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[PMID]:28452705
[Au] Autor:Lin L; Chen Z; Cao Y; Sun G
[Ad] Endereço:Department of Otorhinolaryngology-Head and Neck Surgery, Huashan Hospital of Fudan University, Shanghai, China.
[Ti] Título:Normal saline solution nasal-pharyngeal irrigation improves chronic cough associated with allergic rhinitis.
[So] Source:Am J Rhinol Allergy;31(2):96-104, 2017 Mar 01.
[Is] ISSN:1945-8932
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Upper airway inflammation is one of the most commonly identified causes of chronic cough, although the underlying mechanism is not clear. This study compared normal saline solution nasal-pharyngeal irrigation (NSNPI) and fluticasone propionate nasal spray (FPNS) treatment for chronic cough associated with allergic rhinitis (AR). METHODS: Patients with suspected AR to house-dust mite were enrolled, and the symptom of cough was assessed by a cough symptom score and the Leicester Cough Questionnaire, and cough response to capsaicin was evaluated. AR was assessed by using the visual analog scale (VAS) and the Mini Juniper Rhinoconjunctivitis Quality of Life Questionnaire (MiniRQLQ). Mediators, including histamine, leukotriene C4, and prostaglandin D2, and the major basic protein from nasal lavage fluid (NLF) were examined. The patients were treated with NSNPI (the NSNPI group) or FPNS (the FPNS group) for 30 days, after which they were reassessed. RESULTS: Forty-five of 50 patients completed this study. The scores of the cough symptom and the Leicester Cough Questionnaire, and the capsaicin cough threshold all improved statistically after NSNPI but did not change after FPNS. There were statistically significant changes in the evaluations of the MiniRQLQ and the mediators, including histamine and leukotriene C4, in the NLF in the NSNPI group. However, significant changes were found in the assessments of VAS, MiniRQLQ, and all above mediators including histamine, leukotriene C4, and prostaglandin D2, and the major basic protein in the NLF of the FPNS group. Furthermore, the assessments of VAS and all the mediators were reduced more in the FPNS group compared with those in the NSNPI group. CONCLUSION: The patients with suspected AR to house-dust mite reported a better relief of the cough symptom after 30 days of treatment with NSNPI compared with that after nasal corticosteroid.
[Mh] Termos MeSH primário: Tonsila Faríngea/patologia
Tosse/prevenção & controle
Fluticasona/uso terapêutico
Seios Paranasais/patologia
Rinite Alérgica/terapia
Cloreto de Sódio/uso terapêutico
Irrigação Terapêutica
[Mh] Termos MeSH secundário: Tonsila Faríngea/efeitos dos fármacos
Adolescente
Adulto
Idoso
Animais
Antígenos de Dermatophagoides/imunologia
Doença Crônica
Tosse/etiologia
Seres Humanos
Meia-Idade
Sprays Nasais
Seios Paranasais/efeitos dos fármacos
Pyroglyphidae/imunologia
Rinite Alérgica/complicações
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Antigens, Dermatophagoides); 0 (Nasal Sprays); 451W47IQ8X (Sodium Chloride); CUT2W21N7U (Fluticasone)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE
[do] DOI:10.2500/ajra.2017.31.4418


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[PMID]:29203737
[Au] Autor:Nadraga AB; Dybas IV
[Ad] Endereço:Danylo Halytskyj Lviv National Medical University, Lviv, Ukraine.
[Ti] Título:[Pertussis in children with incomplete active immunization].
[So] Source:Wiad Lek;70(5):901-905, 2017.
