Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 16.949
Filtrar
1.
J Korean Med Sci ; 36(42): e295, 2021 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-34725979

RESUMO

BACKGROUND: To minimize nosocomial infection against coronavirus disease 2019 (COVID-19), most hospitals conduct a prescreening process to evaluate the patient or guardian of any symptoms suggestive of COVID-19 or exposure to a COVID-19 patient at entrances of hospital buildings. In our hospital, we have implemented a two-level prescreening process in the outpatient clinic: an initial prescreening process at the entrance of the outpatient clinic (PPEO) and a second prescreening process is repeated in each department. If any symptoms or epidemiological history are identified at the second level, an emergency code is announced through the hospital's address system. The patient is then guided outside through a designated aisle. In this study, we analyze the cases missed in the PPEO that caused the emergency code to be applied. METHODS: All cases reported from March 2020 to April 2021 were analyzed retrospectively. We calculated the incidence of cases missed by the PPEO per 1,000 outpatients and compared the incidence between first-time hospital visitors and those visiting for the second time or more; morning and afternoon office hours; and days of the week. RESULTS: During the study period, the emergency code was applied to 449 cases missed by the PPEO. Among those cases, 20.7% were reported in otorhinolaryngology, followed by 11.6% in gastroenterology, 5.8% in urology, and 5.8% in dermatology. Fever was the most common symptom (59.9%), followed by cough (19.8%). The incidence of cases per 1,000 outpatients was significantly higher among first-time visitors than among those visiting for the second time or more (1.77 [confidence interval (CI), 1.44-2.10] vs. 0.59 [CI, 0.52-0.65], respectively) (P < 0.001). CONCLUSION: Fever was the most common symptom missed by the PPEO, and otorhinolaryngology and gastroenterology most frequently reported missed cases. Cases missed by the PPEO were more likely to occur among first-time visitors than returning visitors. The results obtained from this study can provide insights or recommendations to other healthcare facilities in operating prescreening processes during the COVID-19 pandemic.


Assuntos
Instituições de Assistência Ambulatorial/estatística & dados numéricos , COVID-19/diagnóstico , COVID-19/prevenção & controle , Tosse/etiologia , Febre/etiologia , Programas de Rastreamento/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Assistência Ambulatorial , COVID-19/epidemiologia , Criança , Feminino , Humanos , Incidência , Controle de Infecções , Masculino , Programas de Rastreamento/organização & administração , Pessoa de Meia-Idade , Pandemias , Adulto Jovem
2.
Indian J Tuberc ; 68(4): 527-528, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34752324

RESUMO

A 26 year old female presented with complaints of high grade fever and cough for 10 days. Nasopharyngeal swab tested for COVID-19 RT-PCR at admission was negative. Clinical examination suggested a patch of bronchial breathing in left infrascapular region and bilateral diffuse rhonchi. Chest X-ray was suggestive of left lower zone consolidation. HRCT showed a large patch of consolidation with GGO along with a cavitary lesion involving left lower lobe. Sputum for RT-PCR COVID 19 was positive. Patient was managed as per covid-19 protocol, subsequently showing clinical and radiological improvement.


Assuntos
COVID-19/diagnóstico , Pulmão/diagnóstico por imagem , Escarro/virologia , Tomografia Computadorizada por Raios X/métodos , Adulto , Broncoscopia , Teste de Ácido Nucleico para COVID-19 , Teste para COVID-19 , Tosse/etiologia , Feminino , Febre/etiologia , Humanos , Radiografia , SARS-CoV-2
3.
Sensors (Basel) ; 21(21)2021 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-34770341

RESUMO

Pneumonia is a serious disease often accompanied by complications, sometimes leading to death. Unfortunately, diagnosis of pneumonia is frequently delayed until physical and radiologic examinations are performed. Diagnosing pneumonia with cough sounds would be advantageous as a non-invasive test that could be performed outside a hospital. We aimed to develop an artificial intelligence (AI)-based pneumonia diagnostic algorithm. We collected cough sounds from thirty adult patients with pneumonia or the other causative diseases of cough. To quantify the cough sounds, loudness and energy ratio were used to represent the level and its spectral variations. These two features were used for constructing the diagnostic algorithm. To estimate the performance of developed algorithm, we assessed the diagnostic accuracy by comparing with the diagnosis by pulmonologists based on cough sound alone. The algorithm showed 90.0% sensitivity, 78.6% specificity and 84.9% overall accuracy for the 70 cases of cough sound in pneumonia group and 56 cases in non-pneumonia group. For same cases, pulmonologists correctly diagnosed the cough sounds with 56.4% accuracy. These findings showed that the proposed AI algorithm has value as an effective assistant technology to diagnose adult pneumonia patients with significant reliability.


