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1.
Biomed Res Int ; 2020: 3292916, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33029503

RESUMO

In December of 2019, there was an outbreak of a severe acute respiratory syndrome caused by the coronavirus 2 (SARS-CoV-2 or COVID-19) in China. The virus rapidly spread into the whole world causing an unprecedented pandemic and forcing governments to impose a global quarantine, entering an extreme unknown situation. The organizational consequences of quarantine/isolation are absence of organized training and competition, lack of communication among athletes and coaches, inability to move freely, lack of adequate sunlight exposure, and inappropriate training conditions. The reduction of mobility imposed to contain the advance of the SARS-Cov-2 pandemic can negatively affect the physical condition and health of individuals leading to muscle atrophy, progressive loss of muscle strength, and reductions in neuromuscular and mechanical capacities. Resistance training (RT) might be an effective tool to counteract these adverse consequences. RT is considered an essential part of an exercise program due to its numerous health and athletic benefits. However, in the face of the SARS-Cov-2 outbreak, many people might be concerned with safety issues regarding its practice, especially in indoor exercise facilities, such as gyms and fitness centers. These concerns might be associated with RT impact in the immune system, respiratory changes, and contamination due to equipment sharing and agglomeration. In this current opinion article, we provide insights to address these issues to facilitate the return of RT practices under the new logistical and health challenges. We understand that RT can be adapted to allow its performance with measures adopted to control coronavirus outbreak such that the benefits would largely overcome the potential risks. The article provides some practical information to help on its implementation.


Assuntos
Infecções por Coronavirus/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Treinamento de Resistência/efeitos adversos , Treinamento de Resistência/métodos , Betacoronavirus , China/epidemiologia , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/transmissão , Desinfecção/métodos , Humanos , Sistema Imunitário/fisiopatologia , Pandemias/prevenção & controle , Pneumonia Viral/fisiopatologia , Pneumonia Viral/transmissão , Treinamento de Resistência/instrumentação , Sistema Respiratório/fisiopatologia , Fatores de Risco , Segurança
5.
PLoS One ; 15(7): e0235346, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32667951

RESUMO

Several studies have recently suggested that an abnormal processing of respiratory interoceptive and nociceptive (painful) stimuli may contribute to eating disorder (ED) pathophysiology. Mood and anxiety disorders (MA) are also characterized by abnormal respiratory symptoms, and show substantial comorbidity with ED. However, no studies have examined both respiratory and pain processing simultaneously within ED and MA. The present study systematically evaluated responses to perturbations of respiratory and nociceptive signals across the levels of physiology, behavior, and symptom report in a transdiagnostic ED sample (n = 51) that was individually matched to MA individuals (n = 51) and healthy comparisons (HC; n = 51). Participants underwent an inspiratory breath-holding challenge as a probe of respiratory interoception and a cold pressor challenge as a probe of pain processing. We expected both clinical groups to report greater stress and fear in response to respiratory and nociceptive perturbation than HCs, in the absence of differential physiological and behavioral responses. During breath-holding, both the ED and MA groups reported significantly more stress, feelings of suffocation, and suffocation fear than HC, with the ED group reporting the most severe symptoms. Moreover, anxiety sensitivity was related to suffocation fear only in the ED group. The heightened affective responses in the current study occurred in the absence of group differences in behavioral (breath hold duration, cold pressor duration) and physiological (end-tidal carbon dioxide, end-tidal oxygen, heart rate, skin conductance) responses. Against our expectations, there were no group differences in the response to cold pain stimulation. A matched-subgroup analysis focusing on individuals with anorexia nervosa (n = 30) produced similar results. These findings underscore the presence of abnormal respiratory interoception in MA and suggest that hyperreactivity to respiratory signals may be a potentially overlooked clinical feature of ED.


