis ; 20(1): 769, 2020 Oct 19.
Artigo em Inglês | MEDLINE | ID: mdl-33076855

RESUMO

BACKGROUND: Norwegian children are more frequently hospitalized with influenza than adults. Little is known about the characteristics of these children. Our aim was to investigate the presence of pre-existing risk conditions and to determine the duration of influenza hospitalizations in children during two influenza seasons. METHODS: The Norwegian Patient Registry holds data on all hospitalized patients in Norway. We included all patients younger than 18 years hospitalized with a diagnosis of influenza during the influenza seasons 2017-18 and 2018-19. Pre-existing risk conditions for influenza were identified by ICD-10 diagnoses in the Norwegian Patient Registry. In addition, information on asthma diagnoses were also retrieved from the Norwegian Registry for Primary Health Care. To estimate the prevalence of risk conditions in the child population, we obtained diagnoses on all Norwegian children in a two-year period prior to each influenza season. We calculated age-specific rates for hospitalization and risk for being hospitalized with influenza in children with risk conditions. RESULTS: In total, 1013 children were hospitalized with influenza during the two influenza seasons. Children younger than 6 months had the highest rate of hospitalization, accounting for 13.5% of all admissions (137 children). Hospitalization rates decreased with increasing age. Among children hospitalized with influenza, 25% had one or more pre-existing risk conditions for severe influenza, compared to 5% in the general population under 18 years. Having one or more risk conditions significantly increased the risk of hospitalization, (Odds Ratio (OR) 6.1, 95% confidence interval (CI) 5.0-7.4 in the 2017-18 season, and OR 6.8, 95% CI 5.4-8.4 in the 2018-19 season). Immunocompromised children and children with epilepsy had the highest risk of hospitalization with influenza, followed by children with heart disease and lung disease. The average length of stay in hospital were 4.6 days, and this did not differ with age. CONCLUSION: Children with pre-existing risk conditions for influenza had a higher risk of hospitalization for influenza. However, most children (75%) admitted to hospital with influenza in Norway during 2017-2019 did not have pre-existing risk conditions. Influenza vaccination should be promoted in particular for children with risk conditions and pregnant women to protect new-borns.


Assuntos
Hospitalização , Influenza Humana/complicações , Adolescente , Criança , Pré-Escolar , Feminino , Cardiopatias/complicações , Hospitalização/estatística & dados numéricos , Humanos , Hospedeiro Imunocomprometido , Lactente , Recém-Nascido , Influenza Humana/epidemiologia , Influenza Humana/imunologia , Pneumopatias/complicações , Masculino , Noruega/epidemiologia , Razão de Chances , Cobertura de Condição Pré-Existente , Medição de Risco , Estações do Ano
11.
Medicine (Baltimore) ; 99(44): e23025, 2020 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-33126388

RESUMO

RATIONALE: Pulmonary hemorrhage is a rare but fatal complication of Henoch-Schönlein purpura (HSP), and more easily ignored in children than in adults due to the absence of clinically evident hemoptysis. Moreover, despite being sporadically reported, given that pulmonary hemorrhage may develop after regression and even disappearance of skin rash, the asynchronous progression of skin and lung lesions poses escalating challenges in the timely diagnosis. We herein presented a delayed diagnosis of late-onset pulmonary hemorrhage in a child with HSP after regression of purpuric rash. PATIENT CONCERNS: A 6-year and 3-month child with a history of self-resolved purpuric rash three weeks ago, presented acutely with cough and dyspnea but without fever. DIAGNOSES: The decreased hemoglobin and diffuse ground-glass opacities of both lungs on CT scan weren't comprehensively evaluated. The child was initially misdiagnosed as pneumonia. INTERVENTIONS: Antibiotic treatment was initiated. However, no improvement of respiratory status was found following aggressive combination therapy. Bronchoscopy was subsequently performed. OUTCOMES: An diffuse alveolar hemorrhage with low inflammatory profile was noted after a bronchoscopy. Considering the history of HSP, the diagnosis of HSP-associated pulmonary hemorrhage was ultimately confirmed and the patient received corticosteroids with satisfactory results. LESSONS: Pulmonary hemorrhage could occur in children with HSP at late onset of disease after regression of skin rash. New-onset respiratory symptoms in patients with a history of HSP should heighten suspicion for pulmonary hemorrhage, particularly if presenting with lack of fever, sudden drop of hemoglobin, new pulmonary infiltrates and unresponsiveness to antibiotics therapy. Bronchoscopy should be performed early to confirm the diagnosis, specifically for children.


