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Sample records for acute respiratory syndrome

  1. Acute respiratory distress syndrome

    ... chap 33. Lee WL, Slutsky AS. Acute hypoxemic respiratory failure and ARDS. In: Broaddus VC, Mason RJ, Ernst JD, et al, eds. Murray and Nadel's Textbook of Respiratory Medicine . 6th ed. Philadelphia, PA: Elsevier Saunders; 2016: ...

  2. Acute respiratory distress syndrome

    ... chap 33. Lee WL, Slutsky AS. Acute hypoxemic respiratory failure and ARDS. In: Broaddus VC, Mason RJ, Ernst ... A.M. Editorial team. Related MedlinePlus Health Topics Respiratory Failure Browse the Encyclopedia A.D.A.M., Inc. ...

  3. The acute respiratory distress syndrome

    Modrykamien, Ariel M.; Gupta, Pooja

    2015-01-01

    The acute respiratory distress syndrome (ARDS) is a major cause of acute respiratory failure. Its development leads to high rates of mortality, as well as short- and long-term complications, such as physical and cognitive impairment. Therefore, early recognition of this syndrome and application of demonstrated therapeutic interventions are essential to change the natural course of this devastating entity. In this review article, we describe updated concepts in ARDS. Specifically, we discuss t...

  4. Acute Respiratory Distress Syndrome.

    Yadam, Suman; Bihler, Eric; Balaan, Marvin

    2016-01-01

    Acute respiratory distress syndrome (ARDS) is a serious inflammatory disorder with high mortality. Its main pathologic mechanism seems to result from increased alveolar permeability. Its definition has also changed since first being described according to the Berlin definition, which now classifies ARDS on a severity scale based on PaO2 (partial pressure of oxygen, arterial)/FIO2 (fraction of inspired oxygen) ratio. The cornerstone of therapy was found to be a low tidal volume strategy featuring volumes of 6 to 8 mL per kg of ideal body weight that has been shown to have decreased mortality as proven by the ARDSnet trials. There are other areas of treatment right now that include extracorporeal membrane oxygenation, as well for severe refractory hypoxemia. Other methods that include prone positioning for ventilation have also shown improvements in oxygenation. Positive end-expiratory pressure with lung recruitment maneuvers has also been found to be helpful. Other therapies that include vasodilators and neuromuscular agents are still being explored and need further studies to define their role in ARDS. PMID:26919679

  5. Pathobiology of acute respiratory distress syndrome.

    Sapru, Anil; Flori, Heidi; Quasney, Michael W; Dahmer, Mary K

    2015-06-01

    The unique characteristics of pulmonary circulation and alveolar-epithelial capillary-endothelial barrier allow for maintenance of the air-filled, fluid-free status of the alveoli essential for facilitating gas exchange, maintaining alveolar stability, and defending the lung against inhaled pathogens. The hallmark of pathophysiology in acute respiratory distress syndrome is the loss of the alveolar capillary permeability barrier and the presence of protein-rich edema fluid in the alveoli. This alteration in permeability and accumulation of fluid in the alveoli accompanies damage to the lung epithelium and vascular endothelium along with dysregulated inflammation and inappropriate activity of leukocytes and platelets. In addition, there is uncontrolled activation of coagulation along with suppression of fibrinolysis and loss of surfactant. These pathophysiological changes result in the clinical manifestations of acute respiratory distress syndrome, which include hypoxemia, radiographic opacities, decreased functional residual capacity, increased physiologic deadspace, and decreased lung compliance. Resolution of acute respiratory distress syndrome involves the migration of cells to the site of injury and re-establishment of the epithelium and endothelium with or without the development of fibrosis. Most of the data related to acute respiratory distress syndrome, however, originate from studies in adults or in mature animals with very few studies performed in children or juvenile animals. The lack of studies in children is particularly problematic because the lungs and immune system are still developing during childhood and consequently the pathophysiology of pediatric acute respiratory distress syndrome may differ in significant ways from that seen in acute respiratory distress syndrome in adults. This article describes what is known of the pathophysiologic processes of pediatric acute respiratory distress syndrome as we know it today while also presenting the much

  6. Pharmacotherapy of Acute Lung Injury and Acute Respiratory Distress Syndrome

    Raghavendran, Krishnan; Pryhuber, Gloria S.; Chess, Patricia R.; Davidson, Bruce A.; Paul R. Knight; Notter, Robert H.

    2008-01-01

    Acute lung injury (ALI) and the acute respiratory distress syndrome (ARDS) are characterized by rapid-onset respiratory failure following a variety of direct and indirect insults to the parenchyma or vasculature of the lungs. Mortality from ALI/ARDS is substantial, and current therapy primarily emphasizes mechanical ventilation and judicial fluid management plus standard treatment of the initiating insult and any known underlying disease. Current pharmacotherapy for ALI/ARDS is not optimal, a...

  7. Surfactant treatment for acute respiratory distress syndrome

    Lopez-Herce, J.; de Lucas, N; Carrillo, A.; Bustinza, A.; Moral, R.

    1999-01-01

    OBJECTIVE—To determine prospectively the efficacy of surfactant in acute respiratory distress syndrome.
STUDY DESIGN—Twenty patients, 1 month to 16 years of age, diagnosed with an acute pulmonary disease with severe hypoxaemia (PaO2/FiO2 < 100) (13 with systemic or pulmonary disease and seven with cardiac disease) were treated with one to six doses of 50-200 mg/kg of porcine surfactant administered directly into the trachea. The surfactant was considered to be effectiv...

  8. Acute respiratory failure following ovarian hyperstimulation syndrome

    Antonello Nicolini

    2013-03-01

    Full Text Available Ovarian hyperstimulation syndrome is a serious and potentially life-threatening physiological complication that may be encountered in patients who undergo controlled ovarian hyperstimulation cycles. The syndrome is typically associated with regimes of exogenous gonadotropins, but it can be seen, albeit rarely, when clomiphene is administered during the induction phase. Although this syndrome is widely described in scientific literature and is well known by obstetricians, the knowledge of this pathological and potentially life-threatening condition is generally less than satisfactory among physicians. The dramatic increase in therapeutic strategies to treat infertility has pushed this condition into the realm of acute care therapy. The potential complications of this syndrome, including pulmonary involvement, should be considered and identified so as to allow a more appropriate diagnosis and management. We describe a case of a woman with an extremely severe (Stage 6 ovarian hyperstimulation syndrome who presented ascites, bilateral pleural effusion and severe respiratory failure treated with non-invasive ventilation. The patient was admitted to the intensive care unit because of severe respiratory failure, ascites, and bilateral pleural effusion due to ovarian hyperstimulation syndrome. Treatment included non-invasive ventilation and three thoracentesis procedures, plus the administration of albumin, colloid solutions and high-dose furosemid. Severe form of ovarian hyperstimulation syndrome is observed in 0.5-5% of the women treated, and intensive care may be required for management of thromboembolic complications, renal failure and severe respiratory failure. Pulmonary intensive care may involve thoracentesis, oxygen supplementation and, in more severe cases, assisted ventilation. To our knowledge, there have been only two studies in English language medical literature that describe severe respiratory failure treated with non

  9. Progress and perspectives in pediatric acute respiratory distress syndrome

    Rotta, Alexandre Tellechea; Piva, Jefferson Pedro; Andreolio, Cinara; de Carvalho, Werther Brunow; Garcia, Pedro Celiny Ramos

    2015-01-01

    Acute respiratory distress syndrome is a disease of acute onset characterized by hypoxemia and infiltrates on chest radiographs that affects both adults and children of all ages. It is an important cause of respiratory failure in pediatric intensive care units and is associated with significant morbidity and mortality. Nevertheless, until recently, the definitions and diagnostic criteria for acute respiratory distress syndrome have focused on the adult population. In this article, we review the evolution of the definition of acute respiratory distress syndrome over nearly five decades, with a special focus on the new pediatric definition. We also discuss recommendations for the implementation of mechanical ventilation strategies in the treatment of acute respiratory distress syndrome in children and the use of adjuvant therapies. PMID:26331971

  10. Pathogenesis of severe acute respiratory syndrome

    ZHANG Ding-mei; LU Jia-hai; ZHONG Nan-shan

    2008-01-01

    Severe acute respiratory syndrome (SARS) first emerged in Guangdong province,China in November2002.During the following 3 months,it spread rapidly across the world,resulting in approximately 800 deaths.In 2004,subsequent sporadic cases emerged in Singapore and China.A novel coronavims,SARS-CoV,was identified as the etiological agent of SARS.1,2 This virus belongs to a family of large,positive,single-stranded RNA viruses.Nevertheless,genomic characterization shows that the SARS-CoV is only moderately related to other known coronaviruses.3 In contrast with previously described coronaviruses,SARS-CoV infection typically causes severe symptoms related to the lower respiratory tract.The SARS-CoV genome includes 14 putative open reading frames encoding 28 potential proteins,and the functions of many of these proteins are not known.4 A number of complete and partial autopsies of SARS patients have been reported since the first outbreak in 2003.The predominant pathological finding in these cases was diffuse alveolar damage (DAD).This severe pulmonary injury of SARS patients is caused both by direct viral effects and immunopathogenetic factors.5 Many important aspects of the pathogenesis of SARS have not yet been fully clarified.In this article,we summarize the most important mechanisms involved in the complex pathogenesis of SARS,including clinical characters,host and receptors,immune system response and genetic factors.

  11. Acute respiratory distress syndrome: Pulmonary and extrapulmonary not so similar

    Inderpaul Singh Sehgal; Sahajal Dhooria; Digambar Behera; Ritesh Agarwal

    2016-01-01

    Acute respiratory distress syndrome (ARDS) is characterized by acute onset respiratory failure with bilateral pulmonary infiltrates and hypoxemia. Current evidence suggests different respiratory mechanics in pulmonary ARDS (ARDSp) and extrapulmonary ARDS (ARDSexp) with disproportionate decrease in lung compliance in the former and chest wall compliance in the latter. Herein, we report two patients of ARDS, one each with ARDSp and ARDSexp that were managed using real-time esophageal pressure m...

  12. Acute respiratory distress syndrome: epidemiology and management approaches

    Walkey AJ

    2012-07-01

    Full Text Available Allan J Walkey,1 Ross Summer,1 Vu Ho,1 Philip Alkana21The Pulmonary Center, Boston University School of Medicine, Boston, MA, USA; 2Asthma Research Center, Brigham and Women's Hospital, Boston, MA, USAAbstract: Acute lung injury and the more severe acute respiratory distress syndrome represent a spectrum of lung disease characterized by the sudden onset of inflammatory pulmonary edema secondary to myriad local or systemic insults. The present article provides a review of current evidence in the epidemiology and treatment of acute lung injury and acute respiratory distress syndrome, with a focus on significant knowledge gaps that may be addressed through epidemiologic methods.Keywords: acute lung injury, acute respiratory distress syndrome, review, epidemiology

  13. Acute respiratory distress syndrome in an alpaca cria

    Simpson, Katharine M.; Streeter, Robert N.; Genova, Suzanne G.

    2011-01-01

    A 7-hour-old alpaca was presented for lethargy and depression. The cria responded favorably to initial treatment but developed acute-onset dyspnea 48 hours later. Acute respiratory distress syndrome was diagnosed by thoracic imaging and blood gas analysis. The cria was successfully treated with corticosteroids and discharged from the hospital.

  14. Aerosolized prostacyclin for acute lung injury (ALI) and acute respiratory distress syndrome (ARDS)

    Afshari, Arash; Brok, Jesper; Møller, Ann;

    2010-01-01

    Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are critical conditions that are associated with high mortality and morbidity. Aerosolized prostacyclin has been used to improve oxygenation despite the limited evidence available so far....

  15. Aerosolized prostacyclin for acute lung injury (ALI) and acute respiratory distress syndrome (ARDS)

    Afshari, Arash; Brok, Jesper; Møller, Ann;

    2010-01-01

    Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are critical conditions that are associated with high mortality and morbidity. Aerosolized prostacyclin has been used to improve oxygenation despite the limited evidence available so far.......Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are critical conditions that are associated with high mortality and morbidity. Aerosolized prostacyclin has been used to improve oxygenation despite the limited evidence available so far....

  16. The acute respiratory distress syndrome: from mechanism to translation

    Han, SeungHye; Mallampalli, Rama K.

    2015-01-01

    The acute respiratory distress syndrome (ARDS) is a form of severe hypoxemic respiratory failure characterized by inflammatory injury to the alveolar capillary barrier with extravasation of protein-rich edema fluid into the airspace. Although many modalities have been investigated to treat ARDS for the past several decades, supportive therapies still remain the mainstay of treatment. Here, we briefly review the definition, epidemiology and pathophysiology of ARDS. Next, we present emerging as...

  17. Consensus for the manaegment of severe acute respiratory syndrome

    Chinese Medical Association,China Association of C

    2003-01-01

    @@ INTRODUCTION Since recognition of the first case of sever acute respiratory syndrome (SARS) in Guangdong Province in November 2002,health care worker engaged in basic medicine,clinical medicine and preventive progress in the understanding of the etiology,epidemiology,diagnosis,treatment and prevention of SARS.

  18. Acute respiratory distress syndrome--two decades later.

    Cunningham, A. J.

    1991-01-01

    Twenty years have now elapsed since Ashbaugh and Petty first described the syndrome of acute respiratory failure associated with a wide spectrum of clinical conditions. During the past two decades, significant advances have emerged in our understanding of the clinical conditions associated with the syndrome and the pathophysiological changes affecting the alveolar-capillary membrane responsible for the characteristic non-cardiogenic pulmonary edema. Recent data have reaffirmed the notion that...

  19. Non-invasive versus invasive mechanical ventilation for respiratory failure in severe acute respiratory syndrome

    Loretta YC Yam; Alfred YF Chan; Thomas MT Cheung; Eva LH Tsui; Jane CK Chan; Vivian CW Wong

    2005-01-01

    Background Severe acute respiratory syndrome is frequently complicated by respiratory failure requiring ventilatory support. We aimed to compare the efficacy of non-invasive ventilation against invasive mechanical ventilation treating respiratory failure in this disease. Methods Retrospective analysis was conducted on all respiratory failure patients identified from the Hong Kong Hospital Authority Severe Acute Respiratory Syndrome Database. Intubation rate, mortality and secondary outcome of a hospital utilizing non-invasive ventilation under standard infection control conditions (NIV Hospital) were compared against 13 hospitals using solely invasive ventilation (IMV Hospitals). Multiple logistic regression analyses with adjustments for confounding variables were performed to test for association between outcomes and hospital groups. Results Both hospital groups had comparable demographics and clinical profiles, but NIV Hospital (42 patients) had higher lactate dehydrogenase ratio and worse radiographic score on admission and ribavirin-corticosteroid commencement. Compared to IMV Hospitals (451 patients), NIV Hospital had lower adjusted odds ratios for intubation (0.36, 95% CI 0.164-0.791, P=0.011) and death (0.235, 95% CI 0.077-0.716, P=0.011), and improved earlier after pulsed steroid rescue. There were no instances of transmission of severe acute respiratory syndrome among health care workers due to the use of non-invasive ventilation.Conclusion Compared to invasive mechanical ventilation, non-invasive ventilation as initial ventilatory support for acute respiratory failure in the presence of severe acute respiratory syndrome appeared to be associated with reduced intubation need and mortality.

  20. Message concerning Severe Acute Respiratory Syndrome ("SARS")

    2003-01-01

    IMPORTANT REMINDER If you have just come back from one of the regions identified by the WHO as being infected with SARS, it is essential to monitor your state of health for ten days after your return. The syndrome manifests itself in the rapid onset of a high fever combined with respiratory problems (coughing, breathlessness, breathing difficulty). Should these signs appear, you must contact the CERN Medical Service as quickly as possible on number 73802 or 73186 during normal working hours, and the fire brigade at all other times on number 74444, indicating that you have just returned from one of the WHO-identified areas with recent local transmission.China: Beijing, Hong Kong (Special Administrative Region), Guangdong Province, Inner Mongolia, Shanxi Province, Tianjin ProvinceTaiwan:TaipeiMoreover, until further notice the CERN Management requests that all trips to these various regions of the world be reduced to a strict minimum and then only with the consent of the Division Leader concerned. Anyone comin...

  1. Serum biomarkers in Acute Respiratory Distress Syndrome an ailing prognosticator

    Pneumatikos Ioannis

    2005-06-01

    Full Text Available Abstract The use of biomarkers in medicine lies in their ability to detect disease and support diagnostic and therapeutic decisions. New research and novel understanding of the molecular basis of the disease reveals an abundance of exciting new biomarkers who present a promise for use in the everyday clinical practice. The past fifteen years have seen the emergence of numerous clinical applications of several new molecules as biologic markers in the research field relevant to acute respiratory distress syndrome (translational research. The scope of this review is to summarize the current state of knowledge about serum biomarkers in acute lung injury and acute respiratory distress syndrome and their potential value as prognostic tools and present some of the future perspectives and challenges.

  2. Surfactant alteration and replacement in acute respiratory distress syndrome

    Walmrath Dieter; Grimminger Friedrich; Markart Philipp; Schmidt Reinhold; Ruppert Clemens; Günther Andreas; Seeger Werner

    2001-01-01

    Abstract The acute respiratory distress syndrome (ARDS) is a frequent, life-threatening disease in which a marked increase in alveolar surface tension has been repeatedly observed. It is caused by factors including a lack of surface-active compounds, changes in the phospholipid, fatty acid, neutral lipid, and surfactant apoprotein composition, imbalance of the extracellular surfactant subtype distribution, inhibition of surfactant function by plasma protein leakage, incorporation of surfactan...

  3. Acute Respiratory Distress Syndrome: Pathophysiology and Therapeutic Options

    Pierrakos, Charalampos; Karanikolas, Menelaos; Scolletta, Sabino; Karamouzos, Vasilios; Velissaris, Dimitrios

    2012-01-01

    Acute Respiratory Distress Syndrome (ARDS) is a common entity in critical care. ARDS is associated with many diagnoses, including trauma and sepsis, can lead to multiple organ failure and has high mortality. The present article is a narrative review of the literature on ARDS, including ARDS pathophysiology and therapeutic options currently being evaluated or in use in clinical practice. The literature review covers relevant publications until January 2011. Recent developments in the therapeut...

  4. Scrub Typhus with Sepsis and Acute Respiratory Distress Syndrome

    Kurup, Asok; Issac, Aneesh; Loh, Jin Phang; Lee, Too Bou; Chua, Robert; Bist, Pradeep; Chao, Chien-Chung; Lewis, Michael; Gubler, Duane J.; Ching, Wei Mei; Ooi, Eng Eong; Sukumaran, Bindu

    2013-01-01

    Scrub typhus is a major infectious threat in the Asia-Pacific region. We report an unusual case of scrub typhus in a patient in Singapore who presented with sepsis and acute respiratory distress syndrome but lacked the pathognomonic eschar. The patient recovered after appropriate diagnosis and doxycycline treatment. Rickettsial diseases should be included in the differential diagnosis of febrile illnesses in regions where the diseases are endemic, and absence of eschar should not be the crite...

  5. Extracorporeal life support for acute respiratory distress syndromes

    Don Hayes; Joseph D Tobias; Jasleen Kukreja; Preston, Thomas J.; Yates, Andrew R; Stephen Kirkby; Whitson, Bryan A.

    2013-01-01

    The morbidity and mortality of acute respiratory distress syndrome remain to be high. Over the last 50 years, the clinical management of these patients has undergone vast changes. Significant improvement in the care of these patients involves the development of mechanical ventilation strategies, but the benefits of these strategies remain controversial. With a growing trend of extracorporeal support for critically ill patients, we provide a historical review of extracorporeal membrane oxygena...

  6. The Current Care for Acute Respiratory Distress Syndrome

    Kawamae, Kaneyuki; Iseki, Ken

    2003-01-01

    The mortality rate of acute respiratory distress syndrome (ARDS) has been still high. A many kinds of strategies for ARDS are being tried in the world. The important factors which influence for pathological-physiology of ARDS during the mechanical ventilation are gravity consolidation, atelectasis, and ventilator induced lung injury (VILI). VILI is caused by shear stress that is induced by the repeated collapse and recruit of alveolus. Alveolar over-distention caused by large tidal volume als...

  7. Acute respiratory distress syndrome associated with severe ulcerative colitis

    Shiho; Sagara; Yasuo; Horie; Yumiko; Anezaki; Hideaki; Miyazawa; Masahiro; Iizuka

    2010-01-01

    Various extraintestinal manifestations including pulmonary abnormalities have been reported in patients with ulcerative colitis. Acute respiratory distress syndrome (ARDS) is a serious and fatal pulmonary manifestation. We have experienced a 67-year-old male patient with ARDS associated with a severe type of ulcerative colitis (UC). Severe dyspnea symptoms occurred during the treatment of UC in a previous hospital and the patient was transferred to our hospital on June 27, 2007. Both blood and sputa culture...

  8. Anti-infectious treatment in acute respiratory distress syndrome

    Gao, Min; Xiao, Zhen-Liang; Fu-xiang LI

    2013-01-01

    Acute respiratory distress syndrome (ARDS) is closely correlated with infection. Severe infection, e.g., sepsis and septic shock, can result in ARDS. Ventilator associated pneumonia (VAP) is one of the common complications in ARDS related infection. As regards ARDS related infection, community acquired infection (CAI) is different from hospital acquired infection (HAI) in bacterial spectrum. The former is mainly caused by Streptococcus pneumonia, Hemophilus influenzae, Moraxelle catarrhalis, ...

  9. Severe Acute Respiratory Syndrome: Clinical and Laboratory Manifestations

    Lam, Christopher W.K.; Chan, Michael H M; Wong, Chun K.

    2004-01-01

    Severe acute respiratory syndrome (SARS) is a recently emerged infectious disease with significant morbidity and mortality. An epidemic in 2003 affected 8,098 patients in 29 countries with 774 deaths. The aetiological agent is a new coronavirus spread by droplet transmission. Clinical and general laboratory manifestations included fever, chills, rigor, myalgia, malaise, diarrhoea, cough, dyspnoea, pneumonia, lymphopenia, neutrophilia, thrombocytopenia, and elevated serum lactate dehydrogenase...

  10. Extracorporeal life support for acute respiratory distress syndromes

    Don Hayes

    2013-01-01

    Full Text Available The morbidity and mortality of acute respiratory distress syndrome remain to be high. Over the last 50 years, the clinical management of these patients has undergone vast changes. Significant improvement in the care of these patients involves the development of mechanical ventilation strategies, but the benefits of these strategies remain controversial. With a growing trend of extracorporeal support for critically ill patients, we provide a historical review of extracorporeal membrane oxygenation (ECMO including its failures and successes as well as discussing extracorporeal devices now available or nearly accessible while examining current clinical indications and trends of ECMO in respiratory failure.

  11. Early Treatment of Severe Acute Respiratory Distress Syndrome.

    Przybysz, Thomas M; Heffner, Alan C

    2016-02-01

    Acute respiratory distress syndrome (ARDS) is defined by acute diffuse inflammatory lung injury invoked by a variety of systemic or pulmonary insults. Despite medical progress in management, mortality remains 27% to 45%. Patients with ARDS should be managed with low tidal volume ventilation. Permissive hypercapnea is well tolerated. Conservative fluid strategy can reduce ventilator and hospital days in patients without shock. Prone positioning and neuromuscular blockers reduce mortality in some patients. Early management of ARDS is relevant to emergency medicine. Identifying ARDS patients who should be transferred to an extracorporeal membrane oxygenation center is an important task for emergency providers. PMID:26614238

  12. Acute respiratory distress syndrome assessment after traumatic brain injury

    Shahrooz Kazemi

    2016-01-01

    Full Text Available Background: Acute respiratory distress syndrome (ARDS is one of the most important complications associated with traumatic brain injury (TBI. ARDS is caused by inflammation of the lungs and hypoxic damage with lung physiology abnormalities associated with acute respiratory distress syndrome. Aim of this study is to determine the epidemiology of ARDS and the prevalence of risk factors. Methods: This prospective study performed on patients with acute traumatic head injury hospitalization in the intensive care unit of the Shohaday-e Haftom-e-Tir Hospital (September 2012 to September 2013 done. About 12 months, the data were evaluated. Information including age, sex, education, employment, drug and alcohol addiction, were collected and analyzed. The inclusion criteria were head traumatic patients and exclusion was the patients with chest trauma. Questionnaire was designed with doctors supervision of neurosurgery. Then the collected data were analysis. Results: In this study, the incidence of ARDS was 23.8% and prevalence of metabolic acidosis was 31.4%. Most injury with metabolic acidosis was Subarachnoid hemorrhage (SAH 48 (60% and Subdural hemorrhage (SDH was Next Level with 39 (48% Correlation between Glasgow Coma Scale (GCS and Respiratory Distress Syndrome (ARDS were significantly decreased (P< 0.0001. The level of consciousness in patients with skull fractures significantly lower than those without fractures (P= 0.009 [(2.3±4.6 vs (4.02±7.07]. Prevalence of metabolic acidosis during hospitalization was 80 patients (31.4%. Conclusion: Acute respiratory distress syndrome is a common complication of traumatic brain injury. Management and treatment is essential to reduce the mortality. In this study it was found the age of patients with ARDS was higher than patients without complications. ARDS risk factor for high blood pressure was higher in men. Most victims were pedestrians. The most common injury associated with ARDS was SDH. Our analysis

  13. Acute pancreatitis and acute respiratory distress syndrome complicating dengue haemorrhagic fever

    Agrawal, Avinash; Jain, Nirdesh; Gutch, Manish; Shankar, Amit

    2011-01-01

    Dengue infection is now known to present with wide spectrum of complications. Isolated cases of acute pancreatitis complicating dengue haemorrhagic fever have been reported in literature. Here the authors report a case of dengue haemorrhagic fever that develops acute pancreatitis and presented with acute onset of breathlessness, which then progressed to full-blown acute respiratory distress syndrome. To our knowledge, this is the first reported case of dengue haemorrhagic fever complicated wi...

  14. Control dynamics of severe acute respiratory syndrome transmission

    WANG Haiying; RONG Feng; KE Fujiu; BAI Yilong

    2003-01-01

    Severe acute respiratory syndrome (SARS) is a serious disease with many puzzling features. We present a simple, dynamic model to assess the epidemic potential of SARS and the effectiveness of control measures. With this model, we analysed the SARS epidemic data in Beijing. The data fitting gives the basic case reproduction number of 2.16 leading to the outbreak, and the variation of the effective reproduction number reflecting the control effect. Noticeably, our study shows that the response time and the strength of control measures have significant effects on the scale of the outbreak and the lasting time of the epidemic.

  15. Small molecules targeting severe acute respiratory syndrome human coronavirus

    Wu, Chung-Yi; Jan, Jia-Tsrong; Ma, Shiou-Hwa; Kuo, Chih-Jung; Juan, Hsueh-Fen; Cheng, Yih-Shyun E; Hsu, Hsien-Hua; Huang, Hsuan-Cheng; Wu, Douglass; Brik, Ashraf; Liang, Fu-Sen; Liu, Rai-Shung; Fang, Jim-Min; Chen, Shui-Tein; Liang, Po-Huang

    2004-01-01

    Severe acute respiratory syndrome (SARS) is an infectious disease caused by a novel human coronavirus. Currently, no effective antiviral agents exist against this type of virus. A cell-based assay, with SARS virus and Vero E6 cells, was developed to screen existing drugs, natural products, and synthetic compounds to identify effective anti-SARS agents. Of >10,000 agents tested, ≈50 compounds were found active at 10 μM; among these compounds, two are existing drugs (Reserpine 13 and Aescin 5) ...

  16. Role of Ventilation in Cases of Acute Respiratory Distress Syndrome /Acute Lung injury

    Hemant M Shah; Shilpa B Sutariya; Parul M Bhatt; Nishil Shah; Shweta Gamit

    2014-01-01

    Introduction: Acute lung injury (ALI) and Acute Respiratory Distress Syndrome (ARDS) are characterized by refractory hypoxemia that develops secondary to high-permeability pulmonary edema. These syndromes are gaining more attention as a means of better comprehending the pathophysiology of ARDS and possiblyfor modifying ventilatory management. In this context a study was done to compare role of invasive and non-invasive ventilation in cases of ARDS/ALI. Methods: in this study patients of AR...

  17. Clinical and radiological analysis of severe acute respiratory syndrome

    Objective: To study the X-ray features of severe acute respiratory syndrome (SARS). Methods: The clinical data and X-ray appearances of 29 cases with SARS were analyzed retrospectively. Results: Epidemic outbreak of SARS has occurred at this area. 29 cases of SARS in this group began with a fever. 15 cases (51.7%) experienced mild respiratory symptoms. In 10 patients (34.5%) the antibacterial medication showed inefficacy before hospitalization. Leucocyte counting was normal in 18 cases (62.1%) and decreased in 11 cases (37.9%). Platelet counting slightly decreased in 7 cases (24.1%). Hepatic function test was abnormal in 16 patients (55.2%), mostly with a decrease of serum enzymology. Obvious abnormalities were seen on the chest films, which were in sharp contrast with the mild clinical respiratory signs. Chest X-ray findings were as follows: Exaggerated and indistinct lung markings with reticular shadow in 7 cases (24.1%), ground-glass opacity in 3 cases (10.4%), small patchy and multi-patchy imaging in 12 cases (41.4%), and large patchy shadow in 7 cases (24.1%). X-ray abnormality was presented later and absorbed slower. Conclusion: SARS carries a variety of X-ray appearances. The combined use of epidemiologic history, clinical situation, laboratory tests, and imaging examinations can make a definite diagnosis

  18. Association of alveolar recruitment maneuvers and prone position in acute respiratory disease syndrome patients.

    Costa, Daniela Caetano; Rocha, Eduardo; Ribeiro, Tatiane Flores

    2009-06-01

    The acute respiratory distress syndrome is the clinical presentation of acute lung injury characterized by diffuse alveolar damage and development of non-cardiogenic pulmonary edema due to increased pulmonary alveolar-capillary membrane permeability. Alveolar recruitment maneuvers and prone position can be used in the treatment of acute respiratory distress syndrome. The objective of this review of literature was to identify possible benefits, indications, complications and care of the associated recruitment maneuvers and prone position for treatment of the acute respiratory distress syndrome. This national and international scientific literature review was developed according to the established criteria for searching the databases MedLine, LILACS, SciElo, PubMed, Cochrane, from 1994 to 2008 in Portuguese and English, with the key words: acute respiratory distress syndrome, alveolar recruitment maneuver and prone position. Despite advances in the understanding of acute respiratory distress syndrome pathophysiology, mortality is still expressive. Alveolar recruitment maneuvers and prone position significantly contribute to treatment of acute respiratory distress syndrome patient aiming to improve oxygenation and minimizing complications of refractory hypoxemia and reduction of pulmonary compliance. However,as there are few studies in literature associating alveolar recruitment maneuvers and prone position for treatment of acute respiratory distress syndrome, additional research and evidences of clinical application are required. PMID:25303351

  19. Anti-infectious treatment in acute respiratory distress syndrome

    Min GAO

    2013-02-01

    Full Text Available Acute respiratory distress syndrome (ARDS is closely correlated with infection. Severe infection, e.g., sepsis and septic shock, can result in ARDS. Ventilator associated pneumonia (VAP is one of the common complications in ARDS related infection. As regards ARDS related infection, community acquired infection (CAI is different from hospital acquired infection (HAI in bacterial spectrum. The former is mainly caused by Streptococcus pneumonia, Hemophilus influenzae, Moraxelle catarrhalis, atypical pathogens and Klebsiella pneumoniae. However, HAI is mainly caused by Pseudomonas aeruginosa, Acinetobacter baumanii, methicillin-resistant Staphylococcus aureus(MRSA, and other drug-resistant bacteria. The drug-resistant bacterial infection not only makes treatment difficult, but also leads to an increase in mechanical ventilation time, length of ICU stay, mortality rate, and medical costs. The present paper has reviewed the relationship between ARDS and infection, therapeutic principles and measures of ARDS related infection, and introduced the optimal strategy of anti-infectious treatment of ARDS.

  20. Inhaled nitric oxide for acute respiratory distress syndrome (ARDS) and acute lung injury in children and adults

    Afshari, Arash; Brok, Jesper; Møller, Ann;

    2010-01-01

    Acute hypoxaemic respiratory failure (AHRF), defined as acute lung injury (ALI) and acute respiratory distress syndrome (ARDS), are critical conditions. AHRF results from a number of systemic conditions and is associated with high mortality and morbidity in all ages. Inhaled nitric oxide (INO) has...

  1. Pediatric Acute Respiratory Distress Syndrome: Fibrosis versus Repair.

    Im, Daniel; Shi, Wei; Driscoll, Barbara

    2016-01-01

    Clinical and basic experimental approaches to pediatric acute lung injury (ALI), including acute respiratory distress syndrome (ARDS), have historically focused on acute care and management of the patient. Additional efforts have focused on the etiology of pediatric ALI and ARDS, clinically defined as diffuse, bilateral diseases of the lung that compromise function leading to severe hypoxemia within 7 days of defined insult. Insults can include ancillary events related to prematurity, can follow trauma and/or transfusion, or can present as sequelae of pulmonary infections and cardiovascular disease and/or injury. Pediatric ALI/ARDS remains one of the leading causes of infant and childhood morbidity and mortality, particularly in the developing world. Though incidence is relatively low, ranging from 2.9 to 9.5 cases/100,000 patients/year, mortality remains high, approaching 35% in some studies. However, this is a significant decrease from the historical mortality rate of over 50%. Several decades of advances in acute management and treatment, as well as better understanding of approaches to ventilation, oxygenation, and surfactant regulation have contributed to improvements in patient recovery. As such, there is a burgeoning interest in the long-term impact of pediatric ALI/ARDS. Chronic pulmonary deficiencies in survivors appear to be caused by inappropriate injury repair, with fibrosis and predisposition to emphysema arising as irreversible secondary events that can severely compromise pulmonary development and function, as well as the overall health of the patient. In this chapter, the long-term effectiveness of current treatments will be examined, as will the potential efficacy of novel, acute, and long-term therapies that support repair and delay or even impede the onset of secondary events, including fibrosis. PMID:27066462

  2. Fibromyalgia after severe acute respiratory syndrome: a case report

    TIAN Xin-ping; ZENG Xiao-feng; XU Wen-bin

    2006-01-01

    @@ Since November 2002, an infectious disease with unknown cause occurred in China and many countries had been involved. Cases were reported in 28 countries and more than 5050 individuals had been infected.1 Lung is the most frequently involved organ and can be fatal in severe cases. At the end of February 2003, it was defined as Severe Acute Respiratory Syndrome (SARS) by World Health Organization. China had a SARS epidemic in the spring of 2003. More than 1000 patients were infected and some patients died of respiratory failure.Finally, a new variant of coronavirus was suspected to be the pathogen although the pathogenesis was still unclear. Since it is a new disease and we have very limited knowledge about its clinical sequela, we followed the survived patients closely in order to understand it in depth. During the follow up, we discovered an interesting patient who was finally diagnosed as fibromyalgia. We report this case herein to share our experience with clinicians who may see patients with SARS or fibromyalgia.

  3. Epidemiology of severe acute respiratory syndrome (SARS): adults and children.

    Zhong, Nan-Shan; Wong, Gary W K

    2004-12-01

    Severe acute respiratory syndrome (SARS) is a newly described respiratory infection with pandemic potential. The causative agent is a new strain of coronavirus most likely originating from wild animals. This disease first emerged in November 2002 in Guangdong Province, China. Early in the outbreak the infection had been transmitted primarily via household contacts and healthcare settings. In late February 2003 the infection was transmitted to Hong Kong when an infected doctor from the mainland visited there. During his stay in Hong Kong at least 17 guests and visitors were infected at the hotel at which he stayed. By modern day air travel, the infection was rapidly spread to other countries including Vietnam, Singapore and Canada by these infected guests. With the implementation of effective control strategies including early isolation of suspected cases, strict infection control measures in the hospital setting, meticulous contact tracing and quarantine, the outbreak was finally brought under control by July 2003. In addition, there were another two events of SARS in China between the end of December 2003 and January 2004 and from March to May 2004; both were readily controlled without significant patient spread. PMID:15531250

  4. Surfactant alteration and replacement in acute respiratory distress syndrome

    Walmrath Dieter

    2001-10-01

    Full Text Available Abstract The acute respiratory distress syndrome (ARDS is a frequent, life-threatening disease in which a marked increase in alveolar surface tension has been repeatedly observed. It is caused by factors including a lack of surface-active compounds, changes in the phospholipid, fatty acid, neutral lipid, and surfactant apoprotein composition, imbalance of the extracellular surfactant subtype distribution, inhibition of surfactant function by plasma protein leakage, incorporation of surfactant phospholipids and apoproteins into polymerizing fibrin, and damage/inhibition of surfactant compounds by inflammatory mediators. There is now good evidence that these surfactant abnormalities promote alveolar instability and collapse and, consequently, loss of compliance and the profound gas exchange abnormalities seen in ARDS. An acute improvement of gas exchange properties together with a far-reaching restoration of surfactant properties was encountered in recently performed pilot studies. Here we summarize what is known about the kind and severity of surfactant changes occuring in ARDS, the contribution of these changes to lung failure, and the role of surfactant administration for therapy of ARDS.

  5. Clinical features of probable severe acute respiratory syndrome in Beijing

    Hai-Ying Lu; Xiao-Yuan Xu; Yu Lei; Yang-Feng Wu; Bo-Wen Chen; Feng Xiao; Gao-Qiang Xie; De-Min Han

    2005-01-01

    AIM: To summarize clinical features of probable severe acute respiratory syndrome (SARS) in Beijing.METHODS: Retrospective cases involving 801 patients admitted to hospitals in Beijing between March and June 2003, with a diagnosis of probable SARS, moderate type.The series of clinical manifestation, laboratory and radiograph data obtained from 801 cases were analyzed. RESULTS: One to three days after the onset of SARS, the major clinical symptoms were fever (in 88.14% of patients), fatigue, headache, myalgia, arthralgia (25-36%), etc. The counts of WBC (in 22.56% of patients) lymphocyte (70.25%)and CD3, CD4, CD8 positive T cells (70%) decreased. From 4-7 d, the unspecific symptoms became weak; however, the rates of low respiratory tract symptoms, such as cough (24.18%), sputum production (14.26%), chest distress (21.04%) and shortness of breath (9.23%) increased, so did the abnormal rates on chest radiograph or CT. The low counts of WBC, lymphocyte and CD3, CD4, CD8 positiveT cells touched bottom. From 8 to 16 d, the patients presented progressive cough (29.96%), sputum production (13.09%), chest distress (29.96%) and shortness of breath (35.34%). All patients had infiltrates on chest radiograph or CT, some even with multi-infiltrates. Two weeks later, patients' respiratory symptoms started to alleviate, the infiltrates on the lung began to absorb gradually, the counts of WBC, lymphocyte and CD3, CD4, CD8 positive T cells were restored to normality.CONCLUSION: The data reported here provide evidence that the course of SARS could be divided into four stages, namely the initial stage, progressive stage, fastigium and convalescent stage.

  6. Acute respiratory distress syndrome (ARDS): HRCT findings in survivors

    Jung, Jung Im; Park, Seog Hee; Lee, Jae Mun; Song, Jeong Sup; Lee, Kyo Young [The Catholic Univ. College of Medicine, Seoul (Korea, Republic of)

    1999-08-01

    The purpose of this report is to describe the high-resolution computed tomography (HRCT) findings of the lung in survivors of acute respiratory distress syndrome (ARDS). Among eleven patients who survived ARDS for one year, chest radiography and HRCT revealed pulmonary fibrosis in four. Causes of ARDS included pneumonia during pregnancy, near drowning, pneumonia during liver cirrhosis, and postoperative sepsis. Thoracoscopic biopsy and histopathologic correlation were available in one patient. HRCT showed diffuse interlobular septal thickening, ground glass opacity, parenchymal distortion, and traction bronchiectasis. Fuzzy centrilobular nodules were seen in two patients and one patient had multiple, large bullae in the left hemithorax. In all patients, lesions affected the upper and anterior zones of the lung more prominently. The distribution of pulmonary fibrosis was characteristic and reflected the pathogenesis of lung injury; fibrosis was largely due to hyperoxia caused by ventilator care. In one patient, histopathologic correlation showed that imaging findings were accounted for by thickening of the alveolar septum along with infiltration of chronic inflammatory cells and fibrosis. Fuzzy centrilobular nodules corresponded with bronchiolitis.

  7. Current status of severe acute respiratory syndrome in China

    Qing-He Nie; Xin-Dong Luo; Jian-Zhong Zhang; Qin Su

    2003-01-01

    Severe acute respiratory syndrome (SARS), also called infectious atypical pneumonia, is an emerging infectious disease caused by a novel variant of coronavirus (SARS associated coronavirus, SARS-CoV). It is mainly characterized by pulmonary infection with a high infectivity and fatality.SARS is swept across almost all the continents of the globe, and has currently involved 33 countries and regions, including the mainland China, Hong Kong, Taiwan, North America and Europe. On June 30, 2003, an acumulative total reached 8450 cases with 810 deaths. SARS epidemic was very rampant in March, April and May 2003 in the mainland of China and Hong Kong. Chinese scientists and healthcare workers cooperated closely with other scientists from all over the world to fight the disease. On April 16, 2003, World Health Organization (WHO) formally declared that SARSCoV was an etiological agent of SARS. Currently, there is no specific and effective therapy and prevention method for SARS. The main treatments include corticosteroid therapy,antiviralagents, anti-infection, mechanical ventilation and isolation. This disease can be prevented and controlled, and it is also curable. Under the endeavor of the Chinese Government, medical staffs and other related professionals,SARS has been under control in China, and Chinese scientists have also made a great contribution to SARS research.Otherstudies in developing new detection assays and therapies, and discovering new drugs and vaccines are in progress. In this paper, we briefly review the current status of SARS in China.

  8. Pulmonary hypertension due to acute respiratory distress syndrome

    S.A. Ñamendys-Silva

    2014-10-01

    Full Text Available Our aims were to describe the prevalence of pulmonary hypertension in patients with acute respiratory distress syndrome (ARDS, to characterize their hemodynamic cardiopulmonary profiles, and to correlate these parameters with outcome. All consecutive patients over 16 years of age who were in the intensive care unit with a diagnosis of ARDS and an in situ pulmonary artery catheter for hemodynamic monitoring were studied. Pulmonary hypertension was diagnosed when the mean pulmonary artery pressure was >25 mmHg at rest with a pulmonary artery occlusion pressure or left atrial pressure <15 mmHg. During the study period, 30 of 402 critically ill patients (7.46% who were admitted to the ICU fulfilled the criteria for ARDS. Of the 30 patients with ARDS, 14 met the criteria for pulmonary hypertension, a prevalence of 46.6% (95% CI; 28-66%. The most common cause of ARDS was pneumonia (56.3%. The overall mortality was 36.6% and was similar in patients with and without pulmonary hypertension. Differences in patients' hemodynamic profiles were influenced by the presence of pulmonary hypertension. The levels of positive end-expiratory pressure and peak pressure were higher in patients with pulmonary hypertension, and the PaCO2 was higher in those who died. The level of airway pressure seemed to influence the onset of pulmonary hypertension. Survival was determined by the severity of organ failure at admission to the intensive care unit.

  9. Severe acute respiratory syndrome: vaccine on the way

    ZHANG Ding-mei; WANG Guo-ling; LU Jia-hai

    2005-01-01

    @@ In November 2002, a new disease-severe acute respiratory syndrome, or SARS-first emerged in Guangdong Province, China. Subsequently, it spread to more than 30 countries worldwide.1 The causative agent was identified to be a previously unknown member of the coronaviridae family, and was named SARS coronavirus (SARS-CoV). SARS coronavirus is a large, enveloped, positive-sense RNA virus. The genome is about 30 kb, which is predicted to contain 14 functional open reading frames (ORFs). Two large 5'-terminal ORFs (1a and 1b) encode the polymerases that are required for viral RNA synthesis. The remaining twelve ORFs encode four structural proteins [spike protein (S), envelope protein (E), membrane protein (M) and nucleocapsid protein (N)] and eight accessory proteins.2 Though the SARS-CoV genome is clear, a great deal more work will be required to develop an efficient vaccine and effective drugs. Neutralizing antibodies were detectable in the convalescent sera of SARS patients, and sera from recovered patients could be used to treat newly infected individuals.3 The data suggest that protective humoral immunity is achievable and that vaccines can be developed for prevention of SARS. In this article, we review and discuss progress towards development of a SARS vaccine.

  10. Fluid in the management of the acute respiratory distress syndrome

    Karki S

    2013-06-01

    Full Text Available Introduction Non-cardiogenic pulmonary edema is the hallmark of the acute respiratory distress syndrome (ARDS. The amount of fluid and which fluid should be used in these patients is controversial. Methods 43 patients with ARDS treated in the intensive care unit (ICU of the Second Hospital, Jilin University between November 1, 2011-November 1, 2012 were prospectively analyzed and was observational. Volume and the type of fluid administered were compared to 90 day mortality and the 24 and 72 hour sequential organ failure assessment (SOFA score, lactate level, oxygenation index (PaO2/FiO2, duration of ICU stay, total ventilator days, and need for continuous renal replacement therapy (CRRT. Results Mortality was increased when hydroxylethyl starch (HES was used in the first day or plasma substitutes were used during the first 3 days (P3000 ml during the first 24 hours or >8000 ml during the first 72 hours were associated with higher SOFA scores at 24 and 72 hours (P<0.05, both comparisons. Colloid, especially higher volume colloid use was also associated with increased SOFA scores at either 24 or 72 hours. Conclusions Limiting the use of colloids and the total amount of fluid administered to patients with ARDS is associated with improved mortality and SOFA scores.

  11. Lung tissue remodeling in the acute respiratory distress syndrome

    Souza Alba Barros de

    2003-01-01

    Full Text Available Acute respiratory distress syndrome (ARDS is characterized by diffuse alveolar damage, and evolves progressively with three phases: exsudative, fibroproliferative, and fibrotic. In the exudative phase, there are interstitial and alveolar edemas with hyaline membrane. The fibropro­liferative phase is characterized by exudate organization and fibroelastogenesis. There is proliferation of type II pneumocytes to cover the damaged epithelial surface, followed by differentiation into type I pneumocytes. The fibroproliferative phase starts early, and its severity is related to the patient?s prognosis. The alterations observed in the phenotype of the pulmonary parenchyma cells steer the tissue remodeling towards either progressive fibrosis or the restoration of normal alveolar architecture. The fibrotic phase is characterized by abnormal and excessive deposition of extracellular matrix proteins, mainly collagen. The dynamic control of collagen deposition and degradation is regulated by metalloproteinases and their tissular regulators. The deposition of proteoglycans in the extracellular matrix of ARDS patients needs better study. The regulation of extracellular matrix remodeling, in normal conditions or in several pulmonary diseases, such as ARDS, results from a complex mechanism that integrate the transcription of elements that destroy the matrix protein and produce activation/inhibition of several cellular types of lung tissue. This review article will analyze the ECM organization in ARDS, the different pulmonary parenchyma remodeling mechanisms, and the role of cytokines in the regulation of the different matrix components during the remodeling process.

  12. Acute Respiratory Distress Syndrome as the Initial Clinical Manifestation of an Antisynthetase Syndrome.

    Kim, Seo-Hyun; Park, I-Nae

    2016-07-01

    Antisynthetase syndrome has been recognized as an important cause of autoimmune inflammatory myopathy in a subset of patients with polymyositis and dermatomyositis. It is associated with serum antibody to aminoacyl-transfer RNA synthetases and is characterized by a constellation of manifestations, including fever, myositis, interstitial lung disease, mechanic's hand-like cutaneous involvement, Raynaud phenomenon, and polyarthritis. Lung disease is the presenting feature in 50% of the cases. We report a case of a 60-year-old female with acute respiratory distress syndrome (ARDS), which later proved to be an unexpected and initial manifestation of anti-Jo-1 antibody-positive antisynthetase syndrome. The present case showed resolution of ARDS after treatment with high-dose corticosteroids. Given that steroids are not greatly beneficial in the treatment of ARDS, it is likely that the improvement of the respiratory symptoms in this patient also resulted from the prompt suppression of the inflammatory systemic response by corticosteroids. PMID:27433180

  13. Ventilator-Induced Lung Injury (VILI) in Acute Respiratory Distress Syndrome (ARDS): Volutrauma and Molecular Effects

    Carrasco Loza, R; Villamizar Rodríguez, G; Medel Fernández, N

    2015-01-01

    Acute Respiratory Distress Syndrome (ARDS) is a clinical condition secondary to a variety of insults leading to a severe acute respiratory failure and high mortality in critically ill patients. Patients with ARDS generally require mechanical ventilation, which is another important factor that may increase the ALI (acute lung injury) by a series of pathophysiological mechanisms, whose common element is the initial volutrauma in the alveolar units, and forming part of an entity known clinically...

  14. The severe acute respiratory syndrome epidemic in mainland China dissected

    Wuchun Cao

    2011-02-01

    Full Text Available This paper provides a review of a recently published series of studies that give a detailed and comprehensive documentation of the severe acute respiratory syndrome (SARS epidemic in mainland China, which severely struck the country in the spring of 2003. The epidemic spanned a large geographical extent but clustered in two areas: first in Guangdong Province, and about 3 months later in Beijing with its surrounding areas. Reanalysis of all available epidemiological data resulted in a total of 5327 probable cases of SARS, of whom 343 died. The resulting case fatality ratio (CFR of 6.4% was less than half of that in other SARS-affected countries or areas, and this difference could only partly be explained by younger age of patients and higher number of community acquired infections. Analysis of the impact of interventions demonstrated that strong political commitment and a centrally coordinated response was the most important factor to control SARS in mainland China, whereas the most stringent control measures were all initiated when the epidemic was already dying down. The long-term economic consequence of the epidemic was limited, much consumption was merely postponed, but for Beijing irrecoverable losses to the tourist sector were considerable. An important finding from a cohort study was that many former SARS patients currently suffer from avascular osteo­necrosis, as a consequence of the treatment with corticosteroids during their infection. The SARS epidemic provided valuable information and lessons relevant in controlling outbreaks of newly emerging infectious diseases, and has led to fundamental reforms of the Chinese health system. In particular, a comprehensive nation-wide internet-based disease reporting system was established.

  15. Acute Respiratory Distress Syndrome and Outcomes after Near-hanging

    Mansoor, Sahar; Afshar, Majid; Barrett, Matthew; Smith, Gordon S.; Barr, Erik A.; Lissauer, Matthew E.; McCurdy, Michael T.; Murthi, Sarah B.; Netzer, Giora

    2015-01-01

    Purpose Assess the case rate of Acute Respiratory Distress Syndrome (ARDS) after near-hanging, and the secondary outcomes of traumatic and/or anoxic brain injury, and death. Risk factors for the outcomes were assessed. Method Single-center, state-wide retrospective cohort study of consecutive patients admitted between August, 2002, and September, 2011, with a primary diagnosis of non-judicial "hanging injury". Results Of 56 patients, 73% were male. The median age was 31 (IQR: 16–56). Upon arrival, 9% (5/56) did not have a pulse, and 23% (13/56) patients were intubated. The median Glasgow Coma Scale (GCS) was 13 (IQR: 3–15); 14% (8/56) had a GCS=3. ARDS developed in 9% (5/56) of patients. Traumatic anoxic brain injury resulted in 9% (5/56) of patients. The in-hospital case fatality was 5% (3/56). Lower median GCS [3 (IQR: 3–7) vs. 14 (IQR: 3–15), p=0.0003] and intubation in field or in trauma resuscitation unit [100% (5/5) vs. 16% (8/51), p=0.0003] were associated with ARDS development. Risk factors of death were GCS=3 [100% (3/3) vs. 9% (5/53), p=0.002]; pulselessness upon arrival of emergency medical services [100% (3/3) vs. 4% (2/53), p<0.001]; and abnormal neurologic imaging [50% (1/2) vs. zero, p=0.04]. Conclusions The ARDS case rate after near-hanging is similar to the general trauma population. Low GCS and intubation are associated with increased risk of ARDS development. The rate of traumatic and/or anoxic brain injury in this population is low. PMID:25596627

  16. Pros and cons of recruitment maneuvers in acute lung injury and acute respiratory distress syndrome.

    Rocco, Patricia R M; Pelosi, Paolo; de Abreu, Marcelo Gama

    2010-08-01

    In patients with acute lung injury and acute respiratory distress syndrome, a protective mechanical ventilation strategy characterized by low tidal volumes has been associated with reduced mortality. However, such a strategy may result in alveolar collapse, leading to cyclic opening and closing of atelectatic alveoli and distal airways. Thus, recruitment maneuvers (RMs) have been used to open up collapsed lungs, while adequate positive end-expiratory pressure (PEEP) levels may counteract alveolar derecruitment during low tidal volume ventilation, improving respiratory function and minimizing ventilator-associated lung injury. Nevertheless, considerable uncertainty remains regarding the appropriateness of RMs. The most commonly used RM is conventional sustained inflation, associated with respiratory and cardiovascular side effects, which may be minimized by newly proposed strategies: prolonged or incremental PEEP elevation; pressure-controlled ventilation with fixed PEEP and increased driving pressure; pressure-controlled ventilation applied with escalating PEEP and constant driving pressure; and long and slow increase in pressure. The efficiency of RMs may be affected by different factors, including the nature and extent of lung injury, capability of increasing inspiratory transpulmonary pressures, patient positioning and cardiac preload. Current evidence suggests that RMs can be used before setting PEEP, after ventilator circuit disconnection or as a rescue maneuver to overcome severe hypoxemia; however, their routine use does not seem to be justified at present. The development of new lung recruitment strategies that have fewer hemodynamic and biological effects on the lungs, as well as randomized clinical trials analyzing the impact of RMs on morbidity and mortality of acute lung injury/acute respiratory distress syndrome patients, are warranted. PMID:20658909

  17. Acute Respiratory Distress Syndrome is a TH17-like and Treg immune disease

    Hu, Wan-Chung

    2013-01-01

    Acute Respiratory Distress Syndrome (ARDS) is a very severe syndrome leading to respiratory failure and subsequent mortality. Sepsis is one of the leading causes of ARDS. Thus, extracellular bacteria play an important role in the pathophysiology of ARDS. Overactivated neutrophils are the major effector cells in ARDS. Thus, extracellular bacteria triggered TH17-like innate immunity with neutrophil activation might accounts for the etiology of ARDS. Here, microarray analysis was employed to des...

  18. [Role of computed tomography in the diagnosis of acute lung injury/acute respiratory distress syndrome].

    Mazzei, Maria Antonietta; Guerrini, Susanna; Cioffi Squitieri, Nevada; Franchi, Federico; Volterrani, Luca; Genovese, Eugenio Annibale; Macarini, Luca

    2012-11-01

    Acute lung injury/acute respiratory distress syndrome (ALI/ARDS) is a complex pulmonary pathology with high mortality rates, manifesting over a wide range of severity. Clinical diagnosis relies on the following 4 criteria stated by the American-European Consensus Conference: acute onset of impaired gas exchange, severe hypoxemia defined as a PaO2 to FiO2 ratio <300 (PaO2 in mmHg), bilateral diffuse infiltration on chest X-ray; pulmonary artery wedge pressure of ≤18 mmHg to rule out cardiogenic causes of pulmonary edema. The aim of this study was to determine the usefulness of CT in the diagnosis and management of this condition. PMID:23096732

  19. Mesenchymal stem cells - a promising therapy for Acute Respiratory Distress Syndrome.

    Hayes M; Curley G; Laffey JG.

    2012-01-01

    Acute Respiratory Distress Syndrome (ARDS) constitutes a spectrum of severe acute respiratory failure in response to a variety of inciting stimuli that is the leading cause of death and disability in the critically ill. Despite decades of research, there are no therapies for ARDS, and management remains supportive. A growing understanding of the complexity of the pathophysiology of ARDS, coupled with advances in stem cell biology, has lead to a renewed interest in the therapeutic potential of...

  20. Altered molecular specificity of surfactant phosphatidycholine synthesis in patients with acute respiratory distress syndrome

    Dushianthan, Ahilanandan; Goss, Victoria; Cusack, Rebecca; Grocott, Michael P. W.; Postle, Anthony D

    2014-01-01

    Background Acute respiratory distress syndrome (ARDS) is a life-threatening critical illness, characterised by qualitative and quantitative surfactant compositional changes associated with premature airway collapse, gas-exchange abnormalities and acute hypoxic respiratory failure. The underlying mechanisms for this dysregulation in surfactant metabolisms are not fully explored. Lack of therapeutic benefits from clinical trials, highlight the importance of detailed in-vivo analysis and charact...

  1. Respiratory protection and emerging infectious diseases: lessons from severe acute respiratory syndrome

    John H. Lange

    2005-01-01

    @@ The severe acute respiratory syndrome (SARS) that emerged 2002-2003 and apparently again 2004 (reported by the news media on December 27, 2003) as the first confirmed case by the World Health Organization (WHO)1,2 raised awareness of emerging infectious diseases.3 Every year there are both new and old infectious diseases emerging as potential pandemic agents.4-6 However, few of these diseases receive the public attention and concern expressed as occurred during the emergence of SARS. Much of this concern was a result of the rapid spread of the novel coronavirus (CoV) to different regions of the world and its high infectivity, especially for health care workers (HCW).3 In many ways, the high percent of HCW infected is a warning of the potential hazards of old and emerging infectious diseases.6 However, SARS was not the only disease (e.g. Monkeypox) that emerged in 2003,3 rather it received the greatest attention.

  2. Severe acute respiratory syndrome: clinical and laboratory manifestations.

    Lam, Christopher W K; Chan, Michael H M; Wong, Chun K

    2004-05-01

    Severe acute respiratory syndrome (SARS) is a recently emerged infectious disease with significant morbidity and mortality. An epidemic in 2003 affected 8,098 patients in 29 countries with 774 deaths. The aetiological agent is a new coronavirus spread by droplet transmission. Clinical and general laboratory manifestations included fever, chills, rigor, myalgia, malaise, diarrhoea, cough, dyspnoea, pneumonia, lymphopenia, neutrophilia, thrombocytopenia, and elevated serum lactate dehydrogenase (LD), alanine aminotransferase (ALT) and creatine kinase (CK) activities. Treatment has been empirical; initial potent antibiotic cover, followed by simultaneous ribavirin and corticosteroids, with or without pulse high-dose methylprednisolone, have been used. The postulated disease progression comprises (1) active viral infection, (2) hyperactive immune response, and (3) recovery or pulmonary destruction and death. We investigated serum LD isoenzymes and blood lymphocyte subsets of SARS patients, and found LD1 activity as the best biochemical prognostic indicator for death, while CD3+, CD4+, CD8+ and natural killer cell counts were promising predictors for intensive care unit (ICU) admission. Plasma cytokine and chemokine profiles showed markedly elevated Th1 cytokine interferon (IFN)-gamma, inflammatory cytokines interleukin (IL)-1beta, IL-6 and IL-12, neutrophil chemokine IL-8, monocyte chemoattractant protein-1 (MCP-1), and Th1 chemokine IFN-gamma-inducible protein-10 (IP-10) for at least two weeks after disease onset, but there was no significant elevation of inflammatory cytokine tumor necrosis factor (TNF)-alpha and anti-inflammatory cytokine IL-10. Corticosteroid reduced IL-8, MCP-1 and IP-10 concentrations from 5-8 days after treatment. Measurement of biochemical markers of bone metabolism demonstrated significant but transient increase in bone resorption from Day 28-44 after onset of fever, when pulse steroid was most frequently given. With tapering down of steroid

  3. Acute lung injury/acute respiratory distress syndrome (ALI/ARDS): the mechanism, present strategies and future perspectives of therapies

    Luh, Shi-Ping; Chiang, Chi-huei

    2006-01-01

    Acute lung injury/acute respiratory distress syndrome (ALI/ARDS), which manifests as non-cardiogenic pulmonary edema, respiratory distress and hypoxemia, could be resulted from various processes that directly or indirectly injure the lung. Extensive investigations in experimental models and humans with ALI/ARDS have revealed many molecular mechanisms that offer therapeutic opportunities for cell or gene therapy. Herein the present strategies and future perspectives of the treatment for ALI/AR...

  4. Hemodynamics of Acute Right Heart Failure in Mechanically Ventilated Patients with Acute Respiratory Distress Syndrome.

    McLean, Barbara

    2015-12-01

    In critically ill patients with circulatory shock, the role of the left ventricle has long been appreciated and the object of measurement and therapeutic targeting. The right ventricle is often under appreciated and dysfunction may be overlooked. Generally, the right ventricle operates passively to support the ejection of the left ventricular diastolic volume. A loss of right ventricular wall compliance secondary to pulmonary pressures may result in an alteration in the normal pressure-volume relationship, ultimately affecting the stroke volume and cardiac output. Traditional right heart filling indices may increase because of decreasing compliance, further complicating the picture. The pathophysiology of pulmonary vascular dysfunction in acute respiratory distress syndrome combined with the effects of a mean airway pressure strategy may create an acute cor pulmonale. PMID:26567491

  5. [Current approaches to the treatment of severe hypoxic respiratory insufficiency (acute lung injury; acute respiratory distress syndrome)].

    Kluge, S; Müller, T; Pfeifer, M

    2011-02-01

    Lung-protective ventilation with a low tidal volume, plateau pressure 90% and permissive hypercapnia results in reduction of the mortality rate in patients with acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). The level of the positive end-expiratory pressure (PEEP) must be chosen in relation to oxygen requirement. High frequency oscillatory ventilation and neurally adjusted ventilatory assist are promising methods. However, further studies with firm end-points have to be awaited before a final judgment is possible. Veno-venous extracorporeal membrane oxygenation (ECMO) can ensure life-sustaining gas exchange in patients with severe vitally compromised pulmonary failure, to provide time for lung tissue to heal and reduce ventilatory stress. The latest guidelines for analgesia and sedation in intensive care medicine demand consistent monitoring of the level of sedation and the intensity of pain. The sedation should be interrupted daily, with phases of awakenings and, if possible, spontaneous breathing. Methods of supportive treatment: Positional treatment (prone position) and inhalation of vasodilators can improve ventilation/perfusion mismatch and thus oxygenation. However, administration of surfactant is currently not advised in adult respiratory failure. PMID:21271478

  6. Azathioprine associated acute respiratory distress syndrome: case report and literature review

    Scherbak D; Wyckoff R; Singarajah C

    2014-01-01

    A 58-year-old Caucasian man treated with azathioprine to prevent rejection of an orthotopic liver transplant, presented to the Carl Hayden VA Medical Center with rapid respiratory decline and appeared septic. He required urgent intubation, mechanical ventilator support and empiric antibiotics. His clinical picture and imaging studies were consistent with acute respiratory distress syndrome; however, extensive infectious work up failed to reveal an offending organism. Review of his current med...

  7. ROLE OF SURFACTANT ADMINISTRATION IN PREMATURE INFANTS WITH ACUTE RESPIRATORY DISTRESS SYNDROME

    Vamseedhar; Praveen Raju; Rama Mohan

    2015-01-01

    BACKGROUND: The significant advancement in the treatment of acute respiratory distress syndrome can be attributed to prenatal identification of high risk pregnancies, prevention of illness through antenatal care, prenatal administration of glucocorticoids, advancemen t in respiratory support and surfactant therapy. These measures resulted in the reduction of mortality and morbidity rates in preterm infants. AIM OF THE STUDY : To find the efficacy of surfactant therapy ...

  8. Progress in Global Surveillance and Response Capacity 10 Years After Severe Acute Respiratory Syndrome

    2013-04-10

    Dr. Mike Miller reads an abridged version of the Emerging Infectious Diseases' synopsis, Progress in Global Surveillance and Response Capacity 10 Years after Severe Acute Respiratory Syndrome.  Created: 4/10/2013 by National Center for Emerging and Zoonotic Infectious Diseases (NCEZID).   Date Released: 4/11/2013.

  9. Characterization of a novel coronavirus associated with severe acute respiratory syndrome

    P.A. Rota (Paul); M.S. Oberste (Steven); S.S. Monroe (Stephan); W.A. Nix (Allan); R. Campagnoli (Ray); J.P. Icenogle (Joseph); S. Penaranda; B. Bankamp (Bettina); K. Maher (Kaija); M.H. Chen (Min-hsin); S. Tong (Suxiong); A. Tamin (Azaibi); L. Lowe (Luis); M. Frace (Michael); J.L. DeRisi (Joseph); Q. Chen (Qi); D. Wang (David); D.D. Erdman (Dean); T.C. Peret (Teresa); C. Burns (Cara); T.G. Ksiazek (Thomas); P.E. Rollin (Pierre); A. Sanchez (Berenguer); S. Liffick (Stephanie); B. Holloway (Brian); J. Limor (Josef); K. McCaustland (Karen); M. Olsen-Rasmussen (Mellissa); S. Gunther; A.D.M.E. Osterhaus (Albert); C. Drosten (Christian); M.A. Pallansch (Mark); L.J. Anderson (Larry); W.J. Belline; R.A.M. Fouchier (Ron)

    2003-01-01

    textabstractIn March 2003, a novel coronavirus (SARS-CoV) was discovered in association with cases of severe acute respiratory syndrome (SARS). The sequence of the complete genome of SARS-CoV was determined, and the initial characterization of the viral genome is presented in this report. The geno

  10. Interleukin-10 polymorphism in position -1082 and acute respiratory distress syndrome

    Gong, M.N.; Thompson, B T; Williams, P.L.; Zhou, W.; Wang, M. Z.; Pothier, L.; Christiani, D C

    2006-01-01

    The GG genotype of the interleukin (IL)-10 promoter polymorphism in position -1082 (-1082GG) has been associated with increased IL-10 production. The current authors hypothesised that the -1082GG genotype is associated with the development of, and outcomes in, acute respiratory distress syndrome (ARDS).

  11. Severe acute respiratory syndrome--a new coronavirus from the Chinese dragon's lair

    Knudsen, T B; Kledal, T N; Andersen, O;

    2003-01-01

    The recent identification of a novel clinical entity, the severe acute respiratory syndrome (SARS), the rapid subsequent spread and case fatality rates of 14-15% have prompted a massive international collaborative investigation facilitated by a network of laboratories established by the World...

  12. Efficacy of prone position in acute respiratory distress syndrome patients: A pathophysiology-based review

    Koulouras, Vasilios; Papathanakos, Georgios; Papathanasiou, Athanasios; Nakos, Georgios

    2016-01-01

    Acute respiratory distress syndrome (ARDS) is a syndrome with heterogeneous underlying pathological processes. It represents a common clinical problem in intensive care unit patients and it is characterized by high mortality. The mainstay of treatment for ARDS is lung protective ventilation with low tidal volumes and positive end-expiratory pressure sufficient for alveolar recruitment. Prone positioning is a supplementary strategy available in managing patients with ARDS. It was first describ...

  13. Lung sonography and recruitment in patients with early acute respiratory distress syndrome: A pilot study

    Stefanidis, Konstantinos; Dimopoulos, Stavros; Tripodaki, Elli-Sophia; Vitzilaios, Konstantinos; Politis, Panagiotis; Piperopoulos, Ploutarchos; Nanas, Serafim

    2011-01-01

    Introduction Bedside lung sonography is a useful imaging tool to assess lung aeration in critically ill patients. The purpose of this study was to evaluate the role of lung sonography in estimating the nonaerated area changes in the dependent lung regions during a positive end-expiratory pressure (PEEP) trial of patients with early acute respiratory distress syndrome (ARDS). Methods Ten patients (mean ± standard deviation (SD): age 64 ± 7 years, Acute Physiology and Chronic Health Evaluation ...