Assuntos
Anorexia Nervosa/fisiopatologia , Transtornos de Ansiedade/fisiopatologia , Transtornos da Alimentação e da Ingestão de Alimentos/fisiopatologia , Dor Nociceptiva/fisiopatologia , Adolescente , Adulto , Afeto/fisiologia , Anorexia Nervosa/complicações , Anorexia Nervosa/epidemiologia , Transtornos de Ansiedade/complicações , Transtornos de Ansiedade/epidemiologia , Asfixia/fisiopatologia , Asfixia/terapia , Comorbidade , Medo/fisiologia , Transtornos da Alimentação e da Ingestão de Alimentos/complicações , Transtornos da Alimentação e da Ingestão de Alimentos/epidemiologia , Feminino , Humanos , Masculino , Transtornos do Humor/complicações , Transtornos do Humor/epidemiologia , Transtornos do Humor/fisiopatologia , Dor Nociceptiva/complicações , Dor Nociceptiva/epidemiologia , Dor/complicações , Dor/epidemiologia , Dor/fisiopatologia , Sistema Respiratório/fisiopatologia
6.
Salud Publica Mex ; 62(5): 582-589, 2020.
Artigo em Espanhol | MEDLINE | ID: mdl-32526820

RESUMO

OBJECTIVE: To analyze the evidence on the relationship between air pollution and an increased risk of morbidity and mortality from Covid-19. MATERIALS AND METHODS: An adaptation of the Cochrane rapid review methodology was used. The search was performed in PubMed and MedRxiv and was limited until April 28 and 26, respectively. The titles and abstracts were reviewed by five researchers who, in turn, reviewed the full texts of the final selection. RESULTS: 450 manuscripts were found, 15 met the inclusion criteria. The evidence reports that the incidence and risk of morbidity and mortality from Covid-19 increase with chronic and acute exposure to air pollution, particularly to particulate matter (PM2.5, P M10) and nitrogen dioxide. CONCLUSIONS: More studies are required especially in Latin American cities. It is necessary to strengthen the recommendations in cities with higher levels of pollutants and to reduce their emissions.


Assuntos
Poluição do Ar/efeitos adversos , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Poluentes Atmosféricos/efeitos adversos , Cidades , Infecções por Coronavirus/etiologia , Suscetibilidade a Doenças , Exposição Ambiental , Monitoramento Ambiental , Humanos , Incidência , América Latina/epidemiologia , Conceitos Meteorológicos , Material Particulado/efeitos adversos , Pneumonia Viral/etiologia , Sistema Respiratório/fisiopatologia , Sistema Respiratório/virologia , Síndrome Respiratória Aguda Grave/etiologia , Síndrome Respiratória Aguda Grave/mortalidade , Saúde da População Urbana
7.
Rev Mal Respir ; 37(6): 462-473, 2020 Jun.
Artigo em Francês | MEDLINE | ID: mdl-32487422

RESUMO

INTRODUCTION: A significant portion of symptoms in some lung diseases results from an excessive constriction of airways due to the contraction of smooth muscle and bronchial hyperresponsiveness. A better understanding of the extracellular molecules that control smooth muscle contractility is necessary to identify the underlying causes of the problem. STATE OF KNOWLEDGE: Almost a hundred molecules, some of which newly identified, influence the contractility of airway smooth muscle. While some molecules activate the contraction, others activate the relaxation, thus acting directly as bronchoconstrictors and bronchodilators, respectively. Other molecules do not affect contraction directly but rather influence it indirectly by modifying the effect of bronchoconstrictors and bronchodilators. These are called bronchomodulators. Some of these bronchomodulators increase the contractile effect of bronchoconstrictors and could thus contribute to bronchial hyperresponsiveness. PROSPECTS: Considering the high number of molecules potentially involved, as well as the level of functional overlap between some of them, identifying the extracellular molecules responsible for excessive airway constriction in a patient is a major contemporary challenge.


