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4.
Am J Emerg Med ; 57: 14-20, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35489220

RESUMO

INTRODUCTION: Adult epiglottitis is a serious condition that carries with it a high rate of morbidity and even mortality due to airway occlusion. OBJECTIVE: This review highlights the pearls and pitfalls of epiglottitis in adult patients, including diagnosis, initial resuscitation, and management in the emergency department (ED) based on current evidence. DISCUSSION: Epiglottitis is a life-threatening emergency that occurs more commonly in adults in the current medical era with vaccinations. Children present more commonly with acute respiratory distress and fever, while adults present most commonly with severe dysphagia in a subacute manner. Other symptoms may include drooling, muffled voice, and dyspnea. Streptococcus and Staphylococcus bacteria are the most common etiologies, but others include viral, fungal, caustic, thermal injuries, and autoimmune. Lateral neck radiographs assist in diagnosis, but they may be falsely negative. Visualization of the epiglottis is the key to diagnosis. Airway assessment and management are paramount, which has transitioned from direct laryngoscopy to flexible intubating endoscopy and video laryngoscopy with assistance from anesthesia and/or otolaryngology if available. Along with airway assessment, antibiotics should be administered. Corticosteroids and nebulized epinephrine are controversial but should be considered. Patients should be admitted to the intensive care setting for close airway observation or ventilatory management if intubated. CONCLUSIONS: An understanding of epiglottitis can assist emergency clinicians in diagnosing and managing this potentially deadly disease.


Assuntos
Obstrução das Vias Respiratórias , Epiglotite , Doença Aguda , Adulto , Obstrução das Vias Respiratórias/etiologia , Criança , Epiglote , Epiglotite/diagnóstico , Epiglotite/epidemiologia , Epiglotite/terapia , Humanos , Laringoscopia/efeitos adversos , Prevalência
5.
Eur Arch Otorhinolaryngol ; 279(8): 4033-4041, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35396955

RESUMO

PURPOSE: The purpose is to analyze the incidence of acute infectious supraglottitis in our center between 2010 and 2020, define the characteristics and trends of those patients and identify factors associated with the need of airway intervention. METHODS: A retrospective single-center observational study of a cohort of patients diagnosed with acute infectious supraglottitis between January 2010 and December 2020. Patients were stratified according to airway management. RESULTS: Eighty eight patients were included: 59 men (67%) and 29 women (33%). A significant upward trend of 9% in the annual incidence rate of supraglottitis was seen during 2010-2020, with an important increase in cases during 2019. Muffled voice (41%) and respiratory distress (38%) were the most common presenting symptoms; and the median duration of symptoms before hospital admission was 2 days [IQR 1; 3]. Airway intervention was performed in fifteen patients (17%). Nine patients (10%) were intubated and six required tracheotomy (7%). Comparing the patients who required airway intervention with those who received a conservative treatment, younger patients (p < 0.01) were more likely to need airway intervention. In logistic regression analysis, we found that epiglottic abscess (p = 0.015), hypersalivation (p = 0.027) and smoking (p = 0.036) were independent factors with a significant association with airway intervention. CONCLUSION: There was an important increase in cases and its severity in 2019, but due to COVID-19 pandemic, it was not possible to define if it was an isolate event or an upward trend. Epiglottic abscess, hypersalivation and smoking could be possible risk factors for airway intervention.


Assuntos
COVID-19 , Epiglotite , Sialorreia , Supraglotite , Abscesso/epidemiologia , Doença Aguda , Adulto , Epiglotite/epidemiologia , Epiglotite/terapia , Feminino , Humanos , Masculino , Pandemias , Estudos Retrospectivos , Sialorreia/epidemiologia
6.
Pediatr Emerg Care ; 38(7): e1355-e1361, 2022 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-35267248

