- StatPearls [BOOK]
- BOOKStatPearls Publishing: Treasure Island (FL)
- Pneumothorax is a principal diagnosis for emergency management services (EMS) providers to make because it is a potentially life-threatening condition that is commonly associated with complaints such...
Pneumothorax is a principal diagnosis for emergency management services (EMS) providers to make because it is a potentially life-threatening condition that is commonly associated with complaints such as chest pain, shortness of breath, and trauma. The condition spans all age groups, and EMS providers should, therefore, maintain a high index of suspicion for pneumothorax for any patient with a sudden onset of acute respiratory distress and ipsilateral chest pain. Pneumothorax is the entry of air into the potential space between the parietal and visceral pleura. Air can enter the chest cavity from a rupture in the lung tissue or trauma to the pleura. Lung tissue can burst spontaneously in patients with risk factors such as tobacco use, Marfan’s syndrome, underwater diving, airplane travel, and male gender. It can also occur secondarily as a part of a chronic lung disease such as chronic obstructive pulmonary disease (COPD), interstitial lung disease, or pneumocystis pneumonia (PCP) due to the destruction of lung tissue. EMS providers may also encounter several different mechanisms of injury that violate the pleura creating a pneumothorax, such as penetrating trauma to the chest or blunt trauma with a rib fracture. EMS providers may be called to the outpatient setting where medical/holistic procedures involving the chest or neck may cause an iatrogenic pneumothorax, such as central venous catheter placement, thoracentesis, and lung biopsies. EMS providers are challenged in making the diagnosis for several reasons. They do not have access to emergency department tools such as chest radiographs and point of care thoracic ultrasound which may clinch the diagnosis. Many patients will have comorbid conditions that may mimic a pneumothorax including COPD/asthma, congestive heart failure (CHF), and pleural effusions, which may have decreased breath sounds during acute exacerbations and acute dyspnea. A hemothorax will have a similar presentation as a hemothorax such as dyspnea, hypoxia, decreased breath sounds, and chest pain. A key clinical finding that separates these two is that a pneumothorax will have hyper-resonance to percussion, but a hemothorax will have a hypo-resonance to percussion. Both of these will need a chest tube, but only a tension pneumothorax will require needle decompression. Ambient noise in the field may drown out differences in lateralized breath sounds. Low light, body fluid, and other environmental factors may make otherwise obvious chest wall openings unapparent in emergencies. In the appropriate clinical setting of acute dyspnea, but equivocal breath sounds, EMS providers may percuss the thorax for unilateral hyper-resonance and asymmetric tactile fremitus in making the diagnosis.
- MicroRNA-200a Affects the Proliferation of Airway Smooth Muscle Cells and Airway Remodeling by Targeting FOXC1 via the PI3K/AKT Signaling Pathway in Ovalbumin-Induced Asthmatic Mice. [Journal Article]
- CPCell Physiol Biochem 2018 Nov 13; 50(6):2365-2389
- CONCLUSIONS: The overexpression of miR-200a may downregulate FOXC1, thereby inhibiting the activation of the PI3K/AKT signaling pathway and ultimately suppressing ASMC proliferation and airway remodeling in asthmatic mice. This evidence supports the potential that miR-200a represents a new approach to treating asthma.
- Color Spectrographic Respiratory Monitoring from the External Ear Canal. [Journal Article]
- CSClin Sci (Lond) 2018 Nov 12
- The need for simple and reliable means of respiratory monitoring has existed since the beginnings of medicine. In this study we describe the use of color spectrographic analysis of breathing sounds r...
The need for simple and reliable means of respiratory monitoring has existed since the beginnings of medicine. In this study we describe the use of color spectrographic analysis of breathing sounds recorded from the external ear canal as a candidate technology to meet this need. A miniature electret microphone was modified with the addition of an adapter to allow it to be placed comfortably in the external ear canal. The amplified signal was then connected to a real-time color spectrogram program running on a laptop personal computer utilizing the Windows operating system. Based on the results obtained, we hypothesize that the real-time display of color spectrogram breathing patterns locally or at a central monitoring station may turn out to be a useful means of respiratory monitoring in patients at increased risk of respiratory depression or other respiratory problems. Finally, we conducted a statistical analysis that suggests that significant spectrogram differences may exist among some groups investigated in the study.
