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1.
Am J Case Rep ; 22: e929906, 2021 Apr 06.
Artigo em Inglês | MEDLINE | ID: mdl-33820905

RESUMO

BACKGROUND Amiodarone is an anti-arrthymic drug used to treat and prevent several types of dysrhythmias. This drug is known for multiple-organ toxicity. Lung toxicity occurs in about 1% to 5% of cases. A wide variety of lung manifestations have been described, from mild to severe forms. Pulmonary toxicity can be acute, sub-acute, or chronic. Amiodarone-induced lung toxicity is a diagnosis of exclusion. The main treatment is discontinuation of the drug. Lung disease may progress initially due to the prolonged half-life and the accumulation of amiodarone in adipose tissue. Regarding the prognosis, lung toxicity can be reversible, but in some cases, it is irreversible and is sometimes fatal. The risks associated with its use must always be considered. Amiodarone should only be used for short periods. CASE REPORT The authors present a case of a 71-year-old female patient, taking amiodarone 200 mg/day for 18 months. The patient presented with amiodarone-induced lung toxicity. After drug withdrawal, without corticosteroid therapy, we observed clinical, functional, and radiological improvement. CONCLUSIONS This case shows that not all cases of amiodarone-induced lung toxicity require corticosteroid therapy, and highlights that is important to consider this diagnosis in patients on amiodarone therapy with respiratory symptoms.


Assuntos
Amiodarona , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Pneumopatias , Idoso , Amiodarona/efeitos adversos , Antiarrítmicos/efeitos adversos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/tratamento farmacológico , Feminino , Humanos , Pulmão/diagnóstico por imagem , Pneumopatias/induzido quimicamente
3.
J Med Chem ; 64(3): 1454-1480, 2021 02 11.
Artigo em Inglês | MEDLINE | ID: mdl-33492963

RESUMO

Sphingosine-1-phosphate (S1P) binds to a family of sphingosine-1-phosphate G-protein-coupled receptors (S1P1-5). The interaction of S1P with these S1P receptors has a fundamental role in many physiological processes in the vascular and immune systems. Agonist-induced functional antagonism of S1P1 has been shown to result in lymphopenia. As a result, agonists of this type hold promise as therapeutics for autoimmune disorders. The previously disclosed differentiated S1P1 modulator BMS-986104 (1) exhibited improved preclinical cardiovascular and pulmonary safety profiles as compared to earlier full agonists of S1P1; however, it demonstrated a long pharmacokinetic half-life (T1/2 18 days) in the clinic and limited formation of the desired active phosphate metabolite. Optimization of this series through incorporation of olefins, ethers, thioethers, and glycols into the alkyl side chain afforded an opportunity to reduce the projected human T1/2 and improve the formation of the active phosphate metabolite while maintaining efficacy as well as the improved safety profile. These efforts led to the discovery of 12 and 24, each of which are highly potent, biased agonists of S1P1. These compounds not only exhibited shorter in vivo T1/2 in multiple species but are also projected to have significantly shorter T1/2 values in humans when compared to our first clinical candidate. In models of arthritis, treatment with 12 and 24 demonstrated robust efficacy.


Assuntos
Compostos Bicíclicos com Pontes/síntese química , Compostos Bicíclicos com Pontes/farmacologia , Pró-Proteína Convertases/efeitos dos fármacos , Serina Endopeptidases/efeitos dos fármacos , Animais , Artrite Experimental/tratamento farmacológico , Doenças Autoimunes/tratamento farmacológico , Biotransformação , Compostos Bicíclicos com Pontes/efeitos adversos , Líquido da Lavagem Broncoalveolar , Quimiotaxia de Leucócito/efeitos dos fármacos , Avaliação Pré-Clínica de Medicamentos , Meia-Vida , Humanos , Pneumopatias/induzido quimicamente , Pneumopatias/patologia , Masculino , Miócitos Cardíacos/efeitos dos fármacos , Fosforilação , Ratos , Ratos Endogâmicos Lew , Relação Estrutura-Atividade
4.
Radiology ; 298(2): 471-475, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33493088

