Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 9.163
Filtrar
1.
Medicine (Baltimore) ; 99(2): e18504, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914021

RESUMO

We aimed to evaluate the clinical significance of bacterial coexistence and the coinfection dynamics between bacteria and respiratory viruses among young children. We retrospectively analyzed clinical data from children aged < 5 years hospitalized with a community-acquired single respiratory viral infection of influenza, adenovirus, or RSV during 2 recent consecutive influenza seasons. Remnant respiratory specimens were used for bacterial PCR targeting Moraxella catarrhalis, Haemophilus influenzae, Streptococcus pneumoniae, and Staphylococcus aureus.A total of 102 children were included; median age was 0.8 years and 44.1% had underlying comorbidities. Overall, 6.8% (7/102) of cases were classified as severe diseases requiring intensive care unit admission and/or mechanical ventilation and ranged from 8.8% for a patient with RSV and 7.6% for those with adenovirus to 0% for those with influenza viruses. The overall viral-bacterial codetection rate was 59.8% (61/102); M catarrhalis was the most frequent (33.3%), followed by H influenzae (31.4%). Influenza cases showed higher bacterial codetection rates (80.0%; 8/10) compared with those with adenoviruses (69.2%; 9/13) and RSV (55.7%; 44/79). S pneumoniae and H influenzae codetections were associated with reduced severity (aOR, 0.24; 95% CI, 0.07-0.89), and reduced risk of wheezing (aOR, 0.36; 95% CI, 0.13-0.98), respectively.We observed the interactions between respiratory viruses and bacteria and the clinical significance of viral-bacterial coexistence in upper airway on disease severity. Future study will be necessary to elucidate the active interactions between different viruses and bacteria and give clues to risk stratified strategy in the management of respiratory infections among young children.


Assuntos
Adenoviridae/isolamento & purificação , Haemophilus influenzae/isolamento & purificação , Infecções Respiratórias/microbiologia , Infecções Respiratórias/virologia , Infecções por Adenoviridae/diagnóstico , Infecções por Adenoviridae/virologia , Bactérias/genética , Pré-Escolar , Coinfecção/microbiologia , Coinfecção/virologia , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/microbiologia , Infecções Comunitárias Adquiridas/virologia , Feminino , Hospitalização , Humanos , Lactente , Recém-Nascido , Influenza Humana/diagnóstico , Influenza Humana/virologia , Masculino , Prevalência , Sons Respiratórios/diagnóstico , Sons Respiratórios/etiologia , Infecções por Vírus Respiratório Sincicial/diagnóstico , Infecções por Vírus Respiratório Sincicial/virologia , Vírus Sinciciais Respiratórios/genética , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/epidemiologia , Estudos Retrospectivos , Índice de Gravidade de Doença , Staphylococcus aureus/isolamento & purificação , Streptococcus pneumoniae/isolamento & purificação , Vírus/genética
2.
Immunity ; 51(6): 977-979, 2019 12 17.
Artigo em Inglês | MEDLINE | ID: mdl-31851903

RESUMO

In this issue of Immunity, Wang et al. identify a developmental transition of neural-immune interactions from postnatal to adult lung. Their findings implicate sympathetic nerve production of dopamine as a contributor to the susceptibility of children to allergen-induced asthmatic responses.


Assuntos
Dopamina , Sons Respiratórios , Adulto , Alérgenos , Criança , Humanos , Inflamação , Sistema Nervoso Simpático
3.
Environ Monit Assess ; 191(12): 716, 2019 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-31686222

RESUMO

The data presented here are from the Offinso North District Farm Health Study (ONFAHS), a population-based cross-sectional study among vegetable farmers in Ghana. The paper addresses knowledge, pesticide handling practices, and protective measures related to pesticide use by self-reported symptoms for 310 adult farmers who completed a comprehensive questionnaire on pesticide management practices and health. In addition, an inventory was prepared using information supplied by pesticide sellers/dealers in this district. We report that cough and wheezing (but not breathlessness) are positively associated with stirring pesticide preparations with bare hands/drinking water while mixing/applying pesticides, and stirring pesticide preparations with bare hands/drinking water/smoking cigarettes while mixing/applying pesticides. There is a significant exposure-response association between the number of precautionary measures practiced while handling pesticides and cough and wheezing but not with breathlessness. We also found unsafe practices to be associated with sexual dysfunction, nervousness, and lack of concentration. The results also suggest a negative association between practice of any precautionary measure when mixing/applying pesticides and sexual dysfunction, nervousness, and lack of concentration. We found that in spite of the fact that farmers have adequate knowledge about the environment and health effects of pesticides, several unhygienic practices are in widespread use, indicating that knowledge is not necessarily always translated in action. Further action is necessary to promote the safe use of pesticides and to replace existing poor management practices among these and other farmers in Ghana.


