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1.
Codas ; 33(3): e20200057, 2021.
Artigo em Português, Inglês | MEDLINE | ID: mdl-34076101

RESUMO

PURPOSE: To present a proposal for speech-language pathology rehabilitation called the Therapy Program for Management of Chronic Cough (TMCC) for the treatment of refractory chronic cough. METHODS: TMCC was developed based on two stages: literature and clinical analysis. The literature analysis stage was carried out through the following procedures: electronic and manual search for articles and books published until June 2019 that included adult participants with chronic cough and intervention with speech-language pathology therapy; selection of sources; analysis of articles and books included; and, preparation of the initial version of the therapy program. The initial version of the therapy program resulting from literature analysis stage was submitted to clinical analysis stage through the following procedures: analysis by three judges; revision of the proposal by the authors; judges' re-analysis; elaboration of the final version called the Therapy Program for Management of Chronic Cough (TMCC). RESULTS: TMCC synthesizes scientific knowledge and current clinical experience on the behavioral management of refractory chronic cough into a program with three main components, each one with specific objectives and strategies. TMCC consists of four sessions, with weekly frequency and duration between 30-45 minutes per session, executed in hierarchical phases, with specific objectives and strategies per session. CONCLUSION: TMCC is a program structured to offer global cough rehabilitation. To obtain scientific evidence about its effectiveness is necessary, so that it can be used in clinical practice.


Assuntos
Tosse , Patologia da Fala e Linguagem , Adulto , Doença Crônica , Tosse/terapia , Humanos , Fonoterapia
2.
Medicine (Baltimore) ; 100(21): e25645, 2021 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-34032692

RESUMO

ABSTRACT: Since December 2019, pneumonia caused by a novel coronavirus (SARS-CoV-2), namely 2019 novel coronavirus disease (COVID-19), has rapidly spread from Wuhan city to other cities across China. The present study was designed to describe the epidemiology, clinical characteristics, treatment, and prognosis of 74 hospitalized patients with COVID-19.Clinical data of 74 COVID-19 patients were collected to analyze the epidemiological, demographic, laboratory, radiological, and treatment data. Thirty-two patients were followed up and tested for the presence of the viral nucleic acid and by pulmonary computed tomography (CT) scan at 7 and 14 days after they were discharged.Among all COVID-19 patients, the median incubation period for patients and the median period from symptom onset to admission was all 6 days; the median length of hospitalization was 13 days. Fever symptoms were presented in 83.78% of the patients, and the second most common symptom was cough (74.32%), followed by fatigue and expectoration (27.03%). Inflammatory indicators, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) of the intensive care unit (ICU) patients were significantly higher than that of the non-ICU patients (P < .05). However, 50.00% of the ICU patients had their the ratio of T helper cells to cytotoxic T cells (CD4/CD8) ratio lower than 1.1, whose proportion is much higher than that in non-ICU patients (P < .01).Compared with patients in Wuhan, COVID-19 patients in Anhui Province seemed to have milder symptoms of infection, suggesting that there may be some regional differences in the transmission of SARS-CoV-2 between different cities.


Assuntos
Antivirais/uso terapêutico , Tosse/epidemiologia , Febre/epidemiologia , Oxigenação Hiperbárica/estatística & dados numéricos , Adolescente , Adulto , Idoso , Antibioticoprofilaxia/estatística & dados numéricos , Sedimentação Sanguínea , Proteína C-Reativa/análise , /epidemiologia , Criança , Pré-Escolar , China/epidemiologia , Cidades/epidemiologia , Tosse/sangue , Tosse/terapia , Tosse/virologia , Feminino , Febre/sangue , Febre/terapia , Febre/virologia , Seguimentos , Geografia , Humanos , Tempo de Internação/estatística & dados numéricos , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , RNA Viral/isolamento & purificação , Estudos Retrospectivos , /isolamento & purificação , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X , Adulto Jovem
3.
Cochrane Database Syst Rev ; 4: CD013110, 2021 04 06.
Artigo em Inglês | MEDLINE | ID: mdl-33822364

