RESUMEN
El neumatocele es una lesión cavitada llena de aire de carácter adquirido que se encuentra en el interior del parénquima pulmonar. Aunque las causas pueden variar, el origen infeccioso bacteriano es lo más frecuente. Los cambios en los serotipos de neumococo y el aumento de las neumonías necrotizantes observado en las últimas décadas hacen de este tipo de lesiones algo cada vez más frecuente. Es importante conocer la evolución esperable, así como también saber qué paciente se beneficia de intervención para evitar secuelas a largo plazo y complicaciones graves. En este artículo se exponen las causas, epidemiología, orientación diagnóstica y una propuesta de manejo para el neumatocele.
A pneumatocele is an air-filled cavitary lesion of acquired nature located within the pulmonary parenchyma. Although causes can vary, bacterial infectious origin is the most common. Changes in pneumococcal serotypes and the increase in necrotizing pneumonia observed in recent decades have made these lesions increasingly frequent. It is important to know the expected evolution and to identify which patients would benefit from intervention to prevent long-term sequelae and severe complications. This article exposes the causes, epidemiology, diagnostic approach, and a management proposal for pneumatocele.
Asunto(s)
Humanos , Niño , Enfermedades Pulmonares/etiología , Enfermedades Pulmonares/terapia , Enfermedades Pulmonares/diagnóstico por imagen , Traumatismos Torácicos , Drenaje , Neumonía NecrotizanteRESUMEN
INTRODUCTION: Cell therapy has emerged as an alternative option for chronic lung diseases with the highest rates of morbidity and mortality rates worldwide. AREAS COVERED: This review addresses the definition of mesenchymal stromal cells (MSCs), their properties, mechanisms of action, as well as preclinical and clinical studies that have used cell therapy in chronic lung diseases such as asthma, chronic obstructive pulmonary disease, idiopathic pulmonary fibrosis, pulmonary arterial hypertension, and silicosis. Ongoing clinical trials are also presented. EXPERT OPINION: Experimental evidence has shown that MSCs have immunomodulatory and regenerative properties that could rescue impaired lung function and histoarchitecture. Their beneficial effects have been mainly associated with their ability to communicate with target cells through the secretion of soluble mediators and extracellular vesicles or even through transfer of organelles (e.g. mitochondria). MSC-derived conditioned medium, extracellular vesicles and mitochondria induce beneficial effects in selected scenarios. The initial results in clinical trials were modest compared with the experimental results, therefore researchers were encouraged to move from bedside back to bench to develop new strategies able to potentiate the effects of MSCs.
Asunto(s)
Asma , Vesículas Extracelulares , Enfermedades Pulmonares , Células Madre Mesenquimatosas , Enfermedad Pulmonar Obstructiva Crónica , Humanos , Enfermedades Pulmonares/terapiaRESUMEN
Se realiza comentario de estudio de Israel en el cual analizan 75 pacientes pediátricos que utilizaron cánula nasal de alto flujo (CNAF) en domicilio, evaluando la seguridad, las indicaciones, los parámetros de utilización, la duración del tratamiento, los resultados clínicos y la satisfacción de los padres. Se acompaña de una revisión de la literatura del tema.
A comment is made on a study conducted in Israel analyzing 75 pediatric patients who used high-flow nasal cannula at home, evaluating safety, indications, utilization parameters, treatment duration, clinical outcomes, and parental satisfaction. It is accompanied by a literature review on the topic.
Asunto(s)
Humanos , Niño , Cánula , Atención Domiciliaria de Salud , Enfermedades Pulmonares/terapia , Apnea Obstructiva del Sueño/terapia , Ventilación no Invasiva , Enfermedades Neuromusculares/terapiaRESUMEN
There is a steadily growing interest in the use of mitochondria as therapeutic agents. The use of mitochondria derived from mesenchymal stem/stromal cells (MSCs) for therapeutic purposes represents an innovative approach to treat many diseases (immune deregulation, inflammation-related disorders, wound healing, ischemic events, and aging) with an increasing amount of promising evidence, ranging from preclinical to clinical research. Furthermore, the eventual reversal, induced by the intercellular mitochondrial transfer, of the metabolic and pro-inflammatory profile, opens new avenues to the understanding of diseases' etiology, their relation to both systemic and local risk factors, and also leads to new therapeutic tools for the control of inflammatory and degenerative diseases. To this end, we illustrate in this review, the triggers and mechanisms behind the transfer of mitochondria employed by MSCs and the underlying benefits as well as the possible adverse effects of MSCs mitochondrial exchange. We relay the rationale and opportunities for the use of these organelles in the clinic as cell-based product.