Assuntos
Fazendeiros , Conhecimentos, Atitudes e Prática em Saúde , Exposição Ocupacional/análise , Praguicidas , Adulto , Agricultura , Tosse , Estudos Transversais , Gana , Humanos , Sons Respiratórios , Autorrelato
5.
Evid. actual. práct. ambul ; 22(3): e002021, nov. 2019.
Artigo em Espanhol | LILACS | ID: biblio-1047108

RESUMO

Una joven de 23 años con asma leve intermitente se presenta a la consulta médica. Se plantea cuál es la mejor alternativa para su tratamiento: el uso de broncodilatadores de acción corta a demanda (SABA, por sus iniciales en inglés) o de broncodilatadores de acción rápida en asociación con corticoides inhalatorios (ICS/FABA, por sus iniciales en inglés) a demanda. Tras revisar la bibliografía se encontraron una revisión sistemática y dos ensayos clínicos que indican que los ICS/FABA serían superiores a los SABA; sin embargo este efecto fue solamente estudiado en casos de asma persistente.Es importante discutir estos hallazgos con los pacientes, junto a sus implicancias económicas, incorporando sus valores y preferencias a la hora de tomar una decisión terapéutica. (AU)


A 23-year-old woman with mild intermittent asthma comes to the doctor's office. The best alternative for treatment is considered: the use of short-acting bronchodilators on demand (SABA) or fast-acting bronchodilators in association with inhaled corticosteroids (ICS/FABA) on demand. After a literature search, a systematic review and two clinical trials werefound, which indicate that the ICS/FABA would be superior to the SABA; however, this effect was only studied in cases of persistent asthma. It is important to discuss these findings with the patients, alongside with their economic implications,incorporating their values and preferences when making a therapeutic decision.


Assuntos
Humanos , Feminino , Lactente , Adulto , Adulto Jovem , Asma/tratamento farmacológico , Broncodilatadores/uso terapêutico , Asma/diagnóstico , Asma/etiologia , Asma/epidemiologia , Sinais e Sintomas Respiratórios , Fatores Socioeconômicos , Broncodilatadores/administração & dosagem , Bronquiolite , Sons Respiratórios , Corticosteroides/uso terapêutico , Tosse , Tomada de Decisões , Dispneia , Adesão à Medicação
6.
Neurology ; 93(14): 630-639, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31570638

RESUMO

Multiple system atrophy (MSA) is a neurodegenerative disorder characterized by a combination of autonomic failure, cerebellar ataxia, and parkinsonism. Laryngeal stridor is an additional feature for MSA diagnosis, showing a high diagnostic positive predictive value, and its early occurrence might contribute to shorten survival. A consensus definition of stridor in MSA is lacking, and disagreement persists about its diagnosis, prognosis, and treatment. An International Consensus Conference among experts with methodological support was convened in Bologna in 2017 to define stridor in MSA and to reach consensus statements for the diagnosis, prognosis, and treatment. Stridor was defined as a strained, high-pitched, harsh respiratory sound, mainly inspiratory, occurring only during sleep or during both sleep and wakefulness, and caused by laryngeal dysfunction leading to narrowing of the rima glottidis. According to the consensus, stridor may be recognized clinically by the physician if present at the time of examination, with the help of a witness, or by listening to an audio recording. Laryngoscopy is suggested to exclude mechanical lesions or functional vocal cord abnormalities related to different neurologic conditions. If the suspicion of stridor needs confirmation, drug-induced sleep endoscopy or video polysomnography may be useful. The impact of stridor on survival and quality of life remains uncertain. Continuous positive airway pressure and tracheostomy are both suggested as symptomatic treatment of stridor, but whether they improve survival is uncertain. Several research gaps emerged involving diagnosis, prognosis, and treatment. Unmet needs for research were identified.


Assuntos
Conferências de Consenso como Assunto , Atrofia de Múltiplos Sistemas/diagnóstico , Atrofia de Múltiplos Sistemas/fisiopatologia , Sons Respiratórios/fisiopatologia , Humanos , Atrofia de Múltiplos Sistemas/terapia , Prognóstico , Resultado do Tratamento
7.
Cir. pediátr ; 32(4): 172-176, oct. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-184104

