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2.
J Affect Disord ; 277: 772-778, 2020 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-33065816

RESUMO

BACKGROUND: The wearing of respiratory protective devices (RPDs) correctly and continually in situations where people are at risk of respiratory infections is crucial for infection prevention. Certain people are poorly compliant with RPDs due to RPD-related annoyance, including respiratory discomfort. We hypothesized that individuals vulnerable to panic attacks are included in this group. No published studies on this topic are available. The evidence for our hypothesis was reviewed in this study as a starting point for future research. METHODS: We selected a set of experimental studies that measured the respiratory physiological burden in RPD wearers through objective and validated methods. We conducted a bibliographic search of publications in the PubMed database (January 2000-May 2020) to identify representative studies that may be of interest for panic respiratory pathophysiology. RESULTS: Five studies were included. Wearing RPDs exerted significant respiratory effects, including increased breathing resistance, CO2 rebreathing due to CO2 accumulation in the RPD cavity, and decreased inhaled O2 concentration. We discussed the implications of these effects on the respiratory pathophysiology of panic. LIMITATIONS: Most studies had a small sample size, with a preponderance of young participants. Different methodologies were used across the studies. Furthermore, differences in physical responses between wearing RPDs in experimental settings or daily life cannot be excluded. CONCLUSIONS: This research supports the idea that panic-prone individuals may be at higher risk of respiratory discomfort when wearing RPDs, thereby reducing their tolerance for these devices. Strategies to decrease discomfort should be identified to overcome the risk of poor compliance.


Assuntos
Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Transtorno de Pânico/fisiopatologia , Pneumonia Viral/prevenção & controle , Transtornos Respiratórios/fisiopatologia , Respiração , Dispositivos de Proteção Respiratória/efeitos adversos , Resistência das Vias Respiratórias , Betacoronavirus , Dióxido de Carbono/metabolismo , Humanos , Oxigênio/metabolismo , Transtorno de Pânico/metabolismo , Transtorno de Pânico/psicologia , Transtornos Respiratórios/etiologia , Transtornos Respiratórios/metabolismo , Transtornos Respiratórios/psicologia , Rinomanometria , Espirometria
3.
Neurol Sci ; 41(12): 3419-3421, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33068195

RESUMO

BACKGROUND: The outbreak of the coronavirus disease 2019 (COVID-19) has had profound impact on health care not only for its direct effects, but also because it deeply influenced the whole clinical practice and diagnostic pathways, particularly in the acute setting. CASE REPORT: We present the case of a patient with respiratory dysfunction due to myasthenia gravis (MG) initially misdiagnosed as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection due to ambiguity in the interpretation of radiological and microbiological findings during COVID-19 pandemic. DISCUSSION: Respiratory dysfunction as first clinical manifestation of myasthenia gravis is rare, but potentially very harmful. Emergency physicians should always consider neurological diseases when dyspnea cannot be explained by cardiac or respiratory causes.


Assuntos
Infecções por Coronavirus , Erros de Diagnóstico , Miastenia Gravis/complicações , Miastenia Gravis/diagnóstico , Pandemias , Pneumonia Viral , Transtornos Respiratórios/etiologia , Betacoronavirus , Humanos , Hipertensão/complicações , Masculino , Pessoa de Meia-Idade , Fumar
4.
Br J Sports Med ; 54(19): 1157-1161, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32878870

RESUMO

SARS-CoV-2 is the causative virus responsible for the COVID-19 pandemic. This pandemic has necessitated that all professional and elite sport is either suspended, postponed or cancelled altogether to minimise the risk of viral spread. As infection rates drop and quarantine restrictions are lifted, the question how athletes can safely resume competitive sport is being asked. Given the rapidly evolving knowledge base about the virus and changing governmental and public health recommendations, a precise answer to this question is fraught with complexity and nuance. Without robust data to inform policy, return-to-play (RTP) decisions are especially difficult for elite athletes on the suspicion that the COVID-19 virus could result in significant cardiorespiratory compromise in a minority of afflicted athletes. There are now consistent reports of athletes reporting persistent and residual symptoms many weeks to months after initial COVID-19 infection. These symptoms include cough, tachycardia and extreme fatigue. To support safe RTP, we provide sport and exercise medicine physicians with practical recommendations on how to exclude cardiorespiratory complications of COVID-19 in elite athletes who place high demand on their cardiorespiratory system. As new evidence emerges, guidance for a safe RTP should be updated.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Miocardite/diagnóstico , Pneumonia Viral/complicações , Guias de Prática Clínica como Assunto , Transtornos Respiratórios/diagnóstico , Volta ao Esporte/normas , Atletas , Biomarcadores/sangue , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Morte Súbita Cardíaca/prevenção & controle , Eletrocardiografia , Humanos , Miocardite/sangue , Miocardite/etiologia , Miocárdio/patologia , Necrose/etiologia , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Transtornos Respiratórios/etiologia , Medicina Esportiva/normas , Avaliação de Sintomas , Troponina/sangue
5.
Top Spinal Cord Inj Rehabil ; 26(2): 116-122, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32760190

