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1.
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.
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
4.
Allergol. immunopatol ; 48(3): 270-280, mayo-jun. 2020. tab, graf
Artigo em Inglês | IBECS | ID: ibc-192030

RESUMO

INTRODUCTION: The first thousand days of life are a critical stage for the development of respiratory and immune systems. Many events in this period may be associated with wheezing in childhood. OBJECTIVE: This study aimed to investigate the association between early life determinants and wheezing in children aged 6-7 years. MATERIALS AND METHODS: Population-based case-control study using early-life related questions. We used the International Study of Asthma and Allergies in Childhood questionnaire to assess wheezing symptoms. Multiple logistic regressions were performed according to a hierarchical framework, considering the complex dynamic of wheezing/asthma and potential interaction between different levels of determination. RESULTS: A total of 820 children were included, from which 162 reported wheezing symptoms (19.7%). Multivariable analysis identified socioeconomic conditions (OR 2.08, 95% CI 1.08-4.00), family history of asthma (OR 2.28, 95% CI 1.37-3.75), vaginal discharge that required treatment during pregnancy (OR 1.68, 95% CI 1.00-2.83), neonatal hyperbilirubinemia (OR 2.00, 95% CI 1.17-3.42), anemia and intestinal parasitosis in the first two years (OR 2.28, 95% CI 1.22-4.25; OR 1.72, 95% CI 1.02-2.92, respectively) independently associated to wheezing at 6-7 years. Intended pregnancy was associated with reduced wheezing (OR 0.47, 95% CI 0.28-0.77). CONCLUSIONS: Several factors were associated with wheezing in childhood. Considering that intended pregnancy reduced wheezing and other associated exposures are considered modifiable, these findings may guide the planning of strategies to decrease the susceptibility to asthma symptoms in childhood


No disponible


Assuntos
Humanos , Masculino , Feminino , Criança , Sons Respiratórios/fisiopatologia , Doenças Respiratórias/epidemiologia , Transtornos Respiratórios/fisiopatologia , Inquéritos e Questionários , Asma/fisiopatologia , Modelos Logísticos , Análise Multivariada
5.
Nature ; 585(7824): 268-272, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32396922

RESUMO

An outbreak of coronavirus disease 2019 (COVID-19), which is caused by a novel coronavirus (named SARS-CoV-2) and has a case fatality rate of approximately 2%, started in Wuhan (China) in December 20191,2. Following an unprecedented global spread3, the World Health Organization declared COVID-19 a pandemic on 11 March 2020. Although data on COVID-19 in humans are emerging at a steady pace, some aspects of the pathogenesis of SARS-CoV-2 can be studied in detail only in animal models, in which repeated sampling and tissue collection is possible. Here we show that SARS-CoV-2 causes a respiratory disease in rhesus macaques that lasts between 8 and 16 days. Pulmonary infiltrates, which are a hallmark of COVID-19 in humans, were visible in lung radiographs. We detected high viral loads in swabs from the nose and throat of all of the macaques, as well as in bronchoalveolar lavages; in one macaque, we observed prolonged rectal shedding. Together, the rhesus macaque recapitulates the moderate disease that has been observed in the majority of human cases of COVID-19. The establishment of the rhesus macaque as a model of COVID-19 will increase our understanding of the pathogenesis of this disease, and aid in the development and testing of medical countermeasures.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/patologia , Infecções por Coronavirus/fisiopatologia , Modelos Animais de Doenças , Pulmão/diagnóstico por imagem , Pneumonia Viral/patologia , Pneumonia Viral/fisiopatologia , Transtornos Respiratórios/patologia , Transtornos Respiratórios/virologia , Animais , Líquidos Corporais/virologia , Lavagem Broncoalveolar , Infecções por Coronavirus/complicações , Infecções por Coronavirus/virologia , Tosse/complicações , Feminino , Febre/complicações , Pulmão/patologia , Pulmão/fisiopatologia , Pulmão/virologia , Macaca mulatta , Masculino , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/virologia , Radiografia , Transtornos Respiratórios/complicações , Transtornos Respiratórios/fisiopatologia , Fatores de Tempo , Carga Viral
6.
Respir Med ; 168: 105990, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32364960

