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1.
Medwave ; 21(6): e8231, 31-07-2021.
Article in English, Spanish | LILACS | ID: biblio-1284247

ABSTRACT

Objetivos Describir las características clínicas y evaluar los factores asociados con la mortalidad de los pacientes adultos con la nueva enfermedad causada por coronavirus 2019 (COVID-19) ingresados a un hospital de referencia nacional de Perú. Métodos Se realizó un estudio de cohorte prospectivo. Se incluyó a pacientes mayores de 18 años hospitalizados con el diagnóstico de infección por coronavirus 2 del síndrome respiratorio agudo severo (SARS-CoV-2). Se excluyó a quienes ingresaron con prueba rápida serológica positiva al ingreso, sin clínica sugestiva ni imágenes compatibles. Los datos se recolectaron a partir de la historia clínica. Resultados Se incluyó un total de 813 adultos, 544 (66,9%) tuvieron COVID-19 confirmado. La media de la edad fue de 61,2 años (desviación estándar: 15) y 575 (70,5%) fueron de sexo masculino. Las comorbilidades más frecuentes fueron hipertensión arterial (34,1%) y obesidad (25,9%). Los síntomas más frecuentes al ingreso fueron disnea (82,2%) y tos (53,9%). Un total de 114 (14%) pacientes recibieron ventilación mecánica, 38 (4,7%) ingresaron a unidad de cuidados intensivos y 377 (46,4%) fallecieron. Se asociaron a la mortalidad el requerimiento de soporte ventilatorio, el mayor compromiso pulmonar y los marcadores inflamatorios. Encontramos que por cada 10 años que aumentó la edad, el riesgo de morir se incrementó en 32% (riesgo relativo: 1,32; intervalo de confianza 95%: 1,25 a 1,38). Aquellos pacientes que requirieron ingreso a unidad de cuidados intensivos y ventilación mecánica tuvieron 1,39 (intervalo de confianza 95%: 1,13 a 1,69) y 1,97 (intervalo de confianza 95%: 1,69 a 2,29) veces el riesgo de morir, respectivamente. Conclusión La mortalidad encontrada en nuestro estudio fue alta y estuvo asociada a la edad, marcadores inflamatorios y compromiso respiratorio.


Objectives To describe and assess clinical characteristics and factors associated with mortality in adult patients with COVID-19 admitted to a national referral hospital in Peru. Methods We conducted a prospective cohort study that included hospitalized patients older than 18 years with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection diagnosis. Patients with a positive rapid serological test on admission but no respiratory symptoms nor compatible images were excluded. We collected the data from clinical records. Results A total of 813 adults were included, 544 (66.9%) with confirmed COVID-19. The mean age was 61.2 years (standard deviation: 15.0), and 575 (70.5%) were male. The most frequent comorbidities were hypertension (34.1%) and obesity (25.9%). On admission, the most frequent symptoms were dyspnea (82.2%) and cough (53.9%). A total of 114 (14.0%) patients received mechanical ventilation, 38 (4.7%) were admitted to the intensive care unit, and 377 (46.4%) died. The requirement for ventilatory support, greater lung involvement, and inflammatory markers were associated with higher mortality. It was found that for every 10-year age increase, the risk of dying increased 32% (relative risk: 1.32; 95% confidence interval: 1.25 to 1.38). Those who were admitted to the intensive care unit and and were placed on mechanical ventilation had 1.39 (95% confidence interval: 1.13 to 1.69) and 1.97 (95% confidence interval: 1.69 to 2.29) times the risk of dying compared to those who did not, respectively. Conclusion We found a high mortality rate among hospitalized patients associated with older age, higher inflammatory markers, and greater lung involvement.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Respiration, Artificial/statistics & numerical data , COVID-19/mortality , Hospitalization/statistics & numerical data , Intensive Care Units/statistics & numerical data , Peru/epidemiology , Prospective Studies , Risk Factors , Cohort Studies , Age Factors , Cough/epidemiology , Cough/virology , Dyspnea/epidemiology , Dyspnea/virology , COVID-19/epidemiology , Hospitals
2.
An. Fac. Cienc. Méd. (Asunción) ; 54(1): 67-76, 20210000.
Article in Spanish | LILACS | ID: biblio-1178627

ABSTRACT

Introducción: La Enfermedades Neuromusculares se caracterizan por la pérdida progresiva de la fuerza muscular, la morbi-mortalidad aumenta con la exageración de la debilidad muscular determinando mayor riesgo de complicaciones respiratorias. Es de suma importancia evaluar e interpretar adecuadamente la función pulmonar y ventilatoria para poder realizar intervenciones que pueda prevenir dichas complicaciones. Objetivos: El objetivo del estudio fue reportar el estado funcional respiratorio de un grupo de pacientes con ENM en control ambulatorio y relacionar estos hallazgos con umbrales clínicamente relevantes de complicaciones respiratorias, reforzando intervenciones basadas en opiniones de expertos. Materiales y métodos: Se realizó un estudio Descriptivo-Observacional de corte transversal, donde fueron evaluados en forma ambulatoria, de marzo del 2017 a agosto del 2018, 30 niños y adolescentes con enfermedades neuromusculares. Resultados: El 46% del total de pacientes presenta capacidad tusígena no funcional con alto riesgo de complicaciones. No obstante, sólo el 10% del total de pacientes fueron aptos para realizar adecuadamente estudios de espirometría. Durante las pruebas espirométricas, sólo el 50% de los pacientes logró mantener 6 segundos la espiración. Conclusión: Si bien la espirometría es la principal prueba de función pulmonar y una alta proporción de pacientes presentó alteraciones en su morfología, su realización en estados avanzados de enfermedad fue poco factible. Para detectar umbrales de complicaciones respiratorias graves, la medición del flujo generado durante la tos resultó mejor. Conclusión: Si bien la espirometría es la principal prueba de función pulmonar y una alta proporción de pacientes presentó alteraciones en su morfología, su realización en estados avanzados de enfermedad fue poco factible. Para detectar umbrales de complicaciones respiratorias graves, la medición del flujo generado durante la tos resultó mejor.


