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1.
Chem Biol Interact ; 310: 108732, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31276660

RESUMO

BACKGROUND: The human body is a home to thousands of microbiotas. It is defined as a community of symbiotic, commensal and pathogenic microorganisms that have existed in all exposed sites of the body, which have co-evolved with diet, lifestyle, genetic factors and immune factors. Human microbiotas have been studied for years on their effects with relation to health and diseases. METHODS: Relevant published studies, literature and reports were searched from accessible electronic databases and related institutional databases. We used keywords, viz; microbiome, microbiota, microbiome drug delivery and respiratory disease. Selected articles were carefully read through, clustered, segregated into subtopics and reviewed. FINDINGS: The traditional belief of sterile lungs was challenged by the emergence of culture-independent molecular techniques and the recently introduced invasive broncho-alveolar lavage (BAL) sampling method. The constitution of a lung microbiome mainly depends on three main ecological factors, which include; firstly, the immigration of microbes into airways, secondly, the removal of microbes from airways and lastly, the regional growth conditions. In healthy conditions, the microbial communities that co-exist in our lungs can build significant pulmonary immunity and could act as a barrier against diseases, whereas, in an adverse way, microbiomes may interact with other pathogenic bacteriomes and viromes, acting as a cofactor in inflammation and host immune responses, which may lead to the progression of a disease. Thus, the use of microbiota as a target, and as a drug delivery system in the possible modification of a disease state, has started to gain massive attention in recent years. Microbiota, owing to its unique characteristics, could serve as a potential drug delivery system, that could be bioengineered to suit the interest. The engineered microbiome-derived therapeutics can be delivered through BC, bacteriophage, bacteria-derived lipid vesicles and microbe-derived extracellular vesicles. This review highlights the relationships between microbiota and different types of respiratory diseases, the importance of microbiota towards human health and diseases, including the role of novel microbiome drug delivery systems in targeting various respiratory diseases.


Assuntos
Sistemas de Liberação de Medicamentos/métodos , Pulmão/microbiologia , Microbiota/fisiologia , Doença Crônica , Humanos , Pneumopatias/microbiologia , Pneumopatias/terapia
2.
Neumol. pediátr. (En línea) ; 14(2): 81-85, jul. 2019.
Artigo em Espanhol | LILACS | ID: biblio-1014999

RESUMO

At present, there is no specific treatment for primary ciliary dyskinesia, nor controlled and randomized clinical trials to determine how the management and monitoring of these patients should be considered. The therapeutic options are extrapolated from other diseases, such as cystic fibrosis, or non-cystic fibrosis bronchiectasis. However, the implementation of specific groups of experts, both in the USA (PDC-foundation) and in Europe (BESTCILIA or BEAT-PD), are helping to increase knowledge of the disease, opening research channels and seeking new treatments. Until we have therapies capable of correcting the basic defect of the disease, the pillars of treatment are the daily cleansing of the airways and aggressive antibiotherapy against respiratory infections. Multidisciplinary care in specialized centers where pulmonary function is monitored and the infection is prevented and treated will improve, as in cystic fibrosis, the results of patients.


En la actualidad no existe un tratamiento específico para la discinesia ciliar primaria, ni se cuenta con ensayos clínicos controlados y randomizados que permitan determinar cómo debe plantearse el manejo y seguimiento de estos pacientes. Las opciones terapéuticas son extrapoladas de otras enfermedades, como la fibrosis quística, o las bronquiectasias no fibrosis quística. Sin embargo, la puesta en marcha de grupos específicos de expertos, tanto en USA (PDC-foundation) como en Europa (BESTCILIA o BEAT-PD), están permitiendo incrementar el conocimiento de la enfermedad, abriendo vías de investigación y buscando nuevos tratamientos. Hasta contar con terapias capaces de corregir el defecto básico de la enfermedad, los pilares del tratamiento son la limpieza diaria de las vías aéreas y la antibioterapia agresiva frente a las infecciones respiratorias. La atención multidisciplinar en centros especializados donde se monitorice la función pulmonar y se prevengan y traten las infecciones mejorará, como en la fibrosis quística, los resultados de los pacientes.


