Application of extracorporeal membrane oxygenation regional treatment pattern in patients with severe cardiopulmonary diseases / 中华危重病急救医学

Objective:To assess the application of extracorporeal membrane oxygenation (ECMO) regional treatment pattern in patients with severe cardiopulmonary diseases.Methods:A retrospective analysis was conducted. Patients with severe cardiopulmonary disease who were transferred to Henan Provincial People's Hospital after ECMO treatment in cooperative hospitals were selected. The patients who received regular ECMO treatment from June 2017 to May 2018 were enrolled as the control group, and the patients who received ECMO regional treatment from June 2018 to May 2019 were selected as the observation group. The ECMO regional treatment pattern referred to implement a referral program for critical patients in primary hospitals, which mainly included the establishment of ECMO regional cooperative treatment network and ECMO referral team, the formulation of ECMO referral management standards, and the promotion of the merging of high-quality medical resources. Time of establishment of ECMO, ECMO regional treatment satisfaction, and the incidence of adverse events were also compared.Results:There were 27 patients enrolled in the control group and 64 patients in the observation group. There were no significant differences in gender, age, body mass index (BMI), ECMO mode, hypertension or coronary heart disease history between the two groups. Compared with the control group, the time for establishment of ECMO in the observation group was significantly shorter (minutes: 38.10±17.19 vs. 54.67±41.30, t = 2.715, P = 0.008), the ECMO treatment satisfaction of the observation group was also significantly higher than that of the control group (98.4% vs. 88.9%, χ 2 = 4.120, P = 0.042), and the incidence of ECMO referral adverse events was significantly lower than that of the control group (6.25% vs. 25.93%, χ 2 = 6.918, P = 0.009). Conclusion:The ECMO regional collaborative pattern in patients with severe cardiopulmonary diseases can shorten the time for establishment of ECMO, improve the satisfaction of ECMO treatment, and reduce the incidence of adverse events in ECMO referral.

Demographic and clinical characteristics of pulmonary arterial hypertension caused by schistosomiasis are indistinguishable from other etiologies

Abstract INTRODUCTION: Pulmonary arterial hypertension (PAH) is a serious pulmonary circulation disease caused by several etiologies, including schistosomiasis. The present study retrospectively evaluated the clinical and hemodynamic characteristics of patients with schistosomal PAH (PAH-Sch) compared to those of non-Sch PAH patients (non-Sch PAH). METHODS: Patients treated at the Pronto-Socorro Cardiológico de Pernambuco and diagnosed by right cardiac catheterization were divided into PAH-Sch and non-Sch PAH groups. Their socio-demographic and clinical characteristics, N-terminal-pro B-type natriuretic peptide (NT-proBNP), and echocardiography and hemodynamic parameters were retrospectively reviewed. RESULTS: Among the included 98 patients (mean age, 45 ± 14 years; 68 women [69.4%]), we found 56 PAH-Sch and 42 non-Sch PAH. The age distribution was heterogeneous in the PAH-Sch group, with patients predominantly ranging from 50-59 (p <0.004). Dyspnea was the most common symptom, reported by 92 patients (93.8%), and commonly present for over two years prior to diagnosis. Clinical symptoms were similar in both groups, with no differences in functional class, pulmonary artery systolic pressure (p = 0.102), 6-minute walk test score (p = 0.234), NT-proBNP serum levels (p = 0.081), or hemodynamic parameters. CONCLUSIONS: Patients with PAH-Sch present clinical, laboratory, and hemodynamic profiles similar to those with PAH resulting from other etiologies of poor prognosis. PAH is an important manifestation of schistosomiasis in endemic regions that is often diagnosed late.

Estudio de costo-efectividad en hipertensión arterial pulmonar Grupo 1: riociguat y sildenafil / Study of cost-effectiveness in pulmonary arterial hypertension Group 1: riociguat and sildenafil / Estudo de custo-efetividade na hipertensão arterial pulmonar Grupo 1: riociguat e sildenafil

Introducción. En los últimos años se han desarrollado nuevas terapias para el tratamiento de la hipertensión arterial pulmonar (HAP); sin embargo, la adopción de estas conlleva un aumento considerable de los costos por parte de las entidades promotoras de salud. Objetivo. Evaluar la costo-efectividad de riociguat versus sildenafil en monoterapia para pacientes con diagnóstico de HAP del Grupo 1 en las clases funcionales II y III. Materiales y métodos. Se diseñó un modelo de Márkov donde todos los individuos inician en clase funcional II con alguna de las dos terapias evaluadas en monoterapia y tienen como desenlaces principales la progresión a la clase funcional IV y la muerte. Se realizó un análisis probabilístico y determinístico de sensibilidad. Resultados. Se encontró una relación de costo-efectividad de riociguat frente a sildenafil de $529.213.933; sin embargo, en el umbral de aceptabilidad para Colombia este no es costo-efectivo.Conclusión. Se aconseja la implementación de sildenafil como medicamento de primera línea