Introduction: Neuromuscular Diseases are characterized by the progressive loss of muscle mass, morbidity and mortality increases with the progress of muscle weakness due to the increased risk of respiratory complications, so it is very important to properly evaluate and interpret the measurements of lung functions and ventilation to be able to carry out a specific treatment that can reduce respiratory complications. Objectives: The purpose of this work is to present the results of the measurements of flows, volumes, respiratory capacities and spirometric patterns in outpatients with neuromuscular diseases and to verify their usefulness to detect vital risks. Materials and methods: A cross-sectional Descriptive-Observational study was carried out, where 30 children and adolescents with neuromuscular diseases were evaluated on an outpatient basis, from March 2017 to August 2018. Results: 46% of all patients presented a non-functional cough with a high risk of complications and only 10% of all patients were eligible for spirometry studies. During the spirometric tests, 50% of the patients managed to maintain expiration for 6 seconds. In 70% of the patients, abnormalities in the Flow-Volume curve could be detected. Conclusion: Although spirometry is the main pulmonary function test, its usefulness and efficacy in neuromuscular diseases depends on the findings of specific alterations in the morphology of the flow-volume curve, which in many cases are not possible to distinguish.


Subject(s)
Spirometry , Cough , Lung , Neuromuscular Diseases , Respiratory Function Tests , Measurements, Methods and Theories , Control
4.
Int. braz. j. urol ; 47(2): 415-422, Mar.-Apr. 2021. tab, graf
Article in English | LILACS | ID: biblio-1154456

ABSTRACT

ABSTRACT Purpose: Patient-reported history of pads per day (PPD) is widely recognized as a fundamental element of decision-making for anti-incontinence procedures. We hypothesize that SUI severity is often underestimated among men with moderate SUI. We sought to compare patient history of incontinence severity versus objective in-office physical examination findings. Materials and Methods: We retrospectively reviewed our single-surgeon male SUI surgical database from 2007-2019. We excluded patients with incomplete preoperative or postoperative data and those who reported either mild or severe SUI, thus having more straightforward surgical counseling. For men reported to have moderate SUI, we determined the frequency of upgrading SUI severity by recording the results of an in-office standing cough test (SCT) using the Male Stress Incontinence Grading Scale (MSIGS). The correlation of MSIGS with sling success rate was calculated. Failure was defined as >1 PPD usage or need for additional incontinence procedure. Results: Among 233 patients with reported moderate SUI (2-3 PPD), 89 (38%) had MSIGS 3-4 on SCT, indicating severe SUI. Among patients with 2-3 PPD preoperatively, sling success rates were significantly higher for patients with MSIGS 0-2 (76/116, 64%) compared to MSIGS 3-4 (6/18, 33%) (p <0.01). Conclusions: Many men with self-reported history of moderate SUI actually present severe SUI observed on SCT. The SCT is a useful tool to stratify moderate SUI patients to more accurately predict sling success.


Subject(s)
Humans , Male , Urinary Incontinence, Stress/surgery , Urinary Incontinence, Stress/diagnosis , Suburethral Slings , Prostatectomy , Retrospective Studies , Treatment Outcome , Cough
5.
Article in English | WPRIM | ID: wpr-880637

ABSTRACT

OBJECTIVES@#Pulmonary alveolar proteinosis (PAP) is a rare disease with non-specific and various clinical manifestations, often leading to misdiagnosis. This study aims to raise the awareness of this disease via summarizing the clinical characteristics, diagnosis, and therapy of PAP.@*METHODS@#We retrospectively analyzed clinical data of 25 hospitalized cases of PAP during 2008 and 2019 in the Department of Respiratory and Critical Care Medicine of the Second Xiangya Hospital of Central South University.@*RESULTS@#Cough with unkown reason and dyspnea were common clinical manifastations of PAP. Five patients had a history of occupational inhalational exposure. Sixteen patients had typical image features including ground-glass opacification of alveolar spaces and thickening of the interlobular and intralobular septa, in typical shapes called crazy-paving and geographic pattern. Fourteen patients underwent pulmonary function tests, revealing a reduction in the diffusing capacity for carbon monoxide. The positive rate of transbronchial biopsy was 95%. Five patients received the whole lung lavage and the symptoms and imaging fcauters significantly relieved after five-years follow-up.@*CONCLUSIONS@#PAP is characterized by radiographic pattern and pathology. Transbronchial lung biopsy is effective to make diagnosis of PAP. The whole lung lavage remains a efficient therapy.


Subject(s)
Biopsy , Bronchoalveolar Lavage , Cough , Dyspnea , Humans , Pulmonary Alveolar Proteinosis/therapy , Retrospective Studies
6.
Article in Chinese | WPRIM | ID: wpr-879029

ABSTRACT

To systemically evaluate the efficacy and safety of Maxing Shigan Decoction in the treatment of community acquired pneumonia(CAP) and provide a reference for the treatment of CAP. Databases of CNKI, Wanfang, VIP, SinoMed, EMbase, Cochrane Library, Web of Science and PubMed were searched(from inception to May 30, 2020) to screen the randomized controlled trials(RCTs) of Maxing Shigan Decoction in treating CAP. Two authors independently screened and selected relevant literature and extracted data based on the inclusion and exclusion criteria. Any disagreement or differences was resolved through discussion. The bias risk assessment tool recommended by Cochrane handbook was used to evaluate the quality of the included studies, and RevMan 5.3 software was used for data analysis. Seventeen RCTs were finally included, involving 1 309 patients. Meta-analysis showed that Maxing Shigan Decoction combined with conventional Western medicine treatment could improve clinical efficacy in patients with CAP more effectively as compared with conventional Western medicine treatment alone, mainly in terms of anti-inflammatory effects, a decrease in C-reactive protein(CRP) content(MD=-6.01, 95%CI[-10.95,-1.06], P=0.02)and white blood cell(WBC) count, a decrease in procalcitonin(PCT) level(MD=-0.74, 95%CI[-0.77,-0.71], P<0.000 1), and shortened recovery time of cough and fever. Maxing Shigan Decoction has certain curative effect on CAP, but there are problems in the methodology of included studies. High-quality stu-dies are still needed for further verification.