Assuntos
Humanos , Síndrome de Kartagener/diagnóstico , Síndrome de Kartagener/fisiopatologia , Síndrome de Kartagener/genética , Síndrome de Kartagener/terapia , Infecções Respiratórias/tratamento farmacológico , Seguimentos , Pneumopatias/fisiopatologia , Pneumopatias/terapia , Pneumopatias Fúngicas
3.
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
4.
Int J Cardiovasc Imaging ; 35(8): 1483-1497, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31030315

RESUMO

Magnetic resonance imaging (MRI) plays an increasingly important role in the non-invasive evaluation of the pulmonary vasculature. MR angiographic (MRA) techniques provide morphological information, while MR perfusion techniques provide functional information of the pulmonary vasculature. Contrast-enhanced MRA can be performed at high spatial resolution using 3D T1-weighted spoiled gradient echo sequence or at high temporal resolution using time-resolved techniques. Non-contrast MRA can be performed using 3D steady state free precession, double inversion fast spin echo, time of flight or phase contrast sequences. MR perfusion can be done using dynamic contrast-enhanced technique or using non-contrast techniques such as arterial spin labelling and time-resolved imaging of lungs during free breathing with Fourier decomposition analysis. MRI is used in the evaluation of acute and chronic pulmonary embolism, pulmonary hypertension and other vascular abnormalities, congenital anomalies and neoplasms. In this article, we review the different MR techniques used in the evaluation of pulmonary vasculature and its clinical applications.


Assuntos
Hemodinâmica , Pneumopatias/diagnóstico por imagem , Angiografia por Ressonância Magnética , Imagem por Ressonância Magnética , Imagem de Perfusão/métodos , Artéria Pulmonar/diagnóstico por imagem , Circulação Pulmonar , Humanos , Interpretação de Imagem Assistida por Computador , Pneumopatias/fisiopatologia , Pneumopatias/terapia , Valor Preditivo dos Testes , Prognóstico , Artéria Pulmonar/fisiopatologia
5.
Pediatr Ann ; 48(4): e169-e174, 2019 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-30986318

RESUMO

Congenital lung malformations (CLM) comprise a spectrum of anatomical anomalies of the lungs and respiratory tree. The prenatal growth pattern of CLMs is unpredictable with larger lesions causing life-threatening complications, such as hydrops fetalis, and smaller lesions remaining asymptomatic and potentially regressing. The most common CLMs are congenital pulmonary adenomatoid malformations, bronchopulmonary sequestrations, congenital lobar emphysema, and bronchogenic cysts. All these lesions have clinically similar presentations when symptomatic, but pathophysiologic differences that must be considered when evaluating and treating. This article reviews the most common CLMs, their pathophysiology, clinical presentation, diagnostic considerations, and current literature on the controversies surrounding CLM management. [Pediatr Ann. 2019;48(4):e169-e174.].


Assuntos
Pneumopatias/congênito , Pulmão/anormalidades , Humanos , Recém-Nascido , Pneumopatias/diagnóstico , Pneumopatias/terapia
7.
Med Clin North Am ; 103(3): 399-412, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30955509

RESUMO

Interventional pulmonology (IP) has evolved in recent decades, and recent advances have greatly expanded the services offered by IP physicians. IP is best defined as the use of advanced techniques for the evaluation and treatment of benign and malignant pulmonary disorders. The field has further advanced with the recent establishment of a board certification via the American Association of Bronchology and Interventional Pulmonology and the release in 2017 of accreditation standards for specialized fellowship training. This article provides a broad overview of the field to serve as a resource for primary care physicians.


