Subject(s)
Carcinoma , Lung Neoplasms , Humans , Lung Neoplasms/diagnosis , Lung Neoplasms/therapy , Nuclear Proteins , Oncogene Proteins, FusionABSTRACT
We present the unusual case of a 60-year-old immunocompetent woman with chronic obstructive pulmonary disease who developed a necrotising pneumonia with isolation of Cunninghamella bertholletiae, Aspergillus niger, Staphylococcus pseudintermedius and adenovirus. The patient recovered with antimicrobial therapy and supportive care in the intensive care unit. The current literature on diagnosis and treatment of these pathogens is reviewed.
Subject(s)
Mucormycosis , Pneumonia, Necrotizing , Adenoviridae , Aspergillus niger , Cunninghamella , Female , Humans , Middle Aged , StaphylococcusABSTRACT
BACKGROUND: Airway Pressure Release Ventilation (APRV) is a pressure controlled intermittent mandatory mode of ventilation characterized by prolonged inspiratory time and high mean airway pressure. Several studies have demonstrated that APRV can improve oxygenation and lung recruitment in patients with Acute Respiratory Distress Syndrome (ARDS). Although most patients with COVID-19 meet the Berlin criteria for ARDS, hypoxic respiratory failure due to COVID-19 may differ from traditional ARDS as patients often present with severe, refractory hypoxemia and significant variation in respiratory system compliance. To date, no studies investigating APRV in this patient population have been published. The aim of this study was to evaluate the effectiveness of APRV as a rescue mode of ventilation in critically ill patients diagnosed with COVID-19 and refractory hypoxemia. METHODS: We conducted a retrospective analysis of patients admitted with COVID-19 requiring invasive mechanical ventilation who were treated with a trial of APRV for refractory hypoxemia. PaO2/FIO2 (P/F ratio), ventilatory ratio and ventilation outputs before and during APRV were compared. RESULTS: APRV significantly improved the P/F ratio and decreased FIO2 requirements. PaCO2 and ventilatory ratio were also improved. There was an increase in tidal volume per predicted body weight during APRV and a decrease in total minute ventilation. On multivariate analysis, higher inspiratory to expiratory ratio (I: E) and airway pressure were associated with greater improvement in P/F ratio. CONCLUSIONS: APRV may improve oxygenation, alveolar ventilation and CO2 clearance in patients with COVID-19 and refractory hypoxemia. These effects are more pronounced with higher airway pressure and inspiratory time.
Subject(s)
COVID-19 , Respiratory Distress Syndrome , Continuous Positive Airway Pressure , Humans , Respiratory Distress Syndrome/therapy , Retrospective Studies , SARS-CoV-2ABSTRACT
No disponible
Subject(s)
Humans , Male , Aged , Inappropriate ADH Syndrome/diagnosis , Coronavirus Infections/diagnosis , Pneumonia, Viral/diagnosis , Pandemics , Betacoronavirus , Saline Solution, Hypertonic , Inappropriate ADH Syndrome/therapy , Coronavirus Infections/therapy , Pneumonia, Viral/therapySubject(s)
COVID-19/complications , Inappropriate ADH Syndrome/etiology , Aged , Humans , Hyponatremia/etiology , MaleSubject(s)
Abdominal Pain/diagnosis , Intestinal Perforation , Multiple Endocrine Neoplasia Type 1/complications , Point-of-Care Testing , Respiratory Distress Syndrome/diagnosis , Shock/diagnosis , Ultrasonography/methods , Zollinger-Ellison Syndrome , Abdominal Pain/etiology , Adult , Diagnosis, Differential , Endoscopy, Digestive System/methods , Gastrointestinal Tract/diagnostic imaging , Humans , Intestinal Perforation/diagnosis , Intestinal Perforation/etiology , Intestinal Perforation/physiopathology , Male , Patient Care Management/methods , Pneumoperitoneum/diagnostic imaging , Pneumoperitoneum/etiology , Respiratory Distress Syndrome/etiology , Shock/etiology , Tomography, X-Ray Computed/methods , Zollinger-Ellison Syndrome/etiology , Zollinger-Ellison Syndrome/physiopathologyABSTRACT
Hepatic lipase (HL) and lipoprotein lipase (LPL) activities (HLA, LPLA) modify lipoproteins and facilitate their binding to hepatic receptors. Apolipoprotein E (APOE) physically interacts with the lipases, and the three common haplotypes of the APOE gene (ε2, ε3, and ε4) yield protein isoforms (E2, E3, and E4, respectively) that are functionally different. Lipase activities themselves differ by sex and exercise training status. The interaction of APOE genotype, exercise training, and sex effects on lipase activities has not been studied. We measured postheparin plasma lipase activities in normolipidemic men and women with the three most common APOE genotypes, which are the haplotype combinations ε2/ε3 (n = 53 ), ε3/ε3 (n = 62), and ε4/ε3 (n = 52), enrolled in 6 mo of aerobic exercise training. These haplotype combinations comprise an estimated 11.6, 62.3, and 21.3% of the population, respectively. Baseline HLA was 35% lower in women than in men (P < 0.0001). In men but not women, HLA was higher in ε2/ε3 group compared with ε4/ε3 (P = 0.01) and ε3/ε3 (P = 0.05). Neither sex nor APOE genotype affected baseline LPLA. Training decreased HLA by 5.2% (P = 0.018) with no APOE effect. The apparent increase in LPLA following exercise was significant and APOE dependent only when corrected for baseline insulin (P < 0.05). Exercise decreased LPLA by 0.8 µmol free fatty acid (FFA)·ml⻹·h⻹ (-6%) in ε3/ε3 compared with the combined increases of 6.6% in ε2/ε3 and 12% in ε4/ε3 (P = 0.018 vs. ε3/ε3). However, these differences were statistically significant only after correcting for baseline insulin. We conclude that common APOE genotypes interact with 1) sex to modulate HLA regardless of training status, with ε2/ε3 men demonstrating higher HLA than ε3/ε3 or ε4/ε3 men, and 2) aerobic training to modulate LPLA, regardless of sex, with ε3/ε3 subjects showing a significant decrease compared with an increase in ε2/ε3 and ε3/ε4 after controlling for baseline insulin.