RESUMO

Respiratory complications following spinal cord injury (SCI) have remained the leading cause of death across the lifespan and are one of the most common reasons for hospitalization. Complications from altered respiratory physiology after SCI include atelectasis, pneumonia, venous thromboembolic disease, and sleep-disordered breathing. The risk for complications is greater with higher SCI levels and severity, and mortality from pneumonia is heightened compared to the general population. Optimal primary care for individuals with SCI includes appropriate surveillance for SCI-specific respiratory disease, key preventive care including promotion of influenza immunization and respiratory muscle training, and early identification and treatment of pneumonia with institution of aggressive secretion management strategies. The respiratory physiology and specific management of respiratory complications after SCI is reviewed.


Assuntos
Atenção Primária à Saúde , Transtornos Respiratórios/etiologia , Transtornos Respiratórios/terapia , Traumatismos da Medula Espinal/complicações , Humanos
6.
Mayo Clin Proc ; 95(10): 2144-2149, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32807522

RESUMO

OBJECTIVE: To characterize the cardiorespiratory abnormalities in patients with necrotizing autoimmune myopathy (NAM). PATIENTS AND METHODS: Cardiopulmonary features of patients with NAM evaluated in our neuromuscular clinic (January 1, 2004, to September 20, 2018) were reviewed retrospectively with respect to autoantibody status and history of cardiac disease. Clinical characteristics and laboratory findings were compared among patient subgroups. RESULTS: We identified 109 patients with NAM: 36 anti-3-hydroxy-3-methylglutaryl coenzyme A reductase autoantibody (anti-HMGCR Ab)-positive, 18 anti-signal recognition particle antibody (anti-SRP Ab)-positive (3 dual anti-HMGCR/anti-SRP Ab-positive), and 58 seronegative. Median age at diagnosis was 60 years (range, 18-86 years). Forty-three patients had dyspnea at presentation and 32 patients had preexisting risk for cardiac disease (10 coronary artery disease and 28 hypertension). The electrocardiogram was abnormal in 55 of 86 patients (33 without cardiac risk factors), including prolonged corrected QT interval (QTc) (n=31), conduction blocks (n=19), and atrial or ventricular ectopic beats (n=10). Echocardiography was abnormal in 34 of 72 patients, including 19 of 45 without preexisting cardiac disease risks. Echocardiographic abnormalities included left ventricular diastolic dysfunction (n=31) and systolic dysfunction (n=8). The left ventricular diastolic dysfunction improved in 4 of 11 patients after treatment. Pulmonary function testing showed changes suggestive of neuromuscular respiratory muscle weakness in 51 of 66 patients and reduced carbon monoxide diffusing capacity in 11 of 35 patients. However, only 6 patients had radiographic evidence of interstitial lung disease (2 anti-HMGCR Ab-positive and 4 seronegative). Overnight oximetry revealed desaturations in 24 of 38 patients. Six patients required mechanical ventilation and 7 required noninvasive ventilatory support. CONCLUSION: Most patients with NAM exhibited cardiac and respiratory muscle dysfunction. Immunotherapy can improve echocardiographic abnormalities. Interstitial lung disease was rarely identified. Formal evaluation of cardiac and respiratory status should be integral in assessment of patients with NAM.