  14. Should Immune-Enhancing Formulations Be Used for Patients With Acute Respiratory Distress Syndrome?

    Roosevelt, Hannah

    2016-08-01

    The potential for regulating immune function in acute respiratory distress syndrome (ARDS) through enteral-administered anti-inflammatory lipids has generated much interest over the past 20 years. Yet recommendations remain inconclusive regarding the utilization of ω-3 fatty acids in patients with ARDS and acute lung injury (ALI). Studies are limited in number, with differing methods, small sample sizes, and conflicting results, making recommendations difficult to interpret. PMID:27339156

  15. Morphological changes of carotid bodies in acute respiratory distress syndrome: a morphometric study in humans

    E.N.G. Vinhaes; Dolhnikoff, M; Saldiva, P. H. N.

    2002-01-01

    Carotid bodies are chemoreceptors sensitive to a fall of partial oxygen pressure in blood (hypoxia). The morphological alterations of these organs in patients with chronic obstructive pulmonary disease (COPD) and in people living at high altitude are well known. However, it is not known whether the histological profile of human carotid bodies is changed in acute clinical conditions such as acute respiratory distress syndrome (ARDS). The objective of the present study was to perform a quantita...

  16. ROLE OF SURFACTANT ADMINISTRATION IN PREMATURE INFANTS WITH ACUTE RESPIRATORY DISTRESS SYNDROME

    Vamseedhar

    2015-07-01

    Full Text Available BACKGROUND: The significant advancement in the treatment of acute respiratory distress syndrome can be attributed to prenatal identification of high risk pregnancies, prevention of illness through antenatal care, prenatal administration of glucocorticoids, advancemen t in respiratory support and surfactant therapy. These measures resulted in the reduction of mortality and morbidity rates in preterm infants. AIM OF THE STUDY : To find the efficacy of surfactant therapy in relation to time of administration. MATERIALS AND METHODS: We analyzed data of 122 preterm babies with Acute respiratory distress syndrome (ARDS hospitalized in the Special Neonatal Care Unit (SNCU of the Pediatric Department, Rajiv Gandhi Institute of Medical Sciences (RIMS, Kadapa, A. P., India. RESU LTS: We investigated the clinical efficacy of surfactant therapy in relation to the time of administration and found that early treatment with surfactant is more effective and resulted in highly significant reduction of mortality rate (p<0.01. CONCLUSION: Surfactant therapy is beneficial in preterm babies with acute respiratory distress syndrome (ARDS. So a reasonable recommendation is to treat the infants with surfactant as soon as the clinical signs of respiratory distress appear.

  17. Acute respiratory distress syndrome in an adult patient with a myelodysplastic disorder.

    Pentimone, F; Cini, G; Meola, N; Ferrannini, E

    1983-01-01

    A 58-year-old man was diagnosed to have refractory anaemia with excessive blasts. After 3 1/2 years of relative control on periodic blood transfusions, the patient developed an acute leukaemia. Although the blastic crisis was not extreme (WBC counts less than 100 X 10(9)/l), a severe, intractable respiratory distress syndrome set in and brought the patient to the exitus in a few days. Overt signs of septic shock were absent, as was evidence of any other known cause of adult respiratory distress. Acute pulmonary failure can be the cause of death in leukaemic patients even in the absence of overwhelming sepsis or hyperleucocytosis. PMID:6404107

  18. Candidate genes and pathogenesis investigation for sepsis-related acute respiratory distress syndrome based on gene expression profile

    WANG Min; Yan, Jingjun; He, Xingxing; Zhong, Qiang; Zhan, Chengye; Li, Shusheng

    2016-01-01

    Background Acute respiratory distress syndrome (ARDS) is a potentially devastating form of acute inflammatory lung injury as well as a major cause of acute respiratory failure. Although researchers have made significant progresses in elucidating the pathophysiology of this complex syndrome over the years, the absence of a universal detail disease mechanism up until now has led to a series of practical problems for a definitive treatment. This study aimed to predict some genes or pathways asso...

  19. MicroRNA Regulation of Acute Lung Injury and Acute Respiratory Distress Syndrome.

    Rajasekaran, Subbiah; Pattarayan, Dhamotharan; Rajaguru, P; Sudhakar Gandhi, P S; Thimmulappa, Rajesh K

    2016-10-01

    The acute respiratory distress syndrome (ARDS), a severe form of acute lung injury (ALI), is a very common condition associated with critically ill patients, which causes substantial morbidity and mortality worldwide. Despite decades of research, effective therapeutic strategies for clinical ALI/ARDS are not available. In recent years, microRNAs (miRNAs), small non-coding molecules have emerged as a major area of biomedical research as they post-transcriptionally regulate gene expression in diverse biological and pathological processes, including ALI/ARDS. In this context, this present review summarizes a large body of evidence implicating miRNAs and their target molecules in ALI/ARDS originating largely from studies using animal and cell culture model systems of ALI/ARDS. We have also focused on the involvement of miRNAs in macrophage polarization, which play a critical role in regulating the pathogenesis of ALI/ARDS. Finally, the possible future directions that might lead to novel therapeutic strategies for the treatment of ALI/ARDS are also reviewed. J. Cell. Physiol. 231: 2097-2106, 2016. © 2016 Wiley Periodicals, Inc. PMID:26790856

  20. Severe acute respiratory syndrome coronavirus persistence in Vero cells

    Gustavo Palacios; Omar Jabado; Neil Renwick; Thomas Briese; W. Ian Lipkin

    2005-01-01

    Background Several coronaviruses establish persistent infections in vitro and in vivo, however it is unknown whether persistence is a feature of the severe acute respiratory syndorme coronavirus (SARS-CoV) life cycle. This study was conducted to investigate viral persistence.Methods We inoculated confluent monolayers of Vero cells with SARS-CoV at a multiplicity of infection of 0.1 TCID50 and passaged the remaining cells every 4 to 8 days for a total of 11 passages. Virus was titrated at each passage by limited dilution assay and nucleocapsid antigen was detected by Western blot and immunofluoresence assays. The presence of viral particles in passage 11 cells was assessed by electron microscopy. Changes in viral genomic sequences during persistent infection were examined by DNA sequencing. Results Cytopathic effect was extensive after initial inoculation but diminished with serial passages. Infectious virus was detected after each passage and viral growth curves were identical for parental virus stock and virus obtained from passage 11 cells. Nucleocapsid antigen was detected in the majority of cells after initial inoculation but in only 10%-40% of cells at passages 2-11. Electron microscopy confirmed the presence of viral particles in passage 11 cells. Sequence analysis at passage 11 revealed fixed mutations in the spike (S) gene and ORFs 7a-8b but not in the nucleocapsid (N) gene. Conclusions SARS-CoV can establish a persistent infection in vitro. The mechanism for viral persistence is consistent with the formation of a carrier culture whereby a limited number of cells are infected with each round of virus replication and release. Persistence is associated with selected mutations in the SARS-CoV genome. This model may provide insight into SARS-related lung pathology and mechanisms by which humans and animals can serve as reservoirs for infection.

  1. The effect of fibreoptic bronchoscopy in acute respiratory distress syndrome: experimental evidence from a lung model.

    Nay, M-A; Mankikian, J; Auvet, A; Dequin, P-F; Guillon, A

    2016-02-01

    Flexible bronchoscopy is essential for appropriate care during mechanical ventilation, but can significantly affect mechanical ventilation of the lungs, particularly for patients with acute respiratory distress syndrome. We aimed to describe the consequences of bronchoscopy during lung-protective ventilation in a bench study, and thereby to determine the optimal diameter of the bronchoscope for avoiding disruption of the protective-ventilation strategy during the procedure. Immediately following the insertion of the bronchoscope into the tracheal tube, either minute ventilation decreased significantly, or positive end-expiratory pressure increased substantially, according to the setting of the inspiratory pressure limit. The increase in end-expiratory pressure led to an equivalent increase in the plateau pressure, and lung-protective ventilation was significantly altered during the procedure. We showed that a bronchoscope with an external diameter of 4 mm (or less) would allow safer bronchoscopic interventions in patients with severe acute respiratory distress syndrome. PMID:26559154

  2. Surfactant chemical composition and biophysical activity in acute respiratory distress syndrome.

    Gregory, T J; Longmore, W J; Moxley, M A; Whitsett, J A; Reed, C R; Fowler, A. A.; Hudson, L D; Maunder, R. J.; Crim, C.; Hyers, T. M.

    1991-01-01

    Acute Respiratory Distress Syndrome (ARDS) is characterized by lung injury and damage to the alveolar type II cells. This study sought to determine if endogenous surfactant is altered in ARDS. Bronchoalveolar lavage was performed in patients at-risk to develop ARDS (AR, n = 20), with ARDS (A, n = 66) and in normal subjects (N, n = 29). The crude surfactant pellet was analyzed for total phospholipids (PL), individual phospholipids, SP-A, SP-B, and minimum surface tension (STmin). PL was decrea...

  3. Education and support needs during recovery in acute respiratory distress syndrome survivors

    Lee, Christie M; Herridge, Margaret S.; Matte, Andrea; Cameron, Jill I

    2009-01-01

    Introduction There is a limited understanding of the long-term needs of survivors of the acute respiratory distress syndrome (ARDS) as they recover from their episode of critical illness. The Timing it Right (TIR) framework, which emphasizes ARDS survivors' journey from the ICU through to community re-integration, may provide a valuable construct to explore the support needs of ARDS survivors during their recovery. Methods Twenty-five ARDS survivors participated in qualitative interviews exam...

  4. Managing severe acute respiratory syndrome (SARS) intellectual property rights: the possible role of patent pooling.

    2005-01-01

    Patent applications that incorporate the genomic sequence of the severe acute respiratory syndrome (SARS) coronavirus, have been filed by a number of organizations. This is likely to result in a fragmentation of intellectual property (IP) rights which in turn may adversely affect the development of products, such as vaccines, to combat SARS. Placing these patent rights into a patent pool to be licensed on a non-exclusive basis may circumvent these difficulties and set a key precedent for the ...

  5. Increased Extravascular Lung Water Reduces the Efficacy of Alveolar Recruitment Maneuver in Acute Respiratory Distress Syndrome

    Alexey A. Smetkin; Kuzkov, Vsevolod V; Eugeny V. Suborov; Bjertnaes, Lars J; Kirov, Mikhail Y.

    2012-01-01

    Introduction. In acute respiratory distress syndrome (ARDS) the recruitment maneuver (RM) is used to reexpand atelectatic areas of the lungs aiming to improve arterial oxygenation. The goal of our paper was to evaluate the response to RM, as assessed by measurements of extravascular lung water index (EVLWI) in ARDS patients. Materials and Methods. Seventeen adult ARDS patients were enrolled into a prospective study. Patients received protective ventilation. The RM was performed by applying a ...

  6. Evaluation of lung recruitment maneuvers in acute respiratory distress syndrome using computer simulation

    Das(2), Anup; Cole, Oana; Chikhani, Marc; Wang, Wenfei; Ali, Tayyba; Haque, Mainul; Bates, Declan G; Hardman, Jonathan G

    2015-01-01

    Introduction Direct comparison of the relative efficacy of different recruitment maneuvers (RMs) for patients with acute respiratory distress syndrome (ARDS) via clinical trials is difficult, due to the heterogeneity of patient populations and disease states, as well as a variety of practical issues. There is also significant uncertainty regarding the minimum values of positive end-expiratory pressure (PEEP) required to ensure maintenance of effective lung recruitment using RMs. We used patie...

  7. A comparison between two different alveolar recruitment maneuvers in patients with acute respiratory distress syndrome

    Mahmoud, Khaled M; Ammar, Amany S.

    2011-01-01

    Background: Alveolar recruitment is a physiological process that denotes the reopening of previously gasless lung units exposed to positive pressure ventilation. The current study was aimed to compare two recruitment maneuvers, a high continuous positive airway pressure (CPAP), and an extended sigh in patients with ARDS. Materials and Methods: Forty patients with acute respiratory distress syndrome were randomly divided into two groups, 20 patients each. Group I received a CPAP of 40 cm H2O f...

  8. Diffuse alveolar damage associated mortality in selected acute respiratory distress syndrome patients with open lung biopsy

    Kao, Kuo-Chin; Hu, Han-Chung; Chang, Chih-Hao; Hung, Chen-Yiu; Chiu, Li-Chung; Li, Shih-Hong; Lin, Shih-Wei; Chuang, Li-Pang; Wang, Chih-Wei; Li, Li-Fu; Chen, Ning-Hung; Yang, Cheng-Ta; Huang, Chung-Chi; Tsai, Ying-Huang

    2015-01-01

    Introduction Diffuse alveolar damage (DAD) is the pathological hallmark of acute respiratory distress syndrome (ARDS), however, the presence of DAD in the clinical criteria of ARDS patients by Berlin definition is little known. This study is designed to investigate the role of DAD in ARDS patients who underwent open lung biopsy. Methods We retrospectively reviewed all ARDS patients who met the Berlin definition and underwent open lung biopsy from January 1999 to January 2014 in a referred med...

  9. Severe acute respiratory syndrome coronavirus papain-like protease: Structure of a viral deubiquitinating enzyme

    RATIA, Kiira; Saikatendu, Kumar Singh; Bernard D. Santarsiero; Barretto, Naina; Baker, Susan C.; Stevens, Raymond C.; MESECAR, Andrew D.

    2006-01-01

    Replication of severe acute respiratory syndrome (SARS) coronavirus (SARS-CoV) requires proteolytic processing of the replicase polyprotein by two viral cysteine proteases, a chymotrypsin-like protease (3CLpro) and a papain-like protease (PLpro). These proteases are important targets for development of antiviral drugs that would inhibit viral replication and reduce mortality associated with outbreaks of SARS-CoV. In this work, we describe the 1.85-Å crystal structure of the catalytic core of ...

  10. The Papain-Like Protease from the Severe Acute Respiratory Syndrome Coronavirus Is a Deubiquitinating Enzyme

    Lindner, Holger A.; Fotouhi-Ardakani, Nasser; Lytvyn, Viktoria; Lachance, Paule; Sulea, Traian; Ménard, Robert

    2005-01-01

    The severe acute respiratory syndrome coronavirus papain-like protease (SARS-CoV PLpro) is involved in the processing of the viral polyprotein and, thereby, contributes to the biogenesis of the virus replication complex. Structural bioinformatics has revealed a relationship for the SARS-CoV PLpro to herpesvirus-associated ubiquitin-specific protease (HAUSP), a ubiquitin-specific protease, indicating potential deubiquitinating activity in addition to its function in polyprotein processing (T. ...

  11. Acute respiratory distress syndrome due to pulmonary involvement by neoplastic plasma cells in multiple myeloma

    Marmor, D B; Farber, J. L.; Gottlieb, J E

    2006-01-01

    Pulmonary involvement with multiple myeloma occurs infrequently and may be difficult to distinguish from more common primary lung tumours, metastatic disease, or other pleural and parenchymal abnormalities. A patient who developed acute respiratory distress syndrome (ARDS) was subsequently found to have multiple myeloma with involvement of lung parenchyma by neoplastic plasma cells. Only one other report of ARDS in association with multiple myeloma was found, and there are no previous reports...

  12. Severe Acute Respiratory Syndrome Coronavirus 7a Accessory Protein Is a Viral Structural Protein

    Huang, Cheng; Ito, Naoto; Tseng, Chien-Te K.; Makino, Shinji

    2006-01-01

    Severe acute respiratory syndrome coronavirus (SCoV) 7a protein is one of the viral accessory proteins. In expressing cells, 7a protein exhibits a variety of biological activities, including induction of apoptosis, activation of the mitogen-activated protein kinase signaling pathway, inhibition of host protein translation, and suppression of cell growth progression. Analysis of SCoV particles that were purified by either sucrose gradient equilibrium centrifugation or a virus capture assay, in...

  13. Mortality and morbidity of acute hypoxemic respiratory failure and acute respiratory distress syndrome in infants and young children

    ZHU Yan-feng; YU Wen-liang; XIE Min-hui; YAN Chao-ying; LU Zhu-jin; SUN Bo; XU Feng; LU Xiu-lan; WANG Ying; CHEN Jian-li; CHAO Jian-xin; ZHOU Xiao-wen; ZHANG Jian-hui; HUANG Yan-zhi

    2012-01-01

    Background Acute hypoxemic respiratory failure (AHRF) often develops acute respiratory distress syndrome (ARDS),and its incidence and mortalities in critically ill pediatric patients in China were 2% and 40% respectively.This study aimed at prospectively investigating incidence,causes,mortality and its risk factors,and any relationship to initial tidal volume (VT) levels of mechanical ventilation,in children ≤5 years of age with AHRF and ARDS.Methods In 12 consecutive months in 23 pediatric intensive care units (PICU),AHRF and ARDS were identified in those requiring >12 hour intratracheal mechanical ventilation and followed up for 90 days or until death or discharge.ARDS was diagnosed according to the American-European Consensus definitions.The mortality and ventilation free days (VFD) were measured as the primary outcome,and major complications,initial disease severity,and burden were measured as the secondary outcome.Results In 13 491 PICU admissions,there were 439 AHRE,of which 345 (78.6%) developed ARDS,resulting in incidences of 3.3% and 2.6%,and corresponding mortalities of 30.3% and 32.8% respectively along with 8.2 and 6.7 times of relative risk of death in those with pneumonia (62.9%) and sepsis (33.7%) as major underlying diseases respectively.No association was found in VT levels during the first 7 days with mortality,nor for VT at levels <6,6-8,8-10,and >10 ml/kg in the first 3 days with mortality or length of VFD.By binary Logistic regression analyses,higher pediatric risk of mortality score Ⅲ,higher initial oxygenation index,and age <1 year were associated with higher mortality or shorter VFD in AHRF.Conclusions The incidence and mortalities of AHRF and ARDS in children ≤5 years were similar to or lower than the previously reported rates (in age up to 15 years),associated with initial disease severity and other confounders,but causal relationship for the initial VT levels as the independent factor to the major outcome

  14. Management of Critically Ill Patients with Severe Acute Respiratory Syndrome (SARS

    2004-03-01

    Full Text Available Severe acute respiratory syndrome (SARS is frequently complicated with acute respiratory failure. In this article, we aim to focus on the management of the subgroup of SARS patients who are critically ill. Most SARS patients would require high flow oxygen supplementation, 20–30% required intensive care unit (ICU or high dependency care, and 13–26% developed acute respiratory distress syndrome (ARDS. In some of these patients, the clinical course can progress relentlessly to septic shock and/or multiple organ dysfunction syndrome (MODS. The management of critically ill SARS patients requires timely institution of pharmacotherapy where applicable and supportive treatment (oxygen therapy, noninvasive and invasive ventilation. Superimposed bacterial and other opportunistic infections are common, especially in those treated with mechanical ventilation. Subcutaneous emphysema, pneumothoraces and pneumomediastinum may arise spontaneously or as a result of positive ventilatory assistance. Older age is a consistently a poor prognostic factor. Appropriate use of personal protection equipment and adherence to infection control measures is mandatory for effective infection control. Much of the knowledge about the clinical aspects of SARS is based on retrospective observational data and randomized-controlled trials are required for confirmation. Physicians and scientists all over the world should collaborate to study this condition which may potentially threaten human existence.

  15. Anesthetic management of parturient with thoracic kyphoscoliosis, malaria and acute respiratory distress syndrome for urgent cesarean section

    Pandey, Ravindra Kr; Batra, Meenu M; Darlong, Vanlal; Garg, Rakesh; Punj, Jyotsna; Kumar, Sri

    2015-01-01

    The management of cesarean section in kyphoscoliotic patient is challenging. The respiratory changes and increased metabolic demands due to pregnancy may compromise the limited respiratory reserves in such patients. Presence of other comorbidities like malaria and respiratory tract infection will further compromise the effective oxygenation. We report a case of kyphoscoliosis along with malaria and acute respiratory distress syndrome for urgent cesarean section. PMID:26702219

  16. Extracorporeal carbon dioxide removal for patients with acute respiratory failure secondary to the acute respiratory distress syndrome: a systematic review.

    Fitzgerald, Marianne; Millar, Jonathan; Blackwood, Bronagh; Davies, Andrew; Brett, Stephen J; McAuley, Daniel F; McNamee, James J

    2014-01-01

    Acute respiratory distress syndrome (ARDS) continues to have significant mortality and morbidity. The only intervention proven to reduce mortality is the use of lung-protective mechanical ventilation strategies, although such a strategy may lead to problematic hypercapnia. Extracorporeal carbon dioxide removal (ECCO₂R) devices allow uncoupling of ventilation from oxygenation, thereby removing carbon dioxide and facilitating lower tidal volume ventilation. We performed a systematic review to assess efficacy, complication rates, and utility of ECCO₂R devices. We included randomised controlled trials (RCTs), case-control studies and case series with 10 or more patients. We searched MEDLINE, Embase, LILACS (Literatura Latino Americana em Ciências da Saúde), and ISI Web of Science, in addition to grey literature and clinical trials registries. Data were independently extracted by two reviewers against predefined criteria and agreement was reached by consensus. Outcomes of interest included mortality, intensive care and hospital lengths of stay, respiratory parameters and complications. The review included 14 studies with 495 patients (two RCTs and 12 observational studies). Arteriovenous ECCO₂R was used in seven studies, and venovenous ECCO₂R in seven studies. Available evidence suggests no mortality benefit to ECCO₂R, although post hoc analysis of data from the most recent RCT showed an improvement in ventilator-free days in more severe ARDS. Organ failure-free days or ICU stay have not been shown to decrease with ECCOvR. Carbon dioxide removal was widely demonstrated as feasible, facilitating the use of lower tidal volume ventilation. Complication rates varied greatly across the included studies, representing technological advances. There was a general paucity of high-quality data and significant variation in both practice and technology used among studies, which confounded analysis. ECCO₂R is a rapidly evolving technology and is an efficacious treatment

  17. New coronavirus outbreak. Lessons learned from the severe acute respiratory syndrome epidemic.

    Álvarez, E; Donado-Campos, J; Morilla, F

    2015-10-01

    System dynamics approach offers great potential for addressing how intervention policies can affect the spread of emerging infectious diseases in complex and highly networked systems. Here, we develop a model that explains the severe acute respiratory syndrome coronavirus (SARS-CoV) epidemic that occurred in Hong Kong in 2003. The dynamic model developed with system dynamics methodology included 23 variables (five states, four flows, eight auxiliary variables, six parameters), five differential equations and 12 algebraic equations. The parameters were optimized following an iterative process of simulation to fit the real data from the epidemics. Univariate and multivariate sensitivity analyses were performed to determine the reliability of the model. In addition, we discuss how further testing using this model can inform community interventions to reduce the risk in current and future outbreaks, such as the recently Middle East respiratory syndrome coronavirus (MERS-CoV) epidemic. PMID:25591619

  18. Acute respiratory distress syndrome in a woman with heroin and methamphetamine misuse.

    Yeh, P S; Yuan, A; Yu, C J; Kuo, S H; Luh, K T; Yang, P C

    2001-08-01

    Methamphetamine, heroin, and cannabis are three of the most commonly misused drugs in Asia. In Taiwan, cases of misuse of methamphetamine have been increasing. In this paper, we report the case of a 23-year-old woman who had a 10-year history of smoking methamphetamine and intermittent use of heroin for 3 to 4 years. She developed pulmonary toxic effects associated with misuse of heroin and methamphetamine. She was brought to the emergency room because of consciousness disturbance and acute respiratory failure. Her symptoms of rapid progression of refractory hypoxemia, ill-defined densities over both lung fields, and normal pulmonary artery wedge pressure were consistent with acute respiratory distress syndrome. Rapid resolution of infiltrations and improvement of oxygenation were observed after mechanical ventilation with positive end-expiratory pressure support and oxygen therapy. She was discharged on the fifteenth hospital day without any sequela except for mild exertional dyspnea. PMID:11678007

  19. The role of heparin-binding protein in acute respiratory distress syndrome

    刘杨

    2014-01-01

    Objective To study the role of heparin-binding protein(HBP)in sepsis-associated acute respiratory distress syndrome(ARDS),and to evaluate the prognostic value of HBP in ARDS.Methods Sixty seven sepsis patients were enrolled in the prospective study.According to whether present ARDS,patients were divided into two groups:ARDS group and non-ARDS group.Blood samples were obtained within 2 hours after patients were diagnosed with sepsis.We measured the level of interleukin-6,interleukin-8 and HBP by ELISA,counted the

  20. Recent Advances in the Management of the Acute Respiratory Distress Syndrome.

    Hager, David N

    2015-09-01

    Advances in management of the acute respiratory distress syndrome (ARDS) include the use of volume and pressure-limited ventilation and a fluid conservative strategy. Despite the extensive study of positive end expiratory pressure, consensus regarding the best approach to its application is lacking. The use of neuromuscular blocking agents and prone positioning in the setting of refractory hypoxemia is supported by the outcomes of recent studies. Alternate modes of ventilation remain unproven. A focus on ARDS risk factor reduction and the development of tools predicting progression to ARDS have the potential to further reduce its incidence. PMID:26304285

  1. Inhibition, Escape, and Attenuated Growth of Severe Acute Respiratory Syndrome Coronavirus Treated with Antisense Morpholino Oligomers†

    Neuman, Benjamin W.; Stein, David A.; Kroeker, Andrew D.; Churchill, Michael J.; Kim, Alice M.; Kuhn, Peter; Dawson, Philip; Moulton, Hong M.; Bestwick, Richard K.; Iversen, Patrick L.; Michael J Buchmeier

    2005-01-01

    The recently emerged severe acute respiratory syndrome coronavirus (SARS-CoV) is a potent pathogen of humans and is capable of rapid global spread. Peptide-conjugated antisense morpholino oligomers (P-PMO) were designed to bind by base pairing to specific sequences in the SARS-CoV (Tor2 strain) genome. The P-PMO were tested for their capacity to inhibit production of infectious virus as well as to probe the function of conserved viral RNA motifs and secondary structures. Several virus-targete...

  2. Acute respiratory distress syndrome caused by Mycoplasma pneumoniae without elevated pulmonary vascular permeability: a case report.

    Takahashi, Naoki; Shinohara, Tsutomu; Oi, Rie; Ota, Muneyuki; Toriumi, Shinichi; Ogushi, Fumitaka

    2016-05-01

    Sporadic patients with acute respiratory distress syndrome (ARDS) caused by Mycoplasma pneumoniae have been reported. However, knowledge about the pathophysiology and pharmacological treatment of this condition is insufficient. Moreover, the pulmonary vascular permeability in ARDS related to M. pneumoniae infection has not been reported. We report a case of ARDS caused by Mycoplasma pneumoniae without elevated pulmonary vascular permeability, which was successfully treated using low-dose short-term hydrocortisone, suggesting that pulmonary infiltration in ARDS caused by Mycoplasma pneumoniae does not match the criteria of permeability edema observed in typical ARDS. PMID:27162691

  3. Guillain-Barre syndrome masquerading as acute respiratory failure in an infant

    Kishore, Praveen; Sharma, Pradeep Kumar; Saikia, Bhaskar; Khilnani, Praveen

    2015-01-01

    Guillain-Barré syndrome (GBS) is a rare entity in infants. We report a case of GBS in a 5-month-old girl. The child presented with cough, loose stools, breathing difficulty, and listlessness. The child was treated as pneumonia with respiratory failure. Due to difficulty in weaning from ventilation with areflexia, marked hypotonia, and reduced power in all four limbs; possibilities of spinal muscular atrophy, poliomyelitis, and myopathies were kept. Nerve conduction velocity study was suggestive of mixed sensory-motor, severe axonal, and demyelinating polyradiculoneuropathy. Cerebrospinal fluid study revealed albuminocytological dissociation. Child was diagnosed as GBS and treated with intravenous immunoglobulin. Child recovered completely on follow-up. GBS should be considered as a differential diagnosis in acute onset respiratory failure with neuromuscular weakness in infants. PMID:26962356

  4. Guillain-Barre syndrome masquerading as acute respiratory failure in an infant

    Praveen Kishore

    2015-01-01

    Full Text Available Guillain-Barré syndrome (GBS is a rare entity in infants. We report a case of GBS in a 5-month-old girl. The child presented with cough, loose stools, breathing difficulty, and listlessness. The child was treated as pneumonia with respiratory failure. Due to difficulty in weaning from ventilation with areflexia, marked hypotonia, and reduced power in all four limbs; possibilities of spinal muscular atrophy, poliomyelitis, and myopathies were kept. Nerve conduction velocity study was suggestive of mixed sensory-motor, severe axonal, and demyelinating polyradiculoneuropathy. Cerebrospinal fluid study revealed albuminocytological dissociation. Child was diagnosed as GBS and treated with intravenous immunoglobulin. Child recovered completely on follow-up. GBS should be considered as a differential diagnosis in acute onset respiratory failure with neuromuscular weakness in infants.

  5. Spatiotemporal interplay of severe acute respiratory syndrome coronavirus and respiratory mucosal cells drives viral dissemination in rhesus macaques.

    Liu, L; Wei, Q; Nishiura, K; Peng, J; Wang, H; Midkiff, C; Alvarez, X; Qin, C; Lackner, A; Chen, Z

    2016-07-01

    Innate immune responses have a critical role in the control of early virus replication and dissemination. It remains unknown, however, how severe acute respiratory syndrome coronavirus (SARS-CoV) evades respiratory innate immunity to establish a systemic infection. Here we show in Chinese macaques that SARS-CoV traversed the mucosa through the respiratory tract within 2 days, resulting in extensive mucosal infiltration by T cells, MAC387(+), and CD163(+) monocytes/macrophages followed by limited viral replication in the lung but persistent viral shedding into the upper airway. Mucosal monocytes/macrophages sequestered virions in intracellular vesicles together with infected Langerhans cells and migrated into the tonsils and/or draining lymph nodes within 2 days. In lymphoid tissues, viral RNA and proteins were detected in infected monocytes upon differentiation into dendritic cells (DCs) within 3 days. Systemic viral dissemination was observed within 7 days. This study provides a comprehensive overview of the spatiotemporal interactions of SARS-CoV, monocytes/macrophages, and the DC network in mucosal tissues and highlights the fact that, while these innate cells contribute to viral clearance, they probably also serve as shelters and vehicles to provide a mechanism for the virus to escape host mucosal innate immunity and disseminate systemically. PMID:26647718

  6. Detection of Severe Acute Respiratory Syndrome-Like, Middle East Respiratory Syndrome-Like Bat Coronaviruses and Group H Rotavirus in Faeces of Korean Bats.

    Kim, H K; Yoon, S-W; Kim, D-J; Koo, B-S; Noh, J Y; Kim, J H; Choi, Y G; Na, W; Chang, K-T; Song, D; Jeong, D G

    2016-08-01

    Bat species around the world have recently been recognized as major reservoirs of several zoonotic viruses, such as severe acute respiratory syndrome coronavirus (SARS-CoV), Middle East respiratory syndrome coronavirus (MERS-CoV), Nipah virus and Hendra virus. In this study, consensus primer-based reverse transcriptase polymerase chain reactions (RT-PCRs) and high-throughput sequencing were performed to investigate viruses in bat faecal samples collected at 11 natural bat habitat sites from July to December 2015 in Korea. Diverse coronaviruses were first detected in Korean bat faeces, including alphacoronaviruses, SARS-CoV-like and MERS-CoV-like betacoronaviruses. In addition, we identified a novel bat rotavirus belonging to group H rotavirus which has only been described in human and pigs until now. Therefore, our results suggest the need for continuing surveillance and additional virological studies in domestic bat. PMID:27213718

  7. Secretory leukocyte proteinase inhibitor is preferentially increased in patients with acute respiratory distress syndrome.

    Sallenave, J M; Donnelly, S C; Grant, I S; Robertson, C; Gauldie, J; Haslett, C

    1999-05-01

    Inappropriate release of proteases from inflammatory and stromal cells can lead to destruction of the lung parenchyma. Antiproteinases such as alpha-1-proteinase inhibitor (alpha1-Pi), secretory leukocyte proteinase inhibitor (SLPI) and elastase-specific inhibitor (elafin) control excess production of human neutrophil elastase. In the present study, the concentrations of alpha1-Pi, SLPI and elafin found in bronchoalveolar lavage (BAL) fluid from control subjects, patients at risk of developing acute respiratory distress syndrome (ARDS) and patients with established ARDS were determined. Levels of all three inhibitors were raised in patients compared with normal subjects. SLPI was increased in the group of patients who were at risk of ARDS and went on to develop the condition, compared with the "at-risk" group who did not progress to ARDS (p=0.0083). Alpha1-Pi and elafin levels were similar in these two populations. In patients with established ARDS, both alpha1-Pi and SLPI levels were significantly increased, compared to patients at risk of ARDS who did (p=0.0089) or did not (p=0.0003) progress to ARDS. The finding of increased antiproteinases shortly before the development of acute respiratory distress syndrome provide further evidence for enhanced inflammation prior to clinical disease. PMID:10414400

  8. Effect and mechanism analysis of continuous blood purification on acute respiratory distress syndrome

    Xiao-Hong Xu; Jia-Bin Chen; Yin-Wen Xia

    2016-01-01

    Objective:To analyze the effect and mechanism of continuous blood purification (CBP) on acute respiratory distress syndrome (ARDS) and provide reference for clinical treatment. Methods:80 cases of patients with ARDS in our hospital were analyzed, the clinical indicators and hemodynamic parameters before and after CBP were compared, and ELISA was used to detect expression change of serum interleukin family and ERK signaling pathway protein. 80 cases of healthy subjects during the same period were taken as control group.Results:Compared with before treatment, heart rate, pulmonary artery pressure and pulmonary artery wedge pressure were effectively normalized after CBP, hemodynamic parameters were effectively improved, and compared with control group, there were significant statistical differences (P<0.05); meanwhile, after CBP, interleukins IL2, IL6 and IL10 as well as TGFβlevels significantly decreased, MEK signaling pathway protein Ras, MEK and ERK1/2 expression significantly decreased, and compared with before treatment, there were significant statistical differences (P<0.01,P<0.05).Conclusions:Continuous blood purification may play the role of treating acute respiratory distress syndrome through reducing levels of interleukins and TGFβ as well as inhibiting MEK signaling pathway.

  9. Message about the « severe acute respiratory disease syndrome »

    2003-01-01

    If you are back from a journey in one of the zones pointed out by WHO concerned by the severe acute respiratory disease syndrome (SARS), it is necessary to monitor your health for at least ten days. This syndrome shows a high fever accompanied by cough or difficulty in breathing. If you become ill, you have to contact as quickly as possible the CERN medical service by dialling 73802 - 73186 during work hours or the Fire Brigade 74444 outside work hours. Tell this service about your recent travel to one of the regions where WHO has reported cases*. * For instant, the areas identified are the cities of Hanoi, Hong Kong, Singapore and the Province of Guangdong (South of China) and Toronto. The medical service recommends to avoid any trip in these world areas until further instruction. CERN Medical Service

  10. Interpretation of chest radiographs in both cancer and other critical care patients with acute respiratory distress syndrome

    Sema Yilmaz

    2013-04-01

    Full Text Available Acute respiratory distress syndrome is a clinical, pathophysiological and radiographic pattern that has signs of pulmonary edema occur without elevated pulmonary venous pressures. Clinical presentation and progression of acute respiratory distress syndrome are followed by frequently ordered portable chest X-ray in critically ill patients. We evaluated chest radiographs of ten cancer and other six critical care pediatric patients. The parenchymal imaging of lung in patients with cancer was reported the same as that of other critically ill children despite underlying pathophysiological variations in our investigation. [Cukurova Med J 2013; 38(2.000: 270-273

  11. Molecular signature of clinical severity in recovering patients with severe acute respiratory syndrome coronavirus (SARS-CoV)

    Wu Ting-Shu; Chiang Ping-Cherng; Eng Hock-Liew; Liu Jien-Wei; Wang Yi-Hsi; Lin Meng-Chih; Yang Kuender D; Chen Lung-Kun; Wei Min-Li; Chen En-Shih; Chao Angel; Chen Chun-Houh; Lee Yun-Shien; Tsao Kuo-Chein; Huang Chung-Guei

    2005-01-01

    Abstract Background Severe acute respiratory syndrome (SARS), a recent epidemic human disease, is caused by a novel coronavirus (SARS-CoV). First reported in Asia, SARS quickly spread worldwide through international travelling. As of July 2003, the World Health Organization reported a total of 8,437 people afflicted with SARS with a 9.6% mortality rate. Although immunopathological damages may account for the severity of respiratory distress, little is known about how the genome-wide gene expr...

  12. Efficacy of prone position in acute respiratory distress syndrome patients: A pathophysiology-based review.

    Koulouras, Vasilios; Papathanakos, Georgios; Papathanasiou, Athanasios; Nakos, Georgios

    2016-05-01

    Acute respiratory distress syndrome (ARDS) is a syndrome with heterogeneous underlying pathological processes. It represents a common clinical problem in intensive care unit patients and it is characterized by high mortality. The mainstay of treatment for ARDS is lung protective ventilation with low tidal volumes and positive end-expiratory pressure sufficient for alveolar recruitment. Prone positioning is a supplementary strategy available in managing patients with ARDS. It was first described 40 years ago and it proves to be in alignment with two major ARDS pathophysiological lung models; the "sponge lung" - and the "shape matching" -model. Current evidence strongly supports that prone positioning has beneficial effects on gas exchange, respiratory mechanics, lung protection and hemodynamics as it redistributes transpulmonary pressure, stress and strain throughout the lung and unloads the right ventricle. The factors that individually influence the time course of alveolar recruitment and the improvement in oxygenation during prone positioning have not been well characterized. Although patients' response to prone positioning is quite variable and hard to predict, large randomized trials and recent meta-analyses show that prone position in conjunction with a lung-protective strategy, when performed early and in sufficient duration, may improve survival in patients with ARDS. This pathophysiology-based review and recent clinical evidence strongly support the use of prone positioning in the early management of severe ARDS systematically and not as a rescue maneuver or a last-ditch effort. PMID:27152255

  13. Lung Postmortem Autopsy Revealing Extramedullary Involvement in Multiple Myeloma Causing Acute Respiratory Distress Syndrome

    Aurélie Ravinet

    2014-01-01

    Full Text Available Pulmonary involvement with multiple myeloma is rare. We report the case of a 61-year-old man with past medical history of chronic respiratory failure with emphysema, and a known multiple myeloma (Durie and Salmon stage III B and t(4;14 translocation. Six months after diagnosis and first line of treatment, he presented acute dyspnea with interstitial lung disease. Computed tomography showed severe bullous emphysema and diffuse, patchy, multifocal infiltrations bilaterally with nodular character, small bilateral pleural effusions, mediastinal lymphadenopathy, and a known lytic lesion of the 12th vertebra. He was treated with piperacillin-tazobactam, amikacin, oseltamivir, and methylprednisolone. Finally, outcome was unfavourable. Postmortem analysis revealed diffuse and nodular infracentimetric infiltration of the lung parenchyma by neoplastic plasma cells. Physicians should be aware that acute respiratory distress syndrome not responding to treatment of common causes could be a manifestation of the disease, even with negative BAL or biopsy and could be promptly treated with salvage therapy.

  14. Acute Respiratory Distress Syndrome: A Rare Complication in Pediatric Diabetic Ketoacidosis.

    Sudhanshu, Siddhnath; Jevalikar, Ganesh; Das, Pravin K; Singh, Pramod K; Bhatia, Eesh; Bhatia, Vijayalakshmi

    2016-05-01

    Cerebral edema (CE) and non cardiogenic pulmonary edema (acute respiratory distress syndrome, ARDS) are life-threatening complications of diabetic ketoacidosis (DKA). In contrast to CE complicating DKA, which is primarily reported in pediatric patients, ARDS is rarely described in this age group. Here, the authors present a child with DKA who developed both cerebral edema and ARDS during the course of her management. It is feasible that severe acidosis, hypotension, azotemia, hypoalbuminemia and the superimposed aggressive intravenous fluid administration were important risk factors for the development of cerebral edema and ARDS in the index patient. The report highlights the importance of early diagnosis and aggressive therapy in the management of ARDS, and summarizes the published literature on this rarely reported complication of pediatric DKA. PMID:26666907

  15. Argument against the Routine Use of Steroids for Pediatric Acute Respiratory Distress Syndrome

    Hartmann, Silvia M.; Hough, Catherine L.

    2016-01-01

    Steroids have a plausible mechanism of action of reducing severity of lung disease in acute respiratory distress syndrome (ARDS) but have failed to show consistent benefits in patient-centered outcomes. Many studies have confounding from the likely presence of ventilator-induced lung injury and steroids may have shown benefit because administration minimized ongoing inflammation incited by injurious ventilator settings. If steroids have benefit, it is likely for specific populations that fall within the heterogeneous diagnosis of ARDS. Those pediatric patients with concurrent active asthma or reactive airway disease of prematurity, in addition to ARDS, are the most common group likely to derive benefit from steroids, but are poorly studied. With the information currently available, it does not appear that the typical adult or pediatric patient with ARDS derives benefit from steroids and steroids should not be given on a routine basis.

  16. Taiwan's traffic control bundle and the elimination of nosocomial severe acute respiratory syndrome among healthcare workers.

    Yen, M-Y; Lin, Y-E; Lee, C-H; Ho, M-S; Huang, F-Y; Chang, S-C; Liu, Y-C

    2011-04-01

    The traffic control bundle consists of procedures designed to help prevent epidemic nosocomial infection. We retrospectively studied the serial infection control measures to determine factors most effective in preventing nosocomial infections of healthcare workers (HCWs) during the 2003 Taiwanese severe acute respiratory syndrome (SARS) epidemic. Fever screening stations, triage of fever patients, separating SARS patients from other patients, separation of entrances and passageways between patients and HCWs, and increasing hand-washing facilities all demonstrated a protective effect for HCWs (univariate analysis; Palcohol dispensers for glove-on hand rubbing between zones of risk, and (ii) fever screening at the fever screen station outside the emergency department, were the significant methods effectively minimising nosocomial SARS infection of HCWs (P<0.05). The traffic control bundle should be implemented in future epidemics as a tool to achieve strict infection control measures. PMID:21316802

  17. Can differential regional ventilation protect the spared lung in acute respiratory distress syndrome?

    Soni, Kapil Dev; Dash, Devi Prasad; Aggrawal, Richa; Kumar, Narendra; Kumar, Niraj

    2015-08-01

    Acute respiratory distress syndrome (ARDS) is a common clinical problem prevalent in intensive care settings. It can complicate many critical illnesses. The general treatment is mainly supportive. Mechanical ventilation, low tidal volume strategy, and control of plateau pressure form the basis of current management. No specific treatment exists for ARDS. Various interventions have been tested for the lethal condition including steroids, fluid restriction, statins, high-frequency ventilation, nitric oxide, and prone ventilation strategy. However, none has shown improvement apart from prone positioning and low tidal volume ventilation. We report our observation in a patient with ARDS, which may potentially show a new mechanism to protect normal alveoli in ARDS lung and thereby may improve survival. PMID:25770594

  18. Molecular biological analysis of genotyping and phylogeny of severe acute respiratory syndrome associated coronavirus

    王志刚; 李兰娟; 罗芸; 张俊彦; 王敏雅; 程苏云; 张严峻; 王晓萌; 卢亦愚; 吴南屏; 梅玲玲; 王赞信

    2004-01-01

    Background SARS-CoV is the causative agent of severe acute respiratory syndrome (SARS) which has been associated with outbreaks of SARS in Guangdong, Hong Kong and Beijing of China, and other regions worldwide. SARS-CoV from human has shown some variations but its origin is still unknown. The genotyping and phylogeny of SARS-CoV were analyzed and reported in this paper. Methods Full or partial genomes of 44 SARS-CoV strains were collected from GenBank. The genotype, single nucleotide polymorphism and phylogeny of these SARS-CoV strains were analyzed by molecular biological, bioinformatic and epidemiological methods. Conclusion The results mentioned above suggest that SARS-CoV is responding to host immunological pressures and experiencing variation which provide clues, information and evidence of molecular biology for the clinical pathology, vaccine developing and epidemic investigation.

  19. Recent advances in mechanical ventilation in patients with acute respiratory distress syndrome

    Nuttapol Rittayamai

    2015-03-01

    Full Text Available Acute respiratory distress syndrome (ARDS is characterised by different degrees of severity and different stages. Understanding these differences can help to better adapt the ventilatory settings to protect the lung from ventilator-induced lung injury by reducing hyperinflation or keeping the lung open when it is possible. The same therapies may be useful and beneficial in certain forms of ARDS, and risky or harmful at other stages: this includes high positive end-expiratory pressure, allowance of spontaneous breathing activity or use of noninvasive ventilation. The severity of the disease is the primary indicator to individualise treatment. Monitoring tools such as oesophageal pressure or lung volume measurements may also help to set the ventilator. At an earlier stage, an adequate lung protective strategy may also help to prevent the development of ARDS.

  20. Recent advances in mechanical ventilation in patients with acute respiratory distress syndrome.

    Rittayamai, Nuttapol; Brochard, Laurent

    2015-03-01

    Acute respiratory distress syndrome (ARDS) is characterised by different degrees of severity and different stages. Understanding these differences can help to better adapt the ventilatory settings to protect the lung from ventilator-induced lung injury by reducing hyperinflation or keeping the lung open when it is possible. The same therapies may be useful and beneficial in certain forms of ARDS, and risky or harmful at other stages: this includes high positive end-expiratory pressure, allowance of spontaneous breathing activity or use of noninvasive ventilation. The severity of the disease is the primary indicator to individualise treatment. Monitoring tools such as oesophageal pressure or lung volume measurements may also help to set the ventilator. At an earlier stage, an adequate lung protective strategy may also help to prevent the development of ARDS. PMID:25726563

  1. Inhibiting severe acute respiratory syndrome-associated coronavirus by small interfering RNA

    张仁礼; 郭中敏; 陆家海; 孟锦绣; 周灿权; 詹希美; 黄冰; 余新炳; 黄民; 潘兴华; 凌文华; 陈系古; 万卓越; 郑焕英; 鄢心革; 王一飞; 冉延超; 刘新健; 马俊鑫; 王承宇; 张必良

    2003-01-01

    Objective To evaluate the effectiveness of small interfering RNA (siRNA) on inhibiting severe acute respiratory syndrome (SARS)-associated coronavirus replication, and to lay bases for the future clinical application of siRNA for the treatment of viral infectious diseases.Methods Vero-E6 cells was transfected with siRNA before SARS virus infection, and the effectiveness of siRNA interference was evaluated by observing the cytopathic effect (CPE) on Vero-E6 cells.Results Five pairs of siRNA showed ability to reduce CPE dose dependently, and two of them had the best effect. Conclusion siRNA may be effective in inhibiting SARS-associated coronavirus replication.

  2. Analysis of high risk factors related to acute respiratory distress syndrome following severe thoracoabdominal injuries

    ZHENG Guo-shou; BAI Xiang-jun; ZHAN Cheng-ye

    2007-01-01

    Objective: To investigate the high risk factors related to acute respiratory distress syndrome ( ARDS ) following serious thoracoabdominal injuries.Methods: The clinical data of 282 patients with serious thoracoabdominal injuries were retrospectively studied. Univariate and Cox multivariate regression analysis were used to determine the risk factors related to ARDS following serious thoracoabdominal injuries.Results: The incidence of ARDS was 31.9% (90/282) in patients with serious thoracoabdominal injuries.The mortality caused by ARDS was 37.8% (34/90). The univariate analysis and multivariate analysis demonstrated that the clinical conditions such as elder age, shock,dyspnea, abnormal arterial blood gas, hemopneumothorax,pulmonary contusion, flail chest, coexisting pulmonary diseases, multiple abdominal injury and high ISS score were the independent high risk factors related to ARDS.Conclusion: There are many high risk factors related to ARDS following severe thoracoabdominal injuries, which should be detected early and treated timely to decrease the incidence and mortality of ARDS.

  3. Low Tidal Volume Ventilation in Patients without Acute Respiratory Distress Syndrome: A Paradigm Shift in Mechanical Ventilation

    Jed Lipes; Francois Lellouche; Azadeh Bojmehrani

    2012-01-01

    Protective ventilation with low tidal volume has been shown to reduce morbidity and mortality in patients suffering from acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). Low tidal volume ventilation is associated with particular clinical challenges and is therefore often underutilized as a therapeutic option in clinical practice. Despite some potential difficulties, data have been published examining the application of protective ventilation in patients without lung inj...

  4. Morphological changes of carotid bodies in acute respiratory distress syndrome: a morphometric study in humans

    Vinhaes E.N.G.

    2002-01-01

    Full Text Available Carotid bodies are chemoreceptors sensitive to a fall of partial oxygen pressure in blood (hypoxia. The morphological alterations of these organs in patients with chronic obstructive pulmonary disease (COPD and in people living at high altitude are well known. However, it is not known whether the histological profile of human carotid bodies is changed in acute clinical conditions such as acute respiratory distress syndrome (ARDS. The objective of the present study was to perform a quantitative analysis of the histology of carotid bodies collected from patients who died of ARDS. A morphometric study of carotid bodies collected during routine autopsies was carried out on three groups: patients that died of non-respiratory diseases (controls, N = 8, patients that presented COPD and died of its complications or associated diseases (N = 7, and patients that died of ARDS (N = 7. Morphometric measurements of the volume fraction of clusters of chief cells were performed in five fields on each slide at 40X magnification. The numerical proportion of the four main histological cell types (light, dark, progenitor and sustentacular cells was determined analyzing 10 fields on each slide at 400X magnification. The proportion of dark cells was 0.22 in ARDS patients, 0.12 in controls (P<0.001, and 0.08 in the COPD group. The proportion of light cells was 0.33 (ARDS, 0.44 (controls (P<0.001, and 0.36 (COPD. These findings suggest that chronic and acute hypoxia have different effects on the histology of glomic tissue.

  5. Middle East Respiratory Syndrome

    2014-07-07

    This podcast discusses Middle East Respiratory Syndrome, or MERS, a viral respiratory illness caused by Middle East Respiratory Syndrome Coronavirus—MERS-CoV.  Created: 7/7/2014 by National Center for Immunization and Respiratory Diseases (NCIRD).   Date Released: 7/7/2014.

  6. Extracorporeal blood therapy in sepsis and acute respiratory distress syndrome: the "purifying dream"

    Xu Xuefeng; Dai Huaping; Jia Chun'e; Wang Chen

    2014-01-01

    Objective To discuss the rationale,hypothesis,modality of extracorporeal blood purification (EBP) techniques for the critically ill animal models or patients,and to summarize the experimental and clinical studies with inconsistent data which explored the EBP's efficacy in the areas of critical care medicine.Data sources Articles referred in this review were collected from the database of PubMed published in English up to June 2014.Study selection We had done a literature search by using the term "(sepsis OR acute lung injury OR acute respiratory distress syndrome) AND (extracorporeal blood purification OR hemofiltration OR hemoperfusion OR plasma exchange OR plasmapheresis OR adsorpiton)".Related original or review articles were included and carefully analyzed.Results Acute cellular and humoral immune disturbances occur in both sepsis and acute respiratory distress syndrome (ARDS).Treatments aimed at targeting one single pro-/anti-inflammatory mediator have largely failed with no proven clinical benefits.Such failure shifts the therapeutic rationale to the nonspecific,broad-spectrum methods for modulating the over-activated inflammatory and anti-inflammatory response.Therefore,EBP techniques have become the potential weapons with high promise for removing the circulating pro-/anti-inflammatory mediators and promoting immune reconstitution.Over the years,multiple extracorporeal techniques for the critically ill animal models or patients have been developed,including hemofiltration (HF),high-volume hemofiltration (HVHF),high-cutoff hemofiltration (HCO-HF),hemo-perfusion or-adsorption (HP/HA),coupled plasma filtration adsorption (CPFA),and plasma exchange (PE).These previous studies showed that EBP therapy was feasible and safe for the critically ill animal models or patients.However,data on their efficacy (especially on the clinical benefits,such as mortality) were inconsistent.Conclusions It is not now to conclude that EBP intervention can purify septic or ARDS

  7. Systemic inflammatory response syndrome, acute lung injury and acute respiratory distress syndrome%全身炎症反应综合征、急性肺损伤与急性呼吸窘迫综合征

    钱桂生

    2005-01-01

    @@ 1967年Ashbaugh等首次报道了成人急性呼吸窘迫(acute respiratory distress in adult),为了和新生儿或婴儿呼吸窘迫综合征(infantile respiratory distress syndrome,IRDS)相区别,被命名为成人呼吸窘迫综合征(adult respiratory distress syndrome,ARDS).

  8. Potential therapeutic application of adult stem cells in acute respiratory distress syndrome

    JIANG Jian-xin; LI Li

    2009-01-01

    Acute respiratory distress syndrome (ARDS) remains a poor prognosis in spite of the recent development of new therapeutic strategies. Cell-based therapy with stem cells has been considered as a promising way for the treatment of vital organ damage. Putative endogenous stem cells have been shown to be located within the adult lung in the basal layer of the upper airways, within or near pulmonary neu-roendocrine cell rests, at the bronchoalveolar junction, as well as within the alveolar epithelium. These stem cells are hypothesized to be the source of lung regeneration and repair. But this mechanism seems to be insufficient after lung injury. There is increasing excitement over the last few years with the suggestion that exogenous stem cells may offer new treatment options for ARDS. Exogenous stem cells have the abihty to differentiate and function as both airway and lung parenchymal epithelial cells in both in vitro and in-creasingly in vivo experiments. However, there is great con-troversy concerning the repair effect of adult stem cells in lung injury. This review evaluates the advances in endog-enous respiratory stem cells, and assesses the evidence for the use of stem cells in the repair of lung injury.

  9. Recent insights: mesenchymal stromal/stem cell therapy for acute respiratory distress syndrome

    Horie, Shahd; Laffey, John G.

    2016-01-01

    Acute respiratory distress syndrome (ARDS) causes respiratory failure, which is associated with severe inflammation and lung damage and has a high mortality and for which there is no therapy. Mesenchymal stromal/stem cells (MSCs) are adult multi-progenitor cells that can modulate the immune response and enhance repair of damaged tissue and thus may provide a therapeutic option for ARDS. MSCs demonstrate efficacy in diverse in vivo models of ARDS, decreasing bacterial pneumonia and ischemia-reperfusion-induced injury while enhancing repair following ventilator-induced lung injury. MSCs reduce the pro-inflammatory response to injury while augmenting the host response to bacterial infection. MSCs appear to exert their effects via multiple mechanisms—some are cell interaction dependent whereas others are paracrine dependent resulting from both soluble secreted products and microvesicles/exosomes derived from the cells. Strategies to further enhance the efficacy of MSCs, such as by overexpressing anti-inflammatory or pro-repair molecules, are also being investigated. Encouragingly, early phase clinical trials of MSCs in patients with ARDS are under way, and experience with these cells in trials for other diseases suggests that the cells are well tolerated. Although considerable translational challenges, such as concerns regarding cell manufacture scale-up and issues regarding cell potency and batch variability, must be overcome, MSCs constitute a highly promising potential therapy for ARDS.

  10. A case of lung cancer associated with acute respiratory distress syndrome after thoracic radiotherapy

    A 73-year-old man presented with dyspnea, cough, fever, appetite loss and stridor due to bronchial stenosis. Fiber-optic bronchoscopy revealed an endobronchial lesion in the right main bronchus and biopsy specimens showed poorly differentiated squamous cell carcinoma. The clinical stage of lung cancer was IIIB (T4N2M0). The patient received 60 Gy in 30 fractions over 43 days to a field including the right hilum and mediastinum. The tumor decreased in size and stenosis of the bronchus disappeared. A week after completion of radiation the patient began to have high grade fever and dyspnea, and progressive hypoxia developed. A chest radiograph showed diffuse bilateral interstitial infiltrates. Despite mechanical ventilation with PEEP and the administration of steroids, he died of respiratory failure three weeks after completion of radiation. Necropsy specimens obtained from the left lung revealed massive deposition of fibrin in the alveolar airspaces associated with hyaline membranes and hyperplasia of type II cells indicating diffuse alveolar damage. The patient had mild pulmonary fibrosis on a CT scan taken before the start of radiotherapy. We conclude that care should be taken if the case has pulmonary fibrosis because radiation therapy can precipitate severe radiation pneumonitis and acute respiratory distress syndrome in such cases. (author)

  11. Recovery and outcomes after the acute respiratory distress syndrome (ARDS) in patients and their family caregivers.

    Herridge, Margaret S; Moss, Marc; Hough, Catherine L; Hopkins, Ramona O; Rice, Todd W; Bienvenu, O Joseph; Azoulay, Elie

    2016-05-01

    Outcomes after acute respiratory distress syndrome (ARDS) are similar to those of other survivors of critical illness and largely affect the nerve, muscle, and central nervous system but also include a constellation of varied physical devastations ranging from contractures and frozen joints to tooth loss and cosmesis. Compromised quality of life is related to a spectrum of impairment of physical, social, emotional, and neurocognitive function and to a much lesser extent discrete pulmonary disability. Intensive care unit-acquired weakness (ICUAW) is ubiquitous and includes contributions from both critical illness polyneuropathy and myopathy, and recovery from these lesions may be incomplete at 5 years after ICU discharge. Cognitive impairment in ARDS survivors ranges from 70 to 100 % at hospital discharge, 46 to 80 % at 1 year, and 20 % at 5 years, and mood disorders including depression and post-traumatic stress disorder (PTSD) are also sustained and prevalent. Robust multidisciplinary and longitudinal interventions that improve these outcomes are still uncertain and data in our literature are conflicting. Studies are needed in family members of ARDS survivors to better understand long-term outcomes of the post-ICU family syndrome and to evaluate how it affects patient recovery. PMID:27025938

  12. Recruitment maneuvers in acute respiratory distress syndrome and during general anesthesia.

    Chiumello, Davide; Algieri, Ilaria; Grasso, Salvatore; Terragni, Pierpaolo; Pelosi, Paolo

    2016-02-01

    The use of low tidal volume ventilation and low to moderate positive end-expiratory pressure (PEEP) levels is a widespread strategy to ventilate patients with non-injured lungs during general anesthesia and in intensive care as well with mild to moderate acute respiratory distress syndrome (ARDS). Higher PEEP levels have been recommended in severe ARDS. Due to the presence of alveolar collapse, recruitment maneuvers (RMs) by causing a transient elevation in airway pressure (i.e. transpulmonary pressure) have been suggested to improve lung inflation in non-inflated and poorly-inflated lung regions. Various types of RMs such as sustained inflation at high pressure, intermittent sighs and stepwise increases of PEEP and/or airway plateau inspiratory pressure have been proposed. The use of RMs has been associated with mixed results in terms of physiological and clinical outcomes. The optimal method for RMs has not yet been identified. The use of RMs is not standardized and left to the individual physician based on his/her experience. Based on the same grounds, RMs have been proposed to improve lung aeration during general anesthesia. The aim of this review was to present the clinical evidence supporting the use of RMs in patients with ARDS and during general anesthesia and as well their potential biological effects in experimental models of acute lung injury. PMID:25881732

  13. Clinical study of critical patients with hemorrhagic fever with renal syndrome complicated by acute respiratory distress syndrome.

    Hong Du

    Full Text Available OBJECTIVES: The aim of this study was to investigate the clinical characteristics and outcomes of critical patients with hemorrhagic fever with renal syndrome (HFRS complicated by acute respiratory distress syndrome (ARDS. MATERIALS AND METHODS: To observe the demographic, epidemiological and clinical characteristics, and to explore the predictive effects for prognosis in laboratory findings, we conducted a detailed retrospective analysis of clinical records for critical patients with HFRS complicated by ARDS, treated at the center for infectious diseases, Tangdu Hospital, between January 2008 and December 2012. RESULTS: A total of 48 critical patients with laboratory confirmed HFRS accompanied by ARDS were enrolled in the study, including 27 survivors and 21 non-survivors, with a fatality rate of 43.75%. Thirty-one individuals (64.6% contracted HFRS between the months of September and December. The non-survivors tended to have lower incidence of overlapping phase (P = 0.025. There were no obvious differences in the needs for mechanical ventilation (MV and renal replacement therapy (RRT, except for the need for vasoactive drugs between the survivors and non-survivors (P = 0.001. The non-survivors were found to have higher frequencies of encephalopathy, refractory shock and multiple organ dysfunction syndrome (MODS, lower incidences of acute renal failure (ARF and secondary hypertension (P<0.05. The non-survivors tended to have lower levels of serum creatinine (Scr (P<0.001 and fibrinogen (Fib (P = 0.003, higher incidences of prolonged prothrombin time (PT (P = 0.006 and activated partial thromboplastin time (APTT (P = 0.020 and higher levels of aspartate aminotransferase (AST (P = 0.015, and the laboratory parameters mentioned above reached statistical significance for predicting prognosis (P<0.05. CONCLUSION: The high mortality rate of critical patients with HFRS complicated by ARDS emphasizes the importance of

  14. Extracorporeal membrane oxygenation as a bridge to liver transplantation for acute respiratory distress syndrome-induced life-threatening hypoxaemia aggravated by hepatopulmonary syndrome

    Monsel, Antoine; Mal, Hervé; Brisson, Hélène; Luo, Rubin; Eyraud, Daniel; Vézinet, Corinne; Do, Chung Hi; Lu, Qin; Vaillant, Jean-Christophe; Hannoun, Laurent; Houssel, Pauline; Durand, François; Rouby, Jean-Jacques

    2011-01-01

    Introduction Combined with massive lung aeration loss resulting from acute respiratory distress syndrome, hepatopulmonary syndrome, a liver-induced vascular lung disorder characterized by diffuse or localized dilated pulmonary capillaries, may induce hypoxaemia and death in patients with end-stage liver disease. Methods The case of such a patient presenting with both disorders and in whom an extracorporeal membrane oxygenation was used is described. Results A 51-year-old man with a five-year ...

  15. Human Cell Tropism and Innate Immune System Interactions of Human Respiratory Coronavirus EMC Compared to Those of Severe Acute Respiratory Syndrome Coronavirus

    Zielecki, F.; Weber, M.; Eickmann, M.; Spiegelberg, L.; Zaki, A. M.; Matrosovich, M.; Becker, S.; Weber, F.

    2013-01-01

    Infections with human coronavirus EMC (HCoV-EMC) are associated with severe pneumonia. We demonstrate that HCoV-EMC resembles severe acute respiratory syndrome coronavirus (SARS-CoV) in productively infecting primary and continuous cells of the human airways and in preventing the induction of interferon regulatory factor 3 (IRF-3)-mediated antiviral alpha/beta interferon (IFN-α/β) responses. However, HCoV-EMC was markedly more sensitive to the antiviral state established by ectopic IFN. Thus,...

  16. Partial ventilatory support modalities in acute lung injury and acute respiratory distress syndrome-a systematic review.

    Sarah M McMullen

    Full Text Available PURPOSE: The efficacy of partial ventilatory support modes that allow spontaneous breathing in patients with acute lung injury (ALI and acute respiratory distress syndrome (ARDS is unclear. The objective of this scoping review was to assess the effects of partial ventilatory support on mortality, duration of mechanical ventilation, and both hospital and intensive care unit (ICU lengths of stay (LOS for patients with ALI and ARDS; the secondary objective was to describe physiologic effects on hemodynamics, respiratory system and other organ function. METHODS: MEDLINE (1966-2009, Cochrane, and EmBase (1980-2009 databases were searched using common ventilator modes as keywords and reference lists from retrieved manuscripts hand searched for additional studies. Two researchers independently reviewed and graded the studies using a modified Oxford Centre for Evidence-Based Medicine grading system. Studies in adult ALI/ARDS patients were included for primary objectives and pre-clinical studies for supporting evidence. RESULTS: Two randomized controlled trials (RCTs were identified, in addition to six prospective cohort studies, one retrospective cohort study, one case control study, 41 clinical physiologic studies and 28 pre-clinical studies. No study was powered to assess mortality, one RCT showed shorter ICU length of stay, and the other demonstrated more ventilator free days. Beneficial effects of preserved spontaneous breathing were mainly physiological effects demonstrated as improvement of gas exchange, hemodynamics and non-pulmonary organ perfusion and function. CONCLUSIONS: The use of partial ventilatory support modalities is often feasible in patients with ALI/ARDS, and may be associated with short-term physiological benefits without appreciable impact on clinically important outcomes.

  17. KL-6 concentration in pulmonary epithelial lining fluid is a useful prognostic indicator in patients with acute respiratory distress syndrome

    Kondo, Tomohiro; Hattori, Noboru; Ishikawa, Nobuhisa; MURAI, HIROSHI; Haruta, Yoshinori; Hirohashi, Nobuyuki; Tanigawa, Koichi; Kohno, Nobuoki

    2011-01-01

    Background: KL-6 is a mucin-like glycoprotein expressed on the surface of alveolar type II cells. Elevated concentrations of KL-6 in serum and epithelial lining fluid (ELF) in patients with acute respiratory distress syndrome (ARDS) have been previously reported; however, kinetics and prognostic significance of KL-6 have not been extensively studied. This study was conducted to clarify these points in ARDS patients.Methods: Thirty-two patients with ARDS who received mechanical ventilation und...

  18. KL-6 concentration in pulmonary epithelial lining fluid is a useful prognostic indicator in patients with acute respiratory distress syndrome

    Tanigawa Koichi; Hirohashi Nobuyuki; Haruta Yoshinori; Murai Hiroshi; Ishikawa Nobuhisa; Hattori Noboru; Kondo Tomohiro; Kohno Nobuoki

    2011-01-01

    Abstract Background KL-6 is a mucin-like glycoprotein expressed on the surface of alveolar type II cells. Elevated concentrations of KL-6 in serum and epithelial lining fluid (ELF) in patients with acute respiratory distress syndrome (ARDS) have been previously reported; however, kinetics and prognostic significance of KL-6 have not been extensively studied. This study was conducted to clarify these points in ARDS patients. Methods Thirty-two patients with ARDS who received mechanical ventila...

  19. Kinetics of Severe Acute Respiratory Syndrome (SARS) Coronavirus-Specific Antibodies in 271 Laboratory-Confirmed Cases of SARS

    He, Zhongping; Dong, Qingming; Zhuang, Hui; Song, Shujing; Peng, Guoai; Luo, Guangxiang; Dwyer, Dominic E.

    2004-01-01

    The sensitivities and specificities of an immunofluorescence assay and an enzyme immunoassay for detection of antibodies specific for severe acute respiratory syndrome coronavirus (SARS-CoV) were compared for 148 laboratory-confirmed SARS cases. The appearance and persistence of SARS-CoV-specific antibodies were assessed, with immunoglobulin G detected in 59% of samples collected within 14 days and persisting for 60 to 95 days after the onset of illness.

  20. Efficacy of positive end-expiratory pressure titration after the alveolar recruitment manoeuvre in patients with acute respiratory distress syndrome

    Huh, Jin Won; Jung, Hoon; Choi, Hye Sook; Hong, Sang-Bum; Lim, Chae-Man; Koh, Younsuck

    2009-01-01

    Introduction In acute respiratory distress syndrome (ARDS), adequate positive end-expiratory pressure (PEEP) may decrease ventilator-induced lung injury by minimising overinflation and cyclic recruitment-derecruitment of the lung. We evaluated whether setting the PEEP using decremental PEEP titration after an alveolar recruitment manoeuvre (ARM) affects the clinical outcome in patients with ARDS. Methods Fifty-seven patients with early ARDS were randomly assigned to a group given decremental ...

  1. Enhanced Surfactant Adsorption via Polymer Depletion Forces: A Simple Model for Reversing Surfactant Inhibition in Acute Respiratory Distress Syndrome

    Stenger, Patrick C.; Zasadzinski, Joseph A.

    2006-01-01

    Lung surfactant adsorption to an air-water interface is strongly inhibited by an energy barrier imposed by the competitive adsorption of albumin and other surface-active serum proteins that are present in the lung during acute respiratory distress syndrome. This reduction in surfactant adsorption results in an increased surface tension in the lung and an increase in the work of breathing. The reduction in surfactant adsorption is quantitatively described using a variation of the classical Smo...

