EMJ Respiratory最新文献

{"title":"Risk Factors for Severe Coronavirus Disease (COVID-19)","authors":"A. Hussain, D. Rao, T. Buttle, L. Linkson, W. Owen, E. Hadley, S. El-Hasani","doi":"10.33590/emjrespir/20-00151","DOIUrl":"https://doi.org/10.33590/emjrespir/20-00151","url":null,"abstract":"Background: During the recent coronavirus disease (COVID-19) pandemic there have been several studies implicating an association between obesity, COVID-19 severity, and mortality. This retrospective study aims to investigate the association between obesity, other risk factors, and COVID-19 mortality of patients admitted over a 6-week period to the respiratory units at the authors’ hospitals.\u0000\u0000Methods: This is a retrospective study of 71 patients who were admitted into a respiratory unit over a 6-week period where the data were analysed for correlation between various risk factors, COVID-19 severity, and mortality. The statistical analysis was performed using excel statistics and SPSS (IBM, Armonk, New York, USA) statistical software. The significance was considered at p<0.05. The multivariate analysis, Z-test, Cox regression, Pearson correlation, and Kaplan–Meier analysis were used.\u0000\u0000Results: The mean age of the patients was 65.8 years (range: 35.0–93.0 years) standard deviation (13.21) and the male to female ratio was 2.73 (52:19, respectively). The most frequent comorbidities were obesity (42/71; 59%), hypertension (36/71; 50%), diabetes (22/71; 31%), heart disease (13/71; 18%), respiratory disease (9/71; 13%), and cancer (8/71; 11%). The mean body weight was 83.7 kg (60.4–147.7 kg) and the mean BMI was 32.2 (22.0–53.0 kg/m2). Smoking was reported in 8 (11%) of the patients. There were 20 (83%) mortalities among patients >70 years old (p<0.0001), 20 (83%) deaths among male patients (p<0.0001), 14 (58%) deaths among patients with a BMI >25 kg/m2 (p=0.001), 17 (70%) deaths reported for patients with hypertension (p=0.008), 6 (25%) mortalities for patients with cardiovascular disease (p=0.001), 14 (30%) deaths among patients who were mechanically ventilated (p=0.00028), and 5 (20%) mortalities among patients with cancer (p=0.003).\u0000\u0000Conclusions: Obesity, cancer, mechanical ventilation, male sex, intensive care unit admission, cardiovascular disease, and hypertension are significant risk factors for mortality in patients with COVID-19.","PeriodicalId":300382,"journal":{"name":"EMJ Respiratory","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126115896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving Antenatal Asthma Management: A Complex Journey","authors":"C.-L. Chen, M. Taing, L. Burr, H. Barrett, V. Clifton","doi":"10.33590/emjrespir/20-00143","DOIUrl":"https://doi.org/10.33590/emjrespir/20-00143","url":null,"abstract":"Asthma is a highly prevalent comorbidity during pregnancy, which can worsen as gestation progresses and is associated with several adverse perinatal outcomes. The adverse outcomes associated with maternal asthma are preventable with appropriate asthma management in pregnancy. However, the prevalence of adverse outcomes has not changed significantly over the last 20 years, even though knowledge and treatments for managing the disease in pregnancy has improved significantly. This is of concern now in the current climate with the coronavirus disease (COVID-19) pandemic and its potential impact on pregnant individuals with asthma. This article will discuss the treatments available for the management of asthma in pregnancy, the barriers for the translation of current knowledge into obstetric practice, and the importance of asthma education and self-management skills.","PeriodicalId":300382,"journal":{"name":"EMJ Respiratory","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128299745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Noninvasive Versus Invasive Mechanical Ventilation on Sleep in the Intensive Care Unit – A Pilot Study","authors":"A. O. Ugurlu, Karthik Jothianandan, C. D’Ambrosio, Samy S Sidhom, Eric Garpestad, N. Hill","doi":"10.33590/emjrespir/20-00011","DOIUrl":"https://doi.org/10.33590/emjrespir/20-00011","url":null,"abstract":"Rationale: Use of noninvasive ventilation (NIV) has increased in intensive care units, but sleep during NIV has received little attention. The authors surmised that due to frequent air leaks and mask discomfort, patients receiving NIV would manifest poorer sleep quality than those receiving invasive mechanical ventilation (INV).\u0000\u0000Methods: A prospective observational study on patients receiving NIV or INV for respiratory failure in a medical intensive care unit or coronary care unit. Patients were monitored by polysomnography for 24 hours with simultaneous collection of data on ventilator and environmental parameters.