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2.
Invest. educ. enferm ; 39(3): 49-62, 15 octubre del 2021. Tab, Ilus
Article in English | LILACS, BDENF, COLNAL | ID: biblio-1348004

ABSTRACT

Objective. To evaluate the ability of the NEWS2-L (National Early Warning Score 2 Lactate) scale to predict the risk of early clinical deterioration (mortality within 48 hours) in patients with dyspnoea treated by the Medical Emergency Services compared with NEWS2 and lactate in isolation. Methods. Prospective, multi-centre study of a cohort of 638 patients with dyspnoea treated in the ambulance and priority-transferred to a hospital emergency service in the cities of Valladolid, Salamanca, Segovia or Burgos (Spain). We collected clinical, analytical and demographic data. The main outcome measure was all-cause mortality within 48 hours. The recommendations of the Royal College of Physicians were followed to calculate NEWS2. When NEWS2 and LA prehospital values were obtained, the two values were added together to obtain the NEWS2-L. Results. Mortality within 48 hours was fifty-six patients (8.8%). The NEWS2-L scale obtained an area under the curve (AUC) of the receiver operating characteristics (ROC) for mortality within 48 hours of 0.854 (CI 95% 0.790­0.917), at seven days of 0.788 (CI 95% 0.729­0.848) and at 30 days of 0.744 (CI 95% 0.692­0.796); in all cases p<0.001, with a significant decrease between the value at 48 hours and at 30 days. Conclusion. The NEWS2-L scale was found to be significantly superior to the NEWS2 scale and similar to lactate in predicting early clinical deterioration in patients with dyspnoea. This scale can help a nurse detect these patients early, as part of their regular practice, and thus guide therapeutic efforts.


Objetivo. Evaluar la capacidad de la escala NEWS2-L (National Early Warning Score 2-lactate) para predecir el riesgo de deterioro clínico precoz (mortalidad hasta las 48h) en pacientes con disnea atendidos por Servicios de Emergencias Médicas, comparado con la escala NEWS2 y el ácido láctico en solitario. Métodos. Estudio prospectivo multicéntrico de cohorte de 638 pacientes con disnea atendidos en ambulancia y trasladados con alta prioridad a un servicio de urgencias hospitalarias en las ciudades de Valladolid, Salamanca, Segovia y Burgos (España). Se tomó información de variables clínicas, analíticas y demográficas, de las cuales la de resultado principal fue la mortalidad por cualquier causa hasta las 48 horas. Para el cálculo del NEWS2 se siguieron las recomendaciones del Royal College of Physicians. Una vez obtenidos los valores del NEWS2 y del AL prehospitalario se sumaron ambos valores y se obtuvo la NEWS2-L. Resultados. La mortalidad, antes de las 48, horas fue de 56 pacientes (8.8%). La escala NEWS2-L obtuvo un Área Bajo la Curva ­ Característica Operativa del Receptor (ABC-COR) para la mortalidad antes de las 48 horas de 0.854 (IC95% 0.790-0.917), a siete días de 0.788 (IC95% 0.729-0.848) y a 30 días de 0.744 (IC95% 0.692-0.796); en todos los casos p<0.001), lo que experimentó un descenso importante entre su valor a las 48 h y a los 30 días. Conclusión. La escala NEWS2-L mostró ser significativamente superior a la escala NEWS2 y similar al ácido láctico en la predicción del deterioro clínico precoz en pacientes con disnea. Esta escala es una ayuda para que la enfermera en su práctica habitual detecte a estos pacientes en forma temprana y así poder orientar los esfuerzos terapéuticos.


Objetivo. Avaliar a capacidade da escala NEWS2-L (National Early Warning Score 2-lactato) de predizer o risco de deterioração clínica precoce (mortalidade de até 48h) em pacientes com dispneia tratados em Serviços de Emergência Médica, em comparação com a escala NEWS2 e a ácido láctico em solitário. Métodos. Estudo prospectivo de coorte multicêntrico de 638 pacientes com dispneia atendidos por ambulância e transferidos com alta prioridade para um serviço de emergência hospitalar nas cidades de Valladolid, Salamanca, Segovia e Burgos (Espanha). As informações foram obtidas a partir de variáveis clínicas, analíticas e demográficas, sendo a principal variável de desfecho a mortalidade por todas as causas em até 48 horas. Para o cálculo do NEWS2, foram seguidas as recomendações do Royal College of Physicians. Uma vez obtidos os valores do NEWS2 e do AL pré-hospitalar, ambos os valores foram somados e o NEWS2-L foi obtido. Resultados. A mortalidade antes de 48 horas foi de 56 pacientes (8,8%). A escala NEWS2-L obteve uma área sob a curva - característica operacional do receptor (ABC-COR) para mortalidade antes de 48 horas de 0.854 (IC 95% 0.790-0.917), em sete dias de 0.788 (IC 95% 0.729-0.848) e aos 30 dias de 0.744 (95% CI 0.692-0.796); em todos os casos p <0,001), experimentando uma diminuição significativa entre o seu valor às 48 he aos 30 dias. Conclusão. A escala NEWS2-L mostrou ser significativamente superior à escala NEWS2 e semelhante ao ácido láctico na predição da deterioração clínica precoce em pacientes com dispneia. Essa escala é um auxílio para o enfermeiro em sua prática habitual detectar precocemente esses pacientes e, assim, ser capaz de orientar os esforços terapêuticos.


