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1.
BMC Pulm Med ; 24(1): 269, 2024 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-38840152

RESUMO

INTRODUCTION: Post-reflux swallow-induced peristaltic wave index (PSPWI) and mean nocturnal baseline impedance (MNBI) are novel parameters reflect esophageal clearance capacity and mucosal integrity. They hold potential in aiding the recognition of gastroesophageal reflux-induced chronic cough (GERC). Our study aims to investigate their diagnostic value in GERC. METHODS: This study included patients suspected GERC. General information and relevant laboratory examinations were collected, and final diagnosis were determined following guidelines for chronic cough. The parameters of multichannel intraluminal impedance-pH monitoring (MII-pH) in patients were analyzed and compared to explore their diagnostic value in GERC. RESULTS: A total of 186 patients were enrolled in this study. The diagnostic value of PSPWI for GERC was significant, with the area under the working curve (AUC) of 0.757 and a cutoff value of 39.4%, which was not statistically different from that of acid exposure time (AET) (p > 0.05). The combined diagnostic value of AET > 4.4% and PSPWI < 39.4% was superior to using AET > 4.4% alone (p < 0.05). Additionally, MNBI and distal MNBI also contributed to the diagnosis of GERC, with AUC values of 0.639 and 0.624, respectively. AET > 4.4% or PSPWI < 39.4% is associated with a 44% reduction in missed diagnoses of non-acid GERC compared to AET > 6.0% or symptom association probability (SAP) ≥ 95%, and may be more favorable for identifying GERC. CONCLUSION: The diagnostic value of PSPWI for GERC is comparable to that of AET. Combining PSPWI < 39.4% or AET > 4.4% can improve the diagnostic efficiency by reducing the risk of missed diagnoses in cases where non-acid reflux is predominant. Distal MNBI and MNBI can serve as secondary reference indices in the diagnosis of GERC.


Assuntos
Tosse , Deglutição , Impedância Elétrica , Monitoramento do pH Esofágico , Refluxo Gastroesofágico , Peristaltismo , Humanos , Refluxo Gastroesofágico/diagnóstico , Refluxo Gastroesofágico/fisiopatologia , Masculino , Feminino , Pessoa de Meia-Idade , Tosse/fisiopatologia , Tosse/diagnóstico , Peristaltismo/fisiologia , Deglutição/fisiologia , Adulto , Idoso , Doença Crônica , Esôfago/fisiopatologia , Curva ROC , Área Sob a Curva
2.
Drug Des Devel Ther ; 18: 1865-1874, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38828019

RESUMO

Purpose: This study was designed to investigate the effects of preadministration of nalmefene before general anesthesia induction on sufentanil-induced cough (SIC) in patients undergoing breast surgery. Patients and Methods: A total of 105 patients scheduled for elective breast surgery under general anesthesia were selected and randomly assigned into three groups: normal saline (Group C), low-dose nalmefene 0.1 µg·kg-1 (Group LN), and high-dose nalmefene 0.25 µg·kg-1 (Group HN). Sufentanil 0.5 µg·kg-1 was injected intravenously within 2 s after 5 min of intervention. The count and severity of cough within 2 min after sufentanil injection, as well as the time to first cough, were recorded. In addition, we also collected intraoperative hemodynamic data, postoperative pain scores, the incidence of receiving rescue analgesics, and side effects up to 24 h after surgery. Results: Compared to Group C, the incidence of SIC was significantly lower in Group LN and HN (64.7% vs 30.3% and 14.7%, respectively; P < 0.001), but no significant difference was observed between the two groups (P=0.126). Compared to Group C, the risk factors decreased by 53.4% (95% confidence interval [CI] =0.181-0.735, P=0.008) in Group LN and by 75.9% (95% CI=0.432-0.898, P=0.001) in Group HN. Of the patients with SIC, less frequent SIC within 2 min after induction and a lower proportion of severe coughs were observed than Group C (P < 0.05), and no difference was detected between Group LN and HN. Additionally, the onset time to the first SIC did not differ significantly between the groups. Intraoperative hemodynamic data, postoperative pain scores, and side effects in the first 24 h did not differ among the groups. Conclusion: Preadministration of nalmefene prior to induction of general anesthesia effectively suppressed SIC in patients undergoing breast surgery, without affecting intraoperative hemodynamic fluctuation and postoperative pain intensity.