\u0000\u0000Results: Eight subjects in each group were studied. Mean total sleep time was 7.29 +1.78 hours (range: 0.57–13.82) in the NIV versus 11.74 +0.65 hours (8.95–15.19) in the INV group (p=0.034). Sleep efficiency was lower in NIV than INV group (30.4% versus 53.3%, respectively; p=0.013). The NIV group had lighter sleep than the INV group (mean % of Stage 1: 36.9% versus 17.2% of total sleep time, respectively; p=0.000), whereas no significant differences were found for other stages. Median total arousal and awakening indexes were higher in the NIV group (16.8/hour versus 4.4/hour and 5.3/hour versus 2.1/hour, respectively; p=0.005), as well as spontaneous arousals and awakenings (p=0.006 and p=0.005, respectively). Sedation was provided mostly by intermittent bolus in the NIV group whereas often by infusion in the INV group.\u0000\u0000Conclusion: Compared to INV, NIV in critically ill patients was associated with poorer quality and quantity of sleep. Future studies should determine whether adjustments in ventilator settings, mask type or fit, or use of sedation/analgaesia can improve sleep in patients receiving NIV.","PeriodicalId":300382,"journal":{"name":"EMJ Respiratory","volume":"401 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132207105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pulmonary Lipoma in an Atypical Location of the Pulmonary Fissure, Extirpated by Uniportal VATS – Case Report and Review of Literature","authors":"","doi":"10.33590/emjrespir/19-00168","DOIUrl":"https://doi.org/10.33590/emjrespir/19-00168","url":null,"abstract":"Lipomas are common benign tumours characterised by soft moveable masses throughout various locations in the body. However, atypical localisation of the pulmonary fissure is uncommon. Herein is reported a rare case of a female with an asymptomatic lesion in the pulmonary fissure of the left lung, extracted by single-port video-assisted thoracoscopic surgery, with a good clinical and radiologic outcome. Single-port video-assisted thoracoscopic surgery technique with a brief review of relevant literature will be discussed.","PeriodicalId":300382,"journal":{"name":"EMJ Respiratory","volume":"262 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133839440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expert Update for Doctors on COVID-19: A Summary of the Event","authors":"","doi":"10.33590/emjrespir/9698019","DOIUrl":"https://doi.org/10.33590/emjrespir/9698019","url":null,"abstract":"In light of the rapid developments of the coronavirus disease 2019 (COVID-19) epidemic in\u0000China, a panel of experts came together on 12th February at the Royal College of Physicians in London, UK. The experts discussed current data on COVID-19 and the measures being taken by Public Health England (PHE). According to Prof Jimmy Whitworth, from the London School of Hygiene and Tropical Medicine (LSHTM), in London, UK, COVID-19 is clinically very similar to a severe flu to which the population has no immunity and for which a vaccine is not available. Therefore, a severe strain could be put on health services if this became a UK epidemic. This could have wider implications on daily life such as transport, food supplies, and mass gatherings.","PeriodicalId":300382,"journal":{"name":"EMJ Respiratory","volume":"13 3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116116257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fibrosis and Damage Markers in Occupational Interstitial Lung\u0000 Diseases","authors":"","doi":"10.33590/emjresp/19-00103","DOIUrl":"https://doi.org/10.33590/emjresp/19-00103","url":null,"abstract":"The investigation of biomarkers for fibrosis and lung tissue damage is\u0000 very important for the diagnosis and prognosis of interstitial lung disease,\u0000 as well as treatment strategies. The biomarkers secreted by Type II\u0000 pneumocytes and cells of the bronchiolar epithelium are most reflective of\u0000 the formation of pulmonary fibrosis and the degree of damage to the lung\u0000 tissue. The levels of Krebs von den Lungen-6 (KL-6), alveolomucin\u0000 (mucin-antigen 3EG5), and Clara cell secretory protein in occupational\u0000 interstitial lung diseases (e.g., exogenous alveolitis, pneumoconiosis),\u0000 caused by exposure to organic and inorganic factors, were analysed in\u0000 dependence of disease activity phase. The level of alveolomucin in\u0000 pneumoconiosis and in occupational alveolitis remission may reflect the\u0000 extent of pulmonary fibrosis, which is a prognostic sign of the outcome of\u0000 the disease. Higher specificity and lower sensitivity of alveolomucin\u0000 compared to KL-6 can be used as a screening test for exogenous alveolitis.