RESUMO

Objetivos. Validar el score clínico de Valdivieso y cols. en el manejo de los pacientes con sospecha de aspiración de cuerpo extraño en un hospital de tercer nivel. Dicho score plantea escenarios diferentes según la puntuación obtenida: broncoscopia, TAC, observación o alta. Material y métodos. Estudio retrospectivo de los pacientes a los que se realizó una broncoscopia por sospecha de cuerpo extraño entre noviembre de 2015 y noviembre de 2018. Se recogieron las variables propuestas por el score (atragantamiento presenciado, estridor, sibilancias, hipoventilación unilateral, radiografía alterada y cuerpo extraño de riesgo) y su puntuación para cada paciente, analizando el rendimiento de la prueba mediante la curva COR (característica operativa del receptor). Resultados. Se realizó broncoscopia en 81 pacientes con una edad media de 2,1 años (7 meses-11 años), encontrando cuerpo extraño en el 33,3%. El área bajo la curva COR del score fue de 0,803 (0,695-0,911). En 6 (22,2%) pacientes con cuerpo extraño confirmado el score indicaba inicialmente observación en 5 casos y alta en 1. Excluyendo a los 49 pacientes con atragantamiento con fruto seco o con auscultación alterada unilateral, a los que en nuestro medio se indica directamente broncoscopia, el score clasificó correctamente a los 32 pacientes restantes, lo que hubiese reducido el porcentaje de broncoscopias "blancas" en un 21%. Conclusiones. El score presenta en nuestra muestra un alto rendimiento diagnóstico pero una tasa de falsos negativos no despreciable. En cambio, tiene una especial utilidad en los pacientes que no presentan atragantamiento con fruto seco y/o auscultación alterada unilateral, permitiendo reducir broncoscopias blancas


Objective. To validate the clinical score of Valdivieso et al. in the management of patients with suspected foreign body aspiration in a tertiary hospital. This score raises different scenarios according to the result: bronchoscopy, CT, observation or discharge. Material and methods. Retrospective study of patients who under-went a bronchoscopy due to suspected tracheobronchial foreign body between November-2015 and November-2018. The variables proposed by the score were collected (choking, stridor, wheezing, unilateral hypoventilation, altered chest X-ray and high-risk foreign body) and the score was calculated for each patient, analyzing the performance of the test using the ROC (Receiver Operating Characteristic) curve. Results. Bronchoscopy was performed in 81 patients with a mean age of 2.1 years (7 months-11 years), finding foreign body in 33.3%. The area under the ROC curve of the score was 0.803 (0.695-0.911). In 6 (22.2%) patients with confirmed foreign body the score initially indicated observation in 5 cases and discharge in 1. Excluding the 49 patients with unilateral altered auscultation or when there was a nut suspected, which in our environment are clear indications for bronchoscopy, the score correctly classified the remaining 32 patients, which would have reduced the rate of normal bronchoscopies from 66% to 45%. Conclusions. The score in our sample presents a high diagnostic power but a non-negligible false negative rate. It has a special utility in patients who do not have unilateral altered auscultation and/or choking with nuts, allowing to reduce the rate of normal bronchoscopies


Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Broncoscopia/métodos , Corpos Estranhos/diagnóstico por imagem , Aspiração Respiratória/diagnóstico por imagem , Obstrução das Vias Respiratórias/etiologia , Corpos Estranhos/complicações , Aspiração Respiratória/complicações , Sons Respiratórios/etiologia , Estudos Retrospectivos
8.
Zhongguo Dang Dai Er Ke Za Zhi ; 21(9): 861-867, 2019 Sep.
Artigo em Chinês | MEDLINE | ID: mdl-31506143

RESUMO

OBJECTIVE: To examine the levels of airway inflammatory mediators in peripheral blood in infants and young children with wheezing and to study the possible pathogenesis of wheezing from the aspects of T helper cell 1 (Th1)/T helper cell 2 (Th2) imbalance and airway inflammation. METHODS: A total of 50 children aged 1 month to 3 years with an acute wheezing episode were enrolled as the wheezing group, and 25 age-matched healthy infants were enrolled as the healthy control group. According to the number of wheezing episodes, the wheezing group was divided into a first-episode group (n=25) and a recurrent wheezing (number of episodes ≥2) group (n=25). According to the presence or absence of high-risk factors for asthma, the wheezing group was divided into a high-risk factor group (n=22) and a non-high-risk factor group (n=28). According to the results of pathogen detection, the wheezing group was divided into a positive pathogen group (n=23) and a negative pathogen group (n=27). Levels of interleukin-2 (IL-2), interleukin-4 (IL-4), interleukin-5 (IL-5), interleukin-13 (IL-13), transforming growth factor-ß1 (TGF-ß1), and total IgE (TIgE) in peripheral blood were measured for each group. For children with wheezing, eosinophil (EOS) count in peripheral blood was measured, and related samples were collected for respiratory pathogen detection. RESULTS: The wheezing group had significantly higher levels of IL-4, IL-5, IL-13, TGF-ß1, and TIgE in peripheral blood than the healthy control group (P<0.05). There were no significant differences in the levels of IL-2, IL-4, IL-5, IL-13, TGF-ß1, and TIgE in peripheral blood between the first-episode and recurrent wheezing groups, between the high-risk factor and non-high-risk factor groups, and between the positive pathogen and negative pathogen groups (P>0.05). The correlation analysis showed that in children with wheezing, EOS count was positively correlated with IL-4 level (P<0.01), IL-4 level was positively correlated with IL-5 and IL-13 levels (P<0.01), IL-5 level was positively correlated with IL-13 level (P<0.01), and IL-2 level was positively correlated with TGF-ß1 level (P<0.05). CONCLUSIONS: Th1/Th2 imbalance with a predominance of Th2 is observed in infants and young children with wheezing. IL-4, IL-5, IL-13, TGF-ß1, and IgE are involved in the pathogenesis of wheezing in these children. Airway inflammation is also observed in these children with wheezing, but it is not associated with the number of wheezing episodes, presence or absence of high-risk factors for asthma, or results of pathogen detection.