  2. Surfactant disaturated-phosphatidylcholine kinetics in acute respiratory distress syndrome by stable isotopes and a two compartment model

    Cogo Paola E; Toffolo Gianna; Ori Carlo; Vianello Andrea; Chierici Marco; Gucciardi Antonina; Cobelli Claudio; Baritussio Aldo; Carnielli Virgilio P

    2007-01-01

    Abstract Background In patients with acute respiratory distress syndrome (ARDS), it is well known that only part of the lungs is aerated and surfactant function is impaired, but the extent of lung damage and changes in surfactant turnover remain unclear. The objective of the study was to evaluate surfactant disaturated-phosphatidylcholine turnover in patients with ARDS using stable isotopes. Methods We studied 12 patients with ARDS and 7 subjects with normal lungs. After the tracheal instilla...

  3. Acute respiratory distress syndrome due to viral pneumonitis in case of varicella zoster in adult: case report

    Anaz Binazeez; Saurabh Kothari; Dhaval Dave; Manish Pendse; Divya Lala; Smita Patil; Archana Bhate

    2015-01-01

    Chickenpox, is a highly contagious disease caused by infection with varicella zoster virus (VZV). The disease is often more severe in adults than children. Here we present a case of adult male suffering from chicken pox who presented with complication of acute respiratory distress syndrome [ARDS] due to viral pneumonitis. Due to his late presentation, despite of giving antivirals, patient had a fatal outcome. So this case highlights the necessity and importance of early administration of a...

  4. A conceptual framework: the early and late phases of skeletal muscle dysfunction in the acute respiratory distress syndrome

    Files, D. Clark; Sanchez, Michael A; Morris, Peter E

    2015-01-01

    Patients with acute respiratory distress syndrome (ARDS) often develop severe diaphragmatic and limb skeletal muscle dysfunction. Impaired muscle function in ARDS is associated with increased mortality, increased duration of mechanical ventilation, and functional disability in survivors. In this review, we propose that muscle dysfunction in ARDS can be categorized into an early and a late phase. These early and late phases are based on the timing in relationship to lung injury and the underly...

  5. Acute respiratory distress syndrome in adenovirus type 4 pneumonia: A case report.

    Narra, R; Bono, P; Zoccoli, A; Orlandi, A; Piconi, S; Grasselli, G; Crotti, S; Girello, A; Piralla, A; Baldanti, F; Lunghi, G

    2016-08-01

    Human adenoviruses (HAdVs) cause a wide spectrum of clinical syndromes, depending on species and types, from mild respiratory infections to deadly pneumonia: in particular, severe infections occur in immunocompromised patients. In this report, we describe the case of a 36 years-old woman admitted to our intensive care unit (ICU) with severe respiratory distress syndrome caused by adenovirus pneumonia, that required invasive respiratory support (mechanical ventilation and extracorporeal membrane oxygenation). Molecular assays detected the virus in respiratory and plasma specimen and sequencing procedure identified HAdV type 4. Patient improved after cidofovir administration. Leukopenia and subsequent bacterial infection occurred, but the patient recovered completely and was discharged from the hospital after 54days. PMID:27354307

  6. Pressure controlled inverse ratio ventilation in acute respiratory distress syndrome patients.

    Tripathi M

    2002-01-01

    Full Text Available Appropriate ventilatory intervention is life saving in acute respiratory distress syndrome (ARDS. Pressure controlled inverse ratio ventilation (PC-IRV is the likely mode of ventilation benefiting in extreme conditions of ARDS. However, guidelines when to start PC-IRV is not yet well defined. The ventilation-related dilemma, which we faced in two illustrative cases of ARDS are presented. The first patient presenting clinically with ARDS but with high peak airway pressure (PIP and low dynamic lung compliance, PC-IRV helped in reducing PIP, improved haemodynamics and the oxygenation of blood. In second patient with similar clinical presentation of ARDS, where although PIP was high but the dynamic compliance was better, the PC-IRV caused deterioration in PaO2. Here, patient rather did better with high PEEP (15 cm H2O and usual I: E ratio (1:2. It is probable that the dynamic lung compliance (< 20ml/cmH2O, PIP (> 50 cm H2O at conventional I: E ratio (1:2 ventilation (10 ml/kg with hypotension might form the basis to develop a scoring system for guidance to switch over to PC-IRV ventilation. Further randomised prospective controlled clinical trials will then be required to establish indication to start PC-IRV in ARDS.

  7. Specific Features of the Contact History of Probable Cases of Severe Acute Respiratory Syndrome

    WAN-NIAN LIANG; MIN LIU; QI CHEN; ZE-JUN LIU; XIONG HE; XUE-QIN XIE

    2005-01-01

    Objective To describe the specific features of the contact history of probable cases of severe acute respiratory syndrome (SARS) in Beijing. Methods Data of SARS cases notified from the Beijing Municipal Center for Disease Control and Prevention (BCDC) and supplemented by other channels were collected. All the data were analyzed by descriptive epidemiology. Results ①The number of probable cases with contact history was significantly higher than the excluded cases. ②The proportion of probable cases with contact history descended with epidemic development, but this situation did not occur in health care workers (HCWs). ③The fatality rate of probable cases with contact history was significantly higher than the cases without contact history (OR=1.489). ④The proportion of probable cases with contact history was 85.86% among health care workers, which was significantly higher than that of non-health care workers (85.86% v.s. 56.44%, OR=4.69). Conclusions ①The susceptible persons with contact history may not get infected, and the contact history is just a sufficient condition of infecting SARS; ②There are 3 conceivable reasons for the descending trend of the proportion in probable cases with contact history; ③The contact history is one of the risk factors of the death of SARS cases; ④The risk of contacting with SARS among health care workers is approximately 5 times higher than that of non-HCWs.

  8. Therapeutic Effects of Integrated Traditional Chinese Medicine and Western Medicine in Treating Severe Acute Respiratory Syndrome

    王融冰; 刘军民; 江宇泳; 吴云忠; 王晓静; 池频频; 孙凤霞; 高连印

    2003-01-01

    Objective: To improve the effects of treatment of severe acute respiratory syndrome (SARS) and to explore the clinical significance of integrated traditional Chinese medicine and western medicine (ICWM) in the treatment of SARS and its influence on the chief indexes in the process of the disease. Methods: The clinical study involving observation of 135 patients of SARS was conducted in the randomized, synchronously controlled and open way. The patients were divided into two groups, 68 in the ICWM group and 67 in the control group, all of whom were treated with the same basic treatment of western medicine, but to the ICWM group, Chinese drugs for clearing Heat, detoxifying and removing Dampness were given additionally. The comprehensive effect on relieving fever, cell-mediated immunity, pulmonary inflammation and secondary infection was compared between the two groups. Results: The therapeutic effect in the ICWM group was better than that in the control group in such aspects as steadily lowering body temperature, alleviating general symptoms, accelerating the absorption of pulmonary infiltration and easing cellular immunity suppression. Conclusion: The therapeutic effect of ICWM is better in treating SARS than that of western medicine alone.

  9. Sequence Analysis and Structural Prediction of the Severe Acute Respiratory Syndrome Coronavirus nsp5

    Jia-Hai LU; Nan-Shan ZHONG; Ding-Mei ZHANG; Guo-Ling WANG; Zhong-Min GUO; Juan LI; Bing-Yan TAN; Li-Ping OU-YANG; Wen-Hua LING; Xin-Bing YU

    2005-01-01

    The non-structural proteins (nsp or replicase proteins) of coronaviruses are relatively conserved and can be effective targets for drugs. Few studies have been conducted into the function of the severe acute respiratory syndrome coronavirus (SARS-CoV) nsp5. In this study, bioinformatics methods were employed to predict the secondary structure and construct 3-D models of the SARS-CoV GD strain nsp5. Sequencing and sequential comparison was performed to analyze the mutation trend of the polymerase nsp5 gene during the epidemic process using a nucleotide-nucleotide basic local alignment search tool (BLASTN) and a protein-protein basic local alignment search tool (BLASTP). The results indicated that the nsp5 gene was steady during the epidemic process and the protein was homologous with other coronavirus nsp5 proteins. The protein encoded by the nsp5 gene was expressed in COS-7 cells and analyzed by sodium dodecylsulfate-polyacrylamide gel electrophoresis (SDS-PAGE). This study provided the foundation for further exploration of the protein's biological function, and contributed to the search for anti-SARS-CoV drugs.

  10. Serum hepatic enzyme manifestations in patients with severe acute respiratory syndrome:Retrospective analysis

    Hui-Juan Cui; Bin Zhang; Chuan-Jin Hua; Yue-Wen Gong; Xiao-Lin Tong; Ping Li; Ying-Xu Hao; Xiao-Guang Chen; Ai-Guo Li; Zhi-Yuan Zhang; Jun Duan; Min Zhen

    2004-01-01

    AIM: To evaluate the hepatic function in patients with severe acute respiratory syndrome (SARS) and possible causes of hepatic disorder in these patients.METHODS: One hundred and eighty-two patients with SARS were employed in a retrospective study that investigated hepatic dysfunction. Liver alanine aminotransferase (ALT),aspartate aminotransferase (AST) and lactic dehydrogenase (LDH) were analyzed in these patients. Patients with different hospital treatments were further investigated.RESULTS: Of the 182 patients, 128(70.3%) had abnormal ALT activity, 57(31.3%) had abnormal AST activity and 87(47.8%) had abnormal LDH activity. The peak of elevated hepatic enzyme activities occurred between the sixth day and the tenth day after the first day of reported fever. Of the 182 patients, 160(87.9%) had been treated with antibiotics, 137(75.2%) with Ribavirin, and 115(63.2%) with methylpredisolone. There was no statistically significant correlation between the duration of Ribavirin treatement and hepatic dysfunction.CONCLUSION: Abnormal liver functions were common in patients with SARS and could be associated with virus replication in the liver.

  11. The interferon gamma gene polymorphism +874 A/T is associated with severe acute respiratory syndrome

    Chan Eric YT

    2006-05-01

    Full Text Available Abstract Background Cytokines play important roles in antiviral action. We examined whether polymorphisms of IFN-γ,TNF-α and IL-10 affect the susceptibility to and outcome of severe acute respiratory syndrome (SARS. Methods A case-control study was carried out in 476 Chinese SARS patients and 449 healthy controls. We tested the polymorphisms of IFN-γ,TNF-α and IL-10 for their associations with SARS. Results IFN-γ +874A allele was associated with susceptibility to SARS in a dose-dependent manner (P IFN-γ +874 AA and AT genotype had a 5.19-fold (95% Confidence Interval [CI], 2.78-9.68 and 2.57-fold (95% CI, 1.35-4.88 increased risk of developing SARS respectively. The polymorphisms of IL-10 and TNF-α were not associated with SARS susceptibility. Conclusion IFN-γ +874A allele was shown to be a risk factor in SARS susceptibility.

  12. Increased extravascular lung water reduces the efficacy of alveolar recruitment maneuver in acute respiratory distress syndrome.

    Smetkin, Alexey A; Kuzkov, Vsevolod V; Suborov, Eugeny V; Bjertnaes, Lars J; Kirov, Mikhail Y

    2012-01-01

    Introduction. In acute respiratory distress syndrome (ARDS) the recruitment maneuver (RM) is used to reexpand atelectatic areas of the lungs aiming to improve arterial oxygenation. The goal of our paper was to evaluate the response to RM, as assessed by measurements of extravascular lung water index (EVLWI) in ARDS patients. Materials and Methods. Seventeen adult ARDS patients were enrolled into a prospective study. Patients received protective ventilation. The RM was performed by applying a continuous positive airway pressure of 40 cm H(2)O for 40 sec. The efficacy of the RM was assessed 5 min later. Patients were identified as responders if PaO(2)/FiO(2) increased by >20% above the baseline. EVLWI was assessed by transpulmonary thermodilution before the RM, and patients were divided into groups of low EVLWI (recruitment maneuver might be related to the severity of pulmonary edema. In patients with incresed EVLWI, the recruitment maneuver is less effective. PMID:22649717

  13. Pulmonar recruitment in acute respiratory distress syndrome. What is the best strategy?

    Cíntia Lourenço Santos

    2015-04-01

    Full Text Available Supporting patients with acute respiratory distress syndrome (ARDS, using a protective mechanical ventilation strategy characterized by low tidal volume and limitation of positive end-expiratory pressure (PEEP is a standard practice in the intensive care unit. However, these strategies can promote lung de-recruitment, leading to the cyclic closing and reopening of collapsed alveoli and small airways. Recruitment maneuvers (RM can be used to augment other methods, like positive end-expiratory pressure and positioning, to improve aerated lung volume. Clinical practice varies widely, and the optimal method and patient selection for recruitment maneuvers have not been determined, considerable uncertainty remaining regarding the appropriateness of RM. This review aims to discuss recent findings about the available types of RM, and compare the effectiveness, indications and adverse effects among them, as well as their impact on morbidity and mortality in ARDS patients. Recent developments include experimental and clinical evidence that a stepwise extended recruitment maneuver may cause an improvement in aerated lung volume and decrease the biological impact seen with the traditionally used sustained inflation, with less adverse effects. Prone positioning can reduce mortality in severe ARDS patients and may be an useful adjunct to recruitment maneuvers and advanced ventilatory strategies, such noisy ventilation and BIVENT, which have been useful in providing lung recruitment.

  14. Distinct Proteasome Subpopulations in the Alveolar Space of Patients with the Acute Respiratory Distress Syndrome

    S. U. Sixt

    2012-01-01

    Full Text Available There is increasing evidence that proteasomes have a biological role in the extracellular alveolar space, but inflammation could change their composition. We tested whether immunoproteasome protein-containing subpopulations are present in the alveolar space of patients with lung inflammation evoking the acute respiratory distress syndrome (ARDS. Bronchoalveolar lavage (BAL supernatants and cell pellet lysate from ARDS patients (n=28 and healthy subjects (n=10 were analyzed for the presence of immunoproteasome proteins (LMP2 and LMP7 and proteasome subtypes by western blot, chromatographic purification, and 2D-dimensional gelelectrophoresis. In all ARDS patients but not in healthy subjects LMP7 and LMP2 were observed in BAL supernatants. Proteasomes purified from pooled ARDS BAL supernatant showed an altered enzyme activity ratio. Chromatography revealed a distinct pattern with 7 proteasome subtype peaks in BAL supernatant of ARDS patients that differed from healthy subjects. Total proteasome concentration in BAL supernatant was increased in ARDS (971 ng/mL ± 1116 versus 59±25; P<0.001, and all fluorogenic substrates were hydrolyzed, albeit to a lesser extent, with inhibition by epoxomicin (P=0.0001. Thus, we identified for the first time immunoproteasome proteins and a distinct proteasomal subtype pattern in the alveolar space of ARDS patients, presumably in response to inflammation.

  15. Structural and Functional Analyses of the Severe Acute Respiratory Syndrome Coronavirus Endoribonuclease Nsp15

    Bhardwaj, Kanchan; Palaninathan, Satheesh; Alcantara, Joanna Maria Ortiz; Yi, Lillian Li; Guarino, Linda; Sacchettini, James C.; Kao, C. Cheng (TAM)

    2008-03-31

    The severe acute respiratory syndrome (SARS) coronavirus encodes several RNA-processing enzymes that are unusual for RNA viruses, including Nsp15 (nonstructural protein 15), a hexameric endoribonuclease that preferentially cleaves 3' of uridines. We solved the structure of a catalytically inactive mutant version of Nsp15, which was crystallized as a hexamer. The structure contains unreported flexibility in the active site of each subunit. Substitutions in the active site residues serine 293 and proline 343 allowed Nsp15 to cleave at cytidylate, whereas mutation of leucine 345 rendered Nsp15 able to cleave at purines as well as pyrimidines. Mutations that targeted the residues involved in subunit interactions generally resulted in the formation of catalytically inactive monomers. The RNA-binding residues were mapped by a method linking reversible cross-linking, RNA affinity purification, and peptide fingerprinting. Alanine substitution of several residues in the RNA-contacting portion of Nsp15 did not affect hexamer formation but decreased the affinity of RNA binding and reduced endonuclease activity. This suggests a model for Nsp15 hexamer interaction with RNA.

  16. Epidemiological Features of Severe Acute Respiratory Syndrome in Beijing Urban and Suburb Areas in 2003

    2005-01-01

    Objective To describe the epidemiologic features of an outbreak of severe acute respiratory syndrome (SARS) in urban and suburb areas in Beijing and to explore their differences between these two areas. Methods Data of SARS cases were collected from daily notification of China Ministry of Health and a database of infectious diseases was established by the Beijing Municipal Center for Disease Prevention and Control (BCDC). All the data were put into dataset files by Microsoft Excel-2000 and analyzed with SPSS version 10.0 software. Results The respective urban incidence and mortality rate were 29.06 and 2.21 per 100 000, while the case fatality rate was 7.62%. In contrast, the respective suburb incidence and mortality rate were 10.61 and 0.78 per 100 000, and the case fatality rate was 7.32%. No significant differences were found in demographic characteristics between the urban and suburb areas. Conclusion Beijing urban area suffered a more serious SARS epidemic than the suburb area in 2003.

  17. Abdominal Muscle Activity during Mechanical Ventilation Increases Lung Injury in Severe Acute Respiratory Distress Syndrome.

    Xianming Zhang

    Full Text Available It has proved that muscle paralysis was more protective for injured lung in severe acute respiratory distress syndrome (ARDS, but the precise mechanism is not clear. The purpose of this study was to test the hypothesis that abdominal muscle activity during mechanically ventilation increases lung injury in severe ARDS.Eighteen male Beagles were studied under mechanical ventilation with anesthesia. Severe ARDS was induced by repetitive oleic acid infusion. After lung injury, Beagles were randomly assigned into spontaneous breathing group (BIPAPSB and abdominal muscle paralysis group (BIPAPAP. All groups were ventilated with BIPAP model for 8h, and the high pressure titrated to reached a tidal volume of 6ml/kg, the low pressure was set at 10 cmH2O, with I:E ratio 1:1, and respiratory rate adjusted to a PaCO2 of 35-60 mmHg. Six Beagles without ventilator support comprised the control group. Respiratory variables, end-expiratory volume (EELV and gas exchange were assessed during mechanical ventilation. The levels of Interleukin (IL-6, IL-8 in lung tissue and plasma were measured by qRT-PCR and ELISA respectively. Lung injury scores were determined at end of the experiment.For the comparable ventilator setting, as compared with BIPAPSB group, the BIPAPAP group presented higher EELV (427±47 vs. 366±38 ml and oxygenation index (293±36 vs. 226±31 mmHg, lower levels of IL-6(216.6±48.0 vs. 297.5±71.2 pg/ml and IL-8(246.8±78.2 vs. 357.5±69.3 pg/ml in plasma, and lower express levels of IL-6 mRNA (15.0±3.8 vs. 21.2±3.7 and IL-8 mRNA (18.9±6.8 vs. 29.5±7.9 in lung tissues. In addition, less lung histopathology injury were revealed in the BIPAPAP group (22.5±2.0 vs. 25.2±2.1.Abdominal muscle activity during mechanically ventilation is one of the injurious factors in severe ARDS, so abdominal muscle paralysis might be an effective strategy to minimize ventilator-induce lung injury.

  18. CT Manifestations of Lung Changes and Complications in Patients with Severe Acute Respiratory Syndrome

    张雪哲; 王武; 卢延; 黄振国; 洪闻; 尚燕宁; 任安

    2003-01-01

    Objective:To investigate the role of CT scanning in diagnosing severe acute respiratory syndrome(SARS). Methods: One hundred and twelve times of spiral CT scanning, 106 times on the chest with standard pulmonary and mediastinal window, 5 on the brain and once on the abdomen, were performed in 82 patients (37 males and 45 females) of SARS. Results: Bilateral shadows showed in 66 patients (80.48%) and unilateral shadow in 16 (19.52%). The lung CT findings were sub-pleural focal consolidation in 26 patients (31.70%), flaky cloudy opacity in 53 (64.63%), large area consolidation in 9 (10.97%), ground-glass blurry shadow in 31 (37.80%), alveolar substantive shadow in 14 (17.07%) and interstitial changes in 16 (19.51%). The pulmonary CT signs of SARS were relatively characterized by: (1) The lesions tending to multiply occur, mostly to be bilaterally distributed and commonly involved in the lower lung field. (2) The lung shadows mostly showed as sub-pleural focal consolidation, flaky cloudy shadow, large area consolidation, ground-glass blurry shadow, and often accompanied with signs of broncho-inflation. (3) Having opacified nodular shadows in the alveolar cavities. (4) Rapid progressions or changes on the size, amount, and distribution of the lesions likely to be found in dynamic observation of chest X-ray and CT scanning, i.e., markedly dynamic changes found within 24 to 48 hrs. Lesions with these characteristics may be recognized as pulmonary changes possibly induced by SARS. Complications were found in 6 patients (7.31%), including tuberculosis of lung and brain accompanied with pneumomediastinum in one patient, secondary infection of lung in 2, pneumothorax in 1, pulmonary fungus in 1, and pyothorax in 1.Conclusion: CT scanning is a sensitive method for diagnosis of SARS, by which more accurate assessment of the abnormal changes of lung and occurrence of complications in SARS patients can be made.

  19. Lung ventilation strategies for acute respiratory distress syndrome: a systematic review and network meta-analysis.

    Wang, Changsong; Wang, Xiaoyang; Chi, Chunjie; Guo, Libo; Guo, Lei; Zhao, Nana; Wang, Weiwei; Pi, Xin; Sun, Bo; Lian, Ailing; Shi, Jinghui; Li, Enyou

    2016-01-01

    To identify the best lung ventilation strategy for acute respiratory distress syndrome (ARDS), we performed a network meta-analysis. The Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE, CINAHL, and the Web of Science were searched, and 36 eligible articles were included. Compared with higher tidal volumes with FiO2-guided lower positive end-expiratory pressure [PEEP], the hazard ratios (HRs) for mortality were 0.624 (95% confidence interval (CI) 0.419-0.98) for lower tidal volumes with FiO2-guided lower PEEP and prone positioning and 0.572 (0.34-0.968) for pressure-controlled ventilation with FiO2-guided lower PEEP. Lower tidal volumes with FiO2-guided higher PEEP and prone positioning had the greatest potential to reduce mortality, and the possibility of receiving the first ranking was 61.6%. Permissive hypercapnia, recruitment maneuver, and low airway pressures were most likely to be the worst in terms of all-cause mortality. Compared with higher tidal volumes with FiO2-guided lower PEEP, pressure-controlled ventilation with FiO2-guided lower PEEP and lower tidal volumes with FiO2-guided lower PEEP and prone positioning ventilation are associated with lower mortality in ARDS patients. Lower tidal volumes with FiO2-guided higher PEEP and prone positioning ventilation and lower tidal volumes with pressure-volume (P-V) static curve-guided individual PEEP are potential optimal strategies for ARDS patients. PMID:26955891

  20. Screening and identification of severe acute respiratory syndrome-associated coronavirus-specific CTL epitopes.

    Zhou, Minghai; Xu, Dongping; Li, Xiaojuan; Li, Hongtao; Shan, Ming; Tang, Jiaren; Wang, Min; Wang, Fu-Sheng; Zhu, Xiaodong; Tao, Hua; He, Wei; Tien, Po; Gao, George F

    2006-08-15

    Severe acute respiratory syndrome (SARS) is a highly contagious and life-threatening disease that emerged in China in November 2002. A novel SARS-associated coronavirus was identified as its principal etiologic agent; however, the immunopathogenesis of SARS and the role of special CTLs in virus clearance are still largely uncharacterized. In this study, potential HLA-A*0201-restricted spike (S) and nucleocapsid protein-derived peptides were selected from an online database and screened for potential CTL epitopes by in vitro refolding and T2 cell-stabilization assays. The antigenicity of nine peptides which could refold with HLA-A*0201 molecules was assessed with an IFN-gamma ELISPOT assay to determine the capacity to stimulate CTLs from PBMCs of HLA-A2(+) SARS-recovered donors. A novel HLA-A*0201-restricted decameric epitope P15 (S411-420, KLPDDFMGCV) derived from the S protein was identified and found to localize within the angiotensin-converting enzyme 2 receptor-binding region of the S1 domain. P15 could significantly enhance the expression of HLA-A*0201 molecules on the T2 cell surface, stimulate IFN-gamma-producing CTLs from the PBMCs of former SARS patients, and induce specific CTLs from P15-immunized HLA-A2.1 transgenic mice in vivo. Furthermore, significant P15-specific CTLs were induced from HLA-A2.1-transgenic mice immunized by a DNA vaccine encoding the S protein; suggesting that P15 was a naturally processed epitope. Thus, P15 may be a novel SARS-associated coronavirus-specific CTL epitope and a potential target for characterization of virus control mechanisms and evaluation of candidate SARS vaccines. PMID:16887973

  1. Identification of novel single nucleotide polymorphisms associated with acute respiratory distress syndrome by exome-seq.

    Katherine Shortt

    Full Text Available Acute respiratory distress syndrome (ARDS is a lung condition characterized by impaired gas exchange with systemic release of inflammatory mediators, causing pulmonary inflammation, vascular leak and hypoxemia. Existing biomarkers have limited effectiveness as diagnostic and therapeutic targets. To identify disease-associating variants in ARDS patients, whole-exome sequencing was performed on 96 ARDS patients, detecting 1,382,399 SNPs. By comparing these exome data to those of the 1000 Genomes Project, we identified a number of single nucleotide polymorphisms (SNP which are potentially associated with ARDS. 50,190SNPs were found in all case subgroups and controls, of which89 SNPs were associated with susceptibility. We validated three SNPs (rs78142040, rs9605146 and rs3848719 in additional ARDS patients to substantiate their associations with susceptibility, severity and outcome of ARDS. rs78142040 (C>T occurs within a histone mark (intron 6 of the Arylsulfatase D gene. rs9605146 (G>A causes a deleterious coding change (proline to leucine in the XK, Kell blood group complex subunit-related family, member 3 gene. rs3848719 (G>A is a synonymous SNP in the Zinc-Finger/Leucine-Zipper Co-Transducer NIF1 gene. rs78142040, rs9605146, and rs3848719 are associated significantly with susceptibility to ARDS. rs3848719 is associated with APACHE II score quartile. rs78142040 is associated with 60-day mortality in the overall ARDS patient population. Exome-seq is a powerful tool to identify potential new biomarkers for ARDS. We selectively validated three SNPs which have not been previously associated with ARDS and represent potential new genetic biomarkers for ARDS. Additional validation in larger patient populations and further exploration of underlying molecular mechanisms are warranted.

  2. Adult respiratory distress syndrome

    Due to improved emergency resuscitation procedures, and with advancing medical technology in the field of critical care, an increasing number of patients survive the acute phase of shock and catastrophic trauma. Patients who previously died of massive sepsis, hypovolemic or hypotensive shock, multiple fractures, aspiration, toxic inhalation, and massive embolism are now surviving long enough to develop previously unsuspected and unrecognized secondary effects. With increasing frequency, clinicians are recognizing the clinical and radiographic manifestations of pathologic changes in the lungs occurring secondary to various types of massive insult. This paper gives a list of diseases that have been shown to precipitate or predispose to diffuse lung damage. Various terms have been used to describe the lung damage and respiratory failure secondary to these conditions. The term adult respiratory distress syndrome (ARDS) is applied to several cases of sudden respiratory failure in patients with previously healthy lungs following various types of trauma or shock. Numerous investigations and experiments have studied the pathologic changes in ARDS, and, while there is still no clear indication of why it develops, there is now some correlation of the sequential pathologic developments with the clinical and radiographic changes

  3. Fas and Fas Ligand Are Up-Regulated in Pulmonary Edema Fluid and Lung Tissue of Patients with Acute Lung Injury and the Acute Respiratory Distress Syndrome

    Albertine, Kurt H; Soulier, Matthew F.; Wang, Zhengming; Ishizaka, Akitoshi; Hashimoto, Satoru; Zimmerman, Guy A.; Matthay, Michael A; Lorraine B. Ware

    2002-01-01

    Apoptosis mediated by Fas/Fas ligand (FasL) interaction has been implicated in human disease processes, including pulmonary disorders. However, the role of the Fas/FasL system in acute lung injury (ALI) and in the acute respiratory distress syndrome (ARDS) is poorly defined. Accordingly, we investigated both the soluble and cellular expression of the Fas/FasL system in patients with ALI or ARDS. The major findings are summarized as follows. First, the soluble expression of the Fas/FasL system...

  4. Innate Lymphoid Cells are the Predominant Source of Interleukin-17A During the Early Pathogenesis of Acute Respiratory Distress Syndrome

    Muir, Roshell; Osbourn, Megan; Dubois, Alice V.; Doran, Emma; Small, Donna M; Monahan, Avril; O'Kane, Cecilia M.; McAllister, Katherine; Fitzgerald, Denise C; Kissenpfennig, Adrien; McAuley, Daniel F; Ingram, Rebecca J.

    2015-01-01

    Rationale: IL-17A is purported to help drive early pathogenesis in acute respiratory distress syndrome (ARDS) by enhancing neutrophil recruitment. Whilst IL-17A is the archetypal cytokine of T helper (Th)17 cells, it is produced by a number of lymphocytes, the source during ARDS being unknown. Objectives: To identify the cellular source and the role of IL17A in the early phase of lung injuryMethods: Lung injury was induced in WT (C57BL/6) and IL-17 KO mice with aerosolised LPS (100 µg) or Pse...

  5. Acute respiratory distress syndrome due to viral pneumonitis in case of varicella zoster in adult: case report

    Anaz Binazeez

    2015-12-01

    Full Text Available Chickenpox, is a highly contagious disease caused by infection with varicella zoster virus (VZV. The disease is often more severe in adults than children. Here we present a case of adult male suffering from chicken pox who presented with complication of acute respiratory distress syndrome [ARDS] due to viral pneumonitis. Due to his late presentation, despite of giving antivirals, patient had a fatal outcome. So this case highlights the necessity and importance of early administration of antivirals, especially in adult pox, to tackle the complications of disease and get a favourable outcome. [Int J Res Med Sci 2015; 3(12.000: 3924-3927

  6. Risk factors of mortality in road traffic injury patients with acute respiratory distress syndrome

    ZHAO Xiao-gang; WU Jun-song; HE Xiao-di; MA Yue-feng; ZHANG Mao; GAN Jian-xin; XU Shao-wen; JIANG Guan-yu

    2008-01-01

    Background Among the deaths due to trauma,about one half of the patients suffer from road traffic injury(RTI).Most of RTI patients complicate acute respiratory distress syndrome(ARDS)and severe multiple injuries.ARDS is a major contributor to morbidity and mortality in trauma patients.Although many injuries and conditions are believed to be associated with ARDS independent risk factors in trauma patients.their relative importance in development of the syndrome are undefined.We hypothesize that not all of the traditionaI risk factors impacting mortality are independently associated with patients strictly identified by traffic injury.This study aimed to sieve distinctive risk factors in our RTI population,meanwhile,we also hypothesize that there may exist significantly different risk factors in these patients.Methods This was a retrospective cohort study regarding RTI as a single cause for emergency intensive care unit (EICU)admission.Patients identified as severe RTI with post-traumatic ARDS were enrolled in a prospectively maintained database between May 2002 and April 2007 and observed.Twenty-three items of potential risk impacting mortality were calculated by univariate and multivariate Logistic analyses in order to find distinctive iterns in these severe RTI patients.Results There were 247 RTI patients with post-traumatic ARDS admitted to EICU during the study period.The unadjusted odds ratio(OR)and 95% confidence intervals(CI) of mortality were associated with six risk factors out of 23:APACHE Ⅱ score,duration of trauma factor,pulmonary contusion,aspiration of gastric contents,sepsis and duration of mechanical ventilation.The adjusted ORs with 95% CI were denoted with respect to surviving beyond 96 hours EICU admission(APACHE Ⅱ score,duration of trauma factor,aspiration of gastric contents),APACHE Ⅱ score beyond 20 EICU admission(duration of trauma factor,sepsis,duration of mechanical ventilation)and mechanicaI ventilation beyond 7 days EICU admission

  7. A Severe Acute Respiratory Syndrome extranet: supporting local communication and information dissemination

    Kealey Cathy M

    2005-06-01

    Full Text Available Abstract Background The objective of this study was to explore the use and perceptions of a local Severe Acute Respiratory Syndrome (SARS Extranet and its potential to support future information and communication applications. The SARS Extranet was a single, managed electronic and limited access system to manage local, provincial and other SARS control information. Methods During July, 2003, a web-based and paper-based survey was conducted with 53 SARS Steering Committee members in Hamilton. It assessed the use and perceptions of the Extranet that had been built to support the committee during the SARS outbreak. Before distribution, the survey was user-tested based on a think-aloud protocol, and revisions were made. Quantitative and qualitative questions were asked related to frequency of use of the Extranet, perceived overall usefulness of the resource, rationale for use, potential barriers, strengths and limitations, and potential future uses of the Extranet. Results The response rate was 69.4% (n = 34. Of all respondents, 30 (88.2% reported that they had visited the site, and rated it highly overall (mean = 4.0; 1 = low to 5 = high. However, the site was rated 3.4 compared with other communications strategies used during the outbreak. Almost half of all respondents (44.1% visited the site at least once every few days. The two most common reasons the 30 respondents visited the Extranet were to access SARS Steering Committee minutes (63.3% and to access Hamilton medical advisories (53.3%. The most commonly cited potential future uses for the Extranet were the sending of private emails to public health experts (63.3%, and surveillance (63.3%. No one encountered personal barriers in his or her use of the site, but several mentioned that time and duplication of email information were challenges. Conclusion Despite higher rankings of various communication strategies during the SARS outbreak, such as email, meetings, teleconferences, and other web

  8. CD209L (L-SIGN) is a receptor for severe acute respiratory syndrome coronavirus

    Jeffers, Scott A.; Tusell, Sonia M.; Gillim-Ross, Laura; Hemmila, Erin M.; Achenbach, Jenna E.; Babcock, Gregory J.; Thomas, William D.; Thackray, Larissa B.; Young, Mark D.; Mason, Robert J.; Ambrosino, Donna M.; Wentworth, David E.; DeMartini, James C.; Holmes, Kathryn V.

    2004-01-01

    Angiotensin-converting enzyme 2 (ACE2) is a receptor for SARS-CoV, the novel coronavirus that causes severe acute respiratory syndrome [Li, W. Moore, M. J., Vasilieva, N., Sui, J., Wong, S. K., Berne, M. A., Somasundaran, M., Sullivan, J. L., Luzuriaga, K., Greenough, T. C., et al. (2003) Nature 426, 450–454]. We have identified a different human cellular glycoprotein that can serve as an alternative receptor for SARS-CoV. A human lung cDNA library in vesicular stomatitis virus G pseudotyped retrovirus was transduced into Chinese hamster ovary cells, and the cells were sorted for binding of soluble SARS-CoV spike (S) glycoproteins, S590 and S1180. Clones of transduced cells that bound SARS-CoV S glycoprotein were inoculated with SARS-CoV, and increases in subgenomic viral RNA from 1–16 h or more were detected by multiplex RT-PCR in four cloned cell lines. Sequencing of the human lung cDNA inserts showed that each of the cloned cell lines contained cDNA that encoded human CD209L, a C-type lectin (also called L-SIGN). When the cDNA encoding CD209L from clone 2.27 was cloned and transfected into Chinese hamster ovary cells, the cells expressed human CD209L glycoprotein and became susceptible to infection with SARS-CoV. Immunohistochemistry showed that CD209L is expressed in human lung in type II alveolar cells and endothelial cells, both potential targets for SARS-CoV. Several other enveloped viruses including Ebola and Sindbis also use CD209L as a portal of entry, and HIV and hepatitis C virus can bind to CD209L on cell membranes but do not use it to mediate virus entry. Our data suggest that the large S glycoprotein of SARS-CoV may use both ACE2 and CD209L in virus infection and pathogenesis. PMID:15496474

  9. Respiratory Failure in Acute Organophosphorus Pesticide Self-Poisoning

    Eddleston, Michael; Mohamed, Fahim; Davies, James OJ; Eyer, Peter; Worek, Franz; Sheriff, Mh Rezvi; Buckley, Nick A.

    2006-01-01

    Background: Acute organophosphorus (OP) pesticide poisoning is a major clinical problem in the developing world. Textbooks ascribe most deaths to respiratory failure occurring in one of two distinct clinical syndromes - acute cholinergic respiratory failure or the intermediate syndrome. The delayed failure appears to be due to respiratory muscle weakness, but its pathophysiology is not yet clear.

  10. A hospital outbreak of severe acute respiratory syndrome in Guangzhou,China

    伍卫; 王景峰; 刘品明; 陈为宪; 尹松梅; 江山平; 严励; 詹俊; 陈锡龙; 李建国; 黄子通; 黄洪章

    2003-01-01

    Objective To describe a hospital outbreak of severe acute respiratory syndrome (SARS) and summarize its clinical features and therapeutic approaches.MethodsThe outbreak started with a SARS patient from the community, and a total of 96 people (76 women and 20 men, mean age (29.5±10.3) years, 93.8% of whom were health care workers) who had exposure to this source patient became infected in a short time. Clinical data in this cohort ere collected prospectively as they were identified.Results(1) The incubation period ranged from 1 to 20 (mean: 5.9±3.5) days. The duration of hospitalization was (17.2±8.0) days. (2) The initial temperature was (38.3±0.6)℃, while the highest was (39.2±0.6)℃ (P<0.001), with fever duration of (9.0±4.2) days. (3) Other most common symptoms included fatigue (93.8%), cough (85.4%), mild sputum production (66.7%), chills (55.2%), headache (39.6%), general malaise (35.4%) and myalgia (21.9%). (4) The radiographic changes were predominantly bilateral in the middle or lower lung zones. The number of affected lung fields was 1.2±0.8 on presentation, which increased to 2.9±1.4 after admission (P<0.001). The interval from the eginning of fever to the onset of abnormal chest radiographs was (3.5±2.3) days, which increased in size, extent, and severity to the maximum (6.7±3.5) days later. The time before the lung opacities were basically absorbed was (14.9±7.8) days. (5) Leukopenia was observed In 67.7% of this cohort. The time between the onset of fever and leukopenia was (4.4±2.3) days, with the lowest white blood cell count of (2.80±0.72)×109/L. (6) The lowest arterial oxygen saturation was (94.8±3.1)% with supplementary oxygen. (7) Antibiotical therapies included tetracyclines (91.0%), aminoglycosides (83.3%), quinolones (79.2%); 18.8% of the patients received a combination of tetracyclines and aminoglycosides, while 11.5% received a combination of tetracyclines and quinolones, and

  11. Association between insertion/deletion polymorphism in angiotensin-converting enzyme gene and acute lung injury/acute respiratory distress syndrome: a meta-analysis

    Matsuda Akihisa

    2012-08-01

    Full Text Available Abstract Background A previous meta-analysis reported a positive association between an insertion/deletion (I/D polymorphism in the angiotensin-converting enzyme gene (ACE and the risk of acute lung injury (ALI/acute respiratory distress syndrome (ARDS. Here, we updated this meta-analysis and additionally assessed the association of this polymorphism with ALI/ARDS mortality. Methods We searched electronic databases through October 2011 for the terms “angiotensin-converting enzyme gene”, “acute lung injury”, and “acute respiratory distress syndrome,” and reviewed all studies that reported the relationship of the I/D polymorphism in ACE with ALI/ARDS in humans. Seven studies met the inclusion criteria, comprising 532 ALI/ARDS patients, 3032 healthy controls, and 1432 patients without ALI/ARDS. We used three genetic models: the allele, dominant, and recessive models. Results The ACE I/D polymorphism was not associated with susceptibility to ALI/ARDS for any genetic model. However, the ACE I/D polymorphism was associated with the mortality risk of ALI/ARDS in Asian subjects ( Pallele Pdominant = 0.001, Precessive = 0.002. This finding remained significant after correction for multiple comparisons. Conclusions There is a possible association between the ACE I/D polymorphism genotype and the mortality risk of ALI/ARDS in Asians.

  12. Follow-up after acute respiratory distress syndrome caused by influenza a (H1N1 virus infection

    Carlos Toufen Jr.

    2011-01-01

    Full Text Available BACKGROUND: There are no reports on the long-term follow-up of patients with swine-origin influenza A virus infection that progressed to acute respiratory distress syndrome. METHODS: Four patients were prospectively followed up with pulmonary function tests and high-resolution computed tomography for six months after admission to an intensive care unit. RESULTS: Pulmonary function test results assessed two months after admission to the intensive care unit showed reduced forced vital capacity in all patients and low diffusion capacity for carbon monoxide in two patients. At six months, pulmonary function test results were available for three patients. Two patients continued to have a restrictive pattern, and none of the patients presented with abnormal diffusion capacity for carbon monoxide. All of them had a diffuse ground-glass pattern on high-resolution computed tomography that improved after six months. CONCLUSIONS: Despite the marked severity of lung disease at admission, patients with acute respiratory distress syndrome caused by swine-origin influenza A virus infection presented a late but substantial recovery over six months of follow-up.

  13. Changes in lung parenchyma after acute respiratory distress syndrome (ARDS): assessment with high-resolution computed tomography

    The aim of this study was to evaluate the appearance, extent, and distribution of parenchymal changes in the lung after acute respiratory distress syndrome (ARDS) as a function of disease severity and therapeutic procedures. High-resolution computed tomography (HRCT), clinical examination, and lung function tests were performed in 15 patients, 6-10 months after ARDS. The appearance and extent of parenchymal changes were compared with the severity of ARDS, as well as with clinical and therapeutic data. Lung parenchymal changes resembling those found in the presence of pulmonary fibrosis were observed in 13 of 15 patients (87%). The changes were significantly more frequent and more pronounced in the ventral than in the dorsal portions of the lung (p<0.01). A significant correlation was observed between the extent of lung alterations and the severity of ARDS (p<0.01), and the duration in which patients had received mechanical ventilation either with a peak inspiratory pressure greater than 30 mmHg (p<0.05), or with more than 70% oxygen (p<0.01). Acute respiratory distress syndrome frequently is followed by fibrotic changes in lung parenchyma. The predominantly ventral distribution of these changes indicates that they may be caused by the ventilation regimen and the oxygen therapy rather than by the ARDS. (orig.)

  14. Successful use of inhaled nitric oxide to decrease intracranial pressure in a patient with severe traumatic brain injury complicated by acute respiratory distress syndrome: a role for an anti-inflammatory mechanism?

    Medhkour Azedine; Papadimos Thomas J; Yermal Sooraj

    2009-01-01

    Abstract Use of inhaled nitric oxide in humans with traumatic brain injury and acute respiratory distress syndrome has twice previously been reported to be beneficial. Here we report a third case. We propose that INO may decrease the inflammatory response in patients with increased intracranial pressure caused by traumatic brain injury accompanied by acute respiratory distress syndrome thereby contributing to improved outcomes.

  15. Acute Respiratory Distress Syndrome diagnosis after coronary artery bypass: comparison between diagnostic criteria and clinical picture.

    Manzar Vakili

    2015-01-01

    Full Text Available Acute Respiratory Distress Syndrome (ARDS is a potential complication of cardiac surgery, given that patients undergoing CABG frequently have hypoxemia and pulmonary dysfunction during initial hours after surgery. Thus, ARDS criteria in these patients are more likely to be positive while these criteria may not match the patient`s clinical picture. We aimed to investigate frequency of rapid onset hypoxemia in Pressure of Arterial Oxygen to Fractional Inspired Oxygen Concentration (PaO2/FiO2 less than 200 and diffuse pulmonary infiltrates as two diagnostic criteria forwards and compared these criteria with the clinical picture of the patients after Coronary Artery Bypass Graft (CABG in this study. The study was prospective case series which carried out in about six months. All patients admitted to intensive care unit of Tehran Heart Center, who had undergone CABG on cardiopulmonary pump (CPB recruited in the study. After considering inclusion criteria, age, sex, duration of intubation, arterial blood gas and chest radiography, on 24 hours and 48 hours after admission to the ICU were recorded. Then, patients with rapid onset of hypoxemia (PaO2/FiO2≤200mmHg and diffuse pulmonary infiltrates and without sign or symptoms of obvious heart failure (probable positive ARDS cases criteria were recorded and comparison between these probable positive cases with clinician`s clinical diagnosis (blinded to the study was performed. In this study, a total of 300 patients after on-pump coronary artery bypass surgery were included. Postoperatively, 2 (0.66 % in the 24 hours and 4 (1.33% patients in 48 hours after surgery were positive for the two ARDS criteria according to the checklists, but; nobody had saved persistently ARDS criteria persistently during 48 hours after surgery. At the same time, clinician did not report any case of ARDS among 300 patients. In this study patients with ARDS criteria had no significant differences in age (P.value=0.937 and sex (P

  16. [A case of acute chronic respiratory failure due to fat embolism syndrome after the left femoral neck fracture].

    Oda, Keishi; Kawanami, Toshinori; Yatera, Kazuhiro; Ogoshi, Takaaki; Kozaki, Minako; Nagata, Shuya; Nishida, Chinatsu; Yamasaki, Kei; Ishimoto, Hiroshi; Mukae, Hiroshi

    2011-09-01

    A 78 year old Japanese woman was transferred to our hospital for the treatment of a fracture of the left femoral neck in April, 2010. She had been taking oral corticosteroid (prednisolone 5 mg/day) for the treatment of idiopathic interstitial pneumonia since 2003, and had been treated by home oxygen therapy since 2007. She fell in the restroom at home and hurt herself, and was transferred to our hospital for treatment of a left femoral neck fracture in April, 2010. Her respiratory status was stable just after the transfer; however, she was transferred to the intensive care unit and started to receive mechanical ventilation due to rapidly progressive respiratory failure on the fourth day after admission. Chest X-ray and computed tomography revealed rapid progression of bilateral ground-glass attenuations, and acute exacerbation of interstitial pneumonia was clinically suspected. However, the elevation of D-dimer over time and characteristic findings of petechial hemorrhagic lesions on her palpebral conjunctivae and neck with microscopic findings of phagocytized lipid in alveolar macrophages in her endobronchial secretion led to the diagnosis of fat embolism syndrome. She was successfully treated with high-dose corticosteroid and sivelestat sodium, and she was discharged on the 21st day after admission. Although a differential diagnosis of acute exacerbation of interstitial pneumonia and fat embolism syndrome was necessary and difficult in the present case, characteristic findings of petechial hemorrhagic lesions of skin, palpebral conjunctiva and lipid-laden alveolar macrophages in endotracheal aspirate were useful for the accurate and prompt diagnosis of fat embolism syndrome. PMID:21913383

  17. Use of an oscillatory PEP device to enhance bronchial hygiene in a patient of post-H1NI pneumonia and acute respiratory distress syndrome with pneumothorax

    Narula, Deepali; Nangia, Vivek

    2014-01-01

    A 26-year-old, 14 week pregnant woman was admitted to our hospital with pneumonia with acute respiratory distress syndrome in an intubated and mechanically ventilated state. She was diagnosed to have polymicrobial infection and left-sided pneumothorax and was put on a ventilator for 2 weeks. Postextubation, she found it difficult to clear her respiratory secretions despite aggressive routine chest physiotherapy. She was planned to undergo a mini-tracheostomy for tracheobronchial toileting. Ho...

  18. Roles of neurally adjusted ventilatory assist in improving gas exchange in a severe acute respiratory distress syndrome patient after weaning from extracorporeal membrane oxygenation: a case report

    Goto, Yuya; Katayama, Shinshu; Shono, Atsuko; Mori, Yosuke; Miyazaki, Yuya; Sato, Yoko; Ozaki, Makoto; Kotani, Toru

    2016-01-01

    Background Patient-ventilator asynchrony is a major cause of difficult weaning from mechanical ventilation. Neurally adjusted ventilatory assist (NAVA) is reported useful to improve the synchrony in patients with sustained low lung compliance. However, the role of NAVA has not been fully investigated. Case presentation The patient was a 63-year-old Japanese man with acute respiratory distress syndrome secondary to respiratory infection. He was treated with extracorporeal membrane oxygenation ...

  19. Turning Crisis into Opportunity: Nature of Science and Scientific Inquiry as Illustrated in the Scientific Research on Severe Acute Respiratory Syndrome

    Wong, Siu Ling; Kwan, Jenny; Hodson, Derek; Yung, Benny Hin Wai

    2009-01-01

    Interviews with key scientists who had conducted research on Severe Acute Respiratory Syndrome (SARS), together with analysis of media reports, documentaries and other literature published during and after the SARS epidemic, revealed many interesting aspects of the nature of science (NOS) and scientific inquiry in contemporary scientific research…

  20. Traumatic memories, post-traumatic stress disorder and serum cortisol levels in long-term survivors of the acute respiratory distress syndrome

    Hauer, Daniela; Weis, Florian; Krauseneck, Till; Vogeser, Michael; Schelling, Gustav; Roozendaal, Benno

    2009-01-01

    Survivors of the acute respiratory distress syndrome (ARDS) often report traumatic memories from the intensive care unit (ICU) and display a high incidence of post-traumatic stress disorder (PTSD). As it is known that subjects with PTSD often show sustained reductions in circulating cortisol concent

  1. Severe acute respiratory syndrome coronavirus protein 6 mediates ubiquitin-dependent proteosomal degradation of N-Myc(and STAT) interactor

    Weijia; Cheng; Shiyou; Chen; Ruiling; Li; Yu; Chen; Min; Wang; Deyin; Guo

    2015-01-01

    Severe acute respiratory syndrome coronavirus(SARS-Co V) encodes eight accessory proteins, the functions of which are not yet fully understood. SARS-Co V protein 6(P6) is one of the previously studied accessory proteins that have been documented to enhance viral replication and suppress host interferon(IFN) signaling pathways. Through yeast two-hybrid screening, we identified eight potential cellular P6-interacting proteins from a human spleen c DNA library. For further investigation, we targeted the IFN signaling pathway-mediating protein, N-Myc(and STAT) interactor(Nmi). Its interaction with P6 was confirmed within cells. The results showed that P6 can promote the ubiquitin-dependent proteosomal degradation of Nmi. This study revealed a new mechanism of SARS-Co V P6 in limiting the IFN signaling to promote SARS-Co V survival in host cells.

  2. Scrub Typhus with Acute Respiratory Distress Syndrome (ARDS) and its Management in Intensive Care Unit: A Case Report.

    Sankuratri, Srinivas; Kalagara, Pavani; Samala, Kartika Balaji; Veledandi, Prabhakar Krishna; Atiketi, Srinadh Babu

    2015-05-01

    Scrub typhus is zoonotic disease caused by Orientia tsutsugamushi (O tsutsugamushi). It is transmitted to humans by the bite of trombiculid mite larvae (chiggers). It is a re-emerging infectious disease in India. Clinical manifestations include fever, headache, anorexia, myalgia, eschar, adenopathy and maculopapular rash. Complications of Scrub typhus develop after first week of illness. Complications include meningoencephalitis, jaundice, myocarditis, ARDS and renal failure. Eschar and rash may be unnoticed or absent. Thorough physical examination, identification of eschar/rash throws light in thinking about scrub typhus, treating and preventing further complications. Here, we report a case of scrub typhus with Acute Respiratory Distress Syndrome (ARDS) and its management with non invasive ventilation in the intensive care unit. PMID:26155511

  3. Sleep after critical illness: Study of survivors of acute respiratory distress syndrome and systematic review of literature

    Dhooria, Sahajal; Sehgal, Inderpaul Singh; Agrawal, Anshu Kumar; Agarwal, Ritesh; Aggarwal, Ashutosh Nath; Behera, Digambar

    2016-01-01

    Background and Aims: This study aims to evaluate the sleep quality, architecture, sleep-related quality of life, and sleep-disordered breathing (SDB) in acute respiratory distress syndrome (ARDS) survivors early after discharge. Materials and Methods: In this prospective, observational study, consecutive patients with ARDS discharged from the Intensive Care Unit (ICU) underwent evaluation with Epworth sleepiness scale (ESS), Pittsburgh Sleep Quality Index (PSQI), Functional Outcomes of Sleep Questionnaire (FOSQ), and overnight polysomnography. Patients having one or more of the following characteristics were classified as having abnormal sleep: ESS>10, PSQI>5, FOSQ 10, seven (35%) had global PSQI>5 and one had FOSQ <17.9. Ten (50%) patients had at least one characteristic that suggested abnormal sleep (4 insomnia, 2 central sleep apnea, 1 obstructive sleep apnea, 1 REM-SDB, and 2 with a high PSQI, but no specific sleep abnormality). Conclusions: Sleep disturbances are common in ARDS survivors early after discharge from the ICU. PMID:27390455

  4. Factors Associated with Death Due to 2009 Influenza A (H1N1) Virus Infection and Acute Respiratory Distress Syndrome in Beijing, 2009-2011

    Jin-qian; Zhang; Li-cheng; Zhang; Na; Ren; Ming; Zhang; Li-min; Guo; Xing-wang; Li; Jun; Cheng

    2012-01-01

    Objective Patients with H1N1 virus infection were hospitalized and quarantined, and some of them developed into acute respiratory failure, and were transfered to the medical intensive care unit of Beijing Ditan Hospital, Capital Medical University in Beijing, China. Methods The clinical features and preliminary epidemiologic findings among 30 patients with confirmed H1N1 virus infection who developed into acute respiratory failure for ventilatory support were investigated. Results A total of 30 patients(37.43 ± 18.80 years old) with 2009 influenza A(H1N1) related acute respiratory distress syndrome(ARDS) received treatment with mechanical ventilation, 15 cases of whom were male and 17 cases died of ARDS. Fatal cases were significantly associated with an APACHE Ⅱ score(P = 0.016), but not with PaO 2 /FIO 2(P = 0.912) and chest radiograph(P = 0.333). The most common complication was acute renal failure(n = 9). Five patients received extracorporeal membrane oxygenation(ECMO), 3 of whom died and the others survived. The major causes of death were multiple organ dysfunction syndrome(MODS)(39%), intractable respiratory failure(27%) and sepsis(20%). Conclusions Most patients with respiratory failure due to influenza A(H1N1) virus infection were young, with a high mortality, particularly associated with APACHE Ⅱ score, secondary infection of lung or type 2 diabetes mellitus.

  5. Comparative Study of pressure-control ventilation and volume-control ventilation in treating traumatic acute respiratory distress syndrome

    杨云梅; 黄卫东; 沈美亚; 徐哲荣

    2005-01-01

    Objective: To observe the clinical therapeutic effect and side effect of pressure-control ventilation (PCV) on traumatic acute respiratory distress syndrome (ARDS) compared with volume-control ventilation (VCV).Methods: Forty patients with traumatic ARDS were hospitalized in our department from June 1996 to December 2002. Twenty were treated with PCV (PCV group) and 20 with VCV (VCV group). The changes of the peak inflating pressure and the mean pressure of the airway were observed at the very beginning of the mechanical ventilation and the following 12 and 24 hours, respectively. The transcutaneous saturation of oxygen pressure, the pressure of oxygen in artery, the mean blood pressure, the central venous pressure, the heart rate and the incidence of the pressure injury were also monitored before ventilation and 12 hours after ventilation.Results: The pressure of oxygen in artery, the transcutaneous saturation of oxygen pressure, the heart rate and the respiratory rate in the PCV group were obviously improved after ventilation treatment. The peak inflating pressure, the mean pressure of the airway and the central venous pressure in the PCV group were lower than in the VCV group. The incidence of pressure injury was 0 in the PCV group while 10% in the VCV group. Conclusions: The clinical effect of PCV on traumatic ARDS is better and the incidence rate of pressure injury is lower than that of VCV. PCV has minimal effects on the hemodynamics.

  6. Positive end expiratory pressure titrated by transpulmonary pressure improved oxygenation and respiratory mechanics in acute respiratory distress syndrome patients with intra-abdominal hypertension

    YANG Yi; LI Yang; LIU Song-qiao; LIU Ling; HUANG Ying-zi; GUO Feng-mei; QIU Hai-bo

    2013-01-01

    Background Intra-abdominal hypertension (IAH) is common in acute respiratory distress syndrome (ARDS) patients and when resulting in decrease of chest wall compliance will weaken the effect of positive end expiratory pressure (PEEP).We investigated the effect of PEEP titrated by transpulmonary pressure (Ptp) on oxygenation and respiratory mechanics in ARDS patients with IAH compared with PEEP titrated by ARDSnet protocol.Methods ARDS patients admitted to the intensive care unit (ICU) of the Zhongda Hospital were enrolled.Patients were ventilated with volume control mode with tidal volume of 6 ml/kg under two different PEEP levels titrated by Ptp method and ARDSnet protocol.Respiratory mechanics,gas exchange and haemodynamics were measured after 30 minutes of ventilation in each round.IAH was defined as intra-abdominal pressure of 12 mmHg or more.Results Seven ARDS patients with IAH and 8 ARDS patients without IAH were enrolled.PEEP titrated by Ptp were significant higher than PEEP titrated by ARDSnet protocol in both ARDS patients with IAH ((17.3±2.6) cmH2O vs.(6.3±1.6)cmH2O and without IAH ((9.5±2.1) cmH2O vs.(7.8±1.9) cmH2O).Arterial pressure of O2/fraction of inspired oxygen (PaO2/FiO2)was much higher under PEEP titrated by Ptp when compared with PEEP titrated by ARDSnet protocol in ARDS patients with IAH ((27.2±4.0) cmHg vs.(20.9± 5.0) cmHg.But no significant difference of PaO2/FiO2 between the two methods was found in ARDS patients without IAH.In ARDS patients with IAH,static compliance of lung and respiratory system were higher under PEEP titrated by Ptp than by ARDSnet protocol.In ARDS patients with IAH,central venous pressure (CVP) was higher during PEEP titrated by Ptp than byARDSnet protocol.Conclusion Positive end expiratory pressure titrated by transpulmonary pressure was higher than PEEP titrated by ARDSnet protocol and improved oxygenation and respiratory mechanics in ARDS patients with IAH.

  7. A Markov computer simulation model of the economics of neuromuscular blockade in patients with acute respiratory distress syndrome

    Chow John L

    2006-03-01

    Full Text Available Abstract Background Management of acute respiratory distress syndrome (ARDS in the intensive care unit (ICU is clinically challenging and costly. Neuromuscular blocking agents may facilitate mechanical ventilation and improve oxygenation, but may result in prolonged recovery of neuromuscular function and acute quadriplegic myopathy syndrome (AQMS. The goal of this study was to address a hypothetical question via computer modeling: Would a reduction in intubation time of 6 hours and/or a reduction in the incidence of AQMS from 25% to 21%, provide enough benefit to justify a drug with an additional expenditure of $267 (the difference in acquisition cost between a generic and brand name neuromuscular blocker? Methods The base case was a 55 year-old man in the ICU with ARDS who receives neuromuscular blockade for 3.5 days. A Markov model was designed with hypothetical patients in 1 of 6 mutually exclusive health states: ICU-intubated, ICU-extubated, hospital ward, long-term care, home, or death, over a period of 6 months. The net monetary benefit was computed. Results Our computer simulation modeling predicted the mean cost for ARDS patients receiving standard care for 6 months to be $62,238 (5% – 95% percentiles $42,259 – $83,766, with an overall 6-month mortality of 39%. Assuming a ceiling ratio of $35,000, even if a drug (that cost $267 more hypothetically reduced AQMS from 25% to 21% and decreased intubation time by 6 hours, the net monetary benefit would only equal $137. Conclusion ARDS patients receiving a neuromuscular blocker have a high mortality, and unpredictable outcome, which results in large variability in costs per case. If a patient dies, there is no benefit to any drug that reduces ventilation time or AQMS incidence. A prospective, randomized pharmacoeconomic study of neuromuscular blockers in the ICU to asses AQMS or intubation times is impractical because of the highly variable clinical course of patients with ARDS.

  8. Kerbs von Lungren 6 antigen is a marker of alveolar inflammation but not of infection in patients with acute respiratory distress syndrome

    Nathani, Nazim; Perkins, Gavin D; Tunnicliffe, William; Murphy, Nick; Manji, Mav; Thickett, David R.

    2008-01-01

    Background Kerbs von Lungren 6 antigen (KL-6) is expressed on the surface of alveolar type II cells, and elevated plasma and epithelial lining fluid levels of KL-6 have previously been shown to correlate with the severity of disease and survival in acute respiratory distress syndrome (ARDS). The relationship between alveolar inflammation and KL-6 measurements has not been ascertained. We hypothesized that the elevation of KL-6 in ARDS is dependent upon the severity of neutrophilic inflammatio...

  9. Monitoring extravascular lung water in acute respiratory distress syndrome induced by probable 2009 pandemic influenza A (H1N1) virus: report of two cases

    LI Hong-liang; WANG Zong-yu; YAO Gai-qi; ZHU Xi

    2010-01-01

    @@ During the spring of 2009, a pandemic novel influenza A (H1N1) vims emerged and spread globally. As of January 3, 2009, more than 208 countries and overseas territories or communities have reported laboratory-confirmed cases of pandemic influenza H1N1 2009, including at least 12 799 death cases.1 Critical cases developed severe acute respiratory distress syndrome (ARDS) rapidly, which was refractory to conventional mechanical ventilation and rescue therapies.

  10. NOX1 is responsible for cell death through STAT3 activation in hyperoxia and is associated with the pathogenesis of Acute Respiratory Distress Syndrome

    Carnesecchi, Stephanie; Dunand-Sauthier, Isabelle; Zanetti, Filippo; Singovski, Grigory; Deffert, Christine; Donati, Yves; Cagarelli, Thomas; Pache, Jean-Claude; Krause, Karl-Heinz; Reith, Walter; Barazzone-Argiroffo, Constance

    2014-01-01

    Reactive oxygen species (ROS) contribute to alveolar cell death in Acute Respiratory Distress Syndrome (ARDS) and we previously demonstrated that NOX1-derived ROS contributed to hyperoxia-induced alveolar cell death in mice. The study investigates whether NOX1 expression is modulated in epithelial cells concomitantly to cell death and associated to STAT3 signaling in the exudative phase of ARDS. In addition, the role of STAT3 activation in NOX1-dependent epithelial cell death was confirmed by...

  11. The Severe Acute Respiratory Syndrome (SARS-coronavirus 3a protein may function as a modulator of the trafficking properties of the spike protein

    Tan Yee-Joo

    2005-02-01

    Full Text Available Abstract Background A recent publication reported that a tyrosine-dependent sorting signal, present in cytoplasmic tail of the spike protein of most coronaviruses, mediates the intracellular retention of the spike protein. This motif is missing from the spike protein of the severe acute respiratory syndrome-coronavirus (SARS-CoV, resulting in high level of surface expression of the spike protein when it is expressed on its own in vitro. Presentation of the hypothesis It has been shown that the severe acute respiratory syndrome-coronavirus genome contains open reading frames that encode for proteins with no homologue in other coronaviruses. One of them is the 3a protein, which is expressed during infection in vitro and in vivo. The 3a protein, which contains a tyrosine-dependent sorting signal in its cytoplasmic domain, is expressed on the cell surface and can undergo internalization. In addition, 3a can bind to the spike protein and through this interaction, it may be able to cause the spike protein to become internalized, resulting in a decrease in its surface expression. Testing the hypothesis The effects of 3a on the internalization of cell surface spike protein can be examined biochemically and the significance of the interplay between these two viral proteins during viral infection can be studied using reverse genetics methodology. Implication of the hypothesis If this hypothesis is proven, it will indicate that the severe acute respiratory syndrome-coronavirus modulates the surface expression of the spike protein via a different mechanism from other coronaviruses. The interaction between 3a and S, which are expressed from separate subgenomic RNA, would be important for controlling the trafficking properties of S. The cell surface expression of S in infected cells significantly impacts viral assembly, viral spread and viral pathogenesis. Modulation by this unique pathway could confer certain advantages during the replication of the severe

  12. Intracellular Localization of the Severe Acute Respiratory Syndrome Coronavirus Nucleocapsid Protein: Absence of Nucleolar Accumulation during Infection and after Expression as a Recombinant Protein in Vero Cells

    Rowland, Raymond R. R.; Chauhan, Vinita; Fang, Ying; Pekosz, Andrew; Kerrigan, Maureen; Burton, Miriam D.

    2005-01-01

    The nucleocapsid (N) protein of several members within the order Nidovirales localizes to the nucleolus during infection and after transfection of cells with N genes. However, confocal microscopy of N protein localization in Vero cells infected with the severe acute respiratory syndrome coronavirus (SARS-CoV) or transfected with the SARS-CoV N gene failed to show the presence of N in the nucleoplasm or nucleolus. Amino acids 369 to 389, which contain putative nuclear localization signal (NLS)...

  13. Administration of intrapulmonary sodium polyacrylate to induce lung injury for the development of a porcine model of early acute respiratory distress syndrome

    Henderson, William R.; Barnbrook, Julian; Dominelli, Paolo B.; Griesdale, Donald EG; Arndt, Tara; Molgat-Seon, Yannick; Foster, Glen; Ackland, Gareth L; Xu, James; Ayas, Najib T.; Sheel, Andrew W.

    2014-01-01

    Background The loss of alveolar epithelial and endothelial integrity is a central component in acute respiratory distress syndrome (ARDS); however, experimental models investigating the mechanisms of epithelial injury are lacking. The purpose of the present study was to design and develop an experimental porcine model of ARDS by inducing lung injury with intrapulmonary administration of sodium polyacrylate (SPA). Methods The present study was performed at the Centre for Comparative Medicine, ...

  14. Increased Risk of Post-Trauma Stroke after Traumatic Brain Injury-Induced Acute Respiratory Distress Syndrome.

    Chen, Gunng-Shinng; Liao, Kuo-Hsing; Bien, Mauo-Ying; Peng, Giia-Sheun; Wang, Jia-Yi

    2016-07-01

    This study determines whether acute respiratory distress syndrome (ARDS) is an independent risk factor for an increased risk of post-traumatic brain injury (TBI) stroke during 3-month, 1-year, and 5-year follow-ups, respectively, after adjusting for other covariates. Clinical data for the analysis were from the National Health Insurance Database 2000, which covered a total of 2121 TBI patients and 101 patients with a diagnosis of TBI complicated with ARDS (TBI-ARDS) hospitalized between January 1, 2001 and December 31, 2005. Each patient was tracked for 5 years to record stroke occurrences after discharge from the hospital. The prognostic value of TBI-ARDS was evaluated using a multivariate Cox proportional hazard model. The main outcome found that stroke occurred in nearly 40% of patients with TBI-ARDS, and the hazard ratio for post-TBI stroke increased fourfold during the 5-year follow-up period after adjusting for other covariates. The increased risk of hemorrhagic stroke in the ARDS group was considerably higher than in the TBI-only cohort. This is the first study to report that post-traumatic ARDS yielded an approximate fourfold increased risk of stroke in TBI-only patients. We suggest intensive and appropriate medical management and intensive follow-up of TBI-ARDS patients during the beginning of the hospital discharge. PMID:26426583

  15. Short Term Outcome and Risk Factors for Mortality in Adults with Critical Severe Acute Respiratory Syndrome (SARS)

    胡先明; 邓勇志; 王峻; 李和平; 李梅; 卢祖洵

    2004-01-01

    The independent risk factors to predict mortality of critical severe acute respiratory syndrome (SARS) were investigated. One hundred and two patients diagnosed with critical SARS were admitted to hospitals of Shanxi Province, from March 7, 2003 to June 4, 2003. The patients were prospectively studied after admission to access their short term outcomes and the risk factors associated with adverse outcomes, defined as death. All the demographic and clinical characteristics were studied and univariate and multivariate Logistic regression were employed to access the risk factors.The results showed that of the 102 cases, 23 patients died, with a crude mortality rate of 22.5%.Multivariate Logistic regression revealed that age above 50 [odds ratio (OR) 1.10, 95 % confidence internal (CI) 1.03 to 1. 16, P=0. 004], lymphopenia at early stage (OR 14.62, 95 % CI 1.78 to 11.97, P= 0.01) were independently associated with mortality. On the other side, psychotherapy (OR 0.01, 95 % CI 0.00 to 0.06, P<0.001) was independently associated with aliveness. It was concluded that critical SARS is a new disease entity that carries significant mortality and morbidity. Specific clinical and laboratory parameters predicting unfavorable and favorable outcomes have been identified.