Subject(s)
Community-Acquired Infections/drug therapy , Cough , Drugs, Chinese Herbal , Humans , Pneumonia/drug therapy , Randomized Controlled Trials as Topic , Treatment Outcome
7.
Article in Chinese | WPRIM | ID: wpr-878965

ABSTRACT

To systematically evaluate the clinical efficacy and safety of Lianhua Qingwen in the treatment of adult pneumonia. The randomized controlled trial of Lianhua Qingwen combined with conventional Western medicine in the treatment of pneumonia were retrieved from PubMed, EMbase, Wanfang database, VIP database, and CNKI from the establishment of database to March 2020. Two researchers independently conducted literature screening and data extraction, and the third researcher was in charge of arbitration in case of any disagreement. Outcome indicators included total clinical effective rate, symptom improvement time, and incidence of adverse events. R 3.6.1 was used for Meta-analysis, and RevMan 5.3 was used for quality evaluation. Twenty-two studies were included, with a total of 2 007 patients, including 1 017 patients in the experimental group and 990 patients in the control group. The results showed that the total clinical effective rate of the experimental group was higher than that of the control group(RR=1.11, 95%CI[1.08, 1.15], P<0.001), and the antifebrile time(MD=-1.81, 95%CI[-2.42,-1.21], P<0.001), cough duration(MD=-2.32, 95%CI[-2.89,-1.76], P<0.001), rale duration(MD=-2.19, 95%CI[-2.74,-1.63], P<0.001), imaging recovery time(MD=-2.17, 95%CI[-2.76,-1.58], P<0.001) and post-treatment CRP(MD=-4.07, 95%CI[-6.39,-1.75], P<0.001] were all significantly lower than those of the control group. However, it did not proved that the experimental group was safer than the control group(RR=0.84, 95%CI[0.57, 1.24], P=0.382). The results confirmed that Lianhua Qingwen combined with conventional Western medicine in the treatment of pneumonia could improve the clinical treatment efficiency, shorten the time of fever, cough, rale disappearance and imaging recovery, improve CRP index and accelerate the recovery of pneumonia patients. However, the literatures included in this study had a low quality, and the conclusions still need to be further confirmed by more high-quality, multi-center, rigorously designed randomized controlled trial.


Subject(s)
Adult , Cough , Drugs, Chinese Herbal/adverse effects , Humans , Pneumonia/drug therapy , Treatment Outcome
8.
Chinese Medical Journal ; (24): 944-953, 2021.
Article in English | WPRIM | ID: wpr-878119

ABSTRACT

BACKGROUND@#Coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has rapidly spread throughout the world. In this study, we aimed to identify the risk factors for severe COVID-19 to improve treatment guidelines.@*METHODS@#A multicenter, cross-sectional study was conducted on 313 patients hospitalized with COVID-19. Patients were classified into two groups based on disease severity (nonsevere and severe) according to initial clinical presentation. Laboratory test results and epidemiological and clinical characteristics were analyzed using descriptive statistics. Univariate and multivariate logistic regression models were used to detect potential risk factors associated with severe COVID-19.@*RESULTS@#A total of 289 patients (197 nonsevere and 92 severe cases) with a median age of 45.0 (33.0, 61.0) years were included in this study, and 53.3% (154/289) were male. Fever (192/286, 67.1%) and cough (170/289, 58.8%) were commonly observed, followed by sore throat (49/289, 17.0%). Multivariate logistic regression analysis suggested that patients who were aged ≥ 65 years (OR: 2.725, 95% confidence interval [CI]: 1.317-5.636; P = 0.007), were male (OR: 1.878, 95% CI: 1.002-3.520, P = 0.049), had comorbid diabetes (OR: 3.314, 95% CI: 1.126-9.758, P = 0.030), cough (OR: 3.427, 95% CI: 1.752-6.706, P < 0.001), and/or diarrhea (OR: 2.629, 95% CI: 1.109-6.231, P = 0.028) on admission had a higher risk of severe disease. Moreover, stratification analysis indicated that male patients with diabetes were more likely to have severe COVID-19 (71.4% vs. 28.6%, χ2 = 8.183, P = 0.004).@*CONCLUSIONS@#The clinical characteristics of those with severe and nonsevere COVID-19 were significantly different. The elderly, male patients with COVID-19, diabetes, and presenting with cough and/or diarrhea on admission may require close monitoring to prevent deterioration.


Subject(s)
Adult , COVID-19/pathology , China/epidemiology , Comorbidity , Cough , Cross-Sectional Studies , Diarrhea , Female , Humans , Male , Middle Aged , Retrospective Studies , Risk Factors
9.
Article in Chinese | WPRIM | ID: wpr-877606

ABSTRACT

OBJECTIVE@#To compare the clinical efficacy of cupping treatment combined with antibiotics and antibiotics alone for bacterial pneumonia in children.@*METHODS@#A total of 72 children with bacterial pneumonia were randomly divided into an observation group (36 cases, 1 case dropped off) and a control group (36 cases). The children in the control group were treated with intravenous drip of cefodizine sodium [80 mg/(kg•d)] for 7 days. Based on the treatment of the control group, the children in the observation group were treated with cupping treatment on the bladder meridian of the back on the first day and the fourth day of antibiotic treatment; each cupping treatment was given for 5-10 min; the treatment of observation group was given for 7 days. The days for complete fever reduction, TCM syndrome scores and Canadian acute respiratory illness flu scale (CARIFS) scores before and after treatment were observed, and the clinical efficacy was evaluated.@*RESULTS@#The days for complete fever reduction in the observation group were shorter than that in the control group (@*CONCLUSION@#Cupping treatment combined with antibiotics has similar efficacy with antibiotics alone for bacterial pneumonia in children, but shows better effect in shortening the duration of fever and improving pulmonary symptoms.