Subject(s)
Humans , Male , Female , Biomarkers , Hospital Mortality , Dyspnea , Clinical Decision-Making , Prehospital Care , Early Warning Score
3.
Arq. gastroenterol ; 58(3): 308-315, July-Sept. 2021. tab, graf
Article in English | LILACS | ID: biblio-1345290

ABSTRACT

ABSTRACT BACKGROUND: Liver cirrhosis (LC) causes several musculoskeletal changes. OBJECTIVE: To test the hypothesis that the peripheral and inspiratory muscle endurance are reduced in patients with liver cirrhosis. METHODS: Twenty-one patients with LC (LC group; 61±14 years) and 18 age-matched subjects (control group; 56±17 years) had accepted to participate in this cross-sectional observational study. To assess peripheral muscle endurance, all volunteers performed a rhythmic handgrip exercise at 45% of their maximum voluntary contraction. A metronome was used to control the contraction-relaxation cycles at 60/min. The inspiratory muscle endurance was assessed using PowerBreath®. Participants underwent inspiratory muscle exercise at 60% of their maximal inspiratory muscle strength. The time until failure characterized the muscle endurance for both handgrip and inspiratory muscle exercises. Additionally, the quality of life of the participants was assessed. RESULTS: The muscle endurance was lower in the LC group when compared to the control group for both handgrip (67 vs 130 s, P<0.001) and inspiratory muscle exercises (40 vs 114 s, P<0.001). The peripheral muscle endurance was directly correlated with the total quality of life score (r=0.439, P=0.01) and to the following domains: fatigue (r=0.378 e P=0.030), activity (r=0.583, P=0.001), systemic symptoms (r=0.316, P=0.073) and preoccupation (r=0.370, P=0.034). The inspiratory muscle endurance was inversely correlated with the total quality of life score (r=0.573, P=0.001) and the following domains: fatigue (r=0.503, P=0.002), activity (r=0.464, P=0.004), systemic symptoms (r=0.472, P=0.004), abdominal symptoms (r=0.461, P=0.005), emotional function (r=0.387, P=0.02) and preoccupation (r=0.519, P=0.001). CONCLUSION: Both peripheral and inspiratory muscle endurance were lower in LC patients when compared to the control group.


RESUMO CONTEXTO: A cirrose hepática (CH) causa várias alterações musculoesqueléticas. OBJETIVO: Testar a hipótese de que as resistências dos músculos periféricos e inspiratórios estão reduzidas em pacientes com CH. MÉTODOS: Vinte e um pacientes com CH (grupo CH; 61±14 anos) e 18 indivíduos pareados por idade (grupo controle; 56±17 anos) aceitaram participar deste estudo observacional transversal. Para avaliar a resistência muscular periférica, todos os voluntários realizaram um exercício de preensão manual rítmica a 45% de sua contração voluntária máxima. Um metrônomo foi usado para controlar os ciclos de contração-relaxamento a 60/min. A resistência muscular inspiratória foi avaliada com o PowerBreath®. Os participantes foram submetidos a exercícios musculares inspiratórios a 60% de sua força muscular inspiratória máxima. O tempo até a falha caracterizou a resistência muscular para os exercícios de preensão manual e de músculos inspiratórios. Além disso, foi avaliada a qualidade de vida dos participantes. RESULTADOS: A resistência muscular foi menor no grupo CH quando comparada ao grupo controle tanto para os exercícios de preensão manual (67 vs 130 s, P<0,001) quanto para os músculos inspiratórios (40 vs 114 s, P<0,001). A resistência muscular periférica foi diretamente correlacionada com o escore total de qualidade de vida (r=0,439, P=0,01) e com os seguintes domínios: fadiga (r=0,030, P=0,378), atividade (r=0,378 e P=0,030), sintomas sistêmicos (r=0,316, P=0,073) e preocupação (r=0,370, P=0,034). A resistência muscular inspiratória foi inversamente correlacionada com o escore total de qualidade de vida (r=0,573, P=0,001) e com os seguintes domínios: fadiga (r=0,503, P=0,002), atividade (r=0,464, P=0,004), sintomas sistêmicos (r=0,472, P=0,004), sintomas abdominais (r=0,461, P=0,005), função emocional (r=0,387, P=0,02) e preocupação (r=0,519, P=0,001). CONCLUSÃO: As resistências musculares periférica e inspiratória foram menores nos pacientes com CH quando comparados ao grupo controle.


Subject(s)
Humans , Adult , Aged , Quality of Life , Hand Strength , Respiratory Muscles , Cross-Sectional Studies , Exercise Tolerance , Dyspnea , Liver Cirrhosis , Middle Aged
4.
Arch. argent. pediatr ; 119(4): e340-e344, agosto 2021. tab, ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1281780

ABSTRACT

La acrodisostosis es una displasia esquelética rara, de herencia autosómica dominante, que se caracteriza por la presencia de disostosis facial y periférica, talla baja y diferentes grados de obesidad. La acrodisostosis de tipo 1, secundaria a la mutación heterocigota en el gen PRKAR1A (17q24.2), se caracteriza por la asociación de resistencia hormonal múltiple con anomalías esqueléticas. Su incidencia está infradiagnosticada debido a que comparte rasgos clínicos y de laboratorio con otras entidades como el seudohipoparatiroidismo. Presentamos el caso de una niña de 8 años, con acrodisostosis tipo 1, confirmada mediante estudio genético. Además del fenotipo característico descrito, la talla baja y la resistencia hormonal, la paciente presentó una afectación progresiva de la función pulmonar: un patrón pulmonar obstructivo no reversible. En la literatura revisada, no se han encontrado otros casos que describan esta asociación entre acrodisostosis y afectación respiratoria.