Assuntos
Pneumopatias/diagnóstico , Pneumopatias/terapia , Doenças Pleurais/diagnóstico , Doenças Pleurais/terapia , Atenção Primária à Saúde/métodos , Pneumologia/métodos , Técnicas de Ablação , Termoplastia Brônquica , Broncoscopia , Cateterismo , Endossonografia , Humanos , Toracentese , Toracoscopia
8.
Med Clin North Am ; 103(3): 503-515, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30955517

RESUMO

There are hundreds of rare orphan lung diseases. We have highlighted five of them, one from each of the five major categories of pulmonary disorders: pleuroparenchymal fibroelastosis (a rare diffuse parenchymal lung disease), pulmonary alveolar proteinosis (a rare autoimmune and diffuse parenchymal lung disease), lymphangioleiomyomatosis (a rare cystic lung disease), yellow nail syndrome (a rare pleural disease), and Mounier-Kuhn syndrome (a rare airway disorder). The pathogenesis, clinical presentation, diagnostic criteria, treatment options, and prognosis of each disorder is discussed. This review is by no means exhaustive and further research is needed to improve our understanding of these disorders.


Assuntos
Pneumopatias/diagnóstico , Doenças Raras/diagnóstico , Humanos , Pneumopatias/terapia , Prognóstico , Doenças Raras/terapia
9.
Subcell Biochem ; 91: 45-74, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30888649

RESUMO

Chronic obstructive pulmonary disease (COPD) and idiopathic pulmonary fibrosis are regarded as a diseases of accelerated lung ageing and show all of the hallmarks of ageing, including telomere shortening, cellular senescence, activation of PI3 kinase-mTOR signaling, impaired autophagy, mitochondrial dysfunction, stem cell exhaustion, epigenetic changes, abnormal microRNA profiles, immunosenescence and a low grade chronic inflammation due to senescence-associated secretory phenotype (SASP). Many of these ageing mechanisms are driven by exogenous and endogenous oxidative stress. There is also a reduction in anti-ageing molecules, such as sirtuins and Klotho, which further accelerate the ageing process. Understanding these molecular mechanisms has identified several novel therapeutic targets and several drugs and dietary interventions are now in development to treat chronic lung disease.


Assuntos
Envelhecimento/patologia , Pneumopatias/patologia , Senescência Celular , Humanos , Fibrose Pulmonar Idiopática/patologia , Fibrose Pulmonar Idiopática/terapia , Pulmão/efeitos dos fármacos , Pulmão/patologia , Pneumopatias/terapia , Estresse Oxidativo , Doença Pulmonar Obstrutiva Crônica/patologia , Doença Pulmonar Obstrutiva Crônica/terapia
10.
Medicine (Baltimore) ; 98(8): e14630, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30813199

RESUMO

RATIONALE: Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is an autoimmune disease that mainly affects the lungs and kidneys. Limited reports of perioperative management of such patients were primarily concerned with airway stenosis. Here, we report a patient with AAV who developed diffuse alveolar hemorrhage (DAH) early after radical thyroidectomy. PATIENT CONCERNS: A 57-year-old female developed wheezing and dyspnea approximately 30 minutes after radical thyroidectomy, with hemoptysis occurring the following day. The patient had a history of AAV and DAH and was maintained with prednisone. DIAGNOSIS: A diagnosis of DAH was made on the basis of the history of AAV, dyspnea, hemoptysis, and chest computed tomography scan results that showed diffuse high-density shadows in the lungs. INTERVENTIONS: The patient was administered high-dose glucocorticoids and cyclophosphamide immunosuppressive therapy. Non-invasive ventilation was needed for 2 days postoperatively due to dysfunction of oxygenation. OUTCOMES: After high-dose glucocorticoids and cyclophosphamide immunosuppressive therapy, DAH improved approximately 2 weeks after the surgery, during which time kidney function was not significantly impaired. LESSONS: Patients with AAV may develop DAH in the early postoperative period and this may be confused with surgical complications and general anesthetic residues. Therefore, it needs to be identified in an appropriate timeframe.