Subject(s)
Anti-Bacterial Agents , Canada , Child , Cough , Cupping Therapy , Humans , Pneumonia, Bacterial , Treatment Outcome
11.
CoDAS ; 33(3): e20200057, 2021. tab
Article in Portuguese | LILACS | ID: biblio-1249623

ABSTRACT

RESUMO Objetivo Apresentar uma proposta de reabilitação fonoaudiológica denominada Programa de Terapia para Manejo da Tosse Crônica (TMTC) para tratamento da tosse crônica refratária. Método O TMTC foi elaborado com base em duas etapas: análise de literatura e análise clínica. A etapa de análise de literatura foi realizada por meio dos procedimentos: busca eletrônica e manual por artigos e livros publicados até junho de 2019 que contemplassem participantes adultos com tosse crônica, e intervenção com terapia fonoaudiológica; seleção das fontes; análise dos artigos e livros incluídos; e, elaboração da versão inicial do programa de terapia. A versão inicial do programa de terapia resultante da etapa de análise de literatura foi submetida a etapa de análise clínica por meio dos procedimentos: análise de três juízes; revisão da proposta pelos autores; reanálise dos juízes; elaboração da versão final denominada Programa de Terapia para Manejo da Tosse Crônica (TMTC). Resultados O TMTC sintetiza o conhecimento científico e a experiência clínica atual sobre o manejo comportamental da tosse crônica refratária em um programa com três componentes principais, cada um com objetivos e estratégias específicos. O TMTC é composto por quatro sessões, com frequência semanal, e duração entre 30 e 45 minutos por sessão, executadas em fases hierárquicas, com objetivos e estratégias específicos por sessão. Conclusão O TMTC é um programa estruturado para oferecer uma reabilitação global da tosse. Faz-se necessário obter evidências científicas sobre sua efetividade para que ele possa ser utilizado na prática clínica.


ABSTRACT Purpose To present a proposal for speech-language pathology rehabilitation called the Therapy Program for Management of Chronic Cough (TMCC) for the treatment of refractory chronic cough. Methods TMCC was developed based on two stages: literature and clinical analysis. The literature analysis stage was carried out through the following procedures: electronic and manual search for articles and books published until June 2019 that included adult participants with chronic cough and intervention with speech-language pathology therapy; selection of sources; analysis of articles and books included; and, preparation of the initial version of the therapy program. The initial version of the therapy program resulting from literature analysis stage was submitted to clinical analysis stage through the following procedures: analysis by three judges; revision of the proposal by the authors; judges' re-analysis; elaboration of the final version called the Therapy Program for Management of Chronic Cough (TMCC). Results TMCC synthesizes scientific knowledge and current clinical experience on the behavioral management of refractory chronic cough into a program with three main components, each one with specific objectives and strategies. TMCC consists of four sessions, with weekly frequency and duration between 30-45 minutes per session, executed in hierarchical phases, with specific objectives and strategies per session. Conclusion TMCC is a program structured to offer global cough rehabilitation. To obtain scientific evidence about its effectiveness is necessary, so that it can be used in clinical practice.


Subject(s)
Humans , Adult , Speech-Language Pathology , Cough/therapy , Speech Therapy , Chronic Disease
12.
Bol. latinoam. Caribe plantas med. aromát ; 20(2): 203-214, 2021. tab, ilus
Article in English | LILACS | ID: biblio-1342225

ABSTRACT

The current study was designed to investigate the traditional recipes used to treat cough in Tehsil Piran, Malakand, Pakistan. These recipes were explored and quantitively analyzed for the first time. A total of 30 species of the plants, 6 animal products and one salt were reported to be used by the community to treat cough. Punica granatum L. and Olea ferruginea Royle dominated with Use value (UV) of 0.84 and Origanum vulgare L. with least use value of 0.1. The frequency citation (FC) of the Papaver somniferum L. is higher (98) while the lowest one is Verbascum thapsus L. (0.13). The large number of traditional recipes used for cough in this area shows that primary health care is still amalgamated in this culture. In future studies, these recipes may be further exploited as a base for modern medicine.


Este estudio fue diseñado con el propósito de investigar las recetas tradicionales utilizadas para tratar la tos en Tehsil Piran, Malakand, Pakistán. Estas recetas fueron exploradas y analizadas cuantitativamente por primera vez. Se constata que la comunidad utilizó un total de 30 especies de plantas, 6 productos animales y una sal para tratar la tos. Punica granatum L. y Olea ferruginea Royle se destacaron con un valor de uso (UV) de 0.84 y Origanum vulgare L. con un valor de uso mínimo de 0.1. La cita de frecuencia (FC) del Papaver somniferum L. es más alta (98) mientras que la más baja es Verbascum thapsus L. (0.13). La gran cantidad de recetas tradicionales utilizadas para la tos en esta área muestra que la atención primaria de salud todavía está amalgamada en esta cultura. En futuros estudios, estas recetas pueden explotarse aún más como base para la medicina moderna.


