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1.
Med Gas Res ; 12(1): 28-31, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34472500

RESUMO

Oxygen application and apneic oxygenation may reduce the risk of hypoxemia due to apnea during awake fiberoptic intubation or failed endotracheal intubation. High flow devices are recommended, but their effect compared to moderate deep oropharyngeal oxygen application is unknown. Designed as an experimental manikin trial, we made a comparison between oxygen application via nasal prongs at 10 L/min (control group), applying oxygen via oropharyngeal oxygenation device (at 10 L/min), oxygen application via high flow nasal oxygen with 20 L/min and 90% oxygen (20 L/90% group), oxygen application via high flow nasal oxygen with 60 L/min and 45% oxygen (60 L/45% group), and oxygen application via sealed face mask with a special adapter to allow for fiberoptic entering of the airway. We preoxygenated the lung of a manikin and measured the decrease in oxygen level during the following 20 minutes for each way of oxygen application. Oxygen levels fell from 97 ± 1% at baseline to 75 ± 1% in control group, and to 86 ± 1% in oropharyngeal oxygenation device group. In the high flow nasal oxygen group, oxygen level dropped to 72 ± 1% in the 20 L/90% group and to 44 ± 1% in the 60 L/45% group. Oxygen level remained at 98 ± 0% in the face mask group. In conclusion, in this manikin simulation study of apneic oxygenation, oxygen insufflation using a sealed face mask kept oxygen levels in the test lung at 98% over 20 minutes, oral oxygenation device led to oxygen levels at 86%, whereas all other methods resulted in the decrease of oxygen levels below 75%.


Assuntos
Apneia , Intubação Intratraqueal , Apneia/terapia , Humanos , Pulmão , Manequins , Oxigenoterapia , Respiração Artificial
2.
J Intensive Care Med ; 37(1): 120-127, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33412988

RESUMO

INTRODUCTION: In infants hospitalized for bronchiolitis on non-invasive ventilation (NIV) via the RAM cannula nasal interface, variables predicting subsequent intubation, or NIV non-response, are understudied. We sought to identify predictors of NIV non-response. METHODS: We performed a retrospective cohort study in infants admitted for respiratory failure from bronchiolitis placed on NIV in a quaternary children's hospital. We excluded children with concurrent sepsis, critical congenital heart disease, or with preexisting tracheostomy. The primary outcome was NIV non-response defined as intubation after a trial of NIV. Secondary outcomes were vital sign values before and after NIV initiation, duration of NIV and intubation, and mortality. Primary analyses included Chi-square, Wilcoxon rank-sum, student's t test, paired analyses, and adjusted and unadjusted logistic regression assessing heart rate (HR) and respiratory rate (RR) before and after NIV initiation. RESULTS: Of 138 infants studied, 34% were non-responders. There were no differences in baseline characteristics of responders and non-responders. HR decreased after NIV initiation in responders (156 [143-156] to149 [141-158], p < 0.01) compared to non-responders (158 [149-166] to 158 [145-171], p = 0.73). RR decreased in responders (50 [43-58] vs 47 [41-54]) and non-responders (52 [48-58] vs 51 [40-55], both p < 0.01). Concurrent bacterial pneumonia (OR 6.06, 95% CI: 2.54-14.51) and persistently elevated HR (OR: 1.04, 95% CI: 1.01-1.07) were associated with NIV non-response. CONCLUSION: In children with acute bronchiolitis who fail to respond to NIV and require subsequent intubation, we noted associations with persistently elevated HR after NIV initiation and concurrent bacterial pneumonia.


Assuntos
Bronquiolite , Ventilação não Invasiva , Insuficiência Respiratória , Bronquiolite/terapia , Cânula , Humanos , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/terapia , Estudos Retrospectivos
3.
Magn Reson Imaging Clin N Am ; 30(1): 1-18, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34802573

RESUMO

Routine and advanced MR imaging sequences are used for locoregional spread, nodal, and distant staging of head and neck squamous cell carcinoma, aids treatment planning, predicts treatment response, differentiates recurrence for postradiation changes, and monitors patients after chemoradiotherapy.