RESUMO

History A 70-year-old man had a posterior left thigh lesion confirmed to be biopsy-proven melanoma. The patient underwent wide excision and sentinel node biopsy, which showed absence of residual melanoma. Two years later, the patient noticed a subcentimeter subcutaneous lump in his thigh. Repeat excisional biopsy showed involvement of the surrounding soft tissue, consistent with a satellite lesion. Follow-up combined PET/CT revealed satellite nodules around the primary lesion, enabling confirmation of subcutaneous metastatic disease. The patient was subsequently started on nivolumab, an anti-programmed cell death 1 (PD-1) immune checkpoint inhibitor that blocks PD-1 and is approved as a first-line treatment in patients with advanced metastatic melanoma. On the baseline scan prior to starting nivolumab, there were no CT findings that suggested metastatic disease, nor were there enlarged mediastinal or hilar lymph nodes. Five months after initiation of nivolumab treatment, the first follow-up chest CT scan was performed and showed new findings in the mediastinum and bilateral lungs. The patient remained asymptomatic during the treatment period. Furthermore, the subcutaneous metastatic disease remained stable during the treatment period, and no other site of metastatic disease was noted on follow-up CT scans obtained during the first 5 months of treatment. The patient had no prior history of infectious or occupational exposures. During the nivolumab treatment cycle, his pertinent laboratory values and physical examination findings were unremarkable.


Assuntos
Antineoplásicos Imunológicos/efeitos adversos , Pneumopatias/induzido quimicamente , Linfadenopatia/induzido quimicamente , Nivolumabe/efeitos adversos , Sarcoidose/induzido quimicamente , Idoso , Humanos , Pulmão/diagnóstico por imagem , Pneumopatias/diagnóstico por imagem , Masculino , Tomografia Computadorizada por Raios X/métodos
5.
Br J Anaesth ; 125(4): 629-636, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32654742

RESUMO

BACKGROUND: Neuromuscular blocking agents (NMBAs) with a non-depolarising mechanism of action carry the risk of postoperative residual paralysis and are associated with postoperative pulmonary complications (POPC). Owing to the shorter duration of action, the depolarising NMBA succinylcholine may be associated with less postoperative residual paralysis, and hence fewer POPC. We tested the association of succinylcholine administration during anaesthesia and POPC. METHODS: In a retrospective cohort study of registry data from two large US academic medical centres, 244 850 adult noncardiac surgical patients undergoing general anaesthesia were included. The primary outcome was POPC, defined as post-extubation haemoglobin oxygen de-saturation to <90%, or re-intubation requiring intensive care unit admission within 7 days after surgery. The association between succinylcholine and POPC and its dose-dependency were tested in a hierarchical fashion using a multivariable logistic regression model. RESULTS: A total of 13 206 patients (5.4%) experienced POPC. Use of succinylcholine was associated with increased risk of POPC (adjusted odds ratio [ORAdj]=1.11; 95% confidence interval [CI], 1.06-1.16; P<0.001; adjusted risk=5.18%; 95% CI, 5.06-5.30 without and 5.69%; 95% CI, 5.53-5.85 with succinylcholine), with a dose-dependent relationship (ORAdj=1.08; 95% CI, 1.05-1.11 per mg kg-1; P<0.001). In patients receiving non-depolarising NMBAs, succinylcholine further increased the risk of POPC (ORAdj=1.08; 95% CI, 1.03-1.14; P=0.001). The association between succinylcholine and POPC was modified (P=0.03 for interaction) by the duration of surgery with higher odds of POPC in patients undergoing surgeries of <2 vs ≥2 h (ORAdj=1.24; 95% CI, 1.15-1.33 and 1.05; 95% CI, 1.00-1.10, respectively). CONCLUSIONS: In contrast to our prediction, succinylcholine administration was associated with an increased risk of POPC. This association was dose-dependent and magnified in surgeries of shorter duration.