Subject(s)
Humans , Plants, Medicinal , Cough/drug therapy , Ethnopharmacology , Pakistan
13.
Rev. gaúch. enferm ; 42(spe): e20200205, 2021. tab, graf
Article in English | LILACS, BDENF | ID: biblio-1251789

ABSTRACT

ABSTRACT Objective To identify symptoms of COVID-19 in adults in the scientific literature. Method Systematic review of studies published from December 1, 2019 to April 21, 2020 from the Scopus, Web of Science and PubMed databases, in order to answer the following research question: "What are the symptoms caused by COVID-19 in adults?" using the keywords "Symptoms", "Clinical Manifestations", "Coronavirus", "COVID-19". Results Of the total 105 references, 13 references that addressed the symptoms of COVID-19 were selected. Fever and normal or dry cough were symptoms present in all studies. Conclusion The symptoms identified in adult patients were fever, normal or dry cough, headache, pharyngalgia, dyspnea, diarrhea, myalgia, vomiting, sputum or expectoration, anxiety or chest pain, fatigue, nausea, anorexia, abdominal pain, rhinorrhea, runny nose or nasal congestion, dizziness, chills, systemic pain, mental confusion, hemoptysis, asthma, taste disorder, smell disorder, belching and tachycardia.


RESUMEN Objetivo Verificar en la literatura científica las manifestaciones sintomáticas de COVID-19 en adultos. Método Una revisión sistemática realizada en las bases de datos Scopus, Web of Science y PubMed con estudios publicados del 1 de diciembre de 2019 al 21 de abril de 2020, con el fin de responder a la pregunta orientadora: "¿Cuáles son las manifestaciones sintomáticas causada por COVID-19 en adultos?" utilizando las palabras clave: "Síntomas", "Manifestaciones clínicas", "Coronavirus", "COVID-19". Resultados Del total de 105 referencias, se seleccionaron 13 que abordaron las manifestaciones sintomáticas de COVID-19, con fiebre y tos normal o seca presente en todos los estudios. Conclusión Las manifestaciones sintomáticas identificadas en pacientes adultos fueron: fiebre, tos normal o seca, dolor de cabeza, faringalgia, disnea, diarrea, mialgia, vómitos, esputo o expectoración, angustia o dolor en el pecho, fatiga, náuseas, anorexia, dolor abdominal, rinorrea, secreción nasal o congestión nasal, mareos, escalofríos, dolor sistémico, confusión mental, hemoptisis, asma, alteración del gusto, alteración del olfato, eructos y taquicardia.


RESUMO Objetivo Verificar na literatura científica as manifestações sintomáticas da COVID-19 em pessoas adultas. Método Revisão sistemática utilizando as bases Scopus, Web of Science e PubMed com estudos publicados de 1 de dezembro de 2019 a 21 de abril de 2020, a fim de responder à questão norteadora: "Quais as manifestações sintomáticas causada pela COVID-19 em pessoas adultas?" utilizando-se as palavras-chave: "Symptoms", "Clinical Manifestations", "Coronavirus", "COVID-19". Resultados Do total de 105 referências, foram selecionadas 13 que abordaram as manifestações sintomáticas da COVID-19, estando a febre e a tosse normal ou seca presente em todos os estudos. Conclusão As manifestações sintomáticas identificadas nos pacientes adultos foram: febre, tosse normal ou seca, cefaleia, faringalgia, dispneia, diarreia, mialgia, vômito, escarro ou expectoração, angústia ou dor no peito, fadiga, náusea, anorexia, dor abdominal, rinorreia, coriza ou congestão nasal, tontura, calafrios, dor sistêmica, confusão mental, hemoptise, asma, comprometimento do paladar, comprometimento do olfato, arroto e taquicardia.


Subject(s)
Humans , Male , Female , Adult , General Symptoms , SARS-CoV-2 , COVID-19 , Asthma , Vomiting , Anorexia , Databases, Bibliographic , Cough , Ageusia , Diarrhea , Dizziness , Fatigue , Fever , Olfaction Disorders
14.
São Paulo; s.n; 2021. 87 p.
Thesis in Portuguese | LILACS | ID: biblio-1177460

ABSTRACT

A tuberculose (TB) é uma doença infectocontagiosa prevenível e potencialmente curável. No entanto, figura entre as dez maiores causas de mortalidade no mundo. Sua transmissão acontece através da inalação de aerossóis contendo a bactéria Mycobaterium tuberculosis eliminados pela via aérea, majoritariamente através da tosse de um indivíduo com a forma pulmonar da doença (que é sua forma transmissível). Por isso, a tosse é reconhecida como o sintoma mais relevante para o ciclo de transmissão, sendo utilizada como ferramenta de triagem inicial em programas de controle de tuberculose. Entretanto, a acurácia desta manifestação no diagnóstico de TB, e, portanto, sua utilidade clínica, manifestada particularmente através de seu valor preditivo positivo (VPP), pode variar amplamente dependendo do contexto onde ela é considerada. Desta forma, o presente trabalho foi conduzido através de uma revisão sistemática com o objetivo de identificar na literatura existente informações sobre o valor preditivo da tosse para a identificação de tuberculose pulmonar. Os descritores utilizados para a pesquisa incluíam termos específicos para "Tuberculose", "Sintomas Respiratórios", "Tosse Crônica" e "Humanos". O teste índice foi a tosse crônica e múltiplos testes referências foram considerados (incluindo baciloscopia, cultura da bactéria, métodos moleculares, ou combinações de métodos). Os critérios de elegibilidade incluíram que o estudo avaliasse a presença de tuberculose pulmonar ativa e quantificasse a ocorrência de tosse através do número mínimo de dias para que esta fosse considerada crônica. A revisão identificou 2.289 publicações únicas que foram avaliadas, das quais 84 foram pré-selecionadas para revisão por completo e, desses, 42 publicações foram finalmente incluídas para análise. Estas publicações foram conduzidas em 22 países, dos quais 16 eram considerados como países de alta carga de tuberculose pela OMS. Os estudos utilizaram múltiplas definições para caracterizar a tosse crônica, mas a maior parte deles (75%) consideraram a definição utilizada pela OMS que é definida como durando um mínimo de 2 a 3 semanas. Entre os estudos identificados, a minoria possuía risco baixo para vieses (16,7%). Para estes estudos, o valor preditivo positivo variou grandemente (entre 0% e 61,49%). Em destaque, a condução do estudo em ambiente hospitalar levava a um VPP com uma mediana mais elevada do que em ambientes domiciliares. Consideramos que não seria adequado realizar uma metaanálise devido a diferenças nas metodologias dos estudos, nas conduções dos desenhos, nas características dos participantes, nas características das seleções e amostragens, na gravidade de apresentação da doença, no padrão de procura por atendimentos médicos, e na avaliação da tosse ou na realização do teste confirmatório, os estudos apresentaram alta heterogeneidade. Como conclusão, podemos citar que o VPP da tosse crônica como sintoma no rastreio de pacientes com tuberculose pulmonar apresenta alta variabilidade, a depender do contexto onde ela é considerada. Desta forma, consideramos que se justifica um levantamento específico desta estimativa em cada contexto populacional específico, para poder aplicar ou adaptar a definição de tossidor crônico como ferramenta de vigilância de TB.