Assuntos
Asma , Sons Respiratórios , Criança , Pré-Escolar , Humanos , Lactente , Mediadores da Inflamação , Interleucina-13 , Células Th1
9.
Zhongguo Dang Dai Er Ke Za Zhi ; 21(8): 812-819, 2019 Aug.
Artigo em Chinês | MEDLINE | ID: mdl-31416508

RESUMO

OBJECTIVE: To systematically evaluate the clinical effect of azithromycin (AZM) adjuvant therapy in children with bronchiolitis. METHODS: Related databases were searched for randomized controlled trials (RCTs) on AZM adjuvant therapy in children with bronchiolitis published up to February 17, 2019. RevMan 5.3 was used to perform the Meta analysis. RESULTS: A total of 14 RCTs were included, with 667 children in the intervention group and 651 in the control group. The pooled effect size showed that in the children with bronchiolitis, AZM adjuvant therapy did not shorten the length of hospital stay (MD=-0.29, 95%CI: -0.62 to 0.04, P=0.08) or oxygen supply time (MD=-0.33, 95%CI: -0.73 to 0.07, P=0.10), while it significantly shortened the time to the relief of wheezing (MD=-1.00, 95%CI: -1.72 to -0.28, P=0.007) and cough (MD=-0.48, 95%CI: -0.67 to -0.29, P<0.00001). The analysis of bacterial colonization revealed that AZM therapy significantly reduced the detection rates of Streptococcus pneumoniae (OR=0.24, 95%CI: 0.11-0.54, P=0.0006), Haemophilus (OR=0.28, 95%CI: 0.14-0.55, P=0.0002), and Moraxella catarrhalis (OR=0.21, 95%CI: 0.11-0.40, P<0.00001) in the nasopharyngeal region. CONCLUSIONS: AZM adjuvant therapy can reduce the time to the relief of wheezing and cough in children with bronchiolitis, but it has no marked effect on the length of hospital stay and oxygen supply time.


Assuntos
Azitromicina/uso terapêutico , Bronquiolite , Bronquiolite/tratamento farmacológico , Criança , Terapia Combinada , Humanos , Tempo de Internação , Sons Respiratórios
10.
Medicine (Baltimore) ; 98(32): e16596, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31393359

RESUMO

We explored the effects of smoking and exercise on pulmonary function (PF) in young adults.This was a 2-year, prospective cross-sectional study on university students. We recorded age, gender, weight, height, pulmonary symptoms, smoking status, and sports habits. Spirometry was used to evaluate lung function; we recorded the forced expiratory volume in 1 second (FEV1), the forced vital capacity (FVC), and the FEV1/FVC ratio.A total of 1014 (552 female, 464 male) subjects were included. Smokers reported significantly more wheezing and sputum production than nonsmokers, but exhibited better FVC and FEV1 values. Those who smoked less than half a pack/d had significantly poorer FVC and FEV1 levels than nonsmokers. Smokers exhibited significantly lower FEV1/FVC ratios than nonsmokers. Overall, those who exercised exhibited better FEV1 and FVC levels, but this was attributable entirely to females.The spirometric percentile data were adjusted for gender, age, and height, and used as indicators of health status (good: >90: average: 25-90, poor <25). ln males, PF was associated with regular exercise (good: 7.8, average: 6.5, poor: 14.2, P = .02). The smoking rate was higher in the "good" group (males: good: 31.3, average: 30, poor: 17.9, P = .02/females: good: 22.4, average: 17.9, poor: 10.4, P = .02).On multivariate regression analysis, above-average PF test results were associated with age (1.32 [1.04-1.69]) and exercising at least once per week (4.06 [1.16-14.20]) in males. In females, above-average results were associated with irregular exercise (2.88 [1.36-6.09]), age (1.85 [1.44-2.37]), and exercising until palpitations developed (0.18 [0.04-0.88]).Smoking improves lung function in young adults; these are "healthy smokers." Physical activity did not improve lung function, but the absence of physical activity significantly worsened lung function.