Acrodysostosis is a rare skeletal displasia, of autosomal dominant inheritance, characterized by the presence of facial and peripheral dysostosis, short stature and obesity. Type 1 acrodysostosis is secondary to a mutation in the PRKAR1A (17q24.2) gene, which results in multi hormonal resistance and skeletal anomalities. This syndrome is under-diagnosed as it shares analytical and clinical characteristics with other entities, such as pseudohypoparathyroidism. We report the case of an eight-year-old girl with genetically confirmed type 1 acrodysostosis. In addition to the characteristic phenotype described, the short stature and the hormonal resistance, the patient suffered a progressive lung function deterioration: an irreversible pulmonary obstructive pattern. We have not found in previous literature cases reporting an association between acrodysostosis and lung function impairement.


Subject(s)
Humans , Female , Child , Osteochondrodysplasias/complications , Dysostoses/complications , Lung Diseases, Obstructive/complications , Osteochondrodysplasias/genetics , Osteochondrodysplasias/diagnostic imaging , Spirometry , Diagnosis, Differential , Dysostoses/genetics , Dysostoses/diagnostic imaging , Dyspnea/complications , Mutation/genetics
5.
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
6.
Cuad. Hosp. Clín ; 62(1): 38-45, jun. 2021. ilus.
Article in Spanish | LILACS | ID: biblio-1284260

ABSTRACT

OBJETIVOS: determinar las principales características demográficas, clínicas, radiológicas y de función pulmonar de los pacientes con bronquiectasias en la Clínica del Pulmón. MATERIAL Y MÉTODOS: estudio observacional, retrospectivo. Se revisaron las historias clínicas de 23 pacientes con diagnóstico de dilataciones bronquiales. RESULTADOS: de los 23 pacientes, con una edad media de 49,4 ± 3,87 años, 13 corresponden al sexo femenino y 10 al sexo masculino, el tiempo de evolución de la enfermedad desde el diagnóstico de la patología inicial es de 17,3 ± 2,92 años. La tuberculosis es la etiología principal en 15 pacientes (65,2%). Las manifestaciones clínicas más frecuentes son la tos y expectoración mucopurulenta por varios años en la mayoría de los pacientes, al que añadimos la disnea y hemoptisis, la auscultación pulmonar revela la presencia de crépitos en 17 pacientes (73,9%). La Tomografía de Tórax de Alta Resolución distingue dos tipos de bronquiectasias: La sacular o quística y la cilíndrica, de localización unilobar, bilobar y multilobar (difuso). La Espirometría Forzada fue indicada en 10 pacientes (43,5%) 7 mujeres y 3 varones, el Síndrome Bronquial Obstructivo fue el hallazgo más frecuente. La asociación de Tetraciclina con Metronidazol indicado en 9 pacientes (39,1%) mejoró el cuadro clínico. La fisiopatología de esta entidad clínica está sujeta a una constante actualización. CONCLUSIONES: en pacientes tosedores crónicos, las bronquiectasias deben tener prioridad diagnóstica, se trata de una patología antigua, pero de actualidad permanente.


The purpose of this document is to determine the main epidemiological and clinical characteristics of patients with bronchiectasis at the Lung Clinic. METHOD: observational, retrospective study. The medical records of 23 patients diagnosed with bronchial dilation were reviewed. RESULTS: the results of the 23 patients studied, with a mean age of 49,4 ± 3,87 years, 13 correspond to the female sex and 10 to the male sex, indicate that the time of evolution of the disease from the diagnosis of the initial pathology is: 17,3 ± 2,92 years. Tuberculosis is the main etiology in 15 patients (65,2%). The most frequent clinical manifestations were cough and mucopurulent expectoration of several years in most of the patients, to which we must add dyspnea and hemoptysis, pulmonary auscultation reveals the presence of crepitus in 17 patients (73,9%). High Resolution Chest Tomography distinguishes two types of bronchiectasis: the saccular or cystic and the cylindrical, the localization is unilobar, bilobar and multilobar (diffuse). Forced spirometry was indicated in 10 patients (43,5%), 7 women and 3 men, Chronic Obstructive Pulmonary Disease is the main diagnosis. The association of Tetracycline with Metronidazole indicated in 9 patients (39,1%) had positive results. The pathophysiology of this clinical entity is subject to constant updating. CONCLUSIONS: in chronic coughing patients, bronchiectasis must have diagnostic priority, it is an old pathology, but it is permanently current


Subject(s)
Humans , Male , Female , Middle Aged , Bronchiectasis , Pulmonary Disease, Chronic Obstructive , Auscultation , Spirometry , Tuberculosis , Dyspnea , Hemoptysis , Metronidazole
7.
Rev. cuba. pediatr ; 93(2): e1268, tab
Article in Spanish | LILACS, CUMED | ID: biblio-1280363