  16. Comparison of initial high resolution computed tomography features in viral pneumonia between metapneumovirus infection and severe acute respiratory syndrome

    Objective: To review and compare initial high resolution computed tomography (HRCT) findings in patients with metapneumovirus pneumonia and severe acute respiratory syndrome (SARS-Coronovirus). Materials and methods: 4 cases of metapneumovirus pneumonia (mean age of 52.3 years) in an institutional outbreak (Castle Peak Hospital) in 2008 and 38 cases of SARS-coronovirus (mean age of 39.6 years) admitted to Tuen Mun hospital during an epidemic outbreak in 2003 were included. HRCT findings of the lungs for all patients were retrospectively reviewed by two independent radiologists. Results: In the metapneumovirus group, common HRCT features were ground glass opacities (100%), consolidation (100%), parenchymal band (100%), bronchiectasis (75%). Crazy paving pattern was absent. They were predominantly subpleural and basal in location and bilateral involvement was observed in 50% of patients. In the SARS group, common HRCT features were ground glass opacities (92.1%), interlobular septal thickening (86.8%), crazy paving pattern (73.7%) and consolidation (68%). Bronchiectasis was not seen. Majority of patient demonstrated segmental or lobar in distribution and bilateral involvement was observed in 44.7% of patients. Pleural effusion and lymphadenopathy were of consistent rare features in both groups. Conclusion: Ground glass opacities, interlobular septal thickening and consolidations were consistent HRCT manifestations in both metapneumovirus infection and SARS. The presence of bronchiectasis (0% in SARS) may point towards metapneumovirus while crazy paving pattern is more suggestive of SARS.

  17. INTERRELATIONS BETWEEN NEUTRO PHIL ENZYMES AND THEIR INHIBITORS IN PATHOGENESIS OF ACUTE RESPIRATORY DISTRESS SYNDROME ASSOCIATED WITH INFLUENZA PNEUMONIA

    E. V. Prutkina

    2012-01-01

    Full Text Available Abstract. Amounts of several neutrophil enzymes (elastase, myeloperoxidase (MPO, MMP-2 and their local inhibitors, i.e., Clara cell protein (CC16 and HSP-70, have been determined in blood plasma from fifty-two patients with various forms of influenza A/H1N1. Sixteen patients have developed acute respiratory distress syndrome (ARDS. In cases of uncomplicated influenza, elastase and MPO levels were shown to be increased, while MMP-2 levels did not change, along with higher contents of HSP-70 and unchanged CC16 amounts. Upon development of influenza-associated pneumonia, elastase and MPO concentrations became elevated, whereas MMP-2 levels were decreased, along with unchanged amounts of CC16 and HSP-70. In cases of ARDS development, CC16 amounts exhibited a sharp decrease. Meanwhile, contents of other proteins remained at the levels shown for pneumonia patients. It has been shown that increased concentrations of neutrophil elastase and MPO with a relative CC16 deficiency and decreased MMP-2 may represent a mechanism of pneumonia development. Decreased CC16 concentration may serve as a risk predictor of ARDS development.

  18. Retroviruses Pseudotyped with the Severe Acute Respiratory Syndrome Coronavirus Spike Protein Efficiently Infect Cells Expressing Angiotensin-Converting Enzyme 2

    Moore, Michael J.; Dorfman, Tatyana; Li, Wenhui; Wong, Swee Kee; Li, Yanhan; Kuhn, Jens H.; Coderre, James; Vasilieva, Natalya; Han, Zhongchao; Greenough, Thomas C.; Farzan, Michael; Choe, Hyeryun

    2004-01-01

    Infection of receptor-bearing cells by coronaviruses is mediated by their spike (S) proteins. The coronavirus (SARS-CoV) that causes severe acute respiratory syndrome (SARS) infects cells expressing the receptor angiotensin-converting enzyme 2 (ACE2). Here we show that codon optimization of the SARS-CoV S-protein gene substantially enhanced S-protein expression. We also found that two retroviruses, simian immunodeficiency virus (SIV) and murine leukemia virus, both expressing green fluorescent protein and pseudotyped with SARS-CoV S protein or S-protein variants, efficiently infected HEK293T cells stably expressing ACE2. Infection mediated by an S-protein variant whose cytoplasmic domain had been truncated and altered to include a fragment of the cytoplasmic tail of the human immunodeficiency virus type 1 envelope glycoprotein was, in both cases, substantially more efficient than that mediated by wild-type S protein. Using S-protein-pseudotyped SIV, we found that the enzymatic activity of ACE2 made no contribution to S-protein-mediated infection. Finally, we show that a soluble and catalytically inactive form of ACE2 potently blocked infection by S-protein-pseudotyped retrovirus and by SARS-CoV. These results permit studies of SARS-CoV entry inhibitors without the use of live virus and suggest a candidate therapy for SARS. PMID:15367630

  19. Efficient Replication of Severe Acute Respiratory Syndrome Coronavirus in Mouse Cells Is Limited by Murine Angiotensin-Converting Enzyme 2

    Li, Wenhui; Greenough, Thomas C.; Moore, Michael J.; Vasilieva, Natalya; Somasundaran, Mohan; Sullivan, John L.; Farzan, Michael; Choe, Hyeryun

    2004-01-01

    Replication of viruses in species other than their natural hosts is frequently limited by entry and postentry barriers. The coronavirus that causes severe acute respiratory syndrome (SARS-CoV) utilizes the receptor angiotensin-converting enzyme 2 (ACE2) to infect cells. Here we compare human, mouse, and rat ACE2 molecules for their ability to serve as receptors for SARS-CoV. We found that, compared to human ACE2, murine ACE2 less efficiently bound the S1 domain of SARS-CoV and supported less-efficient S protein-mediated infection. Rat ACE2 was even less efficient, at near background levels for both activities. Murine 3T3 cells expressing human ACE2 supported SARS-CoV replication, whereas replication was less than 10% as efficient in the same cells expressing murine ACE2. These data imply that a mouse transgenically expressing human ACE2 may be a useful animal model of SARS. PMID:15452268

  20. Absence of association between angiotensin converting enzyme polymorphism and development of adult respiratory distress syndrome in patients with severe acute respiratory syndrome: a case control study

    Chiu Rossa WK

    2005-04-01

    Full Text Available Abstract Background It has been postulated that genetic predisposition may influence the susceptibility to SARS-coronavirus infection and disease outcomes. A recent study has suggested that the deletion allele (D allele of the angiotensin converting enzyme (ACE gene is associated with hypoxemia in SARS patients. Moreover, the ACE D allele has been shown to be more prevalent in patients suffering from adult respiratory distress syndrome (ARDS in a previous study. Thus, we have investigated the association between ACE insertion/deletion (I/D polymorphism and the progression to ARDS or requirement of intensive care in SARS patients. Method One hundred and forty genetically unrelated Chinese SARS patients and 326 healthy volunteers were recruited. The ACE I/D genotypes were determined by polymerase chain reaction and agarose gel electrophoresis. Results There is no significant difference in the genotypic distributions and the allelic frequencies of the ACE I/D polymorphism between the SARS patients and the healthy control subjects. Moreover, there is also no evidence that ACE I/D polymorphism is associated with the progression to ARDS or the requirement of intensive care in the SARS patients. In multivariate logistic analysis, age is the only factor associated with the development of ARDS while age and male sex are independent factors associated with the requirement of intensive care. Conclusion The ACE I/D polymorphism is not directly related to increased susceptibility to SARS-coronavirus infection and is not associated with poor outcomes after SARS-coronavirus infection.

  1. Extremes of Interferon-Stimulated Gene Expression Associate with Worse Outcomes in the Acute Respiratory Distress Syndrome.

    Nick, Jerry A; Caceres, Silvia M; Kret, Jennifer E; Poch, Katie R; Strand, Matthew; Faino, Anna V; Nichols, David P; Saavedra, Milene T; Taylor-Cousar, Jennifer L; Geraci, Mark W; Burnham, Ellen L; Fessler, Michael B; Suratt, Benjamin T; Abraham, Edward; Moss, Marc; Malcolm, Kenneth C

    2016-01-01

    Acute Respiratory Distress Syndrome (ARDS) severity may be influenced by heterogeneity of neutrophil activation. Interferon-stimulated genes (ISG) are a broad gene family induced by Type I interferons, often as a response to viral infections, which evokes extensive immunomodulation. We tested the hypothesis that over- or under-expression of immunomodulatory ISG by neutrophils is associated with worse clinical outcomes in patients with ARDS. Genome-wide transcriptional profiles of circulating neutrophils isolated from patients with sepsis-induced ARDS (n = 31) and healthy controls (n = 19) were used to characterize ISG expression. Hierarchical clustering of expression identified 3 distinct subject groups with Low, Mid and High ISG expression. ISG accounting for the greatest variability in expression were identified (MX1, IFIT1, and ISG15) and used to analyze a prospective cohort at the Colorado ARDS Network site. One hundred twenty ARDS patients from four urban hospitals were enrolled within 72 hours of initiation of mechanical ventilation. Circulating neutrophils were isolated from patients and expression of ISG determined by PCR. Samples were stratified by standard deviation from the mean into High (n = 21), Mid, (n = 82) or Low (n = 17) ISG expression. Clinical outcomes were compared between patients with High or Low ISG expression to those with Mid-range expression. At enrollment, there were no differences in age, gender, co-existing medical conditions, or type of physiologic injury between cohorts. After adjusting for age, race, gender and BMI, patients with either High or Low ISG expression had significantly worse clinical outcomes than those in the Mid for number of 28-day ventilator- and ICU-free days (P = 0.0006 and 0.0004), as well as 90-day mortality and 90-day home with unassisted breathing (P = 0.02 and 0.004). These findings suggest extremes of ISG expression by circulating neutrophils from ARDS patients recovered early in the syndrome are associated

  2. A specific phospholipase C activity regulates phosphatidylinositol levels in lung surfactant of patients with acute respiratory distress syndrome.

    Spyridakis, Spyros; Leondaritis, George; Nakos, George; Lekka, Marilena E; Galanopoulou, Dia

    2010-03-01

    Lung surfactant (LS) is a lipid-rich material lining the inside of the lungs. It reduces surface tension at the liquid/air interface and thus, it confers protection of the alveoli from collapsing. The surface-active component of LS is dipalmitoyl-phosphatidylcholine, while anionic phospholipids such as phosphatidylinositol (PtdIns) and primarily phosphatidylglycerol are involved in the stabilization of the LS monolayer. The exact role of PtdIns in this system is not well-understood; however, PtdIns levels change dramatically during the acute respiratory distress syndrome (ARDS) evolution. In this report we present evidence of a phosphoinositide-specific phospholipase C (PI-PLC) activity in bronchoalveolar lavage (BAL) fluid, which may regulate PtdIns levels. Characterization of this extracellular activity showed specificity for PtdIns and phosphatidylinositol 4,5-bisphosphate, sharing the typical substrate concentration-, pH-, and calcium-dependencies with mammalian PI-PLCs. Fractionation of BAL fluid showed that PI-PLC did not co-fractionate with large surfactant aggregates, but it was found mainly in the soluble fraction. Importantly, analysis of BAL samples from control subjects and from patients with ARDS showed that the PI-PLC specific activity was decreased by 4-fold in ARDS samples concurrently with the increase in BAL PtdIns levels. Thus, we have identified for the first time an extracellular PI-PLC enzyme activity that may be acutely involved in the regulation of PtdIns levels in LS. PMID:19491339

  3. A conceptual framework: the early and late phases of skeletal muscle dysfunction in the acute respiratory distress syndrome.

    Files, D Clark; Sanchez, Michael A; Morris, Peter E

    2015-01-01

    Patients with acute respiratory distress syndrome (ARDS) often develop severe diaphragmatic and limb skeletal muscle dysfunction. Impaired muscle function in ARDS is associated with increased mortality, increased duration of mechanical ventilation, and functional disability in survivors. In this review, we propose that muscle dysfunction in ARDS can be categorized into an early and a late phase. These early and late phases are based on the timing in relationship to lung injury and the underlying mechanisms. The early phase occurs temporally with the onset of lung injury, is driven by inflammation and disuse, and is marked predominantly by muscle atrophy from increased protein degradation. The ubiquitin-proteasome, autophagy, and calpain-caspase pathways have all been implicated in early-phase muscle dysfunction. Late-phase muscle weakness persists in many patients despite resolution of lung injury and cessation of ongoing acute inflammation-driven muscle atrophy. The clinical characteristics and mechanisms underlying late-phase muscle dysfunction do not involve the massive protein degradation and atrophy of the early phase and may reflect a failure of the musculoskeletal system to regain homeostatic balance. Owing to these underlying mechanistic differences, therapeutic interventions for treating muscle dysfunction in ARDS may differ during the early and late phases. Here, we review clinical and translational investigations of muscle dysfunction in ARDS, placing them in the conceptual framework of the early and late phases. We hypothesize that this conceptual model will aid in the design of future mechanistic and clinical investigations of the skeletal muscle system in ARDS and other critical illnesses. PMID:26134116

  4. Bayesian inference of the lung alveolar spatial model for the identification of alveolar mechanics associated with acute respiratory distress syndrome

    Christley, Scott; Emr, Bryanna; Ghosh, Auyon; Satalin, Josh; Gatto, Louis; Vodovotz, Yoram; Nieman, Gary F.; An, Gary

    2013-06-01

    Acute respiratory distress syndrome (ARDS) is acute lung failure secondary to severe systemic inflammation, resulting in a derangement of alveolar mechanics (i.e. the dynamic change in alveolar size and shape during tidal ventilation), leading to alveolar instability that can cause further damage to the pulmonary parenchyma. Mechanical ventilation is a mainstay in the treatment of ARDS, but may induce mechano-physical stresses on unstable alveoli, which can paradoxically propagate the cellular and molecular processes exacerbating ARDS pathology. This phenomenon is called ventilator induced lung injury (VILI), and plays a significant role in morbidity and mortality associated with ARDS. In order to identify optimal ventilation strategies to limit VILI and treat ARDS, it is necessary to understand the complex interplay between biological and physical mechanisms of VILI, first at the alveolar level, and then in aggregate at the whole-lung level. Since there is no current consensus about the underlying dynamics of alveolar mechanics, as an initial step we investigate the ventilatory dynamics of an alveolar sac (AS) with the lung alveolar spatial model (LASM), a 3D spatial biomechanical representation of the AS and its interaction with airflow pressure and the surface tension effects of pulmonary surfactant. We use the LASM to identify the mechanical ramifications of alveolar dynamics associated with ARDS. Using graphical processing unit parallel algorithms, we perform Bayesian inference on the model parameters using experimental data from rat lung under control and Tween-induced ARDS conditions. Our results provide two plausible models that recapitulate two fundamental hypotheses about volume change at the alveolar level: (1) increase in alveolar size through isotropic volume change, or (2) minimal change in AS radius with primary expansion of the mouth of the AS, with the implication that the majority of change in lung volume during the respiratory cycle occurs in the

  5. Bayesian inference of the lung alveolar spatial model for the identification of alveolar mechanics associated with acute respiratory distress syndrome

    Acute respiratory distress syndrome (ARDS) is acute lung failure secondary to severe systemic inflammation, resulting in a derangement of alveolar mechanics (i.e. the dynamic change in alveolar size and shape during tidal ventilation), leading to alveolar instability that can cause further damage to the pulmonary parenchyma. Mechanical ventilation is a mainstay in the treatment of ARDS, but may induce mechano-physical stresses on unstable alveoli, which can paradoxically propagate the cellular and molecular processes exacerbating ARDS pathology. This phenomenon is called ventilator induced lung injury (VILI), and plays a significant role in morbidity and mortality associated with ARDS. In order to identify optimal ventilation strategies to limit VILI and treat ARDS, it is necessary to understand the complex interplay between biological and physical mechanisms of VILI, first at the alveolar level, and then in aggregate at the whole-lung level. Since there is no current consensus about the underlying dynamics of alveolar mechanics, as an initial step we investigate the ventilatory dynamics of an alveolar sac (AS) with the lung alveolar spatial model (LASM), a 3D spatial biomechanical representation of the AS and its interaction with airflow pressure and the surface tension effects of pulmonary surfactant. We use the LASM to identify the mechanical ramifications of alveolar dynamics associated with ARDS. Using graphical processing unit parallel algorithms, we perform Bayesian inference on the model parameters using experimental data from rat lung under control and Tween-induced ARDS conditions. Our results provide two plausible models that recapitulate two fundamental hypotheses about volume change at the alveolar level: (1) increase in alveolar size through isotropic volume change, or (2) minimal change in AS radius with primary expansion of the mouth of the AS, with the implication that the majority of change in lung volume during the respiratory cycle occurs in the

  6. Rapid loss of both CD4+ and CD8+ T lymphocyte subsets during the acute phase of severe acute respiratory syndrome

    李太生; 邱志峰; 韩扬; 王仲; 范宏伟; 吕玮; 谢静; 马小军; 王爱霞

    2003-01-01

    Objective To study the alteration of peripheral lymphocyte subsets in severe acute respiratory syndrome (SARS) patients and to help improve the early diagnosis of the disease. Methods Anti-coagulating blood samples from 98 SARS patients in the acute phase, 56 normal healthy blood donors, and from patients infected by HIV, CMV and EBV were collected. The T lymphocyte subsets were counted by flow cytometry using fluorescence-labeled specific monoclonal antibodies. Results A significant decrease was observed in all SARS patients in their peripheral CD4+ and CD8+ T lymphocyte absolute counts [256(104)×106/L and 256 (117)×106/L, respectively], which were also lower than those of the patients infected with HIV, CMV and EBV. All patients infected with HIV, CMV and EBV had significantly higher CD8+ T lymphocyte counts in comparison with normal controls. Conclusions Decrease of both CD4+ and CD8+ T lymphocytes of patients is related to onset of SARS. T lymphocyte subset analysis would help improve the early diagnosis of the disease.

  7. PCR use in miliary tuberculosis presenting with acute respiratory distress syndrome

    Riachy, Moussa Albert

    2011-01-01

    A 30-year-old pregnant woman admitted to the hospital for rapidly progressive dyspnoea, non-productive cough and altered general status evolving over 1-month period. Her vital signs showed a low blood pressure 90/60 mm Hg, pulse rate 100 beats/min, respiratory rate 32 breaths/min and oxygen saturation on room air of 88%. Laboratory findings showed haemoglobin 9.7 g/dl, white blood cells 15 000/mm3 (neutrophils 82%), C reactive protein 74 mg/l, alkaline phosphatase 320 U/l, alanine aminotransf...

  8. ACUTE ATAXIA, TAKING PLACE AFTER ACUTE RESPIRATORY VIRAL INFECTION IN 2 Y. O. GIRL, AS A DEBUT NEUROLOGIC SIGN OF THE ANGELMAN SYNDROME

    E. B. Voropanova

    2015-04-01

    Full Text Available Angleman syndrome (АS – is a chromosomal syndrome, which is manifested through atypical autism with feeble minding, epilepsy, outrage of the speech development, movement disorders, ataxia, as well as special (happy behavior of patients, combined with outbursts of laugh. The disease is caused by the mutation of 15q11.2–13 maternal locus or by the gene of UBE3A ubiquitinated complex. Such genes regulate the functional activity of hippocampus neurons, of olfactory bulbs, of the parastriate cortex, of the tentorium. We demonstrate the atypical AS case, which clinical presentation developed after acute respiratory viral infection with febrile temperature. The disease started with episodes of acute ataxia, interrupting daily activities of the child. Step by step the speech development was regressing – several words have fallen out,leaving the space for babbling sounds. Also appeared stereotypic movements of upper extremities (bending of arms in elbow joints, its retraction and joggling of hands, unmotivated laugh. Due to the nonrelevant starting presentation in the acute period following conditions were differentially diagnosed: 1 opsoclonus-myoclonus syndrome; 2 cerebral circulation diseases; 3 epilepsy with absences and atonic attacks; 4 paroxysmal dyskenisias and ataxias; 5 start of the neurodegenerative disease; 6 early childhood autism. Results of laboratory research allowed to exclude opsoclonus-myoclonus, the magnetic and resonance tomography and vessels research allowed to exclude the cerebrovascular pathology. Changes, revealed in the course of the videoelectroencephalographic monitoring, as well as anamnesis data (clinical symptoms after fever allowed to narrow the diagnostic search; AS suspected. Provided the combination of ataxia with movement disorders, it was decided to carry out not molecular & genetic, but also micromatrix analysis, in order to exclude the channelopathy, as well as other genetic reasons. The method of

  9. Glycopeptide Antibiotics Potently Inhibit Cathepsin L in the Late Endosome/Lysosome and Block the Entry of Ebola Virus, Middle East Respiratory Syndrome Coronavirus (MERS-CoV), and Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV).

    Zhou, Nan; Pan, Ting; Zhang, Junsong; Li, Qianwen; Zhang, Xue; Bai, Chuan; Huang, Feng; Peng, Tao; Zhang, Jianhua; Liu, Chao; Tao, Liang; Zhang, Hui

    2016-04-22

    Ebola virus infection can cause severe hemorrhagic fever with a high mortality in humans. The outbreaks of Ebola viruses in 2014 represented the most serious Ebola epidemics in history and greatly threatened public health worldwide. The development of additional effective anti-Ebola therapeutic agents is therefore quite urgent. In this study, via high throughput screening of Food and Drug Administration-approved drugs, we identified that teicoplanin, a glycopeptide antibiotic, potently prevents the entry of Ebola envelope pseudotyped viruses into the cytoplasm. Furthermore, teicoplanin also has an inhibitory effect on transcription- and replication-competent virus-like particles, with an IC50 as low as 330 nm Comparative analysis further demonstrated that teicoplanin is able to block the entry of Middle East respiratory syndrome (MERS) and severe acute respiratory syndrome (SARS) envelope pseudotyped viruses as well. Teicoplanin derivatives such as dalbavancin, oritavancin, and telavancin can also inhibit the entry of Ebola, MERS, and SARS viruses. Mechanistic studies showed that teicoplanin blocks Ebola virus entry by specifically inhibiting the activity of cathepsin L, opening a novel avenue for the development of additional glycopeptides as potential inhibitors of cathepsin L-dependent viruses. Notably, given that teicoplanin has routinely been used in the clinic with low toxicity, our work provides a promising prospect for the prophylaxis and treatment of Ebola, MERS, and SARS virus infection. PMID:26953343

  10. Terapia com células-tronco na síndrome do desconforto respiratório agudo Stem cell therapy in acute respiratory distress syndrome

    Tatiana Maron-Gutierrez

    2009-03-01

    Full Text Available A síndrome do desconforto respiratório agudo é caracterizada por uma reação inflamatória difusa do parênquima pulmonar, podendo ser induzida por um insulto direto ao epitélio alveolar (síndrome do desconforto respiratório agudo pulmonar ou indireto através do endotélio vascular (síndrome do desconforto respiratório agudo extrapulmonar. Acredita-se que uma terapia eficaz para o tratamento da síndrome do desconforto respiratório agudo deva atenuar a resposta inflamatória e promover adequado reparo da lesão pulmonar. O presente artigo apresenta uma breve revisão acerca do potencial terapêutico das células-tronco na síndrome do desconforto respiratório agudo. Essa revisão bibliográfica baseou-se em uma pesquisa sistemática de artigos experimentais e clínicos sobre terapia celular na síndrome do desconforto respiratório agudo incluídos nas bases de dados MedLine e SciELO nos últimos 10 anos. O transplante de células-tronco promove melhora da lesão inflamatória pulmonar e do conseqüente processo fibrótico, induzindo adequado reparo tecidual. Dentre os mecanismos envolvidos, podemos citar: diferenciação em células do epitélio alveolar e redução na liberação de mediadores inflamatórios e sistêmicos e fatores de crescimento. A terapia com células-tronco derivadas da medula óssea pode vir a ser uma opção eficaz e segura no tratamento da síndrome do desconforto respiratório agudo por acelerar o processo de reparo e atenuar a resposta inflamatória. Entretanto, os mecanismos relacionados à atividade antiinflamatória e antifibrogênica de tais células necessitam ser mais bem elucidados, limitando, assim, o seu uso clínico imediato.Acute respiratory distress syndrome is characterized by an acute pulmonary inflammatory process induced by the presence of a direct (pulmonary insult that affects lung parenchyma, or an indirect (extrapulmonary insult that results from an acute systemic inflammatory response

  11. The spike protein of severe acute respiratory syndrome (SARS) is cleaved in virus infected Vero-E6 cells.

    Wu, Xiao Dong; Shang, Bo; Yang, Rui Fu; Yu, Hao; Ma, Zhi Hai; Shen, Xu; Ji, Yong Yong; Lin, Ying; Wu, Ya Di; Lin, Guo Mei; Tian, Lin; Gan, Xiao Qing; Yang, Sheng; Jiang, Wei Hong; Dai, Er Hei; Wang, Xiao Yi; Jiang, Hua Liang; Xie, You Hua; Zhu, Xue Liang; Pei, Gang; Li, Lin; Wu, Jia Rui; Sun, Bing

    2004-10-01

    Spike protein is one of the major structural proteins of severe acute respiratory syndrome-coronavirus. It is essential for the interaction of the virons with host cell receptors and subsequent fusion of the viral envelop with host cell membrane to allow infection. Some spike proteins of coronavirus, such as MHV, HCoV-OC43, AIBV and BcoV, are proteolytically cleaved into two subunits, S1 and S2. In contrast, TGV, FIPV and HCoV-229E are not. Many studies have shown that the cleavage of spike protein seriously affects its function. In order to investigate the maturation and proteolytic processing of the S protein of SARS CoV, we generated S1 and S2 subunit specific antibodies (Abs) as well as N, E and 3CL protein-specific Abs. Our results showed that the antibodies could efficiently and specifically bind to their corresponding proteins from E.coli expressed or lysate of SARS-CoV infected Vero-E6 cells by Western blot analysis. Furthermore, the anti-S1 and S2 Abs were proved to be capable of binding to SARS CoV under electron microscope observation. When S2 Ab was used to perform immune precipitation with lysate of SARS-CoV infected cells, a cleaved S2 fragment was detected with S2-specific mAb by Western blot analysis. The data demonstrated that the cleavage of S protein was observed in the lysate, indicating that proteolytic processing of S protein is present in host cells. PMID:15450134

  12. Preparation and development of equine hyperimmune globulin F(ab')2 against severe acute respiratory syndrome coronavirus

    Jia-hai LU; Bing L WONG; Nan-shan ZHONG; Zhong-min GUO; Wen-yu HAN; Guo-ling WANG; Ding-mei ZHANG; Yi-fei WANG; Sheng-yun SUN; Qin-he YANG; Huan-ying ZHENG

    2005-01-01

    Aim: The resurgence of severe acute respiratory syndrome (SARS) is still a threat because the causative agent remaining in animal reservoirs is not fully understood,and sporadic cases continue to be reported. Developing high titers of anti-SARS hyperimmune globulin to provide an alternative pathway for emergent future prevention and treatment of SARS. Methods: SARS coronavirus (CoV)F69 (AY313906)and Z2-Y3 (AY394989) were isolated and identified from 2 different Cantonese onset SARS patients. Immunogen was prepared from SARS-CoV F69 strain. Six health horses were immunized 4 times and serum was collected periodically to measure the profile of specific IgG and neutralizing antibodies using indirect enzyme-linked immunosorbent assay and a microneutralization test. Sera were collected in large amounts at the peak, where IgG was precipitated using ammonium sulphate and subsequently digested with pepsin. The product was then purified using anion-exchange chromatography to obtain F(ab')2 fragments. Results: The specific IgG and neutralizing antibody titers peaked at approximately week 7 after the first immunization, with a maximum value of 1:14210. The sera collected at the peak were then purified. Fragment of approximately 15 g F(ab')2 was obtained from 1 litre antiserum and the purity was above 90% with the titer of 1:5120, which could neutralize the other strain (SARS-CoV Z2-Y3) as well. Conclusion: This research provides a viable strategy for the prevention and treatment of SARS coronavirus infection with equine hyperimmune globulin, with the purpose of combating any resurgence of SARS.

  13. The Hemagglutinin Stem-Binding Monoclonal Antibody VIS410 Controls Influenza Virus-Induced Acute Respiratory Distress Syndrome.

    Baranovich, Tatiana; Jones, Jeremy C; Russier, Marion; Vogel, Peter; Szretter, Kristy J; Sloan, Susan E; Seiler, Patrick; Trevejo, Jose M; Webby, Richard J; Govorkova, Elena A

    2016-04-01

    Most cases of severe influenza are associated with pulmonary complications, such as acute respiratory distress syndrome (ARDS), and no antiviral drugs of proven value for treating such complications are currently available. The use of monoclonal antibodies targeting the stem of the influenza virus surface hemagglutinin (HA) is a rapidly developing strategy for the control of viruses of multiple HA subtypes. However, the mechanisms of action of these antibodies are not fully understood, and their ability to mitigate severe complications of influenza has been poorly studied. We evaluated the effect of treatment with VIS410, a human monoclonal antibody targeting the HA stem region, on the development of ARDS in BALB/c mice after infection with influenza A(H7N9) viruses. Prophylactic administration of VIS410 resulted in the complete protection of mice against lethal A(H7N9) virus challenge. A single therapeutic dose of VIS410 given 24 h after virus inoculation resulted in dose-dependent protection of up to 100% of mice inoculated with neuraminidase inhibitor-susceptible or -resistant A(H7N9) viruses. Compared to the outcomes in mock-treated controls, a single administration of VIS410 improved viral clearance from the lungs, reduced virus spread in lungs in a dose-dependent manner, resulting in a lower lung injury score, reduced the extent of the alteration in lung vascular permeability and protein accumulation in bronchoalveolar lavage fluid, and improved lung physiologic function. Thus, antibodies targeting the HA stem can reduce the severity of ARDS and show promise as agents for controlling pulmonary complications in influenza. PMID:26787699

  14. The nsp2 replicase proteins of murine hepatitis virus and severe acute respiratory syndrome coronavirus are dispensable for viral replication.

    Graham, Rachel L; Sims, Amy C; Brockway, Sarah M; Baric, Ralph S; Denison, Mark R

    2005-11-01

    The positive-stranded RNA genome of the coronaviruses is translated from ORF1 to yield polyproteins that are proteolytically processed into intermediate and mature nonstructural proteins (nsps). Murine hepatitis virus (MHV) and severe acute respiratory syndrome coronavirus (SARS-CoV) polyproteins incorporate 16 protein domains (nsps), with nsp1 and nsp2 being the most variable among the coronaviruses and having no experimentally confirmed or predicted functions in replication. To determine if nsp2 is essential for viral replication, MHV and SARS-CoV genome RNA was generated with deletions of the nsp2 coding sequence (MHVDeltansp2 and SARSDeltansp2, respectively). Infectious MHVDeltansp2 and SARSDeltansp2 viruses recovered from electroporated cells had 0.5 to 1 log10 reductions in peak titers in single-cycle growth assays, as well as a reduction in viral RNA synthesis that was not specific for any positive-stranded RNA species. The Deltansp2 mutant viruses lacked expression of both nsp2 and an nsp2-nsp3 precursor, but cleaved the engineered chimeric nsp1-nsp3 cleavage site as efficiently as the native nsp1-nsp2 cleavage site. Replication complexes in MHVDeltansp2-infected cells lacked nsp2 but were morphologically indistinguishable from those of wild-type MHV by immunofluorescence. nsp2 expressed in cells by stable retroviral transduction was specifically recruited to viral replication complexes upon infection with MHVDeltansp2. These results demonstrate that while nsp2 of MHV and SARS-CoV is dispensable for viral replication in cell culture, deletion of the nsp2 coding sequence attenuates viral growth and RNA synthesis. These findings also provide a system for the study of determinants of nsp targeting and function. PMID:16227261

  15. Surfactant disaturated-phosphatidylcholine kinetics in acute respiratory distress syndrome by stable isotopes and a two compartment model

    Cogo Paola E

    2007-02-01

    Full Text Available Abstract Background In patients with acute respiratory distress syndrome (ARDS, it is well known that only part of the lungs is aerated and surfactant function is impaired, but the extent of lung damage and changes in surfactant turnover remain unclear. The objective of the study was to evaluate surfactant disaturated-phosphatidylcholine turnover in patients with ARDS using stable isotopes. Methods We studied 12 patients with ARDS and 7 subjects with normal lungs. After the tracheal instillation of a trace dose of 13C-dipalmitoyl-phosphatidylcholine, we measured the 13C enrichment over time of palmitate residues of disaturated-phosphatidylcholine isolated from tracheal aspirates. Data were interpreted using a model with two compartments, alveoli and lung tissue, and kinetic parameters were derived assuming that, in controls, alveolar macrophages may degrade between 5 and 50% of disaturated-phosphatidylcholine, the rest being lost from tissue. In ARDS we assumed that 5–100% of disaturated-phosphatidylcholine is degraded in the alveolar space, due to release of hydrolytic enzymes. Some of the kinetic parameters were uniquely determined, while others were identified as lower and upper bounds. Results In ARDS, the alveolar pool of disaturated-phosphatidylcholine was significantly lower than in controls (0.16 ± 0.04 vs. 1.31 ± 0.40 mg/kg, p de novo synthesis of disaturated-phosphatidylcholine were also significantly lower, while mean resident time in lung tissue was significantly higher in ARDS than in controls. Recycling was 16.2 ± 3.5 in ARDS and 31.9 ± 7.3 in controls (p = 0.08. Conclusion In ARDS the alveolar pool of surfactant is reduced and disaturated-phosphatidylcholine turnover is altered.

  16. HLA-A*0201 T-cell epitopes in severe acute respiratory syndrome (SARS) coronavirus nucleocapsid and spike proteins

    The immunogenicity of HLA-A*0201-restricted cytotoxic T lymphocyte (CTL) peptide in severe acute respiratory syndrome coronavirus (SARS-CoV) nuclear capsid (N) and spike (S) proteins was determined by testing the proteins' ability to elicit a specific cellular immune response after immunization of HLA-A2.1 transgenic mice and in vitro vaccination of HLA-A2.1 positive human peripheral blood mononuclearcytes (PBMCs). First, we screened SARS N and S amino acid sequences for allele-specific motif matching those in human HLA-A2.1 MHC-I molecules. From HLA peptide binding predictions (http://thr.cit.nih.gov/molbio/hla_bind/), ten each potential N- and S-specific HLA-A2.1-binding peptides were synthesized. The high affinity HLA-A2.1 peptides were validated by T2-cell stabilization assays, with immunogenicity assays revealing peptides N223-231, N227-235, and N317-325 to be First identified HLA-A*0201-restricted CTL epitopes of SARS-CoV N protein. In addition, previous reports identified three HLA-A*0201-restricted CTL epitopes of S protein (S978-986, S1203-1211, and S1167-1175), here we found two novel peptides S787-795 and S1042-1050 as S-specific CTL epitopes. Moreover, our identified N317-325 and S1042-1050 CTL epitopes could induce recall responses when IFN-γ stimulation of blood CD8+ T-cells revealed significant difference between normal healthy donors and SARS-recovered patients after those PBMCs were in vitro vaccinated with their cognate antigen. Our results would provide a new insight into the development of therapeutic vaccine in SARS

  17. PCR use in miliary tuberculosis presenting with acute respiratory distress syndrome.

    Riachy, Moussa Albert

    2011-01-01

    A 30-year-old pregnant woman admitted to the hospital for rapidly progressive dyspnoea, non-productive cough and altered general status evolving over 1-month period. Her vital signs showed a low blood pressure 90/60 mm Hg, pulse rate 100 beats/min, respiratory rate 32 breaths/min and oxygen saturation on room air of 88%. Laboratory findings showed haemoglobin 9.7 g/dl, white blood cells 15 000/mm(3) (neutrophils 82%), C reactive protein 74 mg/l, alkaline phosphatase 320 U/l, alanine aminotransferase 62 IU/l, aspartate aminotransferase 120 IU/l, γ glutamyl transpeptidase 125 U/l; brain natriuretic peptide 25.4 pg/ml, procalcitonine >2, lactate dehydrogenase 1618 U/l. Chest radiographics showed diffuse bilateral micronodular pulmonary infiltrates and CT of the chest confirmed 1-3 mm diffuse bilateral micronodular infiltrates with ground glass opacities. Complete investigation including bronchoalveolar lavage (BAL) for any viral, bacteriologic, acid-fast bacilli and full serum antibodies panel were all negative. DNA amplification for mycobacterium using PCR on the BAL rapidly rectified the diagnosis of tuberculosis. PMID:22694890

  18. Surfactant therapy for acute respiratory distress in infants

    Corrado Moretti; Barbàra, Caterina S; Rosanna Grossi; Stefano Luciani; Fabio Midulla; Paola Papoff

    2014-01-01

    Acute respiratory distress syndrome (ARDS) remains the primary indication for admission to paediatric intensive care units and accounts for significant mortality, morbidity and resource utilization. Respiratory infections, in particular pneumonia and severe bronchiolitis, are the most common causes of respiratory failure requiring mechanical ventilation in infants and children. This paper reviews the pathophysiology of ARDS and the management of paediatric patients with acute lung injury. Dat...

  19. Endocan Levels in Peripheral Blood Predict Outcomes of Acute Respiratory Distress Syndrome

    Ling Tang

    2014-01-01

    Full Text Available Purpose. To investigate the prognostic significance of endocan, compared with procalcitonin (PCT, C-reactive protein (CRP,white blood cells (WBC, neutrophils (N, and clinical severity scores in patients with ARDS. Methods. A total of 42 patients with ARDS were initially enrolled, and there were 20 nonsurvivors and 22 survivors based on hospital mortality. Plasma levels of biomarkers were measured and the acute physiology and chronic health evaluation II (APACHE II was calculated on day 1 after the patient met the defining criteria of ARDS. Results. Endocan levels significantly correlated with the APACHE II score in the ARDS group (r=0.676, P=0.000, n=42. Of 42 individuals with ARDS, 20 were dead, and endocan was significantly higher in nonsurvivors than in survivors (median (IQR 5.01 (2.98–8.44 versus 3.01 (2.36–4.36 ng/mL, P=0.017. According to the results of the ROC-curve analysis and COX proportional hazards models, endocan can predict mortality of ARDS independently with a hazard ratio of 1.374 (95% CI, 1.150–1.641 and an area of receiver operator characteristic curve (AUROC of 0.715 (P=0.017. Moreover, endocan can predict the multiple-organ dysfunction of ARDS. Conclusion. Endocan is a promising biomarker to predict the disease severity and mortality in patients with ARDS.

  20. Middle East Respiratory Syndrome (MERS)

    Middle East Respiratory Syndrome Coronavirus; MERS-CoV; Novel coronavirus; nCoV ... Centers for Disease Control and Prevention. Middle East ... 2, 2015. www.cdc.gov/coronavirus/mers/faq.html . Accessed April ...

  1. Cerebral gas embolism in a case of Influenza A-associated acute respiratory distress syndrome treated with high-frequency oscillatory ventilation

    Christian M Sebat

    2013-01-01

    Full Text Available A 22-year-old obese asthmatic woman with Influenza A (H1N1-associated acute respiratory distress syndrome died from cerebral artery gas emboli with massive cerebral infarction while being treated with High-Frequency Oscillatory Ventilation in the absence of a right to left intracardiac shunt. We review and briefly discuss other causes of systemic gas emboli (SGE. We review proposed mechanisms of SGE, their relation to our case, and how improved understanding of the risk factors may help prevent SGE in positive pressure ventilated patients.

  2. Induction of Specific Immune Responses by Severe Acute Respiratory Syndrome Coronavirus Spike DNA Vaccine with or without Interleukin-2 Immunization Using Different Vaccination Routes in Mice▿

    Hu, Hui; Lu, Xinya; Tao, Ling; Bai, Bingke; Zhang, Zhenfeng; Chen, Yao; Zheng, Fangliang; Chen, Jianjun; Chen, Ze; Wang, Hanzhong

    2007-01-01

    DNA vaccines induce humoral and cellular immune responses in animal models and humans. To analyze the immunogenicity of the severe acute respiratory syndrome (SARS) coronavirus (CoV), SARS-CoV, spike DNA vaccine and the immunoregulatory activity of interleukin-2 (IL-2), DNA vaccine plasmids pcDNA-S and pcDNA-IL-2 were constructed and inoculated into BALB/c mice with or without pcDNA-IL-2 by using three different immunization routes (the intramuscular route, electroporation, or the oral route ...

  3. Social support during intensive care unit stay might improve mental impairment and consequently health-related quality of life in survivors of severe acute respiratory distress syndrome

    Deja, Maria; Denke, Claudia; Weber-Carstens, Steffen; Schröder, Jürgen; Pille, Christian E; Hokema, Frank; Falke, Konrad J; Kaisers, Udo

    2006-01-01

    Introduction We investigated health-related quality of life (HRQoL) and persistent symptoms of post-traumatic stress disorder (PTSD) in long-term survivors of acute respiratory distress syndrome (ARDS). We wished to evaluate the influence of PTSD on HRQoL and to investigate the influence of perceived social support during intensive care unit (ICU) treatment on both PTSD symptoms and HRQoL. Methods In ARDS patients we prospectively measured HRQoL (Medical Outcomes Study 36-Item Short Form; SF-...

  4. Computed tomographic criteria as expected effect to inhaled nitric oxide in patients with severe acute respiratory distress syndrome

    Purpose: inhaled nitric oxide (iNO) is an effective therapy for severe hypoxemia in most patients with acute respiratory distress syndrome (ARDS). For unknown reason, a subset of ARDS patients does not respond favorably to iNO therapy. We hypothesized that radiological manifestation of lung injury may be related to iNO response. Materials and methods: we retrospectively analyzed data from n = 25 ARDS patients who received iNO, and underwent chest CT within 72 h prior to inhaled treatment. The morphology of coherently pathologic lung tissue was characterized by the length of the borderline between consolidated, infiltrated and atelectatic lung tissue and radiologically normal lung tissue. This quantity was expressed as relative fraction of the visceral pleural circumference and averaged over all CT slices. Furthermore we semiquantitatively determined the total volume of consolidated lung tissue as part of the whole lung. Results: in n = 6 non-responders to iNO (ΔPaO2 10%), we found significantly less coherently consolidated lung tissue evidenced by an increased relative borderline when compared to iNO non-responders (0.09 ± 0.02 vs. 0.1 ± 0.01; P < 0.05). Moreover, there was a moderate and significant correlation between ΔPaO2 induced by iNO and the relative borderline in all patients studied (R = 0.59; P < 0.05). Total fraction of consolidated lung tissue volume was not different between iNO non-responders and responders (60 ± 3% vs. 54 ± 2% n. s.). Conclusion: our data demonstrate that the gross morphological distribution of pathological lung tissue influences iNO response in ARDS. Inhaled NO was most beneficial in injured lungs characterized by many small consolidated areas surrounded by normal lung tissue. The increased borderline between pathologic and normal lung tissue offers additional possibility for iNO to divert blood flow from shunt areas to ventilated lung regions, which consequently improves arterial oxygenation. (orig.)

  5. MRI evaluation of osteonecrosis in knee joints after intravenous administration of corticosteroids in patients with severe acute respiratory syndrome

    Objective: To evaluate MRI features of osteonecrosis in knee joints after intravenous administration of exogenous corticosteroids in patients with severe acute respiratory syndrome (SARS). Methods: MRI was done in 18 patients (medical staff from 4 hospitals) suffered from SARS and treated with intravenous use of exogenous corticosteroids in hip joints and knee joints to indicate the findings and characteristics of osteonecrosis as well as their relation with hormone amount. Results: Eleven patients showed lesions of osteonecrosis in knee joints with bilateral in 7 and unilateral in 4, and 3 patients were complicated with avascular necrosis in bilateral femoral heads. Among the 38 lesions in knee joints, 34 lesions were located in medial condylu, lateral condylus and shaft of femur, and 4 in medial condylus or lateral condylus of tibia. Large-middle lesions showed geographic focus of typically heterogeneous signal (low or intermediate signal intensity on T1WI and high or intermediate signal intensity T2WI) within the marrow that was surrounded by characteristic low signal intensity, serpentine border on T1, T2WI. This border showed a classic double-line sign on T2WI in 4 lesions. Small lesions showed low signal intensity on T1 and low or high signal intensity on T2WI. Subchondral avascular necrosis in middle-upper femoral heads showed intermediate signal intensity on T1 weighted images and high or complicated signal intensity on T2WI encircled with characteristic low signal intensity, serpentine border on T1 and T2WI. This border showed a classic double-line sign on T2 weighted images in avascular necrosis of bilateral femoral heads in 1 case. Conclusion: In these cases, osteonecrosis in knee joints was more than in femoral heads in patients with SARS after intravenous use of exogenous corticosteroids, mostly located in medial condylus, lateral condylus and shaft of femur as well as in medial condylus or lateral condylus of tibia. So, MRI should be early done in

  6. Receptor Interacting Protein 3-Mediated Necroptosis Promotes Lipopolysaccharide-Induced Inflammation and Acute Respiratory Distress Syndrome in Mice.

    Linlin Wang

    Full Text Available Necrosis amplifies inflammation and plays important roles in acute respiratory distress syndrome (ARDS. Necroptosis is a newly identified programmed necrosis that is mediated by receptor interacting protein 3 (RIP3. However, the potential involvement and impact of necroptosis in lipopolysaccharide (LPS-induced ARDS remains unknown. We therefore explored the role and mechanism of RIP3-mediated necroptosis in LPS-induced ARDS. Mice were instilled with increasing doses of LPS intratracheally to induce different degrees of ARDS. Lung tissues were harvested for histological and TUNEL staining and western blot for RIP3, p-RIP3, X-linked inhibitor of apoptosis protein (XIAP, mixed lineage kinase domain-like protein (MLKL, total and cleaved caspases-3/8. Then, wild-type and RIP3 knock-out mice were induced ARDS with 30 mg/kg LPS. Pulmonary cellular necrosis was labeled by the propidium Iodide (PI staining. Levels of TNF-a, Interleukin (IL-1β, IL-6, IL-1α, IL-10 and HMGB1, tissue myeloperoxidase (MPO activity, neutrophil counts and total protein concentration were measured. Results showed that in high dose LPS (30mg/kg and 40mg/kg -induced severe ARDS, RIP3 protein was increased significantly, accompanied by increases of p-RIP3 and MLKL, while in low dose LPS (10mg/kg and 20mg/kg -induced mild ARDS, apoptosis was remarkably increased. In LPS-induced severe ARDS, RIP3 knock-out alleviated the hypothermia symptom, increased survival rate and ameliorated the lung tissue injury RIP3 depletion also attenuated LPS-induced increase in IL-1α/β, IL-6 and HMGB1 release, decreased tissue MPO activity, and reduced neutrophil influx and total protein concentration in BALF in severe ARDS. Further, RIP3 depletion reduced the necrotic cells in the lung and decreased the expression of MLKL, but had no impact on cleaved caspase-3 in LPS-induced ARDS. It is concluded that RIP3-mediated necroptosis is a major mechanism of enhanced inflammation and lung tissue injury in

  7. Comparison of clinical course of patients with severe acute respiratory syndrome among the multiple generations of nosocomial transmission

    伍卫; 王景峰; 刘品明; 江山平; 陈庆瑜; 陈为宪; 尹松梅; 严励; 詹俊; 陈锡龙; 李建国

    2004-01-01

    Background Severe acute respiratory syndrome (SARS) is characterized by both an atypical pneumonia and efficient nosocomial transmissin. However, it remains unknown whether the infectivity and the virulence of the pathogen will change throughout the successive transmission. This study was conducted to compare the clinical features and management regimens of patients with SARS among the multiple generations from nosocomial transmission initiated by a super-spreader.Methods The clinical data of 84 epidemiologically-linked SARS patients from a hospital outbreak were retrospectively studied. All patients, in whom a clear-cut transmission generation could be noted, had a direct or indirect exposure to the index patient and the epidemic successively propagated through the multiple generations of cases within a short period of time.Results There were 66 women and 18 men with mean age of (29.2 ± 10.3) years in this cluster; and 96.4% of whom were health care workers. Detailed contact tracing identified 35 (41.7%) first-generation cases, 34 (40.5%) second-generation cases, and 15 (17.8%) third-generation cases. No statistical differences among the multiple generations of transmission were found in terms of age, gender, incubation period and length of hospital stay. With the advanced transmission generations, the initial temperature lowered, the number of cases with dry cough decreased. There were no statistical differences in the peak temperature and duration of fever, other accompanying symptoms, leucopenia; however, the time from initial pulmonary infiltrates to radiographic recovery shortened (P0.05). No statistical differences were found in modes of oxygen therapy and sorts of antibiotics prescribed among the various transmission generations (P>0.05); however, as with the advanced transmission generations, the number of cases prescribed with methylprednisolone, human γ-globulin, interferon-α, antiviral drugs (oral ribavirin or oseltamivir) increased (P<0.05) and time

  8. A BDNF loop-domain mimetic acutely reverses spontaneous apneas and respiratory abnormalities during behavioral arousal in a mouse model of Rett syndrome

    Miriam Kron

    2014-09-01

    Full Text Available Reduced levels of brain-derived neurotrophic factor (BDNF are thought to contribute to the pathophysiology of Rett syndrome (RTT, a severe neurodevelopmental disorder caused by loss-of-function mutations in the gene encoding methyl-CpG-binding protein 2 (MeCP2. In Mecp2 mutant mice, BDNF deficits have been associated with breathing abnormalities, a core feature of RTT, as well as with synaptic hyperexcitability within the brainstem respiratory network. Application of BDNF can reverse hyperexcitability in acute brainstem slices from Mecp2-null mice, suggesting that therapies targeting BDNF or its receptor, TrkB, could be effective at acute reversal of respiratory abnormalities in RTT. Therefore, we examined the ability of LM22A-4, a small-molecule BDNF loop-domain mimetic and TrkB partial agonist, to modulate synaptic excitability within respiratory cell groups in the brainstem nucleus tractus solitarius (nTS and to acutely reverse abnormalities in breathing at rest and during behavioral arousal in Mecp2 mutants. Patch-clamp recordings in Mecp2-null brainstem slices demonstrated that LM22A-4 decreases excitability at primary afferent synapses in the nTS by reducing the amplitude of evoked excitatory postsynaptic currents and the frequency of spontaneous and miniature excitatory postsynaptic currents. In vivo, acute treatment of Mecp2-null and -heterozygous mutants with LM22A-4 completely eliminated spontaneous apneas in resting animals, without sedation. Moreover, we demonstrate that respiratory dysregulation during behavioral arousal, a feature of human RTT, is also reversed in Mecp2 mutants by acute treatment with LM22A-4. Together, these data support the hypothesis that reduced BDNF signaling and respiratory dysfunction in RTT are linked, and establish the proof-of-concept that treatment with a small-molecule structural mimetic of a BDNF loop domain and a TrkB partial agonist can acutely reverse abnormal breathing at rest and in response to

  9. Rapidly progressive Bronchiolitis Obliterans Organising Pneumonia presenting with pneumothorax, persistent air leak, acute respiratory distress syndrome and multi-organ dysfunction: a case report

    Chakravorty Indranil

    2008-05-01

    Full Text Available Abstract Introduction Bronchiolitis Obliterans Organising Pneumonia (BOOP may often present initially as a recurrent spontaneous pneumothorax and then develop multi-system complications. Case presentation A 17-year-old boy presented with a pneumothorax, which developed into rapidly progressive Bronchiolitis Obliterans Organising Pneumonia (BOOP. He developed multi-organ dysfunction (including adult respiratory distress syndrome, oliguric renal failure, acute coronary syndrome, cardiac failure and a right atrial thrombus which necessitated prolonged intensive care. Diagnosis was confirmed on open lung biopsy and he responded well to treatment with corticosteroids. Conclusion BOOP is exquisitely sensitive to oral corticosteroids but if the diagnosis is not considered in such patients and appropriate treatment instituted early, BOOP may often lead to prolonged hospital admission with considerable morbidity.

  10. Changes in monocyte counts and expression of mCD14 and HLA-DR in the peripheral blood of patients with severe acute respiratory syndrome

    National Research Project for SARS, Beijing Group

    2004-01-01

    @@ Severe acute respiratory syndrome (SARS) is an infectious disease that originally emerged in China in November 2002. It subsequently spread worldwide.Investigators involved in an international collaboration have attempted to determine a specific etiology in order to redefine what is currently best described as a syndrome into a specific disease. At present, a novel coronavirus is generally accepted as the single most probable causative agent. In the case of HIV infection, monocytes/macrophages are infected early in the infection process,and the activation of monocytes/macrophages can influence the susceptibility of these cells to infection. 1Therefore, we examined the number of monocytes and the expression of CD14 and HLA-DR in the peripheral blood of patients with SARS to determine whether monocytes were involved in the pathogenesis of SARS.

  11. Avian influenza virus, Streptococcus suis serotype 2, severe acute respiratory syndrome-coronavirus and beyond: molecular epidemiology, ecology and the situation in China.

    Ma, Ying; Feng, Youjun; Liu, Di; Gao, George F

    2009-09-27

    The outbreak and spread of severe acute respiratory syndrome-associated coronavirus and the subsequent identification of its animal origin study have heightened the world's awareness of animal-borne or zoonotic pathogens. In addition to SARS, the highly pathogenic avian influenza virus (AIV), H5N1, and the lower pathogenicity H9N2 AIV have expanded their host ranges to infect human beings and other mammalian species as well as birds. Even the 'well-known' reservoir animals for influenza virus, migratory birds, became victims of the highly pathogenic H5N1 virus. Not only the viruses, but bacteria can also expand their host range: a new disease, streptococcal toxic shock syndrome, caused by human Streptococcus suis serotype 2 infection, has been observed in China with 52 human fatalities in two separate outbreaks (1998 and 2005, respectively). Additionally, enterohaemorrhagic Escherichia coli O157:H7 infection has increased worldwide with severe disease. Several outbreaks and sporadic isolations of this pathogen in China have made it an important target for disease control. A new highly pathogenic variant of porcine reproductive and respiratory syndrome virus (PRRSV) has been isolated in both China and Vietnam recently; although PRRSV is not a zoonotic human pathogen, its severe outbreaks have implications for food safety. All of these pathogens occur in Southeast Asia, including China, with severe consequences; therefore, we discuss the issues in this article by addressing the situation of the zoonotic threat in China. PMID:19687041

  12. Submersion and acute respiratory failure

    Yu-Jang Su

    2014-01-01

    Objectives:To know the relationship between hypothermia, etiology, respiratory failure and prognosis of submersion in environmental emergency medicine.Methods:FromDecember1, 2002 toSeptember30,2007, there were52 hospitalized near- drowning cases in a medical center at northernTaiwan.Retrospective study of52 submersion patients who were hospitalized during the duration was analyzed.Results:The hypothermic groups are more commonly seen in acute respiratory failure after submersion,36%vs.21%,P<0.05.The hypothermic submersion patients who are older in age than normothermic submersion patients(44vs.27 years old,P<0.05).The suicidal submersion patients are older, hypothermic and longer length of stay than accidental submersion patients.Conclusions:Submersion patients who are hypothermic on arrival of emergency department(ED) are risky to respiratory failure and older, more hypothermic, longer hospital stay in suicidal submersion patients.

  13. Neonatal respiratory distress syndrome

    ... syndrome (RDS) is a problem often seen in premature babies. The condition makes it hard for the ... a slippery substance in the lungs called surfactant. This substance helps the lungs fill with air ...

  14. Turning Crisis into Opportunity: Enhancing Student-Teachers' Understanding of Nature of Science and Scientific Inquiry through a Case Study of the Scientific Research in Severe Acute Respiratory Syndrome

    Wong, Siu Ling; Hodson, Derek; Kwan, Jenny; Yung, Benny Hin Wai

    2008-01-01

    Interviews with key scientists involved in research on severe acute respiratory syndrome (SARS), together with analysis of media reports and documentaries produced during and after the SARS epidemic, revealed many interesting aspects of nature of science (NOS) and authentic scientific inquiry. This novel insight into practice in the rapidly…

  15. Monoclonal Antibody-Based Antigen Capture Enzyme-Linked Immunosorbent Assay Reveals High Sensitivity of the Nucleocapsid Protein in Acute-Phase Sera of Severe Acute Respiratory Syndrome Patients

    Di, Biao; Hao, Wei; Gao, Yang; Wang, Ming; Wang, Ya-di; QIU, LI-WEN; Wen, Kun; Zhou, Duan-Hua; Wu, Xin-wei; Lu, En-Jie; Liao, Zhi-yong; Mei, Ya-bo; Zheng, Bo-Jian; Che, Xiao-Yan

    2005-01-01

    Accurate and timely diagnosis of severe acute respiratory syndrome coronavirus (SARS-CoV) infection is a critical step in preventing another global outbreak. In this study, 829 serum specimens were collected from 643 patients initially reported to be infected with SARS-CoV. The sera were tested for the N protein of SARS-CoV by using an antigen capture enzyme-linked immunosorbent assay (ELISA) based on monoclonal antibodies against the N protein of SARS-CoV and compared to 197 control serum sa...

  16. Acute respiratory distress syndrome (ARDS) complicating influenza A/H1N1v infection--a clinical approach.

    Witczak, Agnieszka; Prystupa, Andrzej; Kurys-Denis, Ewa; Borys, Michał; Czuczwar, Mirosław; Niemcewicz, Marcin; Kocik, Janusz; Michalak, Anna; Pietrzak, Aldona; Chodorowska, Grażyna; Krupski, Witold; Mosiewicz, Jerzy; Tomasiewicz, Krzysztof

    2013-01-01

    ARDS is defined as an acute inflammatory syndrome characterized with bilateral parenchymal lung infiltrates on chest radiograph and PaO2/FiO2 ratiofat embolism, surface burn, massive blood transfusion. Influenza A/H1N1 infection seems to be responsible for the development of extremely severe type of ARDS with poor response to routine treatment. Despite great progress in the management of ARDS with novel agents and sophisticated techniques, including antimicrobial drugs, extracorporeal membrane oxygenation, prostaglandins, nitric oxide, prostacyclin, exogenous surfactant administration and activated protein C, supportive treatment based mostly on advanced mechanical ventilation in the intensive care units seems to be the most important for the prognosis. PMID:24364461

  17. Intercambio gaseoso en el síndrome de dificultad respiratoria aguda Gas exchange in acute respiratory distress syndrome

    G. A. Raimondi

    2003-04-01

    efecto beneficioso de todas estas técnicas en la mejoría del IG en el ARDS, no se ha demostrado efecto beneficioso en la sobrevida.The hypoxemia of acute respiratory distress syndrome (ARDS depends chiefly upon shunt and ventilation-perfusion (V A/Q inequality produced by fluid located in the interstitial space, alveolar collapse and flooding. Variables other than inspired oxygen fraction and the underlying physiological abnormality can influence arterial oxygen partial pressure (PaO2. Changes in cardiac output, hemoglobin concentration, oxygen consumption and alcalosis can cause changes in PaO2 through their influence on mixed venous PO2. Gas exchange (GE in ARDS may be studied using the inert gas elimination technique (MIGET which enables to define the distribution of ventilation and perfusion without necessarily altering the FIO2 differentiating shunt from lung units with low V A/Q ratios and dead space from lung units with high V A/Q ratios. Different ventilatory strategies that increase mean airway pressure (positive end-expiratory pressure, high tidal volumes, inverse inspiratory-expiratory ratio, etc improve PaO2 through increasing lung volume by recruiting new open alveoli and spreading the intra-alveolar fluid over a large surface area. Also prone-position ventilation would result in a marked improvement in GE enhancing dorsal lung ventilation by the effects on the gravitional distribution of pleural pressure and the reduction in the positive pleural pressure that develops in dorsal regions in ARDS. Inhaled nitric oxide (NO has been shown to increase PaO2 in ARDS patients by inducing vasodilation predominantly in ventilated areas redistributing pulmonary blood flow away from nonventilated toward ventilated areas of the lung thus resulting in a shunt reduction. On the same way inhaled prostaglandins (PGI2 or PGE1 causes selective pulmonary vasodilation improving pulmonary GE. Intravenous almitrine, a selective pulmonary vasoconstrictor, has been shown to

  18. Otalgia and eschar in the external auditory canal in scrub typhus complicated by acute respiratory distress syndrome and multiple organ failure

    Hu Sung-Yuan

    2011-03-01

    Full Text Available Abstract Background Scrub typhus, a mite-transmitted zoonosis caused by Orientia tsutsugamushi, is an endemic disease in Taiwan and may be potentially fatal if diagnosis is delayed. Case presentations We encountered a 23-year-old previously healthy Taiwanese male soldier presenting with the right ear pain after training in the jungle and an eleven-day history of intermittent high fever up to 39°C. Amoxicillin/clavulanate was prescribed for otitis media at a local clinic. Skin rash over whole body and abdominal cramping pain with watery diarrhea appeared on the sixth day of fever. He was referred due to progressive dyspnea and cough for 4 days prior to admission in our institution. On physical examination, there were cardiopulmonary distress, icteric sclera, an eschar in the right external auditory canal and bilateral basal rales. Laboratory evaluation revealed thrombocytopenia, elevation of liver function and acute renal failure. Chest x-ray revealed bilateral diffuse infiltration. Doxycycline was prescribed for scrub typhus with acute respiratory distress syndrome and multiple organ failure. Fever subsided dramatically the next day and he was discharged on day 7 with oral tetracycline for 7 days. Conclusion Scrub typhus should be considered in acutely febrile patients with multiple organ involvement, particularly if there is an eschar or a history of environmental exposure in endemic areas. Rapid and accurate diagnosis, timely administration of antibiotics and intensive supportive care are necessary to decrease mortality of serious complications of scrub typhus.

  19. Respiratory Distress Syndrome and its Complications

    Eren Kale Cekinmez; Hacer Yapicioglu Yildizdas; Ferda Ozlu

    2013-01-01

    Respiratory distress syndrome in premature babies is one of the most common and most important health problems in newborns. Respiratory distress syndrome of newborn is a syndrome in premature infants caused by developmental insufficiency of surfactant production and structural immaturity in the lungs. Respiratory distress syndrome begins shortly after birth and is manifest by tachypnea, tachycardia, chest wall retractions, expiratory grunting, nasal flaring and cyanosis during breathing effor...

  20. Detection of respiratory pathogens in air samples from acutely infected pigs

    Hermann, Joseph R.; Brockmeier, Susan L.; Yoon, Kyoung-Jin; Zimmerman, Jeffrey J.

    2008-01-01

    Pathogens causing significant respiratory disease in growing pigs include Porcine reproductive and respiratory syndrome virus, Porcine circovirus 2, swine influenza virus, porcine respiratory coronavirus, Mycoplasma hyopneumoniae, and Bordetella bronchiseptica. The objective of this research was to characterize the respiratory excretion of these pathogens by acutely infected pigs. Pigs were inoculated under experimental conditions with 1 pathogen. Samples were collected from the upper respira...

  1. Middle East Respiratory Syndrome Coronavirus.

    O'Keefe, Louise C

    2016-05-01

    Middle East Respiratory Syndrome Coronavirus (MERS-CoV) is an emerging infectious disease that can present with flu-like symptoms. In individuals with comorbidities or who are immunosuppressed, it can be deadly. The disease is transmitted through contact with someone who has MERS-CoV. The occupational health nurse must be cognizant of and educate the workforce about MERS-CoV transmission, prevention, and treatment. PMID:26407596

  2. Respiratory Distress Syndrome and its Complications

    Eren Kale Cekinmez

    2013-08-01

    Full Text Available Respiratory distress syndrome in premature babies is one of the most common and most important health problems in newborns. Respiratory distress syndrome of newborn is a syndrome in premature infants caused by developmental insufficiency of surfactant production and structural immaturity in the lungs. Respiratory distress syndrome begins shortly after birth and is manifest by tachypnea, tachycardia, chest wall retractions, expiratory grunting, nasal flaring and cyanosis during breathing efforts. Respiratory distress syndrome or complications caused by respiratory distress syndrome are the most important causes of mortality and morbidity in premature infants. This article briefly reviews respiratory distress syndrome and its complications. [Archives Medical Review Journal 2013; 22(4.000: 615-630

  3. Comparison of effectiveness of whole viral,N and N199 proteins by ELISA for the rapid diagnosis of severe acute respiratory syndrome coronavirus

    GUO Zhong-min; ZHONG Nan-shan; ZHU Xing-quan; LU Jia-hai; HAN Wen-yu; LIU Ze-yu; LI Guo-wei; LIAO Jia-wei; WANG Shu-min; WU Ying-song; ZHENG Huan-ying

    2007-01-01

    Background Although severe acute respiratory syndrome(SARS)has been controlled,the subsequently emerging sporadic cases in 2004 emphasize the necessity of developing a rapid diagnostic method,which would be of great help in clinical diagosis and also wild host screening.This study aims to establish an effective and rapid serological tool for the diagnosis of SARS-CoV by comparison among whole viral,N and N199 proteins by ELISA.Methods SARS-CoV N and N199(a truncated nucleocapsid gene)genes were cloned,expressed,identified by Western blotting,and applied in screening of human and swine samples.Sera of SARS convalescent-phase patients,normal human sera,sera of patients with other respiratory diseases,and swine sera were screened by ELISA,with whole SARS-CoV F69,N and N199 proteins as antigens.Results The sensitivity and specificity of N and N199 proteins in human sera diagnosis were approximate(P=0.743),which was higher than whole viral protein but the difference was not significant(P=0.234).The N199 protein proved to be more specific in swine sera screening than whole viral and N protein(P<0.001).Conclusion N199 protein is feasible in both clinical diagnosis and SARS-CoV reservoir screening.

  4. A better recognition of the mechanism of acute respiratory distress syndrome%急性呼吸窘迫综合征发病机制的现代认识

    崔德健

    2002-01-01

    @@ 急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)是在多种原发病和诱因作用下发生的严重急性呼吸衰竭,以非心源性肺水肿和顽固性低氧血症为特征;其病理生理基础为全身炎症反应综合征(systemic inflammatory response syndrome,SIRS);其病理基础为急性肺损伤(acute lung injury,ALI).

  5. Functional characterization of polymorphisms in the peptidase inhibitor 3 (elafin) gene and validation of their contribution to risk of acute respiratory distress syndrome.