Asunto(s)
Mitocondrias/metabolismo , Tratamiento Basado en Trasplante de Células y Tejidos , Humanos , Enfermedades Pulmonares/terapia , Macrófagos/citología , Macrófagos/inmunología , Macrófagos/metabolismo , Trasplante de Células Madre Mesenquimatosas , Células Madre Mesenquimatosas/citología , Células Madre Mesenquimatosas/metabolismo , Mitocondrias/trasplante , Dinámicas Mitocondriales , Comunicación ParacrinaRESUMEN
Mitochondria are essential organelles for cell metabolism, growth, and function. Mitochondria in lung cells have important roles in regulating surfactant production, mucociliary function, mucus secretion, senescence, immunologic defense, and regeneration. Disruption in mitochondrial physiology can be the central point in several pathophysiologic pathways of chronic lung diseases such as chronic obstructive pulmonary disease, idiopathic pulmonary fibrosis, and asthma. In this review, we summarize how mitochondria morphology, dynamics, redox signaling, mitophagy, and interaction with the endoplasmic reticulum are involved in chronic lung diseases and highlight strategies focused on mitochondrial therapy (mito-therapy) that could be tested as a potential therapeutic target for lung diseases.
Asunto(s)
Enfermedades Pulmonares/etiología , Enfermedades Pulmonares/metabolismo , Mitocondrias/genética , Mitocondrias/metabolismo , Animales , Biomarcadores , Enfermedad Crónica , Diagnóstico Diferencial , Manejo de la Enfermedad , Modelos Animales de Enfermedad , Susceptibilidad a Enfermedades , Humanos , Enfermedades Pulmonares/diagnóstico , Enfermedades Pulmonares/terapia , Dinámicas Mitocondriales , Mitofagia , Oxidación-Reducción , Estrés Oxidativo , Especies Reactivas de Oxígeno , Transducción de SeñalRESUMEN
OBJECTIVE: To describe clinical, radiological and treatment characteristics in pediatric patients with SLS. MATERIAL AND METHODS: This is a descriptive and retrospective study in patients under 16 years old with the diagnosis of SLE complicated by SLS at the General Hospital. National Medical Center La Raza. Clinical, radiological and treatment variables were analyzed. Results are shown in frequencies and percentages. RESULTS: Data from 11 patients, 9 females and 2 males were collected. Mean age at diagnosis of SLS was 12.2 years. Age at diagnosis of SLE was 11.1 years. SLEDAI 17.3. Renal desease 72%, hematological 91%, lymphopenia 63%, mucocutaneous 72%, neurological 9%, arthritis 54%, serositis 91%, fever 81%, secondary antiphospholipid syndrome, low C3 72%, low C4 81%, positive ANA 91%, positive anti-DNA 91%. Regarding clinical manifestations of SLE: cough 81%, dyspnea 91%, hipoxemia 81%, pleuritic pain 71%, average oxygen saturation 83%. Chest X-rays findings: right hemidiaphragm affection 18%, left 63%, bilateral 18%. Elevated hemidiaphragm 91%, atelectasis 18%, pleural effusion 91%, over one third of the cardiac silhouette under the diphragm 36%, bulging diaphragm 45%, 5th. anterior rib that crosses over the diaphragm 91%. M-mode ultrasound: diaphragmatic hypomotility 100%, pleural effusion 63%. Pulmonary function tests: restrictive pattern in 45% of the cases. Treatment was with supplementary oxygen 100%, intubation 18%, antibiotics 100%, steroids 100%, intravenous immunoglobulin 54%, plasmapheresis 18%, cyclophosphamide 54% and rituximab 18%. The clinical course was favorable in 81%. CONCLUSIONS: SLS should be suspected in patients with SLE and active disease who present hipoxemia, pleuritic pain, cough, dyspnea, pleural effusion and signs of restriction on chest X-rays. Therefore, a diaphragmatic M-mode ultrasound should be performed in order to establish the diagnosis.