ABSTRACT

Introducción: La neumonía adquirida en la comunidad continúa siendo un problema de salud global. Objetivo: Caracterizar desde la óptica clínico-epidemiológica la neumonía adquirida en la comunidad en la edad pediátrica. Métodos: Estudio descriptivo de corte transversal y prospectivo de pacientes entre 1 mes-18 años, no vacunados con antineumocócica, ingresados en el Hospital Pediátrico Centro Habana, enero 2018-julio 2019 con diagnóstico confirmado por radiología de neumonía adquirida en la comunidad. Los pacientes no presentaban enfermedades crónicas, exceptuando el asma. Los padres o tutores dieron su consentimiento. Se evaluaron variables demográficas y clínicas, factores de riesgo, evolución y complicaciones según grupo de edad. Resultados: Se estudiaron 277 enfermos, predominaron los niños entre 1 a 4 años de edad (39,4 por ciento), superioridad del sexo masculino (55,2 por ciento). Los síntomas más frecuentes fueron: fiebre (98,9 por ciento), disnea (99,3 por ciento), tos (98,9 por ciento) y disminución del murmullo vesicular (96,4 por ciento). Como factores de riesgo predominaron la asistencia a círculos infantiles (31,8 por ciento), lactancia materna inadecuada (23,8 por ciento) y el tabaquismo pasivo (16,6 por ciento). Hubo complicaciones en 110 niños (39,7 por ciento) con predominio de derrame pleural, sobre todo en prescolares y asociación significativa entre complicaciones y edad. No hubo fallecimientos. Conclusiones: Es importante la vigilancia de las neumonías y su desarrollo clínico epidemiológico, para la prevención y diagnóstico en esa etapa previa a la introducción de la vacuna antineumoccócica. En población no vacunada contra el neumococo, es estrategia significativa reducir los factores de riesgo modificables como la insuficiente lactancia materna, el tabaquismo pasivo y la malnutrición(AU)


Introduction: Community-acquired pneumonia continues to be a global health problem. Objective: Characterize from the clinical-epidemiological perspective community-acquired pneumonia in the pediatric ages. Methods: Descriptive cross-sectional and prospective study of patients from 1 month to 18 years old not vaccinated with pneumococcal vaccine, admitted in Centro Habana Pediatric Hospital from January 2018 to July 2019 with diagnosis confirmed by radiology of pneumonia acquired in the community. Patients did not have chronic diseases, except for asthma. Parents or guardians consented. Demographic and clinical variables, risk factors, evolution and complications were assessed according to the age group. Results: 277 patients were studied, children from 1 to 4 years old predominated (39.4 percent); there was male superiority (55.2 percent). The most common symptoms were fever (98.9 percent), dyspnea (99.3 percent), cough (98.9 percent) and decreased vesicular murmur (96.4 percent). As risk factors, attendance to nurseries (31.8 percent), inadequate breastfeeding (23.8 percent) and passive smoking (16.6 percent) predominated. There were complications in 110 children (39.7 percent) with prevalence of pleural effusion, especially in pre-schoolers and significant association among complications and age. There were no deaths. Conclusions: Monitoring of pneumonia and its epidemiological clinical development is important for prevention and diagnosis at this stage prior to the introduction of the pneumococcal vaccine. In populations not vaccinated against pneumococcus, it is a significant strategy to reduce modifiable risk factors such as insufficient breastfeeding, passive smoking and malnutrition(AU)


Subject(s)
Humans , Pleural Effusion , Asthma , Tobacco Smoke Pollution , Dyspnea , Malnutrition
8.
Aquichan ; 21(1): e2116, Abr. 8, 2021.
Article in English | LILACS, BDENF, COLNAL | ID: biblio-1283776

ABSTRACT

Objetivo: determinar los efectos de la rehabilitación pulmonar en hombres y mujeres con diagnóstico de EPOC en una clínica de Colombia. Método: estudio descriptivo longitudinal en 75 pacientes con EPOC que ingresaron a un programa de rehabilitación pulmonar durante el año 2018 y 2019. La población se dividió en grupos según el sexo y se evaluaron algunas características sociodemográficas, la espirometría en porcentaje del predicho, el índice de masa corporal, la disnea mMRC, la capacidad de ejercicio y algunas variables fisiológicas con el test de la caminata de los seis minutos, la ansiedad-depresión (HADS) y la calidad de vida (SGRQ). Se tuvo un valor p<0,05 como estadísticamente significativo. Resultados: el índice paquetes fumados por año fue mayor en hombres 34±29.11 (p<0,001), mientras que la exposición al humo de leña fue cinco veces mayor en las mujeres (p=0,037). Todas las variables de capacidad de ejercicio mejoraron significativamente (p<0,021), sobresaliendo la distancia recorrida 63,26±60,03 versus. 51,53±61,02 a favor de las mujeres. La disnea mMRC fue inicialmente mayor en las mujeres comparado con hombres 0,709±0,287 y evidenció un mayor cambio en las mujeres 1,294±0,415 versus hombres 0,736±0,880 al final de la rehabilitación pulmonar. Conclusión: la rehabilitación pulmonar en mujeres muestra un incremento en la distancia recorrida de 63,26 metros, disminución de 1,294 puntos en la disnea, para hombres 51,53 metros y 0,736 puntos respectivamente, y una mejoría en la calidad de vida en hombres de 11,47 puntos SGRQ con respecto con mujeres de 0,600.