Assuntos
Carcinoma de Células Escamosas , Neoplasias de Cabeça e Pescoço , Carcinoma de Células Escamosas/diagnóstico por imagem , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/terapia , Quimiorradioterapia , Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética , Estadiamento de Neoplasias , Carcinoma de Células Escamosas de Cabeça e Pescoço/diagnóstico por imagem
4.
Handb Exp Pharmacol ; 268: 135-149, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34268615

RESUMO

During the last decades a substantial increase of allergic diseases has been noticed including allergic asthma and rhinoconjunctivitis as well as food allergies. Since efficient avoidance of airborne - and often hidden - food allergens is not possible, allergen immunotherapy (AIT) is the only causative treatment with the goal of inducing allergen tolerance in affected individuals. Efficacy as well as safety of AIT significantly depends on how the allergen is presented to the immune system, meaning both the route and the form of its application. Here, new ways of allergen administration have lately been explored, some of which are auspicious candidates for successful implementation in the therapeutic management of immediate-type allergies. While the first oral AIT has been approved recently by the FDA for the treatment of peanut allergy, further interesting routes of allergen application include either epicutaneous, intradermal, intranasal, or intralymphatic delivery. Besides, rather the immunologically relevant peptides instead of whole allergen may be administered to develop tolerance. In this chapter, we will describe these new and promising avenues of allergen application in the field of AIT. In addition, we will discuss their potential for future treatment of IgE-mediated allergic diseases enhancing therapeutic efficiency while further minimizing the risks of adverse events.


Assuntos
Asma , Hipersensibilidade , Alérgenos , Dessensibilização Imunológica , Humanos , Hipersensibilidade/terapia , Tolerância Imunológica
5.
Artigo em Inglês | MEDLINE | ID: mdl-34753829

RESUMO

BACKGROUND AND OBJECTIVES: It is unclear how multiple sclerosis (MS) affects the severity of COVID-19. The aim of this study is to compare COVID-19-related outcomes collected in an Italian cohort of patients with MS with the outcomes expected in the age- and sex-matched Italian population. METHODS: Hospitalization, intensive care unit (ICU) admission, and death after COVID-19 diagnosis of 1,362 patients with MS were compared with the age- and sex-matched Italian population in a retrospective observational case-cohort study with population-based control. The observed vs the expected events were compared in the whole MS cohort and in different subgroups (higher risk: Expanded Disability Status Scale [EDSS] score > 3 or at least 1 comorbidity, lower risk: EDSS score ≤ 3 and no comorbidities) by the χ2 test, and the risk excess was quantified by risk ratios (RRs). RESULTS: The risk of severe events was about twice the risk in the age- and sex-matched Italian population: RR = 2.12 for hospitalization (p < 0.001), RR = 2.19 for ICU admission (p < 0.001), and RR = 2.43 for death (p < 0.001). The excess of risk was confined to the higher-risk group (n = 553). In lower-risk patients (n = 809), the rate of events was close to that of the Italian age- and sex-matched population (RR = 1.12 for hospitalization, RR = 1.52 for ICU admission, and RR = 1.19 for death). In the lower-risk group, an increased hospitalization risk was detected in patients on anti-CD20 (RR = 3.03, p = 0.005), whereas a decrease was detected in patients on interferon (0 observed vs 4 expected events, p = 0.04). DISCUSSION: Overall, the MS cohort had a risk of severe events that is twice the risk than the age- and sex-matched Italian population. This excess of risk is mainly explained by the EDSS score and comorbidities, whereas a residual increase of hospitalization risk was observed in patients on anti-CD20 therapies and a decrease in people on interferon.


Assuntos
COVID-19/epidemiologia , COVID-19/fisiopatologia , Esclerose Múltipla/epidemiologia , Adulto , COVID-19/imunologia , COVID-19/terapia , Estudos de Coortes , Comorbidade , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/imunologia , Esclerose Múltipla/fisiopatologia , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença
7.
Heart Fail Clin ; 18(1): 155-164, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34776076

RESUMO

DiGeorge syndrome (DGS), also known as "22q11.2 deletion syndrome" (22q11DS) (MIM # 192430 # 188400), is a genetic disorder caused by hemizygous microdeletion of the long arm of chromosome 22. In the last decades, the introduction of fluorescence in situ hybridization assays, and in selected cases the use of multiplex ligation-dependent probe amplification, has allowed the detection of chromosomal microdeletions that could not be previously identified using standard karyotype analysis. The aim of this review is to address cardiovascular and systemic involvement in children with DGS, provide genotype-phenotype correlations, and discuss their medical management and therapeutic options.


