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1.
Am Surg ; 85(9): 1051-1055, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31638523

RESUMO

This retrospective chart review demonstrates the relationship between bedside incentive spirometry (ICS) volumes and risk of pulmonary complications. Two hundred patients admitted for rib fractures between April and October 2016 were reviewed. The inclusion criteria were age 18-98 years, diagnosis of rib or sternal fractures, and no procedures requiring postoperative intubation within 48 hours of admission. The exclusion criteria were intubation before arrival, unable to participate in ICS, or previous tracheostomy. ICS volumes recorded in daily progress notes were collected. Of 200 charts reviewed, 154 met the inclusion criteria. In all, 25 endured at least one pulmonary complication. The average ICS on admission was 1355 cc. Patients who did not experience a complication had significantly higher admission ICS volumes than those who did (1441 ± 660 cc vs 920 ± 451 cc, P = 0.0003). They also achieved higher volumes at discharge (1705 ± 662 cc vs 1211 ± 453 cc, P = 0.006). The groups had similar demographics. An admission ICS volume <1 L was associated with 3.3× relative risk of pulmonary complication. Lower volumes were also associated with discharge to nonhome locations. Bedside ICS is a useful tool to identify patients at risk of pulmonary complications from rib fractures. Patients with admission ICS volume <1 L carry a higher risk of complication.


Assuntos
Pneumopatias/diagnóstico , Pneumopatias/etiologia , Testes Imediatos , Fraturas das Costelas/complicações , Espirometria , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco
3.
Expert Opin Investig Drugs ; 28(10): 891-902, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31550938

RESUMO

Introduction: Alpha-1 antitrypsin deficiency (AATD) is most often associated with chronic lung disease, early onset emphysema, and liver disease. The standard of care in lung disease due to AATD is alpha-1 antitrypsin augmentation but there are several new and emerging treatment options under investigation for both lung and liver manifestations. Areas covered: We review therapeutic approaches to lung and liver disease in alpha-1 antitrypsin deficiency (AATD) and the agents in clinical development according to their mode of action. The focus is on products in clinical trials, but data from pre-clinical studies are described where relevant, particularly where progression to trials appears likely. Expert opinion: Clinical trials directed at lung and liver disease separately are now taking place. Multimodality treatment may be the future, but this could be limited by treatment costs. The next 5-10 years may reveal new guidance on when to use therapeutics for slowing disease progression with personalized treatment regimes coming to the forefront.


Assuntos
Desenvolvimento de Medicamentos/métodos , Drogas em Investigação/administração & dosagem , Deficiência de alfa 1-Antitripsina/tratamento farmacológico , Animais , Progressão da Doença , Drogas em Investigação/farmacologia , Humanos , Hepatopatias/tratamento farmacológico , Hepatopatias/etiologia , Pneumopatias/tratamento farmacológico , Pneumopatias/etiologia , Medicina de Precisão/métodos , Deficiência de alfa 1-Antitripsina/fisiopatologia
4.
Medicine (Baltimore) ; 98(37): e17063, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31517827

RESUMO

BACKGROUND: This study will evaluate the effects of nursing intervention (NIV) on lung infection prevention (LIP) in patients with tracheotomy. METHODS: The electronic databases of MEDLINE, Cochrane Library, EMBASE, Web of Science, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure will be retrieved from inception to the June 1, 2019 for randomized controlled trials investigating the effects of NIV on LIP in patients with tracheotomy without any language limitations. In addition, we will also search grey literature to avoid missing any potential studies. Two independent authors will perform study selection, data extraction, and risk of bias evaluation. RESULTS: This study will investigate the effects of NIV on LIP in patients with tracheotomy. The primary outcome is incidence of lung infection. The secondary outcomes include pulmonary function, quality of life, and complications post-surgery. CONCLUSION: The results of this study will summarize recent evidence for the effects of NIV on LIP in patients with tracheotomy.No ethic approval is needed in this study, because it will not need any individual data. The results of this study will be published at a peer-reviewed journal.


