Facteurs pronostiques des pneumopathies acquises sous ventilation mécanique en réanimation polyvalente du CHU d'Angre (RCI) / Prognostic factors for pneumopathy acquired under mechanical ventilation in multi-purpose resuscitation at the Angre CHU (RCI)

Objectifs : Identifier les facteurs de mauvais pronostic des pneumopathies acquises sous ventilation mécanique(PAVM) afin d'améliorer leur prise en charge.Patients et methode : Etude prospective, descriptive et analytique portant sur les patients admis en réanimation du CHU d'Angré du 1er novembre 2019 au 31 juillet 2021 et ayant présenté une PAVM.Resultats : Nous avons colligé 43 patients sur 625 admissions soit 6,88%. L'âge moyen était de 49,06 ans. Le sex ratio était de 0,38. Le principal motif d'admission était le coma avec 88,37%. L'HTA et le diabète étaient les principaux antécédents .Les PAVM précoces représentaient 53,49%. Le Klebsiella pneumoniae était le principal germe. Les patients intubés à l'admission représentaient 79,07%. La durée moyenne de ventilation était de 26,95 jours et la durée moyenne d'hospitalisation était de 30,8140 jours. Une antibiothérapie probabiliste a été réalisée chez 75,76% des patients. La mortalité était de 76,74%. Les facteurs de mortalité étaient une durée de ventilation mécanique supérieure à 15 jours et l'âge supérieur à 50 ans.Conclusion :La mortalité secondaire au PAVM demeure élevée. L'identification des deux facteurs pronostiques devrait améliorer la prise en charge ultérieure de tous nouveaux cas

Objectives: To identify the factors of poor prognosis of ventilator-associated lung disease (VAP) in order to improve their management. Patients and method: Prospective, descriptive and analytical study of patients admitted to intensive care at the Angré University Hospital from November 1, 2019 to July 31, 2021 and having presented VAP.Results: We collected 43 patients out of 625 admissions, i.e. 6.88%. The average age was 49.06 years. The sex ratio was 0.38. The main reason for admission was coma with 88.37%. Hypertension and diabetes were the main antecedents. Early VAP accounted for 53.49%. Klebsiella pneumoniae was the main germ. Patients intubated on admission accounted for 79.07%. The average duration of ventilation was 26.95 days and the average duration of hospitalization was 30.8140 days. Probabilistic antibiotic therapy was performed in 75.76% of patients. Mortality was 76.74%. The mortality factors were duration of mechanical ventilation greater than 15 days and age greater than 50 years.Conclusion:Secondary mortality from VAP remains high. The identification of the two prognostic factors should improve the subsequent management of all new cases.

Adenocarcinoma pulmonar associado à infecção por Mycobacterium sp. em vaca - relato de caso / [Pulmonary adenocarcinoma associated with infection by Mycobacterium sp. in a cow - case report]

Descrevem-se os aspectos clínicos, anatomopatológicos, imuno-histoquímicos, microbiológicos e moleculares de um caso de adenocarcinoma pulmonar associado à infecção por Mycobacterium sp. em uma vaca. O animal apresentou hiporexia, emagrecimento, vocalizações, postura ortopneica, ingurgitamento da jugular, estase venosa positiva, gemido expiratório e morte. Na necropsia, os pulmões estavam aumentados e apresentavam, na superfície pleural, nódulos branco-amarelados, firmes, multifocais a coalescentes, interpostos por áreas avermelhadas. Ao corte, os nódulos aprofundavam-se ao parênquima e possuíam múltiplos focos de aspecto caseoso e friável e áreas de mineralização. O saco pericárdico e os linfonodos traqueobrônquicos, ilíacos, lombares aórticos e mamários apresentavam lesões semelhantes. Histologicamente, observou-se neoformação carcinomatosa associada a áreas multifocais de necrose e mineralização. As células neoplásicas foram fortemente imunomarcadas pelo anticorpo antipancitoqueratina AE1/AE3. Na cultura microbiológica de fragmentos dos pulmões, houve crescimento de colônias bacterianas compatíveis com micobactérias atípicas. O sequenciamento molecular submetido ao BLASTn identificou o Mycobacterium sp. WCM 7299 (ID: gb|KJ873243.1|).(AU)