Assuntos
Anestesia Geral , Tosse , Naltrexona , Sufentanil , Humanos , Sufentanil/administração & dosagem , Sufentanil/efeitos adversos , Anestesia Geral/efeitos adversos , Tosse/tratamento farmacológico , Tosse/induzido quimicamente , Feminino , Naltrexona/análogos & derivados , Naltrexona/administração & dosagem , Naltrexona/farmacologia , Método Duplo-Cego , Pessoa de Meia-Idade , Adulto , Mama/cirurgia , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/efeitos adversos , Relação Dose-Resposta a Droga
3.
Sci Rep ; 14(1): 12717, 2024 06 03.
Artigo em Inglês | MEDLINE | ID: mdl-38830910

RESUMO

Chiari type 1 malformation is a neurological disorder characterized by an obstruction of the cerebrospinal fluid (CSF) circulation between the brain (intracranial) and spinal cord (spinal) compartments. Actions such as coughing might evoke spinal cord complications in patients with Chiari type 1 malformation, but the underlying mechanisms are not well understood. More insight into the impact of the obstruction on local and overall CSF dynamics can help reveal these mechanisms. Therefore, our previously developed computational fluid dynamics framework was used to establish a subject-specific model of the intracranial and upper spinal CSF space of a healthy control. In this model, we emulated a single cough and introduced porous zones to model a posterior (OBS-1), mild (OBS-2), and severe posterior-anterior (OBS-3) obstruction. OBS-1 and OBS-2 induced minor changes to the overall CSF pressures, while OBS-3 caused significantly larger changes with a decoupling between the intracranial and spinal compartment. Coughing led to a peak in overall CSF pressure. During this peak, pressure differences between the lateral ventricles and the spinal compartment were locally amplified for all degrees of obstruction. These results emphasize the effects of coughing and indicate that severe levels of obstruction lead to distinct changes in intracranial pressure.


Assuntos
Malformação de Arnold-Chiari , Líquido Cefalorraquidiano , Tosse , Hidrodinâmica , Malformação de Arnold-Chiari/líquido cefalorraquidiano , Malformação de Arnold-Chiari/fisiopatologia , Malformação de Arnold-Chiari/complicações , Tosse/fisiopatologia , Humanos , Simulação por Computador , Pressão do Líquido Cefalorraquidiano/fisiologia , Medula Espinal/fisiopatologia , Feminino
4.
Ther Adv Respir Dis ; 18: 17534666241259373, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38877686

RESUMO

BACKGROUND: Chronic cough (CC) affects about 10% of adults, but opioid use in CC is not well understood. OBJECTIVES: To determine the use of opioid-containing cough suppressant (OCCS) prescriptions in patients with CC using electronic health records. DESIGN: Retrospective cohort study. METHODS: Through retrospective analysis of Midwestern U.S. electronic health records, diagnoses, prescriptions, and natural language processing identified CC - at least three medical encounters with cough, with 56-120 days between first and last encounter - and a 'non-chronic cohort'. Student's t-test, Pearson's chi-square, and zero-inflated Poisson models were used. RESULTS: About 20% of 23,210 patients with CC were prescribed OCCS; odds of an OCCS prescription were twice as great in CC. In CC, OCCS drugs were ordered in 38% with Medicaid insurance and 15% with commercial insurance. CONCLUSION: Findings identify an important role for opioids in CC, and opportunity to learn more about the drugs' effectiveness.


Assuntos
Analgésicos Opioides , Tosse , Registros Eletrônicos de Saúde , Humanos , Estudos Retrospectivos , Analgésicos Opioides/uso terapêutico , Analgésicos Opioides/administração & dosagem , Masculino , Tosse/tratamento farmacológico , Feminino , Pessoa de Meia-Idade , Adulto , Doença Crônica , Estudos de Coortes , Idoso , Antitussígenos/administração & dosagem , Antitussígenos/uso terapêutico , Estados Unidos , Prescrições de Medicamentos/estatística & dados numéricos , Medicaid , Meio-Oeste dos Estados Unidos , Padrões de Prática Médica/estatística & dados numéricos , Adulto Jovem , Adolescente , Tosse Crônica
7.
J Coll Physicians Surg Pak ; 34(6): 740-741, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38840363