Assuntos
Inteligência Artificial , Pneumonia , Adulto , Algoritmos , Tosse/diagnóstico , Humanos , Pneumonia/diagnóstico , Reprodutibilidade dos Testes
4.
Front Public Health ; 9: 726491, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34778170

RESUMO

Introduction: The roles of some indicators in the prognosis of patients with coronavirus disease-19 (COVID-19) remain unclear and controversial. This study aimed to explore the epidemiologic characteristics of and prognostic factors for COVID-19 to provide updated recommendations for its prevention, diagnosis, and treatment. Methods: For this retrospective study, demographic, epidemiologic, and clinical data were extracted from the medical records of patients admitted to the Maternal and Child Hospital of Hubei Province (Optical Valley) with COVID-19 between February 19, 2020, and March 19, 2020. The primary outcome was the prognosis that was determined at discharge as mentioned in the medical records. Descriptive statistics, univariate analyses, and stepwise logistic regression analysis were used for data analysis. Results: Of the 1,765 patients included, 93.1% were cured and the mortality was 1.8%. Univariate analyses identified 63 factors significantly associated with COVID-19 prognosis. Logistic regression analysis revealed that a poorer prognosis was associated with undergoing resuscitation, complex disease manifestations, consultation with outside specialists, elevated basophil or lymphocyte counts, an albumin (ALB)/globulin (A/G) ratio > 2.4, and elevated levels of serum aspartate aminotransferase (AST) or creatinine. Patients had a better prognosis if the following conditions were met: dry cough reported as an initial symptom, fatigue as a clinical manifestation, and a diagnosis based on laboratory testing. Conclusion: To prevent clinical deterioration, clinicians should provide special care to patients who underwent resuscitation, with a critical disease, or requiring consultation with outside specialists. Extra attention should be paid to patients with high basophil or lymphocyte counts, a high A/G ratio, and elevated AST or creatinine levels.


Assuntos
COVID-19 , Criança , Tosse , Humanos , Prognóstico , Estudos Retrospectivos , SARS-CoV-2
7.
Ann Palliat Med ; 10(10): 11209-11215, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34763478

RESUMO

Eosinophilic granulomatosis with polyangiitis (EGPA), formerly called Churg-Strauss syndrome, is a rare chronic necrotizing eosinophilic granulomatous inflammatory disease characterized by eosinophil-rich granulomatous inflammation and small- to medium-size vessel vasculitis associated with bronchial asthma and eosinophilia, which is positive for anti-neutrophil cytoplasmic antibody (ANCA) in approximately 50-70% of cases. We report a case of a 23-year-old woman was admitted to our hospital because of a of small vesicles on both lower limbs and a 4-month history of small scattered skin rash with pruritus V6 on both lower limbs four-month history of scattered skin rash with pruritus. Laboratory data from peripheral blood revealed leukocytosis, eosinophilia, thrombocytosis, hyperfibrinolysis, and mild renal injury. Her ANCA was negative, and the skin pathological examination showed granuloma lesions with eosinophils, while elevated eosinophils were also found in the bone marrow. EGPA was diagnosed. On the other hand, the patient had 2-year-long rhinosinusitis, 9-month-long nephrotic syndrome, and 1-month-long dry cough, which might be a type of asthma. With steroid therapy followed by systemic immunomodulatory therapy, the patient's symptoms were relieved. Our case report and literature review highlight the importance of recognizing cough variant asthma as an initial presenting symptom of EGPA, providing an opportunity for early diagnosis and treatment to reduce the risk of further disease progression and morbidity.