RESUMO

BACKGROUND: Bronchiectasis is characterised by excessive sputum production, chronic cough, and acute exacerbations and is associated with symptoms of dyspnoea and fatigue, which reduce exercise tolerance and impair quality of life. Exercise training in isolation or in conjunction with other interventions is beneficial for people with other respiratory diseases, but its effects in bronchiectasis have not been well established. OBJECTIVES: To determine effects of exercise training compared to usual care on exercise tolerance (primary outcome), quality of life (primary outcome), incidence of acute exacerbation and hospitalisation, respiratory and mental health symptoms, physical function, mortality, and adverse events in people with stable or acute exacerbation of bronchiectasis. SEARCH METHODS: We identified trials from the Cochrane Airways Specialised Register, ClinicalTrials.gov, and the World Health Organization trials portal, from their inception to October 2020. We reviewed respiratory conference abstracts and reference lists of all primary studies and review articles for additional references. SELECTION CRITERIA: We included randomised controlled trials in which exercise training of at least four weeks' duration (or eight sessions) was compared to usual care for people with stable bronchiectasis or experiencing an acute exacerbation. Co-interventions with exercise training including education, respiratory muscle training, and airway clearance therapy were permitted if also applied as part of usual care. DATA COLLECTION AND ANALYSIS: Two review authors independently screened and selected trials for inclusion, extracted outcome data, and assessed risk of bias. We contacted study authors for missing data. We calculated mean differences (MDs) using a random-effects model. We used the GRADE approach to assess the certainty of evidence. MAIN RESULTS: We included six studies, two of which were published as abstracts, with a total of 275 participants. Five studies were undertaken with people with clinically stable bronchiectasis, and one pilot study was undertaken post acute exacerbation. All studies included co-interventions such as instructions for airway clearance therapy and/or breathing strategies, provision of an educational booklet, and delivery of educational sessions. The duration of training ranged from six to eight weeks, with a mix of supervised and unsupervised sessions conducted in the outpatient or home setting. No studies of children were included in the review; however we identified two studies as currently ongoing. No data were available regarding physical activity levels or adverse events. For people with stable bronchiectasis, evidence suggests that exercise training compared to usual care improves functional exercise tolerance as measured by the incremental shuttle walk distance, with a mean difference (MD) between groups of 87 metres (95% confidence interval (CI) 43 to 132 metres; 4 studies, 161 participants; low-certainty evidence). Evidence also suggests that exercise training improves six-minute walk distance (6MWD) (MD between groups of 42 metres, 95% CI 22 to 62; 1 study, 76 participants; low-certainty evidence). The magnitude of these observed mean changes appears clinically relevant as they exceed minimal clinically important difference (MCID) thresholds for people with chronic lung disease. Evidence suggests that quality of life improves following exercise training according to St George's Respiratory Questionnaire (SGRQ) total score (MD -9.62 points, 95% CI -15.67 to -3.56 points; 3 studies, 160 participants; low-certainty evidence), which exceeds the MCID of 4 points for this outcome. A reduction in dyspnoea (MD 1.0 points, 95% CI 0.47 to 1.53; 1 study, 76 participants) and fatigue (MD 1.51 points, 95% CI 0.80 to 2.22 points; 1 study, 76 participants) was observed following exercise training according to these domains of the Chronic Respiratory Disease Questionnaire. However, there was no change in cough-related quality of life as measured by the Leicester Cough Questionnaire (LCQ) (MD -0.09 points, 95% CI -0.98 to 0.80 points; 2 studies, 103 participants; moderate-certainty evidence), nor in anxiety or depression. Two studies reported longer-term outcomes up to 12 months after intervention completion; however exercise training did not appear to improve exercise capacity or quality of life more than usual care. Exercise training reduced the number of acute exacerbations of bronchiectasis over 12 months in people with stable bronchiectasis (odds ratio 0.26, 95% CI 0.08 to 0.81; 1 study, 55 participants). After an acute exacerbation of bronchiectasis, data from a single study (N = 27) suggest that exercise training compared to usual care confers little to no effect on exercise capacity (MD 11 metres, 95% CI -27 to 49 metres; low-certainty evidence), SGRQ total score (MD 6.34 points, 95%CI -17.08 to 29.76 points), or LCQ score (MD -0.08 points, 95% CI -0.94 to 0.78 points; low-certainty evidence) and does not reduce the time to first exacerbation (hazard ratio 0.83, 95% CI 0.31 to 2.22). AUTHORS' CONCLUSIONS: This review provides low-certainty evidence suggesting improvement in functional exercise capacity and quality of life immediately following exercise training in people with stable bronchiectasis; however the effects of exercise training on cough-related quality of life and psychological symptoms appear to be minimal. Due to inadequate reporting of methods, small study numbers, and variation between study findings, evidence is of very low to moderate certainty. Limited evidence is available to show longer-term effects of exercise training on these outcomes.


