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1.
G Ital Cardiol (Rome) ; 22(7): 529-534, 2021 Jul.
Artigo em Italiano | MEDLINE | ID: mdl-34175907

RESUMO

Growing evidence about COVID-19 and its possible cardiopulmonary complications have raised concerns about a potential subclinical heart damage even in asymptomatic patients. Many countries worldwide provided recommendations for a safe return to play and sports activity for athletes with previous COVID-19 disease. Italy was among the first nations to deal with the problem of protecting athletes' health. In this regard, after an initial version released on April 2020, on December 11, 2020 the Italian Sports Medicine Federation (FMSI) updated the recommendations for the return play of non-professional athletes. The purpose of this article is to analyze and deepen the contents of the new FMSI recommendations, integrating and comparing them with the previous ones. Further updates may occur if new scientific and epidemiological evidence will rise regarding COVID-19.


Assuntos
COVID-19 , Volta ao Esporte/normas , COVID-19/complicações , Cardiopatias/etiologia , Humanos , Itália , Pneumopatias/etiologia , Guias de Prática Clínica como Assunto
2.
Int J Mol Sci ; 22(9)2021 May 09.
Artigo em Inglês | MEDLINE | ID: mdl-34065111

RESUMO

Dysregulated protease activity has long been implicated in the pathogenesis of chronic lung diseases and especially in conditions that display mucus obstruction, such as chronic obstructive pulmonary disease, cystic fibrosis, and non-cystic fibrosis bronchiectasis. However, our appreciation of the roles of proteases in various aspects of such diseases continues to grow. Patients with muco-obstructive lung disease experience progressive spirals of inflammation, mucostasis, airway infection and lung function decline. Some therapies exist for the treatment of these symptoms, but they are unable to halt disease progression and patients may benefit from novel adjunct therapies. In this review, we highlight how proteases act as multifunctional enzymes that are vital for normal airway homeostasis but, when their activity becomes immoderate, also directly contribute to airway dysfunction, and impair the processes that could resolve disease. We focus on how proteases regulate the state of mucus at the airway surface, impair mucociliary clearance and ultimately, promote mucostasis. We discuss how, in parallel, proteases are able to promote an inflammatory environment in the airways by mediating proinflammatory signalling, compromising host defence mechanisms and perpetuating their own proteolytic activity causing structural lung damage. Finally, we discuss some possible reasons for the clinical inefficacy of protease inhibitors to date and propose that, especially in a combination therapy approach, proteases represent attractive therapeutic targets for muco-obstructive lung diseases.


Assuntos
Imunidade nas Mucosas , Pneumopatias/etiologia , Pneumopatias/metabolismo , Muco/metabolismo , Peptídeo Hidrolases/metabolismo , Animais , Doença Crônica , Cílios/imunologia , Cílios/metabolismo , Suscetibilidade a Doenças , Humanos , Transporte de Íons , Pneumopatias/diagnóstico , Mucosa Respiratória/imunologia , Mucosa Respiratória/metabolismo , Mucosa Respiratória/patologia , Transdução de Sinais
3.
BMJ Case Rep ; 14(6)2021 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-34155024

RESUMO

A 40-year-old man developed granulomatosis with polyangiitis (GPA) following a mild case of COVID-19. Initially, he experienced mild migrating joint pain for 2 months prior to testing positive for SARS-CoV-2 but dramatically worsened following resolution of his infection. The pain continued to progress until he suddenly develope haemoptysis, prompting him to present to a local hospital. The diagnosis of diffuse alveolar haemorrhage secondary to GPA was confirmed with labs, imaging and histopathology. Precipitous deterioration of GPA with concurrent COVID-19 infection indicates a possible temporal relationship. Since the onset of the pandemic, SARS-CoV-2 has been anecdotally associated with the development of various connective tissue disorders. The overlapping clinical presentations and similar appearance on lung imaging present clinicians with a diagnostic challenge. This underscores the importance of having a high index of suspicion of autoimmune diagnoses in patients who present with new or worsening findings following a COVID-19 infection.


Assuntos
COVID-19 , Granulomatose com Poliangiite , Pneumopatias , Adulto , Granulomatose com Poliangiite/complicações , Granulomatose com Poliangiite/diagnóstico , Hemorragia/etiologia , Humanos , Pneumopatias/diagnóstico por imagem , Pneumopatias/etiologia , Masculino , SARS-CoV-2
4.
Front Immunol ; 12: 675169, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33953732