Assuntos
Pneumopatias/induzido quimicamente , Fármacos Neuromusculares Despolarizantes/efeitos adversos , Complicações Pós-Operatórias/induzido quimicamente , Succinilcolina/efeitos adversos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Relação Dose-Resposta a Droga , Feminino , Hospitais , Humanos , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Estudos Retrospectivos , Adulto Jovem
6.
Cell Prolif ; 53(7): e12813, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32515860

RESUMO

OBJECTIVES: Accumulating studies have investigated the PM2.5-induced pulmonary toxicity, while gaps still remain in understanding its toxic mechanism. Due to its high specific surface area and adsorption capacity similar to nanoparticles, PM2.5 acts as a significant carrier of metals in air and then leads to altered toxic effects. In this study, we aimed to use CBs and Ni as model materials to investigate the autophagy changes and pulmonary toxic effects at 30 days following intratracheal instillation of CBs-Ni mixture. MATERIALS AND METHODS: Groups of mice were instilled with 100 µL normal saline (NS), 20 µg CBs, and 4 µg Ni or CBs-Ni mixture, respectively. At 7 and 30 days post-instillation, all the mice were weighed and then sacrificed. The evaluation system was composed of the following: (a) autophagy and lysosomal function assessment, (b) trace element biodistribution observation in lungs, (c) pulmonary lavage biomedical analysis, (d) lung histopathological evaluation, (e) coefficient analysis of major organs and (f) CBs-Ni interaction and cell proliferation assessment. RESULTS: We found that after CBs-Ni co-exposure, no obvious autophagy and lysosomal dysfunction or pulmonary toxicity was detected, along with complete clearance of Ni from lung tissues as well as recovery of biochemical indexes to normal range. CONCLUSIONS: We conclude that the damaged autophagy and lysosomal function, as well as physiological function, was repaired at 30 days after exposure of CBs-Ni. Our findings provide a new idea for scientific assessment of the impact of fine particles on environment and human health, and useful information for the comprehensive treatment of air pollution.


Assuntos
Autofagia/efeitos dos fármacos , Carbono/efeitos adversos , Pneumopatias/induzido quimicamente , Pulmão/efeitos dos fármacos , Metais/efeitos adversos , Animais , Linhagem Celular , Pulmão/metabolismo , Pneumopatias/metabolismo , Lisossomos/efeitos dos fármacos , Lisossomos/metabolismo , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Tamanho da Partícula , Células RAW 264.7 , Distribuição Tecidual
7.
J Occup Health ; 62(1): e12117, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32515878

RESUMO

OBJECTIVE: In this study, in order to investigate the usefulness of intratracheal instillation in assessing the pulmonary toxicity of nanomaterials, intratracheal instillation of nickel oxide-nanoparticles (NiO-NP) was performed. METHODS: In this study, rats were administered test materials by intratracheal instillation at five different research institutions in order to assess the validity of using intratracheal instillation for hazard identification of nanomaterials. Eight-week-old male SD rats were administered NiO-NP dispersed in deionized water by a single intratracheal instillation at doses of 0 (vehicle control), 0.2, 0.67, and 2 mg/kg BW. Three days after instillation, histopathological examination of the lungs was performed. RESULTS: NiO-NP was distributed in the vicinity of hilus of the lung and in the alveoli around the bronchioles. Histopathological changes such as degeneration/necrosis of macrophages, inflammation, and proliferation of type II pneumocyte in the lung were observed, and their severity corresponded with increasing dose. The histopathological observations of pulmonary toxicity were almost similar at each institution. CONCLUSION: The similarity of the histopathological changes observed by five independent groups indicates that intratracheal instillation can be a useful screening method to detect the pulmonary toxicity of nanomaterials.