Assuntos
Bronquiectasia/reabilitação , Tolerância ao Exercício , Exercício Físico , Qualidade de Vida , Adulto , Viés , Exercícios Respiratórios , Bronquiectasia/mortalidade , Tosse/terapia , Progressão da Doença , Dispneia/reabilitação , Hospitalização , Humanos , Saúde Mental , Resistência Física , Desempenho Físico Funcional , Transtornos Respiratórios/reabilitação , Teste de Caminhada
5.
Ther Umsch ; 78(4): 187-194, 2021.
Artigo em Alemão | MEDLINE | ID: mdl-33899515

RESUMO

Cough - an Interdisciplinary Condition: The Pneumologist's Perspective Abstract. Cough is one of the most frequent reasons for a medical consultation. Patients mostly suffer from acute cough (< 2 weeks duration) and subacute cough (2 - 8 weeks) during consultation at primary care. Chronic cough (> 8 weeks) is mostly cared for by specialists. Acute and subacute cough is most frequently caused by infections with primarily viral pathogens. Chronic cough is commonly associated with obstructive airway disease (i. e. Asthma, COPD), gastroesophageal reflux and upper airway cough syndrome. Pulmonary causes are investigated by spirometry, bodyplethysmography, blood eosinophil count, exhaled nitric oxide, methacholine challenge test, chest x-rays and computed tomography. Treatment should target underlying diseases, causing cough. Trials of inhaled corticosteroids can be considered if an asthmatic cause is suspected. Secretolytics and cough-suppressing medications should be used only to reduce patient symptoms if there is no alternative causal treatment. Clinical trials show positive results for treatment of chronic refractory (no improvement of symptoms despite adequate treatment of the underlying condition) and chronic idiopathic cough with Gefapixant, a P2X3 purinergic receptor antagonist. If recent trial results are confirmed a first specific cough modulating substance might be available soon.


Assuntos
Asma , Refluxo Gastroesofágico , Doença Crônica , Tosse/diagnóstico , Tosse/etiologia , Tosse/terapia , Humanos , Espirometria
6.
Ther Umsch ; 78(4): 171-179, 2021.
Artigo em Alemão | MEDLINE | ID: mdl-33899519

RESUMO

Cough from the perspective of a gastroenterologist Abstract. Chronic cough can have numerous origins. The work-up of these conditions should always include a multidisciplinary approach to exclude other causes first (cardial, pulmonary, structural changes of pharynx and larynx, allergies, malignancy) before thinking of an upper GI pathology. Cough as an extra-esophageal manifestation of gastroesophageal reflux disease (GERD) is the most common gastroenterological condition. From a gastroenterologist's perspective eosinophilic esophagitis (EoE) and esophageal motility disorders are potential differential diagnosis. If other worrisome symptoms (weight loss, anemia, dysphagia) are present at the same time an endoscopic evaluation with esophago-gastro-duodenoscopy (EGD) should be performed first to exclude a malignancy. Hereby one should perform biopsies of the esophagus to exclude an eosinophilic esophagitis (EoE). If the macroscopic and histopathology results of the EGD are unremarkable a probatory trial of acid-suppressive therapy with proton pump inhibitors (PPIs) is the first-line therapeutic option. For non-responders to PPI-therapy functional diagnostics are the next step. With the help of ambulatory pH-impedance monitoring one can diagnose a non- erosive reflux disease and an esophageal hypersensitivity. An esophageal manometry can deliver relevant information about the physiological anti-reflux barrier and diagnose motility disorders of the esophagus. Surgical therapy (antireflux surgery) can be an option for selected patients with proven reflux associated cough refractory to medical therapy. The aim of this review is to give an overview over a possible diagnostic-therapeutic algorithm from a gastroenterologist's point of view to approach the symptom cough.