RESUMO

OBJECTIVE: This study aimed to compare statewide emergency medical services protocols for the management of pediatric respiratory distress. METHODS: We performed a descriptive study of emergency medical services protocols for the management of pediatric respiratory distress in the United States, excluding those without model or mandatory protocols. We compared medication recommendations for specific disease processes, including asthma, croup, epiglottitis, anaphylaxis, generalized respiratory distress, intubation, and drug assisted intubation. RESULTS: Thirty-four state protocols were included. All had protocols to address the management of pediatric respiratory distress. There was high agreement in albuterol use for bronchospasm and epinephrine use in anaphylaxis. Epinephrine was recommended in all anaphylaxis protocols, 27 croup protocols (79%), and 3 epiglottitis protocols (9%). Six states (18%) called for albuterol in patients with generalized respiratory distress. Steroid recommendations and indications had variance among states; 26 states (76%) allowed steroid use in patients with asthma, 19 states (56%) recommended steroid use in anaphylaxis, and 11 (32%) recommended steroid use in croup protocols. The route for steroid administration also varied among protocols. Five states (15%) allowed continuous positive airway pressure application in pediatric patients, whereas endotracheal intubation and rapid sequence intubations had varying requirements as well as recommendations for use. Twelve (35%) listed impending or current respiratory failure as an indication, whereas other states had specific markers, such as Glasgow Coma Scale or oxygen saturation, as indications. CONCLUSIONS: All included states had specific recommendations for the management of pediatric respiratory distress. There was consistency in recommendations for albuterol use for wheezing and epinephrine use for anaphylaxis. However, there was wide variability in other uses for epinephrine, steroid administration, continuous positive airway pressure use, and specific treatments for croup and epiglottitis. The findings of this study provide a base for important future evidence-based protocol developments and changes in prehospital pediatric respiratory distress treatment.


Assuntos
Anafilaxia , Asma , Crupe , Serviços Médicos de Emergência , Epiglotite , Síndrome do Desconforto Respiratório , Albuterol/uso terapêutico , Anafilaxia/tratamento farmacológico , Asma/tratamento farmacológico , Criança , Crupe/tratamento farmacológico , Dispneia/tratamento farmacológico , Serviços Médicos de Emergência/métodos , Epiglotite/tratamento farmacológico , Epinefrina/uso terapêutico , Humanos , Estados Unidos
7.
Rev Esp Anestesiol Reanim (Engl Ed) ; 69(2): 65-70, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-35181262

RESUMO

Management by the environment is complex, which means a much higher percentage of difficult airways than in a regulated environment such as the operating room. Failure or prolonged attempt to tracheal intubation is associated with unfavorable outcomes and serious complications. Acute epiglottitis is a life-threatening disorder, classified as a medical emergency within the diseases of the upper respiratory airway and characterized by its sudden and deadly evolution if rapid intubation is not achieved to allow oxygenation of the patient. We describe a 36-year-old male patient with stridor, dyspnea e hypoxemia due to total obstruction of airway, caused by an acute epiglottitis. We aim to highlight this unusual injury and its management from the prehospital until discharge illustrating the severity of the clinical presentation, current treatment and outcome.


Assuntos
Serviços Médicos de Emergência , Epiglotite , Doença Aguda , Adulto , Epiglotite/etiologia , Epiglotite/terapia , Humanos , Intubação Intratraqueal/efeitos adversos , Masculino , Traqueia
9.
J Intern Med ; 292(1): 154-161, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35170099

RESUMO

OBJECTIVE: The objective of this study is to present a novel clinical manifestation of infection with the Omicron variant of the SARS-CoV-2 virus affecting mainly young, vaccinated, and healthy adults. We describe a new group of COVID-19 patients seeking emergency care with symptoms similar to the life-threatening condition epiglottitis. Here, we present a case series and discuss management. METHODS: We performed a retrospective single-center case study of patients diagnosed with COVID-19 who were referred to the Ear, Nose, and Throat Emergency Department (ENT ED) between January 1 and January 23, 2022 with clinical symptoms such as acute odynophagia, severe sore throat, and fever. Ethical approval was obtained from the Swedish Ethical Review Authority (2020-02579). Informed consent was obtained from all patients included in the study. RESULTS: Twenty patients meeting inclusion criteria were identified. Fifteen patients were fully vaccinated against COVID-19. Four patients needed a short hospitalization for their symptoms. The most common diagnoses were COVID-19-associated acute viral laryngotracheitis and/or viral pharyngitis. Six patients presented with signs of secondary bacterial infection and were put on antibiotics. CONCLUSION: Previous variants of SARS-CoV-2 infection affected predominantly the lower respiratory tract and were associated with loss of smell and taste in many patients. The Omicron variant seems to affect predominantly the upper airways and cause acute laryngitis without olfactory dysfunction. In some patients, the clinical manifestation is similar to the symptoms of epiglottitis. In such a case, a prompt examination of the larynx is the gold standard to exclude inflammatory edema in the upper airways. None of the patients described in this study developed epiglottitis. In this study, we discuss the management of acute odynophagia in COVID-19 patients.