Assuntos
Exposição por Inalação/efeitos adversos , Pneumopatias/induzido quimicamente , Nanopartículas Metálicas/toxicidade , Níquel/toxicidade , Animais , Masculino , Ratos , Ratos Sprague-Dawley
8.
Arch Environ Occup Health ; 75(8): 483-490, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32338162

RESUMO

This study aimed to evaluate pulmonary function among workers exposed to 1,3-butadiene and was carried out in a petrochemical industry in Iran. The study participants consisted of fifty male workers with current respiratory exposure to 1,3-butadiene and fifty non-exposed workers as the control group. Exposure to 1,3-butadiene was measured according to the NIOSH 1024 method. Respiratory symptom histories were collected through the American Thoracic Society respiratory symptom questionnaire. Lung functions were evaluated using spirometry method. The results showed that exposed participants had significantly higher prevalence rates of all respiratory symptoms compared to the control group. Statistical tests demonstrated a significant difference between pulmonary function tests of exposed and non-exposed personnel. Ultimately, the results of the present study indicate that respiratory exposure to 1,3-butadiene can lead to negative effects on pulmonary functions.


Assuntos
Butadienos/toxicidade , Pneumopatias/induzido quimicamente , Doenças Profissionais/induzido quimicamente , Exposição Ocupacional/efeitos adversos , Indústria de Petróleo e Gás , Adulto , Estudos Transversais , Humanos , Irã (Geográfico) , Masculino , Testes de Função Respiratória
9.
Artigo em Inglês | MEDLINE | ID: mdl-32276440

RESUMO

(1) Background: Welding fumes (WFs) are composed of fine and ultrafine particles, which may reach the distal airways and represent a risk factor for respiratory diseases. (2) Methods: In vitro and in vivo studies to understand WFs pathogenesis were selected. Epidemiological studies, original articles, review, and meta-analysis to examine solely respiratory disease in welders were included. A systematic literature search, using PubMed, National Institute for Occupational Safety and Health Technical Information Center (NIOSHTIC), and Web of Science databases, was performed. (3) Results: Dose, time of exposure, and composition of WFs affect lung injury. Inflammation, lung defense suppression, oxidative stress, DNA damage, and genotoxic effects were observed after exposure both to mild and stainless steel WFs. (4) Conclusions: The detection of lung diseases associated with specific occupational exposure is crucial as complete avoidance or reduction of the exposure is difficult to achieve. Further studies in the area of particle research may aid the understanding of mechanisms involved in welding-related lung disease and to expand knowledge in welding-related cardiovascular diseases.


Assuntos
Pneumopatias , Soldagem , Poluentes Ocupacionais do Ar/toxicidade , Estudos Transversais , Humanos , Estudos Longitudinais , Pneumopatias/induzido quimicamente , Pneumopatias/epidemiologia , Doenças Profissionais , Exposição Ocupacional/efeitos adversos , Fatores de Risco
10.
Intern Med ; 59(13): 1633-1637, 2020 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-32188805

RESUMO

Influenza vaccination can trigger various adverse reactions, and thrombocytopenia is also rarely reported. Although patients with mild thrombocytopenia are sometimes asymptomatic, severe thrombocytopenia can cause severe bleeding. We herein report a rare case of severe thrombocytopenia that occurred within one day of influenza vaccination and diffuse alveolar hemorrhage (DAH) leading to acute respiratory failure. The patient was treated with glucocorticoid pulse therapy, intravenous immunoglobulin, and temporary mechanical ventilation, and eventually he made a full recovery. Vaccine-related thrombocytopenia and DAH should be considered adverse reactions, even if they develop very soon after vaccination.


