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1.
J Enzyme Inhib Med Chem ; 36(1): 1230-1235, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34074197

RESUMO

The ongoing Covid-19 is a contagious disease, and it is characterised by different symptoms such as fever, cough, and shortness of breath. Rising concerns about Covid-19 have severely affected the healthcare system in all countries as the Covid-19 outbreak has developed at a rapid rate all around the globe. Intriguing, a clinically used drug, acetazolamide (a specific inhibitor of carbonic anhydrase, CA, EC 4.2.1.1), is used to treat high-altitude pulmonary oedema (HAPE), showing a high degree of clinical similarities with the pulmonary disease caused by Covid-19. In this context, this preliminary study aims to provide insights into some factors affecting the Covid-19 patients, such as hypoxaemia, hypoxia as well as the blood CA activity. We hypothesise that patients with Covid-19 problems could show a dysregulated acid-base status influenced by CA activity. These preliminary results suggest that the use of CA inhibitors as a pharmacological treatment for Covid-19 may be beneficial.


Assuntos
Acetazolamida/uso terapêutico , Antivirais/uso terapêutico , COVID-19/tratamento farmacológico , Inibidores da Anidrase Carbônica/uso terapêutico , Anidrases Carbônicas/sangue , Equilíbrio Ácido-Base/efeitos dos fármacos , Doença da Altitude/sangue , Doença da Altitude/tratamento farmacológico , Anticonvulsivantes/uso terapêutico , Bicarbonatos/sangue , COVID-19/sangue , COVID-19/diagnóstico por imagem , COVID-19/virologia , Dióxido de Carbono/sangue , Tosse/sangue , Tosse/tratamento farmacológico , Tosse/patologia , Tosse/virologia , Reposicionamento de Medicamentos , Dispneia/sangue , Dispneia/tratamento farmacológico , Dispneia/patologia , Dispneia/virologia , Febre/sangue , Febre/tratamento farmacológico , Febre/patologia , Febre/virologia , Humanos , Concentração de Íons de Hidrogênio , Hipertensão Pulmonar/sangue , Hipertensão Pulmonar/tratamento farmacológico , Hipóxia/sangue , Hipóxia/tratamento farmacológico , Hipóxia/patologia , Hipóxia/virologia , Oximetria , Projetos de Pesquisa , SARS-CoV-2/patogenicidade , SARS-CoV-2/fisiologia , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X
3.
Ther Umsch ; 78(4): 195-198, 2021.
Artigo em Alemão | MEDLINE | ID: mdl-33899517

RESUMO

Cough from a pharmacological point of view Abstract. Drugs with various protussive or antitussive mechanisms of action are used to alleviate cough symptoms. Phytopharmaceuticals also play an important role. When determining the etiology of persistent cough, long-term medication should be critically assessed and on suspicion of an adverse drug reaction adjusted as necessary.


Assuntos
Antitussígenos , Tosse , Antitussígenos/uso terapêutico , Tosse/tratamento farmacológico , Humanos
4.
J Med Food ; 24(4): 348-357, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33861937

RESUMO

Chronic cough is very common in respiratory clinics, and no effective drugs are available. Schisandra chinensis (Turcz.) Baill. (S. chinensis), an important traditional Chinese medicine, has been extensively prescribed for patients with a persistent cough. Preliminary research indicated that 95% ethanol extracts (EE) of S. chinensis showed remarkable antitussive activity in guinea pigs exposed to cigarette smoke (CS). To find out the antitussive ingredients of S. chinensis, EE was divided into four fractions according to the polarity: petroleum ether extract (PEE), ethyl acetate extract (ECE), n-butyl alcohol extract, and residue extract. The antitussive, antioxidant, and anti-inflammatory effects of the four fractions were evaluated in a guinea pig model of cough hypersensitivity induced by CS exposure. Eighteen main constituents of the two effective fractions, PEE and ECE, were identified using ultra-high-pressure liquid chromatography electronic spray ion time-of-flight mass spectrometry. The cough inhibition activities of compound 1, 3, 9, 10, 17 were evaluated on citric acid induced acute cough guinea pigs. The results showed that the antitussive activity of EE was almost all contained in PEE and ECE. The 16 major peaks in PEE were identified as 15 lignans (1-12 and 14-16) and 1 triterpene (compound 13), and 3 major peaks (1, 17, and 18) in ECE were also identified as lignans. Three doses of five compounds brought about a significant decrease in number of cough efforts (P < .01), and the cough inhibition rates were between 40.9% and 85.1%. Therefore, lignans are the antitussive ingredients of S. chinensis.