- [Specificities of occupational asthma in women and its interactions with hormonal status]. [Journal Article]
- RPRev Pneumol Clin 2018 Nov 09
- CONCLUSIONS: Differences between men and women in OA with variability of symptoms during female genital life have been identified. Further studies to personalized care strategies for women need to be undertaken.
- Piecemeal endoscopic polypoidectomy for the management of a canine pharyngeal hemangiosarcoma. [Journal Article]
- CVCan Vet J 2018; 59(11):1209-1212
- A 7-year-old castrated male Maltese dog was presented for increased respiratory sounds, inability to bark, dysphagia, and hyporexia. Radiographs revealed an ovoid, opaque mass in the caudal nasophary...
A 7-year-old castrated male Maltese dog was presented for increased respiratory sounds, inability to bark, dysphagia, and hyporexia. Radiographs revealed an ovoid, opaque mass in the caudal nasopharynx. An airway examination and computed tomography scan were followed by endoscopic polypoidectomy. The mass was a hemangiosarcoma, and the patient survived > 13 months.
- Health Effects Reported by Adolescent Water Pipe and/or Cigarette Smokers Compared to Nonsmokers. [Journal Article]
- JAJ Adolesc Health 2018 Nov 06
- CONCLUSIONS: Even during the adolescent years, WP and/or cigarette smoking youth experienced reportable negative health effects.
- An unusual case of hypercapnic respiratory failure. [Journal Article]
- RMRespir Med Case Rep 2018; 25:327-329
- Asphyxiating thoracic dystrophy (ATD also known as Jeune syndrome) is a very rare disorder with an incidence in the United States of 1 case per 100,000-130,000 live births. Chronic alveolar hypoventi...
Asphyxiating thoracic dystrophy (ATD also known as Jeune syndrome) is a very rare disorder with an incidence in the United States of 1 case per 100,000-130,000 live births. Chronic alveolar hypoventilation leading to concurrent hypoxia is the main cause of morbidity and mortality in these patients due to its complications. A 22-year-old male with past medical history of ATD and severe kyphoscoliosis presented with progressively worsening shortness of breath for several days. Past surgical history was significant for multiple reconstructive sternal surgeries, his first surgery was at the age of two. His chest exam was without wheezing and was notable for symmetrically decreased breath sounds. Arterial blood gas showed PH 7.17, PCO2 155, PO2 95 and O2 saturation of 97% on 2 L nasal cannulae. PA and lateral chest xrays showed a long and severely narrow thoracic cavity. 2D echocardiography showed left ventricular ejection fraction of 55% and evidence of severe pulmonary hypertension. CT chest angiography showed severe dilatation of the pulmonary artery in comparison to ascending aorta and significant right ventricular enlargement. Right heart catheterization confirmed these findings with a mean pulmonary arterial pressure of 61 mmHg. Within several days of hospitalization, patient developed acute worsening of his chronic hypercapnic respiratory failure thought to be due to worsening of pulmonary arterial hypertension with right heart failure. This in return was attributed to underlying ventilatory failure secondary to severe thoracic dystrophy. ATD is an autosomal recessive genetic disorder. Mutations in the IFT80 gene, which encode for an intraflagellar protein, cause this protein to be defective. Clinically, ATD is characterized by a small, narrow chest and variable limb shortness. While ATD is compatible with life, respiratory failure and infections are often fatal during infancy. Patients that survive past the age of 2 have seen respiratory complications resolve due to less pronounced thoracic malformations, but in our case the main cause of worsening pulmonary function was the degree of pulmonary arterial hypertension and right heart failure. Patients with ATD usually develop progressive hypercapnic respiratory failure due to an abnormally small thorax. Surgical options include lateral thoracic expansion or sternal and chest wall reconstruction. However, these surgeries only add a few years to survival without a definitive cure.