RESUMO

This study explored the clinical features of tracheobronchial foreign bodies (TFB) in children lacking both a foreign body aspiration history and bronchial cut-off signs on imaging. This study was conducted between 2011 and 2021, including 45 children without a choking history or tracheal interruption on CT scans. Common symptoms were cough and wheezing (91.1%, 41 cases), followed by decreased breath sounds (55.6%, 25 cases), rales (48.9%, 22 cases), and wheezing (42.2%, 19 cases). Prior to TFB confirmation, bronchopneumonia was the prevalent diagnosis (88.9%, 40 cases). Vegetable matter was the most frequent foreign body type (75.6%, 34 cases), primarily located in the right main bronchus (31.1%) and left lower lobe bronchus (22.2%). TFB in children with obscure medical histories presents non-specifically, highlighting bronchoscopy's pivotal role in diagnosis and treatment. Key Words: Bronchoscope, Paediatrics, Tracheobronchial foreign body, Diagnosis.


Assuntos
Brônquios , Broncoscopia , Corpos Estranhos , Tomografia Computadorizada por Raios X , Traqueia , Humanos , Corpos Estranhos/diagnóstico por imagem , Corpos Estranhos/diagnóstico , Masculino , Feminino , Brônquios/diagnóstico por imagem , Traqueia/diagnóstico por imagem , Pré-Escolar , Criança , Lactente , Tosse/etiologia , Sons Respiratórios/etiologia , Estudos Retrospectivos
8.
Zhongguo Zhen Jiu ; 44(5): 521-5, 2024 May 12.
Artigo em Chinês | MEDLINE | ID: mdl-38764101

RESUMO

OBJECTIVE: To evaluate the effect of transcutaneous electrical acupoint stimulation (TEAS) for alleviating postoperative cough in lung cancer patients undergoing video-assisted thoracoscopic surgery. METHODS: A total of 110 patients with lung cancer undergoing video-assisted thoracoscopic surgery were randomly divided into a TEAS group (55 cases, 2 cases dropped out) and a sham-TEAS group (55 cases, 4 cases dropped out). In the TEAS group, TEAS was delivered 30 min before anesthesia and on day 1 to day 4 after operation separately, with disperse-dense wave, in frequence of 2 Hz/100 Hz. The acupoints included Feishu (BL 13), Pishu (BL 20), Shenshu (BL 23), Hegu (LI 4), Lieque (LU 7) and Taixi (KI 3) on the both sides. In the sham-TEAS group, at the same time points and same acupoints as the TEAS group, the electrode pads were attached to the acupoints, but without electric stimulation. The interventions were given 30 min each time, once daily in the two groups. The incidence of cough and the scores of visual analogue scale (VAS) for cough on the first day (T1), the third day (T2), the fifth day (T3), 1 month (T4) and 3 months (T5) after operation, as well as the scores of the Leicester cough questionnaire (LCQ) on T4 and T5 were compared between the two groups; the contents of serum C-reactive protein (CRP), interleukin 6 (IL-6) and tumor necrosis factor α (TNF-α) were detected before surgery (T0) and at T1, T2 and T3. The first flatus time, the first defecation time, the first ambulation time, the postoperative hospital day and the incidence of postoperative nausea and vomiting were compared between the two groups. RESULTS: Compared with the sham-TEAS group, the cough incidence at T3 and cough VAS scores at T1 to T5 were lower in the TEAS group (P<0.05, P<0.01), and the LCQ scores at T4 and T5 were higher (P<0.05). The serum contents of CRP, IL-6 and TNF-αat T1 to T3 in the TEAS group were lower than those of the sham-TEAS group (P<0.01). The first flatus time, the first defecation time and the first ambulation time were earlier (P<0.05, P<0.01); and the postoperative hospital day was shorter (P<0.05) and the incidence of postoperative nausea and vomiting was lower (P<0.05) in the TEAS group when compared with those of the sham-TEAS group. CONCLUSION: TEAS relieves cough in lung cancer patients undergoing video-assisted thoracoscopic surgery, improves quality of life and promotes the early postoperative recovery.


