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array:22 [ "pii" => "S253104372300096X" "issn" => "25310437" "doi" => "10.1016/j.pulmoe.2023.05.005" "estado" => "S300" "fechaPublicacion" => "2023-11-01" "aid" => "1878" "copyrightAnyo" => "2023" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Pulmonol. 2023;29:568-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "itemSiguiente" => array:18 [ "pii" => "S2531043723000946" "issn" => "25310437" "doi" => "10.1016/j.pulmoe.2023.05.004" "estado" => "S300" "fechaPublicacion" => "2023-11-01" "aid" => "1877" "copyright" => "Sociedade Portuguesa de Pneumologia" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Pulmonol. 2023;29:570-2" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "An investigation of TB infection and reinfection among stone quarry workers" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "570" "paginaFinal" => "572" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0001" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1574 "Ancho" => 3333 "Tamanyo" => 235424 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "alt0001" "detalle" => "Fig " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spara001" class="elsevierStyleSimplePara elsevierViewall">Detailed analysis of the 12 cases of Cluster 1 by trimester (T) regarding risk factors and time of diagnosis. Infectious period was considered for three months before symptoms onset if positive sputum smear or for one month before symptoms onset if negative sputum smear.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "S. Sousa, C.M. Alves, R. Macedo, C. Carvalho, G. Gonçalves, R. Duarte" "autores" => array:6 [ 0 => array:2 [ "nombre" => "S." "apellidos" => "Sousa" ] 1 => array:2 [ "nombre" => "C.M." "apellidos" => "Alves" ] 2 => array:2 [ "nombre" => "R." "apellidos" => "Macedo" ] 3 => array:2 [ "nombre" => "C." "apellidos" => "Carvalho" ] 4 => array:2 [ "nombre" => "G." "apellidos" => "Gonçalves" ] 5 => array:2 [ "nombre" => "R." "apellidos" => "Duarte" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2531043723000946?idApp=UINPBA00004E" "url" => "/25310437/0000002900000006/v3_202311162326/S2531043723000946/v3_202311162326/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S2531043723000934" "issn" => "25310437" "doi" => "10.1016/j.pulmoe.2023.05.003" "estado" => "S300" "fechaPublicacion" => "2023-11-01" "aid" => "1876" "copyright" => "Sociedade Portuguesa de Pneumologia" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Pulmonol. 2023;29:564-7" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "PI*ZQ0<span class="elsevierStyleInf">Attikon</span> genotype discovery in severe alpha-1 antitrypsin deficiency" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "564" "paginaFinal" => "567" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0002" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1911 "Ancho" => 3333 "Tamanyo" => 250313 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "alt0002" "detalle" => "Fig " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spara002" class="elsevierStyleSimplePara elsevierViewall">Three-generation pedigree of the proband. Numbers below individual symbols are age at inclusion in the study. Smoking status (pack/years) and levels of alpha-1 antitrypsin in serum (g/l) are also depicted. In details shown for each individual [parents I1, I.2, the proband, sister and brother II.1, II.2, II.3 from the third marriage of the father of the proband and children III.1, III.2 first marriage of the proband], the results of the analysis including LUMINEX (L), Isoelectric focusing (IEF) and gene sequencing (S). *The variant c.-428G>A; c.-10T>C found in individuals I.2 and II.3 seems to be like a M variant in the IEF. c.1A>G corresponding to <span class="elsevierStyleItalic">Q0<span class="elsevierStyleInf">Attikon</span></span>newly described mutation is depicted at the proband II.1 in compound heterozygous state with PI*Z as well as at his sister II.3 and his children III.1 and III.2 at heterozygous state. (M/c.1A>G) for individual I.1 indicates an obligate carrier status. All members of the bloodline are reportedly asymptomatic except the proband which presents emphysema (red), bronchiectasis (blue) and asthma (green). In the insert the<span class="elsevierStyleItalic">Q0<span class="elsevierStyleInf">Attikon</span></span> mutation confirmed by Sanger sequencing: sequencing results of proband compared with wild type and reference sequence. Translation initiation codon (Met1) is affected by this mutation (top of the insert figure).