Assuntos
Gastroenterologistas , Refluxo Gastroesofágico , Tosse/diagnóstico , Tosse/etiologia , Tosse/terapia , Monitoramento do pH Esofágico , Refluxo Gastroesofágico/diagnóstico , Refluxo Gastroesofágico/terapia , Humanos , Inibidores da Bomba de Prótons
7.
Ther Umsch ; 78(4): 165-170, 2021.
Artigo em Alemão | MEDLINE | ID: mdl-33899520

RESUMO

Cough from an allergological as well as from the ENT aspect Abstract. Cough is a common problem in the allergological, but less so in the rhinological consultation. The differential diagnostic spectrum for cough is extensive and may range from rhinitis and asthma to eosinophilic esophagitis and rarer diseases. In the case of chronic cough (> 2 months), the four most frequent causes must be sought, or be excluded (upper airway cough syndrome, asthma [cough-variant-asthma], non-asthmatic eosinophilic bronchitis, gastroesophageal reflux disease). Aeroallergens such as pollen, house-dust mites or occupational substances play a major role in allergies. Nevertheless, it is not uncommon for cough to be a main symptom of an antibody deficiency or a Sicca symptom complex. The more chronic the cough, the more thoroughly an investigation is indicated - often interdisciplinary. Therapy depends on the cause of the cough. In allergic respiratory diseases, allergy-specific immunotherapy may be indicated.


Assuntos
Asma , Refluxo Gastroesofágico , Hipersensibilidade , Doença Crônica , Tosse/diagnóstico , Tosse/etiologia , Tosse/terapia , Humanos , Hipersensibilidade/diagnóstico , Hipersensibilidade/terapia
9.
Am J Case Rep ; 22: e928421, 2021 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-33542171

RESUMO

BACKGROUND High-frequency percussive ventilation (HFPV) is a method that combines mechanical ventilation with high-frequency oscillatory ventilation. This report describes 3 cases of patients with severe COVID-19 pneumonia who received intermittent adjunctive treatment with HFPV at a single center without requiring admission to the Intensive Care Unit (ICU). CASE REPORT Case 1 was a 60-year-old woman admitted to the hospital 14 days after the onset of SARS-CoV-2 infection symptoms, and cases 2 and 3 were men aged 65 and 72 years who were admitted to the hospital 10 days after the onset of SARS-CoV-2 infection symptoms. All 3 patients presented with clinical deterioration accompanied by worsening lung lesions on computed tomography (CT) scans after 21 days from the onset of symptoms. SARS-CoV-2 infection was confirmed in all patients by real-time reverse transcription-polymerase chain reaction (RT-PCR) assay from nasal swabs. All 3 patients had impending respiratory failure when non-invasive intermittent HFPV therapy was initiated. After therapy, the patients had significant clinical improvement and visibly decreased lung lesions on followup CT scans performed 4-6 days later. CONCLUSIONS The 3 cases described in this report showed that the use of intermittent adjunctive treatment with HFPV in patients with severe pneumonia due to infection with SARS-CoV-2 improved lung function and may have prevented clinical deterioration. However, recommendations on the use of intermittent HFPV as an adjunctive treatment in COVID-19 pneumonia requires large-scale controlled clinical studies. In the pandemic context, with a shortage of ICU beds, avoiding ICU admission by using adjunctive therapies on the ward is a useful option.