Assuntos
Hiper-Reatividade Brônquica/etiologia , Broncoconstritores/farmacologia , Broncodilatadores/farmacologia , Contração Muscular/efeitos dos fármacos , Contração Muscular/fisiologia , Animais , Asma/etiologia , Asma/metabolismo , Asma/fisiopatologia , Hiper-Reatividade Brônquica/metabolismo , Hiper-Reatividade Brônquica/fisiopatologia , Broncoconstrição/efeitos dos fármacos , Broncoconstrição/fisiologia , Broncoconstritores/metabolismo , Broncodilatadores/metabolismo , Espaço Extracelular/metabolismo , Humanos , Músculo Liso/efeitos dos fármacos , Músculo Liso/fisiologia , Sistema Respiratório/efeitos dos fármacos , Sistema Respiratório/metabolismo , Sistema Respiratório/fisiopatologia
8.
Immunity ; 52(6): 905-909, 2020 06 16.
Artigo em Inglês | MEDLINE | ID: mdl-32497522

RESUMO

Respiratory viruses affect us throughout our lives, from infancy to old age, causing illnesses ranging from a common cold to severe pneumonia. They belong to several virus families, and although many features of infection with these diverse viruses are shared, some have unique characteristics. Here we explain what happens when we are infected by respiratory viruses, including SARS-CoV-2, which causes COVID-19.


Assuntos
Infecções por Coronavirus/fisiopatologia , Pneumonia Viral/fisiopatologia , Sistema Respiratório/fisiopatologia , Imunidade Adaptativa , Betacoronavirus/fisiologia , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/terapia , Infecções por Coronavirus/virologia , Humanos , Imunidade Inata , Pandemias , Pneumonia Viral/imunologia , Pneumonia Viral/terapia , Pneumonia Viral/virologia , Sistema Respiratório/imunologia , Sistema Respiratório/virologia , Fenômenos Fisiológicos Virais , Vírus/classificação
9.
Apunts, Med. esport (Internet) ; 55(206): 81-85, abr.-jun. 2020. tab, graf
Artigo em Inglês | IBECS | ID: ibc-189898

RESUMO

The spread of CoV-2 occurs mainly by respiratory droplets. Its dispersion depends on several factors: viscoelasticity of fluid, ventilation, evaporation rate, exhalations, sneeze or cough. At moment, the preventive distance to avoid the contamination has been established in 1-2 m. We believe that it is necessary to review this aspect, because the respiratory flows change with the intensity of physical activity. The ventilatory response can be evaluated in terms of ventilatory demand or ventilatory efficiency. During maximal effort tests, athletes mobilize an extraordinary amount of air arriving to 150/200 L/min. The respiratory volume follows increase in linear progression during the test in function of power developed. When the air volume is increased 10 times, we think that the distance should be around 6-7 m


No disponible


Assuntos
Humanos , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Expiração/fisiologia , Atividade Motora , Esforço Físico , Sistema Respiratório/fisiopatologia , Ventilação , Espirro , Tosse , Distância Social
10.
Fisioterapia (Madr., Ed. impr.) ; 42(3): 136-144, mayo-jun. 2020. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-191003

RESUMO

ANTECEDENTES Y OBJETIVO: Los niños con parálisis cerebral suelen presentar afectación del sistema respiratorio por debilidad muscular. Varios enfoques terapéuticos se han introducido para mejorar este problema, destacando el uso ergonómico en los sistemas de posicionamiento para mejorar el deterioro neuromuscular debido al mal posicionamiento y que conduce a alteraciones respiratorias. El objetivo de este estudio es analizar la evidencia existente sobre el efecto de diferentes sistemas de posicionamiento en la función respiratoria de niños con parálisis cerebral. MATERIAL Y MÉTODOS: Revisión sistemática de ensayos clínicos siguiendo las recomendaciones PRISMA en las bases de datos PubMed, PEDro, SciELo y Science Direct. Se utilizó la escala PEDro para la validez interna de los estudios y la herramienta propuesta por Cochrane para la valoración de los riesgos de sesgo. La búsqueda fue electrónica y manual. RESULTADOS: Se identificaron 26 estudios, de los que 7 fueron seleccionados para la revisión. Se encontraron resultados significativos en la función pulmonar al emplear asiento adaptado anterior, órtesis de tobillo y pie y sistema de posicionamiento nocturno. El empleo de una silla de ruedas con diferentes adaptaciones supuso mejoras en la función respiratoria, sin resultados estadísticamente significativos. CONCLUSIONES: Los sistemas de posicionamiento pueden mejorar la función respiratoria de los niños con parálisis cerebral. Existen diferentes procedimientos de intervención y de evaluación de los sistemas de posicionamiento destinados a la función respiratoria