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "S.A. Papiris, M. Veith, A. Lazaratou, M. Balduyck, C. Lombard, M. Dechomet, M.-F. Odou, E. Entrena, L. Osaba, M. Kallieri, V. Apollonatou, S. Prountzos, C. Kontopoulou, L. Kolilekas, I. Ferrarotti, J.-F. Mornex, C.-F. Vogelmeier, T. Greulich, E.D. Manali" "autores" => array:19 [ 0 => array:2 [ "nombre" => "S.A." "apellidos" => "Papiris" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Veith" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Lazaratou" ] 3 => array:2 [ "nombre" => "M." "apellidos" => "Balduyck" ] 4 => array:2 [ "nombre" => "C." "apellidos" => "Lombard" ] 5 => array:2 [ "nombre" => "M." "apellidos" => "Dechomet" ] 6 => array:2 [ "nombre" => "M.-F." "apellidos" => "Odou" ] 7 => array:2 [ "nombre" => "E." "apellidos" => "Entrena" ] 8 => array:2 [ "nombre" => "L." "apellidos" => "Osaba" ] 9 => array:2 [ "nombre" => "M." "apellidos" => "Kallieri" ] 10 => array:2 [ "nombre" => "V." "apellidos" => "Apollonatou" ] 11 => array:2 [ "nombre" => "S." "apellidos" => "Prountzos" ] 12 => array:2 [ "nombre" => "C." "apellidos" => "Kontopoulou" ] 13 => array:2 [ "nombre" => "L." "apellidos" => "Kolilekas" ] 14 => array:2 [ "nombre" => "I." "apellidos" => "Ferrarotti" ] 15 => array:2 [ "nombre" => "J.-F." "apellidos" => "Mornex" ] 16 => array:2 [ "nombre" => "C.-F." "apellidos" => "Vogelmeier" ] 17 => array:2 [ "nombre" => "T." "apellidos" => "Greulich" ] 18 => array:2 [ "nombre" => "E.D." "apellidos" => "Manali" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2531043723000934?idApp=UINPBA00004E" "url" => "/25310437/0000002900000006/v3_202311162326/S2531043723000934/v3_202311162326/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Is there a place for mechanical in-exsufflator in the emergency department?" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "568" "paginaFinal" => "569" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Inês Machado Vaz" "autores" => array:1 [ 0 => array:3 [ "nombre" => "Inês Machado" "apellidos" => "Vaz" "email" => array:1 [ 0 => "inessgmv@gmail.com" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Serviço de Medicina Intensiva, Centro Hospitalar Vila Nova de Gaia, R. Conceição Fernandes, 4434-502 Vila Nova de Gaia" "identificador" => "aff0001" ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0001" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1461 "Ancho" => 1508 "Tamanyo" => 117061 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "alt0001" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spara001" class="elsevierStyleSimplePara elsevierViewall">Admission chest X-ray.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="para0001" class="elsevierStylePara elsevierViewall">A seventy-nine-year-old man presented to the emergency department (ED) with dyspnea, cough and bronchial secretions that he was unable to mobilize.</p><p id="para0002" class="elsevierStylePara elsevierViewall">He had a right hemiparesis and dysphagia due to intracerebral haemorrhage, and was a long-term bedridden patient, without cognitive deficits, and with good social support. No previous history of pulmonary diseases.</p><p id="para0003" class="elsevierStylePara elsevierViewall">On admission, he was hemodynamically stable and afebrile, but presented tachypnoea with <a href="https://en.wikipedia.org/wiki/Muscles_of_respiration#Accessory_muscles_of_respiration">accessory muscle use</a>. Pulmonary auscultation revealed decreased breath sounds on the left and scattered rhonchi on both sites.</p><p id="para0004" class="elsevierStylePara elsevierViewall">Blood work revealed leucocytosis (24,15 × 10E3/uL leukocytes) and a C Reactive Protein of 3.57 mg/dL. Arterial blood gas showed isolated type 1 respiratory insufficiency (FiO2 35%, pH 7.468, pO2 36.2 mmHg, pCO2 39.9 mmHg, HCO3- 28.7 mmol/L).</p><p id="para0005" class="elsevierStylePara elsevierViewall">The X ray revealed an opacified white left lung (<a class="elsevierStyleCrossRef" href="#fig0001">Fig. 1</a>). Chest tomography scan showed the left airways filled with mucoid material, with atelectasis of the entire left lung and mediastinal shift to the ipsilateral side. Evaluation of the pulmonary parenchyma did not show any suspicious alterations, including consolidations or expansive lesions.