Asunto(s)
Diafragma/anomalías , Diafragma/fisiopatología , Enfermedades Pulmonares/etiología , Enfermedades Pulmonares/fisiopatología , Lupus Eritematoso Sistémico/complicaciones , Adolescente , Antibacterianos/uso terapéutico , Síndrome Antifosfolípido/complicaciones , Síndrome Antifosfolípido/diagnóstico , Síndrome Antifosfolípido/inmunología , Dolor en el Pecho/etiología , Niño , Terapia Combinada/métodos , Ciclofosfamida/uso terapéutico , Diafragma/diagnóstico por imagen , Disnea/etiología , Femenino , Humanos , Hipoxia/etiología , Inmunoglobulinas Intravenosas/uso terapéutico , Factores Inmunológicos/uso terapéutico , Inmunosupresores/uso terapéutico , Intubación Intratraqueal/métodos , Enfermedades Pulmonares/terapia , Lupus Eritematoso Sistémico/diagnóstico , Lupus Eritematoso Sistémico/inmunología , Masculino , México/epidemiología , Oxígeno/administración & dosificación , Oxígeno/uso terapéutico , Plasmaféresis/métodos , Pleuresia/complicaciones , Atelectasia Pulmonar/etiología , Estudios Retrospectivos , Rituximab/uso terapéutico , Esteroides/uso terapéutico , Ultrasonografía/métodosRESUMEN
BACKGROUND: Hantavirus cardiopulmonary syndrome (HCPS) has a high lethality. Severe cases may be rescued by venoarterial extracorporeal membrane oxygenation (VA ECMO), alongside substantial complications. High volume hemofiltration (HVHF) is a depurative technique that provides homeostatic balance allowing hemodynamic stabilization in some critically ill patients. METHODS: We implemented HVHF before VA ECMO consideration in the last five severe HCPS patients requiring mechanical ventilation and vasoactive drugs admitted to our intensive care unit. Patients were considered HVHF-responders if VA ECMO was avoided and HVHF-nonresponders if VA ECMO support was needed despite HVHF. A targeted-HVHF strategy compounded by aggressive hyperoncotic albumin, sodium bicarbonate, and calcium supplementation plus ultrafiltration to avoid fluid overload was implemented on three patients. RESULTS: Patients had maximum serum lactate of 8.8 (8.7-12.8) mmol/L and a lowest cardiac index of 1.8 (1.8-1.9) L/min/m2 . The first two required VA ECMO. They were connected later to HVHF, displayed progressive tachycardia and declining stroke volume. The opposite was true for HVHF-responders who received targeted-HVHF. All patients survived, but one of the VA ECMO patients suffered a vascular complication. CONCLUSION: HVHF may contribute to support severe HCPS patients avoiding the need for VA ECMO in some. Early connection and targeted-HVHF may increase the chance of success.
Asunto(s)
Oxigenación por Membrana Extracorpórea/métodos , Infecciones por Hantavirus/complicaciones , Cardiopatías/virología , Hemofiltración/métodos , Enfermedades Pulmonares/virología , Adolescente , Femenino , Orthohantavirus/patogenicidad , Corazón/virología , Cardiopatías/terapia , Hemofiltración/normas , Humanos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Enfermedades Pulmonares/terapia , Masculino , Estudios Prospectivos , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Adulto JovenRESUMEN
The relationship between lung and heart diseases has long been recognized, with necropsy studies demonstrating silent myocardial infarctions or coronary artery calcification in patients with advanced emphysema as the death cause. Improvements in non-invasive techniques and epidemiologic approaches established that lung and cardiovascular diseases frequently coexist in mid and late life. Even among those without diagnosed lung disease, lower than expected forced vital capacity, forced expiratory volume in 1 s, and their ratio each portend greater risk of developing cardiovascular risk factors including hypertension, obesity, and metabolic syndrome, and for incident cardiovascular diseases including left heart failure, atrial fibrillation and stroke. Greater longitudinal declines in these spirometric measures are further associated with cardiovascular morbidity and mortality. While obstructive ventilatory patterns are more common, restrictive ventilatory patterns seem to demonstrate an independent and more robust association with cardiovascular diseases such as heart failure. These subclinical alterations in pulmonary function also relate to subclinical abnormalities of cardiac structure and function. Although the biologic pathways linking pulmonary and cardiovascular dysfunction are not clear, chronic systemic inflammation appears to be one important underlying pathophysiologic link. Despite the growing evidence of lung dysfunction as a cardiovascular risk factor, spirometric evaluation is still underutilized in clinical practice, particularly among cardiac patients, and optimal therapeutic and preventive strategies are still unclear. In this review, we address the current knowledge and controversies regarding the links between lung function and cardiovascular disease.