Assuntos
Asma , Síndrome de Churg-Strauss , Granulomatose com Poliangiite , Anticorpos Anticitoplasma de Neutrófilos , Síndrome de Churg-Strauss/complicações , Síndrome de Churg-Strauss/diagnóstico , Tosse/etiologia , Feminino , Granulomatose com Poliangiite/complicações , Granulomatose com Poliangiite/diagnóstico , Humanos , Adulto Jovem
9.
Zhongguo Dang Dai Er Ke Za Zhi ; 23(10): 1044-1049, 2021 Oct 15.
Artigo em Inglês, Chinês | MEDLINE | ID: mdl-34719421

RESUMO

OBJECTIVES: To study the expression levels of microRNA-138 (miR-138) and Runt-related transcription factor 3 (RUNX3) in peripheral blood of children with cough variant asthma (CVA) and their regulatory effects on Th1/Th2 balance. METHODS: Sixty-five children with CVA (CVA group) and 30 healthy children (control group) were enrolled. Peripheral venous blood samples were collected for both groups, and CD4+ T cells were isolated and cultured. Enzyme-linked immunosorbent assay was used to measure the levels of interferon (IFN)-γ, interleukin (IL)-2, IL-4, IL-5, and IL-13 that were secreted by CD4+ T cells. Flow cytometry was used to determine the percentages of Th1 and Th2 cells. Quantitative real-time PCR was used to measure the level of RUNX3 mRNA in CD4+ T cells and the level of miR-138 in peripheral blood. Western blot was used to determine the protein expression of RUNX3 in CD4+ T cells. The dual-luciferase reporter assay was used to determine the targeting effects of miR-138 and RUNX3. The RUNX3-mimic plasmid was transfected into CD4+ T cells, and the effects on the levels of IFN-γ, IL-2, IL-4, IL-5, and IL-13 and the percentages of Th1 and Th2 cells were measured. RESULTS: Compared with the control group, the CVA group showed significantly decreased levels of IFN-γ and IL-2 from CD4+ T cells, significantly increased levels of IL-4, IL-5, and IL-13 from CD4+ T cells, significantly decreased Th1 cell percentage and Th1/Th2 ratio, and a significantly increased Th2 cell percentage (P<0.05). The CVA group showed significantly lower relative expression levels of RUNX3 mRNA and protein in CD4+ T cells in peripheral blood than the control group (P<0.001). The relative expression level of miR-138 was significantly higher in the CVA group than in the control group (P<0.001). MiR-138 could target the expression of RUNX3. Upregulating the expression of RUNX3 in CD4+ T cells induced significantly increased levels of IFN-γ and IL-2, significantly decreased levels of IL-4, IL-5, and IL-13, significantly increased Th1 cell percentage and Th1/Th2 ratio, and a significantly decreased Th2 cell percentage (P<0.05). CONCLUSIONS: MiR-138 regulates Th1/Th2 balance by targeting RUNX3 in children with CVA, providing a new direction for the treatment of CVA.


Assuntos
Asma , MicroRNAs , Criança , Subunidade alfa 3 de Fator de Ligação ao Core/genética , Tosse , Humanos , Interleucina-13 , MicroRNAs/genética , Células Th1 , Equilíbrio Th1-Th2 , Células Th2
10.
Drug Discov Ther ; 15(5): 254-260, 2021 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-34719599

RESUMO

Post COVID-19 sequelae are a constellation of symptoms often reported after recovering from COVID-19. There is a need to better understand the clinical spectrum and long-term course of this clinical entity. The aim of this study is to describe the clinical features and risk factors of post COVID-19 sequelae in the North Indian population. This prospective observational study was conducted at a tertiary healthcare centre in Northern India between October 2020 and February 2021. Patients aged >18 years with laboratory-confirmed COVID-19 were recruited after at least two weeks of diagnosis, and details were captured. A total of 1234 patients were recruited and followed up for a median duration of 91 days (IQR: 45-181 days). Among them, 495 (40.1%) had persistent symptoms post-discharge or recovery. In 223 (18.1%) patients, the symptoms resolved within four weeks; 150 (12.1%) patients had symptoms till 12 weeks, and 122 (9.9%) patients had symptoms beyond 12 weeks of diagnosis/symptom-onset of COVID-19. Most common symptoms included myalgia (10.9%), fatigue (5.5%), shortness of breath (6.1%), cough (2.1%), insomnia (1.4%), mood disturbances (0.48%) and anxiety (0.6%). Patients who were hospitalized were more likely to report fatigue as a feature of long COVID. Hypothyroidism (OR: 4.13, 95% CI: 2.2-7.6, p-value < 0.001) and hypoxia (SpO2 ≤ 93%) (OR: 1.7, 95% CI: 1.1-2.4, p-value 0.012) were identified as risk factors for long COVID sequelae. In conclusion, long COVID symptoms were common (22%), and 9.9% had the post COVID-19 syndrome. Myalgias, fatigue and dyspnoea were common symptoms. Patients with hypothyroidism and hypoxia during acute illness were at higher risk of long COVID.