Assuntos
Antitussígenos , Lignanas , Schisandra , Animais , Cromatografia Líquida de Alta Pressão , Tosse/induzido quimicamente , Tosse/tratamento farmacológico , Cobaias , Humanos , Lignanas/análise
6.
BMJ Open ; 11(3): e041769, 2021 03 29.
Artigo em Inglês | MEDLINE | ID: mdl-33782018

RESUMO

INTRODUCTION: Respiratory tract infections (RTIs) in children are common and present major resource implications for primary care. Unnecessary use of antibiotics is associated with the development and proliferation of antimicrobial resistance. In 2016, the National Institute for Health Research (NIHR)-funded 'TARGET' programme developed a prognostic algorithm to identify children with acute cough and RTI at very low risk of 30-day hospitalisation and unlikely to need antibiotics. The intervention includes: (1) explicit elicitation of parental concerns, (2) the results of the prognostic algorithm accompanied by prescribing guidance and (3) provision of a printout for carers including safety netting advice. The CHIldren's COugh feasibility study suggested differential recruitment of healthier patients in control practices. This phase III 'efficiently designed' trial uses routinely collected data at the practice level, thus avoiding individual patient consent. The aim is to assess whether embedding a multifaceted intervention into general practitioner (GP) practice Information Technology (IT) systems will result in reductions of antibiotic prescribing without impacting on hospital attendance for RTI. METHODS AND ANALYSIS: The coprimary outcomes are (1) practice rate of dispensed amoxicillin and macrolide antibiotics, (2) hospital admission rate for RTI using routinely collected data by Clinical Commissioning Groups (CCGs). Data will be collected for children aged 0-9 years registered at 310 practices (155 intervention, 155 usual care) over a 12-month period. Recruitment and randomisation of practices (using the Egton Medical Information Systems web data management system) is conducted via each CCG stratified for children registered and baseline dispensing rates of each practice. Secondary outcomes will explore intervention effect modifiers. Qualitative interviews will explore intervention usage. The economic evaluation will be limited to a between-arm comparison in a cost-consequence analysis. ETHICS AND DISSEMINATION: Research ethics approval was given by London-Camden and Kings Cross Research Ethics Committee (ref:18/LO/0345). This manuscript refers to protocol V.4.0. Results will be disseminated through peer-reviewed journals and international conferences. TRIAL REGISTRATION NUMBER: ISRCTN11405239.


Assuntos
Tosse , Infecções Respiratórias , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , Tosse/tratamento farmacológico , Humanos , Lactente , Recém-Nascido , Londres , Atenção Primária à Saúde , Ensaios Clínicos Controlados Aleatórios como Assunto , Infecções Respiratórias/tratamento farmacológico
7.
JAMA Netw Open ; 4(2): e210369, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33576820

RESUMO

Importance: There is limited evidence regarding early treatment of novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection to mitigate symptom progression. Objective: To examine whether high-dose zinc and/or high-dose ascorbic acid reduce the severity or duration of symptoms compared with usual care among ambulatory patients with SARS-CoV-2 infection. Design, Setting, and Participants: This multicenter, single health system randomized clinical factorial open-label trial enrolled 214 adult patients with a diagnosis of SARS-CoV-2 infection confirmed with a polymerase chain reaction assay who received outpatient care in sites in Ohio and Florida. The trial was conducted from April 27, 2020, to October 14, 2020. Intervention: Patients were randomized in a 1:1:1:1 allocation ratio to receive either 10 days of zinc gluconate (50 mg), ascorbic acid (8000 mg), both agents, or standard of care. Outcomes: The primary end point was the number of days required to reach a 50% reduction in symptoms, including severity of fever, cough, shortness of breath, and fatigue (rated on a 4-point scale for each symptom). Secondary end points included days required to reach a total symptom severity score of 0, cumulative severity score at day 5, hospitalizations, deaths, adjunctive prescribed medications, and adverse effects of the study supplements. Results: A total of 214 patients were randomized, with a mean (SD) age of 45.2 (14.6) years and 132 (61.7%) women. The study was stopped for a low conditional power for benefit with no significant difference among the 4 groups for the primary end point. Patients who received usual care without supplementation achieved a 50% reduction in symptoms at a mean (SD) of 6.7 (4.4) days compared with 5.5 (3.7) days for the ascorbic acid group, 5.9 (4.9) days for the zinc gluconate group, and 5.5 (3.4) days for the group receiving both (overall P = .45). There was no significant difference in secondary outcomes among the treatment groups. Conclusions and Relevance: In this randomized clinical trial of ambulatory patients diagnosed with SARS-CoV-2 infection, treatment with high-dose zinc gluconate, ascorbic acid, or a combination of the 2 supplements did not significantly decrease the duration of symptoms compared with standard of care. Trial Registration: ClinicalTrials.gov Identifier: NCT04342728.