Assuntos
COVID-19 , Epiglotite , Adulto , COVID-19/complicações , COVID-19/diagnóstico , Humanos , Dor , Estudos Retrospectivos , SARS-CoV-2 , Suécia/epidemiologia
11.
Am J Emerg Med ; 51: 427.e1-427.e2, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34294502

RESUMO

There have been more than 178 million global cases of COVID-19, the disease caused by the SARS-CoV-2 virus, with more than 3.8 million deaths worldwide [1]. COVID-19 can present with a wide variety of symptoms, and one rare manifestation that has been reported in the literature is acute epiglottitis. To date, there have been two reported cases of acute epiglottitis in COVID-19 positive patients [2, 3]. We present a case of a 49-year-old male presenting to a community emergency department with the chief complaint of dysphagia and sore throat, confirmed as acute epiglottitis, in the presence of a positive rapid COVID-19 PCR test.


Assuntos
COVID-19/diagnóstico , Epiglotite/diagnóstico , Doença Aguda , Transtornos de Deglutição/virologia , Epiglotite/virologia , Humanos , Hipertensão , Masculino , Pessoa de Meia-Idade , Faringite/virologia , Síndrome de Wolff-Parkinson-White
12.
Eur Arch Otorhinolaryngol ; 279(5): 2671-2678, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-34807284

RESUMO

PURPOSE: To report changes in adult hospital admission rates for acute ENT infections following the introduction of COVID-19-related physical interventions such as hand washing, use of face masks and social distancing of 2-m in the United Kingdom. METHODS: Retrospective cohort study comparing adult admissions with acute tonsillitis, peritonsillar abscess, epiglottitis, glandular fever, peri-orbital cellulitis, acute otitis media, acute mastoiditis, retropharyngeal abscess and parapharyngeal abscess in the 1-year period after the introduction of COVID-related physical interventions (2020-2021) with a 1-year period before this (2019-2020) in three UK secondary care ENT departments. RESULTS: In total, there were significantly fewer admissions for ENT infections (n = 1073, 57.56%, p < 0.001; RR 2.36, 95% CI [2.17, 2.56]) in the 2020-2021 period than in the 2019-2020 period. There were significant reductions in admissions for tonsillitis (64.4%; p < 0.001), peritonsillar abscess (60.68%; p < 0.001), epiglottitis (66.67%; p < 0.001), glandular fever (38.79%; p = 0.001), acute otitis media (26.85%; p = 0.01) and retropharyngeal and/or parapharyngeal abscesses (45.45%; p = 0.04). CONCLUSION: Our study demonstrates a sizeable reduction in adult admissions for ENT infections since the introduction of COVID-19-related physical interventions. There is evidence to support the use of physical interventions in the prevention of viral transmission of respiratory disease. Preventing ENT infections requiring admission through simple physical interventions could be of great benefit to the quality of life of patients and economical benefit to healthcare systems.


Assuntos
COVID-19 , Epiglotite , Mononucleose Infecciosa , Otite Média , Abscesso Peritonsilar , Doenças Faríngeas , Tonsilite , Adulto , COVID-19/epidemiologia , Hospitais , Humanos , Abscesso Peritonsilar/cirurgia , Abscesso Peritonsilar/terapia , Qualidade de Vida , Estudos Retrospectivos , Tonsilite/epidemiologia , Tonsilite/cirurgia
13.
Infect Dis (Lond) ; 54(4): 308-310, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-34879768