Assuntos
Exantema , Hemorragia/diagnóstico , Pneumopatias/diagnóstico , Púrpura de Schoenlein-Henoch , Criança , Tosse/etiologia , Diagnóstico Tardio , Hemorragia/complicações , Hemorragia/diagnóstico por imagem , Humanos , Pneumopatias/complicações , Pneumopatias/diagnóstico por imagem , Masculino , Tomografia Computadorizada por Raios X
12.
Medicine (Baltimore) ; 99(39): e21941, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32991402

RESUMO

INTRODUCTION: Diffuse pulmonary lymphangiomatosis (DPL) is a rare condition. Most patients with DPL present dyspnea, cough, expectoration, and hemoptysis. There are few reports of DPL accompanied by thrombocytopenia, whose cause remains unknown. PATIENT CONCERNS: An 18-year-old male patient presented with recurrent cough, expectoration, and dyspnea for 5 years, and thrombocytopenia was observed during a 2-month follow-up. DIAGNOSIS: Chest computed tomography showed diffuse patchy shadows in both lungs, and pleural and pericardial effusions. Immunohistochemical lung tissue staining showed lymphatic and vascular endothelial cells positive for D2-40, CD31 and CD34. Routine blood test revealed platelets at 62 × 10 cells/L during follow-up. Bone marrow biopsy was normal. Ultrasound revealed no hepatosplenomegaly. Finally, the patient was diagnosed with DPL accompanied by thrombocytopenia. INTERVENTIONS: He was treated by subtotal pericardial resection, thoracocentesis, and anti-infective therapy. Oral prednisone was administered for 2 months. OUTCOMES: The symptoms of cough and shortness of breath were improved, but thrombocytopenia persisted. We investigated the cause of thrombocytopenia. Whole-exome sequencing identified a mutation in exon 3 of the TNFRSF13B gene in this patient. CONCLUSION: DPL may present with thrombocytopenia and DIC. Patients with thrombocytopenia but not DIC and splenomegaly should be screened for gene mutations.


Assuntos
Pneumopatias/congênito , Linfangiectasia/congênito , Trombocitopenia/complicações , Adolescente , Criança , Humanos , Pneumopatias/complicações , Pneumopatias/diagnóstico por imagem , Pneumopatias/genética , Pneumopatias/patologia , Linfangiectasia/complicações , Linfangiectasia/diagnóstico por imagem , Linfangiectasia/genética , Linfangiectasia/patologia , Masculino , Mutação de Sentido Incorreto , Trombocitopenia/diagnóstico , Tomografia Computadorizada por Raios X , Proteína Transmembrana Ativadora e Interagente do CAML , Sequenciamento Completo do Exoma
13.
Vnitr Lek ; 66(4): 47-52, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32972184

RESUMO

IgG4 related disease (IgG4-RD) is a rare and relatively new group of systemic inflammatory diseases characterized by inflammatory, fibrotic or sclerotic involvement of one or more organs accompanied by increased IgG4plasma cells tissue infiltration andusually elevated serum IgG4(IgG4 > 1.35g/l, normal range 0.08-1.40 g/l) level. Histopathological findings are crucial for the diagnostics of this disease. The authors present a case report of a patient with IgG4 associated disease manifested by a rare combination of autoimmune hemolytic anemia and pulmonary involvement.