Assuntos
/terapia , Ventilação de Alta Frequência , Idoso , Deterioração Clínica , Tosse/terapia , Tosse/virologia , Dispneia/terapia , Dispneia/virologia , Feminino , Hospitalização , Humanos , Pulmão/diagnóstico por imagem , Pulmão/virologia , Masculino , Pessoa de Meia-Idade , Oxigenoterapia , Insuficiência Respiratória/prevenção & controle , Tomografia Computadorizada por Raios X
12.
Med Clin North Am ; 105(1): 31-38, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33246521

RESUMO

Cough is a common presenting symptom for patients in a primary care setting. Chronic cough is defined as a cough lasting for more than 8 weeks. The most common causes of chronic cough are upper airway cough syndrome, asthma, and gastroesophageal reflux disease. Detailed history and physical examination are critical in identifying potential etiologies of cough. When there is no prevailing diagnosis, step-wise empiric trial of medication is a strategic and cost-effective approach. Certain features of chronic cough should provoke an expedited and invasive diagnostic strategy. Effectively treating patients with chronic cough has a high impact on quality of life.


Assuntos
Tosse/etiologia , Algoritmos , Asma/complicações , Asma/diagnóstico , Doença Crônica , Tosse/diagnóstico , Tosse/fisiopatologia , Tosse/terapia , Refluxo Gastroesofágico/complicações , Refluxo Gastroesofágico/diagnóstico , Humanos , Anamnese , Exame Físico , Infecções Respiratórias/complicações , Infecções Respiratórias/diagnóstico
13.
Med. paliat ; 27(3): 171-180, jul.-sept. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-197370

RESUMO

La pandemia por SARS-CoV-2 que expuso a nuestros pacientes a una importante carga sintomática hizo de los cuidados paliativos una herramienta necesaria para la atención de estos pacientes. Los fármacos empleados para contrarrestar el virus y los tratamientos para el control de síntomas tienen múltiples interacciones debido tanto al hepatotrofismo del virus como a las vías de metabolismo de los tratamientos. Con este artículo pretendemos compartir nuestra experiencia y algunas recomendaciones farmacológicas para minimizar potenciales interacciones y efectos secundarios de los tratamientos empleados. Queda mucho por investigar, pero creemos que compartiendo información entre centros podremos brindar el mejor abordaje multidisciplinar que merecen los pacientes


The SARS-CoV-2 pandemic that exposed our patients to a significant symptom burden made palliative care a necessary tool for the care of these patients. The drugs used to counteract the virus and the treatments used for the control of symptoms have multiple interactions due to both the hepatotrophism of the virus and the metabolism pathways of treatments. With this article we aim to share our experience and some pharmacological recommendations to minimize the potential interactions and side effects of treatments. Much remains to be investigated but we believe that by sharing information between centers we shall be able to provide the best multidisciplinary approach that patients deserve


Assuntos
Humanos , Neoplasias Hematológicas/tratamento farmacológico , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/terapia , Cuidados Paliativos/métodos , Infecções por Coronavirus/tratamento farmacológico , Pneumonia Viral/tratamento farmacológico , Betacoronavirus/efeitos dos fármacos , Sistemas de Medicação/normas , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , Pandemias , Infecções por Coronavirus/diagnóstico , Pneumonia Viral/diagnóstico , Manejo da Dor , Dispneia/terapia , Tosse/terapia
14.
J Infect Dis ; 222(8): 1293-1297, 2020 09 14.
Artigo em Inglês | MEDLINE | ID: mdl-32761128

RESUMO

The number of coronavirus disease 2019 (COVID-19) cases has exceeded 10 million. However, little is known about the epidemiology and clinical characteristics of COVID-19 infants. We collected medical information of 46 confirmed patients (<1 year old) and retrospectively analyzed epidemiological history, clinical symptoms, and laboratory test results. The median age was 5 (interquartile range, 2-7) months. Sixteen cases had fever and 27 cases had cough. Moderate disease was present in 40 cases and cardiac injury occurred in 38 cases, following by liver dysfunction in 20 cases and lymphocytosis in no cases. Of all infant patients, 2 received invasive mechanical ventilation and 1 died with multiple organ dysfunction syndrome.