Assuntos
Pontos de Acupuntura , Tosse , Neoplasias Pulmonares , Complicações Pós-Operatórias , Cirurgia Torácica Vídeoassistida , Estimulação Elétrica Nervosa Transcutânea , Humanos , Masculino , Tosse/etiologia , Tosse/terapia , Feminino , Pessoa de Meia-Idade , Neoplasias Pulmonares/cirurgia , Idoso , Adulto , Complicações Pós-Operatórias/terapia , Complicações Pós-Operatórias/etiologia , Interleucina-6/sangue , Fator de Necrose Tumoral alfa/sangue , Proteína C-Reativa/metabolismo
9.
NPJ Prim Care Respir Med ; 34(1): 9, 2024 May 09.
Artigo em Inglês | MEDLINE | ID: mdl-38724543

RESUMO

This cluster randomised clinical trial carried out in 20 primary care centres in Barcelona was aimed at assessing the effect of a continuous intervention focused on C-reactive protein (CRP) rapid testing and training in enhanced communication skills (ECS) on antibiotic consumption for adults with acute cough due to lower respiratory tract infection (LRTI). The interventions consisted of general practitioners and nurses' use of CRP point-of-care and training in ECS separately and combined, and usual care. The primary outcomes were antibiotic consumption and variation of the quality-adjusted life years during a 6-week follow-up. The difference in the overall antibiotic prescribing between the winter seasons before and after the intervention was calculated. The sample size calculated could not be reached due to the COVID-19 outbreak. A total of 233 patients were recruited. Compared to the usual care group (56.7%) antibiotic consumption among patients assigned to professionals in the ECS group was significantly lower (33.9%, adjusted odds ratio [aOR] 0.38, 95% CI 0.15-0.94, p = 0.037), whereas patients assigned to CRP consumed 43.8% of antibiotics (aOR 0.70, 95% CI 0.29-1.68, p = 0.429) and 38.4% in the combined intervention group (aOR 0.45, 95% CI, 0.17-1.21; p = 0.112). The overall antibiotic prescribing rates in the centres receiving training were lower after the intervention compared to those assigned to usual care, with significant reductions in ß-lactam rates. Patient recovery was similar in all groups. Despite the limited power due to the low number of patients included, we observed that continuous training achieved reductions in antibiotic consumption.


Assuntos
Antibacterianos , Proteína C-Reativa , Tosse , Humanos , Antibacterianos/uso terapêutico , Proteína C-Reativa/metabolismo , Proteína C-Reativa/análise , Masculino , Feminino , Pessoa de Meia-Idade , Tosse/tratamento farmacológico , Adulto , Comunicação , Doença Aguda , Infecções Respiratórias/tratamento farmacológico , Padrões de Prática Médica/estatística & dados numéricos , Idoso , Atenção Primária à Saúde/métodos , COVID-19/complicações , Espanha , Testes Imediatos
10.
Sci Rep ; 14(1): 11956, 2024 05 25.
Artigo em Inglês | MEDLINE | ID: mdl-38796481

RESUMO

The Montreal consensus recognizes chronic cough as an extra-esophageal manifestation of gastroesophageal reflux disease. We performed a meta-analysis to assess the effects of acid-suppressive medications in adults with non-specific chronic cough. The protocol was registered on PROSPERO (CRD42022368769). Placebo-controlled randomized trials evaluating the impact of acid-suppressive medications on persistent cough were included. The systematic search was performed on the 1st of November 2022 in three databases. A random-effects model was used for the calculations. The effect size was the standardized mean difference (SMD) with 95% confidence interval (CI). A total number of 11 double-blinded placebo-controlled randomized trials were included in the meta-analysis. Data showed that compared to placebo, PPIs decreased the severity of cough (SMD 0.33; CI 0.05; 0.61). Therapeutic response was not different in patients with non-specific chronic cough only, compared to those with laryngopharyngeal reflux. Prolonged treatment durations did not result in greater symptomatic improvement, with SMD 0.33 (CI - 0.22; 0.88), 0.31 (CI - 1.74; 2.35), 0.32 (CI - 0.29; 0.93) and 0.34 (CI - 0.16; 0.85), following 4, 6, 8 and 12 weeks of treatment, respectively. The pooled analysis of the improvement in quality of life with PPIs found an SMD of 0.39 (CI - 0.51; 1.29). PPIs mildly decrease the severity of non-specific chronic cough, irrespective of treatment duration.