    Tejera, Paula; O'Mahony, D Shane; Owen, Caroline A; Wei, Yongyue; Wang, Zhaoxi; Gupta, Kushagra; Su, Li; Villar, Jesus; Wurfel, Mark; Christiani, David C

    2014-08-01

    Elafin (peptidase inhibitor 3 [PI3]) and its biologically active precursor, pre-elafin, are neutrophil serine proteinase inhibitors with an important role in preventing excessive tissue injury during inflammatory events. Recently, we reported an association between single-nucleotide polymorphism (SNP) rs2664581 in the PI3 gene, increased risk of acute respiratory distress syndrome (ARDS) and pre-elafin circulating levels. This study aims to validate the legitimacy of this association by using a cohort of patients who met the criteria for systemic inflammatory response syndrome and were at risk of developing ARDS (n = 840). A comprehensive functional study of SNPs in PI3 gene was also performed. Luciferase assays and electrophoretic mobility shift assays were conducted to determine the functional relevance of promoter region variants. The effect of the coding SNP rs2664581 on the neutrophil elastase inhibitory activity and transglutaminase binding properties of pre-elafin was also investigated. The variant allele of rs2664581 (C) was significantly associated with increased ARDS risk, mainly among subjects with sepsis (odds ratio = 1.44; 95% confidence interval = 1.04-1.99; P = 0.0276, adjusted by age, sex, and Acute Physiology and Chronic Health Evaluation III). Pre-elafin recombinant protein carrying the amino acid change associated with rs2664581 (Thr34Pro, mutant protein [MT]) had greater capacity to undergo transglutaminase-mediated cross-linking to immobilized fibronectin than wild-type protein in vitro (P A. Our results confirm the association between SNP rs2664581 and enhanced risk of ARDS, further supporting the role of PI3 in ARDS development. SNPs in the PI3 locus may act synergistically by regulating PI3 gene expression and pre-elafin biological functions. PMID:24617927

  6. Incidence of respiratory distress syndrome

    Objective: To determine the incidence of respiratory distress syndrome (RDS) in hospital born babies. Subjects and Methods: All live born infants delivered at the hospital and who fulfilled the diagnostic criteria of respiratory distress syndrome (RDS) were included in the study. Results: Ninety-four neonates developed RDS. Out of these, 88 (93.61%) were preterm and 06 (6.38%) were term infants. There was a male preponderance (65.95%). RDS was documented in 1.72% of total live births. 37.28% of preterm and 0.11% of term neonates born at the hospital. The incidence of RDS was 100% at 26 or less weeks of gestation, 57.14% at 32 weeks, and 3.70% at 36 weeks. The mortality with RDS was 41 (43.61%). Conclusion: RDS is the commonest cause of respiratory distress in the newborn, particularly, in preterm infants. It carries a high mortality rate and the incidence is more than that documented in the Western world. (author)

  7. Critical care ultrasonography in acute respiratory failure.

    Vignon, Philippe; Repessé, Xavier; Vieillard-Baron, Antoine; Maury, Eric

    2016-01-01

    Acute respiratory failure (ARF) is a leading indication for performing critical care ultrasonography (CCUS) which, in these patients, combines critical care echocardiography (CCE) and chest ultrasonography. CCE is ideally suited to guide the diagnostic work-up in patients presenting with ARF since it allows the assessment of left ventricular filling pressure and pulmonary artery pressure, and the identification of a potential underlying cardiopathy. In addition, CCE precisely depicts the consequences of pulmonary vascular lesions on right ventricular function and helps in adjusting the ventilator settings in patients sustaining moderate-to-severe acute respiratory distress syndrome. Similarly, CCE helps in identifying patients at high risk of ventilator weaning failure, depicts the mechanisms of weaning pulmonary edema in those patients who fail a spontaneous breathing trial, and guides tailored therapeutic strategy. In all these clinical settings, CCE provides unparalleled information on both the efficacy and tolerance of therapeutic changes. Chest ultrasonography provides further insights into pleural and lung abnormalities associated with ARF, irrespective of its origin. It also allows the assessment of the effects of treatment on lung aeration or pleural effusions. The major limitation of lung ultrasonography is that it is currently based on a qualitative approach in the absence of standardized quantification parameters. CCE combined with chest ultrasonography rapidly provides highly relevant information in patients sustaining ARF. A pragmatic strategy based on the serial use of CCUS for the management of patients presenting with ARF of various origins is detailed in the present manuscript. PMID:27524204

  8. Síndrome agudo respiratorio severo: un panorama mundial de la epidemia Severe acute respiratory syndrome: a global view of the epidemic

    Carlos Franco-Paredes

    2003-06-01

    Full Text Available A principios de febrero de 2003 la Organización Mundial de la Salud comenzó a recibir reportes de pacientes con un síndrome caracterizado por neumonía atípica, con rápida progresión hacia insuficiencia respiratoria sin una causa identificada. Los casos aparentemente se iniciaron en el sur de China y se han diseminado a otras regiones en Asia, Europa, Sudáfrica, Norte América y Sur América. La causa de este síndrome es una nueva variedad de Coronavirus, aislado en secreciones respiratorias y en otras. El síndrome ha sido definido en inglés como SARS (Severe acute respiratory syndrome por la Organización Mundial de la Salud y se caracteriza por un periodo de incubación de 1 a 10 días (promedio de cinco días, una fase febril prodrómica que aparece entre los días 1 a 3. Posteriormente, aparecen síntomas respiratorios como tos, disnea, y signos como hipoxemia, que en 10 a 40% de los casos requieren de ventilación mecánica. La tasa de letalidad ha variado de 3% hasta 16%. Los hallazgos de laboratorio incluyen trombocitopenia, leucopenia, elevación de creatinin-fosfokinasa, y, en ocasiones, de transaminasas hepáticas y deshidrogenasa láctica. El tratamiento incluye medidas de apoyo; la utilización empírica del antiviral ribavirina es controvertida, debido a que hasta el momento no existe un tratamiento específico. Se recomienda el aislamiento respiratorio de los pacientes, la utilización de máscaras protectoras y el lavado estricto de manos como principales medidas de prevención. Desde el inicio de esta epidemia México estableció un sistema de vigilancia, así como recomendaciones al personal de salud para la identificación, prevención de casos secundarios y manejo clínico de casos sospechosos.In early February 2003, the World Health Organization (WHO began receiving reports of patients with a syndrome characterized by an atypical pneumonia with rapid progression to respiratory failure without an identified cause

  9. Rigid spine syndrome with respiratory failure.

    Morita, H.; Kondo, K.; Hoshino, K; Maruyama, K; Yanagisawa, N

    1990-01-01

    The pathogenesis and therapy of respiratory failure in the rigid spine syndrome are discussed in two cases who improved with respiratory assistance. In both cases, the partial pressures of oxygen and carbon dioxide were reversed in arterial blood gas analysis and %VC was less than 30%. Remission from respiratory failure has been obtained by the use of a ventilator during the night. The cause of the respiratory failure in both cases was severe restrictive respiratory dysfunction due to extreme...

  10. Controvérsias acerca da acidose hipercápnica na síndrome do desconforto respiratório agudo Controversies involving hypercapnic acidosis in acute respiratory distress syndrome

    Liliane Nardelli

    2009-12-01

    Full Text Available A síndrome do desconforto respiratório agudo é caracterizada por uma reação inflamatória difusa do parênquima pulmonar induzida por um insulto direto ao epitélio alveolar (síndrome do desconforto respiratório agudo pulmonar ou indireto por meio do endotélio vascular (síndrome do desconforto respiratório agudo extrapulmonar. A principal estratégia terapêutica da síndrome do desconforto respiratório agudo é o suporte ventilatório. Entretanto, a ventilação mecânica pode agravar a lesão pulmonar. Nesse contexto, uma estratégia ventilatória protetora com baixo volume corrente foi proposta. Tal estratégia reduziu a taxa de mortalidade dos pacientes com síndrome do desconforto respiratório agudo, porém acarretou acidose hipercápnica. O presente artigo apresenta uma revisão da literatura acerca dos efeitos da acidose hipercápnica na síndrome do desconforto respiratório agudo. Para tal, realizou-se uma revisão sistemática da literatura científica conforme critérios já estabelecidos para análise documental incluindo artigos experimentais e clínicos sobre o tema, usando-se como bases de dados MedLine, LILACS, SciElo, PubMed, Cochrane. A acidose hipercápnica é defendida por alguns autores como moduladora do processo inflamatório da síndrome do desconforto respiratório agudo. Entretanto, estudos clínicos e experimentais acerca dos efeitos da acidose hipercápnica têm demonstrado resultados controversos. Logo, é fundamental a realização de mais pesquisas para elucidar o papel da acidose hipercápnica na síndrome do desconforto respiratório agudo.Acute respiratory distress syndrome is characterized by a diffuse inflammatory reaction of lung parenchyma induced by a direct insult to the alveolar epithelium (pulmonary acute respiratory distress syndrome or an indirect lesion through the vascular endothelium (extrapulmonary acute respiratory distress syndrome. The main therapeutic strategy for acute respiratory

  11. A single immunization with a rhabdovirus-based vector expressing severe acute respiratory syndrome coronavirus (SARS-CoV) S protein results in the production of high levels of SARS-CoV-neutralizing antibodies

    Faber, Milosz; Lamirande, Elaine W.; Roberts, Anjeanette; Rice, Amy B.; Koprowski, Hilary; Dietzschold, Bernhard; Schnell, Matthias J.

    2005-01-01

    Foreign viral proteins expressed by rabies virus (RV) have been shown to induce potent humoral and cellular immune responses in immunized animals. In addition, highly attenuated and, therefore, very safe RV-based vectors have been constructed. Here, an RV-based vaccine vehicle was utilized as a novel vaccine against severe acute respiratory syndrome coronavirus (SARS-CoV). For this approach, the SARS-CoV nucleocapsid protein (N) or envelope spike protein (S) genes were cloned between the RV g...

  12. Toxicological Safety Evaluation of DNA Plasmid Vaccines against HIV-1, Ebola, Severe Acute Respiratory Syndrome, or West Nile Virus Is Similar Despite Differing Plasmid Backbones or Gene-Inserts

    Sheets, Rebecca L.; Stein, Judith; Manetz, T. Scott; Andrews, Charla; Bailer, Robert; Rathmann, John; Gomez, Phillip L.

    2006-01-01

    The Vaccine Research Center has developed a number of vaccine candidates for different diseases/infectious agents (HIV-1, Severe Acute Respiratory Syndrome virus, West Nile virus, and Ebola virus, plus a plasmid cytokine adjuvant—IL-2/Ig) based on a DNA plasmid vaccine platform. To support the clinical development of each of these vaccine candidates, preclinical studies were performed to screen for potential toxicities (intrinsic and immunotoxicities). All treatment-related toxicities identif...

  13. Successful management of acute respiratory failure with noninvasive mechanical ventilation after drowning, in an epileptic-patient

    Paolo Ruggeri; Salvatore Calcaterra; Antonio Bottari; Giuseppe Girbino; Vincenzo Fodale

    2016-01-01

    Sea drowning is a common cause of accidental death worldwide. Respiratory complications such as acute pulmonary oedema, which is often complicated by acute respiratory distress syndrome, is often seen. Noninvasive ventilation is already widely used as a first approach to treat acute respiratory failure resulting from multiple diseases. We report a case of a 45 year old man with a history of epilepsy, motor and mental handicap who developed acute respiratory failure secondary to sea water drow...

  14. Dynamic changes of pulmonary lesions on CT in patients with severe acute respiratory syndrome treated by non-invasive positive pressure ventilation

    Objective: To study the dynamic changes of pulmonary lesions of severe acute respiratory syndrome (SARS) treated by non-invasive positive pressure ventilation (NIPPV) on CT. Methods: Serial chest CT images in 18 patients with SARS were retrospectively analyzed before and after NIPPV (4-12 days), and a long-term follow-up (3-36 months) examination by CT was carried out. And 27 SARS cases without NIPPV were enrolled as the control group. Results: (1) There were dynamic changes in 15 cases of 18 cases: partial multilobar consolidations of bilateral lungs changed into ground-glass opacities in 7 of 18 cases, a circular pulmonary emphysema around bronchial vascular strains of the lower lobes was seen in 5 of 18, subpleural pulmonary emphysema was seen in 8 of 18, pulmonary barotraumas were showed in 2 of 18. Residual of subpleural curvilinear shadow related to NIPPV was found in 2 eases on the follow-up scan. (2) Above changes on CT were not found in 27 cases without NIPPV. Conclusion: There were changes of pulmonary lesions of SARS on CT related to NIPPV treatment, It is beneficial to assess the CT images in the NIPPV treatment of the related pneumonia in SARS. (authors)

  15. Diagnostic value of static and dynamic scintigraphy in diagnosis of acute respiratory distress syndrome in the course of sepsis. Part 1. Lung perfusion scintigraphy

    One of the most important complication of sepsis is acute respiratory distress syndrome (ARDS). Diagnosis of the illness is mainly based on chest radiography and gasometric parameters of the blood. The aim of the study was to estimate the diagnostic usefulness of lung perfusion scintigraphy in early detection of blood flow and gas-exchange abnormalities in patients with ARDS in the course of sepsis. Scintigraphic studies of 12 patients in critical condition were performed, using Hungarian planar gamma camera type MB9200 and human albumin microspheres labelled with 99mTc. Perfusion scans of patients with ARDS demonstrated blurring outlines and abundant diffuse foci of lack of radioactivity in both lungs and quantitative analysis indicated relative increase of Tc99m-MSA accumulation in upper zones of both lungs. Scans of suffering from sepsis were similar to control one. The course of the studies showed that scintigraphic methods could be safely use in patients with sepsis and ARDS and may be helpful in the early diagnosis of ARDS in the septic patients. (author)

  16. ARDS诊断——“柏林标准”的价值与意义%Acute Respiratory Distress Syndrome: Berlin Definition

    杨毅

    2012-01-01

    急性呼吸窘迫综合征(ARDS)病死率高,其早期准确的诊断是有效治疗的前提.然而,当前ARDS诊断标准的准确性备受质疑,临床迫切需要便捷可靠严谨的诊断标准.“柏林标准”从起病时间、氧合指数、肺水肿的来源及胸部影像学表现四个方面对ARDS进行诊断,是既往诊断标准的总结与延伸,其有效性及准确性已被证实,对于临床诊疗和科学研究有重大意义.%Acute respiratory distress syndrome is associated with high mortality. It already be commonly conceded that early identification and diagnosis of ARDS be very crucial to following successful treatment. However, contemporary ARDS criteria have met many challenges and thus an integrated and precise definition was urgently needed for clinical practice. The new Berlin ARDS definition includes 4 key components: timing, oxygenation index, origin of edema, chest imagines, and already be considered as summary and extend of previous standard. The validation and reliability of new definition have been verified and therefore would cast significantly influences on future clinical practices and scientific researches.

  17. ORF5 of porcine reproductive and respiratory syndrome virus (PRRSV) is a target of diversifying selection as infection progresses from acute infection to virus rebound.

    Chen, Nanhua; Trible, Benjamin R; Kerrigan, Maureen A; Tian, Kegong; Rowland, Raymond R R

    2016-06-01

    Genetic variation in both structural and nonstructural genes is a key factor in the capacity of porcine reproductive and respiratory syndrome virus (PRRSV) to evade host defenses and maintain within animals, farms and metapopulations. However, the exact mechanisms by which genetic variation contribute to immune evasion remain unclear. In a study to understand the role of host genetics in disease resistance, a population of pigs were experimentally infected with a type 2 PRRSV isolate. Four pigs that showed virus rebound at 42days post-infection (dpi) were analyzed by 454 sequencing to characterize the rebound quasispecies. Deep sequencing of variable regions in nsp1, nsp2, ORF3 and ORF5 showed the largest number of nucleotide substitutions at day 28 compared to days 4 and 42 post-infection. Differences were also found in genetic variations when comparing tonsil versus serum. The results of dN/dS ratios showed that the same regions evolved under negative selection. However, eight amino acid sites were identified as possessing significant levels of positive selection, including A27V and N32S substitutions in the GP5 ectodomain region. These changes may alter GP5 peptide signal sequence processing and N-glycosylation, respectively. The results indicate that the greatest genetic diversity occurs during the transition between acute and rebound stages of infection, and the introduction of mutations that may result in a gain of fitness provides a potential mechanism for persistence. PMID:26961593

  18. Salmonella Typhi-Induced Septic Shock and Acute Respiratory Distress Syndrome in a Previously Healthy Teenage Patient Treated With High-Dose Dexamethasone.

    Ugas, Melissa Brosset; Carroll, Timothy; Kovar, Lacey; Chavez-Bueno, Susana

    2016-01-01

    Typhoid fever is commonly characterized by fever and abdominal pain. Rare complications include intestinal hemorrhage, bowel perforation, delirium, obtundation, and septic shock. Herein we describe the case of a previously healthy 16-year-old male without history of travel, diagnosed with typhoid fever complicated by septic shock and acute respiratory distress syndrome treated with high-dose dexamethasone. This case details severe complications of typhoid fever that are uncommonly seen in developed countries, and the successful response to high-dose dexamethasone as adjunct therapy. High-dose dexamethasone treatment has reportedly decreased Salmonella Typhi mortality, but controlled studies specifically performed in children are lacking, and most reports of its use are over 30 years old and all have originated in developing countries. Providers should include Salmonella Typhi in the differential diagnosis of the pediatric patient with fever, severe abdominal pain, and enteritis, and be aware of its potentially severe complications and the limited data on safety and efficacy of adjunctive therapies that can be considered in addition to antibiotics. PMID:27294165

  19. Noninvasive ventilation in acute respiratory failure due to H1N1 influenza

    Mohapatra, Prasanta R.; Naveen Dutt; Sushant Khanduri; Baijayantimala Mishra; Janmeja, Ashok K

    2011-01-01

    We present a case of severe H1N1 influenza with hypoxemic acute respiratory failure necessitating mechanical ventilation benefited from noninvasive positive pressure ventilation (NIPPV). The NIPPV may be of great use in treating patients with H1N1-related acute respiratory distress syndrome in a resource poor setting or when invasive ventilator is unavailable.

  20. Comparative evaluation of acute respiratory distress syndrome in patients with and without H1N1 infection at a tertiary care referral center

    Tanvir Samra

    2011-01-01

    Full Text Available H1N1 subtype of influenza A virus has clinical presentation ranging from mild flu like illness to severe lung injury and acute respiratory distress syndrome (ARDS. The aim of our study was to compare the demographic characteristics, clinical presentation, and mortality of critically ill patients with (H1N1+ and without H1N1 infection (H1N1-. We retrospectively analyzed medical charts of patients admitted in "Swine Flu ICU" with ARDS from August 2009 to May 2010. Real-time reverse transcriptase polymerase chain reaction (RT-PCR assay was used for detection of H1N1 virus in the respiratory specimens. Clinical data from 106 (H1N1 , 45; H1N1+, 61 patients was collected and compared. Mean delay in presentation to our hospital was 5.7 ± 3.1 days and co-morbidities were present in two-fifth of the total admissions. Sequential Organ Failure Assessment (SOFA score of patients with and without H1N1 infection was comparable; 7.8 ± 3.5 and 6.6 ± 3.1 on day 1 and 7.2 ± 4.5 and 6.5 ± 3.1 on day 3, respectively. H1N1+ patients were relatively younger in age (34.2 ± 12.9 years vs. 42.8 ± 18.1, P = 0.005 but presented with significantly lower PaO 2 :FiO 2 ratio (87.3 ± 48.7 vs. 114 ± 51.7 in comparison to those who subsequently tested as H1N1 . The total leucocyte counts were significantly lower in H1N1+ patients during the first four days of illness but incidence of renal failure (P = 0.02 was higher in H1N1+ patients. The mortality in both the groups was high (H1N1+, 77%; H1N1, 68% but comparable. There was a mean delay of 5.7 ± 3.1 days in initiation of antivirals. Patients with H1N1 infection were relatively younger in age and with a significantly higher incidence of refractory hypoxia and acute renal failure. Mortality from ARDS reported in our study in both the groups was high but comparable.

  1. Intravenous naloxone in acute respiratory failure.

    Ayres, J.; J Rees; Lee, T.; Cochrane, G M

    1982-01-01

    A 58-year-old man presented with acute on chronic respiratory failure. In the acute stage of his illness an infusion of the opiate antagonist naloxone caused an improvement in oxygen saturation as measured by ear oximetry from 74% to 85%, while a saline infusion resulted in a return of oxygen saturation to the original value. When he had recovered from the acute episode the same dose of naloxone had no effect on oxygen saturation. These findings suggest that in acute respiratory failure there...

  2. Middle East Respiratory Syndrome Virus Pathogenesis.

    Singh, Sunit K

    2016-08-01

    Coronaviruses (CoVs) are enveloped RNA viruses that infect birds, mammals, and humans. Infections caused by human coronaviruses (hCoVs) are mostly associated with the respiratory, enteric, and nervous systems. The hCoVs only occasionally induce lower respiratory tract disease, including bronchitis, bronchiolitis, and pneumonia. In 2002 to 2003, a global outbreak of severe acute respiratory syndrome (SARS) was the seminal detection of a novel CoV (SARS-CoV). A decade later (June 2012), another novel CoV was implicated as the cause of Middle East respiratory syndrome (MERS) in Saudi Arabia. Although bats might serve as a reservoir of MERS-CoV, it is unlikely that they are the direct source for most human cases. Severe lines of evidence suggest that dromedary camels have been the major cause of transmission to humans. The emergence of MERS-CoV has triggered serious concerns about the potential for a widespread outbreak. All MERS cases were linked directly or indirectly to the Middle East region including Saudi Arabia, Jordan, Qatar, Oman, Kuwait, and UAE. MERS cases have also been reported in the later phases in the United Kingdom, France, Germany, Italy, Spain, and Tunisia. Most of these MERS cases were linked with the Middle East. The high mortality rates in family-based and hospital-based outbreaks were reported among patients with comorbidities such as diabetes and renal failure. MERS-CoV causes an acute, highly lethal pneumonia and renal dysfunction. The major complications reported in fatal cases are hyperkalemia with associated ventricular tachycardia, disseminated intravascular coagulation, pericarditis, and multiorgan failure. The case-fatality rate seems to be higher for MERS-CoV (around 30%) than for SARS-CoV (9.6%). The combination regimen of type 1 interferon + lopinavir/ritonavir is considered as the first-line therapy for MERS. Antiviral treatment is generally recommended for 10 to 14 days in patients with MERS-CoV infection. Convalescent plasma

  3. Use of dynamic CT in acute respiratory distress syndrome (ARDS) with comparison of positive and negative pressure ventilation

    Helm, Emma; Babyn, Paul [Hospital for Sick Children, Department of Diagnostic Imaging, Toronto (Canada); Talakoub, Omid; Alirezaie, Javad [Ryerson University, Department of Electrical and Computer Engineering, Toronto, ON (Canada); Grasso, Francesco; Engelberts, Doreen; Kavanagh, Brian P. [Hospital for Sick Children and the University of Toronto, Departments of Anesthesia and Critical Care Medicine and the Program in Pulmonary and Experimental Medicine, Toronto (Canada)

    2009-01-15

    Negative pressure ventilation via an external device ('iron lung') has the potential to provide better oxygenation with reduced barotrauma in patients with ARDS. This study was designed to see if oxygenation differences between positive and negative ventilation could be explained by CT. Six anaesthetized rabbits had ARDS induced by repeated saline lavage. Rabbits were ventilated with positive pressure ventilation (PPV) and negative pressure ventilation (NPV) in turn. Dynamic CT images were acquired over the respiratory cycle. A computer-aided method was used to segment the lung and calculate the range of CT densities within each slice. Volumes of ventilated lung and atelectatic lung were measured over the respiratory cycle. NPV was associated with an increased percentage of ventilated lung and decreased percentage of atelectatic lung. The most significant differences in ventilation and atelectasis were seen at mid-inspiration and mid-expiration (ventilated lung NPV=61%, ventilated lung PPV=47%, p<0.001; atelectatic lung NPV=10%, atelectatic lung PPV 19%, p<0.001). Aeration differences were not significant at end-inspiration. Dynamic CT can show differences in lung aeration between positive and negative ventilation in ARDS. These differences would not be appreciated if only static breath-hold CT was used. (orig.)

  4. Clinical efficacy and safety of recruitment maneuver in patients with acute respiratory distress syndrome using low tidal volume ventilation: a multicenter randomized controlled clinical trial

    XI Xiu-ming; JIANG Li; ZHU Bo; the RM group

    2010-01-01

    Background The recruitment maneuver (RM) has been shown to improve oxygenation in some patients with acute respiratory distress syndrome. But there is a lack of standardization and lack of clinical studies to prove the improvement on clinical outcome. We conducted this study to evaluate the clinical efficacy and safety of the RM in patients with acute respiratory distress syndrome (ARDS) using Iow tidal volume ventilation.Methods We randomly assigned 110 patients with ARDS from 14 Chinese intensive care units (ICUs) at the tertiary teaching hospitals. Patients with PaO2 ≤200 mmHg at FiO2 1.0 and PEEP ≥10 cmH2O were included in the study.Patients were randomized into two groups: control group and RM group. The tidal volume was set to 6-8 mi per kilogram of predicted body weight (PBW) in both groups. RM was performed by continuous positive airway pressure (CPAP) of 40 cmH2O maintained for 40 seconds. RMs was conducted every eight hours for the first five days, or stopped within five days if the patient reached the weaning standard.Results One hundred and ten patients had completed the requirements for the primary study goals, 55 from the RM group and 55 control patients. Baseline characteristics remained similar in the two groups. In the RM group the PaO2/FiO2 was significantly increased compared to baseline at 120 minutes after RM on day one and day two (P=0.007and P=0.001). There were no significant differences between the RM and control group in hospital mortality (41.8% vs.56.4%, P=0.13), 28-day mortality (29.1% vs. 43.6%, P=0.11) and ventilator-free days at day 28 (10.8±10.1 vs. 7.4±10.0,P=0.08). ICU mortality (32.7% vs. 52.7%, P=0.03), the rate of survival with unassisted breathing for at least 48 consecutive hours at day 28 (58.2% vs. 36.2%, P=0.02), and nonpulmonary organ failure-free days at day 28 (17.4±11.1vs. 13.0±12.0, P=0.03) favored the RM group. There was no significant difference in mean blood pressure and heart rate before RM and at 30, 60

  5. Turning Crisis into Opportunity: Nature of Science and Scientific Inquiry as Illustrated in the Scientific Research on Severe Acute Respiratory Syndrome

    Wong, Siu Ling; Kwan, Jenny; Hodson, Derek; Yung, Benny Hin Wai

    2009-01-01

    Interviews with key scientists who had conducted research on Severe Acute Respiratory Syndrome (SARS), together with analysis of media reports, documentaries and other literature published during and after the SARS epidemic, revealed many interesting aspects of the nature of science (NOS) and scientific inquiry in contemporary scientific research in the rapidly growing field of molecular biology. The story of SARS illustrates vividly some NOS features advocated in the school science curriculum, including the tentative nature of scientific knowledge, theory-laden observation and interpretation, multiplicity of approaches adopted in scientific inquiry, the inter-relationship between science and technology, and the nexus of science, politics, social and cultural practices. The story also provided some insights into a number of NOS features less emphasised in the school curriculum—for example, the need to combine and coordinate expertise in a number of scientific fields, the intense competition between research groups (suspended during the SARS crisis), the significance of affective issues relating to intellectual honesty and the courage to challenge authority, the pressure of funding issues on the conduct of research and the ‘peace of mind’ of researchers, These less emphasised elements provided empirical evidence that NOS knowledge, like scientific knowledge itself, changes over time. They reflected the need for teachers and curriculum planners to revisit and reconsider whether the features of NOS currently included in the school science curriculum are fully reflective of the practice of science in the 21st century. In this paper, we also report on how we made use of extracts from the news reports and documentaries on SARS, together with episodes from the scientists’ interviews, to develop a multimedia instructional package for explicitly teaching the prominent features of NOS and scientific inquiry identified in the SARS research.

  6. Evaluation of lung infiltration score to predict postural hypoxemia in ventilated acute respiratory distress syndrome patients and the lateralization of skin pressure sore

    Tripathi Mukesh

    2009-09-01

    Full Text Available Context: Mechanical ventilation with positive end expiratory pressure (PEEP is associated with unequal aeration of lungs in acute respiratory distress syndrome (ARDS patients. Therefore, patients may develop asymmetric atelectasis and postural hypoxemia during lateral positioning. Aims: To validate proposed lung infiltration score (LIS based on chest x-ray to predict postural hypoxemia and lateralization of skin sores in ARDS patients. Settings and Design: University hospital ICU. Prospective, observational study of consecutive patients. Materials and Methods: Sixteen adult patients of both genders on mechanical ventilation with PEEP for 24 to < 48 hours. On chest x-ray, 6 segments were identified on each lung. The proposed LIS points (0- normal; 1- patchy infiltrates; 2- white infiltrates matching heart shadow were assigned to each segment. Without changing ventilation parameters, supine, left and right lateral positions at 45° tilt were randomly changed. At the end of 20 minutes of ventilation in each position, we observed arterial oxygen saturation, hemodynamic and arterial blood gases. Later, position change protocol (4 hourly was practiced in ICU, and skin pressure sore grading was noted within a week of ICU stay. Statistical Analysis Used: Nonparametric Bland and Altman correlation analysis, ANOVA and Student t test. Results: Arterial oxygenation (PaO 2 /FiO 2 = 313± 145.6 was significantly (P< 0.01 higher in better lung (lower LIS-down position than supine (PaO 2 /FiO 2 = 199± 70.2 or a better lung-up position (PaO 2 /FiO 2 = 165± 64.8. The positioning-related arterial oxygenation was significant (P< 0.05 at LIS asymmetry ≥3 between two lungs. Conclusions: The LIS mapping on chest x-ray was useful to differentiate between asymmetric lung disease and postural hypoxemia in ICU patients, which predisposed patients to early skin sore changes on higher LIS side.

  7. Síndrome de Distrés Respiratorio Agudo: Utilidad de los Corticoides Acute respiratory distress syndrome: Role of steroids

    Célica L. Irrazábal

    2004-06-01

    Full Text Available En Argentina, el síndrome de distrés respiratorio agudo (SDRA representa el 7.7% de las admisiones en terapia intensiva y está asociado con una alta morbilidad y mortalidad (58%. Con frecuencia la muerte puede ser atribuida a más de una causa. La hipoxemia refractaria es una causa de muerte poco frecuente (15% y en muchos casos puede coexistir con disfunción multiorgánica, sepsis o shock séptico. La utilidad de los esteroides como parte del tratamiento es aún motivo de debate a pesar de las múltiples series de casos y estudios clínicos publicados. En el artículo se evalúa la utilidad de los esteroides en el SDRA a través de la revisión de la bibliografía disponible. Se concluye que los esteroides estarían indicados en un pequeño subgrupo de pacientes con SDRA no resuelto o tardío, después de descartar o controlar una infección activa.The acute respiratory distress syndrome (ARDS represents 7.7% of the intensive care population, and is associated with great morbidity and mortality (58%. Frequently, the mortality can be attributed to more than one cause. Refractory hypoxemia is uncommon (15% and most of the patients also have multiple organic dysfunction, sepsis or septic shock. Although there are many publications concerning series of cases and clinical trials using steroids as a part of the treatment of ARDS, this issue remains controversial. In this article the role of steroids in the ARDS is evaluated by analysis of the available literature. We conclude that steroids are useful in a subgroup of patients with unresolving ARDS, after ruling out an active infection or after treatment with antibiotics.

  8. Evaluation by indirect immunofluorescent assay and enzyme linked immunosorbent assay of the dynamic changes of serum antibody responses against severe acute respiratory syndrome coronavirus

    MO Hong-ying; XU Jun; REN Xiao-lan; ZENG Guang-qiao; TAN Ya-xia; CHEN Rong-chang; Moira Chan-Yeung; ZHONG Nan-shan

    2005-01-01

    Background Severe acute respiratory syndrome coronavirus (SARS-CoV) is a newly emerging virus that gives rise to SARS patients with high rates of infectivity and fatality. To study the humoral immune responses to SARS-CoV, the authors evaluated IgG and IgM specific antibodies in patients' sera.Methods Two methods, enzyme-linked immunosorbent assay (ELISA) and indirect immunofluorescent assay (IFA), were used to detect specific serum IgG and IgM against SARS-CoV in 98 SARS patients and 250 controls consisting of patients with pneumonia, health-care professionals and healthy subjects. The serum antibody profiles were investigated at different times over one and a half years in 18 of the SARS patients. Results The sensitivity and specificity of ELISA for detecting IgG against SARS-CoV were 100.0% and 97.2% and for IgM 89.8% and 97.6% respectively; the figures using IFA for IgG were 100.0% and 100.0% and for IgM 81.8% and 100.0% respectively. During the first seven days of the antibodies trace test, no IgG and IgM were detected, but on day 15, IgG response increased dramatically, reaching a peak on day 60, remaining high up to day 180 and decreasing gradually until day 540. On day 15, IgM was detected, rapidly reached a peak, then declined gradually until day 180 when IgM was undetectable. Conclusion The detection of antibodies against SARS virus is helpful in the clinical diagnosis of SARS.

  9. Submersion and acute respiratory failure

    Yu-Jang Su

    2014-01-01

    Conclusions: Submersion patients who are hypothermic on arrival of emergency department (ED are risky to respiratory failure and older, more hypothermic, longer hospital stay in suicidal submersion patients.

  10. Sustained inflation and incremental mean airway pressure trial during conventional and high-frequency oscillatory ventilation in a large porcine model of acute respiratory distress syndrome

    Wunder Christian

    2006-06-01

    Full Text Available Abstract Background To compare the effect of a sustained inflation followed by an incremental mean airway pressure trial during conventional and high-frequency oscillatory ventilation on oxygenation and hemodynamics in a large porcine model of early acute respiratory distress syndrome. Methods Severe lung injury (Ali was induced in 18 healthy pigs (55.3 ± 3.9 kg, mean ± SD by repeated saline lung lavage until PaO2 decreased to less than 60 mmHg. After a stabilisation period of 60 minutes, the animals were randomly assigned to two groups: Group 1 (Pressure controlled ventilation; PCV: FIO2 = 1.0, PEEP = 5 cmH2O, VT = 6 ml/kg, respiratory rate = 30/min, I:E = 1:1; group 2 (High-frequency oscillatory ventilation; HFOV: FIO2 = 1.0, Bias flow = 30 l/min, Amplitude = 60 cmH2O, Frequency = 6 Hz, I:E = 1:1. A sustained inflation (SI; 50 cmH2O for 60s followed by an incremental mean airway pressure (mPaw trial (steps of 3 cmH2O every 15 minutes were performed in both groups until PaO2 no longer increased. This was regarded as full lung inflation. The mPaw was decreased by 3 cmH2O and the animals reached the end of the study protocol. Gas exchange and hemodynamic data were collected at each step. Results The SI led to a significant improvement of the PaO2/FiO2-Index (HFOV: 200 ± 100 vs. PCV: 58 ± 15 and TAli: 57 ± 12; p 2-reduction (HFOV: 42 ± 5 vs. PCV: 62 ± 13 and TAli: 55 ± 9; p Ali: 6.1 ± 1 vs. T75: 3.4 ± 0.4; PCV: TAli: 6.7 ± 2.4 vs. T75: 4 ± 0.5; p Conclusion A sustained inflation followed by an incremental mean airway pressure trial in HFOV improved oxygenation at a lower mPaw than during conventional lung protective ventilation. HFOV but not PCV resulted in normocapnia, suggesting that during HFOV there are alternatives to tidal ventilation to achieve CO2-elimination in an "open lung" approach.

  11. Acute respiratory distress in a silversmith

    Jignesh Mukeshkumar Parikh

    2014-01-01

    Full Text Available A 25-year-old young male patient presented in casualty department with severe respiratory distress on the fourth day from onset of symptoms. The patient was nonsmoker and had no antecedent medical or drug history. Prior to admission, patient had dry cough and bilateral pleuritic chest pain for the last three days. He was in severe respiratory distress with use of accessory muscles of respiration. On examination, he had heart rate of 120 beats/min, blood pressure (BP of 150/80, respiratory rate of 48-52/min and central cyanosis present. On systemic examination, reduced intensity of breath sounds with extensive rhonchi and crepitation was found in both lung fields, with other examination being within normal limits. On pulse oximetry, oxygen saturation was 28% on room air, which increased up to 36% with the help of 4 L oxygen via nasal prongs. PaO 2 /FiO 2 ratio was 100. Chest X-ray analysis was suggestive of non-cardiac pulmonary edema in view of bilateral fluffy opacity without cardiomegaly. In view of 2/3 positive criteria, his provisional diagnosis was Acute Respiratory Distress Syndrome (ARDS. He required mechanical ventilatory support and was gradually weaned over a period of 10 days. The patient was treated with broad spectrum antibiotics and other supportive measures. On re-evaluation of history, we found that he was a goldsmith by occupation, smelting silver and gold for the past 8-10 years. On the day of onset of symptoms, while smelting silver he was exposed to golden yellow fumes for around 15 minutes, with the quantum of exposure more than any other day earlier. From previous experience and analysis of similar silver metals, he was able to tell us that the silver was adulterated with large amount of cadmium on that day than before. Serum level of cadmium was 2.9 μg/L 6 days after initial exposure. At the time of discharge, he had residual opacities in the chest radiograph and resting oxygen saturation was 94% on room air.

  12. Acute organophosphorus poisoning complicated by acute coronary syndrome.

    Pankaj, Madhu; Krishna, Kavita

    2014-07-01

    We report a case of 30 year old alcoholic male admitted with vomiting, drowsiness, limb weakness and fasciculations after alleged history of consumption of 30 ml of chlorpyriphos insecticide. He had low serum cholinesterase levels. With standard treatment for organophosphorus poisoning (OPP), he improved gradually until day 5, when he developed neck and limb weakness and respiratory distress. This intermediate syndrome was treated with oximes, atropine and artificial ventilation. During treatment, his ECG showed fresh changes of ST elevation. High CPK & CPK-MB levels, septal hypokinesia on 2D echo suggested acute coronary syndrome. Coronary angiography was postponed due to his bedridden and obtunded status. The patient finally recovered fully by day 15 and was discharged. Acute coronary syndrome is a rare occurrence in OP poisoning. The present case thus emphasises the need for careful electrocardiographic and enzymatic monitoring of all patients of organophosphorus poisoning to prevent potential cardiac complication which can prove fatal. PMID:25672037

  13. X-ray picture of the respiratory distress syndrome (shock lung)

    X-Ray picture of the respiratory distress syndrome (shock lung) in 78 patients exposed to high temperature as a result of gas condensate explosion is analyzed. X-ray and morphologic fundings in these patients are compared to those in 13 similar patients in whom acute respiratory failure developed because of other causes. Morphologic basis of the4 majority of x-ray signs of acute respiratory distress has been investigated. A relationship between respiratory distress syndrome development and changes in the heart size has been revealed, which may serve the prediction criterion

  14. Postperfusion lung syndrome: Respiratory mechanics, respiratory indices and biomarkers

    Shi-Min Yuan

    2015-01-01

    Postperfusion lung syndrome is rare but lethal. Secondary inflammatory response was the popularly accepted theory for the underlying etiology. Respiratory index (RI) and arterial oxygen tension/fractional inspired oxygen can be reliable indices for the diagnosis of this syndrome as X-ray appearance is always insignificant at the early stage of the onset. Evaluations of extravascular lung water content and pulmonary compliance are also helpful in the definite diagnosis. Multiorgan failure and ...

  15. Emergency thyroidectomy: Due to acute respiratory failure

    Zulfu Bayhan; Sezgin Zeren; Bercis Imge Ucar; Isa Ozbay; Yalcin Sonmez; Metin Mestan; Onur Balaban; Nilufer Araz Bayhan; Mehmet Fatih Ekici

    2014-01-01

    INTRODUCTION: Giant cervical and mediastinal goiter may lead to acute respiratory failure caused by laryngotracheal compression and airway obstruction. Here, we present a case admitted to the emergency service with a giant goiter along with respiratory failure and poor general health status, which required urgent surgical intervention. PRESENTATION OF CASE: A 71-year-old female admitted to the emergency room with shortness of breath and poor general health status resulting from a giant cer...

  16. A Case with Repeated Recurrent Acute Coronary Syndrome due to Pseudoephedrine Use: Kounis Syndrome

    Metin Çeliker

    2014-01-01

    Full Text Available Allergic reaction-associated acute coronary syndrome picture is defined as Kounis syndrome. Although drug use is the most common cause of allergic reaction, foods and environmental factors may also play a role in the etiology. Herein, a case with acute coronary syndrome that developed two times at 8-month interval due to pseudoephedrine use for upper respiratory tract infection is presented.

  17. Detection of respiratory pathogens in aerosols from acutely infected pigs

    Infectious agents that cause respiratory disease in pigs include porcine reproductive respiratory syndrome virus (PRRSV), porcine circovirus type 2 (PCV2), swine influenza virus (SIV), porcine respiratory corona virus (PRCV), Mycoplasma hyopneumoniae, and Bordetella bronchiseptica. The objective of...

  18. Effects of different levels of end-expiratory positive pressure on lung recruitment and protection in patients with acute respiratory distress syndrome

    GUO Feng-mei; DING Jing-jing; SU Xin; XU Hui-ying; SHI Yi

    2008-01-01

    Background It is still controversial as to the implementation of higher positive end-expiratory pressure (PEEP) in patients with acute respiratory distress syndrome (ARDS).This study was conducted to compare the lower and higher PEEP in patients with ARDS ventilated with low tidal volume,to investigate the relationship between the recruited lung volume by higher PEEP and relevant independent variables and to provide a bedside estimate of the percentage of potentially recruitable lung by higher PEEP.Methods Twenty-four patients with ARDS were studied.A lung recruiting maneuver was performed,then each patient was ventilated with PEEP of 8 cmH2O for 4 hours and subsequently with PEEP of 16 cmH2O for 4 hours.At the end of each PEEP level period,gas exchange,hemodynamic data,lung mechanics,stress index "b" of the dynamic pressure-time curve,intrinsic PEEP and recruited volume by PEEP were measured.Results Fourteen patients were recruiters whose alveolar recruited volumes induced by PEEP 16 cmH2O were (425±65) ml and 10 patients were non-recruiters.Compared with the PEEP 8 cmH2O period,after the application of the PEEP 16 cmH2O,the PaO2/FiO2 ratio and static lung compliance both remained unchanged in non-recruiters,whereas they increased significantly in recruiters.Changes in PaO2/FiO2 and static lung compliance after PEEP increase were independently associated with the alveolar recruitment.Analyzing the relationship between recruiting maneuver (RM)-induced change in end-expiratory lung volume and the alveolar recruitment induced by PEEP,we found a notable correlation.Conclusions The results of this study indicated that the potential for alveolar recruitment might vary among the ARDS population and the higher PEEP levels should be limited to recruiters.Improving in PaO2/FiO2,static lung compliance after PEEP increase and the shape of the pressure-time curve could be helpful for PEEP application.

  19. Physiological relevance and performance of a minimal lung model – an experimental study in healthy and acute respiratory distress syndrome model piglets

    Chiew Yeong

    2012-09-01

    Full Text Available Abstract Background Mechanical ventilation (MV is the primary form of support for acute respiratory distress syndrome (ARDS patients. However, intra- and inter- patient-variability reduce the efficacy of general protocols. Model-based approaches to guide MV can be patient-specific. A physiological relevant minimal model and its patient-specific performance are tested to see if it meets this objective above. Methods Healthy anesthetized piglets weighing 24.0 kg [IQR: 21.0-29.6] underwent a step-wise PEEP increase manoeuvre from 5cmH2O to 20cmH2O. They were ventilated under volume control using Engström Care Station (Datex, General Electric, Finland, with pressure, flow and volume profiles recorded. ARDS was then induced using oleic acid. The data were analyzed with a Minimal Model that identifies patient-specific mean threshold opening and closing pressure (TOP and TCP, and standard deviation (SD of these TOP and TCP distributions. The trial and use of data were approved by the Ethics Committee of the Medical Faculty of the University of Liege, Belgium. Results and discussions 3 of the 9 healthy piglets developed ARDS, and these data sets were included in this study. Model fitting error during inflation and deflation, in healthy or ARDS state is less than 5.0% across all subjects, indicating that the model captures the fundamental lung mechanics during PEEP increase. Mean TOP was 42.4cmH2O [IQR: 38.2-44.6] at PEEP = 5cmH2O and decreased with PEEP to 25.0cmH2O [IQR: 21.5-27.1] at PEEP = 20cmH2O. In contrast, TCP sees a reverse trend, increasing from 10.2cmH2O [IQR: 9.0-10.4] to 19.5cmH2O [IQR: 19.0-19.7]. Mean TOP increased from average 21.2-37.4cmH2O to 30.4-55.2cmH2O between healthy and ARDS subjects, reflecting the higher pressure required to recruit collapsed alveoli. Mean TCP was effectively unchanged. Conclusion The minimal model is capable of capturing physiologically relevant TOP, TCP and SD of both healthy and ARDS lungs. The

  20. The Ratio of Partial Pressure Arterial Oxygen and Fraction of Inspired Oxygen 1 Day After Acute Respiratory Distress Syndrome Onset Can Predict the Outcomes of Involving Patients.

    Lai, Chih-Cheng; Sung, Mei-I; Liu, Hsiao-Hua; Chen, Chin-Ming; Chiang, Shyh-Ren; Liu, Wei-Lun; Chao, Chien-Ming; Ho, Chung-Han; Weng, Shih-Feng; Hsing, Shu-Chen; Cheng, Kuo-Chen

    2016-04-01

    The initial hypoxemic level of acute respiratory distress syndrome (ARDS) defined according to Berlin definition might not be the optimal predictor for prognosis. We aimed to determine the predictive validity of the stabilized ratio of partial pressure arterial oxygen and fraction of inspired oxygen (PaO2/FiO2 ratio) following standard ventilator setting in the prognosis of patients with ARDS.This prospective observational study was conducted in a single tertiary medical center in Taiwan and compared the stabilized PaO2/FiO2 ratio (Day 1) following standard ventilator settings and the PaO2/FiO2 ratio on the day patients met ARDS Berlin criteria (Day 0). Patients admitted to intensive care units and in accordance with the Berlin criteria for ARDS were collected between December 1, 2012 and May 31, 2015. Main outcome was 28-day mortality. Arterial blood gas and ventilator setting on Days 0 and 1 were obtained.A total of 238 patients met the Berlin criteria for ARDS were enrolled, and they were classified as mild (n = 50), moderate (n = 125), and severe (n = 63) ARDS, respectively. Twelve (5%) patients who originally were classified as ARDS did not continually meet the Berlin definition, and a total of 134 (56%) patients had the changes regarding the severity of ARDS from Day 0 to Day 1. The 28-day mortality rate was 49.1%, and multivariate analysis identified age, PaO2/FiO2 on Day 1, number of organ failures, and positive fluid balance within 5 days as significant risk factors of death. Moreover, the area under receiver-operating curve for mortality prediction using PaO2/FiO2 on Day 1 was significant higher than that on Day 0 (P = 0.016).PaO2/FiO2 ratio on Day 1 after applying mechanical ventilator is a better predictor of outcomes in patients with ARDS than those on Day 0. PMID:27057912

  1. Prolonged extracorporeal membrane oxygenation therapy for severe acute respiratory distress syndrome in a child affected by rituximab-resistant autoimmune hemolytic anemia: a case report

    Beretta Chiara

    2009-04-01

    Full Text Available Abstract Introduction Autoimmune hemolytic anemia in children younger than 2 years of age is usually characterized by a severe course, with a mortality rate of approximately 10%. The prolonged immunosuppression following specific treatment may be associated with a high risk of developing severe infections. Recently, the use of monoclonal antibodies (rituximab has allowed sustained remissions to be obtained in the majority of pediatric patients with refractory autoimmune hemolytic anemia. Case presentation We describe the case of an 8-month-old Caucasian girl affected by a severe form of autoimmune hemolytic anemia, which required continuous steroid treatment for 16 months. Thereafter, she received 4 weekly doses of rituximab (375 mg/m2/dose associated with steroid therapy, which was then tapered over the subsequent 2 weeks. One month after the last dose of rrituximab, she presented with recurrence of severe hemolysis and received two more doses of rrituximab. The patient remained in clinical remission for 7 months, before presenting with a further relapse. An alternative heavy immunosuppressive therapy was administered combining cyclophosphamide 10 mg/kg/day for 10 days with methylprednisolone 40 mg/kg/day for 5 days, which was then tapered down over 3 weeks. While still on steroid therapy, the patient developed an interstitial pneumonia with Acute Respiratory Distress Syndrome, which required immediate admission to the intensive care unit where extracorporeal membrane oxygenation therapy was administered continuously for 37 days. At 16-month follow-up, the patient is alive and in good clinical condition, with no organ dysfunction, free from any immunosuppressive treatment and with a normal Hb level. Conclusions This case shows that aggressive combined immunosuppressive therapy may lead to a sustained complete remission in children with refractory autoimmune hemolytic anemia. However, the severe life-threatening complication presented by our

  2. A phase I study evaluating the pharmacokinetics, safety and tolerability of an antibody-based tissue factor antagonist in subjects with acute lung injury or acute respiratory distress syndrome

    Morris Peter E

    2012-02-01

    Full Text Available Abstract Background The tissue factor (TF-dependent extrinsic pathway has been suggested to be a central mechanism by which the coagulation cascade is locally activated in the lungs of patients with acute lung injury and acute respiratory distress syndrome (ALI/ARDS and thus represents an attractive target for therapeutic intervention. This study was designed to determine the pharmacokinetic and safety profiles of ALT-836, an anti-TF antibody, in patients with ALI/ARDS. Methods This was a prospective, randomized, placebo-controlled, dose-escalation Phase I clinical trial in adult patients who had suspected or proven infection, were receiving mechanical ventilation and had ALI/ARDS (PaO2/FiO2 ≤ 300 mm. Eighteen patients (6 per cohort were randomized in a 5:1 ratio to receive ALT-836 or placebo, and were treated within 48 hours after meeting screening criteria. Cohorts of patients were administered a single intravenously dose of 0.06, 0.08 or 0.1 mg/kg ALT-836 or placebo. Blood samples were taken for pharmacokinetic and immunogenicity measurements. Safety was assessed by adverse events, vital signs, ECGs, laboratory, coagulation and pulmonary function parameters. Results Pharmacokinetic analysis showed a dose dependent exposure to ALT-836 across the infusion range of 0.06 to 0.1 mg/kg. No anti-ALT-836 antibody response was observed in the study population during the trial. No major bleeding episodes were reported in the ALT-836 treated patients. The most frequent adverse events were anemia, observed in both placebo and ALT-836 treated patients, and ALT-836 dose dependent, self-resolved hematuria, which suggested 0.08 mg/kg as an acceptable dose level of ALT-836 in this patient population. Conclusions Overall, this study showed that ALT-836 could be safely administered to patients with sepsis-induced ALI/ARDS. Trial registration ClinicalTrials.gov: NCT01438853

  3. Síndrome do desconforto respiratório agudo pulmonar e extrapulmonar: existem diferenças? Pulmonary and extrapulmonary acute respiratory distress syndrome: are they different?

    Cristiane S. N. Baez Garcia

    2008-06-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A patogênese da síndrome do desconforto respiratório agudo (SDRA tem sido explicada pela presença de uma agressão direta (SDRA pulmonar e/ou indireta (SDRA extrapulmonar ao parênquima pulmonar. Evidências indicam que a fisiopatologia da doença pode diferir com o tipo de lesão. O objetivo deste estudo foi apresentar breve revisão das diferenças entre a SDRA pulmonar e a SDRA extrapulmonar e discutir as interações entre os aspectos morfofuncionais e a resposta aos diferentes tratamentos. CONTEÚDO: Esta revisão bibliográfica baseou-se em uma pesquisa sistemática de artigos experimentais e clínicos sobre SDRA incluídos nas bases de dados MedLine e SciElo nos últimos 20 anos. Muitos pesquisadores concordam, com base em estudos experimentais, que a SDRA pulmonar e a SDRA extrapulmonar não são idênticas no que diz respeito aos aspectos morfofuncionais, a resposta à pressão positiva ao final da expiração (PEEP, manobra de recrutamento alveolar, posição prona e outras terapias farmacológicas. Entretanto, os estudos clínicos têm descrito resultados contraditórios, os quais podem ser atribuídos à dificuldade de se classificar a SDRA em uma ou outra etiologia, e de se precisar o início, a fase e a gravidade da SDRA nos pacientes. CONCLUSÕES: Pacientes com SDRA de etiologias distintas perduram sendo considerados como pertencendo a uma mesma síndrome e, assim, são tratados da mesma forma. Logo, é fundamental entender as diferenças fisiopatológicas entre a SDRA pulmonar e extrapulmonar para que a terapia seja mais bem direcionada.BACKGROUND AND OBJECTIVES: The pathogenesis of acute respiratory distress syndrome (ARDS has been described by the presence of direct (pulmonary and/or indirect (extrapulmonary insult to the lung parenchyma. Evidence indicates that the pathophysiology of ARDS may differ according to the type of primary insult. This article presents a brief overview of differences

  4. 儿童急性呼吸窘迫综合征肺复张策略的研究进展%Recruitment maneuvers in pediatric patients with acute respiratory distress syndrome

    谢波

    2014-01-01

    近年来肺复张策略因可打开肺泡,减少肺泡萎陷所致的肺损伤,改善肺顺应性,提高动脉氧分压与氧合指数,减少肺内分流而成为急性呼吸窘迫综合征机械通气治疗手段之一.本文就肺复张在儿童急性呼吸窘迫综合征的应用做一综述.%Recently,alveolar recruitment maneuver is one of effective management of mechanically ventilated patients with acute respiratory distress syndrome.Recruitment maneuvers are widely used in clinical practice to open the lung and prevent lung injury by derecruitment,improving the compliance,increasing PaO2,increasing the PaO2/FiO2 ratio,and reducing the pulmonary shunt fraction,although the evidence is still discussed.This review discussed recruitment maneuvers in pediatric patients with acute respiratory distress syndrome.

  5. Uso de corticosteroide na síndrome do desconforto respiratório agudo em pacientes pediátricos Corticosteroids therapy in pediatric acute respiratory distress syndrome

    Maria Clara de Magalhães Barbosa

    2010-12-01

    mais pesquisas para elucidar a segurança e eficácia da administração de metilprednisolona na lesão pulmonar aguda/síndrome do desconforto respiratório agudo em crianças, bem como estabelecer os melhores parâmetros a serem utilizados no diagnóstico e acompanhamento da doença, na monitorização das complicações da corticoterapia, bem como os desfechos primários mais adequados.The use of corticosteroids in acute lung injury and acute respiratory distress syndrome is one of the most controversial issues in the literature. However, acute lung injury/acute respiratory distress syndrome studies are restricted to adults, despite the widespread use of corticosteroid for hyper-reactive respiratory airway diseases in children. This review aimed to describe experimental and clinical evidence for corticosteroid therapy in acute lung injury/acute respiratory distress syndrome and to point out the risks and benefits of its use in pediatrics. For this purpose, an extensive review of the literature was performed from 1980 to 2010 including both experimental and clinical papers, as well as reviews and meta-analysis, using Medline, Cochrane Central Register of Controlled Trials, Cochrane database of systematic reviews, SciELO, Lilacs and Bireme databases. The search terms were: acute lung injury, acute respiratory distress syndrome, steroids, child, clinical trials, meta-analyses, reviews, and case reports. Most studies showed that the corticosteroids-induced down-regulation of systemic inflammatory response is associated with oxygenation improvement, reduction of multiple organ dysfunctions, mechanical ventilation time, and intensive care units length of stay. Based on the literature, the authors suggest early and prolonged methylprednisolone administration for acute lung injury/acute respiratory distress syndrome, using continuous 1 mg/kg/day infusion to prevent glycemic variability, associated with strict infection surveillance. In addition, they recommend some

  6. Respiratory failure in acute pancreatitis.

    Banerjee, A K; Haggie, S J; Jones, R B; Basran, G. S.

    1995-01-01

    There are a number of important pulmonary complications of acute pancreatitis which make a significant contribution to the morbidity and mortality of the condition. The pathophysiology and management guidelines are given for each and approaches towards better treatment in the future are discussed.

  7. SMART phones and the acute respiratory patient.

    Gleeson, L

    2012-05-01

    Definition of Respiratory Failure using PaO2 alone is confounded when patients are commenced on oxygen therapy prior to arterial blood gas (ABG) measurement. Furthermore, classification of Respiratory Failure as Type 1 or Type 2 using PaCO2 alone can give an inaccurate account of events as both types can co-exist. 100 consecutive presentations of acute respiratory distress were assessed initially using PaO2, and subsequently PaO2\\/FiO2 ratio, to diagnose Respiratory Failure. Respiratory Failure cases were classified as Type 1 or Type 2 initially using PaCO2, and subsequently alveolar-arterial (A-a) gradient. Any resultant change in management was documented. Of 100 presentations, an additional 16 cases were diagnosed as Respiratory Failure using PaO2\\/FiO2 ratio in place of PaO2 alone (p = 0.0338). Of 57 cases of Respiratory Failure, 22 cases classified as Type 2 using PaCO2 alone were reclassified as Type 1 using A-a gradient (p < 0.001). Of these 22 cases, management changed in 18.

  8. Postperfusion lung syndrome: Respiratory mechanics, respiratory indices and biomarkers

    Shi-Min Yuan

    2015-01-01

    Full Text Available Postperfusion lung syndrome is rare but lethal. Secondary inflammatory response was the popularly accepted theory for the underlying etiology. Respiratory index (RI and arterial oxygen tension/fractional inspired oxygen can be reliable indices for the diagnosis of this syndrome as X-ray appearance is always insignificant at the early stage of the onset. Evaluations of extravascular lung water content and pulmonary compliance are also helpful in the definite diagnosis. Multiorgan failure and triple acid-base disturbances that might develop secondary to postperfusion lung syndrome are responsible for the poor prognosis and increased mortality rather than postperfusion lung syndrome itself. Mechanical ventilation with low tidal volume (TV and proper positive end-expiratory pressure can be an effective treatment strategy. Use of ulinastatin and propofol may benefit the patients through different mechanisms.

  9. ANTICOAGULANTS IN ACUTE CORONARY SYNDROME

    I. A. Latfullin; A. A. Podolskaya

    2016-01-01

    Clinical efficacy of unfractionated and low molecular heparins in acute coronary syndrome is discussed. New synthetic heparin derivative fondaparinux (Arixtra) is focused. Author’s brief experience of fondaparinux clinical implementation is presented.

  10. 无创机械通气治疗急性呼吸窘迫综合征的临床观察%Clinical observation of non-invasive mechanical ventilation for acute respiratory distress syndrome

    耿新普

    2012-01-01

    目的 观察无创机械通气治疗急性呼吸窘迫综合征(ARDS)的临床疗效.方法 72例急性呼吸窘迫综合征患者在常规治疗(药物治疗+吸氧)基础上加用无创机械通气,观察患者治疗前后临床症状和动脉血气分析.结果 给予无创机械通气后患者呼吸困难症状明显改善,pH、SaO2、PaO2、PaO2/FiO2等指标上升明显,与治疗前相比差异有统计学意义(P<0.05);呼吸频率、心率、血压、PaCO2,等指标明显下降,与治疗前相比差异有统计学意义(P<0.05).动脉血气PaO2明显上升(P<0.05),PaCO2下降明显(P<0.05).结论 无创机械通气治疗能有效缓解急性呼吸窘迫综合征患者的临床症状,并改善患者的各项血气指标,值得在临床中推广应用.%Objective To investigate the clinical efficacy of the non-invasive mechanical ventilation in acute respiratory distress syndrome. Methods 72 patients with acute respiratory distress syndrome were used non-invasive mechanical ventilation on the basis of the conventional therapy( drug treatment + oxygen ). Before and after treatment, clinical symptoms and arterial blood gas analysis were measured. Results After treatment, the original dificulty breathing symptoms of patients improved, pH,SaO2 ,PaO2 ,PaO2/FiO2 increased significantly, and there were significant differences compared with before treatment P <0. 05 );respiratory rate, heart rate, blood pressure, PaCO2 decreased significantly compared with before treatment with significant differences( P <0. 05 ). Conclusion Non-invasive mechanical ventilation in acute respiratory distress syndrome can quickly relieve the clinical symptoms and improve the blood gas analysis in patients. It is worthy of clinically use.

  11. Respiratory system involvement in Costello syndrome.

    Gomez-Ospina, Natalia; Kuo, Christin; Ananth, Amitha Lakshmi; Myers, Angela; Brennan, Marie-Luise; Stevenson, David A; Bernstein, Jonathan A; Hudgins, Louanne

    2016-07-01

    Costello syndrome (CS) is a multisystem disorder caused by heterozygous germline mutations in the HRAS proto-oncogene. Respiratory system complications have been reported in individuals with CS, but a comprehensive description of the full spectrum and incidence of respiratory symptoms in these patients is not available. Here, we report the clinical course of four CS patients with respiratory complications as a major cause of morbidity. Review of the literature identified 56 CS patients with descriptions of their neonatal course and 17 patients in childhood/adulthood. We found that in the neonatal period, respiratory complications are seen in approximately 78% of patients with transient respiratory distress reported in 45% of neonates. Other more specific respiratory diagnoses were reported in 62% of patients, the majority of which comprised disorders of the upper and lower respiratory tract. Symptoms of upper airway obstruction were reported in CS neonates but were more commonly diagnosed in childhood/adulthood (71%). Analysis of HRAS mutations and their respiratory phenotype revealed that the common p.Gly12Ser mutation is more often associated with transient respiratory distress and other respiratory diagnoses. Respiratory failure and dependence on mechanical ventilation occurs almost exclusively with rare mutations. In cases of prenatally diagnosed CS, the high incidence of respiratory complications in the neonatal period should prompt anticipatory guidance and development of a postnatal management plan. This may be important in cases involving rarer mutations. Furthermore, the high frequency of airway obstruction in CS patients suggests that otorhinolaryngological evaluation and sleep studies should be considered. © 2016 Wiley Periodicals, Inc. PMID:27102959

  12. Variation analysis of the severe acute respiratory syndrome coronavirus putative non-structural protein 2 gene and construction of three-dimensional model

    LU Jia-hai; CHEN Wei-qing; LING Wen-hua; YU Xin-bing; ZHONG Nan-shan; ZHANG Ding-mei; WANG Guo-ling; GUO Zhong-min; ZHANG Chuan-hai; TAN Bing-yan; OUYANG Li-ping; LIN Li; LIU Yi-min

    2005-01-01

    Background The rapid transmission and high mortality rate made severe acute respiratory syndrome (SARS) a global threat for which no efficacious therapy is available now. Without sufficient knowledge about the SARS coronavirus (SARS-CoV), it is impossible to define the candidate for the anti-SARS targets. The putative non-structural protein 2 (nsp2) (3CLpro, following the nomenclature by Gao et al, also known as nsp5 in Snidjer et al) of SARS-CoV plays an important role in viral transcription and replication, and is an attractive target for anti-SARS drug development, so we carried on this study to have an insight into putative polymerase nsp2 of SARS-CoV Guangdong (GD) strain.Methods The SARS-CoV strain was isolated from a SARS patient in Guangdong, China, and cultured in Vero E6 cells. The nsp2 gene was amplified by reverse transcription-polymerase chain reaction (RT-PCR) and cloned into eukaryotic expression vector pCI-neo (pCI-neo/nsp2). Then the recombinant eukaryotic expression vector pCI-neo/nsp2 was transfected into COS-7 cells using lipofectin reagent to express the nsp2 protein. The expressive protein of SARS-CoV nsp2 was analyzed by 7% sodium dodecylsulfate polyacrylamide gel electrophoresis (SDS-PAGE). The nucleotide sequence and protein sequence of GD nsp2 were compared with that of other SARS-CoV strains by nucleotide-nucleotide basic local alignment search tool (BLASTN) and protein-protein basic local alignment search tool (BLASTP) to investigate its variance trend during the transmission. The secondary structure of GD strain and that of other strains were predicted by Garnier-Osguthorpe-Robson (GOR) Secondary Structure Prediction. Three-dimensional-PSSM Protein Fold Recognition (Threading) Server was employed to construct the three-dimensional model of the nsp2 protein.Results The putative polymerase nsp2 gene of GD strain was amplified by RT-PCR. The eukaryotic expression vector (pCI-neo/nsp2) was constructed and expressed the protein in COS-7

  13. Stillbirth during infection with Middle East respiratory syndrome coronavirus.

    Payne, Daniel C; Iblan, Ibrahim; Alqasrawi, Sultan; Al Nsour, Mohannad; Rha, Brian; Tohme, Rania A; Abedi, Glen R; Farag, Noha H; Haddadin, Aktham; Al Sanhouri, Tarek; Jarour, Najwa; Swerdlow, David L; Jamieson, Denise J; Pallansch, Mark A; Haynes, Lia M; Gerber, Susan I; Al Abdallat, Mohammad Mousa

    2014-06-15

    We conducted an epidemiologic investigation among survivors of an outbreak of Middle East respiratory syndrome coronavirus (MERS-CoV) infection in Jordan. A second-trimester stillbirth occurred during the course of an acute respiratory illness that was attributed to MERS-CoV on the basis of exposure history and positive results of MERS-CoV serologic testing. This is the first occurrence of stillbirth during an infection with MERS-CoV and may have bearing upon the surveillance and management of pregnant women in settings of unexplained respiratory illness potentially due to MERS-CoV. Future prospective investigations of MERS-CoV should ascertain pregnancy status and obtain further pregnancy-related data, including biological specimens for confirmatory testing. PMID:24474813

  14. Acute Respiratory Distress Due to Methane Inhalation

    Jo, Jun Yeon; Kwon, Yong Sik; Lee, Jin Wook; Park, Jae Seok; Rho, Byung Hak; Choi, Won-Il

    2013-01-01

    Inhalation of toxic gases can lead to pneumonitis. It has been known that methane gas intoxication causes loss of consciousness or asphyxia. There is, however, a paucity of information about acute pulmonary toxicity from methane gas inhalation. A 21-year-old man was presented with respiratory distress after an accidental exposure to methane gas for one minute. He came in with a drowsy mentality and hypoxemia. Mechanical ventilation was applied immediately. The patient's symptoms and chest rad...

  15. Predictive Factors of Respiratory Failure in Children with Guillain-Barre Syndrome

    Nemat Bilan; Mohammad Barzegar; Parinaz Habibi

    2015-01-01

    Introduction:Guillain-Barre Syndrome(GBS) is the most common cause of acute flaccid paralysis. Respiratory failure is the most serious short-term complication of GBS and invasive mechanical ventilation is required in 30% of patients.moreover,60% of those who are intubated develop major complications including pnemonia,sepsis,GI bleeding and pulmonary embolism. Thus respiratory failure prediction is crucial. the aim of this study was to determine clinical predictors of respiratory failure to a...

  16. Non-invasive mechanic ventilation in treating acute respiratory failure

    Federico Lari

    2009-12-01

    Full Text Available Non invasive ventilation (NIV in acute respiratory failure (ARF improve clinical parameters, arterial blood gases, decrease mortality and endo tracheal intubation (ETI rate also outside the intensive care units (ICUs. Objective of this study is to verify applicability of NIV in a general non respiratory medical ward. We enrolled 68 consecutive patients (Pts with Hypoxemic or Hyper capnic ARF: acute cardiogenic pulmonary edema (ACPE, exacerbation of chronic obstructive pulmonary disease (COPD, Pneu - monia, acute lung injury / acute respiratory distress syndrome (ALI/ARDS. NIV treatment was CPAP or PSV + PEEP. 12 Pts (18,5% met primary endpoint (NIV failure: 11 Pts (17% needed ETI (5ALI/ARDS p < 0,0001, 6COPD 16,6%, 1 Patient (1,5% died (Pneumonia. No Pts with ACPE failed (p = 0,0027. Secondary endpoints: significant improvement in Respiratory Rate (RR, Kelly Score, pH, PaCO2, PaO2 vs baseline. Median duration of treatment: 16:06 hours: COPD 18:54, ACPE 4:15. Mean length of hospitalisation: 8.66 days. No patients discontinued NIV, no side effects. Results are consistent with literature. Hypoxemic ARF related to ALI/ARDS and pneumonia show worst outcome: it is not advisable to manage these conditions with NIV outside the ICU. NIV for ARF due to COPD and ACPE is feasible, safe and effective in a general medical ward if selection of Pts, staff’s training and monitoring are appropriate. This should encourage the diffusion of NIV in this specific setting. According to strong evidences in literature, NIV should be considered a first line and standard treatment in these clinical conditions irrespective of the setting.

  17. Acute respiratory distress in diabetic ketoacidosis: possible contribution of low colloid osmotic pressure.

    Leonard, R. C.; Asplin, C; McCormick, C. V.; Hockaday, T. D.

    1983-01-01

    The "shock lung" syndrome may occur in diabetic ketoacidosis in association with disseminated intravascular coagulation; occasionally it occurs alone after treatment of the ketoacidosis. Two patients developed pulmonary opacities with clinical features of acute respiratory distress such as are seen in the shock lung syndrome; in both, however, the findings suggested a different mechanism from that occurring in the syndrome. Hypoalbuminaemia was prominent, and it is postulated that a low plasm...