BACKGROUND AND OBJECTIVE: Children with cerebral palsy usually have respiratory system involvement due to muscle weakness. Several therapeutic uses have been introduced to solve this problem, including the use of ergonomics in positioning systems to improve neuromuscular deterioration due to poor positioning and leading to respiratory disorders. The objective is to analyse the evidence on the effect of different positioning systems on the respiratory function of children diagnosed with cerebral palsy. MATERIAL AND METHODS: Systematic review of clinical trials following the PRISMA recommendations in PubMed, PEDro, SciELo and Science Direct databases. The PEDro scale was used for the internal validity of the studies and the tool proposed by Cochrane for the assessment of risk of bias. RESULTS: Twenty-six studies were identified, of which 7 were selected for review. Significant results were found in lung function using anterior adaptive seating, ankle foot orthosis and a night positioning system. By contrast, the use of a wheelchair with different adaptations resulted in improvements in respiratory function without statistically significant results. CONCLUSIONS: Positioning systems can improve the respiratory function of children with cerebral palsy. There are different procedures for intervention and evaluation of positioning systems for respiratory function


Assuntos
Humanos , Pré-Escolar , Criança , Adolescente , Paralisia Cerebral/reabilitação , Modalidades de Fisioterapia , Postura , Taxa Respiratória , Paralisia Cerebral/complicações , Sistema Respiratório/fisiopatologia , Prática Clínica Baseada em Evidências , Análise de Dados
11.
Lancet Respir Med ; 8(7): 687-695, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32386571

RESUMO

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in December 2019, causing a respiratory disease (coronavirus disease 2019, COVID-19) of varying severity in Wuhan, China, and subsequently leading to a pandemic. The transmissibility and pathogenesis of SARS-CoV-2 remain poorly understood. We evaluate its tissue and cellular tropism in human respiratory tract, conjunctiva, and innate immune responses in comparison with other coronavirus and influenza virus to provide insights into COVID-19 pathogenesis. METHODS: We isolated SARS-CoV-2 from a patient with confirmed COVID-19, and compared virus tropism and replication competence with SARS-CoV, Middle East respiratory syndrome-associated coronavirus (MERS-CoV), and 2009 pandemic influenza H1N1 (H1N1pdm) in ex-vivo cultures of human bronchus (n=5) and lung (n=4). We assessed extrapulmonary infection using ex-vivo cultures of human conjunctiva (n=3) and in-vitro cultures of human colorectal adenocarcinoma cell lines. Innate immune responses and angiotensin-converting enzyme 2 expression were investigated in human alveolar epithelial cells and macrophages. In-vitro studies included the highly pathogenic avian influenza H5N1 virus (H5N1) and mock-infected cells as controls. FINDINGS: SARS-CoV-2 infected ciliated, mucus-secreting, and club cells of bronchial epithelium, type 1 pneumocytes in the lung, and the conjunctival mucosa. In the bronchus, SARS-CoV-2 replication competence was similar to MERS-CoV, and higher than SARS-CoV, but lower than H1N1pdm. In the lung, SARS-CoV-2 replication was similar to SARS-CoV and H1N1pdm, but was lower than MERS-CoV. In conjunctiva, SARS-CoV-2 replication was greater than SARS-CoV. SARS-CoV-2 was a less potent inducer of proinflammatory cytokines than H5N1, H1N1pdm, or MERS-CoV. INTERPRETATION: The conjunctival epithelium and conducting airways appear to be potential portals of infection for SARS-CoV-2. Both SARS-CoV and SARS-CoV-2 replicated similarly in the alveolar epithelium; SARS-CoV-2 replicated more extensively in the bronchus than SARS-CoV. These findings provide important insights into the transmissibility and pathogenesis of SARS-CoV-2 infection and differences with other respiratory pathogens. FUNDING: US National Institute of Allergy and Infectious Diseases, University Grants Committee of Hong Kong Special Administrative Region, China; Health and Medical Research Fund, Food and Health Bureau, Government of Hong Kong Special Administrative Region, China.