RESUMO

Innate lymphoid type-2 cells (ILC2) are a population of innate cells of lymphoid origin that are known to drive strong Type 2 immunity. ILC2 play a key role in lung homeostasis, repair/remodeling of lung structures following injury, and initiation of inflammation as well as more complex roles during the immune response, including the transition from innate to adaptive immunity. Remarkably, dysregulation of this single population has been linked with chronic lung pathologies, including asthma, chronic obstructive pulmonary disease (COPD) and idiopathic pulmonary fibrotic diseases (IPF). Furthermore, ILC2 have been shown to increase following early-life respiratory viral infections, such as respiratory syncytial virus (RSV) and rhinovirus (RV), that may lead to long-term alterations of the lung environment. The detrimental roles of increased ILC2 following these infections may include pathogenic chronic inflammation and/or alterations of the structural, repair, and even developmental processes of the lung. Respiratory viral infections in older adults and patients with established chronic pulmonary diseases often lead to exacerbated responses, likely due to previous exposures that leave the lung in a dysregulated functional and structural state. This review will focus on the role of ILC2 during respiratory viral exposures and their effects on the induction and regulation of lung pathogenesis. We aim to provide insight into ILC2-driven mechanisms that may enhance lung-associated diseases throughout life. Understanding these mechanisms will help identify better treatment options to limit not only viral infection severity but also protect against the development and/or exacerbation of other lung pathologies linked to severe respiratory viral infections.


Assuntos
Imunidade Inata , Pneumopatias/etiologia , Pneumopatias/metabolismo , Subpopulações de Linfócitos/imunologia , Subpopulações de Linfócitos/metabolismo , Viroses/complicações , Viroses/virologia , Imunidade Adaptativa , Animais , Biomarcadores , Progressão da Doença , Suscetibilidade a Doenças , Interações Hospedeiro-Patógeno/genética , Interações Hospedeiro-Patógeno/imunologia , Humanos , Pneumopatias/diagnóstico , Subpopulações de Linfócitos T/imunologia , Subpopulações de Linfócitos T/metabolismo
5.
Eur J Pharmacol ; 904: 174196, 2021 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-34004207

RESUMO

Severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2), the responsible agent for the coronavirus disease 2019 (Covid-19), has its entry point through interaction with angiotensin converting enzyme 2 (ACE2) receptors, highly expressed in lung type II alveolar cells and other tissues, like heart, pancreas, brain, and vascular endothelium. This review aimed to elucidate the potential role of leukotrienes (LTs) in the pathogenesis and clinical presentation of SARS-CoV-2 infection, and to reveal the critical role of LT pathway receptor antagonists and inhibitors in Covid-19 management. A literature search was done in PubMed, Scopus, Web of Science and Google Scholar databases to find the potential role of montelukast and other LT inhibitors in the management of pulmonary and extra-pulmonary manifestations triggered by SARS-CoV-2. Data obtained so far underline that pulmonary and extra-pulmonary manifestations in Covid-19 are attributed to a direct effect of SARS-CoV-2 in expressed ACE2 receptors or indirectly through NF-κB dependent induction of a cytokine storm. Montelukast can ameliorate extra-pulmonary manifestations in Covid-19 either directly through blocking of Cys-LTRs in different organs or indirectly through inhibition of the NF-κB signaling pathway.


Assuntos
Acetatos/uso terapêutico , COVID-19/tratamento farmacológico , Ciclopropanos/uso terapêutico , Antagonistas de Leucotrienos/uso terapêutico , Leucotrienos , Pneumopatias/tratamento farmacológico , Quinolinas/uso terapêutico , Transdução de Sinais/efeitos dos fármacos , Sulfetos/uso terapêutico , COVID-19/complicações , Síndrome da Liberação de Citocina/tratamento farmacológico , Síndrome da Liberação de Citocina/etiologia , Humanos , Pneumopatias/etiologia , Receptores de Leucotrienos/efeitos dos fármacos
6.
J Clin Neurosci ; 88: 178-184, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33992181

RESUMO

This study investigated whether the rib cage parameters estimated based on reconstructed three-dimensional (3D) images with biplanar stereoradiography reflect pulmonary functional states in adolescent idiopathic scoliosis (AIS) patients. A total of 67 Lenke type 1 or 2 AIS patients (59 females and 8 males, mean age 14.4 years) were enrolled. All patients underwent preoperative pulmonary functional tests (PFT) and biplanar stereoradiography. Vital capacity (VC) and forced vital capacity (FVC) pulmonary functional data were collected. Rib-cage parameters (maximum thickness, maximum width, thoracic index (TI), rib hump (RH), rib-cage volume (RCV), spinal penetration index (SPI), endothoracic hump ratio (EHR), vertebra-sternum angle (VSA), rib vertebral angle difference (RVAD), and vertebral lateral decentering (VLD)) were quantified from 3D images. Patients were divided into two groups: restrictive lung disorder (RLD) (%FVC < 80%) and non-RLD (%FVC ≥ 80%). The maximum width and RCV were significantly correlated with VC (p < 0.0001), and FVC (p < 0.0001). RH, EHR, and VSA were negatively correlated with %FVC (p < 0.01). TI, SPI, and RVAD were not correlated with any pulmonary parameters. The maximum widths of RLD patients were significantly shorter than those of the non-RLD patients (218.3 mm vs. 229.7 mm, p < 0.01). The RCV of RLD patients was significantly smaller than that of the non-RLD patients (3.94 L vs. 4.49 L, p < 0.0001). The maximum width and RCV measured by 3D images with biplanar stereoradiography reflected pulmonary functional variables in patients with AIS.