Assuntos
Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/complicações , Hemorragia/etiologia , Pneumopatias/etiologia , Tireoidectomia/efeitos adversos , Idoso , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/tratamento farmacológico , Ciclofosfamida/uso terapêutico , Feminino , Glucocorticoides/uso terapêutico , Hemoptise/etiologia , Humanos , Imunossupressores/uso terapêutico , Pulmão/diagnóstico por imagem , Pulmão/patologia , Pneumopatias/terapia , Ventilação não Invasiva/métodos , Prednisona/uso terapêutico , Neoplasias da Glândula Tireoide/cirurgia , Tomografia Computadorizada por Raios X
11.
Eur Respir Rev ; 28(151)2019 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-30918023

RESUMO

We are currently limited in our abilities to diagnose, monitor disease status and manage chronic airway disease like asthma and chronic obstructive pulmonary disease (COPD). Conventional lung function measures often poorly reflect patient symptoms or are insensitive to changes, particularly in the small airways where disease may originate or manifest. Novel pulmonary function tests are becoming available which help us better characterise and understand chronic airway disease, and their translation and adoption from the research arena would potentially enable individualised patient care.In this article, we aim to describe two emerging lung function tests yielding novel pulmonary function indices, the forced oscillation technique (FOT) and multiple breath nitrogen washout (MBNW). With a particular focus on asthma and COPD, this article demonstrates how chronic airway disease mechanisms have been dismantled with the use of the FOT and MBNW. We describe their ability to assess detailed pulmonary mechanics for diagnostic and management purposes including response to bronchodilation and other treatments, relationship with symptoms, evaluation of acute exacerbations and recovery, and telemonitoring. The current limitations of both tests, as well as open questions/directions for further research, are also discussed.


Assuntos
Pneumopatias/diagnóstico , Pulmão/fisiopatologia , Ventilação Pulmonar , Respiração , Testes de Função Respiratória/métodos , Testes Respiratórios , Humanos , Pneumopatias/fisiopatologia , Pneumopatias/terapia , Oscilometria , Valor Preditivo dos Testes , Prognóstico , Reprodutibilidade dos Testes
12.
Transfus Med ; 29(1): 55-60, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30779248

RESUMO

BACKGROUND: In ß-thalassemia, there are varying degrees of ineffective haematopoiesis, intermittent haemolysis and iron overload. Excess iron is deposited in organs such as the heart, the liver, the endocrine glands and the lungs. OBJECTIVES: To evaluate the pulmonary functions in asymptomatic beta thalassemic children on regular transfusion therapy and their relation to iron overload. METHODS: The study included 50 transfusion-dependent ß-thalassemic children and 50 apparently healthy children as control. All children had undergone pulmonary function tests (spirometry, lung volumes and diffusion capacities). In addition, test to determine the mean serum ferritin of the last 2 years and pre-transfusion haemoglobin and chest radiograph and echocardiography were performed for the thalassemic children only. RESULTS: A total of 70% of the thalassemic children had diffusion impairment, whereas 34% of them had associated restrictive abnormality. Thalassemic children with serum ferritin >2500 ng mL-1 had significantly lower values of forced vital capacity (FVC), forced expiratory volume at one second (FEV1), peak expiratory flow (PEFR), total lung capacity (TLC) and diffusing capacity of carbon monoxide (DLCO) (P < 0·05). Only diffusion impairment had a significant positive correlation with serum ferritin level. Restrictive impairment had significant positive correlations with age, duration of blood transfusion and serum ferritin level and a significant negative correlation with duration of chelation (P < 0·05). Having a serum ferritin >2500 ng mL-1 was the only predicting factor for diffusion impairment and the strongest predicting factor for restrictive dysfunction. CONCLUSION: Despite being asymptomatic, the majority of thalassemic children in this study suffered from diffusion impairment either alone or in combination with restrictive dysfunction. These pulmonary dysfunctions correlated significantly with body iron stores measured by serum ferritin.


