Efficacy and tolerability of airway stents

The function of airway stents is to keep the tubular structures open and stable. Their insertion is essentially indicated for intrinsic obstruction or extrinsic compression of the airway, fistulae or tracheobronchomalacia. The aim of this study was to determine the tolera bility and efficacy of airway stents in situations in which their insertion was vital. A retrospective study of airway stent insertion with rigid bronchoscopy (23 patients) was carried out over a two year period (2006-2007) at the Diagnostic and Therapeutic Techniques Unit. We assessed indication, efficacy, tolerability, complications and exact insertion based on chest CT imaging. In all situations Dumon flexible silicon stents (Tracheobronxane were used, with the need for complementary techniques such as laser therapy and mechanical dilation having been previously evaluated by flexible bronchoscopy. The authors conclude that stent insertion has no complications and good tolerability in the majority of advanced stage oncological situations with indication for palliative management

The transbonchial lung biopsy for diagnosis of diffuse parenchymal lung disease; Pro

The diagnosis of diffuse parenchymal lung disease (DPLD) may require invasive procedures after all noninvasive tools have failed. The clinical context in which these diseases develop and the radiological patterns are crucial for defining the timing and the methods to be used. After the introduction in clinical practice of HRCT scan, the evaluation of imaging patterns, along with the immunological status of the patient and the clinical course of the disease (acute vs. chronic) seem to be crucial to choose the best diagnostic procedure

Sequelas da COVID-19 Evidência Atual

A epidemia de Coronavirus Disease 2019 disseminou-se pelo mundo em poucos meses, levando à sua designação de pandemia. Múltiplas medidas de saúde pública foram implementadas nos países afetados para conter e mitigar a disseminação da doença. A necessidade de distanciamento físico leva a que esta pandemia tenha um impacto importante na sociedade e particularmente no desporto, provocando cancelamento e adiamento de treinos, competições e eventos. No entanto, o início da pandemia data já de 2019, com preocupações globais, não só na fase aguda da doença com as suas consequências imediatas, mas também com as eventuais sequelas a médio e a longo prazo e o risco de cronicidade de alguns sintomas, em particular na população jovem. Neste artigo revemos a limitada evidência científica atual acerca da relevância clínica das sequelas da COVID-19, em particular do foro respiratório e cardíaco, e finalizamos com recomendações de avaliação das sequelas em atletas e com indicações para regresso seguro à prática desportiva.info:eu-repo/semantics/publishedVersio

Prevalência da exposição ao fumo ambiental do tabaco em casa e do tabagismo na população Portuguesa – o estudo INAsma

ResumoIntroduçãoNeste estudo, pretendemos: 1) estimar a prevalência, na população portuguesa, da exposição ao fumo ambiental do tabaco em casa; 2) estimar a prevalência de tabagismo em Portugal; 3) identificar as características sociais e pessoais associadas ao tabagismo ou à exposição ao fumo ambiental do tabaco.MétodosEstudo transversal consistindo na aplicação, à população, a nível nacional, de questionário telefónico. Completaram a entrevista 6 003 indivíduos. A exposição ao fumo ambiental do tabaco em casa foi definida como a exposição, em casa, ao fumo do tabaco de, pelo menos, um fumador atual. Por fumador entendeu-se um indivíduo com ≥ 15 anos que fumou, pelo menos, um cigarro por dia durante um período de um ano; um fumador atual fumou no último mês.ResultadosReferiram exposição ao fumo ambiental do tabaco em casa 26,6% dos participantes (IC 95%: 25,5-27,7). Viver num agregado familiar constituído por ≥ 4 pessoas (OR=2,31; IC 95%: [1,81-2,96]), ser fumador atual (OR=7,29; IC 95%: [5,74-9,26]) ou ter asma atual (OR=2,06; IC 95%: [1,45-2,94]) associaram-se positivamente à exposição ao fumo ambiental do tabaco. Na análise estratificada por sexo, o efeito da asma atual manteve-se apenas nas mulheres.Atualmente, 19,0% (IC 95%: 18,0-20,0) da população portuguesa é fumadora e 17,2% (IC 95%: 16,2-18,2) são ex-fumadores. A prevalência de fumadores atuais é mais elevada nos homens do que nas mulheres (26,5 versus 12,2%, p<0,001). A probabilidade de ser um fumador atual foi maior nos homens, nas pessoas mais instruídas e nos indivíduos expostos, em casa, ao fumo ambiental do tabaco. Na análise estratificada por sexo, o efeito da escolaridade manteve-se apenas nas mulheres.ConclusãoA exposição ao fumo ambiental do tabaco em casa foi mais elevada do que a anteriormente publicada. Crianças/adolescentes e doentes com asma podem ter um risco de exposição ambiental mais elevado. Este estudo apoia uma tendência decrescente da prevalência de tabagismo nos homens portugueses, mas uma tendência crescente nas mulheres.AbstractBackgroundWe aimed to: 1) estimate the prevalence of exposure to environmental tobacco smoke (ETS) at home in the Portuguese population; 2) estimate tobacco smoking prevalence in Portugal; 3) identify social and personal characteristics associated with smoking or exposure to ETS.MethodsNationwide, cross-sectional, population-based telephone survey. Overall, 6003 individuals completed the interview. ETS exposure at home was defined as exposure to at least one current smoker at home. A smoker was defined as someone with 15 years or older, smoking at least 1 cigarette per day during a year; a current smoker (CS) smoked in the last month.ResultsExposure to ETS at home was reported by 26.6% (95%CI 25.5-27.7) of the participants. Living in households with ≥4 persons (OR=2.31; 95%CI[1.81-2.96]), being a current smoker (OR=7.29; 95%CI[5.74-9.26]) or having current asthma (OR=2.06; 95%CI[1.45-2.94]) were factors positively associated with ETS exposure. When analyzed by gender, the effect of current asthma was only relevant to females.Currently 19.0% (95%CI 18.0-20.0) of the Portuguese population smokes tobacco and 17.2% (95%CI 16.2-18.2) are ex-smokers. CS prevalence is higher in males than females (26.5%versus 12.2%, p<0,001). The odds of being a CS were higher for males, the more educated, and those exposed to ETS at home. When analyzed by gender, school education only affected females.ConclusionExposure to ETS at home was higher than previously reported. Children/adolescents and asthma patients may have a higher risk of exposure. This report endorses a decreasing trend in the prevalence of tobacco smoking in Portuguese males, but a tendency to increase in females

Pandemia COVID-19 e Impacto no Desporto

info:eu-repo/semantics/publishedVersio

Strengths of breath-triggered inhalers in asthma management

publishersversionpublishe

Diagnosis of Respiratory Bronchiolitis associated interstitial lung disease

Background. Respiratory Bronchiolitis (RB), described by Niewoehner et al in 1974, is a common finding in heavy smokers and is characterised by the presence of pigmented macrophages within respiratory bronchioles and adjacent alveoli. In the 1980s, Myers et al described RB associated with interstitial lung disease (RBILD), which is a rare entity expressed as an amplified respiratory bronchiolitis in response to cigarette smoke. Methods. The authors studied a group of 8 patients with biopsy-proven RBILD diagnosed within the last five years, and assessed epidemiological data, clinical and imaging features, lung function tests, bronchoalveolar lavage findings, therapeutic approaches and clinical evolution. Results and Conclusions. The most difficult differential diagnosis is between RBILD and Desquamative Interstitial Pneumonia (DIP), which seems to suggest that these disorders are either end of the same spectrum, although the authors claim that there are some clinical, morphological and prognostic distinctions. The diagnosis of RBILD requires an appropriate clinical setting (including smoking habits), characteristic image findings (like ground glass shadowing and centrilobular nodules), and Bronchoalveolar Lavage (BAL) data to exclude other diagnosis. Pathological confirmation may also be important, not only to exclude more adverse interstitial lung disease, such as idiopathic pulmonary fibrosis, but also, as in the eight cases presented, to illustrate some specific features such as the prevalence of lymphocytosis in BAL

Migration, TB control and elimination: Whom to screen and treat

Tuberculosis (TB) in migrants represents an important clinical and public health threat, particularly in low TB incidence countries. The current review is aimed to assess issues related to screening and treatment of migrants with latent TB infection or TB disease. Keywords: TB migrants, TB elimination, TB control screenin

Germline genetic variants of the renin-angiotensin system, hypoxia and angiogenesis in non-small cell lung cancer progression : discovery and validation studies

© 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).Introduction: The renin–angiotensin system (RAS) is involved in cell proliferation, immunoinflammatory response, hypoxia and angiogenesis, which are critical biological processes in lung cancer. Our aim was to study the association of putatively functional genetic polymorphisms in genes coding for proteins involved in RAS, hypoxia and angiogenesis with non-small cell lung cancer (NSCLC) prognosis. Methods: Genotyping of 52 germline variants from genes of the RAS and hypoxic/angiogenic factors/receptors was performed using MassARRAY iPLEX Gold in a retrospective cohort (n = 167) of advanced NSCLC patients. Validation of the resulting genetic markers was conducted in an independent group (n = 190), matched by clinicopathological characteristics. Results: Multivariate analysis on the discovery set revealed that MME rs701109 C carriers were protected from disease progression in comparison with homozygous T (hazard ratio (HR) = 0.5, 95% confidence interval (CI) = 0.2–0.8, p = 0.010). Homozygous A and T genotypes for KDR rs1870377 were at increased risk for disease progression and death compared to heterozygous (HR = 1.7, 95% CI = 1.2–2.5, p = 0.005 and HR = 2.1, 95% CI = 1.2–3.4, p = 0.006, respectively). Carriers of homozygous genotypes for ACE2 rs908004 presented increased risk for disease progression, only in the subgroup of patients without tumour actionable driver mutations (HR = 2.9, 95% CI = 1.3–6.3, p = 0.010). Importantly, the association of homozygous genotypes in MME rs701109 with risk for disease progression was confirmed after multivariate analysis in the validation set. Conclusion: This study provides evidence that MME polymorphism, which encodes neprilysin, may modulate progression-free survival in advanced NSCLC. Present genetic variation findings will foster basic, translational, and clinical research on their role in NSCLC.M.J.C. was supported by the Associação de Estudos Respiratórios and the Portuguese Pulmonology Society.info:eu-repo/semantics/publishedVersio

Asthma-COPD overlap: A Portuguese survey

Introduction: The overlap between asthma and chronic obstructive pulmonary disease (COPD) (ACO) has been discussed for many years but clinical recommendations for this entity have been diverse. This study is intended to reach a consensus on diagnosis, treatment and patient orientation for ACO, within the Portuguese medical community. Methods: This study was conducted by a multidisciplinary panel of experts from three distinct medical specialties (Pulmonology, Family Medicine and Immunoallergology). This panel selected a total of 190 clinicians, based on their expertise in obstructive airway diseases, to participate in a Delphi structured survey with three rounds of questionnaires. These results were ultimately discussed, in a meeting with the panel of experts and some of the study participants, and consensus was reached in terms of classification criteria, treatment and orientation of ACO patients. Results: The majority of clinicians (87.2%) considered relevant the definition of an overlap entity between asthma and COPD. A consensus was achieved on the diagnosis of ACO – presence of simultaneous clinical characteristics of asthma and COPD together with a fixed airflow obstruction (FEV1/FVC 300 eosinophils/μL or >5% of leukocytes); elevation of specific IgEs or positive skin tests for common allergens). A combination of inhaled corticosteroid (ICS) with long-acting beta2-agonist (LABA) or long-acting muscarinic antagonist (LAMA) was considered as first line pharmacological treatment. Triple therapy with ICS plus LABA and LAMA should be used in more severe or symptomatic cases. Non-pharmacological treatment, similar to what is recommended for asthma and COPD, was also considered highly important. A hospital referral of ACO patients should be made in symptomatic or severe cases or when there is a lack of diagnostic resources. Conclusions: This study highlights the relevance of defining ACO, within the Portuguese medical community, and establishes diagnostic criteria that are important for future interventional studies. Recommendations on treatment and patient's orientation were also achieved.Actelion Pharmaceuticals (undefined)info:eu-repo/semantics/publishedVersio