Assuntos
Pneumopatias/prevenção & controle , Cuidados de Enfermagem , Complicações Pós-Operatórias/prevenção & controle , Infecções Respiratórias/prevenção & controle , Revisão Sistemática como Assunto , Traqueotomia , Humanos , Pneumopatias/etiologia , Metanálise como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Infecções Respiratórias/etiologia
6.
J Surg Orthop Adv ; 28(2): 137-143, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31411960

RESUMO

Timing of definitive fixation of femoral shaft fractures is a subject of continued controversy. The purpose of this study was to determine if early definitive fixation of femoral shaft fractures in the setting of polytrauma decreased the risk of pulmonary complications and mortality. The 2009-2012 National Sample Program of the National Trauma Data Bank was queried for all patients 18 to 65 years with Injury Severity Scores (ISS) >15 who underwent definitive fixation of femoral shaft fractures. Mortality, perioperative complications, and length of intensive care unit (ICU) and hospital stay were the primary outcome measures of interest. Following multivariate analyses, increased time to surgery was found to portend a statistically significant increased risk of acute respiratory distress syndrome(ARDS), mean ventilator time, length of ICU and hospital stay, and mortality. Earlier definitive fixation of femoral shaft fractures in the setting of polytrauma is associated with significantly decreased risk of ARDS, mean ventilator time, length of ICU and hospital stay, and mortality. (Journal of Surgical Orthopaedic Advances 28(2):137-143, 2019).


Assuntos
Fraturas do Fêmur , Pneumopatias , Traumatismo Múltiplo , Fraturas do Fêmur/complicações , Fraturas do Fêmur/cirurgia , Humanos , Escala de Gravidade do Ferimento , Tempo de Internação , Pneumopatias/etiologia , Pneumopatias/prevenção & controle , Traumatismo Múltiplo/terapia , Estudos Retrospectivos , Análise de Sobrevida
7.
Life Sci ; 233: 116711, 2019 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-31374233

RESUMO

AIMS: Insulin is a central peptide hormone required for carbohydrate metabolism; however, its role in diabetes-associated pulmonary disease is unknown. Here, we investigated the preventative effect of insulin against hyperglycemia-induced pulmonary vascular leakage and its molecular mechanism of action in the lungs of diabetic mice. MAIN METHODS: Vascular endothelial growth factor (VEGF) activated transglutaminase 2 (TGase2) by sequentially elevating intracellular Ca2+ and reactive oxygen species (ROS) levels in primary human pulmonary microvascular endothelial cells (HPMVECs). KEY FINDINGS: Insulin inhibited VEGF-induced TGase2 activation, but did not affect intracellular Ca2+ elevation and ROS generation. Insulin prevented VEGF-induced vascular leakage by inhibiting TGase2-mediated c-Src phosphorylation, disassembly of VE-cadherin and ß-catenin, and stress fiber formation. Insulin replacement therapy prevented hyperglycemia-induced TGase2 activation, but not ROS generation, in the lungs of diabetic mice. Insulin also prevented vascular leakage and cancer metastasis in the diabetic lung. Notably, vascular leakage was not detectable in the lungs of TGase2-null (Tgm2-/-) diabetic mice. SIGNIFICANCE: These findings demonstrate that insulin prevents hyperglycemia-induced pulmonary vascular leakage in diabetic mice by inhibiting VEGF-induced TGase2 activation rather than ROS generation.


Assuntos
Diabetes Mellitus Experimental/fisiopatologia , Proteínas de Ligação ao GTP/antagonistas & inibidores , Hemorragia/prevenção & controle , Hipoglicemiantes/farmacologia , Insulina/farmacologia , Pneumopatias/prevenção & controle , Transglutaminases/antagonistas & inibidores , Animais , Proteínas de Ligação ao GTP/fisiologia , Hemorragia/etiologia , Hemorragia/patologia , Humanos , Pneumopatias/etiologia , Pneumopatias/patologia , Neoplasias Pulmonares/metabolismo , Neoplasias Pulmonares/prevenção & controle , Neoplasias Pulmonares/secundário , Masculino , Melanoma Experimental/metabolismo , Melanoma Experimental/patologia , Melanoma Experimental/prevenção & controle , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Transglutaminases/fisiologia , Células Tumorais Cultivadas
8.
Br J Radiol ; 92(1103): 20190448, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31335170