Assuntos
Interpretação de Imagem Assistida por Computador/métodos , Imageamento Tridimensional/métodos , Pneumopatias/diagnóstico por imagem , Caixa Torácica/diagnóstico por imagem , Escoliose/complicações , Adolescente , Criança , Feminino , Humanos , Pulmão/fisiopatologia , Pneumopatias/etiologia , Masculino , Testes de Função Respiratória , Escoliose/cirurgia , Vértebras Torácicas/cirurgia
7.
Molecules ; 26(9)2021 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-33946997

RESUMO

The aim of the present study was to compare the efficiency of targeted and untargeted breath analysis in the discrimination of lung cancer (Ca+) patients from healthy people (HC) and patients with benign pulmonary diseases (Ca-). Exhaled breath samples from 49 Ca+ patients, 36 Ca- patients and 52 healthy controls (HC) were analyzed by an SPME-GC-MS method. Untargeted treatment of the acquired data was performed with the use of the web-based platform XCMS Online combined with manual reprocessing of raw chromatographic data. Machine learning methods were applied to estimate the efficiency of breath analysis in the classification of the participants. Results: Untargeted analysis revealed 29 informative VOCs, from which 17 were identified by mass spectra and retention time/retention index evaluation. The untargeted analysis yielded slightly better results in discriminating Ca+ patients from HC (accuracy: 91.0%, AUC: 0.96 and accuracy 89.1%, AUC: 0.97 for untargeted and targeted analysis, respectively) but significantly improved the efficiency of discrimination between Ca+ and Ca- patients, increasing the accuracy of the classification from 52.9 to 75.3% and the AUC from 0.55 to 0.82. Conclusions: The untargeted breath analysis through the inclusion and utilization of newly identified compounds that were not considered in targeted analysis allowed the discrimination of the Ca+ from Ca- patients, which was not achieved by the targeted approach.


Assuntos
Biomarcadores , Testes Respiratórios/métodos , Pneumopatias/diagnóstico , Neoplasias Pulmonares/diagnóstico , Idoso , Estudos de Casos e Controles , Diagnóstico Diferencial , Suscetibilidade a Doenças , Expiração , Feminino , Cromatografia Gasosa-Espectrometria de Massas , Humanos , Pneumopatias/etiologia , Pneumopatias/metabolismo , Neoplasias Pulmonares/etiologia , Neoplasias Pulmonares/metabolismo , Aprendizado de Máquina , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Compostos Orgânicos Voláteis/análise
8.
Yakugaku Zasshi ; 141(4): 527-540, 2021.
Artigo em Japonês | MEDLINE | ID: mdl-33790120

RESUMO

The biological properties of elastase and Aspergillus flavus elastase inhibitor (AFLEI) from A. flavus were examined. Pathogenicity of elastase was investigated in mice immunocompromised with cyclophosphamide, cyclosporine, prednisolone and carrageenan. Compared to cyclophosphamide immunocompromised mice treated with the spores of elastase nonproducing strain, cyclophosphamide immunocompromised mice treated with the spores of elastase producing strain had a significantly shorter survival rate. Molecular mass of AFLEI was determined to be 7525.8 Da. The elastolytic activity of elastases from A. flavus, and human leukocytes were inhibited by AFLEI. The primary structure of AFLEI was determined by the Edman sequencing procedure. The search for amino acid homology with other proteins demonstrated that amino acid residues 1 to 68 of AFLEI are 100% identical to residues 20 to 87 of the hypothetical protein AFUA_3G14940 of A. fumigatus. When immunocompromised mice administered of cyclophosphamide were infected by inhalation of A. flavus then administered amphotericin B (AMPH) alone or in combination with AFLEI, survival rate tended to be higher with combination treatment than with AMPH alone. Moreover, although extensive bleeding was seen in pathology sections taken from rat lung resected 24 h after elastase was administered to the lung via the bronchus, this bleeding was inhibited by AFLEI. The X-ray analysis has revealed that the structure of this inhibitor was wedge shaped and composed of a binding loop and a scaffold protein core. As synthetic-inhibitor strongly inhibited cytotoxicity induced by elastase in human-derived cells, it could prove beneficial for the treatment of pulmonary aspergillosis.