Introduction: In recent years, new therapies have been developed for the treatment of pulmonary arterial hypertension (PAH), but with considerable increase in costs for health services. Objective: To assess the cost-effectiveness of riociguat versus sildenafil monotherapy for patients diagnosed with Group 1 PAH in functional classes II and III. Materials and methods: A model of Markov was designed. All the individuals in functional class II started one of the two drugs in monotherapy. The main outcomes were the progression to functional class IV or death. A probabilistic and deterministic sensitivity analysis was made. Results: A cost-effectiveness relationship of riociguat versus sildenafil of $ 529,213,933 was found. However, at the threshold of acceptability for Colombia, this is not cost-effective.Conclusion: The implementation of sildenafil as a first line medication is advised.

Introdução. Nos últimos anos, novas terapias foram desenvolvidas para o tratamento da hipertensão arterial pulmonar (HAP); a adoção destes leva a um aumento considerável de custos por entidades promotoras da saúde. Objetivo. Avaliar a relação custo-efetividade do tratamento com riociguat versus monoterapia com sildenafil em pacientes com diagnóstico de HAP do Grupo 1 nas classes funcionais II e III. Materiais e métodos. Foi desenhado um modelo de Markov onde todos os indivíduos iniciam na classe funcional II com uma das duas terapias avaliadas em monoterapia e têm como principais desfechos a progressão para classe funcional IV e morte. Uma análise de sensibilidade probabilística e determinística foi realizada. Resultados. Uma relação de custo-efetividade de riociguat ver-sus sildenafil de $ 529.213.933 foi encontrada; No entanto, no limiar de aceitabilidade para a Colômbia, isso não é rentável.Conclusão. Recomenda-se a implementação de sildenafil como medicamento de primeira linha

Obesidad infantil y su relación con indicadores cardiopulmonares en escolares mexicanos / Childhood Obesity and its Relation to Cardiopulmonary Indicators in Mexican School Children / Obesidade infantil e sua relação com indicadores cardiopulmonares em estudantes mexicanos

Objetivo: determinar la relación entre obesidad y anormalidades de parámetros cardiopulmonares en escolares. Materiales y métodos: participaron 78 escolares entre 5 a 11 años de edad, 47 hombres (60,3%) y 31 mujeres (39,7%), pertenecientes a una escuela primaria particular de la ciudad de Pachuca (México). Se evaluó: índice de masa corporal (IMC), circunferencia de cintura (CC), grasa corporal (GC), frecuencia cardiaca (FC), presión arterial (PA), frecuencia respiratoria (FR) y espirometría. Se emplearon las pruebas estadísticas chi-cuadrado (x2), odds ratio y correlación de Spearman (rs). Resultados: 23,1% de los escolares evaluados presentaron sobrepeso y 29,5%, obesidad. El 38,5 y 11,5% presentaron FC y PA superiores a los parámetros normales, respectivamente; 3,8% de la población presentó FR arriba del promedio y 11,5% mostró valores espirométricos anormales. Se encontraron relaciones entre IMC con GC y CC, GC y CC, CC y FC, GC y PA, y FC y FR. Conclusiones: las prevalencias de sobrepeso y obesidad obtenidas en este estudio fueron altas. Los niños con sobrepeso u obesidad podrían tener mayor riesgo de presentar anormalidades cardiopulmonares en comparación con niños de peso normal. Se sugiere continuar con estudios en el tema en una muestra más amplia.

Objective: Determine the relationship between obesity and abnormal cardiopulmonary parameters in school children. Materials and Methods: The sample involved 78 children between five and 11 years of age: 47 males (60.3%) and 31 females (39.7%). All were enrolled in a specific elementary school in the city of Pachuca (Mexico). Body mass (BMI), waist circumference (WC), body fat (GC), heart rate (HR), blood pressure (BP), respiratory rate (RR) and spirometry were evaluated. A chi-square (x2) statistical test, the odds ratio and Spearman's rank-order correlation (rs) were used. Results: In all, 23.1% of the students who were evaluated were overweight and 29.5% were obese; 38.5% and 11.5% had a HR and BP above the normal parameters, in that order; 3.8% of the population in question had a HR above average and 11.5% showed abnormal spirometric values. A relationship was found between BMI and BF and WC, BF and WC, WC and HR, BF and BP, and HR and RF. Conclusions: The prevalence of overweight and obesity found in this study was high. Children who are overweight or obese might be at increased risk of experiencing cardiopulmonary abnormalities compared to children of normal weight. It is suggested that studies on this subject be continued with a broader sample.