RESUMO

BACKGROUND: In humans, coronavirus disease 2019 (COVID-19) has a variable presentation ranging from mild self-limiting respiratory tract infections to severe acute respiratory distress syndrome. Methods: We present the case of a patient who developed acute epiglottitis after surgery for an intracranial tumour and was subsequently diagnosed with COVID-19. RESULTS: A 58-year-old female patient developed acute-onset respiratory distress on day 6 after intracranial surgery. Neck computed tomography revealed near-total airway obstruction due to severe edoema of the epiglottis and periepiglottis. The patient's SARS-CoV-2 polymerase chain reaction test was positive. Viral respiratory tract panel and sputum and blood cultures were negative. She completed the antiviral and antibacterial treatment regimens recommended by the chest disease department. CONCLUSIONS: We conclude that epiglottitis can be an unusual manifestation of COVID-19.


Assuntos
COVID-19 , Epiglotite , Síndrome do Desconforto Respiratório , Doença Aguda , Epiglotite/diagnóstico , Feminino , Humanos , Pessoa de Meia-Idade , SARS-CoV-2
14.
Eur Arch Otorhinolaryngol ; 279(3): 1425-1429, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34792627

RESUMO

INTRODUCTION: Acute supraglottitis is a potentially life-threatening condition that often necessitates intensive care unit (ICU) admission for airway monitoring. The objective of this study was to identify clinical criteria that predict a benign course for patients with acute supraglottitis. METHODS: A prospective observational study was performed. Adult patients hospitalized in the ICU between 2007 and 2019 diagnosed with acute supraglottitis were included. All patients were treated with antibiotics and corticosteroids. Fiber optic laryngoscopy (FOL) was performed every 12 h, with each exam defined as "improving", "no change" or "deteriorating" based on the presence of airway edema. Need for airway intervention was correlated to changes in the FOL exam. RESULTS: Of 146 patients included, 14 (10%) required intubation, ten on admission, and four during the first 6 h of ICU admission. FOL follow-up was performed on 528 occasions-427 (81%) exams showed improvement, 16 (3%) deterioration, and 85 (16%) with no change. On no occasions was improvement in FOL followed by deterioration. The median ICU length of stay was 3 (IQR 2-3.5) vs. 1 (IQR 1.0-1.25) day for patients who did or did not require intubation (p < 0.001), respectively. CONCLUSION: Improvement in FOL exam accurately predicted the absence of need for intubation and might represent a criterion for early ICU discharge.


Assuntos
Epiglotite , Supraglotite , Adulto , Humanos , Unidades de Terapia Intensiva , Intubação , Estudos Prospectivos
15.
Pediatr Emerg Care ; 38(2): e501-e502, 2022 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-33086360

RESUMO

ABSTRACT: Infective uvulitis is a rare condition in children. In this report, we describe the case of a 4-year old-patient who presented a group A Streptococcus pharyngitis with uvulitis. No signs of epiglottitis were detected at nasal fibroscopy. She recovered rapidly with intravenous antibiotic therapy and 2 days of corticosteroid. Uvulitis is usually caused by group A Streptococcus or Haemophilus influentiae, but also other bacteria can be detected. Uvulitis can be isolated, or it can occur with epiglottitis and become an emergency.


Assuntos
Epiglotite , Infecções por Haemophilus , Faringite , Estomatite , Criança , Pré-Escolar , Epiglotite/diagnóstico , Epiglotite/tratamento farmacológico , Feminino , Infecções por Haemophilus/diagnóstico , Infecções por Haemophilus/tratamento farmacológico , Humanos , Streptococcus pyogenes , Úvula
16.
West J Emerg Med ; 22(6): 1326-1334, 2021 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-34787558