RESUMO

Immunoglobulin G4-related disease (IgG4-RD) is an autoimmune disorder characterized by the infiltration of one or more organs with IgG4-positive plasma cells resulting in inflammatory lesions and fibrosis. Although the pancreas is the most commonly affected organ, involvement of extrapancreatic organs is an increasingly recognized manifestation of the disease. Patients may be asymptomatic and serum IgG4 concentrations may be elevated or normal. Treatment consists of glucocorticosteroid treatment, with excellent response. A definitive diagnosis requires histopathology with imaging playing a key role in avoiding treatment delays. This pictorial review will focus on the most current knowledge regarding IgG4-RD including its common and less common manifestations and the roles of multidetector CT, MRI and ultrasound in the diagnosis and management of suspected IgG4-RD. Knowledge of the varied imaging findings of this multi systemic disease is essential for radiologists to avoid misdiagnosis and assist with timely and effective treatment.


Assuntos
Doença Relacionada a Imunoglobulina G4/complicações , Adulto , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/etiologia , Dacriocistite/diagnóstico , Dacriocistite/etiologia , Feminino , Doenças da Vesícula Biliar/diagnóstico , Doenças da Vesícula Biliar/etiologia , Humanos , Doença Relacionada a Imunoglobulina G4/diagnóstico , Nefropatias/diagnóstico , Nefropatias/etiologia , Pneumopatias/diagnóstico , Pneumopatias/etiologia , Imagem por Ressonância Magnética , Masculino , Mastite/diagnóstico , Mastite/etiologia , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores , Pseudotumor Orbitário/diagnóstico , Pseudotumor Orbitário/etiologia , Pancreatopatias/diagnóstico , Pancreatopatias/etiologia , Fibrose Retroperitoneal/diagnóstico , Fibrose Retroperitoneal/etiologia , Sialadenite/diagnóstico , Sialadenite/etiologia , Ultrassonografia
9.
Zhonghua Er Ke Za Zhi ; 57(8): 620-624, 2019 Aug 02.
Artigo em Chinês | MEDLINE | ID: mdl-31352748

RESUMO

Objective: To improve the awareness of methylmalonic acidemia and hyperhomocysteinemia with diffuse lung disease as an initial or main presentation. Methods: A retrospective analysis of the clinical manifestations, radiological features, laboratory tests, genetic variations, treatments and prognoses was conducted in six children presented with diffuse lung disease and finally diagnosed with methylmalonic acidemia and hyperhomocysteinemia in Ward 2 of Department of Respiratory Diseases, Beijing Children's Hospital, from August 2017 to November 2018. Results: Six children were included in this study. Two children were male and four were female. The average age of onset was 28 months. The mean age at diagnosis was 34 months. The average interval from onset to diagnosis was 6 months. Four children who underwent genetic tests were found to have variants of gene MMACHC and diagnosed with CblC type. All children had respiratory symptoms and signs as initial or main presentation, which were tachypnea (5 cases), exercise intolerance (5 cases), cough (4 cases), cyanosis (4 cases), clubbing (4 cases), dyspnea (3 cases) and retractions (3 cases). Pulmonary arterial hypertension was found in all six children. Pericardial effusion (4 cases), kidney involvement (3 cases), nervous system involvement (3 cases), gastrointestinal system involvement (3 cases) and anemia (2 cases) also coexisted. The high resolution computed tomography (HRCT) features included dilated pulmonary artery (6 cases), ground-glass opacities (4 cases), diffuse poorly defined ground-glass centrilobular nodules (3 cases), pleural effusion (3 cases), thickening of interlobular septum (2 cases), etc. All children had an elevated concentration of methylmalonic acid in urine and homocysteine in plasma. Genetic tests were performed in four patients, and MMACHC genetic mutations were found in all of them. Clinical manifestations, HRCT features and pulmonary arterial hypertension turned better in five children after treatment. One patient who was not regularly followed-up died. Conclusions: Pulmonary involvement including diffuse lung disease and pulmonary arterial hypertension could coexist with methylmalonic acidemia and hyperhomocysteinemia, which may have respiratory symptoms and signs as the initial or main presentation. Characteristic HRCT features were found in some patients. Plasma homocysteine test is a quick method for screening the disease in children with diffuse lung disease and (or) pulmonary arterial hypertension. Both diffuse lung disease and pulmonary arterial hypertension may turn better after treatment.