Asunto(s)
Enfermedades Cardiovasculares/fisiopatología , Sistema Cardiovascular/fisiopatología , Enfermedades Pulmonares/fisiopatología , Pulmón/fisiopatología , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/mortalidad , Enfermedades Cardiovasculares/terapia , Comorbilidad , Humanos , Incidencia , Enfermedades Pulmonares/diagnóstico , Enfermedades Pulmonares/mortalidad , Enfermedades Pulmonares/terapia , Prevalencia , Pronóstico , Medición de Riesgo , Factores de RiesgoRESUMEN
INTRODUCTION: Actinomycosis is a rare infectious disease caused by Gram-positive bacteria. The most common species is Actinomyces israelii. Among its forms of presentation, the thoracic is the least frequent. CASE PRESENTATION: We report two patients with thoracic actinomycosis, 8 and 13 years old, from different geographical areas of Peru. The first case had empyema necessitans and the second, lung consolidation and recurrent hemoptysis. Both had a certain degree of difficulty in their diagnosis but responded favorably to antibiotics and surgical treatment. The diagnosis was based on the histopathological study. However, we were not able to ascertain the species of actinomyces. CONCLUSION: Thoracic actinomycosis is rare in children and presents as a parenchymal lesion with possible fistulization to the chest wall. This article is one of the few in the Peruvian literature, constituting a contribution to the knowledge of the disease and its management in pediatrics.
INTRODUCCIÓN: La actinomicosis es una enfermedad infecciosa poco frecuente, ocasionada por una bacteria Gram positiva. La especie más común es Actinomyces israelii. Dentro de sus formas de presentación, la torácica es la menos frecuente. PRESENTACIÓN DE CASOS: Reportamos dos pacientes con actinomicosis torácica de 8 y 13 años de diferentes zonas geográficas de Perú. El primer caso tuvo empiema necessitatis y el segundo, consolidación pulmonar y hemoptisis recurrente. Ambos tuvieron cierto grado de dificultad en su diagnóstico, pero con una buena respuesta al tratamiento antibiótico y quirúrgico. El diagnóstico fue mediante estudio histopatológico. Sin embargo, no se pudo identificar la especie de Actinomyces. CONCLUSIÓN: La actinomicosis torácica es poco frecuente en niños y se presenta como una lesión parenquimal con posible fistulización a la pared torácica. Este es uno de los pocos casos reportados en la literatura peruana, constituyendo una contribución al conocimiento de esta enfermedad y su manejo en pediatría.
Asunto(s)
Actinomyces/aislamiento & purificación , Actinomicosis/diagnóstico , Enfermedades Pulmonares/diagnóstico , Actinomicosis/microbiología , Actinomicosis/terapia , Adolescente , Antibacterianos/administración & dosificación , Niño , Femenino , Humanos , Enfermedades Pulmonares/microbiología , Enfermedades Pulmonares/terapia , Masculino , PerúRESUMEN
Palliative care was initially developed for patients with advanced cancer. The concept has evolved and now encompasses any life-threatening chronic disease. Studies carried out to compare end-of-life symptoms have shown that although symptoms such as pain and dyspnea are as prevalent in patients with lung disease as in patients with cancer, the former receive less palliative treatment than do the latter. There is a need to refute the idea that palliative care should be adopted only when curative treatment is no longer possible. Palliative care should be provided in conjunction with curative treatment at the time of diagnosis, by means of a joint decision-making process; that is, the patient and the physician should work together to plan the therapy, seeking to improve quality of life while reducing physical, psychological, and spiritual suffering.
Asunto(s)
Disnea/terapia , Enfermedades Pulmonares/terapia , Cuidados Paliativos , Neumología , Humanos , Enfermedades Pulmonares/complicaciones , Dolor , Manejo del Dolor , Calidad de VidaRESUMEN
OBJECTIVE: To report initial experience from the use of extracorporeal membrane oxygenation (ECMO) in patients who received lung transplantation. METHODS: Retrospective study of a single tertiary center in the Brazilian state of São Paulo, a national reference in lung transplantation, based on the prospective collection of data from electronic medical records. The period analyzed extended from January 2009 (beginning of the program) until December 2018. RESULTS: A total of 75 lung transplants were performed, with ECMO used in 8 (10.7%) cases. Of the patients, 4 (50%) were female. The mean age was 46.4±14.3 years. The causes of the end-stage lung disease that led to transplantation were pulmonary arterial hypertension in 3 (37.5%) patients, bronchiectasis in 2 (25%) patients, pulmonary fibrosis in 2 (25%) patients, and pulmonary emphysema in 1 (12.5%) patient. In our series, 7 (87.5%) cases were sequential bilateral transplantations. Prioritization was necessary in 4 (50%) patients, and in 1 patient, ECMO was used as a bridge to transplantation. The ECMO route was central in 4 (50%), peripheral venovenous in 2 (25%) and peripheral venoarterial in 2 (25%) patients. The mean length of the intensive care unit (ICU) stay was 14±7.5 days and of the hospital stay was 34.1±34.2 days. The mean ECMO duration was 9.3±6.6 days with a 50% decannulation rate. Three patients were discharged (37.5%). CONCLUSION: Lung transplantation requires complex treatment, and ECMO has allowed extending the indications for transplantation and provided adjuvant support in the clinical management of these patients.