Assuntos
Síndrome de DiGeorge , Cardiopatias Congênitas , Síndrome de Marfan , Deleção Cromossômica , Síndrome de DiGeorge/diagnóstico , Síndrome de DiGeorge/genética , Síndrome de DiGeorge/terapia , Humanos , Hibridização in Situ Fluorescente , Cariotipagem
8.
Heart Fail Clin ; 18(1): 51-60, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34776083

RESUMO

Mitochondrial diseases (MD) include an heterogenous group of systemic disorders caused by sporadic or inherited mutations in nuclear or mitochondrial DNA (mtDNA), causing impairment of oxidative phosphorylation system. Hypertrophic cardiomyopathy is the dominant pattern of cardiomyopathy in all forms of mtDNA disease, being observed in almost 40% of the patients. Dilated cardiomyopathy, left ventricular noncompaction, and conduction system disturbances have been also reported. In this article, the authors discuss the current clinical knowledge on MD, focusing on diagnosis and management of mitochondrial diseases caused by mtDNA mutations.


Assuntos
Cardiomiopatias , Cardiomiopatia Dilatada , Cardiomiopatia Hipertrófica , Doenças Mitocondriais , Cardiomiopatias/etiologia , Cardiomiopatias/genética , Cardiomiopatia Hipertrófica/diagnóstico , Cardiomiopatia Hipertrófica/genética , Cardiomiopatia Hipertrófica/terapia , DNA Mitocondrial/genética , Humanos , Doenças Mitocondriais/diagnóstico , Doenças Mitocondriais/genética , Doenças Mitocondriais/terapia
9.
Heart Fail Clin ; 18(1): 9-18, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34776087

RESUMO

Sudden cardiac death (SCD) is the most common cause of death in childhood hypertrophic cardiomyopathy (HCM) and occurs more frequently than in adult patients. Risk stratification strategies have traditionally been extrapolated from adult practice, but newer evidence has highlighted important differences between childhood and adult cohorts, with the implication that pediatric-specific risk stratification strategies are required. Current guidelines use cumulative risk factor thresholds to recommend implantable cardioverter defibrillator (ICD) implantation but have been shown to have limited discriminatory ability. Newer pediatric models that allow clinicians to calculate individualized estimates of 5-year risk allowing, for the first time, personalization of ICD implantation decision-making have been developed. This article describes the pathophysiology, risk factors, and approach to risk stratification for SCD in childhood HCM and highlights unanswered questions.


Assuntos
Cardiomiopatia Hipertrófica , Desfibriladores Implantáveis , Adulto , Cardiomiopatia Hipertrófica/complicações , Cardiomiopatia Hipertrófica/terapia , Criança , Morte Súbita Cardíaca/epidemiologia , Morte Súbita Cardíaca/etiologia , Morte Súbita Cardíaca/prevenção & controle , Humanos , Medição de Risco , Fatores de Risco
10.
Thorac Surg Clin ; 32(1): 33-42, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34801193

RESUMO

Social disparities in lung cancer diagnosis, treatment, and survival have been studied using national databases, statewide registries, and institution-level data. Some disparities emerge consistently, such as lower adherence to treatment guidelines and worse survival by race and socioeconomic status, whereas other disparities are less well studied. A critical appraisal of current data is essential to increasing equity in lung cancer care.


Assuntos
Disparidades em Assistência à Saúde , Neoplasias Pulmonares , Fidelidade a Diretrizes , Humanos , Neoplasias Pulmonares/epidemiologia , Neoplasias Pulmonares/terapia , Sistema de Registros , Classe Social
11.
Clin Podiatr Med Surg ; 39(1): 1-14, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34809788

RESUMO

Clubfoot or talipes equinovarus deformity is one of the most common anomalies affecting the lower extremities. This review provides an update on the outcomes of various treatment options used to correct clubfoot. The ultimate goal in the treatment of clubfoot is to obtain a fully functional and pain-free foot and maintain a long-term correction. The Ponseti method is now considered the gold standard of treatment for primary clubfoot. Relapse is common after primary treatment with the Ponseti method, and other interventions are discussed that are used to provide for long-term successful outcomes.


Assuntos
Pé Torto Equinovaro , Moldes Cirúrgicos , Pé Torto Equinovaro/terapia , , Humanos , Lactente , Recidiva , Resultado do Tratamento
12.
Clin Podiatr Med Surg ; 39(1): 57-71, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34809795

RESUMO

Musculoskeletal injuries of the lower limb are frequent in pediatric patients and represent the most common cause of emergency department admissions. Acute sports-related injuries commonly involve the lower extremity, as the knee and ankle are the most frequently injured parts. Physeal fractures are common injuries in children and adolescents participating in contact sports, which may lead to growth disturbances and cause limb length discrepancy. It is imperative for pediatric trauma centers to implement evidence-based multispecialty protocols for the perimanagement of the injured child, especially through the postdischarge and rehabilitation phases, in order for the child to resume active daily living.