Assuntos
Aspergillus flavus/química , Aspergillus flavus/patogenicidade , Inibidores Enzimáticos/farmacologia , Elastase Pancreática/efeitos adversos , Anfotericina B/administração & dosagem , Animais , Aspergillus flavus/enzimologia , Aspergillus flavus/genética , Modelos Animais de Doenças , Inibidores Enzimáticos/administração & dosagem , Inibidores Enzimáticos/química , Inibidores Enzimáticos/isolamento & purificação , Hemorragia/tratamento farmacológico , Hemorragia/etiologia , Humanos , Hospedeiro Imunocomprometido , Pneumopatias/tratamento farmacológico , Pneumopatias/etiologia , Camundongos , Elastase Pancreática/química , Elastase Pancreática/isolamento & purificação , Aspergilose Pulmonar/tratamento farmacológico , Ratos
9.
BMC Public Health ; 21(1): 673, 2021 04 07.
Artigo em Inglês | MEDLINE | ID: mdl-33827504

RESUMO

BACKGROUND: Airborne dusts are being potentially harmful for workers in occupational environment. Exposure to respirable dust is the most important concern in textile workers for the widespread of occupational lung diseases, especially more serious in developing countries. The aim of the study was to assess the respirable dust exposure and associated factors of lung functions among textile workers. METHODS: A cross-sectional study was carried out at a textile mill (Thamine), Yangon Region, from April to December, 2018 and a total of 207 textile workers were randomly selected by using a multistage sampling procedure. Data were collected by using a structured questionnaire for respiratory symptoms, an air sampling pump for assessment of respirable dust exposure, and a spirometer for testing the lung functions. Logistic regression analysis was performed to assess the associated factors of lung functions. Odds ratios with a 95% confidence interval were computed for strength of associations at the significance level of α ≤ 0.05. RESULTS: The mean (± standard deviation, SD) respirable dust exposure was 3.3 mg/m3 (± 0.69) and the prevalence of increased respirable dust exposure (> 3 mg/m3) was 50.7%. The level of respirable dust exposure was highest in the textile workers involving at twisting department. The means (± SD) spirometry values were FVC 82.8% (± 17.8), FEV1 83.6% (± 18.5), and FEV1/FVC 0.9 (± 0.1). Overall magnitude of reduced lung functions was 40.1%, and the prevalence of reduced FVC, FEV1, and FEV1/FVC were 36.7, 34.3 and 3.9% respectively. The current working at twisting department, > 5 years of service duration, respiratory symptoms and increased respirable dust exposure were associated with reduction in FVC and FEV1. CONCLUSIONS: The current working department, service duration, respiratory symptoms and exposure to respirable dust were predictors of lung functions in textile workers. An adequate ventilation, good work practices, hygienic workplace, safety and health training regarding potential health effects, and periodically assessment of lung functions are the critical elements for control of respirable dust exposure and reduction of occupational lung diseases.


Assuntos
Pneumopatias , Doenças Profissionais , Exposição Ocupacional , Estudos Transversais , Poeira/análise , Humanos , Pulmão , Pneumopatias/epidemiologia , Pneumopatias/etiologia , Mianmar , Doenças Profissionais/epidemiologia , Doenças Profissionais/etiologia , Exposição Ocupacional/efeitos adversos , Exposição Ocupacional/análise , Têxteis
10.
Int J Mol Sci ; 22(7)2021 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-33915904

RESUMO

Particulate matter (PM) is a significant environmental pollutant that promotes respiratory diseases, including lung injury and inflammation, by inducing oxidative stress. Rhynchosia nulubilis (black soybean) is traditionally used to prevent chronic respiratory disease via inducing antioxidant and anti-inflammatory effects. To investigate the effects of Lactobacillus pentosus SC65 fermented GR (GR-SC65) and Pediococcus pentosaceus ON81A (GR-ON81A) against PM-induced oxidative stress and cell death in A549 cells, we performed the 2-7-dichlorodihydrofluorescein diacetate and cell counting kit-8 assays, as well as Hoechst 33342 and propidium iodide staining and western blotting. GR-SC65 showed the highest total polyphenolic contents and 1,1-diphenyl-2-picrylidrazil radical scavenging activity among lactic acid bacteria-fermented GRs (p < 0.001 vs. GR). Four soy peptides, ß-conglycinin breakdowns (INAENNQRNF, ISSEDKPFN, LAFPGSAQAVEK, and LAFPGSAKDIEN), were detected in GR-SC65, but not in GR. In GR-SC65, PM-induced A549 cell death was less than that observed in GR-ON81A and GR (p < 0.001 vs. PM-treated group). GR-SC65 significantly decreased intracellular reactive oxidative species (ROS) when compared with PM (*** p < 0.001 vs. PM). GR-SC65 decreased the levels of BAX, active caspase-9, -3, and poly ADP-ribose polymerase (PARP) proteins (#p < 0.01, ###p < 0.001 vs. PM), while increasing the level of BCL-2 protein, a mitochondrial anti-apoptotic protein (###p < 0.001 vs. PM). Our findings indicate that GR-SC65 inhibited PM-induced cell death by suppressing the levels of ROS, active caspase-9 and -3, and PARP proteins, while enhancing the level of BCL-2 protein in type II alveolar epithelial A549 cells. Therefore, GR-SC65 might be a potential therapeutic and preventive agent against PM-induced lung injury.