\u0000 KL-6 and alveolomucin are more useful biomarkers than Clara cell secretory\u0000 protein for diagnosis, exacerbation, and progression of occupational\u0000 alveolitis.","PeriodicalId":300382,"journal":{"name":"EMJ Respiratory","volume":"40 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133622192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimising Clinical Outcomes in Asthma and Chronic Obstructive Pulmonary Disease: Focus on Inhaler Satisfaction and Patient Adherence","authors":"Jessica Thorne","doi":"10.33590/emjrespir/10312088","DOIUrl":"https://doi.org/10.33590/emjrespir/10312088","url":null,"abstract":"The vast array of inhaler devices can be overwhelming for patients with chronic obstructive pulmonary disease (COPD) or asthma. Matching the right inhaler features to patients’ needs is key to maximising adherence and achieving the best outcomes. During this symposium, leading global asthma and COPD experts took an in-depth look at the latest clinical data relating to inhaler satisfaction and clinical outcomes.","PeriodicalId":300382,"journal":{"name":"EMJ Respiratory","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131088469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case of Empyema and a Review of Practice in a District General Hospital","authors":"A. Aujayeb, K. Conroy","doi":"10.33590/emjrespir/19-00070","DOIUrl":"https://doi.org/10.33590/emjrespir/19-00070","url":null,"abstract":"The authors describe an empyema in an immunosuppressed patient. Thoracentesis was attempted and only 60 mL of pus was obtained from her pleural space. She was treated as an outpatient with antibiotic therapy. The authors have recently performed a review of all cases of pleural infection between December 2016 and December 2017 in their trust, of which there were 36. Here, they describe failings that have now been addressed and which helped in managing this particular case. As a result of this review, the authors have developed a pleural procedure form that encompasses all of the recommendations from their case review.","PeriodicalId":300382,"journal":{"name":"EMJ Respiratory","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121340408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Malignant Mesothelioma Presenting After Resolution of a Seemingly Benign Asbestos Related Pleural Effusion","authors":"A. Aujayeb","doi":"10.33590/emjrespir/19-00049","DOIUrl":"https://doi.org/10.33590/emjrespir/19-00049","url":null,"abstract":"A male patient presented with a signs and symptoms of a respiratory tract infection associated with a pleural effusion. The effusion had negative cytological analysis and a CT scan showed mild pleural thickening. The effusion resolved completely on chest radiographs and the patient was discharged from the respiratory service, but the effusion recurred.\u0000\u0000After further investigations and elucidating significant asbestos exposure in the medical history, mesothelioma was eventually diagnosed. The patient is currently receiving chemotherapy with palliative intent.\u0000\u0000This paper highlights the importance of ongoing follow-up in a patient with a label of benign asbestos-related pleural effusion.","PeriodicalId":300382,"journal":{"name":"EMJ Respiratory","volume":"101 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116901188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute Effects of Noninvasive Ventilation on Autonomic Modulation Following Exercise-Induced Bronchoprovocation in Asthmatic Children","authors":"Maisi Muniz Cabral David, Evelim L.F.D. Gomes, Maryjôse Carvalho Mello, D. Costa","doi":"10.33590/emjrespir/10313360","DOIUrl":"https://doi.org/10.33590/emjrespir/10313360","url":null,"abstract":"Aims:To evaluate the autonomic modulation and clinical responses during testing of exercise-induced bronchoprovocation (EIB) and when applying non-invasive ventilation (NIV).\u0000\u0000Methods:A cross-sectional study that evaluated the heart rate variability at rest, during testing of EIB, in rest after 10 minutes of EIB, and during NIV with bilevel pressure with inspiratory positive airway pressure 12 cmH2O and expiratory positive airway pressure 8 cmH²O. Anthropometric evaluation was performed, examining inflammation and lung function. Clinical control was assessed by questionnaire (Asthma Control Questionnaire 6 [ACQ6]).\u0000\u0000Results: A cohort of 55 children aged 10.0±3.3 years were split in response to bronchial provocation test results into a responding group (RG) (n=39) or non-responding group (NRG) (n=16). There was a significant difference between the RG and NRG in clinical control as assessed by ACQ6 (RG=1.16 [0.33–2.0] partially controlled and NRG=0.58 [0.2–1.3] controlled). There was a significant difference in both the time domain and the frequency domain of the heart rate variability, indicating an inhibition of the parasympathetic nervous system during testing of EIB that did not return to baseline levels after 10 minutes and only started to return after the use of NIV in both groups, but the parasympathetic inhibition during the bronchial provocation test in the RG was higher than in the NRG.\u0000\u0000Conclusions:The RG presented with worse clinical control in addition to a less effective autonomic regulation. In both groups, NIV assisted in the return of autonomic activity basal levels after the bronchial provocation test.","PeriodicalId":300382,"journal":{"name":"EMJ Respiratory","volume":"53 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125864055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}