Assuntos
Traumatismos em Atletas , Fraturas Ósseas , Adolescente , Assistência ao Convalescente , Traumatismos em Atletas/diagnóstico , Traumatismos em Atletas/terapia , Criança , Fraturas Ósseas/cirurgia , Humanos , Extremidade Inferior , Alta do Paciente , Estudos Retrospectivos
13.
Clin Podiatr Med Surg ; 39(1): 89-103, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34809797

RESUMO

Recreational sports are more popular, with many athletes involved year-round in multiple sports and on multiple teams. Most athletes do not take proper rest, making them more susceptible to stress-related injuries. There are numerous sports-related injuries in the foot and ankle. These issues can be non-traumatic, due to chronic repetitive stresses, or traumatic. Most of these injuries are managed conservatively, and athletes do well and return to play, while some do better with operative management. This article discusses a few of the sports injuries that are common in the leg, foot, and ankle and the recovery process.


Assuntos
Traumatismos em Atletas , Traumatismos do Pé , Esportes , Atletas , Traumatismos em Atletas/diagnóstico , Traumatismos em Atletas/epidemiologia , Traumatismos em Atletas/terapia , Criança , Traumatismos do Pé/diagnóstico , Traumatismos do Pé/terapia , Humanos
14.
Neuroimaging Clin N Am ; 32(1): 133-144, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34809834

RESUMO

Advances in MR and computed tomography (CT) techniques have resulted in greater fidelity in the assessment of treatment response and residual tumor on one hand and the assessment of recurrent head and neck malignancies on the other hand. The advances in MR techniques primarily are related to diffusion and perfusion imaging which rely on the intrinsic architecture of the tissues and organ systems. The techniques exploit the density of the cellular architecture; and the vascularity of benign and malignant lesions which in turn affect the changes in the passage of contrast through the vascular bed. Dual-energy CT and CT perfusion are the major advances in CT techniques that have found significant applications in the assessment of treatment response and tumor recurrence.


Assuntos
Neoplasias de Cabeça e Pescoço , Recidiva Local de Neoplasia , Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Neoplasias de Cabeça e Pescoço/terapia , Humanos , Imageamento por Ressonância Magnética , Pescoço , Recidiva Local de Neoplasia/diagnóstico por imagem , Tomografia Computadorizada por Raios X
15.
Facial Plast Surg Clin North Am ; 30(1): 11-14, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34809881

RESUMO

Concussion in the setting of facial trauma is an entity that can be overlooked. Having a high index of suspicion is critical in initial management and prompt treatment. Clinical signs can be common manifestations of a concussion. Serial examinations are important as these clinical manifestations can occur later in the hospitalization. Cognitive assessment tools can also give a baseline of a patient and can be used to assess recovery from a concussion. Assessment of the vestibular and oculomotor system can play a critical role in treatment. Prompt recognition and immediate treatment can help shorten the symptomatology and course of treatment.


Assuntos
Traumatismos em Atletas , Concussão Encefálica , Concussão Encefálica/diagnóstico , Concussão Encefálica/terapia , Humanos
16.
Cardiol Clin ; 40(1): 103-114, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34809911

RESUMO

Chronic thromboembolic pulmonary hypertension is a distinct form of pulmonary hypertension characterized by the nonresolution of thrombotic material in the pulmonary tree; whenever feasible and safe, first-line treatment should be pulmonary thromboendarterectomy. In patients who are not operative candidates, balloon pulmonary angioplasty (BPA) has emerged as an effective treatment modality that results in improvements in functional class, symptoms, hemodynamics, 6-minute walk distance, and right ventricular and pulmonary artery mechanics. Careful attention to procedural technique and rapid identification and treatment of complications are critical for a successful BPA program.


Assuntos
Angioplastia com Balão , Hipertensão Pulmonar , Embolia Pulmonar , Doença Crônica , Endarterectomia , Humanos , Hipertensão Pulmonar/terapia , Artéria Pulmonar , Embolia Pulmonar/complicações , Embolia Pulmonar/terapia , Resultado do Tratamento
17.
Cardiol Clin ; 40(1): 115-127, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34809912

RESUMO

Pediatric pulmonary hypertension (PH) is a rare disease with historically very high morbidity and mortality. In the past 20 years, there has been a growing recognition that pediatric PH, although having similarities to adult PH, is a unique entity with its own particular pathogeneses, presentation, and management. With better understanding and earlier diagnosis of pediatric PH, and as more medications have become available, survival of children with PH has also significantly improved. This article reviews the various forms of PH in childhood, with a focus on both established and investigational therapies that are available for children with PH.