[Is] ISSN:0043-5147
[Cp] País de publicação:Poland
[La] Idioma:ukr
[Ab] Resumo:INTRODUCTION: In recent years, a significant increase in the incidence of pertussis among children has been observed both in Ukraine and worldwide. Infants who were partially vaccinated or children who became ill in a short time after complete active immunization with primary vaccination complex against pertussis are more often referred to our clinic with the diagnosis of "pertussis". THE AIM: The clinical peculiarities of pertussis study in partially vaccinated infants and infants who are in the process of vaccination against pertussis. MATERIALS AND METHODS: 83 infants aged 3-12 months in Lviv Regional Hospital of Infectious Diseases were kept under observation. The course of the disease and some laboratory dates have been investigated. Severity of pertussis was estimated by the Preziosi & Halloran score. RESULTS: Pertussis catarrhal period lasted significantly longer in partially vaccinated children. A shorter period of time during which cough with reprises persisted has been determined; a significant lower leukocytes levels and absolute amount of lymphocytes have been revealed both on admission and in the dynamics of the disease in vaccinated children as compared with unvaccinated patients. CONCLUSIONS: We have concluded that the children, who received 1, 2 and/or 3 inoculations during primary vaccination against pertussis in epidemics period, are at high risk for pertussis. The course of the disease in these children is reliably milder, with longer catarrhal period, less duration of spasmodic cough, fewer episodes of cough during the day, lower rate of complications.
[Mh] Termos MeSH primário: Vacinas contra Difteria, Tétano e Coqueluche Acelular/administração & dosagem
Índice de Gravidade de Doença
Vacinação/estatística & dados numéricos
Coqueluche/epidemiologia
[Mh] Termos MeSH secundário: Bem-Estar da Criança/estatística & dados numéricos
Pré-Escolar
Tosse/epidemiologia
Feminino
Seres Humanos
Lactente
Recém-Nascido
Masculino
Medição de Risco
Fatores de Risco
Ucrânia
Coqueluche/diagnóstico
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Diphtheria-Tetanus-acellular Pertussis Vaccines)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171206
[St] Status:MEDLINE


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[PMID]:29191155
[Au] Autor:Ohene SA; Bonsu F; Hanson-Nortey NN; Toonstra A; Sackey A; Lonnroth K; Uplekar M; Danso S; Mensah G; Afutu F; Klatser P; Bakker M
[Ad] Endereço:World Health Organization Country Office, 29 Volta Street Airport, Airport Residential Area, P.O. Box MB 142, Accra, Ghana. salohene@yahoo.com.
[Ti] Título:Provider initiated tuberculosis case finding in outpatient departments of health care facilities in Ghana: yield by screening strategy and target group.
[So] Source:BMC Infect Dis;17(1):739, 2017 Dec 01.
[Is] ISSN:1471-2334
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Meticulous identification and investigation of patients presenting with tuberculosis (TB) suggestive symptoms rarely happen in crowded outpatient departments (OPDs). Making health providers in OPDs diligently follow screening procedures may help increase TB case detection. From July 2010 to December 2013, two symptom based TB screening approaches of varying cough duration were used to screen and test for TB among general outpatients, PLHIV, diabetics and contacts in Accra, Ghana. METHODS: This study was a retrospective analysis comparing the yield of TB cases using two different screening approaches, allocated to selected public health facilities. In the first approach, the conventional 2 weeks cough duration with or without other TB suggestive symptoms was the criterion to test for TB in attendants of 7 general OPDs. In the second approach the screening criteria cough of >24 hours, as well as a history of at least one of the following symptoms: fever, weight loss and drenching night sweats were used to screen and test for TB among attendants of 3 general OPDs, 7 HIV clinics and 2 diabetes clinics. Contact investigation was initiated for index TB patients. The facilities documented the number of patients verbally screened, with presumptive TB, tested using smear microscopy and those diagnosed with TB in order to calculate the yield and number needed to screen (NNS) to find one TB case. Case notification trends in Accra were compared to those of a control area. RESULTS: In the approach using >24-hour cough, significantly more presumptive TB cases were identified among outpatients (0.82% versus 0.63%), more were tested (90.1% versus 86.7%), but less smear positive patients were identified among those tested (8.0% versus 9.4%). Overall, all forms of TB cases identified per 100,000 screened were significantly higher in the >24-hour cough approach at OPD (92.7 for cough >24 hour versus 82.7 for cough >2 weeks ), and even higher in diabetics (364), among contacts (693) and PLHIV (995). NNS (95% Confidence Interval) varied from 100 (93-109) for PLHIV, 144 (112-202) for contacts, 275 (197-451) for diabetics and 1144 (1101-1190) for OPD attendants. About 80% of the TB cases were detected in general OPDs. Despite the intervention, notifications trends were similar in the intervention and control areas. CONCLUSION: The >24-hour cough approach yielded more TB cases though required TB testing for a larger number of patients. The yield of TB cases per 100,000 population screened was highest among PLHIV, contacts, and diabetics, but the majority of cases were detected in general OPDs. The intervention had no discernible impact on general case notification.