Assuntos
Células Epiteliais Alveolares/efeitos dos fármacos , Lactobacillus pentosus/metabolismo , Pneumopatias/prevenção & controle , Extratos Vegetais/uso terapêutico , Soja/metabolismo , Células A549 , Apoptose/efeitos dos fármacos , Avaliação Pré-Clínica de Medicamentos , Fermentação , Humanos , Pneumopatias/etiologia , Estresse Oxidativo/efeitos dos fármacos , Material Particulado/efeitos adversos , Fitoterapia , Extratos Vegetais/farmacologia
11.
Int J Mol Sci ; 22(5)2021 Mar 04.
Artigo em Inglês | MEDLINE | ID: mdl-33806395

RESUMO

Alveolar type II (ATII) cells are a key structure of the distal lung epithelium, where they exert their innate immune response and serve as progenitors of alveolar type I (ATI) cells, contributing to alveolar epithelial repair and regeneration. In the healthy lung, ATII cells coordinate the host defense mechanisms, not only generating a restrictive alveolar epithelial barrier, but also orchestrating host defense mechanisms and secreting surfactant proteins, which are important in lung protection against pathogen exposure. Moreover, surfactant proteins help to maintain homeostasis in the distal lung and reduce surface tension at the pulmonary air-liquid interface, thereby preventing atelectasis and reducing the work of breathing. ATII cells may also contribute to the fibroproliferative reaction by secreting growth factors and proinflammatory molecules after damage. Indeed, various acute and chronic diseases are associated with intensive inflammation. These include oedema, acute respiratory distress syndrome, fibrosis and numerous interstitial lung diseases, and are characterized by hyperplastic ATII cells which are considered an essential part of the epithelialization process and, consequently, wound healing. The aim of this review is that of revising the physiologic and pathologic role ATII cells play in pulmonary diseases, as, despite what has been learnt in the last few decades of research, the origin, phenotypic regulation and crosstalk of these cells still remain, in part, a mystery.


Assuntos
Células Epiteliais Alveolares/patologia , Células Epiteliais Alveolares/fisiologia , Pneumopatias/fisiopatologia , Pulmão/fisiologia , Células Epiteliais Alveolares/citologia , Animais , COVID-19/fisiopatologia , Humanos , Imunidade Inata , Íons/metabolismo , Pulmão/anatomia & histologia , Pneumopatias/etiologia , Pneumopatias/patologia , Proteínas Associadas a Surfactantes Pulmonares/metabolismo , Regeneração
13.
Respir Care ; 66(6): 936-942, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33688091

RESUMO

BACKGROUND: There is a paucity of research on e-cigarette use among adults with chronic lung disease. Accordingly, little is known about the factors that may contribute to e-cigarette use in this population. The purpose of this study was to evaluate the relationship between chronic lung disease and e-cigarette use and to determine whether binge drinking moderates this relationship. METHODS: Data were derived from the 2018 Behavioral Risk Factor Surveillance System (BRFSS). Logistic regression was used to test the association between chronic lung disease status and e-cigarette use, controlling for demographic variables and chronic health conditions. We conducted moderation analyses to test the hypothesis that the association between chronic lung disease and lifetime e-cigarette use would be modified by binge drinking. RESULTS: The prevalence of lifetime e-cigarette use was higher among adults with chronic lung disease than among those without, and more frequent binge drinking was associated with an increased likelihood of lifetime e-cigarette use independent of chronic lung disease status. Binge drinking moderated the relationship between chronic lung disease and lifetime use of e-cigarettes such that the association between chronic lung disease and e-cigarette use was weaker among those who engaged in more episodes of binge drinking in the past 30 d. Among those without chronic lung disease, binge drinking was associated with an increased likelihood of e-cigarette use. CONCLUSIONS: E-cigarette use appears to be more common among adults with chronic lung disease. Although binge drinking was positively associated with e-cigarette use, more frequent binge drinking weakened the relationship between chronic lung disease and e-cigarette use. Though future studies are needed to determine precisely how binge drinking affects this association, it is possible that individuals with chronic lung disease who binge drink more frequently use e-cigarettes less frequently, despite an increased likelihood of having ever used an e-cigarette. (ClinicalTrials.gov registration NCT04135404.).


Assuntos
Consumo Excessivo de Bebidas Alcoólicas , Sistemas Eletrônicos de Liberação de Nicotina , Pneumopatias , Vaping , Adulto , Consumo de Bebidas Alcoólicas/epidemiologia , Sistema de Vigilância de Fator de Risco Comportamental , Consumo Excessivo de Bebidas Alcoólicas/epidemiologia , Humanos , Pneumopatias/epidemiologia , Pneumopatias/etiologia , Prevalência , Vaping/efeitos adversos
14.
JAMA ; 325(15): 1525-1534, 2021 04 20.
Artigo em Inglês | MEDLINE | ID: mdl-33729425