Assuntos
Betacoronavirus/imunologia , Túnica Conjuntiva/virologia , Infecções por Coronavirus/imunologia , Imunidade Inata/imunologia , Pneumonia Viral/imunologia , Sistema Respiratório/virologia , Tropismo Viral/fisiologia , Replicação Viral/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus/fisiologia , Túnica Conjuntiva/imunologia , Túnica Conjuntiva/fisiopatologia , Infecções por Coronavirus/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/fisiopatologia , Mucosa Respiratória/imunologia , Mucosa Respiratória/fisiopatologia , Mucosa Respiratória/virologia , Sistema Respiratório/imunologia , Sistema Respiratório/fisiopatologia
12.
Pediatr Pulmonol ; 55(7): 1601-1607, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32353216

RESUMO

OBJECTIVE: To study impulse oscillometry (IOS) indices of peripheral airway function and FeNO as predictors of future loss of asthma control in preschool children. METHODS: Patients aged 3 to 6 years who were actively being treated for asthma and children without asthma were enrolled in the study. Participants had no change in medication on visit 1 and returned for a follow-up visit within 8 to 12 weeks. At the first visit, nursing assessment, symptom history, IOS analysis, FeNO, and physician evaluation were repeated. RESULTS: Fifty-one (64.6%) subjects had lost asthma control (UC-Group) and 28 (35.4%) subjects had maintained asthma control (C-Group) at their follow-up visit. Thirty-two children without asthma were enrolled in the study as a normal control group (N-Group). R5, R5-20, AX, and Z5 values were all significantly higher in subjects whose symptoms remained uncontrolled compared with those in the controlled asthma group (P < .01) and also significantly higher than those in the normal control group (P < .01). FeNO showed no significant difference between the UC-Group and C-Group (P = .399). Four indices-R5, R5-20, AX, and Z5-had an estimated area under the curve (AUC) of greater than 0.8 and were thus easily able to distinguish the UC-Group from the C-Group. CONCLUSIONS: AX had the highest overall AUC (0.884) of the investigated parameters, and the optimal cut-off point of 37.435 cm H2 O/L was able to predict future loss of asthma control in preschool children.


Assuntos
Asma/metabolismo , Asma/fisiopatologia , Óxido Nítrico/metabolismo , Sistema Respiratório/fisiopatologia , Criança , Pré-Escolar , Expiração , Feminino , Humanos , Masculino , Oscilometria , Testes de Função Respiratória , Índice de Gravidade de Doença , Exacerbação dos Sintomas
13.
Am J Geriatr Psychiatry ; 28(7): 780-783, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32359882
15.
Artigo em Inglês | MEDLINE | ID: mdl-32225030