Assuntos
Tosse , Inibidores da Bomba de Prótons , Inibidores da Bomba de Prótons/uso terapêutico , Tosse/tratamento farmacológico , Humanos , Doença Crônica , Refluxo Gastroesofágico/tratamento farmacológico , Ensaios Clínicos Controlados Aleatórios como Assunto , Índice de Gravidade de Doença , Resultado do Tratamento , Tosse Crônica
11.
Ther Adv Respir Dis ; 18: 17534666241252545, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38780129

RESUMO

BACKGROUND: Sex-related disparities in the prevalence of chronic cough have been consistently reported globally, with varying male-to-female ratios. OBJECTIVES: This study aimed to evaluate sex-related differences by comparing correlations between cough-related symptoms in males and females of different age groups. DESIGN: Adult patients with chronic cough who completed the Leicester Cough Questionnaire (LCQ) were recruited from 16 respiratory centers. METHODS: Correlation networks were constructed based on Spearman's correlation coefficients in males and females of various age groups. The distinct relationships of cough-related symptoms between subgroups were validated by an independent cohort. RESULTS: A total of 255 patients were enrolled in this study (male-to-female ratio, 1:1.71). The following LCQ items were highly correlated: embarrassment and interference with daily work, anxiety, and interference with overall life enjoyment/feeling of being fed up, interference with daily work and overall life enjoyment, interference with overall life enjoyment and feeling of being fed up, and feeling of being fed up and annoyance to partner/family/friends. The patterns of these correlations between LCQ items varied in males and females of different ages. The strongest interrelationship was observed in male patients aged >50 years old, which was similar to those in the validation cohort. CONCLUSION: The correlation patterns between cough-related symptoms vary significantly according to age and sex. Understanding the mechanisms underlying the development of cough-related symptoms may facilitate sex- and age-specific strategies for chronic cough.


Assuntos
Tosse , Humanos , Tosse/fisiopatologia , Tosse/epidemiologia , Tosse/psicologia , Masculino , Feminino , Pessoa de Meia-Idade , Adulto , Idoso , Fatores Sexuais , Fatores Etários , Inquéritos e Questionários , Doença Crônica , Disparidades nos Níveis de Saúde , Prevalência , Adulto Jovem
12.
Sci Rep ; 14(1): 11386, 2024 05 18.
Artigo em Inglês | MEDLINE | ID: mdl-38762573

RESUMO

Aspiration pneumonia is the leading cause of death in patients with Parkinson's disease. The incidence of silent aspiration is high in such patients owing to decreased pharyngeal and laryngeal sensation; thus, interventions for this condition may help prevent pneumonia. In this single-arm, open-label study, we used a cervical percutaneous interferential current stimulation device to activate pharyngeal and laryngeal sensory nerves. We evaluated its effectiveness in patients with Hoehn-Yahr stages 2-4 Parkinson's disease. The primary endpoint was the proportion of patients with a normal cough reflex after consuming 1% citric acid at the end of the intervention compared with baseline measurements. In total, 25 patients received neck percutaneous interferential current stimulation for 20 min twice weekly for 8 weeks. Afterward, the proportion of patients with a normal cough reflex after 1% citric acid consumption increased significantly (p = 0.001), whereas other indicators, such as tongue pressure, peak expiratory flow, and penetration or aspiration during videofluoroscopic examination, remained unchanged. A longer duration of illness, higher Unified Parkinson's Disease Rating Scale total scores, and higher levodopa equivalent daily doses were significantly associated with improved cough test outcomes. Hence, cervical percutaneous interferential current stimulation significantly improved cough reflexes and may improve silent aspiration. Trial Registration: Japan Registry of Clinical Trials, jRCTs062220013, first registered 09/05/2022.


Assuntos
Ácido Cítrico , Tosse , Doença de Parkinson , Humanos , Doença de Parkinson/terapia , Doença de Parkinson/fisiopatologia , Feminino , Masculino , Idoso , Tosse/tratamento farmacológico , Pessoa de Meia-Idade , Pneumonia Aspirativa/etiologia , Pneumonia Aspirativa/prevenção & controle , Terapia por Estimulação Elétrica/métodos
13.
BMC Pulm Med ; 24(1): 222, 2024 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-38714988

RESUMO

BACKGROUND: No objective indicator exists for evaluating cough strength during extubation of tracheally intubated patients. This study aimed to determine whether cough peak expiratory flow (CPEF) can predict the risk of reintubation due to decreased cough strength. METHODS: This was a retrospective cohort study of patients who were admitted to our Emergency Intensive Care Unit between September 1, 2020 and August 31, 2021 and were under artificial ventilation management for ≥ 24 h. The patients were divided into two groups: successful extubation and reintubation groups, and the relationship between CPEF immediately before extubation and reintubation was investigated. RESULTS: Seventy-six patients were analyzed. In the univariate analysis, CPEF was significantly different between the successful extubation (90.7 ± 25.9 L/min) and reintubation (57.2 ± 6.4 L/min) groups (p < 0.001). In the multivariate analysis with age and duration of artificial ventilation as covariates, CPEF was significantly lower in the reintubation group (p < 0.01). The cutoff value of CPEF for reintubation according to the receiver operating characteristic curve was 60 L/min (area under the curve, 0.897; sensitivity, 78.5%; specificity, 90.9%; p < 0.01). CONCLUSION: CPEF in tracheally intubated patients may be a useful indicator for predicting the risk of reintubation associated with decreased cough strength. The cutoff CPEF value for reintubation due to decreased cough strength was 60 L/min.