Assuntos
Ácido Ascórbico/uso terapêutico , Suplementos Nutricionais , Zinco/uso terapêutico , Adulto , Assistência Ambulatorial , Antioxidantes/uso terapêutico , Tosse/tratamento farmacológico , Tosse/etiologia , Dispneia/tratamento farmacológico , Dispneia/etiologia , Fadiga/tratamento farmacológico , Fadiga/etiologia , Feminino , Febre/tratamento farmacológico , Febre/etiologia , Gluconatos/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Padrão de Cuidado , Oligoelementos/uso terapêutico , Resultado do Tratamento
8.
J Neurovirol ; 27(1): 154-159, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33528827

RESUMO

As the SARS-COV-2 becomes a global pandemic, many researchers have a concern about the long COVID-19 complications. Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is a persistent, debilitating, and unexplained fatigue disorder. We investigated psychological morbidities such as CFS and post-traumatic stress disorder (PTSD) among survivors of COVID-19 over 6 months. All COVID-19 survivors from the university-affiliated hospital of Tehran, Iran, were assessed 6 months after infection onset by a previously validated questionnaire based on the Fukuda guidelines for CFS/EM and DSM-5 Checklist for PTSD (The Post-traumatic Stress Disorder Checklist for DSM-5 or PCL-5) to determine the presence of stress disorder and chronic fatigue problems. A total of 120 patients were enrolled. The prevalence rate of fatigue symptoms was 17.5%. Twelve (10%) screened positive for chronic idiopathic fatigue (CIF), 6 (5%) for CFS-like with insufficient fatigue syndrome (CFSWIFS), and 3 (2.5%) for CFS. The mean total scores in PCL-5 were 9.27 ± 10.76 (range:0-44), and the prevalence rate of PTSD was 5.8%. There was no significant association after adjusting between CFS and PTSD, gender, comorbidities, and chloroquine phosphate administration. The obtained data revealed the prevalence of CFS among patients with COVID-19, which is almost similar to CFS prevalence in the general population. Moreover, PTSD in patients with COVID-19 is not associated with the increased risk of CFS. Our study suggested that medical institutions should pay attention to the psychological consequences of the COVID-19 outbreak.


Assuntos
/psicologia , Tosse/psicologia , Demência/psicologia , Dispneia/psicologia , Síndrome de Fadiga Crônica/psicologia , Febre/psicologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Adulto , Idoso , Antivirais/uso terapêutico , /tratamento farmacológico , Tosse/complicações , Tosse/tratamento farmacológico , Tosse/virologia , Demência/complicações , Demência/tratamento farmacológico , Demência/virologia , Combinação de Medicamentos , Dispneia/complicações , Dispneia/tratamento farmacológico , Dispneia/virologia , Síndrome de Fadiga Crônica/complicações , Síndrome de Fadiga Crônica/tratamento farmacológico , Síndrome de Fadiga Crônica/virologia , Feminino , Febre/complicações , Febre/tratamento farmacológico , Febre/virologia , Humanos , Hidroxicloroquina/uso terapêutico , Lopinavir/uso terapêutico , Masculino , Pessoa de Meia-Idade , Oseltamivir/uso terapêutico , Projetos de Pesquisa , Ritonavir/uso terapêutico , /patogenicidade , Índice de Gravidade de Doença , Transtornos de Estresse Pós-Traumáticos/complicações , Transtornos de Estresse Pós-Traumáticos/tratamento farmacológico , Transtornos de Estresse Pós-Traumáticos/virologia , Inquéritos e Questionários , Sobreviventes/psicologia
10.
Z Rheumatol ; 80(3): 270-273, 2021 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-33559755

RESUMO

The article describes the case of a hospitalized 58-year-old female patient with a chronic dry cough and increased inflammation values. Before hospital admission, the presence of coronavirus disease 2019 (COVID-19) was excluded by a normal chest X­ray and two negative PCR tests on throat swabs. On admission the only symptom was a dry cough with clinically inconspicuous auscultation findings. The laboratory investigations revealed anemia and increased inflammation parameters, e.g. C­reactive protein (CRP) 92.4 mg/l and erythrocyte sedimentation rate (ESR) 102 mm/h (according to Westergren). A large vessel vasculitis was demonstrated on magnetic resonance angiography (MRA). After the diagnosis of a giant cell arteritis, treatment with an oral glucocorticoid and subcutaneous methotrexate (MTX) was initiated, with good clinical and laboratory parameter responses. Dry cough has been described in rare cases in the literature as the first sign of large vessel vasculitis.