Assuntos
Erros Inatos do Metabolismo dos Aminoácidos/diagnóstico , Hiper-Homocisteinemia/diagnóstico , Pneumopatias/etiologia , Pulmão/fisiopatologia , Artéria Pulmonar/diagnóstico por imagem , Idade de Início , Erros Inatos do Metabolismo dos Aminoácidos/urina , Proteínas de Transporte , Criança , Pré-Escolar , Feminino , Humanos , Hiper-Homocisteinemia/sangue , Lactente , Masculino , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
10.
Khirurgiia (Mosk) ; (6): 101-106, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31317948

RESUMO

Aorto-esophageal and aorto-bronchial fistulas are rare and life-threatening diseases if emergency treatment is absent. The most of publications devoted to this problem are case reports describing successful treatment of patients with aorto-esophageal and aorto-bronchial fistulas by using of endovascular or open transthoracic surgery. However, we did not find reports of several aortic fistulas in a patient after previous aortic stenting. It is presented case report of patient with aorto-esophago-bronchial and aorto-pulmonary fistulas in postoperative period after thoracic endovascular aortic repair (TEVAR).


Assuntos
Aneurisma da Aorta Torácica/cirurgia , Fístula Brônquica/etiologia , Procedimentos Endovasculares/efeitos adversos , Fístula Esofágica/etiologia , Pneumopatias/etiologia , Fístula Vascular/etiologia , Aneurisma da Aorta Torácica/complicações , Doenças da Aorta/etiologia , Doenças da Aorta/cirurgia , Fístula Brônquica/cirurgia , Procedimentos Endovasculares/métodos , Fístula Esofágica/cirurgia , Humanos , Pneumopatias/cirurgia , Fístula do Sistema Respiratório/etiologia , Fístula do Sistema Respiratório/cirurgia , Fístula Vascular/cirurgia
11.
Virchows Arch ; 475(3): 335-340, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31254069

RESUMO

Pulmonary dirofilariasis is an infection caused by Dirofilaria immitis, which is an endemic parasite in Japan. We experienced 13 surgical cases of pulmonary dirofilariasis in our hospital. Of the 13 patients, 61.5% were men. The responsible lesions were located in the right lung in all cases, and 76.9% of them were in the lower lobe. Histologically, 12 cases showed necrotic nodules with peripheral granuloma with worms inside the pulmonary artery. One case did not show a necrotic nodule but showed only thickening and hyalinization of the pulmonary artery wall with a degenerated worm inside. Eosinophils were found histologically in all cases. Thirteen cases of dirofilariasis in one institution seem to be the largest number in Japan, based on previous reports. One reason for this increased prevalence may be the hot and humid climate of our prefecture considering the ecology of the mosquito as a vector. Elastic staining and eosinophils in peripheral granulomatous areas can contribute to the diagnosis when the worms are degenerated.


Assuntos
Dirofilariose/diagnóstico , Dirofilariose/patologia , Pneumopatias/metabolismo , Adulto , Idoso , Animais , Diagnóstico Diferencial , Dirofilaria immitis/patogenicidade , Dirofilariose/etiologia , Eosinófilos/patologia , Feminino , Cardiopatias/patologia , Humanos , Japão , Pulmão/patologia , Pneumopatias/etiologia , Pneumopatias Parasitárias/patologia , Masculino , Pessoa de Meia-Idade
12.
JAMA ; 321(23): 2292-2305, 2019 06 18.
Artigo em Inglês | MEDLINE | ID: mdl-31157366