Objetivo: determinar os efeitos da reabilitação pulmonar em homens e mulheres com diagnóstico de DPOC em uma clínica na Colômbia. Método: estudo descritivo longitudinal em 75 pacientes com DPOC que ingressaram em programa de reabilitação pulmonar durante os anos de 2018 e 2019. A população foi dividida em grupos de acordo com o sexo e foram avaliadas algumas características sociodemográficas, espirometria em porcentagem do previsto, índice de massa corporal, mMRC dispneia, capacidade de exercício e algumas variáveis ​​fisiológicas com o teste de caminhada de seis minutos, ansiedade-depressão (HADS) e qualidade de vida (SGRQ). Considerou-se o valor de p <0,05 como estatisticamente significativo. Resultados: a taxa de fumaça de maços por ano foi maior nos homens 34 ± 29,11 (p <0,001), enquanto a exposição à fumaça de lenha foi cinco vezes maior nas mulheres (p = 0,037). Todas as variáveis ​​da capacidade de exercício melhoraram significativamente (p <0,021), destacando-se a distância percorrida 63,26 ± 60,03 versus 51,53 ± 61,02 a favor das mulheres. O mMRC dispneia foi inicialmente maior nas mulheres em relação aos homens 0,709 ± 0,287 e evidenciou maior alteração nas mulheres 1,294 ± 0,415 versus homens 0,736 ± 0,880 ao final da reabilitação pulmonar. Conclusão: a reabilitação pulmonar em mulheres mostra um aumento na distância percorrida de 63,26 metros e uma diminuição de 1.294 pontos na dispneia, enquanto para os homens os valores obtidos foram 51,53 metros e 0,736 pontos, respectivamente, e uma melhoria na qualidade de vida nos homens de 11,47 pontos do SGRQ em relação às mulheres, onde foi de 0,600 pontos.


Objective: To determine the effects of pulmonary rehabilitation in men and women with a COPD diagnosis in a Colombian clinic. Method: A longitudinal and descriptive study was conducted with 75 COPD patients who entered a pulmonary rehabilitation program during 2018 and 2019. The population was divided into groups according to gender and some sociodemographic characteristics were assessed, such as spirometry expressed in percentage of the predicted value, body mass index, mMRC dyspnea, and capacity for physical exercise, as well as some physiological variables with the six-minute walk test, anxiety-depression (HADS) and quality of life (SGRQ). A p-value<0.05 was considered statistically significant. Results: The cigarette packs smoked per year index was higher in men, 34±29.11 (p<0.001), whereas the exposure to firewood smoke was five times higher in women (p=0.037). All the variables related to the capacity for physical exercise improved significantly (p<0.021), with distance covered standing out: 63.26±60.03 vs. 51.53±61.02 in favor of women. mMRC dyspnea was initially higher in women when compared to men, 0.709±0.287, and presented a greater change in women with 1.294±0.415 when compared to men, 0.736±0.880, at the end of pulmonary rehabilitation. Conclusion: Pulmonary rehabilitation in women shows an increase of 63.26 meters in the distance covered and a 1.294-point reduction in dyspnea; while, for men, these figures were 51.53 meters and 0.736 points, respectively, as well as an improvement in quality of life in men by 11.47 SGRQ points when compared to women: 0.600.


Subject(s)
Quality of Life , Rehabilitation , Sex , Exercise , Dyspnea , Lung Diseases
11.
S. Afr. med. j. (Online) ; 111(11): 1046-1049, 2021. figures
Article in English | AIM | ID: biblio-1344518

ABSTRACT

South Africa has experienced three deadly waves of the COVID-19 pandemic with devastating consequences, but little is known about the experiences in small-town hospitals in the country. Between May 2020 and June 2021, author GC treated ~100 confirmed COVID-19 cases. This retrospective case series report describes 10 of these cases, 7 with unusual complications and 3 with sudden death.


Subject(s)
Pneumonia , Hospitals, Urban , Comorbidity , COVID-19 , Neurologic Manifestations , Diabetes Mellitus, Type 2 , Dyspnea , Infarction
12.
Rev. méd. Minas Gerais ; 31: 31406, 2021.
Article in Portuguese | LILACS | ID: biblio-1291372

ABSTRACT

A proteinose alveolar pulmonar (PAP) é rara e caracterizada por preenchimento alveolar com material lipoproteináceo. A proteinose alveolar é caracterizada por um alvéolo com material eosinofílico, acelular, finamente granular, com fendas de colesterol. Este relato de caso descreve um paciente do sexo masculino, 2 anos, portador de hipogamaglobulinemia. O paciente foi internado com quadro compatível com Stevens- Johnson após uso de amoxicilina e clavulanato para quadro de otite média aguda. Posteriormente, foi encaminhado à unidade de terapia intensiva devido à piora respiratória clínica e radiológica. Biópsia pulmonar: proteinose alveolar com alvéolos distendidos por material proteináceo, eosinofílico e grumoso com infiltrado linfo- histiocitário local. A proteinose alveolar pulmonar é rara e o diagnóstico correto deve ser realizado para que seja realizado tratamento adequado e acompanhamento da evolução. Deve-se atentar para complicações, especialmente infecções oportunistas.


Pulmonary alveolar proteinosis (PAP) is rare and it is characterized by alveolar filling with lipoproteinaceous material. Alveolar proteinosis is characterized by an alveolus with eosinophilic, acellular, finely granular material, with cholesterol cracks. This case report describes a 2-yearold male patient with hypogammaglobulinemia. The patient was hospitalized with Stevens-Johnson-compatible condition after use of amoxicillin and clavulanate for acute otitis media. Subsequently, he was referred to the intensive care unit due to worsening clinical and radiological breathing. Lung biopsy: alveolar proteinosis with alveoli distended by proteinaceous, eosinophilic and lumpy material with local lymphohistiocytic infiltrate. Pulmonary alveolar proteinosis is rare and the correct diagnosis must be made in order to carry out an appropriate treatment and follow-up of the evolution. Attention should be paid to complications, especially opportunistic infections.