Assuntos
Coronavirus , Arterite de Células Gigantes , Sedimentação Sanguínea , Tosse/diagnóstico , Tosse/tratamento farmacológico , Feminino , Humanos , Pessoa de Meia-Idade
11.
J Neurovirol ; 27(1): 26-34, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33492608

RESUMO

Opsoclonus-myoclonus-ataxia syndrome is a heterogeneous constellation of symptoms ranging from full combination of these three neurological findings to varying degrees of isolated individual sign. Since the emergence of coronavirus disease 2019 (COVID-19), neurological symptoms, syndromes, and complications associated with this multi-organ viral infection have been reported and the various aspects of neurological involvement are increasingly uncovered. As a neuro-inflammatory disorder, one would expect to observe opsoclonus-myoclonus syndrome after a prevalent viral infection in a pandemic scale, as it has been the case for many other neuro-inflammatory syndromes. We report seven cases of opsoclonus-myoclonus syndrome presumably parainfectious in nature and discuss their phenomenology, their possible pathophysiological relationship to COVID-19, and diagnostic and treatment strategy in each case. Finally, we review the relevant data in the literature regarding the opsoclonus-myoclonus syndrome and possible similar cases associated with COVID-19 and its diagnostic importance for clinicians in various fields of medicine encountering COVID-19 patients and its complications.


Assuntos
Ataxia/fisiopatologia , Tosse/fisiopatologia , Febre/fisiopatologia , Mialgia/fisiopatologia , Síndrome de Opsoclonia-Mioclonia/fisiopatologia , /patogenicidade , Adulto , Anticonvulsivantes/uso terapêutico , Ataxia/diagnóstico por imagem , Ataxia/tratamento farmacológico , Ataxia/etiologia , Azitromicina/uso terapêutico , /diagnóstico por imagem , Clonazepam/uso terapêutico , Tosse/diagnóstico por imagem , Tosse/tratamento farmacológico , Tosse/etiologia , Dispneia/diagnóstico por imagem , Dispneia/tratamento farmacológico , Dispneia/etiologia , Dispneia/fisiopatologia , Feminino , Febre/diagnóstico por imagem , Febre/tratamento farmacológico , Febre/etiologia , Humanos , Hidroxicloroquina/uso terapêutico , Levetiracetam/uso terapêutico , Masculino , Pessoa de Meia-Idade , Mialgia/diagnóstico por imagem , Mialgia/tratamento farmacológico , Mialgia/etiologia , Síndrome de Opsoclonia-Mioclonia/diagnóstico por imagem , Síndrome de Opsoclonia-Mioclonia/tratamento farmacológico , Síndrome de Opsoclonia-Mioclonia/etiologia , Oseltamivir/uso terapêutico , Ácido Valproico/uso terapêutico
12.
BMC Pediatr ; 21(1): 29, 2021 01 11.
Artigo em Inglês | MEDLINE | ID: mdl-33430841

RESUMO

BACKGROUND: Acute cough in children often causes discomfort to children and parents, reducing their quality of life. Despite the extensive utilization of over-the-counter remedies for cough, the efficacy of most of these treatments in children has not been confirmed. METHODS: We conducted a randomized, double blind, placebo-controlled clinical trial of 106 children with acute cough to evaluate the efficacy and safety of KalobaTUSS®, a paediatric cough syrup based on acacia honey and on Malva sylvestris extract, Inula helenium extract, Plantago major extract, and Helichrysum stoechas extract by using a validated 6 points Likert scale. RESULTS: Children were orally treated with KalobaTUSS® or placebo for 8 days. Children receiving KalobaTUSS® showed an early and significant reduction in night-time and day-time cough scores measured using a specific scale and a shorter duration of cough than children treated with the placebo. CONCLUSIONS: KalobaTUSS® is well tolerated and produces positive effects by reducing the severity and shortening the duration of cough in children. TRIAL REGISTRATION: Clinicaltrials.gov no. NCT04073251 . Retrospectively registered.