RESUMO

INTRODUCTION: Adult epiglottitis is a disease process distinct from pediatric epiglottitis in microbiology, presentation, and clinical course. While traditionally considered more indolent and benign than in children, adult epiglottitis remains a cause of acute airway compromise with a mortality rate from 1-20%. Our objective was to characterize the disease course and evaluate the rate and type of airway management in this population at a tertiary, academic referral center. METHODS: We conducted a retrospective chart review of all adult patients (age ≥ 18) who were definitively diagnosed with infectious "epiglottitis," "supraglottitis," or "epiglottic abscess" by direct or indirect laryngoscopy during a nine-year period. Double data abstraction and a standardized data collection form were used to assess patient demographic characteristics, presenting features, and clinical course. The primary outcome was airway intervention by intubation, cricothyroidotomy, or tracheostomy, and the secondary outcome was mortality related to the disease. RESULTS: Seventy patients met inclusion criteria. The mean age was 50.2 years (standard deviation ± 16.7), 60% of the patients were male, and 14.3% were diabetic. Fifty percent had symptoms that were present for ≥ 48 hours; 38.6% had voice changes, 13.1% had stridor, 12.9% had fever, 45.7% had odynophagia, and 47.1% had dysphagia noted in the ED. Twelve patients (17.1%) received an acute airway intervention including three who underwent emergent cricothyroidotomy, and one who had a tracheostomy. Two patients died and one suffered anoxic brain injury related to complications following difficult airway management. CONCLUSION: In this case series the majority of patients (82.9%) did not require airway intervention, but a third of those requiring intervention (5.7% of total) had a surgical airway performed with two deaths and one anoxic brain injury. Clinicians must remain vigilant to identify signs of impending airway compromise in acute adult epiglottitis and be familiar with difficult and failed airway algorithms to prevent morbidity and mortality in these patients.


Assuntos
Epiglotite , Doença Aguda , Adulto , Manuseio das Vias Aéreas , Criança , Epiglotite/epidemiologia , Epiglotite/terapia , Humanos , Laringoscopia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
17.
Clin Med (Lond) ; 21(5): e539-e540, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34507943

RESUMO

CASE PRESENTATION: A 68-year-old woman was referred for immunological investigation following an episode of meningococcal epiglottitis with associated septicaemia. Several years previously, she had been diagnosed with undifferentiated connective tissue disease. On investigation, alternative pathway complement function was normal; however, classical pathway complement activation was reduced. C1q, C3 and C4 levels were all measured and found to be within their respective normal ranges, but C2 levels were low. Sequencing of the C2 gene was subsequently performed, confirming a diagnosis of type 1 C2 deficiency (C2D). DISCUSSION: C2D is usually hereditary and inherited in an autosomal recessive manner. C2D is often asymptomatic, however, some patients suffer from infections with encapsulated bacteria and/or autoimmune diseases, particularly systemic lupus erythematosus. Recognition of complement pathway deficiency is important due to the predisposition to severe and/or recurrent infections by encapsulated bacteria. Immunisations have the potential to reduce both mortality and morbidity not only for the patient but also for any affected relatives.


Assuntos
Doenças do Tecido Conjuntivo , Epiglotite , Lúpus Eritematoso Sistêmico , Idoso , Complemento C2 , Proteínas do Sistema Complemento , Epiglotite/diagnóstico , Feminino , Humanos
18.
Emerg Med Clin North Am ; 39(3): 661-675, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34215408

RESUMO

Ear, nose, and throat (ENT) emergencies presenting with a chief complaint of pharyngitis can be due to infection, trauma, or postprocedure complications. The entities described in this article include retropharyngeal abscess, peritonsillar abscess, epiglottitis, bacterial tracheitis, and post-tonsillectomy bleeding. This article provides the emergency physician with the tools needed to decipher between the mundane and the critical, variations in presentation, and their emergent management. All of them require early recognition for any airway compromise or obstruction in order to avoid serious complications.


Assuntos
Epiglotite , Abscesso Peritonsilar , Abscesso Retrofaríngeo , Tonsilectomia/efeitos adversos , Antibacterianos/uso terapêutico , Infecções Bacterianas/complicações , Infecções Bacterianas/tratamento farmacológico , Criança , Técnicas de Apoio para a Decisão , Diagnóstico Diferencial , Drenagem , Epiglotite/diagnóstico , Epiglotite/terapia , Humanos , Medicina de Emergência Pediátrica , Abscesso Peritonsilar/diagnóstico , Abscesso Peritonsilar/terapia , Hemorragia Pós-Operatória/etiologia , Hemorragia Pós-Operatória/terapia , Abscesso Retrofaríngeo/diagnóstico , Abscesso Retrofaríngeo/terapia , Traqueíte/diagnóstico , Traqueíte/terapia
19.
Am J Emerg Med ; 49: 114-116, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34098330