Assuntos
Hipertensão Pulmonar , Adulto , Criança , Humanos , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/epidemiologia , Hipertensão Pulmonar/terapia , Morbidade
18.
Cardiol Clin ; 40(1): 55-67, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34809917

RESUMO

Pulmonary arterial hypertension related to congenital heart disease (PAH-CHD) affects 5% to 10% of adults with CHD and is associated with significant morbidity and mortality. PAH-CHD develops as a consequence of intracardiac or extracardiac systemic-to-pulmonary shunts that lead to pulmonary vascular remodeling through a pathologic process that is similar to other causes of PAH. Eisenmenger syndrome is the most severe phenotype of PAH-CHD and is characterized by severe elevation in pulmonary vascular resistance, with shunt reversal causing hypoxemia and central cyanosis. The primary management strategy for most patients with PAH-CHD is medical therapy, although defect closure is considered in select cases.


Assuntos
Complexo de Eisenmenger , Cardiopatias Congênitas , Hipertensão Pulmonar , Adulto , Complexo de Eisenmenger/complicações , Complexo de Eisenmenger/diagnóstico , Complexo de Eisenmenger/terapia , Coração , Cardiopatias Congênitas/complicações , Humanos , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/epidemiologia , Hipertensão Pulmonar/etiologia
19.
J Intensive Care Med ; 37(1): 100-106, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33307945

RESUMO

BACKGROUND: Despite the importance of transfusion in treating sickle cell disease acute chest syndrome, the target hemoglobin and optimal modality for transfusion remain unknown. OBJECTIVES: To compare hospital length of stay (LOS) in intensive care unit (ICU) patients with acute chest syndrome transfused to hemoglobin ≥ 8 g/dL versus patients transfused to hemoglobin < 8 g/dL; and to compare hospital LOS in acute chest syndrome patients treated with and without exchange transfusion. METHODS: We performed a retrospective cohort study of all acute chest syndrome patients treated in the medical ICU at 2 tertiary care hospitals between January 2011 and August 2016 (n = 82). We compared median hospital LOS in patients transfused to hemoglobin ≥ 8 g/dL by the time of ICU transfer to the medical floor versus patients transfused to hemoglobin < 8 g/dL as well as patients who received exchange transfusion versus no exchange transfusion using Wilcoxon rank-sum tests. We modeled the association between hospital LOS and hemoglobin at ICU transfer to the medical floor using multivariable log-linear regression. RESULTS: Median hospital LOS was about half as long for patients transfused to hemoglobin ≥ 8 g/dL versus hemoglobin < 8 g/dL (8.0 versus 16.5 days, P = 0.008). There was no difference in LOS for patients treated with and without exchange transfusion. On average, a 1 g/dL increase in hemoglobin was associated with a 19.5% decrease (95% CI 10.8-28.2%) in LOS, controlling for possible confounding factors. CONCLUSIONS: Transfusion to a hemoglobin target ≥ 8 g/dL is associated with decreased hospital LOS in patients with acute chest syndrome. There was no difference in LOS between patients who received exchange transfusion and those who did not.


Assuntos
Síndrome Torácica Aguda , Anemia Falciforme , Síndrome Torácica Aguda/etiologia , Síndrome Torácica Aguda/terapia , Adulto , Anemia Falciforme/complicações , Anemia Falciforme/terapia , Transfusão de Sangue , Hemoglobinas/análise , Humanos , Estudos Retrospectivos
20.
Oral Maxillofac Surg Clin North Am ; 34(1): 35-47, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34750009

RESUMO

Control of acute pain in oral and maxillofacial surgery is important for patient care and comfort. Oral surgical procedures are associated with tissue injury and inflammation. Acute pain can arise directly from a surgical procedure or from problems such as dental caries, infection, perforation of maxillary sinus, pericoronitis, and jaw fractures. The major factor in acute pain management is deciding on an appropriate intervention and/or analgesics that will provide the best pain relief. Multimodal pain control has taken a leading role in effectively managing acute pain. This article covers the different options available to dental clinicians.


Assuntos
Cárie Dentária , Procedimentos Cirúrgicos Bucais , Humanos , Manejo da Dor , Dor Pós-Operatória/terapia
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