The clinical, anatomopathological, immunohistochemical, microbiological and molecular aspects of a case of pulmonary adenocarcinoma associated with infection by Mycobacterium sp. in a cow are described. The animal presented hyporexia, weight loss, vocalizations, orthopneic posture, jugular engorgement, positive venous stasis, expiratory groaning and death. At necropsy, the lungs were enlarged and presented firm, multifocal to coalescent yellowish nodules, interposed by reddish areas on the pleural surface. At cut, the nodules deepened to the parenchyma and had multiple foci of caseous and friable appearance and areas of mineralization. The pericardial sac and tracheobronchial, iliac, aortic lumbar and mammary lymph nodes showed similar lesions. Histologically, a carcinomatous neoformation, associated with multifocal areas of necrosis and mineralization, was observed. Neoplastic cells were strongly immunolabelled by anti-PanCytokeratin antibody AE1/AE3. Microbiological culture of lung fragments showed growth of bacterial colonies compatible with atypical mycobacteria. Molecular sequencing submitted to BLASTn identified the Mycobacterium sp. WCM 7299 (ID: gb|KJ873243.1|).(AU)

The zero impact of the vehicle inspection program on public health in São Paulo, SP / O impacto nulo do programa de inspeção veicular na saúde pública em São Paulo, SP

ABSTRACT OBJECTIVE To analyze the impact of two interventions (implementation and suspension of mandatory vehicle inspection) on morbidity and mortality due to conditions related to air pollution, from 2008 to 2017. METHODS Interrupted time series (ARIMA models), using data available in public repositories. RESULTS A total of 229,337 children of up to 5 years old were hospitalized due to respiratory diseases, and 1,053 died (average monthly mortality ratio for this population: 1.12/100,000). Exact 137,876 individuals over 40 years old were hospitalized for an acute myocardial infarction, and 19,492 died (3.7/100,000). A total of 11,010 individuals over 40 years old were hospitalized with malignant neoplasms of the respiratory system; 2,898 died (0.5/100,000). A total of 20,807 individuals over 60 years old were hospitalized with chronic obstructive pulmonary diseases; 2,627 died (1.5/100,000). As for strokes, 69,180 individuals were hospitalized, and 10,866 died (2.1/100,000). We found no significant regression coefficient for the implementation or suspension of the program regarding hospitalizations and deaths. 38,207 children of up to 14 years old were hospitalized with asthma, and 25 of them died (0.007/100,000). The coefficients show a monthly increase of 0.05 deaths/100,000 people (p = 0.01) in the post-inspection period. We found no correlation between the measured concentrations of the pollutants PM2.5 and CO - in a monitoring station, in the central region of the municipality - and the implementation or suspension of the inspection. CONCLUSIONS No evidence confirms that the program had a measurable beneficial impact on morbidity and mortality due to respiratory and circulatory diseases.

RESUMO OBJETIVO Analisar o impacto de duas intervenções (introdução e suspensão da inspeção veicular obrigatória) sobre a morbidade e mortalidade por condições associadas à poluição do ar no período de 2008 a 2017. MÉTODOS Séries temporais interrompidas (método Arima), com dados disponíveis em repositórios públicos. RESULTADOS Houve 229.337 internações por doenças respiratórias em crianças até 5 anos de idade, com 1.053 óbitos (coeficiente médio de mortalidade mensal para a população da idade: 1,12/100.000). Para infarto agudo do miocárdio em maiores de 40 anos, houve 137.876 internações, com 19.492 óbitos (3,7/100.000). Para as neoplasias malignas do aparelho respiratório em maiores de 40 anos, foram 11.010 internações, com 2.898 óbitos (0,5/100.000). Para doenças pulmonares obstrutivas crônicas em maiores de 60 anos, foram 20.807 internações, com 2.627 óbitos (1,5/100.000). Para os acidentes vasculares cerebrais, foram 69.180 internações e 10.866 óbitos (2,1/100.000). Não houve nenhum coeficiente de regressão significativo para a introdução ou suspensão do programa em relação às internações e óbitos. Para asma em crianças até 14 anos, houve 38.207 internações e 25 óbitos (0,007/100.000), e os coeficientes mostram aumento de 0,05 óbitos/100.000 pessoas por mês (p = 0,01) no período pós-introdução da inspeção. Em modelo para os poluentes MP2,5 e CO, em estação de monitoramento da região central do município, não houve correlação entre as concentrações medidas e a introdução ou a suspensão da inspeção. CONCLUSÕES Não há evidências de que o programa tenha tido qualquer efeito benéfico mensurável sobre a morbidade e a mortalidade por doenças respiratórias e do aparelho circulatório.