Assuntos
Doenças Autoimunes/complicações , Cardiopatias/etiologia , Músculo Esquelético/patologia , Doenças Musculares/complicações , Doenças Musculares/imunologia , Transtornos Respiratórios/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Autoimunes/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Musculares/patologia , Necrose , Estudos Retrospectivos , Adulto Jovem
7.
Respir Med Res ; 78: 100768, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32707480

RESUMO

With first cases noted towards the end of 2019 in China, COVID-19 infection was rapidly become a devastating pandemic. Even if most patients present with a mild to moderate form of the disease, the estimated prevalence of COVID-19-related severe acute respiratory failure (ARF) is 15-20% and 2-12% needed intubation and mechanical ventilation. In addition to mechanical ventilation some other techniques of respiratory support could be used in some forms of COVID-19 related ARF. This position paper of the Respiratory Support and Chronic Care Group of the French Society of Respiratory Diseases is intended to help respiratory clinicians involved in care of COVID-19 pandemic in the rational use of non-invasive techniques such as oxygen therapy, CPAP, non-invasive ventilation and high flow oxygen therapy in managing patients outside intensive care unit (ICU). The aims are: (1) to focus both on the place of each technique and in describing practical tips (types of devices and circuit assemblies) aimed to limit the risk of caregivers when using those techniques at high risk spreading of viral particles; (2) to propose a step-by-step strategy to manage ARF outside ICU.


Assuntos
/epidemiologia , Serviços Médicos de Emergência/normas , Oxigenoterapia/normas , Pneumologia/normas , Transtornos Respiratórios/terapia , Doença Aguda , /patologia , Doença Crônica , Pressão Positiva Contínua nas Vias Aéreas/métodos , Pressão Positiva Contínua nas Vias Aéreas/normas , Cuidados Críticos/métodos , Cuidados Críticos/normas , Serviços Médicos de Emergência/métodos , França/epidemiologia , Humanos , Unidades de Terapia Intensiva/normas , Nebulizadores e Vaporizadores/normas , Oxigenoterapia/métodos , Pandemias , Pneumologia/métodos , Pneumologia/organização & administração , Transtornos Respiratórios/epidemiologia , Transtornos Respiratórios/etiologia , Transtornos Respiratórios/patologia , Respiração Artificial/métodos , Respiração Artificial/normas , /etiologia , /terapia , Índice de Gravidade de Doença , Sociedades Médicas/normas
8.
Ageing Res Rev ; 62: 101124, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32683040

RESUMO

BACKGROUND: Influenza vaccination is a simple strategy recommended for the prevention of influenza infection and its complications. This meta-analysis aimed to provide current supportive evidence for the breadth and validity of the observed protective effects of influenza vaccination on cardiovascular and respiratory adverse outcomes and all-cause mortality in older adults and in general adult population. METHODS: We searched PubMed, Embase, Web of Science, and the Cochrane Library to identify all published studies comparing influenza vaccination with placebo from the database inception to November 11, 2018. These included studies reporting the associations of influenza vaccination with the risk of aforementioned adverse outcomes. RESULTS: The pooled adjusted relative risks among influenza-vaccinated people relative to unvaccinated people for the outcomes of interest were 0.74 (95 % confidence interval [CI] = 0.70-0.78) for cardiovascular diseases (63 studies), 0.82 (95 % CI = 0.75-0.91) for respiratory diseases (29 studies), and 0.57 (95 % CI = 0.51-0.63) for all-cause mortality (43 studies). We performed subgroup analysis of age, sex, and region/country and found that these protective effects were evident in the general adult population and particularly robust in older adults and in those with pre-existing specific diseases. CONCLUSION: Influenza vaccine is associated with a significant risk reduction of cardiovascular and respiratory adverse outcomes as well as all-cause mortality. Such a preventative measure can benefit the general population as well as those in old age and with pre-existing specific diseases.


Assuntos
Doenças Cardiovasculares/etiologia , Vacinas contra Influenza/efeitos adversos , Influenza Humana , Transtornos Respiratórios/etiologia , Hepatite B Crônica , Humanos , Influenza Humana/prevenção & controle , Intervenção Coronária Percutânea , Vacinação
10.
Pediatrics ; 146(2)2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32680879