RESUMO

The effects on respiratory health in populations living close to silica-rich gold mine dumps are unknown. This pilot study related respiratory health and exposure to mine dump dust using two measures of exposure: exposure group, based on distance lived from the mine dump-high (n = 93) (home <500 m from a mine dump), moderate (n = 133) (500-1.5 km), and low (n = 84) (>15 km, control group); and cumulative exposure index (CEI) derived from exposure group and number of years of residence in each exposure group. Participants were interviewed about respiratory symptoms and had chest X-rays and spirometry. We adjusted for key respiratory confounders. No subject had radiological features of silicosis. The high relative to low exposure group had significantly elevated adjusted odds ratios (aORs) for upper respiratory symptoms (aOR: 2.76, 95% CI: 1.28-5.97), chest wheezing (aOR: 3.78; 95% CI: 1.60-8.96), and spirometry-diagnosed chronic obstructive pulmonary disease (COPD) (aOR: 8.17; 95%CI: 1.01-65.85). These findings were similar for the high relative to medium exposure group, but no significant associations were found for the medium versus low exposure group. Chronic bronchitis and tuberculosis risks did not differ significantly among groups. CEI and exposure group produced similar results. In conclusion, residents residing <500 m from mine dumps had elevated adverse respiratory health effects.


Assuntos
Exposição Ambiental/análise , Mineração , Sistema Respiratório/fisiopatologia , Doenças Respiratórias/epidemiologia , Instalações de Eliminação de Resíduos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Poeira , Feminino , Ouro , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , África do Sul , Adulto Jovem
16.
PLoS One ; 15(3): e0230419, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32226050

RESUMO

BACKGROUND: The notion that smoking cannabis may damage the respiratory tract has been introduced in recent years but there is still a paucity of studies on this subject. The aim of this study was to investigate the relationship between cannabis smoking, pneumothorax and bullous lung disease in a population of operated patients. METHODS AND FINDINGS: We performed a retrospective study on patients operated on for spontaneous pneumothorax. Patients were divided into three groups according to their smoking habit: cannabis smokers, only-tobacco smokers and nonsmokers. Cannabis lifetime exposure was expressed in dose-years (1d/y = 1 gram of cannabis/week for one year). Clinical, radiological and perioperative variables were collected. The variables were analyzed to find associations with smoking habit. The impact of the amount of cannabis consumption was also investigated by ROC curves analysis. Of 112 patients, 39 smoked cannabis, 23 smoked only tobacco and 50 were nonsmokers. Median cannabis consumption was 28 dose/years, median tobacco consumption was 6 pack/years. Cannabis smokers presented with more severe chronic respiratory symptoms and bullous lung disease and with a higher incidence of tension pneumothorax than both tobacco smokers and nonsmokers. Cannabis smokers also developed a larger pneumothorax, experienced prolonged postoperative stay and demonstrated a higher incidence of pneumothorax recurrence after the operation than nonsmokers did. The risk of occurrence of chronic respiratory symptoms and bullous lung disease in cannabis smokers was dose-related. CONCLUSIONS: Cannabis smoking seems to increase the risk of suffering from respiratory complaints and can have detrimental effects on lung parenchyma, in a dose-dependent manner. Cannabis smoking also negatively affected the outcome of patients operated for spontaneous pneumothorax. A history of cannabis abuse should always be taken in patients with pneumothorax. There may be need for a specific treatment for pneumothorax in cannabis smokers.


Assuntos
Vesícula/fisiopatologia , Fumar Maconha/efeitos adversos , Pneumotórax/fisiopatologia , Fumar Tabaco/efeitos adversos , Adulto , Vesícula/diagnóstico por imagem , Vesícula/etiologia , Vesícula/cirurgia , Cannabis/efeitos adversos , Feminino , Alucinógenos/efeitos adversos , Humanos , Pulmão/diagnóstico por imagem , Pulmão/fisiopatologia , Masculino , Abuso de Maconha/epidemiologia , Abuso de Maconha/fisiopatologia , Pessoa de Meia-Idade , Pneumotórax/diagnóstico por imagem , Pneumotórax/etiologia , Pneumotórax/cirurgia , Enfisema Pulmonar/diagnóstico por imagem , Enfisema Pulmonar/fisiopatologia , Enfisema Pulmonar/cirurgia , Sistema Respiratório/diagnóstico por imagem , Sistema Respiratório/fisiopatologia , Índice de Gravidade de Doença , Fumantes , Tomografia Computadorizada por Raios X , Adulto Jovem
17.
Med Clin North Am ; 104(3): 455-470, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32312409

RESUMO

Respiratory symptoms are common in patients living with serious illness, both in cancer and nonmalignant conditions. Common symptoms include dyspnea (breathlessness), cough, malignant pleural effusions, airway secretions, and hemoptysis. Basic management of respiratory symptoms is within the scope of primary palliative care. There are pharmacologic and nonpharmacologic approaches to treating respiratory symptoms. This article provides clinicians with treatment approaches to these burdensome symptoms.