</p><elsevierMultimedia ident="fig0001"></elsevierMultimedia><p id="para0006" class="elsevierStylePara elsevierViewall">The patient was put on an empiric antibiotic therapy with ceftriaxone 2mg once a day and dual bronchodilation (ipratropium bromide 60 µg every 6 hours, and salbutamol 200 µg every 6 hours).</p><p id="para0007" class="elsevierStylePara elsevierViewall">Since the patient was not deemed eligible for admission to the Intensive care unit (ICU), emergency bronchoscopy was protracted. Instead, and although it wasn't possible to quantify the peak cough flow (PCF) in the ED, the medical team attempted using Mechanical in-exsufflator (MI-E) to clear the tracheobronchial airway.</p><p id="para0008" class="elsevierStylePara elsevierViewall">We used the following parameters for MI-E therapy: oro-nasal interface, automatic mode with cough track, inspiratory pressure of +40 cmH2O for 3 seconds, with low inspiratory flow rate, expiratory pressure of -40cmH2O for 2,5 seconds. We progressively adjusted the pressures with +/- 5cmH2O increments every 2 or 3 cycles, starting with expiration pressure, until +50cmH2O and -60cmH2O, with which we got a MI-E PCF > 280 L/min. The secretions were still hard to expel, so, we added an oscillation on both phases 10Hz, 10cmH2O.</p><p id="para0009" class="elsevierStylePara elsevierViewall">After 8 treatments consisting of 2 series of 5 cycles of MIE, there was a significant increase in vesicular murmur in the left apical region of the thorax and the patient's oxygen saturation increased to 93% with a Ventimask at 31% FiO2. We continued the treatment for an additional two days, six times per day.</p><p id="para0010" class="elsevierStylePara elsevierViewall">A follow-up Chest X-ray (48h hours later) revealed a significant improvement, with complete resolution of the left lung atelectasis (<a class="elsevierStyleCrossRef" href="#fig0002">Fig. 2</a>).</p><elsevierMultimedia ident="fig0002"></elsevierMultimedia><p id="para0011" class="elsevierStylePara elsevierViewall">As the patient kept ineffective cough, with PCF less than 60L/min, we instructed the patient's daughter on how to use the MI-E. At discharge, the patient's oxygen saturation was 94% in air.</p><p id="para0012" class="elsevierStylePara elsevierViewall">The elderly and bedridden population is increasing. Neurological diseases and immobility are associated with respiratory dysfunction, due to weakness of inspiratory and/or expiratory muscles (essential to an effective cough), lung volume changes (a combination of muscle weakness and alterations of the mechanical properties of the lungs and chest wall) and bulbar dysfunction, with loss of the ability to cough and swallow (that may result in pooling of saliva and mucus in the pharynx, predisposing to aspiration). Even so, there aren't any studies on respiratory function, quality of cough, prevalence of respiratory infections, atelectasis, acute or chronic respiratory failure, and their repercussions on morbidity and mortality in elderly people who are bedridden for a long time.</p><p id="para0013" class="elsevierStylePara elsevierViewall">Cough augmentation techniques aim to improve cough efficiency, with potential for both short‐ and long‐term effects on pulmonary morbidity. During episodes of acute respiratory exacerbation, cough augmentation techniques could clear impacted secretions to prevent the progression to respiratory failure. In the long-term, the regular use of cough augmentation is intended to reduce the incidence and/or severity of respiratory tract infections requiring unscheduled hospitalization.</p><p id="para0014" class="elsevierStylePara elsevierViewall">MI-E therapy is a cough augmentation technique that increases inspiratory and expiratory flow to restore cough quality and improve secretion mobilization.<a class="elsevierStyleCrossRef" href="#bib0001"><span class="elsevierStyleSup">1</span></a> Experts suggest that using MI-E in very weak patients is a priority.<a class="elsevierStyleCrossRef" href="#bib0002"><span class="elsevierStyleSup">2</span></a> However, the overall quality of evidence on the efficacy and safety of MI-E is very low. Most of the research on cough augmentation techniques has been carried out in chronic neuromuscular disease (NMD) and in extubation or weaning of critically-ill patients.