RESUMO

OBJECTIVES: Cardiorespiratory and pulse oximetry monitoring in children who are hospitalized should balance benefits of detecting deterioration with potential harms of alarm fatigue. We developed recommendations for monitoring outside the ICU on the basis of available evidence and expert opinion. METHODS: We conducted a comprehensive literature search for studies addressing the utility of cardiorespiratory and pulse oximetry monitoring in common pediatric conditions and drafted candidate monitoring recommendations based on our findings. We convened a panel of nominees from national professional organizations with diverse expertise: nursing, medicine, respiratory therapy, biomedical engineering, and family advocacy. Using the RAND/University of California, Los Angeles Appropriateness Method, panelists rated recommendations for appropriateness and necessity in 3 sequential rating sessions and a moderated meeting. RESULTS: The panel evaluated 56 recommendations for intermittent and continuous monitoring for children hospitalized outside the ICU with 7 common conditions (eg, asthma, croup) and/or receiving common therapies (eg, supplemental oxygen, intravenous opioids). The panel reached agreement on the appropriateness of monitoring recommendations for 55 of 56 indications and on necessity of monitoring for 52. For mild or moderate asthma, croup, pneumonia, and bronchiolitis, the panel recommended intermittent vital sign or oximetry measurement only. The panel recommended continuous monitoring for severe disease in each respiratory condition as well as for a new or increased dose of intravenous opiate or benzodiazepine. CONCLUSIONS: Expert panel members agreed that intermittent vital sign assessment, rather than continuous monitoring, is appropriate management for a set of specific conditions of mild or moderate severity that require hospitalization.


Assuntos
Eletrocardiografia , Monitorização Fisiológica/métodos , Oximetria , Guias de Prática Clínica como Assunto , Transtornos Respiratórios/fisiopatologia , Testes de Função Respiratória , Analgésicos Opioides/efeitos adversos , Analgésicos Opioides/farmacologia , Benzodiazepinas/efeitos adversos , Benzodiazepinas/farmacologia , Criança , Criança Hospitalizada , Técnica Delfos , Relação Dose-Resposta a Droga , Humanos , Oxigenoterapia , Respiração/efeitos dos fármacos , Transtornos Respiratórios/etiologia , Sepse/fisiopatologia
11.
Surg Today ; 50(11): 1452-1460, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32488477

RESUMO

PURPOSE: The best surgical approach for second primary lung cancer remains a subject of debate. The purpose of this study was to review the postoperative complications after second surgery for second primary lung cancer and to investigate the outcomes based on these complications. METHODS: The clinical data of 105 consecutive patients who underwent pulmonary resection for multiple primary lung cancers between January, 1996 and December, 2017, were reviewed according to the Martini-Melamed criteria. RESULTS: After the second surgery, low body mass index (BMI) (< 18.5 kg/m2) (P = 0.004) and high Charlson comorbidity index (CCI) (P = 0.002) were independent predictors of postoperative complications. Survival analysis revealed the 5-year overall survival rates of 74.5% and 61.4% for patients without postoperative complications and those with postoperative complications (P = 0.044), respectively, but the 5-year cancer-specific survival rates of 82.5% and 80.0% (P = 0.926), respectively. During this period, there were significantly more respiratory-related deaths of patients with complications than of those without complications (P = 0.011). CONCLUSION: Surgical intervention is feasible and potentially effective for second primary lung cancer but may not achieve positive perioperative and long-term outcomes for patients with a low BMI or a high CCI. Treatment options should be considered carefully for these patients.


Assuntos
Neoplasias Pulmonares/cirurgia , Neoplasias Primárias Múltiplas/cirurgia , Segunda Neoplasia Primária/cirurgia , Pneumonectomia/métodos , Complicações Pós-Operatórias , Idoso , Índice de Massa Corporal , Causas de Morte , Comorbidade , Feminino , Humanos , Neoplasias Pulmonares/epidemiologia , Neoplasias Pulmonares/mortalidade , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Reoperação , Transtornos Respiratórios/epidemiologia , Transtornos Respiratórios/etiologia , Taxa de Sobrevida , Resultado do Tratamento
13.
Respiration ; 99(6): 521-542, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32564028