Assuntos
Tosse , Qualidade de Vida , Administração Oral , Criança , Tosse/tratamento farmacológico , Método Duplo-Cego , Humanos
13.
J Ethnopharmacol ; 264: 113342, 2021 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-32890712

RESUMO

ETHNOPHARMACOLOGICAL RELEVANCE: Cough variant asthma (CVA) is characterized with its long-lasting cough symptom on clinic. The mechanism of CVA is related to chronic persistent airway inflammation, airway hyperresponsiveness, etc. The traditional Chinese prescription has achieved good curative effect on CVA treatment through reducing cough counts, decreasing airway hyperresponsiveness and alleviating airway inflammation. The mechanism is associated with reducing IL4, IL-13, NGF and CGRP levels, as well as down-regulating TRPA1/TRPV1/TRPV5 channels in both lung and brain tissues. AIM OF THE STUDY: The Chinese prescription, San'ao decoction with scorpio and bombyx batryticatus (SSB), is well known in treating cough in asthmatic patients. In this study, the anti-tussive and anti-asthmatic role of SSB, as well as its mechanism on CVA mice model were explored and evaluated via alleviating airway inflammation and regulation of TRP channels. MATERIALS AND METHODS: The major chemical components in SSB were detected and analyzed by UPLC-QTOF-MS under an optimized chromatographic and MS condition. 60 BALB/c mice were randomly divided into six groups: normal group, model group, dexamethasone group (0.1178 mg/kg/d), SSB high dose group (9.74 g/kg/d), SSB middle dose group (4.87 g/kg/d) and SSB low dose group (2.435 g/kg/d). The cough variant asthma mice model was established by ovalbumin sensitization and challenge. The protective role of SSB on CVA mice model was studied through inducing cough counts by capsaicin, assessing inflammatory cells in peripheral blood and bronchoalveolar lavage fluid (BALF), measuring airway responsiveness, detecting histopathological changes in lung tissues, analyzing cytokines and neuropeptides levels in BALF, as well as examining the mRNA and protein expressions of TRPA1, TRPV1 and TRPV5 in both lung and brain tissues. RESULTS: 17 signal peaks of the chemical components in SSB were identified by using UPLC-QTOF-MS. SSB (especially the high dose and middle dose), showed significantly effects on mice model by reducing mice cough counts (P < 0.01), decreasing eosinophil (EOS) counts in blood (P < 0.01) and inflammatory cell numbers in BALF (P < 0.01), decreasing airway hyperresponsiveness (P < 0.05), reducing the levels of IL-4 (P < 0.05), IL-13 (P < 0.01), NGF (P < 0.01) and CGRP (P < 0.01) in BALF, as well as down regulating the mRNA and protein expressions of TRPA1, TRPV1 and TRPV5 in both lung and brain tissues (P < 0.01). CONCLUSIONS: SSB showed anti-tussive and anti-asthmatic effects on cough variant asthma mice model by reducing cough counts, improving lung function, alleviating lung injury and airway inflammation. The mechanism of SSB might be associated with the regulation of cytokines and neuropeptides in BALF, as well as the regulation of TRPA1, TRPV1, TRPV5 channels in both lung and brain tissues.


Assuntos
Antiasmáticos/administração & dosagem , Antitussígenos/administração & dosagem , Bombyx , Medicamentos de Ervas Chinesas/administração & dosagem , Canais de Potencial de Receptor Transitório/antagonistas & inibidores , Animais , Asma/tratamento farmacológico , Asma/metabolismo , Canais de Cálcio/metabolismo , Tosse/tratamento farmacológico , Tosse/metabolismo , Modelos Animais de Doenças , Quimioterapia Combinada , Feminino , Camundongos , Camundongos Endogâmicos BALB C , Canal de Cátion TRPA1/antagonistas & inibidores , Canal de Cátion TRPA1/metabolismo , Canais de Cátion TRPV/antagonistas & inibidores , Canais de Cátion TRPV/metabolismo , Canais de Potencial de Receptor Transitório/metabolismo , Resultado do Tratamento
14.
J Neurovirol ; 27(1): 12-25, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33367960

RESUMO

With the growing number of COVID-19 cases in recent times. significant set of patients with extra pulmonary symptoms has been reported worldwide. Here we venture out to summarize the clinical profile, investigations, and radiological findings among patients with SARS-CoV-2-associated meningoencephalitis in the form of a systemic review. This review was carried out based on the existing PRISMA (Preferred Report for Systematic Review and Meta analyses) consensus statement. The data for this review was collected from four databases: Pubmed/Medline, NIH Litcovid, Embase, and Cochrane library and Preprint servers up till 30 June 2020. Search strategy comprised of a range of keywords from relevant medical subject headings which includes "SARS-COV-2," "COVID-19," and "meningoencephalitis." All peer reviewed, case-control, case report, pre print articles satisfying our inclusion criteria were involved in the study. Quantitative data was expressed in mean ± SD, while the qualitative date in percentages. Paired t test was used for analysing the data based on differences between mean and respective values with a p < 0.05 considered to be statistically significant. A total of 61 cases were included from 25 studies after screening from databases and preprint servers, out of which 54 of them had completed investigation profile and were included in the final analysis. Clinical, laboratory findings, neuroimaging abnormalities, and EEG findings were analyzed in detail. This present review summarizes the available evidences related to the occurrence of meningoencephalitis in COVID-19.


