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Noninvasive Ventilation in the Critically Ill Patient With Obesity Hypoventilation Syndrome: A Review.
No full textObesity is a global epidemic that adversely affects respiratory physiology. Sleep-disordered breathing and obesity hypoventilation syndrome (OHS) are among the most common pulmonary complications related to obesity class III. Patients with OHS may present with acute hypercapnic respiratory failure (AHRF) that necessitates immediate noninvasive ventilation (NIV) or invasive ventilation and intensive care unit (ICU) monitoring. The OHS is underrecognized as a cause of AHRF. The management of mechanical ventilation in obese ICU patients is one of the most challenging problems facing respirologists, intensivists, and anesthesiologists. The treatment of AHRF in patients with OHS should aim to improve alveolar ventilation with better alveolar gas exchange, as well as maintaining a patent upper airway, which is ideally achieved through NIV. Treatment with NIV is associated with improvement in blood gases and lung mechanics and may reduce hospital admissions and morbidity. In this review, we will address 3 main issues: (1) NIV of critically ill patients with acute respiratory failure and OHS; (2) the indications for postoperative application of NIV in patients with OHS; and (3) the impact of OHS on weaning and postextubation respiratory failure. Additionally, the authors propose an algorithm for the management of obese patients with AHRF.info:eu-repo/semantics/publishedVersio
Extended-release niacin increases anti-apolipoprotein A-I antibodies that block the antioxidant effect of high-density lipoprotein-cholesterol: the EXPLORE clinical trial.
Get PDFExtended-release niacin (ERN) is the most effective agent for increasing high-density lipoprotein-cholesterol (HDL-C). Having previously identified anti-HDL antibodies, we investigated whether ERN affected the antioxidant capacity of HDL and whether ERN was associated with the production of antibodies against HDL (aHDL) and apolipoprotein A-I (aApoA-I).
METHODS:
Twenty-one patients older than 18 years, with HDL-C ≤40 mg dl-1 (men) or ≤50 mg dl-1 (women) were randomly assigned to receive daily ERN (n = 10) or placebo (n = 11) for two sequential 12-week periods, with 4 weeks of wash-out before cross-over. Primary outcome was change of paraoxonase-1 (PON1) activity and secondary outcomes were changes in aHDL and aApoA-I antibodies. Clinical Trial Unique Identifier: EudraCT 2006-006889-42.
RESULTS:
The effect of ERN on PON1 activity was nonsignificant (coefficient estimate 20.83 U l-1 , 95% confidence interval [CI] -9.88 to 51.53; P = 0.184). ERN was associated with an increase in HDL-C levels (coefficient estimate 5.21 mg dl-1 , 95% CI 1.16 to 9.25; P = 0.012) and its subclasses HDL2 (coefficient estimate 2.46 mg dl-1 , 95% CI 0.57 to 4.34; P = 0.011) and HDL3 (coefficient estimate 2.73 mg dl-1 , 95% CI 0.47 to 4.98; P = 0.018). ERN was significantly associated with the production of aApoA-I antibodies (coefficient estimate 0.25 μg ml-1 , 95% CI 0.09-0.40; P = 0.001). aApoA-I titres at baseline were correlated with decreased PON activity.
CONCLUSIONS:
The rise in HDL-C achieved with ERN was not matched by improved antioxidant capacity, eventually hampered by the emergence of aApoA-I antibodies. These results may explain why Niacin and other lipid lowering agents fail to reduce cardiovascular risk.info:eu-repo/semantics/publishedVersio
Sarna Crostosa em Doente com Infecção VIH
Get PDFA infecção pelo VIH predispõe à ocorrência de múltiplas dermatoses que se manifestam frequentemente de forma atípica. Reporta-se o caso de um homem com 57 anos e imunossupressão grave no contexto de infecção pelo VIH que desenvolveu dermatose pruriginosa disseminada aquando de internamento hospitalar prolongado. Tendo por base as características do doente, as queixas e a distribuição corporal das lesões, e apesar de não existirem lesões típicas nem contexto epidemiológico sugestivo, foi admitido o diagnóstico de escabiose, com realização de biópsias cutâneas e dois ciclos de tratamento com benzoato de benzilo, apenas com melhoria transitória. Na repetição de biópsia, viria a confirmar-se hiperinfestação por Sarcoptes scabiei pelo que foi realizado ciclo de tratamento com ivermectina com resolução completa das lesões. A propósito deste caso clínico, os autores revêm aspectos clínicos e o tratamento da sarna crostosa.info:eu-repo/semantics/publishedVersio
Single-cell functional and chemosensitive profiling of combinatorial colorectal therapy in zebrafish xenografts.