RESUMO

Importance: An intraoperative higher level of positive end-expiratory positive pressure (PEEP) with alveolar recruitment maneuvers improves respiratory function in obese patients undergoing surgery, but the effect on clinical outcomes is uncertain. Objective: To determine whether a higher level of PEEP with alveolar recruitment maneuvers decreases postoperative pulmonary complications in obese patients undergoing surgery compared with a lower level of PEEP. Design, Setting, and Participants: Randomized clinical trial of 2013 adults with body mass indices of 35 or greater and substantial risk for postoperative pulmonary complications who were undergoing noncardiac, nonneurological surgery under general anesthesia. The trial was conducted at 77 sites in 23 countries from July 2014-February 2018; final follow-up: May 2018. Interventions: Patients were randomized to the high level of PEEP group (n = 989), consisting of a PEEP level of 12 cm H2O with alveolar recruitment maneuvers (a stepwise increase of tidal volume and eventually PEEP) or to the low level of PEEP group (n = 987), consisting of a PEEP level of 4 cm H2O. All patients received volume-controlled ventilation with a tidal volume of 7 mL/kg of predicted body weight. Main Outcomes and Measures: The primary outcome was a composite of pulmonary complications within the first 5 postoperative days, including respiratory failure, acute respiratory distress syndrome, bronchospasm, new pulmonary infiltrates, pulmonary infection, aspiration pneumonitis, pleural effusion, atelectasis, cardiopulmonary edema, and pneumothorax. Among the 9 prespecified secondary outcomes, 3 were intraoperative complications, including hypoxemia (oxygen desaturation with Spo2 ≤92% for >1 minute). Results: Among 2013 adults who were randomized, 1976 (98.2%) completed the trial (mean age, 48.8 years; 1381 [69.9%] women; 1778 [90.1%] underwent abdominal operations). In the intention-to-treat analysis, the primary outcome occurred in 211 of 989 patients (21.3%) in the high level of PEEP group compared with 233 of 987 patients (23.6%) in the low level of PEEP group (difference, -2.3% [95% CI, -5.9% to 1.4%]; risk ratio, 0.93 [95% CI, 0.83 to 1.04]; P = .23). Among the 9 prespecified secondary outcomes, 6 were not significantly different between the high and low level of PEEP groups, and 3 were significantly different, including fewer patients with hypoxemia (5.0% in the high level of PEEP group vs 13.6% in the low level of PEEP group; difference, -8.6% [95% CI, -11.1% to 6.1%]; P < .001). Conclusions and Relevance: Among obese patients undergoing surgery under general anesthesia, an intraoperative mechanical ventilation strategy with a higher level of PEEP and alveolar recruitment maneuvers, compared with a strategy with a lower level of PEEP, did not reduce postoperative pulmonary complications. Trial Registration: ClinicalTrials.gov Identifier: NCT02148692.


Assuntos
Cuidados Intraoperatórios , Pneumopatias/prevenção & controle , Obesidade/complicações , Respiração com Pressão Positiva/métodos , Complicações Pós-Operatórias/prevenção & controle , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Adulto , Anestesia Geral , Índice de Massa Corporal , Feminino , Humanos , Pneumopatias/etiologia , Masculino , Pessoa de Meia-Idade , Doenças Pleurais/etiologia , Doenças Pleurais/prevenção & controle , Atelectasia Pulmonar/terapia , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/prevenção & controle , Volume de Ventilação Pulmonar , Resultado do Tratamento
13.
Vet Clin North Am Equine Pract ; 35(2): 339-350, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31084976

RESUMO

Exercise-induced pulmonary hemorrhage (EIPH) occurs commonly in horses undergoing strenuous exercise. Reported risk factors include racing in cold temperatures and wearing of bar shoes. In horses with documented moderate to severe EIPH, increasing the interval between races and adopting a negative race pace strategy may reduce the severity of EIPH in subsequent races. EIPH seems to have an impact on performance only when moderate to severe. This occurs in a small number of starters, approximately 6%. EIPH often is erratic in severity from race to race, although across a population it is weakly progressive over increasing race starts.