Assuntos
/fisiopatologia , Tosse/fisiopatologia , Fadiga/fisiopatologia , Febre/fisiopatologia , Meningoencefalite/fisiopatologia , /patogenicidade , Adulto , Idoso , Antivirais/uso terapêutico , Azitromicina/uso terapêutico , /tratamento farmacológico , Confusão/diagnóstico por imagem , Confusão/tratamento farmacológico , Confusão/fisiopatologia , Confusão/virologia , Tosse/diagnóstico por imagem , Tosse/tratamento farmacológico , Tosse/virologia , Dispneia/diagnóstico por imagem , Dispneia/tratamento farmacológico , Dispneia/fisiopatologia , Dispneia/virologia , Eletroencefalografia , Fadiga/diagnóstico por imagem , Fadiga/tratamento farmacológico , Fadiga/virologia , Feminino , Febre/diagnóstico por imagem , Febre/tratamento farmacológico , Febre/virologia , Humanos , Hidroxicloroquina/uso terapêutico , Masculino , Meningoencefalite/diagnóstico por imagem , Meningoencefalite/tratamento farmacológico , Meningoencefalite/virologia , Pessoa de Meia-Idade , Neuroimagem , /efeitos dos fármacos
15.
BMJ Case Rep ; 13(12)2020 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-33370981

RESUMO

A 62-year-old woman presented with a 3-month history of shortness of breath on exertion and dry cough. On examination, she was noted to have fine end-inspiratory crepitations over the upper zone of the lungs. Pulmonary function tests (PFTs) showed a restrictive defect. Initial chest radiography revealed diffuse reticular interstitial shadowing while high-resolution CT scan of the thorax showed fibrotic changes. Avian precipitins were also highly positive for pigeons, parrots and budgerigars. Taking into account these results, the patient was diagnosed with hypersensitivity pneumonitis. Antigen avoidance, oral glucocorticoids and azathioprine achieved an initial improvement in PFTs and symptoms; however, the patient still deteriorated, requiring long-term oxygen therapy. While working the patient up for lung transplantation, rituximab was given to good effect (acting as a bridging therapy) as it achieved symptomatic relief and stabilisation of her PFTs.


Assuntos
Pulmão dos Criadores de Aves/tratamento farmacológico , Tosse/tratamento farmacológico , Dispneia/tratamento farmacológico , Glucocorticoides/farmacologia , Rituximab/uso terapêutico , Animais , Pulmão dos Criadores de Aves/complicações , Pulmão dos Criadores de Aves/diagnóstico , Pulmão dos Criadores de Aves/imunologia , Tosse/diagnóstico , Tosse/imunologia , Resistência a Medicamentos , Dispneia/diagnóstico , Dispneia/imunologia , Feminino , Glucocorticoides/uso terapêutico , Humanos , Pulmão/diagnóstico por imagem , Pessoa de Meia-Idade , Oxigênio/administração & dosagem , Testes de Função Respiratória , Rituximab/farmacologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
16.
Medicine (Baltimore) ; 99(44): e22991, 2020 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-33126376