RESUMO

Importance: Little is known about long-term sequelae of COVID-19. Objective: To describe the consequences at 4 months in patients hospitalized for COVID-19. Design, Setting, and Participants: In a prospective uncontrolled cohort study, survivors of COVID-19 who had been hospitalized in a university hospital in France between March 1 and May 29, 2020, underwent a telephone assessment 4 months after discharge, between July 15 and September 18, 2020. Patients with relevant symptoms and all patients hospitalized in an intensive care unit (ICU) were invited for further assessment at an ambulatory care visit. Exposures: Survival of hospitalization for COVID-19. Main Outcomes and Measures: Respiratory, cognitive, and functional symptoms were assessed by telephone with the Q3PC cognitive screening questionnaire and a checklist of symptoms. At the ambulatory care visit, patients underwent pulmonary function tests, lung computed tomographic scan, psychometric and cognitive tests (including the 36-Item Short-Form Health Survey and 20-item Multidimensional Fatigue Inventory), and, for patients who had been hospitalized in the ICU or reported ongoing symptoms, echocardiography. Results: Among 834 eligible patients, 478 were evaluated by telephone (mean age, 61 years [SD, 16 years]; 201 men, 277 women). During the telephone interview, 244 patients (51%) declared at least 1 symptom that did not exist before COVID-19: fatigue in 31%, cognitive symptoms in 21%, and new-onset dyspnea in 16%. There was further evaluation in 177 patients (37%), including 97 of 142 former ICU patients. The median 20-item Multidimensional Fatigue Inventory score (n = 130) was 4.5 (interquartile range, 3.0-5.0) for reduced motivation and 3.7 (interquartile range, 3.0-4.5) for mental fatigue (possible range, 1 [best] to 5 [worst]). The median 36-Item Short-Form Health Survey score (n = 145) was 25 (interquartile range, 25.0-75.0) for the subscale "role limited owing to physical problems" (possible range, 0 [best] to 100 [worst]). Computed tomographic lung-scan abnormalities were found in 108 of 171 patients (63%), mainly subtle ground-glass opacities. Fibrotic lesions were observed in 33 of 171 patients (19%), involving less than 25% of parenchyma in all but 1 patient. Fibrotic lesions were observed in 19 of 49 survivors (39%) with acute respiratory distress syndrome. Among 94 former ICU patients, anxiety, depression, and posttraumatic symptoms were observed in 23%, 18%, and 7%, respectively. The left ventricular ejection fraction was less than 50% in 8 of 83 ICU patients (10%). New-onset chronic kidney disease was observed in 2 ICU patients. Serology was positive in 172 of 177 outpatients (97%). Conclusions and Relevance: Four months after hospitalization for COVID-19, a cohort of patients frequently reported symptoms not previously present, and lung-scan abnormalities were common among those who were tested. These findings are limited by the absence of a control group and of pre-COVID assessments in this cohort. Further research is needed to understand longer-term outcomes and whether these findings reflect associations with the disease.


Assuntos
COVID-19/complicações , Hospitalização , Pneumopatias/etiologia , Pulmão/patologia , Idoso , Ansiedade/etiologia , COVID-19/psicologia , Transtornos Cognitivos/etiologia , Estudos de Coortes , Depressão/etiologia , Dispneia/etiologia , Fadiga/etiologia , Feminino , Seguimentos , Humanos , Pulmão/diagnóstico por imagem , Pneumopatias/diagnóstico por imagem , Pneumopatias/patologia , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
15.
Anesth Analg ; 132(5): 1438-1449, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-33724961

RESUMO

BACKGROUND: Postoperative pulmonary complications can have a significant impact on the morbidity and mortality of patients undergoing major surgeries. Intraoperative lung protective strategies using low tidal volume (TV) ventilation and positive end-expiratory pressure (PEEP) have been demonstrated to reduce the incidence of pulmonary injury and infection while improving oxygenation and respiratory mechanics. The purpose of this study was to develop decision support systems designed to optimize behavior of the attending anesthesiologist with regards to adherence with established intraoperative lung-protective ventilation (LPV) strategies. METHODS: Over a 4-year period, data were obtained from 49,386 procedures and 109 attendings. Cases were restricted to patients aged 18 years or older requiring general anesthesia that lasted at least 60 minutes. We defined protective lung ventilation as a TV of 6-8 mL/kg ideal body weight and a PEEP of ≥4 cm H2O. There was a baseline period followed by 4 behavioral interventions: education, near real-time feedback, individualized post hoc feedback, and enhanced multidimensional decision support. Segmented logistic regression using generalized estimating equations was performed in order to assess temporal trends and effects of interventions on adherence to LPV strategies. RESULTS: Consistent with improvement in adherence with LPV strategies during the baseline period, the predicted probability of adherence with LPV at the end of baseline was 0.452 (95% confidence interval [CI], 0.422-0.483). The improvements observed for each phase were relative to the preceding phase. Education alone was associated with an 8.7% improvement (P < .01) in adherence to lung-protective protocols and was associated with a 16% increase in odds of adherence (odds ratio [OR] = 1.16; 95% CI, 1.01-1.33; P = .04). Near real-time, on-screen feedback was associated with an estimated 15.5% improvement in adherence (P < .01) with a 69% increase in odds of adherence (OR = 1.69; 95% CI, 1.46-1.96; P < .01) over education alone. The addition of an individualized dashboard with personal adherence and peer comparison was associated with a significant improvement over near real-time feedback (P < .01). Near real-time feedback and dashboard feedback systems were enhanced based on feedback from the in-room attendings, and this combination was associated with an 18.1% (P < .01) increase in adherence with a 2-fold increase in the odds of adherence (OR = 2.23; 95% CI, 1.85-2.69; P < .0001) between the end of the previous on-screen feedback phase and the start of the individualized post hoc dashboard reporting phase. The adherence with lung-protective strategies using the multidimensional approach has been sustained for over 24 months. The difference between the end of the previous phase and the start of this last enhanced multidimensional decision support phase was not significant (OR = 1.08; 95% CI, 0.86-1.34; P = .48). CONCLUSIONS: Consistent with the literature, near real-time and post hoc reporting are associated with positive and sustained behavioral changes aimed at adopting evidence-based clinical strategies. Many decision support systems have demonstrated impact to behavior, but the effect is often transient. The implementation of near real-time feedback and individualized post hoc decision support tools has resulted in clinically relevant improvements in adherence with LPV strategies that have been sustained for over 24 months, a common limitation of decision support solutions.