[Mh] Termos MeSH primário: Programas de Rastreamento/métodos
Tuberculose/diagnóstico
[Mh] Termos MeSH secundário: Algoritmos
Tosse/etiologia
Gana
Instalações de Saúde
Seres Humanos
Pacientes Ambulatoriais
Estudos Retrospectivos
Fatores de Tempo
Tuberculose/patologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180306
[Lr] Data última revisão:
180306
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171202
[St] Status:MEDLINE
[do] DOI:10.1186/s12879-017-2843-5


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[PMID]:29325304
[Au] Autor:Asthma Group of Chinese Thoracic Society; China Asthma Alliance
[Ti] Título:[The Chinese experts' consensus on the evaluation and management of asthma exacerbation].
[So] Source:Zhonghua Nei Ke Za Zhi;57(1):4-14, 2018 Jan 01.
[Is] ISSN:0578-1426
[Cp] País de publicação:China
[La] Idioma:chi
[Ab] Resumo:Asthma exacerbations can do a lot of harm to the patients and consume large amounts of medical resources. This consensus is based on the domestic and foreign guidelines and literatures to standardize the evaluation and management of asthma exacerbations in China. Asthma exacerbations are characterized by a progressive increase in symptoms of shortness of breath, cough, wheezing or chest tightness and progressive decrease in lung function, and usually require modification of treatment. Recognizing risk factors and triggering factors of asthma exacerbations is helpful for the prevention and long-term management. Evaluation of asthma exacerbations is based on symptoms, lung function, and arterial blood gas. Management is stratified according to the severity of disease. Different regimens to treat asthma exacerbations are discussed in this consensus. Glucocorticoids should be used properly. Overuse of antibiotics should be avoided. Management of life-threatening asthma is discussed separately. Special attention should be paid in some special respects, such as asthma during peri-operation period, gestation period, and childhood. Diagnosis and management of complications are also of great significance and are discussed in details.
[Mh] Termos MeSH primário: Antiasmáticos/uso terapêutico
Asma/tratamento farmacológico
Consenso
[Mh] Termos MeSH secundário: Antibacterianos/uso terapêutico
Asma/fisiopatologia
China
Tosse
Seres Humanos
Guias de Prática Clínica como Assunto
Fatores de Risco
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anti-Asthmatic Agents); 0 (Anti-Bacterial Agents)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180222
[Lr] Data última revisão:
180222
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180112
[St] Status:MEDLINE
[do] DOI:10.3760/cma.j.issn.0578-1426.2018.01.002


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[PMID]:29390501
[Au] Autor:Guo T; Chen Z; Tai X; Liu Z; Zhu M
[Ad] Endereço:Yunnan University of Traditional Chinese Medicine, Kunming 650500, China.
[Ti] Título:Space-time acupuncture for intractable cough after lupus nephropathy: A case report and literature review.
[So] Source:Medicine (Baltimore);96(51):e9309, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Some intractable chronic cough remains a common complaint for seeking medical care. Unexplained cough in lupus nephropathy patient is rare and therapeutic options are limited. PATIENT CONCERNS: A 57 year-old woman with a 7-year history of lupus nephropathy. She has suffered from chronic cough for 3 years accompanied with chronic low back pain and fatigue, as the conventional therapy cannot relieve the symptoms. DIAGNOSES: The woman is diagnosed as intractable cough after lupus nephropathy. INTERVENTIONS: 9 times space-time acupuncture (STA) treatment was performed. OUTCOMES: The cough, as well as other uncomfortable symptoms like chronic low-back pain and fatigue have resolved, and no relapse for one year follow-up. LESSONS: STA may be an effective therapy to treat intractable chronic cough.