RESUMO

BACKGROUND AND AIM: Vocal Cord Dysfunction (VCD) and chronic cough (CC) are challenging conditions which lead to significant quality of life impairment. The underlying mechanisms are poorly understood, but laryngeal dysfunction may be common to both conditions. The aim of this study was to determine the characteristics of cough in VCD and whether patients with cough have coexisting VCD. METHOD: Participants included 51 patients with VCD and a comparison group of 39 patients with chronic cough that was refractory to medical treatment. Participants underwent a comprehensive assessment including questionnaires, laryngoscopy, cough frequency monitoring and voice testing. RESULTS: Patients with VCD had significant cough morbidity with an increased cough frequency of 17.3 coughs/hour and reduced cough quality of life with mean Leicester Cough Questionnaire Score of 12.8. Breathing pattern abnormalities were also common in VCD and there was a strong correlation between the number of breathing pattern abnormalities and cough frequency (r = -0.827, p = 0.002). Cough measures were not significantly different between patients with VCD and those with CC. Moderate-severe PVFM was present in 69% of patients with CC. Abnormal vocal fold closure during phonation was also present in patients with chronic cough and was similar between the VCD (n = 40, 78.4%) and cough (n = 25, 64.1%) groups, p = 0.240. CONCLUSION: Cough is an important symptom in VCD. Patients presenting with chronic cough may have underlying VCD as a cause of their cough. Since cough and VCD symptoms co-occur clinicians need to consider cough when are treating VCD and VCD when treating chronic cough.


Assuntos
Tosse/diagnóstico , Doenças da Laringe/complicações , Disfunção da Prega Vocal/diagnóstico , Adulto , Idoso , Doença Crônica , Tosse/etiologia , Feminino , Humanos , Laringoscopia , Masculino , Pessoa de Meia-Idade , Morbidade , Fonação , Respiração , Transtornos Respiratórios/complicações , Transtornos Respiratórios/fisiopatologia , Inquéritos e Questionários , Disfunção da Prega Vocal/etiologia , Prega Vocal/fisiopatologia
8.
ACS Chem Neurosci ; 11(10): 1379-1381, 2020 05 20.
Artigo em Inglês | MEDLINE | ID: mdl-32348111

RESUMO

Following the identification of severe acute respiratory syndrome coronavirus (SARS-CoV) in 2002 and Middle East respiratory syndrome coronavirus (MERS-CoV) in 2012, we are now again facing a global highly pathogenic novel coronavirus (SARS-CoV-2) epidemic. Although the lungs are one of the most critically affected organs, several other organs, including the brain may also get infected. Here, we have highlighted that SARS-CoV-2 might infect the central nervous system (CNS) through the olfactory bulb. From the olfactory bulb, SARS-CoV-2 may target the deeper parts of the brain including the thalamus and brainstem by trans-synaptic transfer described for many other viral diseases. Following this, the virus might infect the respiratory center of brain, which could be accountable for the respiratory breakdown of COVID-19 patients. Therefore, it is important to screen the COVID-19 patients for neurological symptoms as well as possibility of the collapse of the respiratory center in the brainstem should be investigated in depth.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/virologia , Pneumonia Viral/fisiopatologia , Pneumonia Viral/virologia , Transtornos Respiratórios/virologia , Centro Respiratório/virologia , Animais , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/epidemiologia , Modelos Animais de Doenças , Humanos , Camundongos , Camundongos Transgênicos , Pandemias , Pneumonia Viral/epidemiologia , Transtornos Respiratórios/fisiopatologia , Centro Respiratório/fisiopatologia , Vírus da SARS/patogenicidade
9.
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
11.
PLoS One ; 15(3): e0224860, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32187180