RESUMO

BACKGROUND: Idiopathic pulmonary fibrosis (IPF) is a chronic progressive disease with unknown etiology and hidden onset, which causes major health problems worldwide. Cough is a typical manifestation of IPF, which is usually characterized by cough without phlegm, and seriously affects the quality of life (QOL) of patients. At present, the treatment of IPF is mainly focused on prolonging survival time and improving lung function, such as pirfenidone, nintedanib, and N-acetylcysteine (NAC), but lack of effective measures to improve the QOL. Chinese herbal medicines (CHMs) is widely used in the clinical treatment of IPF. The adjuvant treatment of CHMs can effectively reduce the clinical symptoms of patients. Therefore, we designed this study to evaluate the role of CHMs in the treatment of cough in IPF. METHOD: This systematic review and meta-analysis will extract all randomized controlled trials (RCTs) related to the treatment of IPF from the following electronic database without date or language restrictions: PubMed, EMBASE, Cochrane CENTRAL, CNKI, VIP, CBM, and Wanfang database. The primary outcomes will be cough frequency and QOL, while secondary outcomes will include safety events. The methodologic quality of RCTs will be assessed using the Cochrane risk assessment tool. The I test will be used to identify the extent of heterogeneity, and funnel plot analysis will be used to test the publication deviation (the number of studies included >10). We will use RevMan5.3 software for data synthesis and analysis. RESULT: This review evaluates the efficacy and safety of CHMs in combination therapy on cough frequency, the quality of life, adverse reactions and safety incidents in patients with IPF. CONCLUSION: This study protocol will be used to evaluate the efficacy and safety of CHMs in combination with conventional therapy in treatment of cough in IPF. OSF REGISTRATION DOI: 10.17605/OSF.IO/JKQYV.


Assuntos
Tosse/tratamento farmacológico , Medicamentos de Ervas Chinesas/uso terapêutico , Fibrose Pulmonar Idiopática/tratamento farmacológico , Tosse/etiologia , Medicamentos de Ervas Chinesas/efeitos adversos , Humanos , Fibrose Pulmonar Idiopática/complicações , Resultado do Tratamento
17.
BMC Infect Dis ; 20(1): 690, 2020 Sep 21.
Artigo em Inglês | MEDLINE | ID: mdl-32957938

RESUMO

BACKGROUND: From early 2009, the Dutch region of South Limburg experienced a massive outbreak of Q fever, overlapping with the influenza A(H1N1)pdm09 pandemic during the second half of the year and affecting approximately 2.9% of a 300,000 population. Acute Q fever shares clinical features with other respiratory conditions. Most symptomatic acute infections are characterized by mild symptoms, or an isolated febrile syndrome. Pneumonia was present in a majority of hospitalized patients during the Dutch 2007-2010 Q fever epidemic. Early empiric doxycycline, guided by signs and symptoms and patient history, should not be delayed awaiting laboratory confirmation, as it may shorten disease and prevent progression to focalized persistent Q fever. We assessed signs' and symptoms' association with acute Q fever to guide early empiric treatment in primary care patients. METHODS: In response to the outbreak, regional primary care physicians and hospital-based medical specialists tested a total of 1218 subjects for Q fever. Testing activity was bimodal, a first "wave" lasting from March to December 2009, followed by a second "wave" which lasted into 2010 and coincided with peak pandemic influenza activity. We approached all 253 notified acute Q fever cases and a random sample of 457 Q fever negative individuals for signs and symptoms of disease. Using data from 140/229(61.1%) Q fever positive and 194/391(49.6%) Q fever negative respondents from wave 1, we built symptom-based models predictive of Q-fever outcome, validated against subsets of data from wave 1 and wave 2. RESULTS: Our models had poor to moderate AUC scores (0.68 to 0.72%), with low positive (4.6-8.3%), but high negative predictive values (91.7-99.5%). Male sex, fever, and pneumonia were strong positive predictors, while cough was a strong negative predictor of acute Q fever in these models. CONCLUSION: Whereas signs and symptoms of disease do not appear to predict acute Q fever, they may help rule it out in favour of other respiratory conditions, prompting a delayed or non-prescribing approach instead of early empiric doxycycline in primary care patients with non-severe presentations. Signs and symptoms thus may help reduce the overuse of antibiotics in primary care during and following outbreaks of Q fever.


Assuntos
Antibacterianos/uso terapêutico , Febre Q/tratamento farmacológico , Febre Q/etiologia , Infecções Respiratórias/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Criança , Pré-Escolar , Tosse/tratamento farmacológico , Tosse/microbiologia , Surtos de Doenças/estatística & dados numéricos , Doxiciclina/uso terapêutico , Feminino , Febre/tratamento farmacológico , Febre/microbiologia , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Modelos Teóricos , Países Baixos/epidemiologia , Atenção Primária à Saúde , Febre Q/epidemiologia , Febre Q/microbiologia , Infecções Respiratórias/tratamento farmacológico , Infecções Respiratórias/epidemiologia , Estudos Retrospectivos , Adulto Jovem
18.
Am J Trop Med Hyg ; 103(4): 1593-1596, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32815515

RESUMO

Coinfection of SARS-CoV-2/Mycobacterium tuberculosis (MTB) in patients with HIV/AIDS has not been previously reported. Here, we present two cases of coinfection of SARS-CoV-2 and MTB in patients with HIV. The first case is a 39-year-old patient who was admitted with a 7-day history of fever, myalgia, headache, and cough. The second patient is a 43-year-old man who had a 1-month history of cough with hemoptoic sputum, evolving to mild respiratory distress in the last 7 days. Both patients already had pulmonary tuberculosis and subsequently developed SARS-CoV-2 infection during the 2020 pandemic. Nonadherence to antiretroviral treatment may have been a factor in the clinical worsening of the patients.