Assuntos
Transfusão de Sangue , Ecocardiografia , Ferritinas/sangue , Pneumopatias , Pulmão , Talassemia beta , Adolescente , Criança , Egito , Feminino , Humanos , Pulmão/diagnóstico por imagem , Pulmão/fisiopatologia , Pneumopatias/sangue , Pneumopatias/diagnóstico por imagem , Pneumopatias/terapia , Masculino , Testes de Função Respiratória , Talassemia beta/sangue , Talassemia beta/diagnóstico por imagem , Talassemia beta/fisiopatologia , Talassemia beta/terapia
13.
Methods Mol Biol ; 1940: 275-295, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30788833

RESUMO

Lung transplantation is the only option for patients with end-stage lung disease, but there is a shortage of available lung donors. Furthermore, efficiency of lung transplantation has been limited due to primary graft dysfunction. Recent mouse models mimicking lung disease in humans have allowed for deepening our understanding of disease pathomechanisms. Moreover, new techniques such as decellularization and recellularization have opened up new possibilities to contribute to our understanding of the regenerative mechanisms involved in the lung. Stripping the lung of its native cells allows for unprecedented analyses of extracellular matrix and sets a physiologic platform to study the regenerative potential of seeded cells. A comprehensive understanding of the molecular pathways involved for lung development and regeneration in mouse models can be translated to regeneration strategies in higher organisms, including humans. Here we describe and discuss several techniques used for murine lung de- and recellularization, methods for evaluation of efficacy including histology, protein/RNA isolation at the whole lung, as well as lung slices level.


Assuntos
Matriz Extracelular/metabolismo , Pneumopatias/terapia , Pulmão/citologia , Regeneração/fisiologia , Engenharia Tecidual/métodos , Tecidos Suporte , Animais , Modelos Animais de Doenças , Pneumopatias/patologia , Transplante de Pulmão/métodos , Camundongos
14.
J Pediatr Hematol Oncol ; 41(2): e122-e124, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30789847

RESUMO

Langerhans cell histiocytosis is a multisystem disease affecting young children. Lung involvement has a myriad of manifestations and the outcomes for these patients have been poorly defined. We present a 2-year-old child who presented with multisystem disease with multiple lung cysts. Treatment consisted of multiagent chemotherapy for 18 months and was associated with a slow but favorable response.


Assuntos
Cistos/patologia , Histiocitose de Células de Langerhans/patologia , Pneumopatias/patologia , Pulmão/patologia , Pré-Escolar , Cistos/terapia , Histiocitose de Células de Langerhans/terapia , Humanos , Pneumopatias/terapia , Masculino
15.
Thorac Surg Clin ; 29(1): 65-76, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30454923

RESUMO

Nontuberculous mycobacterial (NTM) lung infections are increasingly recognized as a cause of chronic pulmonary disease. This article focuses on the most common NTM species known to cause human lung disease and the treatment options currently available. The diagnosis of NTM lung disease is also discussed, emphasizing the necessity for treating clinicians to have sufficient familiarity of the mycobacteria laboratory to provide optimal patient management.


Assuntos
Pneumopatias/tratamento farmacológico , Infecções por Micobactéria não Tuberculosa/tratamento farmacológico , Micobactérias não Tuberculosas/isolamento & purificação , Antituberculosos/uso terapêutico , Humanos , Pneumopatias/diagnóstico , Pneumopatias/terapia , Infecções por Micobactéria não Tuberculosa/diagnóstico , Infecções por Micobactéria não Tuberculosa/terapia
16.
Enferm. intensiva (Ed. impr.) ; 29(4): 168-181, oct.-dic. 2018. tab
Artigo em Espanhol | IBECS | ID: ibc-ET2-1334