  18. 呼吸机用于急性呼吸窘迫综合征中的临床效果分析%Clinical Analysis of Mechanical Ventilation for Acute Respiratory Ddistress Syndrome

    侯守强

    2014-01-01

    Objective To investigate the application analysis of patients with acute respiratory distress syndrome treatment the clinical ef ect of breathing machine. Methods Randomly selected from our hospital in 30 patients with acute respiratory distress syndrome as the research object, al patients were treated with breathing machine, the treatment of patients were retrospectively analyzed. Results All after ef ective treatment, heart rate, blood pressure, breathing, PaCO2, PaO2, PH, indexes of blood oxygen saturation (SaO2) than before treatment were obviously improved ( <0.05);This group of four patients died, the rest al 26 patients survived, the mortality was 13.3%.Conclusion Patients with acute respiratory distress syndrome with breathing machine ventilation treatment as soon as possible, can effectively reduce the mortality rate, safe and ef ective, worthy of further promotion and application in clinic.%目的探讨分析急性呼吸窘迫综合征患者应用呼吸机治疗的临床效果。方法随机选取我院收治的30例急性呼吸窘迫综合征患者为研究对象,所有患者均采用呼吸机治疗,回顾性分析患者的治疗情况。结果所有经有效治疗后,心率、血压、呼吸、PaCO2、PaO2、PH、血氧饱和度(SaO2)等指标较治疗前均有明显改善(<0.05);本组4例患者死亡,其余26例患者均存活,死亡率为13.3%。结论急性呼吸窘迫综合征患者尽早采用呼吸机进行通气治疗,可有效降低死亡率,安全有效,值得在临床上进一步推广、应用。

  19. The acute radiation syndrome

    Symptoms and signs from medical aspects resulting from whole body exposure, or in the main part, to ionizing radiation are described. The dose-response relationship is studied and the exposure is divided in three parts: central nervous system syndrome, gastrointestinal syndrome and hematopoietic syndrome. Brief comments about the treatment are reported. (M.A.C.)

  20. Successful management of acute respiratory failure with noninvasive mechanical ventilation after drowning, in an epileptic-patient.

    Ruggeri, Paolo; Calcaterra, Salvatore; Bottari, Antonio; Girbino, Giuseppe; Fodale, Vincenzo

    2016-01-01

    Sea drowning is a common cause of accidental death worldwide. Respiratory complications such as acute pulmonary oedema, which is often complicated by acute respiratory distress syndrome, is often seen. Noninvasive ventilation is already widely used as a first approach to treat acute respiratory failure resulting from multiple diseases. We report a case of a 45 year old man with a history of epilepsy, motor and mental handicap who developed acute respiratory failure secondary to sea water drowning after an epileptic crisis. We illustrate successful and rapid management of this case with noninvasive ventilation. We emphasize the advantages and limitations of using noninvasive ventilation to treat acute respiratory failure due to sea water drowning syndrome. PMID:27222793

  1. The protein X4 of severe acute respiratory syndrome-associated coronavirus is expressed on both virus-infected cells and lung tissue of severe acute respiratory syndrome patients and inhibits growth of Balb/c 3T3 cell line

    CHEN Ying-yu; GAN Qi-ni; ZHANG Xin; ZHENG Ying; LIU Shun-ai; WANG Xiao-ning; ZHONG Nan-shan; MA Da-long; SHUANG Bao; TAN Ya-xia; MENG Min-jie; HAN Pu; MO Xiao-ning; SONG Quan-sheng; QIU Xiao-yan; LUO Xin

    2005-01-01

    Background The genome of the severe acute respiratory syndrome-associated coronavirus (SARS-CoV) includes sequences encoding the putative protein X4 (ORF8, ORF7a), consisting of 122 amino acids. The deduced sequence contains a probable cleaved signal peptide sequence and a C-terminal transmembrane helix, indicating that protein X4 is likely to be a type I membrane protein. This study was conducted to demonstrate whether the protein X4 was expressed and its essential function in the process of SARS-CoV infection.Methods The prokaryotic and eukaryotic protein X4-expressing plasmids were constructed. Recombinant soluble protein X4 was purified from E. Coli using ion exchange chromatography, and the preparation was injected into chicken for rising specific polyclonal antibodies. The expression of protein X4 in SARS-CoV-infected Vero E6 cells and lung tissues from patients with SARS was performed using immunofluorescence assay and immunohistochemistry technique. The preliminary function of protein X4 was evaluated by treatment with and over-expression of protein X4 in cell lines. Western blot was employed to evaluate the expression of protein X4 in SARS-CoV particles. Results We expressed and purified soluble recombinant protein X4 from E.coli, and generated specific antibodies against protein X4. Western blot proved that the protein X4 was not assembled in the SARS-CoV particles. Indirect immunofluorescence assays revealed that the expression of protein X4 was detected at 8 hours after infection in SARS-CoV-infected Vero E6 cells. It was also detected in the lung tissues from patients with SARS. Treatment with and overexpression of protein X4 inhibited the growth of Balb/c 3T3 cells as determined by cell counting and MTT assays. Conclusion The results provide the evidence of protein X4 expression following SARS-CoV infection, and may facilitate further investigation of the immunopathological mechanism of SARS.

  2. Resonance frequency in respiratory distress syndrome

    Lee, S.; Milner, A

    2000-01-01

    AIM—To observe how the resonance frequency changes with the course of respiratory distress syndrome (RDS), by examining the effect of changing static compliance on the resonance frequency in premature infants.
METHODS—In 12 ventilated premature infants with RDS (mean gestational age 26.6 weeks, mean birth weight 0.84 kg), resonance frequency and static compliance were determined serially using phase analysis and single breath mechanics technique respectively in the first ...

  3. Metabolic syndrome in acute coronary syndrome

    Objective: To determine the frequency of metabolic syndrome in male patients presenting with acute coronary syndrome Study design: A Descriptive study Place and duration of study: Armed Forces Institute of Cardiology and National Institute of Heart Diseases, Rawalpindi, from October 2007 to September 2008 Patients and Methods: Male patients with acute coronary syndrome (ACS) were included. Patients having angioplasty (PCI), coronary artery bypass surgery in the past and other co-morbid diseases were excluded. All patients were assessed for the presence of five components of metabolic syndrome including hypertension, HDL-Cholesterol and triglycerides, glucose intolerance and abdominal obesity. Systolic, diastolic blood pressures, waist circumference (WC) and body mass index (BMI) were measured. ECG, cardiac enzymes, fasting glucose and lipid profile were also done. Results: A total of 135 male patients of ACS were studied with a mean age of 54.26 +- 11 years. Metabolic syndrome (MS) was present in 55 (40.7%) patients. MS with all five components was documented in 4 (7.27%) while MS with four and three components was seen in 23 (41.81%) and 28 (50.90%) patients respectively. Only 24 (43.63%) patients with MS had diabetes mellitus, remaining 31(56.36%) were non diabetic. Frequencies of diabetes, hypertension and family history of CAD were significantly higher (p<0.05) in patients with metabolic syndrome as compared to patients with normal metabolic status. Conclusion: Metabolic syndrome is fairly common and important risk factor in patients of IHD. Other risk factors like smoking, dyslipidemia, hypertension and diabetes were also frequently found. Public awareness to control the risk factors can reduce the prevalence of CAD in our country. (author)

  4. Emergency department syndromic surveillance providing early warning of seasonal respiratory activity in England.

    Hughes, H E; Morbey, R; Hughes, T C; Locker, T E; Pebody, R; Green, H K; Ellis, J; Smith, G E; Elliot, A J

    2016-04-01

    Seasonal respiratory infections place an increased burden on health services annually. We used a sentinel emergency department syndromic surveillance system to understand the factors driving respiratory attendances at emergency departments (EDs) in England. Trends in different respiratory indicators were observed to peak at different points during winter, with further variation observed in the distribution of attendances by age. Multiple linear regression analysis revealed acute respiratory infection and bronchitis/bronchiolitis ED attendances in patients aged 1-4 years were particularly sensitive indicators for increasing respiratory syncytial virus activity. Using near real-time surveillance of respiratory ED attendances may provide early warning of increased winter pressures in EDs, particularly driven by seasonal pathogens. This surveillance may provide additional intelligence about different categories of attendance, highlighting pressures in particular age groups, thereby aiding planning and preparation to respond to acute changes in EDs, and thus the health service in general. PMID:26415918

  5. FISH ACUTE TOXICITY SYNDROMES IN THE DEVELOPMENT OF MECHANISM-SPECIFIC QSARS.

    The focus of this report is to summarize the development and status of the fish acute toxicity syndrome (FATS) research effort. hus far, FATS associated with nonpolar narcotics, oxidative phosphorylation uncouplers, respiratory membrane irritants, acetylcholinesterase (AChE) inhi...

  6. ACUPUNCTURE TREATMENT OF 42 CASES OF ACUTE UPPER RESPIRATORY TRACT INFECTION

    ManWei; WangJinglan

    2000-01-01

    We made clinical observations on the therapeutic effect of acupuncture on acute upper respiratory tract infection and compared with the effect of paracetamol and Antondine, The result showed that acupuncture therapy could allay fever more rapidly than drugs, so long as the differentiation of syndromes is correct and the acupoint is selected properly.

  7. Clustering of acute respiratory infection hospitalizations in childcare facilities

    Kamper-Jørgensen, Mads; Benn, Christine Stabell; Simonsen, Jacob; Thrane, Nana; Wohlfahrt, Jan

    2010-01-01

    To estimate how risk of acute respiratory infection (ARI) hospitalization in children attending childcare facilities with a recently (within 1 month) hospitalized child is affected by gender, age and other characteristics.......To estimate how risk of acute respiratory infection (ARI) hospitalization in children attending childcare facilities with a recently (within 1 month) hospitalized child is affected by gender, age and other characteristics....

  8. Sjogren's syndrome: a rheumatic disorder with prominent respiratory manifestations.

    Bardana, E J; Montanaro, A

    1990-01-01

    Sjogren's syndrome is an autoimmune condition with extraordinary and unique involvement in the eyes and respiratory tract. These patients frequently present or are referred to an allergist for evaluation. Recognition of the syndrome is critical for effective management. PMID:2404432

  9. Porcine Reproductive and Respiratory Syndrome Virus (PRRSV)

    Kvisgaard, Lise Kirstine

    This PhD thesis presents the diversity of Porcine Reproductive and Respiratory Syndrome viruses (PRRSV) circulating in the Danish pig population. PRRS is a disease in pigs caused by the PRRS virus resulting in reproductive failures in sows and gilts and respiratory diseases in pigs . Due to genetic...... heterogeneity, PRRSV is divided into two genotypes, Type 1 and Type 2. Type 1 PRRS viruses are further divided into at least 3 subtypes. The virus evolves rapidly and reports of high pathogenic variants of both Type 1 and Type 2 appearing in Europe, North America, and Asia have been reported within recent years...... viruses showed both a higher diversity to the other Danish viruses and to the vaccine strain and one virus harbored the largest deletion in NSP2 reported in Danish Type 2 PRRSV. Manuscript IV is focusing on an experimental infection study in pigs with a Type 2 PRRS virus causing significant clinical...

  10. Acute oesophageal necrosis syndrome

    Garas, George; Wou, Constance; Sawyer, Joseph; Amygdalos, Iakovos; Gould, Stuart

    2011-01-01

    An 89-year-old woman with a known hiatus hernia presented to the accident and emergency department with acute onset epigastric pain. CT of the thorax and abdomen revealed a large hiatus hernia with mesentero-axial volvulus but no evidence of strangulation. A large aneurysmal aortic arch and descending aorta were visible with associated mural thrombus. As the pain was worsening, following discussion with the patient, the decision to operate was taken. The hiatus hernia was successfully reduced...

  11. Middle East respiratory syndrome coronavirus in children

    Thabet, Farah; Chehab, May; Bafaqih, Hind; AlMohaimeed, Sulaiman

    2015-01-01

    The Middle East respiratory syndrome (MERS) is a new human disease caused by a novel coronavirus (CoV). The disease is reported mainly in adults. Data in children are scarce. The disease caused by MERS-CoV in children presents with a wide range of clinical manifestations, and it is associated with a lower mortality rate compared with adults. Poor outcome is observed mainly in admitted patients with medical comorbidities. We report a new case of MERS-CoV infection in a 9-month-old child compli...

  12. Middle East Respiratory Syndrome Infection Control and Prevention Guideline for Healthcare Facilities

    Kim, Jin Yong; Song, Joon Young; Yoon, Young Kyung; Choi, Seong-Ho; Song, Young Goo; Kim, Sung-Ran; Son, Hee-Jung; Jeong, Sun-Young; Choi, Jung-Hwa; Kim, Kyung Mi; Yoon, Hee Jung; Choi, Jun Yong; Kim, Tae Hyong; Choi, Young Hwa; Kim, Hong Bin

    2015-01-01

    Middle East Respiratory Syndrome (MERS) is an acute viral respiratory illness with high mortality caused by a new strain of betacoronavirus (MERS-CoV). Since the report of the first patient in Saudi Arabia in 2012, large-scale outbreaks through hospital-acquired infection and inter-hospital transmission have been reported. Most of the patients reported in South Korea were also infected in hospital settings. Therefore, to eliminate the spread of MERS-CoV, infection prevention and control measu...

  13. Acute respiratory infections in young Ethiopian children

    Harris RA

    2015-07-01

    Full Text Available Rebecca Arden HarrisDepartment of Family and Social Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USAThe identification of risk factors for acute respiratory infections (ARI is crucial for designing interventions to both minimize transmission and augment the immune response, particularly in Sub-Saharan Africa where poverty-related ARI is still a major cause of preventable death in young children.1 I therefore read with interest Geberetsadik et al’s recent study of the factors associated with ARI in Ethiopian children.2 Their study uses nationally representative data on households and individuals to build a model of the social, demographic, and anthropometric determinants of ARI. A precise understanding of their model, however, requires clarification of several items in their paper.View original paper by Geberetsadik et al.

  14. Inhaled nitric oxide in acute respiratory distress syndrome with and without septic shock requiring norepinephrine administration: a dose–response study

    Mourgeon, Eric; Puybasset, Louis; Law-Koune, Jean-Dominique; Lu, Qin; Abdennour, Lamine; Gallart, Lluis; Malassine, Patrick; Rao, GS Umamaheswara; Cluzel, Philippe; Bennani, Abdelhai; Coriat, Pierre; Rouby, Jean-Jacques

    1997-01-01

    Background: The aim of this prospective study was to assess whether the presence of septic shock could influence the dose response to inhaled nitric oxide (NO) in NO-responding patients with adult respiratory distress syndrome (ARDS). Results: Eight patients with ARDS and without septic shock (PaO2 = 95 ± 16 mmHg, PEEP = 0, FiO2 = 1.0), and eight patients with ARDS and septic shock (PaO2 = 88 ± 11 mmHg, PEEP = 0, FiO2 = 1.0) receiving exclusively norepinephrine were studied. All responded to 15 ppm inhaled NO with an increase in PaO2 of at least 40 mmHg, at FiO2 1.0 and PEEP 10 cmH2O. Inspiratory intratracheal NO concentrations were recorded continuously using a fast response time chemiluminescence apparatus. Seven inspiratory NO concentrations were randomly administered: 0.15, 0.45, 1.5, 4.5, 15, 45 and 150 ppm. In both groups, NO induced a dose-dependent decrease in mean pulmonary artery pressure (MPAP), pulmonary vascular resistance index (PVRI), and venous admixture (QVA/QT), and a dose-dependent increase in PaO2/FiO2 (P ≤ 0.012). Dose-response of MPAP and PVRI were similar in both groups with a plateau effect at 4.5 ppm. Dose-response of PaO2/FiO2 was influenced by the presence of septic shock. No plateau effect was observed in patients with septic shock and PaO2/FiO2 increased by 173 ± 37% at 150 ppm. In patients without septic shock, an 82 ± 26% increase in PaO2/FiO2 was observed with a plateau effect obtained at 15 ppm. In both groups, dose-response curves demonstrated a marked interindividual variability and in five patients pulmonary vascular effect and improvement in arterial oxygenation were dissociated. Conclusion: For similar NOinduced decreases in MPAP and PVRI in both groups, the increase in arterial oxygenation was more marked in patients with septic shock. PMID:11056694

  15. The damage of pulmonary microvascular endothelial cell barrier and acute respiratory distress syndrome%肺微血管内皮细胞屏障功能损伤与急性呼吸窘迫综合征

    韩凤

    2015-01-01

    急性呼吸窘迫综合征( ARDS)是急性呼吸衰竭发生的主要原因,其特征是弥漫性的肺泡损伤,伴透明膜形成,肺泡腔高蛋白性水肿、毛细血管损伤和肺泡上皮破裂,它最突出的临床表现为顽固的低氧血症. 尽管在最佳的通气支持和液体平衡的治疗改善后,它仍有很高的死亡率及短、长期的并发症. 因此,对这种综合征的早期识别和治疗性干预措施的早期应用至关重要. 本综述描述了肺微血管内皮细胞( PMVECs )屏障功能损伤与ARDS发生、发展的相互关系.具体来说是描述了ARDS定义、PMVECs的屏障功能,以及在ARDS的发生、发展时PMVECs的通透性改变,异常凋亡、分泌和功能失调,以期深入探讨ARDS可能的病理生理学机制.%The acute respiratory distress syndrome ( ARDS) is a major cause of acute respiratory failure characterized by a diffused alveolar damage , formation of hyaline membranes , protein -rich edema fluid in the alveolar spaces , capillary injury and disruption of the alveolar epithelium , and the most prominent clinical manifestation of ARDS is refractory hypoxemia . Despite improvements in intensive care with optimal ventilation support and fluid balance , its development also leads to high mortality, as well as short -and long -term complications.Therefore, early recognition of this syndrome and application of demonstrated therapeutic interventions are essential to change the natural course of this devastating entity .In this review article , we describe the mutual relation between the damage of pulmonary microvascular endothelial cell ( PMVECs ) barrier and the occurrence and development of ARDS .Specifically , we describe the Berlin definition of ARDS and barrier function of PMVECs, as well as the permeability changes , the abnormal apoptosis and secretion and the dysfunction of PMVECs in the development of ARDS in order to further discuss its possible pathophysiological mechanism.

  16. Guillain-Barre Syndrome Presenting as Acute Abdomen

    Faruk incecik

    2015-09-01

    Full Text Available Guillain-Barr and eacute; syndrome (GBS is the most common cause of acute flaccid paralysis in childhood. Symmetric weakness, headache, respiratory symptom, neuropathic pain, muscle pain, paresthesia, and facial palsy were the most common clinical presentations. We report 13-year-old boy with GBS who presented with acute abdominal pain. This is the first report, to our knowledge, first presented of acute abdomen of a pediatric patient with GBS. [Cukurova Med J 2015; 40(3.000: 601-603

  17. Acute viral infections with combined involvement of the respiratory and gastrointestinal tracts in children. Therapy with interferon.

    Dondurei, E A; Osidak, L V; Golovacheva, E G; Golovanova, A K; Amosova, I V; Gladchenko, L N

    2009-08-01

    We evaluated the percent of acute respiratory viral infections with gastrointestinal syndrome in the structure of morbidity in babies aging 6 months and elder. Therapeutic efficiency and safety of anaferon (pediatric formuation) as a component of complex therapy of acute respiratory viral infections with involvement of the gastrointestinal tract were proven; more rapid disappearance of all symptoms and improvement of the immune status parameters were demonstrated. PMID:20027348

  18. Acute aortic valve prolapse in Marfan's syndrome.

    Carr, N J; Cullen, S. A.

    1991-01-01

    A 22 year old man with Marfan's syndrome died suddenly following acute aortic valve prolapse. Although aortic root involvement in Marfan's syndrome is common, we have found no previous description of this particular complication in the literature.

  19. Assessment of a new algorithm in the management of acute respiratory tract infections in children

    Seyed Ahmad Tabatabaei

    2012-01-01

    Full Text Available Objectives: To assess the practicability of a new algorithm in decreasing the rate of incorrect diagnoses and inappropriate antibiotic usage in pediatric Acute Respiratory Tract Infection (ARTI. Materials and Methods: Children between 1 month to15 years brought to outpatient clinics of a children′s hospital with acute respiratory symptoms were managed according to the steps recommended in the algorithm. Results: Upper Respiratory Tract Infection, Lower Respiratory Tract Infection, and undifferentiated ARTI accounted for 82%, 14.5%, and 3.5% of 1 209 cases, respectively. Antibiotics were prescribed in 33%; for: Common cold, 4.1%; Sinusitis, 85.7%; Otitis media, 96.9%; Pharyngotonsillitis, 63.3%; Croup, 6.5%; Bronchitis, 15.6%; Pertussis-like syndrome, 82.1%; Bronchiolitis, 4.1%; and Pneumonia, 50%. Conclusion: Implementation of the ARTIs algorithm is practicable and can help to reduce diagnostic errors and rate of antibiotic prescription in children with ARTIs.

  20. Analysis of arterial blood gas for 113 patients with acute respiratory stress syndrome%急性呼吸窘迫综合征的动态血气监测113例分析

    张玉梅; 周泽芬; 任成山

    2001-01-01

    目的 探讨动态监测血气对急性呼吸窘迫综合征(ARDS)的早期诊断、治疗和预后判断的临床意义。方法 回顾分析了我院16年间危重病患者并发ARDS 113例655例次动脉血气分析、酸碱紊乱类型和氧合指数(PaO2/FiO2)等资料。结果 (1)酸碱失衡类型:113例中单纯酸碱紊乱44例,含呼碱20例,呼酸11例,代酸10例,代碱3例;二重酸碱紊乱53例,含呼碱并代酸12例,呼碱并代碱14例,呼酸并代酸21例,呼酸并代碱6例;三重酸碱失衡(TABD)16例,含呼碱型TABD11例,呼酸型TABD5例。治愈各组以单纯呼碱(17例)和呼碱并代碱(12例)等类型多见;死亡组以呼酸并代酸(19例)、TABD(14例)、呼酸(9例)等类型多见;(2)氧合指数:113例患者的氧合指数均<26.7kPa;(3)113例ARDS治愈52例(46.0%),死亡61例(54.0%)。结论 通过对113例危重患者并发ARDS的血气分析,动态监测血气和计算氧合指数,对ARDS的早期诊断和治疗具有重要的临床价值,而正确分析、判断酸碱失衡类型是正确治疗和提高治愈率的重要环节。%Objective To explore the significance of dynamic determination of arterial blood gas for early diagnosis, treatment and prognosis of patients with acute respiratory stress syndrome(ARDS). Methods The results of 655 times arterial blood gas assayed in 113 patients with ARDS were analysed retrospectively.Results (1)Types of acid-basic disturbance:The simple acid-base disturbances were 44 cases,in which respiratory alkalosis were 20 cases, respiratory acidosis 11 cases, metabolic acidosis 10 cases, metabolic alkalosis 3 cases. Complex acid-base disturbances were 53 cases,in which respiratory alkalosis with metabolic acidosis were12 cases, respiratory alkalosis with metabolic alkalosis 14 cases, respiratory acidosis with metabolic acidosis 21 cases, respiratory alkalosis with metabolic alkalosis 6 cases. Triple acid-base disturbances (TABD) were 16

  1. 压力控制法肺复张在急性呼吸窘迫综合征中的应用%The Use of Pressure-controlled Recruitment Maneuver in Patients with Acute Respiratory Distress Syndrome

    罗婉琳

    2011-01-01

    机械通气是急性呼吸窘迫综合征(ARDS)的主要治疗手段,肺复张手法应用较高压力开放塌陷肺泡,并使用高呼吸末正压防止肺泡塌陷,期望恢复肺泡的同一性,减少呼吸机相关性肺损伤,改善患者预后.但近年的临床试验却得出矛盾的结果,其有效性及安全性及具体实施方法仍无统一意见.现就压力控制法肺复张在ARDS中的有效性、安全性的操作方法予以综述.%Mechanical ventilation is the major treatment for patients with acute respiratory distress syndrome( ARDS) . Recruitment maneuvers that use high tranapulmonary pressure to reopen atelectatic alveoli and employ high end-expiratory pressure to prevent alveolar collapse, with the expectation to reconstruct the alveolar homogeneity ,reduce the ventilation-associated pulmonary injuries, and improve the prognosis of patients. However, the recent clinical studies show controversial results , remaining controversial in the effectiveness , aafety, and protocol. This article reviews the effectiveness and safe practice of pressure-controlled recruitment maneuver.

  2. Opioid overdose with gluteal compartment syndrome and acute peripheral neuropathy

    Adrish, Muhammad; Duncalf, Richard; Diaz-Fuentes, Gilda; Venkatram, Sindhaghatta

    2014-01-01

    Patient: Male, 42 Final Diagnosis: Gluteal compartment syndromeacute peripheral nauropathy Symptoms: — Medication: — Clinical Procedure: — Specialty: Critical Care Medicine Objective: Management of emergency care Background: Heroin addiction is common, with an estimated 3.7 million Americans reporting to have used it at some point in their lives. Complications of opiate overdose include infection, rhabdomyolysis, respiratory depression and central or peripheral nervous system neurological ...

  3. Avian influenza A virus (H7N7) associated with human conjunctivitis and a fatal case of acute respiratory distress syndrome.

    R.A.M. Fouchier (Ron); P.M. Schneeberger (Peter); F.W. Rozendaal (Frans); J.M. Broekman (Jan); S.A. Kemink (Stiena); V.J. Munster (Vincent); G.F. Rimmelzwaan (Guus); M. Schutten (Martin); G.J.J. van Doornum (Gerard); G. Koch (Guus); A. Bosman (Arnold); M.P.G. Koopmans D.V.M. (Marion); A.D.M.E. Osterhaus (Albert); T. Kuiken (Thijs)

    2004-01-01

    textabstractHighly pathogenic avian influenza A viruses of subtypes H5 and H7 are the causative agents of fowl plague in poultry. Influenza A viruses of subtype H5N1 also caused severe respiratory disease in humans in Hong Kong in 1997 and 2003, including at least seven fatal cases, posing a serious

  4. Postoperative Acute Respiratory Failure In Patients Treated Surgically For Goiters

    Buła Grzegorz

    2015-07-01

    Full Text Available The aim of the study was to present a clinical picture, treatment and prognosis regarding patients who developed acute respiratory failure (ARF while treated surgically for a goiter.

  5. ACUTE RESPIRATORY DISEASE AS THE DEBUT OF SYSTEMIC LUPUS ERYTHEMATOSUS

    A. Yu. Ischenko

    2015-01-01

    Full Text Available Systemic lupus erythematosus — a chronic autoimmune disease that is often associated with infectious processes. The paper presents two clinical cases of systemic lupus erythematosus , debuted with acute respiratory infection.

  6. USE OF RESPIRATORY-CARDIOVASCULAR RESPONSES OF RAINBOW TROUT (SALMO GAIRDNERI) IN IDENTIFYING ACUTE TOXICITY SYNDROMES IN FISH: PART 3. POLAR NARCOTICS

    The physiological responses of rainbow trout to acutely lethal aqueous concentrations of the suspected polar narcotics phenol, 2,4,-dimethylphenol, aniline, 2-chloroaniline and 4-chloroaniline were examined. Visible signs of intoxication included tremors that progressed to whole-...

  7. Associação das manobras de recrutamento alveolar e posição prona na síndrome do desconforto respiratório agudo Association of alveolar recruitment maneuvers and prone position in acute respiratory disease syndrome patients

    Daniela Caetano Costa

    2009-06-01

    Full Text Available A síndrome do desconforto respiratório agudo é a apresentação clínica de insuficiência respiratória aguda caracterizada por lesão alveolar difusa e pelo desenvolvimento do edema pulmonar não cardiogênico, devido ao aumento da permeabilidade da membrana alvéolo-capilar pulmonar. As manobras de recrutamento alveolar e a posição prona podem ser utilizadas no tratamento da síndrome do desconforto respiratório agudo. O objetivo deste estudo foi identificar os possíveis benefícios, indicações, complicações e cuidados na associação da manobra de recrutamento alveolar e posição prona na síndrome do desconforto respiratório agudo. Realizou-se revisão de literatura científica nacional e internacional conforme os critérios estabelecidos para a pesquisa documental nas bases de dados MedLine, LILACS, SciElo, PubMed, Cochrane, no período de 1994-2008, nas linguagens portuguesa e inglesa, com os unitermos: síndrome do desconforto respiratório agudo, manobra de recrutamento alveolar e posição prona. Apesar de avanços no entendimento da fisiopatologia da síndrome do desconforto respiratório agudo, essa ainda resulta em significativa mortalidade. A manobra de recrutamento alveolar e a posição prona contribuem significativamente no tratamento desses pacientes com a finalidade de melhorar a oxigenação e reduzir as complicações decorrentes da hipoxemia refratária e diminuição da complacência pulmonar. Entretanto, na literatura, há poucos estudos que associam a manobra de recrutamento alveolar e posição prona no tratamento da síndrome do desconforto respiratório agudo, fazendo-se necessária maior investigação sobre o tema e evidências de sua aplicação clínica.The acute respiratory distress syndrome is the clinical presentation of acute lung injury characterized by diffuse alveolar damage and development of non-cardiogenic pulmonary edema due to increased pulmonary alveolar-capillary membrane permeability

  8. Pathogenic significance of Klebsiella oxytoca in acute respiratory tract infection.

    Power, J T; Calder, M A

    1983-01-01

    A retrospective study of all Klebsiella isolations from patients admitted to hospital with acute respiratory tract infections over a 27-month period was carried out. Ten of the Klebsiella isolations from sputum and one from a blood culture were identified as Klebsiella oxytoca. The clinical and radiological features of six patients are described. Four of these patients had lobar pneumonia, one bronchopneumonia, and one acute respiratory tract infection superimposed on cryptogenic fibrosing al...

  9. Non-invasive mechanic ventilation in treating acute respiratory failure

    Federico Lari; Novella Scandellari; Ferdinando De Maria; Virna Zecchi; Gianpaolo Bragagni; Fabrizio Giostra; Nicola DiBattista

    2009-01-01

    Non invasive ventilation (NIV) in acute respiratory failure (ARF) improve clinical parameters, arterial blood gases, decrease mortality and endo tracheal intubation (ETI) rate also outside the intensive care units (ICUs). Objective of this study is to verify applicability of NIV in a general non respiratory medical ward. We enrolled 68 consecutive patients (Pts) with Hypoxemic or Hyper capnic ARF: acute cardiogenic pulmonary edema (ACPE), exacerbation of chronic obstructive pulmonary disease ...

  10. Surfactant therapy for acute respiratory distress in infants

    Corrado Moretti

    2014-06-01

    Full Text Available Acute respiratory distress syndrome (ARDS remains the primary indication for admission to paediatric intensive care units and accounts for significant mortality, morbidity and resource utilization. Respiratory infections, in particular pneumonia and severe bronchiolitis, are the most common causes of respiratory failure requiring mechanical ventilation in infants and children. This paper reviews the pathophysiology of ARDS and the management of paediatric patients with acute lung injury. Data indicate that adoption of a lung protective ventilation with low tidal volumes and of an open-lung ventilation strategy, characterized by sufficient positive end-expiratory pressure (PEEP to avoid atelectasis, provides the greatest likelihood of survival and minimizes lung injury. The relative benefits of strategies such as high frequency oscillatory ventilation (HFOV, inhaled nitric oxide (iNO, recruiting manoeuvres and prone position are also considered. Moreover this article examines exogenous lung surfactant replacement therapy and its efficacy in the treatment of paediatric ARDS. In infants and children with acute lung injury the endogenous surfactant system is not only deficient, as observed in preterm infants, but altered via a variety of other mechanisms like inhibition and dysfunction. All factors contribute to the altered physiology seen in ARDS. The role of exogenous surfactant in lung injury beyond the neonatal period is therefore more complex and its limited efficacy may be related to a number of factors, among them inadequacy of pharmaceutical surfactants, insufficient dosing or drug delivery, poor drug distribution or, simply, an inability of the drug to counteract the underlying pathophysiology of ARDS. Several trials have found no clinical benefit from various surfactant supplementation methods in adult patients with ARDS, however some studies have shown that this therapy can improve oxygenation and decrease mortality in some specific

  11. Acute effects of winter air pollution on respiratory health

    Zee, van der S.

    1999-01-01

    In this thesis, acute respiratory health effects of exposure to winter air pollution are investigated in panels of children (7-11 yr) and adults (50-70 yr) with and without chronic respiratory symptoms, living in urban and non-urban areas in the Netherlands. The study was performed during three cons

  12. Novel Human Bocavirus in Children with Acute Respiratory Tract Infection

    Song, Jing-Rong; Jin, Yu; Xie, Zhi-Ping; Gao, Han-chun; Xiao, Ni-Guang; Chen, Wei-Xia; Xu, Zi-qian; Yan, Kun-long; Zhao, Yang; Hou, Yun-De; Duan, Zhao-jun

    2010-01-01

    Human bocavirus (HBoV) and HBoV2, two human bocavirus species, were found in 18 and 10 of 235 nasopharyngeal aspirates, respectively, from children hospitalized with acute respiratory tract infection. Our results suggest that, like HBoV, HBoV2 is distributed worldwide and may be associated with respiratory and enteric diseases.

  13. Acute respiratory and cardiovascular admissions after a public smoking ban in Geneva, Switzerland.

    Jean-Paul Humair

    Full Text Available BACKGROUND: Many countries have introduced legislations for public smoking bans to reduce the harmful effects of exposure to tobacco smoke. Smoking bans cause significant reductions in admissions for acute coronary syndromes but their impact on respiratory diseases is unclear. In Geneva, Switzerland, two popular votes led to a stepwise implementation of a state smoking ban in public places, with a temporary suspension. This study evaluated the effect of this smoking ban on hospitalisations for acute respiratory and cardiovascular diseases. METHODS: This before and after intervention study was conducted at the University Hospitals of Geneva, Switzerland, across 4 periods with different smoking legislations. It included 5,345 patients with a first hospitalisation for acute coronary syndrome, ischemic stroke, acute exacerbation of chronic obstructive pulmonary disease, pneumonia and acute asthma. The main outcomes were the incidence rate ratios (IRR of admissions for each diagnosis after the final ban compared to the pre-ban period and adjusted for age, gender, season, influenza epidemic and secular trend. RESULTS: Hospitalisations for acute exacerbation of chronic obstructive pulmonary disease significantly decreased over the 4 periods and were lowest after the final ban (IRR=0.54 [95%CI: 0.42-0.68]. We observed a trend in reduced admissions for acute coronary syndromes (IRR=0.90 [95%CI: 0.80-1.00]. Admissions for ischemic stroke, asthma and pneumonia did not significantly change. CONCLUSIONS: A legislative smoking ban was followed by a strong decrease in hospitalisations for acute exacerbation of chronic obstructive pulmonary disease and a trend for reduced admissions for acute coronary syndrome. Smoking bans are likely to be very beneficial for patients with chronic obstructive pulmonary disease.

  14. Acute respiratory failure induced by bleomycin and hyperoxia

    Bleomycin, a chemotherapeutic agent, and oxygen at concentrations greater than 20%, induce acute pulmonary damage separately and when administered together. The interaction of 5 U/kg intratracheal bleomycin and 24 hours of exposure to 80% oxygen in hamsters produces delayed onset acute respiratory distress syndrome three days after treatment. As little as 12 hours of 80% O2 exposure, after intratracheal bleomycin, induces severe pulmonary damage. Lung lesions are characterized as diffuse alveolar damage. Significantly pulmonary edema, measured by iodine-125-bovine serum albumin and technetium-99m-diethylenetriaminepentaacetate, occurs 72 hours after treatment. Lesions progress from focal mild alveolar interstitial and air-space macrophage and granulocyte infiltrates at 24 hours to marked infiltrates and severe interstitial and air space edema with hemorrhages and hyaline membranes at 96 hours. Significant changes measured by electron microscopy morphometry are increases in volume fractions of neutrophils, alveolar tissue and mononuclear leukocytes. Surfactant assay of bronchoalveolar lavage fluid shows a marked decrease in the lecithin/sphingomyelin ratio at 72 hours. Proposed mechanisms of bleomycin and hyperoxia synergism include enhanced production of superoxide radicals either directly or indirectly by increasing neutrophil activity or numbers, or by alteration of cell mediators. The pulmonary edema, without evidence of severe morphological changes, may be secondary to alterations of transalveolar transport mechanisms

  15. Influence of inspiration to expiration ratio on cyclic recruitment and derecruitment of atelectasis in a saline lavage model of acute respiratory distress syndrome*

    Boehme, Stefan; Bentley, Alexander H.; Hartmann, Erik K.; Chang, Shi; Erdös, Gabor; Prinzing, Anatol; Hagmann, Michael; Baumgardner, James E; Ullrich, Roman; Markstaller, Klaus; David, Matthias

    2015-01-01

    OBJECTIVE Cyclic recruitment and derecruitment of atelectasis can occur during mechanical ventilation, especially in injured lungs. Experimentally, cyclic recruitment and derecruitment can be quantified by respiration-dependent changes in PaO2 (ΔPaO2), reflecting the varying intrapulmonary shunt fraction within the respiratory cycle. This study investigated the effect of inspiration to expiration ratio upon ΔPaO2 and Horowitz index. DESIGN Prospective randomized study. SETTING...

  16. Intra-breath arterial oxygen oscillations detected by a fast oxygen sensor in an animal model of acute respiratory distress syndrome

    Formenti, Federico; Chen, R.; McPeak, Hanne; Murison, Pamela; Matejovic, M; Hahn, Clive; Farmery, Andrew

    2015-01-01

    Background There is considerable interest in oxygen partial pressure (PO2) monitoring in physiology, and in tracking PO2 changes dynamically when it varies rapidly. For example, arterial PO2 ([Math Processing Error]) can vary within the respiratory cycle in cyclical atelectasis (CA), where [Math Processing Error] is thought to increase and decrease during inspiration and expiration, respectively. A sensor that detects these [Math Processing Error] oscillations could become a useful diagnostic...

  17. Intra-breath arterial oxygen oscillations detected by a fast oxygen sensor in an animal model of acute respiratory distress syndrome

    Formenti, F.; Chen, R.; McPeak, H; Murison, PJ; Matejovic, M; Hahn, CEW; Farmery, AD; Galley, HF

    2015-01-01

    BACKGROUND: There is considerable interest in oxygen partial pressure (Po2) monitoring in physiology, and in tracking Po2 changes dynamically when it varies rapidly. For example, arterial Po2 ([Formula: see text]) can vary within the respiratory cycle in cyclical atelectasis (CA), where [Formula: see text] is thought to increase and decrease during inspiration and expiration, respectively. A sensor that detects these [Formula: see text] oscillations could become a useful diagnostic tool of CA...

  18. RESPIRATORY SYNCYTIAL VIRUS INFECTION AMONG YOUNG CHILDREN WITH ACUTE RESPIRATORY INFECTION

    Milani, M

    2003-01-01

    Respiratory syncytial virus (RSV) is the major cause of lower respiratory tract infections in infants,and also an important factor for hospitalization during the winter months. To determine the prevalence and importance of RSV as a cause of acute lower respiratory tract infection, we carried out a prospective study during 5 months period from November to March 1998 in 6 pediatric hospitals. A nasopharyngeal aspirate was obtained for detection of RSV in all cases. Sociodemographic data, clinic...

  19. Noninvasive Mechanical Ventilation in Acute Respiratory Failure Patients: A Respiratory Therapist Perspective

    Hidalgo, V.; Giugliano-Jaramillo, C; Pérez, R.; Cerpa, F; Budini, H; Cáceres, D.; Gutiérrez, T.; Molina, J; Keymer, J; Romero-Dapueto, C

    2015-01-01

    Physiotherapist in Chile and Respiratory Therapist worldwide are the professionals who are experts in respiratory care, in mechanical ventilation (MV), pathophysiology and connection and disconnection criteria. They should be experts in every aspect of the acute respiratory failure and its management, they and are the ones who in medical units are able to resolve doubts about ventilation and the setting of the ventilator. Noninvasive mechanical ventilation should be the first-line of treatmen...

  20. Predictive Factors of Respiratory Failure in Children with Guillain-Barre Syndrome

    Nemat Bilan

    2015-03-01

    Full Text Available Introduction:Guillain-Barre Syndrome(GBS is the most common cause of acute flaccid paralysis. Respiratory failure is the most serious short-term complication of GBS and invasive mechanical ventilation is required in 30% of patients.moreover,60% of those who are intubated develop major complications including pnemonia,sepsis,GI bleeding and pulmonary embolism. Thus respiratory failure prediction is crucial. the aim of this study was to determine clinical predictors of respiratory failure to avoid respiratory distress and aspiration.Methods and materials: in a cross sectional and analytical study 140 patients with clinically diagnosis of Guillain-Barre Syndrome were enrolled in study,from october 2008 to october 2014. .demographic data,nerologic examination,cranial nerve and autonomic nervous system involvement, and respiratory failure were recorded prospectively.Results:15 out of 140 patients(10,7% developed respiratory failure and underwent mechanical ventilation.the male/female ratio in patients with respiratory failure and patients without respiratory involvement were (53%/(47% and (54%/(46% respectively(p-value:0.4.the mean age in these two groups were 2,7±1,9 and 5,5±3,2(p-value:0,003.cranial nerve involvement (7,9,10 was recorded in patients with respiratory failure and without respiratory failure54% and25% respectively (p-value:0,03.absent upper limb deep tendon reflexes in these two groups were 70% and 44% respectively.(p-value:0,03 and autonomic nervous system involvement 24% vs. 14%(p-value:0,3.conclusion : our study suggests that younger age , cranial nerve involvement and absent upper limb deep tendon reflexes are predictive factors of respiratory failure in patients with Guillain-Barre Syndrome(GBS.

  1. Sweet's Syndrome Presenting in Concordance with Acute Coronary Syndrome

    Kassardjian, Michael; Holland, Vanessa; Leong, Tracy; Horowitz, David; Hirokane, Jane

    2012-01-01

    Acute febrile neutrophilic dermatosis (Sweet's syndrome) is typically characterized by an acute onset of erythematous papules, plaques, and nodules in a febrile patient. This dermatosis is classically accompanied by leukocytosis and neutrophilia, and has had reported associations with various underlying etiologies including drug reactions, malignancies, infections, autoimmune disorders, and inflammatory bowel diseases. However, most cases of acute febrile neutrophilic dermatosis are idiopathi...

  2. Unraveling the Mysteries of Middle East Respiratory Syndrome Coronavirus

    2014-03-11

    Dr. Aron Hall, a CDC coronavirus epidemiologist, discusses Middle East Respiratory Syndrome Coronavirus.  Created: 3/11/2014 by National Center for Emerging and Zoonotic Infectious Diseases (NCEZID).   Date Released: 3/11/2014.

  3. The adult respiratory distress syndrome bronchogenic pulmonary tuberculosis.

    R. A. Dyer; Potgieter, P D

    1984-01-01

    In three cases of pulmonary tuberculosis associated with the adult respiratory distress syndrome the clinical features, which were similar to those of patients with miliary tuberculosis and adult respiratory distress syndrome, included a history of cough, fever, and dyspnoea on effort, and the physical signs of fever, tachypnoea, pulmonary adventitious sounds, tachycardia, and hepatomegaly. In these cases the radiological features, though suggestive of diffuse pulmonary oedema, were more prom...

  4. Adult Respiratory Distress Syndrome in Dengue -A Case Report

    Amulya C. Belagavi; H.S. Sunil; Sudhir, U.; K Punith

    2011-01-01

    Background: Being on the verge of Dengue epidemic, there are newer and more complicated versions of the disease being reported worldwide. In the present article, we report a case of Dengue who progressed into Adult Respiratory Disease Syndrome during the illness. Results: The patient did well with the symptomatic treatment for the latter and with appropriate management of Dengue. With the other causes ruled out, Adult Respiratory Disease Syndrome was considered as part of the spectrum of the ...

  5. Fisioterapia respiratória em crianças com doença falciforme e síndrome torácica aguda Respiratory therapy in children with sickle cell disease and acute chest syndrome

    Sandro Valter Hostyn

    2011-12-01

    search of published articles found in Medline, Lilacs, SciELO and Cochrane databases, between 1995 and 2009, was carried out using the following keywords: "sickle cell disease", "acute chest syndrome", "physical therapy", "child", "incentive spirometry", in English and Portuguese; all review studies were excluded. The recovered studies were then classified according to their level of evidence and recommendation. DATA SYNTHESIS: Five papers were retrieved. Among them, three used incentive spirometry that played an important role in the prevention of pulmonary complications associated with acute chest syndrome (evidence levels II, III and IV; one of these studies (evidence II compared incentive spirometry versus positive expiratory pressure and did not find differences between them. One paper reported a clinical bundle to improve the quality of care, including incentive spirometry (evidence level V. Incentive spirometry was associated with shorter length of stay and less requirement of oral pain medications. Another study evaluated the effect of non-invasive ventilation on respiratory distress in children that could not perform incentive spirometry and reported improvement in the oxygenation and in the respiratory distress (evidence level V. CONCLUSIONS: Physiotherapy techniques with incentive spirometry device, positive expiratory pressure and non-invasive ventilation can be performed in children with sickle cell disease and acute chest syndrome, with a C recommendation level.

  6. The effects of colloids or crystalloids on acute respiratory distress syndrome in swine (Sus scrofa models with severe sepsis: analysis on extravascular lung water, IL-8, and VCAM-1

    Rismala Dewi

    2016-04-01

    Full Text Available Background: Acute respiratory distress syndrome (ARDS is a fatal complication of severe sepsis. Due to its higher molecular weight, the use of colloids in fluid resuscitation may be associated with fewer cases of ARDS compared to crystalloids. Extravascular lung water (EVLW elevation and levels of interleukin-8 (IL-8 and vascular cell adhesion molecule-1 (VCAM-1 have been studied as indicators playing a role in the pathogenesis of ARDS. The aim of the study was to determine the effects of colloid or crystalloid on the incidence of ARDS, elevation of EVLW, and levels of IL-8 and VCAM-1, in swine models with severe sepsis.Methods: This was a randomized trial conducted at the Laboratory of Experimental Surgery, School of Veterinary Medicine, IPB, using 22 healthy swine models with a body weight of 8 to 12 kg. Subjects were randomly allocated to receive either colloid or crystalloid fluid resuscitation. After administration of endotoxin, clinical signs of ARDS, EVLW, IL-8, and VCAM-1 were monitored during sepsis, severe sepsis, and one- and three hours after fluid resuscitation. Analysis of data using the Wilcoxon test , Kolmogorov-Smirnov test, Mann-Whitney test, unpaired t test.Results: Mild ARDS was more prevalent in the colloid group, while moderate ARDS was more frequent in the crystalloid group. EVLW elevation was lower in the colloid compared to the crystalloid group. There was no significant difference in IL-8 and VCAM-1 levels between the two groups.Conclusion: The use of colloids in fluid resuscitation does not decrease the probability of ARDS events compared to crystalloids. Compared to crystalloids, colloids are associated with a lower increase in EVLWI, but not with IL-8 or VCAM-1 levels.

  7. Human metapneumovirus and respiratory syncytial virus in hospitalized danish children with acute respiratory tract infection

    von Linstow, Marie-Louise; Larsen, Hans Henrik; Eugen-Olsen, Jesper;

    2004-01-01

    The newly discovered human metapneumovirus (hMPV) has been shown to be associated with respiratory illness. We determined the frequencies and clinical features of hMPV and respiratory syncytial virus (RSV) infections in 374 Danish children with 383 episodes of acute respiratory tract infection...... children 1-6 months of age. Asthmatic bronchitis was diagnosed in 66.7% of hMPV and 10.6% of RSV-infected children (p < 0.001). Overall symptoms and clinical findings were similar among hMPV and RSV positive episodes, but more RSV-infected children required respiratory support. hMPV is present in young...

  8. Respiratory viruses in children hospitalized for acute lower respiratory tract infection in Ghana

    Kwofie Theophilus B

    2012-04-01

    Full Text Available Abstract Background Acute respiratory tract infections are one of the major causes of morbidity and mortality among young children in developing countries. Information on the viral aetiology of acute respiratory infections in developing countries is very limited. The study was done to identify viruses associated with acute lower respiratory tract infection among children less than 5 years. Method Nasopharyngeal samples and blood cultures were collected from children less than 5 years who have been hospitalized for acute lower respiratory tract infection. Viruses and bacteria were identified using Reverse Transcriptase Real-Time Polymerase Chain Reaction and conventional biochemical techniques. Results Out of 128 patients recruited, 33(25.88%%, 95%CI: 18.5% to 34.2% were positive for one or more viruses. Respiratory Syncytial Virus (RSV was detected in 18(14.1%, 95%CI: 8.5% to 21.3% patients followed by Adenoviruses (AdV in 13(10.2%, 95%CI: 5.5% to 16.7%, Parainfluenza (PIV type: 1, 2, 3 in 4(3.1%, 95%CI: 0.9% to 7.8% and influenza B viruses in 1(0.8%, 95%CI: 0.0 to 4.3. Concomitant viral and bacterial co-infection occurred in two patients. There were no detectable significant differences in the clinical signs, symptoms and severity for the various pathogens isolated. A total of 61.1% (22/36 of positive viruses were detected during the rainy season and Respiratory Syncytial Virus was the most predominant. Conclusion The study has demonstrated an important burden of respiratory viruses as major causes of childhood acute respiratory infection in a tertiary health institution in Ghana. The data addresses a need for more studies on viral associated respiratory tract infection.

  9. [Clinical pathway "Acute Coronary Syndrome"].

    Grimm, W; Maisch, B

    2006-07-01

    The clinical pathway "acute coronary syndrome" of the university hospital Marburg describes the guideline-conform and consented management of patients with ST-segment elevation infarct (STEMI), non-ST-segment elevation infarct (NSTEMI) and Troponin negative unstable angina. A 12-lead ECG recording is made and read in all patients within 10 minutes. All patients with STEMI undergo immediate revascularisation using primary percutanuous catheter intervention (PCI) after administration of basic medical therapy. Primary PCI is also used in all patients with NSTEMI, persistent chest pain, rhythm or hemodynamic instability. Patients with unstable angina, who became free of symptoms after application of basic medication, but who have additional risk factors undergo cardiac catheterisation within 48 hours. Acute myocardial infarction can be ruled out in patients with twofold negative cardiac troponin levels during 6-12 hours. In the absence of further symptoms, these patiens undergo differential diagnostic evaluation of cardiac and extracardiac causes of chest pain. The introduction of this clinical pathway 2 years ago, which was consented before by the hospital board and the clinical directors, has lead to a remarkable improvement in the clinical decision-making at the emergency room of the hospital and reduced the door to intervention time considerably. PMID:16763796

  10. Early-onset acute transverse myelitis following hepatitis B vaccination and respiratory infection: case report

    Fonseca Luiz Fernando

    2003-01-01

    Full Text Available Acute transverse myelitis is an acute inflammatory process of the spinal cord and it is a rare clinical syndrome in childhood. In this paper, we report a case of 3 years-old boy who developed acute onset tetraparesia following a viral respiratory infecction and hepatitis B vaccination. Magnetic resonance imaging of the spinal cord disclosed signal-intensity abnormalities from C4 to C3. A diagnosis of acute transverse myelitis was made and the patient was treated with IV methylprednisolone and IV immunoglobulin. The child had a fair outcome despite of the very acute course of the disease and the presence of a cervical sensory level which usually harbor a poor prognosis.

  11. A randomised controlled trial and cost-effectiveness analysis of high-frequency oscillatory ventilation against conventional artificial ventilation for adults with acute respiratory distress syndrome. The OSCAR (OSCillation in ARDS) study.

    Lall, Ranjit; Hamilton, Patrick; Young, Duncan; Hulme, Claire; Hall, Peter; Shah, Sanjoy; MacKenzie, Iain; Tunnicliffe, William; Rowan, Kathy; Cuthbertson, Brian; McCabe, Chris; Lamb, Sallie

    2015-01-01

    BACKGROUND Patients with the acute respiratory distress syndrome (ARDS) require artificial ventilation but this treatment may produce secondary lung damage. High-frequency oscillatory ventilation (HFOV) may reduce this damage. OBJECTIVES To determine the clinical benefit and cost-effectiveness of HFOV in patients with ARDS compared with standard mechanical ventilation. DESIGN A parallel, randomised, unblinded clinical trial. SETTING UK intensive care units. PARTICIPANTS Mechanically ventilated patients with a partial pressure of oxygen in arterial blood/fractional concentration of inspired oxygen (P : F) ratio of 26.7 kPa (200 mmHg) or less and an expected duration of ventilation of at least 2 days at recruitment. INTERVENTIONS Treatment arm HFOV using a Novalung R100(®) ventilator (Metran Co. Ltd, Saitama, Japan) ventilator until the start of weaning. Control arm Conventional mechanical ventilation using the devices available in the participating centres. MAIN OUTCOME MEASURES The primary clinical outcome was all-cause mortality at 30 days after randomisation. The primary health economic outcome was the cost per quality-adjusted life-year (QALY) gained. RESULTS One hundred and sixty-six of 398 patients (41.7%) randomised to the HFOV group and 163 of 397 patients (41.1%) randomised to the conventional mechanical ventilation group died within 30 days of randomisation (p = 0.85), for an absolute difference of 0.6% [95% confidence interval (CI) -6.1% to 7.5%]. After adjustment for study centre, sex, Acute Physiology and Chronic Health Evaluation II score, and the initial P : F ratio, the odds ratio for survival in the conventional ventilation group was 1.03 (95% CI 0.75 to 1.40; p = 0.87 logistic regression). Survival analysis showed no difference in the probability of survival up to 12 months after randomisation. The average QALY at 1 year in the HFOV group was 0.302 compared to 0.246. This gives an incremental cost-effectiveness ratio (ICER) for the cost to

  12. Ventilator Strategies and Rescue Therapies for Management of Acute Respiratory Failure in the Emergency Department.

    Mosier, Jarrod M; Hypes, Cameron; Joshi, Raj; Whitmore, Sage; Parthasarathy, Sairam; Cairns, Charles B

    2015-11-01

    Acute respiratory failure is commonly encountered in the emergency department (ED), and early treatment can have effects on long-term outcome. Noninvasive ventilation is commonly used for patients with respiratory failure and has been demonstrated to improve outcomes in acute exacerbations of chronic obstructive lung disease and congestive heart failure, but should be used carefully, if at all, in the management of asthma, pneumonia, and acute respiratory distress syndrome. Lung-protective tidal volumes should be used for all patients receiving mechanical ventilation, and FiO2 should be reduced after intubation to achieve a goal of less than 60%. For refractory hypoxemia, new rescue therapies have emerged to help improve the oxygenation, and in some cases mortality, and should be considered in ED patients when necessary, as deferring until ICU admission may be deleterious. This review article summarizes the pathophysiology of acute respiratory failure, management options, and rescue therapies including airway pressure release ventilation, continuous neuromuscular blockade, inhaled nitric oxide, and extracorporeal membrane oxygenation. PMID:26014437

  13. Diagnostic value of static and dynamic scintigraphy in diagnosis of acute respiratory distress syndrome in the course of sepsis. Part 2. Lung aerosol scintigraphy

    Rapid increase in permeability of functionally and/or structurally damaged alveolar-capillary barrier is the pivotal factor in non-cardiogenic pulmonary edema development. Rate of exudative changes progress in the lungs decides about prognosis in patients with this serious, over 50% death rate, syndrome. The aim of the study was to estimate the usefulness of dynamic lung scintigraphy in diagnosis of gas exchange abnormalities in sepsis and ARDS. Aerosol scintigraphy with pulmonary clearance of DTPA in 6 septic and in 6 ARDS patients were performed. Studies were done using planar gamma camera, type MB9200, in A-P projection. They were analyzed with the modified NMS Warsaw Polytechnic computer program. Aerosol scintiscans demonstrated very irregular borderlines of both lungs, features of marked impairment in ventilation (with foci of increased radioactivity in the view of main bronchi) and about 2.5-fold faster pulmonary clearance of DTPA in ARDS patients comparing to sepsis and control groups. The results showed that dynamic scintigraphy can be safely performed in patients in critical condition. Changes in scintiscans and rapid pulmonary clearance of DTPA might be an early indicator of ARDS development in septic patients. (author)

  14. Haemolytic Uraemic Syndrome Following Acute Pancreatitis

    Sinha A

    2005-07-01

    Full Text Available CONTEXT: Haemolytic uraemic syndrome is a common cause of renal failure in children but it is a rare condition in adults. Acute pancreatitis in adult as a cause of haemolytic uraemic syndrome is very rare. CASE REPORT: A 19-year-old male presented with symptom and signs suggestive of acute pancreatitis which was confirmed as his serum amylase was significantly raised. Within three days of admission he developed acute renal failure with evidence of haemolytic anaemia and thrombocytopenia. A clinical diagnosis of haemolytic uraemic syndrome was made and he was treated with plasma exchange. He made a complete recovery. CONCLUSION: Renal failure in a patient with acute pancreatitis is rarely due to haemolytic uraemic syndrome. But it is important to consider this differential diagnosis so that early treatment can be instituted to prevent mortality.

  15. An Unusual Cause of Acute Hypercapneic Respiratory Failure

    Janice Wang; Astha Chichra; Seth Koenig

    2011-01-01

    We present a rare cause of hypercapneic respiratory failure through this case report of a 72-year-old man presenting with progressive dyspnea and dysphagia over two years. Hypercapneic respiratory failure was acute on chronic in nature without an obvious etiology. Extensive workup for intrinsic pulmonary disease and neurologic causes were negative. Laryngoscopy and diagnostic imaging confirmed the diagnosis of diffuse idiopathic skeletal hyperostosis, also known as DISH, as the cause of upper...

  16. Respiratory virus infections and aeroallergens in acute bronchial asthma.

    Carlsen, K H; Orstavik, I; Leegaard, J; Høeg, H

    1984-01-01

    Two hundred and fifty six attacks of acute bronchial asthma occurring in 169 children aged over 2 years were studied during a two year period. More attacks occurred during spring and autumn than at other times of the year. In 73 patients (29%) a respiratory virus infection was diagnosed, with the same seasonal variation as the asthmatic attacks. Most of the virus infections were caused by rhinovirus (45%) and respiratory syncytial virus (19%). There was no significant correlation between asth...

  17. Effect of ulinastatin on acute respiratory distress syndrome:A meta-analysis%乌司他丁治疗急性呼吸窘迫综合征效果的荟萃分析

    2013-01-01

    Objective To assess the effect of ulinastatin on acute respiratory distress syndrome (ARDS). Methods A meta-analysis was performed for the clinical trials on ulinastatin in treatment of ARDS covered in PubMed, Embase, CBMdisk, CNKI and Wanfang Database before May 2012 with the software of ReviewManager4.2 on Cochrane Cooperation Network. The curative effect indexes of ulinastatin included respiratory frequency, PaO2/FiO2, PaCO2 and mortality. Results Meta analysis showed that the mean respiratory frequency and mortality were lower whereas the mean PaCO2 and PaO2/FiO2 were higher in ulinastatin treatment group than in control group 7 days after ulinastatin treatment (WMD=-5.74, P=0.003;RR=0.62, P=0.04;WMD=4.78, P<0.000 01;WMD=59.94, P<0.000 01). Conclusion Ulinastatin can significantly improve the pulmonary ventilation and reduce the mortality of ARDS patients.%  目的系统评价乌司他丁治疗急性呼吸窘迫综合征的效果。方法检索2012年5月以前在PubMed、Embase、CBMdisk、CNKI和万方数据库公开发表的有关乌司他丁治疗急性呼吸窘迫综合征的临床研究并采用Cochrane协作网提供的ReviewManager4.2软件对纳入的研究做Meta分析。疗效判定指标包括呼吸频率、氧合指数、PaCO2以及病死率。结果 Meta分析显示,经过7 d的治疗,乌司他丁治疗组的呼吸频率均数小于对照组(WMD=-5.74,P=0.003),而且前者的PaCO2均数(WMD=4.78,P<0.00001)、氧合指数均数(WMD=59.94,P<0.00001)都高于对照组;此外,乌司他丁治疗组的病死率低于对照组(RR=0.62,P=0.04)。结论乌司他丁在改善肺通气和降低急性呼吸窘迫综合征的病死率方面优势明显。

  18. Ineffective airway clearance in children with acute respiratory infection

    Lívia Zulmyra Cintra Andrade

    2014-03-01

    Full Text Available This cross-sectional study was performed with 151 children inpatients of a pediatric hospital in Northeastern Brazil, with the objective to analyze the accuracy of the defining characteristics of the diagnoses ineffective airway clearance in children with acute respiratory infection. A thorough respiratory evaluation was performed and the diagnostic inference was developed by specialists. The most frequent defining characteristics were adventitious breath sounds, ineffective cough, dyspnea, and changes in respiratory rate. Ineffective airway clearance was present in 37.7% of the sample. Agitation was the characteristic with the highest sensitivity. Dyspnea, adventitious breath sounds, orthopnea, changes in respiratory rate and agitation presented higher specificity for the diagnosis. In conclusion, the defining characteristics showed different performances to correctly classify children with infective airway clearance. Studies like this can contribute for a correct nursing diagnostic inference and for the implementation of more effective interventions, thus improving the quality of health care. Descriptors: Respiratory Tract Infections; Nursing Diagnosis; Child.

  19. Acute radiation syndrome in human

    The combination of the different types of irradiation dramatically changes the clinical course of acute radiation syndrome (ARS) in the case of short term exposure. The recent experience has been compared mostly with the data on the atomic bomb victims in Hiroshima and Nagasaki. The comparison of the injuries from different radiation exposures resulted in the possibility to receive summarized data and the actual basis of the observed difference. The situation with total relatively uniform irradiation is observed when human position is at long distance from powerful radiation sources or when he changes his position, as seen in atomic bomb survivors, the results of nuclear weapon tests and the patients in the Chernobyl accident. This is connected with the ARS of bone, marrow and intestine. The situation characterized by the clinical signs of the large area of skin and mucosa injuries was observed in nuclear weapon tests and the Chernobyl accident. In the case of the more localized and less severe beta injuries of skin and mucosa, the long term effects may be important. The majority of accidents in peaceful period are related to the uneven exposure from near sources, and the situation of the combination of external and internal irradiation is related to uneven irradiation and the predominance of internal exposure. (K.I.)

  20. Acute respiratory viral infections in pediatric cancer patients undergoing chemotherapy

    Eliana C.A. Benites

    2014-07-01

    Full Text Available OBJECTIVE: to estimate the prevalence of infection by respiratory viruses in pediatric patients with cancer and acute respiratory infection (ARI and/or fever. METHODS: cross-sectional study, from January 2011 to December 2012. The secretions of nasopharyngeal aspirates were analyzed in children younger than 21 years with acute respiratory infections. Patients were treated at the Grupo em Defesa da Criança Com Câncer (Grendacc and University Hospital (HU, Jundiaí, SP. The rapid test was used for detection of influenza virus (Kit Biotrin, Inc. Ireland, and real-time multiplex polymerase chain reaction (FTD, Respiratory pathogens, multiplex Fast Trade Kit, Malta for detection of influenza virus (H1N1, B, rhinovirus, parainfluenza virus, adenovirus, respiratory syncytial virus, human parechovirus, bocavirus, metapneumovirus, and human coronavirus. The prevalence of viral infection was estimated and association tests were used (χ2 or Fisher's exact test. RESULTS: 104 samples of nasopharyngeal aspirate and blood were analyzed. The median age was 12 ± 5.2 years, 51% males, 68% whites, 32% had repeated ARIs, 32% prior antibiotic use, 19.8% cough, and 8% contact with ARIs. A total of 94.3% were in good general status. Acute lymphocytic leukemia (42.3% was the most prevalent neoplasia. Respiratory viruses were detected in 50 samples: rhinoviruses (23.1%, respiratory syncytial virus AB (8.7%, and coronavirus (6.8%. Co-detection occurred in 19% of cases with 2 viruses and in 3% of those with 3 viruses, and was more frequent between rhinovirus and coronavirus 43. Fever in neutropenic patients was observed in 13%, of which four (30.7 were positive for viruses. There were no deaths. CONCLUSIONS: the prevalence of respiratory viruses was relevant in the infectious episode, with no increase in morbidity and mortality. Viral co-detection was frequent in patients with cancer and ARIs.

  1. 肺源性与肺外源性急性呼吸窘迫综合征呼吸力学的异同及机械通气策略%Respiratory mechanic differences and mechanical ventilation strategy for acute respiratory distress syndrome caused by pulmonary and extrapulmonary Injury

    喻文亮

    2010-01-01

    Acute respiratory distress syndrome(ARDS) can be divided into pulmonary ARDS and extrapulmonary ARDS according to its origin.The prevalent damage in early stages of pulmonary ARDS is intra-alveolar,whereas in extra-pulmonary ARDS it is the interstitial edema.In pulmonary ARDS,lung compliance is worse than in extrapulmonary ARDS,whereas the main abnormality is the decrease in chest Wall compliance.due to abnormally high intra-abdominal pressure.Positive end expiratory pressure,recruitment maneuver and prone position ventilation are more effective in extrapulmonary ARDS,whereas low tidal volume ventilation play equal role in rescuing the two types of ARDS.%急性呼吸窘迫综合征(ARDS)按其病因可分为肺源性ARDS和肺外源性ARDS.肺源性ARDS早期多为肺泡损害,而肺外源性ARDS多为间质性肺水肿.肺源性ARDS患儿肺顺应性降低,而肺外源性ARDS由于腹腔内压增高其胸壁顺应性更低.肺外源性ARDS中应用呼气末正压、肺复张手法及俯卧位通气效果更好,而两者的小潮气量通气效果相似.

  2. Human metapneumovirus and respiratory syncytial virus in hospitalized danish children with acute respiratory tract infection

    von Linstow, Marie-Louise; Henrik Larsen, Hans; Koch, Anders; Eugen-Olsen, Jesper; Nordmann Winther, Thilde; Meyer, Anne-Marie; Westh, Henrik Torkil; Lundgren, Bettina; Melbye, Mads; Høgh, Birthe

    2004-01-01

    The newly discovered human metapneumovirus (hMPV) has been shown to be associated with respiratory illness. We determined the frequencies and clinical features of hMPV and respiratory syncytial virus (RSV) infections in 374 Danish children with 383 episodes of acute respiratory tract infection.......6%) ARTI episodes by real-time reverse transcription-polymerase chain reaction using primers targeting the hMPV N gene and the RSV L gene. Two children were co-infected with hMPV and RSV. They were excluded from statistical analysis. Hospitalization for ARTI caused by hMPV was restricted to very young...