- Human Metapneumovirus: Mechanisms and Molecular Targets Used by the Virus to Avoid the Immune System. [Review]
- FIFront Immunol 2018; 9:2466
- Human metapneumovirus (hMPV) is a respiratory virus, first reported the year 2001. Since then, it has been described as one of the main etiological agents that causes acute lower respiratory tract in...
Human metapneumovirus (hMPV) is a respiratory virus, first reported the year 2001. Since then, it has been described as one of the main etiological agents that causes acute lower respiratory tract infections (ALRTIs), which is characterized by symptoms such as bronchiolitis, wheezing and coughing. Susceptible population to hMPV-infection includes newborn, children, elderly and immunocompromised individuals. This viral agent is a negative-sense, single-stranded RNA enveloped virus, that belongs to the Pneumoviridae family and Metapneumovirus genus. Early reports-previous to 2001-state several cases of respiratory illness without clear identification of the responsible pathogen, which could be related to hMPV. Despite the similarities of hMPV with several other viruses, such as the human respiratory syncytial virus or influenza virus, mechanisms used by hMPV to avoid the host immune system are still unclear. In fact, evidence indicates that hMPV induces a poor innate immune response, thereby affecting the adaptive immunity. Among these mechanisms, is the promotion of an anergic state in T cells, instead of an effective polarization or activation, which could be induced by low levels of cytokine secretion. Further, the evidences support the notion that hMPV interferes with several pattern recognition receptors (PRRs) and cell signaling pathways triggered by interferon-associated genes. However, these mechanisms reported in hMPV are not like the ones reported for hRSV, as the latter has two non-structural proteins that are able to inhibit these pathways. Several reports suggest that viral glycoproteins, such as G and SH, could play immune-modulator roles during infection. In this work, we discuss the state of the art regarding the mechanisms that underlie the poor immunity elicited by hMPV. Importantly, these mechanisms will be compared with those elicited by other common respiratory viruses.
- A Smartphone-Based System for Automated Bedside Detection of Crackle Sounds in Diffuse Interstitial Pneumonia Patients. [Journal Article]
- SSensors (Basel) 2018 Nov 07; 18(11)
- In this work, we present a mobile health system for the automated detection of crackle sounds comprised by an acoustical sensor, a smartphone device, and a mobile application (app) implemented in And...
In this work, we present a mobile health system for the automated detection of crackle sounds comprised by an acoustical sensor, a smartphone device, and a mobile application (app) implemented in Android. Although pulmonary auscultation with traditional stethoscopes had been used for decades, it has limitations for detecting discontinuous adventitious respiratory sounds (crackles) that commonly occur in respiratory diseases. The proposed app allows the physician to record, store, reproduce, and analyze respiratory sounds directly on the smartphone. Furthermore, the algorithm for crackle detection was based on a time-varying autoregressive modeling. The performance of the automated detector was analyzed using: (1) synthetic fine and coarse crackle sounds randomly inserted to the basal respiratory sounds acquired from healthy subjects with different signal to noise ratios, and (2) real bedside acquired respiratory sounds from patients with interstitial diffuse pneumonia. In simulated scenarios, for fine crackles, an accuracy ranging from 84.86% to 89.16%, a sensitivity ranging from 93.45% to 97.65%, and a specificity ranging from 99.82% to 99.84% were found. The detection of coarse crackles was found to be a more challenging task in the simulated scenarios. In the case of real data, the results show the feasibility of using the developed mobile health system in clinical no controlled environment to help the expert in evaluating the pulmonary state of a subject.
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- Evaluation of a Standardized Bakery Product (SUTMEK) as a Potential Tool for Baked-Milk Tolerance and Immunotherapy Research Studies. [Journal Article]
- IAInt Arch Allergy Immunol 2018 Nov 07; :1-9
- CONCLUSIONS: Our bakery products were successfully used in DBPCFC studies and qualified as an acceptable tool for use in the research of interventional tolerance induction. Although spIgE appears useful in determining children at high risk of reacting to extensively heated milk, the predictive cut-off values are still far from being perfect.