Asunto(s)
Oxigenación por Membrana Extracorpórea/métodos , Enfermedades Pulmonares/terapia , Trasplante de Pulmón/métodos , Adulto , Anciano , Anciano de 80 o más Años , Brasil/epidemiología , Bronquiectasia/epidemiología , Bronquiectasia/terapia , Femenino , Humanos , Unidades de Cuidados Intensivos , Tiempo de Internación , Enfermedades Pulmonares/epidemiología , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Estudios Prospectivos , Hipertensión Arterial Pulmonar/epidemiología , Hipertensión Arterial Pulmonar/terapia , Enfisema Pulmonar/epidemiología , Enfisema Pulmonar/terapia , Fibrosis Pulmonar/epidemiología , Fibrosis Pulmonar/terapia , Estudios Retrospectivos , Factores de Tiempo , Resultado del TratamientoRESUMEN
OBJECTIVE: In Peru, prisons are spaces with overcrowding, deteriorated infrastructure, poor sanitary conditions and difficult access to medical treatment. The objective of this study is to estimate the burden of disease and access to treatment for different morbidities in the Peruvian inmate population. METHODS: An analysis of secondary data of the First National Penitentiary Census (PCNP) 2016 in Peru was carried out. The absolute frequencies and percentages of each self-reported health condition, the presence of a diagnosis of a disease before entering the prison system and access to treatment were obtained. RESULTS: 74,130 inmates were included in the analysis. The most common diseases in prisons are depression (9.6%), anxiety (8.6%), chronic lung disease (8.4%) and arterial hypertension (6.9%). All diseases included, with the exception of hepatitis, have a diagnostic before the incarceration of less than 60%. Access to medical treatment was higher in women than in men and in general, mental health illnesses had low access to medical treatment. CONCLUSIONS: Chronic and infectious diseases are frequent in those deprived of liberty, with mental health problems being more prevalent in women. In general, access to treatment is low, especially in men and for mental health illnesses. This situation reflects the need to develop intervention programs that promote health and increase the universality of health care in those deprived of liberty.
Asunto(s)
Enfermedades Transmisibles/epidemiología , Diabetes Mellitus/epidemiología , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Hipertensión/epidemiología , Enfermedades Pulmonares/epidemiología , Trastornos Mentales/epidemiología , Prisioneros/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Enfermedad Crónica/epidemiología , Enfermedad Crónica/terapia , Enfermedades Transmisibles/terapia , Diabetes Mellitus/terapia , Femenino , Disparidades en el Estado de Salud , Disparidades en Atención de Salud/estadística & datos numéricos , Hepatitis/epidemiología , Hepatitis/terapia , Humanos , Hipertensión/terapia , Enfermedades Pulmonares/terapia , Masculino , Trastornos Mentales/terapia , Persona de Mediana Edad , Neoplasias/epidemiología , Neoplasias/terapia , Perú/epidemiología , Prisioneros/psicología , Prisiones , Autoinforme , Factores SexualesRESUMEN
Introduction: Mesenchymal stem/stromal cells (MSCs) have been shown to improve lung function and survival in chronic inflammatory lung diseases, including asthma, chronic obstructive pulmonary disease (COPD), idiopathic pulmonary fibrosis (IPF), pulmonary arterial hypertension (PAH), and silicosis.Areas covered: This review covers rationale for the use of MSC therapy, along with preclinical studies and clinical trials with MSC therapy in chronic lung diseases.Expert opinion: MSC therapy holds promise for the treatment of chronic lung diseases, mainly when administered at early stages. In clinical trials, MSC administration was safe, but associated with limited effects on clinical outcomes. Further studies are required to elucidate unresolved issues, including optimal MSC source and dose, route of administration, and frequency (single vs. multiple-dose regimens). A better understanding of the mechanisms of MSC action, local microenvironment of each disease, and development of strategies to potentiate the beneficial effects of MSCs may improve outcomes.