Assuntos
Anestesia/normas , Anestesiologistas/normas , Técnicas de Apoio para a Decisão , Feedback Formativo , Cuidados Intraoperatórios/normas , Pneumopatias/prevenção & controle , Padrões de Prática Médica/normas , Respiração Artificial/normas , Adulto , Idoso , Anestesia/efeitos adversos , Anestesiologistas/educação , Anestesiologistas/psicologia , Registros Eletrônicos de Saúde , Feminino , Fidelidade a Diretrizes/normas , Conhecimentos, Atitudes e Prática em Saúde , Sistemas de Informação Hospitalar , Humanos , Cuidados Intraoperatórios/efeitos adversos , Pneumopatias/etiologia , Pneumopatias/fisiopatologia , Masculino , Pessoa de Meia-Idade , Respiração com Pressão Positiva/normas , Guias de Prática Clínica como Assunto/normas , Fatores de Proteção , Respiração Artificial/efeitos adversos , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Volume de Ventilação Pulmonar , Resultado do Tratamento
16.
Respir Investig ; 59(3): 302-311, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33753011

RESUMO

Alveoli are the basic structure of the lungs, consisting of various types of parenchymal and bone marrow-derived cells including alveolar macrophages. These various types of cells have several important functions; thus, communication between these cells plays an important role in homeostasis as well as in the pathophysiology of diseases in the lungs. For a better understanding of the pathophysiology of lung diseases, researchers have isolated each type of lung cell to investigate the changes in their gene expressions, including their humoral factor or adhesion molecules, to reveal the intercellular communication among these cells. In particular, investigations during the past decade have focused on extracellular vesicles, which are lipid bilayer delimited vesicles released from a cell that can move among various cells and transfer substances, including microRNAs, mRNAs and proteins, thus, functioning as intercellular messengers. Extracellular vesicles can be classified into three general groups: apoptotic bodies, exosomes, and microparticles. Extracellular vesicles, especially exosomes and microparticles, are attracting increasing attention from pulmonologists as tools for understanding pathogenesis and disease diagnosis. Here, we review studies, including our own, on exosomes and microparticles and their roles in both lung homeostasis and the pathogenesis of lung diseases such as idiopathic pulmonary fibrosis, chronic obstructive lung diseases, and acute respiratory distress syndrome. This review also addresses the roles of extracellular vesicles in COVID-19, the current global public health crisis.


Assuntos
COVID-19/etiologia , Vesículas Extracelulares/fisiologia , Pneumopatias/etiologia , Pulmão/citologia , Pulmão/metabolismo , Comunicação Celular , Micropartículas Derivadas de Células , Exossomos , Vesículas Extracelulares/classificação , Homeostase , Humanos , MicroRNAs/metabolismo , Transporte Proteico , RNA Mensageiro
18.
Int Immunopharmacol ; 93: 107404, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33524804

RESUMO

BACKGROUND: The mTOR inhibitor everolimus used in cancer has immune-modulating effects, potentially contributing to an antitumor response but also leading to pulmonary toxicity. We studied the association of immunological cell subsets with antitumor response and pulmonary toxicity in breast cancer patients treated with everolimus plus exemestane. METHODS: In this exploratory analysis, peripheral blood mononuclear cells (PBMCs) were collected at baseline and 14, 35, 60, and 90 days after start of treatment, and at the moment of pulmonary toxicity. The percentage and absolute number of T-cells, B-cells, NK-cells, monocytes and numerous subtypes were measured in peripheral blood using flow cytometric analysis and were compared using a (paired) t-test. RESULTS: From 20 patients, a total of 89 samples were collected. At baseline, responders versus non-responders had 0.86% versus 0.32% CD4+ effector cells (CD45RA+CD27-) (p = 0.1266) and non-response could be predicted with 0.71 sensitivity and 0.82 specificity. Patients who developed pulmonary toxicity compared to patients without pulmonary toxicity had relatively more NKT-cells at baseline (6.0% versus 1.3%, p = 0.0068, 59 k versus 12 k * 109/l, p = 0.0081) and at the moment of toxicity (5.2% versus 1.2%, p = 0.0106 and 47 k versus 16 k * 109/l, p = 0.0466). Baseline percentage NKT cells predicted pulmonary toxicity with 0.78 sensitivity and 1.0 specificity. CONCLUSIONS: Our results suggest that baseline CD4+ effector cells may be predictive of antitumor responses and baseline NKT cells may be predictive of pulmonary toxicity. These results warrant further validation.