[Mh] Termos MeSH primário: Terapia por Acupuntura
Tosse/terapia
Nefrite Lúpica/complicações
[Mh] Termos MeSH secundário: Doença Crônica
Fadiga/terapia
Feminino
Seres Humanos
Dor Lombar/terapia
Meia-Idade
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180220
[Lr] Data última revisão:
180220
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180203
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009309


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[PMID]:28455405
[Au] Autor:Li Kam Wa ME; Taraborrelli P; Hayat S; Lim PB
[Ad] Endereço:Department of Cardiology, Imperial College Healthcare NHS Trust, London, UK.
[Ti] Título:Respiration driven excessive sinus tachycardia treated with clonidine.
[So] Source:BMJ Case Rep;2017, 2017 Apr 28.
[Is] ISSN:1757-790X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:A 26-year-old man presented to our syncope service with debilitating daily palpitations, shortness of breath, presyncope and syncope following a severe viral respiratory illness 4 years previously. Mobitz type II block had previously been identified, leading to a permanent pacemaker and no further episodes of frank syncope. Transthoracic echocardiography, electophysiological study and repeated urine metanepherines were normal. His palpitations and presyncope were reproducible on deep inspiration, coughing, isometric hand exercise and passive leg raises. We demonstrated rapid increases in heart rate with no change in morphology on his 12 lead ECG. His symptoms were resistant to fludrocortisone, flecainide, ß blockers and ivabradine. Initiation of clonidine in combination with ivabradine led to rapid resolution of his symptoms. We suggest that an excessive respiratory sinus arrhythmia was responsible for his symptoms and achieved an excellent response with the centrally acting sympatholytic clonidine, where previous peripherally acting treatments had failed.
[Mh] Termos MeSH primário: Inalação/fisiologia
Síncope/fisiopatologia
Taquicardia Sinusal/complicações
[Mh] Termos MeSH secundário: Agonistas de Receptores Adrenérgicos alfa 2/administração & dosagem
Agonistas de Receptores Adrenérgicos alfa 2/uso terapêutico
Adulto
Benzazepinas/administração & dosagem
Benzazepinas/uso terapêutico
Fármacos Cardiovasculares/administração & dosagem
Fármacos Cardiovasculares/uso terapêutico
Clonidina/administração & dosagem
Clonidina/uso terapêutico
Tosse/complicações
Tosse/etiologia
Quimioterapia Combinada/métodos
Dispneia/diagnóstico
Dispneia/etiologia
Ecocardiografia/métodos
Eletrocardiografia/métodos
Seres Humanos
Masculino
Síncope/etiologia
Taquicardia/etiologia
Taquicardia/fisiopatologia
Taquicardia Sinusal/diagnóstico por imagem
Taquicardia Sinusal/tratamento farmacológico
Taquicardia Sinusal/fisiopatologia
Resultado do Tratamento
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Adrenergic alpha-2 Receptor Agonists); 0 (Benzazepines); 0 (Cardiovascular Agents); 3H48L0LPZQ (ivabradine); MN3L5RMN02 (Clonidine)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180220
[Lr] Data última revisão:
180220
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170430
[St] Status:MEDLINE


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[PMID]:29365382
[Au] Autor:Chen QP; Zhou RF; Zhang YM; Yang L
[Ad] Endereço:Department of Paediatrics, Taizhou People's Hospital, Taizhou 225300, China.
[Ti] Título:[Efficacy of systemic glucocorticoids combined with inhaled steroid on children with acute laryngitis].
[So] Source:Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi;53(1):53-56, 2018 Jan 07.