Asunto(s)
Enfermedades Pulmonares/terapia , Trasplante de Células Madre Mesenquimatosas , Animales , Enfermedad Crónica/terapia , Ensayos Clínicos como Asunto , Modelos Animales de Enfermedad , Humanos , Fibrosis Pulmonar Idiopática/terapia , Enfermedad Pulmonar Obstructiva Crónica/terapiaRESUMEN
OBJECTIVE: To report initial experience from the use of extracorporeal membrane oxygenation (ECMO) in patients who received lung transplantation. METHODS: Retrospective study of a single tertiary center in the Brazilian state of São Paulo, a national reference in lung transplantation, based on the prospective collection of data from electronic medical records. The period analyzed extended from January 2009 (beginning of the program) until December 2018. RESULTS: A total of 75 lung transplants were performed, with ECMO used in 8 (10.7%) cases. Of the patients, 4 (50%) were female. The mean age was 46.4±14.3 years. The causes of the end-stage lung disease that led to transplantation were pulmonary arterial hypertension in 3 (37.5%) patients, bronchiectasis in 2 (25%) patients, pulmonary fibrosis in 2 (25%) patients, and pulmonary emphysema in 1 (12.5%) patient. In our series, 7 (87.5%) cases were sequential bilateral transplantations. Prioritization was necessary in 4 (50%) patients, and in 1 patient, ECMO was used as a bridge to transplantation. The ECMO route was central in 4 (50%), peripheral venovenous in 2 (25%) and peripheral venoarterial in 2 (25%) patients. The mean length of the intensive care unit (ICU) stay was 14±7.5 days and of the hospital stay was 34.1±34.2 days. The mean ECMO duration was 9.3±6.6 days with a 50% decannulation rate. Three patients were discharged (37.5%). CONCLUSION: Lung transplantation requires complex treatment, and ECMO has allowed extending the indications for transplantation and provided adjuvant support in the clinical management of these patients.
Asunto(s)
Oxigenación por Membrana Extracorpórea/métodos , Enfermedades Pulmonares/terapia , Complicaciones Posoperatorias , Enfisema Pulmonar/terapia , Enfisema Pulmonar/epidemiología , Fibrosis Pulmonar/terapia , Fibrosis Pulmonar/epidemiología , Factores de Tiempo , Brasil/epidemiología , Bronquiectasia/terapia , Bronquiectasia/epidemiología , Estudios Prospectivos , Estudios Retrospectivos , Trasplante de Pulmón/métodos , Resultado del Tratamiento , Hipertensión Pulmonar Primaria Familiar/terapia , Hipertensión Pulmonar Primaria Familiar/epidemiología , Unidades de Cuidados Intensivos , Tiempo de Internación , Enfermedades Pulmonares/epidemiologíaRESUMEN
ABSTRACT Palliative care was initially developed for patients with advanced cancer. The concept has evolved and now encompasses any life-threatening chronic disease. Studies carried out to compare end-of-life symptoms have shown that although symptoms such as pain and dyspnea are as prevalent in patients with lung disease as in patients with cancer, the former receive less palliative treatment than do the latter. There is a need to refute the idea that palliative care should be adopted only when curative treatment is no longer possible. Palliative care should be provided in conjunction with curative treatment at the time of diagnosis, by means of a joint decision-making process; that is, the patient and the physician should work together to plan the therapy, seeking to improve quality of life while reducing physical, psychological, and spiritual suffering.
RESUMO Inicialmente os cuidados paliativos foram desenvolvidos para pacientes com câncer avançado. Hoje este conceito evoluiu e engloba qualquer doença crônica que ameace a vida. Estudos realizados para comparar os sintomas de fim de vida mostraram que os pacientes pneumológicos apresentavam a mesma prevalência de sintomas, como dor e dispneia, porém recebiam menos tratamento paliativo que os pacientes oncológicos. É preciso desmitificar a ideia de que cuidados paliativos só devem ser adotados quando não há mais possibilidade de tratamento curativo. O cuidado paliativo deve ser associado ao tratamento curativo no momento do diagnóstico, por meio de decisão compartilhada, isto é, paciente e médico planejam as decisões sobre a terapêutica a ser tomada, buscam a melhora na qualidade de vida e a redução do sofrimento, tanto espiritual como físico e psicológico.