Assuntos
Hemorragia/induzido quimicamente , Vacinas contra Influenza/efeitos adversos , Pneumopatias/induzido quimicamente , Trombocitopenia/induzido quimicamente , Idoso , Hemorragia/terapia , Humanos , Pneumopatias/terapia , Masculino , Respiração Artificial , Índice de Gravidade de Doença , Trombocitopenia/terapia
11.
Am J Clin Oncol ; 43(6): 381-387, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32079853

RESUMO

OBJECTIVES: Bleomycin, etoposide, and cisplatin (BEP) is the most common and successful chemotherapy regimen for germ-cell tumor (GCT) patients, accompanied by a bleomycin-induced dose-dependent lung toxicity in certain patients. In an attempt to reduce bleomycin-toxicity, we developed a modified-BEP (mBEP) regimen. MATERIALS AND METHODS: Between August 2008 and February 2018, 182 unselected mainly testicular GCT patients (39 with adjuvant purpose and 143 with curative purpose) received a tri-weekly 5-day hospitalization schedule with bleomycin 15 U intravenous (IV) push on day 1 and 10 U IV continuous infusion over 12 hours on days 1 to 3, cisplatin 20 mg/m IV, and etoposide 100 mg/m IV on days 1 to 5. Pulmonary toxicity was assessed through chest computed tomography scan and clinical monitoring. RESULTS: Median number of mBEP cycles was 3 (range: 1 to 4). In the curative setting, according to the International Germ Cell Cancer Collaborative Group (IGCCCG) prognostic system, 112, 21, and 9 patients had good-risk, intermediate-risk, and poor-risk class, respectively; 66 (46%) patients had complete response (CR), 67 (47%) had partial response (52 of whom became CR afterwards), 6 (4%) had stable disease (that in 3 became CR afterwards), 3 (2%) progressed, and 1 (1%) died of brain stroke. At a median follow-up of 2.67 years (interquartile range: 1.23-5.00 y), 1 and 5-year overall survival and progression-free survival were 99% and 95%, and 90% and 88%, respectively. In the entire patient population, there was grade 3/4 neutropenia in 92 patients (51%), febrile neutropenia in 11 patients (6%), grade 1/2 nausea in 74 patients (41%), and no death due to pulmonary toxicity. CONCLUSION: In GCT patients, our mBEP-schedule would suggest an effective treatment modality without suffering meaningful pulmonary toxicity.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Pneumopatias/induzido quimicamente , Pneumopatias/prevenção & controle , Neoplasias Embrionárias de Células Germinativas/tratamento farmacológico , Adolescente , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Bleomicina/administração & dosagem , Bleomicina/efeitos adversos , Institutos de Câncer , Cisplatino/administração & dosagem , Cisplatino/efeitos adversos , Esquema de Medicação , Etoposídeo/administração & dosagem , Etoposídeo/efeitos adversos , Humanos , Masculino , Estudos Retrospectivos , Adulto Jovem
12.
Monaldi Arch Chest Dis ; 90(1)2020 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-32088948

RESUMO

Diffuse alveolar haemorrhage (DAH) is characterised by diffuse pulmonary opacities, respiratory failure, a falling haemoglobin level along with presence of hemosiderin-laden macrophages on bronchoalveolar lavage (BAL). Finding the underlying aetiology of DAH can be challenging but of importance as the treatment and prognosis are largely determined by it. We report a case of DAH with underlying cocaine abuse, a rare cause for the same.


Assuntos
Transtornos Relacionados ao Uso de Cocaína/diagnóstico , Hemorragia/induzido quimicamente , Pneumopatias/induzido quimicamente , Humanos , Prognóstico
13.
Zhonghua Yu Fang Yi Xue Za Zhi ; 54(2): 121-123, 2020 Feb 06.
Artigo em Chinês | MEDLINE | ID: mdl-32074695

RESUMO

This article summarized the use of guanidine disinfectants in China and the use of guanidine cationic disinfectants, polyhexamethylene guanidine (PHMG), in South Korea, which had caused severe lung damage events such as pulmonary fibrosis. The authors reviewed the studies that Chinese scientists employed ultrasonic atomization technology to simulate the actual scenario of human exposure to PHMG and proved the findings that PHMG could cause pulmonary fibrosis. These results could highlight the necessity of full attention to lung damage caused by guanidine disinfectants and its mechanism, so as to provide the important scientific basis for the protection of public health safety and the formulation of corresponding policies.