RESUMO

Against the background of the pandemic caused by infection with the SARS-CoV-2 virus, the German Respiratory Society has appointed experts to develop therapy strategies for COVID-19 patients with acute respiratory failure (ARF). Here we present key position statements including observations about the pathophysiology of (ARF). In terms of the pathophysiology of pulmonary infection with SARS-CoV-2, COVID-19 can be divided into 3 phases. Pulmonary damage in advanced COVID-19 often differs from the known changes in acute respiratory distress syndrome (ARDS). Two types (type L and type H) are differentiated, corresponding to early- and late-stage lung damage. This differentiation should be taken into consideration in the respiratory support of ARF. The assessment of the extent of ARF should be based on arterial or capillary blood gas analysis under room air conditions, and it needs to include the calculation of oxygen supply (measured from the variables of oxygen saturation, hemoglobin level, the corrected values of Hüfner's factor, and cardiac output). Aerosols can cause transmission of infectious, virus-laden particles. Open systems or vented systems can increase the release of respirable particles. Procedures in which the invasive ventilation system must be opened and endotracheal intubation carried out are associated with an increased risk of infection. Personal protective equipment (PPE) should have top priority because fear of contagion should not be a primary reason for intubation. Based on the current knowledge, inhalation therapy, nasal high-flow therapy (NHF), continuous positive airway pressure (CPAP), or noninvasive ventilation (NIV) can be performed without an increased risk of infection to staff if PPE is provided. A significant proportion of patients with ARF present with relevant hypoxemia, which often cannot be fully corrected, even with a high inspired oxygen fraction (FiO2) under NHF. In this situation, the oxygen therapy can be escalated to CPAP or NIV when the criteria for endotracheal intubation are not met. In ARF, NIV should be carried out in an intensive care unit or a comparable setting by experienced staff. Under CPAP/NIV, a patient can deteriorate rapidly. For this reason, continuous monitoring and readiness for intubation are to be ensured at all times. If the ARF progresses under CPAP/NIV, intubation should be implemented without delay in patients who do not have a "do not intubate" order.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Transtornos Respiratórios/terapia , Respiração Artificial , Doença Aguda , Progressão da Doença , Alemanha , Humanos , Hipóxia/etiologia , Pandemias , Gravidade do Paciente , Pneumonia Viral/etiologia , Pneumonia Viral/terapia , Transtornos Respiratórios/etiologia , /terapia , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/fisiopatologia , Insuficiência Respiratória/terapia
16.
J Pediatr ; 222: 85-90.e2, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32417083

RESUMO

OBJECTIVE: To evaluate the impact of exposure to indoor air pollution on respiratory health outcomes (healthcare utilization, symptoms, medication use) in infants and children with bronchopulmonary dysplasia (BPD). STUDY DESIGN: A total of 244 subjects were included from the Johns Hopkins Bronchopulmonary Dysplasia registry. Parents completed an environmental exposure questionnaire including secondhand smoke and indoor combustion (gas/propane heat, gas or wood stove, gas/wood burning fireplace) exposures in the home. Respiratory symptoms, both acute (healthcare utilization, steroid/antibiotic use) and chronic (cough/wheeze, nocturnal cough, use of beta-agonists, tolerance of physical activity), were also collected. RESULTS: Three-quarters of the infants were exposed to at least 1 combustible source of air pollution in the home, and this exposure was associated with an increased risk of hospitalization in infants and children on home respiratory support. Only 14% of the study population reported secondhand smoke exposure, but we found that this was associated with chronic respiratory symptoms, including activity limitation and nocturnal cough. Infants on respiratory support also had increased daytime cough and wheezing. Approximately one-third reported having an air purifier in the home, and its presence attenuated the effect of secondhand smoke exposure on reported activity limitation. CONCLUSIONS: Exposure to combustible sources of indoor air pollution was associated with increased respiratory morbidity in a group of high risk of infants with BPD. Our results support that indoor air pollution is a modifiable risk factor for respiratory health in infants with BPD.


Assuntos
Poluição do Ar em Ambientes Fechados/efeitos adversos , Displasia Broncopulmonar/complicações , Tosse/etiologia , Transtornos Respiratórios/etiologia , Sons Respiratórios/etiologia , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino
17.
J Trauma Acute Care Surg ; 89(2): 411-418, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32282759