Objetivo: determinar a relação entre obesidade e anormalidades de parâmetros cardiopulmonares em estudantes do ensino fundamental. Materiais e métodos: participaram do estudo 78 estudantes entre 5 a 11 anos de idade, 47 do gênero masculino (60,3%) e 31 do feminino (39,7%), pertencentes a uma escola primária particular da cidade de Pachuca (México). Avaliaram-se o índice de massa corporal (IMC), a circunferência de cintura (CC), a gordura corporal (GC), a frequência cardíaca (FC), a pressão arterial (PA), a frequência respiratória (FR) e a espirometria. Utilizaram-se os testes estatísticos qui-quadrado (x2), odds ratio e correlação de Spearman (rs). Resultados: 23,1%o dos estudantes avaliados apresentaram excesso de peso e 29,5% obesidade. 38,5 e 11,5% apresentaram FC e PA superiores aos parâmetros normais, respectivamente; 3,8% da população apresentou FR acima da média e 11,5% mostraram parâmetros espirométricos anormais. Constataram-se relações entre IMC com GC e CC, GC e CC, CC e FC, GC e PA, e FC e FR. Conclusões: as prevalências de excesso de peso e obesidade obtidas neste estudo foram altas. As crianças com excesso de peso ou obesidade poderiam ter maior risco de apresentar anormalidades cardiopulmonares em comparação às de peso normal. Sugere-se continuar com estudos sobre o tema com uma amostra mais ampla.

Reabilitação cardiopulmonar e metabólica na atenção primária em saúde: é possível? / Cardiopulmonary and metabolic rehabilitation in primary health: is it possible?

Os programas de reabilitação cardiopulmonar e metabólica foram desenvolvidos com o propósito de restaurar a condição física, social, laboral e sexual aos pacientes, e usa o exercício físico como principal ferramenta terapêutica não medicamentosa. Tendo em vista que doenças cardiovasculares representam um grupo de enfermidades de elevada prevalência na atenção primária, o acompanhamento clínico e a elaboração de ações preventivas tem sido implementados. Entretanto, pouco se fala a respeito de programas de reabilitação cardiopulmonar e metabólica na atenção primária para atender esta importante fatia da população. Deste modo, discutir a possibilidade de implantação de programas de reabilitação cardiopulmonar e metabólica na atenção primária à saúde pode servir como ponto de partida para elaborar ações de incorporação destes programas nas comunidades. Para tanto, o embasamento em evidências através de protocolos clínicos construídos especificamente para o contexto da prática local,deve ser considerado, assim como os aspectos sociodemográficos da população atendida...

Cardiopulmonary and metabolic rehabilitation programs were developed with the purpose ofrestoring the physical, social, labor and sexual condition to patients, and using exercise as the main nondrugtherapeutic tool. Given that cardiovascular diseases are a group of diseases of high prevalence inprimary care, clinical monitoring, the development of preventive actions have been implemented.However, little is said about cardiopulmonary and metabolic rehabilitation programs in primary care toserve this important segment of the population. Thus, to discuss the possibility of developing metabolicand cardiopulmonary rehabilitation programs in primary health care can serve as a starting pointelaborating actions incorporation of these programs in communities. Thus, based on evidence throughclinical protocols built specifically for the context of local practice, should be considered, as well as thesociodemographic characteristics of the population served...

Cor pulmonale crónico como forma de presentación de fibrosis pulmonar: a propósito de un caso / Chronic cor pulmonale as a presentation of pulmonary fibrosis: report of a case

Introducción: el Cor Pulmonale Crónico es un síndrome caracterizado por hipertensión pulmonar y fallo de las cavidades derechas del corazón secundario a una amplia variedad de enfermedades primarias de la pleura, los pulmones, la caja torácica y la circulación pulmonar. Su relación con la fase final de las enfermedades infiltrativas del pulmón está bien descrita en la literatura. Objetivos: describir un caso atípico de Cor Pulmonale Crónico por fibrosis pulmonar en una paciente joven sin antecedentes de disnea progresiva. Caso clínico: mujer joven de 35 años que ingresa al hospital con disnea, dolores abdominales y edemas severos en miembros inferiores. En el examen físico se encontró, además, soplo cardíaco, ingurgitación yugular y hepatomegalia congestiva. Se realizó tomografía pulmonar y ecocardiograma transtorácico donde se diagnosticó insuficiencia cardíaca derecha y fibrosis pulmonar severa. Conclusiones: con el estudio radiológico y ecocardiográfico se demostró la presencia de Cor Pulmonale crónico producto a neumonitis intersticial aguda.