Tuberculosis is a preventable and potentially curable infectious disease. However, it still appears among the ten leading causes of mortality in the world. It is transmitted through the inhalation of aerosol containing the bacteria Mycobacterium tuberculosis eliminated through the airway, largely by the cough of a person with the pulmonary form of the disease (the transmissible form). Due to this, coughing is recognized as the most relevant symptom for the transmission cycle of the disease and is used as an initial screening tool in several tuberculosis control programs. However, the accuracy of this manifestation for the diagnosis of TB, and therefore its clinical utility, manifested particularly through its positive predictive value (PPV), can vary widely depending on the context where it is considered. Therefore, the present study was a systematic review with the objective of identifying in the existing literature information on the predictive value of cough and on the indicators of diagnostic accuracy of this test for the identification of pulmonary tuberculosis. The descriptors used for the research included specific terms for "Tuberculosis", "Respiratory Symptoms", "Chronic Cough" and "Humans". The index test was chronic cough and multiple reference tests were considered for review (including smear exam, bacteria culture, molecular tests, or combinations of these with other methods). Eligibility criteria included articles describing active pulmonary tuberculosis and quantifying the occurrence of chronic cough. The review identified 2,289 unique publications that were evaluated, of which 84 were fully reviewed and 42 publications were included in the final review. These publications were conducted in 22 countries, of which 16 were considered as countries with a high burden of tuberculosis. The studies used multiple definitions to characterize chronic cough, but most of them (75%) considered the definition used by the WHO which is between 2 and 3 weeks. Among the studies identified, few had low risks of biases (16.7%). For these studies, the predictive value varied greatly (between 0% and 61.49%), highlighting the context where the study is included as a determinant. In particular, studies conducted in hospital environments led to a PPV with a higher median than in domiciliary environments. Considering the different methodologies, different studies design, different characteristics of the participants, different characteristics of the sampling process, different severities of the presentation of the disease, different patterns of healthcare-seeking, and different performances of the index and reference tests, we identified a high heterogeneity of the sample. Thus, we considered it was not appropriate to conduct a meta-analysis. In conclusion, the PPV of chronic cough as a screening tool for tuberculosis is highly variable. We consider that specific evaluations of this estimative are justified in each specific population context, in order to be able to apply or adapt the definition of chronic cough as part of the TB surveillance system.


Subject(s)
Tuberculosis , Communicable Diseases , Cough , Systematic Review
15.
Cienc. tecnol. salud ; 7(3): 381-395, 26 de noviembre 2020. ^c27 cmilus
Article in Spanish | LILACS, LIGCSA, DIGIUSAC | ID: biblio-1130181

ABSTRACT

La Enfermedad por Coronavirus 2019 (COVID-19) supone un reto sin precedentes para la salud pública. Los médicos deben fortalecer sus habilidades clínicas para combatir esta nueva enfermedad. El objetivo de esta revisión fue describir los signos, síntomas y complicaciones de pacientes con COVID-19. Se realizó una búsqueda en la literatura en la base de datos PubMed incluyendo publicaciones entre 1 de diciembre 2019 y 15 de agosto 2020, sin restricciones de lenguaje, utilizando las palabras clave 'COVID-19' cruzada con 'manifestaciones clínicas', 'signos y síntomas' y 'complicaciones'. Se incluyeron revisiones sistemáticas y meta-análisis, estudios epidemiológicos y series de casos. Se identificaron 1,066 artículos, de los cuales se seleccionaron 71 de acuerdo a los contenidos previamente definidos por los autores. La COVID-19 presenta un curso de leve a moderado y severo-crítico, específicamente en mayores de 65 años con o sin comorbilidades. Los signos y síntomas no son específicos y usualmente se superponen de acuerdo a la edad y a la fase de la enfermedad. Los síntomas más comunes son fiebre, tos y fatiga. Síntomas menos comunes incluyen escalofríos, dolor de garganta, cefalea, mialgias/artralgias, pérdida del gusto y del olfato, diarrea, nausea, vómitos, congestión nasal, palpitaciones, opresión precordial y dolor pleurítico. La sintomatología en niños difiere de la de los adultos y el curso es usualmente benigno y de baja mortalidad. La evaluación clínica de COVID-19 supone un reto hoy en día. Sin embargo, el conocimiento de la historia natural de la enfermedad permite situar los síntomas comunes e inespecíficos en el contexto clínico correcto.