Assuntos
COVID-19/complicações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19/epidemiologia , COVID-19/etiologia , COVID-19/patologia , Tosse/epidemiologia , Tosse/etiologia , Dispneia/epidemiologia , Dispneia/etiologia , Fadiga/epidemiologia , Fadiga/etiologia , Feminino , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Mialgia/epidemiologia , Mialgia/etiologia , Estudos Prospectivos , Fatores de Risco , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Distúrbios do Início e da Manutenção do Sono/etiologia , Adulto Jovem
11.
Biomed Res Int ; 2021: 6671291, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34796234

RESUMO

Background: With the COVID-19 epidemic breakout in China, up to 25% of diagnosed cases are considered to be severe. To effectively predict the progression of COVID-19 via patients' clinical features at an early stage, the prevalence of these clinical factors and their relationships with severe illness were assessed. Methods: In this study, electronic databases (PubMed, Embase, Web of Science, and Chinese database) were searched to obtain relevant studies, including information on severe patients. Publication bias analysis, sensitivity analysis, prevalence, sensitivity, specificity, likelihood ratio, diagnosis odds ratio calculation, and visualization graphics were achieved through software Review Manager 5.3, Stata 15, Meta-DiSc 1.4, and R. Results: Data of 3.547 patients from 24 studies were included in this study. The results revealed that patients with chronic respiratory system diseases (pooled positive likelihood 6.07, 95% CI: 3.12-11.82), chronic renal disease (4.79, 2.04-11.25), cardiovascular disease (3.45, 2.19-5.44), and symptoms of the onset of chest tightness (3.8, 1.44-10.05), shortness of breath (3.18, 2.24-4.51), and diarrhea (2.04, 1.38-3.04) exhibited increased probability of progressing to severe illness. C-reactive protein, ratio of neutrophils to lymphocytes, and erythrocyte sedimentation rate increased a lot in severe patients compared to nonsevere. Yet, it was found that clinical features including fever, cough, and headache, as well as some comorbidities, have little warning value. Conclusions: The clinical features and laboratory examination could be used to estimate the process of infection in COVID-19 patients. The findings contribute to the more efficient prediction of serious illness for patients with COVID-19 to reduce mortality.


Assuntos
COVID-19/epidemiologia , COVID-19/etiologia , Proteína C-Reativa/análise , Doenças Cardiovasculares/epidemiologia , Comorbidade , Tosse/virologia , Diabetes Mellitus/epidemiologia , Feminino , Febre/virologia , Testes Hematológicos , Humanos , Hipertensão/epidemiologia , Masculino , Índice de Gravidade de Doença
12.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 52(5): 859-861, 2021 Sep.
Artigo em Chinês | MEDLINE | ID: mdl-34622606

RESUMO

In this study, we report on three immunocompetent children with pulmonary cryptococcosis presenting mediastinal lymphadenopathy as the prominent manifestation. All three children were otherwise healthy previously. Two children had a history of exposure to pigeons and poultry. All three presented persistent fever accompanied by mild cough. There were no obvious positive signs in the lungs. One patient had enlarged cervical lymph nodes. All three had elevated levels of white blood cells, neutrophil count, and C-reactive protein (CRP). The levels of IgG, IgM, IgA, IgE and T cell subsets were normal in all cases, and they were all tested negative for HIV antibody. Two children were tested positive for serum cryptococcal antigen (sCRAG). The chest X-ray and pulmonary CT findings of the three patients all demonstrated marked enlargement of mediastinal lymph nodes, and one patient had nodules in the parenchyma. Surgical biopsies of mediastinal lymph nodes were performed in two children and large numbers of capsule spores were found in the histological examination. In the three cases, definitive diagnosis of pulmonary cryptococcosis were made in two patients, and clinical diagnosis was made in the third patient. Two patients were treated with fluconazole alone. The other patient whose condition was complicated with spleen infection was treated with fluconazole combined with amphotericin B for the first month, and was then given fluconazole for maintenance treatment. The overall treatment course lasted 5-9 months and all three were cured eventually. In conclusion, immunocompetent children with pulmonary cryptococcosis may present mediastinal lymphadenopathy as a prominent or isolated manifestation, which should be considered in differential diagnosis. Treatment with fluconazole alone or in combination with amphotericin B when it was necessary showed good therapeutic outcomes.