<a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0004"><span class="elsevierStyleSup">4</span></a> The author couldn't find any studies on the efficacy and safety of the technique in long-term bedridden patients</p><p id="para0015" class="elsevierStylePara elsevierViewall">The author presents a case of pulmonary atelectasis in a long-term bedridden patient, which highlights the effectiveness of a non-invasive, generally safe and relatively inexpensive technique (the MI-E), even in the context of an ED, for patients not eligible for ICU or broncoscopy.</p><p id="para0016" class="elsevierStylePara elsevierViewall">Future research is needed to evaluate the effectiveness, potential adverse effects, precautions and contraindications of MI-E in the long-term bedridden patients. In addition to clinical outcomes, factors such as patient tolerance, adherence, treatment burden, knowledge of the technique, confidence, availability of devices, and cost should be considered by clinicians, patients, and caregivers.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2023-02-28" "fechaAceptado" => "2023-05-15" "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig0001" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1461 "Ancho" => 1508 "Tamanyo" => 117061 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "alt0001" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spara001" class="elsevierStyleSimplePara elsevierViewall">Admission chest X-ray.</p>" ] ] 1 => array:8 [ "identificador" => "fig0002" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1390 "Ancho" => 1486 "Tamanyo" => 132292 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "alt0002" "detalle" => "Fig " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spara002" class="elsevierStyleSimplePara elsevierViewall">Chest X-ray 48h hours later.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "cebibsec1" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0001" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A review on cough augmentation techniques: assisted inspiration, assisted expiration and their combination" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A. Spinou" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.33549/physiolres.934407" "Revista" => array:6 [ "tituloSerie" => "Physiol Res" "fecha" => "2020" "volumen" => "69" "numero" => "Suppl 1" "paginaInicial" => "S93" "paginaFinal" => "S103" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0002" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Airway clearance techniques in neuromuscular disorders: a state of the art review" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M Chatwin" 1 => "M Toussaint" 2 => "MR Gonçalves" 3 => "N Sheers" 4 => "U Mellies" 5 => "J Gonzales-Bermejo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rmed.2018.01.012" "Revista" => array:6 [ "tituloSerie" => "Respir Med" "fecha" => "2018" "volumen" => "136" "paginaInicial" => "98" "paginaFinal" => "110" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29501255" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0003" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cough augmentation techniques for people with chronic neuromuscular disorders" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "B Morrow" 1 => "A Argent" 2 => "M Zampoli" 3 => "A Human" 4 => "L Corten" 5 => "M. Toussaint" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/14651858.CD013170.pub2" "Revista" => array:4 [ "tituloSerie" => "Cochrane Database Syst Rev" "fecha" => "2021" "volumen" => "4" "numero" => "4" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0004" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cough augmentation techniques for extubation or weaning critically ill patients from mechanical ventilation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "L Rose" 1 => "NK Adhikari" 2 => "D Leasa" 3 => "DA Fergusson" 4 => "D. McKim" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/14651858.CD011833.pub2" "Revista" => array:4 [ "tituloSerie" => "Cochrane Database Syst Rev" "fecha" => "2017" "volumen" => "1" "numero" => "1" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/25310437/0000002900000006/v3_202311162326/S253104372300096X/v3_202311162326/en/main.assets" "Apartado" => array:4 [ "identificador" => "72880" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/25310437/0000002900000006/v3_202311162326/S253104372300096X/v3_202311162326/en/main.pdf?idApp=UINPBA00004E&text.app=https://journalpulmonology.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S253104372300096X?idApp=UINPBA00004E" ]
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