Assuntos
Anemia Hemolítica Autoimune , Doenças Autoimunes , Pneumopatias , Anemia Hemolítica Autoimune/complicações , Anemia Hemolítica Autoimune/diagnóstico , Doenças Autoimunes/complicações , Humanos , Imunoglobulina G , Pneumopatias/complicações
14.
Int J Med Sci ; 17(14): 2187-2193, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32922180

RESUMO

Background: The number of asymptomatic infected patients with coronavirus disease 2019 (COVID-2019) is rampaging around the world but limited information aimed on risk factors of asymptomatic infections. The purpose of this study is to investigate the risk factors of symptoms onset and clinical features in asymptomatic COVID-19 infected patients. Methods: A retrospective study was performed in 70 asymptomatic COVID-2019 infected patients confirmed by nucleic acid tests in Hunan province, China between 28 January 2020 and 18 February, 2020. The epidemiological, clinical features and laboratory data were reviewed and analyzed. Presence or absence at the onset of symptoms was taken as the outcome. A Cox regression model was performed to evaluate the potential predictors of the onset of symptoms. Results: The study included 36 males and 34 females with a mean age of 33.24±20.40 years (range, 0.5-84 years). There were 22 asymptomatic carriers developed symptoms during hospitalization isolated observation, and diagnosed as confirmed cases, while 48 cases remained asymptomatic throughout the course of disease. Of 70 asymptomatic patients, 14 (14/70, 20%) had underlying diseases, 3 (3/70, 4.3%) had drinking history, and 11 (11/70, 15.7%) had smoking history. 22 patients developed symptoms onset of fever (4/22, 18.2%), cough (13/22, 59.1%), chest discomfort (2/22, 9.1%), fatigue (1/22, 4.5%), pharyngalgia (1/22, 4.5%) during hospitalization; only one (1/22, 4.5%) patient developed signs of both cough and pharyngalgia. Abnormalities on chest CT were detected among 35 of the 69 patients (50.7%) after admission, except for one pregnant woman had not been examined. 4 (4/70, 5.7%) and 8 (8/70, 11.4%) cases showed leucopenia and lymphopenia. With the effective antiviral treatment, all the 70 asymptomatic infections had been discharged, none cases developed severe pneumonia, admission to intensive care unit, or died. The mean time from nucleic acid positive to negative was 13.2±6.84 days. Cox regression analysis showed that smoking history (P=0.028, hazard ratio=4.49, 95% CI 1.18-17.08) and existence of pulmonary disease (P=0.038, hazard ratio=7.09, 95% CI 1.12-44.90) were risk factors of the onset of symptoms in asymptomatic carries. Conclusion: The initially asymptomatic patients can develop mild symptoms and have a good prognosis. History of smoking and pulmonary disease was prone to illness onset in asymptomatic patients, and it is necessary to be highly vigilant to those patients.


Assuntos
Infecções Assintomáticas/epidemiologia , Infecções por Coronavirus/diagnóstico , Pneumopatias/epidemiologia , Pneumonia Viral/diagnóstico , Fumar/epidemiologia , Exacerbação dos Sintomas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antivirais/uso terapêutico , Criança , Pré-Escolar , China/epidemiologia , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Feminino , Humanos , Lactente , Pulmão/diagnóstico por imagem , Pneumopatias/complicações , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Gravidez , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Fumar/efeitos adversos , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Adulto Jovem
15.
PLoS One ; 15(9): e0239040, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32915911

RESUMO

BACKGROUND: Individuals with Down syndrome are predisposed to a number of chronic health conditions, but the relationship between these conditions and cognitive ability is not clear. The primary objective of this systematic review is to assess this relationship by evaluating studies that measure cognitive performance in the context of Down syndrome-associated chronic health conditions. METHODS: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Studies included in this review (1) included children, adolescent, and young adult participants with Down syndrome and one or more co-occurring health conditions; (2) were quantitative; and (3) reported outcomes related to both chronic health conditions and cognitive performance. A set of predetermined chronic health conditions that are common in Down syndrome (e.g. sleep disorders, congenital heart disease, thyroid disease, seizure disorders, and pulmonary hypertension) were selected based on prevalence rates in Down syndrome. RESULTS: Fifteen studies met inclusion criteria. The majority these of studies assessed cognitive performance in association with sleep disorders (47%) and congenital heart disease (47%). Fewer studies reported on the effect of thyroid disease (7%) and seizure disorders (7%) on cognitive ability. None of the studies reported cognitive outcomes related to pulmonary hypertension. Of the chronic health conditions evaluated, associations between sleep disorders and cognitive dysfunction were most common among individuals with Down syndrome. CONCLUSIONS: Individuals with Down syndrome exhibit deficits in cognitive ability, particularly related to attention, executive function and verbal processing. These deficits may be further exacerbated by the presence of chronic health conditions, particularly sleep disorders. Individuals with Down syndrome and co-occurring sleep disorders may benefit from early interventions to mitigate their risk for adverse cognitive outcomes.