Assuntos
Hemorragia/veterinária , Doenças dos Cavalos/prevenção & controle , Pneumopatias/veterinária , Condicionamento Físico Animal/efeitos adversos , Animais , Hemorragia/etiologia , Hemorragia/prevenção & controle , Doenças dos Cavalos/etiologia , Cavalos , Pneumopatias/etiologia , Pneumopatias/prevenção & controle , Esforço Físico , Fatores de Risco
14.
Vet J ; 248: 91-94, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31113571

RESUMO

Pulmonary haemorrhage occurs in sport horses performing high-intensity exercise, but the factors involved in the occurrence of pulmonary haemorrhage in jumping horses have not been elucidated. This study aimed to determine the occurrence of pulmonary haemorrhage and factors involved in competitive jumping horses. Fifty adult jumping horses competing in the city of São Paulo, Brazil, were included. The horses were divided into two groups based on jump height at competition: Low group (LG, n=26), with jump height between 1.00 and 1.20m, and High group (HG, n=24), with jump height between 1.30 and 1.50m. Physical examination was performed before and after competition, and airway endoscopy and tracheal wash (TW) were performed 1h after competition. Heart rate (HR; P<0.010), respiratory rate (RR; P<0.010), rectal temperature (RT; P<0.010), and frequency of endoscopic observations of blood in the tracheal lumen (P<0.013) were significantly higher in HG than in LG. TW cytology was not different between the two groups. Incidence of pulmonary haemorrhage was positively correlated with jump height (r2=0.40, P<0.0001), post-exercise HR (r2=0.31, P<0.0001), and post-exercise RR (r2=0.19, P<0.002). In conclusion, pulmonary haemorrhage in jumping horses was associated with the level of performance. Further studies on the pathophysiology of exercise-induced pulmonary haemorrhage in this type of horses are required.


Assuntos
Hemorragia/veterinária , Doenças dos Cavalos/etiologia , Pneumopatias/veterinária , Condicionamento Físico Animal/efeitos adversos , Animais , Feminino , Hemorragia/etiologia , Cavalos , Pneumopatias/etiologia , Masculino , Esportes
15.
Zhonghua Wai Ke Za Zhi ; 57(6): 440-446, 2019 Jun 01.
Artigo em Chinês | MEDLINE | ID: mdl-31142069

RESUMO

Objective: To investigate the effect of perioperative fluid therapy on early postoperative pulmonary complication (PPC) after orthotopic liver transplantation (OLT). Methods: The clinical data of 132 patients who underwent OLT in the First Affiliated Hospital of Xi'an Jiaotong University from April 2016 to December 2017 were analyzed retrospectively. These patients included 96 males and 36 females, aged (47.3±9.6) years (range: 24-69 years). Based on the clinical manifestations, laboratory and imaging findings of patients in ICU and PPC occurrence within 7 days after OLT surgery, the patients were divided into 2 groups: non-PPC group and PPC group. Univariate and multivariate logistic regression analyses were used to evaluate the association between perioperative variables and PPC. The Kaplan-Meier method was used to estimate cumulative survival of recipients with or without PPC within 2-years. Results: During the follow-up, 11 patients (8.3%) died and 72 patients (54.5%) developed PPC after operation. There were 34 cases, 6 cases, 3 cases, 4 cases, 15 cases, 6 cases and 4 cases of only pleural effusion, only pulmonary edema, only pneumonia, pleural effusion with pneumonia, pleural effusion with pulmonary edema, pleural effusion with atelectasis, and pleural effusion with pneumonia and pneumonia in PPC, respectively. Univariate analysis showed that the preoperative factors (model for end-stage liver disease score), the intra-operative factors (duration of surgery, total infusion volume, total blood products) and the postoperative cumulative fluid balance within the first 24 h, 48 h, and 72 h were the prognosis factors of PPC (P<0.05). At least two out of the first three postoperative days with a fluid balance of ≤-500 ml was a protective factor. Using multivariate analysis by Logistic regression, only the red blood units >10 U (OR=3.55, 95% CI: 1.35-9.26, P=0.010) and the cumulative fluid intake >12 L (OR=2.98, 95% CI: 1.14-7.80, P=0.026) within the first 72 h after operation were independent prognosis factors of PPC after OLT. Kaplan-Meier analysis showed that the cumulative survival rate was lower in PPC group than that in non-PPC group (χ(2)=6.590, P=0.01). Conclusion: Massive red blood cell transfusion and the cumulative fluid volume >12 L during perioperative 72 hours are independent prognosis factors of PPC after OLT.