RESUMO

OBJECTIVE: To assess the effects of workplace exposure to hardwood dust on lung function and determine a prevalence of respiratory symptoms among wood workers. STUDY DESIGN: Cross-sectional observational study. SETTING: Tertiary referral center. SUBJECTS AND METHODS: Two hundred seventy-six, non-smoker male wood workers and equal number of non-smoker male office workers, referred to pulmonology clinic included in this study. Evaluation of study participants included completion of a questionnaire regarding respiratory symptoms and baseline spirometry was measured according to the actual recommendations. RESULTS: Respiratory symptoms including cough, phlegm, chest tightness, and wheezing were significantly higher in wood workers than office workers (40.2% versus 29.3% for cough, p = 0.0073; 40.6% versus 23.6% for phlegm, p<0.0001; 38.0% versus 23.1% for chest tightness, p = 0.0001; 25.3% versus 14.5% for wheezing, p = 0.0014). No statistically significant differences were observed for Dyspnea, and upper respiratory tract symptoms among wood workers compared to office workers. While wood workers were more likely to require spirometry test than office workers (21.4% versus 5.4%, p<0.001) the obstructive changes were more prevalent on spirometry test in wood workers (71.4% obstructive pattern versus 28.6% restrictive pattern). Spirometry test revealed the mean values of FEV1 and FEV1/FVC ratio were significantly lower in the wood workers, compared to their mean values in the control group. CONCLUSION: Respiratory symptoms associated with work, are more prevalent among wood workers than office workers. Our data revealed that workplace exposure to hardwood dust may compromise respiratory function, indicating the importance and the need for optimizing preventive measures in workplace to protect the respiratory health among exposed workers. Obstructive changes on pulmonary function test is a dominant pathologic pattern in pulmonary function test among wood workers. Further investigation is required by current available tools such as nasal cytology to detect influence of wood dust exposure on the upper respiratory airway.


Assuntos
Poeira , não Fumantes , Exposição Ocupacional/efeitos adversos , Transtornos Respiratórios , Espirometria , Inquéritos e Questionários , Adulto , Estudos Transversais , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Transtornos Respiratórios/epidemiologia , Transtornos Respiratórios/etiologia , Transtornos Respiratórios/fisiopatologia
12.
BMC Neurol ; 20(1): 79, 2020 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-32138697

RESUMO

BACKGROUND: The most characteristic clinical signs of stroke are motor and/or sensory involvement of one side of the body. Respiratory involvement has also been described, which could be related to diaphragmatic dysfunction contralateral to the brain injury. Our objective is to establish the incidence of diaphragmatic dysfunction in ischaemic stroke and analyse the relationship between this and the main prognostic markers. METHODS: A prospective study of 60 patients with supratentorial ischaemic stroke in the first 48 h. Demographic and clinical factors were recorded. A diaphragmatic ultrasound was performed for the diagnosis of diaphragmatic dysfunction by means of the thickening fraction, during normal breathing and after forced inspiration. Diaphragmatic dysfunction was considered as a thickening fraction lower than 20%. The appearance of respiratory symptoms, clinical outcomes and mortality were recorded for 6 months. A bivariate and multivariate statistical analysis was designed to relate the incidence of respiratory involvement with the diagnosis of diaphragmatic dysfunction and with the main clinical determinants. RESULTS: An incidence of diaphragmatic dysfunction of 51.7% was observed. 70% (23 cases) of these patients developed symptoms of severe respiratory compromise during follow-up. Independent predictors were diaphragmatic dysfunction in basal respiration (p = 0.026), hemiparesis (p = 0.002) and female sex (p = 0.002). The cut-off point of the thickening fraction with greater sensitivity (75.75%) and specificity (62.9%) was 24% (p = 0.003). CONCLUSIONS: There is a high incidence of diaphragmatic dysfunction in patients with supratentorial ischaemic stroke which can be studied by calculating the thickening fraction on ultrasound. Among these patients we have detected a higher incidence of severe respiratory involvement.