Assuntos
Tosse/terapia , Estado Terminal/terapia , Dispneia/terapia , Hemoptise/terapia , Derrame Pleural Maligno/tratamento farmacológico , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/efeitos adversos , Analgésicos Opioides/uso terapêutico , Secreções Corporais/efeitos dos fármacos , Terapia Combinada/métodos , Tosse/epidemiologia , Tosse/etiologia , Tosse/patologia , Dispneia/epidemiologia , Dispneia/etiologia , Dispneia/patologia , Hemoptise/epidemiologia , Hemoptise/etiologia , Hemoptise/patologia , Humanos , Mortalidade/tendências , Cuidados Paliativos/normas , Derrame Pleural Maligno/epidemiologia , Derrame Pleural Maligno/mortalidade , Prevalência , Sistema Respiratório/efeitos dos fármacos , Sistema Respiratório/fisiopatologia , Fatores de Risco
18.
PLoS One ; 15(3): e0229688, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32187193

RESUMO

BACKGROUND: Left ventricular assist devices (LVADs) are an established treatment for end stage heart failure patients. As LVADs do not currently respond to exercise demands, attention is also directed towards improvements in exercise capacity and resulting quality of life. The aim of this study was to explore hemodynamic responses observed during maximal exercise tests to infer underlying patient status and therefore investigate possible diagnostics from LVAD derived data and advance the development of physiologically adaptive LVAD controllers. METHODS: High resolution continuous LVAD flow waveforms were recorded from 14 LVAD patients and evaluated at rest and during maximum bicycle exercise tests (n = 24). Responses to exercise were analyzed in terms of an increase (↑) or decrease (↓) in minimum (QMIN), mean (QMEAN), maximum flow (QMAX) and flow pulsatility (QP2P). To interpret clinical data, a cardiorespiratory numerical simulator was used that reproduced patients' hemodynamics at rest and exercise. Different cardiovascular scenarios including chronotropic and inotropic responses, peripheral vasodilation, and aortic valve pathologies were simulated systematically and compared to the patients' responses. RESULTS: Different patients' responses to exercise were observed. The most common response was a positive change of ΔQMIN↑ and ΔQP2P↑ from rest to exercise (70% of exercise tests). Two responses, which were never reported in patients so far, were distinguished by QMIN↑ and QP2P↓ (observed in 17%) and by QMIN↓ and QP2P↑ (observed in 13%). The simulations indicated that the QP2P↓ can result from a reduced left ventricular contractility and that the QMIN↓ can occur with a better left ventricular contractility and/or aortic insufficiency. CONCLUSION: LVAD flow waveforms determine a patients' hemodynamic "fingerprint" from rest to exercise. Different waveform responses to exercise, including previously unobserved ones, were reported. The simulations indicated the left ventricular contractility as a major determinant for the different responses, thus improving patient stratification to identify how patient groups would benefit from exercise-responsive LVAD control.


Assuntos
Exercício Físico/fisiologia , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/terapia , Coração Auxiliar , Modelos Cardiovasculares , Idoso , Algoritmos , Aptidão Cardiorrespiratória/fisiologia , Simulação por Computador , Feminino , Coração Auxiliar/estatística & dados numéricos , Hemodinâmica/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sistema Respiratório/fisiopatologia
19.
Zhonghua Jie He He Hu Xi Za Zhi ; 43(3): 180-182, 2020 Mar 12.
Artigo em Chinês | MEDLINE | ID: mdl-32164083