Assuntos
Doença Hepática Terminal/cirurgia , Hidratação/efeitos adversos , Transplante de Fígado/efeitos adversos , Pneumopatias/etiologia , Adulto , Idoso , Transfusão de Eritrócitos/efeitos adversos , Feminino , Hidratação/métodos , Humanos , Transplante de Fígado/métodos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
16.
BMC Infect Dis ; 19(1): 451, 2019 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-31113404

RESUMO

BACKGROUND: The emergence of leptospirosis-associated severe pulmonary hemorrhagic syndrome (SPHS) with high case fatality has been reported from many countries. Understanding of clinical disease and sequel of SPHS needs larger studies with adequate numbers. The purpose of this study was to describe the characteristics and sequel by different therapeutic approaches for SPHS in Leptospirosis in Sri Lanka. METHODS: This study was conducted at Teaching Hospital-Karapitiya (THK), Galle, Sri Lanka from June 2015 to December 2017. THK is the main tertiary care center for the Southern Province. All confirmed-cases of leptospirosis who presented during this period and were admitted to five medical units of THK were included in this study. SPHS was defined as a patient presenting; haemoptysis, arterial hypoxemia (Acute Lung Injury Score < 2.5), haemoglobin drop (10% from the previous value), or diffused alveolar shadows in the chest radiograph, without alternative explanation other than leptospirosis. RESULTS: Of the 128 MAT confirmed cases of leptospirosis, 111 (86.7%) had acute kidney injury (AKI) whilst SPHS was seen in 80 (62.5%). Patients typically developed SPHS within the first week of illness, mostly on days 4 and 5. The case fatality rate of this study sample was 28.1% (n = 36), while for patients with SPHS, it was 41.5%. Most of the deaths (n = 19) were within the first 3 days of admission (on the same day 8, and within next 48 h 11). Among SPHS patients, 59 received therapeutic plasma exchange (TPE). The survival rate was higher (n = 35, 74.5%) when the TPE was performed within the first 48 h of detecting SPHS compared to patients in whom the procedure was done after 48 h (n = 5, 54.5%). Of the 19 leptosprosis patients with SPHS who did not receive TPE, 17 died (89.5%). However, the group of patients who received TPE was primarily the patients survived beyond day 3. CONCLUSIONS: We observed that during the study period, SPHS was common and the mortality rate was higher in the study area. The treatment modalities tested need further evaluation and confirmation.


Assuntos
Hemorragia/etiologia , Leptospirose/complicações , Pneumopatias/etiologia , Lesão Renal Aguda/etiologia , Lesão Renal Aguda/terapia , Adulto , Feminino , Hemorragia/mortalidade , Hemorragia/terapia , Hospitais de Ensino/estatística & dados numéricos , Humanos , Imunoglobulinas/uso terapêutico , Leptospirose/mortalidade , Leptospirose/terapia , Pneumopatias/mortalidade , Pneumopatias/terapia , Masculino , Pessoa de Meia-Idade , Mortalidade , Troca Plasmática , Sri Lanka/epidemiologia , Síndrome
17.
Med Clin North Am ; 103(3): 535-548, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30955520

RESUMO

Occupational exposures are a major cause of lung disease and disability worldwide. This article reviews the broad range of types of occupational lung diseases, including airways disease, pneumoconioses, and cancer. Common causes of occupational lung disease are reviewed with specific examples and clinical features. Emphasis on the importance of a detailed history to make an accurate diagnosis of an occupational lung disease is discussed.