[Is] ISSN:1673-0860
[Cp] País de publicação:China
[La] Idioma:chi
[Ab] Resumo:To evaluate the efficacy of systemic glucocorticoid (steroid) combined with high dose inhaled steroid in the treatment of children with acute laryngitis. A total of 78 children with acute laryngitis were randomly divided into study group( =40) and control group( =38) between November 2016 and April 2017. In addition to routine treatment of anti infection and symptomatic treatment, Dexamethasone injection(0.3-0.5 mg/kg, 1-3 d, according to the patient's condition) was provided to each group. In addition to the treatment mentioned above, the study group were assigned to receive 1.0 mg Budesonide suspension for inhalation, oxygen-driven atomizing inhalation, every/30 minutes, 2 times in a row, after that every 12 hours. The improvement of inspiratory dyspnea, hoarseness, barking cough and wheezing of both groups was evaluated at 30 min, 1 h, 2 h, 6 h, 12 h, 24 h and 72 h after treatment.Sigmaplot 11.5 software was used to analyze the data. No significant difference was detected in terms of inspiratory dyspnea, hoarseness, barking cough or stridor score before treatment between the two groups( >0.05). Compared with those before treatment, symptoms of inspiratory dyspnea, hoarseness, barking cough and stridor score of both groups improved markedly at 12 h and 24 h after treatment( <0.05). While there was no significant difference regarding inspiratory dyspnea, hoarseness, barking cough or stridor score at each time point after treatment between the two groups( >0.05). The effective rate was 92.50% and 92.11% in study group and control group, respectively, and no significant difference was noted ( >0.05). Compared with single systemic glucocorticoid, systemic glucocorticoids combined with inhaled steroid possessed similar efficacy in treating acute laryngitis and relieving laryngeal obstruction of children.
[Mh] Termos MeSH primário: Budesonida/uso terapêutico
Dexametasona/uso terapêutico
Glucocorticoides/uso terapêutico
Laringite/tratamento farmacológico
[Mh] Termos MeSH secundário: Doença Aguda
Administração por Inalação
Budesonida/administração & dosagem
Criança
Tosse/tratamento farmacológico
Dexametasona/administração & dosagem
Esquema de Medicação
Dispneia/tratamento farmacológico
Glucocorticoides/administração & dosagem
Rouquidão/tratamento farmacológico
Seres Humanos
Nebulizadores e Vaporizadores
Sons Respiratórios/efeitos dos fármacos
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Glucocorticoids); 51333-22-3 (Budesonide); 7S5I7G3JQL (Dexamethasone)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180215
[Lr] Data última revisão:
180215
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180125
[St] Status:MEDLINE
[do] DOI:10.3760/cma.j.issn.1673-0860.2018.01.012


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[PMID]:28449405
[Au] Autor:Suntrup-Krueger S; Kemmling A; Warnecke T; Hamacher C; Oelenberg S; Niederstadt T; Heindel W; Wiendl H; Dziewas R
[Ad] Endereço:Department of Neurology, University of Münster, Münster, Germany.
[Ti] Título:The impact of lesion location on dysphagia incidence, pattern and complications in acute stroke. Part 2: Oropharyngeal residue, swallow and cough response, and pneumonia.
[So] Source:Eur J Neurol;24(6):867-874, 2017 Jun.
[Is] ISSN:1468-1331
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND AND PURPOSE: Dysphagia is a well-known complication of acute stroke. Given the complexity of cerebral swallowing control it is still difficult to predict which patients are likely to develop swallowing dysfunction based on their neuroimaging. In Part 2 of a comprehensive voxel-based imaging study, whether the location of a stroke lesion can be correlated with further dysfunctional swallowing patterns, pulmonary protective reflexes and pneumonia was evaluated. METHODS: In all, 200 acute stroke cases were investigated applying flexible endoscopic evaluation of swallowing within 96 h from admission. Lesions were mapped using patients' computed tomography/magnetic resonance images and these were registered to a standard space. The percentage of lesioned volume of 137 anatomically defined brain regions was determined on a voxel basis (FSL5.0). Region-specific odds ratios (ORs) were calculated with respect to the presence of oropharyngeal residue, delayed swallow response, insufficient cough reflex and occurrence of pneumonia during hospital stay. Colour-coded lesion location maps of brain regions with significant ORs were created (P < 0.05). RESULTS: Lesion maps for residue and impaired swallow response depicted parietal-temporal areas of the right hemisphere. Limbic structures in the right hemisphere and sensory regions on the left were associated with cough reflex disturbance. There was no overlap of lesion maps for impaired swallow response and insufficient cough reflex or pneumonia, but substantial overlap between the last two conditions. CONCLUSIONS: This study gives new insights on the cortical representation of single components of swallowing and airway protection behaviours. The lesion model may help to risk-stratify patients for dysphagia and pneumonia based on their brain scan.