Assuntos
Exercício/fisiologia , Testes de Função Respiratória/estatística & dados numéricos , Fumar/fisiopatologia , Adolescente , Adulto , Fatores Etários , Pesos e Medidas Corporais , Estudos Transversais , Feminino , Humanos , Masculino , Estudos Prospectivos , Testes de Função Respiratória/métodos , Sons Respiratórios/fisiopatologia , Fatores Sexuais , Esportes/fisiologia , Escarro/metabolismo , Universidades , Adulto Jovem
11.
Nutrients ; 11(8)2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31374861

RESUMO

Maternal diet during pregnancy plays a likely role in infant immune development through both direct nutrient specific immunomodulatory effects and by modulating the composition and metabolic activity of the maternal gut microbiome. Dietary fibers, as major substrates for microbial fermentation, are of interest in this context. This is the first study to examine maternal intakes of different fiber sub-types and subsequent infant allergic disease. In an observational study of 639 mother-infant pairs (all infants had a family history of allergic disease) we examined maternal intakes of total fiber, soluble fiber, insoluble fiber, resistant starch, and prebiotic fiber, by a semi-quantitative food frequency questionnaire at 36-40 weeks' gestation. Infants attended an allergy clinical assessment at 12 months of age, including skin prick testing to common allergens. Higher maternal dietary intakes of resistant starch were associated with reduced doctor diagnosed infant wheeze, adjusted odds ratio (aOR) 0.68 (95% CI 0.49, 0.95, p = 0.02). However, in contrast, higher maternal intakes of resistant starch were associated with higher risk of parent reported eczema aOR 1.27 (95% CI 1.09, 1.49, p < 0.01) and doctor diagnosed eczema aOR 1.19 (95% CI 1.01, 1.41, p = 0.04). In conclusion, maternal resistant starch consumption was differentially associated with infant phenotypes, with reduced risk of infant wheeze, but increased risk of eczema.


Assuntos
Dermatite Atópica/etiologia , Fibras na Dieta/administração & dosagem , Fibras na Dieta/efeitos adversos , Fenômenos Fisiológicos da Nutrição Materna , Estado Nutricional , Efeitos Tardios da Exposição Pré-Natal , Recomendações Nutricionais , Hipersensibilidade Respiratória/prevenção & controle , Adulto , Dermatite Atópica/diagnóstico , Feminino , Humanos , Lactente , Masculino , Gravidez , Fatores de Proteção , Hipersensibilidade Respiratória/diagnóstico , Hipersensibilidade Respiratória/etiologia , Sons Respiratórios , Medição de Risco , Fatores de Risco
13.
Int J Pediatr Otorhinolaryngol ; 125: 199-200, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31382107

RESUMO

We present a unique case of intermittent paradoxical vocal fold motion (PVFM) as the presenting symptom of a rare underlying neuromuscular disorder in a neonate. Paramyotonia congenita (PC) is an autosomal dominant condition that typically presents in infancy with myotonic episodes affecting the skeletal muscles. Our patient developed intermittent episodes of stridor quickly progressing to apnea shortly after birth that were marked by PVFM on laryngoscopy, ultimately leading to the diagnosis of a previously unrecognized mutation in SCN4A, the gene responsible for PC.


Assuntos
Transtornos Miotônicos/diagnóstico , Disfunção da Prega Vocal/diagnóstico , Apneia/etiologia , Feminino , Humanos , Recém-Nascido , Laringoscopia , Transtornos Miotônicos/complicações , Sons Respiratórios/etiologia , Disfunção da Prega Vocal/etiologia
14.
EBioMedicine ; 46: 486-498, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31353293

RESUMO

BACKGROUND: A critical window in infancy has been proposed, during which the microbiota may affect subsequent health. The longitudinal development of the oropharyngeal microbiota is under-studied and may be associated with early-life wheeze. We aimed to investigate the temporal association of the development of the oropharyngeal microbiota with early-life wheeze. METHODS: A population-based birth cohort based in London, UK was followed for 24 months. We collected oropharyngeal swabs at six time-points. Microbiota was determined using sequencing of the V3-V5 region of the 16S rRNA-encoding gene. Medical records were reviewed for the outcome of doctor diagnosed wheeze. We used a time-varying model to investigate the temporal association between the development of microbiota and doctor-diagnosed wheeze. FINDINGS: 159 participants completed the study to 24 months and for 98 there was complete sequencing data at all timepoints and outcome data. Of these, 26 had doctor-diagnosed wheeze. We observed significant increase in the abundance of Neisseria between 9 and 24 months in children who developed wheeze (p = 0∙003), while in those without wheezing there was a significant increment in the abundance of Granulicatella (p = 0∙012) between 9 and 12 months, and of Prevotella (p = 0∙018) after 18 months. INTERPRETATION: A temporal association between the respiratory commensal Granulicatella and also Prevotella with wheeze (negative), and between Neisseria and wheeze (positive) was identified in infants prior to one year of age. This adds to evidence for the proposed role of the microbiota in the development of wheeze. FUND: Research funding from the Winnicott Foundation, Meningitis Now and Micropathology Ltd.