Asunto(s)
Humanos , Cuidados Paliativos , Neumología , Disnea/terapia , Enfermedades Pulmonares/terapia , Dolor , Calidad de Vida , Manejo del Dolor , Enfermedades Pulmonares/complicacionesRESUMEN
INTRODUCCIÓN: La actinomicosis es una enfermedad infecciosa poco frecuente, ocasionada por una bacteria Gram positiva. La especie más común es Actinomyces israelii. Dentro de sus formas de presentación, la torácica es la menos frecuente. PRESENTACIÓN DE CASOS: Reportamos dos pacientes con actinomicosis torácica de 8 y 13 años de diferentes zonas geográficas de Perú. El primer caso tuvo empiema necessitatis y el segundo, consolidación pulmonar y hemoptisis recurrente. Ambos tuvieron cierto grado de dificultad en su diagnóstico, pero con una buena respuesta al tratamiento antibiótico y quirúrgico. El diagnóstico fue mediante estudio histopatológico. Sin embargo, no se pudo identificar la especie de Actinomyces. CONCLUSIÓN: La actinomicosis torácica es poco frecuente en niños y se presenta como una lesión parenquimal con posible fistulización a la pared torácica. Este es uno de los pocos casos reportados en la literatura peruana, constituyendo una contribución al conocimiento de esta enfermedad y su manejo en pediatría.
INTRODUCTION: Actinomycosis is a rare infectious disease caused by Gram-positive bacteria. The most common species is Actinomyces israelii. Among its forms of presentation, the thoracic is the least frequent. CASE PRESENTATION: We report two patients with thoracic actinomycosis, 8 and 13 years old, from different geographical areas of Peru. The first case had empyema necessitans and the second, lung consolidation and recurrent hemoptysis. Both had a certain degree of difficulty in their diagnosis but responded favorably to antibiotics and surgical treatment. The diagnosis was based on the histopathological study. However, we were not able to ascertain the species of actinomyces. CONCLUSION: Thoracic actinomycosis is rare in children and presents as a parenchymal lesion with possible fistulization to the chest wall. This article is one of the few in the Peruvian literature, constituting a contribution to the knowledge of the disease and its management in pediatrics.
Asunto(s)
Humanos , Masculino , Femenino , Niño , Adolescente , Actinomyces/aislamiento & purificación , Actinomicosis/diagnóstico , Enfermedades Pulmonares/diagnóstico , Perú , Actinomicosis/microbiología , Actinomicosis/terapia , Enfermedades Pulmonares/microbiología , Enfermedades Pulmonares/terapia , Antibacterianos/administración & dosificaciónRESUMEN
At present, there is no specific treatment for primary ciliary dyskinesia, nor controlled and randomized clinical trials to determine how the management and monitoring of these patients should be considered. The therapeutic options are extrapolated from other diseases, such as cystic fibrosis, or non-cystic fibrosis bronchiectasis. However, the implementation of specific groups of experts, both in the USA (PDC-foundation) and in Europe (BESTCILIA or BEAT-PD), are helping to increase knowledge of the disease, opening research channels and seeking new treatments. Until we have therapies capable of correcting the basic defect of the disease, the pillars of treatment are the daily cleansing of the airways and aggressive antibiotherapy against respiratory infections. Multidisciplinary care in specialized centers where pulmonary function is monitored and the infection is prevented and treated will improve, as in cystic fibrosis, the results of patients.
En la actualidad no existe un tratamiento específico para la discinesia ciliar primaria, ni se cuenta con ensayos clínicos controlados y randomizados que permitan determinar cómo debe plantearse el manejo y seguimiento de estos pacientes. Las opciones terapéuticas son extrapoladas de otras enfermedades, como la fibrosis quística, o las bronquiectasias no fibrosis quística. Sin embargo, la puesta en marcha de grupos específicos de expertos, tanto en USA (PDC-foundation) como en Europa (BESTCILIA o BEAT-PD), están permitiendo incrementar el conocimiento de la enfermedad, abriendo vías de investigación y buscando nuevos tratamientos. Hasta contar con terapias capaces de corregir el defecto básico de la enfermedad, los pilares del tratamiento son la limpieza diaria de las vías aéreas y la antibioterapia agresiva frente a las infecciones respiratorias. La atención multidisciplinar en centros especializados donde se monitorice la función pulmonar y se prevengan y traten las infecciones mejorará, como en la fibrosis quística, los resultados de los pacientes.