Assuntos
Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Fatores Etários , Betacoronavirus/isolamento & purificação , China/epidemiologia , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Tosse/terapia , Tosse/virologia , Feminino , Febre/terapia , Febre/virologia , Humanos , Lactente , Masculino , Insuficiência de Múltiplos Órgãos/terapia , Insuficiência de Múltiplos Órgãos/virologia , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Estudos Retrospectivos , Resultado do Tratamento
15.
F1000Res ; 92020.
Artigo em Inglês | MEDLINE | ID: mdl-32765833

RESUMO

Cough is a natural process that protects the airway. Cough can occur spontaneously or voluntarily. It is considered chronic when it is present for longer than 4 weeks in children or 8 weeks in adults. In both, chronic cough causes patient distress and increased healthcare utilization. Etiologies of pediatric chronic cough include asthma, protracted bacterial bronchitis, tracheomalacia, habit cough, and various systemic disorders. While some diagnoses are identifiable by careful history alone, others require testing guided by specific pointers. Flexible fiberoptic bronchoscopy has been an important tool to identify etiologies of chronic cough that were not otherwise apparent. In adults, asthma and bronchitis are well-defined etiologies of chronic cough, but much chronic cough in adults is largely a conundrum. Reviews of adult chronic cough report that at least 40% of adults with chronic cough have no medical explanation. Gastroesophageal reflux and upper airway cough syndrome (a.k.a. post-nasal drip) have been common diagnoses of chronic cough, but those diagnoses have no support from controlled clinical trials and have been subjected to multiple published critiques. Cough hypersensitivity is considered to be an explanation for chronic cough in adults who have no other confirmed diagnosis. Gabapentin, a neuromodulator, has been associated with a modest effect in adults, as has speech pathology. While habit cough has not generally been a diagnosis in adults, there is evidence for a behavioral component in adults with chronic cough. Treatment for a specific diagnosis provides a better outcome than trials of cough suppression in the absence of a specific diagnosis. More data are needed for chronic cough in adults to examine the hypothesized cough hypersensitivity and behavioral management. This article reviews etiologies and the treatment of chronic cough in children and the conundrum of diagnosing and treating chronic cough in adults.


Assuntos
Tosse/diagnóstico , Tosse/terapia , Adulto , Asma , Bronquite , Criança , Doença Crônica , Refluxo Gastroesofágico , Humanos
16.
Ann Otol Rhinol Laryngol ; 129(11): 1088-1094, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32486883

RESUMO

OBJECTIVES: Chronic recalcitrant cough is present in 2/3 of pediatric patients evaluated in our tertiary-care multidisciplinary aerodigestive clinic (ADC). This study aimed to determine the impact of chronic cough and efficacy of ADC treatment using the validated Pediatric-Cough Quality-of-Life-27 tool (PC-QOL-27). METHODS: The PC-QOL-27 survey was administered to ADC patients with chronic cough at initial clinic visit and 6 to 12 weeks after cough management. Pre and post survey scores, demographic data, treatment and evaluation season were collected over 16 months. RESULTS: Twenty parents completed pre and post PC-QOL-27 surveys (mean 12.1 weeks later). Patient median age was 6.04 years (IQR: 2.2-10.44 years). A total of 65% were males and 65% were African American. Management was tailored based on clinical assessment and diagnostic studies, including direct laryngoscopy/bronchoscopy (4), pulmonary function tests (PFT's 9), esophagogastroduodenoscopy (9), and flexible bronchoscopy/lavage (9).Following ADC management, changes in physical, social and psychological domain scores of the PC-QOL-27 each met the threshold for minimal clinical important difference (MCID) indicating a clinically meaningful improvement. Improvements were most notable in the physical domain where post survey scores significantly improved from pre-survey scores (P = .009) regardless of age, gender, ethnicity, history of endoscopy and season. CONCLUSIONS: The physical impact of chronic cough in pediatric patients who failed prior management by a single specialist was lessened by an ADC team approach to management.