Assuntos
Microbiota , Orofaringe/microbiologia , Sons Respiratórios/etiologia , Fatores Etários , Biodiversidade , Estudos de Coortes , Feminino , Humanos , Masculino , Metagenoma , Metagenômica/métodos , Vigilância da População , Reino Unido/epidemiologia
15.
Artigo em Inglês | MEDLINE | ID: mdl-31336954

RESUMO

BACKGROUND: The prevalence of asthma is on the rise in Saudi Arabia. Data regarding the immunological profile of asthma in adults in the Aseer region, in southwestern Saudi Arabia, have not been well studied. OBJECTIVES: Our aim was to study the immunological factors associated with sensitization to asthma among adults in the Aseer region. METHODS: A cross-sectional study with a nested case control design in a 1:1 ratio was conducted on a sample of adults attending primary health care centers in the Aseer region. The study used a validated Arabic version of the International study of asthma and allergies in childhood (ISAAC) questionnaire. The presence of wheezing in the past 12 months was used as a proxy for bronchial asthma. Matched age and sex controls were selected. Both groups were tested for complete blood count (CBC), total and differential white blood cell (WBC) count including eosinophils, total immunoglobulin E (IgE) measurement, allergen-specific immunoglobulin E (IgE), and cytokine levels. RESULTS: The present study included 110 cases and 157 age- and sex-matched controls. Rye wheat was found to be a significant outdoor sensitizing agent ((odds ratio) OR = 5.23, 95% CI: 1.06-25.69). Indoors, house dust mites Dermatophagoides petronyssinus (OR = 2.04, 95% CI: 1.04-3.99) and Dermatophagoides farinae (OR = 2.50, 95% CI: 1.09-5.75) were significant. Higher total IgE (OR = 1.84, 95% CI: 1.10-3.06) and eosinophil levels (OR = 2.85, 95% CI: 1.14-7.15) were significantly associated with adult bronchial asthma in Aseer. On the other hand, the role of cytokines was not significant. CONCLUSIONS: In the present study, certain environmental agents were found to be important with regards to sensitization to bronchial asthma in adults. Knowledge about these sensitization agents should be disseminated to health providers and treating physicians in order to enhance preventive environmental control measures and asthma management. Asthma-treating physicians in the region should be alerted to the use of targeted biological therapies in selected asthmatics with difficult-to-control courses.


Assuntos
Asma/epidemiologia , Asma/etiologia , Adulto , Alérgenos , Animais , Asma/imunologia , Estudos de Casos e Controles , Criança , Estudos Transversais , Dermatophagoides farinae/imunologia , Feminino , Humanos , Hipersensibilidade , Fatores Imunológicos , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Prevalência , Pyroglyphidae/imunologia , Sons Respiratórios , Arábia Saudita/epidemiologia , Secale , Inquéritos e Questionários , Adulto Jovem
16.
BMC Med Educ ; 19(1): 275, 2019 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-31337361

RESUMO

BACKGROUND: The use of simulation technology for skill training and assessment in medical education has progressively increased over the last decade. Nevertheless, the teaching efficacy of most technologies remains to be fully determined. The aim of this prospective study was to evaluate if a short individual training on a patient simulator could improve heart and lung auscultation skills in undergraduate students. METHODS: A group of fifth-year medical school students, who had trained on a patient simulator in their third year (EXP, n = 55), was compared to a group of fifth-year medical school students who had not previously trained on it (CNT, n = 49). Students were recruited on a voluntary basis. Students were evaluated in terms of their ability to correctly identify three heart (II sound wide split, mitral regurgitation, aortic stenosis) and five lung sounds (coarse crackles, fine crackles, pleural rubs, rhonchi, wheezes), which were reproduced in a random order on the Kyoto-Kagaku patient simulator. RESULTS: Exposure to patient simulator significantly improved heart auscultation skills, as mitral regurgitation was correctly recognized by 89.7% of EXP students as compared to 71.4% of CNT students (p = 0.02). In addition, a significantly greater percentage of EXP students correctly graphed all the heart diagnoses as compared to CNT students. There were no differences between the groups in lung auscultation. CONCLUSIONS: This study demonstrates that training medical students with a patient simulator, individually for one hour, significantly ameliorated their heart auscultation skills. Our data suggests that patient simulation might be useful for learning auscultation skills, especially when it is combined with graphic sound display.