Spontaneous pneumomediastinum in dermatomyositis: a case series and literature review / Pneumomediastino espontâneo na dermatomiosite: uma série de casos e revisão de literatura

OBJECTIVES: To describe a case series of spontaneous pneumomediastinum in dermatomyositis and to review the literature. METHODS: This was a retrospective single-center case series, reporting 9 patients with pneumomediastinum and defined dermatomyositis, followed from 2005 to 2017. RESULTS: Median age of patients: 33 years; cutaneous and pulmonary involvement in all cases; constitutional symptoms in 88.8% of patients; involvement of the joints in 11.1%, gastrointestinal tract in 44.4%, and muscles in 77.7%; subcutaneous emphysema was observed in 55.5% and pneumothorax in 11.1%, respectively. Muscle weakness was observed in 77.7% of cases and with a median level of serum creatine phosphokinase of 124U/L. Drawing on results for our literature review, the overall analysis showed that the risk factors associated with spontaneous pneumomediastinum were: (a) a history of interstitial pneumopathy; (b) normal or low levels of muscle enzymes; (c) previous use of systemic glucocorticoid; (d) over 50% of patients had subcutaneous emphysema; (e) high mortality as a consequence of severity of the interstitial lung disease. CONCLUSIONS: Our case series revealed that pneumomediastinum is a rare complication in dermatomyositis that occurs in patients with a history of interstitial pneumopathy and may be accompanied by subcutaneous emphysema and pneumothorax.

OBJETIVOS: Descrever série de casos de pneumomediastino espontâneo em portadores de dermatomiosite e revisar a literatura. MÉTODOS: Trata-se de série de casos, único centro, relatando 9 pacientes com pneumomediastino e dermatomiosite definida, acompanhados de 2005 a 2017. RESULTADOS: A mediana da idade dos pacientes foi de 33 anos. Sintomas constitucionais estavam presentes em 88,8% dos pacientes. Houve acometimento cutâneo e pulmonar em todos os casos, acometimento das articulações em 11,1%, trato gastrointestinal em 44,4% e musculatura em 77,7% dos pacientes. Enfisema subcutâneo foi observado em 55,5% e pneumotórax em 11,1%, respectivamente. A fraqueza muscular foi observada em 77,7% dos casos, com um nível médio de creatinofosfoquinase sérica de 124U/L. Com base nos resultados da revisão da literatura, a análise geral mostrou que: os fatores de risco associados ao pneumomediastino espontâneo foram: história de pneumopatia intersticial, níveis normais ou baixos de enzimas musculares, uso prévio de glicocorticoide sistêmico; >50% dos pacientes tiveram enfisema subcutâneo; houve alta mortalidade como consequência da gravidade da doença pulmonar intersticial. CONCLUSÕES: Nossa série de casos revelou que o pneumomediastino é uma complicação rara na dermatomiosite e que ocorre em pacientes com história de pneumopatia intersticial e pode ser acompanhada por enfisema subcutâneo e pneumotórax.

Are pulmonary hemostasis and fibrinolysis out of balance in equine chronic pneumopathies?