Coronavirus disease 2019 (COVID-19) presents an unprecedented challenge to public health. Physicians must strengthen clinical skills for this new disease. This review aimed to describe the signs, symptoms and complications of patients with COVID-19. A literature search was conducted in the PubMed database, including publications between December 1, 2019, to August 15, 2020, without language restrictions, using the keywords 'COVID-19' crossed with 'clinical manifestations', 'signs and symptoms', and 'complications'. Systematic reviews, meta-analysis, epidemiological studies, and case report series were included. A total of 1,066 articles were identi¬fied, among 71 were selected according to the contents previously defined by the authors. COVID-19 has a mild to moderate or severe-critical course, specifically in over 65 years of age, with or without comorbidities. Signs and symptoms are not specific and usually overlap according to the age and stage of the disease. The most common symptoms are fever, cough, and fatigue. Less common symptoms include chills, sore throat, headache, myalgia/ arthralgia, loss of taste and smell, diarrhea, nausea, vomiting, nasal congestion, palpitations, chest tightness, and pleuritic pain. The symptomatology in children differs from that of adults, and the course is usually benign and low mortality. Clinical evaluation of COVID-19 is challenging today. However, knowledge of the disease's natural history allows placing common and nonspecific symptoms in the correct clinical context.


Subject(s)
Humans , Male , Female , Child , Adult , Middle Aged , Aged , Signs and Symptoms , Betacoronavirus , COVID-19 , Pharyngitis , Cough , Ageusia , Diarrhea , Fever , Myalgia , Headache , Literature , Olfaction Disorders , Nausea
16.
Arq. bras. med. vet. zootec. (Online) ; 72(3): 799-806, May-June, 2020. ilus, tab
Article in English | ID: biblio-1129181

ABSTRACT

The purpose of this study was to verify the applicability of the compressive radiographic technique (pressures of 5, 10, 15 and 20mmHg) in the diagnosis of tracheal collapse in small breed dogs, in lateral cervicothoracic radiography. Out of the 50 dogs evaluated, 25 presented tracheal collapse (TG group), 23 did not present tracheal collapse (CG) and two were excluded because they did not tolerate a pressure of 20 mmHg. The TG group presented a smaller internal diameter of the trachea in the region of the fourth cervical vertebra (D4) and at the entrance of the thorax (TDE) compared to the CG group, in all the radiographic projections performed, as well as within the TG group where the compressive technique differed from conventional. Furthermore, there was a correlation between the clinical sign of coughing during cervical collar use and the presence of radiographic tracheal collapse at a pressure of 20 mmHg. It was concluded that the compressive radiographic technique was feasible and efficient in confirming the diagnosis of tracheal collapse in dogs, especially in the pressure of 20 mmHg, where it was associated with clinical signs, and can be used in isolation or complementary to the conventional technique.(AU)


O objetivo deste trabalho foi verificar a aplicabilidade da técnica radiográfica compressiva no diagnóstico do colapso de traqueia em cães de raças pequenas, por meio da comparação do diâmetro da traqueia durante a radiografia cervicotorácica lateral convencional e sobre influência da compressão externa com pressões de 5, 10, 15 e 20mmHg (técnica compressiva). Dos 50 cães avaliados, 25 apresentaram colapso de traqueia (grupo TG), 23 não apresentaram o colabamento traqueal (grupo controle - CG) e dois foram excluídos por não tolerarem a pressão de 20mmHg. Os diâmetros internos da traqueia na região da quarta vértebra cervical (D4) e na entrada do tórax (DET) foram menores no grupo TG em relação ao CG, em todas as projeções radiográficas realizadas, bem como dentro do grupo TG, no qual a técnica compressiva diferiu da convencional. Houve correlação entre o sinal clínico de tosse durante o uso de coleira cervical e a presença do colapso de traqueia radiográfico, na pressão de 20mmHg. Concluiu-se que a técnica radiográfica compressiva foi exequível e eficiente na confirmação do diagnóstico do colapso de traqueia em cães, especialmente na pressão de 20mmHg, em que houve associação com sinais clínicos, podendo ser utilizada de forma isolada ou complementar à técnica convencional.(AU)


Subject(s)
Animals , Dogs , Trachea/pathology , Trachea/diagnostic imaging , Cough/veterinary , Radiography/methods , Radiography, Thoracic/veterinary , Cervical Cord/diagnostic imaging
17.
Medicina (B.Aires) ; 80(supl.3): 25-30, June 2020. ilus, graf, tab
Article in Spanish | LILACS | ID: biblio-1135187

ABSTRACT

Se trata de un análisis de características clínicas, hallazgos radiológicos, variables de laboratorio y mecánica respiratoria en pacientes con enfermedad por coronavirus 2019 (COVID-19) durante el primer mes de la pandemia en Buenos Aires. Es un estudio descriptivo de casos, de un solo centro. Se incluyeron todos los casos confirmados de COVID-19 internados en la unidad de terapia intensiva de adultos (UTIA) del Hospital Italiano de Buenos Aires. Todos los casos se confirmaron por reacción en cadena de la polimerasa con transcriptasa inversa. Un total de 7 pacientes con COVID-19 fueron atendidos en la UTIA. La mediana de edad fue de 71 años (intervalos intercuartílicos: 52-75), 4 hombres y 3 mujeres. Las manifestaciones clínicas más comunes fueron fiebre (7), tos (5), astenia (4) y disnea (3). Entre los hallazgos radiológicos, cinco de ellos mostraron opacidades intersticiales y un paciente consolidación pulmonar bilateral. Cinco requirieron ventilación mecánica invasiva y múltiples sesiones de decúbito prono. Ninguno murió durante la hospitalización, aunque aún tres permanecen en UCI.