  3. Clinic analysis of sequential noninvasive-invasve mechanical ventilation in treating acute respiratory distress syndrome%无创-有创序贯通气治疗急性呼吸窘迫综合症的临床分析

    李文元; 王淑华; 丁士芳; 张堃慧

    2014-01-01

    Objective To investigate the treatment efficiency of acute respiratory distress syndrome ,with the application of direct invasive ventilation and forced in-vasive ventilation after the failure of no -invasive positive pressure ventilation.Methods The clinical data of ARDS patients with the application of direct IV and NIPPV-IV were retrospectively analyzed from January 2008 to January 2011.Results direct IV group was 90 patients and NIPPV -IV group was 47 patients,the analysis showed that sexual,age,the acute physiology and chronic health evaluation Ⅱ(APACHEⅡ)scores,sequential organ failure assessment(SOFA)scores,simple acute physical(SAPⅡ)scores,lung injury scores,the original of ARDS,sepsis severity were no significant between direct IV group and NIPPV -IV group(p>0.05),after the different mechanical ventilation,the number of organ dysfunction,treatment days in ICU and mortality were significant between direct IV group and NIPPV -IV group(p<0.05).Conclusions ARDS patients should be established artificial airway directly for the application of invasive ventilation ,NIPPV should be used with caution in ARDS patients in order to avoid poor prognosis by its failure .%目的:评价无创正压通气失败后被迫有创通气( NIPPV-IV)和直接有创通气( IV)治疗急性呼吸窘迫综合征( ARDS)的疗效和安全性。方法回顾性分析2008年1月至2011年1月综合ICU的ARDS患者的临床资料,分为无创正压通气失败后进行有创通气治疗( NIPPV-IV)组和直接有创通气治疗( IV)组。结果 NIPPV-IV组47例,IV组90例,两组患者之间性别、年龄、APACHEⅡ评分、SOFA评分、SAPⅡ评分、肺损伤评分( Lis)、ARDS来源、脓毒症严重程度无统计学意义(P>0.05),经过治疗后,直接IV组中的器官功能不全数目、ICU住院时间和死亡率低于NIPPV-IV组,差异有统计学意义(P<0.05)。结论 ARDS患者应慎用无创通气治疗,防止无创

  4. Ventilação de alta freqüência em crianças e adolescentes com síndrome do desconforto respiratório agudo (impacto sobre o uso de ecmo High-frequency ventilation in children and adolescents with acute respiratory distress syndrome (impact on the use of ecmo

    Lucília Santana Faria

    2007-06-01

    Full Text Available OBJETIVO: Avaliar o efeito da ventilação de alta freqüência (VAF em crianças e adolescentes com síndrome do desconforto respiratório (SDRA por meio de estimativas de sobrevida e tempo de ventilação. Verificar se a VAF reduziu a indicação de oxigenação de membrana extracorpórea (ECMO em crianças e adolescentes com SDRA. MÉTODOS: A técnica empregada foi uma revisão sistemática da literatura médica sobre o uso de VAF e ECMO em crianças e adolescentes com SDRA. O levantamento bibliográfico utilizou os bancos de dados Medline, Lilacs e Embase. Os termos utilizados para pesquisa foram: adult respiratory distress syndrome, ARDS, acute respiratory distress syndrome, respiratory distress syndrome, extracorporeal membrane oxygenation, ECMO, high-frequency ventilation, high-frequency jet ventilation e high-frequency oscillatory ventilation. Foram procurados ensaios clínicos controlados e randomizados, estudos de coorte e série de casos que comparavam VAF com ventilação mecânica convencional (VMC, ECMO com VMC ou VAF precedendo o uso de ECMO. RESULTADOS: Foram identificadas 289 publicações relacionadas a VAF, SDRA e ECMO. Destas, apenas nove atendiam aos critérios de seleção pré-estabelecidos referindo-se a utilização de VAF e/ou ECMO em crianças e adolescentes com SDRA. CONCLUSÃO: Não foi possível confirmar se o uso de VAF melhora a sobrevida de crianças e adolescentes com SDRA. Quanto ao tempo de ventilação, não houve estudo que comprovasse, com significância estatística, a sua redução ou aumento. Não foi possível verificar se VAF diminui ou não a indicação de ECMO em crianças e adolescentes com SDRA.OBJECTIVE: To assess the effect of high-frequency ventilation (HFV in children and adolescents with acute respiratory distress syndrome (ARDS through estimates of survival rate and time of ventilation. To verify whether HFV can reduce the indication for extracorporeal membrane oxygenation (ECMO in children

  5. Elevated Plasma Tissue-type Plasminogen Activator (t-PA) and Soluble Throm-bomodulin in Patients Suffering From Severe Acute Respiratory Syndrome (SARS) as a Possible Index for Prognosis and Treatment Strategy

    2005-01-01

    Objective To detect the presence of endothelial injury in patients with severe acute respiratory syndrome (SARS) via enhanced levels of tissue-type plasminogen activator (t-PA) and soluble thrombomodulin (sTM). Methods Case patients were from Xuanwu Hospital (Capital University of Medical Sciences, Beijing, China), and all of them met clinical criteria for SARS. Healthy controls were some of the hospital employees. Endothelial injury bio-markers tPA and sTM were detected by commercial ELISA-methods. Results Classic plasma markers of endothelial injury, tPA and sTM significantly elevated in SARS patients in comparison to controls [t-PA: 1.48±0.16 nmol/L versus 0.25±0.03 nmol/L (P<0.0001), and sTM: 0.26±0.06 nmol/L versus 0.14±0.02 nmol/L (P<0.05)]. The only patient who died had extremely high levels of these endothelial injury markers (t-PA: 2.77 nmol/L and sTM: 1.01 nmol/L). The likelihood ratio analysis indicated the excellent discriminating power for SARS at the optimal cut-point of 0.49 nmol/L for tPA and 0.20 nmol/L for sTM, respectively. Significant numerical correlations were found among these endothelial injury markers in SARS patients. The numerical coefficient of correlation Pearson r between t-PA and sTM was 0.5867 (P<0.05). Conclusion Increased plasma concentrations of tPA and sTM in patients with SARS suggest the possibility of endothelial injury. SARS patients might need anticoagulant therapy or fibrinolytic therapy in order to reverse intraalveolar coagulation, microthrombi formation, alveolar and interstitial fibrin deposition. It may not only provide a useful treatment and prognostic index but also allow a further understanding of the pathological condition of the disease.

  6. Epitope mapping and biological function analysis of antibodies produced by immunization of mice with an inactivated Chinese isolate of severe acute respiratory syndrome-associated coronavirus (SARS-CoV)

    Inactivated severe acute respiratory syndrome-associated coronavirus (SARS-CoV) has been tested as a candidate vaccine against the re-emergence of SARS. In order to understand the efficacy and safety of this approach, it is important to know the antibody specificities generated with inactivated SARS-CoV. In the current study, a panel of twelve monoclonal antibodies (mAbs) was established by immunizing Balb/c mice with the inactivated BJ01 strain of SARS-CoV isolated from the lung tissue of a SARS-infected Chinese patient. These mAbs could recognize SARS-CoV-infected cells by immunofluorescence analysis (IFA). Seven of them were mapped to the specific segments of recombinant spike (S) protein: six on S1 subunit (aa 12-798) and one on S2 subunit (aa 797-1192). High neutralizing titers against SARS-CoV were detected with two mAbs (1A5 and 2C5) targeting at a subdomain of S protein (aa 310-535), consistent with the previous report that this segment of S protein contains the major neutralizing domain. Some of these S-specific mAbs were able to recognize cleaved products of S protein in SARS-CoV-infected Vero E6 cells. None of the remaining five mAbs could recognize either of the recombinant S, N, M, or E antigens by ELISA. This study demonstrated that the inactivated SARS-CoV was able to preserve the immunogenicity of S protein including its major neutralizing domain. The relative ease with which these mAbs were generated against SARS-CoV virions further supports that subunit vaccination with S constructs may also be able to protect animals and perhaps humans. It is somewhat unexpected that no N-specific mAbs were identified albeit anti-N IgG was easily identified in SARS-CoV-infected patients. The availability of this panel of mAbs also provided potentially useful agents with applications in therapy, diagnosis, and basic research of SARS-CoV

  7. Síndrome Respiratorio Agudo Grave: El laboratorio de salud pública frente a una emergencia global Severe acute respiratory syndrome: The public health laboratory in a global emergency

    Elsa G. Baumeister

    2005-03-01

    Full Text Available A fines del año 2002 se inicia un brote de neumonía atípica en el Sudeste asiático el cual se extiende posteriormente a otros continentes. El nuevo síndrome respiratorio agudo grave (SARS era producido por un coronavirus novedoso. Debido a la gravedad de la situación y al riesgo de introducción de esta patología en Argentina, se implementaron técnicas de diagnóstico clásicas como la microscopía electrónica, y moleculares como una reacción de retrotranscripción seguida de una reacción en cadena de la polimerasa (RT-PCR. La inclusión en araldita de células infectadas con un coronavirus bovino permitió visualizar más fácilmente las partículas virales, pero requirió más tiempo en comparación con la coloración negativa de partículas libres de cultivos virales. La RT-PCR implementada fue capaz de detectar ARN de cepas de casos de Hong Kong y de Alemania.By the end of year 2002 there was an outbreak of atypical pneumonia in Southeast Asia which soon spread to other continents. This new severe acute respiratory syndrome (SARS was produced by a novel coronavirus. Due to the severity of the situation and risk of introduction of this pathology in our country, the need to arrange specific laboratory diagnostic tests arose. Classic techniques, such as the electron microscopy and molecular biology test such as retrotranscription followed by the polymerase chain reaction (RT-PCR were implemented. The araldit included cells infected with bovine coronavirus which allowed the viral particles to be visualized easily but it took more time in comparison with the negative staining of free particles from viral cultures. RT-PCR was able to detect RNA of isolated viruses from cases in Hong Kong and Germany.

  8. Sweet Syndrome Associated with Upper Respiratory Infection and Amoxicillin Use.

    Volpe, Mark

    2016-01-01

    Sweet syndrome (acute febrile neutrophilic dermatosis) is an uncommon dermatologic eruption characterized by acute onset of painful papules, plaques or nodules on the skin that are red, blue, or violaceous in color. It has been associated with various infections, medications, and malignancies. Here we report the case of a middle-aged male who presents with Sweet syndrome after an upper resipiratory infection and while using amoxicillin. We also review the diagnostic criteria, laboratory testing, and treatment options. PMID:27186450

  9. Biomarkers of Acute Respiratory Allergen Exposure: Screening For Sensitization Potential

    Rationale: An in vitro assay to identify respiratory sensitizers will provide a rapid screen and reduce animal use. The study goal was to identify biomarkers that differentiate allergen versus non-allergen responses following an acute exposure. Methods: Female BALB/c mice rec...

  10. Non-invasive ventilation for surgical patients with acute respiratory failure

    Lee, Byoung Chul; Kyoung, Kyu Hyouck; Kim, Young Hwan; Hong, Suk-Kyung

    2011-01-01

    Purpose Acute respiratory failure is a relatively common complication in surgical patients, especially after abdominal surgery. Non-invasive ventilation (NIV) is increasingly used in the treatment of acute respiratory failure. We have assessed the usefulness of NIV in surgical patients with acute respiratory failure. Methods We retrospectively reviewed the medical charts of patients who were admitted to a surgical intensive care unit between March 2007 and February 2008 with acute respiratory...

  11. Pyogenic sacroiliitis and adult respiratory distress syndrome: a case report.

    Asavamongkolkul, A; Keerasuntonpong, A; Kuagoolwongse, C

    2007-08-01

    Staphylococcus aureus sacroiliitis is uncommon and may lead to bacteraemia, sepsis, and death if diagnosis and treatment are delayed. Its association with pulmonary symptoms has not been reported. We report a 36-year-old Thai woman who presented with a 4-day history of right buttock pain, aggravated by walking, which came on after having a traditional foot massage. She later developed adult respiratory distress syndrome. She was treated with open drainage, respiratory support, and antibiotics. PMID:17709867

  12. Surfactant function in neonates with respiratory distress syndrome

    Griese, Matthias; Westerburg, Bettina

    1998-01-01

    The function of pulmonary surfactant of a group of 14 preterm neonates (birth weight 907 +/- 60 g) who suffered from severe respiratory distress syndrome (RDS) and who had received exogenous bovine lipid extracted surfactant on the first day of life was compared to that in a second group of 8 neonates (birth weight 940 +/- 110 g) with mild RDS who had not received surfactant treatment. Mechanical respiratory support from day 2 on was the same in both groups. The minimal surface tension (gamma...

  13. Umbilical cord blood and neonatal endothelin-1 levels in preterm newborns with and without respiratory distress syndrome

    A.C.W. Benjamin

    2005-09-01

    Full Text Available Increased pulmonary vascular resistance in preterm newborn infants with respiratory distress syndrome is suggested, and endothelin-1 plays an important role in pulmonary vascular reactivity in newborns. We determined umbilical cord blood and neonatal (second sample levels of endothelin-1 in 18 preterm newborns with respiratory distress syndrome who had no clinical or echocardiographic diagnosis of pulmonary hypertension and 22 without respiratory distress syndrome (gestational ages: 31.4 ± 1.6 and 29.3 ± 2.3 weeks, respectively. Umbilical cord blood and a second blood sample taken 18 to 40 h after birth were used for endothelin-1 determination by enzyme immunoassay. Median umbilical cord blood endothelin-1 levels were similar in both groups (control: 10.9 and respiratory distress syndrome: 11.4 pg/mL and were significantly higher than in the second sample (control: 1.7 pg/mL and respiratory distress syndrome: 3.5 pg/mL, P < 0.001 for both groups. Median endothelin-1 levels in the second sample were significantly higher in children with respiratory distress syndrome than in control infants (P < 0.001. There were significant positive correlations between second sample endothelin-1 and Score for Neonatal Acute Physiology and Perinatal Extension II (r = 0.36, P = 0.02, and duration of mechanical ventilation (r = 0.64, P = 0.02. A slower decline of endothelin-1 from birth to 40 h of life was observed in newborns with respiratory distress syndrome when compared to controls. A significant correlation between neonatal endothelin-1 levels and some illness-severity signs suggests that endothelin-1 plays a role in the natural course of respiratory distress syndrome in preterm newborns.

  14. What Is Acute Respiratory Distress Syndrome?

    ... treated in the intensive care unit (ICU) or critical care unit (CCU) of a hospital. Therapies commonly used ... may be done. (See ATS fact sheet on Tracheostomy). What is an ICU and what can I ...

  15. Hearing evaluation of infants with respiratory distress syndrome by TEOAE test

    Mahya Sharifinik

    2015-02-01

    Conclusion: According to results, it seems that the respiratory distress syndrome could affects the cochlear and the function of outer hair cell in it so in infants who suffer respiratory distress syndrome we should use the test battery of hearing.

  16. Posterior reversible encephalopathy syndrome following acute pancreatitis during chemotherapy for acute monocytic leukemia.

    Nishimoto, Mitsutaka; Koh, Hideo; Bingo, Masato; Yoshida, Masahiro; Nanno, Satoru; Hayashi, Yoshiki; Nakane, Takahiko; Nakamae, Hirohisa; Shimono, Taro; Hino, Masayuki

    2014-05-01

    We describe an 18-year-old man with acute leukemia who presented with posterior reversible encephalopathy syndrome (PRES) shortly after developing acute pancreatitis. On day 15 after the third consolidation course with high-dose cytarabine, treatment with broad-spectrum antibiotics was initiated for febrile neutropenia. On day 16, he developed septic shock, and subsequently, acute respiratory distress syndrome (ARDS). After adding vancomycin, micafungin and high-dose methylprednisolone (mPSL) to his treatment regimen, these manifestations subsided. On day 22, he received hemodialysis for drug-induced acute renal failure. On day 24, he developed acute pancreatitis possibly due to mPSL; the following day he had generalized seizures, and was intubated. Cerebrospinal fluid findings were normal. Brain MRI revealed hyperintense signals on FLAIR images and increased apparent diffusion coefficient values in the sub-cortical and deep white matter areas of the bilateral temporal and occipital lobes, indicative of vasogenic edema. Thus, we diagnosed PRES. Blood pressure, seizures and volume status were controlled, with MRI findings showing improvement by day 42. He was extubated on day 32 and discharged on day 49 without complications. Although little is known about PRES following acute pancreatitis, clinicians should be aware that this condition may develop. PMID:24881921

  17. Acute pancreatitis and Cushing's syndrome.

    Clague, H W; B. Warren; Krasner, N.

    1984-01-01

    A case of acute necrotizing pancreatitis in a 53-year-old man with an ectopic adrenocorticotrophin (ACTH) producing bronchial carcinoma is described. The aetiology of acute pancreatitis in relation to steroid therapy and malignancy is discussed and it is suggested that excess endogenous steroid production may also cause acute pancreatitis.

  18. Immotile cilia syndrome: a new cause of neonatal respiratory distress.

    Whitelaw, A; Evans, A.; Corrin, B.

    1981-01-01

    Kartagener's syndrome is a condition that consists of situs inversus, bronchiectasis, and sinusitis. Some patients have respiratory symptoms that date from early infancy, and electron microscopical examination has shown that adults with this condition lack dynein arms in ciliary microtubules. It has been suggested that an inherited defect in ciliary ultrastructure, the immotile cilia, is the basis for the syndrome. We report 6 patients who presented within the first 24 hours of life with tac...

  19. Combination Chemotherapy in Treating Young Patients With Down Syndrome and Acute Myeloid Leukemia or Myelodysplastic Syndromes

    2016-03-16

    Childhood Acute Basophilic Leukemia; Childhood Acute Eosinophilic Leukemia; Childhood Acute Erythroleukemia (M6); Childhood Acute Megakaryocytic Leukemia (M7); Childhood Acute Minimally Differentiated Myeloid Leukemia (M0); Childhood Acute Monoblastic Leukemia (M5a); Childhood Acute Monocytic Leukemia (M5b); Childhood Acute Myeloblastic Leukemia With Maturation (M2); Childhood Acute Myeloblastic Leukemia Without Maturation (M1); Childhood Acute Myelomonocytic Leukemia (M4); Childhood Myelodysplastic Syndromes; de Novo Myelodysplastic Syndromes; Secondary Acute Myeloid Leukemia; Secondary Myelodysplastic Syndromes; Untreated Childhood Acute Myeloid Leukemia and Other Myeloid Malignancies

  20. Middle East Respiratory Syndrome Coronavirus (MERS-CoV) origin and animal reservoir.

    Mohd, Hamzah A; Al-Tawfiq, Jaffar A; Memish, Ziad A

    2016-01-01

    Middle East Respiratory Syndrome-Coronavirus (MERS-CoV) is a novel coronavirus discovered in 2012 and is responsible for acute respiratory syndrome in humans. Though not confirmed yet, multiple surveillance and phylogenetic studies suggest a bat origin. The disease is heavily endemic in dromedary camel populations of East Africa and the Middle East. It is unclear as to when the virus was introduced to dromedary camels, but data from studies that investigated stored dromedary camel sera and geographical distribution of involved dromedary camel populations suggested that the virus was present in dromedary camels several decades ago. Though bats and alpacas can serve as potential reservoirs for MERS-CoV, dromedary camels seem to be the only animal host responsible for the spill over human infections. PMID:27255185

  1. Human Bocavirus: Passenger or Pathogen in Acute Respiratory Tract Infections?

    Schildgen, Oliver; Müller, Andreas; Allander, Tobias; Mackay, Ian M.; Völz, Sebastian; Kupfer, Bernd; Simon, Arne

    2008-01-01

    Summary: Human bocavirus (HBoV) is a newly identified virus tentatively assigned to the family Parvoviridae, subfamily Parvovirinae, genus Bocavirus. HBoV was first described in 2005 and has since been detected in respiratory tract secretions worldwide. Herein we review the literature on HBoV and discuss the biology and potential clinical impact of this virus. Most studies have been PCR based and performed on patients with acute respiratory symptoms, from whom HBoV was detected in 2 to 19% of...

  2. Respiratory Distress Syndrome in Curacao - Conventional versus surfactant treatment

    Verhagen, AAE; van der Meulen, GN; Wiersma, HE; Keli, SO

    2002-01-01

    The aim of this study was to determine the incidence of Respiratory Distress Syndrome (RDS) and to evaluate the efficacy of surfactant treatment at the Neonatal Intensive Care Unit (NICU) at the St Elisabeth Hospital, Curaqao, Netherlands, Antilles, This was a retrospective cohort study of 86 infant

  3. Acute Abdominal Pain Secondary to Chilaiditi Syndrome

    Buicko, Jessica L.; Miguel Lopez-Viego; David Kang; Lopez, Michael A.; Pan, Andrew S.

    2013-01-01

    Chilaiditi syndrome is a rare condition occurring in 0.025% to 0.28% of the population. In these patients, the colon is displaced and caught between the liver and the right hemidiaphragm. Patients' symptoms can range from asymptomatic to acute intermittent bowel obstruction. Diagnosis is best achieved with CT imaging. Identification of Chilaiditi syndrome is clinically significant as it can lead to many significant complications such as volvulus, perforation, and bowel obstruction. If the pat...

  4. Contemporary management of acute coronary syndrome

    Large, G

    2005-01-01

    This review focuses on the modern management of the non-ST elevation acute coronary syndromes (unstable angina and non-ST elevation myocardial infarction). Patients with these syndromes are at varying degrees of risk of (re)infarction and death. This risk can be reliably predicted by clinical, electrocardiographic, and biochemical markers. Aspirin, clopidogrel, heparin (unfractionated or low molecular weight), and anti-ischaemic drugs should be offered to all patients, irrespective of the pre...

  5. Inflammation: a trigger for acute coronary syndrome.

    Sager, Hendrik B; Nahrendorf, Matthias

    2016-09-01

    Atherosclerosis is a chronic inflammatory disease of the vessel wall and a major cause of death worldwide. One of atherosclerosis' most dreadful complications are acute coronary syndromes that comprise ST-segment elevation myocardial infarction, non-ST-segment elevation myocardial infarction, and unstable angina. We now understand that inflammation substantially contributes to the initiation, progression, and destabilization of atherosclerosis. In this review, we will focus on the role of inflammatory leukocytes, which are the cellular protagonists of vascular inflammation, in triggering disease progression and, ultimately, the destabilization that causes acute coronary syndromes. PMID:27273431

  6. Treatment of acute upper respiratory tract infections in children

    Rončević-Babin Nevenka P.

    2002-01-01

    Full Text Available Introduction Acute respiratory tract infections are the most common diseases of childhood. A preschool child suffers up to 5-7 infections of upper airways during a year. Upper airway infections make 80 - 90% of all respiratory infections. Etiology and treatment In 75% of all cases respiratory infections are of viral etiology, 15% of bacterial and 10% are caused by mycoplasma, rickettsiae, fungi, parasites. The treatment of respiratory infections includes antimicrobial therapy (causal, relief of symptoms (symptomatic and application of general principles of child treatment. The choice of antimicrobial drug is based on the evidence of agents and their sensitivity to antimicrobial drugs, age, patient's condition, previous treatment and possible allergic reactions to the drug. In cases where adequate specimen cannot be obtained for microbiologic tests, when these tests do not reveal the agent, or therapy must start before evidence of the agent is available, we must decide about the therapy, taking in consideration the most frequent agents, and those that would cause the most devastating clinical picture. This therapy can be modified later, according to the isolated agent and its sensitivity to the drug. Considering the incidence and importance of respiratory infections in morbidity and mortality of children, the aim of this article was to present guidelines in treatment of respiratory infections. The main point remains that the treatment should take into consideration the individual patient before all.

  7. Adult respiratory distress syndrome due to mycoplasma pneumonia.

    Shah, D. C.; Muthiah, M. M.

    1996-01-01

    A previously fit 48-year-old man was admitted with an acute respiratory failure due to mycoplasma pneumonia that was confirmed by raised mycoplasma titre on complement fixation test. It was also associated with disseminated intravascular coagulopathy. The patient made a full recovery but required intermittent positive pressure ventilation.

  8. Vaccination against acute respiratory virus infections and measles in man.

    Osterhaus, Ab; Vries, Petra

    1992-01-01

    textabstractSeveral viruses may cause more or less severe acute respiratory infections in man, some of which are followed by systemic infection. Only for influenza and measles are licensed vaccines available at present. The protection induced by influenza vaccines, which are based on inactivated whole virus or viral subunits, depends largely on the matching of vaccine strain and circulating virus. Measles vaccines, which are based on attenuated live virus, have been quite effective in control...

  9. Respiratory Complications from Acute Corrosive Poisonings in Adults

    Chibishev, Andon; Simonovska, Natasa; Bozinovska, Cvetanka; Pereska, Zanina; Smokovski, Ivica; Glasnovic, Marija

    2014-01-01

    Introduction: Acute corrosive poisonings are caused by ingestion of corrosive chemicals which are most commonly used as household agents. Intoxications with these kind of agents produce numerous and severe post-corrosive complications of the upper gastrointestinal tract. On the other hand, our experience showed that corrosive agents may also cause injuries of the respiratory system, which makes the treatment very hard and additionally complicates the severe clinical condition of the patient. ...

  10. RESPIRATORY SYNCYTIAL VIRUS INFECTION AMONG YOUNG CHILDREN WITH ACUTE RESPIRATORY INFECTION

    M. Milani

    2003-08-01

    Full Text Available Respiratory syncytial virus (RSV is the major cause of lower respiratory tract infections in infants,and also an important factor for hospitalization during the winter months. To determine the prevalence and importance of RSV as a cause of acute lower respiratory tract infection, we carried out a prospective study during 5 months period from November to March 1998 in 6 pediatric hospitals. A nasopharyngeal aspirate was obtained for detection of RSV in all cases. Sociodemographic data, clinical signs, diagnosis and hospital admissions were documented. During this study period, 365 young infants (51.5% male, 48.5% female with respiratory tract infection were visited in 6 hospitals. The median age of patients was 24 months (range: 1 month to 5 years.RSV infection was found in 70 out of 365 patients (19.18%.Among the 70 children with RSV infection, 29 patients (41.42% were under 12 months of age.The main clinical manifestations of RSV infection were cough (88.57% and coryza (78.57%. There were no significant differences between patients who were tested positive for RSV and those who were tested negative with regard to demographic variables and clinical diagnoses. This study indicates that RSV is an important cause of respiratory tract infection in infants and young children .Distinguishing RSV from other respiratory infection is difficult because of the similarity in clinical presentation among children.

  11. 鱼油对ARDS患者预后影响的Meta分析%Effects of fish oil on patients with acute respiratory distress syndrome:a meta-analysis

    李洋; 黄亮; 曹春水; 熊华威; 占钻; 刘勇; 刘坚

    2016-01-01

    Objective To evaluate the contribution of fish oil in patients with acute respiratory distress syndrome (ARDS).Methods The PubMed,Embase,Cochrane Clinical Trials Register, Highwire,CBM,CNKI,WanFang databases and Current Controlled Trial (www.controlled-trials.com), the U.S.National Institute of Health Clinical Trials(www.clinicaltrials.gov)databases were searched.All related data were extracted.Meta-analysis was conducted using the statistical software Review Manager 5 .2 on the basis of strict quality evaluation,the methods recommended by the Cochrane Collaboration. Results Seven randomized controlled studies (n=994) were included in this meta-analysis.Compared with the non-fish oil group,28-day mortality was not decreased in the fish oil group(RR=0.81,95%CI :0.56-1.18,P=0.27),the time of mechanical ventilation was not decreased in the fish oil group(WMD=-2.06,95%CI :-4.81-0.70,P =0.14),ICU stay time was significantly lower in the fish oil group (WMD=-2.47,95%CI :-4.33--0.60,P=0.009).Conclusions For patients with ARDS,fish oil is non-beneficial in improving the survival and decreasing the time of mechanical ventiation,but can reduce ICU stay time.%目的:评价鱼油对 ARDS 患者预后的影响。方法计算机及手工检索 PubMed、Embase、Cochrane图书馆临床随机对照试验资料库、Highwire、中国生物医学文献数据库、中国学术期刊全文数据库(CNKI)、万方数据库,并在互联网检索正在进行的试验:Current Controlled Trial (www.controlled-trials.com)和美国国立卫生研究院临床试验数据库(www.clinicaltrials.gov)。按Cochrane系统评价的方法,选择试验、评价质量,使用 Review Manager 5.2软件进行 Meta 分析。结果共纳入7项随机对照临床试验,包括994例研究对象。与非鱼油添加组相比:鱼油未能降低ARDS患者28 d病死率(RR =0.81,95%CI :0.56~1.18,P =0.27);鱼油未能减少 ARDS 患者28 d机械通气时间(WMD=-2.06,95%CI :-4.81~0.70,P=0.14)

  12. Extracorporeal lung assist strategy on acute respiratory distress syndrome%体外肺支持策略用于急性呼吸窘迫综合征的实验研究

    甘斌; 翁羡吾

    2013-01-01

    目的:评价和比较静脉-静脉体外膜肺氧合(V-V ECMO)与无泵驱动体外肺辅助(PECLA)技术在急性呼吸窘迫综合征(ARDS)动物模型中应用的效果.方法:将28只幼猪随机分为健康对照组(CON组)、常规机械通气组(MV组)、ECMO联合小潮气量通气治疗组(EC组)、pECLA联合小潮气量通气治疗组(PE组)4组,采用油酸诱导法建立ARDS模型后接受不同方案治疗,进行肺功能监测、血气分析、血流动力学和常规生化检查,对不同时间点的监测数据进行分析.结果:与CON组相比,造模后动物肺功能存在显著差异,体外支持治疗对肺功能损伤较轻,EC组血流动力学无显著变化,MV组与PE组随治疗时间的延长,平均动脉压与心排量下降;MV组最终全部死亡.结论:对于传统机械通气辅助呼吸治疗无效的ARDS,体外肺支持(ECLA)策略是安全、有效的治疗手段;若血流动力学稳定,应用PECLA进行辅助则更为简单、易行.%Objective: To evaluate and compare the effect of vein- veinous extracorporeal membrane oxygenation ( V- V ECMO ) and pumpless extracorporeal lung assist( PECLA ) applied on animal modeled as acute respiratory distress syndrome( ARDS ). Methods: 28 piglets were randomly divided into four groups. ARDS model was established with olive acid followed by different treatment. Lung function, blood gas analysis, the hemodynamic, blood cell test and biochemical examination were carried out at different time points. Results: Compared with group CON, the lung function and blood gas analysis of ARDS animal exist significant differences, but group PE and group EC was better than the mechanical ventilation group; Hemodynamic of group EC was steady, but MAP and CO of group MV and group PE was descent. All of group MV was death. Conclusion: To the ARDS failure in traditional mechanical ventilation treatment, EC LA strategy is safe, effective treatment method. If hemodynamic was stable, PECLA would provide more

  13. Acute cardiac failure in neuroleptic malignant syndrome.

    Sparrow, Patrick

    2012-02-03

    We present a case of rapid onset acute cardiac failure developing as part of neuroleptic malignant syndrome in a 35-year-old woman following treatment with thioridazine and lithium. Post mortem histology of cardiac and skeletal muscle showed similar changes of focal cellular necrosis and vacuolation suggesting a common disease process.

  14. Treatment of acute lower respiratory tract infections in children

    Rončević-Babin Nevenka P.

    2002-01-01

    Full Text Available Introduction Acute respiratory tract infections are the most common childhood diseases. A preschool child suffers up to 5-7 infections of upper airways during a year. Lower airway infections make 5-20% of all respiratory infections. Etiologic factors In developed countries, 75% of pneumonias in childhood are of viral etiology, in 15% of bacterial, and in 10% of some other causative agent (mycoplasma, rickettsiae, fungi, parasites. In developing countries, bacterial pneumonias are present in much higher percentages. Treatment Treatment of respiratory infections includes antimicrobial therapy (causal, relief of symptoms (symptomatic and conduction of general principles in child treatment. The choice of antimicrobial drug is based on evidence of agents and their sensitivity to antimicrobial drugs, age, patient's condition, previous treatment and possible allergic reactions to the drug. In cases where we cannot provide adequate specimen for microbiologic testing, when these tests do not reveal the agent, or when therapy must be started before the agent is available, we must decide about the therapy, taking in consideration the most frequent agents, and those that would cause the most devastating clinical picture. This therapy can later be modified according to the isolated agent and its sensitivity to the drug. Conclusion Having in mind the incidence and importance of respiratory infections in morbidity and mortality of children the aim of this article was to show guidelines in treatment of respiratory infections in children. The main point remains that we should take in consideration the individual patient before all.

  15. Radiobiology of the acute radiation syndrome

    Acute radiation syndrome or acute radiation sickness is classically subdivided into three sub syndromes: the hematopoietic, gastrointestinal and neurovascular syndrome but many other tissues can be damaged. The time course and severity of clinical signs and symptoms are a function of the overall body volume irradiated, the inhomogeneity of dose exposure, the particle type, the absorbed dose and the dose rate. Classical pathophysiology explain the failure of each of these organs and the timing of appearance of their signs and symptoms due to radiation-induced cytocidal effects of a great number of parenchymal cells of hierarchically organized tissues. Contemporaneously, many other radiation-induced effects has been described and all of them may lead to tissue injury with their corresponding signs and symptoms that can be expressed after short or long period of time. Radiation-induced multi-organ involvement is thought to be due to radiation-induced systemic inflammatory response mediated by released pro-inflammatory cytokines. (authors)

  16. [Serological studies of the role of the respiratory syncytial virus in acute respiratory diseases in children].

    Vancea, D; Saşcă, C; Matinca, D; Ivanof, A

    1975-01-01

    The presence of the syncytial respiratory virus was determined by CF in 281 children admitted with acute respiratory diseases between 15 Sept. 1971 and 30 Dec. 1973, using the Long antigen prepared in the "St. Nicolau" Institute of Virology, Bucharest. In 38 children (13.5%) a serologic diagnosis of infection with the syncytial virus was established; in the other cases of respiratory infection of different etiology, antibodies to the syncytial virus were found in low but constant titers in both serum samples. The presence of these antibodies in a high proportion of the children points to the wide circulation of the syncytial virus in the infantile population, with all its clinico-epidemiologic implications. PMID:173009

  17. Middle East respiratory syndrome: A new global threat

    Bhatia, Pradeep Kumar; Sethi, Priyanka; Gupta, Neeraj; Biyani, Ghansham

    2016-01-01

    The outbreak of Middle East respiratory syndrome (MERS) is reported from Saudi Arabia and the Republic of Korea. It is a respiratory disease caused by coronavirus. Camels are considered as a source for MERS transmission in humans, although the exact source is unknown. Human-to-human transmission is reported in the community with droplet and contact spread being the possible modes. Most patients without any underlying diseases remain asymptomatic or develop mild clinical disease, but some patients require critical care for mechanical ventilation, dialysis and other organ support. MERS is a disease with pandemic potential and awareness, and surveillance can prevent such further outbreaks. PMID:27013745

  18. Middle East respiratory syndrome: A new global threat

    Pradeep Kumar Bhatia

    2016-01-01

    Full Text Available The outbreak of Middle East respiratory syndrome (MERS is reported from Saudi Arabia and the Republic of Korea. It is a respiratory disease caused by coronavirus. Camels are considered as a source for MERS transmission in humans, although the exact source is unknown. Human-to-human transmission is reported in the community with droplet and contact spread being the possible modes. Most patients without any underlying diseases remain asymptomatic or develop mild clinical disease, but some patients require critical care for mechanical ventilation, dialysis and other organ support. MERS is a disease with pandemic potential and awareness, and surveillance can prevent such further outbreaks.

  19. Elevated serum haptoglobin in pigs infected with porcine reproductive and respiratory syndrome virus.

    Asai, T; Mori, M; Okada, M; Uruno, K; Yazawa, S; Shibata, I

    1999-09-01

    We examined the two acute phase proteins, alpha (alpha)-1 acid glycoprotein (AGP) and haptoglobin (HP), in serum of pigs following experimental porcine reproductive and respiratory syndrome (PRRS) virus infection. Increased levels of serum HP, but not AGP, were observed from 7 to 21 days post-inoculation in the infected pigs. Furthermore, serum IL-6 increased in the infected pigs, but TNF-alpha did not. The increase of serum IL-6 in pigs following PRRS virus infection may induce production of HP. Also, in the field investigation, serum HP in pigs was dramatically increased after exposure to the PRRS virus. PMID:10507295

  20. 胆红素对成人肝移植术后急性呼吸窘迫综合征的影响%The impact of bilirubin for acute respiratory distress syndrome in post-liver transplantation adults

    赵蔚; Victor W.Xia

    2014-01-01

    目的:回顾性分析成人肝移植患者术后急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)的发生和临床危险因素,探讨胆红素对ARDS发病和预后的影响。方法经医学伦理委员会同意,选择2004年1月1日至2011年12月31日的成人(年龄≥18岁)肝移植患者,所有数据来自加州大学洛杉矶分校(UCLA)的移植数据中心。诊断标准采用2011年ARDS柏林新定义,将患者分为ARDS组和非ARDS(No-ARDS)组两组,均采用全身麻醉。分析数据包括一般情况,实验室检查如总胆红素、肌酐、电解质(K+、Na+)及预后情况。数据分析软件采用IBM SPSS 20.0软件。结果1335例肝移植患者中有57例术后出现ARDS,发生率为4.3%;终末期肝病模型(MELD)评分和术前是否已经气管内插管两组之间差异均有统计学意义(均P<0.05)。电解质和肌酐两组间无明显差异(P>0.05)。总胆红素在术前〔(411.01±322.16)μmol/L比(250.17±271.04)μmol/L〕和术后第7天〔(164.84±146.55)μmol/L比(84.13±91.83)μmol/L〕ARDS组明显高于No-ARDS组(均P<0.05);经logistic分析,术前总胆红素≥324.9μmol/L(P=0.013,95%CI=1.164~3.578)和术后第7天总胆红素≥188.1μmol/L(P=0.001,95%CI=1.488~5.331)是ARDS发生的独立危险因素。ARDS组1年病死率明显高于No-ARDS组(6.10%比3.30%,P=0.033)。结论①肝移植术后ARDS发生率为4.3%,是多个因素作用的结果;②胆红素对ARDS的作用与剂量有关,术前总胆红素≥324.9μmol/L、术后第7天总胆红素≥188.1μmol/L是术后ARDS发生的危险因素。%Objective To retrospectively analyze the incidence and risk factors of acute respiratory distress syndrome(ARDS)in post-liver transplant adult patients, and to approach the effect of bilirubin on morbidity and prognosis of ARDS. Methods After winning institutional review board approval

  1. [Acute tubulointerstitial nephritis following adenovirus and respiratory syncytial virus infection].

    de Suremain, A; Somrani, R; Bourdat-Michel, G; Pinel, N; Morel-Baccard, C; Payen, V

    2015-05-01

    Acute tubulointerstitial nephritis (TIN) is responsible for nearly 10% of acute renal failure (ARF) cases in children. It is mostly drug-induced, but in a few cases viruses are involved, probably by an indirect mechanism. An immune-competent 13-month-old boy was admitted to the intensive care unit for severe ARF with anuria in a context of fever, cough, and rhinorrhea lasting 1 week. The kidney biopsy performed early brought out tubulointerstitial damage with mild infiltrate of lymphocytes, without any signs of necrosis. There were no virus inclusion bodies, no interstitial hemorrhage, and no glomerular or vascular damage. Other causes of TIN were excluded: there was no biological argument for an immunological, immune, or drug-induced cause. Adenovirus (ADV) and respiratory syncytial virus (RSV) were positive in respiratory multiplex polymerase chain reaction (PCR) in nasal aspirate but not in blood, urine, and renal tissue. The patient underwent dialysis for 10 days but the response to corticosteroid therapy was quickly observed within 48 h. The mechanism of TIN associated with virus infection is unknown. However, it may be immune-mediated to be able to link severe renal dysfunction and ADV and/or RSV invasion of the respiratory tract. PMID:25842199

  2. Alternative therapies for respiratory distress syndrome in preterm infants

    Sinha IP

    2011-11-01

    Full Text Available Ian P Sinha1, Sunil K Sinha21Division of Women’s and Children’s Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK; 2Department of Neonatology, University of Durham and James Cook University Hospital, Middlesbrough, UKAbstract: There is growing interest in the use of noninvasive methods of providing respiratory support to preterm infants, especially those born at the limits of viability. This paper relates to the use of noninvasive forms of respiratory support, which could be used to treat preterm infants with respiratory distress syndrome (RDS. Evidence is reviewed from clinical trials that have evaluated the use of continuous positive airway pressure (CPAP, nasal intermittent positive airway pressure (NIPPV, and high flow nasal cannulae (HFNC.Keywords: CPAP, NIPPV, RDS, preterm

  3. Survival of porcine reproductive and respiratory syndrome virus in houseflies

    Otake, Satoshi; Dee, Scott A.; Moon, Roger D.; Rossow, Kurt D.; Trincado, Carlos; Farnham, MacDonald; Pijoan, Carlos

    2003-01-01

    The objectives of the study were to determine the duration of porcine reproductive and respiratory syndrome virus (PRRSV) survival in houseflies (Musca domestica Linnaeus) following feeding on an infected pig, and to determine whether the virus was present on the exterior surface or within the internal viscera of the fly. A total of 210 laboratory-colonized houseflies were allowed to feed to repletion on a pig, experimentally infected with PRRSV on day 7 postinoculation, and then maintained a...

  4. Atrial natriuretic factor and postnatal diuresis in respiratory distress syndrome.

    Rozycki, H J; Baumgart, S.

    1991-01-01

    To find out if atrial natriuretic factor plays a part in the control of urine output during the initiation alone or throughout postnatal diuresis in neonates with respiratory distress syndrome, atrial natriuretic factor concentrations and clinical and renal variables were measured prospectively three times during the first three days of life in 13 premature infants. Atrial natriuretic factor concentrations rose significantly between the first and second sample times as did the urine output an...

  5. The Role of Surfactant in Respiratory Distress Syndrome

    Ma, Christopher Cheng-Hwa; Ma, Sze

    2012-01-01

    The key feature of respiratory distress syndrome (RDS) is the insufficient production of surfactant in the lungs of preterm infants. As a result, researchers have looked into the possibility of surfactant replacement therapy as a means of preventing and treating RDS. We sought to identify the role of surfactant in the prevention and management of RDS, comparing the various types, doses, and modes of administration, and the recent development. A PubMed search was carried out up to March 2012 u...

  6. Genetic risk factors associated with respiratory distress syndrome

    Jo, Heui Seung

    2014-01-01

    Respiratory distress syndrome (RDS) among preterm infants is typically due to a quantitative deficiency of pulmonary surfactant. Aside from the degree of prematurity, diverse environmental and genetic factors can affect the development of RDS. The variance of the risk of RDS in various races/ethnicities or monozygotic/dizygotic twins has suggested genetic influences on this disorder. So far, several specific mutations in genes encoding surfactant-associated molecules have confirmed this. Spec...

  7. Acute Abdominal Pain Secondary to Chilaiditi Syndrome

    Pan, Andrew S.; Lopez, Michael A.; Buicko, Jessica L.; Lopez-Viego, Miguel

    2013-01-01

    Chilaiditi syndrome is a rare condition occurring in 0.025% to 0.28% of the population. In these patients, the colon is displaced and caught between the liver and the right hemidiaphragm. Patients' symptoms can range from asymptomatic to acute intermittent bowel obstruction. Diagnosis is best achieved with CT imaging. Identification of Chilaiditi syndrome is clinically significant as it can lead to many significant complications such as volvulus, perforation, and bowel obstruction. If the patient is symptomatic, treatment is usually conservative. Surgery is rarely indicated with indications including ischemia and failure of resolution with conservative management. PMID:23936720

  8. Acute Abdominal Pain Secondary to Chilaiditi Syndrome

    David Kang

    2013-01-01

    Full Text Available Chilaiditi syndrome is a rare condition occurring in 0.025% to 0.28% of the population. In these patients, the colon is displaced and caught between the liver and the right hemidiaphragm. Patients' symptoms can range from asymptomatic to acute intermittent bowel obstruction. Diagnosis is best achieved with CT imaging. Identification of Chilaiditi syndrome is clinically significant as it can lead to many significant complications such as volvulus, perforation, and bowel obstruction. If the patient is symptomatic, treatment is usually conservative. Surgery is rarely indicated with indications including ischemia and failure of resolution with conservative management.

  9. Posterior leukoencephalopathy syndrome in poststretococcal acute glomerulonephritis

    Reversible posterior leukoencephalopathy (LEPR) is a clinical entity that affects radiation usually the white matter of the cerebral hemispheres. It is frequently associated with acute arterial hypertension and immunosuppressive therapy, among other causes. The clinical presentation is varied, with headache, nausea, vomiting, impaired consciousness and abnormal behavior, seizures and visual disturbances, symptoms that often regress. Computed tomography (CT) and magnetic resonance imaging (MRI) images show white matter edema predominantly in posterior regions of the brain. We present a 10 year old boy with leprosy in the course of a nephrotic syndrome secondary to acute diffuse glomerunefritis (GNDA) poststreptococcal. (author)

  10. 呼气末正压设定对急性呼吸窘迫综合征患者病死率影响的Meta分析%A meta-analysis of effects of high PEEP versus low PEEP upon mortality in patients with acute respiratory distress syndrome

    李明; 张倩; 陈小东

    2009-01-01

    目的 评价呼气末正压(PEEP)设定对急性呼吸窘迫综合征(ARDS)患者病死率的影响.方法 在Medline、Embase、Web of Science、CENTRAL和中国生物医学文献数据库中检索比较高PEEP和低PEEP对ARDS患者病死率影响的随机对照试验,没有限定时间,人选标准为患者数>10例,符合当时的ARDS和急性肺损伤诊断标准,必须使用有创机械通气并且高PEEP与低PEEP之间差异有统计学意义,必须有住院期间的病死率统计.对符合标准的文献进行Meta分析.结果 5篇文献(包含2447例患者)符合入选标准,住院病死率高PEEP组为34.2%(415/1215),低PEEP组为37.7%(464/1232),合并相对危险度(RR)为0.91,95%可信区间(CI)为0.82~1.01,P=0.07.去除没有使用低潮气量通气策略的试验进行敏感性分析,合并RR为0.94,95%CI为0.84~1.05,P=0.25,与剔除前结论基本一致.漏斗图和Begg秩相关法检验表明无明显发表偏倚(X2=8.26,P=0.09).结论 使用高PEEP和低PEEP通气策略治疗,ARDS患者的住院病死率相似.%Objective To evaluate the effects of high PEEP versus low PEEP upon mortality in patients with acute respiratory distress syndrome(ARDS).Methods The databases Medline,Embase,Web of Science,CENTRAL and CBM(Chinese Bio-Medical Literature & Retrieval System) were retrieved by using the key words ARDS,ALI,acute hypoxemic respiratory failure,acute respiratory distress syndrome,adult respiratory distress syndrome,respiratory failure,systemic inflammatory response syndrome,non-cardiogenic pulmonary edema,ventilation,PEEP,and positive end expiratory pressure,so as to search the material about the randomized controlled trials comparing the mortality of ARDS or ALI treated by high PEEP and low PEE P.Study reports were included if they:(1) enrolled over 10 patients;(2) enrolled adult human ARDS or ALI subiects treated with mechanical ventilation;(3) included high PEEP and low PEEP with significant differences;and (4) included hospital

  11. Acute febrile neutrophilic dermatosis (Sweet's syndrome) in a child, associated with a rotavirus infection: a case report

    Makis Alexandros; Stavrou Stavros; Chaliasos Nikolaos; Zioga Aikaterini; Vlahos Antonios P; Gaitanis Georgios; Siamopoulou Antigone; Bassukas Ioannis D

    2010-01-01

    Abstract Introduction Sweet's syndrome characterized by fever, blood neutrophilia and inflammatory skin lesions, is rarely diagnosed in children. It presents in three clinical settings: classical Sweet's syndrome, usually after a respiratory tract infection; malignancy-associated, frequently related to acute myelogeneous leukemia; and drug-induced. We present, to the best of our knowledge, the first case of a rotavirus -infection-related Sweet's syndrome. Case presentation An 18-month-old boy...

  12. Dialysis disequilibrium syndrome: A preventable fatal acute complication.

    Mah, D Y; Yia, H J; Cheong, W S

    2016-04-01

    Dialysis disequilibrium syndrome (DDS) is a neurological disorder with varying severity that is postulated to be associated with cerebral oedema. We described a case of DDS resulting in irreversible brain injury and death following acute haemodialysis. A 13-year-old male with no past medical history and weighing 30kg, presented to hospital with severe urosepsis complicated by acute kidney injury (Creatinine 1422mmol/L; Urea 74.2mmol/L, Potassium 6.3mmol/L, Sodium 137mmol/L) and severe metabolic acidosis (pH 6.99, HC03 1.7mmol/L). Chest radiograph was normal. Elective intubation was done for respiratory distress. Acute haemodialysis performed due to refractory metabolic acidosis. Following haemodialysis, he became hypotensive which required inotropes. His Riker's score was low with absence of brainstem reflexes after withholding sedation. CT Brain showed generalised cerebral oedema consistent with global hypoxic changes involving the brainstem. The symptoms of DDS are caused by water movement into the brain causing cerebral oedema. Two theories have been proposed: reverse osmotic shift induced by urea removal and a fall in cerebral intracellular pH. Prevention is the key to the management of DDS. It is important to identify high risk patients and haemodialysis with reduced dialysis efficacy and gradual urea reduction is recommended. Patients who are vulnerable to DDS should be monitored closely. Low efficiency haemodialysis is recommended. Acute peritoneal dialysis might be an alternative option, but further studies are needed. PMID:27326954

  13. Acute respiratory failure due to ehrlichiosis - CT findings: case report

    Ehrlichiosis is a rare disease, with approximately 400 cases having been documented in the US since its recognition in 1986. Most of the reported cases were in the southeastern US, although 6 cases have been described in Washington state. Although most of these reported patients were admitted to hospital, severe complications developed in only a small proportion. Findings on chest imaging have been described in 3 children. To our knowledge, this is the first reported case of computed tomographic (CT) findings in a young adult with erhlichiosis in whom acute respiratory failure developed. (author)

  14. Acute encephalitis syndrome following scrub typhus infection

    Ayan Kar; Dhanaraj, M.; Devaprasad Dedeepiya; Harikrishna, K.

    2014-01-01

    Objective: The aim was to find the incidence of acute encephalitis syndrome (AES) secondary to scrub infection and to observe the clinical, biochemical, radiological profile, and outcomes in these patients. Materials and Methods: A total of 20 consecutive patients of AES were evaluated for scrub infection using scrub typhus immunoglobulin M enzyme linked immuno-sorbant assay positivity along with the presence or absence of an eschar. Clinical profile, routine laboratory tests, cerebrospinal f...

  15. The Acute Coronary Syndrome in elderly patients

    Kalliopi Vougiouka; Theodore Kapadohos

    2015-01-01

    The Acute Coronary Syndrome (ACS) is one of the most common and also life-threatening diseases. Elderly patients due to comorbidity and changes in anatomy and physiology of the body, present some differentiation in the clinical presentation of the disease and common symptoms. Aim: The purpose of this study was to review the literature about the specific characteristics that elderly people with ACS present. Method: A review of international and Greek bibliography of the last fifteen years was ...

  16. 连续性血液净化治疗儿童呼吸窘迫综合征的疗效与管理%Evaluation and nursing of continuous blood purification therapy on acute respiratory distress syndrome in children

    邹欢; 李爱求; 顾晓英; 陈嘉玲; 张育才

    2013-01-01

    Objective To investigate the efficacy of continuous blood purification (CBP) in treatment of acute respiratory syndrome (ARDS) in children,and the methods as well as the key points in nursing care.Methods There were 97 cases of ARDS,and 18 cases were treated with CBP.The model for CBP was continuous veno-venous hemofiltration dialysis (CVVHDF) or high volume hemofiltration (HVHF).The observational index included arterial partial pressure of oxygen [pa(O2)],arterial partial pressure of carbon dioxide [Pa(CO2)],mechanical ventilation parameters,complications and side reaction during CBP.Results The pediatric critical illness score in CBP treatment group and non-CBP treatment group were (62.5 ± 25.2) and (78.1 ± 16.3) respectively,and the difference between the 2 groups was significant (P < 0.05) ; the median of pediatric risk of score mortality Ⅲ score in CBP treatment group and non-CBP treatment group were 16(10-20) and 12(7-14),and the difference was significant between the 2 groups (all P <0.05).The average duration of CBP in 18 cases was 58 hours(12-232 hours),death occurred in 5 cases,and 2 cases of them were due to giving up treatment,the mortality was 27.8% ;while in non-CBP treatment group,21 cases occurred death and the mortality was 26.6%.The difference of mortality between the 2 groups was not significant (P > 0.05).Pa (O2)/fraction of inspired oxygen (FiO2) and dynamic compliance (Cdyn) were improved after 2-6 hours CBP,and the pulmonary exudation alleviated after 2 hours treatment.Mechanical ventilation parameters including FiO2,peak inspiratory pressure and positive end expiratory pressure were reduced.The complications related with CBP treatment included aggravating anemia,thrombopenia,lower body temperature,hemorrhage,oliguria,thick sputum,pain and dysphoria.No serious lethal complication was observed.Conclusions CBP treatment is a safe and effective rescue method for ARDS in children,it can reduce pulmonary edema,improve pa (O2)/FiO2

  17. ADULT RESPIRATORY DISTRESS SYNDROME SECONDARY TO END-STAGE LIVER DISEASE—SUCCESSFUL OUTCOME FOLLOWING LIVER TRANSPLANTATION1

    Doyle, Howard R.; Marino, Ignazio R.; Miro, Adelaida; Scott, Victor; Martin, Maureen; Fung, John; Kramer, David; Starzl, Thomas E.

    1993-01-01

    The adult respiratory distress syndrome (ARDS) complicating liver failure carries a 100% mortality. Two cases of ARDS that resolved following liver transplantation have been reported, one associated with acute allograft rejection, and the second due to sepsis. There is, however, a great reluctance to transplant these very-high-risk patients. We report the first series of patients with ARDS secondary to liver failure who successfully underwent OLTX. No patient had sepsis or pneumonia. Posttran...

  18. Surfactant therapy for maternal blood aspiration: an unusual cause of neonatal respiratory distress syndrome.

    Celik, Istemi Han; Demirel, Gamze; Canpolat, Fuat Emre; Erdeve, Omer; Dilmen, Ugur

    2012-10-01

    Surfactant replacement therapy is the main treatment of neonatal respiratory distress syndrome. However, surfactant therapy has been shown to be effective in the treatment of other diseases causing neonatal respiratory diseases such as pulmonary hemorrhage, meconium aspiration syndrome, pneumonia/sepsis, pulmonary edema or acute lung injury resulting a secondary surfactant deficiency (SSD). Rarely, as like as in the present patient, exogenous blood aspiration such as breast milk or formula aspiration may lead to SSD. Blood in alveolus leads to a significant biochemical and functional disturbance of the surfactant system and inhibits surfactant production. Here, the authors report a preterm infant of 33 wk gestational age with secondary surfactant deficiency due to maternal blood aspiration because of abruptio placentae. She was received two courses of beractant, a natural bovine surfactant, therapy in 24 h. She was extubated on second day and did not require oxygen on 4(th) day. To the authors' knowledge, this is the first reported case of SSD due to maternal blood aspiration treated with surfactant. In conditions such as abruptio placentae, infant should be protected from blood aspiration and if respiratory distress occurs, surfactant inhibition and need for surfactant administration should be considered. PMID:22120615

  19. Acute rhabdomyolysis associated with atypical Guillain-Barré syndrome.

    Scott, A. J.; Duncan, R; Henderson, L.; Jamal, G A; Kennedy, P G

    1991-01-01

    We report a patient with atypical Guillain-Barré syndrome associated with acute rhabdomyolysis. Rhabdomyolysis may be the cause of elevation of creatine kinase sometimes seen in patients with Guillain-Barré syndrome.

  20. Guillain-Barré syndrome following acute head trauma.

    Duncan, R; Kennedy, P G

    1987-01-01

    A case of classical Guillain-Barré syndrome following acute head trauma is described. The association of Guillain-Barré syndrome with head injury per se is not well recognized, and a possible immunological explanation is proposed.

  1. Effect of porcine reproductive and respiratory syndrome virus (PRRSV) on alveolar lung macrophage survival and function

    Oleksiewicz, Martin B.; Nielsen, Jens

    1999-01-01

    Porcine reproductive and respiratory syndrome virus (PRRSV) recently emerged as an important cause of reproductive disorders and pneumonia in domestic pigs throughout the world. Acute cytocidal replication of PRRSV in alveolar lung macrophages causes the acute pneumonia; however, it remains largely...... analysis of cell size and membrane integrity) led to 40% reduction in the total number of phagocytozing cells. However, viable/uninfected macrophages in PRRSV-infected cultures exhibited normal phagocytic ability at 48 h, indicating that no soluble phagocytosis-suppressive mediators were induced by PRRSV...... infection in this system. In short, in our minimal system containing only a single cell type, phagocytosis-suppressive effects of PRRSV infection were detected, that acted at the culture level by reducing the total number of alveolar lung macrophages....

  2. Contact tracing the first Middle East respiratory syndrome case in the Philippines, February 2015

    Sheryl Racelis

    2015-07-01

    Full Text Available Background: Middle East respiratory syndrome (MERS is an illness caused by a coronavirus in which infected persons develop severe acute respiratory illness. A person can be infected through close contacts. This is an outbreak investigation report of the first confirmed MERS case in the Philippines and the subsequent contact tracing activities. Methods: Review of patient records and interviews with health-care personnel were done. Patient and close contacts were tested for MERS-coronavirus (CoV by real time-polymerase chain reaction. Close contacts were identified and categorized. All traced contacts were monitored daily for appearance of illness for 14 days starting from the date of last known exposure to the confirmed case. A standard log sheet was used for symptom monitoring. Results: The case was a 31-year-old female who was a health-care worker in Saudi Arabia. She had mild acute respiratory illness five days before travelling to the Philippines. On 1 February, she travelled with her husband to the Philippines while she had a fever. On 2 February, she attended a health facility in the Philippines. On 8 February, respiratory samples were tested for MERS-CoV and yielded positive results. A total of 449 close contacts were identified, and 297 (66% were traced. Of those traced, 15 developed respiratory symptoms. All of them tested negative for MERS. Discussion: In this outbreak investigation, the participation of health-care personnel in conducting vigorous contact tracing may have reduced the risk of transmission. However, being overly cautious to include more contacts for the outbreak response should be further reconsidered.

  3. Data on respiratory variables in critically ill patients with acute respiratory failure placed on proportional assist ventilation with load adjustable gain factors (PAV+).

    Georgopoulos, Dimitris; Xirouchaki, Nectaria; Tzanakis, Nikolaos; Younes, Magdy

    2016-09-01

    The data show respiratory variables in 108 critically ill patients with acute respiratory failure placed on proportional assist ventilation with load adjustable gain factors (PAV+) after at least 36 h on passive mechanical ventilation. PAV+ was continued for 48 h until the patients met pre-defined criteria either for switching to controlled modes or for breathing without ventilator assistance. Data during passive mechanical ventilation and during PAV+ are reported. Data are acquired from the whole population, as well as from patients with and without acute respiratory distress syndrome. The reported variables are tidal volume, driving pressure (ΔP, the difference between static end-inspiratory plateau pressure and positive end-expiratory airway pressure), respiratory system compliance and resistance, and arterial blood gasses. The data are supplemental to our original research article, which described individual ΔP in these patients and examined how it related to ΔP when the same patients were ventilated with passive mechanical ventilation using the currently accepted lung-protective strategy "Driving pressure during assisted mechanical ventilation. Is it controlled by patient brain?" [1]. PMID:27358909

  4. Acute decompensated heart failure is routinely treated as a cardiopulmonary syndrome.

    Kumar Dharmarajan

    Full Text Available BACKGROUND: Heart failure as recognized and treated in typical practice may represent a complex condition that defies discrete categorizations. To illuminate this complexity, we examined treatment strategies for patients hospitalized and treated for decompensated heart failure. We focused on the receipt of medications appropriate for other acute conditions associated with shortness of breath including acute asthma, pneumonia, and exacerbated chronic obstructive pulmonary disease. METHODS AND RESULTS: Using Premier Perspective(®, we studied adults hospitalized with a principal discharge diagnosis of heart failure and evidence of acute heart failure treatment from 2009-2010 at 370 US hospitals. We determined treatment with acute respiratory therapies during the initial 2 days of hospitalization and daily during hospital days 3-5. We also calculated adjusted odds of in-hospital death, admission to the intensive care unit, and late intubation (intubation after hospital day 2. Among 164,494 heart failure hospitalizations, 53% received acute respiratory therapies during the first 2 hospital days: 37% received short-acting inhaled bronchodilators, 33% received antibiotics, and 10% received high-dose corticosteroids. Of these 87,319 hospitalizations, over 60% continued receiving respiratory therapies after hospital day 2. Respiratory treatment was more frequent among the 60,690 hospitalizations with chronic lung disease. Treatment with acute respiratory therapy during the first 2 hospital days was associated with higher adjusted odds of all adverse outcomes. CONCLUSIONS: Acute respiratory therapy is administered to more than half of patients hospitalized with and treated for decompensated heart failure. Heart failure is therefore regularly treated as a broader cardiopulmonary syndrome rather than as a singular cardiac condition.

  5. MDCT evaluation of acute aortic syndrome (AAS).

    Valente, Tullio; Rossi, Giovanni; Lassandro, Francesco; Rea, Gaetano; Marino, Maurizio; Muto, Maurizio; Molino, Antonio; Scaglione, Mariano

    2016-05-01

    Non-traumatic acute thoracic aortic syndromes (AAS) describe a spectrum of life-threatening aortic pathologies with significant implications on diagnosis, therapy and management. There is a common pathway for the various manifestations of AAS that eventually leads to a breakdown of the aortic intima and media. Improvements in biology and health policy and diffusion of technology into the community resulted in an associated decrease in mortality and morbidity related to aortic therapeutic interventions. Hybrid procedures, branched and fenestrated endografts, and percutaneous aortic valves have emerged as potent and viable alternatives to traditional surgeries. In this context, current state-of-the art multidetector CT (MDCT) is actually the gold standard in the emergency setting because of its intrinsic diagnostic value. Management of acute aortic disease has changed with the increasing realization that endovascular therapies may offer distinct advantages in these situations. This article provides a summary of AAS, focusing especially on the MDCT technique, typical and atypical findings and common pitfalls of AAS, as well as recent concepts regarding the subtypes of AAS, consisting of aortic dissection, intramural haematoma, penetrating atherosclerotic ulcer and unstable aortic aneurysm or contained aortic rupture. MDCT findings will be related to pathophysiology, timing and management options to achieve a definite and timely diagnostic and therapeutic definition. In the present article, we review the aetiology, pathophysiology, clinical presentation, outcomes and therapeutic approaches to acute aortic syndromes. PMID:27033344

  6. Acute coronary syndrome in pregnant women.

    El-Deeb, Mohammed; El-Menyar, Ayman; Gehani, Abdulrazzak; Sulaiman, Kadhim

    2011-04-01

    The purpose of this article is to review the available information on the pathophysiology, diagnosis, treatment and prognosis of acute coronary syndromes (ST-elevation myocardial infarction [STEMI] and non-ST-elevation myocardial infarction [NSTEMI]) during all stages of pregnancy. We searched the English-language literature indexed in MEDLINE, Scopus and EBSCO host research databases from 1980 through to August 2010 using the indexing terms 'pregnancy', 'ante-,peri-, and postpartum', 'acute coronary syndrome', 'myocardial infarction', 'STEMI' and 'NSTEMI'. Symptomatic coronary artery disease is still infrequent in women of childbearing age, but the recent increase in its prevalence in pregnancy has been attributed to the modern trend of childbearing in older years because many young working women are postponing having children. Although rare, acute pregnancy-related MI is a devastating event that may claim the life of a mother and her fetus. The incidence of MI is estimated at 0.6-1 per 10,000 pregnancies. The case fatality rate has been reported to be 5-37%. Owing to the rarity of the event, information related to MI in pregnancy is derived from case reports and, therefore, is subject to considerable reporting bias. Treatment needs to be prompt and urgent because of the very high mortality rate. Current guidelines for the diagnosis and treatment of MI should be expanded to include pregnancy-related MI. Screening and management of cardiovascular risk factors should be achieved before pregnancy. PMID:21517733

  7. Preventive Effect of Periplaneta Americana Extract on Stress Ulcer Bleeding in Patients with Acute Lung Injury or Acute Respiratory Distress Syndrome%美洲大蠊提取物对急性肺损伤/急性呼吸窘迫综合征患者应激性溃疡出血的预防作用

    张宏伟; 魏立友; 张振宇; 刘淑正; 张静

    2012-01-01

    目的 探讨美洲大蠊提取物对急性肺损伤/急性呼吸窘迫综合征(ALI/ARDS)患者应激性溃疡出血的预防作用.方法 选取2009年1月-2010年1月我院中心ICU住院的严重创伤后ALI/ARDS患者64例为研究对象,随机数字表法分为治疗组和对照组,各32例,对照组给予积极常规综合治疗,治疗组在常规综合治疗基础上,于入院当天给予美洲大蠊提取物康复新液预防应激性溃疡出血,经胃管注入,10 ml/次,3次/d,连用7 d.分别于给药前及给药第7天,测定胃液pH值,测定氧分压,计算氧合指数(PaO2/FiO2);同时记录两组应激性溃疡出血发生率及病死率.结果 治疗前,两组患者胃液pH值、PaO2/FiO2比较,差异均无统计学意义(P>0.05);治疗后,两组患者胃液pH值、PaO2/FiO2比较,差异均有统计学意义(P<0.05).两组患者应激性溃疡出血发生率比较,差异有统计学意义(P<0.05);两组患者病死率比较,差异无统计学意义(P>0.05).结论 美洲大蠊提取物可改善ALI/ARDS患者胃液pH值、PaO2/FiO2,对应激性溃疡出血有预防作用.%Objective To study the preventive effect of periplaneta americana extract on stress ulcer bleeding in patients with acute lung injury and acute respiratory distress syndrome. Methods 64 in - patients with acute lung injury ( ALI ) or acute respiratory distress syndrome ( ARDS ) hospitalized in ICU from January 2009 to January 2010 were randomly divided into treatment group and control group with each group 32 cases. The control group was given positive routine treatment, while the treatment group was given periplaneta americana extract on the admission day to prevent stress ulcer bleeding in addition to routine treatment. The periplaneta americana extract was injected via gastronomy tube by 10 ml per time for seven consecutive days with each day three times. The pH value of gastric juice and oxygen partial pressure were detected before treatment and seven days after

  8. Middle East respiratory syndrome coronavirus: a comprehensive review.

    Shehata, Mahmoud M; Gomaa, Mokhtar R; Ali, Mohamed A; Kayali, Ghazi

    2016-06-01

    The Middle East respiratory syndrome coronavirus was first identified in 2012 and has since then remained uncontrolled. Cases have been mostly reported in the Middle East, however travel-associated cases and outbreaks have also occurred. Nosocomial and zoonotic transmission of the virus appear to be the most important routes. The infection is severe and highly fatal thus necessitating rapid and efficacious interventions. Here, we performed a comprehensive review of published literature and summarized the epidemiology of the virus. In addition, we summarized the virological aspects of the infection and reviewed the animal models used as well as vaccination and antiviral tested against it. PMID:26791756

  9. Radiological diagnosis of adult respiratory distress syndrome (ARDS)

    The bedside chest radiograph represents the imaging modality of choice for diagnosis and monitoring of adult respiratory distress syndrome (ARDS). Imaging findings are strongly influenced by means of mechanical ventilation therapy. The chest radiograph is relatively insensitive and not specific for the diagnosis of complications such as pneumonia or interstitial emphysema. Computed tomography (CT) is suitable for quantitative assessment of lung compartments with respect to the underlying pathophysiology and the effects of ventilation therapy (PEEP) could be improved. The role of CT in the clinical routine is still limited due to the high risk to transport patients with ARDS. (author)

  10. Coxsackievirus A21, Enterovirus 68, and Acute Respiratory Tract Infection, China

    Xiang, Zichun; Gonzalez, Richard; Wang, Zhong; Ren, Lili; Xiao, Yan; Li, Jianguo; Li, Yongjun; Vernet, Guy; Paranhos-Baccalà, Gláucia; Jin, Qi; Wang, Jianwei

    2012-01-01

    During August 2006–April 2010, in Beijing, China, 2 rare human enterovirus serotypes, coxsackievirus A21 and enterovirus 68, were detected most frequently in human enterovirus–positive adults with acute respiratory tract infections. Thus, during some years, these 2 viruses cause a substantial proportion of enterovirus-associated adult acute respiratory tract infections.

  11. Acute respiratory failure due to thyroid storm developing immediately after delivery

    Kitazawa, Chie; Aoki, Shigeru; Takahashi, Tsuneo; Hirahara, Fumiki

    2015-01-01

    Key Clinical Message Acute respiratory failure occurs in less than 0.1% of pregnancies. Thyroid storm should be included in the differential diagnosis of possible causes of acute respiratory failure occurring immediately after delivery, and delivery is a high risk factor for thyroid storm in pregnant women with thyrotoxicosis.

  12. [Severe Japanese Spotted Fever Complicated by Acute Respiratory Failure in Kobe City].