Introduction: chronic Cor Pulmonale is a syndrome characterized by pulmonary hypertension and failure of right heart secondary to a variety of primary diseases of the pleura, lungs, chest wall and pulmonary circulation. His relationship with the final phase of infiltrative lung disease is well described in the literature. Objectives: to describe an unusual case of chronic cor pulmonale pulmonary fibrosis in a young patient with no history of progressive dyspnea. Case: young woman of 35 who entered the hospital with dyspnea, abdominal pain and severe lower limb edema. On physical examination was found also heart murmur, jugular venous distension and hepatomegaly failure. CT was performed transthoracic lung which was diagnosed right heart failure and severe pulmonary fibrosis. Conclusions: radiological and echocardiographic study demonstrated the presence of chronic Cor Pulmonale due to acute interstitial pneumonitis.

Variations in Number of Hospitalized Patients with Cardiopulmonary Diseases Associated with 2009 H1N1 Pandemic Influenza in a Tertiary Teaching Hospital - Comparison with Seasonal Influenza

BACKGROUND: The world encountered the global outbreak of an H1N1 influenza pandemic in 2009. Influenza has accounted for grave outcomes, not only through infectious complications, but also through the exacerbation of underlying chronic diseases. A substantial number of confirmed or probable cases of influenza had been reported during the 2009 H1N1 pandemic in South Korea, but a review of the development of influenza-related complications or the exacerbation of underlying chronic diseases has been absent. This study aims to understand the influence of the 2009 pandemic on the exacerbation of existing cardiopulmonary diseases. MATERIALS AND METHODS: We surveyed the number of hospitalized patients with a diagnosis of pneumonia, asthma, chronic obstructive pulmonary disease, acute myocardial infarctions, and heart failure during the period of the 2009 H1N1 influenza pandemic in a 950-bed teaching hospital in Korea. Three influenza seasons from 2007 to 2009 were compared via a medical records review. Data collection included the number of hospitalizations, patient age, number of deaths from all causes, and underlying medical conditions of fatal patients. RESULTS: The weekly number of cardiopulmonary hospitalizations showed no differences between the 2009 pandemic influenza period and seasonal influenza epidemics (53 and 56 on average, respectively), but the total number of hospitalized patients during the pandemic influenza period was 1481, whereas there were 625 on average for seasonal influenza. The hospitalization rate for patients under five years of age exceeded that of the patients sixty years of age or older in pandemic influenza, and the hospitalization rate of patients twentyfive to fifty-nine during pandemic influenza was significantly higher than that of seasonal influenza outbreaks (P=0.012). On the other hand, the hospitalization rate of the patients sixty years of age or older during the pandemic influenza period significantly fell short of that in past seasonal influenza periods (P<0.001). However, the patients sixty years of age or older had the highest case fatality rate during both periods. The total number of deaths among hospitalized patients with cardiopulmonary diseases in pandemic influenza and seasonal influenza epidemics was 87 and 46 on average, respectively. Weekly fatal cases were 3 and 4. CONCLUSIONS: The cardiopulmonary hospitalization rate during the pandemic period outnumbered that of preceding seasonal influenza epidemics by its extended length. But, the virulence or disease severity of the 2009 H1N1 and seasonal influenza seems to be little different. A larger-scale epidemiological investigation is necessary.

Other Effects of Cimetidine in the Decompensated Stage of Chronic Cardiopulmonary Disease / 中国药房

OBJECTIVE:To observe the other effects of cimetidine in the decompensated stage of chronic cardiopulmonary disease. METHODS: 72 patients with uncompensated chronic cardiopulmonary disease were assigned into therapy group and control group (n=36). Both groups were given routine treatment. Therapy group were additionally treated with cimetidine intravenously for 48 h. The changes of respiration frequency, arterial partial pressure of oxygen (PaO2), arterial partial pressure of carbon dioxide (PaCO2), intake of staple food and electrolytes in blood serum of 2 groups before and after treatment were determined. RESULTS:In therapy group, the respiration frequency, the level of PaCO2 and disorder of electrolytes in blood serum were decreased and the level of PaO2 and intake of staple food were increased. Above items of therapy group were all different from that of control group (P