Assuntos
Isquemia Encefálica/complicações , Diafragma/fisiopatologia , Transtornos Respiratórios/epidemiologia , Transtornos Respiratórios/etiologia , Idoso , Diafragma/diagnóstico por imagem , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Transtornos Respiratórios/fisiopatologia , Acidente Vascular Cerebral/complicações , Ultrassonografia
13.
J Neuromuscul Dis ; 7(2): 101-107, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31903995

RESUMO

BACKGROUND: Duchenne muscular dystrophy (DMD) patients can have various issues that affect their quality of life, including eating and digestive conditions. OBJECTIVE: We sought to identify the relationship between respiratory function and various eating and digestion related symptoms in patients with advanced Duchenne muscular dystrophy (DMD). METHODS: Eating and digestive symptoms, including loss of appetite, nausea, vomiting, diarrhea, constipation, swallowing difficulty, mastication difficulty, early satiety, and aspiration, were evaluated among patients with advanced DMD who were nonambulatory and required noninvasive mechanical ventilatory support. In addition, various respiratory function parameters were measured, including forced vital capacity (FVC), maximal insufflation capacity (MIC), peak cough flow (PCF), assisted PCF (APCF), maximal inspiratory pressure (MIP), and maximal expiratory pressure (MEP). We then analyzed the relationship between gastrointestinal symptoms and respiratory function parameters. RESULTS: A total of 180 patients (age, 22.3±5.0 years) were included in the analysis. Loss of appetite and early satiety showed no correlation with any of the respiratory function parameters. Constipation was correlated with MEP; swallowing difficulty was correlated with MIC, APCF, MIP and MEP; and mastication difficulty was correlated with FVC, PCF, APCF, MIP, and MEP. Notably, age did not correlate with any gastrointestinal symptoms. CONCLUSIONS: Eating and digestive symptoms are more closely correlated with respiratory function than with age in patients with DMD. We think this correlation is mainly caused by the skeletal muscle strength, which is major determinant of both digestive and respiratory function.


Assuntos
Gastroenteropatias/fisiopatologia , Distrofia Muscular de Duchenne/fisiopatologia , Transtornos Respiratórios/fisiopatologia , Índice de Gravidade de Doença , Adolescente , Adulto , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/fisiopatologia , Gastroenteropatias/etiologia , Humanos , Masculino , Distrofia Muscular de Duchenne/complicações , Ventilação não Invasiva , Transtornos Respiratórios/etiologia , Testes de Função Respiratória , Estudos Retrospectivos , Adulto Jovem
14.
Am J Physiol Lung Cell Mol Physiol ; 318(1): L27-L40, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31617729

RESUMO

Enhanced central chemoreflex (CC) gain is observed in volume overload heart failure (HF) and is correlated with autonomic dysfunction and breathing disorders. The aim of this study was to determine the role of the CC in the development of respiratory and autonomic dysfunction in HF. Volume overload was surgically created to induce HF in male Sprague-Dawley rats. Radiotelemetry transmitters were implanted for continuous monitoring of blood pressure and heart rate. After recovering from surgery, conscious unrestrained rats were exposed to episodic hypercapnic stimulation [EHS; 10 cycles/5 min, inspiratory fraction of carbon dioxide (FICO2) 7%] in a whole body plethysmograph for recording of cardiorespiratory function. To determine the contribution of CC to cardiorespiratory variables, selective ablation of chemoreceptor neurons within the retrotrapezoid nucleus (RTN) was performed via injection of saporin toxin conjugated to substance P (SSP-SAP). Vehicle-treated rats (HF+Veh and Sham+Veh) were used as controls for SSP-SAP experiments. Sixty minutes post-EHS, minute ventilation was depressed in sham animals relative to HF animals (ΔV̇e: -5.55 ± 2.10 vs. 1.24 ± 1.35 mL/min 100 g, P < 0.05; Sham+Veh vs. HF+Veh). Furthermore, EHS resulted in autonomic imbalance, cardiorespiratory entrainment, and ventilatory disturbances in HF+Veh but not Sham+Veh rats, and these effects were significantly attenuated by SSP-SAP treatment. Also, the apnea-hypopnea index (AHI) was significantly lower in HF+SSP-SAP rats compared with HF+Veh rats (AHI: 5.5 ± 0.8 vs. 14.4 ± 1.3 events/h, HF+SSP-SAP vs. HF+Veh, respectively, P < 0.05). Finally, EHS-induced respiratory-cardiovascular coupling in HF rats depends on RTN chemoreceptor neurons because it was reduced by SSP-SAP treatment. Overall, EHS triggers ventilatory plasticity and elicits cardiorespiratory abnormalities in HF that are largely dependent on RTN chemoreceptor neurons.