Assuntos
Competência Clínica , Auscultação Cardíaca , Simulação de Paciente , Sons Respiratórios , Educação Médica , Avaliação Educacional , Humanos , Estudos Prospectivos , Estudantes de Medicina
17.
Medicine (Baltimore) ; 98(29): e16419, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31335692

RESUMO

Squawks are lung adventitious sounds with a mix of both musical and nonmusical components heard during the inspiratory phase. Small series have described squawks in interstitial lung diseases. Hypersensitivity pneumonitis and other diseases involving small airways can result in squawks, but new interstitial lung diseases (ILDs) involving peripheral airways are being described. A retrospective analysis was performed on 1000 consecutive patients from a database of ILD of a tertiary referral center. Squawks were recorded in 49 cases (4.9%), hypersensitivity pneumonitis (23 cases), connective tissue disease (7), microaspiration (4), pleuroparenchymal fibroelastosis (4), fibrosing cryptogenic organizing pneumonia (, 3), familial ILD (2), sarcoidosis (2), idiopathic pulmonary fibrosis (IPF; 1), bronchiolitis (2), and nonspecific interstitial pneumonia (1). One patient had a final diagnosis of IPF. There was a significant association between mosaic pattern and squawks: 20 cases with squawks (40.8%) had mosaic pattern compared with 140 (14.7%) cases without squawks (x = 23.6, P < .001).Findings indicative of fibrosis were described on high-resolution chest tomography (HRCT) in 715 cases (71.5%). Squawks were more common in patients with findings indicative of fibrosis on HRCT: 45 of 715 (6.3%) compared with 4 of 285 (1.4%) of those without findings indicative of fibrosis (x = 10.46, P = .001).In conclusion, squawks are an uncommon finding on physical examination in patients with ILD, but when present suggest fibrosing ILD associated with bronchiolar involvement. However, squawks are rare in IPF.


Assuntos
Doenças Pulmonares Intersticiais , Fibrose Pulmonar , Sons Respiratórios , Auscultação/métodos , Bronquíolos/patologia , Bronquíolos/fisiopatologia , Estudos de Coortes , Feminino , Humanos , Doenças Pulmonares Intersticiais/complicações , Doenças Pulmonares Intersticiais/diagnóstico , Doenças Pulmonares Intersticiais/fisiopatologia , Masculino , Pessoa de Meia-Idade , Fibrose Pulmonar/diagnóstico por imagem , Fibrose Pulmonar/etiologia , Fibrose Pulmonar/fisiopatologia , Sons Respiratórios/diagnóstico , Sons Respiratórios/fisiopatologia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodos
18.
Int J Occup Med Environ Health ; 32(4): 553-567, 2019 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-31303647

RESUMO

OBJECTIVES: This study explores the association between self-reported exposure to traffic-related air pollution and respiratory health symptoms, as well as lung functions and skin prick tests in adolescents living in the vicinity of main roads. MATERIAL AND METHODS: The data in the study were acquired using a cross-sectional study conducted between 2004-2005 in Chorzów (Silesia, Poland) among adolescents (N = 936) aged 13-15 years, attending junior high schools. Adverse respiratory health symptoms and exposure to traffic-related air pollution were determined on the basis of a questionnaire. Moreover, all children underwent spirometry and skin prick tests. Multivariable logistic regression with multiple imputation for missing data was used to assess the prevalence of adverse respiratory symptoms in relation to self-reported exposure to traffic-related air pollution, adjusted for socioeconomic and environmental factors. RESULTS: Among respiratory tract diseases, asthma and allergic rhinitis associations were statistically significant (OR = 2.16, 95% CI: 1.12-4.15 and OR = 1.69, 95% CI: 1.08-2.64, respectively). Likewise, among respiratory disorders, statistically significant associations were found in the case of wheezes and dyspnea attack (OR = 1.58, 95% CI: 1.10-2.26 and OR = 2.39, 95% CI: 1.56-3.66, respectively), with respect to the vicinity of the main road. Living in the area with high traffic intensity was statistically significantly associated with a higher prevalence of asthma and wheezes (OR = 2.31, 95% CI: 1.22-4.39 and 1.48, 95% CI: 1.09-2.01, respectively). The results obtained did not confirm the relationship between the adopted way of exposure to traffic-related air pollution and lung function indices or skin prick tests. CONCLUSIONS: Results of the study suggest that children living in the area with intense traffic are more likely to develop respiratory disorders. Moreover, the vicinity of a main road as well as traffic intensity could be suitable in assessing the relationship between road transport and potential health problems among exposed inhabitants. Int J Occup Med Environ Health. 2019;32(4):553-67.