RESUMO

Introducción y objetivos: Los pacientes ingresados en unidades de cuidados intensivos son susceptibles de complicaciones pulmonares por múltiples causas (enfermedad de base, inmovilización, riesgo de infección, etc.). La principal intervención para prevenirlas y tratarlas es la fisioterapia respiratoria (FR), práctica habitual en el día a día de enfermería. Por ello se realizó esta revisión bibliográfica, con el objetivo de describir los métodos de FR más eficaces para la prevención y tratamiento de las complicaciones pulmonares en los pacientes ingresados en unidades de cuidados intensivos, diferenciando paciente intubado y no intubado. Metodología: Se llevó a cabo una revisión narrativa de la literatura en las bases de datos Pubmed, Cinahl y Cochrane Library. Los límites fueron el idioma, la evidencia de los últimos 15 años y la edad. Resultados: Las técnicas de expansión pulmonar, tos, vibración, percusión, drenaje postural, espirometría incentivada y los sistemas oscilatorios y no oscilatorios presentan controversia en cuanto a la eficacia como método de fisioterapia respiratoria. En cambio, la ventilación mecánica no invasiva muestra clara evidencia de su beneficio. En el paciente intubado, la hiperinsuflación manual y la aspiración de secreciones son métodos eficaces para la prevención de complicaciones respiratorias. El resto de métodos de FR aplicados de forma aislada no han demostrado una clara eficacia. Discusión y conclusiones: Las técnicas de FR que han demostrado mejores resultados son la ventilación mecánica no invasiva para el paciente no intubado y la hiperinsuflación manual para el paciente intubado. Respecto al resto de técnicas existe mayor controversia. En ambos grupos de pacientes, la literatura muestra que la terapia combinada es la más eficaz


Introduction and aims: Patients in intensive care unit are susceptible to complications due to different causes (underlying disease, immobilisation, infection risk…) The current main intervention in order to prevent these complications is respiratory physiotherapy, a common practice for nurses on a daily basis. Therefore, we decided to carry out this bibliographic review to describe the most efficient respiratory physiotherapy methods for the prevention and treatment of lung complications in patients in intensive care, taking into account the differences between intubated and non-intubated patients. Methodology: The bibliographic narrative review was carried out on literature available in Pubmed, Cinahl and Cochrane Library. The established limits were language, evidence over the last 15 years and age. Results: Techniques involving lung expansion, cough, vibration, percussion, postural drainage, incentive inspirometry and oscillatory and non-oscillatory systems are controversial regarding their efficacy as respiratory physiotherapy methods. However, non-invasive mechanical ventilation shows clear benefits. In the case of intubated patients, manual hyperinflation and secretion aspirations are highly efficient methods for the prevention of the potential complications mentioned above. In this case, other RP methods showed no clear efficiency when used individually. DiscusSion and conclusions: Non-invasive mechanical ventilation (for non-intubated patients) and manual hyperinflation (for intubated patients) proved to be the respiratory physiotherapy methods with the best results. The other techniques are more controversial and the results are not so clear. In both types of patients this literature review suggests that combined therapy is the most efficient


Assuntos
Humanos , Cuidados Críticos/métodos , Pneumopatias/terapia , Modalidades de Fisioterapia , Terapia Respiratória , Unidades de Terapia Intensiva
17.
PLoS One ; 13(12): e0208188, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30557307

RESUMO

BACKGROUND: Chronic lung diseases contribute to the growing non-communicable disease (NCD) burden and are increasing, particularly in many low and middle-income countries (LMIC) in sub-Saharan African. Early engagement with health systems in chronic lung disease management is critical to maintain quality of life and prevent further damage. Our study sought to understand health seeking behaviour in relation to chronic lung disease and TB in a rural district in Malawi. METHODS: Qualitative data was collected between March-May 2015, exploring patterns of health seeking for lung disease amongst residents of two districts in rural Malawi. Participants included those with and without lung disease, health workers and village leaders. Participants with a history of TB were included in the sample due to similarities in clinical presentation and in view of potential to cause long-term damage to lung tissue. RESULTS: Our findings are ordered around a specific model of health seeking devised by adapting previous models. The model and findings span three broad areas that were found to influence health seeking: understandings of health and disease which shaped whether, when and where to seek care; the care seeking decision which was influenced by social and structural factors; and the care seeking experience which impacted future care decisions creating 'feedback loops'. DISCUSSION: Efforts to improve effective and accessible healthcare provision for chronic lung disease need to address all the determinants of health seeking behaviour identified. This may include: enhancing the structural and financial accessibility of health services, through the strengthening of community linkages; improving communication between formal health providers, patients and communities around symptoms, diagnosis and management of chronic lung diseases; and improving the quality of diagnostic and management services through the strengthening of health systems 'hardware' (equipment availability) and 'software' (development of trusting and respectful relationships between providers and patients).