Assuntos
Extubação , Tosse , Intubação Intratraqueal , Humanos , Tosse/fisiopatologia , Masculino , Feminino , Estudos Retrospectivos , Pico do Fluxo Expiratório , Pessoa de Meia-Idade , Projetos Piloto , Idoso , Respiração Artificial/métodos , Curva ROC , Unidades de Terapia Intensiva
14.
Lung ; 202(3): 275-280, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38733542

RESUMO

This study aimed to investigate the effects of high-dose inhaled corticosteroids (ICS) on chronic cough patients with elevated fractional exhaled nitric oxide (FeNO) levels. In a prospective study, adults with chronic cough and FeNO ≥ 25 ppb, without any other apparent etiology, received fluticasone furoate (200 mcg) for three weeks. Outcomes were evaluated using FeNO levels, cough severity, and Leicester Cough Questionnaire (LCQ) before and after treatment. Of the fifty participants (average age: 58.4 years; 58% female), the treatment responder rate (≥ 1.3-point increase in LCQ) was 68%, with a significant improvement in cough and LCQ scores and FeNO levels post-treatment. However, improvements in cough did not significantly correlate with changes in FeNO levels. These findings support the guideline recommendations for a short-term ICS trial in adults with chronic cough and elevated FeNO levels, but the lack of correlations between FeNO levels and cough raises questions about their direct mechanistic link.


Assuntos
Tosse , Óxido Nítrico , Humanos , Tosse/tratamento farmacológico , Feminino , Pessoa de Meia-Idade , Masculino , Estudos Prospectivos , Administração por Inalação , Doença Crônica , Óxido Nítrico/metabolismo , Óxido Nítrico/análise , Idoso , Resultado do Tratamento , Teste da Fração de Óxido Nítrico Exalado , Androstadienos/administração & dosagem , Adulto , Índice de Gravidade de Doença , Inquéritos e Questionários , Expiração , Corticosteroides/administração & dosagem , Tosse Crônica
15.
CMAJ ; 196(19): E679-E680, 2024 May 20.
Artigo em Francês | MEDLINE | ID: mdl-38772603
16.
Clin Respir J ; 18(5): e13773, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38725329

RESUMO

BACKGROUND: Pulmonary alveolar microlithiasis (PAM) is a rare autosomal recessive genetic disorder with approximately 1000 known cases worldwide, in which calcium phosphate microliths deposit in the alveolar air spaces. As of writing this report, no definitive conventional therapy exists, and many PAM cases may progress to severe respiratory failure and potential death. Bilateral lung transplantation (BLx) seems to be the most optimal solution; however, this procedure is challenging along with limited reports regarding the outcome in PAM. We report a case of PAM successfully treated with BLx for the first time in Iran. METHOD: We present the case of a 42-year-old female with a longstanding history of cough, not responding to conventional antitussive medication, who was diagnosed as a case of PAM following a hospitalization due to coughing, dyspnea on exertion, and hemoptysis. Despite treatment with corticosteroid and medical treatment, no improvement was achieved and she subsequently developed respiratory and right ventricular failure, with oxygen ventilation dependence. Eventually, she was scheduled for BLx. The operation was successful and during her 2-year follow-up, no recurrence or significant postoperative complications has been reported. CONCLUSION: This case presentation and literature review confirm the effectiveness of BLx as a promising treatment for PAM-diagnosed patients, improving both life expectancy and quality of life.