Asunto(s)
Humanos , Síndrome de Kartagener/diagnóstico , Síndrome de Kartagener/fisiopatología , Síndrome de Kartagener/genética , Síndrome de Kartagener/terapia , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Estudios de Seguimiento , Enfermedades Pulmonares/fisiopatología , Enfermedades Pulmonares/terapia , Enfermedades Pulmonares FúngicasRESUMEN
This paper compares and describes the tidal volume (Vt) used in mechanically ventilated dogs under a range of clinical conditions. Twenty-eight dogs requiring mechanical ventilation (MV) were classified into 3 groups: healthy dogs mechanically ventilated during surgery (group I, n = 10), dogs requiring MV due to extra-pulmonary reasons (group II, n = 7), and dogs that required MV due to pulmonary pathologies (group III, n = 11). The median Vt used in each group was 16 mL/kg (interquartile range [IQR], 15.14-21) for group I, 12.59 mL/kg (IQR, 9-14.25) for group II, and 12.59 mL/kg (IQR, 10.15-14.96) for group III. The Vt used was significantly lower in group III than in group I (p = 0.016). The thoraco-pulmonary compliance was significantly higher in group I than in groups II and III (p = 0.011 and p = 0.006, respectively). The median driving pressure was similar among the groups with a median of 9, 11, and 10 cmH2O in groups I, II, and III, respectively (p = 0.260). Critically-ill dogs requiring MV due to the primary pulmonary pathology received a significantly lower Vt than healthy dogs but with a range of values that were markedly higher than those recommended by human guidelines.
Asunto(s)
Enfermedades Pulmonares/veterinaria , Respiración Artificial/métodos , Animales , Perros , Humanos , Enfermedades Pulmonares/terapia , Presión , Volumen de Ventilación PulmonarRESUMEN
OBJECTIVE: to describe proportions and rates of hospitalization for Ambulatory Care Sensitive Conditions (ACSC) among children under 5 years old, in Santa Catarina State, Brazil, 2012. METHODS: this is a descriptive study using Brazilian National Health Service Hospital Information System (SIH/SUS) data, classified according to the Brazilian ACSC List. RESULTS: a total of 32,445 children aged <5 years old were hospitalized, 25,7% of whom were ACSC cases, representing a rate of 20.1/1,000 inhabitants in the same age group; the main causes were infectious gastroenteritis and complications (26.7%), bacterial pneumonia (22.2%) and pulmonary diseases (16.9%); there was a higher hospitalization rate due to ACSC in males (21.1/1,000), and in children <1 year old (43.8/1,000). CONCLUSION: The results showed that the State of Santa Catarina had lower rates and proportions than those found in other Brazilian studies, even though ACSC were the cause of one quarter of hospitalizations in children aged <5 years.
Asunto(s)
Atención Ambulatoria/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Programas Nacionales de Salud/estadística & datos numéricos , Atención Primaria de Salud/estadística & datos numéricos , Distribución por Edad , Brasil/epidemiología , Preescolar , Femenino , Gastroenteritis/epidemiología , Gastroenteritis/terapia , Sistemas de Información en Hospital , Humanos , Lactante , Enfermedades Pulmonares/epidemiología , Enfermedades Pulmonares/terapia , Masculino , Neumonía Bacteriana/epidemiología , Neumonía Bacteriana/terapia , Distribución por SexoRESUMEN
Purpose: To investigate the effects of melatonin on antioxidant capacity, inflammation and apoptotic cell death (through expression of cleaved-caspase 3) in lung tissue samples of diabetic rats. Methods: Thirty male Sprague-Dawley rats were randomly divided into three groups. Group 1 (control group) was made up of healthy rats. Group 2 (diabetes group) received streptozotocin at a dose of 50 mg/kg/day for 5 days.Group 3 (diabetes plus melatonin group) received streptozotocin at a dose of 50 mg/kg/day for 5 days and then they received melatonin at a dose of 20 mg/kg/day between 28th and 35th days of the study. Results: Tissue MDA and MPO levels were found to be significantly higher in diabetes group compared to control group (p< 0.05) whilst administration of melatonin was found to significantly lower this increase down to normal levels (p <0.05). Bronchus associated lymphoid tissue (BALT) was more severe in diabetics whereas administration of melatonin alleviated this hyperplasia. Cleaved caspase 3 activity was severe in hyperplastic BALT in diabetic rats however in lowered down to moderate level when melatonin was administered. Conclusion: The melatonin caused an increase in antioxidant capacity and decreased the expression of cleaved-caspase 3.(AU)