Clinical examination, bronchoalveolar lavage fluid (BALF) cytology, acute-phase protein, and pulmonary hemostasis and fibrinolysis marker (fibrinogen, serum amyloid A [SAA], and D-dimer) results were compared between control and respiratory disease-affected horses. Using a clinical scoring system, horses (n = 58) were classified as respiratory disease-free (Controls, n = 15) or with recurrent airway obstruction (RAO; n = 18), inflammatory airway disease (n = 14) or chronic interstitial pneumopathy (n = 11). There were no significant differences in fibrinogen concentrations among groups, but there was a trend toward a lower value in controls (median 0.0024 g/L) than in horses with chronic pneumopathies (median 0.0052 g/L), in particular, those with RAO (median 0.0062 g/L). Fibrinogen concentration was positively correlated with percentage of neutrophils in BALF (r(s) = 0.377, p = 0.004). SAA concentrations were low; 65.5% of samples were below the detection limit. D-dimer concentrations were also low and quantifiable concentrations were only obtained after ultrafiltration and only in RAO (median 0.1 mg/L). In conclusion, there was limited evidence of increased coagulatory activity in chronic pneumopathies, apart from RAO. It is uncertain whether fibrinogen and D-dimer concentrations increased due to their role as acute-phase proteins or as a misbalance of coagulation and fibrinolysis.

Neumopatia intersticial en pacientes con polimiositis y dermatomiositis: reporte de cuatro casos / Interstitial Lung Disease in Patients With Polymyositis and Dermatomyositis: four Cases Report

RESUMEN Se reporta cuatro casos: tres con dermatomiositis y uno con poliomiositis con compromiso pulmonar, tratados con pulsos de metilprednisolona asociado con azatioprina en tres casos y uno con ciclofosfamida, tres de ellos fallecieron, dos por complicaciones infecciosas pulmonares, el tercero por insuficiencia respiratoria aguda, Uno solo presento buena evolución bajo tratamiento con inmunoglobulina .En los cuatro pacientes el anticuerpo anti Jo fueron negativos.

ABSTRACT We report four cases, three with dermatomyositis and polymyositis one with pulmonary involvement treated with pulse methylprednisolone associated with azathioprine in three cases and one cyclophosphamide, three of them died, two infectious pulmonary complications, the third for acute respiratory failure, one presented good performance under treatment with immunoglobulin .In the four patients were negative anti Jo

O pulmão na doença inflamatória do cólon: estudo experimental em ratos

Although ulcerative colitis has been known since 1875 and many extraintestinal manifesattions of this disease have been described, it was only that emphasis was placed on the involvement of the respiratory tract. Severe complications have been described in patients, such as inflammatory tracheal stenosis, bronchiolitis with pnemonia, interstitial pneumonitis, Wegener granulomatosis, chronic bronchitis with bronchiectasis, necrobiotic nodules, vasculitis, fibrosis and alveolitis. The objective of the present study was to determine the pulmonary changes occuring during the acute phase of the disease in rats submitted to induction of the disease with 10% acetic acid and to compared to normal controls. It was observed that 100% of the animals with colitis developed a pulmonary inflammatory reaction (p=0,0210) of moderate to severe intensity (p=0,0340). Vasculitis was observed in 58,33% of the lungs (p=0,0060) and focal hemorrhage, necrosis and abscesses were detected in 3 animals. These findings permit us to conclude about the presence of a strong correlation between inflammatory colon disease and changes in the respiratory apparatus during the acute phase of the disease in rats.

Embora a colite ulcerativa seja conhecida desde 1875 e muitas sejam as manifestações extra-intestinais descritas nesta doença, só recentemente chamou-se a atenção para o envolvimento do aparelho respiratório. Severas complicações têm sido descritas em pacientes como: estenose traqueal inflamatória, bronquiolite com pneumonia, pneumonite intersticial, granulomatose de Wegener, bronquite crônica com bronquiectasia, nódulos necrobióticos, vasculites, fibrose e alveolites. O presente estudo visa reconhecer as alterações pulmonares, na fase aguda da doença inflamatória do cólon, induzida em ratos com ácido acético à 10% e comparar com controles normais. Foi possível constatar que 100% dos animais com colite apresentaram reação inflamatória pulmonar (p=0,0210) de intensidade moderada à severa (p=0,0340). Vasculite foi vista em 58,33% dos pulmões (p=0,0060) e em 3 animais detectou-se hemorragia focal, necrose e abscesso. Estes achados permitem atribuir uma forte associação entre a doença inflamatória do cólon e alterações do aparêlho respiratório, durante a fase aguda da doença, em ratos.