Assuntos
Infecções por Coronavirus/microbiologia , Tosse/microbiologia , Infecções por HIV/microbiologia , Cooperação do Paciente/psicologia , Pneumonia Viral/microbiologia , Tuberculose Pulmonar/microbiologia , Adulto , Fármacos Anti-HIV/uso terapêutico , Betacoronavirus/patogenicidade , Coinfecção , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/virologia , Tosse/tratamento farmacológico , Tosse/imunologia , Tosse/virologia , HIV/patogenicidade , Infecções por HIV/tratamento farmacológico , Infecções por HIV/imunologia , Infecções por HIV/virologia , Humanos , Masculino , Mycobacterium tuberculosis/patogenicidade , Pandemias , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/imunologia , Pneumonia Viral/virologia , /imunologia , Tomografia Computadorizada por Raios X , Tuberculose Pulmonar/tratamento farmacológico , Tuberculose Pulmonar/imunologia , Tuberculose Pulmonar/virologia
19.
PLoS One ; 15(6): e0235164, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32574206

RESUMO

Inappropriate use of antibacterials is a major public health challenge as it can promote emergence of resistance, wastage of financial resources, morbidity and mortality. In this study, we determined the prevalence and factors associated with antibacterial use in managing symptoms of acute respiratory tract infections (ARIs) in households in rural communities of Gulu district, northern Uganda. A cross-sectional study was conducted among households selected using multi-stage sampling. Data were collected through interviews with care-givers of children under five years, using a structured interviewer administered questionnaire. Out of the 856 children who had symptoms of ARIs, 515 (60.2%; CI: 54.5%-65.6%) were treated with antibacterials. The most commonly used antibacterials were amoxicillin (55.2%, n = 358), cotrimoxazole (15.4%, n = 100) and metronidazole (11.4%, n = 74). The determinants of antibacterial use included; getting treatment from a health facility (AOR: 1.85, CI: 1.34-2.56, P < 0.001), households located in peri-urban area (AOR: 2.54, CI: 1.34-4.84, P = 0.005), and a child having cough (AOR: 7.02, CI: 4.36-11.31, P < 0.001). The prevalence of antibacterial use among children under five years with symptoms of ARIs is high in communities of Gulu district, northern Uganda. Getting treatment from a health facility, if a household was located in a peri-urban area and having a cough are positive predictors of antibacterial use. There is need for targeted education on appropriate antibacterial use in rural communities and hospital settings where over prescription is most likely especially in treating symptoms of ARIs among children under five years.


Assuntos
Antibacterianos/uso terapêutico , Infecções Respiratórias/tratamento farmacológico , Serviços de Saúde Rural/estatística & dados numéricos , População Rural/estatística & dados numéricos , Amoxicilina/uso terapêutico , Pré-Escolar , Tosse/complicações , Tosse/diagnóstico , Tosse/tratamento farmacológico , Estudos Transversais , Feminino , Inquéritos Epidemiológicos/métodos , Inquéritos Epidemiológicos/estatística & dados numéricos , Humanos , Lactente , Modelos Logísticos , Masculino , Metronidazol/uso terapêutico , Análise Multivariada , Prevalência , Infecções Respiratórias/complicações , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/epidemiologia , Fatores de Risco , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Uganda/epidemiologia
20.
Ter Arkh ; 92(3): 98-101, 2020 Apr 27.
Artigo em Russo | MEDLINE | ID: mdl-32598800

RESUMO

Cough variant asthma (CVA) was first described by W. Corrao. CVA was described as the isolated chronic cough as the only presenting symptom responsive to bronchodilator therapy.This phenotype of asthma is present with airway hyperresponsiveness, eosinophilic inflammation airways and bronchodilator responsive coughing without typical manifestation of asthma such as wheezing or dyspnea. CVA shares common features with classic asthma such as eosinophilic inflammation and airway remodeling. Because of that, CVA is clinically considered as a variant type of asthma.


Assuntos
Asma , Hiper-Reatividade Brônquica , Broncodilatadores/uso terapêutico , Tosse/tratamento farmacológico , Humanos , Sons Respiratórios
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