RESUMO

BACKGROUND: In recent years, there has been a growing interest in operative treatment for multiple rib fractures and flail chest. However, to date, there is no comprehensive study that extensively focused on the incidence of complications associated with rib fracture fixation. Furthermore, there is insufficient knowledge about the short- and long-term outcomes after rib fracture fixation. METHODS: This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. The MEDLINE, EMBASE, and Cochrane databases were searched to identify studies reporting on complications and/or outcome of surgical treatment after rib fractures. Complications were subdivided into (1) surgery- and implant-related complications, (2) bone-healing complications, (3) pulmonary complications, and (4) mortality. RESULTS: Forty-eight studies were included, with information about 1,952 patients who received rib fracture fixation because of flail chest or multiple rib fractures. The overall risk of surgery- and implant-related complications was 10.3%, with wound infection in 2.2% and fracture-related infection in 1.3% of patients. Symptomatic nonunion was a relatively uncommon complication after rib fixation (1.3%). Pulmonary complications were found in 30.9% of patients, and the overall mortality was 2.9%, of which one third appeared to be the result of the thoracic injuries and none directly related to the surgical procedure. The most frequently used questionnaire to assess patient quality of life was the EuroQol-5D (EQ-5D) (n = 4). Four studies reporting on the EQ-5D had a weighted mean EQ-5D index of 0.80 indicating good quality of life after rib fracture fixation. CONCLUSION: Surgical fixation can be considered as a safe procedure with a considerably low complication risk and satisfactory long-term outcomes, with surgery- and implant-related complications in approximately 10% of the patients. However, the clinically most relevant complications such as infections occur infrequently, and the number of complications requiring immediate (surgical) treatment is low. LEVEL OF EVIDENCE: Systematic Review, level III.


Assuntos
Fixação Interna de Fraturas/efeitos adversos , Complicações Pós-Operatórias , Fraturas das Costelas/cirurgia , Tórax Fundido/cirurgia , Fixação Interna de Fraturas/instrumentação , Consolidação da Fratura , Fraturas Múltiplas/cirurgia , Fraturas não Consolidadas , Humanos , Fixadores Internos , Qualidade de Vida , Transtornos Respiratórios/etiologia , Doenças Respiratórias/etiologia , Infecção da Ferida Cirúrgica
18.
ScientificWorldJournal ; 2020: 8458359, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32308570

RESUMO

Objective: To relate the levels of air pollution and hospital admissions for cardiovascular and respiratory diseases in the city of Manaus in Brazil from 2008 to 2012. Method: This is an ecological time-series study among children (under 5 years of age) and elderly (above 60 years of age). Data on the daily number of hospitalizations for cardiovascular and respiratory diseases, pollutants (PM2.5), temperature, and humidity were used. Poisson generalized additive models were used to estimate the association between variables. Increases in hospitalizations for cardiovascular and respiratory diseases were estimated for the interquartile range (IQR) daily mean level of each variable studied, with a confidence interval of 95%. Results: Respiratory diseases and children: -0.40% (95% CI: -1.11, 0.30), 0.59% (95% CI: -0.35, 1.52), and 0.47% (95% CI: -3.28, 4.21) for PM2.5, temperature, and humidity, respectively. Respiratory diseases and elderly: 0.19% (95% CI: -0.93, 1.31), -0.10% (95% CI: -1.85, 1.65), and -6.17% (95% CI: -13.08, 0.74) for PM2.5, temperature, and humidity, respectively. Cardiovascular diseases and elderly: -0.18% (95% CI: -0.86, 0.50), -0.04% (95% CI: -1.10, 1.03), and -3.37% (95% CI: -7.59, 0.85) for PM2.5, temperature, and humidity, respectively. Conclusions: The time-series study found no significant association between PM2.5, temperature, humidity, and hospitalization, unlike the evidences provided by the present academic literature. Since there is no air quality monitoring network in Manaus and the option available in the present study was to reproduce some information obtained from remote sensing, there is a need for implementation of ground monitoring stations for health and environmental studies in the region.


Assuntos
Poluição do Ar/efeitos adversos , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Hospitalização/estatística & dados numéricos , Transtornos Respiratórios/epidemiologia , Transtornos Respiratórios/etiologia , Fatores Etários , Idoso , Poluentes Atmosféricos/efeitos adversos , Algoritmos , Brasil/epidemiologia , Doenças Cardiovasculares/história , Pré-Escolar , Feminino , História do Século XXI , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Modelos Teóricos , Material Particulado/efeitos adversos , Vigilância da População , Transtornos Respiratórios/história , Fatores de Risco
19.
Nat Microbiol ; 5(7): 955-965, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32341480