Assuntos
Desinfetantes/toxicidade , Guanidinas/toxicidade , Pneumopatias/induzido quimicamente , China , Humanos , Fibrose Pulmonar/induzido quimicamente , República da Coreia
14.
Zhonghua Yu Fang Yi Xue Za Zhi ; 54(2): 209-212, 2020 Feb 06.
Artigo em Chinês | MEDLINE | ID: mdl-32074712

RESUMO

Polyhexamethylene guanidine (PHMG) is a high molecular guanidine compound with a broad spectrum of antibacterial effects. Since the outbreak of the 'humidifier disinfectant-induced lung injury' event in South Korea, the respiratory toxicity of PHMG had become a public concern. An epidemiological survey in Korea found that PHMG-containing disinfectants were an important risk factor for pulmonary fibrosis. Animal experiments also showed that the exposure to PHMG through the respiratory tract could cause irreversible fibrosis in the lungs. TGF-ß signaling pathway, epithelial-mesenchymal transition and pulmonary inflammation might be the main pathways that could mediate PHMG-induced pulmonary fibrosis. This article provided an overview of the characteristics of population exposure to PHMG and research progress in the field of respiratory toxicology and recommendations for the rational and standard of using PHMG-related products in China.


Assuntos
Desinfetantes/toxicidade , Guanidinas/toxicidade , Pneumopatias/induzido quimicamente , China , Humanos
15.
Am J Surg ; 219(5): 804-809, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32102757

RESUMO

BACKGROUND: The aim of this study was to evaluate quetiapine-associated pulmonary complications (PC) in critically injured trauma patients. METHODS: Injured adults admitted during 2016 to the ICU at a Level I trauma center were analyzed. Outcomes were evaluated by competing risks survival analysis. RESULTS: Of 254 admissions, 40 (15.7%) had PC and 214 (84.3%) were non-events. PC patients were more severely injured, had longer hospital stays and were more likely to die. Patients administered quetiapine were more likely to develop PC and acquire PC earlier than those without quetiapine. Quetiapine was a positive risk factor for PC (sHR 2.24, p = 0.013). Stratification by ventilator use revealed non-ventilated patients administered quetiapine had the highest risk for PC (sHR 4.66, p = 0.099). CONCLUSIONS: Quetiapine exposure in critically injured trauma patients was associated with increased risk of PC. Guidelines for treatment of delirium with quetiapine in critically injured trauma patients should account for this risk.


Assuntos
Antipsicóticos/efeitos adversos , Estado Terminal , Delírio/tratamento farmacológico , Delírio/etiologia , Pneumopatias/induzido quimicamente , Fumarato de Quetiapina/efeitos adversos , Ferimentos e Lesões/complicações , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Centros de Traumatologia
17.
Toxicol Appl Pharmacol ; 390: 114890, 2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-31972177

RESUMO

Due to mass production and extensive use, the potential adverse health effects of amorphous silica nanoparticles (ASiNPs) have received a significant attention from the public and researchers. However, the relationship between physicochemical properties of ASiNPs and their health effects is still unclear. In this study, we manufactured two types of ASiNPs of different diameters (20 and 50 nm) and compared the toxic response induced in rats after intratracheal instillation (75, 150 or 300 µg/rat). There were no dose-related differences in mortality, body weight gain or organ weight between the groups. However both types of ASiNPs significantly decreased the proportion of neutrophils in male rats, whereas the levels of hemoglobin and hematocrit were markedly reduced only in female rats instilled with 20 nm-ASiNPs. ASiNPs-induced lung tissue damage seemed to be more evident in the 20 nm ASiNP-treated group and in female rats than male rats. Similarly, expression of caveolin-1 and matrix metalloproteinase-9 seemed to be most notably enhanced in female rats treated with 20 nm-ASiNPs. The total number of bronchial alveolar lavage cells significantly increased in rats instilled with 20 nm-ASiNPs, accompanying a decrease in the proportion of macrophages and an increase in polymorphonuclear leukocytes. Moreover, secretion of inflammatory mediators clearly increased in human bronchial epithelial cells treated with 20 nm-ASiNPs, but not in those treated with 50 nm-ASiNPs. These results suggest that pulmonary effects of ASiNPs depend on particle size. Sex-dependent differences should also be carefully considered in understanding nanomaterial-induced adverse health effects.