Subject(s)
Male , Child, Preschool , Pulmonary Alveolar Proteinosis , Respiratory Distress Syndrome, Newborn , Opportunistic Infections , Dyspnea , Tachypnea , Familial Primary Pulmonary Hypertension , Amoxicillin
13.
Rev. méd. Minas Gerais ; 31: 31203, 2021.
Article in Portuguese | LILACS | ID: biblio-1291272

ABSTRACT

Introdução: A Organização Mundial da Saúde define como Cuidados Paliativos abordagens que melhoram a qualidade de vida dos pacientes (adultos e crianças) e de suas famílias que enfrentam problemas associados a doenças de risco de vida. Um dos principais objetivos dos Cuidados Paliativos é o alívio da dispneia. Objetivo: Esta revisão sistemática buscou encontrar na literatura evidências que indicam a efetividade das intervenções não invasivas para alívio da dispneia em fase final dos cuidados paliativos. Metodologia: Utilizou-se o guia metodológico da Cochrane Handbook. Resultados: Após a pesquisa inicial,110 artigos foram encontrados, 11 foram removidos por duplicação, 86 excluídos por não preencherem os critérios de inclusão. Após filtragem, 13 estudos foram recuperados em texto completo, e após leitura dos textos completos, 11 não corresponderam aos critérios de elegibilidade. Dois estudos foram incluídos na síntese qualitativa para avaliação da qualidade metodológica, e passaram para a síntese quantitativa. Nesta revisão sistemática, 230 pacientes incluídos foram alocados de forma aleatória para VNI (n=113) e Oxigenoterapia (n=117) seguindo uma randomização simples. Conclusão: Esta revisão sistemática apontou que as duas intervenções são métodos capazes de melhorar a dispneia dos pacientes em fase final dos Cuidados Paliativos Oncológicos, contudo a VNI mostrou ser superior à oxigenoterapia convencional e ao HFCN, principalmente nos pacientes hipercápnicos. Embora o HFCN também tenha apresentado dados significativos, seu uso ainda é controverso.


Introduction: The World Health Organization defines Palliative Care as approaches that improve the quality of life of patients (adults and children) and their families who face problems associated with lifethreatening diseases. One of the main objectives of Palliative Care is the relief of dyspnea. Objective: This systematic review sought to find evidence in the literature that indicates the effectiveness of non-invasive interventions for the relief of dyspnea in the final stage of palliative care. Methodology: The Cochrane Handbook methodological guide was used. Results: After the initial search, 110 articles were found, 11 were removed by duplication, 86 were excluded for not meeting the inclusion criteria, after filtering 13 studies were retrieved in full text, and after reading the full texts, 11 did not meet the criteria eligibility criteria. Two studies were included in the qualitative synthesis to assess methodological quality, and moved on to the quantitative synthesis. In this systematic review, 230 included patients were randomly allocated to NIV (n = 113) and oxygen therapy (n = 117) following simple randomization. Conclusion: This systematic review pointed out that the two interventions are methods capable of improving the dyspnea of patients in the final stage of Oncology Palliative Care, however NIV has been shown to be superior to conventional oxygen therapy and HFCN, especially in hypercapnic patients. Although HFCN has also presented significant data, its use is still controversial. Although supplemental oxygen therapy is widely prescribed, there is little evidence of benefit


Subject(s)
Humans , Adult , Middle Aged , Aged , Aged, 80 and over , Oxygen Inhalation Therapy , Noninvasive Ventilation , Palliative Care , Quality of Life , Hospice Care , Dyspnea
15.
Esc. Anna Nery Rev. Enferm ; 25(4): e20200520, 2021. tab, graf
Article in Portuguese | LILACS, BDENF | ID: biblio-1279021

ABSTRACT

Resumo Objetivo identificar os principais sinais e sintomas manifestados por pacientes em cuidados paliativos oncológicos na assistência domiciliar. Método revisão integrativa nas bases LILACS, MEDLINE e CINAHL em janeiro de 2020. Perguntou-se: "Quais os principais sinais e sintomas manifestados por pacientes em cuidados paliativos oncológicos destacados nos estudos abrangendo o contexto do domicílio?". Foram descritores/termos: Sinais e Sintomas/Signs and Symptoms; Assistência Domiciliar/Home Care Services; Cuidados Paliativos/Palliative Care e Neoplasias/Neoplasms. Elencaram-se como critérios de elegibilidade: texto completo; entre 2015 e 2019; em inglês, português ou espanhol e idade adulta. Para o mapeamento dos dados, consideraram-se: título; país; ano; objetivo; método; sinais e sintomas. Os resultados foram categorizados em subgrupos, considerando a classificação conceitual predeterminada (sinal e sintoma). O elemento contagem facilitou a análise e a comparação de dados. Resultados foram selecionados 35 artigos, sendo identificados 25 sinais e 23 sintomas. Os mais frequentes foram: dor, náusea/vômito, dispneia, fadiga, depressão, ansiedade, constipação, perda de apetite, sonolência, bem-estar e insônia. A maioria (39) relacionou-se ao domínio físico. Conclusão a identificação dos principais sinais e sintomas, neste contexto, direciona a prática dos profissionais de saúde para as intervenções mais adequadas e o mais precocemente possível, contribuindo para viabilizar a assistência domiciliar, e alerta para a necessidade de educação permanente sobre este tema.