Assuntos
Exposição Ambiental/efeitos adversos , Doenças Respiratórias/epidemiologia , Poluição Relacionada com o Tráfego/efeitos adversos , Adolescente , Poluição do Ar/efeitos adversos , Asma/epidemiologia , Asma/etiologia , Estudos Transversais , Dispneia/epidemiologia , Dispneia/etiologia , Feminino , Humanos , Masculino , Polônia/epidemiologia , Testes de Função Respiratória , Sons Respiratórios , Doenças Respiratórias/etiologia , Rinite Alérgica/epidemiologia , Rinite Alérgica/etiologia , Testes Cutâneos , Inquéritos e Questionários , Emissões de Veículos
19.
Medicine (Baltimore) ; 98(28): e16364, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305433

RESUMO

RATIONALE: Esophageal duplication cyst (EDC) is a rare developmental aberration originated from the embryonic foregut. It may remain asymptomatic but produce local mass effect on surrounding organs if rapid enlarges. EDC may sometimes accompany with other congenital malformations. Congenital pulmonary airway malformation (CPAM) is a congenital lung malformation with an unknown chance of developing symptoms. Here we report a rare case of esophageal duplication cyst with type 2 congenital pulmonary airway malformation (CPAM). PATIENT CONCERNS: A 16-month old boy with a prenatal diagnosis of type 2 CPAM presented progressive stridor and respiratory distress and was admitted to our hospital under the diagnosis of pneumonia. The patient responded poorly to antibiotics. A chest Xray (CXR) showed consolidation over the left upper lobe with trachea deviated to right side. A chest computed tomography (CT) revealed a cystic lesion sized 3.3 × 3.3 cm in the superior mediastinum. DIAGNOSES: Post-operative pathological report confirmed the diagnosis of esophageal duplication cyst. INTERVENTIONS: We pre-medicated the patient with steroids and inhaled bronchodilators for airway maintenance. Then the patient received tumor resection via median sternotomy. OUTCOMES: The patient recovered without complication and discharged smoothly 4 days after the surgery. LESSONS: EDC is a rare but potentially life-threatening disease owning to compression of large airways. Chest CT scan could detect the lesion non-invasively and should be considered in patients with persistent stridor, as well as CXR findings of the trachea deviated by a mass lesion in mediastinum, especially for those with CPAM.


Assuntos
Anormalidades Congênitas , Cisto Esofágico/complicações , Esôfago/anormalidades , Laringe/anormalidades , Pulmão/anormalidades , Sons Respiratórios , Anormalidades Congênitas/diagnóstico , Anormalidades Congênitas/terapia , Diagnóstico Diferencial , Cisto Esofágico/diagnóstico , Cisto Esofágico/terapia , Esôfago/diagnóstico por imagem , Esôfago/cirurgia , Humanos , Lactente , Pulmão/diagnóstico por imagem , Masculino , Sons Respiratórios/diagnóstico
20.
Eur J Pediatr ; 178(9): 1385-1394, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31321530

RESUMO

Cough and wheezing are the predominant symptoms of acute bronchitis. Hitherto, the evaluation of respiratory symptoms was limited to subjective methods such as questionnaires. The main objective of this study was to objectively determine the time course of cough and wheezing in children with acute bronchitis. The impact of nocturnal cough on parent's quality of life was assessed as secondary outcome. In 36 children (2-8 years), the frequency of nocturnal cough and wheezing was recorded during three nights by automated lung sound monitoring. Additionally, parents completed symptom logs, i.e., the Bronchitis Severity Score (BSS), as well as the Parent-proxy Children's Acute Cough-specific Quality of Life Questionnaire (PAC-QoL). During the first night, patients had 34.4 ± 52.3 (mean ± SD) cough epochs, which were significantly reduced in night 5 (13.5 ± 26.5; p < 0.001) and night 9 (12.8 ± 28.1; p < 0.001). Twenty-two patients had concomitant wheezing, which declined within the observation period as well. All subjective parameters (BSS, Cough log and PAC-QoL) were found to be significantly correlated with the objectively assessed cough parameters.Conclusion: Long-term recording of cough and wheezing offers a useful opportunity to objectively evaluate the time course of respiratory symptoms in children with acute bronchitis. To assess putative effects of pharmacotherapy on nocturnal bronchitis symptoms, future studies in more homogeneous patient groups are needed. What is Known: • Cough and wheezing are the predominant symptoms of acute bronchitis. • There is a diagnostic gap in long-term assessment of these respiratory symptoms, which needs to be closed to optimize individual therapies. What is New: • Long-term recording of nocturnal cough and wheezing allows for objective evaluation of respiratory symptoms in children with acute bronchitis and provides a tool to validate the efficacy of symptomatic bronchitis therapies.


Assuntos
Bronquite/fisiopatologia , Tosse/fisiopatologia , Sons Respiratórios/fisiopatologia , Doença Aguda , Bronquite/psicologia , Criança , Pré-Escolar , Tosse/diagnóstico , Tosse/etiologia , Tosse/psicologia , Feminino , Humanos , Estudos Longitudinais , Masculino , Monitorização Fisiológica , Pais/psicologia , Aceitação pelo Paciente de Cuidados de Saúde , Qualidade de Vida , Sons Respiratórios/diagnóstico , Índice de Gravidade de Doença , Fatores de Tempo
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA