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Improved survival at the cost of more chronic lung disease?Current management and outcomes in extremely preterm infants born in New South Wales and the Australian Capital Territory:2010-2020

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World Journal of Pediatrics 2024年第3期20卷 230-238页

作者： Nele Legge Himanshu Popat Dominic Fitzgerald Liverpool Hospital Corner Elizabeth and Goulburn StreetsLiverpoolNSWAustralia University of Sydney CamperdownAustralia Children's Hospital Westmead WestmeadAustralia

Background Since 2010,most tertiary care hospitals in Australia have changed how they care for extremely premature infants.However,in-hospital and longer-term outcome data have suggested unchanged or even worse health outcomes in later epochs,especially respiratory outcomes.This study examined the trend in outcomes since these changes were introduced,particularly the prevalence of chronic neonatal lung disease(CLD).Methods This is a retrospective cross-sectional analysis of data from the Neonatal Intensive Care Units'(NICUS)database of all perinatal intensive care units in New South Wales and the Australian Capital Territory,including infants born at≥24 and≤28 weeks of gestational age in tertiary perinatal units between January 1,2010,and December 31,2020.Temporal trends and changes in primary outcome were examined by linear and adjusted multivariable logistic regression models.Results This study included 3258 infants.We saw significant changes in antenatal magnesium sulfate(75% increase),delayed cord clamping(66% increase),delivery room intubations(30% decrease),any time(20% decrease),duration on mechanical ventilation(100-hour decrease),and hours on noninvasive ventilation(200-hour increase).Mortality decreased from 17% to 6%.The incidence of CLD increased significantly even when adjusted for confounders(15% increase).Any time and mean hours spent on mechanical ventilation significantly increased the odds of CLD.This study could not find a significant association of any of the protective antenatal treatments on CLD.Conclusions The last decade saw a significant improvement in survival and survival to discharge without major morbidity.There was increased use of magnesium sulfate,delayed cord clamping,and less invasive respiratory management of extremely preterm infants.The avoidance of mechanical ventilation may impact the incidence of CLD.

关键词： chronic lung disease Extreme prematurity Health outcomes Survival

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Long term survival of patients with raised pulmonary arterial systolic pressure utilizing echocardiography—a five-year prospective study

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Journal of Geriatric Cardiology 2012年第4期9卷 328-335页

作者： Maw Pin Tan Sushil K Bansal Nu Nu Wynn Murad Umerov Angela Gillham Alison Henderson Anthony Hildreth Shahid Junejo Department of Medicine Faculty of Medicine University of Malaya 50603 Kuala Lumpur Malaysia Department of Care of the Elderly Sunderland Royal Hospital Kayll Road SR47TP United Kingdom Department of Cardiology Sunderland Royal Hospital Kayll Road SR4 7TP United Kingdom Centre for Collaborative Gerontology Northumbria University Ellison Place Newcastle upon Tyne NE1 8ST United Kingdom

Ba ckground Pulmonary arterial systolic pressure (PASP) can be estimated with transthoracic echocardiography. However, the significance of raised PASP on routine echocardiography is uncertain. In this study, we evaluated the mortality and hospitalization rates of subjects with raised PASP in a cohort of patients referred directly by their general practitioners for routine outpatient (open access) echocardiography for further analysis of suspected heart failure. Results A total of 485 subjects were referred for open access echocardiography at our hospital in 2002. A cohort of 209/485 (43%) consecutive subjects with measurable tricuspid regurgitation were followed for a minimum of five years investigating hospitalization rates and survival. Some 62 of 209 (30%) subjects had pulmonary hypertension (PH). Subjects with PH were significantly more likely to have four or more hospital admissions (22% vs. 8%; P 30 days of cumulative hospital stay over five years (29% vs. 13%; P chronic lung diseases recorded as immediate or contributory causes of death (50% vs. 14%; P < 0.05). Conclusions PASP ≥36 mmHg on routine echocardiography is associated with recurrent hospital admissions, prolonged hospitalizations and increased cause of mortality. Therefore, the diagnosis of PHon echocardiography deserves further clinical evaluation, with future studies designed at defining a suitable diagnostic strategy.

关键词： chronic lung disease Dyspnoea Heart failure Pulmonary hypertension Transthoracic echocardiography

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Cutaneous Cryptococcosis Arising in a Patient with Idiopathic lung disease: Related Illnesses or “Ticks and Fleas”

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Case Reports in Clinical Medicine 2023年第10期12卷 418-424页

作者： Zoe Parker Cary Chisholm Lubbock Christian University Lubbock USA Dermatopathology Laboratory Epiphany Dermatology Waco USA

Cryptococcus is a yeast typically found in bird feces such as pigeon droppings. Infection may occur through inhalation of spores or via direct inoculation into the skin. Typically there is a history of immunosuppression, but cases are also reported in immunocompetent hosts. Cryptococcus may manifest as pulmonary disease or primary cutaneous infection, but dissemination to a systemic illness is the most life-threatening concern. We present the case of a 71-year-old man with a four-year history of idiopathic lung disease, treated with oral prednisone and mycophenolate, presents with a new onset skin rash on the right wrist. He has a history of cleaning and clearing barns and sheds after a recent storm devastated the area. Birds and bats were present in these structures while he was working. Initial therapy failed, and subsequent biopsy showed the presence of Cryptococcus yeast. Further investigation yielded a positive, low titer Cryptococcus antigen screen but negative blood cultures. This case illustrates three valuable facets of patient care. Ideally, one diagnosis will explain all of the clinical presentation, but when that is not the case then multiple etiologies must be explored. Sometimes first-line therapy is ineffective, and the clinician should not be afraid to recognize that and change course. Importantly with skin lesions, failure to respond to treatment or worsening of the lesion in the face of topical and/or oral steroids should lead one to consider the possibility of infection, particularly in an immunosuppressed patient, and prompt biopsy is prudent.

关键词： Cryptococcosis Cryptococcus Dermatitis chronic lung disease Skin Infection

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Evaluation of Life Quality and Dyspnea Intensity on chronic Airway diseases Patients in Pulmonary Rehabilitation Program

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Journal of Biosciences and Medicines 2016年第1期4卷 10-15页

作者： Kathleen Julia Silva Giseli Domingues Cordeiro Caroline Rossinoli Maurício Longo Galhardo Márcia Maria Faganello Academic of Department of Physiotherapy Unisalesino Lins Brazil Department of Physiotherapy Hospital Unimed Lins Brazil Department of Pneumonology Unimed Lins Brazil Department of Physiotherapy UNESP Marilia Brazil

The chronic obstructive pulmonary disease (COPD) and asthma are chronic airway diseases that cause considerable physical, emotional and social restrictions. The life quality of patients who suffer from these diseases, is more affected by dyspnea then by other symptoms. That way is possible to correlate the impact of dyspnea on their life quality. The Pulmonary Rehabilitation Program (PRP) helps to improve the physical fitness and quality of life. This paper presents a study of the life quality and the dyspnea intensity in chronic lung disease patients. The research has participation of fourteen patients, distributed as seven suffering from COPD and the other seven suffering from asthma, for both gender and with an age average of 74.2 ± 8.9. The patients answer the following questionnaires: Baseline Dyspnea Index (BDI), Medical Research Council (MRC) Dyspnea Scale, Airways Questionnaire 20 (AQ20) and the Brazilian version of the Short-Form (SF-36) life quality questionnaire. From the present study, it was concluded that asthma patients have a less impaired life quality, since the dyspnea intensity is lesser, compared to the one with COPD.

关键词： Life Quality Dyspnea Intensity chronic lung disease

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