This is an analysis of clinical characteristics, images findings, laboratory variables and respiratory mechanics in patients with coronavirus disease 2019 (COVID-19) during the first month of the pandemic outbreak in Buenos Aires. In this descriptive case study of a single-centre, we included all confirmed cases of COVID-19 hospitalized in intensive care unit (ICU). All cases were confirmed by reverse transcription polymerase chain reaction. A total of 7 patients with confirmed COVID-19 were referred to out ICU. The median age was 71 years (interquartile range 52-75), including 4 men and 3 women. Patients most common clinical manifestations were fever (7), cough (5), asthenia (4) and shortness of breath (3). Among the radiological findings, five of them showed interstitial opacities and one patient had bilateral pulmonary consolidation. Five required invasive mechanical ventilation and multiple prone sessions. None died during hospitalization, although three still remain in the ICU. According to imaging examination, 71.4% showed interstitial opacities and one patient bilateral consolidation. Five patients required invasive mechanical ventilation and multiple prone sessions. None of them died during hospitalization, although three still remain in the ICU.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Pneumonia, Viral/diagnosis , Respiration, Artificial , Coronavirus Infections/diagnosis , Coronavirus/isolation & purification , Pandemics , Intensive Care Units/organization & administration , Argentina/epidemiology , Asthenia/etiology , Treatment Outcome , Coronavirus Infections/therapy , Coronavirus Infections/epidemiology , Coronavirus/genetics , Cough/etiology , Dyspnea/etiology , Fever/etiology , Betacoronavirus , SARS-CoV-2 , COVID-19
18.
Rev. Hosp. Ital. B. Aires (2004) ; 40(2): 53-55, jun. 2020. ilus
Article in Spanish | LILACS | ID: biblio-1102484

ABSTRACT

Una de las características de la afección pulmonar por enfermedad por coronavirus (COVID-19) es la disociación entre la gravedad de la hipoxemia y el mantenimiento de una mecánica respiratoria relativamente conservada. En este contexto se ha establecido una teoría en relación con dos fenotipos de pacientes con síndrome de distrés respiratorio del adulto (SDRA): un fenotipo Low, caracterizado por baja elastancia y baja reclutabilidad, y un fenotipo High, con características de alta elastancia y alta reclutabilidad. Presentamos el caso de un paciente que cursó internación en la Unidad de Terapia Intensiva de Adultos de nuestro hospital, con clínica, mecánica ventilatoria y patrón tomográfico compatible con el fenotipo Low de SDRA por COVID-19. (AU)


Dissociation between severity of hypoxemia and relative preserved respiratory mechanics is a characteristic observed in lung impairment due to coronavirus disease (COVID-19). Patients with COVID-19 that present adult respiratory distress syndrome (ARDS) are identified for one of two phenotypes according to a theory recently established. The Low phenotype is distinguished by low elastance and low recruitability; and the High phenotype, by high elastance and high recruitability. The case describes a patient admitted in the adult Intensive Care Unit of Hospital Italiano de Buenos Aires with observed symptoms, ventilatory mechanics and tomographic pattern that are compatible with Low phenotype of ARDS due to COVID-19. (AU)


Subject(s)
Humans , Male , Middle Aged , Respiratory Distress Syndrome/microbiology , Coronavirus Infections/therapy , Phenotype , Respiratory Distress Syndrome/genetics , Respiratory Mechanics , Coronavirus Infections/diagnosis , Coronavirus Infections/physiopathology , Cough/etiology , Dyspnea/etiology , Fever/etiology , Hypertension/complications , Intensive Care Units , Hypoxia/physiopathology , Obesity/complications
20.
Rev. cuba. med. mil ; 49(1): e373, ene.-mar. 2020. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1126689

ABSTRACT

Introducción: En las personas con enfermedad neuromuscular, la incapacidad para toser y para generar flujos espiratorios adecuados constituye el principal limitante para mantener una adecuada salud del sistema respiratorio. La asistencia mecánica de la tos es un dispositivo que genera presión positiva y negativa en la vía aérea y simula una tos normal. Se realizó una revisión bibliográfica. Se incluyeron 9 estudios, con un total de 235 sujetos adultos con enfermedad neuromuscular. Objetivos: Describir los valores de presiones de insuflación y exsuflación utilizados y su relación con los valores de pico flujo tosido. Desarrollo: El 28 por ciento era de género femenino y las edades estaban comprendidas entre 14 a 77 años. Las presiones utilizadas variaron entre los estudios, con valores que iban desde +15/ -15 cm H2O a los +40/ -40 cm H2O. Con respecto a los valores de pico flujo tosido, 7 estudios observaron incrementos estadísticamente significativos al aplicar la terapéutica. En estos estudios, para obtener un flujo espiratorio superior a 160 L/min se requirieron presiones de al menos -30/+30 cm H2O. Conclusiones: Se requieren futuras investigaciones que permitan el desarrollo de un consenso respecto a aplicación de la asistencia mecánica de la tos en sujetos con enfermedad neuromuscular, así como establecer criterios de selección de las presiones de insuflación y exsuflación a programar durante la terapéutica(AU)


Introduction: In people with neuromuscular disease, the inability to cough and generate adequate expiratory flows is the main limitation to maintain adequate health of the respiratory system. The mechanical assistance of the cough is a device that generates positive and negative pressure in the airway, simulating a normal cough. 9 studies were included, with a total of 235 adult subjects with neuromuscular disease. Objectives: Describe the values ​​of insufflation and exsufflation pressures used and to describe their relationship with peak cough flow values. Development: 28 percent were female and the ages between 14 and 77 years old. The pressures used varied between the different studies, with values ​​ranging from + 15 / -15 cm H2O to + 40 / -40 cm H2O. According to the peak cough flow values, seven studies observed statistically significant increases when applying the therapy. In these studies, to obtain an expiratory flow greater than 160 L / min, at least -30 / + 30 cm H2O were required. Conclusions: Future research is required to allow the development of a consensus regarding the application of mechanical cough assistance in subjects with neuromuscular disease, as well as establishing selection criteria for insufflation and exsufflation pressures to be programmed during therapy(AU)


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Pressure , Therapeutics , Beak , Cough , Equipment and Supplies , Neuromuscular Diseases
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