[Mh] Termos MeSH primário: Tosse/epidemiologia
Transtornos de Deglutição/epidemiologia
Pneumonia/epidemiologia
Acidente Vascular Cerebral/epidemiologia
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Tosse/etiologia
Deglutição/fisiologia
Transtornos de Deglutição/etiologia
Feminino
Seres Humanos
Incidência
Masculino
Meia-Idade
Pneumonia/etiologia
Acidente Vascular Cerebral/complicações
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180212
[Lr] Data última revisão:
180212
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170428
[St] Status:MEDLINE
[do] DOI:10.1111/ene.13307


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[PMID]:29267988
[Au] Autor:Rietberg MB; Veerbeek JM; Gosselink R; Kwakkel G; van Wegen EE
[Ad] Endereço:Department of Rehabilitation Medicine, Amsterdan Movement Sciences, MS Center Amsterdam, VU University Medical Center, De Boelelaan 1118, Amsterdam, Netherlands, 1007 MB.
[Ti] Título:Respiratory muscle training for multiple sclerosis.
[So] Source:Cochrane Database Syst Rev;12:CD009424, 2017 Dec 21.
[Is] ISSN:1469-493X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Multiple sclerosis (MS) is a chronic disease of the central nervous system, affecting approximately 2.5 million people worldwide. People with MS may experience limitations in muscular strength and endurance - including the respiratory muscles, affecting functional performance and exercise capacity. Respiratory muscle weakness can also lead to diminished performance on coughing, which may result in (aspiration) pneumonia or even acute ventilatory failure, complications that frequently cause death in MS. Training of the respiratory muscles might improve respiratory function and cough efficacy. OBJECTIVES: To assess the effects of respiratory muscle training versus any other type of training or no training for respiratory muscle function, pulmonary function and clinical outcomes in people with MS. SEARCH METHODS: We searched the Trials Register of the Cochrane Multiple Sclerosis and Rare Diseases of the Central Nervous System Group (3 February 2017), which contains trials from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, LILACS and the trial registry databases ClinicalTrials.gov and WHO International Clinical Trials Registry Platform. Two authors independently screened records yielded by the search, handsearched reference lists of review articles and primary studies, checked trial registers for protocols, and contacted experts in the field to identify further published or unpublished trials. SELECTION CRITERIA: We included randomized controlled trials (RCTs) that investigated the efficacy of respiratory muscle training versus any control in people with MS. DATA COLLECTION AND ANALYSIS: One reviewer extracted study characteristics and study data from included RCTs, and two other reviewers independently cross-checked all extracted data. Two review authors independently assessed risk of bias with the Cochrane 'Risk of bias' assessment tool. When at least two RCTs provided data for the same type of outcome, we performed meta-analyses. We assessed the certainty of the evidence according to the GRADE approach. MAIN RESULTS: We included six RCTs, comprising 195 participants with MS. Two RCTs investigated inspiratory muscle training with a threshold device; three RCTs, expiratory muscle training with a threshold device; and one RCT, regular breathing exercises. Eighteen participants (˜ 10%) dropped out; trials reported no serious adverse events.We pooled and analyzed data of 5 trials (N=137) for both inspiratory and expiratory muscle training, using a fixed-effect model for all but one outcome. Compared to no active control, meta-analysis showed that inspiratory muscle training resulted in no significant difference in maximal inspiratory pressure (mean difference (MD) 6.50 cmH O, 95% confidence interval (CI) -7.39 to 20.38, P = 0.36, I = 0%) or maximal expiratory pressure (MD -8.22 cmH O, 95% CI -26.20 to 9.77, P = 0.37, I = 0%), but there was a significant benefit on the predicted maximal inspiratory pressure (MD 20.92 cmH O, 95% CI 6.03 to 35.81, P = 0.006, I = 18%). Meta-analysis with a random-effects model failed to show a significant difference in predicted maximal expiratory pressure (MD 5.86 cmH O, 95% CI -10.63 to 22.35, P = 0.49, I = 55%). These studies did not report outcomes for health-related quality of