Resumen Objetivo identificar los principales signos y síntomas que manifiestan los pacientes en cuidados oncológicos paliativos en la atención domiciliaria. Método revisión integradora basada en LILACS, MEDLINE y CINAHL en enero de 2020. Se preguntó: "¿Cuáles son los principales signos y síntomas que manifiestan los pacientes en cuidados paliativos oncológicos destacados en estudios que abarcan el contexto del hogar?". Los descriptores / términos fueron: signos y síntomas / /Signs and Symptoms; Asistencia domiciliaria / Home Care Services; Cuidados paliativos / Palliative Care / y Neoplasias/ Neoplasms. Se enumeraron los siguientes criterios de elegibilidad: texto completo; entre 2015 y 2019; en inglés, portugués o español y edad adulta. Para el mapeo de datos, se consideraron los siguientes: título; padres; año; objetivo; método; signos y síntomas. Los resultados se categorizaron en subgrupos, considerando la clasificación conceptual predeterminada (signo y síntoma). El elemento de conteo facilitó el análisis y la comparación de datos. Resultados Se seleccionaron 35 artículos, se identificaron 25 signos y 23 síntomas. Los más frecuentes fueron: dolor, náuseas / vómitos, disnea, fatiga, depresión, ansiedad, estreñimiento, pérdida de apetito, somnolencia, bienestar e insomnio. La mayoría (39) estaban relacionados con el dominio físico. Conclusión la identificación de los principales signos y síntomas, en este contexto, orienta la práctica de los profesionales de la salud hacia las intervenciones más adecuadas y lo más temprano posible, contribuyendo a hacer factible la atención domiciliaria, y alerta sobre la necesidad de una educación permanente sobre este tema.


Abstract Objective to identify the main signs and symptoms manifested by palliative care oncology patients in home care. Method integrative review in LILACS, MEDLINE and CINAHL databases in January 2020. The question was asked: "What are the main signs and symptoms manifested by patients in palliative oncology care highlighted in studies covering the context of the home?" Descriptors/terms were: Signs and Symptoms/Signs and Symptoms; Home Care/Home Care Services; Palliative Care/Palliative Care and Neoplasms/Neoplasms. Eligibility criteria were listed as follows: full text; between 2015 and 2019; in English, Portuguese or Spanish and adult age. For data mapping, the following were considered: title; country; year; objective; method; signs and symptoms. The results were categorized into subgroups, considering the predetermined conceptual classification (sign and symptom). The counting element facilitated the analysis and comparison of data. Results a total of 35 articles were selected, and 25 signs and 23 symptoms were identified. The most frequent were: pain, nausea/vomiting, dyspnea, fatigue, depression, anxiety, constipation, loss of appetite, sleepiness, well-being, and insomnia. Most (39) were related to the physical domain. Conclusion the identification of the main signs and symptoms, in this context, directs the practice of health professionals to the most appropriate interventions as early as possible, contributing to the feasibility of home care, and alerts to the need for continuing education on this topic.


Subject(s)
Humans , Adult , Palliative Care , Death , Home Nursing , Neoplasms , Anxiety , Quality of Life , Anorexia , Constipation , Depression , Dyspnea , Fatigue , Cancer Pain , Sleepiness , Sleep Initiation and Maintenance Disorders , Nausea
17.
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
18.
Article in Chinese | WPRIM | ID: wpr-879905

ABSTRACT

A boy was admitted on day 3 after birth due to shortness of breath for 2 days and cyanosis for 1 day. He had clinical manifestations of dyspnea in the early postnatal period and situs inversus, and was finally diagnosed with Kartagener syndrome. His condition was improved after oxygen therapy, anti-infective therapy, and aerosol therapy. The genetic testing showed that there was a large-fragment loss of heterozygosity, exon 48_50, and a hemizygous mutation, c.7915C > T(p.R2639X), in the


Subject(s)
China , Dyspnea , Exons , Humans , Infant, Newborn , Kartagener Syndrome/therapy , Male , Situs Inversus/genetics
19.
Vive (El Alto) ; 3(9): 166-176, dic. 2020. ilus
Article in Spanish | LILACS | ID: biblio-1252335

ABSTRACT

INTRODUCCIÓN: el COVID-19 es una enfermedad infecciosa que puede causar disfunciones respiratorias y físicas a corto y largo plazo. La disnea como consecuencia de la fibrosis pulmonar progresa a medida que la enfermedad avanza y afecta la calidad de vida. OBEJTIVO: determinar el nivel de disnea y su impacto en la calidad de vida de los pacientes post COVID-19 después del alta hospitalaria. METODOLOGÍA: enfoque cuantitativo, alcance descriptivo relacional, diseño no experimental con una muestra de 82 pacientes de 20 a 65 años de edad, pertenecientes al Hospital Monte Sinaí de la ciudad de Guayaquil. RESULTADOS: el mayor porcentaje de la población evaluada pertenecía al sexo masculino y las edades entre 50 a 59 años, donde la hipertensión sobresale entre las patologías pre-existentes; el 71% de los pacientes evaluados tiene disminución de la capacidad física, 1 a 4 en la escala de Borg; el 30% de los pacientes posee disnea moderada, el 35% indicó que su calidad de vida relacionada con la salud, ha tenido un impacto alto previo alta hospitalaria y se comprobó su dependencia entre el CAT y la mMRC, ya que aquellos pacientes con disnea grado 3 y 4 presentaban un impacto alto y muy alto en su calidad de vida y en el 70% de los pacientes evaluados la fatiga interfiere en sus actividades generales. CONCLUSIÓN: los pacientes Post COVID-19 presentan disnea moderada que interfiere en su calidad de vida, las mismas que están relacionadas a la edad, antecedentes patológicos y el tiempo de evolución.