Assuntos
Doenças do Sistema Nervoso Autônomo/fisiopatologia , Sistema Nervoso Central/fisiopatologia , Células Quimiorreceptoras/metabolismo , Insuficiência Cardíaca/fisiopatologia , Neurônios/fisiologia , Transtornos Respiratórios/fisiopatologia , Animais , Doenças do Sistema Nervoso Autônomo/metabolismo , Pressão Sanguínea/fisiologia , Sistema Nervoso Central/metabolismo , Insuficiência Cardíaca/metabolismo , Frequência Cardíaca/fisiologia , Hipercapnia/metabolismo , Hipercapnia/fisiopatologia , Masculino , Neurônios/metabolismo , Ratos , Ratos Sprague-Dawley , Respiração , Transtornos Respiratórios/metabolismo
15.
Dev Med Child Neurol ; 62(7): 833-836, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-31797351

RESUMO

AIM: To identify factors associated with baseline prolonged corrected QT (QTc) and higher risk of QTc prolongation during follow-up in patients with Rett syndrome (RTT). METHOD: A retrospective review of patients receiving an electrocardiogram (ECG) between June 2012 and June 2018 was performed. Age, methyl-CpG binding protein 2 gene (MECP2) mutation, RTT Severity Scale (RSSS) score, breathing abnormalities, seizure frequency, medications, and ECG parameters were collected. Prolonged QTc was defined as greater than or equal to 460ms. Comparisons at baseline and during follow-up were made. RESULTS: In total, 129 unique patients (all female) had 349 ECGs. At baseline, 12 (9.3%) had a prolonged QTc (median 474ms, interquartile range 470-486ms) and were more likely to have moderate/severe breathing abnormalities (66.7% vs 24.8%; p=0.005) and take selective serotonin reuptake inhibitors (SSRIs) (41.7% vs 15.4%; p=0.04). There was no difference in age, RSSS score, seizures, or mutation. Twenty-six developed prolonged QTc during a median follow-up of 1 year 7 months (interquartile range 0-3y 6mo). QTc prolongation was associated with p.(Thr158Met) mutation versus the remaining six common mutations (hazard ratio 4.1, 95% confidence interval 1.4-12.0; p=0.01) but not with age, RSSS score, seizures, breathing abnormalities, or SSRIs. INTERPRETATION: Breathing abnormalities and SSRIs were associated with baseline QTc prolongation and those with p.(Thr158Met) mutation were more likely to develop prolonged QTc over time. Identification of patients with prolonged QTc warrants increased clinical monitoring. WHAT THIS PAPER ADDS: Breathing abnormalities and selective serotonin reuptake inhibitors are associated with prolonged baseline corrected QT (QTc). Development of QTc prolongation is associated with the p.(Thr158Met) mutation.


Assuntos
Síndrome do QT Longo , Proteína 2 de Ligação a Metil-CpG/genética , Transtornos Respiratórios , Síndrome de Rett , Inibidores de Captação de Serotonina/efeitos adversos , Criança , Eletrocardiografia , Feminino , Seguimentos , Humanos , Síndrome do QT Longo/induzido quimicamente , Síndrome do QT Longo/etiologia , Síndrome do QT Longo/fisiopatologia , Transtornos Respiratórios/complicações , Transtornos Respiratórios/fisiopatologia , Estudos Retrospectivos , Síndrome de Rett/complicações , Síndrome de Rett/tratamento farmacológico , Síndrome de Rett/genética
16.
Behav Neurol ; 2019: 6530539, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31583023