life.Three RCTS compared expiratory muscle training versus no active control or sham training. Under a fixed-effect model, meta-analysis failed to show a significant difference between groups with regard to maximal expiratory pressure (MD 8.33 cmH O, 95% CI -0.93 to 17.59, P = 0.18, I = 42%) or maximal inspiratory pressure (MD 3.54 cmH O, 95% CI -5.04 to 12.12, P = 0.42, I = 41%). One trial assessed quality of life, finding no differences between groups.For all predetermined secondary outcomes, such as forced expiratory volume, forced vital capacity and peak flow pooling was not possible. However, two trials on inspiratory muscle training assessed fatigue using the Fatigue Severity Scale (range of scores 0-56 ), finding no difference between groups (MD, -0.28 points, 95% CI-0.95 to 0.39, P = 0.42, I = 0%). Due to the low number of studies included, we could not perform cumulative meta-analysis or subgroup analyses. It was not possible to perform a meta-analysis for adverse events, no serious adverse were mentioned in any of the included trials.The quality of evidence was low for all outcomes because of limitations in design and implementation as well as imprecision of results. AUTHORS' CONCLUSIONS: This review provides low-quality evidence that resistive inspiratory muscle training with a resistive threshold device is moderately effective postintervention for improving predicted maximal inspiratory pressure in people with mild to moderate MS, whereas expiratory muscle training showed no significant effects. The sustainability of the favourable effect of inspiratory muscle training is unclear, as is the impact of the observed effects on quality of life.
[Mh] Termos MeSH primário: Exercícios Respiratórios/métodos
Esclerose Múltipla/complicações
[Mh] Termos MeSH secundário: Tosse/fisiopatologia
Expiração/fisiologia
Seres Humanos
Inalação/fisiologia
Ensaios Clínicos Controlados Aleatórios como Assunto
Músculos Respiratórios
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180123
[Lr] Data última revisão:
180123
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171222
[St] Status:MEDLINE
[do] DOI:10.1002/14651858.CD009424.pub2


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[PMID]:29200151
[Au] Autor:Patterson GD; Mashegu H; Rutherford J; Seals S; Josey D; Karlson C; McNaull M; May W; Carroll C; Barr FE; Majumdar S
[Ad] Endereço:School of Medicine.
[Ti] Título:Recurrent Acute Chest Syndrome in Pediatric Sickle Cell Disease: Clinical Features and Risk Factors.
[So] Source:J Pediatr Hematol Oncol;40(1):51-55, 2018 Jan.
[Is] ISSN:1536-3678
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Acute chest syndrome (ACS) is a common and serious lung complication in sickle cell disease. A retrospective medical chart review was performed over a 6-year period in all pediatric ACS patients to investigate whether factors during the initial hospitalization were associated with recurrent ACS episodes. There were 386 episodes of ACS: 149 had only 1 episode of ACS, and 76 had >1 episode of ACS; 172 (76.4%) had hemoglobin SS, and 39 (17.3%) had hemoglobin SC. The most common presenting features were fever (83%), pain (70%), and cough (61%), which changed with the number of ACS episodes. Children <4 years old were at greatest risk of recurrent ACS (P=0.018). In addition, history of asthma (adjusted incident rate ratio [IRR]=1.52; 95% confidence interval [CI], 1.22-1.98; P<0.0001), shortness of breath (IRR, 1.29; 95% CI, 1.02-1.62; P=0.033), and length of hospital stay (IRR, 1.04; 95% CI, 1.01-1.08; P=0.017) were significantly associated with prospective ACS events. Multiple episodes of ACS are common in sickle cell disease, and certain risk factors during the initial hospitalization are associated with recurrent ACS.
[Mh] Termos MeSH primário: Síndrome Torácica Aguda/etiologia
Anemia Falciforme/complicações
[Mh] Termos MeSH secundário: Síndrome Torácica Aguda/diagnóstico
Fatores Etários
Criança
Pré-Escolar
Tosse/etiologia
Dispneia
Feminino
Febre/etiologia
Seres Humanos
Tempo de Internação
Masculino
Dor/etiologia
Recidiva
Estudos Retrospectivos
Fatores de Risco
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180112
[Lr] Data última revisão:
180112
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171205
[St] Status:MEDLINE
[do] DOI:10.1097/MPH.0000000000001012



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