RESUMO

A recent epidemic of pneumonia cases in Wuhan China was caused by a novel coronavirus with strong infectivity, the 2019 novel coronavirus (2019-nCoV). The article provides the pulmonary rehabilitation (PR) methods in the principle of 4S (simple, safe, satisfy, save) for patients with pneumonia caused by the novel coronavirus, shows how to establish a ventilative and convectional PR environment to prevent the spread of virus through droplets, how to guide the patients to carry out PR, how to carry out respiratory muscle training, effective cough, expectoration, sneeze, general exercise, digestive function rehabilitation and psychological rehabilitation, and how to clean and disinfect the PR environment.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus , Pneumonia Viral/reabilitação , Reabilitação/métodos , Sistema Respiratório/fisiopatologia , China , Infecções por Coronavirus/complicações , Infecções por Coronavirus/reabilitação , Tosse , Humanos , Pneumonia Viral/complicações , Pneumonia Viral/virologia , Guias de Prática Clínica como Assunto , Respiração Artificial , Mecânica Respiratória
20.
Trials ; 21(1): 130, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-32007099

RESUMO

BACKGROUND: Positive end-expiratory pressure (PEEP) at minimum respiratory elastance during mechanical ventilation (MV) in patients with acute respiratory distress syndrome (ARDS) may improve patient care and outcome. The Clinical utilisation of respiratory elastance (CURE) trial is a two-arm, randomised controlled trial (RCT) investigating the performance of PEEP selected at an objective, model-based minimal respiratory system elastance in patients with ARDS. METHODS AND DESIGN: The CURE RCT compares two groups of patients requiring invasive MV with a partial pressure of arterial oxygen/fraction of inspired oxygen (PaO2/FiO2) ratio ≤ 200; one criterion of the Berlin consensus definition of moderate (≤ 200) or severe (≤ 100) ARDS. All patients are ventilated using pressure controlled (bi-level) ventilation with tidal volume = 6-8 ml/kg. Patients randomised to the control group will have PEEP selected per standard practice (SPV). Patients randomised to the intervention will have PEEP selected based on a minimal elastance using a model-based computerised method. The CURE RCT is a single-centre trial in the intensive care unit (ICU) of Christchurch hospital, New Zealand, with a target sample size of 320 patients over a maximum of 3 years. The primary outcome is the area under the curve (AUC) ratio of arterial blood oxygenation to the fraction of inspired oxygen over time. Secondary outcomes include length of time of MV, ventilator-free days (VFD) up to 28 days, ICU and hospital length of stay, AUC of oxygen saturation (SpO2)/FiO2 during MV, number of desaturation events (SpO2 < 88%), changes in respiratory mechanics and chest x-ray index scores, rescue therapies (prone positioning, nitric oxide use, extracorporeal membrane oxygenation) and hospital and 90-day mortality. DISCUSSION: The CURE RCT is the first trial comparing significant clinical outcomes in patients with ARDS in whom PEEP is selected at minimum elastance using an objective model-based method able to quantify and consider both inter-patient and intra-patient variability. CURE aims to demonstrate the hypothesized benefit of patient-specific PEEP and attest to the significance of real-time monitoring and decision-support for MV in the critical care environment. TRIAL REGISTRATION: Australian New Zealand Clinical Trial Registry, ACTRN12614001069640. Registered on 22 September 2014. (https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366838&isReview=true) The CURE RCT clinical protocol and data usage has been granted by the New Zealand South Regional Ethics Committee (Reference number: 14/STH/132).


Assuntos
Oxigênio/sangue , Respiração com Pressão Positiva , Lesão Pulmonar Induzida por Ventilação Mecânica/prevenção & controle , Testes Respiratórios/métodos , Ensaios Clínicos Fase II como Assunto , Desenho Assistido por Computador , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Consumo de Oxigênio , Respiração com Pressão Positiva/efeitos adversos , Respiração com Pressão Positiva/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Respiração Artificial/métodos , /diagnóstico , Sistema Respiratório/fisiopatologia
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