Assuntos
Androstadienos/uso terapêutico , Antineoplásicos/uso terapêutico , Neoplasias da Mama/diagnóstico , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/diagnóstico , Everolimo/uso terapêutico , Pneumopatias/diagnóstico , Pulmão/patologia , Células T Matadoras Naturais/imunologia , Linfócitos T Citotóxicos/imunologia , Adulto , Idoso , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/imunologia , Quimioterapia Combinada , Feminino , Humanos , Pneumopatias/etiologia , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Estudos Prospectivos
19.
Br J Surg ; 108(1): 88-96, 2021 01 27.
Artigo em Inglês | MEDLINE | ID: mdl-33640908

RESUMO

BACKGROUND: Surgical services are preparing to scale up in areas affected by COVID-19. This study aimed to evaluate the association between preoperative SARS-CoV-2 testing and postoperative pulmonary complications in patients undergoing elective cancer surgery. METHODS: This international cohort study included adult patients undergoing elective surgery for cancer in areas affected by SARS-CoV-2 up to 19 April 2020. Patients suspected of SARS-CoV-2 infection before operation were excluded. The primary outcome measure was postoperative pulmonary complications at 30 days after surgery. Preoperative testing strategies were adjusted for confounding using mixed-effects models. RESULTS: Of 8784 patients (432 hospitals, 53 countries), 2303 patients (26.2 per cent) underwent preoperative testing: 1458 (16.6 per cent) had a swab test, 521 (5.9 per cent) CT only, and 324 (3.7 per cent) swab and CT. Pulmonary complications occurred in 3.9 per cent, whereas SARS-CoV-2 infection was confirmed in 2.6 per cent. After risk adjustment, having at least one negative preoperative nasopharyngeal swab test (adjusted odds ratio 0.68, 95 per cent confidence interval 0.68 to 0.98; P = 0.040) was associated with a lower rate of pulmonary complications. Swab testing was beneficial before major surgery and in areas with a high 14-day SARS-CoV-2 case notification rate, but not before minor surgery or in low-risk areas. To prevent one pulmonary complication, the number needed to swab test before major or minor surgery was 18 and 48 respectively in high-risk areas, and 73 and 387 in low-risk areas. CONCLUSION: Preoperative nasopharyngeal swab testing was beneficial before major surgery and in high SARS-CoV-2 risk areas. There was no proven benefit of swab testing before minor surgery in low-risk areas.


Assuntos
Teste de Ácido Nucleico para COVID-19 , COVID-19/diagnóstico , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Pneumopatias/etiologia , Nasofaringe/virologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/cirurgia , Pandemias , Complicações Pós-Operatórias , Medição de Risco , SARS-CoV-2
20.
Medicine (Baltimore) ; 100(4): e24040, 2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33530198

RESUMO

RATIONAL: Hemocoagulase, a hemostatic, is used in patients with trauma, gastrointestinal bleeding, or pulmonary hemorrhage or those undergoing surgery. However, paradoxical bleeding after hemocoagulase administration is not considered a clinically significant adverse effect. Here, we report a case of paradoxical pulmonary hemorrhage associated with hypofibrinogenemia after administration of the hemocoagulase batroxobin in a patient with hemoptysis. PATIENT CONCERNS: An 86-year-old woman complained of hemoptysis during hospitalization with organophosphate poisoning. Hemocoagulase was administered to manage bleeding; however, bleeding signs, such as hemoptysis, massive epistaxis, and ecchymosis, recurred. DIAGNOSES: The patient was diagnosed with acquired hypofibrinogenemia on the basis of the reduced plasma fibrinogen level after hemocoagulase administration and lack of other causes of bleeding. INTERVENTION: Hemocoagulase administration was discontinued, and fibrinogen-containing plasma products were administered. OUTCOMES: The plasma fibrinogen level normalized and bleeding signs did not recur. LESSONS: It is necessary to measure plasma fibrinogen levels regularly in patients undergoing hemocoagulase administration and discontinue its administration when acquired hypofibrinogenemia is detected.


Assuntos
Afibrinogenemia/tratamento farmacológico , Batroxobina/efeitos adversos , Hemorragia/etiologia , Pneumopatias/etiologia , Afibrinogenemia/complicações , Idoso de 80 Anos ou mais , Batroxobina/uso terapêutico , Feminino , Fibrinogênio/administração & dosagem , Hemoptise/etiologia , Hemostáticos , Humanos
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