RESUMO

Acute epiglottitis is an airway emergency presenting with edema and inflammation of the epiglottis and aryepiglottic folds [1]. Infectious and other non-infectious etiologies may cause significant airway injury presenting with similar clinical symptoms and radiographic findings [1]. While many causes of thermal epiglottitis have been described in the pediatric and young adult population, we describe an unusual case of an adolescent patient with cannabis induced thermal epiglottitis. A 17-year-old previously healthy, vaccinated adolescent male presented to the pediatric emergency department with dysphagia, odynophagia, drooling, and muffled voice with fever, tachypnea, and leukocytosis. Lateral plain film imaging and computed tomography (CT) scan showed significant edema of the epiglottitis. Urinary drug screen in the emergency department was positive for benzodiazepine, opiates, and cannabinoids. Transnasal flexible laryngoscopy and direct laryngoscopy demonstrated significant erythema, edema, and copious secretions. Culture of the epiglottis culture showed normal oropharyngeal flora. The patient was diagnosed with thermal induced epiglottitis secondary to cannabinoid use based on positive substance use history, urinary drug screen, and negative bacterial cultures. Clinicians must consider thermal injury of the epiglottitis due to substance use, specifically marijuana in vaccinated adolescent patients presenting with positive substance use history, progressive dysphagia, odynophagia, and drooling with a muffled voice. It is essential to obtain a thorough history and physical examination and urinary drug screen in the pediatric emergency department since the clinical and radiographic findings are similar in epiglottitis due to infectious and non-infectious etiologies. Prompt management with intubation should occur to protect and maintain airway integrity.


Assuntos
Epiglotite/etiologia , Fumar Maconha/efeitos adversos , Adolescente , Queimaduras/complicações , Queimaduras/terapia , Transtornos de Deglutição/etiologia , Humanos , Laringoscopia/métodos , Masculino , Fumar Maconha/terapia , Pediatria/métodos , Tomografia Computadorizada por Raios X/métodos
20.
Laryngoscope ; 131(11): 2483-2489, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-33830515

RESUMO

OBJECTIVES/HYPOTHESIS: This study investigated the impacts of air pollution and meteorological factors on the occurrence of epiglottitis. STUDY DESIGN: A nested case-control study. METHODS: Participants ≥40 years old in the Korean National Health Insurance Service-Health Screening Cohort were analyzed. A total of 2,615 epiglottitis patients and 10,460 matched control participants were analyzed. The odds ratios (ORs) for epiglottitis associated with meteorological and air pollution factors, including sulfur dioxide (SO2 , ppb), nitrogen dioxide (NO2 , ppb), ozone (O3 , ppb), and carbon monoxide (CO, ppm), after 3, 7, 15, and 30 days of exposure were analyzed using conditional logistic regression adjusted for total cholesterol, blood pressure, fasting blood glucose, obesity, smoking, alcohol consumption, prior upper respiratory infection, tonsillectomy, immunocompromise, autoimmune disease, and the Charlson comorbidity index. RESULTS: The daily temperature range and NO2 exposure after 3 days were associated with increased rates of epiglottitis (OR = 1.03, 95% confidence interval [CI] = 1.02-1.05 for temperature range and OR = 1.78, 95% CI = 1.14-2.77 for NO2 , respectively). These results were generally consistent at 7, 15, and 30 days. CONCLUSIONS: The temperature range and NO2 exposure for 3, 7, 15, and 30 days were positively related to the occurrence of adult epiglottitis. LEVEL OF EVIDENCE: 3 Laryngoscope, 131:2483-2489, 2021.


Assuntos
Poluentes Atmosféricos/efeitos adversos , Poluição do Ar/efeitos adversos , Epiglotite/epidemiologia , Dióxido de Nitrogênio/efeitos adversos , Material Particulado/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Poluentes Atmosféricos/análise , Estudos de Casos e Controles , Monitorização de Parâmetros Ecológicos/estatística & dados numéricos , Epiglotite/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dióxido de Nitrogênio/análise , Material Particulado/análise , República da Coreia , Temperatura
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