Assuntos
Calcinose , Pneumopatias , Transplante de Pulmão , Humanos , Feminino , Transplante de Pulmão/métodos , Adulto , Pneumopatias/cirurgia , Pneumopatias/complicações , Calcinose/cirurgia , Calcinose/complicações , Calcinose/diagnóstico , Resultado do Tratamento , Doenças Genéticas Inatas/cirurgia , Doenças Genéticas Inatas/complicações , Doenças Genéticas Inatas/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Tosse/etiologia , Irã (Geográfico) , Qualidade de Vida
17.
Muscle Nerve ; 70(1): 140-147, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38742544

RESUMO

INTRODUCTION/AIMS: Evaluations of pulmonary, cough, and swallow function are frequently performed to assess disease progression in amyotrophic lateral sclerosis (ALS), yet the relationship between these functions remains unknown. We therefore aimed to determine relationships between these measures in individuals with ALS. METHODS: One hundred individuals with ALS underwent standardized tests: forced vital capacity (FVC), maximum expiratory/inspiratory pressure (MEP, MIP), voluntary cough peak expiratory flow (PEF), and videofluoroscopic swallow evaluation (VF). Duplicate raters completed independent, blinded ratings using the Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) scale. Descriptives, Spearman's Rho correlations, Kruskal-Wallis analyses, and Pearson's chi-squared tests were completed. RESULTS: Mean and standard deviation across pulmonary and cough measures were FVC: 74.2% predicted (± 22.6), MEP: 91.6 cmH2O (± 46.4), MIP cmH2O: 61.1 (± 28.9), voluntary PEF: 352.7 L/min (± 141.6). DIGEST grades included: 0 (normal swallowing): 31%, 1 (mild dysphagia): 48%, 2 (moderate dysphagia): 10%, 3 (severe dysphagia): 10%, and 4 (life-threatening dysphagia): 1%. Positive correlations were observed: MEP-MIP: r = .76, MIP-PEF: r = .68, MEP-PEF: r = .61, MIP-FVC: r = .60, PEF-FVC: r = .49, and MEP-FVC: r = .46, p < .0001. MEP (p = .009) and PEF (p = .04) differed across DIGEST safety grades. Post hoc analyses revealed significant between group differences in MEP and PEF across DIGEST safety grades 0 versus 1 and grades 0 versus 3, (p < .05). DISCUSSION: In this cohort of individuals with ALS, pulmonary function, and voluntary cough were associated. Expiratory metrics (MEP, PEF) were diminished in individuals with unsafe swallowing, increasing their risk for effectively defending the airway.


Assuntos
Esclerose Lateral Amiotrófica , Tosse , Transtornos de Deglutição , Deglutição , Humanos , Esclerose Lateral Amiotrófica/fisiopatologia , Esclerose Lateral Amiotrófica/complicações , Masculino , Tosse/fisiopatologia , Tosse/etiologia , Feminino , Pessoa de Meia-Idade , Idoso , Deglutição/fisiologia , Transtornos de Deglutição/fisiopatologia , Transtornos de Deglutição/etiologia , Capacidade Vital/fisiologia , Adulto , Pulmão/fisiopatologia , Pulmão/diagnóstico por imagem , Fluoroscopia , Testes de Função Respiratória
18.
Eur J Oncol Nurs ; 70: 102598, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38795440

RESUMO

PURPOSE: This study was designed to evaluate the effect of acupuncture on cough, expectoration, and shortness of breath in lung cancer patients. METHODS: Between December 2021 and June 2022, a total of 130 lung cancer patients were recruited, and they were split into control and intervention groups at random. Routine nursing was provided to the control group, whereas routine nursing with acupuncture using LU7 (Lie Que), LU9 (Tai Yuan), BL13 (Fei Shu), and BL20 (Pi Shu) was administered to the intervention group for 7 days. The severity of cough, expectoration, and shortness of breath was assessed 1 day before and after the interventions using the lung cancer-specific module of the MDASI. A two-way ANOVA was performed for group comparisons. RESULTS: Compared with the control group, the symptoms of cough in the intervention group were significantly improved (F = 5.095, MD = -0.32, 95% CI, -0.59 to 0.04, P = 0.025), while expectoration (F = 0.626, MD = -0.11, 95% CI, -0.38 to 0.16, P = 0.430) and shortness of breath (F = 0.165, MD = -0.05, 95% CI, -0.27 to 0.18, P = 0.685) had no significant change. Cough also identified an obvious interaction effect (P = 0.014), and the post-intervention simple main effect test demonstrated a tangible difference between the two groups (MD = -0.66, 95% CI, -0.99 to 0.33, P < 0.001) post-intervention. CONCLUSIONS: Acupuncture using LU7, LU9, BL13, and BL20 can relieve the cough of lung cancer patients, but not relieve expectoration and shortness of breath.