RESUMO

Background: Obstructive sleep apnea syndrome (OSAS) affects up to 4% of a pediatric population, with many comorbidities in the medium-long term. Functional alterations in the prefrontal cortex (PFC) may explain why OSAS impacts aspects such as executive functions, memory, motor control, attention, visual-spatial skills, learning, and mood regulation. Emotional intelligence (EI) is a complex neuropsychological function that could be impaired in many clinical conditions. Purpose: The aim of the study is to evaluate the difference in emotional intelligence skills among children with OSAS and healthy subjects (nOSAS). Methods: 129 children (72 males; mean age 7.64 ± 1.98 years) affected by OSAS were compared to 264 non-OSAS (nOSAS) children (138 males; mean age 7.98 ± 2.13) similar for gender, age, and socioeconomic status. In order to assess the emotional quotient, the Bar-On Emotional Quotient Inventory: Youth Version (EQ-i:YV) was used. Results: The comparison for means and standard deviation between OSAS children and nOSAS children for EQ-i:YV scores showed significant differences for Interpersonal, Adaptability, and Stress Management scales and EQ Total score. Conclusions: Our findings highlighted the role of intermittent hypoxia in the genesis of the effects of sleep-related respiratory disorders, which involves also aspects different from physical impairments.


Assuntos
Inteligência Emocional/fisiologia , Apneia Obstrutiva do Sono/psicologia , Atenção/fisiologia , Criança , Pré-Escolar , Função Executiva/fisiologia , Feminino , Humanos , Itália , Masculino , Memória/fisiologia , Testes Neuropsicológicos , Polissonografia/métodos , Transtornos Respiratórios/fisiopatologia , Transtornos Respiratórios/psicologia , Apneia Obstrutiva do Sono/fisiopatologia
18.
Vet J ; 251: 105347, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31492386

RESUMO

Pulmonary hypertension (PH) is associated with substantial morbidity and if untreated, mortality. The human classification of PH is based on pathological, hemodynamic characteristics, and therapeutic approaches. Despite being a leading cause of PH, little is known about dogs with respiratory disease and/or hypoxia (RD/H)-associated PH. Therefore, our objectives were to retrospectively describe clinical features, diagnostic evaluations, final diagnoses and identify prognostic variables in dogs with RD/H and PH. In 47 dogs identified with RD/H and PH, chronic airway obstructive disorders, bronchiectasis, bronchiolar disease, emphysema, pulmonary fibrosis, neoplasia and other parenchymal disorders were identified using thoracic radiography, computed tomography, fluoroscopy, tracheobronchoscopy, bronchoalveolar lavage, and histopathology. PH was diagnosed using transthoracic echocardiography. Overall median survival was 276.0 days (SE, 95% CI; 216, 0-699 days). Dogs with an estimated systolic pulmonary arterial pressure (sPAP) ≥47mmHg (n=21; 9 days; 95% CI, 0-85 days) had significantly shorter survival times than those <47mmHg (n=16; P=0.001). Estimated sPAP at a cutoff of ≥47mmHg was a fair predictor of non-survival with sensitivity of 0.78 (95% CI, 0.52-0.94) and specificity of 0.63 (95% CI, 0.38-0.84). Phosphodiesterase-5 (PDE5) inhibitor administration was the sole independent predictor of survival in a multivariable analysis (hazard ratio: 4.0, P=0.02). Canine PH is present in a diverse spectrum of respiratory diseases, most commonly obstructive disorders. Similar to people, severity of PH is prognostic in dogs with RD/H and PDE5 inhibition could be a viable therapy to improve outcome.


Assuntos
Doenças do Cão/diagnóstico , Hipertensão Pulmonar/veterinária , Hipóxia/veterinária , Transtornos Respiratórios/veterinária , Animais , Doenças do Cão/tratamento farmacológico , Doenças do Cão/etiologia , Cães , Ecocardiografia/veterinária , Feminino , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/tratamento farmacológico , Hipertensão Pulmonar/etiologia , Hipóxia/fisiopatologia , Masculino , Inibidores da Fosfodiesterase 5/uso terapêutico , Transtornos Respiratórios/fisiopatologia , Estudos Retrospectivos , Análise de Sobrevida , Resultado do Tratamento
19.
Neuromuscul Disord ; 29(8): 569-575, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31395305