Assuntos
Transtornos Cognitivos/complicações , Síndrome de Down/complicações , Síndrome de Down/psicologia , Adolescente , Doenças Cardiovasculares/complicações , Criança , Doença Crônica , Transtornos Cognitivos/psicologia , Epilepsia/complicações , Feminino , Humanos , Pneumopatias/complicações , Masculino , Transtornos do Sono-Vigília/complicações , Transtornos do Sono-Vigília/psicologia , Doenças da Glândula Tireoide/complicações , Adulto Jovem
16.
Acta pediátr. hondu ; 11(1): 1142-1147, abr.- sept. 2020.
Artigo em Espanhol | LILACS | ID: biblio-1145398

RESUMO

Las infecciones respiratorias agudas son causa de alta morbi-mortalidad a nivel mundial. El Coronavirus descubierto en Wuhan, China en el 2019 es de interés mundial por las diferentes manifestaciones clínicas que pueden aparecer en niños. Nuestro objetivo principal es revisar las manifestaciones del COVID-19 en el aparato respiratorio y los hallazgos a nivel radiológicos en pediatría. Se estiman que solo el 5,7% de los niños han sido hospitalizados, siendo los niños con comorbilidades y menores de 1 año los que suponen un riesgo mayor para enfermedad grave. A nivel global la mediana de edad de presentación de los casos es alrededor de 7 años, detectándose más casos a mayor edad, pero siendo la gravedad inversamente proporcional a la edad. La forma asintomática o leve son las presentaciones más comunes reportadas en niños, siendo de hasta en el 90% de los niños infectados. Los estudios de laboratorio pueden ser normales o presentar leucocitos alterados en un 69,2% y a nivel radiológico se ha observado en niños que en un 69% presentan opacidades bilaterales en vidrio despulido. En este momento, cualquier infección respiratoria aguda hay que descartar COVID-19, para poder evitar complicaciones en el paciente...(AU)


Assuntos
Humanos , Pré-Escolar , Criança , Adolescente , Vírus da SARS , Pneumopatias/complicações , Pneumonia/complicações , Infecções por Coronavirus
18.
Geriatr Gerontol Int ; 20(10): 878-884, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32770645

RESUMO

AIM: Spontaneous pneumothorax shows a bimodal age distribution, with the secondary peak including patients aged ≥50 years. The purpose of this study was to clarify the etiology and prognosis of spontaneous pneumothorax in the elderly. METHODS: Patients aged ≥50 years who were admitted to a tertiary university hospital between 2006 and 2016 due to spontaneous pneumothorax were retrospectively investigated. RESULTS: Among 136 consecutive patients aged ≥50 years with spontaneous pneumothorax (mean age, 70 years; 114 men), 124 (91%) had underlying lung diseases, including pulmonary emphysema (42%) and interstitial pneumonia (27%). The median period of thoracic drainage was longer (14 days) in the cases with interstitial pneumonia than in the cases of primary pneumothorax (4 days; P < 0.001) and emphysema (9 days; P < 0.005). Eighteen patients (13%) died within 180 days after the onset of pneumothorax. The mortality rate was highest in the cases with interstitial pneumonia (27%) and was mostly associated with infectious complications. Death or worsened respiratory failure within 180 days from admission was associated with older age, systemic corticosteroid use and interstitial pneumonia in multivariate logistic regression analysis. CONCLUSIONS: Pulmonary emphysema is the most common underlying disease associated with spontaneous pneumothorax in the elderly population. Pneumothorax associated with interstitial pneumonia is less frequent, but it requires prolonged tube thoracostomy and demonstrates higher mortality and morbidity, particularly in those receiving systemic corticosteroids. Different treatment strategies are warranted for patients with interstitial pneumonia-related pneumothorax. Geriatr Gerontol Int 2020; 20: 878-884.