Assuntos
Pneumopatias/diagnóstico , Doenças Profissionais/diagnóstico , Exposição Ocupacional/efeitos adversos , Asma/diagnóstico , Asma/etiologia , Humanos , Pneumopatias/etiologia , Doenças Profissionais/etiologia , Pneumoconiose/diagnóstico , Pneumoconiose/etiologia
19.
Br J Hosp Med (Lond) ; 80(4): 211-215, 2019 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-30951418

RESUMO

This literature review clarifies the role of radiotherapy in the management of low-volume haemoptysis. Embase and Medline were interrogated, and PRISMA guidelines were then used to select relevant articles. Seventy-eight articles were considered relevant and manually reviewed. The evidence suggests that external beam radiotherapy is more effective than endobronchial brachytherapy at controlling low-volume haemoptysis. There is no evidence to recommend a combination of the two techniques. Different doses and fractionations appear equally effective, with a potential survival advantage of higher dose regimens for fitter patients. Palliative radiotherapy is effective at controlling low-volume haemoptysis. External beam radiotherapy is the first-line treatment, with endobronchial brachytherapy recommended following external beam radiotherapy failure. Choice of dose and fractionation should take into account the patient's performance status.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/radioterapia , Hemoptise/radioterapia , Hemorragia/radioterapia , Neoplasias Pulmonares/radioterapia , Carcinoma de Pequenas Células do Pulmão/radioterapia , Braquiterapia , Broncoscopia , Carcinoma Pulmonar de Células não Pequenas/complicações , Fracionamento da Dose de Radiação , Hemoptise/etiologia , Hemorragia/etiologia , Humanos , Pneumopatias/etiologia , Pneumopatias/radioterapia , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/secundário , Cuidados Paliativos , Carcinoma de Pequenas Células do Pulmão/complicações
20.
PLoS Pathog ; 15(3): e1007595, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30845208

RESUMO

Despite a broad cell-type tropism, cytomegalovirus (CMV) is an evidentially pulmonary pathogen. Predilection for the lungs is of medical relevance in immunocompromised recipients of hematopoietic cell transplantation, in whom interstitial CMV pneumonia is a frequent and, if left untreated, fatal clinical manifestation of human CMV infection. A conceivable contribution of CMV to airway diseases of other etiology is an issue that so far attracted little medical attention. As the route of primary CMV infection upon host-to-host transmission in early childhood involves airway mucosa, coincidence of CMV airway infection and exposure to airborne environmental antigens is almost unavoidable. For investigating possible consequences of such a coincidence, we established a mouse model of airway co-exposure to CMV and ovalbumin (OVA) representing a protein antigen of an inherently low allergenic potential. Accordingly, intratracheal OVA exposure alone failed to sensitize for allergic airway disease (AAD) upon OVA aerosol challenge. In contrast, airway infection at the time of OVA sensitization predisposed for AAD that was characterized by airway inflammation, IgE secretion, thickening of airway epithelia, and goblet cell hyperplasia. This AAD histopathology was associated with a T helper type 2 (Th2) transcription profile in the lungs, including IL-4, IL-5, IL-9, and IL-25, known inducers of Th2-driven AAD. These symptoms were all prevented by a pre-challenge depletion of CD4+ T cells, but not of CD8+ T cells. As to the underlying mechanism, murine CMV activated migratory CD11b+ as well as CD103+ conventional dendritic cells (cDCs), which have been associated with Th2 cytokine-driven AAD and with antigen cross-presentation, respectively. This resulted in an enhanced OVA uptake and recruitment of the OVA-laden cDCs selectively to the draining tracheal lymph nodes for antigen presentation. We thus propose that CMV, through activation of migratory cDCs in the airway mucosa, can enhance the allergenic potential of otherwise poorly allergenic environmental protein antigens.


Assuntos
Alérgenos/metabolismo , Citomegalovirus/metabolismo , Células Dendríticas/imunologia , Alérgenos/efeitos adversos , Animais , Apresentação do Antígeno/imunologia , Antígenos CD11/imunologia , Citomegalovirus/patogenicidade , Células Dendríticas/microbiologia , Modelos Animais de Doenças , Feminino , Hipersensibilidade , Inflamação , Pulmão/fisiopatologia , Pulmão/virologia , Pneumopatias/etiologia , Pneumopatias/virologia , Camundongos , Camundongos Endogâmicos C57BL , Ovalbumina , Células Th2 , Ativação Viral/imunologia
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