INTRODUCTION: COVID-19 is an infectious disease that can cause respiratory and physical dysfunctions in the short and long term. Dyspnea as a consequence of pulmonary fibrosis progresses as the disease progresses and affects quality of life. OBJECTIVE: to determine the level of dyspnea and its impact on the quality of life of post-COVID-19 patients after hospital discharge. METHODOLOGY: quantitative approach, relational descriptive scope, non-experimental design with a sample of 82 patients from 20 to 65 years of age, belonging to the Monte Sinaí Hospital in the city of Guayaquil. RESULTS: the highest percentage of the evaluated population belonged to the male sex and the ages between 50 to 59 years, where hypertension stands out among the pre-existing pathologies; 71% of the patients evaluated have decreased physical capacity, 1 to 4 on the Borg scale; 30% of the patients have moderate dyspnea, 35% indicated that their health-related quality of life has had a high impact prior to discharge from hospital and their dependence between CAT and mMRC was confirmed, since those patients with dyspnea Grade 3 and 4 had a high and very high impact on their quality of life and in 70% of the patients evaluated, fatigue interferes with their general activities. CONCLUSION: post COVID-19 patients present moderate dyspnea that interferes with their quality of life, which are related to age, pathological history and time of evolution.


INTRODUÇÃO: COVID-19 é uma doença infecciosa que pode causar disfunções respiratórias e físicas em curto e longo prazo. A dispneia como consequência da fibrose pulmonar progride com a progressão da doença e afeta a qualidade de vida. OBJETIVO: determinar o grau de dispneia e seu impacto na qualidade de vida de pacientes pós-COVID-19 após a alta hospitalar. METODOLOGIA: abordagem quantitativa, âmbito descritivo relacional, delineamento não experimental com amostra de 82 pacientes de 20 a 65 anos, pertencentes ao Hospital Monte Sinaí na cidade de Guayaquil. RESULTADOS: o maior percentual da população avaliada pertencia ao sexo masculino e na faixa etária de 50 a 59 anos, onde a hipertensão se destaca entre as patologias pré-existentes; 71% dos pacientes avaliados têm capacidade física diminuída, 1 a 4 na escala de Borg; 30% dos pacientes apresentam dispneia moderada, 35% indicaram que sua qualidade de vida relacionada à saúde teve um alto impacto antes da alta hospitalar e sua dependência entre CAT e mMRC foi confirmada, uma vez que aqueles pacientes com dispneia Os graus 3 e 4 tiveram um impacto alto e muito alto em sua qualidade de vida e em 70% dos pacientes avaliados, a fadiga interfere em suas atividades gerais. CONCLUSÃO: pacientes pós COVID-19 apresentam dispneia moderada que interfere em sua qualidade de vida, que estão relacionados à idade, história patológica e tempo de evolução.


Subject(s)
Humans , Adult , Middle Aged , Patients , Quality of Life , Dyspnea , COVID-19 , Physics
20.
Rev. cuba. med. mil ; 49(3): e331, jul.-set. 2020. fig
Article in Spanish | LILACS, CUMED | ID: biblio-1144488

ABSTRACT

Introducción: El lupus eritematoso sistémico tiene múltiples formas de presentarse. La afectación del pericardio es la manifestación cardíaca más frecuente. El taponamiento cardíaco es muy raro, pero se presenta como un síndrome clínico hemodinámico potencialmente mortal. Objetivo: Mostrar una forma muy rara de presentación del lupus eritematoso sistémico; el taponamiento cardíaco. Caso clínico: Paciente blanca de 47 años con anasarca, disnea, palpitaciones, polipnea, ortopnea, tiraje intercostal, dolor torácico intenso, punzante, toma del estado general, ansiedad, fiebre, artralgia, artritis, lesiones dermatológicas, acrocianosis, ingurgitación yugular e hipotensión marcada. Comentarios: El paciente con taponamiento cardíaco debe ser asumido por un equipo multidisciplinario que defina el diagnóstico preciso y la conducta, sobre todo cuando se trata del debut del lupus eritematoso sistémico, que con los fenómenos autoinmunitarios, afecta a todos los órganos y sistemas(AU)


Introduction: Systemic lupus erythematosus has multiple ways of presentation. Pericardium involvement is the most frequent cardiac manifestation. Cardiac tamponade is very rare, but it presents as a life-threatening clinical hemodynamic syndrome. Objective: To show a very rare form of presentation of systemic lupus erythematosus; cardiac tamponade. Clinical case: 47-year-old white patient with anasarca, dyspnea, palpitations, polypnea, orthopnea, intercostal retraction, throbbing severe chest pain, bad general condition, anxiety, fever, arthralgia, arthritis, dermatological lesions, acrocyanosis, jugular engorgement and severe hypotension. Comments: Cardiac tamponade patient must be assumed by a multidisciplinary team that defines the precise diagnosis and behavior, especially when it comes to the debut of systemic lupus erythematosus, which with its autoimmune phenomena, affects all organs and systems(AU)


Subject(s)
Humans , Female , Middle Aged , Cardiac Tamponade/diagnostic imaging , Edema , Hypotension , Lupus Erythematosus, Systemic/complications , Dyspnea
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