    Takiguchi, Junji; Okimura, Kenjiro; Ishii, Mariko; Okamura, Kayoko; Sakamoto, Hirokazu; Inamoto, Shinya; Ando, Shuji

    2016-03-01

    We report herein on a case of severe Japanese spotted fever complicated by acute respiratory failure in Kobe City. A 70-year-old female presenting with general malaise and systematic erythema was admitted to our hospital in June, 2013. From her history and physical examination, she was found to be suffering from scleroderma and mild interstitial pneumonia. From admission, the patient was noted to have a fever of 39 degrees C accompanied by relative bradycardia. Physical examination revealed a black eschar on her right leg, making us suspect rickettsial infection since Kobe City is not an area predisposed to Japanese spotted fever. Three days after admission, her condition worsened and treatment with minocycline and levofloxacin was initiated in accordance with the treatment protocol for Japanese spotted fever. The following day, the patient developed acute respiratory distress syndrome (ARDS) and was put on a respirator. She gradually recovered with the antibiotic treatment and was discharged from the hospital 23 days after admission. The diagnosis of Japanese spotted fever was confirmed by conducting a polymerase chain reaction test on the eschar. Japanese spotted fever is noted to occur in any place other than Kobe City. Late diagnoses may result in aggravated cases of Japanese spotted fever, with the possibility of developing ARDS as a complication. PMID:27197438

  13. Extracorporeal membrane oxygenation for the treatment of adult sickle cell acute chest syndrome.

    Parhar, Ken; Parizkova, Barbora; Jones, Nicola; Valchanov, Kamen; Fowles, Jo-Anne; Besser, Martin; Telfer, Paul; Kaya, Banu; Vuylsteke, Alain; Rubino, Antonio

    2016-04-01

    Sickle cell disease (SCD) is a hereditary haemoglobinopathy that results in polymerization of haemoglobin molecules and subsequent vaso-occlusion. A common cause of death in adults is acute chest syndrome (AChS) with resulting hypoxemic respiratory failure.Veno-venous extracorporeal membrane oxygenation (VV-ECMO) has been used successfully in acutely reversible respiratory failure when conventional mechanical ventilation has been unable to adequately oxygenate and ventilate in a lung-protective fashion.We present an adult SCD patient with severe respiratory failure due to AChS, successfully treated with VV-ECMO. We also discuss some of the technical challenges and considerations when using ECMO in the SCD patient. PMID:26130498

  14. Contemporary management of acute coronary syndrome

    Large, G

    2005-01-01

    This review focuses on the modern management of the non-ST elevation acute coronary syndromes (unstable angina and non-ST elevation myocardial infarction). Patients with these syndromes are at varying degrees of risk of (re)infarction and death. This risk can be reliably predicted by clinical, electrocardiographic, and biochemical markers. Aspirin, clopidogrel, heparin (unfractionated or low molecular weight), and anti-ischaemic drugs should be offered to all patients, irrespective of the predicted level of risk. Patients at high risk should also receive a glycoprotein IIb/IIIa receptor inhibitor and should undergo early coronary arteriography with a view to percutaneous or surgical revascularisation. Lower risk patients should undergo non-invasive testing. When inducible myocardial ischaemia is exhibited coronary arteriography should follow. When non-invasive testing is negative, a conservative management strategy is safe. PMID:15811883

  15. Dual pathway therapy in acute coronary syndrome.

    Stachon, Peter; Ahrens, Ingo; Bode, Christoph; Zirlik, Andreas

    2016-08-01

    In 10 % of patients, who suffer an acute coronary syndrome (ACS), a major cardiovascular event occurs despite optimal therapy. The occlusion of the vessel is driven by atherothrombosis, which arises from platelet activation and activation of the coagulation cascade. In the last decade the secondary prevention continuously improved by development of dual anti-platelet therapy with new P2Y12-inhibitors such as clopidogrel, prasugrel, and ticagrelor. Until recently, the coagulation cascade was not targeted in secondary prevention. The coagulation factor Xa plays a crucial role in thrombosis and is elevated in patients after acute coronary syndrome, therefore representing an attractive target for novel therapies in ACS. Former studies with vitamin K antagonists showed reduction of cardiovascular events but increased major bleedings. Two phase-3 trials investigated the role of novel oral anticoagulant agents on top of aspirin and clopidogrel in patients with ACS. The APPRAISE-2 study, which tested the oral factor Xa inhibitor apixaban was prematurely terminated because of an increase of major bleedings in the absence of an effect on cardiovascular events. In contrast, the ATLAS ACS2 TIMI-51 trial interrogating the oral factor Xa inhibitor rivaroxaban in a low dose regimen showed significant reduction of cardiovascular events as well as total mortality. Thus, add-on treatment with low dose rivaroxaban emerged as a new option for patients with ACS. This review illustrates recent advances in the development of antithrombotic therapy in acute coronary syndromes, provides guidance on which patients should receive which therapy for secondary prevention of events, and points out potentially fruitful new strategies for the future of antithrombotic treatment in ACS. PMID:26660521

  16. An undiagnosed myasthenia gravis presenting as isolated recurrent acute respiratory failure

    Shri Ram Sharma; Nalini Sharma; Yeolekar, M E

    2012-01-01

    Acute respiratory failure is an uncommon initial presentation of myasthenia gravis (MG). In our case a 22-year-old woman of unrecognized MG presented to the emergency department with isolated respiratory failure as the first presenting symptom. Initially she presented with dysphonia and was managed by speech therapist and ENT surgeons for 3 months. Subsequently, she presented with signs and symptoms of sepsis and went into acute respiratory failure. This case highlights the need to consider M...

  17. Acute Coronary Syndrome- Conservative vs Invasive Treatment

    LIM; Yean Teng

    2001-01-01

    @@atients with Acute Coronary Syndrome (ACS)are a clinical continuum-with patients presenting with unstable angina on one end, with patients with ST elevation myocardial infarction (STEMI) at the other end of the spectrum. In between are those with non- ST elevation myocardial infarction (NSTEMI) The pathophysiology is similar in these patients, namely isruption and fissuring of an atheromatous plaque,leading to enhanced platelet activation and local vasohyperactivity, with reduced flow and thrombus formation. While medical experts have reached consensus in the management of STEMI patients (thrombolysis nd / or percutaneous coronary intervention), optimalmanagement of patients with UA/NSTEMI remainsunclear.

  18. Acute Coronary Syndrome and ST Segment Monitoring.

    Carey, Mary G

    2016-09-01

    Acute coronary syndrome (ACS) is caused by a critical obstruction of a coronary artery because of atherosclerotic coronary artery disease. Three specific conditions are included: ST elevation myocardial infarction, non-ST elevation myocardial infarction, and unstable angina. The ST segment on the electrocardiogram is a sensitive and specific marker of myocardial ischemia and infarction; however, ST segment deviation is regional not global, thus the ECG lead must be placed over the affected region of the myocardium. This article describes ACS and infarction and the use of ST segment monitoring to detect these conditions. PMID:27484662

  19. Acute pulmonary injury: high-resolution CT and histopathological spectrum

    Obadina, E T; Torrealba, J M; Kanne, J P

    2013-01-01

    Acute lung injury usually causes hypoxaemic respiratory failure and acute respiratory distress syndrome (ARDS). Although diffuse alveolar damage is the hallmark of ARDS, other histopathological patterns of injury, such as acute and fibrinoid organising pneumonia, can be associated with acute respiratory failure. Acute eosinophilic pneumonia can also cause acute hypoxaemic respiratory failure and mimic ARDS. This pictorial essay reviews the high-resolution CT findings of acute lung injury and ...

  20. Effects of acute oligohydramnios on respiratory system of fetal sheep.

    Savich, R D; Guerra, F A; Lee, C C; Padbury, J F; Kitterman, J A

    1992-08-01

    Prolonged oligohydramnios, or a lack of amniotic fluid, is associated with pulmonary hypoplasia and subsequent perinatal morbidity, but it is unclear whether short-term or acute oligohydramnios has any effect on the fetal respiratory system. To investigate the acute effects of removal of amniotic fluid, we studied nine chronically catheterized fetal sheep at 122-127 days gestation. During a control period, we measured the volume of fluid in the fetal potential airways and air spaces (VL), production rate of that fluid, incidence and amplitude of fetal breathing movements, tracheal pressures, and fetal plasma concentrations of cortisol, epinephrine, and norepinephrine. We then drained the amniotic fluid for a short period of time [24-48 h, 30.0 +/- 4.0 (SE) h] and repeated the above measurements. The volume of fluid drained for the initial studies was 1,004 +/- 236 ml. Acute oligohydramnios decreased VL from 35.4 +/- 2.9 ml/kg during control to 22.0 +/- 1.6 after oligohydramnios (P less than 0.004). Acute oligohydramnios did not affect the fetal lung fluid production rate, fetal breathing movements, or any of the other measured variables. Seven repeat studies were performed in six of the fetuses after reaccumulation of the amniotic fluid at 130-138 days, and in four of these studies the lung volume also decreased, although the overall mean for the repeat studies was not significantly different (27.0 +/- 5.2 ml/kg for control vs. 25.5 +/- 5.5 ml/kg for oligohydramnios). Again, none of the other measured variables were altered by oligohydramnios in the repeat studies.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1399988

  1. Examination of virus shedding in semen from vaccinated and from previously infected boars after experimental challenge with porcine reproductive and respiratory syndrome virus

    Nielsen, Thomas L.; Nielsen, Jens; Have, Per;

    1997-01-01

    Danish artificial insemination (AI) centres house several boars antibody positive to porcine reproductive and respiratory syndrome virus as well as PRRSV-naive boars which may become acutely infected, The risk of transmission of PRRSV by semen may therefore constitute a serious problem...

  2. Acute respiratory infections in Pakistan: Have we made any progress?

    Acute respiratory infections (ARI) are the leading cause of death in young children in Pakistan, responsible for 20-30% of child deaths under age 5 years. This paper summarizes the research and technical development efforts over the last 15 years which have contributed to improving the effectiveness of the case management strategy to reduce mortality from 5' pneumonia in children in Pakistan. Community intervention is viable, effective and practical. Rising antimicrobial resistance among commonly used and A low-cost oral agent is of significant concern. Appropriate monitoring and evaluation of the impact of the ARI control programme is lacking. Lack of funding for programmatic activities, lack of coordination with other child survival programs, inadequate training for community health workers and general practitioners in the private sector, lack of public awareness about seeking timely and appropriate care and insufficient planning and support for ARI in the programmatic activities at provincial and district levels are major hindrances in decreasing the burden of ARI in the country. The recent introduction of the community-based Lady Health Worker (LHW) Programme and WHO and UNICEF-sponsored integrated management of childhood illness initiative present ideal opportunities for re-emphasizing early case detection and appropriate case management of ARI. Ultimately, focusing on preventive strategies such as improving nutrition, reducing indoor pollution, improving mass vaccination, as well as introduction of new vaccines effective against important respiratory pathogens will likely have the most impact on reducing severe ARI and deaths from severe disease. (author)

  3. Efficacy of continuous blood purification on rescue therapy of the critically ill children with acute lung injury and acute respiratory distress syndrome%床旁连续性血液净化救治儿童急性肺损伤和呼吸窘迫综合征

    张育才; 徐梁; 戎群芳; 朱艳; 陈容欣

    2012-01-01

    目的 探讨床旁持续性血液净化(continuous blood purification,CBP)治疗在救治危重病儿童急性肺损伤和急性呼吸窘迫综合征(acute lung injury/acute respiratory distress syndrome,ALI/ARDS)中作用.方法 2006年6月至2011年5月,我院共收治ALI/ARDS患儿147例,对其中32例在常规治疗基础上进行CBP治疗.模式为连续性静-静脉血液滤过透析(continuous vein-vein hemodialysis/filtration,CVVHDF),置换液+透析液剂量为35 ~100 ml/(kg·h).观察CBP治疗患儿呼吸指数( FiO2/PO2)、动态肺顺应性(Cdyn)、血气指标、机械通气参数、血管活性药物剂量和肺部X线等指标变化,比较病死率.结果 143例中,男89例(60.5%),女58例(39.5%),平均年龄(43.4±36.7)个月.死亡54例,总病死率为36.7%.ALI/ARDS原因主要为重症肺炎、严重脓毒症和白血病及肿瘤性疾病.CBP治疗组病情程度评分较非CBP治疗组严重,PRISMⅢ分别为15.3和12.7(P<0.05),儿童危重评分分别为66.8 ±19.3和74.6±17.7(P <0.05).CBP治疗平均持续时间为52 h(12~232 h).CBP治疗后2 h PaO2/FiO2和Cdyn有改善,较治疗前比较差异有统计学意义(P<0.05),X线见肺部渗出减轻,呼吸机参数中吸入氧指数(FiO2)吸气峰压(PiP)和呼吸末正压(PEEP)可以下调,合并MODS或休克患儿血管活性药物剂量逐渐下调.CBP治疗组和非CBP治疗组病死率分别为37.5%和36.5%,差异无统计学意义(P>0.05),两组平均机械通气时间差异无统计学意义(P>0.05).结论 CBP辅助治疗ALI/ARDS患儿可以减轻肺水肿,改善PaO2/FiO2和Cdyn,及时下调机械通气参数,达到改善肺部病变的作用,可能是ALI/ARDS治疗有发展潜力的治疗手段.%Objective To investigate the efficacy of continuous blood purification (CBP)in the treatment of acute lung injury/acute respiratory distress syndrome ( ALI /ARDS ) in children.Methods One hundred and forty seven cases of ALI/ARDS were hospitalized to our pediatric intensive

  4. The role of inflammatory stress in acute coronary syndrome

    沈成兴; 陈灏珠; 葛均波

    2004-01-01

    Objective To summarize current understanding of the roles of anti-inflammatory and proinflammatory mechanisms in the development of atherosclerosis and acute coronary syndrome and to postulate the novel concept of inflammation stress as the most important factor triggering acute coronary syndrome. Moreover, markers of inflammation stress and ways to block involved pathways are elucidated.Data sources A literature search (MEDLINE 1997 to 2002) was performed using the key words "inflammation and cardiovascular disease". Relevant book chapters were also reviewed.Study selection Well-controlled, prospective landmark studies and review articles on inflammation and acute coronary syndrome were selected.Data extraction Data and conclusions from the selected articles providing solid evidence to elucidate the mechanisms of inflammation and acute coronary syndrome were extracted and interpreted in the light of our own clinical and basic research.Data synthesis Inflammation is closely linked to atherosclerosis and acute coronary syndrome. Chronic and long-lasting inflammation stress, present both systemically or in the vascular walls, can trigger acute coronary syndrome.Conclusions Inflammation stress plays an important role in the process of acute coronary syndrome. Drugs which can modulate the balance of pro- and anti-inflammatory processes and attenuate inflammation stress, such as angiotensin-converting enzyme (ACE) inhibitors/angiotensin Ⅱ receptor blockers, statins, and cytokine antagonists may play active roles in the prevention and treatment of acute coronary syndrome when used in addition to conventional therapies (glycoprotein Ⅱb/Ⅲa receptor antagonists, mechanical intervention strategies, etc).

  5. Ecstasy-induced acute coronary syndrome: something to rave about.

    Hoggett, Kerry; McCoubrie, David; Fatovich, Daniel M

    2012-06-01

    Ecstasy or 3,4-methylenedioxymethamphetamine is a commonly used illicit recreational drug, enjoying popularity for its stimulant effects. Although acute coronary syndrome is recognized after cocaine and methamphetamine use, association with Ecstasy use has rarely been reported. We report three cases of significantly delayed acute coronary syndrome and ST elevation myocardial infarction related to ingestion of Ecstasy. PMID:22672176

  6. Rivaroxaban in patients with a recent acute coronary syndrome

    Mega, Jessica L; Braunwald, Eugene; Wiviott, Stephen D; Bassand, Jean-Pierre; Bhatt, Deepak L; Bode, Christoph; Burton, Paul; Cohen, Marc; Cook-Bruns, Nancy; Fox, Keith A A; Goto, Shinya; Murphy, Sabina A; Plotnikov, Alexei N; Schneider, David; Sun, Xiang; Verheugt, Freek W A; Gibson, C Michael; Grande, Peer

    2012-01-01

    Acute coronary syndromes arise from coronary atherosclerosis with superimposed thrombosis. Since factor Xa plays a central role in thrombosis, the inhibition of factor Xa with low-dose rivaroxaban might improve cardiovascular outcomes in patients with a recent acute coronary syndrome....

  7. What's new in acute compartment syndrome?

    Harvey, Edward J; Sanders, David W; Shuler, Michael S; Lawendy, Abdel-Rahman; Cole, Ashley L; Alqahtani, Saad M; Schmidt, Andrew H

    2012-12-01

    Acute compartment syndrome (ACS) after trauma is often the result of increased size of the damaged tissues after acute crush injury or from reperfusion of ischemic areas. It usually is not solely caused by accumulation of free blood or fluid in the compartment, although that can contribute in some cases. There is no reliable and reproducible test that confirms the diagnosis of ACS. A missed diagnosis or failure to cut the fascia to release pressure within a few hours can result in severe intractable pain, paralysis, and sensory deficits. Reduced blood circulation leads to oxygen and nutrient deprivation, muscle necrosis, and permanent disability. Currently, the diagnosis of ACS is made on the basis of physical examination and repeated needle sticks over a short time frame to measure intracompartmental pressures. Missed compartment syndromes continue to be one of most common causes of malpractice lawsuits. Existing technology for continuous pressure measurements are insensitive, particularly in the deep tissues and compartments, and their use is restricted to highly trained personnel. Newer concepts of the pathophysiology accompanied by new diagnostic and therapeutic modalities have recently been advanced. Among these are the concept of inflammatory mediators as markers and anti-inflammatories as medical adjunct therapy. New diagnostic modalities include near-infrared spectroscopy, ultrafiltration catheters, and radio-frequency identification implants. These all address current shortcomings in the diagnostic armamentarium that trauma surgeons can use. The strengths and weaknesses of these new concepts are discussed to allow the trauma surgeon to follow current evolution of the field. PMID:22913965

  8. Acute respiratory failure as a manifestation of an arachnoid cyst

    Pillai Lalitha

    2008-01-01

    Full Text Available Arachnoid cysts are the most common congenital cystic lesions in the brain occurring in the middle fossa, suprasellar region and occasionally in the posterior fossa. Conventionally all cysts are considered as benign and symptoms are attributed to expansion of cysts causing compression of adjacent neurological structures, bleeds within the cyst or due to the development of acute hydrocephalus. We are reporting this case of a 15-year-old female patient with non-progressive weakness in the limbs since the age of seven years who presented with acute onset syncopal attacks and respiratory failure. She was intubated and ventilated. An magnetic resonance imaging scan showed large posterior fossa cyst extending up to mid second cervical vertebra causing compression of the medulla and pons, with mild hydrocephalus. After a failed attempt to wean her from the ventilator a cysto peritoneal shunt surgery was performed following which she was weaned from the ventilator successfully. Weakness in the upper and lower limbs, which had increased in the preceding month, also improved following the surgery.

  9. Current status of neonatal acute respiratory disorders: a one-year prospective survey from a Chinese neonatal network

    QIAN Li-ling; WANG San-nan; ZHOU Xiao-yu; SUN Bo; LIU Cui-qing; GUO Yun-xia; JIANG Ye-jun; NI Li-ming; XIA Shi-wen; LIU Xiao-hong; ZHUANG Wan-zhu; XIAO Zhi-hui

    2010-01-01

    Background We conducted a prospective, multicenter investigation of incidence, management and outcome of neonatal acute respiratory disorders (NARD), and evaluated related perinatal risk factors and efficacy of respiratory therapies in neonatal intensive care units (NICUs) in a Chinese neonatal network.Methods Data were prospectively collected in 2004-2005 from infants with NARD defined as presence of respiratory distress and oxygen requirement during the first 3 days of life.Results A total of 2677 NARD was classified (20.5% of NICU admissions). There were 711 (5.44%) with respiratory distress syndrome (RDS), 589 (4.51%) pulmonary infection, 409 (3.13%) meconium aspiration syndrome, 658 (5.03%)aspiration of amniotic fluid and 239 (1.83%) transient tachypnoea. Meconium aspiration syndrome had the highest rate with fetal distress, transient tachypnoea from cesarean section, and RDS with maternal disorders. Assisted mechanical ventilation was applied in 53.4% of NARD, and in above five disorders with 84.7%, 52.3%, 39.8%, 24.5%, and 53.6%,respectively. Corresponding mortality in these disorders was 31.4%, 13.6%, 17.8%, 4.1% and 5.0%, respectively.Surfactant was provided to 33.9% of RDS. In all RDS infants, the survival rate was 78.8% if receiving surfactant, and 63.4% if not (P <0.001).Conclusions This study provided NICU admission-based incidence and mortality of NARD, reflecting efficiency of advanced respiratory therapies, which should be a reference for current development of respiratory support in NICU at provincial and sub-provincial levels, justifying efforts in upgrading standard of care in emerging regions through a collaborative manner.

  10. Chest associated to motor physiotherapy improves cardiovascular variables in newborns with respiratory distress syndrome

    2011-01-01

    Background We aimed to evaluate the effects of chest and motor physiotherapy treatment on hemodynamic variables in preterm newborns with respiratory distress syndrome. Methods We evaluated heart rate (HR), respiratory rate (RR), systolic (SAP), mean (MAP) and diastolic arterial pressure (DAP), temperature and oxygen saturation (SO2%) in 44 newborns with respiratory distress syndrome. We compared all variables between before physiotherapy treatment vs. after the last physiotherapy treatment. N...

  11. Implementing hospital-based surveillance for severe acute respiratory infections caused by influenza and other respiratory pathogens in New Zealand

    Q Sue Huang; Michael Baker; Colin McArthur; Sally Roberts; Deborah Williamson; Cameron Grant; Adrian Trenholme; Conroy Wong; Susan Taylor; Lyndsay LeComte; Graham Mackereth; Don Bandaranayake; Tim Wood; Ange Bissielo; Ruth Seeds

    2014-01-01

    Background: Recent experience with pandemic influenza A(H1N1)pdm09 highlighted the importance of global surveillance for severe respiratory disease to support pandemic preparedness and seasonal influenza control. Improved surveillance in the southern hemisphere is needed to provide critical data on influenza epidemiology, disease burden, circulating strains and effectiveness of influenza prevention and control measures. Hospital-based surveillance for severe acute respiratory infection (SARI)...

  12. Middle East respiratory syndrome coronavirus: current situation and travel-associated concerns.

    Al-Tawfiq, Jaffar A; Omrani, Ali S; Memish, Ziad A

    2016-06-01

    The emergence of Middle East respiratory syndrome coronavirus (MERS-CoV) in 2012 brought back memories of the occurrence of severe acute respiratory syndrome coronavirus (SARS-CoV) in 2002. More than 1500 MERS-CoV cases were recorded in 42 months with a case fatality rate (CFR) of 40%. Meanwhile, 8000 cases of SARS-CoV were confirmed in six months with a CFR of 10%. The clinical presentation of MERS-CoV ranges from mild and non-specific presentation to progressive and severe pneumonia. No predictive signs or symptoms exist to differentiate MERS-CoV from community-acquired pneumonia in hospitalized patients. An apparent heterogeneity was observed in transmission. Most MERS-CoV cases were secondary to large outbreaks in healthcare settings. These cases were secondary to community-acquired cases, which may also cause family outbreaks. Travel-associated MERS infection remains low. However, the virus exhibited a clear tendency to cause large outbreaks outside the Arabian Peninsula as exemplified by the outbreak in the Republic of Korea. In this review, we summarize the current knowledge about MERS-CoV and highlight travel-related issues. PMID:27146399

  13. 肺表面活性物质治疗成人急性肺损伤/急性呼吸窘迫综合征效果的Meta分析%Effects of Pulmonary Surfactant in Adult Patients with Acute Lung Injury/Acute Respiratory Distress Syndrome: A Meta-analysis

    史家欣; 施毅; 苏欣; 徐瑾; 孙文逵; 高伟; 张艳

    2011-01-01

    Objective To review the effects of pulmonary surfactant in adult patients with acute lung injury (ALJ) /acute respiratory distress syndrome ( ARDS). Methods Randomized controlled trials (RCTs) were recruited from PubMed ( 1966. 1-2011. 3), ISI Web of Knowledge (all the years) and Wanfang Database (1982-2011). Related published data and attached references were hand searched. All the RCTs about pulmonary surfactant for the adult patients with ALJ/ARDS were included,then a meta-analysis was performed. Results Eight eligible trials were enrolled. Pooled analysis showed that treatment with pulmonary surfactant was not associated with reduction in 28 or 30-day mortality compared with the control group [ OR 1. 05, 95% CI (0. 90, 1. 22 ), P = 0. 55 ], neither did subgroup analysis in the pneumoia/ aspiration,sepsis,and trauma/surgery induced ALJ/ARDS patients. Three RCTs showed the oxygenation was significantly improved in adult ALJ/ARDS patients receiving pulmonary surfactant compared with the control group ( P < 0.05). Shorter mechanical ventilation days was shown in the ALJ/ARDS patients receiving pulmonary surfactant in one RCT( P <0.05 ). Conclusions Meta-analysis showed pulmonary surfactant did not reduce the 28 or 30-day mortality of adult patients with ALJ/ARDS,however,improved the oxygenation. Pulmonary surfactant can be considered a therapy in ALJ/ARDS.%目的 评价肺表面活性物质对成人急性肺损伤/急性呼吸窘迫综合征(ALI/ARDS)的治疗效果。方法 计算机检索PubMed(1966年1月至2011年3月)、ISI Web of Knowledge(所有年份)和万方数据库(1982年至2011年),手工检索初步入选文献的全文和参考文献中所列的相关文献,收集国内外关于肺表面活性物质对成人ALI/ARDS影响的随机对照研究,利用RevMan 5.0软件进行Meta分析。结果 共纳人8篇随机对照研究文献。合并分析结果 显示,肺表面活性物质不能降低成人ALI/ARDS患者28 d或30 d死亡率[OR 1.05,95

  14. A CASE REPORT ON SICKLE CELL DISEASE WITH HEMOLYTIC ANEMIA, NEPHROTIC SYNDROME AND ACUTE CHEST SYNDROME

    Putta; Yamini Devi

    2015-01-01

    Sickle cell disease is an autoimmune hemolytic anemia due to abnormal hemoglobin. Sickling of RBCs occur due to abnormal hemoglobin which leads to vaso - occlusive crisis. This disease manifests as hemolytic anemia, acute chest syndrome, stroke, ischemic leg ulcers and nephrotic syndrome. This patient presented with hemolytic anemia, nephrotic syndrome and acute chest syndrome. This case was diagnosed by electrophoresis of h emoglobin and peripheral smear. Thi...

  15. Determinants of Noninvasive Ventilation Outcomes during an Episode of Acute Hypercapnic Respiratory Failure in Chronic Obstructive Pulmonary Disease: The Effects of Comorbidities and Causes of Respiratory Failure

    2014-01-01

    Objectives. To investigate the effect of the cause of acute respiratory failure and the role of comorbidities both acute and chronic on the outcome of COPD patients admitted to Respiratory Intensive Care Unit (RICU) with acute respiratory failure and treated with NIV. Design. Observational prospective study. Patients and Methods. 176 COPD patients consecutively admitted to our RICU over a period of 3 years and treated with NIV were evaluated. In all patients demographic, clinical, and functio...

  16. Development of Medical Countermeasures to Middle East Respiratory Syndrome Coronavirus.

    Uyeki, Timothy M; Erlandson, Karl J; Korch, George; O'Hara, Michael; Wathen, Michael; Hu-Primmer, Jean; Hojvat, Sally; Stemmy, Erik J; Donabedian, Armen

    2016-07-01

    Preclinical development of and research on potential Middle East respiratory syndrome coronavirus (MERS-CoV) medical countermeasures remain preliminary; advancements are needed before most countermeasures are ready to be tested in human clinical trials. Research priorities include standardization of animal models and virus stocks for studying disease pathogenesis and efficacy of medical countermeasures; development of MERS-CoV diagnostics; improved access to nonhuman primates to support preclinical research; studies to better understand and control MERS-CoV disease, including vaccination studies in camels; and development of a standardized clinical trial protocol. Partnering with clinical trial networks in affected countries to evaluate safety and efficacy of investigational therapeutics will strengthen efforts to identify successful medical countermeasures. PMID:27191188

  17. Development of Medical Countermeasures to Middle East Respiratory Syndrome Coronavirus

    Erlandson, Karl J.; Korch, George; O’Hara, Michael; Wathen, Michael; Hu-Primmer, Jean; Hojvat, Sally; Stemmy, Erik J.; Donabedian, Armen

    2016-01-01

    Preclinical development of and research on potential Middle East respiratory syndrome coronavirus (MERS-CoV) medical countermeasures remain preliminary; advancements are needed before most countermeasures are ready to be tested in human clinical trials. Research priorities include standardization of animal models and virus stocks for studying disease pathogenesis and efficacy of medical countermeasures; development of MERS-CoV diagnostics; improved access to nonhuman primates to support preclinical research; studies to better understand and control MERS-CoV disease, including vaccination studies in camels; and development of a standardized clinical trial protocol. Partnering with clinical trial networks in affected countries to evaluate safety and efficacy of investigational therapeutics will strengthen efforts to identify successful medical countermeasures. PMID:27191188

  18. Middle East Respiratory Syndrome and Medical Students: Letter from China

    Mengxue Liu

    2015-10-01

    Full Text Available Objectives: The present study aimed to investigate the knowledge of Middle East Respiratory Syndrome (MERS among Chinese medical students. Methods: A structured questionnaire on MERS was conducted among 214 medical students in China. Results: The average correction of the single question varied from 36.0% to 89.7%. There is a significant difference on MERS knowledge among different majors of medical students (p < 0.05. Management students scored significantly higher than students of other majors (p < 0.05. Conclusion: Chinese medical students had good knowledge of MERS. The MERS knowledge score varied among students of different majors. Education on disease control should be included in the school curriculum.

  19. Middle East respiratory syndrome coronavirus: update for clinicians.

    Rasmussen, Sonja A; Gerber, Susan I; Swerdlow, David L

    2015-06-01

    Although much recent focus has been on the recognition of Ebola virus disease among travelers from West Africa, cases of Middle East respiratory syndrome coronavirus (MERS-CoV), including travel-associated cases, continue to be reported. US clinicians need to be familiar with recommendations regarding when to suspect MERS-CoV, how to make a diagnosis, and what infection control measures need to be instituted when a case is suspected. Infection control is especially critical, given that most cases have been healthcare-associated. Two cases of MERS-CoV were identified in the United States in May 2014; because these cases were detected promptly and appropriate control measures were put in place quickly, no secondary cases occurred. This paper summarizes information that US clinicians need to know to prevent secondary cases of MERS-CoV from occurring in the United States. PMID:25701855

  20. The Role of Respiratory Infection in Sudden Infant Death Syndrome (SIDS

    Mage David T.

    2016-06-01

    Full Text Available Introduction: The Sudden Infant Death Syndrome (SIDS is not likely to be explained by a currently measureable presence in all cases and absence in controls, as otherwise it would have been solved already. Indeed, any proposed physiological model for SIDS causation must explain the constant mathematical and statistical properties of SIDS age and gender. We have shown previously that SIDS are characterized by a common 4-parameter lognormal age distribution sparing neonatal infants, by a nominal 50% male excess, and by a higher rate in winter than summer. We test now whether SIDS is closely related to a fulminating prodromal Acute Respiratory Infection (ARI by a common increasing rate with the infants increasing Live Birth Order (LBO, all remaining the same, independent of the change in preferred sleeping positions of the infants, prone or supine.

  1. Prediction of Acute Respiratory Disease in Current and Former Smokers With and Without COPD

    Kim, Victor; Regan, Elizabeth; Williams, André A. A.; Santorico, Stephanie A.; Make, Barry J.; Lynch, David A.; Hokanson, John E.; Washko, George R.; Bercz, Peter; Soler, Xavier; Marchetti, Nathaniel; Criner, Gerard J.; Ramsdell, Joe; Han, MeiLan K.; Demeo, Dawn; Anzueto, Antonio; Comellas, Alejandro; Crapo, James D.; Dransfield, Mark; Wells, J. Michael; Hersh, Craig P.; MacIntyre, Neil; Martinez, Fernando; Nath, Hrudaya P.; Niewoehner, Dennis; Sciurba, Frank; Sharafkhaneh, Amir; Silverman, Edwin K.; van Beek, Edwin J. R.; Wilson, Carla; Wendt, Christine; Wise, Robert A.; Curtis, Jeffrey; Kazerooni, Ella; Hanania, Nicola; Alapat, Philip; Bandi, Venkata; Guntupalli, Kalpalatha; Guy, Elizabeth; Lunn, William; Mallampalli, Antara; Trinh, Charles; Atik, Mustafa; DeMeo, Dawn; Hersh, Craig; Jacobson, Francine; Graham Barr, R.; Thomashow, Byron; Austin, John; MacIntyre, Neil; Washington, Lacey; Page McAdams, H.; Rosiello, Richard; Bresnahan, Timothy; McEvoy, Charlene; Tashjian, Joseph; Wise, Robert; Hansel, Nadia; Brown, Robert; Casaburi, Richard; Porszasz, Janos; Fischer, Hans; Budoff, Matt; Sharafkhaneh, Amir; Niewoehner, Dennis; Allen, Tadashi; Rice, Kathryn; Foreman, Marilyn; Westney, Gloria; Berkowitz, Eugene; Bowler, Russell; Friedlander, Adam; Meoni, Eleonora; Criner, Gerard; Kim, Victor; Marchetti, Nathaniel; Satti, Aditi; James Mamary, A.; Steiner, Robert; Dass, Chandra; Bailey, William; Dransfield, Mark; Gerald, Lynn; Nath, Hrudaya; Ramsdell, Joe; Ferguson, Paul; Friedman, Paul; McLennan, Geoffrey; van Beek, Edwin JR; Martinez, Fernando; Han, MeiLan; Thompson, Deborah; Kazerooni, Ella; Wendt, Christine; Allen, Tadashi; Sciurba, Frank; Weissfeld, Joel; Fuhrman, Carl; Bon, Jessica; Anzueto, Antonio; Adams, Sandra; Orozco, Carlos; Santiago Restrepo, C.; Mumbower, Amy; Crapo, James; Silverman, Edwin; Make, Barry; Regan, Elizabeth; Samet, Jonathan; Willis, Amy; Stinson, Douglas; Beaty, Terri; Klanderman, Barbara; Laird, Nan; Lange, Christoph; Ionita, Iuliana; Santorico, Stephanie; Silverman, Edwin; Lynch, David; Schroeder, Joyce; Newell, John; Reilly, John; Coxson, Harvey; Judy, Philip; Hoffman, Eric; San Jose Estepar, Raul; Washko, George; Leek, Rebecca; Zach, Jordan; Kluiber, Alex; Rodionova, Anastasia; Mann, Tanya; Crapo, Robert; Jensen, Robert; Farzadegan, Homayoon; Murphy, James; Everett, Douglas; Wilson, Carla; Hokanson, John

    2014-01-01

    BACKGROUND: The risk factors for acute episodes of respiratory disease in current and former smokers who do not have COPD are unknown. METHODS: Eight thousand two hundred forty-six non-Hispanic white and black current and former smokers in the Genetic Epidemiology of COPD (COPDGene) cohort had longitudinal follow-up (LFU) every 6 months to determine acute respiratory episodes requiring antibiotics or systemic corticosteroids, an ED visit, or hospitalization. Negative binomial regression was used to determine the factors associated with acute respiratory episodes. A Cox proportional hazards model was used to determine adjusted hazard ratios (HRs) for time to first episode and an acute episode of respiratory disease risk score. RESULTS: At enrollment, 4,442 subjects did not have COPD, 658 had mild COPD, and 3,146 had moderate or worse COPD. Nine thousand three hundred three acute episodes of respiratory disease and 2,707 hospitalizations were reported in LFU (3,044 acute episodes of respiratory disease and 827 hospitalizations in those without COPD). Major predictors included acute episodes of respiratory disease in year prior to enrollment (HR, 1.20; 95% CI, 1.15-1.24 per exacerbation), airflow obstruction (HR, 0.94; 95% CI, 0.91-0.96 per 10% change in % predicted FEV1), and poor health-related quality of life (HR, 1.07; 95% CI, 1.06-1.08 for each 4-unit increase in St. George’s Respiratory Questionnaire score). Risks were similar for those with and without COPD. CONCLUSIONS: Although acute episode of respiratory disease rates are higher in subjects with COPD, risk factors are similar, and at a population level, there are more episodes in smokers without COPD. PMID:24945159

  2. Nuclear Cardiology in Acute Coronary Syndrome

    Paeng, Jin Chul; Lee, Dong Soo [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    2009-06-15

    Nuclear myocardial perfusion imaging is very effective in the evaluation of patients with suspicious acute coronary syndrome (ACS), for adequate diagnosis and treatment. There have been many clinical evidences to support the efficacy and cost-effectiveness. In addition, many authoritative guidelines support the utility of myocardial perfusion imaging in ACS with an appropriate diagnostic protocol. However, with the development of other cardiac imaging modalities, the choice of modality for the diagnosis of suspicious ACS now depends on the availability of each modality in each institute. Newly developed imaging technologies, especially including molecular imaging, are expected to have great potential not only for diagnosis but also for primary, secondary, and tertiary prevention of ACS.

  3. Nuclear Cardiology in Acute Coronary Syndrome

    Nuclear myocardial perfusion imaging is very effective in the evaluation of patients with suspicious acute coronary syndrome (ACS), for adequate diagnosis and treatment. There have been many clinical evidences to support the efficacy and cost-effectiveness. In addition, many authoritative guidelines support the utility of myocardial perfusion imaging in ACS with an appropriate diagnostic protocol. However, with the development of other cardiac imaging modalities, the choice of modality for the diagnosis of suspicious ACS now depends on the availability of each modality in each institute. Newly developed imaging technologies, especially including molecular imaging, are expected to have great potential not only for diagnosis but also for primary, secondary, and tertiary prevention of ACS

  4. Cardiac MRI of acute coronary syndrome.

    Akerem Khan, Shamruz; Khan, Shamruz Akarem; Williamson, Eric E; Foley, Thomas A; Cullen, Ethany L; Young, Phillip M; Araoz, Philip A

    2013-05-01

    Acute coronary syndrome (ACS) is a major cause of morbidity and mortality worldwide. New serological biomarkers, such as troponins, have improved the diagnosis of ACS; however, the diagnosis of ACS can still be difficult as there is marked heterogeneity in its presentation and significant overlap with other disorders presenting with chest pain. Evidence is accumulating that cardiac MRI provides information that can aid the detection and differential diagnosis of ACS, guide clinical decision-making and improve risk-stratification after an event. In this review, we present the relevant cardiac MRI techniques that can be used to detect ACS accurately, provide differential diagnosis, identify the sequelae of ACS, and determine prognostication after ACS. PMID:23668741

  5. The clinics of acute coronary syndrome.

    Cervellin, Gianfranco; Rastelli, Gianni

    2016-05-01

    Risk stratification and management of patients with chest pain continues to be challenging despite considerable efforts made in the last decades by many clinicians and researchers. The throutful evaluation necessitates that the physicians have a high index of suspicion for acute coronary syndrome (ACS) and always keep in mind the myriad of often subtle and atypical presentations of ischemic heart disease, especially in certain patient populations such as the elderly ones. In this article we aim to review and discuss the available evidence on the value of clinical presentation in patients with a suspected ACS, with special emphasis on history, characteristics of chest pain, associated symptoms, atypical presentations, precipitating and relieving factors, drugs, clinical rules and significance of clinical Gestalt. PMID:27294087

  6. Severe Tumor Lysis Syndrome and Acute Pulmonary Edema Requiring Extracorporeal Membrane Oxygenation Following Initiation of Chemotherapy for Metastatic Alveolar Rhabdomyosarcoma.

    Sanford, Ethan; Wolbrink, Traci; Mack, Jennifer; Grant Rowe, R

    2016-05-01

    We present an 8-year-old male with metastatic alveolar rhabdomyosarcoma (ARMS) who developed precipitous cardiopulmonary collapse with severe tumor lysis syndrome (TLS) 48 hr after initiation of chemotherapy. Despite no detectable pulmonary metastases, acute hypoxemic respiratory failure developed, requiring extracorporeal membrane oxygenation (ECMO). Although TLS has been reported in disseminated ARMS, this singular case of life-threatening respiratory deterioration developing after initiation of chemotherapy presented unique therapeutic dilemmas. We review the clinical aspects of this case, including possible mechanisms of respiratory failure, and discuss the role of ECMO utilization in pediatric oncology. PMID:26713672

  7. ANALYSIS OF PRE-HOSPITAL TREATMENT OF ACUTE CORONARY SYNDROME

    O. V. Reshetko

    2015-12-01

    Full Text Available Aim. To evaluate the pre-hospital treatment of patients with acute coronary syndromes (acute myocardial infarction and unstable angina in 2001 and 2006.Material and methods. Retrospective pre-hospital treatment survey was performed in 1114 patients with acute coronary syndrome (acute myocardial infarction (AMI or unstable angina (UA in 2001 and 2006.Results. For acute myocardial infarction use of aspirin, β-blockers, heparin was 0%, 0%, 81,5% in 2001 and 23,9%, 8%, 13,4% in 2006, respectively. Use of aspirin, β-blockers, heparin in unstable angina were 0%, 16,2%, 12,3% in 2001 and 3,4%, 1,6%, 0,5% in 2006, respectively. Fibrinolytic therapy was not provided. Polypragmasia reduced in 2006 in comparison with 2001.Conclusions. This survey demonstrates the discordance between existing current practice and guidelines for acute coronary syndrome.

  8. Acute Respiratory Infections in Travelers Returning from MERS-CoV–Affected Areas

    German, Matthew; Olsha, Romy; Kristjanson, Erik; Marchand-Austin, Alex; Peci, Adriana; Winter, Anne-Luise; Gubbay, Jonathan B.

    2015-01-01

    We examined which respiratory pathogens were identified during screening for Middle East respiratory syndrome coronavirus in 177 symptomatic travelers returning to Ontario, Canada, from regions affected by the virus. Influenza A and B viruses (23.1%) and rhinovirus (19.8%) were the most common pathogens identified among these travelers.

  9. Acute Respiratory Infections in Travelers Returning from MERS-CoV–Affected Areas

    Olsha, Romy; Kristjanson, Erik; Marchand-Austin, Alex; Peci, Adriana; Winter, Anne-Luise; Gubbay, Jonathan B.

    2015-01-01

    We examined which respiratory pathogens were identified during screening for Middle East respiratory syndrome coronavirus in 177 symptomatic travelers returning to Ontario, Canada, from regions affected by the virus. Influenza A and B viruses (23.1%) and rhinovirus (19.8%) were the most common pathogens identified among these travelers. PMID:26291541

  10. Acute Respiratory Infections in Travelers Returning from MERS-CoV-Affected Areas.

    German, Matthew; Olsha, Romy; Kristjanson, Erik; Marchand-Austin, Alex; Peci, Adriana; Winter, Anne-Luise; Gubbay, Jonathan B

    2015-09-01

    We examined which respiratory pathogens were identified during screening for Middle East respiratory syndrome coronavirus in 177 symptomatic travelers returning to Ontario, Canada, from regions affected by the virus. Influenza A and B viruses (23.1%) and rhinovirus (19.8%) were the most common pathogens identified among these travelers. PMID:26291541

  11. Mesenchymal stem cell therapy for acute radiation syndrome.

    Fukumoto, Risaku

    2016-01-01

    Acute radiation syndrome affects military personnel and civilians following the uncontrolled dispersal of radiation, such as that caused by detonation of nuclear devices and inappropriate medical treatments. Therefore, there is a growing need for medical interventions that facilitate the improved recovery of victims and patients. One promising approach may be cell therapy, which, when appropriately implemented, may facilitate recovery from whole body injuries. This editorial highlights the current knowledge regarding the use of mesenchymal stem cells for the treatment of acute radiation syndrome, the benefits and limitations of which are under investigation. Establishing successful therapies for acute radiation syndrome may require using such a therapeutic approach in addition to conventional approaches. PMID:27182446

  12. Preventing acute renal failure is crucial during acute tumor lysis syndrome

    Darmon Michael

    2007-01-01

    Full Text Available Tumour Lysis syndrome (TLS is characterized by the massive destruction of tumoral cells and the release in the extracellular space of their content. While TLS may occur spontaneously before treatment, it usually develops shortly after the initiation of cytotoxic chemotherapy. These metabolites can overwhelm the homeostatic mechanisms and cause hyperuricemia, hyperkalemia, hyperphosphatemia and hypocalcemia. Moreover, TLS may lead to an acute renal failure (ARF. In addition to the hospital mortality induced by the acute renal failure itself, development of an ARF may preclude optimal cancer treatment. Therefore, prevention of the acute renal failure during acute tumor lysis syndrome is mandatory. The objective of this review is to describe pathophysiological mechanisms leading to acute tumor lysis syndrome, clinical and biological consequences of this syndrome and to provide up-to-date guidelines to ensure prevention and prompt management of this syndrome.

  13. Insuficiência respiratória aguda como manifestação da síndrome de eosinofilia-mialgia associada à ingestão de L-triptofano Acute respiratory failure as a manifestation of eosinophilia-myalgia syndrome associated with L-tryptophan intake

    Tiago de Araujo Guerra Grangeia

    2007-12-01

    Full Text Available A síndrome da eosinofilia-mialgia foi descrita em 1989 em pacientes que apresentavam mialgia progressiva e incapacitante e eosinofilia sérica, nos líquidos e secreções. A maioria dos pacientes relatava uso prévio de L-triptofano. Sintomas respiratórios são relatados em até 80% dos casos, eventualmente como manifestação única. O tratamento inclui suspensão da droga e corticoterapia. Relatamos o caso de uma mulher de 61 anos com insuficiência respiratória aguda após uso de L-triptofano, hidroxitriptofano e outras drogas. A paciente apresentava eosinofilia no sangue, lavado broncoalveolar e derrame pleural. Após a suspensão da medicação e corticoterapia, houve melhora clínica e radiológica em poucos dias.Eosinophilia-myalgia syndrome was described in 1989 in patients who presented progressive and incapacitating myalgia and eosinophilia in blood, fluids and secretions. Most patients report previous L-tryptophan intake. Respiratory manifestations are found in up to 80% of the cases, occasionally as the only manifestation. Treatment includes drug discontinuation and administration of corticosteroids. Here, we describe the case of a 61-year-old female admitted with acute respiratory failure after using L-tryptophan, hydroxytryptophan and other drugs. The patient presented eosinophilia, together with elevated eosinophil counts in the bronchoalveolar lavage and pleural effusion. After discontinuation of the drugs previously used, corticosteroids were administered, resulting in clinical and radiological improvement within just a few days.

  14. Acute encephalitis syndrome following scrub typhus infection

    Ayan Kar

    2014-01-01

    Full Text Available Objective: The aim was to find the incidence of acute encephalitis syndrome (AES secondary to scrub infection and to observe the clinical, biochemical, radiological profile, and outcomes in these patients. Materials and Methods: A total of 20 consecutive patients of AES were evaluated for scrub infection using scrub typhus immunoglobulin M enzyme linked immuno-sorbant assay positivity along with the presence or absence of an eschar. Clinical profile, routine laboratory tests, cerebrospinal fluid (CSF analysis, and neuroimaging were analyzed. Patients were treated with doxycycline and followed-up. Results: Among 20 consecutive patients with AES, 6 (30% were due to scrub infection. They presented with acute onset fever, altered sensorium, seizures. "Eschar" was seen in 50% of patients. CSF done in two of them was similar to consistent with viral meningitis. Magnetic resonance imaging brain revealed cerebral edema, bright lesions in the putamen and the thalamus on T2-weighted and fluid-attenuated inversion recovery sequences. Renal involvement was seen in all patients. All patients responded well to oral doxycycline. Conclusion: AES is not an uncommon neurological presentation following scrub typhus infection. It should be suspected in all patients with fever, altered sensorium, and renal involvement. Oral doxycycline should be started as early as possible for better outcomes.

  15. Guidelines to rational use of antibiotics in acute upper respiratory tract infections in Chinese children

    2001-01-01

    @@Acute respiratory tract infections (ARTIs) is the most common disease afflicting Chinese children and ranks first in numbers of outpatients, hospitalization and fatality rate. ARTI is also the most frequent reason that antibiotics are prescribed.

  16. Focus assessed transthoracic echocardiography (FATE) in patients acutely admitted with respiratory symptoms

    Laursen, Christian Borbjerg; Jakobsen, Carl-Johan; Lassen, Annmarie Touborg;

    2012-01-01

    appraisal in patients acutely admitted with respiratory symptoms. Method: We conducted a prospective crosssectional, blinded observational study in a medical emergency department. Patients were included if one of the following symptoms or clinical findings was present: respiratory rate >20, saturation ... the diagnostic performance of the clinical examination in patients with acute respiratory symptoms [3]. Thus FATE could be integrated as a part of the patient assessment, potentially improving diagnostics. We evaluated the use of a sonographic examination, including FATE, performed within one hour of the primary....... Discussion: FATE is a fast, highly feasible and non-invasive bedside method. In acute admissions with respiratory symptoms, routine use of FATE may help the clinician to diagnose acute life threatening conditions, which could otherwise be missed. As use of the FATE protocol seems to improve the diagnostic...

  17. Evaluation of physiological parameters before and after respiratory physiotherapy in newborns with acute viral bronchiolitis

    S Gonçalves, Rodrigo A; Feitosa, Sérgio; de Castro Selestrin, Cláudia; Vitor E. Valenti; de Sousa, Fernando H; F Siqueira, Arnaldo A; Petenusso, Márcio; de Abreu, Luiz Carlos

    2014-01-01

    Background Acute viral bronchiolitis is a respiratory disease with high morbidity that affects newborn in the first two years of life. Its treatment with physiotherapy has been highlighted as an important tool, however, there is no consensus regarding its effects on patients improvement. We aimed to evaluate the physiological parameters before and after the procedure respiratory therapy in newborn with acute viral bronchiolitis. Method This was a cross sectional observational study in 30 newb...

  18. Acute Respiratory Failure due to Neuromyelitis Optica Treated Successfully with Plasmapheresis

    Massa Zantah; Coyle, Timothy B.; Debapriya Datta

    2016-01-01

    Neuromyelitis Optica (NMO) is a demyelinating autoimmune disease involving the central nervous system. Acute respiratory failure from cervical myelitis due to NMO is known to occur but is uncommon in monophasic disease and is treated with high dose steroids. We report a case of a patient with NMO who developed acute respiratory failure related to cervical spinal cord involvement, refractory to pulse dose steroid therapy, which resolved with plasmapheresis.

  19. Acute Respiratory Distress following Intravenous Injection of an Oil-Steroid Solution

    Michael Russell; Aric Storck; Martha Ainslie

    2011-01-01

    Several case reports have described acute lung injury and respiratory distress following the intravascular injection of oil. Although biochemical and mechanical theories explaining the pathological mechanism of pulmonary oil embolism have been proposed, the phenomenon is not completely understood. This report describes a case of acute respiratory distress and hypoxemia involving a 21-year-old bodybuilder who self-administered an injection of anabolic steroids suspended in oil. The ensuing bri...

  20. Intravenous colistin-induced acute respiratory failure: A case report and a review of literature.

    Shrestha, Amardeep; Soriano, Sheryll Mae; Song, Mingchen; Chihara, Shingo

    2014-07-01

    The emergence of multi-drug-resistant gram negative bacillary infections has regained popularity of ancient drugs such as polymyxins. We report a case of acute respiratory failure induced by use of intravenous colistimethate, which is one of the forms of polymyxin. The patient is a 31 year old female with paraplegia due to spina bifida who underwent excisional debridement of large lumbosacral decubitus ulcer with osteomyelitis infected with pan-resistant Pseudomonas aeruginosa and MRSA. Six days after initiation of intravenous colistimethate and vancomycin, she developed acute respiratory failure requiring mechanical ventilation. Pan-culture was negative including a chest radiograph. V/Q scan showed low probability for pulmonary embolism. Echocardiogram showed normal right ventricle with no strain or pulmonary hypertension. Colistimethate was discontinued. Within 24 hours, she was extubated. In the early years after introduction of polymyxin, there were several reports of acute respiratory paralysis. The mechanism is thought to be noncompetitive myoneuronal presynaptic blockade of acetylcholine release. Though a direct causal relationship for respiratory failure is often difficult to establish in current era with multiple co morbidities, the timeframe of apnea, acuity of onset as well as rapid recovery in our case clearly point out the causal relationship. In addition, our patient also developed acute renal failure, presumably due to colistimethate induced nephrotoxicity, a possible contributing factor for her acute respiratory failure. In summary, colistimethate can induce acute neurotoxicity including respiratory muscular weakness and acute respiratory failure. Clinicians should consider its toxicity in the differential diagnosis of acute respiratory failure especially in critically ill patients. PMID:25337492

  1. Acute Respiratory Failure due to Neuromyelitis Optica Treated Successfully with Plasmapheresis

    Massa Zantah

    2016-01-01

    Full Text Available Neuromyelitis Optica (NMO is a demyelinating autoimmune disease involving the central nervous system. Acute respiratory failure from cervical myelitis due to NMO is known to occur but is uncommon in monophasic disease and is treated with high dose steroids. We report a case of a patient with NMO who developed acute respiratory failure related to cervical spinal cord involvement, refractory to pulse dose steroid therapy, which resolved with plasmapheresis.

  2. January 2015 Phoenix pulmonary journal club: noninvasive ventilation in acute respiratory failure

    Mathew M

    2015-01-01

    No abstract available. Article truncated after 150 words. Noninvasive positive pressure ventilation has expanded its role in the treatment of both chronic and acute respiratory failure. Its initial use in conditions such as obstructive sleep apnea, neuromuscular disease and tracheobronchomalacia, have been shown to improve quality of life and reduce mortality. Over the past 20 years studies have looked at using noninvasive ventilation in the management of acute respiratory failure from pulmon...

  3. A chest radiograph scoring system in patients with severe acute respiratory infection: a validation study

    Taylor, Emma; Haven, Kathryn; Reed, Peter; Bissielo, Ange; Harvey, Dave; McArthur, Colin; Bringans, Cameron; Freundlich, Simone; Ingram, R. Joan H.; Perry, David; Wilson, Francessa; Milne, David; Modahl, Lucy; Huang, Q. Sue; Gross, Diane

    2015-01-01

    Background The term severe acute respiratory infection (SARI) encompasses a heterogeneous group of respiratory illnesses. Grading the severity of SARI is currently reliant on indirect disease severity measures such as respiratory and heart rate, and the need for oxygen or intensive care. With the lungs being the primary organ system involved in SARI, chest radiographs (CXRs) are potentially useful for describing disease severity. Our objective was to develop and validate a SARI CXR severity s...

  4. STATE OF MICROBIAL LANDSCAPE OF UPPER RESPIRATORY TRACT IN CHILDREN WITH ACUTE STENOSING LARYNGOTRACHEITIS

    2015-01-01

    The increase in the number of acute respiratory infections in children, accompanied by airway obstruction, often leads to the development of stenotic laryngotracheitis. The primary factors are respiratory viruses, and bacterial flora often joining together, changing the type of the disease which is determined by its outcome. Exposure to infectious agents in the body contribute to the development of chronic infectious diseases of the respiratory tract in children, resulting in damages to the c...

  5. Use of heliox delivered via high-flow nasal cannula to treat an infant with coronavirus-related respiratory infection and severe acute air-flow obstruction.

    Morgan, Sherwin E; Vukin, Kirissa; Mosakowski, Steve; Solano, Patti; Stanton, Lolita; Lester, Lucille; Lavani, Romeen; Hall, Jesse B; Tung, Avery

    2014-11-01

    Heliox, a helium-oxygen gas mixture, has been used for many decades to treat obstructive pulmonary disease. The lower density and higher viscosity of heliox relative to nitrogen-oxygen mixtures can significantly reduce airway resistance when an anatomic upper air-flow obstruction is present and gas flow is turbulent. Clinically, heliox can decrease airway resistance in acute asthma in adults and children and in COPD. Heliox may also enhance the bronchodilating effects of β-agonist administration for acute asthma. Respiratory syndromes caused by coronavirus infections in humans range in severity from the common cold to severe acute respiratory syndrome associated with human coronavirus OC43 and other viral strains. In infants, coronavirus infection can cause bronchitis, bronchiolitis, and pneumonia in variable combinations and can produce enough air-flow obstruction to cause respiratory failure. We describe a case of coronavirus OC43 infection in an infant with severe acute respiratory distress treated with heliox inhalation to avoid intubation. PMID:25118308

  6. Impact of copeptin on diagnosis of acute coronary syndrome

    Zeinab H. El Sayed

    2014-07-01

    Conclusion: In suspected acute coronary syndrome, determination of copeptin and cardiac troponin I provides a remarkable negative predictive value, which aids in early and safe ruling out of myocardial infarction.

  7. Metagenomic analysis of viral genetic diversity in respiratory samples from children with severe acute respiratory infection in China.

    Wang, Y; Zhu, N; Li, Y; Lu, R; Wang, H; Liu, G; Zou, X; Xie, Z; Tan, W

    2016-05-01

    Severe acute respiratory infection (SARI) in children is thought to be mainly caused by infection with various viruses, some of which have been well characterized; however, analyses of respiratory tract viromes among children with SARI versus those without are limited. In this study, nasopharyngeal swabs from children with and without SARI (135 versus 15) were collected in China between 2008 and 2010 and subjected to multiplex metagenomic analyses using a next-generation sequencing platform. The results show that members of the Paramyxoviridae, Coronaviridae, Parvoviridae, Orthomyxoviridae, Picornaviridae, Anelloviridae and Adenoviridae families represented the most abundant species identified (>50% genome coverage) in the respiratory tracts of children with SARI. The viral population found in the respiratory tracts of children without SARI was less diverse and mainly dominated by the Anelloviridae family with only a small proportion of common epidemic respiratory viruses. Several almost complete viral genomes were assembled, and the genetic diversity was determined among several samples based on next-generation sequencing. This research provides comprehensive mapping of the viromes of children with SARI and indicates high heterogeneity of known viruses present in the childhood respiratory tract, which may benefit the detection and prevention of respiratory disease. PMID:26802214

  8. Analysis of the Korean Emergency Department Syndromic Surveillance System: Mass Type Acute Diarrheal Syndrome

    Ahn, Shin; Lee, Jae Ho; KIM, WON; Lim, Kyung Soo

    2010-01-01

    Objectives This study was designed to compare the data from the emergency department syndromic surveillance system of Korea in detection and reporting of acute diarrheal syndrome (mass type) with the data from the Korea Food and Drug Administration. And to offer fundamental materials for making improvements in current surveillance system was our purpose. Methods A study was conducted by reviewing the number of cases reported as acute diarrheal syndrome (mass type) from the Korean Center for D...

  9. Thyroid Hormone Profile in Patients With Acute Coronary Syndrome

    Abdulaziz Qari, Faiza

    2015-01-01

    Background: Thyroid hormone has the a major role in the cardiovascular system function and cardiac a As well as to maintain the cardiovascular homeostasis A slightly change ind thyroid status actually affects cardiovascular mortality hemodynamic. The background of this study was to define the prevalence of thyroid dysfunction in acute coronary syndrome (ACS). Objectives: The primary objective was to define the prevalence of thyroid dysfunction in acute coronary syndrome, including Non-ST Segm...

  10. European consensus guidelines on the management of neonatal respiratory distress syndrome in preterm infants - 2010 update

    Sweet, David G; Carnielli, Virgilio; Greisen, Gorm;

    2010-01-01

    Despite recent advances in the perinatal management of neonatal respiratory distress syndrome (RDS), controversies still exist. We report the updated recommendations of a European panel of expert neonatologists who had developed consensus guidelines after critical examination of the most up...

  11. Surfactant treatment in premature infants with Respiratory Distress Syndrome in Curacao

    Verhagen, AAE; Keli, SO; van der Meulen, GN; Wiersma, H; Arias, M; Angelista, IR; Muskiet, FD

    2001-01-01

    Surfactant replacement therapy for Respiratory Distress Syndrome (RDS) in premature neonates has been established as an effective treatment, although significant mortality and morbidity remain. In Curacao, surfactant became available as a therapeutic option in 1994. A retrospective cohort study was

  12. Virion packaging of multiple cleavage isoforms of porcine reproductive and respiratory syndrome virus nonstructural protein 2

    Porcine reproductive and respiratory syndrome virus (PRRSV) is the cause of a complex disease often resulting in significant morbidity and mortality. Recently, highly pathogenic isolates have emerged which have proven to be devastatingly effective pathogens, resulting in rapid systemic deterioration...

  13. Treatment with exogenous surfactant stimulates endogenous surfactant synthesis in premature infants with respiratory distress syndrome

    Bunt, JEH; Carnielli, VP; Janssen, DJ; Wattimena, JLD; Hop, WC; Sauer, PJ; Zimmermann, LJI

    2000-01-01

    Objective: Treatment of preterm infants with respiratory distress syndrome (RDS) with exogenous surfactant has greatly improved clinical outcome. Some infants require multiple doses, and it has not been studied whether these large amounts of exogenous surfactant disturb endogenous surfactant metabol

  14. The role of inflammation and clotting in the development of neonatal respiratory distress syndrome

    Jaarsma, Anna Saakje

    2003-01-01

    Neonatal Respiratory Distress Syndrome (neonatal RDS) occurs in preterm infants, due to structural immaturity of the lungs and immaturity of the pulmonary surfactant metabolism, resulting in surfactant deficiency and surfactant dysfunction. Apart from these factors there is increasing evidence that

  15. Acute Radiation Syndrome. Consequences and outcomes

    Okladnikova, N.D.; Pesternikova, V.S.; Sumina, M.V.; Azizova, T.V.; Yurkov, N.N. [Branch No 1 State Research Center of Russia, Ozyorsk (Russian Federation). Inst. of Biophysics

    2000-05-01

    The consequences and outcomes of an Acute Radiation Syndrome (ARS), induced by external gamma radiation for 59 persons (49 men and 10 women) have been estimated. All incidents have taken place more than 40 years ago in the yearly years of adjustment of an atomic industry (1950-1953-38 persons, 1954-1958-21 persons). According to the degree of severity ARS 5 groups are selected: the severest degree - 7 individuals (average dose in group 43.8{+-}12.8 Sv), severe - 4 individuals (9.3{+-}1.5 Sv), medium - 14 individuals (2.2{+-}0.8 Sv), a light degree - 15 individuals (0.93{+-}0.13 Sv), ''erased'' from - 19 individuals (0.85{+-}0.07 Sv). In all cases, except for lethal (the severest degree), the characteristics of morphological composition of the peripheral blood were restored in the first year after ARS and now correspond to physiological standard. In 2 cases the moderate hypoplasia of granulocytopoiesis was diagnosed. A marker of the acute exposure was the chromosome aberrations in lymphocytes of the peripheral blood. The frequency of chromosome aberrations correlates with severity degree of ARS (from 3-7 up to 35-50 stable aberrations per 100 cells). In cases of ARS with severe degree the early development of a cerebral atherosclerosis is detected. The radiation cataract was diagnosed in 5 patients (an exposure doses 4.0-9.8 Sv, a period of development 2-5 years). During the first years after ARS in 80% of cases the complete labour rehabilitation is reached. Of 53 patients with known vital status by 45 year of monitoring 19 persons (35.8%) have died, of these in 2 cases the causes of death are not determined. In remaining cases the causes of death were ARS of severest degree (7 persons), Ischemic Heart Disease (5 persons), malignant tumors (4 persons), accidents and traumas (2 persons). (author)

  16. Nuclear cardiology in acute coronary syndromes

    Acute coronary syndromes are a frequent manifestation of a coronary artery disease, usually being associated with chest pain and presenting as a medical emergency. Since a considerable number of patients with chest pain, however, have a non cardiac etiology of trier pain, properly triaging these patients represents a diagnostic challenge for physicians in the emergency department. As the available diagnostic procedures have limited accuracy, many different diagnostic strategies have been evaluated. Among these, radionuclide myocardial perfusion imaging (MPI) at rest or in combination with stress procedures has been investigated in many trails. MPI has been proven to be useful, especially in a patient population with a low to intermediate probability of an ischemic event. Perfusion scintigraphy has a high sensitivity in the detection of myocardial infarction and reveals an excellent negative predictive value, allowing a safe discharge strategy of patients with a negative scan result. Moreover, it enables risk stratification and provides incremental and independent prognostic information regarding short to long term future cardiac adverse events. Several cost effectiveness studies have shown that perfusion imaging leads to lower overall direct costs, mainly by a reduction of unnecessary hospital admissions and diagnostic angiograms, without worsening of the clinical outcome of these patients. As a possible study endpoint, myocardial perfusion imaging in the acute setting enables the quantification of salvaged myocardium and therefore the evaluation of treatment efficacy. Besides perfusion agents, several infarcts avid radiopharmaceuticals have been developed, which in part show promising results. However, larger randomized trials evaluating these tracers in clinical settings are needed to warrant routine clinical application

  17. Acute Radiation Syndrome. Consequences and outcomes

    The consequences and outcomes of an Acute Radiation Syndrome (ARS), induced by external gamma radiation for 59 persons (49 men and 10 women) have been estimated. All incidents have taken place more than 40 years ago in the yearly years of adjustment of an atomic industry (1950-1953-38 persons, 1954-1958-21 persons). According to the degree of severity ARS 5 groups are selected: the severest degree - 7 individuals (average dose in group 43.8±12.8 Sv), severe - 4 individuals (9.3±1.5 Sv), medium - 14 individuals (2.2±0.8 Sv), a light degree - 15 individuals (0.93±0.13 Sv), ''erased'' from - 19 individuals (0.85±0.07 Sv). In all cases, except for lethal (the severest degree), the characteristics of morphological composition of the peripheral blood were restored in the first year after ARS and now correspond to physiological standard. In 2 cases the moderate hypoplasia of granulocytopoiesis was diagnosed. A marker of the acute exposure was the chromosome aberrations in lymphocytes of the peripheral blood. The frequency of chromosome aberrations correlates with severity degree of ARS (from 3-7 up to 35-50 stable aberrations per 100 cells). In cases of ARS with severe degree the early development of a cerebral atherosclerosis is detected. The radiation cataract was diagnosed in 5 patients (an exposure doses 4.0-9.8 Sv, a period of development 2-5 years). During the first years after ARS in 80% of cases the complete labour rehabilitation is reached. Of 53 patients with known vital status by 45 year of monitoring 19 persons (35.8%) have died, of these in 2 cases the causes of death are not determined. In remaining cases the causes of death were ARS of severest degree (7 persons), Ischemic Heart Disease (5 persons), malignant tumors (4 persons), accidents and traumas (2 persons). (author)

  18. Effects of artificial surfactant on lung function and blood gases in idiopathic respiratory distress syndrome.

    Milner, A D; Vyas, H.; Hopkin, I E

    1983-01-01

    We have investigated the effect of giving two 25 mg doses of dry surfactant powder to the airways of 10 preterm babies with severe idiopathic respiratory distress syndrome requiring intermittent positive pressure ventilation. No useful change in static total compliance or blood gases was seen. We conclude that dry surfactant powder does not have a role in the management of severe idiopathic respiratory distress syndrome.

  19. Cost of surfactant replacement treatment for severe neonatal respiratory distress syndrome: a randomised controlled trial.

    Tubman, T. R.; Halliday, H. L.; Normand, C

    1990-01-01

    OBJECTIVE--To estimate the cost of treating babies with severe respiratory distress syndrome with natural porcine surfactant. DESIGN--Retrospective controlled survey. SETTING--Regional neonatal intensive care unit, Belfast. PATIENTS--33 Preterm babies with severe respiratory distress syndrome who were enrolled in a European multicentre trial during 1985-7. 19 Babies were treated with surfactant and 14 served as controls. INTERVENTIONS--Treatment with natural porcine surfactant. MAIN OUTCOME M...

  20. Randomised controlled study of early use of inhaled corticosteroid in preterm infants with respiratory distress syndrome

    Fok, T; Lam, K.; Dolovich, M.; Ng, P; Wong, Van W.; Cheung, K; So, K

    1999-01-01

    AIM—To investigate the therapeutic efficacy of inhaled fluticasone propionate, started on day 1 of age, on ventilated preterm infants with respiratory distress syndrome.
METHODS—Starting within 24 hours of age, ventilated preterm infants (gestation < 32 weeks, birthweight < 1.5 kg) with respiratory distress syndrome were given a 14 day course (two puffs, 12 hourly) of either fluticasone propionate (250 µg/puff) (group 1, n=27) or placebo (group 2, n=26) with a metered dose i...