Get PDFCancer is as unique as the person fighting it. With the exception of a few biomarker-driven therapies, patients go through rounds of trial-and-error approaches to find the best treatment. Using patient-derived cell lines, we show that zebrafish larvae xenotransplants constitute a fast and highly sensitive in vivo model for differential therapy response, with resolution to reveal intratumor functional cancer heterogeneity. We screened international colorectal cancer therapeutic guidelines and determined distinct functional tumor behaviors (proliferation, metastasis, and angiogenesis) and differential sensitivities to standard therapy. We observed a general higher sensitivity to FOLFIRI [5-fluorouracil(FU)+irinotecan+folinic acid] than to FOLFOX (5-FU+oxaliplatin+folinic acid), not only between isogenic tumors but also within the same tumor. We directly compared zebrafish xenografts with mouse xenografts and show that relative sensitivities obtained in zebrafish are maintained in the rodent model. Our data also illustrate how KRAS mutations can provide proliferation advantages in relation to KRASWT and how chemotherapy can unbalance this advantage, selecting for a minor clone resistant to chemotherapy. Zebrafish xenografts provide remarkable resolution to measure Cetuximab sensitivity. Finally, we demonstrate the feasibility of using primary patient samples to generate zebrafish patient-derived xenografts (zPDX) and provide proof-of-concept experiments that compare response to chemotherapy and biological therapies between patients and zPDX. Altogether, our results suggest that zebrafish larvae xenografts constitute a promising fast assay for precision medicine, bridging the gap between genotype and phenotype in an in vivo setting.info:eu-repo/semantics/publishedVersio
Outcomes of Non-Pharmacological Nursing Interventions’ on Patients with Chronic Pain
Get PDFConsidering the high number of people who experience chronic pain, with need
of differentiated care, it is relevant to identify non-pharmacological nursing
interventions in pain control and health gains. The objective of this paper is to
identify nursing intervention and outcomes of non-pharmacological measures
in chronic pain. The results of the analysis of literature allow us to synthesize
some efficient interventions as: (1) auricular point acupressure; (2) hearing
stimulation; (3) manipulation of the cervical and thoracic spine; (4) therapeutic
massage (5) physical activity; (6) incentive the use of woolen underwear; (7)
therapeutic dialogue and (8) behavioral interventions. Significant improvements
in pain control as found, like increased functional capacity, improved quality of
life, control of psychological maladjustment, and increased health literacy. This
nursing interventions are recommended in the hospital environment and in
primary health care.info:eu-repo/semantics/publishedVersio
Neoplasms of minor salivary gland - Retrospective study
Get PDFObjectivos: Análise descritiva dos casos de neoplasias das glândulas salivares minor tratados no serviço de Otorrinolaringologia do IPO de Lisboa, e comparação dos resultados com o que está descrito na literatura.
Metodologia: Análise retrospectiva de todos os casos com diagnóstico histológico de neoplasia das glândulas salivares minor das cavidade nasal, cavidade oral, laringe e faringe, que ocorreram durante o período entre Outubro de 1992 a Novembro de 2015, tratados no serviço de Otorrinolaringologia do Instituto Português de Oncologia de Lisboa, Francisco Gentil.
Resultados : Foram documentados 58 casos de neoplasia das glândulas salivares minor, 60% ocorreram em indivíduos do sexo feminino e 40% ocorreram no sexo masculino, com um média de idades de 57 anos. O sintoma mais frequente na cavidade nasal foi a obstrução nasal, na cavidade oral a presença de úlcera ou tumefacção, e na orofaringe a dor. Os tipos histológicos mais comuns foram o carcinoma adenoide quístico (33%), o adenocarcinoma polimórfico (24%) e o carcinoma mucoepidermóide (22%). A orofaringe foi o local mais comum destas neoplasias. A cirurgia foi o tratamento de 1ª linha em 93% dos casos e 52% realizaram radioterapia adjuvante. A recidiva ocorreu em 20% dos casos. A mortalidade relacionada com o tumor foi de 7%.
Conclusões: As neoplasias das glândulas salivares minor são pouco frequentes, sendo as mais comuns o carcinoma adenoide quístico, o adenocarcinoma pleomórfico e o carcinoma mucoepidermóide. O tratamento cirúrgico é efetivo isoladamente em muitos casos. A mortalidade está relacionada com o estadio e com o tipo histológico do tumor.info:eu-repo/semantics/acceptedVersio
The albumin-bilirubin score predicting the mortality of patients with decompensated cirrhosis.
Get PDFinfo:eu-repo/semantics/publishedVersio