Assuntos
Criptococose , Linfadenopatia , Criança , Tosse , Criptococose/complicações , Criptococose/diagnóstico , Criptococose/tratamento farmacológico , Humanos , Pulmão , Linfonodos
14.
MMW Fortschr Med ; 163(18): 27, 2021 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-34652650

Assuntos
Tosse , Humanos
18.
Am J Case Rep ; 22: e932945, 2021 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-34645779

RESUMO

BACKGROUND Chronic cough is a common medical concern. Giant cell arteritis (GCA) is an uncommon cause of chronic cough and is not usually suspected since symptoms can be non-specific. We present a case of chronic cough due to GCA in which symptoms were subtle but imaging was remarkable and clearly disclosed the diagnosis. CASE REPORT A 71-year-old woman presented to the pulmonary clinic with a concern of worsening cough for 4 months. She had been treated with proton pump inhibitor, intranasal steroids, and antibiotics, without improvement. Other symptoms were an occasional headache for the prior 5 months, but this had resolved. She had a history of early-stage breast and thyroid cancers, both of which were treated surgically several years earlier and were in remission. Results of a physical examination including flexible video laryngoscopy of the upper airway were completely normal. Laboratory investigations showed normal blood chemistries and blood cell counts. Her C-reactive protein level was 1 mg/L (upper limit of normal <10) but her erythrocyte sedimentation level was 121 mm/hr (upper limit of normal <30). A positron emission tomography (PET) scan was performed as surveillance for her prior cancers. This showed diffuse tracer uptake in the aorta as well as bilateral common carotid, subclavian, and common iliac arteries, revealing GCA as the underlying diagnosis. CONCLUSIONS Giant cell arteritis is a rare cause of chronic cough. Other symptoms can be subtle or non-specific as in our case, and a high index of suspicion is needed to obtain a temporal artery biopsy. In these cases, imaging adjuncts can provide a non-invasive diagnosis.


Assuntos
Arterite de Células Gigantes , Idoso , Aorta , Tosse/etiologia , Feminino , Arterite de Células Gigantes/complicações , Arterite de Células Gigantes/diagnóstico , Humanos , Artéria Ilíaca , Tomografia por Emissão de Pósitrons
20.
Intern Med ; 60(19): 3081-3086, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34602522

RESUMO

Objective This study aimed to elucidate the effects of early macrolide administration on genetically confirmed pertussis-induced cough in adolescents and adults. Methods This single-center, retrospective cohort study examined the effects of the early administration of macrolides and antitussive agents on cough secondary to pertussis. We divided the patients into two groups based on the median duration from the beginning of the cough to the initiation of macrolide administration: early macrolide administration group (EMAG) and non-early macrolide administration group (NEMAG). The clinical improvement of cough was defined as maintaining a cough awareness score of ≤3 points for 3 consecutive days. Patients The medical records of 40 patients diagnosed with pertussis (≥12 years old) who were able to maintain a cough diary and received no other antibiotics aside from macrolides were included in the study. A diagnosis of pertussis was made using the loop-mediated isothermal amplification (LAMP) test. Results The EMAG (24 patients) showed a significantly shorter total cough period than the NEMAG [16 patients; 20.0 (95% confidence interval (CI), 16-28) vs. 30.5 (95% CI, 27-40) days; log-rank test, p=0.002]. There was no significant difference in the post-administration cough periods between the EMAG and NEMAG [11.0 (95% CI, 7-19) vs. 13.0 (95% CI, 5-23) days; log-rank test, p=0.232]. Antitussive agents did not affect the cough. Conclusion The early administration of macrolides, but not antitussive agents, is effective for treating pertussis. Therefore, macrolides should be administered as soon as possible for this disease.


Assuntos
Coqueluche , Adolescente , Adulto , Antibacterianos/uso terapêutico , Bordetella pertussis , Criança , Tosse/tratamento farmacológico , Humanos , Macrolídeos , Técnicas de Diagnóstico Molecular , Técnicas de Amplificação de Ácido Nucleico , Estudos Retrospectivos , Coqueluche/tratamento farmacológico , Coqueluche/epidemiologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...