Assuntos
Manuseio das Vias Aéreas/métodos , Tosse/terapia , Qualidade de Vida/psicologia , Criança , Pré-Escolar , Doença Crônica , Tosse/diagnóstico , Tosse/psicologia , Feminino , Humanos , Laringoscopia , Masculino , Inquéritos e Questionários
17.
J Clin Neurosci ; 77: 1-7, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32414621

RESUMO

Chiari Malformation type 1 (CM-I) is congenital or an acquired anomaly of the hind brain; develops when the cerebellar tonsils recede downwards below the foramen magnum. Recurrent post tussive suboccipital headache is the common presentation in a pregnant woman and the diagnosis is usually missed or delayed due to lack of formal understanding of this neurological pathology. Much has been written regarding presentation, morphology and the treatment of CM-I; however, little is known when the etiology is acquired or an iatrogenic in its evolution. Similarly, unknown is the progression of CM-I (diagnosed or undiagnosed) in pregnancy. The objective of this study is to elucidate the causes of progression of CM-I in pregnancy, and how this can be avoided. A detailed literature review has been conducted to find the case reports or case studies on association of CM-I in pregnancy; therefore, the risk factors regarding the progression have been sought. There is a lack of literature on timing, mode of anesthesia, and the management of CM-I. Moreover, authors have sought a questionnaire to screen these patients at pre-conception, intrapartum visits if, the initial diagnosis is delayed. Crucial points of concern including but not limited to the diagnosis, pre-conception counseling, timing of intervention during pregnancy, and mode of anesthesia, have been discussed in detail. In summary, a formal management algorithm has been proposed to avoid the rapid progression of this complex neurological pathology especially, in women of child bearing age and/or during pregnancy.


Assuntos
Malformação de Arnold-Chiari/diagnóstico por imagem , Progressão da Doença , Complicações na Gravidez/diagnóstico por imagem , Adulto , Malformação de Arnold-Chiari/complicações , Malformação de Arnold-Chiari/terapia , Tosse/complicações , Tosse/diagnóstico por imagem , Tosse/terapia , Parto Obstétrico/métodos , Feminino , Forame Magno/diagnóstico por imagem , Transtornos da Cefaleia Primários/complicações , Transtornos da Cefaleia Primários/diagnóstico por imagem , Transtornos da Cefaleia Primários/terapia , Humanos , Imageamento por Ressonância Magnética/métodos , Gravidez , Complicações na Gravidez/terapia , Fatores de Risco
19.
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
20.
Sci Rep ; 10(1): 2030, 2020 02 06.
Artigo em Inglês | MEDLINE | ID: mdl-32029825

RESUMO

Cough is a protective respiratory reflex used to clear respiratory airway mucus. For patients with cough weakness, such as chronic obstructive pulmonary disease, neuromuscular weakness disease and other respiratory diseases, assisted coughing techniques are essential to help them clear mucus. In this study, the Eulerian wall film model was applied to simulate the coughing clearance process through a computational fluid dynamics methodology. Airway generation 0 to generation 2 based on realistic geometry is considered in this study. To quantify cough effectiveness, cough efficiency was calculated. Moreover, simulations of four different coughing techniques applied for chronic obstructive pulmonary disease and neuromuscular weakness disease were conducted. The influences of mucus film thickness and mucus viscosity on cough efficiency were analyzed. From the simulation results, we found that with increasing mucus film thickness and decreasing mucus viscosity, cough efficiency improved accordingly. Assisted coughing technologies have little influence on the mucus clearance of chronic obstructive pulmonary disease models. Finally, it was observed that the cough efficiency of the mechanical insufflation-exsufflation technique (MIE) is more than 40 times the value of an unassisted coughing technique, which indicates that the MIE technology has a great effect on airway mucus clearance for neuromuscular weakness disease models.


Assuntos
Tosse/terapia , Insuflação/métodos , Respiração Artificial/métodos , Sistema Respiratório/fisiopatologia , Escarro/química , Simulação por Computador , Tosse/fisiopatologia , Humanos , Hidrodinâmica , Modelos Biológicos , Modelos Químicos , Viscosidade
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