Assuntos
Enfisema/complicações , Doenças Pulmonares Intersticiais/complicações , Pneumotórax/etiologia , Pneumotórax/terapia , Idoso , Idoso de 80 Anos ou mais , Feminino , Hospitalização , Humanos , Tempo de Internação , Pneumopatias/complicações , Masculino , Pessoa de Meia-Idade , Pneumotórax/mortalidade , Prognóstico , Doença Pulmonar Obstrutiva Crônica/complicações , Insuficiência Respiratória , Estudos Retrospectivos , Fatores de Risco , Toracostomia , Resultado do Tratamento
19.
Transplantation ; 104(8): 1720-1725, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32732852

RESUMO

BACKGROUND: The impact of opioid use in lung transplant candidates on posttransplant outcomes is unknown. Studies on opioid therapy in kidney and liver transplant candidates have suggested increased risk of graft failure or death. We sought to analyze the relationship between pretransplant opioid use in lung transplant candidates and retransplant-free survival. METHODS: We retrospectively reviewed adult patients transplanted consecutively between November 2004 and August 2015. The exposure was any opioid use at time of transplant listing and primary outcome was retransplant-free survival, analyzed via Cox regression model adjusted for recipient age, gender, ethnicity, diagnosis, and bridging status. Secondary outcomes included duration of ventilation, intensive care unit and hospital length of stay, 3-month and 1-year survival, continuing opioid use at 1 year, and time to onset of chronic lung allograft dysfunction. RESULTS: The prevalence of opioid use at time of listing was 14% (61/425). Median daily oral morphine equivalent dose was 31 mg (18-54). Recipient ethnicity was associated with pretransplant opioid use. Opioid use at time of listing did not increase risk of death or retransplantation in an adjusted model (hazard ratio 1.12 [95% confidence interval 0.65-1.83], P = 0.6570). Secondary outcomes were similar between groups except hospital length of stay (opioid users 35 versus nonusers 27 d, P = 0.014). Continued opioid use at 1-year posttransplant was common (27/56, 48%). CONCLUSIONS: Pretransplant opioid use was not associated with retransplant-free survival in our cohort and should not necessarily preclude listing. Further work stratifying opioid use by indication and the association with opioid use disorder would be worthwhile.


Assuntos
Analgésicos Opioides/efeitos adversos , Rejeição de Enxerto/epidemiologia , Pneumopatias/cirurgia , Transplante de Pulmão/efeitos adversos , Dor/tratamento farmacológico , Adulto , Aloenxertos/efeitos dos fármacos , Aloenxertos/fisiopatologia , Prescrições de Medicamentos/estatística & dados numéricos , Feminino , Seguimentos , Volume Expiratório Forçado/efeitos dos fármacos , Volume Expiratório Forçado/fisiologia , Rejeição de Enxerto/etiologia , Rejeição de Enxerto/fisiopatologia , Rejeição de Enxerto/cirurgia , Sobrevivência de Enxerto/efeitos dos fármacos , Sobrevivência de Enxerto/fisiologia , Humanos , Estimativa de Kaplan-Meier , Tempo de Internação/estatística & dados numéricos , Pulmão/efeitos dos fármacos , Pulmão/fisiopatologia , Pneumopatias/complicações , Pneumopatias/mortalidade , Transplante de Pulmão/normas , Masculino , Pessoa de Meia-Idade , Dor/etiologia , Período Pré-Operatório , Modelos de Riscos Proporcionais , Sistema de Registros/estatística & dados numéricos , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
20.
J Bras Pneumol ; 46(3): e20190280, 2020.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32638839

RESUMO

Palliative care was initially developed for patients with advanced cancer. The concept has evolved and now encompasses any life-threatening chronic disease. Studies carried out to compare end-of-life symptoms have shown that although symptoms such as pain and dyspnea are as prevalent in patients with lung disease as in patients with cancer, the former receive less palliative treatment than do the latter. There is a need to refute the idea that palliative care should be adopted only when curative treatment is no longer possible. Palliative care should be provided in conjunction with curative treatment at the time of diagnosis, by means of a joint decision-making process; that is, the patient and the physician should work together to plan the therapy, seeking to improve quality of life while reducing physical, psychological, and spiritual suffering.


Assuntos
Dispneia/terapia , Pneumopatias/terapia , Cuidados Paliativos , Pneumologia , Humanos , Pneumopatias/complicações , Dor , Manejo da Dor , Qualidade de Vida
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