Assuntos
Inflamação/induzido quimicamente , Pneumopatias/induzido quimicamente , Nanopartículas/toxicidade , Tamanho da Partícula , Dióxido de Silício/toxicidade , Animais , Feminino , Masculino , Ratos , Fatores Sexuais
18.
BMJ Case Rep ; 13(1)2020 Jan 23.
Artigo em Inglês | MEDLINE | ID: mdl-31980474

RESUMO

Pulmonary haemorrhage is a rare but a life-threatening complication of thrombolytic therapy in patients with acute ST-elevation myocardial infarction (MI). It usually presents with anaemia, massive haemoptysis, acute-onset respiratory distress and diffuse bilateral lung infiltrates on imaging. We hereby describe two patients, who had pulmonary haemorrhage following streptokinase therapy for acute MI. The first patient improved with conservative treatment, while the second patient died due to respiratory failure. Streptokinase, a fibrin non-specific agent, is a widely used thrombolytic in low-income and middle-income countries. Pulmonary haemorrhage should be suspected in patients who develop sudden respiratory compromise after receiving thrombolytics, especially streptokinase. The management issues related to this uncommon life-threatening complication have been discussed in this article.


Assuntos
Fibrinolíticos/efeitos adversos , Hemorragia/induzido quimicamente , Pneumopatias/induzido quimicamente , Infarto do Miocárdio/complicações , Estreptoquinase/efeitos adversos , Terapia Trombolítica/efeitos adversos , Idoso , Fibrinolíticos/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/tratamento farmacológico , Estreptoquinase/uso terapêutico
20.
Curr Opin Pulm Med ; 26(2): 142-148, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31895883

RESUMO

PURPOSE OF REVIEW: Occupational exposures remain an underrecognized and preventable cause of lung disease in high-income countries. The present review highlights the emergence of cleaning-related respiratory disease and the re-emergence of silicosis as examples of trends in occupational lung diseases in the 21st century. RECENT FINDINGS: Employment trends, such as the shift from large-scale manufacturing to a service economy, the growth of the healthcare sector, and changing consumer products have changed the spectrum of work-related lung diseases. Following decades of progress in reducing traditional hazards such as silica in U.S. workplaces, cases of advanced silicosis have recently re-emerged with the production of engineered stone countertops. With growth in the healthcare and service sectors in the United States, cleaning products have become an important cause of work-related asthma and have recently been associated with an increased risk of chronic obstructive pulmonary disease (COPD) in women. However, these occupational lung diseases largely go unrecognized by practicing clinicians. SUMMARY: The present article highlights how changes in the economy and work structure can lead to new patterns of inhalational workplace hazards and respiratory disease, including cleaning-related respiratory disease and silicosis. Pulmonary clinicians need to be able to recognize and diagnose these occupational lung diseases, which requires a high index of suspicion and a careful occupational history.


Assuntos
Pneumopatias , Doenças Profissionais , Exposição Ocupacional , Humanos , Exposição por Inalação/efeitos adversos , Exposição por Inalação/prevenção & controle , Pneumopatias/induzido quimicamente , Pneumopatias/classificação , Pneumopatias/epidemiologia , Pneumopatias/prevenção & controle , Doenças Profissionais/induzido quimicamente , Doenças Profissionais/classificação , Doenças Profissionais/epidemiologia , Doenças Profissionais/prevenção & controle , Exposição Ocupacional/efeitos adversos , Exposição Ocupacional/prevenção & controle , Saúde do Trabalhador/tendências
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