RESUMO

Monkeypox is a viral zoonotic disease on the rise across endemic habitats. Despite the growing importance of monkeypox virus, our knowledge on its host spectrum and sylvatic maintenance is limited. Here, we describe the recent repeated emergence of monkeypox virus in a wild, human-habituated western chimpanzee (Pan troglodytes verus, hereafter chimpanzee) population from Taï National Park, Ivory Coast. Through daily monitoring, we show that further to causing its typical exanthematous syndrome, monkeypox can present itself as a severe respiratory disease without a diffuse rash. By analysing 949 non-invasively collected samples, we identify the circulation of at least two distinct monkeypox virus lineages and document the shedding of infectious particles in faeces and flies, suggesting that they could mediate indirect transmission. We also show that the carnivorous component of the Taï chimpanzees' diet, mainly consisting of the sympatric monkeys they regularly hunt, did not change nor shift towards rodent consumption (the presumed reservoir) before the outbreaks, suggesting that the sudden emergence of monkeypox virus in this population is probably due to changes in the ecology of the virus itself. Using long-term mortality surveillance data from Taï National Park, we provide evidence of little to no prior viral activity over at least two decades. We conclude that great ape sentinel systems devoted to the longitudinal collection of behavioural and health data can help clarify the epidemiology and clinical presentation of zoonotic pathogens.


Assuntos
Animais Selvagens , Vírus da Varíola dos Macacos/fisiologia , Monkeypox/virologia , Pan troglodytes/virologia , Animais , Ecossistema , Exantema/etiologia , Exantema/metabolismo , Exantema/patologia , Espaço Extracelular/metabolismo , Fezes/virologia , Genoma Viral , Genômica/métodos , Glutationa/metabolismo , Sequenciamento de Nucleotídeos em Larga Escala , Monkeypox/complicações , Monkeypox/metabolismo , Monkeypox/mortalidade , Vírus da Varíola dos Macacos/classificação , Vírus da Varíola dos Macacos/isolamento & purificação , Pan troglodytes/metabolismo , Filogenia , Transtornos Respiratórios/etiologia , Transtornos Respiratórios/metabolismo
20.
Br J Anaesth ; 125(1): e130-e139, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32223967

RESUMO

BACKGROUND: High ventilatory frequencies increase static lung strain and possibly lung stress by shortening expiratory time, increasing intrathoracic pressure, and causing dynamic hyperinflation. We hypothesised that high intraoperative ventilatory frequencies were associated with postoperative respiratory complications. METHODS: In this retrospective hospital registry study, we analysed data from adult non-cardiothoracic surgical cases performed under general anaesthesia with mechanical ventilation at a single centre between 2005 and 2017. We assessed the association between intraoperative ventilatory frequency (categorised into four groups) and postoperative respiratory complications, defined as composite of invasive mechanical ventilation within 7 days after surgery or peripheral oxygen desaturation after extubation, using multivariable logistic regression. In a subgroup, we adjusted analyses for arterial blood gas parameters. RESULTS: A total of 102 632 cases were analysed. Intraoperative ventilatory frequencies ranged from a median (inter-quartile range [IQR]) of 8 (8-9) breaths min-1 (Group 1) to 15 (14-18) breaths min-1 (Group 4). High ventilatory frequencies were associated with higher odds of postoperative respiratory complications (adjusted odds ratio=1.26; 95% confidence interval, 1.14-1.38; P<0.001), which was confirmed in a subgroup after adjusting for arterial partial pressure of carbon dioxide and the ratio of arterial oxygen partial pressure to fractional inspired oxygen. We identified considerable variability in the use of high ventilatory frequencies attributable to individual provider preference (ranging from 22% to 88%) and temporal change; however, the association with postoperative respiratory complications remained unaffected. CONCLUSIONS: High intraoperative ventilatory frequency was associated with increased risk of postoperative respiratory complications, and increased postoperative healthcare utilisation.


Assuntos
Cuidados Intraoperatórios/efeitos adversos , Cuidados Intraoperatórios/métodos , Complicações Pós-Operatórias/fisiopatologia , Transtornos Respiratórios/fisiopatologia , Respiração Artificial/efeitos adversos , Respiração Artificial/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hospitais , Humanos , Masculino , Massachusetts/epidemiologia , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Sistema de Registros , Transtornos Respiratórios/etiologia , Estudos Retrospectivos , Volume de Ventilação Pulmonar , Tempo , Adulto Jovem
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