RESUMO

The aim of this study was to evaluate quality of life (QoL) and its possible determinants in patients affected by Duchenne muscular dystrophy (DMD) in late stages of their disease, when non-invasive ventilation (NIV) is already established. Forty-eight DMD patients who were treated by NIV were enrolled. QoL was assessed by the Individualized Neuromuscular Quality of Life (INQoL) questionnaire. By this questionnaire, different aspects of QoL were assessed on a scale from 0 (best) to 100 (worst). In addition, motor and respiratory function tests were performed. Dysautonomia symptoms, sleep quality, sleepiness, anxiety, and depression were evaluated by validated questionnaires. The global INQoL score was 42.8 ±â€¯19, reflecting a moderately altered QoL. The physical health domain was heavily impaired while the psychosocial domain was only mildly affected. Independence had the highest scores (81.1 ±â€¯21.2), proving to be the most affected item. On multivariate analysis, maximal inspiratory pressure and Pittsburgh Sleep Quality Index, but not daily duration of NIV therapy, predicted global INQoL score. Respiratory impairment and sleep quality were independent predictors of poor QoL in DMD patients under NIV. Sleep quality in DMD is often disregarded, while it should be carefully addressed to ensure a better QoL.


Assuntos
Distrofia Muscular de Duchenne , Ventilação não Invasiva , Qualidade de Vida , Transtornos Respiratórios , Transtornos do Sono-Vigília , Adulto , Humanos , Masculino , Distrofia Muscular de Duchenne/complicações , Distrofia Muscular de Duchenne/fisiopatologia , Distrofia Muscular de Duchenne/psicologia , Distrofia Muscular de Duchenne/terapia , Transtornos Respiratórios/etiologia , Transtornos Respiratórios/fisiopatologia , Transtornos Respiratórios/psicologia , Transtornos Respiratórios/terapia , Transtornos do Sono-Vigília/etiologia , Transtornos do Sono-Vigília/fisiopatologia , Transtornos do Sono-Vigília/psicologia , Adulto Jovem
20.
J Bras Pneumol ; 45(5): e20180032, 2019 Jul 29.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31365614

RESUMO

OBJECTIVE: To investigate the accuracy of chest auscultation in detecting abnormal respiratory mechanics. METHODS: We evaluated 200 mechanically ventilated patients in the immediate postoperative period after cardiac surgery. We assessed respiratory system mechanics - static compliance of the respiratory system (Cst,rs) and respiratory system resistance (R,rs) - after which two independent examiners, blinded to the respiratory system mechanics data, performed chest auscultation. RESULTS: Neither decreased/abolished breath sounds nor crackles were associated with decreased Cst,rs (≤ 60 mL/cmH2O), regardless of the examiner. The overall accuracy of chest auscultation was 34.0% and 42.0% for examiners A and B, respectively. The sensitivity and specificity of chest auscultation for detecting decreased/abolished breath sounds or crackles were 25.1% and 68.3%, respectively, for examiner A, versus 36.4% and 63.4%, respectively, for examiner B. Based on the judgments made by examiner A, there was a weak association between increased R,rs (≥ 15 cmH2O/L/s) and rhonchi or wheezing (ϕ = 0.31, p < 0.01). The overall accuracy for detecting rhonchi or wheezing was 89.5% and 85.0% for examiners A and B, respectively. The sensitivity and specificity for detecting rhonchi or wheezing were 30.0% and 96.1%, respectively, for examiner A, versus 10.0% and 93.3%, respectively, for examiner B. CONCLUSIONS: Chest auscultation does not appear to be an accurate diagnostic method for detecting abnormal respiratory mechanics in mechanically ventilated patients in the immediate postoperative period after cardiac surgery.


Assuntos
Auscultação/métodos , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Transtornos Respiratórios/diagnóstico , Transtornos Respiratórios/etiologia , Respiração Artificial/efeitos adversos , Mecânica Respiratória/fisiologia , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Valores de Referência , Reprodutibilidade dos Testes , Transtornos Respiratórios/fisiopatologia , Testes de Função Respiratória , Sensibilidade e Especificidade
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