Assuntos
Grupos Focais , Acesso aos Serviços de Saúde , Necessidades e Demandas de Serviços de Saúde , Pneumopatias/terapia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Doença Crônica/terapia , Ensaios Clínicos Fase II como Assunto , Feminino , Humanos , Pneumopatias/diagnóstico , Malaui , Masculino , Pobreza , Pesquisa Qualitativa , Qualidade de Vida , População Rural
18.
Medicine (Baltimore) ; 97(52): e13806, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30593169

RESUMO

RATIONALE: Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) is a rare idiopathic disease with only about 100 cases reported in the literature. PATIENT CONCERNS: Here, we presented 4 cases of DIPNECH. Four patients included 2 females and 2 males, aged 54 to 64 years old; 3 had no smoking history and 1 had history of smoking for 30 years. Surgical resection was performed for every patient. Cases 1 and 3 did not receive postoperative chemotherapy or radiotherapy, and case 2 received 4 times of postoperative chemotherapy. Case 4 just finished the operation and after a period of time, he will receive postoperative chemotherapy. DIAGNOSES: Case 1: A 57-year-old female had chest pain, and computer tomography (CT) examination prompted a mass shadow of left lung lower lobe. Case 2: A 64-year-old female had cough and expectoration for more than 1 month. CT examination showed: a lump with diameter of about 2.5 cm and irregular edge was in right lung upper lobe, being largely possibly lung cancer. Case 3: A 54-year-old male, CT examination accidentally found a long strip-shaped nodule in left lung oblique fissure when checkup's, and he had no fever, cough, expectoration, chest tightness, or chest pain. Case 4: A 61-year-old male, checkup's CT examination accidentally found a nodule, fibrosis, bronchiectasis, and secondary infection in the left lower lobe. Combined with pathological morphology and immunohistochemistry, cases 1 and 3 were diagnosed as DIPNECH with multiple carcinoid tumorlet formation and chronic inflammation and bronchiectasis, case 2 was diagnosed as an adenocarcinoma with DIPNECH and multiple carcinoid tumorlet formation, case 4 was diagnosed as an adenocarcinoma with DIPNECH and multiple carcinoid tumorlet formation and chronic inflammation and bronchiectasis. INTERVENTIONS: Surgical resection was performed for every patient. Cases 1 and 3 did not receive postoperative chemotherapy or radiotherapy, and case 2 received 4 times of postoperative chemotherapy. Case 4 just finished the operation and after a period of time, he will receive postoperative chemotherapy. OUTCOMES: Four patients have been followed up and have had good condition. LESSONS: DIPNECH is often found accidentally in a surgical specimen, is easily missed, and needs careful observation. Immunohistochemistry is necessary to make this diagnosis.


Assuntos
Pneumopatias/patologia , Pulmão/citologia , Células Neuroendócrinas/patologia , Feminino , Humanos , Hiperplasia/patologia , Hiperplasia/terapia , Pneumopatias/terapia , Masculino , Pessoa de Meia-Idade
19.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 30(12): 1167-1172, 2018 Dec.
Artigo em Chinês | MEDLINE | ID: mdl-30592952