Assuntos
Terapia por Acupuntura , Tosse , Neoplasias Pulmonares , Humanos , Tosse/terapia , Tosse/etiologia , Neoplasias Pulmonares/complicações , Masculino , Feminino , Pessoa de Meia-Idade , Terapia por Acupuntura/métodos , Idoso , Resultado do Tratamento , Dispneia/terapia , Dispneia/etiologia , Adulto
19.
Drug Des Devel Ther ; 18: 1603-1612, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38774482

RESUMO

Background: Cough is one of the most common complications following intravenous administration of sufentanil during anesthesia induction. The study aimed to investigate the protective effect of alfentanil, afentanyl derivative with short onset time and short duration, in reducing sufentanil-induced cough. Patients and methods: Eighty patients that scheduled for thyroid surgery under general anesthesia were randomly divided into the alfentanil group and normal saline group, with 40 cases per group. Patients in the alfentanil group received intravenous administration of 2 µg/kg alfentanil prior to sufentanil injection during general anesthesia induction, while the same dose of normal saline was administered in the normal saline group. The outcomes measures included the incidence and severity of cough and common side effects of opioids following the administration of sufentanil during the induction of general anesthesia, intraoperative hemodynamics parameters and major adverse events during anesthesia recovery period. Results: The incidence of cough within one minute after the injection of sufentanil during anesthesia induction was 40% in the normal saline group, and the pretreatment of alfentanil significantly reduced the incidence of sufentanil-induced cough to 5% (p < 0.05). Correspondingly, the patients in the alfentanil group had decreased severity of sufentanil-induced cough compared with the normal saline group (p < 0.05). No significant differences in the incidences of common side effects of opioids (dizziness, nausea and vomiting, chest tightness and respiratory depression) within one minute after sufentanil injection were found (p > 0.05). Furthermore, there were no significant differences between the two groups in intraoperative hemodynamic parameters, extubation time, or the incidences of emergence agitation, respiratory depression, delayed recovery from anesthesia and postoperative nausea and vomiting during Postanesthesia Care Unit stay (p > 0.05). Conclusion: Pretreatment with low-dose alfentanil (2 µg/kg) effectively and safely reduced both the incidence and severity of sufentanil-induced cough during anesthesia induction. Clinical Trial Registration Number: Chinese Clinical Trial Registry (identifier: ChiCTR2300069286).


Assuntos
Alfentanil , Tosse , Sufentanil , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Alfentanil/administração & dosagem , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/efeitos adversos , Anestesia Geral/efeitos adversos , Tosse/induzido quimicamente , Tosse/prevenção & controle , Relação Dose-Resposta a Droga , Método Duplo-Cego , Estudos Prospectivos , Sufentanil/administração & dosagem , Sufentanil/efeitos adversos
20.
J Dermatolog Treat ; 35(1): 2355976, 2024 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-38797745

RESUMO

PURPOSE: Based on a potential shared pathophysiology tied to mast cell activity and neurogenic inflammation that may link pruritus and chronic cough (CC), this study, leveraging the All of Us database, examines the association between the two conditions. MATERIALS AND METHODS: A nested case-control comparison was used to examine the association, identifying cases with SNOMED codes 418363000 (pruritus) and 68154008 (CC). Matching was performed on a 1:4 ratio by age, sex, and ethnicity using the MatchIt package in R, followed by maximum likelihood method to estimate odds ratios (ORs) and 95% confidence intervals from 2x2 contingency tables. RESULTS: CC patients (n = 2,388) were more than twice as likely to be diagnosed with pruritus (OR: 2.65) and pruritus patients (n = 22,496) were more than twice as likely to be diagnosed with CC (OR: 2.57), than respective matched controls. CONCLUSIONS: These results highlight the potential bidirectional relationship between CC and pruritus, suggesting possible shared immune and neural pathways. Treatments like difelikefalin and nalbuphine that modulate these pathways, alongside P2X3 targeting agents, are emerging as potential therapeutic approaches for itch and chronic cough given the possible interconnected pathophysiology. This study's insights into the associations between pruritus and CC may pave the way for targeted therapeutic strategies that address their shared mechanisms.


Assuntos
Tosse , Prurido , Humanos , Masculino , Feminino , Prurido/etiologia , Estudos de Casos e Controles , Doença Crônica , Tosse/etiologia , Tosse/fisiopatologia , Pessoa de Meia-Idade , Estados Unidos , Adulto , Bases de Dados Factuais , Idoso , Adulto Jovem , Adolescente , Tosse Crônica
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