RESUMO

OBJECTIVE: To evaluate the effect of extracorporeal membrane oxygenation (ECMO) as a bridge to lung transplantation (LTx). METHODS: The clinical data of 18 patients with end-stage lung diseases was retrospectively reviewed, using ECMO as a bridge to LTx in intensive care unit of Affiliated Wuxi People's Hospital from January 2015 to December 2017. Clinical parameters were obtained from these patients, including gender, age, primary disease, preoperative lactate level, preoperative leukocyte, operation modality (unilateral or bilateral), type of ECMO, ECMO support time as a bridge to LTx, ECMO support time after operation, total usage time of ECMO, ECMO associated complications, primary graft dysfunction (PGD), successful ECMO weaning, and survival. Patients were divided according to type of ECMO, whether successfully weaned from ECMO or not, and primary disease. Clinical data was compared, and the Kaplan-Meier survival of 180-day was studied. RESULTS: (1) The overall situation showed: A total of 18 patients were enrolled, with 14 males and 4 females, age ranged from 23 to 78 years old. Primary disease included 6 cases of idiopathic pulmonary fibrosis (IPF), 3 cases of idiopathic pulmonary hypertension (IPAH), 8 cases of interstitial pneumonia and 1 case of silicosis. Nine patients received venous-venous (V-V) ECMO and 9 venous-artery (V-A) ECMO as a bridge to LTx; 15 patients received LTx successfully, and failed in 3 cases. The average bridge time was 57.5 (14.5, 116.5) hours. ECMO associated complications included 6 cases with bleeding, 12 cases with renal failure, 2 cases with thrombosis, 2 cases with oxygenator leak, and 1 case with leg ischemia. There were 7 unilateral (5 right lungs and 2 left lungs) and 8 bilateral LTx. Three patients died before LTx due to septic shock. Nine patients died after LTx, 4 for septic shock, 4 for multiple organ failure, and 1 for sudden cardiac death. Six patients survived after LTx. (2) Group comparison showed: There was no significant difference in gender, age, ECMO support time as a bridge to LTx, ECMO support time after operation, total ECMO usage time, incidence of PGD, successful weaning from ECMO, and 180-day survival rate between V-V ECMO group (n = 7) and V-A ECMO group (n = 8). There was no significant difference in gender, age, primary disease, type of ECMO, operation modality, preoperative leukocyte count between groups of successfully weaned from ECMO (n = 11) and the failed (n = 7). Lower level of preoperative lactate acid (mmol/L: 3.01±1.51 vs. 8.27±3.49, t = -3.770, P = 0.006), shorter total ECMO usage time (hours: 72.82±40.53 vs. 210.71±107.10, t = -3.907, P = 0.001), and higher 180-day survival rate (54.5% vs. 0, P = 0.038) were found in the group of successfully weaned from ECMO, when compared with the failed group. (3) Kaplan-Meier survival analysis showed that postoperative survival rates of 7, 30, 60, and 180 days of 18 patients was 72.2%, 38.9%, 33.3%, and 33.3%, respectively. Among them, the postoperative survival rates of 7, 30, 60, and 180 days in the group of successfully weaned from ECMO (n = 11) were higher than those in group of failed (n = 7; 81.8% vs. 57.1%, 63.6 % vs. 0, 54.5% vs. 0, 54.5% vs. 0, respectively; log-rank test: χ2 = 8.009, P = 0.005). The postoperative survival rates of 7, 30, 60, and 180 days in IPF group (n = 6) were lower than those in non-IPF group (n = 12; 33.3% vs. 83.3%, 16.7% vs. 50.0%, 16.7% vs. 41.7%, 16.7% vs. 41.7%; log-rank test: χ2 = 4.161, P = 0.041). CONCLUSIONS: The use of ECMO as a bridge to LTx may provide survival benefit for LTx recipients. V-V ECMO provides effective life support for patients without severe heart failure, and V-A ECMO for patients with unstable hemodynamics. Preoperative lactate level and total ECMO duration time were closely related to ECMO weaning rate. Primary diagnosis may affect prognosis.


Assuntos
Oxigenação por Membrana Extracorpórea , Pneumopatias/terapia , Transplante de Pulmão , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
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